It's in peer-reviewed print: no mental illness "chemical imbalance"

[AHunter3]

They've said it about schizophrenia, they've said it about bipolarity, and they've said it about depression.

They, of course, being the pharmaceutical industry and the mental health industry profession. Mental illnesses are, according to them, genuine, specifically known, got-our-scientific-diagnostic-tweezers-on-whats-causing-it, low-level biological brain disturbances, and, to be specific about it. "chemical imbalances".

Take this pill. You feel the way you do because your neurotransmitters are all fucked up. That kind of thing happens, just like thyroid disease and diabetes, you know. We know all about it, and this pill is, for your ailment, just like insulin is for a diabetic.

Horseshit (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392)

We've been saying it for years: they're lying.

(We being the psychiatric inmates' liberation movement. I've been diagnosed manic-dep (before it was renamed bipolar) and paranoid schizophrenic, and have been on the wrong side of the locked doors in a couple of looney bins. But yeah, we're organized and we're mad. Well, OK so we're not all that damn organized, so show me a social-change movement that is?)

Yes, they are lying. Often they have the best of intentions. They want to help. Sometimes they have a bit short of the best of intentions. They want to fill an unmet need and thereby make a profit in the lucrative pharmaceutical arena. Sometimes there's nothing discernably good about their intentions. They want to render an incarcerated population tractable and amenable to rules, regulations, and institutional control and don't much care what it does to them in the process. All of these at various times and places, usually in massive parallel.

That which we call mental illness is an aggregated polyglot mess of human emotional cognitive and behavioral patterns that remain identified as such and therefore fall under the auspices of the mental health profession after the easy picks — the phenomena that yielded their etiological and prognostical secrets to conventional scientific inquiry over the last hundred years — were transferred to portions of medical science that both medicine and science regarded as legitimate in ways they weren't entirely ready to extend to psychiatry. Internal medicine. Endocrinology. Neurology. You no longer get a bed on the mental health ward if you are known to suffer from tertiary syphilis, hypothyroidism, or epilepsy. In the last couple decades of the 20th Century, psychiatry may have mustered enough stature to keep its patients and problems once they are understood — Alzheimer's hasn't been fully pulled out from under them even now that we know how it works. But in many ways it's too late. Most of what's left in the bag are complex phenomenae that probably don't have singular causes, physiological causes to which symptoms can be attributed w/o consideration for social and situational factors, and even things which can't even be unequivocably labeled "undesirable".

We have been saying this. And in response we often get laughed at, ridiculed, dismissed with "OH, come ON, in this day and age are you REALLY going to try to claim that there's no such thing as mental illness? C'mon, they know what causes it now!!"

Well now, whaddaya know?! There's a nice peer-reviewed article reporting research that supports our case!


People who find beneficent effects from psychiatric pharmaceuticals abound; whether the field knows what causes the symptoms we, ourselves, often describe as PROBLEMS or how and why this or that med seems to help alleviate the suffering, that much is still true: some folks benefit from this.

I could also, however, fill a large concert hall with open, out, outspoken, angry survivors of psychiatric treatment we did not benefit from and did not appreciate (yeah, it includes me, I'm in that group).

Many of us were subjected to involuntary treatment. I'd be opposed to involuntary treatment even if they could convincingly prove they had identified a mental illness, knew what caused it and had the cure in their hands. But more to the point, many of us voluntarily turned to them because they said they knew what they were doing, they said they had the fix for the problem, and they were doctors and they were believed, they were listened to and their recommendations followed in good faith.

They lied.



I am not a radical in the movement. I don't demand that psychiatrists and mental health support staff be disbarred, their professions disbanded, their membership prosecuted for crimes against humanity.

But I think they should be required to come clean about how little they know, how much guesswork they're still doing on both problem-description and treatment-attempt, and how much is still unexplained and therefore up for grabs to a good explanatory model.

And of course an end to forced treatment, period.

[BrainGlutton]

Back to sqvare vun . . . zo, tell me about your mutter . . .

[roger thornhill]

Lifelong depressive checking in. I've intuited that "chemical inbalance" is not on the money these forty years. Of course, it IS really "on the money", because of all the drugs psychiatrists chuck at you - together with a hefty bill.

Interestingly, last time I saw a shrink (he actually had the Wall Street Journal spread across his desk during sessions - honest and up-front, I suppose, if nothing else), I said I didn't think my depression (about which I am qualified to talk) was fundamentally a chemical in the brain thing. He actually got quite agitated an spent the next 5 minutes or so trying to persuade me I was wrong.

[Miller]

But yeah, we're organized and we're mad.

Also, you're angry.




Sorry.

[AHunter3]

No, not sorry, just mad and angry :D

[II Gyan II]

Can't be much help right now, but there's an article in Nature Reviews Neuroscience within the last year which said that depression was likely due to certain cortical networks not operating in sync, rather than a "chemical imbalance".

[Q.E.D.]

Sorry, Bucko, but that's not a peer-reviewed research article, it's an opinion piece in the Essays section of PLoS. Right in the margin at the top of the article it says:
The Essay section contains opinion pieces on topics of broad interest to a general medical audience.
An opinion piece doesn't carry the same weight as a peer-reviewed research article, sorry. Which is not to say the essay is wrong in its conclusion, but the supporting evidence is lacking. Citing it as peer-reviewed proof of your position is a bit premature.

[furt]

Lifelong depressive checking in. I've intuited that "chemical inbalance" is not on the money these forty years.Ditto.

Well, ten years. :p

[tomndebb]

Back to sqvare vun . . . zo, tell me about your mutter . . .You call that a mutter? I'd hate to see what it takes for you to think someone is yelling.


(Yesss, I do know vhat he vas really sayink.)

[AHunter3]

Hmmph. I see your point. I'm trying to extract their review-policy / standards w/regards to accepted opinion pieces.

[Q.E.D.]

Hmmph. I see your point. I'm trying to extract their review-policy / standards w/regards to accepted opinion pieces.
Yeah, I don't know what their standards are with regard to essays--the site doesn't say explicity. I've no doubt there is some degree of critical review and fact-checking, but given that it's an opinion piece one must take the conclusion with a grain of sodium chloride.

[II Gyan II]

Ah, here's the PDF, Is Mood Chemistry? (http://www.healthsystem.virginia.edu/internet/neuroscience/education/spring2005nesc720/depression.pdf)

[Diogenes the Cynic]

As an added note- just because something gets accepted to a peer-reviewed journal does not mean that it has actually been peer-reviewed. Publication is the beginning of peer review, not the end.

[Q.E.D.]

As an added note- just because something gets accepted to a peer-reviewed journal does not mean that it has actually been peer-reviewed.
It does on PLoS (http://www.plos.org/faq.html):
Will articles be published prior to peer review?
Quality control through peer review is judged one of the most valued functions of any journal. The articles in PLoS journals will be published only after they have undergone a rigorous and constructive peer-review process that will be managed by academic editors in collaboration with experienced professional editors.
I do not know if the same standards apply to essays published therein, however.

[Hentor the Barbarian]

As an added note- just because something gets accepted to a peer-reviewed journal does not mean that it has actually been peer-reviewed. Publication is the beginning of peer review, not the end.Actually, it typically does. What else would peer reviewed mean, if not 'given a critical review by peers' prior to publication? Whether peers review it afterward is pretty arbitrary, and wouldn't make for very good quality control.

[davenportavenger]

Also, there is nothing in this opinion piece about schizophrenia or bipolar disorder, which are the top two diagnoses of those who are involuntarily treated. I do agree that the term "mental illness" is extremely broad and is sometimes used in lieu of finding out the real causes of the disorders, sort of shoving them into a highly disparate category where they fester in ignominy. I would love to see those two diseases (and others) recategorized as neurological disorders. Would do a lot for credibility, you know. I am also opposed to involuntary treatment for the same reason I don't think people should have to have chemotherapy if they don't want to or amputate a diseased limb if they'd rather not--personal choice. Sometimes you have to detain people for their own good and the good of others (that goes for non-MI people as well), but I agree that it goes too far.

But yeah you didn't pick the best cite to support your case.

[Diogenes the Cynic]

There is usually a different level of review to determine whether something is merely publishable than the more serious and widespread review which occurs afterward. The first level determines whether something is worth calling the scientific community's attention to. the second phase is the one that counts. Michael Behe has gotten himself past the first level once or twice but gotten his ass handed to him after publication.

[davenportavenger]

There is usually a different level of review to determine whether something is merely publishable than the more serious and widespread review which occurs afterward. The first level determines whether something is worth calling the scientific community's attention to. the second phase is the one that counts. Michael Behe has gotten himself past the first level once or twice but gotten his ass handed to him after publication.I work as a research assistant in a hospital, and I can vouch that this is right. It depends on the publication, though; more respected publications do not print articles until they are fully reviewed and passed all levels. My boss explained the whole thing to me. But since this is an editorial I don't know what its process is.

[Shagnasty]

Bipolar patient and former behavioral neuroscience Ph.D. student checking in:

You have an agenda to prove and it is not only scientifically unsound and unlearned, but also dangerous.

The brain is an organ like any other. Do you think it can't develop any problems? Do you think it is just antenna picking up the soul from afar?

Do you really want to debate proven changes like in Alzheimer's disease, strokes, and physical or drug induced brain damage brought on by many causes against parallel symptoms with mental illnesses.

Lithium literally saved my life 2 years ago. It wasn't psychological. I was on several other drugs and then no drugs right before that. The change was so profound that family members cried when they saw me before and after. That is an element. It isn't a drug that the pharmaceutical industry makes money on.

Do you really not believe schizophrenics when they say they hear voices? Have you never seen a Bipolar person manic beyond belief? Those aren't exactly rare things. No one would choose that and I certainly didn't.

The symptoms cluster quite well. I can walk into a psychiatric ward of your choice and give a diagnoses for most of the people in there after talking with them for just a few minutes.

Your attitude is offensive and extremely dangerous to those who will hesitate to get treatment because of attitudes like yours.

[John Mace]

There is usually a different level of review to determine whether something is merely publishable than the more serious and widespread review which occurs afterward. The first level determines whether something is worth calling the scientific community's attention to. the second phase is the one that counts. Michael Behe has gotten himself past the first level once or twice but gotten his ass handed to him after publication.
Exactly. Getting your data/theory published in one journal is just the very beginning of the process. No doubt there are countless other papers showing that "chemical imbalances" are real. And it's entirely possible that mental disorders have multiple causes. I think the OP is getting a bit carried away. And unfortunately (for people like the OP), it's rare indeed for a reigning theory to be overturned by one paper. I'd expect that something like this would take at leat a decade for a new paradigm to emerge.

[davenportavenger]

The brain is an organ like any other. Do you think it can't develop any problems? Do you think it is just antenna picking up the soul from afar?

Do you really want to debate proven changes like in Alzheimer's disease, strokes, and physical or drug induced brain damage brought on by many causes against parallel symptoms with mental illnesses.I don't think that's what he was saying (or anyway, it's not what I was saying). The term "mental illness" has a stigmatizing effect and always has had one. In a sense, psychological disorders are a sort of ghetto where a number of behavioral, probably-brain-based diseases go before scientists decide to start figuring out their causes and cures (and medication is not the same as a cure). As the OP mentioned, the category of mental illness once included epilepsy, which is now categorized as a neurological disorder. Until these diseases are recognized as fully medical, they will always be treated with skepticism. Taking certain disorders out of the DSM would do a lot towards legitamizing them and increasing the search for cures or at least better stopgap treatments.

There is no doubt in my mind that schizophrenia and bipolar disorder (among other diseases) are physical diseases. What some people have a problem with is putting all these disparate problems into a made-up category when there is already a category for brain-based diseases, neurological disorders.

[Normal Saline]

Psychiatric nurse checking in. I have no specific data to cite. Some people benefit from drugs. Some people benefit from cognitive therapy, meditation, stress management. Others seem to fit nowhere, and as a result have become instituionalized, and don't survive anywhere outside the hospital. Yes, it is terribly terribly sad.

Im not fond of some of the things the mental health uh profession do to people we have chosen to lable patients or consumers, or whatever the hip word du jour happens to be. I do not like the idea of warehousing people for the rest of their lifes. I do not like the dependence we create in our patients. Many of my colleauges and I agree where drugs are concerned, less is more.

On the other hand, some people are seriously ill, cannot function on their own. They need to be somewhere safe until such time as they can live on their own. Or can make arrangements to live somewhere safe. Sometimes these people are difficult to have on a ward with others. There may not be any great harm in a tiny old lady who wants to get home to her (condemned by the city) house full of cats, but when she wanders around and taps or grabs someone who is also currently having hallucinations, and paranoia, then there is a threat to everyone's safety, including staff. So we medicate the paranoid, and we medicate the dementia sufferer, so they both can continue to live within our ward, where they are at least sheltered, fed, clothed.

Its not a perfect system. I have ethical and moral doubts every day. I do not deny some truth in the OP. I also see results of some people stabilized on medication. Some people have quirky personalities that should not be olanzapined away. But quirky is one thing, putting self and others at risk is another. So I do my job, and daily remind myself "there but for the grace of [Og] go I". Im not better or worse than the person I pass pills to. Just currently more fortunate.

[Jackmannii]

A few things:

PLOS Medicine may be a peer-reviewed journal, but it does not to my knowledge have much standing in the medical/scientific community.

What I get from the cited opinion piece is that it is dubious to claim that low serotonin levels are the mechanism for a wide range of mental disorders, and that the SSRIs are likely overprescribed. Not much to argue with there. Even their strong supporters are unlikely to claim that all users will benefit, that the side effects won't be too much for some patients, or that alternate meds (or no meds) won't be better for certain sufferers.

I've seen the occasional study showing that a popular antidepressant doesn't work better than placebo. And other studies demonstrating significant effects.

My take is that drugs for psychiatric disorders have taken us out of the dark ages, and given life back to a whole lot of people who otherwise would be institutionalized or not functioning to any major degree. God (or alternate deities) help us if we ever had to go back and rely on having variously warped mental health professionals digging into our ids and superegos.*

*In my psych rotation in med school, it was illuminating seeing the difference between the clinical staff who embraced the new medical therapies, and the old guard, who reacted at times as though someone had taken their candy away.

[Zeriel]

Former severe suicidal depression patient checking in here.

I'm on a middle-of-the-road ground between the two extremes of Shagnasty and AHunter here, I think. My depression was caused by a host of factors, and required a multi-pronged attack of medication and therapy to completely control (I still have severe mood swings, now that I'm unmedicated, but I have psychological tools available to help prevent them from becoming full-blown depressions).

On one hand, I agree with AHunter that the psychiatric establishment needs to immediately and publically come to terms with the fact that, in many cases, they have no idea what medicines will work or why. I also think that involuntary committments ought to be far more carefully examined than they currently are.

On the other hand, I'm with Shagnasty on scaring people away from help with horror stories. There are a lot of folks out there like me, who don't want to talk to a therapist or a pshrink of any type for fear we'll be declared crazy and locked away, or drugged into a stupor (yeah, I know, paranoid much?).

On the gripping hand, I think following AHunter's guidelines halfway with regards to meds and involuntaries would help accomplish Shagnasty's apparent goal of people getting the help they need, whether that's drugs or therapy or just being left alone to figure it out themselves.

[Mr. Duality]

pshrink .

That is so appropriate. Are you the originator, or did you pick up on it somewhere? That's how I'm going to spell it (in the propoer context) from now on, and I urge everyone else to do so as well.

[AHunter3]

Shagnasty: Your attitude is offensive and extremely dangerous to those who will hesitate to get treatment because of attitudes like yours.

You regard it as dangerous that some people, on being familiarized with the MH system's lies, would decide against trying psychiatric treatment. Since some people do benefit from MH drugs (as I acknowledged in the OP), that's probably true.

But because of the lies, many people will suffer, have their lives badly derailed, experience permanent brain damage, and/or even die as a consequence of being led to place unearned trust in the psychiatric system.

I regard the latter as the bigger danger, having been there and having met many other veterans of the system with horror stories to tell. You are entitled to your opinion; you may differ in your evaluation of the relative dangers here.

But, moreover, this is a board dedicated to fighting ignorance, and the point is that the psych + pharma people claim a degree of knowledge that they simply don't possess, and that's a bad thing. Ignorance that pretends, with the authority of medical license and police powers backing their pretention, to knowledge and certainty that just ain't so, is ignorance squared. Dangerous ignorance.

davenportavenger: There is no doubt in my mind that schizophrenia and bipolar disorder (among other diseases) are physical diseases

I deny that they are even necessarily / always diseases. They are conditions. Not always undesirable conditions. Not always conditions that represent departures from the range of healthy processes. Certainly they are often debilitating, unpleasant, destructive, and of course undesirable. But not always.

