Does the public over-biologize mental illness?

[futureapppsy2]

I definitely think that there are biological causes to some mental illnesses and that drugs are a necessary and useful tool in many cases, but it seems like the general publication has, in large part, latched onto the "it's a chemical imbalance / it's just like diabetes" thing over-zealously and in a way that ignores both the environmental/cognitive/behavioral/etc factors that can contribute to and trigger mental illness and the success of CBT and other therapies in treating a lot of mental illnesses and other issues and in treating symptoms and improving quality of life and functioning even in disorders where medication is the primary treatment (e.g., psychotic disorders). I've seen the attitude of "if you don't think it's all a chemical imbalance, you're a stigmatizing and backwards," and as someone who's read a good deal empirical literature on treatment and worked as a therapist, it both bothers and worries me. It seems like people have just latched onto the chemical imbalance thing without really understanding it at all because it sounds good.

Thoughts?

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[Psychadelic2012]

I think it's dangerous to seperate biology from psychology in either direction. I come from a background with physiological training and I've noticed that psychology academics tend to disproportionately attribute physiological disease/symptoms to psychological sources--i.e., that a client's headache = somatization = caused by a mental issue = not really a headache = don't treat the headache, or some such nonsense. Conversely, we can't just call something a "chemical imbalance" (what is that, anyway??) because *a* treatment reverses it. Medication isn't the only way to change physiology. To me, that is terribly sad. But it's our culture. How about the complex nature of the interaction between the "body and mind," or better yet, that psychology IS inherently biology and there is no two seperate entities?

 

[weeblewobble]

I think it's dangerous to seperate biology from psychology in either direction. I come from a background with physiological training and I've noticed that psychology academics tend to disproportionately attribute physiological disease/symptoms to psychological sources--i.e., that a client's headache = somatization = caused by a mental issue = not really a headache = don't treat the headache, or some such nonsense. Conversely, we can't just call something a "chemical imbalance" (what is that, anyway??) because *a* treatment reverses it. Medication isn't the only way to change physiology. To me, that is terribly sad. But it's our culture. How about the complex nature of the interaction between the "body and mind," or better yet, that psychology IS inherently biology and there is no two seperate entities?

100% agree. My perspective is that the treatment works because it changes the way people behave across levels, i.e., including neurochemically and physiologically. BA works (partially) because doing more things and more things you like (vast simplification) increases lots of great biological workings including dopamine, serotonin, norepinephrine, and helps your circadian rhythm get back on track, all things fundamental to mood. Psychology is biology, the perspective and way we treat it is different.

Back to the primary issue, I agree the the general public (and often people in treating/researching fields) think too simply about what "mental illness" and its cause is. The core problem I see is that people think that is mental illness is biological then that means it is inevitable and irreversible, so people with symptoms should not try treatment except maybe meds that they never go off of, because there cannot be a cure for what is "biology", and others see those with mental illness as "deviant" and "other", as is being discussed in the mental health reform thread. Ultimately it can be a reason for stasis and stigma.

 

[futureapppsy2]

100% agree. My perspective is that the treatment works because it changes the way people behave across levels, i.e., including neurochemically and physiologically. BA works (partially) because doing more things and more things you like (vast simplification) increases lots of great biological workings including dopamine, serotonin, norepinephrine, and helps your circadian rhythm get back on track, all things fundamental to mood. Psychology is biology, the perspective and way we treat it is different.

Back to the primary issue, I agree the the general public (and often people in treating/researching fields) think too simply about what "mental illness" and its cause is. The core problem I see is that people think that is mental illness is biological then that means it is inevitable and irreversible, so people with symptoms should not try treatment except maybe meds that they never go off of, because there cannot be a cure for what is "biology", and others see those with mental illness as "deviant" and "other", as is being discussed in the mental health reform thread. Ultimately it can be a reason for stasis and stigma.

I completely agree--behavioral treatment has been shown to have neurological effects (I know this has been shown for EXRP in OCD, probably elsewhere but I haven't personally seen or looked for it) and that conversely, things like trauma can result in neurological changes. However, I think the general public tends to see it as "biology=medication only," and I think that's dangerous. However, I also don't think everything necessarily needs to or should be coached in biological terms--situation factors/events should be acknowledged as such--what's to be gained from taking it down to the neurological level, clinically?

