![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 73. Go back in thread:
Posted by dougb on May 23, 2001, at 11:18:33
In reply to Re: It doesn't get any better than this?, posted by gilbert on May 22, 2001, at 15:45:37
Gil:
I was a tad concerned that you might have mistaken my ranting as being somehow directed at you, which of course it was not.
We need to spread the word, been there, done that, some were helped, the rest were @#$@#$@.
Regardsdb
- Sign the petition, what no petition? organize one -
Posted by dougb on May 23, 2001, at 11:27:59
In reply to Re: It doesn't get any better than this?, posted by stjames on May 22, 2001, at 17:47:21
> Nope, I have been 100 % for 18 yrs on AD's.
>James:
Get out the calculator, and share with us, if it is not to personal a question, a rough ballpark figure of what 100% has cost.
As an aside, why does someone who is 100% hang around this depressing place?
db
Posted by dougb on May 23, 2001, at 11:41:06
In reply to Re: It doesn't get any better than this?, posted by JahL on May 22, 2001, at 19:52:09
>
> Brief AD-induced euthymia taught me 'happiness' (ie feeling normal/alive/human, whatever) *does* exist
--- Ditto> a living death & rejoin the human race.
--- You hit the nail on the head there>
> Doug, you're so right about the price we all pay, but you omitted to mention that a significant few pay the highest price...
>
--- The ommision was only in the post but not in my thoughts. What really upsets me, is the willingness to let a depressive go through hell whilst a distant pdoc/doc goes through intellectually masturbatory excercise of combining chemicals in our deteriorating brain-pans, but bring up the word Euphoria and most run for cover.Considering the ultimate price which some pay, ...........considering the pain and wasted lives.
How, HOW, can they not do _whatever_ it takes to make people better, Damn the profits, Damn the experiments
Well, you get the idea
dbPS have had very little time for fun stuff
> (you listen to that Hicks stuff?)
Posted by stjames on May 23, 2001, at 12:42:49
In reply to Re: It doesn't get any better than this? » stjames, posted by dougb on May 23, 2001, at 11:27:59
> > Nope, I have been 100 % for 18 yrs on AD's.
> >
>
> James:
>
> Get out the calculator, and share with us, if it is not to personal a question, a rough ballpark figure of what 100% has cost.Any amout is worth it, but $20 X 12 months X 18 yrs = $4320. There are free programs for those who cannot afford meds.
>
> As an aside, why does someone who is 100% hang around this depressing place?To help and share knowlage.
>
> db
Posted by Peter S on May 23, 2001, at 13:36:51
In reply to Re: It doesn't get any better than this?, posted by Cam W. on May 23, 2001, at 2:44:09
Cam,
I would be very careful about your use of metaphors and of judging others for not trying to change.
Back in the 50s some bright psychoanalyst thought up the notion of a "schizophrenogenic mother": the idea that mothers cause schizophrenia by sending their children mixed messages. This notion has since been discredited, but it has caused a great deal of damage to many well meaning and loving parents. You seem to be implying that those who continue to be depressed are too lazy to put in the work to rid themselves of their "aberrant thinking and dysfunctional coping mechanisms". I don't think this kind of thinking is constructive to finding real solutions to what is a very complicated phenomenon.
My point is that it is extremely easy for psychologists and wannabe psychologists to sit in their arm chairs and think of explanations for mental illness. Some of these ideas may have a degree of validity in certain cases and some may be pure hogwash. Many times the ideas that tend to be accepted depend on the promotional abilities of the theorist, or what is trendy at that moment in history.
The psychodynamic idea that depression is caused by intrapsychic conflict and the cognitive idea it is based on cognitive distortions both may be true to a lesser or greater extent in certain cases. However depression and mental illness are too complicated to be reduced to simplistic theories. The idea that anti-depressants are only bandages that cover over "real" issues sounds nice- but do you have any actual evidence to support your "bandage" theory?
I personally have spend thousands of dollars on therapy and huge quantities of time and effort working with my thoughts and feelings and have seen very little actual results from my work. The only thing that worked were anti-depressants- unfortunately they pooped-out.
