![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by SLS on October 15, 2005, at 10:56:26
In reply to I'm probably not welcome here........., posted by 64bowtie on October 15, 2005, at 4:57:42
Rod,
Whatever works for you, man...
The civility and all.
> I'm probably not welcome here since I have so little to say about medication as a process that might produce wellness in clients...
What is a client?
> Medications do, however, produce inductive civility (extrinsic motivation to be civil), rendering clients controllable...
What is meant by "controllable"?
Actually, I should think that the term "inductive civility" would better describe the imitation by one individual the behavior of another through observation and repetition. That is quite a fancy phrase, but I can't find it anywhere on Google as a psychological term.
I also find that your use of another fancy phrase, "extrinsic motivation" to be in conflict with your suggestion that medications confer motivation from within rather than its accepted definition as an external reward system to motivate a particular behavior.
Control? Is that all medications do?
Is that all they do for people with depression who are of low energy, quite passive and behaviorally controllable to begin with? Why are so many of these people made well by taking medication and needing nothing more, and for whom wellness brings on assertiveness and less behavioral "controllabity"?
> Clients can also 'suit-up' and 'show-up' reliably for their responsibilities when medicated...
I certainly hope so. This is one of the goals. It is heartening to know that you believe medication can be so effective when treating illness.
> I prefer 'real' civility, but don't we all, really???What is civility?
> Not civility induced by medications;
How have medications affected your civility?
> civility that happens to match up with our obligatory thinking,
Can you give an example of what you consider to be obligatory thinking?
> or the express expectations of others...
This is a pervasive theme that is very much human and does not require medication to occur.
Speaking of themes, why did you choose medication, behavioral compliance, and civility to be yours?
- Scott
Posted by crazy teresa on October 15, 2005, at 12:07:07
In reply to I'm probably not welcome here........., posted by 64bowtie on October 15, 2005, at 4:57:42
IMO, civility as in the babble kind, is over-rated.
Posted by ed_uk on October 15, 2005, at 13:06:46
In reply to I'm probably not welcome here........., posted by 64bowtie on October 15, 2005, at 4:57:42
Hi Rod,
You sound hurt, like you've been hurt by someone on the medication board. I hope you are ok.
Gotta say, medication has never made me civil. Benzos make me aggressive. SSRIs make me selfish. Antipsychotics make me feel like strangling someone.
As glydin said, it's sounds like you've got a lot to say about medication!
With kind regards
~ed
Posted by Declan on October 15, 2005, at 14:18:52
In reply to Re: I'm probably not welcome here......... » 64bowtie, posted by ed_uk on October 15, 2005, at 13:06:46
Ed, you've got an idea there. What's a med combo that will induce civility? For a while, at least. Something illegal no doubt.
One thing drugs do to you over time I'm sure of.
They teach you patience.Declan
Posted by ed_uk on October 15, 2005, at 14:55:28
In reply to Re: I'm probably not welcome here......... » ed_uk, posted by Declan on October 15, 2005, at 14:18:52
Hi Dec,
There isn't a med to make nasty people nice ;-) There isn't a med to make selfish people caring. And there isn't a med to make uncivil people civil!
However...........
There are drugs which make mice less aggressive: the SERENICS (not related to haloperidol [Serenace] - a neuroleptic!)
Behavioural pharmacology of the serenic, eltoprazine
by
Olivier B, Mos J, Rasmussen D.
Department of Pharmacology,
Duphar B.V., Weesp, The Netherlands.
