A-Z of mental health
Information and advice on a huge range of mental health topics
Is the medical model really so evil?
Posted Friday 12 February 2010
A guest post by Zarathustra of the Mental Nurse blog.
Before I became a mental health nurse, I spent a few years as an over-educated, unemployable humanities graduate - hey, I'm not knocking that; being an over-educated, unemployable humanities graduate can be a lot of fun.
I also had quite firm views on psychiatry. I was a huge fan of RD Laing, the radical 60s psychiatrist. I'd tell anyone who would listen that psychiatric diagnoses are a subjective construct, that drugs aren't the answer, and that the medical model of mental illness is irredeemably reductionist (yes, I was the kind of humanities graduate for whom "reductionist" is the ultimate word of abuse).
Comparing these views with what I think now, I get the impression my younger self would be rather disappointed in me. Admittedly I haven't changed my views entirely. I still think there are problems with some forms of psychiatric diagnoses, and these problems are inevitable due to their subjective nature. I still regard the psychosocial aspects of mental health as absolutely vital, and I still regard the drug reps as servants of Beelzebub.
Even so, I also now think the medical model has its merits as well as its flaws. Diagnostic categories do seem to have some usefulness and validity, and psychiatric medication can at times work wonders. The twentysomething, BA-educated version of me would shake his head in sorrow.
So, what's changed my mind on the medical model? Well, the most obvious answer would be that I went into the belly of the beast and trained as a mental health nurse. Certainly cold, hard clinical experience has had a lot to do with it. I can't swan around saying that the drugs don't work, because all too frequently they do work. Admittedly the meds work haphazardly, and sadly all too often with unpleasant side effects, but the bottom line is I've seen too many people benefit from medication to be able to dismiss those benefits.
Crucially though, the people who've most effectively challenged my previous hostility to the medical model have been patients rather than doctors.
I have a friend with bipolar disorder who's also a very intelligent, independent-minded lady. Not the sort to be brainwashed by an evil cabal of shrinks and Big Pharma. She's tried yoga, mindfulness, CBT, person-centred counselling...all of which have had some benefit, but she's also learned to her cost that, unless she takes the meds, all those benefits are immediately cancelled out. Her response to anti-psychiatry is to angrily insist, "Look, I don't have a problem in living, or a social construct, or an existential crisis. I have an illness which is called bipolar disorder, for which I take medication."
"Your diagnosis is this, and we're going to treat it like this" is an explanation that works for a lot of a people. Those people shouldn't be hectored on how they're dupes of the medico-pharmaceutical complex simply for finding the medical model helpful.
While much has been written on how psychiatric diagnosis can label and stigmatise people, you can also demean, belittle and patronise people by telling them they don't have an illness, and that it's all just a social construct/problem in living/spiritual crisis.
Of the anti-psychiatric authors, Thomas Szasz in particular writes with an unpleasant moralistic tone that reeks of, "You could just snap out of it and pull yourself together if you really wanted to."
Ultimately though, any argument about, say, "medical model" versus "psychosocial model" shouldn't be an either/or issue. It's perfectly possible to make use of diagnosis and medication while also taking into account psychological and social issues. And yes, while also being aware of the political and philosophical controversies that psychiatry generates.
Any model of psychiatry, be it medical, psychosocial, existential, social contructivist etc, describes an aspect of the truth from one particular angle. We need to be able to move between the models as and when they become useful, rather than loudly privilege one model while denouncing the others.
Speaking of models, a consultant psychiatrist I know has a fondness for saying that we follow an "ecobiopsychosocial model". I'm gagging for him to say it to me so I can quip back, "That's easy for you to say."
Zarathustra
45 Comments
-
I couldnt agree more. I'm a psychotherapist and am a wholehearted supporter of drugs where drugs are needed. For me, it's not one model versus another but an integration of different approaches tailored for each individual
-
I was diagnosed with moderate severe depression and anxiety last year and referred to a therapist who specialises in CBT, addictions and anorexia and bulimia. I found the CBT helped until I went backwards and my GP prescribed Fluoxetine to help me cope. Since I have been taking the meds combined with CBT I have felt much better, good days and bad still but able to function. .
-
I think the more you medicalize a condition the more you convince people that a tablet IS the answer. Medication should be a last resort and sadly this doesnt happen often. I tend to look on a lot of so called mental health disorders as a personal crisis. A time when spiritually one loses direction. Take hearing voices for example. The voices that are heard are encouraged to be dismissed often when actually there may be very important messages in what they have to say...just one example. I think this is a huge debate. I have a friend who is biploar and has been for 30 years. She is no different or no better today than she was 30 years ago and she is on many meds. It appalls me that she has her meds increased/decreased/changed at very regular intervals and is never well. Personally I think its hard to consider meds 'the answer'. If they were the answer there wouldnt be countless people with continuing mental health problems such as my friend. Give relief...yes sometimes. Cure? no. Relief at the expense of side effects that give people further debilitation...not very good really is it? Not denying conditions exist whereby people need much support and guidance but often meds are an insult to injury. Just my opinion.
