Thursday, March 21, 2019

Comments by kfogel

Showing 5 of 5 comments.

  • Hi Walter, I am afraid I am going to disappoint you, which is unfortunate given the time and effort you put into your comment.
    However, I will offer some food for thought that might address some of what is driving your questions (if I’m wrong in this, I apologize in advance):
    – First off, no, I cannot offer you a numerical estimate. Meds only reduce sx; recovery is indirect effect only;
    – I tell my students that no prescriber can tell any patient when to STOP taking their meds, certainly not based on research. Pretty much all of psychiatry is about what to START and sometimes what to change. But the sooner you can get people off meds the better.
    – For the consent issue, in general, for all patients, they need to know that there are always costs/benefits to taking/not taking meds. Typically, the choice is “experience symptoms” or “experience side effects.” For people experiencing psychosis, can they manage their hallucinations on their own or with the support they currently have? If so, great! However, if they cannot, they face that decision. Some will, reluctantly, choose the meds. Not everyone with psychosis can “tough it out,” or manage their lives by sheer force of will. Sure, some can. But if you read the studies that are pro- or anti-psychiatry, the common theme is that there are always people in the “non-successful” group. On both sides of the argument. If you spend too much time on your own side, you neglect to see the other side.
    – So, in terms of consent, people need to know that a big part of this whole enterprise is guesswork. However, if you have a decent and empathic provider, your chances of success are greater, just from the standpoint of wellbeing. Call it placebo if you want but that does not diminish the positive effect.
    – The problem with using research studies to help people make decisions is that they are based on group statistics. They don’t apply to individual cases. Does it help someone to tell them that there’s a 40% chance of improvement? An 80% chance? What does that mean FOR THEM? What does it mean if they choose the treatment with an 80% chance of “success,” but it doesn’t work? Is there something wrong with them? With the treatment? With the provider? I find that this limits the clinical utility of Cochrane studies. Especially in their studies of meds for mental illness/behavioral health, there are so few good/reliable studies to base their conclusions, that the conclusions are almost always “no conclusion can be made…”
    – A wonderful question to ask a prescriber/physician is if she/he would follow the same protocol with a loved one. And jump on any hesitation. Then you’ll find out the real issues about the treatment. Any clinician who refuses to answer or is uncomfortable with such a “role reversal” is not someone I would want to see for treatment.
    – Another common theme/recommendation of sorts has to do with mindfulness. Increasingly found to be beneficial or effective or whatever you want to call it. If you have a “monkey mind” like most in Western society, trying to be mindful is about as hard a task as you will find. I don’t think it is coincidental that cultures who are more attuned to their present being/context have fewer mental health problems, and those with diagnosable disorders fare better in the treatment offered in those countries (like India).

    So, I apologize again. If you still want some numbers, I can dig some up for some of your questions, or at least in an indirect way, since we know how little there is out there. However, it looks like you are very well read up on this.
    Take care and thanks for the thought-provoking commentary
    Ken

  • OK, so you disrespect my education. Not necessarily relevant to the discussion, certainly rude. But whatever.
    I’m sure you realize that “natural” does not mean “less toxic,” and listing ethanol among the drugs you listed was, well, unfortunate for your argument.
    You provided a link to a list of potential articles about neuroleptics. Not very helpful.
    You provided two links in response to my suggestion of other modes of intervention. One to a blog entry about a shaman’s visit to a mental hospital, which highlighted the importance of considering difference in worldview. I certainly don’t disagree with the premise or conclusions of the article but wonder if you are suggesting that Westernized people consult a shaman for their condition and expect positive results.
    The other link to a review of studies that demonstrate the effectiveness of therapy without medication is helpful, thank you.
    I have helped many people with trauma, in my own, “Psy.D.” way, and I believe my understanding is just fine, thank you.
    No need to link to the laws.
    … and then you refer to me as a “bruha,” the meaning of which I was ignorant. Looked it up. “Witch, hag,” or “asshole.”
    Nice. Whichever one you meant, winking emoji or not.
    You might want to look into the nature of your “awakening,” and wonder how you could talk to people this way…
    No need for me to respond to anything further you say.

