I notice that whenever something newer and more expensive is available, then the truth tends to come out about the previous treatment paradigm. When XYZ comes onto the scene in a few years, we'll start reading about how the atypicals aren't so great after all.

Is the small effect size feature (i.e. that of approximately 14% when compared to placebo) limited to particular classes of antidepressant, or is it the same for all classes (SSRIs, TCAs, MAOIs, SNRIs, NRIs, etc.)?

If this new evidence which is coming to light about antidepressants is true, how do we treat depression? Do ANY medications work at all, or are all classes useless? Do any work, when combined with others, but not particularly well on their own? In other words, should we be studying the efficacy of drug combinations now, rather than individual drugs?

If no pills work, what do we do for people who feel ill in this way?

Francesca,
Excellent point.

John,
I'm of the opinion pills aren't very useful in dealing with mental illness. If they were, well, they'd work. I can count on the fingers of one hand the number of people who enthusiastically tell me their meds are *really* helpful. Mostly all I hear about is side effects, the latest change about which they and their docs are hopeful. Later I get to hear about those sides effects and yet another change about which they and their docs are hopeful. It seems like a racket to me.

There seems to be some evidence CBT actually helps some people. I use it as a tool but I can't say it's been much more than that. It certainly hasn't lived up to its "Feel Good" hype for me, but lots of people swear by it.

Some people find yoga, tai chi, bodywork of various kinds and a whole range of new body-based trauma therapies helpful.

There's much more out there than pills, thank goodness. The other things require work and taking responsibility, though. They're not much like popping a pill.
Sherry

Fine, so no pills work particularly well for mental illnesses.

CBT, not all it's cracked up to be.

"Body-based trauma therapies" helpful to some.

So what are these "other things [that] require work and taking responsibility"? Is that work and responibility on the part of the doctor or patient?

It seems to me, given the above comment, that not a lot works at all (at least currently there's little evidence for anything working, with the evidence for the non-pharmacological therapies still a bit thin-on-the-ground).

I should have noted, I am a very junior psychiatrist (sort of intern level - am in England so the system's different here). I do have faith in the pharmacotherapies, but I have limited clinical experience so far, so am not expert yet.

I do get cheesed-off with the number of anti-psych / anti-pharm blogs. Where are the pro-pharm / pro-psych blogs? Because, some people do find benefit in their treatment. Some are even cured. I find that these anti-pharm blogs tend to be written by people who have experienced mental illness, and are bitter about treatment failure, which often leads to bias in selecting stories to comment on surrporting their loss of faith in the field. People who have cancer whose chemotherapy doesn't work haven't set up such a plethora of anti-chemo blogs have they? It's not a critiscism per se, more an observation/musing. I guess a specialty dealing with patients who have disorders of emotion will predispose to dysphoric blogs / a nihilistic view of treatment. This feature would be particularly pronounced in those whom treatment has failed, who remain dysphoric. But still, the treatment's not worked, and it is supposed to.

Essentially, on the topic of the number of anti-psych blogs, do you think those who create these blogs are the effect of a bizarre selection bias, whereby because they represent a group of people untreated by meds (for whatever reason), they contribute to a disproportionate amount of sites that are anti-psych? You never see sites that are pro-meds, from patients who've been treated successfully, is the other side of it, I suppose.

Just a ponderance there. Do you have any thoughts on this?

***

Also, what are readers thoughts on this. If a patient who has developed depression, who had a pessimistic view of psych meds pre-morbidly (a not uncommon cultural stance), was started on antidepressants, is it possible for them, due to pre-morbid personality, to counter the psychological downstream effects of the drugs? In toher words, if you wanted to, can you think your way out of the drugs working on you (assuming that the negative view of meds was not itself a feature of depression)?

"You never see sites that are pro-meds, from patients who've been treated successfully, is the other side of it, I suppose."

What about CrazyMeds? What about NAMI? What about ALL OF THE FUCKING ADVERTISING?

I smell a shill.

