M. Scott Peck describes the problem and the solution Kong’s ago in his book “The Road Less Traveled.”
As more and more Americans become less and less willing to sacrifice or demonstrate self-discipline we can count on increasing levels of “mental illness.” Why earn positive feelings that come from hard work and success when you can just artificially create happiness with a pill - if only until you need another pill.
9
@John
Plenty of hard-working, ‘successful’ people suffer from depression.
52
@John
Likely said by someone who has never had a mental illness.
27
@John
Personally, I think M. Scott Peck was a creep. I don't recommend his books, I always got a feeling there of something being very wrong, though I can't put my finger on what. Perhaps the judgmental religious overtones.
17
So well said. As a psychotherapist this is my life’s work, along with my husband who is an integrative psychiatrist.
Please check out www.hopepsychiatry.com
And www.lamaida.org
8
Thank you Kelli. I believe you’re as balanced as the everyperson on this earth.
4
Two points to make-
1. Nobody but nobody understands what depression is. They understand what diabetis is. They do not understand what depression is, or any mental disorder. Any "specialist" "professional" etc who says they do-are lying. Period.
2. The more straightforward issues is access to mental health services-which is a societal issue. Any one in their half right mind who thinks a psychiatrist should get paid the same amount for treating a suicidal anorexic bipolar alcoholic -as someone prescribing synthroid for their thyroid should ..rethink their logic. No, treatment of mental health disorders still s not given the gravity it needs, deserves and merits. It is terrible and needs to be fixed. The current system is a travesty-the sickest of the sick have the fewest resources-because their is pathetically low payment for the difficulty of the task-which is not to give a pill, but to get someone better by any means necessary. Embarrassment to society and medicine.
13
Wow. You’re even more disillusioned with psychotherapy than I am!
My son was diagnosed with High Functioning Autism 4 years ago, and I was diagnosed shortly thereafter, at age 42. In retrospect I always knew I was different. Socially inept, clumsy, with an awkward gate and poor muscle tone: I had a passion for architecture that persists (it is now my career).
.
As a preteen and teenager I was sent to a bevy of psychologists, who ranged from useless to tremendously damaging. When I left for college I stopped seeing a therapist, because I didn’t think they’d help and didn’t trust them anyway. I stayed away for 26 years.
.
I’m seeing a therapist again now, but it wasn’t easy to find the right one. For years I saw a guy who swore by the “Nurtured heart” approach, which works for kids but can be poisonous for an adult’s marriage. (Mine is still hanging by a thread, thank God). After that I actually found myself having to explain what “stimming” is to a therapist who was trying to sell me her treatment for HFA. The same therapist couldn’t understand why it might be problematic for a principal in an architecture firm to leave the office every Thursday at 3 for treatment!
.
And then I read the things therapists write about us: “mind blind;”. Prone to “errors of thinking.” “Rigid.” It’s enough to make me want to scream - but I don’t, lest they diagnose me with something else they won’t treat!
13
Limiting treatment to prescribing a pill maximizes profits. No more need to individualize treatment other than determining which pill to give. Side-affects, including increased chance of suicide, are rarely discussed.
11
After 60+ years of bipolar mood swings, I no longer rely on the medical profession for help. I was prescribed every medication under the sun, beginning with lithium, which caused several incidents of sever colitis, but was never warned about that side-effect by my doctors. I quit taking it after my own research at the library. Next was Depakote which gave me such a loose stool, I was afraid to cough when I was out in public. Too many accidents. I tried at least 10 other meds that all had their own quirky side effects. My disorder manifested more as manic behavior and thoughts, with rare bouts of depression. I abused alcohol for years trying to self medicate. I now smoke cannabis when my thoughts are racing and it works fine for me.
16
Kelli - Have you researched the evolving field of the "gut-brain" connection and the impacts on mental health? In effect, an imbalance in your gut's microbiome can be a direct cause of depression and anxiety.
10
For me, so much would improve in both the mental health and physical health arenas if professionals would just practice saying these simple words: " I don't know what is going on. Let's see what we can figure out. It may take a while but we will keep working on it."
32
"Black-and-white narratives of psychopathology neglect the tremendous psychological impacts of social and material circumstance: access to the basics of survival; the burdens of intergenerational trauma and insufficient social support systems; the existential gut punch of pervasive injustice.
Given the author's argument, I would like to hear her explanations as to the reason that siblings are not equally affected.
I was raised in an affluent family .Not only did I have access to the basics of survival, but also to a beach club, private school,
international travel, an Ivy League education for which my father paid, and more. I have not suffered from pervasive injustice, nor have my two nephews and two first cousins who suffer from Clinical Depression and Panic Disorder as do I.
The depression and anxiety in my family is genetic, just as is the Lynch Syndrome that predisposes my family members to stomach cancers. Some of my family members have colon cancer, or have died of it Some suffer from depression and anxiety.
I had thought that people were more enlightened in 2019, while this Opinion Piece and may of the comments prove otherwise.
Some commenters have conveyed shocking ignorance, and the same blame the victim mentality that my parents espoused,
10
In all seriousness, in addition to whatever other mode(s) of treatment seems to help with one's clinical depression (and good on you if you have found such), I highly recommend including a calm, good-natured dog as part of one's regimen if circumstances permit. Mine is always happy to see me, doesn't require appointments, listens attentatively, keeps confidences, and doesn't judge. While he does not give advice or diagnose, his silent affirmation of unconditional loyalty is sometimes all that is needed in the moment. Hospitals don't use therapy dogs for no reason.
19
A lot of people suffer from allergies which produces poor physical results from hay fever to asthma, and even worse symptoms. Allowing dogs in confined locations with allergic people makes some happy and others to suffer significantly.
3
Understood. My wife is one of those who is allergic to many things, including pet dander. She loves the dog as much as I do. Fortunately for all of us, her regular allergy shots for the many allergens protects against pet dander, two.
4
In all seriousness, in addition to whatever other mode(s) of treatment seems to help with one's clinical depression (and good on you if you have found such), I highly recommend including a calm, good-natured dog as part of one's regimen if circumstances permit. Mine is always happy to see me, doesn't require appointments, listens attentatively, keeps confidences, and doesn't judge. While he does not give advice or diagnose, his silent affirmation of unconditional loyalty is sometimes all that is needed in the moment. Hospitals don't use therapy dogs for no reason.
4
Part of the problem has been, and will continue to be, the Diagnostic and Statistical Manual (initial release1952), the bible of psychological "disorders", which attaches a label (the diagnosis) to a cluster of reported and observed symptoms. It does not recommend any treatment regiment of psychotropic drugs. This is left to researchers and the pharmaceutical companies.
The unintended consequence of the DSM is that it introduces a barrier of implicit bias between many practitioners and patients, in which the patient is seen as their diagnosis and not as a unique individual human being.
Researchers find a "non-normal" pattern of neurochemicals in the brain, that pattern is attached to a diagnosis, and drugs are developed that "normalize" those patterns. (Do we dare ask if that pattern of neurochemicals is a resulting byproduct of an individual's mental and emotional state and not the cause?)
Such drugs then become an additive cause of the implicit bias in treatment. What is sitting in front of the practitioner is now a diagnosis with a "non-normal" pattern of neurochemicals that needs to be treated with drugs to normalize that pattern.
This implicit bias isn't characteristic of every practitioner, but it does represent the state of psychiatry today. It's much easier (and more lucrative) to treat diagnoses with drugs, than to do talk therapy with unique, individual human beings.
13
@DoctorJG
Correct. Think Ritalin. Opioids. They become epidemic because it's easy for practitioner and patient. And yes, it's often dehumanizing all around.
4
Drugs and/or therapy can certainly help depression tremendously, whatever the cause, but not enough attention is focused on exercise. I am not speaking for everyone, of course, but near-daily exercise can be as close to a cure-all as there is - so many benefits mentally and physically. It improves sleep, eating habits, mood, self-esteem, etc. Yes, exercise can be difficult but what's an hour of daily pain compared to improved well-being the remaining 23 hours of the day?
16
Excellent article. We are responsible to do all the things you mentioned at the end of the article to maintain mood stability. It has taken me a very long time to get here. But I'm not where I used to be. I thank God for that.
8
In the pre-Prozac era (before 1986) mental illness was thought to be due to childhood trauma, and was best treated by talk therapy. (Amazingly, psychiatrists and psychologists even thought schizophrenia had emotional causes and could be treated by psychotherapy. )
After SSRIs were introduced, doctors came to view mental illness as having mainly biochemical causes, and treatment switched to drugs. Reeeearch showed, however, that the combination of medication and some form of psychotherapy produced the best results. The problem is seeing a therapist for 45 minutes once or twice a week is far more expensive than paying for prescription. Hence low reimbursement rates from insurance, which the better therapists do not accept.
15
I really liked the movie "Girl Interrupted". It deals with borderline disorders that CAN be treated with therapy if the patients are willing. Others in the ward are cut off from reality.. Some will never be able to leave. Everyone gets some medication, and some get a full regimen of antipsychotic drugs. But a group of them support one another out of a need for friendship and often laugh at what their charts say each of them is "suffering from". Some feel embarrassment as well at the same time- how did they build this trap around themselves? Will they ever be free again?
Our society places unrealistic demands on us- be good all the time, smile, have a positive outlook, ignore the underlying problems in the workplace, don't rock the boat. You want your paycheck, and your vacation time. On returning, your desk is a mess and you just have to clean it up and move on. And these are the good paying jobs, the ones you're building up your IRA instead of buying a better car. Maybe we need to stop subjecting one another to stressful situations just to exert authority over them. It does not enhance productivity, it just produces sick calls, alcoholism, etc.
Some companies may practice tolerance and encouragement, but too many believe you won't get any work done if you don't push people around. You start to forget this is the only life you're going to get- don't let "them" ruin it for you. The world is still paradise, and some would steal that idea from your conscienceless.
7
@flyinointment
My management philosophy has always been that if you make your employees happy, they'll make your clients or customers happy. When I had managers who abused their authority I discussed it with them and asked them to change. Those who couldn't or wouldn't didn't last long.
5
Dear author, I have first hand knowledge of circumstances you find yourself in. My daughter was 13 yo when diagnosed with a form of bipolar that was resistant to every treatment mofality. What changed her life was transcranial magnetic stimulation. This non evasive treatment over the course of 1 year brought stability as well as joy into her life. She has been symptom free for 3 years. Please seek out more information.
9
Bipolar disorder and schizophrenia run in my family. I suffered for years under a variety of Freudian diagnoses, hospitalized for months, though endless years of talk therapy, before I even found out about my family’s secret history. By then I had four children. When I was told of a new diagnosis of Bipolar 2, I was thrilled. I had never had psychotic episodes, so I ‘didn’t qualify’ for a diagnosis of bipolar or for medications. Suddenly, I did. A combination of lithium (now Divalproac) and an anti-depressants have been a godsend for me. They literally saved my life and allowed me to blossom in my profession.
Now, two of my sons, both in their twenties, have been diagnosed, one with bipolar and one with schizophrenia. Both resist meds. My bipolar son is a talented artist (BFA from SAIC) who of course doesn’t want his creativity to be diminished. But at 30, he has no outside income. My son who is schizophrenic is a more difficult case. He is currently under court order to receive anti-psychotic meds and his money from his IT job is under conservatorship, after he was scammed out of $30K by a “friend.” He is dangerously psychotic and suicidal when off meds but certain he can “control” his disease without meds because God will direct him.
I don’t think articles like this properly address the struggles of families like mine. Romanticizing a life without meds endangers those whose lives could be in peril without them.
22
Thank you for sharing your account. I appreciate and admire your courage.
12
Thanking myself silently for saying no to all the pills, all the years, and for all the strength it took over my lifetime to say, no, just hold my hand for a minute, I won't do anything stupid.
It turns out I'm a bit of a genius, an over achiever, a writer, a leader. Someone who sees a little further, feels a little deeper, thinks about things a little differently.
Thanking the first country pharmacist in Bertram, Texas who looked at me quizzically when he filled that first prescription, saying, this is really very strong medicine...do you really need this? No, I didn't. Thank you for noticing. Into the trash.
Thanking myself for believing that there was surely a bottom to the abyss and the abysmal quality of life. There was....and once I found my footing about forty, I never looked back. Now my sensitivity hears the birds and coaxes marvelous flowers out of my garden, I write, I play music, I teach. I enjoy. I'm apt not to notice when others love me, which may have always been the mote in my eye. I have my own chemicals, thank you. My brain is full.
9
Congratulations! I had a similar road to yours. More people should say "no" to these powerful, mind and emotion numbing, drugs. Helpful support in the form of counseling, diet, naturopathic therapies and above all, time, should be provided. One often needs time to heal and work out one's place in the world.
7
I recently switched to a new primary care doctor and for every thing, her diatribe was: take this or that pill.
I call it the "we've got a pill for that" like "we've got an app for that."
I do not have mental health issues, fortunately, and I do not disparage anyone who truly finds relief in this way, but honestly we must consider the fact that America is really being blindly led by Big Pharma. And once you take these drugs, there's often no going back.
I think we, as a detached modern people, are suffering more from a spiritual void and hopelessness (more so since this President) and the healing has to start there,
5
It's hard to know the norm in mental health. Up until modern times, probably before Freud, we were all battling with emotional, mental problems, but who dubbed them so?
It was just society- at- large. Sick monarchs, sick peasants,
sick folk, a view of society in the Middle Ages, and before.
Trauma is a part of life, starting with birth, a terrific trauma.
A fetus nestles in a perfect Eden, without worry about food,
healthcare, funds, all of our worries. And, then...boom, birth. From there on in, it gets worse. I suppose, how we deal with our traumas determines our future.
A lot of society self-medicates with opioids, alcohol, food, or other methods of emotional relief. My friend talks to Jesus and he gives her advice. I've wondered, what differentiates her from a schizophrenic. Perhaps, she's harmless because she's only involved in making a better life for herself. Maybe some day, those murders, abusers, dictators (I have several in mind), will be found to be sick, rather than simply evil. It hard to define how people resolve their issues, and if it's people in high places, even more difficult. Could greed be an illness?
6
The author is fortunate to have been born into the era of psychopharmaceuticals. My father was diagnosed as profoundly paranoid schizophrenic in his early twenties and spent most of the 1940s and1950s in the psychiatric ward of a Veterans Administration Hospital in Palo Alto, California.
He was fortunate that the Palo Alto facility was considered, at the time, one of the most advanced psychiatric treatment centers. Its staff help pioneered the “Double Bind Theory” of mental illness. But talk therapy produced no cure or even semblance of a cure.
My father was released from the hospital when the first antipsychotics were release. They did not provide a cure either, but permitted his to live a life that led him to a paupers’ grave on Hart Island, the “Potters Field” of New York City.
3
28 years of Prozac here. I am going to Jamaica in two weeks for 3 psilocybin sessions. 66 years old, and still hoping.
7
Kelli- good for you. Maybe you could write a book called “ Diagnosis: Human. “ Chemical Imbalance” is nothing more than a Big Pharma marketing term, happily adopted by many shallow psychiatrists. While the SSRI/ SNRI classes of anti- depressants are helpful for some, they can also cause a minority of others to commit suicide/ homicide. There is ( after much family pressure) an FDA warning on the label for this, but it has a false age ceiling. Such urges can happen to anyone of any age who takes these drugs.
10
Problematic with effective treatment of mental illness is that Big Pharma wants the sufferer to consume an expensive patented molecule. Regardless of whether that lucrative substance is at all efficacious in allaying the symptoms of suffering. Then we have the massive uptick in teachers' diagnoses of their students with ADHD, often merely a consequence of the instructors' total inability to teach. So those unfortunate minors whose parents are bullied into making their kids gobble down another mess of Big Pharma pills become a valuable market that these pigs have captured. Instead we should hope that many more people will resort to self-medication with cannabis whenever so afflicted and leave Big Pharma yelling for all those customers to come back...
8
"A new book by the Harvard Medical historian Anne Harrington, “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness,” argues that the “tunnel vision” of modern psychiatry, with its fixation on wiring and fixed diagnoses, cannot adequately address what has yet to be understood about the human psyche."
4
Robert Whitaker's book on this subject are also excellent.
1
Bravo, well stated!
1
I live with depression and anxiety. I have found that I need a mixture of modalities: talk therapy (but not Cognitive Behaviour Therapy, which is too goal-oriented), a minimum of drugs and the patience to discover which one works, massage therapy, journaling , and nurturing my creative side. All that said, one of the advantages of being a senior is that things often cost a little less; all these therapies I pay for out of pocket, as they aren't covered under our health care system or by my private insurance. I see a psychologist, not a psychiatrist, and my private insurance doesn't cover pre-existing conditions. For people who have fewer resources than I have, our health care systems (US and Canada) fall very short. It shouldn't ever be the case that people who can't afford the care don't get it!
6
Congratulations on your progress and sharing this. I have often thought as you have expressed here, that is that mental health is often depicted as simply a matter of chemical balance. But it seems clear that human beings are dynamic biological systems, with sensory inputs, responses, feedback loops and the like. I have lost one sister to a failure for solutions. She needed antipsychotics to bring her into a functional state, but she resisted these for reasons I could not understand. So she instead used nicotine, pain killers, and mostly alcohol, eventually dying in a state-supported facility. I have another sister who has acute crises that end up in the hospital. Post-crises, she is in constant search of peace with psychiatrists, psychologists, yoga, diet, meditation. I have one daughter who manages OCD with drugs and otherwise tries to manage her mental health as best she can. I have another daughter who is bipolar but refuses pill treatment, somehow able to with stand extreme highs and lows every month, but often seeming suicidal.
I mention these because I believe many people are like me, blessed with none of these maladies, generally cheerful and even-keeled. I can only imagine the experiences for those suffering. We need to hear your stories to bring awareness so that there are more better outcomes like yours.
5
There's hope. Bloodletting only lasted a thousand years.
9
The VAST majority of (modern day) psychiatrists are nothing more than psycho-pharmacologists. Unless, of course, you have MORE THAN $500 for what amounts to about 45 minutes of a shallow chat.
5
Whenever I hear the injunction to 'maintain', the first place I go to is my initiation into an infantry platoon in Vietnam over 50 years ago. That's what my squad leader told me as we jumped on helicopters for my first combat assault. It's an empty phrase that means nothing in an inner or outer world of shear terror and madness.
As a very wise woman told me years later: you're either rising or falling, to just 'maintain' is a lie you tell yourself...
The mindset to 'maintain' if carried on long enough is just a mental construct that leads to just another blind alley.
3
Please read Maggie Astor's interview today in the Times with Marianne Williamson where she discusses these exact issues.
2
I can't help but wonder if the author ever received Informed Consent and info about the FDA Black Box warning on all SSRIs when she was prescribed these drugs in her teens.
Pharmaceutical products marketed as "antidepressants" carry the most critical FDA Black Box warning for 25 and under stating they can cause suicidal thoughts, suicidal actions and suicide. The reason for these critical risks isn't because a teen might be depressed. Rather, it is called akathisia, a prescription drug-induced disorder.
Akathisia was experienced by healthy volunteers in the drug companies own SSRI clinical trials. It was miscoded by drug companies as "something else" to more easily pass FDA approval and keep the word, "akathisia," out of the public eye.
Akathisia is frequently missed or misdiagnosed by psychiatrists who falsely attribute symptoms to some DSM label/disorder. Some people who experience akathisia are falsely told their symptoms are signs of a DSM label/disorder. When the offending toxin is wrongly increased it can and often does lead to tragic outcomes. This happened to my teen who wasn't "depressed," yet prescribed Zoloft for "OCD-like symptoms." After death blood tests showed Natalie couldn't metabolize the toxin as fast as it was increasingly prescribed.
To learn more about akathisia, see RxISK.org and missd.co. Take the free, accredited, 1-hour Akathisia 101 course at missd.learnupon.com.
4
@Kristina Akathisia happened to me. My psychiatrists (I had four different ones over the years) could not or would not discern that it was the cause of my ongoing problems. I do not know if they were stupid or sinister. Either way, they made a lot of money from my suffering. I am now one year off all of their drugs and the chronic akathisia continues. It is a living hell.
My family doctor is working with me now. He has gone through antidepressant withdrawal with a few other patients. (Yes, antidepressants are addictive. Withdrawal will occur.) He says the only answer is time. I hold on day by day -- still. Drug companies call withdrawal "discontinuation syndrome" and say it lasts two weeks. They say that because that is how long their studies lasted. It is a lie. Many people cannot stop their antidepressants and stay on them to avoid the pain of withdrawal, I've read.
Why did I see a psychiatrist? Sexual abuse by a grandfather, family who kept toxic secrets, children who were disposable, narcissistic parents who were themselves abused, and finally, a chronic physical pain condition. In other words, my anguish was situational and pathologized into a disease: major depression. Then, I was drugged by doctors. What causes akathisia: prescribed drugs.
Imagine. I thought I was lucky because I had insurance and could get "good" medical care.
5
Bravo, well said!
1
I tried therapy in the 90's. It was pretty useless. A lot of that is because I did not remember the events that left me with the constant mental discomfort and emotional reactions to the world that made little sense.
A little over ten years ago the events that ended up causing me to remember were still very painfully confusing and terrifying. I went to a Psychiatrist and explained to him that I feared I had become unmoored from reality and described what had been going on. He immediately told me that I was fine, and that those people (who had legal authority to do me harm) were intentionally doing what they were doing to manipulate me because I was asking to many questions. The relief I felt made me not notice that he then proceeded to manipulate me with fear as well into not filing a complaint about them because of their legal authority.
My point is that an awful lot of what we are told and taught is mental illness is really just reactions to lacking knowledge about how things work and what people are doing.
3
For 4 years, I told my HIV doctor that something was terribly wrong. Severe memory loss, waking up in a puddle of urine and a bit tongue, being found passed out on the floor, etc. I was convinced I had AIDS dementia. For 4 years he dismissed my concerns and finally told me in tears to go see a shrink.
Soon thereafter, my roommate called ETMs to the house twice in one day and got video of me having a grand-mal seizure. When I gained consciousness he handed me the camera and said, "See if your doctor will listen to you now".
Well, he sent me to a neurologist who did a short EEG and told me not to come back until I saw a shrink. I went to him and first thing he said was, "I don't know why they sent you to me, you need an anti-convulsant".
I switched doctors/hospitals and while the next neurologist was trying to figure things out, a lady at the coffee shop where I hung out at told my friends one day that I was bi-polar. She was a therapist and had epilepsy and therefore knew her stuff, she said.
Well, countless catscans, 3-day EEG studies, MRI's, etc., revealed that I was born with a hole in my head and 4 twisted neurons - severe frontal lobe epilepsy. The new neurologist told me that my kind of epilepsy is commonly misdiagnosed as a mental illness.
My diabetic neighbor has the same kind of partial-complex seizures that I do. The neighbors think he is crazy.
If a therapist talks to you for 30 minutes and says you are bi-polar, get another opinion.
7
Since I don’t want to swallow weird chemicals or have some person with a degree in pseudo-science attempt to manipulate me verbally, I’ll stick to my cannabis, thank you.
3
One increasingly acceptable and proven useful tool in the box, psychedelics, can be very helpful. Their mechanisms of action are different but their success rates are on a par with SSRIs and are in some ways they're better. Article (I wrote) about them here,
https://themoderatevoice.com/making-the-sick-healthy-and-the-healthy-even-better-psychedelic-therapy/
2
Psychological may come from faulty brain wiring, or it could come from traumatic experience. OR it could come from a hormonal imbalance. People often forget this third possibility.
4
She's so right. I remember when Psychiatrists acually did something. Now it's just a 15 minute "how are you feeling here's your refills" waste of time...
2
Frequently, biochemistry/genetics loads the gun, awaiting trauma to pull the trigger.
8
Anti-depressant definition: A pill that makes you capable of being able to stand being unhappy. I've been on Zoloft since it came out. It is a good stable floor for me so i no longer get seriously suicidal, but happy.......nah. Stable, like the almost living dead. Yeah. Better than anything out there now. I guess. There are hopeful experiments going on for depression and chronic pain that are already helping thousands, under the radar. See Micro-dosing for depression. Something big pharma hasn't told you is how frighteningly addictive these med's are. Don't believe me? I went full psycho coming off Cymbalta. Still on a low dose to stop the nightmare, for real of withdrawal. Good luck to all of us.
1
Excellent, thank you.
1
How ironic to see this run next to the Times attack on Marianne Williamson. Williamson may not be a professional psychiatrist but she certainly expresses well the doubts of many.
2
Perhaps the discussion of causes and solutions to mental illness will open up even further because a mentally ill person is now in the White House.
4
Good for you. Glad you're doing better.
1
A vigorous system of mental healthcare is the #1-- Number One--need in the U.S. today. The madness of the President is the clearest example of my assertion--did you see his tweets today, attacking Rep. Elijah Cummings? What sort of NUT publicly spews such hate towards professional colleagues without ever privately having attempted to negotiate a civil, working relationship? And what sort of indecent if not utterly insane people, toxically selfish & self centered, support such a man as Leader of the Free World?
Growing up, both my parents were mentally ill. I struggled mightily as I was emotionally & sexually abused. Ironically, my mother had spent 2 years in daily psychoanalysis at the NY Psychoanalytic Institute, suffering without medication, as it was believed mental illness was all in the mind. She was emotionally devastated by abrupt termination, when the student who had been studying her achieved his PhD and left. The Institute offered no further support.
I've taken medication since age 19, but it wasn't til age 39, when a student-psychiatrist agreed to prescribe my independently designed pharmaceutical cocktail, that I achieved remission from manic depression. In the years between 19 & 39, I pursued a wide variety of therapies, from classic one-on-one, to various sorts of groups including 12th Step, to adventure travel (desert Vision Quest), religious retreats, & so on.
My best advice, now in my 50s: EXPLORE what's out there & discover what remedies work FOR YOU.
5
"To be sure, many people need medication, and greatly benefit from it." - is just not true, these "medicine" are proven (LD50 tests) poisons. See for example prozac (fluoxetine) https://pubchem.ncbi.nlm.nih.gov/compound/Fluoxetine . These treatements should be read as a torture crime instead of a cure.
2
Always keep in mind that pharmaceutical companies are driven by the profit motive. Drugs that are designed and studied for usage over a few weeks are often prescribed for years or even a lifetime. Many (or most) drugs that impact mood, anxiety and pain have a withdrawal syndrome and many are addictive. The combinations of dependence, addiction, off label usage, and overprescribing mean billions in profit for drug makers.
In the past we could rely of the FDA, the legal system, and our political system to protect the consumer. NO LONGER TRUE!
I am an insider that has seen the corruption of this part of our medical system 1st hand.
Yes there are great options for some people with both emotional and physical pain. But do not expect safeguards for the consumer.
The most powerful lobby in Washington D.C. is the drug lobby.
4
Colorado is the home of mass killers, almost all were white, males, adolescent, or early twenties, and all had had contact with the mental health profession. John Hickely shot but did not kill President Reagan. He was under the care of a Colorado psyscharist at the time. J.Roll
2
Congratulations to Ms. Korducki for having the wisdom and courage to look past the pseudo-scientific/materialist presuppositions of contemporary psychiatry.
David Burns, one of the members of the research team that came up with the idea of a "chemical imbalance" in the early 1970s, has repeatedly written that the members repudiated this idea by the late 1970s. I'll leave it to the reader to guess why this zombie idea continues to get refuted and then resuscitated.
I personally got so tired of having to explain to patients (I administer psychological evaluations) why it is essential to seriously consider treatment options beyond pills that I added a separate section to my reports to explain why this is so important.
The explanation is here: https://beyondthematrixnow.wordpress.com/framework-for-recommendations/
And a brief overview of the fundamentals of treatment, based on nearly a half-century of study of the research, is here: https://beyondthematrixnow.wordpress.com/the-essence-of-well-being/
www.remember-to-breathe.org
3
The truth is that it doesn't matter how experts or consumers view mental health in this country. We should dispense with this sense of agency that suggests empowerment over our health care decisions; it's not true. What dictates mental health care in the USA, when all is said and done, is either a.) profit or, it's dark-mirror twin, b.) mitigating expenses.
The mountains of evidence are - talk therapy is an effective tool to diagnose, treat, and improve the quality of life not only of those suffering from mental health difficulties but those seeking to improve their lived-life and make sense of our chaotic lives. *It's quite popular, what has become cliche, to advocate 'the best results are a combination of medication+talk therapy' but that is not as simple an answer as the for-profit corporations and the medical establishment would like us to assume. **I'm not 'anti-medication' it can be a useful adjunctive tool.
Carl Rogers and Abraham Maslow, with prescient clarity, cautioned 55-65+ years ago that therapy required constant advocacy via research. What they didn't foresee was the absolute jack-boot oppression of care if suffering could not be profited from. 50 minutes of 'talk therapy' or a psychiatrist engaged in 'med checks' that, literally, are billed in 10 minute segments...that includes the time to walk down the hall, greetings, walking back to ones office, and saying 'hello, how are you?'. Umm, cattle?
The lie of free-market HC is our collective mental illness.
2
America to its citizens: We don't care about your suffering. None of you.
1
Impossible though it is to enter the mind of this author, you do have to ask: isn't consciousness, inescapable even in sleep, a kind of misery?
You know, like, the intolerable shirt of flame, which human power can't remove?
It's no secret that we all of us live in a universe of imponderable miracles and beauty, natural and humanly achieved, but only idiots and fools are happy.
Even dogs, whose every need is catered to, are miserable or bored much of the time.
Why expect otherwise for us?
1
@ jrd
“Even dogs, whose every need is catered to, are miserable and bored much of the time.”
Once they are fed properly and are free of medical problems, dogs are miserable and bored only when their need for affiliative social connection, mental activity, and exercise are NOT met. All dogs have greater cognitive potential than most people realize (consider, e.g., Chaser, who died very recently).
As a beneficiary of excellent care from both therapists and psychiatrists, I think the same is generally true for people, too.
2
Well said!
1
If our brains were simple enough to understand, we’d be too dumb to understand them.
4
A few members of my family have dealt with mental illness while black African American on the South Side of Chicago for a few generatons.
And they were and are callously, cruelly and cynically batted and bounced between medication and incarceration.
4
I’m glad you feel like you belong to the world.
