Wednesday, January 21, 2015

Final Literature Review

Mental Illness
Problem Statement
Too many people are being diagnosed and prescribed medication for “mental issues” that may be easier to relieve without medication.
Literature Review Question
What does the literature say about the overprescription of mental illness in America?
Literature Review
An Ever-Growing Epidemic
Mental illness can be defined by The American Heritage Stedman’s Medical Dictionary as any of various disorders characterized chiefly by abnormal behavior or an inability to function socially, including diseases of the mind and personality and certain diseases of the brain. No one really knows much about it, nor do many people know how to deal with it properly. There is a better way to go about the recent increase in mental illness cases that has come to the surface in America. It’s hard trying to figure out if the sudden increase in diagnosis is because of an actual prevalence of mental disorders or because of a fabricated epidemic with such a vague definition like the one shown above. If the increase in diagnosis is because of an actual prevalence, then there are better ways for people to alleviate these diseases without being prescribed numerous amounts of drugs to be taken; if the increase is because of other reasons, then there needs to be ways to prevent people’s lives from being changed forever due to prescription drugs.
According to Roman Espejo (Ed.), there is no medical reasoning for the increase in people that have mental disorders, and there has been no proof that prescriptions for these illnesses even benefit people in the long run. Espejo explains: “If ‘wonder drugs’ like Prozac are really helping people, why has the number of Americans on government disability due to mental illness skyrocketed from 1.25 million in 1987 to over 4 million today?”. There is no reason why that many people have to be on medication and be funded money in order to survive. According to studies published in medical journals, over time, patients with schizophrenia do better off medication than on it (Espejo). Children who take stimulants for ADHD are more likely to suffer from mania and bipolar disorder than those who go unmedicated (Espejo). There is no reason to drug someone who can recover from their mental health problem without the use of prescription drugs. Jon Ronson explains how the misdiagnosis of Bipolar Disorder, specifically in children, is causing them to be prescribed with unnecessary drugs that tend to have adverse side effects. With Bipolar Disorder, it is diagnosed using a checklist that includes normal child behavior which has been made by psychiatrists (Ronson). His main concern is that children whose behaviour only somewhat matches the bipolar checklist get treated with antipsychotic drugs. These drugs calm down children even when they don’t need to be and can have unpleasant and sometimes dangerous side effects (Ronson). Mani Pavuluri fights for the validity of Bipolar Disorder among children and states that it is a serious problem that needs to be talked about rather than something to be whispered about among people. Being a professor of child psychiatry, Pavuluri has seen many cases of children with this disorder and desire for people to understand the seriousness of Bipolar Disorder in children. Once you give a child a label like that, it stays with them the rest of their life. Pavuluri knows that one size does not fit all and that no one description explains every single symptom of Bipolar Disorder that there is (Pavuluri).
Zinnia Jones, drawing from experiences with her ADHD-diagnosed son, insists that ADHD is misdiagnosed in some children but is a real condition with detrimental effects in others. Jones acknowledges both sides of the argument on the diagnosis of ADHD:
A lot of people seem to have the idea that attention deficit hyperactivity disorder is something less than a real condition. Many have claimed that the diagnosis of ADHD pathologizes what's actually normal childhood behavior, or that it's presented as a problem in order to sell a solution in the form of unnecessary medication with unknown long-term effects. Others say that ADHD is real but overdiagnosed, and medication is used where changes to the child's environment would be more appropriate.
Jones is noticing that there is a possibility that children have been inappropriately diagnosed with this disease, but it doesn’t mean that ADHD doesn’t exist in other children. As a mother, Jones was devastated to see her child call himself ‘the worst kid ever’ and say that he wanted to kill himself; he knew he had a problem and wanted to change himself. For Jones and her husband, it was an easy and obvious decision for them to start putting their child on medication. They didn’t feel comfortable continuing to refuse medication that will ultimately make him feel better. That’s what it all boils down to sometimes; will the medication make the patient feel better?
