Mental illness

Discussion in 'Politics, Religion, Social Issues' started by Cromulent, Dec 12, 2011.

  1. Cromulent macrumors 603

    Cromulent

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    #1
    I've read a few posts on the subject and that got me thinking about how people perceive people with mental illness. Do you think people with severe mental illness should be allowed out into the community? When should people with mental illness be sectioned? Can people be cured from mental illness with medication and with psychologist sessions?

    I'm interested to hear what people about the subject.
     
  2. Mord macrumors G4

    Mord

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    #2
    I have a few mental illness diagnosis on my medical record, I don't agree with most of them tbh but I don't have a choice in the matter.

    I think there's too much stigma associated with them, there are a few that cause people to be a danger to themselves and others but there's also a clear legal and medical framework whereby those people can be put into appropriate care.
     
  3. Daveoc64 macrumors 601

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    #3
    "Mental Illness" covers a huge range of issues, so it's a bit hard to define what should happen to everyone.

    Someone with Obsessive Compulsive Disorder (OCD) probably doesn't need to be locked away from the public, but someone with a serious personality disorder might need to be treated with medication in a secure institution until they are deemed safe to leave.
     
  4. Ugg macrumors 68000

    Ugg

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    #4
    There are way too many variables when it comes to mental illness and a blanket "solution" is not an option.

    What's 'severe' mental illness to you? someone with homicidal/suicidal thoughts? It's way too complex to reduce it to a few soundbites.
     
  5. eljanitor, Dec 12, 2011
    Last edited: Dec 12, 2011

    eljanitor macrumors 6502

    eljanitor

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    #5
    According to this article http://odili.net/news/source/2011/sep/7/803.html over one quarter of the worlds population suffers from some kind of mental illness, or disorder of some kind.

    There is no "cure" for mental illness as it isn't something that can necessarily be "cured", but can be treated. There are many categories of mental disorders. You might just be surprised to see just how many people in the world have some kind of mental disorder and never get diagnosed or treated.

    One of the problems with how most of the worlds society misunderstands mental illnesses is that not all mentally ill people need to be locked away in a mental ward. There are people who do suffer from mental disorders and have committed murders that are in institutions for the criminally insane, and sometimes just plain mental hospitals for long periods of time.

    I do know, and have known people who have been diagnosed with various mental disorders and are not a threat to themselves or others. They walk around in public and go to work like anybody else and you may never know what they have been diagnosed with unless they told you. Some of them are the most caring , sweetest loving people in the world. Some of them work at the desk next to you, ride on the bus with you, bag your groceries, cook your meals at restaurants and you don't know it, nor should it bother anyone.

    I have done some research in this field and have read about and seen the some of the various treatments we have for different mental disorders today. I have seen what people who are "locked away" go through. I have seen how it affects not just them, but also the people in their life. I have also seen how they are sometimes discriminated against by some who do not wish to understand what they may be experiencing.

    There's allot of information for you about mental health, and mental disorders etc. I would recommend this link for more information about mental illness: http://www.aafp.org/online/en/home.html
     
  6. soco macrumors 68030

    soco

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    #6
    As someone who works with the mentally ill every day and constantly fights for their rights in court, I can tell you without hesitation that this framework you speak of is broken.

    The whole "issue" as it were with mentally ill in public is that it's just one of those things that makes most uncomfortable. Where I work there are people who are completely and irreversably insane walking around all the time. The difference is, they've proven to a degree that they won't hurt anyone. They're just nuts.

    While it's true that once someone poses a danger to themselves or others they and those they would hurt should be protected, I know thousands of cases where people are treated as if this were the case and it is not. This may be what Mord was eluding to.

    Just today I was threatened over the phone by a patient who said he wanted to come insert certain things into certain places in my dead body. Clearly a case where he belongs where he is.

    But Friday I spoke to a nice woman who's family had her thrown into an institution on a false warrant (very easy to do by the way) and now the system has her by the balls. She'll get out. I guarantee that. But what a crappy ordeal she has to go through when she doesn't deserve it. And I'm telling you it's not a "better safe than sorry" kind of thing. This woman is perfectly fine, however she's locked up like a criminal and she's got drugs shoved down her throat (literally) every few hours.
     
