There is NO proof that there are “chemical imbalances” in anyone’s brain. I would like to see a link, even one, that **proves ** the connection between ANY brain chemical and mental illness. Right now it’s just a theory, and medications aimed at that theory work for some people, and not for others.
I know very little about diabetes, however, it can be diagnosed with blood samples. Even if actual brain samples are taken there is no medical test to prove mental illness.
And no, they can’t treat it, not for everyone, not for me. Right now it’s all subjective, based on the opinions of mental health professionals and treatment might work, or it might not. We just don’t know enough right now.
Even in the high-profile cases of mental illness, there is NO tangible proof that those people have a mental illness. You can not draw blood, or take readings on brain chemicals to prove that there is a mental illness. There are studies right now using PET scans that might show a difference, but the testing is still too new to be sure.
Insulin does not merely “alleviate the symptoms”. Diabetes is an insulin deficiency condition, the pancreas fails to make insulin so you have to inject insulin to replace it. Hypothyroidism is similar: the thyroid gland fails to produce enough thyroxin so you take a natural or synthetic replacement hormone.
But schizophrenia is not a thorazine-deficiency disease. Depression is not a Paxil-deficiency-disease. Bipolarity is not a lithium-deficiency disease.
No you don’t.
No they don’t.
What is wrong with that? Why should someone suffer from depression, when they CAN treat it?
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Don’t get me wrong, if the medications help you cope, if they work for you, and you decide the risks and side-effects are outweighed by the results, by all means use them. But in your case I think you are a bit short of “fully informed consent”. You’ve been sold a bill of goods. This stuff ain’t “mental health insulin”.
KillerKatt is right. All that “chemical imbalance” is just an unproven theory, most of it derived backwards from studying drugs whose effects on the “mentally ill” made them popular on psych wards and figuring out what the drugs do, and theorizing that “mental illness” consists of the inverse situation.
A broken leg is not a plaster deficiency, bacterial infections are not penicillin deficiencies, and a cancerous tumor is certainly not a deficiency of radiation or the toxins used in chemotherapy. But that doesn’t make those illegitimate medicine.
I won’t enter the “mental illness is a myth” debate; it’s been too long since I read Thomas Szasz. I will say only that I can’t find a lot of scientific support for this view, and that it would strike me as exceedingly odd if the brain turned out to be the only anatomical structure not subject to chronic dysfunction.
Mental/emotional/behavioral disorders are not diagnosed with test tubes, as it happens, but primarily by analyzing the observed behavior and self-reported experience of the patient. If he confides, for example, that men with beards are agents of the devil sent to kill him unless he dispatches them first, or if he is afraid of sunlight, or if six months ago he suddenly discovered that he just loves setting fire to buildings, one might suspect that intervention is warranted. Neurochemistry, MRIs and PET scans are beginning to show some value as indicators, helping in some cases to support a diagnosis, but that’s all. They’re baby technologies. Let them grow.
Mental health care is still primitive enough that it frequently does not lead to outcomes we can comfortably call cures. Clinical psychology is a science with a lot of art mixed in, and I’ll concede that a lot of the relevant pharmacology is aimed at suppressing symptoms and is at least as prone to side effects as it is in other branches of medicine. I still say a situation doesn’t have to be perfect to be an improvement, and sometimes that’s the best you can hope for, and sometimes it’s enough. Ultimately a sufferer must decide if the cure is better or worse than the disease, i.e., is it worth the lethargic episodes to get the voices in my head to shut up? I admit that I think there should be less freedom in this regard if the disorder presents a significant threat to others. And as I pointed out earlier, there is lots of mental health care being practiced that doesn’t involve drugs at all.
Mental health screening is warranted if ignorance and the fear of stigma prevent parents from seeking advice, diagnosis, and help for their children. The Illinois proposal seems like a reasonable effort to extend health care to those who otherwise would not get it.
The plaster cast is a moderately good analogy. You would not want to be in a plaster cast if your leg can function without one, but if your leg is in non-working order a plaster cast can enable you to get around until the leg heals. You would not want to be on psych drugs if you can function without, but some folks find that they enable them to survive and stabilize and as short-term aids they do far more good than harm. But we know how legs work and we can determine breaks with an x-ray, and our doctors set our legs properly before wrapping them in plaster. Psych meds are analogous to wrapping the legs of limping people or people complaining of leg pain or people who can’t walk or people with bone fragments poking out through their skin in plaster without setting the leg or doing an x-ray. In some cases, though not always, the plaster cast keeps the leg from healing, or at least interferes with other possible interventions and processes that could help the leg to heal; and in some cases, not rare ones either, leg pain or inability to walk doesn’t equate to “broken leg” and the cast simultaneously reduces mobility and also completely fails to address the real problem.
