Why I Am Not Anti-Psychiatry

I am scared of psychiatrists.  In fact, my lovely GP excepted, I am generally scared of medical doctors full-stop.  I think that quite a few are incompetent, overpaid megalomaniacs who become disillusioned with the personnel necessarily involved in their chosen career all too quickly, and whose over-the-top professional cynicism grossly deters patients from seeing them to the point where it could be dangerous.

But I am not anti-psychiatry.  In fact, I find some of the claims and terminology bandied about by the anti-psychiatry lobby to be, by turns, hilarious and personally insulting.

Psychiatry is Just a Pseudo-Science!

But of course it’s a pseudo-science.  All science, to an extent at least, is pseudo in that parts of it will have tenets that are based on ‘mere’ theory as opposed to proven, demonstrable results, and psychiatry is no different.  I believe some parts of it can be proven – more on this later – but on the parts that cannot be, or have not yet been, the discipline is no different from any other hard science out there.

Furthermore, psychiatrists themselves will be the first to admit that their particular brand of medicine is not perfect, at least in part because neuroscience is still so poorly understood.

Indeed, would you dismiss the discipline of neuroscience itself merely because it’s investigative and highly speculative?  What about astronomy, cosmology?  Marine biology?  Even human biology to some extent – let’s say stem cell technology.  Clearly a promising field of medicinal investigation, but still very much at a preliminary stage.  Quantum physics has not yet produced a unified and complete theory of everything – do we dismiss it with such ease?

Point: psychiatry is like every science – it seeks to investigate issues through testing and examination with a view to obtaining results that back up or discredit existing theories.  It is dealing with the mind, which is housed in the brain – a poorly understood organ, even now – and, moreover, it is dealing with the unpredictability that is people.  These things, quite probably, make it imperfect, but that does not make its contribution to medicine and to patients invalid and contrived.

It’s a Big Pharma Conspiracy!

On this one, I believe there is a difference between the USA and the UK.  Certainly so-called ‘Big Pharma’ markets its drugs to the NHS, which is then co-funded by prescription charges (where applicable) and those paying national insurance, but individual patients here do not pay in the more traditional sense.

Currently prescriptions are free of charge to everyone in Northern Ireland, though I don’t believe that this applies to the rest of the UK.  Even where prescription charges do apply, they’re something like £7, which – relative to the overall price of the drugs, anyway – is fuck all really.  The point I’m making here is that this means that, for the most part, the NHS has to fund psychiatric (and other) prescriptions.

Anyone who’s followed my story of my battle with the fucking Trust will know that the NHS is completely obsessed with finances and cost-saving, to the point where it frankly endangers the lives of many.  To that end, in my experience, they simply will not prescribe you expensive drugs unless they feel strongly that they are necessary.

As an anecdotal aside, with no disrespect meant to anyone, I personally believe that most British and Irish NHS doctors/buyers are far too cynical to fall for ‘Big Pharma’ bullshit in the first place, unless they see a clear link between Drug A and Improvement.

Point: the ‘Big Pharma’ conspiracy may or may not have weight in some parts of the world, but I think it’s applicability is very limited in this jurisdiction.

Psychiatric Medication is a Form of Social Control…!

I got lambasted on Facebook the other day for making a remark criticising censorship but defending medication.  Apparently all psychiatric medication does is act as a tool of censorship.  “Take the meds like a good little girl – either that or stop banging on about censorship,” the woman ranted hysterically, as if Facebook had newly developed into a dystopian A Clockwork Orange-like world of indoctrination by medicine.

Riiiiiight. I have been taking some form of psychiatric medication since I was 14 – that’s nearly 13 years, and nearly half my life.  I do remember what things were like before it, however – both the good and the bad.  My experience has been that what medication has done for me personally, the stuff that works anyway, is to help me become more like the person I was before mental illness (which apparently isn’t real – that one in a minute!) struck me with the force that it did as a teenager.  It brings me back to some semblance of what I used to perceive as ‘normality’.

I have not become some vapid, compliant, brain-dead bitch because I have taken it – far from it.  In fact, the opposite is true – in general, I am fiercely anti-authoritarian, I am extremely intelligent and because of psychiatric medication I was able to get through school and get myself two degrees.  Anyone who has read this blog should surely to be able to attest to the fact that I am not at all under the influence of some sort of evil tool of social control.  If you think that I am then sorry, but I’m not the delusional one here.  Kindly fuck off.

If you think that I am simply an anomaly, please go and speak to the hundreds of other mental health bloggers, Twitterers and Facebook users out there who take psychiatric medication and are not some degraded servants of the big, bad state.

To be fair, I recognise that particularly strong medication such as Haloperidol can turn individuals into drivelling nobodies devoid of any personality and moral agency, and I agree that use of such drugs is appalling – in general.  If someone is in imminent danger of being violent, though, I can see the need for such tranquilisers.  I think it’s horrific, but I think that it can be – on occasion – a necessity.

I can’t speak for other parts of the world, and in fact I can’t speak from experience either as I’ve never been a psychiatric inpatient, but I really believe that in the vast majority of cases, the hideous days where One Flew Over the Cuckoo’s Nest was a daily grim reality are gone from UK medicine.  People are only forcibly drugged to such grotesque extents when there is a clear and imminent need for it.

Point:  psychiatric medications are only used for ‘control’ purposes when there is some sort of utilitarian reason, such as a need to protect a number of people from violence.  Otherwise it’s merely there to treat illnesses, and is offered to people, not forced upon them.

