Mental illness

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Re: Mental illness

Post by orpheus » Fri May 14, 2010 2:10 pm

anna09 wrote:Mental illnesses do have a physical origin either chemically or structurally and of course a genetic predisposition. Take schizophrenia for example, there are several different types of schizophrenia with different origins. Acute schizophrenia is chemically based and is due to excessive dopamine activity. This type is more responsive neuroleptics unlike Chronic Schizophrenia that arises from structural abnormalities in the brain. (less than average brain weight, enlarged ventricles, reduction of the number of neurons in prefrontal cortex etc.) Some people even have a combination of neurotransmitter issues AND brain abnormalities. There is no cure-all pill for mental illnesses. Some people simply do not respond to certain (if any) medications but that doesn't mean the medication itself is "bullshit". Based on what I've been taught, the common view is that if medication is necessary then therapy is a must. Yes, I am aware there are some psychologists and psychiatrists that don't follow this but don't disregard the whole field becuase a few people are assholes.
Mr Jobby wrote:If possible its definetely better without medications.
Tell that to somebody who suffers from Bipolar Disorder. Manic episodes can only be controlled with medication.
Yes. Well said.

Two other points: first, the much-talked about side effects (particularly associated with SSRIs) are real, but not everybody has those side effects with every drug. Look at five different SSRIs, for example, and they'll all list fatigue as a possible side effect. That does not mean that every person will experience fatigue with every one of them. This is why experimenting with different meds and adjusting dosages is often necessary.

Second: often it is quite dangerous to leave something like bipolar disorder - or even depression - untreated. These things are episodic. The profile for depression is often like this: first episode is triggered by some external stressor (e.g., death in the family, divorce). The second episode often arrives with no external trigger, and is worse. Same with future episodes. The more episodes you have, the more you're likely to have. And they become increasingly harder to treat. Yes, the brain is not a robust organ. And one of the things that can damage it irreparably is repeated episodes of depression or mania.

Furthermore, some people recommend using medication only temporarily. While this can have some merit (avoidance of side effects, for example), often the suggestion is made simply because of a personal bias against medicines for mental health in general - an attitude that if you use meds for mental problems, you're simply using a crutch and instead should "tough it out". You wouldn't tell someone with diabetes or a heart condition to stop taking their medicine when they feel better. This is more than just a matter of personal preference: I know from personal experience that if a medication works and then you stop taking it, there's a very good chance that that med won't work the next time.
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Re: Mental illness

Post by Cunt » Fri May 14, 2010 2:27 pm

Mr Jobby wrote:The average family is going to give a **** more an a long term consistent basis than the average institution.
That average...is it mean, median or mode? How was the data calculated?
Mr Jobby wrote: Long term Consistency is very important for people on the delusional spectrum.
In my experience, for the overwhelming majority of people off the spectrum, too.
Mr Jobby wrote:If its possible, meaning if the family finds it has the resources and capability to do so and the patient is one who is not too far gone or out of control without the medications.
Who decides? Again, would you have DaVinci 'cured'? How about Eeyore?
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Feck wrote:Now My question to anyone who says that meds are not one of a range of treatments used is : How would you like 4 people screaming in your head 24/7 that you are a worthless shit and everybody would be happier if you killed yourself ?
That would probably bother me to no end. By the way, the way you phrase this is, to me, sensitive and caring. I think you have had some experience with this (or uncommon understanding) and I want to say that, although the questions I ask may make it seem that I don't care much, it is because I need to explore those questions.

One I would like to toss out is this:
How does one tell the difference between a person diagnosed with schizophrenia describing symtoms of their mental illness, and a a person diagnosed with schizophrenia pretending to have symptoms?
(by the way, I take all of it at face value for now, but it is something I have to consider quite often)
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anna09 wrote:Tell that to somebody who suffers from Bipolar Disorder. Manic episodes can only be controlled with medication.
Are you sure? Are there simply NO other ways to deal with this? Or are you perhaps over-generalizing?

