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Author Topic: Psychiatry as Astrology  (Read 1802 times)
Tetro Kornbluth
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« on: September 03, 2009, 07:31:08 pm »
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Diagnoses are psychiatry's star signs. Let's listen more and drug people less



Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."

Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses (disorders in which the patient experiences hallucinations or delusions, usually resulting in a diagnosis of schizophrenia or bipolar disorder) – have hardly changed since the Victorian period. Poor countries without well-resourced psychiatric services seem to do at least as well as the developed world. Therefore, although the perception is often different, there is little evidence that modern psychiatric services have had a global, positive impact on mental health.

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.

When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. Much, for instance, has been made of the discovery of a variant of the 5-HTTLPR gene, which appears to make people liable to depression if they are exposed to unpleasant life events. A recently published analysis of the data available on this gene found no evidence that it directly causes depression, or that it makes people vulnerable to depression. However, it was found that negative life events had a direct impact on mood: as our mothers could have told us, bad things tend to make us miserable.

This last observation is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.

Many studies have also reported an association between trauma in early life and psychosis. These effects are large: one recent study estimated that individuals who had been sexually abused in childhood were 12 times more likely than others to suffer from serious mental illness, and another calculated that the population-attributable risk of a diagnosis of schizophrenia associated with an inner-city childhood was 15% (that is, there would be 15% fewer cases if we all grew up in the countryside). The risk associated with having a parent with the diagnosis is 7% (ie, there would be 7% fewer cases if patients stopped having children).

These effects are understandable in the light of psychological research. For example, early trauma seems to disrupt the process by which we distinguish between our own thoughts and our perceptions, leading to a specific risk of hallucinations. Disruption of early relationships with caregivers, coupled with victimisation, create a tendency to mistrust others and to anticipate threats, leading to paranoid delusions.

The cruel and ineffective treatments that characterised psychiatry in the mid-20th century – for instance, prefrontal leucotomy and insulin coma therapy – would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. Biological investigations into psychosis currently outnumber those on environmental factors by at least five to one, and are much more generously funded by the UK's Medical Research Council. To date, about 30 trials of cognitive therapy for psychosis have been completed; by comparison, in the period 2001-3, nearly 400 drug trials were published in the five leading American psychiatric journals. There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.
« Last Edit: September 03, 2009, 07:35:12 pm by Ghyl Tarvoke »Logged



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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #1 on: September 03, 2009, 07:36:01 pm »
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He's from an FF university, that's for sure Grin
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Tetro Kornbluth
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« Reply #2 on: September 03, 2009, 07:36:19 pm »
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Let me just say that I, and for good reason, am very suspicious of any condition which is entirely a bunch of symptoms without any apparent cause.
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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #3 on: September 03, 2009, 07:38:29 pm »
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He's from an FF university, that's for sure Grin

Shhh... Quiet you. Wink
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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #4 on: September 03, 2009, 07:40:08 pm »
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On this note, has anyone ever read Thomas Szasz?
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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #5 on: September 03, 2009, 10:52:10 pm »
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#2 and #3, naturally.  What an absurd argument.  For example:

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When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).

Well, you could also say:

Quote
When new methods of molecular genetics have been used to study human height, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to human height, and that these effects are highly non-specific (the same genes are implicated in patients with different heights).

...and you'd be equally true!  Height is significantly heritable; about 55% of the variation in height within a certain population is due to genetics, which incidentally is lower than the heritability of weight.  It even falls in the realm of "clearly physical traits" (like hair and eye color), which most people don't have a problem with saying are the result of genetics.  Yet geneticists have had serious problems identifying specific genes that have anything to do with height.  The gene they've found that explains the most variance accounts for about 0.5% of the variation in human height, which, um, isn't very useful at all.  Yet no one goes on a long rant along the lines of "OMG HUMAN HEIGHT IS NOT HERITABLE OR BIOLOGICAL!!!"

As per usual with such articles the author frequently confuses correlation and causation, and confounding variables abound:

Migrants have at least a four times greater risk of psychosis than other groups,

People who migrate are not a random sample of the population, especially if they're forced to migrate.