…No, wait!  It’s Not Social Control, It’s Just Placebo.  That’s What I Meant.

So what if it is?  It isn’t, but so what if it was?  A placebo effect is still an effect.

Anyway, I beg to differ; I quite simply would not be alive but for Fluoxetine and Quetiapine.  But why listen to me – I’m just the indoctrinated fuckwit who is compliant with the evil medics and who erroneously just thinks she’s experiencing a beneficial modification in brain chemistry.

Since I am no longer taking Fluoxetine, I’ll concentrate on Quetiapine here:

Study One
Study Two
Study Three

You might also be interested in taking a gander through Neuroskeptic’s neuroscientific archives.

For the sake of brevity (insofar as I am capable thereof), that’s all I’m going to include here for now, but feel free to ask me for further studies should you wish to do so.

*ponders*

Augh, screw it.  Here’s one I liked on Fluoxetine (specifically on how it works) after all.  Now I’m done.

A friend of mine recommended I read a book called The Chemical Cure dealing with the supposed myths of the benefits of psychiatric medication.  I intend to do so, but one criticism I have of the book before even having picked it up is the inference that medicine purports to be a ‘cure’.  It isn’t a cure.  Medication is nothing more than managerial, so the terminology is, I feel, misleading.

In a case like mine, where it can be reasonably argued whether correctly or otherwise that a mental illness is induced psycho-socially, medication can make things less bad, but if the disorder(s) can be cured (and I am not convinced of that), then it is only through proper, individualised psychotherapy.  Just because medication is not a cure, though, does not mean that it is necessarily unhelpful.

In a case where one can reasonably argue that the illness is more organic in nature – and I know supporters of anti-psychiatry dismiss that as a possibility, but indulge me for a minute – medication specifically doesn’t claim to be able to cure; it is prescribed for the management of the disorder in question.  Maybe people can be ‘cured’ of things like schizophrenia, and maybe they can’t.  For now, though, the most provably effective management of such an illness is medication, in conjunction with therapy that helps the sufferer manage specific symptoms when entering or when in ‘an episode’.

Point: medication is imperfect, but for many it is very helpful.

But the Side Effects!  They’re so Insidious and Evil, and You Weren’t Given All the Facts About Them!

I find this an incredibly insulting argument.  Of course I know about the fucking side effects.  I know they suck arse.  I don’t like them and I don’t want them.  I did, however, know about them.

Just because I am mental does not make me incapable of reading, asking questions or weighing up the pros and cons when making a major decision.  I know that both Quetiapine and Venlafaxine, my current medications, are some of the most horrible tablets side-effects wise that are out there.  Nevertheless, I made the decision, based on all the information, to act on my consultant’s advice and take these drugs, because on balance I hoped and believed that their positive indicated effects would outweigh their negative side effects.

This has, indeed, been the case.

Point: don’t insult our intelligences, please.  We have mental health problems, not IQs of -7,293.  Even in the unlikely event that our psychiatrists or GPs don’t tell us about the nasty side effects, we can very easily find them out for ourselves, then weigh up whether or not we feel the bad outweighs the good.

Mental ‘Illnesses’ Aren’t Even Real!  Stop Pathologising Our Humanity!

I actually find this one hilarious, because it is so far removed from most people’s experiences of mental ill health that it’s absurd.

  • Person dies.  Person left behind is depressed.  That’s humanity.  Fair enough.
  • Person gets raped, person develops depression.  That’s humanity.  Fair enough.

In both of the aforesaid, it’s certainly arguable that no mental illness is present.  Nevertheless, it doesn’t mean that psychiatric intervention is a necessarily evil thing.  It doesn’t mean it’s a good thing either.  It’s an individual matter.

Now then…

  • Person gets raped.  Person dissociates (a human coping mechanism, arguably).  Person is fine for years.  Then person develops severe anxiety, depression, yadda yadda.  Person starts self-harming as way to cope and tries to kill his/herself.  Person becomes volatile to be around and enters fugue states randomly.  Person may hallucinate and/or experience delusions.
  • Person has no known issues of trauma.  One day when person is 25 (s)he starts seeing/hearing talking settees on his/her route to work, and eventually befriends them.  Person starts to believe that (s)he is God’s personification on Earth and talks to Jesus, who can be heard (but not seen) by person but not by person’s friend.

Whether trauma is or isn’t present, how such extreme examples can just be seen as ‘just’ humanity is frankly beyond my comprehension and – at the risk of sounding arrogant, I have a high IQ and can see most viewpoints on most things, regardless of whether or not I agree with them.  Arguably there is a sliding scale between a ‘normal’ reaction to something and an ‘extreme’ one – but therein lies a notable point: if a reaction is extreme enough to cause significant and enduring psychological distress, then it is evidently extreme enough to warrant treatment.

Humanity is a very individual concept, and what is ‘normal’ for one person is obviously not necessarily so for another.  Additionally, we all suffer mentally to some extent or another at times in our lives, and would be inhuman if we did not.  Nevertheless, where our ‘humanity’ is exmplified by extreme behaviour and mental agony, help is clearly needed for us.  Psychiatry can, through the process of conceptualising symptoms and possibly prescribing medication, been one avenue amongst several to offer that help.

Point: mental illnesses are real, regardless of whether they are psychosocial, biological or something else entirely.  It almost doesn’t matter whether or not that specific is agreed upon – what is surely undeniable is that mental suffering exists, and in extreme cases thereof, psychiatrists can be of assistance.

