CBT and exercise not as useful in chronic fatigue as study indicated

[birchswing]

I found this interesting:

https://www.statnews.com/2016/09/21...al&utm_source=twitter.com&utm_campaign=buffer

I know that CFS isn't only under the domain of psychiatry, but there had been some talk earlier in the summer on this forum about somatoform disorders. I thought this was quite an interesting reversal on a previous study that found CBT and exercise to be helpful in CFS and also the nature of how science is conducted at times.

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[Shikima]

CHEST released a study citing that those with COPD would benefit from exercise to improve mood and anxiety.

 

[WisNeuro]

Somatoform/cogniform disorders are notoriously hard to treat, by any methods.

 

[SeniorWrangler]

It's a blog post linking to another blog post!
I'd really like to see somebody try to replicate the PACE study with more transparency about methods and results.

 

[tr]

Somatoform/cogniform disorders are notoriously hard to treat, by any methods.

Not my area of specialization but to the best of my understanding CFS is not a somatoform disorder. The CFS center here is run by the infectious disease people.

 

[WisNeuro]

Not my area of specialization but to the best of my understanding CFS is not a somatoform disorder. The CFS center here is run by the infectious disease people.

CFS isn't a somatoform disorder, however, many people "diagnosed" with it definitely fall under that banner.

 

[clausewitz2]

CFS isn't a somatoform disorder, however, many people "diagnosed" with it definitely fall under that banner.

Similarly, Lyme disease = definitely an infectious disease. Possibly majority of people who volunteer information about a Lyme diagnosis = antibiotics ain't gonna help.

 

[birchswing]

I used the term somatoform because of a thread earlier in the summer where CFS was discussed among a number of other diseases under the umbrella somatoform. It's kind of an interesting distinction that seems to me to be rather fuzzy once you think about. A somatoform disorder, from my understanding, is when a person has physical maladies that result from a mental illness. But a mental illness itself is a physical manifestation of various causes, some of which are biological. Some, for example, like PANDAS, even have a clear infectious cause. I've never completely understood the distinction between mental illness, except to that extent that mental illnesses affect mental processes. It's never been described to me that way, but that's the only way in which I can see a clear distinction between physical and mental illness. The idea of a mental illness being distinct in that it originates from mental processes (which is how it has been described to me) doesn't seem like it's distinct enough from physical illness in that behavioral, social, environmental, and biological factors influence all disease—meaning that a mental process, such as the decision to smoke, could be a contributing factor to physical illness, just as much as the mental process of rumination could be a contributing factor to the processes which get people stuck in various mental illnesses.

I think the part about CFS that would relate to mental illness would be if there is a component to CFS by which a person is over-focused on symptoms or is stressed by the ambiguity of them. Then I could see the mental processes worsening the physical maladies. But that could also be an understandable, normal response to a mysterious disease. If you think about asthma and remember that it was considered somatoform, imagine how frustrating it would be to have someone tell you that your inability to catch your breath has to do with unresolved mothering issues. The lack of resolution would probably lead anyone to have mental processes that would seem abnormal to someone who believed there was no physical illness.

 

[Fan_of_Meehl]

Somatoform/cogniform disorders are notoriously hard to treat, by any methods.

Except EMDR (of course), a miracle treatment that cures many otherwise intractable psychiatric illnesses in one or two sessions.

 

[splik]

I used the term somatoform because of a thread earlier in the summer where CFS was discussed among a number of other diseases under the umbrella somatoform. It's kind of an interesting distinction that seems to me to be rather fuzzy once you think about. A somatoform disorder, from my understanding, is when a person has physical maladies that result from a mental illness. But a mental illness itself is a physical manifestation of various causes, some of which are biological. Some, for example, like PANDAS, even have a clear infectious cause. I've never completely understood the distinction between mental illness, except to that extent that mental illnesses affect mental processes. It's never been described to me that way, but that's the only way in which I can see a clear distinction between physical and mental illness. The idea of a mental illness being distinct in that it originates from mental processes (which is how it has been described to me) doesn't seem like it's distinct enough from physical illness in that behavioral, social, environmental, and biological factors influence all disease—meaning that a mental process, such as the decision to smoke, could be a contributing factor to physical illness, just as much as the mental process of rumination could be a contributing factor to the processes which get people stuck in various mental illnesses.

