Psychotherapy and Drugs: A Dangerous Combination?

Recent comments by baz on previous post have drawn me away from the endless reading that is slowly destroying my life and harkened me back to the original idea in relation to that post. My original thought was this:

The use of drugs simultaneously with psychotherapy has value but must be carefully managed. Inducing behavioral change in a patient whose mental state is under the influence of powerful drugs may instantiate the desired behavior change that can easily be lost once the drugs are discontinued simply because the behavior change was created in that context. 

Today I read this: 

Beware small positive studies. By Neuroskeptic.

When selective serotonin reuptake inhibitors (SSRIs) were introduced for depression, effect sizes greater than 1.0 were reported, which created their legacy as a wonder drug. Over the course of 20 years, the mean effect size of SSRIs decreased to around 0.3. A similar trend was demonstrated for cognitive-behavioral therapy.

Psychiatry, Psychology, and Philosophy

6/11/2012 3:31PM

One of the more puzzling features of the mental health profession is the refusal to engage in a rigourous analysis of their own assumptions. It is as if they ignore the warning of Bertrand Russell when he advised that one of the first goals in philosophy is to recognise that a problem exists. Psychiatry is wedded to an excessively reductionist view of behavior , it is as if they have never encountered the concept of emergent properties let alone realised that a bottom up approach to understanding a complex system is almost always doomed to fail when there are many variables in play. The brain is the penultimate complex system. (Perhaps, given we don't know what brains do it may turn out that the processes are very simple, like a series of reiterations of very simple processes.) The psychologists catch and grab and whatever therapy comes along until it is eventually seen to be just another therapy offering little more than the placebo effect. Carl Rogers may deserve more credit than he is given today. Paradoxically the placebo effect may be the principle benefit in many therapeutic interventions but of course neither psychiatrists or psychologists would admit that because that would constitute a problem for them. No-one likes having the foundations of their concepts challenged. It is painful and could demand a complete re-appraisal of a conceptual structure. Hard work.

Society Without God - Phil Zuckerman(Review)

Title: 

Society Without God: What the Least Religious Nations Can Tell Us About Contentment.

Author: 

Phil Zuckerman, Professor of Sociology at Pitzer College

Publisher: 

New York University Press. 

Phil Zuckerman does a good job in dismantling the common mis-perception that religion is essential for society. Focusing on Denmark and Sweden, two countries notably lacking in religious affiliation and influence, the author demonstrates how in these countries the lack of religiosity has not turned them into hell holes of depravity and chaos but rather are outstanding examples of peaceful societies where individuals can enjoy their environment without fear of being mugged or murdered.

The Age of Empathy - Frans De Waal(Review)

If you are one of the great many who subscribes to the view that nature is red in tooth and claw, that humans are fundamentally and biologically selfish and only culture constrains our selfish impulses, please read this book. After you have done that, send a copy to your local politician! By golly they certainly need huge doses of the author's wisdom and insight.

In many of the developed nations the last 30 years has been marked by a distinct cultural shift towards a more Ayn Rand type view of human behavior. I have no idea why anyone would trust a philosopher to instruct them about human behavior, it is like asking a child to create quantum mechanics.

Frans De Waal, in the great tradition of Darwin and all good science, seeks to enlighten us as to the origins of our behavior by referencing not theories and intuitions, but observations tempered by a rigorous empiricism. The Age of Empathy is an outstanding piece of work.  

The Mankind Project: Modern Man Mythologised

Warning: this is a rant. If you like the idea of rediscovering your masculinity then don't bother reading on because you will be offended in every paragraph. Later on in this post I will attempt to give a dispassionate analysis that addresses the philosophical underpinnings of The Mankind Project.

Sunshine, Pathogen Genocide, Vitamin D, Happiness, and Cognition

Immunology has long fascinated me. Somewhere, sometime I read how the immune system was so sensitive it could identify a self from non-self protein in as little as 10 amino acids. "Crap!" I internally exclaimed even though completely ignorant of immunology at that time. As it turns out ...

Sort of true. That is a class of molecular structures known as PAMPS: pathogen associated molecular patterns.  Charles Janeway is the poster boy on that front. Our innate immune system is sensitized to these patterns. When you crunch numbers in a crude off the top sort of way, the immune system does a remarkably good job at fending off pathogens that have certain mathematical advantages. The challenge is so great that evolution came up with(remarkably!) the heavy and light chains which allow a tremendous ongoing creation of antibody types until there is one that "fits". It is a numbers game and while there are good odds with microbes the odds are bad with viruses because their replication and mutation rates are, relatively speaking, much higher. Two modern viruses are excellent examples of this. Hepatitis C and HIV exist in a variety of variants that will keep expanding. So when you think of mass extinctions remember one viable cause is a tiny molecular structure of only two key components which can wipe out a species very quickly and leave no trace. It dies with the species. That is an unsuccessful virus and not our concern. We are concerned with all the bugs that manage to live on and in us.

The Ontological Assumptions of Psychiatry

On the ontological assumptions of the medical model of psychiatry: philosophical considerations and pragmatic tasks

Tejas Patil, James Giordano

Philosophy, Ethics, and Humanities in Medicine 2010, 5:3

Full Text Available here.


