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  #1  
Old 08-06-2011, 12:14 AM
Bloggingheads Bloggingheads is offline
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Default Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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  #2  
Old 08-06-2011, 02:36 AM
thprop thprop is offline
 
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Default John has gone off the deep end

I have little respect for John anymore. His critique of string theory was taken apart in his diavlog with George Musser. He insists that we have free will because it is good to have. Jerry Coyne dismiised those arguments.

Now he is into conspiracy theory. Here are a few counters to Whitaker:
Carlat

A debate on the subject

A mental health professional who says to take his research seriously

John lets his own feelings override science.
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  #3  
Old 08-06-2011, 02:43 AM
cosmic_electrons_dancing cosmic_electrons_dancing is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

A welcome discussion about the single most important malady of our age: emotional disturbance/schizophrenia. Perhaps it is again time to offer the groundbreaking and pioneering work of Murray Bowen MD. Bowen studied, in depth, the schizophrenic "in situ" that is to say: in the family. The interested reader could easily Google "Bowen Theory" or: "Societal Emotional Process" for more information.

Also, thank you for the hat tip to Ocean. Thoughtful comments are always deeply appreciated!
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  #4  
Old 08-06-2011, 05:17 AM
jerusalemite jerusalemite is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Read Dr. Marcia Angell's articles in the "New York Review of Books" (http://www.nybooks.com/contributors/marcia-angell/). John Horgan is spot on about string theory (last week) and the inefficacy of antidepressants.
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  #5  
Old 08-06-2011, 06:42 AM
SkepticDoc SkepticDoc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I hope John and George are not covert Scientologists...
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  #6  
Old 08-06-2011, 07:09 AM
Starwatcher162536 Starwatcher162536 is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I'm twenty-five minutes into this and have heard John mention some dozen times that anti-depressants can improve behavior in the short term but incur long term costs. What are these long term costs?
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  #7  
Old 08-06-2011, 07:20 AM
Starwatcher162536 Starwatcher162536 is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

After sampling John many times over a wide variety of topical subjects it becomes clear that John's claims of being an (?ex?) hippie have truth to them.
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  #8  
Old 08-06-2011, 08:23 AM
frontier_sally frontier_sally is offline
 
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Default Sleep and Depression

Very interesting diavlog. Defintely going to check out Whitaker's book, John.

One question (maybe Ocean has some insight here): What is the status of research on the link between sleep and depression? In particular, sleep deprivation as a treatment for depression. Is this treatment considered 'alternative'? How often is it attempted as a modern treatment of depression? Is there enough anecdotal evidence and/or solid research to warrant more funding/media attention for sleep-modification treatment(s) of depression, especially in light of the high potential costs of coventional psychopharmacology?

Okay, that was more than one question...
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  #9  
Old 08-06-2011, 08:58 AM
bkjazfan bkjazfan is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

What to do with the seriously mentally ill?

One way that is prevalent in California is to have them live in board and care homes. These places are are nothing but glorifed wearhouses and are almost without exception scandously run operations by grubby money seekers who could care less for the people they are responsible for taking care of. The oversight of them by local and federal agencies is laughable. By the way, I have lived in several but not anymore.

Ostensibly the closing of state hospitals was for the purpose of moving the patients to community run operations which in large part have never existed. Consequently, many are living in the streets, incarcerated, or in these corrupt board and care homes. This was not a smooth transition by any measure.

Last edited by bkjazfan; 08-06-2011 at 09:55 AM..
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  #10  
Old 08-06-2011, 09:45 AM
Ocean Ocean is offline
 
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Default Re: John has gone off the deep end

Quote:
Originally Posted by thprop View Post
I have little respect for John anymore. His critique of string theory was taken apart in his diavlog with George Musser. He insists that we have free will because it is good to have. Jerry Coyne dismiised those arguments.

Now he is into conspiracy theory. Here are a few counters to Whitaker:
Carlat

A debate on the subject



A mental health professional who says to take his research seriously

John lets his own feelings override science.
I'm about 16 minutes into the diavlog. I don't know whether I've lost respect for John or not because I'm rather familiar with his overall take on psychiatry and psychiatric medications and also his tendency to get agitated over something he just read that confirms some previous idea he had (confirmation bias).

