How Drug Companies Helped Shape A Shifting, Biological View Of Mental Illness

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sciborg2

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« on: May 03, 2019, 03:10:22 pm »
How Drug Companies Helped Shape A Shifting, Biological View Of Mental Illness

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On why pharmaceutical companies are leaving the psychiatric field

Because there have been no new good ideas as to where to look for new, novel biomarkers or targets since the 1960s. The only possible exception is there is now some excitement about ketamine, which targets a different set of biochemical systems. But R&D is very expensive. These drugs are now, mostly, off-patent. ... [The pharmaceutical companies'] efforts to bring on new drugs in that sort of tried-and-true and tested way — with a tinker here and a tinker there — has been running up against mostly unexplained but indubitable problems with the placebo effect.

But it doesn't mean that the drugs don't work. It just means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing, and you have to be able to be better than nothing. But, of course, if the placebo effect isn't just nothing, then maybe you need to rethink what it means to test a drug. Now, this sort of goes beyond what historians should be talking about, but it does seem that the pharmaceutical company has a big placebo problem on its hands.

H

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« Reply #1 on: May 03, 2019, 03:36:11 pm »
Ugh, so gross.  I'm too strongly opinionated on this to give anything even close to unbaised on this, but man do I dislike "psychiatry" and these fucking drugs.

Not to mention, this shit about "anxiety" as if it is certainly a "biological" affliction.

OK, I'm off the rails already, I need to take a deep breath...
I am a warrior of ages, Anasurimbor. . . ages. I have dipped my nimil in a thousand hearts. I have ridden both against and for the No-God in the great wars that authored this wilderness. I have scaled the ramparts of great Golgotterath, watched the hearts of High Kings break for fury. -Cet'ingira

sciborg2

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« Reply #2 on: May 03, 2019, 04:11:06 pm »
Ugh, so gross.  I'm too strongly opinionated on this to give anything even close to unbaised on this, but man do I dislike "psychiatry" and these fucking drugs.

Not to mention, this shit about "anxiety" as if it is certainly a "biological" affliction.

OK, I'm off the rails already, I need to take a deep breath...

I see mind/body as a sort of "alchemy". We're all human but within that humanity is an incredible amount of inner diversity.

So sometimes one might have a situation that causes anxiety in their mind but they can, say, breathe deeply and calm down. Someone else might take a pill .

And then from there you might try to deal with the situation and not need the pill...but some other people need the pill because it is biological for them...

Psychology/psychiatry IMO should respond to this reality of our plurality rather than engage in physics envy...

H

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« Reply #3 on: May 03, 2019, 04:47:43 pm »
I see mind/body as a sort of "alchemy". We're all human but within that humanity is an incredible amount of inner diversity.

So sometimes one might have a situation that causes anxiety in their mind but they can, say, breathe deeply and calm down. Someone else might take a pill .

And then from there you might try to deal with the situation and not need the pill...but some other people need the pill because it is biological for them...

Psychology/psychiatry IMO should respond to this reality of our plurality rather than engage in physics envy...

Well, I think you hit on why it bothers me so much to prefigure that anxiety is "merely biological" in origin and so much be dealth with bilologically.  Because, lets say different people are put in the same situation.  What "rises" as the psychological state, to one, is then processed one way and "dealt with."  But what happens to the other person, in whom the "same" state arises, but is processed as if it were an affliction?  Now, they have conceded the locus of control to be external, they are at the mercy of the mental state, biological or otherwise.  Regardless of where the "true" locus of control is, an immediate concession to it being entirely external means it will be.  At that point, one already loosens (or loses completely) one's own efficacy.

Anxiety is something broad, different in experiantial character for everyone, but likely it is still something at everyone "feels" in some way, at some time.  The question is, what to do with it?  If it's something like "the fear of what to do when you don't know what to do" then a pill might help, since it is something to do.  This is likely why a placebo "works" to some degree here.  But what can also work is actually answering the question.  What do you do, well, you do what you know to do.  Take stock in what you do know, procedures to figure what could be done, evaluate what should be done.  There is a reason why CBT works, to me.

