cheese it, the cops!

The Reverse Placebo Effect and the Miracle of Psychiatric Medication

 

Piece I wrote in the '90s. No newspaper would buy it, for some reason. I want to link it on Twitter, so I'm rolling it out.

SSRIs and the RPE

By Crispin Sartwell

Recent studies suggest that the anti-depressant medications known as selective serotonin re-uptake inhibitors (SSRIs) may drive you to suicide, even as they improve your mood. This apparently paradoxical result should lead to a deep re-thinking of medical science as we know it.

My own research suggests that the pro-suicide effect of SSRIs is not a matter of brain chemistry or serotonin levels. It’s just that when they tell you that you need anti-depressants, they’re telling you you’re depressed, which is extremely depressing.

Depression is bad enough, but depression about the fact that you are depressed is an infinite downward spiral into hell. The more depressed you are, the more depressed you get. And the more depressed you get, the more depressed you are. Once you enter this process, there is nowhere to go but down, down, into the maw of death itself: the ultimate treatment facility.

Before you know it, you find yourself biting the Cobain stick.

Now on the other hand, many doctors seem to believe one problem is that SSRIs are being overprescribed. So let’s say your depression is misdiagnosed. When the whole thing starts out you’re a happy-go-lucky sap.

Then the fact that they think you need anti-depressants is enough to start you on the same downward spiral. You start asking yourself: if I’m so depressed, why do I feel so happy all the time? Pretty soon your trust of your own senses is entirely compromised and you become radically incapable of self-reflection. Your very selfhood itself is shattered like a cheap mirror.

In short, misdiagnoses of depression have probably dropped millions of friendly suckers into an agony of existential despair and obsessive self-loathing.

Before you know it, you’re swallowing that Marilyn cocktail.

But should you survive this far, the situation becomes far worse, because the doctor indicates that – whether you are suffering or not – you’ll feel better when you take your meds. But because you are on anti-depressants (see above) you are bummed out to an extent that matches or exceeds the relief offered by the medication itself (and I am not denying that anti-depressants are dramatically effective).

So the doctor increases your dosage or drops in another med, which has precisely the same double-edged effect. You return to the doctor, and you catch just that hint of an expression that you know means: Dude. If the anti-depressants don’t work, there’s really no hope. You feel that you’ve been condemned to a lifetime of despair, even if all the time you’re perfectly happy.

Before you know it, you’re doing that Virginia Woolf doggy paddle.

A placebo is a completely ineffective dose of an inert substance, which sometimes has a positive effect. The anti-depressant/suicide connection is an illustration of the “reverse placebo effect” (RPE), in which what are actually effective medications have no actual effects, or actually have negative effects.

Though this conclusion is only provisional and awaits future study, it may be that all medications are subject to a reverse-placebo effect: for example the fact that you need massive doses of opioids only convinces you that you must be in severe pain. Then the more effective a medicine becomes, the worse its results.

It’s enough to make you bake that Sylvia Plath casserole.

 

are you perfectible?

"I have no faith in human perfectibility. I think that human exertion will have no appreciable effect on humanity."

edgar allan poe

ps. eat me, emerson!

well, i share poe's pessimism on this, but the flat formulation is too strong. human exertion has had and will have many appreciable effects on humanity; think about longevity since poe's time, for example, though of course things can regress too. but what emerson and poe are talking about is human moral perfectibility. here i do not think that we have seen any significant improvement since we clawed like swamp thing up from the primordial ooze; nor do i expect to.

perhaps you are now thinking to yourself: well, perhaps we could work on the genome, or hit singularity, and be much much better than we are right now. what i might note is that the people futzing with the genes or the medications or the information technology will be us. these projects, to whatever extent they are pursued or pursuable, will be pursued by people who themselves are vain and venal, self-deluded, self-seeking, megalomaniacal, obsessive, thick as bricks, and hosts for the imp of the perverse.

say they come to believe that they know what morality consists in and impose it through genomics or software. (1) they'll turn out to have been wrong about the content of morality; (2) the actual implementation of this, as any human system, will benefit some and harm others, and perhaps exponentially increase human hierarchy. i myself regard that hierarchy as central to our evil; (3) implementation will be chaotic, flawed, back-and-forth, cowardly; for god's sake you'll have politicians involved and shit; (4) the unintended consequences will swamp the intended effects, leaving us extinct or at least profoundly puzzled and irritated.

