![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 34. Go back in thread:
Posted by stjames on July 5, 2000, at 10:26:08
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
I have a medical condition called depression, which has its roots in biochemistry and neurology.
Since 1985 the meds used to treat this condition
have worked wonderfully.james
Posted by dj on July 5, 2000, at 12:17:38
In reply to Re: Why the drugs don't work, posted by stjames on July 5, 2000, at 10:26:08
> I have a medical condition called depression, which has its roots in biochemistry and neurology.
> Since 1985 the meds used to treat this condition
> have worked wonderfully.
>
> jamesThough the prior poster was a bit long-winded and pedantic, too much run-on rhetoric for this reader, at least, from a quick scan of his rant the truth, I believe, lies between the two extremes in your portrayals - societal vs medical causes. The middle way...which Buddhism is one propoent of but from a health care systemic approach is addressed in Richard O'Connor's very good and reasonable book: "Undoing Depression".
You can check out some of his comments yourself at http://www.undoingdepression.com but here's a sample:
Richard O'Connor, Ph.D.
author of
Undoing Depression:
What Therapy Doesn't Teach You
And Medication Can't Give You
"Medication Marketplace
Depression is a growth industry now. Prozac and its cousins Paxil and Zoloft are now three of the top six largest selling prescription drugs. Considering that these pills are really only slightly more effective than their predecessors - that is, only a little more effective than placebo - their acceptance by both healthcare professionals and the public has been amazing. New reports suggest it's not just amazing, it's corruption.
Ever since Arrowsmith there's been a question about whether for-profit pharmaceutical manufacturers can sponsor truly objective scientific research. Dr. Martin Keller of Brown University has been a respected researcher into depression for decades. He has many, many publications and grants to his credit, some of which have been the foundation for much of our current knowledge about the course, causes, and treatment of this disease. Now the Boston Globe reports that Dr. Keller has been getting rich on payments from some of the drug companies whose products he's been researching. In 1998 alone, Dr. Keller pulled in $556,000 in consulting fees from these companies. That's not grants to fund research, or reimbursement for expenses, or even lavish little conferences in the Caribbean - that's direct cash money into his pocket.In addition, the Globe reports that Dr. Keller did not disclose the extent of his relationships to these companies to the medical journals that published his findings or to the professional associations that sponsored the conferences where he presented his findings.
There's no evidence yet that Dr. Keller cooked his data or slanted his conclusions because of these payments. But we know that kind of thing happens often enough in science just because researchers have an emotional investment in reaching a certain conclusion. Dr. Keller's whole body of work, much of it probably quite good, is now open to question because of these revelations.
Pharmaceutical manufacturers are constantly telling us that the high prices we pay for prescription medicines go to help them fund research into new drugs. I don't know about anyone else, but I'd be willing to pay a lower price and a higher tax, and let the government fund research. Profits and healthcare are a dangerous combination."
Antidepressant MedicationWhen I suggest to a new patient that they consider antidepressant medication, I get a picture of all the misconceptions people have about what these medications do. First of all, they are not happy pills; they don't artificially induce a feeling of bliss or unrealistic well-being. No medication can do that, except for alcohol and some illegal drugs, and their effects don't last. Nor do antidepressants insulate you from life, make you not care about important things, or insensitive to pain or loss. Tranquilizers can do that, for a while, but antidepressants can't. Also, antidepressants aren't addictive, nor does their effect diminish so that you will have to increase your dosage later on. What antidepressants do is somehow prevent us from sliding down the chute into the blackest depths of depression when something bad happens. We still can feel hurt, pain, worry, but we feel these like normal people do, without depression.
These medications also can help us sleep better, give us more energy, and greater ability to concentrate. They seem to help us change our perspective or sense of proportion, so that we can appreciate better the good side of life and not be overwhelmed by the negative..."
"When I was 15, I came home to find that my mother had committed suicide. Until two years before, she had seemed happy, confident and outgoing. When I look back at the course of my own life, I realize now how much it has been shaped by my need to understand what happened to her. I told myself I was tough and smart, and that her illness need not affect me. But when I left home I had no direction except away; and in my 20s and then again in my 40s I suffered through powerful depressions myself.
"I believe now that depression can never be fully grasped by mental health professionals who have not experienced it. Though I can't claim to know everything about depression, I have a unique and powerful perspective: as a suicide survivor, as a sufferer myself, as a patient, and as a therapist. I know that people who are depressed work very hard at living, but much of their effort is fruitless, a waste of energy. It is as if they are in over their heads and don't know how to swim; the harder they work, the worse things get."
Richard O'Connor is a practicing psychotherapist and the executive director of the Northwest Center for Family Service and Mental Health, a private, nonprofit mental health clinic serving Litchfield County, Connecticut. He oversees the work of twenty mental health professionals in treating almost a thousand patients per year.A graduate of Trinity College in Hartford, O'Connor received his MSW and Ph.D. from the University of Chicago, followed by postgraduate work at the Institute for Psychoanalysis and the Family Institute. He has worked in a wide variety of settings, from inner-city clinics to wealthy suburbs."
Posted by dj on July 5, 2000, at 12:26:26
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
Depression leaves sufferer at a loss
Restoring blood balance in the brain
key to treatment, researcher saysSaturday, May 1, 1999
WALLACE IMMEN
The Globe and Mail
If you can't lose the blues, it's because you aren't thinking straight.For the first time, a researcher in Canada has offered an explanation for why people who are very sad or depressed lose the ability to concentrate and think through their problems.
Dr. Helen Mayberg says two parts of the brain work like the ends of a see-saw. When a person is experiencing strong emotions, blood flow increases in the brain's emotional centre, with a corresponding decrease in the area that handles thinking.
But while the balance of the blood flow evens out quickly in healthy people, allowing them to snap out of their muddle, the imbalance persists in people suffering from depression, bringing malaise and loss of appetite.
The finding suggests that treatments could focus on this brain balance and shorten the time it takes to get better, said Dr. Mayberg, who holds the Rotman chair in neuropsychiatry at the University of Toronto and Baycrest Centre.
She also found that drugs such as the antidepressant Prozac and therapy can both help restore the balance.
