Psychiatry Paradox
Psychiatry
Organic Brain Syndrome
Some excerpts:
[quote=Wikipedia]Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders.[/quote]
[quote=Wikipedia]Organic brain syndrome, also known as organic brain disease, organic brain disorder, organic mental syndrome, or organic mental disorder, refers to any syndrome or disorder of mental function whose cause is alleged to be known as organic (physiologic) rather than purely of the mind. These names are older and nearly obsolete general terms from psychiatry, referring to many physical disorders that cause impaired mental function.[3] They are meant to exclude psychiatric disorders (mental disorders). Originally, the term was created to distinguish physical (termed "organic") causes of mental impairment from psychiatric (termed "functional") disorders, but during the era when this distinction was drawn, not enough was known about brain science (including neuroscience, cognitive science, neuropsychology, and mind-brain correlation) [...].[/quote]
[quote=Wikipedia]An organic cause to brain dysfunction is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause, such as a mood disorder.[/quote]
I remember very clearly a doctor friend of mine telling me that psychiatric illnesses were to be considered as a diagnosis only if organic brain syndrome is/was ruled out as impossible.
Organic brain syndromes would be mental symptoms (depression, mania, psychosis, etc.) that are caused by physical changes in the brain (traumatic brain injury, tumors, infections, etc.)
Basically, the whole idea behind psychiatry and organic brain syndrome is predicated on the principle that psychiatric illnesses are not organic i.e. those suffering from psychiatric illnesses have a fully operational, normal brain.
To employ a computer analogy, organic brain syndromes are hardware problems and psychiatric illnesses are software problems.
Let's now discuss treatment:
No issues with organic brain syndromes, tumor/trauma - surgery, infection - antibiotics, and so on. Hardware issues, call a hardware engineer.
What about psychiatric illnesses? Oddly, pharmaceuticals are the mainstay of psychiatric treatment i.e. to treat what are inorganic illnesses, drugs that work organically are used. That makes as much sense as calling a hardware engineer for software problems. Mind you, I'm not saying other, alternative methods of treating psychiatric illnesses don't exist. All I'm saying is they're usually adjuncts to treatment with a host of brain-affecting drugs.
The Psychiatry Paradox: Psychiatric illnesses are inorganic (software) in nature but the therapy is organic (hardware) in nature.
The paradox might have implications for Mind Body Dualism and its offshoots. I'm not all that certain.
Organic Brain Syndrome
Some excerpts:
[quote=Wikipedia]Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders.[/quote]
[quote=Wikipedia]Organic brain syndrome, also known as organic brain disease, organic brain disorder, organic mental syndrome, or organic mental disorder, refers to any syndrome or disorder of mental function whose cause is alleged to be known as organic (physiologic) rather than purely of the mind. These names are older and nearly obsolete general terms from psychiatry, referring to many physical disorders that cause impaired mental function.[3] They are meant to exclude psychiatric disorders (mental disorders). Originally, the term was created to distinguish physical (termed "organic") causes of mental impairment from psychiatric (termed "functional") disorders, but during the era when this distinction was drawn, not enough was known about brain science (including neuroscience, cognitive science, neuropsychology, and mind-brain correlation) [...].[/quote]
[quote=Wikipedia]An organic cause to brain dysfunction is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause, such as a mood disorder.[/quote]
I remember very clearly a doctor friend of mine telling me that psychiatric illnesses were to be considered as a diagnosis only if organic brain syndrome is/was ruled out as impossible.
Organic brain syndromes would be mental symptoms (depression, mania, psychosis, etc.) that are caused by physical changes in the brain (traumatic brain injury, tumors, infections, etc.)
Basically, the whole idea behind psychiatry and organic brain syndrome is predicated on the principle that psychiatric illnesses are not organic i.e. those suffering from psychiatric illnesses have a fully operational, normal brain.
To employ a computer analogy, organic brain syndromes are hardware problems and psychiatric illnesses are software problems.
Let's now discuss treatment:
No issues with organic brain syndromes, tumor/trauma - surgery, infection - antibiotics, and so on. Hardware issues, call a hardware engineer.
What about psychiatric illnesses? Oddly, pharmaceuticals are the mainstay of psychiatric treatment i.e. to treat what are inorganic illnesses, drugs that work organically are used. That makes as much sense as calling a hardware engineer for software problems. Mind you, I'm not saying other, alternative methods of treating psychiatric illnesses don't exist. All I'm saying is they're usually adjuncts to treatment with a host of brain-affecting drugs.
