unhappiness in a sick world

http://www.smh.com.au/news/opinion/terms-of-unhappiness-in-a-sick-world/2007/09/14/1189276986726.html?page=fullpage#contentSwap1
From:

Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de
Melissa Raven
domingo, 16 de setembro de 2007 11:32
SDOH@YORKU.CA
Ahmed 2007 Terms of unhappiness in a sick world

My initial reaction to this article was that it was great, because I was focusing on its critique of psychiatry. I particularly like this statement:
'While the middle classes debate their happiness and psychiatry acquires a cultural prestige well beyond its powers, the poor inherit the new straitjacket of psychological language'.
Then I noticed some jarring statements about disadvantaged people.
Ahmed wrote [my comments are in square brackets]:
'I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology [good point] and not of meaning [semi good point, provided meaning is interpreted socially as well as individually].
The result is that it can blind them to the possibility their actions may have played a role in their problems [victim-blaming].'
I would have much preferred it if he had written:
'I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology and not of structural factors, including social constructions of what it means to be a person. The result is that it can blind them to the possibility their life circumstances may have played a role in their problems. It can also blind them to their own agency to change some of those circumstances.'
Ahmed also wrote:
'They are hardly poor in a historical sense, for they have enough money to eat and are housed, educated and medically treated by the state [This is relatively true in Australia (unlike many countries), with the glaring exception of remote Aboriginal communities]. In formulating their situation, poverty in this sense is more like a psychological condition than one determined by socioeconomics [victim-blaming and pathologising; poverty is not a psychological condition, although it can be exacerbated and entrenched by despair].'
It is a pity that Ahmed's sound criticism of psychiatry is mixed with semi-compassionate victim-blaming.
Much of what he says also applies to less disadvantaged people, but they have more power to reject psychiatric labelling (and in a few cases they pay lawyers to use it to their advantage to escape conviction and punishment for bad behaviour).
Terms of unhappiness in a sick world
Tanveer Ahmed
September 15, 2007
As a doctor working in mental health and within the public hospital system, I am a regular witness to those living on the bottom rungs of our society.
They are the homeless, the drug addicts and those suffering from severe mental illness. More often than not, they are all three at once.
I am struck by their amazing uptake of mental health language. They skilfully weave technical psychiatric language into their reporting of symptoms. As a result, comments such as "I'm pretty sure I'm coming down with a depressive disorder" or "I think I'm developing a personality defect"
are not uncommon, even from people with minimal education.
This is in part a reflection of wider society and how the language of human distress has been overtaken by psychological terminology. I hear very few people tell me they are unhappy. They are almost always depressed, even if their life choices or circumstances would be perfectly consistent with them being miserable.
Increasingly they no longer suggest they feel depressed, but that they are getting depression, in the same way we may catch a cold. The consultation then moves to the awkward dance modern therapists play. I become the healer attempting to cure their condition, pretending somehow their malaise is one of biology and not of meaning. The result is that it can blind them to the possibility their actions may have played a role in their problems.
Barely a week goes by when we don't hear of the crisis in mental health.
Rising depression, worsening drug and alcohol problems and a strained social sector make us think that despite our stupendous prosperity, we remain in some kind of existential abyss. It is a symptom of the market society and individualism that our grievances must be turned on to the self.
