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I just read a couple of articles that have links off of BPWorld News by a psychiatrist describing what he feels is a apathy, or "oh whatever" feeling that SSRI meds induce. He also critiques mood stabilizers, what he feels is an over RX of meds, and an over DX of psychiatric illnesses when a psychological approach, in his estimation, would be better.

I'm not about to tell a well-respected pdoc that he's wrong. But in his challenging the biochemical basis for our disorder(s), is he helping us or taking us back 50 years?

Yes, it is true that many of us have an ever-changing DX and RX schedule, and our pdoc may or may not know our name. What are we supposed to do? We go to the pdoc because we have certain symptoms and feel crappy, we're given whatever, and take it, as long as it is treating our symptoms. We, the people suffering from BP or whatever else, may not care if this pdoc is satisfied with the DSM or prescribing habits of other pdocs. We just want to be productive, happy, stable, and be able to function as people.

These articles really pissed me off!

I don't think anyone could understand, unless they have had an MI, what it is like to truly live under this cloud, to really feel this crappy. I've been DXed as BP1 since I was 7 years old, and because of fears about meds, my BP1 parents, both of them, kept me off meds. I was 18 when I made the choice to take the stuff.

My childhood is lost in the whirl of my emotions. I can't believe I ever got out of school alive, let alone finished high school decently enough to go to such a good college (or any college at that rate) and do well into adulthood.

My point- he's worried about an OVER DX of MI? He SHOULD worry about an UNDER DX! We all know people who need to see the pdoc that would never, due to a still pervasive social stigma. And that is WITH the current emphasis on Nature and not Nurture being the culprit of our woes.

I wish they'd come down from the Ivory Tower of their academic worlds and just ask us, ask us how we feel. Ask us what is our personal history, our family history, ask us to tell them what's up with us in our lives.

What do you think about this view that our woes could be psychological instead of psychiatric? (Personally, if you can't tell, I think it is a chicken and the egg proposition).

LOONIER THAN USUAL!

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I knew (through school) a psychiatrist once who liked to complain that he had to give people all kinds of drugs for perfectly normal reactions.  (His theories involved anxiety and depression being 'perfectly normal' reactions to the environment.)  I don't think he understands that breaking your leg is a perfectly normal reaction to too much pressure, yet we don't complain about having to treat the 'perfectly normal reaction' of broken legs.  He also conveniently forgot the fact that there's variation between people and there are lots of healthy people out there who aren't having this 'perfectly normal' reaction and are doing just fine. 

There's definitely an underdiagnosis of MI.  There may be an overdiagnosis as well; I don't know.

I don't think there's an obvious split between the psychological and the psychiatric; the two are all mixed up.  Psychiatric problems cause psychological ones; psychological ones exacerbate psychiatric problems; external factors can aggravate both.  We could all do with decent psychological help.  But it's not a substitute for decent psychiatric help. 

People who worry too much about the negative effects of meds seem, to me, to be missing the point.  It's like they assume we start out with a stable state and then add damaging meds to it.

I'm glad that guy's not my pdoc.

Speaking of awful pdocs, I read an article once by a male "feminist" pdoc who believed that giving women SSRIs disempowered them because then they wouldn't change the things that were making them unhappy in the first place.  He was clearly advocating not treating depressed women. 

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Just to defend this guy as not an "awful pdoc," even though I'm sure I'm one of the people who "just don't get it," I agree with him 100%. God forbid a psychiatrist would ever ask to understand our psychological history and help us understand how we ended up in the state we're in now.

Depression and anxiety *are* natural responses to life. And guess what? The medical approach doesn't cure them. Relapse/remission rates are incredibly high among those treated with medications. And what are the relapse rates for those not treated? We don't know anymore, because these people are outside the system.

This is a polical issue to me. I can't *get* treatment for my personality disorder because such treatment has been steadily pushed aside by health care providers and insurance companies just as it's been shown to be highly effective, because everyone favors the economics of drugs. I can't get on state-subsidized health insurance (and so am now uninsured) because my mental health issues aren't considered medical disabilities. If I simply found a new psychiatrist and made the case that I'm bipolar and agreed to go back on drugs (which I am opposed to for far more reasons than the sometimes nasty side-effects), I could get on permanent medical disability. All I'd need to do would be to emphasize jobs I've lost, times I've been suicidal, and all the ways in which my moods are undesirable. It would be easy, as several doctors have suggested the diagnosis only to agree with me that it didn't fit when I actively pursued a less simplistic explanation for my history.

Psychology has gone backwards quite a number of years as a result of the psychiatric revolution, which began in the late 1980s, not 50 years ago.

Go ahead, tell me I'm an idiot and should be better medicated because I'm saying crazy things. It's a compelling argument.