2
Death of our mental health system, destruction of unions, trickle-up economics that destroyed our middle class, government corruption, explosion of the federal debt, gross proliferation of the MIC…
Is there any societal ill that can't be traced to (R)onald (R)eagan?
1
"I feel, for the first time, like a person who belongs to the world." Kelli thanks for sharing your perspective. You do belong to the world.
3
Scientifically, there is very little evidence for genetics or biology as a causal source of mental illness. Recently even, the twin studies that seemed to show a powerful concordance for schizophrenia have had their methodology disputed. Correlation isn't causality. And anecdotes do not equal data.
Of course we can assume biological underpinnings to every aspect of human nature. And anyone who grew up in the 60s knows that drugs have powerful effects. The nature/nurture arguments tend to organize themselves not just anecdotally but ideologically.
Frankly I prefer to live in a world where the struggles of living are best taken care of by human relationships, perhaps the specialized human relationship that is psychotherapy. For some, drugs may work very well (although recent scientific evidence suggests that psychotherapy offers benefits longer lasting than medicine), and quickly reducing manifest emotional pain has its benefits. But there is no insight, no self discovery, no emotional learning, no personal progress, when the pains of life as manifest in emotional and psychological struggles are relieved, when indeed they are relieved, by medicine alone.
3
America does not have a health system let alone a mental health care system. Insurers like the "all in your brain and medication can fix it" approach because it is cost effective, eg. cheaper than psychotherapy which requires more than a 15"minute session to renew the pts. medication. Psychiatrists get paid more for their 15" consultation than a social worker or counselor gets for a 50 to 60 " minute psychotherapy session. That's why psychiatrists don't do therapy anymore. Does this have anything do with the fact that most counseling/therapy is conducted by women?
2
@jessie
What would America’s ideal health system and mental health system look like in your mind? Would it resemble the medical services of the US Department of Defense? Would it look like the US Veterans’ Affairs Department? Would it be entrepreneurial with practitioners paid exclusively by patients? Would it resemble one of several health systems of other nations?
Suffered first bout of major depression 3 years ago when husband suddenly left. I did all the right things but resisted the Prozac prescription. Slowly and slowly I started to heal. Sloooowly. Then I discovered microdosing psilocybin. It’s been about 6 months and my entire mental outlook has been altered positively. Seems the bad juju got pruned out, and I am even close now to forgiving my ex, and what a relief THAT is. It’s definitely NOT for everyone - it requires a solid education before trying and some people do have very adverse effects. My point is that There are more options to treat depression available outside the mainstream as well.
2
As a beneficiary of both talk therapy and medication prescribed by a psychiatrist, I believe a combination of the two works best. However, I recently discovered the SSRI I’ve been taking for about 4-5 months comes with some rather disturbing side effects. While two readily known primary SSRI side effects are weight gain and sexual dysfunction, it is not discussed that the sexual dysfunction especially, almost always has some degree of lasting impact. The effects while on the medication varies among individuals (loss of libido, various functionality), but the startling thing for me was to discover that these side effects almost never go completely away and sometimes linger for months and even years! I was aware of the potential side effects. The thing I was not made aware of is that they often continue AFTER use of the medication has stopped (PSSD). This is critical information a prospective patient must have PRIOR to beginning the medication to do an appropriate risk/benefit analysis. Once the SSRI use has begun, it does not take long in some folks for the side effects to manifest, potentially irreversibly. Reputable medical research is still ongoing and limited, but there’s much online and it contains some very despondent individuals whose sex lives have been forever altered with no known way to successfully reverse those effects. One of the reasons is doctor awareness/understanding, plus the difficulty of doctor-patient sexuality discussions. Be informed upfront!
3
I find all this talk about the ineffectiveness of antidepressants kind of depressing. From this author, who does eventually acknowledge at the very end of her piece that medication has helped her, to Marianne Williamson, the candidate for the Democratic nomination for president, the over-prescription of antidepressants has become the topic du jour.
As far as I know, no legitimate specialist advises taking antidepressants without also using talk therapy to help one understand and cope with the illness. I, for one, know I need both. Talk therapy without medication does not help me cope, just as medication without the therapy does not help me deal with days of paralyzing depression.
The author's last paragraph in this piece should have been her first.
3
For decades I blamed my depression, which descended upon me at 10, on character flaws. Then I discovered Prozac and learned --hallelujah -- that it wasn't my fault. Now, Prozac free, I watch my diet, get daily aerobic exercise, spend time alone reading, and quality time with others, keep a gratitude journal, and avoid toxic people. And guess what, in tandem, they work perfectly. I once asked my therapist, "does everyone have to work so hard to be happy?", to which she replied, "I don't know, I just do all those things, too".
6
It's a common misperception that psychiatrists "do talk therapy". That's actually more the purview of psychologists than psychiatrists specifically because psychologists cannot prescribe medication. A psychiatrist certainly can engage in talk therapy but that's not what the bulk of their training is.
2
Talk therapy used to be the purview of psychiatrists and was certainly part of their training. The shift in responsibility is a result of insurance coverage that doesn’t pay for talk therapy AKA cognitive services. This has relegated psychiatrists to the role of a prescription pad. Counselors now predominantly provide talk therapy, a service typically not covered by insurance. Follow the money (reimbursement) that is what is driving our model of mental health care in the U.S. and the focus on medication.
4
I come from a family which on my father’s side you can trace clinical depression and alcoholism for generations. Several men committed suicide. No one could look at that history and say depression is not caused by some chemical imbalance and that it’s inheritable, though in my family it’s impossible to predict who will inherit the bad genes. However, the unlucky ones who are alcoholics and commit suicide are all men.
However, the depression is suppressed by the usual things that lift people’s spirits: a good job, Happy marriage, lots of friends, etc. These are all harder to achieve when saddled with depression and, in some cases, alcoholism.
Drugs are not much help. They work when things are going well and you’re not very depressed, but not when you’re extremely depressed. I would like to try some of the non-drug therapies, which are being developed, but none of them are available to the vast number who could benefit from them yet.
2
Thank-you for an enlightening and well-written article. Being born into a family of schizophrenia, bipolar disease and alcoholism, I’ve had my share of “treatments” and of seeing others go through them. It takes a lot of perseverance, self-reflection and hope to navigate one’s way to health, and more to maintain it, such as you state. Building healthy connections to others without having had childhood role models or after trauma occurs in one’s young life is indeed a life-long learning process of developing trust. Just don’t give up trying. Many unexpected and supportive people, both professionals and non-professionals, can be found to help one along one’s way. Thank-you for sharing your journey.
2
As long as psychiatrists can make much more money prescribing pills than doing "talk" therapy most individuals with mental problems will have to either see a "counselor" (i.e., psychologist, marriage and family counselor, etc.) or forego talk therapy.
3
Psychiatrists are to be respected and are supported by the law in New Zealand. They are accountable for their diagnoses and their prescriptions. They can force their diagnoses and proposed treatment on individuals. I respect them and no longer dare to argue with them unless I intuit that it brings benefit. I think most mental illness is caused through social relations. Some of my other comment which may be read as disrespectful is to be avoided.
1
It's the anomonie of modern life;
No one really talks to anyone, we tweet or text (briefly) about surface things. Workers are pitted against each other, or so rushed there is NO opportunity to socialize (Think Amazon Fulfillment warehouse). Young people expect someone else to organize "something" for them, like their Youth Soccer and play dates. They really don't grasp the requirement to self organize, and that not every recreational activity will have winners and losers and participant medals for everyone.
2
My 48 year old daughter is beautiful and intelligent. Unfortunately she cannot hold a job, she cannot take care of herself and her 8 year old daughter on her own. They live with me and are thoroughly dependent on me not only for a home and food but for every day functioning. And guess what? My daughter screams at me several times a day insisting that she can’t wait to get out of this horrible house. My daughter has been in therapy and on medication for most of her life. She can’t pay for basic services for her daughter such as the after school program she needs that I pay for. .. my daughter gets worse every day and there’s no relief in sight. Yes there are programs that might help her but according to my daughter she is fine thank you very much.
4
It will be an interesting development, I believe, when we can de-criminalize marijuana so that we may actually conduct research studies to find out it's potential benefits (or not). As a menopausal woman recovering from back surgery I have found that it not only helps with my pain, (along with other medications prescribed by the surgeon that I am trying to use less and less of because of their addictive qualities) but it has helped tremendously with dealing with the depression accompanied by my current situation. I understand that it is considered a drug, but you have to admit that it is more natural than Hydrocodone or Prozac. Making the transition from the opioids necessary for the post-surgery pain to just the marijuana will be a major relief to me, but I wish our medical community had more access to marijuana so we had a deeper understanding of its potential benefits and downfalls. I don't think the pharma industry wants that to happen though.
2
Internalizing diagnoses may create identification with your psychiatrist. I do not like others imposing a framework on me when another I prefer. To argue with psychiatrists educated to apply when diagnosing only a materialist world where there is no morality might be to endanger one's mind's well-being, as they have their community to draw on and support assumptions.
2
I shall explain. I have in the distant past had one-sided arguments with psychiatrists who did not seem to understand what I meant by suggesting morality is important. I was just listened to and then prescribed medication. I these days tend to have good, engaging conversations with psychiatrists if I ever meet them – because their needs and desire I consider. Psychiatrists, I believe, may sometimes look down on patients as if sick.
2
A rewrite of my comment above I require.
Internalizing diagnoses may create identification with your psychiatrist. I do not like others imposing a framework on me when another I prefer. To argue with a psychiatrist may involve attempting to do just that. I think some psychiatrists apply a chemical-materialist framework (where there are no moral factors taken, explicitly, into consideration). It may endanger a mind's well-being for someone lower in society to contradict a respected doctor, which might seem conceited; a doctor is often well educated and may possess a wealth of knowledge acquired from studies and observation, as well as the support of his or her professional community.
1
It is hard to avoid generalizing in order to understood others. Insight is required, and perhaps gentle persuasion, dialogue, occasional silence, the pretence nothing is wrong.
This is a powerful personal commentary -- with an emphasis on the need for engaging people as individuals. Psychiatrists have largely devolved to a level as Rx writers, consigning patients to counselors, as the writer says, if they want more than pills. And pill are indeed precisely what many people find critically important to their well-being. But one-size-fits all is not a final answer.
It is the individual person and their unique situation that should be the focus. And that takes time and insight. Thanks to Ms Korducki for such an honest and direct approach to a complex matter -- we all want to be treated as individual persons, and whether medication is required to live decently or not, we deserve to be seen as distinct and unique.
2
Mental Illnesses have a great many connections to early childhood, and developmental traumas which are registered in the right brain as ideas about reality and the self.
This became patently obvious when I began working with foster youth... a very traumatized population with a lot of mental illness.
Things learned implicitly from 0-3 become wallpaper in our minds, they are not cognitions but instinctive thoughts. They are hard to challenge or even see. Often, they become self fulfilling prophesies. Depression and anxiety can have their source in preverbal, unremembered experiences in early life which are emblazoned on the right brain.
4
As a psychologist, I can offer observations on an essential mechanism by which our desire for simple answers is codified into both research and practice. Very few people are aware, but a paragraph in every publication of the DSM cautions readers that it is not to be used as a means for understanding mental illness. It was and is designed only to provide common descriptive language for research and practice so that, when mental health professionals communicate with one another, at least we know we are referring to the same thing. It has been all too easy to decide then that all those diagnosed with, "Major Depression," are conveniently experiencing the same standardized problem for the same reason and should be treated in the same standardized way.
Successful studies, which generate publications, funding, and tenure, thrive on standardization. This is, at least one likely mechanism for the bias being discussed here. For a more complete and thoughtful discussion of The problem, I would turn to professor Jonathan Shedler's work- from which the above thoughts are paraphrased. He just published an article on the Psychology Today website that is very worth reading
https://urldefense.proofpoint.com/v2/url?u=https-3A__www.psychologytoday.com_us_blog_psychologically-2Dminded_201907_psychiatric-2Ddiagnosis-2Dis-2Dnot-2Ddisease&d=DwMFaQ&c=slrrB7dE8n7gBJbeO0g-IQ&r=1YK7cTeazYH01hLDRocuXg&m=5zFayJCFnXYXCnzYdFyQiZ9kSzP9CUnODifV3b6iE3M&s=Af6KesfslwSVtstJ2_HErJOliEN_bIj4rbu1cfotSl8&e=
2
Try acupuncture It works for most people, whatever the origin of the depression.
1
Many doctors and patients seem to forget or be unaware that there are several microorganisms, such as borrelia, babesia and bartonella, that can cause symptoms of depression, anxiety, panic, anger and anorexia.
4
Not a bad argument, but don't think that this is lost on many of those who practice medicine. I'm a current medical student, and they teach us that when it comes to treating depression, therapy and antidepressants have been shown to be about equally effective on average (and the combination more effective). Of course, since doctors aren't paid to spend a large amount of time with patients, and patients often want a 'quick fix', physicians usually write a prescription. Psychiatrists refer out their therapy; primary care doctors often don't even mention it. It's also worth noting that while your points probably apply pretty well to depression and anxiety, those with psychotic or manic disorders (e.g. schizophrenia, bipolar I) benefit from psychosocial interventions as well, but strong evidence suggests that they require lifelong therapy with medications to prevent dangerous, recurrent episodes of psychosis/mania.
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Biopsychosocial. That's the etiology and the path to a possible solution. Unfortunately I had to say possible.
4
you are right on regarding the FACE TIME with physicians!
these days most physicians are the employees of venture capitalists and are forced to works as assembly line workers.
All the talks about mal practice relief,student loan($300,000)relief that could free up doctors has been and is talk!!!
Research spending is being cut and we are basically at the mercy of pharmaceutical companies.
Hopefully senator Warren could offer a PLAN!
6
I'm really heartened to see that there's more nuanced conversation about the causes of mental illness. The author concludes that she's "come to think of my mental health as a reflection of the complex ebbs and flows of life." This is in line with the premise in Johann Hari's book, Lost Connections, a terrific read for anyone close to the subject of mental illness. Hari posits that many people who live with mental illness are showing a natural response to a life that has become very, very difficult. He identifies 7 "lost connections" that can lead to mental illness; loss of connection with other people, with meaningful work, with respect, with a larger community, with childhood trauma (not dealt with), with nature, with hope for the future. Our world is making all of these connections more tenuous, but hopefully mental health professionals are recognizing that the answer is not simply a pill.
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"I quake with anger at the wholesale failure of mental health care in America — a rigid and restrictive system that leaves even the reasonably privileged, like me, with little to work with, and so many others with nothing"
I will show this article to my sister whose daughter almost killed her in the throes of her mental illness.
My sister fought very long and hard to get help for her daughter --there was NONE.
7
I had a doctor refuse my request for medication for my unhappiness reasoning that I was not the one who needed medication. Indeed, he was right. On the other hand, I responded, crazy makers persist and they are not called crazy makers for nothing. I got the medication which took the top off my mountain of emotion, learned to objectively assess the behavior of others and did not need it any more. My pattern of response changed with the help of the medication. Best wishes to all who have even one person who means you emotional harm in your life and know that even though it is not you sometimes the medicine helps you gain the objectivity to help find your way to peace.
9
Good column. I’ve been vulnerable to depression all my life. Looking around at the world we live in, and our society so ruthlessly destroying it, we all have good reason to sit down and weep. I do also find depression to be constitutional, in that I see that many of my friends just don’t get all dark and immobilized the way I do, and I’ve numerous times used antidepressants for temporary respite. But all drugs have side effects, and for me they became intolerable. I have learned to manage my depression with exercise, diet, friendships, socially useful work and a lot of time outdoors. (Yes, a lot of these take some luck and money.) For those in my boat, here’s one of my most useful discoveries: stay away from inflammatory foods. Sugar, white flour, alcohol. Entirely. Life-changing.
6
There are some us, psychiatrists, who spend time with patients, with follow up appointments of 30 minutes, who suggests therapists as collaborators, and who view suffering not simply as a neurochemical imbalance, but explore family of origin and sleep, work place stress and nutrition, and even join the patient in addressing existential questions.
12
Just because anti-depressants aren't a cure-all for everything and everyone it doesn't mean they don't work. Never mind the supposed six weeks it takes for them to work for some, I can still remember where I was and what I was doing 24 years ago when the light turned on for me after two days of taking Zoloft. I've tried several times over the years to "wean off" because I was expected to with all symptoms rushing back. For some of us, it IS about chemical imbalance.
It's amazing to me how we still have so many people bashing pharmaceuticals for mental illness when we live in a society that revolves around drinking alcohol at almost all hours of the day and night almost every day now. Like all these people aren't self-medicating? But I guess as long as we're calling it "craft beer", it's okay.
17
Thanks to the author for sharing her personal feelings and insight with her experience with the mental health system as well as what she has put together by way of solution. At the beginning of this opinion, the author states she started in psychiatric care as a teenager. Hormones changing can wreck havoc in any female, but most especially with a teenager who also is still experiencing a developing brain. Only recently are studies being that take into consideration the effect of hormones in the efficacy of medications. Up until now, most psychiatric medications were tested and approved based on research on male animals only because dealing with female animals was considered too difficult. May the future of psychiatric medicine be more fine tuned to be of assistance to those who need to take medicine temporarily or on long term bases.
6
@vicki yes the antibodies were found.French medicine is very thorough
A lot of people who feel awful do so because their circumstances are awful. We can’t just give them all pills. Social injustice, emotional abuse and neglect, poor diet, sleep deprivation, lack of excise and access to the outdoors can all add up in deeply painful ways. Of course mental illness needs to be treated by qualified healthcare providers, but those factors need to be taken into account by all of us. Don’t forget the power of kindness while you’re at it. Be kind. It makes everyone feel better.
14
As a psychotherapist, I can concur to the validity of treating patients holistically.
Treatment depends on the various presenting symptoms, previous psychiatric history, family psychiatric history, situational stressors, psychosocial and relationship history, medical history and previous treatment responses if any.
I spend up to 2 hours taking a detailed history of new patients, in order to obtain a comprehensive understanding of why this patient is suffering.
Mental health treatment requires both the art of psychotherapy and the science of neurobiology/physiology.
Spending time listening to patients is essential in diagnosing and
treatment and can not be shoved into some constricted assembly line time slot!
8
This is like saying that you don't want to go to a doctor to treat your heart disease. If you want to go to someone else, you can go. But the reality is that more and more evidence shows that there is a biological basis for mental illness, including depression. But biological basis does not necessarily mean genetic. Your experiences can actually change your biology. This is actually my area of study.
15
Stigma? Listen to rich New Yorkers discuss their "therapists" or (even richer ones) their "analysts", and talk of their "neuroses" and anxieties. Maybe they are just boasting that they can afford all this, but there doesn't seem to be any stigma.
We don't hear people talking about their cancer or diabetes. Now, there's a stigma.
7
@Jonathan Katz
For rich people, they're aren't any stigmas. They can do whatever they want-even break the law-and it's all good. We should all know that by now.
5
Regarding “stigma”, there’s a difference between a more or less functioning person seeing a therapist for counseling, and a not-so-functioning person with a “brain disorder” on a cocktail of heavy duty psychiatric pills, with their often heinous side effects. Socio-economic status also weighs heavily on perceived stigma.
3
Remember that there is no such thing as “having it all.” Even the wealthy have pain.
2
Ah yes, article number 150 arguing that it's not all about neurotransmitters and SSRIs but requires talk therapy, and side treatments like exercise diet, good sleep and the rest. Sounds so reasonable. Where is the data that shows talk therapy helps with things like bipolar? Hard data, separating the variables of treatment, going beyond simply correlation. breaking down the components of "talk" and the effect each type of talk has on whatever--subconscious fears for example. Science is a good thing, scientific method the best part of it. This article is ideology
4
Why assume “bipolar” has anything to do with “depression”? Maybe its just conceived this way because currently every deviant mental state is thrown into the same “mental illness bucket”.
2
Where is the test that shows a patient has low seratonin?
3
After 30 years of chronic depression from age early 30's to 1999, I suffered from chronic depression. I was able to try the new SSRIs--Lexapro was magic and for 20 years I have been my old, good self. Every situation is different. For me, definitely a chemical imbalance, but my psychiatrist said I was lucky, medication one helps 40% of the people to take them.
4
What about schizophrenia, severe depression and bipolar disorder? Talk therapy is not nearly as effective as medication in these cases. Why should the term "mental illness" always refer to mild and moderate conditions when people with more serious ailments are ignored? In 2012, there were 350,000 people with severe mental illness in prison (many for crimes such as trespassing and stealing food while homeless) and the number continues to climb. To put it in perspective, there are around 30,000 migrants in detention right now. I agree that less severe forms of mental illness are also debilitating and diminish quality of life. But there is a crisis taking place that requires urgent action.
7
Jails are not prisons, which is where trespassers and petty thieves serve sentences. The mentally ill who end up in prison have committed more serious crimes.
2
Medications from what I have picked up from the mass media have become much better, but they still don’t help a very large proportion of patients. What that means is there is much more to learn about the biology of these disorders.
But if one considers what is known about the brain, the neuroscience, the brain is an organism that is shaped and changed continually and that everyone’s is unique. The connections from neurons to other neurons are continually changing according to use as well as chemistry. Genetic conditioning and chemical balances are not sufficient to determine how brains work. That might mean the treatment which stimulates activity in the brain may be another determinant of outcomes. It is activity that leads to eliminating used connections and adding or improving those being used. The brain functions according to the connections as well as the chemicals and electricity.
1
Even “schizophrenia” is a bucket full of multiple symptoms with multiple causes. Why think the exact same treatment would be warranted for disparate situations?
2
The most difficult aspect of the depression of which I have had to cope is the disempowering, anxiety-producing, self-defeating, negative thoughts, my hypercritical inner critic.
A quality talk therapist may help the sufferer with lowering the volume, frequency, and influence of the negative "radio station" broadcasting its persistent debilitating messages.
The most difficult consideration and decision I have had during my decades of depression and 'bad' thinking is finding the right fit in a therapist, and assessing whether or not they are providing me what I need. Is the process taking too long? What is 'too long'? And, what about which therapeutic modality is going to work within me? On one psychotherapist referral website is listed 43 different modalities.
My experience is that therapists do not come right out and say we aren't working, including after a year or longer of weekly sessions. The decision was left up to me. Have I been trying enough to help myself—doing my 'homework'? What is the therapist supposed to be doing, and me, too? Am I understood? Do I understand what he/she is saying? Is one or both of us at fault or are we just not meshing? And, on and on and on.
I have pretty much given up on talking therapy working. Part of the reason is the work and repetition of finding a fit and assessing my progress. Another reason is that I have little faith in any talk therapy process working.
5
The fact is that a good psychotherapist is willing to offer services for as long as the patient wants. Some become frustrated when patients do not progress despite what seem to be breakthroughs. They let their expectations disappoint themselves.
4
I used to work in the field, before Prozac. I mostly worked with Schizophrenics. I myself suffered from depression. I spent 8 years with different therapists. After I fired the last therapist, I figured some things out on my own and I’ve been fine ever since. The way therapy used to be done was problematic because therapists don’t work with patients depending on the skills they bring to the encounter. It should always have been/should be a team deciding which of them were the most appropriate for the new client and the team should have been/be reviewing all cases on a regular basis. This idea of therapists working in isolation, with no input from other professionals over the course of the therapy, results in many failed attempts to help and a bizarrely never defined ending. Then Prozac arrived along with the “fact” that depression is a chemical imbalance. Who decides when it is and when it isn’t?? So of course counseling should be part of the treatment! Psychological testing should be used. What a skillfully done psychological exam can point out is astounding. Have internists decided that they are qualified to diagnose, since “only a pill” is needed? Of course. What services are available for chronic schizophrenics these days? Does anyone even know how many severely mentally ill people there are in any given state? And therefore what government services are needed? “Take these pills. See you in a month.” As if that is all that is needed. How irresponsible!
1
@Bruce Stern
Sorry to hear that. It is difficult to find the right fit as therapy is an art and a science.
Kalpana Asok
1
What about psychiatric nurse practitioners? Accept insurance, provide therapy, prescribe, not resentful about compensation.
Why absent from the discussion?
11
I suffered from severe depression from adolescence to my mid '50s. Many of the discussed medications were tried to no avail. Then, I saw a wonderful allergist in Oakland CA. I spoke to him about my lifelong depression and he incredibly found the solution on the first try: Effexor (venlafaxine). I have been taking it ever since and haven't thought a single time since of suicide--an option I had considered seriously for most of life. I once attempted suicide and was hospitalized for a month. Thanks to the wonderful and kind Dr. Wacht, I have been able to enjoy many years free of depression. Depression is real and should not be taken as a phase or a problem that just requires an attitude adjustment. Life is overrated as another commenter states, but it can be lived and even appreciated and enjoyed. My mother, who committed suicide when I was 14 always used to say: All I want for you is to be happy. Happiness is an overrated idea and it is fleeting. It's not designed to be the norm.
8
@Suzanne Wheat
Your post breaks my heart.
Life is not over-rated, it is the only reality, all the rest is make-believe!
Happiness is not over-rated and fleeting, it is the only natural state.
Unbelievable as it may sound, we avoid Happiness by fighting Life (all in the name of striving for happiness)!
Letting go is the way to stop fighting Life. Gratitude for Life (not for any specific personal gain) is the result of letting go!
Gratitude is the cause of Happiness, Creativity is its expression!
Anti-depressant drugs are good, talk therapy is good.
But, if you close your mind to the possibility (in fact, the only possibility) of Life and Happiness, you have closed the only window through which the Sun can shine through. As Lao Tzu pointed out 2500 years ago, “You can’t scratch an itching foot from outside of a shoe!”
I am hoping to start a meditation group specifically to help people with depression. Hope I can help a fellow human or two.
2
Thank you for saying whay so many know. But there's no need to be this vague. The 20th century made great strides in knowledge of pycholory but the truth hits people over the head like a hammer and so they prefer the pills. Which are often not neccessary. Like the Opiods they have been dumped by big pharma just for the money. It's as simple as that.
Man's inhumanity to man is the source of MOST mental illness. It's usually the family being inhumane to it's own members, and most often the parents. They are repeating what was done to them, thinking it normal. Never questioning the authority of parents. But it wasn't normal. It was abuse and more commonly neglect (which is a form of abuse.
Alice Miller, Karen Horney and Eric Fromm have written much which can clear up the obfuscation and mystification. Some great film makers have addressed the issue of child abuse as well. such as Jane Campion in Sweety. Seek and yeah shall find.
5
Ms. Korducki's piece in wise and prescient. Another good source is Mindfreedom.org, which offers thousands of articles, videos, books, legal opinions and resources, personal accounts, blogs and directives to local groups and meetings that are wonderfully helpful to people experiencing problems such as Ms. Korducki's.
5
We live in a very complicated world these days, and a majority of us seem to feel stressed to the point of needing medication for anxiety or depression at some time in our life. In fact, acording to Time, "13% of Americans take antidepressants . . . a new report from the National Center for Health Statistics finds that 65% more Americans are taking antidepressants than they were in 1999."
What this writer did not mention is the adverse side effects of, for example, SSRIs. Since a relatively large number of people who take them experience some adverse side effects--like loss of bone density, and a deadening of affect, or the inability to feel love--any article dealing with their use mmight want to mention these effects.
Sadly, the pharmaceutical industry has come between the doctor or psychiatrist and his or her patient. Most patients need the equivalent of an interpreter to explain the pro's and cons of taking many prescription medicines, especially psychoactive medications.
8
@Elizabeth Bennett Totally agree (I posted a long comment about this above)! I recently (Jan 2019) found myself in a steady downward spiral (loss of long term job, long term romantic partner, several family deaths all in less than 2 years). Talk therapy alone was not helping. Fortunately, with ever increasing thoughts of suicide, I found a great psychiatrist AND a new talk therapist. The psychiatrist prescribed an SSRI. I knew of the potential side effects...primarily weight gain and impaired sexual functionality. While I didn’t like that, I figured I could endure while medicating & thought the risk was worth the reward. Both manifested themselves. I was able to get control of the weight issue early on, but the sexual functionality went to practically zero. Just last week, after weeks of complaining about libido loss gone unheeded, the psychiatrist stopped my SSRI. The thing I didn’t know in advance & discovered via my own research is that SSRI sexual functionality sometimes doesn’t alway return fully or at all even AFTER the medication is stopped...maybe for months or years, if ever. Had I known this in advance, it definitely would’ve impacted my decision. Personally, I would have declined medication & risked suicide because the thought of going for however long without the prospect of an active sex life is way worse. I’m hoping beyond hope it returns. It’s too early to tell, but if it doesn’t, then suicide will be back on the table...just for different reasons this time!
2
@Kent Ash Nadkarni, associate psychiatrist at Brigham and Women's Hospital in Boston, said in a Huff Post article abut SSRIs that "Sometimes it's not just your medication . . .it's important to be aware of other possible causes of sexual side effects, including age, alcohol usage, other meds or any leftover symptoms of depression." The article in Huff Post went on to suggest speaking with a sex therapist.
Hope you'll be OK as time passes--often depression is cyclical. Good luck.
1
Luckily, most patients are young and relatively healthy when they have their first experience with the mental health system. I'm glad I had good insurance when I first needed treatment. Now that I have Medicare, no psychiatrist will take my insurance and even my medication management is paid out of pocket. And there are additional charges by my psychiatrist if he needs to prescribe a controlled substance. Of course my counselor is also paid out of pocket.
Luckily I know from long experience when these services are necessary and worth the cost. Even more luckily, paying for them still allows me to buy groceries. If I hadn't learned over time what services I need, the costs would have driven me away from getting the care I need.
3
In Quebec I would say the situation is worse as GPs are now the ones handling mental health issues. And so pills are the default solution, prescribed by an overworked GP who doesn’t have the time to ensure the drug/dose works for the person, or as the author says, to provide talk therapy. Twenty years ago when I had a burnout, I was immediately referred to both a psychiatrist and a cognitive behavioral psychologist who worked together to help me recover. It was fantastic and I owe them a lot. That system is gone, unfortunately. Too many patients, not enough psychiatrists and as the author says, the belief that treating mental health is just about dispensing some drug to cure the chemical imbalance. So a GP can do it, right?
