Posted by Eric on March 29, 2001, at 11:27:47
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> I guess we have some fundamental differences of perspective.I very much think so Scott.
>I share your frustration and anger that medical science has not been able to adequately treat me.
No, you dont sound well to me to be honest.
>I am not happy with the relative lack of focus and use of available resources being allocated to mental illness. However, I still think your statements are not reflective of the state of psychiatry as it has existed over the last twenty-five years.
I do...I think psychiatry sucks the way it currently exists. Its too subjective.
> I find the word "joke" to be personally insulting.
Why would the term "joke" be personally insulting to you Scott? I wasnt directing the word towards you.
>I have been involved in psychiatric research in one way or another since 1982. I have served in the role of patient, research volunteer, and research assistant for two research psychopharmacologists.
Ive been in a research program for TRD myself Scott.
>I have been exposed to the evolution of psychobiology, my focus beginning from about 1978. I cannot agree with your contention that the volume of scientific and clinical inquiry into mental illness has been so small and insignificant relative to other illnesses.
Why Scott? Its true. The amount of research into trying to find out what causes severe forms of mental illness is very small compared to what goes on in other medical research areas. And I dont have to get citations to prove it either Scott.
> I can't help but to think that you may have overlooked quite a bit information or exposure to justify your conclusions.
I dont think so.
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> I like using Medline because it can use specific disease headings called MESH terms that select only those literature entries that are actually addressed as an object of consideration in the citation. In other words, it will exclude a citation that's only occurrence of any of the words [ "parkinson" or "parkinson's" or "parkinsons" ] in the following manner:
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> "I hate parkinson disease."
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> The following Medline searches will give you some idea as to how much attention is paid to either of only two psychiatric disorders: bipolar disorder and depression.Scott, I realize there is research going on for TRD. And Ive seen those Medline searches I know all about them. Most of the TRD research trials are redundant...same old crap. Just more augmentation trials, rTMS, VNS and some deal with ECT for TRD.
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> Medline search:
> "Parkinson Disease"[MESH]
> Results: 19095
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> Medline search:
> Search terms: ""bipolar disorder""[MESH] OR "Depressive Disorder"[MESH]
> Results: 46093
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> When we add schizophrenia to the search we find:
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> Medline Search:
> Search terms: "bipolar disorder"[MESH] OR "depressive disorder"[MESH] OR schizophrenia[MESH]
> Results: 83072
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> Are you still under the impression that such numbers are unimpressive?Yeah I am Scott.
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> I find your statement regarding a lack of a "sense of speeding things up" and the term "notoriously slow" to be hyperbole and doesn't represent well the extreme urgency that REALLY exists in the medical community to understand and treat mental illness. Not a single researcher that I have spoken to has been without this sense of urgency. These researchers include those who SPECIALIZE in researching and treating treatment-resistant cases. Their passionate commitment to helping people in pain is easy to see and difficult to ignore. Maybe I just meet the right people.Scott, most of this research that is being done is notoriously slow. You cant deny that. While some of the individual researchers who physically carry out the research might be highly motivated to expedite things, in reality things move very slowly. Most of this research has to get peer reviewed endlessly over years and years to be accepted. It takes new drugs and treatments years...decades even...to be approved by the FDA. These are the hard facts and nothing but the facts. Things move SLOW in medical research. With possibly one exception. AIDS drug research. And you know why that is? Because of incredible political pressure the AIDS community puts on our country's leadership. The AIDS community is politically active. They are organized. They see it as a war...as an objective to get destroyed. They arent here to piss around, their objective is to get applicable AIDS research completed so they can continue to stay alive and at least somewhat functional. The mentally ill by contrast are the opposite. They arent politically active, they arent organized. The mentally ill community is more like "who gives a shit?"
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> Lip service? I don't understand. What is lip service and who is giving it to whom?You know what lipservice is Scott.
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> > > > Sure, big headway has been made in the past fifteen years or so...
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> > > These two statements seem quite contradictory to me.
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> > > > ...but much is left to be desired.
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> > > I would say, "but much is left to do".
> > > Why? Whats wrong with saying much is left to be desired? Its true. Much IS left to be desired.
