Category: Alternative to mental health treatment

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addiction Alternative to mental health treatment antidepressants Antidepressants effectiveness Mental Health pharmaceutical Industry psychiatric drugs psychiatric medications

Are Psychiatric “Medications”Essentially The Same As Recreational Drugs?

Welcome to From Insults to Respect. Today we shall look at a theory that is certain to fire up some mighty strong emotions.

Most advocates within the medical profession say their prescriptions for psychiatric drugs, which they refer to as “medications,” improve the health outcomes for their patients. There are some within the profession that fervently object to this claim and provide extensive research evidence for their position, but nevertheless are clearly a minority. Meanwhile, taking legal and illegal recreational drugs are mostly viewed as distinctly different not only by medical doctors, but a majority of those in the general population.

That said, I do think it is useful for us to look at the case that although there are some differences, essentially they are the same when it comes to opportunities to 1. assess side effects/toxicity as one makes decisions to partake, and 2. what keeps users to continue consuming them.

Assessing Side-Effects and Toxicity

The Food and Drug Administration provides readily available information on the internet, regarding the side effects and toxicity of these substances. Updated research on this information is regularly appearing in the press. For example, we have recently seen stories about how even one glass of an alcoholic beverage can have negative effects on some aspects of health outcomes.

Anyone who wants to delve into a more thorough assessment of health consequences of any of the legal and illegal recreational drugs and psychiatric drugs can do a literature search. I have found Google Scholar fairly easy to use for this purpose. It provides the abstract of the research for free. There is an occasional pay wall that can be modestly costly in order to read the entire paper, but anyone who wants to make a fully informed decision on the risk of partaking can obtain the available evidence at a reasonable cost. Many of the published evidence can be misleading particularly because most studies look at just short-term results, yet many folks take these drugs for much longer. But this is true for recreational and psychiatric drugs, so assessing safety is hardly perfect regardless of what drug is being considered.

The Physical and Psychological Reasons People Continue to Consume These Legal, Illegal, and Psychiatric Drugs Are Essentially the Same.

Let’s begin this theory by using nicotine as an example and by taking a close look at an impressive study in the scientific literature (see HERE).

smoking 5Our body, upon beginning the habit of consuming nicotine, at first fires its receptors more frequently than usual upon each exposure to this drug. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first start smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”

For smokers, we see evidence of tolerance in studies that indicate fewer responses than do non-smokers to the same amount of nicotine (Perkins et al. 2001b). More specifically, we see a reduction on measures of subjective stimulation that may be viewed as pleasurable, such as arousal, vigor, and a subjective experience often referred to as “head rush” or “buzz.”

Once the down regulation process is complete, you end up with enough receptors to function fairly well as long as you continue to consume using this drug. withdrawal 2However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not regularly consuming the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.

The relief that smokers feel each time they give themselves another dose of nicotine creates the powerful illusion that cigarettes help them to deal with stress. Thus, in a study published in the American Psychologist, researchers found the following:

smokingSmokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

drug withdrwal 1Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.

Another major part of the addiction process is that the addictive substance often is used as part of a ceremony creating a very pleasant experience. As an example of this, listen to the actor John Cusack explaining his smoking habit:

John Cusack

John Cusack

To me, cigars are a much better situation than cigarettes. Cigarettes are compulsive and cigars are kinda, languid, luminous conversation. Like you’re gonna sit for a couple of hours and talk to somebody. If you gotta smoke, I would say, at least have a long conversation with someone you like, rather than just compulsively sucking down a cigarette. That’s how I’m gonna lie to myself so I can keep smoking cigars.

Although the cigarette habit is not John’s cup of tea, many people have fond associations of sharing a cigarette with others, and drinkers have associations of some very good times hanging out with their buddies. Of course, others have very negative associations with an addictive substance.

Can it be that the same two mechanisms–reduced receptors and pleasant ceremony– that creates the illusion for nicotine users are similar for other drugs that are the other legal, illegal, and psychiatric drugs?
Clearly, regular users of alcohol go through a withdrawal reaction when they don’t get a drink around the time they usually imbibe. We get a delightful sense of this listening to Jimmy Buffet singing about it being five o’clock somewhere and his desire for the relief he needs by taking a swig of his favorite intoxicating drink.

How intense the need can become is powerfully brought home to us during Ray Milland’s Academy Award winning portrayal of Mr. Birnam, an alcoholic in the movie, “The Lost Weekend.”