I am in favor of any theory, medication, or treatment that contributes to our understanding of mental illness or works to ease people's suffering. Someone who says that they have "the answer" and that medications are a waste of time or are taking the easy way out is being counter productive.
BTW Cam I've read your posts before and I generally find your contributions very helpful. I also greatly respect your knowledge of pharmaceuticals. I don't mean to be overly critical and I hope this will stimulate some dialog about these questions.
Peter S.
> I find it funny (and ironic) that people expect a pill to make them "normal". Perhaps the psychiatric community isn't explaining what they do, in an understandable manner. Antidepressants (and all medications) are only bandages. They do not "cure" anything. Antidepressants help one function better in society, but the amount they are able to help one function depends on how much work one is willing to do to "get better". One can't take a pill and "fix" yourself. The only way to do that is to change your aberrant thinking and dysfunctional coping mechanisms. It has been my experience that few people are actually willing to go through the pain of changing themselves and would rather blame their situation on medications (it's easier than working on one's problem).
>
> My view - Cam
Posted by tresni on May 23, 2001, at 14:53:37
In reply to Re: It doesn't get any better than this?, posted by stjames on May 23, 2001, at 12:42:49
Hi James,
I've read some of your posts & you seem to be knowledgeable. If I may ask, what meds do you take and what do you take them for? Forgive me if this is too personal a question and have a good day.
Tresni> > > Nope, I have been 100 % for 18 yrs on AD's.
> > >
> >
> > James:
> >
> > Get out the calculator, and share with us, if it is not to personal a question, a rough ballpark figure of what 100% has cost.
>
> Any amout is worth it, but $20 X 12 months X 18 yrs = $4320. There are free programs for those who cannot afford meds.
>
> >
> > As an aside, why does someone who is 100% hang around this depressing place?
>
> To help and share knowlage.
>
>
> >
> > db
Posted by gilbert on May 23, 2001, at 16:27:18
In reply to Re: It doesn't get any better than this?, posted by Cam W. on May 23, 2001, at 2:44:09
Cam,
I must say that I usually look forward to your posts, your intelligence on the chemical side of the mental health industry is excellent. I disagree however with your assesment of the human side or all be it the abberant thinking and low will power and unrealitic expectations of mental health patients in general. I have suffered from panic attacks and agoraphobia since the death of my brother at age four...I am now 42 years old. I have joined and participated in numerous support groups, I have been in CBT pyschonanalysis and had numerous shrinks including pdocs and social workers. I have tried tape series I have fought and white knuckled for every inch of turf I have gained in my life mostly through self will and effort. I have studied Dr Lowes recovery programs and have brought my will to bear discomfort up to most levels most people could not or would not have the balls to do. I have driven down freeways and fought thru panics just to toughen myself so I could be more funtional. I have done this all to become a more functional member of society for my family, myself, and my employer. I have worked my ass off for thirty some years at this process. To even presume that expecting medicine to be more than a band aid I guess is false hope and stupidity on my part but certainly not unrealistic. You see Cam I take blood pressure meds and they have effectively lowered my blood pressure without side effects. Members of my family with sugar take their meds without side effects as well and their condition improve greatly. Cholesterol meds work nicely and most without side effects. So to conclude that the error in thinking is due to high expecations or lack of will and discipline on the part of the mental health patient is a concept I refuse to embrace. Most of us have not curled up in balls in the corner of our bedrooms waiting for drugs to pull us out. Most of us have fought hard to get well only to be dissappointed by the fact that the medical industry produces and markets ineffective meds with patents and high cost well the rest of the health industry is making leaps we are only given an opportunity for baby steps. I think the abberant thinking is not on the patients side but on the side of the industry who pushes sub par meds or meds with side effects that my shrink would find unacceptable for himself, this is where the attention needs to be pointed. The whole band aid theory does not hold water frankly most of us have been bleeding to death and band aids or a pull yourself up by your bootstrap mentality just won't do........Gil
Posted by Cam W. on May 23, 2001, at 17:26:38
In reply to Cam: Bandage Theory, posted by Peter S on May 23, 2001, at 13:36:51
I have worked in pharmacy for more thn 17 years and I have yet to find any cures from medications. The only "cures", where some disease is actually fixed, is through surgery. All the heart meds, cholesterol meds, insulin, psych meds, etc., do not cure anything. Even antibiotics don't cure an infection, they just control the growth rate of bacteria so that the body's defense mechanisms (immune system) can destroy the adult bacteria that are not currently dividing (antibiotics kill only dividing cells).
