Monday, June 28, 2010

It's the BEHAVIOR, stupid!

According to an official U. S. government (SAMHSA) website, some people believe that the term "behavioral health" is problematic because: a) it misconstrues the disease nature of mental illness and addictions; b) it implies a choice which a person can change by free will; and/or c) it focuses too much on symptomological behaviors that a person cannot control.

These arguments are presented (by the U. S. government!) as legitimate. But the disease nature of mental illness is quite literally mythical; and if people can't change or control their behavior by exercise of will, I guess we don't even have any basis for law....

There is not one single diagnosis of mental disorder, which can be diagnosed by any method, no matter how much money is available, other than observation of behavior. There is not one single mental disorder which is defined in any terms other than behavior. The "disease nature" of these things is purely a metaphor.

When the most up-to-date textbooks discuss mental disorders, they never fail to point out that all the neuro-chemical and brain theories are precisely theories. The dopamine hypothesis of schizophrenia remains hypothetical. The latest and finest serotonin manipulations still don't don't even beat placebos for effectiveness against depression. The largest pharmaceutical researchers are abandoning searches for cures to mental illnesses. Guess what guys, that's because no "disease nature" can be discovered.

So I think anything other than "behavioral health" certainly misconstrues the non-disease nature of mental illness and addiction. The fact that we control behavior with drugs which neurologically disable miscreants does not change this. Nor does the fact that people sometimes willingly damage their own brains with drugs. And no psychiatrist pretends to cure anything.

As far as abilities to change behavior go, here's a story.

A client of mine (I'll call him Bobby) was found not guilty of first degree murder by reason of insanity, diagnosed with schizophrenia, and committed to Elgin Mental Health Center about fifteen years ago. One of the things everybody noticed about him was that he kept saying he was the King of Egypt. Another thing everybody noticed was that he refused to take psychotropic meds.

When I first spoke to Bobby, he was especially concerned - perhaps obsessed - that I needed to see the official government identification, held for him by the director of the institution, which established that he was King of Egypt.

After a couple monthly staffing meetings, I told Bobby that his treatment team was not likely to stop using this King of Egypt thing against him. I was pretty sure they would continue to say it was a symptom of his psychosis and proof that he shouldn't be released.

I suggested he do one of three things, whichever seemed best to him: a) he could prove conclusively that he was in fact the King of Egypt (his official ID had not been effective for that; but maybe the Egyptian ambassador could vouch for him, or maybe there were other documents proving his lineage); b) he could convince his treatment team that believing he was the King of Egypt did not make him any more likely to be violent in the future, and therefore that what they saw as his delusion was harmless; or c) he could lie about it and tell everybody he no longer believed he was King of Egypt.

Bobby chose to lie, pursuant to option c). Within a year or two, people stopped listing the King of Egypt thing as a symptom in his psychiatric chart. He subsequently was twice granted expanded privileges by the criminal court, and will soon petition for conditional release with the full support of the state institution.

I don't know whether he still believes he's King of Egypt or not. Actually, come to think of it, I don't know whether he ever did believe it. Maybe he was lying to begin with. What I do know is that Bobby's behavior, observed by all the experts as symptomatic of schizophrenia, changed one day, because he decided to change it of his own free will. Nothing else happened, there was no effective medical intervention.

So ... "behavioral health" seems appropriate to me, if it has to be any kind of health to begin with.

1 comment:

  1. I've found that if a person says he agrees with the high opinions mental health professionals hold of themselves and pretends that what they say actually matters, then the patient is well onto the road to better "behavioral health." All a patient has to do is be pleasant and cooperative and watch his non-verbal cues. Of course, psychiatry doesn't want the general public to know that the system's so easy to game so it's going to obfuscate this fact any way it can.