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Two topics brought up in class (and touched on briefly by Elliot in the forum) that I'd like to explore were the idea of the disorder as entity without the person and the problem of which came first; the disorder or the negative cognition.

"You do know that's the disease talking, don't you?" I've heard permutations of that concept several times from friends in therapy for whatever reason, and I've often wondered (especially when directed towards people who don't consider themselves sick) if it's the discourse that makes one sick, or if those negative cognitions are more analogous to a fever, a symptom of the disorder. It doesn't seem to make sense for a person to talk to themselves about themselves in the deprecating manner characterized by depression of their own volition: that insidious voice has to be the product of too few serotonin receptors or not enough dopamine, much as lowered inhibitions are the product of too much alcohol. You can't really talk yourself into being drunk, and why would you want to talk yourself into being depressed?

So now there's this broken piece of brain generating hateful thoughts in a patient's mind, but can we really consider this broken bit as something external or different from the person who owns it? Even that first sentence, "You know that's the disease talking..." implies that there are two parties privy to the world within the skull: the person and another, darker “disordered” entity. But wouldn't considering the disorder to be an externality, an adjunct to the person him/herself, lend some credence to earlier conceptions of psychopathology as demonic possession? Does this mean that shamanistic practices or exorcisms have the chance to re-enter a modern therapeutic arsenal? Why not, after all, when we cannot seem to decide what mechanisms are responsible for more scientifically condoned talking and/or chemical cures? What harm could a little sage incense and holy water do if the benefit was the eviction of the terrible “other” plaguing the patient?

What was it about these earlier forms of psychotherapy or even our current rudimentary tools that make a person better? From the discussion we had on Tuesday, it seems like an important part of the therapy is changing the discourse a patient engages him/herself in regarding the disorder. If all pharmacotherapy addresses is the dysfunctional biology, perhaps it is the change in self-talk that protects the brain from relapsing. But then we’ve returned agency over the disorder back to the patient’s own verbal behavior, which means, in a sense, that it’s “all in your head” and we know that’s not right either. So self-talk is enough to prevent a disorder but not cause it? And why can’t we all alter our own self-talk without assistance? And now, it seems, we’re back to the beginning, which came first the disorder or the thought?