On the Murphy Bill
December 8, 2015 10:22 AM Subscribe
A Psychiatrist Opposes H.R. 2646: Here’s Why:
"We need to keep in mind that involuntary treatment in public health is generally reserved for situations in which the disease is common, communicable, and has a high potential to be lethal, and in which the cause of the disease is known and the legally required treatment is associated with low risk. Examples would be the tetanus or pertussus vaccines for children, or screening for tuberculosis. Mental health diagnoses and treatments simply do not meet this profile. While many mental health professionals cite “chemical imbalances in the brain” as the cause for psychiatric disturbance and the justification for psychotropic medications, the fact is that such imbalances have never been consistently demonstrated by research. Most recently, a number of alternative theories have emerged that implicate viral genetic material and autoimmune reactions in the central nervous system or generalized inflammation in the etiology of mental illnesses. These novel models of mental illness are promising, but they also call our current treatment practices into question. The fact is, we don’t know what causes mental health disorders, and as a result we don’t know whether the treatments we would force on people are scientifically justifiable or even relevant."
"We need to keep in mind that involuntary treatment in public health is generally reserved for situations in which the disease is common, communicable, and has a high potential to be lethal, and in which the cause of the disease is known and the legally required treatment is associated with low risk. Examples would be the tetanus or pertussus vaccines for children, or screening for tuberculosis. Mental health diagnoses and treatments simply do not meet this profile. While many mental health professionals cite “chemical imbalances in the brain” as the cause for psychiatric disturbance and the justification for psychotropic medications, the fact is that such imbalances have never been consistently demonstrated by research. Most recently, a number of alternative theories have emerged that implicate viral genetic material and autoimmune reactions in the central nervous system or generalized inflammation in the etiology of mental illnesses. These novel models of mental illness are promising, but they also call our current treatment practices into question. The fact is, we don’t know what causes mental health disorders, and as a result we don’t know whether the treatments we would force on people are scientifically justifiable or even relevant."
This post was deleted for the following reason: Hey there, sorry, a single-issue advocacy website is rarely going to be a good core for a Mefi post. The issues raised by the bill could work as a post with different links, though. -- LobsterMitten
"The fact is, we don’t know what causes mental health disorders, and as a result we don’t know whether the treatments we would force on people are scientifically justifiable or even relevant."
Something to think about anytime a psychiatrist wants to prescribe you something.
posted by el io at 10:28 AM on December 8, 2015 [4 favorites]
Something to think about anytime a psychiatrist wants to prescribe you something.
posted by el io at 10:28 AM on December 8, 2015 [4 favorites]
This is why I always saw psychologists, not psychiatrists.
posted by thebotanyofsouls at 10:29 AM on December 8, 2015
posted by thebotanyofsouls at 10:29 AM on December 8, 2015
A lack of understanding of the etiology of mental illness doesn't necessarily mean that a given treatment is scientifically unsupported. Successful clinical trials can demonstrate efficacy in the absence of an understanding of the mechanism.
posted by Mitrovarr at 10:38 AM on December 8, 2015 [3 favorites]
posted by Mitrovarr at 10:38 AM on December 8, 2015 [3 favorites]
Some background, in case anyone other than me isn't aware of the bill: The "Murphy" bill, H.R. 2646 (text here) is the "Helping Families in Mental Health Crisis Act of 2015" (subtitle: "To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes") proposed by Pennsylvania Republican Congressman Tim Murphy in the US House of Representatives this past June. A similar bill has been proposed in the Senate.
NAMI's take on the it. That letter doesn't appear to address any of the concerns being raised by Dr. Kalinowski.
posted by zarq at 10:38 AM on December 8, 2015
NAMI's take on the it. That letter doesn't appear to address any of the concerns being raised by Dr. Kalinowski.
posted by zarq at 10:38 AM on December 8, 2015
Yeah, there's this unfortunate alliance between destigmatizing mental illness (good!) and pushing reductive explanations of mental illness (less good).