(protip - the human spectrum is wide)
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Re: Mental illness

Post by orpheus » Fri May 14, 2010 2:38 pm

Mr Jobby wrote:
orpheus wrote:I guess what's not so obvious to me is why it's better without medications than with.
If possible its definetely better without medications.

Aside from the side effects which can sometimes be life threatening, the neuroleptics for schizophrenia contribute to the damage caused to cortical grey matter by the condition itself, even though they calm down the secondary symptoms (hallucinations, paranioa) caused by high dopamine.

Drugs for mood spectrum disorders tend to prolong an illness if the patient had been able to resolve it in the short term without drugs. Many enzymatic pathways with their associated circuits in the brain are easily broken and often do not recover when hammered with drugs, although we are all different in our robustness, these differences are only just now being addressed.

The human brain is simply not that robust physically in comparison to other mammals. Our accelerated brain growth makes us far more sensitive to disorders, siezures and recovery from blow to the head than other mammals. Probably due the higher densities of matter, and increased variety of neuronal types and processes operating within the same given space.
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.
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 » Fri May 14, 2010 2:40 pm

Cunt I do understand that you care and I agree with you that there are Millions of people that should not be prescribed anti-depressants ,I wanted to make sure that the baby was not thrown out with the bath water .
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Re: Mental illness

Post by anna09 » Fri May 14, 2010 2:47 pm

Cunt wrote:Are you sure? Are there simply NO other ways to deal with this? Or are you perhaps over-generalizing?

(protip - the human spectrum is wide)
Taken from my Child Psychopathology textbook:

"Medication is the foundation of treatment for most children with bipolar disorder because this is the only way to successfully control their manic and depressive symptoms (American Academy of Child and Adolescent Psychiatry, 1997)."

Therapy is very important especially when medication is involved; however, therapy isn't going to eliminate manic episodes. It's not going to get rid of hallucinations if you're schizophrenic. I think one of the biggest misconceptions that people have with psychology is that people don't realize that these disorders are physical.
Cunt wrote:How does one tell the difference between a person diagnosed with schizophrenia describing symtoms of their mental illness, and a a person diagnosed with schizophrenia pretending to have symptoms?
(by the way, I take all of it at face value for now, but it is something I have to consider quite often)


Brain scans would show evidence.

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Re: Mental illness

Post by orpheus » Fri May 14, 2010 2:55 pm

Cunt wrote:
Mr Jobby wrote:
Cunt wrote: Do they really? Have you ever compared the 'no intervention' group to the 'drug intervention' group?
In the 70's schizophrenics were allowed to recover by giving them isolated living spaces where they could sort themselves out and do what they wished within their own time and pace. famous Psychologist did that RD Lang.

Problem is that is just too expensive on resources for most common psychiatric facilities. They have to restrain and control patients somehow, as a lot of them are brought in for forensic reasons. A lot of psychiatric facilities are just caring extensions of the prison system and structured as such.
I think there have been people who have been medicated very carefully, and killed someone anyway (maybe themselves) and people who have been ignored as far as medication goes, and recovered through other means. (maybe just time, maybe family support)
There are bound to be casualties no matter how good the course of treatment, as you basically have people who have spun out of control, manic, deluded etc...and then had to be admitted. The system arose because of the harm that these conditions inflict on society and family when no treatment is given. Its got a long way to go, but you cant say for the most part the people who work in it don't care, or arent trying to solve or manage these problems within their means.
For an awfully long time the solution has been isolating them along with retards and cripples in institutions. This means that:
a) the crazy people don't get as much experience living in the 'normal' world as they might have, thus lacking some social (and other!) skills, and
b) the normal people don't get as much experience living in the real world (the one with ALL kinds of people in it) as they might have.

I think the meds are further isolating them. Would you cure Eeyore?

