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Mammon Cultist

Sissyl's page

7,125 posts (7,932 including aliases). No reviews. No lists. No wishlists. 7 aliases.


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Bombs. A physical object that you apparently can't carry more than X of, and there is literally no way for anyone else to use them.

No. Not at all. A severe diabetes does not impair you mentally. Severe depression does. So, the patient wants to go home. You see a serious risk of suicide. He says that everything will be okay... somehow. Do you let him go home?

I was asked what the possible new laws could be about. I gave a number of suggestions. As for making money on new laws, are you saying that hasn't happened?

I'm eagerly awaiting an answer.

Really? He doesn't even want to stay there. His condition brings a serious risk of suicide. So, are you saying he should be locked up without treatment then? Just, you know, wait the six to eighteen months until it has run its course?

MMCJawa wrote:
I am curious what sort of new massive policy change you would expect from this piece at any rate. This story outlines failing of the system that are not likely to be changed by more laws and regulations. I think its more meant to educate people that the problem of sex slaves isn't a third world problem.

Various data storage laws, laws regulating who is responsible for what on the net, laws giving rights of supervision to what people do on the net, laws detailing what is prohibited to view... the list goes on and on. Thing is, new laws do not actually have to be effective for what they were claimed to do. If they make someone money, that is enough, and then it is better if they do not work. Then you can make more laws for the same problem and make more money.

thejeff wrote:

"The story struck the wrong chord with me, so it's obviously a conspiracy."

Apart from the impropriety of pretending to quote someone when you aren't, you still have not given an answer to anything beyond the fact that you think I am paranoid.

When I see something that doesn't add up, whether it doesn't fit with other stuff I know, it contains people doing stuff nobody would do, or it contradicts itself, I know it's either a mistake or intentional. A highly designed article like this one obviously is does not make it reasonable that it's a mistake. So, if it is intentional, why? Well, somebody always does intentional stuff for a reason. You're welcome to show me otherwise, of course, but fact remains, this article reads like the backstory of a smut novella, misses a few very obvious points, and doesn't fit in with the rest of the site. If it's humour, it's pathetically bad. And of course... it is a safe story to publish, because there is no way to check it.

Oh, one more thing: It doesn't feel like something someone lived through because something is off with the passage of time in the story.

I agree with you that it's not poll-tested. If you want to publish a lie, you don't do polls about it first. Duh.

No. "Oh, I am not saying nobody is held against their will and forced into sex. It's just that the story, after reading it, struck the wrong chord with me." and "Again, I did not question the phenomenon, just the story in the 'investigative article'" are pretty clear, I think.

I am saying the story reads like a heavily designed argument to act against the phenomenon, thought up by a think tank, not something that really happened. If someone wants to pull my heartstrings, they should be decent enough to show me something real. This reeks of "how can we maximize the public reaction with her next situation?".

If someone used for this, and get people to buy the veracity of the story, further arguments will come down the line, just in time for something the originators want. We'll see.

Again, I did not question the phenomenon, just the story in the "investigative article". And oh, I am sure it happens here too. That doesn't mean it's okay to make stuff up and call it real. And as I said, seems to have had quite enough impact factor for a number of people here to take the story seriously.

Yeah, yeah. And not one of all those think tanks, lobby groups, institutes and whatnot... not a one among them would EVER invent a story for a specific purpose, would they? Of course not, that's just me being paranoid.

And of course, is not a site that has any visitors anyway, right? Except, I note that it IS rather an odd fit with that story... and there are obviously some people who bought it wholesale.

Don't you get tired of yourself, thejeff?

NG or CE here. Both are great.

Scythia wrote:

If George is on insulin treatment (is there a non-injectable insulin?), as you stated, then he has previously been informed of the risks, consequences, and possible side effects. Therefore giving him additional treatment in the manner you described would be no significant abrogation of his consent, merely an extension.

However, if he has filed official paperwork to declare his opposition to any form of injection, or carries self same on his person (much as a Jehovah's Witness might in regards to blood transfusion), then I absolutely would not use any treatment that included injections. Not only in respect of his wishes, but also because I have no desire to be sued, nor fired from my job for opening the hospital to legal action. In that event, we'll try the gumline glucose gel, and some orange juice. Patients here in the US can be tremendously litigious.