 

[AcronymAllergy]

I completely agree--behavioral treatment has been shown to have neurological effects (I know this has been shown for EXRP in OCD, probably elsewhere but I haven't personally seen or looked for it) and that conversely, things like trauma can result in neurological changes. However, I think the general public tends to see it as "biology=medication only," and I think that's dangerous. However, I also don't think everything necessarily needs to or should be coached in biological terms--situation factors/events should be acknowledged as such--what's to be gained from taking it down to the neurological level, clinically?

This is a very good point. In some things (mild TBI comes to mind), whether or not there are substantive changes in the brain, that doesn't necessarily change how you're going to treat the current problems/symptoms.

 

[Ollie123]

As others have said, I think this goes both directions. I hate the "chemical imbalance" perspective, but I think it is equally foolish when people think its purely systemic/environmental/behavioral. These things are not just interactive but in many cases are completely inseparable. Much like theoretical orientations, I tend to view strong convictions in either direction as a maladaptive coping mechanism designed to avoid having to think too hard.

 

[PHD12]

Many organizations, such as NAMI, espouse the "chemical imbalance" theory because it is more profitable (I'm sure they are tied to the pharma companies). It all comes down to what increases profits for drug makers.

But I also think the public takes to these simple theories because many people value simplicity and don't like to think on a complex level. It also frees parents from having to take responsibility for their children's problems and having to change their parenting style ("He was born a sociopath...there was nothing I could have done as a parent!").

I think it is a win-win for pharma industry and families who find it convenient to blame one family member for what is often a dysfunctional family (obviously this is not always the case). NAMI holds lots of free workshops for parents with "troubled children" and they send the clear message that it is a "chemical imbalance" and has nothing to do with one's parenting.

 

[Psychadelic2012]

Yeah, the "chemical imbalance" thing is the most popular way that we've found to reduce stigma--it's not you, it's something you can't control, it happened TO you, etc. There must be another way...

 

[Ollie123]

There are plenty of other ways, its just that they are challenging and require more effort than we, as a society, have deemed acceptable!

That said...has it really been effective for reducing stigma? I actually haven't seen much in the way of support for that.

Never mind that one of the primary goals of reducing stigma is to make people more willing to seek treatment...treatments that are unlikely to be effective if people won't take an active role in helping themselves. Its challenging to do, but critical to walk the fine line between blame and responsibility.

 

[Psychadelic2012]

Well, it probably depends on the symptom or disorder, I guess. I see medication ("I'm like a diabetic, I just have to take my meds everyday") as a way to reduce the shame around mental illness quite frequently. It does seem rather old school nowadays, though. Also, there is the widening influence of marketing, which we see much more frequently now thanks to commercials. Maybe it's just a facade, I don't know. There are certainly plenty of anti-medication people out there, if you find the right circle--I even saw people blaming the CT shootings on BIG PHARMA.

 

[LM02]

Look up some of Brett Deacon's work - really good stuff on biological explanations related to increased (not decreased) stigma, as well as poorer clinical outcomes.

 

[projectplat]

I feel that in some cases the chemical imbalance isn't always there. The potential for the chemical imbalance to be triggered is there. It is triggered when stressors in the person's life cause biochemical effects which change the neural pathways in the brain.

 

[erg923]

I feel that in some cases the chemical imbalance isn't always there. The potential for the chemical imbalance to be triggered is there. It is triggered when stressors in the person's life cause biochemical effects which change the neural pathways in the brain.

"Imbalance" would suggest that we know the proper "balance." Can you tell me the proper balance?

 

[Nymphicus]

Diabetes is a "chemical imbalance."

It is also influenced by things such as diet, exercise, other lifestyle factors, genetics, socioeconomic status. Etcetera.

 

[smalltownpsych]

Diabetes is a "chemical imbalance."

It is also influenced by things such as diet, exercise, other lifestyle factors, genetics, socioeconomic status. Etcetera.

