![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 46 to 70 of 70. Go back in thread:
Posted by alexandra_k on September 20, 2006, at 6:03:30
In reply to Re: the brain » alexandra_k, posted by Tomatheus on September 19, 2006, at 23:00:03
:-)
With mental illnesses what is problematic are behaviours (including verbal behaviours).
We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.
Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
> But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.
Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).One could try and interveane at one point...
Or one could try and interveane at as many places as possible...Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
But I still think that for a very long time yet...
If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
Posted by alexandra_k on September 20, 2006, at 6:04:43
In reply to Re: the brain, posted by SLS on September 19, 2006, at 5:20:00
> > 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
> Now that, I get.
> :-):-)
Posted by SLS on September 20, 2006, at 7:24:53
In reply to Re: the brain, posted by alexandra_k on September 20, 2006, at 6:03:30
> If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.
> And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present....Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology. Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain. Who would argue the biological underpinnings of the severe psychotic episode of bipolar disorder? Who could then deny that the paroxysmal switch into severe depression were not equally biological? Afterall, it is merely the antipodal phase of the same biological disorder. Is the depression of bipolar disorder, then, not biological? Is the depression of bipolar disorder the only depression that is biological?
I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
- Scott
Posted by Squiggles on September 20, 2006, at 8:16:05
In reply to Re: the brain » alexandra_k, posted by SLS on September 20, 2006, at 7:24:53
...
Who would argue the biological underpinnings of the severe psychotic episode of bipolar disorder? Who could then deny that the paroxysmal switch into severe depression were not equally biological? ....
Those who have not experienced these bizarre
emotional states, which resemble a physical
illness to the one going through them. Those
who have never had a stroke, never had a
concussion, never had meningitis, never really
had clinical depression, but only dysthimia and
some anxiety-- conditions which CAN be treated
with counselling and drugs, unlike the others, which MUST be treated with drugs. It's the old
"Woodly Allen" syndrome again, confused for
a more serious state of depression, which feels
very different.Squiggles
> - Scott
Posted by Tomatheus on September 20, 2006, at 12:33:05
In reply to Re: the brain, posted by alexandra_k on September 20, 2006, at 6:03:30
> :-)
:-)
> With mental illnesses what is problematic are behaviours (including verbal behaviours).
I would contend that dysfunctional feelings and emotions associated with mental illnesses are also problematic, especially from the perspective of those suffering from mental illnesses.
> We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
Not necessarily. It is not uncommon for people to infer that the origins of problematic behaviors are 100 percent environmental and 0 percent genetic.
At this point, it is impossible for a mental health professional (or anyone else, for that matter) to say with 100 percent certainty whether or not a given patient's illness is influenced (either in whole or in part) by a genetic abnormality and/or a physical injury that affects brain functioning. However, I do think that there is strong evidence in the peer-reviewed neurobiological literature to indicate that such abnormalities and injuries do play a causative role in the development of psychiatric illnesses -- at least in certain individuals. I would contend that illnesses characterized by high levels of severity and/or chronicity have a strong likelihood of having been caused (at least in part) by an inborn biological abnormality.
> Sometimes it isn't about an illness within the person, however, sometimes it can be an illness with society. For example, political dissentors in Russia used to be diagnosed with 'sluggish schizophrenia'. They were involountarily committed and drugged. There wasn't a problem within the individual so much as a problem with society. As another example, if you are living in poverty with substandard living conditions and you present with depression then there isn't a problem within the individual so much as a problem with the individuals greater social environment. There is still a tendency for society to think it better to drug such individuals rather than spending the money that goes to the pharmacutical industry on improving their living conditions.
I agree. Environmental factors have clearly been implicated in the development of mental illnesses. I do think that it's possible that the cause of a person's diagnosed psychiatric illness can be completely environmental. However, I don't think that it should be assumed that this is the case 100 percent of the time, as genetic causes have also been implicated in psychiatric illnesses.
> Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
I agree that this assumption is sometimes made, but I'm not so sure that it's made in a majority of cases. Of course, different mental health professionals make different assumptions. I think that one should always allow for the possibility that a person's mental illness could have both biological and environmental underpinnings.
> But there could be nothing wrong with the hardware, the malfunction could have to do with the level of software (psychology).
>
> As an example of the latter, mental mechanisms have evolved to function within a certain range of environmental conditions. When the environmental conditions are outside the range (if you are raised persistently told you are good for nothing, for example) then the problem can be the content of the information that is being processed rather than a problem with neuro-physiological malfunction.Good point. I agree.
> Drugging a person to deal with those conditions would be inappropriate. It would be a cover up strategy and would fail to deal with the cause of the problem.
True, but in cases where genetically mediated biochemical abnormalities do contribute to the underlying pathology of a mental illness (which have been confirmed in some individuals), I don't think that a psychopharmacological approach is a "cover up strategy." Of course, one could only guess to what extent any given drug might be reversing the effects of a possible biochemical abnormality. I certainly don't think it's ethical to tell those suffering from depression that there is no question that their illness is caused by a chemical imbalance and that a particular drug *will* correct that imbalance. But apparently, it's at least legal (though not necessarily ethical) to make such a claim in advertising.
> > But if the hard drive is malfunctioning, adding new software or removing potentially problematic software won't get to the root of the problem.
>
> That seems correct for the computer case. People are a little different, however. With people it seems that the only way you can change the software is to change the hardware. Does that mean that therapy is a waste of time? Not at all. Therapy works by effecting neuro-physiological changes in the hardware and there is evidence that therapy can lead to lasting neuro-physiological changes.I agree. The analogy is not a perfect one. However, I don't think that it should be assumed that therapy will lead to clinically relevant neuro-physiological changes in all individuals (I'm not saying that you're making this assumption; I just wanted to share my thoughts on the issue).
> Hence... The biopsychosocial model of mental illness. There are two motivations behind the biopsychosocial model (best I can figure).
> 1) Instead of assessing behaviour and prescribing medications clinicians need to take adequate assessments of the persons overall functioning in each of those areas. This is supposed to lead to a more humanistic / humane psychiatry.
> 2) Neuro-physiological, psychological, and social factors can be causes of mental illness. In fact it can be hard to seperate them out. The social facts are represented in the individuals psychology (if you are living in a crap environment and you move to a nice environment then depression can lift). Psychological facts are realised in the individuals neurobiology (changing the psychology is realised as a change in neurobiology). And of course what people have faith in on the meds board, changing neurobiology can lead to changes in psychology too (though not necessarily).
>
> One could try and interveane at one point...
> Or one could try and interveane at as many places as possible...
>
> Research has shown that a conjunction of medication and therapy works better than either one of those on their own. I don't know whether they have been able to compare with alterations in social environment (both individually and in conjunction) but if the biopsychosocial model is correct then it would seem likely that interventions targeted to all three would be more effective than interventions targeted at any one or combination of two.
>
> Of course it might be the case that the causal relationships that hold for individuals are different from the causal relationships that hold for models of kinds of illnesses...
>
> But I still think that for a very long time yet...
>
> If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
>
> And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.Agreed.
Tomatheus
Posted by zeugma on September 20, 2006, at 16:00:31
In reply to Re: the brain, posted by alexandra_k on September 19, 2006, at 5:04:17
hi alexandra
'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
whoever wrote this must have been a psychotherapist
those value-laden adjectives spoil the analogy for me
-z
Posted by alexandra_k on September 20, 2006, at 20:41:42
In reply to Re: the brain » alexandra_k, posted by SLS on September 20, 2006, at 7:24:53
> > If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
> ...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.People with anorexia don't have a lack of appetite they restrict their eating for other reasons.
- Rates of anorexia are highest where women have been most exposed to the western ideal of body weight. (Cross cultural prevalence)
- Rates of anorexia climb where cultures become more exposed to the western ideal of body weight (e.g., in Fiji, children of immigrants from Pakistan living in the UK)
> > And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
> ...Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology.But therapy and changes to society (environment) result in changes to the neural circuitry and intracellular machinery.
> Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain.
I disagree (see my last remark).
> I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
Indeed.
Hence inter-level interventions instead of a uni-level intervention.
Hence the biopsychosocial model instead of a biobiobio model.
Posted by alexandra_k on September 20, 2006, at 20:48:54
In reply to Re: the brain » SLS, posted by Squiggles on September 20, 2006, at 8:16:05
And do the drugs work?
Do the drugs fix the problem?No.
Maybe you think it is just a matter of time...
I think that the biobiobio approach is wrong headed because it fails to take account of the relationships between the different levels of explanation. Alterations to the environment result in alterations to biology, alterations to psychology result in alterations to biology.
If you show someone how to cook they learn to cook because your showing them resulted in alterations to their biology. If you tried to teach them how to cook by directly stimulating their brain... Well... What are the chances of our being able to do that anytime soon?
I'm not saying that the biological approach should be abandoned. I'm not saying that people should come off their meds. All I'm saying is that a biobiobio approach is simplistic compared to a biopsychosocial approach of intervention.
Shouldn't this be good news?
If your meds aren't working so well... If you are on an endless trail of trying to find the right med... If you are waiting for the right med to be invented... All is not lost. There are social / environmental and psychological interventions too and they might be able to do what the meds aren't able to do. Isn't that good news?
Posted by alexandra_k on September 20, 2006, at 21:06:30
In reply to Re: the brain » alexandra_k, posted by Tomatheus on September 20, 2006, at 12:33:05
> > With mental illnesses what is problematic are behaviours (including verbal behaviours).
> I would contend that dysfunctional feelings and emotions associated with mental illnesses are also problematic, especially from the perspective of those suffering from mental illnesses.What I mean by 'behaviour' is very liberal. How do we know that feelings are problematic? By observing emotional behaviours (including flushing, heat rate, jittering, flattened affect, rate and tone of speech, yelling, etc) and verbal behaviour (what the client / patient reports).
> > We then infer that there is a malfunction within the individual that is causing the problematic behaviours.
> Not necessarily. It is not uncommon for people to infer that the origins of problematic behaviors are 100 percent environmental and 0 percent genetic.Not in psychiatry. Psychiatry is dominated by the medical model which has been criticised for being a biobiobio approach instead of being a biopsychosocial approach. A pure social approach is more common amongst sociologists and anthropologists who focus on cross cultural variations.
> > Usually it is assumed that there is a malfunction on the level of hardware (neuro-physiology).
> I agree that this assumption is sometimes made, but I'm not so sure that it's made in a majority of cases.That is the medical / biological model of mental illness. Psychiatry is moving towards a biopsychosocial approach but it is unclear how the different elements can be integrated into a coherent theory that isn't just a muddle of factors...
> in cases where genetically mediated biochemical abnormalities do contribute to the underlying pathology of a mental illness (which have been confirmed in some individuals), I don't think that a psychopharmacological approach is a "cover up strategy."
It doesn't fix the gene... Does it?
What is the contribution of the gene at any rate?
There is a project... Dammit I can't remember what it is called... It is based on health statistics from Iceland. The most recent research shows that (I might get this a little wrong...) As far as a single gene being implicated in schizophrenia... Something like 15% of people with schizophrenia have it... And something like 7% of people without schizophrenia have it. With respect to structural alterations (enlarged ventricles and smaller structures in other areas) I think the stats come out the same. So things aren't looking so good with respect to the schizophrenia gene. Or with respect to finding neurophysiological changes that are predictive of schizophrenia (especially when a number of people with bi-polar may have similar structural abnormality). Maybe other genes moderate the expression of the schizophrenia gene... or maybe... Certain things like a virus in the third trimester, or certain kinds of environmental or psychological conditions are what differentiates between those who have schizophrenia and those who don't.Surely neuro-chemistry is really nothing over and above chemistry. And surely chemistry is nothing over and above physics. Maybe we just need to wait for microphysics to invent an electron gun that is safe to be used on brains...
