Dear Dr Mike,
No confusion on my part. I was pointing out that the balance of the evidence goes against the notion of a lesion or gross chemical imbalance. You appear to be using the weak neuron doctrine ("the brain is the organ of the mind") to support the strong neuron doctrine ("psychiatric problems must have a neronal pathophysiology"). There is currently no evidence for anything other than a functional effect of OCD. No trait markers. Cognitive behaviour therapy and pharmacotherapy are, currently, not "simply two different ways of obtaining the same goal"; they obtain considerably different goals in terms of longer term outcomes. That is, stopping medication leads to approx 90% relapse within 7 weeks. Stopping CBT does not, improvments are largely maintained on the cessation of treatment. The dichotomy of "biologically based" Vs "psychologically based" remains theoretically very productive, and the debate is very much alive. We have not achieved a sensible integrative framework as yet. Disease models hamper this process.
best wishes
Paulo
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