Dysphagia - Symptoms and Treatment

dysphagia

The danger of swallowing disorders is that they can lead to aspiration pneumonia and poor nutrition. Both conditions contribute to declining health and increased length of hospital stays. Symptoms of difficulty swallowing include:

  • coughing
  • choking
  • food "sticking in the throat"
  • drooling
  • nasal drainage while eating
  • weight loss
  • fever from pneumonia

The Diagnosis of Dysphagia

When the above symptoms are noted by physicians, nurses or therapy staff, a speech-language pathologist (SLP) is consulted. Patients hospitalized for neurological disorders such as stroke, brain injury, Parkinsonism, or ALS likely are on the SLP caseload.
Swallowing requires timely and effective coordination of many muscles. When these do not operate efficiently, ingested substances can enter the airway and endanger patient health.

After the referral, an evaluation takes place. The SLP offers different food textures to assess difficulty swallowing them separately. Liquids, pudding, crumbling foods such as crackers and sometimes more complex foods containing mixed textures are introduced. The SLP assesses the patient's ability to:

  • chew (masticate) food thoroughly
  • clear food from pockets in the mouth
  • form a bolus (food ball)
  • use the tongue to project the bolus toward the pharynx
  • maintain timeliness and coordination of oral and pharyngeal movements to keep food on track
  • maintain timeliness of elevation of the larynx (Adam's apple area)
  • clear residual food from pockets around the airway (valecula)
  • move the epiglottis to cover the airway
  • effect travel of the ingested material down the esophagus

Assessments begin at bedside with behavioral observations. In addition to bedside evaluation, the SLP can perform tests such as a modified barium swallow study (MBSS) or a fiberoptic endoscopy study (FEES). The MBSS uses barium, a white substance that shows up on X-ray, indicating the path of ingested material. The FEES uses a camera above the vocal cords and color-tinted food, so the SLP can assess efficiency of food transfer.

These tests also help determine whether there is "silent aspiration." Liquids especially can penetrate into the airway, without coughing, in serious cases of impairment. When patients say they have no trouble at all with liquids, there can still be a dangerous problem.

Treatment of Swallowing Disorders

After determining the nature of the problem, several approaches may come into play. With silent aspiration, or in very severe cases of dysphagia where management is not immediately possible, feeding tubes may be necessary. A nasogastric tube (from the nose to the stomach) or a PEG (percutaneous endoscopic gastrostomy) tube may be placed to provide nutrition until the patient's condition improves.

The following treatments may be appropriate for specific patients:

  • Diet: easy to chew if oral problems occur
  • Thickened liquids when thin consistencies are difficult to manage
  • Sit upright for at least 20 minutes after ingesting anything
  • Small bites and sips to make it easier to manage
  • Slowed intake
  • Provide assistance when needed, especially if the patient is fatigued
  • Oral exercises to increase strength and range of motion (ROM) of the tongue
  • Lip strengthening exercises to improve lip seal and avoid leakage
  • Exercises to increase laryngeal strength

Swallowing Improvement

The good news is that swallowing often improves with therapy. This depends on the nature and severity of impairment. It is important to report these symptoms to one's physician and to follow recommendations. Avoiding aspiration pneumonia also means avoiding severe health complications.

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Stye - Symptoms and Treatment

stye

A stye is an infection, typically a bacterial infection, which causes a painful red lump either on the edge or inside of the eyelid. Bacteria grow at the root of an eyelash follicle or inside an oil gland. The bacteria can be a result of poor hygiene, touching the eyes with unwashed hands or chronic inflammation. The stye resembles a pimple or a boil and is usually filled with pus. A stye does not pose a risk to vision and most often heals without treatment within a week. However, a stye may require treatment with a doctor if the infection does not resolve with at-home remedies.

Symptoms of a Stye

A stye is not usually hard to spot. Not only does a red lump form on either the top or bottom eyelid, but pain is also an immediate symptom of the condition. Typical symptoms of a stye include:
  • red lump on the eyelid similar to a pimple
  • watering of the eye
  • eyelid pain and swelling
  • clear or yellow fluid collecting in the stye
A normal stye will come to a head in approximately three to four days and rupture. The fluid will drain, and the lump will heal within a week. If the stye does not heal independently, the individual should visit a physician for treatment.