This is in spite of psychiatry remaining a hazy field, an arena where diagnosis and treatment are poorly correlated and where clinical energies focus on symptom relief. It is reflected further in the tremendous amount written about happiness studies. If being dissatisfied with life is pathological and health is a right, the implication is that happiness is also our birthright.
The use of psychiatric terminology is also more and more colloquial. During the Andrew Johns saga and his eventual secular confession, bipolar disorder was used widely in the press as a synonym for erratic behaviour. The former Victorian premier Jeff Kennett, a tireless campaigner in raising awareness for depression, openly admits he uses the term not in its medical context, but as a synonym for emotional distress.
But just like fashion and baby names, language eventually filters down the social ladder. The dominance of mental health language in projecting our distress is of dubious value when applied to the most disadvantaged groups.
Indeed, it may be complicit in helping them to maintain lives of dependence and misery, the sick role curing them only of their autonomy and personal responsibility.
Bureau of Statistics figures from 2005 show about a third of the 700,000 people receiving the disability pension have been diagnosed with a mental illness. This is a critical group because the vast majority are young and otherwise physically able. Many could be in the prime of their lives.
Forty years ago, fewer than in one in 30 working-age adults relied on welfare payments as the main source of income. The figure today is one in six. In particular, the proportion of the population on the disability support pension has doubled since 1981.
An important player in this debate is the doctor, for they determine if someone meets the criteria for disability. Patients who are on the margin of receiving the pension or Newstart will often ask to receive the pension. The disability pension is more generous than the unemployment benefit and there is little mutual obligation.
The sick role, however, comes with an obligation to seek and comply with treatment. The patient's compliance with treatment is the priority for a doctor. There are many times when giving in to a patient's wishes elsewhere can ensure their compliance with medication. The pension is often one such compromise.
The flipside is that 90 per cent of those receiving disability pensions never return to the workforce. This is not a fact well known to professionals determining disability. Colleagues working in mental health were flabbergasted when they heard the figure.
For many on the margins of eligibility, there is an incentive to remain sick. The welfare market operates like any other - a better price will increase demand. This lack of incentive to take a more active role in society can strip them of meaning in their lives and perpetuate what may have started as mild mental illness.
A feedback loop of disability, welfare and worsening mental health is created. This is a hidden factor straining both Australia's mental health and welfare systems. They are operating in a kind of pathological symbiosis.
This cycle describes many people who are said to be in a state of deep poverty. They are hardly poor in a historical sense, for they have enough money to eat and are housed, educated and medically treated by the state. In formulating their situation, poverty in this sense is more like a psychological condition than one determined by socioeconomics.
While the middle classes debate their happiness and psychiatry acquires a cultural prestige well beyond its powers, the poor inherit the new straitjacket of psychological language. It not only costs the taxpayer billions of dollars, but encourages recipients to wallow as victims of passive circumstance, stripping their lives of meaning and purpose.
Dr Tanveer Ahmed is a psychiatry registrar and writer.
http://www.smh.com.au/news/opinion/terms-of-unhappiness-in-a-sick-world/2007/09/14/1189276986726.html
Melissa Raven, Adjunct Lecturer
Department of Public Health, Flinders University GPO Box 2100 ADELAIDE SA 5001 AUSTRALIA

