Friday, August 23, 2019

Comments by Layla

Showing 53 of 53 comments.

  • Hi Laura,

    Thanks for this message (and of course no worries at all on responding to my long and winding commentary – I enjoy and appreciate the dialogue we’ve been having, but also understand all too well the unfortunate human condition of so much to do and so little time to do it all!)

    I did want to mention a couple of things (should’ve known myself better than to think I could impose the above-mentioned limit on sharing my thoughts :/)

    I was in (friendly!) debate mode when I replied to your comments, and that framed my response – just want to clarify that I do see and understand the dangers that presently accompany the “mentally ill” label. Although the labels didn’t change how I saw myself in relation to myself (if that makes any sense), it definitely did change how I saw myself in relation to others. I’ve found that some (many) people think they have an inherent superiority over the person who is ‘mentally ill.’ I felt it on inpatient units especially – in my comments on your entry a few months back I mentioned the traumatic inpatient experience I had prior to finding compassionate, skilled clinicians…during that especially, but also other hospitalizations, I felt the powerlessness, lack of autonomy, robbing of dignity that comes with being institutionalized in that way. I also see it in the media, hear it in the public discourse, in the way politicians speak, and – perhaps most disheartening for me – I perceive it in the way some professors and other students in my program talk. Andrew described it perfectly in his comment above – the “us” and “them” mentality, the imposing of “otherness,” the failure to recognize that the similarities far outweigh any differences. I do think that what I’ve talked about as “clusters of phenomena” and “extreme and persistent suffering” are real (your clarification of your views regarding that matter was quite helpful for understanding your position better), but I also agree that a “disease model” is inaccurate. I’m less opposed (theoretically) to the term “mental illness” – I don’t think that’s quite accurate either, but I do think there’s more validity to the conceptualization of these states as “psychologically under the weather” as opposed to “psychologically diseased.” I think it’s clear there’s no disease involved; I find “illness” useful (perhaps mostly because it is a move away from the ‘moral failing’ concept), but I also see the argument for getting rid of that conceptualization — not because it’s not useful in some ways, but because it has become a poisonous conceptualization inextricably linked to bigotry.

    It frustrates me to no end that I feel I can’t speak up in my grad program, can’t disclose my history, can’t tell some of my peers that they’re revealing a profound lack of insight and perspective in the way they talk about mental illness. These are people who have chosen to devote their careers to clinical psychology, yet many of them do not seem to understand a very basic fact: we are all human.

    My thanks again to all for the thought-provoking comments and discussions here at MIA.

    Best wishes,

    Layla

  • Hi Donna,

    As I said, I don’t agree with the “faulty brain” notion at all, so I certainly don’t think “faulty brains” cause PTSD. I’ve also been diagnosed with PTSD (the description fits for me, whether or not the designation “mental illness” does), and I don’t think I have a “faulty brain” any more than the next person (in a sense, I think every one of us has a faulty brain…that is, no one is a Platonic form). I’m not sure where you got the idea that I don’t think context is of crucial importance, as I don’t see how what I’ve written implies that at all. Reductionism need not be dehumanizing…I’m about as loving and compassionate as a person can get, perhaps even to a fault at times, and I do endorse a reductionist view. That’s where I get frustrated — it’s not reductionism’s fault, it’s a corrupt system’s fault. I can honor my – and others’ – experiences, see a human spirit – in all of us – that needs nurturing, see the importance of relationships, believe that experience is deeply personal and something no one but the experiencer can be an expert on, and still think we’re composed of atoms and only atoms. Neuroscience doesn’t even rely on such a strong view, the science of the brain (which is all neuroscience is) only needs to assume that the brain is involved in experience. Neuroscience is not the enemy – a system that incentivizes hurting innocent people is the enemy.

    Best wishes,

    Layla

  • Hi Steve,

    I certainly don’t deny that much of what I’m saying is philosophical, not scientific. What I’ve tried to get at is the fact that science can only study what is physical, and there is reason to think that experience is deeply connected to what is physical (e.g., molecular processes) — of course, it’s an open question as to whether or not there’s something else; I don’t claim to know that there isn’t (I personally doubt that there is, simply because “non-physical” doesn’t make any sense to me, but I totally get that (a) just because I don’t see what “non-physical” could possibly mean does not, in any way, prove anything about the existence of non-physical entities, and (b) there’s nothing scientific about my stance). I just want the science of human experience (i.e., psychology) to continue, including the science of human suffering (I do think there’s a distinction between ordinary suffering and extreme, persistent suffering — hence the bit about the learned helplessness dogs versus the wants-to-spend-more-time -outside dogs…I don’t know that it is best understood as “mental illness,” mostly because of what that term has come to connote for most in our society). One needn’t embrace the claim that “everything is physical” in order to agree that “what is physical is very important for human experience.” I don’t think anything you’ve said about “where does intention come from?” is a serious problem for my tangential argument, but I also know plenty of philosophers disagree with me. Anyway, that is a philosophical discussion, of course. I just think sometimes the emotion (completely justified, understandable emotion) around biological explanations for human experience gets in the way of recognizing that biological explanations need not be threatening. The question is who wields biological explanations and what do they do with them, not whether they are wielded at all…

    Thanks for your comments – with respect to what I think is the most important matter (stopping abuses of power), I’m on your side.

    Layla

  • I’m really sorry for going back on the earlier promise to cease and desist with comments after that last one. It’s just that I realized I didn’t explain something that I think is really important, which is why I care so much about all this today. First. although I did not think of myself differently because I was labeled (still am, I suppose), I was and continue to be very aware of how other people may view me differently…I don’t disclose anything about my “history of mental illness” in my grad program because I know that it would likely be to my detriment to do so. I want to shake many of my fellow students and yell, “don’t you understand!? The label doesn’t mean anything!” I have absolutely felt the stigma and I think it’s a major problem that our society now understands the psychological phenomena commonly referred to as “mental illness” to be permanent conditions of “faulty brains.” I think that’s an absurd notion — there are no “faulty brains,” in my opinion. Second, I am very concerned about my girlfriend, who is on a whole slew of psych meds. I look at the line-up and think, why? You’re not even diagnosed with the disorders these are supposedly efficacious in treating. Then I think, what is this cocktail of powerful chemicals – the effects of which we know so little about – doing to you, the person I love? What are they doing to your brain? What are they doing to the rest of your body? My psychiatrist (whom I still see despite not being on psych meds myself) has agreed with much of what I’ve said to him about my concerns around her regimen – he doesn’t know her and always points that out, but nonetheless, he has voiced agreement. She’s not receptive to hearing about my concerns. I don’t know what to do. It is personal for me, the movement to stop the abuses of power. I think I got really lucky – I had a very wise mentor going into the system, I happened to find truly amazing treaters, and I emerged a “success story” (so far…). I do believe everything I’ve written here about the brain as the seat of experience and all that. But my reason for caring — for coming here to argue about it with patient, friendly Laura over the last couple days — is not that I must convince MIA bloggers and readers that I’m right. It’s that even though I’ve come to see myself as a supporter, in many ways, of this movement, I still get annoyed by the “my suffering isn’t something physical” talk. Not that there’s anything wrong with believing that – I wouldn’t think it necessary or appropriate to go on and on about why I disagree if there weren’t what I perceive as high stakes involved. But I’m as sympathetic as one can get to the views here – and the movement more generally – without being a part of it, per se yet it does bother me. Finally, I figure it’s good for activists to sharpen their arguments through practice with sympathetic but not convinced folks as much as possible 😉

    Anyway, just want you, Laura, and you, everyone, to know that I don’t come here to defend psychiatry, but to do my best to strengthen to grassroots movement that I hope will topple the current psychiatric establishment. Commenters/bloggers here helped me arrive at the position of advocating for that toppling, and the more I learn, the more it troubles me (professionally, but moreover personally). My nagging suspicions around the gf’s regimen that I tried to push out of awareness have become impossible to ignore since the last time I showed up in the comments here at MIA, and I think everyone here for forcing me to stop ignoring or trying to silence those thoughts.

    I do hope we can keep trying to use scientific inquiry to figure out how best to help people who suffer more than they must, but even I would prefer no science to corrupted, abusive, dangerous science.

  • *First: having written out my reply, I see that it is *ridiculously* long, and I want to apologize to all other visitors to the site. I considered editing it down; instead, I am going to go ahead and submit it, but out of respect for others, I will limit my words to this post and commit to leaving this as my final comment here. (This way, any who aren’t digging my stuff will only have to skip over this one 🙂 I hope that eases your annoyance).

    Hi Laura,

    Thanks so much for your detailed response! I’ll try to be as succinct as possible now (still working on the long-winded thing :/) I’ll also do my best to leave out the jargon – my own knowledge is still quite limited, which makes it difficult to say what I mean without relying on such terminology.

    1. I would argue that your examples indicate you are not anti-brain-medicine (i.e., you don’t oppose neurology), but it still seems to me you oppose the scientific study of human experience. Perhaps that’s because you believe it to be fundamentally connected to a non-physical substance of some sort; in that regard, we may simply be at an impasse. I agree there’s a human spirit, but I take “spirit” to be non-literal…thus, I don’t think it’s incompatible with a physicalist picture, nor do I think that picture rules out the possibility of continued existence after death. I certainly don’t believe that viewing ourselves as physical beings in a physical universe in any way diminishes the wonder or beauty or tragedy of human existence (an existence which I believe has all those qualities at once). I also don’t view this ‘spirit’ as unique to human animals – indeed, I believe there is just as much an equine spirit, a canine spirit, a feline spirit, and that those spiritual dimensions to non-human animals also arise from their physical composition. I’m less inclined to think there’s a “repitilian spirit” (though I’m open to the possibility that I’m wrong), and the reason, assuming I’m not wrong, has to do with the particular nature of their physical composition (i.e., their brains lack the requisite components for a spiritual dimension).

    -> …of course, there are studies of “schizophrenics” that show brain shrinkage, but in these studies the participants are on antipsychotics; studies of non-medicated “schizophrenics” show no brain shrinkage).

    There are also studies showing asynchronization of neural oscillations in the brains of people diagnosed with schizophrenia – I can’t remember if any have looked at un-medicated people, so the findings may be confounded in the way you’ve pointed out for gray matter density. Same for decreased connectivity between certain regions that are thought to be responsible higher-order executive functions (namely, integration of information processing within and between neural networks).

    -> Genetic studies to this date that have claimed genetic bases to these “illnesses” are not replicable (see Jay Joseph, PhD’s writing on this).

    Everything in life has a genetic basis – our genetic code is the set of “if…then” statements that determine our response to various environmental inputs (of course, development – throughout the life span – involves the interaction of inputs and “if…thens” in an ongoing interplay). Genetic basis does not mean fixed, of course – the genetic bases of the various cancers are unknown and believed to be complex and highly variable, but there’s little doubt that there is a genetic component to cancer (again, there’s a genetic component to everything). Identical twins do not have uniform outcomes with respect to cancer, so cancer is clearly not genetcally determined (almost nothing is!) but that doesn’t mean genetic make-up is irrelevant (it never is!) Of course, given that genetic make-up is relevant to everything, finding that this or that allelic variant is associated with this or that psychological phenomenon does not tell us anything about whether or not that phenomenon ought to be considered a pathology.

    -> You differentiate between “persistent, extreme mental suffering” and “ordinary suffering” as though they come from different sources (at least, that’s how I interpreted it because you differentiated between them instead of saying ‘the spectrum of suffering’, or something like that).

    I did note the contimuum of psychological functioning and experience of suffering. I also differentiate between persistent and extreme suffering and ordinary suffering, but I mean the difference to be one of degree, not kind. (I defined the former as “extremely far below optimal functioning” on the spectrum, where optimal functioning is relative to the individual)

    -> I’m curious to know what you think there are different “qualities” of suffering, and how do you distinguish between them?

    I think it might be useful to look at non-human animals in trying to respond here. My dog, cat, and horse all show signs of unhappiness when, for example, they would like to be roaming outside but are confined indoors. Back in the day, when researchers used canines and felines the way they still use rodents, depression was modeled in dogs through exposure to chronic, inescapable stress (studies of learned helplessness using eletric shocks to induce despair). The unhappiness from frustration of desire is what I’d call ordinary suffering, the second – persistent, extreme disruption of ordinary psychological functioning as seen in those dogs – is what I’d call, well, persistent and extreme suffering. Behavior is one way to distinguish between the two – does the animal “bounce back” when the situation is changed (horse gallops around with playful bucks then grazes peacefully upon release from the stall) or does the animal show signs of continued dysfunction (not engaging in adaptive escape behaviors when the shocks become escapable again)? For humans, we can often rely on self-report (“I’m interested in doing the things I’ve always enjoyed” versus “nothing seems worth doing” or “I’m able to carry on with my activities despite knowing that the world is full of danger” versus “I’m paralyzed by fears of what could happen if I leave my house/don’t engage in my rituals/etc.”). I know, for me, what is ordinary suffering and what is persistent and extreme…I’d wager that non-human animals do too, even though they can’t tell us about it.

    -> How could anyone be in a position to make these distinctions?
    Again, I think the individual can make these distinctions. I also think family members, close friends, etc. could (in priniciple, I’m not suggesting family or friends “always know best” what’s true of an individual, just that some of the time, others can accurately perceive “she hasn’t been herself lately.” Often, the individual’s assessment and those of close family/friends are in accord – “You haven’t seemed like yourself lately” and “I know, I haven’t been feeling like myself”). We can also make these observations in non-human animals, and, again, I’d bet they can make them too, although the assessment likely looks different given the intrinsic differences in human and non-human animal processing and obviously they can’t tell us anything about what that’s like for them.

    -> Why do you think they come from different sources?
    I don’t think they come from different sources. Again, the distinction I make is one of degree, not kind.

    -> Additionally, while you didn’t say “life-long”, most people who talk about “severe and persistent mental illness” make the assumption that it’s an organic condition that will be with the person for the rest of his/her life. Is this something you agree with?

    No, I don’t agree that the condition of “extreme and persistent suffering” must necessarily be a lifelong one (or even that it typically is).

    -> You say, “Experience is the phenomenon in question, the mind is the seat of experience, and the brain is the seat of the mind. Thus, the brain is the seat of experience. We are seeking to alter the nature of experience, so we are seeking to alter the seat of experience, i.e., the brain.”…I believe that much of our suffering comes from the soul/spirit (I do not mean a religious spirit, but the human spirit).

