to wonder if we have all become mentally ill?

[Alameda]

(and for slightly stalking this blogger)

but can 1 in 2 Americans really have a mental illness? have slightly vested interest in this because would quite like my own mental disorder to be somehow integral to society rather than there actually be something wrong with me

psychopathology of american life

pointythings your field sounds really interesting are there really no definite pointers either way yet in terms of the nature/nurture component of mental illness? I'm really interested in the causes of mental illness, especially where there seems to be a pattern in the family.

only kidding, Alameda!

Interesting how we insist we are individuals who have the power to bend the universe to our will, yet we still have an inate need for support on the quiet. It's expensive, anyway (priests/parents/family were free).

I really don't think, or see, that 'a lot of people recognise that closure is not always possible' though pointy??

I am pleased to see such a lively discussion generated from my article. My argument is that this mass profliferation of what gets labelled as mental illness is not something that is new but has been going on for a century. Psychiatrists wanted to escape the asylums to which they were confined to and work in the community, with private practices, and psychotherapy allowed them to do so, but this required a shift in focus in the sorts of problems they dealt with to more minor problems, and it was in the interests of the profession to convince people they were ill.

As a mental health professional myself I provide psychotherapy, prescribe antidepressants, antipsychotics etc and these treatments have some indications. My contention is some sectors of the mental health industry flourished and profit from convincing people that they are ill, or in need of counselling or medication, when they do not in fact. The threshold for the sorts of problems and emotions that we are expected to seek professional help has lowered. This in itself would be fine if our treatments actually helped, but we often to more harm than good for people with social ills, common unhappiness, misery that is not best described and managed as mental illness.

Alameda is sort of right, the 'chemical imbalance' notion is a marketing rather than medical term, and most doctors do not use this term anymore. In my training we not once are told that mental illnesses are due to chemical imbalances, as this is not only an oversimplification but is just not true. There is not a jot of evidence to support this. It just makes it more palatable to individuals who are prescribed medications to have this explanation the drugs are correcting 'chemical imbalances'. I use medications to treat my patients when I believe they may be of benefit, but I don't pretend I know how they work and it doesn't matter to me I just want to help my patients with whatever works best. We learn about the mechanism of action of medications and talking treatments, and the neurobiology of mental illness, but this notion of mental illnesses as being due to 'chemical imbalances' is simply misleading.

Even if mental illnesses were associated with a chemical imbalance, the real question is what causes this chemical imbalance? For example in schizophrenia, brain imaging studies show increased release of dopamine in a part of the brain involved in emotion and thinking (the mesolimbic system). But what is responsible for this? By reducing complex thoughts and feelings to a neurochemical soup we end up dodging the real issues and complexities of mental health problems, and the minor misery and disaffection that permeate our society.

I won't harp on about the counselling industry now, but be sure I will be writing about though very shortly :o

Priests were only free in the sense that everybody had to pay tithes whether they got any support from the priest or not.

why am I only 'sort of' right? do you mean to be so invalidating?

I had always seen it that a general mood malaise (depression) has a lot to do with thinking patterns ie negative churning thoughts consistently firing the adrenalin impulse, which gets used to pumping uninhibited; in turn reducing feelgood brain chemicals, 'tricking' them into inaction. tis the reason for the surprising (cheap) success of eg CBT, which addresses negative thinking patterns. I had thought that eg SSRIs boost the 'uptake' mechanism of 'feelgood' brain chemicals, getting them 'firing' again.

brave to post that and, clearly, not a medic.

and I'm talking general malaise/misery, not the big boys eg 'proper' mental illness (schizophrenia etc).

Not that I'm suggesting that depression is not a 'big boy' though!

re it's all lumped in together (as a pp mentioned) re 'mild' depression (anything but mild if you have it!) and eg paranoid schizophrenia. All comes under the MH umbrella (probably why people are generally terrified to be associated with mental illness...)

Interestingly CBT doesn't actually make people tink more positively or effectively challenge negative thinking. People who have CBT think just as negatively and have just as many dysfunctional attitudes as before. So it looks like CBT works is other ways - one way is through the behaviour part of it - behavior activation. The tasking activities could be what helps people lift out their depression. Certainly there is no difference between the outcomes for behavior therapy alone compared to cognitive behaviour therapy suggesting you don't need the 'cognitive bit'. A second theory is that CBT changes metacognition - or the way you think and respond to your thoughts. People who experience depression appear to respond more profoundly to the minor negative thoughts that pop into all our heads, and it could be that CBT activates metacognition that stops people responding to negative thoughts with a depressed mood, even though they have as many of them. A final theory is it has nothing to do with the technique or modality, but the power of a meaningful relationship with another human being, someone who gives you the time and space to explore how you feel, the hope that you can get better, and the belief you are worth much more than you believe. The reality we don't really know how these treatments work, but we have an idea of how they DON'T work.

