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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 70. This is the beginning of the thread.
Posted by Squiggles on September 16, 2006, at 15:37:54
I really wish that biological
psychiatry were more popular.
I find diagnosis by sociology and
Foucault et al, very frustrating; especially
when behaviour is so obviously linked
to medications or brain injuries.
When you think of this approach, it
indicates that mental illness IS a STIGMA;
Alzheimer's patients are far more likely
to get an MRI for example. But Alzheimer's
is not in the category of mental illness,
as it should be. Alzheimer's patients are
not analyzed for their childhood traumas,
for example.Just ranting, sorry.
Squiggles
Posted by TJO on September 16, 2006, at 16:42:51
In reply to the brain, posted by Squiggles on September 16, 2006, at 15:37:54
Hi Squiggy,
Rant at will :-). Some social workers at my day program don't beleive in biological psychiatry enough, so I do hear you!Tammy
Posted by bassman on September 16, 2006, at 18:42:42
In reply to Re: the brain, posted by TJO on September 16, 2006, at 16:42:51
If we'd all just go for a nice walk around the block, we wouldn't have any of these problems.
Posted by Squiggles on September 16, 2006, at 19:02:13
In reply to Re: the brain, posted by bassman on September 16, 2006, at 18:42:42
> If we'd all just go for a nice walk around the block, we wouldn't have any of these problems.
You know, Aristotle made his students walk
around the block until they got their arguments
right. The drill was called the peripatetic.
But their conclusion regarding the brain,
was that it was an air-conditioning system.Q.E.D. :-)
Squiggles
Posted by bassman on September 16, 2006, at 19:22:24
In reply to Re: the brain » bassman, posted by Squiggles on September 16, 2006, at 19:02:13
You do know I was kidding, right? :>} I rememeber the story about Aristotle. My dad had a similar story: he said the reason it was hot in the summertime was because people turned on AC units, which produce heat outdoors. His proof was that when everyone turned off the AC units, it got cold outside.
Posted by yxibow on September 16, 2006, at 19:35:38
In reply to the brain, posted by Squiggles on September 16, 2006, at 15:37:54
> I really wish that biological
> psychiatry were more popular.
> I find diagnosis by sociology and
> Foucault et al, very frustrating; especially
> when behaviour is so obviously linked
> to medications or brain injuries.
> When you think of this approach, it
> indicates that mental illness IS a STIGMA;
> Alzheimer's patients are far more likely
> to get an MRI for example. But Alzheimer's
> is not in the category of mental illness,
> as it should be. Alzheimer's patients are
> not analyzed for their childhood traumas,
> for example.
>
> Just ranting, sorry.
>
> Squiggles
>
Biological psychiatry is the current method of examining what are neurochemical disorders -- psychopharmacology.
But the mapping differs with Alzheimers than with disorders such as depression, GAD, bipolar, etc.
Alzheimers actually attacks portions of the brain enough to be visible and so does some degenerative forms of schizophreniform disorders. These can be seen on contrasted MRIs. Our current MRI technology is not able to see intraneuronal disturbances that cause typical depression, etc.
We can make guesses in studies with SPECT and PET imaging, which will show firing of parts of the brain, with contrast, ala Baxter et alia, regarding OCD. But these are expensive methods used for research purposes on primates and human subjects. And they are still not fine enough to show every condition.
So we make do with evidence based psychopharmacology and psychiatry. Evidence shows that compound X in trials reduces region activity in region Y due to transmitter Z, probably from PET scans with subjects. In turn, in use, doctors gather data (Stage IV, post-marketing) from use of medications and further this model.
May the 21st century allow novel diagnosis from below nanometer level resolution for individual patients. But even beyond that, humans have what is known as "free will." Even a psychotic patient has free will to react to their disorder.
Of course one could get into further discussions of the sociopolitic aspects of free will, and free countries, but that is beyond the scope of the medical concept of free will, which is that humans have the capacity for decision making, we are sapient.
