![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 70. Go back in thread:
Posted by WeeWilly on September 17, 2006, at 14:18:41
In reply to Re: the brain » bassman, posted by Squiggles on September 17, 2006, at 12:34:06
Clearly our minds are an orchestra of numerous elements. Any of of these elements not " playing" properly spoils the music(optimum mental function). I will be 47 soon. Over 30 years ago I felt my mood and mental difficulties were caused by a dyregulation in my HPG axis. To this day I still do. A scientist in 1898 proposed a theory and treatment for HPG dysregulation. It pertaind to mood and cognitive problems in cases of menopause. In the 1920's estrogen compounds became available. Now in 2006 the HPG axis is still not understood. It's encouraging to see the increasing focus on HPG dysregulation as the key to understanding cognitive problems in a number of disorders. A study in Feb of 2005 proposed that supplementing with Inhibin would be a prudent course to take in the future in an attempt to reregulate HPG axi's. Evidence in my own case back in 1987 led me to suspect I may not produce enough Inhibin.
Through the years knowledge of Inhibin its subunits, Activin, Follistatin,FSH,LH,testosterone,estrogen, etc., and the HPG axis overall has grown more and more complex. In time many of us will be treated to correct our HPG axis. Like I stated earlier estrogen treatment started in the 1920's, but the mode of action is still is not known. Research is vigorously looking for alternatives to this intervention in the HPG axis because of studies completed in 2004 found estrogen treatments to cause much higher rates of various health problems.
I keep trying AD's(Emsam now), with very little success. My HPG axis is dysregulated also my HPA axis(Dex. non-supressor), so it is not likely I will find a effective treatment until these are addressed.
We sure are in a bizzar situation. Best wishes.
Posted by Squiggles on September 17, 2006, at 14:59:54
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 14:18:41
I had to look up HPG - ok, this is
a possible endocrinological problem;
you say you "felt" that was the cause--
what do you mean by that?Squiggles
Posted by WeeWilly on September 17, 2006, at 15:30:52
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 14:59:54
> I had to look up HPG - ok, this is
> a possible endocrinological problem;
> you say you "felt" that was the cause--
> what do you mean by that?
>
> SquigglesI thought or suspected over 30 years ago. Now I am close to 100% certain.
About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
Posted by Squiggles on September 17, 2006, at 17:25:12
In reply to Re: the brain » Squiggles, posted by WeeWilly on September 17, 2006, at 15:30:52
> > I had to look up HPG - ok, this is
> > a possible endocrinological problem;
> > you say you "felt" that was the cause--
> > what do you mean by that?
> >
> > Squiggles
>
> I thought or suspected over 30 years ago. Now I am close to 100% certain.
> About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
I suppose we all march to a different drummer,
follow the Pied Piper, call the tune, blow
your our own horn, fiddle while Rome burns, etc.
But when the piece is off key, you don't have
to be a neurosurgeon to recognize it.Nice analogy, but complicates matters when
you present a further challenge of correspondence in biological psychiatry. I'm quite content
with feeling "well" rather than depressed,
whatever the music.Squiggles
Posted by WeeWilly on September 17, 2006, at 18:34:08
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 17:25:12
> > > I had to look up HPG - ok, this is
> > > a possible endocrinological problem;
> > > you say you "felt" that was the cause--
> > > what do you mean by that?
> > >
> > > Squiggles
> >
> > I thought or suspected over 30 years ago. Now I am close to 100% certain.
> > About the analogy of our minds being like an orchestra. Your trombone players would have to reach over and assist with the piano playing, the flutists pluck the harps, etc.. Many if not most of the factors that are involved with cognition are multifunctional. Inhibins and Activins, early on were thought to only regulate FSH. Now with identified receptor sites in the adrenal cortex, hippocampus and many othe places, its clear they have wide rangeing roles.
>
>
> I suppose we all march to a different drummer,
> follow the Pied Piper, call the tune, blow
> your our own horn, fiddle while Rome burns, etc.
> But when the piece is off key, you don't have
> to be a neurosurgeon to recognize it.
>
> Nice analogy, but complicates matters when
> you present a further challenge of correspondence in biological psychiatry. I'm quite content
> with feeling "well" rather than depressed,
> whatever the music.
>
> Squiggles
>
>
"But complicates matters when you present a further challenge of correspondence in biological psychiatry"? Not sure what you are saying Squiggles.