And no I don't think they are physical conditions. I think they have physical components. None of the three central psychiatric diagnoses — clinical depression, bipolar disorder, or schizophrenia —are applied to people whose mental, emotional, and behavioral state cannot, far more often than not, be explained in large part by circumstances, events, situations. I would guess that there are physical components that predispose some people's minds to fall into the observed patterns more readily than other folks' do under comparable circumstances. I would also guess that there isn't a person alive whose mind will not, under the proper stimulus of events, go into those patterns.

jackmanii: God (or alternate deities) help us if we ever had to go back and rely on having variously warped mental health professionals digging into our ids and superegos

A common but massively invalid assumption exists in our culture — that prior to the advent of thorazine and other psych meds, the primary treatment for the mental illnesses consisted of having schizophrenics, bipolar-disordered folks, and depressives lie down on a couch and free-associate or talk about their potty training and get past their Oedipal phases or what have you.

Didn't happen. The portion of the population who did the couch-lying thing was confined to the relatively wealthy folks who sought out psychoanalysis on a voluntary basis. The mainstream treatment for schizophrenia, manic-dep (bipolar), and depression in the era before neuroleptic psych meds consisted of less effective medicating (e.g., barbituates), physical restraints (including straitjacket, "wetsheet" wraps, six-point tiedowns, padded cells, immobilizing chairs, and other such therapeutic devices), and shock therapy (ECT and insulin). The kinds of folks who went in for Freudian couch analysis still exist and many still go to Park Avenue shrinks who still do Freudian as well as Adlerian and Jungian and a host of other "deep talk" therapies, as well as more recent trendy behavior-mod focused talk therapy. Quite a few of them also take SSRIs nowadays, too, talk therapy and med therapy aren't mutually exclusive).

davenportavenger : Also, there is nothing in this opinion piece about schizophrenia or bipolar disorder, which are the top two diagnoses of those who are involuntarily treated

I know. In general, the MH system's claims about "chemical imbalances" has been given less credit with regards to schizophrenia and somewhat less with regards to bipolar disorder than for depression. They make the claim across-the-board to the patients, but it is with depression that the marketing has targeted the mainstream, and with the SSRIs many folks who would doubt that schizophrenia is a neuroleptic-deficiency disease were inclined to think that, with depression, the profession really did have it nailed. So yeah, I shorthanded my argumentative way across some logical leaps here. The article doesn't address whether bipolar disorder is a lithium-deficiency disease, but it shows in a generic way that the profession has claimed knowledge that it doesn't possess in making similar claims about depression.

Meanwhile, plenty of folks do indeed get involuntarily incarcerated for clinical dep every year.

[BrainGlutton]

Taking certain disorders out of the DSM would do a lot towards legitamizing them and increasing the search for cures or at least better stopgap treatments.

I'm a little confused here . . . I know homosexuality was famously taken out of the DSM in the '70s, for the purpose of "legitimizing" it in the sense of redefining it as a non-pathology -- a psychological characteristic which is not a disorder and requires no cure or treatment. You would not want to see bipolarity, schizophrenia, or even depression reclassified in that way, would you?

[MLS]

And no I don't think they are physical conditions. I think they have physical components. None of the three central psychiatric diagnoses — clinical depression, bipolar disorder, or schizophrenia —are applied to people whose mental, emotional, and behavioral state cannot, far more often than not, be explained in large part by circumstances, events, situations. I would guess that there are physical components that predispose some people's minds to fall into the observed patterns more readily than other folks' do under comparable circumstances. I would also guess that there isn't a person alive whose mind will not, under the proper stimulus of events, go into those patterns.

Sorry about your particular circumstances; I hope you feel well soon.

Meanwhile, in my observation and (non-professional) opinion, this is (*notes which forum we're in*) garbage. The people I've known with these disorders, and I include myself in this category, have these states regardless of circumstances, events and situations. To use my own experience, it's sure nice now to be able to go outside on a beautiful day, and honestly feel great about it, as opposed to having a gray cloud over it all and think, "Gee, I guess this is the kind of day on which some people are happy." And to not feel horribly afraid all the time. All from a simple daily dose of one pill. I doubt it's just a placebo -- I tried a lot of things before, honestly believing that better nutrition, or more sunlight, or more exercise, or any of a variety of supplements, would finally help.

I saw one friend who was (unbeknownst to me) taking lithium suddenly become an abusive, paranoid, nastly person when he quit the treatment. It destroyed his marriage and the life thereafter of his ex-wife. He simply became another person entirely.

Sure, I imagine that there are situations where psychopharmacology is used inappropriately. I bet there are situations where penicillin is used inappropriately, too. Doesn't mean there's a giant conspiracy of lies. I doubt if I'll convince you, though.

[Kalhoun]

Also, there is nothing in this opinion piece about schizophrenia or bipolar disorder, which are the top two diagnoses of those who are involuntarily treated. I do agree that the term "mental illness" is extremely broad and is sometimes used in lieu of finding out the real causes of the disorders, sort of shoving them into a highly disparate category where they fester in ignominy. I would love to see those two diseases (and others) recategorized as neurological disorders. Would do a lot for credibility, you know. I am also opposed to involuntary treatment for the same reason I don't think people should have to have chemotherapy if they don't want to or amputate a diseased limb if they'd rather not--personal choice. Sometimes you have to detain people for their own good and the good of others (that goes for non-MI people as well), but I agree that it goes too far.

But yeah you didn't pick the best cite to support your case.
Question: What difference would it make if they changed the label? I understand the physical difference between the two, but if you can't prove either one, and they still treat people involuntarily, what impact would it have on the issue at hand?

[devilsknew]

I saw one friend who was (unbeknownst to me) taking lithium suddenly become an abusive, paranoid, nastly person when he quit the treatment. It destroyed his marriage and the life thereafter of his ex-wife. He simply became another person entirely.



This is a great problem for me. I have a suspicion that many psychoactive medications may in fact alter the brain, often irrreperably, and beyond the original symptoms, often for the worse, and in exacerbation of symptoms upon discontinuation. Where is the research into how much these drugs are permanently disabling people and harming them more? I think these chemicals often damage the brain in their "efficacy", often leaving a person who is less of what they were and dependant on the harmful chemicals. The current prescription happy pshrinks (love that term) nonchalance and over(ab)use of some of these medications seems unethical to me.

Also, simply that somebody has become "something" according to somebody else's judgement also smacks of witch hunt accusations and really is the heart of the problem and contention that Ahunter3 is making. Many of the diagnoses are purely subjective and dependant on mere mortals who wield great power over another's life.

[devilsknew]

I think there might be a day sometime in the not to distant future when we will all say, that Tom Cruise was right.

[MLS]

This is a great problem for me. I have a suspicion that many psychoactive medications may in fact alter the brain, often irrreperably, and beyond the original symptoms, often for the worse, and in exacerbation of symptoms upon discontinuation. Where is the research into how much these drugs are permanently disabling people and harming them more? I think these chemicals often damage the brain in their "efficacy", often leaving a person who is less of what they were and dependant on the harmful chemicals. The current prescription happy pshrinks (love that term) nonchalance and over(ab)use of some of these medications seems unethical to me.

Also, simply that somebody has become "something" according to somebody else's judgement also smacks of witch hunt accusations and really is the heart of the problem and contention that Ahunter3 is making. Many of the diagnoses are purely subjective and dependant on mere mortals who wield great power over another's life.
Well, in the situation I observed, I was told that after his self-imposed lithium withdrawal, he reverted to a state similar to what he'd been in prior to its prescription. So a pretty basic case of being o.k. when medicated vs. definitely NOT o.k. when unmedicated. He was most assuredly on the verge of needing to be kept away from others for their safety. Thiscould be observed quite objectively -- anyone who goes from being a nice, gentle man to throwing his wife against the wall and causing permanent injury is not just some subjectively-observed tendency.

After the breakup of the marriage (complete with restraining orders), I lost contact with this individual. However, years later I heard from another friend that he had apparently gotten treatment of some sort again, and was most apologetic about all the damage he had done to others.

[comrade33]

The mainstream treatment for schizophrenia, manic-dep (bipolar), and depression in the era before neuroleptic psych meds consisted of less effective medicating (e.g., barbituates), physical restraints (including straitjacket, "wetsheet" wraps, six-point tiedowns, padded cells, immobilizing chairs, and other such therapeutic devices), and shock therapy (ECT and insulin).

umm, some of this stuff still happens. you didn't think they did away with ect (http://www.ect.org/news/revised.html) did you?

[jshore]

umm, some of this stuff still happens. you didn't think they did away with ect (http://www.ect.org/news/revised.html) did you?

And speaking as someone who just had a very close relative who had become severely depressed treated with ECT, I can tell you that it can be a life-saver. She was severely depressed for over 4 months, in-and-out of hospitals, on various psychiatric drugs, and nothing was helping very much. The ECT treatments completely returned her to her normal self in a matter of a few weeks (with a fair bit of memory loss of the events for the few months leading up to the ECT, but I don't think this is stuff she'd really want to remember). The change was really incredible.

Of course, this isn't to say that ECT is the cure for everyone or even that all mental illnesses are caused by whatever chemical / electrochemical imbalances that a treatment like ECT can cure. But, I think it is dangerous to be too absolutist in the other direction either. The mind is incredibly complex and resists the ability of us to completely characterize it, whether we be pharmaceutical companies, proponents of ECT, or opponents of pharmaceutical solutions or ECT.

[threemae]

I would say that we should back off from the bigger claims here regarding the ethics of institutional medicine, and acknowledge that Ahunter3 and his article do have a number of very salient points that really aren't all that radical. The article isn't arguing that there are no biological basis for psychiatric disorders, it's arguing that the connection between simple serotonin levels and depression is tenuous at best. For certain disorders like schizophrenia and dopamine, we have a very consistent set of theories, clinical trials, and other evidence that supports our view of the biological basis of schizophrenia. We have drugs that actually clearly affect dopamine levels and a lot of data about typical dopamine levels in different populations. At high levels, we see schizoid behaviors, at low levels we see Parkinsonian disorders, and in between we see healthy people. When drugs are used to correct either side, we see actual levels of dopamine change, and when we treat schizophrenics with antipsychotics we often see "Parkinson's disease" through tardive dyskinesia, and when we treat Parkinson's disease, we occasionally see schizoid behaviors. The model works, it has plenty of support, and our clinical findings consistently back up these models of thinking.

For the link between serotonin and depression, the relationship is a lot muddier. We can use tryptophan to vastly increase serotonin levels, but this doesn't seem to ameliorate depression, and we have a huge number of drugs used for clinical treatment of depression that only seem to vaguely affect the levels of serotonin present. I'm not arguing that SSRI's don't work, and neither does the article. The point is that they don't work well (57% of RCT's on SSRI's don't show significant effects between placebo and SSRI's, of course once that number reaches 95% we should really be worried) and we don't really understand how they work very well at all. They don't raise serotonin levels dramatically, if at all, and the way in which they work doesn't seem to make a lot of sense. If more serotonin yields less depression, why do they take 6 to 8 weeks before they start working? Neurons can fire hundreds of time per second and SSRI's should be biologically available within hours, so why don't they start working quickly? Maybe this suggests that they somehow alter, "cortical organization," or whatever else some other posters have hinted at. Basically, the point is that the simple model presented by the Zoloft commerical of some weird little bouncing happy/sad face that asks, "feeling blue? You don't have enough seratonin! Here, we've got a pill that will raise your serotonin, buy it!" It's certainly a convenient explanation for pharmaceutical companies, and the way that peer-reviewed journals are/were set up until this year without pre-trial registration causes publication bias that tends to only get the one study that supports our cobbled-together explanation of serotonin and depression published but ignores the other 19 studies that showed opposite or null effects.

We've got plenty of reason to be skeptical of the serotonin-deficit model of depression, and we need better science to help us figure it all out. In the mean time, psychiatry and pharmaceuticals shouldn't act all pissy when people go around questioning the ethics of compelling people to use treatments of questionable efficacy.

[AHunter3]

umm, some of this stuff still happens. you didn't think they did away with ect (http://www.ect.org/news/revised.html) did you?
I'm well aware that ECT is still around, and not only that, still forced upon people against their will, in long repeating series.

Another treatment for which the profession should be held accountable. It is grandfathered in (wouldn't stand a prayer of FDA approval if introduced now) and every time we try to get legislation passed that simply records morbidity and mortality rates on ECT in a comprehensive manner, fucking NAMI and the electro-shrinks (or electro-pshrinks, heh heh) mobilize against it, claiming (accurately) that our intention is to restrict ECT by acquiring data that shows it's not good for people.

I didn't mean to imply that psych drugs made the older modalities go away. They also still tie people to beds in six-way restraint and wrap them in straitjackets and put them in padded seclusion rooms. I dunno about wrapping them naked in cold wet sheets but I woudn't be surprised.

[Guinastasia]

I think there might be a day sometime in the not to distant future when we will all say, that Tom Cruise was right.


Considering he gets his beliefs from the wacked out cult known as Scientology, I highly doubt that will ever happen. For crying out loud, he referred to Paxil and Ritalin as "anti-psychotics."

[devilsknew]

Just because Scientoligy is considered a cult by some doesn't make the truth any less true.

[Guinastasia]

Just because Scientoligy is considered a cult by some doesn't make the truth any less true.

What truth-that all disease is caused by clusters of alien souls known as "thetans" sticking to you and that you have to spend thousands of dollars to get rid of them?

Trust me, Tom was talking out of his ass. He doesn't know jackshit about psychology (no Tom, methadone was NOT invented by the Nazis, or originally called Adolphene. And no, vitamen overdoses will NOT cure post-partum depression.)

[AHunter3]

MLS: Well, in the situation I observed, I was told that after his self-imposed lithium withdrawal, he reverted to a state similar to what he'd been in prior to its prescription.

That happened with author Kate Millett, also. She just happens to prefer the state she's in when not on lithium. Her right, her choice. Her book on it is available via your local library: The Looney Bin Trip.

BrainGlutton: I'm a little confused here . . . I know homosexuality was famously taken out of the DSM in the '70s, for the purpose of "legitimizing" it in the sense of redefining it as a non-pathology -- a psychological characteristic which is not a disorder and requires no cure or treatment. You would not want to see bipolarity, schizophrenia, or even depression reclassified in that way, would you?

I would. While I would not take it upon myself to define these as non-ailments for everybody, consider the following:

• Go back circa 1955 and if you polled gay folks about the desirability versus pathology of their "condition", from what I've read you'd have gotten pretty high concurrence that it was an undesirable thing, to be homosexual. Without being able to visualize a world in which they were (more) accepted, it would have been hard to distinguish between "these are the consequences of being this way" and "these are the social consequences of people's fucked-up reaction to me being this way".

• Of those of us who have been involuntarily psychiatrized and/or were sufficiently disappointed with psychiatric treatment to discontinue it, you'll find many who say, in essence, "I'm not schizo/bipolar/whatever because there's no such thing", you'll find some who say "I'm not schizo/depressed/etc because they misdiagnose left and right, maybe some people are but there's nothing wrong with me", and you'll find some who say "I am different from the folks who don't tend to get psychiatric diagnoses, I don't know if there's such thing as 'schizophrenia' or whatever or not, but whatever it is, it's who I am and I like it and don't want to be 'cured'." As long as it remains true that mental illnesses are defined as their observable symptoms, it is meaningless to distinguish between having the symptoms but not being schizophrenic (etc) and actually being schizophrenic. I would say furthermore that there's no traction in claiming, as some do, that there's "no such thing". (Sure there is, if we define a constellation of behaviors as a disease and we can clearly observe the occurrence of that constellation of behaviors. Regardless of what it "is", the patterns exist!). So yeah, damn right you have quite a few people who are by that definition schizophrenic (or bipolar, etc) but who do not consider it to be a pathology. Damn right, I'd love to follow the lead of the gay-rights movement, at least in part — at a minimum, pride in who we are despite whatever difficulties our condition may impose on us (as with disabilities-rights folks), and for those of us who feel that way about it, pride in our condition, embrace of it as a positive, and demands that people not only stop discriminating against us in the sense of putting up undue barriers or having laws that pertain to us but not other people, but also get over their mentalism and be neither hateful nor pitying towards us. We are everywhere :)



I should also add that once forced treatment is uprooted, there's a lot more flexibility for choosing to accept a psych diagnosis and seek treatment or rejecting the identity and the treatment, and if under those circumstances you still get people embracing the identity while refusing the treatment, that's an affirmation.

Whereas, as long as the label is one that gets stuck on you by others, the option of rejecting the diagnosis is an option limited to the fortunate, and embracing the identity that is imposed and declaring "OK, fine, well in that case not only am I "one of them", I'm glad I am, proud of it, and I'm putting it on my fuckin' T-shirt" becomes a tactic.

[Stonebow]

That happened with author Kate Millett, also. She just happens to prefer the state she's in when not on lithium. Her right, her choice.

Well, at what point do you think a person is sufficiently impaired that they cannot give meaningful consent? Do you think it's unethical to put someone on suicide watch if they have been diagnosed with clinical depression?

Also, given some of the anti-social behavior we have discussed as a result of various disorders, do you favor a law enforcement response over a medical one?

I'm curious as to how you'd approach this from a policy perspective. Though I do agree that over medicating, and resistance to quantifying it, is not good law or good science.

[AHunter3]

Stonebrow: Well, at what point do you think a person is sufficiently impaired that they cannot give meaningful consent?