The study used brain scans showing differences in activity in the limbic area, which registers emotions, and the cortical region, where thoughts are processed.
Scans were taken of eight men and eight women with severe depression and compared with eight other subjects who had no symptoms of depression.
When the healthy people were scanned, they were told to recite the details of an extremely sad experience in their lives.
The patients were in tears within a few minutes, and the brain images showed a reduction of 10 to 15 per cent in blood flow in the thinking region, along with up to 20-per-cent reduction in the area's energy use.
After their sad thoughts stopped, the imbalance disappeared within minutes.
The depressed patients did not recover on their own, but with therapy achieved a balance after two to 15 weeks. Half were given Prozac, while the rest took a placebo. All of them had cognitive therapy, a counselling treatment that trained them to shift their attention away from their mood and develop coping strategies.
The results appear today in the American Journal of Psychiatry.
"What you need to do to get well is decrease the activity in the limbic region in the lower rear of the brain," Dr. Mayberg said in an interview. She said it is not a question of thinking harder, but of refocusing.
She said antidepressants have effects on many parts of the brain and future medications might be designed to home in more directly on this problem.
Posted by Rick E. on July 5, 2000, at 15:48:02
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
While there may be some truthful statements in this post, the fact remains that "we" as a society could actually care less whether or not "I" live or die. Depression, anxiety, and all of the problems that people come here with are very personal matters, stemming from very personal situations, and all of us need very personal care, be it with medication, therapy, or a mixture of the two.
The picture you paint is of a world so dark and gloomy that it could depress even the most healthy mind. I thank God that my medication was working when I read it.
I'm sure you think that you have helped somebody here by posting this. I am not going to assume that you haven't, but, as for me, I need to tell you this: The drugs DO work, the therapy DOES work, and the world as not as horrible a place as you make it out to be. You are only one person, with one opinion, like any of us, and let's leave it at that.
I've already taken close to a half an hour's focus off of my life, thinking about what you have written. No theraputic value there for me.
Rick E.
Posted by dj on July 5, 2000, at 16:25:19
In reply to Re: Why the drugs don't work, posted by Rick E. on July 5, 2000, at 15:48:02
> While there may be some truthful statements in this post, the fact remains that "we" as a society could actually care less whether or not "I" live or die. Depression, anxiety, and all of the problems that people come here with are very personal matters, stemming from very personal situations, and all of us need very personal care, be it with medication, therapy, or a mixture of the two.
>WE are society and if we are to believe the golden rule of all religions than we are our brothers and sisters keepers. Thomas Merton wrote very eloquently about this in the 1950's in his essay about No Man is an Island, as have many more before him and since. Below I am pasting the intro. from Marriane Williamson's book: Healing the Soul of America, (http://www.marianne.com) which eloquently addresses just this issue...which is reflected by the rising levels of depression around the world, in recent years... You are part of a larger system no matter how you try to deny it (which is a defense mechanism) and denying it may be and probably is unhealthy for you and our societies, when taken to extremes, as too often it is, more and more as we de-personalize our lives...
> I've already taken close to a half an hour's focus off of my life, thinking about what you have written. No theraputic value there for me.
>You may surprise yourself, yet...
First though consider M.W.'s words from her preface, if you will:
"Many people are going around today saying, " In any situation, I just ask myself, 'What would Buddha, or Jesus, do? What would the Torah tell me to do, or the Koran, or the New Testament?'" Thinking about such things is a perfect test, reading the news today. Would Jesus, if he were a citizen of the richest nation on earth, choose to feed the poor or fatten the rich? It's certainly an interesting question.
All of us are better off when contemplation of holy principles is at the center of our lives. But it is in actually applying those principles that we forge the marriage between heaven and earth, while merely dwelling on principle falls short of the human effort needed to carry out God's will. Just as we need the light of the sun--but looking straight into it can blind us--looking straight into the inner light can begin to blind us as well.There is a point in everyone's spiritual journey where, if you are not careful, the search for self-awareness can turn into self-preoccupation. There is a fine line, at times, between self-exploration and narcissism. One way to see how we're doing is to measure the fun factor: spiritual growth that's too much fun all the time usually isn't growth at all. Anything that has become too comfortable cannot ultimately be comforting. The universe is invested in our healing, and healing is a fierce, transformative fire. It is the product of human willingness to change, and change is often hard.
For years, I thought I only had to heal myself, and the world would take care of itself. Clearly we must work on healing our own neuroses in order to become effective healers. But then, having worked on our own issues a while, another question begs for an answer: how healed can we ultimately become while the social systems in which we live and move, and have our earthly being, remain sick?
Years ago, we realized that people's psychology is intimately bound up with the psychology of their family units. Today, it is very clear that the family, too, dwells within a larger psychological system. It's not just our childhoods or families whose dysfunctions influence us; our education system, government, and business structures are often dysfunctional as well, and in a manner that affects us all. None of us lives in isolation anymore, from anyone or anything.
The principles that apply to our personal healing apply as well to the healing of the larger world. First, all healing principles are universal because they come from God. And second, there actually is no objective outer world, for what's out there is merely a projection of what's in our minds. The laws of consciousness apply to everything. Anything, when truly seen for what it is and surrendered to the higher mind, begins to self-correct. But what is not looked at is doomed to eternal re-enactment, for an individual or for a nation.
Politics, ideally, is a context for the care of the public good. The word politics comes from an ancient Greek root politeia, meaning not "of the government," but rather "gathering of citizens." The source of power in America is not the government; the source of power is us. And millions of us, citizens of the United States, have begun to see life in a less mechanistic, more enlightened way. The consciousness revolution has already transformed both mainstream medicine and business: Harvard Medical School has hosted symposiums on the role of spirituality and healing in medicine, and highly paid corporate consultants call on business executives to turn their workplaces into "sanctuaries for the soul." Government is the only major American institution that doesn't yet seem to have heard that the world has unalterably changed.
There are new ideas on the world's horizon, as different from the twentieth-century worldview as the twentieth century was different from the nineteenth century. We are ready to apply principles of healing and recovery, not just to our bodies, not just to our relationships, but to every aspect of life.
