![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
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...
> > >
> > > These two statements seem quite contradictory to me.
> > >
> > > > ...but much is left to be desired.
> > >
> > > 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
Posted by Eric on March 29, 2001, at 11:57:09
In reply to Re: New theories of mental disorders needed (longer), posted by Eric on March 29, 2001, at 11:27:47
Another thing Scott, when pharmaceutical companies develop new psychiatry medications in the drug pipeline they typically list these meds under "CNS pipeline." New antidepressants and anti-psychotics in the drug pipleline are not usually listed under a "psychiatric" category but a Central Nervous System category. Thus, at least the pharmaceutical companies are smart enough to realize major mental illnesses are basically CNS diseases.
Go to a pharmaceutical company website and look at drugs under development for whatever particular company you are looking at. You will see what I am talking about.
If major mental illnesses are heavily CNS diseases, why then not just formally merge psychiatry into neurology and be done with it? Oh boy that would make a lot of heads roll, hehehe.
Eric
Posted by JahL on March 29, 2001, at 19:27:14
In reply to Re: New theories of mental disorders needed (longer), posted by Eric on March 29, 2001, at 11:27:47
> >the technology at that time just didnt allow it so the best Freud could do was to invent psychoanylasis and talk therapy.
The same point I was making on another thread. Psychotherapists like to persuade patients that meds are just a 'band-aid' when in fact it's psychotherapy that's the stop gap measure, inadequately filling in (& confusing the picture) for meds that are yet to be developed.
> > Most serious forms of mental illness are activated by severe environmental stress . But the bottom line is that once youve got it, youve got it and it doesnt go away usually without medical intervention.
Exactly. Knowing how you crashed yr car won't help the mechanic fix it.
> >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.
Yup.
> > I hate psychology.
So do I.
J.
Posted by Eric on March 29, 2001, at 19:46:15
In reply to Re: theories of mental disorders » Eric, posted by JahL on March 29, 2001, at 19:27:14
> > >the technology at that time just didnt allow it so the best Freud could do was to invent psychoanylasis and talk therapy.
>
> The same point I was making on another thread. Psychotherapists like to persuade patients that meds are just a 'band-aid' when in fact it's psychotherapy that's the stop gap measure, inadequately filling in (& confusing the picture) for meds that are yet to be developed.
>
Yeah, most people have it the opposite when it comes to the subject of severe mental illness. The meds are the foundation of your recovery, both short term and long term. Talk therapy is just for stress relief, introspection(which some of us need less of to be honest about it) and therapy does little to actually get rid of the illness.The meds are the meat and potatoes of any good recovery plan. Talk therapy is the dessert.
Eric
Posted by Todd on March 30, 2001, at 0:22:30
In reply to Re: theories of mental disorders » Eric, posted by JahL on March 29, 2001, at 19:27:14
> The same point I was making on another thread. >Psychotherapists like to persuade patients that >meds are just a 'band-aid' when in fact it's >psychotherapy that's the stop gap measure, >inadequately filling in (& confusing the >picture) for meds that are yet to be developed.
Psychotherapy a stop-gap measure? Inadequately filling in for meds that are yet to be developed? In my honest opinion, and very respectfully submitted, Jah, you've obviously been seeing the wrong psychotherapists. I very firmly believe that meds are only a tool to be used in the healing process. If you feel that one day a pharmaceutical is going to heal you, I think that you're denying yourself your own personal power to be firmly engaged in your own healing process. Life is fraught with pain. No pill is ever going to take that away. Learning to live with it lovingly without being afraid is my holy grail. You call yourself Jah. I am friends with quite a few Jamaicans, and they have a saying I love to use. Jah provide, mon! Jah lives in you and surrounds you. I and I will see you through. You know what I'm talking about. Peace and love.
