Mental disorders aren't necessarily valid

[DSeid]

Mr. S.,

It is understandably hard to know what TVAA’s point is. I agree with you that not all of what he says is nonsense, but his valid points are buried in so much pretentious and arrogant claptrap that it is hard to find them. That and that he can’t seem to apply his own proposed standards and meanings consistently.

Let us take this particular op:

1. The diagnostic criteria for ODD take cultural norms for granted.

2. The criteria also make use of extremely vague concepts like “clinically significant impairment”, which does not have a clear or immediately obvious interpretation.

3. They presume that the problem is necessarily with the child instead of with the environment.

Moreover, I claim that these and similar problems exist in the criteria for mental disorders in general.

So his bones to pick are:

that mental illnesses implicitly accept that an individual functions (or fails to function) within a particular culture. True 'nuff. If everybody in a society believed that those who heard voices that others failed to hear were prophets or seers, instead of hallucinating, then schizophrenics might be revered instead of treated. It could be a functional, even an advantageous, state for life within that society. To me however this a throwaway point. These individuals are functioning in this society. Unless the option of existing in a society with markedly diffeent standards exists, it is the standards of current culture that need apply.

that the critera are too vague for his taste. True that these terms get fuzzy at the edges. But such is the means by which progress gets made. The DSM is not a final product; rather it is a work in progress. It is the right approach: create a dictionary so that researchers and clinicians are using the same word to mean the same thing. As research and practice comes along such that it is clear that terms need to be defined more precisely or differently, do so. It is far far from perfect either as is or more so as used. But it is the best thing going to allow scientific study of that which is difficult to quantify. (Remember a past discussion about science needing tools to quantify observations? And how the scientific theories and tols mutually drive each others development? The DSM is another example of this process in action.)

And his third point is just untrue for mental disorders in general. The general understanding today is that environment and biological predisposition usually both play roles in the expression of phenotypes, to various degrees depending on the condition discussed. Figuring out how they interact is the key.

Now how does he apply these standards?

Now, the evidence suggests that autism is some kind of neurological disorder. Unfortunately, our knowledge of the brain and imaging technology isn’t sufficient to demonstrate exactly what the problem with the brain might be, or how the symptoms of autism related to this problem.

Well autism, like schizophrenia and many other labels of the DSM, is indeed based on neurological dysfunction. But it is as subject to his critiques as any other label in the DSM.

It implicitly accepts that individuals function within a culture.

It has critera that are fuzzy at the edges. Qualitatively impaired socialization? Where do you draw the line on that item? Impaired verbal and nonverbal communication? How impaired does it have to be? Restricted patterns of interests and behavior? How restricted? A qualitative judgement.

There is no test for autism. There no single cause of autism: it is associated with multiple genes - some believe at least 10 if not 15.

There is no sharp edge, rather there is a greater appreciation of a broad autism phenotype. Most in the field beleive that the reported rise in incidence is in fact a function of greater use of the label as a result of greater awareness and the availability of less ineffective interventions if and only if it is diagnosed early. Clearly many of those labelled as autistic today would not have been so called 10 or 15 years ago. And the way to intervene is indeed environmental: speech language therapy both formal and home based, developmental therapy, OT, etc. Medications have a minimal role in treating the symptoms for a few.

How about for other mental disorders?

For many the evidence suggests that they are some kind of neurological disorder. Unfortunately, our knowledge of the brain and imaging technology isn’t sufficient to demonstrate exactly what the problem with the brain might be, or how the symptoms of the disorders relate to the problem. For many there are much better leads than for autism, certain alleles definitely associated with increased risk, etc.

Many may indeed end up being not single diseases but collections of phenotypes with commonalities. Some may have been functional in different societies at different times. Or the contributing genes may result in adaptive phenotypes even today but in combination become maladaptive. We have a way to go before we really understand all the neural dynamics involved in these very complex and handicapping conditions. When researchers portray the science as being more advanced than it is, when they imply that they really understand how and why these conditions occur, then they go beyond the knowledge. But when researchers state what is known about biological predisposition and environmental effects, about mechanisms and effective treatments based on label as accurate as today’s understanding allows, then they are being responsible scientists.

