Mental Health: Pharmacotherapy and Talk Therapy I

I think that Ryan raises a really good point.Its interesting to ask the question - "Howdoes a given therapy affect the Brain." But we should not get caught in thetrap of assuming that tracing physical correlates is going to reveal the "real"nature of Mental Health and illness.  Asyou said we can assume that every experience has physical correlates in thebrain - and that every experience changes the brain.   So we can ask other questions:

Forexample how does meditation or prayer affect the brain?

Howdoes diet affect the brain?

Howdoes playing piano affect the brain?

But to really be effective in mental healthwe are always going to be forced back to dealing with both the brain and thesubjective experience of the story teller.

As for what this suggests for next generationof therapies - we should always be curious about how small changes in the braincan cause significant changes in the storyteller.  See this fascinatingarticle regarding how ovarian cysts were shown to cause schizophrenic symptomsin young women.

But we should remember that while a troubledstoryteller may be caused by an ovarian cyst, a bump to the head, a stroke, theloss of a loved one, abuse, or a host of other causes - that originate in thesocial or physical world - the story-teller is on some level what makes usuniquely human. 

To really define mental health and mentalillness - I think we have to continue talking about the storyteller even incases like my father's where the root cause of the illness could be clearlytraced to a very clearly identified problem with a brain structure.

I think the problem is not with the medications themselves that are used to treat mental illness, but the framework in which they are utilized. The medical model, indeed, often sees intervention as being the only and best way in which to alleviate stresses to the body. This myopic understanding of health, mental and otherwise, is of great detriment to the patient and physician alike. Physicians are trained in specialization of the body, not its connectedness, as evidenced by the growing number of clinical sub-specialities. It is this view of health and the body that makes medication an obvious choice in cases of mental distress. Cause and effect in disease and mental health are not always so linear as to make a “magic-bullet” the ideal “solution” to complicated, multi-faceted problems. This can be a problem with talk-therapy, too, when the symptoms as they manifest to an outside observer or are reported by the patient reign supreme over the “whys” of the scenario, over the individual experience of the patient of that “illness.” Treating symptoms is the hallmark of modern medicine, but overlooks the context in which illness takes place, the individual who is experiencing the illness. And what is that individual’s experience of the illness itself? This may well not be as formulaic as medicine would like to think. When medication can be utilized to enable a person to be more available, emotionally, physically, etc. to engage in re-shaping their story, I think it is important, perhaps necessary. As was raised in class, a valid and important issue of which to be mindful is the potential for the medicine to mask the underlying problems and to become, yes, a “fix” to the problem, but sometimes one that is not sustainable without medication. I’m not sure this is a desirable end. If mental health can be viewed as the possibility of continually refining and reshaping out ability to tell stories that maximize choices (free will?), medication alone may not enable us to do that in the long-term, though it may allow us to be open to the possibility of revision of our stories. Psychiatrist Peter Breggin, writes :

“Children become diagnosed with ADHD when they are in conflict with the expectations or demands of parents and/or teachers. The ADHD diagnosis is simply a list of the behaviors that most commonly cause conflict or disturbance in classrooms, especially those that require a high degree of conformity.

By diagnosing the child with ADHD, blame for the conflict is placed on the child. Instead of examining the context of the child's life why the child is restless or disobedient in the classroom or home - the problem is attributed to the child's faulty brain.”


I think this raises an interesting issue, one of which to be wary. By pathologizing to a greater and greater extent, behaviors that are in some way non-conformist, the context of those behaviors is overlooked and the underpinnings of mental distress may fade into obscurity. Medication tends to give us license to ignore the “real” problems by treating the symptoms. The issue of whether medication or therapy or both are useful ways to treat mental illness cannot themselves be removed from the contexts in which they are used. In my mind, over-utilizing therapy is not at issue here, in terms of straining the system. Many people do not have mental health coverage that adequately ensure they receive the best care, so end up cycling in and out of hospitals or taking numerous expensive medications, rather than being able to engage in meaningful long-term therapy that may enable them to break the cycle. I’m not sure how mental health parity  will in real terms affect the quality of care, but hopefully it will make access to care less of an issue. I'm not sure that more money will, in and of itself, enhance understanding or awareness about mental health, but perhaps it can be seen as a step in the right direction... 

I think a general sense of interpersonal disconnection is very much a theme of modernity. As such, therapy enable an interpersonal connection that people may not be encouraged to foster in daily life. It is not the only or best connection, but a unique and important one for many people. 

On group therapy… I really enjoyed the exercise we did in class with Sarah. For me, it was a novel way to enact the working of tacit knowledge. Prior to the exercise, I did not have a working knowledge that I may have certain intution about people. The exercise brought to light some of those unconscious understandings and crafting a story after being drawn to a particular person pushed me to examine and understand my intuition in a way that I likely would not have done otherwise.

In certain contexts, I think group therapy has the potential to be incredibly constructive in serving as a source of new understandings, alternate stories that may prove more useful for the individual. My friend attends Alcholics Anonymous and, for him, this form of therapy is useful. He is open to and actively seeking a new story and interacting with people who have had similar experiences is helping him to create a new story. I think victims of trauma and abuse, may well, also, be served by group work, where shared experience may help to diminish grief, shame, etc. and translate those feelings into a story that is less paralyzing and more conducive to health. This is all very individual, as with anything else, and, of course, not everyone is open to this kind of forum or desirous of sharing their personal experiences with a group.