The Psychiatry Paradox: Psychiatric illnesses are inorganic (software) in nature but the therapy is organic (hardware) in nature.
The paradox might have implications for Mind Body Dualism and its offshoots. I'm not all that certain.
Comments (40)
I think that it comes down to the complex way in which mind is not just dependent on a brain, but the chemicals arising within the brain, especially the neurotransmitters. In particular, dopamine is believed to be implicated in psychotic disorders and serotonin in depression, and there are probably other chemicals which are involved.
What may be interesting for thinking about the mind and body problem is the way emotions work, especially in mood disorders. Treatment for depression often involves antidepressants, and these seem to be very powerful. I can say this on the basis of working with patients who were diagnosed with depression, and I have also taken antidepressants myself. However, what is interesting is the way in which mood can be affected by drug treatment but also by experiences. Life experiences affect moo strongly, as well as the way we process them, which is the basis for various therapy options.
On a slightly different level, we can think about psychiatry and delusions. It does appear that there is a genetic basis which predisposed people to psychotic disorders, and stress can be a factor. Use of recreational drugs also can be a trigger, especially cannabis. So, there is a definite chemical basis for psychotic disorders. However, it also involves the nature of thinking, which is based on chemicals and the brain. However, ideas come into play, and so we could say that delusions may even be seen as being a philosophy problem.
Also, a bullseye regarding how delusions could be managed by introducing the ill to philosophy. :point: Descartes treats Cotard Delusion
Not entirely true, Schema Therapy, Talk Therapy, CBT, and arguably studies with psychedelic's show a way to rewrite the software by gaining chemical induced access. However, it is true and debated that in some cases the short term goal of stability is being over favored against a long term goal of resolution.
That's right. My understanding of this issue is that on the one hand, if you have something physically wrong with your brain, you need a neurologist; and if you are having emotional difficulties adapting to life, you need a therapist. If you want to run a rat through a maze or convince a population to go to war or smoke cigarettes (think Edward Bernays, who realized that these two were the same problem) you need a psychologist.
In no case do you ever need a psychiatrist, and it's unclear exactly what they do.
Paging Doctor Freud!
Yes, I thought about it but it falls under the organic category and psychiatric disorders are inorganic. Mind you, I'm probably using some outmoded ideas in psychiatry. If you read my abstracts in quotes, you'll get an idea of what I mean.
Quoting Cheshire
Quoting TheMadFool
Quoting fishfry
[quote=Old Lady]Does everything have to be a psychological disorder these days?[/quote]
Uh oh. This is one of those flashpoint conversations that I shouldn't get involved in, because I actually haven't followed it in years.. It's just some stuff I read about 20 years ago.
If you have diabetes, you go in for a blood test and they tell you if you have high blood sugar. Then your doctor prescribes medications to keep your blood sugar under control.
If you have depression, you are told by the psychiatric establishment that you have "low serotonin," and you are given SSRIs. The problem is, there is no blood test for low serotonin. That's contrary to the statement you made about medical tests. The truth is you DON'T get a medical test to determine if an SSRI would help you.
There's an extensive literature on this subject, and like I say my knowledge comes from reading up on this many years ago and not having any ongoing interest. But as far as I know, it's not true that psychiatrists send you in for medical tests before prescribing powerful mind-altering drugs. One could note that all these 20-something boys who shoot up movie theaters and schools are invariably on SSRIs, and that immediately after every such event, politicians talk about guns but never about psych drugs. Another flashpoint conversation.
Are the kids crazy therefore they get put on psych drugs so it's no surprise that kids who do crazy things turn out to have been on psych drugs? Or do the psych drugs make some people crazier than they were before? Far too few inquiring minds want to know. Easier to blame guns, or bad parenting, or trench coats. You remember how schools nationwide banned trench coats after Columbine. No wonder the kids are crazy.
So my original point stands, that it's totally unclear what psychiatrists do. If there IS a medical test showing something wrong with your brain, you need a neurologist. Psychiatrists typically prescribe drugs for conditions that are NOT detectible by medical tests. That's an issue that many anti-psychiatry proponents bring up.
Some shrinks practice psychotherapy; some work in diagnostic roles in hospitals; some work in research; some work in detox and drug rehabilitation programs, some work in the criminal justice sector. They are as diverse as any other occupations and although they can prescribe medication, the good ones privilege psychosocial interventions before medication. They usually conduct a robust differential diagnosis to rule out organic issues before making a tentative diagnosis based on the best available evidence they have.
The matter of therapy is a different one and there are a range of professions that practice interpersonal counselling and therapy modes. Again like any other profession there is good and bad. I've see this save too many lives to disregard its significance. But there is no question that there are dubious practitioners, just as there are dubious plumbers, lawyers, mechanics and teachers.