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IMHO the biggest problem isn't that MI isn't over- or under-diagnosed, but that people have absolutist one-size-fits-all views about how to treat it.  Some people say we pathologize everything, and that if everyone would just eat well and get enough exercise and believe in Jesus we'd all be fine.  Some people say that we're all neurotic because of societal fragmentation so if we'd all just get some Jungian therapy we'd all be fine.  Some people say we've all got chemical imbalances so if everyone were on Lithium or Prozac we'd all be fine. 

Bottom line for me is that there's no way to generalize on whether my problems are more psychological than psychiatric, because they're both.  Treating my mood disorder with medication doesn't solve my problems; I'm about 12 years old when it comes to dealing with relationships and stress.  But if I don't take psychmeds, no amount of therapy can help me because I can't learn a damned thing when I'm in mixed-state hell. 

I agree that too many people--not necessarily on this board, but in the world in general--rely too much on meds and not enough on addressing psychological issues.  If your life has been fucked up by MI, you need help to stay med-compliant and to deal with the wreckage.  Taking a pill is only the first step in treatment.  Maybe that's what the pdoc in question was trying to get at in his own inept way?  Or was he really talking about people with non-pathological problems who go shopping for a med to make them "happy"?

On the other hand, if he thinks there's no biochemical basis for mood disorders, he's whacked.  An idiot.  A medical neantherthal.  I don't care how "respected" he is.

Speaking of awful pdocs, I read an article once by a male "feminist" pdoc who believed that giving women SSRIs disempowered them because then they wouldn't change the things that were making them unhappy in the first place.

Actually, I have to agree that in some societies--let's say LDS culture in Utah--doctors would rather prescribe and people would rather take an antidepressant than tell a woman that her depression isn't due to a MI but to an abusive living situation or an oppressive society.  That's why a good pdoc will treat "situational" depression with meds if necessary but encourage the patient to get psychological treatment so she can get off of meds after she's improved her life.

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NARS -- well said, even if you think I'm one of the "some people" you mention. I don't actually believe anything as simplistic as the views you listed in your opening.

noemie -- it can also be difficult to get yourself out of a depressing situation if you *aren't* depressed. This is one point many doctors who have spoken out against psychiatry have repeated, in different ways.

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I have been in therapy and on various meds for 3 1/2 years now.  If it was a simple equation where we just plugged in x med or x therapy, I tend to think I'd be all better now.  I'm not, so I suspect it is actually a complex combination of brain disorder and things that happened in my life.  How much of each?  I have no idea.  At the same time, I am making sure to work on both sides of the equation.

Tommy

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Her Tommy --

That's a good approach. I think for me, I have always done the psychological stuff by talking to my friends, girlfriends, and mother. I don't mean constantly talking about what the hell is wrong with me, I just mean working out issues as they (continuously) arise. I've also talked to therapists, but even in the best therapy relationships this sometimes feels like I'm just paying someone to think out loud. I've also gone to psychiatrists for years, and about 5 years ago sort of gave up on the idea of giving any sort of accurate understanding of my history and just resigned myself to negotiating which drugs I should be on.

While drugs have helped me at points, they've also destabilized me at other points. So long as I believed my problems stem from my brain, this was always something I had to accept. Meanwhile though, and possibly because of life experiences I was only able to have on medications, possibly not, I came to understand the personality issues, fear of abandonment, phobias about certain social situations and intimacy, etc, etc that were steering me over and over to periods of severe mental disturbance. And I noticed that the biggest epiphanies always happened in the aftermath of big disturbances, often having been taken off one or more meds.

At this point I believe the following:

-- I've had some terrible experiences and didn't have a lot of things I needed to grow up with a solid, resilient, well-developed mind.

-- This has led me down the path to mental illness repeatedly.

-- Drugs can help in the short run, but trial and error has shown me they can also precipitate major psychological crisis, and I'd rather not have any more derailings of my life that I can't at least comprehend other than as the result of being given the wrong drug.

-- We never stop growing.

-- It may get worse before it gets better, but I'm going to figure out how to overcome social phobias, rebuild belief in my ability to take care of myself and others, find ways to live my life that foster real connections and make me happy.

Even in my worst states in the last year, I am always very aware of how my mood or anxiety or whatever relates to my situation. And that's nice. I want that. Unfortunately the price has been having to see my actual situation much more clearly, and my situation kinda sucks compared to what I thought it was a few years ago. Yes, things were "going better" then. I thought I was going to get married. I made a lot of money in a career with a lot of room to grow. I had a circle of friends. But in some very real ways, all of these were illusions in the long run. Given my psychological issues, and my past, and other things I was hiding from myself, none of these things were sustainable. Not that girlfriend, not those friends, and not that job. So I had to crash and burn, and instead of finding a way back on track as quickly as possible, I let myself disintegrate, let the illusions fall away.

