![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 60. Go back in thread:
Posted by SLS on September 25, 2006, at 0:09:08
In reply to Leaving the site for a while » Squiggles, posted by Squiggles on September 22, 2006, at 10:42:28
Hi Squiggles.
I know that you travel through Cyberspace and have other destinations. I am disppointed that you are leaving us and am curious as to why. But that is a personal question.
Anyway. I hope that you remain well on your present treatment and that the world smiles upon you.
- Scott
> I have to go now. Sorry,
> to interrupt your conversation;
> i hope others will pick up your
> point and you get an opportunity
> to discuss the successful cases
> of non-biological treatments.
>
> Thanks for the interesting chat.
>
> Squiggles
Posted by SLS on September 25, 2006, at 0:09:08
In reply to Re: the brain » alexandra_k, posted by SLS on September 22, 2006, at 12:24:07
> "Bipolar disorder, also known as manic-depressive illness, is a brain disorder"
>
> C:\Medicine\Neuroscience\Mental Health\NIH\bipolarresfact.cfm.htmOops.
I guess you not likely to successfully link up to my hard drive. Here's the right URL.
http://www.nimh.nih.gov/publicat/bipolar.cfm#intro
- Scott
Posted by alexandra_k on September 25, 2006, at 0:09:08
In reply to Re: the brain, posted by SLS on September 22, 2006, at 12:48:49
about addition.
if you add things in you don't leave things out.e.g.,
lets say you have 2
then you add 5
so now you have 2 5
the 2 is still there, can you see it?
lets say you have biology
lets say you add psychology
then you have biology and psychology
the biology is still there, can you see it?
if you add sociology so you have
biology psychology and sociology the biology is still there, can you see it?
biopsychosocial
the biology is still there, can you see it?
you don't see it, do you?
you don't hear what i'm saying.
did i ever say we should forget about biology?
no.
if you disagree with what i'm saying the thing to do isn't to find proof of how changing biology helps people. biology is in my model too, can you see it?
if you disagree with what i'm saying the thing to do is to find proof that changing psychology and sociology *doesn't* help people. because those things aren't in your biobiobio model. are they? i haven't seen them yet.
Posted by zeugma on September 25, 2006, at 0:09:08
In reply to Re: Redirect: the other two levels » Dr. Bob, posted by alexandra_k on September 21, 2006, at 23:50:28
> > I'd like follow-ups regarding the other levels to be redirected to the other boards. Thanks,
>
> Isn't that just promoting dualism?yes (sigh). I don't think that putting things in boxes is a way to understand how things work.
But here is where I start running into trouble. Because it's really a political matter.
-z
>
>
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to Re: the brain » alexandra_k, posted by SLS on September 22, 2006, at 12:24:07
> I wish that I had the energy to type here the proof you would need to convince you that bipolar disorder is a disorder of the brain.what do you mean by 'disorder of the brain'? if you mean that if you take a bunch of fMRI's and you image peoples brains and you average the results then the bi-polar bunch looks different to the control bunch then sure. I agree. Does that entail that *everyone* with bi-polar has an abnormal brain? Nope.
Even if you have an abnormal brain I think we have been through how experience (incl. environment and psychology) can change the brain like medication can change the brain.
Even if it is an abnormality in the brain of the individual (and that hasn't been established) that doesnt' entail medication is the best or only way to treat that abnormality.
I think I need to say this again:
If people are taking meds that are working for them then great continue to take them. I'm not saying people should stop taking meds. I'm just cautioning against a biobiobio approach where people think that there is something fundamentally wrong with including psychological and sociological factors into the treatment plan when the biobiobio model really isn't helping them...
If you are helped by that approach then fine.
> Anything short of the full recognition that their illness is of biological origin is to confuse their world and sabotage their spirit.
I see.
Well then...
I don't know what to say...I don't want to confuse anyones world and stabotage anyones spirit.
I don't know whether this is based on a fundamental misunderstanding of what I'm saying...
Or if it is tied up with notions like... Blame and responsibility and the like. Society is in the grip of many a myth and myths are created in order to make us feel better about ourselves... I don't want anyone to feel bad... I don't know what to say...
> I am very desiring to know your opinion regarding schizophrenia. Do you believe it to be a biological disorder?
I think that the category 'schizophrenia' is a lot like the category 'super-lunary object' or 'yellow things' which is to say that it doesn't pick out a bunch of things that have any interesting features in common. It doesn't pick out a natural kind. It picks out a hodge podge of different things.
Schizophrenia isn't a particularly helpful scientific category. Having some of the symptoms of schizophrenia isn't highly predictive of having other symptoms of schizophrenia. Having a dx of schizophrenia isn't even highly predictive of future course (because if you get better they just put it down to mis diagnosis).
I don't think there are many interesting generalisations you can make about schizophrenia in general. I'm not sure that you can generalise a commom etiology or structural brain abnormality or functional brain abnormality. We already agreed (?) that there wasn't anything wrong with the brains of the people dx'd with 'sluggish schizophrenia' back in Russia.
You are seperating the levels again. Thinking that I'm saying that some illnesses are disorders of one level and other illnesses are disorders of another.
There is a conflation in society where people think that to say something is *psychological* or that it is even partly *psychological* is to say 'it is all in your head and you should be able to pull yourself up by your bootstraps'. That latter bit doesn't follow. But in defending the 'illness of the brain' view (because people KNOW it isn't their fault' they just avoid the stimga around psychological illnesses.
Whatever...
Feeling like I'm bashing my head against a wall and I have no idea why it is that way.
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to dualism » alexandra_k, posted by zeugma on September 22, 2006, at 18:20:25
> yes (sigh). I don't think that putting things in boxes is a way to understand how things work.
>
> But here is where I start running into trouble. Because it's really a political matter.yeah.
i think you are right.
people don't hear because they've heard all the hype.
and the drug companies get richer and we love them because they give us the message 'it is not your fault' in a way that is easy for us to understand.
of course it isn't your fault.
if it was sociological it wouldn't be societies fault.
if if was psychological it wouldn't be your fault.
but belief in god and libertarian free will and those kinds of myths require us to go down this path... and the drug companies get richer and we don't bemoan them that because they give us the message 'it is not your fault' in a simple way we can understand.
and it isn't your fault.
it is not.
but that has nothing to do with the biopsychosocial model.
it is jus tthat it explains consumer resistence to it.