3
The last therapist I went to was an elderly woman who sat in a dark corner of the room while I spilled my guts out about the mental/emotional dilemma I found myself in and my inability to extricate myself from the situation or state of mind. When I had drained myself of all my self-pity, she said "What do you want me to do about this?" She then informed me she wouldn't charge me for the session but her substantial fee would be double if I ever came back. And threw me out. She was just what the doctor ordered; a wise, thoughtful and direct therapist. That was my last trip to a therapist. True story.
My first visit to a therapist, many years prior, left scars. The therapist forgot the appointment and I sat in waiting for the full 50 minutes in disbelief that such a thing could happen.
The last session erased the damage from the first. Life is a trip.
6
@Jay Stephen
I am so sorry for your experience. Every therapist has a professional organization with who you can discuss the problem. Therapists are accountable to a state licensing board.
2
As a mental health professional with over 30 years experience, I will say I wholeheartedly agree with your sentiments. Psychotropics are valuable, and for some people life saving. But, for most people, mood and anxiety struggles are due to multiple factors, and amenable to multiple treatments including psychotherapy, lifestyle changes, medication, or combinations of all three. Brain chemistry is bi-directional, and research has demonstrated that psychotherapy and, as one example aerobic exercise modify neurotransmitters, just as SSRI's do.
7
"Life is difficult" is the first sentence of a book by psychotherapist, now deceased, M. Scott Peck. As a child I internalized the notion that if I was a 'good girl', I'd have a good future. When the black dog struck early, I coped alone (it was the late 50s), along with endometriosis and pain.
I wish I'd heard those words as a child. I would have been prepared for the hardships most people face. Now, 75 and a caregiver for my husband, my outlook is to find joy in the moment, in people I meet, those I counsel, and with the love of my life.
7
Psychiatrists and researchers often forget that our brains are constantly changing as a RESULT of our psychological experiences (i.e., the science of *neuroplasticity*). This is why we often find people overcome their mental issues with time, when their life circumstances change, etc. But when people are given labels and told that they have a “brain disease” – this takes away hopes for recovery, and disempower people (and labels can also activate nocebo effects - which are opposite of powerful placebo effects).
14
@kdn When it comes to the deeply entrenched chemistry of birth trauma, childhood trauma and abuse, "neuroplasticity" is a hippie-in-the-sky notion. The brain can't reconfigure itself to undo the psycho-biological foundation of the person. Not to be a dismal downer, but I haven't ever met someone whose depression evaporated. I have certainly seen individuals who have moved beyond the darkest depression, usually by career growth, returning to a dysfunctional family, meds or placebo, or through self-deception. I suppose there's a little plasticity involved in that.
2
@Fred It is possible to change regardless of the cause (or how the mental issues originated) – see for example the following meta-analyses:
Dykens, E. M., et al (2014). Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics, 134(2), e454-e463.
There are other such studies too - also interventions such as mindfulness training brings about structural changes in the brain as well.
1
I, too, am privileged and can pay for proper counseling. At 72 I finally feel that I belong. Meds might have helped, but I will not under any circumstance take any. Watching the medical establishment give my mother Thorazine 60 years ago for her drinking, convinced me that meds are not the way to go. Quite honestly, I am very proud of my stance and hard work. Some of that hard work was getting help with the PTSD that came from serious childhood trauma. Now, I can say that the biggest single piece of my recovery has been learning that I deserve to recover and receive the care I did not receive as a child. The op-ed about shame “It’s Not Always Depression” by Hilary Jacobs Hendel, August 4, 2015, was without exaggeration, life changing.
3
As a practicing physician who treats depression and IS TREATED for depression I would like to comment
Prozac was the first medication for depression which was well tolerated. Others were too sedating, dangerous, hard to prescribe and take
Prozac ushered in an era in which non-psychiatrists ( I am a Rheumatologist) could safely and effectively prescribe antidepressants
These medications have SOME role in treating depression in SOME patients
For me, these meds have been life-changing. Not the TOTAL solution, but an important part. Talk therapy, personal insight, exercise, are all important
In my family, EVERYONE has mental illness of one kind or another.
Medications are of no value for some patients. Talk therapy does not help for all patients
I would submit that ALL patients with depression need treatment beyond medications.
There is no simple solutions for complicated issues
We all wish there were
I can tell you as a doctor with 39 years experience that each person with a given medical problem is unique.
As we joked during college, “ All generalizations are FALSE!”
Be very careful about generalizing from one person to another in medical matters
It don’t work that way, y’all, as we would say in Western North Carolina
It don’t
16
I agree with the author. In addition, our American culture of self reliance, lack of community and myth of independence vs. interdependence contributes to our prevalence of depression.
Witness the opiod epidemic: desperate human beings who don't feel they belong anywhere - needing the high of opioids to feel ok - if only for a moment.
7
Towards the end of the article the author mentions exercise and diet. Try exercising more every day (until you break a sweat) and pay attention to your mineral nutrition. Magnesium and zinc are important in maintaining a healthy brain. So are Vitamin D and folate. Check the scientific literature on human mineral nutrition and cognitive function for more.
6
I agree with treating the "whole person" and not equating a person with his or her diagnosis. But an accurate diagnosis provides a wealth of information about how to treat that specific mental illness. I've known compassionate therapists who relied only on their own intuition and, as a result, failed to implement accepted and evidence-based remedies. Empathy must be balanced by rigorous application of medical and psychological knowledge.
3
As a psychiatrist, it has never been either or. Never. It has always been both and. The brain AND the mind both exist. They are different constructs but they both exist simultaneously all the time. I have never, not once, in 30 years of practice, ever just thought of someone as having only a “chemical imbalance” nor have I ever thought of someone in psychological pain as not also having a biological organ, the brain that can make itself known irrespective of what a psychological explanation alone might suggest.
We get into problems when we overvalue ONLY mind or ONLY brain solutions as being inherently “the truth” and we then go about demeaning the other construct. Holistic, recovery based, person centered mind/brain care of complex conditions that affect mental life using evidence based methods is the only approach to improving complex situations. That is what I and many colleagues I know are most often seeking to practice. There are also unrealistic expectations and stigma to try to dispel with every person seen...i.e that unhappiness is the same as depression, that anger is the same as anxiety, that long term belief systems can be changed overnight, that medications are either not needed ever or never helpful or that they are a panacea, etc...Yes, good treatment can be both life restoring and even life saving at times, but there are many aspects of our lives that will have little added to it only by way of psychiatric treatments.
10
@Tony Psychiatrists would sometimes prescribe based on what the nicely dressed pharmaceutical rep presented (along with free pens and lunches in the old days). Psychotherapists would sometimes treat based on the latest workshop quick-fix treatment du jour, which would often be as flaky as heck or just another variety of Cognitive self-talk. Yes -- we are complicated enough that a patchwork quilt of remedies and palliatives may be the best approach in many situations. But essentially -- and I'd bet everything on this -- the most enduring psychological help will be the application of natural processes: redeeming empathy, deep catharsis, deep knowledge.
4
@Fred I can only speak for myself...being a physician involves every aspect of one’s self in caring for another person. It is the highest of provileges and highest of responsibilities. The complexities of suffering caused by the brain and mind do not easily lend themselves ever to a soundbite answer or a snappy editorial piece in the Times. The awesome complexity of the wondrous organ that sits in our cranium deserves persistent humbleness in our approach to its study and to acknowledge the limits of what we know, but also never ceasing to better understand and to advance our knowledge. In the interim, my charge is to do my best each day to care for those who are suffering.
3
The author makes the point that she is now able to afford to pay out of pocket for therapy. Many folks are not though. It is getting hard to find therapists who take insurance. The reason for this is that most insurance companies only pay $65 per session. On a pe annum basis with 20 to 25 (considered a full-time practice because therapists have a lot of documentation requirements for each patient in addition to billing and scheduling as well as research for customizing treatment strategies) patients per week this works out to between $58,00 to $71,500. Don’t forget that out of this the therapist pays for their office, supplies, marketing, administrative assistance, etc. This is for someone who has a masters degree at a minimum and has done 3,000 hours of supervised therapy sessions and additional training, in most cases unpaid. As a freelance economist 25 years ago I made $170 per hour. I consider therapy as still reeling from being mostly a “female ghetto” occupation much like teaching, where women traditionally haven’t been paid commensurate with their skills.
16
This is an issue that has been around for a long time. It seems that our approach has been to diagnose and then treat without really understanding either. I have been involved both personally and professionally for most of my life. Having grown up in a home where there was severe mental illness. I also worked in the field of addictions for over 25 years. I have come to realize that if we keep looking with the same lens we continue to get similar results. We all seem to accept mental illness without even knowing the source. Maybe we need a completely different (radical) approach. In all my years I never came across anyone who ever asked if it were possible to be completely free of anxiety or depression!!! Why not? Have we been lulled into a belief that it can only be managed or tolerated? If we begin to ask the right questions may be our solutions possibly arise by that kind of inquiring. David Bohm proposed that thought was a "system" that may play a role in psychological distress. Psychotherapy is using thought to "treat" a situation that may have been brought about by a kind of thinking that is unnecessary. It is time to not just think outside the box, maybe we need to discard the box itself. Is it possible we can never effectively treat "mental illness" because it only exists as thought? which is only an image in itself. This would open up the possibility of observing this as a complete system rather than in fragments. When the false is exposed, there is only truth left.
1
This is an issue that has been around for a long time. It seems that our approach has been to diagnose and then treat without really understanding either. I have been involved both personally and professionally for most of my life. Having grown up in a home where there was severe mental illness. I also worked in the field of addictions for over 25 years. I have come to realize that if we keep looking with the same lens we continue to get similar results. We all seem to accept mental illness without even knowing the source. Maybe we need a completely different (radical) approach. In all my years I never came across anyone who ever asked if it were possible to be completely free of anxiety or depression!!! Why not? Have we been lulled into a belief that it can only be managed or tolerated? If we begin to ask the right questions may be our solutions possibly arise by that kind of inquiring. David Bohm proposed that thought was a "system" that may play a role in psychological distress. Psychotherapy is using thought to "treat" a situation that may have been brought about by a kind of thinking that is unnecessary. It is time to not just think outside the box, maybe we need to discard the box itself. Is it possible we can never effectively treat "mental illness" because it only exists as thought? which is only an image in itself. This would open up the possibility of observing this as a complete system rather than in fragments. When the false is exposed, there is only truth left.
2
The author is a brave, wise woman who caught on to the cultural scam that is Big Pharma. Psychiatry's complicity in the medicalization and monetization of human suffering will be a sad mark against it in the history books.
While meds can and sometimes do help those suffering from the extremes of depression and/or psychosis, psychotherapy and life style management are far more beneficial for the majority of people suffering from the human condition.
11
Depression is a complicated problem. King Saul suffered from depression and David helped him with harp music. Hamlet, Macbeth and King Lear all showed obvious depressive and suicidal thoughts. Patients with depression are likely to have a family history of depression and/or alcoholism. We know that exercise helps depression as does cognitive behavioral therapy and the drugs have a benefit but most studies show that the drugs only help a little and for adolescents they do not seem to help at all. People who are depressed lose their ability to get up and go and sometimes rewarding yourself for doing things helps your mood. Watching TV news is not likely to improve depression as it is aimed to make people anxious and depressed. It is important that depressed person gets control of his/her treatment as control is a very antidepressant thing to do.
3
I agree wholeheartedly that mental illness is not just a “chemical imbalance”. I have learned, in my first four years as a therapist, that most people have experienced or witnessed some form of trauma. Not trauma like school shootings or fires or earthquakes, but “everyday” trauma like emotional abuse, verbal abuse, physical abuse, sexual abuse, domestic violence. Especially when experienced or witnessed in childhood, these can have a lifelong impact without intervention. It’s unclear why some people are more resilient than others, and of course I only see the people who come for help. There are many therapeutic approaches to heal the effects of trauma. One commenter mentioned EMDR. Another wonderful and healing therapeutic model is Internal Family Systems (IFS). I highly recommend seeking out a licensed therapist practicing one of these. Many therapists offer sliding scale. Open Path Collective is a great resource for finding therapists who reserve a few slots for sliding scale clients. For those who live in remote areas with fewer resources, many therapists now offer therapy via secure video conferencing. Don’t give up on finding the right therapist.
11
@TG
I highly recommend Internal Family Systems work too.
1
The basic problem is many consider a human being to be 100% biological. If that were true then any mental disorder could be treated with drugs. However, there is also the spiritual element which makes up the soul of a person. How that works is not known by science as we do not even know what consciousness is. If drugs do not help a mental illness, one should seek answers in religion or philosophy or a combination of the two.
4
Beautiful, insightful piece. Human beings are complex, we are alive & changing, we each have different stories, different genetics, different histories, thought habits, gifts, loves, skills, perceptions. Continually the medical profession seems intent on overly standardizing care, arrogantly assuming that if you don't fit this or another model, you're deluded, or anti-science. But in medical science, like life, I thought the whole point is always to observe, to re-evaluate, to remain humble & open to new evidence. The major horrors & lesser agonies of mental illness require attention, awareness, practice, compassion. As she states, maintaining is living process. We want to be able to fix it with a drug, or assuage the general population with a billboard slogan.
Life is more complex - more painful - more meaningful and rewarding than that.
5
The development of science began at a time when attributing what people do to nature meant denial of the soul and denial of sin and of divine grace. It lead to a paradox in our views of man and nature. Men were possessed of mortal bodies and immortal souls. The brain was part of the mortal body while a mind was part of the immortal soul. Mental illnesses were sometimes attributed to brain diseases and sometimes to afflictions of the mind or the soul. To this day, a lot of our thinking tends to retain this perspective.
It turns out that the bodies which manage the connecting structures in the brain react to those in use or disuse differently. They remove those that aren’t used and help make better those that are. And even make additional ones. The chemicals have a role but so do the structures. As we use our brains we shape our brains. While it’s probably not truly how things work, one might imagine that the brain and mind make each other what they are. Medication and psychotherapy work differently but both do work.
3
There are genetic tests that may help guide which drugs are more likely to work for an individual based on their genetic profile. GeneSight is one test, among others.
Not a 100 percent guarantee but it may help you and your doctor pick the right drug, or rule out ones not likely to work for you.
2
A visit with the psychiatrist Daniel Amen could be very beneficial to you. There is so much more to mental illness than conventional medicine is treating.
1
I experienced my first full blown episode of clinical depression in 1975 and just "white knuckled" my way through it. It let up after a few months and I returned to a normal existence. It reappeared, with some regularity thereafter, and I finally sought medical help. My doctor prescribed an early anti depressant which, as a side effect, caused severe constipation. I wasn't a moving experience. Years later I was prescribed Prozac and experienced full blown relief. Fearing some kind of rebuke, I remember keep it a secret that I was "on a drug" for my depression. Symptoms subsided and I went off the drug. I see saws back and forth between taking drugs and stopping when symptoms relented. Big mistake. Now, I've learned my lesson and have stayed on 40 MG of Citalopram for years. It works. I feel fine. More importantly I am not depressed. In my case psychotherapy enhanced the chemotherapy...and allows me to discuss my interpretation of events and how I react to them. So, I think we've come a long way. I know I have.
9
At least psychiatry is offering meds, which can be stopped, in lieu of psychosurgery, which is forever. Neurons that fire together. Trauma is everywhere. As for body-mind trauma and mind-body healing, one size does not fit all. Everything is connected.
3
I took anti-depressants for a number of years. They were immensely helpful in the beginning, but eventually stopped working. And withdrawal was the pits. The problem is the brain reacts to them by reducing its own production of the neurotransmitters.
My depression is due to patterns wired into my brain from day 1 by treatment from my parents. I don't know of any treatment yet that can rewire. And I am at the end of my life.
5
@Audaz I can only say that I hope you have had more than just some happiness and contentment -- though on a baseline of depression. And that no clinician of the contemporary "solution-focused," "strength-based," "positive thinking" modalities bothers you with their nonsense. You know much more about life than they do.
2
It’s funny that in the span of 80 years, the psychiatric field went from viewing psychiatric disorders as primarily the result of an un-nurturing mothers to resulting from a “chemical imbalance”.
It seems like this field is still very immature and not so far from the absurdly quaint Female Hysteria and Melancholy diagnosis as we’d like to think.
10
It's not a 'chemical imbalance' at all. It never was. I'm not sure why people are suddenly 'discovering' this. I've read a few such articles lately. They leave me mildly irritated.
The healthcare industrial complex is not set up to benefit patients, nor to allow physicians to practice medicine as it should be practiced. All medical specialties, not only psychiatry, should be first and foremost about the person, not the disease. For psychiatry to ignore the person, as many psychiatrists do, is beyond bizarre.
And yet, contrary to public belief, some psychiatrists do indeed do psychotherapy. They take the whole person into consideration. They spend an hour with patients.
The biggest stumbling block to doing this seems to be the expectation that psychiatrists will ONLY prescribe medications. That they will slap a diagnoses or two on the patient, write a few scripts, and that's that. It's an uphill battle to explain to people that this is not what psychiatry should be about. If I'd spent more time climbing actual hills than fighting this battle, I'd be in a lot better shape. So it goes.
10
@NWwell.com I've been a psychotherapist for twenty years and have yet to chance upon a psychiatrist who does therapy. Interestingly, some of my clients claim that they've previously had therapy, and what they mean is that their psychiatrist asked them some personal questions for ten minutes. Breggin points out that the concept of the "chemical imbalance" was devised by the "paid physicians" at Eli Lilly Corporation. Of course the brain is implicated in our psychological dysfunction. But what "unbalances" the brain? Life!
11
Destiny is a comfort in the real chaos of life. But medical science is still dominated by scientists. They save us from the certainty which makes brain disorders be seen as destiny. The brains of people are the result of their lives not just their genes, not the chemicals present or not, not any one thing, but the result of everything including our conscious and unconscious perceptions.
The neurons connect with other neurons but are connected or disconnected according to their use as well as the chemicals and the preferences due to genes. The result is that no two brains are the same. Research is continually increasing our understanding. The organic mental disorders are in fact a result from a host of factors, not a certain set of inevitable processes. They are displayed due to signals not passing through the pathways of connections which they should, not some pernicious agency that has taken over the mind.
Statistical studies indicate that prompt treatment for depression and schizophrenia reduces the severity of the effects upon people’s brains. There are no cures, yet, but more knowledge does make more likely that possibility. Meanwhile, the knowledge that exists needs to become popularly known to enable patients to be perceived as having bad luck rather than a curse that imperils others.
3
Genes and chemical balances are strong determinants but they are not sufficient by themselves to produce the disorders.
3
In a recent a practitioner of traditional, intensive psychotherapy set about diagnosing this socio-cultural, political economic situation:
"“We live in an age where the over-reach of big Pharma, extravagant expectations placed on medications, the underfunding of psychotherapy by health insurers, in the oversupply of brief, problem-solving therapy supported by slanted science all places traditional talk therapy in jeopardy. Now more than ever there needs to be renewed focus among mental health educators, researchers, professionals, and other advocates to preserve humanistically informed and scientifically backed traditional talk therapy,” writes Gnaulati.
Mental health care is being rationed and and the real political and economic levers of that rationing are being disguised as what science has told us is clinically the best treatment. That is not true however.
Going all the way back to the marketing blitz for prozac and the take over of mental health care by psychoactive medications replacing the longer and supposedly more costly process of psychotherapy the subsequent years have not shown their better for you than talk therapy.
And the "chemical imbalance"? Is that the cause or the effect? In fact no one has a way to measure the chemicals in question and establish norms for their excess or deficit. It's a theory, that's it. If there is an imbalance it's an effect of depression not its cause. But then what is depression anyway? Pharma can't tell you, they don't know
7
Great piece! Thank you!
I have a comment about this particular sentence:
"But I fantasize about a future in which mental illness is understood less in terms of static diagnoses and psychopharmaceutical stopgaps than each individual’s symptoms and the circumstances that might inform them."
This is a great thought...but I want to be sure that you and others know that an individualized, contextual understanding of a person is not a futuristic pipe dream, but instead a historical practice that was common for decades. Psychoanalysts and their offspring have been working in this manner since the early 20th century. We, too, have been and still are pushing back against the very problems you've experienced!
But if what you're looking for is a diagnostic system in particular, it exists! Check out the "Psychodynamic Diagnostic Manual" (Lingiardi and McWilliams, eds).
Be reassured that the treatment you want is out there. We psychoanalysts and psychodynamic therapists agree with you completely and are ready and eager to help, on both a 1:1 and a societal level!
9
@Stephanie
Thanks for referencing the PDM. And speaking up about psychodynamic therapists. There are plenty of good therapists who understand the complexities of human suffering and work hard for their patients.
1
Anti depressants have saved my life. I adamently resisted taking them at first. I take no other mind altering substances including alcohol. However, over the past thirty years, there have been three times when I slowly tapered myself off of my anti depressant. All three times the result was, after an insidious nine month decline, in me voluntarily entering a psychological hospital for help. I could no longer eat, sleep or stop the intrusive unrelenting dark thoughts in my mind. Personally, I wish that the word for what I suffer wasn’t called “Depression” because it is such a common parlance in our society and it is used to describe a broad spectrum of moods. But, Americans lack imagination, if it’s not physical, many minimize what the sufferer is going through and, for those of us who have it, when we are at our worst is also when we are least capable of communicating to anyone the agony of our interior lives. Certainly todays' U.S. mental health care system is in a sad state of affairs and many people are dying quietly in isolation with the legacy of not ever having been understood.
26
I am so sorry you went through the experience of declining on a taper and going to inpatient. Have you considered that what you went through had been antidepressant withdrawal? There are resources that instruct people on how to safely taper, as this is not part of the training of psychiatrists, sadly. I would start by reading the guidelines on SurvivingAntidepressants (dot) org and reading "The Antidepressant Solution" by Joseph Glenmullen, MD.
4
I am a retired Adult and Child Psychiatrist. I loved my work, especially before managed care, when medication was affordable, when I was not limited to a 15 minute "med check" and expected to treat everybody with medication, when waiving a co-pay wasn't illegal (it encourages overuse of insurance benefits). When I could consult with other "providers", see family members, talk to teachers or do therapy myself. "Counselors" are less expensive. Many are excellent but coordinating with them takes time for both of us. None of this is covered now, it is actively discouraged and I didn't have the time, nor did they. My family carries the gene for MRDD. Stanford is researching it. I am in the study, as are many of my patients. MRDD, major recurrent depressive disorder, is not "ordinary" depression (not that it can't be just as painful and it sometimes responds to medication too). MRRD is life threatening and the darn stuff just keeps recurring, all your life. You may be symptom free between recurrences but it is hard to see it coming. MRRD almost always needs medication but always needs psychotherapy. Toward the end of my career I took most patients OFF meds. As my colleague said "No child should be on more meds than their age". It was disheartening. These days I march and call and e -mail and lobby and protest. I'm pretty good at it but I miss my old work with all my heart and soul.
21
As a coach for HSPs I've learned to always screen for trauma in my clients. Individual responses to traumatic conditions can vary a great deal. I listen closely to what clients say about their lasting reactions to events that might not affect others in the same way, as well as about events that most people would find traumatic. I refer out for trauma evaluation and specialist therapy, when it appears a client needs that support.
Some clients cannot benefit from coaching until they are fully professionally supported for processing trauma and other life circumstances that are affecting their ability to function.
4
The clickbait subtitle is not helpful. No one in the last couple decades has said that mental illness is "just" one thing or another. For decades, all we had was talk therapy, and in the 50s and 60s that definitely meant you were damaged goods. But drug treatment without talk therapy, in very many cases, produces no long term change.
Really, this kind of "aha!" gotcha-ism is a distraction.
7
The general public is often not aware of all the kinds of practitioners of mental health services. Counselors, Marriage and Family Therapists, Social Workers, Psychologists, and Psychiatrists have different kinds of training and specialization. Psychiatrists are NOT necessarily trained in Psychotherapy but are doctors trained in medications for psychological problems. Medication is not and should not be the first step in addressing familial, interpersonal, and psychological problems.
Too many women and men, but in my experience, more women, get medicated in an attempt to address interpersonal and familial problems that could be resolved with psychotherapy.
4
Although it is true that some psychiatry residencies do not emphasize psychotherapy, mine did and I am so glad. However, at this point in our area, the need for appropriately prescribed medications (after a thorough evaluation lasting 45-60 minutes) makes it difficult to set aside time to have a therapy practice. Also, getting decent reimbursement from private insurers let alone Medicaid and Medicare doesn’t help. That may sound selfish to the author of this rather unbalanced piece but she doesn’t have student loans to pay.
I will say that as someone who has recurrent depression, that the medications aren’t everything. I will also tell you that my antidepressant along with amazing therapists has saved my life.
6
Mental illness is a chemical imbalance?
After years of having lived on a planet, our only planet so far, as a member of a species which at best operates only with a brain which has more or less enabled it to survive so far, I find it troubling that mental illness would be reduced to a chemical imbalance which of course implies that healthy, mentally competent brains exist, and they are chemically balanced, have some sort of right mixture of chemicals which make them mentally and emotionally sound.
Need I say that I have never heard of anything like the blueprint for the chemically balanced healthy brain not to mention examples of such on the market (except perhaps Trump, stable genius) and in fact all abnormal psychology appears to be science which can offer any number of examples, descriptions, of what has gone wrong but rarely gives us a clear picture of the opposite, the optimally functioning brain?
The science of abnormal psychology, theories of mental illness, reminds me of someone talking about human intelligence but not operating with paradigms such as I.Q. bell curve, and only giving rough descriptions and explanations of what's undesirable (equivalent to low I.Q. end of I.Q. bell curve) and being reluctant to talk about anything above the average.
You have essentially any number of people eager to explain what's mentally and emotionally wrong with you but without the guts to describe anything better than themselves, the true north of optimal human functioning.
4
In both medicine and psychology normal means average, the measure of central tendency in a bell shaped curve, normal distribution, of data.
1
Taking meds probably renders the organism less able to grow.
Highly recommend 12 steps to all. Replace alcohol in No.1 with emotions and voila, a plan for every person. It costs nothing. The money trembles in its boots.
4
To address the main points in this article is something I will do because it might be helpful to the system in general and secondarily to the many who suffer.
Psychiatry as practiced by medical doctors is pathetic. I subjectively characterize the profession because doctors are vetted to be caregivers who forsake motivations based on money. The current state of psychiatrists prescribing medications for a mere "chemical imbalance" and not addressing the complete human being before them is shameful. It is a disservice to an ailing human being to ignore the "co-morbid" circumstances of that individuals life, and simply hand them a "panacea."
For an obviously capable professional to allow reimbursement systems to dictate how one practices is simply lazy. I understand that doctors have to support themselves but let them be honest about it. The profession needs to educate the public that psychiatrists DO NOT provide complete psychiatric care.
The profession should also make it clear that BOARD certified psychiatric care meets the licensing requirements of XYZ certifying agencies if they have an intervention team (psychiatrist, counselor, or counseling system) contractually in place.
Leaving this up to an unsophisticated individual to parse out what truly consists of psychiatric care...again...is appalling.
It should be a quest
10
Wonderful article. I never quite realized how much we misunderstood mental illness until a teenaged girl told me that she now realized that her problems were related to a Prozac deficiency.
4
The Chemical imbalance idea was formulated by a marketing department of a Big Pharm company.
9
For people afflicted with unending night mares and night terrors and searching for psychotherapy, you might be better off trying to understand Buddha's Four Noble Truths, which remain more illuminating than any permutation of fashionable biophysical modeling of human suffering. The proper question for physical medicine is: How much science is there in it? The property question for psychiatry is: How much of it is pseudo-science?
4
The author drops in “the burdens of intergenerational trauma” between “the basics of survival” and “social and material circumstances” — ideas that need no explanation— as if it’s something equally clear. Should I know what intergenerational trauma is?
Full quote: “The jury is out on the extent to which mental illness is hard-wired, but black-and-white narratives of psychopathology neglect the tremendous psychological impacts of social and material circumstance: access to the basics of survival; the burdens of intergenerational trauma and insufficient social support systems; the existential gut punch of pervasive injustice.”
1
Part of depression stems from the fact that life is way overrated. It's a pretty stale, repetitive affair full of pain, fear and boredom. Of course there are those who will say you just can't see the wonder, when in reality, you totally see and understand what they are calling wonderful but you are just totally unmoved.(Is he really excited by that? What a low bar.)
156
@Edward - That outlook on life may be the most depressing comment I read in a long time. Good luck finding something that brings you some joy, excitement, and comfort.
54
I would bet there are reasons why it feels this way to you. We are not born anxious and bored but can become that way if things don’t go well, especially early in life. Just an observation: if you frame your experience as an objective fact about life, you’re sure to get argument from those who want to say life is good. They deny your reality and then there is argument about who is right. No one feels understood
15
Edward’s not necessarily wrong – his views are just ahead of his time.
25
As usual, the discussion of pharmacology is focused on whether you will feel better after being prescribed a drug, but rarely on what will happen in the long run. Yes, countless people have felt a life changing boost after taking SSRI’s, just as countless felt better taking Valium two generations ago. But what happens when you take SSRI’s for five, ten or twenty years?
Spoiler alert: I’ve personally known several people for whom the long term effects were devastating. Worse is the dependency that develops. It can take years of horrifying physical and mental symptoms to wean your brain from SSRI’s. Some never make it.
Our health system is disincentivised to worry about that. Your psychologist has 15 minutes to consult with you and choose a drug to prescribe. Perversely if it doesn’t work it is proof you need more, not less, medicine. If you start having side effects it is proof of your underlying condition is getting worse. It is never the drugs themselves.
What is truly shocking is that an op-ed piece questioning a system that prescribes potentially dangerous medication as a first and only option, potentially for decades of a person’s life, would be considered controversial.
6
When I was 18, I decided to study medicine to become a psychiatrist. 4 years later, I discovered that in my 13 year long training, I wouldn't have one single minute of "talk therapy" training. All I would learn is to go through pre-established questionnaires with yes/no questions together with a new patient, which was then supposed to allow me to know which drug to prescribe, and that was it.
So I switched to psychology. There, however, each theoretical approach had its own professor, and ... each and every one of them claimed to have discovered The Truth about the human psyche, declaring all others "impostors". In the meanwhile, NONE of them had come up with any evidence whatsoever that could scientifically prove that their approach would work.