well-deserved

the notion that obama would appoint a 'messaging expert' as ebola coordinator shows that they don't understand their own problem, which is that they have been unable to distinguish 'messaging' from responding to reality. this is why no one really believes what they're saying, and really, it's why no one has believed any american politician or bureaucrat for some decades now about anything. i think it's a kind of banalized post-modernism, narrative-theory thing. so sometime around 1970, someone pointed out again that there was no external world, only 'narratives' and so on. pretty soon, nike was running ads: 'we are the stories we tell'. it may be that people like obama and bush and clinton really can't tell the difference between the world and a story they are telling. that the story is incredibly self-serving is very hopeful: i can make the world adore and obey me if i can just utter the right phrase. their adoration of me will be their salvation, and then we'll all live in my hopey reality forever. let's focus-group some phraseology and work on 'the narrative', 'the message'. we've got to control the narrative, be more effective in our messaging. then, i think the growth of 'communications' programs and theories and 'strategic communications' exacerbates the effect, and some of the killer clowns who teach in those programs have a straight-up theory on which all communication is an attempt by me to get you to do what i want, and then the only question is, what noises can i make that best accomplish that? all communication is advertising.

in their human-centered, narcissistic, obviously false structure of non-thought, there can be no difference between medicine and messaging.

reality, see, is social, consensual, or 'what your contemporaries let you get away with saying'. then the only question is, what reality can you get people to consent to? unfortunately, the ebola virus is indifferent or impervious to whatever they consent to, as is everything else, even themselves.

for an actual creature in an actual world where something like natural selection operates to lose contact with reality, or to begin to live in its own fantasies and hallucinations, is to flow toward extinction. also, in this particular form, it is to deserve extinction.

health and self-defense

when the first nurse fell ill in dallas, cdc & co blamed her for failing to observe their protocol. and they blamed her before they actually knew anything about how she contracted the virus. this, i suggest, is probably the knee-jerk doc approach: blame the nurse. that was only one of many things that pissed the nurses off (one of the other irritations being that the cdc and everytone else appears to be quite cavalier about their lives). then there was a public backlash against that, and they sort of apparently reversed field, saying that nurses are heroes, and then hinting strongly that she violated the protocol. startegic communications at its best.

yesterday, testifying in congress, frieden simply refused to say whether it was the nurses' failure to observe the cdc protocol, or the cdc protocol itself that was at fault. (the other day, sanjay gupta ran through the whole cdc protocol on cnn, getting spattered with bodily fluids on exposed skin.) i think it was scalise who just kept saying 'did she violate the protocol or not?' 'it's raining outside, congressman.' 'yes or no?' 'here's a picture of my dog, congressman.' it was an idiotic display of inability to admit when you're wrong, and a classic defend-my-bureaucracy reaction. that's always irritating and yet pitiful, but here it's liable to be deadly. a decent, open, and truthful bunch of spokespeople and officials is necessary

how reassuring

there are various problems inherent in authority, and various problems inherent specifically in medical authority, that are very likely to make the ebola situation here in the states worse, and also to result in a major public freakout, already underway. so, a major part of the placebo effect of modern medicine is projecting an air of sort of casual omniscience and a firm reassuring demeanor. i bet they teach young doctors how to project this sort of authority. the first wave of cdc and cdc-mirror statements went like this. "there's no danger of an outbreak. we understand how ebola is transmitted and we understand how to control it. our super-effective selves and ourr super-effective health institutions are on the case." 

first, i think it is very likely that the total improvisational mess that was the dallas hospital's and the cdc's response to the duncan case rested in part on the fact that people actually appeared to think that infection was extremely difficult. reassuring us about that on evidently insufficient data might actually kill healthcare workers, you doinks. apparently on these grounds, the hospital administration was absurdly cavalier in handling duncan. and the very same people who said that we understand how it's transmitted etc said two weeks later that "we need to understand more about how ebola is transmitted". then they let very dire-sounding things escape their lips, and real fear in particular about the situation of healthcare workers. then they lurch right back to 'an outbreak is extremely unlikely', 'everything is under control' stuff, which they are repeating as a script, now incompatibly with the fear in their eyes. these are quotes from this bearded brit cdc mirror on cnn; i'm not pulling up his name, but it's the same with dr. anthony fauci, e.g. then invariably wolf blitzer of chris cuomo thanks him for making it all clear and reassuring us all.

