Sunday, May 22, 2005

Post traumatic stress disorder disorder


Just back from my short course on treatment of drug addiction, more of which tomorrow.

Interesting anecdote the first: They (the detox unit) used to do full psychiatric assessments of people who were going into methadone treatment - a series of screening questions to work out which of the patients might have depression, schizophrenia, anxiety disorders, etc. There's a lot of mental illness in the drug using community, although no-one knows what causes what - does depression cause you to take drugs or does drug-taking cause depression?

Anyway, there were some questions about post traumatic disorder, things like "have you ever been the victim of an assault" "Have you ever been in a motor vehicle accident" "have you ever lost anyone close to you". Almost all of these things have happened to people who are on opiates, they have several centuries worth of misery crammed into a few years.

Well, people kept getting traumatised by the questions designed to test them for post traumatic stress disorder, and eventually someone completely fell apart while reading the questions and ended up having to be sedated and taken away to hospital (which further traumatised other people watching). After that a meeting was held and it was decided that even asking about trauma in our patients was too great a cause of trauma, so they stopped asking. So now when someone says "How many opiate dependent patients have symptoms of post traumatic stress disorder", we have to say no-one knows. Essentially the diagnosis of PTSD vanished. From one point of view, everybody with PTSD was cured.

But (and this is the weird bit) he said it didn't affect much anyway, because treatments for PTSD are "notoriously shit" and they were having pretty much zero success anyway. So going from a hundred people on the unit diagnosed with PTSD to zero didn't really make much of a difference - either to the patients or the doctors. The patients went from getting "notoriously shit" treatment which didn't help, to getting nothing. And as far as the doctors were concerned, the patients were just as sick for just as long whether you treated them for PTSD or not. To a real extent, PTSD ceased to exist in the detox unit.

So what does this mean?

Reminds me of that whole 'the only meaningful definition of a disease is "something that doctors or drug companies have a treatment for."' thing.

My youngest son used to be shy. He blushed and spoke in a small voice in front of strangers, and hid in his room when the next door neighbour (a very tall man with a loud voice and a propensity for practical jokes involving dead animals) came over. Luckily he outgrew this.

But a few years back the drug paroxetine was authorised for the treatment of social anxiety disorder, and what was varyingly a characteristic or a character flaw or a vice became a disease. Previously it had been hardly diagnosed -because there was no treatment. Now he would have social anxiety disorder.

I don't know. Some days I imagine my descendents at some gathering, the family picnic on Titan or something, and my name comes up in passing, the way great uncle Sam's does now - once a decade or so. And one of the more smartarsed amongst them will nod and say "You know, looking back on it, it's quite clear the old bastard had pretty severe CAD* - but nobody even knew about it then."

And my great-great-great grand-intersex will smile and nod and say "It's explain why he was so bloody unpleasant. He could hardly frinkle for a minute without blurding."

"Poor old male" one of my more sentimental progeny will say - this one probably an attempted clone of me from some material found in a hanky when they excavated my room, and thus half composed partially of human cells, partially of cat hair. "Imagine what if must have been like, living like that. Great Grand-robot said he wouldn't get treatment, refused it right up to the end. Not even a minor personalitectomy."

"No wonder all the old people had to be put in those geriatrighettos, on Venus," says my great grand-daughter, a cybernetically enhanced piece of seaweed. "I remember the day the trialobytes came to take him away. It was quite unpleasant. "I'm not going to some prison," the old galah shrieked. "It's not prison," said the trialobyte. "It's quarantine."

Okay. Bed-time.


*Catchy acronym disorder, obviously


Anonymous Camilla said...

HA HA HA HA HA HA!!!! That (the end bit) is bloody brilliant.

The rest is quite scary. Administering drugs for something that's a normal (IMO) part of growing up? Argh! I think we're in danger of medicating humanness out of existence.

The health system is sometimes a bit like a hypochondriac who's got hold of a medical dictionary. A headache becomes a brain tumour.

8:33 AM  
Blogger Benedict 16th said...

Nah,. you got it all wrong...
"Reality is for people who can't handle drugs",
that would include Paroxetine and Heroin.

Actually, there is a big opportunity here --> Heroin (© Bayer) as a treatment for PTSD!

5:29 PM  

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