Penicillin? Really bad analogy. Penicillin cures bacterial infections – the infectious disease has a specific cause and the penicillin directly fixes that by directly eliminating the cause, ending the condition, following which the unpleasant symptoms go away. Thorazine, paxil, and lithium do not rid the body of schizophrenozoa or infectious bipolarites.
Chemotherapy is a moderately good analogy. We know the chemicals are poisonous to the body in general and you sure as hell would not want to be on these toxic chemicals if you didn’t have cancerous tissue you needed to kill off, but because the chemicals are more toxic to the cancer than to the body in general, and because we don’t have a nontoxic cure for cancer to use instead, chemotherapy is deemed appropriate. And we don’t really know what causes cancer. We know what it consists of, though – those awful colonies of uncontrolled-undifferentiating replicating cells, those fast-growing malignant tumor tissues shoving everything else aside and spreading their seeds to colonize the rest of the body. And we know that chemotherapy does directly work to kill the malignant cells of the tumor, and although the success rate isn’t perfect if the chemotherapy does succeed in killing the tumor and it has not spread the patient is cured of cancer and can stop chemotherapy (although far less toxic meds designed to reduce the likelihood of new tumors may be taken for years). In the case of the various mental illnesses, we don’t know what they consist of in the same sense that we understand malignant tumors, and we have no reason to think that psychiatric drugs directly make the physical essence of mental illness – assuming for the moment that one exists – less of what it is in the same way that chemotherapy kills malignant cancer cells. Prescribing psych meds is like prescribing chemotherapy to someone who complains of pain and lumps in her breast, without having any means of verifying that these symptoms mean cancer is present.
Sure; I’d also say that results can also aften be achieved by better diet and exercise, getting a good job and falling in love with the right person.
I’m not denying the symptoms of depression, etc. aren’t real, or that in some cases medication works well… but I’d also say that the causes often have as much or more to do with the kind of society we live in and the choices we make than they do with any chemical imbalance. In addition to being a patient, I’ve worked in several mental health centers and have read several hundred case histories. I’ve seen plenty of cases whose root problems were “parents are getting divorced” or “stressed out from overdue credit cards and marital problems” get diagnosed with “miscellaneous adjustment disorder” or some such crap and fed pills as if they were solving the root problem.
And I have seen people on meds continue to engage in destructive behavior as if the meds took away their responsibility to take charge of their lives. I do it myself. But if I sit in front of the TV all day eating frozen dinners and ice cream, or surf the internet all night long, arguing with people on the SDMB for hours on end, it ain’t much of a mystery why I start getting suicidal.
Screening is required only prior to admission to a mental health facility if the admission is paid for by the state.
It coordinates that which is already being done and makes it more of a priority.
It says that schools need to take the socio-emotional health of their students seriously, try to help kids develop these skills, and attempt to develop metrics to follow how they ( the schools) are doing. And that they need to have established protocols for dealing with children whose problems are getting in the way of their learning.
So if a child has clinical depression appropriately diagnosed outside of the school, and that family and child have opted for treatment, the school can effectively modify a program to help the child achieve. Just like they currently are supposed to do for other identified problems under public law 91-142.
It does not empower the schools to screen or diagnose let alone to dictate treatment.
As to the reality of mental illness. True enough that most mental illness is incompletely understood. But sorry, no friggin way that society is to blame or many are curable by diet and excercise. This isn’t Woody Allen neurosis we are talking about, this isn’t pull yourself up by your bootstrap stuff. These are illnesses.
These aren’t caused by parents getting a divorce, even if that is the proximate trigger. There is a biologic predisposition going on. Various studies, including twin studies and extended pedigree analysis document again and again that various mental illnesses run in families independent of social factors. Some specific alleles have been identified. But they are multifactorial and environment has an effect as well.
AHunter has an illness. He is functional and competent (from what I can tell in my virtual encounters with him) and able to decide what is his own best interest, but I do not think that he’d deny that he is appropriately labelled as schizophrenic. As long as he is not at significant risk of imminently causing harm to himself or others, he has every right to decide to do without treatment. He has the right to decide that the risks outweigh the benefits for him. But he percieves a reality different from the vast majority of the rest of humanity and falling in love wouldn’t change that. If he prefers that reality, fine for him.
Treatment should forced much less commonly that it is. Treatment is not as effective as it is often billed and there are risks of treatment as well as benefits. But the illnesses are real, they are biologic to a large extent (even if poorly understood), and schools being prepared to make acommodations for children with mental illnesses, schools acknowledging that they are a significant part of children’s environments with some power to effect the mental health of the student body, none of these are bad things.
I still see this as a much easier way to put large groups of people on drugs that may help, or may make things much worse.
How do you know this? Can you see through his eyes? I have been given the label of Schizotypal Personallity disorder, read up on it, because it fits to almost everyone I have ever met.
