Is manic-depression a disease to be cured?

[even sven]

In this thread, (http://boards.straightdope.com/sdmb/showthread.php?threadid=190814&pagenumber=2) bnorton said, regarding the decision to medicate people with manic-depression

That's an easy one. The individual's happiness trumps their genius. No contest. No one should be expected to live a life of misery just so others can enjoy their work.

Even if the individual gets enormous satisfaction from the expression of their genius, I would guess that they would trade in in in a heartbeat for a life of normalcy.


Frequently, we hear mental disorders compared to diabetes or pneumonia- a disease which is to be cured. It is a matter of chemicals in the brain being "wrong" which can be "corrected" in a very staightforward and medically sound way, just like any other disease or disorder.

This view doesn't match my reality. While I think anyone who wants treatment should get it, I don't think it is a simple issue or that treatment is the logical next step. I'm manic-depressive. On one hand, I hate it. It makes me pretty darn miserable. It can be unbearable. On the other hand, my manic states are indescribably beautiful. It's the most amazing feeling in the world, and I don't think I could ever part with it. Even my lows have their beauty. It is all so intense that I can't help but think it is wonderful in a horrible way.

And the truth that the drugs they give arn't about "correcting a problem", they are about making you able to hold down a full time job. That is pretty much the standard for "treated". In more extreme cases, the main goal is to prevent suicide. I can't figure out why not commiting suicide is seen as preferable to all situations. Why are we so concerned with keeping people alive, but not with their lives as a whole?

I've read a lot of psychiatric liturature, especially about lithium, manic-depression, and creativity. The consesus is that there is a strong link between manic-depression and creativity. I can feel this in myself. There is something about that kind of fire- and about knowing the highs and lows of life so well- that gives unique insight into the human condition and lots of energy. Living so richly and so extremely makes for some amazing art. When artists are treated with lithium, the qualty of their work becomes more conventional and their quanitity goes up. When they are untreated, they produce sporatic amounts of edgey and sometimes genius work. So essentially lithium keeps people from killing themselves (which is seen as more important than their art and oddly more important than their satisfaction with their lives) while it makes them mediocre. Many artists decline treatment because they miss their old ways, as hard as they were.

And I, for one, have not even started treatment. I don't know if I see what I have as a disease. I see it as more of a tragic mismatch with the world. Whatever it is, it is me. And I don't want to sacrifice it for normalicy. Happiness is not as important to me as satisfaction, rich experiences and adventure. I resent being told that something so fundamental to me is a "disease". It's not. It is something that sucks, and something that can be changed, but not something that should automatically be changed.

What do you guys think? Is there some other way of looking at mental illness that acknowledges it's effect on people's lives without shoving it into a medical model that it doesn't really fit into? Is suicide prevention the most important thing for a treatment to do? Is not seeking treatment a valid option? Is happiness really the most important thing in a person's life? There are a lot of questions here, and I look forward to hearing your guy's takes.

[Zoe]

I don't know much about manic-depression, but I have seen a similar POV expressed by some schizophrenics who believe they
are having mystical experiences and do not wish to be deprived of them.

As to what's most important in a person's life, I think that would vary considerably with the individual. But you have to admit that in order to have something that is important preserved in your life, you have to preserve the life itself. I don't know what the suicide rate is for people with bi-polar disorders. I know that it is high for depression.

Generally, I'm a civil libertarian and belief that people should decide for themselves about their own health issues. But I would also think that in some cases the family and other caregivers have to be considered.

Frequently, we hear mental disorders compared to diabetes or pneumonia- a disease which is to be cured. It is a matter of chemicals in the brain being "wrong" which can be "corrected" in a very staightforward and medically sound way, just like any other disease or disorder.

This view doesn't match my reality.

And I understand that your view of reality needs to be respected. Just remember that your reality isn't the reality of many people who suffer needlessly from chemical imbalances in the brain. There is no way that I can say that you are a person with a disease. I'm not a professional. But I know that I do have a mental illness that is a disease just as much as any other illness that has a physical cause.

It must be really awful to lose your gifts and talents through a treatment which is meant to relieve pain -- not cause it.

[Odesio]

Originally posted by even sven

Frequently, we hear mental disorders compared to diabetes or pneumonia- a disease which is to be cured.


That seems reasonable to me. Especially in regards to mental conditions that make it nigh impossible for someone to function. Manic Depressive Disorder is suppose to affect around 2,000,000 Americans and I imagine most of them are able to function normally in society.


This view doesn't match my reality. While I think anyone who wants treatment should get it, I don't think it is a simple issue or that treatment is the logical next step.


Maybe it doesn't match your patricular situation because your disorder isn't one of the more serious cases. On the other hand there's always the possibility that you're in denial about how harmful your condition actually is.


It's the most amazing feeling in the world, and I don't think I could ever part with it. Even my lows have their beauty. It is all so intense that I can't help but think it is wonderful in a horrible way.


I don't know anything about you're condition personally. In generally a manic depressive in their manic state has a loss of self-control and is easily agitated. I can see how that would cause some problems in someone's life. On the plus side they have an increase in goal oriented activities but who knows how long that will last? When they're manic they're sluggish, have a lower self-esteem and possibly think about suicide, and they lose interest in things you once enjoyed.


And the truth that the drugs they give arn't about "correcting a problem", they are about making you able to hold down a full time job. That is pretty much the standard for "treated".


Part of being a functioning adult in our society is being able to support oneself. Which means being able to hold down a job.


Why are we so concerned with keeping people alive, but not with their lives as a whole?


Who says we aren't?

Marc

[tastycorn]

I feel our society as a whole is borderline insane. Einstein said the definition of insanity (and I'm paraphrasing) was repeating the same action over and over and expecting different results.

How many "normal" people do you know go about their lives buying more and more crap, expecting each time that it will make them "happy". Media feeds us impossible physical ideals, and improbably human relationships on a daily basis. Anyone who actually tries to conform to what society says they should be will almost certainly end up with one or more “diseases” that need curing.

Take a look at the long term cure rates for mental disorders in the US as compared to the rest of the world. They aren’t good.

For me, the single biggest improvement in my mental state has been turning off all the marketing I have control over. TV was first. Then Radio. Then Magazines, Newspapers, Websites with excessive advertising. Any ad I could turn off, I did. It is impossible to turn it all the way off, but with the volume way down, I found I could finally hear myself think. The highs and lows were definitely less pronounced as well. More pleasant waves and less pogo stick.

Exercise is another excellent way of keeping a steady supply of the “good” chemicals flowing to your brain.

I personally consider drugs to be the last resort. I think any psychiatric process that doesn’t take into consideration outside factors is more a disease than a cure.

[tastycorn]

Hmmm, probably should have been improbable, not improbably.:smack:

[Marley23]

Manic-depression, as I understand it, is a disorder, not a disease. (Also it's a kickass song.) That means its effects CAN be debilitating, in which case the decision to treat it with medication can be made. That's a choice to be made, ordinarily at least, by the person who has it. I don't think it's unfair to say it's an imbalance, becuase it IS that: it's different from the way most people function, which is how this sort of thing is defined. Doesn't mean you have to do anything you don't want to as far as I can see.

[Marley23]

Manic-depression, as I understand it, is a disorder, not a disease. (Also it's a kickass song.) That means its effects CAN be debilitating, in which case the decision to treat it with medication can be made. That's a choice to be made, ordinarily at least, by the person who has it. I don't think it's unfair to say it's an imbalance, because it IS that: it's different from the way most people function, which is how this sort of thing is defined. Doesn't mean you have to do anything you don't want to as far as I can see.

[msmith537]

Originally posted by even sven
I'm manic-depressive. On one hand, I hate it. It makes me pretty darn miserable. It can be unbearable. On the other hand, my manic states are indescribably beautiful. It's the most amazing feeling in the world, and I don't think I could ever part with it. Even my lows have their beauty. It is all so intense that I can't help but think it is wonderful in a horrible way.
[/B]

Well isn't that basically the definition of "manic-depressive"? One minute you are incredibly happy - manicly painting the house for the third time, cranking out works of art and being the life of the party - the next minute life is unbearable and you can't get out of bed for a week. I heard this before. M/D describe how "wonderful" things are during the manic stage that they forget about the "depressed" stage.

I guess if you want to live as a suffering artist and your condition is mild, I suppose it's up to you to take your medication. On the other hand, if you can't hold down a job (which IS important BTW) and you are unable to maintain personal relationships, you should consider treatment.

It's not about making you conform to society. It's about curing an afflcition that many people find dibilitating (and will often get worse).


Anyhow, it's pretty obvious that no one here with the possible exception of MGibson knows anything about the mental health field. If you want people to pat you on the back for not conforming to society, come to the SDMB. If you want expert medical advice on a very real condition, talk to a professional.




"Take a look at the long term cure rates for mental disorders in the US as compared to the rest of the world. They aren’t good. "
-tastycorn

Any cites for this?

[Cobalt Blue]

Not a doctor, but I regard bipolar and other depressive disorders as chronic medical conditions to be managed, not acute illnesses to be 'cured'. Management may require medication or not.

As a member of a family riddled with the above-mentioned disorders, I must say that family gatherings are much more rewarding, if less entertaining to the neighbors, since all of us found meds which work. (They tend to take place on the right day, for starters.) Personally, I've happily traded any extra creativity I felt I gained from depression for the stability medication has brought me. And I make my living as an artist, which I was unable to do before; normalcy does not extinguish creativity.

I hope you find a solution that works for you. Please note, though, that it can be very difficult to perceive one's real situation, or judge how severe a disorder is, from within the throes of a manic or depressive state.

[jsgoddess]

In my experience with poets and with depression, I've found that lots of poets think depression helps their poetry. It rarely does.

I wouldn't claim that there can be no link between various conditions and an increase in good creativity, but I've found lots of people swallowing a myth about depression. Too many seem to think that:

a) Depression will make them into good poets,
b) Claiming depression will get them more respect, and
c) Writing about depression and suicide is deep, man. Deep.

I suffer from depression and write poetry. The more depressed I am, the more inward my poetry turns. It becomes incredibly self-involved. It may capture what I was thinking, but that doesn't make it good poetry. It may "speak to" others suffering from depression, but that doesn't make it good poetry either. And in discussion with others, I've found this pattern to be repeated fairly often.

This, of course, is purely anecdotal, but it makes sense to me. Depression impairs judgment. Why couldn't it impair artistic judgment as well?

Julie

[even sven]

My case isn't particularly mild, and manic-depression is progressive. It is pretty likely that I'll end up having to seek help one day. There were some moments that I survived only because I was too lethargic to get out of bed and do something about all the pain. As for my highs, well the only thing I've read that comes close is descriptions of heroin. My manic states are a bit atypical, because they are completly euphoric. Rarely do they degenerate into nervousness and irritabilitiy.

Once again, I want to restate that I believe treatment should be availible to all who want it. What I object to is the medicalization of this "disease". The truth is that we barely know what causes it. We can just barely treat it. I am not an expert on modern treatments, but I know a fair amount about lithium. It is a pretty clumsy hammer. It leaves people feeling stabilized, but it also can leave them wishing for their old life, but too scared to stop their drugs. So they just feel dulled. If thats what they want, all the better for them. But it can hardly be compared to insulen for a diabetic.

I guess I view manic-depression as a tragety. It's something that will never fit in neatly to our society. Our medicalization of it is just an attempt to smooth over a part of reality that will never find the kind of resolution we seek. The truth is that it is not a simple issue. It is not something that we can stick in the medical ghetto and never have to think about again. It is painful and unsettling, and as a society we ought to seek to understand that tere are things that will never be resolved, things that will never be fair or sense-making. We should stop pretending that it is oh so easy of an issue.

[MsRobyn]

Originally posted by even sven
My case isn't particularly mild, and manic-depression is progressive. It is pretty likely that I'll end up having to seek help one day. There were some moments that I survived only because I was too lethargic to get out of bed and do something about all the pain. As for my highs, well the only thing I've read that comes close is descriptions of heroin. My manic states are a bit atypical, because they are completly euphoric. Rarely do they degenerate into nervousness and irritabilitiy.

Then you're lucky. When I go into a manic phase, all I am is nervous and irritable. It's true that I can get a lot done when I'm manic, but it's because I'm trying to work off the anxiety and irritability, not because I'm having a beautiful experience. I'm not. When I'm off my medication, my life turns into a living hell.

Once again, I want to restate that I believe treatment should be availible to all who want it. What I object to is the medicalization of this "disease". The truth is that we barely know what causes it. We can just barely treat it. I am not an expert on modern treatments, but I know a fair amount about lithium. It is a pretty clumsy hammer. It leaves people feeling stabilized, but it also can leave them wishing for their old life, but too scared to stop their drugs. So they just feel dulled. If thats what they want, all the better for them. But it can hardly be compared to insulen for a diabetic.

Then I suggest you educate yourself on bipolar disorder and its treatment. Lithium isn't the only game in town anymore. I'm currently taking Depakote and Serzone, and both of those have been wonderful. I don't feel like I'm constantly on edge anymore, and I can actually relax for a change. The bonus is that I don't feel "drugged" or "dulled". I can live a normal life without worrying about feeling like I'm either coming off a sugar high or too depressed to think straight.

Additionally, there are better meds out there than lithium, and it might take some experimentation before you find a combination that works. Psychiatry isn't an exact science; it's more of an art.

As for the cause, it's pretty clear that the cause is genetic, and they're identifying specific genes (http://www.cnn.com/2003/HEALTH/conditions/06/15/manic.depression.ap/index.html") right now, even as we speak. And the closer we get to finding the specific cause of this disorder, the better the treatments will be.

I guess I view manic-depression as a tragety. It's something that will never fit in neatly to our society. Our medicalization of it is just an attempt to smooth over a part of reality that will never find the kind of resolution we seek. The truth is that it is not a simple issue. It is not something that we can stick in the medical ghetto and never have to think about again. It is painful and unsettling, and as a society we ought to seek to understand that tere are things that will never be resolved, things that will never be fair or sense-making. We should stop pretending that it is oh so easy of an issue.

It's not an easy issue, and no one said it was. As I said, it can take quite a while to get it under control. But it can be managed. I manage it quite well, and so do a lot of other people.

But let me ask you a question. If you object so strenuously to the "medicalization" of bipolar disorder and its treatment, then what do you suggest should be done about it?

Robin

[RickJay]

even sven, I don't think what you're saying has any logical basis at all. You're contradicting yourself over and over:

It is pretty likely that I'll end up having to seek help one day. There were some moments that I survived only because I was too lethargic to get out of bed and do something about all the pain...

What I object to is the medicalization of this "disease".
So let me get thsi straight; this condition has driven you to suicidal thoughts, you admit in another post it would rpevent someone from holding down a job. It has a physical pathology. It has demonstrable, objective negative effects. It's bad for your physical health. If it's not a disease, just what is it??

Of course it's a disease. It is a physical condition that debilitates the subject, as you yourself said in your very first paragraph. How else would you propose medicine handle it?

Complaining about the "medicalization" of manic depression is no different from complaining about the "medicalization" of cancer. There is no such thing as a "medical ghetto." People are just trying to come up with ways for other people debilitated with an illness to fix it. What's wrong with that? Attempting to solve a problem is not equivalent to minimizing the problem. There's no problem of "medicalization" here, no "ghetto." Nobody is claiming this is an "easy issue." Your entire third paragraph is one strawman argument after another.