Treatment for a Stye

If a stye has occurred, certain measures may be taken by an individual to assist in healing. Home treatment may consist of:
  • not wearing eye makeup or contact lenses until the stye heals
  • applying warm, wet compresses
  • allowing the stye to heal naturally
  • using non-prescription medicated ointments or pads, such as Ocusoft Lid Scrub and Stygiene
A doctor may prescribe medicated eye ointments or eye drops for long-term styes. In order to relieve pain and pressure for the individual, the doctor may choose to lance and drain the stye instead of waiting for the stye to drain naturally.

Preventing a Stye

Some individuals are at a higher risk for developing a stye than others. Contact lens wearers who do not cleanse lenses effectively or daily are at risk for infection. Women who use eye cosmetics longer than six months or who share eye cosmetics with others may spread bacteria which can cause a stye. All individuals should protect eyes against heavy dust or air pollution when possible and avoid touching the eyes with unwashed hands or sharing towels and other personal items. A stye is not harmful or dangerous to an individual's vision. However, the condition is painful and irritating. Taking simple steps to avoid spreading bacteria to eyes is an easy way to prevent the onset of a stye.

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Carpal Tunnel Syndrome - Symptoms and Treatment

carpal tunnel syndrome

Carpal Tunnel Syndrome (CTS) is a work-related musculoskeletal disorder often known as a compression neuropathy of the median nerve that passes through the carpal tunnel. Based on clinical symptoms and nerve conduction tests conducted among the general population, CTS is 3.0-5.8% prevalent among women and 0.6-2.1% among men. It is generally believed that CTS is caused when the pressure in the carpal tunnel increases. In recent years, those who use computers in the long run are reported to be the victims of this syndrome.

Symptoms of Carpal Tunnel Syndrome

When the disease is in the initial stage, patients report about the involvement of the sensory component of the median nerve. Only when the disease progresses, patients report symptoms linked with the motor fibers. The widely experienced symptom is the burning sensation along with tingling and numbness in the distribution of median nerve distal to wrist. The parts involved in the symptoms are the thumb, middle finger, index finger and radial half of the ring finger. The little finger doesn’t get the symptoms as it is innervated by the ulnar nerve. Very rarely, the ulnar nerve also gets the pain.

Patients are often disturbed from sleep because of pain and they have to shake their hands vigorously to get relief.

Nocturnal paraesthesia symptoms are reported to be 51-96% sensitive and 27-68% specific. Some patients report of pain radiating to the forearm, elbow or even the shoulder. In Kendall’s series of 327 patients, 313 (95.7%) reported paresthesia; 118 (38%) reported nocturnal symptoms only, 178 (58%) reported symptoms during the day and night, but worse at night, and 17 (5%) reported symptoms during the day only. In the Yamaguchi et al series, 99% of the 433 surgical patients reported paresthesia. In Phalen’s experience, the typical history was that of a gradual onset of numbness and paresthesia.

Treatment for Carpal Tunnel Syndrome

Patients having mild to moderate CTS can be treated without surgery whereas surgery is the only option for severe cases of CTS. The non-surgical recommendations for CTS include:
  • the use of hand braces
  • splinting of the wrist
  • ultrasonic therapy
  • laser therapy
  • oral steroids
  • non-steroid anti-inflammatory drugs (NSAIDs).
  • oral vitamin B6
  • work place modifications and
  • yoga

O’Connor et al conducted a research to find out whether the above non-surgical treatment options in mild to moderate CTS are really helpful. It was concluded that a significant short-term benefits may be noticed with oral steroids, wrist splinting, local ultrasound therapy, yoga, steroid injection into the wrist and carpal bone mobilization. However, the authors did not find any evidence to support the role of other treatment methods.

The division of transverse carpal ligament is done in surgery. This increases the space in the carpal tunnel, reducing the pressure on the median nerve. Surgery is recommended for most of the patients with moderate to severe CTS. Two different surgical procedures are in use. One is the conventional open surgery and the other one is through endoscope. Each has its own advantages and disadvantages. However, open release is highly recommended and performed in higher count.