Teachers are already overburdened, how is adding the responsiblity of “social and emotional” training going to help anything? Teachers already do screening, which is why we have the epidemic of ADHD. Now we are just saying its OK.
I don’t know how long ago you were in grade school, but I seem to remember that it is not a place to start labeling people. Children are mean to other children, and now this is going to add a whole new level.
Unfortunatly, I was involved in New Math*, and several other pilot programs. Changing the way we teach children hasn’t helped in the past, and I don’t see this as helping anything. If they want to increase that 1 in 10 number, I think this might do it.
*New Math: 40+60=100, draw 100 dots to prove this (seriously) :dubious:
(Do you realize how BORING it is to draw pages and pages and pages of DOTS? Especially at 7 or 8 years old.)
Emotional Math: 4 robins are sitting on a fence, 3 fly away, how lonely is the last robin? (Possible future?)
I don’t want to get bogged down in a defense of psychopharmacology because it’s beginning to obscure the topic, which is the Illinois Children’s Mental Health Partnership (created by the Illinois Children’s Mental Health Care Act of 2003) proposal to add a mental health diagnostic protocol to the required medical examinations before kindergarten, 4th and 9th grades, and in certain other settings such as the juvenile justice system. I still like this proposal, because it removes apathy, ignorance and fear as barriers to people seeking help for their children and makes help more accessible.
Perhaps there are some parents who have never looked at their children and wondered "Is that normal healthy behavior? I would call those parents inattentive. But there are understandable, if not strictly rational, barriers to seeking professional advice that do not apply to purely physical afflictions; from the purely visceral “nobody messes with my kid’s head” to the platitudinal “it’s probably just a phase, whatever that is” to the disciplinarian “a swift kick in the pants will straighten him out” to the hysterical “what if they find out about* this* and take him away from me?” However, under the Illinois plan, everybody is involved so no one is stigmatized. For the vast majority, this additional protocol will do nothing except provide some reassurance. And maybe some will find the courage to try to find out why Amy has so many accidents that involve cutting herself, or John suddenly is shunning all his friends, or Melissa filled an entire spiral-bound notebook with the words “I hate my house I hate my life I hate myself” printed, neatly, over and over again.
Psychoactive drugs are crude and sometimes dangerous, and shouldn’t be used when other effective responses are available. I just think that sometimes they can be less destructive of personality and free will than mental illness is. If a drug relieves distress and/or curbs violent or self-destructive behavior, I think they can be justified. The history of medicine is full of things that were used successfully to alleviate suffering long before their mechanisms were completely understood.
Killer, I’m only repeating how AHunter has described his situation himself in the past. He argues not that his perception of reality is the same as others, but that his is no less valid, that it works for him, and, most importantly that it is his choice as to whether or not he gets treatment. I have nothing but respect for his interest in keeping those rights protected.
I also will defer debate on the validity/sensitivity/specificity of the DSM approach, and of efficacy of treatment as they have been covered in the past and are distracting from this particular op.
It is a reasonable position to be skeptical that an overburdened system can actually accomplish the goals of this bill in any other than a bueracratic manner.
But again, the portrayal in the link and even by King is not what is actually in the bill. It does not mandate me (the pediatrician) to assess for mental health (although I already do). It does not mandate or empower the school to label children in any way. It mandates the school to develop programs to somehow encourage social and emotional development. (I may be skeptical of their ability or resources to do so, but in many inner city schools, the school is the most stable emotional base a child has.) It mandates that school systems develop ways to score themselves as to how those programs are doing. It mandates schools develop better ways to work with children who have identified mental health difficulties. It encourages destimatizing mental health disorders. It encourages programs that screen for post partum depression and that encourage and support treatment.
It has been a long time since I was in grade school, but as a peditrician and father I know about labels in schools. Schools are bueracracies. Labels get services. My kid having a label of ADD gets him one on one attention that he would not otherwise get. It gets him resource room help. The school had zero input as to whether or not he is on meds. The school did not screen for ADD.
Yeah, I’ve acknowledged that the bill does not set up mandatory screening. I posted after reading a single news article without googling for concurring stories in other media. They were wrong, I was wrong.
It still looks to me like an initiative to find new kids to put on psych drugs, though (as I’ve also said, and as others have actually said better than I did).
Did you read the posts in this thread by jackmannii and furt?
Depression in particular worries me. From personal experience, a lot of kids who are diagnosed with depression have very good reasons to be depressed, and the treatment for depression, especially in children and adolescents who have very little control over the environment they live in, isn’t going to address the root causes. Aside from any ethical questions this raises (We can’t improve their lives, but we can give them medications to neutralize the bad feelings!), there’s also the whole issue of psych drugs and their effects on developing minds (witness the recent findings that drug companies have essentially supressed the results of studies that showed a possible link between their products and an increase in suicidal tendencies among pediatric patients).
