I do a lot of "extracurricular" work, trying to help folks get back on their feet.
So, not academic. Personal.
> Because in the real world, the therapy method I have mostly seen, was and is keeping people calm with pills.
I consider that offensive. It's a fairly classic "strawman" argument that is used to "dehumanize" people that suffer from mental illness, and also dehumanize people trying to help them. I know many people that would be in very dire straits, if not for medication, therapy, and many years of hard work.
I'm pretty upset by this, and by the reactions.
I am not a therapist. Just someone with "skin in the game."
These aren't "data points." These are people, and chances are good that we all have folks in our orbit that have mental health issues.
The poster was simply providing their viewpoint on the state of mental health that differs from yours.
I understand these things can cause strong emotions, but you don't do yourself or your stance any favors by letting it get the best of you here.
Quite frankly, the pills work. A lot of people would unable to lead normal lives without them.
Sometimes they do and sometimes they don't. I had a seizure because of medication I was put on for a mental illness I didn't believe I had. I wasn't 18 and my parents essentially forced me to take them. The pills didn't do anything for me besides give me a seizure that easily could've killed me (I was hospitalized).
There's also actual research suggesting these pills can increase suicide attempts.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353604/
There is enormous money to be made suggesting these pills are useful, so I don't just assume it to be true. I also know many other people who feel anti-depressants ruined their lives. I also know many people who feel anti-depressants saved their lives.
It's not black and white. Personally, I feel the efficacy of pills for mental health are greatly exaggerated - but it's easy to see why I might be biased.
I don't know your personal journey, but I think it would be fairly easy to find people with very deep, very real mental health problems who fully believe they do not have a problem.
> The pills didn't do anything for me
Again, I don't know your personal journey, but as a counter anecdote when I started taking medication I couldn't tell if they were having any effect at all, but apparently it had such an effect that some of the people around me could tell me the day I started taking it, along with measurable improvements.
Not to invalidate your experiences, just adding to the anecdotal pool
A board certified doc will never prescribe placebo he will get sued, plenty of ppl are getting them via alternative medicine though
It's not "vague, personal anecdotes." It's real world experience.
But you are right. This is upsetting, and seeing the way that it is being treated by people that I respect, otherwise, is upsetting.
This is the last I'll say anything.
You're taking someone else's valid criticism of the state of the therapy methods available today and taking it personally as well as unwarrantedly attributing it to a lack of sympathy.
You fail to understand that the goal of criticizing the therapy method is precisely so we may find ways to improve it.
I consider that offensive"
You might also consider, that other people might have a "skin in the game", with close, intimate relationship to mental illnes patients, too. Some of them tragic.
And my experience simply is not, that in general psychotherapy evolved a lot. I see rather a trend to favor pills to keep people calm as this is cheaper, than deep psychoanalytical therapy.
So consider that offensive, if you must, downvote, if that makes you feel better, but it does not change my personal experience.
However, support for people with mental health problems is still severly underfunded. The improvements we have seen say as much about the terrible treatment of the past as they do about how well we are doing now.
Almost all studies I have read find that a combination of medication and other therapies provide for the best outcomes. Most people can only get funding for medication, which is often better than nothing, but it really falls short of what society could, relatively easily, provide.
It is really a tragedy, not just to the individuals suffering from mental health problems, but also to society as a whole which misses out from all the untapped productivity and creativity.
https://www.psychologytoday.com/us/blog/out-the-darkness/201...
You might have "skin in the game" but then it is depressing you do not know that almost all mentally ill people would in the long run be healthier without these pills. They mostly only work short-term and absolutely destroy ones health long term. You should be advocating for people to get short-term medically help and long term medicine-free therapeutic help if you really care.
Yes, for some people antipsychotics, antidepressants, etc. are a godsend and the difference between living a mostly normal and productive life vs. jumping off a bridge, dying in a homeless encampment because they cannot feed themselves, or committing violent acts against others. To clarify, none of these are hyperbole or exaggeration -- those are two extremes on outcome with mental health issues and antipsychotics can be the difference between the two.
