Thoughts On Mental Illness

[TheAppleCore]

industry practices like paying doctors to give out prescriptions

Is that really a common industry practice? Does it happen in the U.S.? If so, is it against the law?

I'm curious to know just how much pressure is on doctors to hand out prescriptions to patients.

 

[MyDoorsAreOpen]

This reads as though it is sufficient that someone be displeased with how my behavior and cognition affects them that I be considered "sick" (or potentially "sick"). That can't be what you mean.

It depends who that someone is, in what capacity they know you, and whether or not this person's issue with your behavior is part of a larger pattern involving more people in your life. It's not a witchhunt, whereby one person "reporting" you is enough to get you locked up in a straitjacket and jabbed with a needle. It's a case by case thing. The healthcare professional has to see a pattern affecting most or all areas of the patient's life, and by far the weightiest factor is the patient's dissatisfaction with his own mind. Is this system potentially abusable in a police state? Sure. Is it abused this way in the US currently? Probably sometimes, but not on any widespread basis. My aim here is not to be an apologist for the way the US healthcare system (the only one I know well) handles mental complaints. I'm simply informing everyone how it works, as someone who's seen it from the clinical side of the desk. This is something many people in the US have mistaken or skewed notions about, for very understandable reasons.

Why do they warrant "treatment" and not, say, opposition or disagreement or dialogue?

This is an issue of semantics and shop-talk. Confronting the patient and inviting them to dialogue are the first and most important steps of diagnosis and treatment, and for many (most) types of mental complaints, the only ones needed. Lifestyle changes (diet, exercise, changes in social activity, support groups) come next. Drugs and surgical procedures like ECT are avoided if at all possible, and are always accompanied by dialogue, lifestyle changes, and frequent checkups, at least when the treatment guidelines are being followed properly.

 

[Aetherius Rimor]

Being that we're on a drug forum, I feel talking openly about my opinions on this matter should come without a huge fuss.

To me, drugs are simply a tool, regardless of their effects. A hammer can be used with nails to build something, or it can be used to destroy something. The result is in how it's used.

If a person has behaviors or beliefs that hinder their ability to live their life in a manner which they are happy with, you have some choices. You can attempt to rely on neuroplasticity to acquire new behaviors/beliefs through behavioral therapy, or you can directly interact with the brains underlying structure to cause a direct change in behaviors and beliefs using medication.

Behavioral therapy, if successful, can provide longer lasting results, with less risk of damage. However like moving a large object, the force required to move it from a state of rest can be great due to friction, even if the force required to keep it moving might be minimal. The person's brain could be resistant to the changes causing behavioral therapy as a tool to be useless.

Drug therapy is almost guaranteed to do something (positive or negative), and is far more reliable in achieving changes. At that point it's a matter of finding the right one to accomplish the desired goals.

A brain suffering from chemical imbalances can manifest as the symptoms diagnosed as depression. Likewise, it could be learned behavioral adaptations that are manifesting these symptoms.

Example Analogies for Someone with a Chemical Imbalance:

- If behavioral therapy is chosen (and works), and it's a chemical imbalance, it's essentially giving a paralyzed person a wheel chair. Functionality has been permanently and partially restored, but the underlying problem is not resolved.

- If drug therapy is chosen, it's like you're giving them temporary use of their limbs.

- If some how in the future we can permanently alter the brain to correct the imbalance, then it'd be like you cured the paralysis.

If it's an acquired/learned behavioral adaptation, it falls back into the realm of psychology for treatment. Can't create an analogy since it's inherently not a physical problem at that point (unless you start getting into the physical structure of the human memory).

Excusing chemically influenced behavior due to a physical imbalance is no different than excusing behavior due to physical problems. It's not the fault of the colorblind person that he mistook purple for blue, anymore than it's the fault of the schizophrenic for thinking he's being persecuted or the depressed for thinking there is no point to living and thus doing anything. They need assistance to cope with the society and value system the mind set the majority of humans has created. Unless they have the same mind set, it won't make sense to them, and thus, their actions might be detrimental to them and others.

 

[MyDoorsAreOpen]

^ Excellent post. Agreed entirely.

The mental health system is there to help whenever someone perceives a problem and avails themselves of the system to solve it. The system is not there to intrude upon the lives of people who perceive no problem with the way they think and behave, and seem to be getting by in life reasonably well. Believe me, the mental health system (of most countries) hasn't the resources or even the willpower to police the populace, or slap diagnoses on people who don't want them!

Does Big Pharm have an agenda for getting more people diagnosed and medicated up? That's another whole kettle o' fish. But pharmaceutical companies are not themselves part of the healthcare sector. They only court it for business.

 

[MyFinalRest]

Is that really a common industry practice? Does it happen in the U.S.? If so, is it against the law?

I'm curious to know just how much pressure is on doctors to hand out prescriptions to patients.

