Rotten Apple

[vijun]

I am a twenty-three year old male that is currently living in Montreal. I would describe myself as an eccentric self loathing, depressed human being. I dropped out of high school when I was sixteen. I never had a job. I only leave my apartment when I have to. I am currently on medication for depression and social anxiety disorder. Fortunately I was able to make a substantial amount of money from selling things on EBay and making some wise investment decisions. Unfortunately I spent most of the money that I made in a futile attempt to find happiness. I have reached a point where for the first time in my life I am having real financial difficulties. I think the money that I was making in the past was the only thing that stopped me from killing myself. I don’t know how much longer I am going to be alive; therefore I decided to post this letter on various philosophy and science based websites on the net. I would like to communicate with individuals that have something in common with me. I would also like to educate or influence the people that are reading this. What you see below are some of my opinions on psychiatry and the human body.

Medical science has come along way during the past hundred years. Unfortunately it has not come far enough because of capitalism and religious and ethical reasons.

I am impressed with the progress that neuroscientist have made during the past twenty-five years especially in the fields of neurophysiology and cognitive neuroscience. In my opinion the only field of neuroscience that has not progressed that much is psychiatry. I won’t even waste my time writing about the good old days when people were being electrocuted and lobotomized for no reason. I am not satisfied with the way most psychiatrist are trying to treat depression.

One problem that I have is the amount of people in North America that are on antidepressants. Writing a prescription for someone that is depressed is the first thing that most psychiatrist do. In my opinion antidepressants should only be used as a last resort.

The second problem that I have with psychiatry is psychotherapy. The physical act of handing over a hundred dollars or more for an hour of a doctors time made me even more depressed than I was before I went into the office. There is nothing that a psychiatrist or a psychologist can tell me that I can’t learn from a book. Another problem that I have with psychotherapy is the lack of confidentiality amongst people. I had a friend that was a psychiatrist. He is now deceased. He told me everything about his patients. We would have long discussions about the different disorders and problems that his patients were living with. Some people are good at keeping secrets and some people are not. So I would advise people to be careful the next time that you go into a doctor’s office to bare your soul to someone that you have never met before in your life. However I will admit that psychotherapy can be a good alternative to taking antidepressants if you can find the right doctor.

The third problem that I have with psychiatry is doctors that are focused on keeping suicidal individuals alive instead of giving them some pleasure or trying to give them a good reason to want to live. I think psychiatrist need to teach their patients more about neurophysiology and neurochemistry. They also need to develop new techniques for treating their patients. I also believe that an assisted suicide should be a part of psychiatry. It would involve putting a patient in a comfortable environment, and giving them an injection of heroin or some other narcotic to give them pleasure. The second step would involve giving them a sedative to put them to sleep. And finally dose potassium chloride to stop the heart.

The fourth problem that I have with psychiatry is the fact that most psychiatrists think that depression is a disease. It is not a disease. It is a chemical disorder that can be avoided. I have read many books and articles about scientific studies done depression. Based on what I have read I believe that the majority of people in the world that are suffering depression do not have a genetic predisposition to it. It is true that some people have lower than normal levels of serotonin in their brains because of their genetics, but if it was possible to examine everyone in the world that is suffering from some kind of long term depression, I believe the results from the study would prove that the majority of depressed individuals do not have a genetic predisposition to it. Life is an endless dream of pain and sorrow. That is the problem.

Fortunately a few doctors out there are using some new techniques to treat there patients. Unfortunately, these new techniques are not widespread. I am talking about trans cranial magnetic stimulation and using virtual reality to treat patients with phobias. I believe that TMS and virtual reality combined with gene therapy or genetic engineering could completely eliminate depression and all other psychiatric disorders.

Medical doctors have to realize is that a panacea is not going to come in the form of a pill or a serum. That is what the pharmaceutical companies out there would like doctors to believe. Unfortunately the solution to the problem is much more complex than that. Rational intelligent human beings have to get together and start a movement. Neuroscientists have to work together with computer scientists to improve our cognitive abilities and gain better control over our amygdales. (Read The Age Of Spiritual Machines by Ray Kurzweil to understand what I am talking about) Geneticists have to stop thinking that eugenics is a bad thing and do whatever it takes to make life better for human beings. Liberal open minded politicians in every democratic country around the world have to work together to give people more privileges and to help scientists speed up the process of evolution. People around the world also have to be willing to make a slow process from capitalism to socialism. People have to willing to abandon most of their old traditions. Most people on this planet are stilling living like cavemen because irrational behavior is being passed on from generation to generation. Rational intelligent human beings have to get together and come up with a solution to solve all of cultural and genetic problems. I believe that human beings will not be on this planet for much longer if we are not willing to work together to find a solution to all of our cultural and genetic problems.

