Changing MENtality

Talking or Taking Meds?

December 14, 2020 Season 1 Episode 9
Changing MENtality
Talking or Taking Meds?
Show Notes Transcript

In this episode Aidan, Euan and Ben discuss the different approaches to mental health care, the science behind them, the current state of the field, their own personal experiences and how we can move forward

Find other episodes and our social media links over on: https://changingmentality.buzzsprout.com
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If you were distressed by any of the content in this episode or feel you need extra support, please find  some further resources below:

  • Student Space–Online, one-stop shop’ for students in England and Wales who want to find help for their mental health or well-being.
  • Student Minds website- Information about different support services available, including how to find them and what to expect when using them for the first time.
  • Your GP Service- can refer to specialist support and services.
  • University Student Support Services e.g. counseling, mental health advisers, student advice centre, students’ union.
  • Samaritans-phone 116 123, email [email protected]
  • HOPELine UK-phone 0800 068 41 41: confidential service specifically for young people (under 35). They can offer crisis support for someone who is experiencing thoughts or feelings of suicide, as well as providing information and advice for those concerned about someone else.
  • Papyrus: email [email protected]
  • Students Against Depression- The Students Against Depression website has lots of information about tackling depression and low mood, including self -help resources and workbooks for students to work through to start taking steps towards tackling low mood.
  • NHS 111-Non-emergency line run by the NHS.
  • 999-for an emergency situation.
Aidan:

Welcome to the changing mentality podcast. This is just let you know that the following episodes contains personal experience of anxiety and depression, therapy and discussions of mental health treatment. If you're distressed by anything in this episode, please look into description where they'll be linked to find further support. Thank you and I hope you enjoy the episode Hi and welcome to the change in mentality podcast created in association with student minds and funded by comic relief and chaning mentality is conversations stories and interviews on the topics of men's mental health hosted by a group of male students sharing their own experiences to help eliminate stigma, raise awareness and signpost others to find the help they need. Today we're going to talk about the treatment of mental health disorders from a pharmacological perspective and a psychosocial perspective. So I'm with two guys today. And I'm just gonna bring them in to introduce themselves. So Ben, tell me a bit about yourself.

Ben:

I I'm Ben, this is my first podcast with Student Minds. I am a third year student studying psychology at Nottingham Trent. And I'll be taking on a psychosocial and therapeutic perspective.

Aidan:

Awesome and Eaun.

Euan:

Hey, I'm Euan McDonnell. I'm a computational biology PhD student based at the University of Leeds. And I'm taking the more kind of biochemical sort of a physiological perspective.

Aidan:

Thanks for that, guys. So just to give a brief introduction, we all know the prevalence of mental health problems in the population and the men generally. But I just want to take a minute for those who aren't psychology students are not as well versed this to explain what those two terms mean. The pharmacological approach to mental illness basically suggests that those who have mental health issues experienced this as a result of altered chemistry and structures in the brain. And the overall point or goal of this is that if we figure out what goes on in the brain, which causes these experiences, we can target them using medication. So an example is you can take a pill if you're feeling anxious, and you will no longer feel anxious. But this psychosocial approach is kind of the traditional therapy or what everyone thinks of when they think of psychology, talking about and sitting with your problems and following a certain model to have relief. For full disclosure, we're each gonna pay our individual positions on these approaches and mental health. So for me, I am leaning socially. So I go for more of the psychosocial interventions believe that's more effective. How about you, Ben?

Ben:

Yeah, the psychosocial approach is certainly what I'm looking to go into for a career. But I still recognise its limitations. And how the pharmaceutical modelling SSRIs and drugs and all that type of stuff can help a lot of people. For a lot of people, you need to have a phenomenological intervention before he can get them into therapy. That's my position, I'm, I am biassed towards thinking that therapy is going to be what solves problems, if that's a word that we can use here. But I do realise that biomedical model approaches are there for a reason.

Aidan:

So basically, your position, we can have an interaction between the two. So pharmacological intervention can actually level someone out, so to speak.

Ben:

Yeah, I think, um, well, if we're taking the straight up biological approach from it, then most of the issues that we encounter in mental health are going to be hormonal and neurological, which I'm sure Euan will talk about more later. And so we're going to need biological and physical ways to, to, to adapt those bodily functions, rather than just sitting down and talking about it. Because there are some physical things that we just can't change by talking about, you know,

Aidan:

Euan?

Euan:

I think I'm quite similar, though I'm sort of supporting the biochemical argument, I do sort of say a bit more in the middle and maybe even lean a bit more over to the sort of psychosocial argument partly from the sort of reading and understanding I have of antidepressants, and then the under talking therapies, but then also from my own experience of what actually ended up eventually helping me. And I think, I think antidepressants have a real, they really have a lot of usage, and they do help a lot of people and there is some solid science kind of underpinning their effectiveness. But they're almost in a way, like a kind of symptomatic treatment to a problem that like, I think, leading back to what Ben was talking about, it's difficult to say solving or curing, but it's kind of antidepressant seem to be much more like a topical solution to help you through the day or help you to get to a position where you can then function better, which will then help you bring you back and pull you out of you know, the condition that you're dealing with at that point,

Aidan:

just so we're clear, and we're close. opposition's to ensure that everyone listening is aware of our own potential biases is we're not medical professionals, as we've stated we're students at different stages of our academic career. And we just didn't want it to seem like we're favouring one intervention over another. But start off our conversation I'm going to put in bed who is going to talk mainly about his position and research around it.