so maybe the extremely authoritative presentation even of things about which you are not sure at all has the momentary effect of reassuring people. the problem is merely reality: when what you're saying turns out to be incredibly false, people stop believing you. they start generating alternative speculations on this or that. they start believing random websites, which indeed have more credibility. at some level they freak out in the awareness that they've got no idea at all what the truth is. nothing causes chaos like the breakdown of authority, and nothing causes the breakdown of authority like authority.

here's what i'd tell these people: ditch the self-esteem festival and the strategic communications. stop manipulating anyone and start speaking the truth as clearly as possible, including what you yourself do not know. we're going to need a new bunch of experts and spokesmen and authorities however.

soon tom cruise will stride alone through the smoking ruins of civilization

this ebola thing is not going perfectly well. cnn got the story that no one has cleaned up the dallas guy's apartment at all: sheets and god knows what else, with people still living there who had, let's say, no training in hazmat clean-up. there are many scenarios for a flare, even supposing people suddenly started doing competently now what they've been doing incompetently up to now. i would say that i am not finding the cdc and their echoers as reassuring as they think i should. i am very not clear whether they regard their primary mission as providing accurate information or 're-assuring the public'. sadly you can't always do both. also re-assuring the public and showing how wonderful we here at the cdc are is the very same mission, which could also cause truth-type issues. 

so tom frieden and his mirrors (such as the doctor/healthcare reporters on the news networks)  have almost scoffed at the idea that we could have a significant outbreak in the states, because of our '21st-century health infrastructure', 'excellent public health system', and so on. oh the entire handling of the thomas duncan case in dallas makes quite the little hash of that. a hospital sent an infectious ebola patient home. the cdc showed no interest in cleaning up the site, and no one else did either, until cnn broke the story.

so: the idea that ebola is extremely difficult to spread and cannot be spread by people who are asymptomatic: how absolutely actually certain are they about that? to what extent has the transmission of ebola been very carefully and systematically and widely studied before now, in those tiny sporadic outbreaks? because tom frieden and co are betting their lives on it. if we're not certain on that, who counts as a contact is so very very much larger. the problem is so very much larger. i find the difficulty of transmission a bit difficult, though perhaps not impossible, to square with the idea that ebola is increasing 'exponentially' in africa, or projections of a million or more infections in the next few months.

 

Doom, despair and agony oh me...

In which Crusader AXE avoids the snark to reflect semi-seriously on how the current attitude toward science research, funding and community will kill us all thus saving future generations from the problem of debt because they'll never be born or all be dead. 

Problem solved! Gomert-Paul in 1016!errr...2016.

 

death of the individual

it's relatively rare that i would agree with rush limbaugh. but everything he says here is true.

counter-strategic communicaton

it's ridiculous and instructive that romney and ryan are going around accusing obama of cutting medicare by $700 billion. one might think: well, they're just trying to manipulate people; they'll say anything. but instead of considering their strategy, think about their actual position and argument: they think they can accuse obama of doing more or less what they themselves endorse. in other words, maybe their goal is to manipulate, but what they actually construct is a ridiculous scatter of contradictions. we should hold people responsible for that: only really stupid people - people without the slightest notion of logical thinking - could take up simultaneously the positions that they endorse. it's annoying that 'strategic communication' (a contradiction in terms) leads politicians to treat us as idiots. but it should embarass them that it leads them to become idiots. politicians and the folks who teach this sort of 'communications' should stop thinking of themselves as firendishly clever manipulators of the populace and start thinking about what they are actualy encouraging people to say.

