1 in 4 Americans has a clinically-defined mental illness. In this weeks Addiction Radio podcast Dr Darryl Inaba looks at changes in the definitions of mental illnesses, some background and possible causes, and the increasing acceptance of the view of addiction as a mental health disease.
Transcript of podcast (click to listen):
Welcome to the CNS pod cast featuring Dr Darryl Inaba research director for CNS Productions.
CNS: Hello and welcome once again to the addiction radio pod cast from CNS Productions. I’m Howard LaMere here with Dr. Darryl Inaba and we were just talking here before we started recording about the number of people taking anti-depressants and your comment about the number of people that were categorized as having mental illness.
Darryl: Well, if you look at the National Institute of Health, their latest surveys in 2008 demonstrate that 26.2% that, that’s greater than one out of every four of us. 26.2% of the US population have a, or manifest a major neuro-phychiatric illness, something that’s diagnosable and treatable under the DSM4 standard manual diagnosis. The majority of it is, mood disorders, both affect disorders and bipolar disease, are the majority, they have the largest percentage, but then there are also all these different anxiety disorders, panic disorders, there’s the phobias, personality disorders, thought disorders; schizophrenia still represents only a small portion of those people with mental disorders, 1.1 or 1.2% but still when you take the whole group of them and, and realize that one in every four — greater than one in every four persons has a major mental illness then, then you can understand why there are so many people on these medications.
CNS: Right. So we’re not just talking about just being moderately depressed right, we’re talking about a serious mental illness?
Darryl: Yes, that the clinical diagnosis are made upon observations of certain symptoms and also manifestations, or the patient complaining of them lasting for a period of time. There are a number of tools like in major depression things called the Beck’s Depression Inventory, the mood inventories that can separate sort of just normal mundane daily mood shifts to serious debilitating depression that can disrupt somebody’s life. So we’re talking about real diagnosis and we’re talking about you know increasing, there’s been an increasing number of people with depressions. People with major mental illnesses and partially that is because of a different way of counting, maybe we certainly have more mental illnesses than we used to before and every year with the, every time the DSM is edited they add more to it. The current DSM, what they call the DSM diagnostic standard manual number four revised, is in revision to become number five. The DSM5 and in that, serious consideration of including things like internet gaming, internet game dependence and things like that, but a lot of people don’t realize that there are conditions, impulse control disorders — that once addiction used to be called an impulse control disorder, that are included in the current DSM, things like shopping, things like hoarding, things that people may not have thought of as actual pathologic or actually due to mental illness. But we are talking and, your question was you know, is it a real serious condition and we’re talking everybody, at least my daughters anyway love, love to shop, lots of people hoard little things, you know, save rubber bands, save coupons, and things like that. But, but we’re talking pathological, we’re talking beyond the normal realm of people just doing things like that, a pathological shopper has maxed out all of her credit cards, or his credit cards and are in deep trouble for purchasing or, for finances and yet when you go to their abodes or you, you visit them they have just shopping bags that have never been emptied, full of things that they are never going to need you know they’ve got two showers in the house they’ve got twelve Water-Pic shower heads. Things like that and that speaks to a different pathology, a hoarder may hoard food, they may hoard food where its all moldy and turned rancid and real bad but they just do not give it up and, and that’s pathological, that goes beyond normal practices with those conditions so, these mental illnesses all have medical treatments. They are all recognized to affect certain parts of the brain and the development of medications to treat those areas of the brain is what’s been happening so its not, it really is not unusual that we have a huge number of people now on mental health medications. You know, we’re treating so many conditions that we used to just take care or we used to tolerate or we used to notice some person was odd, and that may be short sided because maybe they were suffering you know, if people with these conditions are really suffering it’s a negative in terms of their ego and maybe we should do something to help but, you know, I cant help but think that the brain and the body is such a beautiful organ in terms of keeping its balance and noticing when things are out of balance and then reacting to it and adapting to bring the body more toward balance and when we short circuit the bodies ability to respond and adapt to different neurochemical imbalances by immediately rushing to the most recent fad medication to treat this condition or that condition, we further insult the balance in the chemistry and the ability for the body to try and balance itself and in doing so we may continue to perpetuate or to weaken our emotional states and our biological states because we just are just used to instant gratification and instant response and satisfying our need. But that’s … it leads to a huge philosophical argument about human existence and when are people feeling good and when do we need to intervene and the argument that you present but certainly we seem to be a society that’s headed toward medicating ourselves into not being able to be suited to live on earth without being artificially, we, we become cyborgs or robots to this earth.
