Posted by alexandra_k on September 23, 2006, at 21:28:55 [reposted on September 25, 2006, at 0:09:10 | original URL]
In reply to Re: Leaving the site for a while » SLS, posted by Squiggles on September 23, 2006, at 20:39:26
Hey. I really hope you aren't leaving on my account. Not that I'm all that significant in the great scheme of things or anything like that, but I just mean to say that I hope you haven't felt upset by anything I've said.
I guess I replied to this thread because I thought you were advocating the biomedical (pharmaceutical) approach and though that the other aspects... Were irrelevant. Maybe you were meaning to lament your not getting the meds that have been shown to help you. Sorry if I misunderstood... I thought you were making more general claims than that, however, about mental illnesses being biological hence should be given pharmacutacal intervention alone.
> - endocrinological tests may be significant
> before diagnosis of psychiatric illness;Do you mean because most mental illnesses have exclusion criteria such as 'not caused by a general medical condition'? Garety and Hemsley said that delusions occur across 75 different neurological, endocrine, and psychiatric conditions, for example.
> - the ultimate goal of medicine, is to
> alleviate suffering, not try to unravel
> the metaphysical mysteries of the mind/body
> problem (which may just be a linguistic mirage
> anyway).Though it is controversial whether psychiatry is best thought of as a medical enterprise. But I take your point that psychiatry is an applied field. As such it is more interested in treatment than in discovering the real nature of illness. It is just that in practice... The way science tends to progress... Is that if we investigate the real nature of illness then we discover some interesting things about it. What we have learned has implications for better interventions. If you treat psychiatry as an applied discipline where you take what has been demonstrated to work to a certain extent then you are unlikely to progress as a science and develop better interventions. So I guess there are two parts to psychiatry (at least). 1) The scientific enterprise of finding out the real nature of mental illness. 2) The practical offshoot of that applying what has been found to work to new cases.
> What after all do the anti-psychiatry proponents mean by biological and non-biological?
> They mean nothing at all.I'm not an anti-psychiatry proponent.
Typically the biological component has been cashed out as people studying the the bio-chemistry and structure of the brain.
Typically the psychological component has been cashed out as people studying the cognitive deficits that people may exhibit. (Reasoning biases, inability to do certain cognitive tasks, attribution biases etc).
Typically the sociological component has been cashed out as people studying the difference in prevalence rates for various illnesses across various cultures. Trying to figure out what aspects of culture are relevant for the difference in prevalence rates.
The usefulness of the data that is collected and the usefulness of forming generalisations on the basis of that data (generalisations about etiology or best treatment or course of illness) are only ever going to be as good as the usefulness of the categories that form the unit of study.
Take the following set as a 'diagnostic category'
(autism or bi-polar or substance abuse)
Lets call that condition ABS.
What are the causes of ABS?
What is the best treatment for ABS?
What is the course of ABS?There aren't going to be many patterns because ABS isn't a natural kind it is a collection of unrelated bits and pieces. People in the category ABS are more likely to be similar to people without ABS than other people with ABS. A lot of the current dx categories are like this. Fineline Bob figured there were 256 different ways to meet dx criteria for borderline personality disorder, for example. It might be that some of those combinations are never found to occur. It would be interesting to know why not. It might be that some of those symptoms are always found to occur together. It would be interesting to know why this is the case.
I think the best way to devise adequate categories would be to go to a symptom approach. Sure the same problems occur on the symptom level (is a symptom like 'delusion' similar enough across different people for that to be an adequate unit of research?) The point would then be to compile statistics of what symptoms have been found to be correlated with what other symptoms and to... Built adequate categories on this basis.
Instead of the current scheme of things where more people are NOS than falling under current categories and where research seems to be hindered by lumping a whole bunch of different conditions together in virtue of their being given the same dx category.
With neurological differences in schizophrenia, for example... There were quite a lot of interesting features that people with neurological differences seemed to share. They were the most severe cases for one. They had worse prognosis for another.
I am a little wary of the 'worse prognosis thing...'
But I guess that is an issue for general medicine too...
Telling people how long they have to live...
And that they will never be able to walk again...
And such.I don't know.
poster:alexandra_k
thread:688931
URL: http://www.dr-bob.org/babble/social/20060922/msgs/688953.html