John, perhaps you're right. It could be that I didn't respond to the placebo effect of medications because I didn't have much faith in the medications to begin with. Maybe if I had been more hopeful, the placebo effect would have taken hold and I would have been cured of my diagnosis of severe, recurrent major depression. But, wait?! How can I be cured of a condition that is supposedly chronic/recurrent? Riddle me that.

I am encouraged by your comments, however, because you believe patients can be cured. That's a good sign. I hope you continue to have that attitude, because unfortunately that view wasn't too common among the psychiatrists I met.

I do believe that as long as a psychiatrist believes his/her patients are doomed to a life of chronic mental illness, the liklihood of a "cure" is pretty remote. My road toward wellness didn't happen until I found someone who believed it was possible.

John said:

"I do get cheesed-off with the number of anti-psych / anti-pharm blogs. Where are the pro-pharm / pro-psych blogs? Because, some people do find benefit in their treatment. Some are even cured."

I would love to know your success rate and how you define treatment as beneficial and whether someone is cured. Also, please state for how many years the ADs work.

It would be interesting to hear your statistics in light this exert from the LA Times about using antipsychotics for depression:

"There certainly is an unmet need out there," says UCLA's Leuchter, who has conducted extensive research on antidepressants' effectiveness. "Only about half the patients [on antidepressant drugs] will improve, and fewer than a third will get well with the first antidepressant they try."

http://tinyurl.com/crmver

And when you consider that effectivesness is judged by a 50% reduction of symptoms, that isn't very impressive.

John goes on to say:

"I find that these anti-pharm blogs tend to be written by people who have experienced mental illness, and are bitter about treatment failure, which often leads to bias in selecting stories to comment on surrporting their loss of faith in the field."

You are falsely assuming that people put on psych meds have a mental illness. That may or may not be the case but you can't make that assumption since many people are being placed on these drugs for non psychiatric reasons.

Also, there are many conditions that masquerade as mental illness but really are of a physical origin. Sherry, a commentator on this blogI believe was misdiagnosed when she really had a thyroid ,condition.

And even if they do have a mental illness, what difference does that make? Just because they have a mental ilness doesn't mean they lose their rights to be a fully informed patient. I know you said you were making an observation but that just struck me the wrong way.

You made a comparison with people not putting up anti-chemo blogs. The difference is if those people complain about treatment, they are not usually discredited due to their label.

But anyone with a psych label complains legitimately about any aspect of treatment, it is falsely attributed to their mental illness. I know someone who was very med compliant but complained a particular drug was causing horrific side effects. When the psychiatrist blew it off as being due to this person's illness, she got admittedly beligerent and was involuntarily hospitalized. I understand that is a common situation. Is it any wonder that people become bitter when they are traumatized like that?

There are plenty of pro med sites as Philip has links to them on his blog. They defend meds vigorously come heck or high water.

Finally, I found your comments about people thinking their way out of drugs working insulting even though I am sure that wasn't your intention. And if that is the case, why do people seek treatment with antispsychotics for depression as outlines in the link to the LA Times article that I provided? Shouldn't they be negative about the reputation that APs have? Anyway, that comes across as blaming the patient even though I am sure that wasn't your intention.

Finally, as far as bitterness, psychiatry is not to blame for treatment not working or side effects. But they are to blame for not being honest about everything and instead using the "deny" game to blame everything on the patient's mental illness.

They are also to blame for not being supportive of patients when they want to taper off of the meds and insisting on ludicrous fast tapering schedules that are doomed to failure. Then they falsely blaming that as a return of the patient's illness.

They are also to falsely blame for expecting patients to fail in their tapering off of psych meds.

As an FYI, I am not saying this is true of all psychiatry but a good portion.

John, if you really want productive dialogue with commentators on this site, why don't you ask questions like what would you like your psychiatrist to have done differently in his/her treatment? What would your advice be to people like me? Then step back and listen.
You might be surprised at how people's attitudes change.