Ben:

Yeah, we are not doctors. And so basically, what my area of interest is, is mostly humanistic psychology. A lot of people take issue with humanism, because they might not think it's a real science, which, fair enough, I can understand that argument. But in therapeutic aspects, it certainly is one of the most applicable along with stuff like Cognitive Behavioural Therapy. Client centred therapy is the humanist approach. There are whole different avenues you can get into therapy and that people who are struggling with, with serious mental illnesses can can be helped by therapy. But a lot of the discussion that I'm thinking we're gonna hang around, because I'm sure that a lot of people understand more or less what you do in a therapy session, you go in and you sit down, and you talk about your problems, that's more or less the gist of it. But where a lot of the nuance comes into it is more about the relationship between psychology and therapy. Do you need one to do the other? What's the role of, for example, philosophy in in therapy? How did therapy come about? How did it originate? And then you can talk about more like the relationships between clients and therapists, some people call clients, patients, you can use very well that it doesn't really make a difference. And you can really just get go really in depth with what people kind of expect from therapy with using the word solve and cure for mental issues, but just therapy really do that, is it a pathway to actually solving illness? The evidence doesn't really support that, because it seems that nothing ever really goes away. And that's something that I find really intriguing about therapy is that you can do it forever and ever, and always find new things. And I think that's a really an important difference between the biomedical model and the psychosocial model. Because with SSRIs, if someone's got depression, you just chuck it, Chuck SSRIs at it, and supposedly, according to the biomedical model, that should do it. But we know that that just isn't the case.

Aidan:

Well, we see all of that with the continual rise in rates of mental health issues. If this biomedical model was true, we already had all the answers, you could arguably say that mental health would be eliminated. What mental health problems sighs, something I just want to come back to you. Is that you said, like, does it solve or cure mental illnesses? And where you've kind of come to conclusion from what you've read? Or in the work that you've done, that it never really goes away? Is that something to be concerned about as someone with a mental health issue? Or is this actually a positive thing, even though it seems quite negative,

Ben:

I don't think there's always such a necessary necessity to valence things in that way. Just because something exists doesn't mean it's good or bad. It might just be something that the person has to work around if they find it uncomfortable, or if it's getting in their way. For example, someone with depression, there's a thing called functional depression, where they can look normal, they can go about their entire daily life. But all of the functional stuff, like I say, decision making all of those processes are hindered. But they can still more or less work through them. So there's that aspect to it. But a lot of it is also schematic. So I suffered from depression from a really early age, and I still have the schema leftover from it. I still am quite prone to despair, if I'm being honest. And that's something that I had learned from them at the time when I was actually fully depressed. It was terrible, obviously, and I sought help for it. And but now that I have been left with this schema and the thought processes leftover, I realised that I wouldn't be who I am today, if I hadn't been through those experiences. I think that um, a lot of men in particular, who try and push themselves expand their boundaries in that way might be able to relate to that a lot. I think a lot of people are quick to call something good or bad. And I don't think you should treat mental health in that. way, I think that there is a much wider application for therapy, when you take into account that not everyone is going to find the same things good. Not everyone is going to find the same things bad. For example, cultural differences. If you've got people in China or India, which have got some of the most developed biomedical models, and they're the populations, which are kind of prone to mental illness by Western standards, then that's just not right, because they're not going to be measuring it in the same way. And I don't think it can always be a clear cut. This is what's meant health. This is what's bad mental health, I don't think there's such a necessity and necessity for that clip, by definition,

Aidan:

I get the impression that's quite a radical view, in contrast to the biomedical model, because as someone with depression, anxiety, I've always been taught that there's always a cutoff point, like this way of acting or living in that regard is good. And that is bad, obviously, then that's been pushed by the biomedical model, because you get the impression that you're trying to push a scale score under certain thresholds. And suddenly, you're well again, but however, I'm hearing that you're saying that that's not the case, for the humanist approach, or even the psychosocial approach to mental illnesses, what do people expect? What will happen when you go into therapy, because we've all got this typical viewpoint of like, before you can go and lay on the couch and let everything go. But what do you expect in an actual therapy session?