I'm not sure if it is against the law or against medical board policy, but there is pressure and gross amounts of influence exerted. Doctors do often favor certain treatments over others not based on the patient's needs, but based on how well it was marketed to the doctor. Doctors prescribe what they are familiar with.

Also, what else does a psychiatrist have to offer? A 15 min. time slot and a try this chemical. The system lacks the resources to provide comprehensive treament and gain real insight and understanding to a patient.

All too often this particular method of dealing with people's problems creeps into mainstream culture and teachers and parents waste no time putting their kids on drugs. Even if it can't force a diagnosis on someone, it has the power to make people want one.

 

[modern buddha]

I'm not sure if it is against the law or against medical board policy, but there is pressure and gross amounts of influence exerted. Doctors do often favor certain treatments over others not based on the patient's needs, but based on how well it was marketed to the doctor. Doctors prescribe what they are familiar with.

Also, what else does a psychiatrist have to offer? A 15 min. time slot and a try this chemical. The system lacks the resources to provide comprehensive treament and gain real insight and understanding to a patient.

All too often this particular method of dealing with people's problems creeps into mainstream culture and teachers and parents waste no time putting their kids on drugs. Even if it can't force a diagnosis on someone, it has the power to make people want one.

In somewhat related news, my grandmother was prescribed 10mg of oxycontin twice a day for "extreme back pain". She got really loopy after a week of taking it. Who knows who else that's happening to?

 

[rollingstoned!]

Bullshit. That's what mental illness is.

 

[CoffeeDrinker]

Mental illness...it's gotta be a form of chronic suffering brought on by one's own thoughts, right? Whether it's a suffering brought on by too much logic, or not enough, or logic that is mixed up with imagination to lead a person to muddled and problematic conclusions that affects their daily lives. Mere chemical imbalances could very well be the cause of it all, but I feel the labels we have for the particulars are little more than metaphors at best, and pigeon-holes, at worst, and the states we are in are elastic and dynamic. If cognitive behavioral therapy is valid, then that teaches us that simply reassessing our assumptions about certain things can do a world of good and possibly alter our chemical balances just as much, or more, than most therapeutic drugs can. In other words, simply digesting new information can affect our emotions just as much as digesting new chemicals, so there is a complex interplay going on.

IMO just because a problem lies in the brain doesn't mean a person has a mental disorder because the word "mental" has implications with higher orders of thought and consciousness. Things like the aphasias and agnosias don't strike me as mental problems so much as physical problems that happen to exist within the confines of the brain. Things like people not being blind, but simply unable to register and translate light signals, or people knowing how to complete a task, but maybe a stroke made it so they physically cannot accomplish it, these strike me as simple physical ailments, perhaps beyond our medicine at the moment, but finite and fixable all the same. Mental illness implies something less tangible, and while the labels certainly give therapists a good place to start, they run the risk of hampering improvement past a certain point if they simply assume that a person is going to have all the characteristics of a classic case of such and such "disorder."

 

[MyDoorsAreOpen]

Mental illness...it's gotta be a form of chronic suffering brought on by one's own thoughts, right? Whether it's a suffering brought on by too much logic, or not enough, or logic that is mixed up with imagination to lead a person to muddled and problematic conclusions that affects their daily lives. Mere chemical imbalances could very well be the cause of it all, but I feel the labels we have for the particulars are little more than metaphors at best, and pigeon-holes, at worst, and the states we are in are elastic and dynamic. If cognitive behavioral therapy is valid, then that teaches us that simply reassessing our assumptions about certain things can do a world of good and possibly alter our chemical balances just as much, or more, than most therapeutic drugs can. In other words, simply digesting new information can affect our emotions just as much as digesting new chemicals, so there is a complex interplay going on.

Amen to that. You haven't by chance just finished Alan Watts Psychotherapy East and West, perchance?

I find it very interesting that many psychotherapists I've met have admitted to Hermetic or Alchemical spiritual views. This is perhaps the perfect worldview for this profession, because both recognize and harness the enormous, almost magical power of taking a new perspective, shifting one's frame of reference, and approaching the familiar with a whole new set of underlying assumptions and beliefs.

IMO just because a problem lies in the brain doesn't mean a person has a mental disorder because the word "mental" has implications with higher orders of thought and consciousness. Things like the aphasias and agnosias don't strike me as mental problems so much as physical problems that happen to exist within the confines of the brain. Things like people not being blind, but simply unable to register and translate light signals, or people knowing how to complete a task, but maybe a stroke made it so they physically cannot accomplish it, these strike me as simple physical ailments, perhaps beyond our medicine at the moment, but finite and fixable all the same. Mental illness implies something less tangible, and while the labels certainly give therapists a good place to start, they run the risk of hampering improvement past a certain point if they simply assume that a person is going to have all the characteristics of a classic case of such and such "disorder."

