![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by med_empowered on February 22, 2005, at 15:59:32
Hey! I posted the article on Seroquel because I'm writing a paper about the treatment/mistreatment of the "mentally ill" in the United States, and my take on the ethics (or lack thereof) of such issues as forced hospitalization and forced treatment. Here's the deal: when I started the paper, I had a slight suspicion something was amiss in all of psychiatry, especially when it comes to dealing with more severe mental illnesses. I knew that "mental illnesses" are found in higher rates among minorities and the poor, and that psychiatry also had a long history of sexism and homophobia. The more research I did, the more troubled I became until I reached the point I'm at now, the point at I realized that modern psychiatry is, for whatever reason, misleading the public and mistreating the troubled. Take our popular conception that "mental illness is an physical illness," for instance. We've all heard it, especially on this board--illness "x" is caused by an imbalance in the brain, and treatment(s) are available that correct it. Fact? Nope. No study has been able to pinpoint reliable, consistent differences between the brains of "normals" and "sick" individuals. This is true of all illnesses, but is important to keep in mind when dealing with severe mental illnesses, such as schizophrenia, since these illnesses often result in forced treatment or voluntary treatment with relatively dangerous "medicines". Since I'm talking about schizophrenia, I'll share what I've learned about it. Since schizophrenia became a diagnosis about 100 years ago, scientists of all sorts have done all kinds of research to find its "biological roots". We're talking: autopsies, blood tests, hair tests, brain scans, psychosurgery (LOBOTOMY), dialysis (not a typo; REALLY. NIMH funded research using dialysis on schizophrenics) and the use of numerous medications/drugs on schizophrenics. The only times differences between the brains of schizophrenics and "normal" people have been found are when: the mental illness was in fact due to a physical disease (encephelitis lethargica) that caused incredible brain damage AND when the treatments for the "illness" caused noticeable brain damage. That's it. In addition, the idea that schizophrenia must be a "biological illness" because neuroleptics can effectively "treat" it is fundamentally flawed. Here's some background on Thorazine, for instance: in the 1930's, phenothiazines (chemicals that would later yield Thorazine, Mellaril, and some other neuroleptics) were being used in the United States as a pesticide. While doing research on the toxicity of these chemicals, scientists found that they caused a reduction in activity among rats without inducing noticeable sedation. Fast forward to the 1950s: doctors needed a drug, or drugs, that could prep patients for minor surgical procedures without exposing them to the risks associated with full anesthesia--risks such as shock, for instance. Smith, Kline and French had an experimental drug they thought could do this that asked a French doctor to use on his patients. He loved it. The drug seemed to make his patients enjoy a sense of calm that approached apathy- not only did the upcoming minor surgical procedure not bother them, nothing at all seemed to. He decided to get more of the drug, and use it on institutionalized patients at a mental hospital...remember, the protection of human subjects wasn't such a big deal at this time, especially in psychiatry (lobotomies were still going on, after all). The shrinks loved it...but, contrary to popular belief, they didn't love it because it "cured" or "treated" illness; they liked it because it kept the patients calm and quiet, and therefore made them manageable. Early researchers compared this compound, which would be marketed as THORAZINE, to lobotomy. The drug company saw a huge oppurtunity...Thorazine was quickly approved by the FDA for treatment of nausea (its still used for this in some people) and then the drug company gave it a big makeover. Instead of being viewed as a "chemical lobotomy," the drug's makers pushed it as a "therapy" and a way to keep desperate patients out of the hospital, or bring them home if they were in the hospital. And soon, it wasn't just for schizophrenics anymore. Thorazine and the flurry of other neuroleptics ("antipsychotics") were also used for: "psychoneuroses," "senile agitation," aggressive behavior in children and teenagers, and they were also widely used in adult prisons, juvenile prisons, and in some countries (namely the USSR and China) as a form of social control...they were given to radicals and dissidents in massive doses. Sales took off...thorazine and other neuroleptics (again, the term "antipsychotics" is one developed by and for the drug industry.) were incredibly popular medications, despite the evidence of some serious problems. In 1957, the first known reports of what would later be called "tardive dyskinesia" appeared in the professional literature. Although European doctors seem to have responded by using smaller doses of the new drugs, American and British doctors not only used the higher doses found in the medical literature of the time, but they also EXCEEDED these dosage levels, sometimes giving patients many times the levels found in peer-reviewed journals. In the early 1960's, the first reports of what would become known as "neuroleptic malignancy syndrome" appeared in the professional literature. Although deaths had been reported prior to this, the connection between the new neuroletpics and resulting deaths had not been made; now, many psychiatrists