So There's No Such Thing as Mental Illness Mr. Cruise?

Scientology advice leads to death

Published on March 23, 2006 By JillUser In Current Events

I think we are all familiar with Tom Cruise's advice to Brooke Shields regarding post partum depression. Apparantly scientologists believe that psychiatry is a plot by aliens to control our minds with drugs. Mr. Cruise has declared himself an expert on the subject. I personally believe he himself is insane.

Well, apparently a counselor of the church and her scientologist son took the advice to heart and treated the son's psychosis with vitamins and exercise rather than seeking psychiatric treatment. The son in turn stabbed his mom to death. Seems the vitamins didn't help his alleged mental illness but perhaps gave him plenty of strength for stabbing away at his imagined demons.

I will be interested to see if Mr. Cruise has any comment on the matter (he doesn't thus far). I personally will avoid taking advice from any group who believes we are being controlled (or attemptime to be) by aliens. Strangely I have heard Mr. Cruise state that he won't believe in aliens until he sees one for himself. For someone who makes everyone he works with tour his church, he doesn't seem to have a firm grip on his religion's foundation. Or maybe he does and tries to make it more palatable to the masses. He is an actor after all so who knows what is going on in the mind of the real Mr. Cruise.

Comments (Page 5)

Daiwa

on Apr 01, 2006

Lots of interesting material in this thread. I'll try to add some perspective from the point of view of a practicing primary care internist, though I strongly believe that our generalized opinions about issues of this sort are heavily influenced by our first-hand experiences, something that has a tendency to put subtle blinders on our thinking, no doubt mine as well.

First, the disclaimer: I have two adult children with psychiatric illnesses. One with a form of autism, one with childhood ADD/HD which evolved into true bipolar disorder, and both illnesses have had a devastating impact on their lives. I've been through twenty years of attempts to get help for my sons, not to mention many thousands of dollars, had to deal first hand with the abject deficiencies of our mental healthcare "system" from the patient side of the equation and seen most of that effort go, sadly, for nought. So.

Our "system" is a highly complex and convoluted web of entities making decisions based most often on third-party policies and regulations with unforeseen and unintended consequences, acting in their own self interest when necessary for institutional or personal survival. A series of payor-led efforts, some related & some not, in response to the rising cost of health care in the late 1970's & early 1980's, ultimately resulted in severe underfunding of mental health programs and providers across the board.

The progressive closure of dedicated psychiatric treatment facilities, combined with reductions in physician reimbursement, led over time to fewer and fewer qualified psychiatrists being avaialable to care for patients, even in large urban areas like the one I live in. The insurance industry, as part of this cost-control effort, began consolidating mental health programs through exclusive contracts with corporate behavioral health outfits, leaving many psychiatrists "outside looking in" and they did what they had to do to survive - go elsewhere.

I started practice as an intensivist/ER doc in 1980, then went into private internal medicine practice in 1983. During the early 80's, good psychiatrists were overworked but available routinely and it was possible to arrange care for someone you felt needed it with a simple phone call. By the end of the 80's, what private psychiatrists remained had closed their practices or stopped accepting insurance, had stopped making themselves available for evaluation of hospitalized patients, or had joined one of the exclusively-contracted corporate behavioral health groups (the ones paid to sit in the next room & write scrips, as Baker so eloquently put it). If a new psychiatrist hung a shingle in the area, he usually stopped accepting referrals or relocated within a few months. In those days, hospital regulations required patients who were admitted following a suicide attempt or gesture to remain in the ICU until "cleared" to leave by a psychiatrist. That rule had to be changed, obviously, once there were no longer any psychiatrists available. During the last couple of years of that regulation's life, when getting a psychiatrist in was not actually impossible, just next to impossible, we mostly honored that rule in the breach, accepting that we would have to make those calls on our own, no matter our lack of professional training. By the time the regulaion was rescinded, we'd long since given up trying to get an in-patient psychiatric consult and had come to accept that post-hospital psychiatric care was unavailable as well.

The effect on our office practice was parallel. As psychiatric care became simply unavailable, we were forced to directly address our patient's psychiatric needs without the advice or counsel of trained pyschiatrists. That wasn't all bad, as I've always believed in caring for the patient, as opposed to their organs, but it placed us in a position for which we had neither the training nor inclination (I chose to be an internist, not a psychiatrist, for a reason). We also had the fincancial pressure - noone paid us to provide counseling, they were paying their exclusively-contracted behavioral health provider for that - and if we had spent the time needed to adequately counsel people we would have gone out of business, simple as that. So our patients suffered, in my opinion, from a woeful lack of care of the right kind (and largely continue to do so), but we were largely powerless to do anything about it.

I am hardly the only physician put in such a position, and while almost all of us make a good faith effort to prescribe agents for mood disorders only when really needed, we all make mistakes, because these are some of the most subtle and difficult to discern issues in medical practice. I am able to spend, on average, about 2 to 4 hours with any given patient per year - how on earth could I understand all the issues impacting that given patient's emotional well-being? Could the profession be charged with "over-treating"? Sure. Could we be charged with "under-treating"? Absolutely. Proving either, however, is highly problematic since the aggregate numbers are simply a reflection of countless one-on-one decisions influenced by countless variables.

