If mental illness comes from (say) bad patterns of thinking, then pharmaceuticals won’t work as a treatment, except as a temporary and generalised mood-alterer. According to this narrative, giving a depressed person SSRIs is like giving painkillers to a patient with a broken leg; worthwhile as a temporary measure, but unimportant compared to the crucial task of setting the bone, which only trained therapy can do. Advocates of this point of view typically cite the unimpressive performance of certain kinds of pharmaceutical therapies when compared to placebo.
If mental illness comes from (say) faulty synaptic function, then therapy won’t work as a treatment, except as a placebo. According to this narrative, giving a depressed person CBT is like a nurse providing reassurance to a patient with a broken leg; worthwhile, but unimportant compared to the crucial task of setting the bone, which only biochemical intervention can do. Advocates of this point of view typically cite the impressive performance of pharmaceutical regimens in dealing with certain mental illnesses, the poor performance of various talking therapies compared to “placebo therapy”+, and the historical lack of interest of talking therapies in empirical validation.
Now I call these “narratives” because they are deliberate oversimplifications; riparianx is right that it may well be that some mental illnesses are “mind” and some are “brain,” and some a bit of both. Nevertheless they express very real ways of thinking about the problem. In 1940 the medical consensus was that the first narrative was broadly true. By 1990, the medical consensus was closer to the second.
i.e. allowing the patient to discuss their problems with an untrained, sympathetic listener.
Coming from a reductionist “mind is brain” viewpoint, therapy actually does help. This is pretty well documented in the fact that 73% of patients who go through it say it helped in the long run. (statistic from my psych 101 textbook) Talking to a therapist may not increase your serotonin levels, but it does help teach you new mental “patterns” and ways to cope with the results. Saying the brain doesn’t follow patterns is, well, wrong. The more you have a thought, the more the thought comes to you. If a chemical imbalance puts you in a mood that leaves you susceptible to a kind of thought, then you’ll have that thought and start a negative pattern. So even then, if the chemical imbalance is fixed, you can still be stuck with the results. Therapy helps you build more positive patterns and maybe even let the old ones fade.
Coming from a reductionist “mind is brain” viewpoint, therapy actually does help. This is pretty well documented in the fact that 73% of patients who go through it say it helped in the long run. (statistic from my psych 101 textbook)
You have to admit, this is weak tea. What would you think of a pharmacological study that relied on the fact that 73% of patients “say it helped.” We don’t need no stinkin’ effect size or control! As I’m sure you’re aware, there is a great deal of controversy about the effectiveness of talking therapies, and it is even controversial whether such therapy really does anything more than “just talking.”
Now look, I too am in the reductionist “mind = brain” camp, and I too think therapy can be effective in principle. I am actually very sceptical of the idea that mental problems such as depression, anxiety and OCD result from a generalised “hardware” problem (such as faulty neuroendocrine function). Yet just by mentioning the (very widely held) notion that these problems do have such a basis, I’m apparently espousing dualism. It’s very strange.
Saying the brain doesn’t follow patterns is, well, wrong.
Yet just by mentioning the (very widely held) notion that these problems do have such a basis
The issue isn’t that you mentioned the notion that the problem might be due to faulty neuroendocrine function but that you assume that talking can’t do anything about that.
I’m apparently espousing dualism. It’s very strange.
If you limit talk therapy to the goal of changing the mind and ignore hardware than you lose effectiveness.
Granted it’s impossible to get good feedback to do targeted interventions on the biochemical level but the body is still vitally important.
But even given SSRI isn’t targeted intervention on the biochemical level. According to a recent article:
It is currently impossible to measure exactly how the brain is releasing and using serotonin, the researchers write, because there is no safe way to measure it in a living human brain.
Instead, scientists must rely on measuring evidence about levels of serotonin that the brain has already metabolized, and by extrapolating from studies using animals.
The best available evidence appears to show that there is more serotonin being released and used during depressive episodes, not less, the authors say.
SSRI might also work by reducing inflammation. They also hit targets outside the brain. Depression correlates with inflammatory cytokines. There are efforts underway to focus on diagnosing depression with blood tests and if those tests come the prime measuring stick the official definition of depression might even include inflamation.
Now I call these “narratives” because they are deliberate oversimplifications; riparianx is right that it may well be that some mental illnesses are “mind” and some are “brain,” and some a bit of both.
Or that distinction simply doesn’t make any sense.
If I hug a person and the person feels better I can explain that with a raise in oxytocin or with changed unconscious thoughts about how the person feels liked. Making that distinction isn’t useful for guiding actions.
Any psychopharmaceutical is going to affect thinking patterns.
Furthermore there are issues in depression that are neither mind nor brain.
Above I spoke about releasing a trigger against my neighbors drilling machine. That involved noticing that part of my head get tense in response to the sound and releasing the tension. There’s no mind-body dualism in that approach.
No-one’s saying anything about mind-body dualism—except you.
Maybe a building is toppling over because of faulty design. Or maybe because the materials are substandard. These are separable issues, even though it is quite true that the design of the building is completely explicable in terms of materials.