  7. mkrishnan Moderator emeritus

    mkrishnan

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    #7
    Honestly, coming from the professional side, I have to agree -- the concept of "severe" mental illness or "severe" psychiatric disorders is thrown around a lot but is ill defined. There are people who have reasonably well managed schizophrenia on medications and can be pretty functional, for instance, and there's not necessarily a good reason to view those people as "ticking time bombs." Personality disorders by definition ought to have some pretty profound impact on the person's life, if the diagnosis is truly correct, but even many of these individuals are functional in the community for long segments of their life and do not pose a significant risk to anyone by doing so.

    I agree that Cromulent's question is too broad. Some types of psychiatric disease are eminently treatable either through therapy, medications, or both. Some can be managed to some extent by those means but will continue to be more or less disabling to the individual. And in some cases normal behavior in response to the social milieu and normal, transient emotional disturbances are mischaracterized as psychiatric disorders and treated unnecessarily.

    My challenge would be that one could take the above paragraph and replace "psychiatric" with "neurological" or "cardiovascular" or "neoplastic" and the story would largely be the same. There's nothing unique to psychiatric disease about any of this.

    As a clinician, I like it when the process is flexible, first taking into account risk to the person and risk to others and then providing a maximally free, self-directed lifestyle (and this means long-term institutionalization or residential living for some people). I think we're getting slowly better at this.

    EDIT: To Mord's point, "hypothetically speaking," had I suffered from such a problem myself in the past, I may well have paid for treatment privately to keep it out of my record and then remained silent about it to my professional community. It ought not have to be that way.
     
  8. Mord, Dec 12, 2011
    Last edited: Dec 12, 2011

    Mord macrumors G4

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    #8

    Agreed, my statement factual, I do not agree with the current framework and I think it is indeed entirely broken. I've seen it seriously **** up my friends lives.


    Thanks for the insight, it's interesting to hear about the system from the perspective of someone working from your side.

    It's also interesting how different things are in the UK, over in the states the medical profession seems to enjoy massively overprescribing psychoactive drugs like they're candy, while over here while that's the case with SSRIs anything else is considered more of a last resort.

    I prefer our system, for the most part, though occasionally it's incredibly irritating.



    I'd have loved to do that if I even required any care, in my case they just seemed to be tacked onto my record without my knowing. I suffer from neither depression nor anxiety though seemingly at some point my GP seemed to think I did.
     
  9. torbjoern macrumors 65816

    torbjoern

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    #9
    It's how people behave and what they do which determines how I perceive them, and not some diagnose - whether it's flu, cancer or schizophrenia. Many psychiatrists (and other employees in mental hospitals) are even less sane than their patients.
     
  10. iJohnHenry macrumors P6

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    #10
    That's an old thought.

    They got into the "trade" in an attempt to find out what the Hell was wrong with them.

    Perhaps Shrink would care to give us an insider's opinion.
     
  11. Mord macrumors G4

    Mord

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    #11
    Not so much IME, I know a couple of people training to be MH workers. They've generally survived their own problems and either found the help their received so valuable they feel compelled to help others similarly or so awful that they feel compelled to make a difference or even both with different care providers.
     
  12. mkrishnan Moderator emeritus

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    #12
    This has actually been studied, and at least in terms of recognized psychiatric diagnoses, is probably not true. I can try to find references -- it's been a while since I read up on the topic.
     
  13. iJohnHenry macrumors P6

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    #13
    I concur, but some of them seem to walk that fine line between genius and insanity. ;)
     
  14. torbjoern macrumors 65816

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    #14
    Oh, it's an old thought? I might have known.

    I'm not saying they're all like Hannibal Lector, it's just that I have experienced a lot of weird and random behaviour from employees when visiting a friend of mine who was institutionalised. Some of them were ok, but most of them were hard to distinguish from the patients. They treated me like some kind of criminal who had asked for access to a bank vault or something. I just wanted to see my friend, that's all. I wonder when was the last time those guys saw a psychiatrist - they really seemed to suffer from delusional paranoia.
     
