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It’s just nerves

10/02/2015

The tendency [is] always strong to believe that whatever receives a name must be an entity or being, having an independent existence of its own.
– John Stuart Mill

It is almost a standard joke that psychiatry has pejorative or “put-down” words for every human emotion, as “euphoric” for happy, “fixated” for interested, and “compulsive” for determined.
– Alan Watts

In the midst of the serene world of mental illness, modern man no longer communicates with the madman… There is no common language: or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence. – Michel Foucault

When I was a kid in the 60s people didn’t have mental illnesses. They had nerves.

There were fully fledged loonies about of course, though I never actually saw one. Mostly they were kept locked away. Except for the ones featured in newspapers and horror movies. We’d all heard stories of what happens to people whose cars break down near an asylum.

But the people who screamed or ranted or behaved unpredictably from time to time without attacking you with an axe weren’t crazy. They had problems with their nerves. If things got really bad they might have a nervous breakdown and have to go into hospital for a while.

So when old Benny shouted incoherently for hours or became completely withdrawn, fashioning models of  native wildlife from cigarette foil as he’d done in the camps, it was his nerves from the war.

When Miss Smith went on a sudden corporal punishment binge, caning up to half her class of six year olds in a day and screaming at the rest, it was her nerves.

Mrs Hanbury took too much medicine and got her stomach pumped because she had bad nerves.

Mr Whelan sometimes closed all his doors and curtains and stayed inside for weeks because of nerves from when his wife died.

And when the bruises on my classmates or their mothers didn’t match the stories they told about them it was because the man of the house suffered from nerves.

Like I said, there was no mental illness when I was a kid. A few crack-pots. Some retards. The odd spastic. And lots of people with nerves.

I don’t know how many of them were getting treated for their nerves. Bex and benzos were popular back then. I expect most of it was due to nerves.

The accepted wisdom was that people with nerves were pretty much the same as everyone else except when they had an attack of nerves. In some cases the attacks supposedly had known triggers – dietary, behavioral, conversational … – that needed to be avoided. But mostly you treated people with nerves pretty much like you treated everyone. Nerves weren’t stigmatising like craziness. We all recognised they could happen to anyone. Mind you, people with nerves could be a pain in the neck so it was understandable if you avoided them when their nerves were acting up.

In Crazy Like Us, Ethan Watters says Mexican American Californians often use the term Nervios to refer to a wide range of emotional and behavioral disturbances that their Anglo American counterparts would describe as anything from a vague disquiet to full blown schizophrenia. The term apparently makes it easier for non-professional family carers to offer support than would a more technical, pathologizing word from the DSM. And by treating the behaviors as what they are rather than as symptoms of some underlying disease it decouples the patient’s identity from the illness and makes them better able to participate in the community according to their capabilities. According to researcher Janis Hunter Jenkins, the nervios person is seen as just like everyone else, only more so. Jenkins also found that such families have lower levels of expressed emotion directed towards the patient who in turn has a better prognosis for prolonged or complete recovery.

Maybe there’s no need to try to force all human deviance into the slots provided by the Diagnostic and Statistical Manual. Maybe it’s time psychiatry gave up its efforts to sew the world a straitjacket and trim us all to fit. Maybe if we admit to ourselves that we all know as much about madness and how to respond to it as the ‘experts’ we can  take back responsibility for it in ourselves and in others. And maybe we’ll stop putting medicalised labels between ourselves and our fellow human beings.

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From → DSM

34 Comments
  1. There are many forms of mental illness that are very real and cause great harm and dysfunction for the people who suffer from them. They are not well understood, but there are treatments and interventions that help patients to live close to normal lives. We would never say that a person suffering from cancer just had bad cells and leave it at that. I do not agree that we should find one generalized term for a multitude of actual physical ailments, the brain is after all inseparable from the body like teeth or lungs, so any malfunction of the brain is just as much a disease as cancer or arthritis. We need to have scientist working on these problems not pigeon holing them into nicely packaged terms that discount the suffering of individuals suffering from these disorders. I agree that we need to reduce the stigma society places on sufferers so that people can discuss and actively deal with their disease in constructive ways that improve functionality. Simply labeling and ignoring disease is not a way to effective way to treat it. I do agree that the DSM is often wrong about its labeling, but at this point it is the only way some people actually get help for their condition. The answer to that is to make sure science is scientific and not driven by popular opinion or religious belief as with the labeling of homosexuality as a mental disorder. Just because scientist sometimes get things wrong does not mean doing nothing is better. The most important thing to remember is that all behavior has a physical component that originates in the body. We may not understand how to treat these malfunctions effectively at this point, but mental health is the same as physical health and should be studied and treated as seriously as measles or ebola.