It certainly does! I doubt any type of dualism would get far in most psychiatry programs (academic) but psychosis cases always involve mental content. So, to do it right, both the physical brain should be considered and also the physically contained mental content. There is a problem with the psychiatric profession viewing dualism as the physical and the non-physical and discounting the non-physical. A better wording of the problem would be the physical brain and the physical brains mental content.
The profession has done a poor job on the fundamentals.
I hope that's on topic. I should add that some forms of dualism should not be considered such as stand alone non-physical models (because they are bad models).
I must admit I didn't see it that way although I suppose a paradox is by definition an inconsistency.
Quoting Mark Nyquist
Buddhism - a treatment for depression?
[quote=Karl Marx]Religion is the opium of the maases.[/quote]
Yes! Religions, by and large, seem to be non-pharmaceutical modes of treating pain (to some degree) and suffering (to a greater extent). Mental reorientation/recalibration (software changes) is quite effective in alleviating/eliminating clinical depression or so the claim is.
It kinda makes sense you know, especially Buddhism and whatever other religion inspired it - Maya (the world as an illusion) sounds exactly like delusions in psychiatry as found in schizophrenia and a host of other mental illnesses. Buddhism strives to, aims to, free our minds from Maya (delusions) just like psychiatrists but the methodology differs - Buddhism, religions in general I suppose, basically offers a software package while psychiatry is, bottom line, hardware modding.
I think religions are therapy to a vast amount of people.
Your example of buddhism is pretty much on the mark.
That said philosophy science and secularism are also therapies to cope with the world.
Most of the planet suffers from anxiety.
I'll keep that in mind. Great observation!
Quoting Protagoras
Sad but (probably) true.
[quote=Wise Old Lady]Does everything have to be a psychological disorder these days?[/quote]
A lot of folk wisdom and psychology is excellent.
There are some rare people who use worldviews as an expression of their values rather than therapy.
Those people are great talkers and artists.
Most artist and talkers are neurotic as hell!
Oh well, nobody's perfect.
[quote=Christopher Hitchens]The perfect is the enemy of the good[/quote]
[quote=Robert Watson-Watt]Give them the third best to go on with; the second best comes too late, the best never comes[/quote]
What is common to a broken leg and depression is pain and disability. What is peculiar about most other mental illness though is that it is other people's arses that the 'sufferer' is a pain in. This means that they are social complaints, and that is why the treatment is often social communication of some sort.
Bullseye! I recall writing in another thread that psychiatry and psychology perhaps has got the wrong end of the stick. For instance, given the magnitude of the suffering extant in the world, how callous people are to it, a "normal" person should be in the grips of severe depression and an "abnormal" person should be completely at ease with it. Shrinks and psychologists are looking at the world upside-down. They're treating the normal as abnormal and vice versa. :fear: :grimace:
I think it's more that they're treating normal as healthy and abnormal as sick. :sad: I, at any rate, am not at all saying 'it's all in the mind'; rather, I am saying that judgement is a relation between mind and world (body, perhaps), of the species giving-a-fuck. Thus alien hand syndrome, for example consists of the judgement of foreignness and revulsion towards one's hand (other limbs are available), the sufferer complains about the alien hand. The doctor in this case makes the opposite judgement that the hand is not a foreign body, and therefore calls it a 'syndrome'. In neither case is the hand 'in the mind', only the differing judgements.
That's exactly what's wrong, at least when it comes to clinical depression. The world is depressing and if you're not feeling the blues then something's wrong with you - I believe a lack of empathy is an illness, no?
Quoting unenlightened
Precisely. See my comment above. Of course it all depends on which you think is normal, giving a fuck or not giving a fuck. Is it like the joke that ends with the line, "I have no more fucks to give"? Pain and suffering are soul-sapping, you're drained emotionally, after some time you can't cry any more.
Quoting unenlightened
I don't think that's accurate but hey, you have the right to an opinion. I respect that.
Believe you me, we're all just one bad day away from ending up in a mental asylum.
Be glad you didn't have a bad day in 1955. It could have been step one on the way to a lobotomy. Not a great profession even today and the science is whatever sells drugs. "Peer review and evidence based" is the current lingo. Some how my brain translates this to "junk science". Wow, how does that happen? Anyway, there doesn't seem to be a lot of psychiatry fans around here.
What happened in 1955?
Quoting Mark Nyquist
Yes, it was a method of "treating" intractable cases. I forget the conditions it was reserved for.
