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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by violette on July 12, 2010, at 16:19:10
"So theres tremendous hope for the treatment of the disease."
http://psychiatrist-blog.blogspot.com/2010/07/charlie-rose-brain-series-mental-health.html
Nobel Prize winner Dr. Eric R. Kandel co-hosts the show with Charlie Rose, and to quote Dr. Kandel from the transcript:
The whole history of psychiatry, which is a culmination of EmileKraepelin, is interesting. Weve known about these illnesses sinceHippocrates, the great Greek physician in the 5th century, who notonly spoke about depression and manic-depressive psychosis butspecifically indicated that these are medical illnesses. But this basic idea was lost on European medicine for thelongest period of time. During the middle ages, even later inthe Renaissance period, these were thought as demonic disorders,people possessed by the devil or moral degeneracy. And people with mental disorders were put away in insaneasylums usually far removed from the center of town and oftenthey were kept in chains so they dont move around. Fortunately, this situation was reversed in about 1800. TheParis school of medicine began to really express a very modernview of medical science. And Philippe Pinel, a great Frenchpsychiatrist, realized psychiatric disorders, as Hippocrates hadsaid, are medical illnesses, and he began to institute humanetreatment, the beginning of psychotherapy with mental patients. But from 1800 to about 1900, no progress was made inunderstanding psychiatric disorders. One couldnt localizethem specifically so one didnt know is there one mental illnessor are there many? And thats when our mutual hero, Emile Kraepelin, came on thescene. And his textbooks which began to emerge around 1902 andcontinued until he died in 1926, he outlines, for example, in thisbook in his first three chapters he defines the fact that mentalillnesses are not unitary. They affect two different processes,they affect mood, emotion on the one hand, and affect thinking onthe other. And he defined the disorders that affect mood -- depression andmanic-depressive disorder, and he defined the disorders of thinkingas schizophrenia. He called it dementia praecox. He thought itwas a deterioration of cognitive process in the brain early in life,praecox. And as you outlined, we have some insight into the nature ofthese diseases. We know that depression is an illness that involvesmood, which is associated with the feeling of worthlessness, aninability to enjoy life. Nothing, its all pervasive -- nothinggives one pleasure. And theres a feeling of helplessness, of worthlessness, oftenleading to thoughts of suicide and, tragically, to suicide attemptsthemselves. And 25 percent of people that have depression also have manic-depressive illness. They have the opposite end of the spectrum.They feel fantastic at the beginning of the disease. They feelbetter than theyve ever felt in their life. But ultimately thisleads to grandiosity and frank psychotic episodes. Schizophrenia is a thought disorder that has three types ofsymptoms-- positive, negative, and cognitive. The positive symptomsare characteristic I can of schizophrenia. Its the thought disorder,hallucinations, delusions, the acting crazy. The negative symptomsare the social withdrawal, the lack of motivation. And the cognitivedisorders are the difficulty with organizing ones life and adifficulty with a certain kind of memory, called working memory,short-term memory. Fortunately, as you indicated, we can now see people who have hadeffective treatment who have very productive lives. And Kay Jamisonand Elyn Saks, despite the fact they suffered the this disorder muchof their life, have rich personal lives, both of them involved inmeaningful interpersonal relationships, marriage, that is verysatisfying to them and having spectacular academic careers. So theres tremendous hope for the treatment of the disease.
Posted by linkadge on July 12, 2010, at 19:36:50
In reply to Progress of Psychiatry, posted by violette on July 12, 2010, at 16:19:10
Hope shmope. I'm tired of mentally healthy people saying theres reason to hope.
Don't friggen go on and on about how this drug or that drug is going to change the face of psychiatry. The proof is in the pudding.
Linkadge
Posted by violette on July 12, 2010, at 21:08:16
In reply to Re: Progress of Psychiatry, posted by linkadge on July 12, 2010, at 19:36:50
Did you read the full interview? I only read the blog and planned to read it when I had more time. If it's about this or that drug, I probably wouldn't be interested though.
I think I have a brain magnet that is attracted to the word "hope".
Posted by Questionmark on July 13, 2010, at 2:01:30
In reply to Re: Progress of Psychiatry, posted by linkadge on July 12, 2010, at 19:36:50
> Hope shmope. I'm tired of mentally healthy people saying theres reason to hope.
>
> Don't friggen go on and on about how this drug or that drug is going to change the face of psychiatry. The proof is in the pudding.-Amen brother.
.. Btw Violette i'm pretty sure he wasn't directing that comment to you though. And that does seem like it could be an interesting interview.
But ...