That brings me to Baker's implication that pharmaceutical companies are calling the tune. Despite his anecdote, the vast majority of physicians tolerate pharmaceutical reps as opposed to listen to them. I do it in order to have available sample medications, primarily for 2 reasons - 1) for the substantial number of seniors on fixed incomes for whom we can save a few bucks, and 2) so that I can be sure a particular medication is well-tolerated before spending a patient's (or insurance company's) money on it. I can honestly say that noone with whom I've practiced has ever prescribed a drug solely on the basis of a rep's pitch - just doesn't happen, for the simple reason that we ain't rubes and we are by virtue of our training skeptical thinkers. We actually give our reps something of a hard time. But I admit I'll utilize medications that I have available in the sample closet, hardly exclusively, but I will use them.

Finally, I'll touch on consumer-driven health issues. On the one hand, I am completely opposed to direct-to-consumer drug advertising, even though you'd think it would be good for business (every one of them ends with "Ask your doctor."). I think it creates artificial demand that I have to spend too much time deflecting, time that could be spent on more important problems. On the other hand, I don't believe healthcare should be paternalistic - while knowledge is always something of a two-edged sword, patients are entitled to know as much about their own health as possible. The problem lies in the nature of illness and how our bodies respond to it. There is a relatively finite set of symptoms that can be perceived in the presence of illness - the body only has so many ways of reacting and the vast majority of perceivable symptoms are shared by multiple illnesses, including psychiatric illnesses which science has clearly shown are related to real physiologic abnormalities. That's why Baker could plug the symptoms of Crohn's disease into the depression scale and get a 55. You could easily reverse that and, using the depression scale, arrive at a diagnosis of Crohn's disease. It's all about context, and that's where the doctor comes in (or should) to help sort it all out. Pre-conceived notions about what is wrong with us are brought to every appointment - there is so much information and generic advice in the lay press (Men's Health, Women's Health, Cosmo, Ladies Home Journal, Newsweek, you name it) and on television that none of us are immune to arriving at some preliminary conclusions or suspicions before we even call for an appointment. That doesn't mean that a tool to help people identify (or suspect) a medical problem should be rejected because it is posted on a drug company's website. If a patient doesn't already suspect something is wrong, they'll never seek out or utilize such a tool.

OK, I've exhausted this morning's cup of joe and my brain is now running on fumes, so I'll end here.

bakerstreet

on Apr 01, 2006

"That doesn't mean that a tool to help people identify (or suspect) a medical problem should be rejected because it is posted on a drug company's website. If a patient doesn't already suspect something is wrong, they'll never seek out or utilize such a tool."

But every bout of depression and every low point in life doesn't beg medicating, either. As I said, I get depressed when I look at my house, my car, my checkbook, and in the mirror. Taken with my other illnesses, I'm a prime candidate to want a drug to take all that away.

I agree with you for the most part, but I think you overlook that people take drugs... just to take drugs. People who take cocaine don't believe themselves to be ailing, they just want to feel better. A lot of people have come to the conclusion that "feeling bad" mentally is something you need a pill for, and not just the treatment of specific illnesses.

I just despise the fact that many doctors and insurance companies do the math and decide that a prescription is a high-profit catch-all when people might also benefit from counseling. When was the last time you saw a commercial that urged people to do anything but ask for a pill?

There are a lot of people like me who just need to get their life in order and learn to deal with chronic problems. Pills don't do that for you.

Daiwa

on Apr 01, 2006

But every bout of depression and every low point in life doesn't beg medicating, either.

You are absolutely right about that, but there are inevitably going to be gray areas where it could go either way. That's where those mistakes I talked about tend to happen.

I agree with you for the most part, but I think you overlook that people take drugs... just to take drugs. People who take cocaine don't believe themselves to be ailing, they just want to feel better. A lot of people have come to the conclusion that "feeling bad" mentally is something you need a pill for, and not just the treatment of specific illnesses.

Just ask Tim Leary, although I understand he's now on the ultimate high and can only be reached while completely baked.

Substance abuse is really a different problem, though.

I see lots of folks who just need a little encouragement and reassurance that all is well (or as well as can be) and I'd be surprised if that were not the experience of most doctors. Very few doctors fall into the "take-this-pill-that'll-be-two-hundred-bucks-goodbye" stereotype you describe.

I just despise the fact that many doctors and insurance companies do the math and decide that a prescription is a high-profit catch-all when people might also benefit from counseling.

Insurance & drug companies certainly "do the math" but, with the exception of the fringe patient-mill docs (and I admit they are out there, though small in number), "profit" is not an issue in a physician making treatment decisions. I don't have a lab or x-ray machine, I don't do mesotherapy or office cosmetic procedures (a whole 'nother topic) - all I have to "sell" is my knowledge, judgment and advice, and that's true for most physicians. I will admit that I have for a long time sensed that our cultural mindset is such that if a patient walks out of an appointment without a prescription for something, the time has been wasted ("He didn't do a thing for me."). We are all culpable to the extent that we've facilitated that.

When was the last time you saw a commercial that urged people to do anything but ask for a pill?

Only the occasional PSA on PBS. Like I said, I hate those Crestor commercials, too.

There are a lot of people like me who just need to get their life in order and learn to deal with chronic problems. Pills don't do that for you.

Pills might not do that for you, but medication, often short-term, may break an emotional log-jam of sorts and enable someone else to get off the dime, begin getting their life in order and deal with their chronic problems. One size does not fit all. I've had many patients who've greatly benefitted from medication (whether they got better because of or in spite of is yet another topic) but only needed it a for a few months.

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