Mental Illness and Humanity

[Automaton]

If a person is mentally ill, but they perceive what they see as realistic -- as is often the case with mental illness, such as depression -- and are convinced in their perceptions, and consider them "right", on moral grounds, what right does a doctor have to tell them that they are mentally ill and that their perceptions are ill/wrong?

From a humanitarian perspective, I never understood this. What makes the patient wrong and the doctor right? What makes the doctor so confident that what the patient has is an illness, and not a healthy body reaction to a tough life lived?

Mental illness is often so tied to who we know ourselves to be that it seems wrong to force/coerce us to be something else against our will. I don't know, I guess I'm confused about humanity...

[quirkywords]

Automaton,

What a thought provoking topic.

To consider your question, " What makes the patient wrong and the doctor right?", I would look at the use of the words wrong and right, what do these words mean to you ?

I see the patient and doctor hopefully working together to help the patient obtain better health.

Most people go to a doctor seeking help because they are confused or unwell and want to get better.

I suppose if one's perceptions are considered harmful to oneself or others , a doctor would want to help the person from harming themselves.

Could you describe a specific example, of what you are writing about, because it is easier to discuss in specific terms rather than general terms.

You may disagree with my thoughts, but it is interesting to consider other perspectives.

What do you think?

Quirky

[romantic_thi3f]

Hi Automaton,

Thank you for this post! I personally love discussions like this and I think this is a great platform to use.

When I think about your question I also think about where mental illness started - when doctors didn't know what it was and therefore it wasn't a medical problem. Instead, it was either something a patient made up for attention, a curse or similar. Overtime we started to learn the link between the brain and the body, and that even if the human eye can't see it, it's still there. We know now with depression and other mental illnesses there are changes in the brain that we can see with our own eyes (through a PET Scan for example).

That, for me makes it feel 'moral'. Because it's not necessarily questioning their reality individually, but looking at a person and their group of symptoms and showing them that it's quote on quote "abnormal". I have depression and I get that my brain is wired differently then others. My brain in a scan is going to look different to someone who doesn't have depression. So I'm kind of flipping moral on it's head to what we can see and look more at logic.

The trouble though is when we start to look at diagnosis's and stigma - because instead of looking at 'what is happening in the brain so we can help manage it' to 'where in the dsm-iv (diagnosis) box does this fit and why did it occur'.

I think that in a way we are trying to make it more humanitarian and holistic; so that we aren't just looking at a person and say 'yep they have symptom xyz and so they are unwell', but rather trying to see the whole person; tough life lived and all.

Does this make sense? What do you think?

[Automaton]

This makes sense in the case where the patient is asking for help and both the doctor and the patient agree on the best course of actions. But much more often the case is that the patient is desperately in need of help and the doctor is coercing/convincing them of a treatment they think is best for them -- so the ground is not so even.

It may be subtle to most and unobvious at first, but say you consider this:

The patient has been through some psyche/soul shattering experiences, and their body is trying to recover from and avoid further damage from that impact with what seem to us unproductive processes, such as in the case of PTSD related actions/reactions.

The patient will seek help in coping with their body when it comes to these behaviours because in human society they are perceived as unproductive. This doesn't mean, however, that they are useless to the patient's body (themself).

The doctor will assess the patient's behaviour based on current human social norms, and how the "illness" is affecting their daily life. Then, they will proceed to convince the patient of a treatment the doctor thinks will work to reduce the impact of their "illness", thinking that this will have "cured" them.

But what if all this accomplishes is to suppress certain natural processes in the body, and as a result, the patient will not live a healthier life from these treatments, even if they appear to help return their human life "back to normal" somewhat. The treatment(s) will, in fact, cause further stress on the body -- as is often the documented case with so many side-effects.

Then, to complicate this, add the fact that mental illness has a strong stigma attached to it in our society, where mentally ill people are considered less that reasonable, and their judgement impaired. In instances like this, especially if the patient is a perceived threat to others or to themselves, the doctor gains power over the patient's own free will, deciding entirely what is best for them and their body.

There are many accounts of people getting better from the effects of their mental illness by NOT listening to their doctors, and listening to their body and learning to work with their body instead. After all, doesn't the patient know their own ailment best? How can a doctor claim to know someone else's body workings better than they do themself?

As a patient, this puts a big moral question mark on the whole mental health and medical industry for me.

[Automaton]

See, the problem with this perception is that EVERYTHING that happens in our brain and body makes us who we are. If you cut parts of it out, you lose parts of yourself. Who is to say what is healthy and what is not? Another person, with more authority? Just because something appears different from the majority of cases, or the norm, does that make it necessarily wrong/problematic? This is a widespread problem with our entire human society. Anything that differs even in the slightest needs to be excised for some reason. We are so afraid of the unknown, or the different.

Yet, if you look in nature, you will find that often those things that stand out from the norm, that are different, hold potential for greater developments. I know this suggestion may sound wild, but I guess it all depends on whether you look at it as an illness or a healthy response and body development. We are constantly changing in our lives with the experiences we gain and the physical contacts that affect our bodies' development.

This is the reason a person changes so much in 20-30 years, too.