Carpal Tunnel Syndrome is experienced by most of the people who spend more time using computers. It is believed that numerous biomechanical factors induce pressure on the carpal tunnel resulting in CTS. The important component that is affected by CTS is the forearm muscle which is stressed due to repetitive usage. There are a number of ways to diagnose CTS and surgery is the only way to treat patients with moderate to severe CTS.

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Recognizing PTSD Symptoms in a Loved One

ptsd symptoms

The process begins with awareness. Although information about PTSD is readily available on the web, many people have never heard of the disorder. Therefore, it is not uncommon for PTSD sufferers to live with the condition years before they are properly diagnosed by a physician. An awareness of the fact that traumatic experiences can trigger a psychological disorder is enough to cause friends, family, and trauma victims to want to educate themselves.

How to Identify PTSD Symptoms

Education is the second most important step in the process toward healing from PTSD and it begins with learning about the symptoms. The United States Department of Veteran Affairs developed the National Center for PTSD as a resource for veterans and the general public. Four of the most commonly recognized symptoms described in their pamphlet, “What is PTSD?” include the following:
  • Hyperarousal – The feeling of being on constant edge, as if something bad is about to happen.
  • Reliving the trauma – Reliving can include intrusive flashbacks of the traumatic event.
  • Avoidance – Avoiding events or circumstances that serve as reminders of the trauma.
  • Commitment Problems – The inability to commit to relationships or jobs.

PTSD Treatment Methods

Once PTSD is diagnosed, it’s time to take action. The good news is that people can and do heal from PTSD.
Certified Professional Coach Michele Rosenthal discusses the healing process in depth on her website Heal My PTSD. Its pages contain a wealth of knowledge from scientific research on PTSD to stories of survival. Rosenthal educates the visitor about various forms of treatment, three of which are outlined below.
  • Cognitive Behavioral Therapy – This is a chain reaction that begins with changing the way that someone thinks about their trauma. The technique employs the theory that thought affects emotions and emotions affect behavior. Thus, changing the way one thinks ultimately changes behavior.
  • Group Therapy – Group therapy typically involves attending support groups and group therapy sessions with other PTSD survivors.
  • Talk Therapy – The client and the therapist will talk about the trauma at length to uncover associated problems and find solutions.

It goes without saying that someone who suffers from a disorder such as PTSD should speak with a doctor who can confirm the diagnosis and recommend a good therapist. Whether self-help techniques are emphasized, a therapist, or a combination of both, PTSD should not go untreated.

Disclaimer" This article is meant to increase awareness of PTSD and is not a substitute for medical consultation.

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Pick's Disease – a Condition Similar to Dementia

picks disease

Pick’s disease, characterized by loss of brain function, is similar to dementia and Alzheimer’s disease. However, it is rarer and tends to affect only certain areas of the brain. In Pick’s disease, the damaged areas of the brain have abnormal substances called pick bodies and pick cells. All cells normally contain a type of protein called tau. But, many Pick cells have an abnormal amount or type of tau.

The cause of Pick’s disease is unknown. The disease can occur in both men and women but is more common in women. It can affect a person in early adulthood but usually begins in middle aged to older adults.

Pick’s disease can slowly progress and over time, temporal and frontal lobe tissues of the brain will shrink. This disease causes changes in behavior, neurological processes, communication skills, and emotions and affects just about all aspects of normal daily activities.

It is the difference in symptoms, particularly behavior problems that distinguishes Pick’s disease from Alzheimer’s disease. In Alzheimer’s disease, the earliest and main complaint is memory loss. The earliest symptoms in Pick’s disease relate to behavior, especially in social settings.

Signs and Symptoms of Pick’s Disease

Symptoms of behavior changes include behavior that is not congruent with the social setting, compulsive behavior, repetitive behavior, withdrawal and decreased attention to or lack of personal hygiene habits. Changes in behavior continue to get worse until the person is unable to function and interact appropriately in social settings.

Neurological, thought and physical processes are all affected by Pick’s disease. Some of these symptoms include progressive memory loss, difficulty with coordination and movement, muscle rigidity and generalized weakness.

A person with the condition will have problems with their communication and language skills. These problems include a decrease in the ability to read and write, the repetition of words they hear and difficulty in understanding. Some patients get to the point that they are unable to speak.