Would you 'cure' DaVinci? (there may have been a bit of self-harm there)
Why do you think the meds are further isolating them? A medication or combination of meds that works properly for that person will not isolate them; instead it will help relieve their suffering and allow them to function.

Would I cure DaVinci? Yes. First, he might have been just as creative had he been healthy. Maybe even more. We don't know. Do you want to make that judgment about someone else's life? Do you feel you have a right to?

Second, let's say for the sake of argument that curing him would have meant that he wouldn't have been so stellar. Our being culturally enriched by his work does not trump his right to alleviate his suffering if relief had been available. Let me take another example to make it clearer: Vincent Van Gogh. He almost certainly suffered from a mood disorder. We now know that he was a great artist. But in his own lifetime, he was not really appreciated. Would you tell him "no, we're not going to help relieve your suffering, because we want you to keep painting. People don't give a shit now, but after you're dead we will."

Third, thought experiments like this don't take into account that we're looking at someone's life after the fact. Time machines don't exist; we can't decide to cure him or not, since he's already gone. So you can't apply such examples to people who are already living. You don't know the future. Neither do they. But they do know their present situation.

Apply it to yourself: you don't know whether or not what you do in your life will be appreciated after your death. It might be wildly appreciated by the whole world. But if you do know that right now you're in agony, do you think it justified that someone tells you they're not going to cure you because people will appreciate your work in the future?
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

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Re: Mental illness

Post by anna09 » Fri May 14, 2010 3:29 pm

I just read the OP's article and I'm sorry, but I have to call bullshit. . .
At some later point, however, as the chemical imbalance story repeatedly fell apart, psychiatrists in the research community understood that they were telling a “fib.” I can still remember - this was the summer of 1998 - when I questioned a prominent academic psychiatrist about whether the chemical imbalance story was really “true” and he replied by stating that it was a “useful metaphor” that “helped patients understand why they needed to take their medication.” This really is the tragedy of modern psychiatry - it became a medical discipline devoted to telling a public story that made its drugs look good, as opposed to telling a story rooted in honest science.
I smell conspiracy theorists. :ddpan: "Big Pharma" "Chemical imbalance a useful metaphor?" "just trying to sell the public a story" Are you kidding me!? I'm not trying to come off as some sort of professional (hell,I'm just a psych undergrad) but this is completely unscientific.

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Re: Mental illness

Post by Trolldor » Fri May 14, 2010 3:32 pm

As far as I'm aware, that Depression is caused by a 'chemical imbalance' is not conclusive. Seems like it's a bit of either 'my brain's gone haywire' or 'my life is shitty', neither is the constant.
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Re: Mental illness

Post by orpheus » Fri May 14, 2010 3:41 pm

born-again-atheist wrote:As far as I'm aware, that Depression is caused by a 'chemical imbalance' is not conclusive. Seems like it's a bit of either 'my brain's gone haywire' or 'my life is shitty', neither is the constant.
They're not unrelated. One can cause - or aggravate the other. Falling ("my life is shitty") can cause a broken arm ("my brain's gone haywire"). That doesn't mean you shouldn't get your arm properly treated. And some people have chemical imbalances that predispose them to mood disorders - just like some people have physical weaknesses of one sort or another.

What people tend to forget is this: barring dualism (i.e. mind has no physical basis; it does not arise from brain), then anything you think or feel is connected to electrochemical changes in your brain. Asking if something is chemical in the brain or if it's an emotion connected to an external event is like asking where "X" is on a graph: it's determined by both horizontal and vertical coordinates. It's not just one or the other. In terms of what causes what? That's harder to determine. But if there's a problem, why not attack it from both sides? That's why a combination of medication and therapy seem to work best for many people.
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

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Re: Mental illness

Post by Trolldor » Fri May 14, 2010 3:45 pm

Except that the Medication can actually be quite dangerous to your mental state, and that feeling like shit all the time is completely different to having your brain make you feel like shit all the time. I used to underestimates the value of psychology until I look back at what my psychologist did for me.
"The fact is that far more crime and child abuse has been committed by zealots in the name of God, Jesus and Mohammed than has ever been committed in the name of Satan. Many people don't like that statement but few can argue with it."

