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  #121  
Old 08-09-2011, 09:16 PM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
Originally Posted by willmybasilgrow View Post
There are a LARGE NUMBER of people who get through a diagnosis of schizophrenia without long term use of drugs and their bad effects. It's not at all apparent to me that many participating in this forum are even slightly familiar with these trends and movements beyond just labeling them "anti psychiatry" which of course many are. Seriously, guys, there are lots of people out there cobbling together treatments of their own, with help from friends and family members and the occasional professional. I know such a scenario must conjure up images of shotguns and violent psychotics to many of you, but that just ain't the reality.
I don't know what you mean by a large number of people. About 1% of the population has Schizophrenia. That would be about 3 million people in the US. Since a significant number of them are going to have a more benign course of their illness, they may be able to manage with lots of social support and minimal medications. Most people with Schizophrenia are not violent. So your comment isn't surprising. I just think we need to qualify the "large number" part.

In addition there are a number of people who present what we call brief psychotic episodes. Those are reversible. The symptoms may go away spontaneously within a month or so. I've seen many young people that once the acute psychosis is over, I try to get off their medications carefully. If the symptoms return it may be that they need ongoing medications, but on occasion they do well without medications. Those cases aren't too frequent but it's always a relief for everybody, patient, family and mental health providers as well.
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  #122  
Old 08-10-2011, 11:03 PM
ledocs ledocs is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

So the Angell article has elicited a response and a dialog in "The New York Times," principally this article by the author of "Listening to Prozac."

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html?pagewanted=all#h[]

Kramer's strongest scientific claim is that for mild-moderate depression, or for dusthymia, and based upon clinical trials, antidepressants work better than nothing for about 20% of the population of patients who have been properly diagnosed (50% of the population show no improvement; another large chunk, approaching 1/3 of the population, per Kramer, get better with a placebo). Kramer says that this level of efficacy is typical, but I rather doubt that most patients are aware of this, or are told this.

Kramer makes no attempt to ground the efficacy of antidepressants in a scientific theory, either with respect to aetiology or with respect to mechanism. Carlat says that the serotonin story is essentially a fairy tale.

Kramer does have the following paragraph, in response to Kirsch:

Quote:
One reason the F.D.A. manages to identify useful medicines is that it looks at a range of evidence. It encourages companies to submit “maintenance studies.” In these trials, researchers take patients who are doing well on medication and switch some to dummy pills. If the drugs are acting as placebos, switching should do nothing. In an analysis that looked at maintenance studies for 4,410 patients with a range of severity levels, antidepressants cut the odds of relapse by 70 percent. These results, rarely referenced in the antidepressant-as-placebo literature, hardly suggest that the usefulness of the drugs is all in patients’ heads.
However, this paragraph presumably applies to that part of the population who are responding positively to drug treatment. But if Kirsch has not addressed this finding, and I presume that he has not, he should have done so.

If mind and brain are distinct, the two nevertheless communicate. No one thinks that there is a human mind or consciousness in the absence of a human brain. How there could be a nonphysical entity that is distinct from, but nevertheless acts upon the physical brain, is a great mystery, but no greater than the mystery of an entirely physical consciousness, which to my "mind" is not only a mystery, but an absurdity. To the extent that a predisposition to schizophrenia is inherited, for example, it makes sense that this would be a disease of primarily biological, or genetic origin, representing a dysfunction in the brain. For the common mood disorder, or depression, common sense would say that the origin of the problem tends to be in the conditions of human life generally, or in the patient's life circumstances. That is, by hypothesis, we are dealing with a truly "mental" problem, not with a brain problem. On the other hand, by the same hypothesis, mind and brain do interact, so one can affect both mind and brain by altering the brain.

What troubles me about the discussion we heard, and about the Kramer piece cited above, and about the whole debate, is that it occurs in the apparent absence of serious thought about the mental versus the physical. It also troubles me that Kramer does not address the question of whether the chemical imbalance theory of serotonin deficiency has any scientific basis. Wonderment (and eeeeli) seemed to be content with the idea that results are all that matter. (And I, too, have conceded that I would be most concerned with results if I or someone close to me were the person with serious symptoms of mental disorder.) But I would have preferred, for example, that the diavlog address the question of how often it is the case in science generally that we would rely on the working of something for which there is no good working scientific hypothesis (assuming, for the moment, that this is the case for antidepressants). And Kramer does not address the following crucial passage in the first Angell article:

Quote:
When it was found that psychoactive drugs affect neurotransmitter levels in the brain, as evidenced mainly by the levels of their breakdown products in the spinal fluid, the theory arose that the cause of mental illness is an abnormality in the brain's concentration of these chemicals that is specifically countered by the appropriate drug...Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin...Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug...That was a great leap in logic, as all three authors [sc. under review] point out. It was entirely possible that drugs that affected neurotransitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place...similarly, one could argue that fevers are caused by too little aspirin.
So there are different issues here. One is that of drug efficacy in the treatment of mental disorders, and there the question gets divided between the very serious disorders and the less serious ones. But the other issues have to do with scientific method, the theory of the mental, and the theory of mental disorder. Freud started out as a biologically oriented theorist. He then developed theories of mental disorder that had nothing to do with biology or the brain, or at least nothing explicit. Now psychiatry has lurched or reverted back to a largely biological orientation. My problem with this is insofar as the nature of the mental has already been decided upon implicitly. John Searle, for instance, is completely convinced that mind = brain, but he is no closer to understanding how this could be so than he was thirty years ago. Nevertheless, it must be so, per Searle.