These patients do not show appropriate emotion and may even appear to be emotionless. Their mood may look inappropriate or inconsistent with what is happening at the time.

They will have a loss of interest in activities and may stop participating in all activities including personal hygiene. They may look as though they no longer care about what is going on around them.

Helping the Patient Who Has Been Diagnosed With Pick’s Disease

According to The Alzheimer’s Association in the article “Alzheimer’s Disease / Treatment,” there is no cure for Pick’s disease. There are medications and non-drug treatments that may temporarily help with mental and behavioral symptoms.

There are healthcare providers on the healthcare line of continuum that focus on care at different points of the disease process. These providers include hospitals, out-patient clinics, home health agencies, assisted living facilities, long-term care facilities and hospice agencies.

Pick’s disease is so debilitating that eventually, the patient may need monitoring around the clock and assistance with all care. This can be an enormous strain on loved ones and other caregivers.

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Recognising Listeria

listeria

Listeria has been found in up to five percent or more of normal healthy people usually in the gut. For this reason, exposure to this bacterium is unavoidable. The bacterium can grow at temperatures as low as 0°C.

Diseases Caused By Listeria

L. monocytogenes can cause a variety of diseases, including infections in pregnancy ranging from a mild chill to a severe illness which may precipitate premature birth or miscarriage, and meningitis in newborn children. Septicaemia and meningitis occurs in adults whose immunity to infection is impaired, such as those suffering from cancer or leukaemia or transplant patients.

Infection does occur in otherwise healthy adults and children although this is extremely rare. The infection may be treated with antibiotics but in about one third of cases the disease is fatal. There is no vaccine available to help prevent this infection.

Although the Listeria organism is common in the environment it is a relatively rare cause of infection and commonly only affects 1-3 cases per million of the population per year.

Listeria in Food Leading to Poisoning

Although infection via contact with animals and by neonatal spread occurs, the consumption of contaminated food is believed to be the principal route of infection. A wide range of food types have been implicated with transmission including meat, dairy, fish, shellfish and vegetable products.

The laboratory methods used to detect L. monocytogenes in food have improved in recent years and the organism has been found, but usually in small numbers, in many foods including:
  • Raw fish
  • Shellfish and fish products
  • Raw meat
  • Poultry and their products including hot dogs and pate
  • Raw and processed vegetables
  • Ripened soft cheeses
  • Ice cream
  • Retail cook-chill meals
  • Salads including coleslaw
  • Raw and inadequately pasteurised milk
  • Raw and liquid egg.

Although the organism is killed by proper cooking and pasteurisation, it has been found occasionally in some cheeses made from pasteurised as well as unpasteurised cows and goats milk and the presence of the organism in cooked foods indicated inadequate cooking or contamination after cooking.

Preventing Listeria from Becoming Dangerous

Retail chilled meals carry instructions to reheat before consumption and if this is done correctly L. monocytogenes should be killed. Similarly, it should be eliminated from food taken from cook-chill catering units when it is properly reheated. Conventional ovens should cause no problems, but microwave cookers do not always reheat food uniformly and bacteria may survive in cold spots.

In spite of these facts the number of occasions on which listeriosis has been definitely linked to consumption of food in the UK is small.

Because of the risks of listeriosis during pregnancy, it is advisable that pregnant woman should avoid eating certain ripened soft cheeses such as Brie, Camembert and the blue veined types such as Danish Blue, Stilton or Gorgonzola as these may contain high levels of the listeria organism.

People with deficient immunity are advised to take the same precautions as pregnant women but the risk of infection in healthy people over the age of four weeks is regarded as being too low to warrant any dietary changes.

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Radiation Sickness

radiation sickness

Radiation injury occurs when ionizing radiation directly damages cellular RNA, DNA, or proteins, or when highly reactive free radicals are generated within cells and tissues.

Large doses of ionizing radiation cause cell death, while lower doses interfere with cellular proliferation. Chromosomal damage can result in malignant transformation or inheritable genetic defects.

On September 11, 2001, terrorist attacks on US soil raised concerns about the repetition of similar activities, including attacks on nuclear facilities or the use of nuclear devices. The detonation of a “dirty bomb” (a conventional weapon designed to scatter radioactive material) could expose a large number of citizens to high levels of radiation.

