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Monday, February 11, 2013

Warning, may cause extreem sexiness.

I went to see the movie Side Effects and it explored some really good mental illness questions. (Plus, per the scientific journal People Magazine, it featured two of the World’s Sexiest Men, Channing Tatum and Jude Law.)
So who decides what is insane? Well, right now, the good old Diagnostic and Statistical Manual (fourth edition, text revised) is the compilation of check lists for what is abnormal. Types of mental illnesses go in out and out of vogue. In Freud’s day all women suffered from Hysteria and penis envy. (Silly women! Get rid of those crazy-making uteruses!) Now it is much more fashionable to have a major depressive disorder. (Or at least a diagnosis that insurance companies will pay for.)
How is it decided which of the nuts are normal and which nuts are really nutty? There are an abundance of mental health tests. The MMPI (The Minnesota, Multiphasic Personality Inventory, which asks an enormous amount of yes/no questions) is one of the most famous. It was rolled out in 1939 to screen for a myriad of mental illnesses including, at that time, homosexuality. An example of a Gaydar question: “Do you like to arrange flowers?”
Granted, it has been revised but it is still widely used, especially in security clearance background tests and child custody evaluations. It purportedly has several built in lie detector questions but, really most of the inquiries are pretty easy to circumvent. “I see things . . . around me that others do not see.” Hmmm, want to avoid the crazy label? I’m guessing the correct answer to verbal hallucinations is a big fat no.
Once we determine who is crazy, what can polite society do to rid their boundaries of the wacko’s? That is a tricky question. In the past, it was pretty easy to lock someone up for an undetermined amount of time. For example, there was a study done years ago where volunteers told mental health professionals that they were hearing voices so ta-da, commitment for them. Then in the institution they acted normally. The only people that caught on were the other patients and the study founders had to get them released.
But now, those pesky civil rights are in the way of corralling the societally inconvenient. So the rule is, anyone who is determined to be of a danger to self or to others can be locked up, but generally only for 24 to 48 hours before there is a competency court hearing. Again, relatively easy to avoid, “What is your plan to kill yourself?” “Sharks in the bathtub.” No lock up for you because your plan is not within your means.
Furthermore, the ones who come in with tin foil hats, and are clearly needing medication management, cannot be committed because living on the streets and refusing to take anti-psychotic medication is a personal choice. But (and there always in a but, isn’t there?) considering all the recent shootings, times are changing quickly and we may just see more involuntary commitments.
Which leads to the final piece, psychiatric medications. I have to preface this by saying I am a strong believer in anti-depressants. They do work but it takes months and months to titrate up doses, and if that fails, to then wean off then try something else or try a combination of the two and the side effects can be ridiculous. But given the choice between severe periods of depression and having a dry mouth, well it isn’t really much of a choice.
Who knows how the FDA works? The FDA, after reviewing the presented medication research, gives thumbs up to the pharmacology industry. Great right? Only nice, safe products get released. Well, not really. Most medication research is conducted by the manufacturer and you can bet that, even faced with a multi-million dollar loss, they deliver fair and impartial results. (Wink, wink, nod, nod.)
Then some of the side effects are worse than the original symptoms that indicated prescribing the medication. For example, Xanax is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Side effects may include; depressed mood, thoughts of suicide, unusual risk-taking behavior, decreased inhibitions, hyperactivity, hostility, hallucinations, urinating less than usual or not at all, uncontrolled muscle movements, seizures, blurred vision, memory problems, insomnia, swelling of hands or feet, weight changes and loss of interest in sex.
So we give the suicidal patient a pill that will increase thoughts of suicide and make her more impulsive. Terrific! However, I think urinating less may work out well. Most women haven’t slept through the night without getting up to pee since before they had babies. It makes you wonder what the hell the FDA was thinking! “Sure, this might cause teenage emo like behavior, but go ahead and try it! If you start wearing skinny pants, exaggerated black eye liner and get one or more facial piercings, we’ll try something else. In the meantime don’t start collecting sharks.”

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