Tag: medicine

Posted in psychology, science, Therapy

The Two Branches of Psychology

Posted on by alidware

If you have been or are a psychology major, or you’re thinking about becoming one, you’re probably familiar with (or will become familiar with very quickly) people riding your major off as humanities, soft-science, and asking you “bro, you gunna be my counselor now?” There’s a reason psychology isn’t taken seriously, and part of it is the narrative psychology professionals have created and perpetrated. Let me explain.

Having been this major for a while now, I see two very distinct branches of psychology: the humanities side that dominates the media and is what everyone thinks of when you say you’re majoring in psychology, and the science side, which rarely ever makes the media unless the research hasn’t been peer reviewed and the researcher is money hungry.

Earlier in the year, I wrote a series called “Is Psychology a Science?” which you can read the first of at this link. We concluded there is a lot of science and that the problem is it isn’t being taken seriously, or it’s purposefully being subverted.

The Perfect Example: Gabapentin

At work, I’ve spoken with plenty of people who have been prescribed Gabapentin for anxiety or depression or as a PRN (as needed) medication. After a panic attack which I mistook for an allergic reaction to a medication, I ended up in Urgent Care and was prescribed Gabapentin “to make it through the weekend” because it’s “really great for anxiety.” I picked up the prescription (with insurance, it only cost eighty one cents, kind of how Percocet only cost me one dollar, and no, I don’t have high tier insurance) and got straight to work.

Gabapentin is FDA approved for treating Seizures and Postherapetic neuralgia (nerve pain, particularly after Shingles). It is often prescribed off-label for anxiety (usually social phobia, GAD, panic attacks, and generally worry), depression, insomnia, neuropathic pain related to fibromyalgia, regular pain, just pain, migraines, any headaches that could probably go away with aspirin or time, as a replacement for benzodiazepines (Ativan, e.t.c), as a replacement for opioids (oxycodone, e.t.c), alcohol withdrawal, benzodiazepine withdrawal, alcohol treatment (reduce drinking or sustain abstinence), bipolar disorder, any mood disorder, any perported mood dysfunction, restless leg syndrome. It can be taken as needed or daily. It belongs to its own class of drugs: the gapapentinoids. Another drug you may recognize from commercials that belongs to the gabapentoid class is Pregabalin, a.k.a Lyrica.

Anyone remember Lyrica commercials? God. Disturbing shit. I don’t watch television anymore, only streaming services, so I haven’t seen a pharmaceutical ad in a while. I don’t miss it.

What Does Research Say?

I didn’t take the Gabapentin because research told me what the doctor didn’t, or couldn’t: there is no robust evidence supporting Gabapentin for any of the off-label prescriptions above. My first indication of this came from a Vice article, which I was hesitant to read because, well, it’s Vice. So I took their investigative journalism with a grain of salt and used it to guide my database research. Here’s what I learned:

  • Parke-Davis, the company that funded research and research articles for Gabapentin purposefully avoided publishing the disappointing effects of Gabapentin. They tweaked the research to appear positive. This was found out in 2009, when researchers looked more carefully at the articles more carefully.
  • David Franklin, biologist, started working for Parke-Davis in 1996. He quit three months later, just after an executive “allegedly” told him: “I want you out there every day selling Neurontin. We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money.” You can read more here.
  • This was all in the past, and Parke-Davis paid 420 million in restitution for violating, in the most disgusting way, psychological and biological research. The problem is, the rhetoric that Gabapentin is a “great drug” and “works well for anxiety, depression, and your momma’s broken hip” still permeates the medical world. Particularly the psychological one. This was done purposefully.
  • There is no substantial evidence for any off-label use. I searched the databases all this morning. I found one measly Meta-Analysis (review of multiple studies studying the same thing, analyzed statistically) that showed 7 studies using Gabapentin for alcohol use reduction or abstinence. It was better than placebo slightly, but “the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking.” So, it didn’t stop drinking or help withdrawal, it just kind of made people drink less. Or mix the two. Which is even more dangerous.
  • The only research with Gabapentin and anxiety says it’s not substantial enough to help panic attacks and that many people are most likely experiencing a placebo effect when they take it. Given that I learned that, I saw no point in trying Gabapentin: the chances it wouldn’t work for me because I don’t believe it will was too great. When I checked my college’s database, I went through over ten pages of articles and didn’t see one study geared toward Gabapentin and anxiety.

What Does This Have to do With Psychologists?

Well, the same rhetoric permeates the clinical psychology department of the world as well. That is, psychologists are more likely to trust the word of their colleague than to go read a primary research source themselves, scrutinize the methods, results, and read the confounding variables. Human beings are naturally trusting, and that is a beautiful thing. It gets us into a lot of trouble though–most likely a colleague hasn’t read the primary research either, and is simply going off what their colleague told them.

Believe it or not, this is a research topic in psychology.

I came across this analysis in my searches this morning. In summary, the researchers did a qualitative analysis of different psychologists in private practice, and their attitudes toward things like empirically supported treatments. What did they find?

  • Psychologists are “interested in what works.”
  • They were skeptical about using protocols described by the treatments proved to work.
  • They were worried non-psychologists would use those treatments to dictate practice (which I’m having trouble seeing as bad).
  • Clinicians mostly used an “eclectic framework”, meaning they drew from many sources (most of which were probably not supported by any empirical data, I’m guessing.)
  • They valued: experience, peer networks, practitioner-orientated books, and continuing education that wasn’t “basic”. So, nothing that involves a Starbucks drink I guess.
  • If resources for learning empirically supported treatments became easier to access, they would be interested in implementing them into their practice.
  • Money, time, and training are all aspects which have been preventing psychologists from actually implementing researched practices into their treatment. 68% cited this as a major issue preventing them from adhering their practice to researched methods. 14% said it was because they just didn’t believe in the efficacy of the treatment and 5% said it was because that treatment wouldn’t fit a cliental population. Again, that is a belief, not a fact.
  • Only 19% of psychologists surveyed around the nation (United States) used psychological research papers as their primary source of research information. What the fuck are they reading? The Key To Beating Anxiety by some random self-published author on Amazon?

The analysis is much longer than what I’ve listed here, and gets deep into some real topics anyone considering going into clinical or counseling psychology should pay attention to. The message to take away here is that attitudes and beliefs are driving how we are being treated both in the psychological world and the medical field. Physicians fall prey to the “word-of-mouth” about drugs in the same way psychologists fall prey to the “word-of-mouth” about treatments. This is why I write these articles: it’s up to the consumers to play an active role in what they are putting into their body, how, and why. It’s also up to the consumers to be informed in treatments, ideas, and beliefs.

