Friday, February 23, 2007

A complicated range of other factors

Today’s Guardian reviews Why do People get Ill, the new book by the psychoanalyst Darian Leader and philosopher of science (whatever that means) David Corfield. In it, Leader discusses the benefits and problems associated with popular mental health strategies (Parisian-style psychoanalysis, Cognitive Behavioral Therapy, the American-style throw-the-medicine-cabinet-and-pocket-the-loot strategy) that I discussed a couple posts down.

Listening is not a big feature of modern medicine here or anywhere in the west." Leader's book claims that, on average, a patient speaks for 23 seconds before being interrupted by their GP. The book concedes that most doctors have such staggering workloads that the average consultation with a GP in London lasts between six and eight minutes (the shortest average in Britain). But this may well make quick-fix diagnoses more likely.

...He talks about the government's preference for cognitive behavioural therapy (CBT) over traditional talking therapies. "The government favours this because it is about correcting surface symptoms and reintegrating people who report psychical problems back into the workplace where they can become useful again."

CBT aims at modifying everyday behaviour. Patients are often encouraged to keep a diary of significant events and associated feelings and thoughts. They are urged to question unhelpful or unrealistic assumptions and to do activities that have been avoided. sounds potentially helpful for ameliorating just the kind of symptoms Leader's book spends a great deal of time discussing. Only one problem: he despises this form of therapy. "When was CBT used most widely? It was in Mao's China, when people had to be re-educated to see the world in the way that the authorities wanted." Indeed, he regards CBT as akin to drug prescription. "Some forms claim to target specific aspects of illness; they are supposed to be administered like a pill or injection, and this no doubt makes them attractive to health service providers. But I think it is horrible and fatuous."

Leader believes that unless root causes are addressed, they will simply resurface in another form, some months later.

...But surely one reason analysis is not popular, and particularly not popular with the government, is that psychoanalysis does not claim to produce results, while supporters of CBT claim that it does. "That's true. Having said that, a lot of my colleagues disagree with me and claim that studies show that, over the long term, symptoms will permanently disappear through analysis and that there will be lower rates of consulting GPs." And what is the long term? "They're talking about 20 or 30 years later." No wonder, then, that the government isn't calling on psychoanalysts such as Leader to cure Britain's depressives.

Dr. chuckling doesn’t have much to say on these issues, just finds them interesting. Viewed as a matter of simple distrust, it’s probably accurate to assume that strategies favored by government and big business are worthless at best, more likely counter-productive. Though CBT does not sound that bad to me, even though in this and the other article it is described as insidious brainwashing. But what do I know? Not much, not much.

If I must take a stand, I’ll go for psychoanalysis. It may take twenty or thirty years to produce measurable results, or not produce any results at all, but at least it has a coolness factor whereas CBT sounds like a cliff notes version of a dime-a-dozen self-help book and SSRI’s are definitely not cool (at least for the great majority of users who don’t really need them).

But psychoanalysis? With all the wacky writings of Freud, Jung, Lacan et. al.? And Woody Allen? Just about everybody likes to talk about their dreams (and what can it hurt), but who the hell wants to listen to someone else talk about theirs? Psychoanalysts deserve big money to sit through that shit for thirty years.

The more I think about it, the better it sounds. I propose that we create a huge government agency that guarantees everyone the right to 30 years of psychoanalysis. Think of how much better off people would be talking to a professional on the couch rather than ranting on blogs or sending people off to die in foreign wars. You dream you are Conan, killing hoards of brown people? God tells you what to do? But what about your mother? She laughed at your pee pee? It made you feel inadequate?

Twenty or thirty years? I see immediate results. In order to get bi-partisan support, we can cut taxes to pay for it.

(the following is just an experiment, pay no mind. Britney, shaved head, Anna Nichole, Obama Clinton feud, American Idol)

Wednesday, February 21, 2007

Britney, st. john, hil, and the last honest man

Matt Taibbi reports on some excellent work done by the good folk on Bernie Sanders’s staff.

On the same day that Britney was shaving her head, a guy I know who works in the office of Senator Bernie Sanders sent me an email. He was trying very hard to get news organizations interested in some research his office had done about George Bush's proposed 2008 budget,...

Sanders's office came up with some interesting numbers here. If the Estate Tax were to be repealed completely, the estimated savings to just one family -- the Walton family, the heirs to the Wal-Mart fortune -- would be about $32.7 billion dollars over the next ten years.

The proposed reductions to Medicaid over the same time frame? $28 billion.

Or how about this: if the Estate Tax goes, the heirs to the Mars candy corporation -- some of the world's evilest scumbags, incidentally, routinely ripped by human rights organizations for trafficking in child labor to work cocoa farms in places like Cote D'Ivoire -- if the estate tax goes, those assholes will receive about $11.7 billion in tax breaks. That's more than three times the amount Bush wants to cut from the VA budget ($3.4 billion) over the same time period.