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> When I here the term "much left to be desired", I usually get the sense that it is being used pejoratively. It sort of makes me feel like the speaker is describing laziness or incompetence.Some of it is laziness and incompetence Scott.
>That is what I find wrong with saying that. Perhaps my impression of the phrase is not the same as yours. It just sounds too cynical to me. In general, I don't find cynicism to be terribly productive. Plus, cynicism increases one's risk of heart disease.
Well Scott, if there is a reason to be cynical then something must be wrong. Personally I think there are a lot of things wrong with psychiatry.
Maybe thats why I am cynical?>
> > > What precisely do you feel the medical research community is doing wrong?
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> > I feel the medical research community has other priorities besides mental illness research.
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> > In particular the treatment resistant community is not a priority.
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> I disagree.Well I will agree to disagree with you then. There are basically four options available to TRD. ECT, rTMS, VNS and various augmentation strategies. Two of these four are only research areas and thus not highly available. Furthermore, the only one that really works good is ECT and it has a ton of side effects. Its also extremely expensive. In other words, a lot of people dont want to get it for obvious reasons.
> What about, for example, the continued inquiry into postsynaptic events, including the control of gene expression and how this ultimately results in the modification of neurotransmitter receptors.
I am all for research into genetic engineering approaches for severe mental illness. Pile it on I say. However, I have also read that mental illness may be one of the last areas to get worked on by the genetic engineering people so...same old same old. Im sure heart disease will get more priority in the genetic research< sarcasm >.
> Lithium represents a good example of how such observations and understanding might lead to important breakthroughs in treatment. It is pretty tough, though. Lithium does so many different things. You should check it out. It might give you a better understanding as to why the "research is being done is notoriously slow."
I tried lithium and it didnt do shit for my depression. In fact it made my depression worse. I dont accept this reason you talk about as an excuse not to expedite biological psychiatry research in the quest for better treatments and diagnostic abilities.
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> O.K. What should we as interested parties do about it?Sue your Pdoc for malpractice and use the money to form your own psychiatry reform lobby< warped joke >.
No seriously, write your Congressman and Senators letters and Emails expressing your wishes. A million man march for mental illness in Washington DC wouldnt be a bad idea either. Getting someone into the Presidency who was highly sympathetic to the plight of the mentally ill and the many problems we face would be another good idea. Get political and form pro-mental illness patient special interest groups to lobby our legislators is something else that could be done.
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> I am not enough of a historian to know any better, but exactly when was mental illness ever formally a part of neurology? I do know that Freud started out as neurologists and early in his career offered biological explanations for some mental illness. But he did abandon this approach in favor of psychodynamic explanations.There have been a lot of people who have thought psychiatry really belonged to be a part of Neurology Scott. That is an old argument within psychiatry. Neurology is considered to be psychiatry's cousin. Even Dr. Mark George said that Scott. Its been said that Freud would have preferred that route, but the technology at that time just didnt allow it so the best Freud could do was to invent psychoanylasis and talk therapy. That was as high tech as it got back then...along with cocaine, opiates and ampetamines for depression.
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> I don't feel that mental illness has a place in neurology.Ahem, thats because you probably have very little imagination Scott. If a psychiatrist tells me that longstanding severe depression has caused "changes in my brain" Id like to know why its not being approached at least somewhat as a neurological condition?
>I do feel that neurology has a place in mental illness.
Well then why not just formally combine the two Scott? You just admitted it yourself. Psychiatry should be formally merged back into neurology and could be a subset area within neurology. Sounds like the most logical thing to do IF its really true that severe mental illnesses are in fact brain diseases. Just makes sense.
When I think of brain or CNS illness I think neurology. More and more we are being told depression is a brain disease. Duh...wakeup call.
Not all mental illnesses are circumscribed fully by biological aberrations.
WRONG. All severe forms of mental illness involve serious biological changes. By severe mental illness I primarily am talking about major depression, bipolar manic depression and paranoid schizophrenia and the psychotic disorders. Anxiety disorders are also included.