[electric_sheep]

*Originally posted by DSeid *
Unless the option of existing in a society with markedly diffeent standards exists, it is the standards of current culture that need apply.

“Standards” are set merely through the recognition of their validity, and so it is up to each individual to decide which ones they choose to accept. Factually, there is no singular “culture,” but a range of different points of view, some of which end up being louder than others–also depending on where you put your ear. More and more, the very notion of culture is disappearing within the now only so-called “Western” world.

Is there any reason to accept the vision of society that some psychiatrists are trying to press? This is far from a throwaway point.

[TVAA]

*Originally posted by DSeid *
his valid points are buried in so much pretentious and arrogant claptrap that it is hard to find them.

I take exception to that. I’m pointing out the difference between what we know and what most people believe we know – or at least I’m trying to do so. I honestly don’t see what you consider “pretentious and arrogant claptrap”, but I suppose you’re entitled to your opinion.

that the critera are too vague for his taste.

Not just for my taste: the criteria as written as so broad as to be unusable. They’re evaluative instead of descriptive: the clinician must interpret what is meant by the subjective terminiology, and the only reason they can do so even reasonably consistently is that they’re repeatedly exposed to the same standards during their training.

**The general understanding today is that environment and biological predisposition usually both play roles in the expression of phenotypes, to various degrees depending on the condition discussed. Figuring out how they interact is the key.

** I agree with the first part of this statement, except that we’re not necessarily talking about biological predispositions only – people are claiming that these conditions are inherently physiological. Not just that hereditity influences the conditions, but that they’re actually “biochemical imbalances”.

Anyone familiar with the research knows that’s an erroneous claim, but that’s what a lot of people believe.

**Well autism, like schizophrenia and many other labels of the DSM, is indeed based on neurological dysfunction. But it is as subject to his critiques as any other label in the DSM.

** Indeed. I’m not particularly happy with the DSM criteria. However, the evidence that autistic children are genuinely neurologically unusual is much stronger than the evidence that schizophrenics are neurologically unusual.

Then there are the autism-like conditions, like Asperger’s Syndrome, that blend smoothly into “actual” autism. I’m somewhat annoyed by the difficulty of classifying people with those categories precisely because they’re so difficult to quantify, but…

**There is no sharp edge, rather there is a greater appreciation of a broad autism phenotype. Most in the field beleive that the reported rise in incidence is in fact a function of greater use of the label as a result of greater awareness and the availability of less ineffective interventions if and only if it is diagnosed early. Clearly many of those labelled as autistic today would not have been so called 10 or 15 years ago. And the way to intervene is indeed environmental: speech language therapy both formal and home based, developmental therapy, OT, etc. Medications have a minimal role in treating the symptoms for a few.

** Absolutely correct.

I consider it vitally important that we find objective tests for autism – the people who need help the most are fairly obvious, and the most common forms of treatment don’t strike me as being excessively intrusive, but it would be extremely helpful if we could consider what we’re dealing with clearly.

Especially since it would help determine to what degree these conditions may be side effects of beneficial things. What if Einstein and Newton could be shown in some objective sense to have had Asperger’s? That would suggest that fitting the criteria for Asperger’s isn’t necessarily a bad thing.

**For many the evidence suggests that they are some kind of neurological disorder. Unfortunately, our knowledge of the brain and imaging technology isn’t sufficient to demonstrate exactly what the problem with the brain might be, or how the symptoms of the disorders relate to the problem. For many there are much better leads than for autism, certain alleles definitely associated with increased risk, etc.

