![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 24 to 48 of 60. Go back in thread:
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
Posted by SLS on September 25, 2006, at 0:09:11
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 24, 2006, at 8:13:38
> 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.
What ain't so? I'm confused (not such a difficult thing to accomplish).
Thanks.
- Scott
Posted by Squiggles on September 25, 2006, at 0:09:11
In reply to Re: the brain » Squiggles, posted by SLS on September 24, 2006, at 9:01:03
> > 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.
>
> What ain't so? I'm confused (not such a difficult thing to accomplish).Many sites identify Kraepelin's contribution
as introducing a new categorization in psychiatric
taxonomy and recognizing the distinction between schizophrenia and manic-depressive illness. But infact, in his last chapter on this he seems to place schizophrenia in the larger class of Paranoias (which used to be called dementia praecox - meaning early dementia or dementia at youth).Squiggles
>
> Thanks.
>
>
> - Scott
Posted by Jost on September 25, 2006, at 0:09:11
In reply to Re: Leaving the site for a while » alexandra_k, posted by Squiggles on September 24, 2006, at 8:56:50
Thomas Szasz
SZASZ SZASZ please get this right you are driving me crazy because you keep spelling it wrong, and I keep having to figure out how to spell it and that aint easy.
SZASZ:
S * Z * A * S --yes, S, not T, but S * Z
bessides, if you plan to refer to him in your thesis, you'll have to spell it right there, :)
Jost
Posted by Jost on September 25, 2006, at 0:09:11
In reply to Re: the brain » SLS, posted by Squiggles on September 24, 2006, at 9:23:25
Yeah---but then everybody also says that "schizophrenia" used to be called "dementia praecox"-- and if so, maybe he did actually help in the taxonomy of schizophrenia.
I mean, I think everybody says, well, Kraepelin defined schizophrenia, although he called it "dementia praecox."
eg, Columbia Encyclopedia:"Kraepelin...established the clinical pictures of dementia praecox (now known as schizophrenia) in 1893, and of manic-depressive psychosis (see depression) in 1899, after analyzing thousands of case histories."
Jost
Posted by Squiggles on September 25, 2006, at 0:09:11
In reply to Re: Leaving the site for a while ----alexandra_k, posted by Jost on September 24, 2006, at 10:55:12
> Thomas Szasz
>
> SZASZ SZASZ please get this right you are driving me crazy because you keep spelling it wrong, and I keep having to figure out how to spell it and that aint easy.
>
> SZASZ:
>
> S * Z * A * S --yes, S, not T, but S * Z
>
> bessides, if you plan to refer to him in your thesis, you'll have to spell it right there, :)
>
> Jost
I'm terribly sorry. I apologize Dr. Szasz.If it's any consolation I sometimes misspell
Dr. Shou, sorry Schou.:-)
nothing personal
Squiggles
Posted by Squiggles on September 25, 2006, at 0:09:12
In reply to Re: the brain » Squiggles, posted by Jost on September 24, 2006, at 11:00:51
> Yeah---but then everybody also says that "schizophrenia" used to be called "dementia praecox"-- and if so, maybe he did actually help in the taxonomy of schizophrenia.
>
> I mean, I think everybody says, well, Kraepelin defined schizophrenia, although he called it "dementia praecox."
>
>
> eg, Columbia Encyclopedia:
>
> "Kraepelin...established the clinical pictures of dementia praecox (now known as schizophrenia) in 1893, and of manic-depressive psychosis (see depression) in 1899, after analyzing thousands of case histories."
>
> JostThey were all dementias at the time -- look at
this interesting article (with links):
http://ajp.psychiatryonline.org/cgi/content/full/161/2/381"The authors dramatically describe the appallingly complex diagnostic decisions faced by neuropsychiatrists in Alzheimer’s time, as now: dementia praecox (schizophrenias), dementia agitans (bipolar disorder), dementia paralytica (tertiary syphilis), dementia senilis (arteriosclerosis), and dementia presenilis (p. 81). Alzheimer objectively categorized the problem: which were organic, which functional? After he published his clinicopathological correlations in 1904, four discoveries were made in rapid fire through 1908: Spirochaeta pallidum by a zoologist (Fritz Schaudinn) and a serologist (Erich Hoffmann); the syphilitic origin of general paresis by a psychiatrist (Felix Plaut); a serological test for syphilis by a bacteriologist (August von Wasserman); and "606" (arsphenamine) for treatment by chemists (Paul Erlich and Sahachiro Hata). These multidisciplinary efforts had a major social impact: one-third to one-half of the patients in German mental hospitals and 70% of juveniles were put there by a treatable disease. The only psychiatric events of comparable impact were the discovery sponsored by the Rockefeller Foundation that pellagra was a vitamin deficiency, which halved the population of mental hospitals in the southern United States, and the impact on the state hospital system and psychiatric practice of the discovery of neuroleptics, beginning in the 1950s with Rauwolfia serpentina."