I agree that some forms of mental illness are mostly caused by the environment such as situational depression, dysthymia depression, milder anxiety disorders, etc. These sorts of problems can be fixed by non medical intervention such as talk therapy, counseling, cutting out alcohol, increasing exercise, solving personal problems, etc. Psychology can be applied here sometimes.
>Even the precipitation of bipolar disorder can be linked to chronic psychosocial stress.
Most serious forms of mental illness are activated by severe environmental stress Scott. But the bottom line is that once youve got it, youve got it and it doesnt go away usually without medical intervention. Hence if you want to improve the medical aspect of treatment of mental illness the idea of possibly merging psychiatry with neurology is a good one.
> It is often desirable to treat the psychological contributions that an individual displays to allow for the biological to be receptive to treatment somatic treatments.
Psychological is biological Scott. You aint nothing but a sack of chemicals Scott.Furthermore, trying to use psychological techniques to manage severe forms of mental illness is futile. You can go to all the talk therapy you want but it wont do diddly to fix that severe major depression you have.
>Regardless of what causes any mental aberration, it is still a MENTAL aberration. It is a mental illness.
No its not Scott. You have got to stop separating the mind and body. Your mental functioning is controlled by how well your brain functions. Your brain function is a PHYSICAL thing. It might sound hard and cold to say these things but its basically true if you are brutally honest about it. You aint nothing but a physical biological organism. Like it says in the Bible Scott, ashes to ashes, dust to dust. While here on planet Earth you are a PHYSICAL entity. We live in a MATERIAL world Scott.
Im being kind of sarcastic to you but I doubt you can detect that.
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> I don't have a problem with calling my condition a mental illness.Im not ashamed that I have this illness either.
> The reason is that *I* do not attach a stigma to the label.
Neither do I, but a lot of other people do. And a big part of the reason why that is is due to the fact most people(the lay public) does not think of severe mental illness in terms of "something is wrong with your brain." Its by and large thought of in psychological psycho-babble terms. Freud and all that crap.
>I know its nature. I find it appropriately descriptive and clinically justified. That is just the way I feel.
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> I am just curious. I don't know what condition you suffer from, but do *you* believe that you are mentally ill?Hell yeah I am mentally ill Scott! I have suffered from one of the most severe forms of major depression you can imagine. And yeah I have TR depression Scott.
> It is the field of psychiatry that specializes in the psychobiology of mental illness. It relies heavily on neuroscience.
Why is the diagnosing still based upon psychological models of mental illness Scott? Most of the psychiatrists Ive been to seemed to be all into psychology if you ask me, more than they were into the biology of it. With a handful of exceptions, my doctors have been that way.
>I think your definition of psychiatry may need updating.
I dont think so.
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> If you have any doubts about what condition you suffer from and who is best equipped to treat it, you may want to ask your G.P. to send you to a neurologist. There are such things as subsyndromal epilepsy that can produce depression and social anxiety.No, you misunderstand what I have been saying Scott. Neurology at this present time can not treat the mentally ill. Im saying that it should. I realize my views are radical Scott. I have been to a neurologist, but for other reasons than mental illness.
> At least they tried. I knew Mark George, MD., while he was first looking at rTMS while at the NIMH. Believe it or not, they haven't yet given up on it. I believe it has some utility, even if only to research and diagnose organic disorders.I know Dr. Mark George also. I was in the rTMS clinical trials you talk about at the Medical University of South Carolina. In fact, Dr. George personally administered some of my rTMS treatments. To be honest, I was more impressed by his research in the developing area of neuroimagry for mental illness than I was by rTMS. I found rTMS to work somewhat, but was hardly what I would call "powerful." The impression I got from Dr. George and his associates was that rTMS was kind of lukewarm of a treatment for TRD. They didnt seem enthused about it. It did help me some but trust me, the way rTMS currently is being used the results are mediocre and dont last very long.
Personally I dont think rTMS has much value unless it could be used in "rTMS convulsive therapy" which would be used to induce generalized seizures in TRD patients. A few rTMS researchers have begun investigating its use for convulsive therapy.
> At least they are trying it. Why bother testing something that you know in advance doesn't need to be tested. Again, Mark George seems to think it does. From what I have heard, it is showing some positive results. Of course, not for everyone.