Well, the circumstances should be identical for schizzies and nonschizzies. There are standards that determine if and when you (for purposes of this post assumed to NOT have a psychiatric diagnosis) no longer get to make your own medical (and other) decisions. For most practical purposes, someone alleging you to be incompetent needs to bring a case to a civil court and demonstrate to the judge why you should not be allowed to sign your own documents, manage your own checkbook, or make your own medical decisions. And the burden of proof lies with that someone — can't have Aunt Esmeralda's greedy son having her determined incompetent w/o good grounds just because he doesn't want her to marry Joe Silverhair and perhaps compromise his inheritance!

The presence or absence of psychiatric diagnosis in and of itself should not only not be considered relevant, but in addition, due to the prejudicial attitudes that are very much in existence, should be illegal to speak of in a competency hearing.

[Wesley Clark]

I don't personally believe it. As a single example over half of men who do not respond to conventional antidepressants have low testosterone levels. When given higher testosterone levels the depression cleared up for a third of them, the rest got some benefits.

http://www.webmd.com/content/article/57/66195.htm

Take me for example. I am usually reasonably happy but for the last month I have been mostly depressed and irritable. I have considered this to be a really bad part of my life and I didn't know how to change it. Meditation didn't work, other cognitive tools didnt work, various antidepressants didn't work. However when I was reading the book 'dealing with depression naturally' they covered the fact that allergies can trigger depression. I have noticed my eyes itch alot and I was told by an eye doctor a year ago that I have a mild chronic allergy to 'something' so I started claritin yesterday and I feel much better and I hope to hell that it stays this way.

IMO mental illness is only a problem when the individual or to a lesser degree the individual's friends/family start to suffer because of it. If you are always moody, angry or so out of it that you are homeless then that is a problem. However the deviation between 'illness' and 'eccentric' is very blurry. Why is a schizophrenic with religious delusions ill while someone who wholly believes in teachings to a religion that could be totally false is sane (mainstream religions could be just as false as a schizophrenics delusions)? The definition is when your life or the lives of those around you end up being harmed. If you can maintain a happy demeanor, hold down a job and not harm those around you it doesn't matter if you are mentally ill or not.

[AHunter3]

Sorry, missed this one. Good questions, btw —

Also, given some of the anti-social behavior we have discussed as a result of various disorders, do you favor a law enforcement response over a medical one?

Absolutely. If I, as a schizophrenic, do something that would get you, a nonschizophrenic, busted and charged with a crime, I ought to be busted and charged.

If Tom Businessman can get drunk with the other salesmen, pee in the fountain, get in a fistfight with a supporter of the Other Sports Team or Other Political Party, and get off with no more than a stern warning from Officer Friendly, then I should get the same treatment for being incoherent in public, arguing with people who aren't there, and attacking a guy who stares at me funny. But if Tom goes to jail, so should I.

And my psychiatric diagnosis should have no bearing on how severely I'm sentenced.

[BrainGlutton]

positive[/i], and demands that people not only stop discriminating against us in the sense of putting up undue barriers or having laws that pertain to us but not other people, but also get over their mentalism and be neither hateful nor pitying towards us. We are everywhere :)

This is a whoosh, right?

[Wesley Clark]

However I will agree that the label of 'chemical imbalance due to serotonin' is far too simplistic to describe depression. Many chemicals and neurotransmitters can play a role in depression. Dopamine, norepinephrine, serotonin, NMDA receptor activators/inhibitors, methyl donors, testosterone, estrogen, sleep levels, thyroid, various nutritional deficiencies (zinc, magnesium, the B vitamins, calcium, various amino acids). The list of all the causes of depression is long and only partially complete and to just label all depressed people as 'not having enough serotonin' and prescribing a reuptake inhibitor (which doesn't work anyway in people who don't naturally produce enough serotonin) is very simplistic. It is like prescribing penicillin to everyone who has a microbial infection.

[Voyager]

There is usually a different level of review to determine whether something is merely publishable than the more serious and widespread review which occurs afterward. The first level determines whether something is worth calling the scientific community's attention to. the second phase is the one that counts. Michael Behe has gotten himself past the first level once or twice but gotten his ass handed to him after publication.

Peer review means the first definition - review by others in the field to determine whether the paper is publishable. It does not mean that the work is correct- reviewers do not reproduce the experiment or even look at the original data.

If the paper is important, then others will try to reproduce it. This reproducibility (not a review) is the second level. Sometime others who know more about the subject will write in with objections too.

I edit an opinion column, and the articles don't get reviewed, except for length and grammar. Opinions are opinions, and not facts.

[Guinastasia]

Sorry, missed this one. Good questions, btw —



Absolutely. If I, as a schizophrenic, do something that would get you, a nonschizophrenic, busted and charged with a crime, I ought to be busted and charged.

If Tom Businessman can get drunk with the other salesmen, pee in the fountain, get in a fistfight with a supporter of the Other Sports Team or Other Political Party, and get off with no more than a stern warning from Officer Friendly, then I should get the same treatment for being incoherent in public, arguing with people who aren't there, and attacking a guy who stares at me funny. But if Tom goes to jail, so should I.

And my psychiatric diagnosis should have no bearing on how severely I'm sentenced.


But what happens when someone is truly NOT responsible for his or her behavior? Should we punish them for it? That was the whole point of bringing in insanity as a legal issue-if someone is not in his or her right mind-and I don't just mean a little, I'm talking severely, frighteningly out of it, do they deserve to be punished?

[jshore]

I'm well aware that ECT is still around, and not only that, still forced upon people against their will, in long repeating series.

Another treatment for which the profession should be held accountable. It is grandfathered in (wouldn't stand a prayer of FDA approval if introduced now) and every time we try to get legislation passed that simply records morbidity and mortality rates on ECT in a comprehensive manner, fucking NAMI and the electro-shrinks (or electro-pshrinks, heh heh) mobilize against it, claiming (accurately) that our intention is to restrict ECT by acquiring data that shows it's not good for people.

Do you have a cite for this (i.e., the legislative issues)? I certainly was able to find some mortality rates on the web when my relative underwent ECT treatment. And, it is important to recognize that many of those who are fighting against undo restrictions on ECT are doing so also out of good intentions...because they have seen how it can make a dramatic difference for people when other things are not. The fact is that it remains the treatment with the highest success rate against severe depression...and this rate is particularly good when considering that it is often used as a last resort in patients who have been very resistant to other forms of treatment. That was certainly the case with my relative.

[II Gyan II]

But what happens when someone is truly NOT responsible for his or her behavior?

I don't think the idea of 'free will' being selectively true, is valid. Either we have it despite our brains, or we don't.

[Metacom]

This is a whoosh, right?
Which part of that are you calling a woosh? I agree with pretty much all of it...

[Metacom]

You have an agenda to prove and it is not only scientifically unsound and unlearned, but also dangerous.
...

The symptoms cluster quite well. I can walk into a psychiatric ward of your choice and give a diagnoses for most of the people in there after talking with them for just a few minutes.
It's people who think they can categorize others after speaking with them for a few minutes that are dangerous.

[astro]

Oh AHunter3, you're just a miserably depressed ovoid creature. (http://zoloft.spb.su/img/zoloft/img13.jpg)

[Metacom]

This is a great problem for me. I have a suspicion that many psychoactive medications may in fact alter the brain, often irrreperably, and beyond the original symptoms, often for the worse, and in exacerbation of symptoms upon discontinuation. Where is the research into how much these drugs are permanently disabling people and harming them more?
Read up on something called "tardive dyskenisia." Many psych drugs have irreperably altered many brains for the worse, and has some recent scandals have shown research on negative long-term effects of more recently discovered psych drugs is also frequently lacking.
The article isn't arguing that there are no biological basis for psychiatric disorders, it's arguing that the connection between simple serotonin levels and depression is tenuous at best. For certain disorders like schizophrenia and dopamine, we have a very consistent set of theories, clinical trials, and other evidence that supports our view of the biological basis of schizophrenia.
True, but what gets lost when we use words like "biological basis" is that the etiology is still unknown. Yes, some mental illnesses may correlate to changes in neurochemistry, but that doesn't mean that the mental illnesses are caused by changes in neurochemistry, only that psychological symptoms correspond to physical changes in the brain.

It's like using rouge to treat jaundice.

[Spectre of Pithecanthropus]

Psychiatric nurse checking in. I have no specific data to cite. Some people benefit from drugs. .

Exactly. If the drugs don't work at all, then how does one explain the relapses that somehow occur in some patients, shortly after going "off their meds"?

[Wesley Clark]

Oh AHunter3, you're just a miserably depressed ovoid creature. (http://zoloft.spb.su/img/zoloft/img13.jpg)

LMAO. Break out the paxil, claritin and testosterone patches

[Shagnasty]

It's people who think they can categorize others after speaking with them for a few minutes that are dangerous.

The people that is was referring too were already in the hopsital and had their diagnosis. After talking with them for a few minutes, it was pretty easy to figure out what they had and they usually confirmed it if you talked to them enough. They could do the same with me. There isn't a lot to do in a psych ward except talk to other patients.

Most people read the list of symptoms of given mental illness in the DSM or elsewhere and think "that could be me". The reality is a lot less subtle than that. You will never forget it if you see a person with the ashen look of profound depression or a bipolar patient with full-blown mania. They are far away from the normal end of the spectrum and yet patients with this seemingly unique and detrimental behavior show up again and again.

I had a full-blown manic episode that lasted three months. My wife got sick of it shortly after it started so I decided to go on a road-trip by myself. I traveled 11,000 miles in two months with absolutley no plan even from hour to hour. I traveled all over the eastern U.S. sometimes just dropping in and seeing people I hadn't seen in 14 years. I scared the hell out of most people. My personality was completely confident, aggressive, and obnoxious and quite unlike the me people had always known. I stopped eating shortly after I left. I ate extremely little for over a month and I lost 20 pounds. I stopped sleeping on a regular schedule too. My new routine became to stay up for 3 days and then sleep most of the next one. I did a few things that were completley out of character and will die with me.

When I got back to Boston, my wife had me taken to McLean psychiatric hospital. During my intake interview, they paused to bring students from Harvard Medical School in to observe. It is somewhat rare for Bipolar people to be brought in during the manic stage of the disease and I was a textbook case. They started me on Lithium right away and it started to work within 5 days. Within 2 weeks, I was back to normal.

I completely support the decision to have me committed. It wasn't like One Flew Over the Cukkoo's Nest. Everyone treated me with respect. They just monitored my behavior while we did simple activities and such. After the medicine was demonstrated to work, they let me out. Simple and everything regarding that has been fine since. I understand that some people have had bad experiences but those aren't the norm and the whole system shouldn't be judged by a few bad doctors and hospitals.

[Metacom]

Shagnasty, what point are you trying to make, exactly? Your psychiatric witnessing doesn't seem relevant to the topic of this thread, unless you mean to suggest that your anecdotal evidence is an argument for the "chemical imbalance" myth.

[Shagnasty]

Shagnasty, what point are you trying to make, exactly? Your psychiatric witnessing doesn't seem relevant to the topic of this thread, unless you mean to suggest that your anecdotal evidence is an argument for the "chemical imbalance" myth.

Wow, you just brushed off decades of research based on a stubborn belief system and one little paper against thousands on the other side. We tend to use the word "witnessing" to refer to the supporters of an unconventional belief not supported by most physical evidence. Tom Cruise shares your belief and he bases that on religion. We will just shift the witnessing label back to you and AHunter3.

[Metacom]

So...

What point were you trying to make?

[Shagnasty]

So...

What point were you trying to make?

1) Certain mental illnesses are unmistakable and striking even to a lay-person. Many people have never been exposed to those so they don't picture them correctly. In my experience, people with views like yours often ammend their beliefs when they have significant contact with someone with a major mental illness especially when they have seen them both treated and untreated.

2) The part about me being treated wasn't just an anecedote. It was written up as a teaching case study because it was a textbook case of Bipolar disorder. My exeperiences therefore, have some bearing on the treatment and outcome of a typical case of Bipolar Type I disorder. The doctors at Harvard Medical School looked at it that way.

3) The process to involuntarily commit someone (over 3 days), at least in Massachusetts requires a court hearing showing "danger to oneself or others". I don't see how anyone could see a problem with that if it is executed correctly. They don't throw people in the psych ward forever for hearing voices. Even if there is an evil doctor out there, the hospitals have limited bed space and the insurance companies make them justify extended stays. On top of that, the psych wards that I have seen aren't bad places. You just sit around and read most of the time. It is hardly a dirty, sadistic place filled with medieval treatments. I don't know where this propaganda circa 1900 is coming from.


I still can't believe this whole thread was spawned by someone holding up one trophy paper. Holy bad research techniques Batman! You aren't supposed to pay that much attention to the individual papers. It is the accumulation of evidence over time that matters and that is not on the side of you are the OP. Why doesn't the OP know that?

[Shagnasty]

Here is a more factual critique of the OP that others have partially stated. Academic journals have gradients of quality. At the top, you have journals like the New England Journal of Medicine, Nature, and Science. Near the bottom, you have journals like PLOS Medicine that publish peer-reviewed articles with lower standards of scholarship and/or importance. One of the lowest rungs of scholarship and importance is an opinion piece in a lesser journal. That is what the OP is trotting out here.

[Jackmannii]

God (or alternate deities) help us if we ever had to go back and rely on having variously warped mental health professionals digging into our ids and superegos... A common but massively invalid assumption exists in our culture — that prior to the advent of thorazine and other psych meds, the primary treatment for the mental illnesses consisted of having schizophrenics, bipolar-disordered folks, and depressives lie down on a couch and free-associate or talk about their potty training and get past their Oedipal phases or what have you.My comment above was made in the context of the article questioning the use of SSRIs, and related to depression in particular.

While I don't dismiss the incidence of side effects of these and other drugs (for depression, psychosis and other conditions), for many people they are life-restorers and vastly improved options compared to prior therapies (including ones that you mentioned).

Not to sidetrack this discussion, but a good subject for a future thread would be the concept I have seen floating about lately - that depression is overly considered a detrimental condition and medicated excessively, since numerous gifted and famous people have suffered from it and that depression may actually have fostered their accomplishments. :dubious:

[AHunter3]

Oh AHunter3, you're just a miserably depressed ovoid creature. (http://zoloft.spb.su/img/zoloft/img13.jpg)
:( I'll have you know I'm on a diet and I run, and I do situps and stuff. I'm only a little pudgy, dammit!

[AHunter3]

Shagnasty: Certain mental illnesses are unmistakable and striking even to a lay-person

I do not deny that there are patterns that folks trained in psychiatric medicine will concur on to a better-than-random-chance extent even in a double-blind test, parading the same patients and/or phony pseudopatients and/or maybe-possible-rule-out-MI type patients in front of them for evaluation.

If and when you see me in, umm, full swing, if you've got the training I figure there's an 85% chance you'll say "uh huh, bipolar, in manic phase", unless the content of the ideas I'm enthusiastically throwing out + my incredible confidence that you will of course know what I'm talking about and agree with me completely due to my compelling presentation thereof leads you to think something more in the schizophrenic vein.

So?

I am right to be so enthused, especially insofar as my brilliant insights are indeed fucking brilliant and they are indeed the key to all manners of things, answers to age-old questions, and I know this because I am in personal contact with God and these things were revealed unto me. It's a coincidence that the answers to my personal problems just happen to also be the answers to the problems the world is facing in the post-agrarian, post-patriarchal phase it happens to be in now.


Yeah, I bet you think I'm concocting that in order to sound as looney as all getout, to make my point. Mm?

Yes and no. Do a SDMB advanced search on every thread I've made in GD in the last year, display as indiv posts, and read them.. You may be in for a shock. Having a really fucking profound dislike for locked wards and involuntary injections, I've gotten rather good at learning how to pace, phrase, and otherwise exhibit the kinds of thoughts that used to tend to provide me with invitations to a stay on the locked ward.

I think that there's nothing physically or biologically WRONG with the folks you see on the ward that you so easily recognize as one type or another type of madperson. I think that, under the right circumstances, these same people would sort their thinking and moods out out (that's NOT a euphemism for "stops thinking fucked-up thoughts and starts thinking normal ones instead"), would regain the ability to relate their perceptions and whatnot to the common ground of mental content that folks like you would acknowledge as "normal", and would be able to gently and cautiously describe departures from it, making sure you're following along as they do so. Or (I can practically see you raising your hand to ask) in the case of vivid, careening, and/or astonishingly overwheming emotional content that incapacitates in one way or another, to first ride it and then to cook it, to learn what the feelings are teaching (and hey guess what? pursuing that course of internal activity usually leads to rearrangement of conceptual content. Today's careening or massively defeated person, in the course of making progress, may be tomorrow's schizzy).



Now, having said all that.... labor following pregnancy is a totally natural, healthy, normal, nonpathological activity, despite which set of facts a decent accumulation of mothers will testify that the needle at the right time sure made it a hell of a lot easier to get through. Similarly, even if (as I say) a good healthy dose of "mental illness" is almost invariably a passing-through stage that will ultimately lead to a better mental and emotional state of being (if not grossly interfered with and blocked), it remains true that for some people a bit of pharmacopeia of one sort or another can make the difficult journey a lot easier.

