The medicalisation of mental distress

Kooli

I know a lot of counsellors, psychotherapists and psychologists frequent this forum, so I wanted to see what you all thought about the fact that our society mostly subscribes to the medical model of psychological distress.

I mean the fact that mental health issues, which are usually diagnosed in terms of personal and interpersonal difficulties, are treated medically.

And the fact that people in very serious distress are hospitalised and often strongly sedated.

And what do you think of the idea of mental health diagnoses, such as the DSM-IV - do you see them as an explanation? (i.e. 'I'm feeling this way because I have Generalised Anxiety Disorder) Or a description ('I have Generalised Anxiety Disorder because I feel this way').

In one way I am glad of it being handled this way, because I think it lends legitimacy to mental health issues and destigmatises them (although the fact that this is the case is concerning in and of itself).

But in other ways it just doesn't make sense to me. Life can be full of pain and distress, and our responses are a result of such a complex interplay of factors, that I wonder why it is so much accepted that psychiatry is the answer?

I'd also love if there are any psychiatrists floating about who would like to contribute.

And I realise of course that the issue is very different for different 'disorders' (e.g. depression vs. schizophrenia).

And I'm not arguing against medication by any means, it's more about the fact that we look at these issues through a medical framework.

Xluna

IMO, depression,and in turn anti depressants, are overly diagnosed.It's just an easy answer to what,in many cases, are more complex disorders which would take a lot more time and patience in psycho-therapy. But I guess drugging people up and making them like zombies looks good on paper-sometimes the wrong answer is better than no answer at all.

Valmont

Kooli wrote: »

I mean the fact that mental health issues, which are usually diagnosed in terms of personal and interpersonal difficulties, are treated medically.

What do you mean by usually? Does it not seem limiting to diagnose only according to personal and interpersonal difficulties? What exactly do you mean by these terms?

Kooli wrote: »

the fact that people in very serious distress are hospitalised and often strongly sedated.

I've no doubt that there is some truth in this; although if you could elaborate on what you mean by "serious distress" and "strongly sedated"? What disorders specifically? Is this in Ireland?

The moribund anti-psychiatry rhetoric (not your post) I seem to encounter is not very conducive to reasoned discussion on this subject and I only ask so many questions because I am still learning about this topic myself:)

Kooli wrote: »

I'd also love if there are any psychiatrists floating about who would like to contribute.

I think there a few psychiatry oriented individuals posting in the medicine forum.

JuliusCaesar

I think it may have to do with trying to de-stigmatise mental disorder as something you didn't bring on yourself but 'caught' and have to have treated.

Alcoholism for example - it's a disease, is the notion popularly. Stops the populace being more judgemental than they are!

Odysseus

Its an interesting topic one I have had an interest in for a number of years, and personally I think if you have an interest in this area, you need to develop your own thoughts around this. For example I personally would not work from the DSM or ICD-10, but I am familiar with both.

I do a lot of my work as a therapist in a very medicalised area, a methadone clinic. My area of interest being comorbid disorders, for example addiction and depression, or schizophrenia or any or the long list from the diagnostic manuals.

However, all my interventions revolve around talking, yet without the support of the various medical professions I work with, some of the patients I see would not be my patients. The drug whether its methadone or an SSRI facilitates them in engaging in a process with me.

Above you seem to be talking about people who identify themselves through their diagnosis, we as professionals sometimes end up doing that too. Its something we have to be careful about, not all addicts will steal all the drugs and not all schizophrenics are aggressive.

It’s a difficult one with the meds, they help a lot of people and not all of them will attend therapy, and even if they did it may not help. Whereas in others cases someone’s “disorder “can be controlled with meds and they may never seek or need therapy. I don’t view either as a cure all.

Sometimes people need meds meds to prevent self harm or harm to others, one example being a person with a diagnosis of paranoid schizophrenia who carry weapons when they stopped the meds. This leads to the mistaken that every “mentally ill” person can be dangerous in some people’s eyes.

If you had ever listened to a person discuss the severe effects of some “disorders” on them, it can be a very humbling experience, thought broadcasting or running commentaries or the anxiety behind OCD and how that can limit their ability to “function” in the world. So my opinion is if meds help great, I would personally like to see them in therapy too, but like the use of meds therapy has its limits too.