  • Hi, Julie.
    I’m very, sincerely sorry that you, and the person you recall, went through that experience.
    First of all, right off the bat, someone should NOT be going to the doctor “for drugs.”
    Second, asking if drugs are “helping” is not helpful. We need to ask, “how are they helping/not helping?”
    Third, giving drugs “for depression” is almost always pointless. Now, giving drugs to help someone sleep, maybe, but also not particularly helpful. Meds are for symptoms, not disorders. I disagree about the “minimal harm,” though, because it was based in miscommunication. The relationship and communication are everything.
    Fourth, “benefit” means what it sounds like it means: help. How did the lithium help with the ED?
    Fifth, “helps with your bipolar” is a stupid sentence, a waste of energy and breath, meaningless and foolish.
    Unfortunately, in this day and age, with internet “self-help,” layperson misunderstanding of the kinds of info available online, evil marketing by pharma, spineless prescribers, and everyone’s desire to feel better quicker, meds are the thing.
    Fact is, most things that are worth anything in this world take time, effort, and commitment to get over the initial hump. Most people don’t understand how therapy works. Most people don’t know what they really need. Most people don’t really listen to other people. etc.
    Like I said, I feel bad that you had to experience such stress and heartache.
    Hope what I said makes sense.
    Ken

  • Love this article, Mr. Whittaker!
    Like Susan Rosenthal, I too am a grad school educator. However, I am “closer to the edge of the abyss” as I teach Intro to Clinical Psychopharm and Psychopathology at the Chicago School of Professional Psychology. I am one of several faculty who use your writings in classes, and who strive to encourage critical thinking and skepticism about the current toxic atmosphere in mental health.

    I’ll play a bit of devil’s advocate here, however,in order that we don’t swing the pendulum too far to the other side. As much as Lieberman and the Liebermen do their best to snivel and deceive, one point to salvage is that some people with schizophrenia do in fact benefit. Two truths are (1) that this number is a lot smaller than organized psychiatry would like to believe, and (2) that we DO NOT KNOW who is whom: which people are better off taking them or not. That to me is the research mystery that must be solved. And to add to some of the great research details presented by commenters here, the brain imaging research does NOT help answer the key questions, not least because that field has its own systemic-guild problems…

    I warn my psychopharm students that it will be a VERY pessimism-inducing course, with few answers and few solid recommendations. I can’t imagine that this tone is conveyed in med school…
    One aspect that is more encouraging to me is the growing acceptance that mental health is about more than the brain, something that will ultimately require psychiatry to make substantial adjustments in their model.
    Another is that pharma is investing less money into researching traditional psych meds, so there is less pharmalfeasance. Thus more psychiatrists consider themselves “neuro” or “bio” doctors. For the rest of the meds, it’s more about generics now.

    The overall way I explain psychotropic meds is as a means to help people better use other modes of intervention. But the meds do not work on their own, nor should they be used for an extended period of time–how long? *shrug* But they contribute to the more general process of learning how to manage life, how to change old patterns of behavior, and perceive experiences differently. It’s like someone helping push your car out of a ditch when it’s stuck in the mud or snow. You’re spinning your wheels with no hope of getting out on your own. However, you certainly don’t need that person hanging out in your trunk after you are out of the ditch!

    In any case, thanks kindly and greatly for your in-depth response to this “sell job”
    Looking forward to having my students read and incorporate it.
    Ken Fogel, Psy.D.

  • Excellent work on revealing what is shockingly sloppy work, all the more egregious given the number of researchers and person-hours that went into this thing. It’s not even like this investigation took sophisticated statistical analyses to detect subtle infractions–just patience, persistence, and logic.
    That being said, I will stick my neck out, and add some comments that most readers might find unpalatable.
    First, while this study does nothing to support the “ADHD is a brain disease” theory, neither does it confirm that ADHD is NOT a neuropsychological disorder.
    Second, while the buried IQ data represents a shame of scientific miscommunication, it also says nothing about the nature of ADHD as a disorder.
    Third, I find it unfortunate that arguments against ADHD as a diagnosis often resort to school misbehavior being misperceived. That is, kids who have ADHD are really just unable to manage an unreasonably restrictive school system, so of course they are going to climb the walls. What is unfortunate is that this is only trying to account for one domain of functioning. Say what you will about the inadequacy of the DSM diagnosis, but one of its foundational criteria is the behavior must occur in at least two separate contexts.
    Fourth, methylphenidate (Ritalin) does not “fry your brain.” The differential effect that stimulants have on ADHD vs. non-ADHD kids should be a sign that areas of their brain are functioning differently (notice I said nothing about size, which I agree is a ridiculous variable to target in developing brains). I am NOT advocating for prescribing stimulants for diagnostic purposes, heavens no. I also don’t think they should be prescribed for more than 2-3 years tops (check the MTA study for why).
    Fifth, whatever you choose to call the pattern of behaviors and difficulties faced by these kids, there is no denying its existence–at least not by those who have experience in working with them. That is, there is a percentage of the population, maybe 3-5%, who have ADHD. YES, kids as a whole are overdiagnosed and inappropriately diagnosed kids are wrongly medicated. But this is a baby-bathwater situation. Clearly, if someone is behaving in a markedly different manner than the people around them, then, guess what, their brain is doing it. Now, what one chooses to do with that information is a separate consideration.
    I hope that those of you who have chosen to read this far can do so with a balanced mindset.
    Cheers