Quote
and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis,

People who are separated from their parents early are not a random sample of the population, especially if the state took them away from their parents.

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as have growing up in an urban environment

Urban dwellers are not a random sample of the population.

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and chronic bullying.

Bullies don't pick kids to bully at random.

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Many studies have also reported an association between trauma in early life and psychosis. These effects are large: one recent study estimated that individuals who had been sexually abused in childhood were 12 times more likely than others to suffer from serious mental illness,

People whose parents sexually abuse them (or whose parents let people who sexually abuse them interact with them) are not a random sample of the population.

Quote
and another calculated that the population-attributable risk of a diagnosis of schizophrenia associated with an inner-city childhood was 15% (that is, there would be 15% fewer cases if we all grew up in the countryside).

Again, inner-city youths aren't a random sample of all youths.  And even despite this it's not like this proves that mental disorders are not biological or whatever; environmental toxicity can cause detrimental effects on the biology of people.

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These effects are understandable in the light of psychological research.

He seems to be conflating "psychological research" with "common sense and the public perception of psychological research".

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The cruel and ineffective treatments that characterised psychiatry in the mid-20th century – for instance, prefrontal leucotomy and insulin coma therapy – would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases.

HITLER SUPPORTED A NATIONAL HIGHWAY SYSTEM!!!  LETS BAN THEM ALL OMGZ!!!

(Or, to be more relevant: fascists and racists used biological theories of personality and such to justify their horrible agendas, but that doesn't implicitly mean I'm a fascist or a racist, just like how Stalin used social theories of personality and such to justify his horrible agenda doesn't implicitly mean you're a Stalinist.)

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Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.

That's because that's what psychiatrists are for... clinical psychologists are the ones that do the touchy-feely side.  Talk to either group and they'll tell you just the same.  This is because clinical psychologists aren't allowed to prescribe drugs, so there have to exist by necessity a group of MDs to help out with mental health by doing that prescribing.  If a mental health patient is not seeing both, that's a problem.

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Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.

Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. Biological investigations into psychosis currently outnumber those on environmental factors by at least five to one, and are much more generously funded by the UK's Medical Research Council. To date, about 30 trials of cognitive therapy for psychosis have been completed; by comparison, in the period 2001-3, nearly 400 drug trials were published in the five leading American psychiatric journals. There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

Well, he does have somewhat of a point here: more exploration of cognitive therapy would be very, very useful.  But it's also a lot harder to design and implement properly, especially because it's hard to have a good control group.

However, he neglects to mention that the drug trials find that people usually do do a lot better with drugs.  I do not disagree that cognitive therapy is useful, too; the best research consistently finds that a combination of prescription medications and therapy (especially cognitive-behavioral therapy, which is the best Grin) is the best way to go.  I mean, the studies that exist have even found that psychodynamic therapy helps patients with mental disorders improve, and if Freud can help people, well, anyone can.  His complaints at the beginning and end that mental health facilities and treatments are HORRID and DISGUSTING and are exactly as they were a hundred years ago are completely groundless. 

Oh, and one more comment, on this:

At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.

Obviously I'm sure DSM-bashing is in fashion as it has been for a while.  And with some truth to it; it's clearly flawed in some ways.  I agree that strict, black-and-white segmentation is kind of silly, and I'd be in favor of moving towards a restricted amount of qualification to diagnoses (so instead of saying yes/no to each symptom, one could rank people on a scale of 0 to 10, or some such).  But to argue that it's useless obscures the rationales behind having it in the first place:

  • It's used to help patients get the help they need, both psychiatric and psychological.  Insurance companies are wont to completely ignore the complaints of a patient who does not have a diagnosed disorder.  If no central authority exists by which people can say, "Yes, I have a problem according to this weighty tome, help me treat it!", insurance companies will not pay.
  • It's used to standardize disorder classification.  Obviously there are kinks in the system—some disorders (like schiziophrenia, as mentioned) have way too wide umbrellas for who can fall under a certain category.  But having a central authority by which people can refer to a certain set of symptoms that often appear together helps a lot in making sure patients can receive adequate treatment from more than one person.  Before the DSM, it seems like everything was just a "neurosis" and definitions of what constituted a "neurosis" varied wildly from mental health professional to mental health professional.  Now, though, if I say a patient has "frotteurism", Dr. Yamamoto in Honolulu and Dr. McFarthington in Portland, Maine will know exactly what I'm talking about and will know how to proceed in treatment of my patient should he decide to relocate to an exotic location.

