Has medicalization gone too far?

[odysseus]

I don´t think my humour is over your heads... An attempt to cheer you up, nothing more OK.

[lorem]

Okay

[DGA]

once had a disastrous encounter with a psychotherapist.
...And with that I walked away with a diagnosis of bipolar disorder after one encounter.

Did a little psychologist diagnose you with bipolar? Are they really allowed to give an official diagnosis? I thought you at least need medical school to give a diagnosis for an illness.

According to the diploma on the wall, this person had a graduate degree in social work, qualifying him or her as a counselor/social worker and hence competent to perform psychotherapy. Basically, after ensuring that I wasn't a risk to myself or others, and asking a few banal questions, this person pulled the DSM off the shelf, flipped a few pages, and said "Yeah, that's you." Later on I had to see a psychiatrist who prescribed me some pills and declined to discuss with me any possibility of reconsidering this ridiculous diagnosis (the only reason I consented to see this doctor)... I didn't fill the prescription. Instead I made an appointment with my regular family MD to put an end to this nonsense.

I agree with Nemo's overall point that a healthy skepticism is warranted. There are ways in which some forms of talk therapy can be helpful to people, even people who don't buy into it (Simon E can confirm this if I'm correct or set me right if I'm not). You can't generalize from my experience that all talk therapy is an episode out of a Kafka novel (Mr K, how is your diagnosis coming?)

[Johnny Dangerous]

"Talk therapy" is really so broad a term it doesn't tell you much.

A psychodynamic therapist, and cognitive behavioral person will both engage in "talk therapy", but the viewpoints and methods employed are vastly different...same for the other points of view out there, behavioral, sociocultural, etc.

[odysseus]

You can't generalize from my experience that all talk therapy is an episode out of a Kafka novel (Mr K, how is your diagnosis coming?)

Joseph K. had the diagnosis "nihilistic anti-social disorder" because he didn´t understand the reason why they wanted to dig out his private thoughts (the reason was that they became jealous of him since he was already healthy).


To make it known, I don´t think anyone hates a doctor or psychologist. But people are concerned because it looks like a serious mess.

[Lindama]

once had a disastrous encounter with a psychotherapist.
...And with that I walked away with a diagnosis of bipolar disorder after one encounter.

Did a little psychologist diagnose you with bipolar? Are they really allowed to give an official diagnosis? I thought you at least need medical school to give a diagnosis for an illness.

According to the diploma on the wall, this person had a graduate degree in social work, qualifying him or her as a counselor/social worker and hence competent to perform psychotherapy. Basically, after ensuring that I wasn't a risk to myself or others, and asking a few banal questions, this person pulled the DSM off the shelf, flipped a few pages, and said "Yeah, that's you." Later on I had to see a psychiatrist who prescribed me some pills and declined to discuss with me any possibility of reconsidering this ridiculous diagnosis (the only reason I consented to see this doctor)... I didn't fill the prescription. Instead I made an appointment with my regular family MD to put an end to this nonsense.

I agree with Nemo's overall point that a healthy skepticism is warranted. There are ways in which some forms of talk therapy can be helpful to people, even people who don't buy into it (Simon E can confirm this if I'm correct or set me right if I'm not). You can't generalize from my experience that all talk therapy is an episode out of a Kafka novel (Mr K, how is your diagnosis coming?)

Glad that you took control. I trained ABD in psychology.... Social Workers are an entirely diff animal... they are very good at balancing care with insurance and finding occupational therapists when needed, etc. IMO, their training stops short of quality psychotherapy, family dynamics, trauma and abuse. (as you discovered) So-called talk therapy can be a diff experience depending on who you talk to, what their training and who they are as a being. ofc, I am aware that this is also degraded in favor of behavioral therapy, which I personally would never consent to, although I know it benefits many ppl. it's all a system, take it or leave it.

The take away: one day we will see psychology as primitive.