One of the many problems with psychiatry is the same problem with modern "traditional" medicine in general. It is a business. And as a business, it requires a continuous pool of consumers (patients). So would psychiatry proper be interested in finding the underlying primary biological causes (if there are any per se) of depression, or worse yet cures? Many indiVIDual researchers and clinicians in psychiatry i'm sure are, but overall, unlikely this could ever happen even if it's possible. Do you realize how many millions (billions?) of dollars that pharm companies and physicians and hospitals, etc. would lose if we hypothetically found a cure for depression?
And forget cure, even a perfectly effective (i don't even know what this would look like but humor me) treatment, i.e. drug, would be disastrous for drug companies as well as psychiatry because once the patent expired they would not be able to make much money on that drug anymore or on new antidepressant drugs (because the perfect treatment would already exist for people). Ok this is all theoretical because i doubt there could be a single "perfect" antidepressant for everyone anyway. I don't want to sound hyper-conspiratorial. But i think this illustrates a point. Psychiatry is big money. Psychiatric pharmaceuticals are big money. So psychiatric and drug research, drug development, marketing, and prescribing are probably not going to correlate perfectly with the best interests of the patients. Oh and likewise for related legislative policies and scientific journal publications, which are of course deeply interconnected and influenced (financially and otherwise) by Big Pharma and Psychiatry.
So to the question of progress in psychiatry, with the vast numbers of mentally ill and mentally suffering, i think the progress of psychiatry-the-business will be great. In terms of treatment for the actual people who are mentally suffering and seeking treatment, i sincerely think progress will be slow. Steadily progressing, but very slow.
Posted by SLS on July 13, 2010, at 5:18:20
In reply to Re: Progress of Psychiatry, posted by linkadge on July 12, 2010, at 19:36:50
> Hope shmope. I'm tired of mentally healthy people saying theres reason to hope.
>
> Don't friggen go on and on about how this drug or that drug is going to change the face of psychiatry. The proof is in the pudding.Well, let's hope that your positive responses to amitriptyline and Lexapro are markers of eventual success. They did demonstrate that a biological intervention can make a significant difference in your quality of life. Maybe you don't see it that way right now. My idiotic magnetic is attracted to hope, too. Without it, I would have a hard time justifying living this way for now. Unfortunately, "for now" has already meant a painful investment in 40 years of my life.
- Scott
Posted by linkadge on July 13, 2010, at 9:21:49
In reply to Re: Progress of Psychiatry, posted by SLS on July 13, 2010, at 5:18:20
I'm not taking them a (lexapro/amitriptyline) anymore. They pretty much just make me numb and want to sleep all day.
Linkadge
Posted by linkadge on July 13, 2010, at 9:30:33
In reply to Re: Progress of Psychiatr[ic Business?], posted by Questionmark on July 13, 2010, at 2:01:30
I agree, psychiatry is a buisness. They have taken a big hit in the last few years (SSRI/placebo debate), and they're trying to reesablish themselves.
For some people there is hope, for others there really is no hope. A lot of people are going to continue living their miserable quality of life until the day they die or commit suicide. I'd rather be told the truth, then to live in the unrealistic belief that a cure is just around the courner.
Linkadge
Posted by chujoe on July 13, 2010, at 12:09:56
In reply to Progress of Psychiatry, posted by violette on July 12, 2010, at 16:19:10
This is a fascinating discussion, though pretty depressing. I'm going to watch the video later this afternoon, but even before I do, I have a couple of questions, one "global" & one "local."
1. Is the history of psychiatry different in some fundamental way from the history of other branches of medicine?
2. Does the fact that psychiatric drugs change the chemistry & perhaps the anatomy of the brain automatically lead to the conclusion that such change is "damage"?
In no way should these questions be interpreted as questioning anyone's direct experience. I happen to think that the neo-Kraepelin paradigm is deeply flawed & has helped lead to the idea that all unusual mental states are always pathological; opposing this would be the opposing vier, championed by people like Richard P. Bentall, in which people who experience distress because of their, let us say, non-standard mental states are treated, both with drugs when appropriate, as well as with other sorts of psychological therapies. Once you get rid of the disease model & begin to concentrate on what Bentall calls "complaints," i.e., those things that cause distress, you are forced to treat each patient as a person, not a page from the DSM. Of course, this still leaves many people suffering, but it offers a kind of therapeutic honesty that is very hard to come by in the modern psychiatric industry.
Posted by linkadge on July 13, 2010, at 12:30:53
In reply to Re: Progress of Psychiatry » violette, posted by chujoe on July 13, 2010, at 12:09:56
>1. Is the history of psychiatry different in >some fundamental way from the history of other >branches of medicine?
