After being prodded by several people to update my journal, I'm going to update.
I will say that I had a very nice entry written last friday about alternative/complementary medicine that got deleted accidentally when my computer crashed, and I kind of lost steam after that so I haven't bothered.
Here's something else that I've been meaning to write about and haven't had a chance to yet though. The proliferation of psychiatric medications.
Ask any psychiatrist or researcher in the field of psychiatric disorders and they will spout out the facts for you - 10-14 million people will go on antidepressant medication at some point during their lives, approximately 1% of the total world populations at some point meets the clinical diagnosis for schizophrenia, and the prevalence of anxiety related disorders is steadily increasing (and diversifying, with phobia, post-traumatic stress disorder, generalized anxiety, obsessive-compulsive disorder, as well as newer definitions all existing within the general rubric of "anxiety.") I can think of several prominent reasons for this vast increase in both the number and the specificity of diagnosis for psychiatric disorders. The first being the development and widespread usage of medications with relatively minimal side effects that treat many of theses conditions. The second, which is highly related to the first (the widespread usage part), is the loss of stigmatization of being on a psychiatric medication. In fact, in some social circles it's become something of a badge of honor.
What I'm wondering about is whether this is a good thing. Likely, like all technological and sociological advancements, it has both good and bad aspects to it. So I'll address the good first, because I think they're more straightforward than the potentially bad ones. Far and away the positive results of these leaps in psychiatric medicine stem from the fact that people who are genuinely afflicted with this disorder (and it's not in people's heads, as was once thought, but actual biological problems just as real as a broken leg) are no longer ashamed or afraid to seek treatment, and that effective, relatively harmless treatments (with the exception of haloperidol and clozapine for schizophrenia) exist for these disorders. That advantage cannot be overstated, in prior times these people would often be confined to asylums, left off as crazy or eventually become suicidal.
However.... there's a bad side to everything. With the widespread acceptance of these drugs (most particularly SSRIs for depression, and now being touted as weight loss drugs, a way to stop smoking, "social anxiety disorder," and more or less anything that comes to mind) has convinced many general practitioners who are not especially skilled in the diagnosis of psychiatric disorders to simply prescribe these medications when the person doesn't have the illness. Reading the DSM IV descriptions of symptoms of psychiatric disorders can be intensely misleading, often things like trouble sleeping, inability to think about positive things, etc. can sound very plausible to both patients and untrained doctors. The key to the vast majority of these symptoms is that they have to persist over a long time without abating to constitute an illness. While everyone has ups and downs in their lives, most people do not suffer from a psychiatric disorder. But reading these symptoms can make it sound like they do - and prescribing psychiatric medication without proper cause is generally not a good idea, they can have profound efffects on mood that are not beneficial if the person isn't suffering from the illness that they or their doctor believe they are.
Another unintentional side effect of this sea change in the way psychiatric disorders are treated has been the conception that "everyone's a psychiatrist" now. In prior days if someone was especially fastidious about staying clean or keeping things organized they were described as "anal retentive" (another offshot of psychology, thank you Dr. Freud), or neurotic (a pseudo-psychiatric term with no real clinical definition.) Now people will say "Yeah, I'm totally OCD (obsessive-compulsive disorder)." The simple fact is that you probably do not have OCD. Nor are you qualified to make that diagnosis. But the way that clinical terms with strict definitions have crept into our common lexicon has altered the perception of their meaning. Have too much energy? It's not the 5 cups of coffee you drank, you now have "adult ADD." Shy and don't like to talk to girls? You have "social anxiety disorder." Prefer warm, sunny days to cold, winter nights? You have "seasonal affective disorder." Just ask your friends, they'll tell you.
Some of the examples I used may actually be real psychiatric conditions, and having your friends tell you that you're depressed can sometimes be a very good thing, as it can motivate you to seek treatment when you might not otherwise. But it can also have unintentional negative consequences. First off, if we believe that all of the problems in our lives can be explained away by glitches in neurochemistsry it discourages us from actively seeking solutions to those problems, and just medicating them away (even when we shoudln't be.) Second, pharmaceutical companies are well aware of these changes in perception, and have been actively marketing drugs for conditions that haven't even been acknowledged by the AMA as actual psychiatric disorders directly to consumers in the hopes that they'll then ask their GP for a prescription. This wastes money (and raises health insurance rates for everyone, conveniently funneling that cash to the pharmaceutical companies) and can have negative health consequences if someone takes a powerful psychiatric medication and do not have the condition that it was designed to treat. Finally, it can create uncomfortable positions where individuals are actually coerced into taking a psychiatric medication by other people who are not qualified to make that diagnosis (there has been a spat of school boards and school principals forcing disruptive students to take ritalin and other ADD medication even in the absence of a medical diagnosis.)
Psychiatric medications are often powerful drugs, and the consequences of their long term use is still mainly not known. When consulting with a trained psychiatric the decision to put someone on one is usually made by asking the question "Will this person's life dramatically benefit from being on this drug in such a way that the benefits will overshadow any potential detriments that come from its usage?" Most people are not qualified to answer that question.
I'm not writing this as an indictment of anyone using psychiatric medication, nor am I saying that those of you who are shouldn't be. The point is that I'm not qualified to make that statement either way, nor is really anyone except a trained medical professional. And I do think that it's a wonderful thing that we can finally treat psychiatric disorders as actual illnesses rather than people "not being willing to suck it up" the way it used to be. But it's important to appreciate the negative consequences of these medications as well.
