Dealing with psychological disorders like 'physical' illnesses?

For the purposes of this discussion we shall define the two types of mental health professionals;

Psychiatrists - mainly use the biological/medical model to treat psychological disorders. They also use psychiatric handbooks to diagnose patients. They are, first and foremost, medical doctors.

(Clinical) psychologists - mainly use psychological methods to treat disorders. They are less likely to use the handbooks. They are not medical doctors.

Now, if one goes to one's local general doctor, they are much more likely to refer you to a psychiatrist than a psychologist.

So, the point is, should we deal with psychological disorders - whose causes are (mostly) due to to environment and are abstract, and indeed, subjective - in the same way that we treat physical ailments - whose causes are mostly easily defined?

Why do we have to literally drug people for an issue that exists in their minds?

I'm not discounting the fact that some psychological disorders have a physical cause, of course.

Drugs are just as immedidately effective as psychological methods, however psychological methods work after the therapy, whereas drugs only work for as long as one takes them.

So, why do we not move to a psychology-based model of treatment, instead of the mainly drug-based treatment we have today?

Because our minds are our brains, unless you buy into Descartes, and our brains can be treated like any other organ. (I do think there's a tendency to undervalue the importance of lifestyle changes in favor of pills, but that's for all sorts of things, not just psychiatric illnesses.)

It's easier to down a pill to treat the symptom than to treat the actual cause with therapy and exercises. Though to be fair many disorders are actually caused by chemical imbalances, where a drug is the proper treatment.

Drugs work.

edited 15th Apr '12 7:13:25 AM by Natasel

Which, I think, is a good comparison in this case. Sometimes, a computer does not work properly because of a software issue; and sometimes, it does not do so because of a hardware issue. Different techniques are useful in these two cases: for example, in the first case you might want to check and remove malware, while in the second you might want to replace a faulty memory bank.

Now, the way brains work is still very much unknown,and, often, a combination of psychological therapy and medicinals seems to work best; but both psychological techniques and drugs have their place, I think.

By the way, one thing I feel strongly about is that there is no shame whatsoever in taking medicinals to resolve issues, if they work. My mother, occasionally, has panic attacks; and she has a medicine that does help her a lot with them. However, she keeps thinking that a "strong" person should be able to take care of them without need for medicines, and she keeps trying to stop using the medicinal, and then she gets a panic attack and starts using it again.

This, I think, is ridiculous. As I keep telling her, chemistry is chemistry: if her medicinals can help her with whatever chemical imbalance is there, and if they work and have no side effects, then she should take them. You cannot think yourself out of a panic attack any more that you cannot think yourself out of a flu — you take some damn medicine and that's it.

edited 15th Apr '12 8:01:10 AM by Carciofus

I think somebody on this forum mentioned that the drugs aren't supposed to cure the disorder, just make it more manageable.

Um. I've met clinical psychiatrists who want to strangle other parts of the medical profession who insist on refering patients to them to drug 'em up and keep 'em quiet, when a decent investigation shows that other means are a better solution. One in particular really bangs on about how much he values CBT as a fantastic and viable treatment for anxiety, and would happily tell the pharmaceutical companies to stop pressing fliers on him saying otherwise.

And, then you meet the ones who think drugs are the best thing since sliced bread. <shrugs>

It's not quite that cut-and-dried. Some conditions respond to drugs very well... others to drugs as well as talking it out. And in still others, drugs are very much counter-indicated, if only for the side-effects. It all depends on the individual patient, more than the individual condition, more often then not, anyway.

When it comes to either psychologists or psychiatrists... it's still too often a case of buyer beware, I'm afraid. <sighs>

edited 15th Apr '12 8:08:44 AM by Euodiachloris

While drugs work, I'm a little concerned about how it's blurring the line between what's your own responsibility and what can be blamed on disorders. From a Certain Point of View, everything wrong with a person's behavior can be blamed on stuff beyond their control.

edited 15th Apr '12 9:50:49 AM by RTaco

It very, very much depends on the disorder. Are there people who would respond better to being sat down and talked to than to being put on medicine? I shall certainly grant that.