This doesn't mean we aren't afflicted by biochemical crippling disorders, but free will would dictate that I, the patient, at times, can rise and reintegrate with society, knowing I have a biochemical problem which should be treated better by HMOs (that is an entire other discussion, caps on mental health are abominable in the US), but dealing with it as best as I can with my doctor and my own passion for life and its clear randomness.
Posted by Squiggles on September 16, 2006, at 19:44:58
In reply to Re: the brain, posted by bassman on September 16, 2006, at 19:22:24
> You do know I was kidding, right? :>} I rememeber the story about Aristotle. My dad had a similar story: he said the reason it was hot in the summertime was because people turned on AC units, which produce heat outdoors. His proof was that when everyone turned off the AC units, it got cold outside.
Hee. That may be a corollary to the
Aristotle's walkathons.Squiggles
Posted by Squiggles on September 16, 2006, at 20:00:02
In reply to Re: the brain » Squiggles, posted by yxibow on September 16, 2006, at 19:35:38
> Biological psychiatry is the current method of examining what are neurochemical disorders -- psychopharmacology.
>
>
> But the mapping differs with Alzheimers than with disorders such as depression, GAD, bipolar, etc.That's interesting - i suppose a category
of physical disorders, such as tumour,
lesions, vascular size, etc. are on the
larger scale - easier to pick up?>
>
> Alzheimers actually attacks portions of the brain enough to be visible and so does some degenerative forms of schizophreniform disorders. These can be seen on contrasted MRIs. Our current MRI technology is not able to see intraneuronal disturbances that cause typical depression, etc.Intraneuronal-- hmm, actions between neurons?
That would be the assumption; but it could
be arterial problems as well that cause depression;>
>
> We can make guesses in studies with SPECT and PET imaging, which will show firing of parts of the brain, with contrast, ala Baxter et alia, regarding OCD. But these are expensive methods used for research purposes on primates and human subjects. And they are still not fine enough to show every condition.OK. I was thinking of the "hot" areas that
Dr. Torrey for example shows in cases of
dementias -- maybe that is transient, e.g.
during a manic episode in the brain. Why
should the colour be different -- what is
going on? Something different than the normal
state, but what?
>
>
> So we make do with evidence based psychopharmacology and psychiatry. Evidence shows that compound X in trials reduces region activity in region Y due to transmitter Z, probably from PET scans with subjects. In turn, in use, doctors gather data (Stage IV, post-marketing) from use of medications and further this model.
>It is experimental and the drugs are not great
for the many. Still, it is a biological problem
that has to be solved, and what i was trying to
say was that it is much easier to control a mental
state through drugs, than through a study of the person's circumstances, depending on the degree and cause of course.
>
> May the 21st century allow novel diagnosis from below nanometer level resolution for individual patients. But even beyond that, humans have what is known as "free will." Even a psychotic patient has free will to react to their disorder.I would agree with you part way-- i think that
all animals have a will, but it is not always free. It can be shattered through depression, or
illness, or external constraints to turn it into
action, when it has a practical meaning.
>
>
> Of course one could get into further discussions of the sociopolitic aspects of free will, and free countries, but that is beyond the scope of the medical concept of free will, which is that humans have the capacity for decision making, we are sapient.
>Yeah, unless we suffer brain damage.
>
> This doesn't mean we aren't afflicted by biochemical crippling disorders, but free will would dictate that I, the patient, at times, can rise and reintegrate with society, knowing I have a biochemical problem which should be treated better by HMOs (that is an entire other discussion, caps on mental health are abominable in the US), but dealing with it as best as I can with my doctor and my own passion for life and its clear randomness.All men want to do what they want to do; but
they may be prevented by circumstances or
disability. What we call will, may as well
be what is life in an animal. What it is and
where it comes from, is a mystery to me.
We're getting into obscurities here.Squiggles
Posted by linkadge on September 16, 2006, at 20:30:27
In reply to Re: the brain » Squiggles, posted by yxibow on September 16, 2006, at 19:35:38
Many of the hypothesis that depression is *due* to a biochemical imbalance have been speculative. Antidepressants were discovered to have effect before their actions on monoamines were realized. The existence of medications that provide symptomatic relief of certain sympoms is not evidence of the origins of the underlying issues.