On the other hand, there are contexts in which I think group therapy may not be constructive and may, in fact, be deleterious. If there is no awareness of an alternative story, the possibility of an alternative story, the story teller may well take any incoming information and translate it in such a way so as to confirm and re-confirm the existing story. In group contexts in which a number of people are dealing with the same issues, the group dynamic may serve to reinforce the existing story. Until there is awareness of and openness to another possibility, I think group work may not be constructive.

I found the notion that blogging can be considered a modern form of group therapy an interesting one  For many, blogging can be a way to share a story and receive feedback in order to create new meaning by weaving together the others’ stories and sorting out what may or may not be useful/constructive for one’s own story.

In many cases, the treatments for mental illnesses depend on standard tools of the physician's trade: the administration of drugs, surgery or particular medical intervention. These procedures focus on repairing specific biological problems. However, this view is too easy because mental illnesses involve many different causes, some are biological but other are lodged in a person's circumstances. When a particular form of therapy must be chosen, then it's important to focus on what works instead of focusing only on how the disorder arose. In fact, there may be not a direct correspondence between the trigger of a disorder and the nature of the treatment. Drug therapies appear to be effective but it's absolutely important to seek different forms of therapy that tries to change the thinking and the behavior of the patient.

It's clear that different forms of therapy exist but do they work and why? Are they able to help people? 

I thought the idea that a mood disorder could be a symptom was really interesting, and that by giving drugs, it would be dulling the symptom, and perhaps ignoring the real problem. If everything we feel might be a symptom, is the self, in the larger sense, the problem? Maybe we're sad because of something else going on, and maybe we can make that sadness go away with drugs, but if, under it all, the reason why we were sad stays the same, will the sadness manifest in another way? I'm a big believer in experiencing and feeling what we're meant to experience and feel. The thought of drugs scares me- it scares me that part of a person, that's maybe meant to be there, for some reason or another, can be removed, or covered. I want to believe that we are the way we are for actual reasons rather than randomness. I want to believe that maybe sometimes we're meant to be sad for awhile, if for nothing else, than to be able to empathize with and feel for someone else who may need help from someone who can relate.

I thought the talk therapy activity was interesting and difficult. I like being given ample time to consider different situations, especially when people are involved. I find that I either think things through in a million different ways, when given the time or in a one on one situation, but when put in groups, and especially under timed pressure, I go blank. I don't like saying things that don't have some sort of conscious foundation in my head in front of a group of people, since I like to be able to expand on and defend my views, and with the pressure of being in a group of people, unless I know why I'm doing what I'm doing, I know it'll be difficult to think out something the way I'd like to on the spot. I think it's also hard to genuinely tell someone you barely know why you think you can relate them to others in your life.

Throughout last class, I was thinking that perhaps the storyteller is responsible for depression, bipolar, etc.

I think a faulty storyteller can tell a story that is far from reality and lead to bad thoughts. Such thoughts then lead to unhealthy feelings, and unhealthy feelings are the root of 'mental illnesses'.

This ties well into the whole therapy model...I think the drugs are effective in that they predispose one to more pleasant thoughts and make people receptive to therapy. However, I believe that it is only through therapy that one can adjust their storyteller to tell stories that are more in touch with reality.

Paul's flippant comment at my dislike of the activity on Monday night really exposed something for me. I'm not british. I'll receive my citizenship in about a years time- provided I pass the test. Yet, I have been raised in a very anglophilic household and spent the better part of my education in schools with a large population of Brits. So yes, perhaps because of that I am not a big fan of public displays of emotion. But what does this mean about culture in terms of mental health?

When we talk about pharmacotherapy in the US something really strikes me. A great deal of American culture is based on instant gratification, fast food, fast weight loss, fast money. We like quick fixes. So maybe that is your simple answer to why pharmacology appears to be more prevelent within our society. Drugs are easily administered and require little extra effort on the part of both doctors and patients. And best of all, if you take a pill- poof! You're cured. The problem with psychotherapy is it takes a really, really long time. Years. And maybe the individual will never see the effects because for some reason or another their therapist wasn't entirely effective. 

I don't want to be anti-consumer, because I consume about as much as the next person, but I do believe that this aspect of American society in particular makes pharmacotherapy such an attractive option. 

I think we all agree that nobody should be allowed to just dispense drugs in order to solve a mental problem. Some blend of the two therapies is necessary to ensure that drugs are not abused as a quick fix masking real problems that underly the mental symptoms. 

On the other hand, forms of talk therapy (with a medical proffessional) that are used as a continuous crutch for people throughout life is an unneccessary strain upon an already strained healthcare system. I think the type of support that people get via talk therapy when they don't really have an underlying problem can and should be found among friends and family. Billing your insurance company for that doesn't seem like a legitimate use of community resources. 

For that reason I instinctively dislike activities like the one we all participated in last monday. I think they can be breading gounds for peoples desire to seek self affirmation when what they might need is a stern but caring friend/realitve to tell them to cut the crap and do x y or z.  But, that is just my first thoughts on the subject. I am sure there are situations where that kind of therapy is not only legitimate but it might even be useful.