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Psychiatry Wars: a lawsuit that put psychoanalysis on trial

theguardian.com

81–90 of 106 posts

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#81

Earlier quoted context omitted.

Psychiatrists prescribe medications and psychologists perform counseling. The role of prescriptive medication is to modify behavior that either increases focus or stabilizes emotionally heterogeneous states. That medication is often issued in consultation between a psychiatrist and the treating psychologist to enhance receptivity to counseling (or other social contexts) otherwise it may interfere.

There are few psychologists who deride medication just because they can’t prescribe it. In fact, it’s largely the other way around - psychiatrists look down upon psychologists and often decide their work.

It would depend where the participants work, but I'd love to see an attitudes survey.

It's be tricky as people are unlikely to be entirely honest giving opinions on colleagues.

I linked to a survey of therapists on medication and the highlights of my OP were reflected there.

Some therapists do not trust medications, see them as harmful, overused or subverting therapy.

But therapists are not necessarily clinical psychologists.

And in the UK at least every training psychiatrists would have practiced at least two modalities of psychotherapy. That's mandated by the GMC (General medical council which regulates medical licenses). Usually one cognitive therapy and one psychodynamic therapy.

I've seen research which shows that those that conduct it feel that it's beneficial and effective.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#82
post #5

Earlier quoted context omitted.

While what they're saying is true, to me it rings just as misguided as not taking pain medicine when you have a broken leg until it has properly set first. Medication for neurological issues isn't and shouldn't be the end-all-be-all but can indeed be a way to manage the issues at hand while teaching the tools needed to deal with the symptoms via therapy if possible.

> to me it rings just as misguided as not taking pain medicine when you have a broken leg This is a bad analogy in so many ways. Most pain medications are short-acting, so one knows pretty quickly whether they work. People prescribed antidepressants are told to wait weeks to see positive results, and a large percentage of them won’t actually see any-and even those who do see positive results, it is often unclear if t…

To stop playing that game of chance can certainly be a rational and informed decision. If you've tried multiple drugs of multiple categories and none of them work, chances are good that the next one won't work either.

But not even trying? I don't think that's a rational and informed decision. Sure, it might take two weeks, and sure, there are side effects, but if it works, it'll greatly improve your condition. If your condition is serious, taking a pill every day and waiting for two weeks isn't a huge investment.

It's like betting at roulette, you don't have to pay to bet $10000, but you'll get the full win if you're lucky. And you have to wait two weeks after each bet to know whether you won.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#83

Psychoanalysis is criminally underrated in the US. It’s detractors broadly don’t understand it. It has the potential to seriously help tons of people, but it is understandably challenged, as it represents a painful reckoning with yourself. Who would want to find out that their personality causes many of their problems? Maybe it requires a bit of masochism to take advantage of.

Oedipus complex isn't real. Electra complex isn't real. Freud should be in the dustbin of history.

I disagree on all three counts :)

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#84
post #2

Fascinating story. Thanks for sharing. > Ray’s mother asked the Lodge to give him antidepressants. But to the Lodge psychiatrists the premise of this form of treatment – to be cured without insight into what had gone wrong – seemed superficial and cheap. Drugs “might bring about some symptomatic relief”, Ross, Ray’s psychiatrist, acknowledged, “but it isn’t going to be anything solid in which he can say, ‘Hey, I’m a…

As a trained pharmacist, the previous pharmacist is wrong in their interpretation and in their explanation. Specifically the way they explain the duration and mechanisms of the drugs is incorrect. While the main focus of discussion tends to center around the “serotonin” aspect of SSRIs, this is akin to discussing a road trip and only talking about turning the ignition before you leave the drive way. Serotonin receptors in the prefrontal cortex are the beginning of the signaling pathways that are to a greater extent controlled by glutamate, nmda receptors, and GABA. Not to be forgotten are also the dopamine and epi/norepi. All of which are affected downstream from the initial signaling of 5ht1a/b and 5ht2a receptors. Changes in concentrations of these neurotransmitters, their receptors, and reuptake vesicles, lead to system level changes in mood and behavior. The idea that some “small changes” in serotonin levels for a few weeks is all that occurs with an SSRI is just plain incorrect. The resulting fluctuations from baseline in neurotransmitters and receptors translate to slow changes in plasticity and “direction” as pathways are reshaped. Depression stems from a “negative cognitive bias” that deepens and is self-reinforcing over time. Changing that bias by reshaping pathways takes time. For some people, a very long time, and for others (arguably most) the drugs alone cannot accomplish this change in direction toward s more positive cognitive bias without cognitive behavioral therapy, rebuilding social support systems, and a change of environment. It’s true that everyone has different chemical concentrations, different levels of enzymes for breaking down neurotransmitters, and differences in receptor availability and that has been reduced to an idea of “chemical imbalance” which is not only too simplistic but also it treats a person like a baking recipe that would be turn out well with just more baking powder. That PharmD in the comment did the same kind of reduction here. At a molecular level, permanent changes absolutely can and do happen. That is essentially what the mechanisms at work in ketamine therapy have demonstrated providing strong evidence for thr neuro plastic theory of depression.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#85