That being said, many, if not most, physicians I have worked with agree with the parent comment. For many patients these medications are not effective and are used as chemical restraints [0] rather than with the goal of normalizing their mental health. Eventually the logic becomes "we'll never fix them, but we can sedate them so much they won't hurt themselves or others" so dosages progressively increase until the patient becomes more sedated and somewhat zombie like. This isn't hospital specific; I have seen it across 3-4 different hospitals in different states. Neuroscience and psychiatry is a very young field and the truth is that we do not know what causes mental health issues or how to deal with them. The chemical imbalance theory is just that, a theory, and more importantly, one with very little scientific proof and backing [1].
[0] https://www.medicinenet.com/what_is_an_example_of_chemical_r... [1] https://www.healthline.com/health/chemical-imbalance-in-the-...
Serotonin you may say? Okay, how much is the correct amount of serotonin then? Can you just give me a test to see if I have the right amount?
What’s going on here is not quantifiable science. It’s throw something at the wall and see what sticks.
Yes, modern medicine has a large component of throwing stuff at the wall to see if it sticks.
If it sticks, and it passes all the usual clinical trials to prove it does more good than harm, it's approved, even if we don't understand exactly why it works.
For the record, the treatment plan my cardiologist put me on was explained as "all these things seem correlated with not having heart attacks so we'll just do them all and hope it helps you".
Yes basically throw something at the wall and hoping it stick.
These people are fighting for their lives, and are taken advantage of by an industry. It also doesn't help that plenty of antipsychotics are crucial for people to take, but that's because those are drugs that actually make it difficult to think for people whose thoughts get out of control. They don't claim to be eradicating the chemicals or deficiencies of chemicals that cause all psychosis.
The tactic of pharmaceutical companies creating patients' groups to get sufferers together and lobby "on their behalf" has been going on since the 80s. It's bulletproof, and impossible to attack. In the case of antidepressants, they've also guided them into defending these drugs as a class, rather than on an individual basis.
Funded patients' groups also played a huge part in the prescription opiate epidemic; it doesn't matter how much science says that long-term opiates aren't helping chronic pain, you have to be heartless to dismiss someone with a known painful condition or injury when they're pleading for opiates. Even though you know that people who had nothing wrong with them before going on opiates would plead just as intensely.
On another note, there is one thing you are absolutely incorrect about: antipsychotics are not ineffective managing many mental health disorders. Large clinical trials are done before these drugs are even approved for the sole purpose of proving they are better than no treatment.
> Suicide rates ... are skyrocketing.
I'm confused. You seem to be suggesting that having more conversations about mental health is to blame for an increase of people committing suicide.
This is the exact opposite of my lived experience.
Conversations about my mental health and my problems are why I'm alive (and have no intention of taking my own life) today.
If you have a different lived experience, then fair enough.
But I'd respectfully suggest to take care painting with such a wide, sweeping brush next time. Life ain't binary. Especially when it comes to mental health.
I do not see him suggesting that. He was suggesting that "labeling" more and more people as mentally ill might cause more bad, than good.
Allmost everybody has psychological problems. And yes, it is very important to be able to speak about it openly. But it is a different thing to have "mental problems", or to have a "medical mental condition".
It's also probably not possible to convince the government to let doctors prescribe potentially mind altering drugs to people unless they say the people taking drugs are "ill" and the doctors are treating the "illness".
So yes I'd say there is a push to label people as ill.
I feel like back in the day - our grandparents, or their grandparents, perhaps you'd see men who didn't want to go to the doctor.
Now it is completely normal and expected to get a yearly physical. IMHO we all should be getting a yearly "mental", as well (with a psychologist, not a psychiatrist), and it should be both normal and expected.
You obviously aren't concerned that the "professional brain jargon talking person" will make things worse. I know from experience they sometimes do.
I don't trust mental health professionals nearly as much as you do.
I'm sure you can think of different social developments that relate to this too if you're a hardline "you are responsible for your own situation" capitalist without much thought given to individual privilege. There's plenty of others. Let's take social media incentivizing only sharing positive things, leading to bias when comparing your situation to others, for instance.