In my previous post I meant to post my name as Lisa not John. I was out of coffee this morning so my cognitive function is a bit sketchy.

I don't think this article appeared in the print edition. I don't see how I could have missed it. And I looked on TIME's site under their current issue and the two previous issues (back to May 4) and don't see it listed.

Philip, when you said you read it in TIME, did you mean on their site?

It's disappointing it wasn't published in the actual magazine, but hey, progress is progress.

I'm still looking at their site, and I don't see that their is any way to tell if an article (when viewing it) was published in the magazine or not. It looks like the only way is to click on an issue and then it lists the contents.

Wow John,

Bold of you to post here. I guess I'm not the only one that noticed your comment.

You write:

"I do get cheesed-off with the number of anti-psych / anti-pharm blogs. Where are the pro-pharm / pro-psych blogs?"

Philip has links to several here. There are more pro-pharm and pro-psych blogs than anti. I won't repost them because their information is so harmful. As you know, if you type the name of a psych drug in your browser followed by .com, you get a pro psych web site selling that drug.

You write:

"Because, some people do find benefit in their treatment. Some are even cured."

Again, did you miss depression.com., bipolar.com, adhd.com, schizophrenia.com... And, as mentioned previously, psychiatry sets the rules this way: there is no cure. Mental illness by definition is always chronic and incurable, always must be "treated." Thinking you are cured is a symptom to psychiatrists, not a fact or even a vague and distant possibility. If someone thinks they're cured of depression, well, thinking your cured of depression is hypomanic so this person gets relabeled bipolar. The problem isn't that the person ever was sick. The problem is with the label itself.

You write:

"I find that these anti-pharm blogs tend to be written by people who have experienced mental illness, and are bitter about treatment failure, which often leads to bias in selecting stories to comment on surrporting their loss of faith in the field."

Hmmmm, so you're saying that anti phram blogs and anti psych blogs are the same thing. I think you're mistaken. There are plenty of anti pharm blogs that are not anti psych and not all anti psych folks are anti pharm. I am anti psych but occasionally dabble in SSRI's and Loratadine is great help to me this time of year so I'm certainly not anti pharm. Furthermore, hopefully there are lots more like me told that we were mentally ill who realized this was untrue. My current diagnosis is dysphoria in remission, generalized anxiety disorder in remission. Remission not caused by medical treatment but by removal from pathological living situation according to pshrink. My opinion would be that dysphoria and generalized anxiety disorders are not illnesses so I was never sick.

You write:

"People who have cancer whose chemotherapy doesn't work haven't set up such a plethora of anti-chemo blogs have they?"

Chemotherapy works much more often than psych drugs because cancer is real and does respond to treatment. Sadly, people I've known and loved with cancer who didn't ultimately respond to chemo, were too busy with the business of dying, i.e. the shutting down of their major organs, to do much blogging.

You write:

"It's not a critiscism per se, more an observation/musing."

If you don't think you comment is a criticism, I have to wonder what you would consider a criticism.

You write:

"I guess a specialty dealing with patients who have disorders of emotion will predispose to dysphoric blogs / a nihilistic view of treatment."

Nope, not if the treatment was working. The fact that someone labeled dysphoric would write a dysphoric blog is proof that "treatment" hasn't worked. But it would seem to prove that treatment wasn't necessary in the first place because if someone is really dysphoric they won't be able to blog.

The problem as you seem to be beginning to notice with your profession is that it's less than unnecessary, it's very existence is pernicious.

Andy here's the link within the link Philip provided :

http://www.time.com/time/health/article/0,8599,1895672,00.html

Dear John,
The "other things" are, at the very least, some of the things I listed. I was talking about non-medication options, as I thought I made clear but guess not.

As for work and responsibility, I'm sensing an anti-patient bias in your question, which is sad since you haven't even completed your training. The reason I'm thinking that is because implied in your question is the notion I think *anyone* might be exempt from the need to exercise work and responsibility.

