Psychological Problems are not a Form of "Illness"

I can't be bothered to read that blog properly. But why would anyone label normal behaviour as 'mental illness' when the NHS can't even cope with the amount of people that do desperately need psychiatric help?

Not everything is a conspiracy. My whole family are psychiatric nurses and day care staff. They dont profit from prescribing drugs and certainly dont do it for a laugh. I often sit on at my mothers day centre where the patients spend a lot of time talking, working together and doing all sorts of non-drug treatment. Some of them still require drugs and do quite well off them, even returning back to their regular lives and not needing medication anymore.

There will still be mental health problems after the revolution, I think this is the hardest thing to explain to some people.

Quite right, hence Irish nurses working with an overtime ban at the moment. I have done two front page stories in the last week about people hit hard by health care cuts, one a cancer patient.

GDID, I didn't say that there was necessarily a conspiracy or that psychiatry wasn't useful. However, when it comes to medication, there's little or no evidence that any anti-depressant medications, for example, work better than placebo - this is now quite well established, but I don't want to go over ground that's been well-trodden in these forums before. I was simply noting that the enormous and often quite direct influence of the pharma industry on practitioners predisposes the medical profession to ascribe emotional distress to 'illness'.

Of course not - although there's good evidence that the biomedical model of 'mental illness' encourages public stigmatisation of personal distress (Read et al. 2006, 'Prejudice and Schizophrenia').

Anyway, we should ditch the notion of 'mental illness' primarily because it is incoherent. Schizophrenia etc. are simply not illnesses in the sense of conditions that have an organic cause.

It was a generalisation, but not necessarily so sweeping; I'm happy with the statement that evidence of efficacy beyond placebo for anti-depressant meds is very slight. I was thinking of Moncrieff and Kirsh's (2005) meta-analysis of reviews of the efficacy of SSRIs, which shows that those drugs don't offer clinically meaningful advantages over placebo in the treatment of depression, whether mild or severe.

There are numerous problems with your interpretation of that meta-analysis, Steggsie. Firstly the studies it looked at were trials which lasted a maximum of 4 weeks i think, which is about the time when a lot of people find SSRIs really kick in. Also in the most severe cases SSRIs worked better than placebo. And I'm not sure if i remember correcttly but I think for moderate depressrion SSRIs were significantly (statistically) more effective than a placebo, but not 'clinically significant' according to NICE guidelines. So its not as clear cut as 'SSRIs don't work.' Oh, also SSRIs are used to treat many mental illnesses, depression is just one of those.

Rev. Tap, rates of schizophrenia vary between cultures buts its pretty much impossible to disentangle whether this is due to the effects of capitalism on mental health or other cultural factors which effect the likelihood of someone with schizophrenia being correctly diagnosed.

Two schizophrenics may not have any of the same official symptoms, but they both experience a split from reality. All the possible symptoms are just examples of that. Yes its a heterogenous disorder but thats why there are subtypes. I don't agree that a diagnosis of schizophrenia doesn't inform what sort of meds someone will be prescribed. Obviously its going to be some sort of anti-psychotic and not just something random.

I don't see why an illness isn't an illness just because its cause isn't completely biological (and/or understood), I don't understand that argument. The names of mental illnesses are indeed lables that we put onto clusters of symptoms, but thats also true of many physical illnesses. It doesn't mean they're not 'real', it just makes treatment etc. easier. I don't like the implications of not seeing mental distress as an illness. disability benefits etc...

Anyway, in my opinion the only problem with mental health services is that they're not better funded.

Of course in the case of disability benefits, or the legal system having to judge someone's level of responsibility for a crime they may have committed because of some hallucination or paranoid delusion they were experiencing at the time it may be beneficial to have a nice easy diagnosis, however I would argue that society should recognise these symptoms of mental distress as a legitimate problem in themselves without trying to medicalise them.

The problem with putting these psychological problems into a medical model is that it places the emphasis on finding some sort of cure (usually medication) rather than helping someone work through their problems. For example depression has been shown to be linked to the way people attribute misfortunes or failures which they experience. Most people tend to attribute most of their failings to external situations beyond anyone's control, thus safeguarding their mental health with an arguably over-optimistic view of life (eg I failed the exam because I haven't had time to revise sufficiently, I would have passed otherwise). Depressed people tend to attribute most of their failings to problems specific to themselves, which they can't change (I failed the exam because I am stupid). Paranoid people tend to attribute their failings to the deliberate intentions of others (I failed the exam because the examiners have it in for me and deliberately marked me down.) These ways of attributing events can be shown to have usually developed from early life experiences and the attributions of parents. I would argue that helping someone to recognise unhelpful beliefs they hold about this sort of thing and to try to challenge them will do a lot more to help them out of depression than any drug ( though the drug obviously helps many people in the here and now).

By seeing mental health problems as a disease, with symptoms like any other, the onus is on medication to provide a 'cure', which it can't. And many of these drugs, particularly anti-psychotics, have absolutely horrific side-effects and should never be given unless it is absolutely necessary - they certainly shouldn't be prioritised as the most important aspect of treatment.

IMO the physical equivalent of mental health problems is not some disease but frostbite. If you went to a doctor with frostbite they might examine you and discover that all the blood had left the extremities of your body and that they had gone black and died as a result, and reasonably conclude that you had some sort of terrible disease or physical disorder. However, he would be a pretty shit doctor if he didn't consider the environment in which this had happened, ie a very cold one, which the frostbite was your body's defense against. A health professional who views a mental health problem as a 'disease' with an organic cause and an organic cure without considering the environmental factors which may have caused the person's mind to behave in this way and the changes to their environment which might minimise the problem in future is guilty of similar oversight, in my view. However to speak of 'mental illness' encourages exactly this worldview.