Or maybe... A strictly biological approach is inappropriate as it seems that what is crucial is the interaction of biological psychological and social forces...
> However, I don't think that it should be assumed that therapy will lead to clinically relevant neuro-physiological changes in all individuals
Absolutely. I also don't think that it should be assumed that psychpharmacology will lead to clinically relevant neuro-physiological changes in all individuals, however.
That is my point.
Instead of limiting our interventions to one it is more likely intervention will succeed when it is targeted at multiple levels.
Posted by alexandra_k on September 20, 2006, at 21:08:08
In reply to Re: the brain » alexandra_k, posted by zeugma on September 20, 2006, at 16:00:31
((((z)))) i've missed you!
> 'Psychotherapy is none other than delicate psychosurgery and psychosurgery is none other than crude psychotherapy'
> whoever wrote this must have been a psychotherapist
He says in the preface that he wrote it while training to be a psychiatrist. I think he studied analytic philosophy first because he uses terminology appropriately in places ;-)
> those value-laden adjectives spoil the analogy for me
aw.
can you think of non value-laden replacements?
Posted by Squiggles on September 20, 2006, at 21:09:39
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 20, 2006, at 20:48:54
I may have lost the sequence of
replies here... if you (Alexandra_K)
are saying that clinical mental illness
can be reversed (under all conditions)
without meds, i personally have a
counter-example.And that is the serendipitous occasion
of being given counterfeit/corrupted/old/or/
low drugs of my usual dose. The return of
the illness was indisputable--surprised even
me, maybe even my doctor, who is not
dogmatic in these matters. I became well
again upon resumption of the correct dose.I think that was a kind of scientific proof
that they call "CHALLENGE, DECHALLENGE,
RECHALLENGE". I think it even meets Popper's
falsifiability criterion for test of
the truth of a statement.Squiggles
Posted by alexandra_k on September 20, 2006, at 22:18:25
In reply to the brain » alexandra_k, posted by Squiggles on September 20, 2006, at 21:09:39
> if you (Alexandra_K)
> are saying that clinical mental illness
> can be reversed (under all conditions)
> without meds, i personally have a
> counter-example.I never said that.
Your initial post was about how mental illnesses are biological hence should be treated by medication. I took you to be saying 'all' mental illnesses and 'only' medication and hence I offered counter-examples.What I did say (repeatedly, I thought) was that intervention target at one level was likely to be less effective than intervention targeted at multiple levels. Hence... The best plan of attack is the a multi-levelled one that attempts to interveane on biological, psychological, and social causes of mental illness.
> I became well
> again upon resumption of the correct dose.And so long as you stay on your meds you have a complete remission in symptoms?
Posted by SLS on September 20, 2006, at 22:46:26
In reply to Re: the brain » SLS, posted by alexandra_k on September 20, 2006, at 20:41:42
> > > If you want to teach someone to cook you are better off showing them how than trying to manipulate their brain directly...
> > ...Unless they aren't eating for lack of appetite or for kindled reinforcement of anorectic behavior.> People with anorexia don't have a lack of appetite they restrict their eating for other reasons.
You rushed your reading of me. There were two separate conditions depicted.
> - Rates of anorexia are highest where women have been most exposed to the western ideal of body weight. (Cross cultural prevalence)
> - Rates of anorexia climb where cultures become more exposed to the western ideal of body weight (e.g., in Fiji, children of immigrants from Pakistan living in the UK)I do not argue the cultural biases and psychosocial stresses that contribute to the onset of anorexia nervosa. I think much of the condition is driven by a desire to have control over some aspect of one's life, too. There's something else going on there, though. I am not well read on the topic, and I have not devoted much time thinking about it, but I think there might be an OCD type 5-HT/NE balance type thing going on or a reward-conditioning thing that's hard to break. I don't know.
I don't know why it has to be all one way or all the other. Polarized thinking is bound to be counterproductive when it comes to mental illnesses.