    Agreed. It just seems we have different conceptions regarding the make-up of that spiritual component.

    -> I greatly disagree with your ‘if A=B, and B=C, then A=C’ reductionism of human experience…First, because I don’t agree that each of those things equal each other.
    Fair enough, that’s where we seem to be at an impasse.
    second, because you just can’t reduce the human experience to an equation.
    It’s not really an equation, it’s just a form of logic. You are using a form of logic as well, it seems (neither the mind nor the brain is the seat of experience, therefore neither the mind nor the brain is an appropriate object of our endeavors to change experience). The difference in our conclusions results from the different premises we endorse, I think, not from the manner by which we reason to our respective positions.

    -> Using your logic, I’ll play out a made-up scenario:
-A child grows up…you’re saying that the “target”, i.e. the locus of the problem, is this boy’s brain, because, as you say, “The brain is the seat of experience.” You believe the answer is to alter his brain, and that this will resolve his problem? I’d be curious to hear your response to this…

    Yes, I think that the boy’s brain has developed (in response to what he encountered) in a way that causes him to have a lived-experience full of pain.

    -> As I see it, the “target” is not the boy’s brain, or the boy, at all, but rather, his relationship to the environment around him, and the support he needs is not pharmacological in nature, but rather, a way to process his traumatic past.

    Relationships are simply two (or more) brains interacting with one another (in using “simply” I don’t mean to suggest there’s anything simple about this interaction). On my view, processing means changing the brain (thoughts arise from *and* act upon the brain; that is – in thinking, the brain is acting upon itself). Pharmacological intervention may indeed be unhelpful at best or harmful at worst. I don’t know how much good comes from “processing” one’s past (certainly that’s a part of the healing process, but I think equally important is learning to feel OK despite the fact that the past can never be “resolved.” To draw from a personal example, the pain I feel from having lost my father to cancer 5 years ago will never be “processed” in such a way that it decreases at all, I don’t believe. I can’t vanquish the pain by talking about it, analyzing it, etc., but I can (and have) learned to go on in spite of that ever-present pain. I do believe this ability to go on has resulted from my brain learning that it can hold that pain and hold hope, joy, etc. all at the same time. Again, I don’t see a difference between “I have learned to…” and “my brain has learned to…” It’s useful to talk about ourselves as something distinct from our brains, just not literally accurate. I don’t think the lack of literal distinction diminishes the significance of my achievement in learning to cope with this pain, nor do I think it means that “I” had nothing to do with it because it was all “my brain.” I’m my brain, my brain is me…for now (perhaps there is a continued existence after death in which the thing that is “I” is manifested in a different way – again, brain and person are conceptually distinct, just not literally distinct in this life. On a conceptual level, the physical form that gives rise to this “I” could be different and still give rise to the very same “I”; there’s no contradiction in asserting that my experience arises entirely from my brain and asserting that my experience could arise just as it does from a system that is not in every way identical to my brain).

    -> …I’m sure his biological has been impacted by his environment (likely, increased stress hormones, who knows what else) but that doesn’t mean the solution is to alter his biology.

    The impasse again. I don’t know what it means for something to be “outside nature.” Nature is physical, so any and all alterations within nature are physical in, well, nature. The boy’s biology – that is, his molecular composition – has been and will continue to be altered by every single millisecond he has experienced…whether we ignore him, talk to him, give him massages, feed him pills, shower him with skittles, etc., any action that inflitrates the realm of his experience will alter him – profoundly or trivially – and any alteration takes place at the molecular level (we can talk about the alterations at other levels – e.g., social interactions – but we are still talking about something that takes place at the molecular level).

    -> My answer would be that there is always a root cause of suffering, although it’s not always visible, or definable in one way. Life on life’s terms, and everything we witness in the world— the processed food we eat; the violence we witness on the news and in real life; the rise of the internet and the loss of social connectedness; high-pressured American society; all sorts of societal and family pressures in general— there is sooooo much out there that could be at the root of suffering.

    Agreed. Absolutely. All suffering has a cause (everything has a cause). We need not identify the cause to operate on the maintaining factors, which are not always (and I would argue, not usually) the same as the causal factors.

    -> Just because you don’t have an explicit source of suffering, doesn’t mean the suffering is the direct result of something faulty in your brain. And I’ve found that in honoring my suffering and finding meaning in it, instead of reducing it to a target to be drugged, I’ve found tremendous peace and resolution from much of my suffering.

    Right, I would argue that “honoring [your] suffering” is something that takes place at the molecular level just as much as everything else. Again, I don’t see how that makes it any less special, amazing, or magical. The universe is no less magical for being physical! In my opinion, it is a historical accident that physical has been conflated with less special/wondrous/magical. Also, the fact that you’ve found it helpful to not reduce your suffering to a physical process does not make it irreducible. Some people find it helpful to reduce in that way, which also does not tell us it *is* reducible. Whether or not it is entirely reducible, however, there are grounds for believing that it is substantially reducible (we know that manipulating cellular and molecular processes in humans and animals changes their experience, so those processes have to at least be very involved in, if not totally responsible for, experience). Given that we know this, and that whatever is not reducible to physical components is beyond the realm of science, we are right to focus our scientific study on the physical components of experience.

    -> [Quoting original post,] “Surely it is the brain we alter through meditation, exercise, changed perspectives on gratitude or serenity, triumphant rejection of or liberation from an identity which putatively induced one’s suffering… no? I agree that my biology is changed by the environment I live in, and by the actions I take (or choose not to take) in the world around me. If I’m not mistaken (and apologies if I am, because I do not have a neuroscience background), biology is not just the brain. Much of our biology is connected to our brains, but what about the thyroid (and the rest of our endocrine system)? Our gut?

    -> Yes, absolutely, the body is a physical system – the brain, I’ve argued, is the seat of experience (without it, there’s nothing to experience the workings of the thyroid etc.). Thus, our experiences are due to the ways in which our brain operates, but the brain is absolutely affected by (and affects) all other parts of the system. In some ways, it doesn’t make sense at all to talk about the brain (or any other part of the system) as separable from the system itself – it’s another useful way of conceptualizing and speaking about something, heuristically. The distinction is conceptual, not literal (kind of like we can talk about the lightbulb as distinct from the electrical wiring, but the whole system is what gives rise to the light that emanates – the light is a product of the whole electrical system that the wiring and bulb compose, neither is more essential than the other in giving rise to the light)

    -> But I have to believe that much more than the brain changes
    If the “spirit” is literally distinct from the system (the light is somehow independent of the wiring and the bulb), then yes, more than the brain changes. If the spirit is simply the end result of the system (the light that is wholly caused by the wiring and the bulb), then no, nothing more than the brain changes. If you want pink lighting, you change the bulb, you don’t try to alter the waves by manipulating the light itself – you change what gives rise to those waves. When my dog seems to be “in a funk,” so to speak, I look for ways to bring her out of it – does she need more exercise? Does she need more stimulating toys around? Does she need extra cuddle time? Those are interventions aimed at physical processes (including those that give my dog her “spirit”). Do you agree that my dog’s spirit is synonymous with processing in her brain? Do you agree that humans and non-human animals are continuous? What am I changing about my dog when I give her more attention, change up the toy basket, or extend the length of our morning walk? Something other than her physical system? Does it make it any less important or significant if it is “just” physical processes I’m intervening on?

    -> …just because people feel better when they meditate (and there’s increased brain activity) doesn’t mean they were “ill” to begin with.

    True (although it’s different brain activity rather than just “increased”). That’s why I’ve wanted to use “mental illness” heuristically. We can call it “madness,” which was around long before the medical model (as was “neurotic”), and have the same conversation. We can call it “psychological functioning that is counter-to-optimal-flourishing.” We can call it “intense and persistent suffering.” The social consequences of using “illness” are important, but what we call the phenomenon in question doesn’t really influence whether it should be understood as something that occurs on a physical level.

    -> …However, if there isn’t an actual disease process at play, and really, the stress is connected to the relationship between the person and his/her environment, why do you think the answer is to target the brain (which to my knowledge isn’t what’s targeted in allopathic medicine when treating hormone-related diseases) and not to reconsider the way the person is relating to his/her environment?

    -> Again, the brain is part of an interconnected system. The question is where dysregulation has occurred. The stress response is governed largely by the hypothalamic-pituitary-adrenal axis, and glucocorticoid receptors in brain regions other than hypothalamus are responsible for upregulating (activating) and downregulating (deactivating) the HPA. Dysfunction can occur in any component of the stress response system, which then causes dysfunction in the entire system. A quote from Aaron Beck comes to mind, “Any one instrument in an orchestra can upset the functioning of the entire orchestra.” Beck wasn’t talking about the stress response system specifically, but the analogy works well here too. We want to target the component that is the ultimate cause of the dysfunction (the violinist, say, in keeping with Beck’s analogy), though sometimes the best way to do that is by targeting other, more proximal causes of the dysfunction (the cellists, perhaps, whose altered playing may bring the violinst back into synchrony with the orchestra). Perhaps we want to target the entire orchestra (mindfulness meditation!) because the best way to get the violinst back in tune is by sorting out the lack of harmony amongst the rest of the instruments. Non-human animals experience psychological disturbances as a consequence of stress; interventions on a physcial level (access to preferred environments, for example, which is also a change in how the animal relates to their environment – different environment, different way of relating to it, but it is still a physical change) can reverse those disturbances, repair normal functioning for the animal…why should human animals be any different?

    -> As to your comment on the “growing body of evidence” that an antibiotic used to treat TB can facilitate “learning and memory consolidation.” Are you saying that using a drug that will damage the body’s natural balance of bacteria is the solution to “treating” a repetitive, often very painful and debilitating set of behaviors that undoubtedly have environmental roots (i.e. at some point in a person’s life, something happened that caused him/her to begin to have fear, and that fear continued to magnify and magnify and manifest itself in behaviors that get called “OCD”)?

    Not necessarily. I’m saying that DCS may help learning and memory consolidation (induced by CBT, mindfulness, serenity prayer, AA, etc. etc.) that gets the orchestra back in synchrony. DCS also might not. I’m talking about the in-principle ability of pharmacological agents to have this effect. I don’t know enough about DCS’ effect on bacteria to say whether or not it would damage the body’s natural balance of bacteria. Changing the body’s natural balance of bacteria and “damaging” it are two different things – it might be that DCS merely changes the balance, which then returns to normal after the drug is metabolized out of the system — DCS is not something that would be prescribed for long-term use – IF it turns out to be actually efficacious, it would be so only in intermittent, short-term doses during the process of psychosocial interventions. A quick point about the latter, such interventions (e.g., CBT or mindfulness) can be clinician-delivered or someone could deliver the intervention themselves, by, say, reading a book about CBT and practicing its techniques without a therapist. Anyway, the point is that there may be drugs that operate on cells and molecules in such a way as to enhance the effect of something like CBT. Maybe, maybe not, but there’s no grounds to rule out the possibility a priori. Also, another commenter argued that “growing body of evidence” isn’t what other fields of medicine rely on, but it absolutely is. All of science, medicine included is based on evidence that falls somewhere along a continuum from “non-existent” to “very strong.” Nothing is ever scientifically “proven” and many treatments (like chemo) are very much based on evidence that is not really all that close to “very strong.”

    -> You ask me, “What about those of us for whom the problems are understood to have come prior to any labeling?” Likely, you haven’t read my story, because indeed, my problems began well before I was labeled. I do believe that the majority of my problems arose from being labeled, from being indoctrinated into the “mentally ill” identity, and from taking psychotropic drugs, but certainly, I had some very serious issues before I was labeled (it’s why I ever got labeled to begin with).

    I have read your story; I suppose I should have said, “greatly exacerbated” rather than “caused.”

    -> So, I am just like you in that matter.
As I said in my post, there is great suffering in the world (which you call “problems”).

    I do think it’s fair to characterize impediments to obtainable flourishing as “problems.” This could be lack of sufficient food resources (i.e., starvation, malnourishment), it could be physical deformity (e.g., blindness), and it could be dysregulation in psychological processes (e.g., anxiety-related disturbance in adaptive functioning). We can, and I’d argue should, target all of these problems – help people get proper nourishment, help blind people with either corrective lenses/surgeries or, if that’s not an option, develop braille, train seeing eye dogs, etc., and use psychotherapy along with any other methods we can devise to reduce anxiety-related disruptions (etc.) in closest-to-optimal functioning the person can experience.

    -> I believe it is a profound insult to tell someone his/her “problems” are in her brain (or that the focus of “treatment” should be on the brain), when in truth, suffering happens because we are all in the midst of life on life’s terms, faced with trauma and loss and pain.”

    If you think there is a non-physical component to the universe, I suppose that could be insulting (though is not necessarily). Note that the Dalai Lama – a deeply spiritual person, no doubt – does not object to the brain-targeting approach. Indeed, he welcomes it (see “The Mind’s Own Physician” for conversations between the Dalai Lama and neuroscientists).

    -> I was once right there with you, thinking that a diagnosis was going to give me resolution, peace of mind, and a sense of belonging

    It didn’t give me resolution, peace of mind, or a sense of belonging. It also didn’t give me the opposite of those things. It did nothing in relation to any of those phenomena. The labeling was not a significant part of my experience in the mental health system – it meant little to me – what was significant was the guidance in finding ways to relearn the way I react to/interpret/etc. my experience. I learned to experience differently and it helped; what my therapists and I called the original way of experiencing really didn’t matter to me in the slightest. I was older than you when I entered the system, which may partially account for this difference, and I’d had the good fortune of a mentor who is a philosopher by training and whose work is closely linked to cognitive science; perhaps it was my conversations that her that facilitated my very different experience upon entering the system.

    -> What I’ve learned is that not only is it totally invalidating to reduce someone’s suffering to a label…

    Invalidating for some, yourself included obviously, but not for all.

    -> …it is just not helpful, or healing. I believe it is dehumanizing.
    OK, but some have the opposite experience, so I don’t see how that’s grounds for the position you advocate.

    -> I remember you saying that you’re not on psych drugs anymore. I’m curious to know, why aren’t you?

