Posted by Larry Hoover on November 9, 2004, at 19:48:45
In reply to Re: Psychiatry should be replaced with neurology » Sad Sara, posted by alexandra_k on November 5, 2004, at 18:18:13
Coming late to this thread, after some musing and some procrastination....
Psychiatry is, IMHO, applied neurology. The limitations of psychiatry are those of neurology, plus the inherent uncertainty of classifying disease/disorder/syndrome based solely on behaviour.
We know so little about the workings of the brain that we cannot even say why the meds we currently use have the effects that they do (or lack of effects, as the case may be). We speak of "serotonin reuptake inhibition" as if it is a rebalancer of brain chemistry. But, if it is as we say, how is it that the antidepressant effect takes weeks to emerge? If you take LSD, or peyote, you get an immediate effect mediated by serotonin. That is not at all what we are dealing with in respect of antidepressants. Yet we speak as if we know what is going on. Hardly.
I see no great divide between neurology and psychiatry. They are partners and interactors. They each feed from the discoveries of the other. They grow, together. Any distinction between the two realms is arbitrary, just as is mental diagnosis.
Mother Nature doesn't draw lines between groups. That's totally human nature at work. The DSM, the ICD, they are our best but wholly imperfect systems of categorization. But is it not so that the intellectual reserve we maintain when we consider these guides is simply evidence of their arbitrary and simplistic nature? Let's not forget that a major impetus for the development of the DSM was to standardize insurance billing for mental health issues. The accountants just wouldn't accept "he's a little neurotic and a bit of an oddball" as a diagnosis, and write the cheque. They wanted a little bit more detail than that.
One of the primary failings of the DSM/ICD is that it is an observational system of classification. Are we to assume that each practitioner will see an identical example of "major depression, recurrent" or "narcissistic personality disorder" when patients present themselves? Of course not. So, they had to make the definitions a little fuzzier, or groups (a.k.a. diagnoses) would not likely coalesce from the hodge-podge of behaviour at all. "5 of this list of 9 symptoms, but not any of those down at the end (the differentials)." That's hardly scientific. And, who is to say that a particular collection of behaviours has an identical cause in two different subjects? That's where it really falls apart.
Depression of mood is a symptom, yet it is treated in current medical practise as if it is a clear-cut disease. As a symptom, though, it is heterogenous (having many possible causes). Arthralgia (often mis-spoken of as arthritis), or joint pain, is a symptom of at least 180 different and distinct disorders. Some of the treatments work for more than one of those disorders. Others might even work for most of the real causes of the joint pain, but no treatment works for them all. What if the poor response to psychiatric meds is nothing more than a reflection of the heterogeneity of the symptoms we've mistaken for diseases? You can't treat someone with septic arthritis by giving them tylenol. You need a better and more specific diagnosis to treat properly.
The more I understand, the less I know. The brain is still a "black box". Stuff goes in, and behaviour comes out. Inside, it is Magick™. Psych-iatry, "mind doctoring". It may not be great, but it's the best we've got. And we've come a long way from insulin shock, trans-orbital lobotomies, and "One Flew Over the Cuckoo's Nest".
If anyone reading this has spent any time on the Alternative board, you know of my philosophy that a healthy mind cannot exist in a sick or poorly nourished body. Trying to prod or force healthier brain activity with medication may be a mug's game, absent consideration for the biological basis of the energy of mind itself. Perhaps psychiatry should be replaced by nutritional science, not neurology, after all. Maybe no one would be mentally ill if we could figure out what they specifically needed to consume to be well. Okay, 'same pipe dream, different pills', but best start there, methinks, and medicate/treat after you've gotten the machinery tuned up.
Lar
poster:Larry Hoover
thread:411422
URL: http://www.dr-bob.org/babble/social/20041105/msgs/413998.html