{"id":41293,"date":"2013-11-03T17:24:33","date_gmt":"2013-11-03T22:24:33","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=41293"},"modified":"2013-11-03T17:28:05","modified_gmt":"2013-11-03T22:28:05","slug":"a-success-in-my-book","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/11\/03\/a-success-in-my-book\/","title":{"rendered":"a success in my book…"},"content":{"rendered":"\n

When I asked Sandra Steingard to  post here, I had little worry that we would disagree about much of anything after reading her posts<\/a> on  <\/em>Mad in America<\/a>. In a guest post from Sandy Steingard…<\/a>, she calls herself muddled<\/em> three times. In the face of the complexity of the narratives patients bring to us mental health types, anyone who isn’t muddled<\/em> isn’t even in the game in my book, and hasn’t grasped our place in these stories. As a practicing Internal Medicine physician, away from the situation of training, I found myself muddled<\/em> all the time, but it usually wasn’t about the biological issues in the case. I had been well trained. It was the people, their lives, the interactions between their personae and their physical illnesses. I didn’t find that side of things any different from the clinical medicine or the scientific research I’d done before. Find out everything you can and sooner or later, there would be clues and hunches to follow – blind alleys often, streets of gold occasionally, and sometimes small inroads that moved things forward. I went to psychiatry because it was about those muddles of life<\/em> I had become interested in. So Sandy’s acknowledgement of being muddled<\/em> insured we would likely be on the same page right off the bat.<\/p>\n

I’ll weigh in on the Schizophrenia thing later. Right now there are some other reactions at the front of the line. Skipping down towards the bottom of her post, she says:<\/div>\n
\n
Although I end up with more questions than answers, there are people who have helped me gain some clarity. One of them is the British psychiatrist, Joanna Moncrieff<\/a>. In her books, "The Myth of the Chemical Cure<\/a>" and "The Bitterest Pills<\/a>" she makes the distinction between a drug centered and a disease centered approach to thinking about psychoactive drugs [see her here<\/a>].   She has written about this on MIA<\/a> and there was also a critique of her recent book<\/a>…<\/div>\n<\/blockquote>\n
I remember that happening in the 1980s. I had left academia and was in a solo practice, and I began to see patients who had been told that they had a physical illness, like diabetes<\/em>, that it was caused by a chemical imbalance<\/em>, and that the medication, like insulin<\/em>, rectified that imbalance. That was certainly not known, and at first  I tried to be gentle in talking about it with patients. Then one of them named the source as a psychiatrist I had trained. I called him up and asked where that came from. He told me he knew it was an exaggeration, but that it helped people be more medication compliant. I won’t say what I said after that, but it wasn’t pretty. That kind of malarkey didn’t last in that specific form for more than a few years, but it didn’t go away and haunts us. Dr. Moncreiff also skillfully documents the renaming of the psychiatric drugs as anti-this-and-thats<\/em><\/font><\/strong> [see this must-watch video<\/a>] – antidepressants, antipsychotics, etc. That’s a double-whammy. It implies that depression and psychosis are physical diseases and amenable to ghost-buster techniques. I’m older than Sandy and never believed those widely taught simplistic ideas, but I think we’re all indebted to Dr. Moncrieff’s clarity in discussing the topic and Sandy’s highlighting it for us here. As I said in in the museum…<\/a>, these are primarily symptomatic medications at their best – not like insulin<\/em>, not like vitamins, closer to aspirin. And they all come with a downside, a downside more virulent than aspirin [which has its downside too].<\/div>\n

<\/p>\n

Sandy mentions another blogger, Nev Jones<\/a>, and a particular post on her blog: <\/div>\n
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Another blogger whose work I admire is Nev Jones<\/a> who writes at her site Phenomenology of Madness<\/a>… Nev writes about her own and her family experiences with – to use her term – madness. One of her more poignant posts is <\/em>ain’t no way to deny it, if it’s in your soul<\/em><\/a>. She is so articulate and careful with her language (among other things, she is philosophically trained) that I hesitate to say more and risk misrepresenting her.  She is an activist and a scholar and I find her courageous in her willingness and ability to articulate difficult and sometimes unpopular positions. But if I were to encapsulate the one point Nev has so clearly articulated for me, it is the concept of heterogeneity.<\/div>\n<\/blockquote>\n
Nev’s post [ain’t no way to deny it, if it’s in your soul<\/em><\/a>] and Wiley’s comment<\/a> to Sandy’s piece speak to some of the impossibilities of madness – for a person, for a family member, and, in my case, for a doctor. I shy away from the endless debates about such things because they’re so experience distant from those encounters that they denigrate the essence of the moments. I was never a combat soldier, but I’ve met many and heard them talk about the painful alone-ness they often feel when civilians are talking about war. Nev and Wiley are veterans. Like Sandy, I also "hesitate to say more and risk misrepresenting<\/em>" them, but I appreciate their insight about the fog of madness<\/em> – when the compass is spinning without direction for all involved.<\/div>\n

<\/p>\n

Right now in the comments, there’s something of an interesting debate about distinguishing delusions from strongly held but idiosyncratic ideas. I’m going to add my input about that particular point later when I respond about Schizophrenia. But for the moment, this guest blogger experiment is already a success in my book, and I really appreciate the respectful tone of the comments. These topics are often divisive, but the things I’m reading right now aren’t like that at all and I’m grateful for that…<\/div>\n","protected":false},"excerpt":{"rendered":"

When I asked Sandra Steingard to  post here, I had little worry that we would disagree about much of anything after reading her posts on  Mad in America. In a guest post from Sandy Steingard…, she calls herself muddled three times. In the face of the complexity of the narratives patients bring to us mental […]<\/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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-41293","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41293","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=41293"}],"version-history":[{"count":15,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41293\/revisions"}],"predecessor-version":[{"id":41308,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/41293\/revisions\/41308"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=41293"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=41293"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=41293"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}