Diabetes, especially Type 1, is fairly straightforward, pancreas doesn't make insulin which leads to x, y, and z. A high school biology class can explain the mechanisms for this. To make an analogy between the pancreas and insulin and neurological and psychological functioning is absurd and not really accurate. We don't even know what causes most mental illnesses, not to mention the complexities involved in treating them. Please don't perpetuate this false analogy that the pharmaceutical companies started as a marketing strategy.

 

[AcronymAllergy]

I know future's original post is a few years old, but my take isn't so much that folks over-biologize mental illness, but perhaps over-medicalize it. Because when it's a "chemical imbalance:" 1) it's not my fault; 2) because of that, there's nothing I can directly do about it myself; 3) because of that, only medication can truly be effective; and 4) hey, medication is "easier" than therapy anyway.

Is there a biological underpinning to everything we do/think/feel? Sure. Does that mean mental illness is always caused by some type of malfunction in these systems, per se? I'm not yet sold on that point.

 

[Nymphicus]

Diabetes, especially Type 1, is fairly straightforward, pancreas doesn't make insulin which leads to x, y, and z. A high school biology class can explain the mechanisms for this. To make an analogy between the pancreas and insulin and neurological and psychological functioning is absurd and not really accurate. We don't even know what causes most mental illnesses, not to mention the complexities involved in treating them. Please don't perpetuate this false analogy that the pharmaceutical companies started as a marketing strategy.

My point was how vague the phrase "chemical imbalance" is.

 

[smalltownpsych]

My point was how vague the phrase "chemical imbalance" is.

Oh, I thought that you were supporting the chemical imbalance analogy.

 

[Harry3990]

100% agree. My perspective is that the treatment works because it changes the way people behave across levels, i.e., including neurochemically and physiologically. BA works (partially) because doing more things and more things you like (vast simplification) increases lots of great biological workings including dopamine, serotonin, norepinephrine, and helps your circadian rhythm get back on track, all things fundamental to mood. Psychology is biology, the perspective and way we treat it is different.

Back to the primary issue, I agree the the general public (and often people in treating/researching fields) think too simply about what "mental illness" and its cause is. The core problem I see is that people think that is mental illness is biological then that means it is inevitable and irreversible, so people with symptoms should not try treatment except maybe meds that they never go off of, because there cannot be a cure for what is "biology", and others see those with mental illness as "deviant" and "other", as is being discussed in the mental health reform thread. Ultimately it can be a reason for stasis and stigma.

Some great points in this thread. I would completely agree with the post above. I've presented this viewpoint as part of psychoeducational discussion with several clients and found it to be extremely helpful in combating this misconception (e.g., I don't know why I'm depressed=>maybe the cause is biological=>maybe I need meds/nothing else will help/there's nothing I can do). The idea that changes in cognition and behavior (as initiated by interventions in therapy, etc.) cause direct and profound changes to biology can be a very empowering idea. I sometimes use the analogy that neural connections can be strengthened (i.e., LTP) from something as simple as habitual cognitive restructuring/positive thinking in a similar way to muscles becoming stronger through physical strength training.

First time poster here, but I've been browsing this forum for a while now. I just wanted to take a moment to echo this sentiment that this false dichotomization of psychology/biology is not only a silly oversimplification but can also be harmful to clients in therapy, not to mention the general population.

Also, thanks to all the regulars for the valuable information and opinions that you guys take the time to present on this forum. I have found it quite helpful throughout the past few years of my training.

 

[futureapppsy2]

I know future's original post is a few years old, but my take isn't so much that folks over-biologize mental illness, but perhaps over-medicalize it. Because when it's a "chemical imbalance:" 1) it's not my fault; 2) because of that, there's nothing I can directly do about it myself; 3) because of that, only medication can truly be effective; and 4) hey, medication is "easier" than therapy anyway.

Is there a biological underpinning to everything we do/think/feel? Sure. Does that mean mental illness is always caused by some type of malfunction in these systems, per se? I'm not yet sold on that point.

Yep. Well said, AA.

 

[smalltownpsych]

I know future's original post is a few years old, but my take isn't so much that folks over-biologize mental illness, but perhaps over-medicalize it. Because when it's a "chemical imbalance:" 1) it's not my fault; 2) because of that, there's nothing I can directly do about it myself; 3) because of that, only medication can truly be effective; and 4) hey, medication is "easier" than therapy anyway.

