Categories
Schizophrenia

Cultural Phenomenon: The Medicalization of Schizophrenia

Having a simple cold in America can seem like a dramatic scenario. The flu-shot, for example, is sometimes looked to as if it is a save-all measure. The medicine we have, like the flu-shot, is obviously effective, but we cannot ignore the fact that we almost always turn to science to help us during these times. In contrast to this way of thinking, you say flu-shot, my mom says hot milk with turmeric. Headache, or sinuses acting up? You can take that pill from your local pharmacy, or you can put your head over boiling water and steam your face and nostrils to open up your airways. In other words, in our culture, why are pills the first choice we go to?

We must approach mental illness from a socio-cultural lens to better understand different treatments for a variety of disorders – schizophrenia is no exception. One of the main reasons why patients with schizophrenia face obstacles on the path to treatment is because of the stigma surrounding the illness. In fact, it has been reported that 1 in 5 individuals would be unable to maintain a friendship with someone with schizophrenia (Stuart 2001). This social distance forces patients to be isolated which then affects their health, as social relationships have been seen to promote health and act as a buffer for negative effects caused by stress on the body (House 1988). This debilitating stigma also plagues India. Men hide their illness at their workplace to avoid the risk of ridicule from colleagues, while women with schizophrenia lose prospective marriages due to cultural myths that lead to discrimination (Loganathan 2011).

There is a stark contrast between the diagnoses of mental illness between the Western and Eastern hemispheres, which thereby affects the treatment procedures; schizophrenia is no stranger to this. To the general public, it can appear that, sometimes, the West relies on pharmaceuticals and “aberrant” behavioral observations, which could lead to overdiagnoses (Van Dijk 2016). There are many reasons for this, most notably trying to explain the unknown using science or unfortunately, a reason for profit by Big Pharma (Wyatt 2012). Especially in American society, we tend to focus on biology as the underlying reason for schizophrenic cases. However, this is not the case in the East, including India. Eastern countries tend to rely more on natural remedies, or spiritual explanations, behind behaviors that cannot be readily explained by biological means.

Neurological and psychiatric disorders obviously have a biological basis, but we cannot deny the cultural perspective surrounding them. Different cultures change the label, interpretation, and meaning of different psychiatric disorders (Kirmayer 1989). In America, we are quick to diagnose and start prescribing various drugs to treat someone with schizophrenia. This may be the result of the way our country was formed. Indigenous people believed more in the spiritual side of different aspects in life, but when colonizers came, they viewed this as “strange” and “backwards” (Portman 2006). Following pharmaceutical avenues may be viewed as “better” or “more appropriate” in treating illnesses because (1) we rely too much on science (dating back to the Enlightenment and how those thoughts forever shifted the view to a science-based perspective) or (2) we bombard the public with drugs through direct-to-consumer advertising for monetary gain, leading people to believe they need to be treated even though this may not be the case (Leo 2009). On the other hand, India view psychosis or other hallucinations, including voices and visuals, through a more spiritual lens. Religion and spirituality play huge roles in everyday Indian lives, including in those living with schizophrenia. These two factors can influence treatment and coping methods.

India’s sacred relationship with religion and spirituality can be both a good and bad thing for its individuals with schizophrenia. These beliefs can manifest in either positive ways, which influence treatment outcomes, or negative ways, which lead to greater stigmatization of those with schizophrenia. As Americans, we are used to seeing aspects of spirituality and “the great beyond” in televisions and movies – take for example, Will’s possession in Stranger Things. We think something like this can only happen in movies or novels – but never in real life. This isn’t the case for India, though; there, schizophrenia is either stigmatized or actually not diagnosed (Thara 2000). Instead, spiritual gurus will attribute these delusions to some sort of malevolent entity or possession. This, then, will deter possible treatments for those with schizophrenia. Indian society stigmatizes and discriminates against individuals living with schizophrenia. This leads to lower rates of people actually seeking help and leads to a sense of alienation (Koschorke 2014). Society will often shame these individuals and ostracize them, labeling them as “deviant.” In fact, individuals coping with schizophrenia don’t report their illness because they’re afraid of rejection and loss of marriage offers (Thara 2000). Interestingly, even though these explanations are not biological, when religion is associated with the treatment of schizophrenia, studies show that there are higher rates of treatment adherence and more positive coping methods (Grover 2014). For example, spirituality helps with patients’ well-being, both physically and psychologically. There are also studies showing that there is a better quality of life, which is most probably due to the positive correlation between religion and seeking help (Grover 2014).

If religion was seen as a helpful source for these patients, how can it also act a source of negative discrimination? Are we better off just sticking to a biological basis for understanding this disorder, like here in America? But if there are positive outcomes associated with religion and spirituality, can we integrate the two explanations? We should explore more options for better treatment of schizophrenia. If this means taking a holistic approach in addition to a biological one, we shouldn’t hesitate. This also means breaking down any biases we may have towards other approaches in treatment. Only then can we come together to offer the best treatment options to a variety of patients.

References:

Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, spirituality, and schizophrenia: a review. Indian journal of psychological medicine36(2), 119. Accessed 16 September 2018.