in the age of mechanical reproduction

in case you're wondering, i agree with all these conservative types that catholic medical institutions must be exempted from rules requiring provision of contraception. this, it seems to me, is perfectly clear on constitutional grounds, but also on basic moral grounds according to which one ought not to require people to violate their own ethical and religious principles. as i always say, ask yourself which has been the source of more evil: permitting people to act according to their own moral convictions, or coercing them to act in violation of those convictions. however, on the same grounds, doctors must be permitted to opt out of these state laws requiring that women wanting abortions must be shown ultrasounds or hear their fetuses described in any particular way. here's what i'd actually suggest: such decisions must be left to each individual doctor, working with her patient. this seems entirely obvious to me. stop trying to institute conformity to your own little beliefs, convictions, prejudices, and allow each person to act according to her own.

the post-moral period

it's amazing what is an illness these days: to begin with, your personality, your actions being symptoms. i guess i would think of this as a model, metaphor, or ideology: a central one of our era. apparently weiner is actually entering a residential treatment facility for compulsive sexting. now if one is any sort of materialist, one would have to expect personality and brain configuration to be correlated to some extent, even though i think 'science' is much further from explicating these correlations, or assigning causal roles, than it thinks it is. i think the idea that 'depression is a chemical imbalance,' for example, is an obscure and ham-handed (and basically unsupported) claim. at any rate, the basic idea is to de-moralize various traits or actions, which can be important in helping people stop doing destructive things. of course, it is also potentially an excuse, as when you attribute your harassment of congressional pages to an illness and disappear into treatment. it would be important to de-moralize some things, i think, but though the idea that people are born gay or straight reduces the moral weight, it also seems to concede that there would be moral weight otherwise, and it hints that one or the other might be an organic disorder. it's also kind of ridiculous in that sexual identities are extremely historically liquid, and hetero and homo as we get them have only been around a couple of centuries, more or less.

of course, if whatever you or society thinks is bad is the result of a disordered brain chemistry, then it seems likely that anything good anyone does is the also result of brain chemistry, and credit would be as out of place as blame. however, maybe it is.

at any rate, what hints that these models are ideological is that the positions people take up with regard to them are the positions that are useful for one purpose or another, that help you out politically etc. the rankest use is just the straight-up excuse a la weiner. but eventually it seems likely to excuse everyone for everything. that might be a good idea or it might not: it would be interesting to see what a post-moral culture would look like. one thing: it will be extremely profitable for pharmaceutical companies. 

if it's any comfort to you, i think it's fair to characterize individual responsibility and demon possession as ideologies as well. so then the question might be: which ideology do you prefer? i think the inquiry into us by us has irremediable problems.

i might suggest that treatment would be a good approach for assad or gaddafi after it all goes south, if they're still alive. being a tyrant is surely symptomatic. however, so is tyrannicide.

against 2012

the fact that ron wyden and ron paul are working against the continued expansion of government surveillance, or that they are not perfectly comfortable with the new national motto - "report suspicious activity" - is kind of a...model. i have to say i live in fear of the 2012 campaign, which - if the congressional election this week in new york is any indication - will continue the terminal degeneration of american political discourse into meaningless idiocy. really, i don't quite understand how something like the medicare debate can be so entirely polarized when it's conducted in terms this debased: there's nothing you believe if you agree with either side. if you're not actually saying anything, i can't agree or disagree with you, and the same result follows if there is no you: that's what we professors of communications actually mean by 'messaging': annihilation. 'message' is the opposite of 'meaning.' i hope that messaging is an expression of contempt for the electorate: that would indicate that the people who do it have the capacity to do something else, that they could say something substantial if they thought the audience had minds. surely the contempt of the electorate for the messagers is a reasonable response either way. we're right back to al gore focus-grouping 'risky scheme' and then basing a campaign on the phrase, throwing it down a thousand times. the policies are irrelevant to these 'people'; the only thing they care about is saying what other devices like themselves are saying. they might as well just sing along to nursery rhymes or maybe chorus 'gaga oohlala' for the next 18 months; that would be a more authentic expression of your unity with one another. where's the off switch? just smile at each other or slap one another on the back: there's no call to use words, 'ending medicare as we know it' or 'bankrupting the country' etc. the twin lineups of mp3 players all saying the same words in unison themselves embody an argument for anarchism, or at least an outright refutation of the very idea of democracy. if everything you say is just an attempt to manipulate the electorate by muttering the right words in order, i say quit. go away. 

like all television viewers, i have become an expert on side effects. the best i've ever seen are connected to simponi, an anti-arthritis drug. sometimes it's hard to decide between the disease and the cure, but i suppose once you're dead, the stiffness in your joints, while extreme, is no longer so bothersome.