Despite how the knowledge of what antidepressants do, there exists no conclusive evidence that such dysfunctions are responsable for the illnes.
Like yxibow, I am not saying that such abnormalities don't exist, I am just saying there doesn't exist much solid proof of such theories.
Linkadge
Posted by linkadge on September 16, 2006, at 20:34:21
In reply to Re: the brain » yxibow, posted by Squiggles on September 16, 2006, at 20:00:02
We still have not proven that depression is due to biochemical imballance, and not that biochemical imballance is due to depression.
It is true that neurons may be firing more slowly etc, but is that the cause of the disorder or a consequence?
Linkadge
Posted by Squiggles on September 16, 2006, at 20:42:01
In reply to Re: the brain, posted by linkadge on September 16, 2006, at 20:34:21
> We still have not proven that depression is due to biochemical imballance, and not that biochemical imballance is due to depression.
>
> It is true that neurons may be firing more slowly etc, but is that the cause of the disorder or a consequence?
>
> Linkadge
"Biochemical imbalance" is a loaded term, almost
emotionally loaded, and hence a provocation to the
anti-psychiatry camp. What must exist is a change
between the chemical state of the brain under depression or mania or stupor or motor imbalance, etc. and the reversal of that due to drugs.Words are loaded weapons in psychiatry, but
facts are facts. Perhaps a different language
is needed.Squiggles
Posted by Phillipa on September 16, 2006, at 22:25:30
In reply to Re: the brain » linkadge, posted by Squiggles on September 16, 2006, at 20:42:01
I'm getting off the ad's for now as I can finally cry. Love Phillipa
Posted by willyee on September 16, 2006, at 23:08:53
In reply to Re: the brain, posted by linkadge on September 16, 2006, at 20:30:27
> Many of the hypothesis that depression is *due* to a biochemical imbalance have been speculative. Antidepressants were discovered to have effect before their actions on monoamines were realized. The existence of medications that provide symptomatic relief of certain sympoms is not evidence of the origins of the underlying issues.
>
> Despite how the knowledge of what antidepressants do, there exists no conclusive evidence that such dysfunctions are responsable for the illnes.
>
> Like yxibow, I am not saying that such abnormalities don't exist, I am just saying there doesn't exist much solid proof of such theories.
>
>
> LinkadgeHow can we have solid proof on something we are still at a stand still on understanding.
One could say we dont have solid proof on the latter either,that depression is a emotional disturbance that leads to a brai imbalance.
I agree and dont go for the whole "IMABLANCE CRAP" nor do i believe just about any of the drugs are "treating" anything.
They might however be possably masking,and in some cases masking as in tape just how to do.People have to live,and if a drug is needed to mask symptoms that normaly would keep people from doing these things.....work,family,social,etc.....then peoples decision to use them would i imagine be valid.
Going out,being more social,feeling simply OK,like myself,not feeling like my brain is on fire,etc,these are not options,they are goals,and its clear to me who is in my realm when people offer these as solutions,as if i never thought about opting not to go on the net,come here,and instead go out and party,these are the goals i want to reach,but forcing myself to do this and other things im only kidding myself,when i have short remission periods and do them,i feel content,but i loathe being forced to go "out more" and the like as if i never thought of these options.Im not gonna tell micheal j fox,hey stop shaking,i understand the man is having a malfunction causing this,and with the body suspect in every single area from toe up,i dont understand this stigma to where people dont feel the brain,the most used and complex part,can like the rest of the body,simply have various problems that can occur.
Even a jaquar can break down cant it?
Posted by linkadge on September 17, 2006, at 9:03:28
In reply to Re: the brain » linkadge, posted by Squiggles on September 16, 2006, at 20:42:01
Well what is fact? Cocaine can make a person happy, but that does not proove the existence of a cocaine deficiancy, or an imballance of any of the neurotransmitters that cocaine affects.
Linkadge
Posted by Squiggles on September 17, 2006, at 9:09:34
In reply to Re: the brain » Squiggles, posted by linkadge on September 17, 2006, at 9:03:28
> Well what is fact? Cocaine can make a person happy, but that does not proove the existence of a cocaine deficiancy, or an imballance of any of the neurotransmitters that cocaine affects.
