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Psychiatrists Cast Doubt On Biomedical Model of Mental Illness
jones_supa writes "British Psychological Society's division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a 'paradigm shift' in how the issues of mental health are understood. According to their claim, there is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful. The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out 'reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems', used by psychiatry. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association's Diagnostic and Statistical Manual of Mental Disorders. The manual has been attacked for expanding the range of mental health issues that are classified as disorders."
If mechanics understood cars as well as we understand brains, then dealing with car problems might work like this:
After having cut apart and ground up thousands of working and non-working cars, mechanics would know that a lack of gasoline, oil, or water was a common factor in many common car failures. Thus, whenever a broken car was brought into their shop, they'd pop open the hood and pour a bucket of gasoline, oil, or water over everything (depending on the symptoms) to try and fix the problem.
If they want a replacement they will need to provide one. Until then, people are being treated, with varying degrees of success, with the current model. Even if the model isn't actually an accurate description of what is going on, it is still a fairly useful guide to approaching the problems. Sort of like classical physics versus relativity. A real breakthrough in understanding would be great - and maybe with all of the brain imaging and various other things going on, that will emerge. But so far it seems to mainly be individual studies that aren't producing a cohesive theory or useful guide to treatment. They will need to find their equivalents of Einstein and Dirac.
Another problem with the recent releases of the DSM is that what is considered a disorder sometimes seems to be a question of politics or political correctness.
much of left-wing thought is a kind of playing with fire by people who don't even know that fire is hot - George Orwell
It is worth noting that the central distinction between psychiatrists and psychologists is that generally psychiatrists can prescribe medications (they are doctors). It's therefore not surprising that some psychologists would issue a statement like this. Honestly, this single statement by what appears to be a spokesperson discredits their entire ramblings: "it was unhelpful to see mental health issues as illnesses with biological causes". It's quite shocking to see professionals show such ignorance of their own field, just because they specialize in one aspect of it. While we are certainly still in the dark ages of neuroscience and psychiatry, there is a reason why we can control a ton of psychiatric illnesses with medications. We have many decades worth of research that specifically shows you what goes wrong in a person's brain with many psychiatric illnesses.
Would most people be better off undiagnosed? When it comes to mental "illness", often the only (or at least the best) treatments are behavioral therapy, in which the "illness" is trained away.
I agree. And so do I.
Would most people be better off undiagnosed?
In a word, yes. Since "most people" would not be ill, neither physically nor mentally. This new edition of the DSM risks to change that, as in it provides a convenient way to slap "diagnostic" labels on quite a few people who're today considered pretty much normal.
Cue the observation occasionally voiced that what today is called "ADD" (and but yesterday called "ADHD") and results in prescriptions of ritalin, only a few short decades ago was called "being a kid". We are going a little bonkers with the mental, yes.
Slashdotitis?
About three hours? It's currently 3:30 on the east coast of North America so everybody there is still daydreaming off the lunch stupor. The Europeans are home from work or sleeping, and the west coasters are high so they're not attacking anything.
British Psychological Society's division of clinical psychology says "Psychiatry is bogus"
How much do you want to bet that this is a turf war?
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BMO
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I completely agree with you. In fact, the rambling statement by these psychologists (which does not appear to be scientific) is readily disproven by the biggest and most successful example of medical treatment of a mental health disorder: schizophrenia ( http://en.wikipedia.org/wiki/Schizophrenia#Medication ) and the 1950's discovery of an antipsychotic medication which greatly improved the hallucinations and psychotic breaks undergone by schizophrenic patients: chlorpromazine was found while looking for anti-histamines (for allergies).
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The wikipedia article on chlorpromazine points out: In 1955 it was approved in the United States for the treatment of emesis (vomiting). The effect of this drug in emptying psychiatric hospitals has been compared to that of penicillin and infectious diseases.[50] But the popularity of the drug fell from the late 1960s as newer drugs came on the scene. From chlorpromazine a number of other similar antipsychotics were developed. It also led to the discovery of antidepressants.[53]
Chlorpromazine largely replaced electroconvulsive therapy, psychosurgery, and insulin shock therapy.
In other words, chlorpromazine actually worked so well that the psychiatrists no longer had to resort to ECT, brain surgery, or screwing with the patient's sugar and insulin levels.
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You'd have to be a complete moron to claim that there is no evidence for medical and pharmacologic treatment of schizophrenia: the evidence is almost 60 years old. The only conclusion to draw from this is that the British Psychological Society is, in fact, composed of vast groups of complete morons who do not believe in science or the scientific method.