Which is not answering my question. Thing is, while knowing about such paperwork would make things very simple, you don't have that information. All you have is someone in a very dire situation, and you have the cure at hand. As it stands, the person says he doesn't want it. It is very clear that he is not in a mental state where he even understands what he's saying no to.

Treat, or no treat?

Oh, I am not saying nobody is held against their will and forced into sex. It's just that the story, after reading it, struck the wrong chord with me. Going just by the headlines: It works through the internet, the authorities do not help... it sounds like they are building support for some new horrible law for sabotaging the internet. The story seems designed for maximum emotional impact, i.e. it's a female honors student, the only one who could have helped her died, her parents saw her only as an investment, the cops were in on it too... It's a perfect storm of s+#&, wouldn't you agree? And then when they run into the problem of "Well, if this is so utterly pervasive, so completely monstrous, and the people involved have exactly ZERO hope as it is - how the hell did she manage to tell us the story?", they solve it with a copout: The last guy who bought her for some serious amount of money just throws her out because he found her having sex with someone else.


Mark my words, someone wants something serious out of this article, and expect more in the months to come, leading up to some suggestion or other.

Investigative article? I wouldn't be surprised if this was really part of a push to get some new law into place in a while. Thing is, with this kind of articles, people get an exempt from every sort of standard of providing references and such.

Not saying it's not true, of course, and certainly not saying it isn't horrible if it is, just that anyone could have written that for any reason.

Diabetes huh?

George, a well known diabetes sufferer who has several very bad blood sugar drops in his history and is on large doses of insulin but still doesn't have good stability, comes in to the hospital. He is not making sense when he talks, he was found shouting at people on the street, and he's very angry, but doesn't seem to be taking in information at all.

His blood test comes back, and his glucose levels are dangerously low.

What do you, as his emergency ward doctor, do?

a) Hit him with full treatment via injections and infusions, against his will, FAST?
b) Respect his autonomy (he did say he wanted no part of injections) and let him talk to a nurse about further lifestyle changes?

Now, most of you would probably choose a. Why would the fact that another patient is suffering from severe depression instead change this equation, if it does?

Well, there used to be a discussion about endogenous (internally caused) and exogenous (externally caused) depression. The thinking was that this should show up in treatment studies. If there were different causes, and therefore different mechanisms of pathology, this should be clearly visible. To my knowledge, this difference didn't show up at all. Depression is depression, whatever originally might have caused it. When you break it down after the knowledge we have today, the only clear correlation is that it is rather common for the first episode of depression to follow some sort of crisis or stress. With the following such episodes, no such correlation has been found. In all likelihood, then, using the stress-vulnerability model, there is a large part of the population that can react with depression, and will do so more often when put through something bad enough. Typically, this happens in the teenage years. After this, they keep getting depressive episodes where no real triggering cause can be identified. Note that it is far from every case where you can find a likely trigger even the first time.

Another thing worth noting is that for each depressive episode you have had but did not get treatment for, the next episode becomes more likely, comes sooner, gets more severe, and gets harder to treat. Eventually, a certain situation called refractory depression happens (usually when the person is in his/her sixties), where depression is a constant, and more or less impossible to treat. We also know that depression causes loss of neuron dendrites (connections to other neurons), and that at least SSRI can reverse this degeneration to some degree.

If so, Freehold, anyone whose mental illness prevents them from accepting treatment is just f#&#ed. Is that reasonable? Is that what you want for them?

Sometimes you don't have the best option. Then what do you do?

The choice is between forcing people in extremely bad psychiatric condition to treatment which restores their functioning in a matter of weeks, or abandon them to suffer and die on their own.

Forced medication doesn't mean the patient isn't allowed to influence which drug, of course.

Severe depression, as I said, pretty much rules out talk therapy due to inefficiency. CBT has its place in therapy, but that isn't it.

People did recover from depression before antidepressants, of course. The natural (i.e. without treatment) course of a bout of depression is six to eighteen months until you no longer qualify for the diagnosis.

Ebola has a fair way to go before it reaches the Great Killer's numbers (tuberculosis). Cholera and malaria are also pretty massive. Tuberculosis is sort of understandable given the difficulty of treating it, but cholera is a sodding shame. All you need to handle it is clean water, some salt and some sugar.

Every medicine has side effects. The analysis is whether the effects outweigh the side effects. For different people, that comes out differently for different side effects.