This line hit me hard: > In a draft of his memoir, Ray modified his definition of depression: “This is not an illness, it is not a sickness – it is a state of disconnection.” I've seen it in myself and in some of my closest friends, where we just start to disconnect more and more from others, more and more from ourselves. Especially from how we're feeling. Wanting to avoid emotions and thoughts, suppress them, repres…

The question is, what is it about these challenges that cause you personally to retreat into depression, because we know that there are people who can tolerate some amount of rejection. I think that’s a psychoanalytic question, to explore what it is about you personally that responds with depression.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#86

Earlier quoted context omitted.

What's the takeaway here? We all know physical pain serves a purpose.

Maybe you're depressed because your life and environment is actually shit and you don't know how to fix it. Maybe taking happy pills just eliminates the only signal telling you to take your hand off the hot stove.

I don't think depression is like that. Depression is not being sad but rather just blank and those are not happy pills, those are feel a bit something again pills. Which enabled you to take the hand of the stove albeit imperfectly.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#87

Earlier quoted context omitted.

Maybe you're depressed because your life and environment is actually shit and you don't know how to fix it. Maybe taking happy pills just eliminates the only signal telling you to take your hand off the hot stove.

I don't think depression is like that. Depression is not being sad but rather just blank and those are not happy pills, those are feel a bit something again pills. Which enabled you to take the hand of the stove albeit imperfectly.

Is that really how it is for you? The blank days in my opinion are the good ones, the level and balanced ones where I can just be in the zone or frankly even just zoned out.

The depressing days are the ones where my brain decides to sample from its wine cellar of my past mistakes without my permission.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#88

Earlier quoted context omitted.

Drugs can give you the insight to change your perspective though. From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance which further reinforces the mental state, making it impossible to see outside that worldview. Thus drugs can take you out of that cycle and give a glimpse outside, and then even after the drug wears off the change in perspective is persistent.

> From my understanding, depression is a deadly spiral of mental state leading to chemical imbalance There has never been any good scientific evidence that depression (or any other mental health issue for that matter) involves a “chemical imbalance”. It is, at the very best, a debatable and unproven hypothesis - yet many think it is some proven fact. To pick out just a couple of the numerous sources which confirm thi…

My personal belief is that depression is a deadly spiral stemming from and exacerbating damage to neurons.

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#89

Earlier quoted context omitted.

I don't think depression is like that. Depression is not being sad but rather just blank and those are not happy pills, those are feel a bit something again pills. Which enabled you to take the hand of the stove albeit imperfectly.

Is that really how it is for you? The blank days in my opinion are the good ones, the level and balanced ones where I can just be in the zone or frankly even just zoned out. The depressing days are the ones where my brain decides to sample from its wine cellar of my past mistakes without my permission.

[deleted]

Re: Psychiatry Wars: a lawsuit that put psychoanalysis on trial

#90
post #2

Fascinating story. Thanks for sharing. > Ray’s mother asked the Lodge to give him antidepressants. But to the Lodge psychiatrists the premise of this form of treatment – to be cured without insight into what had gone wrong – seemed superficial and cheap. Drugs “might bring about some symptomatic relief”, Ross, Ray’s psychiatrist, acknowledged, “but it isn’t going to be anything solid in which he can say, ‘Hey, I’m a…

>Relatedly, the chemical imbalance theory of depression was disproved in a popular study published two months ago.

It hasn't been an accepted explanation for years in academia. It's only accepted bc of pharmaceutical commercials and word of mouth

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