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!

My new normal

A new normal - for me. What is that and how is it arrived at? Things happen in life that we are generally unprepared for, that are, as the saying goes, “out of left field”. Is this “karma”? Is this just “happenstance”?

As always it is my attitude that colours or influences my response. People have asked me if I might not find “comfort” and “meaning” by joining a church. Now, having an enquiring mind I not only have the copies but I have actually read the Bible (more than once), translations of the Koran, the Hindu Bhagavad Gita and the teachings of Buddha. I therefore deem it unnecessary to attend a church. I can read and reflect on and interpret what I read. I can relate the wonderful messages contained in these various religious books to my life and my circumstances. Maybe I’m being presumptuous and somewhat hubristic but why should I listen to a stranger telling me how to live? That person wouldn’t know me and would know nothing of my life experience. 

While I am certainly not “religious” in the accepted sense - I do have my own beliefs and they satisfy me. I do draw on the strength that I derive from my reading and my beliefs. It seems that the “core message” from these different teachings is the old and seemingly universal belief that all people need to be treated equally – treat others the way you would like to be treated; that justice for all must prevail; that one’s dealings with others must always have moral underpinnings. And that Love for all beings is the guiding principle of life – or it should be.

One of the things that I have learned over the years is that it is often pointless looking for a reason why “things” happen. Certainly there are times when it is obvious that the principle (the Law?) of “cause and effect” applies but often it seems random events just happen.

And I see no point in blaming God. As I’ve written before, there is an old saying (possibly a Spanish proverb) that goes something like this, “Take what you want from Life,” says God. “Take it and pay.” Also a simpler version is, “you reap what you sow”. Honestly, why should God care what I do? Does He really look down on me and say, “Hey buddy! You had better watch your step!” Really? 

I also believe that His most ancient concern is for “order”. Just for order. His order. No more and no less. And we disturb that order at our peril.

So there is always a balance, or in scientific terms - homeostasis – “a dynamic state of equilibrium that is the condition of optimal functioning for an organism” – it’s a “fluid” state, never static.Homeostasis is brought about by a natural resistance to change in the optimal conditions – again, it’s a constant battle to regain the status quo.

 In this case it’s me and my homeostatic point!

Now in my situation I do struggle sometimes to accept my new “normal” without someone to share my life with. But I am coming to terms with this fact of life. It has taken me over three years and I’m still feeling my way. I don’t resist it, that would be pointless, but I’m not quite there yet. I have no idea where my homeostatic point is or even if I have one; or what I have to adjust to; or what I have to prepare for. It is definitely work in progress! Fortunately I have family and friends who are always there – or at least easily contactable.

It also helps that I have always been able to write about my thoughts and feeling. Getting it all on paper, as it were, enables me to rationalise, to reflect and to arrive at some sort of “homeostasis” in my mind. This can be confronting – I might write something and think, “Where did that come from?” The mind, or at least my mind, is very strange!!

One very important thing I’ve learned is that what has befallen me in my life has made me more understanding and empathetic to the trials and tribulations of others. And I think that is a good thing.

Otherwise, I wonder why are we here? And why us?

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!

Mental health issues - again!

What is it with this (mental “health”) subject, this “condition” that so confuses people? First off, let’s be clear on this, it is NOT an illness, as in measles, or diabetes which have well defined pathological markers and have well documented developmental stages and certain, scientifically proven medical cures or control measures. Mental health, on the other hand, has been closely examined for over 100 years and yet the questions relating to the various “conditions” described in the psychological and psychiatric “Bible” – the Diagnostic and Statistical Manual version IV (DSM IV) produced by the American Psychological Association (APA) are no nearer being answered. Why or how some people suffer from “mental health problems” is unknown.

To me an illness is something defined, medically, by the affect it has on the human body – high temperature, skin eruptions and possible damage to organs leading to their possible failure and such like. This scientific knowledge allows physicians to specifically treat the condition presented and to either prevent it occurring in the first place (preventative medicine) or to either cure it (measles) or control it (diabetes). Thus an illness is something people HAVE – a medical, pathological condition. There is no known pathological test for mental health that will determine whether a person is depressed, schizophrenic or bi-polar (some mental health issues may be the result of the after affects of excessive drug or alcohol intake). There is no proven genetic component. Furthermore no one knows exactly how or why certain pharmaceutical drugs seem to have a beneficial effect.

