Is Medicalization Aversion Disorder a real disease?

August 26, 2006 7:54 PM

Psychiatry by Prescription- Do psychotropic drugs blur the boundaries between illness and health?
posted by Gyan (39 comments total)

I think the issue here is the idea that taking psychoactive drugs is somehow "wrong" in cases of normal health, which means that in order to take them people need to be diagnosed with "diseases".

I think that's ridiculous. Certain personality facets may be problematic but that doesn't make the person "sick", in my view. But if a drug improves their lives, what's wrong with taking it?
posted by delmoi at 8:02 PM on August 26, 2006

If a drug improves their lives, what's wrong with taking it?

If a drug improves the performance of an athlete is it ok? I actually think these drugs give many people a real advantage. Is it risk free or are there unintended consequences? The long-term consequences socially and physically are yet to be played out, it's still a new experiment - kinda like ether and opium in the 19th century where legal and used to improve lives.
posted by stbalbach at 8:17 PM on August 26, 2006

The issue is that people have an inconsistant view of ingesting substances that alter their body's functioning in some way.

Caffeine is so fine kids can buy it in Soda form, but if it's in pill form you can get in trouble at school. Amphetamines are the devil, unless a psychaiatrist prescribes them for your "attention deficit" disorder. Then you can have them in kindergarden.

Alcohol is normal and healthy in moderation, but smoking a joint will get you addicted to harder drugs through some mystical bullshit mechanism.

You can go on and on. And people do. MDMA is good. No, wait it's bad. Oh no, it's good again, unless you're wearing kneepads.
posted by illovich at 8:18 PM on August 26, 2006

But if a drug improves their lives, what's wrong with taking it?

It's the stigma of mental health. You can be a grossly obese chunk of fat who consumes piles of cheeseburgers, but your high blood pressure and diabetes are diseases. Somehow this behaviour is acceptable and medication is appropriate. Having some sort of mental illness be it depression or some sort of phobia is something to be shunned in this society, and taking the drug shows weakness.
posted by Eekacat at 8:22 PM on August 26, 2006 [1 favorite has favorites]

Agree w/delmoi.

My view: For adults, whether a person with a severe mental health condition, a moderate condition, a mild condition/trait, it should be about (informed) choice choice choice.

MH conditions are often a spectrum anyway. We should acknowledge that, make the connections, stop trying to sharply delineate the "healthy" from the "sick." For some, including (especially?) some MH professionals, it's all about the healthy professional "us" versus the crazy patient "them." Acknowledging the spectrum, that MH symptoms/experiences are part of everyday life for many or most, is threatening to some people.

[I do not mean that we should downplay the substantial differences in the severity of symptoms (e.g. from debilitating to mild) among people who may have a similar MH experience ... .]
posted by ClaudiaCenter at 8:24 PM on August 26, 2006

Oh, and the comparison between someone who is taking medication to try to function normally in society and an athlete that's trying to shave a few hundredths off their time is plain moronic.
posted by Eekacat at 8:28 PM on August 26, 2006

If a drug improves the performance of an athlete is it ok?

Well the idea there is that they are competing with other people, and that some people might be willing to sacrafice their long-term health to win. That's the risk with allowing athletes to take whatever drugs they want, but I don't think there's anything wrong with letting amateur athletes take drugs.
posted by delmoi at 8:34 PM on August 26, 2006

Metafilter: some mystical bullshit mechanism.
posted by delmoi at 8:35 PM on August 26, 2006

choice.. is a concept which advertising firms understand better than anyone. i did a little research about this, incidentally.
posted by dminor at 8:36 PM on August 26, 2006

Well, probably. On the other hand...

These psychotropic medications don't come without a cost. In many cases you are talking about a minimum of six months of treatment, four weeks to start seeing results. The first week is likely to involve some non-trivial side effects, the last month involves a stepping down and withdrawl that some people have compared to going off smack cold turkey. In between you may or may not have some life and relationship-affecting side effects like fatigue and sexual dysfunction. Skipping a pill can result in a very bad day.

They are also not happy pills. I don't know many people who take these drugs who are "cured." What they can do is take the edge off the worst symptoms. They don't teach life skills, or public speaking skills.

Granted this author makes some good points. I think that any treatment for mental illness needs to take into account physical, environmental and behavioral issues. However gee, how dysfunctional do I have to get before considering a drug therapy?
posted by KirkJobSluder at 8:48 PM on August 26, 2006

It's hard not to think of "psychiatry by prescription" as being so widespread nowadays because, in the eyes of the HMO, it's cost-effective.