Again, I did not say all depressed people were suicidal. I said severe depression. Repeat that as many times as you feel you need to remember it before responding.

Regarding the bad places of authoritarianism, they are the reason there is openness and legal oversight of the process. If that went away, I would agree with you.

Also, what Alex said.

Analdic the cleric... A friend thought this up... Great name, only then he checked alternative meanings...

Orthos wrote:

We didn't finish it the first time, our group fell apart due to various things around The Lightless Depths. There'll be some changes along the way though, incorporating some things from other APs and otherwise changing up some of the earlier chapters to keep the repeat players on their toes.

(Unless this is a commentary on how you don't like the AP, in which case my group and I couldn't disagree more. =) )

That makes it compute, then. I was just thinking of how we spent two years going through MOST of Shackled City, even longer going through Age of Worms in its entirety... I would love to play Savage Tide as well, but the time investment is... frightening.

BigNorseWolf wrote:
In 2010, a paper by Dr. John Reed and Dr. Richard Bentall found that ECT was only minimally more effective than a placebo during the treatment period, and that there was no difference in effect after the treatment period. In light of this finding, and the risk of side-effects, the authors concluded that the use of ECT "cannot be scientifically justified".[7]

It is worth noting here, that this article bases its judgement on the principle that a study must conduct sham ECT treatments on a control group that you can then compare to real ECT, so you can check the treatment against placebo. It then notes, interestingly enough, that since real ECT gives headaches and short term confusion right after the treatment, a difference the patients notice very clearly, that it may be impossible to disguise this difference. What they then do not conclude is that sham ECT is useless as a placebo treatment - and that their own requirement of sham ECT as a placebo is pretty much completely useless. It would be a good thing if people who wrote articles actually read their own arguments first, no?

BigNorseWolf wrote:
Squeakmaan wrote:
People have just seen them portrayed in media as horrible, and since the vast vast majority of people don't know anything at all about it, they assume that representation is accurate.

Now can the veiled insults.

I wouldn't call this an insult, veiled or not, rather a quite accurate representation of reality. The ranks of the antipsychiatric movement are legion, and they have no compunctions about lying in their propaganda, by omission or outright. And since care for the severe psychiatric conditions is a field people feel better if they believe it could never happen to them, their lies find fertile soil in the minds of the public.

Oh, but that's the thing, Scythia. We DO know what effect the treatment will have on them. Nobody is putting anything into action and "hoping for the best". And "treating everyone with a condition as both a danger to themselves and incapable of refusing consent because some with the condition injure themselves": Severe depression is a lethal condition. It kills people through suicide. It is also known to impair people's judgement. It isn't because some of them injure themselves that they are considered incapable of giving consent, but because they are quite literally incapable of making adequate choices. See, they can't see that any change might be for the better. If you talk to them, this inability is quite easy to see. I agree that it's important to talk to people... but nobody would even consider TREATING kidney failure by talking, so why should brain failure at the most serious levels be treatable by talking?

Forcing someone into medication that you're quite sure will work, or at least has a very decent chance of doing so, for a decidedly dangerous condition that is more dangerous the longer you're in in, for a few weeks, to restore the person to a situation where he or she can then participate in other forms of treatment as well, and more importantly, make an informed decision about the treatment, is not unreasonable, horrible, unlikely to work, "trying anything no matter how dangerous or scientifically ungrounded it is and hope that it works", or anything else it has been describe as upthread.

Yes, it is quite possible, indeed even not that difficult, to determine if someone is too depressed to give informed consent.

CBT works, indeed, but not for the situation where someone is too depressed. You would, among other things, have a hard time finding a serious CBT practitioner willing to do that job for you, since there are few studies on the area. Researchers tend to be quite unwilling to risk having patients commit suicide while under their care, imagine that. Once someone is in better shape and not depressed to that level, CBT is great.

Depression IS a neurochemical disorder. Everyone who shows the symptoms has the neurochemistry. At that point, it doesn't matter WHY they became depressed in the first place. And cognitive symptoms are a part of the presentation of depression.

As for ECT, it is THE most studied treatment in psychiatry, given that it's been with us since the thirties. It provides consistent effect and few side effects. What it does is trigger an epileptic seizure in the brain, using the body's OWN mechanisms for the seizure itself. It is no more dangerous than an epileptic seizure, and further, to reduce muscle cramps and pain due to the seizure, you're also given muscle relaxants. There are side effects, but these are minor and temporary. It is quite possible that someone who was given ECT develops Parkinson's disease, just like everyone else runs that risk, and I am not aware of any greater numbers for this among ECT patients. Nor has any kind of brain damage been shown. Sum total: ECT isn't "trying anything no matter how dangerous or scientifically ungrounded it is and hope that it works" either.

