A mental illness epidemic? Think again

[Cain]

I'm sure what Rog says is part of it.

But I also think it kinda lets off the quacks a little too easy, as well.  Because they'll keep saying modern life is stressful (which it is) but they'll insist it's an environmental cause regardless of the evidence for it, because they have as little a clue as everyone else, and their little books (which are written by people whose wages are paid by the people who make the drugs) keep on diagnosing ever larger numbers of people...

[The Good Reverend Roger]

I'm sure what Rog says is part of it.

But I also think it kinda lets off the quacks a little too easy, as well.  Because they'll keep saying modern life is stressful (which it is) but they'll insist it's an environmental cause regardless of the evidence for it, because they have as little a clue as everyone else, and their little books (which are written by people whose wages are paid by the people who make the drugs) keep on diagnosing ever larger numbers of people...

Oh, yeah, there's loads of money to be made on future shock.

[AFK]

Another piece, if it hasn't already been said, is that the doctor-patient relationship has shifted over the past 10 years.  It used to be, that you went to a Doctor, you told him what was wrong, and he told you how to fix it.  Nowadays, it really has shifted to the point where many will go into the Doctor's office, tell him what's wrong AND how they think it should be fixed and what script the Doctor should be writing to fix it.  You see this reflected in the Rx ads, which of course have also fueled this evolution in the Doctor/patient relationship. 

And the Doctors can get in a real bind too if they don't prescribe something because they can't be seen to NOT be responding to the patient's pain, whether it is legitimate, hyped up, or non-existent.  People expect to be medicated.  They expect a little pill to make everything right. 

Sure, modern medicine has helped to solve needless suffering, but, I think perhaps some suffering is good.  Not the kind that is debilitating.  But the kind that tells you, yeah, you're sick, but your body is going to work through it. 

That, and I think people have forgotten how to step back from the rat race and decompress.  Or maybe they don't know how to do it in the first place.  Everyone has to unplug on a regular basis. 

[Don Coyote]

Maybe that's why I'm not getting any drugs when I go to sickcall. I am doing it wrong.

[Eve]

Ah, you guys make me happy. I have trouble seeing past myself when I read articles like this. I'm always full of indignant "Yeah? Well when I went off meds, the only thing I thought about was killing myself over and over. So.. what do you say to that, huh?" types of thought. That's not to say that I don't think things are horribly fucked up in psychiatry today, but it's nice to have other perspectives to consider.

[Jenne]

Another piece, if it hasn't already been said, is that the doctor-patient relationship has shifted over the past 10 years.  It used to be, that you went to a Doctor, you told him what was wrong, and he told you how to fix it.  Nowadays, it really has shifted to the point where many will go into the Doctor's office, tell him what's wrong AND how they think it should be fixed and what script the Doctor should be writing to fix it.  You see this reflected in the Rx ads, which of course have also fueled this evolution in the Doctor/patient relationship. 

And the Doctors can get in a real bind too if they don't prescribe something because they can't be seen to NOT be responding to the patient's pain, whether it is legitimate, hyped up, or non-existent.  People expect to be medicated.  They expect a little pill to make everything right. 

Sure, modern medicine has helped to solve needless suffering, but, I think perhaps some suffering is good. Not the kind that is debilitating.  But the kind that tells you, yeah, you're sick, but your body is going to work through it. 

That, and I think people have forgotten how to step back from the rat race and decompress.  Or maybe they don't know how to do it in the first place.  Everyone has to unplug on a regular basis. 

There's been SOME movement toward this--at least in Pediatrics.  When it was shown that otitis media resolves on its own, APA stopped recommending anything to "fix" it with.  You can imagine this might piss off a mom who, in the late 90's, got a script to fix the kid's ear infection but in 2005, didn't get squat and was told to give the kid baby Tylenol.

You see, when protocol recommendations CHANGE, people overreact instead of applying logic of "oh, so science shows BETTER results for X sort of treatment NOW."  Instead they want the "fixitquickhurryhurryhurry."  Thinking for yourself = at a premium.

