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!

Is this the new world paradigm?

I wonder if the current method of communicating (in no more than140 characters) is affecting how we see and react to the world about us?

It used to be that when we communicated, face to face or by that, now very “old fashioned” letter writing, we were aware of the need to be polite, to be humble, to show self-restraint and to be discrete, particularly when dealing with those personally unknown to us.

In this regard, you may not be aware of this, but I have more than a passing interest in other religions and beliefs – that is other than Christianity. They are important I feel, as they (these other religions) influence some 6 billion people. That is a fair number!

In this connection I offer a very abbreviated (hopefully reasonably accurate) synopsis of an aspect of Hinduism that I find quite interesting. This is interesting as what has been believed for thousands of years (Hinduism, and it derivatives, is the oldest surviving religion in the world - I understand it even predates Judaism) is strangely applicable in todays rather unsettled world.

The Hindus believe in the “Yugas” – or the different ages that human beings have experienced in the world since we first became human. We are, according to these beliefs, now about 3000 years into the last of the four Yugas - the Kali Yuga wherein civilization degenerates into chaos.

Some of the (alleged) attributes of the Kali Yuga, are that:

•    Rulers will become unreasonable.

•    Rulers will no longer see it as their duty to promote spirituality, or to protect their subjects: they will become a danger to the world.

•    People will start migrating.

•    There will exist no topics on the subject of spirituality or God, even at the residences of so-called saints and respectable gentlemen and nothing will be known of the need for sacrifice, even by word.

With regard to human relationships:

•    Avarice and wrath will be common. Humans will openly display animosity towards each other. Ignorance will be widespread.

•    People will have thoughts of murder with no justification and will see nothing wrong in that.

•    Lust will be viewed as socially acceptable and sexual activity will be seen as the central requirement of life.

•    Sin will increase exponentially, while virtue will fade and cease to flourish.

•    People will take vows and break them soon after.

•    People will become addicted to intoxicating drinks and drugs.

An interesting future! It used to be that facts were facts and news was news. No more!

Quite appropriately, Nietzsche, admittedly not my favorite philosopher, said: “Anyone who fights with monsters should take care that he does not in the process become a monster.”

Antipsychotic medication and physical ill health

I know that I have written quite a few posts on the subject of mental health principally because this is a very important issue which, despite what psychiatrists and psychologists tell us, is little understood. For this reason it has been sidelined by mainstream health and welfare authorities in all countries and by politicians of all persuasions for many years. Mental health problems cannot, ever, be “cured” by drugs alone – in fact antipsychotic and antideressant 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 diagnosis  in mental health is fraught.]

The efficacy of current "cures" with a reliance on drugs is an important question that is more often than not ducked by “Health Professionals” and left unanswered. I am sure many others are as confused as I am by the secretive and sometimes unethical behaviour and the antics of the psycho-pharmacological “industry” and many of the professionals who administer these drugs to the unsuspecting public. There is, however, a great deal of information available, that is both alarming and illuminating, if one is prepared to dig around.

For instance there is quite surprising information in the 2012 report of the Australian National Mental Health Commission. Their finding regarding antipsychotic medications is most concerning. According to the 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 well-being 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.

The national survey of psychotic illness uncovered the extent of general health problems for people in this group:

• ·Diabetes was at a rate over 3 times found in the general population.
•  One third carried the risk of a ‘cardiovascular event’ within five years. 
•  Half have metabolic syndrome, which is associated with an increased risk of  cardiovascular disease and diabetes as a side effect of prescribed antipsychotic medications. 
• They have nearly twice the rate of being obesely overweight. 
•  They smoke at a rate 2 to 3 times higher than the general population. 
•  They have high blood cholesterol levels at 5 times the rate of the general population.

The Commissioners go on to state “These statistics mirror the burden of health difficulties endured by people living with mental health difficulties. It is evident that people with the most severe mental illness have a worse level of overall health than people with more common mental illnesses, which compounds the health difficulties they need to overcome.”

Furthermore the Commissioners state that “We need more research into the medications that treat mental illness and the significant side effects they have upon a person’s health. We need this research to develop best practices for managing and reducing metabolic side-effects (such as weight gain, increased risk of diabetes and heart problems) and assessing what approaches work best with the people who rely upon these medications to sustain their mental health.”

The World Psychiatric Association reported in 2008 that an estimate of the mean weight gain in patients receiving standard doses of antipsychotics over a 10-week period was quite significant: the mean increases were 4.45 kg (about 10 pounds) with clozapine, 4.15 kg (about 9.5 pounds) with olanzapine, 2.92 kg (about 6.5 pounds) with sertindole, 2.10 kg  (about 4.5 pounds) with risperidone, and 0.04 kg (about 2 ounces) with ziprasidone.

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

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.