saw a correlation. Still, American shrinks prescribed mad doses of the drugs, and the FDA didn't require a warning about Tardive dyskinesia or neuroleptic malignancy syndrome to be put on the label of the neuroleptics until 1968. American doctors, it appears, considered this a minor problem, though nurses and orderlies who worked closely with hospitalized patients seem to have been acutely aware of what was now known as "the Thorazine shuffe". In the 1970s, a few American psychiatrists published reports in which they expressed concern that tardive dyskinesia was a)affecting many long-time patients and b)not receiving adequate notice. Most shrinks ignored this until after U.S. Senate hearings were held in the mid-1970s exploring the ill-effects of the neuroleptics, and law makers expressed concern of the "misuse" of neuroleptics in those who were not mentally ill (note that, apparently, it was still ok to expose "schizophrenics" to these risks). Around that time, psychiatric "survivor" groups, still regarded as a deranged nuisance by many psychiatrists (read Surviving Schizophrenia by E. ALfred Torrey for more on this...he hates these people) started a)pressuring law makers for investigations and reform and b) suing negligent shrinks. Suddenly, all of psychiatry was interested--in large part because of costly litigation. In 1980, the American Psychiatric Association organized the first "task force" on tardive dyskinesia. If you're still reading this, this task force was formed a full 23 years after the tardive dyskinesia appeared in the literature. Their findings: TD afflicts women more often than men, and the elerly more often than younger patients; elderly women seem to be at a high risk. About 5% of patients will develop TD per year of exposure to neuroleptics, and around 20% will develop TD (note: many people, even many psychiatrists, have pointed out flaws in the data, such as the under-reporting of TD, especially milder cases. Better studies suggest old antipsychotics will cause TD in at least 20%, with the estimated total being more along the lines of 40%). Despite the risks, it seems that psychiatrists still touted their drugs as safe+effective; indeed, to cite Dr. E. Alfred Torrey again (I cite him b/c he is the self-declared schizophrenia and bi-polar "expert" and a "patient's advocate"), "antipsychotics are some of the safest, most effective drugs available". Torrey also notes that tardive dyskinesia isn't such a problem, after all-- he points out that many patients appear "unaware of their symptoms" (though apparently he and other observers ARE aware) and also points out that INCREASING THE DOSE OF THE NEUROLEPTIC can suppress symptoms. This is true; since neuroleptics tend to reduce ALL motor activity, periodic increases in dosage will suppress the abnormal movements of TD, at least for a while. Flash-forward to today. It is estimated that at least 100,000 people have died from neuroletpic malignancy syndrome worldwide. The new "atypical" antipsychotics which were first hailed for their ability to treat "the negative symptoms of schizophrenia" are now thought to be superior only in tolerability, at least according to the published reports I've read. Lawsuits have already been filed about tardive dyskinesia from these drugs--especially Risperdal. Reports have emerged that even these drugs can cause the dreaded neuroleptic malignancy syndrome, so even the new drugs carry an FDA-mandated warning about tardive dyskinesia and NMS. In addition, the rights the "mentally ill" gained in the 1970s are being lost. In light of "expert testimony" emphasizing the value and low side-effects of the new drugs, many courts have authorized the forced "treatment" of unwilling patients. Many states now allow for the forced hospitalization not only of patients deemed "a risk to themselves and/or others" or "unable to care for themselves," but also of patients deemed "at risk of relapse or deterioration". The mentally ill in these states are also often subject to "outpatient involuntary commitment," in which failure to adhere to provided "treatment" can and will result in hospitalization. This means that millions, one day, possibly billions, of US tax dollars are being used to: build "hospitals" for those who don't want to be "treated"; pay psychiatrists who enforce "treatment"; buy neuroleptics and other drugs that can be forced upon those who don't want them and, finally, to defend this system against lawsuits and legal challenges. Forced hospitalization is supposedly a "therapeutic" measure, but think about it: people who don't want treatment are being forcibly treated--injected with drugs, given electro shock-- against their wishes. The hearings are usually held in closed court and the results are often sealed. Patients in many states are denied the right to sue for monetary damages if they feel their rights have been violated. By comparison, criminal proceedings--even against those who have CONFESSED TO THEIR CRIMES-- are held in the open. Many people who are found guilty don't even go to jail or prison, and in fact, have few restraints upon their freedom--parole/probation is increasingly popular for some crimes, especially drug related crimes, and remains a viable option even for some violent crimes, such as domestic violence. These are people who have been found GUILTY of CRIMES in accordance with applicable laws and the constitution. Increasinly, as cases of wrongly convicted/imprisoned people comes to light, those who are able to prove they were wrongly imprisoned/convicted are able to pursue legal action against the state or federal government to rectify the wrongs. It is not so with mental patients.
