mental illness

[altar]

Dear Dhamma Wheel,
I find the some of the following, which I was once directed to in a thread, and appears in the terms of service, disheartening:

-- Members who are suffering a serious mental illness should seek diagnosis and treatment from a qualified medical professional within their community. Members who are suffering from an acute phase of a mental illness, including intention to self harm and/or suicidal should seek immediate assistance. http://www.befrienders.org/index.asp
-- Members who are experiencing an acute phase of mental illness or suicidal ideation welcome to seek referral to medical and crisis services from administrators and moderators.
-- Members are asked not to use Dhamma Wheel as a platform to express intentions of self harm or suicide, the experience of voices or other hallucinations or other artefacts of acute mental illness.
-- When encountering a member suffering an acute episode of a mental illness, we should treat that member with compassion and refer that member to medical/emergency services within that person's community and to Dhamma Wheel staff.

The third section is fine I just included it because that's how it's displayed. I guess I'll go through this point by point.
"Members who are suffering a serious mental illness should seek diagnosis and treatment from a qualified medical professional..." Many people who are diagnosed have worse lives because of that diagnosis, many are significantly harmed by treatment, and psychiatry very much harms the lives of many. Many reports from people with experience in this area indicate this, as do some studies by "professionals." That people are encouraged to ubiquitously point people down this potentially very harmful path, discouraged from warning them about the dangers, blindly looking to those labelled professionals, is, I think...crazy.
The second section is similar. It might be sensible if people were asked to refrain from all sorts of advice regarding mental illness. However, as it stands, people are asked to forgo any honest advice they might have and only point people towards professionals.
The fourth section is similar.
Particularly strange to me, given that this forum caters to people who appreciate the dhamma, is that the dhamma is not recommended as a cure to mental illness, that capable monks are not listed as agents of help, and that professionals, who often use methods quite contrary to the dhamma, are suggested.
On a final note there is (no small amount) of evidence that modern psychiatric care intensifies and prolongs the very things they intend to help. There are many similar points that can be made, but I think for now I'll leave my case at this.
Please respond if you care to.

Thank you,
Zachary

[Annapurna]

Zachary, I hope this doesn't sound uncaring, but forum staff and members are not a hospital nor proper medication when people are hallucinating, suicidal or a potential threat to others through severe illness phases.

We are not skilled enough to deal with people who are seriously ill where ONLY medication can reduce the onslaught of hallucinations or great desperation, I am sorry I have to say this.

Compassion and loving kindness and the dhamma are certainly very very helpful, but there is a time for everything and somebody psychotic or depressed may not be able to catch it online.

Like, when somebody breaks a leg, he needs surgery, and the medication he needs, like antibiotics, may have very bad side effects for a while, but this shall pass too. ..

And while recovering, he may study and find out how to avoid circumstances which bring him back into the hospital.


See?

Kindly,

Annabel

[Cittasanto]

it isn't an appropriate place for a number of reasons!
people come here to discuss Dhamma topics, not help people suffering mental health problems,
too many cooks spoils the broth! or to many therapists not enough therapy!
it could alienate members, or side track the focus of the forum,
some inconsiderate members could taunt or try to belittle members with mental health conditions (for what ever reason), or pretent to have one in order to make fun of others compassion thus make it unlikely those who actually need it are believed or members end up being fed up and ignoring these types of posts,
legal consequences for the forum 'staff' & 'owners'
the forum isn't a mental health advisory, and the advise may not be appropriate for the person thus have consequences.
discussing mental health treatments on an open forum where the person involved is present would not be the best way to go about it,
There are organisations which have treatment focus both one to one on-line/telephone and in real life which are better equipped to help those looking for help, both legally and in resources.

The moderators and administrators may have other reasons but I think this covers what was mentioned when these TOS were outlined

[altar]

All,
I think it's fine that people are discouraged from discussing these things here, and that they are encouraged to find help.
What I don't think is right, is that it is the policy to blindly point people to modern psychiatry and psychology etc., for this help.
Also, the comparison to surgery does not hold too well because, as far as I know, most modern surgery is able to achieve what it claims, is helpful, and doesn't interfere with dhamma practice, whereas modern psychiatry and professional help is often harmful, often doesn't do what it claims, and does (maybe not always) interfere with dhamma practice.
My suggestion isn't that people no longer be discouraged from discussing these things here, or encouraged to find help.
It is that, if people are allowed, and encouraged to point to modern psychiatry and professionals as the best help, pointing out--even highlighting--the downsides of these methods should not be forbidden.