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    • There are many forms of human suffering that are real and cause great harm, but whether you call them specific illnesses or not is a question that has implications for stigma, diagnosis, treatment and prognosis. Humans have an unfortunate tendency to reify labels, metaphors, concepts and abstractions.

      An example is what some people call melancholia, despair, grief or sadness but which we are now all encouraged to call ‘depression’. All ‘depression’ means – according to DSM – is that a doctor has determined that you more or less fit at least five of nine diagnostic criteria. It says nothing about cause and very little about treatment that is appropriate.

      As almost everyone who isn’t a psychiatrist knows, depression can be caused by any of lots of things. Physical problems, trauma, grief, personal loss, life stressors, drugs, etc. It’s even possible it can be caused by genes or chemical imbalance in the brain, though the evidence for that is slim to non-existent. And obviously the best treatment will vary according to the cause and the circumstances of the patient. Simply calling the problem depression doesn’t mean it will be cured by pills you’ve decided to call ‘anti-depressants’.

      So why do we call depression an illness?

      We don’t have an illness called ‘flu like symptoms’, though they are a very common form of suffering. We use the presence of flu like symptoms as a starting point for diagnosing the underlying cause then we treat it. Any doctor who just sought to suppress the symptoms without looking any further would be rightly seen as a quack and many of his patients would end up with persistent suffering that is just added to by the side-effects of his attempts to block the symptoms. Which is exactly what we see with mental health care, except psychiatrists aren’t recognised as quacks for some reason.

      The answer to that is to make sure science is scientific and not driven by popular opinion or religious belief

      Agreed. But the history of mental health ‘sciences’ has been remarkably lacking in science and is instead driven by fads in both diagnosis and treatment. A century ago vast numbers of western women were diagnosed with ‘hysteria’ – a disease which no longer seems to exist. Neurasthenia was also a very common diagnosis once – and is probably the reason ‘nerves’ was used as a euphemism when I was a kid – but it no longer exists in the DSM (though the ICD retains it).

      Despite announcements to the contrary every few months, there has never been a physiological test that can be used to confirm the existence of a mental illness and the symptomatic diagnoses used often result in different ‘diseases’ depending on which doctor you go to.

      I would argue that psychiatry is a religious belief. Look at all the people who hold tight to the serotonin theory of depression or the dopamine theory of psychosis despite the fact there is no more evidence for them than that Jesus could walk on water. And look at how much morality and assumptions about appropriate social behavior is built into psychiatric nosology.

      The DSM is decided by a committee of ‘elders’ in much the same way the Bible was decided on by the Council of Nicaea. Homosexuality wasn’t removed (or included) because of any scientific discovery. It was the morality and social conventions of the psychiatrists that made it a disease and it was lobbying of those psychiatrists by Robert Spitzer and others that made it a non-disease. All the so called ‘mental illnesses’ are determined the same way.

      Just because scientist sometimes get things wrong does not mean doing nothing is better.

      That can be a very dangerous attitude to have, especially in regard to medical intervention.

      In the west – with all it’s ‘science’ – people who develop psychotic illness do much worse in the medium to long term than people in third world countries that don’t have access to the ‘science’ of psychiatrists. That seems to be an argument that in some cases at least it is better to do nothing.

      If you look at the history of often barbaric and frequently fatal psychiatric therapies you can easily see it would have been better to do nothing than subject patients to beating, wet sheet therapy, deep sleep therapy, ‘recovered memory’ therapies, crippling drug therapies, ill-advised psycho-surgery, etc. But every generation of psychiatrists say they are different and are now ‘scientifically enlightened’. They don’t do that sort of barbaric stuff anymore. Until the fad moves on – often due to scandalous death and injury rates – then the current treatments are declared barbaric and we are presented with a new set with no better basis in science than the last one. I predict that within a decade or so the mass psychiatric medication of children that has sprung up over the past 20 years with little or no understanding of the long term implications for developing brains will also be looked back on as barbaric.

      Mental health professionals are still handing out SSRIs to teenagers and providing critical incident debriefings to trauma survivors despite solid scientific evidence that those treatments are likely to make things worse. It would be better to do nothing.

      The truth is, the emperors have no clothes.

      Yep, psychiatrists know more about psychiatry than most people – just like theologians know more about theology – but whether that knowledge has any connection to real world medicine is an open question.