I'll step on your toes here, but I get the sense you are trying to rationalize your situation and feel better about it by making an argument that there really isn't anything wrong, that rather than being a "disease," it's just a "mismatch" with the world. Not true; it's a disease. Being incapable of regulating emotion is not a "mismatch," it's a medical problem that needs attention. We can argue over the efficacies of various treatments, but why are you denying that you have an illness? Why are you trying to foist the identification of this illness of as "medicalization"? It's an illness, you go to a doctor, they fix it or at least try to.

I don't see manic depression as being any different from me going to the doctor after I've injured my knee. Some people have diseases of the colon, some of the liver, some of the heart, some of the ears, you have one of the brain. Don't make the problem worse by pretending it isn't there or that it's somehow noble to have it or that it makes you more creative (as jsgoddess has indicated, it doesn't.) Just handle it. Go to the professionals, let them work on it, get on with life.

[j.c.]

"The consensus is that there is a strong link between manic-depression and creativity."

You are going to have to some SERIOUS citing if you pull out this old wives tale.

The consensus is that there is s strong link between mental illness and ruined lives of misery and despair.

Here's a fun way to look at it. It's popular on Oprah and in creative writing classes to count up successful artists who have been "considered" to have one form of mental illness or another by folks who read their works or looked at their paintings and just decided they were suffering from whatever disease is currently in vogue. As a counter to this BS, try this: every time you see or read about a homeless person, consider the possibility that, at one point in that person's life, a mental health professional who actually examined that person diagnosed a mental illness. Sure, some people on the street are just bums, or junkies, but plenty of them have serious, untreated mental illness.

Right now, we're tending toward not forcing treatment, so the cycle is Bob the Bum does something really nuts, gets locked up, gets treatment, as the treatment begins to work, Bob the Bum is allowed to decide what he wants, he wants out, he goes back on the street (with a stop-over at a half-way house or with relatives), he stops getting treatment, he does something really nuts, gets locked up.... I don't know if that's better than the old way, when an indigent person who did something really nuts could be locked up in a squalid county hospital for life.

Additionally, I don't know what you mean by "shoving it into a medical model" and "pretending it is oh so easy of an issue." The competent professionals I know are very cautious about diagnosis. They tent do say "shows element of x, with some evidence of c" instead of simply slotting patients in to a short list of possible problems. When someone has cancer, there may be a long discussion about the best possible treatment for that cancer, but the decision to treat it is pretty quick and simple.

You are spot-on about barely knowing what causes mental illness and barely knowing how to treat it. But that's no reason to throw up our hands and just bear it.

[Bishamon]

I've been manic depressive for little over half my life. My highs are incredible experiences. I can feel the pulse of the Earth, I can sense the electrons within appliances and feel their buzz, language morphs and blends in a verbal tapestry that is beautiful to hear and see. Everything is more alive and vivid. My lows are just as extreme. The world is void, all thought gets routed to /dev/null, I would kill myself but squeezing a trigger is too much work. Neither state is conducive to interacting with society. However, I still "function." At best though I would simply call it survival. When I wasn't in the middle of a manic or a depressive mode, regular emotion was hard to generate. I had been at the extremes emotionally for so long anything less than that was simply not registered.

When I was first diagnosed at 19, I was given lithium. And it worked, fairly rapidly even. I found I could concentrate better, I could manage to get myself to class. Too bad the damage to my grades was already done. I guess I was "better." Lithium clipped the extremes from the sine wave that was my emotion. I can't even say that it lessened the amplitude of the wave, it just plain clipped the ends off. I felt robotic after a while. It was just like being "normal" and I really didn't feel much of anything. So I stopped my medications and started drinking heavily in order to produce some kind of feeling, anything at all.

I stopped doing that once I got married knowing that drinking excessivly would be a Bad Thing. But I never got back on my meds either. I kept retreating further and further inside myself in order to shield my wife from my extremes (she did know I was bi-polar before we were married though), but that just isolated her and finally my marriage imploded nearly three years ago. I tried taking paxil about that time in order to deal with things. It worked for the depression, and it didn't ever induce a manic phase. Hey I was cured! So I stopped taking it, and got even worse again. My lows were so low I would get tattos to start feeling something different, to remind me I was alive. My highs left me not sleeping for two or three days and drinking heavily.

And all this time I was surviving. The important things were being taken care of, my children were being loved and cared for (they live with my ex should anyone ask), and I was doing my job. Surviving? Sure. But not living. In fact, last week after staring at a wall for literally six hours unable to motivate myself enough to get out of that chair I decided it was time to get back on the medication. So, last week I did. I'm four pills into this and I can already feel that I'm starting to level out. I'm commited to staying on Paxil until at least Christmas and trying to wean myself off of it after that. The literature here at work seems to indicate 6 months of Paxil helps keep recurrance down, so I'm going to try.

I love my highs, hate my lows, and feel nothing but apathy when I'm not in either. So why did I get back on the medication? Because it was time to find a way to live the life in the middle and not at the extremes. Medication is not everyone. To finally get around to answering the OP, no it is not a disease to be cured like you can something pathogenic or a metastisi to be be removed. It is a condition that can be managed, and I think it is up to the individual to make that decision when and how to manage it. It is a hard decision to make, I know, it took me seven years and cost me a marriage before I realized that it was something I needed to do. I'm not going to make the decision for anyone else though. I can and will suggest they get help if it seems that they want it, but I've known plenty of people who don't complain about their condition so I don't tell them to get help. The people who love you can suggest all they want you get help, but it's not going to happen until you want it to. And if you can live with the consequences of what happens whether good or ill, congratulations, you've done something I couldn't. Good luck with that. And if you can't, maybe it is time to consider help.

Damn, that was rambling.

[Phlosphr]

Psychologist checking in here.

Rick said: Of course it's a disease. It is a physical condition that debilitates the subject, as you yourself said in your very first paragraph. How else would you propose medicine handle it?

It is not a disease Rick it's an imbalance with-in your neural transmitters caused by a variety of environmental factors, diet, mores etc...etc.. Furthermore unless you have it and/or can be a little more sympathetic towards those who do, I'd suggest your scraping for logicalities should stop.

Rick said:
I don't see manic depression as being any different from me going to the doctor after I've injured my knee

This statement essentially makes you unable to understand an provide any sort of meaningful advice to Even Sven.

Sven Some of the things you are saying are quite troubling and I would highly suggest you consult a therapist. Not, I repeat, not a psychiatrist for your first visit. They are the ones who will prescribe your disorder away into oblivian. You need someone who is a behaviour therapist. Someone who will talk with you on a weekly basis and guide you out of your depression. Someone who you can confide in and eventually if you need the assistence of medication they can consult on that with you in conjunction with your behaviour therapy.
Too many docs these days are prescribing patients medication and not making them adhere to a strict therapy regime. That is what works best Sven. You need a guide. Someone to walk you through the process. Is it money? Is the reason you have not found help a financial one? If it is, there are programs you can be one though your state that will allow you to get the attention you need. E-mail me if you want me to find info in your area. Or if you have more pointed questions.
Medication is not the only way out. Trust me I know many people who have beat it for a lifetime after seeing a therapist and being honest in the sessions. Playing with your life is not a matter to take lightly.

[Zoe]

RickJay:

I don't see manic depression as being any different from me going to the doctor after I've injured my knee. Some people have diseases of the colon, some of the liver, some of the heart, some of the ears, you have one of the brain.

I do think there is one difference that is important. Your brain helps you to determine that your knee, colon, liver, heart and ears are diseased or injured. With mental illness, the brain is often not able to function well enough to know that it is ill. And then the brain doesn't realize that it is not able to function well enough to know that it is ill -- and so on.

[MsRobyn]

Phlosphr, I'm going to disagree with you. With mood disorders like bipolar and depression, medication can be a useful adjunct because it helps manage the symptoms until the deeper stuff can be worked through, assuming that therapy is even indicated. Unfortunately, while it's true that many psychiatrists will attempt to prescribe into oblivion, many non-MD therapists will dismiss meds altogether, even though their utility has been proven.

In any event, talking therapy may not always be an option for people with bipolar disorder. It's listed in the "Promising (But Unproven" treatments for depression section of this site (http://www.mentalhealth.com/). (Do a search for "bipolar"; I couldn't get a direct link to that page. I know that for me, anyway, it's useless for me to talk to a therapist about my problems. It doesn't do anything but waste my time and money. YMMV, of course.

Robin

[Phlosphr]

I beg your pardon MsRobyn but I said:Someone who you can confide in and eventually if you need the assistence of medication they can consult on that with you in conjunction with your behaviour therapy.
In Conjunction with. Meds should be used in conjunction with. This is a proven therapy MsRobyn. Meds are only a tool. Therapists guide patients through the process of healing, sometimes with meds sometimes without. I would not say they are useless, especially to someone who is in need of one. Some people handle medication much better than others. What if someone on Klonopin feels wonderful after the first two weeks whereas another starts having seizures. I don't think anyone could convince me therapists are a waste of time, especially with serious depressive disorders.

[MsRobyn]

I'm not trying to pick a fight, but IME, many therapists will not recommend medication. I think I've had two out of about a dozen who gave their blessing to medication. The other ten were so convinced they could "cure" me without it that I was talked out of it. Therapy was then made a waste of time because I was spending so much time and emotional and mental energy trying to control my symptoms myself, when medication could've helped. In short, I was miserable, and all it did was feed the shrink's ego.

Robin

[Phlosphr]

Oh no MsRobyn, no fights being picked here. How could anyone pick a fight with you anyway, always posting such good stuff/advice. I understand your POV completely. I'm sad you saw such inept therapists. There are a fair number of us out there that are good at what we do. I am merely a psychologist. IANA Therapist. In fact I'm an instructor at a college - clinical psych never agreed with me. However, I do have a lot of professional collegues who are good therapists. The gap between PhD'd therapists being able to prescribe meds in shortening I must say.

[Bishamon]

What bothers me most about this whole post is the use of the word "cured." That seems to me that there is an end, a surcease to the condition, and there isn't one. Maybe longer frequency between moods, or different coping strategies for when you are up or down, but that's no more a cure than you can cure MS or diabetes.

I've done lots of therapy in the past. It hasn't been useful to me. I seem to find all the burned out therapists that can do little more than say, "So, what I'm hearing you say is that you are depressed." Seemed to be the therapy du jour when I went looking for help. It wasn't very helpful, so that stopped quickly.

But I'm not discounting it entirely either. I can recognize that I'm in no state of mind to pay any attention to what a therapist says no matter how helpful or valuable the advice might be. Hence returning to medication to at least get me on a keel even enough to listen to them. And then perhaps I could learn different coping stategies. I might even be able to get off of the medication some day once I've learned better methods. But it still won't be a cure.

I know that sounds pessemistic, but it has taken me a long time to come to grips with this being something I cannot take care of myself and I need help in some shape or form, whether it is medication or therapy. It is no longer a condition I can let slide. This is something that I'm going to have to monitor and get help for. Since I'm not going to be "cured," I can at least keep it in check.

[Guinastasia]

even sven-have you ever even had just THERAPY? What you are describing is NOT just "the way you are", it's a disorder.

If you're so depressed you want to die at times, but you can't even muster the strength to move-then you are ill. You need help.

I'm not saying this to be nasty. I'm not bipolar, but I AM Obsessive Compulsive. And you know what? It does have its advantages (like organizational skills, and being extra thurough), but I'd give it all up in a heartbeat NOT to have to deal with crippling depression.

And in case anyone is wondering, I normally saw both a therapist AND a psychiatrist.

[Padmaraga]

Originally posted by Cobalt Blue
Not a doctor, but I regard bipolar and other depressive disorders as chronic medical conditions to be managed, not acute illnesses to be 'cured'. Management may require medication or not.

Exactly how I feel, CB. I'm a mental health patient myself (Borderline Personality Disorder), and it's taken me several years to have it sink in that, while I will always have this condition (and it is medical as well as psychological), I (and to a lesser extent my mental health care professional) have a responsibility to manage it so that it doesn't interfere with my ability to function. The more I take an active role in that management, the better the results. Very much like my friend the diabetic who has to check her blood sugar level, plan meals wisely, and administer insulin to herself. I'm fortunate in that I respond well to low levels of meds and to DBT therapy (when I use it!).

I've had people with psych degrees or counseling backgrounds express concern when I've told them that my MHNP thinks I should be on meds for life. I think there is a certain amount of competition and even enmity between pyschologists and psychiatrists, and the way in which the psychologists tend to come at it (I believe) is to be scornful of the use of psychopharmeceuticals for all but the most psychotic. I was never helped by a LCSW; it took until I received the medical care I needed as well as the therapy before I started to have improvement in my life.

[easy e]

My mother is manic-depressive. When I was younger, it could be fun when she was manic, as she'd buy me lots of presents. But it was also confusing, as she would start crying for no reason, or sleep in really late and not spend much time with me (my parents were divorced and I lived with my dad, so I didn't have a whole lot of time to spend with her as it was).

Now that I'm older and have studied the disorder more, I can definitely where she is in her mood cycle. She has meds, but has frequently gone off them. Whether because she couldn't afford them, she thought she was getting better, or because of side effects (IIRC, one of the side effects of depakote is diarrhea).

This frustrates me, because I don't think she realizes what an effect it has on my life. I'm her only child, and she's not remarried, so she will call me when she's feeling depressed, and there's not much I can do about it. She complains about us not being as close as we used to, but when she's feeling manic, she always interrupts me and never listens to me. She disappeared for about 6 weeks when I was in high school (this was when I was first realizing what it meant for her to be M.D.), shortly after she started dating a new guy, and it worried me terribly. She was actually in the hospital for her M.D., but wouldn't let anyone tell me what was going on.

Okay, I'm rambling a bit and getting a bit too personal. To bring things back on track, I know it can't be cured, but I think it can be treated. But the treatment usually has to be ongoing. This is another stumbling block with my relationship with my mother, because sometimes I think she doesn't want to be treated, because as long as she's showing obvious symptoms, she can use her disorder to excuse her behavior.

Even if you regard manic-depressive disorder as a "tragic mismatch with the world," it is important to recognize that your actions, choices, and behaviors (including whether to seek treatment or not) can and do affect your loved ones. If medication and therapy can improve your functioning in society, I think that that is a good thing. I don't know about creativity levels on and off treatment, so I can't comment on that.

[Odesio]

Originally posted by Phlosphr
Psychologist checking in here.

It is not a disease Rick it's an imbalance with-in your neural transmitters caused by a variety of environmental factors, diet, mores etc...etc.. Furthermore unless you have it and/or can be a little more sympathetic towards those who do, I'd suggest your scraping for logicalities should stop.


If addiction is considered a disease why wouldn't an imbalance of your neural transmitters also be a disease? Maybe you could tell us why because it doesn't make any sense to me.

Marc

[Phlosphr]

MGibson - Addiction is a disease when you are in an Alcoholics Anonymous meeting, or a NA meeting. When you get down to it, an imbalance in your neural-transmitters is a laymans way of saying your brain doesn't produce enough of a certain chemical needed to keep your brain functioning correctly. Many times it is environmental factors affecting the chemical imbalance. Essentially a disease is something that impairs normal functioning. That can be a result of any of a thousand environmental or elemental reasonings.
Take someone with Crohns Disease. Crohn's disease is a disorder of the gastrointestinal tract that is characterized by inflammation and deep ulcer formation in the lining of any region of the tract from the mouth to the anus. My example is only to illustrate that disease has many different definitions. Calling manic depression a disease just doesn't do it justice for one who is out to cure it through non-medicinal or light medicinal pathways. Crohns disease can be cured through medicinal needs only. Put it this way would you council someone to get rid of their crohns disease? No, you'd medicate them. Would you council someone who has depression? Yes, it can have visible verifiable results.
I'll check back in tomorrow, I'm off to get a cat...Check IMHO for reasoning.