Psych meds don't cure, but they can help lead to remission. This is confounded by the fact that many people go into spontaneous remission and ultimately recover (eg. reactive depression) and the pill is given the credit. As for side effects, all meds have side effects. Side effects are only effects of the drug that we don't want at that time. One man's side effect is another man's treatment effect. I have seen people go through a number of cholesterol meds and heart meds, having debilitating side effects (yes, even on the newer ones), similar to the way many of us have to go through antidepressants. If psych meds did cure, then one wouldn't have to take them forever. The best thing that you could say about psych meds is that they either "put a floor under our feet" or "plant our feet on the ground." This allows us to do the work necessary to become productive members of society.
I think that one of the reasons that it looks like drugs for the brain are lagging behind drugs for other medical conditions is that most of the drugs for cholesterol or heart are acting on systems whose mechanisms have been figured out. Our knowledge of the working of the brain is far from complete. It is hard to make a drug that will act only where you want it to; the brain just doesn't work like that. Disparate areas of the brain are intricately linked and playing with one part affects all the parts.
Yes, I know I did over-generalize on people not working to overcome their psychiatric problems, but I still believe that the television and 50 years of patent medicine commercials have given a majority of the Western public the attitude that you can cure all your problems by taking a pill (actually the "take a pill to cure your ills" advertising is hundreds of years old. Yes, baby steps are the only way to monitor our successes and yes, it can be a long drawn out process, consisting of many road blocks and seemingly insurmountable obstacles. But still, we have to scratch away, not give up, and not blame the meds. I apologize to those out there who are truly working to overcome their problems and are trying to lead relatively normal lives. I would hazard a guess that the people who frequent this board are more likely to be working on their treatment (rather than being a passive patient) because just logging on to this site means that one is looking for answers or knowledge.
To really get a handle on therapy, one must be able to work on their disorder in spite of these limitations. One must work with their doctor as a partner, not as a passive follower of doctors orders (yes, many docs are to blame for not allowing patients a say in their treatment). A patient's attitude and imput is very important to the success or failure of a treatment regimen.
I do stand behind the "Bandage Theory" and I still do think that a majority of people do not work to function at the highest possible level that they can. I guess I am a believer in the laziness of man. For a good example, just look at the failure of Soviet communism.
I hope that this shows my position a little clearer and I apologize to those who were upset by my original posts. Again, everything I say on this board is refutable; I don't hold a corner on the "being right" market. I guess now would be a good time for a caveat.
CAVEAT: Never trust my advice without a second opinion. I am as wrong as the next guy; especially in a science as inexact as psychiatry. This is another reason that I like this board. If I do make a mistake, someone out there is bound to catch it.
Fumbling along with the rest of you. - Cam
Posted by stjames on May 23, 2001, at 18:59:31
In reply to Re: It doesn't get any better than this? » stjames, posted by tresni on May 23, 2001, at 14:53:37
> Hi James,
> I've read some of your posts & you seem to be knowledgeable. If I may ask, what meds do you take and what do you take them for? Forgive me if this is too personal a question and have a good day.
