I just want to make the point that these are not reasonable people you are talking about. A reasonable person doesn't drink acid which burns out all their insides in order to die. Or shoot themselves in the head with a nail gun. Or cut up their face every time they are left alone. (All cases I've seen at work). These are mentally ill people. Don't think it's just a case that they have a stressful or horrible life.
Mmmkay. No... It means you haven't found the one that works. This is not ungratefulness; it's chemistry. If one antidepressant worked for everybody we wouldn't need 20-some odd of the things. Different classes of them even. SSRI's, SNRI's, Tricyclics, and MAOI's for those who don't respond to other stuff. Some of the mood stabilizers seem to also have an anti-depressant effect. Some people end up on antipsychotics, either atypical or typical, for severe, treatment-resistant depression. I have a friend who nearly died of anorexia, was suicidal...he's on zyprexa now and has become the sappiest, happiest, most obnoxiously optimistic person I know. I ought to call him and see how him and that new girl are working out-she's a cute goth who wants a husband...and he's wanting to get married...Please Register or Log in to view the hidden image! So...I know someone who went from "wants to die all the time," to "gawd, stop being so happy at me!" through the power of the correct med. No...it's a conflicted state. Your desire to die is at war with your self-preservation instinct. I mean, think about it...why are there so many failed suicide attempts? it's childishly easy to figure out how to kill yourself successfully if you don't mind pain and don't mind leaving a mess.
chimpkin who were you quoting? They oviously neglected to read my post because it CLEARLY states that as one of the myths about suicide.
You think it's fair to force someone to try medication after medication after medication until they find the correct blend of brainwashers? I say if they can count to 10 and distinguish squares from circles, recite today's date, etc. etc., if they have a functional awareness of what's going on around them, it's no one else's business to dictate how they should emotionally feel about something for whatever reasons. It's simply not one's business to impose one's personal life outlook and feelings on others, nor to judge what the "correct" brain chemical balance should be- this is not scientific thinking, it's religious and cultural. Treatment of depression and suicide should be a voluntary process, not imposed, unless the person being treated is in a completely incoherent state such that they're not even aware of their immediate surroundings. If someone's miserable for 10 years and doesn't want your help, that's your cue to piss off.
In Australia at least, treatment of depression is indeed voluntary, unless: The person has a mental illness; The person's illness requires immediate treatment; The proposed treatment is available at an authorised mental health service; Because of the person's illness: There is an imminent risk that the person will harm himself, herself or another person or the person is likely to suffer serious mental or physical deterioration; There is no less restrictive way of treating the person; and The person lacks the capacity to consent the treatment, or has unreasonably refused treatment (s 14(1), Mental Health Act 2000). Note that the link is to Queensland legislation, but my understanding is that the Act was developed federally and passed in all states.
pete your wrong about that. I belive the act started in SA but i could be wrong about that. In the case of the SA legislation the term "mental illness" was removed from the involentry commitment section to allow a wider application. That being that if the inability to give informed concent arises out of anoxia, drugs, server emotional disterbance or whatever cause it doesnt have to be debated on the side of the road. All that needs to be determined is that the person is unable to give concent and that they are a threat to themself or others. http://www.austlii.edu.au/au/legis/sa/consol_act/mha2009128/ this legislation is in the proccess of being reviewed however because the ambulance service is objecting to being required to have a police officer tell them someone is in need of treatment. The heads of SAAS want these powers flipped so the ambos are incharge and the police are required to assist as directed by SAAS. My opinion may be biased in this but i agress with Hugh Gratham's comments to us in class "what makes a constable just out of the acadamy better able to determine if a pt needs treatment than a trained experianced paramedic". Pt care is our responcibility, not that of the police and therefore the decisions should be ours too. Edit actually that looks like the review has been finalised and the changes made. If i read that correctly Ambos now have the power to act under there own authority rather than under that of a police officer
Yes, but my point is that the diagnosis of mental illness is nearly automatic for anyone attempting suicide, at least in Canada (is it perhaps different in Australia?). It's a simplistic tautology. I don't see any flexibility in that outlook, although I expect it's going to stay this way for many decades to come. I can understand a lot of science goes into studying brain chemistry and how it correlates with moods, population medians and averages, etc. At the same time, there's this moral concept of what the ideal chemical balance should be- they should at least be honest that this is a subjective human definition, not some kind of independently demonstrable fact of nature. Sure, you can probably find an anti-depressant that will instill a coping mechanism for nearly any situation, even a concentration camp, or if such a drug doesn't yet exist, it's on the way. My question is whether it's fair to expect someone to find a way to cope with any situation they face, without exception. It's a touchy subject, but I know quite a few people who appear to have suffered pretty substantially at the hands of the local mental health system. Some have benefited tremendously, but others have not improved over the long term and seem trapped in an endless cycle of medications and psychotherapy. I think one day society will have a broader outlook on this subject, but the idea of unconditional therapy to instill the will to live seems almost like a gentle form of slavery- some people have "shitty" lives that they simply won't enjoy if left to their own natural perceptions, and IMO it's their right as individuals to retain those perceptions and to even have a compassionate means of taking their own lives if they so choose. At minimum, there should be some form of generous compensation for an individual who's been forcefully treated and isn't satisfied with the outcome, just as we're supposed to compensate those who've spent time in prison on a false conviction. Ah well, I can say my piece, but ultimately change will only come from within the system, as in most things in life. This is the same kind of society which fights over preserving comatose human vegetables who've given clear prior indications of their intent to pass on if they ever became vegetables.
