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  • Showing only topics in ~health with the tag "psychiatry". Back to normal view / Search all groups
    1. I have a massive gripe with reductive "politicization" of mental health

      Before we start, no, I don't mean "bring politics into" mental health. Politics obviously covers mental health issues, practices, and institutions. However, I've come to realize a certain approach...

      Before we start, no, I don't mean "bring politics into" mental health. Politics obviously covers mental health issues, practices, and institutions. However, I've come to realize a certain approach to mental health has taken root in discussions around mental health. This approach is based on the criticism of mental health from an ideological point. It centers on the idea that mental health is treated only as a chemical imbalance in the brain, and that sociopolitical conditions aren't considered. One of the most prominently figures cited for this is Mark Fisher.

      “The current ruling ontology denies any possibility of a social causation of mental illness. The chemico-biologization of mental illness is of course strictly commensurate with its depoliticization. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.”

      ― Mark Fisher, Capitalist Realism: Is There No Alternative?, 2009

      This, I think, is true to a degree. Denying the mental or physical results of certain policies benefits the rich. However, this criticism, whether intended by Fisher or not, is often used to reduce psychiatry and psychotherapy to mere, atomized, asocial, apolitical practices.

      First of all, this hasn't been true in my case. Sure, I have my criticisms of the procedure and the practitioners, but I've talked about a variety of sociopolitical issues in therapy. I mean, how can you not talk about these issues? There are obviously social patterns in a population, and if they're not bad practitioners, the psychiatrists pick up on them. This doesn't mean that I talked about political theory in my therapy, but among numerous topics, I talked about things like the male gender role, the attached aggression and violence, the effects of emotional repression as a result of traditional roles. I know people who extensively talked in therapy about gender roles, queerphobia, and the associated problems.

      Therapy helped me on political issues too. I used to be much more repressed, unable to express my disapproval, unable to handle any conflict. But with the help of psychiatry, I started expressing my opinions, including my disapproval, more and more. This included standing up for myself, and while there are many power structures I can't overcome as an individual, this change helped me better stand up for myself against people who have power over me. It also helps me feel not as much like a piece of shit when I can't, because learning to face my emotions helps me realize I have limits.

      But, according to the Fisherian argument I've seen repeated countless times, this isn't what psychiatry does. It just treats you like an asocial animal, which is not true at all. If anything, psychiatry emphasizes, again and again, that humans are social animals, therefore, have social needs, and that not meeting those needs will lead to mental problems. Seriously. Search "humans are social creatures psychiatry" on whatever search engine you use and also on Google Scholar. You'll find, page after page, pop article and scientific article, talking about the importance of this.

      The second thing I want to mention is that links between inequality and mental health are an important area of research. You can search for keywords like "socioeconomic status mental health" and "inequality mental health" on Google Scholar to see many articles written about this. You can alternatively replace "socioeconomic status" with "SES" and "mental health" with "mental illness" or a mental disorder of your choosing.

      To add further support to my argument, let's look at the textbook "Psychology, Global Edition, 5th Edition" of Pearson, which is a very widely known publisher. It has an entire chapter dedicated to social psychology (Chapter 12). The chapter about psychological disorders, Chapter 14, has the following listed as one of its learning objectives (emphasis mine): "Compare and contrast behavioral, social cognitive, and biological explanations for depression and other disorders of mood."

      Let's also look at WHO's mental disorders page (emphasis mine).

      "At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function."

      I think one of the other negative things about this argument is that, it denies the possibility that some people face mental illness not mainly as a result of social issues, but as a result of some biological unluck. I haven't checked it out specifically, but I think mental illnesses aren't necessarily mainly a result of social conditions or trauma. I can't claim this with certainty, but neither can the opposing side. However, my approach leaves a possibility open for people who may be experiencing exactly this. Therefore, without knowing, it doesn't claim that certain experiences can't exist.

      Before I finish, I want to say that I don't deny the existence of bad practice. I've heard many stories of bad psychiatrists, and even if I hadn't, it would be unrealistic to think they wouldn't have such a problem, considering the problems in education and funding. However, my point is, it's not realistic to say psychiatry overlooks the social reasons for mental illnesses. There may be problems, but in no way they are a shared, distinctive feature of the field.

      And last of all, this may be harsh but I think it needs saying, Mark Fisher fell victim to suicide. He's not exactly an epitome of healthy coping mechanisms, and his criticisms about mental health should be evaluated with that in mind. I often think intellectualization tends to come in the way of mental health for, well, intellectual people.

      Edit: The last paragraph was poorly explained. I further elaborated here.

      19 votes
    2. "If the role of dysfunctional parenting in psychological disorders was ever fully recognized, the DSM would shrink to the size of a thin pamphlet"

      This statement by traumatologist John Briere is quoted in Pete Walker's FAQ on Complex PTSD, a proponent of the unified Trauma model of mental disorders. Dr. Gabor Mate has become popular in...

      This statement by traumatologist John Briere is quoted in Pete Walker's FAQ on Complex PTSD, a proponent of the unified Trauma model of mental disorders. Dr. Gabor Mate has become popular in recent years, who similarly claims that (e.g.) "Attention Deficit Disorder is a reversible impairment and a developmental delay, with origins in infancy. It is rooted in multigenerational family stress and in disturbed social conditions in a stressed society." Another famous champion of this theory was Alice Miller. Quote: "Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and unique history of our childhood." A more recent bestseller around this topic is Philippa Perry's "The Book You Wish Your Parents Had Read" (Guardian review).

      The various personality disorders from ICD-10 were replaced by a single personality disorder diagnosis in ICD-11, and they finally added Complex PTSD. The director of the largest psychiatric clinic in Germany is in favor of removing the category of "mental personality disorders" altogether (German article).

      Studies seem to confirm strong links between "adverse childhood experiences" and various forms of mental illnesses. To pick just one of the many I found: "Compared to children with no Adverse Childhood Experiences, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration." (https://doi.org/10.1016/j.chiabu.2020.104884)

      I'm interested in hearing your takes, and potentially this thread can serve as a collection of quotes and links around this theory.

      38 votes
    3. Going to work in South Africa, with a depression prescription

      Good news: I'll be starting my new work in Cape Town, South Africa soon. Not so good news: I have depression, and is currently on the antidepressant Sertraline. My question would be the following:...

      Good news: I'll be starting my new work in Cape Town, South Africa soon.

      Not so good news: I have depression, and is currently on the antidepressant Sertraline.

      My question would be the following:

      How are prescriptions of the antidepressant handled in the South African health care system? Can I obtain, from either a GP or a Specialist, a sort of "long-standing" prescription, valid for (say) a few months, that will allow me to refill at pharmacies or dispensing GPs, without me having to be referred to a Specialist each time I need a refill? I understand that recurring examinations by a Specialist are likely necessary, but I don't expect those to be frequent, as my condition is fairly stable now.

      Also a related question: I'm otherwise young and physically healthy, not affected by chronic conditions except depression. However, it seems that any health insurance schemes there that cover my condition would be rather expensive. Those policies typically include a broad coverage of chronic conditions, most of which I don't foresee a need. For one like myself, what suggestion would you give in terms of health insurance selection?

      Many many thanks <3

      7 votes