It's only now, over the past one or two decades, that neurology finally started to study notions such as emotional intelligence, emotional management, and happiness. NOW, we finally know that happiness is a SKILL, and a skill that is highly trainable. And when you start practicing in a specific way, new brain networks grow, just like when you learn a new language. As Western education doesn't include these trainings AT ALL, however, depression has become the number one "disease".
Yes, other brain networks produce other chemicals. But what a happy brain needs are those networks. Putting in chemicals in absence of the proper networks doesn't solve the very cause of the problem at all - nor does merely talking to someone once a week.
9
Everyone's mental health is a reflection of the complex ebbs and flows of life. Everyone needs to develop tools as they grow up to essentially internalise the serenity prayer (i.e., learn to control your response, etc.). People do naturally growing up and some never do, which lead to certain disorders cropping up.
The difference between those who people who can do so and those who can't is the start of mental disease. So my point is that even if the "chemical imbalance" is treated, you still need to be able to do what everyone else does to maintain their mental health.
3
@RamS
Except that there will soon be more people with than without depression. So apparently "what everyone else does" isn't necessarily an example to follow ... ;-)
4
@Ana Luisa "Everyone" is an ideal. I'm referring to everyone who is mentally healthy. It could just be that the increases in cases of clinical depression, especially among the youth, are all due to some chemical imbalance (but likely more than just chemicals - the imbalance part is correct).
There's a bunch of research we're doing that points to the interaction of the large number of chemical compounds in our environment to various biological (and neurological) processes in ways we don't really understand (compounds that didn't even exist as early as 100+ years ago). To even uncover their role in mental health would be an even more significant undertaking (with the terms "mental", "neurological" and "biological" referring to different overlapping sets of interactions). So it could all be "something in the water".
As others have pointed out in this thread, talk therapy treats the symptoms or is a way to cope until the disease is dealt with. I think it's justifiable to argue that the OpEd makes it seem as though that there's something to treating mental disease that goes beyond correcting the disease pathology.
--
I also wanted to add something about "preordained" being confused with "genetic" vs. "preordained" being biological. In both cases, there is no choice. And holistic to me means addressing all the interactions at multiple scales. The goal being to achieve the right balance when the balance is perturbed.
4
@RamS
How does genetic predisposition fit into this?
2
In my experience dealing with friends who suffer from depression as well as other forms of mental illness, I find that taking a pill is an easy way to deal with their problems. These medications offer a level of "functioning" which for many is "good enough". This in my opinion is at least in large part because talk therapy is hard. Not only is it important to find the right therapist but people who are afflicted by these illnesses (I'm talking about those who can at least reason logically ) have to be willing to discuss things that are terribly painful to them as well as in many instances be willing to accept some responsibility for some of these painful and difficult situations, and ultimately forgive themselves and others and "let it go". Accepting that life is many times very difficult and being able to go on in spite of what has happened, and what mistakes have been made, takes a degree of honesty and maturity with yourself that not many people possess.
9
For decades we have known that depression is not caused by a chemical imbalance, but rather the dysregulation of brain systems and atrophy of neural structures as a result of stress and trauma. This is clearly delineated in hundreds of neuroscientific and psychological studies. However, it is important to realize that serotonin (as well as dopamine and epinephrine) can cause neurons to regrow in these brain areas in adults (particularly the striatum and hippocampus). Again, this is counter to the myth that neurogenesis does not occur in adults. Adding these neurotransmitters can also help restore function. Ultimately, addressing trauma and stress is the only way to actually prevent this dysregulation in the brain that causes anxiety and depression.
7
@HW
True to some extent, but I don’t think that it is that simplistic.
The origins of mental illness makes it difficult to treat.
It just isn’t that well understood.
There are genetic predispositions that are not fully understood as well.
4
"The jury is out on the extent to which mental illness is hard-wired," says the author. Wrong. The neurological connection to psychiatric disorders is well-documented.
The author admits being on medication, but does not attribute the ability to manage the "ebbs and flows of life" to medication that is working for her. Without the medication would she be able to create "daily priorities," "exercise," and "eat a balanced diet"?
Happy to know that her medication is working for her, but unhappy to hear her suggest that the mentally ill can exercise and eat their way to mental health.
15
I’m trying to think of how many ways I dislike this article, or the number in errors I can stack up in its content.
The food/psychobiological connection is in the infancy of being established, and there are so many holes you can fly multiple planes through it. However-as a MDD sufferer who has also had his gut flora dna sequenced-I can tell you that I am missing huge chunks of the flora/fauna that a “normal” person should have, and that-as best we (my Dr’s and I know/can determine-the antidepressant I take works via a gut-related pathway (marplan).
We’re trying to rebuild these absent colonies via targeted probiotics. Its a long, exceptionally slow and uncomfortable process. The thing that seems to speed it along the most that is eating pesticide free-but you have to run that foodchain all the way to earth. Any animal you eat has to also eat pesticide free. There are no studies on this, really-but its mostly in countries that use pesticides that have spikes in psychobiological illness in the modern age.
I will say (based on a sample size of one, lol) that pursuing that dietary restriction has caused me to improve cognitively, and also caused me to drop a lot of medication gained weight.
But in 10million years I would not go off the marplan. Three documented generations of MDD are in my family-marplan helped us all, and only marplan, for those who didn’t have access to newer classes of meds.
I will say a 60 year old med should not cost $600/month.
1
This is partly a response to the writer of the article - but perhaps even more to the commentators who insist that these are biochemical problems, to which 'talk therapy' an inadequate tool: Actually, there is almost no evidence of psychological problems being rooted in chemical balances and genetics. One example: SSRI's seem to work for some people. *How* they work is still a complete mystery to medicine. And chemistry is incredibly individual - what may help one person has no effect for another. Why do we have a diagnostic system (DSM-V) the presumes a biological substrate for all mental illnesses without proof that substrate exists? Well, if they're not mental illnesses with a biochemical cause, then why would we need MD's (the only discipline that can prescribe) at the top of the food chain? If you think the 'opioid crisis' was the result of drug companies 'pushing pills', you ought to see their marketing budgets for pills for psychological disorders. It might behoove us to go back to what Harry Stack Sullivan, the first great American psychiatrist, said in the 1940's: Let's not call these 'illnesses' so quickly. Let's call them 'problems in living', which everyone has, to one degree or another. Why do insurance companies favor cognitive behavior therapy over more traditional psychodynamic 'talk therapy?' Because it's less expensive - CBT treats symptoms. Psychodynamic therapy finds a phenomenological context in which the causes of those symptoms make sense.
7
This is an excellent editorial, and I appreciate the author's willingness to challenge the near absolute sovereignty of modern medicine in the diagnosis of mental illness.Too often, we do not look far enough into the world of the sufferer when seeking diagnosis. In the case of SSRI's I think we forget that just living in industrialized society itself can be, as Marx famously noted, alienating. I wonder what our world would look like if we spent more time questioning its norms rather than assuming that the problem lies with the sufferer alone.
7
I, for one, and as a parent of an adult with schizophrenia, Found this article extremely disappointing and unhelpful for anyone dealing with severe mental illness. You didn’t say what your illness you have suffered from, which to me is telling. Perhaps you might read “The Collected Schizophrenia’s” to see a real struggle with finding the right treatments and even diagnoses associated with severe mental illnesses. I am glad you are doing better, but sometimes neither talk therapy or meds will offer a solution.
17
@Kathy Boyce
Severe mental illnesses almost needs a separate category and calls for integrated care including hospitalization at times.
2
Good for you Ms. Korducki! Just what you've written here sounds to me like you at least have a firm grasp on so much of the ridiculous "outer" medical world in which you navigate--obviously a "big pharma" bureaucratic system is not at all what you need when in emotional and mental upheaval and pain.
And brava to you for keeping up so many good health-inspiring ways of living your life. Personally I have found all of those things you are doing to be wonderful in helping offer a reward of balance to dealing with emotional distress.
Personally I've found a very good way of coping with emotional upheaval is by constantly practicing focusing my attention (i.e., the mind) only on being in the immediate moment--of course, fully exercised, it's called meditation technique. But, just to only give attention to what's in front of one--doing the dishes, reading a book, making a meal, talking with another, etc., helps to keep quiet the "inner dialogue" and so many of those feelings that can add distress to the fast-moving and frighteningly domineering emotional upheaval.
I also would recommend (if you're not already familiar with her) the offerings of Pema Chodron, an American Buddhist nun, who teaches how to do this focus (meditate) to help soften struggles with our emotional self--she does a great job of showing how much our feelings of fear have such power. Her work can be found on YouTube or by visiting the Pema Chodron Foundation website.
6
I agree with the premise of this article. I feel like psychology and psychiatry are too limited in their approaches. However, I feel that a combination of medicine and Dialectic Behavior Therapy is a good comprehensive treatment, but it is too expensive for most people and insurance companies won't reimburse for it. Mental health care is just as important as medical care, but the insurance companies don't take that attitude. In the meanwhile, most people will just continue to be medicated without hope for a better recovery.
3
The entire article and most of comments assume that the natural state of affairs for a human is for them to be happy and contented, and that there is a path, or drugs, or knowledge that will lead to this state.
But based on my experience of knowing humans for the last six or so decades, that ain't necessarily so. Just accept your suffering - you and every person will have suffering in their life, you can't avoid it. But don't make yourself suffer more because you can't escape all suffering.
9
@John Keno
Very sorry to read this. “Just accept your suffering” could be advice that could lead to someone’s suicide. Please choose your words more carefully. “Suffering” may be far different from clinical depression—for which there are treatments available.
4
@Margie
Fortunate for those folks, Buddhism has been looking at ways to help one learn to accept their suffering for about 2600 years, lots of help there. Its kinds one of the tenents of that school. Beside, the so-called anti-depressive drugs don't work, or work primarily through the placebo effect as almost everyone in pharmaceutical industry will privately admit.
2
Well said--direct, concise, & spot on!@John Keno
2
Yes, fewer psychiatrists do therapy. Yes, you'd often need to pay out of pocket for it due to lack of insurance coverage. And yes, it is a shame.
The fact that therapy is necessary in addition to medical management, however, is no secret.
In the psychiatric inpatient hospital I rotate at, psychiatrists do medication management (though sometimes they forego medication) and some therapy, but there are also in-house talk therapists, art therapists, music therapists, social workers, etc. These are all integral members of the healthcare team.
It is really not supposed to be us-vs-them. I'm glad you have found your own multi-disciplinary approach.
One more thing:
When someone presents with an immediate plan for suicide, or is speaking to someone who only exists in their head, or has thoughts of hurting someone because of a delusion... I could go on.. they need help *immediately* - someone please page the psychiatrist.
As I understand it, sometimes you need to address these known chemical imbalances before contemplating the "ebbs and flows of life."
There is tremendous variation within "mental illness." There is no shame in any of it.
30
Having experienced mental illness both in myself and my son, I've realized that it is different for each person, even for those who share DNA. While I agree that therapy is essential for many people to get healthy, the "chemical makeup" of the person cannot be dismissed. My illness reared its ugly head in 1981 (7th grade), pre-prozac and pre-SSRIs. Talk therapy was the only option. The therapy helped manage the illness, although I remained a depressed teen who searched endlessly for a hidden trauma that could explain my suffering. In 2000, after the onset of postpartum depression, my doctor prescribed an SSRI. For the first time I felt "normal." Not dumbed down. Not in a fog. Totally me, just without the constant rumination and fear. My son's mental illness also began in middle school. A psychiatrist prescribed him the same SSRI that I had now been taking for 15 years. It was a disaster. The medication made him agitated, impulsive, unrecognizable. Over the course of a year we tried half a dozen other psychotropic medications while our son's life completely unraveled. None of them worked. The therapy, CBT and DBT didn't work. The hospitalizations didn't work. Ultimately a psychiatrist researcher studying treatment resistant depression and suicide prevention discovered a brain-based metabolite deficiency - "a medical pre-ordained sickness." Without the correction of which, our son would not have improved. With suicide rates steadily climbing, we desperately need more research.
19
Articles like this are the classic case of correlation and causality. I'm happy Kelli's solutions work for her, but there is no reason to believe that her ideas would be useful for anyone else, and might even be harmful to many.
11
The so called chemical imbalance model is an invention of the drug companies that sounds good but does not match any physical process that anyone has ever demonstrated. Appropriate treatment for mental disorders often includes medication and some form of therapy. For some disorders such as depression, medication and some specific types of therapy have been found roughly equivalent. The combination is probably better than either alone. For some other problems such as anxiety disorders. some forms of therapy have been found more effective than medication alone. All therapy is not equal. Some specific forms of therapy such as CBT have been shown to be effective for a number of different disorders, and superior to some forms of "talk" therapy.
2
NYT published an article on 2/11/2019 "Shortage of Anxiety Drug Leaves Patients Scrambling". The drug referred to is Flurazepam, a benzodiazepine drug prescribed for some patients with insomnia and anxiety. I can't imagine how the FDA has allowed this crisis to continue. The drug shortage is expected to last until December 2019.
2
I am an educational psychologist with a Ph.D.
One issue I would like to highlight is that a psychologist with a Ph.D. or Psy.D. has engaged in specialist study for six to eight years, but not trained or qualified to prescribe drugs.
It is an all-too-common mistake to view psychiatrists as the supreme purveyors of mental health care and much more appropriate to see them as one of a group of specialists each of whom have distinct skill sets. I have the utmost respect for some psychotherapists with a social work degree, and know that psychiatrists simply don't have the time or the mindset to be everything to everybody.
The other is that there are certainly individual differences in genetic and chemical predispositions to mental health problems. There are also times when medications are contra-indicated and other help such as family therapy is essential. A comprehensive initial evaluation is needed to uncover these critical factors and can take twenty hours or more. This process belongs to the clinical or school psychologist.
We need to establish a system of coordinated mental healthcare for all patients which includes both clinical psychological and psychiatric care as appropriate. Medicating the poor because it is all that is provided by a broken health care system is against good practice and unjust for many reasons.
5
Another great book on the topic is "Lost Connections" by Johann Hari. The book discusses a myriad of topics as they pertain to depression including the fact that pharmaceutical companies can pick and choose which studies they publish, enabling them to publish only the studies that favor their drugs. Additionally, anti-depressants that work better than placebos only work slightly better than the placebos. Although some people are helped by anti-depressants many may be experiencing a simple placebo effect thinking that the medication is helping them and so they feel better. Of course, some people need medication for some psychological problems, but the evidence that it significantly helps depression more than other non-medication techniques is scant.
5
Pharmaceutical companies are no longer allowed to publish selectively. This was true in the heyday of SSRI studies and approvals. Now, all trials must be registered in advance at clinicaltrials.gov and their results reported.
2
I experienced a lifesaving reaction to Prozac. After becoming hormonally thrown out of whack by the necessary removal of my ovaries and uterus at age 26, I spent the next ten years entirely lost from myself, trying talk therapy, spiritual searching and prayer, and looking for love and self-acceptance in all the wrong places, in order to experience an unachievable sense of well-being. I can pinpoint the place where I was standing after only three days of Prozac when I felt my head break the surface after ten years of struggling for air. I still remember the deep relief of feeling, “I’m back.” Thirty years later I still take Prozac, and I’m still here and still me. I continue to believe in therapy and spiritual nurturing, but like the third leg in a tripod, the biochemical component needs to be functioning properly in order to achieve personal stability and well-being.
22
Treating mental illness is not just one thing. It takes multiple things and all at once. Just psychotherapy is not enough. Just medication is not enough.
Here’s what it takes:
- A well-trained professional making the right diagnosis
- Acceptance by the patient and the family of the diagnosis and the need for treatment
- Correct medication (one or a combination of several, which often takes awhile to figure out)
- The patient actually taking the medication every day
- Effective psychotherapy (which needs both honest effort by the patient and finding the right therapist)
- Healthy living (healthy diet and frequent exercise)
- Getting enough sleep
Yes, all of that is needed. It’s no wonder almost everyone is not satisfied with the results.
9
@Tony S
Excellent 7-Steps. I would also start with a good physical exam.
1
Thank you for this piece and the clarity it can offer not just for others who also live with psychiatric brain disorders but for all the people who don’t have one but have the desire to understand mental illnesses. Stories of self study like yours are one of the most powerful tools we have to educate people, thus creating an environment where stigma is replaced by compassion and acceptance. As for your “maintenance” of your life with a PBD, I call it “managing” as in “I manage my life”. This either begins or ends important conversations.
3
Spot on. But nothing can be achieved if the patient himself does not believe that the root cause of mental illness is chemical imbalance. My son has been in chronic pain for so many years. As a physician I've tried so hard that his neuragic pain has morphed into neuropathic pain. And one of the treatment for that is use of anti-depressants and other anti-psychotics. As he puts it he does not want to be addicted! He refuses to understand that neuropathic pain can result in depression.I have tried to point out that his severe anger management issues, severe melancholy and feeling of hopelessness is a chemical imbalance in the brain. But unless the patient recognizes the fact, everything is moot. And it does'nt help that there infinite number of untrained talk therapists who are just undergraduates licensed, after 6-month courses!
7
@NNI, hmmm, I’m not sure what “licensed undergraduates” you’re referring to. Licensure in the mental health field (LPC or LPCC and MFT in most states) requires a masters degree, additional coursework beyond that, and 3,000 hours of supervised clinical experience in order to get licensed. Ask for the pracritioner’s license number and look them up. Get recommendations from people you know. Look at listings in Psychology Today. Best of luck to you.
1
@TG
There are people who prefer a life coach with 6 months training!
perhaps that is what @NNI is referring to.
Best article on mental health in a while. Another in the times by a doctor told of his spending a short time "listening" (counseling!) to a long time patient with a rebirth of problems and he realized a better solution was a different medication. Maybe counseling and prescriptions are part of the solution. We are still in medical infancy on mental health.
5
I am starting my 23rd year of psychotherapy and I attribute my therapist’s persistence to finally pinpointing the root cause of my long-seeded anxiety, depression and resulting inability to get out of my own way.
The diagnosis is ADD...and it took collaboration between patient, psychologist and psychiatrist to get the right solution. I still have some issues with depression and anxiety but a year after making all the changes, including how I recognize my challenges, my progress is terrific.
I lament the years of missteps in my life and wonder where I might be now if the underlying issue had been diagnosed in my teens (I didn’t go to therapy until my mid 30s when I became overwhelmed in a high-pressure career) but I finally have the insight and maturity to accept and manage a frustrating condition....and I don’t think that I’d be in this place had I gotten a quick fix.
8
I was diagnosed as having schizophrenia in 1990. My psychiatrist told me instead I had, "Temporary Reactive Psychosis." I didn't know what it was, and he never told me. I would tell other healthcare providers, and they didn't know what it was. It was not until the mid 2010s that I was finally correctly diagnosed as having schizoaffective disorder - bipolar type. Medication helped, but I have encountered uncaring, and incompetent psychiatrists whose only duty they seem to think of theirs is to push pills. Since I didn't have insurance, I had to see psychiatrists on a sliding scale basis. This would be for 15 minutes, and there was no talk therapy. The doctor would ask how I was doing, any concerns, and then give me refills. Then, in another 3 months I would see him again, and the routine would go over and over again.
In the past 28 years, I have had 8 psychoses, and hospitalized 7 times. It has been a revolving door of imprisonment when I have been hospitalized, because what they call stabilization is really warehousing of the mentally ill. There is such a shortage of psychiatric hospitals and beds within these hospitals, it is a non-stop entry for people in crisis. People come the ER when they are in crisis, and hospitalized for a week or two until they are stabilized, given a new dose for their current prescription, or a new med, that is supposed to work this time. Out mental health system is beyond broken. And, nobody cares...
32
@Dan S.
I am so sorry. We need national mental health insurance.
And national health insurance.
A person at the street corner: sometimes physically disabled, some the disability is not obvious. but his sign says: please help. I do.
1
As an immigrant coming from a background with little to no knowledge of mental disorder, I always thought that whatever I feel is totally normal and I just need to man up a little and everything will be okay. Acquiring an education in an American college changed that for me though. As I started to become more aware of the surrounding, I also started to become more introspective. Eventually, due to the help of a good friend of mine, I was able to get started on therapy which I always thought I never needed. Later, I became okay with the idea of taking a pill, which again, I thought I never needed. After few sessions of talk therapy and couple weeks on a pill, I am happy to say my mind became much more stable (how I describe it) and I am much more content with life than I was before.
But I do agree, it is not just a chemical imbalance. It is also the consequence of the environment we live in.
8
I didn’t see any commenters who self-identified as working at a health insurance or pharmaceutical company. It would be interesting to read responses to the article — and to the other commenters — from those perspectives, too. Do you believe your companies bear as much responsibility for the poor access to talk therapy as many are claiming? What can you say in your industry’s defense?
4
@Matt, there are no fat cats in the backroom twirling their mustache. Pharmaceutical companies rely on basic science research, from physicians and researchers. Most of them work at the NIH. Drug discovery in the brain is difficult because it is extremely expensive and time consuming to do safety studies. Many therapeutics don’t make it. Those that do get marketed. By pharmaceutical companies because that’s how our economy works. It may feel good to blame “Big Pharma” for our lack of new/better medications but it is much more complicated than most people realize.
1
Thank you for reminding us that Big Pharma can't solve everything. As the article informed us, there are a combination of elements that contribute to maintaining a balanced state of mind. And one other element should be included here - meditation - be it zen, transcendental or homegrown - a little goes a long way!
3
The diagnosis and management of "mental" health or illness is extremely difficult, more difficult than dealing with "physical" illnesses. The difficulty is inherent in the nature of mental illness and it is made worse by the stigma of mental illness and the inadequacy of the mental health "system."
The use of "chemical imbalance" to describe mental illness is not something designed to sell drugs or replace other forms of therapy. There was not an a priori theory of the role of neurotransmitters in mental illness, the role of neurotransmitters was discovered because some drugs were found to improve symptoms of mental illness and researchers worked backwards to the neurotransmitters involved. And many who suffer from mental illness prefer to use the terminology about brain chemicals to try to avoid the stigma of a "mental illness."
Treatment studies of mental illness demonstrate that a combination of appropriate medication and psychotherapy works best. Neither approach is a miracle cure; not enough is known about each to decide which medication or therapy is best for which patient.
Someone who wants psychotherapy does not need a psychiatrist, specifically. They are not better at it than clinical psychologists, licensed clinical social workers, marriage and family counselors, and other therapists. These other practitioners usually work with psychiatrists for medication management.
6
Humans are so complex, the only conscious creatures we know of. And that unique, incredible consciousness is inextricably linked with psychological and existential suffering of various degrees. We need to get over the idea that a “normal” human is a happy one. Normal humans are vulnerable and small in a dangerous world and someday we will die... we all have ample reason to be anxious, depressed, and scared all the time. That’s “normal”, and no amount of medical intervention can save us from existential crisis, if we’re honest. It’s amazing how often any of us manage to be just “ok”, not to mention truly joyful, in life.
I think religion and ancient wisdom traditions need more attention in our discussion of human psychological suffering... we are just as much “story” as we are “stuff.” I agree with Dr. John Vervaeke that we ought to be skeptical of the quest for the magic bullet to fix our mental/emotional suffering. Drugs (might) help, but we need a meaning in life that can transcend and transform those kinds of suffering that are an unavoidable part of human existence. Someone I love takes an anti-anxiety drug which enables him to function without panic attacks. This frees him to live and love and work, and to bravely address those aspects of his suffering that medicine can’t touch.
5
Their certainly are chemical imbalances which produce mental effects such as hallucinations confusion slurred speech etc. but I have yet to meet anyone who was even mostly free of strictly psychological impairments. Maybe it's just the crowd I hang with but I think these problems are universal. The most common problem is the persistence of the mother -child romantic bond which is essential for the bonding of child to mother which after lying quiet for years reasserts itself in adolescence leading to the intense crush type of love which can re awaken all sorts of feelings of desperate infantile neediness. These problems can lead to all sorts of intense emotions and probably contribute to the large number of homicides arising out of romantic relationships. Think of the songs which convey the message "I can't live without you, You're the one, Only you" etc.
Fortunately these issues can usually be controlled by strictly psychological means without resort to medication but this requires the help of highly trained people.
1
Look at the package insert for an SSRI antidepressant.
Look at the section on mechanism of action. You'll see-- they don't know how these drugs work.
They also don't know why about a third of people on any particular antidepressant get better, a third get worse, and a third stay the same.
Or why a person can respond to one and not another when their mechanisms are supposedly similar.
These medications help some people, no question. But so do tools like reframing, learning harmful patterns of behavior, triggers, etc--which is what therapy is about.
Drugs are for managibg the present. Therapy is about the future.
4
As I read these comments, I reflect on my almost 90 years on earth and count my blessings. My childhood was not a happy one. I lost my mother when I was 8. My father was a domineering type and I floundered for many years. I guess I should have become a basket case. I married, had children, provided for my family. Fast forward to the present... I live alone. My wife died of Alzheimer's a few years ago, my children have their own lives to live. After my wife died, I came to the conclusion that a life is waisted if it isn't productive. I got a job as a volunteer at an assisted-living facility. Most of the residents are senile and they are lonely. What they need is someone to talk to and to pay attention to what they try to say. I can honestly say it's the most rewarding job I ever had.
26
Let’s parse this out a bit by known facts. Depression has a proven genetic component, is seen more commonly “together” in identical versus fraternal twins, and key - when diagnosed properly - responds to medications. Trying to downplay the role of the brain in mental illness is like saying type 1 diabetes is “environmental” because external factors - eg diet and exercise - impact the disease process. As a rule, most medical conditions involve medical treatment and social support of some kind. Only psychiatry, alone in medicine, indulges in the belief that medicines are optional. This sort of faux holistic view also leads inevitably to stigma, as if depression is not biological, it becomes the fault of the sufferer. Personal experiences are important, but they should not be substituted for actual data.
6
I was carelessly put on Zoloft when I first moved to NYC in 2001. I was anxious and had insomnia. It worked instantly.
Although I believe the 8 years I took Zoloft I wasn’t truly myself. I was an SSRI induced person. When I look back I see someone who was very impulsive and belligerent. After a while I developed tremor side effects and I started to have intense suicidal thoughts.
I picked up one day and moved to Antigua, Guatemala to start over and lived their for 3 years. I started a new life without anti depressants. I flourished. I got to know myself. It was like I was coming out of a fog and waking up.
After moving back to New York a few years ago I started talk therapy which gave me the tools to deal with anxiety and depression. I eat healthy and lift weights 6 days a week. I know everyone has their own thing that works. This is what worked for me.
7
The tendency of a segment of psychiatry to focus on the physical for too long ignored the ways that everything from family dynamics to outright trauma can effect our mental wellness. In a misguided effort to destigmatize mental illness, organizations like NAMI worked diligently to focus on the idea that it is a "brain disease, which should thus be seen as no different than any other physical disease.
Yet, most folks know that we are effected emotionally by our daily lives, relationships, work, struggles, set backs, reverses, crises, traumas and a host of other life events. Sadly, psychotherapy has long been much derided as the environment for the "worried well," as if the pain and real-life struggle of those who seek a therapist is merely something to dismiss as simple weakness or even imagined.
There are, and continue to be, psychiatrists (along with psychologists, psychiatric social workers etc.) who offer psychotherapy using medication only as a supplement. Unfortunately, part of the push to focus on medication came from the healthcare industry. One-on-one psychotherapy is expensive because a doc spends 45-50 minutes with an individual patient - three times (or more) what an internist might spend. Despite laws demanding parity of coverage, insurers have ways to limit access to far less than many people need for full recovery or ongoing support.
5
After years of being exhausted, bone-tired and told I was depressed and needed anti-depressants, I did some research and requested thyroid testing.
Turned out I had Hashimoto’s disease and was severely hypothyroid. I did need medication—just not for depression.
5
@Alexandra
In addition to getting the usual thyroid function checked (TSH level), you need to request that your doctor also check for antibodies in your blood sample in order to find Hashimoto’s disease.
2
Moderation, exercise, lack of trauma, economic insecurity, a planet hurtling towards inability to sustain human life - or a lack thereof. So many elements to ‘Mental Health’. not to mention the increased screen driven rush of life, the lack of control over our schedules - our ‘agency’- this lack of scheduling control precludes regular psychotherapy, even if one has the money and intention.
there really is not a compelling, coherent understanding of how these medications ultimately work, or don’t. however, in my 30 years as an md, mostly psychiatry - if a medication really helps a particular individual - that is golden. if it helps for a year, is slowly withdrawn, the symptoms come back within 6 months, the medication is renewed, the person is much better again, and that is sustained. that is pure gold.that you hang your hat on. and, yet, things can still change.
regular patterns, long term sustaining relationships, a safe environment, love - may we all have these, I pray.
4
As a retired behavioral healthcare executive with many years of successful program development and witness to many other exciting promising creative interventions, I can only share your frustration and anger. The multiple systems of care, treatment and support have been driven almost exclusively, by the healthcare finance and payment system. (Medicaid and Medicare) Further, children, youth and family services have been largely neglected by a system that almost totally focused on the closure of the state hospitals and the need to treat and support these adults in the community. This itself was a disaster of epic proportions as many if not most were dumped onto the streets. Times have certainly changed but our healthcare finance system remains broken.
6
Absence of care and treatment in the state hospitals amounted to nothing more than "warehousing" of people, which equated to nothing more than imprisonment without having been convicted of a crime and afforded due process of law -- which obviously violates the Constitution. The problem was and remains lack of sufficient funding for proper care and treatment for the mentally ill.
2
As someone with PTSD, talk therapy was merely re-traumatizing for me. It just dredged up all the pain.
What did help immensely was EMDR therapy. It was a life-saver. I strongly encourage those with PTSD to look into it.
7
Prozac nauseated me.
Paxil addicted me. Trying to go off it was the worst experience of my life: I couldn't sleep; I had no appetite; I couldn't control my thoughts; my dreams were all nightmares. People thought I was crazy. I never really recovered from that.