Posted by SLS on February 22, 2005, at 16:34:47
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
> The only times differences between the brains of schizophrenics and "normal" people have been found are when: the mental illness was in fact due to a physical disease (encephelitis lethargica) that caused incredible brain damage AND when the treatments for the "illness" caused noticeable brain damage
How do you account for the enlarged ventricles seen in medication-naive schizophrenics?
- Scott
Posted by lunesta on February 22, 2005, at 16:42:06
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
regarding schizophrenic-
i firmly believe that most people that become schizophrenic have an actual physical problem, such as many diseases that have been linked to brain degeneration. the herpes viruses, toxoplasmosis, and chlyamida peniminoia are rampant in the normal population, most peoples immune systems supress all of these viruses, bacteria etc, but many peoples immune systems dont and i truly believe that most schizophrenics could be treated correctly if the available tests were given rather than neuroleptics handed out.
there is animal models of schizophrenic, using i think PCP, or ketamine . very interesting reserch.
everyone in my famiyl has been schizophrenic on my momdes side , and i suffer from fibromyglia and CFS, which my mom did also. i have not gone schizophrenic yet but there is a strong possibly which is why i researched it so much!
lunesta
Posted by med_empowered on February 22, 2005, at 16:46:17
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by SLS on February 22, 2005, at 16:34:47
the "enlarged ventricles" seen in as-yet untreated schizophrenics have been touted as a "sure sign" that the disease is biological is origin. The problems with these and other "findings" (such as reduced volume of the thalamus, etc.) include: 1) although some studies have identified brain "abnormalities" that are more common in the schizophrenic group than the non-schizophrenic group, these "abnormalities" tend to be observed in BOTH GROUPS. They also are not found in ALL, and, often, not even in MOST schizophrenics. The difference between the two groups, then, is one of frequency of the observed abnormality. Compare this to...brain cancer. THose who have brain cancer can be diagnosed with a brain scan showing the presence of tumor. Those without brain cancer don't have such tumors. The physical differences between the two groups is such that they establish a diagnostic test, and the differences are pretty simple: present or not present, therefore the patient is sick or not sick. This is not the case in schizophrenia or any other mental illness. Besides, controlling for neuroleptic use doesn't control for the use of other substances--legal and illegal.
Posted by banga on February 22, 2005, at 16:47:43
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by SLS on February 22, 2005, at 16:34:47
You've been doing a lot of research.
One thing however--twin studies do in fact point out that there is a large genetic basis to schizophrenia in a good proportion of cases. What we don't know is what exactly the undelying biological mechanism is.....
Posted by med_empowered on February 22, 2005, at 17:31:15
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by banga on February 22, 2005, at 16:47:43
hey! OK, here's the deal: schizophrenia MAY be caused by some sort of brain abnormality. The problem lies not in arguing this possibility, but in arguing that this is the ONLY possibility and that this has been established. It hasn't. To date, there have been been no studies finding inconclusive evidence firmly linking observed abnormalities to this malady. There have been observations of various "abnormalities," but nothing that has risen to the level of PROOF. There hasn't even been found an abnormality that is strongly correlated with schizophrenia.