Is there a biological underpinning to everything we do/think/feel? Sure. Does that mean mental illness is always caused by some type of malfunction in these systems, per se? I'm not yet sold on that point.

I actually think that much of what I treat on a daily basis are actually examples of normal neurological functioning. Many of my patients have normal (or perhaps expected is a better word) reactions to abnormal events. Early childhood parental abandonment, sexual abuse, combat exposure, death of a parent (as a child), loss of a child, just to name a few. Each person will react differently depending on a lot of other factors, but when you look at protective factors vs. risk factors, it usually provides a fair prediction of functioning. Neurological functioning, which subsumes neurochemical functioning as well as neuroanatomical function, is just one of those factors.
Dr. Smalltown's Three Rules (just made this up today)
Rule Number One: Medication will not fix their messed up life.
Rule Number Two: Medication will not make them behave.
Rule Number Three: Medication will not make them happy.

 

[projectplat]

"Imbalance" would suggest that we know the proper "balance." Can you tell me the proper balance?

Sure, the proper balance is when someone does not invoke the Baker Act on you.

 

[Ollie123]

Sure, the proper balance is when someone does not invoke the Baker Act on you.

....which stems from behavior, not from chemicals. No one says "We need to Baker Act this person and put them on suicide watch immediately! Their serotonin level is only 0.5 ng/mL." The point is just that we don't know what a good "chemical balance" looks like, because with all the technology we have at present we can still have two people with the exact same serotonergic activity and vastly different behavioral outcomes. So unless one person is talking about hurting themselves...they aren't getting an involuntary commitment.

Will address some of the other points later, but suffice it to say I agree with much of what has already been said with regards to the over-medicalization and over-biologization. And I say this as someone who is building his career off understanding the neurobiology of mental illness in what is perhaps the only area of mental health (drug use) where it would be truly impossible to argue that biology/chemistry don't play SOME role, given the effects of the drugs themselves.

 

[erg923]

Sure, the proper balance is when someone does not invoke the Baker Act on you.

I dont know what that is (72 hour psych hold?), but it sounds delicious.

 

[smalltownpsych]

I dont know what that is (72 hour psych hold?), but it sounds delicious.

There you go again. Making wisecracks. Someone's feelings are going to get hurt.
I was thinking of the gun law at first, but then remembered, "oh that's Brady, not Baker". Who the heck is Baker?

 

[Ollie123]

There you go again. Making wisecracks. Someone's feelings are going to get hurt.
I was thinking of the gun law at first, but then remembered, "oh that's Brady, not Baker". Who the heck is Baker?

Guessing said person is a Floridian (barring a weird coincidence). Its the name of the mental health act in Florida that allows for involuntary commitment. "Baker act" has unfortunately become a verb there referring to involuntary commitments, despite the fact that it won't make sense in communication with anyone outside the state. Of course, that's like the least of FL's problems...

 

[smalltownpsych]

In California it was a 5150. No one outside of Cali knows what that means and lots of people hate it when you say Cali too!

 

[Drrrrrr. Celty]

I actually think that much of what I treat on a daily basis are actually examples of normal neurological functioning. Many of my patients have normal (or perhaps expected is a better word) reactions to abnormal events. Early childhood parental abandonment, sexual abuse, combat exposure, death of a parent (as a child), loss of a child, just to name a few. Each person will react differently depending on a lot of other factors, but when you look at protective factors vs. risk factors, it usually provides a fair prediction of functioning. Neurological functioning, which subsumes neurochemical functioning as well as neuroanatomical function, is just one of those factors.
Dr. Smalltown's Three Rules (just made this up today)
Rule Number One: Medication will not fix their messed up life.
Rule Number Two: Medication will not make them behave.
Rule Number Three: Medication will not make them happy.

I'd imagine that the medication makes it a whole lot easier for them to get the help to fix their messed up lives though. I mean plenty of people have severe symptoms that impair basic daily functions and medication will get them to the point that they can actually come in for long term therapy and or start establishing a normal life.

