Ship of Fools: Setback to more enlightened attitudes to mental illness?

Thread: Setback to more enlightened attitudes to mental illness? Board: Oblivion / Ship of Fools.

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Posted by Tulfes (# 18000) on :

This post is not concerned with the actual circumstances or condition of the pilot who brought down the Airbus. We know very little about him and speculation would seem pointless pending a psychological autopsy. However there is an issue concerning the perception of those suffering fromental illness and their potential for causing death or injury. Much has been done in recent years to remove the stigma of mental illness and to encourage sufferers to come out of the closet. How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by Tulfes:
This post is not concerned with the actual circumstances or condition of the pilot who brought down the Airbus. We know very little about him and speculation would seem pointless pending a psychological autopsy. However there is an issue concerning the perception of those suffering fromental illness and their potential for causing death or injury. Much has been done in recent years to remove the stigma of mental illness and to encourage sufferers to come out of the closet. How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?

I don't really think that it will cause long-term damage, but certainly there are some cringeworthy comments being made, reflecting ignorance and prejudice. I know that some people suffering from depression are feeling angry and alarmed about some of the rubbish being touted, but I think it will pass.

Posted by luvanddaisies (# 5761) on :

I mused on this over on the original thread about the crash, and as you can see from that post, the organisation Mind has been sufficiently concerned by the coverage to have posted a statement about it, to which I've linked over there.

As well as the New Statesman article I linked to earlier, the
Guardian has also published two articles about it.

I think if I was a pilot, or a train-driver, or a bus-driver or whatever, I'd be worrying more today than I would have a few days ago about my work finding out about a history of depression. The tabloids' headlines have not been sensitive to the possibility of vulnerable people, or to the possibility of prejudiced people. Some of them seem to imply that anyone with a history of depression shouldn't have responsible jobs, and, as Mind point out, there are many pilots who have a history of depression, and who fly safely every day.

Posted by Heavenly Anarchist (# 13313) on :

Yes, there is a risk that people will be scared to admit to mental illness.
I worked as a senior nurse when I was diagnosed as having bipolar disorder, and continued working as such for another decade. I declared my illness and was supported by my managers and gained later jobs with no problem. My code of conduct says that nurses are not fit for work if they have an uncontrolled mental illness, mine was controlled so therefore I could work. But I felt it was important my employers had the knowledge in case it did get out of control. Secrecy can be a dangerous thing and it is important that mental illness is not stigmatised.

Posted by Ariel (# 58) on :

quote:
Originally posted by Tulfes:
How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?

I don't know what you mean by "return to the days of stigmatisation". As far as I know we are still in them. Suspicion and contempt are still alive and flourishing and it is still largely true that if you've had a breakdown and been signed off work, you probably won't be trusted with potentially stressful responsibilities when you come back, at least, not for quite some time.

There are still many people who think that suicide is "selfish", depression is something that can be snapped out of or is an attitude problem, and people who think that paranoid delusions are silly and that the paranoid person only has to look at the facts to see it isn't so. And so on.

There is also the instinctive fear of being with people who are irrational, because the media love reporting cases of murders by the seriously unhinged. Most people haven't a clue how to spot the early signs of schizophrenia or much else.

What tends to happen these days is that people are nominally more sympathetic to, as it might be, depression, but when they themselves haven't experienced anything much more than mild gloom, faced with someone who finds it hard to think of a reason for living and is physically incapable of smiling, they are at a loss and often lose patience. There needs to be much more awareness of mental illness, what it is, how to deal with people who have to live with it and how to deal with your own nervousness.

Posted by Porridge (# 15405) on :

Indeed, if news reports are at all accurate, stigmatization may have played a role in keeping the pilot from seeking treatment.

Posted by Leorning Cniht (# 17564) on :

quote:
Originally posted by Ariel:
Suspicion and contempt are still alive and flourishing and it is still largely true that if you've had a breakdown and been signed off work, you probably won't be trusted with potentially stressful responsibilities when you come back, at least, not for quite some time.

If somebody broke his leg, or his back, or had serious surgery, I'd expect him to ease back in to the physical side of his job. I'd expect him to return to work clutching a note from his doctor, and to be assigned to light duty for a while, until he was fully healed. Attempting to do too much too early would only aggravate his injury.

I don't know much about mental illness, but I'd expect it to work in a similar way. If someone had had some kind of breakdown, I'd expect him to need to ease back in to work. Assigning him to the first high-stress role that became available would seem to be taking poor care of him.

Posted by Ariel (# 58) on :

I should have phrased that better. Of course when someone first comes back they need to be eased into the job, but some people are sidelined indefinitely on return - sometimes for years or even the rest of their time with that company, and the possibility of promotion is sometimes shelved because they're perceived as unreliable. This is particularly true if the pressure has been work-related rather than personal.