But, so far, all I can say is that I wish he was more measured in expressing radical opinions.

Thank you, thprop, for your links.
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  #11  
Old 08-06-2011, 09:46 AM
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Default Re: Sleep and Depression

Quote:
Originally Posted by frontier_sally View Post
Very interesting diavlog. Defintely going to check out Whitaker's book, John.

One question (maybe Ocean has some insight here): What is the status of research on the link between sleep and depression? In particular, sleep deprivation as a treatment for depression. Is this treatment considered 'alternative'? How often is it attempted as a modern treatment of depression? Is there enough anecdotal evidence and/or solid research to warrant more funding/media attention for sleep-modification treatment(s) of depression, especially in light of the high potential costs of coventional psychopharmacology?

Okay, that was more than one question...
The quick answer is that it is impractical.
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  #12  
Old 08-06-2011, 10:47 AM
badhatharry badhatharry is offline
 
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Default Re: John has gone off the deep end

Quote:
Quoting thprop:
John lets his own feelings override science.
I don't know about all of his diavlogs, but in this one he seemed pretty even handed in his critique of Whitakers book. In fact, the closing paragraph of the Carlat piece says this:

Quote:
Whitaker does a great job documenting an astonishing rise in psychiatric disability, but he erroneously blames the drugs, when the actual causes are more nuanced and multifactorial.
This may be simply Carlat's opinion because he disagrees or maybe Whitaker doesn't go as far as Carlat is implying or maybe he's correct in his evaluation of the book. At any rate, I think John, although he likes the book wasn't being over the moon about it.
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  #13  
Old 08-06-2011, 11:04 AM
eeeeeeeli eeeeeeeli is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
Originally Posted by bkjazfan View Post
What to do with the seriously mentally ill?

One way that is prevalent in California is to have them live in board and care homes. These places are are nothing but glorifed wearhouses and are almost without exception scandously run operations by grubby money seekers who could care less for the people they are responsible for taking care of. The oversight of them by local and federal agencies is laughable. By the way, I have lived in several but not anymore.

Ostensibly the closing of state hospitals was for the purpose of moving the patients to community run operations which in large part have never existed. Consequently, many are living in the streets, incarcerated, or in these corrupt board and care homes. This was not a smooth transition by any measure.
I worked for a number of years in San Francisco, mainly in the Tenderloin district, which was almost a modern day mental institution, considering the number of mentally ill people living there. (I specifically worked with those with "triple diagnosis", meaning: AIDS, Mental Illness, and Drug Addiction.) Yet what basically happened was that they received a monthly check, which they then spent on a single room in a sleazy hotel. It often seemed nightmarish.

Later, in Portland, I worked with schizophrenics in a residential center and it was far better. But it was still terribly unfunded, and we struggled to provide them anything like quality care.
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  #14  
Old 08-06-2011, 11:52 AM
badhatharry badhatharry is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
Originally Posted by eeeeeeeli View Post
I worked for a number of years in San Francisco, mainly in the Tenderloin district, which was almost a modern day mental institution, considering the number of mentally ill people living there. (I specifically worked with those with "triple diagnosis", meaning: AIDS, Mental Illness, and Drug Addiction.) Yet what basically happened was that they received a monthly check, which they then spent on a single room in a sleazy hotel. It often seemed nightmarish.
I used to live in the Tenderloin, yes I did. Several years ago I went back to show my daughter where her mom and aunt had lived. Big difference, although it was no great shakes when I lived there. The sidewalk in front of Glide Memorial looked and smelled like a toilet.
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  #15  
Old 08-06-2011, 11:59 AM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I'm busy with three or four other things, so I'm listening to this in bits and pieces.

John states that according to Whitaker, mental illness based disability benefits has tripled in recent years. He acknowledges that this could be due to many other factors, possibly unrelated to treatment, but still brings it up as an argument.

We have to decide whether from a scientific perspective, the rate of disability benefits is a good indicator of treatment outcomes, or whether it is not. If it is not, then toss it away. And be mindful that the writer that uses a shaky argument like that to make a point starts to raise eyebrows about his overall credibility.