I know future's original post is a few years old, but my take isn't so much that folks over-biologize mental illness, but perhaps over-medicalize it. Because when it's a "chemical imbalance:" 1) it's not my fault; 2) because of that, there's nothing I can directly do about it myself; 3) because of that, only medication can truly be effective; and 4) hey, medication is "easier" than therapy anyway.

Is there a biological underpinning to everything we do/think/feel? Sure. Does that mean mental illness is always caused by some type of malfunction in these systems, per se? I'm not yet sold on that point.

I think people just don't know anything about neuroscience and when combined with the stigma of mental illness people become very resistant to the idea that there is something chemically altered. I mean to you and I that's not a big deal since we know brain chemistry is by definition about change, but for others who don't have the background is becomes something akin to being told that you have a chronic illness that makes you worse off than others.
Define malfunction to be honest. An abnormal circuit that produces an abnormal response? Or a normal circuit that has had a new influence that causes an abnormal response? The point is that something has changed in your wiring or in your expression of gene products. Which in itself as an explanation is entirely meaningless when talking about the brain....

 

[PsyDr]

Re:"my brain made me do it"

If only there was a term for experiencing the self as an object, like a brain or something...

Last I heard there was an increase in incidence of the associated disorder, and no fda approved medication for it.

 

[projectplat]

....which stems from behavior, not from chemicals. No one says "We need to Baker Act this person and put them on suicide watch immediately! Their serotonin level is only 0.5 ng/mL." The point is just that we don't know what a good "chemical balance" looks like, because with all the technology we have at present we can still have two people with the exact same serotonergic activity and vastly different behavioral outcomes. So unless one person is talking about hurting themselves...they aren't getting an involuntary commitment.

You don't have to say you are going to hurt yourself/others to be committed.

Others only have to perceive you are a danger or a threat to others. If they call 911 on you ... welcome to inpatient.

This is why I hardly say to anyone anymore that I have a mental illness. The worry and caution factor are raised to a level of irrationality that negatively impacts my life at the most inopportune times.

 

[WisNeuro]

Well, there has to be evidence of danger, one can't just make a claim out of the blue. Otherwise there is the option of civil legal action.

 

[Ollie123]

You don't have to say you are going to hurt yourself/others to be committed.

Well yes, I obviously am aware that there are other routes besides outright saying the words. Though I agree with wis its important to recognize that perception won't get you very far in the absence of some sort of significant behavioral evidence.

It all misses the broader point though, which is that while we may have an adopted definition of normative behavior, there is no such thing for a normative chemical level of X - at least with regards to diagnosing mental health concerns.

 

[erg923]

You don't have to say you are going to hurt yourself/others to be committed.

Others only have to perceive you are a danger or a threat to others. If they call 911 on you ... welcome to inpatient.

This is why I hardly say to anyone anymore that I have a mental illness. The worry and caution factor are raised to a level of irrationality that negatively impacts my life at the most inopportune times.

"Perceived" in not the correct terminology at all. This term would suggest that that such things are based on gut instincts rather than clinical/behavioral evidence.

 

[smalltownpsych]

I'd imagine that the medication makes it a whole lot easier for them to get the help to fix their messed up lives though. I mean plenty of people have severe symptoms that impair basic daily functions and medication will get them to the point that they can actually come in for long term therapy and or start establishing a normal life.



I think people just don't know anything about neuroscience and when combined with the stigma of mental illness people become very resistant to the idea that there is something chemically altered. I mean to you and I that's not a big deal since we know brain chemistry is by definition about change, but for others who don't have the background is becomes something akin to being told that you have a chronic illness that makes you worse off than others.
Define malfunction to be honest. An abnormal circuit that produces an abnormal response? Or a normal circuit that has had a new influence that causes an abnormal response? The point is that something has changed in your wiring or in your expression of gene products. Which in itself as an explanation is entirely meaningless when talking about the brain....

Yes, many of my patients take medication and some recognize right away the role of medication in their treatment, but unfortunately most do not and the adjusting of dosages to address fairly typical life events and fluctuation of mood is ubiquitous. That sends the wrong message on a variety of levels. "I'm feeling stressed out because people at work are jerks. I think I need my meds adjusted." Patient knows that if they aren't clear about how bad they are, the change won't happen so they will make sure the doc understands how bad the symptoms are so that something is done.