I have also known people to be put through disciplinary action for depression, as well.

Posted by no prophet's flag is set so... (# 15560) on :

I consult as part of my work, in part, in health care policy. Where I live, there is a duty to report that is imposed on all health care personnel if they think a patient is not safe to drive a car. It usually applied to neuro-perceptual things like vision or seizure disorders, but has occurred with some impulse control symptoms that may reflect uncooperativeness with treatment. This sort of 'risk management' assumes that the person has actually asked for health care, reports symptoms accurately and that the person providing the care is treating for the relevant issue and does a complete job. This obviously isn't or wasn't a process applied here. This sort of procedure seems punitive in some situations.

A more relevant example I think is the RCMP. They are specifically part of the RCMP health scheme, and not part of provincial medicare (which is like the NHS). The RCMP member attends for any health care service and the health care provider must fill out a form with a diagnostic or procedure code, the form (if I remember correctly, they get revised periodically) has a question about fitness for work and restrictions. The form is filed with the appropriate office and reviewed by the RCMP medical officer who will contact the superiors of the officer and convey restrictions, most commonly, to not be on patrol and/or not using firearms. RCMP are required to submit to medical exams of various kinds as part of their duty when required.

It seems to me that the likely outcome of the recent crash is going to be more mandatory examinations, reporting and other such things. A tightened 'due diligence' on these issues will result. I don't know that this will be really about a 'set back to enlightened attitudes', but a rebalancing of 'duty to accommodate' and prevention of disability discrimination so as to manage risks from people who pose them and to prevent preventable harm. There are several interested parties: employee, employer, general public, health care providers, disability insurance companies.

Does an airline owe a trained pilot a job flying aircraft if the pilot is a risk to passengers? The balancing of interests would suggest not, but it will owe the pilot something, like reassignment to non-flight work, provision of insurance benefits for income, possibly a severance settlement and retraining if working in the industry cannot continue.

I'd say development of processes that protect the interests of the public and the individual could be more enlightened not less.

[Tangent]
The 'easing back into work' is called TRTW (transitional return to work) here which means the person is at work doing some of their duties, or different duties, for usually less hours or days per week. GRTW is graduated RTW where the person is resuming their full job roles step-wise. PFI means permanent functional impairment which means that the inability to some duties is medically accepted and the 'duty to accommodate' is imposed by law on employers who only may get out of the duty if they can show hardship. They have to pay severance which takes into account years of service, difficulty getting a comparably paying job, and general employability. Hardship practically means that they have less than 50 employees and insufficient variability in the work roles available to reassign work. There can be no income penalty to the employee. In practical terms, workplace benefit insurance companies will be on the hook for part of the pay, though this is usually invisible to the worker.
[/tangent]

Posted by Schroedinger's cat (# 64) on :

I did post about this, but there are, I think, tow possible responses to this tragedy:

1. The one we are currently seeing from media, which is to emphasise the stigmatisation of those with mental health issues, and declare that they "shouldn't be allowed to work".

2. To see what the dangers of stigmatising mental health are, and make it easier to talk, to discuss it, and to get help.

Naturally, the latter would be a better outcome, but the former makes better headlines. And there is still huge stigma around mental health. In my new job, for the first time, I have spoken to HR at an early stage and explained that I suffer from depression. The only reason is that this was a part of why I had to leave my last job, so I wanted to avoid such a situation occurring again.

I don't work in a life-threatening industry, and yet I have had to hide my illness away, because I would be discriminated against because of it. If I worked in a more significant role, I can see that the danger of being not allowed to work would make me much more reluctant to discuss my problems.

Posted by no prophet's flag is set so... (# 15560) on :

Don;t know what jurisdiction you live and work within. Disclosing this here would mean that HR would have to ensure you were not discriminated against due to the medical condition. Protecting you in fact from discipline and related issues due to illness.

Posted by Soror Magna (# 9881) on :

quote:
Originally posted by no prophet's flag is set so...:
Don;t know what jurisdiction you live and work within. Disclosing this here would mean that HR would have to ensure you were not discriminated against due to the medical condition. Protecting you in fact from discipline and related issues due to illness.

In an ideal world, yes. In the real world, all sorts of shit can happen. Example 1: a manager can go to HR and say everyone is scared of an employee with a mental illness, and HR will offer the employee a severance package. Example 2: an employee with Tourette's was fired three days after being hired because of complaints from his fellow employees. And this is an employer that, in addition to having a massive HR department and agreements with several unions, also has an Equity and Inclusion Office and an Ombudsperson.

