Mental illness

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Re: Mental illness

Post by Trolldor » Fri May 14, 2010 5:16 pm

The person would have to have a genetic predisposition for Depression
What is the genetic predisposition? As far as I'm aware a family history of mental illness only makes you more likely to experience it, but considering how common depression is (1 in 3 according to some national campaign going on ATM in Aust.) that would mean either it's a fairly common element or that there are contributors outside of simply being predisposed to it.

I can tell the difference sometimes I know that I should be happy, nothing is going badly but I just want to die and sometimes I know that a normal reasonable person would feel shit if they were in my situation .
The only 'true' episode I've ever had was when I was around eight or so, because I would apparently just cry for hours on end, not get out of bed etc. (Don't remember this, to be honest, parents telling me was a bit of a shock, but then again it might explain why they took me to see a psychologist.) The closest I've gotten to that was in my first year of Uni where I just stayed in my room for an entire week, but even then I did my work and looked after myself. I feel shit at times, but I don't think I'll be having another episode anytime soon.
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Re: Mental illness

Post by Brain Man » Sat May 15, 2010 12:58 pm

orpheus wrote:
I'm not that familiar with schizophrenia. But I'd like to see the research that supports what you say about mood spectrum disorders, as I've never heard those conclusions. And even if they're true, how does the damage you speak of compare with the brain damage caused by untreated episodes of depression and/or mania? As I said above, we know that left untreated, those often recur, and further recurrences become much harder to treat.
Most of us are aware that synaptic function is the means by which drugs effect their effect. Hammering these repeatedly renders the synapse unable to function without the drug. Anybody who understands neurons knows that a synapse is operated on and effected on by multiple processes, enzymes and feeback loops involving these such that the for the average neuron to fire requires a magnitude less of the single hammer such as the reuptake inhibitor used by many drugs. i.e. Moods are the combination of numbers of factors operating on our complex brain..i.e. we become depressed not because of a single chemical hammer going wrong, but complex reasons including our health, social world, diet etc..which finally causes the imbalance.

That is why drugs have effects such as "poop out", where the drug simply stops working at all due to hammering synapse far more than they were naturally designed for, or such heavy withdrawal that seizures can occur, where it can take years of gradual withdrawal and struggle for the synapses to get used to working at their original baseline levels. i.e Alcohol, SSRi, cocaine, heroin, Benzo withdrawal.

As professor Giovanni Fava and others have pointed out drug administration may cause irreversible damage and turn a single episodic condition into an acute and lifelong one. You can see his many publications here.

http://www.biomedexperts.com/Profile.bm ... nni_A_Fava

Or an easier read book on the subject here which points out that as drugs are introduced to treat minor depression, these cases transformed into bipolar disorder far higher than any previous numbers. American has one of the highest rates of bipolar, and this occured in precise step with the prescription of SSri, which hammer the mood system. Correlation is not Causation as we know with autism, but Autism does not churn out stats like 1 in 10 of the population affected with bipolar, when 1 in 10 of those also had prozac, ritalin and various variants prescribed to them.

http://www.newscientist.com/blogs/cultu ... us-mad.php

It makes perfect sense. Bipolar disorder is a dysregulation of the control mechanism which keep mood in check. As neurotransmitter levels rise too high the neurons tire out and fail to operate, which gives rise to the mood crash. Hammering the synapse is more likely to worsen the situation if the patient is not very carefully dosed and monitored. This kind of depth of care rarely occurs, as the focus is heavily on fix the problem right now.

Prof Fava points out drug companies selectively frame studies such that all the negative aspects are not published so that 50/50 looks like 100% Ok (link below). So how can you conduct treatment if all clinicians have is glowing reports of efficacy ?

http://www.bmj.com/cgi/content/full/336/7658/1405

As psychologist bruce Levine tells us in his books being so careful with dosage on even psychotic patients only happens in finland, where they have the best long term outcomes in the world.
http://www.amazon.com/exec/obidos/ASIN ... punchmaga