As for genes...this is debatable. All the twin studies that have shown that genes may play a factor have also suggested that environment may also play a factor- a BIG factor. This is huge. Whenever you look at statistics, you must be careful not to confuse CORRELATION with CAUSATION. So, yes, there seems to be a genetic correlation...no one will deny that. However, this does not prove that genes CAUSE an individual to develop schizophrenia; it simply indicates that having close relatives with the disorder appears to play a role. What this seems to mean is that since genes have not been proved to CAUSE schizophrenia, external factors may play a huge role....factor in the current lack of any sort of brain abnormality proven to cause schizophrenia or even one that is strongly correlated with its development, and all one can really say is this: thoughts and behaviors labelled as "schizophrenia" may occur in some individuals due in part to genetic factors.
Posted by Phillipa on February 22, 2005, at 17:36:19
In reply to Genes, schizophrenia, and the brain, posted by med_empowered on February 22, 2005, at 17:31:15
They used to say that one's mother caused it. She would give mixed messages as "oh, I love you so much, Get away from me!". I do remember one pt I had that was schizophrenic who claimed he wanted to go to some northern state where the doctors were treating him with vitamins. He seemed okay when he was not in the hospital because when I saw him walking in the street I used to stop to speak to him. A day or two later, he would be back in the hospital involuntarily because he wasn't taking his meds. Fondly, Phillipa
Posted by SLS on February 22, 2005, at 17:50:32
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
What is schizophrenia?
What causes schizophrenia?
- Scott
Posted by med_empowered on February 22, 2005, at 17:51:42
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by banga on February 22, 2005, at 16:47:43
Lots of drugs have been used as models for schizophrenia. The first two were mescaline and LSD...for a while, some psychiatrists even used hallucinogenic agents themselves so they could experience "first-hand" what their patients were going through. THe government also funded many studies using these agents, some of which were highly unethical. The LSD/mescaline model was abandoned for a number of reasons (for one thing, the variability of the drug experience; for another, hallucinogens seem to induce visuals-heavy hallucinations, while schizophrenia is more often characterized by audio hallucinations). Other drug models have been used, as well...amphetamines, Ritalin, ketamine, and (I believe) PCP. Problems with drug models include: there doesn't appear to be any condition in animals that can be reliably compared to schizophrenia in humans. From what scientists have been able to piece together, it appears schizophrenia is a uniquely human experience. Also, the research itself has yielded little insight into treatment or diagnosis. The closest the research came to doing that was the amphetamine/Ritalin research, which suggested that since these drugs can induce or worsen psychosis through an effect on dopamine, schizophrenia may be a dopamine disorder. Since scientists at the time had just figured out that neuroleptics work on dopamine, it looked like they had found a winner. They hadn't. Anyone can have a stimulant-induced psychotic episode...though some people ARE more sensitive to this psychosis than others, it doesn't seem that this sensitivty is related to any underlying mental illness, although people who have been treated with neuroleptics are theoretically more sensitive than most others because of changes in the brain caused by neuroleptics. Also, I always try to remember to look at the study itself...many of the drug-model studies were funded by the NIMH, and continued until 1998. Around that time, there were lawsuits from patients who were claimed they were experimented on without their consent. There were also (and should be) serious ethical concerns about using those in the throes of psychosis in experiments. Those who favored the research said that even the floridly psychotic had the needed competence to agreee to such research (awfully convenient!), even though many of the subjects were INVOLUNTARILY HOSPITALIZED. Basically, these studies were often done on patients that were accessible...this raises serious problems, because the sample sucks (not even close to random) and adequate controls for other variables (drug exposure, gender, age, income, race, length of time with illness) were not in place.
Posted by Phillipa on February 22, 2005, at 18:58:01
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization » med_empowered, posted by SLS on February 22, 2005, at 17:50:32
US News, February 28th edition, states that schizophrenics have an altered sense of smell. They don't elaborate on that. Fondly, Phillipa
Posted by linkadge on February 22, 2005, at 19:24:42
In reply to Drug models of schizophrenia, posted by med_empowered on February 22, 2005, at 17:51:42
Nobody said we had clear cut evidence as to the nature of anything. Infact, anything can be debatable.Here is some truth. The theraputic actions of these drugs were often realized before any purported mechanisms were put into place.