Citalopram or Celexa saved my sanity. It's an SSRI, too, but it fit me better. Like all such drugs, it comes with a long litany of side-effects. I suffer mainly with dry mouth, drowsiness, brief nausea, and wild dreams. Yes! I dread going to sleep: I get in a loop and can't escape till I wake up sweating and yelling. It's awful.
But enough about me. I would avoid psychopharmacology -- if you can. I read the commenters here who insist that they are wonder drugs. Maybe so, but I also wonder if the placebo effect may be in operation there.
Of course, everyone is slightly different, but I wish I had never jumped into this pill pool. I was much better off before I did; I traded a Buick with a few problems for a Chevrolet with worse problems. Look long and hard, brother, before you leap. Many times, you can't go back, which my doctor never mentioned. He probably didn't know himself. Now I'm stuck with the bill that you never stop paying.
4
This article is missing something. It is missing the trauma story or stories that are at the root of the author's illness. It is much more polite and sophisticated to say "I have a chemical imbalence". That the author can admit this is surely a sign of maturity. That is what I used to think about myself. My own mental illness was genetics and brain chemicals. Then at the age of 49, a memory of being sexually assaulted as a child. I was broken by my own father. Now I understand trauma changed my brain. And part of my own story is how I protected evil, at the cost of my own health.
I will know for certain that society is sick if the monster in the White House is re-elected. This clinical discussion of medication and therapy makes me mad because I suspect that as a child the author had her heart broken repetedly or lived in fear. That is a higher truth which, as it is hidden from public, gets no justice or notice.
I have found peace by forgiving my father. And that idea did not come from a therapist. It came from my husband and God. In this article abnomal brain chemistry is the scapegoat. The villain or villians are only discussed in private with the therapist. It is more civilized that way. Broken people take too much blame on themselves.
8
The term “talk therapy” connotes a simplistic approach to psychotherapy as simply venting about problems endlessly. The science of evidence-based therapies such as cognitive-behavioral therapy has provided solid evidence that time-limited and specific treatments can result in major improvements in depression, anxiety, insomnia, PTSD and other common conditions. These can be combined with medications in many cases as needed but can be highly effective on their own. It is important to differentiate types of therapy when considering how to best treat emotional problems.
3
Sometimes the roots of depression are in our genes. Hemochromatosis is an inherited disease whereby the body overloads on iron. One of the symptoms is depression. Many people have hemochromatosis and don't even realize it. The answer is simple: give blood on a regular basis to shed the iron as well as limit iron in-take in the first place. Hemochromatosis is sometimes called the Celtic curse because it is very common in the Irish and Scottish.
Ernest Hemingway had hemochromatosis but didn't know it until very close to his death.
For instances of depression caused by hemochromatosis, talk therapy simply wouldn't work.
5
"The primacy of the chemical imbalance theory of mental and neurological disorders may be at the root of the problem."
Big Pharma makes millions by selling mental health as a chemical imbalance just as they do with many other drugs. They don't care whether the drugs actually work only that their shareholders make money. They also don't care about whether people die as we have seen with their pushing of opioids onto adults and children.
Mental health issues are helped with some drugs but also with counseling and other therapies.
2
Mental illness is the dark matter of human health. We know it exists because of the impact it has on our lives but we do not truly understand it. Our doctors, emboldened by the miracle of antibiotics, sought a similar miracle for anxiety and depression. Unfortunately, the human brain is the most complex thing we have encountered in the universe and does not lend itself to reductionist remedies; our suffering takes place at a much higher level of analysis. Chemical imbalances are a bogus marketing claim.
2
I am glad the author has found what works for her.
However, before we toss out medications completely due to the big bad Pharma, please consider my late mother-in-law. A loving, wonderful woman able to enjoy life while on lithium, but the living embodiment of a nightmare when she wasn’t. Born in 1923, in her day those with mental disorders were institutionalized and rarely spoken of. The shame of being diagnosed with a mental illness when she was around 35 was something she absolutely would not accept. It was only when it was explained to her that she had a chemical imbalance—similar to any other chronic disease—that she consented to treatment. She had 30 wonderful years, and then she had to have back surgery so her docs took her off all her meds. She never took lithium again, and her last two years of life were agonizing for her and for those of us who loved her.
So don’t throw the baby out with the bathwater. Mental illness may turn out to be like cancer in that there is more than one cause and more than one treatment.
10
My suggestion to you is to leave the country for at least six months to another country that has a different language from the one you speak now. Maybe study at a university, or find a job, whatever. I would also suggest no boyfriends, no international romance. Just you.
You pick the country and the reason you want to go there. The primary purpose of my suggestion is to simply leave the USA for while to a different environment.
The USA has the most expensive, least effective medical system in the world. Preventable medical error is the third leading cause of death in this country. The USA and New Zealand are the only two countries in the world that allow direct to consumer advertising of prescription drugs. Medical professionals in this country do not look after the best interests of their patients. They see their patients as income producers. Our medical system is thoroughly corrupt.
Have a nice day and try some Italian ice cream, the real stuff.
5
I have a nephew who suffers from schizophrenia.
He is very creative and always, always thinks outside the box
[ Not sure he ever thought inside the box. ]
He is a very hard and responsible worker but
he often loses his jobs because his suggestions on
how to improve the company are not taken well.
He is kind and thoughtful to all that he meets
and yet he is treated poorly by society.
Why is that ?
5
@John Brown
Because we are all insecure.
We live in a hostile universe made worse by our brand of cut throat capitalism. Lose traction, lose power. Lose power, lose your job. Lose your job, lose everything.
In such a world, it is much more important to win arguments than it is to be correct or to use an argument or discussion to find the truth. People aren’t interested in finding the truth, just surviving, which means hanging on to power by any means necessary, even if at the expense of the truth.
Our society is on a vicious cycle of insecurity generating ever more insecurity and aversion to truth and better ideas.
In all probability, this will not end without some major upheaval.
Hopefully your nephew can find traction in various other spheres of life where creativity is more allowed. Perhaps art, or music, or maybe entrepreneurism of some sort.
5
@Tim Kane
This sounds like a spin on "they're just jealous of you" type told to children who can't manage to make friends.
They may be jealous of your smarts, but you're not that smart if you can't figure out a way to get through to them.
In the workplace, things are the way they are for a reason. Unless you know what those reasons are, your suggestions will often fall on deaf ears.
Newcomers are ignorant of a company culture's history, and how things came to be. Maybe things would be better if they all listened to the new guy.
Or maybe they got to be such a mess because they listened to the last new guy, and the one before him, and so on.
1
Congratulations on finding your way toward mental health!
As one who has been there and finally conquered severe depression over a period of 3 decades, I have often thought, if I were a counselor, I would start my therapy group with benign experiences: gentle exercise, nature walks, healthy meals together, drawing, creative movement, and sharing of hobbies and happy memories - with no discussion of problems allowed until later.
After a few months of positive experiences, we would study Buddhist, non-violent communication, and cognitive therapy principles. We would keep journals and contemplate the importance of forgiveness and inevitability of change. Next we would do role playing, through improvisation and puppets, to practice ways of challenging and transforming our habitual thought and verbal patterns.
At some point, we would make posters depicting all the factors that were affecting our mental health - from personal heredity, bio-chemistry, and life experiences, to family, ideology, and community, cultural, historical, and global contexts.
This would probably take a few years, but medication might not be necessary.
3
@lifecyle
Maybe you should consider being a counselor. Your ideas of treatment are so gentle and humane, they could not fail to help people. Maybe even helping to counsel youth. They need such kindness and understanding.
Medicaid got me through the door to a mental health counselor when I was having trauma-related scary anxiety and depressive episodes that were causing me trouble at work and in life. I had been trying to fix myself with exercise, diet, and hard work--and it was not working. I was extremely distraught, and I thought therapy was for rich people, not me. With Medicaid, I had no copay. I even got a Metrocard with subway fare for every appointment (this was NYC in the aughts). Four years of that, which included a gradual weaning to a very reduced out-of-pocket expense to see same counselor at her private office.
Then I moved, and I had a glorious two years of ACA subsidized insurance that paid for weekly psychologist.
I had to move again, and was then mentally strong enough to call around and find a psychologist in my area willing to accept a greatly reduced fee. I've been seeing him for 4 years. Two years ago, I finally accepted all of these therapists' suggestions to begin antidepressants. They have provided the ability to go deeper into talk therapy, and it has been even more life-changing than I ever thought possible.
Grand total: 10 years of talk therapy + 2 years antidepressants = Leaving abusive relationship, obtaining a graduate degree, and changing careers to something I once thought was only a dreamy possibility.
This amazing life was made possible by government-subsidized health insurance. Human beings deserve access.
53
@Desi
Congratulations on your hard work and recovery. It is good to know that treatment efforts really can work for people and that we can change our lives for the better!
5
@Desi
Yes, Our Nation needs a national insurance program. All a national program means is that all of us are in the pool. And profit is not part of the payment.
National Health Insurance would help a lot of people and our nation.
2
As a sixty-something woman suffering with lifelong depression, I must admit I was caught off guard by this column.
Then I recalled that the writer has no idea what "treatment" was like before the advent of SSRI's. For years before then, I wasted time and money on counseling - none of it helpful. This made me start to question what was wrong with me -- after all, all this "exploring one's feelings" seemed to help other people.
Well, fast forward to Prozac. SSRI's literally saved my life. By the early 90's, I was on them daily, and still am. These medications made it possible for me to have a successful legal career and raise a daughter who is now a wonderful young adult.
Without the "chemicals" the writer mentions, I was drifting inside a black hole, with absolutely no sense that I could ever see my way out. In a sense, depression is an addiction to death -- at times, death seems like not just a solution, but the only solution.
And inside of just a couple weeks after starting these medications more than 25 years ago, I began to wake up, believing that I might actually be able to function in life, that I could start climbing out that black hole. And for more than twenty years, my "counseling" sessions have been at a minimum, and are designed primarily for my doctor to see that my medications are still working.
I am still on these medications, and I know I will be, for the rest of my life. But I absolutely shudder to think what my life might have been like without them.
62
@Everywoman, you are not alone.
3
@Everywoman
Thank you for telling us about this. It is true that some medications work well for some folks.
2
"But I fantasize about a future in which mental illness is understood less in terms of static diagnoses and psychopharmaceutical stopgaps than each individual’s symptoms and the circumstances that might inform them."
But right now this is in far too many ways a fantasy, and neuroscience doesn't seem to promise any shortcuts to mental health nirvana. To be sure, there is much poor psychiatric care in this country; much overuse of SSRI's (and other psychotropic medications); and mental health care that is often much too expensive.
But we live in the world as we find it, and the emotional and cognitive struggles for many are great; they, if they're lucky, will be able to access the medical tools at hand for help. And as Korducki suggests, there are common sense ways to deal with the many painful and difficult realities of being human.
Still, it is worth stressing what Korducki seems to note in only cursory fashion: SSRI's have provided countless people suffering from clinical depression with tremendous relief, even if the neuroscience undergirding such pharmaceuticals is highly imperfect. Absent a medical fantasyland, we need to accept, if critically, the remedies at hand and hope that research continues, as it has for more than century now.
The bashing of SSRI's in all manner of ways has become far too fashionable, and this seems to me both unfair and unwise.
8
Excellent article. I was diagnosed as having a "chemical imbalance" in 1974 while in college. The diagnosis allowed both myself and my family to sidestep deeper problems rooted in the way we handled our emotions. Our emotional patterns were adaptations developed by my family in response to trauma over generations.
It took me well over a decade to gain the strength and insights that would allow me to take a look at myself and begin to heal. Unfortunately, my birth family was not able to join me in this process.
I am deeply grateful for the life which I now know. I have been able to gain my life by using my difficulties as a doorway to know myself and life. I've learn to acknowledge my emotions and use them in a constructive way I am able to do that without the use of chemicals.
I think one of the difficulties with emotional healing in our culture is that knowledge of the self and its cultivation is not a cultural value. Certainly not among our religions, and not in our educational system which is based on performing tasks outside of our selves. Psychiatry can try to make up for our our lack, but learning the ways of the self is not a simple process, and funds to support psychiatrists in this role are in short supply. It's much easier to prescribed pills.
I don't know an answer for our culture, other than simply be honest about the life that we know, and hope that others will also want the same sort of life.
8
I saw numerous psychologists and doctor while an adolescent and young adult and suffering from anxiety and depression and not one of them offered anything beyond medication and the "hereditary" theory. Even worse, not one of them asked me about my dental hygiene and diet. This shocks me now because I recently discovered that silver fillings (mercury dental amalgams) and root canals cause major metal and bacterial toxicity to the brain and other organs that can trigger depression, anxiety and many other illnesses. I recently had all 12 of my silver mercury fillings removed by an IAOMT certified biological dentist and I have started a detox program that includes lots of vegetables, some animal protein, certain minerals that help detox and coffee flushes. I no longer suffer from the crippling anxiety I once had and I am furious at the medical system that failed me for over 20 years and which allowed a dentist to put such poison in my body at the age of 10 and psychologists too ignorant to realize that many mental illnesses are caused by heavy metal toxicity and severe mineral deficiences.
5
I am watching “progress” experienced by one of my extended family members.
Being a professional, I am amazed with lack of resolve.
From one nonsense of “chemical imbalance” to any nonsense, the uneducated psychiatric mind can perceive.
What I see is disaster in making for those who suffer.
The dogma “ pill for ill” works well for Big Pharma only.
Have you ever asked why in North America physicians are
not required to pass professional knowledge updating tests
every few years like in Europe? Have you ever considered
it a practical joke played on you as to how the Food and
Drug Administration, the policing body, is being funded?
Shall we accept the Orwellian paradox: “Ignorance is Strength”?
Our ignorance is a win only for Big Pharma and
its associates; they love it. How should democratic society
react to this incredible threat and resulting rip-off?
Please give it a thought.
2
It is a travesty that the reductionists (psychopharmacologists, drug companies & insurers) have demonized psychological care. It is also much harder to become a skilled psychotherapist than a prescriber. It requires the use of oneself as a container/receiver.
Modern neuroscience has demonstrated that experience tunes the brain, early life stress changes the capacity of the median raphe nucleus to modulate emotion response- like a damaged thermostat. Too much chaos & intensity throws off the sensor.
Psychotherapy is not 'babble.' It is the faulty models that sell medication that is babble. We do not even know how to find a 'thought' in our biological model- let alone the cause of most severe mental suffering & dysfunction. Serious psychological treatment takes time- and yes- it is much less available to poor people. Perhaps universal health insurance can reduce this inequity and Psychiatry can revive it's attention to the Mind, consciousness, meaning, attachment and mentalization and restore sound training. In the meantime, MDMA, ketamine and psilocybin are trying to leap frog over psychological conflict and need to find language to think about experience.
4
I still say beware of this: There is a huge population of people -- psychologists, clinical social workers, "counselors" -- who have a vested interest in championing the efficacy of "talk therapy" because they are not qualified or trained to diagnose illness and prescribe medication. The couch is where they make their living. The science behind what they do is shaky. It is useful to remember that the wellspring of psychoanalysis was an Austrian M.D., Freud, who believed he could accurately diagnose a 5-year-old's fear of horses as the boy's unconscious fear that his father would castrate him. The fact that he'd never met the kid didn't deter Freud or his followers.
5
I can have a perfectly good day - good commutes, good workday, pleasant conversations, good social contacts. Yet, at some point, the despair sets in. I'm not wealthy, but not poor. I have a loving family. A vibrant and caring community. Strong faith. Good health. There's no logical reason for the deep despair that haunts me. Its not continual, just spikes here and there. It doesn't relegate me to bed, though mornings are usually the worst times. I just simply don't want to go on.
This has been going on since my teen years. Not knowing the cause made me extremely guilty as I had a lot of support and love from my family and friends and it lead to suicide attempts. Counseling was useless, until it was explained to me that it was the result of a chemical imbalance. This made sense - at certain random times, though again mostly in the morning and during the late fall, early winter, something goes awry. I acknowledge it, knowing it will eventually fix itself and in hours or perhaps as long as a few days, the despair and dread lifts.
I'm lucky its a temporary condition within my own control. Glad Ms Korducki has also been able to control it.
Many others are less fortunate.
4
@SXM. “There’s no logical reason for the deep despair that haunts me.” That puts me in awe of the complex mystery each of us is no matter how enviable our circumstances appear on the surface.
You seem only more human to me for speaking those thoughts. You have lots of company among poets and writers.
1
Research tells us that the best outcomes are usually achieved via a combination of the right meds at the lowest dose possible to impact the most symptoms with the fewest side effects AND an empirically supported psychotherapy.
9
The author's premise is supported by what's often heard from people who announce, "I'm bipolar," reflecting what their psychiatrist or other provided has said. In medicine, we don't label people by their disorder. Doctors don't say, yes, you're diabetes. The closest is, yes, you're diabetic, in itself not as humane as "yes, Joe, you have diabetes." When I hear, "I'm bipolar," I think, "as a person, aren't you so much more than that?" The term was adopted after the classic and more descriptive "manic-depression" was abolished. Chemistry of the brain may be disordered, but the need to see people as humans, with many needs and vulnerabilities, beyond their disordered chemistry, remains the challenge to all of us and in particular those in clinical fields who educate (hopefully) and influence those seeking help.
5
Lovely piece and perspective, thank you.
4
Pray as you might, to whom you might, for coping powers, then begin the journey to find the truth.
My journey thru & w/ depression began when I was 29 & lasted 24 + 3 years.
It began w/ a break up, which triggered the emergence of latent sorrow that was planted when I was 5 when my family moved 350 miles away from my then close friend & confidant, a girl named Debbie whom i had a unique intellectual relationship as our conversations involved philosophical discussion about being disempowered kids trying to gain traction in the world, that created a deep bond. My mom told me there would be more Debbies where we were going, she meant kids to play w/, I heard soulmates. I suspended grieving in anticipation of finding the new Debbie. Per Freud, an unexpressed emotion never dies, it just grows during its latency until it is strong/big enough to come forth later.
I never found another Debbie. @ 29 a short relationship came close enough that when it ended a titanic sized emotion pain came forth w/in me out of proportion to events. That pain was like a loud siren drowning out most other emotions. 1 loses the ability to feel/sense themselves, others, perspective, etc. I saw a therapist who diagnosed me w/ depression but failed to find its source. I refused medication. I had physiological reactions (chronic blue grass allergies every June on the anniversary of the pain’s emergence) all went away when I finally figured out the source of my pain @ age 54 (+3 years spent processing it)
3
@Tim Kane
My point was that I refused medication because it was an event, and experience, that caused the emergence of pain (and confusion). It seemed absurd to me that a condition caused by an event could be solved by medication. That meant merely an abdication of not solving the problem (applicable maybe to only my case, but I suspect maybe others as well).
In the end the solution did not come through drugs.
I had tried 2 therapist. The 1st taught me much that eventually helped me solve the problem but she kept a great deal of control over the process & never explained to me how it worked. After 3 years & her inability to identify the source of my problem I dropped her. A few years later I returned to another therapist but he made no attempt to resolve my problems, merely to help me cope.
My 1st therapist knew what she was doing. If she had merely done a better job of explaining the process to me - like drawing a simple flow chart of how the mind & emotional processing works, she could have enlisted me & my brain towards trying to solve the problem.
Over time, I began wondering if she was even interested in finding a solution. Curing me meant losing income. She was given a big clue to the source of my pain day 1 - she asked if I had problems with a female thereapist & I told her about my 1st friend who was a girl & my confident & so talking deeply to a female was 2nd nature to me. She never went back to explore that.
3
@Tim Kane
This description of the cause of your unhappiness makes sense to me. I hope you have many happy years to go, now.
1
@JM
Thanks. Rarely get acknowledged. People can’t fathom others pain.
Greatest event of my life was figuring out the source of pain so I could process it out but when I shared it w/ friends/family theres a sense of disbelief.
Things get better but slowly.
There were several realizations necessary to figuring things out.
1
Freud’s “unexpressed emotions never die.”
2) Frued’s concept of the Id (base instincts), Superego (higher self/guilt/conscience) & ego (ordinary part of the “mind” & mediator between id & super-ego)
3) Division of the ego between 2 selves: intellectual & emotional. The former is the adult, logical, learns quickly, from other’s experience, reading a book, but forgets quickly. The latter’s like a pensive child, learns slowly, only from experience, feels most emotions & never forgets. These 2 r like Siamese twins so must cooperate & work together.
4
4 levels of pain: Sharp, hard, soft, sorrow.
5
Pain Emirates from the child side. To be processed out of us, it has to be known by the adult side why there’s pain & it must acknowledge & go thru the pain w/ child side w/ understanding, a sort of holding the child’s hand. Normally when we experience loss we do this process naturally. After I knew all of this I watched myself go thru this when my father died - it took 18 months.
So my depression resulted from alienation btwn the 2 sides of the ego. Intellectually identifying pain is critical to processing it out of us. Do so was the best day of my life.
1
I was on and off anti-depressants for many years.
Only after moving 1600 miles away from any family, thereby extricating myself from the toxic dynamic, was I able to get off and stay off the meds.
That was close to twenty years ago.
The dynamic of my family is hate-centered, and nothing I ever do or don't do can ever change that.
In the interest of self-preservation and self respect, me and my family are done like dinner.
Not saying it's always the family's fault if someone is struggling with mental health. Just relating my own personal experience.
7
Many people with psychological or emotional problems need just a psychologist or therapist for talk therapy, but it has to be the right match of therapist and patient. And the patient has to be mature enough and ready to confront the issues. Many young people are too immature for talk therapy until they are older.
Some people need both talk therapy and medication. Medication alone is not usually helpful unless you have already done enough talk therapy to develop the awareness and skills to handle the issues involved on your own.
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@sfdphd
I’m not quite sure what you might mean about young people being too immature for talk therapy. I was 15 when my mother engaged a wonderful psychologist, kind, pragmatic to help me confront issues of poor self esteem and my place in a really dysfunctional family that resulted in some really bad teenaged judgement. I credit that talk therapy with setting me on the road to ever improving mental health. I’m not sure I’d like to imagine what my life would have been without it. Talk therapy is for all ages. A talk therapist is by necessity a good listener.
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@sfdphd I so agree with you--the right match is key, as is it being the right point in a person's life. I think you have to meet the wall of realization: where everything that used to work for you no longer does.
Also, I live in an area that has a severe shortage of both therapists and psychiatrists. As a result, primary care physicians happily write prescriptions for medication upon request from patients, without even asking if they are in talk therapy. I see the resulting adverse effects in friends all the time. It's like people can't process these new feelings that they're having, and are--see above--still trying to use the old coping systems that no longer work for them.
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@sfdphd I think there needs to be much more investigation into a possible relationship between physical child abuse and the existence of TBI's from childhood and mental illness.
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I encourage those interested in this subject to read Eric R Kandel's "The Disordered Mind: What Unusual Brains Tell Us About Ourselves". "Psychiatrists . . . view all mental disorders, both psychiatric and addictive, as brain disorders" and "we also know that insofar as psychotherapy works, it works by . . .creating physical changes in the brain."
2
@Sharon You have just contributed to a very important aspect of the treatment discussion; healthy reordered thinking can change the brain chemistry. Thanks for that!
2
They should add you to the Editorial Board of the NYT. It would expand their diversity and inclusion. Good luck with your health.
5
In my case, years of talk therapy didn't help at all for social anxiety, but Zoloft, after taking about six weeks to kick-in, was a complete cure. It dramatically improved my life and my work. There is a great deal of evidence for psychological problems bring rooted in genetics and chemical imbalance. For those people who are unlucky enough to have problems for which there is not yet a pharmaceutical solution, talk therapy, and other modalities named by the author, are a reasonable way to cope. In very few cases do they represent a cure. Some newer investigative treatments like MDMA, LSD, and psilocybin seem to hold promise. My point is that people should not take Ms. Korducki's article to suggest that talk therapy is a cure for psychological problems... it generally is not, it's a coping tool. Some of the pharmaceuticals out there ARE cures. People should not shy away from trying them because they are not 'holistic'.
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@ShenBowen Wow these letters seem to take sides, therapy vs pills while recognizing that neither is a panacea, both are inadequate. Learning to understand who you are through sitting meditation (and professional guidance in the form of qualified, certified teachers) is the more demanding route with in my experience more liberating results. Certainly also not a panacea, but a tool to learning to accept ourselves be who and what we are with confidence and compassion.
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@ShenBowen
Did you read the full article? The author isn't suggesting that talk therapy is a cure:
"To be sure, many people need medication, and greatly benefit from it. The right drugs have made my life better too. But I fantasize about a future in which mental illness is understood less in terms of static diagnoses and psychopharmaceutical stopgaps than each individual’s symptoms and the circumstances that might inform them."
I think what she *is* suggesting is that medications are overprescribed, and it can be hard to find drugs that work. It's not a binary.
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I just posted this as a separate comment, but the desire to comment came from reading your experience with Zoloft. I just wrote:
I experienced a lifesaving reaction to Prozac. After becoming hormonally thrown out of whack by the necessary removal of my ovaries and uterus at age 26, I spent the next ten years entirely lost from myself, trying talk therapy, spiritual searching and prayer, and looking for love and self-acceptance in all the wrong places, in order to experience an unachievable sense of well-being. I can pinpoint the place where I was standing after only three days of Prozac when I felt my head break the surface after ten years of struggling for air. I still remember the deep relief of feeling, “I’m back.” Thirty years later I still take Prozac, and I’m still here and still me. I continue to believe in therapy and spiritual nurturing, but like the third leg in a tripod, the biochemical component needs to be functioning properly in order to achieve personal stability and well-being.
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I suffer depression, anxiety and anger issues. I was molested as a child and have been cut off by my family for having the nerve to tell the truth. I take antidepressants. I have found that they allow me to more easily dismiss the anger and anxiety. I see no problem with that. As a matter of fact, when I find myself in my darkest moods I can take a pill a feel better. The relief is difficult to describe, but the best word I can think of is profound. It has allowed me to quit my dependence on alcohol. I have a better relationship with my partner. I rarely contemplate suicide anymore. These drugs are a part of the solution. Therapy doesn't seem to help me. I could be wrong, but the fact remains that antidepressants probably saved my life.
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@Max Deitenbeck Max, I'm truly sorry for your childhood trauma & continued suffering. But I'm glad to hear you're
doing better with meds. If therapy isn't helping, you should try a new therapist. I also recommend a religious approach to dealing with suffering & life in general. Religious faith saved my life, & later meds & therapy helped me deal with anxiety & depression that in a time of crisis threatened to overcome the life force of my faith with the death impulse of my own childhood trauma in combination with a high stress time. However, it turned out that even after the situation causing the high stress was over, I couldn't go off the meds. Every time I tried, I started feeling anxious & depressed. I didn't need meds to cope until my early 30s, & another crisis that caused my anxiety & depression to break through my meds steered me to therapy. Therapy has helped me through that & subsequent crises, but hasn't enabled me to somehow untangle the Gordian knot of my childhood-created personality that includes anxiety & depression.
The dichotomy between psychologists & psychiatrists is a chicken-&-egg issue: do the negative thoughts & feelings in response to trauma cause the chemical imbalance, or does the chemical imbalance cause the negative thoughts & feelings? The psychologist says, change your thoughts & the chemistry will change.
That's 1 of the benefits of a religious worldview: it counters the past with a purposeful present & hope for the future. God be with you.
3
@Max Deitenbeck Anything that saves your life is a good thing! But a note: Therapy doesn't work passively like a drug so it doesn't "help" or "cure" anyone by itself. The therapist has to be skilled and compatible with the client, but even more importantly, the client has to do all the actual work. The therapist is just a guide.
Or as it's often put: Therapy isn't about the hour you spend in the therapist's office every week, but the other 167 hours of that week during which you put into action what you're learning about yourself.
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@Max Deitenbeck As an agnostic, I still want to say, "God Bless you for telling the truth". You've paid the ultimate price for doing so. I'm glad antidepressants have worked.
8
This is a wonderful article and I applaud the author.
In a life fraught with clinical depression, I was deeply fortunate to find treatment at Bellevue Hospital (NYC) in 2013. I saw an absolutely superb young psychiatrist who helped pull me back from the edge. Cost: $15 a session, plus good prices for prescriptions at either the Bellevue Pharmacy or Costco in East Harlem. She encouraged me to start coming once a week for psychotherapy, rather than once-monthly script pick-up. It was life-saving.
No such compassionate care exists upstate however. Here, all patients (even the wealthy and well-connected!) must wait six months just to get an appointment with a pyschiatrist. The in-patient local mental health care facilities are snake pits to be avoided at all cost. I found that a careful talk with a caring pharmacist provided the best help in weaning off my primary medication, whose efficacy was in doubt after such a long time of taking it.
For today, in this my third week off of Prozac after twenty-odd years, it's very much one day at a time. Life is still hard. Not having to work anymore helps a great deal, as does soloing on a low dose of generic Wellbutrin, with a plan underway to move abroad.
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@Bella Wilfer
Good luck with going abroad. The chances are that you will be able to find affordable psychotherapy there. In several European countries, travelers are given necessary medical treatment, even though they are not citizens of the country. A doctor once said, "Of course, we treat visitors to our country. Why would we not? Everyone needs medical care." The U.S. needs to have such compassion for our own citizens.
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@JM Too right. Having lived abroad in the '90s, I share your opinion.
1
I agree that we have taken to going from one extreme (endless talk therapy) to the other (simply medicate). Your insight might help doctors recognize the need to address a person as a unique individual who can be helped by a synthesis of both.
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@Dee This approach is well backed up by research. I've read that people who take both medication and engage in psychotherapy have better outcomes than just one or the other. Sorry I don't have citations handy, and certainly some may do fine with one or the other - but important to recognize that it looks like most people fare best with both.
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@Dee -- As a psychotherapist, I agree. Most of my clients benefit from a combination of psychopharmacology and talk therapy. The combination allows clients to express themselves and know they're heard, to process experiences, gain understanding, and learn new skills, as their medication helps them focus and maintain equilibrium. That said, many people benefit from talk therapy and/or experiential therapy and don't need medication. And there are others whose problems are resolved with simple lifestyle changes.
13
Welcome!
Welcome, welcome, welcome to the world where you do, most certainly, belong.
Take a moment today to be proud of yourself for working so hard to address your demons, for persevering in the face of all the "experts" said, and for learning to stand up for yourself and claim your right to be free. And thank you for sharing your story so openly and unselfishly. It is sure to inspire others.
