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Medicalising everyday life doesn't help anyone's mental health

theguardian.com

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Re: Medicalising everyday life doesn't help anyone's mental health

#41

Earlier quoted context omitted.

I think you're right to question. The rule of thumb I've heard, which seems sensible to me, is is the condition/symptom negatively affecting your ability to go about your day-to-day life . If not, then whatever you're experiencing is probably "normal enough". There's no great mass of people with completely by-the-book mental processes; everyone's a little "weird" in some way. On the other hand, I suppose you may not…

> is the condition/symptom negatively affecting your ability to go about your day-to-day life I wonder though, is this even too broad? Perhaps people need to overcome some of this adversity. Not everything is painless in life nor should it be.

> Not everything is painless in life nor should it be.

No, but a lot of things should be. Leaving the house SHOULD be, but for some people it isn't. If it's causing you so much dread you can't bring yourself to do it, that's not just "overcoming adversity" - that's adversity where there shouldn't be any.

Re: Medicalising everyday life doesn't help anyone's mental health

#42
I have never seen a group of less mentally-healthy people in my life. Mentally healthy people don't drink that much.

The whole stiff upper lip nonsense is the problem. Neglecting and suppressing emotions for long periods of time cause mental health issues.

The problem is that we don't have a clue about mental health in general, the blind are leading the blind.

Antidepressants don't cure depression. In fact, they can make it harder to process emotions. They reduce the symptoms and make it easier to ignore the environmental issues that are causing it.

Actually treating depression requires understanding and addressing the true cause. And the true cause is not a chemical imbalance or people not being tough enough.

Self-pity or using issues as a crutch does not help, but it is also not the cause.

Re: Medicalising everyday life doesn't help anyone's mental health

#43
One of the least enviable things I've ever witnessed in my life was a pair of co-workers who bonded over their medical problems.

It was a really strange thing to notice, and at first, it just seemed like small talk or polite conversation. But then it kept going, and while there was nothing particularly repugnant about the details, the undertones that developed were unsavory.

It was like they relished being sad about their invalidity, like it was one big sick day that gave them an excuse to stay home from school. As if to say, "thank god my body is failing me again, and everyone is powerless to make demands of me."

They would bond over the similar things their doctors would put them through, about the noises of MRI machines, about side effects and being incapacitated by medicines, about being laid up for extended periods of time. Bad news was greeted with a sort of malign enthusiasm, like getting to take the ride again. "Oh yeah, my doctor just told me my tests are bad again."

You had to wonder if they were harming themselves to get back on the radar. These two individuals weren't stupid, and it seemed within the realm of believability that they'd try to maximize all the physical therapy and weird attention that a medical problem would garner them.

Their problems were distinct and different, but with the way they locked in on each other, sharing tips and tricks as it were, it seemed like maybe without any other reason to talk to one another, the way they enjoyed such discussions bordered on perverse.

The tone of each, finding excitement in the other's words, lent an uncanny color to the details I learned by being a fly on the wall. Like hot pink syringes and neon green day glow catheter crazy straws.

On second thought, maybe the bigger problem was the open office floor plan, and the fact that I was forced to listen to conversations that I just didn't want to hear.

Re: Medicalising everyday life doesn't help anyone's mental health

#44

Earlier quoted context omitted.

I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. I can somewhat relate from experience: I went to a doctor for terrible trouble sleeping, to the point that it was affecting my physical health, that we assumed was caused by anxiety/…

> Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. Agreed, and I would say that the answer to this is to have the licensed professionals guide the diagnosis. Don’t just self-diagnose or read a Wikipedia page and think you have an anxiety disorder. (It’s a good starting point and you can take your self-diagnosis to a psych{olog,ia…

> You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy.

IMO and IME this is a really bad idea. My experience with specialists is that they're far, far more myopic than generalists: eg if you have symptoms that manifest in the feet, podiatrists or foot orthopedists won't solve your foot problems, they'll provide foot solutions, whether or not these solutions are relevant or helpful. This stems from the same rotten root of the endemic myopia and lack of critical thinking among medical professionals[1].

As I mentioned above, the problem didn't even end up being with anxiety, so going to a therapist would have been worse than useless for me. My complaint is that my conversation with my doctor was very brief, during which I mentioned fairly strong symptoms of anxiety, and the doctor was immediately gung-ho about anti-depressants. I should also note that this was a GP who (at least nominally) was somewhat specialized in mental healthcare issues, so it's not like this was throwing a case at a random doctor and expecting them to be a specialist. On top of that,using a GP as an entry point to the healthcare system is, roughly speaking, their _only_ job, and what's shocking is how widespread a basic lack of competency at this sole task is.