The extent of tissue damage caused by radiation depends on the source and duration of exposure. The majority of acute radiation syndromes are caused by gamma rays and x-rays because these forms of radiation can cause damage at great distances from their sources. Deterioration of unstable atoms, such as iodine-131, contributes to cellular injury.

Signs and Symptoms of Radiation Sickness

Acute radiation syndromes follow whole-body exposure and exhibit three phases (faster progression through the phases, with more severe symptoms, occurs with higher levels of exposure):
  1. Prodrome (0-2 days post-exposure): Lethargy, weakness, nausea, and vomiting
  2. Latent (1-20 days): Asymptomatic
  3. Overt systemic illness (2-60 days): Classified by the organ system involved (see below)

  • Cerebral syndrome: Universally fatal. Caused by extremely high, whole-body exposures. Prodrome lasts minutes to hours; insignificant latent phase, followed by tremors, seizures, cerebral edema, and loss of coordination. Death occurs within hours to a few days.
  • GI syndrome: Death is common. Prodromal symptoms, often severe, resolve within two days. Latent period of four to five days is followed by intractable nausea, vomiting, diarrhea, dehydration, electrolyte imbalances, and vascular collapse. Bowel necrosis may occur, leading to sepsis. Hair loss is common. Survivors usually exhibit hematopoietic syndrome.
  • Hematopoietic syndrome: Usually due to lower exposures than for cerebral or GI syndromes. Mild prodrome begins six to 12 hours after exposure and lasts 24 to 36 hours. Bone marrow cells are immediately affected--eventually leading to loss of white cells-- but victims remain asymptomatic for a week or more as marrow fails. As neutrophil count and antibody production fall, various infections ensue. Loss of platelets leads to bleeding episodes. Anemia eventually develops as well. Survivors are at increased risk for leukemia. (Mettler RA, Voelz GL. Major radiation exposure—what to expect and how to respond. NEJM 2002;346:1554-1561)

Treatment for Radiation Sickness


  • Decontamination of exposed victims is critical following exposure, both to protect medical personnel and to limit progressive tissue damage. Wounds are checked with Geiger counters and irrigated until counts normalize. Ingested radioactive material should be removed by lavage or induced vomiting.
  • Victims are isolated from other patients, and standard universal precautions are practiced by personnel.
  • Symptomatic treatment is administered for shock, pain, anxiety, and anoxia.
  • Cerebral syndrome is universally fatal; treatment is geared toward patient comfort. Seizure control and sedation are the mainstays of therapy.
  • Aggressive fluid resuscitation, parenteral nutrition to provide bowel rest, antibiotic therapy, blood products and hematopoietic growth factors are administered as indicated. Stem cell transplants may prove useful for selected patients.
  • Medications (potassium iodide, DTPA, or Prussian blue) may limit damage from specific kinds of radioactive particles.
  • Survivors are at increased risk for various cancers, cataracts, and thyroid disease. These conditions are treated as they occur.
  • All individuals living within ten miles of nuclear facilities should have access to a 24-hour supply of potassium iodide (KI) tablets. In the event of accident, KI is ingested prior to evacuation to limit damage due to I-131 exposure. (The Merck Manual, Eighteenth Edition 2006:2601-2606)

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Respiratory Disorders – Croup

croup

When an adult has cardiac related issues, there are numerous factors that may have been the cause. Heart disease, high cholesterol, obesity and high blood pressure, can all contribute to emergency cardiac incidents. In children and infants whose hearts are typically young and strong, a cardiac event is troubling because it is unexpected. Most cardiac arrests in the very young can be attributed to an alternate cause that is usually respiration related, like croup.

What is Croup?

Croup sounds awful. The seal bark cough (stridor) and wheezing, sets parents on high alert. It is an alarming medical event that causes anxiety and restlessness for infant and caregiver alike.

The medical name for croup is laryngotracheobronchitis and it occurs when the voice box (larynx), the windpipe (trachea), and the bronchi (pathways to the lungs) become inflamed. This inflammation causes the airway to partially swell, leading to the characteristic barking cough associated with croup. Predominently caused by the Parainfluenza virus, other viruses such as the respiratory syncytial virus, influenza, adenovirus and measles can also play a role in the development of croup.

