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Saturday, September 22, 2007

Secrets, good or bad?

Adultery, a child from another man, HIV infection, abused as a child, suicidal ideation, all secrets often revealed to Dr Shock by patients during their depressive episode. Depression is often accompanied by pessimistic thoughts, guilty thought, self-blame and ideas of personal failures. That's why Dr Shock usually tries to comfort these patients and advises them to express these secrets only to him or other members of the treatment team not the ones they were hiding their secrets from. Wait until you're depressive episode has gone and then reconsider what to do. Not that they listen. Paternalistic? Maybe. There is no evidence how to handle secrets in depressed patients, no evidence based medicine on this topic yet.

Questions about Secrets and Depression
1. Is keeping a secret because of shame or anxiety harmful?

2. Can a secret become a leaden weight resulting in depression?

3. Might revealing this secret prevent becoming depressed, improve you're mental health?

Gopubmed doesn't help, only 9 articles, not one relevant.
While searching a little bit further the search with "secrets" revealed several articles not very relevant except a recent article in the Dutch Tijdschrift voor Psychiatrie on the second result page of his search. Dr Shock reads this journal every month but hadn't noticed this article. Secrets going bad is explained by the paradox that the attempt to suppress a secret thought leads to thinking more about this secret amplifying the thought to an obsession.

Disadvantages of Secrets:
1. secrets can lead to obsessive thinking and to psychiatric complaints and diseases
2. secrets can lead to somatic illness. An example is the study off HIV positive homosexuals. Those who had to keep their homosexuality as a secret progressed faster to AIDS than those who didn't have to keep it secret. The difference was 1 to 2 years. Another proof was published with non HIV infected homosexuals. Those who had to keep their homosexuality a secret were significantly more prone to infections.
3. Keeping a secret because anxiety for being excluded from their social environment

Advantages of Secrets:
1. Having secrets and sharing them with others requires social skills
2. Prevention from exclusion of social environment

So secrets or having a secret has disadvantages and only a few advantages. Dr Shock found the search term: secrecy and disclosure the best for this topic on gopubmed. Scientific interest in this subject is increasing as can be seen on this graph:

Good instructions for revealing secrets during a depressive episode are lacking so Dr Shock will stick with his regimen until instructed otherwise.

Articles used:
Wismeijer AA, Vingerhoets AJ. Tijdschr Psychiatr. 2007;49(6):383-9. The emotional burden of secrets. Consequences for somatic health and implications for health care
[Article in Dutch] PDF
Departement Psychologie en Gezondheid, Prisma-gebouw, Kamer, AB Tilburg.

NRC W&O 23-9-2007

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