The offerings of the mental health system have been highly praised by many on this board, yea even by many participants in this thread. Not a bit of that is contradictory to the points that I am making. Reciprocally, the celebrated efficacy of this or that MH pharmaceutical in no way supports the proposition that the spokesfolks for the MH system know what the fuck they're talking about.

[Guinastasia]

I am right to be so enthused, especially insofar as my brilliant insights are indeed fucking brilliant and they are indeed the key to all manners of things, answers to age-old questions, and I know this because I am in personal contact with God and these things were revealed unto me. It's a coincidence that the answers to my personal problems just happen to also be the answers to the problems the world is facing in the post-agrarian, post-patriarchal phase it happens to be in now.


:dubious:

This is sarcasm, right?

[AHunter3]

:dubious:

This is sarcasm, right?
Yeah. Right. Sure it is.

:D

[davenportavenger]

Question: What difference would it make if they changed the label? I understand the physical difference between the two, but if you can't prove either one, and they still treat people involuntarily, what impact would it have on the issue at hand?I just have a feeling that it would have more legitimacy. Decades ago, someone with epilepsy would have been locked up, treated as crazy, maybe even subjected to pointless hours of therapy. Now, people with epilepsy aren't treated any different from other people with a serious illness (except for some really backwards religious people who haven't discovered the new devil diseases in vogue), and we know more about epilepsy than ever before. Who knows, maybe the same thing could happen with schizophrenia. I'm not going to parallel SZ with gayness since they are totally different things. There is NO inherent disadvantage in being gay, and most of us will agree that there IS one in being mentally ill.

None of the three central psychiatric diagnoses — clinical depression, bipolar disorder, or schizophrenia —are applied to people whose mental, emotional, and behavioral state cannot, far more often than not, be explained in large part by circumstances, events, situations. I would guess that there are physical components that predispose some people's minds to fall into the observed patterns more readily than other folks' do under comparable circumstances. I would also guess that there isn't a person alive whose mind will not, under the proper stimulus of events, go into those patterns.Okay, I'll buy that a "normal-brained" person could fall into the pattern of clinical depression based on life events alone. Maybe even type II bipolar. But if you're to convince me that every person, no matter how healthy their brain is, could start seeing visions or hearing voices based on life events alone, you're going to have to haul up cites a little more beefy than an editorial from PLoS.

Damn right, I'd love to follow the lead of the gay-rights movement, at least in part — at a minimum, pride in who we are despite whatever difficulties our condition may impose on us (as with disabilities-rights folks), and for those of us who feel that way about it, pride in our condition, embrace of it as a positive, and demands that people not only stop discriminating against us in the sense of putting up undue barriers or having laws that pertain to us but not other people, but also get over their mentalism and be neither hateful nor pitying towards us. We are everywhereI'll never understand the romanticization of mental illness by some so-called activists. I mean, yeah, pride in yourself, sure that's fine. But pride in the actual condition? I'm as radical as they come; I think the pharmaceutical companies themselves are the epitome of base corruption even if they have managed to help some people and I wouldn't mind seeing the insanity defense taken off the books except in the most extreme, extreme cases. However, even I accept the disease model of severe mental illness. I think the romanticization of people with idiopathic brain disorders does a lot more harm than good. If "mentalism" is neither positive or negative, then what impetus do insurance companies have to cover psych visits? What about those people that WANT a cure for their condition; if it's just a natural variation there's no reason to research it. Oh and I have known exactly zero people IRL who say they enjoy being mentally ill, even among those who have concerns about the pharm industry and psychiatry in general. And I know some fairly out-there people.

[AHunter3]

You know one now. Through all of this, even the I-want-to-be-dead parts and the please-hide-me-something's-wrong-with-me parts, I always retained a perverse preference for who and how I was over "normal". Never wanted to be like normal people, like the ones who had never had such problems. Wanted to go someplace, be someplace, where who and how I was would be common and not perceived as weird, yes. And my worst and lowest moments were of thinking my desire for that, along with my difference, was a manifestation of something being wrong with me, in which case I still would rather just be dead than fixed or cured.

I haven't spent my life in misery. I have felt joy and giddy triumph and exaltation and quiet serenity and peace. I like who I am, how I am.

Who I am and how I am is perceived as "not OK in the head" if I am not duly careful. I have to treat you, the rest of my species, with kid gloves. It's like anthropology, once you know how it al works and just get comfy with the idea of being OK in the head despite not getting much if any confirmational feedback from other people w/regards to your picture of reality. You realize how much others do depend on that confirmation process, and how threatened they are if you don't care about it and don't compensate.

I'm not alone though. (And yeah, I'll admit to deriving quite a bit of validation from that. We humans are just plain wired to want confirmational feedback). Many of us think the species mainstream is nutso, so each individual faces the choice of either being individually abberant from the nutso mainstream and therefore nutso due to isolation and lack of confirmational feedback or else conformist nutso to a nutso mainstream mindset.

[Zoe]

AHunter3, I believe that you are mistaken about depression being the result, in large part, of circumstances, events and situations. From what I have been able to observe in myself and others with similar depression problems over the last forty years, in general our circumstances can be really quite good but our perceptions of those circumstances change. We often even feel guilty for having so many advantages and not being able to get it together. (This isn't to say that people don't get depressed after traumatic events or during hard times. There are different kinds of depression that occur for differing reasons.)

AHunter3, what evidence is there, other than anecdotal that psychiatrists are lying to their patients that they "know all about it"? What evidence is there that "they want to render an incarcerated population tractable and amenable to rules, regulations, and institutional control and don't much care what it does to them in the process -- all of these at various times and places, usually in massive parallel"? Which psychiatrists are dangerous? Which institutions are dangerous Which hospitals are dangerous? Which organizations are dangerous? It doesn't do any good to slur the profession with generalities then admit that some of them serve a good purpose. What is your point -- beware of all psychiatric treatment until the science is certain?

Devilsknew: ...Also, simply that somebody has become "something" according to somebody else's judgement also smacks of witch hunt accusations and really is the heart of the problem...

Then perhaps your judgment of therapists as "perscription happy pshrinks" smacks of being a witch hunt and is really at the heart of the problem.

threemae: If more serotonin yields less depression, why do they take 6 to 8 weeks before they start working?

One does not logically follow the other. At any rate, the SSRIs that I'm familiar with begin to work in 2-6 weeks.

threemae: ...the way that peer-reviewed journals are/were set up until this year without pre-trial registration causes publication bias that tends to only get the one study that supports our cobbled-together explanation of serotonin and depression published but ignores the other 19 studies that showed opposite or null effects.

Cite, please.

[SnakesCatLady]

I believe anyone is entitled to be as "nutso" as they choose as long as they do not infringe upon the rights of others. If you are happy the way you are, fine. Go for it. But when you start messing with other people, then there is a problem. My husband was a psych nurse for many years - and finally quit because the administration didn't want to drug patients. Instead of being bitten, hit, kicked in the nuts, etc, he decided to find another field of nursing - and I sleep better knowing he is out of that place, even though they needed him and several of his co-workers have pleaded with him to come back.

I'm not sure of why Metacom was hospitalized against his will - it usually involves some sort of damage to others - either you've hurt someone else, you are a danger to yourself, or you've commited a crime where the authorities are afraid you will be hurt/hurt someone else if in custody.

I don't like the idea of putting someone in the hospital (for physical or psychological reasons) against their will. However, when people act in ways that endanger others, I don't see a lot of choice.

Frankly, I don't know you. I don't care if you kill yourself. But if you choose to do it in a way that takes others with you - that I have a problem with. I'm not talking about the OP in particular - as I said, I don't know what's going on with him. I'm talking about people who don't care about their own lives, so they don't care about the lives of others.

[threemae]

One does not logically follow the other. At any rate, the SSRIs that I'm familiar with begin to work in 2-6 weeks.

Why not? All that I'm saying, is that if SSRI's work simply be limiting the reuptake of serotonin and leaving more serotonin floating around in the synapses between neurons to help treat depression, then why do they begin to work on a timescale of weeks rather than hours? These neurons fire and then reabsorb neurotransmitters on the order of milliseconds. Explain to me with your model why this delay plausibly occurrs.


Cite, please.

Umm, I think you're missing the point, that being that the null findings aren't being published and therefore aren't citeable. When we look at the totality of a certain group of studies, such as refering to all FDA clinical trial stuides, we mind that the majority of studies on the effectiveness of SSRI's find no difference between SSRI's and placebo. If you want other evidence of publication bias, I'll refer you to that 2001 The Lancet metastudy which found that homeopathy was an effective treatment of a number of diseases. Finally, I'm not saying anything that a lot of professionals in medical science don't agree with. In the past months, the most prestigious medical journals including JAMA and The Lancet have taken the very important step of requiring the preregistration of studies before being willing to publish them. Basically, this means that null-findings won't just languish on some scientist's hard drive but be reported in the journals. This should go a long way towards ending or greatly reducing the role of publication bias in modern science and I hope that it sets precidence for a number of similar academic fields such as clinical psychology.

[Zoe]

threemae: Finally, I'm not saying anything that a lot of professionals in medical science don't agree with.

Yeh, yeh, I know. But there's this publishing bias against them and so there are a whole lot more medical professionals on record at this time as supporting other data, and so on.

I am not qualified to answer questions on pharmacology and the brain. I have only anecdotal experience with depression and SSRIs.

Please provide links to your numerical claims.

[Metacom]

I'm not sure of why Metacom was hospitalized against his will - it usually involves some sort of damage to others - either you've hurt someone else, you are a danger to yourself, or you've commited a crime where the authorities are afraid you will be hurt/hurt someone else if in custody.
No, you don't. So please don't speculate, because the implications are slanderous. It was none of those things--I was a minor at the time, so I didn't have the rights afforded to an adult and none of those conditions applied.

And I'm not going to go in to further details, because it's none of your fucking business. Unlike others in this thread, I haven't used my personal history as anecdotal evidence, so it isn't really up for debate.

[Wesley Clark]

Why not? All that I'm saying, is that if SSRI's work simply be limiting the reuptake of serotonin and leaving more serotonin floating around in the synapses between neurons to help treat depression, then why do they begin to work on a timescale of weeks rather than hours? These neurons fire and then reabsorb neurotransmitters on the order of milliseconds. Explain to me with your model why this delay plausibly occurrs.


.

I don't think people know for sure how they work. They could work due to SSRIs bringing about changes receptor sensitivity and regulation as a side effect of the extra serotonin, which would explain why it takes weeks instead of days.

[DSeid]

There are several concepts being intermingled in this thread.

How good is the evidence of SSRI effectiveness on depression?

Fairly good, but only moderately better than placebo.

How good is the evidence that many mental illnesses have a large biologic component?

Overwhelmingly good. Of course it depends on the illness and for some psychosocial factors play a bigger role than others.

Do we really understand the biologic basis of the mind?

No, although we understand much more than we used to and are making substantial progess.

Is mental illness arbitrarily defined relative to function within society? Could the same person be defined as normal within one society and ill within another?

Yes. Our hallucinatory schizophrenic could be another society's revered prophet. And if someone prefers to function within their society of one or few, then our society generally says fine, so long as you do not infringe upon what we consider our rights or represent an explicit harm to yourself.

Have those principles been consistently followed?

No. Many example abound individuals having their rights trampled upon. And honest debate exists over how much society should punish crimes committed in states of mental illness or treat them. Whole long long threads about just that. AHunter believes strongly in the rights and responsibilities of the mentally ill and punishing them for crimes the same as the non-ill.

[threemae]

Yeh, yeh, I know. But there's this publishing bias against them and so there are a whole lot more medical professionals on record at this time as supporting other data, and so on.

I am not qualified to answer questions on pharmacology and the brain. I have only anecdotal experience with depression and SSRIs.

Please provide links to your numerical claims.

You're confusing my scepticism over the explanation of how SSRI's work with arguments over scientific methodology. Again, I might be in the minority opinion regarding SSRI's, but I'm in agreement with the people that run our most prestigious medical journals. Are you simply asking for a citation that the top medical journals have gone to preregistered trials? Sure, if you want, I'll dig up a cite. For everything else, I think that AHunter3's article does quite a good job of summing up the research that leads to my skepticism over the, "story of SSRI's."

Wesley Clark, I agree that changes in receptor sensitivity are the most likely mechanism for SSRI's observed effects. I read an interesting paper in my Computational Cognitive Neuroscience class last year that made the argument that perhaps seratonin is actually positively linked to depression and depressive behaviors. Basically, the arguement continued that SSRI's increased overall seratonin levels at first and the brain responded by overcompensating and being less sensitive to serotonin, and ultimately this is what led to the weeks long gap in their effects, their final effects in treating depression, and possibly played a role in the highly controversial claim that patients are actually at a higher risk for suicide immediately after beginning SSRI's.

DSeid, great job of summarizing this thread.

[SnakesCatLady]

No, you don't. So please don't speculate, because the implications are slanderous. It was none of those things--I was a minor at the time, so I didn't have the rights afforded to an adult and none of those conditions applied.

And I'm not going to go in to further details, because it's none of your fucking business. Unlike others in this thread, I haven't used my personal history as anecdotal evidence, so it isn't really up for debate.

I wasn't speculating, and there is not reason to cuss me when I haven't said anything slanderous in any way. I don't care if you're batshit crazy or not - you have no reason to cuss me.

[Loopydude]

I'd like to point out that, while the "chemical imbalance" trope is, in its common usage, indeed to a large degree a load of horseshit, there is something legitimately to be said for the "serotonin hypothesis" in a wide spectrum of psychiatric disorders.

To give but one example of a rigorously scientific development in the testing of the 5-HT hypothesis, there is the discovery of the short 5-HTT allele (http://www.bio.davidson.edu/courses/genomics/2003/mccord/5-HTT.html). It doesn't take a genius to figure out that a person who clears the synapse of 5-HT hyperefficiently might benefit from a drug that inhibits the serotonin transporter. Such a person would, quite literally, have "low serotonin". Drugs that "raise serotonin" would be a direct intervention with such a problem.

Certainly, to say we've discovered something like a pop-culti "depression gene" in the short 5-HTT would be a gross oversimplification, but the linkage is robust. This gene appears to be a legitimate etiologic factor and hence carriers are probably at a higher risk of developing a mood and/or anxiety disorder. Combine this gene with environmental stressors, maybe other predisposing genetic or gestational issues, and a clinical psychiatric disorder seems probable.

I think it's worth mentioning, in any conversation of this sort, that the implication of certain neurotransmitters (namely 5-HT, norepinephrine, and dopamine) in psychiatric disorders was a serendipitous discovery. The first bona fide antidepressants, the MAOIs, were found completely by accident after a clinical trial of the TB drug iproniazid, left a lot of old and cranky veterans in a surprisingly good mood. Unfortunately, when some of them started eating tyramine-rich foods, serious problems (namely dangerous, even lethal hypertensive reactions) ensued which directly implicated norepinephrine as the culprit. Hence, an unforseend side-effect of iproniazid (the ability to strongly inhibit the breakdown monoamine neurotransmitters) was crucial to the development of the monoamine hypothesis, which itself spawned the more specific serotonin hypothesis in a subset of psychiatric disorders. Sure, the "chemical imbalance" thing gets abused to death, but this isn't some random concept evil pharma-peddlers pulled out of their arses to further their huxleyan goal of world dominatoin through medication.

I hate to say it, but get a grip.

[AHunter3]

Snakescatlady, when you post something that is so easily read as "Well if you got locked up in the looney bin I'm sure that's where you needed to be", you should't be too surprised if you get cussed out for it.

[Wesley Clark]

Wesley Clark, I agree that changes in receptor sensitivity are the most likely mechanism for SSRI's observed effects. I read an interesting paper in my Computational Cognitive Neuroscience class last year that made the argument that perhaps seratonin is actually positively linked to depression and depressive behaviors. Basically, the arguement continued that SSRI's increased overall seratonin levels at first and the brain responded by overcompensating and being less sensitive to serotonin, and ultimately this is what led to the weeks long gap in their effects, their final effects in treating depression, and possibly played a role in the highly controversial claim that patients are actually at a higher risk for suicide immediately after beginning SSRI's.



That is interesting. However Inositol, which is a supplement that can increase serotonin sensitivity is used to treat depression as well. So I'm not sure how it works.

http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/myo_0145.shtml

[SnakesCatLady]

Snakescatlady, when you post something that is so easily read as "Well if you got locked up in the looney bin I'm sure that's where you needed to be", you should't be too surprised if you get cussed out for it.

That is not what I said. I'm sorry you decided to take that way. What I said was that people don't usually get locked up just for shits n giggles, even though there are cases where people have been locked up who didn't deserve it.

[Guinastasia]

AHunter3, I'm not trying to make fun of you. I'm simply saying that if your evidence of being right is


I am right to be so enthused, especially insofar as my brilliant insights are indeed fucking brilliant and they are indeed the key to all manners of things, answers to age-old questions, and I know this because I am in personal contact with God and these things were revealed unto me. It's a coincidence that the answers to my personal problems just happen to also be the answers to the problems the world is facing in the post-agrarian, post-patriarchal phase it happens to be in now.


That God has revealed to you the answer, and thus, we should all take your word at it, well, you know damned well that doesn't fly around here. And I resent that you seem to look down upon those who WANT to be treated. Maybe you don't mean it that way, but that's how it comes off.