[RickJay]

Phlosphr, I honestly don't understand a damned word you're saying. Perhaps you could help me by defining what you use the word "disease" for, because every definition in English would define bipolar disorder as a disease. It's a disease. There's no debate to be had here.

The fact that it can be partially treated through counselling doesn't mean it isn't a disease. Counselling is a valid medical treatment for bipolar disorder. What's unusual about that? Lots of diseases involve more types of treatment than just taking drugs. Counselling is just... physiotherapy for the brain, to put it one way.

The fact that you have particularly strong opinions about what type of treatment should be adopted does not change the central fact that bipolar disorder is a disease.

[lorinada]

First of all, even sven, as of this moment there is no "cure" for diabetes, either type 1 or 2. If insulin were a "cure" then I would only have to take one or two courses of it, like I do antibiotics when I get, say, a sinus infection.

However, your comparison between diabetes and bipolar disorder were right on the money, in my opinion. I have to take insulin for the rest of my life becuase it is merely a treatment, not a cure. However, without it, I would be dead in a matter of days.

So you have to take medication the rest of your life - that's undesirable simply becuase it is not a cure? You have to take it forever instead of just a little while, so skip it altogether?

Or maybe I'm missing one of your many points.

Phlosphr, I, too, am confused about how you differentiate between a "disorder" and a "disease". By your reasoning, my diabetes is not a disease but instead a disorder, because it's simply my body not producing a chemical it needs to function. In that respect, dopamine = insulin, no?

[Guinastasia]

I think she's saying that she feels her manic states are worth it. Or that perhaps instead of a disorder, it's merely a personality feature some people have.

And I worry about her, reading this.

[j.c.]

Okay, now I'm confused. I zeroed in on the term "behavior therapist" in phlosphrsfirst post:You need someone who is a behaviour therapist. Someone who will talk with you on a weekly basis and guide you out of your depression. Someone who you can confide in and eventually if you need the assistence of medication they can consult on that with you in conjunction with your behaviour therapy. If I understood correctly, this is not about "I act out because my mom didn't love me," this is about learning that there always consequences to your actions, the your have responsibilities to yourself and others, etc. etc. That sort of thing might seem simple, but, you know, people with problems need extra help.

[Zoe]

Phlosphr
Essentially a disease is something that impairs normal functioning.

Do you not think that depression and manic-depression impair normal functioning? I have chronic depression. Sometimes it is bad enough to require hospitalization. Most of the time it is less intense but I still have the symjptoms of mood swings, problems with regulating sleep, and problems with concentration. That certainly impairs normal functioning. I have been receiving a disability pension from the state pension fund that I have contributed to. I also receive permanent disability payments from Social Security. I have been receiving these payments for fourteen years now.

I have considered my illness to be a disease, but I am willing to listen to whatever distinctions that you make. Maybe I am mistaken. I do know that like manic-depression, it is a mood disorder. Can disorders be diseases?

I know that there are several different kinds of depression and that what is appropriate treatment for one may not be appropriate for someone else.

In the early years, my access to counselling was limited. I had to travel 200 miles round trip. But even the little bit of counselling that I got was helpful. I took medications that weren't terribly helpful and I had a lot of electrical shock therapy. (I don't remember the latest term for that.) That was forty years ago. The shock treatments then were much different from the shock treatments of today. It took away my symptoms but left me with a lot of memory problems.

When I moved to the city, I saw both psychologists and psychiatrists (though not at the same time). These sessions were for about fifty minutes once a week. The counselling was helpful to me because in addition to depression, I had a lot of childhood issues to be resolved and I needed to learn how to parent myself.

For the last fourteen years I have seen my psychiatrist once a month for twenty-thirty minutes. We focus on the present and not the past. It is usually a check up on how I am handling stress, family and relationships, my medications and symptoms related to the illness. My understanding is that these short once a month sessions are being used more and more often in the treatment of depression. Someone else with depression may need intense counselling.

[Bishamon]

Well, if we are going to bicker about the symantics of disease and disorder now, in my opinion, a disease has some sort of pathogen whether it is a virus, bacteria, parasite, prion, whatever. If it invokes an immunine resonse, it's a disease. If it's genetic, it's a disorder. Bi-polar is a disorder and so is diabetes. In my opinion. I like that reasoning better, because in my mind calling bi-polar a disease is like pointing and yelling "unclean!" I'm being oversenstive, I know. In any case, disease seems to have an external source whether curable or not.

However, according to the 2nd edition of Springhouse's Handbook of Diseases that while bi-polar and alcoholism are "disorders," diabetes is a "disease." How even the book of disease makes the distinction is unclear. Perhaps disease is a general term, while disorder is more specific subset.

So you have to take medication the rest of your life - that's undesirable simply becuase it is not a cure? You have to take it forever instead of just a little while, so skip it altogether?
It isn't that clear cut. It is notoriously hard to get manic-depressives to stay on their medication because when they feel good, they feel that they don't need the medicine. So, when they stop feeling good, they are no longer motivated to take the medicine. It's not so much undesirable for meds, but the inability to stay with the meds. Bi-polar isn't analogous to diabetes in that diabetes will indeed kill you if you don't take your insulin. You don't necessarily end up dead without your lithium. Mortality isn't driving us to maintain the use of our meds. I've gone a very long time without it.

However, I don't think bi-polar's can be treated by therapy alone. The meds are a foot in the door while the therapy is there to help keep you on them and understand what is going on and how to deal best with it. More effective survival skills in essence.

[Zoe]

even sven, maybe you can find some helpful suggestions at this site:

http://www.dbsalliance.org/PDF/Dealing_Effectively2.pdf

[Zoe]

Bishamon: Well, if we are going to bicker about the symantics of disease and disorder now, in my opinion, a disease has some sort of pathogen whether it is a virus, bacteria, parasite, prion, whatever. If it invokes an immunine resonse, it's a disease. If it's genetic, it's a disorder.

I did not intend to sound as if I were bickering. I asked for clarification from Phlosphr since he is a psychologist.

I do see "mental illness" and "mental disease" used interchangeably on other websites, but that doesn't mean they are necessarily correct.

I wasn't asking for an opinion on what a disease is. I was asking for factual information.

[Phlosphr]

Bishamon said:in my opinion, a disease has some sort of pathogen whether it is a virus, bacteria, parasite, prion, whatever. If it invokes an immunine resonse, it's a disease. If it's genetic, it's a disorder. Bi-polar is a disorder and so is diabetes. In my opinion. I like that reasoning better, because in my mind calling bi-polar a disease is like pointing and yelling "unclean!" I'm being oversenstive, I know. In any case, disease seems to have an external source whether curable or not.

I would agree with most of this. I am not a clinician, I already said that. My job is to teach expose college students to all psychology has to offer. That's what I do. I specialized in Environmental psychology, and thats what I have my PhD in. MOst people know that about me here.

As Zoe said, I do not intend on bickering either. Anyway you cut the cake even sven needs some help. I don't want to grapple with whether or not he needs medication, or the efficacy therein of any particular drug. Someone said that psychologists and Psychiatrists have had their differences throughout the years. This is some what accurate. Psychiatry and psychology vary between individuals. They may have the credentials but any joe can run into a dumbass psychiatrist or therapist.

I'm also not going to speak anymore about what the definition of a disease is. Thats just a hijack to what we are supposed to be talking about here. For some interesting reading on the subject I will provide a good link (http://www.ncbi.nlm.nih.gov/disease/) to the National Center for Biotechnology. They have great definitions of what a disease is at the genetic level.

Even Sven my best to you. I do wish you good health and luck with your future Endeavor...

[Purple Scottie]

Even Sven , have you ever read Touched with Fire or An Unquiet Mind by Kay Redfild Jaminson? She is a psychologist who writes about her own manic depression and the relationship between manic depression and creativity. I've not made it all the way through both books yet but so far they are fairly interesting.

Personally I've had four serious bouts of depression -- we're talking psychotic level at some points (I don't want to get too much into that here) and have had an occasional hypomanic spell. I know that I have almost a 100% chance of recurrence at this point even with my medication (8 pills per day!). I see it as a part of me now -- a part that I can manage with meds and therapy but something that my identity will never let go of.

As to whether someone should take medication for bipolar disorder, it is pretty much up to the individual unless the patient is involuntarily hospitalized and as a result must take medication.

[Cobalt Blue]

Even Sven , could you give us some examples of the "many artists" who produce their best work during manic periods, but get dull after treatment? Say we put depressive disorders out of a medical model, and I'll concede that various mental imbalances can give unique insights.

However, art--writing, painting, composing, or any other form--involves a lot of sheer hard work and self-criticism. Inspiration may come in a brilliant flood, but you might need to spend an amazing chunk of time and energy, not to mention planning, realizing that inspiration. Some coherence is needed. Few I have known are really capable of that in a manic state. Perhaps you're luckier than most.

I think the 'lone genius' image is more of an archetype than a reality, today or in the past. An artist has to be able to deal with the 'real world' on at least a basic level, even if it's writing up a grant application so you can continue to be divinely mismatched. :D Is it really such a good thing when your brain chemistry prevents you from accomplishing the most basic work?

It was easier to romanticize my disorder, and those of others, when I was 20 or so. Not nearly so much time had been lost to the low periods, and the idiosyncrasies of college life buffered it.

As MsRobyn notes, if a medication makes someone feel like he's lost an essential part of his personality, it's the wrong med. The proper one won't do that.

[Bongmaster]

Interesting OP, and I agree that people should be able to decide for themselves when and if to get treatment for bi-polar disorders. That said, your experiences are very different from mine (I am bi-polar as well). I do not have any desire to hang onto this condition, if it could be wiped away with a wand I would do it. The highs can be nice, and they really do inspire me to be artistic. Still, I don't find the balance to work out in my favor, the lows dominate most of the time. So while in your case perhaps you spend more of your time riding the crest of the wave, lots of us are being dragged along the bottom for the majority of the experience. This is the very reason I agree that everyone should get to choose for themselves based upon the very different experiences individuals have.

[Witch]

I suffer from bipolar disease.

I thank the gods everyday for lamictal, topomax, and wellbutrin, as they have literally given me my life back over the past year. If I have to take 10 seconds out of my day for the rest of my life taking these meds so be it. I'd NEVER want to go back to feeling the way I did before.
Added creativity unmedicated? I was either too tired to move or too ansty to concentrate. Now I'm actually starting to write again, and the feeling is indescribable.
I am a walking, talking, example of just how much good the right meds can do for a manic depressive.
Therapy? YMMV, but it never did diddle for me. I'm not disputing it works wonders for some people, but I'm not one of them.
Even Sven, good luck.

[lorinada]

It is notoriously hard to get manic-depressives to stay on their medication because when they feel good, they feel that they don't need the medicine. So, when they stop feeling good, they are no longer motivated to take the medicine. It's not so much undesirable for meds, but the inability to stay with the meds.

<snip>

However, I don't think bi-polar's can be treated by therapy alone. The meds are a foot in the door while the therapy is there to help keep you on them and understand what is going on and how to deal best with it. More effective survival skills in essence. [/B]

You have hit the nail right on the head there, Bishamon, in my humble, untrained-but-experienced-with-a-bipolar-friend opinion.

[monty2_2001]

If any of you see a person in full manic mode, going on about the Bible (and getting it all wrong), then you'll see it's not a joke.

[Zoe]

Phlosphr: I'm also not going to speak anymore about what the definition of a disease is. Thats just a hijack to what we are supposed to be talking about here.

Thanks for the link.

The thread title: Is manic-depression a disease to be cured?

Isn't that what we are supposed to be talking about here?

In answer to the OP's question, the link that Phlosphr provided indicates that genetic illnesses can also be considered diseases.

However, one of the most difficult problems ahead is to find out how genes contribute to diseases that have a complex pattern of inheritance, such as in the cases of diabetes, asthma, cancer and mental illness. -- The National Center for Biotechnology

Although science may not be able to cure this disease yet, research, incuding genetics, may sled some light on solutions. But the symptoms are certainly treatable and maybe some of the newer medications could relieve your symptoms without damaging your creativity.

I am not a physician.

[Primaflora]

Anecdote -- my partner was diagnosed with bipolar last year. He's a writer, well-published and shortlisted for awards and has received fellowships etc. So he's not a creative wanna-be, he really was already successful.

Last year things got impossible for him and with him. He trialled depakote with grave misgivings about the (possibly mythical) effects on his creativity. His normal output was 2 books in a good year with lots of time off for depression and inability to deal with life.

In the past year he's written 6 books, one of them the best he's ever written. Without the cycling of bipolar, he's more productive, more happy in himself and a damned sight easier to live with.

I don't view bipolar as this romantic condition where the price of genius is suffering. Neither does he any more.

[jsgoddess]

Originally posted by Primaflora
I don't view bipolar as this romantic condition where the price of genius is suffering. Neither does he any more.

That's exactly my experience with depression. When I was untreated, I thought I was a great writer. Treated, I discovered that I was writing self-indulgent crap, but I was so tortured and dramatic that it seemed somehow laudable.

I do not, of course, claim this is true of everyone. But it seems to be true more often than not.

Julie

[Guinastasia]

And really, what is the rate of successful untreated manics, with the unsuccessful?

For every Van Gogh, you probably have about 100 who aren't successful.

[CrankyAsAnOldMan]

I am not manic-depressive, but I can share some of the concerns expressed here.

I have always felt cynicism, a grim outlook, and a curmudgeonly demeanor to be a part of my identity, my personality. It is who I am.

When my dissertation coach told me she thought I might be getting depressed, I started wondering what my doctor was going to want to do if that diagnosis panned out. I had a grave concern about the effect of pharmaceuticals. I worried that they wouldn't just "fix" my dysfunctions, they would also strip away that delightfully bitchy outlook which is the hallmark of who I am.

I would imagine some artists feel something analagous to this--that the more tortured parts of their souls are a font of genius and creativity. It is who they are. They don't want to lose that.

I think such concerns are valid. However, in my understanding of how medication and other therapies work--and in my own personal experience--it turns out that the fears are unnecessary. The goal of therapy and of drug treatment is not to erase the extremes of human emotion. I'm still a bitch. I'm just a functional bitch. What is gone are the negative thoughts which were irrational, such as assuming my boss loathed me. The general negative thoughts (grumble, grumble; damn, that singing bird is annoying) stay with me.

I presume that an artist who uses strong emotions as a wellspring of material doesn't have to be clinically and constantly depressed to succeed. You can improve the depressive (and manic) symptoms but the essense of the person will still be the same.

[AHunter3]

I just met with a group of psychiatric inmates' liberation / "consumers-survivors-expatients" movement people and we talked about public perception of us and public education and how we wish to be perceived.

Is it a "disease"? Some of us do believe there is a difference and that at least under some circumstances this difference is the reason we have received psychiatric diagnoses, although we don't tend to attach much credibility to the medical model of mental illness.

But a difference only becomes a disability (let alone a disease) when we, on an individual basis, determine that we find that difference disabling -- and not all of us do.

And the bottom line is this: no coercion. No forced treatment. We have the right to be untreated uncured crazy people. (As with noncrazy people, nondiagnosed people, etc., we are subject to laws that govern behavior and if we violate them we can be charged and arrested like anyone else). And it is our right to choose to remain untreated and uncured that we are fighting for.

[Guinastasia]

That's all well and good-but when "untreated crazy people" become a danger to themselves and others, then their right to remain untreated ends.

