In my opinion, there seems there is a continuum of support for the medicalization of mental illness. One one end of the continuum there are anti-psychiatry folks like Breggin (who are totally opposed to using diagnoses AND medications), and some psychiatric survivors like Ted Chabasinski. Others take more moderate approaches (Anthony, Deegan, Chamberlin) and may question the validity of diagnoses, but in general, don't object to the use of medication, if it is helpful for folks. they would be in the middle of the continuum. On the other end of the spectrum are folks who take the recipe-book approach to diagnosis and treatment with medications, ECT, cingulotomy, and capsulotomy. "This diagnosis gets this treatment." These folks clearly see mental illness as a disease of the brain, a "chemical imbalance" that needs to be medicated or cured.
Not all psychiatric survivors are radically anti-psychiatry, and not all practitioners are pro psychiatry. Do pro-recovery principles automatically qualify as anti-psychiatry? Can someones be pro-recovery AND pro medicalization/psychiatry? Or is this a false dichotomy?
Review the figure below. If you had to place Recovery on this continuum, where would you place it? Where do you think your beliefs fall on this continuum of "antipsychiatry?" Describe your rationale, then comment (respectfully) on at least one of your classmates' replies.
I think people can be pro recovery and pro psychiatry. If you're in the middle of the continuum that was posted and believe that medications can be an aid and that diagnosis can sometimes be helpful then you're kind of on both ends of the spectrum. Personally I believe that mental illness is partly caused by a chemical imbalance in the brain, but I also think it has a lot to do with environment and trauma. I am definitely in the middle of the continuum, because I think medications and diagnosis can sometimes be helpful but I think therapy, working on coping skills, social skills and vocational skills are most important to help individuals become independent and recover from crisis. I think sometimes diagnosis is not the best when it comes to helping people with mental illness because it carries a lot of stigma and it can place people in boxes for treatment, also the Dx is stuck with you for life, it follows you where ever you go. I do not think that medications alone are a good treatment for MI. MI is more then just a physical problem, it is emotional and environmental, all areas of a person's life can be effected by mental illness, therefore all areas of life should be worked on and looked at.
ReplyDeleteElizabeth, I agree about seeing the need of diagnosis for some to be more helpful than destructive. Putting a label on what someone may be going through may help humanize it or personalize it and help someone think "There is a name for what I am experiencing and so then maybe there is help through it!". I think the topic should be more about how a diagnosis is presented to a person; compassion, humility, hope, resilience and education should all be part of a diagnosis when it needs to be given.
DeleteThat diagnosis following a person like an albatross around the neck is a major concern. People often don't realize that diagnoses can change, or even "disappear" as they recover. It's as if once you're diagnosed with something, you are stuck with it for life.
DeleteBarbara's comment reminds me about two supervisor's approaches in Dx using our electronic medical records. One supervisor closes out all Dx (resolved/ended) when a consumer is discharged. Another supervisor closes some, but not all Dx. I have asked my supervisor to look into what is the correct way to go about this, since Axes cover a wide range of information.
DeleteKelly, I too am concerned about the lingering diagnosis after discharge. My approach with kids it to diagnose with adjustment disorder (a reaction to stress). The disorder (I hate calling it that because don't we all have difficulty adjusting to stress at some point?) is resolved after 6 months of elimination or adjustment to the stress. This buys me some time in the billing world and is justifiable, especially with kids! In my discharge, I note either elimination of the stress or adequate adjustment to the stress and resolve of the symptoms. It is nice when it ends this way and you, the practitioner, know they are not carrying on a label.
DeleteI do think one can be pro recovery and pro psychiatry. Examples have been given where people with SMI have recovered with medication, therapy, peer support, employment etc. However, it is a helpful thing to remember that recovery has not had a definitive meaning or definition that all have accepted. And thinking back on the use of medications as initially pill form lobotomies, what kind of recovery are we speaking of? Perhaps symptom free, and dull your personality so you can go to work and live on your own?
ReplyDeleteI personally gravitate toward the no medication side. However, I think it would be unfair to push that on to anyone who thinks medication may help him or her. I would definitely promote non-medicinal forms of recovery.