Abstract
A common theme in the contemporary medical model of psychiatry is that pathophysiological processes are centrally involved in the explanation, evaluation, and treatment of mental illnesses. Implied in this perspective is that clinical descriptors of these pathophysiological processes are sufficient to distinguish underlying etiologies. Psychiatric classification requires differentiation between what counts as normality (i.e.- order), and what counts as abnormality (i.e.- disorder). The distinction(s) between normality and pathology entail assumptions that are often deeply presupposed, manifesting themselves in statements about what mental disorders are.
In this paper, we explicate that realism, naturalism, reductionism, and essentialism are core ontological assumptions of the medical model of psychiatry. We argue that while naturalism, realism, and reductionism can be reconciled with advances in contemporary neuroscience, essentialism - as defined to date - may be conceptually problematic, and we pose an eidetic construct of bio-psychosocial order and disorder based upon complex systems’ dynamics. However we also caution against the overuse of any theory, and claim that practical distinctions are important to the establishment of clinical thresholds. We opine that as we move ahead toward both a new edition of the Diagnostic and Statistical Manual, and a proposed Decade of the Mind, the task at hand is to re-visit nosologic and ontologic assumptions pursuant to a re-formulation of diagnostic criteria and practice.


This is an interesting paper, especially their treatment of essentialism and the impressive way in which they associate epistemological demands with clinical realities(see the Conclusion). They also present a very good systems theory approach to understanding why psychiatric diagnosis will never have the precision we would like. Below I will address some of their statements but be warned, the paper should be read in full; and carefully. There are some difficult issues here, beware of what seems plausible. As the authors note:

In other words, naturalistic intuitions are not evidence of their content.

The Truth About Stress

Author: Angela Patmore
Publisher: Atlantic Books, London, 2006

About the Author:

Former University of East Anglia research fellow and International Fulbright Scholar. Her book, Sportsmen Under Pressure(1986) was a Times sports book of the year. The Truth About Stress was shortlisted for the MIND Book of the Year Award 2007.





General Thesis

1. Stress is a bad concept. Not defined.
2. The stress response has been pathologised but is vital to our survival.
3. We are medicalising a response to contingencies when we should be managing those responses to contingencies.
4. That most drugs to treat anxiety and stress are next to useless if not dangerous.
5. That the stress industry is largely un-regulated and is costing governments, business, and individuals too much money.
6. That the best approach to managing stress is to introduce people to stress. Inurement. Basically, train people to cope with stressful events.

page 81
"This [steady state hypothesis of physiology -Cannon's] has led to the fight-or-flight mechanism being viewed as a hard-wired, primitive, malfunctioning sort of bodily self-destruct system, that is even referred to in some of the literature as 'the fight-or-flight syndrome', as though the survival mechanism were an illness."

What Caused Me?

I thought history had long answered the below issue. 

While we may believe that our moral principles are rigid and based on rational motives, psychological and neuroscientific research is starting to demonstrate that this might not actually be the case.

The Science of Morality

http://www.bbc.co.uk/programmes/p00rdps3

John, now settled into his new locale, finds hope on the BBC.co.uk website. This series is about understanding human behavior. That is somewhat absurd because we can only understand human behaviors with respect to specific individuals in specific circumstances at specific times and even then we have to attach a margin error of unacceptably large proportions. It is intrinsically impossible to create global models of human behavior, too bloody NP hard by a galactic lifetime or two. So when you hear people talking about models of human behavior, whether it be astrology or psychology, tell said person to be wary of individuals falling from the sky who tried to fly to close to the sun.

One of the striking features of Milgram's research, tucked away into the data, was that of all the groups that were willing to administer lethal doses of electricity to actors feigning pain, Roman Catholics figured prominently in this regard. Now to a person who believes that their behavior is guided by their morality I would like to remind you that during the Japanese militarism of the 30's Zen masters were quite happy to offer their metaphysical support for unmitigated violence and hatred against the Other, once again demonstrating that morality in front of a gun, and behind it, can be remarkably flexible. The Roman Catholic predisposition is much better explained by the fact that Roman Catholics are taught to submit to authority from a very early age. Human beings are like cars: get ém when they are brand new, keep ém clean, service ém regularly, take them places to explore the world, give ém regular baths, take them to parks so they can mix with their own kind, avoid head-on collisions as these damage the steering, don't demand more than they can give but always be prepared to put the foot down when necessary, and you should get a long and reliable service out of car and human.

We think we are in control of our behavior but that is absurd. That is not possible. How can anything be in control of its behavior? Intentionality may be an emergent property but it has its antecedents from which it cannot be divorced. Socrates said: Know Thyself. Arrogant Twit. Camus wrote: Forever shall I be a stranger to myself. Bloody pessimist. It will take another 50 years for the full implications and value of this behavioral research to bear fruit in our public debates. That's good, we need to recognise the mythologies about ourselves. Away with Essentialism, get back in your kennel your naughty little genetic determinist puppy for tomorrow we put you down. 30 years I've waited! I'm going to watch you draw your last breath, hear your last heart beat as I pump in the KCL and no there won't be any anesthetic you sick little puppy.

Immunological Turncoats Ward off Tumour Eradication

Confocal microscope image of a spontaneous breast cancer tumor in a mouse. (Credit: Image courtesy of University of California - San Francisco)

This news report from ScienceDaily highlights how much progress has been made in our understanding of cancer. The picture is beautiful because it presents an image of what has long been suspected. 

As the news article states ....

Instead, these immune cells are headed off at the pass. A completely separate set of healthy cells that are already in contact with the tumor effectively establish a defensive perimeter around it.

This is very important information, it provides insight into one of the fundamental mysteries of cancer: why the immune system can both recognise and mount a T cell attack that gets headed off at the pass. Cancer Immunotherapy began long ago with a chap named Steven Rosenberg ...