inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #51 of 178: Jennifer Simon (fingers) Sun 7 Mar 10 12:20
    
Stories are no freer of misuse and abuse by people with a desire for
control than drugs, and they're every bit as powerful.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #52 of 178: Gail Williams (gail) Sun 7 Mar 10 13:00
    
Good pont.  The story changes from top-down and from bottom-up.  
Perhaps we also are changing what "sick" means in terms of the
narrative.  Mother dies, father is revealed as a stranger, and a deep
"sickness" falls upon the protagonist. Sounds like a fairy tale, with
dark Jungian undertones. 

So what's the correct mythic turn?  Perhaps we could accept that "so
she started to eat magic beans, and was able to function to lead a
productive life" and "so she started a torturous journey step by step
back to the sunlight" could both be acceptable choices, but I doubt it.
The big money's on the magic beans.
 
Can the concoctions and the ability for the patient to fine-tune the
dosage be adjusted so that the blessed relief and the hard won wisdom
might both be possible?  So many people have self-medicated themselves
through those kinds of twists and turns with street drugs and booze.
They do this without any scientific side-effect list recitations; 
though there's jail, of course, a wretched side effect for the act of
trying to tune your chemicals.  

(Justice, indeed.  Thanks for bringing that question up.)
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #53 of 178: Brian Slesinsky (bslesins) Sun 7 Mar 10 13:09
    
While I expect a solid neurochemical account of selfhood would be a
huge achievement and open up some new possibilities, it seems a bit
doubtful that it would really be inconsistent with the stories we
already tell ourselves? They're two ways of looking at the same thing,
and we do already know quite a lot about how humans behave.

Grief is a natural process, but then again so is healing a broken leg.
It seems to me that some good comes just from watching over people, if
it can be approached in the right way.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #54 of 178: Gary Greenberg (gberg) Sun 7 Mar 10 13:34
    
>Stories are no freer of misuse and abuse by people with a desire for
>control than drugs, and they're every bit as powerful.


Of course, but the history of this is dialectical. People can always
engage their critical faculties against a prevailing narrative. Take
the Freudian backlash of the eighties, the one capped off by Jeffery
Masson's book, Assault on the Truth. It was a rejection of the theory
that childhood sexual abuse was mostly fantasy, which, so Masson and
other critics said, was responsible for fifty or seventy-five years of
patients (mostly women) being mindfucked by analysts who blamed the
victim. Now, I think this was a bit of a straw man argument, but it
certainly happened, and when people started objecting, they were able
to do so in plain language--"No, I really was sexually assaulted"--with
the result that the mythos changed significantly. 

This is a microcosmic version of what happens as democratic culture in
a free society unfolds, and it happens because the means of reform are
well within the grasp of your average person. I don't think it is
impossible to counter the neurochemical account of depression (or mind
in general) with language, but it is very difficult, because the
tendency of that account is to devalue meaning. Couple the authority of
science with the complexity of the account, and you have the makings
of a kind of domination that is hard to resist, let alone undo.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #55 of 178: Gary Greenberg (gberg) Sun 7 Mar 10 13:36
    
>Perhaps we could accept that "so
she started to eat magic beans, and was able to function to lead a
productive life" and "so she started a torturous journey step by step
back to the sunlight" could both be acceptable choices, but I doubt
it. The big money's on the magic beans.

Right. The question, as always, is cui bono? Or, as the man said,
Follow the money.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #56 of 178: Gary Greenberg (gberg) Sun 7 Mar 10 13:44
    
>While I expect a solid neurochemical account of selfhood would be a
huge achievement and open up some new possibilities, it seems a bit
doubtful that it would really be inconsistent with the stories we
already tell ourselves? 

