Monday, November 22, 2010

Rectifications (24) – Mental disease / illness??

Rectifications (24) – Mental disease / illness??
Torrey Orton– Nov 22, 2010

What to call a mental problem? There are good names for many of them – anguish, ecstasy, obsession, compulsion, anxiety, outrage, and so on, moving forwards. These are found in the heart of psychological / psychiatric description (with greco-latinate equivalents – e.g. anhedonia - for the more medically deterministic mentalities of the DSM series). They are also found in the heart of human languages. They are the material which occupies the arts…in fact, occupies pretty much everything except the natural sciences and scientistic technologies – engineering, medicine, etc.

These problems of course are the stuff of a life, not "mental problems". Sometimes they can get a bit big. Major life changes, by choice or fate, tend to be associated with these normal problems. A good grief lasts quite a while and can be incapacitating for weeks. So can a rabid infatuation! It is the difference between being depressed and having depression. We are in the grip of the latter and are affected by the former.

'Disease' suggests a medical condition, something to be treated with a pill or a patch. A broken body is not a diseased or sick one, or even an ill one. It is injured, impaired. Some diseased bodies require breaking (surgery) on their way to repair, but the breaking is not a disease. Mental health problems can produce physical symptoms of great intensity.Or, the reverse, bodily disorders can reflect or constitute mental problems. This is because the state of the mind is also physical and behavioural. We are thinkingfeelingacting beings. So is our cat, only somewhat less imaginatively than we.

Mental health matters are injuries to the mind/body, which is probably part of why we have a naming problem. Naming has become embroiled in a marketing problem posing as an awarenessproblem. The awareness problem – about the reality, normality and ubiquity of mental health issues – has been attached to our existing awareness of mostly troubling, inconvenient, not terrifying health problems. This has been to normalise the mental ones, which so scare us they remain the sometime content of myths and demonologies and movies.

The marketing problem is the public campaign by McGorry and others to increase government financial commitment to early intervention in youth mental health issues. How far there is to go in public understanding can be seen in a recent AFR BOSS (Nov. 2010, pg. 65-66) article called "Mind Games" which misquotes McGorry, misrepresents the nature of acute conditions like bi-polar and schizophrenia, and prints a recommendation from psychiatrist Ben Teoh that "any employee displaying evidence of mental illness be referred to a psychiatrist for immediate assessment." If these conditions are difficult I wonder how anyone in the average workplace can pick them or confront them. If lawyers, doctors and dentists can't, then can HR or the CEO????

The larger proportion of Medicare funded mental health treatments are in the non-psychotic, non-acute mental health domains. It is our apprehension about falling into the psychotic which accompanies the very idea of mental health problems. Many of my anxiously depressed clients are relieved to have me confirm that they are certainly not crazy, though their acutely anxious and depressed periods feel crazy, feel threatening to their sanity. Try on OCD episode, a suicidal ideation or a public panic attack for a taste.

Piggybacking the mental on the medical encourages a pre-existing tendency to see it as amenable to physical treatments alone – pills or patches. The current evidence about effective treatment of mental problems is clear: medication alone can never resolve them. It is a useful and, in acute stages, essential part of effective treatment. The reason is that mental problems are biopsychosocial events, not merely biological ones, including the apparently "chemical imbalance" ones. See Lyn Bender's recent article for another take on this discussion, and a vigorously disappointed reader (the 4th comment) on therapy.

Both the Australian and American psychological associations actively promote biopsychosocial thinking and use it to evaluate and drive research, yet it has barely made it out of the professional policy box in which it has been installed for 10 years. And to think in this way stretches the competence of most allied health care practitioners well out of shape. We have neither the breadth of knowledge nor conceptual potential to use it.

The socio part of the construct is an often acknowledged component of mental health but inconsistently included in research or therapeutic action frames because the 'target' of the action is the individual. Their troubles are really social – they involve families (of origin and choice), playmates (the binge drinkdrugsex scene or footy squad, for instance) and workmates (bullies and their facilitating social systems of workplace control) and the authorisations of commercial culture (to booze, sexualise, and commercialise).

So, what can we call "mental" problems which is true and not banal? How about emotional issues, challenges, hurdles…well, in fact these are true, and banal due to their humanity. Sometimes that humanity overwhelms us, and always it is attached to other "issues" which we try to engage dryly, unexcitedly, numerically. The tide of heartless sciences is ebbing, but the names for biopsychosocial ones have yet to emerge. I wish I could do better.

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