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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Chris A on April 17, 2002, at 13:02:34
I have a couple of 'friends' who have decided to go into counseling. They are lay people and have gone to couple of conferences that dispute any physical (chemical and genetic) contributors to any 'mental illness'. They specifically mention major depression, bipolar disorder, schizophrenia, ADHD, OCD and panic disorder. They consider 'chemical imbalance' to be a weak theory, since they say there is no way to measure neurotransmitters between human synapses. They quote Nancy Andreasen, M.D. from her book "The Broken Brain" as saying "Like the dopamine hypothesis, the catecholamine hypothesis is theory rather than fact..." They are taking that totally out of context for their proof-text. They also say that "labels" (what I call accurate diagnosis that lead to appropiate treatment) and telling people there is a biological basis for their feelings or behavior causes people to blame-shift and not take responsibility for their actions. Consequently they say that "mind altering drugs" (psychotropic medications) have no role in treating these symptoms (they refuse to call them illnesses - they have no trouble in treating Alzheimers, Parkinsons, etc. with meds, however).
I realize causative factors are complex and that there are "just a few" (hundreds) of research articles are out there somewhere that refute what they are pushing. Yes, they are pushers. They have taken a friend of mine who has serious bipolar under their wing. If anything happens to her I will be MAD. Can anyone help me succinctly refute these misguided people? I want to write a position paper that is filled with documentable evidence that will help them at least soften up on the absolutely "no-meds" stance. As a retired RN with an MA in counseling and a doc for a hubby, I am angry that they wouldn't have had the respect to consult with us first prior to adopting their counseling approach. They can't be reported to the state grievance board since they don't charge for their 'services'. It is even more insulting since they know I have struggled with bipolar disorder. My cognitive damage makes it difficult for me to feel confident in refuting their arguments with solid science. They are very assertive in their lack of knowledge and misguided approach and I tend to back down from that. I know psychiatry and meds aren't perfect, but throwing them out would be a disaster for many suffering people.
Help! I know this is l-o-o-ng, but this issue has really been upsetting me and I am scared for my friend, knowing how devasting her disease has been to her and her family.
Chris A.
Posted by crepuscular on April 17, 2002, at 13:45:44
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
with respect to bipolar disorder, how does one explain the 75% concordance rate between twins raised apart? surely any reasonable person must conclude that some pre-existing causal factor is responsible.
how does one explain why some people can be exposed to absolutely horrendous childhoods and still turn out stable & happy, while others with normal, even exceptionally healthy upbringings, are plagued with mental illness?
have any of these people observed a floridly schizophrenic person close up? psychosis is so obviously a deficit in *the physical act of thinking* that one is hard pressed to explain it any other way (short of possession i suppose).
why would a person think the brain, unlike any other organ of the body, be exempt from physical failure of one sort or another?
i think these people do not believe that the brain is a physical object. to be sure, the epiphenomenon of thought & personality cannot be reduced to synaptic interactions alone, but the physical substrate is a major player. to deny this is to deny the entire project of scientific inquiry.
i'll go even further, it is a denial of modernity.
people like this are "flat earthers" in my estimation...
Posted by Ritch on April 17, 2002, at 13:51:34
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
> I have a couple of 'friends' who have decided to go into counseling. They are lay people and have gone to couple of conferences that dispute any physical (chemical and genetic) contributors to any 'mental illness'. They specifically mention major depression, bipolar disorder, schizophrenia, ADHD, OCD and panic disorder. They consider 'chemical imbalance' to be a weak theory, since they say there is no way to measure neurotransmitters between human synapses. They quote Nancy Andreasen, M.D. from her book "The Broken Brain" as saying "Like the dopamine hypothesis, the catecholamine hypothesis is theory rather than fact..." They are taking that totally out of context for their proof-text. They also say that "labels" (what I call accurate diagnosis that lead to appropiate treatment) and telling people there is a biological basis for their feelings or behavior causes people to blame-shift and not take responsibility for their actions. Consequently they say that "mind altering drugs" (psychotropic medications) have no role in treating these symptoms (they refuse to call them illnesses - they have no trouble in treating Alzheimers, Parkinsons, etc. with meds, however).
