In a Pharmaco-Centric Era, Mental Health Nursing is More Important Than Ever

There is no singular and uncontested psychiatric view of anything, but it is clear that a naive biomedical pharmaco-centric orthodoxy prevails at the present time.

This poses a substantial threat to the future of mental health nursing, the credibility of psychiatry and the wellbeing of the nation.

This pharmaco-centric orthodoxy refers to the simplistic notion that one has an illness resulting in an underlying biochemical imbalance that can and ought to be corrected by a drug.

As a result, a large proportion of the population being medicated.

I am convinced that we will look back on this era - particularly the last twenty years - with a mixture of incredulity and shame. Insulin coma, lobotomy and unmodified Electroconvulsive therapy (ECT), which we now view as crude and cruel treatments, were confined to a small number of people relative to the extent that people are medicated today.

Regardless of evidence of iatrogenic harm, or of evidence-based guidelines which ought to have put a brake on prescribing, and regardless of scandals demonstrating the unscrupulous and sometimes criminal behaviour by pharmaceutical companies in their pursuit of extending markets, the increase in medicalization and medicating of distress has been exponential.

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The best era for treating mental illnesses so far.

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And that is, not only because of a great improvements in both diagnostics and prognosis as well as increasing the diversity and quality of patient’s life but also because of the visible shifting of paradigms between ours and previous centuries. And if that change comes from what once was metaphysical ‘absent reason’ of madness to a more rational, pragmatic, and yes biological approach: so it be and hell I’m grateful to live in this century.

(Just a side note of the paradigms I.e dominant treatments of mental illnesses before our flawed era.

**"After his discussion of the various aspects and conditions that form madness, Foucault examines their treatments. He analyzes a central part of the process of confinement, and the development of the idea of curing or treating madness. Initially, madness was not seen as an illness or something that could be treated. But Foucault suggests that even when the idea of a cure developed, it was not a medical development. Madness was still seen in terms of morality and the links between body and soul that come from a theory of the passions.

The initial cures that he discusses (consolidation, purification, immersion and regulation of movement) all relate to the body, but affect both body and soul, such as purification. There is a great difference between this and nineteenth century techniques which center on the moral improvement of the madman. These techniques force the madman to face up to his abnormal or “bad” behavior. The doctor or warder encourages the madman’s conscience to operate; he is made to fear both his captors and the consequences of bad behavior. Earlier, Foucault discussed the idea of madness as a punishment for immoral behavior; here, immoral behavior provoked by madness is punished. The introduction of punishment and guilt into the treatment of the madman represents a more sophisticated kind of confinement. Valuing and using the madman’s guilt indicates a certain ideal of sanity and good behavior—the “normal” person observes recognized standards of good behavior and obeys his conscience."**

(summary on M.Foucault, Madness and Civilization)

History of the treatment of ‘madness’ only goes back 3 to 400 years & is confined to the West - i keep forgetting.

I’d say from experience in the trenches on both sides of the nursing stations at close to a dozen acute psych wards that what you describe was far more often the case in the '80s and '90s, somewhat less and '00s and quite significantly less in '10s. Though it varies considerably. The movement away from knee-jerk, slam-dunk, FDA-dose medication towards a combination of lower dosage and/or slower titration for less severely afflicted pts along with CBT-type psychotherapy is slower than I would like to see, but it is occurring. At least in the US, Pacific Rim Asia and western Europe.

See the last sentence above, but overall, I agree based on the trends I have seen since the late '80s.

This is hugely important. And let’s hope that the extremist, religious fundamentalism (for the sake of “social order”) that is growing again in many places does not overwhelm the advance of rational empiricism (see below) that underpins the progress you mentioned above. We’ve had several ebbs and flows since the Renaissance, I have to point out. Sigh.

Some (like Jules Henry in Culture Against Man, Donald D. Jackson in Myths of Madness, and Alice Miller in several of her books) argue that it is the very same cabals of politically powerful hyper-moralists who both inflict and then perpetuate mental illness via belief-bound, black-and-white / all-or-nothing thinking at the doctor’s desk as well as in the culture in general.

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