> TresniEffexor and Remeron for depression/ADD, Dexadrine for ADD
Posted by Fred Potter on May 23, 2001, at 19:00:31
In reply to Re: Bandage Theory (Peter and Gil) » Peter S, posted by Cam W. on May 23, 2001, at 17:26:38
Cam I always try to read your posts as they are so informative. However I thought your assertion that antibiotics don't cure anything was a bit laboured. We'll be talking about the wisdom of the body in healing itself next. Also, as psychotherapy and hard work aren't surgery, these can't cure either
Fred
Posted by Cam W. on May 23, 2001, at 19:18:55
In reply to Re: Bandage Theory Cam, posted by Fred Potter on May 23, 2001, at 19:00:31
Fred - Good point on psychotherapy and hard work, but antibiotics only kill dividing bacteria, not those who are not dividing. The non-dividing bacteria are kept in check by the body's immune system. A clinically important bacterial infection occurs when the rate of bacterial dividing is faster than the body's immune system can remove it. Hence, the bacteria will not disappear and may grow back after the antibiotic is withdrawn, if enough bacteria remains in a non-dividing state during antibiotic treatment. I know it is splitting hairs, but is a fact. - Cam
Posted by Marie1 on May 23, 2001, at 23:49:13
In reply to Re: It doesn't get any better than this?, posted by Cam W. on May 23, 2001, at 2:44:09
Cam,
I join most of the previous poster in lauding you - sincerely. You are very much of a giver to people in need of your expertise. I think that you, through your unselfish efforts in providing knowledge to those of us who are clue-less, and in your own time with nothing expected in return, is true humanitarianism at its best. That said, I have to tell you that I disagree that your assertion that people can't rely only on drugs to "cure" their mental health problems (although frankly, who gives this message to the average consumer but the drug companies themselves). Is it concievable to you that some people have a strictly biologically based depression? When I first started taking prozac in 1995, I felt I was cured (as long as I continued taking the drug). At this point, given the incidences of major depression, I realize the best I can hope for is remission. But to me that is semantics; the end result of feeling normal again is the only requisite. I'm not so sure that people who only have the biological type of depression either need or benefit from talk therapy. It isn't a matter of having to work hard in talk therapy to regain a sense of normalcy. In my case, that occurred about 3 weeks after beginning prozac. And I stayed okay until I quit taking it. I also understand that I'm one of the lucky ones who do respond to ADs. But those who don't shouldn't be castigated and made to feel it's their fault they remain depressed despite the plethora of drugs available.Marie
Posted by Neal on May 24, 2001, at 2:06:47
In reply to Re: Bandage Theory Cam » Fred Potter, posted by Cam W. on May 23, 2001, at 19:18:55
Those who experience complete euthymia thru meds will believe in meds, those who don't experience it - won't.
Posted by Anna Laura on May 24, 2001, at 2:15:01
In reply to Re: It doesn't get any better than this? CAM, posted by JAMMER on May 23, 2001, at 10:29:46
> > I find it funny (and ironic) that people expect a pill to make them "normal". Perhaps the psychiatric community isn't explaining what they do, in an understandable manner. Antidepressants (and all medications) are only bandages. They do not "cure" anything. Antidepressants help one function better in society, but the amount they are able to help one function depends on how much work one is willing to do to "get better". One can't take a pill and "fix" yourself. The only way to do that is to change your aberrant thinking and dysfunctional coping mechanisms. It has been my experience that few people are actually willing to go through the pain of changing themselves and would rather blame their situation on medications (it's easier than working on one's problem).
> >
> > My view - Cam
>
> I think your right on, Cam. Bandaids over an exisiting wound may keep it clean and protected, but learning how to keep from getting the wound in the first place is the way to go. And yes, it's alot of work to solve issues that cause psycho symptoms, and meds help alleviate the "bad feelings", but doing the work to solve the root cause of bad feelings, is the real solution to returning to "normalcy". And it is work!!!
> -James
Hi guysHope this mail is not going to sound arrogant or too proud: every single word in this mail is the bare truth.
I've been working very hard on myself, i swear to god, i'm not boasting myself a genius.
I did cognitive therapy and all sorts of therapies (gestalt, psychoanalisis and so on) and i still wonder what's wrong with me.
I digged deep inside of me. I buried my pride and tried to observe myself in an objective manner.
I've been doing self-investigation all my life trough.
I answered thousands of questions and unraveled the most intricate personal issues.....Still, the wound is still there....
I know for sure (i always knew) that i'm sick cause i've been badly hurt as a child.
I was abused by my mother, both psychologically and phisycally.
She locked me up in a closet for hours, forcing me to eat my vomit, whipping me with a belt every day.
By the age of thirteen i read Freud and Jung, trying to find the answers to my discomfort.