-
I find that a number of approaches help me: diet, exercise, CBT, social interaction, going to church...However, when I come off my medication I relapse very badly. I'd much rather not to take the pills but time and time again I have found coming off has been extremely detrimental to my mental health.
-
Hi Wendy
Have you ever considered that that might be purely because your brain has become accustomed to the change in the brain chemistry that those medications enforce? Any change in the brain re chemicals will make one feel unwell until such time has elapsed for adaptation. Taking them again reinforces the belief that there is a dire need for those medications when that drug induced chemical balance is restored.
Did you have any chemical testing to determine what chemicals you needed and in what quantities? -
If, as a patient, you think of yourself as ill, then you'll like being treated as a patient i.e. "medicalized"... if you don't, you'll not like and want to be called a service user, or something else.
-
After years of fighting the medical model of my own care I finally conceded to take haloperidol regularly, even when I feel well. Diet, exercise, psychotherapy etc did not work alone for me but now with my four main 'pillars' (diet, exercise, drugs and talking) it has all made me come together. I agree the medical model approach is most definitely not the only approach but it is certainly part of the whole
-
I have bipolar disorder. For thirty years, I managed without medication, then I went on it. Medication helps me to stay alive. I use a combination of different drugs, including PRN antipsychotics, and they make life bearable. I wish I'd had them decades ago instead of working my way through well over a hundred self-help books and tapes, five different types of therapy, spiritual healing and various forms of exercise and meditation.
I can't say what would happen if I came off the medication now, but I know what it was like before I went on it and one of my biggest fears is having my medication taken off me.
-
Frankly I don’t care what model people subscribe to for themselves so long as they choose it for themselves and don't have it imposed on them [no matter what it is]. No single model should be more dominant than another, and no one should be made to feel bad for whatever they choose. If someone says to me that banana therapy works for them - I'll pass them the bananas
-
Without my medication I'd be dead. Medication IS the answer where someone is sick.
As for Sue's statement that ' the more you medicalise a condition the more you convince people that a tablet is the answer' is merely another indication of the low opinion in which mental health patients often find themselves held. Perhaps we shouldn't medicalise diabetes, MS, epilepsy or arthritis; all long term illnesses just like mental illnesses. Perhaps we should tell sufferers that they should just go to see pain management specialists. Or perhaps we should tell them to sit back and suffer their symptoms and then go see a counsellor afterwards to talk about it.
But noone would suggest that. Would they??
My illness is just as real as any 'physical illness' and I will continue to take my medicine just like people with physical illnesses.
-
I was really anti-medication and only went on it as I wasn't functioning. After a year I came off. Three months later I was over the side-effects of coming off it but getting worse. For another two months I resisted. Back on them now, for me I need them. The other things don't work otherwise and I try hard with exercise and CBT!
-
Another person with bipolar disorder here. Medication works wonders for me. I am part of the luck 1/3 of sufferers who get pretty close to full remission from medication. CBT has also helped me, but in the same way physio helps you after knee surgery - no good on its own.
Quite frankly I am bored with the idiots who run around yapping that pills are eeeeevil and that somehow sitting around in lotus position or paying up a fortune for Freudian analysis is somehow better for you because a pill is not swallowed. I mean, if sitting in lotus position helps you, please do as much yoga as you see fit - I have no problem with that.
But as far as I'm concerned I have an illness and my medication helps control it. I understand that a lot of people are not helped by medication. That doesn't change the fact that they are sick.
If you are experiencing the types of mood swings, psychosis and suicidal ideation common to bipolar disorder then something is WRONG. This is not normal, any more than a hole in your heart or high blood pressure. You are sick.
It may not be curable in your case. That sucks. I am not suggesting you take meds for the sake of it to make your doctor feel better in that case. There are a lot of terrible psychiatrists out there. I know that a lot of medical teams will refuse to do anything else other than hand out pills - this is bad medical practice. Like someone who has a cardiac problem or a stroke, they should ensure you get all the rehab care you need - CBT, OT help, a CPN, assertiveness training, art therapy - whatever will best help you deal with your condition and live with a minimum of disruption and disability. (My local NHS trust is pretty good on this front).
This all fits just fine into the medical model. Having a diagnosis does not mean that you will only be given pills. Medical treatment is not and has never been limited to simply dishing out prescriptions. Nurses are just as important for patient care as doctors. See how stroke patient rehab works, for example.
If one more internet moron tells me I am a "sellout" or alternatively a "victim" because I take side-effect-free medication that allows me to live a normal life I will have to design an internet pointy stick.
-
Daisy- Not to say that illnesses like diabetes, MS, epilepsy or arthritis aren't real or need treatment, but pain management specialists can often be a very important part of that treatment.