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Re: Mental illness

Post by Brain Man » Sat May 15, 2010 1:10 pm

anna09 wrote:"A source of insight into the neurological basis of depression was the observation that patients given reserpine for HBP often became severly depressed. Reserpine depletes monoamines, which include norepinephrine, dopamine, and serotonin. This observation led to the idea that monoamines might be reduced in depression, and postmortem studies of suicide victims supported this hypothesis. Research in the past decade has complicated the picture, because it is now clear that many different receptors exist for each monoamine and that specific receptors may be disrupted in depression. An added complication is that no unifying theory accounts for the action of antidepressand medications to treat depression. For example, neurotrophic factors may play a role in the action of antidepressants. BDNF (brain derived neurotrophic factor) acts to enhance the growth and survival of neurons and synapses, BDNF dysfunction may adversely affect monoamine systems through the loss of either neurons or synapses." (Fundamentals of Human Neuropsychology. Kolb and Wishaw 2009)

If it's not neurotransmitter dysfunction and it's nothing physical in the brain then what is actually going on? The article doesn't suggest anything but rather dismisses it based on no evidence.
born-again-atheist wrote:What I am saying is that you can't shoehorn depression in to a simple 'chemical imbalance' if the contributing factor is Environmental, because no matter what pills you give them they aren't going to get any better.
The person would have to have a genetic predisposition for Depression the only role "environment" plays is that it can be a risk factor. A high stress environment would bring out an onset of symptoms more so than a low-stress environment. The predisposition is still there regarless of your environment.
Some of this may be due to MAO enzyme efficiency in our populations. You may have heard of the "warrior gene" which predisposes our energy levels through life. It may even be the working class gene evolved from our histories of war. Some of us are prone to being more ON or OFF in neural energy terms. Those who are MAO efficient produce less neurotransmitters, but this will better with age, as the enzyme degrades naturally. While this with natural inefficiency could cause other to become more hotheated and hypertensive with age, perhaps leading to the synapes becoming naturally imbalanced past the age of 40. There could be a case for intervention then in the warrior gene group, and they are prone to alcoholism later in life.

But again its a complex organ the brain, and current psychiatry is little more than uncontrolled human experiments.

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Re: Mental illness

Post by Cunt » Sat May 15, 2010 2:19 pm

Mr Jobby wrote:
orpheus wrote:
I'm not that familiar with schizophrenia. But I'd like to see the research that supports what you say about mood spectrum disorders, as I've never heard those conclusions. And even if they're true, how does the damage you speak of compare with the brain damage caused by untreated episodes of depression and/or mania? As I said above, we know that left untreated, those often recur, and further recurrences become much harder to treat.
Most of us are aware that synaptic function is the means by which drugs effect their effect. Hammering these repeatedly renders the synapse unable to function without the drug. Anybody who understands neurons knows that a synapse is operated on and effected on by multiple processes, enzymes and feeback loops involving these such that the for the average neuron to fire requires a magnitude less of the single hammer such as the reuptake inhibitor used by many drugs. i.e. Moods are the combination of numbers of factors operating on our complex brain..i.e. we become depressed not because of a single chemical hammer going wrong, but complex reasons including our health, social world, diet etc..which finally causes the imbalance.

That is why drugs have effects such as "poop out", where the drug simply stops working at all due to hammering synapse far more than they were naturally designed for, or such heavy withdrawal that seizures can occur, where it can take years of gradual withdrawal and struggle for the synapses to get used to working at their original baseline levels. i.e Alcohol, SSRi, cocaine, heroin, Benzo withdrawal.

As professor Giovanni Fava and others have pointed out drug administration may cause irreversible damage and turn a single episodic condition into an acute and lifelong one. You can see his many publications here.

http://www.biomedexperts.com/Profile.bm ... nni_A_Fava

Or an easier read book on the subject here which points out that as drugs are introduced to treat minor depression, these cases transformed into bipolar disorder far higher than any previous numbers. American has one of the highest rates of bipolar, and this occured in precise step with the prescription of SSri, which hammer the mood system. Correlation is not Causation as we know with autism, but Autism does not churn out stats like 1 in 10 of the population affected with bipolar, when 1 in 10 of those also had prozac, ritalin and various variants prescribed to them.

http://www.newscientist.com/blogs/cultu ... us-mad.php

It makes perfect sense. Bipolar disorder is a dysregulation of the control mechanism which keep mood in check. As neurotransmitter levels rise too high the neurons tire out and fail to operate, which gives rise to the mood crash. Hammering the synapse is more likely to worsen the situation if the patient is not very carefully dosed and monitored. This kind of depth of care rarely occurs, as the focus is heavily on fix the problem right now.