World conditions challenge us to look beyond the status quo for responses to the pain of our times. We look to powers within as well as to powers without. A new, spiritually based social activism is beginning to assert itself. It stems not from hating what is wrong and trying to fight it, but from loving what could be and making the commitment to bring it forth. A nonviolent political dynamic is once again emerging, and it is a beacon of light at the dawn of the twenty-first century. Its goal, as in the words of Martin Luther King, Jr., is "the establishment of the beloved community." Nothing less will heal our hearts and nothing less will heal the world.
It is a task of our generation to recreate the American politeia, to awaken from our culture of distraction and re-engage the process of democracy with soulfulness and hope. Yes, we see there are problems in the world. But we believe in a universal force that, when activated by the human heart, has the power to make all things right. Such is the divine authority of love: to renew the heart, renew the nations, and ultimately, renew the world.
Amen."
Copyright ©1997 by Marianne Williamson --From Healing the Soul of America : Reclaiming Our Voices As Spiritual Citizens, by Marianne Williamson. © February 2000 , Marianne Williamson used by permission.
Posted by SLS on July 5, 2000, at 18:05:30
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
Dear Alex,
I appreciate that you have sincere convictions regarding the subjects you have written about. You have probably posted here in an effort to help everyone who you hoped would read your opinions. This an admirable and commendable motive.It doesn't appear that you have gone out of your way to be provocative, although I'm sure you realized when you posted this that there would be some resultant contention to such confidently declared affirmations of universal truths.
Your issues appear to be more political and philosophical than they are scientific or medical. I'm not sure what it is you were trying to accomplish by writing this.
What would you like to see happen as a result of your posting your opinions regarding the causes and treatment of depression?
I don't know if it is important enough to you, but I would be curious to have you summarize your conclusions by providing a numbered list of one-sentence statements. It would help to clarify the input you have tried to offer here.
My opinion:You arrive at your conclusions based solely upon your personal and subjective experiences of things to which the word depression has been chosen to describe. This is probably an innocent and understandable mistake. The English language has come to rely upon one word to label several different things. It is a description of what is observed rather than a description of what is wrong. I think you may be making the mistake of explaining the whole world by equating it with how you explain yourself.
My questions:Are you recommending to the people around the world who are reading this that they should discontinue taking the medication that has been prescribed to them because they really don't need it?
Are you confident that not a single person being treated for a diagnosis of major depression, bipolar disorder, or schizophrenia suffers from a malady that has been determined to be a brain disorder by the consensus of current medical research?
When you posted this, were you ready and willing to assume the responsibility to God for the consequences that would result from everyone acting upon your assertions?
Discourse:> There is a big black hole obscuring the subject of human emotional suffering. It seems to me that there is very little mention or debate on these pages of the causes of the pain that every one is so anxious to be rid of.
I see some on the board currently.
> There is a dangerous assumption
> (no doubt fuelled by the self interests of the pharmaceutical companies and the pyschiatry/therapy business)
Ah... a cynic.
> that we are all suffering from ‘illnesses’ that are a combination of genetic/physiological or moral deficits.
I have never, never read anything written by anyone that has made such a statement. ALL? Who said this?
> Of course it is not one or the other nor is it some nasty combination of the two.
Are you sure?
> We have become obsessed with palliative care as if treating the causes of our real suffering was hopeless, so hopeless in fact that we too often happily deceive ourselves that no such causes exist at all.
What are the causes of which you speak?
> To refute that our society is intrinsically ‘ok’ and that we are ‘ill’ when we feel unable to be happy in it has become a great taboo.
Well, I don't know about taboo.
Personally, I have never refuted or advocated the idea that society is *intrinsically* O.K. However, I look around and see quite a bit of it that *is* O.K. - even healthy. I think it is important to recognize these pockets of healthy society and encourage them to grow and prosper. It seems to me a bit easier to recognize what's wrong in society than it is to recognize in it what is right.
No need to define the word "healthy" here. Let's just Imagine.
> We do suffer but not because we are morally or organically deranged.
Are you sure? Always? Never? Universal?
> Our abilities to function in a healthy moral manner and keep our brain chemistry on course are utterly compromised by finding ourselves coerced into taking part in a social structure that alienates us from our real selves.
Perhaps. Things can get pretty difficult sometimes. Unfortunately, it is always difficult for some people. Some of these things represent the psychosocial stresses that can cause someone to become ill, psychologically and/or biologically.
> Our emotional perceptions are uncannily correct
I agree. In healthy people, it is uncanny just how uncannily correct they can be - sometimes, even in not-so-healthy people.
> (for we do not feel ‘bad’ for no real cause, we do not imagine it)
Semantics are critical here. "real" "cause"
> These ‘normative’ procedures unwittingly conspire (in spite of the best will of their practitioners) to reinforce the criplingly false notion that it is the individual who is sick and that our social structuring is healthy.
Who is refusing to take into consideration sociological phenomena? Everyone? Not me. Not the people who write stuff.
> Incidentally the ‘poop out effect’ often seen with antidepressant drugs confirms that the problem is not a biochemical one...
Are you sure?
> I do not believe that there is any medical salvation to be had for such ‘non-medical’ problems
Which non-medical problems have you described exactly?
Oh well...Just a few of my beliefs:
1. Many maladies that are considered mental illnesses are brain disorders.
2. These brain disorders are treatable using somatic therapies.
3. Psychosocial stresses can trigger self-perpetuating unhealthy brain function.
4. Psychosocial stresses can produce psychological as well as physiological pathologies.
5. Psychotherapy can help treat both.
6. Depression is one word that is used to describe different phenomena.
7. Someone with a healthy brain can have an unhealthy mind.
8. Someone with an unhealthy brain can have a healthy mind.
9. Clinical depression is simply a diagnostic description, regardless of etiology.
10. Healthy people can get depressed about stuff. This depression is phenomenologically different from the condition labelled as "major depression" or "bipolar depression". It even feels different. I know.
I found much of what you wrote to be relevant and consistent with my own beliefs. Thanks.