To just shovel down pills in an attempt to root our procedural problems seems absurd to me.  To me, it is like the tail trying to wag the dog.  It misses the entire point and essentially is a Materialist/Deterministic view.  I don't buy it, certainly not in the way that these drugs try to present it.  If you do not change the method of thinking, you will not change the eventual outcome, even with all the drugs in the universe.  It's as if, to me, you have a knife in your side and it hurts, so it would be best to pump yourself full of morphine so you don't feel it.  But that will never, not in a million years, get the knife out of your side.  And eventually, you'll habituate to the painkillers and you'll still have to deal with what the root cause is.

But again, I am worked up here and cannot unbias myself...
I am a warrior of ages, Anasurimbor. . . ages. I have dipped my nimil in a thousand hearts. I have ridden both against and for the No-God in the great wars that authored this wilderness. I have scaled the ramparts of great Golgotterath, watched the hearts of High Kings break for fury. -Cet'ingira

BeardFisher-King

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« Reply #4 on: May 03, 2019, 05:57:27 pm »
...but man do I dislike "psychiatry" and these fucking drugs.

Not to mention, this shit about "anxiety" as if it is certainly a "biological" affliction.
I'm on H's side of this matter. It is a terrible thing to fall into the hands of the psychiatric professionals, imho:

"Take this. It should make you feel better. If it doesn't, come back, and we'll adjust the dosage."

("Or, hell, maybe we'll try a placebo ... it's not like we know what these drugs do, or why they work...")

Now I need to take a deep breath....anyway, thanks to sciborg2 for the post!
« Last Edit: May 03, 2019, 05:59:29 pm by BeardFisher-King »
"The heart of any other, because it has a will, would remain forever mysterious."

-from "Snow Falling On Cedars", by David Guterson

TLEILAXU

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« Reply #5 on: May 04, 2019, 06:10:41 pm »
Lol @ this demonization of the big pharma. Of course nothing is perfect, and sure you've got doctors around who just put you on various shitty ass anti-depressants whose side effects are perhaps not even worth it, but at least somebody is fucking trying.
Tell you what, if you ever end up with a kid with e.g. schizophrenia a you'll be happy that there's somebody making drugs to treat it.

themerchant

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« Reply #6 on: May 04, 2019, 08:48:00 pm »
Big Pharma are total cunts. Regardless of the veracity of anything else, imo.

BeardFisher-King

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« Reply #7 on: May 04, 2019, 10:10:35 pm »
Here's the book behind the NPR interview summary that sciborg2 linked above: "Mind Fixers" by Anne Harrington

Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness https://g.co/kgs/b57deo

From the conclusion of the introduction:

"I have written this book because I believe that history matters. We perhaps don't need history to see that psychiatry today is not a stable enterprise marked by consensus about mission, but rather a fraught one, where rhetoric still outstrips substance, where trust is fragile, and where the path forward is unclear. But we do need history to understand how we came to be where we are now and therefore what might need to happen next. Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction by inviting us to despise cartoonish renderings of our perceived rivals and enemies. The price we all pay, though, is tunnel vision, mutual recrimination and stalemate. For the sake not just of the science but of all the suffering people whom the science should be serving, it is time for us all to learn and to tell better, more honest stories"
« Last Edit: May 04, 2019, 11:59:17 pm by BeardFisher-King »
"The heart of any other, because it has a will, would remain forever mysterious."

-from "Snow Falling On Cedars", by David Guterson

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« Reply #8 on: May 06, 2019, 12:14:16 pm »
Lol @ this demonization of the big pharma. Of course nothing is perfect, and sure you've got doctors around who just put you on various shitty ass anti-depressants whose side effects are perhaps not even worth it, but at least somebody is fucking trying.
Tell you what, if you ever end up with a kid with e.g. schizophrenia a you'll be happy that there's somebody making drugs to treat it.

Well, the gulf between an "anxiety" or "depression" diagnosis and schizophrenia is really vast, in my opinion.

Like I said though, it isn't as if I am unbiased on this.  However, that doesn't mean I am 100% incorrect to think that some things could be better treated without drugs.  I actually think that the "fact" that drugs work for something like schizophrenia is part of why it is assumed that it would work for something like "general anxiety."  But just because both fall into the  realm of "psychology" does not mean they are best handled via the same (sort of) proscription.

