I once worked with a therapist who would respond to generalities from me by saying, "Pretend I am from Mars and explain please what exactly you mean." Phillip Dawdy's post today --
There was a fascinating exchange of letters in this month's American Journal of Psychiatry concerning just how much depression doctors should accept in their patients and the implications of such decisions. What prompted the initial letter was the federally-funded STAR-D trial, which showed that current depression treatments--including some psychotherapies--are no where near as robust as doctors (and presumably patients) would like. What the trial showed, in short, was that various anti-depressants had anywhere from an 8 percent to 30 percent chance of success in remitting symptoms of depression.
That leaves a large subset of people who do not get relief using current therapies and that raises a host of practical issues for the mental health field. This situation affects millions of Americans.
Dawdy goes on --
I've noted previously how obsessed the psych world is with complete symptom remission in all forms of mental illness and how useless such a goal is for patients.
I would say to the researchers and others obsessed with "complete symptom remission" -- "I'm from Mars. Please explain to me just what you mean when you say "complete remission".
As I wrote in my comment to this post on Dawdy's blog --
It seems to me that one significant problem here is the notion that medications are the solution and by implication, that depression is pretty much purely a medical disease. The whole disease model disposes toward this view.
What would "complete remission" look like? Would that be a state of steady happiness? Would there be normal ups and downs? How would anyone know what complete remission is as there is nothing to measure except via symptom checklist and surely these are greatly influenced by individual perception. Is my "off day" someone else's mild depression? We have no way to know. There is nothing to measure, no tests or indices to measure against so there is just theory.
And what about those people who are Eeyores -- gloomy, kind of depressed looking by virtue of their personality? Should they be medicated into happiness? How? To what end?
And what of the people who move out of depression by working in therapy? Oh right, we don't know about them because we don't study them.
I meant to post a while ago something that came to me after reading an earlier post by Dawdy, about the notion that one never ends having a mental illness, one can only best aim for remission. It occurred to me then that we do not have that kind of thinking about acute physical illness. If I have pneumonia and recover, I am not tagged as having pneumonia in remission.
And physical illness is something I *have* not what I am. Yes, there are exceptions with some chronic illness -- like diabetes, where I could be called a diabetic -- but even then it does not define me. But with a psychiatric diagnosis, the patient becomes the illness. A bi-polar. A depressive. A schizophrenic. Psychiatric diagnosis seems to be less a identification of illness than it is a state of being. And maybe that is why once diagnosed, one is never cured but can only hope for remission. Because the illness, the diagnosis is the person and how does one recover from that?