The last time i went to therapy was a couple of months ago. "It's because of your mother"- the therapist said. "But i know all this stuff already! I always knew that!!!!"
"Well, if you had been unaware you would have been much sicker than that!" - he insisted.
By the time passed by, the therapist felt very uncomfortable and puzzled cause i was "conscious" and had "deep insights" (his words) still, i was sick. ."Sorry, I can't do anything for you: may be you should find the right medication" was his answer.
He told me he didn't know what was wrong with me since i was very mature and aware.
The same thing happened with a Junghian psychoanalist few weeks ago.
"I don't know, may be you're too much "psychic". was his intuition. ("psychic" means you're thinking too much).
"Of course i think too much: i'm anhedonic and don't feel anything, so i'm living too much inside my head " was my reply. (chicken and egg type of thing).
I solved the biggest issues in my life:now i can carry on lasting and satisfactory relationships, whereas i couldn't do that before, i'm finally able to get social, i can work and concentrate well enough to get my job done (i had ADD when i was a teenager and a young adult): STILL, I' M SICK .
The situation really sucks, believe me , cause i don't know where to turn now.
I wish the only thing to do was to work hard on myself, believe me: i would be much less desperate then i am.
Anna Laura
Posted by Lorraine on May 24, 2001, at 9:35:38
In reply to Re: It doesn't get any better than this? CAM, posted by Anna Laura on May 24, 2001, at 2:15:01
Well, thinking it over, I think that even if you have worked like a dog to overcome this disease, meds are a bandaid. And, the reason is just as CAM said, they aren't intended to cure just ameliorate the symptoms. They are an anuity check for the drug companies. I'm not going to go into conspiracy theories on drug companies, but I am wonder what incentives there are for drug companies to work on cures as opposed to annuity checks? I don't think we put the carrots in the right place.
Posted by Elizabeth on May 24, 2001, at 12:34:26
In reply to Re: Naltrexone » Elizabeth, posted by shelliR on May 21, 2001, at 22:09:12
> > It could be that when they take naltrexone, these people no longer experience relief when they cut, so they stop doing it. Another possibility is that naltrexone prevents dissociation, which may be associated with or lead to cutting. ...
>
> Elizabeth, I think your first thought was the correct one, based on the view of my friend's therapist who is an expert on dissociation and drug abuse. He gave her naltrexone because cutting actually can create a high.Yes. Cutting often seems to have the quality of an addiction -- people have almost irresistable urges to do it.
Your experience with naltrexone does not surprise me. Naltrexone is a full opioid antagonist, and from what I've heard, people with straight depression usually feel worse on it, not better (although there are stories of augmentation here and there).
-elizabeth
Posted by dougb on May 24, 2001, at 15:29:03
In reply to Re: It doesn't get any better than this?, posted by stjames on May 23, 2001, at 12:42:49
>
> Any amount is worth it
--- That sounds like and advertisment for the drug companies>, but $20 X 12 months X 18 yrs = $4320. There are free programs for those who cannot afford meds.
$20 a month? $20 a month? What are you taking? At one time my meds were running $12 a DAY - and crap that it was, was still not working
db
Posted by Fred Potter on May 24, 2001, at 16:33:51
In reply to Naltrexone and cutting » shelliR, posted by Elizabeth on May 24, 2001, at 12:34:26
I have anxiety, depression and fatigue but no cutting. Naltrexone 25mg daily + 20mg Prozac works for me, although I strongly suspect Alpha Lipoic Acid supplementation may be helping
Fred
Posted by SLS on May 24, 2001, at 17:31:50
In reply to Naltrexone and cutting » shelliR, posted by Elizabeth on May 24, 2001, at 12:34:26
> > > It could be that when they take naltrexone, these people no longer experience relief when they cut, so they stop doing it. Another possibility is that naltrexone prevents dissociation, which may be associated with or lead to cutting. ...
> >
> > Elizabeth, I think your first thought was the correct one, based on the view of my friend's therapist who is an expert on dissociation and drug abuse. He gave her naltrexone because cutting actually can create a high.
>
> Yes. Cutting often seems to have the quality of an addiction -- people have almost irresistable urges to do it.
