the diagnostically homeless

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one of my special interests is mental health diagnosises and the people who fall through the cracks and are between diagnosises ( this may be in part to my various diagnosises over the years) i was wondering if any one would like to discuss these topics? here is an artical to read about one group of diagnostically homeless


http://www.jfponline.com/pages.asp?aid=856#1

(here is same article in pdf form)
http://www.currentpsychiatry.com/pdf/04 ... ticle2.pdf

here is another article about the the "classifications" of MCDD and MDI (the article is not reffering to boderline personality childhood borderline is an old proposed name meaning borderline between autistic / developmental issues and phychotic/ mood regulation issues
http://www.ahealthymind.org/ans/library ... erline.pdf

I'd like to discuss it but I don't have time to read the article right now or get my thoughts together. Just wanted to say I think it's an interesting topic.

Most of the homeless and mentally ill I encounter have schizophrenia and were not well enough to seek help themselves, or have refused help, and cannot be forcibly medicated or hospitalized unless they are disturbing the peace.

However I do know people who are physically ill such that they're not bedridden or completely disabled, however the nature of their illness is such that they cannot get a job because they are not reliable workers due to the nature of their illness. These are the people who fall through the cracks the most, because they are usually not considered disabled enough for government aid, but no one will hire them or put up with their unreliability.

My mother had this problem when she had uncontrollable hypertension. She would have seizure and stroke like episodes when her blood pressure would spike and had to be rushed to the hospital multiple times in one week and put on IV medications to bring her blood pressure down. She could not drive and also has severe osteoporosis so had to have someone with her at all times in case she fell, which she did on numerous occasions. She was not fit to hold a job in the eyes of an employer and yet was turned down for government aid.

People really underestimate how difficult it is to get a job one is capable of doing. Employers are really quite picky, and if they think you cannot be reliable for any reason, they will not hire you. People complain about those who get government aid and seem well enough to work, but then they turn right around and complain about the co-worker who was sick and couldn't come in, or became ill and had to leave early, or who does not work fast enough, cannot get their on time every day, or always has doctors appointments.

It is an interesting topic. Seems from the literature that many diagnostically homeless people are kids, and that these may be "prodomes" of later disorders? To what extent do people who don't fit in a category find themselves in trouble later on in life? I'm thinking that if you fall into this "category" (if you can call being categoriless a category) you're more likely to get little or no help, and end up struggling on benefits, jobless, and perhaps even homeless. Do people "grow into categories", or do you think people end up being pigeon holed in an effort to help them?

Both of the writers of that article work for drug companies, which to me does not make their views really valid. Diagnosing someone assumes that you can pigeonhole them and put them in this little box, do this for them and that will magically solve the problem. I can assure you that medicating the mentally ill is a total waste of money and resources. It assumes that medication can "fix" most people, that they have been diagnosed correctly and that once medicated these people will magically be able to go out and rent a property, get a job, etc, etc. Wouldn't it be nice if medication was that brillant. Anyone that thinks so is incrediby niave.

I live in a country with the highest level of forced mental health treatment anywhere in the world and the mere suggestion that you may have any level of mental health issue automatically gives a psychiatrist the right to forcibly medicate you with no appeals possible. We have "specail teams" that go out and inject the mentally ill each month and it has done nothing at all to help them, if anything it makes them worse. First episode patients are always fully housed when they are admitted to hospital and they all ALL discharged on compulsory community treatment orders. Yet over the same period of time they become more and more disengaged from society and more and more marginal and those that are on forced treatment are much more likely to be homeless than those not on forced treatment. Treatment here involves medication, thanks to submissions from US based NAMI to our governments. Parents have no right to consent to a child's psychiatric treatment and since children could never possibly give informed consent they are always involuntarily treated. We have forced ECT and that includes on toddlers, and each year a good 100 children under the age of 4 are given ECT. We have forced psychosurgery and the laws are in the proces of being changed to allow that to be given to children as young as 12, at present it can only be given to adults!! ! The fact is forcing medication on these people has only increased the symptoms of these people and made them more and more seperate from soceity and more and more chroncially ill.

I have gained from medication and have friends who swear by it, but the fact is MOST people do not. Research consistly shows that only a small percentage of people do well on medication long term and significant numbers show no benefits at all. There are no drug alternatives that are also much cheaper. That does not mean that medication should not play a role and I for one do not know of anyone who is totally anti medication, but we are very anti lies, and the fact is we are currently being lied to. There is no anti psychotic properties in any medications. What such drugs do is to act like major tranquallisers and sedate people so much that the voices are not such a issue for them. The problem is that people show the same levels of change on low and high doses and yet we continue to force them on obsessively high doses. For many people valium would do the same thing with signficantly less side effects. The other reality is that people do not relapse more often if they are not on med's and people on med's do relapse. Over 95% of our patients in hospitals are relapse ones that were on forced treatment orders and had had all injections. HOW can the medication be so effective if so many relapse when on medication. I can also assure you that significant percentages of people relapsing in the US are also totally compliant with all medication. In Europe people are on much lower doses, regularly have drug free periods, etc and they do as well if not better than those in more medicated countries.