Other Points to Note

  • In the afore-referenced Facebook discussion, someone said that they wanted me to make an informed choice regarding medication (as clearly I am incapable of same on my own).  Assuming I had suddenly managed to become informed after so obviously having no conception of anything to do with the medication prior to the person’s incredibly insightful comment, they told me that they would not judge me for my decision. However, the use of scare quotes and derogatory terminology, as often seen being used by many people who hold these beliefs, spoke very much to the contrary.  It is clear to me that whether consciously or, more likely in fairness, unconsciously, those of us that are not anti-psychiatry are constantly being judged and looked down upon by many of those who are.
  • I believe in the effectiveness of psychotherapy, but just like the psychiatric medication so derided by the anti-psychiatry lobby, it is a highly individual concept.  CBT, DBT, life-coaching, NLP – this, to me, is all complete and utter wank.  To some it may be life-saving.  Psychodynamic therapy was helping me (the only reason it did not continue to do so was because it was cut short, not because it was per se shit), and I believe also that analysis could do so.  For others it may drive them to suicide.  No talking therapy may work for some people.  Ditto lifestyle changes, ditto herbal remedies, ditto whatever.  The point is that treatment for mental illness/pathologised humanity/distress/whatever you want to call it is by its very nature highly individualised, and there is no one size fits all.  For some, psychiatry has no place.  For others, it does.  Denying, stigmatising or shaming those people who choose to utilise psychiatry has exactly the same effect on society as anti-psychiatry supporters claim psychiatry itself does – that of censorship, a removal of choice, a degrading of an individual’s personal agency.

Conclusion

Despite the tone of the forgoing, I am actually not anti-anti-psychiatry – not conceptually, at least.  What I am anti is anti-choice.  Most people will claim to not be anti-choice, but I have to say that I think that some ardent supporters of the anti-psychiatry movement, through their belittling terminologies and vehement contempt of medication, are effectively putting themselves in the role of a ubiquitous, societal decision-maker.  I think that that is wrong.

On a related note, I also find the proselytism of some members of this lobby to be grossly offensive, because it again strikes me as being an attempt to remove choice, and assumes that I do not have the mental capacity to have reasoned the relevant issues in my own mind.

Anti-psychiatry has got some things right.  Some historical methods of psychiatric treatment were vile beyond description, and defied even the most rudimentary understandings of human rights.  To a lesser extent, hardcore medications such as Haloperidol do the same when they are used as chemical restraints – though, as argued above, I firmly believe that this is only done in the most extreme of circumstances, at least in this country.

And therein lies a point – just because things might be ‘OK’ in the UK, it doesn’t mean they are elsewhere.  We must therefore demonise psychiatry, right, so that those nations where disgustingly outdated and demeaning practices are ongoing know that what they’re doing is evil?  Er…no.  We must show that it doesn’t have to be like that, and that regulation, rather than prohibition, is an absolute must (as it should be in any medical or caring profession).

Medication is not a ‘chemical cure’, and although I have provided a critique of that above, let’s be honest here – for a long time that was exactly how it was treated.  By some GPs, it frankly still is.  That, to me, is exactly why psychiatry is a necessity: GPs do not and cannot have the refined, if flawed, understanding that specialists do, and are thus more likely to simply throw drugs at you.  A psychiatrist may feel that your case may be better dealt with by therapy, or different drugs, or a combination of both.  But drugs are not a cure, whatever the case, and perhaps anti-psychiatry can be credited for originally making that point (though I’m not sure).  Nowadays, however, as noted above, no one feels that medication is a cure.

Do psychiatrists exist to serve the will of ‘Big Pharma’?  As I stated above, perhaps to a certain extent they do in some jurisdictions, and if indeed that is the case, then I am grateful to the anti-psychiatry lobby for raising awareness on the issue.  As I stated, though, I am not sure how applicable this argument is to the nationalised healthcare we normally see here in the UK.  Additionally, even if psychiatrists are plying patients with medication because ‘Big Pharma’ says so – well, it doesn’t necessarily mean that those drugs are shit.  They may be over-marketed, but that in itself does not mean that they are of no value. They are only of no value if they are of no value, not because their manufacturers are cunts.

Finally, yes – sometimes mental distress and, indeed, our very humanity is over-pathologised.  We all experience worries, anxieties, low periods and traumas, and mostly it’s just life.  Existence is not all fun and games, nor should it be.  Bad things happen, bad feelings result.  That’s life.

But it’s not all just life, is it?  The demarcation line is blurred, to be sure, but there’s normal human suffering and then there’s severe and enduring mental distress, of the like unimaginable unless you have personally experienced it.

And this is the whole point; the only point that ultimately matters in this whole debate.  No one is asking for permanent happiness; life is about mere tolerance or, at best, accepting contentment.  When we are at our lowest, our worst in whatever form that may be, and when that’s beyond a normal life experience or is chronic in nature, in order to achieve some contented state of being – or, frankly, to even come remotely close to it – it is only natural and right that we seek help.  For some, that help may be something as simple as a modification in diet, or a daily walk.  For others, it may include meditation or a talking therapy.  For some, it may be psychiatry, whether alone or in conjunction with other treatment(s).

It is not evil to look to a psychiatrist for help in easing mental agony.  For some of us, it is a simple necessity.