[Qadgop the Mercotan]

AHunter3, I don't disagree with you, but I would like your view on this sort of situation:

A patient of my acquaintance is bipolar, rapidly cycling (4 or 5 full cycles a year), and completely psychotic during both the severe depression and severe mania (catatonia, hallucinations). When not on medication, these cycles are devastating to the family, especially the young children. The patient is unreliable as a parent during these extremes, yet breaks no laws. Spouse, family and friends are always on high alert to mitigate risk and damage to the children and to the patients, but things do slip thru. The patient agrees the behavior is a problem, but only wants medications during exacerbations. However, during the exacerbations, the patient then refuses medications. Clear and present danger is difficult to demonstrate to the courts, and they have declined to intervene.

What should the family do? What should society do?

[NinetyWt]

even sven, my baby sister just started taking a time-release Lithium which has improved her mental health greatly. She has struggled with bipolar since she was a teenager (she's now 31). She has gotten worse and worse with time. It's been a struggle for the family to help her through it all, and medication has been a big stumbling block. She's had bad experiences with most of the standard medications, including Lithium, depakote, and wellbutrin. You might like the time-release Lithium.

A couple of words about the disorder/disease (I'm not gettin' in that fight!): It's awful. Hideous. Here's a few excerpts from some of the e-mails I've gotten from her:

The lithium is giving me stomach aches, and although it helps, it doesn't always give a "sense of complete well being." It slows me down and helps me to think, but I still have sleepless nights and I still don't feel "right" as a person.
I still feel inadequate to the task of living. I've thought about discussing anti-depressants, or even small doses of anti-psychotics to help insure a perfect balance of emotion,
<snip>

Must it be that I am ever the 12 year old, trapped inside the body of a 30 year old woman, never smart enough, never good enough, always flawed in some way? When does it ever end? And, should I even try to better myself with another career, or should I make peace and be a cafeteria worker all of my life.....For God's sake...I live in a trailer park...with a man who likes books but also who leaves the chocolate milk by the computer, and paper everywhere..I mean it seems to me that the good life and success have pretty much passed me by....Sometimes, I just feel that being "above average" doesn't cut the mustard, and although I am used to higher intellects being around me, I don't like the way they always put me down and make me feel like I am nothing
........I am SO VERY tired.......tired of my dignity being dashed to the ground, and tired of failing.................
<snip>

I stay up until 5AM. Now, good little girl whose-been-on-her-meds will have to UP THE DOSE. I'm not worried, p-doc likes that. "Let's make zombies yea" (to the tune of "Time Warp."
<snip>

No one can seem to keep up with my pace. Is this a gift or a curse?
<snip>

I feel better, but if things don't change with some issues here at home, my mental health is going to get worse.

THE GOOD NEWS is that I am supposed to go to the doctor THIS THURSDAY, THANK GOD!! I am bordering on hysteria and mild psychosis, so it's time.
<snip>

I was very angry after ---- and I left the Unemployment Office. Ladies, I had a fit of flight or fight and I tried to kick the dashboard. Instead, I kicked the wind shield. Now, we have a lovely flowered pattern on the passenger side of the car's windshield

Sorry for the length, but I'm trying to illustrate what a fight it is for her. You would do well to see a mental health professional; it's not the type thing that I would advise anyone to "self-treat".

P.S. Upon preview, after reading QtM's post, I will add that she has a 10 yr old daughter whom she is incapable of parenting due to her bipolar. They have zero relationship. It's very heart-wrenching to us, as her family.

[even sven]

Let's see....I'm going off of a few articles...

The first one is "Manic-Depressive Illness and Creativity" by Kay Redfield Jamison". She begins by showing a relationship between creative thinkers (writers, painters, etc.), manic-depression and suicide. She states "First, the common feature of hypomania seem highly conducive to origional thinking" and goes on to say that "sharpend and unusually creative thinking and increased productivity' is in the diagnostic critera. She then theorizes that manic-depression allows people to understand the moods and contradictions of humanity better than a person with a more consistant outlook on life. She says that while may people seek treatment, "these drugs can dapan a person's general intellect and limit his or her emotional and perceptual range". She then pins her hopes on genetic thearapy.

Next, I am looking at a sections of "Touched with Fire" also by Kay Redfield Jamison. In this section, she looks at the effects of lithium on creativity. She finds evidence that lithium not only changes the personality and temperment of the patient, but it can actually lower their intellectual capacity. She points out that manic-depressives are resistant to treatment not because they are too crazy to make decisions (as some of you have posited) but because they miss the power of their everchangeing moods. She then states once again that modern medicine helps, but that individuals must be free to choose their own level of treatment.

Finally, I looked at "Connecting Depression with Anxiety" by Richard A Friedman, in which he relates the very interesting story of a photographer who began treament for mild manic-depression. Her resulting art changed dramatically. It became very commercially sucessful, but fairly mundane. She began taking pictures of cute kids and couples and abandon her more challengeing work. She went off of drugs for a while, but then went back on them.

Anyway, all these articles seem to point to a link between creativity and manic-depression, and clearly explain some of the complications that come with treatment.

AHunter3, you are just the person I was hoping would show up. Can you share some more of your views?

[even sven]

Some more about my personal situation....

I tried the medication thing once, and within twenty minutes of walking into the office I walked out with a prescription for Celexa (they didn't even ask if there were any manic elements of my depression). I took a couple doses but I realized A: The side effects were too severe for me to be getting used to them during finals week B: School was ending and I had no way to maintain a $70.00 a month perscription over the summer, and it would be dangerous to have to quit cold turkey once I got used to them C: They wern't evenn putting enough thought into this whole thing to get an accurate diagnosis.

I tried the consuling thing. The guy asked me why I didn't want to take medication. Then he asked me if I got enough excersize (at the time I'd wander around for four or five miles a day crying). Then he said there wasn't much he could do for me.

In the meantime, I've been having my ups and my downs. Whenever I feel 'normal', everything feels so stagnant and dull that I almost wish I felt bad again. I've had some pretty increadable lows, but somehow I keep on suceeding in my life. I've managed to graduate college with a variety of honors, even though I spent huge chunks of school in hiding under my blankets crying. I don't really understand it, but it seems to "work" at the price of "normallicy" that never really feels alive to me anyway. I'm a filmmaker, and I know that the super-confidence, endless energy, and heightend competence that comes with my manic states has helped me in so many of my projects. It's like I'm a superhuman when I am busy, and totally depressive when I'm not. I know it will just get worse if I don't do something, but right now it is the only way I know how to live. The devil I know and all..

In the meantimes, I decided against the whole having kids thing. I know too well what it is like to be the dependent of someone who is unstable. And I know that it is enough of a struggle just to remain responsible for myself, much less another helples person.

[Primaflora]

The coercion thing -- I'll freely admit I coerced my partner into treatment. He either sought out treatment of whatever kind, meds, therapy, whatever or he left the family home until he was willing to. I did not see that he had the right to remain untreated when his effect on the children was so negative. This household was a nightmare place to live and for me, I am not so respectful of someone's disorder/disease that they get to make me and my kids suffer alongside them. He chose meds and yes, I think it was under duress but he could have walked. The door was open.

The creativity thing -- maybe we were lucky or a statistical anomaly. I have not seen a decrease in creativity and Mr P certainly doesn't think he has had one. Prozac was worse in that regard. I don't value creations bought at the cost of human misery though.

[AHunter3]

Guinastasia:That's all well and good-but when "untreated crazy people" become a danger to themselves and others, then their right to remain untreated ends.

Under the same circumstances (and no others) that your right to remain untreated would end were you to become a danger to yourself and/or others, I presume?

If it were you, you'd have to actually do something? Or would the opinion of some people that in their excellent judgment you were likely to do something dangerous suffice?

And if you become dangerous, how shall we "treat" you?

[AHunter3]

Qadgop the MercotanAHunter3, I don't disagree with you, but I would like your view on this sort of situation:

A patient of my acquaintance is bipolar, rapidly cycling (4 or 5 full cycles a year), and completely psychotic during both the severe depression and severe mania (catatonia, hallucinations). When not on medication, these cycles are devastating to the family, especially the young children. The patient is unreliable as a parent during these extremes, yet breaks no laws. Spouse, family and friends are always on high alert to mitigate risk and damage to the children and to the patients, but things do slip thru. The patient agrees the behavior is a problem, but only wants medications during exacerbations. However, during the exacerbations, the patient then refuses medications. Clear and present danger is difficult to demonstrate to the courts, and they have declined to intervene.

What should the family do? What should society do?

I think if it were me, I'd have an attorney draft me two documents:

a) a Springing Power of Attorney designating someone as my "official take-over decision-making person" should I become incapable of making my own decisions. I would be very explicit about this authority expiring as soon as I was once again able to determine matters for myself, and also about restricting the area of authority to a select few areas, mostly medical/pharmaceutical.

b) a Health Care Proxy and/or Living Will, designating the same person and laying out in explicit details how I'd like to be treated medically (psychiatrically) and for what duration.

I think the combination of the two would be sufficient to "protect myself from myself" if that's what I wanted. The POA by itself might not do it because questions would be raised about whether or not I were sufficiently incapable of still managing my own affairs, but in conjunction with the HCP which indicated that were I to still be in my right mind I'd be taking pyschiatric pharmaceuticals until I was once again in my right mind, I think it would convey a pretty clear sense of what my (normative) wishes were.

Good question :)

[AHunter3]

Primaflora:I am not so respectful of someone's disorder/disease that they get to make me and my kids suffer alongside them. He chose meds and yes, I think it was under duress but he could have walked. The door was open.

That's reasonable.

I'll tell you right now that there are many people in the movement who are not pleasant to deal with.

Ultimately that's OK. I had a college professor who had a sign in her office that read something like "Gender equality is not when a female genius can go as far as a male genius; it's when a female schlemiel can get by as easily as a male schlemiel". In our case, we need the freedom to be as unpleasant to deal with as people who don't have psychiatric diagnoses, without facing any involuntary treatments they wouldn't.

But your individual private little household is not an institution and his freedom and interests don't get to override yours. I think it's reasonable to say "Fine, don't take the drugs if you don't want to. There's the door. I want to be on the other side of it from you while you're like this."

[Guinastasia]

H'uh?

You mean, if I were a danger to people, should I be treated? Hell yes!

[thatDDperson]

I'm a caretaker for a person with mental illness.

There is nothing harder to do than invoke a Medical POA, or one for Mental Healthcare, when you're dealing with a person indulging in dangerous behavior, doing things that will cause real problems, but still with it enough to 'pull her act together' for the cops and EMTs.

Several times, I have had to allow her to get into binds that cost me a fortune to get her out of, in order for an authority figure to stop her. Then I have to get her out of jail and into the psych hospital.

If one has to go to that extent to be able to 'cope with my illness in my OWN way', one should expect to lose the trust of friends and family members. Make sure that you choose a POA that isn't as undependable as me. I keep on having to have cancer treatment and surgery, and when the attention is not on this person full-time, she acts out. I've had to have a phone brought to me in the ICU to contact her psychiatrist and psychologist.

As my time is running out, I can't find someone willing to take the responsibility. What does society do then? Allow her to make the decisions that will end up with her being a corpse or a bag lady? Hospitalize her for the rest of her life? Hire someone to follow her around to turn off burners, close freezers, pull her out of the middle of streets, take away broken bottles and knives, take away drugs, stop her from all the things that she'll do to hurt herself and others?

If you want to function in society, you have to make certain sacrifices. You have to decide what they are. Society gets to decide if it's enough.

[AHunter3]

What does society do then? Allow her to make the decisions that will end up with her being a corpse or a bag lady? Hospitalize her for the rest of her life? Hire someone to follow her around to turn off burners, close freezers, pull her out of the middle of streets, take away broken bottles and knives, take away drugs, stop her from all the things that she'll do to hurt herself and others?

Option #1 may have to be the way to go, if only because people are damaged more severely and significantly by coercion, no matter how often it may be fueled by good intention, than by a commitment to respecting people's liberty and self-determination, no matter how often it means letting them die of neglect and failure to intervene.

Some of the best options for improving on that sad set of choices have been user-run alternatives, which have ranged from housing and mutual support groups to out-and-out Safe Freakout Centers. But these are hard to keep going without dependable funding streams and the mental health system's record for funding user-run alternatives has been spotty at best. And if the individual does not perceive him or herself to be in need of help, we certainly aren't going to impose it!

So...I suppose some of you are wondering...what [does AHunter3 think] should one do when a person is essentially dangerous, but mainly to themselves and therefore isn't violating any law for which they could be locked up, and can pull themselves together well enough to "pass" when the cops come? Mostly: respect their right to make stupid decisions and/or be weird and disruptive and/or highly unpleasant company to all in their surround and/or destroy their lives. Because you could be wrong in your assessment of these things, see? And because if they are sufficiently out of it to warrant intervention over their objection, then a court of law should be able to find them so.

Anyone competent enough to "pass" is no different from your dear Aunt Harriet who persists in eating foods that are not good for her and dating men who are not nice to her and who drinks way too much and bar-hops through the more dangerous parts of town very late at night: you're absolutely convinced she's gonna kill herself one way or another, but the world is a better place for the fact that there isn't a damn thing you can do about it unless you can convince her that she should change her ways.

[AHunter3]

Guinastasia:You mean, if I were a danger to people, should I be treated? Hell yes!


Suppose there's an experienced doctor who has been reading your posts and decides that your various statements and the stories you've related over a period of time indicate that you are maladjusted and would benefit from treatment in his locked ward, and that you represent a danger to yourself? I don't mean "if your behavior on the board had been different", I mean as it has actually been?

Or, to ask it again, should you only be treated if you actually do something overtly self-destructive or engage in illegally violent crimes against other people?

[Zoe]

AHunter3:

Anyone competent enough to "pass" is no different from your dear Aunt Harriet who persists in eating foods that are not good for her and dating men who are not nice to her and who drinks way too much and bar-hops through the more dangerous parts of town very late at night: you're absolutely convinced she's gonna kill herself one way or another, but the world is a better place for the fact that there isn't a damn thing you can do about it unless you can convince her that she should change her ways.

I agree with you that there is not much that can be done if the person has been judged competent by a court. But overall there is a big difference in Aunt Harriet and someone who is bi-polar. The person with BPD has a malfunction of her or his "decision-maker" -- the brain.

Ninetywt, I am not a doctor, but it sounds to be like your sister needs to be hospitalized for help. Have you considered a second opinion?

At one point in my struggle with mental illness, I was given the wrong medication by an extremely poor psychiatrist who had misdiagnosed me. It drove me beserk. I couldn't form complete sentences and could barely walk. I have never experienced that much pain. The physical pain that I have had from abdominal surgeries did not hold a candle to this mental anquish. All it took was one good psychiatrist and one dose of a medication and my sanity was restored. I know that it is not that easy for most people. One pill just won't do. But I think your sister needs reevaluation and immediate help.

[Zoe]

even sven, I read the article "Manic-Depressive Illness and Creativity" by Kay Redfield Jamison. She certainly has the credentials to know what she is talking about -- Professor of Psychiatry at Johns Hopkins. Your summation was very good. But this is also an important point that she makes:

Most manic-depressives do not possess extraordinary imagination, and most accomplished artists do not suffer from recurring mood swings. To assume, then, that such diseases usually promote artistic talent wrongly reinforces simplistic notions of the "mad genius.