Psychotherapy is expensive -- think $200 per session. On the other hand, $50-$75 a month for pills is a hell of a lot cheaper.
posted by clevershark at 9:09 PM on August 26, 2006

delmoi - But if a drug improves their lives, what's wrong with taking it?

IMHO, nothing. But society sets up moral dictates, where BLTC is, so far, verboten, unless it's disguised into an existing tolerated practice. Practising BLTC openly may have social repercussions.

KirkJobSluder - I think that any treatment for mental illness needs to take into account physical, environmental and behavioral issues.

Is that practically possible? The logistics of enunciating the nuances seem non-trivial. A HMO practitioner on a schedule seems ill-equipped to take into account all those factors. And if the prevalence of mental "illness" is as widespread as the cites in the article, then even specialists won't have the time.

I don't know many people who take these drugs who are "cured."

If "cured" = [limited-time treatment regimen] --> [long-lasting remission], then, Sure. But is that really a problem? Maybe 'depression' is a systemic feature that doesn't lend itself to a 'magic bullet'. Symptom management may be the most viable approach to a consonant outcome.
posted by Gyan at 9:13 PM on August 26, 2006

I would guess 25% of MeFi forum members have tried antidepressants. The phrase "your mileage may vary" applies in this realm in spades. Wellbutrin? Prozac? Benzos? The Talking Therapy? Self-Help Books? Thinking that Suffering accelerates Christian Spiritual Growth? Simple Buddhist Awareness? Prayer? Heroin?

If your family were struggling with survival and warfare, probably somewhere without internet access, these questions would not of course arise.

We are lucky and unlucky.
posted by kozad at 9:24 PM on August 26, 2006 [1 favorite has favorites]

Girl, you have no faith in medicine.
posted by scottreynen at 9:27 PM on August 26, 2006

Gyan: Well, I think that's a limit of health systems in general. It's not just mental illness where behavioral and environmental factors need to be considered.
posted by KirkJobSluder at 9:28 PM on August 26, 2006

KirkJobSluder - It's not just mental illness where behavioral and environmental factors need to be considered.

I don't disagree. Just pointing out that your advice is an expression of idealism rather than a feasible proposal, at least as far as medicine is practised currently.
posted by Gyan at 9:35 PM on August 26, 2006

If a drug improves the performance of an athlete is it ok? I actually think these drugs give many people a real advantage.

Know anything about depression? No?

Being a well functioning person is definitely a big improvement over being hopelessy depressed, suicidal, or in a mental hospital like people were confined to years ago.

I wouldn't call getting a person back to "normal" is an advantage. It's more of an equalizer. Not everything in life is a contest with winners and losers. Forget the zero sum approach to being healthy.

Is it risk free or are there unintended consequences? The long-term consequences socially and physically are yet to be played out, it's still a new experiment - kinda like ether and opium in the 19th century where legal and used to improve lives.

If you don't like psychiatric drugs, don't use them. If you are against abortion, don't get one. But don't be quick to judge others, please.
posted by bim at 9:50 PM on August 26, 2006 [1 favorite has favorites]

Symptom management may be the most viable approach to a consonant outcome

I can attest to this. It's a scary proposition, especially given a) the length of time it can take to find an effective medication/med combo, and b) their tendency to stop working after awhile.

I actually think these drugs give many people a real advantage

Sorry, but bim's right on with this one. The goal is reaching equilibrium, not becoming some kind of monstrously efficient joy-machine (or whatever the mental equivalent of a doping athlete would be). This is not to say that abuse doesn't exist, but I'd wager the percentage of people doing that is far smaller than you think.
posted by Vervain at 10:16 PM on August 26, 2006

Gyan: I don't disagree. Just pointing out that your advice is an expression of idealism rather than a feasible proposal, at least as far as medicine is practised currently.

I don't know if it's that idealistic. At some point the rising costs of treatment are going to force preventative care for many diseases.
posted by KirkJobSluder at 10:17 PM on August 26, 2006

Vervain: Ditto. And I think for many people that equilibrium involves finding the least painful trade-off between the negative side-effects of the drug, and the effects of mental illness.
posted by KirkJobSluder at 10:23 PM on August 26, 2006

Is that practically possible? The logistics of enunciating the nuances seem non-trivial. A HMO practitioner on a schedule seems ill-equipped to take into account all those factors.

That's why (if possible) the person should be be empowered to make choices, be in the driver's seat, put together their plan which can be medical and/or other stuff ... The doctor could never know all.
posted by ClaudiaCenter at 10:26 PM on August 26, 2006

I wonder if any major pharmaceutical companies research drugs whose purpose is non-medical, e.g., the new caffeine. Can they even do that kind of research? Maybe the reason we have to be sick is because they can't sell us drugs otherwise.