Prof Fava points out drug companies selectively frame studies such that all the negative aspects are not published so that 50/50 looks like 100% Ok (link below). So how can you conduct treatment if all clinicians have is glowing reports of efficacy ?

http://www.bmj.com/cgi/content/full/336/7658/1405

As psychologist bruce Levine tells us in his books being so careful with dosage on even psychotic patients only happens in finland, where they have the best long term outcomes in the world.
http://www.amazon.com/exec/obidos/ASIN ... punchmaga
So it seems that in a perfect world, drug treatment would be a helluva good tool to use. What would you suggest in the reality we use every day?

With disinterested/overworked/unethical (yes - I think it's unethical to do a half-assed job as a psychiatrist) shrinks being the best we have, what would you suggest be the actual course of treatment?

Remember, you can't just say 'have proper psychiatrists practicing because it doesn't happen.
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Re: Mental illness

Post by Brain Man » Sat May 15, 2010 6:54 pm

Cunt wrote: So it seems that in a perfect world, drug treatment would be a helluva good tool to use. What would you suggest in the reality we use every day?

With disinterested/overworked/unethical (yes - I think it's unethical to do a half-assed job as a psychiatrist) shrinks being the best we have, what would you suggest be the actual course of treatment?

Remember, you can't just say 'have proper psychiatrists practicing because it doesn't happen.
We have the internet now, which we didn't have when psychiatry began. You can get hard information, put it together and demand answers on these subjects from the professionals. They absolutely hate it, not because the patient gets it wrong, but it sometimes creates pressure on them to update their knowledge base, when their preference is for such pressure to come above their hierarchy. Cant be a bad thing, they are professionals after all.

There is a lot of information coming out, on how drug companies are sponsoring the structure of new fields of medicine without a scientific basis, and changes are already occurring at the high level anyway for various reasons. i.e In britain the psychology system is also distancing itself from the use of psychiatry...so drug treatment becomes later resort rather than an initial one, and its supervised under psychological treatment. Thats the idea i heard, but i dont know whats actually going on.

More pressure bottom up, top down should make a big difference.

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Re: Mental illness

Post by orpheus » Sun May 16, 2010 12:05 am

Cunt wrote:
Mr Jobby wrote:
orpheus wrote:
I'm not that familiar with schizophrenia. But I'd like to see the research that supports what you say about mood spectrum disorders, as I've never heard those conclusions. And even if they're true, how does the damage you speak of compare with the brain damage caused by untreated episodes of depression and/or mania? As I said above, we know that left untreated, those often recur, and further recurrences become much harder to treat.
Most of us are aware that synaptic function is the means by which drugs effect their effect. Hammering these repeatedly renders the synapse unable to function without the drug. Anybody who understands neurons knows that a synapse is operated on and effected on by multiple processes, enzymes and feeback loops involving these such that the for the average neuron to fire requires a magnitude less of the single hammer such as the reuptake inhibitor used by many drugs. i.e. Moods are the combination of numbers of factors operating on our complex brain..i.e. we become depressed not because of a single chemical hammer going wrong, but complex reasons including our health, social world, diet etc..which finally causes the imbalance.

That is why drugs have effects such as "poop out", where the drug simply stops working at all due to hammering synapse far more than they were naturally designed for, or such heavy withdrawal that seizures can occur, where it can take years of gradual withdrawal and struggle for the synapses to get used to working at their original baseline levels. i.e Alcohol, SSRi, cocaine, heroin, Benzo withdrawal.

As professor Giovanni Fava and others have pointed out drug administration may cause irreversible damage and turn a single episodic condition into an acute and lifelong one. You can see his many publications here.

http://www.biomedexperts.com/Profile.bm ... nni_A_Fava

Or an easier read book on the subject here which points out that as drugs are introduced to treat minor depression, these cases transformed into bipolar disorder far higher than any previous numbers. American has one of the highest rates of bipolar, and this occured in precise step with the prescription of SSri, which hammer the mood system. Correlation is not Causation as we know with autism, but Autism does not churn out stats like 1 in 10 of the population affected with bipolar, when 1 in 10 of those also had prozac, ritalin and various variants prescribed to them.

http://www.newscientist.com/blogs/cultu ... us-mad.php

It makes perfect sense. Bipolar disorder is a dysregulation of the control mechanism which keep mood in check. As neurotransmitter levels rise too high the neurons tire out and fail to operate, which gives rise to the mood crash. Hammering the synapse is more likely to worsen the situation if the patient is not very carefully dosed and monitored. This kind of depth of care rarely occurs, as the focus is heavily on fix the problem right now.