Posted by zeugma on September 25, 2006, at 0:09:09
In reply to Re: dualism, posted by alexandra_k on September 22, 2006, at 18:39:15
taking a pill is a psychological act (how else to explain the placebo effect?). and certainly if you are in the group of pill-takers, then you are in a particular social group (a disparate one to be sure, but still it is significant, whether you are a known pill-taker or not. The community of pill-takers is not necessarily one that self-advertises.).
anyway, what i was trying to say earlier is it's better to be in a conceptual free market, where you can unburden yourself of preconceptions, rather than have readymade categories that someone else invented do your thinking for you.
Foucault is very good on this- the archaeology of ideas. An 'archaelogical' investigation of the development of psychopharmacology in no way validates the thought that CNS disorders- or, if you like, syndromes- are an illusion. In fact, it seems to me to show just how little is gained by talking about 'levels' which themselves are likely illusions (the tripartite scheme of physical, psychological, and social, for instance), in order to dissipate the phenomena themselves, which are so noumenal (I mean, not easily categorizable. I suppose categorizing is in the interest of insurance companies. But the experience of being mentally ill, or however you want to call it- it's noumenal, the problem I have with psychotherapists [narrow sense] is that they do not seem to accept this. I never had a pill prescriber interfere so drastically with this noumenality. Nothing like being told that my inner life is wrongly self-interpreted to p*ss me off. Please prescribe the pills instead, they may make me miserable with side effects but they don't mess with this noumenality. Sorry for this parenthetical rant, it's rather a sore point.)
I just wonder why 'biopsychosocial' is preferable to 'biobiobio,' when neither are concepts that can be well elucidated.
And, as you pointed out, it is on the behavioral level that this discussion takes place. Behavioral phenomena really do invite a conceptual free market, since they cannot be translated into convenient other terms without considerable loss of meaning.
-z
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to conceptual free market » alexandra_k, posted by zeugma on September 22, 2006, at 19:46:28
(((((((((((((((((((((z))))))))))))))))
I've missed you :-)What I'm thinking... Is that typically people talk about different 'Kuhnian paradigms' that have been applied to the investigation and explanation of abnormal behaviour. As examples...
Biomedical paradigm
Psychoanalytic paradigm
Humanist and existentialist paradigm
Cognitive paradigm
Behavioural and Learning paradigm
Sociological paradigm
Etc etc (not meant to be exhaustive.
Two points:
1) The notion of a Kuhnian paradigm is unclear / controversial. There are as many different theories of the nature of Kuhnian paradigms as there are alleged Kuhnian paradigms. Thus calling these 'Kuhnian paradigms' is unlikely to be illuminating.
2) It is controversial whether the above theoretical frameworks (hopefully that is fairly neutral) are appropriately thought of as Kuhnian paradigms. In particular... If psychoanalysis isn't a scientific theory (which many have argued it is not) then it wouldn't be a Kuhnian paradigm.PROBLEM: How do these theoretical frameworks (is that neutral enough?) relate to one another?
One way of trying to answer the problem...
Supervenience. Most people accept this little hierarcy:
Psychology
Biology
Chemistry
MicrophysicsIt is controversial whether you get to put consciousness on the top... I'm not sure whether to deal with events, facts, processes, properties or what... But if we deal with facts the notion is the low level facts fix the high level facts whereas the converse is not the case. Some people reckon you can put sociology on top (Not sure whether that goes on top of consciousness... Perhaps) because the social facts are fixed by the individuals psychological facts (and the environmental facts but if you are a broad content person then you probably get environmental facts for free in the psychological facts).
So... If that is right maybe the medical paradigm just gets plugged in to the biological level of analysis. Regarding psychology... I guess psychoanalysis, folk psychology, cognitive psychology and maybe phenomenology gets to be at the psychological level of analysis. How those 'paradigms' relate to one another at a level is tricky... Do they conflict with one another or are they consistent? Dunno... Then you have the sociological facts one level up. And supervenience where the low level (biology) fixes the higher levels (psychology then sociology).
But there is multiple realizability too... That seems to entail that reduction won't work hence we get explanatory autonomy at each level. But Jaegwon Kim has written something or other about the causal exclusion principle and so long as we have token reduction (which is entailed by supervenience) then causal exclusion would take away causation at higher levels and bio would be fundamental.
Dunno... Pretty tricky. I want to argue for supervenience without explanatory / causal reduction. But I dunno howish...
I'm wondering if there is 'explanatory breadth' wiich is horizontal. About how much subject matter is shared (at a level). So to cash out the rivalry (?) at the psychological level that way... And there is 'explanatory depth' which is vertical. About the supervenience with explanatory autonomy relationship between different levels (with respect to causation and explanation).
Ak.
Make sense kinda?
Posted by zeugma on September 25, 2006, at 0:09:09
In reply to Re: conceptual free market elucidation... » zeugma, posted by alexandra_k on September 22, 2006, at 20:15:02
Supervenience. Most people accept this little hierarcy:
Psychology
Biology
Chemistry
MicrophysicsIt is controversial whether you get to put consciousness on the top... I'm not sure whether to deal with events, facts, processes, properties or what... But if we deal with facts the notion is the low level facts fix the high level facts whereas the converse is not the case. Some people reckon you can put sociology on top (Not sure whether that goes on top of consciousness... Perhaps) because the social facts are fixed by the individuals psychological facts (and the environmental facts but if you are a broad content person then you probably get environmental facts for free in the psychological facts).
So... If that is right maybe the medical paradigm just gets plugged in to the biological level of analysis>>
OK, but not so fast. Because there is a conflict between the biological, mechanistic explanation, and the statistical nature of disease:
<Evidence can be interpreted in many ways, partly because the knowledge we acquire through clinical trials, especially the RCT, is statistical in nature (meaning that the results are based on effects observed on populations). In combination with the selection of study variables, outcome units, and level of statistical significance, this inevitably leads to uncertainty in dealing with individual patients>
What I take this to mean is that although supervenience may be true, one is dealing with probablilities rather than certainties (and thus there is no determinism). I know this is not expressed perfectly in the article I am quoting from, but it appears that adherents of the RCT in psychiatry (as elsewhere) accept the assumption that statistics supercede basic science (predicated on molecular-level mechanisms, say) in evaluating treatments. OK< I'm not getting this right. The 'numerical method' basicially claims that supervenience can't be followed through, because one needs to arrive inductively at answers to medical questions, and induction has inherent limitations which preclude supervenience.