Drug Metabol Drug Interact 1990;8(1-2):31-83ABSTRACT
In this paper the effects of serenics (eltoprazine and fluprazine) are described in several animal models for offensive agonistic, defensive agonistic and predatory behaviour. They are compared with the effects of a number of other putative anti-aggressive compounds or drugs used clinically in order to ameliorate aggressive behaviour of psychiatric patients. In isolation-induced offensive aggression in mice, eltoprazine has a marked and potent anti-aggressive activity, although numerous other psychoactive drugs also exert anti-aggressive effects. The behavioural specificity of this anti-aggressive profile was investigated using an ethologically derived animal model, social interaction in male mice. In this model, eltoprazine has a very specific anti-aggressive (serenic) profile, inhibiting aggression while social interaction and exploration are not decreased but even enhanced; inactivity, a measure for sedation, is not affected. Such a profile contrasts sharply with that of neuroleptics (chlorpromazine, haloperidol), psychostimulants (d-amphetamine) or benzodiazepines (chlordiazepoxide), which exert severe sedation (neuroleptics) or even aggression-enhancing effects (BDZ). After subchronic treatment no tolerance for the anti-aggressive effects of eltoprazine occurred. The specific anti-aggressive effects of eltoprazine were also found in rat models of offensive agonistic behaviour. In one such model - resident-intruder aggression - eltoprazine reduced offensive behaviour specifically, leaving social interactions and exploration intact, and did not induce sedation or other unwanted side-effects. The neuroleptic haloperidol was very sedative in this model, as was the 5-HT1A-agonist buspirone. Benzodiazepines (chlordiazepoxide) have a biphasic effect in this paradigm, enhancing offence at low doses and decreasing it at higher doses, due to muscle relaxation. In another offensive model, colony-aggression, in which a dominant and subordinate male in a colony are confronted with a male intruder, eltoprazine reduced offensive behaviour of both the dominant and the subordinate against the intruder. In contrast, chlordiazepoxide enhanced aggression, at least at lower doses, whereas alcohol had, up to very high doses, no effect on the offensive behaviour. In a brain-stimulation induced offensive model--hypothalamically-induced aggression in rats--eltoprazine specifically reduces offence. Locomotion, a measure for sedation, was either unaffected or even somewhat enhanced, indicating the absence of any sedatory activity of this serenic compound. In contrast, haloperidol heavily sedated animals, making them incapable of aggression.PS. Some scientists have suggested that eltoprazine reduces aggression simply by inducing a 'timid' state of anxiety.
~Ed
Posted by Racer on October 15, 2005, at 21:24:47
In reply to I'm probably not welcome here........., posted by 64bowtie on October 15, 2005, at 4:57:42
> I'm probably not welcome here since I have so little to say about medication as a process that might produce wellness in clients...
I'd say that your welcome has a lot less to do with how much or how little you have to say about medications, than with how much support and information you are willing to share with those of us who have decided that medication *does* have a place in our treatment.
I'm sorry that you've gotten the mistaken impression that psychotropic medications act by making patients more docile. The medications discussed on this board control a number of different disorders which have both physical and psychological symptoms, doing so through a variety of different mechanisms. It's unfortunate that so many people have been given the idea that they're nothing more than "happy pills" that do nothing but mask psychological problems. I believe that, if this one idea were finally wiped out entirely, much of the stigma of mental illness would be lifted, as there would be a clearer understanding that most of these disorders have a biological basis.
If you'd like to learn more about psychotropic medications, though, this is the place to do so. We have a lot of very well informed individuals who are very generous in sharing their knowledge wiht others. I'm sure they'd be glad to help you learn.