>
> LinkadgeIn this context, if a person in a state of
suicidal depression is given drug X, and
the heavy mood of depression and despondence
lifts, and he/she feels at peace again, THEN
it is a fact that he was depressed before
drug X and not depressed after taking it.Squiggles
Posted by linkadge on September 17, 2006, at 9:19:47
In reply to Re: the brain, posted by willyee on September 16, 2006, at 23:08:53
I'm not saying that certain depression might not be due to a chemical imballance, but there is a bit of a difference between parkinsons and depression.
You don't see drug companies come on television to push their parkinsons drugs, cause they know that either you have it or you don't. With depression, a drug company knows that it can push an antidepressants on people who are depressed for normal reasons.
Nowadays everbody is on an antidepressant. There was an anonymous poll done on my psychology class which found that almost 1/2 of the class was on an antidepressat. Now do I believe that they all have genuine chemical imballances? No. I think that school can be tough, and that stess causes a lot of people to become very depressed.
Stress doesn't cause parkinsons, and you can't get parkinsons by loosing a loved one.
Thats not to say that some forms of depression don't have biochemical underpinnings, its just that there are too many factors to chalk it all up to "brain chemsitry"
Linkadge
Posted by bassman on September 17, 2006, at 9:58:50
In reply to Re: the brain » willyee, posted by linkadge on September 17, 2006, at 9:19:47
For my 2 cents, certainly there is such a thing as depression (if not, please tell me, so I can stop being depressed); and certainly some people respond to medication, for whatever reason. The real question is, "is the neurotransmitter theory correct', that is, are neurotransmitters primarily involved in anxiety and depression? The main problem is that no matter how much we find out about what happens to neurotransmitter levels during mental disturbance, we can't say that they are the cause-they could just co-exist with the "real" cause. Sort of like when people take TCA's; no one assumes that because their pulse rate goes up that having a faster heart rate is what is causing the person to be less depressed.
An interesting idea that I've seen is that in fact depression (at least "severe" depression, by which I mean a disturbance that causes someone to lose some important functionality) is actually an as yet undiscovered organic disease which has as its SYMPTOMS the manifestations we perceive when we are depressed, and refer to as “depression”. Who know if that is right, but it emphasizes the idea that we might be way off base with what causes depression.
BTW, I agree completely with the comment about as many as 50% of people taking AD's; I'm closer to retirement age than college age, but I've found that LOTS of people confide in me that they take AD's (I'm "out of the closet" on depression and anxiety because I facilitate an anxiety/depression support group-and so I’m viewed as safe, I think). Which leaves the question, “are lots of people taking AD’s that probably don’t need them; or, is there really an epidemic of sorts going on?” Fits nicely with the disease model, no?
Posted by Squiggles on September 17, 2006, at 10:16:22
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
When i look at articles on PubMed and
read books on the theories about causes
of mental illness, i am always impressed
by the variety of biochemical models
presented to explain what is going on.
The serotonin theory is one prevalent
today, but not the only one. Also, the
actual causes that lead to mental illness
are variable. Whether they all target the
same neurotransmitters, regardless of their
origin, or not, in order to make a person
depressed or happy, or forgetful, is
a difficult question. I think it is still
a huge field under investigation.But for practical purposes, what is important
to people now, is that they have something to
take to prevent them from becoming seriously
ill, as that can lead to suffering and tragedies
in their life and the life of others.So, as a layman, i can only appreciate
psychiatry and psychopharmacology from
an empirical point of view. The rest, you
really have to have a medical degree, and
a lot of insight and imagination. And yes,
i agree, the drug companies do not aspire
to scientific discovery as their ideal,
unfortunately.Squiggles
Posted by linkadge on September 17, 2006, at 10:18:41
In reply to Re: the brain » linkadge, posted by Squiggles on September 17, 2006, at 9:09:34
>In this context, if a person in a state of
>suicidal depression is given drug X, and
>the heavy mood of depression and despondence
>lifts, and he/she feels at peace again, THEN
>it is a fact that he was depressed before
>drug X and not depressed after taking it.But, that doens't say a whole lot about the validity of assumtpion that a biochemical imballance is the cause of depression and not a conseqence.
