The Second Apocalypse
Miscellaneous Chatter => Philosophy & Science => Topic started by: sciborg2 on May 03, 2019, 03:10:22 pm
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How Drug Companies Helped Shape A Shifting, Biological View Of Mental Illness (https://www.npr.org/sections/health-shots/2019/05/02/718744068/how-drug-companies-helped-shape-a-shifting-biological-view-of-mental-illness?utm_source=pocket-newtab)
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.
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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...
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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...
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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...
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...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!
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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.
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Big Pharma are total cunts. Regardless of the veracity of anything else, imo.
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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"
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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.
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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.
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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.
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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.
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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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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.
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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.....
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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.....
Which actually does happen, except in the cases of the most successful drugs and even those don't often exceed the effect of the placebo by all that much in most cases. I think many people would be surprised at how effecting placebos actually are. And I think many people would also be surprised to lean that placebos can still work even when the person given them is actually told that they are placebos and are not actually drugs. IT even works for things that would seem like they are not really treatable. I've seen a case where someone was heavily medicated for constant migraines and the placebo effect seemed to manage to "stop" the migraines. Another, where it mitigated the effect of severe eczema where medication had not.
Anecdotes, of course. But it was scientific study and it was not completely unsuccessful in achieving results. Which, even if it turns out the effect doesn't last, or is only effective in corner cases, it's still rather preposterous that it works at all, ever. That is, if it is the case that say, consciousness is totally an "illusion" and there is nothing akin to an "internal" locus of control.
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drugging yourself likely will not have the long-term effect one would likely want.
I completely agree.
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
Does it have to be? I mean what about a case by case basis?
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.
Why? Maybe the incessant need to be in control actually fuels these things, and being told it's not your fault can be a relief.
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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
Does it have to be? I mean what about a case by case basis?
Well, I think you are mischaracterizing my point though. I am saying, that yes, any effectiveness will indeed be a case by case basis, but, my hunch is that there are more cases where a non-drug approach could and would work than are currently both proscribed and generally accepted by patients. I think part of that could be because the non-drug approach is also a lot of work and will require changes in assumptions, world-view and manners of thought, which many people just don't want to do. POeople really do seem to have a "just give me a pill" approach. In the same way that where I live, most people have high blood pressure, but won't alter the slightest bit of their diet. "Just give me a pill, I am not going to change what I am eating."
Forgive my bias, but I can't help but imagine that psychology can work the same way.
Why? Maybe the incessant need to be in control actually fuels these things, and being told it's not your fault can be a relief.
That absolutely could be the case, and in those cases, something like a drug will likely work to get one out of a sort of positive feedback loop.
But, on the other hand, if you don't learn how to think in a way that can get yourself out of the mind-space that demands such a need for control, means that once you'd habituated to the drugs, you are right back where you started. Locus of control is really not about an "all or nothing" position. I mean, I drive to work, some of what will happen will be within my control, so I can "worry" about that, but I can't control what a meteor from space might do, or what the guy on the other side of the road might do. So, indeed, it is a matter of fact that one can be a "victim of circumstance" and have little not no control over what might happen. But at some point, you will likely have control over something, be it your reaction, your way of thinking about how to overcome what happened, or what you can do in the present to effect a positive outcome in the future.
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Why? Maybe the incessant need to be in control actually fuels these things, and being told it's not your fault can be a relief.
That absolutely could be the case, and in those cases, something like a drug will likely work to get one out of a sort of positive feedback loop.
But, on the other hand, if you don't learn how to think in a way that can get yourself out of the mind-space that demands such a need for control, means that once you'd habituated to the drugs, you are right back where you started. Locus of control is really not about an "all or nothing" position. I mean, I drive to work, some of what will happen will be within my control, so I can "worry" about that, but I can't control what a meteor from space might do, or what the guy on the other side of the road might do. So, indeed, it is a matter of fact that one can be a "victim of circumstance" and have little not no control over what might happen. But at some point, you will likely have control over something, be it your reaction, your way of thinking about how to overcome what happened, or what you can do in the present to effect a positive outcome in the future.
In my work as a driver, I'm often observing driving situations and reviewing what could I have done better or differently to achieve a better outcome (for example, a smoother merge). Collisions are way more preventable than most people think; after all, nothing "comes out of nowhere".
