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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by SLS on January 14, 2009, at 10:44:23
How much do we really know to say that we know?
I know enough to know that I don't know what causes depression.
I know enough to know that I don't know how antidepressants work.
I feel fortunate that I know enough to know how much it is that I don't know.
Are we really smarter than the neuroscientists? They claim not to know what many of us claim we do know.
Are we smart enough to recognize that which is merely conjecture on our part, and not fact?
How do I know?
I don't.
- Scott
Posted by Garnet71 on January 14, 2009, at 12:05:24
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
Scott, that's a very interesting question.
Remember though-scientists thought the world was flat and other crazy things. Science is not perfect. For example, the scientists at the FDA have proven drugs are safe--then later take them off the market.
Research is only as good as the methodology and the intent of the researcher. It can be very biased. It seems rather easy to take a stance on something, then design a project to prove what you want to 'prove'. Not that this happens all the time, but it should be considered.
Anticedotal (can't spell right now) evidence is very, very important to me. I think it proves a lot.
Also, for the intuitive types, right-brained thinkers like me, it is so difficult to beleive things counter to my intuition. It is so strong.
People with amplified intuition-psychics--not the fake kind you see--but there are some and their actions/thoughts cannot be explained by science--is something to think about too. So clearly, science doesn't have all the answers.
I also think that in 100 years, we are just going to disprove everything we know about psychiatry/neuroscience today. This is purley intuition on my part. It is very hard to explain to those that don't experience this sometimes torturous trait.
But-it's not that much different, to me, than looking back and saying I can't believe we thought women were witches and deserved to be murdered. We are still very primitive, but will evolve when we spiritually evolve.
Posted by Phillipa on January 14, 2009, at 12:32:42
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
Scott well if you don't know surely I don't know which I know so fear meds. As no one can prove to me that any med will do anything for me. Might for others but is it psychological or trust of the person prescribing the med. Hence hesitant to mess any more with my brain. In my 20's was so young I just figured the docs knew. Now know they don't. Goes round and round in my head til so confused don't know my head from my feet. But I know I don't know. I'm ignorant. I do sense when something isn't the right thing for me that's all though. Boy this thread should bring so many responses. Thanks for posting it. Love Phillipa
Posted by Garnet71 on January 14, 2009, at 12:42:04
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
I have another perspective.
So--If I won a million dollars right now, my condition would improve greatly. Does that mean a million dollars is a cure to my psychiatric problems? The elevated dopamine effect of winning a million dollars would eventually disappear--but the effects of SSRIs also disappear for many of us.
If I were to have sex right now, same thing. So since sex offers relief, should it be prescribed?Though more temporary than psych meds.
Psych meds do the same thing as winning a million dollars in some sense. Just because a pill is designed for something to treat,doesn't mean its any more credible than using a million dollars to cure. I hope I'm making sense.
I think, however, the overall problem is continually designing drugs to create symptoms rather than researching the actual cures. There's more money in the drug research; if anyone doubts there is a medical-industrial complex in our society, I would say that's a bit naive.
So, drugs have little credibility, in my view.
Just my two cents.
Posted by Sigismund on January 14, 2009, at 12:54:23
In reply to Re: How much do we really know to say that we know? » SLS, posted by Garnet71 on January 14, 2009, at 12:05:24
Geez, I don't feel that I know much.
Posted by Sigismund on January 14, 2009, at 12:57:44
In reply to Re: How much do we really know to say that we know? » SLS, posted by Garnet71 on January 14, 2009, at 12:05:24
>We are still very primitive,
Yes
>but will evolve when we spiritually evolve.
Maybe
I'm not sure about the idea of progress outside of technological progress.
I've not seen evidence to suggest the existence of it.
Posted by SLS on January 14, 2009, at 13:38:47
In reply to Re: How much do we really know to say that we know? » SLS, posted by Garnet71 on January 14, 2009, at 12:05:24
I am in agreement with you.
I think the principle of the scientific method is valid.
I think anecdotal reports are important, too. I often rely on them.
The point I was trying to make is that it sometimes takes honest self-reflection and a desire to be objective, so as to be able to tell the difference between what one knows and what one does not know. This includes neuroscientists, physicians, and patients. This is both a philosophical and practical approach which is practiced independent of the contemporary state of the art. It is a way of being. For some of us - like me - it is not an easy challenge.
It is very tempting to present personal conjecture as fact. I'm afraid I do it quite often myself. A great many of us are not comfortable without knowing and without understanding - or worse yet - that no one in the world should know or understand.