As for the Whitaker book, no one here has read it, except for Horgan. It probably overstates its case in various ways. I also looked at a review of Carlat's book in "Psychiatric Times" and at Carlat's reply to the review. That review, by a professor of psychiatry, also avoided the entire subject of the chemical imbalance theory.
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Last edited by ledocs; 08-10-2011 at 11:08 PM..
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  #123  
Old 08-11-2011, 12:28 AM
Wonderment Wonderment is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I don't really see the basis for dragging the whole mind-body problem into the discussion of treatments for mental illness.

Most practitioners and research scientists are not philosophers, and they have no need to be; they are just looking for efficacious treatments. The consensus for psychiatric illness, including clinical depression, is that a combination of therapy and medication works best.

What distorts the good science and the best clinical practices are not philosophical misunderstandings but rather economic interests and systemic dysfunctionalities: pharma wants to sell all the pills it can, insurers don't want to cover talk therapy, patients with no insurance or high co-pays are disinclined to seek early treatment, people self-medicate with drugs, alcohol and other addictions.
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  #124  
Old 08-11-2011, 06:48 AM
ledocs ledocs is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
I don't really see the basis for dragging the whole mind-body problem into the discussion of treatments for mental illness.
The basis would be that one would presumably like to know what a mental illness is, or represents, in order to treat it properly. The reason for dragging this thorny issue into the debate is that psychiatry went the way of the body (psychopharmacology) and psychology went, by and large, the way of the mind (psychotherapy). And the reasons for this bifurcation were as much economic-institutional as they were theoretical, I suspect.

Obviously, it might well be a mistake to treat an illness that is not really biological on the basis of a theoretical model of the illness that is biological. Human consciousness is not a car, not a house, it's not a hi-fi system, not an airplane, not an H-bomb, but the tendency has been to treat it as if it were. If, from a methodological point of view, psychiatry and philosophy were withholding judgment on the mind-body question, that would be one thing. But I don't think that is the case, on balance, because the weight of science is with physicalism, as it must be. I am trying to argue that in the area of mental illness science should show some humility and, at the very least, withhold judgment on how the mind-body problem is to be resolved, if it is to be resolved. Another way of putting this is that psychology, and clinical psychotherapy are generally regarded by its practitioners as art, not science. The last psychotherapist I saw, a psychologist, was highly eclectic and pragmatic in his approach, he had anything but a unified theoretical model. From what he told me, it was a complete grab-bag of Freud, Jung, existential psychology, behavior modification techniques like bio-feedback, and so on. Psychiatry went the way of science, and has tried to arm itself with the trappings of science.

I am at a loss to understand you or anyone else when he says that I am importing an irrelevant question into this debate. Carlat, for example, has a lot of negative things to say about the relevance of medical training to the current practice of psychiatry. I am quite confident that some of this scientific training could be profitably abandoned in favor of training in the history of philosophy and of the mind-body problem, and it is my opinion that psychiatry would be the better for the change. This radical proposal runs entirely against the grain of the scientific impulse of psychiatry, of course, but that impulse is precisely what is at issue.
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  #125  
Old 08-11-2011, 07:25 AM
SkepticDoc SkepticDoc 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 Wonderment View Post
I don't really see the basis for dragging the whole mind-body problem into the discussion of treatments for mental illness.

Most practitioners and research scientists are not philosophers, and they have no need to be; they are just looking for efficacious treatments. The consensus for psychiatric illness, including clinical depression, is that a combination of therapy and medication works best.

What distorts the good science and the best clinical practices are not philosophical misunderstandings but rather economic interests and systemic dysfunctionalities: pharma wants to sell all the pills it can, insurers don't want to cover talk therapy, patients with no insurance or high co-pays are disinclined to seek early treatment, people self-medicate with drugs, alcohol and other addictions.
Thanks for a great synthesis!
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  #126  
Old 08-11-2011, 07:46 AM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Quote:
Originally Posted by ledocs View Post
So the Angell article has elicited a response and a dialog in "The New York Times," principally this article by the author of "Listening to Prozac."

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html?pagewanted=all#h[]

Kramer's strongest scientific claim is that for mild-moderate depression, or for dusthymia, and based upon clinical trials, antidepressants work better than nothing for about 20% of the population of patients who have been properly diagnosed (50% of the population show no improvement; another large chunk, approaching 1/3 of the population, per Kramer, get better with a placebo). Kramer says that this level of efficacy is typical, but I rather doubt that most patients are aware of this, or are told this.
The article you linked to, reads:

Quote:
A reliable finding is that antidepressants work for chronic and recurrent mild depression, the condition called dysthymia. More than half of patients on medicine get better, compared to less than a third taking a placebo. (This level of efficacy — far from ideal — is typical across a range of conditions in which antidepressants outperform placebos.) Similarly, even the analyses that doubt the usefulness of antidepressants find that they help with severe depression.
You said that you doubt that most patient are told "this". What do you mean by that? What is it that patients should be told?

Patients could be told that studies show placebo response. And then what? Send patients home? Or should we tell them to take a sugar pill daily instead of pursuing treatment of any kind? We can't give them a sugar pill without their knowledge, since patients that come for treatment are not participating in a study. We don't have an explanation for placebo effect. What exactly should be the conclusion driven from its existence that could be communicated to patients?