Prof Fava points out drug companies selectively frame studies such that all the negative aspects are not published so that 50/50 looks like 100% Ok (link below). So how can you conduct treatment if all clinicians have is glowing reports of efficacy ?

http://www.bmj.com/cgi/content/full/336/7658/1405

As psychologist bruce Levine tells us in his books being so careful with dosage on even psychotic patients only happens in finland, where they have the best long term outcomes in the world.
http://www.amazon.com/exec/obidos/ASIN ... punchmaga
So it seems that in a perfect world, drug treatment would be a helluva good tool to use. What would you suggest in the reality we use every day?

With disinterested/overworked/unethical (yes - I think it's unethical to do a half-assed job as a psychiatrist) shrinks being the best we have, what would you suggest be the actual course of treatment?

Remember, you can't just say 'have proper psychiatrists practicing because it doesn't happen.
Actually, it does happen. There are good ones out there.
I think that language has a lot to do with interfering in our relationship to direct experience. A simple thing like metaphor will allows you to go to a place and say 'this is like that'. Well, this isn't like that. This is like this.

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Re: Mental illness

Post by Cunt » Sun May 16, 2010 12:39 am

orpheus wrote:
Cunt wrote: Remember, you can't just say 'have proper psychiatrists practicing because it doesn't happen.
Actually, it does happen. There are good ones out there.
I was a bit too broad in my description, but in the majority of my experience, they get shit results. With such a large number misusing drug treatments, what is the rational choice for treatment/healing?
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Joe wrote:
Wed Nov 29, 2023 1:22 pm
he doesn't communicate

The 'Walsh Question' 'What Is A Woman?' I'll put an answer here when someone posts one that is clear and comprehensible, by apostates to the Faith.

Update: I've been offered one!
rainbow wrote:
Mon Nov 06, 2023 9:23 pm
It is actually quite easy. A woman has at least one X chromosome.
Strong ideas don't require censorship to survive. Weak ideas cannot survive without it.

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Re: Mental illness

Post by natselrox » Sun May 16, 2010 4:50 am

With researches coming out every week about the efficiency (or the lack thereof) of these neuro-modulating drugs, I think, we have to wait till we have a better understanding of the science.

I'm pro-neurodiversity FWIW.

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Re: Mental illness

Post by TumblingPear » Tue May 18, 2010 2:31 pm

I'm new to this community and this is my first post. I hope to will speak to a few issues touched upon at various points in this discussion.

I'm of the position that each person's mental illness unique to that person with my depression/schizophrenia/anxiety disorder/bipolar disorder/personalty disorder being "my" illness, not a generic. As such, my illness ought to be diagnosed in accordance with its uniqueness and a personalized treatment designed, one that doesn't take a black or white view towards medication, taking into account the benefits and risks of psychopharmacological treatment. In my view, psychotherapy is essential to treatment and the psycho-therapeutic relationship, meaning the right match of patient and therapist (although finding that good match can be a crap-shoot, especially, as in any profession, the significant percentage of mediocre and unskilled practitioners), is essential to the success of treatment. If I choose to take medication, it ought not mean I should exclude considering psychotherapy as part of my treatment.

Unfortunately, in the United States, psychotherapy has become increasingly harder to come by over the last 30 years, and its even more difficult to get my insurance company to cover it. Beginning sometime in or around the 1970s, at which time insurance companies pretty much covered outpatient psychotherapy and long-term inpatient treatment, health insurance began to restrict and limit and manage coverage for mental health treatment. Despite today's "parity" laws, today's health insurers, seeking to treat on the cheap, cover prescriptions, but manage and severely limit coverage for psychotherapy. Mental health practitioners have had to adapt. Today's medical schools train in pscyhopharmacology but I believe it to be the exception to find a program that really trains its students in psychotherapy. Psychiatrists have become prescription writers with the rare doctor offering psychotherapy. Mental health practitioners who do offer psychotherapy have had to crop treatment modalities. They usually have to regularly justify to the insurance company any extension or increased frequency in the number of sessions.