- Scott
Posted by SLS on January 14, 2009, at 13:56:58
In reply to Re: How much do we really know to say that we know? » SLS, posted by Garnet71 on January 14, 2009, at 12:42:04
> I have another perspective.
>
> So--If I won a million dollars right now, my condition would improve greatly.If your condition is reactive to external events, you are fortunate. Mine never was.
> Does that mean a million dollars is a cure to my psychiatric problems?
What type of psychiatric problems, specifically?
> The elevated dopamine effect of winning a million dollars
You see, here is an example of what I was trying to explain. I know I am being imputent, but how do you know that there is an elevated dopamine effect from winning a million dollars?
> would eventually disappear--
Sort of like extinction?
These are some huge mental leaps we are taking, such that I know I am without the knowledge or insight to justify. I just don't think we can relegate human experience to a single variable (levels) of a single substance (dopamine). In my way of thinking, it is too simplistic to be plausible when one looks at the sophistication of the brain and its interrelated processes.
> but the effects of SSRIs also disappear for many of us.
Yup. Anything like extinction?
> If I were to have sex right now, same thing. So since sex offers relief,
It never affected one bit my level of depression - even momentarily. Two different things in my experience.
> should it be prescribed?
Hell yes!
Do you know how sex works to be able to compare it to SSRI poop-out? Dopamine? Really? NE? ACh? Autonomic reciprication? It really is interesting. ACh gets you hot, NE gets you off. DA makes you want more.
That's too simplistic, but I don't know much more than that.Gosh. This can be taken as so insulting, and I don't mean it to be. I just think it is good every now and then to admit our own ignorance - that is, of course, should we have any? If one is ignorant of their ignorance, does that make them wrong? :-)
- Scott
Posted by JadeKelly on January 14, 2009, at 15:01:40
In reply to Re: How much do we really know to say that we know? » Garnet71, posted by SLS on January 14, 2009, at 13:56:58
Just to lighten things up a bit, my brother and I have what we call "million dollar days". If one of us is having a million dollar day, even being handed a million dollars would not lighten our mood.
I don't "know" that the A/D that I am taking will last longer than sex, or money, or whatever. But I can make a choice to continue with it based on the duration and the results I've seen in others.
~Jade
Posted by Jay_Bravest_Face on January 14, 2009, at 17:15:28
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
Nobody...I mean NOBODY, can tell you, or I, how WE feel inside. That is what I hate about many pdocs and such, saying, "you take X, so you should feel like Y". It's quite simple...forget all of the b*llsh*t...if it feels "better" than our baseline (as opposed to "good"...an elevated, artificial high...which is only temporary) just go with it. We DON'T need to know the WHY of everything!
Jay
Posted by SLS on January 14, 2009, at 17:33:20
In reply to Re: How much do we really know to say that we know? » SLS, posted by Jay_Bravest_Face on January 14, 2009, at 17:15:28
> Nobody...I mean NOBODY, can tell you, or I, how WE feel inside.
Are you sure? In my experience, a good psychotherapist can. This is a good thing.
I bet you're feeling anxious and angry inside right now. (How am I doing)?
> That is what I hate about many pdocs and such, saying, "you take X, so you should feel like Y". It's quite simple...forget all of the b*llsh*t...if it feels "better" than our baseline (as opposed to "good"...an elevated, artificial high...which is only temporary) just go with it. We DON'T need to know the WHY of everything!
Sure we do. That's how we can reproduce and improve results while doing the least harm.
As a patient, you certainly don't have to know a damned thing as long as your treatment works and is doing you no harm.
Sometimes, a lot of education goes a short way.
- Scott
Posted by seldomseen on January 14, 2009, at 18:13:19
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
Maybe I'm wrong, but I think what you are getting at is the difference between knowledge and wisdom.
Neuroscientists know a lot, we know a lot, the internet has a lot of information. I'm not sure, as patients, we should be seeking more knowledge.
I think we should be seeking wisdom.
I think what certain neuroscientists/physicians/experienced patients have is the ability to synthesize tons of information and sort out what has merit and what does not.
Personally, I'm not an anecdotal person, but a well-documented case history or report can have merit. So can a case series. But there is the unavoidable fact of regression to the mean.
I will reveal here that I am a scientist, though not in the field of psychiatry. I can say with absolute certainty that the most highly educated, impeccably trained scientists will freely admit that they don't know much, only as much as their next study.
Seldom.
Posted by SLS on January 14, 2009, at 18:44:37
In reply to Re: How much do we really know to say that we know? » SLS, posted by seldomseen on January 14, 2009, at 18:13:19
> I can say with absolute certainty that the most highly educated, impeccably trained scientists will freely admit that they don't know much, only as much as their next study.
