Last edited Sat Dec 24, 2011, 02:59 PM - Edit history (2)
from mental illness, or if a later occurrence of mental illness in a formerly mentally ill person should be considered a new and independent illness (as in the way we think about episodes of common cold, or influenza) or if they should always be treated as a relapse.
The main reason for my uncertainty is the psychiatric industry's lack of understanding of mechanisms underlying mental illness. Whether or not there are factors that lead to resistance of mental illness (the equivalent of cellular and humor immunity to non-self biopathogens) is almost completely unknown.
The lack of knowledge about these things is because for decades psychology lacked the tools and understanding to pursue issues of causation and mechanism.
Clinical psychology and the development of clinical treatments was really a matter of treating symptoms. As a scientist, I'd leave open the possibility that just as treating symptoms of TB would leave the TB infection untreated or as resting spores, treating mental health symptoms may not interrupt or eliminate the mechanism of a mental illness.
As an industry they aren't even very certain if the recognized illnesses all deserve that recognition, and as a scientist I must allow that they know nothing of mental illness that's not yet gained diacritical independence and recognition. The concept of mental illnesses as 'brain diseases' and the rise of importance of neurophysiology is pretty new. And the use of the term 'brain disease' vs 'mental illness' actually is helpful in understanding the philosophical school to which care-givers subscribe.
Prima faciae, the population evidence suggests that resolution for many mental illnesses is actually common. Many governments around the world suggest that ~20% of their populations suffer from mental health symptoms (with varying seriousness although depression appears most common around the world) every year. That prevalence number represents a balance between new illnesses being added and old cases being removed from the population some by recovery and some by removal of the ill person from the population. Those same governments suggest that the life-time risk of depression, alone, is about 15-20% (varying somewhat with gender). If people didn't experience resolution of their symptoms from _any_ of the many mental illnesses the cumulative occurrence of mental illness would need to be greater than the 20% prevalence reported.
As a scientist I'm rather more comfortable with the position that psychiatry still doesn't know much about the variability, quality and possibility of recovery from all the different mental illnesses. Prognosis for recovery of many mental illnesses appear good, while the psychiatric industry's understanding of the durability of 'recovery' is not good.
As a scientist the phrase "can never really be cured" as a generalization seems overly simplistic and prematurely certain. As a person with an interest in that definition I'm concerned that such simplicity could facilitate a variety of unwarranted mischief in society.
If you can never be well, you are forever different to the world once you are diagnosed. "Never really be cured" are four easily remembered words that reflect none of the diversity of mental illness, or any possibility of change in the future that could lead to mentally healed persons. Indeed it's a step toward validating stigmatization.
The terms resolution or recovery have multiple roles to play within the MH industry...those words can be chosen to give hope, or to promote the sale of psycho-pharmaceuticals, etc. They have therapeutic, economic, political and social importance.
And they are chosen BY the industry not science. Would we trust bankers, insurance companies, weight-loss diet aid manufacturers, or used car salesmen to make their own rules for customer relations?
If we never get well, there is less hope. Seeking treatment requires some expectation of hopeful outcome.
If the mentally ill never get well we become a cash cow, we can and will be sold drugs and/or therapy sessions indefinitely.
If the mentally ill never get well and are always at risk of recurrence and associated treatment costs, insurers and employers will have actuarial data to discriminate against a once diagnosed person for the rest of their life.
As a patient and a 'scientist', I'm in favor of less certainty, and more yet unknown possibilities.
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