And they take blogger news as sacrosanct, so THERE goes the neighborhood with the folks who won't vaccinnate, etc. because of the internet scares that happen all over the fucking place.

It's inevitable, really, that insurance companies AND drug companies would be able to, through the help of corporate-friendly government, take over a large part of what is the "service industry" sector of medicine.  It's ripe for that sort of treatment, since really, no one gives a doctor a personality test to see if they are the RIGHT SORT OF PERSON to be one.

Nope.  It's trial by fire in med school and then residency, and that's that.  So any gaps left in the field (pedantism, fear of change, fear of technology, giantism of the ego, lack of ability to accommodate for difference in culture, language, upbringing, etc.) can be manipulated by outside forces.

[Jenne]

Ah, you guys make me happy. I have trouble seeing past myself when I read articles like this. I'm always full of indignant "Yeah? Well when I went off meds, the only thing I thought about was killing myself over and over. So.. what do you say to that, huh?" types of thought. That's not to say that I don't think things are horribly fucked up in psychiatry today, but it's nice to have other perspectives to consider.

Patients who have high success rates with treatment are actually the norm, or at least, not so thin on the ground.  It's the reason why the SSRIs are so popular, period.  And they fix a LOT of shit...more than they were originally intended for.

I think hearing about success stories is JUST as important, for perspective, as hearing about failures.  Helps the big picture, really.

[Wyldkat]

I recently went off prescription anti-depressants because I had been stable for awhile and hated the side effects.  I can definitely tell the difference, but I'm really working to stay off them because I hate the idea of being medicated forever.  I am being absolutely truthful when I say that anti-depressants saved my life more than once.  Whether or not they work the way it is described they do work and they work better for me than herbals or other options.  I truly feel there is a physical cause for severe depression, articles like this are good (research is almost always a good thing!) but it has taken so long for depression to be recognized as a real issue that they concern me because of the possibility of it going back to "oh just buck up and get over it."

My doctor is a close friend.  She keeps up with all the current research and has been on anti-depressants herself.  I love her dearly but she does tend to be medicate first, ask questions later, although she goes light on that with me because I dig my heels in like a pissed off mule.  The pediatrician, on the other hand, has a very wait and see mentality.  That's good for some things, but it meant that my son went undiagnosed for a lot longer than he might have if she was a different type of doctor.

I think a lot of it has to do with which doctor you get and how much the actually give a shit.

[The Good Reverend Roger]

I just stuff myself full of little yellow pills and never worry about it.

[Freeky]

I just stuff myself full of little yellow pills and never worry about it.

I'm on the pink and white ones, and I'm quite happy with the product, though one can never be TOO perfectly healthy through the magic of modern science.  Would you reccommend the little yellow ones, as well?

[The Good Reverend Roger]

I just stuff myself full of little yellow pills and never worry about it.

I'm on the pink and white ones, and I'm quite happy with the product, though one can never be TOO perfectly healthy through the magic of modern science.  Would you reccommend the little yellow ones, as well?

Yes, but if you're gonna mix 'em, you'd better use some whiskey as a binding agent.

[Luna]

I just stuff myself full of little yellow pills and never worry about it.

I'm on the pink and white ones, and I'm quite happy with the product, though one can never be TOO perfectly healthy through the magic of modern science.  Would you reccommend the little yellow ones, as well?

Yes, but if you're gonna mix 'em, you'd better use some whiskey as a binding agent.

Does it have to be whiskey, or will rum do?

[The Good Reverend Roger]

I just stuff myself full of little yellow pills and never worry about it.

I'm on the pink and white ones, and I'm quite happy with the product, though one can never be TOO perfectly healthy through the magic of modern science.  Would you reccommend the little yellow ones, as well?

Yes, but if you're gonna mix 'em, you'd better use some whiskey as a binding agent.

Does it have to be whiskey, or will rum do?