I think the part about CFS that would relate to mental illness would be if there is a component to CFS by which a person is over-focused on symptoms or is stressed by the ambiguity of them. Then I could see the mental processes worsening the physical maladies. But that could also be an understandable, normal response to a mysterious disease. If you think about asthma and remember that it was considered somatoform, imagine how frustrating it would be to have someone tell you that your inability to catch your breath has to do with unresolved mothering issues. The lack of resolution would probably lead anyone to have mental processes that would seem abnormal to someone who believed there was no physical illness.

i think you have gotten somewhat confused here. somatoform disorders aren't due to mental disorders, they are mental disorders (they are not due to mental disorder, nor are these psychological processes in any meaningful way "biological" though they of course influence physiological processes). CFS is not a mysterious disease. I have yet to meet someone with CFS who isn't disturbed. They seem to have an enormous amount of energy when it comes to trying to refute claims that psychological factors aren't important in CFS, even though that would make it singularly unique in the history of chronic illness.

I have a special interest in functional somatic syndromes and somatization, but I have to say I leave CFS alone.

 

[clausewitz2]

i think you have gotten somewhat confused here. somatoform disorders aren't due to mental disorders, they are mental disorders (they are not due to mental disorder, nor are these psychological processes in any meaningful way "biological" though they of course influence physiological processes). CFS is not a mysterious disease. I have yet to meet someone with CFS who isn't disturbed. They seem to have an enormous amount of energy when it comes to trying to refute claims that psychological factors aren't important in CFS, even though that would make it singularly unique in the history of chronic illness.

I have a special interest in functional somatic syndromes and somatization, but I have to say I leave CFS alone.

Surely we are none of us dualists now and must accept only a division between "readily identifiable biological substrate" and "not yet identifiable biological substrate"?

 

[splik]

Surely we are none of us dualists now and must accept only a division between "readily identifiable biological substrate" and "not yet identifiable biological substrate"?

which is why i put "biological" in quotations

 

[birchswing]

i think you have gotten somewhat confused here. somatoform disorders aren't due to mental disorders, they are mental disorders (they are not due to mental disorder, nor are these psychological processes in any meaningful way "biological" though they of course influence physiological processes). CFS is not a mysterious disease. I have yet to meet someone with CFS who isn't disturbed. They seem to have an enormous amount of energy when it comes to trying to refute claims that psychological factors aren't important in CFS, even though that would make it singularly unique in the history of chronic illness.

I have a special interest in functional somatic syndromes and somatization, but I have to say I leave CFS alone.

I think it's difficult not to be confused when it comes to these disorders, at least for a lay person, but I don't see anything substantively different in what you wrote from what I said, except the order of my sentence was different:

"A somatoform disorder, from my understanding, is when a person has physical maladies that result from a mental illness"

I could have said, "A somatoform disorder, a mental illness, results in a person having physical maladies," and I think then I would have been saying what you did—although I do believe the first thing I said was really the same thing.

Unless you are saying the person doesn't actually have physical maladies?

As far as people with CFS refuting claims of psychological illness contributing to it, I have to say that I don't have personal experience with CFS or know anyone with it. I did see the episode of Golden Girls which exemplified what you're saying to a T. Dorothy was chronically tired and was told it was "all in her head" and then eventually gets a diagnosis of CFS and then happens to see the doctor who told her it was all in her head in a restaurant and gives him a good tongue-lashing, while the doctor's wife chimes in that he never listens. The great triumph at the end of the episode was that she wasn't crazy—implying that mental illness would be worse than a physical illness with a proposed biological cause. Dorothy's mother, Sophia, is also proud of her daughter for not being "crazy" and for finding the answer. In fact the episode featured Dorothy visiting a doctor who explained that her CFS was probably caused by a virus and that he would be running lab work to confirm her diagnosis but that he was already sure it would show she had CFS (this was back in the early 1990s I think). I'm not sure what labwork they were referring to. Of course, I understand it was a sitcom. (They also had an episode that featured Rose addicted to unspecified pills, what seemed like some sort of sedative, probably benzos, maybe barbiturates.)

