Is the world set up for the mentally ill?

[rav3n]

What about when the actual issue is a physical illness that causes mental symptoms? Hope the mental care practitioner is knowledgeable enough to recognize that? (not trying to be argumentative, seriously asking)

This is why people should start with physical health checkups and if it's not physical, get referred to a mental health practitioner.

 

[Qlip]

You'll often find people with ADD/ADHD hyperfocusing on video games, to the extent of insufficient focus on the balance of their lives. There's sufficient novelty in video gaming. Do they make campfires multiple times a day, every day?

Don't confuse focus on novelty with repetitive grind. Repetitive grind is problematic for people with ADD/ADHD.

That said, IMO, there are individuals who've been misdiagnosed by GPs with ADD/ADHD, who don't have it. It's also appalling to me that GPs can diagnose mental health issues and prescribe accordingly. IMO, the initial diagnosis should come from a mental health practitioner and if meds are necessarily, prescribed and monitored by a mental health practitioner until symptoms have leveled out. From there, a GP can handle the refills while ensuring that the meds aren't negatively impacting on physical health (kidney, liver functions, etc).

I feel like we're getting into straw man territory. Anyway, I'll leave this here and feel like I've said my peace.

Social construct theory of ADHD - Wikipedia

Quote to get the gist of the issues discussed:

A common argument against the medical model of ADHD asserts that while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional. However, by definition, in order to diagnose with a mental disorder, symptoms must be interpreted as causing a person distress / espec. maladaptive. In America, the Diagnostic and Statistical Manual (DSM-IV) requires that "some impairment from the symptoms is present in two or more settings" and that "there must be clear evidence of significant impairment in social, school, or work functioning" for a diagnosis of ADHD to be made.[7]

In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as 'problems'.

...

There is a heck of a lot of grey area when we talk about being 'maladaptive', and a lot of mental disorders exist there.

 

[rav3n]

I feel like we're getting into straw man territory. Anyway, I'll leave this here and feel like I've said my peace.

Social construct theory of ADHD - Wikipedia

Quote to get the gist of the issues discussed:



There is a heck of a lot of grey area when we talk about being 'maladaptive', and a lot of mental disorders exist there.

This is a real issue.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30049-4/abstract

Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis

Background
Neuroimaging studies have shown structural alterations in several brain regions in children and adults with attention deficit hyperactivity disorder (ADHD). Through the formation of the international ENIGMA ADHD Working Group, we aimed to address weaknesses of previous imaging studies and meta-analyses, namely inadequate sample size and methodological heterogeneity. We aimed to investigate whether there are structural differences in children and adults with ADHD compared with those without this diagnosis.

Methods
In this cross-sectional mega-analysis, we used the data from the international ENIGMA Working Group collaboration, which in the present analysis was frozen at Feb 8, 2015. Individual sites analysed structural T1-weighted MRI brain scans with harmonised protocols of individuals with ADHD compared with those who do not have this diagnosis. Our primary outcome was to assess case-control differences in subcortical structures and intracranial volume through pooling of all individual data from all cohorts in this collaboration. For this analysis, p values were significant at the false discovery rate corrected threshold of p=0·0156.

Findings
Our sample comprised 1713 participants with ADHD and 1529 controls from 23 sites with a median age of 14 years (range 4–63 years). The volumes of the accumbens (Cohen's d=−0·15), amygdala (d=−0·19), caudate (d=−0·11), hippocampus (d=−0·11), putamen (d=−0·14), and intracranial volume (d=−0·10) were smaller in individuals with ADHD compared with controls in the mega-analysis. There was no difference in volume size in the pallidum (p=0·95) and thalamus (p=0·39) between people with ADHD and controls. Exploratory lifespan modelling suggested a delay of maturation and a delay of degeneration, as effect sizes were highest in most subgroups of children (<15 years) versus adults (>21 years): in the accumbens (Cohen's d=−0·19 vs −0·10), amygdala (d=−0·18 vs −0·14), caudate (d=−0·13 vs −0·07), hippocampus (d=−0·12 vs −0·06), putamen (d=−0·18 vs −0·08), and intracranial volume (d=−0·14 vs 0·01). There was no difference between children and adults for the pallidum (p=0·79) or thalamus (p=0·89). Case-control differences in adults were non-significant (all p>0·03). Psychostimulant medication use (all p>0·15) or symptom scores (all p>0·02) did not influence results, nor did the presence of comorbid psychiatric disorders (all p>0·5).