Those are some unfortunate examples, considering both schizophrenia and bipolar disorder are at least partially heritable and there's other good evidence both have a big biological component.
Psychologists have a good point that considering all mental illnesses to be biologically caused and solely pharmaceutically treatable is not a good thing, but these ones seem to have gone overboard the other way.
But with more people being diagnosed as mentally ill, and thus more people receiving prescription medicines, the profit margins of Big Pharma (tm) will only go up!
Will no one think of the major pharmaceutical companies?
I don't think its a vast conspiracy, so much as generations of doctors being educated that drugs are the solution to mental problems, and that all mental illness can be treated by some drug treatment. Also this wacky idea that we all have to match some theoretical norm of some sort. "When all you have is a hammer..." etc.
"The first time I got drunk, I got married. The second time I bought a chimpanzee, after that I stayed sober" Arian Seid
How about another way of looking at things: These are devastating illnesses. Non medical treatment hasn't been shown to be terribly effective. What the hell else do you do?
While I'm one of the first people to dump on Big Pharma, we've gone to a biopsychosocial model because chaining people up in asylums and beating them just didn't get the job done. The brain is clearly chemical in nature and at some point reductionist medication SHOULD point the way to detailed understanding and treatment. We just aren't there now. Doesn't surprise anyone in the field. We use the SAME drugs for many "different" diseases. How's that supposed to work?
Yes, by limiting discussion to just a certain framework of diseases you can inappropriately narrow thinking and treatment. You can make it so that it's hard to come up with a different paradigm.
The DSM was the first attempt to come up with a reasonable framework and language. It's not very accurate but you have to start somewhere. Everyone is open to suggestions.
Faster! Faster! Faster would be better!
Would be nice if true. Fact of the matter is most people get 15 minutes, a prescription, and sent home.
Violence is like duct tape. If it doesn't solve the problem, you didn't use enough.
It's a pretty crappy headline. My apologies for the length and tangential nature of this post. This is a very personal subject for me.
The problem is that we really don't have a decent understanding of the brain (or its abnormalities) at all. We have collections of symptoms appearing in varying severities with varying results, and we have treatments that alter those symptoms. As far as medicine goes, that's really about it.
The problem with a diagnosis is that it's a label. Someone who says "I'm bipolar" can expect that every action will be judged harshly as to whether it's actually their intended "normal" action, or the manifestation of their depression or mania, whichever happens to be the case that day (or hour). A child who's inattentive in school may just be bored, but the diagnosis of ADD opens the door to differently-structured classes that may help - as well as opening the door to ridicule for being different. Sometimes, yes, it's better to stay undiagnosed, and sometimes it's better to get the diagnosis and do nothing with it.
On the other hand, diagnosis is necessary for any treatment. Someone can understand "I'm sad all the time, and don't like it", but without the term "depression", it's very difficult to find information about how to improve. I've met several people who, in the 90's when depression was highly stigmatized, had traumatic experiences that they couldn't talk about and couldn't do anything to recover from, partly because they wouldn't consider the possibility of actually being "depressed".
To make matters worse, there are still an enormous number of people who simply deny the existence of any mental illness. They assume that kids with ADHD are just being active children, or people with depression are just sad, or people with bipolar disorder are just moody. The illness isn't what's visible from the outside, though. The illness is what's happening in the brain to cause the outward symptoms. The ADHD child can't calm down and focus - his mind always jumps to doing something else. The depressed people can't cheer up - even happy times are often plagued by a sadness that's always present in their minds. The bipolar person can't control their mood - the emotions are overwhelming.
What's happening now, albeit slowly, is that the stigma is being countered by awareness programs. This story is in a similar vein to the one a few days ago decrying DSM-5 for not being valid regarding mental health. As our understanding and openness about mental illness improves, we're starting to recognize that typical Western medicine may have done some serious harm to our society. A recent Broadway musical explored this question well.
In next to normal, a woman who grieved four months for a dead child was diagnosed as "depressed", and began 16 years of treatment. One of the questions explored is whether her illness was really because of the loss, or whether it was because of the trauma of ongoing treatment. There is no answer. There is no happy ending. There's only the promise of a next-to-normal life, where everything is perfect except for when it isn't, and there's always some new treatment to try.
That's the ongoing problem with our current handling of mental illness. We have collections of symptoms, and drugs that treat them, but we don't really understand how. The DSM-5 is so vague and imprecise that a particular symptom is painted with a wide brush to be a whole set of disorders. With no testing for suitability, medications are tried that aren't fully understood, in the hope that it's the right drug to set everything right quickly. When it doesn't work, another regimen is proposed, also with little or no testing for suitability. As the patient's treatment drags on, whole classes of drugs are ruled out for their side effects, then brought back be
You do not have a moral or legal right to do absolutely anything you want.