This is a system that ought to be reformed, not scrapped entirely.
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« Reply #6 on: September 04, 2009, 01:00:10 pm »
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Psychiatry is a science. It did horrible mistakes in the past and can obviously be improved, but comparing it with astrology makes no sense.
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« Reply #7 on: September 04, 2009, 03:45:23 pm »
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I was hoping you would respond Verin.

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and you'd be equally true!  Height is significantly heritable; about 55% of the variation in height within a certain population is due to genetics, which incidentally is lower than the heritability of weight.  It even falls in the realm of "clearly physical traits" (like hair and eye color), which most people don't have a problem with saying are the result of genetics.  Yet geneticists have had serious problems identifying specific genes that have anything to do with height.  The gene they've found that explains the most variance accounts for about 0.5% of the variation in human height, which, um, isn't very useful at all.  Yet no one goes on a long rant along the lines of "OMG HUMAN HEIGHT IS NOT HERITABLE OR BIOLOGICAL!!!"

As per usual with such articles the author frequently confuses correlation and causation, and confounding variables abound:

Irrelevant. What he is basically saying is that there is no known causation for any available "mental illness" and that this is contrary to any widely perceived view that it is. He is also saying that no evidence has been shown to link genetics with any mental illness and those that say that there is were already going out of their way to find some.

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People who migrate are not a random sample of the population, especially if they're forced to migrate.

#1 How many forced migrants actually part of the total British population of migrants though? I can't imagine it is a huge percentage
#2 The migrant comment is a criticism of the genetic view of mental illness. Of course it isn't a random sample of the population. That's the point - their experience of migration or experiences associated with it (loneliness, for example) are causing the problem. Yet we blindly proscribe drugs for every god damn mental problem based on a flawed purely biological approach to human beings.

Unless of course you wish to argue that migrants are somehow genetically different or more predisposed to be mentally ill than native British people. But I don't think you want to go down that road.

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People who are separated from their parents early are not a random sample of the population, especially if the state took them away from their parents.

Again, It is not meant to be a random sample of the population. Your point is irrelevant. He is comparing Group A "People who were separated from their parents at an early age" to Group B "those that didn't" and Group A are far more likely to be "mentally ill". While I can't point to the study in question; how is that study not properly scientific?

And note none of this mentions Biology.

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Urban dwellers are not a random sample of the population.

See above.

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Bullies don't pick kids to bully at random.

Que? Relevance?

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People whose parents sexually abuse them (or whose parents let people who sexually abuse them interact with them) are not a random sample of the population.

Wallbang.

Quote
Again, inner-city youths aren't a random sample of all youths.  And even despite this it's not like this proves that mental disorders are not biological or whatever; environmental toxicity can cause detrimental effects on the biology of people.

Okay that last bit is certainly true. But don't you remember what you said about Correlation and Causation.

Quote
He seems to be conflating "psychological research" with "common sense and the public perception of psychological research".

No doubt. But so are you, just a different form of "common sense".

Quote
Well, he does have somewhat of a point here: more exploration of cognitive therapy would be very, very useful.  But it's also a lot harder to design and implement properly, especially because it's hard to have a good control group.

However, he neglects to mention that the drug trials find that people usually do do a lot better with drugs.  I do not disagree that cognitive therapy is useful, too; the best research consistently finds that a combination of prescription medications and therapy (especially cognitive-behavioral therapy, which is the best Grin) is the best way to go.  I mean, the studies that exist have even found that psychodynamic therapy helps patients with mental disorders improve, and if Freud can help people, well, anyone can.  His complaints at the beginning and end that mental health facilities and treatments are HORRID and DISGUSTING and are exactly as they were a hundred years ago are completely groundless.