Many may indeed end up being not single diseases but collections of phenotypes with commonalities. Some may have been functional in different societies at different times. Or the contributing genes may result in adaptive phenotypes even today but in combination become maladaptive. We have a way to go before we really understand all the neural dynamics involved in these very complex and handicapping conditions.

** Aren’t you emphasizing genetics just a bit too much, here? And there is also evidence to suggest that at least some – and I suspect most – people suffering from certain mental disorders don’t have any physical problems with their brains at all.

I agree with your next statement, but when the mechanisms of the treatments are misrepresented, and when their effectiveness relative to other treatments isn’t discussed, then we have a problem.

[NeSBiT]

*Originally posted by TVAA *
**If schizophrenia were caused by a global deficit in GABA levels, it would be treatable with alcohol.

Since I’ve never heard even a suggestion that schizophrenia responds to alcohol, I conclude that NeSBiT is either grossly ignorant, lying, or privy to information that will win someone the Nobel Prize. Guess which possibility I think is most likely. **

Are you illiterate? Did you even read my post?

And as for alcohol and GABA:

1. how about a cite relating to alcohol’s effect on GABA?
   2.GABA is inhibitory to the central nervous system
   3.alcohol affects the sympathetic nervous system
   So unless alcohol affected GABA in some way, it has nothing to do with schizophrenia.
   hallucinations from schizohrenia are caused by excess of neurons which results in an excess amount of dopamine. This has been shown by examining the brains of schizophrenics who die as young adults and comparing them to newborns’ brains.
   I have cites for all this if you want them.

[Zoe]

Originally posted by DSeid
his valid points are buried in so much pretentious and arrogant claptrap that it is hard to find them.

Originally posted by TVAA: I take exception to that. I’m pointing out the difference between what we know and what most people believe we know – or at least I’m trying to do so. I honestly don’t see what you consider “pretentious and arrogant claptrap”, but I suppose you’re entitled to your opinion.

Some of you might want to read this relevant thread:

http://boards.straightdope.com/sdmb/showthread.php?s=&threadid=218026
While being pitted for this very same “pretentious claptrap,” TVAA was compelled by a moderator (Coldfire) to admit that he lacks professional experience. In his own words, he is an “amateur.”

TVAA, you are your own worst argument

[TVAA]

*Originally posted by NeSBiT *
**And as for alcohol and GABA:

1. how about a cite relating to alcohol’s effect on GABA?
   2.GABA is inhibitory to the central nervous system
   3.alcohol affects the sympathetic nervous system
   So unless alcohol affected GABA in some way, it has nothing to do with schizophrenia.
   hallucinations from schizohrenia are caused by excess of neurons which results in an excess amount of dopamine. This has been shown by examining the brains of schizophrenics who die as young adults and comparing them to newborns’ brains.
   **

1. You’ve gotta be joking. The primary effects of alcohol occur through interaction with GABA receptors. That’s what makes alcohol “alcoholic”.

2. Points 2) and 3) are pointless. Alcohol affects the entire nervous system, not merely its sympathetic aspects.

The last part is so incoherent I don’t even know how to begin analyzing it. There was a claim quite some time ago that schizophrenia was caused by viral infections disrupting the growth and movement of neurons, but the particular disruption was found to occur in plenty of normal people as well. No one was able to demonstrate that degree of neural disruption could predict symptom severity.

[NeSBiT]

1. can you read? CITE!
   as far as the last part, I didn’t say anything about symptom severity. and a schizophrenics brain has excess neurons because his body isn’t killing them off, as evidenced by comparing their brains to newborns. when you compare the brains of non-schizophrenics, they have less neurons than a newborn.

[TVAA]

*Originally posted by Zoe *
**While being pitted for this very same “pretentious claptrap,” TVAA was compelled by a moderator (Coldfire) to admit that he lacks professional experience. In his own words, he is an “amateur.”

TVAA, you are your own worst argument **

Coldfire asked me to state my amount of professional experience. I am not a practicing therapist, nor have I ever been.