    I don’t need any. Maybe I did before, maybe I didn’t. Yes, the dominant view/standard line in psychiatry has been that psych drugs are needed on a continuous basis throughout the lifespan, but I’m not arguing that the dominant view is correct. I don’t think it is. I just don’t think that means every aspect of its theoretical basis is also, necessarily, incorrect. I assert that one can have disrupted functioning that occurs on a physical level, reverse the dysregulation that causes that disruption (cancer is dysregulation in cellular processing), and then no longer need the intervention that did the reversing. (Chemotherapy works some of the time, but not all of the time – experts disagree on the appropriate use of chemotherapy. But no one thinks you should stay on chemo after your cancer has remitted. Chemo drugs are also brutal on the body/mind, as many psych drugs are, so even if psych drugs do help at times, I certainly don’t think long-term use should be the norm). Anyway, whether for me it was clinician-delivered CBT/DBT, the psych meds, a combination, or some other thing that reversed my disturbances, I don’t require that intervention at this time. I do continue to practice mindfulness and, in a way, I continue to CBT-myself – just as exercise and diet can promote health after chemo ends, so exercise, diet, meditation, CBT techniques, etc. can promote psychological well-being after acute intervention via psychotherapy and/or psych meds.

    -> if you think you have a biologically-based condition, then why don’t you take these drugs? You said you “have absolutely no reason to think they hurt”… If this was the case, then why don’t you still take them?

    Again, because I don’t need them. Also, while I don’t think they hurt me, I do think there are a ton of problems with current psychopharmacology and that there are very serious risks to taking current psych meds. It’s a huge problem. I just don’t think it’s because the entire theoretical framework upon which psychiatry is built is erroneous. Parts of it may be, and some likely are, but the entire enterprise is not misguided. What is inarguably a very serious problem is corruption and poor science (often the poor science is due to the corruption, though not always). That’s why I’d like to see the enterprise reformed. Abolishment, on the other hand, doesn’t make sense to me.

    -> Additionally, you say that “it seems totally reasonable to [you] that some pharmacological agents— be they known or unknown at present— could facilitate the alterations in learning and memory systems that therapies like CBT accomplish.

    Putting future drugs aside, what are you basing your evidence on that current drugs do this? I’m assuming your knowledge base comes from studies and journal articles you’ve read. I’m also assuming you realize that the vast majority of all pharmaceutical research is funded by the pharmaceutical industry, itself. Does this impact the way you internalize this so-called “knowledge”? Do you not question what you’re told when it comes from the mouths of people who have all the incentive in the world to tell a story of drug effectiveness that might very well not be true? As a researcher, don’t you think you deserve better than to acquire knowledge that is inherently biased and filtered through a profit-driven greed?

    -> Yes, all very serious problems. I don’t think there’s any way to know what the true efficacy of any existing drugs are because there is too much corruption. That’s why I’m mostly interested here in the in-principle point — I’m not trying to say that psychiatry has been successful, only that it could be and that that possibility offers a compelling (though not necessarily final) justification for not shutting down the entire enterprise of looking for pharmacological agents that might help as adjuncts to psychotherapy. We should reform – we *must* reform – but I don’t see how that means we should summarily dismiss the underlying endeavor itself. I think reform is harder when there’s a call for overthrowing the institution rather than overthrowing the establishment – it makes it easier to dismiss the opposition when the opposition says “it’s an outright impossibility that science can reveal anything about the root causes or true/deep/essential nature of human experience; the brain isn’t the real cause of mental suffering, so targeting it doesn’t make any sense.” It gets even easier when the opposition says, “it’s about relationships and trauma, so it can’t be all about the brain.” That just makes scientists dismissive – we need people who have been hurt by the psychiatric system to say “what you are doing is wrong because the way you are doing it is wrong”; saying instead that it’s wrong because “you think it’s biology when it’s really relationships and trauma” is easily met with, “that statement indicates you do not understand what biology is.”

    -> You said, “My understanding of myself did not change when I was labeled “mentally ill””. I’d like to respectfully challenge you on that. Although I don’t know you and I don’t know your story, I am completely perplexed at how you think you haven’t changed the way you understand yourself in being labeled “mentally ill”. The pre-Psychiatry you likely did not think of yourself as comprised of biologically-based “symptoms” that needed “treatment” (whether CBT or pharmacological). I try to never make assumptions about people’s experiences, but I just find that statement very hard to believe. I can’t help but think the pre-Psychiatry you didn’t see herself as “different”, or “abnormal”, or faced with a life-long “condition”. I don’t want to speculate any further because it’s very uncomfortable for me to make these assumptions, but I’d love to hear more about how you think believing you’re “mentally ill” didn’t change the way you understood yourself. Just believing you’re “mentally ill” is changing the way you understand yourself!”

    -> Sure, in a sense believing I’m “mentally ill” changes the way I understand myself. But I don’t put much stock in the semantics around “mentally ill.” I knew I was not flourishing as much as I believed possible long before any labels entered the picture. Heuristically, I think of it as being “mentally ill,” yes, but that doesn’t shape how I understand what was holding me back – I thought of it using the phrase “mental illness” before I was labeled “mentally ill,” but it was after entering the mental health system that I came to earnestly believe I could cease to be held back in that way – I had always held out some hope, but as year after year went by and my best efforts met only with further spiraling down, I wasn’t so sure. Once I began the process of therapy and things did start to change, I became increasingly convinced that I was not doomed to a lifelong condition of “not the self I believe I could be if whatever it is that holds me back were to release its grip.” I never thought of myself as comprising nothing but “symptoms” nor do I now. We can call them symptoms, sure, but I see them as “holders-back” and while I do believe those holders-back are manifested at the level of circuitry, and cellular and molecular processes, I don’t think that means they represent a permanent condition nor something over which I have no power. I saw myself as partly composed of many such “holders-back” before I was labeled and I saw myself in the same way after. I believe I have changed in a way that I am no longer held back such that it demands any concentrated intervention, but I also recognize that I am not immune from such holding-back in the future (nor is anyone — under the right (or, perhaps more accurately, wrong) circumstances, any of us can have our flourishing derailed by psychological dysfunction). I do what I can to preserve and promote my flourishing, while believing it is all reducible to physical processes and while believing it is a beautiful, wondrous, awe-inspiring capacity.

    Thanks again for your thoughtful response.

    Best wishes,

    Layla

  • Hi Laura,

    At the risk of seeming ineducable, I must say…I’m still having a hard time understanding why you’ve adopted an “anti-brain-science” position with respect to reforming – or, in your phrasing, abolishing – the mental health system. That is, why must the study of the brain itself be an inherently futile and/or misguided approach to understanding and alleviating severe impairment and/or distress related to psychological functioning? Setting aside the mired ethical terrain of forced treatment, endeavoring to relieve such suffering, as myriad philosophical traditions (Buddhism and Stoicism among the most notable) have done, surely makes sense — doesn’t it? Accepting that such an endeavor is a reasonable one does not logically entail commitment to endorsing the development of pharmacological agents, of course, although searching for drug treatments may also make sense. I’d argue that it does; however, I’d also suggest that pharmacotherapies ought to be understood as adjuncts to psychosocial interventions, rather than the other way around.

    We can also set aside persistent, extreme mental suffering and simply look at what we might call ordinary psychological stress, anguish, suffering (dukkha, in Pali). Assuming we agree on the reasonableness of attempts to understand the causes of this suffering and relieve it to whatever extent possible, what reason is there to summarily dismiss any attempt to do so by way of brain science? Whether we’re talking about the extreme mental suffering (sometimes occurring in the absence of identifiable factors responsible for causing and/or maintaining the relevant state) or what I’ve termed, in a way that admittedly minimizes the phenomenon, “ordinary suffering,” it seems from previous comments of yours that we are in agreement when it comes to this: experience is the phenomenon in question, the mind is the seat of experience, and the brain is the seat of the mind. Thus, the brain is the seat of experience. We are seeking to alter the nature of experience, so we are seeking to alter the seat of experience, i.e., the brain. Surely it is the brain we alter through meditation, exercise, changed perspectives on gratitude or serenity, triumphant rejection of or liberation from an identity which putatively induced one’s suffering…no?

    I’ve come to believe that what we currently call mental illness — a term I use heuristically here for the sake of expedience — is, fundamentally, dysfunction in learning and memory. I should note that I intend a broad construal of those constructs, as memory is not one function at all, but rather numerous, dissociable systems for which the term “memory” is, again, a useful heuristic. At the level of neuroscience, this view can be conceptualized in terms of cell growth, survival, and synaptic plasticity. The link between dysregulation in the neuroendocrine stress response and mental illness (again, a heuristic here) has long been recognized. Now, with major technological advances in recent decades, the link is becoming more completely understood. For each individual, stress response is determined, it seems, by a complex set of factors including the type, duration, and severity of stress that the individual experiences as well as a host of genetic and other environmental factors. For those in whom stressors lead to stress system dysregulation (e.g., the overproduction of glucocorticoids in the adrenal gland, hyperactivity in the hypothalamus, dysregulated glucocorticoid receptor activity in various regions, etc.), the cellular and molecular processes governing neural survival and plasticity can be disrupted such that psychological functioning is compromised. I would argue that just about everyone has less than optimal psychological functioning, but some individuals (myself included), at some times, fall extremely far from optimal on the continuum.

    You throw around terms like “neuro-reductionist,” but what, exactly, does that mean? That we somehow exist outside our physical embodiment? Even if that’s true, the manner in which we do so is obscured from earthly knowledge and, hence, not a promising avenue of research. We know that the brain – thus, experience – can be changed by, e.g., cognitive-behavioral therapy. Do you think it is quackery to employ CBT as a means of alleviating a condition someone perceives as problematic, a hinderance to their flourishing (where flourishing is meant to denote the Greek (e.g., Aristotelian) concept of “eudaimonia”)? If so, why? Do you think Epictetus was misguided in teaching the value of what today we might call decentering or psychological distancing? Do you think if Epictetus could have used scientific knowledge regarding the link between stress, neural survival and plasticity, and psychological functioning, he should have ignored it and approached theorizing about distress and mental suffering as though nothing were known of the cellular and molecular processes involved therein?

    As for pharmacological agents…for the sake of simplicity, I’ll first use specific phobias to illustrate the general point I’d like to make. Let’s say someone has a severe phobia of spiders, so severe that it is, by their own account, impeding their flourishing. We know that exposure therapy works very well for helping people to overcome phobias. There’s also a growing body of evidence that d-cycloserine (DCS), an antibiotic used to treat TB, can facilitate extinction learning and memory consolidation. There’s also very tentative, preliminary evidence that DCS paired with CBT for psychosis can substantially improve outcomes with respect to real-world functioning and subjective well-being. DCS operates on NMDA receptors, which are crucially involved in regulating glutamate, a neurotransmitter known to play a central role in regulating plasticity (i.e., memory and learning). I’d argue that while there is unlikely to be any “magic bullet” or panacea in the form of a drug for mental illness (again! heuristically!), there may very well be agents (perhaps DCS will turn out to be one, perhaps not, I use it for illustrative purposes only) that can aid psychotherapies in restoring those cellular and molecular – processes responsible for regulating the growth, survival, and plasticity of neurons. Why shouldn’t we pursue this avenue of research? It does, unfortunately, involve a great deal of what I see as reprehensible cruelty to animals, but so does nearly all medical research, so unless one wants to advocate the abolishment of any medical research that uses animal models (a position toward which I am sympathetic), there’s no reason to support singling out psychiatric research.

    Your experience was one in which you perceive labeling as preceding the problem, and you’ve inferred that the labels caused the problem. I don’t mean to suggest here that you’re wrong; you may be entirely correct, and I’m certainly in no position to say that you aren’t. But, what about those of us for whom the problems are understood to have come prior to any labeling? It can’t be the labels that caused the problems, as the latter existed prior to the former. You seem to be advocating the abolishment of the system that is in place to serve the needs of people who come to be labeled after they themselves have identified a problem(s) which we currently label psychiatric disorder X, Y, or Z. Why not reform the system instead? Otherwise, those of us who seek help in moving closer toward optimal on the continuum of psychological functioning are stuck hoping that our friends, family members, or the wisdom of authors whose books we’ve read will suffice. My understanding of myself did not change when I was labeled “mentally ill,” so I did not need to recover any lost identity (nor have I needed to reclaim one that was obscured). I did need help getting to a place where I am able to achieve (loosely, Aristotelian) flourishing. Meditation, CBT, DBT all helped. Whether or not the psychiatric drugs helped or did nothing is unclear (I have absolutely no reason to think they hurt), but it’s not inconceivable that, say, the SSRI I took for a while may have helped to increase the expression of proteins involved in neural survival and plasticity in certain regions and thereby facilitated the recovery process. Either way, it seems totally reasonable to me that some pharmacological agents — be they known or unknown at present — could facilitate the alterations in learning and memory systems that therapies like CBT accomplish.

    I know this is getting insanely long, and I’ll bring it to a close here. Just finding myself frustrated again…Neuro-reductionist and similar buzzwords/phrases sound threatening, but all it really means is recognizing that our experience can be studied at the physical level. What is wrong with recognizing that and pursuing such study?

    (ducks for cover)

    Best wishes,

    Layla

  • Nijinksy,

    Thank you for sharing your thoughts — I just read through them all, and I’d really like to reply properly. I won’t be able to do that for a few days, though, due to a busy schedule this week — noticed Jonah’s musings on whether or not I needed more time, so wanted to say yes! I’m finding your comments thought-provoking and just waiting until I have more than 2 mins to share some of my thoughts about what you’ve said.

    Again, thank you for sharing your reflections.

    Best wishes,

    Layla

  • Duane,

    Thank you for the apology – I appreciate it, although any hard feelings I might have had about the comment had already dissipated. It wasn’t a big deal in the scheme of things anyway, and I have a better sense of where everyone was coming from now. I was feeling attacked, but someone rightly pointed out – what did I expect? I did come on pretty strong, which in retrospect was a counterproductive way for me to bust into a conversation among people who have visited this site a lot more than I have. It was an expression of frustration because I’d wanted to comment for a while – I say that by way of explanation, not an excuse, because obnoxiousness almost never serves any worthwhile purpose. It certainly didn’t serve mine, and I wish I’d chosen to ask questions instead of making assumptions and accusations. Once Laura explained how I’d misinterpreted her position, I realized how off base I was before. Much of the criticism I’ve received has been warranted – I have been listening and reflecting, but unfortunately I mostly did that after coming back with a reply, rather than before. I’ve got a stubborn, contrarian streak and it was silly to let that get in the way. And I know I’m inordinately verbose. Totally fair that some called me on that. I’m trying not to do it again now, especially because I realize people are surely very sick of hearing from me at this point, but long-windedness is a bad habit that’s hard for me to break. I’m working on it. I also didn’t know what I didn’t know – another reason to begin with questions and reflection. One thing I didn’t know was the depth of pain some feel around the topic at hand. I really do feel very bad about that, and my apologies again to anyone reading this. I’m wondering if maybe I’m not in touch with my own pain around traumatic psych hospital experiences. Since I’m trying to chill out on the long-windedness thing as best I can, and because I don’t want to do any more inadvertent triggering, I won’t get into that, other than to say I rarely connect, inside, with anything around what happened, and on the occasion that I start to, I shudder and block it out. When I talk about it, it’s as though I’m describing a scene in a movie or book – perhaps that feeling is holding me back from understanding something important.