I would surmise some people with CFS have probably been previously told that they have a psychological disorder like depression for quite some time rather than CFS, and perhaps then are reluctant to accept a mental process as a contributing factor because they think it's a slide back into a purely mental disorder diagnosis. Why someone would prefer to have the illness categorized as physical rather than mental goes back to confusion and ambiguity people feel with mental illness, and perhaps stigma, as well. I myself am still confused exactly as to what a mental illness is. I understand that unlike other illnesses there are more contributory causes outside the realm of biological—that the social and environmental play a larger role. The part I've never understood entirely is that we're still talking about what is essentially flesh and blood to be crass. I don't know where the "mental" is that is sick that is separate from the rest of the "physical."

 

[splik]

yes it is a confusing subject! I am amazed at how many psychiatrists don't know the difference between somatoform and psychosomatic (in addition to not knowing the difference between factitious disorder and Munchausen's but that's a different kettle of fish altogether!)

 

[hamstergang]

Some, for example, like PANDAS, even have a clear infectious cause.

Assuming PANDAS exists, of course. Not that this was really central to your point, though.

 

[birchswing]

Assuming PANDAS exists, of course. Not that this was really central to your point, though.

Yeah, I don't know much about PANDAS. Just one that sticks out in my memory because it's so interesting, but I didn't know it was a controversial diagnosis. Are there better examples of mental illness with a clear biological cause? I think I remember hearing that schizophrenia was the most empirically observable in terms of structural brain changes; although, that still doesn't give you the cause.

 

[splik]

PANDAS is not a mental illness. it's not a mental disorder if there is clear biological cause. which poses some problems for our definition as many in the field believe (naively) that a clear biological causes will be found for all mental disorders, but history has shown us that diseases that have a clearly pathology cease to be psychiatric disorders (for example neurosyphilis, huntington's, pick's disease, Alzheimer's and so on).

I don't think schizophrenia is a particularly good example, the best meta-analyses show there is no agreement in the structural brain abnormalities found in "schizophrenia" - only that there are some. There is also quite a bit of controversy about whether any brain changes are fixed (i.e. found at the onset of illness only) or progressive (i.e. more akin to kraepelin's concept). The best evidence seems to suggest most of the progressive changes can be explained by exposure to neuroleptics. for example, neuroleptics have been shown to decrease brain volume by 10% in macaque monkeys (who were not schizophrenic, presumably). The oft repeated claim that schizophrenia is associated with increased ventricular size is entirely explainable by antipsychotics.

 

[birchswing]

PANDAS is not a mental illness. it's not a mental disorder if there is clear biological cause. which poses some problems for our definition as many in the field believe (naively) that a clear biological causes will be found for all mental disorders, but history has shown us that diseases that have a clearly pathology cease to be psychiatric disorders (for example neurosyphilis, huntington's, pick's disease, Alzheimer's and so on).

Is there a difference between people who naively believe a clear biological cause will be found and those who believe there is a biological cause (even if it can't be found)?

And is the suggestion that if a biological cause can be found for all mental illness, that psychiatry will cease to exist? Does that make psychiatry sort of a field of syndromes rather than illnesses?

And is there a suggestion that some mental illnesses don't have a biological component? That's the part I can never get my head around (and why I have trouble understanding what a mental illness is). If it's not of the body, what is it of? It makes it sound very much in the ether.

I don't think schizophrenia is a particularly good example, the best meta-analyses show there is no agreement in the structural brain abnormalities found in "schizophrenia" - only that there are some. There is also quite a bit of controversy about whether any brain changes are fixed (i.e. found at the onset of illness only) or progressive (i.e. more akin to kraepelin's concept). The best evidence seems to suggest most of the progressive changes can be explained by exposure to neuroleptics. for example, neuroleptics have been shown to decrease brain volume by 10% in macaque monkeys (who were not schizophrenic, presumably). The oft repeated claim that schizophrenia is associated with increased ventricular size is entirely explainable by antipsychotics.

Very interesting.

 

[splik]

Is there a difference between people who naively believe a clear biological cause will be found and those who believe there is a biological cause (even if it can't be found)?

yes, the latter are particularly dangerous because they are indulging in faith rather than science. believing something to be the case even if no evidence can ever been found is the very definition of anti-science

And is the suggestion that if a biological cause can be found for all mental illness, that psychiatry will cease to exist? Does that make psychiatry sort of a field of syndromes rather than illnesses?