I sense that maybe I am not expressing myself well to you. In a nutshell, tests to diagnose and treatments to correct HPG and HPA axis dysregulation is on the horizon. It will be the the appropriate treatment that many of us have been looking for. What percentage of present sufferers that this is the key to their disorder I would speculate as high as 60%. Best wishes
Posted by Squiggles on September 17, 2006, at 18:53:50
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 18:34:08
I think i misunderstood -- that there are
tests for this, makes the dx possible. What
i meant was that it's hard to correlate
with neurological states. Were you tested,
diagnosed and treated, successfully?Squiggles
Posted by WeeWilly on September 17, 2006, at 19:54:38
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 17, 2006, at 18:53:50
> I think i misunderstood -- that there are
> tests for this, makes the dx possible. What
> i meant was that it's hard to correlate
> with neurological states. Were you tested,
> diagnosed and treated, successfully?
>
> SquigglesThere are tests for most of the known hormonal proteins,peptides,and various other elements that constitute the HPG and HPA axi's. There are treatments to elevate or lower some of them if appropriate but not all. It's the peptides like Activin, Inhibin, etc that are'nt here yet for clinical use. Correlating with neurological states? Well like with the Hypothyroid condition if your thyroid tests out of range the neurological state you will likely represent mirrors that of types of depression. Likewise with dysregulation the HPG and HPA axi's. Best wishes
Posted by Squiggles on September 18, 2006, at 8:39:49
In reply to Re: the brain, posted by WeeWilly on September 17, 2006, at 19:54:38
I don't know if i was tested for
peptides, etc. Depression and manic-depression
can be caused by so many different things.
In a state of crisis, such as psychosis,
or mania, they have to give the drugs that
work no matter whether they are the best drugs.
I think that our health system has to rely
on external signs for economic reasons.
You sound like you have access to private health care, and the privilege of getting many tests.
If they got that right, good for you.Squiggles
Posted by alexandra_k on September 19, 2006, at 5:04:17
In reply to Re: the brain » WeeWilly, posted by Squiggles on September 18, 2006, at 8:39:49
I should read the meds board more :-)
An analogy.
Lets suppose I'm trying to write this computer program and the program isn't working. I take the back off my computer looking for something to fix. I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
"The Philosophical Defence of Psychiatry" p. 156
Posted by SLS on September 19, 2006, at 5:20:00
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
> I should read the meds board more :-)
>
> An analogy.
>
> Lets suppose I'm trying to write this computer program and the program isn't working.So, it was concluded that the program was faulty?
> I take the back off my computer looking for something to fix.
Someone's program was truly faulty.
> I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
Not getting it, Alex. I wouldn't have opened up the box. If I had my doubts, I would have tested the program on another computer.
> 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
Now that, I get.
:-)
(Just busting them)
- Scott
Posted by Tomatheus on September 19, 2006, at 23:00:03
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
> Lets suppose I'm trying to write this computer program and the program isn't working. I take the back off my computer looking for something to fix. I mean... Computers are physical systems aren't they? If the program isn't working then shouldn't I tinker around with the hardware in order to fix the program?
Of course not. But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem. In the case that I described, no competent computer engineer would say that attempting to repair the malfunction in the hard drive is just "masking the real problem" or like providing the computer with a "crutch."
Obviously, problems with both the hardware and the software of a computer can occur. And the two types of problems need to be addressed in different ways. It's also conceivable that problems with both a computer's hardware and its software could interfere with its ability to function optimally, in which case both problems would need to be addressed appropriately.
Because we created computers, we obviously understand how they work and what causes them to stop functioning properly better than we understand how we "work" and what causes us to function less than optimally. Just because we don't fully all of the processes that contribute to the way we function mentally doesn't mean that we should dismiss the things that we do know as being pseudoscientific or that we shouldn't keep trying to improve our understanding of these processes (I'm not saying that you've suggested these things, but there are a lot of people out there who have).
I'd like to think that we'd want to put our own well-being over that of our computers, but it seems from the rhetoric of some groups and individuals that there is not universal agreement that humans should be a priority.
Tomatheus
Posted by alexandra_k on September 20, 2006, at 6:03:30
In reply to Re: the brain » alexandra_k, posted by Tomatheus on September 19, 2006, at 23:00:03
:-)
With mental illnesses what is problematic are behaviours (including verbal behaviours).
We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.
Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
> But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.
Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).One could try and interveane at one point...
Or one could try and interveane at as many places as possible...Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
But I still think that for a very long time yet...
If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
Posted by alexandra_k on September 20, 2006, at 6:04:43
In reply to Re: the brain, posted by SLS on September 19, 2006, at 5:20:00
> > 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
> Now that, I get.
