In mental health, conditions are often sorted into two groups, "major" and "minor". Illnesses such as psychosis are called major. Anxiety, depression and psychosomatic pain are often placed in the second group. We must stop and ask one question: minor to whom?

To a clinician comparing one diagnosis with another, a case of anxiety may look small beside a psychotic illness. To the person who lives inside it, it is anything but small. It decides whether they sleep, whether they eat, and whether they can go to work or sit through a family function.

The unseen struggle

These people carry a silent agony that only they can feel. A fracture shows on an X-ray. A tumour shows on a scan. This pain shows on nothing. No MRI, no CT scan and no expert, however senior, can look inside and measure how deep it goes.

So the person hears, "All your reports are normal," and goes home feeling worse. Now even the pain is not believed.

Why the treatment asks so much

In some severe illnesses, medicines do much of the early work. In these so-called minor conditions, medicine alone is rarely enough. The treatment asks for three things.

• Time and patience. Hours of listening, including to fears the person has never said aloud.
• Empathy. Understanding the distress from the inside, and not judging it from the outside.
• Trust. The person must come to believe, "Here is someone who understands me and can help me."

Slow and careful work

Building that trust, and helping a person put their emotional life back in order, cannot be hurried. There is no single procedure and no fixed date of recovery. It is done one session at a time, and it asks as much skill and attention as any major treatment in medicine.

To call these struggles "minor" is to measure them with the wrong ruler. The right measure is how much of a person's life the suffering has taken away.

From the clinical team at Dr Anandhan's MINDCARE

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