Saturday, February 23, 2008

Suicide and War

Just a drive-by post. I'm in the middle of writing a much longer one, but it's taking me a while and I didn't want to go too long without posting.

There has been a fair amount of discussion in the mainstream news media recently about veteran suicides:
Miami Herald story
CBS news story

This really highlights the "environment" vs. "individual biology" question a lot of people struggle with when dealing with mental health issues. I think most people would agree that soldiers aren't predisposed to mental illness, although they may be, as a group, less able to access care (this is especially true of older veterans, as opposed to Iraq or Afghanistan war veterans), which could in turn influence suicide and attempt rates. But I think it's also clear that the experience of conflict can be extremely damaging. (I've written about the psychological stresses of battle - especially the stress of overcoming one's natural revulsion at the thought of killing another human, and the attendant guilt - at my other blog, here.)

Obviously individual differences play a major role here, otherwise many more people would be suicidal. But at the same time, I think it would be foolish to claim that the trauma of war is not causing, at least in part, some of these soldiers' suicides. If we can accept that the environment is systemically producing "mental illness" in these soldiers, why can't we accept that it might be doing so in other circumstances and in less obvious ways?


Saturday, February 2, 2008

On Disease

There's an article by Bruce Levine up at Alternet about Oppositional Defiant Disorder (ODD).

In 1980, the American Psychiatric Association (APA) created oppositional defiant disorder, defining it as "a pattern of negativistic, hostile and defiant behavior." The official symptoms of ODD include "often actively defies or refuses to comply with adult requests or rules" and "often argues with adults." While ODD-diagnosed young people are obnoxious with adults they don't respect, these kids can be a delight with adults they do respect; yet many of them are medicated with psychotropic drugs.

Apparently the diagnostic criteria listed in the DSM-IV-TR are:

• Deliberately annoying people
• Blaming others for own mistakes
• Easily annoyed
• Angry and resentful
• Spiteful or even vengeful

Meeting four out of five of these criteria gets you a diagnosis of ODD.

ODD seems like a perfect example of the way our society pathologizes behavior, especially behavior that we find discomforting. Levine emphasizes the ways in which these behaviors might be a natural response to a negative environment - controlling parents, a school that doesn't meet one's approval or one's needs, etc. He points out that most children diagnosed as ADHD will show no symptoms when engaged in an activity that they've chosen and they enjoy.

While I enthusiastically agree with much of Levine's article, some of the sentiments expressed in the comments disturbed me. I think there is a tendency in this movement to discount the possibility that some people may really be suffering from a disease.

I was raised by a psychologist who is a passionate advocate for mental health parity. I have always believed that mental illness is as "real" as physical illness - as cancer or arthritis or the common cold. I support the expansion of health care to cover the costs of treating mental illness (whether with medication, therapy, or some other treatment) and I hope, as most people do, for a day when it is no longer stigmatized. And I think there are clearly some examples which back up this point of view - Alzheimer's disease, drug addiction, disorders which involve severe psychosis, just to name a few.

So for me, seeing certain behaviors as a disease is something that can be empowering. And while I believe in challenging our conceptions of mental illness - what causes it, how we should treat it, whether we should treat it - I think we run the risk of denying people the right to understand and categorize their own experiences in whatever manner they see fit.

I think this is a conflict where mental health and radical psychology advocates can draw something from other progressive movements. I've noticed, for instance, a strong focus among supporters of GLBTQ rights on letting individuals define themselves and their experiences. There is a deep respect for people's autonomy, for the diversity and the validity of each of their experiences. Another example is abortion rights - forced abortion is just as unacceptable as not having access to abortion. That's why feminists work against laws and conventions which pressure women in one direction or the other. Because when it comes to people's lives, choice is paramount.

What is so disturbing about ODD is not that we are given a person a certain label - it's just a label after all - but that we are using that label to justify treating them in certain ways, frequently against their will. When it comes to labeling children, this is even more troubling, as children are less likely to understand their situation, more likely to internalize the opinions and judgments of others. However, we have to be careful not to go too far in the other direction. We don't want to tell someone they're sick, when they're not. But it's not necessarily our place to tell someone they aren't, if they are.

Hat tip to Laurie Corzett on the RadPsych list.