RE: Hyperinflation of mental diseases - The way we people see ourselves?
Oh, Erika, it is apparent that not only your work, but your life experience has influenced this long reflection on mental illness. As you probably remember, I taught at a school where every student carried a psychiatric diagnosis. So, this is a subject I have considered many times.
As I read your piece, particularly those areas that address individuals who are distinct from a group, I thought of all the 'witches' that were burned throughout history. In many cases these people were just 'different' in a way that troubled those around them.
I thought of the 'snake pits' in which those diagnosed as insane were confined, sometimes for their whole lives.
And I though of Thomas Szasz, who suggested mental illness might just be a bureaucratic construct.
I thought especially of the Rosenhan study, in which undercover investigators convinced psychiatrists to admit them to an institution for 'treatment'.
It is clear to me that the DSM, to a large extent, exists to justify payments from insurance companies and government agencies. In order to receive compensation for 'treatment' of a patient, the provider needs a diagnostic code. The more codes there are, the more possibilities there are for treatment justification.
Despite this cynical perspective on the DSM, I have to assert that mental illness does exist. What is that? If someone cannot cope with everyday responsibilities, if there is a sense of anguish--then intervention by the medical community might be appropriate. Unfortunately, a clear understanding of how to diagnose and treat mental illness does not exist.
I"m with Dr. Insel--hard science needs to buttress the soft science of psychiatry. We need to understand the biological basis (what is actually going on in the brain when a person can't cope) while never ignoring the subjective experience of someone who is suffering.
Thank you for coming and the link drops, I will have a look at them:)
Yes, without a doubt there are mental disorders.
I know an old lady who took care of her husband for all her life. He was mentally poor, a silent, unintelligent man who would not have survived alone. This woman, to whom in our modern world one would undoubtedly acknowledge her great sacrifice, who acted as protector and commander of her husband, does not have a bad life when asked (her man, incidentally, did not take psychotropic drugs).
For these particular cases, when a man is unable to carry out his duties, mankind has created a huge arsenal, an industry, research and funding. So that, in the event of the worst case, we have a way of helping people who are so incapable of living. I know of few families in which a member has such a serious personality disorder that one must assume total incapacity for life.
We have taken precautions for a minority. Of course, it would be an economic miscalculation for this small part of the population to make such an effort, and so it (inevitably?) happens that milder cases of incapacity and inappropriateness serve the dominant dimension of a helper culture that earns its living. The babbling imbecile, physically and mentally disturbed, who cannot feed himself, dress himself, wash himself: this is less frequent. But it was for these cases in the first place that people stood up to research, help and find causes. Which makes sense.
However, a research institution needs purpose because the few in number are not economically interesting. We recognize that this medical industry has already taken up space and has become too big to fall, so to speak.
The hunt for the cure for an illness will never have a final end, because things are permanently intertwined as causes and effects and what causes healing or improvement on the one hand, causes aggravation and illness on the other hand - often with delays and unforeseen. No matter whether one takes the biological approach or the soft sciences make an effort.
Diseases are like dishes. If you have just finished washing one dish, the next is already waiting.
Apart from that, I am interested in finding answers and personal decision-making aids that combine science and philosophy plus wisdom.
I am so much in sympathy with your point of view, while not being in complete agreement. I only worked at my school ( for adolescents with psychiatric illness) for 8 years, but that was enough time to become thoroughly acquainted with issues related to mental illness. My feeling eventually grew to be that many of the students needed to be where they were mostly because they required a rest from the pressures of life. The school gave them a chance to grow in peace. It seemed to me, however, that by being grouped with others who were diagnosed with mental illness, there was almost an incentive to be mentally ill. After all, they were all adolescents. The inclination toward group identification is very strong at that age. So, in a way, their protective environment worked to exaggerate symptoms.
Of course, there's no easy solution to the question of mental illness. Always we want to help people who are suffering. We want to save lives--depression kills and that's a fact. Yet, it is not helpful to pathologize symptoms of distress that arise from ordinary circumstances. @abigail-dantes, I believe addressed this when she looked at the difference between circumstantial depression (grief at the loss of a loved one) and clinical depression.
You raise many important points in this blog. It was a good read and obviously one that prompted me to think.
As much as I appreciate disagreement, since it often points me to things I don't necessarily encounter myself, I don't recognize where you contradict me?
I see it just like you do.
I have drawn this very long arc in my article to make it clear that the ever-increasing concern with mental illness, the technologicalisation and industrialisation of medicine are producing their own psychological and social blossoms, which - because in the communities, due to gainful employment, people are not sufficiently available and people feel isolated as a result, for example, can trigger depression.
Thus what helps on the one hand is what causes suffering on the other. To put it briefly: from a tribal society, to an agrarian society, to an extended family, nuclear family and single households, where the feeling of security through a familiar group (relevant in familiarity, number and diversity) is missing. I remember the concept of "anonymity", which I first heard in my childhood and which somehow already appeared to me at that time as something existing.
