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.
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.)
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.
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.
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.
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.)
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.
Gary Greenberg (gberg) Sun 7 Mar 10 15:35
<scribbled by gberg Sun 7 Mar 10 15:37>
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.
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.
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.
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.
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.
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.
Travis Bickle has left the building. (divinea) Mon 8 Mar 10 11:18
Nor a personality disorder, nor sociopathy.
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.
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?
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.
Jennifer Simon (fingers) Mon 8 Mar 10 15:34
It isn't a matter of choice.
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.
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.
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.
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.
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.
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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