In addition, there used to be numerous long-term residential treatments centers that included intensive psychotherapy as part of their program. As insurers took these institutions off their provider lists and limited inpatient coverage to the only a few days or simply denied covered treatment programs by informing the insured that treatment wasn't "medically necessary," these institutions shut down or reinvented themselves as short term facilities. There is now only one long-term inpatient residential treatment facility in the U.S. where the treatment-resistant mentally ill can turn when everything else has failed to help them. I don't mean to advocate for institutionalization or for the the kind of warehousing of the mentally ill that used to be the norm (and, sadly, continues in U.S. prisons where a significant portion of the inmates are mentally ill and/or addicted to drugs). But there is a place for long-term inpatient residential treatment, when the patient chooses to be admitted and when the treatment is of a high quality and helps the patient recover and lead a productive and meaningful life outside a hospital.

There is also a place for intensive outpatient treatments like psychoanalysis, or such treatments should still be an available and affordable, should any of us choose it for ourselves. There has been some talk about Finland. In Finland, psychoanalysis is covered by the health program.

Any of us who might suffer from a mental illness ought to have affordable (ideally government-paid) choices among many treatments, be it one or a combination of such treatments as psychopharmacology, psychotherapy, psychoanalysis, short or long-term inpatient residential or non-residential treatment, group homes, acute care programs, etc.

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Re: Mental illness

Post by orpheus » Tue May 18, 2010 2:58 pm

TumblingPear wrote:I'm new to this community and this is my first post. I hope to will speak to a few issues touched upon at various points in this discussion.

I'm of the position that each person's mental illness unique to that person with my depression/schizophrenia/anxiety disorder/bipolar disorder/personalty disorder being "my" illness, not a generic. As such, my illness ought to be diagnosed in accordance with its uniqueness and a personalized treatment designed, one that doesn't take a black or white view towards medication, taking into account the benefits and risks of psychopharmacological treatment. In my view, psychotherapy is essential to treatment and the psycho-therapeutic relationship, meaning the right match of patient and therapist (although finding that good match can be a crap-shoot, especially, as in any profession, the significant percentage of mediocre and unskilled practitioners), is essential to the success of treatment. If I choose to take medication, it ought not mean I should exclude considering psychotherapy as part of my treatment.

Unfortunately, in the United States, psychotherapy has become increasingly harder to come by over the last 30 years, and its even more difficult to get my insurance company to cover it. Beginning sometime in or around the 1970s, at which time insurance companies pretty much covered outpatient psychotherapy and long-term inpatient treatment, health insurance began to restrict and limit and manage coverage for mental health treatment. Despite today's "parity" laws, today's health insurers, seeking to treat on the cheap, cover prescriptions, but manage and severely limit coverage for psychotherapy. Mental health practitioners have had to adapt. Today's medical schools train in pscyhopharmacology but I believe it to be the exception to find a program that really trains its students in psychotherapy. Psychiatrists have become prescription writers with the rare doctor offering psychotherapy. Mental health practitioners who do offer psychotherapy have had to crop treatment modalities. They usually have to regularly justify to the insurance company any extension or increased frequency in the number of sessions.

In addition, there used to be numerous long-term residential treatments centers that included intensive psychotherapy as part of their program. As insurers took these institutions off their provider lists and limited inpatient coverage to the only a few days or simply denied covered treatment programs by informing the insured that treatment wasn't "medically necessary," these institutions shut down or reinvented themselves as short term facilities. There is now only one long-term inpatient residential treatment facility in the U.S. where the treatment-resistant mentally ill can turn when everything else has failed to help them. I don't mean to advocate for institutionalization or for the the kind of warehousing of the mentally ill that used to be the norm (and, sadly, continues in U.S. prisons where a significant portion of the inmates are mentally ill and/or addicted to drugs). But there is a place for long-term inpatient residential treatment, when the patient chooses to be admitted and when the treatment is of a high quality and helps the patient recover and lead a productive and meaningful life outside a hospital.