Please try and leave dogma and damnation at the door on this issue and remember that we are all different – and that it is crucial to our most fundamental human rights that we are allowed to remain so, in whatever field of play that may be.

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36 thoughts on “Why I Am Not Anti-Psychiatry

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  3. A really well written post. I agree with virtually everything you said. Perhaps everything, but I can’t quite concentrate well enough at the moment to read that well, so I may have missed bits, and therefore added the virtually as a disclaimer. But I agree with you. I think to say that medication is evil and doesn’t work and causes illness is bollocks, as you don’t actually take psychiatric medication in the first place if all is well, and to say that mental illness doesn’t exist is even more ridiculous. I find myself getting very frustrated sometimes. It is incredibly invalidating to read things saying that mental illness doesn’t exist, when it so clearly does, and when you are feeling really terrible it can make you feel a hundred times worse, as it just leaves this feeling of complete inadequacy, as if mental illness doesn’t exist and you aren’t coping then you must just be a complete failure as a person to not be able to do the things that everyone else does. Whilst those feelings are around some of the time anyway, you can at least partially justify your lack of contribution to society when people remind you that you are ill and that is why things are more difficult. If you aren’t ill, then what on earth are you? Just a nothing. I find it insulting and upsetting. The trouble is, I think those in the anti Psychiatry movement are too blinkered to see any other points of view, however well meaning they may be.
    x

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  6. Since after hearing my views on medication some people would classify me as “anti-psychiatry” (although I wouldn’t!) I feel compelled to respond 🙂

    First of all, bravo- this was a really well written, well thought out post.

    However. Just a few things I’d like to respond to:

    re: Big Pharma’s influence in the UK- I need to respectfully disagree with you on this point. I won’t say exactly how I know this to protect my semi-anonymity, but I do actually have some inside knowledge on this front. The pharmaceutical companies do influence prescribers here, definitely- it’s just that since as you say patients don’t pay directly for their meds and direct to consumer advertising is not allowed, most of the wrangling between the pharmaceutical companies, prescribers and commissioners goes on behind the scenes, removed from the patient’s view. Regarding the cost of meds- it’s true that the NHS generally wants to save as much money as possible (especially right now) but that doesn’t always mean patients are always going to get prescribed the cheapest ones on cost grounds alone- sometimes that’s a result of reviewing the evidence, sometimes that’s due to Big Pharma’s marketing.

    And that brings me to my biggest issue when it comes to the pharmaceutical industry and psychiatric medication- the evidence. Specifically, the pharmaceutical’s industry’s role in sponsoring drug studies, which makes up most of the published evidence that medical professionals based their views on. If you do happen to read books such as The Myth of the Chemical Cure (I recommend it, btw) you’ll find out how the design of studies are often considerably skewed in favour of getting good outcomes for the drug in question (understandable, since often the purpose of the study is to try and get the drug licensed.) Additionally, those studies which do end up showing a negative result are usually unpublished, which further skews the corpus of available evidence out there. Finally, there are some who argue that the peer-reviewed journal system in general inhibits critical research into psychiatric drugs, since a lot of journals receive a huge sum of money from the industry in terms of advertising monies.

    re: Mental illness not being “real”- I would actually agree with that statement, but not in the way that you describe in your post. The term ‘mental illness’, to me = a disease, ie, a pathological process with roots in biology. Of course, you could argue that everything in humanity’s experience has its roots in biology, which is true, but that doesn’t mean the whole gamut of human experience is or should be pathologised. After my research, I’ve come to the conclusion that as of now, it’s never been scientifically demonstrated that what is referred to as mental illness is the result of specific biological processes in the brain becoming abnormal. Take the whole chemical imbalance theory, for example- the theory is that psychiatric drugs correct a chemical imbalance in the brain, which implies that prior to drug treatment, neurotransmitter levels have somehow reached abnormal levels. Except no one knows what a normal level of these neurotransmitters should be- there’s no test your doctor can give you to measure your serotonin/dopamine levels, tell you, “oh, that’s definitely too low/high, you definitely have depression/schizophrenia”, and then give you the appropriate drugs to rectify it. The lack of evidence for a disease process in mental health leaves only one option, that psychiatric drugs are simply psychoative substances, not treatments to manage a physical disease.

    That being said, though, that doesn’t mean that depression isn’t real, that anxiety isn’t real, that schizophrenia isn’t real. Of course they are! Just because they aren’t physical diseases doesn’t mean those collections of symptoms don’t exist and cause real, awful, horrendous human suffering. Anyone who says otherwise is daft.

    re: placebo effect, management of symptoms, etc- I actually generally agree with you here. I think the strength of the placebo effect for antidepressants has been pretty convincingly demonstrated, but an effect is an effect- in that way, antidepressants are effective, but just not in the way most people think. For the long term management of symptoms in conditions like schizophrenia and bipolar, I agree with you that medication is often very effective indeed. I’m not anti-medication- I believe psychiatric meds have their place. They’re not going to cure the underlying problem, but they are supremely useful in managing symptoms, as long as they’re prescribed appropriately (I don’t think that prescribing antidepressants for someone with mild depression is appropriate prescribing, for example and NICE agrees! But for severely depressed people, yes, meds can help.)