For instance, the actions of the MAOI's were noted far before anyone ever knew what MAO was.
I guess what I am getting at is this. What gives?
What does it matter if we know how these drugs work. It is more about ethics.Sure the drugs aren't reliable all the time. But neither is anything else we have. If we had something that worked better, then we would use it.
Every time I get paranoid about the whole concept of mentall illness (how some propose that it is invented by the drug compaines) I remember our little friend Lithium.
Not only is it effective for bipolar disorder, and some forms of schisophrenia, and depression,
it is not a money maker for "anyone". Does it matter that we don't know the actions of lithium.Of course it doesn't. What matters is that it is robustly neuroprotective, neurotrophic, increases grey matter, antisuicide effect, reducing rehospitalizaction bla bla bla.
It comes down to this. People are suffering. We know that some of these agents (perhaps not all) do have some ability to relieve human suffering. Isn't that enough incentive to continue their use.
It only takes a sane brain a few minautes in conversation with a schitsohrenic to know that they have problems.
------------------------------------------
"No study has been able to pinpoint reliable, consistent differences between the brains of "normals" and "sick" individuals"
------------------------------------------Well I guess we havn't been able to "pinpoint" why aspirin relieves certain pain. Should we stop using it alltogether. Its a world of speculation, and in the midst of such profound and immanent suffering, can we afford not to act on certain speculations?
If we believe that these people are geniune in their illness (ie they're not pretending), if it wasn't the brain that mediated this behavior, what mediates it?
Anyone can raise a flag. I at least admire the effort of these scientist to make real and tangable changes in the lives of people who are suffering.
Have you seen the movie, A beautiful Mind? If this was not a "mental illness" what do you propose was at the heart of this man's suffering?
If haldol helps, when vigourous exercise, proper nutrition, and adequate social contact fails, what does it matter?Linkadge
Posted by linkadge on February 22, 2005, at 19:36:49
In reply to Re: Drug models of schizophrenia, posted by linkadge on February 22, 2005, at 19:24:42
One study found exceedinly more biproducts of phenylalanine, and anandamide in the brains of schitsohrenics. Anandamide is a naturally occuring brain compound with anticholinergic, and delieriant effects in high doses. Its action is mimicked by some of the halucinogenic compounds in marajuana, chocolate, and excssive exercise.
Phenylalanine can also produce paranoia, and delerium in human subjects at ultra-physiological doses.
Posted by med_empowered on February 22, 2005, at 19:46:41
In reply to Re: Drug models of schizophrenia, posted by linkadge on February 22, 2005, at 19:24:42
I don't know what the motives of those constantly searching for the biological basis of schizophrenia are. Really, for me its a non-issue. In scientific endeavors, even in sociology, which is my future field, all research is subject to review...a harsh, scathing, rip-it-apart review. This isn't done to be mean or destroy data, its done for the good of the whole pursuit...it helps move closer towards understanding. The biological basis of schizophrenia or any other mental illness isn't proven, yet we are told that "it must be biological"...this ignores other perspectives that could yield some insight. Take the Soteria Project, which in the 70's provided a non-drug environment in which people with schizophrenia could come to live and connect with a few other people with schizophrenia, and a mostly non-professional staff. The results were great, and the data is solid (it was started by Loren Mosher, who was the first head of NIMH), and some European countries are using the concept now, and there may be an Alaskan Soteria House soon. But...no one pursues it here. THe biological perspective is the "accepted" understanding of schizophrenia and mental illness. When we ignore other perspectives in something as serious as schizophrenia, and ignore the shortcomings of available data, we do science and the mentally ill, and society as a whole a great dis-service. I personally think along more or less the same lines as Thomas Szasz, who concluded that a diagnosis of any mental illness is really a "moral judgement". Maybe calling someone who is acting and thinking oddly "schizophrenic" is a relatively humane option, but are there others? Could we spend some of the money we spend on forced treatment on, say, helping the poor and minorities? (the poor and minorities are overrepresented in the schizophrenic group, and have been since the disease was "discovered"). Could we try some non-biological therapies, and see how that goes? I'm not saying we won't one day find that schizophrenia has some of its roots in biology, but I AM saying that the current "broken-brain" orthodoxy is seriously damaging to any kind of inquiry that seeks an alternative way to help individuals. I'm also afraid that telling troubled people that they are "sick" excuses society. Yes, mental illness responds to treatments that address the brain, but does this mean that ignoring possible social factors is good science, or even ethical? Isn't it concerning, also, that people who display abnormal behaviors are cast off as suffering from "a brain disease"? It lets everyone ignore them and what they're going through, and it denies us all an oppurtunity to learn.
