I forgot to clarify. Exactly when a disorder starts interfering with a person’s life is a subject of debate.
I hope this clears things up.
Shouldn’t people be told exactly what drug they are being given, what it is supposed to do, how long it will take, what percentage of people who take the drug actually improve and what are the side effects?
Or should they just be handed a medication, be told “It’s not drugs” and be forced to take it without knowing anything about it?
You were right the first time, it was coping skills, but the voices were referring to your inability to follow the lines when cutting patterns in wood. That explains the tracing paper as well.
Of course they should. I don’t think I was ever told what percentage of people improved, but I was always told the rest.
This has never happened to me
coping skills are learned. medication that reduces anxiety can give someone an opportunity to learn coping skills, that would have been impossible otherwise.
I’m not sure if this is what you’re suggesting, but telling someone with complex psychological problems “you’ll be cured in [x amount of time]” seems really unreasonable.
I know you had a very bad experience with this at least once, but generally I think your expectations above are met by psychiatrists. There are some psychiatrists that are really shitty, but all of mine have been pretty clear about side-effects and informed consent. Generally you take a medicine for a few weeks and then come back and discuss how it’s going - this is a good time to talk about any side effects with the doctor and what might be done about it. When I first started trying meds (when I was 18) I had to get regular blood tests to make sure my liver wasn’t shutting down or something. I was pretty closely monitored.
My experience with meds has been mixed. I went through a litany of medications in college - about twelve different attempts in a handful of years - and all I got for my effort was nasty side-effects and a flagging sense of hope. When I finally did find a combo that worked okay, it made me gain 50 pounds. Once I discovered CBT around the time I was 23, I went off meds convinced I could handle my own shit. I did do better for a while, but then things got hard again, so I went back to a doctor. At this point I believed nothing would ever help me but was willing to try anything. I mean I was really scraping the bottom of the barrel in the ‘‘hope’’ department, having just dropped $10,000 out of pocket on transcranial magnetic stimulation, which had failed to help me. By this point I was basically told I had a biologically based mental illness that was not going to go away.
And then my doctor gave me Wellbutrin. And the heavens opened up. My depression is still a thing, but it is MUCH more manageable. I mean I’m able to go to work during major depressive episodes and everything. Just a small example, today I was feeling depressed and wanted to go hide under the bed, but instead I decided to clean the bathroom. And now I feel better.
So here is a clear example of a positive experience with medication that cannot be explained by the placebo effect. I still have to deal with the side effects - my vision is screwed up so I can’t wear contacts anymore, and my once extremely sharp memory has gone to shit in a way that is sometimes quite embarrassing. But on the other hand, I can get out of bed and clean my house and shit, and that means something. I mean, I don’t even need weekly therapy anymore. It’s been over a year since my last therapy appointment.
It’s true that medications aren’t as effective as a lot of mental health professionals assume them to be. But it’s also true that they can be effective.
My brother is bipolar. Trust me, it’s very real.
Of course doctors should go over all of the facts first – and that applies to all medication, not just for mental illness. But for some reason, it’s only psychiatric meds that are being exploited by “drug companies”. Not other sorts of illnesses. :dubious:
Well, yeah, because if a doctor gives you a med for a physical problem, there jolly well better be physical proof that you need it. But all a shrink needs to say is that they think you might maybe have a mental problem, and they can prescribe anything that might maybe possibly help.
Image if my broken wrist had been treated the same way my (supposed) mental problems were, by giving me some pain med that might maybe work after two or three weeks or might cause more pain?
You hear this kind of thing about cancer drugs too, sometimes, but pretty much nothing in between. ‘They don’t want to cure cancer, they just want you to stay alive so you can keep taking their drugs (and all you get out of it is living longer), but not cure it even though you’d presumably have to live longer and take other drugs, because, um.’
And that confirms that psychiatric illnesses are tougher to identify and treat than physical illnesses. Is that supposed to be a surprise?
How do you know you had a broken wrist? How do you know wrists even break? The “broken wrist” model of perceived wrist pain is only one possibility. And who decides if it’s broken? Who are doctors to say there’s one and only one way wrists are supposed to be.
When you see your wrist bone sitting three inches below where it’s supposed to be, and see the X-ray, you know you have a broken wrist. The orthopedist who specializes in wrist fractures determined it was broken. A wrist bone is supposed to connect the two arm bones. Mine wasn’t.