- Scott
Posted by JohnL on July 6, 2000, at 4:55:16
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
I've seen the right medication totally change the lives of sufferers over and over and over. Statistics give it about a 70% to 80% success rate, but that represents a few million people in the USA alone. Not too shabby.
I've also seen people not improve much with counseling and psychotherapy, aimed at targeting the very topics you've discussed. When the right medication was found, all those supposedly big problems became minor.
Depression has a way of turning molehills into mountains. Perspective is twisted. All the psychosocial issues become quite tame and easily manageable however once the depressive chemistry has been fixed. Those mountains can be reduced to tiny molehills.
It's interesting to pose theories on why this or why that causes depression. It's interesting to blame society and politics. That could be correct. Maybe not. Who knows for sure. Just theory. I think it is a shameful waste of human energy though. Talent would be better utilized in helping alleviate the suffering, rather than pointing fingers.
JohnL
Posted by dj on July 6, 2000, at 8:27:37
In reply to Re: Why the drugs don't work - but they DO work., posted by JohnL on July 6, 2000, at 4:55:16
> I've seen the right medication totally change the lives of sufferers over and over and over. Statistics give it about a 70% to 80% success rate, but that represents a few million people in the USA alone. Not too shabby.
>In one of my first university classes, Intro. to Business, taught be a brilliant mediator he carefully and rightfully outlined how statistics can and do distort pictures, because they are often based on false evidence. The book "Prozac Backlash" by a Harverd prof. details some of the distortions in pharm. company statistics which are reflected in those companies ethics, which are a part of the presidential race discussion in your country now.
And rightfully so, as the price mechanism there is grossly distorted. On CBC (Canadian Broadcasting Corp - a very credible, publically supported system)Radio the other night they discussed this and how some drugs cost your citizens twice as much in your country as they do elsewhere because of price gouging practices.
> I've also seen people not improve much with counseling and psychotherapy, aimed at targeting the very topics you've discussed. When the right medication was found, all those supposedly big >problems became minor.
All one has to do is look at this board over time to see the often negative impacts and results of ADs, and the human misery they can and do cause. "Prozac Backlash" goes into this in careful detail of the facts about the negative impacts of ADs which the pharm. companies have often ignored or covered over to make their stats. and marketing look better than they are in reality.See the above quotes from "Undoing Depression" as well, which also focus on these issues from various angles.
And there are bad counsellors just as there are bad ADs. And there are clients too, who are often not willing to do the hard work to dig down deep enough to deal with and move through the real pain they experience(d). And hence they suffer still and needlessly, sometimes from the ADs.
My experience with ADs was that they helped me stabilize emotionally but cognitively and physcically they had negative impacts, which were intolerable to me once stabilized and who knows what the longterm impact would have been...nobody, especially not the pharm. cos.!!
> Depression has a way of turning molehills into mountains. Perspective is twisted. All the psychosocial issues become quite tame and easily manageable however once the depressive chemistry has been fixed. Those mountains can be reduced to >tiny molehills.
Depressives often (though not always) see more clearly than non-depressives what is really going on in their lives and the world and hence more deeply experience the pains of our lives and societies because we are often more deeply sensitized to and by them.> It's interesting to pose theories on why this or why that causes depression. It's interesting to blame society and politics. That could be correct. Maybe not. Who knows for sure. Just theory. I think it is a shameful waste of human energy though. Talent would be better utilized in helping alleviate the suffering, rather than pointing fingers.
> JohnLDepression is an at-times shameful waste of human energies and as Stanford Neurologist and McArthur Fellow Robert M. Sapolosky clearly points out in his very good book: "Why Zebra's Don't Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping": "...depression is a genetic disorder of being vunerable to a stressful environment." I wrote a bit about that and my experience about that in my Linkages note below, from last night.
And as many articles clearly point out both stressors and depressions rates are increasing, hand-in-glove, throughout our societies.
Point being, that AD's deal with the effect and NOT the cause and hence only relieve the symptoms. Good counselling CAN help one dig deeper and deal with some of the issues that DO have to do with the way we percieve and re-act to and deal, effectively or not, with issues.
Some of the actions we can take individually and jointly are to carefully analyze and deal with the sources of stress at individual, local and societial levels as Marianne Williamson brilliantly points out in her books - "Return to Love" & "Healing the Soul of America"(and others elsewhere. See my posts quoting from the latter on Healing Self and Society above and Post 4th of July Reflections below...
So if taking a pill and just getting by is sufficient for you, good on you. I believe that in the short run pressures and depressions in our societies are going to build and get worse, unless brave people dig deep and take constructive action for the better. If you and I don't deal with these issues on a systemic individual and societal basis, then we are part of the problem rather than part of the solution, are we not???
We can stay home and just watch Survivor and babble on, until we really need to call on real deep survival skills as society detiorates around and about us...or we can make a deeper and impactful difference both for ourselves, our children (if we have any) and our friends and neighbours. Consider that, possibility...
Namaste!
dj
Posted by noa on July 6, 2000, at 8:45:48
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
> We have become obsessed with palliative care as if treating the causes of our real suffering was hopeless, so hopeless in fact that we too often happily deceive ourselves that no such causes exist at all.
I want to address myself to the term "palliative care".
I don't see antidepressants as "palliative". Sure, they are not curative, but they definitely halt the progress of the disease. Without treatment, the brain can undergo structural changes due to such things as high cortisol levels. People who have chronic untreated depression are more likely to have a progressively worsening course of the disease. Treating the illness stops this process and can therefore change the course of the disease and halt the damage to the brain.
Now, to address your more "macro" outlook on things: In a complex system, such as the system I will call "person-in-society", there are many points in the system that one can focus on if one wants to identify and define a problem or set of problems, and set about constructing possible solutions to such problems. Depending on where one focuses, the problems will obviously be defined differently and different courses of action to solve those problems will make sense. In the "person-in-society" system, one can focus on the smallest level, such as the atoms that comprise the chemicals that make up the cells of the person's body, or one can focus on a slightly larger scope, such as the person's relationships with family, or one can focus on a larger scope, such as the person's community, or even larger, the person's larger societal issues, etc. There are many examples both of the different size of the scope or the different types of things one can look at within each level.