Ben:

Yes, it's good that you mentioned Freud. Cuz he's you we based off of all of our Western therapy, essentially, obviously, you can make a linear history of it all. But he was really kind of the revolutionary for it, whether he was good or bad is up to your own discretion. Um, but when people kind of go into therapy, a lot of the time they might expect the the counsellor or therapist to tell them what to do. And to, like we say magically solve all their problems. But we know that's not, that just doesn't work. Because if you want something like that, you can go to a guidance counsellor, who will just give you advice. And I read this book by someone called Urban yalom, at the minute, who's a really big psychotherapist. And he basically explained what he does in his processes are, someone comes in, he will sit down with them and learn about them. And he'll do what he was trained to do, he will do the psychoanalysis, he will go through the psychotherapy, and he'll look for all the hidden meanings that come up in pop culture, you know, not to say that pop culture is relevant. But there is an aspect of you go in and talk deeply about your problems, and your therapist kind of lives through them with you. That's what the therapist is trying to do. But then after that, the therapist might start to give advice, if the person is resistant to the treatment into the therapy, if they're just not having or they're not kind of understanding what the therapist might be explaining to them about all of the unconscious processes, then the therapist might just give them advice. And yalom explains how you combat if the person isn't responding to that either. They're not following what the therapist is explaining to them, then Yellen will just beg and say, Please, this isn't working. You know, that's what he explains in his book loves execution. I fed him wants to read it really good. Yeah,

Aidan:

it's funny your you mentioned love execution, because actually what I'm reading too, so you're saying is that in therapy, the therapist guides, the individual through experiences and helps them process it in a different way. Rather than being this all encompassing figure who offers advice and tells them exactly what to do.

Ben:

Yeah, I'm a guide is, is an appropriate term. And it's one that is used in therapy a lot. But I'm more than that what the therapist is doing, because obviously have to be really empathic to be a therapist. What therapist is doing is in vitro, which means basically imagination, trying to relive and go through the experiences that the client is telling them. So if the client saying I'm, I'm coming, I'm really depressed, I can't get out of bed in the morning. And I think this is the reason why. Whatever the client says, The therapist will just let all of that information flow through them. And they'll wait to hear the what's called the client's kind of true voice, and they'll try and find that moment where they can kind of pinpoint our start to explore it, you know, so short, they can guide them through say, Oh, this is so clients, you're feeling like this. I hear you're feeling like this, when you tell me more about that. They can guide them in that way. Sure. But it's more about the listening and then employing the psychological tactics like okay, someone says they're depressed. I know about Beck's cognitive triad, for example, and I can implement that and use that to not explain in like, Okay, this is what you're feeling type of way. But in a more, is this applicable to you, if that makes sense.

Aidan:

So that was really interesting. Thanks so much for that. Ben, I just want to end by asking, how does this relate to men who say, haven't gone into therapy before, there's a lot of stigma around men's mental health? So say, for example, that I'm a man who has not had any form of psychosocial intervention before? And I'm about to head into a therapy room? What is sort of the knowledge that I need within myself? Or what do I need to be comfortable with, to be able to get the most out of these sessions

Ben:

is interesting to be talking about men, because I never want to act like a representative for all men. I'll just give my opinion on it and just say, okay,

Aidan:

that You are the supreme man.

Ben:

Oh, yeah, totally, totally. So I think it's really important that you find a therapist who is right for you. And if men are feeling that they only want to talk to men, or if they want to talk to a female or they want to a non binary, or other genders, counsellor, then they can do that you can go online, and you can find what appropriate for you. Most therapists will give all of their details about what type of things they practice and other clients they've worked with in the past. So all that information is out there, you can find therapists that you're interested in working with. Um, but kind of biggest thing is just don't be afraid. And if you are, it's okay to be afraid. And the therapist is probably seen it all before, and that they're trained to be empathic, and they're trained to look after you and they're trained to be okay with everything that you say, I've always said they wouldn't be doing the job, if they weren't equipped to handle anything you bring to them, then they wouldn't be doing it. I think that if, if a man is going to go into therapy, and he's really, I don't want to do therapy, I've never wanted to do therapy, I'm here, because I've been told to then go in with that mentality. Honestly, I don't think you should try to suppress any feelings for the top accomplish a goal in therapy, I think therapy will kind of take its own path. And the the men who might be hesitant to go to therapy, that's perfectly fine. Once you're there, it will probably go well, if it doesn't, then the therapist will refer you to another, another clinician, and you can get another treatment that way. And there are so many different pathways you can take if you need help. It's not just you go in and sit down for an hour a week, and then it's left it back. That's the problem is done. It's a process that you work on. And oftentimes, it's just work. It's just something you've got to do. So I don't think there's such a need to make it a grandiose thing for our men, when you go to therapy men should do this . It's more just. Just see what you're feeling. Essentially,

Aidan:

you know, it sounds so simple, and I wish it was. But that is very good advice. As someone who has been in therapy and has overcome that barrier. If you go in with that mindset, it will go Okay, it's going to be extremely bizarre and scary, especially if you haven't had a period of time where you entirely focused on yourself and your feelings. therapy works for a lot of people. And hopefully, if you get the opportunity to go in therapy, you may become better for it. Thanks for that, Ben.

Ben:

Actually, one thing I was also just going to say as well, you're gonna cry, you probably will. Some dudes might be like, Oh, I don't cry. But a lot of the time you think that and you will and that's okay. And that's the main thing that people should come away with is that whatever emotion you have, don't pay attention to the stigma. It's okay to feel however you feel if but I don't want to make that like a pressure thing. Like, oh man, it's okay to cry. If you want to cry, do it if you don't want to cry, don't you know? And in my experience, when I've had bouts of depression, or I've been in therapeutic instances myself, then it gets to a point of catharsis. For me personally, at least when I'm saying all this stuff, I might not really be getting to the to the point. I'm just Trying to make. But then it will just click, and it'll hit me. And I'll probably start crying. And that that's healthy for me. If that's what works for you, then you shouldn't be ashamed of that. I think that's an important lesson.

