Posted by llurpsienoodle on August 19, 2008, at 12:51:44
In reply to Re: The stakes are too high., posted by Nadezda on August 19, 2008, at 11:49:48
I find it interesting that one of the symptoms of clinical depression is hypochondria, indeed, "melancholia" and "hypochondria" have been used alternatingly during some periods in history to describe what has now become known as 'depression' what a bland word. Sounds like a weather pattern. blah.
Another interesting tidbit is the observation that of all the natural sciences, [presuming that psychology is a natural science] psychology alone holds the possibility that publishing reports can affect the very subject of empirical investigation.
Charcot, memorably, hypnotized his female hysteria patients finding that they indeed showed some of the characteristic hysteria symptoms of the day. The cluster of symptoms seems bizarre and arcane to us nowadays, but in Victorian times, this syndrome was a part of the culture. As a culture-bound mental illness, it was expected that female hysterics would display certain postures and symptoms, including somatic symptoms. The line between physiological neurology and psychology has been blurred from the beginning of psychology.
Part of the magic of medicine is the interface between mind and body. Submitting our physicial woes to the care of an expert confers some healing, even when that expert administers nothing more than a sugar pill. Some of that magic is lost when a double-blind study becomes more transparent. Placebo effects disappear when the "authoritative" treatment is revealed to be no more than a sugar pill. The mind, in seeking to make meaning of one's treatment "allows" the body to heal, perhaps even facilitating healing. By denying ourselves the optimism that a treatment may work (even if it's week 5 out of a 6-week trial) we may suffer.
How much do we sacrifice by stripping experts of their authority? By memorizing receptor subclasses and their respective agonists, we may neglect the large part of physicians' knowledge that is acquired through their interactions with scores of patients, over the life of their careers.
Empiricism in medicine takes the form of published, peer-review studies, but one cannot neglect the more casual empirical observations made over the course of a lifetime of practice.
Often in the search for a comprehensive theory of some mental illness scientists fail to appreciate the contribution of individual differences. Large studies of samples use methodology that is often insensitive to meaningful individual variation. For instance, Freud's early hypothesis that all neuroses were a result of early childhood sexual abuse was rejected by him later in his career, because he somehow "knew" that surely not ALL of his patients were molested. This theory neglected to consider that neurosis, unlike tuberculosis, may not be caused by a single factor (a bacterium, for instance). Another example is the monoamine theory of depression. If depression were a homogeneous condition, one might expect all people to respond to a treatment in similar fashion. The current empirical research on mental disorders seems stuck in the pattern of defining an illness in ever narrower terms, in the hope that its cause may be reduced to a single factor, be it a gene, or a neurotransmitter, or a childhood event. Of course, most of us know (if not abstractly, then from personal experience) that mental illness is a complicated thing; even if one falls neatly into a diagnostic category, one may not respond with the standard therapy.
A good doctor can often suggest a novel or unorthodox combination, based on her experience with treatment-resistant patients, and by having observed a diverse range of symptom clusters and illness subtypes. The qualities of the human mind that permit judicious application of therapies to symptoms is far beyond what a computer or a textbook can accomplish. Human doctors are experts in decision making, and they have more information available to them than we do. Our knowledge of our own responses to treatments must contribute to their decision-making as well. But I'm not convinced that it can supplant a doctor's experience and power to observe us without being wrapped up in our consciousness (and possibly hypochondria)
-Ll
poster:llurpsienoodle
thread:847169
URL: http://www.dr-bob.org/babble/20080814/msgs/847221.html