Ray“Just give me a drink,” says Mr. Birnam with exquisite anguish.
The bartender, in a disbelieving voice: “Mr. Birnam, this is the morning!”
“That’s when you need it most, in the morning,” Mr. Birnam replies with disgust. “Haven’t you learned that yet! At night, it’s a drink, in the morning, it’s medicine!”

Like nicotine, regular consumers of alcohol get a pleasant relief from the sensation of drug withdrawal reactions, and it is often associated with particularly good times.

Often, it is a combination of these drugs that work together to create the illusion that they are a type of “medicine,” relieving stress and feeling an improved sense of being.

Consider Jerry Irby who tells us in his song, One Cup of Coffee and a Cigarette:

IrbyHotlineNow when I get up in the morning
And I’m feeling mighty low
There’s just one thing that will pep me up
And I want you all to know.
Well it happens every morning
No matter where I’m at
I just gotta have a cup of coffee
And a cigarette
Coffee, coffee,
And a Cigarette
Is a habit
That you can’t forget…
There is no doubt that each of the legal, illegal. and psychiatric drugs have powerful withdrawal actions that is relieved when one once again consumes them. The ceremony that medical doctors use to encourage their patients to use psychiatric drugs involves a highly respected professional describing a process in which people often report feeling better as a result of consuming their prescription.

With so called “antidepressants” the withdrawal reaction is referred to as “Antidepressant Discontinuation Syndrome.” It causes a variety of symptoms like nausea, insomnia, fatigue and achiness. Interestingly, prescribing doctors of these drugs, when the patient reports not being helped by the first prescribed drug, often will prescribe others, and even a cocktail of others until the patient reports improvement. During this time the patient might have improved without the drug but attribute feeling better to the drug.

Different people find some drugs pleasant when they first try them while others are not. I know someone, for example, who loves his cigarettes but doesn’t like how marijuana makes him feel. The process that doctors use when trying different prescriptions until one is found that the user happens to feel better on serves this illusion creating process perfectly.

Support for the theory I am putting forth comes from several studies.

People Who Get Over Depression Without “Antidepressants” Do Better Than Those Who Had Taken Them

A recent publication in the journal American Psychologist by Professor Steven Hollon neatly summarizes what I am referring to.

Depression is an inherently temporal phenomenon. Any given episode tends to remit spontaneously even in the absence of treatment but recurrence is common (at least among people seeking treatment). There is reason to believe that depression may be an evolved adaptation (like pain or anxiety) that increases reproductive fitness (the likelihood that one’s gene line will pass on). If so, then any treatment that facilitates the functions that depression evolved to serve is likely to be preferred to one that only anesthetizes the distress.  

After this opening statement, Prof. Hollon provides a more complete description of his theory:

Depression is an adaptation that evolved because it keeps organisms focused on (ruminating about) complex social issues until they can be resolved and that medications work not so much by addressing a nonexistent deficit in neurotransmitters in the synapse as by perturbing underlying regulatory mechanisms to the point that they reassert homeostatic control over those systems. If the latter is true then medications may work to suppress symptoms in a manner that leaves the underlying episode unaddressed and patients at elevated risk of relapse whenever they are taken away. 

So, I hope you will consider this theory of the illusion regarding how helpful these drugs are and please feel free to express your reactions in the comment section below.

My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
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Alternative to mental health treatment conflict resolution dealing with anxiety dealing with criticism

A Psychological Maturity Approach for Addressing Psychological Concerns

Welcome to From Insults to Respect.

Regular readers of this blog know that I have become disenchanted with the mental disorder/mental illness/medical model for addressing psychological concerns (see, for example, HERE). Today I describe how this came about, along with my reasons for preferring a psychological maturity approach.

My Disenchantment With The Mental Disorder Model

Let’s begin with my early education as a psychologist. At first, I was quick to adopt the medical model for dealing with the types of concerns that lead people to seek psychological services. This was because I was incredibly impressed with the medical model for dealing with physical illnesses.

You see, when I was very young, I had seen films of polio victims stuck in iron lungs. My generation was the first to benefit from the vaccine Dr. Jonas Salk came up with to prevent these awful infections, and he was hailed as a “miracle worker.” Later, I hurt my leg in a football game and to my extreme distress, I couldn’t walk on it. The doctor I went to took an x-ray and saw I had broken my fibula. He put a cast on my leg, and three months later, I was starring on my high school baseball team with absolutely no pain. Grateful for preventing polio infections and healing my leg, coupled with the respect others in my community had for medical doctors, I had become primed to think that the same model would be helpful for psychological concerns.