Otherwise, you’re giving your life up to someone who may not know what they’re talking about any better than you do.

Lastly, let’s get something straight: I’m thankful for every medical professional I’ve ever come in contact with, because they’ve all taught me something for better or for worse. I’m thankful for the front-line workers who have spent the last 8 or 9 months using insanely inventive strategies to try and keep their worse Covid patients alive. Doctors are reading researched evidence because the links to research are suddenly in the media, and researchers are putting out what works and what doesn’t, as they should always be. This scramble to beat Covid has stirred probably the most ethical (and probably also the most unethical) research that’s been done in a while.

It suddenly makes sense to do things right when your life is at stake.

The point is, stay informed, stay healthy, and read.

Agree or disagree? Leave it in the comments below, or find me here:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciate every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in Peer Support, Questions for you, science, Voices

What’s Your Ideal Treatment?

Posted on by alidware

I think one thing that frustrates me the most about mental health treatment services today is that the services available are shoddy, expensive, and instead of being tailored toward the individual they’re tailored to the diagnosis.

For example, if you walk in to your average psychiatrist and say: “I have a diagnosis of Schizophrenia. My mom just passed and I’ve been struggling a lot at work. I haven’t had to be on meds for a while (or, I’m on a low dose of meds, or my medication usually works), and really I’ve just been struggling with anxiety. I’m shaking a lot and I think I need some help. What do you suggest?” Chances are all your psychiatrist heard was “schizophrenia”.

It’s better to leave the diagnosis out of it.

I use this example because I can empathize with it. My most recent psychiatrist, for example, couldn’t get it out of her head that I hear voices sometimes, even though I said my voices and I are on pretty decent terms compared to what others struggle through. For me, they aren’t 24/7, they are a mix of inside my head and outside of my head, aren’t very commanding, and I gather comfort from their perspective sometimes. I am not overly attached to them. What I went to her for was anxiety and mood issues, as my official diagnosis is schizoAFFECTIVE. She seemed to remove the affective part, completely ignored the fact that a death close to me unhinged me (she said “Oh, that’s tough”, and moved on), and continuously tried to medicate my voices instead of focusing on ways I could help my anxiety–the reason I came to her.

Mind you, through all of our appointments, she never once asked me what my voices are like, what I think about them, how they respond to me. The reception staff messed up on my insurance and suddenly I owe them money I don’t have. Every time I email her for a simple question, which could be answered in an email, she wants to set up an appointment so I have to pay for it. This is why I stayed away from mainstream mental health.

But it’s not just that.

Studies show residential, communal, and peer support services are, dare I say, essential for growth and recovery, and yet you’ll be hard pressed to find any of those services affordable, available, or promoted in your area. I work in peer support, and I didn’t learn about any programs until I got a job there. Doctors didn’t know, therapists didn’t know, and of course it would be much too hard for them to do their job and help me find something.

Maybe this is just a California complaint.

There are wonderful communal options and residential facilities, places where true growth and opportunity are available . . .to those who can afford 35,000 dollars a month.

My point here is not a rant. My point is that mental health treatment has gone from ice baths in asylums backed by half-assed scientists to money traps and one-size-fits-all cardboard boxes backed by people with degrees who haven’t read a psychological research paper since their undergraduate research methods class.

We’ve dropped the ice baths, the asylums, AND the scientists.

Don’t you think this needs to change? What would you change? What is your version of ideal treatment? Leave your comments below or come to my instagram and join the discussion!

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciate every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in science

A Medication-Free Anxiety Treatment

Posted on by alidware

Briefly last week, I considered getting back on medication. My panic attacks have been relentless, my voices have been annoying, my thoughts have been in and out of this world. I went as far as going online to a pain center my previous psychiatrist worked at. She is long gone, but there are other great doctors there, and I have nothing bad to say about this particular institution of health professionals. They were informative, kind, and their offices are quiet, clean, bright, and overlook trees even though they’re one hundred feet from a freeway entrance.

While browsing their website to see if they conducted Telehealth appointments, I found a tab specified for panic disorder and within that tab they listed a new, medication-free treatment for anxiety. Curious, I investigated.

What is the treatment?

This treatment is the FDA approved “Freespira” developed by Palo Alto Health Sciences. For this section, I’ll be getting my information from the Freespira website and this patient brochure.

Firstly, Freespira is a breathing trainer. You receive a special Freespira tablet and medical censor that tracks your breathing rate and your Carbon Dioxide output. The hypothesis here is that those of us who panic have irregular breathing patterns even when we aren’t panicking. When we do get anxious, our breathing rate becomes even more so arrhythmic and we aren’t outputting as much carbon dioxide as is healthy. This physiological response cannot be addressed by therapy or drugs, and this is the response Freespira targets. The device teaches you how to regulate your breathing so that you exhale the proper amount of carbon dioxide. Their website says “by training panic suffers to permanently change their breathing patterns, panic attacks are dramatically reduced and, in many instances, completely eliminated.”

This takes a set amount of sessions over the course of a few weeks.

Why This Was Exciting

As a desperate panic sufferer, I know all too well of the tingling in the limbs, the racing heart, the feeling that death is imminent. I lost count how many times I’ve went into the ER because my hyperventilation threatened my consciousness. I won’t spend breathless paragraphs reiterating the doctors who accused me of drug use, who almost refused me treatment, who took my blood without consent to test for meth. The idea of an anxiety treatment that doesn’t including putting poorly tested chemicals in my body daily, or risking “as needed” medication becoming “need” medication and eventually, if not severe physiological dependence, than addiction, almost made me cry.

The statistics are promising. Their website states clinical results are as followed:

Protocol Adherence (meaning participants followed instructions correctly): 83%

Panic-Free immediately post treatment: 85%

Panic-Free 12 months post treatment: 81%

Reduction in panic symptoms 12 months post treatment: 94%

A Stanford trial in 2008 showed “positive changes in respiratory physiology, and strong evidence for safety and tolerability”. 68% of participants were panic free, 93% had a reduction in symptoms after 12 months.

Another trial showed similar results, with protocol adherence and freedom from panic ranging from 71% to 88%.

The last study they cite has no verifiable link on google.

