Diagnostic Overshadowing- A Myth or Reality

MSN-Mental-HealthAnxiety! Sadness! Depression! To some these are words of discussion, to some they are merely words, to some they are words to mock but to some this is the way of living. They live in constant sadness; they are anxious and they gradually go into depression. Mental illness is a silent killer, less understood much hyped.

Mental illness is stigmatized; people look down upon them. For decades and decades not only commoner but even medical practitioner didn’t feel the need of taking this condition serious. For them lending a shoulder, lecturing and preaching them was all that was required. But is it!!

Anxiety, Depression, Bipolar, Schizophrenia, PTSD, OCD, psychosis and many more.

People with these conditions usually never go to Psychiatrist, their first point of contact would always be their physician. As Dr. Jerome concluded in his book, ‘How Doctors think’, ‘On an average Doctors interrupt patients within eighteen seconds of, when they begin telling their story! An article by Thomas H. Maugh III stated that physicians listen to patients’ concerns for about 23 seconds before interrupting them and starting to ask questions, as per a report in Wednesday’s Journal of the American Medical Assn. that’s about five seconds better than in earlier studies, but it is still short enough that as many as a quarter of patients never get a chance to express their most serious concerns. Physician in their rushed OPD hours might not get time to identify the inner layers which is troubling and effecting the physiological parts.

What should anyone do, when someone comes and talk about listening voices all over, or when they announce they wish to kill themselves, or how their divorce made them stalker or how their moods get effected by seasons. The obvious answer is; refer to mental health professionals! But do they?

Primary care professionals manage high blood pressure and cholesterol but refer people with heart attacks to cardiologists; they might perform Pap tests and prescribe birth-control pills but send pregnant women to obstetricians; they diagnose cancer but don’t treat the one. Isn’t this same for mental illness. When one body part gets effected we send them to specialist but when the entire personality get effected we tend to treat part of it.

As per psychiatrist Norman Sartorius, a leading figure in the international promotion of mental health for half a century stated, ‘It’s a paradox. Mental illness constitutes a staggering burden of disease, yet it isn’t a priority. He underscores the fact that for a long time, there weren’t any effective treatment options. But he identifies the chief cause not in any lack of knowledge or treatments, but in the stigmatization of mental illness. The stigma of mental illness marks not only people who suffer from it, but also their families and the people who provide them with care and mental health service. And it leads to discrimination that affects people in all walks of life.

WHO in 2014 characterized the stigmatization of the mentally ill as “a hidden human rights emergency.’ Even when inexpensive medicines are available, it doesn’t guarantee that governments and health care providers will supply them. Why? “Because the mentally ill patient is considered by them as having no value,” he explains. “And if he is of no value, then any treatment is too expensive. Even one penny is too much.”

What exactly go wrong-

  • Consequences of the stigma of mental illness are worse than the illness itself.
  • Delays or problems with diagnosis or treatment
  • Problems with identifying needs
  • Difficulty providing appropriate care in response to changing needs.
  • Acceptance by medical practitioners.
  • Reference to psychiatrist or mental illness professionals by medical practitioners.

Key points to eliminate diagnostic overshadowing-

  • Never make assumptions about a person’s quality of life.
  • Respect confidentiality, as for any other patient
  • Always communicate with the patient directly.
  • Acknowledge the symptoms and refer to right department.
  • Moral lecture and preaching should be stopped.
  • No stigmatizing.


‘Preaching’s doesn’t help, Talking Helps

Sympathy doesn’t help, Empathy does

Suicide doesn’t kill people, sadness does!’


 Aware! Acknowledge! Accept! Ascribe

From the desk of Counseling Psychologist

Dr Reene Bhansali (Ph.D)











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