“In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were pure brain disorders that would eventually yield to drugs. Now they are recognizing that social factors are among the causes, and must be part of the cure.”

“It’s not just about the brain. It’s not just about genes. In fact, schizophrenia looks more and more like diabetes. A messy array of risk factors predisposes someone to develop diabetes: smoking, being overweight, collecting fat around the middle rather than on the hips, high blood pressure, and yes, family history. These risk factors are not intrinsically linked. Some of them have something to do with genes, but most do not. They hang together so loosely that physicians now speak of a metabolic “syndrome,” something far looser and vaguer than an “illness,” let alone a “disease.” Psychiatric researchers increasingly think about schizophrenia in similar terms.”

There’s nothing “new” here but it’s nice to see the psychopharmacology “revolution” coming to and end.

The British Journal of Psychiatry calls for an “end” to the psychopharmacological revolution.

“In sum, Holmes sent signals that he was on the edge—but once he left school, he was on his own. That is the fact at the center of this tragedy and others like it. James Holmes has far too much in common with Jared Loughner, who pleaded guilty this week to killing six people and wounding 13 more in the Arizona shooting that seriously injured Rep. Gabrielle Giffords. Loughner also dropped out before the shootings, after he was suspended from Pima Community College for erratic outbursts.”

Is it possible, if we had nationalized/single-payer healthcare, these people, and others in their state, would have sought and gained the consistent mental healthcare they so desperately needed?

“…it’s likely that the best support we can offer [for psychosis] does not consist of trying to bring the individual’s experience back into alignment with consensus reality, but instead consists of helping them meet their needs from within the context of their own experiences.”

While not directly related to ADD/ADHD I’ve read some interesting things about how, especially for serious mental illnesses, medications can rob you of the ability to learn from your condition, to have lucid experiences, and maintain a hold on some version of reality (i.e., the meds can fog your mind and make things less clear).

I also really like the idea that ‘madness’ is what a mind/psyche does to cope with a completely un-copeable situation, and not some discreet disease/injury to the brain, since there is little real convincing evidence of that after so many decades of research.

“…the available evidence indicates that antipsychotics aren’t very effective at treating “resistant” depression and aren’t the best choice for this use for most people. …And it remains unclear whether antipsychotics are any better than a placebo at preventing a relapse or return of depression over the long-term. Antipsychotics can also cause serious side effects, such as involuntary movements of the tongue, lips, face, trunk, arms, or legs (tardive dyskinesia), significant weight gain, and an increased risk of type 2 diabetes, heart disease, and stroke. In addition, they are very expensive, with some costing more than $1,000 a month.”

Mysteriously missing from the list of non-medication options is… exercise!

Do you all know of the Rosenhan experiment from 1973? It was one of the major reasons, as a critique of psychiatry at the time, for the decision to do a third revision of the DSM.

“The study concluded, “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” and also illustrated the dangers of dehumanization and labeling in psychiatric institutions.”

“What do we mean when we say someone has a mental illness? If we are to take the phrase literally, we mean that someone’s mind is ill. But can a mind be ill with disease? To believe so, one must make two serious assumptions: one, that the mind is a tangible object with discrete boundaries, and two, that the health of that object can be measured.”

I don’t agree with everything in this essay, but it brings up some good points, especially concerning the nature of ‘mind’ and how that is measurable.

“One of the most interesting findings in the new report from Germany is about the underappreciated — and under-studied — role of nocebo effects in clinical trials.

If you tell a group of trial volunteers that they’re testing a new drug that may relieve the pain of migraines, a significant number of volunteers will experience pain relief after taking the drug — even if they’ve been randomly assigned to the placebo group and are receiving nothing but sugar pills. The placebo effect in action.

But here’s where it gets interesting.  If you tell the volunteers that the side effects of this new medicine may include dry mouth, tingling in the hands and feet, and slight dizziness, some volunteers will experience precisely these side effects — inboth groups. In fact, some volunteers who are taking nothing but sugar pills will be made so uncomfortable by these symptoms that they will choose to drop out of the trial early.”

“If people are going to understand themselves and work through emotional problems, it is essential that they get curious about their experiences and reflect on what might be triggering them.  Sometimes such curiosity or reflection results in getting valuable messages from those experiences, or at other times, it involves identifying a mistake that triggered the emotional experience, which then allows for resolution…”

“When people are convinced their problems are biochemical, they are also less likely to explore the problem with others or with a therapist.  And when a therapist is convinced that his or her client’s problem is “biochemical” then that therapist is likely to focus on sending the client in for a “medication check” rather than looking deeper into what may be going on.  (“Biochemcal imbalance” theories are also great for explaining away any failures of understanding on the part of therapists!)

The end result is that marketing misinformation may itself be hugely iatrogenic, and be one of the primary causes, along with negative long term effects of drugs, of the worsening of mental health outcomes.”