Anecdote: in the clinic where I work I get patients sent by the Board of Social Services because during an interview with a social worker they said something that sounded like depression. The person applying for benefits is told to come to the clinic for evaluation and treatment and additionally because they may qualify for some form of disability benefits. One has to wonder whether as welfare benefits were cut down and shifted to the individual states, there was a shift of those welfare recipients who may have psychiatric symptomatology to the disability benefits system.

John also mentions the increase in antidepressant/antipsychotic prescribing. Most antidepressants are prescribed by primary care physicians. The advent of the newer (20+ years ago) safer antidepressants and improved education about mental illness in medical schools have been most likely the main reasons for this increase.

I'll see if I can finish listening to this conversation.
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  #16  
Old 08-06-2011, 12:02 PM
dannyc dannyc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

John has argued this point strongly before. It is certainly important that this discussion be had. But perhaps having a diavlog with John and an expert on this who disagrees would be more helpful.
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  #17  
Old 08-06-2011, 12:31 PM
bkjazfan bkjazfan is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

The Minerva Cafe, a Greek restaurant in the Tenderloin, has good food. I worked for a few years at The Canterbury Hotel on Mason which is not far from the Tenderloin, while living in the Mission district.

Uh oh, I see the Minerva has moved to Pacific Heights, a swanky area, indeed.

Last edited by bkjazfan; 08-06-2011 at 12:35 PM..
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  #18  
Old 08-06-2011, 12:35 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Yikes!

The Hamilton Depression Rating Scale is not an instrument to be self administered and it is not an instrument to diagnose depression. It is meant to be used with patients who have already been diagnosed as having depression (which is a clinical diagnoses, made by a training clinician). The scale is used to quantify the symptoms of depression.

If treatment is going to be started, treatment outcomes will have to be measured. The Hamilton scale provides a way of quantifying symptoms that can be repeated at certain intervals to quantify improvement.

There are lots of limitations to these instruments, but they are an approximation to quantification. Otherwise the treatment outcome would have to be defined in "feeling better", "a little better", "much better". What does that mean?

Definitely not a perfect instrument, just a means to grossly quantify outcomes. Not a diagnostic instrument.

And yes, there is an overlap of symptoms between symptoms of depression and other conditions, some medical, some old age problems.

The original introduction of the instrument is here.

Of note this instrument was created long before (1960) the new antidepressants entered the market or were even conceived. Hard to argue it's part of the massive worldwide conspiracy.
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  #19  
Old 08-06-2011, 12:42 PM
willmybasilgrow willmybasilgrow is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

It's good to have this discussion, but for those of us who've done reading on it - book upon book - this is the basic stuff. Like so much in current culture, this discussion is at the beginning stages, and we never really advance, and go deeper into reason, logic, etc... It's like nonstop headline repeating.

Drill down: 'seriously deranged,' -- can we be a little more detailed and challenge our assumptions here?

Neither one seemed to know about past programs in the US where meds were last resort. There were some.

"serious mental illness," -- again, the point of Whitaker is to challenge these labels, not reinforce them.

I doubt GJ is going to read the book even though he says he's interested in it. I doubt he is. He's a total believer in anti depressants.

So what are psychiatrists doing? They're not knowingly harming patients. They're being careless and watching their wallets. They have given up logic. End of story. They are careless and illogical.

John undoes everything by calling them "diseases."

Again, GJ's assumptions about the state of people who went into mental hospitals. So many unquestioned assumptions. So many. Guess no one wants to question hospital dementia. No one, nohow, nowhere.

GJ's assumptions could have been less draconian and stereotypical and more current and real world to today.
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  #20  
Old 08-06-2011, 12:51 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Originally Posted by willmybasilgrow View Post

So what are psychiatrists doing? They're not knowingly harming patients. They're being careless and watching their wallets. They have given up logic. End of story. They are careless and illogical.
Wow. And all that based on what exactly?
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  #21  
Old 08-06-2011, 12:54 PM
willmybasilgrow willmybasilgrow is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Experience.
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  #22  
Old 08-06-2011, 01:09 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Then there's this bit about people with Schizophrenia doing better without treatment than with treatment. Another amazing claim. Where's the evidence? John says it's anecdotal and non conclusive. So, perhaps we should also toss out claims based on anecdotal and inconclusive evidence.

