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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by SLS on August 23, 2021, at 21:50:54
Biology or Psychology?
I wrote this 20 years ago in order to educate the staff of a local psychiatric clinic. They were somewhat less than enlightened.
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BIOLOGY OR PSYCHOLOGY?
The best answer to this question may be either and both.
Most of us here have been diagnosed as having a major mental illness. Mental illnesses are not
mental weaknesses. The diagnoses that we are most familiar with include:
1. Major Depressive Disorder (MDD - Unipolar Depression)
2. Bipolar Disorder (BD - Manic Depression)
3. Dysthymia (Minor Depression)
4. Seasonal Affective Disorder (SAD)
5. Schizophrenia
6. Schizoaffective Disorder
7. Obsessive-Compulsive Disorder (OCD)
8. Post-Traumatic Stress Disorder (PTSD)
9. Generalized Anxiety Disorder (GAD)
10. Social Anxiety Disorder
11. Panic Disorder
All of these illnesses have one thing in common. They are not our fault. Each disorder has both
biological and psychological components. We all begin our lives with a brain that is built using
the blueprints contained within the genes we inherit from our parents. Later, hormones change
the brain to prepare it for adulthood. It is continually being changed by the things we experience.
The brain determines the mind as the mind sculpts the brain. Unfortunately, the brain can also be
changed in negative ways by things such as drugs, alcohol, injury, trauma, and chronic stress.
How we think and feel are influenced by our environment. Probably the most important
environment during our development is that of the family, with the most important time being
our childhood. We all have both positive and negative experiences as we travel through life.
How we are as adults is in large part determined by these positive and negative experiences.
They affect our psychology, our emotions, and our behaviors. All of us can be hurt by unhealthy
negative experiences.
Some of us are also hurt by unhealthy brains. Medical science has long recognized that many
mental illnesses are actually biological disorders. Even Sigmund Freud, who we know for his
development of psychoanalysis, proposed a role for biology in mental illness. He was, after all, a
neurologist. The first solid evidence for this concept in modern times came with the discovery of
lithium in 1947. Lithium was found to reduce the symptoms of bipolar disorder (manic-
depression) or cause them to disappear completely, allowing previously disabled people to lead
normal lives. Lithium helps to correct for the abnormal neurotransmission in the brain that is the
cause of bipolar disorder. Subsequent medical discoveries included the observations that the
drug, chlorpromazine / Thorazine (an antipsychotic), successfully treated schizophrenia, and that imipramine / Tofranil (a tricyclic antidepressant) successfully treated depression. Again, these drugs help to correct for the abnormal biology of the brain that accompanies these disorders. Since then, a great many drugs have been added to the arsenal of doctors to treat mental illness. In addition, there are some newer brain stimulation techniques that work without the need for medication.
What about psychology? What role does it play in mental illness? This can be a two-way street.
The abnormal biology that occurs with some mental illnesses affects our psychology how we
think, feel, and behave. On the other hand, our psychology can also affect our biology. As we
now know, the emotional stresses and traumas we experience change the way our brains operate.
This is especially true of things we experience during childhood. These stresses can trigger the
induction of abnormal brain function that leads to major depression, bipolar disorder,
schizophrenia, and other major mental illnesses. In order for this to happen, however, there must
be a genetic or some other biological vulnerability to begin with.
It is important to remember that not all psychological and emotional difficulties are biological in
origin. Again, we are all products of our environments family, friends, enemies, school, work,
culture, climate, love, war, etc. Environments that are unhealthy often produce unhealthy people.
However, this, too, is not our fault.
In conclusion, regardless of the cause of our mental illnesses, it is important that we treat both
the biological and the psychological. We will all benefit most if we do.
By SLS
Posted by Lamdage22 on August 24, 2021, at 0:56:54
In reply to Biology or Psychology?, posted by SLS on August 23, 2021, at 21:50:54
Nicely put, Scott. I totally agree. I think my psychology messes up my biology. If it wasn't like that, I'd fare well without adding drugs and supplements in order to keep the status quo. The stress just increases and it leads to previously sufficient treatments not being sufficient anymore :(
Parents :(
Posted by Lamdage22 on August 24, 2021, at 0:59:58
In reply to Re: Biology or Psychology?, posted by Lamdage22 on August 24, 2021, at 0:56:54
It doesn't adress the root cause. Worse even, it can allow the root cause to become worse. The root cause is family dysfunction.
Posted by SLS on August 24, 2021, at 6:28:18
In reply to Re: Biology or Psychology?, posted by Lamdage22 on August 24, 2021, at 0:59:58
> It doesn't adress the root cause. Worse even, it can allow the root cause to become worse. The root cause is family dysfunction.
Absolutely.These are two terms that are used for what you described.
1. Developmental PTSD
2. Complex Trauma DisorderUnfortunately, "Developmental PTSD" has disappeared as a term.
In 2002 wrote something else that was a kind of model to understand depression and antidepressants. I called it "Depressive Pressure".
________________________________________
"Depressive Pressure"Year: 2002
[Taken from a thread appearing on the Psycho-Babble website]
http://www.dr-bob.org/babble/20020416/msgs/103824.html
"
I dont know if this helps, but this is how I currently approach things. I like to use
the word spectrum.1. Clinical depression is a diagnosis of an observable syndrome.