Todd
Posted by Dubya on March 30, 2001, at 0:40:12
In reply to Re: theories of mental disorders , posted by Eric on March 29, 2001, at 19:46:15
I mean, we can see and READILY ADMIT that DOGS can HAVE SEPARATION ANXIETY and this seems acceptable by us. However, people being 'mentally ill', no way, that can't be possible, can it? We must realize as SOON AS POSSIBLE, the effects of such an illness which can lower our self-worth/esteem, cause us to feel down, cause us to commit suicide or harm ourselves and even cause us to break relationships. Our brain has 3 chemical transmitters which come to mind; serotonin, dopamine, and neurotonin. these must be in balance otherwise, we are 'screwed' over. medicines (I hope) will do the job to adjust or account for low levels of these chemicals. CBT in my view, can only complement meds, it can't replace it. THus, we must find out AS SOON as POSSIBLE when THESE CHEMICALs are out of WHACK.
Posted by stjames on March 30, 2001, at 1:01:58
In reply to Meds are only a TOOL » JahL, posted by Todd on March 30, 2001, at 0:22:30
I very firmly believe that meds are only a tool to be used in the healing process. If you feel that one day a pharmaceutical is going to heal you, I think that you're denying yourself your own personal power to be firmly engaged in your own healing process. Life is fraught with pain. No pill is ever going to take that away.
James here....
Psycothearpy never helped my depression but it did help with other things. At least in me depression is a medical condition and the right
AD's make me normal. Almost total remission. All the psycothearpy in the world cannot fix a medical condition. That is not to say that all depressions are medical conditions, but mine is.Also, it seems that no one has any trouble understanding that BP, OCD, ect are medical conditions. For some depression is the same.
James
Posted by Eric on March 30, 2001, at 12:02:10
In reply to Meds are only a TOOL » JahL, posted by Todd on March 30, 2001, at 0:22:30
>Life is fraught with pain. No pill is ever going to take that away. Learning to live with it lovingly without being afraid is my holy grail.
You dont know what you are talking about. We are specifically discussing severe forms of mental illness...major depression, bipolar manic depression, paranoid schizophrenia, severe OCD, etc. We are not talking about situational depression here or even dysthymia. Im not talking about the kind of "pain" life is normally fraught with if you are healthy and free of mental illness.Obviously you have never been severely mentally ill before or you are in denial of your problems. For severe forms of mental illness meds are not a "crutch" they are the foundation of recovery.
Got a severe form of mental illness? Without meds you are screwed and up the river...most likely you will end up disabled.
Eric
Posted by Eric on March 30, 2001, at 12:07:40
In reply to Re: Meds are only a TOOL, posted by stjames on March 30, 2001, at 1:01:58
>That is not to say that all depressions are medical conditions, but mine is.
Any severe form of depression in which basic bodily functions deteriorate IS a medical condition! If the depression has gone beyond just emotions and feelings and has begun seriously destroying sleeping, eating and sex drive cycles you DO have a serious medical condition. For some major depressives cognition is severely destroyed, this is further evidence it is a medical condition.
Real chemical imbalance depression problems go way way WAY beyond just sadness and suicidal thoughts and impulses. Real depression destroys your overall health. I dont know how anybody can deny that is a serious medical problem.
I aint talking about dysthymia and situational depressions here on this message board.
Eric
Posted by adams on March 30, 2001, at 13:15:31
In reply to Re: Meds are only a TOOL, posted by Eric on March 30, 2001, at 12:07:40
I never got anything from talk-therapy, I think some people clearly have some chemical problem in there brain or body that is affecting the brain. I think its possible sometimes to adjust your entire perspective on life to deal with depression, if the person has been depressed for a very long time they might get used to it, eventually you forget what real life is like, and someone might think they are ok then because they found jesus or whatever, but you still never really cure the chemical problem, if I am really going to get better I think it will be because of drugs. Well thats the way I see things, if anyone cares.
Posted by Eric on March 30, 2001, at 13:25:22
In reply to Re: Meds are only a TOOL, posted by adams on March 30, 2001, at 13:15:31
> I never got anything from talk-therapy, I think some people clearly have some chemical problem in there brain or body that is affecting the brain. I think its possible sometimes to adjust your entire perspective on life to deal with depression, if the person has been depressed for a very long time they might get used to it, eventually you forget what real life is like, and someone might think they are ok then because they found jesus or whatever, but you still never really cure the chemical problem, if I am really going to get better I think it will be because of drugs. Well thats the way I see things, if anyone cares.
I agree with you.Eric
Posted by SLS on March 30, 2001, at 13:53:34
In reply to Re: New theories of mental disorders needed (longer), posted by Eric on March 29, 2001, at 11:27:47
Dear Eric,
I guess I am left with but a question and a few comments.
