Wendel Abel - I AM WHAT I THINK

"ONE NIGHT I received a bad message by phone. I immediately started to experience chest pains and shortness of breath. I went to the emergency room. Initially the doctor thought I had a heart attack. I have seen several doctors for chest pain, light-headedness, racing heart and a lightening sensation in my body," reports Sheryl.

Angella was involved in a motor vehicle accident. She sustained head injuries.

"Ever since the accident I have never been the same. I have terrible headaches which do not respond to painkillers. I have bad dreams and flashback of the accident," she said.

"I was diagnosed with high blood pressure. I was placed on several medications. Then I started to have weird feelings, headaches, dizziness and drowsiness. I felt I was going to die until my husband pointed out that it may be due to side effects from the medication," recalled Agnes.

These are the recollections of Errol: "I was diagnosed with diabetes. The doctor told me that it is not bad and that it can be controlled with diet alone. I have felt sick ever since. I developed lower back pains and I am feeling depressed. I feel weak most of the times and find myself crying without a cause. I feel I am going to die."

What do these persons have in common? They are all sick and are not getting better. A number of conditions may lead one who is sick to feel that one is not getting better. These include:

1. The individual may genuinely have a condition that can neither be cured nor treated.

2. The individual may have a long-standing (chronic) disorder which cannot be cured but is treatable and may flare up occasionally.

3. Medications may also cause side effects which may be unpleasant to the individual taking them. This may sometimes lead one to feel that one is not getting better.

4. In addition to the main disorder which is being treated the individual may have other conditions which may have been missed. This is especially true for a number of psychiatric disorders such as depression, anxiety disorder and post-traumatic stress disorder.

Let us look at these common psychiatric conditions. What could be contributing to Sheryl's, Agnes', Errol's and Angella's feelings of being sick and not getting better? If you are sick and can't better:

1. Have a frank discussion with your doctor about your diagnosis. Tell your doctor everything, don't hide anything. Every bit of information is important in making a correct diagnosis.

2. If you are not satisfied with your diagnosis you may want to discuss this with your doctor. You may even discuss the need for a second opinion or consultation. At the same time avoid doctor shopping. Moving from doctor to doctor without each knowing who you have seen before and therefore not having access to your previous records, doesn't serve your best interest.

3. Ensure that you are familiar with your medication. All medications have side effects and these side effects may vary from one individual to another. Agnes had developed side effects from her medication which gave her the feeling that she was not getting better although her main condition was getting better.

4. Make sure you know all about the medications you are taking. Medications may also interact with each other and with some food items and may produce distressing symptoms.

5. If you suspect there is an emotional component to your illness don't hesitate to see a psychiatrist or a psychologist. Sheryl had an anxiety disorder which presented her with a lot of physical symptoms. Errol's depression made him feel severely ill. Because Angella never received treatment for the post-traumatic stress disorder, she developed a number of symptoms.

Dr. Wendel Abel is a Consultant Psychiatrist and Senior Lecturer, University of the West Indies.