-
The danger of the medical model is that it doesn't always recognise that the value judgements underlying some (not all) diagnostic categories are often controversial. For example, not everyone wants their voices to be labelled as a symptom of brain disease. Not everyone wants to be described as having a personality disorder.
No-one objects to the medical model when doctor and patient values align. For example, everyone agrees dementia is a bad thing; you don't tend to get dementia pressure groups arguing for that label to be dropped.
Personally, I believe we need an evidence-based, rational approach to healthcare. From that perspective I feel uncomfortable with many of psychiatry's claims. Even strong advocates of the medical model have to acknowledge the explicit and controversial moral judgements contained in, for example, the 'personality disorder' categories.
Advocates of the medical model in psychiatry would also do well to remember that many doctors outside of psychiatry would be sceptical of the validity of many psychiatric categories. That is, the medical model in psychiatry often doesn't live up to the demands of the medical model in medicine generally.
-
i take medication for schizo/affective disorder which years ago was diagnosed as bi-polar. i am not sure why i am taking them and sometimes attempt to come off my medication but coz i am so used to what the medications does my brain feels all funny and i often get depressed when i tey and stop. i speak to the psychiatrist and he suggests cutting down (weening off) and i do this with an anti depressent i take but not the anti psychotic i take. well i will just say i am in two minds whether i will be any better medication free or if how i feel on the medication is better for me.
so i am trying an experiment, i am to come totally off my medication under the guidance of the doctor and then see how i feel. i have a sneaking suspicion that i will get very depressed and feel weird coz the chemicals i have become used to will not be there, but people like me are convinced they will be so much happier if they come off the medication. i don't want a constant feeling that i am not being myself coz i take medication, and i blame my symptoms as side effects of what i take. its all got very confusing so i guess in the end i will not stop and always wonder what i would be like if i didn't take medication
-
"not everyone wants their voices to be labelled as a symptom of brain disease."
Y'see this is where I have a problem. Not everyone may want a hole in the heart to be labelled a symptom of cardiac disease either, but it is one.
I know people who have heard voices all their lives and haven't got any problems with them - I wouldn't say they were ill or that they needed treatment. One lady I know finds them handy when composing music, for example.
But if you hear nasty, distressing voices all the time and they are causing you severe difficulty in living your life, or you are unable to tell that they are not real - then you have a problem, and I would call that a brain disease.
I'm very sick of the "I'm not illlll" crowd - look, if your functioning is impaired by your mental health to the point that you need to be sectioned, something is wrong, end of story. I'm not suggesting the maximum dose of olanzapine is what will fix it, mind you, merely pointing out the denial.
My mood swings are not normal. Mania is not normal. Depression is not normal. Neither is paranoia, excessive anxiety or delusional thinking. Trying to jump out the 4th floor window of an acute ward is not normal. These are all symptoms of my illness and the reason I get them is because I am SICK.
I get very fed up with people who go in for great mental gymnastics in order to view themselves as not ill and so distance themselves from the likes of me, who is a lifelong "mentalist". Yes, you are ill, so am I, so are lots of people, get over the idea already and stop trying to look down your nose at me.
-
DeeDee
First of all, I think you're arguing against things that I - and many others who are critical of the medical model - haven't actually said and don't even think (e.g., that a person who dislikes their experiences being referred to as a symptom of illness or disease is somehow superior to someone who prefers that terminology).
Secondly, your 6th paragraph suggests you believe that normality is a desirable thing in and of itself and that abnormality is undesirable. If so, surely you accept that others may disagree with you AND that they have a right to disagree? For example, it is abnormal for a male to desire to be a female. Is it undesirable? Should these people be treated against their will or at least accept the view that they ill? The French have a view on this http://www.mindhacks.com/blog/2010/02/france_strikes_trans.html
It is also abnormal to be a world-class sprinter, and so on. Is this an illness? Abnormality matters when it indicates the presence of something that is likely to lead to further suffering, impaired autonomy and / or death. Abnormality also matters if you want to be normal. However abnormality in itself is not necessarily a bad thing. We also have no right to impose our desire to be normal onto others.
Thirdly, I was certainly not saying that people who experience extreme suffering because of their voices do not somehow have a problem. Of course they do. They will want and need help and everything should be done to help them. Empowerment will be important to them, but probably not while they can't sleep or think properly. They will most likely need medication, and they will most likely wish to take it.
Fourth, you place too much importance on functioning in relation to voice hearing. That is, IF I am not asking people for help for my distressing experiences and IF I retain the capacity to make the decision to accept / refuse help, then regardless of the impact the voices are having on my functioning I believe services should respect my views as to (a) how I wish to refer to my experiences and (b) how I therefore wish to be treated.