anyway. politics, and the NHS:
http://jme.bmjjournals.com/cgi/content/full/30/2/171
I agree with the following statement:
<Evidence based medicine brings us to the question of power over the clinical encounter: will it be the doctor, the patient, or the payer who decides what kinds of treatment are delivered and on what basis? It is likely that this tension is contributing to the apparently growing frustration of doctors worldwide.33 Restating traditional medical ethics will not solve the problems because the economic crisis of medicine is here to stay, but requiring doctors to combine both traditional and modern duties is not a simple solution either. It is possible that the profession will split into two: doctors who can afford to follow traditional ethics with wealthy patients, and doctors trying to deliver the best possible care to poorer patients within the financial constraints imposed from above. This gap is likely to widen along with the scientific development and commodification of health care.34 Clinical practice guidelines have an internal logic that will make them more and more binding in the long run. It is also important to note the potential frustration of patients: paternalism in medicine has long been in decline and patient autonomy has been promoted to the extent that patients now tend to be called "clients" of health care. Evidence based medicine used for rationing will equally limit the autonomy of both the doctor and his/her clients. In conclusion, it would appear that using practical EBM for cost control may easily become the European equivalent of managed care.>
-z
Posted by SLS on September 25, 2006, at 0:09:09
In reply to Re: the brain, posted by alexandra_k on September 22, 2006, at 18:15:17
> about addition.
> if you add things in you don't leave things out.
>
> e.g.,
>
> lets say you have 2
>
> then you add 5
>
> so now you have 2 5What happened to Gestalt? Emergent properties? 7?
Then we are in agreement. You can't get to 5 without going through 2, so 5 depends on 2. Without 2, you have no 5, and thus, no 7. Sometimes, all you need is to treat the 2, and then 5 and 7 become possible when they had not been previously.
Some people don't see the 2 or the 5. They see only the 7 - the Gestalt - and attempt to treat the emergent properties. Are you in favor of treating the emergent properties only, and hope that the 2 and 5 are taken care of automatically?
I might have missed some of the dialogue along this thread, so I apologize if I am repeating questions that have already been asked of you.
If your brother or cousin or uncle were to display classic bipolar I manic behavior, and were detained at the county jail for public nudity in a shopping mall and yelling out to people that he was the second coming of the Messiah while passing out flyers to come see him in his own rodeo that he was to perform at the Whitehouse, how would you treat him? For the sake of this example, let us say that he has been diagnosed as DSM IV-R Bipolar I Disorder and that alternative diagnoses have been eliminated. He is a manic depressive. What are you going to do for this family member? He is on no medication, and this is his first episode. He will not listen to anyone, as he is determined that he is the Way. When spoken to, he either cannot speak coherently on a single topic, often asking to know what is in his mailbox, or begins to recite passages of the Bible, particularly when challenged.
It might be that you and I agree on this. I will be interested to see.
And from the previous post, you neglected to answer my question: Do you think schizophrenia is a biological disorder?
- Scott
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to Re: the brain » alexandra_k, posted by SLS on September 23, 2006, at 4:00:39
What is an emergent property?
(I've heard the term, I'm just not sure that the notion is clear)
Is it a property like liquidity?
The atoms that make up the molecule H2O don't individually or together have the property of liquidity. But if you have enough H2O molecules together (in the right kind of way) then you get the emergent property of liquidity. Is that what you mean?What would the emergent properties of mental illness be?
The behaviour?
The only way to change emergent properties is to change the lower level properties that realize them.Another analogy. There is a law in economics. Fisher's Law. It says (roughly) that all other things being equal that if you increase the amount of money in a society (by some proportion) then the worth of the money decreases by that same proportion (I think) - inflation. So that is a law of economics. It can be used to predict when inflation is likely to occur. It can be used to interveane to prevent (or minimise) inflation. Etc. But 'money' is kinda like an emergent property. I mean on the physical level money can be bits of paper or bits of metal or marks on a page even. Some number in a computer or whatever. If you had all the facts of the bits of paper and metal and marks on the page and so forth do you think you would be able to predict whether inflation was going to occur? Sometimes low level models / explanations don't capture interesting generalisations that are relevant for what we want explained. Don't know how this is relevant. Maybe it is relevant because even if we know that we need to take some money out of circulation so as to reduce inflation we can only take money out of circulation by taking away some of those bits of paper and the like.
> It might be that you and I agree on this. I will be interested to see.
I think we probably do agree. Medication, sure. But... I'd be interested to know why the problem emerged at that particular point in time. But you know time is a limited capacity resource and you don't get through as many patients in a day if you actually talk to them...
> And from the previous post, you neglected to answer my question: Do you think schizophrenia is a biological disorder?I don't think schizophrenia is a natural kind hence I'm not sure that the same explanation can be offered for all the conditions that currently are dx'd as schizophrenia.
I asked you a question (sort of). Do you think the people with sluggish schizophrenia (the political dissentors in Russia) had a biological disorder?
Modelling can be hard... Models are typically developed at the level of dx category. That is only interesting in so far as members of the same dx category are importantly similar. Unfortunately there is often more variability between members of the same dx category than there is between members of different dx categories. Basically... We aren't carving mental illnesses up right. I think it is likely that for some people... Biological intervention is likely to be most effective. For some other people psychological intervention is likely to be most effective. For some other people sociological / envioronmental is likely to be most effective. For some people a combination of two of those... For some people a combination of three...
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to Re: the brain, posted by alexandra_k on September 23, 2006, at 8:54:13
Posted by alexandra_k on September 25, 2006, at 0:09:09
In reply to free market vs. NHS » alexandra_k, posted by zeugma on September 22, 2006, at 21:59:56
> OK, but not so fast. Because there is a conflict between the biological, mechanistic explanation, and the statistical nature of disease:
> <Evidence can be interpreted in many ways, partly because the knowledge we acquire through clinical trials, especially the RCT, is statistical in nature (meaning that the results are based on effects observed on populations). In combination with the selection of study variables, outcome units, and level of statistical significance, this inevitably leads to uncertainty in dealing with individual patients>
The 'knowledge we acquire through clinical trials' is statistical in nature. Okay. That doesn't mean that disease is statistical in nature, however. They don't seem to be concerned with the nature of disease so much as *given* the kinds of diseases we delimit at present what have been shown to be the most effective treatments (given a little cost benefit analysis including $$$ and time aka $$$ and risk etc)? It might be that they need to rely fairly heavily on their stats because the current kinds of disease aren't adequate. It might be that the information they are taking as 'evidence' is tricky because it is heavily sponsored / conducted / helped along by pharmacutacal companies...
> What I take this to mean is that although supervenience may be true, one is dealing with probablilities rather than certainties
I'll grant you that anyway. While it is controversial there is meant to be some proof that the hidden variable thesis is false and hence there is an irreducibly probabilistic element to the behaviour of the basic entities in physics. Presumably those indeterminacies percolate up to the macroscopic level too... Though if superstring theory comes along... It would be nice to smooth over the indeterminacies. But I take your point, okay.