Interpretation
With the largest dataset to date, we add new knowledge about bilateral amygdala, accumbens, and hippocampus reductions in ADHD. We extend the brain maturation delay theory for ADHD to include subcortical structures and refute medication effects on brain volume suggested by earlier meta-analyses. Lifespan analyses suggest that, in the absence of well powered longitudinal studies, the ENIGMA cross-sectional sample across six decades of ages provides a means to generate hypotheses about lifespan trajectories in brain phenotypes.

 

[Qlip]

This is a real issue.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30049-4/abstract

Thre's a real 'difference', I never said there wasn't, but what makes it an 'issue' is a societal judgment. I mentioned that distinction before, and it is recognized in the article I posted.

 

[rav3n]

Thre's a real 'difference', I never said there wasn't, but what makes it an 'issue' is a societal judgment. I mentioned that distinction before, and it is recognized in the article I posted.

To consider people with ADD/ADHD within the normal spectrum sets them up to fail since they're perceived as lazy, self-indulgent and lacking in impulse control.

Back when, people fought the discovery of dyslexia, considering children stupid.

 

[Lark]

There are two sides to mental illness, the individual who suffers from mental illness and the people around them who suffer. This is a social issue that needs to be addressed by governments. Better healthcare including mental healthcare so everyone benefits.

I do agree with that, its often something that's not considered a lot by politicians, the public at large, even some professional groups too.

Something I remember being very aware of when training in social work was that the role of social workers, whether they were public servants or NGO employees, was that their interventions, assessments, plans were always meant to be time limited actions in response to breakdowns in informal support networks, like families, or more broadly speaking families, neighbours, schools, communities etc. The primary objective could be safeguarding, or identifying accomodation or some sort of care provider but the secondary one was always restoring the informal network to full functioning status and a tertiary objective exists the whole time of raising awareness of existing informal networks or trying to build them up some how.

I probably dont need to level with anyone that not every professional thinks that way, some think there's no one like them and no one can cope (or should even try) without them. Ivan Illich wrote about this in his book about disabling professionals, he also wrote another book called medical nemesis which makes some of the same points but also makes other points about unrealistic expectations of medics and medicine more generally, I share a lot of his skepticism about experts and expertise.

I also still find some of Erich Fromm's observations, like the "caring sadists" in Fear of Freedom, who seek out and perform care functions because the sick are at their mercy or within their control, scarily accurate in some instances.

There's a few scary stories from within the UK of those types, Harold Shipman was a doctor who administered lethal injections on home visits to vulnerable elderly people, there was another care assistant who tortured residents and staff in the residential home he worked in by administering insulin to them, another case of a nurse who killed the babies in their care. In Japan I think I remember hearing about some care assistant who massacred people in his care with a sword.

So informal solutions can be preferable to simply creating a strong institutional response which attracts shady types to it who can exploit it in wicked ways. Still that's far short of what Bush Did 9/11 recalls but its still an issue.

Plus, not for all because there's the thorny issue of hereditary make up, but a lot of people would benefit from much more broad public expenditures than simply funneling money to psychiatric and psychological services, inadequate education, housing, utilities, roads and other public goods, the stress of relying on those or even providing them, especially were you are not content to say everything is fine when its not, all takes its toil and causes people to become unwell.

Then into the bargain you've got managerial culture and business culture for most people who making out as employees, do they work for organisations which are fine examples of the Dunning-Kreuger effect? Are they likely to find other sorts of work easily if they do? Is their organisation full of people like those featured in movies like Horrible Bosses or whose main model in terms of management has been someone mainly influenced by reality TV, scandal and office politics? I dont know how you necessarily police those factors but they are big factors. Social issues not necessarily easily corrected with public money or services.

Finally, crime, war and violence, how much of it is there, its no mistake that people suffering that or with an expectation of the same are liable to become unwell or develop disturbed traits. One of the most important, probably the single most important, factors in recovery from trauma of any sort is a place of safety and the experience of safety.

 

[Lark]

This is why people should start with physical health checkups and if it's not physical, get referred to a mental health practitioner.

What you're talking about is often referred to as an organic cause or the medical model of mental illness.

 

[Lark]

I feel like we're getting into straw man territory. Anyway, I'll leave this here and feel like I've said my peace.

Social construct theory of ADHD - Wikipedia

Quote to get the gist of the issues discussed:



There is a heck of a lot of grey area when we talk about being 'maladaptive', and a lot of mental disorders exist there.