Euan:

Yeah, I actually want to chime in here and say, I completely agree with that. And in the sense that kind of, it can be very much release in the act of crying can be therapeutic in itself. And I quite like you're the sort of sentiment that it can almost bring about a bit of sort of self enlightenment.

Aidan:

So after we've been talking predominantly about the psychosocial intervention for mental health, we're now going to hear from you and talking predominantly about the pharmacological interventions. So Euan, can you tell me a bit more about this approach to mental health treatment and

Euan:

the benefits it has? Okay, so it's kind of I guess my opinions on this is kind of following on from what I said before is I do believe at a fundamental level humans are, you know, physical, or physiological organisms. And there are these mechanisms underpin how we function. I think the problem then comes, you know, understanding how much of the human biology and human brain we understand. And I think it's best to kind of think of these medications as often some ways quite blunt, they're not quite as blunt, I think, because a lot of people think they are, and certainly not as blunt as I thought they were going into reading about them for this podcast episode. But I think it's also important to say that all of these theories, there's no real sort of single molecule mechanism that explains all aspects of the most mental disorders, right? They're highly heterogeneous, including especially depression, which is hugely heterogeneous, there's lots of different manifestations, which require a lot of different therapies to treat them with. Some therapies respond very well to some manifestations, respond very well to pharmacological treatment where some don't, some respond much better to therapy or fighting or vice versa, or sometimes, both don't work, or both work really well together. Now I think the core idea of the sort of biochemical view of depression and then mental illness more generally, is the probably the one that most people heard of is the chemical imbalance, balanced theory kind of follows on from what we said at the start, where, you know, you've got this kind of imbalance in your brain of a sort of a neurotransmitter use the this kind of chemical that's important for neurological processes. And at some point, for some reason, they get a bit sort of our shifted sort of imbalanced with each other, then that results in, you know, the depressive symptoms that people you know, the main symptoms of mental illness that people would usually associate with these conditions. Now, in the case of depression, the general one is the monoamine hypothesis. And this is included as compounds. So the one most people know is to search for serotonin, but also things about noradrenaline, dopamine. And there's quite a bit of evidence suggest why these might be crucial molecules involved in depression and a lot of mental illnesses as well, including ADHD and schizophrenia as well, I believe. And it's the depletion of these compounds in humans in animals. It has been via various drugs has shown to trigger symptoms of depression, and is also vice versa compounds to increase the activity of these chemical ceilings increase result in sort of anti depressive symptoms, you know, high mood, high energy, that kind of thing. And there's lots of kind of empirical evidence that says on various antidepressants and the price, so things like tri cyclic antidepressants or mono amine oxidase inhibitors, and probably the most well known ones, which is SSRIs, selective serotonin reuptake inhibitors actually have clinical effects and are very beneficial to people. And it's hard to argue that with, you know, it's sometimes hard to argue from an empirical perspective, this person is taking this medication, it's transformed her life is made them far more happy, you've kind of got to pay credence that at least, understanding that they are having a beneficial effect. There's quite a few other causes or thoughts about what might underpin depression. And I'll be a bit more brief in summarising them, but it's quite extensive. So there's ideas around the the hypothalamus, pituitary adrenal axis. Now this is the axis that in large part controls cortex cortisol release. And it's also associated with impaired cognitive function, which is, you know, another symptom of quite severe depression is sort of an inability to focus or concentrate. Another one that I think is a bit more interesting and recent or of interest in recent years is inflammation, which is generally mediated by these compounds called cytokines, which you can kind of think of as the sort of immune system signalling molecule specific to the immune system. And there's actually good evidence that suggests that introduction of these cytokines artificially, because many of them are used as medication for various conditions and infections, various things, they can introduce trigger depression, so things like interleukin two and interferon gamma, while aisle six which is a really enfant, inflammatory, cytokine cytokine. High levels of that in childhood is associated with depression later in life now I think probably the most interesting sort of cause of depression that I came across as reading because I was very much of the understanding of antidepressants, as I say, relatively blunt, and that they're quite static, and they impact people's mood and quite a static way in that it's like, you know, you, you increase the amount of serotonin or whatever the neurotransmitter, which means you feel happier, if you stop taking, it suddenly goes down, you return to normal. But it's not quite that simple, apparently. And I think this kind of contrasts in some way, the point that Ben was saying about understanding that some things that sort of understanding that it's not just a kind of static biochemical view, these drugs aren't just static and biochemical, you know, they're not quite so blunt, in the sense that they can actually induce this thing called neurogenesis and neuroplasticity, which is this idea that stem cells exist within the brain, on importance for cell growth and network rewiring. And this is basically, you know, the biochemical, there's a physiological process that undermines you know, changing kind of your ways of thinking about things in some ways or sort of processes in your brain, and how that impacts you know, your behaviour and things like that, which is in large part, what the idea of therapy for depression a lot of mental illness is trying to do, right? It's trying to cater, it's particularly things like CBT and DBT. Cognitive Behavioural therapies and dialectic behavioural therapies are trying to do is sort of rewire exactly how you think about approach things. And I think it's really interesting that these drugs don't just have this sort of base level effect, they do have the potential to have kind of a lasting impact on the people taking the medication. And I believe they're similar similar observations observed for other medications, such as those that used to treat ADHD.