Focusing on one part of the whole system, constructing a definition of a problem withing that part, and trying to solve that problem might or might not involve integrating solutions to problems in other parts of the system, or wider or narrower scopes. Optimally, one can address problems both as narrowly and as widely as possible at the same time, but this is rarely feasible. More feasible are the actions that find a manageable solution to a specific problem, but this does not preclude other solutions to other problems in the system, or wider scopes of action on larger parts of the system.
Taking antidepressants is not palliative care. It is not a cure, either, but it is a manageable solution, for now, to address a specific problem that left unaddressed, would likely shut down the person-in-society system altogether. That is the case for me, anyway. My taking antidepressants does not stop me from being aware of the society and world around me, or ignoring other aspects of my person-in-society system, or acting on more "macro" approaches to problems that occur on wider scopes within the system.
Drugs don't solve all the world's problems, and yes, there are some causes of suffering that won't be addressed by medicines, but that doesn't negate the fact that medications help a lot of people's problems in such a significant way.
To give a rather crude analogy, my toilet plunger doesn't make my house more energy efficient, but does that mean I must throw away the toilet plunger? Or if I use the plunger to unclog the toilet, does it necessarily follow that I am ignoring the need to make my house energy efficient? Or that the toilet plunger manufacturer is conspiring against the advocates of more energy efficient homes?
Posted by dj on July 6, 2000, at 11:19:10
In reply to Re: Why the drugs don't work, posted by noa on July 6, 2000, at 8:45:48
Though depression is not specifically noted in the following article from today's Globe and Mail (http://theglobeandmail.com)Dr.Maté's thoughtful commentary is relevant to the above discussion. He has written eloquently about the ADD syndrome (see the end of the article) which if I remember correctly (and I may not...) he may be challenged by himself. Read on:
Decoding the hype
Looking for genetic cures for disease lets us
sidestep the need to tackle the social
and environmental causes, says Dr. Gabor Maté
Dr. Gabor MatéThursday, July 6, 2000
Expressions of near-religious awe and prophesies of dramatic medical advances greeted last week's announcement that scientists are close to deciphering the human genome, the genetic blueprint for the human body. "Today, we are learning the language in which God created life," President Bill Clinton said at the White House ceremony marking the truce between two groups of scientists racing to complete the genome. "This is going to revolutionize medicine," enthused Stephen Warren, a U.S. medical geneticist. "We are going to understand not only what causes disease but what prevents disease."
The actual results are bound to be disappointing, except perhaps to the profit margins of pharmaceutical companies and to the grant coffers of researchers. A sober assessment suggests that little can be expected from the genome program that will lead to significant health benefits in the near future, if ever.
First, our current state of knowledge regarding human genetic makeup is like citing an incomplete copy of The Concise Oxford English Dictionary as "the model" from which Shakespeare created his plays. "All" that remains now is to find the prepositions, grammatical rules and phonetic indications, then figure out how Shakespeare arrived at story lines, dialogue and literary devices.
"The genome is biological programming," one thoughful science reporter has written, "but evolution has neglected to provide even the punctuation to show where genes stop and start, let alone any helpful notes as to what each gene is meant to do."
Second, contrary to the genetic fundamentalism that pervades medical thinking and public awareness these days, genes by themselves cannot possibly account for the complex psychological characteristics, behaviour or health or illness of human beings. Genes are codes for the synthesis of the proteins that give a particular cell its characteristic structure and functions. They are, as it were, alive and dynamic architectural and mechanical plans. Whether the plan becomes realized depends on far more than the gene itself.
The activities of cells are defined not simply by the genes in their nuclei, but by the needs of the entire organism -- and by the interaction of that organism with the environment in which it must survive. Genes are turned on or off by the environment.
Only a handful of illnesses is genetically determined. The most we can say is that some conditions are strongly genetic. Even in the case of well-known single-gene diseases such as Huntington's, a usually fatal degeneration of the nervous system, there may be protective environmental factors; of those who carry the gene, a few live to a ripe old age without developing signs of the disease.
In the case of schizophrenia, a mental illness it is currently fashionable to consider genetic, the most that can be shown is that if one member of a pair of identical twins is diagnosed with it, the other has a 50 per cent or 60 per cent chance of being similarly diagnosed. Lest people think this proves even a 50 per cent or 60 per cent genetic contribution, it must be remembered that identical twins spend nine months in the same formative uterine environment, and are acted on by identical biological and psychological influences. So the genetic effect in schizophrenia is less than half. The rest is environmental.
For the commonest North American afflictions -- heart disease, lung cancer, diabetes -- we don't need to seek genetic origins. The causes are apparent. The northwest Ontario Cree suffer diabetes at a rate five times the Canadian average, despite the traditionally low incidence of diabetes among First Nations populations. The genetic makeup of the Cree hasn't changed in a few generations. The destruction of their physically active way of life by what we call civilization, the introduction of high-calorie diets, and increased stress are responsible for the alarming rise in diabetes rates.
Among hard-core drug users in Vancouver's downtown east side, virtually anyone can give wrenching histories of childhood abuse or deprivation. Yet at a conference on addiction medicine I attended last year, not a single session was granted to social or psychological issues. Time was devoted, instead, to the genetic bases of substance addictions and alcoholism, as if the environment was not of fundamental importance in both causation and healing.
Given the paucity of evidence for the decisive role of genetic factors in most questions of illness, why all the hoopla about the genome project?
Science, as all disciplines, has its ideological and political dimensions. The assumption that illnesses, mental or physical, are primarily genetic allows us to avoid disturbing questions about the nature of the society in which we live. If genes -- rather than poverty or man-made toxins or a stressful culture -- are responsible for diseases, we can look to simple pharmacological and biological solutions. This approach helps to justify and preserve prevailing social values and structures. And it's profitable. The value of shares in Celera, the private company participating in the genome project, has risen 1,400 per cent in a year.
In Genesis,God fashions the universe first, then nature, and only afterward shapes humankind from the substance of Earth. God knew, if Mr. Clinton does not, that from their earliest beginnings humans could never be understood apart from their environment.