We presume to know what our body needs, yet we do not live to nature's rules, but to our own, human social rules.

[Automaton]

Important: Note that the word "perceived", also, means the (perhaps unreasonable) judgement of someone else in this case. So the doctor's -- or a few doctors' -- "reasonable" judgement is all that is needed to strip someone of their own free will and subject their body to harm.

And thanks for the input, guys. ^_^ Sharing of different perspectives/experiences is what I'm looking for in this moral discussion.

[Automaton]

I'll also mention that one benefit of depression -- that people rarely talk about -- is that it makes you see the world not hormone-dazed and (unreasonably) hopeful as the rest of humanity sees it, but rather plainly and realistically for what it is, good, bad, and all, thoroughly, in all its details. This has shown in studies, too: depressed people see the world more realistically.

In this light, if you can find a natural way to keep yourself happy and stable, depression can actually be considered a positive development in a person, a healthy growth response to negative experiences -- however absurd that may sound at first. Just an example of where our human ignorance as a society may fail us, and where nature's way may make more sense.

[quirkywords]

Automaton,

thanks for this discussion.

i know for me I spent over 16 years denying I had a problem and trying every natural way to control my extreme moods. in that time I ruined by reputation, my bank balance and was in lots of debt and ruined my life in many ways that some still affect me today.

WHen I agreed to medication very reluctantly mynlife became manageable.

i think we are all different and everyone,s choice as to how they manage their health should be respeted .

Some people have found ways other than through the medical system to handle their mental health and that is good but it does not work for everyone.

I feel I have a greater empathy with others and compassion and understanding for what I have been through.

Quirky

[Lici]

Hi Automaton (and a wave to everyone else),

This is an interesting topic and as a psychology student it's rather interesting to ponder on. Correct me if I'm not understanding your stance correctly, but it seemed to me from reading your comments that you're saying that gps and psychologists can take someone's sense of self away from them and somewhat force them to take treatments that they may not need or want?

One thing to remember in everything you've said, is that the person has chosen to go to the doctor to receive treatment to (I assume) get better. Most mental illnesses (save for a few such as schizophrenia) have "symptoms cause clinically significant distress or impairment in social, occupational or other important
areas of functioning." ( Quote from DSM IV diagnostic criteria for a major depressive episode) as part of the diagnosis criteria, this is there for a reason. If the person with the issue doesn't think that it's a problem, and it's not significantly affecting their functioning and they're not experiencing significant distress from their illness, then a) they wouldn't be seeing a gp or psychologist for help, and b) the doctor wouldn't be giving them treatment because they wouldn't meet the diagnostic criteria for a mental illness.

I think you put too much power in the doctors hands in this case, a person wouldn't be seeking treatment for a mental illness if they were perfectly happy and fine with the way their mind and life is.

In terms of "But much more often the case is that the patient is desperately in need of help and the doctor is coercing/convincing them of a treatment they think is best for them" in terms of medications, there is a ton of research done so doctors can prescribe medications that can help people. At the moment there is no biomarker to definitively say "this person has this specific type of depression so this specific type of medication will work" so it's a little hit and miss, but there is a lot of genetic studies being done into what genes are involved with depression and other mental illnesses so this can change.

When it comes to seeing a psychologist, there are a lot of different therapies out there and psychologists have to continuously keep up to date with reading research to determine what therapies are best for their clients.

In the end, none of this research etc matters if the person doesn't want the help or think they need it.

[romantic_thi3f]

Hi,

Thanks for your reply - it definitely made me think!

You’re absolutely right, everything happens in our brain. I kind of feel like there’s two aspects to the post here - number one is that what makes things healthy vs not healthy and number two is that what makes a doctor an authority?

I think it’s worth thinking about helpful vs harmful too. As someone with depression, I don’t feel like I have greater potential - when I’m in the midst of it, I feel like I’m drowning. I feel hopeless, worthless and completely isolated. It genuinely comforts me to know that there are things happening in the brain that cause this and I can work on it.
Another example could be spirituality - if you have two people who believe in higher power that can be considered healthy. However if one person believes the devil is talking to them and starts committing crimes, then that could be diagnosed as schizophrenia or grandiose delusions. If another believes God is talking to them though and engages in prayer or kindness - then that’s not considered a mental illness. We’re still interested though into how the brain lights up or responds, regardless of whether it’s helpful/harmful.

I kind of (respectfully) disagree with the ‘benefit of depression’. I have read those studies out of curiosity and it seems like it’s been taken out of proportion.
Quote on quote “In this study, psychiatric patients who met criteria for major depressive disorder underestimated control in a contingent situation and were consistently more negative in their judgments than were nondepressed controls. Depressed patients were no more likely to use the appropriate logical heuristic to generate their judgments of control than their nondepressed counterparts and each appeared to rely on different primitive heuristics. Depressed patients were consistently more negative than their nondepressed counterparts and when they did appear to be more “accurate” in their judgments of control (as in the noncontingent situation) it was largely because they applied the wrong heuristic to less accurate information.”

Anyway, I’ll stop now! It’s been an interesting discussion and hopefully a productive one!