Mental Health And Medicine

[markwhite]

we suffered..... a lot

We had to learn how to deal with our suffering without reaching for a prescription pad everytime something caused us pain.

[DogNo1]

we suffered..... a lot

We had to learn how to deal with our suffering without reaching for a prescription pad everytime something caused us pain.

Just some suggestions for reference: Dr. Thomas Szasz wrote a number of books about psychiatry including "The Myth of Mental Illness." You can read excerpts from his books on Amazon.com. Regarding depression, CBS News recently did a piece on the deep electrical stimulation of Area 25 in the brain to help severly depressed people. Here's the link:

www.cbsnews.com/stories/2006/09/29/60minutes/main2053537.shtml

Time magazine also published an article about Area 25 just a few months ago.

I think that reading studies of various techniques for treating depression helps to make our opinions objective and not too personalized. If it were possible for us humans to understand our own mental processes well, we could probably help ourselves a lot, but Sigmund Freud pretty well established that part of our minds are not directly accessible. From what I have read, depression is quite variable and while exercise, drugs and talk therapy, alone or in combination, help many people, for some it's not enough. For these poeple, deep brain stimulation and newer drugs may hold the key.

While Western Medicine is conducted accoring to the scientific standard, I personally think that medicine is also an art. We must find the cures that are right for the individual. I do believe that for many people, depression is very painful. I admire people who are able to cure themselves through exercise, diet and right thinking but it seems that many people can't do this. Maybe AA veterans might interpret this as they "won't" cure themselves. Their "tough love" approach is admirable, but not effective sometimes.

In regard to the abuse of medication, it certainly exists but I have heard doctors say that patients are not content to leave the office without a prescription, so they end up prescribing more than they feel is necessary. Perhaps some doctors make money from overprescribing indirectly through freebies from drug companies, but certainly patients' demands for medicine make it easy to do. Sometimes it's a tough call: does the patient really need the medicine....or not?

Just my two cents.

[sriracha john]

we suffered..... a lot

We had to learn how to deal with our suffering without reaching for a prescription pad everytime something caused us pain.

No... actually people just suffered, horrendously so.

People in throes of pyschosis, for example, are completely unable to "learn to deal with their suffering."

Through the advent of medications, a monumental level of of relief was obtained.

Are there physicians who over-prescribe? Yes.

Should we swing to opposite side of the pendulum and dismiss the appropriate dispensing of medications so out-of-hand? I would hope not. Otherwise it's back to medieval-style mental institutions where the suffering was practically unimaginable.

Edited November 15, 2006 by sriracha john

[sriracha john]

I do believe that for many people, depression is very painful. I admire people who are able to cure themselves through exercise, diet and right thinking but it seems that many people can't do this. Maybe AA veterans might interpret this as they "won't" cure themselves. Their "tough love" approach is admirable, but not effective sometimes.

It's precisely this type of misjudgement that has the strong potential for ending up with fatal consequences due to their misunderstanding of the issues involved.

Depression can excruciatingly painful and is not something that anyone would willingly choose to have.

[markwhite]

>Just some suggestions for reference: Dr. Thomas Szasz wrote a number of books about

>psychiatry including "The Myth of Mental Illness." You can read excerpts from his books

I had the book once, but found Szasz approach far too dry and uninteresting to be able to wade through it.

>I think that reading studies of various techniques for treating depression helps to make our

>opinions objective and not too personalized.

There is no such thing as a truly objective or depersonalised opinion. We are people. Our opinions are personal to us. Others may agree with our observations, but it is just their personal opinion happening to match ours to a close enough degree. When enough people agree to a close enough degree, it is felt to be an objective fact. But it's not really.

>If it were possible for us humans to understand our own mental processes well, we could probably

>help ourselves a lot

It is possible. Study yourself for 10 or 20 years and see what you think after that.

>but Sigmund Freud pretty well established that part of our minds are not directly accessible.

And Newton showed that the universe is mechanistic and predictable it behaviour. Einstein and quantum theory have shown that this is not the case.

Much of Freud's work still stands, and provided a great foundation from which modern theories have developed. But it is not gospel and much of it is outdated.

>From what I have read, depression is quite variable and while exercise, drugs and talk therapy,

>alone or in combination, help many people, for some it's not enough. For these poeple, deep

>brain stimulation and newer drugs may hold the key.

Something in this statement makes me want to disagree, but 'some' and 'may' are nicely used so I won't get picky :-)

>While Western Medicine is conducted accoring to the scientific standard, I personally think that

>medicine is also an art.

I don't understand the use of the term 'art' here.

>I do believe that for many people, depression is very painful.