How can any of you argue such things, when all around us, we see, hear and feel, all the,–do as I say and not as I do, from our government on down. As all of us know, children need structure, from the time we are very small, right thru life and if from childhood, the kids hear one thing and see and feel quite the opposite, there can be no psychology or philosophy to life.
DSeid, we’re evidently not talking about the same thing. As I said in my very first post, The Illinois Children’s Mental Health Act of 2003, among other things, established the Illinois Children’s Mental Health Partnership and directed it to submit a preliminary comprehensive children’s mental health plan by the end of next month and a final plan by June of next year. That plan is obviously subject to revision and may or may not become law even then, but given the arguments advanced in the OP and subsequently, I’m pretty sure that it’s the Partnership’s proposal, not the text of the ICMHA-2003, that was/is at issue. Here’s another link to the preliminary proposal:
Sections I-D-2 and 3, on page six, cover the addition of mental health diagnostic protocols to already-mandatory school medical exams, and screening for children passing through DCFS and juvenile justice.
AHunter, My apologies for having missed pertinent posts. Obviously my comments were unneeded given links already made. Do you have any crow left over to pass my way? I’ll take mine with hot sauce please.
To be sure, psychiatric diagnosis is a squishier business than lots of the rest of medicine. There is a lot of gray, a lot of fuzzy edges, and a paucity of reliable research. At the core are the clearly ill some of whom are scared off of treatment by the stigma of the label. But off at the edges are those for whom a label pathologizes what may also just be “different”. The DSM is the worst method to diagnose mental illness, except for the fact that there is no other. (To bastardize Churchill.) Progress must be made and the DSM will improve with each edition.
Labels must be accepted provisionally, and treatment plans agreed to full consideration of known risks and benefits. An individual right to accept or decline treatment must be preserved unless they present a clear and present danger to themselves or others.
This particular bill is well intended and despite the fears of a slippery slope does nothing neferious. It will likely do nothing is all, except more paperwork for all involved.
Oh King, I didn’t mean to ignore your comment. This is not a mandated screening by a psychiatrist. This is a proposal that in the future I as a pediatrician be mandated to assess socio-emotional health and document that I did so. Truth is that most good pediatricians do this as our everyday business at well care exams already, but I dislike the extra boxes to check that this will entail, and fear the bueracractic approach that may result of mandated standardized screening instruments. Forms to have filled and scored and referalls advised based on arbitrary results. Blech.
I did say it was. Actually I didn’t, because I didn’t know whether Illinois required school-related K-4-9 exams to be performed by an MD. Oh, well, at least we’re talking about the same thing now.
I certainly didn’t know* that*. If it isn’t currently the law, why?
I take it you’re not thrilled with the prospect. This gives me pause, as wipespread provider disinterest would make an enormous difference in my view of how and even whether the ICMHP plan might (or might not) work.
Thank you, DSeid, for taking time to join this discussion. As a professional who would be directly involved in the Illinois proposal’s implementation, you have knowledge and experience that I, at least, completely lack.
Pediatricians are looked to for information on cognitive, social, and emotional development by parents. Well care isn’t just shots and the physical exam. It is also anticipatory guidance: safety, what to expect in physical development, what to expect in cognitive and socioemotional development. We are expected to screen for the need for early intervention services, to pick up signs of autism early on, to screen Mom’s for post partum depression and make referrals for her, and so on. It is what we do because it is our job, not because it is the law.
Thank you, DSeid. That was a large answer in a few words. I’m not surprised at your response, as it was my experience as a child (back when doctors knew their patients by sight most of the time) and as a parent (once we found the right pediatrician). Do you think, therefore, that perhaps the medical guidelines are unnecessary, especially with the presumptive reliance on DSM-IV (we really don’t know yet what it will be – I still don’t know what the Edinburgh diagnostic protocol for post-partum depression is, but I assume that it differs from DSM-IV), especially as you don’t seem to view them as particularly useful?
Also, how do you presently view parental responses to your efforts to assess cognitive, emotional and behavioral development? Is is forthright, guarded, uncommunicative, hostile? Is the preliminary plan, now that you’ve had a chance to read it, a good , well-intentioned but useless, or a bad thing? Would the educational provisions be worthwhile if the clinical provisions fail in the legislature? What would social/emotional educational education look like in Illinois?
I’m sorry, but now that you are here, I must go from arguing to asking mode. It’s an imposition, I know, but you’re the first contributor who seems to know both the legislative and clinical ends of the discussion. You’ve been a little cagey thus far, as is your right, but can you tell us, what is your assessment of the ICNHP plan, as is, with respect to the children of Illinois?