Personal behavior change is hard. Taking pills is easy. And the placebo effect strikes at the heart of consciousness and will.
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In my work as a driver, I'm often observing driving situations and reviewing what could I have done better or differently to achieve a better outcome (for example, a smoother merge). Collisions are way more preventable than most people think; after all, nothing "comes out of nowhere".
Personal behavior change is hard. Taking pills is easy. And the placebo effect strikes at the heart of consciousness and will.
And also, what it actually within something akin to control, or really, likely an influence, even if it is not something we are radically conscious of. Even just a minor shift in focus, or directed attention, could have a drastic result, in driving, or anything else (for the "better" or "worse").
My point though, is, that if we necessarily imagine that we are only victims of circumstance, than that is all we could ever be. If we imagine that we have some influence on how things could be, no matter how small that influence might be, we have the chance to effect the outcome we desire. Sartre would call the extreme of this position, a "radical freedom" that we are totally free, but it need not be so radical or total. But the result could still be anxiety, or depression. To imagine the opposite, that we are all just victims of circumstance or biology, has it's place, to give us reason to believe that we have no culpability in the state of ourselves, and relieve to some degree the responsibility that choice places on us.
While it stands to reason that one could be a victim of things totally outside one's own influence, I think the likelyhood at all things are necessarily divorced from your own influence is sort of absurd.
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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
Does it have to be? I mean what about a case by case basis?
Well, I think you are mischaracterizing my point though. I am saying, that yes, any effectiveness will indeed be a case by case basis, but, my hunch is that there are more cases where a non-drug approach could and would work than are currently both proscribed and generally accepted by patients. I think part of that could be because the non-drug approach is also a lot of work and will require changes in assumptions, world-view and manners of thought, which many people just don't want to do. POeople really do seem to have a "just give me a pill" approach. In the same way that where I live, most people have high blood pressure, but won't alter the slightest bit of their diet. "Just give me a pill, I am not going to change what I am eating."
Forgive my bias, but I can't help but imagine that psychology can work the same way.
I mean, I don't necessarily disagree with the first part of what you said; if I had e.g. depression I wouldn't want to take any drugs myself, because I'd be too afraid of the side-effects. Still, by denying or downplaying the biology involved we're doing ourselves a huge disservice. Just take Mikhaila Peterson. Auto-immune problems, depression etc. all seemingly connected to some real weird gut microbiome phenomenon. It was never about changing the world-view in her case, it was just about changing her diet.
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I mean, I don't necessarily disagree with the first part of what you said; if I had e.g. depression I wouldn't want to take any drugs myself, because I'd be too afraid of the side-effects. Still, by denying or downplaying the biology involved we're doing ourselves a huge disservice. Just take Mikhaila Peterson. Auto-immune problems, depression etc. all seemingly connected to some real weird gut microbiome phenomenon. It was never about changing the world-view in her case, it was just about changing her diet.
But in her case, imagine that she had no intent on changing her way of thinking and behavior. If she just insisted that she should do nothing different, but be given the pill to make her condition go away. In fact, that sort of what is what happened with her as a kid, with the initial diagnoses and the poor results it gave her. All the anti-inflammatory drugs in the world could not help. Only once she started to think about the "problem" in a different way and changed her conceptualizing of the nature of the problem and her behavior, was she able to change the outcome. See, she actually took control over her own health, rather than being a victim and demanding a pill to stop it. So, I don't think your example proves your point, in fact, really just the opposite.
See, this is why I see the "I'm not going to change anything I think or do, just give me a drug to make it stop hurting" is not going to work, long term. You need to get down into the more "fundamental" roots of things. If the way you think causes problems, all the drugs in the world won't work. If the fundamental problem is just a biological mis-working, then sure, it can work to just take a pill. My hunch though, is that there are far more people in the former camp, than in the biologically malfunctioning camp.
If fact, I think many people with poor health, are in this camp. They don't want to stop eating bad food, they don't want to stop over-eating, they just want a pill to make these things have no consequences. It seems plausible that it could work the same sort of way psychologically for a variety of issues, in many cases.
