“looking past these behaviors”

Lowering_The_Bar_Cover_2010.09.22This article got me thinking about the bigotry of low expectations and the importance of continuing to assert that every addict should be offered treatment services that provide a path to full recovery, not just symptom or harm reduction.

If it’s not suicide or drug overdoses doing the killing in psychiatric patients after all, how does that change the way we see severe mental illness? For one thing, it jerks this sort of disease back into the world of everyday misery. Society is excellent at sealing off the deep end, so to speak. Because this kind of illness is behavioral and has to do with the very ways in which we experience the world, it becomes easy to put the brakes on empathy. The study suggests that psychiatric patients are mostly dying in normal ways, albeit in hyperdrive: living life fast but miserable.

Hartz et al’s study also suggests that anti-smoking and other public health campaigns have effectively bounced off the mentally ill, perhaps in part because doctors are looking past these behaviors. “Some studies have shown that although we psychiatrists know that smoking, drinking, and substance use are major problems among the mentally ill, we often don’t ask our patients about those things,” Hartz says. “We can do better.”

via How Mental Illness Kills | Motherboard.

Recovery vs. Disease Management

hopeThe Hopeworks Community blog has an outstanding post contrasting recovery and disease management.

His focus is on mental illness, but the parallels are clear. One can’t help but reflect on the fact that the addiction recovery movement rose in response to the failure of the mental health system to help addicts recover.

There’s a lot there. It’s worth reading the entire post. Here are a few of my favorite points.

  • Recovery believes that individuals matter.  No degree of impairment or difficulty makes them matter less.
  • Disease management believes that the disease or diagnostic label is the most important thing about anybody.

On recovery vs. symptom management:

  • Recovery  believes the primary thing the  individual recovers is  control over his own life through the acquistion of knowledge, the development of tools that enables him with the support and encouragement of others to begin building the type of life that enables him to be the best and most version of himself possible.  It believes that recovery involves success in activities, connection with other people, in the contetxt of a life of meaning and purpose.at is important to that individual is important: his thoughts, feelings, goals, aspirations, and interests.  No degree of impairment makes those things matter least.
  • Disease management believes  that symptom management is the best things can be.  And for the most part it believes that those symptoms will be chronic, always in danger of reoccuring.  It largely believes that medication will be a life time need.

On hope:

  • Recovery assumes that hope is a real thing.  Life can and should be a movement towards better things.  The steps may be slow and require much in the way of patience, but no matter how slow or small they are they are real and should be valued and treasured.
  •  Disease managment believes that hope is limited to symptom management.  It assumes that people will need continual treatment and that life will always tend to be disrupted by the “course of the disease.”  Life never really gets better, the hope is that it get less worse.

On the humanity of people with mental illness:

  • Recovery assumes that mental illness does not cause you to lose anything essential to being a human being.  Mental illness may block you.  It may disrupt you.  It may damage you.  It may detour you.  It does not diminish what it means for you to be a human being.
  • Disease management believes that the much of what you do, much of what you think, much of  what you feel, and even much of what you believe is either a symptom of your disease or a reaction to a symptom of your disease.

Personal responsibility:

  • Recovery assumes personal responsibility.  It is not something done to you.  It is not something you are given as much as it is something you get.
  •  Disease management identifies responsibility as following directions given to you by medical personal.

On helping that helps the helper:

  • Recovery assumes that you can support and help others, that often, the greatest help you get is in the help you give.
  •  Disease management believes that your capacity to give to others is not as great as people who are not “mentally ill.”  They do not believe you can be near as helpful as a medical person.

Top Posts of 2011 #6 – The Epidemic of Mental Illness: Why?

CNN.com summarizes a NYT Book Review review of three recent books that challenge conventional wisdom about mental illness.

All of the authors of the new books agree on two thought-provoking viewpoints:

1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, through both legal and illegal marketing.
2. Mental illness is not caused by chemical imbalances in the brain.

You can view a talk from the author of Anatomy of an Epidemic here. He does not appear to be the gadfly one might expect. He appears pretty dispassionate and grounded in (ignored) research.

My impression is that it might be unfair to say that he argues  “mental illness is not caused by chemical imbalances in the brain”. This would give the impression that he believes mental illness is entirely exogenous. Rather, he seems to argue three points:

  1. That we have been barking up the wrong trees focusing on dopamine and serotonin regulation for psychiatric symptoms;
  2. that we overestimate the helpfulness of psychiatric drugs and underestimate the long term harms; and
  3. that the assumption that psychiatric symptoms indicate a chronic brain imbalance is wrong and that many people experiencing psychiatric symptoms might be better off if they are not placed on psychotropics on a long-term basis.
He suggests a different path for treatment that does include use of medications:
This does not mean that antipsychotics don’t have a place in psychiatry’s toolbox. But it does mean that psychiatry’s use of these drugs needs to be rethought, and fortunately, a model of care pioneered by a Finnish group in western Lapland provides us with an example of the benefit that can come from doing so. Twenty years ago, they began using antipsychotics in a selective, cautious manner, and today the long-term outcomes of their first-episode psychotic patients are astonishingly good. At the end of five years, 85% of their patients are either working or back in school, and only 20% are taking antipsychotics.
I also just noticed this unrelated paper finding high rates of recovery from borderline personality disorder. This conflicts with the conventional wisdom and raises the question of whether “personality disorder” is the proper way to characterize what’s going on with these patients.

The Epidemic of Mental Illness: Why?

CNN.com summarizes a NYT Book Review review of three recent books that challenge conventional wisdom about mental illness.

All of the authors of the new books agree on two thought-provoking viewpoints:

1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, through both legal and illegal marketing.
2. Mental illness is not caused by chemical imbalances in the brain.

You can view a talk from the author of Anatomy of an Epidemic here. He does not appear to be the gadfly one might expect. He appears pretty dispassionate and grounded in (ignored) research.

My impression is that it might be unfair to say that he argues  “mental illness is not caused by chemical imbalances in the brain”. This would give the impression that he believes mental illness is entirely exogenous. Rather, he seems to argue three points:

  1. That we have been barking up the wrong trees focusing on dopamine and serotonin regulation for psychiatric symptoms;
  2. that we overestimate the helpfulness of psychiatric drugs and underestimate the long term harms; and
  3. that the assumption that psychiatric symptoms indicate a chronic brain imbalance is wrong and that many people experiencing psychiatric symptoms might be better off if they are not placed on psychotropics on a long-term basis.
He suggests a different path for treatment that does include use of medications:
This does not mean that antipsychotics don’t have a place in psychiatry’s toolbox. But it does mean that psychiatry’s use of these drugs needs to be rethought, and fortunately, a model of care pioneered by a Finnish group in western Lapland provides us with an example of the benefit that can come from doing so. Twenty years ago, they began using antipsychotics in a selective, cautious manner, and today the long-term outcomes of their first-episode psychotic patients are astonishingly good. At the end of five years, 85% of their patients are either working or back in school, and only 20% are taking antipsychotics.
I also just noticed this unrelated paper finding high rates of recovery from borderline personality disorder. This conflicts with the conventional wisdom and raises the question of whether “personality disorder” is the proper way to characterize what’s going on with these patients.