An “amateur” is one who does something for the love of it rather than to support himself. I’m not a professional – I just know more about the field than most other people, including quite a few professionals.

[TVAA]

Ooh, Mr. S, read the following:

http://www.psychiatrist.com/pcc/pccpdf/v05s02/v64s0201.pdf

Interesting stuff, especially since the most recent emphasis has been on drugs that affect only one neurotransmitter directly. First people boasted that their drugs affected multiple systems, then they boasted about the selectivity of their drugs, now it would seem that the pendulum is swinging back the other way again.

[rickiwatts]

What do you mean by ‘known disease process’ TVAA? It sounds like you are getting caught up in semantics. Have you considered that maybe the medical community describes psychological problems as diseases because that is how that is how they
want to aproach them? I can’t fault doctors for trying to use language to convey the possibility of treatment and cure. What good does it do a patient to tell him that he has depression and there is no hope of it ever getting better?

I’m sorry if you think the symptoms are defined vaguely, but as soon as someone quantifies the value of a patient who hear’s St. Peter telling him to wear a foil hat to protect him from brain-beams fired by the monkey-men on mars, I’ll let you know. Didn’t we already go over this? Can you measure the symptoms of Autism? If one of the signs is ‘not looking into someones eyes,’ that could also be explained by the child being shy, or simply not wanting to deal with you. Children under the age of 1 are not known for their attention spans.
Psychologist have to observe and interview their patients, its not much different than a visit from a family doctor in that sense. A patient can tell his doctor he has pain in his knee, but like depression, it can’t be measured. The root cause may be just as hard to find, a sports injury, infection, or family history of bad knees. Dammit TVAA, they’re doctors, not miricle workers!

'Panic attacks do not necessarily occur without a stimulus.'

Thats a wonderful way to dodge my point. From SentientMeats posts, his mothers panic attacks occur without a stimulus(or just an unknown one). Why not treat it as a disease? Attempt to find the trigger, or therapy to manage these attacks.

How many people are afraid of spiders, even though most
spiders are not only harmless to humans but extremely
beneficial (through killing insects)? How many people do NOT
have a fear of cars, even though cars are a major source of
injury and death?

“Normal” human responses are often no more justified than
phobias, and sometimes much less.

Whats your point in these two paragraphs? A woman stayed in a room filled with scorpions for a week with poisonous scorpions, got stung several times in fact, just to get in the record books. I personally saw a man cross 5 lanes of busy highway traffic like it was nothing, I wouldn’t do that for a million $. It is obvious we have come to the amazing conclusion that different people are scared by different things, sometimes personal, sometimes cultural.

But the nature of an abstract threat is necessarily
subjective. And there are plenty of rational fears – such as
a fear of being in the hospital – that most people would
regard as strange or “sick”.

Once again, where is the problem? “doctor! my knee hurts!” Thats subjective too. Along with dizzyness or feeling tired. If its something that can’t be measured, its subjective, whether its a physical ailment or mental problem. Hopefully one day you will figure this out. Everyone feels paranoid once in a while, they should seek treatment if it hampers their quality of life.

Because they’re not giving the scientific information to the
patients, and they’re giving them easy-to-understand
pseudoscience instead.

And you know this…how? Can you give me a reason for any doctor to talk to their patients in a way they cannot understand?

Patient: “doctor! My knee hurts!”
Doctor: “arble greeble deuble floo!”
Patient: “huh?”

Did this happen to you or someone you know, or did you read about it somewhere? Until you tell me I’ll just consider it to be your personal opinion.

If your problem is with the improper use of medication, It would be more prudent to start a thread on that subject. Instead of complaining that subjective things are subjective and that people are weird.

[Mr.Svinlesha]

DSeid:

I don’t have much of a reply to your post – I pretty much agree with what you’ve written – but I just wanted to pause a second and say hello. Haven’t bumped into you in a while.