>
> I realize causative factors are complex and that there are "just a few" (hundreds) of research articles are out there somewhere that refute what they are pushing. Yes, they are pushers. They have taken a friend of mine who has serious bipolar under their wing. If anything happens to her I will be MAD. Can anyone help me succinctly refute these misguided people? I want to write a position paper that is filled with documentable evidence that will help them at least soften up on the absolutely "no-meds" stance. As a retired RN with an MA in counseling and a doc for a hubby, I am angry that they wouldn't have had the respect to consult with us first prior to adopting their counseling approach. They can't be reported to the state grievance board since they don't charge for their 'services'. It is even more insulting since they know I have struggled with bipolar disorder. My cognitive damage makes it difficult for me to feel confident in refuting their arguments with solid science. They are very assertive in their lack of knowledge and misguided approach and I tend to back down from that. I know psychiatry and meds aren't perfect, but throwing them out would be a disaster for many suffering people.
>
> Help! I know this is l-o-o-ng, but this issue has really been upsetting me and I am scared for my friend, knowing how devasting her disease has been to her and her family.
>
> Chris A.
Gee, hate to burst their bubble, but *all* science is related to "working theories". Their assertions are just alternative theories as well. The monoamine hypothesis may be weak, but that is the best working hypothesis at the time. The weight of empirical evidence (facts) I would say is much *weightier* with it than with these people's theory. What would be interesting is if they put all their "cards" out on the table and see what empirical facts they have to support their theories. First, what is their theory? Can they explain it? If they don't even consider it a theory, they pretty much have shot themselves in the foot already!Mitch
Posted by SLS on April 17, 2002, at 22:26:14
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
Hi Chris.
I always like showing people the official declarations published by the United States governmental agency responsible for overseeing the research and treatment of medical conditions:
http://www.nimh.nih.gov/publicat/index.cfm
Sick 'em!
- Scott--------------------------------------------
"Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function."
http://www.nimh.nih.gov/publicat/bipolar.cfm
------------------------------------------
"Bipolar disorder, also called manic-depressive illness, is a serious disorder of the brain. More than 2.3 million American adults, or about one percent of the population in a given year, have bipolar disorder. Abnormalities in brain biochemistry and in the structure and/or activity of certain brain circuits are responsible for the extreme shifts in mood, energy, and functioning that characterize bipolar disorder."http://www.nimh.nih.gov/publicat/bipolarresfact.cfm
------------------------------------------
Posted by Chris A on April 17, 2002, at 22:42:42
In reply to Re: Need help to refute the anti-biological camp, posted by crepuscular on April 17, 2002, at 13:45:44
Do I have permision to quote you? Your comments are right to the point - very well stated (which I am having a bit of trouble with). Perhaps I should enlist you to write my rebuttal :-)
I need all the help I can get.Blessings,
Chris A.
Posted by Chris A on April 17, 2002, at 23:01:14
In reply to Re: Need help to refute the anti-biological camp » Chris A, posted by Ritch on April 17, 2002, at 13:51:34
Does this mean that nothing ever becomes fact? Guess I need to have my 18 year old refresh my brain regarding the scientific method. I have working theories, but I want to be right!!
Thanks,
Chris A.
Posted by Chris A on April 17, 2002, at 23:18:29
In reply to Re: Need help to refute the anti-biological camp » Chris A, posted by SLS on April 17, 2002, at 22:26:14
Thanks for the links, Scott. I knew I could count on you to come through. Why it didn't cross my mind to check the nimh site is beyond me. I can't blame it on the anesthesia when it's been nine days.
You sound like you're doing a bit better. I hope and pray it's true.Blessings,
Chris A.
Posted by Ritch on April 18, 2002, at 8:21:26
In reply to Re: Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 23:01:14
> Does this mean that nothing ever becomes fact? Guess I need to have my 18 year old refresh my brain regarding the scientific method. I have working theories, but I want to be right!!