    Thanks to all, and maybe I’ll see you around.

    Peace (sincerely, not the snarky way),

    Layla

  • I am truly sorry to any and all who have been triggered by anything I’ve said. That was certainly never my intention, and I regret that anyone who has been through trauma — I do understand that forced treatment is traumatic; honestly, I do — has suffered further pain because of insensitivity on my part. Whatever the nature and intent of the comment about “it’s like a rapist,” it was painful for me. Nonetheless, I believe I can learn and grow by sticking around, so I hope that anyone who was hurt by triggering caused by my insensitivity will grant me the favor of pressing “reset” and starting fresh should I pop up in the comments on some future (or other) blog entries.

  • I had no intention of commenting further, but having reflected upon what I said, I realize that in a post criticizing reactivity, I was being almost entirely reactive. I’d like to take myself to task for that. Furthermore, I’d like to leave in the spirit of politeness that has generally characterized this conversation, So, if I may, I’ll take a mulligan…

    I wouldn’t call this a retraction, per se, but I do regret going with a snarky and sanctimonious delivery. I blame it on my brain. No, I’m kidding — seriously though, without getting into whether or not various parts of the message were warranted or unwarranted, I’d like to offer an apology for it’s tone.

    I have read through the comments posted since my last one, and I’d like to respond to a few:

    Duane, thank you for the resources on outcomes of antipsychotics, and I’m sorry I didn’t get back to you before. I really appreciate the tips, and I’ve been slowly making my way through the articles. They are very interesting and very alarming – certainly a lot for me to read and think about. Thanks again

    madincanada, I know you didn’t direct any comments to me, but I wanted to say something to you anyway. Whatever differences of opinion there may be between myself and others here, I feel pretty sure we all agree on one thing: there is hope.

    Nathan, thank you for your message. I’m deeply sorry for the tough road you’ve had to travel. I sympathize with your concerns about gay adoption; how tragic that loving parents and an orphaned child might be kept apart because of something so utterly inconsequential as what happens in the bedroom between two consenting adults, who love each other nonetheless. I wish you the very best.

    Richard, thank you for your message as well. I have appreciated the dialogue with many here — I’ve learned and grown from many of the exchanges. I’m not sure I’ll be back though. Hostility, sarcasm, etc. are all things I can handle (not sure I’d choose to stick around – maybe, maybe not, but I can handle it). But the comment comparing me to a rapist is…I don’t know how well I can handle that, to be honest.

  • Jonah,

    I had intended my previous post (at 1:49pm) to be my last words in this conversation. However, shortly after posting that comment, I saw this reply to me. At first I planned to keep the previous post my last one, but I’ve since decided that I’d like to respond directly to you before exiting the conversation.

    First, as I’m sure you realize, I did not have you in mind when I spoke of hostility or a lack of gentleness and compassion. I have very much appreciated your thoughtful replies. I have no objection to being told I’m wrong – only to being told in a way that seems callous or mocking (yeah, you mocked a little, but you did so gently and in the context of respectfully disagreeing with me). You are not alone, of course, in approaching me this way – I have learned from several others who’ve posted in response to me, and I appreciate the opportunities to grow afforded by the dialogue with all who chose to go this route. I recognize that I don’t know everything – or even a small fraction of everything – and I understand that there is much to be learned by keeping an open mind when receiving criticism. So, to you and all others who avoided hostility and what I’ve called “slamming” I say, in sincere gratitude, thank your for your thought-provoking remarks and for engaging in friendly dialogue with me. I will continue to reflect upon the perspectives and wisdom you have offered, and I hope that I may grow as a person and as a student of psychology as a result.

    Second, I couldn’t help but notice your selective approach in quoting me about who determines what counts as “gone awry” processing. You leave out the part where I wrote – of friends and family members as qualified judges – “The problem there, of course, is that family members and friends can (1) have malevolent intentions or (2) be well-intentioned but not truly acting in the individual’s best interest.” That seems a rather significant omission – I addressed exactly what made you laugh/cry when reading my comment by pointing out exactly the problem you describe. I characterized the question of forced treatment as very complicated and fraught. Good can come of it (I didn’t kill myself, which I very well might have) and bad can come of it (your experience, along with that of so many others, proves as much). It is a moral dilemma – if we were omniscient, we could detect when it is for the good (preventing me from the not-unlikely fate of suicide) and when it is bad (harming in the name of “for your own good”) but we are not omniscient, and so no matter what we do, we run the risk of failing to produce a good outcome (sparing someone, who will later be glad, from suicide or other serious, self-inflicted harm) and/or we run the risk of producing a bad outcome (harming someone in the name of protecting them). It is a vexing dilemma – which side of caution do we err on? I agree that medication ought never be forced – I agree that one’s own brain is inviolable. Before I write the next sentence, may I ask that this be viewed as a *thought experiment* rendering the possibility that drugs could benefit an individual an assumption of the argument, NOT a statement about the reality. Here, I believe the cost of making the wrong decision (harming someone by forcing them to take drugs) too vastly outweighs the benefit of making the right decision (helping someone whose life is improved, from their own perspective, by taking the drugs). Again, I am not saying that drugs necessarily have the potential to improve someone’s life — I am remaining agnostic on that for the purposes of this point — I am saying that even when the thought experiment stipulates that drugs are, in fact, able to improve some lives, the risk of harming by drugging outweighs the potential benefit of helping by drugging. Selective reading and/or treating each sentence I’ve written as stand-alone seems to have led to a number of misinterpretations about my views.

    Third, I probably shouldn’t have gotten into the whole “everything is physical” stuff because I know it’s generally received as a radical view that doesn’t sit comfortably with most. It is really irrelevant to anything else I’ve said, and it is certainly not going to be relevant to the way I approach a career in psychology. It’s a fun idea for me to play with, it does not inform how I go about my daily life. My girlfriend became very upset and cried when it came up that I “don’t believe in free will.” She wondered what loving someone could possibly mean to me in light of that belief. As I told her, I love just like everyone else loves. Perhaps it is only (or mostly) those who have formally studied philosophy who don’t see beliefs about metaphysics as necessarily a very serious matter. Trying to wrap one’s mind around arguments put forth by people like Josh Greene makes my head spin in a way that feels funny (strange, not haha) and fun. I get that most people don’t like puzzling over Zeno’s arrow paradox or how many grains of sand constitute a pile. I like playing with these ideas, I don’t live according to them (I don’t go about my life as if motion is impossible and I know a pile of sand when I see one). So, I should probably leave out the flippant, half-jesting, and provocative free will/physicalism stuff. Lesson learned.

    Fourth, I haven’t learned a whole lot from psychiatry. My overarching views about the brain come from training in cognitive science, not clinical psychology and certainly not from psychiatry. I just started studying clinical psychology — I spent years working as a research and teaching assistant in cognitive science.

    Fifth, and finally, thank you for the generous compliments about my intelligence and ability to effect changes in the field of clinical psychology. However intelligent I may be or not, I want nothing more than to be a force for all that is good in humanity — love, compassion, kindness, gentleness, empathy, genuine concern for others, and on and on. My fervent hope is that I will not be led astray as I seek to promote the good in life. For your earnest attempts to ensure that my path be in the light, so to speak, I thank you.

    Best wishes,

    Layla

  • Parting comments:

    Many comments here make it clear that some have only reacted to – and not reflected upon, even for a moment – what I’ve said. For example, in NO WAY WHATSOEVER have I said ANY of the following (*nor does anything I HAVE said entail what follows*): Working through trauma is not important/trauma history is irrelevant to treatment; biology is the be-all end-all; emotions are to be feared; the unconscious is to be feared; everything is innate; experience doesn’t shape who we are; there are no behaviors or they are unimportant; CBT must be effective because it aims to rewire the brain; human existence isn’t an extraordinary experience, etc. etc. Raising any objections like these makes it clear that you have not understood my position. Perhaps it is my fault for not communicating it well enough, but I do notice that many responses seem to imply some bizarre assumptions (do you think I don’t have a fully human experience? I’m human! I don’t experience things as chemicals, I *understand* them to be chemicals. There is a *huge* difference. In light of that, why on earth would I think that one’s accent doesn’t have anything to do with the accent typical of one’s community?? How could I possibly think that the way I experience vision is by thinking about chemicals? How, as someone who has identified herself as having a trauma history, could I possibly think trauma is irrelevant to treatment?).

    Many of you talk about psychiatrists leading you to believe you were broken or dependent in some way or less than, and so on and so forth. I’m not sure any of you see how YOUR words can be insulting, belittling, and offensive to others who struggle with mental illness and don’t share your experience. Let’s run through how your position can sound to the former/current patients not in the anti-psychiatry club (maybe I am doing to your argument what you have done to mine…?): “Take responsibility and work through your issues” can sound an awful lot like “stop whining and pull yourself up by the bootstraps” to those of us who haven’t shared the experience of getting better without the help of mainstream psychiatry and psychology. Weakness of will arguments seem to be lurking in the background. In some cases, even moral failing arguments can be detected (e.g., “I choose to respond to life” – the rest of us don’t?). Your message seems to suggest that those of us who aren’t “all better now” aren’t taking responsibility for ourselves (after all, isn’t that the surest way to recovery?). Any message along the lines of, “you have a spiritual problem not a physical problem” isn’t any less cutting – in fact, if anything, it feels worse for some of us because a spiritual problem implies some kind of deep-seated personhood problem (for a lot of us, we’d rather be told our brain is faulty than that our spirit is faulty – and honestly, who’s making subjective value judgments now? Your problem is…dysfunctional relationships, not being in touch with your inner self, unresolved trauma because you haven’t worked through it. Nothing to do with your biological make-up (again: biological make-up DOES NOT EQUAL genetic code), so it’s…what? My weak will? My lack of personal responsibility? My failure to nurture and nourish my spirit?). If this blog were just about sharing common experiences – just a survivor’s support group – then, fine, no need to take into account the differing perspectives of other former/current patients. But that’s not all this is about, right? It’s a social movement to take down psychiatry. In seeking to *annihilate* the *entire* institution, do away with – not just temper, but get rid off – the biological perspective, and swap in your conception of mental illness, you seek to impose *your* view of mental illness on all of us. Many of you tend to come across as though you believe you are speaking for all patients. You’re not.

    I would also like to point out that many (not all) of you haven’t been very kind in the way you’ve chosen to respond to me. Might I point out that being nice is a nice way to be? And given that I’m, in your view, an indoctrinated psychiatric patient, wouldn’t it make sense to be gentle and compassionate with me when pointing out all the ways in which you’re sure I’m wrong? Sure, I’m working with a very responsible psychiatrist now, but I have stacks of medical records saying I’m mentally ill — what happens when my psychiatrist retires, or I move somewhere else? Having a couple semesters of grad school isn’t going to protect me from any abuses of power. Is it really more important, given your stated beliefs, to slam my posts than it is to reach out to someone who may be in grave danger at the hands of her next psychiatrist? If you really believe I’m indoctrinated and you really believe it could come to cause me serious harm (which, surely it could, if I’m indoctrinated, labeled mentally ill, and in the care of a psych hospital), then your response to me has been unconscionable. (Again, I am not directing this at everyone who directed comments at me). Emotions and anger run high here on MIA, I get that. Patients at the Hospital on the Hill read this blog. Some of them have been following this conversation; I know this for a fact – we’ve spoken about it. If you don’t care about reaching them, I’m not sure why you bother with the whole social movement thing – you’re free from psychiatry, aren’t you? If you do care about reaching them, you should know that the message you have sent – collectively – in responding to me is one of hostility toward anyone who doesn’t fall in line with exactly what you say (sound familiar?).

    Peace,

    Layla

  • Jonah,

    Thanks for sharing your thoughts on my previous reply to you. I’d like to clear up a few things, as best I can. First, to my way of thinking brain processing gone “awry” is largely determined by the individual – I am hesitant to wade into the waters of forced treatment, as it is such an impossibly complicated question. I would easily say “no forced treatment” except that I view myself as one who has benefitted – in a profound way – from having been involuntarily committed once before. Tricky stuff. My therapist told me back then that everyone he’d ever worked with (he follows up with all his patients when they move on) who was extremely suicidal at one point has later told him that they were glad they lived. I remember thinking “ok, maybe that’s true for everyone else, but not me. I’m the exception.” Was he wrong to commit me? I don’t know, but I’m glad I’m alive. Like I said, tricky territory and I’m not going to try to work through the enormously fraught intricacies here. Mostly, though, with brain processing gone awry, I’m saying it’s when it ceases to be adaptive, from the perspective of the individual and in terms of interfering with his or her ability to function as they have reason to believe they otherwise could. The other people qualified to judge whether someone is suffering from processing gone “awry” would be close friends, family members, etc. The problem there, of course, is that family members and friends can (1) have malevolent intentions or (2) be well-intentioned but not truly acting in the individual’s best interest. Assuming I continue on to become a psychologist and don’t stay in the lab my whole career, I would hope that the future me will be as cautious about imposing “normal” or “socially acceptable” on anyone in my care as the present-day me would expect from that future self. The famous quote “it is no measure of health to be well-adjusted to a profoundly sick society” is far from lost on me. I have also been a bucker of systems much of my life, though I suppose I’ve fallen into line in many areas of life these days (not entirely, though, as I mentioned in my response to Steve a little while ago, I’m biding my time on voicing dissent in the field of clinical psychology – I’m too young and unproven to have any credibility — rightly so — at this point). I’m also gay, and well aware of the history around homosexuality and the DSM. I’ve also got a big heart, so I hope that will help me keep my sights on being a promoter of flourishing, not a promoter of conformity. (Flourishing, to me, doesn’t mean “being a productive member of society” it is far more complex and individuality-honoring than that). Finally, I am quite taken with Buddhist psychology and would hope that stays with me and that my main goal will be helping people gain insight into their true nature, their true aspirations, and find ways to work toward fulfilling that nature and reaching those aspirations. As long as I stick with the practice of loving-kindness meditation, I should be okay 🙂 hopefully!

