Black is the new black – Mental illness touches more of us than we realise (or want to admit)

I rarely get sick.

I say this while superstitiously touching my wooden desk to try and avoid putting the mockers on myself.  Thankfully, I have a fairly robust immune system and, after years or working in hospital paediatrics and general practice, and having been sneezed at or coughed on multiple times a day, I have been exposed to just about every variation of the cold virus and influenza possible.

Even for those of us with an immune system as solid as a prize bull, we still get sick every now and then.  We all get upper respiratory viruses so commonly that we just consider it a normal part of life.  Most people will take some paracetamol or ibuprofen and keep going.  Some people will go to their GP, and while a most will (… should …) come away some simple reassurance, occasionally some will need a prescription medication for a nastier bacterial infection.  An even smaller percentage will need admission to hospital because of a much more severe infection.

I read an interesting blog this week on Psychology Today by Dr David Rettew.  Its provocative title was, “Is Mental Illness the Rule Rather Than the Exception?”

The blog discussed the study being carried on in Dunedin which has been following a cohort of a thousand people for the last thirty-five years.  This particular study looked for common factors that were shared by those people who had never been affected by a certifiable psychiatric disorder.  What was interesting was that only seventeen percent of the people in that cohort had NOT been affected by a mental illness at some point in that thirty-five-year time frame.

Now for the average Australian, there are some obvious kiwi jokes going begging here (like, I’d be depressed too if I had to live in New Zealand, or how can someone tell if a sheep is really depressed or not, etc. etc.).  All jokes aside, seventeen percent of people not affected … that’s a remarkable figure.  In researching my latest book (soon to be released …) I had come across the figure of fifty percent of people had a lifetime prevalence of any mental illness.  That’s one in every two, and chances are that if you weren’t the person affected, you would know someone who was affected, but the Dunedin figures are even higher.  If you can accurately extrapolate them, four out of every five people will be affected by mental illness at some point in their lives.

The inevitable response from modern psychiatry’s critics is entirely predictable – there will be claims that the DSM5 is simply making diseases out of normal human life experiences, that our humanity is being pathologised and over-medicated for the benefit of big Pharma.

But as Rettew points out in a separate blog post, something may be such a common occurrence as to be considered part of the normal human experience but it can still be a pathology.  The common cold is so common that it’s a normal part of life, but it’s still a disease.

Whether four out of every five people will be affected by mental illness or one out of two, whatever the number, the idea that most of our population will be afflicted with a mental illness at some point in their lives isn’t necessarily a negative thing.  As Rettew also discusses, we don’t arbitrarily change the definitions of physical illnesses to match how many people we think should suffer from them, and neither should we arbitrarily change the diagnostic boundaries of mental illness so less people appear mentally unwell.

We need to accept that, at times, people will be functionally impaired to varying degrees because of mental illness just like people will be functionally impaired by physical illness.  We need to treat mental illness with the same respect as we would physical illness.

In the same way that not all physical illnesses require medication, neither do all mental illnesses.  By and large, most mental illnesses that people suffer from will be short lived and self-limiting, the psychiatric equivalent of having a cold.  Some people will need treatment for their mental illness, but usually this takes the form of structured behavioural therapy like ACT or CBT.  Occasionally, people will need to take a medication and very occasionally, some people will need to be hospitalised because of their mental illness.

For too long, mental illness has been viewed from an extreme perspective – mental illness is uncommon and severe. The nuances of mental illness have been lost or ignored in the white noise of ignorance and sanctimony.  The lack of subtlety and understanding has failed us as a community.  When treated early, mental illness has a much better prognosis, but the stigma, fear and misunderstanding perpetuated by the all-or-nothing approach has left a lot of people without treatment and therefore with worse outcomes overall.

If people were to realise that most of us will be touched by mental illness at some point, then perhaps there would be more understanding and less judgement, something that would lead to less suffering because of mental illness.

