Mental health bill moves forward in Congress

A recent discussion on mental health after reading this article:

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2007-02-15T135333Z_01_N14417499_RTRUKOC_0_US-CONGRESS-MENTAL.xml&src=rss&rpc=22


Doctor Baby~
I'm not terribly happy with this 'indulgence' bill. Few people are nuts and they are typically too nuts to have jobs or insurance. This is for the Cindys of the country and we get to pay for it. Perhaps they just get a grip instead. I have real issues with 'diseases' with no biomarkers. "We made the diagnosis by talking to them." Real scientific.

I'm glad I have my tiger-repelling computer in front of me. I know it works, I don't see any tigers.

PhatShady~
But people do need someone who is not so judgmental when faced with overwhelming stress. You can make a mental health diagnosis 'by talking to them,' I do it everyday. You don't just talk to the person; you watch their body language and the context that they bring the problem forth. PTSD has no'bio marker' but it is a very real mental illness that can only be understood and treated by 'talking' along with the proper med support.

Doctor Baby~
I agree that people do need a sympathetic shoulder in times of crises. We all have a threshold. However I see a number of glaring problems with the current approach to mental health. While I understand that it is more than just listening to their words, I find it entirely subjective. Itis based on too much on the Standard Model approach. The medical establishment defines what's normal via the DSM. Anything outside this agreed upon range is then by definition not normal. Unfortunately this is predicated upon the beliefs that humans are generally rational creatures and that certain behaviors are defects as opposed to simply variation in type. Both, in general, are ludicrously incorrect assumptions. How rational is the belief in an invisible friend, like God? Why not Zeus?

Too many people know how to 'act' crazy or eccentric. They know exactly what they need to say or do. Some learn to do so intentionally to work the system. Others do it instinctively because that's how they make their way in life (i.e. Cindy). Any attention is good attention so to speak. Additionally the accepted method of diagnosis is based too much on the 'we think the brain works thusly' methodology. But we don't know how it works with ANY scientific accuracy. Without demonstrable proof how do you know your right? What scientific proof can be offered and how can it be independently verified? "Well, we believe......" That is not proof.

Remember there was a time in the early 20th century when women went to the doctor to be masturbated. I cannot remember the exact aliment nor what they called the treatment but it was considered a medical condition.The medical establishment had similar assertions of medical validity then also. Have you forgotten that the DSM (III) listed homosexuality as a mentalillness until 1989? Never mind that there was, and continues to be, not a shed of scientific proof to support this conclusion. And let's not forgetone of my personal favorites either, bloodletting. "I have your diagnosismiss, you have too much blood." Where are these 'treatments' and conclusions now?

True madness unquestionably exists. I would never make the case that
it does not. But it is difficult to accurately assess without real world observation. The kind that seldom occurs in reality due to the poor cost benefit analysis. A better approach to diagnosis might be: A) Does the behavior manifest when it isn't convenient? Is it physically detrimental? Even that is still less than exact. But psychology today has given us such foolishness as Social Anxiety Disorder. What we once used to call being shy is now a condition. Now, instead of having a shot of booze to loosen up we have this nice little pill. Possible side effects are loss of scalp and penis. As long as psychology continues to tell us it's not our fault this problem will fester.

Psychology is good at assessing large groups of people. It becomes increasingly unreliable when applied to smaller groups and particularly individuals. And exacerbating the situation is the fact that there is a small percentage of people in your profession like you. People that have the ability to accurately assess others. I bet you rely more on your empirically gained experience than your training. Regardless, too many of the remainder of your colleagues are quacks with deep seated issues of their own. And they are the ones writing the DSM.

PhatShady~
Wow, I think you just about nailed it, and here I was ready for a 'Battle Royal' (with cheese!). The DSM like many things is a work in progress, just as our understanding of humanity is a work in progress. The DSM-IV is an imperfect object, but it is the best tool we have to be consistent in our documentation of mental illness. Insurance companies that don't want to pay unless a person meets DSM-IV criteria have hijacked the purpose of the DSM-IV. The most important criteria, and sadly most overlooked, is the impact the illness has on the person's ability to function in their environment. Functionality is key in our approach here in the Cow Counties. While you may be shy or depressed, does this feeling have a significant impact on your ability for self care, employment, and/or education.

Social anxiety can be very real if it keeps you locked in your home, afraid to answer the door when the pizza guy comes (and most likely indicative of something greater than social anxiety). However, if your anxiety just means that you are often dateless on Fridays, then maybe a support group would be more appropriate. But social anxiety is a real phenomenon, just like shyness. Where can a person turn if they feel that their shyness is getting in the way of living a fulfilling life? We used to be surrounded by families and friends in a community we grew up in. Now we often find ourselves removed from the familiar and all alone in the crowd. With no one else to turn to shouldn't the mental health professional be available to assist, replacing traditional modes of personal resolution? Again, yes, social anxiety is a condition, but it is its impact on functionality that needs to be assessed before a treatment intervention can be formulated. If you choose to call it shyness that is fine, but as a professional, if you want to be reimbursed by the insurance company then its 300.23 Social Phobia with a GAF of 55 or lower.

Just because our past understanding of mental illness was flawed is no litmus that our current understanding is as flawed or worse. I admit that we have a long way to go to understanding how and why our brain and body work the way they do. We have advanced, albeit slowly. Just as our understanding of homosexuality continues to evolve so will our understanding of heterosexuality. Much of this depends on the social pressures and focus. Malingering is another matter and readily ferreted out by the trained professional. But, alas, as you commented few professionals don't take the time or are overburdened and just passed the person through. I have been somewhat guilty of this in respects to Southeast Asians. I give them the benefit of the doubt because I feel a collective guilt in over how our country disrupted and abandoned our allies during the conflict. Often inmates are medicated for mental illness while incarcerated. This is done so the 'system' can manage their behavior, not for the benefit of the individual. This is a jacket that they use and wear proudly post release to further their victimization of the community.

Psychology does not tell people that it's not their fault; this is a huge fallacy and misinterpretation of the craft. Often a client will utilize a label like 'social phobia' to avoid taking responsibility. But if they are active in their treatment then they are learning to assume responsibility for their emotions. All of the major intervention therapies (i.e., CBT, DBT, and ACT) emphasize that while we can't change the past we can change the way we think and feel about it today. We have a saying; if you are not at treatment then you are not in treatment. Next time you hear a person say they can't because they are Bipolar (my favorite) or something else ask what their treatment plan is, what's the goal? If they respond that they are taking a rectal bleeding pill then their treatment provider is not serving them. All mental illness is manageable with the appropriate level of care. (Unfortunately not many of the severe chronics can afford this; hence you get the basket people.) Challenge them to advocate for better care if they are serious about getting better. Consumer Reports did and exhaustive study that indicated that the best treatment for mental illness was therapy with med support.

I agree that many people get into this profession to fix or better understand themselves rather than assist our population. This is sad. Also you find a great many narcissists in this field. What kind of gall is it that you think you can fix another person? (Myself included ;)

Yes I do rely on empirical evidence. But it is evidence gained by seeing symptoms on a continuous basis, consulting with colleagues, and measuring that information against the criteria set forth in the practitioner's bible, the DSM-IV.