ndrosen | Entries tagged with mental health

I will admit that I don’t have good or complete answers to the various dilemmas which arise in treating the more or less insane. Should people be forcibly medicated with drugs that can have seriously distressing side effects? Should they be free to refuse medication even if they become raving mad without it, and are minimally sane and able to function with it, or at least quiescent and harmless? Should refusal to take prescribed drugs be treated as proof of paranoid delusions, or do some sane people have good reasons not to take medications which they in fact do not need? Are psychiatrists at least mostly wise, and sincerely trying to help, or are they appallingly arrogant and abusive in some cases?

There is a Reason article on the campaign to save a man from court-ordered shock therapy. It may not be without bias, and I don’t have the mental hospital’s side of the story, but there seem to be genuine issues of a patient’s difficulty in getting a fair hearing before a judge, as well as of the harmful effects of electroshock treatment — and yes, I know that electroshock can be truly helpful to some people with severe depression or other problems.

There is also mention of mental hospitals encouraging their staff to label patients as “combative”, and to avoid using words like “calm”, so as to generate a record to justify keeping the so-called patients imprisoned in the hospital until their insurance is exhausted. I remember a scandal in the 1990s over one chain of mental hospitals doing this kind of thing, and basically kidnapping sane people to fleece their insurers. If this kind of fraud can be proven, making the hospitals disgorge their ill-gotten gains should be the start of it; there is also something to be said for having the responsible doctors and hospital administrators flogged in the public square.

A woman who was the victim of sexual assault has a story in Slate about how the psychologist she saw was less than helpful to her, with further criticisms of therapy in general. To be clear, she does not propose to abolish therapy altogether, and does believe that some kinds can be genuinely beneficial, but she does challenge the notion that going to psychotherapy is something which we should all do. This is a position I share, although without her experiences; I have not been therapeuted to any substantial extent.

One of the minor annoyances of modern life is being exposed to psychological blather that is taken much more seriously than it ought to be, and other twaddle preceded by the tag, “Experts say.” (This is not a condemnation of everything said by actual, competent psychologists.) A recent example was a front page article in Tuesday’s Washington Post, “Trump shooter remains difficult to categorize,” with the subheading, “Determining gunman’s motives may take years, experts say.”

If we don’t know now, we probably never will know. How will supposed experts, chewing over the same lack of evidence for years, determine the motives of the late Thomas Matthew Crooks? Possibly he thought that he was saving his country from fascism, possibly he wanted fame of some sort at almost any cost, possibly he hoped to impress a girl. Who can know? Even if he wrote or vlogged some kind of manifesto or diary that remains to be discovered, we will likely not know whether it is truthful, or what interior thoughts and feelings produced his words.

The rather lengthy story could have been trimmed by a good editor to, “We don’t know just what a dead man was thinking or feeling, and we probably never will. We, the two reporters, did not need to consult any experts to reach this conclusion.”

There is a Reason podcast and transcribed interview with Abigail Shrier, criticizing much of what passes for psychological therapy, especially as applied to children, and as forced on them in the schools as “social-emotional learning.” She is not opposed to therapy of any kind under any circumstances, but does think that great harm is done by, inter alia, pressuring children to think of themselves as traumatized and incapable, and to obsess over their own emotional states, instead of pulling up their socks and accomplishing things. Real accomplishments, such as learning math or excelling in athletics, would not only contribute to their education, but give them a sense of self-efficacy, which is different from the unearned “self-esteem” that pop psychology claims is good for them.

I was impressed enough to go to Barnes & Noble, and buy a copy of her book, Bad Therapy. Whether or not I would agree with her in every particular, I think she makes a number of excellent points, and her book deserves to be widely read.

The Gentle Reader may wish to look up what I wrote under the tag “Mental Health” back on May 21, 2020.

A week or so ago, I read an advice column, I think by Carolyn Hax. A woman had written in about what was wrong with her adult daughter; the woman’s now adult son had molested her when they were children, and so the daughter didn’t want to have much to do with her brother, and was not notably cordial to him, which the writer saw as a problem for the family.

The columnist was quite firm with the letter writer, telling her not to blame the victim, and I agree about that. The columnist also wrote that if the brother had not been to therapy, he should get it, about which I am skeptical. He is not (one hopes!) sexually assaulting people now, so he does not have a current condition to be cured. Before “therapy” became popular, people would likely have said that he ought to humbly apologize to his sister, and do whatever he could to make amends. He might well have been directed to go on a pilgrimage, or do something else mandated by his religion; today, a professional dispenser of advice says that he should go to therapy.

What would therapy do for him? It would not cause his wrongdoing not to have happened, and would not necessarily satisfy his sister. It might help him deal with guilt feelings, if he has any, but then, it could be said that someone who has done grave wrong ought to bear the burden of feeling guilt, which may perhaps keep him from committing further offenses.

