The Biological Basis of Mental Illness
I just read an article posted on the American Journal of Psychiatric Rehabilitation's Facebook page about a psychiatrist who does not believe people should be diagnosed with disorders such as schizophrenia, bi-polar, depression, and ADHD. He has a couple of arguments, one being that there is no biological basis for these illnesses. The same argument he uses against the biological basis can be used for one. If mental illness manifests because of experience, trauma, etc. why doesn't every family member who had the same or similar emotional experience during childhood have the same diagnosis in adult-hood? Is it just a manifestation of one having more coping skills or not having received a gene which would predetermine they have a specific diagnosis. Then there are twin studies in which twins have been adopted at birth and subsequently separated. Longitudinal studies over the life span of separated twins show higher rates of incidence despite environmental factors not being shared. There are confounds in these studies, however. Both twins were adopted at birth and whether they are told or not cannot be controlled.
Dr. Timimi also argues "diagnosis has become an explanation for what is wrong with someone, rather than a description of what is wrong" and that "people want compassion, and trust and to be listened to and taken seriously; every person’s story and the reasons why they are distressed, is different." I don't think diagnosis has become an explanation, it helps guide treatment like any other biological diagnoses. I would start by examining the field of Psychiatry to help alleviate these issues. I do not know many people who can tell their story in a 15 minute appointment, so how can one be compassionate in such a time frame? People do want compassion, and the human condition varies from individual to individual. I would also suggest psychiatry programs conduct interviews for acceptance similar to Ph.D. programs in clinical psychology, or all Psychologists should be able to prescribe medication. I do agree with Dr. Timini partially about medication. The medication that is currently available is the best available, but it could be better. Medication works for some individuals and not for others. Anyone who is prescribed psychotropic medication should also be receiving some form of therapy to help with building coping skills in addition to medication. If the medication becomes ineffective, an individual is left with no organic coping methods and possibly an emergency.
Perhaps why I am so emotionally riled by Dr. Timimi's arguments is because of my brother, Josh who had schizophrenia and when he began displaying symptoms of his illness I felt guilty that I didn't have the same symptoms. After all, we shared the same environment for our entire lives, why would only one of us have an illness that was possibly environmentally caused? It wasn't strictly environmentally caused, my brother had a predisposition I did not and gene expression explains this better.
If medication was not available, the incidence of addiction would be even higher. Most alcoholics I have known suffer from intense anxiety. Is having a glass (or two) of wine each night better than being prescribed Klonopin? Some would argue yes, some would argue no. But in both cases, one-on-one therapy could help an individual cope with their anxiety and learn organic methods of coping such as mindfulness.
Dr. Timimi's suggestion that people are merely being labeled is a step back against fighting stigma. No one would ever suggest the diagnoses of cancer or diabetes not be given, but using the term cancer used to illicit stigma. Compassion toward psychiatric diagnosis starts with those in the profession setting an example of empathy, not suggesting moving backward in the field.
It isn't the diagnosis itself that causes stigma... it's the preconceptions of those who really have no clue about mental illness and assume that the worst they see and hear in the media applies to everyone who has been diagnosed, regardless of the fact that no two diagnoses, just as no two people, are exactly the same.
ReplyDeleteThe thing I am trying to remind those around me (and beyond) is that Bipolar II, Borderline Personality Disorder and Post Traumatic Stress Disorder are what I have... they are not who I am.
One big problem is that the labels are most likely not accurate. Being diagnosed with bipolar disorder is not like being diagnosed with tuberculosis or strep throat. From the director of the NIMH (not exactly an anti-psychiatric organization) "Depression, schizophrenia, borderline personality disorder, and autism spectrum disorder are complex syndromes. It may be that many different disorders are embedded within each of these categories. The lesson from other areas of medicine is that a diagnosis that relies solely on manifest symptoms is not the best guide to choose the most effective treatment." I sat next to a gentleman in my DBSA support group one night. We both have bipolar as a diagnosis. We both have the same psychiatrist. We aren't even that far apart in age. Our disabling symptoms were nearly completely different. He was very thankful that our doctor had found the one drug that helped him. That same doctor and I had decided that it wasn't worth trying drugs any longer after 3-4 years of failure and some dangerous reactions. You can't tell me we both have the same "disease."
ReplyDeleteMichelle, I wish we could ban the media from publishing negative stories, or that they would actively publish a positive story for each negative one. I think our misconceptions are based on media and big-screen portrayals. There are so many facets of what makes up our personalities, and our experience and our world-view has more to do with it than anything else.
ReplyDeleteJoanne, two people with the same type of cancer can have very different reactions to the same medication based on personality, hopefulness, religiosity, etc. yet it is acceptable to diagnose them alike based on symptoms and medical tests. I agree with you that the experience of bi-polar symptoms varies from person-to-person. Humans are not perfect and Clinical Psychology does not view diagnoses as the end-all be-all because recovery should be client-centered. I don't consider a diagnosis merely labeling someone, but merely a guide to enable recommending an evidence-based approach toward recovery.