[Lindama]

Fact..there is a sizeable association in the UK of Buddhist practitioners who are Mental Health professionals. The members of that association do not feel the need to compromise either their medical or their Dharma practise.

Sounds good, but they can´t convince a client to become a Buddhist "to relieve their suffering". But they can place Buddhist ethics and point of views into their work and have a clean conscience. To start talking about the Four Noble Truths and the Eightfold Path will not do much difference, so where is Buddhism actually involved there?

"Buddism is actually involved" as the presence and openness of the therapist... not a word about Buddhism needs to be spoken. I learned that on my very first day of grad school with Frances Vaughn. It is not a therapist's job to place Buddhist ethics, or any other point of view into the client... second lesson on the first day. A therapist is there to help a person to reconcile their disonace as they see fit, for their sensibility and culture ... the therapist's values are not relevant nor useful... except in their willingness to be present with a client.

welcome back Simon, been away myself... your comments remind me that I must point out my experience with the system is in the US and gets stranger with each revision of the DSM. It sounds quite diff from the UK... I don't know that I have fully taken that in before.
linda

[Johnny Dangerous]

As to how Buddhism is involved, I think Lindama summed it up very nicely, the openess of th therapist as a Dharma practitioner it's own thing. I actually went out of my way to find a therapist that is a practitioner. Beyond that, there a quite a few clinical applications of mindfulness, then there's stuff like EMDR, which isn't too far off from meditation in some ways. There are all kinds of tools and approaches that gel pretty well with a dharma outlook. Look up "acceptance and commitment therapy" for instance.

[Ayu]

I don't know about US but where I live, mindfulness as form of therapy becomes like a new fashion these days. Nobody tells it is from Buddha. Nobody has to become buddhist. May it benefit the people deeply.

But in the case with severe mental disturbances we (friends and me) had the experience, that doctors are inclined to give pills (that have to be taken long-therm) instead of long-thermed therapies.
If such a medication is an support to a real therapy, I can understand that. But often the treatment seems to me like: "Take these pills, (they are new and we like to test them further), and then shut up and go to work again."
I know, my view is not professional but personal and I don't want to talk about "all of them" or "most of them" - but I do understand full-heartedly what Jesse means here:

There is another problem. How do you treat a disorder and not a person?

I felt and experienced the same on the other side of the planet here!
Important: no individual is to blame. It is a system that treats doctors bad, that keeps sientists afar from the practical field, which makes the system to treat the patient not like a human being...

But also I see, there are many good changes, at least here in northern west europe.

[odysseus]

It is not a therapist's job to place Buddhist ethics, or any other point of view into the client...

I didn´t suggest that. I meant being mindful of Buddhist ethics while you work. And consider the Buddhist point of view in your practice. I didn´t suggest to start telling the client about the Buddhism, no maam.

[lorem]

Ayu, pills are about the only thing that can treat some more severe disorders currently. Schizophrenia for instance, there is not much else that has met with much clinical success from what I've read. Some therapies are used with the drugs, but with many severe disorders, unfortunately there are no real solutions currently - so as imperfect as it is, medication is standard treatment. I think the over-medicating of people with less severe disorders, who can be helped as well or better by other therapies, is a bigger thing to be concerned with.

Nicotine as Therapy

I'm hoping someday they'll be able to do something with nicotine.

[Ayu]

.... I think the over-medicating of people with less severe disorders, who can be helped as well or better by other therapies, is a bigger thing to be concerned with.

Yes. That was, what I was trying to talk about, when I said "severe". It's not always easy to make clear, what I mean.
I meant people who need more help then awareness and Chi Gong, but who are healthy enough to work. A real therapy with talking, behaviour exercises, analysis and whatever is more expensive and needs more effort than giving medication. But I think, a human being should have a right to get help in becoming a whole.
But maybe I don't understand it right and maybe money is a real huge problem. Maybe it is not possible to give proper therapies to all.
Maybe our invironment and (enlightened) society should fill this gap in future.