I'm not sure about this. It could be that I exaggerate the
significance of this change, but we should remember that
self-understanding, by which I mean our account of what huma life is
for and how it should be lived, has undergone immense change in
history. Consider the way that only 500 years ago, the idea of human
rights didn't exist, at least not as the universal that it is now,
which inb turn means that it was rare, and certainly not the cultural
norm, for people to think that they were the masters of their own
destinies and that their lives were a quest for meaning. Tht was an
epochal change in the stories people told themselves, and it can be
traced to (or at least seen in) some very clear historical and cultural
developments: the Protestant reformation, the Age of REason, the
printing press, etc. 

(There is a remarkable book on this subject by the philosopher Charles
Taylor, called Sources of the Self.)
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #57 of 178: Jennifer Simon (fingers) Sun 7 Mar 10 15:16
    
The knife cuts both ways.  Consider the case of Bettelheim.  It was
neuroscience that freed us from the oppression of the Refrigerator
Mother Syndrome story about autism.

How does figuring out how our brains work devalue meaning?  The
problem seems to lie more with what we make of those workings.  That's
socially constructed part.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #58 of 178: Gary Greenberg (gberg) Sun 7 Mar 10 15:35
    <scribbled by gberg Sun 7 Mar 10 15:37>
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #59 of 178: Gary Greenberg (gberg) Sun 7 Mar 10 15:37
    
It was neuroscience that freed us from the oppression of the
Refrigerator Mother Syndrome story about autism.

Not exactly. It was the failure of psychoanalysis that debunked the
refrigerator mother syndrome, and the ascendance of neuroscience that
leads us to replace thaqt unlamented theory with a theory that autism
is neurogenic rather than psychogenic. But has the neurology of
autism,
let alone the actual cause of that neurology, been uncovered? Not last
I checked. The neurogenic explanation is just a strong presumption,
one that I'm guessing will someday be fulfilled, at least in the case
of the severe end of the autism spectrum, but that is still an
assumption.

I'm not suggesting that I think that autism is not neuroogenic, just
that the fact that it makes common sense to think so doesn't make it
true. In the 50s and 60s, the refrigerator-mother theory of autism
also
made sense. 


>How does figuring out how our brains work devalue meaning?  The
problem seems to lie more with what we make of those workings.  That's
socially constructed part.

Sure, I totally agree. Much depends on who this "we" is. If it's you
and I, at least judging from what you're saying here, then I'm pretty
sure we can keep straight the fact that we're talking about different
facets of the same thing, and not trying to reduce, say, consciousness
to its molecular substrates. But if the we are the people that the
molecular biologist Carl Woese calls "fundamentalist reductionists,"
who think they ahve solved the mind-body problem, and if those are
people with lots of power, then I think it is quite possible to turn
the interesting science of how our brains work into an overreaching
theory of everything, and in turn to influence the social construction
of that knowledge. This is what I think shows up in the depression
industry.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #60 of 178: Jennifer Simon (fingers) Sun 7 Mar 10 17:34
    
A number of neurological differences, as well as genetic difference,
have been shown to be common in autism, although the diagnosis is still
symptom-based and ill-defined at this point.  We don't know enough
about autism to say what it is, let alone pin down a cause, but I don't
believe the neuroscience on it so far is likely to be discredited in
the way Refrigerator Mother Syndrome was.  It's not made up out of
whole cloth by a consummate storyteller, just incomplete.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #61 of 178: Gary Greenberg (gberg) Mon 8 Mar 10 03:41
    
That's a great way of putting it. For now, anyway, the biochemical
story about autism seems superior. It certainly seems like it ought to
yield a cure or two--if not drugs for treatment, then identification
and remediation of toxins or other causes. But I think it's possible
that the biochemical account is not only incomplete in the sense that
we don't know enough of the biochemistry. It's also possible that
understanding lurks in some arena in which we haven't even begun to
look. There may be master narratives other than the ones we're talkiong
about here--the biographical and the biochemical. 
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #62 of 178: Steven McGarity (sundog) Mon 8 Mar 10 06:33
    