The biological psychiatrists will say it's nonsense that if a brain disease is found to cause a mental illness then that mental illness will fall under the province of neurology, but that is historically what has happened. The reality is that psychiatry is not going anywhere despite claims of its death as far back as the 1970s. I think it is a minority position within the field to believe that all problems psychiatrists see are brain diseases. I think most people accept that some of the problems we deal with are clearly due to brain disease (for example someone with vascular dementia who is paranoid that people are stealing from them or someone with traumatic brain injury with affect dysregulation), others are behaviors (for example phobias, addictions), some problems are simply due to sh*tty life cirumstances, other problems are clearly related to life events (bereavement reactions, adjustment disorders) or trauma (PTSD), and many problems are a confluence of factors including randomness, biology, and psychosocial factors (like borderline personality disorder). There is good reason to think that a small proportion of what we call "schizophrenia" is actually genetic disease, a very small number of cases of what we have called "bipolar disorder" are inherited in a mendelian way, and many cases of psychosis are primarily related to environmental factors (both biological like meth or cannabis use or viral infections, and social factors likely deprivation, inequality, racial discrimination).

Some people will argue that major depression is brain disease, which is different to people with sh*tty lives, but I fail to see how the two can be separated in practice.

And is there a suggestion that some mental illnesses don't have a biological component? That's the part I can never get my head around (and why I have trouble understanding what a mental illness is). If it's not of the body, what is it of? It makes it sound very much in the ether.

Well since we can theoretically reduce all human experience and consciousness to neural activity, of course mental illness has a biological component, but no more than any other facet of human experience. The issue comes down to the level of explanation that provides a good explanation for what is going on and provides a way of intervening. I usually teach this as the "levels of explanation" model that presumes we can view all mental disorders at multiple levels, but in a given case one level may be more preferable.

The levels are:
- descriptive (simply describing the problems)
- neurobiological (considering the problem as a result of brain dysfunction)
- psychodynamic (considering the problem as due to intrapsychical conflicts, developmental arrests, interpersonal relationships, and internalized objects)
- cognitive (considering the problem as due to information processing errors or failure or metacognitive monitoring)
- behavioral (considering the problem as due to maladaptive learned behaviors)
- systemic (considering the problem as due to dysfunction in a system such as a couple, family, or organization rather than the individual)
- social realist (considering the problem as shaped by wider social factors such as deprivation, inequality, poverty, discrimination etc)
- social constructivist (considering the problem as a social construction, a problem of narrative)

Of course we can trace emotions and thinking to the brain, but I am entirely unconvinced that this is the most appropriate way of conceptualizing psychiatric problems in the majority of cases. This is not ignoring a biological basis to mental illness, but rejecting neuroessentialist narratives which have held back progress in the field by stifling more pragmatic research and innovations, providing moral exculpation for bad behavior, disempowering people, and leading the mass drugging of the population with psychotropics that they do not need for sociopolitical reasons.

Edit: one of my interests is in how psychiatrists conceptualize different kinds of problems and the widescale implications of this, particularly in terms of criminal responsibility. And you will see that for the most part psychiatrists cannot even agree on what is and isn't mental illness except for a very few diagnostic labels, and they cannot agree on how much biological, social, psychological factors play in different kinds of disorders. but we do know that psychiatrists who primarily see their patients as having brain diseases tend to treat their patients more poorly, and are less likely to include their patients in treatment decisions and are less empathic.

 

[Salpingo]

yes, the latter are particularly dangerous because they are indulging in faith rather than science. believing something to be the case even if no evidence can ever been found is the very definition of anti-science

I assume you're referring to Karl Popper, and the idea that a scientific theory must be falsifiable (if it isn't, its unscientific, but not necessarily "anti-science"). So for a theory to be scientific, there has to be an at least hypothetical way to disprove it. While that's the big criticism of the psychoanalytic model of the mind, I'm not sure how that applies here. There are very few psychiatrists who hold onto the belief that mental disorders have a biological basis AND hold the belief that there is no way to disprove scientific theories of the mind (otherwise, the NIMH wouldn't be spending millions of dollars on fMRI, GWAS, etc). Even Freud hedged that his theory was a practical placeholder to (1) make some cash, (2) wait until there were sufficient scientific advances to study the mind.

Its easy to make the case for a biological basis of psychiatry. You can induce panic/anxiety with various chemicals, mania with prednisone, depression with interferon. You can also change personalities with specific lesions to the brain. So while we can't necessarily say that major depressive DISORDER is a circumscribed disease in the same way bacterial pneumonia is, the theoretical symptoms at least mirror a biological process.