Posted by linkadge on February 22, 2005, at 20:03:33
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
Hey, I'm all for non-biological alternatives. The medications are just one tool in the box. They are by no means the only tool.
There are many factors that may interact, genes, environment, stress etc. Tackling any aspect could improve the lives of those involved.
But on the other hand, the medications do have a place. Just as not everyone responds to drugs, some cases only respond to drugs.
If understanding the drugs mechanisms helps us develop more effective drugs with less drastic long term side effects, then all for it.
But you are certainly right in that it is really pointless, (and dangerous) for us to force ourself to believe that the disease has only one root.
Linkadge
Posted by banga on February 22, 2005, at 20:23:22
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
I don't know...I at least have understood for a long time that in many ailments including schizophrenia, both biological and psychosocial elements play a role. In recent twins studies it has been noted that in twins discordant for schizophrenia (one twin has it, the other doesn't), the one who doesnt is found to nevertheless have some underlying deficits--hinting that perhaps (of course this is theory)she/he has the biological vulnerability but wasn't triggered by environmental factors.
It is certainly not that you don't have some good points, but I am not sure who your audience is.....in psychology I think it is quite accepted that mental health issues often involve BOTH bio and environmental factors....and just because someone believes biology plays a role and meds can be helpful doesņ't mean they think other nonmed treatments aren't helpful and legitimate, and say "the more power to you!" if you do find a nonmed treatment that works well.
Though I am sure that some pdocs think tons of meds alone is the full answer, I think very many pay attention to data that show a combo of psychosocial intervention along with meds for any illness is the best recipe. I see plenty of studies looking at how people with schizophrenia can be helped with other, nonmed interventions, with great results.
I am not sure why you frame it as if it has to be one or the other.....A good parallel (perhaps overused) could be very high blood pressure--you have a predispotition, which has a greater chance of emerging if you expose yourself to external conditions (stress, diet, exersise or lack thereof)... some people may find ways to control it without meds, but many find that in addition to better lifestyle they do need a little medication to keep it under control.
I suffered ten years before I agreed to take antidepressants. Yes they are far, far from perfect; I agree that people should be more careful with wording--that the neurotransmitter deficiency theories for now are theories, not facts. They should label much better RE risks and withdrawal effects. But these meds are what we have got. It would be unethical for doctors to deny suffering patients these medications because we haven't proven *why* they work. And unethical to give them to a patient who lacks the judgement to see she/he is doing worse without them and is a danger to themselves.
Having said all that, I am of course VERY concerned about the instances where patient/subject rights are not protected, where people are overmedicated, etc. I am sure especially years past patients were mistreated and used like guinea pigs. Less so these days.
I believe that meds can be very helpful AND I believe we actually know little about them. I do also believe they are powerful and misuse of them can be harmful.Anyways I am gabbing on a bit here...
Posted by gardenergirl on February 22, 2005, at 20:44:43
In reply to OK, I guess this is my point..., posted by med_empowered on February 22, 2005, at 19:46:41
I'm really lost here. I've never heard that schizophrenia is entirely a biological disorder. Like every diagnosis of mental disorders I can think of, there has been evidence that shows correlations to biological factors and to environmental factors. It's all nature/nurture.
So, some scientists are exploring nature. Some nurture. I seriously doubt that there will ever be ONE answer in my lifetime. We're far too complex beings.