well that at least has changed in SA, the right to medical treatment and palitive care act allows for advance directives to let someone die in that situation. I have one and my partner has one, its as simple as looking up the act and printing off the form at the end of it and filling it out. Give a copy to those who need them (such as eachother for PB and I) and then hope we never need to use them
I should inquire about that, I have a lot of crazy family members who'd probably insist on preserving me in that kind of situation, fight to the last defective blood cell and all that. Anyhow my recommendation is that anyone feeling depressed should indeed consult a medical professional and seek or inquire about therapy, there's really no harm in at least trying. I merely disagree with the establishment's attitude that if therapy doesn't work, the solution is clearly to seek further therapy, ad infinitum. That's like if the rain doesn't come, just keep praying until it does.
Captain, I think you're stepping over into end-of-life planning, which is off this topic. Also suicide ideation or even a suicide attempt is not enough to warrant a mental health diagnosis. For example, a diagnosis of Major Depressive Disorder (i.e. Depression) implies that a person has had symptoms that meet the DSM criteria for a major depressive episode: Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.[ Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide The symptoms do not meet criteria for a Mixed Episode. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. The DSM is an internationally recognized psychiatric diagnosis reference. The other one is the mental health part of the ICD-10, which has similar criteria. EDIT - Sorry, I took a while compiling that post, and missed some new posts in the process.
Where does a doctor draw the line between bereavement and a depressive disorder? If a guy failed to get the girl of their dreams and spent the next 20 years all alone, and they're still miserable about it, I'd still call it bereavement even after all that time. The conditions are still set up so that a person with long term thoughts of suicide is almost unquestioningly considered to have a mental illness. If they're miserable because they feel something substantial is missing in their lives, they won't be able to function well, and it should be very easy to tick off 5 or more factors on your list. To put my thinking in more explicit terms: what's the thermodynamic equation for God's preferred dopamine balance?
Don't know. I'm a student. But if I was still tearing up and overwhelmed with loss after 20 years... that would not seem healthy to me.
Actually, I note that in Pete's criteria, it does mention that the symptoms are only to be considered if there's been a substantial change in functioning in the recent past, I think I misunderstood it when I last checked. So would any of those criteria qualify for disorder diagnosis if they've been present for several years? Wouldn't seem healthy to me either, but I figure I couldn't judge them unless I'd been through a nearly identical set of life experiences myself. Anyhow I'm not a doctor, I don't pretend to have expertise in how the system works or why, but I do question the degree to which morality and cultural ideals enter the system under the guise of science.
Don't know... I'm not sure how strictly things are applied in practice. I think the point of that criteria is to distinguish mood (short term) from personality characteristics (long term).
those are the criteria for diognosing clinical depression, not the definition of a mental illness used by those in the front line. Front line proffessionals (ambos, nurses, A&Es) use a different standed which relates to distress and threat. 1) is the person in distress? 2) is the person a threat to self? 3) is the person a threat to others? 4) is the person able to give INFORMED CONCENT? The fact that someone has a mental illness isnt enough to justify treatment against there will. Its those 4 factors (especially the last 3) which are the justification for involentry treatment
I think it is unreasonable, absolutely. If someone's in a bad mood, that's a symptom of... them having a bad mood. When doctors make a diagnosis based on a chemical imbalance, what's the benchmark? It can't just be "Joe Average over here has X levels of dopamine, and Y levels of seratonin. He's happily plugging away with his life, why can't you be just like him?" If someone has a clear perception of the physical reality around them, how are we supposed to pass scientific judgment on their social perceptions? What's the difference between a depressive disorder matching the symptoms you listed, versus possessing an alternative outlook on life and society from what is deemed average or normal, when that outlook doesn't include unconditional self-preservation?
what makes you think all med is scientific? i wanted to copy some guidelines for you from the ARC but it is protected and wont let me copy so i will just have to let you look for it. http://www.resus.org.au/ If you click on Guidelines and scroll down to "Guideline 11.5" and click on that you will see this Every drug used in resucitation has limited or no evidence at all to surport its use. That doesnt stop us from using them however. Med is moving TOWARDS a scientific model but its not compleatly scientific and psycology is hardest to quantify but its also one area which gives massive amounts of distress to people. It would be unfair on those pts to say "no measurable data means you dont have any problems" when its clear to anyone with a brain that these people are in distress