While it's funny to imagine that I am taking some Luddite line here, it's really not the case.
I am a warrior of ages, Anasurimbor. . . ages. I have dipped my nimil in a thousand hearts. I have ridden both against and for the No-God in the great wars that authored this wilderness. I have scaled the ramparts of great Golgotterath, watched the hearts of High Kings break for fury. -Cet'ingira

BeardFisher-King

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« Reply #9 on: May 06, 2019, 12:27:20 pm »
The brief discussion in the NPR interview of the history of lithium was interesting. Useful element, apparently, but unprofitable, since it's an element and not a compound. 
"The heart of any other, because it has a will, would remain forever mysterious."

-from "Snow Falling On Cedars", by David Guterson

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« Reply #10 on: May 06, 2019, 01:59:18 pm »
The brief discussion in the NPR interview of the history of lithium was interesting. Useful element, apparently, but unprofitable, since it's an element and not a compound.

Yeah, it's interesting, because Sodium and Potasium are kind of "essential" yet Lithium has such a "different" effect, even though they are all Alkali metals.  But I'm sure the actual chemistry and perhaps something about what the Lithium is delivered with, although could also be how it ends up bonded in those sorts of things.  My highschool chemistry reminds me that it is likely a really, really bad idea to try to ingest straight Lithium, haha.
I am a warrior of ages, Anasurimbor. . . ages. I have dipped my nimil in a thousand hearts. I have ridden both against and for the No-God in the great wars that authored this wilderness. I have scaled the ramparts of great Golgotterath, watched the hearts of High Kings break for fury. -Cet'ingira

TaoHorror

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« Reply #11 on: May 06, 2019, 02:40:06 pm »
Well, I'm out of my depth and likely irresponsible of me to chime in - but I'm a bit with TL on this in that there are at least some situations where medication is a savior. That said, the treatise is real - human psychology is so differentiated that it makes appropriate treatment at least challenging ( hard to say if impossible as we should drive for greater understanding so we can be more effective ). Still more said, simplistically put, the proper approach should always be develop strategies to overcome psychological distress and then augment ( not replace ) with medication as needed - but that's where the rubber meets the road, what is distress and what is proper functioning psychology - so much has to happen to identify that accurately ( patient has to be compliant, but not too compliant and accurate, but not too accurate ) - well, that's why we have the science, we're learning and trying to be better at treating people. The reality is hyper-jacked because we're fussing with people's conscious experience directly as with all else, it's indirect. So every industry/job/science is fraught with incompetence/fraud/crime and mistakes, it's harder to swallow seeing this in psychology/psychiatry - the stakes appear higher, so we're less accepting of error. But it seems to be we should continue and books like these ( to me ) are corrective action, not to put a stop to it.
It's me, Dave, open up, I've got the stuff

TLEILAXU

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« Reply #12 on: May 06, 2019, 03:06:15 pm »
Lol @ this demonization of the big pharma. Of course nothing is perfect, and sure you've got doctors around who just put you on various shitty ass anti-depressants whose side effects are perhaps not even worth it, but at least somebody is fucking trying.
Tell you what, if you ever end up with a kid with e.g. schizophrenia a you'll be happy that there's somebody making drugs to treat it.

Well, the gulf between an "anxiety" or "depression" diagnosis and schizophrenia is really vast, in my opinion.

Like I said though, it isn't as if I am unbiased on this.  However, that doesn't mean I am 100% incorrect to think that some things could be better treated without drugs.  I actually think that the "fact" that drugs work for something like schizophrenia is part of why it is assumed that it would work for something like "general anxiety."  But just because both fall into the  realm of "psychology" does not mean they are best handled via the same (sort of) proscription.

While it's funny to imagine that I am taking some Luddite line here, it's really not the case.
In what sense? You can talk about loci of control but that doesn't make them anymore concrete. Who are you to say that somebody's suicidal thoughts aren't just as much an 'external' locus of control as somebody else's epilepsy? Isn't the notion that these diagnoses are not really biological, not "real" diagnoses, in a sense responsible for pertuating the stigmatization? Like I'm not saying CBT should be thrown out, obviously taking anti-depressives alone might not cure your depression, but while you're talking about "procedural issues", these drugs are helping patients, except when they don't of course, because nothing is perfect and everybody is unique and not everybody responds to drugs the same way, but at least somebody is trying to make products to improve the livelihood of patients, can you believe that?
I just think it's funny/sad that it's become such a popular opinion to hate "big pharma" these days. People sharing stories on facebook about how it's all a big scam and how "natural" plant pills (which you can buy from our 100% natural ayurvedic medicine store) and "mindfulness" cured their depression and what have you.

