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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Squiggles on February 1, 2006, at 17:02:47
I already have Porter, Jamison and Goodwin,
Plath, Goodman and Gilman, lots of Torrey,
lots of Healy,Schou and recently one of my favourites:
FRONTAL LOBE FUNCTION and DYSFUNCTION by
Levin, Eisenbrg, and Benton, and lots lots more
psych books.I never read Peter Kramer, and he is the one who
wrote THE book on Prozac. Should I get it?
Should I put it in quotes for Dr. Bob's benefit -
double quotes right?Gosh, there are so many prima donnas in
this field - i'd love to see Dr. Healy and
Dr. Kramer in a "forum", with protective gear :-)Squiggles
Posted by pseudoname on February 11, 2006, at 15:36:33
In reply to Kramer?, posted by Squiggles on February 1, 2006, at 17:02:47
> I never read Peter Kramer, and he is the one who wrote THE book on Prozac. Should I get it?
I was going to reply to this a few days ago, but I figured you'd already bought or not-bought it. Well, anyway, here's my thinking.
Peter Kramer's (1993) "Listening to Prozac" is really more of a very long (*slightly* verbose) philosophical essay on personal identity, not Prozac or depression. It doesn't have much clinical information on Prozac, and that would be out of date now, anyway. I don't think I would suggest to anyone on a budget to buy it, but if you're interested in that sort of thing, it's worth reading many of the chapters.
I can recommend Kramer's (2005) "Against Depression". To a certain extent, he fights a straw man in it: Who these days really thinks depression is so romantic? A likelier, more serious problem, I think, is resigning yourself to depression, thinking that you might as well put up with it.
But Kramer's summary of recent research puts the fight in you. Depression has ongoing, cumulative, long-lasting deleterious effects in the brain, in cognition, in overall physical health, and in life expectancy (apart from suicide). He spells it out: get rid of depression as thoroughly as possible. It's serious.
It's because I read "Against Depression" last fall that I went back to a pdoc again. And because of that, I eventually got a buprenorphine (Subutex) script that worked!
You do a lot of great reading in psych, Squiggles. Do you have any favorite theories or insights about it?
Posted by Squiggles on February 11, 2006, at 15:57:32
In reply to Re: Kramer? “Against Depression” » Squiggles, posted by pseudoname on February 11, 2006, at 15:36:33
pseudoname,
I really appreciate the feedback; i buy books
I am interested in second hand, or if not
sure of their desirability, borrow from the
library -- sometimes sell them;
Kramer caught my eye because he seems
"diametrically" opposed to Healy. I might
borrow "Against Depression".I studied Psychology and turned to Philosophy
and that might explain my interest. I failed
my logic course and stopped short of the
dissertation.Thanks
Squiggles
Posted by pseudoname on February 11, 2006, at 19:18:59
In reply to Kramer?, posted by Squiggles on February 11, 2006, at 15:57:32
> Kramer caught my eye because he seems "diametrically" opposed to Healy.
Kramer has a more ambiguous and less enthusiastic attitude toward drugs than his book title implies. He says that after his patients achieve some stable improvement, he asks them to try going without their meds. He's well aware of the drugs' long-term health uncertainties. He knows they aren't the only answer, just one that we have and should use. He had psychoanalytic training and I think mostly practices "talk" therapy.
He does passionately believe, however, that depression is a real, fully-fledged illness. For a contrast between Kramer and someone who's diametrically opposed to him on that, there's a transcript of a debate he had with Thomas Szasz (among others) here: http://www.szasz.com/isdepressionadiseasetranscript.html ("Is Depression a Disease?" 3/31/98. Produced by Warren Steibel)
Posted by Squiggles on February 11, 2006, at 21:00:52
In reply to Re: Kramer vs · · · » Squiggles, posted by pseudoname on February 11, 2006, at 19:18:59
> > Kramer caught my eye because he seems "diametrically" opposed to Healy.
>
> Kramer has a more ambiguous and less enthusiastic attitude toward drugs than his book title implies. He says that after his patients achieve some stable improvement, he asks them to try going without their meds. He's well aware of the drugs' long-term health uncertainties. He knows they aren't the only answer, just one that we have and should use. He had psychoanalytic training and I think mostly practices "talk" therapy.