>
> Thanks,
>
> Chris A.
Hi Chris,It would be more accurate to say that theories never are "really" true (scientifically speaking). They are never the "last word" on anything. There always *could* be more facts turn up that could cast doubt on the current working theory that appears to be the last word. Facts are just the tidbits of empirical data picked up with your senses that are interpreted by your mind. Given that, different people are going to have somewhat different views and hence different competing theories to explain phenomenona either because they dispute certain "evidence" or "facts" (whether it should be considered as pertinent at all), or they dispute the *interpretation* of accepted evidence or BOTH. I found it interesting reading about the putative mechanism that explains how lithium "works" to stabilize mood. It *is* a theory, but as time passes and evidence gets collected there is a tendency for things to get, well, a little more complicated. When a new theory comes about as an alternative explanation to unseat the current one it tends to have a simpler sound and feel to it. Since we *prefer* things to have simple explanations over complicated ones-it tends to be very alluring for good or ill.
Mitch
Posted by judy1 on April 18, 2002, at 18:23:40
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
Hi Chris,
I think Scott has given you some great links, but I want to make sure you don't get really frustrated. As the QUEEN of denial, maybe your friend is going through denial too? When I started posting here, I got hammered by my Breggin quotes, and I went off meds and got manic again. I just saw some show last night about DNA sequencing, how they can sequence your blood at birth and give you the probability of having a disease and they showed a clip from an old sci-fi movie (I forget which one), where they prick the baby's heel and say probability of manic-depression 98%, heart disease 60%, etc. Anyway, I seem to remember they/ve linked it to some site on chromosome 18, but that's probably in Scott's links. You sound so good, I hope you feel that way! Take care, Judy
Posted by Chris A on April 18, 2002, at 20:25:41
In reply to Re: Need help to refute the anti-biological camp » Chris A, posted by judy1 on April 18, 2002, at 18:23:40
Thanks for the support, Judy. Yes, my friend is in denial and she's getting a ~~lot~~ of encouragement for it. I am writing, but it is rather garbled, so I am frustrated. Hopefully my hubby will edit and help, since he's the one who told me I should do it. He's done a lot of writing in his career and has a level head (mine's feeling rather skewed about now). My writing ability is such a vague shadow of it's former self. Arrgghh! Besides, I never took molecular genetics or cell biology. Biosynthesis and metabolism was hard enough - I stand in awe of the subject and wish I had a better grasp of it.
I'm feeling pretty good, but will probably pay for not resting today. I went to the couch and the dog had taken over, so came back to the computer to write some more. DNA sequencing is fascinatihg, but it raises ethical issues that are difficult to address.Here's to stability,
Blessings and hugs to you and yours,
Chris A.
Posted by BarbaraCat on April 22, 2002, at 1:16:06
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
Chris,
Most of us on this board are here because of the part meds have played in our lives, so it's difficult to get an unbiased opinion. I'd like to think that therapy would be enough, have thought of going into the profession myself, but can honestly say that it is not enough for the industrial grade woes we present here.Let me give you some recent insights I've had into this nature/nuture topic. I've gone off my 20 year antidepressant career many times and each time I've come gratefully crawling back. I have a strong spiritual bent and believe in the power of love to heal, that perfect love is the strongest medicine and truly is capable of healing our broken brains and hearts. The rub comes in, as I see it, that there is precious little perfect love out there. Therapists do mean well, I have been helped tremendously by good men and women, however, their help has never been enough, it has never been strong enough medicine for what has ailed me. And with the risk of getting too gooey, my particular brand of depression always smacks me squarely in the face with the dreary, bleak and sad face of a mechanized world being poisoned and dying from a lack of love.
I think my vision on things is not delusional, I think that my depression, anxiety is a very normal response to what is ultimately, for me, an issue and anguish of the soul. But there is NO ONE, not one other person living or dead who can fix me up. That soul sickness has to manifest in some way and for me it is neurological, so that's where I go to get fixed. No matter how much yoga, meditation, fasting, praying, talking it out, rescuing abused animals or planting trees, it always comes back to strong medicine. I wish it weren't so but am so glad there's help to be had. Therapists have an important place, but as guides and teachers, not gods.