I don't. Both parties need to exhibit those qualities. The listening on the part of the doctor requires hard work and taking responsibility for his/her screw ups (which, inevitably, will happens with humans). The person seeking help (or being forced to accept help) needs also to work hard and accept responsibility. I'd go so far as to say a lot of getting out of a mental illness is basically a process of growing up and taking responsibility and learning new ways of thinking and behaving, of being accountable. Does that float your boat?

Yes, I was misdiagnosed. For 30 years. Here's what I've noticed, now that everyone agrees I have a physical ailment: When I asked about side effects of psychotropics (each and every one of which are loaded with them) I was told it "couldn't be the drug, it's your (non-existent, let's not forget it was non-existent) mental illness." I was assured repeatedly that I was "mentally ill", would always be "mentally ill" and that I would need to be on medication "the rest of your life." The fact the meds didn't really change much, other than to make things worse, didn't seem to matter.

When I first went on the thyroid hormone after 30+ years of non-treatment it was like taking a trip to the moon. Given the response to previous medication queries, it was hard for me to call to enquire about this but it was all so unpleasant I simply had to.

I was stunned by the response--an immediate and respectful "Oh yeah, that's the meds. You should cut the dose in half for a couple of weeks. I'm sorry about this." Big difference. Huge difference. Night-and-day difference, in fact. How odd. Do you think it really should be that different? I don't.

I do hope you'll keep your listening ears cleaned and open. If you do, you may begin to understand just how and why people spend the time, energy, money and effort to maintain what you call "anti-psych" blogs. People do that sort of thing only when they've been pushed to the wall. You might want to put in a little time and effort into understanding what's going on instead of exhibiting the contemptuous attitude that we all somehow just jumped out the box angry.

If you're coming here to collect brown stamps and confirm your pre-existing biases (which are sticking out all over the place in your posting) well, that's just what you'll get. Then you can join your colleagues in well paying, happy clueless whining about the very people you claim to help.

By the way, it is NOT the norm that people are anti-drug prior to taking psych meds. I don't know where you got that idea. We have all, like everyone in our society, been brainwashed into trusting our doctors. We're taught to revere and trust them from the time we're knee high to a grasshopper. We're the original pre-sold customer--you have to really work at it to lose our trust.

Those of us who have LOST FAITH in the system once had faith to lose. We did not come out of the box that way. Your esteemed colleagues are the very people who taught me who they are. Do you think I somehow would have known in advance? Why would I have not trusted them? They were doctors, right up there with Officer Friendly in the pantheon of Helpful People.

My trust nearly cost me my life. Please excuse me for learning truths you find unpalatable. But don't you dare blame me for learning what your colleagues taught me about themselves.

Welcome to Furious Seasons.

Sherry, very powerful comment. When I finished reading it all I could say was WOW!

Thank you, WoH. I get tired of these assholes coming in, thinking they're going to shoot some fish in this barrel.

Well said, Sherry.

And since the Leonard Cohen thread has been closed, I wanted to quote dguller here: "Anyway, if you're agreeing with some form of the chemical imbalance theory, with adequate caveats, then that is certainly surprising to me, because I thought that you rejected in its entirety the idea that mental illness is due to any kind of chemical imbalance in the brain. But, perhaps I just misunderstood your previous position on the matter, or confused you with someone else."

dguller, I think you have mistaken me for another poster or else I really, really need to work on my writing clarity because I have NEVER believed that mental illness is not connected to brain chemicals. I wouldn't call that a "chemical imbalance theory," however, just an acknowledgement that the state of depression, for instance, is reflected in brain chemistry. And I don't know of anyone who believes differently.

Do you believe that adrenaline causes fear? That might be called the "adrenaline theory" of fright. Like the biochemical imbalance theory, it's true as far as it goes but it doesn't help the person deal with their fear.