Anything affecting a person’s mind, on the other hand, may result in behaviour not generally considered as normal. Again, referring to the DSM IV this altered behaviour, observed by others, checked against certain criteria listed in the DSM IV determines if a person is “diagnosed” as depressed, schizophrenic, bi-polar or whatever. Thus there is nothing objectively “scientific” about any “diagnosis”. Any “diagnosis” is subjective and based on the opinion of the observer (however well trained they may be). Then there is the claim that some “mental illnesses” may be genetic in origin (ie schizophrenia) but this is a long way from being proven. Anyway even if genes are involved genes are not “self emergent” – they are “switches” that need to be turned “on” or “off”. In other words they do not operate on their own accord. They need a “trigger” to operate – always something in the environment.

If the environment is the culprit this would mean that something witnessed or experienced by the sufferer has affected them to such an extent that they now view the world from a different perspective. Does this make them “sick”? It has been admirably stated by others that, “If you talk to God you are praying. If God talks to you, you are schizophrenic.” 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”? Anyway there is no known, universally accepted, definition of “normal” – what is “normal” for me may not necessarily be “normal for you. Is it not conceivable that certain behaviour be just considered as eccentric?

Consider Moses (Exodus 3.2) - he heard the voice of the Lord coming from a burning bush but no one thinks that is odd. Now if I presented myself to a hospital and said that I heard the voice of the Lord coming from a burning bush I know that I would be considered mentally ill and most probably medicated to calm me down!! 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?

Why must we (and I include myself in this “we’ as I am part of the Australian society) force our views on what “we” consider to be right or wrong on to others who may hold quite valid but different views?

If (according to the Australian Bureau of Statistics) one in four people in Australia either has suffered, is suffering or will suffer from a mental “illness” (as defined by DSM IV) then surely there is something dramatically wrong with the way we currently live our lives? Just read any daily news paper, or tune in to any radio or TV news programme and all you read or hear about is Man’s inhumanity to Man – the cruelty, the injustice, the manifest unkindness, general lack of consideration and want of compassion is quite extraordinary. All this is bound to affect people in one way or another. Is it not possible that people who are diagnosed as “mentally ill” are just trying to adjust to a way of life that appals them, that may be too much for them to accept and they are just trying to escape to a “safe” place? Medicating such people to the point of stupefaction is no answer and certainly not the correct solution. Nor is incarcerating them in mental institutions.

To conclude maybe I should, once again, repeat the words of the Indian sage Krishnamurti who once said, “It is no measure of health to be well adjusted to a profoundly sick society”.

Why is suicide considered a bad thing?

Amended September 11, 2018:

I know this is quite an old post but I strongly believe it is as relevant as ever. Some people do commit suicide and this has surely happened since humans first walked the earth.

This is not a treatise on the causes or possible reasons for suicide but the complexities behind the act have puzzled me for many years. In particularly our seeming abhorrence and our obvious dismay, regret and great sadness that anyone should even contemplate the need to end their life, by whatever means has taxed my understanding and the meaning of my life.

What follows below is my considered opinion:-

I ask the question – why is suicide considered such a bad thing? Now I am not advocating that anyone should commit suicide. I am just trying to pick apart the emotional clutter that accompanies this very personal and private act. The only answers I get are that it is a waste of a (usually) young person’s life; that they were loved; that they had unlimited potential, now never to be realised; that they had a future to live for – etc., etc.

This is partially correct but is not a real answer. The person concerned – the person now deceased – obviously had a different view of life. Their view, which I am not discussing (I have no idea what that was); I am discussing our view; that of the outsider; the ones left behind.

Why do we “outsiders” (I deliberately use this word because we are “outside’ that person’s inner world) consider suicide to be such a bad thing? Are we affronted because someone considers living – in their current situation – to be so bad, so threatening, so limiting as to be not worthwhile continuing? Are we discomforted because this rejection, this dismissal of all we has striven for (in “our” world), may reflect poorly on us, those left behind, regarding the way we have organised the world? Are we disturbed by the confronting prospect of having to admit that we make mistakes and that the way in which the economy, our legal, welfare and education systems are set up may actually cause distress, that we are not always fair or just in our dealings? Do we feel guilty that we have developed a financial system that promotes the massive imbalance between the very wealthy and the very poor and the disadvantaged?