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I mean, I don't necessarily disagree with the first part of what you said; if I had e.g. depression I wouldn't want to take any drugs myself, because I'd be too afraid of the side-effects. Still, by denying or downplaying the biology involved we're doing ourselves a huge disservice. Just take Mikhaila Peterson. Auto-immune problems, depression etc. all seemingly connected to some real weird gut microbiome phenomenon. It was never about changing the world-view in her case, it was just about changing her diet.
But in her case, imagine that she had no intent on changing her way of thinking and behavior. If she just insisted that she should do nothing different, but be given the pill to make her condition go away. In fact, that sort of what is what happened with her as a kid, with the initial diagnoses and the poor results it gave her. All the anti-inflammatory drugs in the world could not help. Only once she started to think about the "problem" in a different way and changed her conceptualizing of the nature of the problem and her behavior, was she able to change the outcome. See, she actually took control over her own health, rather than being a victim and demanding a pill to stop it. So, I don't think your example proves your point, in fact, really just the opposite.
I mean, I see what you're getting at but no, haha, I don't agree. She didn't 'will' her condition away, it wasn't about world-view or having a positive outlook on life, it was about physical illness caused by some weird digestive shit. I agree that the drugs didn't help, and in that case you do what you have to do (been there myself, googling, experimenting with my own solutions when the doctors and the pills kept not improving anything), but I don't think this has anything to do with 'control'. Just because something is not in your control doesn't mean you have to lie down and be a fatalist victim, I mean, why should you? On the contrary it can be a liberating experience since you don't have to feel guilty about not 'controlling' your life the proper way.
If the way you think causes problems, all the drugs in the world won't work. If the fundamental problem is just a biological mis-working, then sure, it can work to just take a pill. My hunch though, is that there are far more people in the former camp, than in the biologically malfunctioning camp.
But are you sure of that? And what of everybody in between, who need that joint therapy?
If fact, I think many people with poor health, are in this camp. They don't want to stop eating bad food, they don't want to stop over-eating, they just want a pill to make these things have no consequences. It seems plausible that it could work the same sort of way psychologically for a variety of issues, in many cases.
I just don't agree here. I don't think anybody actually wants to be a fat fuck. They might rationalize it (because they're in control of their lives after all, aren't they?), but I don't think anybody genuinely wants to be stuck in these unhealthy behavioral loops.
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I mean, I see what you're getting at but no, haha, I don't agree. She didn't 'will' her condition away, it wasn't about world-view or having a positive outlook on life, it was about physical illness caused by some weird digestive shit. I agree that the drugs didn't help, and in that case you do what you have to do (been there myself, googling, experimenting with my own solutions when the doctors and the pills kept not improving anything), but I don't think this has anything to do with 'control'. Just because something is not in your control doesn't mean you have to lie down and be a fatalist victim, I mean, why should you? On the contrary it can be a liberating experience since you don't have to feel guilty about not 'controlling' your life the proper way.
Well, no, I wasn't trying to say that she "willed" it away. What is "willpower" anyway?
You say though, that it has nothing to do with "control" but really, she did take over responsibility for her own health, took to influencing her own outcome rather than passively handing it off to a doctor, or anyone else. So, indeed, if you don't like the word "control" don't use it, but she certainly did exercise influence on her outcome. That's the point. If you don't like the notion of "locus of control" call it whatever you like, the outcome is still the same. Rather than be passive and think of things as just happening to her, she took action and changed behaviors and got better results for it. Maybe people do not do that.
I guess though, we can ask, if one is "not control their life in the proper way" by their own metric, and feel "guilty," again by their own metric, should they?
But are you sure of that? And what of everybody in between, who need that joint therapy?
I never precluded that such a thing could not happen. In fact, just the opposite. I already said that sometimes drugs can and likely do help people get out of positive feedback loops. But I do think (note: think, not know) that drugs alone will likely not "cure" a number of common psychological maladies, such as general anxiety and depression.
I just don't agree here. I don't think anybody actually wants to be a fat fuck. They might rationalize it (because they're in control of their lives after all, aren't they?), but I don't think anybody genuinely wants to be stuck in these unhealthy behavioral loops.