Good point, Kelly, as I would also gravitate towards the no medication side, but it is ultimately up to the client and whether they wish to use medications in their treatment. Another case where we have to be mindful of our prejudices and not push them onto the client unknowingly!
DeleteJust wanted to say you have a great point as to what is "recovery". Who decides ultimately that you are recovered. When you do not use medication and you see marked improvement I think that when someone says you are recovered it has more meaning. the recovery can not be attributed to a dulling of the symptoms through medication and it means that something is actually changing to be attributed as recovery.
DeleteMedication does work! The major issue I have with use of meds is when it is the sole treatment modality. Looking at MI from a holistic lens allows us to consider all of the factors and possible treatments. I write a "self-care" goal in every treatment plan and have the client identify 3 ways they will work on improving physical health. We spend a lot of time talking about how physical health impacts mental health and vice versa.
DeleteI do not believe that pro-recovery principles automatically qualify as anti-psychiatry. I believe that someone can be pro-recovery and pro medication/psychiatry. I would place recovery on both sides. Individuals with mental illness will gravitate to the best method that works for them. In some cases, individuals can recover without medication while others may need that medication to start the recovery process. I believe that I would fall in the middle of the continuum. I am not for it or against it, I strongly believe that in most cases the individual seeking treatment knows what will work the best for them in their recovery process.
ReplyDeleteI have to disagree with your statement that people with mental illness will gravitate toward the method that works best for them. Here in rural areas, especially, there are few choices and too few practitioners for people to have a clear idea of all the choices that there really are. Many people rely on their PCP, who isn't even trained in mental health care yet can write prescriptions for anti-anxiety or anti-depressant meds. Over prescription and a lack of behavioral support is a dangerous combination.
DeleteBarbara, Maybe I was unclear with my statement. I was not suggesting that an individual self diagnose. I was trying to emphasize the fact that with proper supervision an individual will know the best method that will work for them when presented with an array of possible treatment plans.
DeleteI'm in the middle of the continuum with leanings toward anti-psychiatry/anti-medications. I have personally seen a number of lives negatively impacted by incorrect diagnoses, stigma from diagnoses, over-reliance on prescriptions, and mis-prescription. While my experiences do not mean that psychiatry and use of medications are necessarily wrong, I do see a strong trend to over-rely on the expert/professional and a tendency to minimize our own strengths in working with the traits that make us unique. Anxiety and depression can be harnessed and incorporated in a life scheme that makes us more aware of positivity, beauty, and strength. Hallucinations, as we have seen in our class work, can also be incorporated into coping skills in such a way that we are better able to recognize triggers, to be aware of issues in our environments that may need to be changed. We haven't discussed it in this class, but I believe other diagnoses, such as PTSD and explosive anger issues can likewise be used to improve our lives, rather than be viewed as a deficit.
ReplyDeleteI do believe that diagnoses and medications have a place. I just believe that they are too often used to judge and marginalize people whose differences could instead be celebrated. We could all learn so much from each other.
Hi Barbara,
DeleteI appreciated your comment on positivity, beauty and strength. It reminds me of some of the articles/videos we saw about the Quakers/Soteria House, etc. When we are in such an environment, we can be more aware of these things. I think many individuals Sx stem from the lack of these three elements in their environment or overstimulation of negative elements.
Also, I go to many med mgmt. apmnts with youths and parents and find it hard to imagine how these meetings are truly effective, despite the effort of consumer and provider. The whole person sometimes gets missed as a checklist occurs (BP, weight, Sx, side effects) in 15 minutes per month. And one generally should not question these practitioners or ask them to look into research/provide info (i.e., conflict!). In addition, some really wonderful practitioners in the Portland, Maine area have closed their practice due to the silliness of Medicaid and Medicare (i.e., making it hard to help patients and also stay in business).
I believe that pro-recovery principles are essential for any person (with a MH Dx or not), as this way of planning and executing healthy living would be valuable in all our life transitions, adjustments as well as symptoms of distress. I also do not see pro-recovery and pro-psychiatry as definitely being at odds, as there are a variety of movements, practices and practitioners in the field of psychiatry all over the world. Some psychiatric practitioners are and have been key in the recovery movement as some of our readings and videos have noted.