Gabor Maté, a Vancouver physician, is the author of Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder.
Posted by Rick E. on July 6, 2000, at 12:55:05
In reply to An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 11:19:10
I have no argument with you over the genetics. I am a firm believer that my depression/anxiety state is caused by enviromental issues alone. What I do have a problem with, however, is this notion that drugs are not needed to curb the "side effects", if you will, of my conditions. I truly believe that if anybody has experienced the darkest side of depression, and then been treated and relieved by medications, they will read your posts with a great disbelief of the ignorance that surrounds this form of treatment. It DOES work.
After all, and you may consider this a selfish viewpoint, but we are only on this earth for a short time. In terms of measurement, my life is halfway over, and it has taken me this long to learn that there is hope for my anxious condition. I have had therapy for years, starting when I was 17 years old, and much of it, I still carry with me today, some of it I dismissed early on. Today, I deal with some side effects that are bothersome, but in comparison to the side effects of untreated depression, they are very, very mild. Maybe if I had treated my conditions with medication earlier, I never would have reached the depression state that I did 6 months ago. One truth that I have learned: MY ENVIRONMENT IS NOT GOING TO CHANGE, SO I WILL HAVE TO. All this talk of the 21st century being an enlightened society, pills for every ache and pain, blah, blah, blah...I don't buy it. I never have. If you want to talk about God, then I suggest that you read more of the bible and less worldly works. Revelation is the key here...the world is NOT SUPPOSED to become a better place, just a place where the human mind is much more easily led astray. I see that all around me. On the TV, this computer as I type!
Back to the land of solutions...I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion. THAT I am sure of. Imagine that this were a board of cancer survivors offering advice and compassion to newly diagnosed patients. Would you then feel so comfortable posting messages that portrayed cancer as a purely environmental effect? Would anyone care what the cause was? I believe many people come here, already accepting the fact that there is SOMETHING WRONG, and their best efforts...were of no avail. So they, like me, seek out medical treatment. It's no easier to "think" cancer cells out of my body than it is to "think" my way out of depression. I know. I've lived through both. And both were miserable.
You have some interesting points, things I've started to ponder myself, and I thank you for that. However, when my time comes, and I must stand before God, I want to feel confident that I have done as much as I can to HELP others when they were in need...as others have helped me. Society as a whole is supposed to crumble. I believe it was planned. We as human beings were designed to suffer...and treatment of my condition, to me, is what God wants me to do. Were I laying around suffering from untreated depression, I would be thinking of ways to end my life right now, not out of pure selfishness, but out of wanting to stop suffering such excruciating mental AND physical pain. The drugs DO work, and I am convinced beyond the shadow of a doubt, that society and the spiritual world are better places for it.
Rick E.
Posted by stjames on July 6, 2000, at 13:15:35
In reply to Sometimes they DO work, on the surface..., posted by dj on July 6, 2000, at 8:27:37
My experience with ADs was that they helped me stabilize emotionally but cognitively and physcically they had negative impacts, which were intolerable to me once stabilized and who knows what the longterm impact would have been...nobody, especially not the pharm. cos.!!
James here....
Many of us don't have the negative impacts you mention. Longterm.....people have been on AD since the 1950's, how long term do you mean ?
james
Posted by dj on July 6, 2000, at 14:30:54
In reply to Re: Sometimes they DO work, on the surface..., posted by stjames on July 6, 2000, at 13:15:35
> James here....
>
> Many of us don't have the negative impacts you mention. Longterm.....people have been on AD since the 1950's, how long term do you mean ?
>
> jamesJames,
As the economist John M. Keynes once noted,in the long term we are all dead. The question with ADs is do they help make your life worth living, while you are still here on earth? With me the answer was no, except for a brief period (months) while I worked through the issues and stresses that led me there.
Obviously you and others have had more postive experiences and more power to you. However, that is not necessarily the norm. It may be but I've read and experienced enough to not trust the pharm. co's stats. and reporting of the immediate and longer term negative effects. Scientists and doctors not affiliated with pharm. co's. are the ones who should be judging this, as well as those who've experience with ADs, both good, bad and ugly.
Sante!
dj
Posted by dj on July 6, 2000, at 15:03:04
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by Rick E. on July 6, 2000, at 12:55:05
I don't have the time to deal with your whole post right now. It seems you did not carefully assess all of my comments or those whom I quoted. I suggest you re-read them and think about them very carefully. I will deal with a few of your comments below...
> MY ENVIRONMENT IS NOT GOING TO CHANGE, SO I >WILL HAVE TO.
Both can and do change, via various mechanisms including ADs, therapy, spirital and political action.
> If you want to talk about God, then I suggest that you read more of the bible and less worldly works. Revelation is the key here...the world is NOT SUPPOSED to become a better place, just a place where the human mind is much more easily led astray. I see that all around me. On the >TV, this computer as I type!
Perhaps that is your revelation and it is your view. I respectfully disagree and can and have cited sources whom I trust and consider authorative.
> Back to the land of solutions...I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion. >THAT I am sure of.
Don't be so sure of yourself because you are wrong. Compassion comes in many forms, not just in dogmatic agreement with what you choose to believe.
>Imagine that this were a board of cancer survivors offering advice and compassion to newly diagnosed patients. Would you then feel so comfortable posting messages that portrayed cancer as a purely environmental effect? Would >anyone care what the cause was?
If you carefully re-view my comments they are taking a systemic look at the issues, not a dogmatic one. My father died of cancer. Others in my family are dealing or have dealt with it and a systemic approach to healng was and is key.
Three people from my highschool graduating class (over 25 years ago) two of whom were dear friends died at thier own hands, one a month after my Dad died. And you wouldn't have wanted to experience the major depression I did at that and other times. All of these elements inform my sytemic analysis and interpretation.
> You have some interesting points, things I've started to ponder myself, and I thank you for >that.
You are welcome.
>However, when my time comes, and I must stand before God, I want to feel confident that I have done as much as I can to HELP others when they >were in need...as others have helped me.
