Tuesday, December 6, 2022

Comments by Artanis12

Showing 9 of 9 comments.

  • Under the heading of “seems reasonable to me” (which is worth what you paid for it) I certainly do lean in the direction of believing in the mind being able to effect physical changes in the organ of the brain. My point was, in the context of something so short term as say, 6 months or even a year, of talking with a social worker or psychologist once a week, for example, we just really don’t know that. Nor do we currently have adequate methods to determine if changes occur from psychotherapy, or to know what any changes we might see are caused by.

    To see the effects of a treatment, we would need to know where to look, what changes we expect to see (both of those are huge hurdles) get a baseline, and then track. This can’t and won’t happen any time soon, believe me. Why do I say that, and why should you believe me?

    Well, cost is a biggie as always. Then there is the fact that neurologists are all atwitter right now about brain atrophy in MS, and are pounding on it online to anyone who will listen: be afraid be very afraid, here take this drug (which may or may not have had info about brain atrophy while in clinical trials). Yet they aren’t actually able to track that yet. While certain MRI software is capable of extrapolating volume (yes, it is extrapolated by an algorithm. The issues that can arise from poorly written medical software are a HUGE issue too). for a myriad of practical reasons I won’t bore you with, this type of imaging is still not ready for prime time and is not being used in the clinical setting outside of more easily controlled studies. And that’s just trying to track something as simple (ha!) as brain volume over time, not subtle changes in specific spots.

    So since we’ve already seen how a bit of information about “brain chemicals” got blown completely out the realm of “gee that’s interesting, let’s find out more” science and into something almost as durable as religious belief, I can easily see that happening with a few brain studies on monks and cabbies. I suppose that’s me thinking that the psychotherapy side of the room would be better served by NOT trying to make scientific claims to support what they do. Meaning, if you’re going to be a counselor or a shaman or a spiritual advisor (what I call my social worker, and she said she loved that idea), then be that and embrace the mystery of what you do. Healing in a psychological context will never be able to be imaged, it can only be the subjective self-report of a person. So leave the brain talk to the more stolid types who assume they can quantify state of being with chemical levels or a graph. (And as an aside, if wishes were horses, this beggar would “mind away” the lesions in her head. Alas, I don’t think mind effecting brain works quite that well.)

    And just look at us, all of us here, talking about the mind as if we know what it is. We don’t. We don’t know if it is a phenomenon of brain processes, if it is an expression of something extra-corporeal that we still can’t apprehend, and merely expresses via the organ of our brains, we simply don’t know. So we’re back to religious/philosophical discussions.

    OK, I’m done musing. I don’t post here often Steve, but I always appreciate reading YOUR responses. You always add a lot to any discussion. So thank you! 🙂

  • Some things that just flashed through my mind (har) as I read this piece.

    When asked about direction and which is predominant – brain affecting mind versus mind affecting brain – we sort of know that brain can affect mind (drugs that can cause changes in thinking or mood, injuries causing personality changes, etc), so that seems to be the the more common position because we can SEE that: so most people would say brain affects mind more.

    But when we ask about mind affecting brain, and people say not as much as the other direction, well, why wouldn’t most people say that? Have we ever checked? I mean, what would constitute enough of a change in the brain and how would we find it and quantify it? If I think X thought for long enough then I get rid of a brain lesion? I grow extra gray matter? As someone who has been in an MRI tube more times than I care to remember, I can attest to the limitations of that beast, for all that neurologists are in a unhealthy love affair with it, with researchers especially loving the fMRI (see the now classic “dead salmon study”).

    So IMO, (and I’m sure someone will correct me if I’m wrong) thinking that mind doesn’t affect brain as much (I’m talking to you, drug-dealing psychiatry) is mostly unsupported, as is the idea that talk therapy leads to lasting changes in the brain (talking to you too, psychotherapists). Both are simply positions with little evidence to back them up. It would be far better for both sides to simply say we just don’t know, but “experts” have a real aversion to that statement.