> >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.Thanks. I wasn't sure there for a moment.
I could really use some feedback here. Please. What exactly is it about me that doesn't sound so well to be honest? Please don't be bashful about being perfectly so.
I guess what I need to know is if the ways in which I don't sound well to you have impacted so heavily on my judgment and perspective along this thread as to make questionable my contributions to it.
Perhaps I am too defensive...
> > 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.
It doesn't really matter who you directed it toward. It targeted a whole lot of people, including me. Your statement necessarily makes me a part of the joke. At the moment, I find it difficult to express how empty I find your statement. I hope I didn't spend a few hours a day in the Rutgers medical school library for five years, sharing the results of my literature reviews with investigative physicians, just to aid in the synthesis of a joke. You are telling me that I vehemently believe in a joke.
In my opinion, anyone who comes to the conclusion that the research being conducted in biological psychiatry is a joke doesn't have a clue. Not a clue. This was not directed toward you personally.
I think there is often a lack of appreciation for which organ is being researched so intensely. It is the most complex object in the world. The brain is being studied feverishly. Tons of data are being produced from every yet conceived direction. Neuroscience. Tons. What is painfully slow for everyone is the process of putting this data together to produce what we call understanding. Neuroscience is fully cognizant of how much greater its resolution needs to be. The technology necessary to resolve the detail of intracellular structures and mechanisms is one of the most limiting factors. Even the measurement of macroscopic phenomena is extraordinarily difficult to accomplish, with different experiments conducted on the same function yielding conflicting results.
I guess the brain is the most notoriously difficult organ in the human body to understand.
Let's give neuroscience the credit it deserves. Let's give it the appreciation for the difficult task it has set out to accomplish. If anyone would like to determine for themselves whether or not research in the areas of neuroscience and psychiatry is a joke, I recommend going to a medical school library and pulling out some of the journals from the shelves. If you don't have access to such a library, the federal government has established an online compendium of citations and abstracts of all of the articles to be found in those medical journals dating back to 1966. Read them. I doubt too many people will come back thinking that our research has been a joke. This database is administered by the National Library of Medicine, and is known as Medline. It is free to the public. Enjoy.
I hope my previous post did not give people the impression that most of the cases of mental illness appearing on this board are anything other than psychobiological, for which somatic treatment is necessary and sufficient. I also hope that people retain the impression that not all mental illnesses are of biological origin, nor even perpetuated by systemic dysregulation. I hope the impression resides in each of us that for many people, the biological and the psychological are inextricably linked dynamically, and that the best chance for someone with a biological depression to remain biologically well is to address adequately the psychological that is not. Continued psychosocial stress, whether coming from an internal milieu of depressive or other maladaptive psychology, or an external milieu of depressive or other dysfunctional influences, must be addressed to reduce the risk of medication breakthrough and relapse.
Why the term mental illness?
Because these illnesses manifest as changes in mental state or function, and are idiopathic rather than secondary to another condition.
Oh no, I've said too much. I haven't said enough.
One of the most striking biological markers of depression is an increase in REM.
Dumb, I know.
- Scott
Posted by coral on March 30, 2001, at 15:05:31
In reply to Re: New theories of mental disorders needed (longer), posted by SLS on March 30, 2001, at 13:53:34
Maybe my case is very different because one of the major markers for the severe clinical depression I experienced was the lack of dreaming or REM sleep.
Posted by Dubya on March 30, 2001, at 15:40:46
In reply to Re: Meds are only a TOOL, posted by Eric on March 30, 2001, at 12:02:10
Over 15yrs of suffering for me from OCD, panic attacks, anxiety, etc. I mean, if meds don't work, I'd um, give up on myself if u know what I mean. I almost pray that meds can work, even if I go bald or whatever else that could go wrong, I really want to be happy and not feel or act like an idiot. Oh yeah, I am tired of not being able to stick up for myself because of being intimidated and, I am at the point where, when I have a bad day, I can start to cry. Sad isn't it.