Quote:

If mind and brain are distinct, the two nevertheless communicate. No one thinks that there is a human mind or consciousness in the absence of a human brain. How there could be a nonphysical entity that is distinct from, but nevertheless acts upon the physical brain, is a great mystery, but no greater than the mystery of an entirely physical consciousness, which to my "mind" is not only a mystery, but an absurdity. To the extent that a predisposition to schizophrenia is inherited, for example, it makes sense that this would be a disease of primarily biological, or genetic origin, representing a dysfunction in the brain. For the common mood disorder, or depression, common sense would say that the origin of the problem tends to be in the conditions of human life generally, or in the patient's life circumstances. That is, by hypothesis, we are dealing with a truly "mental" problem, not with a brain problem. On the other hand, by the same hypothesis, mind and brain do interact, so one can affect both mind and brain by altering the brain.

What troubles me about the discussion we heard, and about the Kramer piece cited above, and about the whole debate, is that it occurs in the apparent absence of serious thought about the mental versus the physical. It also troubles me that Kramer does not address the question of whether the chemical imbalance theory of serotonin deficiency has any scientific basis. Wonderment (and eeeeli) seemed to be content with the idea that results are all that matter. (And I, too, have conceded that I would be most concerned with results if I or someone close to me were the person with serious symptoms of mental disorder.) But I would have preferred, for example, that the diavlog address the question of how often it is the case in science generally that we would rely on the working of something for which there is no good working scientific hypothesis (assuming, for the moment, that this is the case for antidepressants). And Kramer does not address the following crucial passage in the first Angell article:



So there are different issues here. One is that of drug efficacy in the treatment of mental disorders, and there the question gets divided between the very serious disorders and the less serious ones. But the other issues have to do with scientific method, the theory of the mental, and the theory of mental disorder. Freud started out as a biologically oriented theorist. He then developed theories of mental disorder that had nothing to do with biology or the brain, or at least nothing explicit. Now psychiatry has lurched or reverted back to a largely biological orientation. My problem with this is insofar as the nature of the mental has already been decided upon implicitly. John Searle, for instance, is completely convinced that mind = brain, but he is no closer to understanding how this could be so than he was thirty years ago. Nevertheless, it must be so, per Searle.

As for the Whitaker book, no one here has read it, except for Horgan. It probably overstates its case in various ways. I also looked at a review of Carlat's book in "Psychiatric Times" and at Carlat's reply to the review. That review, by a professor of psychiatry, also avoided the entire subject of the chemical imbalance theory.
I don't think that any of the people involved in this debate is considering or questioning that mind is a direct product of the brain. That's why you don't see it discussed.
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  #127  
Old 08-11-2011, 08:02 AM
Ocean Ocean is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

ledocs,

You're bringing in the mind-brain duality issue into this discussion. I won't question your interest in the topic. But you make it sound as if it's central to the discussion when it's not.

You even say something about lacking humility, and I think that's a completely gratuitous criticism since it's based on an erroneous interpretation, on your part, as to what the discussion is about (not your discussion, but what everyone else here, including the authors you're citing, is talking about).

Whether you argue or favor psychotherapy or pharmacology for the treatment of psychiatric conditions we're still talking about mind as the product of the brain. You can affect brain and mind by providing medications or other psychotropic substances. Think about when you drink alcohol. Do you have doubts that it affects your mind? It obviously affects your brain and its product: mind.

But you can also affect mind (and brain) with experience, or talk, or psychotherapy. When we learn something, say by going to a class and listening to the teacher, doing homework and some reading, we are establishing connections in our neuronal network that allow us to remember what we learn and apply it to other circumstances. That's an example of something that is not a substance, that affects your brain (neuronal connections). The same applies to psychotherapy. There are imaging studies showing brain changes as a result of psychotherapy.

So, again, I don't think anyone in the field of psychology or psychiatry is questioning that mind is the product of the brain. The duality issue that you raise can only be construed in the sense of studying the two from different perspectives, as a philosophical topic if you want. But it doesn't belong to this discussion and there's nothing that the current authors being discussed have said that can be extrapolated to argue for duality.
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  #128  
Old 08-11-2011, 08:42 AM
Florian Florian 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 ledocs View Post
To the extent that a predisposition to schizophrenia is inherited, for example, it makes sense that this would be a disease of primarily biological, or genetic origin, representing a dysfunction in the brain. For the common mood disorder, or depression, common sense would say that the origin of the problem tends to be in the conditions of human life generally, or in the patient's life circumstances. That is, by hypothesis, we are dealing with a truly "mental" problem, not with a brain problem. On the other hand, by the same hypothesis, mind and brain do interact, so one can affect both mind and brain by altering the brain..
I think this is a valid point, and I am not sure why it meets with such resistance from some psychiatrists (I am not thinking of you ocean!) If certain mood disorders---depression, melancholy, boredom, despair, anguish-----are related to the patient's life circumstances, or more generally to the "human condition," then there is a justification for examining what circumstances in particular, either in the present or the past, are at work in bringing about the mood disorders. Drug therapy, by working mainly as a sedation (or a stimulant) to the brain, forecloses self-understanding or self-analysis. Self-knowledge is difficult, as philosophers and writers have always known, because self-knowledge is always the self-knoweldge of a particular person, and it helps to be able to talk to an understanding but neutral listener to gain some clarity about oneself.