On the other hand, there are mental diseases that have been thought to have the ability to be treated without the use of medication. Tim Calton argues that Schizophrenia, one of the most dreaded of mental illnesses, can be treated without the use of prescription drugs, proving the unnecessary use of antipsychotic drugs for other types of disorders:
There is certainly a wealth of historical evidence supporting a nonmedical approach to madness ranging from Geel, the city in Belgium where the 'mad' lived with local families, receiving support and care that allowed them to function in the 'normal' social world despite the emotional distress some experienced, to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century, which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry.
Studies have shown that people with Schizophrenia have responded better to treatments that put emphasis on respect and interpersonal relationships. This allows them to function in daily life and become more independent while still having people to bond with, and it also shows that there are other ways for people with mental illnesses to recover.
Though there is a lot of research about not using medication at all, sometimes it is of much more benefit if the drugs being prescribed to people are being monitored. The NIMH (National Institute of Mental Health) aims to teach the world about the power of antidepressant drugs and the possible side effects of adolescent use of said drugs. Studies show that antidepressant use has been effective for adults, but may cause suicidal behavior in children and adolescents (NIMH):
In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts—twice the rate of those taking placebo, or sugar pills. In response, the FDA adopted a ‘black box’ label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD. A black-box warning is the most serious type of warning in prescription drug labeling.
Why would you give a child with so much time ahead of them and so much potential to live their life a drug that has a warning on it about the potential suicidal thoughts? There’s no reason to let a label like a mental illness be the deciding factor in whether they have a promising future or not. It has been proven that a combination of medication and psychotherapy is the most effective treatment for adolescents with depression (NIMH). Sometimes making a personalized plan for how you are going to treat the patient helps the most.
People have always been trying to figure out a better way to treat patients that are mentally ill. Eila Sailas and Mark Fenton did an experiment on the idea that seclusion and restraint are a better option than other ways to recover or alleviate symptoms from mental disorders. The research they found goes against what people think sometimes and it validates the use of other methods of recovery. Seclusion and restraint have been used in the past in the treatment and management of violent behavior in the mentally ill. Their research suggests that these methods of recovery tend to reduce or prevent aggression. Though there were definite benefits among people with mild to moderate diseases, these practices are not recommended for those who have serious mental illnesses. The experimenters found that:
No controlled studies exist that evaluate the value of seclusion or restraint in those with serious mental illness. There are reports of serious adverse effects for these techniques in qualitative reviews. Alternative ways of dealing with unwanted or harmful behaviours need to be developed. Continuing use of seclusion or restraint must therefore be questioned from within well-designed and reported randomised trials that are generalisable to routine practice.
It’s hard to have a certain set treatment for everyone because every single case is different. Generalizing is something that needs to stop when it comes to diagnosing people with mental illnesses. The brain is one of the most complex things known to man. It’s nothing like a disability to your legs or heart or spine; all of those are physical things that can be easily seen, explained, and relieved. No one knows how someone else is feeling, because feelings are one of the few things in this world that totally belong to us.
There are definite problems with the treatment and prescribing elements of mental illnesses, but we have to go right to the source of the problem. Ashley Pettus discusses the possibility of mental illnesses being too broad and easily diagnosed; using the definition of “mental illness”, shouldn’t everyone be diagnosed with some sort of mental disorder in their lifetime? Pettus decides to talk about what many people choose not to talk about: the possibility of mental illness being way too easy to “catch”. Not everyone who is different is mentally impaired. A recent survey estimated that nearly half of Americans, in their lifetime, will be diagnosed with a mental illness (Pettus). The real issue is that people are saying that normal forms of mental and emotional distress are diseases, so it’s hard to differentiate a distinct line between the two. "’By medicalizing ordinary unhappiness,’ says professor of psychiatry and medical anthropology Arthur Kleinman, who is also Rabb professor of anthropology, ‘we risk doing a disservice to those people who have severe mental illnesses’". As Ashley Pettus described in her article, though treatments have become better in the last couple of years, there still are no definite ways to prove that someone has a certain illness; clinical tests have still not been able to do so, she says:
Chemical remedies thus play a role in measuring and defining mental disorders. But skeptics warn that if clinicians' mere ability to treat symptoms identifies something as illness, disease categories will continue to expand while doctors' understanding of what they are treating will remain imprecise.