    And that brings me to my final point, which is recovery. Part of the reason I am extremely critical of psychiatry now (a fairly recent development, actually- I have a 10-year psychiatric history and for most of that time would have been totally on board with the mainstream biological psychiatric views) is the perspective it’s given me on recovery. For most of the last decade I thought that my depression was an illness that would just always haunt me, that would always need to be managed. I didn’t really believe that total recovery was possible. Now, after reading different perspectives, I do believe that total recovery is possible from depression, because I don’t believe that it’s a physical illness. This has really transformed my approach to my mental health for the better, and made me a lot less willing to put up with bullshit from the medical profession because it’s my life on the line here, and I’m not willing to settle for anything less than recovery at this point, now that I know it is a possibility. Obviously, though, I don’t have a psychotic condition, and I know the picture can be a little more murky there. And no, not everyone is going to recover, and that’s no fault of their own- the power of the human mind to twist itself in knots is staggering. But for me, looking beyond psychiatry has given me something priceless- hope.

    (Apologies for the massive comment, by the way! I’ll probably turn it into a blog post and make it even longer, hehe.)

    • Hello 🙂

      Thanks for commenting, good to have you here.

      I take your point on the influence that the pharmaceutical companies may after all have on the UK market – I can’t claim to be an insider myself! The thing about sponsored drug trials though – I think some literature and some who are anti-medication (not that I’m accusing you you of this – far from it) tend to overplay the incidence of this, at least on occasion. That is obviously not to say that ‘Big Pharma’ sponsored drug trials don’t happen – self-evidently they do, that much is merely a three-second Google-search away.

      Nevertheless, I have seen first-hand-ish (not first hand completely as I am not a chemist) that not all such studies are thus sponsored. One of my alma maters was (and, I believe, is…and I’ve heard whispers of the other one getting in on the act too) involved heavily in the testing of the efficacy of medical drugs, including psychiatric drugs. These weren’t initial clinical trials admittedly – they were ‘merely’ the Department of Medicinal Chemistry’s attempt to prove or disprove the effectiveness of the medications after they had already been licensed and available to those who needed them.

      In one or two of these cases, funding was garnered from the government, and I suppose it’s at least arguable that there exists a partial and influential chain of command meaning that the government pressurised the research, themselves having been pressurised by the drugs companies. Still, I’m not sure that I feel that this inherently impacts on the credibility of the researchers and the observable and reported experiences of the patients and control groups in the various studies. Even if it did, at least one study of which I’m aware was funded by a mental health charity (who, in fact, have now set up their own research department, which conducts admittedly very small-scale but nevertheless interesting investigations of their own), and I would wager that they’re quite unlikely to have been spurred on by the pharmaceutical firms.

      Additionally, I think that the modern-day freedom of the internet makes it impossible to sustain huge cover-ups like this, at least in situations where the matter (drugs, in this case) about which a cover-up exists is so (relatively!) easily obtainable by people. That is a key benefit of anti-psychiatry, particularly in the digital era: it alerts us to the fact that potentially untoward practices may be going on, and encourages our individual investigation thereof. Thus we have a multitude of service-user and impartial-but-professional websites and blogs that put forward the information that the drugs companies would not like us to know, thus allowing us greater scope for individual decision-making.

      On the point of mental illnesses at least having some basis in biology, I would have to disagree, though of course I recognise that there is a particular body of research that would support your viewpoint. On the other hand, I personally have read so many books and professional websites that have impartially researched that I feel that there is definitely a place for the bio-medical model in this arena. Even in the cases where the illness is a psychosocial issue originally – arguably, in my case, because of molestation by a paedophile, parental abandonment, bullying and emotional abuse – it seems evident to me that neurological pathways are damaged considerably through the relevant catalysing factors. Furthermore, I understand that a number of independent studies have shown that behaviour in the amygdala (the region of the brain controlling emotion and memory) is considerably differentiated in disordered* patients from control groups with no notable mental distress, thus suggesting a potential neurological pre-disposition to mental ill health. This goes some way to explaining how certain people cope with serious and/or prolonged trauma with no evident psychopathology, whilst others fall utterly to pieces after what may be considered a relatively ‘mild’ traumatic experience.

      (* In patients with PTSD and BPD, conditions on which my reading has mainly focused because I am diagnosed with them. Of course I am sure there is similar research for other disorders too).

      My favourite book dealing with this – specific to personality disorders unfortunately, but still worth reading in general – was Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment by a key PD expert named Joel Paris. Also of interest was (as I have a differential diagnosis of bipolar disorder, type II) Bipolar II Disorder: Modelling, Measuring and Managing (ed: Gordon Parker), and certain points on Judith Herman’s flagship study of trauma, Trauma and Recovery, touched on it.

      All that said (*deep breath*), I agree with your point that ultimately it doesn’t matter how the illness or distress occurs; whatever the cause, the symptoms are there, and in most cases, they can be treated. In the end, this is the only hugely importantly issue in the debate.

      I totally agree – and, for once (!), I agree with NICE – that medication for something like mild depression and/or anxiety is deeply inappropriate (at least as the first point of call). I have to say that whilst Fluoxetine undoubtedly changed my life for the better and probably kept me alive for several years, I do believe that when I first presented with depression to my GP, it would have been preferable (at least initially) to have referred me straight to a CAHMS psychologist/therapist, rather than prescribing drugs. To be fair, I was very severely depressed, and as I say Prozac was a wonder-drug. Still, as noted, it’s not a cure – where, possibly (though not in my view ‘probably’, as I don’t really believe that I at least can be cured), therapy could have been.