TVAA:

• Not just for my taste: the criteria as written as so broad as to be unusable. They’re evaluative instead of descriptive: the clinician must interpret what is meant by the subjective terminology, and the only reason they can do so even reasonably consistently is that they’re repeatedly exposed to the same standards during their training.*

I’ve agreed with the general thrust of a lot of what you’ve been saying in this thread, but I just one to also point out where we disagree: you say the above like it’s a bad thing.

Typologies are useful social constructs. They are transmitted socially from experienced members of the society (“experts” or “teachers”) to inexperienced members of the society (“laymen” or “students.”) The process might not strike you as particularly “scientific,” but I can’t see anything fundamentally wrong with it. Clinicians learn to diagnose through being taught how to diagnose by more experienced clinicians. It’s a hands-on, learned skill, much like a craft. I’d bet dollars to donuts that DSeid, as a practicing physician, can attest to the importance of having a “feel” for a diagnosis that goes beyond the mere descriptive criteria he learned in med school (even though those criteria are also centrally important).

There are also advantages to having criteria that allow a certain level of interpretive flexibility. No two people and no two situations are exactly alike; in such an environment criterion that attempt to enforce judgements that are “exactly alike” will invariably prove misleading. But basically, its the difference between robotically classifying other people according to “objective criteria” (which you appear to prefer), or allowing some “subjectivity” to also govern our understanding of human nature.

And by the way, you really do need to back up and provide some documentation for many of the assertions you’ve made in this thread.
NesBit:

• hallucinations from schizohrenia are caused by excess of neurons which results in an excess amount of dopamine. This has been shown by examining the brains of schizophrenics who die as young adults and comparing them to newborns’ brains.
  I have cites for all this if you want them.

*I for one would like to see your evidence for the above claim.

[TVAA]

Socially-transmitted medical beliefs can also hide major errors and misconceptions. I can no longer locate the article, but Discover magazine had a great example of such a problem some time ago. A physician was discussing a particular treatment for stroke – rerouting blood around the stroke center by establishing an alternate pathway with veins – that everyone knew was effective, despite the lack of evidence that this was so. When a study of the treatment showed that it not only didn’t help patients but actually made them worse, the treatment was abandoned.

In regards to the roughly equal effectiveness of therapy vs. medication, take a look at the second paragraph of this paper.

This analysis of another article is actually hostile to the idea that antidepressants aren’t much better than placebos and that they’re equivalent to therapy. You may find its analysis helpful, as well as the referenced articles it mentions.

This site seems fairly trustworthy, and it contains links to several papers which discuss the topic.

These are found after just a few minutes of Googling. I’m working on finding direct sources, but doing so is somewhat more difficult. Will get back to you as time permits. If you would care to point out the specific claims of mine that you’d like sources for, I can try to concentrate on them.

[rickiwatts]

Don’t fault the medical community for socially-transimitted beliefs, it happens everywhere. Scientist used to think that the sun went around the earth too.

‘I consider it vitally important that we find objective tests for autism’

What is up with your hard-on for objective tests? What do you think things like the DSM are for?

Let me explain this one more time:
Pschology lacks any measuring tools. Therefore little of it can quantified.
It is difficult to have objective analysis from observation and patient interviews. Things that are naturally subjective.

Despite all of this psychologists are attempting to pool their data into the DSM. By codefying their observations, its one of the few objective things psychology has.

'Especially since it would help determine to what degree these 
 conditions may be side effects of beneficial things. What if 
 Einstein and Newton could be shown in some objective sense to 
 have had Asperger's? That would suggest that fitting the 
 criteria for Asperger's isn't necessarily a bad thing.'

This is exactly the DSM, and psychologists, have to deal with. Fear is often a helpful human response, it keeps out of danger. It becomes a problem when you can’t leave the house, you’re scared of the neighbor’s cat and you are terrified of the letter C.