Existence is information and perception. Information in the form of energy, subatomic particles, atoms, molecules, planets, stars, and carbon based life forms like us. Perception in the form of programmed reactions to the information that we receive through our five senses. You might have heard the phrase one rotten apple destroys the whole pack. Imagine that the world is a bag with five good apples in it and one rotten apple in it. The rotten apple is a representation of all of our cultural problems and our genetic problems. You can’t remove a small piece of the rotten apple and not expect the bacteria to spread. That is the problem with the world. We are not willing to do what it takes to get rid of the whole apple. Your problems are my problems and my problems are your problems. We are all connected. I believe that psychiatrists have an important role to play in the process of removing the rotten apple. If you would like to know more about my beliefs you can read my other thread (Chemical Illusions) and you can take a look at the websites that you see below.

http://www.transhumanism.org http://www.transtopia.org http://www.imminst.org

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[bth7]

Wow, what an intense post.

Much of what you say is very interesting. One overall comment that comes to mind, you seem to believe your personal state of well-being is closely linked to the overall socio-economic well-being of society.

If you understand that you existence is just information . . . 5 senses, synapses firing, etc., why not investigate thoroughly the state of your own existence which you have more direct access to, before worrying about the more difficult task of diagnosing the entire system, which, let's face it, you have very little control over, especially if you are depressed.

My suggestion would be meditation. A great way to investigate the mind.

Here's 3 great books:

Zen Mind, Beginner's Mind by Suzuki
Cutting through Spiritual Materialism by Chogyam Trungpa
I Am That by Nisargadatta

 

[joanithan]

I am a twenty-three year old male that is currently living in Montreal. I would describe myself as an eccentric self loathing, depressed human being. I dropped out of high school when I was sixteen. I never had a job. I only leave my apartment when I have to. I am currently on medication for depression and social anxiety disorder. Fortunately I was able to make a substantial amount of money from selling things on EBay and making some wise investment decisions. Unfortunately I spent most of the money that I made in a futile attempt to find happiness. I have reached a point where for the first time in my life I am having real financial difficulties. I think the money that I was making in the past was the only thing that stopped me from killing myself. I don’t know how much longer I am going to be alive; therefore I decided to post this letter on various philosophy and science based websites on the net. I would like to communicate with individuals that have something in common with me. I would also like to educate or influence the people that are reading this. What you see below are some of my opinions on psychiatry and the human body.

Medical science has come along way during the past hundred years. Unfortunately it has not come far enough because of capitalism and religious and ethical reasons.

I am impressed with the progress that neuroscientist have made during the past twenty-five years especially in the fields of neurophysiology and cognitive neuroscience. In my opinion the only field of neuroscience that has not progressed that much is psychiatry. I won’t even waste my time writing about the good old days when people were being electrocuted and lobotomized for no reason. I am not satisfied with the way most psychiatrist are trying to treat depression.

One problem that I have is the amount of people in North America that are on antidepressants. Writing a prescription for someone that is depressed is the first thing that most psychiatrist do. In my opinion antidepressants should only be used as a last resort.

The second problem that I have with psychiatry is psychotherapy. The physical act of handing over a hundred dollars or more for an hour of a doctors time made me even more depressed than I was before I went into the office. There is nothing that a psychiatrist or a psychologist can tell me that I can’t learn from a book. Another problem that I have with psychotherapy is the lack of confidentiality amongst people. I had a friend that was a psychiatrist. He is now deceased. He told me everything about his patients. We would have long discussions about the different disorders and problems that his patients were living with. Some people are good at keeping secrets and some people are not. So I would advise people to be careful the next time that you go into a doctor’s office to bare your soul to someone that you have never met before in your life. However I will admit that psychotherapy can be a good alternative to taking antidepressants if you can find the right doctor.

The third problem that I have with psychiatry is doctors that are focused on keeping suicidal individuals alive instead of giving them some pleasure or trying to give them a good reason to want to live. I think psychiatrist need to teach their patients more about neurophysiology and neurochemistry. They also need to develop new techniques for treating their patients. I also believe that an assisted suicide should be a part of psychiatry. It would involve putting a patient in a comfortable environment, and giving them an injection of heroin or some other narcotic to give them pleasure. The second step would involve giving them a sedative to put them to sleep. And finally dose potassium chloride to stop the heart.