Would most people be better off undiagnosed? When it comes to mental "illness", often the only (or at least the best) treatments are behavioral therapy, in which the "illness" is trained away.
[anecdote ahead]
Well, I am currently on lithium, and it has helped me more than the CBT ever did. How do I know? I haven't tried to kill myself in a very long time. I haven't even given it serious thought. IT is the emotional life equivalent of watching widescreen movies on 4:3. The worst ups and worst downs simply are no more. (I blatantly stole this quote from someone)
The principle of first do no harm comes into play. If someone in a position of medical authority is going to offer you a treatment we need good evidence that the benefits of that treatment outweigh the harms.
This is almost impossible to do if the very definitions you have of mental illness aren't meaningful. And the evidence that backs the DSM is very very weak.
A diagnosis may also be less useful when the problem is a natural reaction to a social environmental situation and lead to attempting to 'cure' the patient rather than fix the problems causing the reaction. Trying to treat of depression or anxiety caused by stress with long term use of medications is likely to lead to eventual failure of the medication or in the case of anti-anxiety drugs lead to addiction and problems from that, leaving the patient in an even worse situation than before.
I was diagnosed as bi-polar about 6-7 years ago after suffering a serious manic episode with full scale hallucinations. While it was not the first time this had happened to me, it was "the final straw" that led to me being diagnosed.
Since then I've been on Resperidone to control the manic phases, and Effexor to limit the depressive phases. I've had no hallucinations, breakdowns, suicidal thoughts, or any other problems since being put on the medication, except when I've run out of medication, thinking "Maybe I don't need it any more."
But the return of symptoms after 2-3 weeks without medication has me convinced that the diagnosis is valid and the medication effective.
I do not fail; I succeed at finding out what does not work.
The brain is not just chemical in nature. Many of the important properties of the brain come from the physical arrangement of neurons. If the neurons are connected in the wrong way, you can't fix that by bathing the entire brain in some chemical, so there are almost certainly problems that can occur in the brain that cannot be fixed by just administering a medication.
Mental health is a large subject, let's take a smaller slice for discussion: depression.
Depression meds work no better than placebo. Depression meds have lots of unpleasant side-effects, so being treated for depression is - on average - worse than going undiagnosed.
Depression is a symptom of many diseases - at least 18 of them commonplace. Many cases of depression are the result of 1) underactive thyroid (40% by one accounting), 2) Low levels of vitamin D, and 3) sleep apnea.
And yet, the symptom is treated as a disease in and of itself. Prescription meds which do more harm than good are commonly prescribed under the flimsiest of circumstances:
Patient: "doctor, I feel tired and run down"
Doctor: "It sounds like depression. Try this and see if it goes away".
After all is said and done, a casual reading of the research would suggest that the scientific method used in psychology research is crap. That's a strong statement, but not completely without merit.
Psychiatrists need to stop worrying about publishing the next trivial follow-on paper, and need to stop theorizing by making up stories. Get your evidence first, make theories to explain the evidence, and then throw out theories which have no testable predictions.
Go back to basics, and stop making money from giving people false hope through increased suffering.
(Grrr! A close friend got chewed up and spit out by the medical profession because of depression.)
When it comes to mental "illness", often the only (or at least the best) treatments are behavioral therapy, in which the "illness" is trained away.
For mild forms of mental illness (bearing in mind that what we call "mild" mental illness can be crippling and painful from the perspective of the individual), perhaps. I'm not sure I agree with the way you phrase your position, but it is at least a valid position.
But behavioral therapy supposes that patient has enough function to engage with the therapist; even in the days before neuroleptics, it was recognized that some forms of mental illness did not respond well to talk therapy. A severely disorganized schizophrenic will turn even the simplest statements into jumbled hash; a catatonic depressive might not have sufficient volition to even reply.
Therapy is pretty advanced when dealing with patients who can't function enough to take care of their basic survival needs -- I'm not talking about acceptance of particular choices or values (by society or by self), or even whether they fit in well enough to hold a job. Rather, individuals rendered unable to attend to basic functions like "avoid freezing to death in winter" or "obtain and prepare sufficient food to maintain life, without endangering others". In such cases it is often a useful adjunct, but supposes that the patient can improve enough to be establish some level of meaningful communication.
Still, seeing a symptom and treating it with a drug, skipping "thinking", probably misses an enormous chunk that needs to be built back into the model.