We have no idea how eye color is determined, but its probably the result of several genes, so there are probably dozens if not hundreds of ways you could be blue-eyed. Similarly, schizophrenia as a syndrome has a set criteria of behaviors and characteristics that likely have a biological basis, but the people DIAGNOSED with schizophrenia are probably a range of individuals with various diseases, conditions and social circumstances that presents in a specific way, which is then clustered together as an illness since they loosely look the same.

 

[Nasrudin]

yes, the latter are particularly dangerous because they are indulging in faith rather than science. believing something to be the case even if no evidence can ever been found is the very definition of anti-science



The biological psychiatrists will say it's nonsense that if a brain disease is found to cause a mental illness then that mental illness will fall under the province of neurology, but that is historically what has happened. The reality is that psychiatry is not going anywhere despite claims of its death as far back as the 1970s. I think it is a minority position within the field to believe that all problems psychiatrists see are brain diseases. I think most people accept that some of the problems we deal with are clearly due to brain disease (for example someone with vascular dementia who is paranoid that people are stealing from them or someone with traumatic brain injury with affect dysregulation), others are behaviors (for example phobias, addictions), some problems are simply due to sh*tty life cirumstances, other problems are clearly related to life events (bereavement reactions, adjustment disorders) or trauma (PTSD), and many problems are a confluence of factors including randomness, biology, and psychosocial factors (like borderline personality disorder). There is good reason to think that a small proportion of what we call "schizophrenia" is actually genetic disease, a very small number of cases of what we have called "bipolar disorder" are inherited in a mendelian way, and many cases of psychosis are primarily related to environmental factors (both biological like meth or cannabis use or viral infections, and social factors likely deprivation, inequality, racial discrimination).

Some people will argue that major depression is brain disease, which is different to people with sh*tty lives, but I fail to see how the two can be separated in practice.



Well since we can theoretically reduce all human experience and consciousness to neural activity, of course mental illness has a biological component, but no more than any other facet of human experience. The issue comes down to the level of explanation that provides a good explanation for what is going on and provides a way of intervening. I usually teach this as the "levels of explanation" model that presumes we can view all mental disorders at multiple levels, but in a given case one level may be more preferable.

The levels are:
- descriptive (simply describing the problems)
- neurobiological (considering the problem as a result of brain dysfunction)
- psychodynamic (considering the problem as due to intrapsychical conflicts, developmental arrests, interpersonal relationships, and internalized objects)
- cognitive (considering the problem as due to information processing errors or failure or metacognitive monitoring)
- behavioral (considering the problem as due to maladaptive learned behaviors)
- systemic (considering the problem as due to dysfunction in a system such as a couple, family, or organization rather than the individual)
- social realist (considering the problem as shaped by wider social factors such as deprivation, inequality, poverty, discrimination etc)
- social constructivist (considering the problem as a social construction, a problem of narrative)

Of course we can trace emotions and thinking to the brain, but I am entirely unconvinced that this is the most appropriate way of conceptualizing psychiatric problems in the majority of cases. This is not ignoring a biological basis to mental illness, but rejecting neuroessentialist narratives which have held back progress in the field by stifling more pragmatic research and innovations, providing moral exculpation for bad behavior, disempowering people, and leading the mass drugging of the population with psychotropics that they do not need for sociopolitical reasons.

Edit: one of my interests is in how psychiatrists conceptualize different kinds of problems and the widescale implications of this, particularly in terms of criminal responsibility. And you will see that for the most part psychiatrists cannot even agree on what is and isn't mental illness except for a very few diagnostic labels, and they cannot agree on how much biological, social, psychological factors play in different kinds of disorders. but we do know that psychiatrists who primarily see their patients as having brain diseases tend to treat their patients more poorly, and are less likely to include their patients in treatment decisions and are less empathic.

This is the first time...I realize now...that i think i've understood the framework of your various positions overall.

Nasrudin digs.

Well. Except for the Psychodynamic level. Which could easily be replaced with Poetic Level. Or metaphorical level. Which would be fine. Except for the history of psychiatry. And the mass sale of metaphor as science. or fact.

 

[splik]

Well. Except for the Psychodynamic level. Which could easily be replaced with Poetic Level. Or metaphorical level. Which would be fine. Except for the history of psychiatry. And the mass sale of metaphor as science. or fact.