The fourth problem that I have with psychiatry is the fact that most psychiatrists think that depression is a disease. It is not a disease. It is a chemical disorder that can be avoided. I have read many books and articles about scientific studies done depression. Based on what I have read I believe that the majority of people in the world that are suffering depression do not have a genetic predisposition to it. It is true that some people have lower than normal levels of serotonin in their brains because of their genetics, but if it was possible to examine everyone in the world that is suffering from some kind of long term depression, I believe the results from the study would prove that the majority of depressed individuals do not have a genetic predisposition to it. Life is an endless dream of pain and sorrow. That is the problem.

Fortunately a few doctors out there are using some new techniques to treat there patients. Unfortunately, these new techniques are not widespread. I am talking about trans cranial magnetic stimulation and using virtual reality to treat patients with phobias. I believe that TMS and virtual reality combined with gene therapy or genetic engineering could completely eliminate depression and all other psychiatric disorders.

Medical doctors have to realize is that a panacea is not going to come in the form of a pill or a serum. That is what the pharmaceutical companies out there would like doctors to believe. Unfortunately the solution to the problem is much more complex than that. Rational intelligent human beings have to get together and start a movement. Neuroscientists have to work together with computer scientists to improve our cognitive abilities and gain better control over our amygdales. (Read The Age Of Spiritual Machines by Ray Kurzweil to understand what I am talking about) Geneticists have to stop thinking that eugenics is a bad thing and do whatever it takes to make life better for human beings. Liberal open minded politicians in every democratic country around the world have to work together to give people more privileges and to help scientists speed up the process of evolution. People around the world also have to be willing to make a slow process from capitalism to socialism. People have to willing to abandon most of their old traditions. Most people on this planet are stilling living like cavemen because irrational behavior is being passed on from generation to generation. Rational intelligent human beings have to get together and come up with a solution to solve all of cultural and genetic problems. I believe that human beings will not be on this planet for much longer if we are not willing to work together to find a solution to all of our cultural and genetic problems.

Existence is information and perception. Information in the form of energy, subatomic particles, atoms, molecules, planets, stars, and carbon based life forms like us. Perception in the form of programmed reactions to the information that we receive through our five senses. You might have heard the phrase one rotten apple destroys the whole pack. Imagine that the world is a bag with five good apples in it and one rotten apple in it. The rotten apple is a representation of all of our cultural problems and our genetic problems. You can’t remove a small piece of the rotten apple and not expect the bacteria to spread. That is the problem with the world. We are not willing to do what it takes to get rid of the whole apple. Your problems are my problems and my problems are your problems. We are all connected. I believe that psychiatrists have an important role to play in the process of removing the rotten apple. If you would like to know more about my beliefs you can read my other thread (Chemical Illusions) and you can take a look at the websites that you see below.

http://www.transhumanism.org http://www.transtopia.org http://www.imminst.org

Vijun:
I will assume that you are being sincere. Your manifesto covers a fairly broad range of opinions. I would share a few thoughts that are not meant to insult you.
1. You need a better psychiatrist.
2. A psychiatrist's role is not to GIVE you pleasure or to GIVE you a good reason to live. If you assume a purely passive role in your treatment, you will continue to be dissatisfied. You must work to bring yourself to these ends by establishing a relationship of mutuality with your physician.
3. We have essentially incontrovertible evidence that depression is a disease, or at least a problem driven in part by a “genetic predisposition.” For example, studies of identical twins reveal that when one identical twin has MDD, the other will suffer MDD about 50% of the time. This is in comparison to a statistically significantly smaller percentage amongst their siblings (or, of course, the general public).
4. "Electrocuting" patients, which I assume means ECT, is the single most effective modality for treating MDD, with efficacy between 80-95%.
5. You do not seem to believe that psychotherapy or psycho pharmaceuticals are the answer to depression; outside of ECT, these are the only treatment modalities that we know for a scientific fact (i.e., a belief system based on reason and logic) to be effective in treating MDD.
6. Much of your argument is one of based on strong feelings without relying on fact. I respect your feelings, but it is probably antithetical to ask "rational" people to join what is essentially an emotion-driven position.