Okay I agree that this is an exaggeration. But the point is here

Quote
Obviously I'm sure DSM-bashing is in fashion as it has been for a while.  And with some truth to it; it's clearly flawed in some ways.  I agree that strict, black-and-white segmentation is kind of silly, and I'd be in favor of moving towards a restricted amount of qualification to diagnoses (so instead of saying yes/no to each symptom, one could rank people on a scale of 0 to 10, or some such).  But to argue that it's useless obscures the rationales behind having it in the first place:

Great! Rating people on a completely arbirtrary numbering system!

Quote
It's used to help patients get the help they need, both psychiatric and psychological.  Insurance companies are wont to completely ignore the complaints of a patient who does not have a diagnosed disorder.  If no central authority exists by which people can say, "Yes, I have a problem according to this weighty tome, help me treat it!", insurance companies will not pay.

Okay this is a problem. But has nothing to do with scientific status of biological psychiatry. And everything to do with the perception of it by insurance firms (which gives lie to the view that the opinions of this author are "common sense").

Quote
It's used to standardize disorder classification.

Yes. Which just shows how "scientific" (read: not at all) these disorders actually are. Apparently there has been a several fold leap in Autism in the past 10-20 years - and new syndromes are being found all the time. But how many of these Autistics are diagnosed in a matter akin to a medical diagnosis - in cancer there are tumours, in Autism there is ??

Quote
Before the DSM, it seems like everything was just a "neurosis" and definitions of what constituted a "neurosis" varied wildly from mental health professional to mental health professional.  Now, though, if I say a patient has "frotteurism", Dr. Yamamoto in Honolulu and Dr. McFarthington in Portland, Maine will know exactly what I'm talking about and will know how to proceed in treatment of my patient should he decide to relocate to an exotic location.

Which of course tells us nothing at all about the accuracy of such a diagnosis

Stuff to read (just on schizophrenia for a start):

http://bjp.rcpsych.org/cgi/content/full/186/5/361
http://www.schizophrenia.com/sznews/archives/004467.html
http://www.amazon.com/Protest-Psychosis-Schizophrenia-Became-Disease/dp/0807085928 (This from a professor who came by my university one day and gave a talk on this very book. Fascinating. Unfortunetly I don't have it to hand.)

Btw I will note that I am not arguing that genetics play no role in serious mental illness, however we define it. Rather I am arguing and so is the author is that we should focus on people's actual subjectivity and conditions of life rather than just giving them drugs and trying to find what is 'wrong' with them and labelling them.
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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #8 on: September 04, 2009, 04:49:59 pm »
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Who cares what the disease is based on?

The drugs work. By refusing drug treatment for mental illness, you are advocating a return to the 1930s or earlier, where doctors tried to treat schizophrenia solely with therapy and of course failed at it and mental hospitals were full of patients.

Modern drugs allow at least some of these people to care for themselves and have at least a semi-normal life. You want to sacrifice the well-being and mental sanity of these people to satisfy your philosophical prejudices, and that is nothing short of immoral. I thought better of youç.
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« Reply #9 on: September 04, 2009, 05:09:43 pm »
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Who cares what the disease is based on?

So you are suggesting that we should give patients medication from things which may or may not exist? For conditions diagnosed and subscribed entirely by the somewhat arbitrary opinions of fashion among doctors? The history of medicine, especially psychology, is not particularly pretty when it comes to inserting socioculture prejudice into its theories. Freud is a classic case of this. How else can we explain the sudden rise of conditions like ADHD, Aspergers and the like? How real are they? Or are they labels to either genetic predispositions or products of enviornmental upbringing (delete according to prejudice).

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The drugs work

They do? At a sufficient level compared to drugs for other biomedical conditions? (And let's not forget, alot of drugs taken here in these cases are actually placebos).

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By refusing drug treatment for mental illness, you are advocating a return to the 1930s or earlier, where doctors tried to treat schizophrenia solely with therapy and of course failed at it and mental hospitals were full of patients.

Modern drugs allow at least some of these people to care for themselves and have at least a semi-normal life. You want to sacrifice the well-being and mental sanity of these people to satisfy your philosophical prejudices, and that is nothing short of immoral. I thought better of youç.