I can't answer this one.
>2. Does the fact that psychiatric drugs change >the chemistry & perhaps the anatomy of the brain >automatically lead to the conclusion that such >change is "damage"?
If the changes are not reversable, and are associated with further impairment, then I would call it damage.
Linkadge
Posted by chujoe on July 13, 2010, at 12:57:58
In reply to Re: Progress of Psychiatry, posted by linkadge on July 13, 2010, at 12:30:53
Yeah, me too, if those are the criteria, with "impairment" being the operative word. And, again, not to minimize anyone's distress or suffering, I'd just note that the "normal" brain changes as we age & in response to environmental factors; some of these changes are distressing, others not; some are reversible, others not. In any case, a drug that can be shown to cause irreversible changes that are distressing to the patient ought not be approved, though one of the complications with psychiatric drugs is that they seem to affect different brains in different ways.
Posted by jade k on July 13, 2010, at 14:24:34
In reply to Re: Progress of Psychiatry » linkadge, posted by violette on July 12, 2010, at 21:08:16
Hi Violette!
> I think I have a brain magnet that is attracted to the word "hope".Me too.
I haven't read the interview yet but will soon.
Thanks for posting it.Jade :-)
Posted by weatherfreak on July 13, 2010, at 18:34:48
In reply to Re: Progress of Psychiatry » violette, posted by jade k on July 13, 2010, at 14:24:34
Try and find a Doctor (not a psychiatrist) that is a little older and wiser, who has worked in the mental health field.
I've been lucky enough to find one by accident. Although I have treatment resistant depression he has helped me more than anyone with my illness. He doesn't try to play pdoc at all and totally understands my mortal fear of psychiatrists due to past experiences, but boy has he got some tricks up his sleeve.
I just can recommend it highly enough to everyone.
Posted by jade k on July 13, 2010, at 18:45:22
In reply to Re: Progress of Psychiatry, posted by weatherfreak on July 13, 2010, at 18:34:48
> but boy has he got some tricks up his sleeve.
You gonna share with the rest of the class?
~Jade
Posted by emmanuel98 on July 13, 2010, at 21:55:04
In reply to Re: Progress of Psychiatry » weatherfreak, posted by jade k on July 13, 2010, at 18:45:22
I have to jump in and defend psychiatry. My p-doc sees me once a week for an hour. For this he gets paid $115, including my copay. He could be seeing 4 patients in this time and getting 50-65 dollars per patient, but even med patients he sees for half-an-hour at a time. I recently stopped meeting with him weekly for therapy and he still sets aside an hour for monthly med visit, for which he gets $115. He is cautious about meds and urges me to get off after a year, see how I do without them, so I'm not dependent for life. He also urged me to see a DBT therapist, so I was not just depending on him for psycodynamic therapy. So there are good p-docs out there. Many of them. It's true, he is older and made his money to buy his big house and cottage on the cape when he was younger and insurance reimbursements were higher. But now he is satisfied and not greedy and wants to do the best by his patients.
Posted by jade k on July 13, 2010, at 22:32:43
In reply to Re: Progress of Psychiatry, posted by emmanuel98 on July 13, 2010, at 21:55:04
> I have to jump in and defend psychiatry.
Not to me.
>My p-doc sees me once a week for an hour. For this he gets paid $115, including my copay. He could be seeing 4 patients in this time and getting 50-65 dollars per patient, but even med patients he sees for half-an-hour at a time. I recently stopped meeting with him weekly for therapy and he still sets aside an hour for monthly med visit, for which he gets $115. He is cautious about meds and urges me to get off after a year, see how I do without them, so I'm not dependent for life. He also urged me to see a DBT therapist, so I was not just depending on him for psycodynamic therapy. So there are good p-docs out there. Many of them. It's true, he is older and made his money to buy his big house and cottage on the cape when he was younger and insurance reimbursements were higher. But now he is satisfied and not greedy and wants to do the best by his patients.
My pdoc is really good too. He had me bring in results of full lab work-up, along with pharmacy printed script history. He also had me provide a list of meds that "worked" (at all), and those that didn't. So I'm not gonna have to trial and error so much.
~Jade
Posted by Questionmark on July 14, 2010, at 1:13:40
In reply to Re: Progress of Psychiatr[ic Business?] » Questionmark, posted by linkadge on July 13, 2010, at 9:30:33
> I agree, psychiatry is a buisness. They have taken a big hit in the last few years (SSRI/placebo debate), and they're trying to reesablish themselves.