Posted by lizzyg on April 22, 2002, at 7:50:15
In reply to Need help to refute the anti-biological camp, posted by Chris A on April 17, 2002, at 13:02:34
Dear Chris
This is a subject that I find of great interest. Can I briefly give you my case history?
I am a 39 year old woman and have had six episodes of major depression with associated anxiety over a period of 19 years.
I had a happy and uneventful childhood and am now in a professional job, with a stable marriage and three children. In terms of personality, I am cheerful and easy-going. For me, the depression can strike even at times when I am perfectly content. It has always been treated successfully with antidepressant and anxiolytic medication (the only problems I've experienced have been side effects). Between depressive attacks, I have no symptoms. A couple of times, different GPs (family doctors) have insisted that I see a psychotherapist. On both occasions, after two sessions the psychotherapists have concluded that I'm well balanced and that the depression is biological in nature. My father was also prone to depression, so it must have a genetic component.
I'm not saying this because I believe this sort of endogenous depression is better, or worse, or 'purer' than any other kind, but because many people - including some of the medical establishment here in the UK - seem to find it difficult to believe that this etiology exsits. It makes me doubt myself sometimes, and wonder whether there is a little bit of torment somewhere in my psyche... but I can't seem to find it.
So in my case, drug therapy works efficiently and reasonably quickly, whereas talking therapy doesn't have a role to play. I wonder how your 'friends' would explain that? I'm afraid this isn't a scientifically valid argument, but - along with BarbaraCat's piece - serves to illustrate that there are a great number of different causes and treatments for psychiatric illness, and no one great truth that covers all.
Best wishes
Lizzy
Posted by SLS on April 22, 2002, at 14:09:48
In reply to Re: Need help to refute the anti-biological camp » judy1, posted by Chris A on April 18, 2002, at 20:25:41
I don't know if this helps, but this is how I currently approach things. I like the word "spectrum".
1. "Clinical depression" is a diagnosis of an observable syndrome. It is not an assignment of cause or etiology.2. The etiologies of what is characterized as "depression" are numerous. For example, the word "depression" is used to describe a symptom of hypothyroidism. In this case, depression can disappear immediately upon the ingestion of pills containing T3 or T4 hormone. Is not the cause of this depression completely biological?
2. The word "depression" is used by people to describe quite a variety of subjective experiences. Any two people whom describe themselves as being depressed might be experiencing completely different things. In such a case, person #1 might have a tendency to deem their depression as being equivalent to that of person #2. It makes sense to person #1 that person #2 came to be depressed in the same way, and that the same treatment will prove successful.
3. There is a spectrum of varying ratios of nature versus nurture as contributions to the evolution of depression in the individual. At one end, there is a depression that is completely psychological, and at the other a depression that is completely biological. (I think it is worth repeating that the one word "depression" might be describing two completely different experiential phenomena). In between lies a dynamic interaction between biological vulnerability and psychosocial stress.
I like to use the term "depressive pressure" to describe the psychological experiences that act to stress the biological system. Sometimes these are acute events like the death of a spouse or child. Sometimes they are chronic patterns of depressive thought-styles. For those individuals whom possess a biological vulnerability, there is a threshold of depressive pressure beyond which causes the biological system to collapse beneath this pressure and function abnormally.
1. Some people experience depression, even though no collapse of the biological system has occurred. Psychotherapy alone can be sufficient.
2. Some people who have experienced a collapse of the biological system can recover, as the system will repair itself once the depressive pressure is removed. Psychotherapy alone can be sufficient. However, the continued depressed mood produced by the alterations in biology can hinder one's ability to respond to psychotherapy, as it is more difficult to process through thought the psychological issues producing the depressive pressure. This can end up being a self-reinforcing loop that perpetuates the dynamics causing the depression. Additional treatment with antidepressants might alter the system in such a way as to produce a more functional milieu within which psychotherapy can work.