I'm not criticizing the drugs per se. I'm criticizing the attitude behind the drugs. I don't doubt that drugs can help people in certain circumstances but to suggest that biology without any reference to human social life. To make clear, I'm against biological reductionism - the simple fact is that we don't know what causes schizophrenia, bipolar, depression and all these other conditions. To say otherwise is a lie. We know that there is sort of hereditary component as Verin will no doubt explain. But emphasize just the drugs and the biology is morally indefensible imo.

Actually in certain cases drugs can make the condition worse rather than better you know.

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You want to sacrifice the well-being and mental sanity of these people to satisfy your philosophical prejudices, and that is nothing short of immoral. I thought better of youç.

Okay I admit that isn't entirely untrue (the philosophical prejudice bit anyway); but this is actually based on personal experience. Perhaps the title was a bit overblown. But hey attention.

I'm actually surprised you are against me on this. Given that you are the libertarian and have shown opposition to overly biological views of human beings in the past.
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Keith R Laws ‏@Keith_Laws  Feb 4
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« Reply #10 on: September 05, 2009, 09:56:35 am »
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Who cares what the disease is based on?

So you are suggesting that we should give patients medication from things which may or may not exist? For conditions diagnosed and subscribed entirely by the somewhat arbitrary opinions of fashion among doctors? The history of medicine, especially psychology, is not particularly pretty when it comes to inserting socioculture prejudice into its theories. Freud is a classic case of this. How else can we explain the sudden rise of conditions like ADHD, Aspergers and the like? How real are they? Or are they labels to either genetic predispositions or products of enviornmental upbringing (delete according to prejudice).
Freud's theory was unfalsifiable. These theories produce testable predictions. Dopamine antagonists work to treat schizophrenia, just like the dopamine hypothesis predicts. It doesn't matter whether scientific theories bear any relation to reality, only that their predictions bear testing.


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The drugs work

They do? At a sufficient level compared to drugs for other biomedical conditions? (And let's not forget, alot of drugs taken here in these cases are actually placebos).

What drugs are placebos? I have no idea what you're talking about.

And what do you mean "compared to drugs for other biomedical conditions"? That far from a uniform standard. What biomedical conditions? Cancer? Hypertension? Lupus?


Quote
By refusing drug treatment for mental illness, you are advocating a return to the 1930s or earlier, where doctors tried to treat schizophrenia solely with therapy and of course failed at it and mental hospitals were full of patients.

Modern drugs allow at least some of these people to care for themselves and have at least a semi-normal life. You want to sacrifice the well-being and mental sanity of these people to satisfy your philosophical prejudices, and that is nothing short of immoral. I thought better of youç.

I'm not criticizing the drugs per se. I'm criticizing the attitude behind the drugs. I don't doubt that drugs can help people in certain circumstances but to suggest that biology without any reference to human social life. To make clear, I'm against biological reductionism - the simple fact is that we don't know what causes schizophrenia, bipolar, depression and all these other conditions. To say otherwise is a lie. We know that there is sort of hereditary component as Verin will no doubt explain. But emphasize just the drugs and the biology is morally indefensible imo.

Actually in certain cases drugs can make the condition worse rather than better you know.

No psychiatrist will tell you the current state of science tells us what causes these disorders.

But we have randomized, placebo-controlled trials which show the drugs work. And we have the societal evidence of the emptying of psychiatric hospitals caused by the discovery of Thorazine in the 1950s.

On the other hand, what can you show? Has therapy alone ever successfully treated anyone from their schizophrenia, or bipolar disorder?
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You want to sacrifice the well-being and mental sanity of these people to satisfy your philosophical prejudices, and that is nothing short of immoral. I thought better of youç.

Okay I admit that isn't entirely untrue (the philosophical prejudice bit anyway); but this is actually based on personal experience. Perhaps the title was a bit overblown. But hey attention.

I'm actually surprised you are against me on this. Given that you are the libertarian and have shown opposition to overly biological views of human beings in the past.

I am a libertarian, but that only means I oppose the abuses within the psychiatric care system, which are only furthered by the sort of long-term hospitalizations that would result of an abandoning of psychiatric medication. Just because I support the civil liberties of mentally ill people, doesn't mean I want to throw the baby out with the bathwater.