I wish they could research and market non-medical substances. The ads would be less likely to make me feel sick. :p
posted by owhydididoit at 10:52 PM on August 26, 2006

ClaudiaCenter - That's why (if possible) the person should be be empowered to make choices

That would require the population becoming well-informed and well-versed with critical thinking. I think that's even some more way off.
posted by Gyan at 8:14 AM on August 27, 2006

*musing*

Religious experience alters brain chemistry too. Perhaps extremism could be treated with the right medications.

I don't think people with some mental illnesses are capable of making an informed choice when they're highly delusional. I vote for putting Anti-Religious Extremism drugs in the water supply, at least until the symptoms have been relieved.

Imagine how different the afflicted's lives would be...
posted by merelyglib at 9:02 AM on August 27, 2006

I recently received a prescription for potent psychotropic medication, and found myself wrangling with this issue every time I popped one of those delicious pills in my mouth. Seriously, they tasted great - some kind of orange flavouring.

When I was first given them, I expressed to my doctor that I didn't quite feel as though this was a true solution to my problems. Certainly, it may be possible that these drugs would make me feel better, but just like getting drunk and smoking a joint - wasn't it just an artificial sense of well-being promoted by some kinky chemicals penetrating the blood-brain barrier? Wouldn't the core issues that had made me feel this way from the outset still be there, lingering in some corner of my mind waiting for their chance to crawl out and lay waste to my life anew?

Her reply was: No. "If someone comes in with a disease, and I cure that disease with a presciption, am I falsely curing their illness?"

In the way of such things, I had no good rebuttal to her statement, but immediately after I left it occured to me that no, it's not like that at all. It's more like if someone comes in complaining of malaria, and you give them some tylenol for the headache. You may have treated the symptom, but the disease is still there, slowing destroying the patient's body.

I still haven't made my mind up. I keep taking them, and admit that my life has moderately improved, yet I don't think anything is fundamentally changed.. I think it's a little bit like inmates that get antidepressants on death row. These little pills will make you feel better. But should you really be feeling okay, after killing three people and setting a liquor store on fire? Isn't it "right" that you should feel bad about it? That's the real problem about these pills, to me. They make it so you can feel alright, even when you probably should feel bad.

Anyway, this is all rather rambling and poorly-composed, but that reflects the lack of clarity in my own feelings towards the matter. I really hope this doesn't turn this discussion into a "my meds" type conversation, I hate those.
posted by kfx at 9:46 AM on August 27, 2006 [1 favorite has favorites]

kfx: Certainly, it may be possible that these drugs would make me feel better, but just like getting drunk and smoking a joint - wasn't it just an artificial sense of well-being promoted by some kinky chemicals penetrating the blood-brain barrier?

Only if you're a dualist. If all mind is due to brain, then chemical modulation is as "artificial" as talk therapy.

Wouldn't the core issues that had made me feel this way from the outset still be there, lingering in some corner of my mind waiting for their chance to crawl out and lay waste to my life anew?

Now that depends on the specific condition and the specific drug. In the current state of neuroscience and drug design, this may still be true.
posted by Gyan at 9:53 AM on August 27, 2006

From my experiences, drug therapy isn't going to resolve those nasty issues with family, end the bad relationship, resolve your guilty consience or give you the dream job. Nor will it make you happy about the bad things in your life.

What they do is help to blunt the kind of obsessive and borderline delusional preoccupation with the worst possible scenarios that make it possible to get out of bed in the morning, or go to the mailbox without experiencing a panic attack.
posted by KirkJobSluder at 10:10 AM on August 27, 2006

For me, "true solutions" (which are, of course, incomplete and neither true nor solutions) include choices about lifestyle, medications, talk therapy, employment, sleep, etc., etc. If it matters, all of those kinds of choices show up on PET scans -- everything influences "brain chemistry." Can medications can interfere with dealing with "core issues"? I haven't experienced that (almost the opposite, actually), but I'm sure there are people who have.

An interesting question to me is the impact of medications upon identity and self-image. It can be strange to live for years with one type of internal emotional life, and then to have it change with medications.
posted by ClaudiaCenter at 10:44 AM on August 27, 2006

I've had social phobia and I can tell you that I have literally wished I had cancer, so it's funny to read that in the article. The problem people have with psychotropic drugs is that they are an affront to that most sacred of sacred cows: Free Will. Year after year it's becoming more and more apparent that what we call Self is just an epiphenomenon of neural firings. Eventually our model of self will catch up philosphically with science. Until then we'll just have to live with the "sickness" model.
posted by zorro astor at 10:55 AM on August 27, 2006 [1 favorite has favorites]

On the other hand, $50-$75 a month for pills is a hell of a lot cheaper.

