Anatomy of an Epidemic (Part Four)

In his book Anatomy of an Epidemic Robert Whitaker talks about best practices from around the world in treating depression and other mental disorders. One of them is from Finland:

The Turku psychiatrists decide on treatment based on case specific, but most important, they settled on group family therapy – of a particularly collaborative type – as the care treatment. Psychiatrists, psychologists, nurses, and others trained in family therapy all served on two- and three-member “psychosis teams”, which would meet regularly with the patient and his or her family. Decisions about the patient’s treatment were made jointly at those meetings. In those sessions, the therapists did not worry about getting the patient’s psychotic symptoms to abate. Instead, they focused the conversation on the patient’s past successes and achievements, with the thought that this would help strengthen his or her “grip on life”. The hope is that they haven’t lost the idea that they can be like others. The patient might also receive individual psychotherapy to help this process along, and eventually the patients would be encouraged to construct a new “self-narrative” for going forward, the patient imagining a future where he or she was integrated into society, rather than isolated from it.

“With the biological conception of psychosis, you can’t see the past achievements” or the future possibilities.

“I would advise case-specific use (of the drugs)”, Rakkolainen said. “Try without antipsychotics. You can treat them better without medication. They become more interactive, They become themselves”. Added Aaltonen: “If you can postpone mediation, that’s important”.

Psychiatrists and psychologist in Western Lapland have a different conception of psychosis. It doesn’t really fit in either biological or psychological category. They believe that psychosis arises from a very frayed social relationships. ”Psychosis does not live in the head. It lives in the in-between of family members and in-between of people”, Salo explained, “It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she “wears the symptoms” and has the burden to carry them”.

Within 24 hours of a call, a meeting with mental health professional, patient and the family members is held. There must be at least two staff members present at the meeting, and preferably three, and this becomes a “team” that ideally will stay together during the patient’s treatment. Everyone goes to that first meeting aware that they “know nothing”, said nurse Mia Kurtti. The job is to promote an open dialog in which everybody’s thoughts can become known, with the family members (and friends) viewed as co-workers.

From the onset, the therapists strive to give both the patient and family a sense of hope. ”the message that we give is that we can manage the crisis. We have experience that people can get better, and we have trust in this kind of possibility”, Alakare said. It may take time for a patient to recover.

Open dialog therapy had drawn the attention of mental health professionals in other European countries. This approach produced good outcomes, “This really happens, it is not just a theory”.

Why does it work? “We like to know what they (doctors) really think, rather than just have them give us advice”, said the parents of the meetings. My own idea is that they value fair process and being recognized and treated as a special individual who is appreciated not as a crowd.

Natural antidepressants:

In Domestic Medicine, Buchan prescribed this pithy remedy for melancholy: “The patient ought to take as much exercise in the open air as he can bear. A plan of this kind, with a strict attention to diet is a much more rational method of cure than confining the patient within doors, and plying him with medicines”.

Two centuries later, British medical authorities rediscovered the wisdom of Buchan advice. In 2004, the National Institute for health and Clinical Excellence, which acts as an advisory panel to the country’s National Health Service, decided that “antidepressants are not recommended for the initial treatment of mind depression, because the risk-benefit ratio is poor.” Instead, physicians should try non-drug alternative and advise “patients of all ages with mild depression of the benefits of following a structured and supervised exercise program”.

Today more than 20 percent of the GPs in the UK prescribe exercise to depressed patients with some frequency, which is four times the percentage who did in 2004.

A “prescription” for exercise typically provides the patient with twenty-four weeks of treatment. An exercise professional assess the patient’s fitness and develops an appropriate “activity plan” with the patient than given discounted or free access to the collaborating YMCA or gym.

Patients work out on exercise machines, swim, and take carious exercise classes. In addition, many exercise-referral plans provide access to “green gyms”. The outdoor activities may involve group walks, outdoor stretching classes, and volunteer environmental work (managing local woodlands, improving footpaths, creating community gardens, etc.)

Throughout the 6 months of treatment, the exercise professional monitors the patient’s health and progress. Patients have found “exercise-on-description” treatment to be quite helpful. They told the Mental Health Foundation that exercise allowed them to “take control of their recovery” and to stop thinking of themselves as “victims” of a disease.

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