There is also a place for intensive outpatient treatments like psychoanalysis, or such treatments should still be an available and affordable, should any of us choose it for ourselves. There has been some talk about Finland. In Finland, psychoanalysis is covered by the health program.

Any of us who might suffer from a mental illness ought to have affordable (ideally government-paid) choices among many treatments, be it one or a combination of such treatments as psychopharmacology, psychotherapy, psychoanalysis, short or long-term inpatient residential or non-residential treatment, group homes, acute care programs, etc.
:clap:

Well said. And welcome!
I think that language has a lot to do with interfering in our relationship to direct experience. A simple thing like metaphor will allows you to go to a place and say 'this is like that'. Well, this isn't like that. This is like this.

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Re: Mental illness

Post by Feck » Tue May 18, 2010 3:04 pm

My file is stamped "not responsive to treatment(personality disorder)"like it's my fault ,and that gives them a reason not to treat me .
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Re: Mental illness

Post by TumblingPear » Wed May 19, 2010 10:10 am

Feck wrote:My file is stamped "not responsive to treatment(personality disorder)"like it's my fault ,and that gives them a reason not to treat me .
Treating mental illness primarily with medication, attributing to it a biological source, runs the risk of implying that those who respond cannot help being ill and fall into an "acceptable" class. The thinking goes that a physiological or genetic source removes the patient from any so-called "responsibility" in having fallen ill, leaving those among us who don't respond to medication or choose another kind of treatment as open to being blamed for our illness. We see this twisted and cruel "logic" misapplied with particular vehemence with those diagnosed with personality disorders, who are viewed, even and especially among mental health practitioners as difficult to treat, to be avoided, and as having severe character flaws, all rendering them less deserving of our sympathy and compassion.

I'm sorry Feck that you might be experiencing some of this. Because a personalty disorder can't usually be righted by a doctor simply scribbling out a prescription, these illnesses present a challenge for a doctor or therapist. Unfortunately challenges aren't always viewed positively. So, a doctor's inadequacy manifests itself in a patient being blamed for being ill. And, the patient's suffering might thereby be increased by her having to endure the stigma associated with something that doesn't have an easy fix. It isn't anyone's fault that they become ill. Society at large and the therapeutic community haven't evolved enough not to need to cause greater suffering to those who already suffer, simply because society feels uncomfortable and doctors feel helpless and reluctant to work hard with a patient who doesn't present an easy/quick win. Just because we can't be cured by a easy and quick dose of medication, doesn't mean we want to remain sick.

We have come to view mental illness in terms of a certain false paradigm: Now that we believe (right or wrong or both) that depression and bipolar disorder and other illnesses are caused by a chemical imbalance we see a patient as separate from and absolved from playing any role in her illness (along with absolving all of us in a patient's environment from shouldering any responsibility, which would have required us to examine ourselves) and aren't to be blamed for it. If an illness doesn't respond to medication, it must not be the result of a chemical imbalance and the patient must therefore have chosen to be ill or be playing a role in not getting well -- in short as being defective (no longer just ill) in some way. In the way this paradigm plays out, we become free to blame the patient as having caused her illness or impeded its cure. It's interesting that a similar nature vs. choice worked out better for promoting the rights of GLBT folks. It's a shame that we have come to rely upon biology to cure us of our discomfort and bigotry. Absent the ability to blame biology, we fault the person for whoever or whatever they are, no matter the cruelty involved. Society tends to almost embrace the mentally ill who respond to medication while seeming to shun those who don't.

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Re: Mental illness

Post by Feck » Wed May 19, 2010 10:14 am

The Best was the they told my GP to double the dose of my anti -depressants the leaflet in the box has In bold letters MUST not be used for patients with Personality Disorders .