Alameda why am I only 'sort of' right? hmm do you mean to be so invalidating?

Ah the therapeutic culture strikes again! maybe you should have some therapy to help in your search for validation?

Behaviour activation is what does it for my dd: she needs to stop negative thoughts before her muscles tense up and go into spasm as that is part of her physical condition- and then being in pain and not being able to get up leads to depressive thoughts. So anything that can stop the process at stage 1 is essential. CBT works quite well for that- though it has to be said that it was only after several weeks of Prozac that she was able to actually implement any of the CBT techniques she had been taught; before that, her anxiety levels were just too high.

oh ha ha, did you miss the bit where I said although nobody is too well to benefit from therapy some (ie me) are too ill

you can have that quote for free if you like

woh, are things getting uneasy here - don't frighten me now!

I should've thought answering the q would have been helpful tbh canard. instead of doing that tennis thing. Therapists eh

Isn't the US approach very much dictated by the DSM-IV for diagnoses so there is a vested financial interest in diagnosing people with MH conditions? Basically if it's defined in the DSM-IV (a catalogue of psychiatric conditions) it can be claimed for under health insurance and back in 2000 when DSM-IV was put together by the American Psychiatric Association just over half of the psychiatrists responsible for deciding on definitions of "new" conditions were financially tied to pharmaceutical companies - thus compromising their independence and a direct conflict of interest for a fair few - one big loop of self-financing, with psychiatrists creating demand by definition and feeding supply.

You are absolutely right. As i describe in the extract, when I was a naive student I did not realise I would have to make a diagnosis of 'mood disorder' in someone who did not have a mental disorder, but it was the only way the hospital would be reimbursed. Interestingly, the DSM-IV does allow you to code for 'no diagnosis' but you will not get much/any money for that. By contrast, the ICD-10 the diagnostic system used in the UK has no such code for 'no diagnosis' - which is to say there is no provision to code for someone who does not have a mental illness! It's no better in the UK. What a lot of people don't realize is even NHS hospitals get paid for making diagnoses, ordering investigations etc. by the PCTs. So even in the UK there is a financial incentive to make diagnoses and to make diagnoses which allow you to bill more. It's a broken system, but it's a whole other discussion on how we should finance the healthcare system.

Alameda - I was gobsmacked at your line in your OP about wanting to have a mental illness so you could integrate better.

As someone who has a mental illness - depression - I find that hugely offensive. Mental illness isn't a fashion accessory, and I wouldn't wish depression on anyone - it has blighted most of my life.

Looking back, I became depressed when I was bullied at school as a teenager, and my parents dismissed the issue and did nothing about it. I was suicidal by the age of 14 - but it wasn't until someone told me, 3 years ago, that it is not usual for 14 year olds to be suicidal, that I realised that this was when my depression started.

I am on antidepressants - I wish I wasn't - I hate the fact that I can't function without the medication (sometimes I feel I am measuring out my life one white tablet at a time), but when I tried to come (very gradually and under my gp's supervision) off the tablets last year, I went into another deep depression. I can't count the number of times I have felt suicidal. The tablets bring me up to a slightly better level - one where I may be able to make some use of the psychotherapy group I attend weekly.

It's still a shit way to live though. I do not like myself, I have no self esteem and little confidence (though I can put on a very good mask of confidence when I need it), it has affected my marriage, my experience of being a mother - and I worry that I have adversely affected my children too. I just thank heaven that there has been some help outwith the home for me (antidepressants etc), otherwise I am sure I would have damaged the children - so relying on 'family' might have helped me, but at what cost to them??

You can have my depression if you want it.

it's ok thanks, have a severe mental disorder of my own

SDTGisAnEvilWolefGenius - Alameda - I was gobsmacked at your line in your OP about wanting to have a mental illness so you could integrate better.

That's not what OP said. She said:

have slightly vested interest in this because would quite like my own mental disorder to be somehow integral to society rather than there actually be something wrong with me

you must have only half-read my posts?

Ah - I misread - sorry. I read it as saying that having your own mental disorder would make you integral to society. I did read it twice, but made the same mistake both times.

Again, apologies.

we could have a competition though and see who spends most time in hospital every year, who takes the most horrible antipsychotics and oh I cant be bothered!

is ok :)

Phew, glad that got cleared up! Very interesting OP Alameda, thank you!

glad you found it interesting

I should probably try to express myself a bit more clearly and a bit less chippily - would this be better in mental health do you think? Could ask MMHQ

Possibly, but obviously traffic is greater here. It's up to you

Maybe both? Might be worth a try?

maybe not, I think of the MH bit as a support area rather than a discussion around the issues sort of thing