Posted by Teilhard (# 16342) on :

This episode makes it much less likely that a troubled person will admit such ...

Nobody wants to (can afford to) be laid off or fired for being depressed and/or anxious ... Nobody wants to be regarded as both mentally ill and dangerous to self and others ...

Posted by Heavenly Anarchist (# 13313) on :

My own experience of informing my work that I have a psychosis has been far more positive, I guess, than most people's experience because my employers have been the NHS and the famously inclusive Open University (in the health faculty).

Posted by Liopleurodon (# 4836) on :

quote:
Originally posted by Schroedinger's cat:
I did post about this, but there are, I think, tow possible responses to this tragedy:

1. The one we are currently seeing from media, which is to emphasise the stigmatisation of those with mental health issues, and declare that they "shouldn't be allowed to work".

But if the millions of people in the western world with depression all quit their jobs and went on benefits, the media would demonise us as lazy scroungers. It's become incredibly difficult to get benefits if you're mentally ill, even if you're lying in bed all day crying. Because in theory, there's nothing to stop you from getting up and putting on a suit and hopping on that train. In theory... though it's actually completely impossible.

Depression, in particular, suffers from the "good day / bad day" issue that messes up access to work and benefits. At your best, you're healthy enough to work, so no benefits. At your worst, you're far too ill to hold on to a job. As such, people who are depressed but in work will tend to cling on to their job with everything they have, minimise and cover up illness, drag themselves into work when all they can do is stare into space and try not to cry. It's not doing anyone any good, but the fear of losing the job and having no safety net is there and only makes the depression worse.

So I can see why someone with escalating mental health problems would do their utmost to pretend that everything was fine. The vast majority of depressed people are not dangerous, of course. I don't know what was going through the mind of this pilot but there's more to the story than depression.

Posted by Twilight (# 2832) on :

quote:
Originally posted by Tulfes:
However there is an issue concerning the perception of those suffering fromental illness and their potential for causing death or injury. Much has been done in recent years to remove the stigma of mental illness and to encourage sufferers to come out of the closet. How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?

E. Fuller Torrey, one of America's leading researchers in schizophrenia and director of the Treatment Advocacy organization, has stated that studies show a huge increase in stigma after a big news story like this one.

Anti-stigma ads don't carry much clout compared to the hostility in the general public after something like the Newtown killings by a mentally ill person.

Dr. Torrey believes that the best answer to stigma against the mentally ill is to allow greater access to treatment and more power to families and doctors when it comes to forcible commitment. He is in favor of opening more psychiatric hospitals, including locked institutions, for the currently homeless and imprisoned people with uncontrolled schizophrenia.

I tend to agree with him. No one wants a return to the abusive mental institutions of the past, but well run institutions are far better than living out of garbage cans or in prisons where no medical care is available. With forced commitment patients would have a chance to get stabilized on medications before they were returned to their families. As it is now, many psychotic patients are picked up from the streets, taken to the ER, given medication for 48 hours, and released back out to the streets.

The stigma would lessen for everyone as fewer incidents showed up in the news.

Posted by cliffdweller (# 13338) on :

Liopleurodon and Twilight: both spot on. Thank you for adding valuable insights.

Posted by no prophet's flag is set so... (# 15560) on :

quote:
Originally posted by Soror Magna:
In an ideal world, yes. In the real world, all sorts of shit can happen. Example 1: a manager can go to HR and say everyone is scared of an employee with a mental illness, and HR will offer the employee a severance package. Example 2: an employee with Tourette's was fired three days after being hired because of complaints from his fellow employees. And this is an employer that, in addition to having a massive HR department and agreements with several unions, also has an Equity and Inclusion Office and an Ombudsperson.

Both situations you post about are illegal here. There are always horror stories about someone doing something wrong, and we cannot hope to prevent all evils.

Your story may point to HR people who are inexperienced idiots. Normal is to inform the company about their responsibilities and they normally quickly conform, because the alternative is very punitive to them. Inexperienced caregivers with occupational health is another stumbling block.

I work on the side of the equation which is about making things work properly, and usually this is what happens. Seldom do these things go beyond a couple of faxed letters, a meeting or a phone call.

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Twilight:

quote:
Originally posted by Tulfes:
However there is an issue concerning the perception of those suffering fromental illness and their potential for causing death or injury. Much has been done in recent years to remove the stigma of mental illness and to encourage sufferers to come out of the closet. How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?
E. Fuller Torrey, one of America's leading researchers in schizophrenia and director of the Treatment Advocacy organization, has stated that studies show a huge increase in stigma after a big news story like this one.

Anti-stigma ads don't carry much clout compared to the hostility in the general public after something like the Newtown killings by a mentally ill person.