No, of course they do not want to be in a state such as obecity. But they are also not, generally, open to modifying their behavior. So, of course they do not want the disastrous consequences of overeating and eating unhealthy, but they do still want to do those things for a variety of reasons. Take your above example, lets say that Mikhaila Peterson said, "Look, I don't want to keep losing joints, but I won't give up eating carbs. It's just not something I can do." It's not that she wants to loose the joints, be in pain, just that her perceived value in continuing her behavior (eating what she wants) is greater than the perceived negative value of the pain.
Honestly, I see this in action all the time. Likely that skews my perception of it. But I know people with diabetes that have literally said, "I'd rather die than not eat sugar" and I even know someone who did. I know people who smoke, knowing full well the damage it does to them, and still will not modify their behavior. Now, we can absolve them of any compliance in their own undoing, and to some degree that might be true, but I'm not willing to buy the idea that they could not stop if they actually wanted.
So, no, I don't buy the idea that the majority of people who are suffering something like general anxiety or depression, are biologically determined to be so. Even if they are biologically predisposed to it, there is almost certainly, in my mind, something they could do, psychologically, to ameliorate it.
No, I don't have empirical data. No, I don't know it to be a certainty. No, I am not saying that it must be all psychological. But there is no real evidence that something like anxiety is 100% biological either. My point is that, in my opinion, the way you frame the problem is going to determine what could even possibly work.
So, there is some confluence between biology and psychology. If there were not, either drugs or therapy would work 100%. But neither does, so there is some relative values between. My point is, that in my opinion, our "empirical worldview" too often makes people believe that the only possible effective one would be drugs and wrongly so.
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You say though, that it has nothing to do with "control" but really, she did take over responsibility for her own health, took to influencing her own outcome rather than passively handing it off to a doctor, or anyone else. So, indeed, if you don't like the word "control" don't use it, but she certainly did exercise influence on her outcome. That's the point. If you don't like the notion of "locus of control" call it whatever you like, the outcome is still the same. Rather than be passive and think of things as just happening to her, she took action and changed behaviors and got better results for it. Maybe people do not do that.
She changed behavior in the sense that she changed her diet but that's not the same as the "dude just be more positive" that you often hear. I mean, maybe I'm misunderstanding what you meant with control and agency, I took it to mean control of your own mentality, so to speak, which is where Mikhaila's case is so interesting because it wasn't about any of that, it was about diet.
"I'd rather die than not eat sugar"
I mean, shouldn't that tell us something about how deeply people are stuck in these things? I'm reminded of the Bakker example with the moth flying into a bug zapper. It can't resist the light.
there is almost certainly, in my mind, something they could do, psychologically, to ameliorate it.
I mean, I don't disagree, but I see this more as behavioral re-wiring rather than assuming some locus of control or whatever.
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She changed behavior in the sense that she changed her diet but that's not the same as the "dude just be more positive" that you often hear. I mean, maybe I'm misunderstanding what you meant with control and agency, I took it to mean control of your own mentality, so to speak, which is where Mikhaila's case is so interesting because it wasn't about any of that, it was about diet.
Well, that is the thing, something like CBT is not "dude just be more positive" at all. And if that is what one is getting out of it, than certainly it will fail. Because that is not what it should be. The thing is, one's method of thinking, the frame of mind, is a sort of process akin to behavior as well. If you change that way of thinking, you can change the metal outcome. So, sure, it is something of controlling your mentality, but it's also about changing that mentality. So, again, if she had the mentality that she should not have to change her diet, then certainly her outcome would have been different.
So, if she had this idea that her original diet, which was making her sick, was so ingrained in her mental identity, that she could not even think of giving it up. But that is a way people think about themselves. Even though, there is no reality to that.
I mean, shouldn't that tell us something about how deeply people are stuck in these things? I'm reminded of the Bakker example with the moth flying into a bug zapper. It can't resist the light.
But are people really as incapable of modifying their thoughts and actions as an insect? Are they really incapable or just unwilling? I think we are bound to always disagree if you want to take the line that people are no different than biological machines with no agency to modify their thoughts or actions.
I mean, I don't disagree, but I see this more as behavioral re-wiring rather than assuming some locus of control or whatever.
Well, if that's what you want to call it, sure. But in either case, it is something you do to not be a "victim of circumstance." It's where you dictate how things will be, to the maximal degree which is possible.