    But then, I though of this: Then of course there is the constantly shifting rhetorical focus of psychiatrists assuring us out of one side of their mouths that our symptoms are psychosomatic, meaning mind IS affecting body, at least as long as they can’t explain the symptoms in 15 minutes and want to get the difficult patient out of the clinic. But when the body part in question is the brain, which they assume is generating the mind, well, they shift to the other side of their mouth and assure us that only drugs can touch that particular organ (unlike ALL the others) can only work in the direction of brain affecting mind, which is naturally right in their wheelhouse to make easy money prescribing drugs. It’s enough to drive one a little, well, crazy.

    Bottom line, psychiatrists and psychotherapist for all they are labeled “experts” for their supposed greater knowledge, are no more removed from the cultural stew they’ve grown up in or proof agains the difficulties of trying to wrap their thinking around a concept of mind – which is very much akin to trying to see one’s own eyeballs – than “laypeople”, they just like to think they are and tell the rest of us we should believe whatever they are telling us at that moment. In this piece, in fact, we are ALL of us, bricklayers, doctors, researchers, all, “laypeople”. There are no experts in this, just philosophers apparently, who are, according to Mel Brooks, BS artists

  • I was reading the latest, and poked my head in this blog entry and nearly hurked up a lung. Yes Kindredspirit!! This! And this is proof yet again, that expertise in one area absolutely does not automatically confer expertise in any other area, as evidenced by a shoddy stereotype-filled and self-serving analysis of the last 40 years. I wish I had a dollar for every doc out there who thinks he has a handle on “human nature” based on which subset of patients he chooses to focus on. A single doctor’s anecdotal use of the word “some” or even “many” does not constitute data. Actual numbers or it never happened.

    The myopic view that fuels this RANT could only come from wearing old-privileged-white-guy glasses and steeped in cultural/religious tropes like “suffering is good for the soul” and that the belief that humans are at the core, depraved. Choosing to focus on “some” patients and extrapolate to all humans is both short-sighted and hypocritical. Psychiatry is often slagged on MIA as being notoriously context-averse. We see it here, in spades. You have to be pretty wrapped up in your own little world to not be able to connect a few dots in the 40 years from Reagan to now. Overall ease? Did the good Dr miss the Great Recession? The concentration of wealth that’s been going on? The decrease in actual buying power of salaries since the 70s? The skyrocketing costs of higher education? The breakdown of public education overall? He clearly thinks a significant subset of his patients are trying to game the system while not looking too hard at his own group, which expects – and receives – money-for-nothing with its rent-seeking investment portfolios.

    People aren’t less tolerant of stress “these days”, they’re just more vocal and less willing to suffer quietly like in the “good old days” when women and other minorities knew their place, enabling white men to not have to deal with the really uncomfortable fact of old-white-guy-induced pain for everyone who isn’t an old white guy. I particularly liked how the use of Valium by housewives in the 60s is trivialized to women just being bored and too lazy to find things to do, since being a housewife became so easy once they didn’t have to beat the rugs and kill the chickens anymore. That whole little “analysis” is sadly, what I’ve come to expect as the unselfconscious and unapologetic misogyny that the current regime has made acceptable again in public. And writing nostalgically of a time when life was so physically hardscrabble that people didn’t have time to think past the next food crisis, let alone dare ask for anything from their betters? Really?? Reading this was like reading something straight from another century. Except that we have obviously never gotten past that crap and it just keeps bubbling up from from the collective midden.

    The vibe of everyone is suspect, dishonest, and trying to pull a fast one, obvious disdain for humans overall, and for patients and their “complaints” (a word more often applied to women and one that is just loaded with all sorts of unspoken crap) is not at all unique to psychiatry, and is precisely why I have pretty much replaced every male doctor I can possibly replace with a female one. And I’m talking about all specialties, and having cancer and MS, plus the usual types, that’s a few. I realize women doctors are educated in male-created systems and so fed a diet of male biases too, but on the whole, I feel I have a better chance of avoiding the most egregiously antiquated attitudes by avoiding male docs altogether.

