don’t throw out the baby with the bathwater<\/em>", is exactly what I felt when I was thinking about this case. In the great revolution of 1980, psychiatry threw out Neurosis, and Conversion Reactions were the prototype for that category – cases that looked like Brain Disease [neuro·logic] but were really Mind Disease [neuro·tic]. We don’t see Conversion much these days. In fact, I’ve never seen a case of Conversion among the urban educated. But I’ve seen plenty at the edge of the galaxy – Charity Hospitals in Memphis and Atlanta, here in Appalachia – the more primitive parts of our culture. The urban rich find more sophisticated ways to get sick with stress and conflict.<\/p>\nThe treatment of Conversion isn’t Celexa and Depakote – nor is it the psychoanalysis of Freud’s discovery days a century ago. Actually, it’s not all that hard. All it requires is an understanding that "The symptom or deficit is not intentionally produced or feigned [as in Factitious Disorder or Malingering]<\/em>" like it says in the DSM-IV, and knowing the difference between primary gain [the psychological problem solved<\/em>] and secondary gain [the real world problem solved<\/em>]. In the case in the last post, the secondary gain is that it got her out of her work situation. Most people intuitively get that part but see it as malingering. What they don’t see is the primary gain, her intense personal need for control and order [something she came by honestly], and that she literally feels like she’s going to come unglued in chaotic situations. Psychiatrists stopped thinking like that thirty years ago, and it was a loss [the "baby"], as illustrated here. Over the ensuing years, she’s become avoidant, afraid it<\/em> will happen again, but she doesn’t know what she’s avoiding or why. There are any number of ways to help her with that once her obligatory need for control is the identified problem rather than some vague fear of an unknown brain disease that looms up ahead. But enough of that. The point here is that it was a multiple whammy to me – iatrogenic illness from misuse of medication, an untreated treatable<\/em> illness, and a missed opportunity to prevent the avoidant illness that followed. <\/p>\nSo the Depakote part of this post is about the damage a medical approach that is over-reliant on medication [given casually] can do. But the other part is what’s been lost in the post DSM-III take on mental ill·ness. There was a lot in those 1980 days that needed to change, but a lot of things that were essential to an everyday common sense understanding of the people that come for help needlessly went with it – neurotic illness being a prime example. Today, we’re in a time when there’s a major disillusionment with psychoactive medications in general – well earned and something I can’t seem to stop talking about. So it may seem an odd thing for me to say, but I hope in the coming reforms, we can avoid that "
baby with the bathwater<\/em>" thing this time around [not the one Lieberman was talking about!]. This pendulum has done enough swinging and needs to stop somewhere near the middle. Rational and careful use of biological treatment has helped and can help a lot of people in spite of all the misuse and damage. The problem is not the medication. It’s the overwhelming interference of other interests [including the collusion of segments of medicine itself] that have us so far out at sea right now…<\/div>\n","protected":false},"excerpt":{"rendered":"I don’t know much about Depakote. I see a lot of patients who announce, "I’m Bipolar" or "I’ve been told I’m Bipolar" but the overwhelming majority have neither the clinical narrative nor the family history to support that diagnosis. I do my best not to bludgeon them with my skepticism, but taper them off of […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-31991","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31991","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=31991"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31991\/revisions"}],"predecessor-version":[{"id":32019,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31991\/revisions\/32019"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=31991"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=31991"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=31991"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![](\"http:\/\/1boringoldman.com\/images\/modern-times-revisited.gif\")
<\/p>\n![](\"http:\/\/1boringoldman.com\/images\/depakote.jpg\")
<\/p>\n![](\"http:\/\/1boringoldman.com\/images\/depakote-1.jpg\")
<\/p>\n