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The author made a telling statement near the end. She said she was able to finally find a therapist because she could afford to pay out of pocket. The reason many psychiatrists don't do talk therapy anymore is because insurance refuses to pay for it, and most people can't afford to pay for it without insurance. It's getting harder to find a therapist than it is to find a psychiatrist. Insurance covers medications and medication management visits. They do not pay for the hours of therapy that I usually recommend for my patients who are on medications but who also have family problems, job worries, trauma history, etc. Not to mention that many of patients tell me 'therapy doesn't work' without even trying it.
Don't blame psychiatrists for the state of our mental health care system. We're trying to do what we can and still get paid. Psychiatrists are among the least-compensated of the medical specialties, and we still go through all the training that cardiac surgeons do.
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@Liz It is absolutely horrifying how we treat mental illness in our country. Can you imagine what would happen if we treated dogs the same way that we treat the mentally ill - outrage ! And yet, we have mentally ill people that cannot be discharged from hospitals because there is no place available to send them to for continued care. In Minnesota, they interviewed the head of the jail system and he talked about how as many as 40% of the people in our jails were untreated mentally ill humans. Why is it acceptable to pay for these dear ones to be held in jail, receiving the minimum of care? Why are we not allocating the necessary funding for mental health care treatment and supportive housing so the mentally ill can progress and heal and live productive and meaningful lives ? In my state we have a billion dollar stadium that was funded with contributions from taxpayer money. A billion dollar stadium - how many people could have received supportive healthcare with that money ?
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@Liz
Cardiac surgeons have more years of training than psychiatrists, and there are fewer of them than psychiatrists. I'm not sure that explains their higher incomes.
And, like all physicians not doing procedures they are paid less than those who do procedures. The original health insurance plans were established in the 1930s by surgeons and hospitals.
Psychiatrists definitely save lives, too!
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@Liz Having taught budding psychiatrists for many years, programs increasingly focus almost solely on medications and research - psychotherapy, except in programs in some of our largest cities - is an after thought, sometimes to the extent that it's seen as necessary to maintain academic accreditation, and little else. Except for psychiatrists that have been through analytic training, most of them are pretty clueless about psychotherapy. Psychologists, on the other hand, sometimes come from programs that focus on how to do psychotherapy. But even then, there has been a huge structural change of what kind of therapy is possible to obtain without paying completely out of pocket: Insurance favors Cognitive Behavioral Therapy, which really just focuses on how to deal with symptoms - techniques to manage anxiety, depression, etc. Without ever addressing causes, which is generally the realm of psychodynamic psychotherapy. But insurance companies love CBT because it's measured in a small number of sessions - symptom remission achieved, case over. And psychology programs, in response to this 'marketplace', often solely train psychology practitioners in CBT, since insurance will not pay for extended treatment. So, bottom line: yes, it's hard to find a good psychotherapist. And getting harder the more the marketplace is driven by what insurance will or will not support.
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"What I wanted, and still want, were options."
That's funny, what most people want is a solution. Perhaps you are approaching this problem all wrong.
4
The next to last paragraph got me to thinking: How can I treat my depression/anxiety by staying active if I'm too depressed to activate myself? Kind of the chicken or the egg question.
In my case, a combination of meds, therapy and activity (physical, social and spiritual) seems to have reduced the weight of my depression/anxiety.
10
This is a nicely written piece of galaxy-sized ignorance. One shouldn't need to know that the "chemical imbalance" theory has been debunked to reach a personal sense of the internal factors contributing to one's emotional pain. We are hurt by people; we don't get enough or the right kinds of help; the pain becomes part of us, which leads to all the diagnostic symptom constellations. I tell my clients: We are not defects; we are injured.
4
@Fred I appreciate your perspective re: the impact of environmental factors, but I object to much of what you have written here. The writer has not stated that chemical imbalance "theory" has been debunked - as indeed, it has not been. Rather, many chemical imbalances related to cognitive and emotional difficulties are being scientifically validated. The writer asserts and many of us writing in here agree that the treatment trend has moved too far from one extreme (it's all environmental) to the other (it's all chemical). For someone who is evidently concerned about the well-being of injured people, your opening statement strikes me as needlessly hurtful to the writer - surely you could have made your point without being so pejorative?
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Environment, personality, genetic family history (fight or flight, survival stress, rather than chemical history), all play a role in this along with chemical imbalance. I saw this in my mother. I see some in myself. People say I have too much anxiety (they're refrain, don't worry be happy). I say I was born this way (had colic as a baby, led to great sensitivity in my well being). And when, even in my adult life, I try to relax, something crucial is missed and there is some major upheaval requiring repair and attention. Do we manifest our realities? Perhaps. Is some of it circumstantial? Yes. But like poverty, its usually a combination of factors that allows depression to flourish and a combination that will help mitigate it. There is no single quick fix. Its complex. We need to recognize this.
3
It wasn't so long ago that those with mental health issues and without sufficient income to afford a therapist were essentially on their own. Health plans were extremely slow to cover talk therapy and other forms of mental health care and, in fact, ultimately were mandated to do so by federal law, but that was in 2008. My view of this reluctance of so many to first acknowledge and try to treat
2
Great article. A purely biological approach to understanding mental illness is indeed short sighted. I'm a psychiatrist (Professor in Canada), and I think readers will want to know that almost all professional Psychiatric training bodies (in Canada, US, Europe ,etc) explicitly train their students to see mental illness as being the product of what is called the Bio-Psycho-Social model. Meaning - these illnesses are formed by the interaction of 3 spheres: Biological, Psychological, and Social factors. Yes - psychiatrists are being pushed to focus more on meds, which is a tragedy. But almost all, wil lvery be aware that other factors (like talk therapies) can be equally important - even if other (lest costly) professionals are given this task....
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I think you have written a very helpful article. I wonder what you would make of what, to my opinion at least, read like a take-down of Marianne Williamson in todays Times.
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I realize the SSRIs don't work for everyone but my wife en through 10 year of depression, anxiety, gastro issues, panic attacks, vertigo back pain all of which are classic signs of serotonin issues. Finally I googled anxiety and depression and found this out. For some ridiculous reason, I figured anxiety and depression were opposites so couldn't have the same root cause. Not a single doctor correctly diagnosed her. Went to pharmacy (in Mexico) and got a generic for like $8. # weeks later she was a completely new person with all these gone. You should always google your conditions before you see your doctor, There is a staggering amount of incompetence and dimwittedness in the medical profession.
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@Aurthur Phleger
Doctor here. SSRIs and SNRIs can be very effective for anxiety disorders. They're generally less effective for depression, but every patient is different.
Anxiety disorders include generalized anxiety disorder, panic disorder, social phobia, other phobias, obsessive compulsive disorder, and so on.
Often people with anxiety will start to get better in a couple weeks whereas for depression the meds take up to 8 weeks or more to have an effect.
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Thank you Kelli, as one from a family with generations of mental illness, I also know the devastating impact mental illness has on lives, families, cultures and nations. The suffering people with such illnesses have endured are tragic and historic.
Let’s be careful, though, not to generalize about mental illnesses. Treating a victim of schizophrenia with therapy alone is futile. Same, too, for many other mental illnesses.
Likewise, why do we call them “mental illnesses?” What happens the day we discover that a “mental illness” actually originated in the pancreas or elsewhere in the endocrine system, for example??
Truth be told, it is the division of health into “mental” and “physical” that may well be why treatments of so many illnesses affecting the brain lack cures or even research. Medicine has cast them aside or even punished people with illnesses affecting the brain. We all suffer because of it in ways ranging from gun violence to employment discrimination to bullying to suffering and isolation. Illnesses that affect the brain affect us all. It is an American tragedy that we don’t do more about it!
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Another problem of the system where the doctors do not take time to talk to patients is that they cannot tell if the drugs are having the desired effect. The drugs may be resulting in poor decision making which the doctor could tell about from some conversatio
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@Suetoo
I see patients in follow up to see if the medicine is working. That is standard medical practice.
2
This is a courageous article and I am glad the NYTimes is running it.
All I can say to those who swear by big Pharma, wait until you want to get off those drugs that you are now addicted to, and worry that the real basis of the dysfunction isn't being treated in even a minor way, so in a year, or ten, you will be facing the dangerous aspect of recovery that involves weaning yourself off the drugs that the shrinks won't help you walk away from.
Trauma trains us to be dysfunctional, and in my experience, traditional psychiatry is worse than the drug dealer down the street at understanding and helping you understand your very real suffering.
Big Pharma has a huge army it has purchased, with the right to get them money for a diagnosis, if they are willing to be addicted to those drugs.
Some of us belong to the anti-psychiatry movement, and I, for one, found help at www.madinamerica.com, in understanding why healing isn't in the DSM 5.
We need to belong, to matter, to feel safe and loved, and we get sick when that is missing.
Hugh
7
The ability to manipulate neuro chemistry is a step forward. It doesn't always work properly, it is sometimes treated incorrectly, but it is a net positive for society. As we learn it will get better. The most important next step is accessibility. With time, knowledge, research and good will it will get better.
3
Ms Korducki who is a writer has another resource to heal: writing. And I hope that doctors of all types read what she says here. My experience mirrors what has been available from the late 70's until now for treat meant of depression. But I can clearly see that the subtle interaction between chemistry and life experiences are what really shape the status of our minds. I suspect that some folks are better at passing for normal and somehow are comfortable enough to maintain an equilibrium. But what I see as I learn the constellation of my own brain that most all people struggle at some point. Some are better equipped for the struggle and some are not. Why do some with manic depression function well with help and others will not get medical attention? Why do people use their obsessive compulsions in creative ways and others self destruct? How much of our situation is inherited not just genetically but through strange twists in the generations of bad luck or extensive trauma? Here is what might be going on: humans are still evolving and we are untangling generations of mental evolution. I look forward to reading more of Kelli Maria Korducki's observations and thank her for these.
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Bravo! As I work through a bad cold and grief over the loss of a dear friend of 50 years, it's shown me, once again, time -not drugs- seems to heal. Maybe instead of telling people they're "broken, damaged, imbalanced, hopeless..." , consider sharing creativity, resourcefulness, resilience, and healthy habits. exercise, meditation, foods, naps, breaks, self-compassion, connections with supportive/kind people, spirituality, nature, hobbies... above all, giving "options" are critical. I understand "quick fixes" are preferred. Change. takes. time. yes - "complex ebbs and flows" are part of being human. And, I realize there's a range. A non-drug approach may not apply to all. yes - "process, not prognosis." Gratitude Kelli for a much needed article. Kudos!
1
The next to last paragraph got me to thinking: How can I treat depression by staying active if I'm too depressed to activate myself? Kind of the chicken or the egg question. Anyway, in my case, a combination of meds and therapy and activity have helped me to arrest my depression/anxiety. .
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I was once in that situation, and it was like quicksand. I got out only because I was blessed with friends, family, and a boss who were all familiar with symptoms of depresssion, and who helped me see that I needed treatment. Without them I wouldn’t have made it out.
1
I have found The Body Keeps the Score By Bessel van der Kolk a useful, instructive read. It addresses much of what the author references here. Others may find it helpful, too.
1
I had my ovaries and uterus removed, due to severe endometriosis. Overnight, as if by a miracle, my lifetime of depression and anxiety disappeared as soon as the estrogen patch was pasted on me in the recovery room.
There's so much we don't know about the causes of depression and mental illness, and the myopic fixation on SSRIs as the cure-all has caused us to lose 30 precious years of research time.
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@Victor, like occasionally having to put up a cold or the flu or experiencing physical pain of one kind or another, mental and emotional pain are part of being human. For whatever reasons -- biochemical, situational, personal history, intergenerational trauma -- some of us suffer emotionally more than others.
For this particular human, it seems there are only two possible responses to this. We can survey the pain and struggles of others and choose to cast judgment -- find them weak and wanting in some way -- while we congratulate ourselves on our own talents for self-distraction. Or, as @Allison and many other commentators have suggested, we can open ourselves to real empathy, real feeling, real human connection.
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Beautifully written and honest piece. Is it possible that our limited contact with humans face to face, and less time spent in nature with feet on the ground, not pavement, and the lack of clean air in cities, the deterioration of our food due to mega-farming, and the on-going onslaught of breaking news, and the loss of close family ties, could these also be a factor in the surge of mental Illness? I believe in treating depression or other mental illness with certain drugs under the care of a talk therapy psychiatrist psychologist or counselor only if the program promotes self-reliablity which empowers the patient. I’ve also benefitted from aura readings and astrology, a safe way to get in touch with oneself. I support NAMI and those working in the field of psychology, and education of the public to accept mental illness for what it is without stigma.
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It seems as if therapists are the group most opposed to wholistic care. They often resent prescribers who offer a combination of therapy or counseling and medication management. They prefer to see themselves as the “real” therapist and would like the prescriber to be a technician who tinkers with the meds.
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@Tom
From your personal experience? That's not what the author says...
1
Medical insurance doesn't want to cover the longterm,costly process of therapy; it wants to pay for one or two visits to a psychiatrist to give you pills and send you on your way. There are many, many therapists whose work it is to talk with patients and help them address/negotiate their problems, it's just that almost none of them will accept insurance because they won't get paid a reasonable amount. The problem isn't so much that the medical establishment believes that psychological problems can be solved with pills--it's that our insurance companies get to decide what kind of care we get.
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Mental health can be impacted by lyme and the many co-infections. Please explore that possibility, especially when there is a sudden change in mental health.
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I am a family doctor who has treated a lot of mental illness, collaborating closely with psychiatrists and psychologists.
This author sets up a a straw man and knocks him down, misunderstanding medicine in the process. Doctors know that adverse life experiences, often combined with a biological predisposition, can cause depression. We see this every day in the clinic and the hospital.
Depression and other mental illnesses are the result of brain changes, anatomic and/or physiologic and/or chemical, but the ultimate problem often seems to mainly environmental. Even so, the proximate causes give us a chance to use medicine. We also try to manipulate the environment, by advising the patient to see a psychologist, for example.
The ultimate cause of a case of left-sided heart failure might be hypertension or coronary artery disease, but the proximate cause is decreased function of the left ventricle. This gives us a chance to use medicine. We also try to manipulate the environment, by advising the patient to eat less salt, for example.
Some depression seems to be mainly chemico-physiological. There are many people who have it without much in the way of adverse life events. There are many other people whose main problem seems to be adverse life events. Still these latter folks often respond to medicine.
This "realistic, nuanced" approach to mental illness has been around for all my time, over 34 years of seeing sick people.
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@vbering
The problem is that what you call the "realistic, nuanced" approach hasn't really worked, now has it?
If you acknowledge that the source of most people's problems is environmental, then it stands to reason that emotional adaption is key. That should take priority instead of pharmaceuticals, yet it hasn't.
The per capita prescription of medication has skyrocketed, and people are still depressed. There are any number of "natural" anti-anxiety potions, like the current rabid craze for CBD oil, as if that actually does anything to teach you how to regulate your emotions.
Studies have shown that medication doesn't work better than placebo unless the patient has severe depression - which most people don't.
Yet even in the Marianne Williamson article, you have "experts" chiming in that medication is key and shouldn't be maligned, despite ample studies to the contrary.
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@Viv
I agree that the medicines are most effective for patients with severe depression. As regards treatments not having worked, not all diseases have good treatments. Hey, medical technology has not yet given us everything we want. Ever met someone with pancreatic cancer?
I assure you that psychotherapy is no panacea either.
Agree that CBD and the like are silly fads.
My comment had to do with the model of the disease process. If you dispute that, you might want to get a better understanding.
2
@vbering
This isn't a discussion of the "disease process". It's a discussion of the efficacy of current treatment modalities - modalities that have failed a lot of people.
If a chemotherapy treatment fails 70% of the time, you don't market it to patients as a cure. Yet that's what pharmaceutical companies do. You tell them this may work, but statistically it's unlikely that it will.
1
In 1966, I suffered a trauma deep enough to leave me with a not yet identified and categorized PTSD, that developed into what my psychologist described as "severe clinical depression." Talk therapy was in its prime then, and the now all but forgotten human potential movement of the 70s was just around the corner. I don't know that any of it helped me, but it gave me a program to follow and some hope, which gave me time to heal. I also began self-medicating with cannabis, a practice I've never regretted for so much as a moment and one I continue to this day.
It induces a sense of presence, rest, and relief with pleasant, rather than nasty chemical side effects.
I've also studied the teachings of Buddha, who I consider the greatest cognitive psychologist of all time. Watching the workings of his mind, he identified the simply obvious truth that life is full of dissatisfaction and change and that it is utterly impersonal. Our cultural denial and search for perfection increase that suffering. Had I been told, and had I been able to hear that the trauma I experienced at 16 was a common, rather than an aberrant experience I suspect I would have suffered a lot less. But America has medicalized common human experiences. Doing so by selling drugs, I fear, makes a few people rich, but actually helps very few people.
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Mental illness and mental symptoms can have many different causes.
Some may be purely biochemical, a deficient chemical reaction in the body.
Some may be purely psychological.
Some may be a combination of biochemical and psychological cause.
Psychological treatments may or may not help someone deal with the effects of a biochemical illness.
It is essential that someone suffering severe mental problems have a full MEDICAL examination by a medical doctor trained in inborn errors of metabolism.
While individually rare, inborn errors are collectively numerous so their total occurrence is not rare.
Psychiatrists /psychologists while dedicated do not have the training or expertise to recognize these errors.
It is tragic if a treatable inborn error is not recognized because a full medical examination is not performed.
Any psychiatrist /psychologist who does not refer someone suffering with severe medical illness for a full medical examination is a quack whose licence should be revoked.
4
There are techniques that can be used to reliably condition someone to be depressed. Just train them to have disdain for positivity, for enjoyment, for spontaneity. This is a well worn groove of the human psyche, a gear the transmission is happy to pop into. After all, being hard to please gets people bending over backwards for you and prevents you from being overly enthused with the common things of the riff raff. If you are a member of the nobility it can be quite appropriate. For anyone else, it's inappropriate so of course it is dysfunctional. You see this attitude developing in teenagers who find everything such a bore. This is an appropriate outlook for someone who has something specialized that is their one fascination. In a society where we are expected to find that fascination, but not told that we are, we learn to do the pose and hate everything except___--except the blank is left blank. Or becomes blank when the career ends or the loved one dies or the great work is completed or the heroin is no longer available. Health is simply abandoning the illusion of dignified poses for following a variety of interests, without nonsensically hanging on to anything past its time. Social health is one thing that helps because people are varied and change. But with awareness of the real problem, lack of varied enthusiasms, maybe you can manage depression avoidance independently. Or offer half your kingdom to whoever can make the princess smile.
1
I, as a psychotherapist, appreciate the nuanced message Ms. Korducki presents. Mental health is not just one thing. Body, mind and spirit are connected and it is important to attend to it all. Thank you for writing this!
23
Szaaz wrote "The Myth of Mental Illness" in 1960. Unfortunately, a medical model is till prevalent. Psychiatrists are physicians, and as such, inappropriately prepared to engage in the systematic "talking therapy" you describe. Cognitive behavior therapy approaches, grounded in the science (yes, experimental science) of psychology have been empirically validated as treatments for a host of emotional, cognitive and behavioral problems.
9
@J. Charles Szaaz did immeasurable harm to the delivery of mental health, starting with California, where the Reagan administration seized on his nutty thesis as an excuse to dismantle the state's mental health system. Result: an ongoing explosion of mentally-ill people in the tents and shacks of that state--a public-health disaster that has spread nationwide.
He was a quack. End stop.
2
Kelli, your essay touches my heart. I will not go into detail re my own personal experiences, but I will say that I hope readers heed your sage advice. Too often psychiatrists prescribe anti-depressants without digging deep enough into an individual's desperate call for help. As we are learning, some medications which were lauded to be "cure-alls" fell short, with even serious, untoward side effects. Others have so-far proven to be safe and effective. But these drugs are but band-aids, covering over wounds that are not healing as they should. There is so much more that we must do as you point out...exercise, eating well, sleep, yoga, reading, and so on. Included is good counseling. And this is where our medical establishment has failed. Psychologists are too few, too expensive, too inaccessible. Yet, there is a silver lining. By speaking up, the stigma of mental illness is waning. We find that as we reveal these "skeletons in our closet," there are thousand of others who are like us.
8
The author may well be one of the individuals who suffer Atypical Depression which is genetic, and begins in adolescence. It is frequently missed which means that the young person is deprived of the swift and effective treatment by the MAOIs, in particular, Nardil. Not only is Atypical Depression seldom considered but its treatment is denied because of ill-informed fear of dietary restrictions associated with the MAOIs. These have been proven to be wildly over-emphasized. Warnings about suicide in youn people on SSRIs are well founded if, as appears possible, the SSRIs are the wrong drug and the nature of the depression misdiagnosed
3
@Irene Campbell-Taylor
This way of understanding and treating depression is exactly the context-less and biologically-based approach the author is arguing against.
6
@Jenny
Not quite. It is genetic due to a error on chromosome 15. It has nothing to do with "chemical imbalances". It is very real and horribly distressing to its sufferers. My point is that it is capable of not "cure" but normalization.
1
The US health care system to an extreme degree in mental health is disfunctional. Living/working in MX 15 years I finally got great psychiatric care by a professional who spends a full hour with me, does medication with psychotherapy, checks in on life decision issues, will refer out to psychologists & other MD´s when he feels he cannot address an issue. México has universal health care similar to the German model: all are covered but in a variety of systems including public/government pay, pay through university/ government/some large company jobs into a system called IMSS with its own hospitals, private insurance at whatever level one wants & private pay from very inexpensive up to whatever you want to pay. It works in part as the University system including medical and dental teaching schools is government funded and free, or again people can choose private universities. A social service requirement provides doctors in residence to underserved areas and we have now a surfeit of medical professionals.
US exceptionalism is simply a myth.
I agree 100% with the author here Kelli María Korducki. Pharmaceuticals are not a magic bullet for mental health. What she is doing with self help is necessary - diet, exercise, inward looking research and constant research into what meds one is prescribed. Health care USA needs a complete fix. Including university & med school financing, increasing number of doctors. Limiting power of the drug companies.
7
Part of my work involves looking at electronic records of behavioral health recipients. The BHRs carry multiple and ever-changing diagnoses from the various editions of the DSM (now currently the DSM 5) and, likewise, are prescribed an alarming number of psychotropics and medication for physical health conditions, some of which are side effects of their psychotropics. I nearly always look, at least briefly, as the BHR's psychosocial history; it is rare that I do not see significant history of adverse childhood experiences (ACEs), most often family violence, including emotional neglect/abuse and physical and/or sexual abuse by a person known to and trusted by the family. Most are not receiving psychotherapy; "counseling" is usually just reminders "to use coping skills" and attend offered "groups".
Unfortunately, we do not have a workforce sufficient in number to address the need, and what there are do not receive sufficient education, training, and regular supervision by qualified professionals to provide clinical intervention. From my observation and from reports I have heard from colleagues, few behavioral health service providers ensure their front line staff (most of whom are young in the field) are developing skills an competencies to do the work beyond on-line trainings (I look at these records as well). I've noted these observations to stakeholders. What has happened to my profession is depressing; that it has been allowed to happen is ethically troubling.
11
The brain itself is a complex anatomical, chemical, electrical, biological instrument and its relation to the "mind" is still pretty mysterious. As a sufferer from Manic Depression first diagnosed in 1997, I have had really good success with drugs and a really smart psychiatrist. Drugs are not just a simple fix but must be often recalibrated and adjusted, but faithfully sticking to my regimen has allowed me to lead a balanced normal life. I always respond negatively to those who have a knee jerk reaction against drugs just as I do to those who see drugs as a miracle cure. I take responsibility for my own mental health and am thankful for the assistance medicine provides.
21
I was a Clinical Psychologist and Professor of Psychology who trained students to be therapists for the mentally ill. I consulted with Community Mental Health Centers, in addition to having been part of the team that trained many of the counselors at those centers.
Time with a Psychiatrist is very expensive. In addition, none of those (fine) Psychiatrists I worked with had the intensive, supervised training in psychotherapy that our master's graduates in our training program had.
Quite frankly, the nursing staff and many of the therapy staff knew which medications would be prescribed by the Psychiatrist, and would have been accurate about 95-99% of the time. But asking the Psychiatrists to conduct talk therapy? As great as all of them were as people, they were not trained, they did not enter the field thinking this is what they wanted, and they had not dedicated their lives to improving those skills.
Another, alarming fact, is that in the past 50 years the number of counselors has increased astronomically, to the point where a few years ago someone predicted that in another 100 years every person would either be a patient or a counselor.
Yet the problems remain almost untouched. As I say, this is scary. If psychiatrists, programs and counselors are the answer, we would expect to have seen a massive reduction in social problems, but we haven't.
We are missing something. What we shouldn't be missing is compassion. Thank you Ms. Korducki for your openness.
17
May experience is that my psychiatrist prescribes pills with minimal vetting of my depression/anxiety while the therapist tries to understand my psyche and eliminate harmful thought habits. And never the twain shall meet.
Medicating is a trial and error process. I tried several meds that had intolerable side effects. I settled on Paxil at the minimum therapeutic dose (and vitamin D) together with talk therapy and slowly recovered over many months. I have no idea what worked.
I quit therapy after two years - eventually, I run out of things to say. I have not relapsed after several years, but there's always the lingering feeling of uncertainty. I think that that is what the author is pointing out.
8
I'm surprised she couldn't find a therapist who was covered by insurance.
2
@onlein Well, I do not believe it to be so easy, especially if you are coping with depression at a lower moment than usual. My Emblem Health primary physician said "Here's the list of therapists/psychiatrists. Just call until you find one that is available and can see you." The list was 10 pages long, and had no point of reference. So one starts to call, and finally realizes that the list needs vetting (and that is by the patient doing the calling) to find the hidden treasure, an available provider. When one is in an acute dark episode of what is chronic depression, one needs more that a list of providers. It is to say the least, depressing.
6
@Barbara Ruether
What I meant is therapists are licensed and are covered by insurance--at least in the states I'm familiar with. It may be very hard to find a therapist--period. But if one does, chances are insurance will cover some if not all the cost.
1
@onlein Been to NY State recently?
Only the unchecked rise of capitalism above all other social constructs could produce an age where doctors have been reduced to drug pushers. Markets are not the solution to human problems, as the author points out. It’s the worst greedy cynicism to pretend otherwise.
15
@Evan
Nonsense. In the National Health Service in the UK, socialized medicine, doctors prescribe these medicines extensively. The medicines are prescribed because they often work.
5
What if what we call mental illness today in most cases is actually just a normal response to the abnormally stressful lives that we lead today, particularly at the lower end of the precarious income scale? Wouldn't the right medicine be the social change then? Yes, it is possible to talk about chemical imbalance. But there is no proof that imbalance is genetically pre-ordained (except maybe in handful of schizophrenia and epilepsy cases). Most people may never develop a chemical imbalance in their brain if they are not exposed to stressors - jusr as most people would never develop diabetes 2 if they don't overeat sugar-laden diets. Yet we don't put diabetes 2 patients so easily on insulin as we do people who complain of anxiety and depression on atypical anti-psychotics that as a side effect can cause tardive dyskinesia. Why is that so? We tell our diabetes 2 patients to change their diets and make them feel guilty for not doing so. But we know we can't do that for our mental health patients. Because we know they cannot change the social circumstances that cause or exacerbate their mental anguish. The psychiatry became the safety valve of capitalism, tasked with sedating and tranquilizing the laboring masses so they can more cheerfully cope with their lot of capricious bosses, endless work-hours, never enough money, not having any time for physical exercise, etc. And psychiatrists became rare and only interested in peddling new pills.
7
@ivo skoric
There have always been stressors in society, one way or another.
I doubt that the stress of living through the Depression, or the atomic bomb was less than the stress of living through 9/11, school shootings and the million little daily annoyances.
What has changed is that people used to know how to regulate their emotions far better. They also knew that it was normal not to be ecstatic all the time. They knew that it was normal to be sad when something bad happened, and how to pick up the pieces and move on without being paralyzed as if you have some debilitating illness.
They didn't have they eyeballs glued to a smart phone, consuming media and commercials that told them how to feel about anything and everything under the sun - along with products/pharmaceuticals to make that feeling go away.
5
@ivo Depression and anxiety are ailments of the developed world and have little to do with poverty of the individual and everything to do with poverty of the soul.
The fault does not lay at the door of capitalism, but more belongs at the door of a modernism obsessed with the physical world and ignorant of the grand narratives essential to bringing meaning to life and creating a bulwark against suffering.
4
@ivo skoric In my early thirties I was prescribed meds for both anxiety and depression, at the time I was married to a women that wanted to have children, I did not, she had issues with spending and in hindsight was obviously unfaithful. About a month after getting divorced I felt much better and told my doctor I thought I should stop the pills. His response was that I only felt better because of the pills and If I stopped I would be right back to where I started. I stopped anyways, and have felt fine ever since. My doctor fired me as a patient for not picking up my prescriptions, I think the term he used was not "compliant". Ending the relationship with him was almost as nice as my divorce.
At least in my case my situation was a huge part of the problem and my doctor was completely unable to deal with or understand that part.
5
There is a lot of blame to go around regarding the sad state of mental health care in this nation, and not all of it belongs to psychiatrists though some does. The reason psychiatrists have abandoned psychotherapy is that they can't get paid enough to keep the lights on in their offices for the time it takes. This is because in the 1980s the insurance companies found that psychologists and other therapy providers did just as good a job for less money. This relegated psychiatric physicians to the role of medication management which at least pays a decent sum but only if they keep the visit length at 15 minutes. The next higher payment level requires 25 minutes but is not proportional.
As to the chemical imbalance theory, it was basically a shorthand way of telling patients the source of their pain. It never postulated that any mental illness was "hard wired" and therefore inevitable and hopeless. Also, nerve cells are not "wired" to each other. Their electrical impulses cause the outflow of chemicals into the tiny spaces between them (synapses) which may stimulate or inhibit the next cell in the system. Whether through medication or talk therapy, change occurs in the neural networks that, when off "balance", produce the symptoms of mental illness. In other words, they affect the functions of the brain, not the structures. The best outcomes occur when medication is combined with therapy, but getting collaborative/complementary providers of them is not easy to find or afford.