It is not an assignment of cause or etiology.2. The etiologies of what is characterized as depression are numerous. For
example, the word depression is used to describe a symptom of
hypothyroidism. In this case, depression can disappear immediately upon the
ingestion of pills containing T3 or T4 hormone. Is not the cause of this
depression completely biological?3. The word depression is used by people to describe quite a variety of
subjective experiences. Any two people whom describe themselves as being
depressed might be experiencing completely different things. In such a case,
person #1 might have a tendency to deem their depression as being equivalent to
that of person #2. It makes sense to person #1 that person #2 came to be
depressed in the same way, and that the same treatment will prove successful.4. There is a spectrum of varying ratios of nature versus nurture as contributions
to the evolution of depression in the individual. At one end, there is a
depression that is completely psychological, and at the other a depression that is
completely biological. (I think it is worth repeating that the one word
depression might be describing two completely different experiential
phenomena). In between lies a dynamic interaction between biological
vulnerability and psychosocial stress.I like to use the term depressive pressure to describe the psychological
experiences that act to stress the biological system. Sometimes these are acute
events like the death of a spouse or child. Sometimes they are chronic patterns of
depressive thought-styles. For those individuals whom possess a biological
vulnerability, there is a threshold of depressive pressure beyond which causes
the biological system to collapse beneath this pressure and function abnormally.1. Some people experience depression, even though no collapse of the
biological system has occurred. Psychotherapy alone can be sufficient.2. Some people who have experienced a collapse of the biological system can
recover, as the system will repair itself once the depressive pressure is
removed. Psychotherapy alone can be sufficient. However, the continued
depressed mood produced by the alterations in biology can hinder ones ability
to respond to psychotherapy, as it is more difficult to process through thought the
psychological issues producing the depressive pressure. This can end up being a
self-reinforcing loop that perpetuates the dynamics causing the depression.
Additional treatment with antidepressants might alter the system in such a way as
to produce a more functional milieu within which psychotherapy can work.3. For some people, the biological collapse can produce long-lasting
deformities in supportive structures, leaving these people more vulnerable to
depression with each successive collapse. Removal of the majority of
depressive pressure through psychotherapy might not be sufficient to prevent
periodic collapses, especially when the system is challenged by subsequent
psychosocial stresses. Longer-term antidepressant therapy might be indicated.
Perhaps this extended use of antidepressants creates a temporary structure to
support the weight of the depressive pressure while the system rebuilds itself.
However, managing psychosocial depressive pressure with continuing
psychotherapy can be important or necessary. Of course, sometimes the system
cannot rebuild itself sufficiently to remain standing when the scaffolding created
by antidepressants are removed. Indefinite treatment with antidepressants might
be necessary.4. For some people, the biological system can begin to function abnormally in
the absence of concurrent depressive pressure. A variety of genetic and
environmental factors can play a role in the evolution of system dysfunction.
Bipolar depression is probably a good example of this, although I think many
cases of unipolar are just as biological. Studies of heritability probably
demonstrate this for both, and the genes responsible eventually will be
identified. Treatment with antidepressants alone are necessary and often
sufficient. However, psychotherapy might be helpful to manage the perturbations
in psychosocial function produced within the milieu of the biologically altered
state of affect and cognition. Indefinite treatment with antidepressants is often
necessary, especially if recurrent episodes have occurred. Each successive
collapse of the system produces an increasing deformity of the structure of the
biological system, such that it becomes less amenable to repair and treatment-
resistant.
"- Scott
Posted by Lamdage22 on August 31, 2021, at 12:55:11
In reply to iology or Psychology? - 'Depressive Pressure', posted by SLS on August 24, 2021, at 6:28:18
That makes sense. There is also complex PTSD. Been diagnosed with something along those lines, too. Not by everyone but by some.
Posted by Jay2112 on September 5, 2021, at 19:40:58
In reply to iology or Psychology? - 'Depressive Pressure', posted by SLS on August 24, 2021, at 6:28:18
> > It doesn't adress the root cause. Worse even, it can allow the root cause to become worse. The root cause is family dysfunction.
>
>
> Absolutely.
>
> These are two terms that are used for what you described.
>
> 1. Developmental PTSD
> 2. Complex Trauma Disorder
>
> Unfortunately, "Developmental PTSD" has disappeared as a term.
>
>
>
> In 2002 wrote something else that was a kind of model to understand depression and antidepressants. I called it "Depressive Pressure".
>
>
> ________________________________________
>
>
> "Depressive Pressure"
>
> Year: 2002
>
> [Taken from a thread appearing on the Psycho-Babble website]
>
> http://www.dr-bob.org/babble/20020416/msgs/103824.html
>
>
> "
> I dont know if this helps, but this is how I currently approach things. I like to use
> the word spectrum.
>
>polite snip<
>
> - Scott
>
>WOW! A very nice essay!!
Indeed, as we have agreed, the entire DSM-V seems to look more and more like a classification of illness right across a spectrum, with many, many intersections.
The example I always use is Autism...with it's Autistic Spectrum Disorders. I've worked with many autistic clients over the years, and plotting points of conversion and diversion on the Spectrum, from high to low functioning, has been a task for me many times. I 'teach' much of this to my client's parents..it gives them a sense of where to go and what to expect with their kids on the ASD.
Jay
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