Sincerely, best of luck to you.

 

[OldPsychDoc]

Vijun:
I will assume that you are being sincere. Your manifesto covers a fairly broad range of opinions. I would share a few thoughts that are not meant to insult you.
1. You need a better psychiatrist.
2. A psychiatrist's role is not to GIVE you pleasure or to GIVE you a good reason to live. If you assume a purely passive role in your treatment, you will continue to be dissatisfied. You must work to bring yourself to these ends by establishing a relationship of mutuality with your physician.
3. We have essentially incontrovertible evidence that depression is a disease, or at least a problem driven in part by a “genetic predisposition.” For example, studies of identical twins reveal that when one identical twin has MDD, the other will suffer MDD about 50% of the time. This is in comparison to a statistically significantly smaller percentage amongst their siblings (or, of course, the general public).
4. "Electrocuting" patients, which I assume means ECT, is the single most effective modality for treating MDD, with efficacy between 80-95%.
5. You do not seem to believe that psychotherapy or psycho pharmaceuticals are the answer to depression; outside of ECT, these are the only treatment modalities that we know for a scientific fact (i.e., a belief system based on reason and logic) to be effective in treating MDD.
6. Much of your argument is one of based on strong feelings without relying on fact. I respect your feelings, but it is probably antithetical to ask "rational" people to join what is essentially an emotion-driven position.

Sincerely, best of luck to you.

This is so much nicer than what I was thinking of as a reply...

 

[Mr. Beef]

I'm going to assume that you are not a Troll and are sincere in your diatribe. You post some intresting things and posting them on a psychological web board is not going to change a lot of minds that are already made up about the science of Psychology.

Medical science has come along way during the past hundred years. Unfortunately it has not come far enough because of capitalism and religious and ethical reasons.

I am impressed with the progress that neuroscientist have made during the past twenty-five years especially in the fields of neurophysiology and cognitive neuroscience. In my opinion the only field of neuroscience that has not progressed that much is psychiatry. I won’t even waste my time writing about the good old days when people were being electrocuted and lobotomized for no reason. I am not satisfied with the way most psychiatrist are trying to treat depression.

By electrocution do you mean Electro Convulsive Thereapy? I have spent my share of time in Psyche wards and knew a man who had his last round of ECT right before I got there and he seemed fine to me. I see ECT as a last resort when thereapy and medications do not work.

One problem that I have is the amount of people in North America that are on antidepressants. Writing a prescription for someone that is depressed is the first thing that most psychiatrist do. In my opinion antidepressants should only be used as a last resort.

As someone has already said and I'll state again, antidepressents are the best thing that can be given to patient that is depressed. Granted it takes a few weeks for them to work, and the person may need to be on them for the rest of their life, but if a pill plus psychotherapy can make someone feel better about themself so they do not have to live with the constant down feeling of depression that so takes over their life.

The second problem that I have with psychiatry is psychotherapy. The physical act of handing over a hundred dollars or more for an hour of a doctors time made me even more depressed than I was before I went into the office. There is nothing that a psychiatrist or a psychologist can tell me that I can’t learn from a book. Another problem that I have with psychotherapy is the lack of confidentiality amongst people. I had a friend that was a psychiatrist. He is now deceased. He told me everything about his patients. We would have long discussions about the different disorders and problems that his patients were living with. Some people are good at keeping secrets and some people are not. So I would advise people to be careful the next time that you go into a doctor’s office to bare your soul to someone that you have never met before in your life. However I will admit that psychotherapy can be a good alternative to taking antidepressants if you can find the right doctor.

I don't know where your friend got off telling you about his clients, but he violated the most basic tenant of medicine. Do not discuss anything about patients outside the treatment team. If someone saw what you just posted and was a patient of his he could be facing a major lawsuit. I'm just a lowly volunteer at a senior clinic, but I know the rules of HIPAA, and your friend would so be fired from any hospital in the states if word got back to someone at the hospital that he was doing what you just said. As I said above psychothereapy + antidepressents are generally the best thing that someone can do to take care of depression.

The third problem that I have with psychiatry is doctors that are focused on keeping suicidal individuals alive instead of giving them some pleasure or trying to give them a good reason to want to live. I think psychiatrist need to teach their patients more about neurophysiology and neurochemistry. They also need to develop new techniques for treating their patients. I also believe that an assisted suicide should be a part of psychiatry. It would involve putting a patient in a comfortable environment, and giving them an injection of heroin or some other narcotic to give them pleasure. The second step would involve giving them a sedative to put them to sleep. And finally dose potassium chloride to stop the heart.

