Organic rule-outs - Six top-priority concerns when you're having a bad day

By: Tom Cloyd - 6 min. read (Published: 2014; reviewed: 2023-04-09)

When we feel bad, we may tend to look for psychological causes of our distress - focusing on our current relationships or problems in our personal history. We too often forget that our mind is easily influenced by the condition of the body it lives in. The concerns listed below address this problem quickly and can lead to an appropriate improvement or solution to our mental distress. Only after working through this brief list of possible organic causes of mental dis-ease is it appropriate to consider possible psychological factors.


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Because many mental health problem symptoms can be triggered by basic organic problems, we should first rule out the six possible causes below, approximately in this order, because this reflects their approximate likelihood of being present:

Go too long without eating, and you’ll get low blood sugar. The effect is clear: low energy. You may also feel cold. You may shake a little, if you’re really depleted. Your thinking will happen more slowly and with more effort and less clarity. You may well feel unmistakably depressed.

Solution: Eat something that will provide you with quick energy - but accompany it with something that digests more slowly, so that your don’t have another blood sugar crash after your quick-energy food is digested!

Sleep-deprivation fatigue is a real problem for many people, and the problem seems to be getting worse every year. Lack of sleep degrades your ability to think, to make decisions, and to respond to your environment. It also will almost certainly depress your mood. And, “if you’ve been awake for a full 24 hours…it’s like you have a blood alcohol level of .10…(for reference, .08 is considered drunk).”1

Solution: Get adequate sleep as soon as possible. A nap may get you to the end of the day, but truth sleep debt recovery typically takes two full night’s sleep. Allow plenty of time, especially for the first of the two nights. Avoid setting an alarm if at all possible. Also avoid sleeping medications, as they tend to degrade sleep quality.

Physical sickness can induce or trigger distinct changes in your state of mind. The effects are various. Depressed mood, low energy, confused thinking…and a few other mental problems, can all derive directly from impending or ongoing illness.

Solution: In general, recovery from illness takes rest, time, adequate fluid and food intake, and possible professional care and medication. Avoid stress, including exercise or conflict. The most rapid recovery comes from responding to an illness intelligently and patiently.

Severe stress early in a person’s childhood can “…induce changes in the functional status of neurons and, eventually, cell death.” Recent studies of individuals with developmentally early trauma have revealed “atrophy or decreased volume” in the cerebral cortex.2

Hormone imbalances for these or other reasons should be ruled out whenever depression or mania symptoms are present.

In women, unusual fluctuations in mood, anxiety level, mental focus, activity level, among other things suggest the need to rule out premenstrual syndrome3 or Premenstrual Dysphoric Disorder (DSM 625.4)4.

Solution: Obviously, due to the complex and variable nature of hormonal imbalances, qualified psychiatric and/or other medical assessment and management is required.

While they are easy to forget, the wide range of known drug side effects are impressive, and some of these effects are mental. This problem can arise even with a drug you’ve been successfully taking for a long time, and without any change in dosage, if some key aspect of your metabolism has recently changed.

Solution: Any pharmacist will tell you that almost any drug can cause any side-effect, but each does have a typical pattern that is most commonly seen. You can identify these common, most-likely side-effects by consulting the information here on this website.

Other than in the case of a stroke which has gone undetected (and this is very possible with small, undramatic strokes), most people with brain injury know they have it. Drug or alcohol induced brain injury, however, can be present without having been identified by anyone, so this possibility must be considered as well. The effects may not show up for years. “Brain injury” is a broad term, and so are its effects.

Solution: Distressed emotional states attributable to brain injury require formal psychiatric consultation and management. Medication, either ongoing or as-needed, may be needed. Adaptive psychotherapy may also be helpful.

The possible effect of organic factors on a person’s mental state and behavioral effectiveness is taken very seriously in the professional mental health community. Consider the following statement:

[The diagnosis may be made if]“…the enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., a head trauma).”

This statement, or one virtually identical to it, is a part of the formal diagnostic criteria formulated by the American Psychiatric Association for General Personality Disorder5, Schizophrenia6, Major Depressive Disorder7, and virtually every other disorder formally defined in their Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). There is no real doubt: Organic factors must be considered before psychiatric or psychological factors when we are attempting to make sense of a disordered mind.

If any of these organic problems are suspected or known to be impacting you, they can make it difficult for you to see past them to clearly identify a psychological problem. In addition, in many people, a physically caused problem in mood or perception can trigger an additional problem of purely psychological origin – a secondary reaction, to your awareness of your primary problem. The only way to reduce this problem to manageable simplicity is to address the physical (organic) problem first, getting rid of it as much as possible.

Realistically, a minority of individuals may not be able to completely remove an organic problem, and its effect on their mental state. What cannot be fully resolved must simply be managed like any other mental or physical vulnerability. Many people do this successfully. The first step toward this goal is to reduce the presence of these organic problems in your life as much as you can, when you know you are impacted by them.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). Washington, D.C: American Psychiatric Association.

National Sleep Foundation. (n.d.). “Drowsy Driving vs. Drunk Driving: How Similar Are They?” Retrieved 2019.08.01 from https://WWW.sleep foundation.or/articles/drowsy-driving-vs-drunk-driving-how-similar-are-they.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition). Wolters Kluwer; /Library.

  1. National Sleep Foundation (n.d.). ^

  2. Sadock, B. J., et al. (2014), p. 350. ^

  3. American Psychiatric Association. (2013), p. 174. ^

  4. American Psychiatric Association. (2013), p. 171. ^

  5. APA (2013), p. 647. ^

  6. APA (2013), p. 99. ^

  7. APA (2013), p. 161. ^


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