Yes, psychoparmaceuticals affect thinking patterns, and yes, thinking patterns are fundamentally explicable in terms of biochemical states. But it is nevertheless the case that no amount of talking is going to fix someone’s pre-synaptic uptake processes.
I’m afraid you’re missing the point.
If mental illness comes from (say) bad patterns of thinking, then pharmaceuticals won’t work as a treatment, except as a temporary and generalised mood-alterer. According to this narrative, giving a depressed person SSRIs is like giving painkillers to a patient with a broken leg; worthwhile as a temporary measure, but unimportant compared to the crucial task of setting the bone, which only trained therapy can do. Advocates of this point of view typically cite the unimpressive performance of certain kinds of pharmaceutical therapies when compared to placebo.
If mental illness comes from (say) faulty synaptic function, then therapy won’t work as a treatment, except as a placebo. According to this narrative, giving a depressed person CBT is like a nurse providing reassurance to a patient with a broken leg; worthwhile, but unimportant compared to the crucial task of setting the bone, which only biochemical intervention can do. Advocates of this point of view typically cite the impressive performance of pharmaceutical regimens in dealing with certain mental illnesses, the poor performance of various talking therapies compared to “placebo therapy”+, and the historical lack of interest of talking therapies in empirical validation.
Now I call these “narratives” because they are deliberate oversimplifications; riparianx is right that it may well be that some mental illnesses are “mind” and some are “brain,” and some a bit of both. Nevertheless they express very real ways of thinking about the problem. In 1940 the medical consensus was that the first narrative was broadly true. By 1990, the medical consensus was closer to the second.
i.e. allowing the patient to discuss their problems with an untrained, sympathetic listener.
Coming from a reductionist “mind is brain” viewpoint, therapy actually does help. This is pretty well documented in the fact that 73% of patients who go through it say it helped in the long run. (statistic from my psych 101 textbook) Talking to a therapist may not increase your serotonin levels, but it does help teach you new mental “patterns” and ways to cope with the results. Saying the brain doesn’t follow patterns is, well, wrong. The more you have a thought, the more the thought comes to you. If a chemical imbalance puts you in a mood that leaves you susceptible to a kind of thought, then you’ll have that thought and start a negative pattern. So even then, if the chemical imbalance is fixed, you can still be stuck with the results. Therapy helps you build more positive patterns and maybe even let the old ones fade.
You have to admit, this is weak tea. What would you think of a pharmacological study that relied on the fact that 73% of patients “say it helped.” We don’t need no stinkin’ effect size or control! As I’m sure you’re aware, there is a great deal of controversy about the effectiveness of talking therapies, and it is even controversial whether such therapy really does anything more than “just talking.”
Now look, I too am in the reductionist “mind = brain” camp, and I too think therapy can be effective in principle. I am actually very sceptical of the idea that mental problems such as depression, anxiety and OCD result from a generalised “hardware” problem (such as faulty neuroendocrine function). Yet just by mentioning the (very widely held) notion that these problems do have such a basis, I’m apparently espousing dualism. It’s very strange.
Who exactly said that?
The issue isn’t that you mentioned the notion that the problem might be due to faulty neuroendocrine function but that you assume that talking can’t do anything about that.
If you limit talk therapy to the goal of changing the mind and ignore hardware than you lose effectiveness.
Granted it’s impossible to get good feedback to do targeted interventions on the biochemical level but the body is still vitally important.
But even given SSRI isn’t targeted intervention on the biochemical level. According to a recent article:
SSRI might also work by reducing inflammation. They also hit targets outside the brain. Depression correlates with inflammatory cytokines. There are efforts underway to focus on diagnosing depression with blood tests and if those tests come the prime measuring stick the official definition of depression might even include inflamation.
Or that distinction simply doesn’t make any sense.
Do you really think it doesn’t make sense to make a distinction between:
Mental illnesses are caused by negative patterns of conscious and unconscious thought.
Mental illnesses are caused by biochemical imbalances in the brain.
Or are you just trolling?
If I hug a person and the person feels better I can explain that with a raise in oxytocin or with changed unconscious thoughts about how the person feels liked. Making that distinction isn’t useful for guiding actions.
Any psychopharmaceutical is going to affect thinking patterns.
Furthermore there are issues in depression that are neither mind nor brain.
Above I spoke about releasing a trigger against my neighbors drilling machine. That involved noticing that part of my head get tense in response to the sound and releasing the tension. There’s no mind-body dualism in that approach.
No-one’s saying anything about mind-body dualism—except you.
Maybe a building is toppling over because of faulty design. Or maybe because the materials are substandard. These are separable issues, even though it is quite true that the design of the building is completely explicable in terms of materials.
Yes, psychoparmaceuticals affect thinking patterns, and yes, thinking patterns are fundamentally explicable in terms of biochemical states. But it is nevertheless the case that no amount of talking is going to fix someone’s pre-synaptic uptake processes.
Using substandard materials is itself a design flaw.
Distinguishing the mind from the brain is what mind body dualism is all about.
I have no reason to believe that’s true. Talking can trigger hormonal release and those hormons can change pre-synaptic uptake processes.