Freud-type stuff has been largely shot down, but the brain, when thinking, builds and reinforces thought and memory pathways. If the thinking thinks odd things, it's going to reinforce odd things. What's the mental problem rate of farmers working all day keeping their brain busy vs. poorly-employed people sitting around brooding all day?
Brooding, thinking, builds and reinforces memories and thinking. Any model of "mental symptom + drugs" completely skips that mechanism.
BTW, I have no idea if that's what this group of psychologists (not psychiatrists) is suggesting, but that's what I'd suggest.
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
Here is a scenario that happens daily in Alaska. I do not know if other states have this issue: 1. Kid goes to school and have a school breakfast. 2. That breakfast is full of sugar (pancakes w/ syrup). 3. Kid cannot sit still in class due to being full of sugar. 4. Teacher reports this to the school counselor who talks to a Psychiatrist. 5. Psychiatrist recommend drugs for the kid. 6. Government steps in telling the parent that the kid must have drugs or they will be kidnapped (stolen by "Family Services"). 7. (If parent chooses to fight back against this crime, the kid will be kidnapped) 8. Kid gets doped up on drugs, which causes side effects. 9. Kid gets other drugs to negate side effects, causing more side effects. 10. Kid is stuck on drugs for life. This literally happens all the time in Alaska. F U Psychiatrists.
If you got 15 minutes you were lucky. I got ten, a scrip, and a followup cancelled by the doctor.
Psychiatrists take the Hippocratic oath? Considering their treatments and "remedies" they don't seem very good at upholding it.
"Wait. Something's happening. It's opening up! My God, it's full of apricots!"
Stuff that isn't science that is sure it "knows" is prejudice. By pretending to be science such "stuff" gets to deprive you of you liberty in a court based on prejudice because you're a bit socially eccentric and someone else doesn't like that for "moral" reasons or whatever and wants to "straighten you out" whatever that means to them. Do you dress funny? Have sex? The wrong skin colour? These kinds of things...
Stuff that isn't science that pretends to be so usually results in evil of the worst, most uncivilised kind. It should always be called for what it is, ie unscientific. Psychology and psychiatry have a history of being right there in the middle of the absolute worst of it, in all our countries. If they want to be treated with any more respect than the utter garbage that is Scientology they need to prove each piece of research is actual science and, as a "discipline", publicly and loudly call out pseudo-science and bs-prejudice masquerading as something more. Starting with their own history ripping everything down that does not make the grade. They have earned themselves the right as a "discipline" to be treated with extreme suspicion.
Dick Feynman is popular around here and rightly so. His commencement address from 1974 on what he calls "Cargo Cult Science" one of the great speeches and worth 5 minutes of your time if you haven't happened to have encountered it yet.
http://neurotheory.columbia.edu/~ken/cargo_cult.html
"So I have just one wish for you--the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity."
What follows is not an argument from authority or even an argument at all, just some well phrased thoughts, you'll make up your own mind.
"Incidentally, psycho-analysis is not a science: it is at best a medical process, and perhaps even more like witch-doctoring. It has a theory as to what causes disease - lots of different "spirits" etc. The witch doctor has a theory that a disease like malaria is caused by a spirit which comes into the air ; it is not cured by shaking a snake over it, but quinine does help malaria. So, if you are sick, I would advise that you go to the witch doctor because he is the man in the tribe who knows the most about the disease; on the other hand his knowledge is not science. Psychoanalysis has not been checked carefully by experiment... " --Richard Feynamn, Six Easy Pieces
"It's a great game to look at the past, at an unscientific era, look at something there, and say have we got the same thing now, and where is it? So I would like to amuse myself with this game. First, we take witch doctors. The witch doctor says he knows how to cure. There are spirits inside which are trying to get out. ... Put a snakeskin on and take quinine from the bark of a tree. The quinine works. He doesn't know he's got the wrong theory of what happens. If I'm in the tribe and I'm sick, I go to the witch doctor. He knows more about it than anyone else. But I keep trying to tell him he doesn't know what he's doing and that someday when people investigate the thing freely and get free of all his complicated ideas they'll learn much better ways of doing it. Who are the witch doctors? Psychoanalysts and psychiatrists, of course."
Third lecture. David Goodstein reports that the entire Psychology department walked out in a huff at this point [7]. -- The Meaning of it All
Um, he's absolutely correct. The British Psychological Society is the one making the statement. It's the first three words of the summary. The British Psychological Society is full of psychologists. Unlike the Royal Psychiatric Society, which has a lot of psychiatrists as members and is obviously a little peeved.
