At this stage, I'm thinking about two issues that are extremely relevant to this whole thread. The first of these is Reductionism. For those unfamiliar with this term, here's a simple example:
Patient X walks into a clinic looking miserable, is tearful and reports having been unhappy for days.
On this basis, a diagnosis of depression is made and assumed to be the sole cause.
Patient X walks out with a prescription for depression, a mental illness solely due to a misfunctioning of Patient X's defective brain.
Reductionism is basically "scientists wearing blinkers and jumping to a simplistic conclusion which they mistake as being scientifically explanatory".
What might have happened t if a non-reductionist been applied to Patient X's presentation: first, he was asked, what has been going on in your life in the past 3 months?
He discloses that it has been a very tough time. Patient X's loved mother recently died, he is under massive stress from managerial issues at work, the bank is going to foreclose on his mortgage, and as a result of these pressures he is unable to sleep, his angina is playing up. On examination it is found that his blood pressure has skyrocketed, his cortisol levels are so high that they are inducing typical secondary symptoms of depression, he is gaining weight because of his skyhigh cortisol levels, stress has raised his C-Reactive Protein levels to a point that it is causing arteries to narrow and blood flow through them to be less efficient, and for all of these reasons, which need identification, consideration and treatment, he is a mess. He is a prime candidate for an imminent heart attack and needs immediate intervention for that. He needs support and counsel from financial advisers on his financial problems. Grief counselling and support seems indicated. Intervention to manage and lower his stress levels is urgent, and he is referred to stress management providers. He needs to rest and restore normal sleep cycles. A full blood count and laboratory tests are indicated to assess his current physiological status before completing the treatment plan.
That's the core problem with psychiatry that deals with "mental" illness. It's reductionist, it leaps to simplistic assumptions, it confuses symptoms with causes, it blames every "mental" condition of a "malfunctioning brain disorder". Depression typically has wider roots in social components, personal components, situational components, cultural components, physical components, lifestyle components, emotional components and psychological components - the latter often stemming from unresolved abuse and abandonment in childhood. In every serious "depression" there is whole story behind it in many chapters. Psychiatry is uninterested in the story, in the personhood of the patient, uninterested in the stigmatising effect of their pronouncing such a person as "mentally ill". The multifactorial approach they almost never bother with takes time, care, respect, open-mindedness, diligence, sensitivity, and empathy. And the drug companies do not pay the high bonuses for that, only for the prescriptions of prozac et al.
You can call this stupidity, or short-sightedness, or self-interest, or even corruption - or none of these depending on your point of view. I think I have at least made mine pretty clear: in all areas of medicine, people presenting with "mental" symptoms are the most poorly treated, undertreated and it is no surprise that many make no profound recovery despite taking the SSRIs for years. Some just experience blankness. This makes them no further trouble to the medical profession who can then write repeat prescriptions in the smug knowledge that they are "helping" the patient "manage" his symptoms. The quality of life that the patient experiences is not a priority in such thinking.
Reductionism sucks, bigtime.
14 Nov 2014, 10:52 am
