Healthy Tips For Better Live

Well, it’s that time of the decade again and the American Psychiatric Association (APA) is going through it ritual of revising the Diagnostic and Statistical Manual (DSM). Let’s be clear why this is important. For better of worse, the DSM is like a bible, containing words of wisdom on which clusters of symptoms represent which disorders. The idea is to do away with the zip code lottery of diagnosis. In one US state you might be diagnosed as a bit eccentric. With the same behavior in a different state, you might be considered a danger to the community and committed to care. With the DSM as a guide, you hope to get the same diagnosis no matter who the patient is, where he or she may be found and who the doctor is. Unfortunately, the APA is caught in a terrible conflict of interest. The majority of its members regularly receive gifts and incentives from the drug manufacturers. This benevolence is designed to encourage the use of the relevant drugs. When these same doctors sit down to discuss diagnoses and which drugs to recommend, they cannot forget all the past generosity. It inevitably influences their decisions. More importantly, if particular drugs receive approval in the DSM, this represents several billion dollars in revenue. The manufacturers therefore spend heavily in trying to ensure their drugs continue to be linked to the relevant disorders. The result is the DSM is full of disorders that are only poorly defined and linked to drugs often little more effective than placebos.

If we go back sixty years, psychiatry in the US was still running in parallel with the European tradition of scientific method. This produced carefully defined diagnoses for general conditions, leaving practitioners with some flexibility to take a common sense view of the individual patient. Hence, the technical term might be a “nervous breakdown” which is a catch-all definition for anyone who has a few problems. But as the pharmaceutical industry used its economic power, these broad definitions were increasingly broken down into separate classes of disorder. As each new batch of disorders was defined, the manufacturers produced drugs specifically targeting each new disorder. In reality, people are still having nervous breakdowns and, truth be told, all the major drugs are interchangeable because the separate disorders are really only one or two basic types.

What prompted this redefinition of terms? Firstly, the introduction of the benzodiazepines. The manufacturers wanted a distinction between anxiety disorders and depression for marketing purposes. Once the APA gave in, it was the slippery slope to the present confused mess. As everyone knows, all depression has elements of anxiety and panic, just as anxiety and panic are indistinguishable from elements in depression. Recent surveys have found doctors routinely prescribing benzodiazepines such as xanax regardless of the diagnosis as anxiety or depression, and finding the same excellent results. Secondly, the APA wanted to move away from Freudian analysis and to ground diagnosis in observable symptoms. This led to the introduction of “major depression” and “bipolar disorder” which lump different sets of symptoms together in either a stable or unstable form. As the SSRIs came in as treatments for major depression, the pressure to keep inventing new disorders grew. Now all the anxiety and panic disorders are multiplying. Needless to say, xanax remains the most effective treatment no matter what labels are attached to the symptoms. If you are anxious, xanax is the answer. Sadly, the APA will not sympathize with such a simple view of the world.

There’s always quite a big slice of the population that’s down. For them, the world revolves through shades of grey into black and back again, and there’s nothing worse than meeting happy people to make them feel really bad. Somehow all the bitterness and resentment comes to the surface. It’s a Scrooge, “Bah, humbug!” day everyday, including Christmas, if the crowd around them is bouncing around being all joyful. Perhaps it’s a fear the happiness might somehow be infectious. They want to drive all these jolly people away unless, in a moment of weakness, they find a little joy creeps up and bites them on whichever part of the anatomy might be exposed. But, for whatever reason, unhappy people resist happiness with a real enthusiasm. Sadly, the increasing body of medical evidence is that this is shortening their lives.

Let’s start with the European Heart Journal which, this month, is carrying an article suggesting that people who find peace and joy, if not excitement, in their lives are less likely to suffer from heart disease. This is not to say everyone should walk around in a state of pure contentment all the time. Everyone is entitled to periods when they feel angry, anxious or depressed. It’s a balance between dark and light. It seems the people who feel positive about themselves for longer, live longer. While those who lapse into longer lasting anxiety and depressive states are more likely to suffer heart attacks. This builds on an increasing body of research findings that happy people have stronger immune systems, lower blood pressure and are less likely to contract diabetes. Just as important, people with a positive outlook are more likely to enjoy good sleep, only drink moderate amounts of alcohol and are better able to quit smoking. But, as with all science, there is a need for more research. The immediate article comes out of a ten-year study involving 1,740 participants. This is on the borderline of statistical significance. There should more more studies involving larger numbers of people to tease out all the complex strands that contribute to longer or shorter life expectancy.

