Incidently I would suggest that Boris refrain from hyperbole in the future. I would not go calling another’s points unfounded unless they actually peruse the literature. In reference to the detrimental effects of SSRIs I would refer you to the work of Teicher, Dasgupta, King, and others.
Oh, and not to nitpick but replying to Sentinel:
You are correct to note a link between Social Anxiety and Depression, but this is because of their social problems causing low self esteem (and hence depression), and not a biochemical cause. There is NO evidence anyone is born with Social Phobia/Anxiety or any other anxiety disorder (except possibly OCD)
I think when you say OBC you mean OCD…there is no OBC.
I also think you mean AFFECTIVE disorders, not effective. Affective disorders are essentially depression (as well as Bipolar which is not linked with Social Anxiety)
There is no such thing as “Maladjustment to Adult Society” disorder.
I agree that many people with various complaints are overdiagnosed. But that doesn’t mean the disorder doesn’t exist.
For exampple: You have the flu. It can be mild or severe. You may need aspirn. You may need decongestant. You may need nothing. You may need oxygen. If you are slightly ill with a cough you DON’T need to sit in the hospital in an oxygen tent. (though someone with the same condition MAY need to, due to other conditions such as advanced or young age. But this is exactly what some therapists are doing. They are giving the equivilent of emergency service to those who need an asprin.
Why??
My own example is back in '80 I suffered SEVERE anxiety attacks. I spent three days on one side of the bed as my anxiety was so bad I was sure that if I moved to the other side I’d lose it. I didn’t even go to the bathroom (I was in horrible shape). At the time no one knew what anxiety attacks were. After a YEAR of looking I found a therapist who had a vauge idea of how to treat me (she new and just of out college). All the medical doctors and psycologist didn’t have a clue to if I was faking or what was going on. (I recall being at the GP for a check up. His office was in Osteopathic Hospital and I went from totally calm to severe panic. He was so thrilled. He called all the other doctors to watch as he said he’d never seen anything like it and it was fascinating.
Anyway using ONLY behavior therapy within 5 months they completely stopped. Over 13 years went by and I had no more attacks. Then after losing a job and being out of work for awhile they resurfaced. Well now they knew more about anxiety attacks. They suggested Tofrinal(Sp??). I though no way a pill can’t help me. But this time I no longer had the luxury of NOT working so I had to do something. As God as my witness. I took my first pill at 9pm and by midnight I had noticed my concentration had improved. After a week I was normal again. Then after two months I tapered off and never needed it again. (so far 
)
The point is you can have equally bad situations and treat them different ways with the same results. Would I have gotten better had I not taken meds and used behaviour therapy. Most likely. But I would have been miserable for months and probably been homeless (I wasn’t working the second time remember).
Again. If you have a headache do you need an asprin? Most likely your headache will go away by itself. But why suffer when you can take an asprin and it will be gone in a half an hour. That is why meds were invented.
Avalongod said:
I hope by “empirically valid” you do not mean “actually get people back to functional status”; My main argument here is that therepy as it is practiced is not offering a viable alternitive to medication for most people. Granted, my evidence is mostly anecdotal, but from what I have seen therepy, especially quick shot, six weeks programs, tends to be ineffective. We have a very high rate of bipolarism in my immediate family, and I have watched relitives wander from therepist to theripist for years without any relief. I know many people who have seen therpists and thought thy were doing better, only to slip back into depression as soon as the therepy ended. Those who have to work within the limits of an HMO, which means that they don’t even have the luxury of shopping around, nor of staying when they find a theripest they arecomfortable with, never seem to improve much.
Why is fault so important here? Who cares who is at fault? Even if we accept , for the purpose of debate, that the vast majority of emotional diseases are caused by “weak personalities”, (and the corrolary, that a “weak personality” is the result of some sort of individual choice, a position which is dubious at best) the fact remains that we do not know how to fix “weak personalities”; we do know how to help people with “weak personalities” deal with some of the symptoms of that condition. I cannot see dening that treatment to people until someone can come up with an alternitive that works.
