Medicalizing Society
September 5, 2018 1:23 PM Subscribe
The rise of psychiatry was funded by America’s Gilded Age industrialists. Their aim: to cast society’s ills as problems of individual "mental health." (Zola Carr, Jacobin).
"The medicalized lexicon of “mental health” purports to cover a vast terrain of everyday experience. According to a report from the World Health Organization, rates of major depression worldwide increased by 18.4 percent globally between 2005 and 2015, reaching 322 million sufferers. Psychiatric epidemiology demonstrates rising levels of psychological stress, anxiety among high-schoolers, major depression (diagnosed roughly twice as often among women as among men, and on the rise globally); “hopelessness” in undergraduate populations; and PTSD rates among civilians that exceed even those found in veterans from Iraq and Afghanistan. This medicalization has made the language of “mental health” sacrosanct across the political spectrum, even on the left.
Yet the idea that population-wide rates of despair and social dysfunction should be understood as biological diseases, rather than the result of rampant class inequality and miserable labor conditions, is hardly self-evident. In fact, it has a highly political history."
"The medicalized lexicon of “mental health” purports to cover a vast terrain of everyday experience. According to a report from the World Health Organization, rates of major depression worldwide increased by 18.4 percent globally between 2005 and 2015, reaching 322 million sufferers. Psychiatric epidemiology demonstrates rising levels of psychological stress, anxiety among high-schoolers, major depression (diagnosed roughly twice as often among women as among men, and on the rise globally); “hopelessness” in undergraduate populations; and PTSD rates among civilians that exceed even those found in veterans from Iraq and Afghanistan. This medicalization has made the language of “mental health” sacrosanct across the political spectrum, even on the left.
Yet the idea that population-wide rates of despair and social dysfunction should be understood as biological diseases, rather than the result of rampant class inequality and miserable labor conditions, is hardly self-evident. In fact, it has a highly political history."
I do think it's an interesting question though, wrt depression, anxiety, etc.. anyhow: are you depressed because there is something wrong with you that we can treat with medication and therapy, or are you depressed because there's something wrong with society and we need to treat society's problems first otherwise you'll just be treating the symptoms and not the cause?
posted by some loser at 2:30 PM on September 5, 2018 [22 favorites]
posted by some loser at 2:30 PM on September 5, 2018 [22 favorites]
There's also the blunt reality that even successful transformations of society don't happen overnight and it'd be awfully nice for people not to be incapacitated or even self-harming while waiting for the state to wither away.
posted by praemunire at 2:36 PM on September 5, 2018 [65 favorites]
posted by praemunire at 2:36 PM on September 5, 2018 [65 favorites]
Simultaneously, this shift prioritized a paradigm of privatized mental health in which individual citizens shouldered responsibility for non-severe, everyday problems like depression. By lumping both severe mental illness (such as florid psychosis or schizophrenia) together with the common varieties of medicalized affect (garden-variety anxiety and depression) and rejecting the medical basis of both, the antipsychiatry movement unwittingly colluded in the destruction of state resources for mental health care.
I'm trying to read this charitably, but this really reads as if the author is saying that depression can never be severe, life-threatening, or worthy of state-funded mental health care, which is frankly offensive.
posted by IjonTichy at 2:40 PM on September 5, 2018 [47 favorites]
I'm trying to read this charitably, but this really reads as if the author is saying that depression can never be severe, life-threatening, or worthy of state-funded mental health care, which is frankly offensive.
posted by IjonTichy at 2:40 PM on September 5, 2018 [47 favorites]
Also, this is really just yet another example of the worn-out brain versus environment debate. Complex traits like depression emerge from a complex interaction between biological predispositions and the environment in which one finds oneself. This is something that biologists are well aware of, and neuroscientists have not embarked on a "hyper-biologized" question for the "location" of depression in the brain. Anyone who focuses on one of the sides of that equation to the exclusion of the other has an axe to grind.
posted by IjonTichy at 2:55 PM on September 5, 2018 [9 favorites]
posted by IjonTichy at 2:55 PM on September 5, 2018 [9 favorites]
this is really just yet another example of the worn-out brain versus environment debate
What the author has pointed out is that certain class elements have succeeded in removing environmental factors from the equation for their own gain. Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
posted by MillMan at 3:04 PM on September 5, 2018 [18 favorites]
What the author has pointed out is that certain class elements have succeeded in removing environmental factors from the equation for their own gain. Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
posted by MillMan at 3:04 PM on September 5, 2018 [18 favorites]
For a more personal perspective on this subject: Mark Fisher's Good for Nothing.
At some not very submerged level, I evidently still didn’t believe that I was the kind of person who could do a job like teaching. But where did this belief come from? The dominant school of thought in psychiatry locates the origins of such ‘beliefs’ in malfunctioning brain chemistry, which are to be corrected by pharmaceuticals; psychoanalysis and forms of therapy influenced by it famously look for the roots of mental distress in family background, while Cognitive Behavioural Therapy is less interested in locating the source of negative beliefs than it is in simply replacing them with a set of positive stories. It is not that these models are entirely false, it is that they miss – and must miss – the most likely cause of such feelings of inferiority: social power. The form of social power that had most effect on me was class power, although of course gender, race and other forms of oppression work by producing the same sense of ontological inferiority, which is best expressed in exactly the thought I articulated above: that one is not the kind of person who can fulfill roles which are earmarked for the dominant group.
It's a complicated issue. Saying "we should attack the cause, not the symptom" ignores the fact that for all therapy and medication is far, far less effective than we would like it to be, it is still a far better thing to pin your hopes on than the chance of society spontaneously fixing all its ills.
On the other hand ignoring the fact that depression and anxiety might be caused by cultural factors instead of a lack of serotonin or whatever means that those in power can excuse themselves from any sense of responsibility for it.
Power is very, very good at doing that- evading responsibility for the harms it causes. Power tells you that it's not that you aren't getting paid enough for your work; it's that you didn't invest in education, or invest in the right subject for your education. It's not systematic racism; it's culture and black-on-black crime. It's not systematic sexism; it's that women aren't interested in certain subjects. And now, it's not we've set up a society that alienates people from sources of meaning, from time spent on leisure and family, in favor of the Productivity God; it's depression. It's not that we've set up a society that rewards hyper hyper hyper competitiveness and where there's only the barest fragment of a safety net in the case of unemployment or sickness or plain bad luck; it's anxiety.
Asking why so many people are prone to depression and anxiety does not have to mean invalidating depression and anxiety as illnesses or invalidating the treatments that we have for it, not any more than tracing an e coli outbreak to the mishandling of lettuce invalidates e coli as an illness.
posted by perplexion at 3:08 PM on September 5, 2018 [43 favorites]
At some not very submerged level, I evidently still didn’t believe that I was the kind of person who could do a job like teaching. But where did this belief come from? The dominant school of thought in psychiatry locates the origins of such ‘beliefs’ in malfunctioning brain chemistry, which are to be corrected by pharmaceuticals; psychoanalysis and forms of therapy influenced by it famously look for the roots of mental distress in family background, while Cognitive Behavioural Therapy is less interested in locating the source of negative beliefs than it is in simply replacing them with a set of positive stories. It is not that these models are entirely false, it is that they miss – and must miss – the most likely cause of such feelings of inferiority: social power. The form of social power that had most effect on me was class power, although of course gender, race and other forms of oppression work by producing the same sense of ontological inferiority, which is best expressed in exactly the thought I articulated above: that one is not the kind of person who can fulfill roles which are earmarked for the dominant group.
It's a complicated issue. Saying "we should attack the cause, not the symptom" ignores the fact that for all therapy and medication is far, far less effective than we would like it to be, it is still a far better thing to pin your hopes on than the chance of society spontaneously fixing all its ills.
On the other hand ignoring the fact that depression and anxiety might be caused by cultural factors instead of a lack of serotonin or whatever means that those in power can excuse themselves from any sense of responsibility for it.
Power is very, very good at doing that- evading responsibility for the harms it causes. Power tells you that it's not that you aren't getting paid enough for your work; it's that you didn't invest in education, or invest in the right subject for your education. It's not systematic racism; it's culture and black-on-black crime. It's not systematic sexism; it's that women aren't interested in certain subjects. And now, it's not we've set up a society that alienates people from sources of meaning, from time spent on leisure and family, in favor of the Productivity God; it's depression. It's not that we've set up a society that rewards hyper hyper hyper competitiveness and where there's only the barest fragment of a safety net in the case of unemployment or sickness or plain bad luck; it's anxiety.