When I think about some of these dynamics, I don't envy the psychiatrists and understand how difficult/mpossible these dynamics can be to address on a 15 minute 2 to 3 month follow-up. Then the challenge for me is how to work on the perception without engendering splitting or worse, the patient impetuously dc'ing their medication.

 

[erg923]

I'd imagine that the medication makes it a whole lot easier for them to get the help to fix their messed up lives though. I mean plenty of people have severe symptoms that impair basic daily functions and medication will get them to the point that they can actually come in for long term therapy and or start establishing a normal life.



I think people just don't know anything about neuroscience and when combined with the stigma of mental illness people become very resistant to the idea that there is something chemically altered. I mean to you and I that's not a big deal since we know brain chemistry is by definition about change, but for others who don't have the background is becomes something akin to being told that you have a chronic illness that makes you worse off than others.
Define malfunction to be honest. An abnormal circuit that produces an abnormal response? Or a normal circuit that has had a new influence that causes an abnormal response? The point is that something has changed in your wiring or in your expression of gene products. Which in itself as an explanation is entirely meaningless when talking about the brain....

You'd imagine yes, but anecdotally speaking, in the absence of severe mental illness, I rarely see psych medications 1. significantly reduce any distress/symptoms. 2. facilitate the therapy or behavioral change process.

 

[AcronymAllergy]

I'd imagine that the medication makes it a whole lot easier for them to get the help to fix their messed up lives though. I mean plenty of people have severe symptoms that impair basic daily functions and medication will get them to the point that they can actually come in for long term therapy and or start establishing a normal life.



I think people just don't know anything about neuroscience and when combined with the stigma of mental illness people become very resistant to the idea that there is something chemically altered. I mean to you and I that's not a big deal since we know brain chemistry is by definition about change, but for others who don't have the background is becomes something akin to being told that you have a chronic illness that makes you worse off than others.
Define malfunction to be honest. An abnormal circuit that produces an abnormal response? Or a normal circuit that has had a new influence that causes an abnormal response? The point is that something has changed in your wiring or in your expression of gene products. Which in itself as an explanation is entirely meaningless when talking about the brain....

And this is exactly one of the key problems to the "chemic imbalance" perception and description. As has been previously mentioned, we don't know what normal or healthy levels of these chemicals are (or even if normal/health levels actually exist), nor do we know if "abnormal" levels are truly associated in a causative way with mental illness. Are the differing levels due to underlying neuronal dysfunction? And what does healthy/normal neuronal functioning look like? Might mental illness reflect "normal" or adaptive neurobiological effects in response to dysfunctional/maladaptive environments (ala stress being both helpful and harmful, depending on the situation)? Are there certain firing tendencies/patterns that cause one to be more susceptible to, say, stress-reactivity or worry-proneness? All of the above?

Just spewing random thoughts.

 

[Drrrrrr. Celty]

And this is exactly one of the key problems to the "chemic imbalance" perception and description. As has been previously mentioned, we don't know what normal or healthy levels of these chemicals are (or even if normal/health levels actually exist), nor do we know if "abnormal" levels are truly associated in a causative way with mental illness. Are the differing levels due to underlying neuronal dysfunction? And what does healthy/normal neuronal functioning look like? Might mental illness reflect "normal" or adaptive neurobiological effects in response to dysfunctional/maladaptive environments (ala stress being both helpful and harmful, depending on the situation)? Are there certain firing tendencies/patterns that cause one to be more susceptible to, say, stress-reactivity or worry-proneness? All of the above?

Just spewing random thoughts.

I think fundamentally it's why the issue is kinda not worth talking about. We should agree that medical intervention provides relief from symptoms and the sort. Empirically this means that the restoration of closer to normal function imply that there's a difference or change within the function before said intervention. But what it what or whether it was external or internal in all honesty is clinically irrelevant.

 

[Drrrrrr. Celty]

You'd imagine yes, but anecdotally speaking, in the absence of severe mental illness, I rarely see psych medications 1. significantly reduce any distress/symptoms. 2. facilitate the therapy or behavioral change process.