3. For some people, the biological collapse can produce long-lasting deformities in supportive structures, leaving these people more vulnerable to depression with each successive collapse. Removal of the majority of depressive pressure through psychotherapy might not be sufficient to prevent periodic collapses, especially when the system is challenged by subsequent psychosocial stresses. Longer-term antidepressant therapy might be indicated. Perhaps this extended use of antidepressants creates a temporary structure to support the weight of the depressive pressure while the system rebuilds itself. However, managing psychosocial depressive pressure with continuing psychotherapy can be important or necessary. Of course, sometimes the system cannot rebuild itself sufficiently to remain standing when the scaffolding created by antidepressants are removed. Indefinite treatment with antidepressants might be necessary.
4. For some people, the biological system can begin to function abnormally in the absence of concurrent depressive pressure. A variety of genetic and environmental factors can play a role in the evolution of system dysfunction. Bipolar depression is probably a good example of this, although I think many cases of unipolar are just as biological. Studies of heritability probably demonstrate this for both, and the genes responsible eventually will be identified. Treatment with antidepressants alone are necessary and often sufficient. However, psychotherapy might be helpful to manage the perturbations in psychosocial function produced within the milieu of the biologically altered state of affect and cognition. Indefinite treatment with antidepressants is often necessary, especially if recurrent episodes have occurred. Each successive collapse of the system produces an increasing deformity of the structure of the biological system, such that it becomes less amenable to repair and treatment-resistant.
- Scott
Posted by Chris A. on April 22, 2002, at 15:59:56
In reply to Re: Need help to refute the anti-biological camp » Chris A, posted by lizzyg on April 22, 2002, at 7:50:15
Thanks for your insights. Everyone's experience is a bit different. Simplistically, one could say we're like snowflakes, made up of the same basic materials, but each is an individual work of art.
That aside, my hubby pulled out the book, "Mind <-> Body Deceptions: The Pyschosomatics of Everyday Life" by one of my favorite pDocs, Dr. Steven Dubovsky (UCHSC - Colorado). I would highly recommend it, as he treats the subject so thoughtfully, and is also a very good writer (as well as being super smart, humble and personable at the same time). It is too bad the book isn't still in print, but you might be able to find it at your library or through inter-library loan. It was published by W.W. Norton and Co., 1997; ISBN 0-393-02943-3.
He's the pDoc that diagnosed me with bipolar disorder ten years ago, and at each subsequent consultation the discussion has centered around the biological aspects and treatment with medication. However, he's always suggested that I continue with talk therapy as an adjunct. Just re-reading parts of his book make me appreciate his grasp for the big picture and ability to grapple with the difficult issues. He is one person who's brain I would really like to have the opportunity to pick. He's the one who suggested trying the calcium channel blockers verapamil and nimodipine a few years back. He recommended ziprasidone (Geodon) 1 1/2 years prior to it's release by the FDA. My buprenophrine trial was his suggestion. He is also the one who thinks too much Lamictal causes a bit of anxiety and agition for me, so even though it's the best med for me, I need to cap the dose at 200 mg.All I can say, is that we are complex creatures; but I need my medicine and anyone who tells me that I don't is going to have to answer for it. Anyone who tells me that my brain doesn't have a role in this is in for getting piles of journal articles stacked on their doorstep. Perhaps I should add just a bit of Trileptal to my cocktail tonight, as feeling so strongly about something is a sign of hypomania for me. When I'm depressed I would just hide my head under a pillow and cry.
Blessings,
Chris A.
Posted by Chris A. on April 23, 2002, at 11:25:22
In reply to Nature/Nuture - Barbara, Lizzy, Sott and all, posted by Chris A. on April 22, 2002, at 15:59:56
Good news. I checked with Dr. D's office. He has changed publishers and the book is to come out as a new edition this fall. I am interested to see what he has to add five years later.
Chris A.
Posted by sjb on April 24, 2002, at 13:59:17
In reply to Re: Need help to refute the anti-biological camp » Chris A, posted by BarbaraCat on April 22, 2002, at 1:16:06
This is the end of the thread.
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