But on the other end of the spectrum, you have people like me, who are chemically imbalanced and whose mental disorders simply can't be effectively treated any other way. Because of that, my first reaction is to shy away from a wide-scale, indiscriminate shift away from drugs as treatment for mental disorders. Have you ever seen someone trying to talk a diabetic into just getting up the vim to produce more insulin? That works about as well as talking therapy for clinical depression.

As has been said: sometimes drugs are the best solution, sometimes therapy is the best solution, sometimes a mix of the two are.

The problem of people being given drugs too often rather than treatment isn't because drugs don't work, but because of certain psychiatrists being bad at their jobs. Some are perfectly fine, or great even, while others will just ask a little about you and then prescribe a bunch of stuff. Hell, I had a psychiatrist take an hour of slowly asking variants of "are you depressed" and talking about tangents that don't actually have to do with my depression, and then take about 2 minutes to go "Would you like some drugs? No? Why not? Do you not trust drugs? You should take some. Just try them. Really, you should. Your dad takes like 20 different drugs. You should try some more drugs than what you're already prescribed. Even though we've determined that your problems are situational, not physiological. Please?" (Note: I don't mean that there was an hour of carefully determining my specific type of depression followed by an honest prescription. I've gone through that, that's fine. This was not that. I'd been to this psychiatrist before, he had skipped out on our sessions thrice. Two of them being on adjacent days, with the latter as a rescheduled appointment. And he never informed me that he was going to miss them, or why he missed them, I only learned the reasons why second-hand.)

5:

Unfortunately, mental illness tends to involve damage/malfunction in the system responsible for detecting and dealing with damage/malfunction, like a broken repair droid (sorry, best analogy I could come up with).

Probably because it's easier. Pills do have effects that can indeed control these things. Now whether or not a patient needs the medication is the question that needs to be asked and in many cases I'm going to say no. Personally I prefer to tell people to see a clinical therapist first and then, if the therapist recommends a psychiatrist, see the psychiatrist in addition to the therapist. Keeping very close contact between the two of them in some fashion.

This is partly because I don't think many people need the medication. Many psychological problems aren't by and large chemical in nature, which are what most medications deal with. Chemicals. SSR Is for example force the intake of serotonin in those who aren't receiving enough of it. This can have a variety of effects on a person. Many of which aren't good. Part of this is due to individual medications, you have to try around, and part of this is due to the class of medicines just being a bad thing for the person in general. Or maybe the person isn't taking them right. Either way problems can arise.

Many. And medication? It's expensive. As are psychiatrists. More so than therapists in my experience. Let's not get into the issues of inpatient care and related intensive therapies either. Yet this is the first thing we want to give people. Pills.

For certain people however medication is a must. People such as myself. Do I like that I have to be on SSR Is? No. Not really. They kind of suck. But without them I'm far too much of an unstable mess emotionally. I'm paranoid and switching from extreme levels of mania and depression rapidly until I just kind of crash into one prolonged state of depression and give up for a week or so. On my pills and with the addition of my other practices however, my medication means little without lifestyle plans and therapies, I'm much less prone to that. I still do it at times, but not nearly as often nor nearly as badly. I feel a numbness at times that I hate, but I can live through that numbness and do things. I can't do things when I'm throwing teacups at my mother and telling her that she never cared because she married the man she did and that he hates us all.

Psychological therapy and psychiatry aren't exact. They won't be for a long while. We have to feel around in the dark, psychologists and patients both, until we find something that works. And we keep looking. There's no one way to fix any given disorder. Some OCD sufferers do best on heavy meds. Others don't. Some just need lots of therapy and changes in how they go about their lives. While it's dangerous to say "We should treat everyone with medicine because everyone needs it!" it's also dangerous to say "We don't need it because it doesn't work!"

As for thinking yourself out of panic attacks...You can. I have to do this myself. I meditate on whatever task I'm supposed to be accomplishing. Deeply thinking about that task while still yet mindful of the world around me. Medication can help certain individuals who suffer them however. It depends on why the person has them.

