over the past few days, I was reading a new book, on the "psychiatry's troubled search for the biology of mental illness". Why is this search so troubled? Why the management of mental health is so problematic?
As a chemist working on the interface of biology/biochemistry/inflammation, I have been wondering for a long time now: do GPs and consultants receive adequate training on the chemistry of drugs? on the pharmacology of diseases? is it just a module they are taught or something more substantial?
Psyche is not as simple as a petri dish. Psychiatrists can not use X-rays or microscopes to examine the inner soul. But, they can use a manual, they call it Diagnostic and Statistical Manual of Mental Disorders
( as if our psyche can fit in a bloody manual ) !
So, from that manual, they can derive that I suffer from X (e.g. Schizophrenia), you suffer from Z (e.g. bipolar disorder, type 1 or type 2 or type 234566, you see...
there are some many different bipolar disorders...
that's why now they (have to) call it "bipolar disorder spectrum"
and the new (sic!) concept now is "personalized treatment".
Copying page 271 of Anne's book:
"the bold 1980s venture to bring about a "biological revolution" has now run into the sand as well. Far from flocking to psychiatry, many pharmaceutical companies have recently been fleeing it, as the prospects for new and potentially lucrative psychiatric drugs have dimmed. The manual on which the profession has rested so much of its biological authority has come under sharp attack, not just by cranky outsiders but by informed insiders committed to the mission".
(...)
"Among the very many people who present to a general practitioner or a psychiatrist with a mental affliction, some are (almost certainly) suffering from a real illness, one that is understandable (in principle) like any other medical complaint. By the same token, others are (almost certainly) not. Mental suffering takes many forms and has many causes, only some of which have roots in disease. The suffering of those who are not really ill in any meaningful medical sense can still be acute."
Let's move back to the hospital (aka prison) environment and read the case of Daniel Paul Schreber. Schreber's career as a prominent German judge ended when, in 1884, he went mad at the age of 42. His renowned Memoirs of My Nervous Illness, written during a remission and published in 1903, describes with astounding lucidity damned near every torment that schizophrenia can bring. Of these, Schreber's worst agony was clearly the isolation his treatment forced on him. At the asylum he was placed in (the same sort Kraepelin visited to refine his view of dementia praecox), Schreber was miserable and spoke little. He writes that, while hospitalized there, he was "completely cut off from the outside world, without any contact with my family," "forsaken," "left to rot."
The completeness of this alienation helps explain the anthropologist's fascination with schizophrenia. Schizophrenia is where culture—Western culture, anyway—disintegrates.
Over the past few years, through different life environments, I studied closely the biochemistry of brain diseases and mental disorders; the (lack of) holistic approach that the mental healthcare have in Ireland and the pharmacology of Second Generation Antipsychotics (SGAs) .
The more I read, the more questions emerged...
Why isn't there any holistic treatment?
Why can't psychiatrists collaborate actively (not in paper!) with therapists (like psychologists, clinical psychologists, mentors etc)?
Once a patient is diagnosed with a disorder (what a stigma to be called "I have this DIS-order" as if all the rest are orderly fine!), some medication is prescribed and all...grand (is it though? All grand?).
What about re-assessing this person?
How often?
By the same practitioner?
Is there any bias involved if the same psychiatrist assesses the same person for life?
And what about the (lack of) "holistic approach"?
How can medication work on its own? Well it doesn't but this is the easiest (and most profitable!) approach.
They don't really care about us.
They are here to sell us drugs.
They are here to keep feeding our bodies with pharmaceuticals as if mental health can be promoted only by chemical "stuff".
And what about the soul? Psyche means soul...but, hey, the medical establishment can't think outside the DSM manual and the BigPharma shortsighted horizons.
Let's imagine this picture for a moment: it is time for the monthly check up but our imaginary patient is not seen by a psychiatrist but by a team of people (nutritionist, PE mentor, mentor, psychologist and psychiatrist) and they all have a chat...not for five minutes (as it happens now!) but for an hour, to talk about life, the weather, the moods, cinema, music. They can then collectively design their therapeutical approach beyond mere prescription of "drugs".
Hey Yannis? Are you mad?
This takes a lot of listening and much less prescribing of "stuff"...
Uncomfortable truths...
YannisZ
Clonlara 7.7.2020
Further reading
on stigma
side effects of SGAs in children