Just because a doctor has the ability to treat symptoms that someone is having, it doesn’t mean that they have a disease. It has been said that milder forms of mood and anxiety disorders have similar symptoms to everyday reactions to life. So are people with mild to moderate anxiety disorders just reacting like everybody else or should everyone be diagnosed and prescribed?
Richard Friedman uncovers the hidden benefits of screening children for mental illnesses earlier in their lives; finding their issues early in life will make for an easier transition into recovering and coping in the future. Friedman argues for the fact that their is an epidemic among children having to do with their mental health; rather than ignoring their feelings, he wants them to talk about their problems. Based on the National Comorbidity Survey, half of adult psychiatric cases—including major depression, anxiety disorders, and substance abuse—start by 14 years of age, and most are very prominent by the age of 25 (Friedman). Friedman argues that catching these illnesses early will be the biggest help with mental illness cases:
But it is not psychiatric morbidity that makes headlines; rather, it is the most extreme consequence of psychiatric illness: suicide. In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age
If children are able to find out about their illnesses earlier then they will have an easier time coping with the symptoms that come along with it. Waiting until the illness gets unbearable to start doing something about it is not the way to deal with these kinds of disorders. Children that have the beginnings of a mental illness and do not treat it, they are more likely to commit suicide, or attempt to commit suicide sometime in their lifetime.
The most shocking thing about mental illness today is the absolute prevalence of it in this country. According to Roman Espejo (Ed.), the prevalence of mental illness in the United States has caused family problems, has cost the state a lot of money, and has resulted in a higher suicide rate in this country. Roman Espejo (Ed.) uses many groups that have to do with mental illnesses like NAMI (National Alliance on Mental Illness), the Crisis Intervention Team, and the Bazelon Center for Mental Health Law and use statistics about the groups in order to argue that there is an extreme prevalence of mentally ill people in the United States:
“I challenge you to find any family, during a family's lifetime, that doesn't have some kind of mental health problem,” Pennartz said. “Not a mental illness maybe but a mental health problem. For example, here in Fort Smith, we had a lot of people laid off from work. To expect them not to be depressed about that is unrealistic. And in some cases, if the depression is prolonged, they may seek out mental health counseling for that."
A recent study by the Bazelon Center for Mental Health Law found that 14.5% of men and 31% of women in jails that they studied had some type of serious mental illness (“Mental Illness”). There are many problems that come along with having a family member that has a mental illness, but worrying about crime and safety is just one of them. In “Mental Illness is Prevalent in America”, it is stated that the average person who is mentally ill probably will not get assistance from law enforcement, because they simply do not know how to deal with it, even though they are supposedly trained on the subject. Besides the lack of safety for the families and themselves, families with mentally ill people have to focus on the financing part of it as well. The Baker family knew that they were going to need help with that:
"We saw real quick we were going to have to take advantage of state funding through Social Security Disability,” Baker said. “He had numerous files and so it was a fight getting him on there. That allows you to take them to different facilities and have them in-house treated. It's about the only way to afford mental illness. Otherwise, you're spending ten grand ($10,000) a month."
Community Mental Health Centers are forced to treat people who can’t pay, but have had no increases in funding during this time when mental illness has been steadily increasing; in fact, some have endured cuts in funding (“Mental Illness”). If there is such a serious prevalence, then why is there little to nothing being done to help with this epidemic?
Without money being funded into mental health centers around the country, there aren’t a lot of options for people that actually need the help. Mental Health America states that patients should have access to any psychiatric drugs that are medically necessary and claims that limiting this access hinders the ability for patients to recover from these disorders. MHA is against policies that restrict access to medically necessary prescriptions and fights for the appropriate procedures for prescribing people with these mental disabilities. Based on the fact that every patient is different and there are various ways to be prescribed, lack of access to medications is a serious problem (“Restricting Medication”). There are a lot of ways to alleviate this problem:
Such strategies—which are premised on open access to all medications approved for the treatment of mental health conditions—include closer scrutiny of utilization data to manage cases of polypharmacy, fraud and abuse; provider education initiatives targeted at high volume prescribers; disease management programs; best practice prescribing edits; and algorithms and other practice standards that promote appropriate prescribing based on clinical data and evidence-based practice.
