Gail Williams (gail) Tue 9 Dec 08 16:23
Oooh, I want to hear it.. what's the link for the replay? All I found was a text chat summary...
David Gans (tnf) Tue 9 Dec 08 17:36
Andrew Alden (alden) Tue 9 Dec 08 17:48
The trouble with the hot-salsa technique is that Gary wouldn't be able to talk.
Steve Silberman (digaman) Tue 9 Dec 08 17:51
So Gary, our wonderful conversation here is drawing to a close tomorrow. Is there anything you'd like to add, or wish I'd asked? Feel free to ask yourself and answer -- we're listening.
Linda Castellani (castle) Tue 9 Dec 08 19:36
This has been such an excellent discussion!
Gary Greenberg (gberg) Wed 10 Dec 08 08:15
It's been really good for me too. During the interview, Angie read back to me something I wrote here, something I'd forgotten already, and I realized that you all pushed me to put some thoughts that have been kicking around my attic into words. I do think that the most important thing to say, and I've probably said it, is that we should get in the habit of thinking about diseases as social and political phenomena, rather than as strictly biochemical ones. Even outside the realm of consciousness-related diseases, the ones I mostly focus on, this is crucial. Consider type 2 diabetes as a paradigm case. It's got a biochemical component, but it's so clearly a social and political problem, both in terms of how we get it (high fructose corn syrup, which itself is a product of corporate farming; fast food, which is often the only food available in poor neighborhoods; sedentary lives, common among people who have to work two or three jobs to stay afloat; and so on) and how we treat it (drugs, amputations, dialysis, rather than education, prevention, and self-care--which, as the NY Times series last year showed, is too unprofitable to be of much interest to the HealthCareSystem). So if you think of disease as a way to make a claim on social resources, rather than as a purely internal problem, alternatives open up. And thanks so much, Steve, for an excellent interview, for all the time and thought you put in.
Gail Williams (gail) Wed 10 Dec 08 10:53
This has been flat-out fascinating. Thanks to all the participants.
Steve Silberman (digaman) Wed 10 Dec 08 12:18
Thank you all, and Gary, particularly to you for creating such a thought-provoking -- and brilliantly written! -- book.
(dana) Wed 10 Dec 08 14:00
More kudos from here. This topic has been a great read.
Sharon Brogan (sbmontana) Wed 10 Dec 08 17:35
Damn. I was called away due to an illness in the family, just began the book today, and all of this is fascinating to me. Can't we just keep going for another week? So much here... One thing -- the 'alcoholism as a family disease' -- a few years ago I worked for a local National Council on Alcoholism office, and had an intense discussion with my colleagues about this. My argument was that it's either a disease -- in which case, only the person who is alcoholic has it -- or it isn't. If it's a metaphor, it doesn't work. Evil, therapy, illness, ... I'm so sorry I missed this, and I'm loving the book.
Gary Greenberg (gberg) Thu 11 Dec 08 03:18
Disease works as a metaphor, or a narrative device, maybe better than it does as a biological category. Unless it's the idea of metaphor that Susan Sontag demolishes in her book Illness as Metaphor. But when the doctors try to have it both ways--the authority of science, the power of myth--they overstep.
Sharon Brogan (sbmontana) Thu 11 Dec 08 09:13
We don't speak of diabetes as 'a family disease', even though the family must be involved in treatment. We accept that the disease itself is in one person, though the effects may be felt by the whole family. Shouldn't the same be true of addiction, if it really is a disease? I have a similar problem with the concept of 'codependency' -- which you don't speak to in your book, but I bet you could. I think if we took any 100 women, all from different backgrounds and with different psychological profiles, and married them off to alcoholics -- in ten years, they would look very alike. Wait -- we *are* doing that study...
Gail Williams (gail) Thu 11 Dec 08 11:47
Linda Castellani (castle) Thu 11 Dec 08 13:07
When I was at the pharmacy recently, I asked how I could find out if any of the medications I take are placebos. They said that the pharmacist was not allowed to tell me, but that if I asked my physician they were required to, by law. Do you know if that's true, Gary?
Maria Rosales (rosmar) Thu 11 Dec 08 13:24
The best studies, I thought, were double-blind, because of the evidence that doctor's can subtly affect people when doctors know which are placebos.