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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.....
Well, if they indeed do work better, we're taking the author's statistics on this for granted as "true". How many and which drugs was this the case? I like Beard's example, there are some drugs/situations no one would want a placebo. Would like to see more of the research on that before throwing in the towel on medications. Just so much can go wrong with such a study - is it based on the reporting of the psychologist, the patient or from where? Is it long term success of the placebo? This just has the odor of lining up the data to support what you want to believe ( may not be the case, but would want to understand more before entertaining the ramifications if true ).
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And I think many people would also be surprised to learn that placebos can still work even when the person given them is actually told that they are placebos and are not actually drugs.
I've read about this before and I find this amazing. And those who still think they work try to get more to continue treatment. I wish I could remember how they explained how and why this is.
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Well, since I got myself all worked up, I went and got the book.
I'm only on the introduction so far.
Instead of reflecting on the extent to which the Freudians had lost credibility by insisting that they could be experts on everything, the new generation of biological revolutionaries repeated their mistake: they declared themselves the new experts on everything. No one suggested that it might be prudent to decide which forms of mental suffering were best served by a medical model, and which might be better served in some other way. Revolutionaries don’t cede ground.
So, I think the author, like me, is not against the idea that there is biology involved, or that pharmaceuticals can help people, rather, that things are too often made out to be "all or nothing."
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Well, since I got myself all worked up, I went and got the book.
I'm only on the introduction so far.
Instead of reflecting on the extent to which the Freudians had lost credibility by insisting that they could be experts on everything, the new generation of biological revolutionaries repeated their mistake: they declared themselves the new experts on everything. No one suggested that it might be prudent to decide which forms of mental suffering were best served by a medical model, and which might be better served in some other way. Revolutionaries don’t cede ground.
So, I think the author, like me, is not against the idea that there is biology involved, or that pharmaceuticals can help people, rather, that things are too often made out to be "all or nothing."
So you see that, you're saying - the psychiatric industry are pursuing drugs too much, like way too much, too much everywhere? I don't know, just seems like medical malpractice to prescribe drugs the doctor knows likely won't work - or is that the point, too many psychiatrists genuinely are too all in with prescription drugs to treat psychological maladies? I guess that falls under "mistake", but even errors are malpractice if the doctor is "supposed to know better". You're saying they don't know better?
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So you see that, you're saying - the psychiatric industry are pursuing drugs too much, like way too much, too much everywhere? I don't know, just seems like medical malpractice to prescribe drugs the doctor knows likely won't work - or is that the point, too many psychiatrists genuinely are too all in with prescription drugs to treat psychological maladies? I guess that falls under "mistake", but even errors are malpractice if the doctor is "supposed to know better". You're saying they don't know better?
That's a difficult question. Do they know better? It's hard to say exactly what they know.
To not get too epistemological, even the "hardest" of "hard science" does not assert itself as "certain." So, I'm not sure what they answer is, honestly. It is my thought that biology and drugs are "too often" a go-to. That doesn't mean none of them work, or that none of them are helpful. To proscribe something one knows would not work would indeed seem like malpractice. But what about the case where professional training informs your decision that in the case of X, give Y? In this sense, you would likely surmise that Y will help with X, why would you question it?
It's rather complicated, honestly, because what we would want is hard, empirical data that tells us the exact quantitative results. But we don't really have that, and we might not be able to get that.
Here is another passage from the book, as far as I am in:
Meanwhile Bleuler’s new term for dementia praecox, schizophrenia, spread, its appeal heightened because it seemed to convey a less desperate, fatalistic course than dementia praecox had done. By the 1910s, American alienists were beginning to use the new word, and by the 1920s, the term dementia praecox was on its way to becoming archaic.
What largely failed to travel to the United States, though, was Bleuler’s insistence that schizophrenia was best understood through a double lens: both neurobiologically and psychoanalytically. Instead, views on the disorder fractured. On the one side were those who assumed that schizophrenia was best understood in strictly biological terms, even as they disagreed over what those terms should be. On the other side were clinicians who were more interested in the degree to which the disorder resulted from bad experiences, bad habits, and bad upbringing. As early as 1914, the Harvard pathologist Elmer Southard referred to these two camps as the “brain spot men” and the “mind twist men.”