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Re: Mental illness

Post by orpheus » Fri May 14, 2010 4:00 pm

born-again-atheist wrote:Except that the Medication can actually be quite dangerous to your mental state, and that feeling like shit all the time is completely different to having your brain make you feel like shit all the time. I used to underestimates the value of psychology until I look back at what my psychologist did for me.
But, as I've said above, mental illness left untreated can also be quite dangerous. If medications are needed and are not used, the long term result can be illness that becomes impossible to treat. I think it's a mistake to say that since medications can be dangerous, they shouldn't be used.

This is why it's important to work with a good, experienced and knowldgeable psychiatrist to monitor the effects of medication.

Medication in general can be quite dangerous - physically and mentally. And they can also be quite helpful. That's why we have trained doctors, and why they monitor our meds. Just because we know less at this point about medications for mood disorders than we do about those for other ailments does not mean that we know nothing.

I realize that not all psychiatrists are good, experienced and knowledgable. However, that's no reason to paint them all with the same brush - although it's tempting, especially in conjunction with our currently limited knowledge of these meds. Don't throw the baby out with the bathwater.

By the way, one other thing to keep in mind when talking about psychiatrists: in many clinics and hospitals, psychiatrists spend far too little time with patients not because they're quacks, necessarily, but because they often have enormous pressures on them to process large numbers of patients quickly. This runs directly counter to the fact that with the science in its infancy, it actually takes a good deal of time to diagnose and properly treat many mental conditions. (My father is a psychiatrist who in fact quit working at a clinic for this very reason. The deck was stacked against his being able to do a good job.)
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 Trolldor » Fri May 14, 2010 4:06 pm

I never said that psychiatry never had a basis, nor that it didn't work. I'm not that idiotic, if the brain is purely biological then anything which can change or alter how it is operting can work. 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 fact is that far more crime and child abuse has been committed by zealots in the name of God, Jesus and Mohammed than has ever been committed in the name of Satan. Many people don't like that statement but few can argue with it."

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Re: Mental illness

Post by orpheus » Fri May 14, 2010 4:16 pm

born-again-atheist wrote:I never said that psychiatry never had a basis, nor that it didn't work. I'm not that idiotic, if the brain is purely biological then anything which can change or alter how it is operting can work. 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.
I understand, and perhaps I was too broad in my response. I guess where we disagree is in the effect of an environmental contributing factor. If a person has an latent predisposition to depression, then an environmental factor can trigger it. That's what happened with me, and what seems to happen for a lot of people. In such cases, therapy is incredibly helpful - necessary, even - to help one learn how to deal with oneself in the external world. But that doesn't negate the chemical aspect as well. In fact, sometimes it's the reverse of what you say: no matter how much therapy they get, they aren't going to get better without proper meds, because whatever the environmental factor, the brain's chemistry is now involved.

This is also, I think, why so many people have a first episode triggered by an external event - but then a second (and third and fourth...) that seem to come out of nowhere, with no environmental stressor. The more recurrences you have, the more you're likely to have. And, as I said above, these recurrences are often increasingly difficult to treat. I know I sound like I'm simply a cheerleader for medication, but this is a real and serious reason to consider medication early on.
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

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Re: Mental illness

Post by anna09 » Fri May 14, 2010 4:20 pm

"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.

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Re: Mental illness

Post by Feck » Fri May 14, 2010 4:23 pm

born-again-atheist wrote:As far as I'm aware, that Depression is caused by a 'chemical imbalance' is not conclusive. Seems like it's a bit of either 'my brain's gone haywire' or 'my life is shitty', neither is the constant.

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 .
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