I know. I wasn't commenting on scientists other than trying to express my respect for them and their methods.
Talk about needing an objective approach and an open mind, my uncle, an electrochemist, was delegated the task of investigating cold fusion for the US government. Skeptical or not, he did his job.
- Scott
Posted by ricker on January 14, 2009, at 18:54:27
In reply to How much do we really know to say that we know?, posted by SLS on January 14, 2009, at 10:44:23
> How much do we really know to say that we know?
No more than a cancer patient needs...or wants to know about their treatment.
>
> I know enough to know that I don't know what causes depression.Welcome to the club.
>
> I know enough to know that I don't know how antidepressants work.Again, why do you need to know how they work?
>
> I feel fortunate that I know enough to know how much it is that I don't know.OK
>
> Are we really smarter than the neuroscientists? They claim not to know what many of us claim we do know.I would begin to worry if I thought, for one minute, I was smarter than the people that make my pills!
>
> Are we smart enough to recognize that which is merely conjecture on our part, and not fact?Depends on how stable we are...at the moment.
>
> How do I know?
>
> I don't.
>Again, why the need to know? The majority of all other illness's are treated.... some with much success, without the patient ever asking what their red, orange or yellow pill is doing.
They are content with the fact they're in remission. The mere fact that some people with mental disorders ruminate so much only confirms they're illness.... no matter how educated they are.
It's not out of ignorance that I can't recite every psychiatric med and it's pharmacology. Only when I'm not stable, obsessing about my mental state, is when I neurotically scour the Internet, looking for the magic pill.
I'm not suggesting it's unhealthy to educate one self with their meds, but, I believe there is a difference between that and living in front of a computer with the intent of making that miraculous discovery that thousands of well paid and educated scientists have attempted.
The more I know about psychiatric medicine, the sicker I am, or am becoming. Sad, but true, for me anyway.
Posted by Phillipa on January 14, 2009, at 19:34:38
In reply to Re: How much do we really know to say that we know?, posted by ricker on January 14, 2009, at 18:54:27
Ricker how I relate to your last statement. Love Phillipa
Posted by uncouth on January 14, 2009, at 19:53:58
In reply to Re: How much do we really know to say that we know?, posted by ricker on January 14, 2009, at 18:54:27
I know that right now, I feel like things are hopeless, and that my life is a failure, and that I'll never find anyone to love me, and that I've squandered every opportunity that i've ever gotten, and that i'm spending too much time thinking about myself, and that i'm self-absorbed in my own depression by even writing these words, and I feel like i'd rather die than live a life that's going to feel like this most of the time, and I know that the constant thoughts: of my own funeral, of killing myself with a rope on my bed, of writing a suicide note that goes on and on, and writing the content in my head during the day, I know that all of this, all of this, can be responsive to medicine, the right medicine, but that it takes time for medicine to work, and that i must endure this level of suffering, and the suffering over the suffering itself, and the pain of ruminating over the pain, and of the special shame of knowing that ruminating over the depression feels better than sometimes picking yourself up and doing something positive. I know I must endure all of this because someday, somehow, I will find the right combination that will give me my life back.
What sort of life it will give me back, i'm not sure, and it scares me when I think about my old life, and my potentially new life, and how they may be very different.
And that's why I don't go through with what my mind obsesses about all the time when things get very bad (as they are right now).
So that's what I know, and that's all I know. Everything else (tianeptine's a miracle! parnate's the key! ssri's are the devil's work!) i'm deciding to be less judgemental about, trust my doctor more, and stop using myself as a guinea pig.
-Uncouth, trying to hold on tightly in the face of immense pain, sadness, regret, sorrows, fears, and heartbreak. (Somehow all of this can exist at the same time). Please pray for me, the next week is going to be difficult (in the middle of my 14 day washout from Parnate before I try pristiq).
Posted by Neal on January 14, 2009, at 20:32:22
In reply to Re: How much do we really know to say that we know, posted by uncouth on January 14, 2009, at 19:53:58
I'd say to talk is better than not to talk.
That this board is to share not only personal experiences, but ideas and gleanings from the web.
That no one is claiming to be a neuroscientist.
That bad or false ideas will be swatted down.
That posters should post responsibly.
And that, as Dr. Bob says at the top of the page: "Don't necessarily believe everything you hear. Your mileage may vary. The only posts I take responsibility for are my own. In a crisis, please also get help in person. It's good to give as well as to receive. What you say may conceivably be used against you."
