Eleven Questions, One Long Breath

Nomvula, forty-one, had put off her first appointment with a psychiatrist in Durban for six months. She was afraid the doctor would judge her or write a label that would follow her. Her sister Thandi came along and carri…

The doctor began by asking what had been happening. Nomvula described waking at three each morning, losing interest in her shop, and being unable to concentrate. The doctor asked about sleep, appetite, work, family, money, alcohol and her childhood. Nomvula's voice shook at some of the questions, but she answered honestly. When asked about thoughts of self-harm, the doctor was kind and direct. Nomvula admitted that she had wished not to wake up.

The doctor explained that this question is routine, not a sign that she was seen as dangerous. She watched Nomvula's speech, mood and concentration, asked about medicines, and ordered blood tests to rule out physical causes. A short questionnaire was done too. With Nomvula's permission, Thandi added what she had seen.

At the end, the doctor said it looked like depression, called it a working diagnosis, and explained treatment options with benefits and risks. Nomvula used her sister's list and asked: 'How long before I might feel better? What should I do if things get worse?' She left with a plan, a review date and, for the first time in months, a feeling of relief.

How to recognise it

Delay in seeking help because of fear of judgement or labels.
Sleep, appetite, energy and interest all changed for weeks.
Difficulty concentrating, and an effect on work and family life.
Thoughts of not wanting to live, which must be mentioned to the clinician.
Worry about what a diagnosis will mean for identity and privacy.

What this story explains

This story shows the steps of a good assessment: the interview, mental state examination, a questionnaire, physical checks, information from others, a risk check, and a formulation with a working diagnosis and plan.

Probable root causes

Fear of stigma and being labelled.
Not knowing what happens in an assessment.
Symptoms that make it hard to take the first step.
Pressure of work and family duties.
Belief that a diagnosis will define who you are.

What to do

Write down your symptoms, when they began, and what makes them better or worse.
Bring a list of medicines and physical illnesses.
Take a trusted person with you, if you wish, and give permission for them to speak.
Answer honestly, including about safety, alcohol and drugs.
Ask your questions: what is my diagnosis, how certain is it, what are my options?
Ask what to do if things get worse and when the review will be.

Whom to consult

Family doctor as a first step, especially if you do not know where to begin.
Psychiatrist or clinical psychologist for a full mental health assessment.
Counsellor for support while waiting for a specialist visit.
Emergency service or nearest hospital if you have thoughts of ending your life or are in danger.

Do and don’t

Do	Don’t
Do prepare notes.	Don't hide thoughts of self-harm.
Do be honest, even when it is hard.	Don't expect an answer in minutes.
Do ask questions.	Don't treat a diagnosis as a life sentence.
Do bring someone you trust.	Don't diagnose yourself beforehand.
Do ask for a review date.	Don't skip the physical tests.

How to behave and communicate

As a companion: 'I will come with you, and I will only speak if you want me to.'
Listen without interrupting her account.
Avoid saying 'you are fine' or 'just try harder.'
To the clinician: 'Can you explain that in plain words?'
Use a calm, supportive tone and let her set the pace.