Aidan:

Yeah, and that all sounds great. So basically, we've summed up there's a, there's a lot of approaches, and there is not one silver bullet, so to speak, for depression, anxiety, any kind of mental illness. My question is that how does this translate to people actually wanting mental health support? So you've mentioned that SSRIs are quite good for anxiety and depression? But is this something we should be concerned about? Or someone coming in for the first time, should we be worried about these drugs that cause changes to our underlying chemistry?

Euan:

Yeah, that's a very good point. And kind of, they can be quite potent drugs. And certainly in the past, they were much more potent. However, the current release of drugs are a bit less potent and have tend to be a bit better tolerated by people who take them, you know, they get better, quote, unquote, reviews, how they impacted in some of their side effects. I don't think that's entirely true for some of the SSRIs. This, I don't have a huge amount of first hand experience with a lot of these medications. And they can have some quite impactful effects on people. But I think it's very much leading back to that point of, you know, heterogeneity between people, just as you need various different treatments and therapies for different genders of individuals themselves and their experiences that's going to shape the sort of treatment that they can feel they need.

Aidan:

Okay, so we've covered quite a lot of the way that mental illnesses are formed as a result of differences in brain chemistry or structure. But how about genetics? Do they have a big impact?

Euan:

Yes. So for depression, the current studies that have just come out of there called genome wide association studies, these are effectively studies that link a genomic locus, so basically a position on the genome to a given trait. So in this case, it's depression. Now, these studies, you we could only really do them quite recently, just to this year. And this is an example of the heterogeneity of depression, in the sense that you could only do them now or identify these genes. With up to I think the last study I read was 400,000 different individuals. So that's 400,000 individuals with sequence genomes. So it's just giving you an idea of some of the complexity of depression going into talking about the genetics behind it. But what we see is with depression, generally, at least, specifically major depressive disorder, which is this, which is the one that I think is often studied, and most well characterised. So with respect to in heritability, about 40% of cases can be or explained or at least attributed to sons or parental genetics. Now, it's interesting because it does vary between mental health and mental illnesses and mental disorders, such as ADHD, he has a much stronger genetic component of about 60 to 90% of the heritability. Now, these two studies that I mentioned, they identified upwards of 17 and 44, possible genomic variants. So these are just regions of the genome that vary between the unpopulated people that you tested, that are associated with depression, some more ADHD as well. And I think it's important to understand this and understand that not the concept that your genes and is talked about, quite These days, I think it's very important to not understand the concept that your genes make it absolutely that you will get depression or absolutely, that you won't get depression if you don't have these variants. But it's understanding the fact that they sort of predisposed you, at least from a kind of population, or just a school perspective, if you have some of these variants, it makes you more likely to have to potentially suffer from these illnesses at some point in your life.

Aidan:

That that's extremely interesting. In terms of genetics, it's very difficult, because as you said, some somewhere from 400,000 genetics to find the exact variants that are causing this effect. And I guess, this kind of links into previous point you made, but I know that many people consider it a foregone conclusion that if they are related to someone who has a mental health condition, say depression, schizophrenia, that they're going to get it. And it's essentially like a death sentence, so to speak. So I know you mentioned about the heritability. But just to pull back on that is does the research suggests that it's 100% going to happen for someone who's related to say, say their parent has schizophrenia. But um, no, I

Euan:

think, I think generally, these things, it's more like, from the perspective of, you know, if you're looking at, say, 1000 people, when I say, you know, 40%, it means that you would expect 40% of them to have to suffer from depression due to with contribution due to their genetics. However, that's again, you couldn't say any one person was necessarily going to suffer from it, right? That's the kind of idea you've got to get across here is it's not, it's not an absolute number. And as I say, it's not a you know, like a quote, unquote, death sentence or an absolute thing that's going to happen. And I think, in some ways, knowing that knowing that you are open to, you know, in the same way, as our physical, a lot of understanding of genetics is helping in our in physical, with our physiological with more than a medical conditions, that it kind of helps you then start to tailor your lifestyle, so you're less open to things like that. And that actually bleeds into a concept in medicine that's coming through, which might people might have heard about, it's called precision medicine, just about tailoring treatments, specifically to the individual that you're looking at. And a lot of that has a basis in genetics, about how we are all to an extent genetically different. And there's a huge amount of variation between people within any populations and across the whole population. So, you know, you've got to tailor the therapy, and it's entirely likely and mean realistic that you'd have to modulate a therapy for the treatment of mental health issues as well.