Posted by JahL on March 30, 2001, at 17:14:49
In reply to Re: Meds are only a TOOL, posted by adams on March 30, 2001, at 13:15:31
> I never got anything from talk-therapy, I think some people clearly have some chemical problem in there brain or body that is affecting the brain. I think its possible sometimes to adjust your entire perspective on life to deal with depression, if the person has been depressed for a very long time they might get used to it, eventually you forget what real life is like, and someone might think they are ok then because they found jesus or whatever, but you still never really cure the chemical problem,.
YES, YES, YES!!!
Psychotherapy persuades people to accept an inferior state of living; to accept that you are doomed to a joyless life of melancholia & missed experiences.
I, like any sane individual am intent on doing whatever it takes to get some semblance of a life going; this involves swallowing meds.
Thanks adams.
J.
Posted by judy1 on March 30, 2001, at 17:23:50
In reply to Re: New theories of mental disorders needed (longer), posted by SLS on March 30, 2001, at 13:53:34
>I also hope that people retain the impression that not all mental illnesses are of biological origin, nor even perpetuated by systemic dysregulation. I hope the impression resides in each of us that for many people, the biological and the psychological are inextricably linked dynamically, and that the best chance for someone with a biological depression to remain biologically well is to address adequately the psychological that is not. Continued psychosocial stress, whether coming from an internal milieu of depressive or other maladaptive psychology, or an external milieu of depressive or other dysfunctional influences, must be addressed to reduce the risk of medication breakthrough and relapse.
I wish I could have expressed myself nearly as well as you by writing this statement, you know my history Scott- and I fervently agree with this statement. I, too, was hurt by the insinuation of Eric that the years I have spent in research along with many of my peers was a joke? Maybe I got lost somewhere along this thread, I know my cognitive abilities are down, but at no point did I get that impression from your posts. Just my thoughts for what it's worth. Take care- judy
Posted by Eric on March 30, 2001, at 17:41:10
In reply to Re: New theories of mental disorders needed (longer) » SLS, posted by judy1 on March 30, 2001, at 17:23:50
> > I, too, was hurt by the insinuation of Eric that the years I have spent in research along with many of my peers was a joke? Maybe I got lost somewhere along this thread, I know my cognitive abilities are down, but at no point did I get that impression from your posts. Just my thoughts for what it's worth. Take care- judy
Judy...I was not insinuating that anybody on this board was a joke. Im just trying to educate people is all. I can be sarcastic in the way I write but its only the way I talk. Im not specifically coming down on anyone on here. I dont understand why you thought I was specifically talking about you? I too have been in a research program for TRD and I learned a lot. But I did learn that much is to be desired when it comes to real research into TRD and mental illness in general. Thats why I called it a joke.
I called it a joke because number one I dont feel there is enough of biological psychiatry research and number two I dont feel it is speedy enough. People are dying because of these problems, many are also disabled due to TRD. Its a drain on the national economy and on Social Security Disability. SS disability doesnt have enough money to pay out disability to all the TRD patients. Do you know how hard it is to get SS Disability for TRD?
I called it a joke also because I honestly believe there is not priority in this country towards the severely mentally ill. I truly feel this way. No priority=lipservice. Lipservice=JOKE.
Just look at the health insurance laws concerning mental health. Insurance has totally different rules and regulations concerning the mentally ill vs. "physical" illnesses which are "real." I gotta tell ya, severe mental illness IS a physical illness and its as real as it can be. WHY do they have separate rules in the insurance industry for mental illness? Its the old lipservice thing...mental illness doesnt have priority...we are blown off a lot of times.
These are all reasons why I call much of what exists in psychiatry and the mental health profession a "joke." Cause it is.
Eric
Posted by JahL on March 30, 2001, at 17:51:13
In reply to Meds are only a TOOL » JahL, posted by Todd on March 30, 2001, at 0:22:30
> > > >The same point I was making on another thread. >Psychotherapists like to persuade patients that >meds are just a 'band-aid' when in fact it's >psychotherapy that's the stop gap measure, >inadequately filling in (& confusing the >picture) for meds that are yet to be developed.
> > Psychotherapy a stop-gap measure? Inadequately filling in for meds that are yet to be developed?
Absolutely. In serious psychobiological illnesses, such as my own, therapy is an irrelevance, no a *hindrance*.
