Monday, February 16, 2009

Of Psychiatry and Antipsychiatry

In January, I asked readers this question: "What best describes your condition over the past 30 days?" Only 14 percent replied they were "back to where they want to be" or "better than they ever could have imagined."

This month, I'm asking: "How do you rate your meds in managing your illness?" So far, 82 percent rate their meds as either "most important," or as important as other tools. Only 12 percent ascribe little or no importance to their meds.

Do you perceive a discordance between the two poll results here? Granted, this is not a scientific survey. Nevertheless, the results beg the following question: Why do we place such great emphasis on meds, when obviously they are not living up to our expectations?

Or: Are our expectations so low to begin with that we have given up on ourselves?

Hold those thoughts for a second, then surf around to various patient/consumer/survivor/whatever blogs. You will note the vast majority have a decided antipsychiatry slant to them. Many of these blogs set out to expose the lies of the drug industry, which - believe me - are in abundant supply. Others have a much greater emphasis on helping their readers achieve recovery through non-pharma interventions.

Even blogs that find value in meds and psychiatry (such as this one) do so in the context of sharply critical enquiry.

It's as if we're all saying in unison to psychiatrists: We trusted you. We placed our faith in you (and apparently still do). But we're the ones who have to live with the results, and - let's put it this way - we're not exactly happy.

Simply put: If meds worked the way the drug industry and psychiatrists would have us believe, compliance rates would be nearer to 100 percent (instead of more like 30 or 40 percent over the long term), we would enjoy similar employment rates and stable relationships as the rest of the population, and mental illness would be in sharp decline rather than (apparently) on the rise.

Thus, there is a rational basis to antipsychiatry.

But life is never that simple. If we have to be binary in our beliefs, it's much more useful to think in terms of "smart vs dumb" than "pro vs anti." Far too many of us have been victims of dumb psychiatry. Similarly, dumb antipsychiatry (and there is an awful lot of it going around) can lead to disastrous personal decisions.

The antidote to both is "smart."

More on this in future blogs ...


Francesco Bellafante said...

I believe in minds without limits.

Existence is a linguistic phenomena, to humans anyway. The words you use to describe aberrant human behavior, such as "mental illness" have so many different meanings to so many different people that it is no wonder how un-simple life is when you look at what people at the extremes of any distribution are doing.

I love this post. Thanks for writing it.

Demostenes said...

I am a Costa Rican Psychologist and recently did some community service with the National Association of Bipolar Patients. To prepare myself I studied a lot about Bipolar (as my university years were clearly insufficient to understand the complexity of the condition) During the group therapy Clients commonly commented their problems with medication. I was astonished to see how this people had to live with lots of side effects that I considered unbearable. Yet their psychiatrist have not even informed them about the possible complications. That was absolutely incomprehensible for me. It's sad to see this situation, and the lack of human contact between some psychiatrist and their patients.
On a side note, thank you very much for your blog and your other website, it has really helped me to better understand how is it to live with Bipolar Disorder.

John McManamy said...

Many thanks for your input, Demostenes. The biggest complaint I get about psychiatrists - they don't listen. It is my belief that they err on the side of overmedicating us. A good many are totally indifferent to the side effects and what these meds do to our health and quality of life. Not surprisingly, meds compliance rates are abysmally low, but who gets blamed? The patient.

If you go to two of my early blogs, you will read how I suggested to a group of clinicians to improve meds compliance and hence patient outcomes. They practically ran me out of town on a rail.

I'm all for smart psychiatry and smart meds. But there's way too much dumb psychiatry going on. The antidote to this is smart patients.

John McManamy said...

Hey, Francesco. Absolutely agree - language tends to be limiting and confusing. I hate the term mental illness. We have a real paradox here. I use it because readers generally know what I mean, instantly, without having to stop reading and try to read my mind. I'm generally using it in the context of bipolar, depression, schizophrenia, and anxiety. I generally distinguish mental illness from personality traits and most forms of behavior.

Even if people question my use of the term, the important thing is we all know what we're talking about. Again, I'm not happy with the term - it is pejorative, but for now it's the best we got, and I dread any substitute terms that a committee of politically correct types might come up with.

As for extreme forms of behavior aiding enquiry across the broad range of behavior - this is an accepted technique over a variety of disciplines. I have a law degree. In law school we learned general legal principles by studying court decisions. Court decisions are all about things going wrong, not right. The situations were extreme, not likely to be encountered in real life, where things tend to be a lot more routine.

As to how the memory works, much of the pioneering investigative work was done on a man who lost his long-term memory as a result of an accident that lodged a piece of metal in a particular part of his brain.

Similarly, we learn a lot about how organs in the body work when they stop working.

Right now, I'm working on this set of principles:

If you want to know about why we feel up or down, consult the depression and bipolar experts.

If you want to know how the thinking parts of the brain work, consult the schizophrenia experts.

If you want to know about the stress-panic response, consult the anxiety experts.

If you want to know about behavior, consult the personality disorder experts.

On and on it goes.

cretin said...

Something I think the antipsychiatry folks do somewhat right is question the definition of mental illness. There is too much effort on the part of APA and industry to push normal "abnormal" behaviors as illness in order to sell their wares (the "dumb psychiatry"). So much is being "defined" as mental illness, that the public is questioning everything that is called mental illness, even what is truly pathological. Antipsychiatry has pretty much scooped up the ball and are running with it. But they tend to take it to extremes by denying even the pathological cases since they don't fit their philosophical bent. I am tired of the comments that bipolar or schizophrenia are not illnesses, they are a way of life. Obviously those who say that have not been afflicted and distraught with them. They are not "a way of life"; however you want to call or define them ("the pink disease" or "bad humours"), they are unbearable suffering brought on by a brain gone haywire.

You are very right to comment how these pathological cases have led to a greater understanding of the brain/mind. This is often the case in medicine. Unfortunately, another example is how AIDS has taught us a lot about the immune system. Just the way it goes.

John McManamy said...

Hi, cretin. Took the words right out of my mouth. As long as we have dumb psychiatry, we will always have antipsychiatry. "Smart" antipsychiatry legitimately challenges psychiatry's tendency to over-pathologize behavior. Then, as you note, antipsychiatry gets incredibly dumb.

These extremes cloud very important issues that need to be discussed. For instance, I have bipolar. Clearly I have a biological illness compounded by life stresses. Clearly it has wrecked my life no end of times.

Yet, at the same time, my bipolar is also part of the very healthy parts of myself, the parts that function at normal and "better than normal" levels in society.

I'm sure this is the case with a good many individuals across a range of diagnoses. The antipsychiatrists say there is nothing wrong with us - that we can control our behavior. The psychiatrists look at us as diagnostic freaks.

We need to make a strong stand on who we really are.

Thanks for getting my thinking going. I'm looking forward to a full airing of these issues. Please keep posting. Also, you may want to consider doing a guest blog. This is all about dialogue and you are a very important part of the dialogue.