Croup – Symptoms and Diagnosis

Prior to immunizations, croup was a daunting disease. Today this disorder is more mild, although it can on occasion develop potentially dangerous aspects. Typically croup hits children between the ages of three months to six years and while the virus is usually contracted one time only, reoccurrance can happen in some children that are prone to it, particularly boys.
If croup combines with a bacterial infection, bacterial tracheitis (a rare but infectious upper airway obstruction) can develop that may evolve into epiglottitis. This dangerous combination will require a hospital stay with airway evaluation and intravenous antibiotics.

Croup initially presents with the symptoms of the common cold and a low-grade fever. As croup progresses, additional symptoms that usually present within two to three days include:
  • a barking cough similar to a seal bark (worse at night)
  • wheezing upon breathing out
  • a sore throat, voice loss
  • restlessness and irritability

There are no specific tests for diagnosing croup. The distinctive cough is usually sufficient enough for a diagnosis but doctors will always assess for breathing difficulties, poor oxygen intake and additional complications or causes.
Severe croup must be evaluated immediately. If a child develops these additional symptoms, contact healthcare professionals immediately:
  • difficulty breathing and rapid shallow breathing that includes, sucked in ribs and chest (retractions); see-saw breathing (abdomen moves opposite to the chest) and nasal flaring
  • wheezing becomes high pitched
  • dehydration, no fluids being taken in and reduced urine output
  • bluish tinge to the skin (cyanosis)
  • difficulty talking, words being forced out one at a time

Treatment for Croup

Being a virus, there is no treatment for croup directly. Antibiotics are only prescribed if croup presents alongside a bacterial infection. Severe cases may require hospitalization and treatments with IV fluids, humidified oxygen therapy and albuterol administered through a nebulizer to open the airways. In extremely severe cases with additional complications, maintaining the airway may be necessary.

If a doctor deems the infant stable enough to be treated at home, then recovery may be aided by:
  • the use of a portable humidifier
  • in cool weather, wrap a child up and take them outside, the cool air can ease breathing
  • over-the-counter acetaminophen
  • keeping the child calm to prevent crying that stimulates coughing
  • keeping the infant propped semi-upright at night
  • pushing fluids like milk rather than thinner fluids that may loosen mucus and secretions and increase coughing

Croup is a contagious disease, so avoid exposure to the virus and keep an infected child at home. Keep the home smoke free and practice basic hygiene, particularly handwashing. Never hesitate to seek professional medical help if needed.

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Redefining Depression and Medicalizing Sadness

depression and medicalizing sadness

“And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your mortality about in a bottle. Christianity without tears -- that's what soma is.”
-- Aldous Huxley, Brave New World

Sadness is an inevitable occurrence in the span of our transient lives. However, many cultures throughout history have recognized that some people are inexplicably stricken with a persistent despair that has no particular cause or that is not proportional to the loss suffered. This condition is what we know today as depression.

However, as Horwitz and Wakefield argue in their 2007 book The Loss of Sadness, the current DSM definition of depression also includes many people who are actually suffering normal sadness proportional to life events, rather than a mental disorder.

This overly broad definition risks medicalizing normal sadness, because currently many people who have reasonable cause for their sadness fit the diagnostic requirements for the medical condition of depression.

Distinguishing Sadness Proportional to a Cause from Depression

Horwitz and Wakefield distinguish between sadness proportional to a cause, which they posit is a normal human reaction, and persistent sadness without cause, which qualifies as depression.

They criticize the DSM definition for only exempting sadness from bereavement, and that only for two months; they compellingly argue that many other life events (breakups, divorce, losing one’s job, a diagnosis of a serious illness, etc.) can also cause symptoms of depression without being a true mental disorder.

When these problems are overcome, many people recover emotionally; this suggests their sadness was not a disorder, but a proportional reaction to distressing life events.

Moreover, many symptoms – such as tiredness or trouble sleeping – are common to much of the population, and may not indicate anything.