As somone who has been on the sucidial end of things I'm glad that there are people out there that want to see me live for another day even when I've not had my best of days. They gave me some great reasons to live every single time and I've even been able to snap myself out of some suicidial funks by thinking about how my family would be. It's not up to the Psychologist to make the person feel better, it's up to the person to make themself feel better. As for pleasure everyone derives pleasure differnt ways and if you think a doctor is going to be able to pull one of those out of thin air then you have another thing coming my friend.

As for your assisted suicide paragraph, there is a reason why most doctors worth their salt won't do that because it's immoral and unethical to kill someone. The first listing in the Hippocratic Oath is: First, do no harm. Killing a patient is doing major harm to the patient and their family. Why kill them while they are on the unnatural high and feeling good. What if the person rethinks that they don't want to die after giving them Heroin? Congradulations you just created a Heroin addict just because the unnatural high that makes them feel good.

The fourth problem that I have with psychiatry is the fact that most psychiatrists think that depression is a disease. It is not a disease. It is a chemical disorder that can be avoided. I have read many books and articles about scientific studies done depression. Based on what I have read I believe that the majority of people in the world that are suffering depression do not have a genetic predisposition to it. It is true that some people have lower than normal levels of serotonin in their brains because of their genetics, but if it was possible to examine everyone in the world that is suffering from some kind of long term depression, I believe the results from the study would prove that the majority of depressed individuals do not have a genetic predisposition to it. Life is an endless dream of pain and sorrow. That is the problem.

Depression is 100% a disease and anyone that tells you otherwise is a liar. If someone is genetically predisposed to depression (like myself), than short of an act of god they will become depressed. As for your last two sentences that is the saddest thing I have read and I have written some pretty sad things. That sentence is pure opinion in an otherwise good paragraph.

Fortunately a few doctors out there are using some new techniques to treat there patients. Unfortunately, these new techniques are not widespread. I am talking about trans cranial magnetic stimulation and using virtual reality to treat patients with phobias. I believe that TMS and virtual reality combined with gene therapy or genetic engineering could completely eliminate depression and all other psychiatric disorders.

I'm all for treating phobias with Virtual Reality because the more you are exposed to the thing the more you adapt to it and the less scared of it you become. But you are going to show me some hard science in a medical journal that says Transcrainal Magnetic Stimulation is really good at treating depression.

Medical doctors have to realize is that a panacea is not going to come in the form of a pill or a serum. That is what the pharmaceutical companies out there would like doctors to believe. Unfortunately the solution to the problem is much more complex than that. Rational intelligent human beings have to get together and start a movement. Neuroscientists have to work together with computer scientists to improve our cognitive abilities and gain better control over our amygdales. (Read The Age Of Spiritual Machines by Ray Kurzweil to understand what I am talking about) Geneticists have to stop thinking that eugenics is a bad thing and do whatever it takes to make life better for human beings. Liberal open minded politicians in every democratic country around the world have to work together to give people more privileges and to help scientists speed up the process of evolution. People around the world also have to be willing to make a slow process from capitalism to socialism. People have to willing to abandon most of their old traditions. Most people on this planet are stilling living like cavemen because irrational behavior is being passed on from generation to generation. Rational intelligent human beings have to get together and come up with a solution to solve all of cultural and genetic problems. I believe that human beings will not be on this planet for much longer if we are not willing to work together to find a solution to all of our cultural and genetic problems.

What you are talking about is playing god in order to take care of something that is something minor in the grand scheme of things. Eugenics was about making genetic supermen, not eliminating disease, and that is also playing god. I'm all for working together to solve cultural problems, but much like your medication pancea, eliminating depression and other mental illnesses is going to cause more problems than it solves.

(URL's and rest of post eliminated for brevity.)

You make some good point's but what you have said has been said before and has been shot down by hard science.

I'm going to renig on what I said in the beginning and say that you are in fact a Troll and I hope that you find some help for what you are feeling. Even though you are not going to see this post so why did I respond to it. Because your reasoning is flawed at best.

 

[Anasazi23]

The third problem that I have with psychiatry is doctors that are focused on keeping suicidal individuals alive...

Those pesky psychiatrists.....keeping their patients alive and some such nonsense.

