the task ahead

I am almost finished telling everyone who sent a request that I will get to their question some time in the next -- who knows when --- but I will.

In my message to the Listserve I said I would answer questions and of the 260 responses, a bit more than half seem to be legitimate questions.  In the piece I wrote I stated that nothing that people do surprises me anymore. After reading the comments, I find I am not surprised, I am a bit saddened that there are so many people out there who are not only struggling with so much, but are also searching for a way to find help.

As I have said in the past, I am not a fan of psychiatric diagnoses.  I feel that these labels only mark people as "sick" when they are really just dealing with the shit the world has handed them, often from the moment they meet their parents.

The causes of upset and strife are similar all over the world: stress, loss, loneliness, illness, trauma, and inadequate resources.  These are the factors I usually look at when I try to define a problem and then set about looking for a solution; something that is always a joint process with the patient.

The sad part to me is that there are so many terrible situations that people are reporting, and I hope to be answering them really soon.  The other side of the picture is that only one percent of the readers of the List felt the need to respond, so the other 99% either thought what I said was OK or useless, but they are moving on well enough without me.

In some ways that's comforting.

Diagnostic discussion

Given all of the talk about how helpful, accurate or scientific psychiatric diagnoses are, and how embarrassing DSM V is, there is an attempt o bring some hope to psychiatry in an article in the Sunday NYT Review section.  In that piece, Dr. Eric Kandel, a Noble Prize winner in physiology, tries to make the case that we are well on the way to having better diagnostics through brain research.

In his explanation he gives a very positive nod to the use of psychotherapy as an effective treatment for mental disorders.  Along the way he re-labels psychotherapy as a brain-treatment, and takes a slap at therapists lack of scientific rigor, but his view of therapy is general very positive.

He makes a case, that is much more hopeful than real, that further study of neuroscience, genetics, and bio-chemistry will eventually, in years to come, reveal the underlying causes of mental disorders, and greatly improve diagnosis and treatment.

I certainly agree with Dr. Kandel that these sciences are of great importance to the understanding of some of the contributing causes of emotional and behavioral irregularities but, given who he is and where he comes from, he is trapped in a very reductionist, medical model.  If psychotherapy is a “biological brain-treatment” as he states, so is a family, a sub-culture, and a romantic relationship.  These things also have a major impact on how a person feels and behaves, and they cause many major changes in the brain.  Until we learn how to integrate all of these factors into our attempts at understanding what causes what,  we will be still fumbling around with inaccurate half-truths.

At present, diagnoses are often as much a political act as they are a science.  They are descriptions of what is considered, at the time, unacceptable behaviors.  What is unacceptable changes with the culture, and the soical values of the times.  There are many, many examples, from hysteria to homosexuality, that were illnesses then, but are seen as acceptable now.  I am sure what is now called bi-polar disorder in ten years will have four different names.

Yes, our mind is a product of our brain, but our brain reacts to what is happening in the world around it as much as what is happening inside our skulls.

That’s my view, even without a Nobel prize.