If you are interested try some of these:

The History of Madness, The Birth of the Clinic both by Foucault. The first is very interesting and a tad difficult, but the second is hard work

The myth of mental illness by Tomas Szasz.

Making us crazy by Kutchins & Kirk.

My own position is that no discipline possesses all the answers, its easy to point the finger at GPs or psychiatrists for giving out SSRI’s, but no psychotherapeutic model can offer a cure all, and neither can psychiatry.

None of my medics I work with really understand what I do, and that is down to training and the way medicine and psychology search for an objective truth to a subjective suffering. However, that’s merely the position I take in my own work, a follow therapist I work with takes a completely different position in her work and gets results.

My understanding of medicine is my doctor when I visit him objectively observes the signs and symptoms of my illness which leads him to a diagnosis of my condition; and designates a treatment based upon that. I don’t know if that is possible with “mental illness”. However, it is an opinion, I think we should be looking beyond the symptom. Yet professionals who work that way help people every day.


I hoped I haven’t gone to far off your question and just rambled on.

Kooli

Valmont wrote: »

The moribund anti-psychiatry rhetoric (not your post) I seem to encounter is not very conducive to reasoned discussion on this subject and I only ask so many questions because I am still learning about this topic myself:)



I think there a few psychiatry oriented individuals posting in the medicine forum.

I don't feel that I'm anti-psychiatry, but I'm just a little uncomfortable with psychiatry having jurisdiction over psychological issues. People who are severely mentally unwell are lucky to see a psychologist or counsellor, and it would be very rare to get to see one for any long period of time.

I know that medication can sometimes have quicker effects than counselling, and for this reason it can seem like the 'easy answer'. But sometimes I feel it is just papering over the cracks rather than properly dealing with anything, and the psychiatric services get clogged up with people who are chronically unwell for decades.

When I mentioned diagnosis being in terms of personal or interpersonal distress, I mean just that.

For many 'mental illnesses' (not all of course) the diagnosic criteria are based around thoughts, feelings and interpersonal behaviours. So at a very fundamental level it doesn't make sense to me that the treatment for such a presentation would be medical.

I suppose I'm coming at this more from an ideological perspective - the bigger question, rather than the specifics of individual cases or disorders. I'm just wondering about the value of this being our understanding of mental illness in a broad sense.

Valmont

Kooli wrote: »

When I mentioned diagnosis being in terms of personal or interpersonal distress, I mean just that.

Even though you never mentioned "distress" until this post I have quoted above. "Difficulties" seemed too vague a term which is why I questioned it.

Kooli wrote: »

For many 'mental illnesses' (not all of course) the diagnosic criteria are based around thoughts, feelings and interpersonal behaviours. So at a very fundamental level it doesn't make sense to me that the treatment for such a presentation would be medical.

Why not? Does the medical treatment of these mental illnesses not focus on the thoughts, feelings and interpersonal behaviours? If a benzodiazepine is supposed to reduce anxiety and in turn reduces the adverse effects on one's feelings, thoughts etc why does that not make sense? Lithium is supposed to reduce both manic and depressive episodes in individuals suffering from bipolar 1 disorder, does this not in turn directly affect their thoughts, feelings and interpersonal behaviours? The use of medication and in turn, a medical approach, seems perfectly rational to me, not perfect, but rational. I could go through a list of psychoactive drugs and how they are supposed to impact upon one's thoughts and feelings but you get the point.

I agree that we, as psychologists (or students, as I am) should question the medical paradigm as it applies to mental illness but if this questioning is to lead anywhere constructive, we must look at our underlying assumptions as to why we believe that medical intervention may not be the most viable treatment option. You say that you're not concerned with individual disorders, yet inductive reasoning is at the core of the scientific method and we should be concerned with the actual evidence available to us rather than beginning with an opinion and going from there.

metrovelvet

I dont have a psych background and I see what OP is saying but doesnt it depend on the mental illness? I have a friend who is manic depressive and when she went off the lithium for periods. OMG did she do some wacky things, and no amount of therapy can rewire what is not wired correctly in her.

At the same time I do think there are way too many bored housewives on xanex.