You have no experience of depression, or mental illness, yourself?

[markwhite]

>No... actually people just suffered, horrendously so.

There are many examples of cures that were used in times gone past to alleviate the suffering of people with mental illness. Shamanism, exorcism, laying on of hands or faith healing, tribal rites of passage to a degree. That sort of things.

When we developed to a point where we decided those things were no longer...maybe civilized is the best word, we lost something. Many people now believe the pill to be the best possible solution to mental illness.

My point is that there are other ways, and there is more than one way of considering what is truly being represented when an individual is experiencing mental illness.

>People in throes of pyschosis, for example, are completely unable to "learn to deal with their

>suffering."

Pyschosis is defined by in ability to relate to the consensus reality. If I truly believe I am Napoleon despite all evidence to the contrary, I am psychotic.

Psychotics are mostly encouraged not to indulge in their fantasies or delusions, and to fight them off using medications. A school of thought (Stanislav Grof and others 'Spiritual Emergency') sees many pyschotic episodes as something that is a natural part of personal growth and spiritual development. Having been there, done that, and come out the other side, my personal experience agrees with this.

This does not mean that there are not individuals who 'need' to be medicated for whatever reason.

But it is not black and white. It is not that one approach is right or wrong. But that there are different approaches which may work for different people in their individual circumstances.

[sriracha john]

>No... actually people just suffered, horrendously so.

There are many examples of cures that were used in times gone past to alleviate the suffering of people with mental illness. Shamanism, exorcism, laying on of hands or faith healing, tribal rites of passage to a degree. That sort of things.

And the success rate of these "treatments" was....?

Sorry, but it's not realistic to think that a handful of people who achieved any relief from the placebo effect of these methods meant much when balanced against the millions who suffered unspeakable agony until the advent of the psychotropic medications that revolutionized treatment for psychotic sufferers.

When we developed to a point where we decided those things were no longer...maybe civilized is the best word, we lost something. Many people now believe the pill to be the best possible solution to mental illness.

Depending on the mental illness, medication is the cornerstone which, without it, sends the person spiralling out of control, be they a bipolar disorder sufferer or schizophrenic, for 2 examples. If we're discussing psychosis, no other treatment, whatsoever, begins to approach it's effectiveness in helping the patient. Are medications the only treatment provided when treating psychotic illnesses? Certainly not, but then, no one single treatment is even close to being in the ballpark in terms of it's worth to the patient's improvement.

My point is that there are other ways, and there is more than one way of considering what is truly being represented when an individual is experiencing mental illness.

>People in throes of pyschosis, for example, are completely unable to "learn to deal with their

>suffering."

Pyschosis is defined by in ability to relate to the consensus reality. If I truly believe I am Napoleon despite all evidence to the contrary, I am psychotic.

Psychotics are mostly encouraged not to indulge in their fantasies or delusions, and to fight them off using medications. A school of thought (Stanislav Grof and others 'Spiritual Emergency') sees many pyschotic episodes as something that is a natural part of personal growth and spiritual development.

That's an interesting school of thought, but one which conflicts with what I've experienced working with hundreds of sufferers over the years. Indeed it is paramount to point out to the psychotic what is real and what is not as their ability to do so is impaired. By helping them to separate reality from delusion, fact from hallucination, they become more grounded in the real world and the suffering lessens. Being psychotic is quite often an extremely terrifying experience to the one afflicted.

Having been there, done that, and come out the other side, my personal experience agrees with this.

I congratulate you for being able to overcome your illness and wish you all the best.

This does not mean that there are not individuals who 'need' to be medicated for whatever reason.

That would statistically be the vast, vast majority of all people with psychosis.

But it is not black and white. It is not that one approach is right or wrong. But that there are different approaches which may work for different people in their individual circumstances.

In any discussion of treatment of severe mental illness, it's important to see which works for most as it involves millions of people world-wide. Isolated cases of improvement utilizing this method or that method are worth noting, but when they've been shown to work for only a small finite minority, then that must be balanced with what works best for most. Current mental health treatments have developed from extensive studies and research and is constantly being fine tuned. Ongoing research looking for future break-throughs and further refinement of current treatments is essential.

[DogNo1]

Hi,

In reference to my previous comments:

While it is true that reality is social in nature ( there is actually a book by that name-"The Social Nature of Reality), the scientific community attempts to reach as objective an approximation of truth as possible. For example, tests of medicines are conducted using the "double blind" method and the results must be must have a 98% possiblity of being right statistically before a medicine can be accepted by the FDA. All professional journals are refereed, that is, a board of experts reviews any submission for publication to ensure its accuracy, correctness and relevancy. Only when an article passes their examination may it be published. This not only includes JAMA, Lancet and the New England Journal of Medicine, but journals in other fields. By reading journals, we discover the results of the best current research. Science invites argument and disagreement in order to better approximate the truth and we can find these both in the relevant magazines and online. I guess that you are correct in saying that the truth is a matter of opinion but it's how the truth is put to the test that matters.

