Mental Health

It has been reported for years that the rate of mental disorders in Australia (and, I might add, most of the developed nations) is an alarming one person in five (1 in 5). This is a truly astounding figure. In fact I would call it a national catastrophe.

Just imagine the outrage and panic if 1 in 5 were diagnosed with AIDS or contracted influenza. There would be panic and a national enquiry and millions would be spent on research and medications of some sort. But mental health? If 1 in 5 of the population will suffer from some mental problem – what then is normal and how is this determined?

It is worth remembering that with mental health: “the facts are uncertain, values are in dispute, stakes are high and decisions are urgent”. In such circumstances it is difficult to resist the temptation to cherry pick data to suit whatever popular theory is being promoted at the time. The flow is from theory to observation to statistical analysis and back again – if great care is not taken then cherry picking will again take place in a misleading and apparently endless loop. Convention, it seems, must be followed – this is obvious from the fact that authors of articles that are not “politically correct” find it very difficult to have them published in mental health journals!

Prescribing mind altering drugs to people already suffering mental issues is counterintuitive. Yet this is what happens. The problem, which the “experts” seem to find difficulty in accepting, is that medications in various formulations and strengths have been prescribed for mental “illness” for something like one hundred years. Yet the problems remain. Logically this leads to the conclusion that, ipso facto, either the medications are ineffective or the aetiology (the study of causation, or origination) of mental disorders is misunderstood and therefore, by default, misdiagnosed – or all three.  

Using the same methods over and over again expecting different results each time is not very clever – in fact I believe this is an indication of some mental problem! Following the same course of action – prescribing medications that cause problems that further application of more powerful medications cannot alleviate is, also, not very clever. And yet this is what we seem to be doing with the current approach to mental health!!!

It is almost as if psychiatrists and psychologists are circling around the subject of mental health without fully appreciating what needs to be done (for example, after nearly one hundred years of research there is no effective biological test for any mental disorder – it's a matter of a health professional’s judgement regarding the apparent behavioural and thought disorder patterns presented by an individual. Furthermore if some mental disorders are deemed to have a genetic base the questions relating to any evolutionary advantage will need to be answered). I find it bizarre that there are over 360 different psychiatric disorders listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders – fourth edition – text revised, published by the American Psychiatric Association) with the further understanding that U.S. insurance companies (through their close relationship with pharmaceutical companies) now require a DSM-based diagnosis before they will reimburse prescription drugs on health plans. So again I ask the question that needs to be asked - what now is considered normal?

In this regard an over reliance on pharmacology is fraught; a “chemical imbalance” in the brain means what, exactly? What is the “correct” chemical balance and how is this determined? There is no known test that can determine the “correct” level of chemicals in the brain! Furthermore it should not be forgotten that behaviour can never be considered a “disease”, as an illness. A person may behave in a seemingly bizarre fashion and may be ill at ease but this does not mean they are “sick” – unless there is a pathological (medical) reason, which would then be beyond the scope of psychiatry or psychology.

Nothing is more fitting or useful than to be considered a normal human being living a fulfilling life in society but then, if the Australian Bureau of Statistics is correct, and 19% of Australians will suffer some degree of mental disorder during their lifetime then, once more, what is normal?

The needs and necessities of individuals vary. What is a prison for one sets another free. Yet “normal” can range from mildly eccentric with not a few who are apparently happy when leading a life some may think as abnormal, non-social and “odd ball”. There are seven billion individual ways human life is currently being expressed. I repeat, what is normal and, more importantly, who is checking?

What is needed is a complete rethink on the “medicalization” of mental health; a complete rethink on the causes (aetiology) of mental problems and a greater realisation that there are real problems in the administration and application of the law - as it applies to mental health; real problems caused by the obscene imbalance of income between the very rich and the very poor and the continuing, corrosive, effects of injustice which is prevalent in all societies. These have a major impact on mental health generally.

More drugs are not the answer.