> The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable.

I may have failed expressed myself clearly, but this is sort of my point: the bar that I'm setting is one that I think anyone with fundamental critical thinking skills could clear, barring a gross case of apathy towards patient welfare. It's been my unfortunate experience that this minimal combination is pretty lacking when it comes to doctors, either specialist or generalist. The notion that a doctor should jump to prescribing medicine because it's all they know how to do is insane to me, since it completely rules out the possibility of understanding the patient's case further instead of grabbing whatever hammer happens to be lying around.

Now granted, I have a fairly limited sample size personally, but I've seen the same thing play out with family members whose care I've been involved in, and my empirical anecdota are theoretically supported by conversations I've had with doctor friends/family over the years. At the very least, I've _personally_ decided to treat doctors as nothing more than legal impediments to prescription medicine, an incomplete chatbot UI to medical knowledge, and an occasional source of novel medical information. This has worked out _far_ better for me than the alternative of assuming that a typical GP has a baseline of competence (I've made more progress on my sleep issues in the last year than the previous half decade by taking this approach, and dealt with some niggling minor medical issues that every GP I've ever had completely failed to address).

> Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest.

Just to reiterate, the complaint is not that your best friend would have something different to say from your priest, but that either of them would respond with a stock answer instead of listening to you and thinking about it. If your pastor says "Say ten hail marys" to any person's request for advice, the problem isn't that he has a narrow view but that he's a shitty priest. If you can replace a doctor, or a priest, or a best friend with a post-it note or a first-page Google search, it seems almost tautological that they're somewhat incompetent.

[1] (though again, I don't think this is because they're dumber than the average person or anything like that; rather, the institutional pushes in the other direction that they get are strong enough that the only doctors I know (sadly, not as a patient) that do think critically about their patients' issues are the very-intelligent ones that would probably excel in most fields).

Re: Medicalising everyday life doesn't help anyone's mental health

#45

Earlier quoted context omitted.

I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. I can somewhat relate from experience: I went to a doctor for terrible trouble sleeping, to the point that it was affecting my physical health, that we assumed was caused by anxiety/…

How did you fix your sleep problem? And if they both disappeared at the same time, how can you be certain that your not the one mixing up cause and effect?

> if they both disappeared at the same time

They didn't disappear at the same time. I was on antidepressants for a year and my time on antidepressants was pretty much independent of the degree to which my sleep problems were fixed. I probably was slightly less anxious while on the antidepressants, but this was far overwhelmed by the fact that I get/got anxious & depressed after the nights my sleep was poor and I don't/didn't whenever I sleep well. I was able to narrow it down to this specific direction of causality (bad sleep -> anxious the next day) through the fact that my sleep was often affected by exogenous physical factors.

I apologize for not going into too much identifying detail on a pseudonymous account, but I solved it by completely ignoring the medical establishment, reading voraciously about the problem, and experimenting on myself until I got myself to an 85% solution that at least allowed me to get back to work. This happened at a far, far slower and more grinding pace than the counterfactual in which I had any competent doctors around me (or rather, if competency wasn't ludicrously uncommon within medicine), since 1) I was sick, 2) I was employed until I quit to focus on the issue, and 3) I don't have an educational background in medicine the way that a doctor (ostensibly) would.

I'm far, far, far more comfortable reading papers in noisy epistemological environments than most people; I can't even imagine how horrible and expensive and drawn-out this process would have been had I not been had the confidence or ability to take this route and had to rely on the medical establishment.

After getting most of the way there myself, I still have issues sleeping once every week or two, and I decided to visit the relevant specialist to use them as a reference to expedite my path to a 100% solution[1]. It's a criminal indictment of our medical system that the only recourse for patients with complex, multi-factor health problems is to themselves navigate both medical knowledge and the medical system until they've narrowed it down to a fairly well-defined, simple solution. To the extent that the system's abdication of responsibility is driven by individuals' decisions, they should be ashamed of themselves (though again, I will reiterate once again that I think that the problem is systemic; I think most people of average intelligence would behave similarly in the situations that doctors find themselves in and I haven't seen any evidence that leads me to believe that most doctors are particularly extra-bright).