      If you’re talking harm, dysfunction and suffering, psychiatrists know no more than anyone else. We have all experienced those things in ourselves and seen it in others for all our lives and have taken a close interest in what might relieve them. I don’t believe four years of indoctrination into a largely evidence-free system of belief makes psychiatrists any more knowledgeable than the rest of us and in fact a lot of that doctrine is about ‘unlearning’ the folk wisdom we have all picked up for dealing with such problems. And the main piece of wisdom is that people with unrelieved suffering (which includes everyone) need support from those who know and care about them. Not someone with a white coat and a faith-based book of symptoms who will slap on a label that separates them from their community.

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    • For Fox Sake permalink

      “The answer to that is to make sure science is scientific and not driven by popular opinion or religious belief as with the labeling of homosexuality as a mental disorder”

      There is an awful lot of moralizing in the current diagnostic manuals. Why is ‘excessive sexual activity’ listed as symptom and mostly applied to females presenting with psychological
      distress?

      Take a slut-walk through the DSM-5 with a highlight pen and make yourself an
      aluminium foil chastity belt. Might get a better reception from the aliens than the hat!

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      • For Fox Sake permalink

        Neurasthenia was the macho term for hysteria in men. Specifically, males
        who had developed shell-shock or ‘Soldier’s Heart’ as it was called in
        WWI; now better known as PTSD. The chaps used to get a bullet in the
        back of the head as one of the treatment options. They didn’t have
        ‘nerves’ – they were considered cowards and shirking their duties.

        Work-shy would be the term used by the DHS.

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        • Neurasthenia was actually one of the first attempts at biopsychiatric diagnoses (it posits ‘worn out nerves’ as the physiological basis of illness). I think it pre-dates hysteria (don’t quote me on that) and it’s not gender specific. Mary Baker Eddy was a lifelong sufferer and was practically disabled with it when she first met Phineas Quimby and the New Thought movement was born (as Damian Lovelock would say “Thank you America”).

          I wonder when the DHS will be authorised to shoot deserters from work.

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      • Psychiatry has never been scientific and so piggy-backs on religious, political and economic power bases for it’s authority. So mainstream morality has always been an important component.

        IMHO one of the worst things about it’s current manifestation is the way it supports authoritarianism within families.

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        • For Fox Sake permalink

          New Thought. Now wasn’t that a fantastic delusion of grandiose proportions.
          Every one knows there has not been one original ‘new’ thought on this
          planet since some technician in Atlantis said, “Hey, what does this button
          do?”

          Liked by 1 person

        • I wish New Thought was a delusion. Unfortunately it still is a delusion, albeit under a thousand different labels from ‘positive thinking’ to ‘prosperity gospel’ to ‘life coaching’ to practically everything that comes out of Oprah Winfrey’s mouth.

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        • For Fox Sake permalink

          From the post you had prepared earlier:

          …. the Nazi T4 Project, in which psychiatrists emptied the asylums of Germany by sending those who could labour to camps where they were worked to death and executing those who couldn’t, usually with lethal gas…

          That is now called sTream-4 by Australian employment service providers. The reference
          is lost, though, on the baby-faced case managers who are entirely oblivious to the fact
          that are appendages to the Department of Dehumanizing Services.

          Can I have my cyanide capsule now. Please. Pretty please. Pretty please
          with sugar on top.

          On second thoughts, hold the sugar. I need to test my blood-sugar levels first
          by pricking my finger on a spindle.

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      • I agree. Having a lot of sex is not a problem if it healthy and not messing up the rest of your life, and definitely not more unhealthy for women than men. Excessive is a subjective and relative description. It could mean once to some people if it is with the “wrong” people or done the “wrong” way.

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  2. any malfunction of the brain is just as much a disease as cancer or arthritis

    Here you are accepting without question that ‘mental illness’ is both a ‘malfunction’ and ‘of the brain’.

    Flu like symptoms are pretty unpleasant but they are generally not a malfunction (though they can be). They are usually the adaptive response of the body to some kind of insult – i.e. the immune system acting to minimise damage and initiate repairs. It seems more than possible to me that many of the symptom clusters that define mental illnesses are the psycho-social equivalents of immune responses. A way of escaping from or alleviating an intolerable situation until normal repair and rejuvenation mechanisms have had a chance to deal with it.