House, James S., Karl R. Landis, and Debra Umberson. “Social relationships and health.” Science 241.4865 (1988): 540-545. Accessed 30 September 2018.

Kirmayer, L. J. (1989). Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine29(3), 327-339. Accessed 16 September 2018.

Koschorke, M., Padmavati, R., Kumar, S., Cohen, A., Weiss, H. A., Chatterjee, S., … & Balaji, M. (2014). Experiences of stigma and discrimination of people with schizophrenia in India. Social Science & Medicine123, 149-159. Accessed 16 September 2018.

Leo, Jonathan, and Jeffrey Lacasse. “The manipulation of data and attitudes about ADHD: A study of consumer advertisements.” S. Timimi & J. Leo (e.), Rethinking ADHD: From Brain to Culture (2009): 287-312. Accessed 25 September 2018.

Loganathan, Santosh, and Srinivasa Murthy. “LIVING WITH SCHIZOPHRENIA IN INDIA: GENDER PERSPECTIVES.” Transcultural psychiatry 48.5 (2011): 569–584. PMC. Web.Accessed 30 September 2018.

Portman, Tarrell AA, and Michael T. Garrett. “Native American healing traditions.” International Journal of Disability, Development and Education 53.4 (2006): 453-469. Accessed 25 September 2018.

Stuart, Heather, and Julio Arboleda-Florez. “Community attitudes toward people with schizophrenia.” The Canadian Journal of Psychiatry 46.3 (2001): 245-252. Accessed 30 September 2018..

Thara, R., & Srinivasan, T. N. (2000). How stigmatising is schizophrenia in India?. International Journal of Social Psychiatry46(2), 135-141. Accessed 16 September 2018.

Van Dijk, W., Faber, M. J., Tanke, M. A. C., Jeurissen, P. P. T., & Westert, G. P. (2016). Medicalisation and Overdiagnosis: What Society Does to Medicine. International Journal of Health Policy and Management5(11), 619–622. Accessed 16 September 2018.

Wyatt, W. J. (2012). Medicalization of Depression, Anxiety, Schizophrenia, ADHD, Childhood Bipolar Disorder and Tantrums: Scientific Breakthrough, or Broad-Based Delusion?. Postępy Nauk Medycznych. Accessed 16 September 2018.

Categories
Anxiety and Anxiety Disorders

Beyond Medication: You Have Options

“Let food be thy medicine and medicine be thy food”

-Hippocrates

Before becoming a physician, many medical students take an oath commonly referred to as the Hippocratic Oath. This code of ethics not only dictates the roles of physicians, teachers, and students of medicine but also requires physicians to make a commitment to only provide beneficial treatments, reduce the risk of harm and refrain from corrupted or mischievous behaviors. The code also mentions controversial topics such as a physician’s role of engaging in abortions and euthanasia. Social, economic and political changes have influenced the modification of the oath. But, in doing so it is possible that Hippocrates’ intent has been ignored. Although little is known of this Greek “Father of Medicine”, he was a huge proponent of holistic, natural or as we say today alternative medicine.

Natural medicine has been overlooked and outsourced to make room for pharmaceutical medication. While pharmaceutical medication, which has become the conventional form of medicine proves to be beneficial, it is commonly used as a sole source of treatment rather than a supplement to natural remedies. Natural medicine may involve the use of acupuncture, pilates, meditation, therapeutic massages, proper nutrition and the use of herbs such as sage, rosemary, ginger, and lavender. However, these unregulated sources of treatment prove as a threat for multi-billion dollar pharmaceutical industries such as Pfizer and Johnson & Johnson. While the FDA regulates medication for safety and efficacy for Americans, there is an overabundance of medication and pharmaceutical companies the department is responsible for. Therefore, it takes a while before pharmaceutical companies are fined for mislabeling and/or over-promoting their medication for use by vulnerable populations such as individuals under the age of 18 or those with a mental disorder.

Individuals experiencing mental illness such as depression or anxiety, consent to pharmaceutical medication with an inordinate amount of side effects usually without the option to pursue holistic treatments. For example, pharmacotherapy and psychotherapy medications such as benzodiazepines, serotonin reuptake inhibitors, buspirone, and pregabalin are commonly prescribed to patients diagnosed with Generalized Anxiety Disorder. However, they carry side effects such as dizziness, sedation, agitation, amnesia, insomnia, and organ damage, thereby creating a paradoxical effect of worsening anxiety disorder symptoms and creating new ailments. On the other hand, herbs such as passionflower and kava have been shown to reduce nervousness, anxiety, and insomnia in patients diagnosed with Generalized Anxiety Disorder and show less side effect than their pharmaceutical counterpart.

No treatment is perfect. Both herbal medicine and pharmaceutical medicine have risks of side effects and both industries make large profits in the realm of health. However, natural medicine is significantly cheaper than conventional forms of medication but is rarely given as a treatment option. A study published in the Journal of Health Services Research revealed that doctors will commonly use natural remedies for their illness but will not recommend them to patients. Therefore, consumers are left with the responsibility of understanding and expanding their options, yet many are unaware that they even have an option. Maybe it is easier to prescribe medication than to try convincing individuals to make positive lifestyle changes. But, why settle for less with our health. Don’t we deserve to have options?