I also believe that an assisted suicide should be a part of psychiatry. It would involve putting a patient in a comfortable environment, and giving them an injection of heroin or some other narcotic to give them pleasure. The second step would involve giving them a sedative to put them to sleep. And finally dose potassium chloride to stop the heart.

What would the reimbursement rate be for this procedure? Is reimbursement even possible considering the patient is now dead?

Speaking of heroin....

Seriously though, I hate the fact that psychiatry is the specialty that got stuck with addiction. Maybe it's just because I'm in a major city hospital, but frankly, I'm tired of it.

 

[OldPsychDoc]

Seriously though, I hate the fact that psychiatry is the specialty that got stuck with addiction. Maybe it's just because I'm in a major city hospital, but frankly, I'm tired of it.

What specialty do you think is better suited to care for individuals with a brain disease that influences their behavior? A relapsing and remitting disease with fatal consequences for the affected individual? A disease that does respond to a combination of psychotherapies and pharmacological support? A disease that requires that the clinician take into account the entire biopsychosocial composistion of the patient?

And given that 50% of pts with major mental illness also have a substance problem--you'd better get used to it. You're not going to be able to turf it to someone else like the surgeons do.

Maybe you're just post-call and need some time off, Anasazi.

 

[Anasazi23]

What specialty do you think is better suited to care for individuals with a brain disease that influences their behavior? A relapsing and remitting disease with fatal consequences for the affected individual? A disease that does respond to a combination of psychotherapies and pharmacological support? A disease that requires that the clinician take into account the entire biopsychosocial composistion of the patient?

And given that 50% of pts with major mental illness also have a substance problem--you'd better get used to it. You're not going to be able to turf it to someone else like the surgeons do.

Maybe you're just post-call and need some time off, Anasazi.

I was post call....that said....

The truth is that the concept of dual diagnosis (especially in the context of bipolar disorder) has been proven false. The concept of "self medication" has largely been disproven as well. This is evident in incarceration studies, as well as by popular theorists. I had a noncompliant diabetic patient of mine die recently. She refused to listen to her doctors regarding her diet, and came in again in hyperglycemic coma. As usual, she was intubated and supported. This time it was too much however. Her drug of choice was food, and ultimately it was her maladaptive personality that killed her.

I do not buy the fact that heroin abuse is a brain disease from an etiological standpoint. It's a pathological personality that exacerbates, remits, and results in the abuse of substances. It only affects their behavior in that the behaviors (the drug taking) is illegal and has bad health consequences. Cavemen didn't have heroin abuse problems, and had no addiction brain disease.

Working in a NYC hospital, I see my share every single day at all hours. I understand substance abuse from a neurochemical perspective, sociological perspective, and a psychodynamic perspective. I also see lots of very sick folks who choose not to abuse substances. People have the populations they like working with and the ones they don't like. I just don't like substance abusers, and will likely tailor my private practice accordingly.

Take care.

 

[OldPsychDoc]

1) The "truth" that the concept of dual diagnosis has been proven false somehow was not taught in my addiction fellowship. It also seems to have escaped the notice of the leaders of NIMH, NIAAA, and NIDA. Of course, now the buzzword is "co-occuring disorders" so maybe that's what you meant by dual diagnosis being proven false...
2) "Self medication" I'll cede to you--as it's usually cited by my patients as an excuse for why they're treating their depression with Vicodin and Ativan.
3) "a pathological personality that exacerbates, remits, and results in the abuse of substances"--but not a disease... Do you not believe in treating personality disorders, then? And the reams of research showing long-term changes in brain activity with abuse of substances? Physiological changes, predictable course and prognosis, etiological agent, affected organ system---but it's not a disease?

Good luck on tailoring your private practice to deal with only the patients you want...

I was post call....that said....

The truth is that the concept of dual diagnosis (especially in the context of bipolar disorder) has been proven false. The concept of "self medication" has largely been disproven as well. This is evident in incarceration studies, as well as by popular theorists. I had a noncompliant diabetic patient of mine die recently. She refused to listen to her doctors regarding her diet, and came in again in hyperglycemic coma. As usual, she was intubated and supported. This time it was too much however. Her drug of choice was food, and ultimately it was her maladaptive personality that killed her.

I do not buy the fact that heroin abuse is a brain disease from an etiological standpoint. It's a pathological personality that exacerbates, remits, and results in the abuse of substances. It only affects their behavior in that the behaviors (the drug taking) is illegal and has bad health consequences. Cavemen didn't have heroin abuse problems, and had no addiction brain disease.