The problem is not your failure to “hold people’s hands”; rather, it is your persistient choice of such emotionally charged words as “weak”; “doping”;“lazy”,etc. If you are an educated person, you should have enough control over the language to get your point across without using words that are inevitably going to derail this entire discussion into a rant. You are new, which is why I am being patient; you may not have seen this as many times as I have. You are setting up the argument such that you will never convince anyone of anything. By your own terminology you have made it so that anyone taking Paxil or Prozac has the choice of either a)violently defending themselves or b)accepting the extremely negitive lables of “weak” and “lazy”. You are unknowingly inviting a flamewar, not a discussion. I am enjoying this, and trying to keep it civil. If you would like to aviod being drowned out by the roar of people who have to discredit you to the world in order to preserve thier own self-worth, you must watch your word choice.
I guess I will reply directly to Manda Jo:
First and foremost, I do want to emphasize if any of my wording has caused offense to any, I SINCERELY appologize. My intent is not to offend or hurt anyone, but rather to simply report scientific evidence I am familiar with which is relevant to this issue. Much of what I have been reading in many posts seems to come from “pop” psychology (books like Prozac Nation) which are usually hopelessly in error, and I believe an empirical evaluation of this issue is relevant. In regards to terminology such as “weak” personality or “lack of coping skills” although these are not “scientific” terms, they are fairly commonly used in clinical psychology. That they denote personal responsibility for mental illness is no accident. It is not meant to be derogatory (“fault” was your word not mine)but rather to denote the critical role of the individual in changing their own behaviour (in which psychotropic medication need not play a role or only plays a small role). So I hope you will understand that nothing I say is meant personally, and once again HOPE I offend no one. I am enjoying this conversation as well, and glad that you are too.
That said, I do want to point out you used Bipolar Disorder as an example of a biochemical illness, which it absolutely is (in fact I used it as an example of such in not one but two posts). There is not a psychologist in the world who would advise a bipolar patient be treated without some form of medication (usually Lithium, Tegratol or Depakote).
Depression is another matter entirely. As I mentioned before about 1/3 of the cases of depression are biochemical in nature (and thus needing SSRI or other medication…often these people are depressed without knowing why…everything is fine in life, yet they are depressed) but the remainder are due to poor coping skills or (again) deficits in personality structure. Why this is an important note is that is changes the treatment recommendation,psychotropics might be used initially (for several months) to overcome the acute depression with psychotherapy the core treatment…changing cognitive distortions, enhancing coping skills, etc.
You make an erroneous statement in suggesting that psychotherapy is less effective than medications. In fact empirical evidence suggests that psychotherapy is MORE effective. I will refer you to the work of Murphy et al (1984), Elkin et al (1989), Weissman et al (1979) and others. I would be happy to give full references if you would like. The articles are a bit technical (read=boring) but if you are into the subject you might find them enlightening. There are many more articles, all of them reaching the same conclusion.
As far as why asking “why” is important, this is the question that suggests how to best treat a disorder.
Also…no you wouldn’t give cough suppressants to someone with pneumonia…this would actually make their disease worse. You would want to treat the ACTUAL CAUSE of the disease, not suppress the symptoms. Symptoms tell us that something is wrong, if we ignore them the problem never goes away. Same is true for psychology, we must concentrate on treating the CAUSE of a disorder.
In terms of what I mean by “empirically valid” do I mean “getting back to functional status”, actually I do. It should be noticed that no psychiatrist would ever claim psychotropic medications relieve all symptoms (and thus a magic bullet) but usually are happy with a 50-70% reduction.
In closing, I probably am not telling you what you want to hear, but this is where the scientific evidence is pointing. Again, please do not take this personally, although you suggest that I am “inviting” a flame war I hope you will note that I impart this information with a sense of compassion. I believe that by accepting responsibility for one’s own well being, a number of psychological accomplishments. To this it should be noted that having an “internal locus of control” and a sense of personal responsibility for mental health symptoms has been noted to be instrumental in recovery even from biochemical conditions such as bipolar and schizophrenia.
Best of luck!
Um… duh. It was a joke. It was meant to point out that people did handle their fears in other ways in the past. Next time I will explain sarcasm and irony.