> > > And if you want to teach someone to manage anxiety / depression etc therapy does something that direct manipulation of their brain is unable to do at present.
> > ...Unless each of these occur as the result of the defects in neural circuitry and intracellular machinery now demonstrated with the aid of modern technology.
> But therapy and changes to society (environment) result in changes to the neural circuitry and intracellular machinery.YES!
> > Direct manipulation of the central nervous system is sometimes the only way in which to treat a particular mental illness; one that is a disorder of the brain.
> I disagree (see my last remark).They are not mutually exclusive. Again, polarized thinking. Think multidimensionally! Think both ways simultaneously.
"The brain determines the mind as the mind sculpts the brain."
> > I think it helps to remain open to recognize the wide array of human conditions that can produce similar behavioral outcomes.
> Indeed.
>
> Hence inter-level interventions instead of a uni-level intervention.
>
> Hence the biopsychosocial model instead of a biobiobio model.You don't seem to know me or my writing well enough. Stick around.
;-)
- Scott
Posted by Squiggles on September 21, 2006, at 7:34:42
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 20, 2006, at 22:18:25
> What I did say (repeatedly, I thought) was that intervention target at one level was likely to be less effective than intervention targeted at multiple levels. Hence... The best plan of attack is the a multi-levelled one that attempts to interveane on biological, psychological, and social causes of mental illness.OK - thank you for repeating your point.
"Multi-levelled", well, I don't know; it
sounds like a "crap shoot" if you will excuse
the phrase.>
> > I became well
> > again upon resumption of the correct dose.
>
> And so long as you stay on your meds you have a complete remission in symptoms?
>
>Yes. I was hoping that i had a chance at
being normal, in this accidental withdrawal.
The fact that i didn't proves that I am bipolar.Squiggles
Posted by SLS on September 21, 2006, at 7:43:21
In reply to Re: the brain » SLS, posted by alexandra_k on September 20, 2006, at 20:41:42
> They are not mutually exclusive. Again, polarized thinking. Think multidimensionally! Think both ways simultaneously.
Sorry, Alexandra.
This is condescending, I think.
The point I make is too important, though.
I don't think I can rephrase it much better, but:
"I think this represents polarized thinking. I think we need to think multidimensionally. It involves thinking both ways simultaneously."
- Scott
Posted by zeugma on September 21, 2006, at 8:23:40
In reply to Re: the brain » zeugma, posted by alexandra_k on September 20, 2006, at 21:08:08
(((alex)) mised ya too
> those value-laden adjectives spoil the analogy for meaw.
can you think of non value-laden replacements?well, first, I would like a broader definition of 'psychotherapy.'
I suppose 'psychotherapy' can be any intervention meant to promote psychological health. I suppose then that exercise, dietary regimes, etc., can be considered 'psychotherapeutic' if applied with the intention, specifically, of promoting this end.
Psychotherapy in the narrower sense is something I have a lot of problems with. An idea promulgated from therapist to patient, or attitude promulgated, can have far more toxic long-term effects than clumsy pharmaceutical interventions. I am convinced that excessive exposure to psychotherapy significantly worsened my conditions (which far predated psychotherapy, so I am not saying my illnesses are iatrogenic. Still, they were worsened, iatrogenically, and the doctors in this case were all psychotherapists). I don't believe that I can generalize from this, however.
As regards biobiobio vs. biophysicalsocial, social interventions can change a person's biology, but only if the disposition is there already. There is probably a 'top-down' vs. 'bottom-up' distinction. A social intervention makes use of 'top-down' mechanisms, but, (I am making use of an account of psychotherapy in Joseph LeDoux' "Synaptic Self") this is dependent on the integrity of the corticolimbic pathways (there's some biobabble). If those pathways are broken down, then (and LeDoux doesn't say this, but I am extrapolating from his account) maladaptive pressure is being applied to a particularly damaged circuit, which results in the functional, and possibly physical, equivalent of crude psychosurgery.