Asking why so many people are prone to depression and anxiety does not have to mean invalidating depression and anxiety as illnesses or invalidating the treatments that we have for it, not any more than tracing an e coli outbreak to the mishandling of lettuce invalidates e coli as an illness.
posted by perplexion at 3:08 PM on September 5, 2018 [43 favorites]
What the author has pointed out is that certain class elements have succeeded in removing environmental factors from the equation for their own gain.
The author is vigorously attacking a straw man. Here, let's look at literally the first abstract on the genetics of depression I was able to find:
"Genetic variants are expected to have only small effects on overall disease risk, and multiple genetic factors in conjunction with environmental factors are likely necessary for the development of MDD."
This is in Current Psychiatry Reports.
posted by IjonTichy at 3:13 PM on September 5, 2018 [6 favorites]
The author is vigorously attacking a straw man. Here, let's look at literally the first abstract on the genetics of depression I was able to find:
"Genetic variants are expected to have only small effects on overall disease risk, and multiple genetic factors in conjunction with environmental factors are likely necessary for the development of MDD."
This is in Current Psychiatry Reports.
posted by IjonTichy at 3:13 PM on September 5, 2018 [6 favorites]
Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
It's that way because most of us are Americans, and in America, the presumption is that if something is bothering you, you either change it or accept it. If you let it make you miserable, you're a loser and deserve to feel what you're feeling. (Hence the popular proverb "No one can make you feel inferior without your permission.") In our culture, there's not a lot of daylight between "depression can have environmental causes" and "depression is the sufferer's fault." So people who deal with these conditions are not enthusiastic about having this argument with lay people.
A while back, I fell and busted my knee because of sunken bricks in a sidewalk. Fixing the brickwork would have prevented other people from falling, but it would have done nothing for my knee. Removing environmental causes for major depressive and anxiety disorders is not always enough for everyone.
posted by Countess Elena at 3:15 PM on September 5, 2018 [36 favorites]
It's that way because most of us are Americans, and in America, the presumption is that if something is bothering you, you either change it or accept it. If you let it make you miserable, you're a loser and deserve to feel what you're feeling. (Hence the popular proverb "No one can make you feel inferior without your permission.") In our culture, there's not a lot of daylight between "depression can have environmental causes" and "depression is the sufferer's fault." So people who deal with these conditions are not enthusiastic about having this argument with lay people.
A while back, I fell and busted my knee because of sunken bricks in a sidewalk. Fixing the brickwork would have prevented other people from falling, but it would have done nothing for my knee. Removing environmental causes for major depressive and anxiety disorders is not always enough for everyone.
posted by Countess Elena at 3:15 PM on September 5, 2018 [36 favorites]
Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
Nice straw man you have there.
posted by Homo neanderthalensis at 3:23 PM on September 5, 2018 [24 favorites]
Nice straw man you have there.
posted by Homo neanderthalensis at 3:23 PM on September 5, 2018 [24 favorites]
Usually when you hear folks rail against psychiatry and such it's from a very different angle. I wasn't expecting to find this in any way a compelling argument, but I am.
"The idea that population-wide rates of despair should be understood as biological diseases, rather than the result of rampant class inequality and miserable labor conditions, is hardly self-evident."
Maybe it's just feeding into my established classism, but this way of framing it makes a lot of sense to me.
posted by GoblinHoney at 3:56 PM on September 5, 2018 [5 favorites]
"The idea that population-wide rates of despair should be understood as biological diseases, rather than the result of rampant class inequality and miserable labor conditions, is hardly self-evident."
Maybe it's just feeding into my established classism, but this way of framing it makes a lot of sense to me.
posted by GoblinHoney at 3:56 PM on September 5, 2018 [5 favorites]
Psychiatry allowed us to filter all long term or serious emotional distress through the lens of labelling and medication. I believe this is truly and injustice and a harm, one that we actually owe active apology and restoration to the people still struggling from what has been done to them in the past and what the medical establishment continues to do with them without accountability despite what is currently coming out in research.
The fact that current research reflects the knowledge of environmental harms does not change that the system is still being run by people trained ten, fifteen, twenty years ago and significant public announcements of these new changes and hauling the system has not happened. Therefore these updates can wind up meaning little for someone seeking help at present who could be offered the same old diagnostic criteria from the DSM and have pills thrown at them even when they say they have side effects that are worse than when they started. I have hopes things will change, even quickly, but there is a lot to be done so calling this a strawman seems very uncaring to those being harmed by the current system which very often functions with the old assumptions in tact.
This is a paper that discusses how findings in epigenetics call for responses outside just the medical field, for policy changes that are human friendly and repercussions in many other fields.
Because epigenetics and ACES studies are usually filtered through "health research" and health research is overwhelmingly used to make money by pharmaceutical approaches to disease, using this vast array of knowledge we have about how poverty, trauma, inequality, school environments, violence neighborhoods, racism, abuse, poor nutritional factors, toxic exposures impact not only the epigenetic and health landscape of an individual, but also their children and grandchildren. The solutions being proposed however are still interestingly, how we can use this research to give people pills that will stop them from showing signs their environment harmed them. Very little discussion, though some DOES!, is given to the ways these responses may even be resilient or part of a healthy reaction and process of responding to harmful environments. Grieving is healthy and if you have more to grieve, it might take longer and have greater impact on work and life performance. But it doesn't necessarily mean the mechanism needs to be transferred to a pill.
We already know so many factors that undisputedly increase mental illness in people and for us to focus purely on what pills to force and shame people into taking, rather than on fixing the problems is quite heinous.
posted by xarnop at 4:00 PM on September 5, 2018 [12 favorites]
The fact that current research reflects the knowledge of environmental harms does not change that the system is still being run by people trained ten, fifteen, twenty years ago and significant public announcements of these new changes and hauling the system has not happened. Therefore these updates can wind up meaning little for someone seeking help at present who could be offered the same old diagnostic criteria from the DSM and have pills thrown at them even when they say they have side effects that are worse than when they started. I have hopes things will change, even quickly, but there is a lot to be done so calling this a strawman seems very uncaring to those being harmed by the current system which very often functions with the old assumptions in tact.
This is a paper that discusses how findings in epigenetics call for responses outside just the medical field, for policy changes that are human friendly and repercussions in many other fields.
Because epigenetics and ACES studies are usually filtered through "health research" and health research is overwhelmingly used to make money by pharmaceutical approaches to disease, using this vast array of knowledge we have about how poverty, trauma, inequality, school environments, violence neighborhoods, racism, abuse, poor nutritional factors, toxic exposures impact not only the epigenetic and health landscape of an individual, but also their children and grandchildren. The solutions being proposed however are still interestingly, how we can use this research to give people pills that will stop them from showing signs their environment harmed them. Very little discussion, though some DOES!, is given to the ways these responses may even be resilient or part of a healthy reaction and process of responding to harmful environments. Grieving is healthy and if you have more to grieve, it might take longer and have greater impact on work and life performance. But it doesn't necessarily mean the mechanism needs to be transferred to a pill.
We already know so many factors that undisputedly increase mental illness in people and for us to focus purely on what pills to force and shame people into taking, rather than on fixing the problems is quite heinous.
posted by xarnop at 4:00 PM on September 5, 2018 [12 favorites]
This is not a new idea; the Sozialistisches Patientenkollektiv, founded in 1970s West Germany by a Marxist psychiatrist and his patients, asserted much the same sort of thing (that mental illness was a structural artefact of capitalism), and instead of attempting to cure it individually, sought to weaponise it to bring down the system (“turn illness into a weapon” was their slogan).
posted by acb at 4:03 PM on September 5, 2018 [9 favorites]
posted by acb at 4:03 PM on September 5, 2018 [9 favorites]
For anyone interested this is also an interesting paper on where the "predispositions" to be more likely to respond to environmental factors might come from. I would love to hear others interesting research finds on this topic, there's so much coming out month to month and it's hard to find open access papers.
posted by xarnop at 4:10 PM on September 5, 2018 [3 favorites]
posted by xarnop at 4:10 PM on September 5, 2018 [3 favorites]
I'm more than a bit mouthy on the reality that minority stress is already recognized as being as big of a killer of African Americans as smoking, and I suspect it will displace violence and HIV for LGBTQ populations. But the problem there is there's no bright-line cause-effect case to be made in the same way as emphysema and lung cancer.
