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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.
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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.
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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?
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.
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:
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!
Shagnasty:
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.
:dubious:
This is sarcasm, right?
Yeah. Right. Sure it is.
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.
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.
I’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.
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.
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?
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.
One does not logically follow the other. At any rate, the SSRIs that I’m familiar with begin to work in 2-6 weeks.
Cite, please.
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.
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.
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.
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.
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 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.
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.
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.
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.
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. 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.
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.