      On your final point, I think this underlines the fundamentals of the individuality on which I endlessly banged in the post: looking to psychiatry has actually given me hope. Partly because of medication that is highly effective in managing my symptoms – whether I’m taking that on a long-term temporary basis, or whether it will be permanent – and partly it’s because I feel much more content knowing (or believing) that I have an actual illness, rather than a fucked-up or otherwise flawed personality (tune in on Monday for a rant about wankers who think that I do!). I believe that sometimes mental health problems can be cured, that others can remit, that yet others can merely be managed (and in a few tragic cases, not even that, but mercifully this seems to be fairly rare). Ultimately, as long as we are comfortable with our treatment and how our illnesses/problems progress as a result, no matter how divergent our experiences may be from those of others, then we are on the winning side, which is the most important thing.

      Anyway, in conclusion (*deep intake of breath* ;)), thank you for your well-reasoned, rational, and respectful comment. Although we disagree on several points, respectful and reasoned discussion is enlightening and is always welcome, and that is exactly what you have provided. It makes a lovely change from the patronising, inane rambling to which I have recently been subjected, and which ultimately catalysed my writing of this post 🙂

      Take care and hugs ❤ xxx

      • I think I would say re: pharmaceutical companies and drug studies- I think most of the damage has been done by the time a drug is licensed for sale. Those studies are invariably funded by the pharmaceutical companies and I think that’s when the shadiest practices can happen. I agree, though that things may be changing a bit on that front and I’m so encouraged to hear about universities, charities and others that are doing critical independent drug studies! I also agree that the internet makes it harder for pharmaceutical companies to restrict access to information, although unpublished studies done by pharma is a bit of a grey area I expect (but Irving Kirsch et al got access to them for their antidepressant meta-analysis, so things are changing on that front too!)

        re: biological illness- you know, I think there’s room for both our viewpoints on this subject, simply because we know so little about the brain and how it works. I do stand by my assertion that as of today it’s not been convincingly scientifically demonstrated that mental distress fits the physical disease model that something like diabetes does, but I’m not closed to the possibility that a larger role for the biochemical model may yet be discovered in the future! As you said in your original post, it’s all kind of a woolly kind of science at the moment- my major problem is that most of the time psychiatry is portrayed as more authoritative and definite than it actually is.

        And on recovery/hope- I really do understand where you’re coming from on this. When I was originally diagnosed with Major Depressive Disorder with Psychotic Features (I used to know the DSM-IV code, but not anymore!) way back in 2000, it was such a relief to find out that this wasn’t my fault, that I wasn’t inherently defective (according to my doctors anyway- I still believed I was, but that was part of the disorder!) Problem for me was that my doctors then went straight to symptom management/maintenance treatment, rather than even broaching the subject of complete recovery. Which meant I wasn’t recovered when I thought I was fine, cue multiple relapses, etc, etc, which demoralised me so much that I went looking elsewhere, found an entirely different perspective on mental distress, and developed the views I hold today. But yes, I agree with you that it’s entirely individual and different for everyone how they approach their conditions- and in the end, we all want the same outcome- a life worth living. 🙂

        Thanks for your lovely response to my comment! Am frankly amazed I was brave enough to comment in the first place (boo social anxiety) but you caught me on a good day. 🙂

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  8. Well said!

    IMO the problem comes when doctors don’t acknowledge the uncertainties in psychiatry, and start presenting theories as facts, telling you that antidepressants will cure you, etc. In my personal experience it has been mainly GPs who have done this (though not my current GP who is fab). Interesting that you’ve found that too. I know there are some rubbish psychiatrists out there, and psychiatry has its fair share of problems, but I think I would probably be dead by now if it wasn’t for my meds.

    RC

  9. The Big Pharma argument applies in the UK to the extent that the NHS generally does what the Department of Health pays it to do, the Department of Health follows NICE guidelines, NICE interprets research findings, and researchers find whatever Big Pharma pays them to find. That’s why nationalisation and regulation do nothing to improve the situation — the bad guys simply cosy up to the national bureaucrats and the regulators.

    UK doctors are also the targets of direct advertising. You might think this would have little effect, but a lot of money continues to be spent on it.

    As you say, none of this means that the drugs or their makers are evil, but it is one of the factors that make individuality and choice more difficult to assert.

    • …it is one of the factors that make individuality and choice more difficult to assert.

      I don’t see how. No one forces medication on anyone except, as noted in the post, in the most extreme circumstances. Even if the whole ‘Big Pharma’ idea is true (and I take the point made by you and Andrea that in some cases the drugs companies fund biased research – of course you’ll be aware that this is not always the case, and anyway, the internet makes ‘lies’ of this magnitude all but impossible), doctors analyse the most appropriate medication for an individual not based on studies alone, but on their clinical observations and reports of patients. They then conclude that if a drug is appropriate, it is Drug A or Drug B or whatever, and (if they are competent) advise the patient as to why they feel this is a desirable course of action.

      The patient is then in a position to decide as to whether or not he or she agrees with the assessment, and ergo whether or not he or she wishes to take the drug. Some studies may well be biased, but there is plenty of impartial analysis of each medication out there (both from laypeople and professionals), and to that end I cannot see how choice is reduced. All it takes is someone who wants to make an informed decision, which I am sure is the vast majority of us.

  10. Great post and very well written.

    I’ve heard of all thatr Big Pharma conspiracy and similar to the IK, in Australia the government help subsidises the cost of medication. So we only end up paying $33 AUD at the most. It cost the government more than it costs the patients and like your NHS, I don’t think the government wants to spend more than it has to.