Squiggles
Posted by alexandra_k on September 25, 2006, at 0:09:12
In reply to Re: the brain » Jost, posted by Squiggles on September 24, 2006, at 11:58:03
ahhhhhhhhhhhhhhhhhh syphylis, a success for psychiatry!then what do they do with it?
they give it back to general medicine.
tut tut, they should have kept it ;-)
Posted by Phillipa on September 25, 2006, at 0:09:12
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 24, 2006, at 12:33:13
Chronic lyme's disease which is all over the world in different forms also resembles syphylis. It's only by selective blood testing that differention is made. And cerebral spinal fluid crosses as you know the blood brain barrier. And one of the long term problems from lymes is brain related and treated with pschiatric medication once the acute infection is cleared up with an antibiotic that also crosses the blood brain barrier. Not all are capable of this. But damage to the brain is quite common leaving a person with maybe depression. I have chronic lymes but my spinal fluid was clear. But it hides in the organs of the body and at some point as maybe that's really what happened to me it can come out and do more damage. Heart damage and arthritis are frequent results of the infection. Also MS is diagnosed on MRI they ruled that out with me. But again psychiatric meds would be used along with medical drugs. Mental illness can come from many different things and diseases that come from other parts of the body. Spinal menengitis might be another one. Love Phillipa
Posted by Squiggles on September 25, 2006, at 0:09:12
In reply to Re: the brain » alexandra_k, posted by Phillipa on September 24, 2006, at 19:12:45
What are lymes?
As you probably know Dr. E. Fuller Torrey
has considered the hypothesis of viruses
being responsible for mental illness; and
the medical books are full of disorders
belonging to vitamin deficiencies (e.g.
pellagra), hormonal problems, bacterial
infections, viruses, structural abnormalities,
infections, and on and on, that are responsible
for mental illness. Infact, there are so many
that I have stopped asking why drs. do not
perform "differential diagnoses" as it might
just take a lifetime to find out.I take it that your lyme disease has actually
cured you of a mental disorder? If so, you
have won a diagnostic lottery.Squiggles
Posted by Phillipa on September 25, 2006, at 0:09:12
In reply to Re: the brain » Phillipa, posted by Squiggles on September 24, 2006, at 19:20:29
Squggles I wish. Lymes is a disease transmitted from the deer tick so tiny a speck, from outside in your yard, rodents carry it too. Google lymes' it's very complicated. I just didn't show any spirochettes( the little things that hide in body organs and cause the problems) in my cerebral fluid at the time. No one knows how long or where I got it. It showed up on a freak blood test when I said I'd had a tick. But it wasn't the right type. Love Jan
Posted by Squiggles on September 25, 2006, at 0:09:12
In reply to Re: the brain » Squiggles, posted by Phillipa on September 24, 2006, at 20:42:57
> Squggles I wish. Lymes is a disease transmitted from the deer tick so tiny a speck, from outside in your yard, rodents carry it too. Google lymes' it's very complicated. I just didn't show any spirochettes( the little things that hide in body organs and cause the problems) in my cerebral fluid at the time. No one knows how long or where I got it. It showed up on a freak blood test when I said I'd had a tick. But it wasn't the right type. Love Jan
How big? Can you see it? What does it look
like without a microscope? You say it can
be seen in the cerebral fluid? You know, i
am so terrified of spinal tap, after that movie,
that i think i would just accommodate the little
buggers. :-)Seriously, are you sure? The drs. said they
found it in the cerebral fluid?Squiggles
Posted by Jost on September 25, 2006, at 0:09:12
In reply to Re: the brain » Phillipa, posted by Squiggles on September 24, 2006, at 19:20:29
Wow E. Torrey Fuller-- the name takes me back...... ah, graduate school.
Gee, he sounds a little... how shall I say this?... a little off his rocker?
He wrote an entire book attacking the evils of Ezra Pound-- which I had to read for my thesis-- I wondered how anyone could keep up the drumbeat of invective, even against someone who was, okay, not exactly the sweetest guy.
So while I still don't know the answer, at least it's he's moved on, so to speak.
Jost
Posted by Phillipa on September 25, 2006, at 0:09:12
In reply to Re: the brain » Phillipa, posted by Squiggles on September 24, 2006, at 20:48:07
Squiggles you didn't google it. It's so small about the head of a pin in size. Anyway no it wasn't in my spinal fluid when they did the lumbar puncture. But before that it could have been. If you google it it shows pics and everything. Love Phillipa
Posted by Squiggles on September 25, 2006, at 6:52:49
In reply to Re: the brain » Squiggles, posted by Phillipa on September 24, 2006, at 21:37:02
I went to the images. Interesting--
i have had small circular rings with
raised dots around on my arm, esp. when
i was a kid-- but they are gone. I thought
that was just a temporary viral thing;
also, i do not see any psychiatric symptoms
that would resemble bp in this disease.Squiggles
Posted by SLS on September 25, 2006, at 8:26:00
In reply to Re: the brain » Phillipa, posted by Squiggles on September 25, 2006, at 6:52:49
Was this thread redirected appropriately?
Please see:
http://www.dr-bob.org/babble/admin/20060918/msgs/688978.html
Thanks.
- Scott
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