So, if I follow your explanation, even if one deals with severe
cognitive or behaviorial disruptions - abuse or some other traumas for
example, often in multiples from early childhood onwards, then you
still stand there faced with the biochemistry. I thought that was
Bateson's whole point when he worked with the veterans at Palo Alto.
What then? Some of my friends in Austin got paid pretty well for
testing new drugs. I really never wanted to mess with that. I think
that if we just "walk in a beautiful way" as the Navajo might put it
then everything will be all right. I suppose I believe we can work our
way out of mental illness. 
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #63 of 178: Gary Greenberg (gberg) Mon 8 Mar 10 07:09
    
>abuse or some other traumas for example, often in multiples from
early childhood onwards, then you still stand there faced with the
biochemistry

I don't think that any conscious experience is possible without
neurochemical events. Taht's why I am grateful to my brain chemicals. I
don't think that brain chemistry is a sufficient condition to explain
consciousness, but for all I know that thought is just the result of
some misfiring neurons. 

>I suppose I believe we can work our way out of mental illness. 

I do too, and as some have already pointed out, that's not
incompatible with taking drugs. But it becomes less compatible to the
extent that the drugs are prescribed as the cure for a disease.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #64 of 178: Jennifer Simon (fingers) Mon 8 Mar 10 11:01
    
Your mental illness may vary:  there's no working one's way out of
schizophrenia, for instance.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #65 of 178: Travis Bickle has left the building. (divinea) Mon 8 Mar 10 11:18
    
Nor a personality disorder, nor sociopathy. 
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #66 of 178: Autumn Storhaug (autumn) Mon 8 Mar 10 12:54
    
According to the reading I've done, what (divinea) says is true about
antisocial personality disorder.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #67 of 178: Gail Williams (gail) Mon 8 Mar 10 13:12
    
Putting aside all the complexities of labeling and diagnosis for a
moment, what does that mean about historical times?  Did people who
suffered the general conditions currently called schizophrenia or
antisocial personality disorder have ways to self-medicate if they
could not voluntarily make changes? 

For the future of people with similar problems, is there accepted
medication used now? Will there be? What happens to those who don't
like being medicated or who cannot tolerate side effects?
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #68 of 178: Gary Greenberg (gberg) Mon 8 Mar 10 15:28
    
It seems pretty clear that certain literary figures would have been
diagnosed as schizophrenic. Take Ezekiel, or any of the visionary
prophets of the Old Testament. They were raving lunatics, and even
though what they were saying often proved to be true--their searing
moral vision, of course, is what made their ravings worth repeating and
then writing down--their behavior was pretty darn crazy. Ezekiel in
particular engages in some ritualistic behavior, lying on one side and
then the other for forty days (if I remember right), that might be
thought of as self-medicating. 

There's often a strain of focused and penetrating critique in
schizophrenia, at least in the paranoid type. That is waht has led to
the romanticization of it, or at least to the notion that schizophrenic
people are just sane people in an insane world. I think that's a vast
oversimplification, but not entirely off the mark. That form of
craziness seems to enable a kind of insight that is off-limits to most
of us. But ask any schizophrenic if the insight is worth the suffering,
or whether the suffering is simply the world inflicting its view of
normalcy, and he or she will most likely tell you no. 
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #69 of 178: Jennifer Simon (fingers) Mon 8 Mar 10 15:34
    
It isn't a matter of choice.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #70 of 178: There are more things in heaven and earth..... (robertflink) Mon 8 Mar 10 16:41
    
The discussion puts me in mind of "Politics and the Spirit of Tragedy"
 
J. P. Diggins' work on Max Weber.  It could be that being mentally
"healthy" includes some insensitivity to the necessarily tragic aspects
of life such that those that suffer are needed to keep us in touch
with "reality".

Thanks for the discussion and all the insights, those of Well members
as well as Mr. Greenberg.  I'm looking forward to the book.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #71 of 178: David Dawson (dawson54) Mon 8 Mar 10 16:57
    
> "or at least to the notion that schizophrenic
people are just sane people in an insane world. I think that's a vast
oversimplification, but not entirely off the mark."