And I still don't know what you'd do for those whose illnesses do make them genuinely dangerous. You'd punish them for something beyond their control?

[Loopydude]

WHOOPS! It's the LONG allele (well, some of the variants of the long allele) that is more active, not the shorter one. At any rate, two copies, which alters 5-HT signaling, enhances risk for a variety of psychiatric disorders, and directly implicates serotonin, just as the drugs do.

[BrainGlutton]

Which part of that are you calling a woosh? I agree with pretty much all of it...

I was reluctant to believe AHunter3 was serious in arguing that things like schizophrenia and bipolarity should be reclassified as non-pathological personal characteristics, like homosexuality. I'm sorry, but these things, however widespread and little-notices they might be in our society, are illnesses, and nobody afflicted with them can live or function optimally without treatment.

[Loopydude]

Here's (http://www.reason.com/rb/rb080702.shtml) an OK article on linkages between antisocial behavior and deficiencies of the enzyme monoamine oxidase A.

It's interesting that two different drug classes, the reuptake inhibitors, and the monoamine oxidase inhibitors, specifically target molecules encoded by genes with variants that have robust linkages to psychiatric illness.

And this reminds me of something I forgot from reading my mom's textbooks: These drugs increase synaptic neurotransmitter levels, but the actual signaling of these neurotransmitters can be decreased by down-reglation of neurotransmitter heteroreceptors in the post-synaptic cell. Also, homoreceptors in the presynaptic cell play a role in regulation of neurotransmitter release and reuptake. The take-home message is the drugs screw with this system, and changes in neurotransmission ensue. In the case of antidepressants, it is these adaptive changes to artificially-increased signaling by some or many neurotransmitters that is hypothesized to mediate the therapeutic effect, and may also at least partially explain the delay in response to antidepressant meds., as the changes in neurotransmitter levels they induce are fairly immediate.

[Loopydude]

This (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12955294&dopt=Citation) is kind of interesting, and encouraging. The study indicates that when you go back and look a sertraline responders, the time-to-onset of efficacy, and efficacy itself, are impacted by patient genotype, specifically if they are homozygotes for one of the long-allele variants of the serotonin transportoer. In other words, the more they have of the drug target, the better response to the drug. Here we are witnessing, perhaps, the beginnings of effective psychopharmacogenomics. And again, of course, serotonin is involved.

[AHunter3]

BrainGlutton: I'm sorry, but these things, however widespread and little-notices they might be in our society, are illnesses, and nobody afflicted with them can live or function optimally without treatment.

Actually, I'm doing quite well and do not consider my condition an illness. I thank you very much for your concern, as long as your concern doesn't take the form of imposing upon me "help" that I do not appreciate or want.

Guin: That God has revealed to you the answer, and thus, we should all take your word at it, I didn't say you should take my word for it. I didn't say that back when my statements got me a diagnosis and a visit to the locked ward, either. What I've usually said is some variant of "I've had a revelation from God" <insert content here> "...of course I could be deluded about the 'revelation from God' thing, as could anyone making such a claim, and you should always do the grain-of-salt thing w/reference to such claims. If the content itself isn't compellingly sensible to you, believing that I obtained it via divine inspiration isn't going to make it any more so."

And I still don't know what you'd do for those whose illnesses do make them genuinely dangerous. You'd punish them for something beyond their control?

If such a person does not voluntarily seek treatment and/or arrange to be held where they can't harm anyone, and then subsequently does something violent to others, then, yes. It's what we do to people who hurt others. If that's not an appropriate response to the hurting of people by others, we need to revamp the entire philosphy of criminal justice, but that's what we've got.

If the person is genuinely incompetent, then the designated guardian can make arrangements for that person's care (and/or isolation from people that this person might harm). This is how we deal with people who lack judgmental capacity in general.

In both cases, there should not be a separate set of standards and regs and laws pertaining only to people who are "mentally ill".

[Metacom]

How good is the evidence that many mental illnesses have a large biologic component?

Overwhelmingly good. Of course it depends on the illness and for some psychosocial factors play a bigger role than others.
What greatly raises my ire though, is that the "psychosocial factors" seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors.

I think there are several reasons for this:

Thinking of mental illness like it's a physical disease absolves the patient of responsibility.
Thinking of mental illness like it's a physical disease absolves others in the patient's life of responsibility (I'm looking at you, NAMI).
Thinking of mental illness as a physical disease means pharmaceutical companies can make a LOT of money.


Further, I think that there are many cases when "mental illness" is a normal response to an abnormal situation, and leads to a situation where medicating the symptoms is more common (and more profitable) then truly helping the person.

(I'm also against non-consensual treatment, which is another thing that I dislike about the mental health establishment. But that's definitely another thread...)

[Loopydude]

What greatly raises my ire though, is that the "psychosocial factors" seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors.

Haven't spent much time in the "Self Help" section of the bookstore, I see.

[Metacom]

Haven't spent much time in the "Self Help" section of the bookstore, I see.
Do you think that the "Self Help" section of the bookstore represent the mental health industry?

[Loopydude]

Well, as far as the non-drug angle of that industry goes, given that many of the good books in the Self Help section are written by psychologists, yeah I do. There's an entire field devoted to the notion that patients take ownership of their problems and strive to make their thinking more healthy and constructive. It surprises many that it's not the "mental health industry" so much as the insurers that make getting talk therapy so difficult. Why? Because talk therapy is hugely expensive.

[ouryL]

Lake Erie College of Osteopathic Medicine
Lake Erie College of Osteopathic Medicine
Lake Erie College of Osteopathic Medicine

[Metacom]

Well, as far as the non-drug angle of that industry goes, given that many of the good books in the Self Help section are written by psychologists, yeah I do.
OK... I'll agree that books that aren't about drugs represent the non-drug portion of the industry. :)

I didn't say that the non-drug angle didn't exist, I said the mental health industry was increasingly dominated by a viewpoint that favored biological factors over psychosocial ones.

[Metacom]

On second glance, you may have been keying off "grossly neglected by the mental health industry" as a whole, and not the immediate "increasingly dominated ..."

I believe both clauses, of course...

[Loopydude]

I didn't say that the non-drug angle didn't exist, I said the mental health industry was increasingly dominated by a viewpoint that favored biological factors over psychosocial ones.

To which I say I disagree completely. Nearly every article one can cite on the subject of pharmacogenomics mentions the importance of environment in the etiology of mental illness. In fact, the most oft-mentioned reason for explaining the difficulty of finding the genetic components of disease has been the importance of environment, as the heterogeneity of phenotypes vs. genotypes tends to confound any attempt at making simple genetic linkages. It's a completely built-in concept now: Genetic factors don't act alone, and there is no single "depression gene" (or BPD gene, or ADD gene, or schizophrenia gene, or any other). The idea that talk therapy is helpful for a vast majority of cases, and can even be substituted for pharmacotherapy in many instances is virtually universally held among mental health practitioners (of which my mother is one). Both drugs and talk are regarded as useful tools, and as talk has few, if any side-effects, many a psychiatrist would rather see their patients get it. Again, the biggest hurdle in the way of patients getting the talk therapy they need are the draconian restrictions put on the number of sessions that will be funded before the patient must pay out-of-pocket. As a single therapy session can easily cost more than a month's supply of psychiatric drugs, the math isn't difficult to do.

Plus, everyone wants a drug for what ails them, so in the popular media, talk about "the depression gene" and the "cure for mental illness" that comes in a pill gets all the air time. It's not nearly as sexy on the tube as the months of sometimes arduous and/or tedious talk in an office or group setting that psychotherapy involves. The popularized notion of Prozac Nation is a gross distortion of how care is actually delivered, and how caregivers would like it delivered.

[Metacom]

To which I say I disagree completely. Nearly every article one can cite on the subject of pharmacogenomics mentions the importance of environment in the etiology of mental illness.
That explains why that unhappy ovoid in the Zoloft commercial paused to explain that pills may not be the answer.
The popularized notion of Prozac Nation is a gross distortion of how care is actually delivered, and how caregivers would like it delivered.
That's an overgeneralization. It may be a gross distortion of how care is delivered to some, but it's a pretty accurate represenation of how it's delivered to others.

[Metacom]

Does anyone have statistics on:

The number of prescriptions for psych drugs written by non-psychiatrists (like, say, pediatricians prescribing ritalin, or GP's prescribing anti-depressants or minor tranqs) compared to the number written by psychiatrists.
The number of people using meds as their sole form of treatment, the number using psychotherapy as their sole form of treatment, and the number using both?
Of those using both psychotherapy and meds, how frequently are their sessions?
The amount of money spent on psych drugs and psychiatrists vs. the amount of money spent on psychotherapy.

Just to inject some hard facts into this mess, if that's possible. :p


You're kind of proving my argument, Loopydude. You're saying that we're not a Prozac nation, then you're saying that it's much harder to get long term psychotherapy then psych drugs.

The industry may acknowledge the importance of environment, but what matters isn't what it believes but what it actually does. And, for a variety of reasons, in action it really seems to be favoring a predominantly biological model. That now-infamous Zoloft commercial may not have represented what doctors believe, but it does represent how many act--the "it's just a chemical imbalance, take the pill" line isn't some off-the-wall caricture.

[DSeid]

the "psychosocial factors" seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors.
I do not totally disagree that the biological/medical model is pre-eminent but I think there are other reasons more pertinent.

Therapy aimed at psychosocial factors has little evidence of actually bringing significant results. (Cognitive Behavioral Therapy has an evidenciary basis but is not quite the same.) It is time and labor intensive and not at all cheap.

Psychiatrists are not well compensated for therapy, they are compensated for volume. They are no longer well trained for therapy, they are trained well in psychopharmocology. They want to help and really only have one set of tools left in the box, the hammers that are meds. So lots end up looking like nails.

Psychologists and social workers are trained in therapy but are paid less well and quality varies drastically. It takes time. Results are often unimpressive. Especially in the absence of treatment with medication as well. Payors often drastically limit the number of sessions approved. Paying for this out of pocket is out of the question for most ... excepting Woody Allen, of course. Still there are many out there and therapy is hardly underrepresented as a treatment option.

[Loopydude]

You're kind of proving my argument, Loopydude. You're saying that we're not a Prozac nation, then you're saying that it's much harder to get long term psychotherapy then psych drugs.

How so? You're making odd and unsubstantiated assertions about what motivates the "mental health industry", I say the perception of those motivations is distorted, point out how an unhealthy skew toward pharmacotherapy is largely a function of the expediency of drugs, and you say that proves your point. Nor does the "Prozac Nation" caricature in any way resemble the true status of the "industry". Sure, drugs are probably used when therapy would be just as beneficial due to time or money constraints, and sure primary caregivers probably shouldn't be doling out these drugs as much as they do, if at all, but again that's a function of limited resources, not some self-serving campaign on the part of "the mental health industry" to make everything into a biological drug target for profit.

[zagloba]

A major reason, if not the main reason, why SSRIs take a lon time to have an effect is that they have very long half lives in the body. On a given dosage of Prozac, IIRC, it takes on the order of two weeks for the drug's concentration in the body to reach steady state.

[Loopydude]

A major reason, if not the main reason, why SSRIs take a lon time to have an effect is that they have very long half lives in the body. On a given dosage of Prozac, IIRC, it takes on the order of two weeks for the drug's concentration in the body to reach steady state.

Half-lives in the SSRI class vary widely. It's nearly two weeks for fluoxetine, but it's only about 20 hours for paroxetine. So far as anyone can tell, the most salient practical concern for the patient is the potential for severe SSRI withdrawl syndrome should the drug be terminated, or a dose is missed, with the shorter half-life drugs. Delay to therapeutic onset is roughly the same for all of them, despite the differences in pharmacokinetics.

[Loopydude]

The Hell? I hit Preview, dammit. Please delete first post above...

[jshore]

I agree (with Metacom et al.) that anti-depressives are probably overprescribed, at least in large part because of the push of the pharmaceutical industry.

Another problem is that the expensive SSRIs are pushed in preference to good old-fashioned dirt-cheap tricyclics. While it is true that the tricyclics have troubling side effects for some, this is not a blanket statement. I am one person for whom the side effects for the tricyclics are non-existent to positive (e.g., to the extent that the one I'm on produces a little sedation...which for me seems to be fairly little anyway...it is a good thing). My one trial on an SSRI (Prozac, as this was ~1990 and it was the only one around) was a complete disaster...I was agitated and couldn't eat or sleep.

Anyway, this is just by way of saying that these drugs are certainly not one-size-fits-all. They affect different people in different ways. And, one shouldn't necessarily assume that the newer, way more expensive drugs will be more effective (or more tolerable) for you than the older, cheaper ones.

[Loopydude]

Another problem is that the expensive SSRIs are pushed in preference to good old-fashioned dirt-cheap tricyclics. While it is true that the tricyclics have troubling side effects for some, this is not a blanket statement.

Blanket statements can't be made about any drug class, even the SSRIs these days, as dirt-cheap generic brands of fluoxetine and paroxetine are now available.

In the tricyclic class, there are the secondary and tertiary amine subclasses, and the latter tend to have particularly noxious side-effects for some, due to their potent anticholinergic and anti-histaminergic properties. If you were on desipramine, for instance, your side-effects might be relatively minor, but you might find amitriptyline unbearable. Also, the tertiary amines have a more potent ability to block alpha-1 adrenergic receptors, which can lead to dangerous AV block in certain cardiac patients, and yield an abnormal EKG even in heart-healthy patients. As it so happens, the secondary amine tricyclics have little or no ability to potentiate serotonin (inhibiting only the reuptake of NE significantly), while the tertiary amine tricyclics are good dual-acting compounds (sometimes even more selective for 5-HT, as in the case of clomipramine), and hence may be better for a broader spectrum of depressed patients, as well as OCD (clomipramine was the first drug approved for that indication).

For the great majority of patients needing a serotonergic drug, an SSRI is a much better choice than a tricyclic. Same goes for a dual-acting drug, in that venlafaxine or duloxetine is probably going to be much better tolerated. This is the primary reason why tricyclics are no long first-line drugs. It's not because people are being discouraged from for specious marketing reasons, it's because the side-effects of these drugs are typically unpleasand, can can be downright dangerous for some. No antidepressant has exceeded the effectiveness of MAOIs, but would you want to be the doctor prescribing them to patients who you can't trust to stick to the diet?

You guys should really read up on this stuff before you proclaim it's all a big conspiracy. Yeah, the benefits of Prozac were oversold, but the excitement over the SSRI class was as big among the clinicians as anyone else, who knew the biggest reason patients who needed the meds kicked them was because of the unbearable side-effects of older agents.

[jshore]

In the tricyclic class, there are the secondary and tertiary amine subclasses, and the latter tend to have particularly noxious side-effects for some, due to their potent anticholinergic and anti-histaminergic properties. If you were on desipramine, for instance, your side-effects might be relatively minor, but you might find amitriptyline unbearable.

My personal experience is with Sinequan (Doxepin), which I believe is a tertiary amine...at least I know it is a tricyclic that is supposed to have amongst the most potent anticholinergic and anti-histaminergic properties.


This is the primary reason why tricyclics are no long first-line drugs. It's not because people are being discouraged from for specious marketing reasons, it's because the side-effects of these drugs are typically unpleasand, can can be downright dangerous for some.

Well, I don't doubt that the SSRIs may be best for most people. However, doctors need to recognize that not everybody is the same and I, in particular, find the side effects of what is probably the most sedating tricyclic to be a positive...And I found the side effects of at least one of the SSRIs to be completely intolerable. Am I an average patient? Probably not...but I am sure there are others like me. If I were a physician, I would ask patients things like how they react to sedating or activating drugs...and, if they are someone like me who tries to avoid almost any activating substances and finds little effect...usually beneficial if at all...from sedating drugs, I would at least consider the possibility of using tricyclics on this patient.


You guys should really read up on this stuff before you proclaim it's all a big conspiracy. Yeah, the benefits of Prozac were oversold, but the excitement over the SSRI class was as big among the clinicians as anyone else, who knew the biggest reason patients who needed the meds kicked them was because of the unbearable side-effects of older agents.

Personally, I am trying to walk a middle road between some of the extremes in this thread. I am not saying it is all a big conspiracy. I know that there are legitimate reasons to be excited about the SSRI class. However, I do wonder if the extreme to which the preference has evolved toward SSRI's (and particularly the newest few that are still not in generic form and are quite expensive) is at least partly a result of marketing.

[Loopydude]

Well, those qualifications sound perfectly reasonable, but your earlier post more than implied the majority of prescription of SSRIs (at least, the non-generic variety) was a function of marketing.

Of course direct-to-consumer marketing is a vile practice, but it's not limited to antidepressants, and it's not consumers who are ultimately writing the prescriptions. I'm sure it has an impact on overprescription in general, but again, this is not a problem limited to the mental health field. I think among the biggest reasons physicians are happy to write scripts when asked for Prozac or its ilk is because those drugs are actually quite safe for the vast majority of people. Not true of the tricyclics, which are quite lethal in overdose, for instance (my Mom once told me that 20,000 people a year OD'd on tricyclics in 1995, and 500 of those died, whereas it's almost impossible to kill yourself with a typical supply of Prozac), or MAOIs, which can not only be lethal in overdose, but also with the wrong foods or drug. combos (including common cold remedies).

