Posted by bob on February 20, 2000, at 1:45:36
In reply to Re: Eric- psychiatry and neurology, posted by Eric on February 19, 2000, at 18:33:01
> > Do I ever agree with you on this point! I was fortunate to recently get a consultation with a neurologist who is also a board certified psychiatrist. This is the first time in many years that I have felt completely understood (dxed with bipolar and panic disorders).
But Judy, do you know what bipolar disorder is? I don't have a DSM-IV next to me, but the DSM-IIIR I just borrowed says nothing about the neurology of that disorder. And if you've read anything by Kay Jamison, considered to be one of the foremost experts on this disorder (as well as someone who has it), she refuses to call it bipolar disorder -- she believes the manic aspect of it and the depressive aspect of it are separate dimensions, where "bipolar" clearly implies they are two opposite ends of one spectrum. But this information on defining the disorder doesn't come from the results of precise neurological measurements -- it comes from clinical observation. So, was it the psychiatric training or the neurological training that primarily informed the decision-making process of your pdoc?
> If mental illnesses are truly diseases of the brain...
Sorry, Eric (geez ... I'm finding myself apologizing to you a lot in the last half hour ;^) but I STRENUOUSLY object to having what is wrong with me labelled as an illness or a disease. I don't have a cold, and I don't have an infection. My immune system is not going to produce some antigen that will cure me; similarly, I have seen no evidence to suggest that any chemical compound will cure me either, in the sense that I will take it for some course of time and, when I'm out of pills and refills, what's wrong with me will be gone.
Furthermore, there is no conclusive evidence to demonstrate that my disorder is purely neurological. There certainly is evidence that it has a genetic component that has produced "faulty wiring" in my head. That does not rule out that the "firmware" or "software" up there that I gained through my experiences is not a significant (even predominant) component of my disorder. Medical science is having a rough enough time right now chemically correcting those wiring faults that may result in mismanagement by my brain of certain neurotransmitters -- I don't even want to think about someone trying to rewrite my software through the application of chemicals, electric pulses, or magnetic fields.
It gets back to what Cam has said several times -- it takes an interdisciplinary team to come to a well-rounded understanding of mental disorders. To ignore or dismiss the perspective of an expert in the fit between an individual and her environment (physical and social) means blinding oneself to entire dimensions of the whole problem.
There may come a day, perhaps sometime soon, when a neurologist can run some tests, takes some pictures, and tell me just how my brain is malfunctioning. She may even be able to prescribe a chemical that will make up for my brain's deficiencies. But will the alleviation of symptoms as a result of ingesting that chemical produce a spontaneous remission in habituated self-destructive behaviors I've picked up as a result of that malfunction? Will it also cause the spontaneous emergence of more "healthy" or "adaptive" behaviors which I've never seemed to be able to pull off prior to being given this cure?
Call me a cynic, but I have my doubts.
cheers
bob
poster:bob
thread:21801
URL: http://www.dr-bob.org/babble/20000209/msgs/22639.html