  15. Sydde, Dec 14, 2011
    Last edited: Dec 14, 2011

    Sydde macrumors 68020

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    #15
    Some years back, I spent five months in the state hospital while they tried to suss out my problem. I was fairly rational but just delusional enough to have impaired judgement (yes, I know, lingering evidence...). It was not Nurse Ratched's facility but one a little less restrictive (and a tiny bit more modern).

    The lesson I took away from that (which was apparent not "never do acid again") was: how is this supposed to actually work? It seemed kind of analogous to the way prison functions more as con-college than rehabilitation. I distinctly remember one guy who just paced in a circle and shouted "hirseshit!" if you every tried to speak to him. A young woman who appeared to be too shy to speak. A guy who was totally irrational and could become violent at times. A woman who would spontaneously start chasing invisible butterflies. A stew of various mental and/or emotional issues, all thrown together to roil, but not really so much to help each other get better.

    It was a garbage dump, a place to send away the ones we would rather not deal with. Some of them were basically untreatable, and so they ought to be (?) consigned to a lesser life. Some were sort of on vacation from the rat race. Some were involuntaries (I was Randle Patrick McMurphy, but without the boat), some were just trying to get better.

    I understand about the convenience of the staff, but I wholly detest the out-of-sight out-of-mind ethos. Just like garbage. For the ones who can get better, they need to have more exposure to stable people, not so much to the outliers. Really, the stigma itself is a huge problem. We all need to take an active part in helping potentially productive people back on their feet. Or even to finding ways to mitigate the more severe social stresses that send some over the edge.
     
  16. Scepticalscribe Contributor

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    #16
    An excellent, informed and very informative thread. Actually, I'm amazed, moved and impressed by some of the posts here - it takes real courage to discuss such matters, especially if they have played a role in one's own life. Well done all.
     
  17. mkrishnan Moderator emeritus

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    #17
    I think this is a social psychological effect and/or response to environment rather than any kind of underlying psychiatric disease. Are you familiar with the "prisoner" study or the infamous study in the 60s (I think) of starvation behavior that elicited anorexia-like behaviors in healthy men? A big part of this is that places like inpatient psychiatric facilities (and jails/prisons) are weird places that develop their weird cultures for a mix of sensible and non-sensible / no-longer-sensible reasons. These kinds of environments can make normal people act oddly (much like that famous case study of the woman being stabbed in NYC doesn't mean that she "happened" to be witnessed by dozens of people who coincidentally were all sociopaths).
     
  18. Naimfan macrumors 68040

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    #18
    I think the public perception of mental illness is quite different from the reality. By that I mean the public hears "mental illness" and equates it to mean "that person is crazy." There is little nuance or understanding of the degree of severity - most people don't understand that different mental illnesses will have differing levels of impact on the patient, or have differing levels of severity, which themselves can change.

    I also don't think people understand the differences among mental illnesses. I went out with someone suffering from a fairly serious case of Borderline Personality Disorder - serious enough that it severely and negatively impacted her life, but not so serious that she was a serious threat to herself or others, her numerous suicide threats notwithstanding. It was HELL. BPD is, IIRC, an Axis II illness, and as such does not qualify for most state treatment because Axis II diagnoses still assign responsibility for one's actions to the individual, compared to Axis I illnesses, where a person may not be completely responsible for their actions. (She was diagnosed as suffering from BPD by two independent psychologists - not by me.)

    Also, I think the public has heard so much about mental illness that the slightest indication - say, someone frequently washing their hands - becomes a hip-pocket diagnosis - in that case, the hand-washer must have OCD.

    Finally, I think mental illness is like politics or constitutional law - most people have their own firmly fixed ideas around it, and most of them have very little understanding of what they're talking about (which I probably demonstrated two paragraphs above re BPD).
     
  19. mkrishnan Moderator emeritus

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    #19
    Does your state really operate that way? I don't think that's common. Michigan is actually fairly pro-active about offering dialectical behavioral therapy (which is primarily indicated for BPD) through community mental health, although not in enough places / with enough seats in the program.