First off, a Drizzt movie would be a disastrous concept. Really, truly and horribly so. It is a sad fact that Drizzt is the most well-known character... That is not saying a lot, unfortunately. To make a good D&D movie, you would need characters. The first movie had exciting characters like the evil wizard, the good princess, the lvl 1 wizard, the lvl 1 rogues, the lvl 1 dwarf fighter. Second, you would need a fantasy setting that actually works and can be explained quickly. Third, you need to NOT DO THE DESPICABLE ATTEMPTS AT HUMOUR. The worst, most jarring of these incompetent moments was the ostrich race organizer in Prince of Persia, even going so far as having him complain about government taxation of small enterprise. This shattered the pretty decent work done in the entire rest of the movie for building atmosphere. Worse, they even showed they could manage to do decent in-character humour before that. This third demand, not doing imbecile humour in the movie might be the biggest hurdle. Consider the autobots hiding from the hero's mother while trampling the garden.

So, people should just suck it up and suffer? Or go through psychotherapy they are too ill to participate in? I fail to see your alternative, Scythia.

Still think Charisma needs to go as a stat entirely, along with the sixth of the BP people get to boost it. It would solve such a wondrous amount of problems.

Another very good resource would be the 2nd edition book Forgotten Realms Adventures. After that it depends mostly on what you want to delve into.

Orfamay Quest wrote:
Sissyl wrote:
Orfamay Quest wrote:
Fabius Maximus wrote:

I think you're both wrong. You should treat other people like you want to be treated by them.
So in your world, a masochist should go around randomly assaulting people?
Orfamay: Ahhhh yes, the ancient moronity of an argument against treating people as you would want them to treat you.

I was wondering why 2000 years of philosophical development had passed you all by.

The so-called Golden Rule didn't work then, doesn't work now, and won't work in the future. But it does provide a great excuse for imposing your cultural views on other people and then acting all haughty about how unreasonable people are to want something other than what you want, and how much you're threatened by others being different from yourself.


Orfamay Quest wrote:
Fabius Maximus wrote:

I think you're both wrong. You should treat other people like you want to be treated by them.
So in your world, a masochist should go around randomly assaulting people?

Orfamay: Ahhhh yes, the ancient moronity of an argument against treating people as you would want them to treat you. Seriously, are all your arguments this tired, or is that just unfortunate randomness?

Thank you for the cupcake, ShinHakkaider. However, everyone else in this thread is still disrespecting me and treating me badly since they haven't also given me cupcakes. I am waiting.

Transparency. Accountability.

Orfamay Quest wrote:
Sissyl wrote:
Orfamay Quest wrote:

Treating everyone the same regardless of their social status is just as heinous as giving the same medical treatment to everyone regardless of their state of health.

This is about the best argument against having this kind of discussion at all. Seriously, if treating people the same is STILL racism, it is quite simply not something that can be avoided.
Have you considered treating people the way THEY want to be treated, instead of the way YOU feel they should be treated?

I want you to give me cupcakes. Why am I not getting cupcakes? Do you have something against me?

ShinHakkaider: The discussion was far from civil. Don't pretend.

MrTsFloatinghead: The principles of Rule of Law were in far better force some time ago, this is true. Heard of Habeas Corpus? Right of peaceful assembly? The reasons for these changes are many, but a particularly egregious issue is that Equal before the law got shot down with various demands for a "level playing field". No, I don't think everything was better at some previous point in history - that doesn't change the fact that some things were. Accountability, removal of stupid rubber paragraphs and revised police guidelines should work wonders to improve race relations, wouldn't you think?

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Orfamay Quest wrote:
NobodysHome wrote:
The best I can do is treat you exactly the same as I would treat anyone else. If you demand more, I refuse. Does it make me a racist to refuse to treat someone differently because of their race or gender or whatnot?


Treating everyone the same regardless of their social status is just as heinous as giving the same medical treatment to everyone regardless of their state of health.

This is about the best argument against having this kind of discussion at all. Seriously, if treating people the same is STILL racism, it is quite simply not something that can be avoided.