These results are pale in comparison to those reflected by drug therapies and every other talk therapy except Cognitive Behavioral Therapy for panic disorders. It is easy, quick, self-administered, and finally puts to use all those breathing techniques you learned that felt useless. Suddenly, they’re not so useless because you have a tablet and sensor telling you they’re not.

So what’s the truth?

I hope you don’t feel as let down as I did.

In my excitement, I didn’t fall blind to the fraudulent world of psychology research. And so, I researched. My first hint that something was off came from the website healthnewsreview.org, a website dedicated to “improving your critical thinking about health care”.

Some of the noteworthy things they mentioned, briefly summarized because I love you guys, are:

1: The cost treatment is not discussed. In 2015, a news story reported the monthly cost as $500.*

2: No absolute numbers are released, just overall percentages states on the website.

3: No mention of what the harms could be, if any, and there were no links to the studies mentioned on the website. We’ll come back to this.

4: one of the most IMPORTANT: Freespira website DOES NOT discuss or post who funded these studies. We’ll come back to this too.

5: No alternatives discussed. I mentioned CBT earlier in this article, as it is one of the leading and most proven methods for treating panic disorder. A comparison is no where mentioned.

*link to the ‘news story’ on healthreview.org

By this point, I’d lost hope.

And so, I’ve done the nice, hard work of finding the studies Freespira reports as their evidence. They did indeed provide citations eventually of their sources, but I could only find them when I switched from desktop view to mobile view. I have linked them above.

The Results?

The “Stanford Study”

Let’s remember How to Read a Research Paper before continuing. I don’t know if this was actually conducted at Stanford, but Freespira lists this citation as the Stanford study they mentioned.

Not Freespira specific, but tested for the effectiveness of capnometry-assisted breathing therapy, the type of device freespira is purporting to be.

Methods and participants: 37 participants, 31 with panic disorder and agoraphobia, 6 with panic disorder and NO agoraphobia. 20 were randomly assigned to the treatment, 17 were wait-listed as a control group. Recruiting happened with community advertisements. You can read the study for more in depth description of the participants.

Treatment: educating patients on breathing, showing them problematic respiratory patterns, having them perform breathing maneuvers with feedback, teaching ways to control carbon dioxide levels, and having them practice breathing exercises daily. Twice daily, 17 minutes, at home. Read for more in depth description.

Results: Low attrition (drop out rate). 40% experienced no more panic attacks during the four weeks. 2 month follow up, 62% had experienced no further attacks, and 68% were panic free at 12 months. This shows brief capnometry breathing therapy can be therapeutic. Improvements were seen in the treated but not untreated participants and success improved as time passed. Non-respiratory mechanisms, such as treatment rationale (meaning they told the participants the point of the study) let the patients develop cognitive components needed to avoid catagstrophic thinking and gave patients a sense of control–one thing we lose in panic attacks. The breathing exercises triggered sensations similar to those we experience in panic attacks, and desensitization may have occurred to the bodily clues rather than respiratory changes being the sole drive. Need future studies testing viability (success of the treatment).

Limitations: The first thing you learn in an introductory research course is that when you are studying treatments for mental health disorders, you can’t simply pair the treatment with an untreated population. In order to test for something like viability, you need to compare your treatment to other treatments. This study did not do that, and lists it in their limitations section.

This study was supported by the NIMH.

The Multi-Center Trial

Freespira specific.

Methods and Participants: Primary diagnosis of Panic Disorder, 18-65, moderately ill or greater based on the Clinician Global Impression Scale, and were off medication or had been stable on medication for 3 months. Conducted at multiple non-academic clinical sites with different clinicians at different levels of expertise.

Procedure/Treatment: 4 weeks. Breathing sessions 17 minutes long with baseline stage (sitting quietly with eyes closed for 2 minutes), a pacing stage (monitoring of Carbon dioxide levels with breathing at a specific rate for ten minutes), and a transition stage (patient maintains breathing pattern with feedback for 5 minutes).

Results/discussion: 20% dropped out. Significant decrease in panic disorder severity over four weeks, early identical results to the previous study. Patient compliance was high as well as patient satisfaction. This treatment can be made largely available at a low cost. Side effects were rare, like mild dizziness or lightheadedness in the beginning training sessions.

Limitations: Again, no control group, not even a wait list. The study itself says “these results cannot be considered a definitive documentation of efficacy”, but instead “extends [the previous studies’] findings to document feasibility and utility in more naturalistic treatment settings.” It discusses no alternative reasons for why they may have seen significant results and a decrease in panic symptoms.

This study was funded by Palo Alto Health Sciences, the developers of Freespira.

Several of the doctors on this so-called study have received research grants and/or consulting fees from PAHS and Merck. This is listed as the Conflicts of interest. For obvious reasons.

Should You Try Freespira?

Results show the need for many, many more studies, but no real evidence of efficacy.

Try at your own risk. Especially if it means you’re paying out of pocket.

If you go in thinking it will work, it will probably work. if you go in remembering this evidence, it probably won’t.

If you have tried Freespira and it worked for you, leave your experience below or message me and let’s write about it! The same applies for if you have tried Freespira and it hasn’t worked for you.

Also, notice the degree of ethical practice reduces when the study is funded by the developer of the treatment. Keep that in mind for when we discuss the studies of psychotropic medications.

For conversation, support, and updates on research and posts, follow me:

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Posted in Community, science

Our Scientific Crisis

Posted on by alidware

In the wake of this lighting striking all over the world, there’s been a level of social (media) distancing I can appreciate. I haven’t written since my break because I don’t just want to talk about COVID. It’s just that everything else seems so irrelevant now. So, I have something very simple to say.

We are in a SCIENTIFIC CRISIS.

What does this mean?

It means we’re not focused on the task at hand: containing a rapidly spread, generally mild but sometimes very severe illness. Instead, we’re focused on our infrastructure, media reporting, fear mongering, and blame-gaming.

How many people have actually went to the CDC website and read up on what a Coronavirus is versus how many people went out and hoarded N95 masks to the point healthcare workers are falling short of the protection they need? I’m not saying self-preservation is bad. I’m saying stupidity is bad.

I’m sick of the fear mongering, in particular. I follow The Mighty, although I’ve never been published by them, probably because for my previous blog Mental Truths I email-interviewed the C.E.O pertaining to questions about the outrageous amount of funding they suck down from pharmaceutical companies in exchange for all the pro-medication ads on their website. If you want to know my stance on biological treatment, give this and this a read (i’m not against it). In my email this evening, a new article came in from one of The Mighty’s editors, summarizing this idea that doctors across the states are considering DNR’s for all COVID patients.