> > In my honest opinion, and very respectfully submitted, Jah, you've obviously been seeing the wrong psychotherapists.
All psychotherapists are intrinsically 'wrong' since their thinking is fundamentally flawed. Psychiatry is gradually waking up to this (I hope).
> >I very firmly believe that meds are only a tool to be used in the healing process. If you feel that one day a pharmaceutical is going to heal you, I think that you're denying yourself your own personal power to be firmly engaged in your own healing process.
I no more have the power to 'heal' serious biochemical disturbances in my brain than you have to say, self-heal a faulty heart valve.
> >Life is fraught with pain.
Yes but only masochists willingly submit to it.
> >No pill is ever going to take that away.
I think maybe you are confused. I have no pain, no emotional suffering (other than a life lost to mental illness). I have no hang-ups, no personal tragedies. I suffer from a hereditary disorder which makes pleasure, sleep, cognition etc all but impossible.
> >Learning to live with it lovingly without being afraid is my holy grail.
IMO therapy is useful for situational depression, breakdowns, bereavement & child abuse survivors (+...?). The difference btwn these people & people like myself & Eric (et al) is that *they* have *issues* which could reasonably be expected to impacty upon their mental hlth. I don't.
> > You call yourself Jah.
No my friends call me Jah.
> > I am friends with quite a few Jamaicans, and they have a saying I love to use. Jah provide, mon! Jah lives in you and surrounds you. I and I will see you through. You know what I'm talking about.
I don't think I do. My head is twisted enough & doesn't need anything remotely religious/spiritual messing things up more:)
> > Peace and love.
I agree with that bit!
J.
Posted by Noa on March 30, 2001, at 17:55:45
In reply to Re: Meds are only a TOOL » adams, posted by JahL on March 30, 2001, at 17:14:49
> Psychotherapy persuades people to accept an inferior state of living; to accept that you are doomed to a joyless life of melancholia & missed experiences.
I wholeheartedly disagree (respectfully, of course) with this statement.
I think psychotherapy liberates people from this sense of doom, helps them see options and possibilities.
If you had an experience of psychotherapy that attempted to persuade you to accept an inferior state of living, it was not a good psychotherapy experience, and hopefully not typical.
I think dividing the brain and body isn't as clear cut as saying that it is chemical for some and psychological for others. It is a complex interaction for all of us. We can choose to intervene at one or more points of this complex system, and there is no one way to intervene.
Posted by judy1 on March 30, 2001, at 18:10:08
In reply to Re: New theories of mental disorders needed (longer), posted by Eric on March 30, 2001, at 17:41:10
Dear Eric,
Okay, my sarcasm detector meter is out. And also I tend to be defensive about Scott because he has provided me with so much support and he sounded upset which makes me upset. That being said, I am fortunate enough to live in a state that provides parity with physical and mental illness (California). I am on SSD, it took 4 months because I had a psychiatrist who recognized the severity of my illness and I retained a lawyer because I was unable to fill out a form. I realize that my story is very much in the minority. I think you made a comparison earlier to AIDS research and the ability for those with AIDS to raise money. Well, we (those of us with severe mental illness) not only suffer from stigma, we don't have the ability to call our representatives, or organize a march or anything else. Often I wonder how much of that is the actual disorder or the debilitating effects of psychotropic drugs. Try a depot injection of haldol sometime and see if you can make it into the shower, never mind organize your thinking to hold rallies or fundraisers. I refer to myself as a psychiatric survivor, I will spare you the details. But I have been fortunate enough to have worked with people who have dedicated their lives to finding answers in research, and incredible psychiatrists and psychologists who have prevented me from taking my life on more than one occasion. I wish there were answers for all of us, but I find it more helpful personally to look for hope, rather than tear everything down which seems to have happened here. I truly hope some of this makes sense. Take care, judy
Posted by Dubya on March 30, 2001, at 18:21:50
In reply to Re: Meds are only a TOOL » adams, posted by JahL on March 30, 2001, at 17:14:49
I think I can relate! I (or we) get so used to living w/depression, we don't really know what 'normal' or life is like. Very sad to look back at 'missed' opportunities or regret just about everything I (or we) do. I think I can also agree on the psychotherapy talk, it makes us either accept a lower state of life or it tries to make us think differently and assume that we can overcome obstacles. The chemicals in the brain can be replenished possibly through extremely happy changes in life.