Gary Greenberg (gberg) Fri 12 Dec 08 08:43
I don't think any of the drugs that you get at the pharmacy are placebos unless you are on a clinical trial, in which case it is true that they can't tell you. But if you're a research subject in a double blind, placebo controlled study, you signed a paper consenting to remaining in the dark. If, on the other hand, the question is whether you were prescribed, say, an analgesic or an antibiotic as a placebo (as more than half the doctors queried in a recent NIH study admitted to doing), then the pharmacist wouldn't know. Only your doctor would. And if you were prescribed, say, dextrose (very rare if ever done), the label would have to say so, or at least give a brand name that a quick glance at the pdr would reveal as placebo. The double-blind study is considered the "gold standard" for medical research. It is not without its problems, however. An example of one of them is in my book. The short version is that when I finished my trial, I asked whether I'd been on placebo. They wouldn't tell me. The latest protocol is that you don't reveal it so that the doctors don't start figuring out who's in which group by associating responses that they've observed with the knowledge they get when thy unblind the subject. But then they offered me more medication. Why? Because I had improved. So whenever they think someone is improving, they assume they're on the med. Which, of couse, has an influence on the placebo effect. Only it comes from ignorance, which is probably worse than coming from knowledge. I once did a story about a woman who had a strong placebo response on an antidepressant trial. After they unblinded (which they did in those days) and they discovered she was on placebo, they offered her the drug (Effexor) free for a year, her payment for the study. If she did well on placebo, they told her, she'd do even better on drug.
Gary Greenberg (gberg) Fri 12 Dec 08 08:47
As for codependency, I wrote a whole book about it. I wouldn't recommend it. It's a long slog through the groves of postmodern literary deconstruction, and a lot of swatting flies with sledgehammers. I mean, critiquing Melody Beattie with martin Heidegger is just plain unfair. The bottom line is that the idea of codependence--and I mean the expanded version, the one that cropped up in the 80s that said that anyone who sufered what Beattie called "the agony of entanglement" is sick-- is what comes up when you get as confused as we are about how to lose ourselves in love. Which doesn't mean that alcoholism isn't a family problem, just that the solution may not be to pathologize everyone.
David Gans (tnf) Fri 12 Dec 08 16:36
> Can't we just keep going for another week? So much here... <gberg> has been a WELL member for years, and so of course is <digaman>, so I would assume they'll both keep visiting this topic.
Linda Castellani (castle) Fri 12 Dec 08 18:12
I hope they do because it seems like we've barely scratched the surface.
Kurt Sigmon (kdsigmon) Fri 12 Dec 08 22:51
Is that why I'm itchy?
Gary Greenberg (gberg) Sat 13 Dec 08 02:13
I'll be around.
Elisabeth (wickett) Thu 18 Dec 08 06:56
Good! I ordered the book, but it hasn't arrived yet. I've been utterly fascinated by this discussion. I do have a question: do you classify clinicians as scientists?
Gary Greenberg (gberg) Thu 18 Dec 08 12:55
Some clinicians classify themselves that way. Psychiatrists, most obviously, and psychologists, who officially adhere to something called the scientist/practitioner model, unless you have a Psy.D. instead of a Ph.D., in which case you are a practitioner/scientist. In real life, of course, most practicing therapists wouldn't claim to be scientists. But they have to engage in a scientific discourse if they want to be licensed and insured and collect money from insurance companies. That is, they ahve to take licensing exams in which their knowledge about supposedly objective facts is assessed, fill out treatment reports and render diagnoses. So to make a good living, you have to give lip service to science, even if you are denying it out of the other side of yoru mouth. Best of both worlds, I suppose, otherwise known as bad faith. And if you want to see just how ridiculous it is to think of the therapy profession as a scientific one, just read the article on the front page of today's Times, in which the whole unfolding debacle of the DSM-V is described. http://www.nytimes.com/2008/12/18/health/18psych.html?_r=1&ref=todayspaper
Linda Castellani (castle) Thu 18 Dec 08 20:13
I think that the amount of money they are allowed to accept from pharmaceutical companies should be dropped to zero. $10,000 is still way too much.
Elisabeth (wickett) Fri 19 Dec 08 01:44
Thanks for the article. That certainly confirms my objection to therapists (psychiatrists as well as psychologists, PhDs and PsyDs) as scientists. I call them all paradigmologists embedded in social subjectivity and power (money) conflicts. I also question whether medical clinicians are scientists. To take an example, my neurologist treats a lot of patients with both lupus and multiple sclerosis. She would love to interest a medical researcher to comb through her files, set up parameters, and compare with other cadres of patients to find interlinkages or perhaps a more accurate grouping of criteria that could lead to more accurate disagnosis and treatment.
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