But, both the medicine and the anti-medicine approaches to this are utterly tainted by their own class-based biases, which are based on a false dichotomy between community and health care. Consider, that some of us choose to engage in community-building AND take medication to reduce the fucking undeniable mortality risks of major mental illness.
posted by GenderNullPointerException at 4:17 PM on September 5, 2018 [24 favorites]
But, both the medicine and the anti-medicine approaches to this are utterly tainted by their own class-based biases, which are based on a false dichotomy between community and health care. Consider, that some of us choose to engage in community-building AND take medication to reduce the fucking undeniable mortality risks of major mental illness.
posted by GenderNullPointerException at 4:17 PM on September 5, 2018 [24 favorites]
Or to put it another way, demanding that people experiencing significant trauma due to oppression stop taking medication is rather like demanding that we stop taking PrEP or HRT because in some utopian world they might not be necessary.
posted by GenderNullPointerException at 4:54 PM on September 5, 2018 [24 favorites]
posted by GenderNullPointerException at 4:54 PM on September 5, 2018 [24 favorites]
Even if, e.g. depression, is a symptom of a sick society that needs to be fixed, I suspect that people suffering from depression are going to be less able to fix it than people whose depression has been treated.
Small scale: if you're severely depressed because you're in an abusive household, you know, it would be great if that household never existed or if somebody could just remove you from it. But if you're going to participate in fixing or escaping that household, you'll do it better if you're not incapacitated by symptoms of depression.
posted by edheil at 4:56 PM on September 5, 2018 [7 favorites]
Small scale: if you're severely depressed because you're in an abusive household, you know, it would be great if that household never existed or if somebody could just remove you from it. But if you're going to participate in fixing or escaping that household, you'll do it better if you're not incapacitated by symptoms of depression.
posted by edheil at 4:56 PM on September 5, 2018 [7 favorites]
This is not a new idea; the Sozialistisches Patientenkollektiv, founded in 1970s West Germany by a Marxist psychiatrist and his patients, asserted much the same sort of thing (that mental illness was a structural artefact of capitalism),
Foucault discussed this in Suicide as well, comparing historical rates of suicide with data from when Britain and France (iirc) developed as industrialized economies. Of course course, Foucault was a Marxist.
That increasingly many people are being pathologized due to 'the ills of modern life' is an accepted tenent of sociology. In the US, however, sociology is perhaps the most discredited of all the soft sciences... Probably for exactly the reasons discussed in this article.
posted by subdee at 5:00 PM on September 5, 2018 [3 favorites]
Foucault discussed this in Suicide as well, comparing historical rates of suicide with data from when Britain and France (iirc) developed as industrialized economies. Of course course, Foucault was a Marxist.
That increasingly many people are being pathologized due to 'the ills of modern life' is an accepted tenent of sociology. In the US, however, sociology is perhaps the most discredited of all the soft sciences... Probably for exactly the reasons discussed in this article.
posted by subdee at 5:00 PM on September 5, 2018 [3 favorites]
Or to put it another way, demanding that people experiencing significant trauma due to oppression stop taking medication is rather like demanding that we stop taking PrEP or HRT because in some utopian world they might not be necessary.
who would be so foolish?
Other than I guess maybe the author of the article?
posted by some loser at 5:04 PM on September 5, 2018 [1 favorite]
who would be so foolish?
Other than I guess maybe the author of the article?
posted by some loser at 5:04 PM on September 5, 2018 [1 favorite]
oMG I got my sociologists wrong... Emile Durkenheim wrote "Suicide" exploring the link between modernization and suicide in 1897.
My apologies, everyone.
posted by subdee at 5:14 PM on September 5, 2018 [3 favorites]
My apologies, everyone.
posted by subdee at 5:14 PM on September 5, 2018 [3 favorites]
*durkheim
posted by Ndwright at 5:30 PM on September 5, 2018 [3 favorites]
posted by Ndwright at 5:30 PM on September 5, 2018 [3 favorites]
Yes... Ahem...
posted by subdee at 5:41 PM on September 5, 2018 [2 favorites]
posted by subdee at 5:41 PM on September 5, 2018 [2 favorites]
Or to put it another way, demanding that people experiencing significant trauma due to oppression stop taking medication is rather like demanding that we stop taking PrEP or HRT because in some utopian world they might not be necessary.
I think we actually are supposed to stop taking HRT because we wouldn't want to "medicalize" menopause, and forgo epidurals because we wouldn't want to "medicalize" childbirth, and deny opioids to chronic pain sufferers because we should treat the root causes of chronic pain in a capitalist/individualist/irreligious/whatever society rather than just, you know, stopping the pain. (No, none of these arguments ever applies to erectile dysfunction.)
posted by Ralston McTodd at 5:46 PM on September 5, 2018 [18 favorites]
I think we actually are supposed to stop taking HRT because we wouldn't want to "medicalize" menopause, and forgo epidurals because we wouldn't want to "medicalize" childbirth, and deny opioids to chronic pain sufferers because we should treat the root causes of chronic pain in a capitalist/individualist/irreligious/whatever society rather than just, you know, stopping the pain. (No, none of these arguments ever applies to erectile dysfunction.)
posted by Ralston McTodd at 5:46 PM on September 5, 2018 [18 favorites]
Yeah a lot of the “stop using psychiatric meds because capitalism is the real problem” arguments are pretty indistinguishable from “just suck it up buttercup- depression/anxiety/etc ain’t so bad” arguments so while I do think there are points to be made about the various ways psychiatric meds are not a panacea... this type of article always pegs my sceptic-meter up to 11.
posted by Homo neanderthalensis at 5:58 PM on September 5, 2018 [10 favorites]
posted by Homo neanderthalensis at 5:58 PM on September 5, 2018 [10 favorites]
I'm trying to read this charitably, but this really reads as if the author is saying that depression can never be severe, life-threatening, or worthy of state-funded mental health care, which is frankly offensive.
The entire thesis of this article is very offensive and ignorant. Society is not to blame for everything because we are all in society, and if you have people who have organic disorders, they impact society as well as those who don't. This is typical "it is someone's else's" fault sophistry that does an enormous disservice to those who do have severe psychological problems.
Schizophrenia is not caused by a bad society. Tourette's is not caused by a bad society. People often show psychological problems through organic origins, from untreated STDs, brain tumours, and lead poisoning And there is folie a deux where two isolated people have the same delusion, and then they are separated: the person who is not naturally afflicted with the illness suddenly no longer holds that delusion, while the person who does have the illness maintains it.
And even people who are completely isolated from a "bad society" show the same predictable symptoms and cause themselves the same kinds of harm, meaning the hypothesis is bunk.
There is not a single society -- no matter how different it is than other societies -- that doesn't have people with depression, bipolar, anxiety, and the like, and the hallmark of these disorders is that the person feels or behaves in a dysfunctional way regardless of the circumstances. Society is not bad to everyone equally, yet you have rich, famous, and beloved public figures have the same psychological disorders as people who are poor and living on the fringe. It runs in families. We see brain differences in scans. This isn't made up junk. While I agree that much of the profession over-expands what it knows, not everything is tainted.
Clinical psychology -- and we are talking about clinical psychology here -- is far from perfect, but as there is more research, much of the archaic and bigoted ideas are dropped. We do evolve, but when I read something like this, I know this isn't a factual piece, but partisan opinion with very little understanding of the profession or its complexities. You can spew big words all you want, but sophistry and sophistry, and this is sophistry.
posted by Alexandra Kitty at 5:59 PM on September 5, 2018 [21 favorites]
The entire thesis of this article is very offensive and ignorant. Society is not to blame for everything because we are all in society, and if you have people who have organic disorders, they impact society as well as those who don't. This is typical "it is someone's else's" fault sophistry that does an enormous disservice to those who do have severe psychological problems.
Schizophrenia is not caused by a bad society. Tourette's is not caused by a bad society. People often show psychological problems through organic origins, from untreated STDs, brain tumours, and lead poisoning And there is folie a deux where two isolated people have the same delusion, and then they are separated: the person who is not naturally afflicted with the illness suddenly no longer holds that delusion, while the person who does have the illness maintains it.
And even people who are completely isolated from a "bad society" show the same predictable symptoms and cause themselves the same kinds of harm, meaning the hypothesis is bunk.
There is not a single society -- no matter how different it is than other societies -- that doesn't have people with depression, bipolar, anxiety, and the like, and the hallmark of these disorders is that the person feels or behaves in a dysfunctional way regardless of the circumstances. Society is not bad to everyone equally, yet you have rich, famous, and beloved public figures have the same psychological disorders as people who are poor and living on the fringe. It runs in families. We see brain differences in scans. This isn't made up junk. While I agree that much of the profession over-expands what it knows, not everything is tainted.