[Ambrosius80]

So what? Have you never been to a bad medical doctor (non psychiatirst)? I have, i've been to lots of them.

Sure I have. Many times. Its only when it actually becomes more common to receive bad treatment instead of good, that you start thinking there is something wrong with the system. Not to mention if most of the doctors cannot even speak your native language at all, and do not understand what you are trying to tell them. That is common in Finland nowadays. I admit it is not so much of a problem for younger people who can speak English, but still.

Little more complicated than this, a lot more in fact. They DO know better than the patient in some respects, that is undeniable, if they didn't have information and training the patient lacks, the patient would not need their help.

I am not saying doctors don't know how to practice medicine. I am saying that some of them refuse to believe you when you tell them you are allergic to certain chemicals , that their colleagues have already found out the best possible treatment for you, or that they think they know your illness infinitely more better than you, even though you have had it longer than they have lived. As you said, that is god-complex at its worst, and it is getting more and more common these days according to my experiences.

In my experiences "bad doctors" are like "bad teachers", people who likely didn't start out that way but ended up sort of giving up due to a variety of institutional factors. I think by and large that medical practitioners have altruistic intentions, but are sometimes unable to carry them out, for a complex network of reasons.

That is true. But there are also doctors who are only interested in the scientific aspects of medicine, and have extremely poor social skills. These are the doctors who will show the least sympathy towards their patients, and treat them like they would be handling the sickness itself instead of a human being. Not to mention some who only studied to be doctors because "daddy told me to" or because they heard somewhere doctors earn 5000 a month.

Some medical schools perform personality tests and interviews on their applicants. I believe that is an excellent solution. In my opinion, medical schools should automatically prune out applicants who show anti-social tendencies, who show disregard for life and suffering, and those who are just in it for the money. It is wrong if you can get to practice medicine basically by taking the right classes and doing well in a few exams; you need to have the correct personality in addition to that.

Really? you know how "most" of the mental healthcare is conducted in your country? How did you find that out?

Issues in public health care and especially mental health care have been an issue recently. According to surveys, people deliberately avoid going to hospitals and therapies because they feel the treatment they receive there is both useless and expensive. I was into psychology myself, but I dropped that career option pretty quickly when I saw what the education was like. Basically, it is taught that people suffering from mental health issues are more or less just weak-minded losers, who only require a pat on the back and a boatload of meds. That thinking is one of the reasons so many do suicides here, particularly depressed and lonely people.

[Johnny Dangerous]

Can you please provide some specifics on the last part Ambrosius? What school of psychology teaches that suffering people are weak minded losers who simply require medication? It sounds to me like you have very little knowledge of the field, or the range of things taught in it, but i'll anxiously await being proven wrong.

So by all means, tell me the specifics of what you disagreed with in your education in the field of psychology, therapy etc. I'm definitely gonna expect that you back up a bold claim like that with something.

Especially if you're going to do things like blame suicide rates on mental health professionals, you need to substantiate thay with something other than the vaguely presented claims in your last post.

[Jesse]

http://www.madinamerica.com/2013/03/do- ... -question/

[Johnny Dangerous]

Jesse, did you read that whole article, and if so, what are the conclusions you are drawing from it? The article is not saying that schizophrenics shouldn't be medicated at all, it is saying that in many cases the drugs are overused, might be causing a sort of rebound, and suffer from issues of increased tolerance to the drugs, and that it is time for a rethinking of treatment regimens. It is not saying that schizophrenics are better off without medication, and if that is what you are trying to say, you are reading it incorrectly in a huge way IMO.

this summation is the gist of the article:

“Overall, the longitudinal studies cited do not provide conclusive proof of a causal relationship between being off medications and being psychosis free. They do clearly indicate that not all schizophrenia patients need continuous antipsychotics for a prolonged period, providing extensive evidence of samples of medication-free schizophrenia patients with favorable outcomes . . . The longitudinal studies indicate the importance of further research on how many schizophrenia patients profit from continuous administration of antipsychotics over a prolonged period, what factors identify and separate schizophrenia patients who do not need prolonged antipsychotic treatment, and whether or not prolonged use of antipsychotics is harmful for some or many patients.”

