Should You Give Amateur Medical Advice to People With Mental Illness? A Flowchart »« LogiCon: The Little Convention That Could: Guest Post by Jason Bathon

Why You Really, Seriously, No Fooling, Should Not Give Unsolicited Amateur Medical Advice to People with Mental Illness (Or to Anyone, Really), Episode 563,305

Sigh.

In response to my recent post, “The drugs are hurting us more than they are helping us”: How Not to Talk to People With Mental Illness, Episode 563,304, I received this comment from one Timothy Matias:

Just my two cents:

“It is seriously fucked-up to undermine people’s [efforts to improve the lives of mentally ill people] for the sake of preserving their ” relationships with their health care providers.”.

Here’s a bit more than two cents, based on my experience:

[link edited out, since I don't want to reward him with blog traffic; if you really want to see it, I have not edited the link out of the original comment -GC]

Everyone’s entitled to their opinions. When you call them “fucked up” for expressing their opinions about medication, the only “fucked up” person is you!

This kind of closed-minded, self-righteous response is no different than a Christian telling an atheist that it’s fucked up to suggest that a person should quit God. HOW DARE they risk damning the person’s soul to hell because of personal experiences of feeling better living without God. HOW DARE they undermine the relationships and trust between Christians and their church elders and leadership?

This kind of closed-minded approach to medicine, and the application thereof, is nothing short of RELIGIOUS :/

I will say that again: I received this comment, in direct response to my post explaining why it was a bad idea generally to give unsolicited amateur medical advice to people with mental illness (or with any illness, for that matter), and specifically to tell people with mental illness to ignore their doctor’s advice and not take prescribed psych meds, and saying that the blog posts here discussing this matter were not the right place for these debates. (And yes, just to be perfectly clear, that policy applies to this post as well. Meta-discussion of how to discuss mental health care with people who have mental illness is acceptable (although I’ll be keeping a close eye on it); unsolicited medical advice to people with mental illness is not, and will result in the commenter being put into comment moderation.)

Sigh.

Okay. I’m going to spell this out as clearly as I possibly can.

Do you really not see the difference?

Apparently not. Okay, I will spell out the difference.

God from Monty Python and the Holy GrailFirst: There is a significant difference between offering your unsolicited advice about religion, and offering your unsolicited advice about people’s medical care. The existence of God is not a topic on which anyone is an expert. Some people are experts on religion, theology, apologetics, etc. — but nobody is an expert on God. You don’t need any special training to reasonably come to the conclusion that there are no gods. (The fact that nobody is an expert on God, and that nobody can say anything about God with any degree of certainty or hard evidence, is actually one of the best arguments supporting the conclusion that God does not exist.)

This is not the case with medicine. Medicine is a field where some people really do know more than others. Trained medical providers are very far from infallible, but they still know a hell of a lot more about medicine than Some Guy On The Internet. (It’s hard not to notice that the link you linked to doesn’t actually contain any research, or even any links to any research — it’s just your opinion.)

At the same time, medicine is a field in which some people have special training and expertise — but it’s also a field in which, by its nature, that expertise is often not precise or universal. This is especially true for psychiatry and mental health care. What works for one person often doesn’t work for another, and providers often have to proceed with some degree of educated trial and error to find a care plan that works for each particular person. Therefore, it is incredibly arrogant for Some Guy On The Internet to assume that they know what mental health care plan would work for me — better than my medical providers, who have detailed information about my particular condition and priorities and medical history, and better than me, who knows more about my condition and priorities and medical history than anyone.

It is depressingly common for sick people — people with mental illness, with chronic non-mental illness, even people with common colds — to get deluged with unsolicited amateur medical advice. At best, it’s annoying; at worst, it undermines your ability to make your own decisions, and your confidence in that ability. When you’re trying to make medical decisions for yourself, it’s already difficult enough without a barrage of uninformed, under-informed, and ill-informed advice filling your head. And it’s already difficult enough without advice that amounts to the message, “You’re doing it wrong. I know better than you. If you want to please me, you’ll do it my way.”