And I'm not following how the "cause" of schizophrenia relates to involuntary hospitalization. From my work and educational experience, a person must be a danger to themselves or others to be non-vol'd. Doesn't matter what their diagnosis is or how they "got" it, it's the symptoms, behavior, and support system (or lack of) that are the determinants. Being a danger to oneself includes not being able to take care of oneself.
Even if we were able to determine that schizophrenia, for example, is entirely nurture, that doesn't mean that biological treatments might not be affective in treating the symptoms. And it doesn't mean that someone might not be a danger to themself.
gg
Posted by banga on February 22, 2005, at 20:52:35
In reply to Re: OK, I guess this is my point..., posted by gardenergirl on February 22, 2005, at 20:44:43
Yes, exactly....What I said in 3000 words, both linkadge and gardenergirl said in 30 so well!
Posted by med_empowered on February 22, 2005, at 21:51:20
In reply to Re: OK, I guess this is my point..., posted by linkadge on February 22, 2005, at 20:03:33
hey, yet again! The reason I posted this whole thing, which I REALLY DID NOT MEAN TO CAUSE TOO MUCH CONTROVERSY was that the more I researched this paper, the more flaws I found with the "broken brain" concept. Oh, before my next big message-- LOTS of states (in the late 90s about 41) have changed their commitment laws. Commitment laws went from kind of lax to much more stringent following: deinstitutionalization and the psychiatric survivor's movement. Most states only allowed for hospitalization if the person involved was considered a threat to himself and/or others, or if the illness in question was so severe that the patient could not even work towards his/her own basic survival. This was a pretty big standard, and 19 states also allowed the person in question to request a trial BY JURY. Now, the standards have changed. If a patient is at high risk of "relapse" or "deterioration," he/she might be committed. In addition, patients who are NOT considered a risk to themselves or others can be compelled to take medication under the threat of hospitalization/re-hospitalization. The old laws weren't great, mind you, but they at least provided some protections...the new laws treat hospitalization much more lightly. When you take into consideration the fact that this "therapeutic intervention" involves depriving people of their freedom and/or forcing them into "treatment" (in fields of medicine besides psychiatry, patients have the right to refuse treatment..even if they may die or suffer serious harm as a result), this becomes a huge issue: these states are basically giving the mentally ill fewer civil rights than everyone else. I know hospitalization is supposed to "help," and that the shrinks involved are trying to "assist" the patient, but it's like the old saying goes: the road to hell is paved with good intentions. Whatever the intent, the result is that many states can now forcibly hospitalize far more patients than before, which not only negatively impacts the shrink/patient power-balance, but also the society/individual power-balance as well.
Posted by med_empowered on February 22, 2005, at 22:13:47
In reply to Re: OK, I guess this is my point..., posted by banga on February 22, 2005, at 20:52:35
Here's the deal: my paper/ pet project on mental illness led me to the conclusion that the biological perspective in terms of mental illness is pretty flawed. Inquiry into alternative perspectives and treatments has been seriously hampered. This is not just bad science, this is flat-out misleading and deceptive. We do not KNOW that mental illness is a "brain disorder," though it is a popular theory. We do know that chemical/biological treatments are often effective...but to connect the two would be inappropriate. Science isn't supposed to be dogmatic; the idea is that scientific inquiry should be used to explore issues/problems and that no one explanation should be valued more than another without very strong, very compelling data. In terms of mental illness, especially schizophrenia, the US psychiatric establishment has focused single-mindedly on the "broken brain" concept. Take, for instance, the international studies on schizophrenia...there are 2 BIG ones. The first showed that patients in the United States and other western, developed countries have a tendency to become chronically ill, even with medical treatment. Poorer countries, in Africa, Asia, etc. had better results in terms out long-term outcome, despite a low (16%) level of regular medication use. The follow-up showed pretty much the same thing. Psychiatrists have tended to dismiss the study, but the data was incredibly high-quality and consistent; furthermore, the studies were done by the World Health Organization...the same Org. that has helped in massive vaccination efforts, helped fight the war on AIDS, etc. There wasn't a political motive--it was simply scientific inquiry that produced results those dogmatically attached to one explanation didn't like. The studies continue to be ignored. This is a HUGE issue...in 1994, Harvard researchers released a study in which they concluded that the outcome for schizophrenic patients was essentially unchanged since the 1800's. Schizophrenics continue to have incredibly high suicide rates (around 15%) and other problems. So, to sum all this up, I didn't start this "discussion" to say that genetics don't play a role, or that genes don't play a role, but instead to emphasize that maybe society has a role, a big role, in the entire concept of mental health. While we're looking at brain scans and investigating drugs, we also need to look at very basic questions that I simply don't think have been adequately addressed. HOW do we define mental illness? Why does this seem to change over time? WHO are the mentally ill? Why does it seem that an unusual number of them are women, minorities, and/or poor? Why do mentally ill do better in some situations and/or societies than others? How do we define "improvement," anyway?