[davenportavenger]

Just wondering, AHunter3, Metacom, et al, what are your opinions of those who seek psychiatric help? (Either talk therapy or drugs.) Do you think they're brainwashed? Sell-outs? Conformists? Do you think less of people when you find out they take medication or do therapy? I believe that people should be allowed to decline treatment but I also try to respect the treatment decisions of others (to a point... I do think ECT should be outlawed and the doctors who perform it kicked out of the profession), and I was just wondering where you stand personally with people who choose to employ such treatment options.

[MLS]

Just wondering, AHunter3, Metacom, et al, what are your opinions of those who seek psychiatric help? (Either talk therapy or drugs.) Do you think they're brainwashed? Sell-outs? Conformists? Do you think less of people when you find out they take medication or do therapy? I believe that people should be allowed to decline treatment but I also try to respect the treatment decisions of others (to a point... I do think ECT should be outlawed and the doctors who perform it kicked out of the profession), and I was just wondering where you stand personally with people who choose to employ such treatment options.
Before you say ECT should be outlawed, you should hear the stories of those who have found that it helped them. Yes, it should be IMHO a last resort, but it does sometimes have beneficial results. For a story about one such person, check out the book Electroboy (http://www.amazon.com/gp/product/0812967089/102-8951321-2267369?v=glance&n=283155&n=507846&s=books&v=glance) by Andy Behrman. After numerous failed therapies, and a life in ruin, he found that a series of (voluntary) electroshock treatments enabled him to finally find some balance.

[jshore]

but I also try to respect the treatment decisions of others (to a point... I do think ECT should be outlawed and the doctors who perform it kicked out of the profession)

Did you read my posts earlier in the thread? ECT can be a virtual lifesaver for some people...and it is done very differently now than it was in the days of old. It is actually safer and far more effective for the treatment of severe depression in the elderly than drugs are. Let's try to keep an open mind here.

[jshore]

The post numbers are #34 and #49, BTW.

[Metacom]

ECT can be a virtual lifesaver for some people...and it is done very differently now than it was in the days of old.
Correct. Now they use sedatives so it's not as emotionally traumatic to the patient; however, they have to use more current to overcome the sedatives and induce convulsions to it's more physically traumatic.

Much better.

[Metacom]

You're making odd and unsubstantiated assertions about what motivates the "mental health industry", ...
No I'm not. I gave some reasons for why I think the biological model is becoming predominant. That's not at all equivalent to saying that those things are what motivates the mental health industry.

[Telemark]

Did you read my posts earlier in the thread? ECT can be a virtual lifesaver for some people...and it is done very differently now than it was in the days of old. It is actually safer and far more effective for the treatment of severe depression in the elderly than drugs are. Let's try to keep an open mind here.
I've got a friend who's life was pretty much saved by ECT. It's probably not for everyone, and it can have serious side effects, but it can work wonders.

[Metacom]

I've got a friend who's life was pretty much saved by ECT. It's probably not for everyone, and it can have serious side effects, but it can work wonders.
So can placebos, which is why anecdotal testimony like this isn't the best evidence.

[AHunter3]

davenportavenger: Just wondering, AHunter3, Metacom, et al, what are your opinions of those who seek psychiatric help? (Either talk therapy or drugs.)

I think they are in the same position as someone who finds it necessary to go shopping for a good used car in a northern Mexican town close to the US border. Caveat fucking emptor. Watch your back. I do not have contempt for these people. I was one of them once. Consider me, ummm, thrice burned and ultrashy or something like that but I have absolutely no contempt for someone seeking the help.


Do you think less of people when you find out they take medication or do therapy? I believe that people should be allowed to decline treatment but I also try to respect the treatment decisions of others

Me too. I'm not saying I don't have some prejudices and uneasinesses, but I, of all people, have no business second-guessing someone else's medical decisions. I mean, talk about not being able to have it both ways!!

(to a point... I do think ECT should be outlawed and the doctors who perform it kicked out of the profession)

Nope, not that either. I think with fully informed consent (which ain't happening right now, more lies and/or absence of whole truths), hey, if you want to lick the live end of a lamp socket and your doc recommends it, who am I to get in your way? I have an abysmally bad opinion of ECT though.

[jshore]

So can placebos, which is why anecdotal testimony like this isn't the best evidence.

Well, there have been controlled studies of this. But, you also have to realize that we are talking in most cases about people with very severe depression who have had a number of other treatments that they did not respond to. The effect is incredibly dramatic and strongly correlated in time with the treatments which last a couple of weeks in most cases (and, to be honest, with my relative specifically with when the treatments also started to show the side effects in her memory). While it can't be ruled out in any individual case that some sort of "miraculous recovery" occurred spontaneously, it seems rather unlikely...And, as I said, there are more rigorous studies too.

Look, our family (which includes both a psychologist and a social worker) was very leery of ECT and really held out against it for a while when it was being strongly advised by the doctors. But, I think its dramatic effects has made believers out of all of us. I know everybody's experience is not as positive...But, as I said, it is the single most effective treatment for severe depression and, in elderly patients who don't tolerate medication well, it is also said to be the safest.

[jshore]

My guess, although I am not sure I read this anywhere, is that ECT also probably works best for someone who has generally been mentally well but has a severe depression with a sudden, acute onset. That describes my relative well...She has always been a worrier, prone to anxious and obsessive thinking, but was otherwise fine and happy and fully functional in the world. In a manner of a week or so's time she descended into a severe depression. And, concurrent with the ECT, within a week or so's time, she completely pulled out of it.

[davenportavenger]

Did you read my posts earlier in the thread? ECT can be a virtual lifesaver for some people...and it is done very differently now than it was in the days of old. It is actually safer and far more effective for the treatment of severe depression in the elderly than drugs are. Let's try to keep an open mind here.Well, as safe as running thousands of volts of electricity through a sensitive organ can be. Even aside from the memory loss, some of the side effects of ECT are cognitive impairments (though not standard, a drop in IQ is not all that unlikely), brain hemorrhage, and broken bones caused by jerking against restraints. Brain damage as a result of ECT, from the American Journal of Psychiatry. (http://www.idiom.com/~drjohn/amjpsych.html) And though death is uncommon, it still occurs at a rate of one out of 10,000. And according to this site (http://www.pai-ca.org/Pubs/539801.pdf#search='ect%20side%20effects') (warning: PDF!), you can receive ECT without consent, and it can also be given to children over 12 (something I didn't know), in which case their parents decide for them. I don't care how "safe" it is, I don't see any good reason for pumping volts into a growing brain.

[jshore]

broken bones caused by jerking against restraints. Brain damage as a result of ECT, from the American Journal of Psychiatry. (http://www.idiom.com/~drjohn/amjpsych.html) And though death is uncommon, it still occurs at a rate of one out of 10,000.

The broken bones and restraints are from the days before they used sedatives and muscle relaxants. That article you cite is 30 years old and very biased. Look, I am not saying that ECT is a walk in the park...but neither is severe depression. If you saw someone who was very close to you in the midst of it and then recovered after the ECT treatments, your view of it might change quite a bit.

[jshore]

Here (http://www.psycom.net/depression.central.ect.html) is a site with lots of good links on ECT.

From the first link:


ECT has a higher success rate or severe depression than any other form of treatment. It can be life-saving & produce dramatic results. It is particularly useful for people who suffer from psychotic depressions or intractable mania, people who cannot take antidepressants due to problems of health or lack of response & pregnant women who suffer from depression or mania. A patient who is very intent on suicide, & who would not wait 3 weeks for an antidepressant to work, would be a good candidate for ECT because it works more rapidly. In fact, suicide attempts are relatively rare after ECT.

...

While there are certainly patients who perceive the treatment as terrifying & shameful, & some who report distress about persistent memory loss, many speak positively of the benefits. An article entitled "Are Patients Shocked by ECT?" reported on interviews with 72 consecutive patients treated with ECT. The patients were asked whether they were frightened or angered by the experience, how they looked back at the treatment, & whether they would do it again. Of the patients interviewed, 54% considered a trip to the dentist more distressing, many praised the treatment, & 81% said they would agree to have ECT again.


From the 2nd link:


The current practice of ECT is considered safe and clinically effective. The efficacy of ECT has been well established in study after study. The published experience has been peer-reviewed and endorsed by commissions and task forces delegated from the American Psychiatric Association and most recently from the Office of the Surgeon General. The overall safety record of ECT has been remarkable, especially when considering the risk to benefit ratio for patients with severe emotional disorder who are actively suicidal or severely malnourished. In the United States an estimated 100,000 patients per year receive electroconvulsive treatment. In 1988, the mortality rate had been reported at approximately one death per 10,000 patients treated. The rate of significant morbidity and mortality at that time was believed to be lower with ECT than with administration of antidepressant medications, despite the frequent use of ECT in patients with medical complications and in the elderly.6,7 For many elderly depressed patients with medical comorbidities, ECT is the safest and most effective treatment available.

[Loopydude]

Oh, dear Og, not the ECT tinfoil hattery as well. When will this bizarre meme finally die?

[davenportavenger]

Here (http://www.psycom.net/depression.central.ect.html) is a site with lots of good links on ECT.You mean, links you agree with. Thanks for the heads-up about the date of the last article, though. Here's a fresh one. (http://www.ect.org/effects/2-18-2003_cognitivemaint.html) "Safer" does not necessarily mean "safe." And while I'm glad your relative improved, I'm sure there's plenty of anecdotal evidence that showed lobotomy was a good idea too. I think that in thirty years we'll look on new-and-improved ECT as the lobotomy of our day--perhaps beneficial for a few, but by and large a barbaric practice.

I mean really. You're pumping electricity!!! Into the brain!!! This is right up there with dwarf bone-breaking and botulism for wrinkles. Think about it.

[Loopydude]

Here's where I check out. This is clearly devolving into something not even remotely related to evidence-based debate over psychiatry, if ever it was. Might as well be sparring with Scientologists.

[davenportavenger]

Here's where I check out. This is clearly devolving into something not even remotely related to evidence-based debate over psychiatry, if ever it was. Might as well be sparring with Scientologists.Do you think there is no chance that ECT might be regarded as less than a miracle in the coming decades? I've admitted that it does some good for some people; I just think the side effects outweigh the good things and that the potential for abuse makes it a less-than-optimal treatment option. Why are the ECT supporters so confident in the safety of the procedure? Haven't "medical miracles" ever been discredited?

[jshore]

And while I'm glad your relative improved, I'm sure there's plenty of anecdotal evidence that showed lobotomy was a good idea too.

Dude, you have no freakin' idea what you are talking about. We are talking about someone who was in a hospital terrified, seeing "filaments" in the walls, obsessively terrified about simple everyday things (like clean laundry). Within a few weeks, she was back to going to see plays and movies, cooking and entertaining, reading, enjoying her grandchildren...and, to be honest, several weeks after the procedure, I couldn't see any cognitive/memory impairments from her pre-depressive state whatsoever.

I'm beginning to see what you mean, Loopydude. People will believe what they want to believe.

[davenportavenger]

Dude, you have no freakin' idea what you are talking about. We are talking about someone who was in a hospital terrified, seeing "filaments" in the walls, obsessively terrified about simple everyday things (like clean laundry). Within a few weeks, she was back to going to see plays and movies, cooking and entertaining, reading, enjoying her grandchildren...and, to be honest, several weeks after the procedure, I couldn't see any cognitive/memory impairments from her pre-depressive state whatsoever.And I could probably pull an anecdote that shows ECT is a dangerous. Oh wait, I can. (http://www.healthyplace.com/Communities/Depression/ect/news/newyork/andretest.asp) The plural of anecdote is not proof. Do you honestly believe that ECT has NEVER harmed anyone, that its outcome is ALWAYS good? You accuse me of hearing what I want to hear, but from where I stand you're doing the exact same thing. And you're not even admitting to the possibility of harm, while I've stated the possibility of benefits.

Fine, if somebody wants to shock themselves, be my guest. But I don't think that the approval process is strict enough, and I don't believe all the benefits and risks are laid out to the patients fully enough before they begin the procedure. There are enough dissatisfied customers of ECT that lead me to believe this. And I don't care how many nondepressed grandmothers there are as a result of the procedure, if even one person suffered ill effects or felt they were pressured into it, then that needs to be taken into account. I honestly believe that the hit-to-miss ratio on ECT, if it were applied to a non-mental illness-related procedure, would cause it to be banned or at least reviewed a LOT more seriously than it is currently. I think its shoddy record is allowed to continue because the people receiving it are by and large disenfranchised and not taken seriously. You may disagree. But don't you dare call me a Scientologist or say that I'm not hearing your side. I'm reading your links. I just don't agree with them.

[Shagnasty]

And I could probably pull an anecdote that shows ECT is a dangerous. Oh wait, I can. (http://www.healthyplace.com/Communities/Depression/ect/news/newyork/andretest.asp) The plural of anecdote is not proof. Do you honestly believe that ECT has NEVER harmed anyone, that its outcome is ALWAYS good? You accuse me of hearing what I want to hear, but from where I stand you're doing the exact same thing. And you're not even admitting to the possibility of harm, while I've stated the possibility of benefits.

You have to take into account that ECT patients usually have severe clinical depression which, in case you have never seen it first hand, makes someone look and act like truly like death. They tend to resemble a person in a nursing home during their last days of life. It is completely non-functional. These aren't people that just feel a little sad.

Also take into account that ECT is rarely used as a front-line treatment. Doctors usually try medications, talk therapy, and light therapy before ECT.

ECT has improved tremendously over the last few decades and the risks are fairly low. Your fallacy is that you don't take into account that many of these patients will suffer irrevocable harm and possibly even death if they don't get a successful treatment. You have to weigh both sides of the risks to the patient before you can say if ECT is appropriate for a patient or not.

[even sven]

Exactly. If the drugs don't work at all, then how does one explain the relapses that somehow occur in some patients, shortly after going "off their meds"?

The same way you explain "Well, after a while sometimes the drugs just stop working, and you have to ajust the medication, try some different things, different doses...."

[Guinastasia]

I mean really. You're pumping electricity!!! Into the brain!!!

Yep. Did you know they also use it on our HEARTS too? Imagine that!

:dubious:

I seem to remember you saying in a Pit thread not long ago that you were raised with the meme that mental illness is a sign of weakness, and that you still have to struggle with this. Might this not be coloring your opinions here?

Once again, ECT is used rarely, and only in extreme cases. Lobotomies are NOT performed anymore, and to compare the two is quite ludicrous.

[Shagnasty]

Yep. Did you know they also use it on our HEARTS too? Imagine that!

:dubious:

I seem to remember you saying in a Pit thread not long ago that you were raised with the meme that mental illness is a sign of weakness, and that you still have to struggle with this. Might this not be coloring your opinions here?

Once again, ECT is used rarely, and only in extreme cases. Lobotomies are NOT performed anymore, and to compare the two is quite ludicrous.

I agree. davenportavenger is completely ignorant of the reality surrounding severe mental illness as are many of the others. I was thinking about the defibrilator comparison too. It has risks but it saves lives when nothing else can. Don't worry about the long-term consequences of using your fire extiguisher if your house is about to burn down with your family in it.

I swear some of these people are judging mental illness by their friends that got Prozac from the student health center doctor. It is not always that way and it gets much, much more dire. There is no way that someone could spend a day in a psychiatric lockdown ward without having those views shattered.

It is also not fair to single out psychiatric drugs because we don't have a full understanding of what they do. The human brain is the most complicated thing in the known universe. It could range from many years to many hundreds of years before we have it all tied together.

This isn't unique to psychiatry. Other fields have findings all the time that are similar. Take an aspirin a day to protect your heart. "How does that work exactly down to the lowest level of detail?". We don't know. It just correlates well with the data. Most circulatory drugs are that way. Should we wait to we can model everything down to the sxubatomic level before we treat diseases using what statistics tell us?

Try this the next time your computer has a bug or crash. Try to research the lowest level of detail including the operating system, drvers, bios, and hardware. You say: "Rebooting/reinstalling solved the problem, I am all set?" That is not what you are requiring from psychiatric resaerchers. They just want an effective solution. It doesn't matter if it comes from drinking pink KoolAid as long as good research studies show a scientifcially valid positive outcome. It is the same thing earlier people did to try to come up with treatments for various diseases. It is Ok for the theoretical framework to lag behind the practical findings.

[Metacom]

I seem to remember you saying in a Pit thread not long ago that you were raised with the meme that mental illness is a sign of weakness, and that you still have to struggle with this. Might this not be coloring your opinions here?
A similiar statement could be made that your positive experiences with psychiatric care are colouring yours. Pretty much everyone in this thread has had experiences that influence their opinions. And unless he offers up his own experiences as evidence of something, I don't see how they have a place in the debate (same as your experiences).
Once again, ECT is used rarely, and only in extreme cases. Lobotomies are NOT performed anymore, and to compare the two is quite ludicrous.
Given that they both "work" by causing brain damage, I'd say a comparison between the two is appropriate. Obviously ECT isn't as bad as a lobotomy, but that doesn't mean it's "ludicrous" to compare the two.