Quote:
Freud started out as a biologically oriented theorist. He then developed theories of mental disorder that had nothing to do with biology or the brain, or at least nothing explicit. Now psychiatry has lurched or reverted back to a largely biological orientation. My problem with this is insofar as the nature of the mental has already been decided upon implicitly. John Searle, for instance, is completely convinced that mind = brain, but he is no closer to understanding how this could be so than he was thirty years ago. Nevertheless, it must be so, per Searle..
Exactly. I would also say that this kind of biological determinism is a perfect example of what Sartre calls "la mauvaise foi": The self flees before its freedom into the inauthenticity of thinghood.

Last edited by Florian; 08-11-2011 at 08:51 AM..
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  #129  
Old 08-11-2011, 10:40 AM
ledocs ledocs is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Ocean said:

Quote:
You're bringing in the mind-brain duality issue into this discussion. I won't question your interest in the topic. But you make it sound as if it's central to the discussion when it's not.
I realize that you and probably most others who have any standing here (as I do not), if those who have standing are licensed psychiatrists in the US, say that it does not belong to the discussion, but I insist that it does, for the reasons, historical and theoretical, that I have given. All I can say is that you should reread my post. I am just as bewildered by your apparent failure to understand what I am on about as you are by my insistence on repeatedly bringing it up. I am also astonished that there is no literature that I am aware of about the relationship between the mind-body problem and the divide between psychology and psychiatry, the training curriculum in those two fields, and so on. (That I am not aware of such a literature does not by any means mean that it does not exist.) I have the vague feeling that this subject may come up in the work of that novelist Robert Wright talked to, Rebecca Weinstein. (And I now see how it was that Wright got to her, having looked her up in Wikipedia -- she is married to Stephen Pinker). I fear that we are at an impasse. I would just repeat that, even if Carlat would not subscribe to my prescriptions, I would think that psychiatry would profit from [re]introducing philosophy and the history of psychiatry into its required curriculum and discarding some of the medical training. But this would require a faculty that probably does not exist, it would have to start with a few people at a single place and then branch out.

I don't want this to be personal. I've tried to make my points. But whether or not mind-body is introduced into the discussion, there should be legitimate debate about the meaning of the clinical trials for antidepressants and all the other psychoactives, and about whether the serotonin deficiency model for depression has any real validity, even within the confines of physicalism, and so on.
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Last edited by ledocs; 08-11-2011 at 11:02 AM.. Reason: Thought better of concluding sentence, corrected an error
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  #130  
Old 08-11-2011, 12:23 PM
cosmic_electrons_dancing cosmic_electrons_dancing is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Bowen has said: "There is a little schizophrenia in all of us." In my view it is clearly the case. It is a basic part of nature itself. The hottest part of summer, in the northern hemisphere, occurs when the earth is at its farthest distance from the sun. Conversely, the coldest part of winter, in the northern hemisphere, is when the earth is closest to the sun in its migratory orbit around the sun. The seasons can be viewed as a schizophrenic phenomenon! Phenomena observed on biological, psychological, and sociological levels are interrelated.

"Family systems theory is based on the assumptions that the human is a product of evolution and that human behavior is significantly regulated by the same natural processes that regulate the behavior of all other living things. A corollary assumption is that clinical disorders are a product of that part of man he has in common with the lower animals. The human's elaborately developed cerebral cortex and complex psychology contribute to making him unique in some respects, but, despite these specializations, systems theory assumes that homo sapiens is far more like other life forms than different from them. While developed on the assumption of man's tie to nature, family systems theory is only a step towards understanding the human in this context of natural systems, since we have barely scratched the surface of what will eventually be known about the forces of nature which regulate the behavior of all life."

"In other words, one assumes not only that the activity of a cancer has an impact on the psychological state of the patient and on the patient's family relationships, but also that the family relationships and psychological state have some impact on the cancer. This is not to say that what is occurring in the family causes the cancer to act in certain ways, but only that the biological process of the cancer and the emotional process of the family, are to some degree, mutually influencing one another. While this kind of assumption is supported by ever increasing amounts of evidence from sources too numerous to mention, it still cannot be regarded as proven fact. If one assumes, however, that further research will only confirm the interrelationship of biological, psychological, and sociological levels, it can be easily seen that an integrative theory will eventually be developed, and that factors related to the family system will be an important part of that theory."

Quotes from: "FAMILY EVALUATION" by Kerr and Bowen
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  #131  
Old 08-11-2011, 01:50 PM
badhatharry badhatharry 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
Branch out.
I am actually not familiar with Fuller. I originally intended to post what were the impressions that I got from reading A Beautiful Mind and watching the movie of the same name. From those it seemed that Nash eschewed the drug regime he was under and decided to fight his disease head on with his 'beautiful mind'.

But then I read Fuller and thought that my original impressions were incorrect.

I am not someone who believes that mental health professionals are the only recourse for the mentally troubled/ill.