>
> He does passionately believe, however, that depression is a real, fully-fledged illness. For a contrast between Kramer and someone who's diametrically opposed to him on that, there's a transcript of a debate he had with Thomas Szasz (among others) here: http://www.szasz.com/isdepressionadiseasetranscript.html ("Is Depression a Disease?" 3/31/98. Produced by Warren Steibel)-------------
Well, that was an interesting debate and given
the seriousness of the issue, conducted in a
very civil manner.I am familiar with the views of Dr. Szasz in
psychiatry, as well as those of Dr. Goodwin,
have heard of Dr. Schaler's, and Dr. Klein's,
but not Dr. Kramer's or Dr. Leifer's.I was interested in Dr. Kramer's position because
he wrote the book on Prozac and I wanted to
see how he prescribed the drug and how he differed
from the very aggressive campaign against SSRIs
heralded by Dr. David Healy.In my own observation and readings, I have noticed that not only SSRIs but all antidepressants as well as benzodiazepines, and lithium, can in the interim of stopping, falling below the stability dose, and starting again to stabilize there is a dangerous gap. I have given a name to that gap:
"the twilight zone" -- here is where the suicides,
the murders, the extreme agitation, mania and
other psychotic states take place.And if this is true, then it is not the SSRIs
exclusively that are responsible for these
tragic indicdents, but all psychotropic drugs
in that "twilight zone" -- perhaps even alcohol,
cocaine, and other drugs.So, that is my interest in what Dr. Kramer has
to say in contrast to Dr. Healy. In this interview, I learn something about Kramer's psychiatric views -- they seem to be pragmatic. He admits to have written books about "Woody Allen" depression, but concedes to the depth and severity of more serious depressive states, which once were called psychoses. He also concedes to the evidence of brain abnormalities as evidence of
disease. Tofranil by the way was brought to
Montreal around the 50s - the golden era of
psychiatry.Much ink is spent on the definition of DISEASE,
and the debate reminds me of the scuffle over
the word ADDICTION in the case of benzos.Dr. Leifer has an interesting insight into the
complexity of mental states, and I think that
is a richer way of approaching the concept of
mental illness as a disease; however, I must agree
with Dr. Klein that depression is an illness open
to medication. And I think that that points to
our current state of the disease of the brain
being vague (because of our limited knowledge),
and also because a true doctor's duty is to
alleviate suffering -- however impoverished his
scientific and theoretical knowledge of the causes
of that suffering are.Dr. Goodwin is pragmatic and points to the
advances made in scanning for brain disorders
which give rise to strange behaviour. And I would
like to say here that on the question of behaviour
which Dr. Schaler seems to think distinct from
organic illnesses, if the disease were that of an
organ such as the liver, or some other organ than
the brain, there would be not dispute. And I think that is revealing of something that we do
not pay attention to, i.e. that the brain is the
seat of consciousness, personality, and emotion --
the effects of a biochemical change in the brain
therefore are much more dramatic and alarming than
a cancerous pancreas.But, the bottom line is
that there are many causes that can change the
biological state of the brain, permanently or
transiently, depending on what those causes are --
a lesion is likely to be permament, a traumatic
experience maybe transient, degeneration of the
cells through age will not be reversed, and some
drugs may even cause permanent damage.As for Dr. Szasz, I do think that he is more
concerned in the social and human rights issues
about mental illness, especially the libertarian
conviction that a man has the right to do what
he wants be he sick or not. Well, that's his
opinion and perhaps the opinion of some of his
patients.In my case, I think my life was saved by lithium,
and I owe a great deal to my doctors and to
Dr. Mogens Schou (recently died). But, I confess,
that I am still searching for the initial cause
of my illness -- as I do suspect that Valium
withdrawal may have been the cause, but I cannot
prove that.One of the problems with medicine in general,
including mental illness, is the lack of good
scientific methodology, and ignorance. And so
we have to proceed it seems by taking people
out of the hell that Dr. Schaler cannot possibly
understand when he says manic depression is being angry and sad, and "do no harm", or at most
"the least harm".Squiggles
Posted by James K on February 12, 2006, at 2:05:50
In reply to Re: Kramer vs · · ·, posted by Squiggles on February 11, 2006, at 21:00:52
I admit to perusing the boards drunk, so please if you may, excuse me, but have you read "Noonday Demon" by andrew solomon. other than his love of (I think zyprexa) it is one of the best and most fascinating books on depression I have ever read. If you have something interesting to add about this, or can direct me to a previous thread, please do, if not, carry on. I'm just jumping in.
Dang, when I put in the wrong password, and had to go back, I saw I had linked to all kinds of stuff. this is the first time I used the double quotes feature, I guess I used it correctly. I will look into this tomorrow.
James K
james k
Posted by Squiggles on February 22, 2006, at 8:12:20
In reply to Re: Kramer vs · · · » Squiggles, posted by James K on February 12, 2006, at 2:05:50
Yes, I read "Noonday Demon". It was
excellent and well-researched.Sorry, I did not see your post for a while.
Squiggles
This is the end of the thread.
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