>
> Your experience with naltrexone does not surprise me. Naltrexone is a full opioid antagonist, and from what I've heard, people with straight depression usually feel worse on it, not better (although there are stories of augmentation here and there).
>
> -elizabeth
Do you think there is some sort of adrenaline rush going on in addition to the endorphin/enkephalin stuff?
- Scott
Posted by Elizabeth on May 24, 2001, at 21:45:49
In reply to Re: Naltrexone and cutting, posted by SLS on May 24, 2001, at 17:31:50
My question about naltrexone is whether it works immediately or takes a few weeks (like regular ADs). Long-term use might lead to increased opioid receptor sensitivity.
Posted by JahL on May 25, 2001, at 11:30:50
In reply to Cam: Bandage Theory, posted by Peter S on May 23, 2001, at 13:36:51
Peter. Thank you for expressing so well what I am too angry to put into words right now. I don't take Cam's words personally; he knows nothing about me or my struggles (this much is obvious). To be quite frank tho' it's an insult to all the hard work I've put in over the years. Like coming top of the year @ a school already biased towards intelligent pupils. Like being only the 3rd pupil *ever* to score perfect grades @ my college. Like earning a place @ a top 5 uni. All this required hard work & amounts to some achievement bearing in mind I was seriously ill (ADD a component) thru' all of it.
[ "What's that? Right. Burying my head in books to avoid confronting my emotional demons. OKaaaay. Actually, tried working, heavy socialising, girlfriends.You name it. Still v. depressed. So what gives???" ]
Therapy wasted over 2 years of my life & $10,000 I didn't have. I was more depressed at the end of it. Not for lack of effort. Tried group, interpersonal, cognitive, behavioural etc. And you know what? The only people I saw get 'better' were those who had a clear case of 'enviromental' depression (ie recent loss of a loved one), and a girl whose speed-induced psychoses gradually faded with time (she no longer used). Of course the therapists were only too happy to claim the credit for that one. She wasn't cured; she just gained acces to a caring, supportive group who encouraged her to stay away from the drugs, allowing the psychosis to resolve (no bad thing of course). At best the majority of patients were cajoled into a grudging acceptance of their condition, & perhaps gained a little self-knowledge.
The fact is psychoanalytic theory looks great on paper but has little real-world application. The main problem? Mixed up causality. I have **nothing** to be depressed about so why do these individuals continue to invent obscure & frankly bizarre explanations as to why I am? Also it's seen as politically correct (ie virtuous, 'natural', involves taking 'responsibility'; or more accurately, *the blame*) & so is protected from criticism.
Many years ago it made sense to believe the earth was flat. We'd all fall off the edge of the world if it wasn't. "Surely". Then some brave individuals posited that actually the world is round. Of course they were condemned & ridiculed for their views but gradually science caught up with theory & Einstein 'discovered' gravity. Case closed. I believe there are still many 'flat-earth' believers in relation to psychiatry.
I reckon I could quite easily discredit psychotherapy (or more accurately, its bold claims) in its entirety, but the severe mental retardation & agitation I suffer from (due to my *biological* illness, & I think I wld know) would prevent me doing so in either a lucid or civil manner. And perhaps this isn't the board for it anyway.
Anyway, (more than) enough said.
Thanks also to those who posted along similar lines. We must continue to educate those who'd have it that we are in some way responsible for our mental illness. Yes, hard work & endeavour are rec'd but this is so for all people, whether mentally ill or not. It's certainly no answer for serious mental illness."Walk away Jah."
"Okay I will. This is doing my stress levels no good. Thanks & Goodbye. J."========================================================================
> I would be very careful about your use of metaphors and of judging others for not trying to change.
> Back in the 50s some bright psychoanalyst thought up the notion of a "schizophrenogenic mother": the idea that mothers cause schizophrenia by sending their children mixed messages. This notion has since been discredited, but it has caused a great deal of damage to many well meaning and loving parents. You seem to be implying that those who continue to be depressed are too lazy to put in the work to rid themselves of their "aberrant thinking and dysfunctional coping mechanisms". I don't think this kind of thinking is constructive to finding real solutions to what is a very complicated phenomenon.
