Interesting show on Radio Boston yesterday about anti-recovery and ableist views

On Radio Boston yesterday, they talked with Robert Whitaker, who has written a book claiming:

Whitaker says his research which examines for the first time the long-term effects of psychiatric drugs, shows that these medications are often making diseases such as depression and schizophrenia worse, not better. He points to a major increase in the number of people getting federal disability benefits for mental illness who are taking these medications as a sign that the drugs are, in fact, contributing to chronic mental illness in America.

I haven't read the book, and after the show I have to say I'm not terribly interested in reading it -- the viewpoint is interesting, but it's pretty clear that the methodology is quite flawed and the author clearly has an agenda.

I thought the show was pretty decently balanced. They had on a mainstream psychiatrist and took a lot more calls than usual. My guess is that about 75% of the callers talked about how medications had helped them and about 25% raised validly critical points about having been prescribed medications before trying anything else or having difficulties when they inquired about weaning off of meds.

What didn't really get discussed though (and I sent them a couple tweets, but they weren't aired) was that his measures of people doing "better" or "worse" are totally flawed. Whitaker kept discussing how more people being on SSI and/or more people taking medications means that mental illness is "worse."

The mainstream psychiatrist didn't get into much theoretical discussion, since he seemed too busy correcting all the basic misinformation was presenting, namely post hoc fallacies and citing a "study" that involved eight people without a randomly assigned control group. I would have really liked to hear someone point out the premises of the recovery model and shoot down his ableism though. Throughout the hour, he repeatedly pointed to statistics about the increases of people receiving SSI/SSDI for psychiatric disabilities as evidence that medications are causing psychiatric disabilities. He also seemed to use "taking medication" to mean that someone was "doing badly" and "not taking medication" to mean someone was "doing well." There was little to no discussion about symptoms or individual perception of quality of life.

My thinking is that, yes, there's gray area, and there are certainly people for whom medication is not the best treatment, and people who are receiving less-than-optimal treatment. Sure. But what really needs to be looked at is people's quality of life and daily functioning as measures of wellness. Before there was widespread use of SSI/SSDI for people with mental illness, people had to force themselves to make a living rather than deal with their illness. Based on what people who dealt with mental illness in the '60s-'80s have told me, they couldn't try different medications and different types of treatments because of risk of a setback that could jeopardize their job, so they were just steadily miserable and stressed. Or, in many cases, folks worked 9-5 jobs because they had to, but they lost jobs frequently and made an ass of themselves all day at these jobs because they just aren't someone who can handle a full-time job. Yet once it became more accessible and more common to receive SSI/SSDI for mental illness, all of that stress from losing one job after another has vanished and they're able to do productive and meaningful things at their own pace. For many folks, just knowing that they aren't going to lose their housing and income greatly increases their mental health.

Which is "better" mental health -- not being on SSI/SSDI, but burning bridges at a different job every month and feeling miserable and not having time or energy to deal with one's mental health, or having SSI/SSDI that guarantees a roof over one's head and food on the table so that one can pursue part-time self-employment or hobbies or enjoyment of friends and family?


Mr Punch said...

Further doubt is cast on the validity of the argument (isn't it?) by last month's Globe series on SSI, which focused on how the financial incentive distorts diagnosis and drug use.

eeka said...

Interesting. Yeah, and I think that too often it gets put into black-and-white terms, where people staying on it when they could possibly work is seen as outright SSI abuse, or someone who stays on a drug so as not to jeopardize SSI when they might otherwise consider weaning off is viewed as faking the whole thing.

It's of course much more dynamic than this. SSI is designed so that it's hard to get off and back on. Most mental illness and a lot of physical illness comes and goes in waves, but SSI seems to hold the viewpoint of "you worked in March, so why can't you work in April?" It also requires that people go through all the months of applying and being examined every time they're out of work, so their bills are sitting there unpaid, the stress of which is going to make any illness work, and they're going to all these appointments explaining again, possibly to different people, that the same illness is acting up. People would surely be doing more working if they could just be certified as having an illness that comes and goes, and were allowed to just have their regular provider certify that they're back to having pain or paranoia or vision problems or whatnot. Instead, these folks with the transient illnesses are just not working and are collecting SSI for years at a time. Seems to me that this has much more to do with the system than with actual wellness. Hell, many of these folks have great, productive, happy lives, and aren't what anyone would consider "ill," but they're on SSI longterm because they're stuck with it since they might need it periodically.