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From: Alamaine <[EMAIL PROTECTED]>
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Subject: [CTRL] Medicating the Mind (Pts 1 & 2)
Date: Friday, March 24, 2000 6:59 PM
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From
http://www.philosophynews.com/whip/pc/ARCHIVED/pc200002.htm
Pt 1
{{<Begin>}}
Philosophical counseling
February 22, 2000
Medicating the mind (part 1)
by PETER B. RAABE
RELATED LINKS >>>at site<<<
* Shadow Syndromes by Ratey & Johnson
* The Enigma of Health by Gadamer
* More articles by Peter Raabe
Many of the feelings that help define us as human beings, and help us cope with
human affairs, are now being diagnosed as disorders that need to be "corrected"
with psychotropic drugs. In fact, a recent issue of a popular magazine carries
advertisements for pharmaceutical products claiming to combat everything from
feeling uncomfortable in a crowd ("social-affective disorder") to excessive
worry ("adjustment disorder" or "depressive disorder" -- which may mean a man
still feeling low even though it has been six months since his spouse left
him). The advertising copy literally says swallowing the pills will end your
worries.
Some professional therapists are insisting that sadness, anger, depression, and
even the inability to finish a task have nothing to do with a person's
character, self-esteem, or internal belief system, but rather are "hidden
psychological disorders" or "shadow syndromes" (e.g., John J. Ratey and
Catherine Johnson, Shadow Syndromes (Pantheon, 1997). They believe "shadow
syndromes" are simply inherent in the structure and chemistry of the individual
brain, and recommend that these syndromes be treated with a regimen of powerful
medication. In the six years between 1990 to 1996, prescriptions in the United
States for the antidepressant fluoxetine (sold under the brand name "prozac")
rose from 136,000 to 2.5 million. The total number of prescriptions for all
similar medications written in 1996 alone was 5.4 million.
While the use of medicines to correct a mechanical malfunction in cerebral
biochemistry seems legitimate and justified, the use of psychopharmaceuticals
to control emotional distress, confusion, or depression is a highly contentious
issue for many philosophical counselors. This is because the use of drugs to
alter feelings or thoughts seems to be based on the faulty assumption that
feelings of distress must have originated in a chemical imbalance in the brain
because drugs can be used to change the brain's chemistry and thereby alleviate
feelings of distress.
The question of which came first, the feelings or the chemical imbalance, is a
chicken-and-egg problem. Research has shown that while the chemical activity
within the brain generates thoughts, thinking causes a change in the chemical
activity within the brain. In other words, the relationship between brain
chemistry and thinking is clearly reciprocal. This reciprocity is what causes
concern among philosophical counselors when medication is used to treat a
client in distress. They see the medication of the brain as a simultaneous
medication of the mind. By prescribing psychotropic drugs, the assumption that
causality rests in brain chemistry has been affirmed. The problem with this
assumption is that it relegates external reasons for emotional distress to a
place of lesser importance. The resultant predicament this causes can be
illustrated with the following case based on a true story.
"Stan," an average college student and a player on a winning basketball team,
visited a philosophical counselor with the consent of his psychiatrist. He was
taking both antidepressant and antipsychotic medication to combat what he
described as profound sadness, confused feelings, and anger that could erupt
seemingly for no reason. Stan explained how distressed he had been lately at
his having become unreasonably angry with his friend Karl. During the course of
discussion with the philosophical counselor the story emerged of how Stan
considered Karl to be a far better basketball player than himself, how Karl
never had any problems getting girls and always had several girlfriends at the
same time, and how Karl had recently charmed Stan's girlfriend away from him,
supposedly as a harmless joke. Stan said he could understand why his girlfriend
had left him and gone with Karl. He wondered if he was even worthy of a
girlfriend considering how poorly he played basketball compared to Karl. But
through all this he insisted Karl was a good friend, and that "all's fair in
love and war," even between friends. When asked to define what a friend is,
Stan responded that it is someone you respect but are inferior to.
