Posted by SLS on May 25, 2001, at 12:43:20
In reply to Re: It doesn't get any better than this? CAM, posted by Lorraine on May 24, 2001, at 9:35:38
> Well, thinking it over, I think that even if you have worked like a dog to overcome this disease, meds are a bandaid. And, the reason is just as CAM said, they aren't intended to cure just ameliorate the symptoms. They are an anuity check for the drug companies. I'm not going to go into conspiracy theories on drug companies, but I am wonder what incentives there are for drug companies to work on cures as opposed to annuity checks? I don't think we put the carrots in the right place.
Much of what I wrote below is nothing more than conjecture.I don't have very much say, but I do have a set of beliefs regarding biological versus psychological variables in the evolution of some mental illnesses (please note the word "some"). It can be one or the other or both. I believe that for each individual, there is a unique psychobiological terrain. Like so many other facets of life, there exists a phenomenological spectrum within which lies a great variation in the genesis of mental illness.
It is difficult for me to affirm that there are unresolved psychological issues responsible for the perpetuation of an individual's presentation of schizophrenia. I suspect that there are many cases of bipolar disorder and schizoid disorders that emerge in the absence of psychosocial pathology. Although it can be argued that the striking morphological changes seen in the brains of great percentage of cases of schizophrenia are the indirect result of an illness for which is necessary a psychosocial inducer, I have not encountered any evidence that these changes can be reversed, regardless of the treatment approach. In other words, psychotherapy cannot spawn the regrowth of brain tissue formally occupying the enlarged ventricles within the brain. Clearly, there are biological differences here between the healthy versus the pathological brain. These changes cannot be not reversed, despite a successful resolution of psychological issues, had there been any before the onset of illness. Nor do these changes seem to be reversed upon treatment with antipsychotics or other somatic treatments. If, during an extended period of remission produced by pharmacotherapy, the application of psychotherapy yields a mind without pathology (I don't see why this would be any less possible than can be produced in an individual without schizophrenia), I doubt the rate of occurrence of schizophrenic symptoms for these individuals is no higher than that seen in the general population. Once induced, schizophrenia often remains recurrent or chronic, despite psychosocial influences. Schizophrenia is thus biological de facto. Hard work does not make it less so.
I chose schizophrenia as an example because the biological pathology is so easily recognized. Another striking example of a mental illness that's biological phenomenology is easily recognizable is bipolar disorder. The most stark observation is that of ultra rapid-cyclicity or ultra dian (ultra-ultra) rapid-cyclicity. The cycle evidenced by the dramatic switches between severe depression and mania can be so regular as to allow for the prediction of mood states hours, days, weeks, or months in advance. There are people who follow a 48 hour cycle regularly for extended periods of time. It seems unlikely that some psychological dynamic produces such a precise oscillation, especially when, as research patients, they are evaluated several times a day. Hard work performed during one state does not prevent the switch into the other.
I don't think all cases of major (unipolar) depression need have a psychosocial etiology. I wouldn't want to guess at percentages, though. Although not as obvious, some people seem to experience an onset and remission of depression in the absence of psychological pathology or environmental changes. Some very mentally healthy and happy people suffer an abrupt shift into or frequent recurrences of a clinically depressed state. A striking example of this is seasonal affective disorder (SAD). Consider that a half-hour of light a day can be much more effective than one or more hours a week of psychotherapy.
I'm starting to babble now. Obviously, I didn't anticipating writing so much.
I am not terribly attracted to the term "bandage" such that it be applied globally to all cases of depression, although it can apply well to some. I think it depends where along the continuum - the spectrum - the gestalt of contributors lie. I think medication can act to push the physiology of the brain in a direction so as to correct or compensate for some pathology. In so doing, the system is influenced to function in a way reflective of the way it was designed to. For some people, this nominal function is retained once the medication is discontinued. For others, it is not. Sometimes, the abberant biology is such that it becomes the functional ground state, and the only way to maintain remission is to continue to apply compensatory "pressure". However, sometimes the reverse is true. It is the "depressive pressure" produced by a psychosocial pathology that, when applied to a healthy system, produces a dysregulation of brain function. Here, psychotherapies are crucial to bring about remission either with or without medication. It is through the reduction of this depressive pressure through continued psychotherapy that helps maintain nominal function and prevent relapse. The tough part is acknowledging the myriad interactions between the psychological and the biological as they contribute to a single depressive episode.
I definitely have too much free time. :-)
By the way, I may disappear for a little while during my move into a new apartment within the next few weeks. I should reappear shortly thereafter.
- Scott
poster:SLS
thread:63214
URL: http://www.dr-bob.org/babble/20010522/msgs/64217.html