SIMPONI™ can lower your ability to fight infections. Serious and sometimes fatal events can occur. There have been reports of serious infections including tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that have spread throughout the body. Other serious side effects include lymphoma or other cancers, hepatitis B, heart failure or nervous system problems.

johnson and johnson recalls hip implants. forcibly, if necessary.

i thought i might have a crack at some examples of what i might call strategic beliefs, which i think raise important questions in both epistemology and actual science and social policy. so here are my examples:

(1) alcoholism (or in general addiction) is a disease.

(2) people are born straight or gay.

(3) depression (or for example bipolar disorder) is a chemical imbalance in the brain.

now i am not a researcher and i haven't really had a serious crack at the evidence. but my view is that these assertions are either false, misleading, or so vague as to be unevaluable for truth value (for example: the notion of "disease" is an extremely vague, ambiguous, and problematic folk concept). but i also think that in certain situations each of these might be extremely important to believe: those circumstances are, roughly, treating addiction or depression, and making peace with one's sexual orientation and allowing people to have whatever sexual orientation they have.

each of these claims relieves the depressed, addicted, or gay person from personal responsibility for their situation: they all declare that the situation is not the result of the free decisions of the subject. now i think this actually has basically good consequences. i think this is the fundamental reason, for example, for the success of twelve-step programs, which i have experienced at first hand. it is a dogma in aa that alcoholism is a disease (or, as the big book says at one point, an allergy). if you think that your alcoholism is your fault, you will be filled with self-loathing, particularly at the point where it has destroyed your career or family. well this self-loathing will get you drinking. the typical drinking alcoholic is in a cycle where he desperately tries to exercise will power over his condition, which might work for a while, then lead to a collapse in which he succumbs. the typical addict runs through this cycle again and again. so you "turn your will over," you stop thinking that you can make yourself stop and are a horrible person because you fail. then you can stop.

so i would say that the recovering addict may need to believe that alcoholism is a disease (whatever that means, exactly). i might encourage someone to believe this - and i have - because it is more or less essential to recovery. and recovering addicts often are entirely outraged even by asking questions about this. but that does not make it true, which shows among many other things that the pragmatic theory of truth is false.

the "evidence" that depression is a chemical imbalance in the brain is kind of pathetic. i'll believe that when doctors are diagnosing depression by pet scan or urine test. depression is diagnosed on the basis of..sleep patters or energy levels, "suicidal ideation," etc.  and of course even if there were chemical changes in the brain associated with depression, that would not establish direction of causation: the emotional condition could be causing the brain changes as well as the other way round. the fact that seratonin re-uptake inhibitors are (sort of) effective in treating depression no more shows that depression is a chemical imbalance than the fact that you can treat pain with morphine shows that pain just is a morphine shortage.

try saying something like this to someone who believes or needs to believe that bipolar disorder is a chemical imbalance, and you will just get rejected with extreme dogmatic insistence. no it just is a fact. but that you believe it the way a christian loves jesus doesn't show it's true.

honestly i think that sexual orientation probably has extremely complex or chaotic origins, including i would think the nature of one's early sexual experiences, what sort of person one comes to associate with orgasm. but saying that is dangerous: it indicates that we could manipulate people into heterosexuality etc; it hints at a kind of genocide or something. it hints that if we want our kids to be het we should keep them away from gay people at all costs. basic acknowledgment of the full humanity and basic rights of gay people may be well-served by 'born that way.' but that doesn't make it true. 

there might be a hundred-year scientific consensus that depression is a chemical imbalance. but then, one might notice that much of the research is actually paid for by people who manufacture chemicals. and after it's over it might be entirely obvious that the claim was vague, ill-formed, and...wrong. that doesn't mean science doesn't converge on it for decades. to say that scientists are subject to social consensus, economic context, peer pressure, the models under which they were educated, etc is an understatement. well, there will be a new social consensus in 2045, and science will explore and explain the useful or consensus notion as the objective truth. it's happened many times, and will happen many more.