You haven't priced psychotropic drugs lately, have you?

I'm a medicated bipolar. Those of you that remember my bunnyfire days are GLAD I am properly medicated. The thing is that medicine is not a total cure but it enables one to be stable enough to face the life stressors and other problems that contribute to the disease. (That goes for depression and other MIs as well.)

Do I exercise? Yes. Do I practice proper sleep hygeine? Most of the time, yes. Do I practice good mental hygiene (positive thinking, etc.) Yes. Do I take care of my spiritual life? Yes.

All of these are a part of my health. But I require the Lamictal in order to be able to do those other necessary things.

I do believe that some folks who don't need meds are on them, but I'd risk that in order that those that do can take them without stigma.
posted by konolia at 1:40 PM on August 27, 2006

They make it so you can feel alright, even when you probably should feel bad

Whoa. That's some seriously depressive thinking there, my friend. (Also, seriously Catholic--but I say that as someone who comes from a long line of dysfunctional Catholics.) I'm medicated, have been for several years, and it has not stopped me from feeling bad when bad things happen. What it does do, and should do, is remove the warped mental filter that KirkJobSluder describes upthread. kfx, was this your GP, or someone who specializes in psychiatric medication? I hate to beat the same old drum in every mental health thread, but I strongly believe that psychotropic medications are something that really should be handled by a p-doc.

You haven't priced psychotropic drugs lately, have you?

Heh. I was thinking the same thing. My health insurance is pretty good, and I still pay at least $250 out of pocket every month. Good times...
posted by Vervain at 2:57 PM on August 27, 2006

For the past 14 years i've found that taking (often high doses of) antidepressants has helped me do things -- like stay out of bed more than four hours a day, run my own little errands (even by myself!) without dissolving in sweating panic, think about something besides what death-deserving scum I am, occasionally even have short conversations with people that don't involve whining or blubbering -- that before the pills were very difficult and sometimes flat-out impossible. I'm still barely functional, but hey.

What I wonder is how say 20 mgs. a day of Lexapro would help a person without my "disorders". Would s/he become, say, supercompetent, awesomely fearless and a thrillingly engaging conversationalist?
posted by davy at 5:54 PM on August 27, 2006

The most cited scientist on the subject of ADD (attention deficit disorder) and ADHD during the past decade, Biederman cites evidence from genetic and molecular imaging studies, as well as from epidemiological statistics from across the world, that in his view confirm ADHD as “a universal biological condition” that can extend into adulthood with potentially devastating consequences. Far from being overtreated, he says, “at least half the kids with the diagnosis are not treated at all,” largely because of fears of using medications in children. There’s a seven-year average gap from the time of the onset of symptoms to the onset of treatment, he says. “If this were a cavity,” he asks, “would you dare leave it untreated this long?”

I have what's called Adult ADD (or ADHD), which used to be ADHD when I was a kid. That's what the doctors and the DSM-whatsit calls it.

I think it's a crock of shit personally. It's not a disorder -- it's the way I am. I have a really hard time focusing on boring things, I hyperfocus on interesting things, however you want to describe it. I answer yes to 80% of the questions on a 100 question "Do you have ADD" questionnaire. But it's still not a disorder.

I agree in spirit with Thom Hartmann's hunter/farmer notion of ADD, although I find it a little too dualistic. It's more complicated than he presents it, but ADD probably is in some way a sort of vestigial brain configuration rather than a disorder. Or something like that. It doesn't bother me personally at all. For every frustration it has caused me, it has given me gifts that I'm thankful for, that make me truly useful to many people in many ways. I would not want to be "cured" of ADD in any case. I think actually that it would be devastating to not be this way.

But on the other hand, I work in computers and I'm in graduate school. It's great that I have inspiration, and left-hand-path-creativity, and whatever else the benefits are... but I also need to be able to do "farmer" tasks in order to have the success I want and need to have to support my family.

I don't believe I have a disorder. But I do believe that I am somewhat mal-adapted to the demands of local environmental conditions. 5mg tablets of amphetamine (aka Adderall) seem to change my neurological behavior enough that I am able to function in a modern office environment much better in general, and it doesn't seem to effect my health (mental or otherwise) too severely.


My serious reaction to this article is -- yes, it's true that not every entry in the DSM is actually an "illness" as defined by medicine. But that doesn't mean that there are not states which while not disorders or illnesses are still detrimental to the well being of a person in their environment.