And for people with mental illness in particular, this is especially difficult. Mental illness has tremendous stigma, which people with mental illness often internalize, and we often (a) feel like we’re letting people in our lives down by having mental illness, (b) feel like having to get treatment for mental illness is a sign of weakness, and (c) are barraged with paternalistic messages telling us that simply having mental illness makes us incapable of making any decisions about our care. Unsolicited advice in this area is more than just annoying. At best, it is patronizing and demoralizing, which itself undercuts our mental health. At worst, it can lead people to make terrible decisions about their mental health care, with devastating results.*

Homeopathic Dilution RhustoxSo unless someone tells you that their health care provider is prescribing actual quackery (like homeopathy or something), or unless you have some crucial piece of information that you’re pretty sure the person you’re talking with isn’t familiar with (and “Psych meds are all horrible and nobody should take any of them/ the entire mental health care profession is borked and is not to be trusted” doesn’t count — believe me, we’ve heard that before), or unless you have some more substantial evidence for your position than “I know that the established standard of care is (X), but this one guy disagrees and wrote a book about it,” it is seriously fucked-up to undermine people’s relationships with their health care providers.

I absolutely want for there to be vigorous, rigorous public discussion and debate about medical standards of care — especially when it comes to mental illness. I am well aware of serious problems in the medical system (especially in the United States), and people speaking out about those problems is how they get addressed. And I understand that there is serious debate, even within the medical community, about how to best handle mental illness. I want that debate to happen, and I want people in the general public who are affected by the medical system (which is to say, everyone) to participate in that conversation. But have that discussion and debate in public spaces, where people agree to discuss and debate. Don’t shove it in people’s faces who are trying to make good decisions for themselves, and who haven’t asked you for your opinion. People who want advice will generally ask for it. If they don’t, then offer empathy, and shut your cakehole about how much smarter you are than they are.

Which brings me to my other point.

Second: Even if you don’t accept this difference between debating religion and debating medicine? There’s a difference between simply debating religion, medicine, or anything else — and doing so in a space where the host has specifically said that they don’t want these debates.

Yes, I am a big advocate of arguing with believers about their beliefs in God (for atheists who want to do that, that is). But even I don’t advocate telling believers, “You’re wrong to believe in God, here’s why,” in spaces where people have specifically said, “I don’t want to debate this.” There are plenty of other spaces for those debates.

You have every right to express your opinions about mental illness and mental health care. You do not have the right to offer these opinions in personal spaces, to people who have not asked for them. And you definitely do not have the right to offer them in spaces where people have specifically said that they don’t want to host that debate.

You have violated my clearly- and repeatedly-stated request about comments. I am putting you into comment moderation. Future comments from you will have to be approved by me before they are posted.

* Here are a few particularly eloquent things that other people have said on this topic in these discussions here.

Let me tell you what you’re really saying when you tell someone to stop taking their anti-depressants. You’re saying, “I don’t believe you.” You’re saying, “You’re weak for taking what makes you feel better.” You’re saying, “I don’t really care about how you’re actually feeling, even if these medications are making you feel better.” You’re saying, “My opinion is more important than your health.” You’re saying, “I am not someone you can rely on for help in these, or perhaps any, troubling situations.” You’re saying, “I need to be right. I need to have the last word. And I am willing to do this at the expense of your mental health, even though I’m now aware that that is an area in which you are experiencing problems severe enough that you and your doctor have decided to put you on medication. In other words, I don’t really care about you or how you’re feeling, and I am the most important person right now, and your actual problems don’t really matter to me.” Most of all, you are saying, “I am not someone who can be trusted.”
-Emma

I’ve had random strangers and acquaintances give me unsolicited advice — about my health, about my life, about how to handle my kids — and it’s always been rubbish. (Actually, so has a lot of the solicted advice.) When they realize I have no interest in taking it, they usually get all concerned (cf. SC’s “out of concern for you”) and try to get me to consider the possibility that they’re right and I’m wrong.

The thing is, I (or in some cases, my kids) are the ones who will suffer if they’re wrong, not them. If I listen to SC and stop my son from taking his Lexapro, and he kills himself, is SC going to give me my son back? No, he’ll make up some excuse as to why he’s still right. And I’ll be left with the funeral and the grief.