Posted by SLS on October 15, 2005, at 21:30:20
In reply to Could that be because... » 64bowtie, posted by Racer on October 15, 2005, at 21:24:47
Posted by Declan on October 15, 2005, at 23:41:51
In reply to Could that be because... » 64bowtie, posted by Racer on October 15, 2005, at 21:24:47
Posted by med_empowered on October 16, 2005, at 6:02:17
In reply to Could that be because... » 64bowtie, posted by Racer on October 15, 2005, at 21:24:47
I think the poster raises an important point--historically, medications have often been used to control "symptoms" (and people) instead of empowering them. Look at Thorazine and the other early neuroleptics. Not only were they used on those with schizophrenia, they were also used: in "hostile" elderly people (very popular in old folk's homes...minimized staff costs), in prisons (both on the mentally ill and the generally aggressive), in juvenile facilities, and in foster homes. In fact, some states in the US have recently been found to have over 50% of their foster children on at least 1 psychotropic drug. Think about it. 50% of the kids are mentally ill? Even when you take into account the "disturbed" pasts some of these kids might have, when you have over 1/2 of them on some sort of psychotropic, and many of them on several, there are serious problems. Apparently, a number of them are on un-tested, possibly dangerous combos--like 2+ stimulants together, highly sedating "super combos" (depakote+klonopin+zyprexa..that kinda thing). Sooooo, the point is, I guess, that medication is really like any other drug--they're not really inherently good or bad; the usefulness of their effects really depends on context. Some drugs (like Thorazine) seem pretty much designed to control people, and should be abandoned now that we have better medications. Some drugs (such as Valium) have the potential to help EMPOWER people, but can also be mis-used to trap people in an existence of stifled emotions, dulled cognition, and chemical dependency. So..its a mixed-bag. Personally, I think with some major "tweaks" in the current system, things could be much better. My "tweaks" would include: the end of forced hospitalization, the end of forced medication, the end of use of "depot" injections, increased penalties for shrinks who over-prescribe and/or expose their patients to unnecessary risk, increased emphasis on truly **informed consent** for all drugs--in my ideal vision, docs would have to have forms signed for most drugs given to patients, and these forms would have to include data regarding side effects and alternative medications and/or non-drug treatments. In addition, I'd like to see a form where doctors could be rated by their patients. ((In the university setting, at least in the US, a large part of what determines of professor's pay, rank, and tenure status is the student evaluation; why should psychiatrist's be exempt from scrutiny based on the experiences of the very people they are supposed to treat?)) So...I guess I'm saying that yes, drugs can be used for behavior control, and sometimes its very frightening to read "testimonials" for certain drugs, especially when those being treated are children and/or disabled...I recently read one where the mother of a bipolar child was amazed at how "compliant" and "cooperative" Abilify had made her child. In the entire testimonial, I didn't see one single reference to how the kid felt--it was all about how compliant and "friendly" he had become, and how much easier it was for everyone to get along with him. Creepy..very, very creepy. Still, the potential exists for pretty much all drugs to empower the patient to live a more productive, fulfilling life...the important things would be drug selection and dose calibration, informed consent of the patient, and a decision on just who's goals--the docs or the patient's--are going to be at the center of the treatment plan.
Posted by Racer on October 16, 2005, at 13:58:06
In reply to Treatment or control?, posted by med_empowered on October 16, 2005, at 6:02:17
> I think the poster raises an important point--historically, medications have often been used to control "symptoms" (and people) instead of empowering them. Look at Thorazine and the other early neuroleptics. Not only were they used on those with schizophrenia, they were also used: in "hostile" elderly people (very popular in old folk's homes...minimized staff costs), in prisons (both on the mentally ill and the generally aggressive), in juvenile facilities, and in foster homes.
That was pretty much what they had at the time, though. It may not be pretty, but sometimes ya gotta do the best you can with whatcha got, ya know? (I just gotta play The Apologist. Dunno why. Just my mood today.)
>>In fact, some states in the US have recently been found to have over 50% of their foster children on at least 1 psychotropic drug. Think about it. 50% of the kids are mentally ill? Even when you take into account the "disturbed" pasts some of these kids might have, when you have over 1/2 of them on some sort of psychotropic, and many of them on several, there are serious problems.
Yep. That is a problem, and I find it sickening, too. It's unfortunate that the most vulnerable members of our communities are also the least likely to be defended by others. And I'll shut up on that subject before I become uncivil.
>>Sooooo, the point is, I guess, that medication is really like any other drug--they're not really inherently good or bad; the usefulness of their effects really depends on context.
Absolutely, and well stated.
This is where there are a few problems, though, in my experience and opinion. I'm gonna break it into pieces, and hope it ain't too confusing:>> My "tweaks" would include: the end of forced hospitalization,
There really isn't much in the way of forced hospitalization in the US anymore. Mostly, now, there's the short term involuntary hospitalization, for stabilization, and only in cases where there's a pretty clear and immediate danger. This is good and bad, but mostly a good thing.