> The 'numerical method' basicially claims that supervenience can't be followed through, because one needs to arrive inductively at answers to medical questions, and induction has inherent limitations which preclude supervenience.
They said something interesting about not worrying about causal mechanisms about staying away from theory and just sticking to the math. If they want the discipline to mature as a science, however, then they are going to need to get over their phobia of mechanisms, theoretical entities, and theory in general. The germ theory of illness led to significant advances in treatment. You can be eclectic (go with what works or with what the math says works) but that doesn't drive future research in new directions. Theory is what explains and theory is what drives future research in new directions. Theory should offer places where interventions are possible. We might not be able to interveane at those points at present but if people start working on it new treatments could be developed.
The DSM's decision to stay a-theoretical (and actually think that is something to be proud of) is an unfortunate hangover from the psychoanalytic / behaviourist debate (seems to me). Unfortunately... Sciences do progress by moving beyond shoving things together into categories on the basis of superficial features to finding things that share scientifically interesting features in common. Like etiology. Like causal mechanisms. Etc.
Is the use of induction in psychiatry interestingly different from the use of induction in medicine or biology? I don't know...
>Evidence based medicine used for rationing will equally limit the autonomy of both the doctor and his/her clients. In conclusion, it would appear that using practical EBM for cost control may easily become the European equivalent of managed care.>
Of course the drug companies have a lot to gain with being considered first port of call. There is pressure on doctors from consumers as consumers want meds to fix them more meds more kinds of meds more meds to deal with the side effects more and more meds... When the drug companies present their findings (their newly subsidised / funded studies) where their drugs helped people and hence surely it is unethical for a doctor to withold this med from their patients.
Ugh.
Posted by Squiggles on September 25, 2006, at 0:09:09
In reply to Re: Leaving the site for a while » Squiggles, posted by SLS on September 22, 2006, at 12:41:35
I'm back; with two points that i have
probably made once too often:- endocrinological tests may be significant
before diagnosis of psychiatric illness;- 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). What after all do the anti-psychiatry proponents mean by biological and non-biological?
They mean nothing at all.Squiggles
Posted by alexandra_k on September 25, 2006, at 0:09:10
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.
Posted by SLS on September 25, 2006, at 0:09:10
In reply to Re: the brain, posted by alexandra_k on September 23, 2006, at 8:54:13
> What is an emergent property?
> (I've heard the term, I'm just not sure that the notion is clear)
> Is it a property like liquidity?It is sort of like the concept of gestault where the whole is more than the sum of its parts. This is something we see most often with living things. I would refer you to Wikipedia, but I find its explanation to be verbose and ineffective. How can we account for personality by simply dissecting neurons? As we travel up the heirachy of elements that compose an organism from quark to behavior we see properties emerge along the way that can only come into being as a result of the interactions between the components. Oh, what the heck:
http://en.wikipedia.org/wiki/Emergence#Emergent_properties
> The atoms that make up the molecule H2O don't individually or together have the property of liquidity. But if you have enough H2O molecules together (in the right kind of way) then you get the emergent property of liquidity. Is that what you mean?
I think that is close enough to win a cigar.
> What would the emergent properties of mental illness be?
> The behaviour?Yes.
> The only way to change emergent properties is to change the lower level properties that realize them.
Gosh. That sounds as if you would like to change the biology; something closer to the level of the neuron.
It depends upon the illness. To change the behaviors in some illnesses, cognitive therapies are necessary and biological therapies are of little value.
Regarding my example of treating a manic episode of bipolar disorder:
> > It might be that you and I agree on this. I will be interested to see.
> I think we probably do agree. Medication, sure.
Why?
> But... I'd be interested to know why the problem emerged at that particular point in time.
We can't be sure. His girlfriend had broken up with him about two weeks prior. After interviewing her, it seems that he was calling her at all hours of the night for the first week or so. Apparantly, he wasn't sleeping or eating.
> But you know time is a limited capacity resource and you don't get through as many patients in a day if you actually talk to them...
But this is your family member, and you have the resources to treat him in any way you feel is best.
> > And from the previous post, you neglected to answer my question: Do you think schizophrenia is a biological disorder?
> I don't think schizophrenia is a natural kind
What is a "natural kind"?
> hence I'm not sure that the same explanation
What explanation are you referring to?
> can be offered for all the conditions that currently are dx'd as schizophrenia.Let's talk about the real schizophrenia. You know, the one with the thought disorder - word salads, hearing voices, delusional paranoia, hallucinations, etc.
> I asked you a question (sort of). Do you think the people with sluggish schizophrenia (the political dissentors in Russia) had a biological disorder?
I am unfamiliar with this historical event. However, you are portraying these people as having been persecuted for their political beliefs and probably being condemned as being mentally ill so that they could be sequestered. They did not have a biological disorder if it was as you say. And this is meant to teach us what?
Schizophrenia is probably the most misrepresented of the mental illnesses.
> Modelling can be hard... Models are typically developed at the level of dx category. That is only interesting in so far as members of the same dx category are importantly similar. Unfortunately there is often more variability between members of the same dx category than there is between members of different dx categories. Basically... We aren't carving mental illnesses up right. I think it is likely that for some people... Biological intervention is likely to be most effective.
Which people do you think this would be true for?
> For some other people psychological intervention is likely to be most effective.
Agreed.
> For some other people sociological / envioronmental is likely to be most effective.
Yup.
For some people a combination of two of those... For some people a combination of three...
Multidimensional thinking. Multimodal approach to recovery.
- Scott
Posted by Squiggles on September 25, 2006, at 0:09:10
In reply to Re: Leaving the site for a while, posted by alexandra_k on September 23, 2006, at 21:28:55
> 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.
No, just had to do some other things.
>
> 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.You're right i am for biomedical approaches
for clinical mental illness, but kindness
and understanding certainly helps in transient
conditions as well as permanent ones; it's just
that serious conditions require medical
intervention.Maybe you were meaning to lament your not getting the meds that have been shown to help you.
No. I am extremely fortunate and greatful
to my doctor for treating me successfully.
For 25 years, I have been able to lead a
normal life - something that the victims of
neglect and ignorance in the past, could only
make entreties and plead for help.
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.Drugz are the answer -- unless you are not
seriously mentally ill.>
> > - 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.There are many causes - endocrinological ones
are numerous and should be examined. We have
to be humble because we don't know yet what
the original causes are and how they are
connected to the signs and symptoms.