I also think a lot of families of the mentally ill, like schizophrenics, like to pin the tail on biology so they dont have to take any accountability for their double binds and whatever screwed up dynamics were in the family.

eth0_

metrovelvet wrote: »

I dont have a psych background

metrovelvet wrote: »

I also think a lot of families of the mentally ill, like schizophrenics, like to pin the tail on biology so they dont have to take any accountability for their double binds and whatever screwed up dynamics were in the family.

Schizophrenia is just a wee bit more complex than having a sh1tty childhood.

Kooli

eth0_ wrote: »

Schizophrenia is just a wee bit more complex than having a sh1tty childhood.

Yes it is more complex than that, but that does not actually disprove her point that it is difficult to look elsewhere than biology in the understanding of such illnesses because of the taboo of blaming the family.

It's an understandable taboo - it'd be hard enough to have a kid with schizophrenia without the additional burden of wondering whether you are to blame. BUT if it is not allowed to even suggest there is an environmental component then it holds back our understanding of how these things come about.

And yes metrovelvet I agree that it depends on the mental illness - bipolar disorder, schizophrenia, anything with psychotic symptoms I of course would never question the value of medication.

Valmont I see what you're saying, but it seems like we are coming at it from opposite directions. You seem to be saying that because these medications have an effect on thoughts and feelings that of course it makes sense that they be used in the treatment of thoughts and feelings.
I am not doubting that the medication are often effective, but my question comes earlier than that - how did it become something we TRIED to fix with medication (and eventually got it right, or close to right) when it doesn't seem to me to present as a medical issue.

Painkillers work for headaches. But that does not mean that someone who gets headaches every day should be told to take painkillers every day for the rest of their lives. We would look to solve the problem! (It's not a perfect analogy I know but I just think that because something works it doesn't mean it's necessarily the answer).

Odysseus

Valmont wrote: »

Even though you never mentioned "distress" until this post I have quoted above. "Difficulties" seemed too vague a term which is why I questioned it.
Why not? Does the medical treatment of these mental illnesses not focus on the thoughts, feelings and interpersonal behaviours? If a benzodiazepine is supposed to reduce anxiety and in turn reduces the adverse effects on one's feelings, thoughts etc why does that not make sense? Lithium is supposed to reduce both manic and depressive episodes in individuals suffering from bipolar 1 disorder, does this not in turn directly affect their thoughts, feelings and interpersonal behaviours? The use of medication and in turn, a medical approach, seems perfectly rational to me, not perfect, but rational. I could go through a list of psychoactive drugs and how they are supposed to impact upon one's thoughts and feelings but you get the point.

I agree that we, as psychologists (or students, as I am) should question the medical paradigm as it applies to mental illness but if this questioning is to lead anywhere constructive, we must look at our underlying assumptions as to why we believe that medical intervention may not be the most viable treatment option. You say that you're not concerned with individual disorders, yet inductive reasoning is at the core of the scientific method and we should be concerned with the actual evidence available to us rather than beginning with an opinion and going from there.

Hi Valmont, just my own thoughts on the above.

It doesn't make sense to me around the anxiety example, here you are totally treating the symptom not the cause. Benzos work great in one way, but even in my work [about 75% opiate abuse] they cause more damage than heroin. Bi-polar is a different matter, but then some people benefit form both treatment formats.

Yes some people left on benzos for the rest of the life, this is rarely justified. Here ideally the use of benzos should merely be an adjunt to treatment not treatment in totality.

Does the treatment not focus on symptoms rather than the thoughts, feeling etc? Also I could be wrong here [amd may open a can of worms I rather not]. I suspect the OP is coming at this from a psychotherapy viewpoint, the concept of evidence is different here than with psychology. I don't what to start battle of posts here, however, as you know this forum attrachs a varity of different therapists from different modalities. Each one of these will have a different viewpoint on the place of "evidence" in the way the work. Personally, I cringe at meetings when I hear the usual "evidence based practice", however, I have always noted here that I know lots of therapists here who do excellent work with one of those areas.