2 people marked this as a favorite.

This is a very, very sad way of discussing. Starting by saying "you gotta acknowledge collective white privilege to be accepted in this discussion", claiming this is important despite a complete absence of things we as individuals can do to correct it, showing deplorable police policies as examples of this untouchable collectivist power structure (seriously, tear up the police departments enough and you will solve that particular piece of s++!), all of it channeling into "white privilege is the central problem here, but we're not blaming you white guys, just know that the only reason your lives aren't living hell is because of white privilege and don't forget evil white men kept slave m'kay?" It is a collectivistic circle jerk. The way to solve this is to give up the crap about collective identities, ensure Rule of Law is reinstated (this would efficiently kill off all the driving while black offenses, btw), and yes, let us treat each other with empathy. Don't forget, what you're saying above is very close to saying people don't have empathy.


It is also worth mentioning that the much vaunted "level playing field", at least in the area of university applications and affirmative action led directly to asian-americans getting an even worse deal than whites did. Should then the asian-americans be given restitution for this?

Why, there is a lot you could do with them. We really need robot geishas.

The next poster will tell us about a recent encounter with one.

thejeff wrote:
Simon Legrande wrote:
Alex Smith 908 wrote:
thejeff wrote:
Nah, I can do it in my head. It just struck me, that's all.
It's a rather sad thing that the mentally disabled are much more likely to be victimized than the general public, and that when they do lash out it is usually at someone trying to help them.

It's a rather sad standard human nature thing that the mentally disabled those who are different are much more likely to be victimized than the general public those who conform to the standard.

It's human nature, man. Thousands of years of human nature. It's going to take a looooooong time to undo things that have been reinforced by thousands of years of practice.

Well I'd say the sad twist on that is that we then portray the mentally disabled as particularly dangerous, when they are in fact more likely to be victims.

That said, there are some disorders that do make people more dangerous. They are often ones that go undetected and untreated until too late.

Being a victim in no way prevents someone from being dangerous, or vice versa. Our culture is suffused with the myth of the victim, and it is difficult for so many people to accept that being a victim doesn't absolve you from what responsibility you do carry. Thus, various s*@# theories about how it is society's fault because of a crappy childhood that someone robs a bank, etc. Still, if you learn how to act when someone is in a bad state (confusion, mostly), violence becomes something very rare.

Also, the disorders that make someone dangerous are typically personality disorders (antisocial, for example), i.e. A lack of empathy, coupled with poor impulse control.

Sounds like exactly what I expected. I assume the rest of them are the same level of disturbed (because that's supposed to be better TV), only somewhat more socially skilled.

One more thing: All serotonin-acting drugs can have the increased difficulties of achieving sexual release. Note: Not inability. For this reason, they are used to treat premature ejaculation and such problems. As I said, sex usually doesn't function when someone is depressed, so that usually isn't a problem. However, it can certainly become one after the patient has recovered from the depression. If so, all it takes is switching to another drug. See, to reduce the risks of recurring depression, patients are recommended to take the drugs for a few months to a year after improvement. That doesn't mean you need the same drug.

ShadowcatX wrote:
@Sissyl: You know (or should know) that I respect you, but I think you are seriously downplaying the risks associated with medications and forced treatment. Please correct me if I'm wrong on any of the following.

Okay, I will.

ShadowcatX wrote:
Let's talk about depression, Sissyl mentioned the side effects include gaining a pound or two. First, "a pound or two" is possible, but going from a normal, healthy weight to morbidly obese is also possible, and can bring its own serious health (both physical and mental) risks.

For most antidepressants, the weight gain IS a pound or two. SSRIs and SNRIs primarily, being two of the most widely used types, have this pattern. However, there is a different type of antidepressant, called NASSA, or Mirtazapin, that goes with greater weight gain than that. Thing about it is that a) if you are going to gain weight, that will be clear in the first two weeks and you can switch to another drug, b) the last number I saw for that effect was 7%, likely correlated to whether the patient has weight problems as it is, and c) Mirtazapin is a drug that is quite potent and also has a good sedative and anxiolytic effect, so for some patients it is worth it. In particular, people without weight problems and cancer patients usually have very good results. Sum total, it isn't for everyone, but it definitely has a place.

