We Want Something Else And Other Delusions

Every so often, I run into an article that makes me think a bit differently about what's going on with mental health in our culture. It also helps my mood if the article confirms most of what I've been saying on this blog since last fall. The article is from the British magazine Prospect and concerns itself with the fact that cognitive behavior therapy (CBT) has completely swept aside, at least in the UK, psychoanalysis and other "talk" therapies. Not that that's news to anyone in the field, but to patients in this country it is news for reasons that have everything to do with how tilted systems of care in this country are towards the pharma model and our cultural prejudice for the immediate fix to eternal problems. We talk as if fixing behavior and feelings through meds is a cure when in fact it is little more than a treatment. Over time, it doesn't fix the brain--or whatever the hell the seat of our problems might be--so much as it tamps down our demons but leaves the embers burning.

I especially agree with the authors on:

"Does this mean that the big dream of the talking cure inspired by Freud has been swept aside by a biology of the mind? Far from it. Despite the development of increasingly refined pharmacological treatments, new drugs do not work much better than the old ones. At the front line of psychotic disorders, the beneficial effects of medication are often accompanied by devastating side-effects. Having made its big pharmacological leap, psychiatry remains largely a process of diagnosis, risk assessment, containment and care. Almost nothing has yet come of the great hope of the 1990s that—as with Huntingdon's and Alzheimer's disease—the genetic sources of mental illness would be revealed. For the moment, the big themes of mental illness have been distilled into "gene-environment interaction," the old question of how a person's life-circumstances trigger and shape his biological predispositions, and vice versa."

I don't think anyone with smarts claims that CBT can fix psychosis in a crisis situation, but it's been having such good results preventing nastiness with depression, some of the bipolar spectrum, personality disorders and, surprisingly, in some people with schizophrenia that the British National Health Service (aka, their socialized medicine bureaucracy) authorizes its use. And pays for it. (I've written elsewhere about the growing blowback in the UK against some psych meds and an embrace of CBTish approaches.)

In this country, the pharma/medical insurance/bio-psychiatric powers would likely fight a broader embrace of CBT in this country with hammer-and-tong--and hookers and money, if need be. These are rich and powerful interests and such interests will never give up their riches and power willingly--especially when their paradigm rests on treating long-term conditions as if they were perpetually repeating short-term patterns.

If you think I am joking, then consider the way atypical anti-psychotics are being adopted for practice in bipolar disorder (OK, the adoption period is over, it's full on sex now). Almost anyone who displays the least bit of psychosis, grandiosity, anger, delusional thinking and so on will be on Zyprexa or Seroquel right away. That's fine for addressing short-term crises (for chronically delusional schizophrenics, life can be a perpetual short-term crisis, of course), but most bipolars don't live in such a space all the time. And the anti-psychotics have never proven very effective at batting down long-term problems (I don't consider half-remission and full-remission of symptoms barely 50 percent of the time to be effective, especially given the toll of these meds' side-effects on patients. It's a bad trade-off.). Given all of that, then why the hell is this class of meds being pushed on bipolars for long-term use when they have limited powers of prevention?

It's like using what works all the time for the few and expecting it to work for the many. I have heard clearer thinking come from the mouths of delusional schizophrenics.

That said, we need to start embracing different approaches to treating mental illnesses in America. Whatever the approach, it needs to be patient-centered and have practical existential results. It's kind of hard to have that discussion in a public way in America when the opinion pages of leading newspapers fasten on the immediacy of a tragedy and print arguments supporting the notion that shot-term solutions are long-term solutions.

We want something else. Because the current solutions are failing us miserably as a culture.