    In contrast I do believe there are some private insurances that have made this kind of limitation; I'm not sure if the parity situation is changing this or not. Their logic is usually that the disorder needs chronic / long-term treatment, although since they do not make this limitation on hypothyroidism, diabetes, or a wide variety of other chronic conditions, it's clearly a non-parity situation.
     
  20. Gelfin macrumors 68020

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    #20
    I get so torn about Axis II disorders, actually. I don't know where the line is between saying someone isn't a bad person because his/her behavior is caused by a diagnosed medical condition, and on the other hand understanding Axis II to be simply classifying different types of bad person. To label a personality disordered individual does not excuse their behavior, and certainly does not make it any easier to live with one. Especially considering the ones that are almost impossible to treat, like NPD, or in lay terms, "being a giant douche."
     
  21. mkrishnan Moderator emeritus

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    #21
    In the case of BPD, I think the fact that DBT provides them empirically supported benefit is a strong argument, but you make a good point.

    What gets more messed up (but intriguing) is a sociobiological or ethological explanation of personality disorders. There are some animal populations in which a minority of males engage in "sneaky copulation" -- that is, rather than mating in the common way of these animals, they try to "sneak" action with females (who willingly cooperate). Evolutionary optimization of the behavior basically results in a small but stable percentage of the population engaging in this behavior (that is, the averaged kind of fitness values are highest when a small percentage of the population does this).

    The same idea can be extended to bad human behavior.

    For instance, if you consider theft, we mostly generally agree that theft is bad and people shouldn't steal. We like to minimize theft. However, if we somehow magically had absolutely zero theft, we would suddenly have to deal with firing all the security guards, police officers, detectives, etc, who make a living dealing with theft. One can make a fairly strong argument for the idea that a behavior like theft has an optimal set-point in a population (probably that set point is modifiable by a wide-range of environmental factors), and that set point is generally greater than zero. The same argument applies by extension for things like antisocial traits, narcissism, and so on.

    The population does not tolerate these at high base rates (everyone can't be antisocial), but arguably they become a stable competing strategy at very low base rates.

    But I definitely agree with you, what constitutes a "personality disorder" vs. someone who is simply a jackass and has to live with the consequences of their behavior is an important element of figuring out how to make psychiatric diagnosis make sense.
     
  22. Gelfin macrumors 68020

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    #22
    It's a bit off topic, but I'm with you apart from this bit. This is broken window fallacy. Every bit of effort spent offsetting loss carries an opportunity cost. In a population of three, you can have one farmer, one thief and one security guard, or you can have three farmers. The latter is the optimum.

    I understand what you're getting at, and I definitely understand viewing, say, sociopathy in terms of "alternate evolutionary survival strategy," but I don't think that example is getting you where you want to be.
     
  23. mkrishnan Moderator emeritus

    mkrishnan

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    #23
    Hmm, I'm not an economist, but I'm not sure your argument is correct until you get to very small populations like the one you describe (of just three people).

    An economist would have to deal with the question of why, if this is the optimum / most transparent / economically maximized scenario, why it never obtains. I'd actually be really curious about this -- is there an economics theory or quantitative argument that backs this idea up -- that economic theft behaviors' impact are optimized at zero in larger populations?

    From a biological standpoint, the question would be why you see the same apparent failure to optimize in the form of eliminating comparable "bad behavior" in animals in spite of millions of years of time to engage in the genetic optimization process.

    Actually I think the confluence of economics and psychology (which really look at a lot of overlapping questions) is really interesting. :)
     
  24. Gelfin macrumors 68020

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    #24
    In this case, though, you're confusing economics and psychology in a way that doesn't produce meaningful insight. Thievery happens not because of some "invisible hand" optimization of the overall economy, which is what you're getting at, but only because it advantages an individual beyond what he could (or is willing to) achieve by working, at cost to others. Expenditures towards offsetting or preventing a loss are always a resource sink overall. There's no hidden efficiency to it.
     
  25. torbjoern macrumors 65816

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    #25
    Your explanation of odd behaviour by employees in mental healthcare seems plausible - although I'm not familiar with the prisoner study you mentioned. Interesting reference to the Kitty Genovese case, by the way. It's far more likely that she was surrounded by sheeple than by sociopaths - evil happens when good men do nothing.
     

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