![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 60. This is the beginning of the thread.
Posted by Squiggles on September 25, 2006, at 0:09:07
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 21, 2006, at 21:09:17
>
> You think it is chancier to interveane on the biological, psychological, and social levels than it is to interveane on the biological level only?I think the greater the number of interventions
into possible causes, the greater the possibility
of increasing the risk of error.
I don't understand how that could be so... Unless... You are concerned that giving more attention to the psychological and social levels will result in less attention being paid to the biological level...Not less, attention--more.
>
> Remember I'm not saying we should forget about / ignore the biological level. I'm saying we should appreciate that the other two levels are just as important. A multi-level approach instead of a uni-level approach.Well, perhaps you have had success with this.
I don't see it being done with other illnesses,
e.g. malaria.
>
> > the personal crisis, it could be the background of the person, it could be alienation or early separation, it could be syphillis, it could be a brain tumour, or it could be-- gasp-- mental illness.
>
> How are those other conditions not mental illness?You got me there :-)
>
> > Well, I had the same symptoms as those of 20 years ago
>
> Whether you are approapriately dx'd with bi-polar or not depends on if you meet the list of behavioural symptoms for bi-polar or not. You display the symptoms therefore you are appropriately dx'd with bi-polar.What else could it be? Got any ideas?
>
> Lithium helps other conditions than bi-polar so it isn't a specific medication for bi-polar. What determines whether you have bi-polar or not is a function of what behaviours you exhibit.
>
> > at least lithium worked for whatever those symptoms which they call "bipolar" were.
>
> Yay. Successful intervention.It was something I did by myself- it seemed
like common sense; my dr. just cooperated;
i think he trusts my judgement.
>
> That is great :-)Thank you for your concern. I came
close to joining the great majority.
>
> But when intervention at one level isn't successful then maybe it is time to try an inter-level approach.I'm game for anything, but experimentation
does carry its risks and takes a long time
if you make medical errors, and even longer
time to reverse them.Squiggles
Posted by alexandra_k on September 25, 2006, at 0:09:07
In reply to Redirect: the other two levels, posted by Dr. Bob on September 21, 2006, at 21:19:42
> I'd like follow-ups regarding the other levels to be redirected to the other boards. Thanks,
Isn't that just promoting dualism?
I mean...
The way the term tends to be used in psychiatry / psychology.
Where the paradigms or levels or domains or theoretical frameworks or whatever you want to call them are considered to be independent... And where you get different camps instead of promoting holism?
Where are we supposed to discuss integrative / multi-level approaches?
Posted by alexandra_k on September 25, 2006, at 0:09:07
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 21, 2006, at 21:22:41
> I think the greater the number of interventions
> into possible causes, the greater the possibility of increasing the risk of error.Do you mean the more people try and develop inter-level models that try and take into account biological, psychological, and social causes... The more messed up the models become?
That is the main criticism of an inter-level / eclectic approach. The problem is thought to be that if you try and incorporate factors from the biological, psychological, and social levels the models become messy and either too general (so that they are not predictive or useful with respect to offering ways to interveane) or they are too specific (so that they don't apply to any individuals, or so that they apply to just one individual.
I think the first step is taking what looks rather like a brainstorm of factors and... Eliminating redundency...
> I don't understand how that could be so... Unless... You are concerned that giving more attention to the psychological and social levels will result in less attention being paid to the biological level...
> Not less, attention--more.You are concerned that a biopsychosocial approach will result in a biobiobio approach? I'm not sure I get you...
> Well, perhaps you have had success with this.
> I don't see it being done with other illnesses,
> e.g. malaria.Malaria isn't a mental illness. If there was a virus or a bacteria that caused mental illness and if figuring out how to kill the virus or bacteria cured the mental illness then of course we should do that. Perhaps you think that one day in the future neuro-biology will find viruses or bacteria that cause mental illness and will develop the medication to eliminate them and mental illness along with it. People are trying to look for such things... And I think they should keep up looking for such things... I wouldn't want to put all my eggs in the 'lets wait for the drug companies' basket, however, because that approach might turn out to be wrongheaded. Or that approach might turn out to be wrongheaded for my variety of disorder. It might be that the breakthrough comes from the sociologists. That they figure out an intervention (education and social change, for example) and that is implemented and the disorder disapears in virtue of that. It might be that the breakthrough comes from the psychologists. That they figure out an intervention (some kind of education or therapy, for example) and that is implemented and the disorder disappears in virtue of that. I would say that even more likely... A combination of such factors figure in the etiology of mental illnesses (given current taxonomy).