I think we all have a responsibility to be some what awear of how others work and think. For example, I have an "in service" training day tomorrow, the AM will focus on a certain modality the HSE want all of us trained in, the PM will be focused on practice of that modality. I will go in the morning to keep myself in loop of that particular nosology, however, I will never work that way, so I'm out of there in the PM. I do think its essential to be aware of other ways of working or theories.

Human suffering has become medicalised, in some cases it helps in others it doesn't, especially where the treatment, i.e. the pill is seen as the cure. In some cases it may well be, but in others I think not.

The above example whereby a person takes a pill for an anxiety disorder and sees it as the cure is a concern for me. The recovering addict who takes naltraxone and sees the pill as being responsible their recovery is another. As you said the list can go on from both sides, benefits and drawbacks.

It's a hard call and personally I see the challenge as being able to hold a flexible position around it. Fundamentalism in any format only leads an impass.

Odysseus

Kooli wrote: »

Yes it is more complex than that, but that does not actually disprove her point that it is difficult to look elsewhere than biology in the understanding of such illnesses because of the taboo of blaming the family.

It's an understandable taboo - it'd be hard enough to have a kid with schizophrenia without the additional burden of wondering whether you are to blame. BUT if it is not allowed to even suggest there is an environmental component then it holds back our understanding of how these things come about.

There are plently of theories around aetiology of schizophrenia, goggle Lacan and psychosis for one example. [Though I warn you its quite complex if you not familar with it] That's just giving you the one I'm most familar with. With time, study and clinical work you will become more familar with the type of questions you are asking, and of course you will just tighten how you formulate those question? Beware of seeking an ultimate answer:)

Kooli

Odysseus wrote: »

There are plently of theories around aetiology of schizophrenia, goggle Lacan and psychosis for one example. [Though I warn you its quite complex if you not familar with it] That's just giving you the one I'm most familar with. With time, study and clinical work you will become more familar with the type of questions you are asking, and of course you will just tighten how you formulate those question? Beware of seeking an ultimate answer:)

OK I ignored your first response that I need to 'find my own answer' with suggested readings, I recognise the good intentions, but here I feel I need to address the assumption you have made that I am some leaving cert student or something!

I am a qualified, registered, practising psychologist. This is not my first time thinking about the issue. Yes, I have already read around it. And no, Lacan wouldn't be 'too complex' for me (although I wouldn't be as familiar with psychoanalysis as you would). I was just looking for a discussion around the subject with differing points of view. I am not actually looking for 'answers from the experts' or advice or guided reading!!

I know there are differing theories of schizophrenia, but none that you will read in the Health Supplement of the Irish Times. It would simply be a can of worms to implicate the family, that's what I was saying. I'm aware of the competing theories regarding mental illness and its origins, but what I was hoping to discuss here is how people feel that the biological theories of mental illness have become the mainstream theories. Some people may even take them as fact.

Sorry if that's a hot-headed response, perhaps I didn't make it clear enough where I was coming from with this!

eth0_

Medication isn't the only treatment for schizophrenia and other serious psychiatric illnesses.

But look at it this way. Yes, talking therapies, CBT etc can help. But if a patient is having a psychotic episode you aren't going to get very far with talking, and if they are a danger to themselves/others then sedation and anti-psychotics are often necessary.

DublinWriter

Kooli wrote: »

And I'm not arguing against medication by any means, it's more about the fact that we look at these issues through a medical framework.

R.D. Laing was a genius.

Read his papers on the treatment of schizophrenia in working class women in Glasgow and the infamous 'thud' experiment and you'll hate Gay Byrne for ever for his treatment of him on the Late Late in the 70's.

Odysseus

Kooli wrote: »

OK I ignored your first response that I need to 'find my own answer' with suggested readings, I recognise the good intentions, but here I feel I need to address the assumption you have made that I am some leaving cert student or something!

I am a qualified, registered, practising psychologist. This is not my first time thinking about the issue. Yes, I have already read around it. And no, Lacan wouldn't be 'too complex' for me (although I wouldn't be as familiar with psychoanalysis as you would). I was just looking for a discussion around the subject with differing points of view. I am not actually looking for 'answers from the experts' or advice or guided reading!!