>the end of forced medication,
I guess I don't know much about forced medication. I have no idea how much of that goes on, because I've never come across it.
> increased penalties for shrinks who over-prescribe and/or expose their patients to unnecessary risk,
Amen to that. I don't remember if you were here when I was going through my nightmare with the psychiatrist whom I reported to the licensing board? Let's just say you'll find no disagreement on this point.
>> increased emphasis on truly **informed consent** for all drugs--in my ideal vision, docs would have to have forms signed for most drugs given to patients, and these forms would have to include data regarding side effects and alternative medications and/or non-drug treatments.
Aha! This is what I really wanted to respond to. During my Nightmare, the doctor had informed consent forms for every drug he prescribed. All the forms included side effect profiles, and a bunch of other stuff. I signed each and every one.
Now ask me if the doctor discussed any of the information on the forms? Ask me if he gave me time to read the forms before signing? Ask me if my consent was truly informed in any way that you and I would recognize?
Having the forms, having the information available, is a wonderful idea, but it's not going to fix the underlying problem for most of the country. For anyone who doesn't have insurance -- had I had insurance, I would have been spared the misery I experienced -- or anyone who doesn't have access to adequate mental health care, the problem will continue as doctors shove forms under our noses and hurry us along into signing. Until there are some fairly extensive and fundamental changes made to our health care system in general, there is very little chance that most patients will be able to give informed consent, no matter what the rules governing it may be.
(Not, you understand, that I have any opinions on this subject...)
I really hope you don't mind that I jumped in on this. Mostly, I agree with you, just had a few experiences that proved to me that informed consent rules aren't nearly enough to protect patients, and felt the need to jump in.
Thanks for your thought-provoking post, by the way. I find your perspective very interesting, always.
Posted by bigcat on October 16, 2005, at 22:55:30
In reply to Re: I'm probably not welcome here......... » 64bowtie, posted by SLS on October 15, 2005, at 10:56:26
SLS- I think you rendered him speechless. Wow, I got a real kick out of reading that. I wouldn't have had the patience to be "civil" in responding to a post like that, but I commend your ability to speak the utter truth and dispel fallacy. You made it look easy.
Posted by 64bowtie on October 17, 2005, at 17:45:05
In reply to Re: I'm probably not welcome here......... » 64bowtie, posted by Glydin on October 15, 2005, at 7:48:07
Posted by 64bowtie on October 17, 2005, at 17:57:42
In reply to Re: I'm probably not welcome here........., posted by bigcat on October 16, 2005, at 22:55:30
...I get busy and have to prioritize...
Rod
PS:us (we) coaches have clients, toooo...
Posted by 64bowtie on October 17, 2005, at 18:00:03
In reply to What kind of civility are you referring to? » 64bowtie, posted by crazy teresa on October 15, 2005, at 12:07:07
Civility as in the kind where we can ride the city bus and not get stabbed or beaten...
Rod
Posted by 64bowtie on October 17, 2005, at 18:23:10
In reply to Re: I'm probably not welcome here......... » 64bowtie, posted by ed_uk on October 15, 2005, at 13:06:46
Actually, I got dumped onto the meds board by Dr-B saying that what I was calling an alternate modality was really a treatise on avoidance of meds... This is, afterall, Dr-Bob's house, and I am just visiting...
Basically I avoid this board and the Faith board because they get me into trouble with Dr-Bob... Even though I've seen clients recovering and healing, and I've witnessed clients in wellness and mental health, since I'm not a licensed practitioner in a field acceptable to his industry, I must be careful to stay light and fluffy so that I don't get blocked... How am I doing???
Rod
Posted by 64bowtie on October 17, 2005, at 18:25:23
In reply to Re: I'm probably not welcome here......... » ed_uk, posted by Declan on October 15, 2005, at 14:18:52
...teaching, as you put it, is an inductive process...