>
> > - 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.Really? Who said it was controversial?
Perhaps you are thinking of psychoanalysis?But I take your point that psychiatry is an applied field.
No. I think it is biology.
As such it is more interested in treatment than in discovering the real nature of illness.That is not because it is "evil" but because
there is a long road to travel to understand
the causes.
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.
>Fair enough.
> > 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.Oh.
>
> 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.That sounds like statistics, not psychiatry.
>
> 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.Specificity of clusters of symptoms as
belonging to a definite condition, is
an ideal in scientific endeavour right now.
It's good enough that you can take a
terrified, hallucinating man out of his
personal hell, with drugs.
>
> 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.
>Beyond my scope, for sure.
> 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.Yes, if i were a doctor i would not do that--
it's cruel and may even be false, but they
are relying on historical data i guess.
>
> I don't know.
>
>
>
>
Research methods is not my field, so I
don't understand some of the concepts
here.Squiggles
Posted by alexandra_k on September 25, 2006, at 0:09:10
In reply to Re: the brain » alexandra_k, posted by SLS on September 23, 2006, at 21:32:57
> > What would the emergent properties of mental illness be?
> > The behaviour?
> Yes.hmm... i'm not sure how this is emergence in the sense i specified. emergence is... one of those terms like 'liberty' and 'justice' that are bandied about with no clear meaning. i think someone or other wrote a book on emergence where he outlined maybe 20 different things that might be meant by the term. it is one of those terms that philosophers tend to shy away from using because it is very unclear what it means. i gave the liquidity example because that is probably the clearest example i've found and most people will accept those kinds of (physical) emergent properties.
i'm not sure how behaviour is an emergent property... action might be. in the sense that action only makes sense if you are talking about an agent. behaviour is a term that can be applied more generally so you can talk about the behaviour of kidneys and neurons and hearts and eyes. action seems to just apply to agents. except action seems all bound up in the notion of moral responsibility (ugh) and i don't really want to go there.
> > The only way to change emergent properties is to change the lower level properties that realize them.
> Gosh. That sounds as if you would like to change the biology; something closer to the level of the neuron.the only way you can change high level properties is by changing low level properties. the only way you can change behaviour is by changing biology. but experience changes biology too. if you want someone to learn how to cook you are better off demonstrating to them rather than fiddling with their brain directly...
> > I think we probably do agree. Medication, sure.
> Why?because if i didn't i'd probably lose my lisence. i'm not sure what the evidence based medicine says regarding the efficacy of mood stabilisers for bi-polar. i think it is pretty good - isn't it? but i don't really know. my guess would be that if that is the 'party line' treatment then you should tow the party line if you don't want to lose your lisence... and sure, if it helps most people then you should probably do that.
if the person gives consent. regarding locking the person up against their will and giving them the drug by force... i'm getting a little squeemish now...
> > But... I'd be interested to know why the problem emerged at that particular point in time.> His girlfriend had broken up with him about two weeks prior. After interviewing her, it seems that he was calling her at all hours of the night for the first week or so. Apparantly, he wasn't sleeping or eating.
so relationship went pear shaped. i wonder whether therapy might help the person deal with such things...
> > But you know time is a limited capacity resource and you don't get through as many patients in a day if you actually talk to them...
> But this is your family member, and you have the resources to treat him in any way you feel is best.i don't know you are allowed to treat family members... you should probably refer them on... but if money isn't the issue... therapy would probably help i reckon.
> > > And from the previous post, you neglected to answer my question: Do you think schizophrenia is a biological disorder?
> > I don't think schizophrenia is a natural kind
> What is a "natural kind"?well philosophers have been wondering about that for centuries...
Very roughly... A natural kind is meant to be a kind of thing that is found in nature. According to ESSENTIALISM Members of a kind are thought to be members of a kind in virtue of sharing the same essential properties. For example... Water is a natural kind. All members (or instances, or samples) of the kind 'water' share the same underlying essence (of being H2O).
It has become fashionable to take a more liberal view of natural kinds these days. How come? Because shared essences are hard to come by... For example, typical examples of natural kinds include not only physical properties like mass and change, and chemical properties like gold and water, but also biological properties like lions and onions. Biological kinds don't seem to share the same underlying essence. One might be tempted to think that there is something genetic to determine what kind of thing a living kind is. Unfortunately mutations mean that living things don't share the same essence.
Biologists thus consider living kinds to be historical kinds. Clades (or kinds) are grouped on the basis of evolutionary history (kind of like etiology). Thus we learn surprising facts like 'crocodiles are similar to birds' and 'onions and lillies belong to the same overarching kind / family'.
Some people take a very liberal view of natural kinds where any kind of thing that features in a science counts as a natural kind. E.g., mountains, forests, planets, ecosystems, etc etc.
Boyd's view (that I like) is fairly liberal. He says that in nature we find that certain properties are often to be found clustered together. If we find that a, b, c, d, e, f, and g are typically found clustered together then finding something with properties a, b, c, and d might be highly predictive of that thing also having properties f and g. If this is so... Then he thinks this deserves to be called a natural kind as there are interesting generalisations we can make on the basis of those properties.
Generalisability. That is crucial. If you can't make interesting generalisations... Then you aren't really dealing with a natural kind. Boyd's view is in line with scientific practice but some metaphysicians say it is fairly agnostic on *why* there are such generalisations to be had (realists say the reason for the generalisations are that there is a shared essence).
But anyway...
Thats why there aren't interesting generalisations that are to be had about lots of dx categories. Because they don't 'carve nature at its joints'. They draw a fairly arbitrary circle around things that are fundamentally different. As an example of a non-natural kind...
superlunary object - anything outside the orbit of the moon. (or sun i can't remember)
yellow things
schizophrenia
tree - whether something is a tree or shrub depends on environmental conditions biologists don't consider 'tree' to be a natural / useful kind.> Let's talk about the real schizophrenia. You know, the one with the thought disorder - word salads, hearing voices, delusional paranoia, hallucinations, etc.
Is that a natural kind? Are there interesting generalisations that can be made on the basis of those symptoms?
> > I asked you a question (sort of). Do you think the people with sluggish schizophrenia (the political dissentors in Russia) had a biological disorder?
> I am unfamiliar with this historical event. However, you are portraying these people as having been persecuted for their political beliefs and probably being condemned as being mentally ill so that they could be sequestered. They did not have a biological disorder if it was as you say. And this is meant to teach us what?That there may be aspects of this tied up in the present DSM too...