> :-):-)
Posted by SLS on September 20, 2006, at 7:24:53
In reply to Re: the brain, posted by alexandra_k on September 20, 2006, at 6:03:30
> If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.
> And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present....Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology. Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain. Who would argue the biological underpinnings of the severe psychotic episode of bipolar disorder? Who could then deny that the paroxysmal switch into severe depression were not equally biological? Afterall, it is merely the antipodal phase of the same biological disorder. Is the depression of bipolar disorder, then, not biological? Is the depression of bipolar disorder the only depression that is biological?
I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
- Scott
Posted by Squiggles on September 20, 2006, at 8:16:05
In reply to Re: the brain » alexandra_k, posted by SLS on September 20, 2006, at 7:24:53
...
Who would argue the biological underpinnings of the severe psychotic episode of bipolar disorder? Who could then deny that the paroxysmal switch into severe depression were not equally biological? ....
Those who have not experienced these bizarre
emotional states, which resemble a physical
illness to the one going through them. Those
who have never had a stroke, never had a
concussion, never had meningitis, never really
had clinical depression, but only dysthimia and
some anxiety-- conditions which CAN be treated
with counselling and drugs, unlike the others, which MUST be treated with drugs. It's the old
"Woodly Allen" syndrome again, confused for
a more serious state of depression, which feels
very different.Squiggles
> - Scott
Posted by Tomatheus on September 20, 2006, at 12:33:05
In reply to Re: the brain, posted by alexandra_k on September 20, 2006, at 6:03:30
> :-)
:-)
> With mental illnesses what is problematic are behaviours (including verbal behaviours).
I would contend that dysfunctional feelings and emotions associated with mental illnesses are also problematic, especially from the perspective of those suffering from mental illnesses.
> We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Not necessarily. It is not uncommon for people to infer that the origins of problematic behaviors are 100 percent environmental and 0 percent genetic.
At this point, it is impossible for a mental health professional (or anyone else, for that matter) to say with 100 percent certainty whether or not a given patient's illness is influenced (either in whole or in part) by a genetic abnormality and/or a physical injury that affects brain functioning. However, I do think that there is strong evidence in the peer-reviewed neurobiological literature to indicate that such abnormalities and injuries do play a causative role in the development of psychiatric illnesses -- at least in certain individuals. I would contend that illnesses characterized by high levels of severity and/or chronicity have a strong likelihood of having been caused (at least in part) by an inborn biological abnormality.
> Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
I agree. Environmental factors have clearly been implicated in the development of mental illnesses. I do think that it's possible that the cause of a person's diagnosed psychiatric illness can be completely environmental. However, I don't think that it should be assumed that this is the case 100 percent of the time, as genetic causes have also been implicated in psychiatric illnesses.
> Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
I agree that this assumption is sometimes made, but I'm not so sure that it's made in a majority of cases. Of course, different mental health professionals make different assumptions. I think that one should always allow for the possibility that a person's mental illness could have both biological and environmental underpinnings.
> But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
>
> As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.Good point. I agree.
> Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
True, but in cases where genetically mediated biochemical abnormalities do contribute to the underlying pathology of a mental illness (which have been confirmed in some individuals), I don't think that a psychopharmacological approach is a "cover up strategy." Of course, one could only guess to what extent any given drug might be reversing the effects of a possible biochemical abnormality. I certainly don't think it's ethical to tell those suffering from depression that there is no question that their illness is caused by a chemical imbalance and that a particular drug *will* correct that imbalance. But apparently, it's at least legal (though not necessarily ethical) to make such a claim in advertising.
> > But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
>
> That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.I agree. The analogy is not a perfect one. However, I don't think that it should be assumed that therapy will lead to clinically relevant neuro-physiological changes in all individuals (I'm not saying that you're making this assumption; I just wanted to share my thoughts on the issue).
> Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
> 1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
> 2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).
>
> One could try and interveane at one point...
> Or one could try and interveane at as many places as possible...
>
> Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
>
> Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
>
> But I still think that for a very long time yet...
>
> If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
>
> And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.Agreed.
Tomatheus
Posted by zeugma on September 20, 2006, at 16:00:31
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
hi alexandra
'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
whoever wrote this must have been a psychotherapist
those value-laden adjectives spoil the analogy for me
-z
Posted by alexandra_k on September 20, 2006, at 20:41:42
In reply to Re: the brain » alexandra_k, posted by SLS on September 20, 2006, at 7:24:53
> > If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
> ...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.People with anorexia don't have a lack of appetite they restrict their eating for other reasons.
