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What the libertarians moderate on madness

The Orphans of Liberty website has a “whistleblower” talking about the new Western Australia Mental Health Bill. It is a bill — for those of you who are not part of the Commonwealth, that means that it is currently out for comment.

Now, the exact wording really is not my business. I live in NZ. The NZ Mental Health Act… is. Like all MHA, it is fairly draconian — and needs to be. The entire moral justification for a MHA is that some people are not in their right mind & it is not the correct time for a nice chat and cup of tea, but to literally hold them, restrain them… and then, once in a safe (and at times locked) place, treat them.

Which is what I do for a living.

What wound me was a comment.

And the fact that an awful lot of what passes for psychiatry and psychology is not supported at all by serious studies means that they are further subjecting children to complete quackery.

It’s late, and I’m angry. So… this is in moderation over there, but stuff it, I’m putting it up anyway.

Um, NO.

In fact, hell, No.

Over the last two or three decades there has been this thing called (ahem) Double Blind Trials. Like for Aspirin… give half the bunch placebos, the other lot what you think will work, and don’t tell them or the doctor which is which.

Only way to get rid of this thing called hope… or the placebo effect.

Sounding cynical? OK… Now for some data.

ECT at proper dose works better than low dose ECT. Both work better than sham ECT.

ECT at too high a dose causes more memory loss than proper dose, and low dose causes about the same as proper dose. Sham ECT doesn’t

Antidepressants work better than placebo for anxiety disorders and mood disorders (I’m shortening that statement — I spend a fair amount of my professional life reviewing said studies).

Simple, cheap, and manualised therapies work better than long and non scripted therapies such as psychotherapy. It looks like computerised therapy works almost as well.

Psychosurgery generally causes more side effects than benefits.

If you don’t Belleville me… look up Clinical Evidence, The Cochrane collaboration. We use the same clinical tools in psychiatry as a cardiologist uses to sort out what works and what does not.

Now for the kiddies…

Behaviour Therapy generally works. Meds less so (exceptions include stimulants for ADHD, and I mean real ADHD — unable to sit still, unable to attend to friends, unable to learn, miserable because your classmates are getting you to do stupid things that get you into trouble).

Family therapy helps for some things.

Cognitive therapy, particularly in groups, helps adolescents. As people get more like adults, the medications become more useful.

On ECT for kids, I used to run an ECT service. In the two centres in NZ I have worked, I have never seen a kid have ECT. Most ECT is used in the very old — where the drugs we usually use (yes, I’m talking about modern antidepressants such as fluoxetine (Prozac) etc) are more dangerous than ECT.

Now…

Everything I’ve said has not changed much for the last 10 or 20 years. Moreover, what we do generally works.

So kindly do not call those treating the mad, the sad and the bloody desperate quacks. We use this thing called science. And… we are aware that one in two of us will have some form of mental illness during our lives,

The mad deserve proven, effective and safe remedies. We have them. But there are some ideologues who just think of mad doctors, like the mad, as either a tool of the state or to be shut away.

Rubbish. The mad are not only with us, at times we can all be crippled by anxiety, despair, trauma or the living hell that is psychosis. The mad, sadly, are us.

Hat tip Crusader Rabbit.

UPDATE…

I type too fast. Should be beleive me not Bellvue me — but since that is the name of a big psychiatric institution in New York I’m leaving it in.

 

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