Rod
Posted by 64bowtie on October 17, 2005, at 18:30:28
In reply to Could that be because... » 64bowtie, posted by Racer on October 15, 2005, at 21:24:47
It is worthy of a well thought out response... Can I have your permission to think it over and carefully state my case???
Rod
Posted by 64bowtie on October 17, 2005, at 18:56:58
In reply to Re: Treatment or control? » med_empowered, posted by Racer on October 16, 2005, at 13:58:06
Please allow me to address my response to Racer to include responding to you... I am humbled by what style and clarity your response contained... I will need some time to do this response justice...
I personally haven't had drugs or medications in my history... I have been party to their prescription and use, mostly in a clinical learning setting... In my efforts at suicide prevention (2 years), I found myself frustrated and disgusted by client use and abuse of legal and illegal substances... Toooo many succeeded at ending their lives unchallenged by the very entity that society trusts to bring mankind toward health; healthy feelings, healthy motives, and healthy behaviors; the mental health industry...
I ask the rhetorical question: What did mankind do to find mental health before the likes of Freud??? Shaman, Philosophers and Ministers appear in literature to be the counselors of the ages, for at least 3,000 years in text... We seem to have lost our way for the last 150 to 2000 years... Most folks can't seem to even define mental health with any certainty... Sad, very sad!!!
Rod
Posted by 64bowtie on October 17, 2005, at 19:01:11
In reply to Re: Treatment or control? Thanks so much, » Racer, posted by 64bowtie on October 17, 2005, at 18:56:58
Posted by gardenergirl on October 17, 2005, at 21:33:37
In reply to Thanks ed_uk, posted by 64bowtie on October 17, 2005, at 18:23:10
>
> ...since I'm not a licensed practitioner in a field acceptable to his industry, I must be careful to stay light and fluffy so that I don't get blocked... How am I doing???I disagree, and I emailed you about it.
gg
>
Posted by med_empowered on October 18, 2005, at 0:34:30
In reply to Re: Treatment or control? Thanks so much, » Racer, posted by 64bowtie on October 17, 2005, at 18:56:58
hey! I dont disagree, and I'm not saying that people "need medication" to "correct" some sort of poorly-understood "chemical imbalance" A lot of times, meds are overused, improperly used, or flat out ineffective. And when they are "effective," the question becomes: just what "effect" is being pursued here? I had a shrink who oohed and ahhed about the amazing effects a neuroleptic had on me. I felt like I was dying on the inside. I realized that all he cared about was reducing my hostility, my angst, etc...the BIG picture, like my values and individuality, didn't count for anything. I stopped the neuroleptic, and I stopped seeing him.
Now, though, I can see how meds can help--if someone can't leave their house, given them some Ativan. If someone can't sleep and its making them nuts, give them ambien for a while and then address it. The problem is that modern psychiatry de-contextualizes all our problems, so its as if we have these wild, uncontrollable brain cells just going crazy (when without meds) and making us do crazy things--there is no "self" in the entire equasion. Its oddly similar to Freud's idea that we are all being driven by subconscious, often repressed "impulses" and "neuroses"...again, there is, implied or directly stated, a total denial of the existence of a Self that exists in a social structure and has any measure of autonomy. I think maybe this de-humanization of suffering human beings into "patients" and "subjects" explains how psychiatry is sometimes capable of such horrible, inhumane, unscientific MIS-treatment; lobotomy, insulin shock, metrazol, high-dose neuroleptics, so on and so forth. I'm worried that with our growing reliance on medication, and our conceptualization of misery and despair as being "a chemical thing", out of our control, we may well enter into another dark period of invasive, damaging procedures and widespread degradation. But..I guess my point is that you can't really judge medication without analyzing the context in which it is used. Do I think someone with anxiety should just be handed a big candy dish full of Valium and told to take as needed? No. Do I think that denying that anxious person is OK? No. I think its callous and punitive. Used correctly, that person could be empowered to live life more fully--possibly with continued use of valium, possibly without it. Used incorrectly, that person could become oversedated and dull. See the difference? The problem isn't medication--its the dehumanization and labelling and degradation that often occurs as a matter of course in standard psychiatric "treatment".