The problem with a diagnosis is that it's a label. Someone who says "I'm bipolar" can expect that every action will be judged harshly as to whether it's actually their intended "normal" action, or the manifestation of their depression or mania, whichever happens to be the case that day (or hour).
And any person who says that needs some behavior modification anyways. No one walks around saying "I'm heart disease" or "I'm the flu" when they are suffering from those disorders or illnesses. Only mental health and diabetes have that distinction. And it's a bloody stupid one that continues to allow people with mental illnesses to continue to blame their illness for everything, because they treat it as a label. It's stupid for the reason you bring up as well, because it allows others to blame that one thing instead of anything else.
If people with mental illnesses treat it as an illness, not a defining feature of themself . . . well, there is a reason that's part of behavioral therapy already.
The brain is clearly chemical in nature and at some point reductionist medication SHOULD point the way to detailed understanding and treatment.
[just an example below]
I have a problem with my Windows computer. Now and then Firefox crashes when I visit a certain site. Since the computer is clearly electrical in nature, I'm considering taking this here 120V AC wires and sticking them into various places on the motherboard. Random places, actually - because I have no idea how the motherboard works. Will that help with the problem?
Thinking aloud a bit more now. Will *any* electrical interference with operation of a CPU give me *any* hints how the software works?
As someone on venlafaxine, I concur about the ups and downs being gone more than through CBT. CBT requires such an effort that at least to me it seemed that if I could seriously benefit from CBT, I wouldn't need it in the first place since then I wouldn't have the problems I've had functioning. Venlafaxine is not an ideal medication for me but because I have epilepsy, it reduces the options what doctors can prescribe me. Out of curiosity, I ask if you notice the effects some other way? For me, an unfortunate effect has been a lowered ability to concentrate. At first, I noticed that every time I was getting a bad, depressive thought, I just forgot it and thus didn't end up in my depression cycle. It's, however, not a "precision weapon" so other thoughts are often "collateral damage" so I often forget what I'm thinking of even if I try to concentrate really hard. In the past, I instead associated to something negative in my life from almost anything and thus my productivity was lower not because I forgot thoughts but precisely because I didn't - I was able to constantly make jumps like "I heard this unusual word the first time when I saw movie X and there was a poster for movie X in location Y which was where I met girl Z for the last time" and even much more far-fetched associations to anything that made me feel sad and I just couldn't stop those associations from being constantly formed. Now that i no longer do that, I'm also a lot less angry with myself and that might have harmed my productivity in a different way, I'm more forgiving to myself if I skip exercising, do a shitty job and so on (although I know that prior to my medication, my perfectionism was quite extreme by most peoples' standards). So how has your productivity level changed on lithium?
And to "normal" people, i.e. those few that have never gone through depression or had to take antidepressants: If you're curious to find out what it can be like, you can first think about what it's like to suddenly be reminded of something by making an association Then imagine that you constantly associate things with something negative - as if you had had e.g. pictures of all bad things you've ever experienced and all people that have hurt you placed all over your room/cubicle/house...
When your poor, you're are nutty: when you're rich; it's called "eccentric".
When you're poor, you're called an asshole. When you're rich; you're called forceful and driven.
Actually, in both cases if your behavior is causing you harm, you are not nutty or eccentric, you are mentally ill. The qualifier of the DSM has, and remains, that the behavior is causing harm. Hear voices that aren't there, but they just are normal conversations or Jesus/Batman telling you to do good deeds? Not a problem unless you want it to go away. Same voices telling you that people are after you and that you need to hurt other people? That's a mental illness. Same for behavioral problems, like narcissistic personality disorder. Someone poor might be called an asshole, someone rich might be called driven, but a good psychiatrist wouldn't care about that. If it is causing harm in relationships with other people or to the patient, it's a disorder and illness.
As for who gets to determine whether it's causing harm, that's still not an issue. The patient, 99% of the time. The doctor has input, and can overrule with 72-hour holds if they feel someone is a danger to themself or others but that is the only time that a doctor gets to determine whether it's a treatable illness or just a personality trait.
It's Scientology's elusive parasitic division. There's a scientape worm in these peoples' brains, causing inflammation and rendering them useless. It's the only logical reason I can think of for that kind of statement.
You can dance if you want to.
Back in the olden days when they still repaired computer boards rather then simply throwing them out, the way they figured out which chip needed to be replaced was by using electrical equipment to test circuits. It took forever even back then, with much simpler circuits, but if you had the right tools you could still do it today.
