Monday, May 10, 2021

Comments by Zetetic

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  • It doesn’t sound to me that this fellow understands neuroscience very well. When he says things like “the chemical imbalance theory has been discredited” he sounds like a rank amateur. No one who studies the neuroscience of depression ever seriously used the term “chemical imbalance”. Does the neurotransmitter serotonin affect mood? Yes it does. Can drugs based upon this help people – yes some. No doctor practicing evidence-based medicine thinks drugs are the be-all and end-all in psychiatric illness. But for this fellow to promulgate the notion that there are no biological bases for psychiatric illness just shows that he a) doesn’t read (or understand) the literature very carefully and that b) he doesn’t understand neuroscience very well. For instance, schizophrenia has strong associations with over 100 genes (indicating that the biological bases are complicated) and has also been shown to have altered connections during development between the temporal and frontal cortex. These findings have been replicated and incontrovertible. Now how one goes from these alterations to the constellation of symptoms that we call “schizophrenia” is very complicated, but by understanding the biological substrates we can make progress treating the disease with BOTH drugs and/or psychotherapy.

    A reason contemporary psychiatry has lost its moorings is simple to understand. First, psychiatry is one of the lowest paid medical specialties. If someone comes to your office and you have to treat them with a long psychotherapy session, you will make less money than if someone comes to your office and you see them for 10-15 min and send them away with some drugs. So you punt the psychotherapy off to the clinical psychologists since they can’t, for the most part, prescribe medication. If you are a psychiatrist looking to pay off medical school loans and make an upper-middle class living you go to shorter patient visits to reap the volume. That is why your primary care doc sees you for such short times.