Clinical psychology -- and we are talking about clinical psychology here -- is far from perfect, but as there is more research, much of the archaic and bigoted ideas are dropped. We do evolve, but when I read something like this, I know this isn't a factual piece, but partisan opinion with very little understanding of the profession or its complexities. You can spew big words all you want, but sophistry and sophistry, and this is sophistry.
posted by Alexandra Kitty at 5:59 PM on September 5, 2018 [21 favorites]
Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
Others (maybe just in politics threads) seem to be suspicious of those of us who aren't depressed/anxious. I hope those people are joking
posted by Pruitt-Igoe at 6:21 PM on September 5, 2018 [1 favorite]
Others (maybe just in politics threads) seem to be suspicious of those of us who aren't depressed/anxious. I hope those people are joking
posted by Pruitt-Igoe at 6:21 PM on September 5, 2018 [1 favorite]
Suggesting that depression has an environmental component is taboo on the left
Also? not true? It's people on left who strongly believe that depression has an environmental component, usually while also believing in evidence based meds (hello it me.) Like, I honestly think at times in my life that meds saved me from myself, but I also think it was meds+therapy+better life habits, like its the whole package?
I have honestly never heard of this taboo.
posted by Homo neanderthalensis at 6:38 PM on September 5, 2018 [9 favorites]
Also? not true? It's people on left who strongly believe that depression has an environmental component, usually while also believing in evidence based meds (hello it me.) Like, I honestly think at times in my life that meds saved me from myself, but I also think it was meds+therapy+better life habits, like its the whole package?
I have honestly never heard of this taboo.
posted by Homo neanderthalensis at 6:38 PM on September 5, 2018 [9 favorites]
Yeah, as someone with severe enough ADHD that it's negatively impacted my life in any number of ways, I definitely believe that a) the particular brain-wiring that manifests as ADHD in our modern industrial society would not have caused the same kinds of difficulties in a preindustrial society, b) it probably would have caused some different kinds of difficulties, though, and c) I am still enormously relieved to have access to meds and therapy that make my ADHD manageable. And also, you know, access to plumbing and wi-fi.
posted by nonasuch at 6:53 PM on September 5, 2018 [19 favorites]
posted by nonasuch at 6:53 PM on September 5, 2018 [19 favorites]
I can vote and donate money towards things that will improve that for other people, but I can't instantly fix it. I do those things. I make career and life decisions with my brain in mind. Those things are easier for me to do effectively, to help myself and others, because of the care I've gotten from modern psychiatry. I can't imagine wanting to live in a socialist space utopia without ADD medication to ensure I can properly focus on the things that are meaningful to me and without anxiety medication for times when my brain thinks that a no-stakes conversation with strangers is an equivalent threat to being eaten by a bear.
But obviously, like, the panic attacks were worse when I had no sick days and was always on the verge of missing rent and getting utilities shut off, and the ADD was worse when I was always in jobs where I was treated as disposable. If people in places like this don't talk about that, I think it's usually because we assume the people we're talking to are on the same page about it but it's not an area where you can tell people they need to go start making more money and/or start a revolution to feel better.
posted by Sequence at 7:19 PM on September 5, 2018 [8 favorites]
But obviously, like, the panic attacks were worse when I had no sick days and was always on the verge of missing rent and getting utilities shut off, and the ADD was worse when I was always in jobs where I was treated as disposable. If people in places like this don't talk about that, I think it's usually because we assume the people we're talking to are on the same page about it but it's not an area where you can tell people they need to go start making more money and/or start a revolution to feel better.
posted by Sequence at 7:19 PM on September 5, 2018 [8 favorites]
I am also unfamiliar with the alleged taboo of attributing the contemporary prevalence of various mental health issues to environmental factors (on a side note, LOL at the conflation of "the left" and MetaFilter). Anyone who's done their research is familiar with the fact that personality disorders are defined contextually. I fully believe that, in a public health sense, incidences of depression and ADHD in particular are symptomatic of broader cultural pathologies. I also take medicines to alleviate both of those conditions, because, guess what, that's the water I swim in! It's deeply frustrating on the one hand to be told by dogmatic shitheads on the left that I'm just swallowing pro-capitalism pills to make me a better worker, and on the other hand to be told by shitheads in the pharmacological-industrial complex that I'm a broken cog and that a little mechanical–psychoactive intervention is all that's needed to properly oil my gear teeth. It's only because of those meds that I'm able to devote a portion of my energies to activism and political change, so, in summary, fuck just about everyone.
posted by invitapriore at 8:06 PM on September 5, 2018 [11 favorites]
posted by invitapriore at 8:06 PM on September 5, 2018 [11 favorites]
For those of you that haven't read the article, there's not a single sentence where the author advocates that anyone stop taking medication.
What's interesting about the article are the historical references to psychiatrists advocating that they have found the medical solution to labor strikes.
In fact there are a couple of paragraphs that warn against a facile anti-psychiatry, with a little bit of history of how that has made things worse.
For those of you who are interested in the history of this topic that extends further back than 1865, you could do worse than read the drapetomania Wikipedia page, or the page for "Wandering Womb."
posted by eustatic at 8:13 PM on September 5, 2018 [24 favorites]
What's interesting about the article are the historical references to psychiatrists advocating that they have found the medical solution to labor strikes.
In fact there are a couple of paragraphs that warn against a facile anti-psychiatry, with a little bit of history of how that has made things worse.
For those of you who are interested in the history of this topic that extends further back than 1865, you could do worse than read the drapetomania Wikipedia page, or the page for "Wandering Womb."
posted by eustatic at 8:13 PM on September 5, 2018 [24 favorites]
I admit I haven't read the entire article, only skimmed it—did I mention I've got AD/HD?
So no it never directly says "stop taking meds" but it nods and waggles its eyebrows all to often in that effective neighborhood, and most importantly doesn't do hardly any of the mandatory groundwork to establish that I should trust the author to "get it", so to speak, and to understand it as not trying to drive a wedge in our community. Because this:
posted by traveler_ at 8:58 PM on September 5, 2018 [3 favorites]
So no it never directly says "stop taking meds" but it nods and waggles its eyebrows all to often in that effective neighborhood, and most importantly doesn't do hardly any of the mandatory groundwork to establish that I should trust the author to "get it", so to speak, and to understand it as not trying to drive a wedge in our community. Because this:
It is only by historicizing the political function of the attempt to medicalize everyday distress — and to frame it as equally as biologically medical as severe psychotic disordersis all wedge. That dichotomy is all over this essay and I've got a hunch which side of it the author would put me on.
posted by traveler_ at 8:58 PM on September 5, 2018 [3 favorites]
I believe that mental illness is a structural byproduct of capitalism (and +1 to Mark Fisher, absolutely) but also that psychiatry and medication are life-saving (n=1) and what I need to remain engaged in daily life and the larger project of reforming the world we live in. Mental illness is disabling or fatal and doesn't wait for you to find and address its roots.
posted by ahundredjarsofsky at 9:00 PM on September 5, 2018 [4 favorites]
posted by ahundredjarsofsky at 9:00 PM on September 5, 2018 [4 favorites]
While I'm thinking of it: after being diagnosed, to help understand my ADD I did a lot of reading and found a book that summarized the state of the research at the time. One part that jumped out at me is the condition is "overdiagnosed"—for American children who are white and male and have two-parent homes and are in the middle class or higher. Change any variable in any dimension and it goes the other way: underdiagnosis.
So any discussion of that condition that talks about "overdiagnosis" or has evocative images of psychiatry throwing pills at people to make them productive workers instead of proverbially fixing their root causes. That's perpetuating the problem. That's part of the bias, and part of (to match the theme of this essay) the classist system keeping us down, not part of any solution. It needs to stop twenty years ago.
posted by traveler_ at 9:10 PM on September 5, 2018 [15 favorites]
So any discussion of that condition that talks about "overdiagnosis" or has evocative images of psychiatry throwing pills at people to make them productive workers instead of proverbially fixing their root causes. That's perpetuating the problem. That's part of the bias, and part of (to match the theme of this essay) the classist system keeping us down, not part of any solution. It needs to stop twenty years ago.
posted by traveler_ at 9:10 PM on September 5, 2018 [15 favorites]
It is only by historicizing the political function of the attempt to medicalize everyday distress — and to frame it as equally as biologically medical as severe psychotic disorders
When I read sentences like this, it's totally obvious to me what the author means because there's a range of scholarship pointing to the same questions and problems having to do with politics and society, and the sorts of claims and issues they raise using this terminology, I've picked up over time by osmosis. With these, I'm at the point of "Yada yada, this is the zillionth variation of this problem", and I'm ready to get back to work and go on a deeper level. Where I'm coming from, these statements have a context and an ongoing conversation that academics and some activists are engaged in. Like, maybe they're classist because they're inaccessible so it's hard to fathom what exactly they're advocating and not advocating? Unlike the scholarly material they are based on, these articles tend to preach to the choir, are a little clickbaity, and people from a different political orientation coming in but kind of not part of the larger ongoing conversation understandably have a differing set of concerns.