- Rates of anorexia are highest where women have been most exposed to the western ideal of body weight. (Cross cultural prevalence)
- Rates of anorexia climb where cultures become more exposed to the western ideal of body weight (e.g., in Fiji, children of immigrants from Pakistan living in the UK)
> > And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
> ...Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology.But therapy and changes to society (environment) result in changes to the neural circuitry and intracellular machinery.
> Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain.
I disagree (see my last remark).
> I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
Indeed.
Hence inter-level interventions instead of a uni-level intervention.
Hence the biopsychosocial model instead of a biobiobio model.
Posted by alexandra_k on September 20, 2006, at 20:48:54
In reply to Re: the brain » SLS, posted by Squiggles on September 20, 2006, at 8:16:05
And do the drugs work?
Do the drugs fix the problem?No.
Maybe you think it is just a matter of time...
I think that the biobiobio approach is wrong headed because it fails to take account of the relationships between the different levels of explanation. Alterations to the environment result in alterations to biology, alterations to psychology result in alterations to biology.
If you show someone how to cook they learn to cook because your showing them resulted in alterations to their biology. If you tried to teach them how to cook by directly stimulating their brain... Well... What are the chances of our being able to do that anytime soon?
I'm not saying that the biological approach should be abandoned. I'm not saying that people should come off their meds. All I'm saying is that a biobiobio approach is simplistic compared to a biopsychosocial approach of intervention.
Shouldn't this be good news?
If your meds aren't working so well... If you are on an endless trail of trying to find the right med... If you are waiting for the right med to be invented... All is not lost. There are social / environmental and psychological interventions too and they might be able to do what the meds aren't able to do. Isn't that good news?
Posted by alexandra_k on September 20, 2006, at 21:06:30
In reply to Re: the brain » alexandra_k, posted by Tomatheus on September 20, 2006, at 12:33:05
> > With mental illnesses what is problematic are behaviours (including verbal behaviours).
> I would contend that dysfunctional feelings and emotions associated with mental illnesses are also problematic, especially from the perspective of those suffering from mental illnesses.What I mean by 'behaviour' is very liberal. How do we know that feelings are problematic? By observing emotional behaviours (including flushing, heat rate, jittering, flattened affect, rate and tone of speech, yelling, etc) and verbal behaviour (what the client / patient reports).
> > We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
> Not necessarily. It is not uncommon for people to infer that the origins of problematic behaviors are 100 percent environmental and 0 percent genetic.Not in psychiatry. Psychiatry is dominated by the medical model which has been criticised for being a biobiobio approach instead of being a biopsychosocial approach. A pure social approach is more common amongst sociologists and anthropologists who focus on cross cultural variations.
> > Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
> I agree that this assumption is sometimes made, but I'm not so sure that it's made in a majority of cases.That is the medical / biological model of mental illness. Psychiatry is moving towards a biopsychosocial approach but it is unclear how the different elements can be integrated into a coherent theory that isn't just a muddle of factors...
> in cases where genetically mediated biochemical abnormalities do contribute to the underlying pathology of a mental illness (which have been confirmed in some individuals), I don't think that a psychopharmacological approach is a "cover up strategy."
It doesn't fix the gene... Does it?
What is the contribution of the gene at any rate?
There is a project... Dammit I can't remember what it is called... It is based on health statistics from Iceland. The most recent research shows that (I might get this a little wrong...) As far as a single gene being implicated in schizophrenia... Something like 15% of people with schizophrenia have it... And something like 7% of people without schizophrenia have it. With respect to structural alterations (enlarged ventricles and smaller structures in other areas) I think the stats come out the same. So things aren't looking so good with respect to the schizophrenia gene. Or with respect to finding neurophysiological changes that are predictive of schizophrenia (especially when a number of people with bi-polar may have similar structural abnormality). Maybe other genes moderate the expression of the schizophrenia gene... or maybe... Certain things like a virus in the third trimester, or certain kinds of environmental or psychological conditions are what differentiates between those who have schizophrenia and those who don't.Surely neuro-chemistry is really nothing over and above chemistry. And surely chemistry is nothing over and above physics. Maybe we just need to wait for microphysics to invent an electron gun that is safe to be used on brains...
Or maybe... A strictly biological approach is inappropriate as it seems that what is crucial is the interaction of biological psychological and social forces...
> However, I don't think that it should be assumed that therapy will lead to clinically relevant neuro-physiological changes in all individuals
Absolutely. I also don't think that it should be assumed that psychpharmacology will lead to clinically relevant neuro-physiological changes in all individuals, however.
That is my point.
Instead of limiting our interventions to one it is more likely intervention will succeed when it is targeted at multiple levels.