Posted by Phillipa on January 14, 2009, at 21:12:02
In reply to Re: How much do we really know to say that we know, posted by uncouth on January 14, 2009, at 19:53:58
Uncouth hang on so you're switching from parnate to pristig? Are you will family or someone? Please call for help is find yourself unable to cope. I care. Love Phillipa
Posted by uncouth on January 14, 2009, at 22:24:29
In reply to Re: How much do we really know to say that we know » uncouth, posted by Phillipa on January 14, 2009, at 21:12:02
thanks. yes with family. yes, it is hard. trying to cope, trying to push all those regrets, bad memories, sadness, feelings of failure back in the bottle as best i can.
at all parts of the spectrum, and at all ratings on the 1 - 10 mood scale, this is a horrible illness.
when i've been "better" i'm never really "well". does anyone actually ever get "well"? or is "better" the best I can ever hope for in my life.
Posted by SLS on January 15, 2009, at 7:21:21
In reply to Re: How much do we really know to say that we know, posted by Neal on January 14, 2009, at 20:32:22
> I'd say to talk is better than not to talk.
Important point. That shines a special light on the subject for me. Thanks.
- Scott
Posted by SLS on January 15, 2009, at 9:17:32
In reply to Re: How much do we really know to say that we know, posted by uncouth on January 14, 2009, at 19:53:58
> I know that right now, I feel like things are hopeless, and that my life is a failure, and that I'll never find anyone to love me, and that I've squandered every opportunity that i've ever gotten,
It is crucial that you maintain the insight that this is "right now" and that you "feel" like things are hopeless. Right now, I feel the same way. During my switch from one drug to another, I have had my depression gradually return.
What you did here is courageous and healthy:
> and that i'm spending too much time thinking about myself, and that i'm self-absorbed in my own depression by even writing these words, and I feel like i'd rather die than live a life that's going to feel like this most of the time, and I know that the constant thoughts: of my own funeral, of killing myself with a rope on my bed, of writing a suicide note that goes on and on, and writing the content in my head during the day, I know that all of this, all of this, can be responsive to medicine, the right medicine, but that it takes time for medicine to work, and that i must endure this level of suffering, and the suffering over the suffering itself, and the pain of ruminating over the pain, and of the special shame of knowing that ruminating over the depression feels better than sometimes picking yourself up and doing something positive. I know I must endure all of this
God bless your positive resolve:
> because someday, somehow, I will find the right combination that will give me my life back.
> What sort of life it will give me back, i'm not sure, and it scares me when I think about my old life, and my potentially new life, and how they may be very different.
The uncertainty can be scary and exciting at the same time. The real unknown is, "Who is Me? Who am I and what am I like without the depression that I am so familiar with? How will it feel? How will I behave? What decisions will I make? Will I really have the power to build a happy life?"
> So that's what I know, and that's all I know. Everything else (tianeptine's a miracle! parnate's the key! ssri's are the devil's work!) i'm deciding to be less judgemental about, trust my doctor more, and stop using myself as a guinea pig.
Gosh. What huge insights!
> -Uncouth, trying to hold on tightly in the face of immense pain, sadness, regret, sorrows, fears, and heartbreak. (Somehow all of this can exist at the same time). Please pray for me, the next week is going to be difficult (in the middle of my 14 day washout from Parnate before I try pristiq).
I will indeed pray for you.
- Scott
Posted by uncouth on January 15, 2009, at 9:41:29
In reply to Re: How much do we really know to say that we know » uncouth, posted by SLS on January 15, 2009, at 9:17:32
thank you, scott. your msg was a good way to start my morning.
Posted by Phillipa on January 15, 2009, at 19:44:55
In reply to Re: How much do we really know to say that we know, posted by uncouth on January 15, 2009, at 9:41:29
Feeling more positive? I hope so. Love Phillipa
Posted by Phillipa on January 15, 2009, at 19:46:24
In reply to Re: How much do we really know to say that we know » uncouth, posted by SLS on January 15, 2009, at 9:17:32
Scott truly sorry. What will you do go back to previous meds? Love Phillipa
Posted by SLS on January 15, 2009, at 19:52:56
In reply to Re: How much do we really know to say that we know » SLS, posted by Phillipa on January 15, 2009, at 19:46:24
I am on exactly the right drugs. I just need a dosage adjustment. I need to be patient, though. I doubt my doctor will simply take my word for it that I need a 100% increase. So I will be relegated to suffer from a cautious and logical set of decisions made by a great doctor.
- Scott
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