We have to recognise that we are all, all, party to the ills of the world. We created them. If we look with even a modicum of insight we should see in ourselves the cause of these short comings and see ourselves reflected in the eyes of the distressed. And we should be dismayed.

Is this why we consider suicide a “bad thing” and are so shocked when it occurs?

It is needful to remember that we, each one of us, have our own experiences of life. These are our own. No one can see the world through our eyes with the same imagery and emotional response. No one can see the world through our eyes with our life experiences and our interpretations of those experiences – these are our own.

So I ask the question again – why is suicide considered such a bad thing? Obviously for the person concerned the prospect of death is more alluring than continuing living as currently experienced. What is “wrong” with that? It is their choice.

Then for some to say that only God can decide when or where a person dies is surely a gross over assumption - how do they know? What special insight do they possess? Is it not possible, because (I assume) God gave us free will that God may have already decided to allow a person who wants to die, to die?

Furthermore to declare (as some authority figures do) that most people who commit suicide suffer from a mental "illness" or disorder is surely wrong. It is also highly presumptuous on the part of the person making such a declaration – how do they ACTUALLY know! This is categorising a person, who now has no recourse or ability to refute the presumption. This is putting a label on someone. And then what about those “outsiders” left behind to live with the event – the family and friends? Are they to be made to suffer further pain with the stigma provided by so called experts who provide the “knowledge” that their son, daughter, friend, brother, sister “must have been mentally deranged” to have committed such an act. This implies that no “normal” person would ever do such a thing! What about self-sacrifice when there is loss of life? Isn’t this an act of suicide? But if it saves the life of others it is considered “noble”!! ("There is no greater love than this, that a man should lay down his life for his friends" - English King James Bible: John 15:13).

Research on completed suicides is notoriously difficult. It is always referring to an historic act – something that has already happened. Police, coronial, autopsy, psychiatric and psychological and counselling reports are analysed and carefully combed to try and establish some reason or motive for the suicide. This is fraught as it is impossible to know what was actually going through the person’s mind at the precise moment in time when they took their own life. At that moment they made a choice. Why? We can never know.

Shall we now look at what suicide actually is? Someone taking their own life – right? It seems that the “act” is only considered suicide if it results in the quick death of the person concerned. But what about those who commit suicide in the “long term”? Those who drink or drug themselves to death over a number of years, what about them? They may suffer from abuse, or from unbearable pressures associated with their domestic arrangements or at work. They may determine that the easiest and most “socially acceptable” way of easing this pressure or pain, is to get drunk or to get “stoned” on a regular basis. It may take some time but in possibly five or ten years they will be dead.   The emotional (and economic) “cost” of this (“long term suicide”) far exceeds that of any number of “quick” suicides.

To get back to the “mental illness or disorder” accusation. Disordered from what? What are these people supposed to be disordered from? From “normal”? As far as I can discover there is no accepted definition of “normal”. Possibly those considered “disordered” react to life’s trials and tribulations differently from those around them. Are they wrong? Or are we “outsiders” just being intolerant and lacking in understanding or compassion? Maybe these people are just eccentric – God knows there are enough odd ball people in the community!! Some behaviour may be considered mal-adaptive or possibly anti-social by “outsiders” but not by the people concerned – otherwise they wouldn’t act the way they do!

Similarly, why should anyone "live" according to another's expectations?  

There is an essay, “Suicide”, by the Scottish philosopher David Hume (1711 – 1776) wherein he wrote, “I believe that no man ever threw away Life while it was worth keeping.”

What follows below is a warning relating to anti-depressant drugs:-

USA Federal Drug Administration Product Information Warning

Patients with major depressive disorder, both adult and pediatric, may experience worsening of their

depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient’s presenting symptoms.

From the above it is apparent that psycho-pharmceutical medications are not always the answer!

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!