DSM-V expected to explore physical, mental health links

DSM-V expected to explore physical, mental health links
The manual's planned revision also will look at psychiatric health throughout the lifespan as well as gender and cultural issues.
By Victoria Stagg Elliott, AMNews staff. Aug. 13, 2007.
The Diagnostic and Statistical Manual of Mental Disorders is about to get a makeover -- it will be the focus of a detailed overhaul that experts hope will reflect emerging scientific understanding and expect to take years to finish.
Those involved in the process predict that the completed revision will place a greater emphasis on how psychiatric illnesses change throughout a person's life and how different mental health issues interact. Gender and cultural issues also are expected to play a bigger role, along with a greater examination of the connection between mental and physical health.
With this article Links
Discuss on Sermo See related content
"It's very important to have a better paradigm than what we've been using to look at somatic presentations of mental disorders, and the relationship to disorders in other organ systems," said Darrel Regier, MD, MPH, vice chair of the task force on the revision and the American Psychiatric Assn.'s director of research.
The last full revision, the DSM-IV, came out in 1994, although a text update was issued in 2000. The DSM-V is due out in 2012, but there is a lot of work to be done before then.
Last month the APA announced the members of the revision task force. Working groups addressing specific mental health issues will be appointed later this year.
A draft will be available for public comment in 2009. This step also will allow researchers to undertake clinical trials to determine the usefulness of the diagnostic categories.
The last full revision of DSM was in 1994.
"As the nation's dictionary of mental illnesses, the Diagnostic and Statistical Manual plays a vital role in assuring that patients get proper diagnoses and treatments for their mental health concerns," said David J. Kupfer, MD, task force chair. "The APA has entrusted the revision of the DSM to world-renowned scientists who have vast experience in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy."
In light of the increasing attention being paid to conflict-of-interest issues, the organization also announced rules governing this issue for task force members. Participants are required to reveal all potentially conflicting relationships and are restricted to no more than $10,000 in annual income from industry sources except for unrestricted research grants.
"Patients deserve a diagnostic manual based upon the latest science and free of conflicts of interest," said APA President Carolyn Robinowitz, MD.
Input sought
The organization also will be accepting input through its DSM-V Prelude Project, which can be accessed online (http://www.dsm5.org/), and many organizations and individuals already have weighed in on possible changes. For example, the American Medical Association will be forwarding for consideration a report adopted at its June Annual Meeting on the possible emotional and behavioral effects of video games.
But while this book is influential, it is not without controversy, and critics hope diagnostic criteria will be less expansive. Some feel it currently can lead to people being categorized as having a mental health issue such as depression that could be more related to a temporary situation such as the death of a loved one rather than a psychiatric illness. Questions also have been asked about whether some diagnoses are useful.
"The emphasis on symptoms without context probably needs to be rethought," said Leonard Sax, MD, a family physician in Poolesville, Md., who also holds a PhD in psychology. "And I wonder whether conduct disorder is really a meaningful diagnosis. Maybe the child needs a change in parenting or a change in the peer group? This diagnosis makes it easier for parents to believe that medication is appropriate, but it's not." His book, Boys Adrift: The Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men, is due out this month.
Meanwhile, some of the experts involved in previous revisions are concerned that 2012 may be too tight of a deadline.
"That's five years to review all the issues and review suggestions for changes and collect data in field trials. I don't see how that can be done in five years," said Robert Spitzer, MD, who was involved in previous revisions and is a professor of psychiatry at Columbia University in New York.
Discuss on Sermo Back to top.
ADDITIONAL INFORMATION:
Weblink
DSM-V Prelude Project (http://www.dsm5.org/)
American Psychiatric Assn. (http://www.psych.org/)

Fronteiras do Pensamento » O Blog

Fronteiras do Pensamento » O Blog:
Valderês e eu estamos acompanhando semanalmente as conferências do "Fronteiras do Pensamento" e gostaríamos de compartilhar com os amigos algo do que temos aprendido. Vai aqui o link para o Blog do curso no qual podem ser lidas resenhas (obviamente com imperfeições) das conferências. Na última 3a. feira (15 de maio) assistimos dois psicanalistas (um Belga, Lebrun, e outro francez, Melmann), acessíveis através deste Blog, conversando sobre o mundo sem limites...

"Fronteiras do Pensamento é um curso de altos estudos, parte integrante do Projeto Copesul Cultural, realizado de março a dezembro de 2007 em Porto Alegre.
Este Blog é um espaço semanal organizado por nossa equipe para levar ao público fotos, vídeos e matérias dos eventos ocorridos nos Salões de Atos da Universidade Federal do Rio Grande do Sul e da Pontifícia Universidade Católica do RS.
A Programação e mais informações sobre o Fronteiras do Pensamento estão disponíveis no site www.fronteirasdopensamento.com.br
Seja bem-vindo!"