Over the weeks that followed Stan told of how his mother had remarried when he
was young, how he had several younger step-siblings, and how his stepfather
treated "his own flesh and blood" with more love and respect than he felt Stan
deserved. His stepfather was quick to point out his faults, and never offered
to help Stan correct his mistakes. His stepfather taught Stan to develop a
negative view of the world, the people in it, and himself. Stan remembered
asking his stepfather questions that were judged by his stepfather to be bad
questions that a good boy would not have asked. Stan said his stepfather was
never a friend to him and that he had convinced Stan he could never do anything
right. When the counselor asked if he could perhaps think of one thing he had
gotten right since then, Stan could not answer. When she asked him about the
fact that he was a player on a winning basketball team, Stan said his ability
to concentrate and focus on the game had deteriorated dramatically over the
past month and he was considering quitting the team.
The sessions continued in this vein. Stan revealed that he expected only
perfection from himself. When he failed to reach this goal on the basketball
court, Stan saw it as a confirmation of his own and his stepfather's low
opinion of him. He recalled all his failures -- every missed basket -- in vivid
detail but could not think of a single success. He was even worried that he was
failing to do what the counselor expected of him in the counseling sessions.
But by the end of the fourth session the counselor was already beginning to see
some improvement in Stan's self-confidence. Stan was clearly enjoying the
opportunity to speak freely and to ask questions without the fear that his
questions would be judged good or bad. The counselor and Stan agreed that Stan
had a serious case of low self-esteem and that he would probably benefit from
an exploration of a number of issues such as what he believed about himself and
why, what friendship is all about, and what success means when you are part of
a team.
When Stan arrived for his fifth session he was smiling broadly. He began by
announcing to the counselor that he had discovered the meaning of life. His
conclusion was that "the purpose of life is movement." This puzzled the
counselor who asked Stan to explain. Stan said when he looked around him it was
as if he could see movement in everything. This explained where his problems
had come from. He said that when he now comes up against a problem with a girl
he simply tells himself "everything is movement" and the problem goes away. In
this way, he assured her, he could now solve any problem he might encounter.
"In fact," he told her, "I feel invincible."
The philosophical counselor sensed that something was not right. She asked Stan
if he had been drinking. Stan said he had not. She then asked if his medication
had been changed. Stan replied that he had gone to see his medical doctor and
the doctor had doubled the dosage of his antidepressants. The counselor
cautioned him that his euphoric state may just be the result of the increased
medication, and not because all of his problems had been resolved. Stan agreed
this might be the case but said it simply did not matter as long as all his
problems were gone. She explained that the antidepressants were like taking a
painkiller for a broken leg: they alleviate the pain but do not fix the leg.
But Stan was confident that the counselor's services were no longer required.
Finally the counselor warned him that just like his medication had been
increased as his body had adapted to the original dosage, it would probably
adapt to this higher dosage as well.
"When that happens," she told him, "you're likely to be faced with the reasons
for your depression and anger again. Are you simply going to have your doctor
increase the dosage again?"
But Stan was adamant. He did not return after the fifth session.
What the philosophical counselor had seen in Stan as axiological issues -- that
is, issues of negative self-evaluation and low self-esteem -- had instead been
perceived by Stan's medical doctor as a malfunction in brain chemistry and
diagnosed as requiring psychotropic drug intervention. Psychiatrists Jerome and
Julia Frank point out in their book Persuasion and Healing (Johns Hopkins,
1991) that it is possible that a drug's physical effects on the brain can
undermine therapy by relieving the symptoms that motivate a patient to "work."
It is this "work" that eventually resolves the problems which created the need
for medication in the first place. But drugs work faster; they can help a
client feel good overnight. How can the long hours of hard work and painful
emotions encountered in counseling compete with that!
Philosopher Hans-Georg Gadamer argues that modern psychiatric drugs seem to
have "instrumentalized" the human body. In his book The Enigma of Health
(Stanford, 1996), he finds it worrisome that through psychiatric drugs "doctors
are now able not only to eliminate and deaden various organic disturbances, but
also to take away from a person their own deepest distress and confusion." His
point is that using drugs in psychotherapy is often simply the act of "taking
away" rather than helping the person to resolve, readapt, and reintegrate into
society.