Has to be whiskey.

[Luna]

I just stuff myself full of little yellow pills and never worry about it.

I'm on the pink and white ones, and I'm quite happy with the product, though one can never be TOO perfectly healthy through the magic of modern science.  Would you reccommend the little yellow ones, as well?

Yes, but if you're gonna mix 'em, you'd better use some whiskey as a binding agent.

Does it have to be whiskey, or will rum do?

Has to be whiskey.

If I have to drink whiskey, I reserve the right to rinse it with something sweeter.

[Slyph]

Carlat refers to the chemical imbalance theory as a "myth" (which he calls "convenient" because it destigmatizes mental illness),

Ben Goldacre, The Guardian, Saturday 9 October 2010
What does it mean to say that a psychological or behavioural condition has a biological cause? Over the past week more battles have been raging over ADHD, after a paper published by a group of Cardiff researchers found evidence that there is a genetic association with the condition. Their study looked for chromosomal deletions and duplications known as "copy number variants" (CNV) and found that these were present in 16% of the children with ADHD.
What many reports did not tell you – including the Guardian – is that this same pattern of CNV was also found in 8% of the children without ADHD. So that's not a massive difference.
But more interesting were the moral and cultural interpretations heaped onto this finding, not least by the authors themselves. "Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children," said Professor Anita Thapar. "We hope that these findings will help overcome the stigma associated with ADHD."
Does the belief that such problems have a biological cause really help to reduce stigma?
In 2001, Read and Harre explored attitudes among first year undergradute psychology students, with questionnaires designed to probe belief about the causes of mental health problems, and responses on 6-point scales to statements like "I would be less likely to become romantically involved with someone if I knew they had spent time in a psychiatric hospital". People who believed more in a biological or genetic cause were more likely to believe that people with mental health problems are unpredictable and dangerous, more likely to fear them, and more likely to avoid interacting with them. An earlier study in 1999 by Read and Law had similar results.
In 2002 Walker and Read showed young adults a video portraying a man with psychotic symptoms, such as hallucinations and delusions, then gave them either biogenetic or psychosocial explanations. Yet again, the "medical model" approach significantly increased perceptions of dangerousness and unpredictability.
In 2004 Dietrich and colleagues conducted a huge series of structured interviews with three representative population samples in Germany, Russia and Mongolia. Endorsing biological factors as the root cause for schizophrenia was associated with a greater desire for social distance.
And lastly, more compelling than any individual study, a review of the literature to date in 2006 found that overall, biogenetic causal theories, and labelling something as an "illness", are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. They identified 19 studies addressing the question. 18 found that belief in a genetic or biological cause was associated with more negative attitudes to people with mental health problems. Just one found the opposite, that belief in a genetic or biological cause was associated with more positive attitudes.
These findings are at odds with everything that many people who campaign against stigma have assumed for many years, but they're not entirely nonsensical. As Jo Phelan explains in her paper "Genetic bases of mental illness – a cure for stigma?", a story about genetic causes may lead to people being conceived of as "defective" or "physically distinct". It can create an "associative stigma" for the whole family, who in turn receive new labels such as "at risk" or "carrier". What's more, this stigma may persist long after the ADHD symptoms have receded in adulthood: perhaps a partner will wonder: "do I really want to risk having a child with this person, given their genetic predisposition?"
Perhaps it will go further than that: your children, before they even begin to show any signs of inattentiveness or hyperactivity, will experience a kind of anticipatory stigma. Do they have this condition, just like their father? "It's genetic you know." Perhaps the threshold for attaining a diagnosis of ADHD will be lower for your children: it's a condition, like many others, after all, with a notably flexible diagnostic boundary.
Blaming parents is clearly vile. But before reading this research I think I also assumed, unthinkingly, like many people, that a "biological cause" story about mental health problems was inherently valuable for combatting stigma. Now I'm not so sure. People who want to combat prejudice may need to challenge their own prejudices too.

Whooops...