ReplyDeleteUnfortunately, I cannot see the figures below this blog post question (it shows an X box for both figures), so it is hard for me to comment on placing "Recovery" on a continuum. I did not see other students make comments about this figure either in reviewing their posts. When I looked up the anti-psychiatry continuum online it noted that on one end is an individual that is skeptical/questioning of psychiatry and the other end it indicates a person who is an antagonistic zealot that "harms" people with mental illness. I'm not sure what "harm" indicates here. However, being a zealot, allowing anger and condemnation to influence how you dialogue about and with individuals and groups (those who have Dx, practitioners) is clearly not productive. I believe being thoughtful, informed, self-advocating, advocating for those less fortunate is a more helpful path. Skepticism about the workings of the medical model (as well as insurance industry and government) is advantageous for anyone. I also recognize that this path takes time and effort and relates to being a responsible part of the community. Investing in those causes that we care about and that touch our lives may help one prioritize, as we all have limited time and resources. As we grow and experience life, causes will naturally shift (e.g., children's concerns if we become a parent, etc.).
Overall, I know of many people who have been helped by psychiatric meds over the years. Some feel that they have a very trusting relationship with their psychiatrist and talk often about the plan to titrate off the meds when they have developed strategies that work every day to keep them healthy (i.e., even during a crisis).
Kelly -- I posted the graphic in our G+ community because this blog was being glitchy...
Delete(FROM DEB HOLDEN)
DeleteYou make an excellent point about the value of the trusting relationship that some people have with their psychiatrist and having a plan to titrate off the meds, and I am sure that it takes a great deal of courage to take those steps, especially if they have been told that they really need them in order to balance their brain chemistry, and have experienced some very scary episodes of mental illness. I think it takes some very strong evidence of other success stories before some folks dare to try it, and I hope more success stories make it into the media to help all of us understand that it is not only possible, but enables a much more fulfilling life.
I would place myself in the middle of the continuum, but more on the side of anti-psychiatry. I get the reasoning/importance(insurance) of having a diagnosis, but I also think that so much is focused around that diagnosis that can be more harmful to the client than helpful. I also think that even though people may have the same diagnosis, they can also be very different and present differently. A diagnosis may not be permanent, and is also likely to change, so to me, it makes no sense to rely and focus so heavily on something that most likely will change. Medication is also a slippery slope where I understand the need and importance of medications for some disorders and illnesses and for some it may be the only way to not experience symptoms and lead a somewhat healthy, productive life, but I do not agree at the throwing of meds to any and all for a cureall. I think that more treatments should be holistically centered and more focus should be on what is right for the individual, not the easy choice of prescribing medications. Education on diet, exercise, coping skills, therapy, ect, should also be utlizied in place or addition to medications.
ReplyDeleteI agree Jess! I think that holistic treatment should be part of the process in treatment. As diagnosis are constantly changing as you mention there can be a lot of confusion when someone has several diagnosis which do you go with? Then the individual is on several medications to cure all.
DeleteI definitely agree with you here Jess :) As you say, a diagnosis may not be permanent, in fact is likely to change, so why focus on medicating it? What was that Loren Moser espoused everyone saying when first meeting a consumer? "What do you want?" and "How can I help you get it?" I'll be no consumer, or very few, would come back with "a diagnosis" and "psychotropic medication".
DeleteMy perspective around whether or not you can be pro psychiatry and pro medicalization/psychiatry is to be yes that it is possible. I have drawn this conclusion from the examples from our reading as well as studies that have stated how people have recovered both ways. I believe that everyone is different and every mental illness is different so depending on the individual will determine the treatment approach that includes client’s choice and participation. Before taking this class I honestly thought medication necessary in recovery, although I have a different perspective on medications in general. It has been proven that people can manage their symptoms strengthening their skills through therapy, support, medication, employment and social support.
ReplyDeleteRecovery is a life-long process and maybe medication is beneficial at some point while building your support and establishing healthier ways in improving one's well-being and wean off the medication.
I have to admit I have always been anti-medication for my own personal reason and wouldn’t push medication on anyone. If medication is considered for the client then I feel it is important to research the medication so the client is aware of all side effects
I think researching medications is extremely important when determining which one(s) would be the best fit for clients because they can have some serious risks. I think medications can be one of many tools that can be used in the recovery process and are worth trying if they could help clients, but certainly not best when used alone without therapy or other treatments.
