Lauren O @30 said:

I find the attitude that “society went on for multiple millenia without these pills, and did pretty much alright” rather problematic.

Ditto. Mental health medications in particular are the ones which a lot of people appear to regard as “unnecessary”. I’m something of a part-time history geek. I can sum up the attitude to mental health throughout those multiple milennia without pills quite easily: mentally ill people weren’t considered part of society. Instead, they were segregated away from the society they were born into – they were mad, after all. If you were lucky enough to be born into a wealthy family, you might be locked up in a private wing of the house, with just a few attendants to look after you. If you were middle class, it was off to the asylum with you, and nobody spoke of you ever again. If you were poor, it was Bedlam, or the poorhouse, or begging on the streets. If you were really lucky, you could turn your insanity into working in a freak show as some kind of prophet or seer.

Oh, and that doesn’t take into account the ones who were ostensibly part of society, but self-medicated with alcohol, sex, opiates, food, or anything else they could get hold of in order to keep their personal demons down.

Thanks, but no thanks.

“The only people I think need to be on mental medications are people who are an immediate harm to others. Schizophrenics. Various other psychoses. People who are irrevocably nonfunctional, and don’t fit into society because they’re a threat to others.” — Black Thirteen, comment #35

That’s a lovely view. There’s only one smallish problem with it: it doesn’t take into account the following factors –

* Some of the most destructive psychological dysfunctions are personality disorders, such as narcissism, antisocial personality disorder etc, which are not (so far as I’m aware) presently able to be treated, either by medication or by any form of behavioural therapy, alternative medicine, or surgery.
* Your definition of “harm to others” could do with a certain amount of refining. For example, I grew up with two depressed parents, and wound up with depression myself. I spent a lot of my young life being very angry with both of my parents for not being there for me emotionally, and it wasn’t until I got treatment for my own depression that I was able to forgive them for it. (For my own part, I’m taking the Larkin solution to the problem[1].) Were they causing me harm? Well, it depends how you define “harm” – physically I was fine, but emotionally and psychologically I was damaged.
* You also need to define “irrevocably nonfunctional”. Does this mean “unable to beg in the streets”? “Unable to break into houses and steal?” A lot of homeless people are mentally ill. So are a lot of drug addicts. There are a lot of people who are unable to function in society, but who are also not a physical threat to others.

Your overall picture of mental illness appears to be positively mediaeval. I’m surprised you’re not recommending exorcism as an option for the psychotics, just to make sure the demons are gone.

Oh, and just for the record: in the grip of my worst depressive spasms, I would hit myself over the head, cut myself, and attempt to dislocate my fingers and toes. I would scream, yell, cry hysterically, and spend at least three days afterwards completely and thoroughly mentally and emotionally numb, cleaning up the debris. I stressed out my partner, and I probably caused him a lot of hurt emotionally. But I don’t recall ever hurting anyone else physically.

[PS: for anyone who wants a good way of explaining just how damn annoying the whole "cheer up" thing is for someone who's depressed, my analogy of choice is that it's the equivalent of saying "breathe water" to someone who's drowning. Yes, that *will* solve the problem. Good thinking, Poindexter. Now how the blip do I *do* it?]

[1] “… get out early while you can, and don’t have any kids yourself.” (Philip Larkin, “This Be the Verse”)

I was not initially fully fit to make informed decisions about my own health, but with a little bit a treatment I *was* fit to make informed decisions, and then I did. (Obviously, applying this to everyone requires a perfect world with truly benevolent parents. This would be a somewhat less practical if done by an *institution*…)

I totally get what you’re saying, and I’m glad things worked out for you. I think the way things worked for you are a great model of how people who care about someone who is ill should behave. No one threw you into an institution, shoved drugs down your throat, or otherwise negated your ability to make decisions. You were resistant, and others pressured you, but at the end of the day you went to the therapists your parents dragged you to. You chose to take an antidepressant. You might not have liked it, you might have resented the pressure, but at the bottom you still retained your agency.

I agree with the objection to “paternalistic control” on principle, but I’m not sure how much this applies to some forms/degrees of mental illness. For me, a certain amount of outside influence was exerted against my preferences, and it was very beneficial.

(I am *only* going to point out my own experience here, and I am *not* trying to universalize it, ’cause that could go horribly wrong in about a nanosecond. This is just one example of how maybe not everyone is %100 fit *all the time* to decide their own welfare.)

When I was a kid, I descended into depression very gradually over a period of years. By the time I was a teenager, I was full-on clinically depressed but couldn’t tell because it felt normal to me. When my mom told me that there was something wrong, I got angry and didn’t believe her, and could not remember a time when I felt different.

My parents pressured me to go to therapy, which I did very reluctantly. We were advised to try an antidepressant, but I thought it would change my personality or make me artificially happy in a terrible rotten tragic world that wasn’t worth living in. :p I thought that *not* being miserable would be, like, a betrayal of all the people who suffered and died every day. Long story short, I refused to try anything.

My parents kept sending me to different therapists to try and find one that could convince me that I was depressed, and constantly gently pressured me into trying medication. Eventually I *did* try an antidepressant, and it made me a teeny bit better. After improving my condition slightly, I was able to realize that no, my personality hadn’t changed, and no, there was no reason for me to punish myself emotionally for the state of the world, and yes, feeling good was *okay*. I agreed (after the fact) that going on anti-depressants was *exactly* what I’d needed, and from then on I was given full control of what I tried, how long, what my goals were, etc.

To summarize: I was not initially fully fit to make informed decisions about my own health, but with a little bit a treatment I *was* fit to make informed decisions, and then I did. (Obviously, applying this to everyone requires a perfect world with truly benevolent parents. This would be a somewhat less practical if done by an *institution*…)

The whole drugs-as-an-easy-way-out trope pisses me off too. Finding meds that worked was no small task–if this was the easy way out, I can’t imagine the hard way. There’s nothing easy about going through the wringer of praying the new drug will make me feel one iota better, titrating up, dealing with side effects, realizing the new drug is a failure, weaning off, going through more side effects and finding the will to do it again 15+ times over the course of 3 years, and I know plenty of people never get lucky enough to have a psychiatrist that persistent or find a drug that actually works.

(Though I will say, even with my in-defense-of-psych-meds rant, that the best thing for my depression has been dealing with some awful shit in regular ol’ talk therapy. Unfortunately, I was completely incapable of engaging in any sort of useful therapy until I was medicated enough to get out of bed and stop obsessing about death.)

Sure, there are plenty of people who aren’t allowed to make a choice, plenty of people who make a choice and are ignored, but not a whole lot of people who are unable to make a choice.

I fully agree, which is why I originally wrote “not in a position to…”, rather than ‘unable’ or ‘incapable’.

If I misunderstood your intent, I apologize.

It’s fine–no harm done :)

If I misunderstood your intent, I apologize.