I'm quite aware of that because when I was studying in university I was also working as a tech, repairing IBM/360 [alike] video terminals, like this and like this - though marginally newer.
I must tell you, there is nothing you can do, regardless of how many tools and test equipment you pile up, unless you have the detailed schematics of everything in that box, and placement diagrams of all components. And even then you would be completely baffled now and then; for example, when you have a multiple component failure.
I'm glad that medication helps you and others. Computers sometimes can also be medicated like that. I have a box that, until recently, was crashing randomly when it is cold. Keeping it running 24/7 prevented the crashes. (In the end, it was the HDD that was the cause.)
According to Wikipedia about 1/4 th of the world's population is infected with some sort of parasitic infection (ie: worms). IIRC, some estimates are as high as 1/3. Doctors are terrible at detecting these things (doctors are also terrible at detecting malnutrition, ie: a lack of a certain vitamin. They don't really ask diet related questions, for example, doing a simple analysis comparing your symptoms to the symptoms of any deficiencies you may have based on your diet. So many health problems can be fixed by this). If your read the symptoms of these parasites many of them seem to be similar to the symptoms of depression, ADHD, and other mental disorders ( "Delayed intellectual development" ).
http://en.wikipedia.org/wiki/Parasitic_worm
(the entire article is worth reading).
Studies have shown that a good percentage of people who get medication for these infections benefit from it.
It stands to reason that if such a high percentage of people in general have these sorts of infections a much higher percentage of people with health or mental or other problems, especially symptoms known to have a high correlation with those infected, have these problems. Why is it that animals and dogs get regularly treated for these things but not humans. I suspect that if these things are regularly screened for and doctors did more to ensure people didn't have these infections and to regularly treat and screen them we would all generally be much better off.
My wife and I adopted four siblings who were later diagnosed with Bipolar, all before they were six years old. But only after the state transfeered them to our insurance. County Mental health counselors, school behaviorist, school psychologists and school nurses have continually given us misinformation, refused to make basic accommodations, and denied them a 504 plan because there was no evidence of the medication being helpful, despite a doctors report. This isn't because they are evil, but more so because they are un-exposed, lack knowledge, and never see the cycle (euphoric, dysphoric, depressed) from start to finish.
So I asked them, sarcastically, would it help if we took them off medication for two weeks of the data collections. They then threatened to call Child protective services if they found we weren't giving our children doctor suggested medication. They spent next four months every time there was a hiccup in my child's life calling us asking us if the kids got their medication. My response was it doesn't matter the school has not found there to be any medical benefit in providing it.
Medication has been the saving grace for our kids and they will tell you they don't like life without it, or even getting late.
According to Wikipedia, "Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy."
In other words, clinical psychologists focus on the "soft" stuff – talk therapy, Rorschach test, Myers-Briggs and all that crap. So it's not surprising that they would consider the efforts of real scientists to be an intrusion on their turf. We don't use talk therapy to treat depression any more; SSRIs are far more effective (not to mention much cheaper). The only type of talk therapy that has been shown to have any positive effects is cognitive behavioral therapy. All the rest is just crap, and most insurance companies won't pay for it any more because it's basically unproven pseudoscience.
It may be that diagnosis and treatment would be theoretically beneficial... IF THEY IDENTIFIED THE ACTUAL CAUSE! I don't know about anxiety, but a typical doctor dealing with depression will just throw SSRIs, SNRIs, TCAs, or even MAOIs at the problem. They don't think, they just prescribe. They make no attempt to understand the underlying pathology.
You brought up stress induced depression. The average doctor won't consider stress related disorders when dealing with depression, even if you ask him to. Tell a doctor you have depression and fatigue, and most of them wont even think about hypothyroidism. Tell a doctor you have depression and have trouble sleeping, and they'll tell you that it is a symptom of your depression*. They won't wonder about sleep apnea.
*(This is from the "depression is a disease not a symptom" philosophy. At the very least, there's a high chance of co-morbidity, or that the depression has been exacerbated by a sleep disorder.)
The medical profession really needs to wake up and understand that depression is not a disease. It is a symptom. There are many known causes, and probably many that are unknown. When dealing with a chronic condition, you can't just assume that it is idiopathic and treat the symptom, hoping that it will go away. That's unethical.
(You must make a true, good-faith effort to show that it really is ideopathic first. Just because you don't know what it is off the top of your head is no excuse to slack off.)
The problem seems to be made worse because doctors seem to like depression. Depression, as a diagnosis, is popular. It's almost as if doctors are hoping you'll be a depression patient.