Patient with severe mental illness, including schizophrenia, ended up their days in state hospitals, or asylums. Some, the ones that had families and not serious behavioral problems, may have been kept in their homes, taken care of by family members. That's what happens in much of the world with intact extended families, especially if there's significant stigma associated with mental illness. People suffering from those problems are hidden from the rest of society because they're a shame to the family.

In the US, after desinstitutionalization, thanks to the availability of antipsychotic meds, patients were supposed to be reintegrated to the community through programs that would provide the necessary support. At the beginning the idea is that with the money saved from long term hospitalization those programs can be funded. Of course, those are the programs that get cut every time we get governments that decide that cutting spending is more important than the health or wellbeing of the most vulnerable populations.

So, many of those patients dropped out of treatment. Some are in the streets, in the shelter systems. They are many of the homeless that you can see living under bridges. Others are in prison. Others end up in state hospitals, in and out.

Psychiatric patients who follow up with treatment, manage to stay out of the hospitals and in their communities. Many of them know about the side effects caused by medications. I encourage patients who present some of the worse side effects to decrease the dose of their medications or switch to something that is less likely to cause them. Most of the most severely ill don't want to change anything because what they're taking is working. They aren't hearing voices or paranoid or violent. They have managed outside the hospital. Some of them have part time jobs (pushing carts in supermarkets is a popular one). Or they help with building maintenance or landscaping. In the old times they would have stayed in the hospital until they died.
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  #23  
Old 08-06-2011, 01:09 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Originally Posted by willmybasilgrow View Post
Experience.
What experience?
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  #24  
Old 08-06-2011, 01:22 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

If anyone has a link to the Finland studies that John mentions, I would like to take a look.

People with schizophrenia were treated with psychotherapy only in quite a number of facilities in the US and it was a total disaster. I grant that the treatment approach is key to success or failure of treatment, so I'd love to see those studies.

One of the main theories of how schizophrenia symptoms occur is that there is a deficit of dopamine to certain areas of the brain. That causes social isolation and decreased motivation. The brain in an attempt to compensate increases the availability of dopamine. Unfortunately that availability increases everywhere, not just in the areas that were lacking. So an increase of dopamine to the temporal lobes, for example, will cause auditory hallucinations, in others paranoia or violent reactions out of fear. Some Scandinavian countries had started an early intervention program by which teenagers showing the early signs of schizophrenia would be started on medications to prevent progression to the worst forms. Those patients had a better outcome than those who were not treated with antipsychotics. Here: easy reading.
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Old 08-06-2011, 01:43 PM
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
Originally Posted by Ocean View Post
If anyone has a link to the Finland studies that John mentions, I would like to take a look.

People with schizophrenia were treated with psychotherapy only in quite a number of facilities in the US and it was a total disaster. I grant that the treatment approach is key to success or failure of treatment, so I'd love to see those studies.
Why do they need treatment at all? What's wrong with the good old-fashioned straitjacket? Why should I have to pay because someone else is mentally ill?
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Old 08-06-2011, 02:08 PM
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Originally Posted by apple View Post
Why do they need treatment at all? What's wrong with the good old-fashioned straitjacket? Why should I have to pay because someone else is mentally ill?
Are you branching out from hating all mooslems all the time to including the mentally ill? Straitjackets cost money to. Why not just euthanize?
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  #27  
Old 08-06-2011, 02:13 PM
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Are you branching out from hating all mooslems all the time to including the mentally ill?
Why should I hate them? I just don't see why taxpayers should be forced to pay to give the mentally ill expensive treatments. They're the ones with the problem, not the taxpayers.

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Straitjackets cost money to.
They cost money to do what?
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  #28  
Old 08-06-2011, 02:14 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I'm still digesting one piece of conversation at a time.

I got to the part where John kindly requests my comment on the book. So, here's what I have to say:

I can't comment on a book that I haven't read. I can comment on what I hear John describe about the book and a few reviews that I looked at following thprop's links. All the comments I already made are based on this discussion.