I know there are differing theories of schizophrenia, but none that you will read in the Health Supplement of the Irish Times. It would simply be a can of worms to implicate the family, that's what I was saying. I'm aware of the competing theories regarding mental illness and its origins, but what I was hoping to discuss here is how people feel that the biological theories of mental illness have become the mainstream theories. Some people may even take them as fact.

Sorry if that's a hot-headed response, perhaps I didn't make it clear enough where I was coming from with this!

Well, I appeared to have p!ssed you off, and I can assure you that I wasn't trying to do that, so on one hand I do apologise, but like us all you have to find your own answers. So if you thought I was being condescending I do apologise. Though to be fair you may totally disagree with you, but most people would struggle with Lacan, even I do after a long time. I'm sure you can admit that there are certain texts within your own field which are difficult to work with. I have given that general warning with Lacan the few time I have metion him here.


No I never thought you where some LC student or some thing similar, I'm not being funny here but your post clearly showed that you where not. If it came across that way sorry, some of that stuff is quite complex, I first read it about 12 years ago and would still struggle with it. However, I did read into your post that you may be coming from a psychotherpy view-point, but certainly not LC.

I also don't think I could be accussed as setting myself up as an expert as I constantly stated that I was merely giving my opinion.

Well I certainly wouldn't take biological theories as fact and I think I tried to state that in my posts. Alot of psychologists I know wouldn't have read the stuff I was suggesting. My point there being I was offering you another way of looking at it through the view-point of different authors. You appear to have disliked this. There is not that much else I can say on that one.

Discussion is what we are hear for, but I still stand over the you have to find you way through your clinical position. Having had another look over your op again, in my follow up posts, I think I gave you my opinions on the questions you asked. You may not have liked the "suggested reading" but that's how I respond to questions, What do you think of X? My general response in working life is have you read Y?

I find it useful when its put back to me, in that it my make me read something out of my field and reflect on it. Though I do wish I had the time to read all the recommendations. If you experienced that as patronising, I state again that was not my intention. In fact, I would have been interested in what you where reading in oder to try answer your question, and I wouldn't have seen it as "guided reading".


It would have told something about your current position and how you have arrived it. Did the authors I metioned not give some backbround into my opinions on the subject? Though that does not mean I agree with them.

So I'm not sure if I have anything else to say on in response to your last post, except maybe the "suggested reading" was part and parcel of some of the work that influenced the opinion that I was stating. Additionally I hope it supplies some background to my posts.

hotspur

DublinWriter wrote: »

R.D. Laing was a genius.

Read his papers on the treatment of schizophrenia in working class women in Glasgow and the infamous 'thud' experiment and you'll hate Gay Byrne for ever for his treatment of him on the Late Late in the 70's.

I agree that RD Laing was an amazing guy and The Divided Self is one of the most insightful psychology books I've ever read, but having seen footage of him on the Late Late that time he was utterly pissed. Laing may have been a great psychiatrist but he was also an irascible prick.

There is a huge amount to pick over and go into in this thread, too much to really go into. Any full analysis of the factors which have contributed to the dominance of the biological focus on mental illness would need to look at the political issues of professional domain within the health field, the role technology, the role of the profit based pharmaceutical industry, the role of health insurance companies, and the economic constraints within public health institutions which are demanding of the most parsimonious solutions.

In truth the current situation runs a little like this:
You are experiencing psychological distress such as depression? Take a pill and see if that works.
If not, some CBT might do the trick, but still take a pill because doctors, chemists, and pharmaceutical employees have families to feed too you know.
No joy? How about another pill, there's more than one neurotransmitter you know. Try some therapy which is more naturally focused on deeper longer lasting schemas or has some efficacy for personality disorders (though cognitive therapy is trying to branch into this too), we have over 200 psychotherapeutic modalities to choose from, ya pays your money and takes your choice.

From a consumer's perspective psychiatric medication has a lot to recommend it. How elegantly and painlessly hermeneutical is having a biochemical imbalance which can be ameliorated by taking a pill.

Unfortunately this is one of those topics which it is difficult to engage in because of the idiocy and ignorance of many who hold similar opinions. I'm not anti-psychiatry as such and I get bored by the Szasz type brigade arguing from a libertarian political perspective, or the nutcases. But it's a topic which I feel needs to be engaged in at a societal level and not at psychiatry conferences.