15
The lack of true freedom while living under the banner of the Free and the Brave adds a great deal to the exploding depression in this country. When a person can't feel empowered by having a job because they still can't make ends meet, can't afford a house and all the other pressures of modern life because of economic inequality, throwing pills at people is an easy bandaid. The opiod crisis shows how bad it is when people lose control of their lives through no fault of their own. Reality begins to close in and escape is the only alternative.
15
Absolutely love your paragraph on making things like exercise, nutrition, and social bonding "a daily priority". This busy world makes us think that these are a waste of time, but they are (as you point out) essential to our emotional and psychological well-being.
In the past, when these were part of our survival it was much harder to let go and sit around all day. But sitting around comes with a price. In my case, a sensation of lethargy all weekend that creeps into the week
19
This is not news. Some people (but only a minority) are helped by drug treatment for depression.
The pharmaceutical industry (and the psychiatry residency programs that teach nothing but how to write prescriptions) promulgate the myth of drug treatments for their own personal profit. The new media (that means you, NYT) is also an enabler of the myth. See recent NYT articles on the magic of Esketamine.
Psychotherapy works for some who don't respond to drugs, but there are still many who don't find an effective treatment in the mental health system. And our current health care system certainly does not support people finding effective treatment for any problem that is not simple or easy to treat.
Whether depression is biologically determined or not (the evidence points mostly to not), nobody should be blamed or shamed for being depressed - they should be supported and treated with compassion.
11
Can you provide the evidence for your statements that only a minority are helped by drug treatments, and that depression is largely not biologically determined? Thanks.
6
@Leonie Finkel
Only a minority of depression patients have major depression. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100461/
For those with major depression, medication works better than placebo.
For those with mild to moderate depression, i.e. 70% of cases, medication does not work better than placebo.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
1
There is no simple answer to the puzzle of depression. The idea of depression is misunderstood, and the word is used for everything from ennui to trying to live in the mental and emotional black pit. Some people with depression are born that way, some are suffering emotional or physical neglect or violence, some are unlucky in life and struggling with adversity, but for many of us there’s no single/simple identifiable cause. Don’t knock psychotherapy or psychopharmacology; for some of us it’s what keeps us going.
10
The recently published "Obtaining Consensus in Psychotherapy: What Holds Us Back?" by Marvin R. Goldfried of Stony Brook University is a long journal article, but well worth at least skimming. https://www.stonybrook.edu/commcms/psychology/_pdfs/clinical/Goldfried%20AP%20Consensus%20AP.pdf
What the general public doesn't understand that the MD psychiatrists who are seen as being on top of the mental health profession rarely practice psychotherapy. If they did real therapy to make the money they can make by cramming as many medication reviews as possible into an hour they'd have to charge $1000 or more per session.
11
@Hal Brown, MSW Many thanks for this, I will pass it on to doctors and mental health workers I know.
2
What you wanted was a psychoanalyst, not a counselor. Depression, like all bodily illnesses is complex and we each have to take the actions of exercise, nutrition, sleep, structured work time, distance from toxic people, artistic endeavors, etc. to live with our condition. I don't do the drugs, I use discipline and structure and the list of activities and a good psychoanalyst.
2
Thanks for reminding us all dealing with emotional illnesses is complex. One of the most overlooked issues, in my opinion, is the failure of our doctors to understand how difficult it is to stop taking these SSRI's. The "discontinuation" symptoms can be horrendous even with a very gradual reduction. Why don't our docs tell us this? Instead, the usual recommendation is to cut the dosage in half for a few days and then stop all together. On the upside, this advice helps keep the addiction recovery shops open and profiting.
11
@WHS I was on Prozac for awhile for something other than mental illness. My doctor wasn't happy with the results (nothing basically) and wanted to try another drug. He made a calendar with everyday marked with the dose I was to take for about 4-6 weeks (can't remember exactly). It worked perfectly and I had no problems. The other drug was successful. Maybe it's not the drug, but the doctor?
3
@WHS
I too experienced serious and severe anxiety problems after attempting to gradually withdraw and taper off of Effexor XR over a 90 day period, which I have been taking since the drug was first introduced some 20 years ago. I simply had to resume taking the medication to remain reasonably stable, and at the age of 79 will do so until I eventually pass away. Yes, these SSRI's are very addictive!
6
@WHS Because its profitable for the medical establishment to just listen to the spiel handed out to them by pharmaceutical sales reps. If you ever get a chance to drop in on a meeting of them you will emerge a bit shocked.
3
Anyone interested in the extremes of the psychiatric profession in promoting SSRI dugs and related cocktails should watch youtube vids made by Laura Delano, a CT teen who got mired in its claws, starting with "bipolar'.
She spent years on these drugs, attempted suicide, but today is off drugs, has found her mind again, is organizing and speaking out to change the psych profession.
From personal experience, SSRI drugs are the FIRST CHOICE of the psycho-therapeutic profession. Something i clearly wrong with that approach.
7
Certain psychiatrists, hand in hand with the pharmaceutical companies, have managed to turn any reaction to a rough patch in life to a "disorder", complete with a drug to deal with it. And because many people would much rather take the easy route than work on changing their situations, facing their grief, slowing down to lessen the stress and anxiety in their over busy lives the drug industry is thriving. Students now demand anti anxiety drugs to cope with exams, rather than take responsibility for not doing the work all along to prepare. There are people who, indeed suffer from biological causes for depression, anxiety or mood swings and for them drugs are appropriate. But many people can benefit from accepting that life is not always easy or fair, but that a little bit of resilience and self- awareness can help them cope with and overcome many of those hurdles with support. But there is good money to be made from the unhealthy, dysfunctional and disordered, and their enablers are the ones who benefit from keeping them that way. I've seen it time and time again in the work I've done over the years. And the saddest is children who don't conform or who learn differently are now being diagnosed with things like autism and ADHD and of course, there are drugs for that too. We have become a lazy society who wants nothing but instant fixes for everything.
19
As a psychotherapist, I’ve long dealt with the divide between talk therapy and psychiatry. So many patients and practitioners see it as an either/or situation when research says both or a combination of the two are the most helpful.
Unfortunately this is where America’s healthcare system gets in the way. Insurers promote quick and cheap short-term fixes which lead to medication first, therapy last.
Psychiatrists have to chose between the best treatment and the most profitable treatment which is, of course, medication. Add to the financial incentives; professional jealousies and misunderstandings along with the unique situation of every patient and the unique abilities of every provider, and you end up with another healthcare crisis left to the patients to sort out as best they can.
I have enormous sympathy for those who’ve sorted through all this to find themselves in my office. I wish it was different but nothing is going to change as long as financial incentives drive treatment.
15
@Greg Gearn Yes. It is systemic. The USA health system is broken.
1
What is Ms Korducki's point?
She calls the mental health care system in America a "wholesale failure," yet acknowledges that psychotherapy and medications have helped her. Is she angry that there is no cure? Most chronic complex disorders have treatments but not cures.
Is she angry that her psychiatrist would not do therapy? In modern practice psychiatrists take care of the biological side of the illness, and therapist, far more trained in the emotional aspects, provide counseling and therapy.
Is she disturbed by the concept that psychiatric disorders have both genetic and biologic determinants, and social and experiential roots? She seems to acknowledge that complex duality in her piece. "Chemical imbalance," biologic determinants are the predominant cause in disorders such as schizophrenia, whereas social determinants predominate in disorders such as PTSD.
Or is the problem one of insurance coverage; that her therapy should be paid for by insurance? Most insurance companies pay for some counseling, but they do limit it due to high cost considerations.
50 years ago I was a young boy living with a horribly depressed mother, for whom there were few treatment options. In the ensuing years I have seen remarkable progress, and research is shedding new light daily.
8
@A Doctor, I perceive her plaint as rooted in the tendency to treat mental illnesses with drugs first and foremost, with side effects and lack of successful outcomes in a fair number of cases. And when that occurs, the substitution of other drugs, with scant provision or offers of other therapies, such as CBTs and others. This has often occurred in conjunction with insurers' attempts to head off continuing counsel services for much less expensive drug regimens, as I have seen the process. Some doctors and insurers are quite determined in insisting on this, even with some brusqueness or contempt should a patient seek other avenues than drug therapies. I hear in your own imaginings of the author's thoughts and your inquisitorial tone some of that same disrespect, frankly. Her meanings were pretty clear to me, and your response does more to illustrate her point than you likely intend.
9
@jb
I do have some experience in this arena. I work in a clinic which serves the poor and uninsured, and many are depressed. We have a robust counseling service, which is free to patients.
For "uncomplicated" depression, treatment by the primary caretaker is the standard of care, with psychiatry reserved for special circumstances. Both psychotherapy and medication have been found to be effective, and the combination may be the best. Many of my patients decline psychotherapy for many reasons, including time constraints, or preferring to try the simple approach of medication first (not an unreasonable choice). Many do a few sessions then drop out. Therapy is work intensive for the patient, and not for everyone. None of the providers I work with are dismissive.
My inquisitorial tone stems from the authors broad dismissal of the health care system, which I am part of, a criticism which is not supported by the remainder of her piece!
1
@A Doctor You sound very much like my father who was, what else, A Doctor.
Thoughout the '80s, whilst pimping for the AMA with the insurance companies, he touted the values of he called "vouchers" for the uninsured and insisted that the ER was perfectly fine for regular health care -- all the while travelling first class and staying at the best hotels. Well, he's gone and from what I hear, the AMA has changed its stance.
Having lived mostly with US healthcare, and for several happy years under French healthcare, I've experienced both injustice and equality. Guess which is better. Ever tried Medicaid? The author is absolutely right in her quite well-substantiated dismissal of the inherent cruelty in the healthcare system in this country.
3
If you've lost someone to the chemical-cure industry, you know the significance of this essay. We have all had difficult dark times, some of us from childhood, but there's nothing like having to sit and watch someone say that they can't do anything but stay drugged and in bed, for a lifetime. People of a certain era were told that pharmaceutical meds were the necessary cure to their depression, while the cure renders them unable to participate in life. Ironically, drugs are always covered by insurance, even if they render people zombies suffering terrible side effects, while talk therapy is limited or not covered at all. And of course, the aggression of income inequality is something we're supposed to celebrate, even as we struggle on our own to try to change our circumstances within an abusive system.
6
Born in 1955, I suffered from OCD (obsessive compulsive disorder) until the mid 80’s, when Prozac became available. Before that I tried everything that Psychiatry had on offer, but was trying to fix a problem with a broken tool. I was honest, open to any solutions and committed to changing my behavior no matter the consequences. However, good intentions, prayer and my family’s dwindling resources could not fix a brain that was wired the wrong way. The S.S.R.I.s provided the relief from my brain attacking itself and once that was taken care of, the other problems, triggers and physical ailments that accompanied the underlying problem, disappeared. The only problems from that point on were the side effects of the medication, which included sexual dysfunction. Because of that, and the false feeling of being cured, I would occasionally go off the medication only to find myself back at square one. the second to the last time I went off the meds I went cold turkey and was told that was dangerous, so the last time I went to a sit-down, talk-it-out psychiatrist so that he could monitor my withdrawal. Instead of being happy with that task, the doctor informed me, after ten minutes of talking, without ever looking at me or looking away from his computer screen, that I had Bi-Polar disorder. I left immediately (a first for me) and thanked God we had those pharmaceuticals, because other, fallible, human beings can be as unreliable as your own brain.
6
I'm the same age as Ms. Korducki.
This 'chemical imbalance' may or may not be true. But, I'm sure just as the pharma companies wanted, psychiatry is just as she stated. Prescribe pills. Then suddenly, people get better?
Yeah, only in America would people believe that to be true.
Seems people are beginning to understand that this is false, but how long will it take to make real progress?
3
@Iain No one looks at it that way. It is obvious and proven that drugs help many. Not all drugs work on people the same way. But given the right drug or combination they can be a life saver. Therapy also helps, sometimes both is needed. Talk therapy alone does not have the success rate of drugs. I know someone who is schizophrenic, acutely. She has been helped enormously by drugs. There are side effects, but they are worth having. Without these drugs she would be hallucinating and incoherent, but with them she has a job, an apartment and a life.
1
@Iain The doctors and psychiatrist responding here, and in fact whom you can ask anywhere, will detail for you how the for-profit insurance industry gets head on in the way of treatment they know they could give. The US system does not work because of how health care is paid for and owned by insurance companies and pharmaceutical companies. It is literally killing the USA.
2
The New York Times published an excellent summary on this very issue a few years ago.
The primary take-aways:
1. It is a hard disease to treat and to study because symptoms wax and wane on their own.
2. Literature over-reports the success of specific treatments due to a 'publishing bias'
3. The bottom line? "...antidepressant drugs and talk therapies are modestly effective, and the combination is better than either approach alone."
Four years later, we still at the same place.
https://www.nytimes.com/2015/10/01/health/study-finds-psychotherapys-effectiveness-for-depression-overstated.html
4
Wow! After reading this, I can only imagine the mental anguish undocumented immigrant workers and asylum seekers must be going through.
I think it is important we take care of these people first -since they do the jobs the rest of us don't want to do- and make sure they have a stable home, job and family.
Everyone else can go to their local animal shelter and adopt a service dog.
4
@ Aaron
What makes you think immigrants, refugees or any other class are any different in their needs?
In the first place, there are enormous variations in adaptability: some refugees may be better able to deal with anguish than middle-class people with apparently lighter traumatic events, and vice-versa. All are equally deserving of treatment.
It might please you to know that therapy for the downtrodden is, and has been, widely practiced in America, in Brazil and elsewhere. Homeless people in Philadelphia, for instance, find that the analytic couch is the only couch they know.
3
Maybe there’s nothing really at all wrong with the rat in the cage, just the cage itself. The rat in it just does what a rat does when anything squeezes it so tight like that. To the rat a boa constrictor and a cage are the same thing, but at least the boa puts what it swallows to some use whereas the cage nothing.
2
Regardless, Medicare for All will ensure that Everbody can get "their" SSRI for "free." Problem solved.
2
@JCX
Have you any evidence that public health care programs prescribe more SSRIs than the US system, or are you being funny?
1
Spot On!! Sounds like you are in a great place :) Kudos for putting the effort in and having the insight to make a more healthy you!! :)
3
The most salient effect of psychiatric treatment is the transfer of autonomy to another person, one with the cultural Imprimatur of authority over one's feelings and actions. It is not unlike belonging to any cult or religion, relief from the challenge of living, interacting with other mere mortals.
Psychotropic medication such as prozac then can not only cause a change in the individual, but allow one to be part of a movement.
We are social beings, and being different, not part of a group, any group-- religion, party, gang, value system- can cause great suffering. And all of this has a bio-chemical correlate in our brain chemistry.
There's an infinite variation in achieving a sense of well-being. When someone ends their own life they have not found one that works for them, and can endure existence no longer. Sure, Prozac worked since one felt taken care of by a higher authority, this time in a white coat. One can get the same satisfaction in a confessional booth from one with a direct connection to God.
For millions of years our species evolved just to survive, get satisfaction out of sex, and nurturing offspring, and then disappear, with no sense of loss as we no longer exist. This human quality of knowing of our short existence is unbearable, so we create powerful humans who can dispense some relief.
Those pills are just part of the ceremony of feeling cared for by one of greater power.
1
@Call Me Al
Al....No disrespect intended. But this is a gross simplification of the subject at hand.
Bottom line is most people I have dealt with fail to take steps to ensure treatment of their individual situation. They pass it off onto a professional or self medicate with drugs, alcohol ect. ect and fail to actively participate. This author has the right approach and in my experience the only one that works.
3
It known now that childhood trauma can change the epigenetic signature in the brain making the affected individual over react to stress.
Lithium is known to lower the stress hormone cortisol which is over produced in some people.
In my case, the lithium enabled me to address the other aspects of my life such getting enough exercise maintaining hobbies and friendships, eating well and educating myself , all while enjoying a happy 41 year marriage.
I am also a strong pro proponent of therapy. In my teens. I was fortunate to have had years of good insightful therapy equipping me with a lifelong habit of honest self examination.
10
@A Nash Thanks for this info re lithium. I was only aware if its use treating bi-polar disorder. I took it for @3 years in the 1980s for that, and found it made me feel calm, but at the time I didn't focus on that effect. Your info makes me put the pieces together a bit differently.
1
If you meet with a psychiatrist, they'll recommend medications. If you meet with a psychologist, they'll try to talk you through your problems. If you meet with a surgeon, they'll recommend surgery (although hopefully not for psychiatric issues). If you meet with an acupuncturist, they'll stick needles in you.
Each specialist will use the tools with which they're most familiar. Unfortunately, that means that, as patients, we must choose the specialist whose techniques are most likely to help with our actual problems, and that's sometimes difficult.
55
I do understand there are very real and dangerous mental illnesses that require professional medical treatment, but I wonder how much of the rampant depression in this country is cultural, and not-so-subliminally marketed by pharmaceutical companies and the mental health industry. What's the adage (and I paraphrase); To a man with a hammer every problem is a nail?
I see younger people who are told that if their goals aren't met or they suffer life setbacks, the result should be depression - for which it just so happens they have a remedy. Who tells them that? The pharmaceutical and mental health industries.
12
@JL22
I can assure you that anxiety and paranoia are two real conditions that twist reality into a frightening perception of our world. Only people who experience this know this condition.
7
@JL22 you are talking about situational depression, aka unpleasant circumstances create negative feelings, aka life. Fix the challenges, the bad feelings go away. Real mental illness has nothing to do with money, support, etc. It does not discriminate and does not care. It's real.
2
@JL22,
Peter Z and amy, Did I not write, "I do understand there are very real and dangerous mental illnesses that require medical treatment..."?
This article in right on. There is a place in health care for meds but too many Americans think the cure for everything is a pill. Thanks to this writer for such an insightful article
11
@Margaret More to the point, most Americans have garbage life circumstances that are producing sad lives. That's not depression, so of course "a pill" won't help. Actual depression occurs regardless what quality of life you have. THAT is treatable with "a pill" in conjunction with therapy and attention to daily needs.
1
Dear Kelli,
Thank you. Family and friends of people that are suffering would benefit from reading this article. There's a lot of stigma and misunderstanding out there. For a greatly loved one in my life I've found what you've said it true: it's a continuous process of support and a sometimes a daily struggle. Like you, we are privileged to get treatment, and I feel terrible that people out there cannot get access to even basic treatment. Thank you for sharing your story.
3
I agree with much of your thinking. But chemical imbalance is no longer the prevailing meme in modern psychiatric research; We should differentiate between the actual flowering of understanding how our brains work, including development of neural networks, the interplay between environmental impact (both social and physical) and our unique genetic fingerprints, (which absolutely point to a process), and the profit-driven determinants that make big Pharma decisions about what drugs to develop and the social and economic stigma that still sticks to mental illness.
1
With several family and friends having various psychological problems, I relate to this. I think the writer hit the nail on the head. She is on her way to have a good rest of her life.
2
We in the medical field know that the DSM is an imperfect tool, with the definitions too rigid and cookie cutter. Partly this is due to insurance, as a diagnosis is necessary for us to prescribe medication. The field of psychiatry is undergoing a revolution of sorts as more data from imaging and genomics is made available to us. But we are not there yet, unfortunately.
Stay strong Ms. Korducki, and find a provider who understands that difficult balancing act between the art and science of medicine.
11
The cause of depression is the flooding of the mind with fearful or anxious thoughts, coupled with the inability to turn the mind away from grasping at the thoughts. With meditation, one trains oneself to watch the thought arise and depart without attachment. Instead of becoming the thought, we distance ourselves from thoughts, and make them the object of our critical gaze.
What does one do if a room is in a mess. We observe critically everything that is in the room, then allow our faculty of detachment to take root before we throw things out. Following are the stages of meditation on depressing thoughts, in order of application:
1) The effort should first be to ignore them, so that they die down on their own; 2) If the negative thoughts still continue to persist, an effort must be made divert the mind to a stream of directed positive thoughts, so that the distractions die down on their own; 3) If, however, the negative thoughts persist, the bad repercussions of having such thoughts must be recalled, so that they can be discouraged from inhabiting the mind; 4) If still present, the meditator then needs to study the underlying causes for their arising, the cause-effect relationship for their birth, and by this understanding and unmasking, they die down on their own; 5) Finally, if the negative thoughts still continue, they must be dominated by a strongly benevolent gaze, with upright posture and teeth clenched!.
4
There are FIVE KNOWN CONTINUOUS GENERATIONS of people in my family who live(d) with mental illness. Why aren’t we any closer to helping these wonderful people? It’s complicated and I’m grateful his article illustrates that there are no magic pills.
4
Thank you for this informative considerate article. As a musician, years ago when I was in therapy 3 times per week (thanks to the generosity of an excellent psychologist) I briefly considered seeing a psychiatrist who would prescribe medication. In the midst of filling out detailed questionnaires in preparation for my appointment, I met a musician colleague and close friend for dinner who asked: "Does the psychiatrist know you are a musician?" Somehow, the understanding of my friend who knows the ins and outs and ups and downs of trying to be a musician in the USA was a watershed moment. I currently weekly see a therapist and believe strongly that anyone considering meds should also be in therapy.
As it happens I am also a practitioner of the Feldenkrais Method which addresses the body and the psyche. Highly recommend!
8
@Karen Clark, 100% agree. Once the meds start you are in an altered state. Would have long discussions with judges and parents allowing their out of control children to be administered psychotropic meds "before" medical exams and psych testing because the test results would be altered and not a true reflection of the problems.
2
I was a psychotherapist who struggled with not knowing if clients were improving as it was difficult for me to measure progress and many problems were cyclical. I eventually studied Oriental Medicine which has physical signs, like palpating pulses and abdomens as well as viewing the color and shape of the tongue, that may describe factors associated with anxiety or depressive symptoms. I find it helpful to have these assessment tools as well as access to the traditional and natural remedies associated with this medicine to support client's recovery and measure the effects of contemporary strategies.
1
Congratulations to Kelli. In her "mental illness" she's found the secret to enjoyment of life. Life as a process, ever evolving, never complete. No pill will ever change that so why not embrace it and allow oneself the experience.
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@d. roseman Enjoyment? I hear a long list of things done to, in her word, maintain some balance. These activities and practices are still work, especially when you are fighting psychological problems. These don't turn your life around, they just keep it from crashing again. "Enjoy" does not come as easy as you think.
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@d. roseman Sounds like someone lucky enough to never experience depression/ anxiety etc who is projecting a Happy Face on the life long struggle to gain some peace in life. Just a another way to say a version of that old nugget "pull yourself up by your bootstraps" I have heard my entire adult life, with a new "embrace it" spin. No, the struggle with mental illness is not the secret to enjoyment in life. I will finish by expressing my gratitude to SSRIs, my therapists, my doctors, and my loving family for helping me and guiding me through my darkest days. I have been very lucky to have this support.
9
@d. roseman This vapid version of "Just cheer up!!!" could only be offered by a person who hasn't suffered and doesn't suffer with depression, anxiety disorder or PTSD. Cheering up in the throes of depression or panic attacks is akin to lifting a boulder when one has a bad back.
5
There are also societal causes. As Mark Fisher said in "Good For Nothing": "many forms of depression are best understood – and best combatted – through frames that are impersonal and political rather than individual and ‘psychological’ [...] the most likely cause of feelings of inferiority is social power. The form of social power that had most effect on me was class power, although of course gender, race and other forms of oppression work by producing the same sense of ontological inferiority, which is best expressed in exactly the thought I articulated above: that one is not the kind of person who can fulfill roles which are earmarked for the dominant group."
Our current capitalist order churns through human beings as grist for its mill in order to manufacture more plastic toys and sell more cell phones, all while convincing its population it is not cut out to do anything better, that it is unable to challenge an order that makes us feel powerless and unwanted. We watch helplessly as those plastic toys choke the oceans and those cell phones are made with slave labor.
No wonder everyone is on SSRIs and anti-anxiety drugs. It is not your fault, the people destroying the world are profiting from it, and have names and addresses. Strangely enough, they are probably sad and isolated in their gilded mansions as well, having created a tiered society that necessarily alienates them from others.
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@Thomas Watson Thanks for this incredibly insightful post and for the Fisher reference.
3
I'm more than twice your age, but learned the same lessons. That period of extreme relief -because the drugs did help -- and because - as with yourself - the self-blame was no longer foremost because a physical 'cause' could be named. Also it's easier to let other people fixate on the simplistic chemical imbalance explanation when the real story is too complex - and we don't really have easy answers.
There is a lot missing in our "system" of care - accessing therapists and getting them paid remains a impossible hope for too many with mental health issues. Drug treatment was seized on by cost cutting insurers; counseling and coaching considered immaterial. Yet one without the other does not work as well as a combination of approaches. To use a word that insurers hate, a holistic approach, using all the tools of healthy living plus drugs, can keep the black dogs snuggled up in their crates.
Change is slow and frustrating; still it's a whole lot better than in the a 1950's-1960's.
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It used to be said, "It's all in your head." What did that mean? Now it is said, "It's all in the chemicals in your head."
I prefer to think of mental issues and the chemistry involved in depression as big waves in an ocean: they come and they go but they are not the whole story. We are much more than chemistry and how we live obviously impacts the line up of chemicals to which so much has been ascribed.
In reading personal texts by philosophers and intellectuals from 200 to 400 years ago, it was striking how much of their concerns centered on how to live a balanced life, how to sustain themselves as working, successful beings in all aspects of life. It seems to have been a central concern of life for many historical figures and they obviously managed most the task or we wouldn't remember them at all.
The ending of this column, "a person who belongs to the world" reminded me strongly of a song by Jackson Browne, a wonderful statement of having arrived and having survived personal crisis and trauma. It is my hope that the writer of this op-ed, and others, will take a listen. It is an affirmation of survival and lasting intention to make a contribution:
https://www.youtube.com/watch?v=axYfIwiNywA
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@Doug Terry
Lovely. Thank you so much!
1
@Doug Terry
I know and love that song.
How can a psychiatrist who is not also a psychotherapist know enough about the patient to make an accurate assessment and make a diagnosis?How much can you learn about someone in 15 minutes?
Mature , insightful, caring, respectful psychiatrists are hard to find.
I did find one, and when he retired he could not recommend another psychiatrist in the area and told me to get medication through my GP.
That strategy has worked for the past 22 years.
The medication was low dose .lithium , no side effects., A life saver.
4
Beautifully articulated journey, Kelli. May you continue to share your voice.
From my perspective - having lost a child to major depression - our health care system would do well to develop preventive care for mental health. You know, those wellness visits for which there is often no co-pay? As well, I would love to see the development of interdisciplinary high school and/or undergraduate courses that combine psychology, biology and sociology. With one in five adults reportedly coping with a mental health issue, there is zero reason why we are not engaging in better education.
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@Marny Lombard This would also save many teenagers from being lost to drugs and drinking. Think how relieved they would be to take an ACES scale evaluation and realize how their brains and bodies were being impacted by their homes' domestic violence, their parents drinking, the premature deaths of people close to them. They might seek productive outlets like arts, sports, writing, academic interests, and social connection to a drama club, cycling, or a church group rather than to the local heroin crowd.
3
@Sara We are seeing an steep rise in adolescent mental health disorders particularly anxiety and depression. As the parent of 2 teenagers I think our educational system is a large driver. School, particularly high school, has become a race to nowhere, burning out the "high achievers" and beating down the average students unwilling or unable to take the honors/AP courses they are told they need, and need to get an "A" in, in order to get into college (our counselor quite literally told a group of parents this when I was enrolling my first one into 9th grade). Don't even get me started on the school start time on 7:20 at our local HS, a recipe for sleep deprivation and its consequent deleterious mental health effects for any adolescent. Elementary schools have put the cart before the horse, expecting kids to kids to be able to read and write by kindergarten despite no instruction, and middle schools pile on hours of HW for 6-8th graders eating into time with family and friends. This environment is not conducive to good mental health. And yet, schools are defensive and reluctant to change any of this - I now because I've been labeled the "difficult" parent railing against this for years. We are damaging our kids with this environment, and the solution is to change it, not to medicate our children.
3
@BCO
The university track is such hype!
Both my ex and my brother took advantage of the same loophole. They dropped out of high school after enrolling at the community college and then transferred to the University to complete their degrees. CC is underrated. The teachers are actual professionals, and they are available because our classes hold 20 students, opposed to 100+. Graduating in 4 years is also insane. What's the point of an education if you didn't have the time to learn the material?
Maybe you could find one of those online homeschool programs and save them some grief.
1
It’s complicated! The reality is that nobody fully understands mental illness. Drugs, talk therapy, diet, exercise certainly help. The writer is taking responsibility for her illness. That is a huge part of the solution.
12
Most illnesses that today have pharmaceutical cures were once attributed to demons, humors and whatever woo-woo this or that culture's witch doctors dealt in. It's easy to understand why we'd look at every illness as having a chemical solution.
1
This comes to mind: "It is no measure of health to be well adjusted to a profoundly sick society." Jiddu Krishnamurti.
Thank you for sharing so deeply. Its powerful and profound.
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Drs need to get to a diagnosis quickly so they can give you an Rx, like diuretic for high bp or ssri for any mental issue, sometimes helps..
Counselors are now similar, short term "cognitive behavioral therapy" under the simple notion that feelings come from bad thoughts, sometimes true (emotions are far more complex)
Talk therapy mentioned is helpful advice but can go on for years without getting to the problem's root. Because it's unknown: no simple problem, only simple docs and counselors with their emotional need for a simple solution.
2
Oh yes, I remember when women (usually wives) were drugged into compliance with a sexist culture which frowned on female aggression and condemned us to domestic prison. After 8 years of marriage to an alcoholic verbally abusive prominent husband (lawyer/politician), taking prescribed anti-depressants etc, the day I flushed these meds down the toilet and arranged for divorce was a rebirth for me. I went back to college, earned PhD, became licensed psychotherapist, professor, and book author. If you have genuine manic-depression or true schizophrenia, by all means take appropriate meds which can be life-savers. Otherwise, get outdoor exercise daily, eat a balanced diet, forego alcohol and caffeine, and if you have SAD (seasonal affective disorder, as I do) get a daily dose of sunlight. Welcome people who love and are supportive of you, avoid the "downers." Most depression and anxiety are situational, so change your situation rather than masking with pills. This works. Do it.