Posted by JahL on March 30, 2001, at 18:39:34
In reply to Re: Meds are only a TOOL, posted by Noa on March 30, 2001, at 17:55:45
> > > > Psychotherapy persuades people to accept an inferior state of living; to accept that you are doomed to a joyless life of melancholia & missed experiences.
> >I wholeheartedly disagree (respectfully, of course) with this statement.
> > I think psychotherapy liberates people from this sense of doom, helps them see options and possibilities.Yes & no. What I mean by the above is that psychotherapists frequently give the lie that meds are just a 'band-aid'. They are no more a band-aid 4 me than insulin is 4 a diabetic. Psychotherapists are in an influential position & by denigrating the benefits of meds (& thus restricting the options you speak of), they potentially deny someone the chance of an infinitely better quality of life.
> > If you had an experience of psychotherapy that attempted to persuade you to accept an inferior state of living, it was not a good psychotherapy experience, and hopefully not typical.
*Extensive* & varied experience. All the same.
> >I think dividing the brain and body isn't as clear cut as saying that it is chemical for some and psychological for others. It is a complex interaction for all of us. We can choose to intervene at one or more points of this complex system, and there is no one way to intervene.
Maybe, but my point is that psychotherapy is fine (& probably beneficial) in addtn to meds, but it *should not* (as it so often is) be portayed as a SUBSTITUTE for somatic treatment. With the exceptions I mention in the post above, it most certainly isn't.
Sincerely,
J.
Posted by JahL on March 30, 2001, at 20:08:05
In reply to Re: Meds are only a TOOL YES JahL!!!, posted by Dubya on March 30, 2001, at 18:21:50
> > I think I can relate! I (or we) get so used to living w/depression, we don't really know what 'normal' or life is like.
Hi Dubya (go *girl*!).
Had I listened to psychotherapists ("maybe it's just the real you" or "learn to love yourself as you are" etc), & not persisted with meds I would not be aware of what it is to be euthymic; what it is to be *human*. Psychotherapy contrived to deny me this knowledge. With nothing to compare, I could be persuaded that my level of functioning is somehow normal; acceptable (as if).
> > Very sad to look back at 'missed' opportunities or regret just about everything I (or we) do. I think I can also agree on the psychotherapy talk, it makes us either accept a lower state of life or it tries to make us think differently and assume that we can overcome obstacles. The chemicals in the brain can be replenished possibly through extremely happy changes in life.
Yeah. All the 'happy', 'rewarding' experiences in the world don't mean sh*t if you suffer from anhedonia & therefore are *physically unable* to experience pleasure.
Has your doc raised your puny dose of Clomip. yet?:)
Jah.
Posted by Dubya on March 30, 2001, at 20:37:09
In reply to Re: Meds are a TOOL which get the job done. » Dubya, posted by JahL on March 30, 2001, at 20:08:05
Hehe, I am a guy, so "you go girl" unfortunately doesn't apply to me. Mila also thought I was a girl. hmm, gees, no wonder I an depressed, anxious, have OCD, hehe everyone seems to think I am a woman (just kidding).
I don't know what to tell the doc, I mean, he raised from 10 to 20mg now to 30mg when I complained about my anxieties. HE says that 30mg should help, if not, I should seem him in 2wks to try Paxil.
Posted by Dubya on March 30, 2001, at 22:28:47
In reply to Re: Meds are a TOOL which get the job done. » Dubya, posted by JahL on March 30, 2001, at 20:08:05
I may sound happy now but, I am really messed, I really want to 'hurt' my wrist just a bit to satisfy myself. This only has been happening since on meds, I take my problems out on my wrists w/a wallpaper knife blade. I also see a need for attention argh. I have often thought I had ADD/ADHD b/c, I have impulses that are unique, as well as hyperactivity, even at 8am after eating only a bagel and having OJ. Coffee seems to calm me down. I mean one day, I had 5 caffeine items (2 coffees 9am, a Pepsi 3pm, an espresso at 11:30pm, a double espresso at 12:30am , by 1:15am, I'm sound asleep. I really need to someone to take my advice and trust me for reassurance.
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