I think a lot of psychodynamic theory is clearly voodoo but it is hard to argue with the core principles: our past experiences shape our present experience, our subjective consciousness is unique and should be respected, we are less aware of our motivations for actions than we like to think, our past relationships play out in the clinical arena, and our minds have carefully developed methods to help us ignore or avoid that which we do not wish to acknowledge. This is what I am talking about when referring to psychodynamic factors as oppose to castration complexes and the like.

 

[Shikima]

I think a lot of psychodynamic theory is clearly voodoo but it is hard to argue with the core principles: our past experiences shape our present experience, our subjective consciousness is unique and should be respected, we are less aware of our motivations for actions than we like to think, our past relationships play out in the clinical arena, and our minds have carefully developed methods to help us ignore or avoid that which we do not wish to acknowledge. This is what I am talking about when referring to psychodynamic factors as oppose to castration complexes and the like.

Yup! The past does explain the present, but doesn't dictate the future.

 

[Nasrudin]

I think a lot of psychodynamic theory is clearly voodoo but it is hard to argue with the core principles: our past experiences shape our present experience, our subjective consciousness is unique and should be respected, we are less aware of our motivations for actions than we like to think, our past relationships play out in the clinical arena, and our minds have carefully developed methods to help us ignore or avoid that which we do not wish to acknowledge. This is what I am talking about when referring to psychodynamic factors as oppose to castration complexes and the like.

See. Ok. When we describe observable patterns and discuss them it can be continuous and overlapping with all the other levels in your model. Which is perfect.

But we have the problem of the language we employ being completely based in pure wizardry. And yet we're taught that it is the high art of what we do. That it's ok to question god, in the vein of Moses interceding and arguing with God on behalf of the tribe... but would be completely unthinkable to to abandon the burdensome symbology completely. As we should do posthaste. (or wtf haven't we yet....?!!?)

This is f@cking amazing to me. Amazing... how has this group of people convinced us that humans have existed for hundreds of thousands of years and yet somehow a particular group of intellectuals in Vienna--not all of them, just this one particular sect--discovered the human mind and to unlock it. And further, what to do with that wizard technology.

F'n amazing. One of the biggest intellectual hoaxes in human hx. On the level of religions.

 

[FlowRate]

@splik , Do you reserve medications strictly for those syndromes which you think have a "biological" basis or use them to treat symptoms (e.g. psychosis) regardless of potential etiology (deprivation, racism, poverty)? (Or some other circumstances?)

 

[splik]

@splik , Do you reserve medications strictly for those syndromes which you think have a "biological" basis or use them to treat symptoms (e.g. psychosis) regardless of potential etiology (deprivation, racism, poverty)? (Or some other circumstances?)

I think it is entirely a false dichotomy to consider drugs for "biological" problems whatever that means. For example, I prescribe antidepressants but my formulation for their indication is psychological (i.e. reducing hyperreactivity to perceived internal and external threats and reducing negative selective attention biases). Similarly one can formulate the effects of neuroleptics in psychological terms (i.e. dampening aberrant salience attribution) which is liable to occur when people experience discrimination and marginalization leading to a form of sensory deprivation. Conversely, we know that psychotherapies influence the brain and could be reconceived as "biological" interventions. I am not convinced that it is helpful to do so in the majority of cases. The main time I formulate psychotherapy as a brain-based treatment is to patients with functional neurological disorder. You get more buy in if you can show them brain scans and explain you are modulating brain activity with the treatment, which in a sense is true.

 

[Merovinge]

See. Ok. When we describe observable patterns and discuss them it can be continuous and overlapping with all the other levels in your model. Which is perfect.

But we have the problem of the language we employ being completely based in pure wizardry. And yet we're taught that it is the high art of what we do. That it's ok to question god, in the vein of Moses interceding and arguing with God on behalf of the tribe... but would be completely unthinkable to to abandon the burdensome symbology completely. As we should do posthaste. (or wtf haven't we yet....?!!?)

This is f@cking amazing to me. Amazing... how has this group of people convinced us that humans have existed for hundreds of thousands of years and yet somehow a particular group of intellectuals in Vienna--not all of them, just this one particular sect--discovered the human mind and to unlock it. And further, what to do with that wizard technology.

F'n amazing. One of the biggest intellectual hoaxes in human hx. On the level of religions.

Definitely going to come back to this at some point and re-soak it all in. But thank you for typing that out. I cannot imagine the backlash some folks I trained under would have for a resident who dared to type that.