If someone has mild psychiatric symptoms that can go away with therapy for adjustment or etc, then medication is most likely irrelevant unless they're in a situation in which said mild symptoms can explode into something worse.... which I suppose is the whole purpose of the evaluation and assessment of individual patients.

In either case, we know that the combination of drug therapy and psychological therapy or counseling produces the best outcomes. And I believe they provide different roles. Undershooting the pharm is simply not a smart thing to do because it does help.

 

[WisNeuro]

In either case, we know that the combination of drug therapy and psychological therapy or counseling produces the best outcomes. And I believe they provide different roles. Undershooting the pharm is simply not a smart thing to do because it does help.

Agree, in part. For depression, definitely, lots of data suggesting combo therapy outperforms either mono. And, in some cases (e.g., Bipolar, schizophrenia) obviously psychotherapy is not going to be able to do much in a mono role at all. But, for many things on the anxiety spectrum, pharm is actually not helpful at all, and can lead to worse rebound anxiety. Here's where the eval and assessment become essential. All mental illness is not equal and deserving of the same treatment.

 

[psych844]

Doesn't depression, (in the majority of cases), go away without any intervention?

 

[WisNeuro]

A major depressive episode will eventually remit in most cases, but 50%+ will have another depressive episode later, and something like 80%+ of those will have recurring episodes.

 

[projectplat]

"Perceived" in not the correct terminology at all. This term would suggest that that such things are based on gut instincts rather than clinical/behavioral evidence.

Not necessarily. Perception is the lens by which people view the world.

 

[WisNeuro]

I left solipsism behind in my undergraduate philosophy classes.

 

[erg923]

Not necessarily. Perception is the lens by which people view the world.

The purpose of clinical training and criteria sets is to counter act this. Generally it works well. Nobody is throwing patient in psych wards because they "just feel like it."

 

[projectplat]

Yes, many of my patients take medication and some recognize right away the role of medication in their treatment, but unfortunately most do not and the adjusting of dosages to address fairly typical life events and fluctuation of mood is ubiquitous. That sends the wrong message on a variety of levels. "I'm feeling stressed out because people at work are jerks. I think I need my meds adjusted." Patient knows that if they aren't clear about how bad they are, the change won't happen so they will make sure the doc understands how bad the symptoms are so that something is done.

When I think about some of these dynamics, I don't envy the psychiatrists and understand how difficult/mpossible these dynamics can be to address on a 15 minute 2 to 3 month follow-up. Then the challenge for me is how to work on the perception without engendering splitting or worse, the patient impetuously dc'ing their medication.

Isn't there a difference between rational stress from difficult events and irrational stress from a misconceived notion of what is going on or catastrophizing?

 

[projectplat]

Doesn't depression, (in the majority of cases), go away without any intervention?

Maybe if it is mild and doesn't worsen and the person can work through it. But, I think there is a difference between having the blues and having clinical depression.

 

[psych844]

Maybe if it is mild and doesn't worsen and the person can work through it. But, I think there is a difference between having the blues and having clinical depression.

Not saying there isn't a difference in terms of how a person feels..I'm saying that the research shows that basically all cases of major depression go away on their own eventually.

 

[smalltownpsych]

Isn't there a difference between rational stress from difficult events and irrational stress from a misconceived notion of what is going on or catastrophizing?

Yes and medication would not be the primary indicated treatment for either scenario. Although to be fair, depressed mood does shape perspectives and medication has been demonstrated to be helpful with improving mood which in theory could help reduce negative thought processes. You might have missed my point though, which was the tendency for patients to begin looking at medications as the essential agent to regulate mood and the need to emphasize that with their psychiatrists.

 

[smalltownpsych]

Not saying there isn't a difference in terms of how a person feels..I'm saying that the research shows that basically all cases of major depression go away on their own eventually.

I think that is a misreading of the statistics as it as an episodic illness. Also, in many cases the depression goes away because the patient committed suicide. In other words, Major Depressive Disorder is a serious condition that should be treated.

 

[WisNeuro]

Not saying there isn't a difference in terms of how a person feels..I'm saying that the research shows that basically all cases of major depression go away on their own eventually.

I think you are conflating Major Depressive Disorder with a Major Depressive Episode.