  • I MAY agree with certain things Williamson says, but the real issue is not her correctness on certain issues. The real issue is that she’s absolutely not qualified in any way to be president, and so her running is a waste of our (the country’s) time and money. If we really want another four years of Trumpenstein, all we need do is taking our eyes off the prize to start frothing amongst ourselves about slightly wacky dilettante candidates like her who are running simply for self-promotion and money. Seriously, why should we give her our attention and give weight to what she thinks? Just because she’s a well-known public figure? I may think the same thing – that antidepressants are overused (I read MIA after all) – but I don’t try to run for president as a means of beating that particular drum. She’s got a plenty big enough audience of her own. She doesn’t need to run for president. And yes, I’ve heard Williamson talk, and found her to be overly-emotional and far too preachy. For someone who purports to be a spiritual teacher, her massive ego is ALL over her and doesn’t appear to be in check to me. Her running for president demonstrates that yet again, IMO.

  • Sir, you are delightfully relentless. Of all the writing on MIA, I confess I enjoy yours the most. Your skill at not just detecting BS, but calling it out, dissecting it, refuting it, and thus beating the BS-er over the head with it, it unparalleled. I’m sure Pies’ has fits of private rage every time he hears you’ve responded to him AGAIN. Bravo as always.

  • Steve, we could both be missing something. I haven’t read much of modern feminist thought, but the little I read a few years ago seemed more concerned with internecine battles and the subject of intersectionality and how (now old, so it had a generational vibe) second-wave mostly-white feminists were so bad for not having vigorously addressed the concerns of LGBT and black women. Also, until just recently, my observation (somewhat limited it’s true) has been that younger women have been loathe to even identify as “feminist”, preferring instead to call themselves “humanist”. (In the driest, dustiest tones possible): I think the last 2 years have probably taught them the error of that position.

  • The comments are all about the psychiatrists and their failings, and no doubt that’s an issue, but I never made it to a psychiatrist, and you will see why in a sec. My aha! moment came from one of the arguably truest abusers of psychiatric meds, a GP. About 10 years ago, I started feeling like I had the flu all the time – hurt all over, you couldn’t touch me, etc. A rheum eventually did dx me with fibromyalgia. But not before I had dutifully gone to my GP to see what he could do. I was having a particularly rough day and it showed – I wasn’t actually crying, but I was worn out and hardly at my best. Out came the script pad, and he started scribbling away. I asked what he was writing and he said a name I knew was an antidepressant. I asked why he was giving me an antidepressant, and he said “Well, people in your condition are often depressed.” Only I wasn’t depressed, just bloody tired of hurting. I was pretty gobsmacked and of course I refused the script. But I remained shocked and annoyed that he went straight for trying to drug me for “depressed” in under 15 minutes. That’s not a dx, that’s a blow-off. He’d been my GP for a while at that point, and I was (and still am), a pretty squared-away person, even now with several significant health problems.

    Anyway, being the old feminist that I am, his response pissed me off so much, that I eventually found MIA, which has been exceedingly informative over the years.

    And it may seem somewhat tangential to some, (although I don’t see it as such since the topic is pain and its treatment), but I will say that I don’t read everything here, so this could have been addressed somewhere at some point and I missed it, but I’ve not seen the issue of women and the over-prescribing of psychiatric drugs, addressed. The ingrained bias in the culture against women, manifests in the medical world as the subtle blow-off, the impatience with women’s pain, and disbelief at what women report. We are the ones who more frequently show up with “medically unexplained symptoms”. The question becomes though, ARE they unexplained, or do women with difficult presentations (typically autoimmune) then get blown of as unexplainable because they’re women, or attributed to mental problems more often, also because they’re women? And does it even delay the serious research that autoimmune conditions are just now starting to get?

    All of those those medical attitudes and behaviors mentioned contribute to the delay women often experience in receiving correct diagnoses, since women suffer disproportionately from painful autoimmune conditions like RA, MS, and Lupus, conditions that often present earliest with very difficult to explain pain. And now that antidepressants are prescribed with a handy Pez dispenser, the blow off often just looks a bit different than the eyeroll of previous generations.

