This Week in Mentalists (103)

TWIM comes a day late this week, as I was busy yesterday.

This week we have post on staying happy as civilization collapses, childhood sexual abuse (warning: possible triggers), the distinction between depression and suffering, psychiatric cartoons and more.

New to my blogroll this week is Peak Oil Blues, dedicated to “exploring emotional reactions to peak oil, climate change and economic collapse.” Fun fun fun. She offers ten tips for staying psychological grounded as Western civilization makes its transition from consumerist playground to Mad Max-style apocalypse.

(2) If you are interested in figuring out who might be a “government agent,” you should ask yourself why that matters to you. Ask yourselves, instead: “Who is fragmenting, creating divisions, spreading hopelessness and distrust?” Then, stay away from those people, not because they are “agents,” but because those people are difficult to be around and work around. They encourage the very feelings and distance that will kill cooperative action for commonly shared goals.

(3) At the same time, welcome the dissenting voice, especially if that person is doing good work that benefits people directly. There is not “one way” to do anything, and people bring alternative creative ideas they feel passionately about. Allow plenty of room for people who “think differently” to still have a voice at the table, and value their contribution, especially if they are willing to work hard for mutual benefit.

(4) Develop a center, a core set of beliefs about the world, after being influenced by a host of conflicting thoughts and belief systems. Try to avoid pushing extreme beliefs that alienate you from people you are closest to emotionally. You can believe whatever you believe about the world, but keep yourself grounded in local actions. Look for common ground, and focus your mutual energies there.

(5) Cultivate a reputation for listening respectfully to the opinions of others. Ask yourself which ones fit most closely to what your own life experience has told you. Don’t try to convert anyone to your way of thinking, or be easily swayed by theirs. Just share your ideas. Remember the line: “A fanatic is someone who won’t change their minds and won’t change the subject.”

Another new addition to my blogroll is Confessions of a Serial Insomniac, who has a candid post on childhood sexual abuse.

As I’ve stated several times before, I think very little about my late childhood and early adolescence, but this brings back a lot. Whilst recognising objectively that I have no reason to feel to blame, I am so horribly ashamed nevertheless.

Ashamed that I flirted with anyone, especially him, ashamed that it was seemingly a catalyst for my fairly early sexual self-explorations, ashamed that I lied and stole at times, ashamed of my aggression (which still hasn’t gone away), ashamed that I ever let any of it happen.

Marine Snow wants to starve, but also doesn’t.

But what has struck me in the past 12 hours is that I want to starve, and I want to return to shopping in the kids section of , but I don’t want to be starving. I want to feel freezing cold and shakey and sick, and all those lovely indicators of a day well spent, a successful day according to The-Anorexic-Charter, but I don’t want the falling over and not being able to get out of bed bit. I don’t want to have to give up work, give up college, lie to people, and hurt them. Just like I want people to notice, but really I don’t. I want people to raise an eyebrow and try and intervene, and talk some sense into me, but only so I can tell them to fuck off and leave me alone. And only in my head where it’s safe and there are no consequences. Because in reality that’d never happen. I’d just get embarrassed and bolt for the door and then beat myself up for a few hours about being a skanky attention seeking screw up. I want the certainty of an eating disorder, the plan, the glory, but without an audience. I’d like to stop playing with fire, but it looks so damn pretty and warms me up. I’d like to have the reason I’m feeling this way, to be because I truly believe that my life would be better if my thighs were not so gelatinous. I’d like to have less insight. I’d like to care less. I’d like to be sick but without the bad bits please.

Made With Awesome discusses the difference between depression and regular suffering.

You don’t have to have Major Depression or an anxiety disorder to suffer. Suffering comes in lots of types and intensity, and just because someone doesn’t have Major Depression doesn’t mean they aren’t suffering or that they are suffering any less. They are just suffering differently. (Okay, maybe there are a few people whose suffering I do want to minimize or dismiss, but they are a special case. These would be the people who feel they are entitled to a blissful existence without a blip of unhappiness.)

Still, it really steams me when people who do not have Major Depression (which I am using here only as an example, any other diagnosis could be substituted) are diagnosed with it or fish around for a diagnosis.