Also, I have always wondered if by studying people who experience paranoia when using marijuana there might be some insight into the paranoia experienced by schizophrenics. The reason I think this might be a feasible path of inquiry is that with marijuana users the effect can be induced in a controlled environment whereas with schizophrenics it is unpredictable.
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  #132  
Old 08-11-2011, 02:06 PM
badhatharry badhatharry is offline
 
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Originally Posted by ledocs View Post
I have the vague feeling that this subject may come up in the work of that novelist Robert Wright talked to, Rebecca Weinstein. (And I now see how it was that Wright got to her, having looked her up in Wikipedia -- she is married to Stephen Pinker).
The name is Rebecca Goldstein. She is not only a novelist and married to Steven Pinker, but has her doctorate in philosophy from Princeton. She has written about Spinoza and Gödel
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  #133  
Old 08-11-2011, 03:18 PM
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

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Originally Posted by ledocs View Post
Ocean said:



I realize that you and probably most others who have any standing here (as I do not), if those who have standing are licensed psychiatrists in the US, say that it does not belong to the discussion, but I insist that it does, for the reasons, historical and theoretical, that I have given. All I can say is that you should reread my post. I am just as bewildered by your apparent failure to understand what I am on about as you are by my insistence on repeatedly bringing it up. I am also astonished that there is no literature that I am aware of about the relationship between the mind-body problem and the divide between psychology and psychiatry, the training curriculum in those two fields, and so on. (That I am not aware of such a literature does not by any means mean that it does not exist.) I have the vague feeling that this subject may come up in the work of that novelist Robert Wright talked to, Rebecca Weinstein. (And I now see how it was that Wright got to her, having looked her up in Wikipedia -- she is married to Stephen Pinker). I fear that we are at an impasse. I would just repeat that, even if Carlat would not subscribe to my prescriptions, I would think that psychiatry would profit from [re]introducing philosophy and the history of psychiatry into its required curriculum and discarding some of the medical training. But this would require a faculty that probably does not exist, it would have to start with a few people at a single place and then branch out.

I don't want this to be personal. I've tried to make my points. But whether or not mind-body is introduced into the discussion, there should be legitimate debate about the meaning of the clinical trials for antidepressants and all the other psychoactives, and about whether the serotonin deficiency model for depression has any real validity, even within the confines of physicalism, and so on.
You seem to see a great gap between psychology and psychiatry from a conceptual perspective. I don't see that there's such gap. The difference is mostly about treatment modality, because one discipline specializes in psychotherapy, while the other has been pushed towards medication management by the market. (managed care). So, there's no real struggle between disciplines. It's mostly team work with different approaches. Of course there are always people on both camps that will think that their respective approach is better. That's unavoidable. But I don't see huge conceptual gaps in the fundamental principles.

You talk about mind-body here. There is a distinction between mind-brain, and mind-body in popular culture. I want to make sure we're talking about the same. Are you using those two indistinctly?
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  #134  
Old 08-11-2011, 03:30 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 Florian View Post
I think this is a valid point, and I am not sure why it meets with such resistance from some psychiatrists (I am not thinking of you ocean!) If certain mood disorders---depression, melancholy, boredom, despair, anguish-----are related to the patient's life circumstances, or more generally to the "human condition," then there is a justification for examining what circumstances in particular, either in the present or the past, are at work in bringing about the mood disorders.
That's correct. If someone is experiencing depression reactive to a life circumstance, a stressor, and the depression doesn't acquire the severity of a major depressive disorder where the person is unable to function, sleep, communicate with others, etc. medications may not be indicated. Even if the depression acquires the severity that indicates that they may benefit from medications, still the psychosocial stressor needs to be addressed.


Quote:
Drug therapy, by working mainly as a sedation (or a stimulant) to the brain, forecloses self-understanding or self-analysis. Self-knowledge is difficult, as philosophers and writers have always known, because self-knowledge is always the self-knoweldge of a particular person, and it helps to be able to talk to an understanding but neutral listener to gain some clarity about oneself.
That idea, is no longer accepted. There are some situations, for example heavy substance abuse, when it becomes clear that as long as the person is sedated or numbed out of their distress, they will not be willing to look at their problems in depth. As a matter of fact, it is because they don't want to look at their problems in depth that they may be abusing those substances.

However, antidepressants are not sedatives or stimulants. They don't foreclose self analysis. They restore balance at most. People are in a better position to analyze and work through their problems because their ability to process their life events and emotional responses is more intact.

Quote:
Exactly. I would also say that this kind of biological determinism is a perfect example of what Sartre calls "la mauvaise foi": The self flees before its freedom into the inauthenticity of thinghood.
I'm familiar with the idea.

When we talk about the kind of psychiatric disorders that we started talking about in this thread, we are not talking about those kinds of subtle existential escapes.
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Old 08-11-2011, 05:21 PM
Florian Florian is offline
 
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I'm familiar with the idea.

When we talk about the kind of psychiatric disorders that we started talking about in this thread, we are not talking about those kinds of subtle existential escapes.
This may be the reason why we (you and ledocs, and I) are engaged in a "dialogue des sourds." But I still wonder, after reading the NYRB article, if the tendency among American psychiatrists of the past 30 years hasn't been to revert to a biological/medical model of psychiatric disorders in order to avoid confronting the "existential" questions. That was the dominant model before Freud, and it appears to be once again the dominant model, at least in the US.

I am not suggesting that Freud is the only possible alternative to the biological/medical model of psychiatric disorders---Sartre, for example, thought that the Freudian idea of the unconscious was incoherent---but there are other ways of dealing with depression, melancholy, boredom, anguish---than popping pills.