And near the end of the article, this:

Left untreated, however, manic-depressive illness often worsens over time--and no one is creative when severely depressed, psychotic or dead. The attacks of both mania and depression tend to grow more frequent and more severe. Without regular treatment the disease eventually becomes less responsive to medication. (Bold type added)

But she offers hope when she says that both depression and manic depression are fairly common and very treatable diseases.
[
I don't envy the choices you face.

The article itself is really interesting reading and I'm glad that you mentioned it.

[AHunter3]

Zoe:I agree with you that there is not much that can be done if the person has been judged competent by a court. But overall there is a big difference in Aunt Harriet and someone who is bi-polar. The person with BPD has a malfunction of her or his "decision-maker" -- the brain.

That's your opinion. The person that you view as having "bipolar disorder" (who may or may not view themselves in the same fashion) may not agree with you. In fact, one of us may think that your decision-maker is on the fritz.

Some of us prefer to be this way. Some of us regard our brains as being more that just our decision-makers, and consider them to be the most quintessential "us" of any subpart we've got. (You probably do too). Some of us have just never developed much appreciation for having who we are defined by someone else as a disease.

(It's different if we don't like the difference or its consequences and want help, but that's individually OUR decision).

[AHunter3]

PS -- in case it's kind of escaped your awareness, part of the reason for many of us having this attitude is that we were your Aunt Harriet (or Guinastasia, or you) until one day a psychiatrist changed that by applying a little label to us.

Many people in the movement were subject to occasional "spells" of being miserable and out of sorts and inclined to seek some therapeutic help now and then, but did not think of ourselves as being non compos mentis, just a bit moody.

Many others did not seek, were not seeing, and had never sought help of any sort remotely akin to "mental health" and yet still inspired someone to think we weren't OK in the head, often for some pretty outrageous and appallingly narrow reasons.

It could happen to you. To absolutely anybody on this board. (In fact, a tendency to spend hours per week reading this board would be sufficiently indicative of mental disorder in the eyes of some overzealous shrinks, if your worried mom or coworker or ex-husband phoned them about you). And once it has happened once, however briefly, you no longer get to be simply the independent and willful and eccentric Aunt Harriet. Instead you get to be sick Aunt Harriet whose brain dysfunction explains everything she says or does that the people who know her would not have said and done, or, even if they would have, thinks that she should not have said and done.

[Zoe]

Yes, it is my opinion and I am not a physician. It is an educated opinion when I am speaking of my own illness. I know little about manic-depression as I stated originally.

And I do know that the article that even sven mentioned refers to both depression and manic depression as diseases. You may prefer that it not be considered a disease. That's your business. But I have no intention of being dishonest about what I have learned just to accomodate your feelings about it.

I choose "to dance with the man that brung me." Psychiatry has provided me with relief from some of the worst of my symptoms. It has literally saved my life. My illness is a treatable disease. It is also considered a disorder. You, of course, are free to call it whatever you like.

BTW, no reputable psychiatrist or other physician would make a diagnosis without examining the patient. I don't think we have to worry about being snatched from SDMB and placed in a hospital against our will just because of something said here.

Many others did not seek, were not seeing, and had never sought help of any sort remotely akin to "mental health" and yet still inspired someone to think we weren't OK in the head, often for some pretty outrageous and appallingly narrow reasons.

You are absolutely correct.

[NinetyWt]

Zoe, thank you for your concern. Currently my sister is married to a wonderful man who is a big help in guiding her along; ensuring that she takes her meds and goes to the doctor. She's probably down to about 3 or 4 full cycles a year. (some years she went about 6).

I don't want to hijack this thread too badly, but concering a second opinion: in the course of her illness she has probably seen 8 to 10 different medical professionals. Part of that is becase she is dirt poor. Paying for Dr. and meds is a big problem, so she turns to gov't subsidy. Then she is very limited to what Dr.s she can see. The turnover is high and she's not assured of seeing the same person twice. Transportation becomes a big issue when the gov't Dr. is in the next county and she's driving a piece of junk car. We (the family) would like to help but are not financially able to do much.

I think that there is truth to both sides of this debate. AHunter brings up the issue of independence, of free will in deciding your own fate. That's important to me. OTOH, some folks really are a danger to themselves. The rub comes in the gray area - where it's really hard to tell if someone's rights should be curtailed. For borderline cases, it would be extremely difficult for me to have the chore of deciding who should be labeled "mentally ill" and who shouldn't. I don't think there are any easy answers here.

[The Calculus of Logic]

i personally doubt genius really makes manic depression worth it.

I do not have the report onhand, but i was reading a magazine article once about Ed Diener & happiness, and it stated that happy people make aroun $12k more a year. They also have better relations with their family & friends

Then i read things like this (http://www.springfieldnewssun.com/news/content/coxnet/headlines/0618_depression.html) which show that depression costs alot in productivity.

So if you ask me, being miserable, making less money, having worse relationships and being less productive at your job (assuming the person can hold one) but being able to write good poetry is far from an even trade.

[AHunter3]

I choose "to dance with the man that brung me." Psychiatry has provided me with relief from some of the worst of my symptoms. It has literally saved my life. My illness is a treatable disease. It is also considered a disorder. You, of course, are free to call it whatever you like.

As are you, and there's no denying that many folks find psychiatric treatment to be akin to a miracle, something that enables them to live and thrive.

As long as you respect my right to define my difference in other terms, believe me I have no intention of depriving you (or others who wish for and benefit from psych meds & other psych treatments) of what works for you.

I don't think we have to worry about being snatched from SDMB and placed in a hospital against our will just because of something said here.

I wouldn't expend any energy worrying about that, because you could also get snatched up and placed in a hospital against your will for what you said in a college classroom, or for the "please clean up your mess" sign you posted in the coffee area at work, or for having long or short hair, or for believing or not believing in God, or for wearing your baseball cap backwards -- in other words, for damn near anything at all because under the right circumstances anything at all can be considered indicative of your need for treatment.

One of the more famous stories in movement lore is that of Leonard Roy Frank. He was an investment professional of some sort with a six-digit income and then got laid off, and with plenty of money saved up in his personal account he decided to take some time out and get in touch with his roots (Jewish, non-observant parents) and grew his hair out long & with peyot curls and beard, became vegetarian, got immersed in the Torah, etc. His folks came to visit, freaked out that he was doing this instead of seeking a job commensurate with his experience and prior salary, and spoke to their family doctor, who spoke to a psychiatrist he knew, who arranged to meet Leonard Roy Frank and upon doing so had him committed involuntarily, held him for quite some time, had him electroshocked as well as drugged (involuntarily in both cases), and who identified the goals of Frank's therapy as the dropping of all these recent changes in his life.

Nor is it by any means always family members' involvement that precipitates these things. Huey Freeman was in a condo or hotel lobby waiting for his girlfriend to come down to meet him and he was dressed fairly downscale for the building, and a person he did not know starting asking him questions about his dress and demeanor and Freeman replied with some variation on "who asked you?" or "I wear what I please" and added that it was a free country, yes? The person to whom he was speaking was a psychiatrist, identified himself as such, informed Freeman that he had problems and that he (the shrink) could help him and that he (Freeman) should come to his clinic for treatment, and when Freeman expressed a lack of interest, the psychiatrist had him committed and held him involuntarily for quite some time and subjected him to forced treatment. I've met Freeman (was on a talk-radio presentation with him years ago).

I'm sure many of you would like non-subjective, non-anecdotal references for the occurrence of this kind of thing. So would we, but how does one get objective quantitative stats? Get the states to pass laws requiring psychiatric facilities to report the percentage of involuntary commitments where the patient was not really a believable danger and was just minding his/her own businesss? We know it occurs often enough to fuel a rather angry portion of our movement.

Sort of happened to me. I upset my RA and a couple of other folks on campus with some things I'd written excitedly late at night and xeroxed and handed to them, asking them for their opinions. In my case my commitment was voluntary, but I did not understand that what I was signing was other than an "I agree to talk to the doctor and I do so of my own free will", there was nothing on that paper that indicated that I would be deprived of shoelaces and belt and placed on a locked ward and held for a couple weeks -- I just figured I'd talk to the 'nice doctor' for an hour and we'd argue about Freud and potty training and whether my writings were brilliant insights or if instead my excitement over them was misplaced blah blah blah, and then I'd go back to my classes and the folks I'd upset would quit bugging me to talk to the shrinks about it.

PART of the problem is that the psychiatric system doesn't have a good protocol for admitting and treating someone who is upset and mentally scrambled from horrible things that have happened to them in real life, but that's where they get taken nonetheless. So people with a nine-year history of childhood sexual abuse and survivors of Bosnian concentration camps get diagnoses bipolar or depressed or schizophrenic. Yet these are supposedly diagnostic categories for people with organic brain dysfunctions -- sloppy sloppy sloppy sloppy!!! Indeed, the inter-rater reliabilitiy of psychiatric diagnoses is right around chance level (i.e., if two doctors independently assess a person without knowledge of the findinds of the other, chances are no better than a roll of the dice that the disgnoses will overlap even in broad categories). Small wonder that so many folks in our movement do not believe "mental illness" exists as a genuine physiological phenomenon at all!

I've mostly been inclined to think maybe it does, that there is a "difference in wiring" that makes one more likely to end up with the psychiatric diagnostic label, although I also believe that anyone can go into the mental state called "schizophrenia" or the one called "depression" under the right set of circumstances (and no I'm not confusing the blues with depression).

Look, folks. We have been told we are different, and that our difference justifies your doctors treating us in ways we don't necessarily want to be treated, because our difference is an "illness". And certainly there are many of us who wish we were normal and also say that it is an illness. In 1961, you would have heard very very similar things being said about (and by) gay people. Would you, in 1961, have said "No, no, it's a difference and it's biological in nature and real and all that, but it's not an inferiority and certainly not a disease, and unless they want to be changed and made 'normal', it's not our place to try to normalize them" -- ??

No, I think if you are honest, most of you would say that you would not have been able to say that in 1961. (Some of you clowns will say that's because you weren't alive in 1961. You know damn good and well what I mean ;)). You would not have come to think of gay folks in that way until there was a movement which expressed this viewpoint along with some justifiable anger and liberationist outrage.

That's why we have a movement. Grant that we may enjoy at least a modicum of the success attained by the gay rights movement. I'd like to start with the sophisticated people who constitute this board.

That includes you folks who go to psychiatrists and benefit from what they provide you. We need to come together in such a way that we are not speaking for you and you are not speaking for us. Or rather in such a way that we remember to speak for each other's contingent when we do speak. I said "the difference becomes a disability only when, on an individual basis, we find it to be one". When one finds it to be a disability, one is entitled to receive the special care and considerations due to other disabled people, where special provisions must be made in order to maximize their ability to participate in society, but without a mantle of CRIPPLED draped over your head as a consequence. To have autonomy held in the highest regard. To receive treatment in the least restrictive setting. To have access. To have insurance companies told that they cannot deny you the treatments needed to be able to function in society. And to have a consumer voice.

[Guinastasia]

Perhaps a professional can clarify, but I HIGHLY doubt someone could have me committed, based on my postings at the SDMB.

Look, if you want an easy-answer, I don't have one. IANAP.

[AHunter3]

They could. You, and Polycarp and me and Spooje and Manhattan and Anthracite and Exprix and anyone else. Why not? There's absolutely nothing keeping a psychiatrist from doing so aside from their own perspectives and beliefs as they apply to "mental health and mental illness". (They do need the concurrence of a second psychiatrist in most jurisdictions, but you'd be amazed at how akin to a rubber-stamp these little professional mutual back-scratching concurrence-evals tend to be. Or maybe you wouldn't, I don't know.)

[Guinastasia]

Perhaps then, you could show me a cite?

[Primaflora]

Guin, why are you getting so defensive? FWIW I'm totally in agreement with AHunter3. I know that last year if I had not been alert and respectful of my partner's boundaries and rights I could have had him committed. I had a psychologist who was scared of what she saw when she saw the two of us the day he went off the air, it would have been very very easy for me to have him committed. I do believe that if some 'concerned' person were to use our posts on the SDMB as support for their POV, it could lead to involuntary hospitalisation.

My kid was nearly committed last year after he had a reaction to zoloft. If he had been, I would have lost parental rights for the period of time he was in the psych unit. I'm not sure how that would have translated in terms of what input I had into his treatment. The psych nurse who first assessed us was pushing to find out what kind of abuse I'd been dishing out to my kid and she really really wanted him in the unit. The doctor decided not to admit him as by the time we waited in the ER, P the E had calmed down considerably. If we had been seen an hour earlier, when he was raving and hearing voices and attacking me physically, relentlessly I'm sure he would have been committed and probably assessed as bipolar.

[AHunter3]

Cite (http://makeashorterlink.com/?E19D32305
):
Although HHC eventually prevailed in showing dangerousness or potential harm, it should not have been necessary under the parens patriae standard under Section 9.27. All HHC would have had to prove was that Ms. Boggs would have benefited from proper care and treatment and does not realize her condition of mental illness

Cite (http://makeashorterlink.com/?M2BD12305):
Under the Fifth Standard that Wisconsin advocates secured in 1995, a person can be placed in treatment if a court finds a substantial probability that "if left untreated," he or she will "lack services necessary for his or her health or safety and suffer severe mental, emotional or physical harm that will result in the loss of the individual's ability to function independently in the community or the loss of cognitive or volitional control over his or her thoughts or actions.

Cite (http://www.namiscc.org/newsletters/May01/forced_treatment.htm):
As a mental patient of some experience, I can sadly report, that I have been committed , 1) upon the phone call of a wife to my therapist, (Alameda Co. '89) 2) by being driven around Fresno, Ca. from hospital to hospital, by a tactless parent; until "taken in", ('90) and 3) diagnosed over the phone as "a threat to myself", and ordered to drive myself to an emergency room for processing and commitment, (Kings Co. '91).

Cite (http://www.cchr.org/elderly/hdico.htm):
1. Emergency detention is the fastest and easiest method of commitment and is used most often because it circumvents the judicial process and therefore deprives the person of nearly all rights. It is "the predominant commitment route in many states, especially major cities," according to a 1984 survey of 20 state's laws and it is "often used even when no emergency actually exists." Community psychiatrists or mental health practitioners only need write a statement with "facts" showing why a person should be admitted.

2. Non-judicial commitment differs from emergency commitment only in that it does not require immediate capture and detention of the victim. A psychiatrist examines a person and certifies, in writing, that hospitalization is required. A judge then reviews the paperwork for authenticity and signs the authorization for involuntary detainment. The individual is not present at this transaction and therefore has no right to defend him or herself--it is merely a rubber-stamp procedure.

Cite (http://www.rodneyyoder.net/advocacy/2002-08-19+Madness.pdf):
To quote my friend, Jerry Boswell, executive director of the Texas division of the Citizens Commission on Human Rights: "How does involuntary commitment occur? In two words, "very easily"." (2) The fastest and easiest is emergency detention. In Texas, this is called an order of protective custody (OPC) which provides for a 72 hour "holding period" for observation, purportedly to determine whether a patient is dangerous to self or others (despite the well established fact of psychiatry"s incapability of predicting violence). Cindy was detained on Sunday night. Her "probable cause" hearing was scheduled for Thursday morning " a judge, not a jury " would decide whether the state hospital could hold her another week before a second hearing would be held for the judge to decide whether to approve a 90-day incarceration. I visited Cindy again the next day (Tuesday) and found her very heavily sedated (zonked); she had been forcibly injected with Atavan, a powerful tranquilizing drug, ostensibly for "non-cooperation." "Non-cooperation" is used by psychiatry to justify force. It, in fact, means force because only those who don"t want the "treatment" and express it are forced to receive it.