Annabel, you mention

We are not skilled enough to deal with people who are seriously ill where ONLY medication can reduce the onslaught of hallucinations or great desperation, I am sorry I have to say this.

However even people who prescribe these medications have very poor success with and very little knowledge about these medications, and when and where to use them. My main concerns are mentioned above, so I won't get too into the drugs now, though they are very much related, but if we get into the drugs, there is a wealth of information about how harmful they are, and how they often make people have more problems and exacerbate the old ones. Also, if one wants to reserve medication to times when only medication is helpful, if it ever is, modern psychiatry and professionals should be avoided. Hospitals use them not only when they are necessary for subduing a patient, but use them almost immediately, often without having seen a doctor, on harmless patients. I think outside of hospitals they are encouraged in the absence of hallucinations. After being put on them, patients are usually discouraged incredible amounts, or forbidden, from getting off of them for months or years, even in the (numerous) cases with bad reactions.

And while recovering, he may study and find out how to avoid circumstances which bring him back into the hospital.

Actually, there was a study that showed that people in under-developed countries, who presumably get less of the kind of treatment suggested on this forum, have a much lower rate of being put back in hospitals. Some popular mental health organization doubted the study, did their own study, and found the same thing.

Zack

[Cittasanto]

hi Zack
People aren't discouraged from discussing these issues here [but it has to be in an appropriate way] they are discouraged from seeking help here, they are however pointed to somewhere where they can recieve help! the medical profession has problems in every area, it is unavoidable due to the very nature of medicine (including surgery) but it is completely inappropriate to send someone who needs urgent treatment or prolonged treatment to somewhere namely for the legal reasons I mention above!

the TOS are there so people go to [are directed to] somewhere where they can get help, not for speculation on where they can.

EDITED in [...]

[altar]

Manapa,
For the most part this sounds okay, however an attitude has been espoused here, including by a moderator, that people here are not able to give advice on this issue, however advising one to seek assistance from doctors seems regularly permitted or encouraged. Doctors in this case means psychiatrists I think. I think this results from unfamiliarity with just how our modern psychiatric system works and ignorance regarding how deficient and harmful, and misinformed it is.
So, some kind of rewording of the TOS might be a good idea, otherwise I guess leave it as is...
Zack

[Cittasanto]

Hi Zack

Manapa,
For the most part this sounds okay, however an attitude has been espoused here, including by a moderator, that people here are not able to give advice on this issue

this is a theravada Buddhist forum, where related topics, and practice is discussed, it is not a mental health advise board which talks about how best to treat and advise people, or for 20 people to give 20 differing types of advise with little or no background on the people seeking the advise.

however advising one to seek assistance from doctors seems regularly permitted or encouraged. Doctors in this case means psychiatrists I think.

Doctor would mean their Doctor, or other appropriate medical professional of that grade who could refer them to an appropriately trained service provider. but who would you advise people to see as a standard TOS? the TOS here is for general application, and if an appropriate service adviser was know to be in an area and a member advised their use to a member in the area I am sure that would meet the TOS.

I think this results from unfamiliarity with just how our modern psychiatric system works and ignorance regarding how deficient and harmful, and misinformed it is.
So, some kind of rewording of the TOS might be a good idea, otherwise I guess leave it as is...
Zack

this isn't a medical advisory board, it is a forum for discussing the Dhamma related to the theravada, the TOS are following generally accepted standards, advising members to direct people to their doctor, or mental health provider.
and there are three therapists that I know of on this forum (and a couple of students), and I am sure there are other medical professionals here as well, but this isn't the place for people to seek advise or anything else regarding treatment of mental health.