The Overdiagnosis of Depression

Depression diagnoses have skyrocketed, especially with the advent of symptom-based questionnaires with broad questions intended to detect all possible victims of depression. Questionnaires are much cheaper to use than actual physician consultations, and arguably more objective, but their inclusiveness inevitably results in a very high number of false positive diagnoses.

Ideally these initial diagnoses would all be reconsidered by a physician, but due to financial constraints, many are not. This overdiagnosis of depression can create many problems, such as unnecessary expense, stigma, change in one’s perception of self, side effects of drugs, and the increase of medical surveillance, even for people who may not be truly sick.
Moreover, diagnoses in people who are not sick may reduce the medical care available to those who truly need it (156).

The Increase of Medical Surveillance

The perception that depression is increasing and exists undiagnosed in many people has increased medical surveillance; for example, screening has become common in schools.

However, as Horwitz and Wakefield point out, screening has not proven accurate; the loss of a romantic attachment is the strongest predictor for depression, but teens usually soon recovered from these emotions (159).

Screening is often supported as a strategy to prevent teenage suicide, suggesting that depression is a social danger, but this too has not proven accurate. Some anti-depressants may even increase the risk of suicide or violence, potentially making depression an iatrogenic condition.

The Function of Sadness

Sadness is inevitable, but not necessarily desirable. Although many hypotheses exist for why humans have evolved to feel sadness, the question also remains as to whether there is any useful function of sadness in today’s world.

Normal sadness is not a medical disorder, but this does not necessary preclude it from medicalization. Many other natural life occurrences, such as death, birth, aging, and menopause, have also been medicalized because people prefer to reject them or wish to experience them in a different way.

Anti-Sadness Medicine: The Future?

The argument for clarifying the definition in the DSM is compelling, but even if depression is reconceived in narrower, more accurate terms, the specter of medicalized sadness under a different name still remains.

It is easy to imagine the marketing of anti-sadness medicine, and easy to understand its temptation. Like mental enhancement drugs, drugs to treat normal sadness may offer the choice to improve oneself through medicine. But this improvement may come with costs.

Brave New World: The Dystopia of a World Without Sadness

Aldous Huxley’s 1932 dystopian novel Brave New World, set in London in 2540, provides a portrayal of a world without sadness. Its society is highly medicalized, with complete state control of reproduction, and the ubiquitous use of soma, a “perfect drug.”

Soma is an antidepressant and hallucogenic drug with no harmful side effects – “All the advantages of Christianity and alcohol; none of their defects.” There is no sadness in this society, but no love, no intellectual or creative pursuits.
Sadness is considered deviant, and characters urge each other to take soma when they seem even a little glum. When a character accidentally forgets her soma during a stressful visit to a reservation (where people live as they do today), she can barely function without it.

The Meaning of Sadness as Part of Human Experience

Huxley’s novel implies that sadness is a necessary part of the human condition, and that life is meaningless without it. Soma is an escape, not only in the most literal sense that it provides a hallucinatory break from life, but it also is an escape from life’s problems, from life’s difficulties, which give our lives meaning.

In his 1958 nonfiction Brave New World Revisited, Huxley concludes that our world is moving towards that of his dystopian novel faster than he had anticipated.

The Consequences of Medicalizing Sadness

Horwitz and Wakefield conclude that “if they find that their lives seem brighter when they are medicated, a belief in autonomy and free choice dictates that people should not be prevented from seeking that relief from a responsible physician” (192).

But the consequences of making treatments for normal sadness available could be widespread. If it becomes common to treat sadness with drugs, then normal coping networks of friends, family, religion, spirituality, and so on, might disappear.
Deviancy and normality could be redefined so that one might not have a choice about how to cope with one’s sadness. It could become socially unacceptable to be sad, taboo to grieve.

Autonomy and free choice are worthy goals, but medicalization is often a process invisible to the public, which then results in a structure that seems so natural that few question it. And once in place, the medicalization of a condition may be supported by the authority of the medical profession, societal norms, and even the government.

Horwitz and Wakefield present a compelling argument to tighten the definition of depression to exclude those with normal sadness. However, the issue of medicalizing normal sadness as something different from depression still remains.

The medicalization of normal sadness has the potential to not only make another option available to people, but also risks causing a fundamental shift in the way sadness is understood, which would affect everyone in society.

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