What I meant by saying that although medicine is science-based, it is an art, is because a number of factors are invoved in whether a treatment succeeds or fails. What is effective medicine for one person may not suit another due to social, psychological and physical factors. Apparently medicines work best when they are accepted in the community and people believe that they will work. Around 1946, there was a smallpox epidemic in Japan. Attempts by the occupation medical corps to administer smallpox immunization injections were thwarted by Japanese doctors who claimed that medicine that worked on Americans wouldn't work on Japanese. It took quite a lot of reasurring and providing evidence that the immunization shots were effective before the medical community in Japan cooperated. When the Japanese people got the injections, the epidemic was halted.

I do have personal experience with depression. Although I am not suffering from it presently, I have in the past. I am treating my depression with medication, exercise, diet and cognitive therapy. I've felt pretty good for quite a while now, but didn't do well when I stopped my medication a couple of years ago. For me, the multi-pronged approach seems to be effective.

BTW, Freud was a pioneer in the understanding of psychology. There are books such as "Freud 2000" in which modern psychiatrists discuss the relevance of Freud's theories in light of present-day knowledge. Some of the most exciting work these days, in my opinion, is being done in examining the physical nature of the brain and what areas are used in certain circumstances. That's what led to the discovery of the "gate theory" regarding area 25. It appears that in people who don't suffer depression, area 25 serves to quiet thoughts. When area 25 doesn't work correctly, obsessive negative thinking occurs. When area 25 is electrically stimulated, the thoughts decrease for a significant number of patients. As I mentioned, area 25 was covered by CBS News and Time Magazine.

I am quoting from an earlier post by markwhite: "Hormones are indicators of moods, not the other way round." Do you mean that hormones don't affect moods? I wonder what your evidence is. Would you be willing to say this to a woman in menopause? Don't estrogen and testosterone levels have a strong influence on mood?

[DogNo1]

I would like to clarify my statement regarding the "tough love" approach. I am not advocating it alone. When I was living in San Francisco, I observed some Synanon meetings in both San Francisco and Oakland. Synanon, a drug-addict treatment organization, seemed to me to be similar to AA in the respect that it emphasized responsibility and accountability and encouraged a tough attitude toward addiction. For example, there was no apologizing for mistakes at group meetings and the women sometimes shaved their heads for infractions. This contrasted with the approach I had experienced while working as an aide in a southern California psychiatric hospital. The general feeling there seemed to be that mental illness was not voluntary, even for alcholic and drug-addicted patients. My own viewpoint is somewhere in between the two. I believe that much mental illness is involuntary but that people can sometimes benefit from a greater sense of responsibility for themselves and their conditions. Karen Horney wrote about "neurotic claims" which are demands for special attention, consideration and love. Sriracha John obviously has rich experience in the psychiatric field and can judge much better than I the appropriateness of psychiatric treatments. There is a huge range of personalities and psychiatric conditions, and each warrants an appropriate approach in my opinion. I don't think that is ever useful, though, to tell someone that their problems are a figment of their imagination.

Just another two cents.

[markwhite]

>Sorry, but it's not realistic to think that a handful of people who achieved any relief from the

>placebo effect of these methods

Handful of people?

The incidence of mental illness (in terms of stress and depression) amongst so-called primitive or uncivilized people is negligible compared to the endemic amongst so-called civilized western people. Much of the discussion here has compared the more-so chilled approach to live in Thailand and how mental health issues are less prevalent here than in the US. Who is living the life that is best for them?

We have created a problem with mental illness through the way that we live. We create those conditions, and then prescribe drugs to mask the symptoms.

The solution is to look at the lifestyle people have and see how this can be changed to offer a solution to the cause of their disease.

While the symptoms are masked, this is not a necessity. If the symptoms are not masked, the individual is forced to accept responsibility for their own condition and do something about it.

Making people accept responsibility for their lives is often painful for them. The pain manifests itself in many ways, including severe mental disorders. People withdraw, they refuse to accept their reality. They become psychotic.

To tell them this is wrong does not help. To even say that they are ill (I use the term 'mental illness' in this way myself) is not a positive thing. It is standardising your thoughts on how they should be and judging them for being different. To accept the psychosis as their reality and work with it is an option. Just as strong medication (I profess to having little experience in this field, but allow myself to be open to the idea) may also have it's place.

