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Treatment of people with mental health disorders is a super complicated problem, and is obviously better dealt with before it becomes a big enough problem for s
by olliej 5y ago
Treatment of people with mental health disorders is a super complicated problem, and is obviously better dealt with before it becomes a big enough problem for someone to become homeless, but obviously many places have a huge homelessness problem and a disproportionate number have severe mental health issues.
Some people say forcing treatment is acceptable, which as a general blanket statement I disagree with.
However if you have a person who has a severe issue like later stages of schizophrenia, dementia, etc they may be in a position that they cannot make informed consent without receiving treatment that they by definition can’t consent to. I believe that the UN decided that that would be unethical, but in this case I would disagree. In the absence of initial treatment I would not consider that a person has in fact chosen not to be treated and in failing to provide initial treatment you are in effect robbing them of the opportunity to make a long term choice.
The obvious follow on question is what you do if a person with a severe condition subsequently says no to further treatment. At that point forcing treatment is clearly unethical (LGBT were forced into “treatment” into the 70s for example). Historical options have included incarceration which functionally criminalizes anything classed as a mental health problem (see again treatment of lgbt people). You could wait until they perform a criminal act, which raises the question of why you let it get to that point, etc
It seems like all the options are bad, and forced long term treatment seems clearly wrong, incarceration in a jail seems wrong, but historically mental health institutions have not been much better (and often times worse).
- tcj_phx 5y agoRobert Whitaker chronicles the deteriotation of mental health treatment in Mad In America. The Quakers had asylums for people who had 'episodes'. The clients were fed 4 meals a day and kept safe. 80-90% recovered to the point where they could leave the asylum. Non-quaker asylums were much less effective. Then the doctors started doctoring on psychotic patients... Labotomies, ECT (brain electrocution). These treatments didn't work at all. The use of ineffective treatment made Psychiatry an easy capture by the drug industry. See my other comment in this submission: https://news.ycombinator.com/item?id=30549579 https://news.ycombinator.com/item?id=30549579
- olliej 5y agoA problem with ECT treatment in the past is that they are pretty much aversion therapy - the patient is conscious in such treatment and in the US, with the exception of "conversion therapy" (which is absolutely intended as pain based aversion "therapy") it it performed while the patient is unconscious and with a muscle relaxant to avoid convulsions. The modern ECT protocols have very high success levels with treatment resistant depression.
- tcj_phx 5y agoRobert Whitaker's introduction to his present work was when he was an investigative reporter at the Boston Globe. He noticed something about how the clinical trials for Prozac showed this drug made some people suicidal. Prozac got approved anyways. Sometimes SSRI's help depression because they increase allopregnanolone in the brain [0], not because of effects on serotonin. [0] https://news.ycombinator.com/item?id=23859433 https://news.ycombinator.com/item?id=23859433 The first-generation anti-depressants, the MAOI's, were reasonably effective at getting people out of a funk. But they didn't combine well with fine cheese [1], so when the patents expired the industry moved on to less effective drugs. [1] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=fine%20cheese%20tcj_phx&sort=byPopularity&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que... This MIA blog post says the evidence base for ECT is not very strong: > No studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have concluded that ECT is more effective than placebo, despite the studies’ multiple failings. Meanwhile evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated. - https://www.madinamerica.com/2022/02/fear-loathing-ect-debate/ https://www.madinamerica.com/2022/02/fear-loathing-ect-debat...
- olliej 5y agoCalling depression a "funk" is incredibly dismissive of what people like me deal with. The data I've seen for ECT has it at an 80% effectiveness at long term remission. Most anti-depressants do have people for who there is a addition of or increase in suicidal ideation, which is why its something prescribing doctors are expected to monitor. This is not dissimilar to heart drugs causing heart problems, etc - by design these drugs influence chemistry in the target region (and probably others because l o l multicellular organisms are complicated) so if they do induce something there's a chance it could be a not great response. So being approved shouldn't be a sign of anything nefarious - most medications have side effects MAOIs are still used today, as is lithium, neither covered by patents but the side effect profiles are much worse than many modern targeted drugs. its not just a "doesn't agree with fine cheese" its a "oh you accidentally ate too much cheese, turkey, ..., time to go to hospital" response. Similarly benzodiazepines are useful for some things (although tolerance and addiction problems mean they're avoided if possible), but those have a "whoops you had something with grapefruit? time to go to hospital" problem as well.