|Few things can arouse
greater passions than those that become engaged when the topic of
treatment of mental illness is raised. It might easily be included
in a list with politics and religion as the least desired topics at a
That such passions are aroused so easily speaks more to the difficulty of determining just what we are dealing with when we invoke the term mental illness. Return if you will, to the prologue and the discussion in the introductory class on abnormal psychology and the often used description of "abnormal" as creating a dysfunction in a person's ability to handle events in their life. This "ability" to handle life comes in many forms like the famous case of Howard Hughes who is described as the "eccentric" billionaire. Clearly by the standards of the DSM-IV diagnostic manual Mr. Hughes suffered from a mental illness. In his case, however; he had the resources to shape his world to his own desires and could avoid the recommended treatments for his disorder but at the same time, he continued to suffer from his condition.
This presents us with a treatment dilemma. Since Mr. Hughes could afford to suffer his condition very privately, should we as a society allow those who can economically afford to choose to suffer their condition on their terms? This then begs the question about the person who is not able to function like the majority of citizens who work and pay their way by the fruits of their labors. Should they be afforded the right to act as Mr. Hughes and remove themselves, or are they to be subject to rehabilitative treatments or asked to complete a recovery?
There are large numbers of people who have been forced to be treated in societies and they range from the person who has committed a crime against another person as well as people who have harmed no one and are guilty of nothing more serious than a great deal of anxiety about their place in life.
Unfortunately, much of the debate has centered around the idea that a person should either be forced to participate in treatment, or they have the right in a free society to refuse treatment as an expression of their free will. It is not such an easy question to put into an either or type of situation. In the world of binary computers all things can be reduced to either or states of being. In real life, not so much. In the information technology world, considerable engineering has been undertaken to approximate the logic that is used in things like focusing a camera by using a programming technique called fuzzy logic. This mimics a decision making process that can make a determination of where in the picture to choose an object that most likely represents the "best choice" to achieve the desired outcome. While this can be achieved for a relatively complex task quite easily, the variables found in mental health treatment far exceed the logic of a computer program.
Mental Health disorders/diseases/conditions/causes are incredibly complex in their presentation in human behavior. Simply coming to grips with the concept of a single diagnosis is often difficult because the diagnosis is a complex blend of behaviors and measures that often need to be exhibited over time and in differing environments. It is also involved with societal norms, criminal justice and family relationships. When all of this is taken into consideration, it is a wonder that "abnormality" and "illness" can be agreed upon, much less diagnosed.
Once there is a tenuous agreement about a person's condition, then the real difficulty begins. Since the condition is defined by behavior, what happens when the behavior changes. Indeed, my experience has been that some parents and family members were afraid that their loved one would be given a medication and they would stop the behavior that caused concern and the person would be deemed "well" and released from treatment. This creates a real problem, as the result is what might be desired, but the reversal in the patient's condition is only temporary and the symptoms return upon cessation of the treatment.
Another factor in the equation is the relatively small amount we know about the precise nature of the disorders. This is not to say that there is not a great deal of knowledge. Indeed there is, but science is at the relatively early stages of defining the diseases themselves. Schizophrenia is generally classified as one of four types, but there is no unifying characteristic that is common to all persons diagnosed as having the disease. There is no definitive chemical test. There is no unifying treatment. Indeed, there is an extremely wide range of individual stories and differing levels of achievement for those diagnosed with the disease. In reviewing those stories it is sometimes difficult to understand how the individuals could be considered to be suffering from the same condition.
In addition to the differing types of schizophrenia, there is the rather perplexing problem that not a single medicine has ever been developed "on purpose" to treat the disease. Indeed, the discoveries have all been serendipitous. That is to say, they just happen to work. Granted, there are type of compounds that work on some highly involved neurotransmitters, but even those are effective on some patients and not others. Interestingly, there are even some medications that might be seemingly unrelated to the brain function like allopurinol which is used for treating gout, but has been shown in studies to increase the effectiveness of some antipsychotic medications.
Where does this leave the patient, the family members, friends and loved ones and the medical profession? It is a complex problem. What should come from all of this is a meeting of the collective minds about goals and process. What all parties need to keep in perspective is the balance that we all strive to keep in our lives. We want to have freedom to choose, but we also have responsibilities. The medical profession and the patient need to work toward compatible goals. The treatment professionals need to integrate the desires of the patient but remain mindful of the medical needs of symptom relief. Parents need to gain a measure of compassion for the struggles of their children. Criminal justice systems need to look at causes of improper behavior and treatments not just enforce statutes. Individuals need to accept the norms of society and understand their role in the function of society.
Most of all we must press for greater understanding of the disorders and push for better, more effective and humane treatments that help those who suffer from disease. If the goals are pursued in concert with understanding, progress will be made.
How do you see the issue?
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