Posted by Phillipa on February 22, 2005, at 23:22:51
In reply to And I guess this is why I posted..., posted by med_empowered on February 22, 2005, at 22:13:47
The ability to function according to Society's expectations. Of course, that means what society, it could be a simple society as in lets say a remote Island setting. Or a complicated setting such as a big City like New York. More stresses, more crime, more expectations, more money required to survive, it goes on and on. Again, I say let's form Babbleland. All these minds and knowledge. You stand in front of them and state your problems and all the experts put their minds together and come up with a plan. Alternative as well as medical. Now that would be a place I would want to be. I'm tired so I guess I'm really Babbling. Fondly, Phillipa
Posted by linkadge on February 22, 2005, at 23:28:01
In reply to And I guess this is why I posted..., posted by med_empowered on February 22, 2005, at 22:13:47
------------------------------------------------
We do not KNOW that mental illness is a "brain disorder,"
------------------------------------------------
Few!!! I was beginning to think that mental illness was a disorder of the large intestine!
Linakdge
Posted by linkadge on February 22, 2005, at 23:33:15
In reply to Re: And I guess this is why I posted..., posted by linkadge on February 22, 2005, at 23:28:01
------------------------------------------------
We do not KNOW that mental illness is a "brain disorder,"
------------------------------------------------Are you another propotent, of the mental illness is a disorder of the large intestine theory ??
Linkadge
Posted by linkadge on February 22, 2005, at 23:42:47
In reply to ******What I meant to say.....***, posted by linkadge on February 22, 2005, at 23:33:15
It doesn't make any sence to me. With a name like "med-empowered" it seems like you must be taking medications for some type of mental illness. Which means that you are buying into the idea that mentall illness *is* a brain disorder.
To turn that around and say that another mental illness is factitious, made up, and not a brain disorder doesn't make any sence to me.
I mean if you want proof, stop taking your meds long enought to give yourself a refresher on why mental illness *may infact* be a brain disorder.
Linkadge
Posted by Mistermindmasta on February 23, 2005, at 0:02:14
In reply to Re: Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 16:46:17
"The problems with these and other "findings" (such as reduced volume of the thalamus, etc.) include: 1) although some studies have identified brain "abnormalities" that are more common in the schizophrenic group than the non-schizophrenic group, these "abnormalities" tend to be observed in BOTH GROUPS. They also are not found in ALL, and, often, not even in MOST schizophrenics. The difference between the two groups, then, is one of frequency of the observed abnormality."
So you are saying that certain abnormalities are more frequent among schizophrenics? I wouldn't say this is a sure sign that the disease is biological in origin, but it definitely adds to the data to support the idea.
"Compare this to...brain cancer. THose who have brain cancer can be diagnosed with a brain scan showing the presence of tumor. Those without brain cancer don't have such tumors. The physical differences between the two groups is such that they establish a diagnostic test, and the differences are pretty simple: present or not present, therefore the patient is sick or not sick."
I don't think that's a good analogy. It's ok, but not good. If, for example, seeing underactive NMDA glutamate pathways were as easy as seeing tumors, then yes, I would say it's a good analogy.
Posted by SLS on February 23, 2005, at 7:33:52
In reply to Why I Hate Neuroleptics and Forced Hosptialization, posted by med_empowered on February 22, 2005, at 15:59:32
I have a great deal of trouble reading. If you have already answered these questions, perhaps you can just post the link for it here:
Thanks.
- Scott
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