But I want to add another piece, perhaps a disclosure about my general position as a psychiatrist.

My interest in psychiatry started as an interest in psychology and psychotherapy. I followed advise to pursue medical training and psychiatry instead. My understanding of psychiatry was that I would be able to integrate psychotherapy and medications to offer both treatment modalities. Unfortunately I entered this field at a time when managed care decided that it was too expensive to pay for psychiatrists providing psychotherapy and therefore they would be relegated to medication prescribing. Since I'm not independently wealthy I had to follow the same trend as the rest of my colleagues.

However, because of my initial interest, I'm among the psychiatrists who favor psychotherapeutic interventions whenever possible. I also favor using the lowest effective doses of medications. I favor using fewer medications instead of polypharmacy. I favor family and social interventions. I favor stress reduction, symptom management, coping skills, relaxation techniques. I try to engage patients in decision making within the boundaries of what's medically reasonable.

I see patients that don't respond to certain medications but respond to others. Obviously brain chemistry is very individual and the exact properties of a given medication may not be a good match for everybody. Some people come to see me after having been treated by other psychiatrists. They may walk in taking eight or more different medications. Sometimes they are taking what I call (as with street drugs) uppers and downers. I refer to medications that are stimulating but can increase anxiety and cause hypervigilance and insomnia (uppers), and they are combined with sedatives to counter those effects (downers). Very often I start to get people off those meds. Very often they do better with less than with more. Sometimes people have very refractory psychiatric problems and seem to benefit from multiple meds. I wish I had more resources to take them off all meds and try them on one or two at a time until we find the optimal combination. Most of the time that's difficult or impossible because patients can become symptomatic while in the process and have to be hospitalized.

In brief, and going back to John's request, I haven't read the book. According to some of the commentary he cites many important studies and historical evidence, but he may not be interpreting that evidence correctly. If that's the case, once you trim his book from all the misinterpretations how much is left that has real substance? I can't answer the question, but I think that we have to follow the experts who have commented on it.

I do resent that John would be given to think of any kind of master plan conspiracy, as if an entire community of physicians, not just in this country but in the entire world are colluding to pretend that medications are beneficial to patients if they were not.

George was interested in the review article from NEJM about depression. He seemed surprised about serotonin being only one of the neurotransmitters in the pathways that mediate depression. Just in case, that wasn't clear, it isn't new that it is not the only one. We've known this for a long time. There are plenty of other neurotransmitters and peptides implicated.

I recommend that people read that article which is linked in the main page, but here's again. I think that paying attention to the studies with mice that have been subjected to certain conditions (abuse) and how their responses are different to normal mice and reversed by antidepressants is of note. Not everything has to be placebo or determined by previous exposure to antidepressants. And it also shows long term consequences of abuse being biologically mediated.

Quote:
Adult rodents that were separated from their mothers or abused as pups show increased immobility in the forced swim test, which is reversed by antidepressant treatment.
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  #29  
Old 08-06-2011, 02:17 PM
Wonderment Wonderment is offline
 
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Default Re: John has gone off the deep end

Quote:
But, so far, all I can say is that I wish he was more measured in expressing radical opinions.
I love John, but it's probably best for him not to come on BHTV the morning after he's under the impression that he's just read the most important book in the whole wide world.

John gets passionate about radical ideas (a trait I have some personal familiarity with), and he is a tad conspiratorial and susceptible to polemical anti-authoritarian arguments (I prescribe a homeopathic dose of anti-Prozac once a year to cure this malady).

I'm glad George tried to talk John down from the most radical claim about the MSM being in cahoots with Big Pharma not to review groundbreaking books.

Having said all that, I'm certainly disgusted by overprescribing practices of physicians (as Ocean has pointed out before, most are general practitioners, not psychiatrists) regarding stimulants for children (Ritalin, Adderall, etc.) and anti-depressants for anyone who walks in the door feeling sad or fatigued. There's also the huge problem that psychiatrists no longer can afford to do therapy and have to see 4 patients an hour (or something like that) for med-management.

The jury is still out on anti-depressants. It's clear that they help some people (beyond placebo effect), while they may do nothing except placebo for millions of others who have had them prescribed.

