Thursday, October 31, 2019

Mental health - again!

I know that this is a highly contentious subject but I just cannot understand why it is now proposed that Australian schools should be provided with “mental health and wellbeing counsellors”.
These are children growing up in a fractured world with raging hormones just trying to “fit in”! 
Now don’t get me wrong! I am fully aware of the indisputable fact that there are many mentally distressed people who are in desperate need of help and support. My “beef” is with how this distress is diagnosed, categorised and finally the efficacy of any treatment offered. 
Firstly, let it be known, and widely known, that there is no consensus or definition of “normal”. What is a “normal” human being? There are roughly 7.2 billion people alive today. That means there are roughly 7.2 billion different people going about their lives, doing different things and behaving in different ways. Does this mean there are roughly 7.2 billion different ways of being “normal”?
Please tell me!
Then we come to the diagnosis of “mental illness”. A popular “diagnostic tool” is the HONOS – Health Of Nations Outcome Scale (please check this on line if you doubt me). Now this scale, as with any others used to “diagnose” a patient’s mental health, and there are plenty of them, is purely subjective. It is a “tick a box” exercise. Using this HONOS each question – there are twelve of them – must be rated 0 to 4. More than a previously determined “score” and you are diagnosed as depressed, schizophrenic, psychotic – or whatever and in need of help. 
Ok. When that is done – what now?
The important question now arises - what is the cause of any distress?
The answer? Nobody knows. Simple. There are plenty of, “the inference is”, the assumptions are”, “there is hope that further research will determine”, etc, etc….!
Again let it be known, and widely known, that there are no objective tests, no biological cause – no blood tests, no fMRI tests (functional Magnetic Resonance Imaging), no genetic link, and particularly no causal link between an apparent “symptom” and the distress evident in the presenting patient. The symptoms enumerated in the DSM5 (Diagnostic and Statistical Manual version 5 of the American Psychiatric Association –APA), used world-wide, were agreed by a committee.
The simple fact is that the “etiology” - the cause – of most mental disorders (Huntingdon’s and Alzheimers disease are more or less determined) are not understood enough to accurately distinguish the “mentally ill” from the rest of us.
Now we enter the minefield of the treatment of “mental illness”. The fall back position of psychiatrists and clinical psychologists is to consider a “mental illness” as a biological condition and treat it as such with a perfect cornucopia of psycho-pharmaceutical drugs produced by “big pharma” to their enormous profit. There is limited evidence regarding the efficacy of these drugs compared to other treatments (“Big Pharma” are very reluctant to release any research that does not support their advertising). Furthermore the side effects – heightened risks of metabolic disorders, rapid weight gain, diabetes, sexual disfunction and heart disease for instance – are carefully sidelined.
That some people do derive benefit from these drugs cannot be denied. They do. But these drugs never “cure” – they are a stop-gap offered to often desperate patients by medicos “stumbling in the dark”.  Often a “suck it and see” approach is applied – “Try this one. If that doesn’t work, try this at double the dose”, kind of thing. But then again, many people get better on their own or feel better with a placebo (sugar pill).
So – to get back to my opening statement about treating school children - until we know the CAUSE of the obvious mental distress experienced by some patients, how can anyone determine, with any certainty, what treatment should be offered? 
Finally I will repeat a quote, from the Indian sage Jiddu Krishnamurti (1895-1986), who said, "It is no measure of health to be well adjusted to a profoundly sick society".
There we have it in a nutshell!

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