If I’m going to be the one who will suffer, then I’m going to reserve the right to decide what advice I’ll take. Random strangers who know nothing about me and who don’t have to live my life, but are arrogant enough to tell me I’m Doing It Wrong, well, they can just f— o–.
-AMM

You know, I really wish more people had cheered for the medicine, and fewer acted like it was a personal failure and a potential death sentence to take psychiatric meds. Because I’d still have a mother if she’d listened to her first and best psychiatrist, rather than the assholes who told her she could and should do without the drugs.

As it stands, I have a shell of what used to be my mom, living in residential care and never able to leave it. There’s nothing left of the person I adored. Just an echo. Her mind would still be intact if she’d stayed on her drugs. She didn’t, and now she’s gone.
-Dana Hunter

I get this same crap about my epilepsy, actually. I used to have a roommate who kept telling me he’d read about people who control their seizures via diet, and don’t use medication. Actually, that is a legitimate thing. It’s called a ketogenic diet, and it’s extremely restrictive. It’s kind of like the Atkins diet turned up to 11, and it’s usually used for children who don’t respond to medications, or can’t take them for some reason. People don’t understand, too, that there are a lot of different kinds of epilepsy, and each individual case has unique characteristics.

Same thing with depression. First of all, there’s this bias against anything that’s “not natural,” like medication. Second, with depression, unlike with seizures, there’s a certain feeling among people that if you don’t “get over it” by yourself, you’re weak, if not a spoiled brat. That stigma allows people to feel a lot more liberty in giving their advice.

There is a little bit of hypocrisy, here: I was resistant to taking antidepressants for years, partly because I’m already taking so much crap for my seizures. My GF is the one who nudges me to keep taking the antidepressants, even though my brain is totally okay with them in theory.
-Chris Hall

Thank you so much for writing this. My sister has severe problems with mental health (something along the lines of bipolar and schizofreny, we never got a definitive diagnostic) and between bad doctors and her own distrust of medicine, it took having a psychotic break and getting interned in the psyh ward for her to start getting medication. And yes, it zombified her at first, but for the first time in my life i felt like my sister was there, lucid, listening to people and not living in her own closed off world.

Then she got a boyfriend who convinced her to stop taking her meds. I tried and tried to talk her into at least going to see a psychiatrist, to no avail…and now she’s back at the psych ward, worse than she’s ever been, sleeping in restraints and has slipped from a prognosis of “needs therapy and meds for all her life” to “will never be stable enough to live alone”.

Mental illness is a bitch. You wouldn’t tell a diabetic to stop taking insulin (I hope) so don’t tell mentally ill people to stop their meds!
-quanticsakura

This is about unsolicited medical advice. I have a number of chronic physical medical issues….the most oppressive and persistent being my adult-onset NON-allergic asthma. Because of substantial use of prednisone to dampen my many and prolonged flare-ups, I now have osteoporosis and avascular necrosis (a condition in which blood supply to the bone is cut off). The latter led to a hip replacement and a revision of the replacement…all in less than 12 months. I have several other medical conditions that impact my life. But what drives me bonkers is the onslaught of “advice” one receives from “well-meaning” people on how to treat or “cure” my issues. Most of what people tell me is pure non-scientific bunk (I am a proponent of evidence-based medicine). And while western medicine is not perfect (or else there would be better options than prednisone for folks like me…..but the logic is that you have to be able to breath and stuff like hips can be fixed)….I still think it is the best option available. I do not have the energy, money or health to gamble on all the quackery people throw at me, some of which could be potentially harmful. I don’t care if “X cure” worked for your husband’s uncle’s friend who allegedly has what I have. I have lived with my medical issues and know what has and has not worked for my particular body.
-shortwind

What she’s warning against is giving unsolicited, inexpert advice to vulnerable people whose health could depend on following the professional advice they’ve received. That’s a completely different thing to saying “everyone should always have blind faith in authorities”.
-Silentbob