What Gadamer's argument suggests is that just like physical pain indicates a
cause of that pain, so mental or psychological pain denotes the presence of a
reason for that pain. If it is clearly a mistake to believe that in using a
medication to take way the physical indicator (the pain) we have eliminated the
cause of the pain, then it is likewise clearly a mistake to believe that in
using a psychotropic drug to eliminate a mental or psychological pain we have
eliminated the reason for that pain.
But despite cases like Stan's, and Gadamer's persuasive argument, philosophical
counselors have not utterly condemned the use of psychotropic drug therapy.
Some argue that if one of the most important goals in philosophical counseling
is helping to make the client feel better, then why not allow this goal to be
reached by means of drugs? And if swallowing a pill can end your worries, why
bother with counseling at all? Others point out that
making a person feel better is not all a drug does. There are many other
effects which are often accepted as a reasonable price to pay for the relief of
metal anguish. But what price is too high when peace of mind is involved? These
issues and more will be discussed by a number of philosophical counselors in my
next column.
____________________
Dr. Raabe welcomes inquiries by email >>>See end of Pt 2<<< , telephone at
(604) 986-9446, or regular postal mail at Dr. Peter B. Raabe, 46-2560 Whiteley
Court, North Vancouver, B.C., Canada, V7J 2R5.
Copyright (c) 2000 by the
Philosophy News Service.
All rights reserved.
{{<End>}}
Pt 2 http://www.philosophynews.com/whip/pc/ARCHIVED/pc200003.htm
{{<Begin>}}
Philosophical counseling
March 22, 2000
Medicating the mind (part 2)
by PETER B. RAABE
RELATED LINKS >>At site<<
* Medicating the Mind (Part 1)
* Blaming the Brain: The Truth About Drugs and Mental Health
* American Philosophical Practitioners Association (APPA)
* WHiP Archive: Philosophical Counseling
An information leaflet from the National Parkinson's Foundation in Gainesville,
Florida, explains that more than 40% of people with Parkinson's disease (a
degenerative neurological disorder) develop depression. It says that this
depression "should be evaluated, treated and monitored on an ongoing basis by a
physician." By implying that the depression can be treated by a physician, the
leaflet leaves the reader with the impression that it is caused by a
neurobiological malfunction. The reader is thereby led to the conclusion that
medication is called for. What is wrong with this picture?
Most psychotherapists agree that depression is a symptom of something. What
they do not agree on is whether depression, and other so-called mental
disorders, are symptomatic of a chemical imbalance in the brain or of an
irrational thought process in the mind. Some philosophical counselors are now
even proposing the hypothesis that depression, rather than being caused by a
chemical imbalance or irrational thoughts, is a perfectly reasonable reaction
to certain seemingly hopeless situations in life. But if depression is
sometimes reasonable, why use drugs to get rid of it?
In the 1980s seratonin-based drugs flooded the marketplace and became the cure-
all of choice for treating depression. When risks of their use started to be
made public in the early '90s, there was a brief but widespread rejection of
the practice of taking a pill to reduce depression. The view that depression
was the result of social rather than chemical factors was once again dominant
within the helping profession. In 1995 only 20 percent of psychiatrists felt
that depressed individuals should be treated with drugs. But since then the
next generation of "more reliable" and "safe" drugs have been developed and
aggressively promoted by pharmaceutical corporations, and drug use has
increased correspondingly. Discursive therapy is once again being perceived as
an adjunctive treatment to maximally implemented drug therapy.
Canadian psychiatrist Heinz Lehman was one of the early pioneers of what is
sometimes called "biologic psychiatry" or drug therapy for mental illness. In
an interview broadcast in February 2000 on CBC television, Lehman said he and
his colleagues at a Montreal psychiatric hospital had discovered that
empathetic discussions were very effective therapy for the majority of their
patients. But they were forced to abandon such discussions, and compelled to
give their patients psychoactive drugs, when hospital administrators deemed
therapy sessions too expensive in comparison to the cost of newly developed
medications. In other words, their treatment of choice was discussion but this
was almost entirely abandoned due to financial considerations.