Finally, there is a lot of evidence that fear of mental disintegration and madness is a major factor in young people with a schizophrenia diagnosis committing suicide. Perhaps they have this fear because they are told they have a 'brain disease' for which they need to take medication for the rest of their lives. Now the outlook may be bleak for many, however there is also good evidence to suggest that the hopelessness and fear associated with the brain disease message plays a major factor in (a) stigma and social exclusion and (b) fear and distress in relation to particular experiences. There is good evidence that stigma, social exclusion, fear and distress make particular experiences (such as voice hearing) much more frequent and intense.
-
I would love to be free of my mental illness, and the word "normal" was used in that context. I think people who go around going on that their mental illness is a "gift" are suffering extreme cognitive dissonance or are quite simply idiots - idiots whose behaviour results in an increase in stigma due to my disorder being viewed as a middle-class artistic affectation. Since this behaviour is causing me and all other mentally ill people harm I have every right to be annoyed.
Regarding transpeople, I don't want to get into that particular argument as it's a cause very very dear to my heart - something you were not to know - but here is not the place to discuss it.
On to treatment: Like all persons with full capacity, the patient and the patient alone decides if they want to take anti-psychotics, have risky surgery, remove a kidney now or in 5 years etc etc. I think we are both agreed there.
Where we disagree is in the language used to refer to the experiences of the voice hearer. If you're hearing voices that are causing extreme distress, then the neurons that govern perception are not functioning properly and I think it's perfectly ok to say this is a disease of the brain. It's the same paradigm for diseases of the kidneys, back problems, heart problems etc. - observed abnormality + distress = disease.
Do you have any evidence that telling schizophrenic patients they have a brain disease, in and of itself, contributes to suicide? Or is it woefully inadequate services that dump them in a council flat and refuse to offer them concrete help that are to blame? We could speculate all day in the absence of data. (Personally I think crappy services do not help).
Just because a patient doesn't like being told they are ill doesn't mean they are not. I don't agree that just because someone has an experience that absolutely no-one else can make any comment on it.
I'm not saying that the person themselves feels they are not ill - yes, I can see they think that. What I'm saying is that they are mistaken - they are sick.Why on earth is it so hard for people to accept anyway? I don't see arguments of this type among heart or kidney patients? Do people suffering chronic pain insist that they are "not ill" but that chronic pain is a "variation in human experience"?
It wouldn't be a desire to not be seen as a "mentalist" and so feel they are getting away from stigma, would it? Not that I'd blame someone if that were the case. Perhaps we should view this as a type of denial forced on someone by an unpleasant social context?
And We are a bit Judean Peoples' Front here really. Me included...
-
From my own experience, one of the real dangers of militant anti-psychiatry (or even well-meaning friends for that matter) is that it can instil fear of getting medical help when it would be useful, or even life-saving.
This can (and does) contribute to people taking their own lives, or remaining in a living hell that prevents them functioning properly.
-
DeeDee
(Apologies in advance for the long reply.)
“I think people who go around going on that their mental illness is a "gift" are suffering extreme cognitive dissonance or are quite simply idiots - idiots whose behaviour results in an increase in stigma due to my disorder being viewed as a middle-class artistic affectation.”
If people wish to classify their experiences as a gift, then that’s a matter for them. I may not agree, but I wish them well. However if they are unable to consider the evidence suggesting that without treatment they are likely to experience extreme suffering and impaired autonomy – or cause others suffering – then their doctor might conclude their capacity to make decisions about their treatment is reduced.
If describing one’s experiences as a gift invalidates the suffering of other people then that is obviously a concern. But they might respond that the brain disease message hardly reduces stigma - and they might be able to cite some evidence to support their view. For example, a 1997 study found that people were more willing to give electric shocks to people described as having a brain disease, than they were to people whose difficulties were presented as a consequence of childhood adversity (see Mehta et al., 1997).*
“Where we disagree is in the language used to refer to the experiences of the voice hearer.
No, I’m getting the sense that we disagree over whether people are operating ‘within the realms of reason’ if they choose to refer to their problems without using disease / illness terminology. My view is that it is quite reasonable to use this sort of language and quite reasonable not to use it. My understanding is that people generally ‘do better’ when the language is avoided.
“If you're hearing voices that are causing extreme distress, then the neurons that govern perception are not functioning properly and I think it's perfectly ok to say this is a disease of the brain.”
So do I. But I also think that someone is perfectly entitled to refuse to say so. There is room for both perspectives here. This is an extremely important point, given a refusal to endorse the disease terminology is often classified as a symptom of disease itself. You should not feel pressured to change the way you talk about your problems. Equally, an advocate of brain disease terminology ought not to force others to use it, if they would rather not.
However, with respect to your example, no-one is entitled to deny the objective facts. It is true that there has been some change in this person’s brain and it is true that they are hearing extremely distressing voices as a result. It may even be true that without treatment more brain changes will result, and their voices may become more frequent. However, as you noted, there are many people who hear voices but are not distressed by them – many even value them. Presumably their brains have changed too. Does this mean they also have a disease? Or is it the extreme distress of the first person that means only he or she qualifies for having a disease? But if so, then what does the term ‘disease’ add? Does it mean we will take them more seriously? I’m not sure; I take the presence of extreme distress seriously enough.