    I don’t think I’m wrong about brain processing and its ability to go awry, though. (Note I don’t say I *know* I’m not wrong – as with nearly all things, I keep an open mind). Who defines awry is one thing, whether it happens is another. I’m a big fan of Dr. Sacks, having devoured his books with fascination and awe, and I’m familiar with the article you linked in your post. I don’t think, though, that the commonality of hallucinations means they are not processing gone “awry” – the “goal” (if I may speak teleologically) of the visual system is to construct representations of the world, visual illusions constitute going awry, so do hallucinations (same for other senses). Is synesthesia “awry”? Well, yes, but beautifully so! This is again where I’d say it has to come down to the individual – I don’t believe in free will but I do believe in the freedom to choose.

    For me, PTSD, depression, social anxiety, and drug addiction were all cases of my brain going awry on me, and I needed help to get it back in line with what promotes my flourishing. I find brain rewiring is a great way to think about how we can change ourselves – and be changed. It has been hugely helpful for me in working through the labels – or as I might call them, brain betrayals – I listed above. Down the road, if I practice psychology and am working with someone who doesn’t like the brain rewiring way of thinking about it, I’d never (assuming, again, future me lives up to current me standards) insist that they look at it that way. We’d just work together on rewiring without calling it that 🙂 I’m also a big fan of Jon Kabat-Zinn and I don’t know that anything rewires us more than mindfulness meditation does (perhaps some things change us as much, but sustained, committed mindfulness practice is…amazingly rewiring!).

    I am very averse to arguments about how “special” human consciousness is. I don’t think it’s any more special than the consciousness of a deer or a tiger or a mouse. To the extent that the consciousness of those creatures is special, so to is the human consciousness. No more, no less. This is one area where I don’t have much of an open mind.

    As with all my posts here, I’ve had to write basically “streams of consciousness” – I’m spending a lot of time trying to reply to everyone and make the replies coherent enough to get the basic gist across. As with the others, this one may not represent what I’d say if I had more time to think about what it is I believe and how best to articulate it.

    best wishes,

    Layla

  • Steve,

    Wow (or, maybe, “whoa”). Thank you for the advice to read up on Loren Mosher – I’ve only had a chance to look at his resignation letter, but already, very interesting and certainly eye-opening. It’s not a revelation that the relationship of drug companies and psychiatry is problematic, but it seems I’ve perhaps underestimated the depth of the problems – frightening, as I’ve estimated them to be quite bad. Of course, being the cautious soul that I am 🙂 I will explore Mosher’s position more carefully before reaching any settled conclusions, but I must say, I’m very intrigued to learn more about him and the relevant history.

    I appreciate the tip on his work/dissent because while I respect the work of people like Robert Whitaker, I tend to be skeptical of narratives like his – one need only look at the work of Jared Diamond or Jonah Lehrer to see how easy it is to tell a convincing story while getting the details wrong or finding ways to put them together to fit the story one is trying to tell. (Not that I think my own reasoning isn’t susceptible to such trickery and that I’m never led astray by my own “narratives” but there’s only so much one – or, I should say only so much I – can do about that (try to keep an open mind and check in critically with one’s – er, my – beliefs)). Anyway, I’m always on the lookout for insider info that seems less narrative-y and that I can incorporate into my understanding. Mosher seems like a rich resource indeed. Sigh, why must all my hopes and dreams of idealism be dashed? (I say that because of my recent concern about psychology research prompted by Daniel Kahneman’s open letter to social psychologists. Even putting fraud cases (Stapel, Hauser, and Smeesters) to the side, it seems the research in social (and no doubt other areas of) psychology are rife with serious problems. Simmons, Nelson, and Simonsohn “proved” that listening to “When I’m 64” reduced participants’ ages by an average of 3 years (they did that as a way to illuminate the problems, of course – although Daryl Bem was totally serious when he published findings that later study of word lists predicted improved performance on earlier memory tests…) I could go on (bonobo research gets me going too – the researchers doing careful fieldwork toil in obscurity, while Franz de Waal writes books with sweeping claims and is considered the “foremost expert” despite never having seen a bonobo in the wild). On and on it goes, but I’ll try to stop rambling. Makes me want to go into perception research – those guys are more hardcore, you can’t get away with shoddy work as easily, though I’m sure plenty slips in nonetheless…I was just thinking the other day, though, that I have a lot of criticisms for clinical psychology (for one, “beware the pendulum swing!” I’m afraid we’ve thrown the baby out with the bathwater in the rejection of psychoanalysis), so I suppose I’ll stick with it in hopes I might shake things up a bit one day, and maybe bring about some positive changes…but, I must bide my time as my views are unlikely to be well-received what with the fact that I can be dismissed as just a young upstart. Ok, reining in the ramble for real now.

    In closing, I don’t foresee changing my mind on the whole “I am my brain” thing anytime soon (though, really, what do I know about what I’ll change my mind about or not?), but I am both interested and filled with dread to educate myself on Mosher’s views.

    Thanks to all for the interesting and engaging dialogue.

    Best wishes,

    Layla

  • Richard,

    Thanks for sharing your thoughts with me. I don’t have time to give your remarks the careful attention they merit, so I’ll just briefly touch on a couple points that seem relevant to the gist of what you’ve said.

    First, yes, you are absolutely correct that the mental health professionals who have been helpful for me have also been those who do not adhere rigidly to any one treatment approach or perspective. I would hold them up as models of competent treaters. Note, however, that the biological psych perspective did have a role in how my psychiatrist treated me — he prescribed meds, which I did not find to have a damaging effect and which seemed help. Just my perspective of course, but one that undoubtedly informs my views. I realize that for those who have *only* felt harmed by meds (I did have that experience as well, when I was on an outrageous cocktail of many all at once), a different viewpoint feels equally compelling.

    Second, I don’t know where you’re getting the idea that I hold, in any way, a view of “genetic original sin.” I can’t imagine anyone who understands human development would hold what that implies.

    Third, I’d like to note that I understand bio-psycho-social to refer not to levels of causality but to levels of explanation. It is all biological – a point I will let stand alone here, as I have gone into quite a bit of detail on that view in other posts – but sometimes biological explanations are not the most useful level of analysis to employ. We can use the level of psychological and we can use the level of social – we’re talking about biology, but in a way that makes communication more effective. What would “non-biological” psychiatry look like, exactly (in the present day)? Is it biological psychiatry that’s a problem, or is it certain tendencies among the bio-psychiatry crowd that’s a problem? Should we abandon trying to understand the biology of the brain?

    Finally, my point about statements like “psychiatry is a cult” and all that: this kind of position is polarizing. Making something black-and-white/good-or-bad, with no room in the middle, you end up with two diametrically opposed camps “pro” and “anti”; “us and them.” But it’s not just psychiatrists who are getting stuck in the “them” camp, it’s anyone whose views fall somewhere in the middle. By grouping “middle-of-the-road” with “other-end-of-the-spectrum,” you end up forcing middle-of-the-roaders to be against you. I think that’s happened some with my posts – I am being painted into the “pro-psychiatry” corner. I’m not saying all posters have done this, but I do think it has happened in some cases. Regardless, when you view someone as “them” and go on the offensive in response to what they say, it often pushes them to defend the opposite extreme, even though that’s not where they really stand. This likely moves the person away from your camp and toward that of the declared “them.” We can see it in the political arena — if we turn it into “pro-government” and “anti-government” the discussion becomes a shouting match. Someone who stands in the middle (government is bad in some ways, good in others) gets stuck “picking sides” – a middle-of-the-road view in a conversation dominated by those who are anti ends up in the position of defending government. They may share many of the same views as the “anti” crowd, but there’s no way to talk about the common ground because their viewpoint will be rejected unless they defect from the “middle” and join the “anti” whole hog. The political analogy can be fruitfully extended, I think. There’s no denying our government has all sorts of problems/dysfunctions, but the solution isn’t to do away with government, it’s to try to make it better. Anyway, what difference does it make if it’s polarizing? Well, some people who visit this blog could really benefit from thinking more critically about what their psychiatrist tells them and prescribes them. But, they are turned off by the polarizing, extreme position, so they tune out before any part of the message can reach them. I’m talking about actual, real-life patients who aren’t going to accept the “evil empire” framing of psychiatrists and so aren’t going to learn anything from hearing about Laura’s experience. This is what I meant when I talked about only reaching those who are already in full agreement. People who already view the matter in these terms undoubtedly feel validated and vindicated by the conversations they’re having with one another. People who don’t subscribe to this “evil empire” view – and there are patients of psychiatrists reading this blog who don’t – get irritated by what they see as over-the-top and tune out. These are missed opportunities to get people who are being treated by psychiatrists – and who aren’t going to just stop seeing them altogether – to question their treatment, to think critically about it, to learn from Laura’s experience even though what they learn isn’t going to make them take up her cause.

    I have to stop here, but hopefully I’ve managed to get across where I’m coming from.

    Best wishes,

    Layla

  • Nijinsky,

    “Chemical imbalance” is certainly a massive oversimplification. For one thing, it is not about presence or absence of neurotransmitters, as “chemical imbalance” might suggest, but rather the activity of receptors. For another, neural communication is electrical as much as it is chemical.

    I’m not sure what you mean by “sight came from thought thinking about chemical reactions” – I don’t know how to interpret that sentence, but it sounds like you are saying that I suggested sight comes from thinking about chemical reactions…that’s certainly not what I meant, unless you’re defining “thought” and “thinking” in a very non-standard way. I wrote that sight arises from processing in the visual cortex, by way of making the point that emotion arises in much the same way.

    I would like to point out that I am not claiming to have all the answers, and I am only offering a perspective different from the one that tends to get shared on this blog. I think psych meds are overprescribed and that the approach to prescribing often unthinking; I don’t doubt that this causes harm in some cases. At the same time, I don’t think psych meds are *always* damaging *every* time they are prescribed to *any* individual. That’s a very strong claim, and unless I’m mistaken, it’s not the one advanced by Robert Whitaker. All I’m saying is that it’s not the case that there’s *never any* basis for prescribing psych meds and they *always* do more harm than good. Yes, far greater care must be taken in when/why/how/to whom they are prescribed, but the entire science is not “just a sham.” We do know quite a bit about the brain and what is currently referred to as “mental illness” – not as much as some researchers and clinicians make it seem, but it’s just not the case that we don’t have any solid evidence regarding the underlying biology. To say we don’t is to take an extreme position; I’m not trying to take the extreme at the opposite end. In saying emotion is biological, I’m really not saying anything very radical. Of course it’s biological, we’re biological organisms – everything we are/do is biological.

    Best wishes,

    Layla

  • Steve,

    I think there are all sorts of problems with the DSM. I accept the biological model in a sense, yes. Setting aside DSM definition, I believe (roughly) what I said in response to Jonah – that the mental illness is what we call the stuff that happens when some neural systems go awry. What does “go awry” mean? Here is where I think a little common sense – still setting aside DSM definitions – is called for. I understand how a cluster of phenomena occur in depression/schizophrenia/addiction/etc., and I’m guessing all of you do too. Forget how we define them or whether they’re “illness” – we know what we’re talking about when we refer to these clusters of phenomena in, say, addiction or PTSD (and what we’re referring to is all the more salient for those who with firsthand experience). I am saying that these clusters of phenomena represent brain processing gone “awry.” These clusters are qualitatively different from their non-awry counterparts – sadness, excitement, spontaneity, reading into things in a fearful way, trepidation, etc. all have counterparts — “clinically” depressed mood without another explanation (don’t get me started on the addition of complicated grief, I think it’s absurd); intense arousal, again in the absence of another explanation; impulsivity that overrides reflectively endorsed commitments to particular ways of behaving; paranoia in the absence of another explanation (e.g., cultural fear of government); paralyzing anxiety. The non-awry counterparts can be pleasant or unpleasant, effective or ineffective, etc., but they are “normal” emotional and cognitive functioning in the same way that perceiving sound originating from sound waves is normal auditory processing. Everyone sometimes experiences processing-gone-awry: we all feel sad in a way that is exhausting and that we can’t explain as part of a response to something; we all get keyed up in the absence of a reason to be; we all make impulsive decisions we later regret; we all interpret e.g., someone laughing as being directed at us when there’s no reason to think so other than the feeling that they are; we all freeze because we feel anxious. Similarly, we all mistakenly “hear” from time to time – we say, “what?…oh, I thought you said something.” It is when what I’m calling “awry” processing is systematic and persistent that the phenomena become clustered in a way that sets the experience apart from ordinary “awry” processing. This stuff – the systematic clustering of gone-awry phenomena – is what we call “mental illness.”

    Where it gets tricky is that phenomena can cluster for different reasons, and the way to deal with any given clustering is going to vary depending on the circumstance. The medical model runs into trouble with this — it is one thing to understand what we mean when we talk about these clusters, it is another to try to define them systematically. This is messy stuff – it’s not clear cut, so trying to make it clear cut is no straightforward matter. The approach that’s been taken thus far has involved categories rather than dimensions (there are reasons for this, but it is not without problems) and “decision by committee.” On the one hand, we’ve ended up with clear delineation where in reality the lines are fuzzy and shifting. On the other hand, if we tried to stay true to the phenomena, there’d be no delineating at all (due to so many possible alternative explanations for any individual case), and it’d be impossible to make sense of what a particular cluster has in common across different individual cases. The firm delineations work fine, as long as the people using them understand that they don’t map onto reality in an exact way. This is where clinical judgment comes in, and psychiatry/psychology becomes more art than science. Unfortunately, many clinicians can’t or don’t exercise careful, insightful judgment. Moreover, though, we don’t need the delineations to treat the clusters (except the insurance companies insist we do) as much as we need them in order to scientifically study them – the reliance on clinical judgment means that each individual case is analyzed on its own, so grouping clusters into categories isn’t necessary (it might help to have a rough sense of how they tend to group together, but, again, formal, rigid categories aren’t needed for that). However, we can’t apply scientific methodology to understanding the clusters *unless* we define them. There are two choices: (1) don’t study the clusters scientifically, or (2) define them as best we can and revise the definitions as research sheds light on what we’ve gotten wrong. I advocate for (2). Have these “clusters” I’ve been referring to, which we call “mental illness,” been defined as best they can be given our present understanding of them? No, probably not. Are there complicated issues with going the route of (2)? Yes, for one thing, how we define the phenomena under study is going to dictate how we approach the study of it, which means that our definitions can lead us badly astray. Do many researchers understand this? Yes, that, I believe, is the impetus for NIMH’s Research Domain Criteria, which asks researchers to study mental illness with a bottom-up approach – set aside the top-down (i.e., current definitions of mental disorders) and investigate the phenomena along these dimensions, remaining agnostic with respect to how they’ll inform nosology.