posted by polymodus at 10:12 PM on September 5, 2018 [1 favorite]
When I read sentences like this, it's totally obvious to me what the author means because there's a range of scholarship pointing to the same questions and problems having to do with politics and society, and the sorts of claims and issues they raise using this terminology, I've picked up over time by osmosis. With these, I'm at the point of "Yada yada, this is the zillionth variation of this problem", and I'm ready to get back to work and go on a deeper level. Where I'm coming from, these statements have a context and an ongoing conversation that academics and some activists are engaged in. Like, maybe they're classist because they're inaccessible so it's hard to fathom what exactly they're advocating and not advocating? Unlike the scholarly material they are based on, these articles tend to preach to the choir, are a little clickbaity, and people from a different political orientation coming in but kind of not part of the larger ongoing conversation understandably have a differing set of concerns.
posted by polymodus at 10:12 PM on September 5, 2018 [1 favorite]
The article is not really about any particular mental illness, not about not taking medications for them, and explicitly talks about not going to extremes in either direction; it's from a political point of view detailing the links between early psychiatry and efforts to engineer class conformity.
posted by blue shadows at 11:11 PM on September 5, 2018 [4 favorites]
posted by blue shadows at 11:11 PM on September 5, 2018 [4 favorites]
Well I'm also coming from a place where these claims and issues and contexts have an ongoing conversation—among the psych/disability/advocacy community. And in that group the natural obvious dichotomy on this subject everyone would fall into would be between individual change and systemic change. More rugged wheelchairs versus smoother sidewalks for example.
And I suppose there's a place for an outsider perspective that looks at what the economic system wants and how it rations its definitions to shape our treatment. But even then the new perspective must have its own dichotomy with the old.
Otherwise it's a problem that the article not only not engages with our preferred (maybe hoary old?) dichotomy, it doesn't engage with our perspective at all. In academic language this is a colonialist tract in which its subjects are things. I don't like being used.
The question of classism doesn't come much from ideas that the words are all ivory-tower jargon that don't makes sense down here with us mice.
It's that historically, the "treatment" for people with mental illness was often no treatment at all: blame us, send us to remedial school, where we fail out to jail and find workhouses ready to make us productive laborers their way.
Medicalization comes in contrast as an improvement that gives us chances to expand our degree of participation in society. These chances are based on hearing our concerns and giving us tools to handle them. How wacky and radical this experiment! What sort of class-based perspective looks at this status quo and decides untreatment for the non-severe cases is more freeing for us midgrade crazies? My treatment got me my home!
The subect matter itself, and the community itself, is about these things. If the article tries to not be that's its failing—it's not seeing the true thing it's talking about. (Colonialism again.)
And of course it talks about not going to extremes in any direction: it's measured them! Laid out the points of view, set its dichotomies, surveyed the shapes of what the boundaries of the conversation are and taped up little note cards that say "too far" so we can all know which way that is and that they don't advocate it. Meanwhile:
Yet simultaneously, there is the danger of the inverse mistake: accepting the psychiatric paradigm for all emotional or mental distress.One of those "too far" directions is exactly what I want! It's not the end of the world if I get a little scratch on my finger but I want that scratch to be fully medicalized and accepting the orthopedic paradigm. Maybe that means Neosporin and a bandage, but maybe it means going to the ER and getting shots and stitches like the time my finger's scratch went deep through all the skin courtesy of a car door.
I want absolutely nobody to be thinking it's in any way conscionable to try to take away the psychiatric paradigm for mental distress by smuggling some out as "everyday".
Now if y'all'l excuse me, I'm going to take a sleeping pill so I can get some rest because I've been debating a core part of my identity past midnight. Go ahead and blame it on my job and need for productivity to pay rent. If I could I'd give anyone who doubts a copy of the nightmares I get when my insomnia hits. They frighten me and I have years of experience so good luck.
posted by traveler_ at 12:14 AM on September 6, 2018 [6 favorites]
I'm actually surprised that so many disagree with even having discussion of whether the medical model is appropriate for all experiences of trauma and grief or emotional issues that might interfere with performance. As a person with what can be defined as mental illness if it's the desired term, I feel there is a need for diverse perspectives that includes variety in this discussion. That includes the value people have found from medication, and also the value people have found from being free to not take medication or labels they found did them more harm than good and to have their voices and experiences of healing in the conversation.
I can completely understand why those who find the medical model has been at the heart of their recovery process experience, or of their loved ones recovery experience, that it would feel important to destroy any inkling of discussion over whether the foundation of criteria was itself based on a proven sound theory base for all forms of emotional or mental difficulties.
However for those of us harmed by the current treatment model, and we are many, it would be extremely relevant to have this discussion, especially if certain issues like a predisposition for trauma or adhd actually had some relation to trauma and adverse experience history of both the individual and parents and grandparents. Often studies have compared general talk therapy with medication, but what they often haven't compared is trauma therapy like emdr or eft which do seem to have some impact on treating depression and PTSD. If we are to find that healing trauma through trauma focused therapies actually altarts a range of other effects like deficits in memory and other functioning that would be quite relevant, and if some of the epigenetic inheritance given to people impacting their predisposition to mental illness might have some response to trauma focused therapies based on their parents or grandparents issues this is an avenue that might be worth exploring with time and research. It has been for me.
The problems in current research and assumptions behind them do need to be discussed, because if there were better treatment models that could help people in recovery we should be making those available to people. I don't think the article did very well at talking about the research or the problems with the foundation of the research. I would love to see this same subject written with a focus on studies that demonstrate where the medical model helps, for which there is certainly evidence, and when and who the medical model might not help as well, for which there is also evidence that some people don't respond or respond negatively to many types of medicalization of their emotional difficulties. However that doesn't mean that even evaluating where we might have gone wrong in a theory base behind some human difficulties is innately bad, it can only help us understand the truth better. And it certainly doesn't mean that people who have experienced benefit from medication should be forced or shamed into stop taking. Empowering diverse voices who have been impacted by what we call mental illness can be hard because it might seem some of us invalidate each other, but I don't think that has to be the case. People can heal different ways and we can all work hard to ensure that more options are available to people with diverse experiences and needs.
posted by xarnop at 5:10 AM on September 6, 2018 [8 favorites]
I can completely understand why those who find the medical model has been at the heart of their recovery process experience, or of their loved ones recovery experience, that it would feel important to destroy any inkling of discussion over whether the foundation of criteria was itself based on a proven sound theory base for all forms of emotional or mental difficulties.
However for those of us harmed by the current treatment model, and we are many, it would be extremely relevant to have this discussion, especially if certain issues like a predisposition for trauma or adhd actually had some relation to trauma and adverse experience history of both the individual and parents and grandparents. Often studies have compared general talk therapy with medication, but what they often haven't compared is trauma therapy like emdr or eft which do seem to have some impact on treating depression and PTSD. If we are to find that healing trauma through trauma focused therapies actually altarts a range of other effects like deficits in memory and other functioning that would be quite relevant, and if some of the epigenetic inheritance given to people impacting their predisposition to mental illness might have some response to trauma focused therapies based on their parents or grandparents issues this is an avenue that might be worth exploring with time and research. It has been for me.
The problems in current research and assumptions behind them do need to be discussed, because if there were better treatment models that could help people in recovery we should be making those available to people. I don't think the article did very well at talking about the research or the problems with the foundation of the research. I would love to see this same subject written with a focus on studies that demonstrate where the medical model helps, for which there is certainly evidence, and when and who the medical model might not help as well, for which there is also evidence that some people don't respond or respond negatively to many types of medicalization of their emotional difficulties. However that doesn't mean that even evaluating where we might have gone wrong in a theory base behind some human difficulties is innately bad, it can only help us understand the truth better. And it certainly doesn't mean that people who have experienced benefit from medication should be forced or shamed into stop taking. Empowering diverse voices who have been impacted by what we call mental illness can be hard because it might seem some of us invalidate each other, but I don't think that has to be the case. People can heal different ways and we can all work hard to ensure that more options are available to people with diverse experiences and needs.
posted by xarnop at 5:10 AM on September 6, 2018 [8 favorites]
xarnop: Which "current treatment model" and "medical model" are you criticizing here? The drug focused model? The equally corporate "wellness" model built around coercing compliance with exercise, yoga, and meditation workshops? Or the cost-cutting "community" model that's pushing more and more health care responsibility to nurses, social workers, ministers, and teachers? (Not that there's anything wrong with community support systems, but they're not a replacement for checkups and checkins.)