CHRIST! A title like that would scare me too. If I didn’t know any better. The comments were full of immuno-compromised and chronically ill people TERRIFIED. Utterly TERRIFIED. And for GOOD REASON! A breakdown of ethics of THAT magnitude would mean all hope is lost.

Doctors have indeed been discussing DNR’s in relation to those having severe respiratory reactions to COVID. These matters are discussed on a case-by-case basis with the family as they have always been since the dawn of DNR in western medicine. There are no current guidelines for COVID treatment, one of the reasons this has become such a scary time. What makes it scarier is when a website dedicated to chronically ill and vulnerable people can’t cite their sources or present an argument objectively, not even when the argument pertains to peoples’ livelihood, health, and well-being.

I’m seething behind my keyboard.

As other doctor’s have stated (you can find the quotes in that linked CNN article above), the DNR discussions have not been blanket DNR’s–essentially the statement “every COVID patient who’s respiratory system has failed will be left to die for the sake of health care workers and other patients” is the message The Mighty and other media giants like The Washington Post have been spreading. While it IS a concern for a healthcare worker to climb on a failing patient and give mouth-to-mouth when they’ve tested positive for COVID, killing all respiratory distressed COVID patients not only isn’t practical, it’s reprehensible. Two good reasons why it would never happen.

Okay, there is ONE CASE in which this would become a reality in the United States: hospitals in all states are overrun with the infectious disease, there aren’t enough doctors to care for patients because ALL the doctors are sick too, and bodies are piling up in the street. Then it’s safe to say ethics are out the window and the survival of those well enough to survive become precedent because it would be happening in all other countries as well. Luckily, COVID is not going to be the virus to drive us to extinction. Imagine more of a virus that causes the symptoms of Ebola but spreads like the Bubonic Plague. That will be our demise, surely.

What’s going on in Italy and Spain are examples of this: overrun hospitals, bodies having to be stored in people’s quarantined homes (Italy) and on ice rinks (Spain) because there is just no safe way to handle them, or any businesses open to do so. Will this be a reality for the entire world? I strongly doubt it. Is this reality for those countries horrible? I couldn’t even put into WORDS how absolutely sorrowful their experiences are right now.

We are in a SCIENTIFIC CRISIS because funding has been cut to the CDC, the WHO has made countless mistakes, researchers are ignored in favor of big business, and NOW, in the quarantine, people are forced online and what’s online? Secondary, third, fourth, fifth sources that are easy to read but entirely misinformed and not very analytical. People aren’t paying attention to the exponential growth curve of the spread of COVID, nor have they reasoned that the lack of tests (one of the reasons we in the U.S have now become the leader in contracting COVID cases) means many more people have the disease and many more people have recovered at home.

I suggest staying off of Apple News and instead read updated information on the CDC website. I suggest reading your own county information in your own state (if you’re in the U.S). I suggest straying from Instagram, Facebook, or Twitter for reliable pandemic information. I also HIGHLY SUGGEST JAMA Network, a website of specialty journals that are consistently uploading studies and scientific information about SARS-CoV-2, aka COVID-19. If you struggle reading this kind of technical information, read this about how you don’t need to be medicine-inclined to get something reliable and important out of these studies. The reason why the media is so misinformed is because the people who report on experiments do so incorrectly, misunderstand conclusions, and often know nothing about the scientific process. That article will give you just enough basics to read a scientific paper, think critically, and extract the important information. It’s a lot easier than it sounds. And this time, the life of your mother, father, aunt, uncle, and cousin with or without underlying health conditions may be on the line. That’s some good encouragement to READ.

Want some information NOW? Read this article published by Louisiana State University that, with further research, may help us understand why “underlying conditions” can post a threat for coronavirus patients. Hint: it has more to do with the medications they are taking than the actual conditions.

Many people are unaware of what the tiniest bit of misinformation can do in this pandemic: it WILL make or break us. If we are not informed, if we are not reasonable, panic will consume us and all the N95 masks. Please, for the sake of your neighbors, for your coworkers, for your kids, your family, yourself, for my dad who struggles with high blood pressure, seizures, COPD, and congestive heart failure, keep yourself informed, stay indoors, limit or eliminate your contact with non-essential people, and wash your hands. If you’ve ever needed a purpose, this is a time for you to contribute to the health of the globe. You make the difference.

If something in this article hit home for you, if you want others to inform themselves about this pandemic and stay on top of relevent information, please share on your Facebook, Instagram, Twitter and any other social media. The people who look to those sites for information could use this more than you, perhaps.

Stay healthy everyone, please. Someone in the world dearly misses their loved ones because action was not swift enough, because people thought this was the flu, because people didn’t take this seriously. Let’s not make the same mistake twice.

I’m not putting my normal blurb at the end of this article. The only thing I ask is that you share this and think scientifically.

If you have a surplus of PPE or N95 masks, gloves, or disinfectant wipes, please donate some to your local medical facility. Check your county website to see if they have set up protocol for donations. Mine has.

Be safe, stay home, and stay informed.

Posted in Community, psychology, science, travel

The Do’s and Don’ts of COVID-19

Posted on by alidware

My social media break has officially broken, and I am back amid panic, turmoil, and pandemic simply because being quarantined means there is nothing better to do than browse social media, panic more, and then realize that fear is more constrictive than any virus outbreak could be.

If this pandemic has been affecting your Mental Health, you’re not alone. Even if you understand the numbers are not as bad as the media portrays, even if you understand that over 90% of the people who may come in infectious contact with the virus recovery well, with mild to moderate symptoms, the tension in the air, the way people drive, the mad scramble for food, toiletries, and essentials can twist a lot of stress in your body.

So, what should we do and what shouldn’t we do during this time?

DO:

Maintain as regular as a routine as you can. Enjoy healthy meals, and try to avoid stress eating sweets and other things that not only compromise your mental health but your immune health. Exercise in nature if applicable to you: there are forests, state parks, beaches, where you can get a healthy bout of endorphins running and kick your immune system up. The gym isn’t the only place in the world to get exercise.

DONT:

Eat a pot full of garlic and think that will protect you. Chances are, you may come in contact with this virus. This chance, depending on where you live, is either very low or very high. Don’t pretend like staying in your house and sleeping all day is healthy; in fact, it could compromise you more. Fit in exercise and health where you can and however you can.