Fetishes, for example. Some of the sexual disorders... Should have been cast out along with homosexuality. They are there because society disaproves. Sounds like a social problem to me, once again...Is there something biologically malfunctioning in the case of homosexuality? Even if there was does homosexuality count as a mental disorder? Why not?
Has it to do with behaviour that society deems unacceptable?
> Which people do you think this would be true for?
Need to find statistical correlations to see...
I don't know.> Multidimensional thinking. Multimodal approach to recovery.
yeah. though that being said... i think squiggles was onto something in the sense that you don't want to f*ck around wasting time when someone is in crisis and they have had excellent results from treatment x in the past...
Posted by Phillipa on September 25, 2006, at 0:09:10
In reply to Re: the brain, posted by alexandra_k on September 23, 2006, at 22:22:07
I believe but could be mistaken that there are actual changes on MRI's or other imaging devises that show the brain of a schizophrenic is not the same as someone without it. Someone correct me if I'm wrong. Love Phillipa
Posted by alexandra_k on September 25, 2006, at 0:09:10
In reply to Re: the brain » alexandra_k, posted by Phillipa on September 23, 2006, at 22:46:25
> I believe but could be mistaken that there are actual changes on MRI's or other imaging devises that show the brain of a schizophrenic is not the same as someone without it. Someone correct me if I'm wrong. Love Phillipa
If you take a bunch of people with a dx of schizophrenia
a, b, c, d, e, f, g,
And you neuroimage their brains...
Then around 14% have enlarged ventricles and correspondingly smaller other structural areas. I don't have the book with me... But I think it is around 14%. That isn't even *most* of them. Then what you find is around 7% of the control group (people who don't have schizophrenia) also have enlarged venrticles and correspondingly smaller other structural areas. I'm pretty sure that some of those people are considered *normal* controls in the sense that they haven't been dx'd with a mental illness and their behaviour doesn't meet criteria for one. Other patient controls have similar structural abnormalities but they don't have a dx of schizophrenia because their behaviour doens't meet criteria. Instead, they have another dx, such as bi-polar.Do you know what they do then?
They average the results of a, b, c, d, e, f, and g to come up with ONE image of a 'typical brain of a person with schizophrenia'. By 'typical' they don't mean 'if you have schizophrenia this is what your brain is likely to look like'. If you have schizophrenia your brain is more likely to look like a persons in the control group than it is likely to look like the 'typical brain of the person with schizophrenia'. Someone or other said 'it is easy to tell the brains of people with schizophrenia - they are the ones that look normal' because for the most part, they do.
But what is normal? That is a statistical notion again. Take a population of people without a dx of mental illness and neuro-image their brains. Then average the results so you have one image and there is your 'normal / typical brain'. Statistically speaking, even if you didn't have mental illness your brain would be abnormal if it were to look just like the 'normal / typical brain'. There is considerable variation across the non mentally ill population just as there is considerable variation across the mentally ill population just as there is considerable variation across the brains of a population dx'd with a particular disorder.
So when they say that people with schizophrenia have abnormal brains they don't mean that the majority of individuals with schizophrenia have abnormal brains.
So there is a significant problem with saying that abnormal brains cause schizophrenic behaviours / symptoms. The problem is that the majority of people with schizophrenia have normal brains (which is to say brains that fall within the range of normality and their brains can't be differentiated from people without mental illness).
Though things are more complicated...
More dopamine receptors on autopsy. But once again... *Some* people with schizophrenia not *all* and how many people without schizophrenia have more dopamine receptors on autopsy?
Perhaps the neuroimaging isn't detailed enough... Or perhaps sctuctural / neuro-transmission abnormalities aren't necessary or sufficient for schizophrenia... Or perhaps... Schizophrenia isn't a natural kind.
My understanding is that those with the 'abnormal' brains are those who display the most extreme negative symptoms that significantly interfeare with their lives. They might form a natural kind. But schizophrenia in general... Not likely.
Posted by alexandra_k on September 25, 2006, at 0:09:10
In reply to Re: Leaving the site for a while » alexandra_k, posted by Squiggles on September 23, 2006, at 22:03:03
> No, just had to do some other things.
Okay :-)
> it's just
> that serious conditions require medical
> intervention.but there are serious conditions that aren't helped by medical intervention, aren't there? the ones that aren't helped by medical intervention... might be better helped by other varieties of intervention, that was my thought.
> No. I am extremely fortunate and greatful
> to my doctor for treating me successfully.
> For 25 years, I have been able to lead a
> normal lifethat is terrific :-)
> - something that the victims of
> neglect and ignorance in the past, could only
> make entreties and plead for help.i guess it took a while for the treatments to be developed / made available
> Drugz are the answer -- unless you are not
> seriously mentally ill.so if drugs aren't working then you aren't seriously mentally ill?
or do you allow that future developments will mean that people who aren't currently being helped by them will be helped by them?you don't think there are serious mental illnesses that can't be helped by drugs as a matter of principle?
your thinking is very much in line with Szatz. he maintains that there aren't any such things as mental illnesses. only illnesses of the brain that should be treated with medications.
> > Though it is controversial whether psychiatry is best thought of as a medical enterprise.
> Really? Who said it was controversial?there is controversy. thats what i meant to say.
> Perhaps you are thinking of psychoanalysis?
no, i'm talking about psychiatry. the debate around whether psychiatry is a science like medicine, or whether psychiatry is a form of social control that picks up on norm violations by locking people away and drugging them when they exhibit behaviour that we do not value (like political dissent, expressions of economic hardship, delusions and hallucinations which are revered in other societies etc etc).
> But I take your point that psychiatry is an applied field.
> No. I think it is biology.i just meant that psychiatry isn't merely descriptive. it doesn't seek solely to classify different kinds of mental illness. in fact... it is a subject of controversy whether the DSM and ICD are scientific taxonomies or not. if there is a science of nosology / classification then it is an infant science indeed. some would scoff at its claim to be attempting a scientific nosology / classification scheme. if whether someone is mentally ill or not is solely an objective matter then nosology / classification can be a scientific enterprise. if whether someone is mentally ill or not depends on value judgement (that the behaviour is harmful or undesirable or unwanted) then it is unclear that nosology / classification can be scientific because science is supposed to be objective and doesn't require value judgements for classification. medicine has been criticised on the same grounds only people aren't locked up and medicated against their will in general medicine, only in psychiatry.
psychiatry is also an applied field (as is medicine) because its aim is the prevention and treatment of mental disorder. those seem to require value judgements of what *should* be prevented and what *should* be treated even if the classification scheme / nosology doesn't require value judgements.
biology isn't an applied field. it seeks to classify and to develop theories that posit underlying causal mechanisms. then one can interveane on the variables to see whether there is a systematic relationship between them. drug trials aren't very good science at times... need double blind tests (how many of those are there?) on decent sample sizes to figure placebo vs other varieties of med vs the drug you are testing. trouble with these studies is the ethics of placebos (or failure to treat). that doesn't arise for biology.