I'm not finding a good link for the "second shrink's opinion tends to be a bit of a rubber-stamp" part, but I could ask around for one.

As for cites backing up my assertion that you and I and the other people I mentioned could be committed, will quotes from a few Pit threads do?

:D

[Guinastasia]

Ah, but soully, without actually meeting the person in, well, person?

I can't see it. Now, if you're saying it's easy to commit someone, well, I'm sure it is. However, I would think they'd at least have to see me, or have some interest in me. I can't see some doctor reading my posts at random and suddenly saying I need to be committed.


The thing is, what scares me is that this reminds me of those "Pro-Ana" sites. IANBP, but I am Obsessive-Compulsive. I know what depression is about. Treatment isn't about changing who I am-it's about fixing a chemical imbalance in my brain.

[lekatt]

So much pain and suffering in this thread. Can make a person sad reading about it. This is a really major problem today. Science has promised to cure depression, but it evades them still.

Maybe a different perspective or course will help. I believe these problems can be helped and even cured through behavioural and/or belief changes. Sometimes the simplest method is the best. When I was working through fear I used affirmations. It took a while, but persistence paid off.

What we try to do with the affirmations is get a larger picture of things. We are like walking around in a maze, thinking there is no way out, but if we can raise our position a bit we can see the whole maze and its exits. That is what affirmations and other studies do. The fear people hold weighs them down, when the fear is released through forgiveness, non-judgement, affirmations, etc., they will just naturally be able to see those exits.

I hope all the posters won't feel they are above and beyond trying such a simple process. It has been a help to many. Affirmations will take about a month to notice a difference and a year to effect real change. They should be used while reading some good self-help books. If you want things done in this world, you just got to do them yourself, others can point, but you must do the walking.

I wrote the affirmations on the link below and can attest they have helped many, including myself. But you can make up your own as long as they are positive, or search the web. Lots of affirmation sites on the web.

http://ndeweb.com/Affirm.htm

On the web:
http://www.affirmation.com/

Hope this is of some help.

[AHunter3]

GuinastasiaI can't see it. Now, if you're saying it's easy to commit someone, well, I'm sure it is. However, I would think they'd at least have to see me, or have some interest in me. I can't see some doctor reading my posts at random and suddenly saying I need to be committed.

Naah, me either, thank God :)

But now suppose you had a roommate who had decided that your immersion in this 'board' thing was unhealthy, and that some of the things you'd shared with 'total strangers' or 'the whole friggin world of internet users' seemed awfully risky and self-destructive (cuz like isn't that how people get killed and raped these days? stalkers from the internet, right?), and your concerned roommate contacted a university-affiliated psychiatrist and gave the psychiatrist the URL? Possibly a different story.

Even then they'd generally have to meet you first, although they might have their mind already made up.

I don't want to be guilty of exaggerating the risks and dangers here. (A bit of unnecessary painting of lilies that would be!)

[Zoe]

b]lekatt[/b]:

Maybe a different perspective or course will help. I believe these problems can be helped and even cured through behavioural and/or belief changes. Sometimes the simplest method is the best. When I was working through fear I used affirmations. It took a while, but persistence paid off.

Would you suggest this way of coping to someone with diabetes? a brain tumor? Parkinson's Disease?

letkatt, I believe that your suggestions come for your compassion and your experiences. I am familiar with affirmations and there may be much to be said for them. Learning to stop the negative self-talk has also been helpful in coping with ups and downs in general. I believe in positive thinking and in working on my attitudes.

But in my situation we are talking about a commonly terminal illness. Sometimes I am not even "present" in any mental way. We (my husband, my psychiatrist, and I) refer to it as "going away." That's sometimes what I do when I am having a bout of major depression. (Most of the time I have chronic, low grade depression that allows me to have more contol.)

During major depression, I don't "feel" much of anything. Just numbness.


Many of us who have the illness known as "depression" hope that some day people will stop telling us to cheer up and actually read about what depression really is.

From the National Institute of Mental Health: http://www.nimh.nih.gov/publicat/invisible.cfm

"Research Findings:
Brain imaging research is revealing that in depression, neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly, and that the regulation of critical neurotransmitters is impaired. 10
Genetics research, including studies of twins, indicates that genes play a role in depression. Vulnerability to depression appears to result from the influence of multiple genes acting together with environmental factors. 11
Other research has shown that stressful life events, particularly in the form of loss such as the death of a close family member, may trigger major depression in susceptible individuals. 12
The hypothalamic-pituitary-adrenal (HPA) axis, the hormonal system that regulates the body's response to stress, is overactive in many people with depression. Research findings suggest that persistent overactivation of this system may lay the groundwork for depression. 13
Studies of brain chemistry, mechanisms of action of antidepressant medications, and the cognitive distortions and disturbed interpersonal relationships commonly associated with depression, continue to inform the development of new and better treatments.

I wish they would change the name so that people don't just think we are just down in the dumps or depressed about something.

AHunter3, I understand better now where you are coming from. Both of us would like to destigmatize our situations. We seem to come at it from opposing directions, but at least I hear what you are saying now.

Hospitalization has been a positive experience for me except in the 1960's. I am grateful that they take away those things with which I might hurt myself. I can just "be" for a while until I am able to actually think. And other patients are so kind and funny to talk with. But I can understand how it is not a good situation for those who are getting poor care or who do not want help.

BTW, I have not had to be hospitalized since June of 1995. I have terrific support and understanding from my husband. Short monthly sessions with a psychiatrist and medications have been a God-send.

[Guinastasia]

lekatt-depression, by it's very nature, does not PERMIT one to make an "affirmation."

[AHunter3]

:) peace, Zoe

[MsRobyn]

AHunter3, I'm glad you brought up some of these points.

In the past, it was very difficult for me to find a suitable counselor. My family is Jewish, and there were some cultural issues that a non-Jewish therapist would find abnormal if not pathological. I've also found the converse to be true; that is, a therapist can operate under some major misconceptions about a person's culture.

I've also had the misfortune of being "ordered" to go into counseling as a young-ish (maybe 9 or 10) child. I was being bullied constantly by a group of older boys, and found the only way to make it stop was to bring a razor blade to school, with the intention of using them. These boys were bigger than I was, and they reinforced it by physically assaulting me. Since I knew I'd be the one to get into trouble if I fought back, I didn't bother until I brought the blade.

My point is, the therapist I was forced to see turned the situation back onto me. It wasn't the boys' fault for beating the snot out of me; it was my fault for being such an attractive target. Imagine the messages I got from this. I grew up feeling that I was odd, and that odd is bad. (Now that I'm older, I don't care how odd I am, because it doesn't matter.)

So, it's important to "audition" therapists to find one who's going to work for you.

Robin

[Ludovic]

Originally posted by AHunter3

Look, folks. We have been told we are different, and that our difference justifies your doctors treating us in ways we don't necessarily want to be treated, because our difference is an "illness". And certainly there are many of us who wish we were normal and also say that it is an illness. In 1961, you would have heard very very similar things being said about (and by) gay people. Would you, in 1961, have said "No, no, it's a difference and it's biological in nature and real and all that, but it's not an inferiority and certainly not a disease, and unless they want to be changed and made 'normal', it's not our place to try to normalize them" -- ??

No, I think if you are honest, most of you would say that you would not have been able to say that in 1961. (Some of you clowns will say that's because you weren't alive in 1961. You know damn good and well what I mean ;)). You would not have come to think of gay folks in that way until there was a movement which expressed this viewpoint along with some justifiable anger and liberationist outrage.


How do you know that? How come you know that YOU are the only sensitive one here? Oh sure, YOU recognize there is a current injustice no one else sees, but NO ONE here would have recognized the injustices in 1961, because we ALL FELT THE SAME BACK THEN.

Look, I have plenty of distrust of forced committals, especially those that impose a financial burden on the committed, but to say that I myself don't hold views that will be considered cutting-edge for my time, nor would I be able to see the inherent skewedness in another age, is a big assumption.

[AHunter3]

How do you know that? How come you know that YOU are the only sensitive one here? Oh sure, YOU recognize there is a current injustice no one else sees, but NO ONE here would have recognized the injustices in 1961, because we ALL FELT THE SAME BACK THEN.

Huh??

I make no claims for being gifted with spectacularly unusual & empathic insights. I happend to understand the schizzy lib stuff because I'm on the receiving end of the shit, not because I'm more sensitive than thou. In 1961, the people who got it about homosexuality would have been almost exclusively gay themselves, but because of the movement and its message a considerable portion of the rest of us get it too -- nowadays.

But sorry if I've offended you. I think.

And why "especially those that impose a financial burden on the committed"? That's like deploring the activities of Pol Pot because he caused so many families to lose their farms and cattle, isn't it?

[Zoe]

Peace, AHunter3! :)

[Ludovic]

Originally posted by AHunter3

And why "especially those that impose a financial burden on the committed"? That's like deploring the activities of Pol Pot because he caused so many families to lose their farms and cattle, isn't it?

I knew I'd be called on this. What I mean is that, despite the fact that forced committals are nasty no matter what, there will still be people who will benefit by it, either patients whose lives were saved, or victims of patients who would have been harmed by them. So, in essence, one must balance liberty versus safety, and I am not sure which side to lean on*.

On the other hand, when money comes into the equation, you have the double effect of depleting the resources of the patient while at the same time creating an incentive for the psych. community to "diagnose" as many people as possible, for financial gain. Now, if the diagnosis is incorrect, the patient AND their insurance company should NOT have to pay, someone else should, most likely the facility or the government, then the facility could sue, if they wanted to, the person who called the person in to recover damages from the frivolous committal.

*Although I am sure that probably the police, perHAPS psychologists, and definitely not judges should be the ones to decide if someone is criminally dangeous, since the police are the ones who deal with acts of non-psychologically disturbed violence.

[MsRobyn]

Originally posted by Ludovic
On the other hand, when money comes into the equation, you have the double effect of depleting the resources of the patient while at the same time creating an incentive for the psych. community to "diagnose" as many people as possible, for financial gain. Now, if the diagnosis is incorrect, the patient AND their insurance company should NOT have to pay, someone else should, most likely the facility or the government, then the facility could sue, if they wanted to, the person who called the person in to recover damages from the frivolous committal.


In point of fact, Ludovic, this is a lot less likely to happen now than it used to.

In the Seventies and Eighties, there was such a profit motive to mental-health services that psychiatrists were holding people against their will purely for the money these patients' insurance would pay. And the insurance companies, for their part, were complicit in this abuse, because they'd pay whatever the hospitals demanded without question. Got a kid who got caught once with a pill? He's an addict, get him into a six-week rehab program. Who cares about the cost; the insurance company will pay, and we get credit for another patient. Makes the bottom line look good for Corporate, dontcha know.

As a consequence, insurance companies stopped covering mental health services as comprehensively as they once did. Services were severely restricted; some patients couldn't get help at all.

Now, the pendulum is somewhere in the middle. New laws have helped patients get access to mental health services, while demanding accountability from therapists and hospitals to justify their decisions. An insurance carrier can (and often will) ask for information to justify lengthy courses of counseling (in the form of progress notes). Inpatient care now requires precertification to make sure that is the best course of action for the patient.

In Pennsylvania, where I live, an insurance carrier MUST cover at least 60 outpatient or office visits AND 30 days of inpatient care. (This is Act 150.) The patient can swap 1 inpatient day for 2 outpatient visits. However, as I said, the carrier can refer a patient to Case Management to make sure their dollars are doing something for the patient besides of fattening a shrink's wallet.

Robin

[AHunter3]

Well, I acknowledge that there are financial issues. I usually think of them as being in the "insult added to injury" category, like Linda Andre who was charged for the electricity used to give her involuntary electroshock. More often than not, insurance companies eat it, and some hospitals are notorious in our community for suddenly determining that stabilization has occurred right around the time the insurance benefits run out.

The biggest economic/financial damage done by psychiatry is loss of housing: you're not dirt poor perhaps but paying your monthly rent eats up a big part of your monthly income and then POW you get committed, and then if you're reasonably lucky you get your tongue out of the gears of the system only to find out that eviction proceedings were started while you were locked up because you weren't paying your rent. You may in fact be homeless, or you may end up that way after not much longer. And then of course people will say you're homeless because you're mentally ill. (Certainly some people are indeed homeless as a direct consequence of their mental condition, but there are also a lot of homeless people who have pyschiatric intervention to thank for the loss of their rental situations).

What I mean is that, despite the fact that forced committals are nasty no matter what, there will still be people who will benefit by it, either patients whose lives were saved, or victims of patients who would have been harmed by them.

No, I don't buy that. Who benefitted when Leonard Roy Frank was committed?

I think it is still statistically true that we (people who have been labeled "mentally ill") are no more likely to assault people than folks not so labeled, and furthermore that the psychiatric profession has not shown itself to be an accurate predictor of future dangerousness. You could not have been reading my posts if you still think that when involuntary commitments occur "there will still be people who benefit from it".

There may now and then be involuntary commitments that benefit someone. That's not sufficient reason for them to continue to exist.

Before psychiatric treatment is forced on a person who doesn't want it, it should have to be proven that the intended recipient is incompetent according to the legal standard thereof, without reference to psychiatric diagnosis. (i.e., whether I am a schizophrenic or not is completely irrelevant -- to force treatment upon me it should be necessary to show that I'm incapable of making my own decisions and that I am in need of a guardian, as if I had late-stage Alzheimer's or something).

[ambushed]

It seems to me that perhaps even sven and a few others are failing to sufficiently consider and empathize with their loved ones and others with whom they come into contact. Everyone I know personally who suffers from bipolar disease is surprisingly egocentric when it comes to analyzing the impact of their illness and their decision to take medication or not, almost always focusing far more on how they feel about it than the effects of their medically uncontrolled disease on others.

In one truly sad case, the wife of someone suffering from bipolar disease killed herself apparently out of the extreme anguish and frustration and sense of failure she experienced because she couldn't manage to get through her husband's "selfishness shield" wherein he refused to take his meds because he didn't like how he felt on them, regardless of the huge cost he was making her pay in terms of the incredible emotional and financial stresses his illness brought upon the marriage.

In my experience, this is an all-too-typical dynamic. The sufferers I've known who elect not to take their medications consistently give far too little regard to the costs of their selfishly anti-medication stance on their loved ones and friends and coworkers, essentially expecting them to yield their own happiness to the happiness of the sufferer. This is just one of the consequences of the phenomenon discussed earlier in this thread whereby the illness in the absence of medication results in making the sufferer exceptionally susceptible to very poor judgements regarding their own treatment.

It is for such reasons that I can't help agreeing with those posters who've expressed similar thoughts -- and as I've suggested in the past after the mentally ill brother of a friend of mine viciously murdered his own mother with an axe after deciding that he didn't want to take his medication any longer -- that there's a vital societal interest in isolating (even forcibly, if necessary) those among the seriously mentally ill (which ordinarily wouldn't include depressives or the bipolar), who would otherwise present low risks to society as long as they continued to take their medication but nevertheless refuse to do so. I'm a strong advocate of expansive civil liberties, but I'm an ever stronger advocate of the most basic civil liberty of defending life itself from those who are unable to control their own behavior due to their mental illness. (I'm glad to see some support for this idea in this thread. When I expressed this same idea some time back, I was roundly condemned as a malevolent "enemy of civil liberties")

[even sven]

So I should drug myself so that I don't bug anybody?