DO:

Listen to science. For the sake of your neighbors, your friends, your family, LISTEN TO SCIENCE. The facts are there. Yes, COVID-19 is indeed SARS-cov-2, according to the CDC. Yes, there are many cases. But the numbers show a different story than the media. It’s important to help curb the spread, just as it would be for any new infectious virus no matter how severe, but the fact is there are so many people in the United States who haven’t been tested, who have probably come in contact with the virus, been sick, stayed home, recovered, and are now not being counted as a COVID-19 case. This means the survival rate and infection rate is higher than being reported. This means, most likely, you’ll be okay.

Dont:

Act only in SELF-PRESERVATION. Stores are sold out of all cold, flu, and cough medicine, toilet paper, meat, and cleaning essentials. This is NOT the end of the world. By hoarding items, you are SELFISH. By hoarding masks, you are CARELESS. Most likely, especially if you are in the U.S right now, you will NOT get sick. Buying three bottles of Tylenol ISN’T NECESSARY. Masks are for the MEDICAL PROFESSIONALS taking care of the SEVERELY ILL. If you are standing in Safeway with a cart full of items right now reading this, chances are you AREN’T SEVERELY ILL. Chances are, you won’t ever be.

It was advised people get enough items for 2 weeks of self-quarantine, IF NECESSARY.

Six bottles of bleach? That’s going to last you two months, if not more.

Seven boxes of Tylenol? You’ll kill yourself. Even if you did get sick, you couldn’t continuously use it at the rate you would need to to finish seven boxes in fourteen days.

This selfishness is why people are panicking. It’s how the virus will continue to spread. It’s why young people aren’t taking anything seriously, it’s why many people aren’t social-distancing–the hysteria is off-putting, it makes it seem unimportant. So, by hoarding food, house items, and cough medicine, you’re single-handedly increasing the chances of this infection spreading quicker and harder. Those of us who are young are the ones MOST LIKELY to SPREAD this infection without knowing it. Instead of facing this scientifically, intelligently, which would make most of us young folks pay better attention, everyone is facing this hysterically, with misinformation.

Thank you, apocalypse shoppers, for ruining our chances of a speedy, national recovery.

DO:

Wash your hands for at least 20-30 seconds. If you weren’t doing that before, I’m worried. Disinfect surfaces frequently, and personal items like keys, your phone, and the inside of your car, if you want to be extra cautious.

DONT:

Touch your face or put strange objects in your mouth. If you’re anything like me, and a writer, this can be tough if you are, well, writing with a pen. I used to bite on my pens in mid-thought. Can’t be doing that right now.

DO:

Understand that if you get sick, you have a very high chance of being okay. People are dying, and that can’t be overlooked. There are some young people who lose the battle, and many older folks, most of which (from both categories) have some type of underlying cardiac or other health condition. If you smoke, your lungs will have a harder time to push back against this illness. And even still, there are some people in their 80’s and 90’s who are surviving, and some people with underlying conditions who are surviving. This is not endgame.

DONT:

Pretend like you can’t get sick just because you’re young. You can, and if it doesn’t become severe, that’s wonderful. Problem is, you will spread your germs and get the vulnerable population sick. Again, stop acting in SELF-PRESERVATION. Everything isn’t always about YOU. Sorry if that hurts your feelings. Start acting like a community. Start showing some compassion and intelligence. Keep yourself healthy, keep your neighbors healthy. It doesn’t take six bottles of bleach and all the food in Trader Joe’s to keep you healthy. Stop being stupid.

DO:

If you have mental health issues, don’t forget about self-care. Focus on activities you like. Read, write. Play video games, watch television, have a laugh. Engage in news and stories and conversation that isn’t just about COVID-19. Stay updated on current local information, but do not become consumed by it. Unlike COVID-19, panic can spread through the internet and radio.

DON’T:

Spend all your time listening to White House addresses if you’re in the U.S. For the love of God.

DO:

Recognize that people are hurting. The stories coming out of Italy are heartbreaking. Take this seriously without losing yourself.

DON’T:

Become a doomsdayer or conspiracy theoriest. Wait until the global emergency is over for all that.

The world is in so much pain right now, and is so confused. China has made great efforts and cases of COVID-19 have been drastically reduced. Recovery surpassed 80% there, days ago. This will pass.

Every once in a while, humans need to be reminded that we aren’t impenetrable. We aren’t immortal. We aren’t invincible. We’ve gotten so cocky on Earth, we think we know everything, think we can have a sustainable life with the way we purge natural resources. This pain on a global scale isn’t necessarily what we deserve, but it is a reminder that we are only organisms. There is so much more to life than money, jobs, school, Apple T.V, Trump, drugs, sex. And when our life gets disrupted, look how we crumble. Look how fast we are to only save ourselves. Life always, always has a way of curbing arrogance. Always.

We’re not curbing this virus. It’s curbing us.

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Posted in science, Therapy, Voices

Where Research In Re-Framing Our Thoughts Could Take Us

Posted on by alidware

We get consistent word from our therapists that if we re-frame our thoughts, we can change the way we think, the way we perceive things, and that will ultimately help us cope with life. This is often done with Cognitive Behavioral Therapy, which is a very proven (as in scientifically) therapeutic method.

There are people who praise this method for saving their lives and others who don’t, and CBT takes a lot of work–a hell of a lot of work. You won’t see results if you don’t take it seriously, and if you’re anything like me, it’s hard to take it seriously when you’re heavily depressed or so anxious you want to jump from your skin. Let me give some background on why this topic is so interesting today.

Amidst all the anxiety this morning, I spiraled down with thoughts of failure, pain of where I am in my life right now versus where I could be, and felt out of place in the classroom; other students whispered about me, and thought very loudly about me. I lost focus in the lecture and I felt bad about that.

The professor popped a meme up on the screen of some woman with a stack of papers at work scribbling maddeningly and saying “this is a two-cupcake Friday”.

I don’t remember what this portion of lecture was about, or if the meme was even relevant, but through all my cloudy thoughts and thoughts of the students around me, one of my voices said calmly “you’re having a bad day.”

And I was. But the significance of this is far greater than just that realization.

Another thing therapy shoves down our throat is that our problems which feel permanent and hopeless are often temporary and malleable. In the moment, I felt miserable. I thought I was falling into another depression, that I’d spent the last year and a half off meds and this day, today, was going to be the day I decided to go back on them because I just couldn’t take the pain anymore.

It’s been a hard three weeks, and to ignore all of those factors and conclude “it’s just my brain making me mental again” would be foolish. I’ve been stressed, and today has been particularly difficult: I had a bad day. There’s nothing else to look at.