    For any woman here, but hopefully even some of the men reading, I can’t recommend this book on the subject of the misdiagnosis of women because they’re women, highly enough: “Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick” by Maya Dusenbery. If Robert Whittaker’s writing was one big aha moment for me, Dusenbury’s book was an even bigger one. She even outright describes what I intuited long before I read her book, and that is the terrible double-bind of presenting pain to doctors either emotionally or stoicly. It really is a no-win. We often aren’t believed on the occasions that we present with acute pain either, and for the same reasons.

    So, you can see why some of the attitudes on display in the good doctor’s piece above, are setting off my alarms. When you can say it would be better to assume that there never was an epidemic of chronic pain, essentially saying chronic pain is a problem that was only manufactured by the overprescribing of opioids (uh, no), and that it would be better for society if we went back there, where people just toughed it out, I have to seriously disagree. The probable reality is that most people just suffered in silence, men because they’re MEN! and women because they knew (still often know) instinctively that they’ll be brushed off as “hysterical” or lying.

  • While the actual medical details of this piece are surely beyond my pay-grade’s ability to comment, I pretty much stopped listening when the words “simple solution” floated across the page. It’s always so tempting to trot out the simple solution, especially those that promise that we can threaten and punish our way to success. But as usual, the devil’s in the details. Enforcement of any law is the key, but in the day of drowning government and government regulation in the bathtub, I wonder what exactly, such enforcement of the Harrison Act would actually look like. And if you’re going to say that the simple problem needing the simple solution is doctors’ bad prescribing of pain meds, and that the government should apply punitive measures and should jail doctors, where is the will in the doctor community to create their own methods to drum the bad docs you’re pointing a finger at, out of the profession entirely? Why should it be the government’s job to “scare doctors straight” and enforce a level of ethics that the medical profession itself won’t truly demand of its members? You mention sanctions, but apparently those have zero teeth. You guys are the smartest guys in the room, what’s the solution for that then?

    I also strongly disagree with your assertion that chronic pain was not a problem before opioids, which is just another way of saying you don’t believe in people’s reports of their own pain. God, can things get any more demoralizing than that from a patient point of view? More likely that prior to opioids being prescribed for anything but near death, people just suffered in silence, and died off as early as possible to get away from it. I assure you, chronic pain can get worse over time and become a thing from undertreatment, just as it can from overtreatment with opioids. I’m the poster-child for sucking it up until it’s too late.

    I’m glad you’re not dealing with pain, but many really do, and there’s not much out there for it at present. Downplaying the impact of chronic pain on quality of life, is standard doctor method for dealing with their own discomfort: you can’t help much, so assauge your own feelings of helplessness by being dismissive, or just flat out not believing patients to be reliable reporters of their own pain, especially if the patient is female, because you know, women. Then tell her she’s probably psychosomatic and offer to give her a script for (wait for it) antidepressants! In this I’m speaking from the experience of having a condition that is frequently first misdiagnosed as MENTAL (can you say depression/anxiety/conversion disorder?) and that many docs STILL insist is not painful: MS. So doctors holding forth on what pain is legitimate or not, tends to get my dander up.

    Somehow I’m thinking that going back to the days when the prevailing attitude was suffering is good for the soul and hyper-masculine stoicism was held up as some ideal, is not going to work anymore. I also think that pushing a solution that requires the same medical community that according to many, went to the extreme of passing out opioids like candy, to now go back to the other extreme of withholding any opioid until the patient is dying with stage IV cancer pain, is not going to work out so well either. Both of those extremes are lazy, IMO. Just like hustling everyone with a sad face or with pain, out the door with an antidepressant is lazy.

    I go on the assumption (based in experience) that most of the time that if I hold it together, the doc will assume I’m overstating my pain, but that if I’m emotional, the doc will equally dismiss me with the hysterical label. There’s really no way to win, so I don’t play. But while I personally am sucking it up, I don’t expect that will always be an option. I understand quite well why people in chronic pain might want to check out permanently, and the responses of doctors have had a large hand in that understanding.

  • Maybe because you own default assumption is that everyone else is like you and should feel no pain, or doesn’t mind remembering their colonoscopies? I can tell you, I’m not one of those people and I think you would find if you asked, that a good proportion of people are more like me.