Ditto with evolutionary psychology; just because I reject it doesn't mean I endorse sociological theories either.

And I have some mental health issues myself and I know drugs can help a lot.
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« Reply #11 on: September 08, 2009, 10:20:12 am »
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I was hoping you would respond Verin.

Of course you did, else you would've avoided "biological" and "genetic" Wink

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and you'd be equally true!  Height is significantly heritable; about 55% of the variation in height within a certain population is due to genetics, which incidentally is lower than the heritability of weight.  It even falls in the realm of "clearly physical traits" (like hair and eye color), which most people don't have a problem with saying are the result of genetics.  Yet geneticists have had serious problems identifying specific genes that have anything to do with height.  The gene they've found that explains the most variance accounts for about 0.5% of the variation in human height, which, um, isn't very useful at all.  Yet no one goes on a long rant along the lines of "OMG HUMAN HEIGHT IS NOT HERITABLE OR BIOLOGICAL!!!"

As per usual with such articles the author frequently confuses correlation and causation, and confounding variables abound:

Irrelevant. What he is basically saying is that there is no known causation for any available "mental illness" and that this is contrary to any widely perceived view that it is. He is also saying that no evidence has been shown to link genetics with any mental illness and those that say that there is were already going out of their way to find some.

...and my point was that there is plenty of evidence for heritability and that we haven't been very successful in finding specific genes for certain disorders isn't proof of that mental disorders are not inherited, just like that we haven't been very successful in finding specific genes for height isn't proof that height isn't inherited.

Here, have a link about heritability.

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{you wondering what the heck my point is with random sample}

If any of those criteria for "increased risk of mental disorder" were a random sample from the population, you might find it easier to try to point at causation.  But they're not.  There are confounding variables.

Let's take being bullied as a "risk factor", for example.  People who are bullied are not randomly chosen from the population.  They're associated with a few things (and, again, causation is nearly impossible to determine):

  • Low social status.
  • Fewer friends.
  • Being, in general, an "outlier".

I'm sure there are various other reasons.  These traits are, in turn, associated with some other things, like a poor self-concept and weak interpersonal skills.  This isn't to say that those who are bullied deserve it, or something, which would be absurd; I'm just saying that it's not like bullies go and pick on Candace, the popular school cheerleader.

Now, which way do you point causation?  The very traits that might predispose someone to be bullied (low social skills) are also associated with a lot of mental disorders.  If you have, say, autism, you're not going to do well at recognizing when to fight and when to flee, or how to bluff, or how to make friends so you're less of a target for bullies.  So perhaps autism->being bullied.  Or, as I would prefer, there is probably a third option, where a set of underlying traits causes predisposition to being bullied and to developing mental illness.  So someone with "pre-schizophrenic traits" (disconnection from reality, illusions, etc.) would be more likely to develop schizophrenia and to be bullied because of that disconnection from reality causing troubles.

Even more apparent is something like Down Syndrome, where there is a definite correlation between the two but it would be entirely laughable to say that being bullied leads to Down Syndrome.  I know you're not going that far, but I'm saying your contention that "if we do not know the precise mechanism of heritability it is not heritable" puts a false line in the sand.

Of course, who knows what way the correlation arrows are pointing... you sociologists don't like to figure that out, just repeat correlations over and over again Wink God, a sociology book I once glanced through told me I'm more likely to commit suicide because the fact I'm a Protestant means I want to worship alone, and therefore I will be more isolated and will want to kill myself.  Protestantism causes suicide Roll Eyes

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Again, inner-city youths aren't a random sample of all youths.  And even despite this it's not like this proves that mental disorders are not biological or whatever; environmental toxicity can cause detrimental effects on the biology of people.

Okay that last bit is certainly true. But don't you remember what you said about Correlation and Causation.

Yup, but we know the biological mechanisms behind, say, lead/mercury/carbon monoxide poisoning, and experiments have been conducted, so...