What you're talking about is the border between neurology and psychiatry. And you're absolutely right -- psychiatry aims to treat disorders primarily of thought. Granted, thought problems are a presenting symptom in many (most?) diseases of the central nervous system that fall under the jurisdiction of neurology. But this thought disturbance is considered secondary, because it's only one of an array of symptoms, most of which have nothing to do with thought. This also cuts to the core of why psychiatry is a more controversial medical discipline than neurology: a patient's thought cannot be directly observed and tested. A psychologist or psychiatrist can only observe and test behavior, and take a leap of faith that the behavioral states correlate reliably, in the patient before him, to thought states. This degree of uncertainty and subjectivity turns off a good deal of hard-nosed physicians who demand hard evidence before making any medical decision. I argue instead that the good done to communities by having good, judicious, empathetic psychiatrists justifies the admittedly soft science. In other words, I'd rather a few unfortunate people be put on Haldol undeservedly, than not have Haldol available to anyone. (I think Haldol is a nasty, nasty drug, FWIW.)

 

[CoffeeDrinker]

No I've never read any books on the subject beyond D.T Suzuki and a few other Zen books. I guess Alan Watts fits into that category though. But I have been subjected to Western psychiatric care with numerous shades of disappointment, which no doubt colors my views, and one shining example of success, which was the DBT that was highly influenced by buddhist teachings.

I recently had a falling out with my latest psychiatrist, and I honestly don't know the difference in knowledge between them and a psychiatric Nurse Practitioner besides the fact that the NPs seemed to show more human emotion and common sense, perhaps brought on by the reality that they have less authority to simply throw every drug they think of at me and see if any are worth the filler they're made with, so they are forced to actually talk to me. If the Psyche doc possesses any deeper knowledge it was certainly not plain to see. I felt like an Obama voter when going to see them, high hopes followed by a silent bubble bursting and their inability to correct the eroding of trust. I came to the conclusion that the SSRI and/or the SNRI are pure scams in the vast majority of cases and situations tend to deteriorate once such doubts fail to be assuaged. How much of their practice is sheer guesswork, and how much could benefit from drugs that are looked-down upon or illegal? I remember you once told me about ketamine procedures, and I've heard stories of ibogaine, and while I never would expect a magic bullet in the form of a drug, it seems insane to condemn these drugs while propping up nearly useless medications. I feel like the "wait several weeks to several months, and try not to kill yourself" aspect of SSRIs or SNRIs makes it so they can just keep charging you for visits while doing little more than lobbing up guesses and platitudes. Wellbutrin was on in particular that did absolutely nothing. It's supposed to make it so you can't smoke, or really really don't want to smoke, but my time on anti-depressants was the most nicotine filled period of my life.

I feel like I've outgrown the need for psychiatric care after a few months of a particularly successful therapy group because everything seemed so boilerplate and predictable after that. I would admit to having a limited scope of experience in spite years of therapy, but it seems like a good movie or song or buddy does more for the psyche than the best psychiatric care ever could. I'd rather watch a cheesy inspirational movie involving a psychiatrist than actually go see one at this point because they seem to say smarter stuff in the movies. The good therapy experience was a long time ago with lots of disillusioning experiences in between.
It seems that if you're able to make yourself happy then everything becomes much much simpler, and that's where I am right now and I can't ever see myself feeling the need to beg for help with my own problems again. I've been completely psyche-drug/behavioral-crutch free since just before Christmas after telling my recent psychiatrist to fuck off, and I've never felt better mentally.

 

[-=SS=-]

but it seems like a good movie or song or buddy does more for the psyche than the best psychiatric care ever could.

A friend or loved one has far more potential available in terms of your mental well being than a man in a suit. They have direct access to you because of trust and the bond you've established between each other, they can reach much deeper and provide nourishment for that part of you that is lost or dark.

 

[drgreenthumb00]

AAAHHHHHHH the grand sociological vs. biological debate. I had to write many papers in college about this. I was never big into learning about psychology and mental illnesses. That was until after I took many psychology classes and then ended up going out with a girl who had her masters in psychology and doctorates in clinical psychology. Then she suggested I go to a psychiatrist. I was contemplating on going to see one for years before this. I did eventually go. Since then it had opened my mind to mental illness and learning the biological/sociological/chemical makeup of mental illnesses.

I was never huge on taking meds and seeing a psychiatrist. But my brain was a total hot mess and I was losing my sanity. Talking to my doctor and medicating my mental illnesses has made me realized my years of irratic behavior and drug abuse was because I was mentally ill and I was self medicating myself. I started off with a psychologist and later found out they cannot prescribe meds. I've spent many years talkn to psychologist and counselors and came to the conclusion I need to see specialists and psychiatrists. Taking medication definitely has helped my illnesses. I have learned some illness that I have been diagnosed with are biological and some are from sociological damage. Mostly the damage I have inflicted to myself thru substance abuse, concussions, and letting the negative and depressed people in this world change the way I was thinking