Posted by Racer on October 18, 2005, at 13:52:26
In reply to Re: Treatment or control? Thanks so much,, posted by med_empowered on October 18, 2005, at 0:34:30
Although my little brain ain't up to much this morning, I did want to put a few thoughts out there on this subject, because I think you've hit on something important. Forgive me if I can't make myself clear this morning, and feel free to ask for clarification of anything I try to write...
>>>I think maybe this de-humanization of suffering human beings into "patients" and "subjects" explains how psychiatry is sometimes capable of such horrible, inhumane, unscientific MIS-treatment; lobotomy, insulin shock, metrazol, high-dose neuroleptics, so on and so forth. I'm worried that with our growing reliance on medication, and our conceptualization of misery and despair as being "a chemical thing", out of our control, we may well enter into another dark period of invasive, damaging procedures and widespread degradation.
I agree that there is a trend towards decontextualizing psychiatry these days, but I don't think it's related so much to the medications available or to the psychiatrists who prescribe them, so much as it is to a trend generally in the past decade or two. It seems as though this is happening all over the board -- I'm thinking of things like the standardized tests in school that are driving the curriculum, or the new bankruptcy laws that just went into effect. It seems to be related to the trend towards having paraprofessionals take over so many professional duties, which -- surprise! -- saves money. In order to allow, say, a PA to do the prescribing rather than bringing in a fully trained MD, there's gotta be a pretty cut and dried protocol to reduce liability: if the PA listens to a patient, and then says, "well, in my opinion, the best choice of medication for you is [x]" there's a liability issue if that medication causes a problem. On the other hand, if there's a protocol in place that says 'the following symptoms are treated first by drug [x], then if that doesn't work try drug [y]' you've just removed that issue. This is true for doctors, too, when you think about it. In today's litigious America, at least, a lot of doctors practice with self-protection at the back of their minds, so prescribing based on a pretty simple formula would make sense.
I don't know. Maybe I'm just nuts, but I do think that there's a problem with this sort of thing all over the boards these days. I don't think it's any sort of malice on the part of doctors, but I do think it's a real phenomenon.
Of course, that's not even mentioning the health insurance plans that will cover psychotropic medications, but not psychotherapy...
There. Some of what's in my mind today.
By the way, Med_empowered, I do find your posts consistently thought provoking, and I appreciate that. Please take this as constructive criticism, and not any sort of personal criticism: I also find many of them hard to read because they lack paragraphs. I know, it's mostly my aged eyes, but I *want* to read them so much, I thought I'd mention it to you.
Thank you.
Posted by med_empowered on October 18, 2005, at 14:28:18
In reply to You always make me think! It's great » med_empowered, posted by Racer on October 18, 2005, at 13:52:26
thanks for mentioning it! I tend to just write in big chunks (sorry bout that), so I'll break it up in the future. thanks for the input...im glad you enjoyed my post!
Posted by ed_uk on October 18, 2005, at 16:29:35
In reply to Thanks ed_uk, posted by 64bowtie on October 17, 2005, at 18:23:10
Hi Rod,
I avoid the faith board too - would definitely get into trouble with Dr. B :-O
~Ed
Posted by Racer on October 18, 2005, at 18:53:32
In reply to paragraphs, posted by med_empowered on October 18, 2005, at 14:28:18
> thanks for mentioning it! I tend to just write in big chunks (sorry bout that), so I'll break it up in the future. thanks for the input...im glad you enjoyed my post!
I am so relieved by reading this. I was so afraid that you would be offended, and nearly didn't write that part. Thank you for being so gracious.And I tend to kinda spill over at the keyboard myself. I've just learned over the years -- in real life before finding this place -- to break it up for readability. When my depression/anxiety get really bad, though -- well, I'm more than a bit embarrassed by the length and impenetrability of some of my posts here!
Thank you again.
This is the end of the thread.
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