Working in a NYC hospital, I see my share every single day at all hours. I understand substance abuse from a neurochemical perspective, sociological perspective, and a psychodynamic perspective. I also see lots of very sick folks who choose not to abuse substances. People have the populations they like working with and the ones they don't like. I just don't like substance abusers, and will likely tailor my private practice accordingly.

Take care.

 

[Anasazi23]

Certainly didn't mean to offend.... All I'm trying to say is that there is evidence the notion that simply because these two disorders co-occur does not mean they're biologically related. Anecdotally, in speaking with both forensic psychiatrists and addiction psychiatrists in the city, there is a growing consensus that a diagnosis of bipolar disorder is the most common diagnosis given to the arrested or referred patient. This does not automatically mean that the patient has both disorders or a dual-diagnosis. Studies have shown that after a forced wash-out period, the rate of the co-occurance drops dramatically. The bipolar symptoms remit, and the use of substances obviously decreases when none are available. In fact, our addiction specialist insists that one must wait at least 6 months after the cessation of the use of substances to truly make the diagnosis of dual-diagnosis. Otherwise, you're seeing the pathological behavioral effect of the substance, and not the true underlying condition. This is akin to our commonly faced scenario while on call....the drunk suicidal patient. 8/10 times, that person renegs on their suicidality when they sober up, and admit that it was the effect of the alcohol. The new buzzword that you brought up does indeed recognize the fact that these conditions tend to be separate entities.

I recently attended a meeting regarding the new reimbursement codes for Mediare. This phenomenon appears to be recognized by them, as evidenced by the upcoming negative penalty in reimbursement rate for drug/alcohol abuse patients that carry this diagnosis. This in no way indicates that Medicare has the inside scoop on psychiatric diagnosis and treatment, but is nevertheless interesting.

Whether or not alcoholism or drug use is truly a disease is a hotly debated topic, as you know. If all alcohol left the face of the earth tomorrow, the cure rate of this "disease" would be astonishing.

I don't mind treating personality disorders at all, as difficult as that can be. Substance use disorders, however, are not (currently) classified as Axis II, as you know. It's not a very big deal that this is not my favorite patient population, and I'm glad that there are good folks like you out there willing to do the addiction fellowships. Lots of psychiatrists hate forensic work, despise working with the criminal population and largely refuse to voluntarily work as a psychiatrist in court. I don't blame them on many counts, even though I plan to work in forensics myself. I certainly didn't mean to offend, and perhaps should have just stated that people just have their schticks, their populations with which they work well....and I recognize that "bipolar disorder manifesting as addiction" isn't mine.

Of course forensic work has in large part, substance abusers. However, the psychiatrist's role in this setting if quite different. It's not so much about treating only the patients I want, but more not treating the patients I'm less comfortable with, so to speak. Perhaps I'll refer to you, or psychiatrists like you, who are better suited to the task specializing in this area.

Peace.

 

[OldPsychDoc]

...I certainly didn't mean to offend, and perhaps should have just stated that people just have their schticks, their populations with which they work well....and I recognize that "bipolar disorder manifesting as addiction" isn't mine.

Of course forensic work has in large part, substance abusers. However, the psychiatrist's role in this setting if quite different. It's not so much about treating only the patients I want, but more not treating the patients I'm less comfortable with, so to speak. Perhaps I'll refer to you, or psychiatrists like you, who are better suited to the task specializing in this area.

Peace.

Now that's the Anasazi I expected--a thoughtful, reasoned post.

I agree with you about the bipolar issue, and the issues of diagnosis that you brought up. Since you're in NY, you probably aren't seeing the plague of meth that the West has seen and which is growing in the midwest. It would be very irresponsible to dx them as bipolar, even when they look that way. Of course, I also have borderline patients who have adopted a bipolar dx for themselves to explain their mood swings. It's not a very carefully diagnosed entity in the real world.

"If all alcohol left the earth...", we'd still have a brain that's vulnerable to psychoactive substances. Homo sapiens has been enjoying fermented beverages since before recorded history, not to mention chewing on kaat or coca, smoking poppy resins, and chewing cactus buttons. Technology just lets us distill the spirits and refine the pure substances these days.