No. If I am going to change my brain, your damn right I'm going to be concerned about what it will do to me. Because my brain is all I got. It's who I am. It's me. And I really don't care what my mom, or aunt Susan, or my next door neighbor thinks I should do with my brain. If you could change your brain to make you more likable and easier to be around, would you do it? Of course not. You probably have the same standards for mucking around with your brain chemistry as I do- which is that there better be a damn good reason to.

This is exactly what I get upset about. I'm sorry it's so inconvient that I'm crazy. I'm just...you know...trying to figure out the essense of self, the meaning of life, the role of myself in society. I know it makes your luncheon a bit uncomfortable when I'm grappling with these issues instead of complimenting your cucumber sandwiches. I'm glad you like the life you've got going for you. Theres times that I'm not too thrilled with mine. But I really don't think the automatic solution is for me to change myself so that I'm happy with your life, too. I'm still thinking about it. Still trying to work things out. I may never mesh seemlessly with the rest of the sane world. I've got some pretty fundamentally different ideas about reality. And I'm not convinced that they are wrong just because they arn't what everyone else thinks.

I'm not saying that my way is any better or any worse than yours. But it's the way I've been given and the life I know. I won't actively hurt anyone. I'll work my hardest never to have dependents, and if that should happen I'll realize that I have responsibilites that extend beyond myself. I will always strive to be honest and earnest about the things that I do. But in the meantime, I'm not going to swing my whole world around just so that I don't ever run the risk of causing a scene now and then. There are some things that are more important than keeping the status quo, like being true to oneself, even if that self.

[even sven]

....errr....

even if that self is a little nutty.

[ambushed]

Yikes!!

Thank you for demonstrating with all-too-disturbing candor the truth of exactly what I was talking about.

[ambushed]

You mean, "Screw my loved ones and everyone else if they don't slavishly bow to my selfish need to do whatever the hell I want," eh?

[AHunter3]

How about we put the normal ones on enough tranquilizers that our egocentric and eccentric behaviors no longer upset them and drive them to suicidal acts?

This fellow ambushed is looking rather upset to me, and given his state of mind and his sentiments, I fear that he might try to assault one of us. What do you think, even sven? Do you concur?

Come now, mister ambushed (hee hee hee gotta love it, perfect screen name for the situation). It's for your own good, you'll be less upset. And even if that isn't entirely true, you'll be less upsetting to us...

[Ludovic]

Originally posted by AHunter3

I think it is still statistically true that we (people who have been labeled "mentally ill") are no more likely to assault people than folks not so labeled, and furthermore that the psychiatric profession has not shown itself to be an accurate predictor of future dangerousness. You could not have been reading my posts if you still think that when involuntary commitments occur "there will still be people who benefit from it".

There may now and then be involuntary commitments that benefit someone. That's not sufficient reason for them to continue to exist.

Before psychiatric treatment is forced on a person who doesn't want it, it should have to be proven that the intended recipient is incompetent according to the legal standard thereof, without reference to psychiatric diagnosis. (i.e., whether I am a schizophrenic or not is completely irrelevant -- to force treatment upon me it should be necessary to show that I'm incapable of making my own decisions and that I am in need of a guardian, as if I had late-stage Alzheimer's or something).

You must not have been reading my posts when I said that a person should be held as a legal danger to others or themselves, rather than per a psychologist's opinion. Since the only reason to hold people involuntarily is for safety, and legal authorities (i.e. cops) are the ones most experienced in safety from the non-psychiatric standpoint, it stands to reason they are the most competent in determining an individual's danger, period. The only downside is that they, too, could be in some cases too rash to commit someone out of fear of bad PR if that person is indeed dangerous, but they have to deal with that sort of pressure anyway in their everyday dealings with people. IMO they arent perfect but they have more experience.

In other words, a situation needs to be pretty close to a situation in which you'd call the cops, anyway, regardless of mental condition, before I would acquiesce to forced committals. But doesnt mean I want to do away with them altogether.

[MsRobyn]

Originally posted by Ludovic
You must not have been reading my posts when I said that a person should be held as a legal danger to others or themselves, rather than per a psychologist's opinion. Since the only reason to hold people involuntarily is for safety, and legal authorities (i.e. cops) are the ones most experienced in safety from the non-psychiatric standpoint, it stands to reason they are the most competent in determining an individual's danger, period. The only downside is that they, too, could be in some cases too rash to commit someone out of fear of bad PR if that person is indeed dangerous, but they have to deal with that sort of pressure anyway in their everyday dealings with people. IMO they arent perfect but they have more experience.

In other words, a situation needs to be pretty close to a situation in which you'd call the cops, anyway, regardless of mental condition, before I would acquiesce to forced committals. But doesnt mean I want to do away with them altogether.

Look at your own reasoning, in light of what I'm about to say.

Cops aren't clinicians. They aren't trained to recognize psychopathological behavior; they're trained to recognize criminal behavior, which is as it should be. Someone who is behaving consistently with mental illness may not be breaking any laws, yet they may still be a danger. Since they're not breaking laws, the police are powerless to intervene. There have also been situations where mentally ill people were killed or severely injured because the police did not know how to deal with them.

Which brings us back to the issue of having a psychiatrist certify a commitment. Psychiatrists and psychologists are trained to recognize psychopathology; it's what they do. True, there may be a profit motive to committing people, but this is easily solved by removing that. It's not that hard to do; all the law has to do is specify that the psychiatrist authorizing the commitment must have no financial or other relationship with the patient.

Robin

[Guinastasia]

even sven, that's fine. However, say someone with bipolar disorder has a child. Said bipolar refuses to take her meds, yet without them, she cannot care for her child properly, and refuses to let someone else care for the child.

Is THAT right?

Mental illness DOES have a lot of stigma attached to it, and that's one thing I get so angry about, practically on a daily basis. I have Obsessive Compulsive Disorder. I can't change that. It's there.

But my disorder is not who I am. It's something that has an adverse effect on my life, and I can't function without medication. I don't like having to take my meds-but I do anyways, because otherwise, I'm a wreck. And that's not fair to myself, or my loved ones. The main reason this sticks in my craw is because for ages I've had people tell me I don't REALLY need my meds, and I should go without them. And when someone else says that Oh, meds are just to drug someone into submission, that pisses me off. Because that's NOT true.

We're not talking about someone asking you to cater to THEM, we're saying-if your actions are having a negative effect on those you care about-and you (generic you, not YOU, personally) refuse to change that-what does that say?


If a person cannot function in society, without medication and/or treatment, but refuses to get that treatment, then that person should not expect everyone else to cater to him/her.

However, I do think ambushed is rather harsh. I don't think those of us who have a mental illness and/or disorder are any different from someone with a physiological illness who needs treatment.

[AHunter3]

Ludovic, would you want police officers to have the authority to arrest and detain you if that police officer happened to hold the opinion that you might do something dangerous? Wouldn't you prefer it to be the case that the police officer can only arrest you if the police officer is going to charge you with a crime, and that you have some protections against false arrest? Is there anyone on this board who -- without reference to the presence or absence of psychiatric diagnoses -- thinks the public good would be well-served if police officers could arrest anyone at any time on the basis of thinking that the person is dangerous and might do something violent?

Put those hands in the air. Higher, so I can count them.

All right, now the rest of you: justify treating someone different on the basis of alleged psychiatric condition. If I'm a law-abiding paranoid schizophrenic with delusions of grandeur, why the fuck should I be subject to detainment and arrest (let alone forced psychiatric treatment!) just because some grandiose personage with delusions of omniscience thinks I might do something?

I should not be held responsible for what you, some cop, or some shrink thinks I might do.

If I engage in an arrestible action -- an action that would be arrestible if any John Q Citizen engages in it -- then you get to intervene. That would include making threats.

If you think I might hurt myself as a result of being incompetent, start a guardianship proceding and me and my lawyer will be present to contest your allegations. If it's an emergency -- i.e., I'm climbing bridges or apparently trying to hurl myself out of windows or something -- the police have the authority to intervene immediately.

Aside from those rather narrowly constructed responses, though, your opinion of my mental processes should not count for much.

And the presence of an MD and a specialization in psychiatric medicine on your resume shouldn't change that.

[Guinastasia]

I have to ask-what happens then when someone IS a danger to him/herself and/or others?

[AHunter3]

Let's pretend my next-door neighbor is. (dangerous, I mean) What happens next is he acts on it, or he threatens to; or else he doesn't.

If he doesn't, the world keeps spinning on its axis and nothing in particular happens. My next-door neighbor may be, as Ian Anderson once put it, "eyeing little girls with bad intent", perhaps from his apartment window, but insofar as he hasn't done anything yet (not even downloaded kiddie porn as far as we know), we don't do anything, even if both you and I are convinced that Mr. Neighbor is Evil in the Making®.

That's the American justice system, that's its basic premise. We intervene when people actually do something, in order to stop them from doing more of the same; but we do not intervene when we think someone might do something.

So if what happens next is that Evil Neighbor confronts some little girls and asks them things like if they've ever seen an adult guy's parts, maybe that's enough to take some action, yes? I'd think at least an Order of Protection making it a crime for him to approach them again, and now we can open a file on the dude. Mister Child Sexual Abuse Waiting to Happen, we got your number. As of yet, though, I doubt that he's committed an arrestible crime.

That's the gist of it with regards to "danger to others".

Danger to self works a bit differently. It is a victimless crime but common law says you dont have an unimpeded right to bleed all over my rug or litter up the streets or rivers with your corpse, and that you or I or Society in the form of its uniformed representatives are within our rights to intervene if you threaten suicide or engage in action that looks rather specifically geared towards killing yourself.

But suppose we're worried about Joseph, the young 20something guy down the block. He seems to have a death wish. He's joined one of those clubs where folks climb trees and mountains using ropes and not much in the way of safety equipment, he rides a motorcycle in rush hour city traffic and weaves in and out of lanes, and perhaps more to the point in conversations with us at parties and such he says provocative things about preferring to live a short electrically charged life full of risk and dare because whenever he is safe he is so bored that the prospect of remaining alive for years to come makes him wish he were dead.

What comes next is, he either does something overtly and immediately self-destructive like playing Russian Roulette with a loaded revolver or he doesn't, and if he doesn't we don't get to intervene against his wishes. (We can berate him and plead with him to take some safety precautions, that's about it).

Then there's Tom who is walking out into the midst of the West Side Highway and attempting to lay his hands upon the hoods of the rushing cars and says he is "blessing" them, which would seem to constitute "danger to one's self", don't you think? We can call the police to get him out of the road (or drag him to the curb ourselves if we're so inclined) and if this kind of thing happens often we can initiate a competency hearing to see if he is so out of touch with reality that he meets the legal criteria for "lacking capacity". If he doesn't, though, he's in a grey area and what happens is that we err on the side of respecting his right to make stupid judgments and engage in silly behaviors as long as it seems that he knows what he's doing and understands the risks and issues.

How about Laura, though? She's extremely nearsighted but refuses to wear her glasses, and fumbles around when she travels, needing to get within inches of signs to read them and otherwise has to ask questions of strangers; when we last went to visit her, she was lying face down in the garden in back of the house. Later the same evening, she says she is profoundly unhappy about something but won't tell us what, and she asks you to step on her chest and put nearly your full weight on it because it makes her feel better because it matches how she feels inside. Oh, and she has something she wants to show us in her room, and when we go to her room it looks like she has every piece of paper she's ever owned since she was in 3rd grade lying in piles on the floor, and she crawls around blind as a bat on her floor peering at different piles until she comes up with a petition she thinks we should sign. And she has lots and lots of clothing, some folded in piles and some kind of wadded up, also on the floor, along with some blankets and pillows and it looks like she sleeps on the floor too. She has this really intense way of talking, like she's coldly angry, talking very fast and clipped and moving from one subject to another often with very little warning. Oh, and she has a psychiatric history but is not taking any medication and does not see a psychiatrist. She says they try to poison her. What do you think we should do about her?

What I did was work with her and try my best to keep up with her, as she is one of the hardest-working and efficient leaders in the movement. She's one of us and this is how she is and she is entitled to be left alone. Protection and advocacy groups and conference leaders and workshop leaders in the movement all across the country and internationally know of her and her work.

[j.c.]

even svenSo I should drug myself so that I don't bug anybody?

We don’t care how you accomplish that goal. The discussion starts when the bugging won’t stop. Change the way you behave, seek talk therapy, take drugs, cook up some weird delusion were you “pretend” to be someone else 24-7. As long as you’re not bugging anyone, the issue of your brain isn’t going to come up.

If you are, in fact, “bugging” anyone, and cannot respond to their dialog about please stop the bugging, then eventually, people are going to stop expecting you to stop the bugging on your own, and find some other way to end the bugging.

(As far as I know, you, even sven are not currently bugging anybody. Just using “you” as an example of how to deal with a bugger.)

AHunter3She has this really intense way of talking, like she's coldly angry, talking very fast and clipped and moving from one subject to another often with very little warning. Oh, and she has a psychiatric history but is not taking any medication and does not see a psychiatrist. She says they try to poison her. What do you think we should do about her? This is what I think you should do about her: You should teach her to understand that if the way she talks makes her seem coldly angry, and if she often jumps erratically from subject to subject, she can’t expect to be a popular conversationalist. And you might want to try and find out where she got the idea that she’s so important the shrinks feel the need to poison her.

[ambushed]

You play a fairly good game, AHunter3, but although you take considerable care to try to disguise your dogmatic Randian, ultra-libertarian let-the-dangerously-and-willfully-insane-do-whatever-the-hell-they-want ideology with polite-sounding rhetorical ploys, you're certainly not fooling me (although it's obvious you're fooling a lot of other posters).

I am myself on psychotherapeutic medications and -- quite unlike you and your foolishly libertarian, politically correct, ill-thinking fans -- I would demand that I be put into medical confinement if there were plausible indications that I might pose a physical danger to others, even without actually committing a crime first! And because -- also quite unlike you and your fans -- I have an intelligent respect for the rights and liberties of your potential victims, the same reasoning should be applied to others who present such a risk. It is utterly deplorable that you and your unthinking fellow travelers would clearly refuse to do the same.

Your rights do NOT -- or at least certainly SHOULD not -- come before the rights of others to be protected from people who are reasonably potential sources of violence because of their refusal to take medically reasonable psychotherapeutic medications.

You and sven are echoing the precise same sentiments and arguments as my friend's brother who chopped up my friend's mother into tiny pieces for no other reason than he refused to take his medications. In fact, even now -- after this vicious murder -- he is still making the exact same arguments that you're spouting!

Calling me insane for purely rhetorical purposes as you've quite insultingly done is by no means equivalent to a rational argument, no matter what your politically correct ultra-libertarian fan club thinks.

[Guinastasia]

Well, I suppose it's a case of "your right to swing your fist ends at my nose" sort of thing.

[MsRobyn]

Originally posted by Guinastasia
Well, I suppose it's a case of "your right to swing your fist ends at my nose" sort of thing.

What Guin said.

"Danger to self and others" isn't just physical violence. Someone can be a danger to self if they are unable to take care of themselves. Someone with paranoid delusions might refuse to bathe because they believe the water supply is poisoned, making life difficult for the people around them. Animal hoarders (there was a recent thread about this; I'm not going to tax the hamsters to find it) might live with so many animals, and the resulting waste, that their house might become a breeding ground for disease.

As for nonviolent danger to others, well, that's not hard to demonstrate, either. Mental illness causes people to do strange things. Verbal abuse, extreme financial irresponsibility, sudden disappearing acts (auntie em's co-worker comes to mind), poor-quality work all strain relationships, often to a breaking point. I once turned in a paper in college that was written in a rather, ah, manic phase. It was so incoherent that I flunked the course and had to retake it when I was a little more stable. Yeah, it was "only" a college paper, but what if it had been an important assignment at work? Does my right not to be medicated take precedence over my obligation to my employer? Does my right not to be medicated take precedence over my dependents' right to live comfortably and safely, free from financial insecurity and abuse?