Yes, VNS does seem to hold more promise than rTMS does. Time will tell. Remember several years ago they were saying the same kind of stuff about rTMS, that is was going to possibly replace ECT and was effective. It was the hippest, hottest experimental treatment around for TRD. Turned out to be hype. Its fast becoming obvious rTMS is not that powerful of a tool for TRD, certainly not as powerful as ECT. However I will give you that rTMS doesnt have any significant side effects. I personally found it to have NO side effects whatsoever. Possibly that is because rTMS doesnt really do very much to begin with however.
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> > And a few clinical trials here and there for treatment resistant people,
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> What? A few here and there?Yeah...not very many Scott. And like I told you before, most of them all revolve around three things. rTMS, VNS and augmentation strategies for antidepressants.
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> They are trying to find what works. God bless them.Its not enough Scott, nor is it research that gets to the root cause of many cases of TRD.
> At the very least, we can see that some drugs work for both conditions.
Yep. And why is that Scott? Is it possibly due to the fact that severe forms of mental illness are in fact BRAIN DISEASES?
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> It doesn't seem that your search parameters were adequate if your results were so skewed towards treatments of rTMS and VNS.Scott...trust me on this. If you do a search for TRD ANYWHERE, using ANY search engine including Medline, much of the results will be concerning rTMS or VNS. Its all the same old shit.
> In other words, you found sites that address just about every strategy to treat treatment-resistant cases. I don't understand your point regarding the inclusion or exclusion of existing strategies in the results of your search.
Most of the sites all are just variations on a theme Scott. Different authors and different people discussing the same shit...rTMS, VNS and augmentation strategies that give lukewarm results. Different research centers and different psychiatry departments at different teaching hospitals, but its all the same shit and none of it really works that great.
> Trust me. Novel approaches are being worked on. You just don't seem to know about them.
Yeah I do. I knew about VNS way before most others knew about it. I learned about long before there was a lot of publicity about it when I was down at MUSC in the rTMS trials. I know some research is being done in this area, Im just saying they need to do more of it and they need to HURRY THE FUCK UP!
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> For you.
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> I know Dr. George became very interested in VNS and is very optimistic as to its efficacy, but he has not abandoned rTMS. Perhaps he should, but he did recommend it to a friend of mine during a personal communication.They ended most of their rTMS trials down at MUSC Scott. Last I heard they only had one rTMS trial going on down there under Dr. George, some trial for older men. Dr. George has moved onto newer and better things. Mainly VNS...as well as his much beloved work on neuroimaging for mental illness that I personally feel is even more important than the research on rTMS and VNS for TRD. There is one other thing down there that is being worked on by George, something called "Deep Brain Stimulation." Where they insert a small wire into a part of your brain that is turned on to stimulate a part of your brain associated with severe depression. Whether it actually really works or not for TRD is another story. However, thats why they call it experimental.
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> For you, perhaps. Perhaps you should dive back into the augmentation pool.
>You may want to research it if you feel your case might otherwise benefit from mood-stabilizers, this includes lithium. Like it or not, there are probably many of existing medical strategies you have never considered that are potentially effective for you and demonstrably effective for others.
Ive been on most of the augmentation strategies Scott. Anti-convulsants make me worse. Ive already tried lithium augmentation. When I try a mood stabilizer I crash even more and my depression gets worse.
By the way Scott, just because I am cynical and argumentative does not mean I am bipolar.
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> In what ways is it not expeditious? Do you think it is a fiscal matter, an administrative matter, a unique lack of coordination or communication, a lack of competent researchers,... I don't know. I think that there are a lot of really smart people out there trying very hard to get you and me well. At least I like to think so.There are a few. But not that many. I dont believe the best brains in medicine are focused on mental illness. Thats my personal opinion...sorry. Most of the heavy duty research is in other branches of medicine. Furthermore, much of what research has been done in psychiatry is ultimately psychology based and is poor in quality.
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> There are problems with psychiatric research. Treatment-resistant depression, for example, has not been subject to large-scale clinical investigations.There have been VERY FEW real clinical trials for TRD Scott. Its a hard thing to study...thats a fact.