That also relates to what I posted about how some mental disorders are highly adaptive, in some contexts, and the context is key.

That question is something that people have struggled with for a long time, the best that's come up with is that its a combination of recessive genes and environment, giving rise to thoughts and behaviour which cause suffering to those experiencing them and those around them. Or something along those lines, its in the DSM anyway.

There is, I think, objective illness but it will always remain contentious. Maybe that's alright too. I think Erich Fromm did a great job identifying how sociology could provide some insight into individual illness, even if some of his social pathology is hard to frame as testable hypothesis, but others dismiss him as simply seeking to perpetuate his own idiosyncratic marxism or jewish faith. There was a time a lot of homosexuality was a treatable mental illness, then that idea was ditched wholesale and replaced (I think with the equally problematic) with the idea that anything short of approval of the same was a sign of homophobia and possibly an indicator of repressed homosexuality itself.

Psychology is as likely as anything else to be subject to vogues and fashions, unfortunately, and sometimes it does touch on issues of minority-majority relations too.

Outside of what you're mentioning here, disorders like ADHD, there's the whole thing of the so called "worried well" and labels long since ditched, at least here, of people being "neurotics".

 

[gromit]

No I do not think it is. A lot of my patients struggle with doing everyday things and I can see that the world is not designed for them. But what I try to do is to help them to find ways to work within the demands and expectations of "the world".

To be honest though I don't know if a 40 hr work week is actually healthy for anybody.

Alas its it's how our culture operates.

 

[prplchknz]

No I do not think it is. A lot of my patients struggle with doing everyday things and I can see that the world is not designed for them. But what I try to do is to help them to find ways to work within the demands and expectations of "the world".

To be honest though I don't know if a 40 hr work week is actually healthy for anybody.

Alas its it's how our culture operates.

but most people can do it without having a breakdown or functioning being lowered to where they can't keep up without letting other responsibilities go. I think we should have more holidays and less work hours and better pay. you'd think robots would make that possible but it's not.

 

[gromit]

but most people can do it without having a breakdown or functioning being lowered to where they can't keep up without letting other responsibilities go. I think we should have more holidays and less work hours and better pay. you'd think robots would make that possible but it's not.

I am with you there

 

[ceecee]

We're better set up than when eugenics laws were on the books and we locked up and forced-sterilized the mentally ill, but we still have a long way to go in understanding the human problems in general; let alone in creating the right infrastructure to handle them.

Yes. And while I think a good amount of stigma is dissolving quickly, that doesn't mean we even have a slight grasp on where to go from there. But the current environment in the US (and it's been there for some time) means there will not be improvements in health care nation wide (it is happening in small pockets), mental health care will be last, as it always is. This has almost nothing to do with funding. It's the - not my problem - mentality. We have to have a cultural and ideological shift, government has to start earning trust, until then we go nowhere as a country.

 

[prplchknz]

although stigma is lessening there is still a lot of misconceptions, for example last night someone said that you're not really suicidal if you tell someone and just looking for attention which is often times false. sure a small percentage might be, but that's a tiny percentage. This is one of the more dangerous misconceptions out there. I thought about making a thread on misconceptions. But I now have a third subject i can talk about DnD. So the subjects I like talking about is food, mental health, and DnD

 

[Frosty]

Not really, but it IS getting better at least.

 

[Lark]

although stigma is lessening there is still a lot of misconceptions, for example last night someone said that you're not really suicidal if you tell someone and just looking for attention which is often times false. sure a small percentage might be, but that's a tiny percentage. This is one of the more dangerous misconceptions out there. I thought about making a thread on misconceptions. But I now have a third subject i can talk about DnD. So the subjects I like talking about is food, mental health, and DnD

Lately, I've been thinking that the world actually fosters mental illness in healthy people were it can. Some of that's to do with what I'd said before about certain sorts of maladjusted or disturbed personalities proving highly adaptive in some contexts. Some of it is in the actual responses to mental illness itself.

Distinctions between organic illness (which the medical model of mental illness considers to be about the only sort of mental illness) and the so called "worried well" (intermittent illness, traumas which resilient individuals or groups can recover from often spontaneously with maybe informal support of friends and family) dont translate well to a simple advertisement. The needs of those two groups are pretty different though. There's a lot of misconceptions about mental illness which arise from the failure to appreciate the diversity within any group of people labelled that way.