And pardon, my advocacy is for a radically queer mode of health care that empowers LGBTQ people to choose what keeps us alive another month. If you think that's "disagree(ing) with even having discussion," you were not paying attention.
In the article, trying to tease out schizophrenia from mood disorders using the word "grief" is a old dog whistle.
posted by GenderNullPointerException at 5:56 AM on September 6, 2018 [2 favorites]
And pardon, my advocacy is for a radically queer mode of health care that empowers LGBTQ people to choose what keeps us alive another month. If you think that's "disagree(ing) with even having discussion," you were not paying attention.
In the article, trying to tease out schizophrenia from mood disorders using the word "grief" is a old dog whistle.
posted by GenderNullPointerException at 5:56 AM on September 6, 2018 [2 favorites]
I'm not sure why you think I disagree with allowing LGBTQ people to choose what keeps us alive every month or why that is what you would think I meant. But to be clear that is most certainly not what I said or meant.
"But, both the medicine and the anti-medicine approaches to this are utterly tainted by their own class-based biases, which are based on a false dichotomy between community and health care."
I think this is a sensitive subject matter, for both myself personally and others here and there is a tendency to view this conversation as a battle between one or the other instead of having a nuanced discussion of diverse perspectives. That is all would like to see and is precisely what I meant. I wish to be included in the discussion as someone who has been labelled with a mental illness and who did not find the biological model helpful, indeed who found real healing only happened for me when I moved away from it and wish others to be afforded that freedom. I also wish those who found great healing and stability with meds to be trusted and supported in their experiences and use of the tools that most help them. I have had huge disagreements with the exploitation in the "new age" or "new wage" exploitative healing methods as well. I don't think we have any particular disagreement that I can yet see, but in a conversation that is hardly ever nuanced and diverse I can see why it's easy to think anyone who challenges the biological model in any way would subscribe to the stereotype of the most extreme challengers to the biological model.
posted by xarnop at 6:29 AM on September 6, 2018 [3 favorites]
"But, both the medicine and the anti-medicine approaches to this are utterly tainted by their own class-based biases, which are based on a false dichotomy between community and health care."
I think this is a sensitive subject matter, for both myself personally and others here and there is a tendency to view this conversation as a battle between one or the other instead of having a nuanced discussion of diverse perspectives. That is all would like to see and is precisely what I meant. I wish to be included in the discussion as someone who has been labelled with a mental illness and who did not find the biological model helpful, indeed who found real healing only happened for me when I moved away from it and wish others to be afforded that freedom. I also wish those who found great healing and stability with meds to be trusted and supported in their experiences and use of the tools that most help them. I have had huge disagreements with the exploitation in the "new age" or "new wage" exploitative healing methods as well. I don't think we have any particular disagreement that I can yet see, but in a conversation that is hardly ever nuanced and diverse I can see why it's easy to think anyone who challenges the biological model in any way would subscribe to the stereotype of the most extreme challengers to the biological model.
posted by xarnop at 6:29 AM on September 6, 2018 [3 favorites]
I will add you placed a huge assumption on me when I speak about grief. I was hospitalized and given anti-psychotics after I was sexually abused in a situation that started as statutory rape and included a great deal of other abuses, and then lost my daughter to adoption.
I dealt with extreme grief and PTSD that I believe very much was misclassified and mislabeled. Calling my perspective a dog whistle without even getting to know where I am coming from will not help us better understand and value each others perspectives. I hope we can all do more of that. I am quite knowledgeable about the degree of severity of symptoms people can face including dissociation, confusion, not even know where you are or what is happening, terror, inability to speak, screaming and crying in inappropriate places and settings, curling up in a ball in a fetal position screaming no no no no no no when you are asked to wear a hospital gown, I KNOW the severity of difficulties many people face. I also know that the meds they gave me made it worse and healing through trauma focused therapies opened doors of healing to me that were not previously present.
I have worked with homeless populations, lived among those coping with homelessness, addiction and severe mental illness and trauma. So I'm not coming from a perspective where when diagnosed with a mild depressive disorder I simply started eating healthy and exercising and came through. I have no expectation that anyone dealing with these symptoms should do so alone, or should have any capacity for the kind of self care or even BASIC daily functioning that is often heaved onto those facing the greatest obstacles often by both the new wage healing industrial complex and traditional psychiatry alike.
I want real discussion from people who have lived these things, with what has worked and what hasn't, and for those of who have been there to open our hearts and minds to the idea that different forms of support work better or worse for different people. Some people try a great deal of trauma therapy, EMDR, somatic experiencing, yoga, exercise and find no real healing comes until they take medication. These are important experiences that matter. So too are experiences like mine, as treatment resistant depression can sometimes respond better to non-pharmacological approaches and give people with horrible side effects of constantly trying new meds some options that don't make them feel so horrible that don't make them ostracized from the medical community and their familial and peer support system.
posted by xarnop at 6:41 AM on September 6, 2018 [4 favorites]
I dealt with extreme grief and PTSD that I believe very much was misclassified and mislabeled. Calling my perspective a dog whistle without even getting to know where I am coming from will not help us better understand and value each others perspectives. I hope we can all do more of that. I am quite knowledgeable about the degree of severity of symptoms people can face including dissociation, confusion, not even know where you are or what is happening, terror, inability to speak, screaming and crying in inappropriate places and settings, curling up in a ball in a fetal position screaming no no no no no no when you are asked to wear a hospital gown, I KNOW the severity of difficulties many people face. I also know that the meds they gave me made it worse and healing through trauma focused therapies opened doors of healing to me that were not previously present.
I have worked with homeless populations, lived among those coping with homelessness, addiction and severe mental illness and trauma. So I'm not coming from a perspective where when diagnosed with a mild depressive disorder I simply started eating healthy and exercising and came through. I have no expectation that anyone dealing with these symptoms should do so alone, or should have any capacity for the kind of self care or even BASIC daily functioning that is often heaved onto those facing the greatest obstacles often by both the new wage healing industrial complex and traditional psychiatry alike.
I want real discussion from people who have lived these things, with what has worked and what hasn't, and for those of who have been there to open our hearts and minds to the idea that different forms of support work better or worse for different people. Some people try a great deal of trauma therapy, EMDR, somatic experiencing, yoga, exercise and find no real healing comes until they take medication. These are important experiences that matter. So too are experiences like mine, as treatment resistant depression can sometimes respond better to non-pharmacological approaches and give people with horrible side effects of constantly trying new meds some options that don't make them feel so horrible that don't make them ostracized from the medical community and their familial and peer support system.
posted by xarnop at 6:41 AM on September 6, 2018 [4 favorites]
Calling my perspective a dog whistle without even getting to know where I am coming from will not help us better understand and value each others perspectives.
That was explicitly a criticism of the article (and its particular genre), and labeled as such.
posted by GenderNullPointerException at 6:50 AM on September 6, 2018 [1 favorite]
That was explicitly a criticism of the article (and its particular genre), and labeled as such.
posted by GenderNullPointerException at 6:50 AM on September 6, 2018 [1 favorite]
I've had to deal with enough people touched by the Church of Scientology in my life to be unduly sceptical of antipsychiatry messages. I agree that this article manages to walk a balance better than most.
I've come to think of a large number of health issues as failures of homeostasis in the body/brain/mind/soul/what-you-will. A healer who can get to know you and watch you for a long time and work out how your life is and how your body and mind react to it can work with this process of homeostasis. How do you recover from extreme states? That's more important than "how extreme is your state at moment
When we come to the doctor and measure with high blood pressure, they prescribe statins, which lower the blood pressure but have to fight the homeostatic processes pulling it back up. So we end up taking them for the rest of our lives.
When a local politician in my area said "well how about instead I take on a lifestyle change?" the doctor said "you're probably too busy." He took up cycling everywhere and brought everything to normal quickly, not by lowering his blood pressure but by raising it in ways that could help his body gain homeostasis. He keeps the (never filled) prescription for statins as a souvenir, and recalls his doctor saying "I need to get a bike!" as he left her office.
I often consider therapeutic systems that encourage the patient to engage with traumatic experiences in controlled environments. It's not treating the ailment by lowering fear or anxiety, but by raising it in a manner that allows the patient's mind (if that is in fact where the systems lie) to strengthen homeostatic abilities.
I know people who work as mental health technicians in the NHS, and the fights they have with doctors, nurses, and administrators over things as simple as dosages are kind of fascinating. Sometimes they're fighting to get someone a higher dose for relief, and sometimes they're trying to avoid blasting the "neurologically naïve" brain of a new patient. And sometimes they're teaming up with the nurses to tell the doctors that there's a history here that's being ignored by a once-over-diagnosis-and-prescription process.