so the news networks are covering bill clinton's like routine follow-up operation (at least that's what they're saying it is) exactly as intensely as they covered the earthquake in haiti. if i was them i would send in anderson cooper and dr. sanjay gupta through a catheter in a magic schoolbus. kaboom!

pro-ana(rexia) websites have been causing quite a fuss lately. i was once engaged to an anorexic who was also a remarkable political theorist. the shit is life-threatening and must be taken seriously as a problem. but i think it is far more complex and interesting and important than people think. it's usually treated as a mimicry problem: girls mechanically imitating pictures in a monkey-see monkey-do structure. that is certainly an unbelievably impoverished, simplistic, and condescending account. we should think of it as raising issues of the power of girls over their own bodies, as a massive assertion of will or self-control, a declaration of autonomy. we need to think of food as a vector of power between parents/institutions and children, and also as a symbol of our animality and dependence on the world around us, a way the world enters into us and the way it leaves us. anorexia, among other things, is a demanding ascetic discipline, and provides the pains and pleasures, the slaveries and liberations, of ascetic disciplines everywhere. it is problematic on multiple grounds. but it is not simple, and it is not a mere reflection of misogyny or self-loathing. it is full of content, symbolic and actual, emotional, political, physical. it is more than a desire to disappear. it is self-assertion as well as self-abnegation. it is not always fundamentally a matter of false body image or of media effects. i think to treat it, we'd better try to deepen our understanding of it. it's not at all surprising that people find each other and support each other even in such a problematic way on the web; it's one of the things that the web is good for. i would not censor or break it in any way. there are thousands of problematic communities, or communities of people with problems, or people who are exploring ways out, around, through, and into the power structures of our society, and our dilemmas as existing human beings. it's ok. or it's not ok. but it's true. and it's important.

speaking of who's making the money on bipolar disorder. etc.

i see the history like this: we moved from various previous models, in which emotional distress was accounted for by demon possession or whatever it might be, to the concept of mental illness. this was a useful metaphor, or extension of the concept of illness, and nothing prevents a metaphor from becoming literal: after everyone calls things like schizophrenia an illness for a hundred years, it is an illness; it falls within the proper extension of the predicate. you could have two parallel but entirely distinct kinds of illnesses, of the body and of the mind. but the dualism behind that made everyone uncomfortable, and was of course thrown into question by the intimacy of the relation: damage someone's brain and, as it were, you hurt their feelings. so the research program moved to a model in which mental illnesses were supposed literally to be physical illnesses. here is where the terrain gets all scumbled up, where you suddenly realize you don't have a very good grasp on concepts like "disease" at all, where dormitive-virtue fallacies proliferate like fungi, etc. that's the conceptual mess we're researching inside now, and the most urgent task would be a clear set of definitions, acceptable standards of reasoning, and so on.

and then the question of whether addiction is a disease is far more complex even than the bipolar case. first, it would support the externalist notions: you can't be an addict just in virtue of brain states: you've got to ingest external substances. which you ingest and how are relevant to the brain chemistry, of course. here we have a huge family of behaviors and stuffs, on a continuum: i've known addicts who didn't last more than a year or two: just did what they did all the time until death or recovery. and i've known addicts who could probably go on to a normal life span, having, say, a few drinks every day, more or less. (let's hold in abeyance addictions to food, pornography, love, sex: good christ.) that it's a coherently-describable brain syndrome seems ridiculous. on the other hand, the disease model(s) gives you important truths about the phenomenology: it doesn't seem to be fully under your conscious control, it seems to have a genetic piece, and so on. and believing that it is a disease turns out to be pragmatically effective to some extent: it means you are not yourself completely to blame, or the people around you, and if you feel completely responsible, that's a collapsing burden of guilt that will keep you using unto death. but again, what is of use to believe and what is true are radically distinct questions. at any rate, i think it's extremely unlikely that you'll find the one wrong gene, or screwed-up synapse. keep trying, though, please.