Psychotherapy, in the broad sense, appears to be one of those fields where 'delicate' and 'crude' are not distributed evenly. Gross physical or behavioral damage is easy enough to point to, but since the fundamental pathology of virtually all CNS disorders (or conversely, the mechanisms of its proper functioning) are mostly unknown, the only truly 'delicate' intervention is a placebo, because of the economy of means relative to behavioral effect.
I once posted the results of a head-to-head trial pf placebos, in which one was significantly better than the other. Maybe the more efficacious placebo qualifies as delicate psychosurgery.
-z
Posted by alexandra_k on September 21, 2006, at 18:41:16
In reply to Re: the brain » alexandra_k, posted by SLS on September 20, 2006, at 22:46:26
:-)
I'll try and remember to read the meds board...
:-)
Posted by alexandra_k on September 21, 2006, at 18:44:39
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 21, 2006, at 7:34:42
> thank you for repeating your point.
No problem.
> "Multi-levelled", well, I don't know; it
> sounds like a "crap shoot" if you will excuse
> the phrase.No problem. Psychiatry has been critiqued for giving lip service to the biopsychosocial model (which seems to the the politically correct thing to do) then continuing on their merry way with the biobiobio model in practice. And in theory too, I guess.
Why does it sound like a crap shoot to you?
Do you mean in your case of in the case of bipolar in general? Do you mean in your case or in the case of mental illness in general?
> Yes. I was hoping that i had a chance at
> being normal, in this accidental withdrawal.
> The fact that i didn't proves that I am bipolar.I don't understand how it proves you are bipolar. Bipolar is a name given to describe certain behaviours. That is all.
Posted by alexandra_k on September 21, 2006, at 18:46:03
In reply to Re: the brain - I apologize » alexandra_k, posted by SLS on September 21, 2006, at 7:43:21
> Sorry, Alexandra.
> This is condescending, I think.No problem. Thanks for the rephrase though. Some of what I said probably came across the same. Sorry about that. I'm sure we will get used to each other :-) It (typically) takes a great deal to bug me so its okay.
Posted by alexandra_k on September 21, 2006, at 18:54:24
In reply to Re: the brain » alexandra_k, posted by zeugma on September 21, 2006, at 8:23:40
> well, first, I would like a broader definition of 'psychotherapy.'
Do you mean with respect to the psycho in biopsychosocial? I was kinda (simplistically) thinking of three levels in a hierarcy like this
Social
Psychology
BiologySupervenience... What is at the psychology level... Oh sh*t... Probably folk psychology and psychoanalysis and cognitive psychology. Those three I guess. But then you have the learning / behavioural people and where do they go on the hierarchy? We can add Behaviour (as that which is observed and dx'd)... Oh sh*t... I don't know.
I guess when I was talking about therapy I was talking about CBT as the one that has been studied fairly extensively experimentally. But sure other varieties of therapy too... Whether group therapy counts as therapy... Whether art therapy and recreational and occupational and physio count as therapy... Massage... Oh sh*t I don't know.
Hard to draw a line between mental and physical eh.> Psychotherapy in the narrower sense is something I have a lot of problems with.
Because you had a reaction to a therapist or two?
Has that ever happended to you with a medication or two?Hrm... I haven't read Synaptic Self. I read something else of his, though... Can't remember what. Keep getting him mixed up with Damasio... Something on emotions at any rate...
Sorry z I have to go to work.
Today is Friday.
I'm going to check in tonight.
I'm NOT drinking tonight
I'm WORKING.
I have to come say I'm doing that...
Okay?
Posted by Squiggles on September 21, 2006, at 19:31:56
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 21, 2006, at 18:44:39
...........
> Why does it sound like a crap shoot to you?
>
> Do you mean in your case of in the case of bipolar in general? Do you mean in your case or in the case of mental illness in general?Crapshoot means "chancy", as in throwing the
dice and letting roll where it will. And that
is what I mean-- that covering many areas of
mental illness is a crapshoot-- it could be
the personal crisis, it could be the background of the person, it could be alienation or early separation, it could be syphillis, it could be a brain tumour, or it could be-- gasp-- mental illness.