References:

Bystritsky, A. (2018). Pharmacotherapy for generalized anxiety disorder in adults. Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorderinadultssearch=anxiety&source=search_result&selectedTitle=1~150&usage_type=default&display_rank1

Calm Clinic. (n.d.). Dangerous anxiety medication side effects. Retrieved from https://www.calmclinic.com/anxiety/drugs/side-effects

Encyclopedia Britannica. (2018). Hippocratic Oath. Retrieved from https://www.britannica.com/topic/Hippocratic-oath

Independent Vital Life. (2016). Why doctors do not prescribe natural alternatives. Retrieved from http://www.ivlproducts.com/HealthLibrary/HealthConcerns/SupplementVitaminsWelness/Why-Doctors-Do-Not-Prescribe-Natural-Alternatives/

Herbs vs. drugs: get the facts about medicine. Retrieved from https://www.motherearthnews.com/natural-health/herbs-vs-drugs-facts-about-medicine-zmaz06djzraw

Lakhan, S & Vieira, K. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959081/

Smith, M., Robinson, L., & Segal, J. (2017). Anxiety Medication: What you need to know about benzodiazepines and other anxiety drugs. Retrieved from https://www.helpguide.org/articles/anxiety/anxiety-medication.htm

Smith, W. (2018). Hippocrates. Retrieved from https://www.britannica.com/biography/Hippocrates

Trueman, C. (2015). Hippocrates. Retrieved from http://www.historylearningsite.co.uk/a-history-of-medicine/hippocrates/

Zerbe, L. (2011). Docs use natural remedies (but don’t prescribe them). Retrieved from https://www.rodalewellness.com/health/natural-remedies-0

Categories
Anxiety and Anxiety Disorders

Modernizing Medicine through Internet-delivered Treatments

Because of the efficacy in terms of both cost and outcome of exposure-based cognitive behavioral therapy (CBT) in treating anxiety disorders, it is imperative to make this type of treatment accessible to all of the patients who can potentially benefit from it (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  One group in particular that can improve from CBT treatment is the child and adolescent population suffering from specific phobia.  According to the DSM-V, the individual with specific phobia has a constant fear of an object, place, or situation, a fear that is disproportional to the threat or danger actually posed by the feared object.  Studies have shown exposure-based CBT to be effective in treating specific phobia in young people, but aside from the lack of awareness about this type of treatment, many children do not receive it because there are not many therapists who have the right training (Vigerland et al. 2013).

One way of providing treatment to a wider range of those who need it is through the Internet using Internet-delivered CBT, or ICBT (Vigerland et al. 2013).  This special kind of cognitive behavioral therapy has done well with adults who have anxiety disorders, and there are also studies that have demonstrated that this method can make for good results with children as well (Vigerland et al. 2013).  In a 2013 study by Vigerland and colleagues, a slightly different approach was taken: here the parents of the child with specific phobia would be the ones primarily helping the child through the treatment.  The parents did have scheduled phone calls with a therapist throughout the treatment process, but moving through the cognitive behavioral therapy was largely reliant on the parents educating themselves with the information provided by the Internet-delivered treatment and following the instructions provided, implementing the treatment with their children (Vigerland et al. 2013).

Exposure-based ICBT for children with specific phobia presents a new and modernized approach to treating this mental health disorder.It takes an evidence-based, effective treatment and adapts it to technological advances, making it more flexible with demanding schedules that leave little spare time for trips to a therapist’s office, thus making treatment a more feasible option for people who have very rigid schedules.  Parents participating in this study were encouraged to follow the time schedule suggested by the researchers, but with this treatment model, each family could work together in treating the child’s specific phobia at their own pace (Vigerland et al. 2013).  Not only is this great for busy, working parents and school-aged children, but this is also a plus for people with mental health disorders who have to rely on public transportation, or getting a ride from a friend, or paying costly taxi fares to get to their therapist appointments. Bringing treatment to the home can save clients a considerable amount of time and money, again making treatment more attainable.  Just as well, speaking to clients over the phone rather than having them come in to the office allows the therapist to treat more clients at a lesser cost for each patient (Vigerland et al. 2013).

This pilot study showed significant reductions in anxiety symptoms reported by both the parents and the children, and almost all of the children responded that they were highly satisfied with the treatment they’d received (Vigerland et al. 2013).  Parents, however, were largely positive about the treatment experience itself, but less so in terms of using the online treatment platform, which did present some difficulties in saving answers and reading therapists’ responses (Vigerland et al. 2013).  Further studies are needed to fine-tune the Internet-based treatment and make it even more effective, but the improvement of Internet-delivered treatments to help those with anxiety disorders is certainly something to look out for in the future.

References:

Vigerland, S., Thulin, U., Ljótsson, B., Svirsky, L., Ost, L., Lindefors, N., & … Serlachius, E. (2013). Internet-delivered CBT for children with specific phobia: a pilot study. Cognitive Behaviour Therapy, 42(4), 303-314.

Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, & E., Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9-17.