Aidan:

But what I'm hearing is that genetically, we can be vulnerable to a certain mental illness, it doesn't mean that we're going to get it. But it's a combination of the probability genetically, and what we experienced throughout our life. So it's been shown that, say, having a low socioeconomic status, being in poverty, being a migrant, etc, is associated with worse mental health outcomes. So it's basically a link between the gene environment

Euan:

Yeah, very much. So I think it's, it's very easy to get quite tunnel visioned with a lot of stuff and thinking, you know, you read into one specific understanding, and then you can, I guess, you start applying that to yourself. But if you don't have the full picture, and the full understanding, or sort of the ability to weigh up these different kind of, sort of sources of risk and sources of variability, it can be quite hard to to get the full picture and the aspect like, none of these things generally, absolutely. Decide for you what you're going to end up like, I don't think anyone could any anyone could ever predict, you know what someone's gonna be like, given, you know, say the circumstances of their life at any one point, right? It's just too much variability, and too many things impacting it. But I think you can make, you can go through certain steps that limit certain aspects of your vulnerability. And I guess the flip side of that is means that it means even if you do do that, it's not absolutely going to be protective. It's not like a cure or an absolute preventative measure. You know, it just helps it decreases your risk. Awesome. So

Aidan:

can you just summarise that whole position for me? So what is the best attitude to take towards medications and the biopsychosocial approach to mental health?

Euan:

So I think in somewhat contrast to what Ben said about I do completely agree with a lot of the things that he was saying with regards to understanding, you know, the sort of less binary aspect of there being good and positive emotions and attitudes is much more of a kind of, it's much more of, you know, like a kind of a sort of multi dimensional spectrum of different types of emotions, and perhaps even sort of more fundamentally, a lot of these emotions are underlying parts of the human experience and are very important, you know, both from an evolutionary perspective and from our understanding of how we approach things in life, right emotions are, in some ways a feedback mechanism to tell us, you know, what are, our core values are the impact and that kind of thing. But that's kind of the ideal world, right? The ideal world where everybody would be able to get therapy, and everybody would benefit from the therapy that given the specific characteristics they're given. But the problem is, you know, the, in reality, it could be much more complicated than that, especially considering how difficult even in this country where we have freely available medical services and psychiatric services, it takes a long time to get access to, then your alternatives are often quite expensive, you know, private counselling, which is still really good, if you can afford it. So amazing. But it could be upwards of 50 60 70 pounds of session, which for a lot of people, they just kind of can't afford that. Now, I should say, and I think it'll be relevant to people around Leeds that I was actually lucky enough that if you're a student there, there's a service, I believe they rebranded their name away from what they originally were, we'll include it as a link or a tweet or something like that. But it's service based and Bradford that does quite cheap counselling out, and long term counselling which you can get the student medical practice for about 10 pounds a session, and I think it's five pounds a session for the first one. So I'd highly recommend that. But I'm sorry, just to bring it back to the original point. Yeah, I think it's very much a kind of pragmatic and empirical approach, right, that there are certain features and observations we see when we use this medication, there are certain realities in the world that you know, people from lower incomes might not be able to afford such the ideal therapy for what they need. Even though there are some side effects of the medications, they can have their drawbacks, I think it's generally good to have these as options. And then the patient can decide if the side effects outweigh the, the actual effects of the drug.

Aidan:

So I've heard quite a lot about the two approaches. And we're just going to have a discussion about the pros of these advantages, the cons, and the impacts on society and men are low. But the first point I personally want to make is the tribalism related to these schools of thought. So you see it very much in scientific and academic backgrounds, where people are people over in one click or another. But what is lost in this is the fact that we're treating humans were treating people. So my point I want to make is that has this tribalism, this approach this kind of battle between actually hurt mental health care? And how can we move forward from this?

Ben:

From my perspective, a lot of stuff that I encounter, like people say therapy doesn't work talking about it doesn't work. That's, that's true, it doesn't work all the time. And sometimes, you just you just got to look for other things. But I think a lot of the problems for psychology is whether it's treated as a science or not, I think a lot of psychiatry and biology, obviously, quite hard sciences that employ drugs as their main is their main treatment. There's empirical, quantifiable support behind that, for a lot of the psychosocial approach and therapeutic approaches, a lot of the content is idiographic. So in based on the individual's experiences, humanism gets a very bad rap, because a lot of people would treat it with a kind of, oh, you're just talking about things, you're not actually measuring anything? I think that's a big point. And so I think, kind of, they can be tribalism. But I think, more and more these days, were realising like Euan instead, we use drugs and talking therapies in combination with each other. I think the, as soon as people start to realise that that's actually what happens, rather than from a lay person's perspective, where it's just, oh, I went to therapy, and that was it. Or I'm on drugs now. And that's it. There's massive interactions between everything. There's never a clear cut response. And I think tribalism really does hurt that or at least people who hold that type of mentality. Yes. So

Aidan:

essentially, what you're saying is that we need to if this mentality exists, and we need to what sort of repackage mental health care in a way so rather than being drugs psychosocial interventions is two separate things, bring them together. And when someone presents with a mental health condition to a GP, or whoever they do, and they're okay, we were going to offer you this, but also explore this option, put it back to the patient and explain fully what's there. That makes sense.