.
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Old 08-11-2011, 06:10 PM
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This may be the reason why we (you and ledocs, and I) are engaged in a "dialogue des sourds." But I still wonder, after reading the NYRB article, if the tendency among American psychiatrists of the past 30 years hasn't been to revert to a biological/medical model of psychiatric disorders in order to avoid confronting the "existential" questions. That was the dominant model before Freud, and it appears to be once again the dominant model, at least in the US.
I think that moving to a biological-medical model is not an attempt to avoid the existential questions. Those existential questions were abandoned due to the rapid growth of the biological model (due to advances in the science behind it -whether good or bad science) which took over the field at a time when there were economic forces pushing psychotherapeutic approaches into other disciplines (psychologists and social workers). So there was no active avoidance but often being forced to give up that area. Many psychiatrists, including me, still resent that shift. I really came to this field with a different idea and not to limit my practice to prescribing medications. But we were forced by managed care and their impact on health care delivery systems.

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I am not suggesting that Freud is the only possible alternative to the biological/medical model of psychiatric disorders---Sartre, for example, thought that the Freudian idea of the unconscious was incoherent---but there are other ways of dealing with depression, melancholy, boredom, anguish---than popping pills.
Most certainly that's the case. Except for the most severe psychiatric disorders, for many others, psychotherapy in its different varieties, is still either one of the main treatment approaches or the main treatment approach.

Freud tried to put his ideas together too nicely and in detail, and he used a lot of imagination for that. That was his merit and his flaw. He contributed immensely to the field but no one follows him exactly any more. His ideas have been modified and improved by many. Some of his concepts were tossed out, others perfected.

There are other non-Freudian approaches to psychotherapy that are very effective for a variety of problems. Not everything has to go through the unconscious mind.
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Old 08-11-2011, 06:23 PM
miceelf miceelf is offline
 
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Most certainly that's the case. Except for the most severe psychiatric disorders, for many others, psychotherapy in its different varieties, is still either one of the main treatment approaches or the main treatment approach.
Even with the severe disorders, psychotherapy, albeit a different kind, can still be a really useful addition to treatment. As part of my internship, I worked in a program that did a modified CBT with chronic schizophrenics, focused on improving day to day functioning and essentially teaching them how not to act weird in a way that would mark them for everyone they met.

Complete aside, but the other APA (ours not yours) has a very large video series on sale, with leading therapists from different schools conducting therapy and then doing commentary on what they were doing. It's very enjoyable and I learned a lot outside of my comfortzone.
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  #138  
Old 08-11-2011, 06:45 PM
badhatharry badhatharry is offline
 
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yeah, now I'm real confused...

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You seem to see a great gap between psychology and psychiatry from a conceptual perspective. I don't see that there's such gap. The difference is mostly about treatment modality, because one discipline specializes in psychotherapy, while the other has been pushed towards medication management by the market. (managed care). So, there's no real struggle between disciplines.
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Quoting Ocean: Badhat, you're confusing the practice of psychiatry with psychoanalysis.
But I don't really want to talk about it and won't be checking back to this thread for any convoluted and/or insulting explanations from obfuscation R us.
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  #139  
Old 08-11-2011, 07:42 PM
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yeah, now I'm real confused...





But I don't really want to talk about it and won't be checking back to this thread for any convoluted and/or insulting explanations from obfuscation R us.
badhat, there's no contradiction in those statements even if you are confused about them.

There is no significant conceptual disagreement between the disciplines of psychology and psychiatry in terms of how psychiatric illnesses originate or their mechanisms. The biggest difference these days is that psychiatrists end up (due to managed care) prescribing medications, while psychologists and other mental health providers do psychotherapy.

This thread, based on the book that Horgan discussed has been mostly about the medication part. Psychoanalysis wasn't part of the discussion at all. When you gave the example it referred quite concretely to the kind of therapy situation that would be encountered in psychoanalysis (your reference to a couch) or in similar forms of therapy.

Is that clear now?
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  #140  
Old 08-11-2011, 07:45 PM
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Even with the severe disorders, psychotherapy, albeit a different kind, can still be a really useful addition to treatment. As part of my internship, I worked in a program that did a modified CBT with chronic schizophrenics, focused on improving day to day functioning and essentially teaching them how not to act weird in a way that would mark them for everyone they met.
Yes, I do some of that because patients often have residual symptoms.

In my previous comments, I meant that in the most severe cases, mainstream psychiatrist would always use medications, to which psychotherapy is an important add-on. For other disorders, psychotherapy may be the main treatment modality.
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  #141  
Old 08-11-2011, 07:57 PM
bkjazfan bkjazfan is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

I read this one report by Stanford University on how wonderful the anti-psychiotic drug clozaril is. Granted, everything they said about it was probably true. What they didn't say is the extreme docility and lethargy it produces in many of the people who are prescribed it. In fact, that is my main objection to heavily medicated psychiatrict patients who live in these board and care/assisted living homes. It's like the majority are going through the motions at best of what we call living. They may not be in state hospitals but those places are nothing but glorified warehouses for the mentally ill. They are a disgrace.

Last edited by bkjazfan; 08-11-2011 at 08:15 PM..
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  #142  
Old 08-11-2011, 08:06 PM
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I read this one report by Stanford University on how wonderful the anti-psychiotic drug clozaril is. Granted, everything they said about it was probably true. What they didn't say is the extreme docility and lethargy it produces in many of the people who are prescribed it.
I wouldn't call any antipsychotic drug wonderful.