[Metacom]

I agree. davenportavenger is completely ignorant of the reality surrounding severe mental illness as are many of the others. I was thinking about the defibrilator comparison too.
It's a completely bogus comparison. The impending death of someone with a heart attack is FAR more immediate then the possible suicide of someone with depression.
There is no way that someone could spend a day in a psychiatric lockdown ward without having those views shattered.
There most certainly is a way. Other people have had different experiences and have formed different opinions then you.
It doesn't matter if it comes from drinking pink KoolAid as long as good research studies show a scientifcially valid positive outcome. It is the same thing earlier people did to try to come up with treatments for various diseases.
It's also the same thing they did to come up with lobotomies, insulin comas, metrazol injections, and sterlization programs. Those things all "worked," in that they produced an outcome that the doctors (and society) wanted and were endorsed by the brightest minds in psychiatry at the time.

[Shagnasty]

[QUOTE=Metacom]It's a completely bogus comparison. The impending death of someone with a heart attack is FAR more immediate then the possible suicide of someone with depression.[QUOTE]

People think that severe depression means that someone is just really, really sad. It isn't that way at all. "Depression" refers to the fact that whole body and brain systems are shutting down. It is caused somewhere in the nervous system but that doesn't mean the person has conscience control over it.

The immediate threat of heart stoppage isn't important. The person is dead in any practical sense and there may be some spontaneous recovery or no recovery over time. There is no way to know but there is a treatment that will help them get better fast and the risks are low but not nonexistant.

[QUOTE=Metacom]There most certainly is a way. Other people have had different experiences and have formed different opinions then you.[QUOTE]

Time to pay the piper on this one.

Who has spent a significant time on an adult lockdown psychiatric ward and come to the conclusion that:

A) Severe psychiatric disease are just misinterpreted human actions within the normal range.
B) There is no such thing as a psychiatric illness
C) All patients will just snap out of it on their own given time.
D) People can choose not to have a psychiatric disorder if they try hard enough
E) People classified with severe psychiatric illnesses can be cured if you put them in the right environment.

Answer point by point if you know someone.

[Gorgonzola]

Lake Erie College of Osteopathic Medicine
Lake Erie College of Osteopathic Medicine
Lake Erie College of Osteopathic Medicine
Truly, the money phrase (http://www.aacom.org/om.html).

[Zoe]

In the early 1960's I was twice given a series of ECT without my consent. The series lasted for about a two week period. At first they were every day and then maybe every other day. I don't remember. I mostly remember being told. I was about nineteen or twenty.

Unlike what was pictured in the movies of that time, I was put to sleep first. I didn't have any idea what was going on until I asked why I had sticky spots on the sides of my head. That I remember asking.

I lost a lot of my memory of my early twenties. I have memory problems now, but I don't know how much is related to the meds that I take now and how much is because of the confusion that depression causes.

Anything would have been better than the "double depression" that I was living with.

The former Director of Mental Health for the state that I live in told me that the amount of electricity that is used for shock treatment now is considerably less than it was in the 1960's. I would not hesitate to use it again if other methods stopped working.

I have found both the scientific data and the anecdotal information to be helpful in the fight against ignorance in this thread. I suspect that many of us tend to project from our own experiences. That's understandable, isn't it?

But it can be carried too far. Just because some have been mistreated, misdiagnosed, and mislabeled doesn't mean that all are being abused by our psychatrists, live irresponsible lives, or take unneeded medications.

[Guinastasia]

Metacom, considering the pain I went through with my depression, I'd almost rather have suffer a fatal heart attack than EVER go through that again. EVER.

If electric shock therapy had been my ONLY option (thank god it wasn't), I would have done it. As it is, therapy and Paxil did it, and now I used Paxil to treat my anxiety disorder (OCD). Do you have OCD? You can't reason with it. You can even KNOW your fears are irrational-that's the thing. You know it's completely ridiculous, but you can't stop it. And even then, I often had "pure obsession", which was the obsession without the compulsions. Basically, the compulsion is to try and rationalize it away, to sit there and analyze it to death, which only feeds into it and makes it worse.

And then to have people like Ahunter3 come waltzing in and state, "Nope, it's not a chemical imbalance, people, it's just a part of your personality, some quirk of life if you will", well, that's just insulting. It's no different from some religious wacko who once told me that if a person is depressed, it's because God WANTS you to be that way, it's part of his plan.

Well, no. No it's not. I can joke about my OCD, and such, and I can manage it now. But I don't ever, EVER want to go through what I went through before being diagnosed again. I can't imagine anyone else WANTING to go through that kind of pain.

[Metacom]

People think that severe depression means that someone is just really, really sad. It isn't that way at all. "Depression" refers to the fact that whole body and brain systems are shutting down.
Um, no. The body and brain aren't shutting down, at least in any medical sense that I'm aware of. Are you speaking metaphorically? :confused:
It is caused somewhere in the nervous system but that doesn't mean the person has conscience control over it.
It's not caused in the nervous system. The causes are unknown, but environmental factors play a huge role, and there may be genetic factors that increase one's risk. I've never heard it seriously argued that depression is caused by something that occurs in the brain (that isn't a result of an environmental stimulus).

Except on Zoloft commercials, of course.
The immediate threat of heart stoppage isn't important. The person is dead in any practical sense and there may be some spontaneous recovery or no recovery over time. There is no way to know but there is a treatment that will help them get better fast and the risks are low but not nonexistant.
The immediate threat of death is important. With someone who's heart has stopped, that person will die within minutes if it's not started again. If someone has severe depression, that person isn't going to die if their prevented from killing themselves. Depression simply isn't as immediately threatening to health as a stopped heart.
Time to pay the piper on this one.
That's not "paying the piper" that's "stuffing the strawman."

[DSeid]

So we've moved on from SSRI's to ECT?

ECT is a big deal. It should not be undertaken lightly. Modern techniques dramatically reduce the risk, and certainly make it look prettier, but there are often lasting effects on memory that are poorly understood. But the main indication is severe debilitating recalcitrant medication-resistant depression, and that is a pretty damn big friggin deal itself. Used for that indication the benefits are often great enough to warrant the risks. It is one of the most effective interventions available.

Now if you are going to claim that its "hit to miss ratio" does not justify its use, then I'd ask you to back up that claim with more than anecdotes. The procedure has lots of stigma attached, some real significant adverse effects, but it works and for some is a life saving procedure.

[Metacom]

And then to have people like Ahunter3 come waltzing in and state, "Nope, it's not a chemical imbalance, people, it's just a part of your personality, some quirk of life if you will", well, that's just insulting.
Being insulted by something doesn't mean it isn't true.
It's no different from some religious wacko who once told me that if a person is depressed, it's because God WANTS you to be that way, it's part of his plan.
No, it's very different. When you claim that your emotional problems are caused by a chemical imbalance, you're making a scientific claim, not a religious one.
But I don't ever, EVER want to go through what I went through before being diagnosed again. I can't imagine anyone else WANTING to go through that kind of pain.
I don't think anyone in this thread holds the opinion that psych drugs should be outlawed, or even that ECT should be outlawed (I certainly don't). Nor is anyone in this thread promoting a "Make Guinastasia mentally ill" agenda. So calm down.
So we've moved on from SSRI's to ECT?
Let's do trout fishing next, just for a change of pace.

[Zoe]

MetacomI've never heard it seriously argued that depression is caused by something that occurs in the brain (that isn't a result of an environmental stimulus).

I'm aware that environmental situations can serve as triggers, but never have I seen a reputable source claim that all causes of depression originate outside of the brain in the environment. I don't think anyone understands the full complexity of the causes yet. They do know that changing the functioning of the nerve pathways in the brain can relieve some depression.

Google: "Harvard Medical Schools" "Consumer Health Information" "The Future of Depression Treatment"

Do you also think that all causes of Parkinson's originate outside the brain? Is it possible that...

1. Thinking of Parkinson's Disease like it's a physical disease absolves the patient of responsibility?
2. Thinking of Parkinson's Disease like it's a physical disease absolves others in the patient's life of responsibility?
3. Thinking of Parkinson's Disease as a physical disease means pharmaceutical companies can make a LOT of money?


Of course my questions are outrageous. Your statements upon which I based them seem as ignorant to me.

[DSeid]

it can also be given to children over 12 (something I didn't know), in which case their parents decide for them. I don't care how "safe" it is, I don't see any good reason for pumping volts into a growing brain.This is a great example of how a closed mind operates to perpetuate ignorance. No matter how safe the procedure, no matter how severe the disease, this poster is just too freaked out by the concept that it is electricity. No other facts would matter.

Did you know that kids are treated with radiation too? For some conditions that radiation is focused into a concentrated beam at the growing brain. They are also pumped with toxic chemicals that nearly kill them. Sometimes injected directly into the fluid around their brains. Some will have learning difficulties as a result forever. Some heart problems. And they have no say in it. Their parents and doctors are deciding for them that their cancer is a severe enough disease to warrant treating them with effective measures.

Get over your being freaked out over the word "electricity." What matters is risk versus benefits. The evidence there is solid. For appropriate indications, the significant risk of side effects (in particular on memory) are slight compared to the benefits in effecitively treating an extremely severe disease that is not responding to other measures.

[Metacom]

I'm aware that environmental situations can serve as triggers, but never have I seen a reputable source claim that all causes of depression originate outside of the brain in the environment.
"All causes"? Probably not. "Most causes"? I believe so. Do you think most people with severe depression go from happy and well-adjusted to waking up one morning and say "Gee, I feel like killing myself today." or do you think they can identify one or more events in their life that are precipitated their downward spiral? They may have biological (e.g., genetic) or psychological risk factors that make it more likely they'll actually develop depression as a result of the event, of course.
They do know that changing the functioning of the nerve pathways in the brain can relieve some depression.
So? The fact that physical treatments work doesn't mean that environmental causes aren't predominate.
Do you also think that all causes of Parkinson's originate outside the brain? Is it possible that...
No. We're talking about mental illness here. Parkinson's disease ain't in the DSM.

[davenportavenger]

Did you know that kids are treated with radiation too? For some conditions that radiation is focused into a concentrated beam at the growing brain. They are also pumped with toxic chemicals that nearly kill them. Sometimes injected directly into the fluid around their brains. Some will have learning difficulties as a result forever. Some heart problems. And they have no say in it. Their parents and doctors are deciding for them that their cancer is a severe enough disease to warrant treating them with effective measures.Cancer will kill a child if left untreated. Depression--on its own--won't. Apples and oranges. And don't you think that some of the depression a kid faces might not, I don't know, be because they're going through a lot of hormonal and social changes? The point is, we don't know whether a child (or adult's) depression is due to physical causes, psychological causes, or a combination of the two. We DO know the mechanisms of cancer. It's a fallacy to compare the two.

I think kids should have the right to refuse cancer treatment, too. But that's a whole other story.

[Metacom]

Did you know that kids are treated with radiation too?
Correct. Because they're suffering from cancer, a physical disease that will kill them unless they're treated.

However, mental illness isn't a physical disease, and their deaths could also be prevented by more expensive psychosocial interventions (e.g., a secure facility) that kept them from harming themselves. Of course, that would be a great deal more expensive.

Now, let's go back to the cancer analogy: Let's say Phizer invents a new pediatric cancer drug, Elysioft, that has 25% chance of instantly curing cancer in children with no side effects. Unfortunately, Elysioft costs $1,000,000 per course of treatment.

Would Elysioft get routinely used? I'd be inclined to say "yes." Would a depression-relieving psychosocial intervention that cost $1,000,000 (like, say, putting the depressed kid under round-the-clock care by a team of psychologists and social workers) by used? I doubt it.

Another difference that bothers me greatly is that, with cancer, the parent's (who are making those major decisions) didn't cause the cancer. With major depression, it's very likely that the parents had a great deal to do with causing the depression. Somehow, letting the parents approve of brain-damaging therapies that will make their child more amenable to living in the shitty environment they've created just doesn't seem just to me.

[Wesley Clark]

Correct. Because they're suffering from cancer, a physical disease that will kill them unless they're treated.

However, mental illness isn't a physical disease, and their deaths could also be prevented by more expensive psychosocial interventions (e.g., a secure facility) that kept them from harming themselves. Of course, that would be a great deal more expensive.

Now, let's go back to the cancer analogy: Let's say Phizer invents a new pediatric cancer drug, Elysioft, that has 25% chance of instantly curing cancer in children with no side effects. Unfortunately, Elysioft costs $1,000,000 per course of treatment.

Would Elysioft get routinely used? I'd be inclined to say "yes." Would a depression-relieving psychosocial intervention that cost $1,000,000 (like, say, putting the depressed kid under round-the-clock care by a team of psychologists and social workers) by used? I doubt it.

Another difference that bothers me greatly is that, with cancer, the parent's (who are making those major decisions) didn't cause the cancer. With major depression, it's very likely that the parents had a great deal to do with causing the depression. Somehow, letting the parents approve of brain-damaging therapies that will make their child more amenable to living in the shitty environment they've created just doesn't seem just to me.

Why isn't mental illness a physical disease? Why do drugs that upregulate dopamine receptors help treat positive symptoms (delusions, hallucinations) in schizophrenia? Why do drugs that block reuptake pumps for dopamine, norepinephrine or serotonin treat depression? Why does the metal lithium change a person's personality when they are in a manic state? Depression is 40-70% genetic (http://www.eurekalert.org/pub_releases/2003-07/uopm-prf063003.php), the idea that it is due solely to behavioral and cognitive situations isn't true. Some people are depressed no matter what and some people never get depressed no matter what. Some people respond to a setback or lifestyle change by developing a mental illness, and some people do not. Cognitive and behavioral situations alone do not cause mental illness unless the biochemistry making the mental illness possible already exists. If it did then everyone who had 'situation X' (losing a job, abuse) would respond exactly the same. But they do not. However on the other hand behavioral situations can play a major role in depression since homosexuals have rates of depression about 3-5x higher than non homosexuals. If homosexauls were not reviled and mocked I doubt their rates of depression or suicide would be any higher than the public at large. Obesity is also tied into depression.

Cancer on the other hand is a disease of lifestyle. Roughly 2/3rds of cancer deaths could be avoided with proper screening, healthy diet, regular exercise and not smoking. Combine that with other ways to decrease cancer (taking statins, taking aspirin, leading a low stress lifestyle, using nutritional supplements) and cancer death rates could be cut by 80-90%.

So the line between cancer being a 'physical' disease vs mental illness being a 'cognitive' disease is not really true. Cancer is due (in part) to bad lifestyle and depression is due (in part) to neurotransmitter imbalances.

Elysioft would be rarely used. Even if it is a miracle cure most people aren't going to spend a million dollar for a 25% cure rate for cancer.

[MLS]

Another difference that bothers me greatly is that, with cancer, the parent's (who are making those major decisions) didn't cause the cancer. With major depression, it's very likely that the parents had a great deal to do with causing the depression. Somehow, letting the parents approve of brain-damaging therapies that will make their child more amenable to living in the shitty environment they've created just doesn't seem just to me.
Yeah, lay another guilt trip on Mom.
I've not heard or read any reputable source that confirms this.
I am here to tell you that my own depression had nothing, zip, nada, zero to do with my upbringing. The only possible connection is that my mother had depression, too, except that in her day one did not speak of such things.

[DSeid]

Nope, not trout fishing, into the nature/nurture etiology of illness, in particular mental illnesses. Both at least include people casting out lines and perhaps baiting a bit?

Diabetes: caused by both inheritied biologic factors and by environmental factors such as diet, exercise, and various habits/exposures, many of them learned at parents' knees.

Hypertension: same.

Autism: in DSMIV and is mainly tracked to inheritable factors, despite the heyday of Bettelheim's blaming it on "refrigerator mothers."

Schizophrenia: in DSMIV and is mainly tracked to inheritable factors and perhaps certain environmental exposures but certainly not parenting style.

Depression: multiple twin studies documenting a large inheritable component with environmental triggers. Hormonal triggers. Situational triggers. Crappy parenting? Certainly can be a trigger in some but let's face it, most of us can find many events in our lives that were lousy and have lots to complain about. As a parent I can tell you, I am lucky that most kids will turn out okay despite all the mistakes we all make.

I can go and pull up the cites documenting the large inheritable nature of depression and many other mental illnesses independent of environment. If any of you believe that "most" mental illness is caused by parenting style or social factors, then please provide the evidence for that or admit that it is just you pulling it out of your ass.

Risk/benefit analysis is something that we do for all potential interventions whether they are potentially fatal or not and whether they are caused by intrinsic biologic factors or environmental ones. Of course, the more severe the disease and the greater the benefit of the intervention, the greater the risk that is tolerable. On the one hand we have your proposed option of lockdown possibly forever feeling miserable and hopeless. On the other hand we have a few sessions of unilateral ECT and the very real risk of spotty memory loss of maybe a year of your life or more. And then being able to function again. Feeling better. Able to be a wife and mother or husband and father. Or in rare cases, able to go to your Prom and to college and to fall in and out of love and in again and live a life.

I know what I'd choose.