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
You're skipping right over numerous known causes of depression, including several endocrinological, nutritional, and even oncological causes.
Not faulting you. Most doctors overlook them too (to their fault).
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
That was actually a very good computer analogy. Top notch researchers are almost at the oscilloscope level. They don't really know what's going on in there, but they've found ways to get glimpses. The average doctor treating (for example) depression? Just randomly connecting wires. That doesn't work? Let's put some voltage behind them.
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
Yes, I did write that. And yes, the stigma is still pervasive in areas dominated by the old ideology, including law, medicine (sadly), religion, and news media. Fortunately, mental health awareness is indeed spreading through the public. Help agencies are advertising suicide hotlines and informal discussion groups, and hanging up posters saying that "mental illness is an illness", highlighting how it's a condition affecting an otherwise-normal person. Then there are the many more popular artistic works like next to normal that are ever-so-slowly highlighting the fact that mental illness is a daily part of millions of lives, and only very few ever reach the point of seriously considering harming others.
It took a century after the Civil War for America to recognize that African Americans are regular people, and there's still some holdouts. We're only about 20 years into this fight.
You do not have a moral or legal right to do absolutely anything you want.
CBT is a wonderful advance in psychology.
but most honest practitioners of it will concede that a short course of (the correct) meds will make CBT a lot more effective.
how do you tell someone to calm down when they can't hear you above their own screaming? sometimes people get into a state where they're simply not going to be receptive of any talk-based therapy. if this happens to somebody in your life, you'll be glad that drugs exist, and in enough variety that one of them is quite likely to be just the ticket.
an analogy i've heard is that the patient is like someone walking through snow wearing nothing but underwear. giving them meds is like handing them a coat and scarf. it'll work, but eventually that person has to get themselves out of the snow because it's pretty damn cold.
Indeed. Psychiatry and the DSM-IV (and soon-to-be DSM V) have issues, but people who insist that schizophrenia is not a disease are, not to put too fine a point on it, absolutely fucking insane. Is it a perfectly defined disease? No, because brains are such complex things that they often go wrong on a continuum (e.g., the high incidence of schizophrenia among artistic types may explain why they are artistic: people whose internal/external boundary is weak may be able to see the world differently, but they're also at risk of losing their grounding in reality). But that doesn't mean that psychosis doesn't exist, or that it isn't amenable to pharmacotherapy. That pharmacotherapy is necessarily blunt, because drugs can't choose to suppress receptors in one part of the brain and not the others, and it's necessarily broad-spectrum, because neurotransmitters affect a lot of things. But antipsychotics do work.
I'm not a psychiatrist, but I do work at a mental hospital part-time. You should visit one some time and get to see a real schizophrenic in florid psychosis.
You may not be able to fix the brain, but you can use drugs to put a cap on runaway processes that are the result of a miswired brain.
The problem with mental illness is that the brain gets caught in a feedback loop which manifests itself in various ways. This is probably the price we have to pay for the level of intelligence we have - our brains are unusually complex. Many very creative persons are also known to have had a history of mental disorder of some kind. The balance between genius and madness is always close.
Salvador Dalí was from some perspective a bit crazy, but he was also a very smart and creative person. Franz Kafka was riddled with depressions but nevertheless an important author.
As for experiencing depression/anxiety myself - without the drugs I would be stuck in a bad loop most of the time.
If builders built buildings the way programmers wrote programs, then the first woodpecker would destroy civilization.
they doubled down on the meds and he ended up not being able to function on how own (or even hold a conversation) and in a group home.
Post hoc, ergo propter hoc.
quidquid Latine dictum sit altum videtur
Every time I see this pointlessy show-offy use of latin, all I can think of is telling the OP is caput tuum revelle tuo e culo.
(And now we get an endless debate about whether I should have used clunes, and velle rather than revelle, and that's the real reason for the fall of the Roman empire, not the inability to terminate strings but the fact that they spent most of their time arguing over grammar).
Would most people be better off undiagnosed? When it comes to mental "illness", often the only (or at least the best) treatments are behavioral therapy, in which the "illness" is trained away.
Perhaps not. I think the point they are trying to make is that the traditional diagnoses do not reflect any deep insight into the nature of the disorders - they merely describe a set of symptoms, and trying, like the American manual, to pin it out in ever more specific categories does little to help in that respect.
There is some research to suggest that the actual underlying disorder in the brain may be essentially the same for at least several of the common diagnoses (like schizophrenia and depression), while some disorders that are considered variants of the same may be caused by different, underlying problems. Current treatments are only directed at the symptomatic diagnosis, really, and it would be a lot better to understand the disorders well enough to treat the underlying conditions.