Depression, Antidepressants, and the Risk of Suicide

http://content.nejm.org/cgi/content/full/NEJMp078015?query=TOC
On May 2, 2007, the Food and Drug Administration (FDA) ordered that all antidepressant medications carry an expanded black-box warning incorporating information about an increased risk of suicidal symptoms in young adults 18 to 24 years of age. Since October 2004, antidepressants have been required to have a black-box warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents.
The new warning also states that there is no evidence of an increased risk for adults older than 24 years of age and that the risk is actually decreased for adults 65 years of age or older. Strikingly, the label states that "depression and other serious psychiatric disorders are themselves associated with increases in the risk of suicide," which makes it the first black-box warning to note that a disease itself carries risk — and implies that there is risk in not using the very medication being warned about.
The new warning was developed in the wake of a December 2006 meeting of the FDA's Psychopharmacologic Drugs Advisory Committee, which focused on the controversial link between antidepressants and suicide risk in adults. During an often contentious public session, the advisory committee heard from psychiatric experts and from aggrieved family members, who sometimes expressed outrage at the FDA when they spoke of the death of loved ones who had taken antidepressants. In the end, the committee voted 6 to 2 in favor of extending the black-box warning to include adults 18 to 24 years of age.
The notion that antidepressants might be associated with an increased risk of suicidality (suicidal ideation, behavior, or both) in some patients is hardly new. Clinicians have known for years that during the first few weeks of treatment with antidepressants, some patients become "activated" — energized and agitated — before their depressed mood lifts, and that combination makes them more likely to act on preexisting suicidal impulses. But because suicidal thinking, feeling, and behavior are core symptoms of depression, there is no way to know whether suicidal symptoms that develop during treatment are due to the underlying illness or the medication. /.../

Dementia UK

Dementia UK

A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College London, for the Alzheimer’s Society
Project directors: Professor Martin Knapp and Professor Martin Prince Research team: Dr Emiliano Albanese, Professor Sube Banerjee, Sujith Dhanasiri, Dr Jose-Luis Fernandez, Dr Cleusa Ferri, Professor Martin Knapp, Dr Paul McCrone, Professor Martin Prince, Tom Snell, Dr Robert Stewart
Alzheimer’s Society 2007

Available online as PDF file [103p.] at: http://www.alzheimers.org.uk/News_and_Campaigns/Campaigning/PDF/Dementia_UK_Full_Report.pdf

“….It is now over a century since 1906 when German neurologist Alois Alzheimer diagnosed the disease which bears his name. What progress has been made? How much better do we understand the diseases that cause dementia? As our population ages, Alzheimer’s disease and other causes of dementias are becoming ever more common and important. We urgently need to understand the impact of dementia in the UK now and in the future. This report is an attempt to answer these key questions and to inform a serious debate about how we as a society can respond to the challenges posed by dementia.

There has been significant progress since 1906, both in our scientific understanding of dementia and public awareness about the diseases which cause it.
We know more now than we ever did. We know that dementia is not a natural part of ageing and that it is caused by a variety of diseases which affect people in different ways. We also now have a range of options to treat the symptoms of dementia and to offer practical support to people with dementia and their families. However, we are a long way from fully understanding dementia and being able to offer a comprehensive response…..”

Content:
1 Introduction
2 The Expert Delphi Consensus on the prevalence of dementia in the UK
3 Number of people with dementia in the UK
3.1 Calculation methods
3.2 Number of people with dementia in the United Kingdom
3.3 Projected increases in the number of people with dementia in the United Kingdom
3.4 Regional variation
3.5 Young onset dementia
3.6 Projected increases in the number of people with young onset dementia
3.7 Number of people with young onset dementia, by age and gender
3.8 Late onset dementia
3.9 Projected increases in the number of people with late onset dementia
3.10 Number of people with late onset dementia, by age and gender
3.11 Dementia subtype
3.12 Residential status
3.13 Ethnicity
3.14 Mortality
3.15 Conclusions
4 Service development
5 Mapping social service provision
Residential care provision
Home care provision
Day care provision
Comparisons of indicators across countries
6 The financial cost of dementia in the UK
7 Recommendations
References
Appendices

