I received a panic call from Jim, who had been a patient for over ten years.  His 5-year-old daughter had passed out.  Amanda was rushed to the ICU for new onset diabetes.  After stabilization, she was transferred by helicopter to a university hospital for an insulin pump insertion.  He knew that her life, his life, would never be the same.

Two weeks later, I received another call from Jim.  This time, his son had been hospitalized for attempted suicide.  Michael had started college at the age of twelve and was about to graduate at fifteen when he started drinking.  First alcohol.  Then drugs.  His racing thoughts could not be contained.  He would go nights without sleeping.  Once, he had spent all his savings on fake baseball cards.  At fourteen he was an exemplary child.  At fifteen, chaos had taken over.  “Bipolar vs. schizophrenia” echoed in Jim’s ears.

Two months later, after a period of relative quiet, we sat in my office, both exhausted.  His tears bled with each pump of his heart.

What surprised me was his disappointment in Michael.  After all, he understood the lack of insulin production by Amanda’s pancreas, and could see the metallic device to the left of her belly button.  What he couldn’t grasp was why Michael had to act this way?  Jim had spotted Michael’s talents early and had honed his skills.  They had spent hours juggling math together.  They went to sport games.  They had dinner together almost every night.  Jim had been a perfect dad.  Where did he go wrong?

Such is the nature of mental illness.  Grief can hide behind the most seductive face.  Insanity is sheltered behind a handsome smile.  Alcohol may sooth the soaring sirens inside the head until the teenager ends up with his car wrecked.  Depression is masked by lipstick.

Even a caring father like Jim may not realize that the same type of hormone deficiency that is found in diabetes is responsible for his beloved son’s mental illness.  Physical is seen, mental hidden.

I care for a world class model who self mutilates out of severe depression.  She pulls out her hair and has large patches missing, covered with scabs and newly dried blood.  But on the runway, in the store, no one would know.  She is stunning outside, a mess inside.  Yet, when she takes her medicine, she has months of stability and happiness.

Mental illness can be caused by genetics, by lack of chemicals in the brain, by hormonal insufficiencies such as dopamine and serotonin.  There are no broken bones.  There is no metal device.  There is no obvious scar.  The depressed may appear like you and I or even better.  Well intentioned loved ones often hinder the recovery of the ill by not allowing proper diagnosis or treatment.

When severe depression, bipolar disorder, generalized anxiety disorder take hold of a loved one’s life, we need to respect their need for medical evaluation and treatment.  Counseling, diet, exercise, community, spirituality, music and art can all be used as adjunctive therapy.  But just as in severe cases of diabetes, we need to show love and support to the patient and provide medications needed to stabilize missing hormones.

Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists.