Archive for April, 2012

I want to give a slightly less personal and a slightly more factually based version of the last blog. There are some factual errors that exist within the complex world of diagnosis that are problematic and in many cases the problem is, as ever, money. The problem with money is also a stupid one as actually, if we are to believe that work is good for you, a fact banded about by politico’s of a left and right wing background, then surely it would make more sense to have everyone be well enough to work? Apparently, it doesn’t and you and I are silly for even thinking it. I am not going to go into an in depth analysis of why capitalism requires that so many percent be unemployed to scare the brown stuff out of the people who are employed and keep them grateful for their minimum wage. I am however, going to go through some of the numbers related to mental health and those signed off as ill.

I remember from my sociology lessons the pretty awful tactics of governments from England putting posters up all around the Caribbean, Africa and India offering fantastical jobs to people if they are just willing to move to England and work here. Then when they got here, they were treated like crap by all and sundry and then, to top it all off blamed for the entire countries problems by politicians. Apart from being pretty disgusting behaviour and apart from the fact that all three parties play a part in this behaviour now, it set an example. It set an example that would permeate the rest of society. In this instance, in mental health was subjected to this same treatment, not by the government but by individualistic society as a whole.

Consider, for a moment, the language surrounding mental health conditions. Starting at the beginning, to have a mental health condition officially, you must be diagnosed. This is usually by someone with a medical degree, which in my opinion is the beginning of the problem. Dr’s undoubtedly deserve respect. They are a selection of the best and brightest. They work ridiculous hours and all that stuff. This is not having a go at them. However, they deal with illness. They deal with the body as a thing that is functional and that is all. They also receive practically no formal training in cognition, consciousness, narrative, or even really the human condition, especially compared to C.P.N.’s and psychologists. The medical model, as I have discussed before, sees humans as machines that have things wrong with them that can be fixed.

If this were the case, we would not see figures like anti-depressants only being successful in 33% of participants in any one trial, yet still being the first treatment offered. I have already discussed the money involved in this process, so won’t go there again for now. The medical model has failed to account for a number of healthcare problems and it comes from reducing peoples interactions to beneath that of the societal. Since Wilhelm Wundt started the first psychology laboratory in 1879, there has been an understanding that the whole is greater than the sum of its parts. One thing that is not really discussed in introductory text books is that Wundt also focussed much of his work on volkerpsychologie or folk psychology.

Folk or social psychology understands that things like social isolation, poverty or any other number of social events may have a physiological effect on a person’s condition but they do not fail to remember that it began as a social problem and physiologically altering the level of psychoactivating neurotransmitters or synthetically preventing the re-uptake of serotonin does not fix this social problem, it just masks it. This explains not only the massive relapse into conditions like chronic depression, addiction and personality disorders once the results of psychoactive pharmacological interventions have worn off. This is not even mentioning that most of these drugs are highly addictive and many of the drugs used in treating serious conditions, like schizophrenia have been suggested by many professionals to not only be addictive but physically harmful and might cause schizophrenia, psychosis and a load of other things they are supposed to stop.

So, the medication is not necessarily what it should be but that is not really the point I am making. If people have a reason to be depressed, then the best thing is to probably allow them to be depressed and most importantly, find out why they are depressed. If someone is depressed for a long time, then there is probably something really wrong with their life or coping mechanisms. There is a powerful argument that there are biological implications within psychopathologies like depression. There is even evidence of elevated levels of hormonal transmission evident in people with depression but there is little evidence as to whether depression caused these altered levels or the altered levels caused depression. The point is that everyone responds differently, whether because of their genotype, environment personality traits or life experience/ situation. To assume that you can mask one of the things that makes the human condition interesting, so they will continue to behave in an often thoroughly depressing world, is to ignore human pain. To assume that you can do that forever without there being serious ramifications is just stupid.

To continue the theme of diagnosis, I am going to talk about some of the more personal stuff, personal to me and personal to people that gets ignored from time to time. Personality disorders, as I mentioned in the last post are even contested as not existing by some theorists. The presentation of many of them is actually being badly behaved. This is pretty silly when you think about it. I like being badly behaved. I tell dirty jokes, I laugh at other people’s misfortune (within reason) and I swear like a navvy. When the government cut stuff, I get all shouty and kick off and I refuse to carry out orders from people who I don’t want to. So, at what point does that become a personality disorder?

It is actually not very clear. I have a diagnosis of emotionally unstable personality disorder, which if you believe the books means I have trouble regulating my emotions. That alone is a pretty strange thing to suggest of a person. It came about when I used to blow up and lose my temper. However, they are willing to consider that this might be caused by the various things I have been through in my life. I am not saying this for sympathy, I am just not that guy and wouldn’t appreciate it if I got it. I am saying it to explain something.

They are willing to accept that my condition might have been caused by life events that sucked but nevertheless it has stayed being described as a ‘condition’, a medical condition. What does that mean? It’s basically a condition that means that there is something that is physically wrong with me. This argument takes on many aspects but one way of looking at it, is that basically because I lose my temper rapidly and don’t hide it or control it like other people, I am physically ill. There are things in that that I just don’t like.

I don’t particularly agree with Szasz on everything. I think he actually makes some leaps that are even less likely than the things he is opposing but one thing that occurs in a lot of his writing, is that what is often described as being ill, is being human. There are record numbers of people being diagnosed with depression. What a massive surprise! Mervyn King says we are in the biggest financial slump since The Great Depression. There are 2 million unemployed young people. There are people losing their homes, their pensions, their jobs and yet there is genuine surprise that a lot of people are depressed. It can’t just be me that thinks this is just about the stupidest thing ever?

I often think it the same thing with my condition. I am cursed with being fairly smart and am certainly smart enough to realise the pain in the world at the minute. I am also smart enough to realise that to stop that, I am going to have to unit with everyone else and fight to change it as getting sad about it isn’t going to change a thing. I realise the futility in trying to explain to the ruling class how evil their actions are generally and that makes me angry. I then lose my temper at the slightest thing because I spend most of my day bloody furious about every headline. The thing that gets me and I will end this rather self indulgent post with this though, who wouldn’t be bloody furious in this world? Seriously?

Diagnosis is the thing I am going to complain about today. It’s a contentious topic in psychology that most psychologists have to cover at some point in their degree. There are famous anti-psychiatrists, such as Thomas Szasz and R D Laing. They will tell you that all diagnosis is probably a bad thing. Szasz going as far as to suggest that all behaviour is normal and ADHD doesn’t exist. Laing says that what we call mad is actually a perfectly reasonable response to a mad world. Whatever your take on this, it is worth bearing a few things in mind.

The first thing to consider is that most of the systems of diagnosis used are actually reliant on an archaic system of statistics, many of the formulae used in which, were actually designed for agricultural study and not people. These have been around for just long enough for most of the people  using them to have little or no idea how they were conceived and the ones that do, have been so convinced by their efficacy that they don’t bother to question it. The problem with this is, firstly they are based on research that is usually challenged within minutes of hitting a peer review system and due to epistemological differences there is never any certainty anyway. This then due to its numerical or statistical nature, requires arbitrary lines to be drawn around conditions. So, someone who hits a score of 58 on a depression scale does not get a diagnosis of depression whereas someone who gets a 60 does. They would get the same diagnosis as someone who scored 68 despite being considerably more depressed and closer to the person who does not apparently have this condition at all.

This is pretty much the case for most conditions in the diagnostic statistics manual, which is written by the American Psychiatric Association and used by clinicians in the UK, The USA and several other places. What is not explained to the person who has obviously been suffering enough to go and get checked out the first place, never mind the tribulations you have to go through to actually get to see a psychiatrist in the ridiculously underfunded NATIONAL Health Service, is the detail behind this. There are several scales within each test and they are usually constructed through testable measures but rarely actually just measure one thing. The depression tests will conform to some personality scale and it should really. If it just measured if you were sad, then that is not really depression. The arbitrary lines drawn around the diagnostic description of depression has been developed in studying people who exhibit disabling traits that might roughly be described as depression in common language or have been exhibited by a ‘significant’ number of people with the condition, depression.

Another thing to consider is that the research that results in this, while mostly well intentioned by the professional funding it, is largely funded by a pharmaceutical company. In America many post graduate students of psychopharmacology are actually funded by pharmaceutical companies. They often govern which articles get published and will quash research that does not result in a handy pill that they have already developed, yet strangely fits the exact bill of the studies that make it through peer review. Mental health has become big business and the significant number of studies getting out there on it, have a vested interest largely supported by capitalist greed, though what isn’t right?

A study that was brought to my attention last year which left me in that strange emotional place between crying and laughing, suggested that self administered online cognitive behavioural therapy would be made available within the NHS and it would ‘cut costs’. This is just about the stupidest idea anyone has ever had. It doesn’t work. There is evidence to suggest that it doesn’t work and yet because it is cheaper and is shown to work at about the same rate of recovery as people would evidence if you left the alone in the room for an hour, it is being implemented.

So, what is the point of this little rant? Well, to start a discussion really. I am going to continue ranting about this from various angles over the next few days and see where it takes me but really, I think i just wanted to get writing again and start asking some questions of the system we are compliant with due to lack of information. There are several areas that are worthy of discussion. There are some philosophical ones that are worthy of considering, where basically, most of the research done is from a philosophical perspective which all the coolest folk pretty much ignore. There is some history that would challenge this behaviour as a continuation of the savage institutions we used to have all over the world. So, it should be interesting.