Also Kooli if Lacan doesn't confuse you then you're not paying enough attention A good easy book on him is Bruce Fink's A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique. A wonderful book imo.

Odysseus

hotspur wrote: »

In truth the current situation runs a little like this:
You are experiencing psychological distress such as depression? Take a pill and see if that works.

If not, some CBT might do the trick, but still take a pill because doctors, chemists, and pharmaceutical employees have families to feed too you know.
No joy? How about another pill, there's more than one neurotransmitter you know. Try some therapy which is more naturally focused on deeper longer lasting schemas or has some efficacy for personality disorders (though cognitive therapy is trying to branch into this too), we have over 200 psychotherapeutic modalities to choose from, ya pays your money and takes your choice.

From a consumer's perspective psychiatric medication has a lot to recommend it. How elegantly and painlessly hermeneutical is having a biochemical imbalance which can be ameliorated by taking a pill.

Unfortunately this is one of those topics which it is difficult to engage in because of the idiocy and ignorance of many who hold similar opinions. I'm not anti-psychiatry as such and I get bored by the Szasz type brigade arguing from a libertarian political perspective, or the nutcases. But it's a topic which I feel needs to be engaged in at a societal level and not at psychiatry conferences.

Also Kooli if Lacan doesn't confuse you then you're not paying enough attention A good easy book on him is Bruce Fink's A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique. A wonderful book imo.

You make some excellent points there Hotspur, but I still recommend reading Szasz, I don't buy the logic, but I think he is still important because of the points you make. However, I usually balance it out by referring to Jone and Poletti and "The Italian Experience".

I would need to re-read Laing again its been too long.

Valmont

Kooli wrote: »

You seem to be saying that because these medications have an effect on thoughts and feelings that of course it makes sense that they be used in the treatment of thoughts and feelings.

That's all that I am saying- Proposing that their approach doesn't even make sense is rather condescending and doesn't contribute in any way to meaningful debate on the subject.

Great post Hotspur.

sambuka41

Just on the subject of medication, my mother was diagnosed with Agoraphobia 17 years ago. She has been on several different anti depressants, about 9 years ago she started on an SSRI and it has changed her life compelely. She is now able to go out alone for short trips. This is not solely a result of the meds, she used to attend a psychiatrist. She done this for 11 yrs, she stopped therapy when she felt that she gained all she could from it. During those years she learned how to accept that she may never know the incident or cause of her condition ( she personally believes its a combination of her childhood and hereditary) She continues to take her "happy pill" (as she calls it!) every day and knows that she will have to do that every day for the rest of her life. Unfortunately agoraphobia in her case is not one of those things that will be resolved thru therapy-life long for her.

My point thru all this is that although i would be skeptical of the use of the medical model but in her case it worked,also the meds are what gives her a quality of life. A quality of life that therapy would not be able to provide.

Odysseus

sambuka41 wrote: »

Just on the subject of medication, my mother was diagnosed with Agoraphobia 17 years ago. She has been on several different anti depressants, about 9 years ago she started on an SSRI and it has changed her life compelely. She is now able to go out alone for short trips. This is not solely a result of the meds, she used to attend a psychiatrist. She done this for 11 yrs, she stopped therapy when she felt that she gained all she could from it. During those years she learned how to accept that she may never know the incident or cause of her condition ( she personally believes its a combination of her childhood and hereditary) She continues to take her "happy pill" (as she calls it!) every day and knows that she will have to do that every day for the rest of her life. Unfortunately agoraphobia in her case is not one of those things that will be resolved thru therapy-life long for her.

My point thru all this is that although i would be skeptical of the use of the medical model but in her case it worked,also the meds are what gives her a quality of life. A quality of life that therapy would not be able to provide.

Thanks for your personal example, it shows the subjective nature of what we are talking out here. I don't know because I wasn't there but alot of psychiatrists don't engage in psychotherapy its a common misconception. However, I personally know some who gained added psychotherapy qualifications. So maybe het psychiatrist did engage in therapy with her, especially if she seen the same one for such a long period.

We could dissect the form of treatment she engaged in, but my viewpoint would be it not only worked for here, but you seem to suggest that it significantly improved her quality of life, whicj at the end of the day is the main thing.