Multiple things came to mind as a result of this voice presenting his softer side. The first was–I tell myself the very same thing all the time. I’ll say to myself, “Ugh, today is a bad day.” And I’ll recognize it, but the reality doesn’t always sink in. And so I thought, as I sat through my second course more invigorated and positive, are we more likely to believe others about our true state of self, of being, than we are to believe ourselves?

Let’s look at this through two lenses:

The Theory Behind It All:

  1. Personality Research Shows that friends/family are more accurate in describing things we may be good at, like school/work. (Look up INFORMANT JUDGEMENTS and studies by Connolly (2010).)
  2. Research in this area also shows friends/family are better than us at predicting our personality traits like contentiousness and openness.
  3. Some personality researchers focus only on showing how much we DON’T know about ourselves (like WHY we think the way we do, or WHY we did something/feel something).
  4. Researcher Carol Dweck studied growth/fixed mindset and the influence on intelligence. In her study, children were influenced with praise on their intelligence versus praise on their effort. The study didn’t have anything to do with the effect of the words, but the outcome. Still, the words had a great effect on the thoughts of the children.

The Questions That Now Arise:

1.We are our largest critics, so they say. Why does it seem we doubt the POSITIVE things we tell ourselves, but are convinced of the NEGATIVE things about ourselves?

2. Can we use this possibility to our advantage?

3. For those of us who hear voices, can we train our voices to re-frame their approach, or do they naturally mature as emotional stability improves and coping mechanisms enhance state of living/being?

4. What makes us more likely to believe NEGATIVE things about ourselves versus POSITIVE things?

5. What makes us put more weight on OTHERS words versus our own?

6. How could research in this area of behavior and cognition help further treatment and therapies for psychosis?

These are passing thoughts I had during my second and last lecture. I wondered about it because I had been soothing myself all morning, giving myself reminders that my anxiety is bad, I’m not having a heart attack, that I’m just having a bad day. The moment my voice reiterated that, relief washed over my body. Suddenly, my heart rate slowed and I could focus in class. My head wasn’t as clouded and I went to my second lecture in a great mood–partly because I was fascinated at the effect he had on me.

And so the wonder continues: there is no argument that when a voice tells you you’re worthless, or stupid, or that you’re going to die, you feel immediate dread, sadness, anger. Therefore, were one to tell you something positive, it seems reasonable the same intensity, but positive (happiness, comfort, contentment) has the potential to flow through you. The problem is there isn’t a lot of research in helping people unite with their voices, nor with themselves, regardless of whether they hear voices or not.

When I attended a Hearing Voices Workshop in San Francisco, the man in the couple leading the discussion heard voices and had just been diagnosed with dementia. They’d been spending time training his voices to remember things for him. According to his self-report, and his wife’s informant judgement, it had been working.

This would be regarded as a case study and we can’t put a lot of weight on those scientifically. But it can be a catalyst for real research and potentially a new therapeutic avenue for soothing psychosis.

It seems that we need affirmation when it comes to positive things about ourselves. It seems we need someone to agree with us, or remind us, that yes, we are safe. Yes, we are okay. Yes, this too shall pass. Yes, you are strong, yes you are this, yes you are that. It’s as if we have the inability to create that foundation for ourselves and truly believe it.

But when it comes to the negative things, our failures or short comings, we take them at face value. We don’t need someone telling us “yeah dude, you failed”, for us to think of ourselves as a failure. In fact, someone affirming our negative beliefs about ourselves seems to make it more likely we’ll believe that in the future, whereas someone affirming our positive traits/beliefs doesn’t.

What could this mean? How could we study it?

Many of us may internalize what trauma we’ve experienced as children or adults and so the automatic sense of “everything is horrible” may influence our natural thought. But even among memories of trauma and experiences of trauma, we had moments of great fun. I grew up with my dad being violent and using drugs, terrorizing my house. But I have equally intense, positive memories of being out in the garden with him, planting tomatoes and helping him work on his cars.

Why is it that the negative becomes the basis of my emotional foundation? And can we use what we know (and can still learn ) about this very automatic bias to creative equally positive, habitual thoughts?

I suppose it’s worth mentioning that since one of my False Angels reminded me I’m “just having a bad day”, I haven’t heard anyone else talking, my anxiety is at a steady, manageable level, and I’m more motivated than ever to finish this degree and research.

And to think: I’ve ignored them for SO long.

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Posted in advocacy, science

How Important Are Your Psychiatric Medications?

Posted on by alidware

This question is for all of us, including myself, without much judgement. There are those who quit their medication and are fine, those who quit and are not fine, those who want off but are worried about withdrawal (which can trigger an upswing of serious symptoms again), and there are those who want off but their doctors disagree.

For those with any diagnosis related to psychosis, one thing you’re told especially is to stay on your meds. The reasons for why are a little less clear. This is what research says.

The Papers:

I found two articles on this topic, both Meta-Analysis (they’ve collected a group of studies and used statistics to quantify the average results of all the studies)

They both discuss studies assessing whether long term antipsychotic treatment maintains sufficient and healthy remission for individuals experiencing first-episode psychosis. There are two conclusions you will often find when searching databases for this kind of research: 1) long term medication works and 2) long term medications interferes with progress. One of these analyses kinds of lands in the middle, and the other is 100% supportive of medication.

We’ll discuss possible reasons why both valid analyses come to such different conclusions, and what this means for us.

1. Maintenance Antipsychotic Treatment Versus Discontinuation Strategies Following Remission From First Episode Psychosis: Systematic Review.

This analysis follows studies which look to understand the risks of maintenance (Long-Term usage) compared to risks of discontinuing medication AFTER remission in first episode psychosis. Seven studies were included.

Now, they looked for specific things, particularly comparing hospital relapse rates and hospital admission rates of those First Episode Psychosis individuals who maintained antipsychotic medication to those who were discontinuing their medication. For the studies which used an intermittent treatment approach, the participants medication was discontinued by 50% every two weeks. For those exhibiting prodromal symptoms, medication was reintroduced. In the crisis-based approached, medication was only reintroduced upon a full-blown episode.

Ultimately, higher relapse rates and hospitalization rates were seen in those discontinuing medication.

Two of the studies provided information on psychosocial outcomes like employment status or quality of life measurement.

