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FALL 2011
While psychotherapies play a critical and important role
in the treatment of certain conditions, psychiatric illness
is no different from any other medical illness. In some
disease states, such as the common cold, no pharmacologic
intervention is necessary. In others, nonpharmacologic
treatment is extremely important and may prevent the need
for drug treatment; an example of this scenario might be an
individual with hypertension, who is successfully treated with
a program for weight loss, including proper nutrition and
exercise and even, perhaps, meditation.
Similarly, in some psychiatric diseases, psychotherapy
alone may be appropriate. However, many psychiatric
diseases are not completely or sufficiently responsive to
nonpharmacologic intervention, and the use of psychiatric
medication is not only warranted, it is critically important to
achieve remission of symptoms.
PRINCIPLES FOR CLEAR ASSESSMENT
Because psychiatric illnesses are generally biologically
driven, willpower, stoicism, self-medication and denial are
usually woefully unsuccessful in dealing with the problem.
Unemployment, chemical dependencies, school failure and
social struggles are often comorbid with these disorders. We
know that as it relates to depression, patients who are 50 to
99 percent recovered from an episode of major depressive
disorder have a statistical risk of approximately 75 percent of
experiencing a full-blown relapse within one year. In the same
data, those who are 100 percent recovered carry only about
a 25 percent risk of full-blown relapse within a year. Clearly,
psychiatric illnesses impose a catastrophic degree of anguish,
impaired function and comorbid medical risk in unremitted
and undertreated states.
The concerns facing a medical evaluator therefore are
twofold. First, does the illness itself pose a current or
ongoing threat to the safety of the diver or those with him?
Second, what risk is imposed by medication? Psychological
management of anxiety and phobic issues in divers is a bigger
discussion outside the scope of this article. However, the
principles for clear assessment of the prospective diver with a
psychiatric history are straightforward.
First, the primary requirement is the prospective diver
be in remission from her illness. “In remission” means the
diver should have no symptoms of illness whatsoever. Should
the evaluator have any doubt, the health-care provider
responsible for the prospective diver’s psychiatric condition
should be consulted and in absolute agreement the patient is
completely without symptoms and able to function without
limitation. The understanding that psychiatric illness is
similar to any other significant, potentially recurring medical
disease is helpful here. Should a patient with asthma,
diabetes, cancer or infectious disease wish to dive, remission
is a necessary condition. So it is with psychiatric diseases.
In terms of being fit to dive, there is nothing unique to
psychiatric illness in comparison to other major medical
conditions. This is the key principle of the evaluation: The diver
must be symptom-free. He must be able to function without
Remission from any psychiatric
illness is imperative because of
the many tasks divers must juggle
and the unforgiving nature of the
aquatic environment.
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