So, in response to the guardians latest article on mental health (http://www.guardian.co.uk/society/2013/may/12/psychiatrists-under-fire-mental-health)
I feel it’s appropriate to write a blog on mental health diagnostic criteria and the use of the current treatments that are available.
As of current, mental health disorders are most commonly classified and diagnosed from one of two manuals – the ICD-10 or DSM-IV. Between the two manuals there are more than four hundred different definitions of mental disorders.
The problem is that there are so many different mental health disorders included that alot of the diagnostic criteria can overlap into different diagnosis and it is not uncommon for someone to get two or more different diagnosis from different doctors. Alot of the diagnostic criteria is vague and doesn’t take into consideration social circumstances of the individual. For example someone who is stressed about an upcoming exam or assignment may well show all the signs of depression but may not actually be depressed.
I do not think that prescribing drugs as a form of treatment for mental health problems is neither safe or effective. No two people are the same and neither are their circumstances. It is irresponsible to give the same medication to completely different people based on the guidlines of a textbook. Ultimately the ICD-10 and the DSM-IV are there to guide and provide information, but I believe it is down to the psychiatrist to use their own judgement based on the individual, their needs and their environment to decide upon the best plan of action and treatment.
As someone who has spent seven months as an inpatient in the priory hospital for major depression and schizo affective disorder I feel that too much emphasis is placed on the diagnosis and not enough time is spent on getting to the root of what caused the problems to begin with. The truth is if you look at the diagnostic criteria for mental health illnesses, nearly everyone can be categorized as having some kind of personality disorder. Having met over thirty young people struggling with mental health problems ranging from depression, to psychosis to boderline personality disorder whilst on my hospital ward, I can say that eight out of every ten people had mental health problems due to environmental and social factors such as trauma, abuse or social breakdown. Despite this EVERY person on my ward was put on either morning medication, afternoon medication or night medication or all of the above. I feel very strongly that unless the trigger which has caused a decline in mental health is solved or eradicated then regardless of medication you will not get better. Which is why I have to agree with the original article in question and say that I do not support the use of medication being so freely handed out to treat mental illnesses.
The other problem I have with medication is that it is used to supress your irrational behaviour and thinking. For example someone with ‘schizoaffective disorder’ like myself would get perscribed a high dosage of aripiprazole on top of a high dosage of fluoxatine to supress negative thoughts. The only reason it appears to show positive results in terms of supressing the negative behaviours is because the medication is so strong, it supresses your thinking completely, to the point where you become too tired, and too drowsy to even be able to gather any negative thoughts together hence the appearance of no longer being depressed. The major problem here is that the medication is giving a false sense of security, giving the impression you are making progress when infact all you are doing is masking the underlying problem.
An example of this is going to the toilet. Instead of flushing the toilet to get rid of the waste you spray air freshener over the top. At first the smell is disguised in fact you start to convince yourself its gone but after a while it starts to smell again. The air freshener hasn’t worked so next you decide to close the lid. Once again the smell is gone for a while but every now and then you get whiffs of the stink. But not enough to be concerned about. Soon you realise that actually you need to use the toilet again so you lift the toilet lid up and low and behold not only is the left over waste still there but in fact it actually smells worse than before. Completely defeated you realise that the only way to solve the problem is to get rid of it completely. The only option left is to flush the toilet.
It is exactly the same principle when it comes to dealing with mental health problems. You can try and cover it up with medication and choose to be in denial of the root of the problem but no matter how much medication you are on, it doens’t hide the fact that the problem is still there. You just end up in a viscious loop. When the meds stop working, the psychiatrist just ups the dose or changes the medication. Soon you become so reliant on it that you start to depend on it. To the point where you don’t know how to live any other way. Medication and hospitals only work in the short term. Over prolonged periods of time they can actually start to have a detrimental affect and cause more harm than good.
Medication is a short term solution to a long term problem.
Giving a mental health patient medicaton takes a matter of minutes. Building up confidence takes years. If a patient goes to their doctor and tells them their symptoms, the doctor ticks the boxes, diagnoses an illness and perscribes the medication to match. The whole process can be done in a few minutes. The patient goes away happy and so does the doctor.
The problem is that everybody is looking for a quick fix. Confidence takes years to build and just seconds to break. What doctor or psychiatrist is going to tell their twenty something year old patient who is suffering with major depression as a result of low self esteem and a lack of confidence that the only way they will get better is by having several years of intensive therapy and counciling and even then there is a chance that unless the root of the issue which originally caused the issue is eliminated from that persons life, after several years they STILL might not be better.
So whilst you could argue that medication does nothing more than mask the problem whilst prolonging a full recovery, encouraging the patient to become heavily dependant and reliant on medication. One could also argue that for some having the security and comfort of having that medication to fall back on at a time when mental health services are being cut is essential to ensure the safety of those who need it.
Whether or not giving medicine out for this reason is morally right or not is a different matter.
I strongly believe there are three stages to dealing with mental health. The first being prevention, starting from educating our children at school age on health and wellbeing and how to manage a healthy mind including learning about stress and the pressures they may face growing up. The second stage is diagnosis with the third being cure. Unfortunately when it comes to mental health there seems to be a grey area in between diagnosis and cure. Instead of trying to irradicate the problem we isnstead seem intent on papering over it, which will work for a while but in time will prolong the problem making it harder to cure.
We all know and agree that regular therapy sessions mixed with councilling is probably the best way to go about recovering from most mental illness. But the big question is, do we have the resources and the funds available to be able to offer this to everyone who has mental health problems. Taking into consideration all the cuts to the services which are specifically there to deal with mental health such as the social services sector, child and adolescent mental health services plus the many closures of a&e departments up and down the country. This is one of the reasons I believe it is important to remain vocal and against the proposed plans to cut so much of the funding from the mental health services of an already over stretched and vital sector of society.
In an ideal world there should be less emphasis on medication to treat mental health illness and the label that comes with it but it makes for a near impossible task if the money and the resources to do so are not available.