Stephany, thank you for the courtesy, but what I was trying to write in my muddled way, was that although the article was published on TIME's site, it wasn't published in TIME magazine. Not all articles published on their site appear in the magazine. They update their site daily, but the magazine is published weekly and so not all content gets into the print edition. Though they seem to have 4 print editions (US, Europe, Asia, South Pacific), so maybe it was in one other. I subscribe to the US edition and it was the only one I checked on their site to see if it contained the article.

Francesca:

Thank you for clarifying your position.

I agree that adrenaline plays a role in fear and anxiety, but I disagree that knowing this is unhelpful to those suffering from anxiety disorders.

I have found patients to find the notion that their panic is due to the release of adrenaline, and that adrenaline's natural metabolism in the body takes a few minutes. The idea is that through mindfulness exercises or cognitive restructuring techniques, for example, if they can avoid fusing with their catastrophizing thought distortions for a few minutes, then the adrenaline will be gone and their panic attack will be less intense and have a shorter duration. Again, in my experience, using adrenaline in my explanation has been helpful to patients. Some people reported a drastic reduction in the intensity of their anxiety just by understanding this theory! :)

Anyway, I'm wondering if other posters here could clarify their position on whether mental illness is related to a chemical imbalance in the brain, so that there will no longer be any confusion -- at least, by me! -- about the matter.

Francesca,

Well said!

A chemical imbalance implies, necessarily, a chemical balance. If only one could tell me what the "correct" balance should be for any given circumstance then perhaps we could speak of imbalances - if only we could measure them.

This is pure sophistry, a lie, a construct used to deceive. What is so hard in saying: "We don't know what's going on in the brain, we don't really know how these drugs work, they may offer you some short-term relief at best, and they come with significant risks"? Why throw in the lie of a chemical imbalance?

Naturally, the answer is fairly obvious to most. An ideology built on falsehoods must continue to lie in the interests of self-preservation.

IMHO.

Thanks, Sally. I value your opinion greatly.

dguller, you said "Anyway, I'm wondering if other posters here could clarify their position on whether mental illness is related to a chemical imbalance in the brain, so that there will no longer be any confusion ...."

As Paul points out above, "imbalance" is a problematic, loaded word. To even call it a "chemical imbalance theory" suggests that the answer is to chemically rebalance the brain. That's horsesh*t. Solve the depression and the brain's chemistry is irrelevant, it can take care of itself. I'm pretty sure that 99.9% of the posters here will agree that a depressed person's brain is different from a healthy person's brain. The point is that that is irrelevant and useless information (at this stage of medical science, anyway).

Francesca,

You write:

"I have NEVER believed that mental illness is not connected to brain chemicals. I wouldn't call that a "chemical imbalance theory," however, just an acknowledgement that the state of depression, for instance, is reflected in brain chemistry. And I don't know of anyone who believes differently."

Exactly. I've been down this road with Dguller as probably have you and many other folks here.

Dguller, I remember explaining that the fact that involuntary body functions such as breathing are controlled by the brain doesn't mean emphysema is caused by a chemical imbalance in the brain.

And as Francesca explained adrenaline doesn't cause fear. The fact that people have extreme emotions doesn't mean the chemicals in their brains are imbalanced and you can't prove it does. Treating panic as a chemical imbalance has been a debacle, wouldn't you agree?

It seems like you are renouncing your past position that chemical imbalances cause feelings and behavior and now your thinking is more reflective of science and human experience if I read your adrenaline analogy correctly. So back off the attitude.

I don't think that explaining to "patients" that fear causes a release of adrenaline contradicts anything Francesca wrote. The problem comes when telling patients that they have nothing to be afraid of but their brains are "unbalanced"and releasing adrenaline when there's no reason to be afraid and then attempting to medicate or treat away the purported "imbalance," instead of understanding what the "patient" is afraid of.

Exactly.

Without knowing why, a pill is no answer - it's at best a crutch that can kill you.

In my experience it come down to hubris, but never a lack thereof.

I think that we are all in agreement that mental illness is rooted in neurobiology, and that neurobiology is not a stand-one phenomenon. Rather, it is influenced by genetics, life experiences, internal cognitive processes, individual behaviors, and so on.