Robin

[AHunter3]

MsRobyn:
Does my right not to be medicated take precedence over my obligation to my employer?

Sure. But your employer's right to have assignments completely coherently and in a timely manner sure as hell trumps your right to remain employed. So if you require medication in order to be able to function at work, you get to decide between meds and lack of employment. But it is your choice.

Does my right not to be medicated take precedence over my dependents' right to live comfortably and safely, free from financial insecurity and abuse?

Again, definitely. But your family's, and the state's, right to see to it that your dependents receive adequate care trumps your right to retain custody or remain married, etc. If you prefer being unmedicated to retaining custody of your kids or to having your spouse stick with you, you should have that choice. Oh, and to take away your kids they should have to prove actual neglect or maltreatment or parental incompetence, they should not be allowed to treat your choice of declining pysch meds as ipso facto indication that you are unfit to be a parent, and certainly not your status as a person with a psychiatric diagnosis.

[AHunter3]

Forcing someone to take mind-altering medications against their will is an incredibly cruel and invasive act, an assault on one's personhood that exceeds most physical assaults and in some cases exceeds outright killing.

I'd rather be beaten up than be psychdrugged with short-term medication, if the beating is something I could limp away from.

I'd rather be anally raped, knifed, and beaten up badly enough to require hospitalization than be psychdrugged with long-acting medication ("depo" shots, etc), if I could recover with no permanent disability or bodily dysfunction as a consequence.

I would suffer permanent disability including loss of limb, sight, or hearing in order to escape an ongoing administration of psychmeds with no end in sight, or electroshock, either one.

If my only choices were being permanently drugged up with psych drugs or an electroshock series or behavior-mod psychosurgery, on the one hand, or just being executed, I'd choose death.

Now...all I'm asking for is a straightforward extension of identical nondiscriminatory due process in cases where y'all think we are dangerous to others -- i.e., the same laws that apply to violence and assault that are applicable to so-called "normal" people; and a straightforward extension of identical nondiscriminatory due process in cases where y'all think we are a danger to ourselves -- i.e., the same laws that apply to senility and other mental incapacity when they strike so-called "normal" people.

And outside of those parameters, we have choices and choices have consequences and we live with the consequences of the choices we make.

This is Great Debates. Explain why the fuck it's OK to treat us according to different standards and subject us to different rules. Defend that. And as you do so, refresh your memory of my post on how easy it is for anyone to acquire one of these diagnostic labels, and keep in mind that when you defend this double standard you're effectively saying "It's OK to suspend normative due process as long as you first call someone 'schizophrenic' or 'bipolar' or 'depressed' ". And if you don't agree with that summary, explain and defend your dissent from it.

[Ludovic]

Originally posted by AHunter3
Ludovic, would you want police officers to have the authority to arrest and detain you if that police officer happened to hold the opinion that you might do something dangerous?

and this is different from the present state of affairs how?


Wouldn't you prefer it to be the case that the police officer can only arrest you if the police officer is going to charge you with a crime, and that you have some protections against false arrest?

as I have previously stated, if the detention is proved to be frivolous there should be consequences for the parties involved.


Is there anyone on this board who -- without reference to the presence or absence of psychiatric diagnoses -- thinks the public good would be well-served if police officers could arrest anyone at any time on the basis of thinking that the person is dangerous and might do something violent?

I think if anyone has that ability, it's police officers. Psychiatrists are too self-serving to do that. Because by committing all the crazy people out there they can look out and say "look at all the crazy people we need to be protected from!" Officers on the other hand, not being part of the psychaitric establishment dont have the incentive to find as many crazies. On the other hand they have experience in determining the dangerousness of a situation. There will of course be mistakes made, there always are.

It should be almost as difficult to force detention on psychiatric grounds as it is to arrest them for threats or the like. Which is what "they might do something dangerous" boils down to anyway. A threat from a supposedly sane person should be looked at the same as from a putative non-sane one.

I'll try to look up a cite for this later, but in a psychological book itself I read that 3 groups of professionals were asked their opinion of their ability to spot lies: psychiatrists, detectives, and, i think, teachers. All rated their personal ability above average, but besides, the detectives, all were merely average.

[AHunter3]

I'll buy that, or a lot of that. Problem is, some of us would like some protection against misuse of power by police officers, who in some jurisdictions and under some circumstances have been known to be less than clinically detached from every conceivable political or social issue.

I'd much rather see in writing what behaviors are officially "indicative of dangerousness", such that if you don't engage in them you can't be arrested or detained for being potentially violent. Citizens need to know where we stand and what our rights are, don't you think?

[Guinastasia]

AHunter3, what the hell? You'd rather be dead than have to take medication?

You know, I take medication. I have to. And I'm not "all drugged up."

[jsgoddess]

Originally posted by AHunter3
Forcing someone to take mind-altering medications against their will is an incredibly cruel and invasive act, an assault on one's personhood that exceeds most physical assaults and in some cases exceeds outright killing.


So, the father of a friend of mine lands in the hospital with heart failure and advanced emphysema. He starts saying people are trying to kill him, and pulls out his IVs and catheter, etc. and they start dosing him with anti-psychotics.

In your opinion, is this justifiable?

Julie

[AHunter3]

jsgoddess -- Short-term (emergency), based on physicians' assessment that his actions directly and immediately endanger his health, yeah, they can do that, and they can tie his hands. I already said that the laws of our land support intervention to keep people from doing things that represent and immediate and direct threat to themselves. If you draw a knife and make like you're going to slit your throat, expect people to try to stop you. That would include me. That's very very different from saying "In my opinion you've shown evidence of self-destructive decompensated behaviors that indicate that you are likely to do self-destructive things, and that therefore you need to be put on Prolixin whether you agree to it or not".

Guinastasia: Yeah. No one gets to play with my brain or its chemistry without my permission.

[lekatt]

I mostly agree with AHunter3.

I can remember when things like alcoholism, depression, anxiety, and other such things were considered behaviour problems even by the Doctors. That was before genes were being blamed for everything. I read that a gene has been found for dumbness.

Well, I am not sure what the causes are, and don't think it matters. I do know that some people I know got cured of these things by going to support groups, doing affirmations, reading self-help books and generally working with their beliefs and thoughts. I have never heard of anyone being cured of these things by medicine.

Just my observations and opinions.

Love
Leroy

[MsRobyn]

Originally posted by lekatt
Well, I am not sure what the causes are, and don't think it matters. I do know that some people I know got cured of these things by going to support groups, doing affirmations, reading self-help books and generally working with their beliefs and thoughts. I have never heard of anyone being cured of these things by medicine.

Just my observations and opinions.

Love
Leroy

Some people are helped by these things. However, in my 16-plus years of OA and AA membership, and exposure to NA, I have seen so much BS slung around as gospel fact. I'm talking unproven treatments completely based on anecdotal evidence, untested, and accepted on blind faith because the guy trying to sell it has initials after his name. I've seen articles by "counselors" who have numerous sets of initials, but no actual college degree and no supervised clinical training.

This is not to say that it's all crap. There are some good self-help materials out there. The problem is that a book isn't going to do for me what one-on-one counseling or meds are going to do. I don't care how good the book is.

Originally posted by AHunter3:
Again, definitely. But your family's, and the state's, right to see to it that your dependents receive adequate care trumps your right to retain custody or remain married, etc. If you prefer being unmedicated to retaining custody of your kids or to having your spouse stick with you, you should have that choice. Oh, and to take away your kids they should have to prove actual neglect or maltreatment or parental incompetence, they should not be allowed to treat your choice of declining pysch meds as ipso facto indication that you are unfit to be a parent, and certainly not your status as a person with a psychiatric diagnosis.

If the state is interested in my parenting ability, chances are I'm too unstable to be able to make the choice of whether I want to be medicated or not. If the state is investigating, there have already been signs of abuse or neglect. That's just the reality.

And, yes, there is such a thing as due process. I can't be considered a risk merely because I have a psych diagnosis. My doctor (who knows and treats Aaron) knows I have a psych diagnosis. It's in my medical record. So far, no one has even indicated a desire to call CPS. No one called CPS even when I wasn't taking meds. Why? Because there was no problem. Aaron was being well taken care of. He eats well, is always in clean clothes, and does not have signs of physical or emotional abuse.

Furthermore, any CPS caseworker who would consider removal on the sole basis that a parent has a psych diagnosis or isn't on medication, with no other indication that there is a problem should be on the receiving end of a court challenge, and they deserve to have their ass handed to them. Period.

Robin

[lekatt]

Originally posted by MsRobyn
Some people are helped by these things. However, in my 16-plus years of OA and AA membership, and exposure to NA, I have seen so much BS slung around as gospel fact. I'm talking unproven treatments completely based on anecdotal evidence, untested, and accepted on blind faith because the guy trying to sell it has initials after his name. I've seen articles by "counselors" who have numerous sets of initials, but no actual college degree and no supervised clinical training.

This is not to say that it's all crap. There are some good self-help materials out there. The problem is that a book isn't going to do for me what one-on-one counseling or meds are going to do. I don't care how good the book is.

Robin

One-on-one counseling is good if it helps. Reading books provides more input. There must be hundreds of self-help books out there. The more read, the better the understanding. I pay little attention as to whether an author has letters after their name and what those letters are. I read a book for its contents, by what it can say to me.

I really think the best way is support groups. Not the kind where you have one counselor and five patients. I like the kind where the group is composed of people who don't have problems with one that does. The understanding comes much faster.

I have participated in many spiritual groups, they are great for people having problems with life. When I worked at a hospital we had a support group mostly of health care workers. It was a great group and help many people to cure their own problems.

AA has a better record of success than any other alcohol program because it is run by the alcoholics themselves and they know what it takes.

The programs that work the best are spiritual programs, because spiritual concepts can change the way people think. I am talking here of spiritual not religious principles. If you have an aversion to spiritual things you can still use their principles to help with problems. The greatest principles being: forgiving yourself and others, holding a non-judgemental attitude toward others, and loving yourself and others for what they are, not as you think they should be.

http://ndeweb.com/info01.htm

The above is an article about coping with death, that might be helpful.

Mark Twain said:

There are people who believe they can
and
There are people who believe they can't
both are correct.


Love
Leroy

[jsgoddess]

Originally posted by AHunter3
jsgoddess -- Short-term (emergency), based on physicians' assessment that his actions directly and immediately endanger his health, yeah, they can do that, and they can tie his hands. I already said that the laws of our land support intervention to keep people from doing things that represent and immediate and direct threat to themselves.

My question is, do you agree with such laws. You said you'd rather be dead than drugged, so then I'd assume you don't agree with my coworker's father being drugged?

Julie

[Chief Crunch]

AHunter3, quoting the Scientology front group The Citizens' Commission on Human Rights (http://www.cchr.org) doesn't much help your argument.

[lekatt]

Originally posted by Chief Crunch
AHunter3, quoting the Scientology front group The Citizens' Commission on Human Rights (http://www.cchr.org) doesn't much help your argument.

Can't find any reference to Scientology on the web site.
Perhaps you could show us the info on this site being a part of scientology.

[Chief Crunch]

"Articles by L. Ron Hubbard" on the menu to the left? If that's not good enough for you, there's mention of them in this article (http://www.objectivethought.com/articles/scientology.html).

[AHunter3]

argument ad hominem, Chief Crunch. The fact that they have an ulterior motive doesn't make them wrong.

Umm, where did I quote the Hubbies? Is one of the cites I provided on one of their sites? (I hadn't noticed, but I might have included one of theirs when I was pulling together some references)

Or are you intending to imply that one or more of my own posts consists of materials taken from their writings? (not so, I write my own)

[Chief Crunch]

Originally posted by AHunter3
argument ad hominem, Chief Crunch. The fact that they have an ulterior motive doesn't make them wrong.

Umm, where did I quote the Hubbies? Is one of the cites I provided on one of their sites? (I hadn't noticed, but I might have included one of theirs when I was pulling together some references)

Or are you intending to imply that one or more of my own posts consists of materials taken from their writings? (not so, I write my own)

On page two, you throw up several citations. One of them links to www.cchr.org It certainly doesn't make it right, either, friend. Given Scientology's history, they don't quite have a record of honesty or integrity. Would anyone on this board dare quote Fred Phelps' site in an argument regarding homosexuality?

[AHunter3]

jsgoddess:My question is, do you agree with such laws [supporting emergency use of psych drugs]. You said you'd rather be dead than drugged, so then I'd assume you don't agree with my coworker's father being drugged?

If your coworker's father had a health care proxy or an advance directive or a living will or something of that sort that stated that he (now) does not want pysch drugs administered to him (in the future) in the event that he becomes incapable of making that decision, they should honor that if they have other means of preventing him from yanking out his IVs &etc., such as tying his arms down, and if there are not substantial overriding reasons why those alternatives are not realistic options (e.g., in order to prevent him from yanking out the IVs they find they have to tie him down so tightly that his circulation is impaired).

Mostly I support the law -- although I think it is abused a lot in psychiatric hospitals and nursing homes (where "emergency" too often consists of "is refusing to take the meds voluntarily" or "is telling the nurse to go away and leave her alone after the 14th time that the nurse tried to get her to take the meds voluntarily"), I'm under the impression that this is pretty rare in a regular medical-surgical floor or private medical office type of setting.

What I said was that I would rather be dead than drugged on a neverending permanent basis. I would not say that I prefer death to being drugged on an emergency basis, as I would live to see another undrugged day after the situation had been sorted out.

[AHunter3]

mea culpa, Chief Crunch. I try to avoid their stuff. They have been known to show up at our events and sort of lay claim to the movement as if we were all in agreement with them about how wonderful an alternative Scientology was.

:rolleyes:

Guess I missed that one.

[Chief Crunch]

Originally posted by AHunter3
mea culpa, Chief Crunch. I try to avoid their stuff. They have been known to show up at our events and sort of lay claim to the movement as if we were all in agreement with them about how wonderful an alternative Scientology was.

:rolleyes:

Guess I missed that one.

Well, you certainly like Latin. ;) For the most part, I agree with you. I've been to the Behavioral Health Unit of a local hospital several times. While I was always there voluntarily, I've the had the chance to interact with people who were not. Some of them simply said the wrong thing to the wrong person. I can't speak for other states or areas, but in Pennsylvania, a person commited involuntarily has a right to a "hearing" with 120 hours. The hearing consists of the head psychiatrist, case worker, patient, public defender and a local magistrate. In the six or seven times I've been in there I've never seen a patient win one of these. All the psychiatrist needs to utter are "homicidal", "suicidal" or "danger to himself or others". Keep in mind, not taking meds is non-compliance, which in turn makes one a danger to himself. Usually; however, the end result of this is the person staying another five to seven days before he or she is discharged. I only recall one time when a person was moved to a more long term facility. Still, the shift of power needs to change. I met a girl who was there based on a police report filed by an ex-boyfriend. He said she was suicidal, she has a seven or eight thousand dollar hospital bill to deal with and ten days of her life taken away from her. Don't get me wrong, psychiatric medication and counseling have improved unbearable areas of my life, but it was always my choice. More work needs to be done to ensure the rights of consumers.

[Ludovic]

Originally posted by lekatt

There are people who believe they can
and
There are people who believe they can't
both are correct.


But Tony couldn't fly, Tony Died.