    I’m not sure why we would better off abandoning the project. The mind/brain is incredibly complex, yes, but that just means it will not be easy to arrive at an understanding of it – not that we can’t possibly hope to. We’ve made a lot of progress in understanding the mind/brain (in general) at the biological level over the last 60 years; I believe we will continue to make rapid progress and that what we discover will improve the treatment of mental illness, which for many is something they would like treatment for. For now, we should do the best we can with what we know – part of “doing the best” means recognizing the limitations of that knowledge. This is where some researchers and clinicians fail, but it is the fault of individuals (and various forces, like insurance companies, that influence them) when that happens, not the fault of the enterprise itself. Furthermore, the failure of some individuals does not entail the failure of all. In all fields, careful science happens some of the time, but not all the time – that doesn’t mean we should abandon science completely, but rather that we should do what we can to ensure as much careful science is being conducted as possible. Hence, my call to improve psychiatry as a research-based, scientific endeavor, not destroy it.

    Apologies to all for so many lengthy replies – it’s hard to talk about this stuff without going into a fair amount of detail, and since I’ve received a lot of tough questions, I’ve felt the need to respond with enough depth to accurately communicate my answers. It’s also not possible for me to take the time to craft what I’m writing, so apologies for any lack of clarity.

  • As I’ve discussed in other posts – my views fall under what in philosophy is known as physicalism, namely, I believe that the mind IS the brain. More broadly, I’m inclined to believe that everything in the universe is physical (I’d like to clarify that I don’t buy into a lot of conclusions that one might think follow from this premise — I don’t claim to known anything about whether or not there’s an afterlife, I don’t think “everything is physical” rules out a spiritual side in life (and beyond) – my conception of spirituality involves it being a physical thing, which may sound counterintuitive, but in my view “physical” does not equal “not special/not meaningful/not astonishing/etc.” After all, our existence is all those things (special, meaningful, and astonishing), and I believe it’s entirely physical). Some spiritual traditions posit a connection between all beings in the universe – I’m on board, just think such a connection is/would be physical, in terms of its fundamental nature. One can’t “prove” this position, and for some, it may never make sense. We do, however, have compelling evidence that the mind is, in many important ways (don’t have to accept it is in all ways for the general point to stand), identical to the brain.

    Here is how I understand something like open dialogue: chemical does not mean “only influenced by drugs/exogenous substances.” Conversations operate on the same chemical processes that drugs do; so does everything else we experience. Let’s take drug craving as an example: if I’m addicted to a drug, my brain learns to respond to cues that have been paired with drug intake (e.g., a particular location, paraphernalia, etc.) – the feeling of craving is a chemical response to these learned associations. You can rewire the brain to “unlearn” this association and thereby reduce cravings (to an extent, for most recovering addicts the risk of cue-induced relapse remains for a very long time, even a lifetime) by *behaving* differently. That is, by changing habits, you change the brain – you *rewire* the brain. All of the changes take place at the level of chemical — and electrical — activity. It doesn’t feel like this when you’re living it – it feels like, well, addiction recovery (becoming free from the overwhelming urge to use), which refers to the same change process but does so from a higher level of analysis. What is “recovery”? It’s rewiring of brain systems, and rewiring means acting on chemical processes.

    The brain can be rewired in many different ways, ingesting exogenous chemicals – i.e., taking drugs — is one way, but it is certainly not the only way. We don’t need to understand brain re-wiring to make use of it in changing ourselves – Aristotle was talking about brain rewiring when he said that virtue of character is cultivated by habit (the habit of acting virtuously). We do need to understand it, quite well, to make use of it in pharmacological treatments. Are we there yet? I honestly don’t know. Can we get there? I would argue yes, we can, and we mostly will.

  • Jonah,

    I agree that “brain processing gone awry” is quite vague, but I don’t think it’s inaccurate. My background is in philosophy (that is, my way-back-when background), and I fall in the “physicalism” camp of philosophy of mind. So, what is mental *is* physical – it is corporeal, just as much as anything else. Sight, for example, is an entirely physical process – it involves the eye, of course, but where it really takes place is in the visual cortex (along with some other areas, few brain processes take place in isolation – that is, in just one system or another). Most people don’t have too much trouble buying into this (incidentally, the psychology of perception is *fascinating*! Take vision – the brain has to convert 2D retinal images into a 3D representation of the world, but an infinite # of arrangements “out there” in the world could correspond to the same light pattern hitting the retina…so how does the brain construct the 3D representation? By making assumptions based on regularities in the world. It’s remarkably good at this, but sometimes it assumes wrong (that’s when we experience visual illusions)), but people tend to hit a stumbling block when they get emotion and various other higher-order functions. Before I address that, let me point out that in schizophrenia, hallucinations – let’s take auditory hallucinations, as they are the most common – occur in the auditory cortex. That’s why it seems to the person as though they are really hearing, e.g., voices – because, as far as the brain is concerned, they *are* hearing the voices, just as they would if information about the sounds were coming into the brain through the ears. So, back to emotions, which is where a lot of people have trouble getting on board with physicalism. It just doesn’t feel like emotions could be physical, but then, neither does it *feel* like our brain is doing all that computational work to construct visual representations – we open our eyes and, boom, there’s the world. There are clear evolutionary explanations for emotions; they’re adaptive. I think of emotions as just like sight – they arise from processing that takes place in emotion-processing systems, just like 3D representations of the world take place in visual-processing systems. Either system can “breakdown” so to speak, or be disrupted. It is the auditory cortex that’s doing funky things in the case of auditory hallucinations, and it’s the emotion processing system (e.g., the mesolimbic system and the prefrontal cortex) that’s doing funky things in emotional disorders. Feeling sadness/fear/anger is generally useful in life, it’s adaptive, but sometimes the system goes awry – just like the auditory system sometimes does – and its activity ceases to be adaptive. It tells us (that is, it tells higher-order executive function systems) that we are feeling, e.g., despair, when there’s nothing signaling “it’s time for despair-mode” just as the auditory system tells us we’re hearing something when there’s no corresponding sound waves “out there.”

    So, basically, my point is simply that we are nothing more, and nothing less, than all our systems working together in complex ways – in my view, mental illness is what we call the stuff that happens when some of those systems go awry.

    Best wishes,

    Layla

  • Hi Laura,

    Indeed, meeting the love of my life has been friggin amazing! (I met her in treatment, incidentally, it helped move along the recovery, like-woah. I certainly don’t think meds are all there is to treatment and recovery — I would not be doing nearly as well as I am today were it not for many other aspects of my treatment, including mindfulness meditation, not to mention meeting my lady).

    I suppose it would be fair enough to say my disease is “in remission.” First, I should clarify that I’m not fully on board with the disease language, either. I think it’s useful, to a point. Kind of like “mind/brain” is a useful distinction, and “nature vs. nurture” is useful to talk about…useful, but not entirely accurate. Again, I don’t know that the best way to conceptualize mental illness is by thinking of it as exactly the same as other illnesses. But back to the not-on-meds issue. I think meds can help, but I don’t think they are necessarily needed continuously on a life-long basis. For some people, in some cases – maybe. But definitely not across the board.

    So, how can I have mental illness and be off meds? Well, I believe that my struggles were related to chemical processes in my brain, yes, but it’s simplistic to think only chemicals in the form of drugs can operate on/alter chemical processes in the brain. Everything I do/perceive/ingest/etc. operates on chemicals in the brain. The more I learn about neuroscience, the more I appreciate the intricacy of this system – one of the reasons I believe great care must be taken when meds are prescribed, to whom they are prescribed, and why. I think psych meds were helpful for me in the beginning of recovery, and I’m open to the possibility that they might be helpful again somewhere down the road. But they were not the whole answer, and, from the fact (let’s call it a fact for the purposes of this point) that they helped at one point, it does not follow that I must continue to take them in order to maintain stability. To the latter point: I am constantly rewiring my brain (as we all are, evidence of which is the fact that we change from day to day and, moreover, year to year), so the brain I had, say, 3 years ago is quite different from the brain I have today. Today’s brain doesn’t seem to need medications to “see the light,” so to speak. 3 years ago’s brain…well, different story. I should add, I can’t be sure that the medications helped back then, but they did seem to – at first, no, but then careful adjusting and readjusting got me to a sort of “breakthrough moment” where I was, fairly suddenly, able to operate in ways that I hadn’t been able to previously, even though I’d been trying quite sincerely and diligently. It was at this point that the other parts of treatment began to “get through to me” – again, so to speak – where previously I couldn’t seem to do anything with what therapists were trying to work with me on, suddenly I found that I could make some progress. To the former point (i.e., they weren’t the whole answer): in many ways, I think that my treatment has been a lot like physical therapy — teaching my body (in this case, my brain) to function differently. Rewiring it. I would never advocate for just putting someone on meds and then saying, “OK we’re done here, you’re good to go. Good luck!” I have been fortunate to work with extremely competent and compassionate therapists. My psychiatrist is one – he’s not one of these 15-minutes-once-a-month kind of psychiatrists; he does actual therapy along with med prescribing. He’s become someone I really value and trust as a guide, not just as a doctor or prescriber, but as someone who helps me work through issues by talking to me about them. Having been trained in psychoanalysis (he’s older), he brings a different perspective than the CBT/DBT psychologists I work with, who also don’t stick rigidly to one or another approach, but guide me in ways that suggest they are connecting with me as a human being, rather than running through a treatment manual (they use DBT and CBT, to be sure, but they aren’t CBT/DBT-ing me, they’re just helping me, with techniques from those treatments as part of their approach). So, anyway, I think my brain right now is wired in such a way as to not require medication for stable-enough functioning. If I were to experience another episode of depression, I would not be unwilling to go back on meds, though I wouldn’t do so unthinkingly either. For anxiety, I’m lucky enough (lucky in a sense!) that I can’t be on benzos because of my addiction history…anxiety is one area where I really don’t think meds should have a role unless there’s a very good reason why they’re actually going to help the underlying problem. Exposure, exposure, exposure! It sucks, but it works. Quick fixes aren’t the answer – meds shouldn’t be used for that; they should be used, if at all, for far more thoughtful reasons. That’s the thing: I’m not super-pro-med. I used to be fundamentally opposed to even trying them; I came around, they seemed to help, now I would take them, but only if it seemed crucial. Mental illness is all chemicals in the brain, yes, and meds are one way to manipulate those chemicals, but there are other ways too. I’m still manipulating the chemicals in my brain, all the time as we all are….if the non-med manipulations, let’s call them the infantry, need a little support from the med cavalry, I’ll go back on them until the situation is under control in a way that the infantry can go it alone.

    Does that give you a sense of where I’m coming from?

    Best wishes,

    Layla

  • Hi Laura,

    Thanks for taking the time to respond. I appreciate your viewpoint, and you have clarified your understanding of psychology, so I retract my earlier statement that said you don’t seem educated on the basics. You and I seem to have had mirror-image experiences with the mental health system. I’m 29, so I believe we’re roughly the same age. I started to struggle in the early teens as well. I didn’t enter treatment until I was 26, and although I’ve had some really negative experiences as a patient, I’ve also had (more) positive ones. I didn’t need a mental illness label to feel I couldn’t find a way to live the life I wanted for myself – it was only after I was given such a label that I did begin to find ways of living that life. You were inspired to fight against the mental health system; I was inspired to become a part of it. I think, as former/current patients, we both have something important to offer in the conversation about “madness in America.” That we have such different perspectives is something I take to be indicative of the value in adopting a middle-ground position. It’s not all bad, and it’s not all good. That is really all I’ve hoped to get across. Perhaps I have not served my ends very well by getting caught up in issues related to what the brain does and doesn’t do. In any case, I don’t feel that I’ve been inclined to take less responsibility for my life since entering treatment, to the contrary I’ve finally begun to really live, instead of wallowing in self-perpetuating thoughts and habits. So, before treatment, I was held back. Now, after/in ongoing treatment, I seem to be growing by leaps and bounds. My point in commenting on this blog has simply been to point out that anecdotes can vary widely in what they tend to suggest, and, for this reason, taking an extreme position based on one’s experience may not be advisable.

    Best wishes,

    Layla

  • Well, no, the monkeys aren’t *just* hunched over – it’s one measure (amount of spontaneous activity). And their behavior is compared to that when they are not under the influence of whatever drug or procedure is attempting to induce depression. If you don’t think you can make an animal depressed, try torturing your dog for a little while (don’t really! you can just go to a factory farm anyway…any meat-eaters open to vegetarianism I can convert on here? See Alastair Norcross “Puppies, Pigs, and People”!) You say I’m providing factoids, I say I’m providing – however ineptly – a different perspective. That of patient who also happens to be working toward a career in the mental health system. Someone who has experienced first-hand the good, the bad, and the ugly of psychiatry, doesn’t feel visceral contempt for the field, and has studied cognitive science, developmental/cognitive/social psychology, and clinical psychology.

    You may condescend and label me “indoctrinated” but I am perfectly willing to listen to other viewpoints and think carefully about what is raised in them (see my responses to other comments; I’m not just trying to shut down anything, or anyone, that/who doesn’t agree with what I currently think). The responses to my posts suggest that I’m being viewed as a pro-psychistry zealot, which I’m not, and as “one of them,” but turning it into an us-vs-them doesn’t allow anyone other than people already in full agreement to be part of the conversation. And that, I suppose, is my point, well one of them, in posting here.

    What is my point? It is (1) to offer a perspective from a more middle-of-the-road position – psychiatry has lots of problems, it can and does do some good, it needs and ought to be improved. I’d call that pretty balanced. Neither pro nor anti psychiatry, per se, a mix of both. (2) Related to (1), to bring in a different viewpoint to a conversation that seems to be very much insular. Talking to and hearing from only those who share your view has a way of reinforcing it without critical thought. If nothing else, I can serve as a stand-in for people who don’t agree, which allows all here to get a sense of what someone like me (a patient who doesn’t hate psychiatrists) might say and to formulate responses to those of us who hold more moderate views. I’m not getting anything out of this – in fact, it has been rather draining. I’m writing because I think that the perspective of people, like Laura, who have had really negative experiences with psychiatry can offer such valuable insight to the dialogue. I just wish it were more tempered and less black-and-white.