I will say that I had a very nice entry written last friday about alternative/complementary medicine that got deleted accidentally when my computer crashed, and I kind of lost steam after that so I haven't bothered.
Here's something else that I've been meaning to write about and haven't had a chance to yet though. The proliferation of psychiatric medications.
Ask any psychiatrist or researcher in the field of psychiatric disorders and they will spout out the facts for you - 10-14 million people will go on antidepressant medication at some point during their lives, approximately 1% of the total world populations at some point meets the clinical diagnosis for schizophrenia, and the prevalence of anxiety related disorders is steadily increasing (and diversifying, with phobia, post-traumatic stress disorder, generalized anxiety, obsessive-compulsive disorder, as well as newer definitions all existing within the general rubric of "anxiety.") I can think of several prominent reasons for this vast increase in both the number and the specificity of diagnosis for psychiatric disorders. The first being the development and widespread usage of medications with relatively minimal side effects that treat many of theses conditions. The second, which is highly related to the first (the widespread usage part), is the loss of stigmatization of being on a psychiatric medication. In fact, in some social circles it's become something of a badge of honor.
What I'm wondering about is whether this is a good thing. Likely, like all technological and sociological advancements, it has both good and bad aspects to it. So I'll address the good first, because I think they're more straightforward than the potentially bad ones. Far and away the positive results of these leaps in psychiatric medicine stem from the fact that people who are genuinely afflicted with this disorder (and it's not in people's heads, as was once thought, but actual biological problems just as real as a broken leg) are no longer ashamed or afraid to seek treatment, and that effective, relatively harmless treatments (with the exception of haloperidol and clozapine for schizophrenia) exist for these disorders. That advantage cannot be overstated, in prior times these people would often be confined to asylums, left off as crazy or eventually become suicidal.
However.... there's a bad side to everything. With the widespread acceptance of these drugs (most particularly SSRIs for depression, and now being touted as weight loss drugs, a way to stop smoking, "social anxiety disorder," and more or less anything that comes to mind) has convinced many general practitioners who are not especially skilled in the diagnosis of psychiatric disorders to simply prescribe these medications when the person doesn't have the illness. Reading the DSM IV descriptions of symptoms of psychiatric disorders can be intensely misleading, often things like trouble sleeping, inability to think about positive things, etc. can sound very plausible to both patients and untrained doctors. The key to the vast majority of these symptoms is that they have to persist over a long time without abating to constitute an illness. While everyone has ups and downs in their lives, most people do not suffer from a psychiatric disorder. But reading these symptoms can make it sound like they do - and prescribing psychiatric medication without proper cause is generally not a good idea, they can have profound efffects on mood that are not beneficial if the person isn't suffering from the illness that they or their doctor believe they are.
Another unintentional side effect of this sea change in the way psychiatric disorders are treated has been the conception that "everyone's a psychiatrist" now. In prior days if someone was especially fastidious about staying clean or keeping things organized they were described as "anal retentive" (another offshot of psychology, thank you Dr. Freud), or neurotic (a pseudo-psychiatric term with no real clinical definition.) Now people will say "Yeah, I'm totally OCD (obsessive-compulsive disorder)." The simple fact is that you probably do not have OCD. Nor are you qualified to make that diagnosis. But the way that clinical terms with strict definitions have crept into our common lexicon has altered the perception of their meaning. Have too much energy? It's not the 5 cups of coffee you drank, you now have "adult ADD." Shy and don't like to talk to girls? You have "social anxiety disorder." Prefer warm, sunny days to cold, winter nights? You have "seasonal affective disorder." Just ask your friends, they'll tell you.
Some of the examples I used may actually be real psychiatric conditions, and having your friends tell you that you're depressed can sometimes be a very good thing, as it can motivate you to seek treatment when you might not otherwise. But it can also have unintentional negative consequences. First off, if we believe that all of the problems in our lives can be explained away by glitches in neurochemistsry it discourages us from actively seeking solutions to those problems, and just medicating them away (even when we shoudln't be.) Second, pharmaceutical companies are well aware of these changes in perception, and have been actively marketing drugs for conditions that haven't even been acknowledged by the AMA as actual psychiatric disorders directly to consumers in the hopes that they'll then ask their GP for a prescription. This wastes money (and raises health insurance rates for everyone, conveniently funneling that cash to the pharmaceutical companies) and can have negative health consequences if someone takes a powerful psychiatric medication and do not have the condition that it was designed to treat. Finally, it can create uncomfortable positions where individuals are actually coerced into taking a psychiatric medication by other people who are not qualified to make that diagnosis (there has been a spat of school boards and school principals forcing disruptive students to take ritalin and other ADD medication even in the absence of a medical diagnosis.)
Psychiatric medications are often powerful drugs, and the consequences of their long term use is still mainly not known. When consulting with a trained psychiatric the decision to put someone on one is usually made by asking the question "Will this person's life dramatically benefit from being on this drug in such a way that the benefits will overshadow any potential detriments that come from its usage?" Most people are not qualified to answer that question.
I'm not writing this as an indictment of anyone using psychiatric medication, nor am I saying that those of you who are shouldn't be. The point is that I'm not qualified to make that statement either way, nor is really anyone except a trained medical professional. And I do think that it's a wonderful thing that we can finally treat psychiatric disorders as actual illnesses rather than people "not being willing to suck it up" the way it used to be. But it's important to appreciate the negative consequences of these medications as well.
VIEW 25 of 54 COMMENTS
He was much too young and cool and smart for that
[Edited on Apr 22, 2005 9:48AM]