    The notion that mental illness is in your brain is pretty arbitrary. Of course it’s possible to adopt a worldview whereby everything is in your brain and that completely changing your life is just a matter of changing how you think. Many new age self-help courses are based on that premise. But when I cry over my dead 4yo nephew it’s not because my brain is malfunctioning or because I suffer an inadequacy of serotonin. It’s because my nephew died. When an overworked company executive suffers frequent bouts of lethargy and despair it’s not because his brain is no good, it’s because his job is no good. When someone with chronic pain feels that life is no longer worth living it’s not because her brain is kaput it’s because she is in constant pain. When a child abuse victim keeps self harming it’s not because her brain is to blame. The person who abused her is.

    Everyone already knows these things, but put them on the opposite side of a desk from an MD blathering about synapses and serotonin and all of that knowledge goes straight out the window. I’d imagine that a few centuries ago people were just as easily bamboozled by authoritative churchmen telling them it was all due to demons. The only thing that’s changed is the language and uniforms of the ‘experts’.

    Drug companies would love us to believe that mental illnesses are like cancer or arthritis (or, especially, diabetes). That there are well understood aetiologies, specific and definitive diagnoses and (more or less) effective therapies. The problem is that none of that is true and deep down we all know it.

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  3. Hear! Hear!

    I read Crazy Like Us a few years ago and first comes the psychiatry and next the
    one-size-fits-all silver spandex jumpsuits!

    Who decides the parameters of malfunction…surely not elite Victorian-era Austrian
    bearers of testicles!

    It is psychic air-brushing to lump mental perturbations in with diabetes, for example. I met an
    American woman once who stigmatized herself over a diagnosis of mature onset
    diabetes, because it had been associated as being ‘no different’ to a mental illness!

    “”In the United States, the initial stimulus for developing a classification of mental disorders was the need to collect statistical information. What might be considered the first official attempt to gather information about mental health in the United States was the recording of the frequency of “idiocy/insanity” in the 1840 census. By the 1880 census, seven categories of mental health were distinguished: mania, melancholia, monomania, paresis, dementia, dipsomania, and
    epilepsy.””

    Quote source: http://www.psychiatry.org/practice/dsm/dsm-history-of-the-manual

    I have heard that in Australia, the preferred manual is the ICD so it may be a good start,
    cabrogal, to not reference the DSM any further and de-louse your blog from all that
    white American elitist tricky-dicky glom rattling around near your hippocampus and amygdala.

    We have to retrieve our human-ness from the zealotry of the apothecaries who cannot
    tell the difference from a fungi and mummified sheep poo. Which, curiously, has the same spherical dimensions of first generation anti-psychotics.

    Unfortunately I notice these small things. Details. Devil.

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    • I think you’ll find DSM is the bible here too (rather than ICD).

      Certainly the Medicare item numbers are based on DSM rather than ICD diagnoses, which is one reason autism and bipolar II rates took off here at the same time as in the US (I had the foresight to be diagnosed early and avoided the rush).

      That may change soon however. DSM-V hasn’t been well received by mental health professionals and there’s increasing questions about why the world needs two standards. As well as only reflecting the opinion of one national body (the APA) rather than a notionally more democratic international one (WHO) the DSM is becoming increasingly expensive, with sales providing over 10% of the APA’s income. ICD is free to download and much cheaper than DSM in hardcopy.

      Like

      • For Fox Sake permalink

        I noticed that the psychiatrists who gave expert medico-legal consultations for
        individuals seeking compensation from the TAC, Dept of Defence, etc, or were
        making claims for disability pension, were required to reference the DSM-IV for
        the paper-work. That was 2003.

        I had forgotten about that. Now I am depressed. Time to self-medicate with
        a pizza and half-tub of chocolate gelato.

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        • Your condition seems serious. Better go for chili-chocolate gelato (gelato forte).

          Like

  4. For Fox Sake permalink

    Help!! I can’t decide: 100s & 1000s, chopped nuts or chocolate sprinkles?

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    • Try one and if that doesn’t work switch to another. Then another. Then another …

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    • Oh, and better grab some chinotto to counter the side-effects of the pizza.

      (Warning: Psychiatric medication can result in weight gain).

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      • For Fox Sake permalink

        Which is why SANE needs to lobby for clothing allowances!

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        • Don’t invoke SANE after talking about chopped nuts. They’re very sensitive to stigmatisation you know.

          It’s necessary to lobby loudly for stronger involuntary commitment laws because, you know, individuals suffering from mental illness are a danger to themselves and others. But if you call your shampoo ‘Headcase’ mental health consumers (brain eaters?) will be spat upon in the streets.