> My point is that it is extremely easy for psychologists and wannabe psychologists to sit in their arm chairs and think of explanations for mental illness. Some of these ideas may have a degree of validity in certain cases and some may be pure hogwash. Many times the ideas that tend to be accepted depend on the promotional abilities of the theorist, or what is trendy at that moment in history.
> The psychodynamic idea that depression is caused by intrapsychic conflict and the cognitive idea it is based on cognitive distortions both may be true to a lesser or greater extent in certain cases. However depression and mental illness are too complicated to be reduced to simplistic theories. The idea that anti-depressants are only bandages that cover over "real" issues sounds nice- but do you have any actual evidence to support your "bandage" theory?
> I personally have spend thousands of dollars on therapy and huge quantities of time and effort working with my thoughts and feelings and have seen very little actual results from my work. The only thing that worked were anti-depressants- unfortunately they pooped-out.
Posted by SLS on May 25, 2001, at 12:43:20
In reply to Re: It doesn't get any better than this? CAM, posted by Lorraine on May 24, 2001, at 9:35:38
> Well, thinking it over, I think that even if you have worked like a dog to overcome this disease, meds are a bandaid. And, the reason is just as CAM said, they aren't intended to cure just ameliorate the symptoms. They are an anuity check for the drug companies. I'm not going to go into conspiracy theories on drug companies, but I am wonder what incentives there are for drug companies to work on cures as opposed to annuity checks? I don't think we put the carrots in the right place.
Much of what I wrote below is nothing more than conjecture.I don't have very much say, but I do have a set of beliefs regarding biological versus psychological variables in the evolution of some mental illnesses (please note the word "some"). It can be one or the other or both. I believe that for each individual, there is a unique psychobiological terrain. Like so many other facets of life, there exists a phenomenological spectrum within which lies a great variation in the genesis of mental illness.
It is difficult for me to affirm that there are unresolved psychological issues responsible for the perpetuation of an individual's presentation of schizophrenia. I suspect that there are many cases of bipolar disorder and schizoid disorders that emerge in the absence of psychosocial pathology. Although it can be argued that the striking morphological changes seen in the brains of great percentage of cases of schizophrenia are the indirect result of an illness for which is necessary a psychosocial inducer, I have not encountered any evidence that these changes can be reversed, regardless of the treatment approach. In other words, psychotherapy cannot spawn the regrowth of brain tissue formally occupying the enlarged ventricles within the brain. Clearly, there are biological differences here between the healthy versus the pathological brain. These changes cannot be not reversed, despite a successful resolution of psychological issues, had there been any before the onset of illness. Nor do these changes seem to be reversed upon treatment with antipsychotics or other somatic treatments. If, during an extended period of remission produced by pharmacotherapy, the application of psychotherapy yields a mind without pathology (I don't see why this would be any less possible than can be produced in an individual without schizophrenia), I doubt the rate of occurrence of schizophrenic symptoms for these individuals is no higher than that seen in the general population. Once induced, schizophrenia often remains recurrent or chronic, despite psychosocial influences. Schizophrenia is thus biological de facto. Hard work does not make it less so.
I chose schizophrenia as an example because the biological pathology is so easily recognized. Another striking example of a mental illness that's biological phenomenology is easily recognizable is bipolar disorder. The most stark observation is that of ultra rapid-cyclicity or ultra dian (ultra-ultra) rapid-cyclicity. The cycle evidenced by the dramatic switches between severe depression and mania can be so regular as to allow for the prediction of mood states hours, days, weeks, or months in advance. There are people who follow a 48 hour cycle regularly for extended periods of time. It seems unlikely that some psychological dynamic produces such a precise oscillation, especially when, as research patients, they are evaluated several times a day. Hard work performed during one state does not prevent the switch into the other.
I don't think all cases of major (unipolar) depression need have a psychosocial etiology. I wouldn't want to guess at percentages, though. Although not as obvious, some people seem to experience an onset and remission of depression in the absence of psychological pathology or environmental changes. Some very mentally healthy and happy people suffer an abrupt shift into or frequent recurrences of a clinically depressed state. A striking example of this is seasonal affective disorder (SAD). Consider that a half-hour of light a day can be much more effective than one or more hours a week of psychotherapy.
