Thanks Meg for sharing your personal story. When you mention the prevalence of depression in your family, it makes me think that depression is something that can sometimes occur regardless of any underlying psychological trauma or issues. Something that is even hereditary. And that makes me think that counselling may help treat depression sometimes, but not in all or even most instances. Sometimes there may be nothing to counsel, but ones mind is just not playing nicely.

The unfortunate fact is that meds sometimes have terrible side effects, and that even the best doctors can literally only guess at which ones will work for a particular patient, and use trial and error to find this out. This is the current state of the science of psychiatry, and I wouldn't call it a problem with the system. But on the balance, if the pros of meds (when the correct combination/dose is eventually found) did not outweigh the cons, people would not take them. Except in the sad scenarios where they are compelled to because they are committed to an institution or something :(

Meg Thornton:
" What I DO have, and what I think should count here, is a forty-year working knowledge of what it feels like to be living inside my head. I'm the world expert at that. "

Damn straight you are, well said. I think it should count here and I think as far as working with another individual human being or a small group is concerned, it does.

Unfortunately we have this category called Depression which is not understood yet. How do we tell the difference between Depression Because Someone was Really Mean to Me versus Depression Due to Something In the Water versus Depression Due to Some Family and or Medical Issue That May or May Not Even Start in the Brain?

The DSM in my view has never told clinicians how to do that. I know it's supposed to. I know this symptom is semi-arbitrarily not in this category but it does occur in these five other categories. But how to actually tell the difference is murky at best, so, I think some clinicians rely on their speciality and experience and have difficulty recognising when a foot that doesn't fit their shoe has walked in the door. That is true of all specialists, not just mental health workers. And I think there is a systematic problem here were specialists are living in their camps but the evidence is actually saying that patients exist in a complex reality where their bodies are part of and reacting to multiple camps.

But patients aren't always educated accurately how to navigate the jargon to communicate their expertise on how as an individual they are relating to each camp. And clinicians rarely have the time. Each doing their best (usually) hoping to flaming goodness it meets in the middle sooner rather than later, and works, while the rest of the world says Do It Faster You Need To Be Working To Make Other People Rich, having no idea just how big a struggle this stuff really is, and how rushing it is actually making these problems more difficult to fix.

That's not to say that meds are bad. When they work, they're awesome. Do they work is the question, and why. And more importantly, aAre they the best option for this particular person or does this person have a better idea, maybe they need to have a chat, maybe they need a social worker, or an immunologist, or a dietician, or a loan to move house, rather than a psychiatrist. Just because a person is depressed and depression is in the DSM it doesn't mean that depression is actually the illness or the cause of the illness. And it doesn't mean that it's not. Or that it's just one or the other. Yet the socioeconomic system seems to treat it as such, and rush to judgement, with clinicians and patients scrambling around it like rats in a maze.

Sue, I am usually deferential to your considerable knowledge around public health, but I take particular issue with your comment about people "being managed well on medication". The paternalism inherent within this phrase is the real crux of the issue.

The concept of informed choice is an illusion in the context of mental health. I find it concerning - no - abhorrent - that capacity to make decisions is removed from individuals by virtue of the fact that they have had a diagnostic label applied to their condition. Why is it acceptable for an individual to refuse treatment for a debilitating condition (like cancer), yet individuals diagnosed with a mental illness are deemed to have a "lack of insight" if they question the use of psychotropic medication? Equally, why is it acceptable to society that legislation exists to enforce pharmaceutical treatment of mental illness, but not similarly debilitating conditions like cancer? The psychiatric profession claims to have an understanding of client-centred trauma-informed care, but I would argue that the mere existence of Community Treatment Orders in this day and age refutes that.

For the record, I work with mental health consumers. Day in, day out, I hear stories about the significant detriment to quality of life that a significant proportion of people on antipsychotic medication experience as a result of the psychiatric imperative toward "medication compliance".

I am not anti-psychiatry or a 'wowser' by any means - I have qualifications in Psychology, and am undertaking a PhD in Population Health. I do, however, question the hegemony of psychiatry when there is unquestionable evidence within the psychopharmacological field that disputes the effectiveness of psychotropic medications in reducing symptoms - particularly in the context of psychotic illness.

Nevertheless, I respectfully seek your (and others') opinion as a clinician on the value of thinking about and moving toward the goal of recovery in terms of an individual's quality of life in more broad terms than just a reduction of symptoms. If this philosophy is, in fact of value to the psychiatric discipline, why the imperative toward medication as a monolithic 'treatment' for mental illness?