Kooli

Odysseus wrote: »

Well, I appeared to have p!ssed you off, and I can assure you that I wasn't trying to do that, so on one hand I do apologise, but like us all you have to find your own answers. So if you thought I was being condescending I do apologise. Though to be fair you may totally disagree with you, but most people would struggle with Lacan, even I do after a long time. I'm sure you can admit that there are certain texts within your own field which are difficult to work with. I have given that general warning with Lacan the few time I have metion him here.


No I never thought you where some LC student or some thing similar, I'm not being funny here but your post clearly showed that you where not. If it came across that way sorry, some of that stuff is quite complex, I first read it about 12 years ago and would still struggle with it. However, I did read into your post that you may be coming from a psychotherpy view-point, but certainly not LC.

I also don't think I could be accussed as setting myself up as an expert as I constantly stated that I was merely giving my opinion.

Well I certainly wouldn't take biological theories as fact and I think I tried to state that in my posts. Alot of psychologists I know wouldn't have read the stuff I was suggesting. My point there being I was offering you another way of looking at it through the view-point of different authors. You appear to have disliked this. There is not that much else I can say on that one.

Discussion is what we are hear for, but I still stand over the you have to find you way through your clinical position. Having had another look over your op again, in my follow up posts, I think I gave you my opinions on the questions you asked. You may not have liked the "suggested reading" but that's how I respond to questions, What do you think of X? My general response in working life is have you read Y?

I find it useful when its put back to me, in that it my make me read something out of my field and reflect on it. Though I do wish I had the time to read all the recommendations. If you experienced that as patronising, I state again that was not my intention. In fact, I would have been interested in what you where reading in oder to try answer your question, and I wouldn't have seen it as "guided reading".


It would have told something about your current position and how you have arrived it. Did the authors I metioned not give some backbround into my opinions on the subject? Though that does not mean I agree with them.

So I'm not sure if I have anything else to say on in response to your last post, except maybe the "suggested reading" was part and parcel of some of the work that influenced the opinion that I was stating. Additionally I hope it supplies some background to my posts.

Yes it did piss me off at the time, I'm very sensitive to being talked down to, but I'm feeling fine now!

I don't mind the odd suggestion of reading, and I do that myself if I feel it fits with what the OP is looking for, but my point is that I'm actually here on this discussion board to discuss it! Not here as someone who has never thought about it and just wants to know where to start.

So I was actually more interested in what the people here think, rather than what the famous theorists in the area think.

Kooli

hotspur wrote: »

There is a huge amount to pick over and go into in this thread, too much to really go into. Any full analysis of the factors which have contributed to the dominance of the biological focus on mental illness would need to look at the political issues of professional domain within the health field, the role technology, the role of the profit based pharmaceutical industry, the role of health insurance companies, and the economic constraints within public health institutions which are demanding of the most parsimonious solutions.

Yeah I totally agree. But sometimes I wonder if the medication route just seems like it is more economically viable...

And I don't necessarily think psychotherapy is always the answer either. Sometimes it is, and I think often the patient/client knows when that is what they need.

But there are also bigger questions about how our society runs these days that can be conducive to psychological distress. (For example the fact that we are a very individualistic society, and the fact that there is still such a stigma discussing mental health issues)

Kooli

Valmont wrote: »

That's all that I am saying- Proposing that their approach doesn't even make sense is rather condescending and doesn't contribute in any way to meaningful debate on the subject.

Great post Hotspur.

I don't really get what you're saying here (or maybe I just disagree!)

I don't see how saying something doesn't make intuitive sense to me is condescending and non-contributary to be honest.

Like if someone were to say "It just doesn't makes sense to me that someone has been jailed for mortgage arrears and someone else got a suspended sentence for holding thousands of child porn images", would that be condescending? Or is it just a statement that something doesn't seem to make personal sense to that individual.

All I'm really saying is that treating psychological distress medically doesn't fit with my understanding and experience of psychological distress. I'm not saying it should never be done. I'm not saying it doesn't work. I'm not saying psychiatry is bad. I'm just questioning some of the widespread assumptions about what mental illness actually is. I don't see how that is condescending or not open for debate.