That's me. Time will tell if I fell or merely stumbled, but If you'd seen me a mere two years ago, on an ADD stimulant, and anti-anxiety drug, an anti-depressant, and a mood stabilizer, and much much worse than I have been even this past week (when admittedly I haven't been doing too well). On all those meds, I was angry and venomous around my friends. I came close to suicide 4 times in 3 months, going to the ER once. I couldn't concentrate enough to read a book. I was a wreck. Nowadays, I go through sadness and worry, but I only allow myself to dwell in it for a couple hours before I decide that's as productive as that's going to be right now, and I go do something healthy. I'm off all the meds except I'm still taking .375 mg Klonopin, almost off it, which is 1/4 the dose I was on 2 years ago.

None of this is proof of anything. It's just explaining my own experience, as much to sanity check myself as to back-up my perspective on psychology vs. psychiatry.

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On psychology vs. psychiatry, nature vs. nurture-

I think some people do have a normal reaction, or at least can learn to moderate this reaction through non-medicinal means.

I regulate some of my more normal/reasonable/nurture type issues with a combination of alternative means that work for me. I think that we do need to be looked at as whole beings and not either patronized or robbed of our choice to make informed decisions. \

The school pdoc when I was in college actually told me that I could get better by finding Jesus! I have no doubt that any positive belief system can help, but finding Jesus would not make my BP1 or psychotic issues go away.

I agree that taking meds does enable us in a lot of ways to actually think our ways out of our personal holes to reap the benefits of other treatment. My whirling brain went on for years and years until I was 18 and took meds based on my own informed choice. I had all the counseling and support from my family that anyone could possibly want during my childhood and teenage years. It was the meds that let me get a grip on Reality. Before then, as I said, my thoughts and cycles were so bad and fast that I don't know how I managed to deal with school.

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On psychology vs. psychiatry, nature vs. nurture-

I think some people do have a normal reaction, or at least can learn to moderate this reaction through non-medicinal means.

One of the first things we learned in school is that the word "normal" has no accepted definition regarding mental health. Some people use it to mean "not screwed up," as you're basically using it. Some use it to mean "correct," despite the fact that there exists no reference for the correct responses to the infinite realm of experience. The most accurate way to define it as meaning "normative". The middle of the bell-curve. If you asked 100 people on the street what is something you give to someone you love, and the most frequent response was "a ring," this would be the normal response. 

It's important to consider this when you define your own reactions as abnormal. As compared to what?

I am not inclined to believe mentally ill people are reacting in some fundamentally different way than non-mentally ill people. I believe mentally ill people are reacting to a different set of circumstances, including the make-up of their own mind as it's formed over their lifetime, than people who don't have the same "reactions". If you compare two people's reactions to being reprimanded by their boss, you cannot explain away any differences in their reaction has simply as "how this person reacts to being reprimanded by their boss." There are an infinite number of other factors, from the context of this relationship in their work history, to their inner beliefs about self-worth, to their economic realities, both current and in their upbringing.

Still, to most observers, the person who can't handle criticism, or who argues with their boss, or who starts crying uncontrollably is simply abnormal, regardless of which definition of normal you prefer. Since no one can compare their own life experiences directly to those of anyone else, we often don't know why our own reactions are considered inappropriate or aren't the same as others. But that doesn't mean they aren't legimate responses to our psychological reality.

There is much more value in being real than in being normal. Ask any normal person, if you can locate one.

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Still, to most observers, the person who can't handle criticism, or who argues with their boss, or who starts crying uncontrollably is simply abnormal, regardless of which definition of normal you prefer.
Geez, that's me at work, and I thought I was doing so well.  :)

Ask any normal person, if you can locate one.

I think they've all gone into hiding;)

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Heya,

FWIW, I see MI in all its forms as:

*both* under- and over-diagnosed

*both* under- and over-treated

I know I can come up with examples from all 4 categories.

*also* the mis-dx'd and mis-tx'd varieties.

I'm sure you all can too.

Bugs me to no end when some guy with credentials uses that credibility to undermine a lot of good work that's being done. 

Sometimes doctors are idiots, especially when they talk to the media.

But you folks don't need me to tell you *that.*

;)

--ncc--

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  • 2 weeks later...

When I was on Prozac I didn't care as much about things.  Whatever.  I can agree with that part. 

Some popluations are overdiagnosed and overmedicated: some populations of kids.  Bipolar kids and Ritalin kids.  Symptoms of Bipolar disorder generally start to show up at around age 18 or 19?  So where do they get all these Bipolar kids?  And remember the Ritalin craze?  Maybe we are still in the middle of that.

For people over 40 it's the other way around.  I don't remember EVER hearing about ANYBODY with Bipolar Disorder when I was in K-12th grade or even in college (aside from psych classes).  For us it's an insult to hear that MI is overdiagnosed.  Maybe for the youngsters it is but for us it's been a long painful road of wondering what's wrong, denial, and self-discovery.

Nowadays pre-teens talk openly about the problems of having Bipolar Disorder and the medications involved.

If a Doc complains about overdiagnosis maybe s/he has worked with kids.

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