Are you sure? Of course I'm not questioning your perception of how you feel/felt, rather your certainty that people without a diagnosis of depression feel completely different from you - how do you know this? I can certainly think of at least one period in my life when I met the DSM IV criteria for depression by having a number of the extra symptoms it requires over and above feeling shit ie insomnia, lack of appetite, no energy, anhedonia etc. It was related to working nights (the symptoms of depression are very similar to those of jet lag and one theory is that once depression interrupts your sleep pattern you start on a downward spiral of symptoms - you probably know all this). There wasn't a lot I could do with myself at the time and I did absolutely nothing other than go to work, get through it in a zombie-like state, go home and lie in bed unable to sleep. In the nicest possible way, who are you to say that what I felt like then was qualititively different from the way you feel?

This of course doesn't make me feel entitled to judge people who feel even worse than that (eg not even being able to make it in to work, feeling suicidal or whatever), because they are clearly undergoing a worse, more debilitating experience than I did. That doesn't mean that I think they have a 'disease' which i don't have though, or that their problems can be dealt with within a medical model (you seem to agree with me on that point, which is the essential question of this thread).

This is the criteria for schizophrenia:-

Clearly they don't all involve a split from reality, and neither do they share any other common theme, indeed number 3 often presents as pretty much the opposite of number 5. The only thing they have in common is that they are all experienced by people who have been diagnosed as having schizophrenia, a self fulfilling prophecy if ever there was one.

Clearly someone suffering from any number of these 'symptoms' has a problem, but there is no underlying disease process which causes all of them.

I don't think so, especially when you look at the connection between demonic possession, people being witches, etc that cultures around the world have, and which inevitably have been traced back to a mystification of what are brute psychological issues. This is not to imply western society is better, or deals with the problem necessarily in a more progressive way, but clearly mental illness has manifested itself in cultures throughout the ages.

That said, I would argue that the stresses and depredations of hierarchical society (be it Mayan, Egyptian,Confucian, or neo-liberal capitalism) seem to push people more and more to both a physical and mental exhaustion.

I would disagree with some on here who say that see the cause of mental illness as the society we live in, or at the very least exacerbates it, and don't acknowledge that that same society is the one who uses shuttles people in and out of a mental health system that has been turned into, not due to the efforts of the workers inside of it, into a glorified pill dispensing machine. Precious few psychiatrists view their job as simply dispensing medication, and forbidding pateitnts to go get therapy. Most recommend and actively work with therapists and others to assist people with problems.

Where things go wrong though, is that the psychiatrist is the easiest person in the chain to commodify. The psychologist, whose "results" are harder to quantify and measure, is considered useful, but wholly unable to fit into the "health investment" equations that many health systems operate by. Meanwhile, its very easy to keep track of and account for the psychiatrists pill dispensing, whether he can tick off a box saying the patient is "improved", stamping a form, and calling it a day.

I'd agree with this, but I'd add that the innapropriate application of the medical model to mental 'illness' exacerbates this problem. For example someone might be hearing voices telling them that other people hate them and want to kill them. Now studies have shown that when we talk to ourselves our speech muscles move imperceptibly - and that when a psychotic person hears voices, their speech muscles move in the same way. The hearing of voices seems highly likely to be simply the misattribution of your own inner voice, and is more likely to occur when in certain environments, under a lot of stress, hearing certain types of noise etc (just as these factors can affect anyone's judgement about what is or isn't real). Further work has been done into why these 'voices' might be saying paranoid things, this is also related to the person's experiences, environment etc and different delusions & hallucinations tend to occur in different parts of the world, and at different times in history (eg highly religious in content in the middle ages, very grandiose during the great depression and so on.)

Now rather than considering all of these and other factors properly a medical model would encourage us to simply say "He has schizophrenia". How do we know this? "Because he has some of the symptoms of schizophrenia." And what has caused these symptoms? "Schizophrenia". Circular thinking which would not be acceptable in any other area of healthcare, but which encourages the use of medication above all other interventions on the mistaken premise that these problems are caused by some underlying disease process (which noone has ever identified) just like any other disease, and that this must be somehow 'cured' before the person can get better. Any other types of therapy are just window dressing, if this model is followed logically (though I agree with you this isn't always the case).

Winrar.

I'd argue that excluding the medical model entirely can be equally problematic though.

I've had conversations with people for example who deny the existence of ADHD (a condition I used to suffer from when I was younger), on the grounds it's a medical condition (an imbalance of chemicals in the brain which can be 'cured' in some cases via balancing drugs such as Ritalin) in which the method of classification remains woefully inexact.

Now while there is no doubt that people are routinely marked off as ADHD when their actual problem is nothing of the sort, it is also very clear (certainly in my own experience) that it is a real condition which can be significantly affected by medical treatments. When I was given Ritalin it made a huge difference to my concentration levels and ability to self control. Although I stopped taking it due to unwanted side-effects, others have seen dramatic improvements.

At the moment, the medical sector is simply not very good at understanding how the human brain functions. It's the single most complex machine on earth and we're using the crude tool of powerful chemicals to try and deal with it - the equivalent of trying to fix a microchip with a big rock.

But to say the problem is simply this or that, that medical models are inherently inadequate or wrong, misses what should be the point that it works in some cases. Not in all, and it shouldn't be to the exclusion of other methods, but deriding it as an option is removing a tool which can be helpful.