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Hearts and Minds

Now this is very interesting. Young people with a close family history of depression but no depression themselves showing elevated risk factors for cardiovascular disease (hypertension, stiffened arterial walls, insulin resistance…).

Put that together with the emerging evidence that poor diet is associated with an increased rate of depression (and is not only secondary to the depression), and that young people who are obese have an elevated risk of adult depression, and the importance of proper healthful eating and physical activity starts to become very clear.

The mind, and its moods, are of course nothing more than functions of the brain, which being just a part of the body, must have evolved with the same basic requirements as the rest of the body. An organism that needs one set of conditions for proper brain function and another for proper cardiovascular function is not going to get far. So it makes sense that the two are this linked.

In fact, it’s not "the two", is it? It’s all one.

Violence, Mental Illness, Assumptions, and Stigma

In the wake of the horrifying shooting at the Sandy Hook primary school in Conneticut there has, of course, been a lot of talk about “mental illness”. This man did something that to all of us seems “crazy”, and the natural response therefore is to think he must be mentally ill. However, as I noted with regard to Anders Breivik, that is something that – while possibly correct – should not be assumed.

Then I read a piece entitled ‘I am Adam Lanza’s Mother’. It bothered me: the assumptions it made about Lanza, and about mental illness; and what she wrote – and how she wrote – about her son.

Then, tweeted by Vaughan Bell, I saw something I liked much better; as Bell wrote: “A much needed reply appears”

Pease read it. I will quote here two of the bullet points. They are all good and important, but these two are the ones that I really want to emphasise:

3) The article complains about mental illness stigma while reinforcing it by explicitly tying it to violence, and in particular, mass killings. The reality is that there is no such observed link: “after analysing a number of killers, Mullen concludes, ‘they had personality problems and were, to put it mildly, deeply troubled people.’ But he goes on to add: ‘Most perpetrators of autogenic massacres do not, however, appear to have active psychotic symptoms at the time and very few even have histories of prior contact with mental health services.’” And most people with mental illness are not violent, although they are far more likely to be victims of crime (see here, for instance).

4) The article, with this link established, implies a desire to stop violent crime allegedly perpetrated by those with mental illness shoul motivate better care and provision for those with mental illness, and not, say, the lower life expectancy, unemployment, isolation, suicidality, homelessness, victimization or in general the suffering endured by those with it. The continual disregard for this reality perpetuates stigma on all levels of society and further exposes those with mental illness to harm.

And for something more on the “how she wrote it” side of that post, there is this discussion of other posts by the same blogger.

The only “simple” thing about this shooting is that it was awful and horrifying. The motivation/s, the antecedents, the mental state of the killer – at the time, and leading up to it: these things are not simple, and we might well never really know with certainty (especially his mental state). It does no good, and does real harm, to assume mental illness simply because a person does something we don’t understand, and can’t imagine ourselves doing. That is not the same thing as having a psychiatric illness, and equating them just does not serve any useful purpose. What it does do, is further increase the stigma, discrimination, hatred, and consequent violence suffered by people with psychiatric illnesses: people who already face a great deal of that on top of distressing and debilitating illnesses, which if they weren’t bad enough in themselves, carry increased risk for just about everything you care to name, and mean they will die an average of a quarter of a century earlier than the rest of the population.

Lets not make it worse by shouting “crazy!”, “insane!”, “mentally ill!” every time someone commits horrific violence. Without even knowing if that was the case.

It’s a Madhouse

So, the care of people with schizophrenia in Britain is in the news.

Sadly, there’s not much (if anything) different anywhere else I’ve worked or read about. People with schizophrenia often get no, or inadequate, care – delivered often in unhelpful environments or ways. Like people with other major psychiatric illnesses (though quite probably worse), they die very young. In many cases, meaningful relationships and satisfying employment are (kept) out of reach.

Sometimes the illness is such that our current treatments are inadequate, (and many of them do very clearly have major problems of their own), but sometimes (often?) it is the case that they are failed by the service – and by society.

We have come a long way in psychiatry, but there is still a long way to go.

Ruby Wax on Mental Illness

You can find a whole lot of stuff on Tumblr, of all sorts. I rather liked this photoset of Ruby Wax:

Ruby Wax

She highlights a good point: in psychiatric illness you don’t have broken limbs, or coughed-up mucus, or whatever other easily-visible sign with which to proclaim “I am sick”. I’m sure that must add to the stigma, and the moralising and judgemental attitudes often levelled at people with psychiatric illness.

Psychiatry Committing Professional Suicide

… Or so David Healey has said at a meeting of the American Psychiatric Association.

I’ve always seen Healey as one of the anti-psychiatry psychiatrists, but what is quoted here from his talk is actually reasonable and sensible. He doesn’t appear anti-psychiatry – or even anti-antidepressants, despite his very public attacks on them. I agree with what he said about the role of the doctor being

… to manage risks, not view drugs as harmless. “Medical treatment is poison and the art of medicine is trying to find the right dose,”

(via Psychiatrist Contends the Field Is ‘Committing Professional Suicide’ | Healthland | TIME.com)

I’m also thinking it’ll be we’ll worth getting Ben Goldacre’s book: Bad Pharma: How drug companies mislead doctors and harm patients.

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