The current system is a band aid on top of structural issues, nothing else. No amount of CBT and SSRIs can fix these.
the labels are a form of victim-blaming.
Bipolar disorder, clinical depression / major depressive issues, etc.
Plus, since each "band aid" in this case is a human life - a person who may then be able to go on to help others and reform the system, I'm definitely a fan of pursuing both avenues at the same time.
But still, my point is I don't believe 100% of mental health issues have the dysfunctions in our society as their root cause.
Which isn't to say that some do and that it's not a big deal - it is.
Not globally. A search suggests suicide rates are down 15% in 10 years. That is, suicides have gone down remarkably.
If we're talking about the UK/US (which I haven't sourced but I can believe), it's more likely that conservative policies are driving people to feel they have no alternative.
I dunno, in most common diseases going around right now the solution is to treat people with pills. How is depression any different?
Secondly: a bacteria infection and the treatment with antibiotic is very well understood - and is actually solving the issue.
The brain is not at all understood. Lifting peoples mood with drugs is not solving, why they were constant unhappy in the first place.
Still, we have only the faintest idea of how the mind truly works.
CBT is great and I personally benefited from it, but it's not a recent phenomenon and its effectiveness is very hard to evaluate. There was a meta-study analysis in 2015 that pointed at a decline in its effectiveness between 1977 and 2014. I wonder whether it's because studying anything to do with a human brain is hard and we can't trust the numbers or if it's because of changes in society that caused people's personality to shift in a direction which makes CBT less effective.
Autism and schizophrenia were differentiated in 1980, so that's not in the last 2 decades.
Homosexuality stopped being a mental illness in 1973 (or 1987 if you include sexual orientation disturbance), so that's not in the last 2 decades. This was a great success, there were studies that pointed at a marked decrease in suicides among people in same-sex relationship over time.
Gender Identity Disorder stopped being a mental illness in 2013 but I think the issue has been politicised and the outcome doesn't necessarily make a lot of sense. I can bring a personal anecdote from a friend of mine who started using a female name for a period and wanted to perform a reaffirmation surgery, who later changed his mind.
- Most kids who experience gender dysphoria before puberty grow out of it.
- Suicide rates are high even after reaffirmation surgery and even in western societies, which are accepting of transgenders. Moreover, if discrimination was the cause of suicide rates, I think we would see a high suicide rate in minorities. There is way more discrimination towards people of color than towards transgender.
- If Gender Identity Disorder is not a mental illness, shouldn't we be consistent and label Body Integrity Dysphoria (aka people who believe they're amputee) as diversity and approve of cutting off of healthy limbs?
I'm skeptical on including this as a win for the field.
And while it's progress for psychology itself, and good for society, it's certainly not an achievement. People were killing themselves and being institutionalized because psychologists were calling them insane, and this stopped happening when psychology chose to stop calling them insane. I can't claim an important discovery in abuse prevention if I choose to stop abusing someone.
Another theory is that methodology doesn’t matter and the result mostly depends on personal qualities of the psychiatrist. And CBT was effective because the best specialists adopted it. When the rest of the profession caught up effectiveness went down.
Depends on your country. The WHO's ICD-9 document, published in 1977, still included homosexuality as a disease. It was removed in ICD-10, but it was only published in 1990. Countries adopted it in the 1990s and early 2000s. Germany belongs to the group which adopted it in the 2000s. So yes, it happened in the last 20 years.
The discussion about 2decades seems to about accepted academic outcome not policy execution, which is always varied.
FGM or homeopathy or chinese medicine is still a problem in many parts of the world. We don't think validaty of science or anatomy depends on your country.
ICD-10 could be one unambiguous way to classify.
2) Transgender people do not have the legal protections that people of color do. There have only recently been laws to protect transgender people to be employed, have healthcare, etc. on the federal level- and what protections exist can be easily stripped away due to "moral disagreement" of the employer. You cannot refuse as an employer to give a black woman healthcare because you have a "moral disagreement" with her being black.
Personally I am not convinced about that. Or do you mean that from an academic perspective?
Because in the real world, the therapy method I have mostly seen, was and is keeping people calm with pills.