Chickens and Eggs
A man came into my office and tells me, in a blacked out rage, he physically assaulted his wife. Nothing like this had happened before, he stated. Other sources, including his wife, attested he had never been violent. When talking it became clear that he and his wife had increasingly been irritable with each other especially in the evenings. Discussing matters further, he was diabetic and had not been managing his medications and diet properly.
Here is an excerpt from an article in Psychology Today that presents this particular issue very well:
Humans are built like all the other animals—and animals get very unhappy when blood sugar is low. It is an evolutionary mechanism that is designed to make finding food a priority. This priority is important, for it helps to avoid starvation. But in us humans, low blood sugar can have a very negative effect on mood.
While the primitive animal goes into food-finding mode, sometimes our more complex human brain doesn’t realize it is a food issue, and instead simply feels anxious, depressed, angry, or even all three. That primitive part of us starts to stress about other issues (work, relationships) and the real culprit—low blood sugar—is not addressed.
There are often underlying medical conditions that contribute, if not outright cause, expressions of mental health disorders. If that client had not disclosed his diabetes, I’d have been trying to help him with intermittent explosive disorder, and it would not have helped. Instead I was able to focus on the communication with his wife, helping to alter language that reduces irritability, and worked with his physician to help him manage his diabetes. And wouldn’t you know, it got a lot better?
Too often health practitioners, therapists, doctors, psychiatrists, sometimes get lost following the rabbit hole of symptom management and forget to look upstream. As a rule the most easily addressed and treatable issues should be ruled out first. To mix metaphors, if one hears the beat of hooves, don’t expect to see an okapi coming over the hill.
Other conditions such as thyroid, and other hormonal conditions, blood pressure, diet, toxic exposures, infections can cause a wide array of mood and other psychiatric conditions. Kidney dysfunction can present as delirium, anxiety, panic, depression. Given all the variables it is important to find practitioners one trusts and are open to examining all possibilities, those who view the whole person and not just the injury.
David Aronson LCSW