“Do you have any evidence that telling schizophrenic patients they have a brain disease, in and of itself, contributes to suicide?”
Yes, see Hawton et al., (2005)** for a systematic review of suicide risk factors in this group. Keith Hawton is the UK's foremost expert on suicide. He and his colleagues conclude that fear of mental disintegration (amongst many other things) was a risk factor for suicide in people with a schizophrenia diagnosis. Of course this fear may be a consequence of other factors – it’s unlikely to be solely related to being told one has a brain disease.
“Just because a patient doesn't like being told they are ill doesn't mean they are not… What I'm saying is that they are mistaken - they are sick.”
If a person (a) is in great pain and gradually losing cognitive function, (b) recognises and understands they will shortly lose their capacity to make informed decisions about their lives, (c) understands that the changes they are experiencing are part of a recognisable pattern of undesirable changes and (d) asks their mental health professional for appropriate help (to remove the pain and restore their decision-making capacity), then what additional purpose would it serve for them to have to also describe their problems as a brain disease? What does being compelled to use this language actually add, apart from fear and anxiety? It may reduce your level of annoyance, but is this really reason enough?
I have to emphasise this is NOT an anti-psychiatry position. I believe psychiatry, medication and a scientific approach to classification of different types of problems are all essential to helping people who are all too often marginalised, stigmatised and left to suffer without any help.
Anyway, don’t take my word for it. Check out work on values by Bill Fulford (professor of philosophy and consultant psychiatrist) and many others (such as Derek Bolton, professor of psychopathology at the Institute of Psychiatry – or John Sadler***). See also the entry on mental illness in the Stanford Encyclopedia of Philosophy.****
Vaughan Bell over at Mindhacks has provided possibly the best short summary I’ve read regarding the role of values in psychiatric terminology.*****
*http://psycnet.apa.org/?fa=main.doiLanding&uid=1997-38409-004
**http://bjp.rcpsych.org/cgi/content/full/187/1/9
***http://ukcatalogue.oup.com/product/9780198526377.do
****http://plato.stanford.edu/entries/mental-illness/#1
*****http://www.mindhacks.com/blog/2009/05/valuing_the_unusual_.html -
I am sorry if I offended anyone. That was not my aim. I didnt have an aim exactly, I just spoke my opnion after having taken psychiatric medication for decades and having got well without them. During all my time as a sevice user I felt there were some people that needed 'something' to quell their fears when first 'diagnosed'. The option primarily is pills even if its pills with a therapy of some kind. If its the latter in the UK you are one of the lucky ones. I know of many who have been in the services for many years and dont get offered any kind of alternative help any more.
The word 'illness' is open to personal interpretation. I think of myself during all my years as a service user as imbalanced....my original reasons for becoming detached from the 'norm' (whatever norm is!), were not addressed until many years after diagnosis.
On original diagnosis I went on to identify with all other metal health service users for a very long time.
Bipolar can be a cruel affair. Has anyone read Kay Redman Jamison's An Unquiet Mind? She learned how to control and deal with bipolar and became an eminent clincial psychologist. Can you say that your average psychiatric hospital and team workers would help you find the best in yourselves, work through the bipolar and support you to succeed in life? If so then you are extremely lucky and my neck of the woods must be the only bad place to be.
My point was people tend to think pills first and anything else second. Medications in psychiatry were originally intended to squash the dilemma of how to deal with people that seemingly were 'different'. If that has changed I would welcome someone to tell me how exactly.
Someone mentrioned illnesses such as diabetes etc. These medical illnesses have been well understood through research and for most of todays illnesses tests are available to diagnose and thus treat accordingly. Psychiatry has an appalling record for testing and treating is done by a list of symptoms and a little observation. Whilst this is the case there will always be debate.For those who get rather angry when these facts are pointed out, I am wary that a portion of their anger is perhaps their keeness to keep the new identify they have found...and no that was not me saying that they want to be 'ill', rather that they dont strive to question fully and seek alternative solutions.
-
“Focus-group participants [individuals with psychiatric disorders] felt that healthcare clinicians, friends, and family often placed too much emphasis on the efficacy of psychiatric medications and too little emphasis on the role that people diagnosed with psychiatric disorders play in their own recovery. Having one’s recovery attributed to the efficacy of a pharmaceutical left focus-group members feeling disempowered. Focus-group members stated that recovery from psychiatric disorder is not simply a matter of swallowing pills. They said their recovery is about changing their lives, not their biochemistry. Their recovery is hard work and it requires personal agency, will, vision, hope, fortitude, courage, imagination, commitment, and resilience.” (Deegan, 2005; User-led research)
“When asked what changes those interviewed [individuals with psychosis] would like to see in mental health services in order to facilitate recovery, the following were identified: a more collaborative approach; more continuity in care; protection from harm by professionals; a wider choice of treatment; more emphasis and guidance on recovery; alternatives to the medical model; more user involvement; an end to stigma and discrimination… There is a need for a greater choice of treatment. If service users are to make informed choices about their treatment they need access to information about the different treatment available to them.” (Pitt, Kilbride et al, 2007; User-led research)
-
I had a total and complete nervous breakdown about 1 1/2 years ago. My mind became separated from my body. Were it not for Lithium, Geodon, and a number of other medications, my mind would still be trapped outside of my body, and my family would still be missing their mother/wife/daughter/sister.