Research has shown that the type of improvement following antidepressant
medication is indistinguishable from the improvement following cognitive
therapy (Imber, et al, in the Journal of Consulting Clinical Psychologists
[1990]). Research has also shown that two-thirds of all psychotherapy patients
put on drug treatments for depression do as well as or better with a placebo
than those treated with an active medication (Greenberg and Fisher The Limits
of Biological Treatments for Psychological Distress [Lawrence Erlbaum
Associates, 1989]). Researchers have theorized from this that the positive
"chemistry" between the patient and the doctor may be more important to the
well-being of most patients than the chemistry in the medication.
Not only is the necessity of psychopharmaceutical treatment questionable, but
the consumer who takes a drug for depression has to pay a price. For example,
common side-effects of antidepressant medications are nervousness,
restlessness, sleep disturbances, nausea, tremors, constipation, bladder
problems, blurred vision, dizziness, and drowsiness. Taking a drug to relieve
depression may also result in a chemical dependency, not only because of the
intrinsic addictive nature of some drugs, but because of the body's natural
adaptation to a prescribed dosage which must be increased in order to maintain
the drug's perceived level of effect.
If taking a drug is often no more effective than a therapeutic discussion, if
it leaves the client vulnerable to a variety of side effects, and if it
requires increased dosages to maintain perceived effects, why would anyone want
to take a drug in the first place? There are a number of possible answers. It
may be because taking medication is more private. That is, it does not require
an individual to divulge and argue about sensitive personal material with an
often judgmental authority figure. Furthermore, pills are often cheaper than
therapy. It may also be because our fast-food society has conditioned people to
expect a quick fix for whatever ails them, forcing doctors to prescribe pills
rather than counseling in an attempt to give their patients what they want.
Unfortunately, many physicians and psychotherapists see emotional distress as
having a biological or chemical origin. The problem with this is that
prescribing medication can convince a patient that his problem is beyond
voluntary control, even when the origin of his problem lies within his familial
or societal environment. By adopting a reductionist scientific model and
defining the range of subjective human experiences and emotions largely in
terms of degrees of pathology, psychotherapy has, until very recently,
championed a mechanistic conception of human thinking and conduct linked more
closely with objective chemical reactions than with subjective reasons,
intentions, and desires. Philosophical counseling on the other hand sees the
importance of dealing directly with those very human concerns.
Jon Mills, philosophical counselor and professor of psychology and philosophy
in Toronto, points out that "there is a presumptive bias in the medical,
psychiatric, and behavioral sciences that views the mind from a reductive
ontology. The standard mentality is to give a pill for any psychological
ailment and wait for the results." From his own experience Mills has found that
medication may ameliorate the severity of symptoms, but it has little effect on
eliminating the source of a client's malaise. Even when medication works, he
says, there are often many needs and conflicts that a pill could never address.
Philosophical practitioner and professor, Wanda Dawe, agrees: "If the client
originally presented with some one or more philosophically interesting problems
with which he was struggling, no medication can possibly provide the solution."
Michael Russell says that he is not at all opposed to medication because he
does not see an inherent conflict or incompatibility between human affect seen
as choice, and seen as a physiological matter subject to helpful chemical
intervention. Russell, who is professor of philosophy and human services at
California State University, research psychoanalyst and philosophical
counselor, says, "There are plenty of people who are extremely miserable,
dangerous, etc., without medication, and in a reasonable position to make good
use of one form of counseling or another with it. " He asks rhetorically why it
should be considered "an inauthentic path" to take when a person uses a drug to
treat a distressing mood which could not be alleviated by means of
philosophical counseling.
Paul Sharkey, vice president of the American Philosophical Practitioners
Association (APPA), says that he has had clients "who, after beginning a course
of medication, were much more, rather than less, inclined to engage in
philosophical reflection. Most of them recognized that even when their
biological conditions were stabilized (and sometimes even because of it) they
still had a lot to do to resolve the various kinds of issues confronting them
(issues of ethical responsibility, meaning, purpose, etc.) which they were
simply incapable of addressing while not taking medication."