Then, in the early part of my undergraduate psychology courses at Brooklyn College, the various psychological concerns were all described as various mental illnesses, psychopathologies, and mental disorders. At first, this seemed to make sense. But then, in more advanced courses, doubts began to emerge.

In the courses that taught principles of science, I began to see that the definition of “mental disorder” and the various types of “mental disorders” are seriously flawed. Studies were coming out indicating that doctors looking at the same data about a case did not reliably come up with the same diagnosis. When reliability is low, so too must be validity according to well established principles of statistics. Meanwhile, the chemical imbalance theory that had been viewed as support for the notion that these concerns were illnesses just like physical illnesses proved to be unsupported by the evidence. In courses on the history of psychology, I learned that utilizing the medical model for psychological concerns led to lobotomies, shock treatment, and drug treatments that, from my scientific literature review, convinced me that they resulted in far more harm than good.

To be clear, I recognized millions of people that received drug treatments for their mental health concerns reported they found them helpful, but I also found that millions of others came to the opposite conclusion. I began to wonder if there was an approach that would be less likely to have people end up feeling they were harmed.

Meanwhile, I learned that many psychologists and counselors who provide mental health services also recognize the flaws in the medical model approach. Although they don’t prescribe drugs as a treatment approach, to their dismay, in order to have a viable professional practice, they are required to utilize the same invalid medical jargon as drug prescribing doctors because insurance companies require for reimbursement a mental disorder “diagnoses.”

Given this educational background, I began a search for an alternative model for providing psychological services.

Discovering a Developmental Psychological Maturity Model

In one of my classes I began to learn about Abraham Maslow, who had recently been elected president of the American Psychological Association. Rather than treating people as a bag of mental disorder symptoms, he focussed on identifying people who exhibited the most mature aspects of life, and he looked to see how these developed. He referred to those at this highest developmental level as self-actualized.

Maslow’s approach focussed on this highest level of maturity, but at about this same time period, I began to come upon other researchers who described various aspects of psychological development as a process of going through four or five stages. In these models, higher stage functioning is viewed as “better” than lower in the long run.

After graduating with a masters degree and getting a job in which I was to address various psychological concerns, having this developmental model in mind proved enormously helpful. The two most common concerns that I addressed were depression and anxiety. From Maslow’s model, a major impediment to reaching the highest level of maturity is not having one’s basic needs met. So, in addition to providing a safe place for my clients to get emotional support, which is one basic need, I also focussed on coming up with my clients plans that can better achieve their other basic needs. For example, when seeing someone who was dealing with poverty, and therefore was insecure about food and shelter issues, we would work on a career development plan.

At the same time, many clients had difficulties fulfilling their love and belonging needs. When I explored this issue with them, it became clear that the way they handled criticism was a major hinderance. They would describe nasty, attacking interactions which left a bad state of affairs for both parties. These began with either someone criticizing them, or they criticizing others. Further discussions led me to understand that when they made mistakes they utilized the same nasty, attacking criticism style directed at themselves.

With the developmental stages model in mind, I developed a five stage model for handling these criticism situations; the higher the stage, the more mature the approach (see HERE, HERE and HERE). To find out how people perceived the five stages, I made a lot of TV shows with a variety of actors, each one depicting a scenario in which someone responded to criticism.

When I showed these videos to students in conflict resolution classes that I had been teaching, they rated the actors who displayed responses to criticism in a style consistent with the higher levels as more likable, respected, and mature.

When I described these stages to my counseling clients in a way that did not claim they represented an absolute truth, but was a starting point to think about these issues, I found that there was something about the stages that seemed to them plausible. And then, after a few practice sessions in which we would rehearse using the highest level, the feedback that I got from clients was very rewarding. Long standing flareups with family members and others often completely disappeared, and criticism situations changed from being nasty to playful fun, and a valued learning experience. Clients also reported that this increased the amount of respect they received from others, as well as their own self respect. This led me to feel I was on to something that might be better than the medical model approach for dealing with psychological concerns.

I then went on to study for my PhD at the University of Minnesota.