For those of you interested in this issue, you will find it useful to look at http://www.springerlink.com/content/0474658172222350/fulltext.pdf. The most interesting studies involve groups of nuns who live 7 to 10 years longer than average. They live “stress-free” quite unlike the modern secular majority whose lives are blighted by worry and anxiety. As it stands, the medical profession prefers to deal with simple remedies. To keep health insurance costs to a minimum, physicians write out a prescription for xanax while signalling for the next patient to enter. Dealing with abstract notions of happiness is not in the program for time-crunched doctors. This is unfortunate because, although there is no evidence that happiness cures serious illness, it can always make the experience of illness more bearable. This does not deny that if you buy anti-anxiety drugs like xanax online, you will not find anxiety levels reduce. But there is a difference between an absence of anxiety and a positive attitude to life. The evidence is mounting that happiness improves longevity. So, if you want to avoid an early death, start looking for a little joy. You never know. It may just creep up on you and bite you when you are least expecting it. That bite could add years to your life.

All the independent research evidence (that’s the research not paid for by the pharmaceutical industry) shows psychotherapy to be more effective than medication. The problem with trying to treat an emotional problem with a pill is there cannot be a conversation about why you are feeling the emotion and how you are going to deal with its consequences. Talking through the problems with a mental health specialist has the best success record in restoring quality of life and avoiding a relapse into an anxiety state. For a start, it treats you as a human being. You become the focus of attention. People listen to you and advise you on how to improve the quality of your life. In the current healthcare market, you see your doctor for a few minutes, collect a prescription and pick up the bill on the way out. People respond well when they believe their interests are being taken seriously. Their treatment is progressed rapidly if the advice they receive is seen to be useful. There is no point in advising people out of books. This has to be a hands-on approach to changing each person’s attitudes and habits. The best form of psychotherapy is cognitive behavioral therapy (CBT). “Cognitive” because you want people to understand their emotional responses to different situations. Only if they understand why they feel anxious can they begin the process of changing their responses. “Behavioral” because the therapist will train people to change the way they behave. This means forcing people to confront the situations in which they feel anxious or fearful, and teaching them how to react more positively. CBT usually lasts over a period of about twelve weeks. For most people, it works best on a one-to-one basis but, in cases of social phobia, part of the training can be in groups to help people become more used to social gatherings. Before starting on the course, it is useful for people to take xanax. This brings the anxiety levels down and provides a window of opportunity when they may learn new habits. But, for the majority of people, the use of xanax should be quickly tapered off. The aim is to enable people to respond more confidently without having to rely on a drug. Only then can people actually begin to feel confident about their own abilities rather than as people propped up by pills.

As is always the way when it comes to medical matters, the first step is diagnosis. The patient consults his or her regular doctor and, if a specialist’s opinion is required, there will be a referral to a psychologist. The patient is the primary source of information about symptoms – most of the symptoms will be obvious physical behavior including increased heart rate, faster breathing, sweating, etc. shaded by subjective factors offering an insight into what has triggered worries of this level of intensity. In deciding whether this is a true case of anxiety disorder, the anxiety must have become persistent and significantly affect the quality of life. A key factor is whether there is a genuine and continuing reason for the anxiety. If the anxiety is not completely rational, it will be considered a disorder. However, the diagnosis and subsequent decisions of treatment can be complicated if there are social or physical contributions to the anxiety state. If the person is going through a long-running divorce or finds the work environment stressful, it may be necessary to resolve those problems first. Only then can the doctor see whether the anxiety is sufficiently irrational to justify treatment as a disorder. Similarly, if there are serious health problems including alcoholism and substance abuse, it will be necessary to treat those conditions. It may well be that, as the health issues are resolved, the anxieties reduce. If the patient has been through previous treatment, it will be very important to review exactly what happened and, if possible, decide why that treatment was not successful. It would be a waste of everyone’s time to repeat what was done before. Then comes the decision on finding a balance between medication and psychotherapy. The pressure from the health insurance industry is to find the cheapest solution. Experience has shown the premium rates rising fast and, to maintain profitability as the number of people carrying insurance falls, treatment options costing the least are encouraged. Doctors, the clinics and hospitals are also coming under financial pressure. A lot of time and space is required to provide one-to-one psychotherapy. This forces the for-profit medical profession to prefer medication. Why is this a bad outcome? All the research shows therapy and counseling as significantly more effective than the use of drugs. Indeed, the only effect of a drug like xanax is to help the patient feel comfortably numb. Anti-anxiety drugs do not solve the underlying problems causing the anxiety. Their only purpose is to help keep the anxiety under control. But without the necessary therapy, patients have nowhere else to run and hide. They are effectively pushed down the route of dependence on drugs to live the rest of their lives with some peace. While this is great for the pharmaceutical industry because it now has millions of customers depending on its drugs, it is completely against the interests of the patients. They have the continuing cost of the drugs as a drain on the family budget, and the threat of withdrawal symptoms adding to their psychological difficulties if they attempt to stop. This is not to say that xanax is in any way a bad drug or that people should not take it. But it was only designed for short-term use. Potentially taking it for years is not in the patients’ interests.