Ben:

Yeah, for sure. I've known people who have had serious problems, and that they've just, there's so much stigma around it, they go in for a problem. And I know it's, it's just depression, or it's just anxiety and you won't get anywhere with it end up, that person just won't get any treatment. I've come across like that. And so yeah, as soon as the stigma surrounding mental health, and obviously for men, it's becoming increasingly a talking point, there just needs to be more collaboration, and there needs to be less walls to accessing treatment, it shouldn't be. Once you get it, you're done. And if you can't get it, then you're screwed. It should, there should be just massive awareness about it. all that type of stuff. You know, that's where I stand on it. I think we can all agree on that. Yeah, I

Aidan:

think we can. Euan how do you feel about this is? Is this tribalism and the solution to that being the combination, actually, without help men in the long run? Or will this breed new problems that we're not aware of? Yeah.

Euan:

Yeah, I think kind of marrying the ideas of these therapies as being, you know, each effective, you know, in their own context and having their drawbacks understanding and really communicating that well to the person needs. therapy's really important. I think what's particularly interesting is pretty much from all the reading I do and what I've been advised by medical professionals, is generally what's most effective is combo therapies, right? anti depressions and therapy alongside these kind of dual, I guess, attacks on the conditional and solvent, ways of treating it tend to be what are most effective. And I think I should go back to what I was talking about with some of the underpinning, mechanistic things that underpin you know, how depression develops and how mental illness develops. Although, you know, I did this from the perspective antidepressants, a lot of these effects you actually observed from therapy as well, in particular, neuroplasticity, neuroplasticity, and neurogenesis, you know, it tends to have the same effect. And even things like even things like the mono amine hypothesis and the sort of the idea to classic chemical imbalance, you know, you do start to see a bit of a kind of, sort of remission of these conditions, through fellow therapy alone as well, obviously, it's just generally battering combination. Yeah. And I think even more specifically to men, it's interesting that from a few studies that I've read, and even my own perspective, and how to deal with is that men do tend to view the problems that they face in terms of their mental health and particularly depression, as more of a medical issue and a physiological issue. Yes. Good. medicalization is sort of treating all conditions that pretend to go quote, unquote, wrong with a human being, as being entirely medical, whether that and particularly it comes from whether it relates to mental disorders, right. And a problem with this is it can result in the mental take it sort of less responsibility in a way for the condition in sort of day of view their responsibility as going to a traditional doctor, taking the medication, and taking that medication routinely, and nothing else, you know, treating it much more like a physiological symptom, or a medical condition, where it's, you know, the evidence tends to say, and I think from what we said before, that it's, you know, it's a bit more complicated than that. least there are other avenues for treatment of it that are also beneficial. And when you know, you're considering someone's well being, it can be really important, you'd assume that people won't want to be as you know, at one and as sort of self actualized and happy, quote unquote, happy or at least, you know, more fulfilled in their life as they can be. So I think specifically for men, there's an interesting kind of links there to perceptions of men, mental health from a male perspective.

Aidan:

It says something in regards of, like, I've read a few papers, etc, it's suggests that women are more likely to take the psychosocial approach, is that something within sort of a social construct of masculinity and how men are raised, that we want to disassociate ourselves from this problem, that it's something that is evil, we need to treat it with with medicalization, rather than go down sort of a psychosocial approach, which is quite introspective and something that we've met and not really talked to. And

Ben:

yes, on that point, I'd say that women are about 1.5 times to four times more likely to seek help for any mental disorder than men. I don't have the answer that no one does. Some people like to say we're taking a socio cultural aspects. I'm feeling this up in my experience. I think that's a large part of it. But I don't think it's the main thing. I think that there should be just more accessibility for everyone. And I think that people should realise that it's more, it's less of a male thing, it's more of an individual thing. I don't think that there's male specific mental health, which is a weird perspective to have on a male mental health podcast. But I think the point that I want to drive home is that everything is individual. Sure, we can come across with patterns, and we can come up with all these different explanations for things and these grand theories theorizations whether it be biological, socio cultural, or therapeutic kind of perspective you're taking on them. It really just depends on the person what their reason for going into therapy is or for taking drugs are. So that there's not just one thing I've got, there's no clear cut answer, I think you can agree with that. I think by using stuff like the DSM, as kind of a cookie cutter, this is what health is, that's just not helping anyone really short. It tells clinicians and psychiatrists what they can use to give a person and what they can use to I classically, identify mental health as, but or a mental health disorder as well, that is really, in my opinion, just strips away any amount of individual differences that an individual might encounter?

