Initial History: Your patient is a 77 year-old woman who has been more socially
ID: 56939 • Letter: I
Question
Initial History:
Your patient is a 77 year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. It is now 30 minutes later.
Discussion questions part one:
What is your differential diagnosis based on the information you now have?
What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.)
Explanation / Answer
Social relationships are important for anyone in maintaining health, but for the mentally ill it is especially important. People with mental illness value contact with family. But families may be unwilling to interact with their mentally ill family member. Social isolation is also sometimes due to the unwillingness of others to befriend the mentally ill. The public may avoid them altogether. The stigma associated with mental illness creates huge barriers to socialization.
People with severe mental illness are probably the most isolated social group of all. They are judged, disrespected and made into pariahs. They fear rejection from others, who may be afraid of the mentally ill, so the mentally ill person may feel overwhelmed by the thought of attempting to form new friendships. Just avoiding any contact is often the choice. Or, they may make a great effort to conceal their condition from others, which results in additional stress from worrying about their true condition being discovered.
It is sometimes the case that the severely mentally ill person becomes homeless. This in itself is isolating, and they then must suffer the double stigmatization of being homeless as well as mentally ill.
Another reason the person with mental illness may experience social isolation is the nature of their mental illness. Social phobias like agoraphobia, or severe anxiety or depression often cause the suffering person to be afraid to venture out into society.
When anyone, mentally ill or not, does not have enough social contact, it affects them mentally and even physically. Loneliness creates stress, taking a toll on health. Other things affected can be the ability to learn and memory function. High blood pressure is also seen. It can be the trigger of depression and alcoholism. (2) Imagine the consequences, then, if you are already depressed or have other mental illnesses? Loneliness can make you worse. Loneliness and loss of self-worth lead many mentally ill to believe that they are useless, and so they live with a sense of hopelessness and low self-esteem.