Like lately, I'd shared something on social media, it was some article from a webpage I usually find is better than most and was something like "14 lifestyle tips to deal with anxiety". A friend responded by saying that they felt that anxiety was being misused and he felt the article was really about "worry", some of the lifestyle changes proposed would actually have been triggers to persons experiencing what he knew as anxiety. I read the article and I thought about it and tended to agree with their assessment. In which case I'd inadvertently been sharing poor/bad information and contributing to problems people could be experiencing who are experiencing genuine anxiety.

That's not to say that lifestyle issues or problems are minor, the often are not, it could just be something really different. The gulf between essence and existence is no minor thing either. That's just looking at the most generic, universal human being and not even taking account of complex types or traits.

 

[prplchknz]

Lately, I've been thinking that the world actually fosters mental illness in healthy people were it can. Some of that's to do with what I'd said before about certain sorts of maladjusted or disturbed personalities proving highly adaptive in some contexts. Some of it is in the actual responses to mental illness itself.

Distinctions between organic illness (which the medical model of mental illness considers to be about the only sort of mental illness) and the so called "worried well" (intermittent illness, traumas which resilient individuals or groups can recover from often spontaneously with maybe informal support of friends and family) dont translate well to a simple advertisement. The needs of those two groups are pretty different though. There's a lot of misconceptions about mental illness which arise from the failure to appreciate the diversity within any group of people labelled that way.

Like lately, I'd shared something on social media, it was some article from a webpage I usually find is better than most and was something like "14 lifestyle tips to deal with anxiety". A friend responded by saying that they felt that anxiety was being misused and he felt the article was really about "worry", some of the lifestyle changes proposed would actually have been triggers to persons experiencing what he knew as anxiety. I read the article and I thought about it and tended to agree with their assessment. In which case I'd inadvertently been sharing poor/bad information and contributing to problems people could be experiencing who are experiencing genuine anxiety.

That's not to say that lifestyle issues or problems are minor, the often are not, it could just be something really different. The gulf between essence and existence is no minor thing either. That's just looking at the most generic, universal human being and not even taking account of complex types or traits.

yeah i find a lot of those wellness cure depression/cure anxiety posts on FB and Twitter to be bullshit sorry but if you have clinical levels of anxiety or depression simply walking outside and exercising isn't going to help.

 

[Frosty]

yeah i find a lot of those wellness cure depression/cure anxiety posts on FB and Twitter to be bullshit sorry but if you have clinical levels of anxiety or depression simply walking outside and exercising isn't going to help.

Yeah that was like the first therapist I ever saw telling me that the reason why I was depressed was because I wasnt trying hard enough to think happy thoughts.

When you have therapists saying stuff like that it just really goes to show that mental health education has a long way to go

 

[Lark]

yeah i find a lot of those wellness cure depression/cure anxiety posts on FB and Twitter to be bullshit sorry but if you have clinical levels of anxiety or depression simply walking outside and exercising isn't going to help.

That is absolutely what I'm talking about! Totally!

I think the recommendations as serious BS even for having "the blues" let alone, as you say, clinical levels of anxiety or depression.

Sometimes I think those things are written by people who're absolutely happy and decide to engage in a bit of self-congratulation, its like Paris Hilton's "Stop Being Poor" T-Shirt (Seriously?), and have never had to contend with real life crisis let alone mental illness proper.

 

[Lark]

Yeah that was like the first therapist I ever saw telling me that the reason why I was depressed was because I wasnt trying hard enough to think happy thoughts.

When you have therapists saying stuff like that it just really goes to show that mental health education has a long way to go

Where they a CBT professional? I experience a lot of CBT as being like that, also NLP which I think of being a sort of CBT for Ad Men.

Also the every single positive thinking guide I've EVER read and I've suspended disbelief and tried those ideas.

 

[Frosty]

Where they a CBT professional? I experience a lot of CBT as being like that, also NLP which I think of being a sort of CBT for Ad Men.

Also the every single positive thinking guide I've EVER read and I've suspended disbelief and tried those ideas.

No clue I only saw her once. Immediately after the session I switched therapists.

She was young though. Maybe like 26/27 to my 19 at the time. And seemed to like feel that one size fit all when it came to therapy and just didnt know how to deal with... different.

I will say I threw a ton of philosophical bs at her though that I think made her uncomfortable.

But yeah. Not all therapists are good. And thats sad really. Not all therapists are good but like... I really think the awful ones do a ton of damage.