How do you determine someone is depressed enough to need meds, and that a specific med will help them?
Ideally, a patient would see a psychiatrist and a psychotherapist. Two independent observers, observing through two different lenses.
A patient tries drugs–singularly or in combination–until they find something that works. Simultaneously, they work out their problems through therapy. Until that starts to work. Both professionals collaborate with each other and the patient, making sure that everyone is on the same page with regard to diagnoses and recommendations.
Then, over some period of time of success, the patient experiments with tapering off one or both lines of treatment.
Hopefully, caution was used at every step, and no inappropriate medication or therapies were prescribed.
Do you want to be able to lay down under a scanner and have a computer diagnose you based on your brain activity? I don’t. I don’t want the process to be so sterile and cut-and-dried. As soon as you make an “objective” assessment, you give assholes license to downplay your symptoms. “Sorry, it’s impossible that you’re seriously depressed. Your brain scans reveal a perfectly normal brain. You aren’t sick. You’re just sickening, my dear.” Or you will hear, “Well, I know you say you aren’t hearing voices, but the activity in your scan shows that you are. Maybe you don’t realize it. Are you too embarrassed to tell me the truth?”
I have had asshole doctors tell me what I’m feeling before. I can only imagine how assholish these people would become if they had an objective way of characterizing their patients’ conditions.
That’s doesn’t hold together. If the available technology actually was able to tell what was wrong (or not wrong), then such assholes couldn’t make such comments without openly lying. And if they’re willing to lie in the face of the evidence then the objectiveness of what they are lying about doesn’t matter. They won’t be able to “downplay your symptoms” without lying either because they’d be right there on the screen with everything else. If the machine is saying “subject is depressed and hearing voices” and some guy is saying, “you’re just making it up”, then the problem isn’t the machine.
And frankly, if there was something wrong with my mind I’d rather have technology that can actually help me fix it. Instead of relying on psychologists/psychiatrists who are making stabs in the dark at best most of the time.
Wow. Blind stabs in the dark. Random diagnoses, essentially.
What evidence do you point to in support of that characterization?
In that case, I don’t mean to say that it is literally a placebo (that is, a sugar pill). I mean that people might get better on the placebo effect. Notice that I use the word “might.” I don’t know and I haven’t studied this with any particular agenda for or against the pharmaceutical companies. Maybe some people get better through a placebo effect. Maybe others get their brains adjusted by the chemicals. I don’t know. What I do know, however, is that a lot of times, it’s a hit or miss.
I was in the hospital a few months ago for pulmonary embolism. I was given two shots a day in the stomach and then took Coumadin. Those meds did the job and got me out of a perilous situation. But it doesn’t work this way with psychiatric medication. Whereas most people in my situation would have been given the stomach meds (the name escapes me) and then Coumadin (with some exceptions depending on circumstance), with something like depression (speaking from experience; I can’t speak for the other mental illnesses), one guy goes on Prozac, another on Zoloft, another on Luvox. If it works, fine, but if it doesn’t you change the Prozac for Zoloft or you add an adjunct and then you adjust this dose and that dose and replace this with that. And the doctor can never say for sure that this new med will help. It’s all a crapshoot.
I’ll repeat again that I’m not against medication and treating serious mental illnesses should use everything at our disposal at this point in time to make people healthy. And just because we don’t know exactly what causes mental illness and how these meds try to help, I don’t think they should be banned or labeled with big warnings. I just think that people should know that they are not as perfect as they are prescribed to be by mental health professionals who’ve told me that I need to be on meds for the rest of my life when, well, maybe I don’t.
Right. Like I said in my other post, I used a wrong choice of words. I meant it’s a sort of “placebo effect.” But I think hit or miss is the best way to summarize it. We just need to wait until we understand the brain better to know just what is happening and what needs to be fixed so that these meds can work consistently in all people, all the time.
This very thread for one thing; “give drugs and see what happens. Repeat until we stumble on the right drugs.” That’s not a course of action taken by doctors who really know what they’re doing.
You were talking about diagnostics and identification. Now you are talking about treatment decisions. Do you understand the difference?
With regard to deciding amongst drugs, you are washing across disorders and drugs. Do you know that lithium, for example, is not tried as a medication for PTSD?
Besides which, it would be stupid for this thread to be the source of one’s knowledge on this subject.