Posted by Tomatheus on September 20, 2006, at 12:33:05
In reply to Re: the brain, posted by alexandra_k on September 20, 2006, at 6:03:30
> :-)
:-)
> With mental illnesses what is problematic are behaviours (including verbal behaviours).
I would contend that dysfunctional feelings and emotions associated with mental illnesses are also problematic, especially from the perspective of those suffering from mental illnesses.
> We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Not necessarily. It is not uncommon for people to infer that the origins of problematic behaviors are 100 percent environmental and 0 percent genetic.
At this point, it is impossible for a mental health professional (or anyone else, for that matter) to say with 100 percent certainty whether or not a given patient's illness is influenced (either in whole or in part) by a genetic abnormality and/or a physical injury that affects brain functioning. However, I do think that there is strong evidence in the peer-reviewed neurobiological literature to indicate that such abnormalities and injuries do play a causative role in the development of psychiatric illnesses -- at least in certain individuals. I would contend that illnesses characterized by high levels of severity and/or chronicity have a strong likelihood of having been caused (at least in part) by an inborn biological abnormality.
> Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
I agree. Environmental factors have clearly been implicated in the development of mental illnesses. I do think that it's possible that the cause of a person's diagnosed psychiatric illness can be completely environmental. However, I don't think that it should be assumed that this is the case 100 percent of the time, as genetic causes have also been implicated in psychiatric illnesses.
> Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
I agree that this assumption is sometimes made, but I'm not so sure that it's made in a majority of cases. Of course, different mental health professionals make different assumptions. I think that one should always allow for the possibility that a person's mental illness could have both biological and environmental underpinnings.
> But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
>
> As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.Good point. I agree.
> Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
True, but in cases where genetically mediated biochemical abnormalities do contribute to the underlying pathology of a mental illness (which have been confirmed in some individuals), I don't think that a psychopharmacological approach is a "cover up strategy." Of course, one could only guess to what extent any given drug might be reversing the effects of a possible biochemical abnormality. I certainly don't think it's ethical to tell those suffering from depression that there is no question that their illness is caused by a chemical imbalance and that a particular drug *will* correct that imbalance. But apparently, it's at least legal (though not necessarily ethical) to make such a claim in advertising.
> > But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
>
> That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.I agree. The analogy is not a perfect one. However, I don't think that it should be assumed that therapy will lead to clinically relevant neuro-physiological changes in all individuals (I'm not saying that you're making this assumption; I just wanted to share my thoughts on the issue).
> Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
> 1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
> 2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).
>
> One could try and interveane at one point...
> Or one could try and interveane at as many places as possible...
>
> Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
>
> Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
>
> But I still think that for a very long time yet...
>
> If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
>
> And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.Agreed.
Tomatheus
poster:Tomatheus
thread:686603
URL: http://www.dr-bob.org/babble/20060919/msgs/687691.html