Clozaril is considered one of the most effective medications for psychotic symptoms but it's far from being side effect free. It can actually cause very serious (but rare), life threatening side effects.
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Old 08-11-2011, 08:08 PM
bkjazfan bkjazfan is offline
 
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I wouldn't call any antipsychotic drug wonderful.

Clozaril is considered one of the most effective medications for psychotic symptoms but it's far from being side effect free. It can actually cause very serious (but rare), life threatening side effects.
Thank you for your valuable input.
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  #144  
Old 08-11-2011, 10:45 PM
willmybasilgrow willmybasilgrow is offline
 
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Why does everyone call the bad effects side effects? To me there are no side effects, just bad effects. The very vocabulary is telling.
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Old 08-12-2011, 02:22 PM
Florian Florian is offline
 
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There are other non-Freudian approaches to psychotherapy that are very effective for a variety of problems. Not everything has to go through the unconscious mind.
When I am unhappy, bored, melancholic, anguished I listen to music. It works wonders. Such as these two pieces from Saint Saën's Carnaval des animaux:

http://www.youtube.com/watch?v=AsD0FDLOKGA

http://www.youtube.com/watch?v=b44-5...eature=related

A stroll through the Louvre also cures me. Instantly. Or a good, well-written book.

A chacun sa vérité.

Last edited by Florian; 08-12-2011 at 02:48 PM..
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  #146  
Old 08-12-2011, 04:38 PM
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When I am unhappy, bored, melancholic, anguished I listen to music. It works wonders. Such as these two pieces from Saint Saën's Carnaval des animaux:

http://www.youtube.com/watch?v=AsD0FDLOKGA

http://www.youtube.com/watch?v=b44-5...eature=related

A stroll through the Louvre also cures me. Instantly. Or a good, well-written book.

A chacun sa vérité.
http://www.youtube.com/watch?v=cJsyM...otation_379719
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  #147  
Old 08-12-2011, 07:05 PM
willmybasilgrow willmybasilgrow is offline
 
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http://www.hulu.com/watch/266529/the...-nassir-ghaemi

A First Rate Madness

Our worst leaders are mentally healthy.

Colbert: "A manic depressive person then has the whole package."
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  #148  
Old 08-12-2011, 07:39 PM
Ocean Ocean is offline
 
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Originally Posted by willmybasilgrow View Post
http://www.hulu.com/watch/266529/the...-nassir-ghaemi

A First Rate Madness

Our worst leaders are mentally healthy.

Colbert: "A manic depressive person then has the whole package."
Heh. Great segment.

Yes, I agree with Dr. Ghaemi (about the overall idea, I don't know enough about the presidents but it sounds about right).

Indeed, many people being diagnosed with bipolar disorder (manic-depression), have difficulty accepting the idea that they may have a potentially severe (not always severe) psychiatric condition. I remind them that many people with bipolar are extremely high functioning, such as CEO's, political leaders, artists of different kinds. I remind them that many of the most creative people we have known in history have been manic-depressives.

So, yes, it is a bipolarity in many ways. Often patients ask me if there's a way of keeping them always a little hypomanic (feeling well and creative but not so much that they get in trouble due to risk taking or other impulsive behaviors). I wish I could help them with that. Unfortunately, most of the time, mania or hypomania are followed by depression, and sometimes that's a very high price to pay. But I've known people who can keep the extremes under control for extended periods. It's a risk, but not an unreasonable choice. I encourage them to have family involved so that they can monitor in case it gets out of control.

Family education is really very important. That's another good point for psychotherapeutic interventions since family education and therapy has been proven to reduce the rate of relapse/hospitalization in bipolar disorder. That is if you were to believe in those studies.

Here, here, here, and controversy.
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  #149  
Old 08-12-2011, 07:40 PM
Ocean Ocean is offline
 
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Originally Posted by Florian View Post
When I am unhappy, bored, melancholic, anguished I listen to music. It works wonders. Such as these two pieces from Saint Saën's Carnaval des animaux:

http://www.youtube.com/watch?v=AsD0FDLOKGA

http://www.youtube.com/watch?v=b44-5...eature=related

A stroll through the Louvre also cures me. Instantly. Or a good, well-written book.

A chacun sa vérité.
Beautiful music, Florian. It cures me too.
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  #150  
Old 08-12-2011, 08:11 PM
ledocs ledocs is offline
 
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Yes, I use mind-body and mind-brain interchangeably, because the brain is that organic component of the body with which mind would interact. Brain is a stand-in for body. If the mind is communicating with other parts of the body than the brain, it is doing so through the intermediary of the brain.

Another thing, Ocean. It seems to me that you and wonderment had a different understanding about what our discussion was about than I did. I tried to define it as being about the Marcia Angell articles in the NYRB, which Horgan introduced but then did not discuss as much as he ought to have, in my opinion. In addition, I introduced discussion of the books/authors that Angell was reviewing, in addition to Whitaker. So basically, I tried to broaden the purview of the discussion to be that of the biological orientation of psychiatry and the problems that that may raise, not limited to just the pharmaceutical treatment modality. And I do think you are underplaying the degree of conflict, both theoretical and institutional, between clinical psychology and psychiatry, but,as often, I'm going on my intuitions and the reading I've done in conjunction with this discussion over the past few days. On the other hand, if one's job is essentially to diagnose people's behavioral symptoms and then to prescribe psychoactive drugs to counteract the symptoms, and if the diagnosis part of the job typically goes rather quickly, for economic reasons if nothing else, it is very likely to follow that the discipline in question is going to become a handmaiden of neuroscience, any other outcome would be extremely counterintuitive. And I actually read a comment by a female psychiatrist, published in the NYT in response to Kramer's op-ed there, in which she envisages a machine that will scan the brain and generate appropriate recommendations for drug treatment regimens. So that was instructive and indicative, to me, of the future of psychiatry.
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  #151  
Old 08-12-2011, 08:25 PM
Ocean Ocean is offline
 
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Yes, I use mind-body and mind-brain interchangeably, because the brain is that organic component of the body with which mind would interact. Brain is a stand-in for body. If the mind is communicating with other parts of the body than the brain, it is doing so through the intermediary of the brain.