But this isn't a failure of psychiatric medication. It's a failure to build systems that help us all observe our own homeostatic systems and find not "what's my blood pressure" or "what's my anxiety level" but rather "when I get anxious to a certain level, how long and difficult is it for me to go back to baseline?" or "When I push myself, how long does it take me to get my blood pressure back to baseline?" Acceleration and braking distance, not speed, is often the problem I think.
posted by rum-soaked space hobo at 7:29 AM on September 6, 2018 [6 favorites]
I've come to think of a large number of health issues as failures of homeostasis in the body/brain/mind/soul/what-you-will. A healer who can get to know you and watch you for a long time and work out how your life is and how your body and mind react to it can work with this process of homeostasis. How do you recover from extreme states? That's more important than "how extreme is your state at moment
t?"When we come to the doctor and measure with high blood pressure, they prescribe statins, which lower the blood pressure but have to fight the homeostatic processes pulling it back up. So we end up taking them for the rest of our lives.
When a local politician in my area said "well how about instead I take on a lifestyle change?" the doctor said "you're probably too busy." He took up cycling everywhere and brought everything to normal quickly, not by lowering his blood pressure but by raising it in ways that could help his body gain homeostasis. He keeps the (never filled) prescription for statins as a souvenir, and recalls his doctor saying "I need to get a bike!" as he left her office.
I often consider therapeutic systems that encourage the patient to engage with traumatic experiences in controlled environments. It's not treating the ailment by lowering fear or anxiety, but by raising it in a manner that allows the patient's mind (if that is in fact where the systems lie) to strengthen homeostatic abilities.
I know people who work as mental health technicians in the NHS, and the fights they have with doctors, nurses, and administrators over things as simple as dosages are kind of fascinating. Sometimes they're fighting to get someone a higher dose for relief, and sometimes they're trying to avoid blasting the "neurologically naïve" brain of a new patient. And sometimes they're teaming up with the nurses to tell the doctors that there's a history here that's being ignored by a once-over-diagnosis-and-prescription process.
But this isn't a failure of psychiatric medication. It's a failure to build systems that help us all observe our own homeostatic systems and find not "what's my blood pressure" or "what's my anxiety level" but rather "when I get anxious to a certain level, how long and difficult is it for me to go back to baseline?" or "When I push myself, how long does it take me to get my blood pressure back to baseline?" Acceleration and braking distance, not speed, is often the problem I think.
posted by rum-soaked space hobo at 7:29 AM on September 6, 2018 [6 favorites]
Suggesting that depression has an environmental component is taboo on the left; it certainly is on mefi.
OK, I'll bite:
Depression has an environmental component because everything has an environmental component.
(waiting)
(waiting more)
Hmmm. No sign of the Great Leftist Conspiracy approaching to demand the traditional taboo breaker's penalty* with menaces... I guess I'll have to try getting even edgier.
Happiness is not mandatory! How ya like that, huh? Huh? HUH? Come at me, I can take it.
*$20, SAIT
posted by flabdablet at 7:29 AM on September 6, 2018 [6 favorites]
OK, I'll bite:
Depression has an environmental component because everything has an environmental component.
(waiting)
(waiting more)
Hmmm. No sign of the Great Leftist Conspiracy approaching to demand the traditional taboo breaker's penalty* with menaces... I guess I'll have to try getting even edgier.
Happiness is not mandatory! How ya like that, huh? Huh? HUH? Come at me, I can take it.
*$20, SAIT
posted by flabdablet at 7:29 AM on September 6, 2018 [6 favorites]
I've come to think of a large number of health issues as failures of homeostasis in the body/brain/mind/soul/what-you-will.
Either that, or homeostasis working just fine to maintain the bodymind in some completely unhelpful state.
posted by flabdablet at 7:30 AM on September 6, 2018 [1 favorite]
Either that, or homeostasis working just fine to maintain the bodymind in some completely unhelpful state.
posted by flabdablet at 7:30 AM on September 6, 2018 [1 favorite]
metafilter: a tendency to view this conversation as a battle between one or the other instead of having a nuanced discussion of diverse perspectives.
posted by some loser at 8:13 AM on September 6, 2018 [2 favorites]
posted by some loser at 8:13 AM on September 6, 2018 [2 favorites]
Well I mean I'd call a helpful state "healthy" and an unhelpful one "unhealthy", and consider the situation you describe as a failure of homeostasis. Can you help me understand more of what you mean?
posted by rum-soaked space hobo at 8:13 AM on September 6, 2018
posted by rum-soaked space hobo at 8:13 AM on September 6, 2018
I was taking homeostasis to be the process whereby an organism's internal systems maintain each other in a stable state, i.e. a state that the organism will resist being shifted out of. The question of whether that state is one that's actually good to be in is secondary to that reading of the idea of homeostasis.
Depression, for example, can display some pretty extreme stability. The way I see it, that's not because homeostasis is failing at all; in fact it's working extremely well. It's just that the state being stably maintained is not one that's any fun at all to be in.
Shifting depression, then, can be viewed as a process of altering assorted set points so that the bodymind's homeostatic processes, which have up until then been ably maintaining a stable depressive state, start maintaining a different and hopefully less unpleasant state as the new stable normal.
On this view there would be good grounds to think of something like the extreme mood swings associated with bipolar disorder as a failure of homeostasis, but not the grinding resistance of all kinds of chronic condition to any attempt at change.
If you add the idea of maintaining an optimal state, as opposed to a merely stable one, to your definition of homeostasis then I can see how you'd see any departure from optimality as a failure. But it seems to me that internal processes that work to stabilize a bodymind are not, in general, going to be capable of magic. It seems a tall order, to me, for such processes to seek out and achieve optimality in an environmental context substantially different from that in which those processes evolved.
For example, the way my own bodymind's food and transport environment interacts with its appetite regulation processes makes it home in on a set weight that remains quite reliably stable if I don't mess with it; but because I am far more sedentary than my ancestors could feasibly have been even as little as a few thousand years ago, and live in an age and a culture that provides far readier access to food, that set weight is unhealthily high and I end up experiencing, completely stably for years at a time (between periods of enthusiasm to go another sixteen rounds wrestling with varying degrees of success against some astonishingly robust homeostasis) all the chronic joint pain and tiredness that follows naturally from lugging around, everywhere I go, 160kg that I can never shrug off and put down.
And since chronic pain and tiredness is depressing, I have spend a fair bit of time dealing with chronic melancholy as well. Homeostasis isn't failing there, but working entirely too well. I just don't much enjoy the state it's maintaining for me.
posted by flabdablet at 8:48 AM on September 6, 2018 [4 favorites]
Depression, for example, can display some pretty extreme stability. The way I see it, that's not because homeostasis is failing at all; in fact it's working extremely well. It's just that the state being stably maintained is not one that's any fun at all to be in.
Shifting depression, then, can be viewed as a process of altering assorted set points so that the bodymind's homeostatic processes, which have up until then been ably maintaining a stable depressive state, start maintaining a different and hopefully less unpleasant state as the new stable normal.
On this view there would be good grounds to think of something like the extreme mood swings associated with bipolar disorder as a failure of homeostasis, but not the grinding resistance of all kinds of chronic condition to any attempt at change.
If you add the idea of maintaining an optimal state, as opposed to a merely stable one, to your definition of homeostasis then I can see how you'd see any departure from optimality as a failure. But it seems to me that internal processes that work to stabilize a bodymind are not, in general, going to be capable of magic. It seems a tall order, to me, for such processes to seek out and achieve optimality in an environmental context substantially different from that in which those processes evolved.
For example, the way my own bodymind's food and transport environment interacts with its appetite regulation processes makes it home in on a set weight that remains quite reliably stable if I don't mess with it; but because I am far more sedentary than my ancestors could feasibly have been even as little as a few thousand years ago, and live in an age and a culture that provides far readier access to food, that set weight is unhealthily high and I end up experiencing, completely stably for years at a time (between periods of enthusiasm to go another sixteen rounds wrestling with varying degrees of success against some astonishingly robust homeostasis) all the chronic joint pain and tiredness that follows naturally from lugging around, everywhere I go, 160kg that I can never shrug off and put down.
And since chronic pain and tiredness is depressing, I have spend a fair bit of time dealing with chronic melancholy as well. Homeostasis isn't failing there, but working entirely too well. I just don't much enjoy the state it's maintaining for me.
posted by flabdablet at 8:48 AM on September 6, 2018 [4 favorites]
So too are experiences like mine, as treatment resistant depression can sometimes respond better to non-pharmacological approaches and give people with horrible side effects of constantly trying new meds some options that don't make them feel so horrible that don't make them ostracized from the medical community and their familial and peer support system.