CNS: It does remind us, it reminds me of science fiction books that I read as a teenager.
Darryl: And as we continue to perpetuate our species in such a way we continue to become farther suitable to be here. We become an infection on earth so to speak and what human beings are doing is just, they’re just, a so much unhappiness and so much unrest, so much envy, so much anger, so much ignorance, that in order to deal with it we find ourselves becoming mentally unhealthy or seeking either prescription medications to make us feel, at least artificially sound or seeking drugs of abuse, seeking our own drugs to try and make ourselves feel better.
CNS: It seems like we’re developing an attitude that recognizes addiction more as a disease, as opposed to a moral weakness and that seems like its very useful.
Darryl: If we can actually, in general that is, if we can ask a society, nation or group of people, even as the world began to accept that addiction is a biological, cellular body condition and not a moral weakness or a shirking or just a need to get loaded by human beings that would be a major, major event. The evidence, this is one of my soap boxes, since I began in this field over forty years ago, the evidence is just overwhelming, overwhelming, just staggering, warehouses full of papers and scientific research that’s been well vetted and well understood empirical studies that show that addiction is a biological anomaly or, a disease or disorder or, you know, schizophrenia is and so is depression, so is diabetes, so is hypertension, so is heart disease, they’re not because somebody wants to be diabetic, or wants to slough off, its because they have processing biology in a different way that the majority of people process things and, and the evidence is very clear we even have the histology we even recognize the cells themselves and what they look like that are different within an alcoholic verses a non-alcoholic and an addict and a non-addict. We know the places in the brain that are functioning differently and these circuitries and the big science world, we are now pursuing is, looking at the chronic relapsers and why some addicts and alcoholics relapse more than others and we’re finding discrete areas of the brain that can predict whether or not a person is going to relapse or not so, all the evidence is there but some how through the history and to the current time the majority of the public even with the passage of the addiction equity act that says you have to no longer discriminate against addicts because they have an illness just like diabetes even with that act the vast majority of this country want to view addicts and alcoholics as somebody who is criminal, somebody who wants to just slough off responsibilities, somebody who is just weak-willed and bad and stupid and crazy and non-educated, and the evidence is the opposite. Addicts are amongst our most wonderful people but they have a biological anomaly they have a biologic system that causes them to react to the world in a totally different way, and react to drugs in a totally different way than the majority of people react to them.
CNS: Yeah a genetic pre-disposition.
Darryl: It’s partially genetics and, and I want to always emphasis that, because genetics sort of sets the template for how people are going to react and how their biological systems are going to be but then it’s a combination not just of genetics but stress plays a role in how your brain chemistry responds and how your brain function responds and, chronic stress and emotional situations also effect the way your brain is going to react and the food you eat determines your brain chemistry and, and then finally the toxicology of the drugs themselves, certain drugs effect the right areas of the brain and then certain toxic areas that if you’re pre-disposed genetically then you’re going to respond a lot quicker. If you’re not pre-disposed genetically you’re going to, you’re not going to have as much problem, you’ll be able to delay it for longer and longer period of time or some people just are not born pre-disposed to addiction and they’re never going to develop it but for those who are you still have to have the drug that initiates all of that. But what’s initiated is not because you’re weak, it’s not because you want to slough off, it’s because you have a biological condition that robs you of your ability to stop using once you start using.
CNS: Well we’re not going to answer this question obviously and its an ongoing one, obviously it is a philosophical as well as a mental question, a mental health question and we’re just going to continue looking at it, I guess and, do the best we can. I think it does help to talk about it and so thanks Darryl. If any of you have any comments or questions we would very much love to hear them. Go to our website which is cnsproductions.com and just drop us an email, ask a question, make a comment and we’ll try to reply or respond as possible. Thank you very much Darryl, talk to you soon.
Darryl: Thank you Howard
CNS: That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com
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