Of course the fact that news organizations have no interest in reporting the most important news of our time is nothing new. The idealistic and just plain naive among us get confused because we continue to refer to them as “news organizations.” In easily observable reality, the real question is rather they are primarily entertainment organizations or ad delivery systems. Six of one, half dozen of the other. But news? Puh-leeze.

So it’s not their fault. They are what they are and the only question left to be answered is “how much?” Or more accurately, “how many?”

How many are watching? If more of us would watch them report on the looting of our country by the Walton’s, Cox’s, Nordstroms, Gallos and their political lackeys in all branches of government, then that’s what we’d see.

But are the lefty blogs that much better? Are they significantly less personality driven than the old-fashioned media? Is the constant hubbub about the various wankers and progressive heroes really that different than Britney and Anna Nichole?

I don’t know if Sanders’s office is trying to get the lefty blogs interested in that very well-presented research, but if they are, they’re not having much, if any, more success.

Some pundit or politician says or does something stupid or smart. That's news. If Joementum shaves his head and checks into rehab, that's big news. It doesn't have to matter a whit to those thousands whose health will suffer so the Waltons can have many more millions.

Yea, the daily adventures of Hil, the Joes, Obamas and Osamas, Britneys and Carols don't matter a whit, not much more anyway, but if their name recognition is big, they provide a spike in hits and a bump in click-through advertising.

We’re still not sure what we are, and we’re not yet asking “how much?” But “how many?” That resonates on the same frequency these days.

Sunday, February 18, 2007

Thinking is the cause of your illness

Flawed plan at Writhe Safely calls attention to an article by London Communists that criticizes contemporary mental health care in Britain which consists of happy-drugging the poor sods and/or happy-talking them into mental health with Cognitive Behavioral Therapy (CBT), “in which patients are told to control their thinking, block negative thoughts and to think only positive thoughts.”

Our Communist friends, it seems, believe that our ascendent Capitalism, with its wars and economic injustices, makes it only natural for people to be depressed. In these times, they say, severe depression is proof of good mental health.

This approach insists that the depression comes from inside the brain of the patient – not from the objective reality of the outside world. But in a world threatened by global warming and ecological disaster, by wars involving nuclear, chemical and biological weapons and by extremes of wealth and poverty, is it madness to be depressed? At a more personal level the working classes are now more exploited, more in debt and working longer hours while traditional community and social structures are disappearing. What is the sane response to living in a mad world?

Personally, I do not know what mental illness or depression is. Of course I sometimes feel depressed, but I don’t know how that relates to other people who say they are depressed. Are we really feeling the same thing? Is there some kind of MRI or like device that can compare the mental state of different individuals? And where is the line that separates what is a normal, albeit occasional, state for human beings? I don’t know.

I hope this does not come off as disrespectful, but I will tell you frankly that I think the great majority of treatment for normal type depression is hokum. I grew up in the seventies and have tried, recreationally, many of the common drugs that doctors prescribe for depression, and even severe mental illness, over the years. When I was in high school, just about everything could be found among the medicine cabinets of my family and friends? Not only Valium and Xanax, but strong stuff like Tuinal and Nembutal. Why were doctors prescribing that crap to normal housewives? What the fuck was the medical purpose of a Quaalude? Why did my grandmother have a prescription for Nembutal in her medicine cabinet, from which she took precisely one pill? And speed is off the subject, but back then the quacks were prescribing it to anyone with cellulite (Kurt Vonnegut writes well about this in his novel Bluebeard).

I was older when SSRI’s came along and had gone happily beyond mom’s medicine cabinet for my recreational activities, but I tried Prozac and Paxil just to see what the buzz was about. Apparently, the quacks pushed these “remedies” on any woman who walked through the door. With my experience, it was glaringly obvious that these were terribly dangerous drugs and that normal people had no business taking them. It was especially clear that Paxil would cause far worse problems than it alleviated, the comedown leaving people worse than they were before they took the shit. So my opinion of the pharmaceutical industry and the quacks that peddle their pills comes from personal experience and is significantly less than positive.
These drugs, Selective Serotonin Re-uptake Inhibitors (SSRIs), include Prozac, Serotonin, Cipramil, Fluoxetine and others. They do help some people but many patients find the side-effects cause more problems than they solve. These side effects include kidney problems and water retention and they can be addictive or they can make the depression worse. These drugs have been linked with suicides and violent outbursts.

On the other hand, I have read articles, I remember one in particular from Harper’s, that told of people for whom SSRI’s were miracle drugs that allowed them to function as they weren’t able to before. And a friend of mine, the brother of my best friend, turned schizophrenic and eventually killed himself. This was someone I knew for many years, had many deep conversations with, and deeply respected. The last time I spoke with him, he emphasized that he had a serious medical condition, that there was no way it was some kind of depression resulting from something that happened in his personal life (a devastating book on this subject is The Eden Express by Mark Vonnegut).
Last year a senior executive of Glaxo-Smith-Kline admitted that most of their drugs are effective on only about a third of patients. Even when they work, the drugs do not address the root cause of the problems of depression.

So yea, I trust that there are medical conditions for which these drugs are necessary, and maybe even helpful in the long run, but I suspect that they represent a small percentage of the prescription base. For the most part it’s insane, and should be criminal, to give that crap to regular folk.

