July 23, 2008

Psychiatry is the pressure valve of society

In case you doubted, here is today's front page of USAToday: Economy's stuck, but business is booming at therapists' offices.

If that was the end of the story-- if people had social troubles and turned to psychiatry for help because of those troubles, it would be a good thing.  Get help where you can.

But the larger problem is that in going to psychiatry, their socioeconomic issues get demoted to "factors" and the feelings become pathologized.  Psychiatry doesn't explain, it identifies.  You're not depressed because you lost your house; you have depression, and one of the triggers is losing your house.  See the difference?

You'll say this doesn't happen all the time, maybe not even the majority of the time.  But even if it doesn't happen to a specific individual, it still happens to enough people that it bolsters  psychiatry's role as the necessary player in managing suffering of any kind.

A 20% increase in therapy visits will be interpreted by psychiatry as a 20% increase in depression and anxiety.  It will say depression has a prevalence of X, it will say it is underdiagnosed and undertreated, etc. And it will creep into the social consciousness that these are pre-existing diseases with triggers, not the consequences of external events.

Society needs that illusion, it needs that lie, because it has created unrealistic expectations in people and no way of fulfilling them.   Here's what a society looks like under the similar economic conditions, but without psychiatry:

The absence of hope

Today's popular frustrations over flat-lining living standards have been building for years. The recent boom, felt only by the already well-off, has done little to change that discontent. Labor unrest has been growing for months; violent protests erupted... corporate taxes will be raised and gasoline subsidies cut... The move was designed to take the steam out of boiling anti-government sentiment.

The above article, also from USAToday, has a slightly different title: Egypt's economy soars; so does misery.


What kinds of things would ... (Below threshold)

July 23, 2008 3:18 PM | Posted by andy: | Reply

What kinds of things would constitute an explanation?

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Here is my opinion as a psy... (Below threshold)

July 23, 2008 11:14 PM | Posted by therapyfirst: | Reply

Here is my opinion as a psychiatrist of 15 + years:

We cannot treat poverty, we cannot treat greed, we cannot treat culture, and we cannot treat politics. We can help with insight, we can help with judgment, we can help instill hope and faith, and we can help accept the past and strive for a better present and future.

We treat people as individuals, and at the end of our day, when a person tells us we helped him/her, we reply, "we helped you help yourself, and thank you for listening."

Just remember, colleagues, at the end of our name is M.D., not GOD.

Good column, sir.

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Statistics will always lie,... (Below threshold)

July 24, 2008 12:28 AM | Posted by Diane Abus: | Reply

Statistics will always lie,serving the powers that be,perhaps pessismistic..Know thyself as the good Socrates tells us advisedly.the post is tres informative......................

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You really hit the nail on ... (Below threshold)

July 24, 2008 9:15 AM | Posted by Jack: | Reply

You really hit the nail on the head. Probably the best post I've seen here. Funny that it comes from a psychiatrist -- but I'll take good posts where I can.

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The following sentence sums... (Below threshold)

July 24, 2008 9:51 AM | Posted by Sally: | Reply

The following sentence sums up the problem: "You're not depressed because you lost your house; you have depression, and one of the triggers is losing your house. See the difference?" Good thinking.

Some of the worst developments in the mental health field have been the studies trying to prove that mental illness is genetic. The above could be said about veterans too, i.e. You don't have ptsd because you were in a war, you have ptsd and one of the triggers is fighting in a war.

It's how the victim is blamed as you say. Still I believe counseling can work if only therapists whehter counselors, social workers, psychiatrists, or psychologists would understad that intense stress is a reaction to something.

I really think that counseling is most crucial to people in crisis that are not of their own making, though it must be anonymous to do any good. Today's papers have a story about a woman who faxed a lettter to her mortgage company that said, "by the time you foreclose on my house, I'll be dead," and then shot herself. According to the story, she had been intercepting the mortgage bills and had not told her husband the mortgage hadn't been paid. She left him a note instructing him to pay up on the house with her life insurance. Unfortunately, I don't think life insurance pays out after suicide.

