Moving Forward: The Last Fifty Years of Psychiatry

I’ve read a lot about the history of psychiatry. It’s interesting. Lately, I’ve taken an interest in reading about how patients were treated in the past in “asylums”, now called mental health facilities.

Most of the treatments would now be considered illegal. Many of those psychiatrists, nurses and “orderlies” (today, they would be called mental health workers) would be fired and probably jailed, among other punishments.

The buildings were in terrible shape, the patients were barely fed, clothed and heavily medicated so they wouldn’t have to be dealt with. When the staff did have to do anything with them, it was far from therapeutic. Many patients were terribly abused- physically, sexually and emotionally. This is a horrifying thing to me, as a person that has spent their career working with patients in various settings. Even if I didn’t, I still have a heart and it’s just wrong. I discussed this a bit in Book Review: “For Their Own Good”

Call me a “psych nerd” if you will, but I didn’t spend 5 years getting a BA for nothing, everyone. I’d go back for a Master’s, but the way my short-term memory is set up, I’d need someone to re-read my notes to me daily. School isn’t an option for me at this point, so therefore I read. A lot. My specialty is not in pharmacology or neurology (that’s why my insurance pays my adorable neurologist to give me shots to prevent migraines every 12 weeks) so I’m going to skip all the great big words today and break it down to the good parts.

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The Progress- Medication Is A Good Thing

Over the last 50 years, medications have been coming out quite often. There are so many commercials for anti-depressants these days, I’ve lost count. The side effects of psychiatric medications started out to be bad ones- for example, tardive dyskensia. This is about the worst side effect I have ever seen in a medication.

It was mainly seen in the very first hardcore medications, like Thorazine, which came out in the 1950s. This affects facial muscles, and they can twitch horribly, on either one side or both sides of the face. It can be stopped if the doctor is told quickly, and the dosage is lowered or medication is stopped completely (another issue within itself) but once it sets in, it is most likely permanent. It can also come in the form of tongue clicking. The patient may not always realize that the movements are going on and that can put off the timing in which the doctor is notified.

These days, this side effect has been greatly lessened thanks to the ability of patients to notify their doctors and the FDA of adverse side effects and the reformulation of this and similar medications. Weight gain has been another big woe for many that take anti-depressants and other psychiatric medications. There are medications currently being released that are weight-neutral so that patients aren’t so afraid to take them. This can be a relief. It’s not fun to take meds when you worry about gaining 15 lbs in 2 months. Some stop taking their meds for this reason.

Another advantage of medication over the years is extended release- patients don’t have to take as many pills during the day. In other medications, this may not be an option, but in many psychiatric medications, including Julian’s ADHD meds, the extended release option can be a great thing. It allows patients to plan their days a bit easier without having to stop and take pills throughout the day. There still may be a need to take night medications, but it’s definitely an improvement.

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The Larger Changes- Treatment As A Whole

Brain imaging has become a way to help with understanding the brain structure regarding mood and psychiatric disorders. This helps with research that will assist future diagnoses and book writing. Genetics are being used to help with diagnosis. It is starting to be seen that many psychiatric disorders are caused by a gene and environment interaction, which again leads to further research. This can help those in the future know signs and how to help others.

In the 1970s and 1980s, there was a movement to deinstitutionalize patients. Many had been in facilites for years and weren’t prepared for life outside them, so when they were released, many started committing crimes and/or using substances, which led to jail. Currently, there is a movement to avoid jail when possible and move those in this situation towards a rehabilitation facility, mental health facility (in or outpatient) or into another setting. Jail or prison is not a good setting for those with mental health issues.

Many insurance companies only cover so many days of an inpatient stay at a rehabilitation or mental health facility. I’ve seen people leave facilities that I worked in for this reason, even though they were not ready. This usually leads to them coming back because the issue they came in for wasn’t resolved. This leaves me at a loss. Most people cannot afford to cover the days left over after the insurance stops paying but yet need the treatment. What options does one have besides leaving? Many outpatient facilitites do operate on a sliding scale, which is a wonderful thing, but there are a lot of people that need the specialized care that inpatient facilities provide.

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There are now laws and regulations against patient abuse. Thanks to the jobs I’ve had, I have learned a lot about them. Unfortunately, there are people that break them everyday and those people should not be working in this field. There are also a lot of policies out there and whole agencies that make sure mental health facilites are clean, safe and make sure their employees are well-trained. (I seriously hated those inspections. I won’t lie.) Each state has its own set of laws on how to get someone an emergency psychiatric evaluation. It’s not easy or pretty to do so, but it can save a life. These laws have come into focus over the last couple of decades.

Advocacy has also made a huge splash. There are so many groups that have started to advcocate for those with mental illness. NAMI and AFSP are just two groups, but there are many more.

Moving Forward

There is always progress to be made. I’m curious and pretty much don’t stop reading, so I’ll be learning more as this field grows.

Pics courtesy of Unsplash

Information courtesy of: Health Affairs

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