  • Nijinsky (3:06am),

    You’ve made a number of very compelling points. You’re entirely right that the comparison drawn between psychosis and a drug trip was crude and insensitive – my apologies to any who may have been offended by it. I have struggled with, albeit moderate, psychosis myself and certainly don’t mean to suggest that it’s equivalent to a drug trip (which I’ve also, um, experienced a number of times). I will point out that drug use can induce psychosis – indeed, that was one factor in my own experience of it (synthetic cannabinoids, I highly recommend avoiding those!), which is one reason why I get frustrated by the whole “marijuana can’t be bad for you” argument one hears from legalization advocates. Anyway, that last point is neither here nor there. Bottom line: I did not mean to trivialize the experience of psychosis by comparing it to a drug trip.

    What I was trying to get at, in a rather poorly worded attempt, was that (1) chemicals can have really profound effects on perception and cognition, so there’s no reason to think that psychosis couldn’t arise from “mere” chemical reactions (that’s what everything arises from!) and (2) if chemicals can have such effects then, in principle, it should be possible for chemicals to counter disruptions in these processes (which is what is happening when psychosis abates for *any* reason — getting in touch with whatever one may get in touch with is itself a chemical process).

    You’re absolutely right that my not “seeing” how something could be doesn’t mean that it *can’t* be, only that I don’t see it. No question, I agree. I didn’t mean that to be a statement of truth-with-a-capital-T (this *means* it’s not possible), just that I was thinking psychosis seems a little different than, say, anhedonia, in this respect. And fair enough, I stand corrected – various other means can mitigate psychosis. I know that for me, being on anti-psychotics seemed to help (*seemed* – I can’t say for sure that they did, of course, we’re not talking careful science there, just my perception). That was when my then-moderate psychosis was not as mild as it is today – I essentially don’t have true psychotic features at this point in time, just little hints of it, which I deal with by applying other tools from the proverbial toolbox.

    Let’s set aside psychosis, then, shall we? How about anhedonia (crudely defined here as lack of pleasure)…can drugs alleviate anhedonia? I’d argue that yes, they can. Why? Because they can target the reward-reinforcement circuitry such that pleasurable experiences are responded to as they are in the absence of depression. Are current anti-depressants the very best we could ever do? No way. Do they seem to work for some people? Yes. Do other non-pharma treatments seem to work as well or even better? Yes. Does that mean that no patient will benefit from the inclusion of an anti-depressant in their treatment? No. What is true on average is not necessarily true for any individual.

    Look, even if psychiatry is wrong about every current drug on the market, the answer is not to do away with psychiatry, it’s to make it better. The basis of the argument to the contrary is that this is in-principle impossible. The other argument, I suppose, is that *all* people can *always* get better without pharmacological treatment. That’s a very strong statement…

    Best wishes,

    Layla

  • @Marian: by evaluating options and choosing between them. You don’t need free will to do that! (See Josh Greene’s “mr. puppet” arguments for a better sense of where I’m coming from — he’s a philosophy phd turned neuroscientist at Harvard who works on the psychology of morality. Fascinating stuff! Guaranteed to be fun puzzling, even if you don’t end up agreeing with his views)

  • Jonah,

    You make some excellent points. I agree, we get into very dangerous waters when psychiatrists are brought in rather than sought out. I also agree that schizophrenia is a rather questionable medical diagnosis at this time. There’s much disagreement within the field that calls attention to this (e.g., papers written by Keshavan, Nasrallah, and Tandon; Bentall, Jackson, and Pilgrim). However, that there is such a thing as mental illness, and that it has to do with brain processing gone awry seems to me to be very well-established indeed.

    Best wishes

    Layla

  • Oops never mind, I see it…what I’ve seen in the literature suggests that med non-compliance is actually one of the strongest predictors of poor outcomes (in terms of various measures like age of mortality, education, work, quality of relationships, independent living, etc.)

    Can you point me to research indicating that medication has such poor outcomes? (That’s not meant to be facetious, I’d like to take a look – genuine interest, although I’d only be interested if it’s coming from peer-reviewed sources. And no, there’s no conspiracy to keep legit, but counter-to-conventional-wisodm results out of peer-reviewed publications. If you think there is, take a moment to consider how such a view might be similar to fringe right-wing paranoia…)

  • @Rachel, You raise an excellent and interesting point. Before I respond to it, let me make it clear to all that I am not blindly “pro” psychiatry, nor have I had *only* positive experiences as a patient of psychiatrists. At one psych hospital, I was over-medicated, put in restraints (sometimes, looking back, I probably needed to be – it was because I was out of control, hurting myself, and realistically couldn’t be stopped any other way; other times, it seems they jumped the gun and taking more time to talk me through what I was experiencing probably would have done the trick), and I was traumatized by the experience. It is my experience, on the whole, that I view positively. As a gay person, I am very aware of the issues with decision-by-committee on what constitutes abnormal. I believe there are serious problems with the role that drug companies and insurance companies play in shaping how mental illness is defined and treated. I am constantly asking critical questions in my classes (e.g., who decides what counts as “clinically significant” impairment or distress?) The professor who taught a class on psychopathology that I took last semester constantly pointed out the troubling issues surrounding nosology, including the fact that most diagnostic categories were designed at a time when we had almost no understanding of the brain science that informs us today. Many in the field are aware of the fact that there are serious problems with how mental illness is defined and understood, and there are efforts to address these issues. (For one such effort, see the NIMH call for research based on “Research Domain Criteria” laid out on this website http://www.nimh.nih.gov/research-funding/rdoc/index.shtml ). I also learned a lot about the history of the DSM; there is no question that it is a work in progress and someday students in psychopathology classes will be looking back at where we are now and learning about how it was gradually corrected to be what it is in their present-day. Then, further down the road, even more-distant-future students will look back on the first group’s present-day DSM (or whatever it’s called then) and learn about how *that* one got X and Y all wrong and what’s changed since, and so on and on – no human endeavor ever reaches perfection.

    I think there is a very valid point to take from the comparison you draw to love. Conceptualizing mental illness as illness like every other kind may not be the best approach, though this does not mean there is no such thing as mental illness, just that we may have to reexamine how we should understand illness in this context. Note that disruption of normal functioning does not, in and of itself, constitute illness, even in our current paradigm. For example, I might experience a disruption of normal functioning because I am high on meth, but that’s not considered an illness. I might experience a disruption in normal functioning because I am spending all my time writing replies on a blog post comments section instead of attending to my to-do list 🙂 but I don’t know that I have “commenting illness” contrary to how others posting here may diagnose me. The idea of “brain circuits gone awry” surely has merit – a degree of common sense tells us that being in love and being clincially depressed or having OCD to the point that one cannot leave one’s house are qualitatively different. In the case of addiction, there is ample evidence of disruptions in reward-circuit processing as well as disruptions in glutamtergic activity that leads to alterations in long-term potentiation (aka synaptic plasticity). Addiction is easier to understand in this way because of the obvious ways in which exogenous chemicals hijack normal processes and exert an influence on brain chemistry, but there is plenty of reason to believe that other mental illnesses involve relevantly similar processing disruptions. The idea that because disruptions in processing occur naturally they must not be illness doesn’t make sense when we consider it in light of, say, an auto-immune disorder like arthritis. Arthritis is immune functioning gone awry, depression/schizophrenia/PTSD is brain circuit functioning gone awry. Insel’s point, I take it, is that our understanding of mental illness as disordered brain circuitry ought to inform our diagnostic practice, which seems quite right. Again, see the Research Domain Criteria. Finally, being in love is something that few seek treatment for, whereas mental illnesses are something that many seek treatment for. We get into very sticky territory when it comes to forced treatment – there are no easy answers to be had. I look at my own history and see how complicated it can be in a single individual case. Was it right that I was once involuntarily committed? I guess it depends on what is meant by “right.” On the one hand, I most certainly would have told you it wasn’t at the time. On the other, I am now very glad it happened. I probably wouldn’t be alive today had I not been committed. Was it my right to kill myself? Maybe, but I’m glad I didn’t, so I’m glad someone thought it wasn’t my right. Thought experiment: but what if, in the future, I decide that I want to die and it is in fact the case that I would never regret it (assuming I could look back on the decision, this is a thought experiment, remember) if I actually went through with the decision – would it be right to hospitalize me and so prevent my doing so? No, probably not. But how can we know in advance whether someone would look back and regret it (if they were able to) or wouldn’t (if they stay alive)? We can’t. Again, no easy answers.

    And that’s really my point in all of this – I’m not trying to “defend” psychiatry. No, my point is to call attention to what I view as weak reasoning and overly strong conclusions. Why am I doing this? Because Laura seems very intelligent and I believe she could be of great service to the movement to improve psychiatry (a movement all around us that is happening every day and actually does have a chance of getting somewhere), but she can’t do that unless she’s willing to accept that it needs improvement, not annihilation. Psychiatry will not go away, but it will be improved. The posts I’ve written are a call for those who understand how badly it needs improving to take up the cause of making it better. The more we all do to help psychiatry help itself (like we would help oncology help itself – not for the sake of the oncologists, but for the good of those in need of cancer treatment), the faster it will improve.

    Given my history, I am quite sensitive to the vulnerability of psychiatric patients and equally averse to the manner in which some mental health professionals run roughshod over those in their care. It’s a little hard to take the “us vs. them,” “kill the beast,” “psychiatrists are liars and frauds” arguments though. A little AA wisdom: easy does it.

  • I actually wasn’t using my experience to suggest anything other than that some patients *can* and *do* have what they feel were helpful, positive experiences with psychiatry. This is proved by my anecdotal evidence — it is one of the few things anecdotal evidence can prove (the existence/possibility of something; if it exists in one case, it exists/is possible, period). The point, actually, was to show how easy it is to refute strong claims grounded in anecdotal evidence – all one needs to do is find an anecdote showing the opposite and the strong claim is undermined. Of course I haven’t “proved” the validity of psychiatry by sharing my experience; there are far too many ways to explain my experience that don’t depend on psychiatry’s being valid.

    As for the animal models – of course we can’t measure directly what they’re feeling. Here’s a little bit about how it works for anxiety in rodents: rats and mice are afraid of tall, open spaces – fear of heights and exposure, basically, so researchers capitalize on this natural fear by building mazes (there are two main kinds) that have enclosed, dark portions, and open, light portions, then they put the animals in and see how much time they spend in each kind. Administering drugs that have anti-anxiety properties in humans causes the animals to spend more time in the enclosed, light portions than they do in the absence of those drugs. A simpler model just uses light side/dark side of a cage. The inference is that the drugs reduced their fear, made them less anxious, so to speak. For depression: monkeys work well, you can see how much time they spend hunched over, sitting passively, versus exploring their enclosure. With rodents there’s the forced swim test, learned helplessness paradigms with electric shocks, and using persistence in feeding themselves despite receiving a shock every time they press the lever that delivers food as a measure of their motivation to satisfy drives. My objection to all of this is the cruelty inflicted upon animals, which gets me seething because I do not believe there is such a thing as a “lesser being” in any sense that justifies this torture. Bentham’s insight (“the question is not do they reason, but do they suffer?”) was spot on. To me, no end from medical research (any, not just psych) justifies these means. Anyway, that’s a whole other can of worms.

    You may laugh, but what I’m saying, however unclearly or inaccurately, is based on many years of research, performed by good scientists (by good I mean careful, adherents of the scientific method). If you don’t even understand how animal models can be used, I doubt you have an in-depth understanding of much when it comes to this research. Rather than laugh, try learning (not from me, from the research itself). Then you will be in a position to critique comments like mine in a way that doesn’t depend on misstating my argument (re: anecdotal evidence) or ignorance (re: animal models). I appreciate constructive criticism, it helps me learn, but you didn’t offer anything constructive, which is a shame. What’s the point in mocking? What might that get you or me or anyone else who reads it?

  • PS I’m not on psych meds at the moment, but the love of my life is, and she wants to be because she believes they help her. If some of the people who have written here had their way, she couldn’t be because they’d be “done away with.” Think for a moment what you are advocating. Not all patients of psychiatrists are helpless objects being acted upon who can’t think for themselves and need to be “rescued.”

  • I don’t have time to respond to all the replies to my posts, nor did I have time to respond very carefully to those I did.

    A general comment: Laura’s experience is not representative of all who have entered the mental health system. I am not alone in this belief; many of my fellow “hospital-on-the-hill” patients agree that her experience does not represent theirs. Attacking the entire profession of psychiatry as an evil empire is counterproductive. If you really want to change psychiatry, you have to factor in perspectives like my own because the evidence “I had a bad experience with it” can easily be countered with accounts from people like me who say “I had a good experience with it.” Saying that mental illness is a natural expression of the mind that shouldn’t be “corrected” invalidates the experience of people like me who feel that we couldn’t just “find it within ourselves” to change the way we felt. Finally, if you’re going to argue against a science, you must be able to speak intelligently in the language of that science, otherwise, you will not be taken seriously. This means that you need to have an in-depth understanding of the research that has been produced, which can’t come from reading someone else’s critique of the science. The mainstream isn’t engaging with these arguments because the mainstream can easily dismiss them.

    Note that Robert Whitaker himself takes a far less extreme position:

    “This does not mean that antipsychotics don’t have a place in psychiatry’s toolbox. But it does mean that psychiatry’s use of these drugs needs to be rethought, and fortunately, a model of care pioneered by a Finnish group in western Lapland provides us with an example of the benefit that can come from doing so. Twenty years ago, they began using antipsychotics in a selective, cautious manner, and today the long-term outcomes of their first-episode psychotic patients are astonishingly good. At the end of five years, 85% of their patients are either working or back in school, and only 20% are taking antipsychotics.” (from HuffPost in 2010)

    That paragraph is nuanced. “Take down the evil empire” just isn’t.

  • Marian, diseases are natural. Cancer is natural and it makes sense in light of the person’s genetic predisposition and environmental inputs. What on earth does that have to do with anything? There’s something called the “naturalistic fallacy” that seems to be in play in your remarks. I understand trauma and the extreme reactions it brings about, I’ve lived it. There’s no desperation in my remarks about psychiatry – this is not in any way high-stakes for me.