Your judgement that this is merely a placebo effect does not encourage me that you are even open to the idea that solutions might exists outside of the view that you hold. That's up to you. Certainly your view is different from my experience.

>If we're discussing psychosis, no other treatment, whatsoever, begins to approach it's

>effectiveness in helping the patient.

What other treatments do you have knowledge of?

On re-reading this is far too open a question and is a direct challenge to your knowledge. I'd like this to be a discussion not an argument, though this question does not reflect that.

>Are medications the only treatment provided when treating psychotic illnesses? Certainly not

Fair enough to a degree, but frequency of application does not prove ultimate validity. We bomb the crap out of countries that disagree with certain 'world' policies, and some would argue that it elicits a regime change that is positive. But is it the only way, and the best way of achieving a change?

Just because we do it more often that not, doesn't make it right.

>Indeed it is paramount to point out to the psychotic what is real and what is not as their ability to

>do so is impaired. By helping them to separate reality from delusion, fact from hallucination, they

>become more grounded in the real world and the suffering lessens. Being psychotic is quite often

>an extremely terrifying experience to the one afflicted.

I think is the fundamental difference in our opinions.

You say that you have a view of reality which is objective. And that pointing this out to psychotics is the way to help them to see what it in their mind and what is real? I'm trying to get understanding of your point of view here.

But to them a hallucination is real. And it is no less real to the hallucinations you accept to be your reality.

Okay, this descends into the murky world of existentialism and philosophical arguments to a degree, and I have no real wish to go there.

But to say that what a psychotic experiences is not real merely adds to their confusion. Accepting that their reality consists of things that we do not take as real at least gives them a stable ground from which to start to make sense of their experiences.

>I congratulate you for being able to overcome your illness and wish you all the best.

Thank you

>That would statistically be the vast, vast majority of all people with psychosis.

The fundamental point still applies. What we, separately, define as helping someone or making them 'better'.

>In any discussion of treatment of severe mental illness, it's important to see which works for most

>as it involves millions of people world-wide.

I'm with the next poster who uses the term 'art' in discovering what is best. You are not dealing with a group of people who exist solely as a group of people. You are dealing with lots of individuals who have been categorised as a group because they are all 'mental ill'. There exists no other common thread, except their humanity, to connect them. Every individual will respond separately and will get different benefits dependant on their individual needs.

>Isolated cases of improvement utilizing this method or that method are worth noting, but when

>they've been shown to work for only a small finite minority, then that must be balanced with what

>works best for most.

I must be misunderstanding this. I read this that if it works for most people, it should be applied to all people, even if there is something better suited to an individual. Help me to get your point here.

>Current mental health treatments have developed from extensive studies and research

That often looks at the experience of mental health with a western, reductionist, scientific approach. It can be the best way, but it is not the only way. Though I think from what you've said we agree to a point on this one.

Cool discussion. It is only by seeing the shortcomings in my own views that I learn.

[markwhite]

>Science invites argument and disagreement in order to better approximate the truth and we can

I'm up for that. An approximation of the truth is a good term.

find these both in the relevant magazines and online. I guess that you are correct in saying that the truth is a matter of opinion but it's how the truth is put to the test that matters.

>Apparently medicines work best when they are accepted in the community and people believe

>that they will work.

A large influence of the placebo effect then?

>I do have personal experience with depression. Although I am not suffering from it presently, I

>have in the past.

I wish you well, and hope the path to your solution is a short one.

>BTW, Freud was a pioneer in the understanding of psychology

The father of modern pyschology. I agree.

>Some of the most exciting work these days, in my opinion, is being done in examining the

>physical nature of the brain and what areas are used in certain circumstances. (area 25)

What are the views on what is the cause and what is the symptom? If area 25 is less developed or functional in certain individuals, is it felt that this is as a result of increased levels of negative thinking, or is this what causes the increased levels of negative thinking?

Another murky door open around the subject of the mind and consciousness and whether these are only manifest though the existence of a physical brain to do the thinking and be conscious...

>Do you mean that hormones don't affect moods? I wonder what your evidence is.

I still stand by what I said that a mood is the persistence of a feeling. You say you do exercise which I accept from what people say (if I've remembered correctly) leads to the production of seratonin. The crux is whether the exercise produces seratonin directly, or whether the exercise produces a pleasurable feeling (mood) which leads to the production of seratonin.

Though your next question is not one I'd considered before.

>Would you be willing to say this to a woman in menopause? Don't estrogen and testosterone

>levels have a strong influence on mood?

I'm tempted to make an ill-informed response, but I recognise it will be only that. Tell me a little more about the way this is viewed physically so I can understand better.