I encourage you to read the analysis for yourself. I found it shocking that things like an individual’s place in society, their level of function in their community, their sense of purpose, the amount of support available, was not included. Yes, medication discontinuation seems to increase the likelyhood of relapse according to this analysis, but what could be the reason for this? Only medication? Or what about lack of support? What about the fact that tapering off medication with 50% of the dosage broken down every two weeks is indeed quite fast? Perhaps the speed effected the results of that one study.

Another rather glaring fact which makes me worry for the integrity of the analysis is the possible bias of the authors. One of them recieved support from Janssen-Cilag (think Haldol) and Otsuka Pharmaceuticals (think Abilify). This author also was an investigator on trials funded by AstraZeneca (think Seroquel) and Janssesn-Cilag. He holds a Pfitzer (think Prozac) Neurosciences Research grant.

Another author received sponsorship from Otsuka to attend a conference, and has shares in GlaxoSmithKline (think Paxil) and AstraZeneca. The last author attended meetings supported by Sunovion Pharmaceuticals (think Lunesta).

The only inherent problem with this is conflict of interest. There are times many researchers have been caught falsifying data or misreporting data with the agreement that they would get paid extra by the pharmaceutical companies funding their research. This is also common in the world of regular medical science and was particularly a catalyst for the Opiate Epidemic. Think Purdue Pharma.

This is the largest issue medical science faces today.

2.Improving Outcomes of First-Episode Psychosis: an Overview

This overview looks at possible prevention of psychosis, which is curious in itself. You can read in the paper all the different steps and stages they present which could, with further study, advance the way psychosis is treated and/or identified in an individual. They acknowledge that despite all the preventative strategies currently in place, often people will fall back into old symptoms following their first episode.

They updated a 3-trial meta-analysis to 12 trials and found that relapse rates while undergoing preventative care strategies were, on average, lower than relapse rates of those undergoing standard treatment. However, they found that there was no substantial meta-analysis support that showed integrative preventative strategies significantly improved anyone’s potential rate of relapse in comparison to a standard level of care.

They also found that the hypothesis that each new psychotic episode “damages” the brain or is “neurotoxic” to the brain and therefore “progresses the disease” has no significant empirical evidence to support it. This hypothesis is known as the “neurotoxic hypothesis of psychosis” and I’ve heard people cite it quite often.

The overview goes on to discuss future studies and cannot conclude that any one way is the correct way. They advise against using certain medical strategies that observe and study physical illness to observe, study, and treat mental health conditions; the brain varies more so than the body in more ways than one, and to assume that both can be treated equally is pretty far fetched.

There is a lot of theory in this overview and I’m not sure how much of it could be put into practice. They discuss some ways in the article, if you’re interested, including areas of support. Accordingly, their authors were not previously supported by any pharmaceutical companies.

And so where does this leave us? We have empirical evidence that medication can halt a crisis, but it is unclear, according to the second study, if we’re simply prolonging the inevitable or helping cease the progression of something. In the case of prolonging the inevitable, it would seem more humane to let people ride through the torture and support them in other ways. In the case of ceasing the progression of something–well, it seems like we’d have more reliable and verifiable data if that were the reality.

I stopped medication because I don’t like uncertainty. And the truth of medication is uncertain. I stopped medication because I don’t like being lied to. And much of medication research and marketing is based in lies, even small ones.

This may not be the path for you. What makes your medication important to you? What makes it torturous for you? Do the risks outweigh the benefits? Would you like to discontinue them some day?

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Posted in advocacy, Community, Emotions, Voices

The Power Of Un-Positive Thinking

Posted on by alidware

I profess that I am not the type to belt out cheesy posts. I don’t put cheesy one-liners on Twitter, and I don’t post mushy paragraphs on Instagram. I don’t spend a lot of posts talking about the bad things about schizoaffective, or what kind of medications I’ve taken. It seems that a lot of people think that’s what advocacy is about, though: cheesy posts about staying positive, the struggles of living with a mental health condition, and stressing the importance of medication.

It gets boring.

And so I’d like to challenge everyone in the mental health community. I’d like to challenge this belief that in order to lift each other up, we must constantly mull on our struggles so that others can reach out and spurt lines of hope we won’t believe in. I’d like to challenge those advocates who don’t have any experience with having a mental health condition but still insist on belting out “you can do this” posts every five minutes.

The thing about negative thoughts is that pelting positive thoughts at them won’t change the negative thoughts’ status. They will still be louder, they will still be heavier, and they will still be more constant. It’s kind of like trying to tear down a brick wall by chucking oranges at it. It would take millions of years to make a dip.

Sometimes it’s just not enough to wake up in the morning and tell yourself the day will be good. Sometimes it’s not enough to remind yourself that life is grand, even when you feel the opposite. Sometimes it’s not about thoughts as much as it is action.

And so I wonder how many of us have given negative thoughts a chance? Have we tried observing the pain when we wake up in the morning and not placing judgement on the thoughts (or voices) that tell us we’re worthless or useless? When the pain runs deep, have we tried breathing it in?

The way to take power from negative thoughts isn’t to replace them with positive thoughts. It’s to show them that you are not submissive. That doesn’t mean arguing or fighting with yourself all day. Save some of that energy. It means accepting their negativity, accepting the struggle, and moving through it not with the intention of “reaching the other side”, just with the intention of braving the moment.

All we really have are moments. They’re brief, seconds long, maybe nanoseconds long, or maybe it’s physically impossible to quantify them. But they are all we really have. And so the pain in that single moment is very real, but beyond that there is nothing else. Before that, there was nothing else. We experience time in a linear fashion, which means existing second by second, moment by moment, feeling by feeling, and so although it seems like pain strings along for years, that’s really just an accumulation of painful moments.

We observe time passing like bullet points in an essay. The only difference is the document is read-only, and there’s nothing we can edit. And so we read each bullet point and we get a feeling from it, we experience that one bullet point, and we move on to the next one.

But in life we get caught up in one bullet point and suddenly every bullet point reads like that first one. We can’t edit, so we feel helpless, and we can’t stop reading because life doesn’t stop moving. We can’t change how we feel about the pain and we can’t change the nature of the pain. The only thing we can change is our reaction.

And so I encourage all of us to be compassionate to these passing moments. They’re stuck to you as much as you are stuck to them. The more time we spend hating these moments, or running from these moments, or arguing with these moments, is just more time not spent living the way we’d like.