So it sounds like a compassionate thing to say, your condition is "just" a chemical imbalance in the brain. But we don't actually understand most conditions well enough to support that assertion.
I think there has been a sense that, well, (1) SSRIs work for depression, (2) SSRIs work by adjusting the balance of brain chemicals, therefore (3) depression is (or is caused by) an imbalance of brain chemicals. But there are various problems with this argument, not least that the evidence of SSRIs working for depression is not all that great.
posted by grobstein at 10:39 AM on December 8, 2015
So it sounds like a compassionate thing to say, your condition is "just" a chemical imbalance in the brain. But we don't actually understand most conditions well enough to support that assertion.
I think there has been a sense that, well, (1) SSRIs work for depression, (2) SSRIs work by adjusting the balance of brain chemicals, therefore (3) depression is (or is caused by) an imbalance of brain chemicals. But there are various problems with this argument, not least that the evidence of SSRIs working for depression is not all that great.
posted by grobstein at 10:39 AM on December 8, 2015
Ari Ne'eman of the Autistic Self-Advocacy Network has written against the bill: Mental illness: an easy scapegoat for those who won't point fingers elsewhere.
posted by Lexica at 10:43 AM on December 8, 2015 [1 favorite]
posted by Lexica at 10:43 AM on December 8, 2015 [1 favorite]
Something to think about anytime a psychiatrist wants to prescribe you something.
It's something to think about, that doesn't mean it's the only thing to think about. Mental health disorders can also be lethal or, if not lethal, very nearly life-destroying when inadequately treated. I don't know if the problem with my ADD is that my brain lacks dopamine; it doesn't actually matter. Taking a stimulant at modest doses changed my life. There are people I know who wouldn't be alive if it weren't for antidepressants. But that doesn't mean that involuntary treatment is the answer. If anything, it's more reason that it isn't. Different medications help different people, and I'm not the only one who had to go to several different doctors before I got a good fit and a regimen that really helped me. One was happy to keep me on a drug that made me so nauseous that I was living on meal replacement shakes and nearly fainting in class, because at least it wasn't a stimulant. People need to have control over the context in which they receive medical treatment whenever possible, including for mental health disorders.
If these treatments were all magic bullets with no drawbacks, then the mandate would be less objectionable, but also people would probably be much more willing to seek treatment in the first place. The author here mentions how the positive outcomes in one case also came with a whole bunch of money poured into care. This is a fundamental problem no matter what kind of treatment you're discussing... you'd probably benefit more from just throwing more money at mental health care, right now. If people object to medication, we need to be dealing with why that is, not just shoving it down their throats, in almost all cases.
posted by Sequence at 10:47 AM on December 8, 2015
It's something to think about, that doesn't mean it's the only thing to think about. Mental health disorders can also be lethal or, if not lethal, very nearly life-destroying when inadequately treated. I don't know if the problem with my ADD is that my brain lacks dopamine; it doesn't actually matter. Taking a stimulant at modest doses changed my life. There are people I know who wouldn't be alive if it weren't for antidepressants. But that doesn't mean that involuntary treatment is the answer. If anything, it's more reason that it isn't. Different medications help different people, and I'm not the only one who had to go to several different doctors before I got a good fit and a regimen that really helped me. One was happy to keep me on a drug that made me so nauseous that I was living on meal replacement shakes and nearly fainting in class, because at least it wasn't a stimulant. People need to have control over the context in which they receive medical treatment whenever possible, including for mental health disorders.
If these treatments were all magic bullets with no drawbacks, then the mandate would be less objectionable, but also people would probably be much more willing to seek treatment in the first place. The author here mentions how the positive outcomes in one case also came with a whole bunch of money poured into care. This is a fundamental problem no matter what kind of treatment you're discussing... you'd probably benefit more from just throwing more money at mental health care, right now. If people object to medication, we need to be dealing with why that is, not just shoving it down their throats, in almost all cases.
posted by Sequence at 10:47 AM on December 8, 2015
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posted by Melismata at 10:25 AM on December 8, 2015