It would be nice to see mental medicine branch out past the well/sick dichotomy, and begin to explore a treatment methodology & philosophy that isn't focused on "curing" people (forcing them into fairly rigid parameters of being) as much as helping them adapt to non-optimal conditions. In a non-evolutionary, ad-hoc way.

I think Foucault had a bunch of ideas about this, but I'm too lazy to go look it up. Also, I've had a couple beers, if you couldn't tell.
posted by illovich at 6:39 PM on August 27, 2006 [1 favorite has favorites]

But that doesn't mean that there are not states which while not disorders or illnesses are still detrimental to the well being of a person in their environment.

That's pretty much the definition of an illness - "detrimental to the well-being of a person". Who would care about malignant tumours if they didn't cause you pain and reduce your lifespan or other undesired deficits to 'well-being'?
posted by Gyan at 7:17 PM on August 27, 2006

Her reply was: No. "If someone comes in with a disease, and I cure that disease with a presciption, am I falsely curing their illness?"

This doctor's question, and the poster's response, gets really close to the core of my own ambivalence about this medicated world.

The answer to the doc's question is, as it is stated, certainly 'no'. But a sceptic might restate it 'If someone comes in with a disease, and I eliminate the symptoms of the disease with a presciption, am I falsely curing their illness?' The answer to that question is, to me at least, far less clear.

I don't have any good answers -- I'm quite firmly in the camp of letting individuals choose what they want to put into their bodies if they cause no harm to others -- but it is a good fulcrum to try and get some leverage, that.

As so often with thorny questions, defining one's terms is of great importance. What do we mean by 'disease' in this context, and what does it mean to 'cure'?
posted by stavrosthewonderchicken at 7:24 PM on August 27, 2006

If you are deeply interested in the subject of this thread, you might want to read some of Peter Kramer's books. I haven't yet (I've been meaning to), but I heard him give an interview on the radio and I thought that he was a wise man.

Listening to Prozac

Against Depression
posted by bim at 7:42 PM on August 27, 2006

Mental health prescriptions are handled today in a way akin to general medicine more than a century ago. We have an idea of how a pill works, but we're not entirely sure, and finding out what it is we need to do is equally difficult for today's medical field. So, throw a pill or three at it and see what happens.

Let's not worry about the side effects, withdrawal symptoms, or the fact that many patients are very apt to simply stop taking the pills if they don't feel better right away, or suffer any form of relapse whatsoever.

This is not to say that some of these medications are virtual godsends to certain people. Everything else in life might be perfectly manageable, or even going very well, except for that misfire in the brain that changes everything. For other people, a pill would do no good. Perhaps they need to fix their own life, they might have a subtle physical illness bringing them down, or it might just be their environment. It's different for many people, and something we can only pay attention to due to even the working class living a relatively affluent lifestyle compared to long ago.

In the end, our system is ill equipped to take care of mental health issues, and it will remain this way until we find a "miracle" breakthrough. Medicine is a business, the cheapest solutions are pushed first and hardest. Mental health is not well understood, even by many of the professionals, so garnering support for more comprehensive treatment would be difficult, let alone supporting any particular plan of action. Anyone with mental health issues had best hope they're well served by one of the major psychotropic drugs available. If not, they're in for a long and arduous journey, even if they are wealthy enough to afford it.

Still beats the hell out of being thrown in an asylum and whipped daily. Go progress!
posted by Saydur at 8:55 PM on August 27, 2006

Nice post, I'm sorry I missed it when it was made. Several people seem to have missed that the author and the skeptics were not suggesting that mental illness exists, just that we seem to be in a time when normal behavior is characterized as mental illness and treated as such. This seems based on three different factors coming together, two of which the author talks about: no valid diagnostic mechanisms (and the reliability of the DSM is really not that great, despite what's suggested in the article) and easy access to these meds. What isn't really discussed in the article is that the meds really do have some pretty severe side-effects for many people, and yet they're treated as if they were so safe that we need not worry about those. Heck, in children and adolescents suicidality is a side-effect that has lead to the FDA putting black-box warnings on some of the SSRIs.

Of course the meds help some people, but that doesn't mean that we've adequately wrestled with their ramifications (by which I don't mean the 'moral goodness' that suffering confers, I think that's bullshit, but simply that they do come with a cost and their prevalence increases that cost).
posted by OmieWise at 8:24 AM on August 30, 2006

Big Pharma Bankrupting US Health Care System
posted by homunculus at 6:11 PM on August 31, 2006