-
Thanks for the links Paul, you've given me lots to think about and follow up.
-
Re -the burn's post. I found that very interesting, thanks for posting that. I personally would like to see at least one psychologist on site within the hospitals/units all over the country. In our area we dont have a trained psychologist or hypntherapist within the offered nhs therapy services that are community based never mind in hospital. Years ago this was different ( why I ask myself?) As I am involved with quite a few service users and through our local mind I am becoming increasingly aware that many patients are having to ask instead of therapy services being offered. The longer you have been a service user the more this would seem to be the case ie if one of two attempts failed you are sometimes deemed 'unsuitable'. That may sound ok but it gives the patient a 'no hope' status ! One should never say never and all that.
We have to remember also that a psyhciatrists primary role is to diagnose and treat and whether we like it or not this does mean medications 95% of the time. If you have got as far as seeing a psychiatrist the stuation itself most probably mean pills.
GP's prescribing antidepressants is on the increase both here and at an alarming rate in USA. I heard ( good source) that GP's only have to see a couple of symptoms to diagnose depression whereas the checklist was much longer before.
There is also the issue that if you are sectioned it is highly likely that you will be given drugs of their choice not yours. No one is likely to say would you like to take this drug or that drug...its more likely to be said that this or that drug is needed. Period. I stem from an era where they held your nose and held you down if needs be to get the pills down you. Most had mouths checked in those days. -
'I stem from an era where they held your nose and held you down if needs be to get the pills down you'
I stem from the era when they held you down and shoved a needle in your derriere if they needed to medicate you. That can make you really despise the medical model.
-
Know it well rielouise!
I'd like to give an example if I may:Doing a critical psychology course recently we used a lot of real life material. One such story example was this:
A young lady was admitted to a psychiatric ward with bipolar and hearing voices. She hadnt wanted to go into hospital but was sectioned and so had to.
She had had the voices for a number of years and was used to them. In fact she used the voices as a measuring stick for where she was at spiritually. This enabled her to live in peace with them. They were her personal messages that helped her gauge what to do...she found through her voices a love of the countryside..it gave her peace and made her feel good when the voices were there. It eased the voices.When she was admitted and it was known that she was hearing voices she was instantly put on the medications to 'help send them away'! She cried. She argued...no dont take the voices away but they didnt listen. (that was probably seen as 'crazy talk') She went much further downhill after that and had to endure months of hospital. Now she dreads that scenario again.
See, one cap doesnt fit all. Not everyone wants 'all' their symptoms squashing.
Sue
-
I am also a fan of R.D.Laing, I have referenced him in every essay for my Bsc in Mental Health Nursing. I am also a service user. Medication does help but I find that people all to often refer to this as treatment. treatment should be holistic. Cheers.
-
RD Laing?! OK he had some interesting ideas, and like Zarathustra I was suckered in by his theories when I was a trendy humanities student, but the man was a cruel, egotistical alcoholic whose dogmatic theories on the family as a cause of mental illness were completely at odds with his appalling treatment of his own.
"We are effectively destroying ourselves with violence masquerading as love." Hmmm.
I can't believe people still sign up to the Laing myth.
http://women.timesonline.co.uk/tol/life_and_style/women/families/article6058901.ece
-
"Cold, hard clinical experience" (personal nursing observation and talking to friends) doesn't enable you to tell how much of the effect of the drugs you dispense is placebo, what the effect on the brain is, what the average long-term effect on recovery is, what the society-wide effect is.
This real issue here isn't even about a medical model, but a chemical model.
And given that virtually all drug studies are funded by giant multinational pharmaceutical companies, and reported by their statisticians and psychiatric hangers-on, it takes specific form as a capitalist chemical model. Where it's even harder to tell the truth.
Pharmaceutical Industry Agenda Setting in Mental Health Policies
http://www.uow.edu.au/~sharonb/pharm-agenda.htmlMany medical journals have become marketing offices of pharmaceutical companies
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020218Drug reps the servants of Beezlebub - yes and often they are in disguise http://www.bmj.com/cgi/content/full/336/7658/1402
-
Yes Dan, RD Laing was an Alcoholic. And an Acid Head. And he fought Psychiatry. Coincidence?