Dr. Torrey believes that the best answer to stigma against the mentally ill is to allow greater access to treatment and more power to families and doctors when it comes to forcible commitment. He is in favor of opening more psychiatric hospitals, including locked institutions, for the currently homeless and imprisoned people with uncontrolled schizophrenia.

I tend to agree with him. No one wants a return to the abusive mental institutions of the past, but well run institutions are far better than living out of garbage cans or in prisons where no medical care is available. With forced commitment patients would have a chance to get stabilized on medications before they were returned to their families. As it is now, many psychotic patients are picked up from the streets, taken to the ER, given medication for 48 hours, and released back out to the streets.

The stigma would lessen for everyone as fewer incidents showed up in the news.

Part of the problem with current crises in mental health "treatment" is the current fad of psycho pharma remedies ...

The idea is all about brain chemistry adjustment -- "Here ... Take these pills and you'll be 'cured' ... !!! Well, okay, there are commonly some terrible side effects, but we have pills for those, too ... You would like to spend a lot of time with a skilled compassionate therapist ... ??? Good luck with that -- it's really expensive ... So just take the pills ..."

Posted by quetzalcoatl (# 16740) on :

My local GPs are pro-therapy, and there are some in-house, but certainly cost is a problem, both for the NHS and the individual going private.

Posted by Mere Nick (# 11827) on :

quote:
Originally posted by Tulfes:
How much are the tragic events likely to cause a return to the days of stigmatisation and fear of admitting to eg depression?

I don't believe it will. If anything, maybe some more folks will realize it is a serious medical issue. I think one of the things that stands in the way of understanding depression is that the word "depressed" covers too much ground. It could mean you have a severe chemical imbalance in your noggin or your favorite team just lost a game. Most folks who have never suffered from it or had a close friend or family member suffer from it tend to have much understanding of it if what they say to those suffering is any indication.

Posted by Twilight (# 2832) on :

quote:
Originally posted by Teilhard:
Part of the problem with current crises in mental health "treatment" is the current fad of psycho pharma remedies ...

The idea is all about brain chemistry adjustment -- "Here ... Take these pills and you'll be 'cured' ... !!! Well, okay, there are commonly some terrible side effects, but we have pills for those, too ... You would like to spend a lot of time with a skilled compassionate therapist ... ??? Good luck with that -- it's really expensive ... So just take the pills ..."

I would never call "psycho pharma" remedies a fad. I don't know very much about the treatment of depression, but I've seen medication bring tremendous relief from symptoms and great improvement in the lives of people with schizophrenia and bipolar. Many mental illnesses are caused by imbalances in brain chemistry. I agree that time with a therapist can be very beneficial but I wouldn't expect talk therapy alone to keep their disease under control, anymore than I would expect therapy to keep diabetes under control.

Posted by JoannaP (# 4493) on :

quote:
Originally posted by quetzalcoatl:
My local GPs are pro-therapy, and there are some in-house, but certainly cost is a problem, both for the NHS and the individual going private.

I was very pleasantly surprised when my GP said she would not prescribe me anti-depressants unless I agreed to be referred to the local CBT service. MrP and I are currently receiving couples therapy on the NHS, in the hope that we can work out how not to drag each other down.

Such a difference from my first bout when I all got was meds and minimal follow-up.

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Twilight:

quote:
Originally posted by Teilhard:
Part of the problem with current crises in mental health "treatment" is the current fad of psycho pharma remedies ...

The idea is all about brain chemistry adjustment -- "Here ... Take these pills and you'll be 'cured' ... !!! Well, okay, there are commonly some terrible side effects, but we have pills for those, too ... You would like to spend a lot of time with a skilled compassionate therapist ... ??? Good luck with that -- it's really expensive ... So just take the pills ..."
I would never call "psycho pharma" remedies a fad. I don't know very much about the treatment of depression, but I've seen medication bring tremendous relief from symptoms and great improvement in the lives of people with schizophrenia and bipolar. Many mental illnesses are caused by imbalances in brain chemistry. I agree that time with a therapist can be very beneficial but I wouldn't expect talk therapy alone to keep their disease under control, anymore than I would expect therapy to keep diabetes under control.

Yes .. Some people do benefit from psychoactive meds ... But there is a fad approach for now a couple of decades that reduces mental illnesses to simply brain chemistry alone as if mental and emotional illnesses are akin to a broken arm or a malfunctioning pancreas, whereas the problem is often a broken life and an injured soul ...

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by JoannaP:

quote:
Originally posted by quetzalcoatl:
My local GPs are pro-therapy, and there are some in-house, but certainly cost is a problem, both for the NHS and the individual going private.
I was very pleasantly surprised when my GP said she would not prescribe me anti-depressants unless I agreed to be referred to the local CBT service. MrP and I are currently receiving couples therapy on the NHS, in the hope that we can work out how not to drag each other down.