The best way to treat mental illness is by affecting the individual's neurobiology, whether directly (e.g. through medications, ECT) or indirectly (e.g. through addressing their cognitive distortions, their psychosocial stressors, etc.). Either way, it seems to me, we are changing the brain to help alleviate distress.

It is certainly true that although we know a great deal more about the brain and its role in mental illness today than before, there is still much more that we are ignorant of, and only further research will ameliorate this condition. I think that the chemical imbalance theory (i.e. low serotonin = depression, high dopamine = schizophrenia) is completely wrong, and these conditions are much more complex and multifaceted, probably including neurotransmitters as part of the story.

Is it fair to say that there is a consensus here that all our mental life -- healthy and unhealthy -- is secondary to neurobiology, which can be affected by multiple biopsychosocial factors?

Dguller,

No, it's safe to say that neurobiology is secondary to our mental life. Feelings aren't caused by neurobiology, they cause it, at least in my opinion and research bears this out. I know you've even argued that the cause of ptsd is neurobiology, and I've argued that ptsd shouldn't be considered an illness but a sane response to an insane world and most people reading this probably fall in the middle.

This is not as fine a point as it seems. Take the classic NAMI example. Family thinks they didn't cause identified patient's illness so all problems identified patient ("ip") has with family are blamed on ip's biological illness and the underlying family issues are never addressed and the problems escalate and the person getting "treatment" deteriorates because the problem is not neurobiology, it's social, interfamial, what have you.

And then there's the problem with the subjective nature of what we consider mental illness as you know. Labeling someone as mentally ill is a kiss of death for that person, where as the same person with the same behavior, accepted not labeled, isn't perceived as sick at all...unlike cancer or diabetes where whether you're identified as ill or not, you still get sick.

dguller, "rooted in neurobiology" sounds like you're trying to imply "caused by neurobiology." These are quite different concepts and I've kind of reached the end of my patience for discussing how they differ. I'm just going to go back to the adrenaline thing and say that our goal should be to reduce the patient's fear, not her adrenaline (although, obviously, that will be affected as she recovers).

People are being forced to take drugs that screw around with their neurochemistry, even though we have little understanding of the complexities of the human brain. Even though outcomes are better without intervention. Even though life expectancy is reduced by drugs. Even though forced treatment offends justice and civil liberties. Even though psychiatry is driven by Big Pharma and is more religion than medical science.

If mental disorders were illnesses, for one thing we would just call them that, no need to add the word "mental." Second, we'd consult neurologists for our "biologically based brain disorders." Third, outcomes would improve as medical science advanced. But none of these things have come true. We still tag people as mental cases to indicate to them and to society that they're not full citizens. Neurologists can't and will never be able to help us. And, worst of all, outcomes are getting grimmer.

In the good old days, you could have a breakdown as a young adult, rest, refocus, recover and be free to live the rest of your life. Now, try to have a nervous breakdown and you're handed a life sentence.

Sally:

Just a few questions:

(1) If our feelings cause changes in our neurobiology, then how do you account for the induction of emotional states by stimulating various neurocircuits (e.g. induction of sadness and hopelessness by stimulating specific areas of the brainstem)?

(2)How do you explain the ABSENCE of certain emotional states where there are neurological lesions in certain key neurocircuits (e.g. absence of fear in those with damaged amydgalae)?

(3) How do our thoughts and feelings change our brains unless they are fundamentally neurobiological in nature?

(4) Isn't your position assuming some kind of creeping Cartesian dualism?

Francesca:

First, my point is for everyone to accept that all our mental life is a result of our neurobiology, and that our mental life is both caused by and influences our brains, but that is only because our mental life is, in some sense, neurobiological. I think that this is the only way to eliminate Cartesian dualism, which comes with insoluble paradoxes.