That would only be a good thing.

~~~~~

If you think you might be affected by mental illness or if you would like to know more, see your local GP, family physician or psychologist.  On line information can be found at many reputable sites including Beyond Blue – https://www.beyondblue.org.au

Echinacea: No better than blessings

Back in the sixth century AD, most of Europe was succumbing to the bubonic plague.  One of the first signs of the plague was sneezing, and so as legend has it, Pope Gregory the Great was the first to say “God bless you” when anyone sneezed, presumably as a pre-emptive death rite.

The practice of saying “Bless you” to any and all steternatory reflexes spread across Europe just as quickly as the plague did, and then to other parts of the world where they developed their own local variation (for example, apparently people in Arabic countries say, “Alhamdulillah,” which means, “praise be to God.” Hindus say, “Live!” or “Live well!”).  There were also some superstitious meanings attached.  For example, people can to believe that a sneeze was someone’s soul detaching itself and exiting the body, and saying “Bless you” would stop Satan from stealing their untethered soul (http://goo.gl/znyyuY).

These days, we know that the humble sneeze has nothing to do with detaching souls or the Bubonic Plague, but interestingly, the cultural phenomenon of blessing people every time they sneeze is something that lives on.

While it’s not the only reason people sneeze, we know that the main cause for sneezing, especially at this time of year, is viruses.  There are lots of different home and herbal remedies that people swear by for colds and flus.  I hear about them every winter.  Last year I reviewed the effectiveness for Olive Leaf Extract.  Another popular herbal remedy is Echinacea.

Echinacea is a family of perennial flowering plants which are in the same broad class as sunflowers.  Early botanists gave the flowers the name Echinacea, from the Greek root word is rooted in the Greek word ‘echinos’ because the distinct spiky appearance and feel of the flower heads looks a little like an echidna or hedgehog.

Traditionally, Echinacea products are thought to enhance the action of the white blood cells, which in turn, is supposed to help the body fight off various sorts of infections.  There are many different variations of Echinacea products that are available for consumers, but these vary widely in composition. They contain different extracts from different bits of different Echinacea species which result in vastly different chemical compositions between the products.

So, do Echinacea products work?  Are they worth the money people are spending on them?

As I was poking around the internet today, I came across this article in Natural News.  The article boasted: “Echinacea preparation as effective as Tamiflu in early flu cases in large clinical trial” … “Echinaforce Hotdrink has here been demonstrated as attractive therapy for acute influenza treatment with better safety and comparable efficacy profile to the neuraminidase inhibitor Oseltamivir.” (Oseltamivir is also known as Tamiflu, the gold standard influenza treatment).

That sounded promising, until I looked at the actual paper the article was referencing.  Natural News failed to report the most important paragraph, “This study was sponsored by A. Vogel Bioforce AG, Roggwil, Switzerland, manufacturer of Echinaforce Hotdrink. R. Schoop is an employee of Bioforce AG, and K. Rauš and P. Klein have received honorarium funds from the study sponsor.” [1]  In other words, this journal article was the scientific equivalent of an infomercial.  No particularly independent or trustworthy results there.

What about independent trials into Echinacea?  Do they show any benefit?

Ah, that would be “no”.  Echinacea products have been reviewed several times in the past [2-4] and the same conclusion has been reached every time.  In fact, a Cochrane review (the gold standard of clinical research) was published on the use of Echinacea for the common cold in 2014 [5].  The best that it could say for Echinacea was that there was a weak trend towards benefit for prevention of colds, but there was also a trend towards people dropping out of the study because of side effects.  There was no evidence at all for treating a cold with Echinacea.

In biostatistics lingo, ‘trend’ means there was a small blip one way or another, but it could be entirely related to random chance.

The bottom line is that there’s no strong evidence that Echinacea does anything for a cold or influenza.  In terms of health benefits, taking Echinacea for a cold is equivalent to saying “bless me” whenever you sneeze.  At least blessings don’t cost $15 dollars a bottle.

So when you’re inevitably struck down by the modern plague of common colds this winter, stick to rest, fluids, and some paracetamol.  They’re much more of a blessing than Echinacea supplements.

References

[1]        Raus K, Pleschka S, Klein P, Schoop R, Fisher P. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial. Curr Ther Res Clin Exp 2015 Dec;77:66-72.
[2]        Barnes J, Anderson LA, Gibbons S, Phillipson JD. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. J Pharm Pharmacol 2005 Aug;57(8):929-54.
[3]        Hart A, Dey P. Echinacea for prevention of the common cold: an illustrative overview of how information from different systematic reviews is summarised on the internet. Preventive medicine 2009 Aug-Sep;49(2-3):78-82.
[4]        Allan GM, Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 2014 Feb 18;186(3):190-9.
[5]        Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. The Cochrane database of systematic reviews 2014;2:CD000530.