a few notes: i'm more or less a materialist, and i accept some version of a token-token identity thesis: that is, for example, there might not be an interesting identity between, let's say, anger, and a discernible family of material brain states, but in any given case of anger, there is some material state that corresponds to or is that event. my only qualification would be that the state is not necessarily exclusively a brain state, but could encompass a state of the nervous system, the organism as a whole, and the external world (i am a "content externalist").
also, on the concept of disease: we usually think of disease as the operation of an external agent on an organism, like a virus, e.g. but this is a difficult question, and some ways that the organism might degenerate or be deranged could count as diseases, as in some caused by malnutrition or vitamin definciencies etc: the notion of disease is not well-defined in common use. alzheimer's is an interesting case, for example.
but i don't think that bipolar is likely to be well-described in either of these senses. rather, there might be a family of characteristic brain conditions correlated to some extent with a constellation of symptoms. but that's the very best you will get, moving from an extraordinarily rough symptomatic constellation, generalized as a disease. since every brain-state resembles every other brain-state in indefinitely many respects (indeed, every thing resembles every other thing in indefinitely many respetcs) it's definitely not surprising if we could roughly identify some resemblances between the token brain states correlated with bipolar mental/emotional states. and notice, there might also be correlations to environmental factors and so on that are probably more or less exactly as good.
then direction of explanation introduces a whole host of further complications, not seriously present even in a case like alzheimer's: you're not liable to be able to temporally arrange the relevant brain states as prior to the emotional symptoms and so on.
and then you have to ask: what do you get out of believing that bipolar is a disease? who's making the money and devising the models? etc. i don't do all this to fuck up your treatment, but what one wants or needs to believe to get better is not the same as what is true; indeed, that you want or need to believe it or benefit from believing it is a good reason to be sceptical of it.

i want briefly to consider henry's view that bipolar disorder is a brain disease, treatable with drugs. i do not reject it out of hand, and also i am not really acquainted with the research, so this will be at a pretty high or useless level of generality. now first of all of course the illness is not defined in terms of brain states, but in terms of symptoms: you're down, then you're manic. do that intensely enough, and you're bipolar, whatever your brain states. furthermore, i will stipulate that any particular (token) emotion, thought, etc is identical to some sequence of physical events, (some of them) in the brain. but it's not like we have a bacteria or virus which we can identify as the cause of the symptoms, which is what gives heft to the physiological concept of disease. now what we want to do is see whether, in people that report such symptoms, there are underlying similarities of neural structures or events, pharmaceutically alterable. i am betting that there are such similarities among many, though not all, cases, if we withdraw to a suitable level of generality. but once you give any very precise characterization of these similarities, i'm also betting that there are people with bipolar symptoms who don't display them, and people who don't have bipolar disorder who do. also i'm betting that to encompass as many cases as possible, the characterization of brain states has to become more and more amorphous and impressionistic, taking in as many varied individual states as possible: the characterization of the brain states is from the get-go an attempt to account for as many symptomatically-similar mental states as possible: the reasoning is from symptom to state rather than vice versa. in such a strategy, you will always be able to generate a rough set of symptom-correlated brain states. furthermore, though there are good reasons to think that people who display the symptoms of bubonic plague are all caused to do so by a certain germ, in the bipolar case the relation, to whatever extent it does intend to identify an organic cause, is far, far more elusive, ranging over constructed families of similar brain events. and of course, the matter is correlation rather than causation: the bacteria causes plague, more or less demonstrably. but the brain states, described at a certain level of generality, sort of correlate with the emotional states; either might be the cause of the other or, plausibly, the causal relations are extremely complex.
to just say it's a brain disease is, hence, simplistic. to the extent that this helps us diagnose and treat - to the extent that it makes people less miserable (for one thing by eliminating the disturbing idea that one is responsible in some way for one's emotional disaster) it is useful, though for all that...metaphorical. the "disease model of addiction" is surely exactly like this, and it's embroiled in a whole ethics of responsibility and a whole strategy for treatment. the question of whether it's true or not, no matter how many recovering addicts believe it with total commitment, is a hard question. yes and no. it depends on what you mean, etc.