I agree with you about your experience with the students. I see the protection and intermission time that people need as a necessity, but just like you I also see the tendency that people who are among their equals are beginning to take advantage of this status and it is a balancing act for all pedagogues and other practitioners not to comply with it. Depression is by no means a disease in which you are no longer in control of your senses. You can read, write, calculate, give rational answers and ask reasonable questions, you are mobile and able to go from A to B alone. Depression sufferers absolutely need physical activity, physical touch, a good daily structure in which they have a duty, tasks in the company of others and a positive prospect of improvement.
Unfortunately, next to what works and helps, I also experience that those who work with the diagnosed people are also involved in increasing helplessness/illness without knowing it. You have to be hellishly careful not to get carried away as a helper in exaggerating your role and promoting unconscious dependency (guess you can confirm that?). In my opinion this requires years of practice and work with people and constant reflection and work on one's own affairs.
I have been doing my work for about seven years and have advised well over one thousand clients during this time (poor ones who were my beginner clients:). In every difficult case I sought the advice of colleagues, exchanged with my confidants and read a lot and reflected inwardly. I am a practitioner through and through. In addition a quite strong follower of systemics (which is also somehow engaged to parts of Asian philosophy). I don't want to say too much, but I was also on the other side and am familiar with the clinical.
If you browse through my article again, you may notice this passage that is consistent with what you mention in Abis's former article:
I think my position does not necessarily reach the dimension of contradiction, but rather one of degree. I do give greater latitude I think toward acceptance of mental illness as a defined condition and treatment as a necessary intervention, sometimes. I think I would allow for more conditions to be treated than you might. My own experience with students was instructive.
I was always skeptical of ADHD as a diagnosis--saw it more as an attempt to control unruly students. Then I had a girl in my class--quite unruly. More than that, simply unsettled, in and out of school. I had her for a couple of years. In the third year she was prescribed medication specifically for ADHD. The girl was suddenly at peace. She was at least 16 by that time, close to graduation, and yet this intervention allowed her to study, finish her requirements and simply be more comfortable in her own skin. It was an amazing transformation, not one I appreciated because it made my life easier as a teacher, but one I appreciated because it made the student's life easier.
There was another student who was very smart, very sociable, very agreeable. Unfortunately, she had a little chemical imbalance and from time to time this would assert itself. One episode forced her to discontinue her studies and go for intensive therapy and drug intervention. She was diagnosed as bipolar (this had been previously diagnosed). That's a name, a diagnosis, that allows certain treatment. In her case, it worked. She recovered and went on to a successful university career, but her acceptance of this chemical issue, and willingness to treat it, would be necessary for the rest of her life.
There are so many examples--I'll stop here. I wish psychiatry was more science-based. I wish psychiatrists really understood why their interventions work, and don't work. I don't think they do. But sometimes it's all we have.
I think your blog is great. You raise a number of issues others are not willing to address. That takes courage. Shining the light on any topic can only serve to inform and advance discussion.
Oh, I see! :)
It's true, my willingness to allow more diagnoses - especially those of mild form to medicalize - is actually more limited to yours if that's what you're saying. I think everyone has their role and mission in life and mine is that I am very critical of what is generally postulated to be successful and subsequently exaggerated. Thank you for addressing the point. As far as acute need is concerned, I have nothing against medication. It satisfies the distress and is a bridge to use a calm mind again. But if people don't also come to encourage someone, trust him, then the drugs are often not as promising as one would like them to be. You know cases where you describe it positively, I know cases where I describe it negatively. The thing is: you can agree with both of us, we speak from our subjective experiences and preferences. The subjective element in each of us may be there, has its justification. You are basically at an advantage with your greater tolerance;-) because you will agree with me that we live in a world where swallowing pills is made very easy and already happens frivolously. Among other treatments and methods that the biological approach pursues and is far more productive than the psychological one. Since I don't think this scene needs much defense, since the lobby is very strong anyway, I take a counter-position that is needed in my eyes.
Sometimes science is not the final conclusion and outside of it there are possibilities and insights of a very special kind.
Have a good day, I'm going to bed now. Tomorrow the twins have their birthday and I'm off on my journey again.
edit:
Through systemic teaching and what I learned there, I have had surprising experiences working with people for myself. The resource-orientated one in revealing the accustomed helplessness and the learned mistrust of oneself as a mental construct without imposing anything on people, quite simply by encouraging the good and strong qualities of another, is a good deed. I love my work and value it very much. A lot of time and patience is sometimes such a fantastic medicine.
One-on-one work is not even so unusual here, because more and more people find their livelihood in the niches between patients and doctors/therapists, schools and parents, offices and beneficiaries, couples and courts. Here in our country there are countless counselling centres in the public sector.
Of course, it is very badly paid and my fee is a joke. But I don't mind that much. I like to do that and want to live off it and be able to afford something from time to time. I am much freer and more independent than the people in the clinics or the permanent employees in the facilities. In all my life I have never been able to work so freely and enjoy so much trust from my customers (the institutes that commission me).
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HaHa, thanx, I will give it to my brothers.
Hug for you!
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