ShadowcatX wrote:
Second, one of the biggest risks in anti-depressants is an increased risk of suicide (usually in the first week or so of treatment) when people are regaining their motivation to act, but their vision is still colored by a lack of hope.

As for suicide risk, that risk is minor compared to the risks of not taking medicine and being depressed for several more months. Not to mention, since it is an effect of gaining willpower before feeling better, the very same risk will happen once the depression starts to improve (usual duration is 6 to 18 months) anyway. So: it is better to know WHEN this risky period happens, so you can deal with it. It is bad practice to just give someone antidepressants and then say Kthxbye. Because of this risk, a doctor should make sure to meet the patient after one to two weeks to check on the situation, and preferably make sure the patient has people around him or her who can help if bad things should happen. If the patient is in a very bad state, admission to the hospital for two weeks or so is a good idea.

ShadowcatX wrote:

But there are treatments far more distressing than being forced into anti-depression medication. Say the anti-depressants don't help (and they don't help everyone), you may get to be graduated to ECT* which has a whole host of permanent side effects including permanent brain damage (which is actually the goal of ECT) and permanent nerve damage.

(Spoiler shown)If you don't know what ECT is, you might know it by its more common name, electric shock therapy, aka. where they strap you to a table, face down so you don't choke on your own vomit, and try and destroy enough of your brain so you're not depressed any more.

If that is what you believe, I understand your feelings about psychiatry. The positive side is that I have some very good news for you.

Electroconvulsive Therapy (ECT) is not what you think. First, let me describe the process. The patient, lying on the back in a bed, without being strapped anywhere, is given a very short-term anaestesia (a few minutes) by an anaesthesiologist. Muscle relaxants are injected. Some gel is applied to one of the patient's temples and to the top of the head. Electrodes are put to the gel, and a special machine sends a series of low-intensity electric pulses through the electrodes. The process takes about a second or so, then this stimulation triggers a seizure in the patient. This lasts for about half a minute to a minute, and due to muscle relaxants only a little muscular contractions can be seen. After this, the patient wakes up, and is under supervision for a while to make sure nothing untoward happens, just like after other anaesthesia.
It does not cause brain damage on any level that has been shown, and for the love of everything that's holy, that has never been its purpose! The truth is, we know it causes a release of signal substances. The point of it is that there is random electric activity in the brain - which is pretty much the most neutral state of our brains. It's a bit like switching off and on a computer. The effects are clear, and given 2-3 times per week, you will have a good antidepressive effect in 3-4 weeks' time. It is particularly suited to the elderly (who often have more side effects than others with medication) and pregnant women (where you don't necessarily want to use drugs). The problems are that a) the effect doesn't last more than 2-3 months, b) there is short term memory loss and c) long term memory loss. However, the memory loss effect has been extensively studied, and the current consensus is that while the period you get ECT will always remain blurry, the long-term memory loss does recover fully. Again, if it were me, I would not mind going through it if there was indication for it.
ShadowcatX wrote:
Also, the process of getting someone declared incompetent against their will (which is what the whole force them into medical treatment relies upon), is neither easy nor cheap (especially if you want it to be done quickly, which if there's serious problems you would want). You'll have a leg up if the person is an immediate relative, but if the person is functioning (which many people with depression and mania are) then you're in for a serious struggle and you're not guaranteed to win, even if you're right.

I am no expert on US legal practices. However, I suspect you're not using the right terminology here. Getting someone declared incompetent is a process where you let someone else assume responsibility for an adult who can't take that responsibility him- or herself. It's something done relating to people with mental retardation of various kinds to help them get a functioning existence. Forced psychiatric treatment is an entirely different process. It is done in acute situations because someone is in a very serious psychiatric condition, it is quicker, and usually legally tried after the fact. As I said, laws like that exist in most of the civilized world. The standard to judge them by is whether they provide an open process, means of having such decisions tried, and what the principles used when giving such care are - not whether they exist.

Answers enough?

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This would be a wonderful idea to watch... if only the participants were not the usual gallery of severe personality disorders. The site certainly seems to confirm they are. Calm, collected people who want to play well with others, who know things, who want more than fifteen minutes of fame... that would be a society-building show to see.

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We all like to think ourselves immortal, invulnerable and utterly sane at all times. We always think that what we perceive is more or less the definition of REALITY. This doesn't really change, to paraphrase one of the greatest thinkers of our time, until you get hit.