On anti-psychotics, there is no question that the medications can successfully treat many forms of severe mental illness. Of course, they have serious side effects. What doesn't? The idea that schizophrenics should be left unmedicated sounds completely whacko to me.
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  #30  
Old 08-06-2011, 02:37 PM
bkjazfan bkjazfan is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

It appears John is misinformed about the debilitating effects of mental illness and it it should be treated. Other than reading books about it how much time on the ground with the mentally ill has he spent? Everything he says on the subject should be taken with a grain of salt.
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  #31  
Old 08-06-2011, 02:41 PM
AemJeff AemJeff is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Originally Posted by apple View Post
Why should I hate them? I just don't see why taxpayers should be forced to pay to give the mentally ill expensive treatments. They're the ones with the problem, not the taxpayers.



They cost money to do what?
Because tomorrow it might be me, and I'd like treatment then, please.
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  #32  
Old 08-06-2011, 03:09 PM
BornAgainDemocrat BornAgainDemocrat is offline
 
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Default Re: Oral Sex and Squamous-cell carcinoma

As a former patient (stage III) I have some bad news and some good news regarding squamous-cell carcinomas of the head and neck. The bad news is that ORAL SEX has recently been shown to be an important causative factor for this particular cancer. The vector is a certain papillomavirus which is widespread in the general population. This fact has not received widespread coverage in the media to date, probably because the subject is embarrassing and because the link has only been established over the past ten years or so. But, hey, after AIDS nothing should be embarrassing.

The good news -- which is very new indeed -- is that those whose stage III carcinoma has been caused by the papillomavirus have a 90% 5-year survival rate, not the 50% rate I was informed I had twelve years ago. My doctors at Sloan Kettering were dubious when I told them that I had never been a big smoker or drinker, which at the time were the only two big known risk factors. Oral sex and papillomaviruses weren't on their radar at the time.

I got this good news by the way just two weeks ago via my back-up surgeon, Dr. James Netterville, at Vanderbilt University, who is well-respected in the field and a good friend of Jatin Shah, my primary surgeon at Sloan Kettering. I am sure he knew what he was talking about.

Anyway, a good story here for a science writer. P.S. There are shots available to prevent the papillomavirus.

Last edited by BornAgainDemocrat; 08-06-2011 at 03:38 PM..
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Old 08-06-2011, 03:16 PM
SkepticDoc SkepticDoc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I am a "PCP" in the trenches, SSRIs are popular because they work and are safe.

Nobody forces any patient to take them, most patients stop them too early and then it is harder to gain any benefit from them. Many of my patients decide to continue them because they feel better on them after they wean them off for whatever reason.

Several of the medications are cheap generics, paroxetine, fluoxetine and citalopram are available for $4 for 30 days or $10 for 90 days at WalMart, Kmart, Target and other major retailers. So much for the 'Big Pharma" conspiracy.

George should know better when taking about biochemical analysis of neurotransmitters, the total amount is not important, the availability at certain points of the neuronal complex is, I would not dare question particle physics theory because the analysis is complex and involves extensive training and expensive equipment, the "Physics Gospel" comes after computer analysis and statistical massaging of data, the validation comes after duplication of the experiments. With people that is impossible, we all are unique collections of matter/energy with perhaps some non-physical element, soul/mind/spirit or none of the above. Each individual's condition is unique with many factors outside of the person, upbringing, family and work experiences, non-medical drug use/experimentation and many other factors. Physicists can smash electrons and protons at will to study the physical reality, even if we lost all ethical sense and dissected a mentally ill person, we would not be able to find the biologic abnormality that caused the illness.

Hippies experimented with hallucinogens, some suffered long lasting brain damage, others were able to be productive in fields like Science and Writing in spite of their drug experimentation, look up Ken Kesey. Alex Gibney was interviewed by Bob Edwards for his newly released film http://www.magictripmovie.com/ , the interview revealed Kesey was an experimental subject for the CIA projects to use hallucinogens in interrogations, and he discovered that he really liked the "trips", and let's not forget "Dr" Leary!

There is evidence of "Big Pharma" marketing expensive drugs on TV, I am particularly concerned with the promotion of the use of expensive branded major tranquilizers that are associated with weight gain and diabetes, from ProPublica, there are several other cases and medications.