Though doing this would help people that actually need to be prescribed, it also makes it easier for people who don’t need to be given drugs to be diagnosed and prescribed. This makes it harder to fight for the type of recovery that involves no medication.
There are other ways for people to get help that don’t involve the use of medication at any point. Judith Beck fights for the validity of Cognitive Behavioral Therapy rather than prescribing someone with an array of medications that only hurt them in the end. Being the Director of Cognitive Therapy and Research, Beck proves the idea that evaluating negative thoughts and distorted or dysfunctional thinking is a better option than drugging someone up to make them feel better:
According to Beck, cognitive behavioral therapy is based on the premise that distorted or dysfunctional thinking affects mood or behavior; treatment is designed to teach patients the skills to counter these patterns, evaluate negative thoughts, and solve current problems. She points out that patients with clear-cut issues such as depression and anxiety are ideal candidates for cognitive behavioral therapy.
Cognitive behavioral therapy is based solely on the fact that distorted and unhelpful thinking has a negative impact on the patient’s mood, behavior, and often physiology (Beck). This thinking can be alleviated and resolved through the use of other techniques rather than prescribed medication.
The literature surrounding the epidemic of mental illness in the United States reveals that there is no evidence that it should even be happening. The research points out that there are many more benefits to recovery methods without medication than there is for medication. Of course there have been cases when using drugs to help someone is completely necessary, but in order to get rid of, or limit, the amount of people that are considered “mentally ill” then there has to be a line that we don’t cross when it comes to prescribing people with drugs that are going to change their lives forever. If there is something you can do that doesn’t involve the use of prescription drugs, then that is what research has proven is the best option. The literature states that being prescribed with medication should be Plan B for everyone.
Gap Identification
Once again, the bulk of literature states that there is no reason why there should be an epidemic of mental illness in this country. There are many ways to recover from mental illness that don’t involve medication. Something that my research did not answer is what characterizes someone who has a mental illness. It’s hard for people to know exactly what defines having a mental illness when doctors are prescribing drugs to people who are having natural feelings and actions.  Naturally, this gap in existing research leads one to ponder the following question:
Research Question
What are people’s impressions of the definition of mental illness?
Asking a question that will likely result with qualitative answers makes for more varied responses. This means that people’s opinions will be able to come forth much more than they would with any kind of quantitative questions. Qualitative answers mean that I will most likely not be able to come to any sort of black and white answer like using quantitative data would. The conclusion will most likely be a grey area and will be more of a compromise than a one-sided decision.
Data Collection Process and Instrument/ Sample Population
The idea of mental illness is something that is known everywhere. Because of its omnipresent nature, many schools teach their students about the past and present of mental institutions and the idea of being “crazy”. I decided that the best way for me to get my data was to ask my English class the question: “What defines someone as having a mental illness?”. Using my English class as a sample population was a good idea because I had everyone anonymously answer the question, first of all, but also because it was before the subject was taught in our class. This made for data that wasn’t swayed or influenced by direction in any way.

Data Analysis
Answers from participants varied greatly; some people thought that mental illnesses are a result from lack of development and intelligence while some people simply defined it as having some sort of chemical imbalance. One participant refused to answer in a way:
I do not know what would constitute someone as being mentally ill. I do not believe there is a way to draw a line for who is or is not mentally ill. Normal people can easily have unstable emotions at times, but that does not mean they are mentally ill.
This idea of there not possibly being a way to define having a mental illness did not come up often. Only a couple people really connected the idea of totally sane people having times of emotional strain. Someone else defined it as “not being able to conform to societal norms”. meaning this person would consider any type of rebellious person to be mentally ill. The idea of people being medicated and treated was also all over the place when it came to explaining when people should be medicated. The answers ranged from “people should get help when they hear voices and act on the will of those voices” to “medications should never be necessary”. All in all, answers were all over the place and no two people really agreed with their opinions.
After analyzing all of the responses that I received, there was not a unanimous conclusion whatsoever. With all of the varying answers, it just means that more research needs to be done on this subject. This ignorance towards the subject could easily be from confusion in general on all parts or from people just not being taught about the seriousness about it. This also might mean that the overprescription of mental illness could be from the lack of knowledge on the subject.