Such a difference from my first bout when I all got was meds and minimal follow-up.

A lot of GPs are pro-therapy; one problem with the NHS is time and money, so you get about 12 sessions, inadequate for many people. CBT? Well, I will bite my lip.

Posted by JoannaP (# 4493) on :

quote:
Originally posted by quetzalcoatl:

quote:
Originally posted by JoannaP:

quote:
Originally posted by quetzalcoatl:
My local GPs are pro-therapy, and there are some in-house, but certainly cost is a problem, both for the NHS and the individual going private.
I was very pleasantly surprised when my GP said she would not prescribe me anti-depressants unless I agreed to be referred to the local CBT service. MrP and I are currently receiving couples therapy on the NHS, in the hope that we can work out how not to drag each other down.

Such a difference from my first bout when I all got was meds and minimal follow-up.
A lot of GPs are pro-therapy; one problem with the NHS is time and money, so you get about 12 sessions, inadequate for many people. CBT? Well, I will bite my lip.

Personally, I did find the CBT helpful but I am aware that not everybody does. Also, as I agreed to be seen by a trainee, I had 20 sessions rather than the standard 12.

Posted by Soror Magna (# 9881) on :

quote:
Originally posted by no prophet's flag is set so...:
Both situations you post about are illegal here. .... Your story may point to HR people who are inexperienced idiots. Normal is to inform the company about their responsibilities and they normally quickly conform, because the alternative is very punitive to them. ...

And they're illegal here too. But the HR people are not being idiots - like anyone else, they'll try the path of least resistance first. In example 1, the employee who had been a shop steward with another employer stood up for his rights and eventually returned to full time work. In example two, the employee was a recent grad who didn't know any better and didn't stand up for himself and lost his job.

I'm not saying disclose or don't disclose - I'm just saying things can go wrong either way and fighting your employer for your rights while also fighting an illness is hard work. Some people may decide that keeping their sanity is a higher priority than keeping one particular job.

Posted by Soror Magna (# 9881) on :

quote:
Originally posted by Teilhard:
Part of the problem with current crises in mental health "treatment" is the current fad of psycho pharma remedies ...

Yes .. Some people do benefit from psychoactive meds ... But there is a fad approach for now a couple of decades that reduces mental illnesses to simply brain chemistry alone as if mental and emotional illnesses are akin to a broken arm or a malfunctioning pancreas, whereas the problem is often a broken life and an injured soul ...

Psychoactive meds have been available for far longer than a couple of decades and they have helped more than just 'some' people. They're no more a fad than antibiotics or vaccines. Please stop calling life-saving medications a "fad".

And btw: I'M. NOT. BROKEN. I have a serious illness which is managed with a combination of medications and therapy.

Posted by Gwai (# 11076) on :

Let's please be intentional about what we say. Be as robust as you like, but remember that whatever condition you talk about, someone may well have it. And of course the corollary is not to take things personally.

(No, I'm mostly not talking about anyone who's already posted. This is mostly heading off a possible problem.)

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Soror Magna:

quote:
Originally posted by Teilhard:
Part of the problem with current crises in mental health "treatment" is the current fad of psycho pharma remedies ...

Yes .. Some people do benefit from psychoactive meds ... But there is a fad approach for now a couple of decades that reduces mental illnesses to simply brain chemistry alone as if mental and emotional illnesses are akin to a broken arm or a malfunctioning pancreas, whereas the problem is often a broken life and an injured soul ...
Psychoactive meds have been available for far longer than a couple of decades and they have helped more than just 'some' people. They're no more a fad than antibiotics or vaccines. Please stop calling life-saving medications a "fad".

And btw: I'M. NOT. BROKEN. I have a serious illness which is managed with a combination of medications and therapy.

The "fad" has been engaged during the last couple decades, in which the medical/pharma establishment pushes pills while not encouraging "talk therapy" (which is time consuming and frequently very expensive) ...

Compliance with medication is one of the huge problems with any medication regime, but especially so with psychoactive meds ... For some -- not all, but a significant percentage -- the side effects are troublesome ... and then, OTOH, when the meds are doing their *magic* not uncommonly the patient decides to try going off the meds, since the symptoms are no longer evident ...

Posted by Eliab (# 9153) on :

quote:
Originally posted by Mere Nick:
I think one of the things that stands in the way of understanding depression is that the word "depressed" covers too much ground.