[Annapurna]

Hello, Zack,

it is obvious, that you have a bone to pick with psychiatric hospitals and specialists, perhaps from own sad experience, who knows, and no system is perfect, and you also may have points, but again, there is little or no alternative, and this forum is not it.

This forum is for dhamma discussion, and nobody should expect or seek sound mental advice here.

It also can't be given, -it is unprofessional and illegal to counsel strangers without a proper diagnosis, examination, etc.

I know a case of schizophrenia with a person ending up cutting his throat, because he refused to seek professional help.

The authorities of Vipassana retreats ask people to not attend if they are currently mentally ill.

I also witnessed only recently how a good friend lost it due to great pain, and became psychotic, like believing that member XY was actually the Dalai Lama, and she was advised to go offline, before she upset herself and others even more.

People who didn't know her took great offence, called her a troll, all the while we tried to help her go off line and seek help.

It was for her best, and she is back to normal.

[altar]

Annabel, Manapa, everyone else,

TOS are following generally accepted standards, advising members to direct people to their doctor, or mental health provider.

I guess I am suggesting that in this case the TOS deviate from generally accepted standards, in favor of a more helpful, realistic approach. Modern mental health systems often fly in the face of dhamma. I.E. heavy doses of very potent drugs, "positive thinking," self-affirmation, frivolous socialization, not thinking about death, and some more.

but who would you advise people to see as a standard TOS?

It doesn't seem necessary to advise people to go to one certain area. Maybe a close real life friend? Sangha? A trusted professor? A trusted doctor? A trusted employee/r? A parent? A sibling? An different internet forum? Maybe a PM to someone on this forum would be permitted--I don't know. If a person wanted help from here, to some extent it suggests that they are looking for advice that is by the dhamma, not merely the generally accepted standard, especially in this case where that advice could be harmful.

it is obvious, that you have a bone to pick with psychiatric hospitals and specialists, perhaps from own sad experience, who knows, and no system is perfect, and you also may have points, but again, there is little or no alternative, and this forum is not it.

It is often that only after something enters into one's personal life that they research it more thoroughly and become more acquainted with it, and with others who have personal experience with it. As for there being little or no alternative, that doesn't mean you should do it; bearing it out with patience may in fact be the best "alternative." Many systems might not be perfect, what I am pointing out here is that this system can be particularly harmful, and to direct people towards it is not a good idea. There are many places on the internet to find out what's good and bad about this system, places where you can hear about the practices of the companies involved, studies you can read, forums you can visit, websites where you can see thousands of patient reports, claims by experts, doctors, reporters, family members, etc..

The insistence that this is not the forum to do this sort of thing--I understand that. I'm just saying that the byline might be changed from "see a professional or doctor," and that in places where seeing a doctor is suggested, stating the downsides of this should be permitted.
Stating that people here are unqualified to talk about this sort of thing alongside suggesting one see a doctor implies that doctors are qualified to talk about this, when the case is that some might be and some might not be. The opinions among doctors alone varies so hugely, which alone is enough to suggest that if some of them are right, some of them are not. Therefore, find someone you trust might be better byline-advice than put trust in someone because of their profession.
The administration of drugs might seem a separate topic, but there is something of a mania of prescribing drugs today. Maybe someone should just put the fifth precept alongside the recommendation to see a doctor; if we talk about whether or not the medicines qualify as intoxicants, I think it could go on for a while without getting anywhere, so maybe the best thing to do is remind people of the precept so they can make up their own mind.
from,
Zack
metta

[Laurens]

I think those rules are in place simply because we are Buddhists, not doctors. If a person is suffering from mental health issues we are not qualified to offer advice. Because the majority of us are unqualified to treat or offer advice to people suffering from mental illness, it could potentially result in someone giving harmful advice (I don't mean that people here might offer malicious advice, rather that the person due to their mental health issues may interpret advice wrongly and this could create more problems etc).

I believe the most compassionate advice a Buddhist can give to anyone who is ill, is to say 'go to the doctor', there is no exception with mental health problems, just because we meditate doesn't mean we are qualified to treat them.

