Mental health treatment's paradigm

What is mental illness, severe mental illness, has may definitions to the single (nebulous?) word. For it to be an illness it must have a biological component to the deficit or disorder. Otherwise it's not an illness. There are other understandings of what mental illness is outside the biomedical model but these still assume the paradigm of the biomedical model which, in my view, is a dangerous misappropriation of the privilege of medicine.

Mental health treatments for severe mental illnesses such as bipolar or schizophrenia are usually based on medication primarily with other treatments such as talking therapies used far less often and society change seen very rarely.

The medication might be considered biological because the neurochemicals create behavioural changes and alleviate some symptoms. In the sense that these treatments are true medicines, ones which seek to treat the biological problem, is debateable. The chemical imbalance hypothesis is not a scientific fact. There is no scientifically established normal level of dopamine or serotonin. Certain behavioural changes can be achieved by using certain neurochemicals, but this doesn't mean their medicines or things which people who take the Hippocratic Oath should be prescribing.

There are studies which show differences and deficits. The MRI study commented on in this blog which looked at children with early onset schizophrenia showed a 5% overall reduction in a type of brain matter (grey or white, the less important kind) versus a 1% reduction compared to the carefully chosen control subjects during the length of the study. It is unclear whether this is due to the medication itself or an effect of the social exclusion. Children's brains are still developing through their experiences of life and if these are reduced by the impact of severe mental illness when the brain is in a more plastic state then this could influence organic brain development. There is a study showing taxi drivers have brain differences and these are achieved in adult brains with signficantly less plasticity to a child's brain. The taxi driver study is also commented on in an earlier blog post.

The medication does nothing to regenerate the brain and they may be neurotoxic themselves. The dopamine hypothesis isn't about the brain dysfunction as the mode with which the undesireable behaviours can be controlled.

The latter is the function of the majority of mental healthcare in my opinion especially for severe mental illnesses. The example is the extension of the use of the major tranquiliser, misnamed the antipsychotic, outside the treatment of supposed illnesses like schizophrenia. This drug type is also know as the chemcial cosh because it has the action of a straitjacket. It makes people docile and reduces unwanted behaviour. These drugs became used on the elderly in the community in the UK. The drug does not regenerate brain matter. It doesn't slow the progress of Alzheimers. All it does is treat the behavioural symptoms. It coshed the elderly into subdued states.

The treatment reduced life expectancy by 50% according to one highly influential observational study on the very elderly. This promoted the UK government to commission a report from the Royal College of psychiatry. They estimated the treatment killed 1,800 people a year in the UK unnecessarily.

First do no harm. This is the original first line of the oath which every doctor takes to be a doctor.

Because society's norms has changed so much they decided the behaviour of the elderly was abnormal enough to warrant change. I don't think they bothered doing any proper trials on how antipsychotics could stop or even reverse the neurodegenerative process involves in Alzhiemers. They didn't need to. This wasn't the objective. The objective was the same as had doctors recommended straitjackets and gags for the elderly, but those would have been safer. More obviously inhumane to the public consciousness too. Imagine the headlines: doctors are gagging and straitjacketing hundreds of thousands of the elderly.

This is the problem of the privilege of medicine applied to the problems of emotional and behavioural health. The privilege shouldn't because it's not always about illness and when it's not about a genuine illness then a different system or way of thinking needs to be applied.