Second, if adrenaline is a key component of panic, for example, accounting for the autonomic symptoms, then why not attempt to lessen someone's crippling panic by reducing their adrenaline? How is that different from prescribing painkillers to reduce pain due to, say, an incision?

Third, it is fairly common in medicine to add an adjective to the word "illness", as in "respiratory illness" or "cardiac illness", in order to specify the bodily organ that is the source of the illness. I suppose the idea behind "mental illness" is to specify that the illness is rooted in a patient's mind, and not a consequence of problems in other bodily organs, other than the brain? Maybe a better term would be "neurobiological illness"? And I think that you are right that ultimately, neurology and psychiatry will unify, as they were a century ago, as the neurological origins of mental illness are elucidated.

I completely agree. Neurobiology is primarily a product of the mind. Again, the issue is one of control: to control what you think, what you do, what you say.

Let's not forget the power of the purse, one's own ego, and plain evil. When a study is designed to control for these elements, I'll be a bit more observant of the results. Check that. I don't think that RCTs can be properly designed for divining the mind. RCTs are suitable for well understood, controllable processes and systems; systems that are predictable and falsifiable.

This is the basic flaw, imo. We're trying to apply euclidean geometric laws in a non-euclidean space. The intersections are circumstantial, yet treated as evidence of proof.

The mind is not an inherent biologic entity.

Consider the following:

Objective moral values, abstractions, forms: are these mere products of chemical interactions? Horseshit. Perhaps Primes exist due to neurobiology... Utter crap. Is a personal relationship with the creator a neurological coincidence? Is it so only for those who believe, but not for those who don't?

The mind, our perception of reality, drives our biology. Biology provides feedback, but the mind is what matters (snicker). I truly cannot fathom why Psychiatry has lashed itself to flotsam spiraling down the whirlpool. If you want to supplant God I think you'll find the shoes impossibly large to fill.

There is no pill for the mind. In my experience, only a mind can heal another.

dguller,

You hit the nail on the head, for emotional states to change, the brain must be stimulated. Neurobiology is a response, not a cause. As for Cartesian Dualism, interesting, at first it glance it would seem you are correct which is one reason biopsych was appealing to me when I first encountered it. However, in the end the idea that there is a special class of people who have emotions independent of events is the dualism bit. Think about it this way, if I say that you have a brain disease that makes your body happy and your mind sad, DeCartes responds, no impossible, where there is distress in the mind, there must be a real reason for distress. It's the biopsych idea that some people have minds out of touch with the other parts of our bodies, that our minds are discrete little chem labs, that really slices the body from the mind. Think about it...

guller,
Can you possibly explain to me why any of us here need to be justifying our positions or beliefs to you to your satisfaction? I'm tired of your expectation that this is a requirement, that we cannot have a discussion without having to justify every jot and tittle of what we say to make your left brain happy.

It just came to me that this is the root of my experience of you as arrogant. You have a deeply seated belief that you have the right to control the discussion, set all rules of debate, determine the proper standards of proof. All on someone else's blog. This really is an incredible display of arrogance. Go start your own damned blog if you want to control the discussion.

"Second, if adrenaline is a key component of panic, for example, accounting for the autonomic symptoms, then why not attempt to lessen someone's crippling panic by reducing their adrenaline?"

Sure, it's worth alleviating the distress in the short term. However, that's only masking the symptom. It does nothing to address why the person's fearful in the first place. Too many psychiatrists would consider their work done at that point, sending their patient merrily on her way with a lifetime prescription for addiction.

"How is that different from prescribing painkillers to reduce pain due to, say, an incision?"

Because pain due to an incision is expected and temporary. The cause is obvious and can't be altered. That's not true for anxiety disorders.

"Third, it is fairly common in medicine to add an adjective to the word 'illness', as in 'respiratory illness' or 'cardiac illness', in order to specify the bodily organ that is the source of the illness."