There are probably several reasons for this. Most of the TRD studies usually include no more than fifty participants. Eligible patients are not easily found within any one locale. Of course, this paucity of subjects can be seen as being a good thing. To my knowledge, there has not been a multi-center standardized program to investigate treatment resistant depression and bipolar disorder. This should be the next step. However, much can be gleaned by reviewing the results of the many small studies that already exist. Such reviews have produced consensuses among specialists for treatment strategies.
The only way TRD is going to get studied and fixed is for it to get priority. The only way thats ever going to happen is if its recognized by our country's leadership in Washington DC. It will also cost a lot of money. Way more money than is currently being spent on mental illness research.
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> You are probably right.I am right.
> Trust me. All of this stuff is being worked on with urgency.
It is now being worked on, but I dont know if I would say with urgency. I also dont agree that the volume of research is enough. I think more money needs to be allotted to study these problems.
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> I guess I have some homework to do in medical history, but I don't recall that psychiatry was ever within the purview of neurology.It never has been, but its an old argument thats been around since Freud or maybe before. Neurology vs. psychology. There has always been a small minority who have recognized the severity of some of these problems and realized that those who have truly severe and chronic mental illness have fucked up brains. Neuroimaging research done by guys like Dr. Mark George and Dr. Amen is beginning to confirm all these suspicions more and more every year. These guys can take a SPECT or PET or fMRI image of the brain of a severely depressed person off meds and compare it to the brain of a healthy person with no history of mental illness. It is blatantly obvious there are fundamental differences in physical functioning between the two. The same goes for those with other severe mental illnesses like bipolar manic depression and schizophrenia.
Dr. Mark George has said that "neurology is psychiatry's cousin" and I think he is 100% correct. I developed my ideas on this subject after having been hit by very severe major depression. It was so severe that it was impossible for me to deny something was physically wrong with me. And then after having several psychiatrists tell me that severe depression changes the brain, including one at Duke, it became pretty obvious to me.
I try to spread the word and try to make others realize that they need to quit thinking of mental illness purely in terms of psychology. And begin thinking of it in terms that there is really something medically wrong with them.
It pisses off a lot of people but I really dont care.
>I don't think it belongs there anyway. I think it is better that psychiatry draw eclectically from as many resources as medical science makes available - INCLUDING PSYCHOLOGY. Mental illness is not circumscribed by neural and endocrine phenomena. Not all mental illnesses are biological in nature.
Yes they are. All severe forms of mental illness(the big three) are fundamentally biological in nature. More than environmental or "psychological." They all involve physical changes in brain functioning. Sure, it usually takes environmental stress or "psychological" stress to activate these illnesses, but once youve got them youve got them and they are here to stay. They all are related to decreased brain functioning, that is the bottom line.
>I'm sure you know that aleady.
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> I know this may seem unpalatable to you, but you are mentally ill.Why would that seem unpalatable to me? I have known I was severely mentally ill for three years. Never been in denial of it. In fact, I will be the first to tell you that my illness has been more severe than many others who claim to have mental illness. I just think of mental illness in a different way than most, perhaps because I am more brutally honest than others are.
When I was so sick I couldnt sleep at all without drugs to knock me out I knew something was physically wrong with me. When I was severely losing my appetite and losing weight without trying I knew something was physically wrong. When I totally lost my sex drive and had severe "limp dick syndrome" it was pretty obvious to me something was physically wrong with me. And last but not least, when I developed severe cognitive problems as a result of my depression(concentration, memory, decisionmaking, etc) I knew I had a serious problem. When people began talking to me in psychological terms I was like "bullshit, fuck that, there is something seriously wrong with me in a medical or physical kind of way."
I hate psychology. I have long realized how stupid and subjective psychologically based psychiatry is for more severe forms of mental illness. I just think the scientists need to get on the stick and figure this thing out. And I believe these problems need to get more priority. It needs to be approached as a medical or neurological kind of problem. And not as a "behavioral" or psychological problem.
Eric
poster:Eric
thread:5334
URL: http://www.dr-bob.org/babble/social/20010324/msgs/5334.html