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!

Iatrogenesis

This, by my standards, is a rather long post.

Iatrogenesis, for me, is a new word. I had never heard of it before. Apparently it from the Greek for "brought forth by the healer" and refers to (quote), “any effect on a person, resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health, that does not support a goal of the person affected”.

This is a rather long-winded way of saying that a medical professional, instead of doing “no harm”, is actually causing harm.

The fact that word “Iatrogenesis” even exists gives cause for concern and gets me on my “high horse”, again! This is particularly so in relation to mental health.

NOTE - In case you were unaware:-
Common adverse effects of antidepressant medications include headache, nausea, agitation, sedation, sexual dysfunction, cognitive changes, weight gain, and metabolic abnormalities.

Rarer, more serious adverse events include cardiac, neurologic, and hepatic effects. Possible increased risk of suicidality is also an issue in certain patient populations.

In this regard there is quite surprising information in the 2012 report of the Australian National Mental Health Commission. According to this report:

“…. there is little or no accountability as to what improvements we are getting for such a significant investment, whether it improves the health and wellbeing of people with a

mental illness and provides them with the services they need.

Most Australians may not know that treatments with prescribed psychiatric drugs may lead to worse physical health. There are increased risks for some specific treatments such as antipsychotics and for those with underlying vulnerabilities such as diabetes. This can mean that the antipsychotic medications that are prescribed to manage severe mental illnesses such as schizophrenia, contribute to the risk of having severe physical illnesses.”

Interesting. I wonder why this information is not widely disseminated?

If, as many mental health professionals assert, mental disorders are genetic in origin it is interesting to note the curiously plaintive comment made by David Kupfer, MD, Chair of Diagnostic and Statistical Manual, version 5 (DSM 5) Task Force, in the American Psychological Association (APA) press release No. 13-33, dated 3^rd May 2013 wherein he stated:

“The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

In all this the human brain remains a 1.4 kilogram (3 pound) lump of grey matter, alive but without any sense of touch (it has no pain receptors).

Now I fully appreciate that, often, 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.

Mental health, however, cannot ever be “cured” by drugs alone – in fact antipsychotic and antidepressant drugs are not as effective as “big Pharma” would like us to believe.  I read somewhere (source unknown) that one can hardly prescribe drugs without knowing what is wrong with the patient - and that requires the delivery of a diagnosis – but diagnosing problems in mental health is fraught. There is currently no way – repeat no way – to accurately diagnose a mental health “problem” – apart from Alzheimer’s disease.

The reasons for relying on drugs is an important question that is more often than not ducked by “Health Professionals” and left unanswered. There is, however, a great deal of information available, that is both alarming and illuminating, if one is prepared to dig around.

My point is IF (and it is a big if) these drugs - which have been around in one form or another for over fifty years - are so effective, and if the percentage of people with mental health issues has remained constant for years, at (so we are told) about 1 person in 5, why then is the use of these drugs increasing – not just in Australia, but worldwide?

The medicines, the pharmaceutical drugs that have been developed for use in situations when a person’s mind is deemed to be unhinged or they are behaving in a manner considered to be “abnormal”, work up to a point, to maybe calm the patient. But no one (psychiatrists, psychologists, neuroscientists, pharmacologists et al) knows WHY or HOW they work.

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 the current approach to mental health!!!

So there!!!

It has been admirably stated by others that, “If you talk to God you are praying. If God talks to you, you are schizophrenic.”

Consider Moses (Exodus 3.2) - he heard the voice of the Lord coming from a burning bush but no one thinks that’s odd. Now if I presented myself to a medical professional and said that I heard the voice of the Lord coming from a burning bush I know that I would be diagnosed as schizophrenic and immediately medicated!!

A “mental illness” may affect a person’s behaviour - something that they DO.  How can anyone, except the person concerned, determine if such behaviour is “wrong” or “abnormal”? To my knowledge there is no universally accepted definition of “normal” – what is “normal” for me may not necessarily be “normal” for you.  Is it not conceivable that certain behaviours  may be considered eccentric? Surely there are enough “odd-ball” and eccentric people in the broader community to allow for the odd extremes without hospitalising and forcing pharmaceutical drugs on them against their will.

Fixed name diseases – a patient “is” psychotic; or “is” schizophrenic. Whereas another patient may “be a” diabetic; or may “have” breast cancer. Note the difference – the patient is not “breast cancer”. At least with cancers and diabetes there is a physiological condition – something that may be confirmed with a biopsy, a blood test or by other medical means.

What chemical, hormonal or neurological predisposition is there for psychosis, schizophrenia or depression? There are none. That people do suffer from mental problems is indisputable – but what is the cause? And what is the “best” remedy? Is there a “remedy”? If so, why and how would the remedy “work”?

Is it not possible that any and all “mental problems” are the result of the sufferer’s retreat from a perceived threat; a shutting down of “normal” reactions and defence mechanisms; an overwhelmed emotional system; the result of some “unconscious” fear?

More drugs are not the answer!