[Guinastasia]

Cancer will kill a child if left untreated. Depression--on its own--won't. Apples and oranges. And don't you think that some of the depression a kid faces might not, I don't know, be because they're going through a lot of hormonal and social changes? The point is, we don't know whether a child (or adult's) depression is due to physical causes, psychological causes, or a combination of the two. We DO know the mechanisms of cancer. It's a fallacy to compare the two.

I think kids should have the right to refuse cancer treatment, too. But that's a whole other story.

So because we don't know what causes depression, we shouldn't treat it?

And no, it won't kill someone on its own. It will, however, make you WANT to kill yourself, most of the time.

[Metacom]

Both at least include people casting out lines and perhaps baiting a bit?
Now that you're apparently accusing me of trolling (and putting words in my mouth to boot), I think I'm going to bow out of this thread.
If any of you believe that "most" mental illness is caused by parenting style or social factors, then please provide the evidence for that or admit that it is just you pulling it out of your ass.
I NEVER FUCKING SAID THAT MOST MENTAL ILLNESS WAS CAUSED BY PARENTING.

Read what I said in context. I was speaking specifically of depression in children, and I didn't even say that it was always caused by crappy parenting. As you said, there are situational and environmental triggers. And guess who has the most control over the environment that children live in? I met an awful lot of severely depressed children, and their families, and I can't recall a single one that came from a happy home.

This is exactly the kind of attitude I was talking about when I gave reasons for why I thought the biological model was so fervently latched on to: The mere suggestion that crappy parenting is often responsible for depression in children sends you off on a defensive tangent (Depressed kids come from shitty homes created by crappy parents?? NO WAY! It's genetics. And hormones. It's just like diabetes!).

I wonder if another reason the biological model is so readily accepted is that it allows mental health care providers to rationalize their actions: They may not be able to make Johnny's mom stop drinking, but they can write him an Effexor scrip. If you think of depression has a result of the person's environment, then giving Johnny his happy pills is using chemicals to coerce him into accepting a shitty lot in life; if you think of depression has a biolgical disease, then writing the scrip is curing an illness, just like an ear infection.

I know which one I'd prefer to believe if I was in that position.

[Wesley Clark]

Now that you're apparently accusing me of trolling (and putting words in my mouth to boot), I think I'm going to bow out of this thread.
.


You shouldn't bow out, this thread would be boring if everyone agreed on everything.

You do have a point that environment can play a major role in depression. Social stigmas like sexual abuse, feeling different in general or homosexuality can greatly increase the risk of depression.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9468687&dopt=Abstract

SUBJECTS: 1189 women were screened and 237 subsequently interviewed; 132 were depressed. RESULTS: 49 (37%) of the depressed interviews and 24 (23%) of the non-depressed interviews reported experience of sexual abuse when they were aged under 16 years.

http://www.diet-blog.com/archives/2005/09/08/teen_obesity_shame_and_depression.php

Also, obese teens were more likely to say they had been treated in a degrading manner, had been ignored or otherwise had shaming experiences within the past three months than were their normal-weight or overweight peers.

Further, adolescents who reported the highest number of shame experiences were more than 11 times more likely to be depressed than those who reported the lowest number of shame experiences, the report indicates.

The association between obesity and major depression disappeared, however, after the researchers took into consideration the adolescents' gender, parental employment, and parental separation, the report indicates.

Teenagers with unemployed parents and those in families in which the parents were separated were more likely to have depressive symptoms than their peers. In fact, these variables predicted major depression among the study group, the researchers note, and were unrelated to the teens' weight.

http://www.narth.com/docs/whitehead.html

It concluded that on average, male homosexuals were 5.1 times more likely to exhibit suicide- related behavior or thoughts than their heterosexual counterparts. Some of this factor of 5.1 was associated with depression and substance abuse, which might or might not be related to the homosexuality. (


I know that I myself never suffered from depression before I developed schizophrenia, and it caused alot of damage for 6 years until I got chemical treatment for it. Once these events happen (abuse, shame, whatever) there really isn't much you can do about them. You can't go back in time and prevent the acts from happening. Most people can't work through a problem just through therapy until they reach the point where they are just as mentally healthy now as they were before, they are going to need drugs to undo the damage that the event has done to them.

[Shagnasty]

Cancer on the other hand is a disease of lifestyle. Roughly 2/3rds of cancer deaths could be avoided with proper screening, healthy diet, regular exercise and not smoking. Combine that with other ways to decrease cancer (taking statins, taking aspirin, leading a low stress lifestyle, using nutritional supplements) and cancer death rates could be cut by 80-90%.

So the line between cancer being a 'physical' disease vs mental illness being a 'cognitive' disease is not really true. Cancer is due (in part) to bad lifestyle and depression is due (in part) to neurotransmitter imbalances.

Even though I agree with you, I think this is a great argument and I am going to have to use it sometime.

I just have to take solace in the fact that some of these people have never actually seen what they are debating about. They are picturing one of their friends saying they are on Prozac when things actually get so much more distinctive and dire than that. It is like people that have never seen someone with terminal anorexia. Sounds simple enough, a girl want to be thin so she over diets. Get her to eat. The reality is so much more scary and different than that most people have no business discussing it until they have seen what is really happening.

[DSeid]

Meta, the "baiting" bit was out of line ... I apologize. The trout set-up was just irresistable. No need to yell, though. I can read just fine without caps.

a. Do you think you'd be a happy parent dealing with a chronically mentally ill kid?

b. If mental illness is to a large degree genetic then should it surprise you that other members of the household have some forms of mental illness as well?

c. Given these chicken-egg conundrums we each have to interpret our anecdotal experiences with caution. That is why those twin and adoptive studies are so important. Again, they show that the biggest role is genetics, the next biggest the individual (non-family) environment, and the shared (family) environment less important.

Which is not to say that family issues and counselling are unimportant, but the claim that childhood depression is "very likely" caused by crappy parents has no evidenciary basis. None. To define a parent as so poor of a parent as to not be compentent to make medical decisions for their children's best interest, solely on the basis of their child's having a depression, is, at best, unfair and unjustified.

I'll grant you one thing. As a doctor I care most about what works. If a condition is caused by an environmental factor that I can't change but I can safely treat the condition and reduce harm and enable function, guess what, whether it is DM or asthma or mental illness, I'm going to go for getting the indivdual better as my personal bottom line. That's the medical model for you. We like using what works to get people better. Go figure.

[Jackmannii]

...whether it is DM or asthma or mental illness, I'm going to go for getting the indivdual better as my personal bottom line. That's the medical model for you. We like using what works to get people better.Yeah, that's Western allopathic doctors for you - just treating the disease.

Whereas homeopaths treat the patient.




d&r

[Wesley Clark]

Which is not to say that family issues and counselling are unimportant, but the claim that childhood depression is "very likely" caused by crappy parents has no evidenciary basis. None. To define a parent as so poor of a parent as to not be compentent to make medical decisions for their children's best interest, solely on the basis of their child's having a depression, is, at best, unfair and unjustified.
.

It isn't totally caused by it but it plays a role

http://www.cbsnews.com/stories/2003/01/23/world/main537754.shtml

Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study.




That study only found double the risk. And it could just be that those who are genetically prone to mental illness end up with one as a result of living in a broken home.

[Otara]

[QUOTE=Wesley Clark]It isn't totally caused by it but it plays a role

http://www.cbsnews.com/stories/2003/01/23/world/main537754.shtml

Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study.
/QUOTE]

Did they control for why the family broke up in the first place?

Ah:

"There may also be a genetic element: More irritable people are more likely to become separated, but they are also more likely, whether they are separated or not, to have more irritable children, Scott said."

Ie the broken home could be just another way genetics plays out rather than environment as such.

Otara

[Zoe]

If you think of depression has a result of the person's environment, then giving Johnny his happy pills is using chemicals to coerce him into accepting a shitty lot in life; if you think of depression has a biolgical disease, then writing the scrip is curing an illness, just like an ear infection.

And if you stop thinking of depression as an either/or situation and do some open-minded reading on the research, you will find that SSRIs are not "happy pills." If you are not having physical problems with low seratonin levels, they are not going to make you "high." They don't make you "happy" anyway. They help to make your brain chemistry normal -- not above normal. Rather than having to accept a "shitty lot in life," one is more empowered to do something about it.

Certainly lousey parenting can have a depressing effect on a person. It can undermine self-esteem that can take years to rebuild. For many people, the added problem of lower seratonin levels makes the problem even more difficult to grapple with.

BTW, Parkinson's Disease and depression are related illnesses -- "cousins," so to speak, in their causes. (I don't mean to imply that depressed people get Parkinson's or vice versa.)

Adding to the list of physical illnesses that are often associated with depression is polycystic syndrome.

I heard recently that for the first time researchers have been able to detect changes in the brain scan of depressed people. Do any of you know about any of these studies?

[davenportavenger]

So because we don't know what causes depression, we shouldn't treat it?

And no, it won't kill someone on its own. It will, however, make you WANT to kill yourself, most of the time.I'm saying you shouldn't treat it with controlled brain damage that might make a kid lose a year of his life, which to him would be roughly a twelfth of it.

And Shag, Guin, et al, many of us on the "other side" (Am I on the other side? I'm certainly not as anti-psychiatry as AH3 or Metacom.) have had first-hand experience with serious mental illness or family members diagnosed with it and I feel it's disingenious to act as though we come from a place of ignorance. I am not going to trot out my whole "pedigree" but suffice it to say that there are seriously mentally ill people in my family, I have been to a mental ward (though not as a patient), and I have struggled with issues that directly or indirectly led to the death of a relationship and several jobs. Hell, I pretty much want to die all the time, including right now. It is not necessary to say "oh, depression isn't just feeling sad" every fifth post because we already know that. My opposition to ECT is not rooted in thinking depression doesn't exist; it is because I feel that it is still not safe enough and I feel that patients are rushed into it without knowing all the risks. Two people can have the same information and experiences and still come to different conclusions. It's happened before.

[Guinastasia]

If you think of depression has a result of the person's environment, then giving Johnny his happy pills is using chemicals to coerce him into accepting a shitty lot in life; if you think of depression has a biolgical disease, then writing the scrip is curing an illness, just like an ear infection.


I think the above statement is why these discussions get so heated. Referring to anti-depressants as "happy pills", unless you're just kidding around, is really insulting to those who take them to treat legitimate medical conditions. I resent the implication that we just pop pills to avoid a "shitty lot in life."

:rolleyes:

[jshore]

You accuse me of hearing what I want to hear, but from where I stand you're doing the exact same thing. And you're not even admitting to the possibility of harm, while I've stated the possibility of benefits.

I've never made any such claims. All I have said is that there are cases where the benefits far outweigh any possible harms and therefore it still has an important place in treatment of particular severe and refractory cases. And, while you are now claiming to be open-minded about ECT, your original statement that I reacted to was "I also try to respect the treatment decisions of others (to a point... I do think ECT should be outlawed and the doctors who perform it kicked out of the profession)".

I agree with you that the risks and benefits of ECT should be presented fully to the patient...although I personally find it likely, given "One Flew Over the Cuckoo's Nest" and such, that there are far fewer people who have an unrealistically positive view of ECT than have an unrealistically negative view.

[fessie]

I picked up the October '05 copy of Parents magazine yesterday. There's a lengthy (for a crap magazine) story on mommies these days using antidepressants - not to treat major depression, but to keep "pepped up". Could Taking Antidepressants Make You a Better Parent is the name of the article. It's truly frightening.

The first example they use is a woman who sent neglected (their word) her 2- and 5-yr-old children by sending them off to play by themselves or watch TV "too often" (no idea where that boundary is). So now she's on Prozac. And she's a "much better mommy." More calm, more engaged. Sure.

This is the same magazine with ads on every other page - "Moms can be heroes" (buy some Mederma, no sign of childhood scrapes in your house!). "Is your child's asthma really under control, or do you just think it is?" Their editorial on Halloween - "OMG! My kids brought home 213 pieces of candy! I wrote down all the brands and did some research! That's a gazillion calories! Enough to feed Jamaica for an hour!"

Yeah. No pressure to that job, no reason for those women to be anxious and overwhelmed, nuh-uh! Talk therapy? Why bother - pills are cheaper! Plus what (good, self-sacrificing) mommy has time for appointments?

It's even scarier to me that mothers are evidently supposed to seek a forced calm, a false reality. No freaking out or your kid will be screwed up - keep happy, damn you.

I'm seeing you guys debate "crappy parenting" in this thread, and whether or not it's a factor in mental illness. I don't know how you define "crappy" parenting. But I will tell you for a fact that crazy parenting sometimes makes for crazy children.

In my experience, playing around with reality is dangerous. Denying what's really happening, what people are honestly feeling and thinking - those will make a child crazy. Crazy families put pressure on their children to embody the parents' fantasies about themselves, the reality they wish existed. That can make a child crazy. Read I Never Promised You a Rose Garden.

Not that antidepressants are always bad - they can really help a person change course, lift themselves out of a series of depression-based choices and into a new set of options that were previously unimaginable. And for new moms in particular, PPD can be debilitating. My post-partum anxiety attacks were so strong, I couldn't breathe. Much less walk.


AHunter3 your OP really resonates with me; I've tried to join this thread several times, but just end up sobbing; there's so much I want to say, this topic is so overwhelming. My Mother is mentally ill. I agree with you that the vast majority of therapists (Ph.D., MD, PsyD, MSW) are lousy; I did meet one profound exception, but only the one. The person who has helped my mother the most was a minister, whom she saw for 10 years. I agree with you that the physical component is (often) a symptom of, not the source of, the problem. Personally I think the problem is (often) spiritual at its core. In my experience, people struggling with mental illnesses are (often) at war with themselves, with their existence. I've learned to love my Mother with her illness, with her quirks and disabilities, and with or without her meds! And I agree with you, ECT is barbaric. I wish you peace.

[even sven]

Can there be no middle ground?

Can we not picture a world where we look for biological causes, and seek to create the best treatments possible....but where we also accept what people would like to do to their brains and do not rush to prescribe whatever we can as soon as we can? A world where mental illness is both a problem and a part of you? A world where we can take the reasoned knowledge of doctors into consideration without handing over total control of our brain chemistry to them and deriding anyone who does't follow suit?

Nobody is arguing that phychiatric medicine should be abondon or that there is no physical companent to mental illness. What people are arguing is that the situation is way, way more complicated than it is commonly portrayed- and that sometimes the problem isn't "you havn't found the right meds quite yet." I've been mentally ill and gotten better (for now at least) without drugs. It may not be the right solution for everyone, but it was the right solution for me. All I am asking is for the right to make that decision.

[Zoe]

fessie: I'm seeing you guys debate "crappy parenting" in this thread, and whether or not it's a factor in mental illness.
I don't know how you define "crappy" parenting. But I will tell you for a fact that crazy parenting sometimes makes for crazy children.

I thought that most did not deny that crappy parenting could be a contributing factor in some mental illnesses. I'm certain that it was in my own case. So was genetics.

...the vast majority of therapists (Ph.D., MD, PsyD, MSW) are lousy;

It's true that none of them have all of the solutions yet, but how can you pass judgement on all therapists?

I've learned to love my Mother with her illness, with her quirks and disabilities, and with or without her meds!

You are stronger in that regard than I. I was abused physically and emotionally and had to set boundaries that don't allow for a lot of love -- just duty.

The person who has helped my mother the most was a minister, whom she saw for 10 years.

I think a minister would have helped my mother as much as anyone for her mental disorder, but it wasn't depression. And my own problems were no spiritual. They began when I was a religious education major. One of the friends that I met during my first hospitalization -- a seminary student -- committed suicide.

I'm very sorry that your situation (and this thread) have caused you such pain. Mental illness affects a lot more than just the person who is ill.

I've been mentally ill and gotten better (for now at least) without drugs. It may not be the right solution for everyone, but it was the right solution for me. All I am asking is for the right to make that decision.

And I want the same for me -- whether it be counselling, medication or ECT. I don't think anyone is saying that medication is appropriate for everyone.

[foolsguinea]

I don't know what to say.

This year I've become convinced that the reason my mother has been depressed for 20 years is that her endocrine system has been malfunctioning. A real medical problem, which was missed. We now think that her pituitary was damaged 20 years ago. Prozac & progesterone partially treated some of the symptoms, but it seems like some doctors (even internists) didn't look deeply enough for the cause. Easier to label it as a disease in vogue: PMS, serotonin uptake, whatever.

[foolsguinea]

On the other hand, since my mom was apparently nuts, & my biological father was apparently nuts (I'm still unclear on how much was addiction) it was all too easy to believe I was, too.

So I was told that I had to be on Prozac, when going through some mental stuff which derived cognitively from having unhealthy parents, & general teenage confusion. I ended up believing it enough, that I flirted with suicide. This was seen as part of my irrationality & thus a symptom of the disease, rather than a response to the idea that I was mad. Self-fulfilling prophecy. I've been treated as mentally ill so much, it's part of my persona now.

[Zoe]

foolsguinea, that sounds like where I was forty years ago! Since "mad" isn't a medical diagnosis, I certainly hope you aren't buying into that BS. If the prozac didn't work, then obviously it wasn't the answer for you. But if you are still feeling self-destructive or overwhelmed, I hope that you will try something else or seek out another doctor. This really doesn't have to become a permanent part of your persona.