Friday, January 14, 2011

Fantastic Future Friday: Mental Health

One undeniable fact of the Arizona tragedy is that the shooter was mentally ill. If he hadn't decided on a political assassination he might have targeted a school or a mall. I unfortunately know quite a few people who struggle with mental illnesses (not to the point that they are dangerous) so I have done a bit of research on this topic in the past.

What is a mental illness?

This question sounds stupid but it really isn't. A lot of the mental illnesses that make people anti-social are actually evolutionary hold overs from a time when anti-social behavior was a benefit to society. That sounds strange but when humans lived in small tribes of hunter/gatherers having an anti-social couple helped to ensure tribe survived, by casting those members out. When an anti-social couple left a tribe they would then have to create a new settlement and humans spread around the world. Naturally if every member of the new settlement was anti-social the society would break down, so for it to be beneficial anti-social thinking had to skip a generation or two so it is tied to many different genes that turn violent when combined. So there is a large genetic component to the mental illnesses that lead to anti-social behaviors.

What is the historical treatment of mental illness?

Crazy people have been around throughout history, when we were hunter/gatherers they were cast out. As the human population grew to the point that this wasn't an option they were locked up. In the 1800's Sigmund Freud developed a more clinical way of dealing with mental illness. Even though most of his ideas were wrong, in psych class I loved when his name popped up on a test as I knew the answer was he was wrong, the idea of talking to a person with a mental illness and finding ways for the person to cope in society has benefited many people.

After World War II we began looking at mental illnesses the same way we did physical illnesses. We started analyzing what physical reactions were taking place in the brain and developed “cures” for the chemical imbalances. This lead to the discovery of some promising drugs from 1950 to 1980. Unfortunately this approach stalled in the 1980s for a number of reasons. First, the chemical imbalances in the brain are only part of what makes a person mentally ill. Second, the amount of chemicals is small so getting the right balance takes years of experimentation to find what drugs work for the individual. Finally, as our medical system went from being a private low profit industry to a private for profit industry, research into drugs that help people that have a hard time keeping a job became the most unprofitable sector for drug makers. Most drug makers are getting out of researching drugs for mental illnesses.

For most people suffering from mental illnesses medical treatment for it is out of reach. The best method we have at this time for treating people with a mental illness is regular sessions of psychotherapy and medication. Naturally people who have trouble holding a job also have trouble paying a $100 or more for a therapy session and $600 to $1,000 a month for medication. So most turn to self medicating themselves with Valium or Marijuana, which for people that are Bi-Polar or Schizophrenic have a lot of the same benefits of the prescription drugs but make them a lot less productive.

What does the future bring?

Since this is Fantastic Future Friday talking about the future might be a good idea. New treatments for mental illnesses are currently stalled as we've gotten the about the point where we can't do much more to help with drugs and psychotherapy. For most people these treatments are like putting a bandaid on a gunshot wound, they help but not enough. To do more we have to examine the genetic component of anti-social mental illnesses. Genetic medicine is at its infancy and genetic research into mental illness is non-existent. Optimistically, Genetic therapy for mental illness will take at least 50 years of research. This amount of research is off the table in a for-profit model. Companies simply don't spend money on a product that they know won't pay for itself in less than a century.

If any thing good is to come out of the shooting in Arizona, we can use it to push for two things:

1)Increase access to mental health treatment.
2)The Government can start funding research into the genetic causes of mental illnesses, this third approach to treating people with mental illness won't show any results for at least half a century and will need another half century of refinement but when it is finally done it will mean that tragedies like Arizona, Columbine, Virginia Tech and a whole list of other events will be relic of our, and our children's, age but not something that our grandchildren will ever have to witness.

It is tough to make a plea for something that won't help the current generation and will take a hundred years to help society but in this case I believe it is worth it.

If we can do this then our grandchildren will live in a world free of random violence that is an evolutionary hold over from when we had a whole world to conquer, and that will give our grandkids a fantastic future.

By Darrell B. Nelson author of Alien Thoughts


Stephanie Barr said...

It is not an easy dilemma nor are having medicines (or not having medicines) the only part of today's problems.

Part of it is being mentally ill can hide the very fact someone needs help from that someone who needs it. It may not be obvious to everyone/anyone on the outside (particularly since many mentally ill people are short on friends).

Even if someone mentally ill needs help (and knows/suspects it), and has access to care, it's still not easy. There's a stigma to it, so people, particularly in jobs where the implication that they're "crazy" can hurt them (or they think it will). My ex, a cop, had textbook depression and paranoid schizephrenia (and also severe hypochondria, but that's less dangerous), but he was afraid to see a psychiatrist because of whether they would take his copness away. Think about that. Because he's licensed to wear a gun, he refused to have his mental health assessed. Don't think he's the only one.

But here's the real kicker. On every other type of disease, people have some say in their treatment. They can choose to not be treated. When it comes to mental health, those choices can be taken away. It's enough to scare a lot of people from being diagnosed. What's more, it begs the question. When is it right to curtail someone's rights? And which ones?

Andrea Yates and her children would undoubtedly have been better off if they had been removed from her care while she was treated. But there might be hundreds of women fighting the same mental illness who pose no threat to their children. Should those children be taken away?

The real problem is,far too often, we don't see how dangerous someone really is until the damage has been done. By that same token, there are problem hundreds if not thousands of people in mental institutions who are no threat to anyone, but have lost control of their lives. I don't want to go back to where we once were, locking away loonies and treating them like animals. But I worry about preserving their rights to "defend themselves" and bear little victims to their insanity.

I don't have the answer. Prevention would really be something. Assuming it's all genetic.

Greg said...

You have said it all, and said it well.

Mental Illness not only is expensive to treat but it carries a stigma with it that in effect is similar to the casting out you so aptly described. You are in effect cast out, and this can lead to an increase in the detrimental thoughts that accompany the illness.

Treatment, and acceptance are simple steps. Informing the public and in many cases the sufferer of simple steps that can alleviate the effects of the illness will help to. Your post goes along way toward achieving this, thank you!

Project Savior said...

It isn't ALL genetic, but genetics does play a large part in bipolar and schizophrenia. As this is researched it will provide better treatments for people suffering from these disorders.
I know too many people who would like to get treatment but because of our current methods it takes over a year to find the right balance of medications to get them feeling "right".
That year of treatment is a living hell as the meds leave them more imbalanced while they need to be tweaked.
Between facing this, the huge cost, and the social stigma most people just self medicate and try to live with it.
Researching the genetic side would lead to less time in exploring the right treatment and lower costs. Which would make for better results meaning less social stigma.
It is a long road that will only show small progress in our lifetimes but the reward for future generations is worth it.