The point being people in crisis often don't think clearly, not because they're biologically defective but because they're in crisis. All people seen by mental health "professionals" should be treated with this in mind and if the goal of therapy was to help people look to the outside to find what was upsetting them and to learn ways of handling whatever the problem is, psychiatry could indeed treat poverty. It's not that people who are in crisis are mentally ill, it's that being in crisis is scary and folks really need help, really need a pressure valve.

Few of you object to the role of psychiatrists as keepers of social order. I don't why you object to being a pressure valve. Society needs pressure valves more than it needs social order, and if you provide a pressure valve, society won't boil over and need social order enforced. Psychiatrists would rather enforce social order which doesn't work than be pressure valves which does work. Why is that?

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You don't have to be psychi... (Below threshold)

July 24, 2008 10:26 AM | Posted by Sally: | Reply

You don't have to be psychiatrist to note that posting back to back indicates I care about this topic. It's intriguing that psychiatrists don't want to treat clients for the emotional problems caused by factors not of their own making. This analogy came to me, it's like an oncologist saying s/he'll only treat patients who got lung cancer from smoking. If the patient got cancer from second hand smoke, do you really think an oncologist would say, "sorry, this isn't your fault so I can't help you."

This could have a lot to do with why "patients" dislike psychiatrists so much. Patients go to pshrinks for help with situations they don't know how to handle. Instead of getting that help, they get diagnosed as sick for needing it in the first place. Hmmmm.

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Hey Alone, you're not a Sci... (Below threshold)

July 24, 2008 11:36 AM | Posted by theskepticalshrink: | Reply

Hey Alone, you're not a Scientologist, are you? It seems unlikely, but...those Dianetics ads keep popping up on your site. Otherwise, another great post.

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I'm a little puzzled by som... (Below threshold)

July 24, 2008 12:04 PM | Posted by dubya: | Reply

I'm a little puzzled by some of these comments. The points made in the article are certainly good to keep in mind. I glad I came across it. But what about patients who actually do have a mental illness based on biology and their pedigree? Lithium doesn't help someone with bipolar disorder? Perphenazine doesn't help with the hallucinations and delusions of someone with schizophrenia? Amitriptyline doesn't help someone with depression? You might want to lay off the kool-aid, folks.

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Americans who depend on USA... (Below threshold)

July 29, 2008 10:35 AM | Posted by Jack Coupal: | Reply

Americans who depend on USA Today newspaper for "news" are like the folks in the old Soviet Union who only had Pravda to read.

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After reading this column, ... (Below threshold)

July 30, 2008 11:48 AM | Posted by medsvstherapy: | Reply

After reading this column, here is one way that it occurred to me to sum up the main point:
If you, doc, help the patient to solve the depression, the financial problem does not go away. However, if you, doc, or someone else, helps the person to solve the financial problem, then the depression very well may go away, or at least the depression will retreat greatly.

I think it is true that someone goes through a depressing, or traumatizing, or anxiety-provoking experience, and the person is left with symptoms or thinking or habits that linger after the stressor is over. Well, then, the doc has a role to help address the remaining symptomatology as long as the stressor is resolved. But I just don't see aggressive treatment of depression, as a primary focus, WHILE someone is facing foreclosure. The person might need help with depression symptoms, but will definitely need some kind of help - from wherever or whomever appropriate, to address the foreclosure.

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I must admit when things go... (Below threshold)

August 6, 2008 1:10 AM | Posted by The joker: | Reply

I must admit when things go wrong, there's always a need to find something else to blame in order to make us feel better. The so called mainstream explaination of "brain chemical imbalance" is not yet validated in a more persuasive way to make us feel any less in control of our feelings. People with disturbed mental condition can not afford to be any more guilty about their unhappiness is, in fact a result of the way they think.

I personally interpret mental illness as a condition when one's perception( expectation, interpretation, self-evaluation) is not adjusted in a equilibrium state with ones surrounding environment.

I disagree with the way you portrait human,much overtly vulnerable than we already are. My attitude is sceptical but not cynical, the difference is cynics are "do-nothingism", so strong on their POV but at the same time so weak to believe in themselves.

If we can't change how things are, then change the way we think. Roads are only exists by your willingness to explore. I'm not kidding either.

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