Drug Disorders Has Affected 10% of Americans -

A Variety of Drug Disorders Has Affected 10% of Americans - CME Teaching Brief® - MedPage Today
Primary source: Archives of General PsychiatrySource reference: Compton WM et al. "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Drug Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions." Arch Gen Psychiatry. 2007;64:566-576.
BETHESDA, Md., May 7 -- About one American in 10 has had a problem with legal or illegal drug use according to researchers here.That figure includes about one in 50 who has been frankly dependent on drugs at some point, according to Wilson Compton, M.D., of the National Institute on Drug Abuse here.
Action Points
Explain to interested patients that drug use disorder includes drug abuse and drug dependence, according to the DSM-IV.
Note that this survey suggests that about one American in 10 has either abused drugs or been dependent on drugs over the course of his or her lifetime.
These data come from face-to-face interviews with 43,093 persons in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, Dr. Compton and colleagues reported in the May issue of Archives of General Psychiatry.
The survey is the first in more than 16 years to try to get a handle on drug use among American adults, the researchers said.
"Although extensive data on drug use in the U.S. population have been available on an ongoing basis for adults and adolescents," they reported, "epidemiologic data on the prevalence, correlates, disability, treatment and comorbidity of drug use disorders among adults are seldom collected."
Using DSM-IV definitions, the survey used a validated questionnaire aimed at discerning details of alcohol and drug use disorders, nicotine dependence, mood and anxiety disorders, and seven of the 10 personality disorders, the researchers said.
The questionnaire asked about the use of sedatives, tranquilizers, opiates (other than heroin), stimulants, hallucinogens, cannabis, cocaine (including crack cocaine), inhalants/solvents, heroin, and other drugs.
The study found:
10.3% of Americans had drug-use disorder at some point in their lives.
That was broken down into drug abuse (7.7%) and drug dependence (2.6%).
Over the year immediately prior to the interview, 2.0% of Americans reported a drug-use disorder.
That broke down into 1.4% reporting drug abuse and 0.6% reporting drug dependence. /.../

From MEDPAGE TODAY
U.S. Psychiatric & Mental Health Congress
San Francisco, CA • April 21, 2007
New Definitions on Tap for Mixed Manias SAN FRANCISCO -- Dysphoric mania and other mixed mania states of bipolar disorder will become easier to diagnose with better definitions, a researcher said here. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5511
Insomnia Treatment Boosts Antidepressant Efficacy SAN FRANCISCO -- A significant number of patients with major depression also suffer from chronic insomnia that hampers recovery, and treating the insomnia may improve both conditions. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5510
Atypical Antipsychotic Medication Cuts Behavioral Symptoms in Autism SAN FRANCISCO -- While the behavioral symptoms of autism have been treated with a wide spectrum of medications, atypical antipsychotics may be the most effective drug class.
http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5509
Depression Remission Rates Remain Low, But There’s Hope SAN FRANCISCO -- Remission rates remain low for major depression even with multiple antidepressant drug classes available, but the recently approved selegiline patch (Emsam) aims to bring the rates up. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5508
Vigilance Still Necessary for Atypical Antipsychotics SAN FRANCISCO -- Atypical antipsychotic medications have improved adverse-event profiles compared with the older generation of antipsychotics, but careful attention to major side effects is still required. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5507
Concurrent Treatment Works for ComorbidADHD and Substance Abuse SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions. http://www.medpagetoday.com/MeetingCoverage/USPsychiatricMentalHealthCongress/mr/5501

Depression cited as the top cause of medical disability

Depression cited as the top cause of medical disability
The disease takes a toll, not just personally but economically, reports a U.S. mental health expert.
By Susan J. Landers, AMNews staff. April 2, 2007.

Thomas Insel, MD, director of the National Institute of Mental Health, attended the annual meeting of the World Economic Forum in Davos, Switzerland, in late January, where he caused a stir with a presentation on the high cost of depression.
He recently spoke with AMNews about his remarks.
Question: How big a burden is depression?
Answer: It's the leading source of nonfatal medical disability among people ages 15 to 44 in developed countries like the U.S. and Canada. It is the leading cause by far. Nothing else is even close. In the whole world it is the second or third greatest cause of disability. It costs the United States $53 billion annually in direct treatment costs, mortality and lost productivity.
Q: How are those figures arrived at?
A: You can calculate it in one of two ways: either as a source of disability for people in that age bracket, 15 to 44, or, the way the World Health Organization likes to do it, with a DALY, or disability-adjusted life years. That's the years lost to disability.
Q: It seems a surprisingly high figure.
A: Yes. It doesn't comport with what most of us would think about if we thought about the big killers: heart disease, cancer and stroke. Those are the three big killers, but they aren't the ones that cause the most disability. They cause mortality.[...]