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James Brody March 19th, 2007 11:58 AM

What Psychiatrists Do
The enemy must bleed! I heard one of their organizations whimper this morning in a radio ad informing all of us that a psychiatrist is the only professional qualified by training the match medications to other methods in mental health treatment.

Psychiatry, however, experiences Internet outcomes: as information becomes more public, it also becomes less costly. Dealers in car insurance, auto prices, and real estate have all reduced their prices, often $250 to walk in the door. A second, more fundamental outcome: patients walk in the door with a diagnosis and medication already in mind. One shrink remarked that he generally gives his patients whatever they ask for!

Psychiatry's ad brought to mind a rant I have made before:

1) Pharmaceutical companies are in an arms race to reduce side effects while providing some illusion of benefit. Changes are slow and usually small variations of last year's drug.

2) Individual responses vary, however, and any physician of any training, will have to "trial and error" you. The day may come when a lock of your hair tells what pills to give and in what circumstances, but we ain't there yet.

3) Foreign medical graduates are as plentiful as Muslims in the Russian army...a near majority! I understand a FMG's ability to splice a femur but am skeptical about their ability to transcend cultures to fine-tune an angry Celt. Again, the pill-designers prevent that need from occurring and protect many psychiatrists from charges of incompetence.

4) The main business of a psychiatrist is often "medication checks." (These practitioners often call themselves "neuropsychiatrists" in the same manner that a plumber is a "sanitary engineer." The doc asks "How's it going?," scribbles a note, and often gets you out in seven minutes. Within those seven minutes the practitioner must convey sincerity and kindness while not poisoning you. After all, the more abrupt or arrogant the healer, the greater his chances of being sued.

5) There are no genes for plumbers but some of the bags for carpenter genes attended medical school rather than VoTech. Nonetheless, psychiatrists must work in a plumber's shared environment. (Psychologists, a different genome, obsess about ethics, rules, and appropriate treatment. They write grand unifying theories. Psychiatrists produce few GUTs and tend to be pragmatists and sometime risk-takers who want to find their own recipes for their cafe visitors.)

6) Psychiatry, however, survives because of an accident: Suicide is considered as an emotional problem but medications for "depression" were once lethal and no other physician would write an order for them! Psychiatrists, I suspect, remain the exploratory edge for medications management in the treatment of emotional distress. GPs and Nurse Practitioners wait for the preliminary results from what is known in the computer world as "beta testing."

7) Psychiatrists are reputed to be the lowest paid medical specialty and to have the lowest aptitude scores. According to Kay Jamison, a gifted psychologist who can be bipolar herself and studies creativity and bipolar disorder, psychiatrists and female therapists share high risks for suicide.

End of rant, no extra charge...

alexandra_k April 3rd, 2007 04:46 AM

Re: What Psychiatrists Do

I'd just like to add that some side-effects are very welcome indeed. Prozac, for example, has a side affect of weight loss that was partly responsible for the popularity of the drug (and hence for the income generated from it).

I wonder just how seriously they are attempting to reduce the side effects to do with disruption to sexual desire / performance...

James Brody April 4th, 2007 12:03 PM

Re: What Psychiatrists Do/Side Effects

In Ned Hallowell's words, "Someone, sometime, will respond to some medication in some way." Natch, an MD and a showman who claims to have ADHD but also memorized John Milton's "Paradise Lost" the night before a Harvard Exam.

Anyhow, the docs, the ones un-sued, don't write a script and say, "See you in a month."


James Brody February 18th, 2008 11:18 AM

NIU Murders
A talk show host almost stammered when he remarked that the NIU shootings made him consider eugenics. Of course, I had to react!


"your mention of "eugenics" sat me up right up, real fast! Here are ten ideas and a suggestion.

"1) Hayek tells us that thugs find opportunities in idealist's dreams. For example, Frank Galton, a nice guy although sometimes bipolar, was horribly misused in an era of "whatever is social is right and there is no definition of right beyond that." The left - whose leaders included Hitler, HG Wells, Oliver Wendell Holmes, and other progressives - justified removal of the emotionally, intellectually, and racially variant. None of them recognized, however, that high IQ is itself a people make inventions, money, and professional societies but not children. Idealists who advocate eugenics are like other bright people - not only more likely to commit suicide but also make jobs for thugs.

"2) Motives, like wealth and like genetic influences, follow 80-20 rules. That is, twenty percent of the causes account for eighty percent of the results but suppressing the big reasons may not solve the problem. The reason is that human outcomes - if you include the environments that people make for themselves - may sometimes be as much as eighty percent derived from internal characteristics. And some of those internal traits may be influenced by prenatal events that make one developmental sequence more likely than a different one.

"3) Murder has things in common with suicide and other disorders. They are exaggerations of relatively normal motives (yes, most of us will kill another human given the right contexts) and the results of complicated networks of events. One result is that the first explanation is rarely correct and you need a special kind of mind if you are to find the contributors to any one nightmare.)

"4) Murder, like suicide, is often more explainable after it occurs. Prediction is far more difficult and you must confine more than 1000 people who have nearly identical features and histories in order to catch the one. Lawyers, costs, and good sense keep you from doing this.