Euan:

Yeah, I think I can completely get behind the idea of individuality and being like, like, you kind of say, like, I think the way I tend to approach this understanding this is people exist somewhere in a distribution, right, and that distribution might be totally centred on some point. And that's the sort of that's what the EU would generally assign as being, you know, this is the characters on belongs to, but it's important to understand that there is there are tables, and there's houses distribution, and people are going to be present along this distribution, you know, to get full effective therapy, particularly for everybody, you've got to consider the variability of different people. And this brings in this idea of, you know, personalised medicine, and personalised psychiatry, but I think in regards to things, you know, and how it relates treatment for men, specifically, and I think the problem was that, that, that leads into a much bigger topic, which is stigma around mental health, and man, you know, and that tends, or stigma and kind of entrenched ideas of, you know, masculinity and sort of the ideas of self reliance, and is often in the lack of wanting to show vulnerability, which is often what's required in therapy, like, you know, we're talking about crying, we're talking about opening yourself up to what feels like potential harm, sometimes you put yourself in very vulnerable positions. So yeah, I think, again, that's a much bigger topic. And me and Aiden actually did a podcast episode on that, that we released last week is one of the first ones out with him changing mentality. So if you want a bit more about that, I'd recommend checking that out.

Ben:

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Aidan:

Yeah, I was kind of like, I could go on for hours. Euan what would you say is an important thing we need to consider,

Euan:

I think an important thing to consider with these things as well is the idea of correlation versus causation. I think this is a big problem, they've probably heard about this a lot in life as well, you know, with kind of the understanding of, you know, application of machine learning and big data is becoming a very important thing that you have to be aware of. But it's this idea of, you know, you observe a certain effect. So you treat them with a drug and you observe an effect. And that might be you know, reduce serotonin in their brain, and an improvement in their depressions civilizations, but it's like, oh, it seems like this drug is directly causing them a benefit. And it's, we're seeing this change, therefore, that change must be what's causing the, the the, the reduction in the depressive symptoms, but it's just not that simple. And I think particularly when you bring in the idea that we don't fully understand how the brain functions or how the body even functions, that it's almost a bit like this black box, and if you imagine the signals are maybe getting a bit mixed up, or, you know, there's all this other stuff that's happening beneath the, the hub, the, you know, the hood of the car, and this now for, though, you know, we don't observe we don't really know the mechanistic underpinnings of. So I think it's you've got to always be aware that just because you observe these effects in tandem with each other, you know, that's necessarily just indicates correlation, you know, that these two things occur. At the same time. They might have some impact on each other, but you can't say that for definite statistics. Make your point.

Ben:

And I was just gonna say that bidirectionality is a really big thing for me as well. We mentioned earlier, does therapy cure illnesses? You can't make that conclusion, you know, I've learned from from own studies that you need, you can take a look at schizophrenia with stuff going on in the dopamine hypothesis there, and, and all other different kinds of treatments as well. Do these drugs work? Or do they just work for this person? Do? Are these symptoms? what is causing anxiety, depression, schizophrenia, that type of stuff? Or are they symptomatic of it? I think those are really good discussions to have with people. And when you're talking to your therapist, or your psychiatrists, and you should bring up those points and make sure that you're fully clear on what's actually going on in your body.

Aidan:

So I feel we've had a really good discussion, and we've covered a lot of different theories and impacts of mental health, and how this translates to clinical practice, I guess. But to sum up this whole episode, if I'm gonna ask you, if you could offer one piece of advice or something to take away from this podcast, anyone that may be listening, what would you say I'm going to pick on you and first, but don't.

Euan:

So I think my one bit of advice would be just kind of be open to the idea of different therapies and kind of accepting that some of them may work, some of them will work, which will be great. And then some of them won't work. But the important thing is to, you know, if you feel like one's not work here, it's not been as beneficial for you trying to kind of find the right. the right mix, or the right kind of combination that really work for you find really kind of improve your kind of perspective, your fulfilment and outlook on life, because you are an individual, and you require individual treatments has been banging on about this idea of, you know, personalised medicine that applies so much to your psychological needs as much as it does to your medical needs.

Ben:

Yeah, um, I agree. individual needs above all else, when you're talking about mental health, the last thing you want is, is to walk into someone's office and be treated like the person that was in there five minutes before you fully agree with that. biggest piece of advice I say, and I'd give to two men, and really to, similar to non binary is other genders into women as well is just, it's sort of like a, you know, the biggest thing I think is all I want to do is give them a hug, just put my hand on the shoulder and tell them I'm here with you. And, and just things like that. It's always the little bits that get us through the day or can ruin the day. And I think when events like that come up, and they dysregulate your life and all that type of stuff. I've rolled with it, and think it's okay and go with it. If that works, that's fine. Or if you want to knuckle down and do the work, that's fine as well. I think the people and men who are expecting all of their answers to be solved when they go into a treatment scheme. That's not how it works. It's work you have to put the time in. That's my bit of advice. And that might intimidate some people and that's fine. If it intimidates you, then you work with everyone you can. So it's less hard. If you're up to the challenge, then you can do it. I don't want to treat mental health, like it's an obstacle to overcome. And it's something that, oh, it's just a challenge. I don't want to put it down in that way whatsoever. I want to help men empower themselves to realise that they can take stuff on if they feel that they can't. That's why I want to get across.

Aidan:

Thank you for listening to the change in mentality podcast. If you like what we do, please check out our social media description. And we'll hopefully see you next time. Thanks.