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  5. For Fox Sake permalink

    It is said that individuals who believe they are Jesus Christ receive a diagnosis
    of grandiose delusions, bipolar or schizophrenia. Call me crazy but if
    christianity were eradicated from this planet, would that constitute a miracle cure
    for all the grandiose-slash-bipolar-slash-schizophrenics?

    What about the atheist grandiose/bipolar/schizophrenics….don’t they get a
    messiah complex too? Could that be why Paganism is on the upswing…

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    • Secular loons are given the option of believing they’re Napoleon Bonaparte. Psychiatry doesn’t discriminate on the basis of religion. Every child gets a prize.

      Did you ever see The Ruling Class?
      I especially like the scene where the Old Testament God and the New Testament God meet in an asylum.

      “Where is the saviour all the critics speak about now?
      He’s telling jokes to all the saviours in the ward.” – from ‘Is is now’ by Midnight Oil.

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      • For Fox Sake permalink

        Vague memory of seeing The Ruling Class yonks ago. Not a big fan
        of Peter O’Toole, he’s so up himself.

        If I said I was Lawrence of Arabia, I could wear a tea-towel on
        my head and shout “No prisoners! No prisoners!”.

        I had been planning to say that I was a French bath-house attendant by
        the name of Charlotte Corday although I think that who they shot
        outside of Hungry Jacks the other day.

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        • The only other O’Toole movie I ever saw was The Day of the Jackal (though I did see the Naked Vicar skit Bruce of Arabia). IMHO O’Toole is superb in The Ruling Class. Maybe it was type casting.

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        • I think that who they shot outside of Hungry Jacks the other day.

          The police had to shoot her. She might have killed herself otherwise.

          There seem to be some demarcation issues between police and non-unionised violent psychotics.

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        • For Fox Sake permalink

          She was only on her way to audition for Iron Chef.

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    • I wonder if it’s occurred to any Christians that maybe Jesus has already returned and is currently in a locked ward being crucified with olanzapine.

      Like

      • For Fox Sake permalink

        I like to think that Jesus has wised up and learned to not place himself at risk
        by coming back to this planet. I simply cannot believe in a messiah who
        is slow on the reuptake.

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  6. Our psychiatrist does not use labels when treating our son. We frame his treatment as him growing up, gaining impulse control and insight, taking more control of caring for his own mental health as he is now an adolescent. Honestly, I do not know what primary diagnosis is right now, and I feel comfortable with that. It shows my son that we have confidence in him. We discuss symptoms, behavior, thoughts, and my son will be going back to therapy next week where he can do work that will hopefully help him. My son’s adolescent brain is still changing. It has changed considerably since he was a four year old first brought to a child psychologist due to behavioral problems at preschool. He, too, remains uniquely sensitive to both internal and external stimuli. The kid is gifted.

    I, though, wear bipolar as part of my identity. I own crazy. I treat it for my own and my family’s sake, but I feel no shame.

    Like

    • Sounds like you found yourself a pretty good p-doc there.

      It’s only common sense of course. If there was really some kind of fixed line between bipolar and ‘normal’ the DSM committee wouldn’t keep changing it. So any progress isn’t about ‘cures’ – acquiring and losing labels – it’s about developing and adjusting.

      But how come you got a type 2 diagnosis?
      Surely your mania and psychotic breaks qualify you for Numero Uno.

      Liked by 1 person

      • Perhaps I do have número uno and my pdoc isn’t telling me and I’m not demanding a look at my chart. He doesn’t discuss diagnosis with me either, so I’m going with my initial diagnosis which may have changed when I was hospitalized a decade ago. My manic break was in response to tricyclic medications. I did no harm, had no history of spending, excessive drug use (just occasional pot smoking typical of my age), or promiscuity. Even when manic twenty years ago, I did no harm, just had racing thoughts and was aware that those thoughts were racing and could stand back and observe them, so to speak. But when I was hospitalized at my own insistence, I did not appear manic but was aware that I was fragile and labile. While hospitalized and partially hospitalized, my pdoc at that time said that they were observing rapid cycling and mixed states (which indicated bipolar I, but again we did not discuss diagnosis). I probably am bipolar type I. And I probably should remove qualifiers from my descriptions.

        Like

  7. Gosh, you guys are smart. I could just sit in the corner all day and listen. Got any extra tin foil?

    Like

    • Gosh, you guys are smart.

      Good to see you entering into the sarcastic spirit of the blog.

      You and I are gonna get on just fine, Sandy.

      Like

    • For Fox Sake permalink

      Lemme run out a buy a family block of Cadburys.

      Like

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