I agree with you overall here but not on what form compassion and compassionate action might take and I don't speculate about what happens at the end. I generally focus on what I can do here and now, on an individual and systemic basis.
>Society as a whole is supposed to crumble. I believe it was planned. We as human beings were >designed to suffer
That is your belief, not mine.
I believe the degree of suffering we experience is influenced by the choices we make including what we choose to believe, as Buddhism and other approachs explain. First however we must become conscious of our choices and how they affect us and others.
For instance, scientific studies of whiplash pain sufferers have experienced have shown different experiences of pain in different cultures, dependant in some cases on the societal reward for suffering that being the way the insurance system evaluated and compensated for the impact. I recall discussing this with a health insurance rep. on an airline, around the time my Dad died, and have seen similar studies cited on occassion.
>...and treatment of my condition, to me, is what God wants me to do. Were I laying around suffering from untreated depression, I would be thinking of ways to end my life right now, not out of pure selfishness, but out of wanting to stop suffering such excruciating mental AND physical pain. The drugs DO work, and I am convinced beyond the shadow of a doubt, that society and the spiritual world are better places for it.
>
> Rick E.No place have I written that the drugs do not work. I've only questioned the degree of their effectiveness and their value in contrast with other approachs. And I noted that they deal with symptoms and not root causes. Only those affected can deal with root causes, if they so choose.
Something for you to ponder, if you choose to...
Peace be with you!
Namaste!
dj
Posted by SLS on July 6, 2000, at 16:07:00
In reply to An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 11:19:10
Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant style of being wrong.
> "Looking for genetic cures for disease lets us
sidestep the need to tackle the social
and environmental causes, says Dr. Gabor Maté"How is it that such eloquent people manage to create such unsophisticated constructs that rely upon unwarranted mutual exclusion? This is silly.
I can't even begin to deal with the rest. Maybe another time.
- Scott
Posted by dj on July 6, 2000, at 19:31:30
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by SLS on July 6, 2000, at 16:07:00
> Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant
> style of being wrong.Or right!
>
> > "Looking for genetic cures for disease lets us
> sidestep the need to tackle the social
> and environmental causes, says Dr. Gabor Maté"
>
> How is it that such eloquent people manage to create such unsophisticated constructs that rely >upon unwarranted mutual exclusion? This is silly.The cited piece is from the editor's summary of what the article is about, so it is the editor's construct you are referencing. I doubt that Dr. Mate's view exludes the value of ADs, just their value by themselves alone.
> I can't even begin to deal with the rest. Maybe >another time.I'd love to see you or anyone attempt to refute the facts he cites, eloquently or not. The issue at essence is the historic argument of nature vs. nurture and he argues for the systemic interaction of both. Anyone who focuses on one only at the exclusion of the other is foolish, in my view.
Sante!
dj
Posted by shar on July 6, 2000, at 22:55:47
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 19:31:30
With all due respect, and I mean that, and I am not trying to be antagonistic, I noticed that some of the people in the above posts and in other posts on this board, have indicated that they don't experience depression, anxiety, bipolar, etc. So, no need for therapy or meds, or both, they (I suppose) would be "normals".
So, I am sincerely curious why does someone post here that does not need the "support and education" offered by the Psych part of PsychoBabble? To make their opinions known to us, and perhaps change our lives/perspectives?
This especially would apply to the fellow with the initial post, that I didn't make it all the way through, who doesn't seem to "mesh" with this forum? I know it's a free country, and everyone has the right to post, but that seemed to be a more sociological/political/societal milieu oriented post.
I am curious, that's all. Obviously some of the PB's did read and respond to the post, so must have thought it was relevant.
BTW, I've been depressed without meds and then took meds. With meds is better, all things considered.
S
Posted by dj on July 6, 2000, at 23:44:38
In reply to With all due respect.....Y RU Here?, posted by shar on July 6, 2000, at 22:55:47
> With all due respect, and I mean that, and I am not trying to be antagonistic, I noticed that some of the people in the above posts and in other posts on this board, have indicated that they don't experience depression, anxiety, bipolar, etc. So, no need for therapy or meds, >or both, they (I suppose) would be "normals".
In my case, Shar, I have experienced severe major depressions as I've indicated above and elsewhere and still experience some depressive symptoms when feeling stressed though generally I am dealing much better with stress these days than I have in the past. And I have used ADs, had some one on one counselling intermittantly over the past 25 years as well as lots of different group dynamic experiences, done much reading and self exploration.
Around this time last year, I discovered the board when I was undergoing MAJOR depression. The folks and info. on the board helped me sort through some of the AD issues when I was considering going back on them, at my PDoc's advice. I received conflicting advise from some group counsellors whom knew me over a period of time. I did eventually do the ADs, after expermenting with several types and eventually ended up on a combo. of Wellbutrin and Prozax for several months.
However, once I stabilized thanks to the ADs and the counselling (from various sources) I eventually became wary of the negative side effects I was experiencing from the ADs and when I felt ready, phased them out, knowing I had successfully done so in the past and based on advice from a number of sources and what I was experiencing and had experienced in the past.
I am still dealing with many of the pressures that led to my major depressions but am dealing with them much better and generally with few indications of other than sometimes generally fleeting depression and anxiety more and more which I have come to recognize as my personal patterns or "algorithms" for going into and out of those cycles.
However, I am still sorting through and making sense of these patterns. And coming back to PB, for a while and some of the discussions here have helped me with this sifting and sorting of patterns. Some of the recent feedback I've recieved from Noa and Cass who experienced my sometimes less than gracious patterns previously, before taking a break from PB which I will probably do again soon, indicates to me that they've witnessed the progress which I've experienced.
My nature is to be very curious, scientific in my examination of issues and open to various possibilities. And when obssessive, as I have been and can be when experiencing my stress excessively, I can be dogmatic, perfectioistic and challenging but constantly work at not being so.
So to make a long story short I'm here attempting to clean up and connect some loose ends and doing some of this publically in this forum, as I ponder some issues and angle for some learning and integration of concepts I'vebeen pondering for years... which make more sense to me now, when considered from a systemic perspective.
