Wednesday, March 2, 2011

What is "the human mind"?

As a psychologist, I have been studying and working with "the human mind" for years, yet through most of my study, the concept of what the mind is has not been directly addressed. I believe that most psychologists would agree that the human mind is very complex and at times very difficult to understand.

Humans have been struggling to understand and describe the human mind for thousands of years and yet only in about the last one hundred of years or so have we been scientifically trying to examine what the mind is and what it can do. While we have made many advances through neuroscience, psychology, and other related fields, there is still so much that we do not understand.

But what is the mind?

Is it our conscious awareness? If so, what about the parts of our cognitive life of which we are unaware?

Can we reduce the human mind to the physical existence of the brain? Or is there something more to our mind that include concepts such as the soul or spirit?

Far be it from me to be even able to answer any of these questions conclusively. I simply do not know for certain. Though, I do have some ideas, though, that help me in how I work with my own mind and the minds of my patients, who are suffering.

For the purposes of my writing here, I am going to define "the human mind" as the totality of our awareness, cognitive activity like thoughts (both in and outside of our awareness), and emotions (both in and outside of our awareness). This is a pretty broad definition, but it helps us get started in thinking about how our minds operate and what makes up "the human mind".

While our minds are always at work, we are often unaware of what are minds are doing. I'll write more another time about self-awareness and something others have called "Mindfulness."

Friday, January 28, 2011

Over-diagnosis of Bipolar Disorder: Why is it a problem?

It has struck me over the past few years that more and more individuals were being diagnosed, mainly by psychiatrists, as suffering from Bipolar Disorder. I haven’t seen any published surveys to support this observation, but other psychologists have also reported seeing the rise in how frequently this diagnosis is made. I have had more than a few occasions where patients have been, in my professional opinion, diagnosed with Bipolar Disorder, whey I believed that they instead suffered from other disorders, such as Major Depression, Borderline Personality Disorder, Post-traumatic Stress Disorder, or Obsessive-Compulsive Disorder. So what’s all the fuss about—it’s just a label, right?

Labels have consequences. Let me point out a few that you might want to consider:

1. Bipolar Disorder is a Major Mental Illness and is seen as truly a physical disease process in the brain. There has been very strong evidence published for at least over the past 20 years that it is strongly influenced by genetics—that is to say that you likely inherit the disorder or at least a tendency to develop the disorder. Studies have shown that if one parent has Bipolar Disorder, children from this parent may have about a 20% chance of also having the disorder. If there is a strong family history of Bipolar Disorder, that is to say if several blood relatives also have Bipolar Disorder, the chance for a child to have the disorder skyrockets. If the parent and several blood relatives have the disorder, the chance for a child to have the disorder may be near 70%. This raises some concern for parents who are considering having children and whether parents want to risk creating a child that has a high risk of a serious mental illness that is not curable and may cause severe disability in life. Now, with increased frequency of this disorder being made, sometimes inappropriately in my opinion, parents who are faced with a possible dilemma that is not actually present.

2. Bipolar Disorder is treated with several different powerful classes of drugs, including anti-seizure medications and anti-psychotic medications. Many of these medications are relatively new to the market, and as such, they are extremely expensive. Also, it is not uncommon for psychiatrists to prescribe more than one of these medications to a “bipolar” patient at the same time. The prices were derived from the website on 01/28/2011. See the example below:

LAMICTAL XR (brand) 100 MG TER (30 tab) $309.99
Trileptal (brand) 300mg (60 tab) $235.99
Seroquel XR (brand) 600 MG (60 tab) $617.00
Risperidone (generic) 3 mg (60 tab) $299.99
Risperdal (brand) 3 mg (60 tab) $756.00 (estimated from price of 30)
Zyprexa Zydis (brand) 10 mg (30 tab) $529.99
Invega 6 mg (100 tab) $1,372.99
Geodon 60 mg (60 tab) $574.97

Cheaper medications such as Lithium (which is cheaper) are still sometimes used, but not as frequently now as these newer classes of drugs.
Now while some individuals without the diagnosis of Bipolar Disorder may be prescribed the anti-psychotic and anti-seizure medications, many more are treated effectively with simply an anti-depressant medication.

Now also consider the cost of prescription anti-depressants:
Sertraline (generic) 100 mg (30 tabs) $15.99
Zoloft (Brand) 100 mg (30 tabs) $131.99
Fluoxetine (Generic) 40 mg (30 tabs) $40.99
Prozac (Brand) 40 mg (30 tabs) $398.49
Lexapro (Brand) 20mg (30 tabs) $109.99
Celexa (Brand) 20 mg (30 tabs) $120.49
Citalopram (generic) 20 mg (30 tabs) $39.99
Pristiq (brand) 50mg (30 tabs) $141.99

Also remember that Bipolar Disorder is a life-long condition that necessitates medication (most of the time) for a life-time. Many other disorders may require long-term medication, but not necessarily for the rest of a patient’s lifetime.

3. Labels have consequences: while any psychiatric diagnosis carries a stigma, some of which may be more stigmatized than Bipolar Disorder, applying the incorrect diagnosis might mean that the person faces discrimination based on that diagnosis that they might not otherwise face.

4. Finally, when a misdiagnosis of Bipolar disorder is made, the accurate diagnosis may be missed and specific treatments, such as psychotherapy, may be not considered, when they are very effective. Treatment may be focused on simply maintaining the patient and controlling symptoms (that is to say with ongoing medication), rather the ameliorating the mental health problem (helping the person function more effectively with or without medication).