That's exactly right. It's as if we were stuck with just the expression "I've got a virus" to describe afflictions ranging from the common cold to ebola. If the ordinary way to say one had a condition (like a cold) that was inconvenient but self-treatable was the same as that to describe something horrible and scary but which could hopefully be managed with increasingly improved medication (like HIV) and the same as that used to describe something likely to be rapidly fatal and requiring the patient to be isolated for the safety of others (like ebola), it really wouldn't be a very useful description. At present "depression" is the usual word* for mental afflictions of exactly that range of severity.

Saying people with depression shouldn't have responsible jobs is no more sensible than saying people with viruses shouldn't have responsible jobs - but where an infection or a mental conditions poses a real threat to the safety of others, there's nothing wrong with saying so. It's just that those conditions aren't typical of most things we call "depression".

(*This is possible not true of how medical professionals use the word - I don't claim any technical expertise - but its certainly true of media and popular use)

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Eliab:

quote:
Originally posted by Mere Nick:
I think one of the things that stands in the way of understanding depression is that the word "depressed" covers too much ground.
That's exactly right. It's as if we were stuck with just the expression "I've got a virus" to describe afflictions ranging from the common cold to ebola. If the ordinary way to say one had a condition (like a cold) that was inconvenient but self-treatable was the same as that to describe something horrible and scary but which could hopefully be managed with increasingly improved medication (like HIV) and the same as that used to describe something likely to be rapidly fatal and requiring the patient to be isolated for the safety of others (like ebola), it really wouldn't be a very useful description. At present "depression" is the usual word* for mental afflictions of exactly that range of severity.

Saying people with depression shouldn't have responsible jobs is no more sensible than saying people with viruses shouldn't have responsible jobs - but where an infection or a mental conditions poses a real threat to the safety of others, there's nothing wrong with saying so. It's just that those conditions aren't typical of most things we call "depression".

(*This is possible not true of how medical professionals use the word - I don't claim any technical expertise - but its certainly true of media and popular use)

Yes … "I'm 'depressed' … " is not necessarily the same thing as "clinical depression" …

Further, too often these days many are increasing suffering from a malady called "the medicalization of ordinary life," in which we are told that that we should never have to endure any pain or sadness or loss of function, but should look to the medical/phama industry to solve every ill and cure every problem …

"Ask your doctor of 'Fraudulin' is right for YOU …"

Posted by Evangeline (# 7002) on :

Frankly, I'm a bit peeved. As a type 1 diabetic I'm not allowed to fly a plane and I have to jump through various hoops-some of which are completely lacking an evidence base in order to be granted a licence to drive a motor vehicle. If a Dr perceives I'm not well controlled my drivers licence can be cancelled and yet it seems there's few restrictions on people with mental illness. I'm finding it hard to accept that there's a greater stigma attached to mental illness than certain physical illnesses or that there isn't an overly lax attitude to mental illness.

[ 01. April 2015, 06:21: Message edited by: Evangeline ]

Posted by Karl: Liberal Backslider (# 76) on :

Yeah, lock us all away in case we become dangerous psychos. Fire me forthwith in case I go mad and destroy the computer network at work, or just take a machine gun to everyone.

[ 01. April 2015, 08:06: Message edited by: Karl: Liberal Backslider ]

Posted by quetzalcoatl (# 16740) on :

I'm disgusted that a well-known depressive and hardened drinker was in charge of the war effort in WW2. I say, posthumously sack Churchill!

Posted by Evangeline (# 7002) on :

Plenty of people have to get medical clearance to do their jobs why shouldn't people with mental illnesses have to do the same?

Posted by Golden Key (# 1468) on :

I'm not sure why a person's biochemistry being broken *isn't* like having a broken arm. (Per what was said upthread.)

IME, (IANAD) it's possible to have both situational depression and biochemical depression--sometimes simultaneously.

And some of us start with talk therapy, then find we need to add meds. And need to stay on them long term.

*Evangeline*, I'm sorry about the way people limit your experiences due to your diabetes. FWIW: mental illness really does have a major stigma, at least in the US. Even with health insurance--it often doesn't cover mental health, or only does so minimally. People have pushed for equal coverage, including...I think it was Tipper Gore, wife of Clinton's vice-president. She'd been through it herself. And one notable thing about Obamacare is that it supports mental health care equity.

Many people either minimize a mental illness sufferer's suffering (as they do with migraines, CFIDS/CFS/ME, etc.), or think only of the most scary sorts of mental illness. Some people don't have a concept of mental illness, other than demonic possession. And then you get folks who don't believe in psychiatry--Scientology comes to mind.

There was an episode of the hospital drama "ER", where the staff dealt with someone having a serious mental health episode. (Schizophrenia, IIRC.) Two of the characters (Carol and someone else, IIRC) were walking down the hallway, and one said, "we're lucky to have the right brain chemicals". That one simple comment helped people.