Dr. Sprinthall

There, one of my professors, Norman A. Sprinthall, published a paper in the American Psychologist that further validated my new way of thinking. It reviewed the research evidence demonstrating the value of reaching higher levels of maturity. Thus, Dr. Sprinthall wrote:

“By providing detailed information on the content and structure of the multiple domains of psychological development, contemporary theorists are filling in the gaps and advancing more accurate successive approximations to critical definitions of developmental stages and sequences.”

He then discussed several studies that found life skills and success after the completion of formal education are more closely related to psychological maturity than to scholastic aptitude or grade point achievement. For example, a Ford Foundation study followed for over 16 years a group of “at risk students” who had scholastic aptitude scores about 150 points below average for college students. Estimates of their psychological maturity by counselors and principals when these students were in high school were a more effective predictor of success than their academic record, not only for college itself, but also in the following years.

Finally, Dr. Sprinthall summarized six studies that provide support for the contention that certain education programs can be designed to successfully promote psychological maturity. In all of them, those in the experimental maturity promoting programs improved their level of psychological maturity; those who were not in these programs did not.

To be successful, Dr. Sprinthall argued, these programs must include a constant interplay between opportunities to learn some basic principles of psychological maturity, opportunities to apply the principles to one’s own actual, real world experiences, followed by readings to help illuminate the possible meanings of such experiences. More recent research suggests that certain narratives such as found in novels in which readers can identify with characters dealing with the types of situations requiring higher levels of maturity can also promote this type of development.

This body of research sometimes falls under the three headings of “emotional intelligence,” “social intelligence,” and “positive psychology.” When all three are taken together they cover much of the same ground as the more general concept of “psychological maturity.”

Given these findings, I found myself in recent years taking to heart something psychologist George A. Miller promoted in a classic 1969 paper. There he urged psychologists to give psychology away. What he meant by this was that elder psychologist professionals should create a new psychology that could be given away to the public. These professionals, he advocated, should select principles and practices that the public could use in their own behalf. He wanted a psychology not for the profession, not for the Library of Congress, and not for graduate student’s eyes only, but a psychology that everyone could use, a practical psychology that would help each person manage his or her own life with greater effectiveness and competence.

This blog, From Insults to Respect, aims to do exactly that. It is completely free, and I have been drawing on what I have found to be the most helpful principles and practices that, once learned, can be used by the average Joe or Jill in any way they might choose. Early posts, which can be retrieved by beginning HERE, introduce some basic ideas, and I then describe the following tentative description of psychological maturity:

Psychological maturity is “better” in the long run, it considers more variables, and represents more comprehensive cognitive problem solving. Individuals who tend to act at higher levels of psychological maturity can think more critically, logically, and scientifically while acting civilly to people with whom they disagree; they can graciously admit they are wrong when information comes in supporting such a conclusion; they welcome receiving criticism, respond without getting defensive, though they know it can be emotionally concerning for them; they are hesitant to provide uninvited criticism, only doing so when they can formulate it in a way that promises to be specific enough to be helpful, and they do so without insulting tones of voice or name calling; they can role-play and empathize with the emotions of a wide variety of human beings and can process moral dilemmas according to standards of democratic justice and the golden rule; they understand that melancholy and anxiety, rather than symptoms of mental disorders, are part of the natural process of addressing concerns about losses and fears; and they have the ability to puzzle through the tough problems of living, to take a stand, and yet to remain open to possible revisions and new information—thus demonstrating a capacity to make successive approximations toward more efficient, effective, economical, and beautiful accomplishments.

Such a description of maturity, in a general sort of way, can be a valuable aid to challenge each of us to begin to consider what psychological maturity means. It is not claimed that it is absolutely true for everyone and every conceivable situation. The paragraph is my personal best effort to summarize what respected theorists have written, and there is some preliminary evidence that it describes a type of functioning that is predictive of life success, and interventions can help to promote higher levels of functioning.

When, in my posts, I offer suggestions for dealing with specific types of situations, I aim to stay consistent with the summary, while providing additional details for handling such situations. In many of them, I describe a little assignment that provides an opportunity for readers to apply what they have just read to some event in their own personal life. Moreover, to get a deeper sense of handling specific situations, readers are encouraged to access my three novels (see HERE).

So, in conclusion, I invite readers to give this free approach a try.

Assignment: If you will, reread the paragraph in italics that describes, in summary form, psychological maturity, and then write a paragraph or two about how the various phrases in the description relate to your own way of dealing with life.

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence.  To begin at the very first post you can click HERE.