Quoting Mark Nyquist
The idea behind this seems to be scientific validation. "If it's not science then it's nothing" is the mantra!
Quoting Mark Nyquist
This is an oxymoron.
I agree with you 'if you're not feeling the blues there's something wrong with you.' I am surprised by people who seem impervious to everything around them in the world. It does seem that some people are much more vulnerable than others and don't seem to get affected by almost anything that happens to them, or in the world. I am not sure that it is even a good thing.
One interesting aspect aspect of it is how some people get a delayed response of depression, being unaffected by things when they happen. But, suddenly depression, or some other psychiatric problem arises, although I am wary of using the term 'psychiatric' because it has a certain diagnostic characteristic. As far as I can see, life comes in waves and it seems natural to me for our inner life to be turbulent, but, of course, if we are not strong it can become too much. We probably have to learn to surf the waves.
Here is something current to consider: Advocates of Electroconvulsive Therapy claim memory loss is caused by depression, not ECT itself.
I know many individuals who have had ECT and almost all of them claim a clear relationship with the treatment, The explanation for how the treatment works is not known clearly, but my own observations of witnessing people going through the treatment in mental health care makes me wonder if the main way it works is through enabling people to forget difficult memories, especially as they are frequently groggy for many hours afterwards.
When I was a student nurse I remember how we had so much class discussion about ECT and I was mostly on the side against it. However, having worked in psychiatric nursing, I see it a little differently. I know of some people who feel that the treatment had a really detrimental effect on them, mainly younger people. However, I know how many people over the age of 60 who feel it helped them so much. I think that this is recognised by psychiatrists and most now view the treatment as a better option for people over about the age of 60, and, from what I have seen in recent years, most to be cautious about using it for younger ones, except in rare cases.
I will just add that I have never come across lobotomy in England. However, I came across a trainee clinical psychologist last year who was involved in some clinical research which seemed to involve rods placed against the head. But I don't know the full details, and this form of therapy was only at an experimental stage.
From ward round discussions in which I was present, the main criteria were severity of a person's mental health condition and whether all other options had been explored. It would usually be that a person had tried a number of medications and not had any noticable improvement. Also, it depended on what the patient wanted to happen next and, the concerns of family members.
From my perspective it's hard to find the line between science or professional advocacy of a procedure. There are definitely negative side effects.
It is far more complex. In the immediacy of the moment , like when aggressive behaviour is taking place, immediate decisions about medication, have to be made amongst a team. Safety is a key issue, but any decisions have to be justifiable and are accountable by law. It may be that the patient is not always the one who has the ultimate say, but they can appeal against decisions and put in complaints. Generally, most decisions about ECT are carefully thought out though, although I believe that many years ago this was less so. But, medication and injections are more frequently given against individuals' wishes, often as a preventative risk measure.
I think that you in your post you are touching upon one of the main areas which is involved in the ethics of psychiatry, which is capacity to consent, which has to be assessed fully and carefully.
I am not really an advocate of ECT and certainly I didn't enjoy taking patients to ECT. But, it was often the patients themselves who said how they felt that they benefitted from it, so hopefully it was not 'voodoo'. Even with medication, no one knows exactly how it works in many cases but hopefully neuroscience will give us more answers in time. There is, of course, the whole placebo effect, but it don't think that it can come down to that because people notice major differences between different medications, so it is probably mostly about neurotransmitters.
Oh! I didn't know that. All I know about 1955 is that Albert Einstein died that year. I guess God lobotomized the human race. :rofl: Makes sense since dear Albert was proving to be an intractable nuisance with his E = mc² which flagged off the nuclear arms race. The doomsday clock has been ticking ever since. We can't put the genie back in the bottle. Might as well make our 3 wishes.
Quoting Mark Nyquist
I concur. My memory has never been the same since I had melancholia for as long as I can "remember." It's a vicious cycle: sadness -> memory loss -> sadness -> memory loss ->.... I wonder if the ouroboros is allowed to complete the process of eating itself what would happen? A broken heart can't learn by heart!
Quoting Jack Cummins
I would've preferred it if I were wrong but, for better or worse, I'm not. One only needs to look at the two greatest role models of the world, one western, Jesus, and the other eastern, the Buddha to realize this. Both gentlemen were deeply concerned with suffering, one (the Buddha) was probably certifiable as reeling under bouts of major depression. The point? That people consider these two as ideals to be emulated leaves no room for doubt that people all over the world want us to feel the world's agony. The duo were later upgraded to divine beings and that's as big as hints get - empathy at that level no mere mortal can achieve.