Posted by Karl: Liberal Backslider (# 76) on :

quote:
Originally posted by Evangeline:
Plenty of people have to get medical clearance to do their jobs why shouldn't people with mental illnesses have to do the same?

They do. It's just that mental illnesses themselves shouldn't normally be a bar. Unless you want 25% unemployment, of course.

It's for you (or rather the employer) to show why depression, anxiety disorder, or whatever, is a reason why a person shouldn't be allowed to do a particular job.

[ 01. April 2015, 11:19: Message edited by: Karl: Liberal Backslider ]

Posted by quetzalcoatl (# 16740) on :

'Mental illness' is such a catch-all term; it covers a spectrum ranging from anxiety to bizarre delusions. To bar people who have been depressed from various jobs seems bizarre in itself to me - for example, I've known quite a number of GPs have periods of depression - should we sack them?

Posted by Karl: Liberal Backslider (# 76) on :

Aye. That's where the stigma is fed by the stereotype - "treated by the Mental Health Service" = "dragged off the street by men in white coats after running down the High Street with an axe"

Posted by quetzalcoatl (# 16740) on :

Also, if you did bar people who have been depressed from various professions, one obvious consequence might be concealment. You could go back to the dark days when it was unmentionable, and people would seek treatment in secrecy. There might in fact be more spectacular suicides.

Posted by Mere Nick (# 11827) on :

"tend to NOT have much understanding" is what I meant to say.

The folks in my congregation who I talked to during my bout were better than I had hoped in their understanding and treatment of me, though. I was even surprised by some of those who stepped up and went the extra mile with me.

Like others have said, being down from time to time is normal. A death of a friend, pet or family matter. Your favorite team losing. The pub being out of your favorite brew.

It seems you have a problem that will probably need treatment if you can't enjoy being around friends, pets and family members, your favorite team winning, or someone buying your favorite brew at the pub. And on the way home, you can't enjoy a beautiful sunset and you have trouble sleeping. Anhedonia, is it?

Posted by quetzalcoatl (# 16740) on :

You also get old childhood stuff resurfacing in some people, and this can happen at any age, leading to anxiety and depression. Ban them, I say!

Posted by Golden Key (# 1468) on :

q--

Are we banning the people, or the depression and anxiety?
[Biased]

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by Golden Key:
q--

Are we banning the people, or the depression and anxiety?

To be on the safe side, all of them, especially men.

Posted by Porridge (# 15405) on :

The problem boils down to (1) we're far from expert at diagnosing MI, never mind devising ways to treat &/or manage same. Miles ahead of where we were, certainly, but also miles from where we need to be, since the general public seems to think we have to achieve perfection at this before we can let folks just get on with their lives. There's also the issue that people who are managing and carrying on with their work and family responsibilities along with their MI do not make headlines.

The second issue we're dealing with is the result of spending decades segregating folks into institutional enclaves, so that we've all been deskilled in dealing with behavioral differences as they come up in ordinary life.

Posted by lilBuddha (# 14333) on :

Golden Key,

A broken arm is a different thing in that the treatment and recovery are known parameters. There are more "conventional" maladies, like epilepsy or diabetes that share some of the same issues as MI*.
Assessment and management are more individual and difficult to delineate for MI.

*general catch all, not specific.

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Porridge:
The problem boils down to (1) we're far from expert at diagnosing MI, never mind devising ways to treat &/or manage same. Miles ahead of where we were, certainly, but also miles from where we need to be, since the general public seems to think we have to achieve perfection at this before we can let folks just get on with their lives. There's also the issue that people who are managing and carrying on with their work and family responsibilities along with their MI do not make headlines.

The second issue we're dealing with is the result of spending decades segregating folks into institutional enclaves, so that we've all been deskilled in dealing with behavioral differences as they come up in ordinary life.

Yes … Mental "health" vs. mental "illness" is a false dichotomy … What is real in persons' lives is a continuum, a spectrum, of various adaptations and adjustments, maladies and successes, struggles and struggles … and more struggles (with and within one's own self, with other selves, with one's history, with hope and anxiety, strength and weaknesses, etc., etc. …)

Here in "the States" the standard diagnostic schema is given in the latest edition of the "Diagnostic and Statistical Manual of Mental Disorders" (the DSM) …For any given particular disorder, a diagnosis is made on basis of, say, "X" out of the following ten signs and symptoms that have persisted for at least "X" period of time ...

Posted by Golden Key (# 1468) on :

lilBuddha--

quote:
Originally posted by lilBuddha:
Golden Key,

A broken arm is a different thing in that the treatment and recovery are known parameters. There are more "conventional" maladies, like epilepsy or diabetes that share some of the same issues as MI*.
Assessment and management are more individual and difficult to delineate for MI.

