Just What We Need: More Stigmatizing Research

I'm a bipolar who--the last couple years--has not been manic, but have been weighed down by very deep, very long, very destructive depressions which last over 6 months. In addition to 2 mood stabilizers, I also use a light in winter and take Paxil year-round. Twice, my psychiatrist and I have tried to wean me off Paxil, but invariably I sink into depression within a few days of stopping it. 

      This is NOT a placebo effect. I hate taking pills, but know after 25 years of this illness when I must take a specific medication. And my doctor agrees.

   I think the study in England did not account for either a normal placebo effect(found in all meds.) nor for the fact that each depressed person has a different physiology.  Some respond to MAOs, some to anti-psychotics, some to mood stabilizers; some even to light- therapy, exercise, particular vitamins or a change in diet. Some of us are clinically depressed; some patients are depressed because of negative events(like death), and some of us are bipolar and require an anti-depressant temporarily or every day. 

    This English research bothers me:  I KNOW what works or doesn't work for me.  It has taken many years for me to slog through all the treatments and find out what works best. A study which does not consider these personal differences and how unique bodies react to SSRIs is flawed.  To publish it as a factual review of "how treating depression doesn't work" is irresponsible.  When one is depressed, finding the initiative to seek help is almost impossible.  This study is yet another barrier for the exhausted, mentally-ill person to climb over.  Because of this research, even more precious energy must be exerted by those of us who are depressed... .

Dear Sue,

I so enjoy your incisive and sensitive reporting/opinion contributions.  People as dedicated as you are the educators on issues of mental illness.  We can depend upon you for clarity and accuracy and, so, I expect your gracious acceptance for what follows.

Forgive me for offering a little background on dear old St. Augustine.  I come rather directly from that cultural tradition...I'm a Roman Catholic.  During my college years, (I graduated 50 years ago!), I read "The Confessions of St. Augustine."  It was rather slow going, because he lived and wrote before 400 A.D. and his communication might have been great back then but it was a struggle to get through it.  My confrers, (confreras??) in the dorm in the '50's were eager to read all the dirt on a saint, only to be bitterly disappointed by his pious exposition. 

Augustine, at the age of 16, had an affair and an illigitimate child a year later.  He was known for his carousing and womanizing, and in general, he lived according to the cult of the body.  To his mother's dismay, his life-style changed not a wit until he was in his thirties.  Augustine was intellectuallly brilliant and I personally might say he had all the earmarks of a budding bipolar!!

  However, after toying with many philosophies, including Platonism and its "world of ideas", he did a complete about-face, and began fighting heresies in the Church.....the major one, ( I shall try to spell, but after all, I am 71 & not as smart as I used to be) Manicheanism.

His return to the Church was credited to the prayers of his mother, St. Monica (as a mother, I consider her the bigger saint....), and Augustine, rebounded to total renunciation of physical pleasure and lived the life of an intellectual and a monk for the rest of his days until his death at age 72.

Yes, deplorably, in those days, monks and bishops and lowly priests, were encouraged to take "the discipline," which consisted in self-flaggelation and the wearing of hair shirts.

Probably Augustine overdid it because of his strenuous grief over his past behavior.  It happens to the best of us when we cannot accept the evil we do....but we find other ways to accomplish self-punishment.  Some of us shave our heads as we punish our body for our sins of the flesh. 

 Personally, I think Augustine has got a "bum-rap" for something, I think, is just human nature... trying to separate the mind and the body.

  Of course, as the mother of a gay son whose life-style is frowned upon by my Church which, in the part of the country in which I live, prefers to exclude gays from services and activities, I find considerable comfort in dear old Augustine who in his instruction upon true Christianity told his people that the Church on earth can, without losing its holiness, tolerate sinners within its pale for the sake of converting them.  (Okay, so that does sound priggish, but consider his era.)

Somehow, I believe, he would have compassion upon us hapless bipolars and schizophrenics, and would defend us against us against the psychological heresies predominant today.

Please forgive my loquacity....I love your "column"!

This appeared in The Economist. It talks about the analysis of unpublished studies that lead to the conclusion that  AD's are no better than a placebo. But it provides the counter argument that some of those unpublished studies are "shody". At the end, it talks about how suicide rates decrease depending on how often SSRI's are prescribed. The article gives a balanced argument as to the effectiveness of AD's. 

http://www.economist.com/science/displaystory.cfm?story_id=10765331

First, I have been diagnosed with BP disorder for about 6 months now.   It is a blessing (having an explaination) and a curse(stigma).

I have been a hospice nurse for most of my professional career and at least in my practice we have always approached death and dying from a holistic perspective.  I believe that mental illness should also be approached by a holistic perspective.  To manage it either as a physiological problem only allows for the creation of stigma from faulty or poorly done research.  Treating it as an emotional problem ignores the physiologic aspects of the illness.  Denying the spiritual impact that mental illness has on one's soul creates a situation that prevents an individual from being whole and free from spiritual crises (such as guilt, lack of forgiveness, connectedness with a higher power, etc.).  

There will always be bad research out there for John Q. Public to read.  There will always be misrepresentation of findings presented by the press to the public.  The question is how do we empower ourselves to show that the majority of folks with mental illnesses can and do function normally?  I'd love to hear what others think would be good strategies for us to get the support and understanding that is necessary so that we are not stigmatized by bad information.