Tuesday, January 1, 2013

Dr. Dawson's Neighborhood

 “Politicized science is an inevitable part of the human condition, but society must strive to control it. Although history shows that politicized science does much more damage in totalitarian societies than in democracies, even democracies are sometimes stampeded into doing very foolish and damaging things." – William Happer, Harmful Politicization of Science in Politicizing Science: The Alchemy of Policymaking

When I was a kid, I walked five blocks a day back and forth to primary school and kindergarten for the first seven years of my schooling. I got to know the people along that route very well. In those days in a small town people looked out for you when you were a kid. They offered you things to eat and you knew it was safe to eat.  You got to know their problems.  They told me about being gassed in World War I and never getting over it or drinking a pint of gin a day for thirty years and then stopping.  Some were engaged in behaviors that were difficult to explain such as laughing uncontrollably or making statements that seemed to be directed to you but that did not make any sense. Other people told me about their neighbors having alcoholism or having undergone shock treatments. There were adults with developmental disabilities. I visited several families with my parents and I can remember witnessing shocking behavior in those private residences - shocking for a kid but not so much for a psychiatrist.  Plenty of shocking events happened right at my own home.  That was my neighborhood as a kid and I lived there a long time.

Over the next four decades, I have thought a lot about my old neighborhood from time to time. The most frequent thought I get is how common psychiatric disorders are and how they are easily recognized by most people in your neighborhood.  The second most frequent thought I get is how there was nearly a complete lack of professional help for people with those problems. There was an extremely high threshold for assistance and when that threshold was met people were often sent hundreds of miles away to institutions until they recovered or remained in those institutions on an indefinite basis.  Some of these institutions doubled as sanatoriums for the mentally ill and patients with tuberculosis.  My aunt was a nurse in one of those places and was assaulted.  I can remember thinking: “Why would somebody with TB attack her?”

My mother had severe bipolar disorder, and was treated for years with tricyclic antidepressants by her family physicians. She eventually was able to see a psychiatrist and got more appropriate mood stabilization, but only after decades of mood instability.  My father seemed very depressed and lethargic. He probably had obstructive sleep apnea, a condition that psychiatrists routinely screen for these days but back then it was unknown. I found him dead one morning when he was 42 years old.  Medical treatment in general was pretty bad in those days.  Treatment for mental illness and access to psychiatry was practically nonexistent.  

There was no DSM when I was walking back and forth from school.  And yet the people with mental illnesses who were impaired were obvious to most people. That consensus was necessary, because their neighbors knew that they had to be more patient and kind based on those problems.  They knew they had to keep children from teasing or ridiculing these folks and teach them how to treat the disabled.  Some of our neighbors who interacted with my mother were incredibly tolerant at all hours of the day or night.   I don't know where I would have ended up without that level of assistance and recognition that there was a huge problem.  I think that level of common sense prevails today and is the basis of studies that look at whether or not psychiatric disorders are considered to be "diseases" by most people.  Those survey studies generally show that most people view severe mental illnesses and addictions as diseases. The idea that there is no such thing as a psychiatric disorder, forms the basis of anti-psychiatry rhetoric, but it is not rooted in reality or common sense.  The average person on the street does not need a DSM to detect mental illness.

The reality of psychiatric disorders and their treatment is really the focus of this blog.  It is something I have been focused on since before I became a psychiatrist.  Psychiatry is the most politicized and maligned medical specialty. It is rarely covered in an objective manner by the media. It has been manipulated by businesses and the government for their mutual advantage. It is the only specialty where there are significant profits made from continuously criticizing every aspect of the discipline.  It has few rational and fewer effective advocates.     

I continue this blog with those thoughts and the memories of my old neighborhood in mind and wish any readers here a Happy New Year.

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