I'm starting to babble now. Obviously, I didn't anticipating writing so much.
I am not terribly attracted to the term "bandage" such that it be applied globally to all cases of depression, although it can apply well to some. I think it depends where along the continuum - the spectrum - the gestalt of contributors lie. I think medication can act to push the physiology of the brain in a direction so as to correct or compensate for some pathology. In so doing, the system is influenced to function in a way reflective of the way it was designed to. For some people, this nominal function is retained once the medication is discontinued. For others, it is not. Sometimes, the abberant biology is such that it becomes the functional ground state, and the only way to maintain remission is to continue to apply compensatory "pressure". However, sometimes the reverse is true. It is the "depressive pressure" produced by a psychosocial pathology that, when applied to a healthy system, produces a dysregulation of brain function. Here, psychotherapies are crucial to bring about remission either with or without medication. It is through the reduction of this depressive pressure through continued psychotherapy that helps maintain nominal function and prevent relapse. The tough part is acknowledging the myriad interactions between the psychological and the biological as they contribute to a single depressive episode.
I definitely have too much free time. :-)
By the way, I may disappear for a little while during my move into a new apartment within the next few weeks. I should reappear shortly thereafter.
- Scott
Posted by Cam W. on May 25, 2001, at 13:24:56
In reply to Re: Bandage Theory (Peter and Gil) » Peter S, posted by Cam W. on May 23, 2001, at 17:26:38
I guess that I wasn't really clear. I did not mean that hard work and insight to change aberrant thinking would "cure" any disease (especially biologically based one's like schizophrenia, bipolar disorder and chronic depression), but that the hard work would give one a better quality of life than if one didn't work at understanding their disease. I still think a vast majority of people think that a pill will cure their disorder or that they could just "snap out of it". Obviously these two beliefs are false. If everyone tried to live a better quality of life, despite their illness, there would be a lot more productive people in the world. Again, I do not think that not working is indicative of most who frequent this board. Coming to this board actually shows that one is working to overcome their illness and not try and let it run their life. - Cam
Posted by JahL on May 25, 2001, at 13:28:17
In reply to Re: It doesn't get any better than this? CAM, posted by SLS on May 25, 2001, at 12:43:20
Kind of what I was trying to say, only more considered, more grounded in fact & certainly less 'ranty'. I omitted to say that I do accept the concept of heterogeneity. However, & I'm guessing here, most of the babble participants fall more on the 'biological' side of the spectrum & so I can't see the purpose of Cam's remarks other than to provoke.
Reading Cam's remarks was kinda like finding out yr wife of 10 yrs has been cheating on you all this time. Altruistic chap, good psychopharmacologist, & his presence used to define this board, but his take on the origins & cure for depression....well, sad to say, the guy loses pretty much all credibility in my eyes. I realise that Cam's something of a sacred cow rnd here so I'll butt out. J.
> > Clearly, there are biological differences here between the healthy versus the pathological brain. These changes cannot be not reversed, despite a successful resolution of psychological issues, had there been any before the onset of illness.
Preee-cisely.
Posted by Cam W. on May 25, 2001, at 13:54:47
In reply to Re: spot on » SLS, posted by JahL on May 25, 2001, at 13:28:17
Jah - I do not see anywhere in this thread where I said anything about a "cure". I do not believe that depression (or other chronic illness) can be cured, but that doesn't mean one can sit idly by and let a drug, which alleviates some of the symptoms, but the cognitive therapy, social skills training, etc., improves the quality of life by teaching one to "live", rather than "exist". I don't believe that one with a chronic illness cannot improve themselves; having a chronic illness is not an excuse for not working hard to improve oneself.
As for my opinions on the origins of depression, check the archives for "HPA axis" and nature v. nurture issues (pretty much any long debate with Scott).
Please, what don't you understand in what I have written in this thread. Perhaps you should read my posts a little closer to see what they say, not what you think they mean. - Cam
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