If medication is working I'm not suggesting people should stop taking it. If medication is helping (even just a little) I'm not suggesting people stop taking it.
I guess I'm mostly thinking of people who have been looking for that right med... Looking and looking and looking... And yet they aren't prepared to consider other types of interventions because they figure their mental illness must be treated on the biological level and they write off other treatment approaches as bogus. I'm just saying that other treatment approaches (therapy and social intervention) can change biology too. So that if people haven't found the right med... It might be worth supplimenting the medication search with other interventions. Thats all. If you have found what works for you thats great :-) I guess I'm just thinking of the people who are still searching...
Posted by Squiggles on September 25, 2006, at 0:09:07
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 22, 2006, at 0:15:26
I have given you a personal example
of serious debility and recovery from
a drug that is specific to bipolar disorder.
You do not seem impressed, except to say
"yey, or good for you".If that does not impress you, then perhaps
you prefer to continue with other models
of mental illness than biological. And I
would certainly be glad to hear of some
recovery stories from this field.Also, if you want to discuss non-biological
models, i can meet you at Psychology, as
Dr. Bob recommended. See you there?Squiggles
Posted by alexandra_k on September 25, 2006, at 0:09:08
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 22, 2006, at 8:21:08
> I have given you a personal example
> of serious debility and recovery from
> a drug that is specific to bipolar disorder.
> You do not seem impressed, except to say
> "yey, or good for you".Um... I meant 'yay' and 'good for you' most genuinely. I'm sorry I didn't manage to convey that. I meant it really very sincerely.
:-)
Posted by Squiggles on September 25, 2006, at 0:09:08
In reply to Re: the brain, posted by alexandra_k on September 22, 2006, at 8:28:03
> > I have given you a personal example
> > of serious debility and recovery from
> > a drug that is specific to bipolar disorder.
> > You do not seem impressed, except to say
> > "yey, or good for you".
>
> Um... I meant 'yay' and 'good for you' most genuinely. I'm sorry I didn't manage to convey that. I meant it really very sincerely.
>
> :-)
>
>
>It's not a personal matter. It's not
as if I am offended that you seem
flippant about it. I would like
you to appreciate the significance of
biological psychiatry through this example.
This is why I asked you, if it was not the
drug that brought stability, what DO YOU
think it was? And do you think it could
be anything else BUT the drug? It was
PROOF.Squiggles
Posted by Squiggles on September 25, 2006, at 0:09:08
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 22, 2006, at 8:35:49
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 » Squiggles, posted by alexandra_k on September 22, 2006, at 0:15:26
Gosh, Alexandra.
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. I don't. It is one of the cruelties of the disorder. Those who are the most severely affected and need the most help are the ones who are the least capable of advocating for themselves. One of the most critical and often life-or-death needs that anyone with bipolar disorder must have met is that for those around them to recognize that they have a biological illness - a disorder of the brain. Without this, they will not receive the biological treatment that will get them well nor the psychological support that will sustain them emotionally. Anything short of the full recognition that their illness is of biological origin is to confuse their world and sabotage their spirit.
The National Institutes of Health (NIH) is the official national repository of medical research. They not only perform research at their own sites, they fund and review research all over the world. They have an extensive psychology program along with their departments of neuroscience and biological psychiatry.
"Bipolar disorder, also known as manic-depressive illness, is a brain disorder"
C:\Medicine\Neuroscience\Mental Health\NIH\bipolarresfact.cfm.htm
The fact that bipolar disorder is a multi-gene illness with epigenetic contributions that are not yet fully mapped out makes it no less physiological. Scientists do not have schizophrenia or Alzheimers Disease completely mapped out either. That does not make them psychological by default.
I am very desiring to know your opinion regarding schizophrenia. Do you believe it to be a biological disorder?
- Scott
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
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