You seem to say that it works, therefore it makes sense. I just don't agree with that thinking. But I'm happy enough to disagree!

Odysseus

Kooli wrote: »

Yes it did piss me off at the time, I'm very sensitive to being talked down to, but I'm feeling fine now!

I don't mind the odd suggestion of reading, and I do that myself if I feel it fits with what the OP is looking for, but my point is that I'm actually here on this discussion board to discuss it! Not here as someone who has never thought about it and just wants to know where to start.

So I was actually more interested in what the people here think, rather than what the famous theorists in the area think.

I repudiate your statement that I was talking down to you, you may not have got want you where seeking but there is a big difference there. I generally use theory to formulate my thoughts maybe you don't fair enough.

There are many ways to view the question of mental health, without reviewing what other researchers think you don't move forward, offering you one small line of thought does not equate with thinking that you have never researched the topic in hand. However, you find that offensive, but that down to you. I was told something similar by some with 20+ years more experience than me today. I know he wasn't talking down to me. Sorry if this is rushed I'm on a break and have to go now go.

Valmont

Kooli wrote: »

You seem to say that it works, therefore it makes sense.

You seem to not understand what a straw man is. How you managed to deduce that is beyond me and, apparently, my previous posts. Instead of talking about what I seem to say why don't you engage with the points I have made in a straight forward manner? I would still like you to explain how you can confidently assert that the entire medical field of psychiatry simply doesn't make sense. Treating depression with a spoon and a basketball doesn't make sense but psychiatry, despite its varying levels of efficacy, has an established rationale and logic behind it and denying that is just plain ignorant.

Kooli

Kooli wrote: »

Valmont. You seem to be saying that because these medications have an effect on thoughts and feelings that of course it makes sense that they be used in the treatment of thoughts and feelings.

Valmont wrote: »

That's all that I am saying-

Kooli wrote: »

You seem to say that it works, therefore it makes sense. I just don't agree with that thinking. But I'm happy enough to disagree!

Valmont wrote: »

How you managed to deduce that is beyond me and, apparently, my previous posts. Instead of talking about what I seem to say why don't you engage with the points I have made in a straight forward manner?

Maybe I made some leap there along the way but I don't see it?

I actually didn't mean to argue with anyone about anything! So maybe it's best I withdraw from this. I'd hoped to get people's own personal opinions about this as we are all people who either work in the field or are interested in it.

I understand that my one snotty post to Odysseus was probably a bit over-snotty, but I'm not sure why else I'm drawing such irritation here!

Anyway, I bow and retreat...

Kooli

Odysseus wrote: »

I repudiate your statement that I was talking down to you, you may not have got want you where seeking but there is a big difference there. I generally use theory to formulate my thoughts maybe you don't fair enough.

There are many ways to view the question of mental health, without reviewing what other researchers think you don't move forward, offering you one small line of thought does not equate with thinking that you have never researched the topic in hand. However, you find that offensive, but that down to you. I was told something similar by some with 20+ years more experience than me today. I know he wasn't talking down to me. Sorry if this is rushed I'm on a break and have to go now go.

It wasn't the suggested readings that made me feel talked down to, it was more the comments like: "With time, study and clinical work you will become more familar with the type of questions you are asking, and of course you will just tighten how you formulate those question? Beware of seeking an ultimate answer" That just sounded a little patronising to me. But who cares really, it's fine, I still wanted to discuss it!

I never said I was seeking the 'ultimate answer', and when Valmont mentioned 'straw man' it made me wonder where I gave the impression that I wanted to debate this one side versus the other, and prove somebody wrong.

You seem to think that I don't want to read about any of these things. That's not what I'm saying. What I'm saying is that that is not what I came HERE for. I thought this was a discussion board where we could discuss it! And discuss our own views on it. That's all really. And I know that can include a recommendation of reading, but it seems like you thought a recommended reading was all I needed because I was looking for 'the ultimate answer'.

I believe this is an issue that touches all our work. I thought people would like to discuss it! Yes I agree that reading about this stuff is important, but only with the view to coming to your own conclusions. But anyway, not to worry, I'll find someone who will discuss it with me!

p.pete

Guys, you're all grown ups, please don't make me have to moderate.