Lets say you've got your hand on a hot burner. An opiate might releive the pain, but you can't jump to the assumption that one now has an opiate deficiancy.
Linkadge
Posted by Squiggles on September 17, 2006, at 10:28:17
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 10:18:41
> >In this context, if a person in a state of
> >suicidal depression is given drug X, and
> >the heavy mood of depression and despondence
> >lifts, and he/she feels at peace again, THEN
> >it is a fact that he was depressed before
> >drug X and not depressed after taking it.
>
> But, that doens't say a whole lot about the validity of assumtpion that a biochemical imballance is the cause of depression and not a conseqence.
>
> Lets say you've got your hand on a hot burner. An opiate might releive the pain, but you can't jump to the assumption that one now has an opiate deficiancy.
>
> LinkadgeIt seems to me self-evident, that there MUST
be a biochemical change in the brain, in the
examples you give. To put it bluntly, if
you do not have a brain, then neither an opiate
nor a drug, nor a stimulus in the environment
will have an effect on consciousness and
behaviour.Squiggles
Posted by SLS on September 17, 2006, at 10:29:19
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
> or, is there really an epidemic of sorts going on?”
Is there more psychosocial stress in our society to precipitate affective disorders or is there just more recognition and announcement of them, even though their proportion remains stable? Remember, our population has increased over the years. Even if all else were to remain status quo, reported cases would increase.
- Scott
Posted by linkadge on September 17, 2006, at 10:34:25
In reply to Re: the brain, posted by bassman on September 17, 2006, at 9:58:50
I think its more that we've discovered a group of drugs that has a desired effect.
There is a lot of trust out there that these are safe drugs, and without potential long term consequence.
As such, they are used for lesser and lesser problems.
The fact that they have some sort of positive effect for so many people who take them, kind of detracts from the notion that they are some magic chemical entities desined to target the exact biochemical abnormalities that exist in endogenious depression. The fact is that drugs like prozac are used recreationally (sometimes). They're just pep pills.
Cocaine was used for depression 100 years ago, but was it fixing anything? Were people better off because of it? Did it get to the underlying issue?
I just don't think we're at the stage where we can say, depression is due to such and such biochemical imballance.Linkadge
Posted by SLS on September 17, 2006, at 10:39:53
In reply to Re: the brain, posted by SLS on September 17, 2006, at 10:29:19
Look at the severe psychotic mania of bipolar disorder. At this point in time, who would imagine that to be a psychological deviation rather than a biological one. Now, consider that depression is a phase of that same disorder. How can one then argue that at least some presentations of depression are not biological too.
Let that be the thought experiment of the day.
- Scott
Posted by bassman on September 17, 2006, at 10:53:02
In reply to Re: the brain, posted by linkadge on September 17, 2006, at 10:34:25
I agree completely-empirically, some drugs just help some symptoms. Does that mean we know the mechanism? No. Does it mean we should stop taking them? No. I like the comment about, e.g. SSRI's, being such very safe drugs that the benefit/risk ratio is pretty high even for sub-clinical depression, for example. If I feel lousy all day, drag myself through the day, but am generally functional, it really becomes an issue of "happiness" (whatever than means). If I now take 20 mg Prozac or whatever and life takes on a new brightness, it may well be worth it. So now I take the AD and increase the percentage of people that are taking AD's, but that doesn't mean that there are more depressed people-back to empiricism-the only thing we know for sure is more people are taking AD's. Thanks Scott and Linkadge, I always learn something by reading your posts!
Posted by TJO on September 17, 2006, at 11:02:38
In reply to Re: the brain, posted by SLS on September 17, 2006, at 10:39:53
Hi,
Well if it is NOT a biological illness, then WHY do antidepressants work (for some people)?? There must be something that is being corrected and I think the percentages are too high for it to just be the placebo effect.Tammy
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