 

[Anasazi23]

I agree with you about the bipolar issue, and the issues of diagnosis that you brought up. Since you're in NY, you probably aren't seeing the plague of meth that the West has seen and which is growing in the midwest. It would be very irresponsible to dx them as bipolar, even when they look that way. Of course, I also have borderline patients who have adopted a bipolar dx for themselves to explain their mood swings. It's not a very carefully diagnosed entity in the real world.

Yes, I saw a news program detailing what you mentioned. We see a good deal of crystal meth use, particularly in the homosexual population here in the city. This doesn't appear to be unique to the east coast, however and has been well documented .

 

[MJD503]

Well, interesting thread, indeed. I find the OP to be well spoken and have several good points but why not get out of the house, work and make some friends? That is bound to help your depression. Your able to form very complete thoughts, obviously, so you should be able to hold down a job,conversation and have a few friends to keep your mind off changing the entire scope of psychiatry. In my experience of dealing with depression and psychiatrists treating me for this, they almost strictly rely on the medication to keep you stable. If it doesn't, YOU need to find what will work for you. Therapy..etc Look at it this way, the doctor has many patients, he is not endentured to your care. You need to be your own advocate. Certaintly you have this concept because your interested in current psychiatry practice. I am myself.

Having seen several different Psychiatrists for depression, they usually all have different ways of treating MDD. Medications are numbero uno, support and encouragment are up there as well. Maybe you present yourself in a manner that says you only need medication and that your 'with it' enough to deal with the other sides of it...? They don't know if your not telling them.

On the bi-polar/drug issue, it seems borderline and bi-polar are almost always coincide together as diagnoses as well. When in fact, the borderline is often the main culprit behind the mood swings. Makes you wonder if some docs are using medications on patients who could be treated with other methods/medications..etc

 

[vijun]

It took me a while to decide to reply to the responses that I got because I no longer have internet access in my apartment. I was not lying when I said that I only leave my apartment when I have to.

E.C.T- I would kill myself before I allowed a doctor to use E.C.T to treat my depression. The glucocorticoids in my body have impaired my cognitive abilities enough already. I don’t need to add the side effects of E.C.T to my list of problems.

DEPRESSION- I was not surprised by the responses that I got when I said that depression is not a disease. I was trying to say that the majority of people that are suffering form depression do not have something that should be considered a disease. It is unfortunate that most people believe in absolute truth. You may have read a text book in medical school that referred to depression as a disease. You learned from your teachers and you were programmed to treat your depressed patients in a specific way. A psychiatrist form China, Japan, or India might be more inclined to agree with my belief about depression. It does not mean that I am right and you are wrong or you are right and I am wrong. Like I said before existence is information and perception. I would encourage you to scan the globe and take in as much information as possible.

I would compare depression to diabetes. I think most people in the world that are depressed have a form of depression that could be compared to type1 diabetes. This form of depression should not be considered a disease and it should not be treated with medication because the high level of glucocorticoids and low levels of serotonin in these individuals’ brains have nothing to do with a genetic predisposition to depression. It is all about the environmental factors in the lives of these individuals. ( I am not trying to say that type1 diabetes is not a disease, even though it usually can be avoided if the majority of people in countries like the U.S.A would stop stuffing their mouths with food until they become obese.)

Let me give you an example of why I think depression should not be considered a disease in most cases. I remember watching a show on PBS a couple of years ago. It was about the life spans of different life forms on this planet. One of the life forms that was mentioned was the opossum. The opossum is a marsupial that lives in North America. The average life span an opossum in captivity is eight years. The average life span of an opossum in a high predatory environment is two years. Opossums that are lucky enough to avoid predators and die of old age usually don’t make it past the age of five. There is a small population of opossums on an island somewhere on the east coast of the U.S.A. These opossums don’t have to deal with the stress of avoiding predators. The average life span of opossums on this island is even longer than opossums in captivity. I don’t remember what the exact age was but I think it was nine or ten years. The biology of these opossums is different than the opossums on the mainland. They actually age slower because they don’t have to deal with the stress of being hunted. Does that mean that the opossums on the mainland have a disease or is it their environment that is the problem?

 

[Milo]

( I am not trying to say that type1 diabetes is not a disease, even though it usually can be avoided if the majority of people in countries like the U.S.A would stop stuffing their mouths with food until they become obese.)

Not to dilute your argument or nit pick, but you're thinking of type II diabetes, or non-insulin dependent diabetes. Type I diabetes is the juvenile onset, autoimmune related destruction of pancreatic cells.