Respectfully, I could not disagree more strongly.  Having dealt with
three severe psychotic episodes suffered by a close family member --
I'm being discrete because this is a public forum -- I have to say that
it's a bit frightening to read a statement from a clinician who
believes that "the insight" of a patient suffering from serious
delusions of persecution is "worth the suffering."

What insight?  That family members are trying to poison them?  That
the government is monitoring their thoughts through the TV set?  That
the fire extinguishers in the hallway of their apartment complex are
alive, and are lunging at them as they walk past?

What is the "worth" of the suffering?  Is it beneficial, insightful,
or skillful for such a person to cringe in the corner of their room
every night, whimpering with fear?  What value can be discerned from
their refusal to bathe, use a toilet, brush their teeth, or swallow a
pill for fear that the water is contaminated?  Is the suffering "worth
it" when the sufferer digs the Gillette razor blades out of the
medicine cabinet and listens to the screaming voices in their heads
that tell them that their terror and misery can be treated by making
the ultimate decision in self-medication?

Gary, I think your thesis that Big Pharma is inventing and magnifying
behavioral illnesses to market their wares is on target.  It's an
important message.  And I agree wholeheartedly that our culture has,
probably at the behest of the drug companies, trended toward equating
ordinary suffering with depression, or excessive fidgeting in bored
kindergartners with "autism spectrum." 

But to view schizophrenia (or any other serious mental disorder,
including depression) as "sane people in an insane world" is
dangerously irresponsible.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #72 of 178: Jennifer Simon (fingers) Mon 8 Mar 10 17:18
    
David, I agree wholeheartedly with much of what you have to say, but
autism spectrum disorder is not commonly treated chiefly with drugs. 
Big Pharma is not behind the rise in diagnosis.  Viewing the symptoms
of children with ASD as "excessive fidgeting" due to boredom is, at the
very least, dismissive.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #73 of 178: David Dawson (dawson54) Mon 8 Mar 10 20:23
    
> Viewing the symptoms of children with ASD as "excessive fidgeting"
due to boredom is, at the very least, dismissive.

Sorry -- it was meant to be an absurd example.  I was under the
impression that the same group that was treated for ADHD a few years
ago was now being diagnosed with "autism spectrum disorder."  Don't
recall where I picked up this info, but obviously I was misinformed or
I have remembered it incorrectly.

The example of what Gary is talking with depression that comes closest
to creating a diagnosis to fit a new medication seems to me to be
Bipolar Disorder, especially in children.  With atypical antipsychotics
like Seroquel and Abilify proving successful in treating BD with fewer
side effects than older meds, I'm told that drug companies are pulling
out all the stops to market them, and to broaden the classification of
bipolar illness to do so.

I'm trying hard not to be offensive here, suffering from my own
psychiatric illnesses and knowing how easily offense is given.  I just
had a bit of a tantrum about the schizophrenia example, having only
recently dealt with this problem.  Sorry about fouling up the bit about
autism.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #74 of 178: Jennifer Simon (fingers) Mon 8 Mar 10 20:30
    
It is a common misunderstanding.  The problem is mostly that nobody
really knows, with this stuff.  The impulse to come up with an answer
so we can do the right thing about it isn't wrong, just unrealistic.

Every time I think about this topic, I run up against the way support
is tied to diagnosis.  As long as that is the case, and as long as
there are people who can't afford to purchase support on their own, I
don't see another work-around.  I wonder how providing support without
regard for diagnosis, particularly in the field of mental health, would
affect diagnosis rates and favored treatments, Big Pharma aside.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #75 of 178: Jennifer Simon (fingers) Mon 8 Mar 10 22:18
    
One more point to clarify: there's a whole lot more to the diagnosis
of ADHD than excessive fidgeting out of boredom as well.  It is no more
absurd than ASD.  Dismissal won't make it go away or get better.
  

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