Wednesday, 28 January 2009

This is why psychiatry is important.

I am infuriated by the "all in your head" school of denial of mental illness, or the "just get over it" approach. My very simple response to these sorts of crashingly ignorant attitudes is to point to a line which occurs, as far as I'm aware, in basically every definition in the DSM, and which says "Causes signifcant impairment in school, work or social functioning." For there, you see, is the rub.

A mental illness is not just behaviour we don't like or aren't used to, it's behaviour we aren't used to and which seriously fucks up the sufferer. We lump them together in diagnoses based upon shared patterns of symptomatology not because we have the definitive proof that they actually are related (physiologically, we don't), but because this allows us to talk about patterns of behaviour that respond in a similar fashion to certain treatments, and therefore guides us in which treatments we should be using.

Over at Science-Based Medicine, Harriet has written the best post I think I've ever seen which summarises these matters and explains
why psychiatry is important and needs our research dollars. If you want a more in-depth look, Steven Novella links to a five-part series he wrote on Neurologica about mental illness denial.

The problems discussed by Harriet are the usual problems which will always plague any school of medicine which can't show you before-and-after X-rays, and are ones which even I have made reference to over the years - flawed studies done using the inherently difficult-to-research subject matter of people; the inability to do a blood-test for mental illness (can't do one for migraine, either); the problems with the DSM, an inherently political and cumbersome document (which, incidentally, contains shifting diagnoses that have lead to a large part of the hysteria about the so-called and completely fallacious "autism epidemic") and so on.

Psychiatry remains like many other fields of medicine - the practitioner is important, the relationship between the practictioner and the patient is crucial, and just like your GP when they don't have access to blood tests and want to play on the safe side, medication is an inexact science.

But people who deny treatment because they deny the existence of psychiatric disorders, or are terrified about suidical ideation, are firmly in the same category as people refuse other forms of medical treatment - they are dying basic human rights, and perpetuating abuse through neglect.

Link to entry "Psychiatry Bashing" on Science-Based Medicine


hankm said...


No one says that psychological problems or overwhelming feelings of emotional distress don't exist. What I am saying is that these feelings aren't necessarily MEDICAL.

Psychiatry makes the mistake of treating SYMPTOMS, not etiology. Your example of migraine headaches is flawed because it too is a SYMPTOM. Get to the bottom of the symptom and you have your cure.

But for God's sake, don't mask the true underlying problem with a powerful and potentially addictive psychoactive substance that can come with some severe short and long-term side effects.

True solutions, if they are medical, could be an underlying illness like encephalitis or Lyme Disease, or allergies, lack of sleep or even a bad diet.

Or if not medical, it could just be a personally toxic environment or the way the person is living his life.

Viewed in this context, mental problems could be seen as an opportunity for real change. But not if you cover it up with psych meds.

This is what I believe the debate is all about.

I hope people on this site take the opportunity to understand this viewpoint instead of flaming back at me.

Dubito said...

Unfortunately, hankm, I can only assume that you failed to read the article I am discussing, and have also mis-construed everything I actually said. Otherwise, you would see that using migraine as an example was perfect, and for exactly the reason you cite.

I question that "no one" denies the existence of psychological problems - I've seen people arguing exactly that - and the word "medical" needs a fair bit of discussion in this context. Although psychiatric disorders are, by definition, things which don't have an underlying physiological cause, such as infections, parasites or neurological trauma, we have a wealth of evidence that there are common and underlying neurological causes - poorly functioning hippocampi in mood and stress disorders, randomly distributed functions in schizophrenia, etc.

Many of these biological causes can be addressed using medications when necessary, giving the sufferer breathing space and support to address the psychological issues - coping strategies, life structure, inappropriate peers, etc.

I think you have taken hold of the other extreme - that drugs shouldn't be used to cover up psychological issues - and that this is just as wrong as the extreme which says that psychiatric disorders don't exist.

Nor are psychiatric medications only useful for purely psychological reasons - many people with neurological injuries from trauma, stroke, infection, or the thousand other causes, benefit from antipsychotics for mood stabilisation, or anti-depressants for coping with severe life changes until life can be stabilised.

You hopefully read as far as me saying that the relationship between patient and practitioner was all-important, and this is why - purely psychological therapies may be sufficient in less extreme cases, but for cases where the psychiatric disorder is so overwhelming that the sufferer does not have the strength or focus to make changes, or where there are distinct, strong neuropsychological reasons for the disorder, then medications are a vital co-therapy.

For some people, a carefully selected medication at a carefully adjusted dose becomes necessary even in the best life.

But the absolute last thing that anybody should ever say about any medical debate is "That viewpoint is absolutely wrong, and I'm right, because." You will never be right - everything to do with any biological system as complicated as an animal which has evolved consciousness is always going to be more complicated than binary beliefs can cope with.

calvin said...

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