Through all of my research I have found that more needs to be done. Not many people are questioning the controversial way that mental illness is handled. This topic affects everyone, and future research needs to focus more closely on the idea of what makes someone “mentally ill”. That’s where most of the confusion lies right now with most people.

Works Cited
Beck, Judith, Michael F. Shaughnessy, and Judy Madewell. "Cognitive Behavioral
Therapy Is a Valuable Treatment." Mental Illness. Ed. Roman Espejo. Detroit:
Greenhaven Press, 2012. Opposing Viewpoints. Rpt. from "An Interview with
Judith Beck About Cognitive Therapy." North American Journal of Psychology
(2009). Opposing Viewpoints in Context. Web. 18 Nov. 2014.
Calton, Tim. "Schizophrenia Can Be Successfully Treated Without Medication." Mental
Illness. Ed. Roman Espejo. Detroit: Greenhaven Press, 2012. Opposing
Viewpoints. Rpt. from "Treating Schizophrenia Without Drugs? There's Good
Evidence for It." Psychminded. 2009. Opposing Viewpoints in Context. Web. 18
Nov. 2014.
Friedman, Richard A. "Mental Health Screenings in Schools Help Children." Mental
Illness. Ed. Roman Espejo. Detroit: Greenhaven Press, 2012. Opposing
Viewpoints. Rpt. from "Uncovering an Epidemic—Screening for Mental Illness in
Teens." New England Journal of Medicine (28 Dec. 2008). Opposing Viewpoints in
Context. Web. 20 Nov. 2014.
Jones, Zinnia. “Attention Deficit/ Hyperactivity Disorder Is a Real Disease.”
Behavioral Disorders. Ed. Roman Espejo. Farmington Hills, MI: Greenhaven Press,
2014. Opposing Viewpoints. Rpt. from “Sometimes ADHD Is Real.” Huffington Post.
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"Medications for Mental Illness Are Overprescribed." Mental Illness. Ed. Roman Espejo.
Detroit: Greenhaven Press, 2012. Opposing Viewpoints. Opposing Viewpoints in
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"Mental Illness Is Prevalent in America." Mental Illness. Ed. Roman Espejo. Detroit:
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National Institute of Mental Health. "Monitored Antidepressant Use Can Help Prevent
Teen Suicide." Teen Suicide. Ed. Christine Watkins. Farmington Hills, MI:
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Children and Adolescents: Information for Parents and Caregivers." 2012.
Opposing Viewpoints in Context. Web. 19 Nov. 2014.
Pavuluri, Mani. "Bipolar Disorder in Children Is a Serious Problem." Behavioral
Disorders. Ed. Roman Espejo. Farmington Hills, MI: Greenhaven Press, 2014.
Opposing Viewpoints. Rpt. from "Yes, Bipolar Disorder Does Occur in Children."
What Works for Bipolar Kids: Help and Hope for Parents. Guilford Press: New
York, 2008. Opposing Viewpoints in Context. Web. 19 Nov. 2014.
Pettus, Ashley. "Mental Illness Is Too Broadly Defined." Mental Health. Ed. Ann Quigley.
Detroit: Greenhaven Press, 2007. Current Controversies. Rpt. from "Psychiatry by
Prescription."Harvard Magazine (July-Aug. 2006). Opposing Viewpoints in
Context. Web. 19 Nov. 2014.
"Restricting Medications for Mental Illness Harms Patients." Mental Illness. Ed. Roman
Espejo. Detroit: Greenhaven Press, 2012. Opposing Viewpoints. Opposing
Viewpoints in Context. Web. 18 Nov. 2014.
Ronson, Jon. "Bipolar Disorder Is Widely Misdiagnosed in Children." Behavioral
Disorders. Ed. Roman Espejo. Farmington Hills, MI: Greenhaven Press, 2014.
Opposing Viewpoints. Rpt. from "Bipolar Kids: Victims of the 'Madness
Industry'?" New Scientist (8 June 2011). Opposing Viewpoints in Context. Web. 18
Nov. 2014.
Sailas, Eila, and Mark Fenton. "Seclusion and restraint for people with serious mental
illnesses." Cochrane Database of Systematic Reviews 2 (2000).

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