They've taken a big hit in terms of criticism possibly. But my guess would be that a higher percentage of the population are "consumers" of psychiatry now. In fact, there was that statistic that came out not long ago... Let me search it...
Ok from:
http://www.usatoday.com/news/health/2009-08-03-antidepressants_N.htm
"The number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall, a study shows."
So i guess i may *technically* be wrong, but essentially right-- depending on what specifically we mean by "psychiatry."
But yeah, so we are Americans our drugging ourselves more and more and more. And i'm sure many other "developed" countries' people are as well.
> For some people there is hope, for others there really is no hope. A lot of people are going to continue living their miserable quality of life until the day they die or commit suicide. I'd rather be told the truth, then to live in the unrealistic belief that a cure is just around the courner.Sadly, I completely agree.
Posted by Bob on July 14, 2010, at 2:36:33
In reply to Re: Progress of Psychiatry » SLS, posted by linkadge on July 13, 2010, at 9:21:49
> I'm not taking them a (lexapro/amitriptyline) anymore. They pretty much just make me numb and want to sleep all day.
>
>
> Linkadge
>
>Wow Linkadge, you dropped your meds just like that? I've been wanting to do that ever since I first touched a psych med 18 or so years ago, but have never been able to. So you're off of everything?
You mentioned in another post that you exercise almost every day. That's impressive too. I mean, most people who don't have depression don't even get around to that.
Your ability to exercise and be off meds is cause for some hope I would think? Heck, I can't manage either.
-Bob
Posted by SLS on July 14, 2010, at 5:24:58
In reply to Re: Progress of Psychiatry » linkadge, posted by Bob on July 14, 2010, at 2:36:33
> > I'm not taking them a (lexapro/amitriptyline) anymore. They pretty much just make me numb and want to sleep all day.
> Your ability to exercise and be off meds is cause for some hope I would think?Especially if remission were attained and maintained.
- Scott
Posted by Lou Pilder on July 14, 2010, at 18:27:04
In reply to Re: Progress of Psychiatr[ic Business?] » Questionmark, posted by linkadge on July 13, 2010, at 9:30:33
> I agree, psychiatry is a buisness. They have taken a big hit in the last few years (SSRI/placebo debate), and they're trying to reesablish themselves.
>
> For some people there is hope, for others there really is no hope. A lot of people are going to continue living their miserable quality of life until the day they die or commit suicide. I'd rather be told the truth, then to live in the unrealistic belief that a cure is just around the courner.
>
> Linkadge
>
> Linkadge,
You wrote,[...for others there is really no hope...I'd rather be told the truth...live in the xxx belief that a cure is just around the corner...].
I am unsure as to what you are wanting to mean here. If you could post answers to the following, then I could have the opportunity to respond accordingly.
A. Is it your opinion or fact as to who are the others that you are referring to that there is really no hope?
B. what is the hope that you are wanting to mean, if you know?
C. What criteria do you use to determine that, if there are criteria used?
D.What is the truth that you would rather be told, if it is known?
E. (redacted by respondent}
F. Why would, in your opinion, a belief that a cure is just around the corner be xxx?
G. Other replies not related to the above requests
Lou
>
>
>
Posted by violette on July 15, 2010, at 18:58:29
In reply to Re: Progress of Psychiatry » violette, posted by chujoe on July 13, 2010, at 12:09:56
Well I read the transcript 9, which is where the excerpt came from. Not too much new information there, but it was good to see 2 of the main researchers have bipolar and schitzophrenia.
One of the researchers stressed how significant psychodynamic therapy was to her progress and ability to lead a better life. It's promising to hear of researchers speak of those conclusions rather than promoting an assembly line of mental health patients treated according to some DSM code.
But I didn't have an overal positive feeling since that type of therapy is inaccessible to many people with mental illnesses. Those who need help the most, such as those unable to sustain employment-absolutely do not have access to that type of treatment. As others pointed out, and like other economic sectors, money has a large influence. Which is why how research funds are directed is so important.
Chujoe, in regard to your question: Is the history of psychiatry different in some fundamental way from the history of other branches of medicine?
Well, yes, because there's more subjectivity involved, i.e.-homosexuality was a 'mental illness' until (I think) the 80s. Also, because emotions are not tangible-you can't see or feel hopelessness. A doctor who never experienced depression may not be able to emphathize as a doctor treating any of the large number of conditions that involve pain. People seem to identify most with what they themselves can see and feel... I guess those are more obvious differences that may have contributed to the history of psychiatry.
This is the end of the thread.
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