This damnably stupid PLOS scandal is still muddying the issue, wise up it's been discredited:
http://www.mdf.org.uk/?o=92253And I beg you; don't let fanatical anti-capitalists with no right to an opinion through no proximity to the issue fog your mind! Let me put it like this, Dock: "Big Pharma" can HAVE our money! Why should we suffer to satisfy your emotional investment in a wacky ideological crusade?!
-
The "Big Pharma" line is a tired old Lefty rallying cry. This is about the Health Crises of Individuals and I can't stand it when people try and score points and win converts off of that. You'd expect Lefties to actually care that by scaring people off drugs they're keeping people's lives in Hell for longer.
http://www.socialismdoesntwork.com -
Zeke
I read Persaud’s article with interest. It doesn’t discredit the findings of the PLoS meta-analysis in any way, shape or form. In fact, his points are so weak that I can only conclude you're winding us up!
Persaud claims no experts believe that drugs on their own are more effective than placebo for depression. He also suggests depression is not a particularly valid diagnostic construct. He’s clearly wrong that experts don’t believe this (why else are millions spent examining this very question?) as well as guilty of shifting the goalposts – but even if this were true it’s hardly the critique of the PLoS findings you promised us. In fact, it rather suggests he agrees with them!
I also note he doesn’t apply his scepticism about the depression diagnosis to research which supports his view (i.e., the one study he cites showing meds plus therapy are more effective).
Perhaps more substantially, Persaud claims that the negative results of the PLoS meta-analysis are due to (i) inadequate expertise of prescribers, (ii) people not receiving a big enough dose, (iii) prescribing not being individually tailored in RCT’s, and (iv) trials being too big. These are potentially interesting hypotheses to test (if they haven't been already), but they are hardly the knock-down substantive criticisms you alluded to.
He also refers to a retrospective study which found falling suicide rates correlated with increased prescribing of newer antidepressants. He seems to suggest this is because they work better. It’s strange he doesn’t mention the alternative view; that the newer antidepressants (e.g., SSRI’s) are much harder to kill yourself with than the older ones (e.g., tricyclics such as amitryptaline). It’s also strange he doesn’t consider that increased antidepressant prescribing and falling suicide rates may both be a consequence of some third variable - such as changing attitudes to mental health.
Anyway, no-one is even suggesting that antidepressants don’t reduce suicide rates! Remember the PLoS study found meds were effective for severe depression (just not mild-moderate). Persaud seems guilty of setting up a Straw Man argument here.
-
So you're just going to disregard that the PLOS study was selective about which drugs it looked at? There are many more than it mentions. The Raj Persaud article does discredit it, just not to your satisfaction.
As to it seeming irrelevant, I included it mainly to point out that the PLOS journal is not to be trusted, since another poster had used another PLOS article to back something up.
I'll take Raj Persaud over Internet Nobodies any day.
-
I also don't like your implication that the only way someone on the newer antidepressants is going to attempt suicide is by trying an overdose of them. That's not the only way people try it, so I'd say he's quite justified in saying they work better.
-
Sick of the culture of stigmatisation? Well, did your parents make sure they sent you to a school that taught a course in mental health issues? Is that what everyone does now it's the i-pod/Wii/Facebook generation and educational attainment is even more likely?
-
Zeke
The PLoS study was a 'meta-analysis' of drug trials. You can access the article for free here:
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045
I'm not sure you'll change your mind about the quality of the study - so for the benefit of others, here's a quote:
"Conventional meta-analyses are often limited to published data. In the case of antidepressant medication, this limitation has been found to result in considerable reporting bias characterized by multiple publication, selective publication, and selective reporting in studies sponsored by pharmaceutical companies. To avoid publication bias, we evaluated a dataset that includes the complete data from all trials of the medications, whether or not they were published. Specifically, we analyzed the data submitted to the FDA for the licensing of four new-generation antidepressants for which full data, published and unpublished, were available. As part of the licensing process, the FDA requires drug companies to report “all controlled studies related to each proposed indication”. Thus, there should be no reporting bias in the dataset we analyze."
I also note other meta-analyses and large trials have since found similar results to the PLoS study since. Here's a discussion of one of them:
http://neuroskeptic.blogspot.com/2010/01/severe-warning-for-psychiatry.html
Sorry you misunderstood my point about antidepressants and suicide. I was not implying that was the only way people on newer antidepressants commit suicide is by overdosing on them. I think that's clear to anyone who read my comment. I was simply suggesting one other interpretation of the data. I don't think it's controversial to say tricyclics are more dangerous in overdose. E.g.;
http://www.ncbi.nlm.nih.gov/pubmed/1460734?dopt=Abstract
One problem you face when using an 'appeal to authority' as a grounds for being right is that I can simply do the same thing. Where does that get us? There are many people, just as credible as Persaud, who accept the PLoS study findings. Other problems with the appeal to authority fallacy are detailed here:
http://en.wikipedia.org/wiki/Argument_from_authority
Finally, you describe me as an 'Internet Nobody'. Well, thank you very much! Problems with ad hominem attacks are detailed here:
-
For the further benefit of others I'd point out that all the Philosophical goop in the World doesn't change the fact that people who stick with Medication programs fare better than those who don't.
