A paper on depression, in actual fact, does say little about human misery and treatment. There is a body of people who assume psychiatric research into depression answers the questions of human misery but they're wrong. Research is only into what psychiatrists agree is depression. Individual misery is not a main concern no matter how much we'd all hope that that's what psychiatry can offer.
Subjective report of unwellness. That's what I'm calling misery. Now I know it's sort of more complicated when considering the finesse of psychopathology but, perhaps, it isn't.
The mental health system should be that simple but it isn't. The research is into what psychiatrists have agreed is a clinical syndrome. The syndrome is measured in research and operational tools are used in practice but these do not work on what patients expect.
I'll give you a true example. I met a girl in a bar. She was a new starter where I used to work. Somehow we got chatting about psychiatry. Her brother had recently been diagnosed with schizophrenia. He had noticed distress thoughts some of which seemed external in origin. He'd told his mum and his mum had taken him to a doctor.
The doctors treated him by sticking him in a psychiatric ward and starting him on medication. The medication is the chemical cosh or chemical restraint. There is no scientific evidence nor effort to find out if it would reduce the delusions and hallucinations which brought this young man into psychiatric care. The only thing was to ensure he was docile. This is the frightening truth of treatment. He was also incacerated in a psychiatric ward.
If I were him I wouldn't be happy with the result of treatment. If he knew what I know about schizophrenia he still wouldn't be happy with his treatment. A life of misery because of medication to make him docile and fit in better, bereft of all the pleasures of the schizo-type.
Let's take another real example. I'm pretty miserable at times. If I went to my doctors I could get a diagnosis of depression. Twenty years ago all he would have done is handed me antidepressants.
The problem is that, as far as I am aware, there is not a single research study on the effect of antidepressants on subjective unwellness. There is lots of research into the syndrome of depression, the accepted psychiatric concept. The problem is self report of unwellness doesn't really factor in.
Let me be precise. Someone who is suicidal could report unwellness. Someone who is hopeless or has lost interest in pleasurable things might also report subjective unwellness. But....and here's the big but...someone who reports feeling mentally unwell might not show the symptoms of clinical depression. In fact there's a study somewhere which shows this effect. As more and more symptoms from the cluster are required fewer people are clinically depressed even though all report subjective unwellness. Roughly equal numbers of men and women report subjective unwellness in this study but the rate of not meeting the criteria for depression using increasing numbers of symptoms gets worse quicker for men.
None of the studies are based on people who meet the sole criteria of subjective unwellness. In fact here's the thing about psychiatry and psychopathology of depression. People who didn't report subjective unwellness but got a diagnosis of depression (which is a possibility and lack-of-low-mood depression is an established thing inpsychiatry) would be clinically depressed whereas people who report unwellness but don't meet the criteria are considered in research as not depressed.
So there's no science to help people nor the human condition. There's just the bullshit of psychopathology. This has little relevance to patients...but they don't matter...because if they did then these questions would have already been banswered or attempted to be answered scientifically.
No comments:
Post a Comment