Delete(FROM DEB HOLDEN)
ReplyDeleteI wish I could say that I am 100 per-cent anti-psychiatry, because in my heart I really am! However, realistically I feel that there are certain situations when a person is in such a state that they are unreachable and when medications can help to stabilize them to where they can become reachable. Additionally, there are those who are absolutely convinced that medications keep them safe, so they are afraid to take the risk of trying to live without them. And sadly, for some people, taking responsibility for their own health is just too overwhelming- that starting an exercise program, changing their diet, changing their thoughts, becoming educated, and participating in attending counseling and peer group counseling, is very scary for them. This doesn't mean that they will never get to the point where they have the strength to undertake those challenges, but until they are ready to do so, then medication does provide a safety net for them until they are ready to make those changes. Ideally, I would love to know that medications are a last resort to treating mental health, and then they are only used until the person is ready to take on their own recovery.
So, at this point and going forward, it seems that we all have to help to re-educate the public about the dangers of medication, and about the big lie that has been told – the lie that is keeping people from taking control of their health and the course of their lives. We need to publicize the success stories of those who have recovered without using medication, and the stories of those who are on the road to recovery as well, and contrast those stories with those who are struggling through their lives because they are on medication. We all need examples of the success of others who have walked in our shoes in order to develop the courage to take risks - its very powerful motivation!
Deb, I like your emphasis on using meds to stabilize. At times it is helpful to get people to a place where they can receive information, retain it and do something with it. It is certainly difficult to accept new information or think rationally when in crisis.
DeleteDeb, thank you for your post. I hear what you're saying and it makes sense to me, though I think I posted an opposing view. You reminded me that I have met folks with some levels of MI, though not SMI, when I was a lay leader for SMAAA, co-leading a course called "Living Well for Better Health" where we introduced the registrants to healthy ways to improve their health. In one class we did have a registrant who was morbidly obese and severely depressed. Change was very scary for her. Though she tried, after just 2 weeks, she stopped attending, though the participants tried to encourage her and she had a buddy who checked in on her to offer camaraderie and support. She was a lovely woman but severely traumatized when she was very young. She clearly needed more than we could offer. I think in her case her PCP or psychiatrist had hoped she was ready for the next step but she was not. These are the consumers that I want to be able to reach. And thank you also for helping me with my language. I should have used the word "stabilize" versus "crutch" because that's exactly what I meant. You're the best :)
DeleteThis just ate my entire response. I'll be back in a few to redo it.
ReplyDeleteI did want to apologize for responding late to this thread. You all deserve better than that. :/
DeleteAs far as the continuum goes, I’d like to say I lean to the far left, and could stand with those who are Anti-Anti, but in actuality, I’m more towards the center. However, I would prefer to see “heavier” medications used for a short time, if that makes sense, while the consumer learns new healthier tools to cope with their difficulties. Rather like using them as a crutch, while learning how to meditate, change diets, add vitamins, minerals and exercise, attempt talk therapy, either individually or in a group, whatever it takes to find peace and find their center. I also believe that holistic, “new age” and eastern remedies can work. Remedies like flower essences, essential oils, herbal teas, acupuncture, massage, yoga, and the like. Although, like anything, the consumer needs to work with someone knowledgeable, educate themselves and self-advocate (when and if they can).
ReplyDeleteNot having known anyone with serious mental illness, I cannot speak to whether or not alternative remedies could always work but from our readings over the past week, it sounds like alternative care, using kindness, respect and love, could work; at least a good portion of the time. And certainly keeping people within their own environment or within a residential environment (Moser, 1971, Cohort II) exhibited a good outcome, narrowly described as “having no more than mild symptoms and either living independently or working or going to school at both 1- and 2-year follow up.” That sounds fairly significantly improved to me.
In the end, I suppose I believe medications have their place, but only as a last option, and for the shortest amount of time possible. The unknowns of the long term effects on the body, (organs, muscles, tissues, etc.) and the brain, along with the side effects, both known and unknown, make them my least favorite option. And as for Dx, we can all do without labels; there are more than enough labels in our world as it is, thank you very much.
http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/#soteria7183