You are correct about the diagnosis accuracy. I worked during my studying years, in a mental institution. The reality is that if you send a patient to four different doctors the patient is going to come back with five or more mutually exclusive diagnosis. Psychology is less accurate than astrology.
Maybe I'm "absolutely insane" but I don't see how what you wrote proves, or even demonstrates, that schizophrenia is a disease. The whole point is that disease/illness is a paradigm used to understand a collection of behaviors which people suffer from. This paradigm usually involves some kind of pathogen attacking bodily functions. Pharmacology can be used to destroy the pathogens and treat the disease. With mental "illness" this is untrue. Rather we believe that the brain is largely chemical, and that current "illnesses" result from non-harmonious interactions of these brain process. With chemicals we can correct the bad processes, or supplement processes that aren't firing.
But why call it a disease at all? We could equally look at mental illness more like, say injury. When my ankle is broken, some amount of drugs may ease pain, or possible reduce damage caused by swelling, but no drugs can heal it, because there is no pathogen to be killed. I am not suffering from "cantwalkitis", even if supply of opiates reduces much of my suffering and allows me to hobble along and ignore the pain. The best way to fix the problem is to repair it manually (not an option with the brain I know). Indeed, perhaps mental health problems are caused by psychological "injuries", sometimes the bodies own mental processes may exacerbate these "injuries".
I know one of the problem of those who criticize models is not supplying their own, which is why I tried my "mental injury" model above as a contrast, but I'm not a psychologist or neuroscientist. Perhaps my model is equally lacking? Someone with more knowledge and insight than me can propose a better one. However, even I can see the theoretical limitations of the mental illness paradigm of disease. As I've said "Where are the pathogens?", but there are equally compelling questions about contagion (almost all diseases are, no mental "diseases" are), or the difference between disease and condition (which exists for physical ailments but not mental ones). The disease model doesn't just allow for us to diagnose something bad and supply drugs to stop it. It also explains various other phenomena, cause, spread, contagion. The model was developed to deal with real world phenomena around diseases, ones that simply do not exist for mental "diseases".
I understand the appeal of the disease paradigm, which has had great explanatory power for dealing with pathogen induced illnesses. I also understand the desire to remove responsibility for actions that are beyond persons control, which is one reason we moved from the possession model of mental health to the disease model. I am also not claiming that people who suffer from mental "illnesses" aren't really suffering, from real phenomena beyond their control. The question is does the current model put our knowledge in a conceptual schema that aids us understanding and helping those who suffer. I feel the disease model has gotten us as far as is possible, given theoretical limitations
I suffer from major depression. When I go off my mess I feel like crap. I stop being able to concentrate and I feel overwhelming hopelessness. On the wrong medication I was failing basic courses at uni. On the right medication I got credit/distinctions on average and have not only held down a job for 3 years but excelled at it.
I have gone off my medication in the past because I wasn't convinced that the problem was chemical rather than environmental. When I go off my medication I'm sometimes fine for months. But eventually things get worse. I've been on the same medication for 4 years now, I've yet to have any issues.
I explored several options before settling on medication. Even then I explored the possibility that the depression was environmental or situational. I've been proven wrong each time.
Are some people incorrectly medicated? Definitely. But the idea no-one needs this medication to live a fulfilling life is reckless and ill informed.
Well... I have to say it's not news to me, but maybe I've just been lucky. My son was diagnosed as bipolar (which didn't exactly come as a surprise to me considering his mother is schizophrenic) last year. Combined with his behavioural issues as well, this was actually a bit of a relief. As far as treatment I have not encountered the "turf war" between psychologists and psychiatrists at all. In fact, my son has sessions with both a psychiatrist (monthly) and a psychologist (weekly) and the two of them talk once or twice a week about his case and work together to try to figure out an holistic solution to his issues.
The psychiatrist has also been really clear from the outset that the medications aren't to treat the problems, rather to make the problems and perceptions of the problems more manageable so that behavioural modification can be developed to combat the issues long term. She has been fantastic in helping us deal with his issues.
Maybe I've just been really fortunate with the group I have been working with here. While his medication is still a bit "hit or miss" there is no doubt in my mind that it has made it a lot easier for him to cope with his issues and put focus into working on his problems that would otherwise be focused elsewhere. While it's still incredibly difficult, it's definitely made things better.
While I agree with the article in that psychiatric drugs do not fix any problems, I think it's a little inflammatory in the way it approaches the statement. Then again, it's "newsworthy" when it's inflammatory I suppose.