Yes but the term mental illness isn't used that way. When the public hears about a "mentally ill" person, they don't think "Oh, someone whose illness is located in the brain." They think "unstable, dangerous, dirty, frightening." To call somebody "bipolar" or "schizophrenic" is to write off the whole person. There's a reason why it's called "mental" illness and not "neurological" illness. A person's mind is their whole essence.

"And I think that you are right that ultimately, neurology and psychiatry will unify, as they were a century ago, as the neurological origins of mental illness are elucidated."

Again, your bias is showing. We will never "elucidate" mental illness's neurological "origins" because it doesn't originate there. What's more likely to happen is that eventually we'll know what anxiety, depression, mania, etc. looks like neurologically and have the ability to alter the brain accordingly. Big Pharma makes more money. Psychiatry finally gets to be called a medical science. Everybody wins! Oh, except for the patient of course who will be denied an opportunity to make positive life changes and who will also suffer the side effects of the drugs.

Paul:

You seem to imply that the mind is an independent entity from the brain that causes changes in neurobiology. I wonder how you would account for the fact that changes in mental states have been demonstrated to FOLLOW changes in neurobiology? I agree that our thoughts can change our brain, but only because our thoughts are essentially neurocircuits encoded in our brain that can be activated and deactivated. Otherwise, how could you account for the presence of retrograde amnesia following damage to the brain?

Now, you raise many intriguing points about mathematics, values and logic and whether they are simply activated neurobiological pathways in the human brain. With regards to values, I do not believe that they are Platonic forms that exist independently of human beings, but rather are normative rules that we have developed over millennia, differing depending upon our different cultural and religious backgrounds. Some values are better than others, but only due to their ability to generate happiness and contentment in our lives, both of which are essentially neurobiological in nature. So, some sets of beliefs and behaviours have an increased chance of leading to human flourishing than others, and those are what we value. If our brains were wired differently, then what we value would also be different, which is why what birds value is different from what we value, for example.

With regards to mathematics and logic, the case is much more difficult, because their universality and incorrigibility appear to make them ideal candidates for Platonism, and a former university professor of mine has made a persuasive case for this position. I haven’t entirely worked out my thoughts on this matter, but I like Wittgenstein’s position that the indubitability of logic and mathematics are complex byproducts of our evolutionary history that we consider immutable due to the central place their occupy in our conceptual schemes, mainly due to their incredible utility in manipulating and understanding our environment.

I’m not too sure if these rambling thoughts go an way to addressing the important issues you raised, but I’m sure we clarify things further in our future discussions.

I suppose I am constitutionally anti-Cartesian and anti-Platonic. :)

And there are certainly pills for the human mind. Pain is a mental experience, generated by the brain, and there are medications that can alleviate pain. Also, it is well known that other drugs (e.g. marijuana, LSD, PCP, cocaine, etc.) have a clear impact on our mental states, as well. Perhaps you are referring to certain mental states as being immune to biological intervention by medications?

Sally:

I completely agree that the brain circuits responsible for our mental states must be activated in order to occur. There are a variety of triggers that could activate neurobiological circuits, including other neurocircuits, hormones, electrolytes, cytokines, and so on. Even antecedent thoughts and feelings can do it, but I contend that it is because they are fundamentally neurobiological encodings that can influence other neural pathways.

Also, I do not believe that one can understand the mind-brain independent of its interactions with its body, which interacts with its environment. I think that there is lots of intriguing work in philosophy of mind on the EMBODIED nature of mind and how it is incoherent to talk about a mind independent of a body, because the mind coevolved with a body to form a tightly integrated entity. If you are interested, the clearest work is by Fracisco Valera and Evan Thompson. I think you’d like it. :)

Francesca:

I wholeheartedly agree with everything you wrote, except for the final paragraph.

I do believe that the final pathway for mental illness is the brain, and that clinical research is usefully pursued to elucidate the neurobiological components of such illnesses. I think that it would be useful to know such information in order to help those who suffer from mental illness. However, I do agree with you that any treatment that followed such a knowledge base must include encouraging patients to make "positive life changes" and not expect all their problems to disappear with a pill.