just back into the breach for a second: "wait. is that a metaphor?" or "to what extent is our conceptuality embroiled in dormitive-virtue fallacies?" are not questions you can answer with, say, mri studies or something. these are questions that lie well outside of the sciences that they are about, and - evidently - outside the skill-sets of the scientists doing the studies. insofar as there are experts on questions like that, they're, like, literary critics or critical-thinking teachers. but obviously they go right to the heart, straight at the foundation, of what these scientists are doing. the discussion cannot be internal to the scientific community. you can't have any science, and you definitely can't have good science, without moving to external questions about taxonomies, methodologies, genealogies. to take the last: ok, say we're doing mri studies on adhd or opposional defiant disorder. when did this concept emerge, and from what, and by whom? how is it deployed in institutions? who benefits? and what then happens to the diagnosees? how else might we conceptualize this terrain? how have we before and how might we later? etc etc. if you've got no take on that, and just keep giving people pills and watching their brains light up, you don't even have any idea what you're doing or why.

i think one implication of the sort of observations i make below is that there just cannot be science without philosophy. the taxonomies and basic methodological assumptions on which a set of scientific results rest cannot be the results of the very inquiries they make possible: that is, science cannot rest on science, or on actual observation and experiment. so for example you can have a couple of centuries of science resting on the concept of race, but the initial taxonomy of races and the initial development of the concept of race are not themselves scientific results; they are assumptions. nor do they yield or dissolve at last under scientific scrutiny, because the observations made under their auspices always confirm them. (in ths case, they yielded to political pressure.) the disease model of emotional difficulties is similar. once you start identifying or enumerating the illnesses under the auspices of the model, all data confirm it, necessarily. and it's not within the purview of science per se to say, hmmm: is that a metaphor? or what? if such things are illnesses, then of course they must be categorized and so on, even if this activity lands you in extreme dormitive-virtue-type fallacies. if there are logical fallacies at the basis of a science (or if, as in the kiddie-dsm case, there is nothing at the bottom besides such a fallacy) that science cannot of course identify them: you need some sort of logician.
putting this in a more practical manner: these "scientists" are so inside questions like whether the proper diagnosis is severe mood dysregulation or oppositional defiant disorder or adhd, and so funded up to their eyeballs inside the whole idea that such questions are significant, and so basically non-conceptual in their approach, that they're just not going to go: what the hell are we doing over here? how do these terms secure reference? etc. they don't have sufficient externality to their own questions to evaluate the basic conceptions on which they rest, and on which their research cannot, by definition, bear.

i was antiquing and quilt-shopping in lancaster county today with the redoubtable ms. judith s, and i bought a little dovetailed wooden box that once evidently contained a patent medicine: "hemaboloids, arseniated with strychnia." feel better, honey?

thus the guardian/observer

Infections from the debilitating norovirus stomach bug will peak this week as millions return to work after the holidays and spread the germs, the government has warned. People are advised to protect themselves by washing their hands thoroughly at all times.

on the other hand, if you're washing your hands "at all times" you may also end up hospitalized, though in a different ward. quite the damn dilemma.

i think we better fight for this guy's right to run his own life. and death. i think we better fight for everyone's.

this is an interesting, hard story. and speaking of "alternative treatments in mexico," you may remember that as the final move of andy kaufman  and coretta scott king, who should have been a couple.

sneeze on

leave it to the diabolical mind of charles krauthammer to wise us up to an extreme unnoticed emergency: that osama is about to release the 1918 flu, creating the final pandemic, the end of the glory that is america. this is how a neocon thinks: here's an interesting event, essentially irrelevant to my worldview: how can i fold, spindle, and mutilate it until it becomes a motivation for increasing the power of america abroad and the power of the executive branch at home?

new brain cells

good news for your head .
i always hate to quibble with rigorous scientific methodology, but this result does rest on the somewhat questionable inference that a bad case of the munchies is evidence that a rat's anxiety has lifted. spelling out the various possibly unwarranted assumptions impacted into this result would mess up my high.

Zhang's team suspected the new brain cells also might be associated with a reduction in anxiety and depression, because previous studies had indicated medications used to treat anxiety and depression achieve their effect this way.

To find out, they treated rats with HU210 for 10 days and then tested them one month later. When placed in a new environment, the rats were quicker to eat their food than rats that did not receive the compound, which suggested there was a reduction in anxiety behaviors.

Another group of rats treated with HU210 showed a reduction in the duration of immobility in a forced swimming test, which is an indication the compound had an anti-depressant effect.