Another thing, Ocean. It seems to me that you and wonderment had a different understanding about what our discussion was about than I did. I tried to define it as being about the Marcia Angell articles in the NYRB, which Horgan introduced but then did not discuss as much as he ought to have, in my opinion. In addition, I introduced discussion of the books/authors that Angell was reviewing, in addition to Whitaker. So basically, I tried to broaden the purview of the discussion to be that of the biological orientation of psychiatry and the problems that that may raise, not limited to just the pharmaceutical treatment modality. And I do think you are underplaying the degree of conflict, both theoretical and institutional, between clinical psychology and psychiatry, but,as often, I'm going on my intuitions and the reading I've done in conjunction with this discussion over the past few days. On the other hand, if one's job is essentially to diagnose people's behavioral symptoms and then to prescribe psychoactive drugs to counteract the symptoms, and if the diagnosis part of the job typically goes rather quickly, for economic reasons if nothing else, it is very likely to follow that the discipline in question is going to become a handmaiden of neuroscience, any other outcome would be extremely counterintuitive. And I actually read a comment by a female psychiatrist, published in the NYT in response to Kramer's op-ed there, in which she envisages a machine that will scan the brain and generate appropriate recommendations drug treatment regimens. So that was instructive and indicative, to me, of the future of psychiatry.
Yikes!

But I think I know what you mean by the computer-scan generated treatment.

It's good that you clarified that the discussion was a bit mismatched because we were talking about various related, but somewhat different topics. I was also discussing different subtopics in this thread with various people.

I think that it's likely that psychiatry will continue to become closer to neuroscience, as you said, and will specialize in those disorders that are primarily biologically determined. The rest of our everyday neurotic troubles, and some others, will be addressed in psychotherapy. It is likely that psychotherapeutic approaches will continue to diversify and specialize for different kinds of problems.

At a personal level, I'm a bit torn. On the one hand, I really enjoy working in an environment that's somewhat academic, being able to teach medical students and residents, and develop programs within a large system. The problem with that is that my clinical work is mostly the typical medication prescribing. I've been considering, and will most likely do, developing a small private practice where I can see people for a variety of problems and use a wider range of interventions. We'll see how that goes. Finding the time will be difficult. But if I give up BhTV...
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Old 08-15-2011, 06:44 AM
SkepticDoc SkepticDoc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

So, you are a sensitive human after all. Please remember during your museum strolls that the Mona Lisa is not your self portrait...
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  #153  
Old 08-15-2011, 07:05 AM
Florian Florian is offline
 
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So, you are a sensitive human after all. Please remember during your museum strolls that the Mona Lisa is not your self portrait...

I never look at the Mona Lisa. It is usually surrounded by hordes of American tourists, no doubt a bit like scepticdocs who know little about anything but who think that it is the greatest work of art ever.

And a good thing it is that there are so many fools in the world. The rest of the Louvre is almost empty.

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  #154  
Old 08-15-2011, 07:13 AM
SkepticDoc SkepticDoc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Of course you don't like it, it is Italian, not French.
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  #155  
Old 08-15-2011, 07:17 AM
Florian Florian is offline
 
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Of course you don't like it, it is Italian, not French.
Non-sequitur, like most of what you say. I didn't say I disliked it. I said I didn't look at it because it is surrounded by hordes of scepticdocs. And as a matter of fact I really do like Italian painting.
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  #156  
Old 08-15-2011, 07:24 AM
SkepticDoc SkepticDoc is offline
 
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Default Re: Science Saturday: The Mental Illness Epidemic (John Horgan & George Johnson)

Your true colors are showing...
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  #157  
Old 08-15-2011, 07:31 AM
Florian Florian is offline
 
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Your true colors are showing...
So be it. You can just ignore me then. As I will ignore your invariably silly and childish remarks.
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Old 08-15-2011, 08:43 AM
sugarkang sugarkang is offline
 
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So be it. You can just ignore me then. As I will ignore your invariably silly and childish remarks.
Say something about his education first.
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  #159  
Old 08-15-2011, 11:59 AM
Florian Florian is offline
 
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Say something about his education first.
Why should I? Cela saute aux yeux.

I admire you, sugarkand, for always coming to the defense of your fellow countrymen, like a loyal dog, but if you had an ounce of fairness you would see that I did not begin this string of silly comments by the ineffably silly scepticdoc.
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Old 08-15-2011, 12:06 PM
sugarkang sugarkang is offline
 
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Why should I? Cela saute aux yeux.

I admire you, sugarkand, for always coming to the defense of your fellow countrymen, like a loyal dog, but if you had an ounce of fairness you would see that I did not begin this string of silly comments by the ineffably silly scepticdoc.
I was j/k Florian. I don't know who started what.
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