All the best
Laurens

[altar]

Laurens, I am not insisting that we are qualified to treat them (some of us might be, some might not). I am insisting that the mental health system's competency in this area be taken into question, or else not recommended. The techniques used today have poor success rates, and are not as tried and true as more physically related medicine. It is a simpler issue with physical health; the problem is more or less confined to the body. For instance, you have frostbite, you cut off the foot. In mental health, most doctors wish to treat the mind through the body. As for the other half--treating the mind with the mind; this is very much a part of the Buddha's teaching, so it's really not so inapplicable as people are making it out to be.
Even many doctors criticize common psychiatric practices.
I think that it is actually maybe necessary for someone to research modern psychiatry before recommending people go to them, and I would appreciate if people would take the time to do this before saying, "doctors are the appropriate place to go if you have mental health issues." Most likely they will find that it is not something as reliable as other fields of science, and that, whereas in some fields of science, I think, studies support their methods, in psychiatry, this is often not the case.
People are insisting that doctors are the right place to go. Doctors who deal with mental health are generally psychiatrists, I think. So I'm simply questioning psychiatrical practices, stating that they are often harmful and not in accordance with the dhamma, and people should not be pointed towards them [exclusively and unreservedly] as the by-line.
Zack

[tiltbillings]

The above replies very nicely point to why the TOS are in place and there is no need top repeat them.

I guess I am suggesting that in this case the TOS deviate from generally accepted standards, in favor of a more helpful, realistic approach. Modern mental health systems often fly in the face of dhamma. I.E. heavy doses of very potent drugs, "positive thinking," self-affirmation, frivolous socialization, not thinking about death, and some more.

Heavy doses of very potent drugs for someone actively psychotic may be far better than the alternatives. As for the rest, cultivation of healthier states of mind are very much in keeping with the Dhamma.

You might want to read through Jack Kornfeild's A PATH WITH HEART, given that he addresses some of these issues from a Buddhist perspective and from a perspective of one who has taught/done countless retreats.

[altar]

Heavy doses of very potent drugs for someone actively psychotic may be far better than the alternatives. As for the rest, cultivation of healthier states of mind are very much in keeping with the Dhamma.

Yes, they might be. Then again, probably just to bear out a terrible state is preferable to bleeping out one's mind during it (and risking developing other symptoms, or worsening current ones). http://www.askapatient.com seems to be a good website where you can get user reports on many of these drugs from thousands of people. Reports range from stellar to horrendous, and it would be my observation that based on this and studies [and friends and acquaintances], in general (because we are talking about general advice here, a kind of by-line), these drugs should not be used [except with extreme moderation, and certainly shouldn't be handed out like they are today]. If you don't know what drugs to search, common antipsychotics are abilify, lexapro, zyprexa, seroquel, clozapine, and geodon.
from,
Zack

[Laurens]

Laurens, I am not insisting that we are qualified to treat them (some of us might be, some might not). I am insisting that the mental health system's competency in this area be taken into question, or else not recommended. The techniques used today have poor success rates, and are not as tried and true as more physically related medicine. It is a simpler issue with physical health; the problem is more or less confined to the body. For instance, you have frostbite, you cut off the foot. In mental health, most doctors wish to treat the mind through the body. As for the other half--treating the mind with the mind; this is very much a part of the Buddha's teaching, so it's really not so inapplicable as people are making it out to be.
Even many doctors criticize common psychiatric practices.
I think that it is actually maybe necessary for someone to research modern psychiatry before recommending people go to them, and I would appreciate if people would take the time to do this before saying, "doctors are the appropriate place to go if you have mental health issues." Most likely they will find that it is not something as reliable as other fields of science, and that, whereas in some fields of science, I think, studies support their methods, in psychiatry, this is often not the case.
People are insisting that doctors are the right place to go. Doctors who deal with mental health are generally psychiatrists, I think. So I'm simply questioning psychiatrical practices, stating that they are often harmful and not in accordance with the dhamma, and people should not be pointed towards them [exclusively and unreservedly] as the by-line.
Zack

Ok, but despite what you think about psychiatry, it still doesn't make any of us qualified to give advice to people suffering from mental health issues. Having not needed to use a psychiatrist - I don't hold an opinion as to the ethics of what they are doing. My post was simply stating that the rules are there because the majority of us are not in a position to help people in that position.