Comments

  1. Philip Hansen says

    I was that guy when I first got “into” atheism. I found axp, joined an atheist group on facebook and got into a lot of vigorous debate, where it was due. A lot of members from fundie groups came to drop big passages of nonsense under various topic forums on the group page, and eventuelle I started going to their groups to give my two cents on every little conversation they were having. I did not, at the time, how stupid, brash and invasive that was, and today I am not very proud at all, of being a prick so full of his own newfound hipster-intellectualism that I had to tell the entire world. I think my weakness, to indulge in skepticism/atheism superheroing is something present in a lot of other atheists and skeptics, and obviously in this case, where what could easily be construed as a need for validation and BRINGING THE REASON becomes harmful and invasive.
    Hopefully the commenter learns that there really is still, religion or no religion, a time and place for everything.

  2. says

    Many many years ago, when I was fairly newly sober, I “sponsored” a young woman who had been diagnosed with schizophrenia and prescribed anti-psychotic medication. The medications had horrible side effects, and when she talked about them, random people in AA meetings would tell her that she should stop taking them and rely on God. I told her to talk with her psychiatrist.

    She stopped taking her medication, had a serious paranoid psychotic episode, and killed herself.

    Her name was Nancy Sullivan. She taught me a lot about not giving advice outside of my expertise and about being quite conservative about what my areas of expertise actually are.

  3. says

    As someone who also suffers from mental illness (PTSD, anxiety and depression, to be precise), I can relate. I know that people mean well, but my illness is not their soapbox.

    What I find most annoying is that these people almost invariably take it personally if you don’t immediately take their advice. The fact is, I am more likely to trust the opinion of a trained and experienced medical professional than some random person not involved in any form of medicine.

  4. says

    I’d like to propose a new logical fallacy, the “I’m rubber, you’re glue” fallacy. It’s a fallacy in which a person in a position of privilege, cannot see their own oppressive behavior and views any discussion of it as a reciprocal form of oppression.

    Example:

    You can’t call me a misogynist for liking women to be ladies and not [some gender slur]. That’s misandry.

    Why do all these [racial slurs] get preferential treatment at work now. It used to be that hard working white people could get ahead on their own merits and now I have to compete with this affirmative action. This is racism.

    This public school had a Christian prayer, every morning, over the loud speaker and a painting of Jesus in every room. Now the ACLU is making us stop because a few godless heathens objected. That’s religious persecution!

    And of course, the message you quoted above, because random internet dude’s right to feel like he’s helped you with your mental illness is more important than your right to be able to set boundaries about what you want to talk about and when, and if you don’t grant him an open platform to treat your illness over the internet, you are dogmatically oppressing him, like religion. Yah!

  5. Anne Marie says

    When I was 14 and going through my first bout of depression, I confided in my best friend what was going on. She said that she hated to tell me this, but it was just “teen angst” and said something about me being a statistic. She had also made or went on to make a bunch of anti-psychiatry remarks (not sure on the timeline for this part). I was depressed to the point of not really having emotions or feeling human anymore and she just declared me to be a melodramatic teen. It stung – especially since guilt was such a big aspect of my depression. How could I be worried about depression when it was just typical teen angst? I must be a terrible, uncaring person.

    Thankfully, my relationship with my mom stayed strong despite it all and I decided my friend was wrong and that this was something atypical. Her willingness to play psychologist/psychiatrist could’ve been devastating if things had gone differently. I started going to therapy and took my first psychiatric medication 13 years ago. Things haven’t always been easy, but I’m so grateful that my parents listened to me and trusted the experts treating me. It infuriates me when people lecture about the horrors of psychiatric medications because I just think about what my life was and could’ve become without them.

  6. patgreene says

    Thank you for this post. There is so much stigma out there, and armchair psychiatry just makes things worse. I have had people argue about whether I should be taking medication (and which ones), and even try to argue me out of my diagnosis — “how can they be sure your bipolar? You’ve had a lot of trauma in your life, maybe that’s causing your symptoms.” Not to mention the “just deal with it” people — including one of my in-laws who told my husband after a psych hospitalization that I was merely being “lazy” and that I was a bad influence on my children.

    And let me not get started on the people who respond to legitimate expressions of anger (i.e., actually caused by something) with “you seem angry. Did you take your meds today?”

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