It's not like that's a non-medical viewpoint, though, even if it's a non-pharmacological viewpoint. Plenty of physical health issues are treated with physical therapy and lifestyle changes. Plenty of physical health issues are complicated by social and class issues on a broad scale and on an individual level by things like workplace conditions or poverty without necessarily only existing because of those things.
Psychiatry definitely has a ton of things that, as a field, need to improve, but there's a huge difference between saying modern psychiatry still has a long way to go and saying that it is inappropriate to have a broad medical model of mental health. I don't, in particular, think there's any chance that a hypothetical economic utopia would lead to people not having things like PTSD and treatment-resistant depression, along with stuff like CPTSD and BPD. In fact, I think those things are really poorly addressed by this article, which seems to be focused on, ironically, the kinds of problems that actually respond better to medication: "the common varieties of medicalized affect" as they refer to it.
posted by Sequence at 9:57 AM on September 6, 2018 [4 favorites]
It's not like that's a non-medical viewpoint, though, even if it's a non-pharmacological viewpoint. Plenty of physical health issues are treated with physical therapy and lifestyle changes. Plenty of physical health issues are complicated by social and class issues on a broad scale and on an individual level by things like workplace conditions or poverty without necessarily only existing because of those things.
Psychiatry definitely has a ton of things that, as a field, need to improve, but there's a huge difference between saying modern psychiatry still has a long way to go and saying that it is inappropriate to have a broad medical model of mental health. I don't, in particular, think there's any chance that a hypothetical economic utopia would lead to people not having things like PTSD and treatment-resistant depression, along with stuff like CPTSD and BPD. In fact, I think those things are really poorly addressed by this article, which seems to be focused on, ironically, the kinds of problems that actually respond better to medication: "the common varieties of medicalized affect" as they refer to it.
posted by Sequence at 9:57 AM on September 6, 2018 [4 favorites]
Hmmm. No sign of the Great Leftist Conspiracy approaching to demand the traditional taboo breaker's penalty* with menaces... I guess I'll have to try getting even edgier.
There is no leftist conspiracy, although you escalating "taboo" to "conspiracy" gets at why I think it exists. It's a product of the culture war and our politically polarized world. If depression and mental illness are anything other than genetic, then this opens you up to attacks from conservatives (and across the spectrum really) who will then say, well, that means you can control it, therefore your depression is fake, you're a moral failure, get back to work, pay your share of taxes, etc - all the unfair behavior policing we see being thrown around, almost always from people with more privilege than those being attacked.
So with that dynamic as a cultural substrate, and even on mefi which is still combative but at least doesn't have your man-baby racist uncle from facebook, we often end up arguing over how much nuance is allowed on a given topic as much as the topic itself.
posted by MillMan at 10:25 AM on September 6, 2018 [5 favorites]
There is no leftist conspiracy, although you escalating "taboo" to "conspiracy" gets at why I think it exists. It's a product of the culture war and our politically polarized world. If depression and mental illness are anything other than genetic, then this opens you up to attacks from conservatives (and across the spectrum really) who will then say, well, that means you can control it, therefore your depression is fake, you're a moral failure, get back to work, pay your share of taxes, etc - all the unfair behavior policing we see being thrown around, almost always from people with more privilege than those being attacked.
So with that dynamic as a cultural substrate, and even on mefi which is still combative but at least doesn't have your man-baby racist uncle from facebook, we often end up arguing over how much nuance is allowed on a given topic as much as the topic itself.
posted by MillMan at 10:25 AM on September 6, 2018 [5 favorites]
You know what would help avoid polarizing this discussion? Not handwaving away a century of feminist, black, and LGBTQ discussions about structural oppression and mental health in order to claim some sort of leftist "taboo" against discussing these issues.
Because I feel like I've been shouting and screaming about cultural and institutional homophobia and how that affects our inner lives for almost 30 years now, and you'd rather do discourse hot-takes than listen.
posted by GenderNullPointerException at 11:09 AM on September 6, 2018 [9 favorites]
Because I feel like I've been shouting and screaming about cultural and institutional homophobia and how that affects our inner lives for almost 30 years now, and you'd rather do discourse hot-takes than listen.
posted by GenderNullPointerException at 11:09 AM on September 6, 2018 [9 favorites]
this opens you up to attacks from conservatives (and across the spectrum really) who will then say, well, that means you can control it, therefore your depression is fake, you're a moral failure, get back to work, pay your share of taxes, etc
I don't think honest, good-faith discussion ever "opens you up" to such attacks; conservatives have been polluting every available discussion with exactly that kind of wilful bad-faith bullshit since approximately forever. It's just what they do. The way to avoid getting "opened up" to those attacks is to understand that they're not actually about the topics they talk about, but exist solely to prop up the just-world delusion that allows conservatives to continue embracing conservatism without experiencing moral implosion.
Not every online discussion will end up being a valuable resource for people interested in discovering truths about the topic in question. Wherever know-nothing bloviators with nothing informed to contribute exist in numbers that overwhelm the available moderation, simply not playing in their playgrounds strikes me as a much sounder option than self-censoring in an attempt to deny them their standard opening moves.
posted by flabdablet at 10:35 PM on September 6, 2018
I don't think honest, good-faith discussion ever "opens you up" to such attacks; conservatives have been polluting every available discussion with exactly that kind of wilful bad-faith bullshit since approximately forever. It's just what they do. The way to avoid getting "opened up" to those attacks is to understand that they're not actually about the topics they talk about, but exist solely to prop up the just-world delusion that allows conservatives to continue embracing conservatism without experiencing moral implosion.
Not every online discussion will end up being a valuable resource for people interested in discovering truths about the topic in question. Wherever know-nothing bloviators with nothing informed to contribute exist in numbers that overwhelm the available moderation, simply not playing in their playgrounds strikes me as a much sounder option than self-censoring in an attempt to deny them their standard opening moves.
posted by flabdablet at 10:35 PM on September 6, 2018
On the community having the conversation
Well I'm also coming from a place where these claims and issues and contexts have an ongoing conversation—among the psych/disability/advocacy community
Which is a different article and different thread. But ya'll are coming in here kind of deadgoating the actual topic, and I for one don't find that helpful. On the one hand, I hear you i.e. the standard non-leftist perception of what this and other leftist authors and scholarship seem to be insinuating in problematic ways. On the other, I'm not feeling like sharing my voice much given the tone of the room.
posted by polymodus at 10:50 PM on September 6, 2018 [1 favorite]
Well I'm also coming from a place where these claims and issues and contexts have an ongoing conversation—among the psych/disability/advocacy community
Which is a different article and different thread. But ya'll are coming in here kind of deadgoating the actual topic, and I for one don't find that helpful. On the one hand, I hear you i.e. the standard non-leftist perception of what this and other leftist authors and scholarship seem to be insinuating in problematic ways. On the other, I'm not feeling like sharing my voice much given the tone of the room.
posted by polymodus at 10:50 PM on September 6, 2018 [1 favorite]
Which is a different article and different thread.
But the same us! This is why I called the article "colonialist"—it talks about us but we aren't present and have no voices in it. I don't know what "deadgoating" means but it sure feels like the article left one on my breakfast table. Again, no mention of the history of industry preferring to homogenize mentally ill workers through more traditional non-medicalized modes of discipline and punishment and law, and the author spends precisely zero time paying the "good faith tax" of establishing why anyone should trust them with a matter so close to our core being.
posted by traveler_ at 8:01 AM on September 7, 2018 [2 favorites]
But the same us! This is why I called the article "colonialist"—it talks about us but we aren't present and have no voices in it. I don't know what "deadgoating" means but it sure feels like the article left one on my breakfast table. Again, no mention of the history of industry preferring to homogenize mentally ill workers through more traditional non-medicalized modes of discipline and punishment and law, and the author spends precisely zero time paying the "good faith tax" of establishing why anyone should trust them with a matter so close to our core being.
posted by traveler_ at 8:01 AM on September 7, 2018 [2 favorites]
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In the 19th century a huge proportion of the chronically mentally ill had neurosyphilis -- these cases have all but disappeared thanks to medical interventions. HIV dementia is now readily recognized and treated. Post-stroke and post-partum depressive states are recognized as "real". At the same time psychiatry is still home to any number or fads and trends. The mind-body problem is hard just as the person-society problem is hard. Psychiatry intersects both of these.
posted by fraxil at 2:04 PM on September 5, 2018 [47 favorites]