Even if we posted what seemed to be sound down to earth advice, people who might be suffering with delusions or paranoia etc, can interpret things in the wrong way. This being the case, it is better for us not to interfere with the issue.

I have a friend who suffers from schitzophrenia, and he has had a huge amount of help from the mental health professionals, and they continue to help and support him. I don't think its far to say that it's dangerous to seek such help, cause I dread to think where my friend would have ended up without that care and help.

[Cittasanto]

Hi Zack,
the ToS are about Acute, severe, and dangerous episodes of mental health problems, modern mental health treatments don't fly in the face of Dhamma, even ultra conservitive monks with take morphine when a doctor prescribe it, and there are many approaches which incorporate or are conductive with Dhamma, some are MiCBT (Aus), MBSR (US) MBCT (UK if I remember correctly), Sati Therapy (Cz), Morita therapy (sp?)(Japan), ACT, REBT, and DBT.

The majority of people here are not therapists, or counsellors, myself having experience of mental health issues, and studied CBT (awaiting final results) for dhammic study purposes can honestly tell you severe cases of mental health problems need professional help, not a forum giving 50 different sometimes conflicting advise, or sugesting members put themselves in a potentially unwanted predicament of having to tell another member to back off.

[LauraJ]

I think it would be careless to try to give mental health advice over the Internet.

[Annapurna]

Dear Altar,

medication is not intoxication. It is a remedy. So it doesn't conflict with the dhamma.

You're certainly right that there are sometimes bad circumstances in our psychiatric hospitals, no doubt.

But we also have bad restaurants, where you catch food poisoning, bad lawyers, who lose a case and rip you off, and bad plumbers, who set your house under water.

Fact is, you have good and bad people in each profession, but you still need them sometimes.

You learn from experience. Sometimes you lose money, sometimes something else.

Perhaps it is a case of karma as well.

If people are unhappy with their therapy, it is up to them and friends and family to seek help elsewhere, but a forum really can't put disclaimers in the TOS...at least that is how I feel.

Mentally ill people can participate here, unless they upset members with suicide threats and their hallucinations that simply overchallenge and scare medical lay people.

I feel it is ok to tell members so and also to point them to people who we feel are better equipped to help, but of course we can't know details...

Mental illness is a sad chapter, yes, absolutely...and I can't really encourage alternative methods here as completely safe as well.

I could recommend healthy food, healthy relationships, feeling loved, hair mineral analysis, hormone status, homeopathy, (yes) etc, but we can't put those in the TOS, can we. Not really.

But thank you for your good intentions! May you be happy and have peace of mind.

[PeterB]

As a psychiatrist I can tell you that there as many psychiatrys as there are psychiatrists. Just as with mechanics, gym teachers and vets etc etc.

[PeterB]

I think those rules are in place simply because we are Buddhists, not doctors. If a person is suffering from mental health issues we are not qualified to offer advice. Because the majority of us are unqualified to treat or offer advice to people suffering from mental illness, it could potentially result in someone giving harmful advice (I don't mean that people here might offer malicious advice, rather that the person due to their mental health issues may interpret advice wrongly and this could create more problems etc).

I believe the most compassionate advice a Buddhist can give to anyone who is ill, is to say 'go to the doctor', there is no exception with mental health problems, just because we meditate doesn't mean we are qualified to treat them.

All the best
Laurens

I am both a Buddhist and a psychiatrist and there is no way that I would become involved in a discussion about someones mental health on an internet forum, except in the broadest most generalised form, and that would mostly take the form of referring them to medical help of a hands on nature.

[Monkey Mind]

I am not sure what the agenda of the OP was, but When I first read this post it touched on a concern I have.
In my therapy office, I've encountered people who refuse to take pain meds, psychiatric meds, even HIV or cancer meds because they believe to do so is inconsistent with Buddhist teachings. Most of these folks have been the "do it yourself" variation, I encourage them to seek monastic guidance. However, there is a Tibetan Rinpoche in my area who promotes an anti-med agenda. All I can do is shrug and say that's not what I learned in Buddhism 101.