What really interested me about the article was the information about Cognitive Behavioral Therapy (CBT). I had come across CBT recently in my reading and thought it sounded like a very good idea.
The National Association of Cognitive Behavioural Therapists (based in the United States) described CBT:

“It is a form of psychotherapy that emphasises the important role of thinking in how we feel and what we do. CBT therapists teach that when our brains are healthy, it is our thinking that causes us to feel and act the way we do. Therefore if we are experiencing unwanted feelings and behaviours, it is important to identify the thinking that is causing the feelings/behaviours and to learn how to replace this thinking with thoughts that lead to more desirable reactions.”

Sounds about right to me. I’ve spent most my life informally studying this type of thing. Thoughts are real. They affect the our brains and bodies. We can train our minds to control our bodies, at least to some extent. That is not some kind of new agey shit. It is scientific fact.

But can scientific fact and social services bureaucracy co-exist?
Patients (no longer called patients, that is too negative, but renamed “service-users”) who report that global warming, ecological disasters, wars, injustice, poverty and exploitation make them feel depressed are told that they are thinking too much. “Thinking is the cause of your illness. You must stop thinking your way and start thinking our way. You must think positively about the world.”

…This perpetual optimism, totally at odds with objective reality, is likely to make depressed patients feel worse, not better. They are told that the world is as it is and cannot be changed but that thinking it might be changed makes you ill and depressed.

Apparently not. The bureaucratic logic doesn’t hold water.
…Bourgeois psychologists have wrestled long and hard with the problem of optimism. Statistical analysis shows that pessimists are usually better at predicting the future than optimists. Yet they insist that optimists have better mental health. They also say that those most in touch with objective reality are the sanest. Both statements cannot be true.

Then we get the Marxist analysis:
CBT is taking the place of religion in persuading the exploited masses to resign themselves to their lot in life but it is grounded in an idealistic philosophy which ultimately claims that the material world exists as the creation of an idea (God’s) and is experienced through our ideas of it. This is the opposite of the Marxist-Leninist historical materialist view of the world which says that objective reality exists outside our own heads. And not only can it be changed but it is in a constant state of change in any case. For us, the sane method is to analyse that objective reality and the way it changes in order to be able to influence those changes – to think for ourselves and not be fooled by rosy illusions.

But what does it mean?
If we take the view of the CBT advocates, we cannot do anything to change any of this but must adjust our minds to see it all through rose tinted spectacles. This leads some people to hedonism – escapism through refusing to listen to the news, being obsessed with the celebrity culture, drinking and partying as much as possible: “if there is no hope we might as well enjoy ourselves while we can”. This is one trend that has taken a large proportion of the working class away from active participation in anything political.

That’s supposed to be a bad thing? Okay, I'll grant them celebrity culture, but partying?
The other trend is despair, which has captured many of those who cannot turn off their minds, who cannot help but see what is happening around them. But feeling isolated and helpless they become paralysed by depression and or by suppressed anger. They become unable to function as part of a society which they can see is going mad.

The only sane and rational alternative is to ignore the CBT people and the pills, take stock of objective reality and set about trying to change it.

I’m afraid that I have to disagree that political activism is the only sane and rational alternative. I would call it a courageous and noble alternative, but effective mental health therapy? I very much doubt that political activism is any better in that respect than pharmaceuticals or happy talk, could be a lot worse.

But maybe that’s just me projecting again. I know all about the sad state of world politics, far more than most people, but I neither let it get me down or try to do much of anything about it. I can tell my Communist friends from personal experience that it’s possible to know of the great and myriad crimes committed by our government abroad and be personally screwed by the current economic system and still be positive and happy in one’s personal life. Although I am not a Communist, I share their Materialist world view and believe that this life is all we’ve got. Those of us fortunate enough to have been born in relatively wealthy societies are only trapped by our desires. As noted below, I would be more than content to live in a tent in the desert. Unless you are genuinely mentally ill, otherwise sick, starving, jailed, or being tortured, happiness is all in your head. Think happy. Stop wanting all that crap. Be happy. And if that fails, eat well, get exercise, consume quality alcohol (mostly)in moderation, and maybe smoke a little weed or something on occasion. And don't forget good sex. The more, the better. Thus spake dr. chuckling.

Year of the boar

First draft of this year's Chinese New Year's photos here.

Update: A few people have questioned whether or not these pictures are "Photoshopped." No, this is actually a technique I developed specifically for Chinese New Years. Of course I do a little color balancing, but no filters or plug-ins are applied. This is an event that I go to every year, usually with the kids. I'd never seriously photographed it before, but I always took a few pictures with one of my toy cameras. The straight photos, not just mine, but others I've seen as well, fail to capture the event as I experience it. There's just too much extraneous detail in the background and a sharp photo gives little, if any, hint of the movement, which along with the cacophony and color, is what makes the event what it is. Experience is inherently subjective. A lot of people don't like this technique, but it works for me and portrays, I think, a more representative reality.