> As such it is more interested in treatment than in discovering the real nature of illness.
> That is not because it is "evil" but because
> there is a long road to travel to understand
> the causes.yeah. but someone has gotta do it ;-)
> > I'm not an anti-psychiatry proponent.
> Oh.i'm interested in providing a unifying theory for psychiatry that will help psychiatry progress as a *scientific* enterprise. i won't say 'just like physics' but maybe 'just like biology' and maybe at times 'just like medicine'. there are many different theoretical orientations (e.g., biomedical, psychoanalytic, behavioural and learning, cognitive, sociological, anthropological, evolutionary psychological, social psychology, humanist and existential etc etc) and i'm interested in how much they fit together and how much they conflict with one another in order to develop a unificatory framework. i'm not anti... i'm trying to help :-) i'm not calling for radical overhaul / revolution i'm trying to assemble the present for a more unified future :-)
> > 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.
> That sounds like statistics, not psychiatry.yeah. i provided three methodologies for discovering the nature of mental illness. if we learn more about their nature then that should give us some understanding of causal mechanisms in order for us to develop new interventions however. better treatments. but not just better treatments at the biological level, better treatments at the psychological level as well... people can learn to reason better... interventions at the sociological level as well (pressure for hollywood / fashion to stop presenting people with eating disorders / drug problems as potential role models) etc.
> > 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.
> Yes, if i were a doctor i would not do that--
> it's cruel and may even be false, but they
> are relying on historical data i guess.Yeah :-(
I think the worst thing a doc can say is 'you have this dx which means you are chronic but should grow out of it in old age' or whatever. given the current dx categories are inadequate... given how much that kind of information tends to take away hope and make it more likely that the person will come to believe it and thus make it so... i'm seriously concerned about the ethics of that. that is why it is important to get the dx categories right. so we don't harm people by making generalisations that are false :-(> Research methods is not my field, so I
> don't understand some of the concepts
> here.it isn't really mine either. i'm probably misusing concepts all over. sigh.
take care.
Posted by SLS on September 25, 2006, at 0:09:10
In reply to Re: the brain, posted by alexandra_k on September 23, 2006, at 22:22:07
> > > What would the emergent properties of mental illness be?
> > > The behaviour?
> > Yes.
> hmm... i'm not sure how this is emergence in the sense i specified.Well, let's then refer to wikipedia afterall. It is a rather complex - or perhaps complicated is a better term - concept. If you would prefer to use the term "emergent behavior" here as emergence pertains to human behavior, that would be fine.
http://en.wikipedia.org/wiki/Emergence#Emergent_properties
My conclusion that human behavior is an emergent property/behavior of the human organism and human evolution might not be ubiquitious, but I don't see how it is avoidable.
> > > The only way to change emergent properties is to change the lower level properties that realize them.> > > I think we probably do agree. Medication, sure.
> > Why?
> because if i didn't i'd probably lose my lisence.Let us not worry about licenses to lose.
What would you do if you had your choice in treating this psychotically manic family member?
Simple question?
> > > But... I'd be interested to know why the problem emerged at that particular point in time.
> > His girlfriend had broken up with him about two weeks prior. After interviewing her, it seems that he was calling her at all hours of the night for the first week or so. Apparantly, he wasn't sleeping or eating.
> so relationship went pear shaped. i wonder whether therapy might help the person deal with such things...So, then, you would take naked Joe with his rodeo flyers asking what is in his mailbox quoting from Exodus and give him therapy. That is your answer.
> i don't know you are allowed to treat family members... you should probably refer them on... but if money isn't the issue... therapy would probably help i reckon.
THERAPY.
Finally. We have an answer.
You give psychotic manic bipolar I naked Joe therapy.
Hey, that's all I was asking.
To make things really rough on you, Joe goes on to become an ultra-rapid cycler with a period of 11 days; 8 days of severe depression followed by 3 days of mania. To make it easier on you, his 3 days of mania do not give him enough time to develop complex delusions of rodeo showmanship any longer, although messianic religiosity and public nudity are still recurring problems.
Now, about the schizophrenia.
Thanks for the explanation regarding natural kinds.
> > Let's talk about the real schizophrenia. You know, the one with the thought disorder - word salads, hearing voices, delusional paranoia, hallucinations, etc.
> Is that a natural kind?Is that essential for the conversation?
> Are there interesting generalisations that can be made on the basis of those symptoms?
I don't know. These are the things I see when I meet people who have been diagnosed with schizophrenia. These are the things I see when I read about the illness of schizophrenia. The people I meet who have the disease and display these symptoms are, to me, quite natural, if uncommon.
So, then, how are we to treat someone with a symptom cluster that includes those that I listed? We don't need to bring up Russia or fetishes anymore, now do we?
Is schizophrenia a biological disorder?
- Scott
Posted by SLS on September 25, 2006, at 0:09:10
In reply to Re: the brain » Phillipa, posted by alexandra_k on September 24, 2006, at 2:32:54
>
> Is schizophrenia a biological disorder?
>Oh. I think you answered this sufficiently well in your reply to Phillipa. Thanks.
You think the negative symptomology might represent a natural kind. Is there any chance the same thing might apply to the severe psychomotor retardation seen with certain depressions?
- Scott
Posted by Squiggles on September 25, 2006, at 0:09:11
In reply to Re: the brain » Phillipa, posted by alexandra_k on September 24, 2006, at 2:32:54
.........
> So there is a significant problem with saying that abnormal brains cause schizophrenic behaviours / symptoms. The problem is that the majority of people with schizophrenia have normal brains (which is to say brains that fall within the range of normality and their brains can't be differentiated from people without mental illness).
I'm not sure that what they are saying is
abnormal brains *cause* schizophrenic symptoms.
Just as in cases of stroke, after recognizing
a familiar pattern of behaviour (waddling,
one-sided paralysis, etc.), an MRI correlates
those symptoms with what is seen in the brain--
usually a large area of bleeding. To that,
blood tests may be given to corroborate the
dx. Maybe, that is what you mean by multi-dimenisonal?
>
> Though things are more complicated...