IME experience so far in school, the above point of view is not controversial at all, and in fact similar points of view are mentioned in my textbooks...personally I think it is completely sensible, I hope the above research happens, and that we develop more humane and less clumsy treatments.

There are also two orders of anti psychotic drugs, one of which is known to have much worse long tmer side effects than others, unless I missed it..the info in the article was not specific as to which order of drugs was involved.

One place where I know "drug induced psychosis" is a big problem is with mental health care of the elderly, where there have been cases of us basically heavily medicating people to keep them quiet in nursing homes, and actually causing psychotic episodes. Maybe it is a similar dynamic at play over all, it's easier to just dope people up than to figure out better use of the medication, in combination with other therapeutic approaches. Having schizophrenia in my family, that is not hard to observe..by the same token, there is no question in my mind that the drugs themselves are of huge benefit in stabilizing many people.

[Jesse]

Jesse, did you read that whole article, and if so, what are the conclusions you are drawing from it? The article is not saying that schizophrenics shouldn't be medicated at all, it is saying that in many cases the drugs are overused, might be causing a sort of rebound, and suffer from issues of increased tolerance to the drugs, and that it is time for a rethinking of treatment regimens. It is not saying that schizophrenics are better off without medication, and if that is what you are trying to say, you are reading it incorrectly in a huge way IMO.

this summation is the gist of the article:

“Overall, the longitudinal studies cited do not provide conclusive proof of a causal relationship between being off medications and being psychosis free. They do clearly indicate that not all schizophrenia patients need continuous antipsychotics for a prolonged period, providing extensive evidence of samples of medication-free schizophrenia patients with favorable outcomes . . . The longitudinal studies indicate the importance of further research on how many schizophrenia patients profit from continuous administration of antipsychotics over a prolonged period, what factors identify and separate schizophrenia patients who do not need prolonged antipsychotic treatment, and whether or not prolonged use of antipsychotics is harmful for some or many patients.”

IME experience so far in school, the above point of view is not controversial at all, and in fact similar points of view are mentioned in my textbooks...personally I think it is completely sensible, I hope the above research happens, and that we develop more humane and less clumsy treatments.

There are also two orders of anti psychotic drugs, one of which is known to have much worse long tmer side effects than others, unless I missed it..the info in the article was not specific as to which order of drugs was involved.

One place where I know "drug induced psychosis" is a big problem is with mental health care of the elderly, where there have been cases of us basically heavily medicating people to keep them quiet in nursing homes, and actually causing psychotic episodes. Maybe it is a similar dynamic at play over all, it's easier to just dope people up than to figure out better use of the medication, in combination with other therapeutic approaches. Having schizophrenia in my family, that is not hard to observe..by the same token, there is no question in my mind that the drugs themselves are of huge benefit in stabilizing many people.

Mainly I think anti-psychotics aren't really to help patients in most cases, they are to alleviate the fear of those who know the schizophrenic person. My best friend developed schizophrenia, and I remember asking him why he doesn't take his medicine.. he told me he just wanted to be accepted for who he was, not medicated for the benefit of those who are afraid of him.

Anti-psychotics both a-typical and the older variety have terrible side-effects, alot of people would probably describe being on them similarly to being poisoned.

I am also familiar with psychosis, and it's my personal belief that psychosis can only really be treated by mind-training, and self-knowledge of how the mind works, combined with effort to mitigate factors which cause psychotic episodes.

Something I recently jotted down for my own self-reference:

Thought's can mimic reality. In a way thoughts are like a programming language. Thoughts create habitual thought tendencies, and habitual thought tendencies arise, building entire belief sets, realities and perceptual filters.

In this way you can create toxic realities, which make people sick.. and are probably behind most mental illnesses.