[1] At which point regulatory BS popped up again and I was legally required to have a perfunctory appt (at the cost of several hundred dollars, of course) with a doctor to request a referral to this type of specialist

Re: Medicalising everyday life doesn't help anyone's mental health

#46
post #33
post #17

I couldn't get a vitamin B12 injection, the materials cost of which is less than £1 with no negative side effects, more often than every 12 weeks from my doctor. Despite feeling awful at 8 weeks onwards, to the point of not being able to work, and better again every time I had the injection. I didn't care if it was placebo (although why it would be placebo at 8 weeks but deemed not a placebo at 12 weeks I struggle to…

Curious, why do you need an injection? I thought only vegans had issues with B12, and only if they weren't paying attention to what they ate.

I'm a ~30 year old meat-eating male in a family with a history of anemia on my mother's side (including my sister).

It was discovered sometime within the past few years during a routine blood test that I had low hemoglobin from a moderate-to-severe Iron/B12 deficiency (no full blown other condition, though)

I was never recommended injections, however. Doctor told me to take an off-the-shelf supplement and to eat more red meat. (I rarely did)

When I don't follow through with those items I do notice. Following his advice has greatly improved my overall feeling of well-being. I would otherwise feel tired, foggy-headed, weak, faint, anxious, nauseous at times—sometimes a mix of all of the above. Used to think my blood sugar was just low.

Re: Medicalising everyday life doesn't help anyone's mental health

#47

Earlier quoted context omitted.

> Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. Agreed, and I would say that the answer to this is to have the licensed professionals guide the diagnosis. Don’t just self-diagnose or read a Wikipedia page and think you have an anxiety disorder. (It’s a good starting point and you can take your self-diagnosis to a psych{olog,ia…

> You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. IMO and IME this is a really bad idea. My experience with specialists is that they're far, far more myopic than generalists: eg if you have…

> As I mentioned above, the problem didn't even end up being with anxiety, so going to a therapist would have been worse than useless for me.

I wouldn't go that far. Therapy is a broadly-useful non-medical intervention that can increase across-the-board mental health. It bridges the gap between medical intervention, where specialists act as necessary gatekeepers to otherwise-dangerous courses of action, not that they're always successful at reducing the danger, and self-help, which is thoroughly hit-or-miss.

There is an established body of psychological research that the therapist brings you in contact with that the medical community is only tangentially aware of. Sure, you could read up on this stuff yourself. But it's the talk therapist's job to know about it. And even if you don't find purchase on your stated problem, you might find other problems that you didn't realize you'd had.

If you can afford it or get it covered, I highly recommend regular sessions for a few years.

Re: Medicalising everyday life doesn't help anyone's mental health

#48
post #27

Reminds of this paragraph of Mark Fisher in Capitalist Realism: "I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of tress that has taken place over the last thirty years, we need to ask: how has it be…

Mark Fisher's entire work can be summarised without much loss by saying "It's all capitalism's fault!" How is this interesting? I met him personally a couple of times, I don't think he would have been able even to say what e.g. fractional reserve banking was, or the labour theory of value, not to mention Böhm-Bawerk's famous critique.

Anyway, since I've just violated de mortuis nil nisi bonum, let me finish by saying that Fisher had good taste in music.

Re: Medicalising everyday life doesn't help anyone's mental health

#49

> One of the things that is most protective to mental health is not to spend too much of our lives consciously obsessing about it. That last statement is rather asinine and seems at odds with the rest of the article. I think it's fair to say negative emotions aren't the same as mental illness, but ignoring those negative emotions and keeping a "stiff upper lip" can lead to much bigger emotional problems down the road…

We need to be reflective enough to know when we have a mental health problem and need to do something about it. But it's also true that one of the most common causes of mental health problems are patterns of thought that can be changed by conscious self-discipline. Indeed, that's the basic premise of Cognitive Behavioural Therapy.

I also think there's a social point: we often feel bad because we fear that other people will think less of us for various reasons (money, status, lifestyle). A lot of the time, it's important to resist that natural social impulse and to live on your own terms.

Re: Medicalising everyday life doesn't help anyone's mental health

#50
post #27

Reminds of this paragraph of Mark Fisher in Capitalist Realism: "I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of tress that has taken place over the last thirty years, we need to ask: how has it be…

Mark Fisher's entire work can be summarised without much loss by saying "It's all capitalism's fault!" How is this interesting? I met him personally a couple of times, I don't think he would have been able even to say what e.g. fractional reserve banking was, or the labour theory of value, not to mention Böhm-Bawerk's famous critique. Anyway, since I've just violated de mortuis nil nisi bonum , let me finish by sayin…

I just know that in our economic system, humans are capital and anything that compromises their economic productivity is pathologized. Who Fisher was or what he did is irrelevant to this discussion.
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