    I agree with a lot of the points you have made. Medication has helped a lot of people with their mental health issues, even if psychiatry isn’t an exact science.

    Take care,
    Cassie x

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  12. So when are you going to write a book?

    I always read your blog (though I am apparently lazy about commenting) and aside from your sharpness and clarity on all this I love your style.

    i do think it sounds different in the UK than US (I am in the US). and I think that the anti-psych people do make some very valid points but then they also can get all-orthodoxy-oversimplying over it, and then it can get silly. it does, especially, seem a problem to tell people they shouldn’t be taking meds (or anything really) because that just seems like it’s someone else saying they know what’s best for the person in question.

    thanks for your blog!
    eeabee

  13. “Big Pharma” conspiracy – I agree here that the UK will differ from the US as we have “free at the point of contact care” therefore the NHS HAS to consider cost. So this is beneficial to patients as we will not simply be prescribed a drug that may not help, but detrimental as it is sometimes difficult to get drugs that WOULD definately help i.e. “postcode lottery” etc.

    Placebo – Call me indoctrinated as well if you will but quite frankly Citalopram has changed my life for the better in unimaginable ways. I never thought I would be this “OK”. No I’m not fully better but the Citalopram has stabilised my moods to a point where I can start to work on other stuff. If this was a placebo effect I would have improved when put on mirtazapine or fluoxetine (which actually made me 100 times worse – horses for courses). I didn’t. As you pointed out though, a placebo effect is still and effect and I would have been glad of one.

    Side effects – Yes, they can be horrible. No, I shouldn’t think ANYONE wants to experience them. Yes, they can be worth it. And as for not knowing about them, fair enough some docs are a bit shit and won’t volunteer the information but A) you should ask anyway, B) you can buy a BNF for a penny on amazon or C) find the information free on teh interwebs. If somebody took medication without trying to find out what the side effects were then they would be extremely stupid!

    It’s very easy to condem others for their choices when you have a closed mind and no experience of the subject. If only people could recognise their lack of knowledge and be willing to learn.

  14. I know youv’e already said it Pan and so have several others but meds have simply made my sisters and my life bearable. She has BPD with an ED and depression, I “just” have depression and anxiety- neither of us are leading _wonderful_ lives but meds make it so much better than without. So, so very many people see positive effects like this that it is surely too big a coincidence to just be a placebo- I find the idea that thats all it is to be a bit odd really.

    Thanks for this great post Pan

    Best wishes
    Kate

  15. Pingback: This Week in Mentalists- BPD Edition « Mental Nurse

  16. I’m also not a huge fan of doctors, which makes my career choice mildly ironic. Although my current psychiatrist is lovely.

    Loving that you used the controversial issue of stem cell research to back up a (mildly) controversial argument.

    Had something amazing to say, but the Quetiapine kicked in and I think I may just about fall asleep on this keyboard!

    Much love
    – Little Miss Sunshine

  17. The thing I don’t get about people who claim that mental illness doesn’t exist is that the brain is just another organ. If they liver, lungs and heart can screw up, why can’t the brain?

    There is actually fairly robust evidence that DBT, CBT and the like work in clinical trials. Unfortunately, the average sufferer isn’t likely to experience the same level of quality therapy as in the trails. Furthermore, they often target certain things (ie, emotion regulation, cognitive bias’s or conditioning).

    I think the best model to use to help people understand mental illness is specific phobia, which has a very clear cause and treatment.

  18. I find the social control argument kind of funny, because I’m actually much stroppier when the meds are working. Nothing sends me docile and brain-foggy like depression does. When I’m on meds, I’m all “why” this and “oh hell no” that.

  19. I agree with you – my medication saved my life and is the only thing keeping me sane. I knew about the side-effects, but the benefits are bigger. As for the ‘mental illness is just a spiritual problem’ argument – LMAO.

  20. RAPTUOUS APPLAUSE.

    That was great.

    And I think Quetiapine is a great drug. It gave me really freaky manic side effects and I had to stop it within 24 hours, but loads and loads of people take it with no ill effects to speak of other than bleariness in the morning.

    There’s no point in arguing with these people anyway. It’s like the mummy wars on breastfeeding v. bottlefeeding. Lots of people are completely irrational and do not listen.

  21. Great post, Pandora!
    Alot of times when individuals are hurt by something, their feelings go overboard and they do a black and white “all is bad” sort of thing-aka “all psychiatry is a crock of shit”…because their own experience was bad and they have heard others who were.
    The problem with all doctors including psychiatrists is, lol, that they are human beings and being so can be flawed in ways all humans are, including being closeminded and judgemental and rigid. Doctors, especially psychiatrists are in such a position of power that when they show up that way they cause a boatload of harm more, I think, than other people even other doctors. And being “mental”, the client has less power, is less likely to be believed, and has more self doubt.
    I believe it is those kinds of bad experiences…which are probably very traumatic and harmful…that turn people so strongly against psychiatry and are behind the reason they are so vehemant. I am so glad you seemingly (have read your entire blog but I could have missed it or not know) have not had a psychiatrist who did not SEE who you are, that you were intelligent and had some valid things to say about yourself and your illness that would help them help you. I, on the other hand, also being an intelligent person (but not quite as so as you…still I have a strong medical background working with patients so that should count for something also), have encountered a dismissive attitude amongst psychiatrists…and therapists…that had been very hurtful. I have felt they do not or can not see that I have the smarts education intuition to contribute to the relationship. I get that from GP’s too. Here in the US everyone is so rushed in appointments that they dont’ have the time I think to be as intuitive about Who their client is and what they might thus be able to contribute. Recently my GP had to leave her practice suddenly and I inherited another who was a complete arse and acted affronted whenever I asked for somethign I needed (a script for meds I had been on in the past, for example, that helped me with chronic pain). Anyway, I have had traumatic reactions to being so vulnerable and not believed with my physical healthcare. Have seen psychiatrists who really dont’ care or have ability to know me (but have not beeen traumatized because I didn’t feel dependant on them for my wellbeing…they still would write my script)…so I can imagine that people who have been traumatised by poor psychiatric care are the ones reacting so strongly against psychiatry as a whole profession. That’s my theory,, anyway.