Posted by alexandra_k on September 20, 2006, at 21:08:08
In reply to Re: the brain » alexandra_k, posted by zeugma on September 20, 2006, at 16:00:31
((((z)))) i've missed you!
> 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
> whoever wrote this must have been a psychotherapist
He says in the preface that he wrote it while training to be a psychiatrist. I think he studied analytic philosophy first because he uses terminology appropriately in places ;-)
> those value-laden adjectives spoil the analogy for me
aw.
can you think of non value-laden replacements?
Posted by Squiggles on September 20, 2006, at 21:09:39
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 20, 2006, at 20:48:54
I may have lost the sequence of
replies here... if you (Alexandra_K)
are saying that clinical mental illness
can be reversed (under all conditions)
without meds, i personally have a
counter-example.And that is the serendipitous occasion
of being given counterfeit/corrupted/old/or/
low drugs of my usual dose. The return of
the illness was indisputable--surprised even
me, maybe even my doctor, who is not
dogmatic in these matters. I became well
again upon resumption of the correct dose.I think that was a kind of scientific proof
that they call "CHALLENGE, DECHALLENGE,
RECHALLENGE". I think it even meets Popper's
falsifiability criterion for test of
the truth of a statement.Squiggles
Posted by alexandra_k on September 20, 2006, at 22:18:25
In reply to the brain » alexandra_k, posted by Squiggles on September 20, 2006, at 21:09:39
> if you (Alexandra_K)
> are saying that clinical mental illness
> can be reversed (under all conditions)
> without meds, i personally have a
> counter-example.I never said that.
Your initial post was about how mental illnesses are biological hence should be treated by medication. I took you to be saying 'all' mental illnesses and 'only' medication and hence I offered counter-examples.What I did say (repeatedly, I thought) was that intervention target at one level was likely to be less effective than intervention targeted at multiple levels. Hence... The best plan of attack is the a multi-levelled one that attempts to interveane on biological, psychological, and social causes of mental illness.
> I became well
> again upon resumption of the correct dose.And so long as you stay on your meds you have a complete remission in symptoms?
Posted by SLS on September 20, 2006, at 22:46:26
In reply to Re: the brain » SLS, posted by alexandra_k on September 20, 2006, at 20:41:42
> > > If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
> > ...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.> People with anorexia don't have a lack of appetite they restrict their eating for other reasons.
You rushed your reading of me. There were two separate conditions depicted.
> - Rates of anorexia are highest where women have been most exposed to the western ideal of body weight. (Cross cultural prevalence)
> - Rates of anorexia climb where cultures become more exposed to the western ideal of body weight (e.g., in Fiji, children of immigrants from Pakistan living in the UK)I do not argue the cultural biases and psychosocial stresses that contribute to the onset of anorexia nervosa. I think much of the condition is driven by a desire to have control over some aspect of one's life, too. There's something else going on there, though. I am not well read on the topic, and I have not devoted much time thinking about it, but I think there might be an OCD type 5-HT/NE balance type thing going on or a reward-conditioning thing that's hard to break. I don't know.
I don't know why it has to be all one way or all the other. Polarized thinking is bound to be counterproductive when it comes to mental illnesses.
> > > And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
> > ...Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology.
> But therapy and changes to society (environment) result in changes to the neural circuitry and intracellular machinery.YES!
> > Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain.
> I disagree (see my last remark).They are not mutually exclusive. Again, polarized thinking. Think multidimensionally! Think both ways simultaneously.
"The brain determines the mind as the mind sculpts the brain."
> > I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
> Indeed.
>
> Hence inter-level interventions instead of a uni-level intervention.
>
> Hence the biopsychosocial model instead of a biobiobio model.You don't seem to know me or my writing well enough. Stick around.
;-)
- Scott
Posted by Squiggles on September 21, 2006, at 7:34:42
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 20, 2006, at 22:18:25
> What I did say (repeatedly, I thought) was that intervention target at one level was likely to be less effective than intervention targeted at multiple levels. Hence... The best plan of attack is the a multi-levelled one that attempts to interveane on biological, psychological, and social causes of mental illness.OK - thank you for repeating your point.
"Multi-levelled", well, I don't know; it
sounds like a "crap shoot" if you will excuse
the phrase.>
> > I became well
> > again upon resumption of the correct dose.
>
> And so long as you stay on your meds you have a complete remission in symptoms?
>
>Yes. I was hoping that i had a chance at
being normal, in this accidental withdrawal.
The fact that i didn't proves that I am bipolar.Squiggles
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