One thing that can provide that hit is depression. Slowly, over months, you stop seeing the good things in your life. You can't see that things can go right. You can't make mental pictures of succeeding. You, your close ones, your situation, your economy, your future look bleak, dreary, and unchanging. What you lose is HOPE. People tell you it's not that bad, and you can't see it. People tell you to fight on, and you REALLY CAN'T see the point. You slow down, you start thinking of yourself as a loser, you find it harder and harder to get out of bed. You lose your appetite and you wake up early in the morning with a bad feeling that doesn't relax until late morning. Anxiety mounts and gets harder to deal with.

And if you get medication for it, you can get out of it in around a month, get your entire emotional range back, start seeing light and colour again. Or, you can slog on, running a very real risk of death by suicide. Clinical depressions are dangerous, some studies show them about as dangerous as heart attacks. The medication you get will give you some side effects, like gaining a pound or two, some problems achieving sexual release (not that sex works very well when depressed anyway), dryness of mouth. Simple, right? Remember that depression colours your vision. Given the offer of such drugs, you may well find that you can't see the point. After all, everything is a mess and they aren't going to work, and besides, they have side effects, right? Much better to slog on and hope you can fix things... eventually... some way.

In this situation, yes, it IS a good thing that patients are forced to accept care, including medication. The only other alternative is letting someone take a very serious risk for reasons that are treatable.

Another situation is psychosis. This includes: Mania, where you are far too active, start massive numbers of projects only to lose interest very quickly, tell people a lot of unconsidered stuff (telling your boss what you really think of him might not be the best idea), spending massive amounts of money, being very angry with someone trying to get you help or prevent you from doing what you want, not sleeping, starting relationships you didn't consider, and the like. Paranoia, where you feel threatened unceasingly, isolating you more and more, making you react with fear or anger against the closest people around you. Schizophrenia, where you lose touch with reality, hear your own thoughts as voices, sometimes telling you horrible stuff like telling you to kill yourself, sometimes forcing you to obey odd or dangerous commands, where you can't make sense of things at all, where you could have a tangible sense of impending doom, or feel the people on the TV are talking directly to you. Where you can feel everyone else can read your thoughts, or you can control theirs. And of course, fear and anxiety on a level most people hopefully never have to reach.

All these conditions require pretty strong medication. These drugs certainly aren't much fun, mostly giving sedation, the truth is that they work in two to three weeks. In the case of mania, it takes a week or so to recover fully after that, but patients usually return to normal. Paranoia and other schizophrenia also gets treated well with the drugs, also in a few weeks, but usually the disorder leaves serious traces on the person in other ways - worse the longer they were psychotic. Now, manic patients don't feel they need medication at all, they need everyone to stay out of their way and let them forge ahead. Paranoid patients certainly are not going to accept horrible and threatening drugs. Schizophrenic patients usually can't understand the concept of medication at all. And... if they don't get help, each of these patients will systematically wreck every single corner of their existence: Apartment, relations, economy, health... and run a strong risk of suicide.

Again, they need help. Contrary to what some believe, it is NOT just a matter of being dangerous to others. If you are in a situation where you CAN'T make decisions that are vital to your entire existence, then it's not okay to say "He said he didn't want help, so it's on him". Because it ISN'T on him, since he was not in good enough shape to make those calls.

If I ended up in such a state, my view now is that I would want people to force me into effective treatment. It is the same if it was one of my loved ones. If the choice is between complete ruin for the foreseeable future and being forced to take medicine for a few weeks, that isn't even something a healthy me would hesitate on. If I said no due to my illness, and some moron took that as reason not to help me... if I ever recovered, I would see that person as utterly despicable, incompetent and dangerous. I should also add that when a follow-up study was made in Sweden regarding our forced treatment laws, the vast majority of the people who had been subjected to such care were grateful they had gotten it.

You are not the definition of sanity. We can ALL end up there. Certainly, it would be horrible to subject a healthy person to this - but that isn't what we're talking about.

Mental ailments change who you are. With the right medication, you can correct that, become who you were supposed to be all along. When starting an antidepressant treatment, it is not uncommon for the patient's close ones to be the first to notice the effect. Typically, they say something like "Now I recognize you again."

No one is supposed to be depressed, psychotic or manic. I'll repeat that: No one is supposed to be depressed, psychotic or manic.