Medication does not and nor will it solve everything, anymore than labelling someone will. People with exactly the same symptoms are regualarly given different diagnoses from different psychiatrists and the like. The amount of off label prescribing also leaves a lot to be desired. If these drugs are trely anti psychotic in nature then WHY are they given to every single resident of nursing homes, junville facilites, foster children and the like. You can medicate the whole world if you like and why not just add these pills to the water supply so that the whole world can obtain their benfits. I mean we add flouride to water to help with dental decay, why not antidepressants and antipsychotics and then we supposedly wont have any problems at all as the whole country will be medicated. And you know what, the levels of mental illnesses will not change, they will continue to increase and the level of disability of such people will also increase as it is currently doing.

The outcome rates for people diagnsosed with scrizophrenia today in the US are the worst they have ever been in history. They are acutely ill for longer periods are less able to function and more socially isolated than they have ever been. They are less likely to work than they ever have and much less likely to recover. In fact our definitons of recovery have changed in a very downward trend over time and that shows just how desperate we have become. It used to be that recovery meant returning to a full active life in the community, working in the open labour market at standard wages, marrying and raising children, studying full time, etc, etc. Now it means staying out of hospital for 6 months and yet when we refuse to admit people who are acutely psychotic then that is not hard to achieve.

There have always been people who were different, people who struggled to fit in, etc, etc. The rates of autism are not increasing, our diagnosis of it is. We are now diagnosing people mroe and more at the fringe. Whether such a label actually helps them is questionable. 30 years ago many of them were labelled as scizophrenic and if the DSM 5 task force has there way they will be again. They are proposing a psychosis risk syndrome the primary symptom of this said condition is social isolation. What this means is that they are proposing that we put every single socially isolated person on antipsychotics and that such drugs, while doping them to the point where they can barely work will apparentl make them normal and ensure they do not develop psychosis. I guess that means the whole world should also live permantley on chemotherapy so we do not develop cancer.

Perhaps if we accepted people as they were and put people in to actually spend time with them, just average lowly paid people and we might actually discover that some of these people do not have half the problems we thought. What happened to allowing people to be different. NO instead we now need to label them. If you are not good at maths you have mathematics disorder and yes there are people who claim that antipsychotics and antidepressants can fix that!! The fact is not all people are good at all things, yes we need to support kids as much as possible at school, but we do not need to medicate every single person who is not perfectly normal. As for normal, can someone please tell me what normal is and what all of these people are doing that is so abnormal.

In regards to homelessness the fact is we simply do not have enough low cost accommodation, and more than that suitable low cost accommodation for people to live them. We are very quick to label the mentally ill as mentally ill in some way and yet most people who ended up in the situations that they end up in would be exactly the same. Instead of blaming them for not taking medication, perhaps you need to blame the people who do not provide them with a place to call home!! How is taking a pill going to provide a person with a home if there are not enough homes to go around. Look at how the people were behaving who were left after hurricane katrina. They were going nuts yes, and for a bloody good reason, they had no where to go, no food, no water, no toilets, no nothing, would medicating them with prozac have helped them?? I think not. It was a very rational response to a very extreme situation. But these were people who had no families in other states and/or no money, so its very easy to see why they ended up as distressed as they were, no one cared and if we are to take this article seriously apparently giveing them prozac would have helped the situation!! !! !! We already know that over 75% of people who end up in the mental health system have suffered severe trauma, perhaps if we addressed that trauma they would not be behaving as they currently are.

All Psychological conditions overlap when it comes to symptoms. Etiology is going to really be key to sorting out the overly fuzzy world of psychiatry

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Perhaps we should review the list of people who have contributed something great and lasting to mankind, be it in the field of science, or art, et ceterra, and see how many of these people have been 'normal.' It is almost always (and I might dare to say always, without exception) the 'abnormal' person who pushes the envelope in the direction of progress, and achieves beyond what was previously thought to be possible, because to achieve, really, one must break the rules, "think outside the box," as they say, and the person considered to be 'normal' is always and merely the person maintaining the status quo, the person following all the rules, social and otherwise, of a particular society at a particular time in history. The definition of normal is arbitrary. The person considered to be 'normal' is, in short, the person who remains within the box his or her society has created, while the person considered to be 'abnormal' is always just the opposite. Is it possible that in the process of trying to 'correct' all of our 'abnormals' that we are inadvertently destroying all of our potential visionaries, all of our potential geniuses? We ostracize those among us with the most creative potential!

Try and think of one great artist in all of history who could be considered "normal" by the standards of his or her day. Go ahead, give it a shot.

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