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Obviously I'm sure DSM-bashing is in fashion as it has been for a while.  And with some truth to it; it's clearly flawed in some ways.  I agree that strict, black-and-white segmentation is kind of silly, and I'd be in favor of moving towards a restricted amount of qualification to diagnoses (so instead of saying yes/no to each symptom, one could rank people on a scale of 0 to 10, or some such).  But to argue that it's useless obscures the rationales behind having it in the first place:

Great! Rating people on a completely arbirtrary numbering system!

Until you manage to address the two points I made in my first post, we will need a level of (admittedly, somewhat arbitrary) quantification in diagnoses.  Right now, you must essentially diagnose patients on a scale of 0 to 1 on a range of potential symptoms.  I'd think you'd prefer wide range of qualification over a simple yes/no.

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It's used to help patients get the help they need, both psychiatric and psychological.  Insurance companies are wont to completely ignore the complaints of a patient who does not have a diagnosed disorder.  If no central authority exists by which people can say, "Yes, I have a problem according to this weighty tome, help me treat it!", insurance companies will not pay.

Okay this is a problem. But has nothing to do with scientific status of biological psychiatry. And everything to do with the perception of it by insurance firms (which gives lie to the view that the opinions of this author are "common sense").

You don't need to think disorders are biological to want to systematize them, for a variety of reasons.  This point was more "you're throwing the baby out with the bathwater"; not only does the author throw out all biological explanations for mental illness, he also throws out a system of quantification that's useful for a lot of reasons.
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« Reply #12 on: September 08, 2009, 10:21:04 am »
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It's used to standardize disorder classification.

Yes. Which just shows how "scientific" (read: not at all) these disorders actually are. Apparently there has been a several fold leap in Autism in the past 10-20 years - and new syndromes are being found all the time.

Yes.  And so?

Allergies are virtually unheard of outside the developed world, and have experienced an extreme rise recently.  But arguing that allergies are "not biological" is simply incorrect: we know quite well that they're an autoimmune disorder.  Now, why they're more common recently is up for some debate.  Most allergists now think that it's because of modern hygiene.  We are sanitizing our environments too well.  Consequently, our immune systems get bored and start attacking, say, ragweed pollen and cat dander (in my case) or worse (hmm, schizophrenia is on that list under "suspected"... interesting!), because they're essentially bored.  It's like the allergies are hijacking a biological, genetic predisposition (allergies are quite heritable) to have an active immune system; what used to be very beneficial is now a hindrance.  Well, not entirely, because it's very, very rare that I ever become sick, but, eh.

To move to what I think is a closer approximate, how about obesity?  Obesity happens the world over, but there's no question it's a good deal more common recently, particularly in the developed world.  It also differs from culture to culture, subgroup to subgroup, for obvious differences in diet, social factors, etc.  Yet, within populations, it's highly heritable.  How could something so heritable be able to change so much over time?  Well, I'm sure you've heard what all the commentators are all saying; food, and food that's bad for you (but yummy and hard to resist), is so much more common today, that those who might have been born 100 years ago with a sweet tooth that was hard to satiate (or satiated with berries or not-so-bad-things) can now be born into a culture with $0.99 candy bars and cake for every occasion.  This doesn't mean it's not biological; it's hard to imagine a drive like hunger not being biological (though I'm sure you'd quibble over the specifics).

And now for conjecture: perhaps mental disorders behave similarly.  Someone with obsessive-compulsive disorder has very powerful frontal lobes (confirmed with fMRIs and whatnot).  Like, really-super-powerful.  This might've been great in another environment, where they had plenty of things to manage at once (the frontal lobes are implicated in coordination of tasks and higher order thinking and a lot of other things we associate with "humanness", by various semi-experimental setups, which I could go into if you want), but perhaps in the modern environment it becomes less than adaptive.  They have "too much" frontal lobe resources for modern life, and they respond by ordering things that don't at all need to be ordered, or performing rituals that aren't necessary.

I just kinda made that up, so don't judge psychology too harshly depending on how you think of it, but it was just my attempt to think of a mechanism whereby mental orders are both changeable and biological.