I'm also here because, as part of this sifting and sorting process, I'm writing up a mediation over my educational experience last year, which was the source of much of my stress, anxiety and eventually my major depression because of a systemic quality mismatch between what I paid for and what I was delivered. And the ideas I've been exploring here, match up in some ways with the ideas I'm exploring in the mediation process I'm working on wrapping up, soon, very soon...
And as K. Vonnegut wrote, so it goes...
Namaste!
dj
Posted by Dr. Bob on July 7, 2000, at 0:38:36
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by Rick E. on July 6, 2000, at 12:55:05
> I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion.
Please don't jump to conclusions about the experiences of others or imply that they're delusional or not compassionate.
Or, if you do, at least don't do it in a post!
Bob
PS: Thank you, dj, for not over-reacting to the that post.
Posted by Dr. Bob on July 7, 2000, at 0:39:45
In reply to With all due respect.....Y RU Here?, posted by shar on July 6, 2000, at 22:55:47
> I know it's a free country, and everyone has the right to post...
Yes, it's a free country, but no, not everyone has a right to post. Only those who abide by the rules may post. Thank you for your cooperation,
The Management
Posted by KarenB on July 7, 2000, at 2:59:32
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
Just me, being civil...
Karen :#
Posted by harry b. on July 7, 2000, at 3:39:24
In reply to Re: I suggest www.drlaura.com/forum , posted by KarenB on July 7, 2000, at 2:59:32
> Just me, being civil...
>
> Karen :#OK, you did it.....my first laugh-out-loud of the
day, and it's only 4:30am
hb
Posted by kazoo on July 7, 2000, at 8:09:51
In reply to Re: I suggest www.drlaura.com/forum , posted by KarenB on July 7, 2000, at 2:59:32
> Just me, being civil...
>
> Karen :#^^^^^^^^^^^^^^^^
The "Wall Street Journal" recently reported that Dr. Laura had contributed 80 percent of her
brain to Harvard's Psychiatric Brain Acquisition Program back in 1990, which explains a lot of
things (but not to her).http://members.aol.com/drewfusmydrewfus/drlaura.html
KaZoO
Greetings to KarenB, and, of course, harry b.
Posted by SLS on July 7, 2000, at 8:26:21
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by SLS on July 6, 2000, at 16:07:00
> > Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant
> > style of being wrong.
>
> Or right!Of course.
> > > "Looking for genetic cures for disease lets us
> > sidestep the need to tackle the social
> > and environmental causes, says Dr. Gabor Maté"
> >
> > How is it that such eloquent people manage to create such unsophisticated constructs that rely >upon unwarranted mutual exclusion? This is silly.
>
> The cited piece is from the editor's summary of what the article is about, so it is the editor's construct you are referencing. I doubt that Dr. Mate's view exludes the value of ADs, just their value by themselves alone.My apologies to the doctor, however, as it is written, it appears as though those were the doctor's words.
> > I can't even begin to deal with the rest. Maybe >another time.
>
> I'd love to see you or anyone attempt to refute the facts he cites, eloquently or not. The issue at essence is the historic argument of nature vs. nurture and he argues for the systemic interaction of both. Anyone who focuses on one only at the exclusion of the other is foolish, in my view.I am a bit confused. Who wrote the following?
"In the case of schizophrenia, a mental illness it is currently fashionable to consider genetic..."
Fashionable?
I think this one word drew my attention.
Also.
"For the commonest North American afflictions -- heart disease, lung cancer, diabetes -- we don't need to seek genetic origins"
This one I also found unpalatable. It seems far too polarized a statement and doesn't take into consideration the benefits that the knowledge of which genes are responsible for which processes in the body can bring - even in healthy people. Evaluation of a healthy person's genes may give rise to a screening process that would identify exactly which foods, drugs, and behaviors can be avoided for that individual to prevent these things from happening. Such would lead to much greater compliance to a change in lifestyle. That is just one example of what can be gleaned from figuring out just how our bodies operate. I don't understand how anyone can decide what is not worth discovering when only its discovery can determine its importance.
If the genetic constitution of the Cree lends itself to such intolerance of a particular foodstuff for which there is little opportunity to currently avoid, perhaps turning ON or turning OFF a combination of genes would remedy the situation. Of course dietary changes might help. How well? Which would be more practical (quicker - save more lives) given the current state of human affairs? In addition, there is no mention of what the rate of these diseases were in the Cree prior to European settlement. What does "alarming" mean. Was it high to begin with? If these diseases manifest at an age later than the child bearing years (allowing for successful reproduction), it could have been alarming all along. Perhaps knowledge of their genetics could lead to a better understanding of how to manage these diseases if dietary changes are not sufficient. These are just a few hypotheticals I came up with. That we *don't* need to seek genetic origins for the Cree has not yet been determined. I don't think it can be until we see how well the application of changing diet and exercise behaviors actually solves the problem in real life. Until then, perhaps the Cree would think differently about the need for genetic study. I don't know.
"Given the paucity of evidence for the decisive role of genetic factors in most questions of illness, why all the hoopla about the genome project?"
Again, I don't understand how anyone can decide what is not worth discovering when only its discovery can determine its importance. There is no paucity of evidence, in my opinion. Mendelian evidence has been recognized for a great many maladies for a great many years. Specific genes have already been identified that encode for specific proteins and enzymes that are responsible for a great many of these and other maladies. Inheritance and mutation need both be considered, among other things. Of course there are other factors involved in the expression of genes. But a great many illnesses cannot occur without the genes necessary to produce them, even if they are not produced in 100% of the individuals in which these genes exist.
Huntington's Chorea sucks.
Hurray for the Human Genome Project! By the way, the project has not been completed, but has only just begun. I don't think the media has done a very good job describing this. So far, we have identified all the words, but we haven't discovered all of their definitions yet. Sort of like deciphering the Rosetta Stone.
- Scott
Posted by dj on July 7, 2000, at 21:28:16
In reply to Re: please be civil, posted by Dr. Bob on July 7, 2000, at 0:38:36
>
> PS: Thank you, dj, for not over-reacting to the that post.Thank you for your thoughtfulness, Dr. Bob. My measured response is part of my self-mediation process. ; )
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