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Another quote from the book, which this historical point likely also connects with a different point about how we came to, now, proscribe anphatamines to people now on large scales:
Then in 1955, meprobamate arrived on the scene (see Chapter 3), sold under the brand names Miltown and Equanil and known to the public as a “minor tranquilizer.” Unlike Benzedrine and Dexedrine, it did not treat depression or fatigue. It treated anxiety, now understood to be the problem underlying virtually every neurotic complaint.
That was all well and good, but many family doctors pointed out that their allegedly anxious patients frequently suffered from symptoms of depression as well. They worried incessantly but also felt despondent and had no energy. Some drug companies, responding to this market opportunity, therefore began offering “combination” drugs to doctors. In 1950, before meprobamate came on the market, Smith, Kline & French had already begun selling a drug that combined the lift of an amphetamine (Dexedrine) with the sedative properties of a barbiturate (amylobarbitone). Called Dexamyl, it targeted (in the words of one ad) “the depressed and anxiety-ridden housewife who is surrounded by the monotonous routine of daily problems, disappointments and responsibilities.” Within a few years, the drug became a staple of family medicine.
A few years later, after Carter-Wallace realized it had a best seller on its hands with Miltown, it developed a combination drug of its own that it called Deprol, which combined the active ingredient of Miltown (meprobamate) with a muscle relaxant (benactyzine). Like Dexamyl, it targeted the depressed and anxiety-ridden housewife.
It is important to realize that none of these widely dispensed combination drugs were prescribed to cure a specific disease called depression—they were prescribed to treat a symptom of neurosis. Depression was still generally assumed, by analysts and family doctors alike, to be a mask that hid something deeper. As one Philadelphia physician, writing about Dexamyl, admitted: “Of course, the ideal treatment would be to discover the causes of the patient’s emotional turmoil—the nagging wife or husband; the tyrannical parent; the unsuitable job; the financial burden—and remove it. Unfortunately, this is impracticable. Although dragging a secret worry out in the open—‘getting it off one’s chest’—is often in itself of benefit, it is not always enough.” When it was not practical to try to dig deeper, the pills could help.
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Finished the book. Pretty good and interesting. It really is not an anti-pharma book at all. I think the end sums it up fairly:
The 1980s bilogical revolutionaries were not the first group in the history of psychiatry to make audacious promises on which they could not deliver. The nineteenth-century mental hospital has failed as a therapeutic institution? All right, forget about therapy, and focus on learning what you can from the brains of your patients after they die. The anatomical research program has been a disappointment? No problem: focus instead on collecting all possible relevant facts and pursuing any and all somatic therapies, because times are desperate, and one can never have too much data. All those diverse facts have turned out not to add up to very much? The Wild West world of shock and surgical treatments has likely caused more harm than good? That’s okay: the postwar world is in crisis and needs the insights provided by psychoanalysis and social science. Things haven’t worked out with the Freudians’ expansive social agenda? Psychiatry is on the brink of losing all credibility as a profession? Not to worry: let the biologists take over!
The bold 1980s venture to bring about a “biological revolution” has now run into the sand as well. Far from flocking to psychiatry, many pharmaceutical companies have recently been fleeing it, as the prospects for new and potentially lucrative psychiatric drugs have dimmed. The manual on which the profession has rested so much of its biological authority has come under sharp attack, not just by cranky outsiders but by informed insiders committed to the mission. Too many of the severely mentally ill remain shamefully underserved in prisons and elsewhere. Mental illness still is stigmatized in ways that other kinds of illness are not.1 Racial bias and other inequities persist. And of course, firm understandings of psychiatry’s illnesses, of their underlying biology, continue to elude the field.
So where should the profession go from here? Can today’s biological psychiatry resist the temptation to lurch into yet another chapter of overpromising zealotry that is likely to end in tears? Can it appreciate that trashing all rivals generally means that everyone becomes more ignorant, not smarter? Can it rein in its professional insecurities and see that there is nothing to be gained from premature declarations of victory? Can it acknowledge and firmly turn away from its ethical lapses—and especially the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering?
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Interesting stuff, Honorable! Thanks for sharing and giving me something to chew over. I won't respond, I simply don't know enough, but this is helpful :)