Jung At Heart

...Ramblings About Psychotherapy and Whatever Else Comes to Mind...

Whatever happened to ups and downs?

I have always been intrigued by nosology and the way that diagnostic systems reflect much deeper philosophical issues than might be obvious. The pressure to make human problems into diseases grows and what used to be fairly ordinary problems in living now become disorders which of course require medications.

The two major classification systems, the DSM IV and ICD-10, the former used in the US and the latter in Europe, point up some of the differences in how emotional problems are being viewed in each place. In the US, there is a tendency to  leave nosology to physicians and thus the classification system reflects what is known as "the medical model", a model which is built on an investigative process which assumes an underlying disease process which creates predictable and reliable symptoms. Thus the presence of a certain number of symptoms associated with disease X indicate that the patient indeed suffers from disease X. There is also an assumption that there is some causative agent and in much of medicine such an agent can be found.

Now we come to psychiatry where the same principles used to determine physical diagnoses begin to falter. Very very few psychiatric disorders, outside of the group of organic brain diseases, have a determinable causative agent. We talk about brain chemistry but when stripped of what sounds very scientific, this level of explanation is not terribly far above systems which preceded it, like the four humours of Hippocrates. Study after study attempting to pinpoint the cause of such problems as depression have failed to pinpoint a cause, something which can be identified, measured and which can be shown to lead to a particular mental illness or emotional problem. Still the diagnostic system  trundles along as if such causation exists and that there is a direct correlation between the existence of symptom cluster A and disease B.

And it appears that there are researchers who are thinking seriously about this problem, though I find it interesting that they are not in the US where most research in mental health is funded by drug companies, which of course depend on the very model that bears deeper scrutiny. I digress.

I find this study--‘Schizophrenia’ may not exist-- intriguing and actually quite radical.

Schizophrenia has been attributed to everything from genetic predisposition, brain chemistry, sufferers’ home environment and even cat-borne viruses, but no consistent causal pattern has ever been identified. As a result, treatment outcomes for today’s patients are not very different from those of patients treated 100 years ago...

"Psychiatric diagnoses are based on a set of false assumptions stemming from the 19th century," says Professor Bentall, writer of the highly successful book ’Madness Explained’. "Although deep-seated, these assumptions have very little scientific value, and could actually be detrimental to patients and their treatment options.

"The idea that there is a clear division between ’mad’ and ’sane’ people, and that distinct psychiatric categories like ’schizophrenic’ actually exist, is resulting in the mass-application of treatments which, will benefiting some, are very harmful to others. And because psychiatric patients are seen as having a biological brain illness which affects their rationality, they are not usually allowed a say in the matter." ...

Although psychiatric drugs and other traditional treatments can be helpful, they are not nearly as effective as is often thought and can have detrimental, even life-threatening side-effects. There is also a significant risk of relapse when treatment is stopped.

"Rather than diagnosing and treating people on the basis of psychiatric categories, which actually contain many people with no symptoms in common, we need to look at each sufferer’s symptoms individually from a psychological perspective," says Professor Bentall. "It then becomes relatively easy to understand why they might be happening and how the sufferer can address and cope with them.”

In other words, these investigators are challenging the basic underlying assumptions of the diagnostic criteria -- that all people showing some number of a list of symptoms have the same problem.

On the other hand, I also happened upon a report in The Mercury News(article now no longer available) of a study -- "Researchers studying treatment for `the blahs'."

The "blahs" referred to is Dysthymic Disorder, which I have always suspected is a category that just about every thinking human being has experienced at one time or another. I offer the European description:

A chronic depression of mood which does not currently fulfil the criteria for recurrent depressive disorder, mild or moderate severity, in terms of either severity or duration of individual episodes, although the criteria for mild depressive episode may have been fulfilled in the past, particularly at the onset of the disorder. The balance between individual phases of mild depression and intervening periods of comparative normality is very variable. Sufferers usually have periods of days or weeks when they describe themselves as well, but most of the time (often for months at a time) they feel tired and depressed; everything is an effort and nothing is enjoyed. They brood and complain, sleep badly and feel inadequate, but are usually able to cope with the basic demands of everyday life. Dysthymia therefore has much in common with the concepts of depressive neurosis and neurotic depression. If required, age of onset may be specified as early (in late teenage or the twenties) or late.

Now to the study --

What is the best way to cure ``the blahs''? A new exercise routine? A trip to the therapist? Or could medication help a patient who persistently feels blue but doesn't have major depression?

That's what Stanford University doctors hope to learn in a provocative new study that tests if a drug can treat melancholy. But critics wonder if drugs are the answer.

Already approved for use against major depression, the drug Cymbalta is being given to volunteers at the university's medical school to see if it combats a milder type of depression called dysthymia -- that persistent down-in-the-dumps mood that affects as many as 18 million Americans.

``Dysthymia hasn't gotten the attention it deserves,'' said Dr. Elias Aboujaoude of Stanford University School of Medicine. The condition is frequently considered just a character trait, and untreatable, according to Aboujaoude. ``The assumption is: `This is just what my personality is like,' '' he said...

The Stanford study, which has 15 volunteers so far and is funded by drug manufacturer Eli Lilly & Co. of Indianapolis, gives the drug to eligible volunteers for 12 weeks. Volunteers must visit the clinic 10 times to be studied and interviewed....

Of the trial, psychologist David Antonuccio said, ``It is the triumph of drug marketing over science.'' Antonuccio is professor of psychiatry and behavioral sciences at the University of Nevada-Reno School of Medicine.

Psychotherapy has been the conventional treatment for patients with dysthymic disorder. Patients learn to feel better through exercise, stress management, relaxation techniques, improved social skills and changed thought patterns.

So the state, formerly known as the Blahs becomes a disease which requires medication, despite the fact that other forms of intervention such as talk therapy, exercise, and even journal keeping have been shown to be effective. And I ask who benefits from this? The patient? Not likely.

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