  • The complexity of the brain makes understanding it a challenge, but that doesn’t mean it can’t be done. I didn’t prove your point at all – you suggested that trying to “fix” a brain by acting on its neurons is like trying to “fix a computer by acting on its hardware instead of reprogramming it. I pointed out that acting on neurons *is* reprogramming the brain.

    Also, minimizing the seriousness of eating disorders by referring to them as “eating too little” is offensive to anyone who has had, or loves someone who has had, an eating disorder.

  • People did just fine talking to their spiritual counselors? Really? People weren’t locked up in the back shed because they were “raving lunatics”? What did I do wrong that talking to my friends, family members, etc. didn’t enable me to do “quite well.” There are certainly problems with nosology – it is a vexing one that must be addressed. There are also certainly problems with drug company incentives, but suggesting that all psychiatrists are evil tormentors is way over the top.

  • Early mortality is very much associated with schizophrenia. As an aside, I almost died from mental illness. The fact that we can’t yet look at the brain and “see” schizophrenia doesn’t mean it’s not a pathology. To say that it’s not a brain disease “like” A.D. or P.D. isn’t saying much. Of course it’s not, but that doesn’t mean it’s not a brain disease of another kind. Crohn’s disease is not a gastric disease “like” stomach cancer is a gastric disease, but it’s still a pathology. Tell the families of loved ones with schizophrenia that it’s not “that serious.”

  • Right, all conclusions at this point are tentative ones – good scientists (and practitioners) know this, bad scientists (and practitioners) don’t. But that doesn’t mean there isn’t any evidence. Furthermore, given what we now understand about the brain, in general, it seems obvious that a subset of the population that has a number of commonalities regarding abnormal experiences (the symptoms of schizophrenia are definitely not the norm) would also have a number of commonalities regarding brain function.

  • I’m not sure how anything I’ve said suggests that we ought to fear emotion. In fact, a big part of my recovery has been regaining the ability to feel any emotions in the first place. I have been on psychiatric medications, and I did not find that they damaged me. You can say I’m wrong about my own experience, but I was barely able to function — that is, I was very clearly not able to live the life I wanted, which I don’t think was my fault or an expression of the “true nature” of my mind, whatever that is — and now I am. I took medications and I received psychotherapy. Yes, I found psychotic features, depression, and paralyzing anxiety to be both unpleasant and hindering. I don’t think there’s anything wrong with preferring the way I think and feel now. You seem to be suggesting that people with mental illness ought to be “left alone” – in some cases, sure, but I’m grateful I wasn’t “left alone” to experience the “natural expression” of my mind. There seems to be a theme here of suggesting that the only “right” way to experience the mental health system is as an evil empire, but that is very invalidating for those of us who believe we have benefitted from our experience as patients.

    Also, human thought is no different from anything else in the universe – it comes down to electrical activity, just like the rest of it. Thinking there’s no way that chemical reactions could cause thoughts about themselves is like thinking there’s no way evolution could produce something as complex as sight.

  • First, my focus as a grad student (in *psychology*) is on studying mindfulness meditation, a practice derived from the Buddhist tradition, as a treatment for mental illness. The Buddhist psychology around mindfulness, and in general, is rich and goes back over 2,000 years. So, no, you are wrong – I’m defending something that has nothing to do with my future “lucrative” career (I assure you I could make a lot more money by going into a different field).

    Of course we can, in principle, reprogram the brain with chemicals that act on receptors – how we can do this in such a way as to have beneficial effects is another question, but there’s no question that we can. Just start smoking pot or snorting coke multiple times every day for a while, and see if the targeting of certain receptors doesn’t reprogram your brain. Then reevaluate whether it is “preposterous on its face” that human thought can be reprogrammed by altering neurotransmission.

    Again, there’s a long way to go in psychiatry before this “reprogramming” can be done as reliably and effectively as we’d like, but that doesn’t mean it’s impossible. The science in all this is so very young – it would be the strangest case of scientific progress in history if it had all the answers, or even was most of the way, already. Why should we give up on trying to understand the brain and how it can be manipulated?

  • So, in your analogy, what should we do if we can’t reprogram the computer? Should we just say, oh well, sorry computer, you’re just going to keep slowing down? Or should we go ahead and do what we can to improve its performance?

    I’m afraid your analogy fails, though. The brain is not a computer, and the analogy to one has been rejected by most cognitive scientists (it can be useful to employ the analogy, but it also increases the susceptibility to confusions). The code that runs computers would be analogous to DNA, but DNA isn’t static like a code. Its expression depends on environmental inputs. The functions a computer performs depend on input, but what the code does in response to inputs is not changed by the inputs themselves. This is not the case with DNA. What any given brain does depends on how the DNA of the relevant individual is expressed. How the DNA is expressed depends upon what environmental inputs it receives, and this is a dynamic process that never stops as long as the organism is alive. If I take cocaine, it alters transcription factors in my nucleus accumbens, which return to their previous levels of activation after the effects of the drug have dissipated. If I take cocaine over and over again, the transcription factors will behave differently even when the drug isn’t in my system. Transcription factors regulate the expression of DNA, so my DNA is expressed differently in the presence of cocaine (than it would be in the absence) and it is expressed differently over longer periods, in the absence of cocaine, if I use the drug chronically. So, the brain can, in fact, be “reprogrammed” by chemicals that act on neurotransmitters. This is what we are doing when we take cocaine, and it is what we are doing when we take psychiatric medications. It is true that we don’t yet know enough to be precise in what we change and how – epigenetics is an extremely young field and cannot yet inform psychiatry. Some psychiatrists undoubtedly think they know a lot more about how it all works and what they are doing when they prescribe than they actually do My psychiatrist doesn’t – I am learning about all this as a grad student in psychology (a career I was inspired to pursue by the help I received from my treaters; I like learning about the brain, but I enjoy the level of analysis in psychology, which is why I’m not going into psychiatry, along with the fact that I hate blood and guts, so couldn’t survive med school), so I talk with my psychiatrist about these sorts of things. Even before I went back to school, though, he was upfront about the limitations of what is known about the drugs we talked about in the context of my treatment (I have been on medications and off them since entering treatment – at the moment I am off and doing well enough that neither I nor he thinks I need to be on any at the moment). He would say things like, “this can help with that” not “this does help” and “we can try it; here are the side-effects.” He would also say “this class *seems* to work better than that class, although there’s some uncertainty about whether it should be used to treat X at all. Here’s what I *think*”

    Again, let’s try to improve the field, not destroy it. It would be great if all psychiatrists were aware of and upfront about the limitations of their knowledge, but saying that their field is “a lie” doesn’t accomplish much. Instead, one might try saying, “some psychiatrists overestimate or misrepresent the extent of their understanding about brain processes.” Psychiatric drugs have a long way to go, as does everything brain-related, but they are not without any success. Ask Elyn Saks, who wrote “Successful and Schizophrenic” for the NY Times recently. Note that she is critical of a number of things about conventional psychiatric thinking, yet she also mentions reaching out to her doctors when she feels that she is starting to slide. She talks about symptom management techniques that are not pharmacological, but she also mentions increasing her medications when she notices that she’s starting to slip. She offers a nuanced perspective, which is the only kind that makes any sense in the context of psychiatry, psychology, or anything else brain-related.

  • I suppose it’s worth mentioning that I have been treated at a psychiatric hospital that I suspect, given your references to Harvard Medical School, is the same “hospital on the hill” where you feel you were indoctrinated. I have also been told there that I have “serious mental illness,” which I didn’t need to be told because I already knew it to be the case. I have also been hospitalized as an inpatient, including one involuntary admission. It was indeed painful and traumatic to be locked up against my will, but I am very grateful that I was, for if I hadn’t been, I almost certainly wouldn’t be alive today. I do not feel defined by my illness any more than I feel defined by other parts of who I am. I am a person who suffers from mental illness; I am not the illness. No treater at the hospital or anywhere else has led me to believe any differently, nor have I perceived any effort on their part to do so. I am doing well today, living a full and productive life that I enjoy. For me, it is because of psychiatry and psychology, not in spite of it.

  • Hi again,

    I didn’t see your response to David before posting my previous comment. You say in that response that you are well aware of the brain as the seat of experience, so I imagine that would your response to much of what I wrote. But some things aren’t making sense to me. How do you explain your position that there is no mental illness? All other biological processes are subject to pathology, why think the brain is any different? I take it you don’t object to the concept neurological diseases (such as Alzheimer’s and Parkinson’s). If the brain can become “diseased” in ways that disrupt memory and motor function, why can’t it become “diseased” in ways that disrupt emotional processes? Many people who are diagnosed with depression report that the experience isn’t normal *for them* and they can report, after successful treatment, that they have returned to normal *for them* so…isn’t that enough to say that they have a pathology in the brain, which isn’t normal? Feeling sad is a brain process, and it is a normal one, but entering a state of clinical depression is not “normal” in the sense that (1) it is not the norm, and (2) it is qualitatively different from the experience of states of non-clinical depression. Depressed mood and depression are not synonymous – I have had depressed moods and I have had depression; it is not hard for me to see that one is “normal’ and something that can be worked through without the help of either medication or other therapy, whereas the other is not “normal” and I need help to get back to normal (not necessarily medication, but treatment of some kind). I have experienced grief – I lost my father when I was 24 – and it was a very painful experience, but I can identify the ways in which it was not akin to my experience of depression. Maybe non-pharmacological remedies are best for depression and anxiety. Maybe, in some cases, combined pharmacological and other treatments are best (as in most effective). Psychosis is a different story. I don’t see how one can expect to help someone in the grips of psychosis by talking them through it or any other technique. Here again, I have a question: if psychosis can be chemically-induced (e.g., LSD), why should we think it cannot be countered with chemicals? Psychiatric drugs aren’t up to par yet, but it’s a very young science and studies an extraordinarily complicated system. It seems odd to conclude that its limited success to date must mean the whole enterprise is mistaken. Are there serious issues with drug companies? Absolutely. Is the answer to abandon the project of understanding how pathology in the brain might be mitigated through chemicals that act on its constituent parts? I don’t think so, and that answer certainly doesn’t follow logically from the premise. Again, improve the system, don’t destroy it.

    Best wishes,

    Layla

  • Hi Laura,

    I’m sorry for the struggle you describe. I don’t wish to comment on your experience, as it is yours, but I would like to caution against the use of anecdotal evidence to support a strong, broad conclusion, as you seem to be doing by tying your personal experience into the argument about psychiatry. Having read some of your other posts, I notice a tendency to use your story as an indictment against the entire field. I have had a very different experience with psychiatrists and other mental professionals. I don’t feel I’m “broken” as a person, or anything else along those lines, but I do struggle with what I believe is accurately characterized by mental illness, and I have been helped by several psychiatrists and psychologists. It seems that most of the people who leave comments have had experiences similar to yours, but it is not representative of all who have entered the mental health system.

    Also, I’m puzzled by your take on Thomas Insel’s remarks. You seem to be suggesting that behavior is independent of brain function; from what do you think behavior arises? The soul? Setting aside the matter of mental health or illness, what is it that you think the brain does? How does ingesting certain chemicals (i.e. neuroactive drugs, including LSD, cocaine, etc.) lead to altered states of consciousness and changes in behavior? Take LSD, for example, how do you think it has the effects that it does? People under its influence have perceptual and cognitive experiences that are quite different – to put it as an understatement – from those that ordinarily arise. Intoxication from alcohol also corresponds to many changes in behavior, emotion, and cognition. What are these substances acting on? Behavior is a manifestation of brain function. Returning to mental illness diagnosis – many are spoken of as behavioral disorders, but it is not as though most diagnoses are made on the basis of observing behavior. Psychiatrists don’t go out on the streets and watch people, trying to figure out who might be mentally ill and then diagnosing them as such. Sometimes observable behavior is part of the diagnostic process, but more often than not people *report* their experience of symptoms. People with depression describe how they feel and what sorts of thoughts they are having. People with schizophrenia generally do the same. The onset of schizophrenia occurs between the ages of 18-30; people change dramatically, which is evident to those who know them, and usually to the individual as well. The changes are not mere existential suffering that might be a “normal” part of human experience – they involve profound disruptions to cognitive and perceptual processes. What do you think causes these changes, if not changes in the brain? What would you suggest to these people? You’re fine, don’t worry about it? Try getting in touch with your true, inner self and you’ll stop experiencing hallucinations, delusions, etc., many of which you understand are not “normal” and which may be very unpleasant, frightening, or hindering your ability to living the life you otherwise would?

    Dr. Insel was clearly talking about *risk* states, not illness states. He was asking whether research might find ways to “see” illness before it arises, as it can be “seen” in people who are at-risk for Alzheimer’s or cardiac disease. There most certainly is evidence of structural and functional changes in the brains of people with schizophrenia. The science in all this has a long way to go, to be sure, but the call to abandon the belief that the brain is the seat of human experience – normal or otherwise – is…absurd. States that look very much like what we see – observable behaviors – in humans who report depression can be induced in non-human animals by targeting certain systems with drugs. Signs of anxiety brought on by induced stress in, say, rodents can be mollified by giving them drugs that have anti-anxiety effects in humans. When a railroad spike went through Phineas Gage’s brain, his personality changed dramatically, including his moods, as evidenced by a significant increase in irritability, anger, etc. These few examples hardly begin to touch on the overwhelming evidence that the brain is responsible for experience. You would not be taken seriously in the mainstream because you appear to know very little about the basics of psychology (as in the science of human experience, not the science of a particular kind of human experience). There are very basic confusions evident in, e.g., your response to the passage you cited from Thomas Insel.

    I don’t see how “take down the system” is in any way productive. You think psychiatry is a cult, but you don’t seem to see how what you’re spouting sounds like a conspiracy theory. Psychiatry and (clinical) psychology have a long way to go and are in need of many reforms, and people like you have so much to offer because those us who have had the experience of being patients can bring unique perspectives to the table. I wish you’d use your passion more wisely – no amount of fervor is going to dismantle the field of psychiatry. Instead of spinning wheels trying to take it down anyway, you could work toward improving it, which is not only possible but also bound to happen one way or the other. You seem very intelligent – if you educated yourself more about the science of psychology (again, the broader definition of psychology, not just clinical psychology), then you could work toward an end that isn’t so futile.

    Best wishes,

    Layla