Wednesday, September 15, 2010

Are some questions just too difficult? Part I: Should I blog about DIP?

The other day I was talking to Ruth about this blog. Ruth is a nurse who has worked in psych wards and prisons. So she has an interesting range of experiences to talk about and she's interested in economics.

I mentioned that there were some issues that I steered clear of in my blog because they were just too difficult. Ruth objected strongly to this approach on the grounds that ‘someone should be writing about the difficult issues’. I’m not sure why that someone should be me, but I can see the point she was making.

The first example that Ruth gave of what she was talking about was the high incidence of mental illness among young people that has been linked to drug use. She said that this had increased to a huge extent, since the 1990's. We talked around the problem for a while and later exchanged emails about it. The story that Ruth tells below is one of the saddest stories I have ever read.

Ruth says that the most prevalent mental health diagnosis in acute mental heath facilities these days is a relatively new one - Drug Induced Psychosis (DIP). People are only admitted to acute mental health facilities if they are in danger to themselves or someone else (not simply suffering extreme effects of illness as was the case prior to the onset of the drug problem). DIP is now recognized in the DSM4 manual - the diagnosis tool used by all western mental health medics. A major difference between DIP and schizophrenia is the level of associated violence and treatability. Schizophrenia is treated reasonably well with psychotropic medications as the primary treatment regime whereas DIP is treated mostly through drying out and containment (of extreme violence) with medications used as secondary measures.

Ruth tells me that she has chosen not to study a great deal of the theory about the relationship between drug use and mental illness because she wants to stay in touch with the reality on the wards. She writes:
Can I tell a story? It's the story of a young man, well, a boy about to be a man. He was out with his friends celebrating early, his 18th birthday which was to fall during the next week. So this weekend he and his friends went partying to celebrate. During the night one of his friends slipped him a tablet - slyly into his drink. The young man woke the next day still tripping. He was happy as can be, but by the Tuesday, his parents were very worried and took him to the doctor; he was still tripping - having a laugh. He celebrated his 18th birthday in an acute mental health ward, thinking he was still tripping, but was now fed up with being unable to tie his shoe laces, unable to get the fork into his mouth and having to eat with his hands. He was now hating this experience and getting angry with himself for not 'straightening out'. He began to cry in desperation. He cried over and over again, day in day out, while the medics tried in vain to help. After a couple of weeks, his parents wanted to take him home - they wanted to get him out of hospital thinking that maybe it was the hospital causing their son's problem. They took him home and he stopped crying. He still could not tie his shoe laces, or dress himself if there were buttons to be managed. But his parents were happy he'd stopped crying. After all, this fine young man was looking down the barrel of a great career as expected dux of his school, and a fine life. They were devastated at this turn of events. After a few days they brought him back to the hospital. They had not helped him and were even more devastated than they were before. This young man spent nearly a year in hospital, unable to 'get off his trip' as he so beautifully put it.

I was one of his nurses at the time. I was 22 years old, just 4 years his senior. Eventually both he and I left that hospital. But our paths met again in another hospital, another city even, about 6 years later. He told me he had never had a job for more than a few days, he still couldn't do up his buttons - he didn't wear buttoned garments - and that he was still having his 18th birthday trip. He still wanted to study economics (ironically enough) at university. He could still quote and discuss GDP / inflation / employment figures, monetary and fiscal policies, but old figures, those he'd learned for the HSC he still wanted to sit. And yet that young man has no mental health issues in his family, had all the academic potential in the world and a caring, present family. His parents had never divorced, his siblings all got along ok, his relationship with his girlfriend was going well. And there were no identifiable early warning signs of a mental illness about to strike. This man has DIP. He has never been diagnosed with schizophrenia, or any other mental illness.

Ruth concluded:
I wish I was telling the story of just one man, but I'm not. I've seen this same story and similar others so many times. Are some questions too difficult? Yes Winton, absolutely some questions are too difficult and too costly to avoid asking AND finding answers for.

The discussion continues in the next post.

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