Typically, autistic patients are helped by anxiolytics and sedatives to handle anxiety and sleep disorders, and since they do have a higher risk of other psychiatric disorders, many other specific treatments can be useful at various points. However, nobody has yet found any sort of drug that specifically and significantly helps them with their ASD problems.

It is not as if non-drug treatments have not been studied as to efficacy as well. We know by now pretty well which conditions it helps in a significant way. Generally, the more severe psychiatric disorders are not receptive to such treatment, because when you're in that situation, you can't make sense of the therapy anyway.

Yes, indeed, nobody should be forced into medication - so long as their condition doesn't prevent them from understanding such treatment options. A severely paranoid, delirious, psychotic or severely depressed person can't make those calls, and needs society to step in and force him or her to an effective treatment. These sorts of laws exist in most or all countries in the world. I am deeply thankful for them, to be honest - it would be horrible if people who are that ill couldn't get help.

Granted! There are slow-release tissues, chewing gums and even sprays to choose from today.

I wish everyone was a bit smarter.

7 people marked this as a favorite.

Good questions. Let me try to answer this.

What existed before the DSM (and the ICD) was no system at all. Depression was one thing in France and another in the UK. Studies diverged hopelessly since the points measured varied so widely. In short, having a standard for psychiatry is a GOOD thing. Now, if someone in South Africa makes a study about depression, everyone will know that the criteria used were at least roughly comparable. I say roughly, because there are certainly other related issues that have not been solved (such as which rating scales are used).

The making of the DSM is not a secret process. Rather, it is open, widely debated, involving many, many people. Certainly, there is factionalism and people trying to profit, but they are far from alone in writing it. Note also that though the diagnoses are detailed in it, there are no recommendations for treatment there. Most significantly, though, psychiatry is much like foreign aid: Unceasing need and demand, always a lack of supply. Trust me when I tell you that nobody has a serious interest in "making patients". Yes, Big Pharma would love that, but every diagnosis is something a doctor needs to put and then treat. Psychiatric patients typically have the resources to pay for long-term care themselves, and so they only get it if someone helps pay for it. At the end of the day, it is the politicians who decide what psychiatric care looks like, which patient groups to prioritize, and so on. Sum total: Don't worry about too much psychiatry.

This becomes even more clear when you look at the ratio you describe. About half of humanity will have a serious depression in their lives. At any given moment, 8% of us suffer from depression. 10% or so will have substance-abuse problems at some point. 1-5% will be bipolar. 1% will have schizophrenia. Everybody has anxiety every so often, but 10-25% have clinical levels of OCD, panic attacks, generalized anxiety disorder, or such. Add in Alzheimers disease, psychiatric problems associated with other disorders (depression after stroke, for example). Suicides are expected to (or have already) overtaken accidents in various measurements of risk of death, after only cardiovascular disorders. All this points to one serious conclusion: Psychiatric disorders are ALREADY a massive problem that leaves noone or very few people untouched. The sad fact here is that we can't deal with what we have today due to a lack of resources. If people did more than give a collective shrug, the effect would be massive.

Drugs are not what most people think they are. Each psychiatric drug, like all other medical drugs, has been tested for more than a decade in very expensive and thoroughly exhaustive studies. The substances are purified and isolated to lower the risk of side effects. VERY few of them are addictive (Morphine derivates, bensodiazepines and central stimulants, generally). The side effects they do have are at least fairly minor. So... if we have a patient who can't have a functioning life without taking medication (schizophrenia, bipolarity, serious depression at least), why is it wrong to test a drug to see if it helps them? If they don't feel better for it, they will stop taking it. It is not uncommon that someone has to switch to another drug that suits them better. I don't see it as a problem.

Finally, it is worth addressing the principle here. As human knowledge grows and we understand the system better, we will naturally come to see certain traits as expressions of disorders that were not previously identified. Why? Because it gives us a handle on helping those people. It is all well and good to say things like "ADHD is just b#@*~~~* designed to sell medicine" if you and yours do not have that particular problem - but should this be the basis for health care in our society? "Cut out cancer care, it's too expensive, and in my family we always die before sixty in heart attacks anyway", "Alzheimer's disease is a lie, and nobody in my family has ever gotten it, so who cares if there are medications that work?"

Ah. =)

Are you saying ASD is a fairy tale, BNW? Or something else, hopefully?

I liked the "Twice the caffeine" slogan on Jolt cola...

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