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“When, in my early 20s, I asked a new psychiatrist — one of the only mental health providers I could find who would accept my insurance and had openings for new patients — if we could try discussing some of the problems I’d been having, she looked at me as though I’d proposed a joint mission to Mars. “Ohhhhh,” she said, nodding, as my meaning dawned on her. “You want to see a counselor.” Spot on! My experience mirrors hers!
4
To ignore socio-economic causes of depression and anxiety is cruel and incompetent. Validation of experiences, and taking action to address root causes of suffering is empowering and actually helpful. Thank god people are starting to realize this. This is an important essay.
6
The sad, and real, irony here -- about the false premise of seeking to correct a "chemical imbalance" -- is that no even knows what a "chemical imbalance" is. It is merely marketing jargon. See "Psychiatry's Incurable Hubris", in April's Atlantic.
15
@DavidF
Thank you!
1
I am reminded by the author’s way of living with mental illness of something I’ve said of a physical issue, bone spurs that started when I was in my late 20s: My painful neck/back is the daily reminder to me to get up, get away from my desk, go take a walk, go to sleep on time, do yoga, etc. It probably influenced my (beneficial) change of careers. I wouldn’t wish it on others, but when I stopped seeing it as something to fight against and instead something to work with, it made a positive difference in my life. Ironically, I might well be less healthy today (25 yrs later) if there had been a drug to just mask the pain or even erase the spurs. This is not to say that medicine isn’t important, for both mental and physical health, but once we can reach a certain general level of functioning, maybe a goad to “healthy living” is a useful companion.
2
Thank you for having the courage to write this.
Like Maryann Williamson (see the related interview), I too believe that medication has become too prevalent in the treatment of depression.
IMHO, there are two kinds of depression - environmental and chemical. Environmental depression is sadness / hopelessness that is directly related to an environmental cause - the ending of a relationship, the death of a loved one, or "the slings and arrows of outrageous fortune". This kind of depression can and often will pass - especially if the suffering person is given access to an effective form of psychotherapy.
Long-term depression due to brain chemistry is another matter. That type of depression surely benefits from the right type of medication.
Unfortunately, psychiatrists and psychologists are being increasingly compelled by the insurance industry to opt for medication and extremely short-term therapy.
I was lucky; my ex-wife had great insurance, and I was able to work with a skilled practitioner in a non-traditional approach to psychotherapy called Psychosynthesis for 6 years, in additional to couples and group therapy.
Today, I have no need of medication - even in this appalling season of Trump; but, of course, my sadness was purely environmental. Today, even in my darkest moments, I can avail myself of meditation or yoga to completely alter my brainwaves.
Not everyone has the brain chemistry to do that. Insurance companies need to admit that there is a difference.
8
Interesting that there are two articles on mental health care and the use of antidepressants on the front page this morning. I read the interview with Marianne Williamson on the subject first and then came to this one. Certainly this is a subject that should be addressed more widely. Whatever one may think of Ms. Williamson's positions on the subject, one must certainly agree with her statement that our society is depressed! We need to address the roots of this societal sickness.
19
This has nothing to do with Trump, Republicans or their 60 million MAGA adherents. So let's find another reason.
@JCX No one has mentioned Trump here. But, since you brought him up, he is not the cause of the problem but he is certainly a shining example of the problem. He is the poster child of what's wrong with this society If you want reasons here are a couple: materialism---the idea that any problem can be solved by taking a pill, greed---the goal of Big Pharma to make profits over the welfare of the people. What reasons do you come up with?
1
@Christa. Thanks, I was going to mention the Williamson interview too. NYT, how about a conversation between these two? The subject affects probably every person in the US.
There is a growing understanding of the relationship between common viral and bacterial infections and behavioral problems in children and teens. Too many psychiatrists have not read this research, and some may refuse to believe the results of research, no matter how strong. Strep infections have been shown to cause neuro-psychiatric problems such as motor tics, anxiety and obsessive behavior but many physicians will not even consider this possibility. Certain genetic conditions may also be related to depression, or behavioral problems, but how many patients have been tested? Neuro-immunologists are trying to understand the relationship between many common infections and psychiatric illness because these conditions can be treated, and even cured. There may be other medical problems which might mimic psychiatric diagnosis, but because medicine is so fragmented, and so specialized, a proper diagnosis may never be obtained.
6
Wonderful article. Research shows that a combination medication AND counseling produces the best outcomes. The problem? Counseling can be a long-term proposition that can cost hundreds of dollars a session. Meds are cheaper. Insurance companies take the less expensive route. The author's MI began as a teen. 50% of lifetime MIs are evident by age 14 with 75% by age 24. Why would anyone expect a teen, with a still developing brain, to be be able to navigate an MI on meds alone? As a result of the advent of SSRIs, psychiatrists, as the author pointed out, are focused on medication management and no longer appear to have psychotherapeutic skills. Even psychologists are more attuned to research and psychological testing than psychotherapy. Finding an experienced an knowledgeable therapist is key to recovery from MI. As an aside, the same is true for substance use disorders that often begin in early teens but are sometimes mis-diagnosed as MI with drug use being mis-identified as self-medication.
4
@Dustin Chapman Think of all of the billions of US$ routed to huge insurance companies that could cover care of people.
2
It might not just be a chemical imbalance for the author, but SSRIs allowed me to clear the depression clouding my outlook since childhood. For me, it was not an oversimplification - after decades and thousands of dollars wasted on therapy focused on relationships with my parents, women, mentors, other therapists - it was a necessary simplification. It was the answer.
Though some may quake with anger at the "wholesale failure of mental health care in America," I thank my lucky stars Pfizer chemist Reinhard Sarges invented sertraline in the 1970s. It changed my life for the better.
33
@BobMeinetz I'm so happy that this worked for you! And I think those who can take sertraline are thanking him, and those who can take other things are thanking those people. I don't think anyone is saying that it's oversimplification for everyone. I think that the author is saying that for many people—most people—it is.
3
@BobMeinetz Exactly. All the therapy in the world won't help if you can't function enough to get to it.
3
@BobMeinetz,
I understand every point you've made. Thank you for speaking out.
1
Americans have refused Freud as they have rejected Marx about the economy.
The behaviorist psychology and cognitive kind of thinking hsve suppressed all philosophical and language based analysis.
The lelev of general education in philosophy and psychoanalysis of American psychiatrists and psychologists is very low and unfortunately has stained onto Europe as well.
So called philosophy of science. No metaphysics and no phenomenology. Even less semiologie. They say semiotics.
3
My impression with a lot of our health care system is that is too much about money.
I, too, was looking for some therapy. I was told that the local psychiatrist team was for prescribing medicine and I should look for a psychologist.
And when I see a doctor, they spend more time entering notes in my electronic medical record to bill the insurance company than talking with me.
Their incentive system is getting paid by number of patients seen and it is reflected in the care we get.
I have read that the doctors at Mayo Clinic and Cleveland clinic are on salary and it makes a difference, both in cost and care.
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@Independent
Every physician, np, PA detests the way the health care system is today in the US. The paperwork constraints are driving people into other fields after years upon years of specialized training. It's the insurance companies who are making all lives miserable.
6
"I'd... been raised to trust in the hard, scientific grounding of modern medicine."
The concept that a mentally healthy human being should be able to manage the modern world in a state of functional contentment is not the least bit scientific. The cultural environment of modern society is so far removed from the world we evolved in, you could just as well say that if you are content in this one you must be crazy.
We are years away from the time psychology can provide truly scientific answers about who, what and why we are and that will probably only come when we understand by way of clear microscopic data how our brains work.
I am very sorry that you feel cheated by false promises of the pharmaceutical industrial complex, but this is capitalism.
What products are ever marketed with honest and realistic descriptions of their value?
There are many good reasons why many intelligent people don't feel that very lightly fettered capitalism is the best venue for the health care of a nation.
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@alan haigh
The problem of psychology and psychiatry isn't what is inside the brain. Rather, it is what context is the brain inside. Studying the brain itself without context is pointless.
2
@Peter Everything the brain does is biological and chemical. Until we have an understanding of the "moving parts", the science of psychology can't do a very good job of analyzing what is going on in the brain of anyone. A thorough understanding is completely impossible and experiments can only suggest, but fail to establish a clear picture that would allow much better treatments for mental illness that might treat causes instead of symptoms.
4
@alan haigh
Yes the brain is biological and neurochemically driven. However, the brain does not exist in a vacuum (or a vat as they like to say) it exists in culture and history and has been shaped by external factors for the entirety of its (our) existence. Scientific truth is essential (and always political) but scientific truth is also contingent. What we call normal and abnormal is socially constructed and historically determined. Science can help but it is not the absolute, objective truth. Human beings cannot dot a view from nowhere from which to understand themselves or their (our) brains.
1
The 'chemical balance' theory and the anti-depressant meds to cure depression seems to be made up by big pharma.
These days it seems that it is big pharma that is educating doctors and psychiatrists on depression and how to deal with it.
In reality, licensed social workers, marriage family counselors and psychologists have more clinical training with actual clients/patients then do psychiatrists.
If one reads the side effects of anti depressants one would be concerned about taking them. Some of the side effects are exactly what the meds are supposed to cure. Additionally, many anti depressant meds are prescribed at the same time although usually the interactions are not know.
Many suicides are probably a result of anti depressant medication but other medications also have similar effects.
While there may be a chemical imbalance in depression, it is not able to be measured. The chicken or the egg dilemma comes into play as well, did the chemical imbalance cause the depression or did the depression cause the chemical imbalance.
Talk therapy should always be included in mitigating depression however giving someone a pill is far cheaper and the bottom line is what insurance companies are interested in and big pharma makes billions from its psychotropic medications.
41
@Dr. B Will you just stop with the "Evil Pharma" already? These drugs have saved countless lives, as readily admitted by those for whom this is true. Of course it is essential to have counseling, therapy, to learn how to reshape your life and all the unhealthy coping mechanisms, but it's not enough, especially for things like bipolar, schizophrenia, relentless depression. Blame capitalism for making health about money. ALL health related professionals-doctors, pharmacists, drug makers are affected by insurance and profits. It wasn't always this way.
9
@Dr. B
Wow, I cannot believe how many have upvoted this post. I seriously doubt that you are a doctor, since you are spreading dangerous misinformation.
Medication is not going to fix all, but combined with talk therapy and/or social support systems it can give someone suffering some control over their thoughts and the ability to make positive changes. When depressed, it's almost impossible to enjoy life, even things that should be joyous. It's like being constantly choked by a black fog.
I went to a support group for my depression (which I very much recommend) and everyone there was on medication except for one woman. Her family was anti meds and she was embarrassed about her depression. She was clearly suffering the most. One day she told us she was starting medication. A week later, she was clearly better than before. By two weeks, she was so much more lively and so much less despondent.
Also, the only time I have been borderline suicidal was when I was on zero medications. I've never heard of anyone committing suicide just from being on antidepressants. I know many on antidepressants (many of whom I had never known were on meds before I was also on them) and other psychiatric meds and they lead happy and productive lives.
As for my own experience, I am so happy that meds like Zoloft exist. I felt it lift the fog; there is zero question about it for me.
4
I was expecting a reference to the work of Johann Hari's "Lost Connections: Uncovering the Real Causes of Depression - And the Unexpected Solutions." Hari looks at the social dimension of wellness and identifies our illness in alienation and the lack of community.
21
I did talk therapy for years, resisting SSRIs as long as possible, but it was insufficient. I finally got tired of putting myself and my family through all the suffering.
I am a fast responder. I took an SSRI and after two weeks literally saw the darkness lifting. I still remember the moment. I have gone off them for periods without the withdrawal some experience, but eventually the darkness creeps back in.
I don't bother to try to go off any more. If life throws me a huge problem, I go back to talk therapy until I work through it.
Others don't have this experience. I call myself a "lucky unlucky one" because while I am unlucky to suffer from chronic depression, I am lucky that I can find such relief in a pill.
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@Lucky unlucky one
You are, indeed, a lucky unlucky one! What I wouldn't give to have found relief from one of the many pills I've cycled through over the years. Instead, I've begun the process of unwinding myself from the medications and taking a step back.
That's where I'm at. I know medication works for many people and I'm happy for those who respond well to it.
5
@Lucky unlucky one
It’s dangerous to stop SSRIs without doing it gradually. Ever heard of Serotonin Syndrome? Google it.
1
@Lucky unlucky one
My experience sounds nearly identical to yours, except that I no longer use talk therapy at all. The response to fluoxetine (Prozac) 20+ years ago was life-changing and sustained. My early experiments with stopping the medication convinced me that, whatever the exact mechanism, I needed that medicine. It is now just part of who I am. Incidentally it was Peter Kramer's book, "Listening to Prozac" that convinced me that my situation was very similar to that of the patients in his book who were responders to fluoxetine. Still grateful for his work.
The many difficulties of coping with 4th stage cancer led my wife to seek counseling, and it has proven very effective. Her positive experience led me to seek support from the same service, and I've benefited significantly. We're both mature, reasonably rational people who accept realities and work to make the best of them. We're dealing with issues that could have been addressed decades ago with positive outcomes for our lives. I wonder why we waited so long and only took on some of our problems in extremis. Talk therapy seems like a valuable tool, but I think the author has it right when she says that it is just one in a whole quiver of tools for building mental health, a lifetime process.
27
Lovely article pointing out the dynamic interactive fact of mental health. It is an ever moving fluid combination of personal thoughts and perceptions, physiology, social supports and chemicals. All aspects must be addressed to lead a healthy balanced life to the greatest extent possible.
9
Great presentation of the sorry state of psychiatrists and their 10 minute appointments. In my psychiatric training, it was the 70s and I managed to get supervison outside the department from therapists and philosophy profs, I also managed to duck under the ray gun which erased all humanity from my colleagues. Some understand that big Pharma suppressed the negative (no difference from placebo) SSRI research. Some understand that cognitive therapy works best to prevent recurrent depression. Besides robotic pill pushers, most SSRIs (80%) are prescribed by prrimary care providers who use a two-question screening for mental health problems. It's the standard of care!
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From every drug company TV ad run every 15 minutes: "Talk with your doctor..." They know the only talking is BY the doctor, or more likely the nurse practitioner or physicians assistant. Hence the prescription and scheduling of re next appointment and test. Welcome to The Disease Industry.
10
Really good article; I appreciate the author sharing their journey through the mental health maze.
For people experiencing mental illness, it’s not always effective to rely only on what a psychiatrist can prescribe. Most need counseling. Humans are wired to need social interaction, and therapy helps fill that need in a constructive way. Cognitive Behavioral Therapy is also very effective in learning new ways to cope. And meditation and even yoga can go a long way in helping with depression.
Another thought; don’t let your general family doctor prescribe drugs that should be dispensed by a real psychiatrist. Many mental disorders are first misdiagnosed that way and that can exasperate the problem. As an example, an anti-depressant can cause mania in someone with bipolar disorder. Different medication is needed to regulate those moods.
We’ve learned a lot about mental illness over the last 30 years, but along with the research, work still needs to be done on the stigma associated with it.
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@Dorothy
I agree, if one requires psychiatric medications, it is far better to be treated by a psychiatrist than an internist or family physician. However it is difficult to find a competent psychiatrist who will accept your insurance. Most internists will not prescribe psychiatric medications, for a lot of reasons. If you find one that is willing to prescribe psychiatric medications, that help you function better, count yourself fortunate.
4
Agree with many mental illnesses meds are better than no meds. I support the ACA making brain health care equal to body health care. People need access.
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@Dorothy - "Many mental disorders are first misdiagnosed..."
For 4 years, I went to my HIV specialist telling him that something was terribly wrong. I will spare everyone the details. He told me to see a psychiatrist because there was nothing physically wrong with me according to his HIV lab tests.
Then, I had two grand-mal seizures in one day requiring my roommate to call EMTs to the house twice. He got video of one of the seizures and when I regained consciousness, he handed me the camera and said, "See if your doctor will listen to you now".
I took it back to the doctor who then sent me to a neurologist but she said to not come back till I saw a shrink. The psychiatrist's first words to me were, "I have seen your EEG and I have no idea why they sent you to me. You need an anti-convulsant and I'm not going to prescribe anything".
I changed doctors/hospitals and the next neurologist told me that my type of epilepsy is commonly misdiagnosed as a mental illness and to always wear my medical alert bracelet as he has had patients wake up in the psychiatric ward.
I quit wearing them the day another roommate called EMTs to the house and they insisted on testing me for diabetes even though he told them I was not diabetic, that I was epileptic, and was wearing the bracelet and the necklace bearing the name of the regional epilepsy center on it. They never bothered to look and I woke up in a hospital with a jabbed finger along with 2 i.v.s in me.
Crazy, huh? :)
3
Very spot on piece. If you aren’t depressed about the state of the human experiment, maybe you just have found a way to create your own reality. But if, like the author, you are dealing with intergenerational trauma and existential doubts any sensitive intelligent human would find challenging, being told to take a drug is not really gonna do it.
The overdetermined nature of personal psychology requires sophisticated multi-disciplinary approaches. Adding diet and exercise isn’t just “a good idea” its fundamental to mental health. We could also use some better cosmology. We can’t just live to retire and have nice vacations.
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The mental health system is broken for everyone. Long term talk therapy and emotional support through mental health with an opportunity to articulate your worst thoughts and pain and bad behaviors with a goal to be a higher functioning human with or without a DSM diagnosis is all but lost. In today’s world it is 2 talk therapy sessions and off to the Psychiatrist for meds and future appointments to adjust the meds.
Too many people hurting today and too many people with mental health issues inflicting pain on others with little support from the mental health community.
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I think every human being is entitled to talk therapy throughout their life, I wonder why we get our teeth cleaned every six months, get an annual physical every year and why oh why can’t we all get our mind cleaned every six months?
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@Juliana James . Thank you Juliana for raising this idea. We are relational beings. We need to talk. We need to talk about what is bothering us with someone trusted, someone who won't dismiss us, deny the issue, or minimize things.
11
@Juliana James: Get our teeth cleaned every six months? Only those with dental insurance or those who can pay out of pocket. I went without a tooth cleaning for two years because of lack of funds. I've had serious dental problems ever since.
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@Juliana James that used to be called church on Sunday and organized religion, at its best, is basically a weekly mental health break. It is easy to see the problems in religions and forget the important cultural function and mental clarity some (or any) sort of spiritual practice provides.
2
My experience is that medication did wonders when I could not stop crying, could not concentrate, could not work, could not function.
But talk therapy was indispensable and still is, even as I am now stable enough to taper off drugs.
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Glad to hear you are doing well and ready to taper. Antidepressants must be tapered very slowly, over a year or longer. Yes, even if you are taking an antidepressant for other reasons like migraines or pain. If you are tapering, read guidelines on SurvivingAntidepressants (dot) org. The folks on the site read the scientific literature and understand the effect of dose change on receptor occupancy.
Know this: to prevent horrific withdrawal syndrome, reduce at 10 percent dose reductions per month with compounding or liquid tapers. Do not cut dose in half or jump off cold turkey.
1
It’s not simple and never has been. Many factors are involved but keep on working to help those who need help. Hoping the combinations are effective.
7
I have been subject to depression for many years, after studying hard in a graduate program, doing really well there, and being unable to get a job (including some very sexist situations in job interviews and some men with fewer qualifications getting the jobs).
My profession has gone to "contract work" for the majority of its workers and, while I've been employable, I went for 15 years without a steady paycheck and benefits. I could never take a vacation because jobs would come and go capriciously. The one time I took two weeks off, I lost out on a $5000 job. And, after all these years, I started to face what seemed like it might be age discrimination, as well.
This year, I got a pleasant full-time job with good benefits, decent pay, and interesting work. Funny how, for the first time in 15 years, I don't feel depressed at all! I tried therapy several times during those years, but talking about my feelings of uselessness and poverty didn't get me anywhere. Making me actually less useless and poor did. Not disagreeing with the author, but I wonder how much many depressed people are actually suffering from real life circumstances that they are trying, but not succeeding, in fixing.
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@heliotrophic: I've said this for many years.
Often what people lack are things like steady jobs, good health insurance coverage….economic security....friends, family, a support network….romance.
I've seen people who suffered long-term chronic depression and "fatigue" and were on various anti-depressants. Then they fell in love and suddenly they were FINE. They hadn't been depressed after all -- THEY WERE LONELY.
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@heliotrophic When I went to a therapist during a long recovery from a physical injury that I didn't know if I would be able to play music again (my profession), my therapist said, "you have good reason to be depressed".
She advised me to look into guided meditation and other wellness activities - which did really help.
Actually, just being told how I felt was normal and to be expected really helped me feel better.
108
@Concerned Citizen, then they were misdiagnosed, or self diagnosed, not depressed. Don't muddy the waters. It undermines the struggles of people with actual depression.
24
I am bi polar. Medication helped me a great deal. Two weeks ago a friend threw out all my medication because she said I was acting like a zombie. I have been crashing and my "emergency" doctor appointment is 3 weeks ahead. I hope I make it that far. My mother and grandmother were also bi polar. Medication was not available for them. If the meds are there take them. Save yourself a lifetime of anguish.
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@Sharon Conway
Some “friend”. That’s good grounds for ending a friendship, in my opinion. I’m bipolar too, and you have my best wishes as you get through the next few weeks.
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@O. Clifford Thank you. I can't stop trembling. I can't eat or sleep. I am truly frightened for my health for the first time in 71 years. And I am angry with her.
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@Sharon Conway dearest Sharon, Please call your mental health association in New York. You can find them by doing a google search. They can help you to find medication replacement. Please call them, Sharon. They can help you. God bless, karen
25
"I also make it a daily priority to get at least some light exercise, whether a walk or a jog or a bicycle commute. I maintain a regular yoga practice, try to eat a balanced diet and get enough sleep, read constantly, and work to nurture social connections and build community. "
I wonder how many of the "mentally-well" folks even attempt to do those things.
29
@point-blank. Interesting that you point this out. I don't suffer from issues that the author describes, although I am close to people that do and so found the article interesting and well written. When I came to the paragraph you quoted though, I thought it actually spoke directly to how I (sometimes unconsciously) organize my own life. To me, it reflects perhaps what all of us need (in various combinations) as we strive for life balance. From what I read in the article and the comments, sometimes this list can include chemicals .. and in all reality it likely does for most people: some in the form of the chemicals in this article, or for many others the various other chemicals that we deem socially-acceptable: e.g. caffeine, ethanol, THC, ... I would guess it is the rare human that eschews the entire list of mood-altering chemicals throughout life (although full well recognizing that chemicals can go quite wrong for people too!)
2
@point-blank It's an upside to mental illness that it kind of forces you to learn to take care of yourself. Like the author, I take medication for depression and likely always will, but I've also learned over the years that I feel much better when I'm exercising, getting enough sleep, having meaningful social contact, consuming books and art that enrich my brain and soul, etc. (without becoming obsessive about any of the above, of course). Abstaining from alcohol and recreational drug use also makes a major, major difference in my mood (my last drink was 6+ years ago and my anxiety symptoms dropped dramatically from that change alone). If I didn't have a chronic tendency toward depression, I don't know that I ever would have discovered all the mental-wellness levers at my disposal.
1
@point-blank
when a person is so depressed that there is no energy for even the lightest of exercise, when one can't get out of bed, when one is fatigued and exhausted 24 hours a day, such a simple thing to you is like being trapped under a boulder for some of us. You clearly don't seem to understand the true nature for those of us who are overwhelmed by the state of of brains and bodies.
I feel like there’s a whole generation of teens and adolescents in first world countries over the past 50 years that take normal teen angst and magnify it 100 fold through intensive navel-gazing and negative feedback loops. These kids weren’t depressed years ago. They didn’t suffer through endless emo soundtracks and Netflix movies reinforcing the notion that teens should and do feel depressed and angst-ridden. They didn’t sit bored to death in classroom and then navigate the Snapchat-sphere of teenage bullying. Most of these kids just need a job, so to speak. A project, a task. Something to constructive to keep their bodies and minds busy and distracted.
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@Victor Yes, they were depressed, it just wasn't talked about. Perhaps the good ole days were good for you, but I'm an older person too and I am so thankful that the door has been opened on mental illness and it can be talked about, treated and researched. Please don't demean or simplify this.
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@Victor, rather agree with you. Most teens and young adults I interact with today do not have an intact family system, parents too busy with heads down looking at cell phones and social media to have healthy verbal interaction, peer pressure to dress in high end clothing, and soooo much more. Some of these social pressures have always been around but hard pressed where I live to see neighborhood kids hanging out with other neighborhood kids, parents showing up at soccer practice, etc.
Society never factored in the presence of cell phones and major social media that disrupt and change every aspect of human interaction in today’s world and can be very, very self destructive and depressing to one’s mental health for all of us.
30
@Victor Sadness is a human emotion, as is angst, and hopelessness. Is it any surprise that artists choose to produce mass media which engages these emotions? I think not, and I don't think it is harmful. Depressed people are not depressed because they watch sad movies. In my experience, and in watching others go through therapy, the root causes of mental anguish are always personal, profound and thoroughly experienced in "real life." If you've never learned this, and get along just fine in life, consider yourself lucky, and also consider developing some empathy for those whose circumstances are less fortunate. If, on the other hand, you're taking your own advice and using a job to distract yourself from sadness, consider exploring that emotion with a qualified professional.
16
I have struggled with bipolar disorder for more than 35 years. I was fortunate enough to find as my first psychiatrist one was a psychotherapist, as well. He saved my life and my careeer at least three times. I was a corporate bankruptcy lawyer for more than 25 years at three of the largest lawfirms in the world. That there were three is important. Each move was preceded by an severe acute manic/depressive episode. Stigma may not be as bad as it was 35 years ago, but it is still horrible.
Now I have retired to Panama and I am English tutor for two of the largest pharmaceutical companies in the world, one of the largestic cosmetics companies in the world and one of the largest lawfirms in Panama. I have not been able to find a psychiatrist who is also a psychotherapist here. But mine has an open mind and wants to hear about approaches my NY psychiatrist took to problems. In effect I am teaching him psychotherapy which is an interesting way to experience it. Modern medicine in general has become too theorectical and lost touch with its empirical roots. Pharmacy and medicine have to rediscover their beginnings and combine them with modern molecular biology if we are to make true progress with brain disorders. While the brain is a physical organ, its complexity precludes a pure theoretical approach which is much better suited to cancer treatment. Cancer cells are very well understood in comparison to the brain.
27
@James Ricciardi, excellent comment. Yes even if you have money of your own and a medical insurance plan that covers individual therapy one is hard pressed to find a clinician that will support one on one sessions.
4
Mental illness may have to do with chemical imbalances in the brain, but what about all the environmental toxins? Do we really believe 7 billion humans on the planet is going to leave us "mentally well"? And to not talk about abuse and trauma and be expected to pull oneself up by their bootstraps and get on with capitalism also makes one mentally ill. I blame capitalism (which is legalized greed) for much of our mental illness.
70
This author is spot on. I would add that an environment at hand has more than enough to contribute to mental health. Maybe those suffering aren’t always broken; if might be our culture.
59
No competent psychiatrist or other mental health professional views mental illness as "preordained" or due to a "chemical imbalance". It's not an either/or phenomenon. Mental illness is a true bio-psycho-social condition requiring addressing these 3 areas of an individual's life. All though quite a number do, there are not enough psychiatrists practicing in this country to prudently and effectively prescribe and provide medication management let alone provide time for labor-intensive formal psychotherapy. Thank God, there are many trained and professional "counselors" who do. There are options, what's needed is greater access to them.
52
@Uskame, dunno personally see few counselors available for talk therapy and most people are thrown simply MEDS and therein starts a cognitive behavioral cycle that can only be changed with a different dosage of meds.
Have ADHD kids and severely wounded via neglect and abuse kids on my caseload and always struggle with the courts and doctors NOT to prescribe meds BEFORE a psych evaluation and complete assessment can be done because once you start with the psychotropic meds you are an altered mind space and is the behavior the true persona or the meds?
5
Yes, thanking a fictional almighty deity who you believe controls your destiny is perfectly acceptable and not considered a psychiatric disorder.
1
referring to doctors, "they tend to meet with patients briefly and write prescriptions" is not inaccurate, to judge from the opinions of my sister, a california anesthesiologist.
as a behavioral scientist, i will say that most adult mental functioning is genetically "hard wired," understood to mean that the "hard wiring" is in the developmental process. we're not hard wired to be, but to become.
needed services for the needy is a fine concept -- now, will that be cash or charge? being "entangled on my own terms" in the medical system is still entanglement, albeit entanglement that can be life saving and spirit lifting. give doctors the credit due.
but i don't think anyone can be "entangled" in the american health care system without feeling that the radical reforms proposed by some democrat candidates are not really radical enough.
the great merit of the author's article is that she looks at that problem not through the lens of sickness, but of health.
14
The author is taking is the wisest approach possible: exercise, diet, sleep, and talk therapy. But before being too hard on herself, some European studies suggest that trauma is inter-generational and the reconfiguring of the brain by severe trauma, such as surviving the Holocaust, may be inherited by future generations. If at all possible, I hope she gets an affectionate pet - they can provide tremendous emotional support even in the darkest times.
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@Elimy
My dogs are my four legged children.
But even though I am a animal / dog lover, I hadn't stopped to think about that.
Once you said it, my reaction was "of course."
8
@Eli Here's a good example of the barriers to good mental health. Not only must we move away from family and friends in order to stay employed in a globalized, capitalist "system" that rewards only the oligarchs, but most of us can't afford a home any longer so that we can have an animal companion (or even an apartment that allows pets)!
14
@Sara
See if you can find a job where you can telecommute. My VOIP shows I am 1000 miles away in FL and I work from home with my two dogs by my side. Housing is affordable and the area is beautiful. I would go insane in a corporate office and I am ten times more productive at home, working on a laptop in my nightgown. Life is short - don't let the bosses control you.
3
Humanity would benefit greatly from fewer psychologists and more philosophers.
17
@Tucker What in the Sam hell does that mean ?
3
Hooray! Right on!
6