Eite Veening, one of the pioneers of philosophical counseling in the
Netherlands, says the practice of prescribing antidepressants is not as
frequent in the Netherlands as it is in the US. Veening suggests that the issue
of whether medication should or should not be prescribed is a question of who
is in charge; it concerns the issue of what the client wants from the
philosophical counselor. Veening sees the client as being allowed to make his
own decisions regarding what kind of treatment he wants. While the counselor
may explain and discuss the impact of medication on thinking with a client who
is perhaps taking an antidepressant, his primary role, according to Veening, is
to deal with the client's philosophical beliefs and opinions. Veening holds
that a client's emotional issues are psychological and therefore "his feelings
will be his concern, not mine."
Mills says in his own practice he has seen drugs work in a number of ways: They
can relieve his patient's symptoms without removing the desire to talk; they
can help his patient cope and manage therapy better; they can aid his patients
to distance themselves from examining other problems; they can mask the
original issue or underlying problem.
Dawe cautions that when medication screens a problem, "the client moves from a
position of restricted or unrealized liberty to a position of still greater
unfreedom." This leads her to think that "in any discussion of patient/client
substance dependency, the issue of the individual's liberty and capacity for
self-governance would be raised." For Dawe the question is, "If one is to be
held up/together by some strings, however gossamer, who will be the puppeteer?"
Along a similar line of argument, Maria Colavito, president of the Biocultural
Research Institute in Florida, psychologist, and philosophical counselor takes
a different stance on the issue. She maintains that, according to the
scientific model, the environment selects for appropriate mental and emotional
development in each individual's ecosystem. In that case, she asks, "who are we
to alter it pharmacologically?" She argues that if emotions outside the
accepted curve of so-called normalcy are in fact the way some individuals adapt
to their environment then medicating them to force their emotions back into
that acceptable range of normalcy is nothing less than new millennial eugenics.
However, Lou Marinoff, president of the APPA cautions philosophical counselors
to remember that their clients are autonomous beings, and as such have the
right to request, accept, and reject any of the variety of treatments offered.
"If the client terminates the counseling process because his problem is under
symptomatic control [through medication] that is his business. As long as he
poses no threat of harm to others, the counselor is bound to let him go."
Philosophical counselors respect the autonomy of their clients, and part of the
meaning of autonomy, according to Marinoff, is "the liberty to choose freely,
and perforce to make unwise choices at times. Making mistakes presents [the
client with] opportunities for learning." Marinoff believes that while the
philosophical counselor can and should voice her professional opinion, she
should not interfere "in the client's autonomous choice to take medication or
terminate counseling. The same would be true of clients who self-medicate with
alcohol or non-prescription drugs, saying they feel better and therefore
require no further counseling." According to Marinoff, "a philosophical
counselor is not the best judge, nor any judge, of his client's better
interest."
While philosophical counselors are divided as to the advisability of altering a
client's thoughts and emotions with medication, consumers of psychotropic
medication can similarly have mixed feelings about taking them. The following
message was received by email and is reprinted with permission:
"I have received psychological counseling on and off for many years, and having
taken many 'rounds' of different psychotropic drugs to relieve depression. The
drugs are not all they are cracked up to be ... For me, the drugs can alleviate
the worst, blackest end of the depression, allowing me to at least care enough
to make the effort to get counseling. Without the drugs, I wouldn't have been
able to believe that psychological counseling could help me, and would probably
not be here today. I agree that the relationship between mind and brain is a
highly reciprocal one. I think [drugs] work best for people to whom depression
is a real disability, but I do believe that they are over-prescribed."
____________________
Dr. Raabe http://www.interchange.ubc.ca/raabe/
welcomes inquiries by email
[EMAIL PROTECTED],[EMAIL PROTECTED]
telephone at 604-986-9446, or regular postal mail at Dr. Peter B. Raabe, 46-
2560 Whiteley Court, North Vancouver, B.C., Canada, V7J 2R5.
Copyright (c) 2000 by the
Philosophy News Service.
All rights reserved.
{{<End>}}
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