              (responding to DSeid)'I agree with the first part of               this  statement, except that  we're not necessarily              talking about biological predispositions 
              only -- people are claiming that these conditions are 
              inherently physiological. Not just that hereditity influences 
              the conditions, but that they're actually "biochemical 
              imbalances".'

So all we’re talking about is the chicken and the egg problem? Do I percieve something I unknowingly fear, then subconscoiusly my mind brings into motion the chemicals/hormones/signals that make up a panic attack? Or does my brain produce the same chemicals and signals at the incorrect time, so that I feel panic when I think I shouldn’t?
Once again psychology does not have any mind reading devices or detect-o-meters. Either theory is valid, even a mix of the two is possible.

Why you so upset that there is some much effort into exploring the physilogical side of mental illness? Its much easier to quantify, which I know that you are big into, it may even answer the causeality of these problems, which interests you as well.

Once again, it sounds like you are bothered by something that has nothing to do with this thread.

[Mr.Svinlesha]

TVAA:

• Socially-transmitted medical beliefs can also hide major errors and misconceptions.

*This is undoubtedly true, but goes to the point that no system is perfect; each has its strengths and weaknesses. That would seem to imply that the path of wisdom involves being aware of the strengths and weaknesses of any given system. That would be especially true in a field like psychology which studies complex, contested, ambiguous phenomena. But what should we do otherwise? Abandon it entirely?

Anyway, all medical beliefs, even “scientific” ones, are socially transmitted. And many of them also hide major errors and misconceptions, and are subject to refinement over time.

The cite I was curious about concerned your previous assertions regarding anti-depressives, specifically this claim:

• n studies of the effectiveness of antidepressants, the placebo response accounts for between 25-50% of the clinical response of antidepressants (it’s most often around 30-35%). That’s much higher than many other types of drugs.

Researchers have also found that people respond more the placebos that have noticable physiological side effects (presumably because they find it easier to believe they’re taking a real drug), which brings into question most comparisons of drug effectiveness to placebos.*

Your last posted contained the info I was looking for. Now it only remains for auliya to present her counter arguments.

[greck]

*Originally posted by TVAA *
**I’m not a professional – I just know more about the field than most other people, including quite a few professionals. **

Mr. S: You’ve worked with enough people who have delusions, Tell him what this sounds like.

TVAA, the nerve you have taking exception to being called arrogant.

[auliya]

*Originally posted by Mr. Svinlesha *
Now it only remains for auliya to present her counter arguments. **

Sorry Mr S I am snowed under with end of semester work atm, so haven’t time to go into great detail here. However, bearing in mind that depression is a many faceted beast ( classifed variously as meloncholic, psychotic, neurotic, chronic, episodic, etc etc) with many different interpretations on acceptable outcomes (full remission, some residual features, rates of relapse etc etc) and effectiveness of treatments at different stages of depression (acute, continuation, maintenance), there is a lot of research out there. I am sure you don’t need me or any one else to produce references for you, as you point out you are a psychotherapist with 10yrs clinical experience and as such would be be aware of the data available for the disorders you are dealing with.

However here a couple to be going on with, noting that my response was to TVAA’s claim that

Antidepressants are rarely significantly better than placebos.

not to the claim that there are varying placebo effects found in different studies

Antonuccio, D. O., Danton, W. G. & De Nelsky, (1995). Psycho therapy verus medication for depression: challenging the conventional wisdom with data. Professional Psychology: Research and Practice, 26(6), 574-585.
De Oliveira, I. R. (1998) The treatment of unipolar major depression: pharmacotherapy, cognitive behaviour therapy or both
Journal of Clinical Pharmacy ans Therapeutics, 23467-475

[DSeid]

Hi Mr. S.!

How’s the baby? Toddler by now probably. Nice to run into you again. Ah for respectful disagreements with people able to learn from each other as I have from you (and I hope in reverse as well).

Electric!Sheep,

Is there any reason to accept the vision of society that some psychiatrists are trying to press?