  22. above reply is obviously narrowly meant to address the vehemance I’ve seen online from some (former)
    psych patients. I didn’t mean that all or most people with similar viewpoints are neccesarily reacting
    to having had a bad experience (like Andrea above who’s comments are wonderfully well reasoned). I am much less well read that some of you on this issue but what I have seen in anti-Psychiatry circles
    has been from people formerly diagnosed with mental illnessses and their comment are often unusually strident. In thinking about the content of your post and Andrea’s responses, maybe what is out there is much broader and I wasn’t clear on that…but I was commenting on what I had myslef known to be out there. Sorry if it feels off topic

  23. Well written post Pandora! For me it’s the whole NHS Psychiatry thing that scares me… looking back to the past two weeks and the care under the crisis team I have received. God only knows how I have managed not to lose my temper with them yet.

  24. Hi, so I’ve never commented, but I’ve been reading your blog for about a year now, so it’s probably time I did to be honest… This post was brilliant. I’m a bit rubbish with words, so I can’t quite explain, but you’ve really helped me to sort out an awful lot of self-blame here. I know it’s generally a fuzzy area of science/psychology/whatever, but you make a lot of sense in your arguments.

    On a slightly related subject, I thought of you when I read this: http://www.gifted-adults.com/content/view/34/93
    I can’t work out whether it’s rubbish or not.

    I probably sound like a massive stalker here, but yeah. Thank you for your blog. It’s been a massive help and I think you’re awesome, especially with what you’re doing with your Trust.

    May just shut up now.

    *slinks off to lurk quietly*

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  26. That is a great post! I like the way you went point after point and refuted them.

    I’ve had pdocs and GPs who’ve treated me like an idiot, when most people with bipolar disorder and other inherited mood/personality disorders, are among some of the most intelligent people there are, when they are able to think clearly. Brain fog does not equal lack of intelligence, it equals static in the wiring.

    Are lamebrains telling diabetics they don’t really need that medication, that it’s all a scam? There *are* people who believe that about gestational diabetes, which I had. I did get that remark once or twice. Sorry, not going to risk my child’s health. I know one woman who was not dx’d with it, did have GDM, and between that and birth trauma, needs expensive care for her son.

    One of the commenters above said something about people who know nothing about the subject, condemn you for something with which they have no experience. Parents of deaf children with cochlear implants (saw one the other day) probably get a lot of flak for “putting that machine in the poor dear’s head”.

    Parents of neurologically-atypical children get this a lot. We got muttered at a few times–A had gross & fine motor skill development delays, as well as a lively sense of curiosity, as a toddler. It was difficult to shop together in a non-grocery, because there was no way to confine him while we investigated what we were trying to buy, and this was more true when we were out of town.

    As he got older, his imagination took hold, and his K teacher just couldn’t handle that. He was showing ealry signs of early-onset bipolar at that time, and was dx’d at seven. Of course i was castigated for “drugging” my child, when if I were only disciplining him properly, he’d behave. And I don’t want your child around mine/your child is not welcome here/you’re raising a monster/he’s an ingrate/he doesn’t listen to what I say…

    Six and more years later, the discipline quailed in the face of his mixed states. No thanks to the pdoc he’s had since 2004 (county issued–rather like the jerk you wrote the letter about), he’s only this last May been stabilized. He’s a really nice kid–he always was, but he’s easier to be around now, same as I was once I got stabilized around 2006 or so. He turned his grades around from abysmal to Wow! over the summer, because he was finally motivated and wanted to do the work. *He’s* not stupid, he just was going his own path, making some phenomenally bad choices from bad wiring.

    No, I don’t think there’s a cure in medication, not for us, not for diabetics. Gene modification or stem cell research or getting some sort of therapy that rewires damaged synapses or whatever–that’s probably what’s needed. As long as none of us are forced to take the change, we’re good. When my brain *is* working, I rather like the way it functionss, the intuitive leaps and all. I don’t want to lose that part.

    Again, brava for such a great post!

  27. Nice post. Very well written. You have brought out the problems in psychiatry is so well. I cant say all but most psychiatrists have actually asked themselves the questions brought up by the anti-psychiatrists, and decided to go on with psychiatry because they found that it works in many individuals, but with a few people nothing works and it is very painful. I know it because I am a psychiatrist myself. The science of psychiatry is so young and so complex, that it is going to take years to understand it fully, but does not mean it is not a science. No science is complete, it’s only the level of questions getting more complex.

  28. Pingback: >No Word from Mental Health Team… Part III « Just Difficult

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