* I do not like it when people do this as a way to one-up each other in terms of “proving” their suffering. I may disagree with the concept of diagnosis, but I recognize that diagnoses exist for a reason and this abuses the concept of diagnosis.
* I do not like it when people are diagnosed with Major Depression, whether they asked for it or not, when they unambiguously do not fit the criteria. This also does violence to the concept of diagnosis. Major Depression is a tricky thing to study because (as I understand it) the studies done on it must operate under the assumption that Major Depression is a discrete thing, that all people with Major Depression have something, other than their symptoms and the “Major Depression” label, in common, even though we haven’t identified it yet. I am not convinced of this assumption, but even so, adding more people to the mix, people who do not even fit the criteria, only confound the already questionable studies of Major Depression. Labeling extra people with Major Depression will water down the diagnosis (which I think is already watered down) and give both professionals and lay people a distorted understanding of Major Depression.
* I do not like that the diagnostic criteria for Major Depression is so wide as to include many normal life situations. Diagnoses are meant to identify pathology. Sometimes, people are sad. This is normal and healthy (and I know that “normal” does not equal “healthy”) in many circumstances. The only life circumstance that the criteria specifically say to make sure you don’t mistake for depression is bereavement, but people can be sad for longer than two weeks for other reasons and still not have a mental illness.
* I do not like it when people take labels of mental illness lightly. Mental illness is serious and having a label of mental illness has serious consequences. No, I do not think mental illness is something to be ashamed of or stigmatized. I’m not saying that I think it is inappropriate to joke about mental illness. But mental illness is not cool. If you do not have a mental illness, it is probably a bad idea to get yourself labeled with one (it can still be a bad idea to get labeled with mental illness even when it is legitimate). Many people have used the insanity plea to get out of jail sentences and regretted it when they succeeded. While most people will not spend years in forensic wards of a mental hospitals because they got themselves labeled with a mental illness they didn’t have, they still may face unpleasant consequences as a result.

Obsessively Compulsively Yours discusses acceptance.

I have OCD. It isn’t fair, and yet it is not unfair – tiny flaws in the biochemistry of my brain means that I live with a chronic and debiliating condition.

Change cannot happen without acceptance – I cannot recover without first accepting that I was ill in the first place. Perhaps I am not a sick, homicidal maniac just about to break free of my inhibitions and kill everyone in sight, perhaps I am poorly. Perhaps I am not responsible for everything that surrounds me, blessed with a God like power, perhaps I just have a disorder that means that sometimes I have a hard time working out that my presence and actions have a limited effect.

I suppose that at the end of the day this elusive acceptance means coming to terms with the fact that this world is not perfect and nor am I, that I must live in the present rather than ruminating over the past and worrying about the future. Instead of using all my physical and mental energy to control the uncontrollable it is time for me to make some goals, to start the hard and long journey to the new, OCD free me.

It is not that I am not up for a challenge and my competitive spirit is itching to get out, to attack the progress charts that are lurking inside my computer, it is just that there is this tricky acceptance thing in the way.

A quick trip to the cartoon blogs, here’s My Medicated Cartoon Life…

…and Prozacville, the world of walking, talking Prozac pills.

Neuroskeptic notices a rather bizarre trend. Rates of depression are going down, but antidepressant prescribing is going up.

The change doesn’t look like much, but remember that even a small change in the number of long-term users translates into a large effect on the total number of sales, because each long-term user takes a lot of pills. The authors conclude

Antidepressant prescribing nearly doubled during the study period—the average number of prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004. … the rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment.

Wow. I didn’t see that coming, I’ll admit. A lot of people, myself included, had assumed that rising antidepressant use was caused by people becoming more willing to seek treatment for depression. Or maybe that doctors were becoming more eager to prescribe drugs. Others believed that rates of clinical depression were rising.

There’s no evidence for either of these theories in this British data-set. The recent fall in clinical depression diagnoses, following an increase in young people over the course of the 1990s, is especially surprising. This conflicts with the only British population survey of mental health, the APMS. The APMS found that rates of depression and mixed anxiety/depression increased between 1993 and 2000 in most age groups but least of all in the young, and little change 2000 to 2007. I trust this new data more, because population surveys almost certainly overestimate mental illness.

How does this result compare to elsewhere? In the USA, the average number of antidepressant prescriptions per patient per year rose from “5.60 in 1996 to 6.93 in 2005″ according to a recent estimate. In this study yearly “prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004.” So there’s a major trans-Atlantic difference. In Britain, the length of use increased greatly, while in the US it only rose slightly, but from a higher baseline.

Finally, why has this happened? We can only speculate. Maybe doctors have become more keen on long-term treatment to prevent depressive relapse. Or maybe users have become more willing to take antidepressants long-term. Modern drugs generally have milder side effects than older ones, so this makes sense, although some people would say that this is just further proof that modern antidepressants are “addictive”…