"5) Being killed ends not only life, it also prevents future children but killers, in some cultures, actually father more offspring, not fewer. On the other hand, gossip and ridicule have a similar outcome; for the mating prospects of an awkward male, the giggles of a high school girl can be a lethal as a bullet.

"6) Beware the neurosurgeons! Frontal lobotomies were developed in the mid '30s and continued into the '80s ( ). Rage often disappeared. So did the ability to plan. At one point, the kind psychosurgeons wanted to make this gift available to the poor and found ways to do the operation through your eye socket after you were knocked out by electroshock. (Experimentation in the '60s sometimes used prisoners: I recall Jose Delgado's recording and film of a violent criminal who, post-surgery, played a guitar and sang tribute to Dr. Freud, "...oh how I wish you had been differently employed.")

"7) Medication - There is a fundamental contradiction when we look for a medicine that (a) does something useful but (b) makes no one sick! It is true that there are genetic and social similarities between us that provide stability, there are also differences that admit each of us to a different future. Any food or medicine, thus, will poison some of us but help others: a medicine that bothers no one usually does nothing for anyone. And medicines intended to weaken rage will, in some people, make it worse. (Even dodge ball will cripple some kids, the trick is predicting which ones.)

"8) Genetics: it will be surprising to find even one behavior trait that does not show heritability. (Even watching television has a genetic loading.) "OGOD" - one gene, one disorder - is an exception. The trick is in finding the network of genetic contributors and the environments that turn on some of them. So far, there have been lots of candidates for depression, bipolar disorder, schizophrenia, and Aspergers - none of them have passed rigorous inspection.

"9) The media - as if it were a modern Greek chorus - has a role in this! That is, heavy media exposure allows like-minded people to seek similar outcomes, including murder. A Japanese physicist, Yoshiki Kuramoto, defined the conditions under which pendulums will come into synchrony swing left or right at the same instant. In the language of Brooklyn, hook up similar things to each other - whether fireflies, transistors, or guys and dolls - and they will march to one same cadence. Similarity, thus, is the strongest contributor to love and marriage. Further, psychopathology is an important element of similarity! Implications: any madman can find a soul mate on today's Internet and each generation may be more bizarre then the prior one.

"10) There's another aspect to media influence: most of us want to see, warn about, and avoid similar gunmen. There is also more concern about changing one of them immediately, even if in ways that may be inconsistent with the other aspects of his personality. The outcome is that the social isolation that exaggerates deviancy increases: killers become better at hiding from therapists, psychiatrists, and lobotomists while confiding only to other killers!

"The NIU slayer is not about guns but about the nature of individuals and societies. That is: "Organisms are extremely internally heterogeneous. Their states and motions are consequences of many intersecting causal pathways, and it is unusual that normal variation in any one of these pathways has a strong effect on the outcome. To be ill is precisely to be dominated by a single causal chain. (emph. added, jb) To be obsessed by an idée fixe which motivates all one's actions, or to be convinced that all behavior on the part of others, without distinction, is hostile, is a form of mental illness...Indeed, we may define 'normality' as the condition in which no single pathway controls the organism." (Richard Lewontin, 2000, 93-94)

"Bottom line - one man pulled the trigger but any one of us might have done the same and any one of us - with the best of intentions - might have helped him do it. His medicines could contributed to his madness, his brilliance could have fired his resentment over failure, a quirky religion could have made another kind of suicide bomber, and counselors may have taken his money while accomplishing little. Although we ain't there yet, science, common sense, and a respect fo human nature will eventually make the NIU event less likely. Meanwhile, be careful of what you blame and cures you endorse!

"With greatest respect, thanks for your show..."

Barabási A-L (2002) Linked: The New Science of Networks. NY: Perseus.
Brody JF (2008, March) Rebellion: Physics to Personal Will. Lincoln, NE: iUniverse.
Buss D (2005) The Murderer Next Door: Why the Mind Is Designed to Kill. NY: Penguin.
Colt GH (2006) November of the Soul: The Enigma of Suicide. NY: Scribner.
Hayek FA (1944/1944) The Road to Serfdom. Chicago: Univ of Chicago.
Lewontin R (1998/2000) Triple Helix: Gene, Organism, Environment. Cambridge, MA, Harvard.
Maes HH, Neale MC, Kendler KS, Hewit JK, Silberg JL, Foley DL, Meyer JM, Rutter M, Simonoff E, Pickles A, & Eaves L (1998) Assortative mating for major psychiatric diagnoses in two population-based samples. Psychological Medicine, 28(6), 1389-1401.
Ridley M (2000) Genome: The Autobiography of a Species in 23 Chapters. NY: Harper Collins. (Current, but more technical, information about behavior genetics in Plomin, R., DeFries J, McClearn G, & Rutter M. ,1997, Behavioral Genetics, 3rd ed., NY: Freeman.)
Strogatz S (2003) Sync: The Emerging Science of Spontaneous Order. NY: Hyperion.
Voracek M (2004) National intelligence and suicide rate: an ecological study of 85 countries. Personality & Individual Differences 37:543-553."

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