A Baffled Look

The straight dope on mental health

Month: March, 2014

Don’t Judge a Book by Its Cover

The book by Charles Barber titled “Comfortably Numb: How Psychiatry is Medicating a Nation” isn’t antipsychiatry. Most of it isn’t about psychiatrists. It’s about the pharmaceutical companies targeting people through television ads to ask their general practitioners for antidepressants. The first half of the book explores how pharmaceutical companies target both the public through direct advertising and use data mining to market antidepressants to doctors. The second half of the book suggests how cognitive behavioral therapy can be more appropriate for the mildly depressed or people without mental illnesses that have trouble with a temporary situation in their lives. Barber, who worked for ten years with homeless people with severe mental illnesses, claims the people who need the most help are getting left behind because they are a much smaller market compared to people who have trouble adjusting to a temporary, but difficult life situation. Therapy can work as well or better for the “worried well” and mildly depressed. He states that psychotropic medication is absolutely necessary for serious mental illnesses such as major depression, bipolar disorder or schizophrenia. Barber discloses in this NPR interview that he has obsessive compulsive disorder and takes Prozac. It’s been a while since I’ve read this book, but this interview on altertnet.org sums it up nicely.
I really wish that Barber had named his book something else because it’s much more nuanced than the title suggests. I guess he wanted to grab readers’ attention. That’s unfortunate because an interview of him on YouTube gets lumped with antipsychiatry videos.

The Real Crazies

While I was watching some DVDs about the Holocaust I got an idea about how the Nazis euthanized people with mental illnesses. It made me wonder if physician assisted suicide could lead to people who can’t take care of themselves being euthanized as an official policy like it happened in Nazi Germany. In 2006, the Swiss Supreme Court ruled that mentally ill people can have access to physician assisted suicide. I found a lot on this online from many sides of the issue. The logic goes that since mental illnesses are accepted as biologically based mentally ill people should have the same options available as terminally ill people. If the mentally ill person is deemed in temporary remission from a chronic, debilitating mental disorder then they should be considered rational enough to be assisted in killing themselves. A lot of physicians, especially psychiatrists, see this as anathema. For psychiatrists, suicide is failure. What happened to “First, do no harm.”? Moreover, some people with terminal illnesses are depressed. Some articles were alarmed – including an editorial on MindFreedom International’s website. Many consider all physician assisted suicides a “slippery slope.” Will it lead to patients being encouraged to die so they are no longer a burden to society? In Nazi Germany, mentally and physically disabled people were exterminated for this reason. Many psychiatrists report that one consultation with a person who wants physician assisted suicide is not enough to determine if someone is rational enough to go through with a permanent solution for their suffering. Oregon has a law permitting physician assisted suicide for terminal illnesses, but now that intractable mental illnesses are viewed as biologically based, will the mentally ill have the same “rights” as the terminally ill? According to a Medscape article, “we are entering an era during which psychiatric patients do not need to be protected, but empowered. Our goal should be to maximize the options available to the mentally ill.” From a civil liberties perspective this seems logical, but mental illnesses distort reasoning. Should someone with impaired judgment be “empowered” or should they be helped to overcome their condition? Even MindFreedom International sees access to physician assisted suicide for mentally ill people as having potential to lead to coerced or forced euthanasia of those labeled mentally ill. MindFreedom usually supports civil liberties for persons with a mental illness.
If someone with a mental illness wants to kill himself, he will find a way without the help of a physician. There’s a libertarian type reasoning to some of these articles – a cold appraisal similar to the Nazi’s reasoning that those who can’t work and care for their survival shouldn’t be allowed to be a “burden to society.”
According to a 2002 article in the British Journal of Psychiatry, there are no clinical criteria to guide such an assessment for determining the rationality of the right to physician assisted suicide. It seems crazy that physician assisted suicide be available to the mentally ill – especially if there is no standard for a “rational” decision. Mental illnesses may be biologically based, but it affects your brain, where you need to think rationally enough to make an informed decision.

Poverty of Spirit

People who have a serious mental illness such as schizophrenia or bipolar disorder have a much higher prevalence of substance abuse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 25.7% of adults with serious mental illnesses have substance abuse problems. They are 70 percent more likely to abuse substances than the general population according to the National Institute of Health.
According to a video I watched of a presentation by Canadian psychology researcher Dr. Bruce Alexander, addiction is caused by dislocation – a loss in life’s meaning because of loss of cultural identity and support. People who are diagnosed with a serious mental illness often lose their sense of meaning. It’s a traumatic experience. People who experience dislocation try to fill the void with some kind of substitute that becomes a compulsive behavior. Alexander rejects the disease model because it supposedly doesn’t address psychosocial integration. The disease model posits that addiction has a genetic component and that consumption over time alters the brain. Addiction is incurable but can be managed. Treatment can work. This view comes from science. Although my experience with 12 step programs has enabled me to achieve psychosocial integration, I believe the avalanche of studies that support the theory that addiction is a disease. I don’t believe Alexander’s view provides a full picture because pleasurable activities release dopamine, a spike in the neurotransmitter causes a feeling of pleasure. I see how my mental illness dislocated me and how I finally became reintegrated socially through a twelve step fellowship and the treatment I received for my bipolar disorder. A multitude of studies show there’s a strong genetic component to addiction. Addiction is probably caused by both biochemical and psychosocial forces. It’s the same “nature vs. nurture” debate. The dislocation hypothesis of addiction does address part of the problem, but the other piece of the puzzle has a biological basis as well. It’s not either or, but both.
According to a paper by Alexander, the globalization of the free market economy has led to dislocation on a mass scale and has sparked an avalanche of addiction. I’m blogging about this because I think the dislocation theory has some merit, but the bulk Alexander’s claims that the definition of addiction is too narrow and vague and his assertion that that anything can be addictive is even more vague and imprecise. Where is the quantitative analysis of his hypothesis? With so many different kinds of addiction that he claims exist it’s not possible to provide a standard measure. Alexander claims addiction is a “poverty of spirit.” Twelve step programs address this issue. Most people who have recovered from addiction through a twelve step program also subscribe to the disease model of addiction. I think Dr. Alexander’s claim that anything can be addicting trivializes the suffering that occurs with addiction to alcohol and some drugs. I’m blogging about this because I think Alexander’s ideas might interest some people even though some of his assertions are beyond the scope of this blog. The video I mentioned above is worth watching because some of it addresses some of the reasons why some mentally ill people might abuse substances.