Therapy, however, has become the quasi-religion of many people today, and so it is apt to be recommended whether effective or apt in a particular case or not.

I have intentionally used the British spelling for the subject of this post, because it is used in the URL for the webpage. It seems that when a child is labeled autistic, behaviors which would be regarded as normal and even commendable in a neurotypical child are labeled as pathological. This is of interest to me, partly because I have a dash of general skepticism about pshrinks, and partly because, if I had been born a few decades later, I would very likely have been declared autistic. In my salad days, though, “autistic” seems to have been used principally to describe children who were non-verbal, or otherwise incapable of ordinary human functioning.

The laundry should be dry quite soon. Then I’ll go to bed.

Friday’s newspaper contains an obituary for Dr. Aaron T. Beck, the founder of cognitive behavioral psychiatry, who lived to be one hundred. The article describes his questioning the support for Freudian psychoanalysis, and developing cognitive techniques, and his facing considerable opposition from what was then the reigning orthodoxy among head shrinkers. I believe that I have read about him before, although I did not recall his name.

Here was a man who dared to think, relied on evidence and reasoning in place of authority, dared to say that the emperor was naked, and seems to have accomplished real improvement in the treatment of mental distress. May he rest in honored remembrance.

Free Britney! I admit that I do not know just what Ms. Spears’ current mental condition is, or how much of a mess she is likely to make of her own life, as compared to how much harm is being done to her by her father and others. I have, however, heard of other cases of people being put or kept under guardianship or conservatorship for questionable reasons, and sometimes with evil intent, and I do believe that the presumption should be in favor of autonomy.

One reason to hold libertarian views on such issues is that, even when someone is not notably prudent, or inclined to make sound decisions for herself, someone else appointed to run her life for her may also be prone to poor decision making, and may look out for his own interests rather than hers.

Current Music: “As Good as Any,” Echo’s Children

Jamilah Lemieux’s advice column in Slate addressed, among other matters, a letter from a mother whose fourteen year old daughter insists that she does not want therapy. A year ago, when she was thirteen, her father suddenly died in her presence, and she has other sources of distress in her life, so it was certainly understandable that Ms. Lemieux favored requiring her to see a therapist, but the situation is not so clear to me.

The columnist seemed to take for granted that therapy would help rather than harm the girl, but some people have received bad advice from so-called therapists, or otherwise been left very much unsatisfied. For example, the form of therapy that requires people to talk about traumatic experiences has been criticized as re-traumatizing them, and causing them additional distress. I do not claim to have all the answers, but I point out that there are disputed questions. Even if a teenage girl should not be permitted to decide for herself whether or not to take antibiotics for her bronchitis or insulin for her diabetes, psychological “therapy” is a rather different kettle of fish.

I recall an article somewhere (it may have been by Cathy Young) reporting that people who kept quiet and didn’t talk about their personal problems did better than those who did. The author observed that this did not prove that stoicism worked better than letting it all hang out; it might only mean that stoicism worked better for those inclined to practice stoicism. Nonetheless, when there is less than compelling reason to believe in the benefits of a form of treatment or a way of dealing with the pangs and sorrows of the human condition, it seems to me that people, even people not old enough to vote, should be at liberty to make their own choices.

There was an article in the Science/Health section of Tuesday’s Washington Post about the shortage of beds in mental hospitals and mental wards. As a result, people who are having psychotic breaks, or are otherwise mentally nonfunctional, are often kept for hours or days in hospital emergency rooms, which are not good or restful places for them, waiting for a bed to be vacated. I believe that this is a real problem, and there probably is a need for more places in mental wards.

And yet, reading it, I could not help but remember a post I had recently read in Quora, which was not the only account I have read of wrongful psychiatric imprisonment. The poster gave an account of how a psychiatrist had begun from the assumption that she was suicidally depressed, which she was not. The psychiatrist had treated her unkempt appearance as evidence of mental illness, when actually she had been kept in a hospital emergency room for two days, with no chance to take a shower or shampoo her hair. The psychiatrist refused to listen to her, and tried to press her to agree to “voluntary” commitment, or else she would be involuntarily committed. She refused to agree, and was involuntarily committed, and then kept in a mental hospital for weeks, and dosed with lithium and other drugs. At first, she insisted that she was not suicidal, and then gave up, pretended that she was, and let herself be “cured.”

It would free up at least some beds in mental hospitals to release people who are not crazy, and don’t belong there. Granted, in some cases, it’s hard to know who those people are, but in other cases, people have been locked up for frivolous reasons, or based either on bogus accusations from third parties, or presumptions of insanity by psychiatrists acting sua sponte.

If I were in a state legislature, and a bill was introduced to pay for more beds in mental wards, I would make my support for it contingent on provisions guaranteeing involuntary patients the right to an actual judicial hearing within 48 hours, and otherwise guarding against abuses.