-
Let's have a full and frank criticism of the way PLOS does business, eh? Here you go:
http://smokles.wordpress.com/2010/02/24/plos-likes-to-use-the-word-science-but-doesnt-exactly-like-what-it-stands-for/ -
Here's something else rather hilarious about PLoS:
http://en.wikipedia.org/wiki/Public_Library_of_Science
And I quote: "To fund the journal, PLoS charges a publication fee to be paid by the author or the author's employer or funder."So PLoS is just VANITY PUBLISHING FOR SCIENTISTS!
Crikey Moses... -
"Wow, it got into PLoS?! That Journal is so exclusive and discerning that only people with the money get published by it!"
Say it with me, now: "There is a term for 'Alternative Medicine' that has been Proven to Work: 'Medicine'".
-
So is that special place in Hell for the people who told me praying for Healing beats Medication anyday also full of the scientifically illiterate?
Ah, Meta-Analyses! The research preserve of those too lazy to collect fresh data...
http://en.wikipedia.org/wiki/Meta-analysis
(Note large "Problems with" paragraphs!) -
Thanks for all your comments - it's great to see our blog posts provoking such interesting discussions. However, can you bear in mind our comments policy, and show respect for other commenters, even if you strongly disagree with their opinions!
http://www.mind.org.uk/blog/comments_policy -
Zeke,
I'm honestly not sure how attacking the credibility of PLoS is going to help your argument that the specific meta-analysis we are discussing has been discredited. Raj Persaud attempts this in his article as well, describing PLoS as 'obscure'.
Have a look at the method section. This should be detailed enough to allow you to repeat what they've done - you can then see whether you come up with the same finding. Alternatively, it may be that you discover their methods are flawed. For example, some criticism of the statistics they used can be found here:
http://pyjamasinbananas.blogspot.com/2008/03/regression-in-depression.html
If you find a major flaw in the study then it might be worth writing to the Editor of PLoS. After all, if antidepressants do work better than placebo for mild to moderate depression then that's an extremely important finding - and one which would be taken seriously by anyone who believes in evidence-based medicine.
In addition, if you develop a way of evaluating the effectiveness of different types of medication that improves on meta-analysis then that might be worth publishing too. You might be up against the system here though, as most healthcare scientists - including, no doubt, Raj Persaud - believe meta-analysis to be the best tool we have at the moment for knowing what works, what doesn't and what actually causes harm.
-
As a strong opponent of long-term medication myself, I decided to incorporate my views into a semi-autobiograhical, but notionally fictional work. Bloggers might hopefully find it helpful.
A novel approach to schizophrenia
"Defragmenting the Soul" traces the path taken towards recovery from his previous psychiatric condition by the protagonist, Matthew, who has spent a whole lifetime in the role of the outsider.
In his travels through the passages of his deepest subconscious mind, Matthew relives childhood experiences, explores fantasy worlds and, perhaps most significantly of all, he encounters Jean-Paul, an entity he refers to as his spirit-guide, who assists him in putting his life back together in preparation for his return to the "real" world.
We see how Matthew negotiates the enigmatic world of psychiatry, challenging the received wisdom of the profession charged with his recovery. He goes cold turkey on his medication (haloperodol). We gain an insight into his manic mind which has no truck with authority, believing himself to be of superior intelligence to all such figures. His delusions of grandeur are accompanied by a totally disinhibited state of mind, where he shows no discretion. Regardless of the consequences, Matthew always feels impelled to reveal the truth as he sees it.
Matthew’s rehabilitation is assured once he stops focussing on himself and starts to take an interest first of all, in his fellow-sufferers, then ultimately in his fellow-human-beings. Before he can empathise with others, however, he needs a creed which stops him dwelling on the traumatic events of the past and prompts him to live in the present. It is as follows: creative, recreative, procreative.
Having experienced depression, mania and hallucinations himself, Matthew feels that he is able, not only to empathise with the people who suffer from similar conditions - he feels the need to act on their behalf and encourage them to contemplate a better world where stigma is challenged and recovery encouraged by family and friends.
This book is not for the squeamish, sharing as it does, the dark side of our nature, but it is liberally peppered with light-hearted comic moments. Anyone wishing to purchase a copy can find it in e-book format by going straight to this link:
http://chipmunkapublishing.co.uk/shop/index.php?main_page=product_info&products_id=1548
Copies of his first book of poems in paperback, "Rare Frequencies", are also available on line at:
http://chipmunkapublishing.co.uk/shop/index.php?main_page=product_info&products_id=1527
Commenting is now closed.