>
> > Yes. I was hoping that i had a chance at
> > being normal, in this accidental withdrawal.
> > The fact that i didn't proves that I am bipolar.
>
> I don't understand how it proves you are bipolar. Bipolar is a name given to describe certain behaviours. That is all.Well, I had the same symptoms as those of 20 years ago when i was given lithium for severe mood swings, insomnia, psychomotor agitation, and depression and mania, and suicidal ideation.
Upon reinstating the proper lithium, those symptoms stopped. All them.
Therefore, when the lithium (the usual one; not the counterfeit or bad one) was removed, after some months manic-depression reared its ugly head. Upon taking the right lithium i recovered.
If that is not proof of bipolar disorder, then at least lithium worked for whatever those symptoms which they call "bipolar" were. Got any suggestions of what else it could have been?
This is a six-month trial-- not a long test, and a surprising one too-- i was actually analyzing the counterfeit powder to see how it was different. I knew it was different - i felt great at first, and then started sinking into those symptoms.
Certainly, my doctor has not disputed it.
Squiggles
>
>
Posted by alexandra_k on September 21, 2006, at 21:09:17
In reply to Re: the brain » alexandra_k, posted by Squiggles on September 21, 2006, at 19:31:56
> > Why does it sound like a crap shoot to you?
> Crapshoot means "chancy", as in throwing the
> dice and letting roll where it will.You think it is chancier to interveane on the biological, psychological, and social levels than it is to interveane on the biological level only? I don't understand how that could be so... Unless... You are concerned that giving more attention to the psychological and social levels will result in less attention being paid to the biological level...
Remember I'm not saying we should forget about / ignore the biological level. I'm saying we should appreciate that the other two levels are just as important. A multi-level approach instead of a uni-level approach.
> the personal crisis, it could be the background of the person, it could be alienation or early separation, it could be syphillis, it could be a brain tumour, or it could be-- gasp-- mental illness.
How are those other conditions not mental illness?
> Well, I had the same symptoms as those of 20 years ago
Whether you are approapriately dx'd with bi-polar or not depends on if you meet the list of behavioural symptoms for bi-polar or not. You display the symptoms therefore you are appropriately dx'd with bi-polar.
Lithium helps other conditions than bi-polar so it isn't a specific medication for bi-polar. What determines whether you have bi-polar or not is a function of what behaviours you exhibit.
> at least lithium worked for whatever those symptoms which they call "bipolar" were.
Yay. Successful intervention.
That is great :-)
But when intervention at one level isn't successful then maybe it is time to try an inter-level approach.
Posted by Dr. Bob on September 21, 2006, at 21:19:42
In reply to Re: the brain » Squiggles, posted by alexandra_k on September 21, 2006, at 21:09:17
> Remember I'm not saying we should forget about / ignore the biological level. I'm saying we should appreciate that the other two levels are just as important. A multi-level approach instead of a uni-level approach.
Sorry to interrupt, but I'd like follow-ups regarding the other levels to be redirected to the other boards. Thanks,
Bob
Posted by Dr. Bob on September 25, 2006, at 0:18:04
In reply to Redirect: the other two levels, posted by Dr. Bob on September 21, 2006, at 21:19:42
> I'd like follow-ups regarding the other levels to be redirected to the other boards.
I know there's not a board specifically for multi-level approaches. So let's consider it a "general" topic, and those go to Psycho-Babble Social. Here's a link:
http://www.dr-bob.org/babble/social/20060922/msgs/688931.html
Thanks,
Bob
Posted by Dr. Bob on October 1, 2006, at 23:19:41
In reply to Re: Redirect: multiple levels, posted by Dr. Bob on September 25, 2006, at 0:18:04
> I know there's not a board specifically for multi-level approaches.
And I'd like to redirect follow-ups regarding that to Psycho-Babble Administration. Here's a link:
http://www.dr-bob.org/babble/admin/20060918/msgs/688978.html
Thanks,
Bob
This is the end of the thread.
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