Psychiatrists do not create the vision of society. Society has norms. They do not create or enforce them. As you suggest our diverse cultural mix makes for a wide berth in what is normal. The critera is that a condition handicaps function within that wide range of normals within a society.

rickiwatts,
They are inherently physiologic. Anything that involves the function of a biologic entity is physiologic: I learn and my behavior changes - how that occurs is physiology. The implication that I think you find objectionable is as to locus of control and responsibility. Can an autistic child change himself by force of will and being held accountable? Someone with schizophrenia? with depression? with ADD? with ODD? I’d have different answers depending on the condition and the individual case. But being based in physiology has nothing to add to that discussion. Physiology is how it works, whether hardwired or experience dependent. Whether it can’t be helped or it is a matter of personal choice. Now as to whether or not some overstate our understanding of the physiology … that is also another matter.

[TVAA]

**Psychother Psychosom. 1999;68(1):3-14. Raising questions about antidepressants.
Antonuccio DO, Danton WG, DeNelsky GY, Greenberg RP, Gordon JS.

Antidepressant medication has apparently become the most popular treatment for depression in the USA. Several beliefs about the efficacy of antidepressant medications prevail among mental health professionals and the public. This paper explores relevant research data and raises questions about these beliefs. Many of the common beliefs about these medications are not adequately supported by scientific data. The following issues are raised: (1) industry-funded research studies which result in negative findings sometimes do not get published; (2) placebo washout procedures may bias results in some studies; (3) there are serious questions about the integrity of the double-blind procedure; (4) the ‘true’ antidepressant drug effect in adults appears to be relatively small; (5) there is minimal evidence of antidepressant efficacy in children; (6) side effects are fairly common even with the newer antidepressants; (7) combining medications raises the risk for more serious complications; (8) all antidepressants can cause withdrawal symptoms; (9) genetic influences on unipolar depression appear to be weaker than environmental influences; (10) biochemical theories of depression are as yet unproven; (11) biological markers specific for depression have been elusive; (12) dosage and plasma levels of antidepressants have been minimally related to treatment outcome; (13) preliminary evidence suggests that patients who improve with cognitive-behavioral psychotherapy show similar biological changes as those who respond to medication, and (14) the evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.

**

---

J Clin Pharm Ther. 1998 Dec;23*(6):467-75.
The treatment of unipolar major depression: pharmacotherapy, cognitive behaviour therapy or both? de Oliveira IR
There is no clear-cut line separating normal and abnormal moods. Therefore, psychiatrists often describe patterns of symptoms (syndromes) to suggest the existence of diseases for which no obvious brain abnormalities can be demonstrated. These uncertainties create room for much doubt about the best way of treating unipolar major depression. I present here a case report of a patient with unipolar depression treated with cognitive therapy. The patient had been treated with an SSRI and a tricyclic antidepressant without substantial improvement. This case is discussed in the light of the current controversies in the literature concerning the comparative value of psychotherapy, particularly that designed to treat depression, and pharmacotherapy. We would suggest that cognitive therapy, as well as other depression-specific short psychotherapies, is the treatment of choice in milder depressions. However, there is evidence to support the widespread clinical impression that combined therapy with both psychotherapy and pharmacotherapy is superior to each single mode of therapy for the treatment of more severe, recurrent depressions.

**

[TVAA]

*Originally posted by DSeid *
**Electric!Sheep,
Psychiatrists do not create the vision of society. Society has norms. They do not create or enforce them.

** Shenanigans!

Everyone creates the norms, and to a degree everyone enforces them. Psychiatrists spend all their time applying subjective and evaluative criteria to people that society (or themselves) has decided have problems living in this world, and you expect us to believe that they don’t shape and enforce the norms?!

I call shenanigans!

[electric_sheep]

*Originally posted by DSeid *
Electric!Sheep,
Psychiatrists do not create the vision of society. Society has norms. They do not create or enforce them.

All interpretative acts are ones of creation and enforcement.