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« Reply #13 on: May 06, 2019, 03:40:58 pm »
In what sense? You can talk about loci of control but that doesn't make them anymore concrete. Who are you to say that somebody's suicidal thoughts aren't just as much an 'external' locus of control as somebody else's epilepsy? Isn't the notion that these diagnoses are not really biological, not "real" diagnoses, in a sense responsible for pertuating the stigmatization? Like I'm not saying CBT should be thrown out, obviously taking anti-depressives alone might not cure your depression, but while you're talking about "procedural issues", these drugs are helping patients, except when they don't of course, because nothing is perfect and everybody is unique and not everybody responds to drugs the same way, but at least somebody is trying to make products to improve the livelihood of patients, can you believe that?
I just think it's funny/sad that it's become such a popular opinion to hate "big pharma" these days. People sharing stories on facebook about how it's all a big scam and how "natural" plant pills (which you can buy from our 100% natural ayurvedic medicine store) and "mindfulness" cured their depression and what have you.

Well, one, to restate my position, I don't "hate big pharma."  I don't "think it's all a scam" or anything like that.  What I do think though, is that too often are people handed a hammer, so they start to treat too many problems as if they were nails.

That is not to say that a drug can't work in a given case.  Or that it is incorrect to proscribe a drug to address a "problem."  What I am saying though, is that, in my opinion, "too often" are drugs a "go-to" option in addressing issues.  To go back to what the article (and seemingly to the book too) is talking about, if that if a drug barely beats the placebo effect, we could wonder what it is that it is actually doing.  In other words, indeed, that does make me wonder if there might well be a "better way."  If a placebo would work at all, again, what are we really doing with drugs then?

So, no, I am not trying to frame out pharmaceutical companies as some megalithic evil, or any such thing.  What I am saying, is that in my opinion, the fact that psychotropic drugs do work for some things, does not preclude that it should work ideally for any psychological problem.  But the view that any psychological malady is solely biological misses much the point, to me, and drugging yourself likely will not have the long-term effect one would likely want.  Especially not when one likely considers what long-term side effects of escalating drug usage might be.

Does it mean that a non-pharmaceutical approach is always best?  Likely not, as you point out, individuals are different.  But by the same token, does that mean that a pharmaceutical should be the "default" method of treating any given ailment?  Again, by your own point, no, that makes little sense.

So, where does that leave us?  My assumption, which could like be wrong, because who the fuck am I, but it would be that more "general anxiety" and "general depression" could be dealt with through a non-pharmaceutical approach, which would avoid the potential harmful side effects and be more successful in the long term, because it does not fall into the sort of habituation that can befall any drugs.

It is, to me, a mistake the even court the idea of a total "biological locus of control" for most cases of general anxiety or depression.  Again, this does not preclude that some cases might well feature such a thing.  But to default to the idea of that, is, in my opinion, a mistake, because it will tend to inform a lack of agency on the part of the sufferer.  Even if they are indeed largely a victim of circumstances outside their control, conceding even the small amount of control they do have, in my opinion, is a massive mistake.

But if you want to take my general position of "pharmaceutical seem likely to be over prescribed vs. methods of non-pharmaceutical intervention" to be a condemnation of "big pharma as evil" well, then so be it.  But that is not what I am saying.
I am a warrior of ages, Anasurimbor. . . ages. I have dipped my nimil in a thousand hearts. I have ridden both against and for the No-God in the great wars that authored this wilderness. I have scaled the ramparts of great Golgotterath, watched the hearts of High Kings break for fury. -Cet'ingira

BeardFisher-King

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« Reply #14 on: May 06, 2019, 04:18:12 pm »
I would think that the placebo effect in psychiatry is significantly more important that it would be in other areas of medical science. For example, I can't imagine you'll get very far in local anaesthesia with placebos. But as for psychiatry, as H notes above, if placebos work better than drugs.....
« Last Edit: May 06, 2019, 04:19:46 pm by BeardFisher-King »
"The heart of any other, because it has a will, would remain forever mysterious."

-from "Snow Falling On Cedars", by David Guterson