Maybe John will work out his aversion to medications and his prejudice against Psychiatrists
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Old 08-06-2011, 03:23 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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There is evidence of "Big Pharma" marketing expensive drugs on TV, I am particularly concerned with the promotion of the use of expensive branded major tranquilizers that are associated with weight gain and diabetes, from ProPublica, there are several other cases and medications.
I'm appalled by the way medications are promoted to the public. It's a terrible practice. I guess that's part of free marketing.

I have patients that come in asking "how about medication A? I heard on TV that's great for depression! Can we try it?" At the same time, this person may not have a diagnosis of depression at all.
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Old 08-06-2011, 03:37 PM
SkepticDoc SkepticDoc is offline
 
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Default Re: Oral Sex and Squamous-cell carcinoma

http://www.tripdatabase.com/search?c...+carcinoma+hpv

This is reliable medical information.
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  #36  
Old 08-06-2011, 03:40 PM
BornAgainDemocrat BornAgainDemocrat is offline
 
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Default Re: Oral Sex and Squamous-cell carcinoma

Thanks, Skeptic.
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Old 08-06-2011, 04:15 PM
BornAgainDemocrat BornAgainDemocrat is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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One of the main theories of how schizophrenia symptoms occur is that there is a deficit of dopamine to certain areas of the brain. That causes social isolation and decreased motivation. The brain in an attempt to compensate increases the availability of dopamine. Unfortunately that availability increases everywhere, not just in the areas that were lacking. So an increase of dopamine to the temporal lobes, for example, will cause auditory hallucinations, in others paranoia or violent reactions out of fear. Some Scandinavian countries had started an early intervention program by which teenagers showing the early signs of schizophrenia would be started on medications to prevent progression to the worst forms. Those patients had a better outcome than those who were not treated with antipsychotics. Here: easy reading.
I am in favor of anything that works, but when it comes to understanding the actual causes and mechanisms we know so little. You might like Kevin Mitchell's reporting on the subject, Ocean. The guy can really write.

Last edited by BornAgainDemocrat; 08-06-2011 at 04:25 PM..
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Old 08-06-2011, 04:35 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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I am in favor of anything that works, but when it comes to understanding the actual causes and mechanisms we know so little. You might like Kevin Mitchell's reporting on the subject, Ocean. The guy can really write.
Yes, I liked this article.

Kevin puts together the theory I was talking about, with another possible mechanism (which can coexist with the dopamine theory) the over or underpruning of synaptic connections. He then describes a computer model that imitates a simplified neural network. I loved that part because it's so difficult to explain to people who are not informed about how these networks work. And he proceeds to describe the modeling of hallucinatory experience.

The bottom line is that hallucinations are the false recognition of stimuli which can be generated by one's own thoughts or externally. Network activation patterns misidentify the incoming stimuli as words.

Thanks. Good reading.
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Old 08-06-2011, 04:44 PM
ohreally ohreally is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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One of the main theories of how schizophrenia symptoms occur is that there is a deficit of dopamine to certain areas of the brain.
Carlat call this "a myth." Marcia Angell (former NEJM editor-in-chief) writes: "because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine. ... That was a great leap in logic, as all three authors point out." By that same logic, she writes "one could argue that fevers are caused by too little aspirin."

By the way, Marcia Angell makes Horgan's worries seem rather tame. And medicine is her field.
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Old 08-06-2011, 04:50 PM
whburgess whburgess is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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I worked for a number of years in San Francisco, mainly in the Tenderloin district, which was almost a modern day mental institution, considering the number of mentally ill people living there. (I specifically worked with those with "triple diagnosis", meaning: AIDS, Mental Illness, and Drug Addiction.) Yet what basically happened was that they received a monthly check, which they then spent on a single room in a sleazy hotel. It often seemed nightmarish.

Later, in Portland, I worked with schizophrenics in a residential center and it was far better. But it was still terribly unfunded, and we struggled to provide them anything like quality care.
I have a lot of admiration and appreciation for folks like you who do this work.
I'd like to take this opportunity to thank you.
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