Selling Sickness 2013

my new year wish … rethinking mental health

I (K.W.) have been thinking a lot lately about mental health. It seems every where you turn, there’s something about “mental health” in the headlines. Whether its another shooting, the high profile suicide of Robin Williams, or the kid who has difficulty focusing in school, the conversation quickly turns to the need for MORE mental health services, MORE screenings, MORE treatments to address these issues. What if LESS is actually more?

The public has been convinced through drug company marketing, psychiatry, and the medical establishments that “mental illness” is a biologically-based condition. Every day life’s distresses and problems are being sold as undiagnosed mental disorders caused by a “chemical imbalance” requiring a pill solution.  Often times, it is without full disclosure of the dangerous side effects.  There are a lot of powerful self-interests at play in this current model of medicalizing life stresses. Big Pharma, American Psychiatric Association (APA), and various patient advocacy groups such as NAMI all have something to gain. Drug companies are highly motivated to spend billions of dollars selling “illnesses” to push their pill treatments. The APA and academic psychiatry want to protect their roles as the “trusted” medical institution that really understand psychiatric care. Meanwhile, 70-80% of psychiatric medicines are now prescribed by primary care doctors, often after a 7-minute visit with a patient. The public certainly has a role in this current paradigm too. We have been conditioned for a quick fix pill solution after seeing drug commercials encouraging us to “ask our doctors”.

In today’s world, “mentally ill” is such a vague, general term that it lacks any real meaning. The APA’s Diagnostic Statistical Manual has set up such broad definitions of “psychiatric disorders” that 1 in 4 Americans are said to suffer some sort of “mental illness” each year. Undesired behaviors such as grief and sadness, oppositional defiant disorder and ADHD in children, to substance abuse, and so on get classified as “mental illness” requiring psycho-pharmaceutical  “treatment”.

There’s got to be a better way.

For starters, I would like to see the conversation change from mental health to focusing on mental well-being. Mental health implies a “sickness” model. The current narrative of the medical model is that untreated “mental illness” threatens the safety, security, and health of America. Therefore, we need MORE treatments.

With more of behavioral health falling into the hands of primary care facilities, the opportunity is NOW to rethink and challenge the current mental health treatments. We need a new “public trust” entity that will give us a better way of thinking about psychiatric disorders. The current system being driven by pharmaceutical companies, APA, and highly effective advocacy front groups doesn’t work. A new multidisciplinary group comprised of professionals and consumer advocates needs to take on this task to envision what a new system could look like.

Last month, I attended The International Society for Ethical Psychology & Psychiatry (ISEPP) conference in LA and there was a lot of discussion and presentations around redesigning a better system that really helps society thrive. There were a couple presentations that  made an impression on me. First, the debate between Allen Frances and Bob Whitaker about the role of psychiatry and the APA in helping shape society’s thinking around mental illness was fascinating and uncomfortable at times. Then, there was Laura Dulano’s personal story about being trapped in the “mental health system” since she was 13 years old. She offered some really great thought provoking ideas and solutions that ultimately helped her escape the system and now lives drug-free. Shannon Hughes’ presentation on how consumers sharing their real world drug experiences online has disrupted the one way flow of information and challenged commonly accepted versions of “what we know” about psychotropic drugs was enlightening. Her presentation further cemented my belief that real world experiences of consumers/patients has to be part of this new conversation around mental well-being.

In March 2015, I will be part of a panel at the Lown Institute’s Road to Right Care conference discussing the over-treatment and over-use of psychiatric drugs. It will be another opportunity to engage the audience in discussions around improving mental well-being while avoiding over-medicalizing life distresses.

I feel passionately that something needs to change.  We got to do better for future generations.  Are we giving people the tools and skills to deal with life’s challenges vs popping pills?  Where’s the community-based care with human connection? What about more peer support groups like Face It Foundation?  Would having better housing and jobs available help people live more meaningful lives? Are we really listening and engaging with people/patients?  What role does faith an d spirituality play in our mental well-being?   How about more empathy and love?  The answers to these questions make me believe that there is, indeed, a better way.

Ultimately, we need to empower the public to challenge the current powerful mental health system to ask “what if less is really more?”

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