Why is it that when someone says "you don't really have a disease, it's toxins in your cell phone, you just have to think yourself healthy, your aura's the wrong color, etc. etc." they're not taken seriously outside Sedonia, but replace "disease" with "mental illness" and suddenly it's reasonable? If Aeon's post were about asthma, or hep C, it would sound silly to most people, right? Is it because the lungs and liver aren't as mysterious?

^ With physical illness, the problem isn't that your aura is the wrong color, but the problem may be that you need to eat right and exercise more. As vital as drugs are, they're overprescribed in all spheres.

Depends on the illness. No one who thinks hep C can be cured by a vague healthy lifestyle gets taken seriously.

Which is why pills shouldn't be prescribed for everything, but for where they actually help.

@ Hersh. What you must realise is that psychological therapies aren't exactly new age voodoo.

They're actual therapies that involve solving the problems. Drugs simply treat the problem. Which, for some things (e.g. schizophrenia) are fine.

But you can't drug someone out of a phobia, for example. That's impossible. You can make sure the anxiety is decreased, but the phobia still remains.

Fully agrees. Cognitive Behavioural Therapy doesn't help you balance, for example, the norepinephrine-to-dopamine level of your brain-chemistry, but it can help you deal with the effects of the imbalance in your day-to-day life so you don't make it worse on yourself. Which in turn helps you recover from your depression (or pin-point whatever is making you depressed: never underestimate the power of an underlying cause) quicker. (Yum: feedback loops!)

And, it also arms you against spiralling into another deep depressive phase at a later date, if you keep it up, as those who do are more likely to spot the signs earlier, and therefore take steps. Which is much preferable to playing the ostrich.

This is not supposition, moonbeams and woo-woo science. It's part and parcel of the facts you have to groan through in Abnormal Psychology classes, making sure you note them down, as they will come up later. (Unless you're unlucky, and you get a question on psychotic disorders and not depression, instead, 'cos your tutor is a sneaky bastard.)

I'm not sore. Honest!

edited 17th Apr '12 11:16:32 PM by Euodiachloris

More or less. Our understanding of the brain and its relationship with the mind is iffy at best. Neuropsychology is a relatively new field, whereas people have studied the lungs and liver for decades. Time is a really big factor for development in medicine because apart from all else, living things are so complex that it is very rare to have a clear "event A leading to B" thing going on. If you look at most medical journals most reports are more likely to be "event A increases the chance of B happening by something something percent". This is even more so for something as complex as the human mind and brain, given that there's environment factors and cultural factors that need to be taken into account (and the psychologists are beginning to realize that they have been focusing too much on the WEIRD (white, educated, industrialised, rich, and democratic) people and not enough on people from other backgrounds).

Yeah: the bane of any investigation... pinning down the various environmental factors. You know Chaos Theory is part of the Social Sciences when you try to tot all the possible variables up.

Not only that, but the more factors there are, the most likely that there will be some that researchers cannot control (either it is impossible, or in case of people behavior, unethical).

It's an interesting topic in AS Psychology (hence why I created the thread). The psychological methods (except psychodynamism, which is the real voodoo) are extremely rigorous.

Also, environmental factors, man. Like, everyone keeps underestimating them. Biological psychology (which is mainly what medical psychiatrists are hopped up on) assumes that everything is biological. If that was true, schizophrenia would have a 100% concordance rate in twins. It only has 48%. And considering that most twins are brought up in the same environment...

I may be correct in thinking that the "PSYCHOLOGICAL TREATMENTS ARE VOOODOOO" is due to the fact everything thinks that Freud Is Right. Ladies and gents, the only thing he was right about was the role of early childhood. And he... kinda went overboard with that.

He had a good idea with the whole defense mechanism thing. Save a few of them.

edited 18th Apr '12 3:34:32 PM by Aondeug

Oh, I forgot about those. Indeed, some of the defence mechanisms were pretty good. I mean, a bit simplified in his theories, but then again, he was from the 30s.