So in my opinion, to combat psychosis first you need to understand how the mind creates these realities, you need mindfulness to watch the mind as it does it, and then obviously you need to stop the mind from doing it. I won't deny the medications can help someone in the grip of an acute psychotic episode, but the medications do not HEAL the problem. They are hard-core drugs that should be used short-term at best.

Anyway, that's my 2c.

[HePo]

Ambrosius80 wrote:

According to surveys, people deliberately avoid going to hospitals and therapies because they feel the treatment they receive there is both useless and expensive

As Ambrosius seems rather strong opinioned with a great disregard for facts.

Healthcare in Finland

Wikipedia:

The quality of service in Finnish health care is considered to be good; according to a survey published by the European Commission in 2000, Finland has the highest number of people satisfied with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[1]

Statistics may be somewhat old, still ... even if it dropped 50 %!!

Wikipedia:

User fees:
The out-of-pocket fee amount for a doctor's visit or treatment in the primary health care is set at a maximum of EUR 13.70 (in 2010) and the amount varies from one local authority to another. Hospital out-patients pay EUR 27.40 per consultation; in-patients pay a per diem charge of EUR 32.50. For long-term illnesses, the charges are based largely on income.[25] Although a vital part for health financing and provision, the current system of the user fees has been discussed to contribute to the inequities in the access of health services among the low-income residents.[26]

http://www.oecdbetterlifeindex.org/countries/finland/

In Finland, the average household net-adjusted disposable income per capita is 26 904 USD (22 000 Euro) a year, more than the OECD average of 23 938 USD a year.

Wikipedia:

Health care indicators:
Finnish health care can be considered good by several indicators. For example, due to public health interventions and progress in medical care there have been remarkable improvements in life expectancy in Finland over the past few decades.[4] Life expectancy in 2012 was 84 years for women and 78 years for men,[5] which ranks Finland high on a global comparison.

Wikipedia:

Smoking in Finland has reduced, and now the smoking rates among adults in Finland in 2009 stood at 18.6%, lower than the OECD average of 22.3%

Drug use is not a major public health problem in Finland. The most commonly used drug is cannabis. According to a study from 2008, the percentage of the population aged 15 to 69 who had at some point in their lives tried cannabis was 13%; 3% of the population had used cannabis within the previous 12 months.

3% of the Finnish population had used cannabis within the previous 12 months, in the US 14%.

Perhaps Ambrosius could explain why all these reports are wrong.
http://en.wikipedia.org/wiki/Healthcare ... References

Also:

Ambrosius:
It is wrong if you can get to practice medicine basically by taking the right classes and doing well in a few exams

http://en.wikipedia.org/wiki/Medical_school#Finland does not agree with the above statement.

[Mkoll]

3% of the Finnish population had used cannabis within the previous 12 months, in the US 14%.

That says nothing about the healthcare systems of the respective countries. For one, they're both completely different cultures. Marijuana use has become much more acceptable here in the US. It has long been part of teenage and young adult culture, popular culture, and it has a culture of its own. A few states have even legalized it and many have medicalized it. Another thing is that there is also a lot of it grown here and in neighboring Mexico and Canada, much of it outdoors. I would think that most of Finland's climate wouldn't be conducive to growing plants that produce high quality bud: it's too darn cold and there's not enough sunlight.

Here, this is from the DEA museum website. Green denotes high-producing countries.

[HePo]

MKoll wrote:

HePo wrote:
3% of the Finnish population had used cannabis within the previous 12 months, in the US 14%.

That says nothing about the healthcare systems of the respective countries.

I agree, it doesn't - i found it amusing how low the % was in Finland.
The 14 % in the US - i lived in the SF Bay area for a long time and based on that my estimate would be a lot higher.

However, i meant to comment on Ambrosius's post and it would be unfortunate if this is the only fact you did read.
http://en.wikipedia.org/wiki/Healthcare_in_Finland.

- I am not going to spend any more time/energy on this subject.