*general catch all, not specific.

Yes, and I almost added in some other illnesses. But I was working with Teilhard's statement, up page, that rather stunned me:

quote:
Yes .. Some people do benefit from psychoactive meds ... But there is a fad approach for now a couple of decades that reduces mental illnesses to simply brain chemistry alone as if mental and emotional illnesses are akin to a broken arm or a malfunctioning pancreas, whereas the problem is often a broken life and an injured soul ...

All of a person is intertwined: physical affects mental affects emotional affects spiritual. (Or however you (gen.) want to divide it up.) But IMHO sometimes an injury is in one specific part of the "world" that is a person. E.g., all sorts of circumstances can lead to a broken arm:

--you're walking down the street, an earthquake hits, and a piece of a building falls on your arm.

--you're roller skating in the park, trip over a fault in the sidewalk, and land on your arm.

--you've got an unknown fault in the bone (maybe brittle bone disease/osteogenesis imperfecta), and your arm breaks in normal use.

Sometimes, things just happen--and sometimes you're born with a fundamental problem. Sure, mental illness can be due to life experiences; but also due to physical problems (biochemistry, tumor, etc.), or a combination of things.

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Golden Key:
lilBuddha--

quote:
Originally posted by lilBuddha:
Golden Key,

A broken arm is a different thing in that the treatment and recovery are known parameters. There are more "conventional" maladies, like epilepsy or diabetes that share some of the same issues as MI*.
Assessment and management are more individual and difficult to delineate for MI.

*general catch all, not specific.
Yes, and I almost added in some other illnesses. But I was working with Teilhard's statement, up page, that rather stunned me:

quote:
Yes .. Some people do benefit from psychoactive meds ... But there is a fad approach for now a couple of decades that reduces mental illnesses to simply brain chemistry alone as if mental and emotional illnesses are akin to a broken arm or a malfunctioning pancreas, whereas the problem is often a broken life and an injured soul ...
All of a person is intertwined: physical affects mental affects emotional affects spiritual. (Or however you (gen.) want to divide it up.) But IMHO sometimes an injury is in one specific part of the "world" that is a person. E.g., all sorts of circumstances can lead to a broken arm:

--you're walking down the street, an earthquake hits, and a piece of a building falls on your arm.

--you're roller skating in the park, trip over a fault in the sidewalk, and land on your arm.

--you've got an unknown fault in the bone (maybe brittle bone disease/osteogenesis imperfecta), and your arm breaks in normal use.

Sometimes, things just happen--and sometimes you're born with a fundamental problem. Sure, mental illness can be due to life experiences; but also due to physical problems (biochemistry, tumor, etc.), or a combination of things.

Yes … But generally a broken arm isn't experienced as a life-long existential crisis that deeply affects every aspect of one's being ...

Posted by Golden Key (# 1468) on :

ISTM a brain or brain chemistry problem certainly could be experienced that way--impacting the person's life, disrupting function, causing a sense of impending doom and hopelessness.

I'm just saying that sometimes mental health problems start as a physical problem. Talk therapy may help with coping; but the fundamental physical problem isn't going to get better until it's addressed as a physical problem.

Just as someone with brittle bone disease is going to keep getting broken bones, unless bone-strengthening treatment comes along.

FWIW.

Posted by Teilhard (# 16342) on :

quote:
Originally posted by Golden Key:
ISTM a brain or brain chemistry problem certainly could be experienced that way--impacting the person's life, disrupting function, causing a sense of impending doom and hopelessness.

I'm just saying that sometimes mental health problems start as a physical problem. Talk therapy may help with coping; but the fundamental physical problem isn't going to get better until it's addressed as a physical problem.

Just as someone with brittle bone disease is going to keep getting broken bones, unless bone-strengthening treatment comes along.

FWIW.

Yes … Some people get some benefit from psychotropic meds … But they're not the near universal answer that is too often touted the last couple decades ...

Posted by no prophet's flag is set so... (# 15560) on :

Thought processes and emotions cause brain chemistry changes. The pathways we know about are cortex (where your consciousness is) to hypothalamus, amygdala, limbic system more generally, to thyroid, pituitary, thymus, adrenals. We also see neurological changes from thought process training via neurofeedback treatment. --It is incorrect that allegedly physical problems must be dealt with only physically or even need physical approaches. How we think, perceive and feel, what we expect, and other psychological processes are integral to physical and emotional health and treatment. Hence behavioural medicine, a field of practice. Hence functional rehabilitation, application of such principles with better outcomes than traditional physical medicine for chronic health, psych and psychophysical problems. Which is why we see public and private funding of same.

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