>
> More dopamine receptors on autopsy. But once again... *Some* people with schizophrenia not *all* and how many people without schizophrenia have more dopamine receptors on autopsy?It sounds to me like this dopamine exam upon
autopsy is an experimental phase of examination into people who have had hallucinations and
anxiety, and paranoia in their life--who may have beein diagnosed as schizophrenic in their life. I don't think it is a diagnostic endeavour.And btw, did you know that though Kraepelin recognized bipolar disorder as a definite, definable illness, he was sceptical about schizophrenia and speculated about its being in the class of severe anxiety; Most people just call him the father of making a distinction between bp and schizophrenia, and if you read his "Manic Depression Illness and Paranoia"-- it ain't so.
>
> Perhaps the neuroimaging isn't detailed enough... Or perhaps sctuctural / neuro-transmission abnormalities aren't necessary or sufficient for schizophrenia... Or perhaps... Schizophrenia isn't a natural kind."Natural kind" -- sounds like Wittgenstein on
a field trip; what kind of kind is that:=)?
Squiggles
Posted by Squiggles on September 25, 2006, at 0:09:11
In reply to Re: Leaving the site for a while » Squiggles, posted by alexandra_k on September 24, 2006, at 2:59:42
> i guess it took a while for the treatments to be developed / made availableMaybe; i think that mistakes are also made,
and in some poor countries, mental illness
is not regarded with the sophistication we have
in the west-- let alone the drugz;
>
> > Drugz are the answer -- unless you are not
> > seriously mentally ill.
>
> so if drugs aren't working then you aren't seriously mentally ill?It could be the wrong drug; this sounds like
a leading question;
> or do you allow that future developments will mean that people who aren't currently being helped by them will be helped by them?Let's hope that better drugs are developed for
mental illness.
>
> you don't think there are serious mental illnesses that can't be helped by drugs as a matter of principle?I don't know. I think that maybe post-traumatic stress may be an example. Soldiers coming back from war, people who have undergone torture, etc. I don't know if all such cases recover or if a mark is left on their psyche for life, that needs treatment. It is possible for a situation to change your brain i think for life. But that would be equivalent to a mental illness from birth wouldn't it?
>
> your thinking is very much in line with Szatz. he maintains that there aren't any such things as mental illnesses. only illnesses of the brain that should be treated with medications.:-) Poor Dr. Szatz - i haven't been very kind with him.
>
> > > Though it is controversial whether psychiatry is best thought of as a medical enterprise.Well, i guess it depends on the psychiatrist.
>
> > Really? Who said it was controversial?
>
> there is controversy. thats what i meant to say.
>
> > Perhaps you are thinking of psychoanalysis?
>
> no, i'm talking about psychiatry. the debate around whether psychiatry is a science like medicine, or whether psychiatry is a form of social control that picks up on norm violations by locking people away and drugging them when they exhibit behaviour that we do not value (like political dissent, expressions of economic hardship, delusions and hallucinations which are revered in other societies etc etc).You're from Mindfreedom aren't you?
>
> > But I take your point that psychiatry is an applied field.
>
> > No. I think it is biology.
>
> i just meant that psychiatry isn't merely descriptive. it doesn't seek solely to classify different kinds of mental illness. in fact... it is a subject of controversy whether the DSM and ICD are scientific taxonomies or not. if there is a science of nosology / classification then it is an infant science indeed. some would scoff at its claim to be attempting a scientific nosology / classification scheme. if whether someone is mentally ill or not is solely an objective matter then nosology / classification can be a scientific enterprise. if whether someone is mentally ill or not depends on value judgement (that the behaviour is harmful or undesirable or unwanted) then it is unclear that nosology / classification can be scientific because science is supposed to be objective and doesn't require value judgements for classification. medicine has been criticised on the same grounds only people aren't locked up and medicated against their will in general medicine, only in psychiatry.I agree that the DSM is a loose guide-- but that
is to its credit, because they don't pretend to be taxonomically precise.
>
> psychiatry is also an applied field (as is medicine) because its aim is the prevention and treatment of mental disorder. those seem to require value judgements of what *should* be prevented and what *should* be treated even if the classification scheme / nosology doesn't require value judgements.Yes, it's not just theoretical. But it is better to practice pharmacology, than to do nothing in the case of severely mentally ill people-- they suffer and others suffer too.
>
> biology isn't an applied field. it seeks to classify and to develop theories that posit underlying causal mechanisms. then one can interveane on the variables to see whether there is a systematic relationship between them. drug trials aren't very good science at times... need double blind tests (how many of those are there?) on decent sample sizes to figure placebo vs other varieties of med vs the drug you are testing. trouble with these studies is the ethics of placebos (or failure to treat). that doesn't arise for biology.Granted.
>
> > As such it is more interested in treatment than in discovering the real nature of illness.Granted.
>
> > That is not because it is "evil" but because
> > there is a long road to travel to understand
> > the causes.
>
> yeah. but someone has gotta do it ;-)
>
> > > I'm not an anti-psychiatry proponent.
>
> > Oh.
>
> i'm interested in providing a unifying theory for psychiatry that will help psychiatry progress as a *scientific* enterprise. i won't say 'just like physics' but maybe 'just like biology' and maybe at times 'just like medicine'. there are many different theoretical orientations (e.g., biomedical, psychoanalytic, behavioural and learning, cognitive, sociological, anthropological, evolutionary psychological, social psychology, humanist and existential etc etc) and i'm interested in how much they fit together and how much they conflict with one another in order to develop a unificatory framework. i'm not anti... i'm trying to help :-) i'm not calling for radical overhaul / revolution i'm trying to assemble the present for a more unified future :-)That sounds like the unified theory of knowledge, lol -- only of the mind. I wouldn't touch that; i would feel safer with an empirical approach.
And it's bound to fall into the hands of the
bureaucrats and then where is the freedom of mentally ill patients?
>
> > > 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.
>
> > That sounds like statistics, not psychiatry.
>
> yeah. i provided three methodologies for discovering the nature of mental illness. if we learn more about their nature then that should give us some understanding of causal mechanisms in order for us to develop new interventions however. better treatments. but not just better treatments at the biological level, better treatments at the psychological level as well... people can learn to reason better... interventions at the sociological level as well (pressure for hollywood / fashion to stop presenting people with eating disorders / drug problems as potential role models) etc.I think you are biased against biological psychiatry-- just reading this makes me think that you include biology in mental illness just to make it look fair; but your real interest is in psychology and sociology--which i believe are contexts within which mentally ill people find themselves. Rarely, can you change the person biological state, by changing the context. I think the Soteria project was one attempt, and I just read of the Leros island-- and all i can say is mentally ill people need drugz and human compassion. But the cause remains biological in most cases.
Squiggles
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