I don't take them anymore :D
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Re: Mental illness

Post by orpheus » Wed May 19, 2010 11:22 am

TumblingPear wrote:
Feck wrote:My file is stamped "not responsive to treatment(personality disorder)"like it's my fault ,and that gives them a reason not to treat me .
Treating mental illness primarily with medication, attributing to it a biological source, runs the risk of implying that those who respond cannot help being ill and fall into an "acceptable" class. The thinking goes that a physiological or genetic source removes the patient from any so-called "responsibility" in having fallen ill, leaving those among us who don't respond to medication or choose another kind of treatment as open to being blamed for our illness. We see this twisted and cruel "logic" misapplied with particular vehemence with those diagnosed with personality disorders, who are viewed, even and especially among mental health practitioners as difficult to treat, to be avoided, and as having severe character flaws, all rendering them less deserving of our sympathy and compassion.

I'm sorry Feck that you might be experiencing some of this. Because a personalty disorder can't usually be righted by a doctor simply scribbling out a prescription, these illnesses present a challenge for a doctor or therapist. Unfortunately challenges aren't always viewed positively. So, a doctor's inadequacy manifests itself in a patient being blamed for being ill. And, the patient's suffering might thereby be increased by her having to endure the stigma associated with something that doesn't have an easy fix. It isn't anyone's fault that they become ill. Society at large and the therapeutic community haven't evolved enough not to need to cause greater suffering to those who already suffer, simply because society feels uncomfortable and doctors feel helpless and reluctant to work hard with a patient who doesn't present an easy/quick win. Just because we can't be cured by a easy and quick dose of medication, doesn't mean we want to remain sick.

We have come to view mental illness in terms of a certain false paradigm: Now that we believe (right or wrong or both) that depression and bipolar disorder and other illnesses are caused by a chemical imbalance we see a patient as separate from and absolved from playing any role in her illness (along with absolving all of us in a patient's environment from shouldering any responsibility, which would have required us to examine ourselves) and aren't to be blamed for it. If an illness doesn't respond to medication, it must not be the result of a chemical imbalance and the patient must therefore have chosen to be ill or be playing a role in not getting well -- in short as being defective (no longer just ill) in some way. In the way this paradigm plays out, we become free to blame the patient as having caused her illness or impeded its cure. It's interesting that a similar nature vs. choice worked out better for promoting the rights of GLBT folks. It's a shame that we have come to rely upon biology to cure us of our discomfort and bigotry. Absent the ability to blame biology, we fault the person for whoever or whatever they are, no matter the cruelty involved. Society tends to almost embrace the mentally ill who respond to medication while seeming to shun those who don't.
That's an unfortunate situation you describe. It doesn't happen everywhere and in all cases, and I think it's becoming less common, albeit not quickly enough. It's ridiculous that it happens at all.

There are doctors who take a much more helpful and more accurate view: that treatment-resistant disorders simply require different treatment: different meds, finely tuned dosages, sometimes complicated combinations of meds, etc. My psychiatrist, for example, specializes in treatment-resistant mood disorders. (After a series of very smart psychiatrists had limited success, I went to him, with very good results.)

This may be more the case here in NYC, where there is a large number of psychiatrists and less stigma than in other places.
I think that language has a lot to do with interfering in our relationship to direct experience. A simple thing like metaphor will allows you to go to a place and say 'this is like that'. Well, this isn't like that. This is like this.

—Richard Serra

TumblingPear
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Re: Mental illness

Post by TumblingPear » Wed May 19, 2010 1:37 pm

I'm also treatment-resistant. I used to live in New York City, albeit quite some time ago. Even there I had two psychiatrists dump me. Still, there were so many psychiatrists that I always had someone committed to me and my treatment. I now live in a rural area where there are few psychiatrists. Of these, most are only psychopharmacologists, offering no psychotherapy. Among psychiatrists who do offer psychotherapy, I have yet to find one who was taking new patients and who are willing to take me on (AND that I found acceptable), what with my history of illness and resistance. Right now I am in treatment with someone over two-hundred miles away. I see him for a face-to-face session as often as I can but our therapy is often conducted over the phone.

The Austen Riggs Center in Western Massachusetts is the only long-term residential treatment center still in operation in the U.S. The Center specializes in treatment resistant patients. Good luck finding a way to afford it though. It costs about $1000/day for the highest level of care and the Center only accepts patients with private health insurers who are willing to cover a 30-day minimum stay. A significant portion of the patients are likely of considerable means and paying out of pocket. Austen Riggs isn't what one would expect in a hospital. Patients are free to come and go and every patient receives four sessions/week of psychotherapy among other intensive psychodynamic treatment.

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