Another point would be that terms like "autism" are just ways to look at traits that have always been distressing but have never had a proper name for them.  Schizophrenia and depression exist the world over (at least, they're the ones I remember the most cross-cultural evidence for), but it's likely that many cultures don't have specific terms for them, just like I'm sure many don't, I don't know, link the different types of hepatitis or something.

(My personal pet theory for the rise of ADHD, btw, is that hyperactive people are just those who are biologically predisposed to less-obese builds burning off the extra calories gained from modern life.  But shh, that's just entirely random speculation!)

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But how many of these Autistics are diagnosed in a matter akin to a medical diagnosis - in cancer there are tumours, in Autism there is ??

Here's what the DSM says.  First you say that it's a problem that the DSM will allow for quantifiable diagnoses, then you ask for one... make up your mind Wink

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Before the DSM, it seems like everything was just a "neurosis" and definitions of what constituted a "neurosis" varied wildly from mental health professional to mental health professional.  Now, though, if I say a patient has "frotteurism", Dr. Yamamoto in Honolulu and Dr. McFarthington in Portland, Maine will know exactly what I'm talking about and will know how to proceed in treatment of my patient should he decide to relocate to an exotic location.

Which of course tells us nothing at all about the accuracy of such a diagnosis

Stuff to read (just on schizophrenia for a start):

http://bjp.rcpsych.org/cgi/content/full/186/5/361
http://www.schizophrenia.com/sznews/archives/004467.html
http://www.amazon.com/Protest-Psychosis-Schizophrenia-Became-Disease/dp/0807085928 (This from a professor who came by my university one day and gave a talk on this very book. Fascinating. Unfortunetly I don't have it to hand.)

Yes, more correlations.

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Btw I will note that I am not arguing that genetics play no role in serious mental illness, however we define it. Rather I am arguing and so is the author is that we should focus on people's actual subjectivity and conditions of life rather than just giving them drugs and trying to find what is 'wrong' with them and labelling them.

I'm not sure how labeling people to better treat them using drugs and cognitive therapy has a negative impact on people's conditions of life...
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« Reply #13 on: September 08, 2009, 04:33:14 pm »
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Thanks Verin and Bono, I will respond soon (just an original reply to Bono's post that was really long was eaten up to my horror by the computer). So think of this as a placeholder.

Just to add Verin I'm not claiming to know any causation just that there are certain things to be worried about. In the 1950s the majority of those diagnosed with Schizophrenia (in the United States) were white, now the vast majority are black. Don't you think this a problem?

Also, for the DSM on Autism, those are symptoms not actual signs of the condition. What's actually there is what I'm looking for.
« Last Edit: September 08, 2009, 04:36:04 pm by Ghyl Tarvoke »Logged



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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #14 on: September 08, 2009, 04:38:58 pm »
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Btw, I wish to point out I'm in no way trying to defend the worst aspects of sociology (or English Literature for that matter) teaching as done in many third level institutions in the United States.
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Keith R Laws ‏@Keith_Laws  Feb 4
As I have noted before 'paradigm shift' is an anagram of 'grasp dim faith'
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« Reply #15 on: September 08, 2009, 10:56:50 pm »
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Btw, I wish to point out I'm in no way trying to defend the worst aspects of sociology (or English Literature for that matter) teaching as done in many third level institutions in the United States.

Well, tough, because clearly you must wholeheartedly endorse the fact that I will inevitably commit suicide as a result of my Protestantism!  So there!

Incidentally, the sociology experience I discussed was in secondary education, not in tertiary; my high school required a class during the last year of high school that was a combination of economics and sociology.  You can imagine how much I loved that class.

Just to add Verin I'm not claiming to know any causation just that there are certain things to be worried about. In the 1950s the majority of those diagnosed with Schizophrenia (in the United States) were white, now the vast majority are black. Don't you think this a problem?

I'm not saying it isn't, just like I'm not saying that IQ differences between the races aren't.  Insofar as differences between the races are environmental (and there's pretty good evidence that racial differences in IQ are basically entirely environmental) we ought to address them.  I am a librul Wink

However, African-Americans have assorted themselves differently from how they did in the 1950's, as have whites.  Any time you're dealing with a time span of 50 years you have a lot of problems with confounding variables.
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