There’s no easy answer for living with a mental health condition. There’s no magical pill, there’s no magical therapy, and there’s no magical, positive quote on Twitter that will cure you. Life has pain, life endures pain, and pain isn’t a disease you can cure. So that one account you follow with 30 thousand followers that spouts out ropes of sticky, cheesy, positive one-liners is disillusioned. It fills people with this false sense of hope that if they just think positively long enough, something will change.

That’s just not how life works. I suppose the internet is quite infamous for distorting reality.

We shouldn’t run from pain. We shouldn’t fight it or disregard it or try and shove it away in a corner to rot because it will never rot. It’s non-perishable. When we speak about our experiences, let us talk about the negative and positive equally. Let us share things in a way that inspires hope not because our story concludes with general well-being, but because we’ve learned something from it, because we’ve discovered this balance in life that’s required to exist. Let us inspire people through our bravery in embracing pain and not just through our ability to share what’s happened to us. Let us empower each other through our confidence in living life as everyone else, not just through our living life while diagnosed.

Many of us write about mental health. I encourage all of us to scrutinize how we present our material, who we follow, who we re-tweet, or re-post. I encourage us to evaluate what our goal is in our advocacy work.

There is no right or wrong way to share your life or to lift people up. But some ways are productive and some get dull after a thousand re-tweets.

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Posted in psychology, science, Voices

Is Schizophrenia a Brain Disease?

Posted on by alidware

This is hard to write.

I’m sitting here enraged. Confused. Fearful, even, of what I’m about to share.

I told myself I’d only start another blog if I had important things to say, and we’ve covered some very important topics, most recently pertinent information in the series Is Psychology A Science? where we concluded the subject’s only scientific attributes are being ignored and/or underutilized due to political and monetary factors such as an APA president calling randomized clinical trials “fundamentally insane”.

These last few weeks have been incredibly tough for me, hence my lack of posting–because trust me, I have plenty to say–and I’ve spent too much time this week in my head, not exercising, falling into old eating habits and connecting dots that shouldn’t be connected. There are enough thoughts in my mind right now to fill an Olympic pool and they’re not rushing like Olympic swimmers, but they are kind of clustered like when all the palm leaves from the tree near your pool cover the surface until you finally get your lazy ass off the couch to scoop them out.

Jokes aside, there were a few nights I considered voluntarily committing myself. Things have been broadcasted to me, twins are following me, Juice WRLD died not because of Percocet and whatever the fuck “lean” is (I know what it is but because it’s so stupid I just can’t comprehend it’s actual existence), but because of possession, a sign to me–then I remembered I have shitty, low tier health insurance and don’t want medication. So I’m somewhat functioning here in what I’m starting to feel is purgatory. Part of this is stress. My lack of tending to myself. The other part is the effects of Klonopin which does indeed act upon serotonin–I researched it–and had that psychiatrist I ranted about last time listened to my incessant pleas that drugs which so much as touch my serotonin really mess with me–anyway.

In studying for my final, my distracted mind wondered about randomized clinical trials and about psychosis. I wondered if the studies done on those experiencing psychosis for the first time, un-medicated, before the *possible* structural changes due to antipsychotic use, showed structural changes.

This is important. Why?

Well, a disease isn’t a disease unless there is definitive (i.e substantial, valid, reviewed and repeated) proof physical abnormalities are attributed to the alleged progression of the alleged disease.

And so I went onto my favorite place to find psychological research papers. And no, it’s not Healthyplace.com. It’s not some person’s Instagram. It’s not The Mighty or anything related to any kind of advocacy because advocacy is very rarely based in research. It’s NCBI, otherwise known as the National Center for Biotechnology Information. I find myself most often in the PMC section because it’s free and I can use the paper references to find the full length articles in a database. There’s great neuroscience and clinical psychological research articles there, including the PubMed database.

So I’m sure we’ve all heard that “severe mental disorders” like Schizophrenia have notable brain abnormalities such as deformed (enlarged or constricted) ventricles, changes (reduction or increase ) in gray matter, or white matter, or certain neurotransmitters, or this, or that, up, or down, right, or left–and that’s about how accurate all the information you hear is.

Most of it is coming from secondary sources like a textbook or from what I like to call Triple-Source advocacy websites like HealthyPlace that continuously vomit basic and quite honestly uninformed opinions labeled as facts. And I’m not talking about personal stories. I’m talking about those faux information pages that blurt lists of symptoms that pretty much overlap with normal shit and make people worry that hearing their name called in a store means schizophrenia. Here, kind of like this page. Beautiful example of a well-structured, well-written, horribly basic-bitch attempt at explaining something we have no real understanding of.

That’s what I hate the most about advocacy pages I think. I love personal stories and empowerment. I hate the perpetuation of the idea that we really know what’s going on physically in our heads. We don’t. If someone tells you we do, they’re either in the middle of a delusion of grandeur or they’re lying.

And so my first topic to research revolved around first-episode psychosis because that psychosis is *mostly* untouched by heavy psychiatric medications. I researched under the assumption that psychiatric medications influence the structure of our brains and could very well be presenting the “structural abnormalities” which are being used as “evidence” of a “brain disease”. You will find studies that support this. You will find studies that don’t support this. And I found a study tonight, which you can read here, which concluded we don’t really have solid evidence for either hypothesis.

Next post we’ll talk about how to read these papers and determine whether a study has a proper operational definition (is the measurement procedure correct?) and construct validity (is the study measuring what it claims to be?) and how to spot confounding variables (which should be NOTED).

In 2017, a review paper entitled Structural brain changes at different stages of the illness: a selective review of longitudinal magnetic resonance imaging studies concluded there is “adequate evidence that schizophrenia is associated with progressive grey-matter abnormalities particularly during the initial stages of the illness”. These results were concluded after reviewing studies done on patients labeled as “pre-clinical stage” patients, first-episode psychosis patients, and patients labeled with “chronic schizophrenia”.

Even in the abstract, which you can get on the NCBI, they WARN AGAINST using these results as a way to EXPLAIN symptoms of patients. They even mention their confounding variable: antipsychotic medication and long-term treatment.

In 2011, a study entitled Lack of progression of brain abnormalities in first-episode psychosis: a longitudinal magnetic resonance imaging study concluded there were no ventricle abnormalities which could be contributing to symptoms, and that the gray matter abnormalities found have the potential to be easily reversed.

Because they did not list their confounding variables in an easy to find place, and it’s 10:30pm at night as I write this, I searched their references for a study which could either contradict or confirm their findings. I found this study, which you can download as a PDF from Google Scholar. IT concluded gray matter decreases were due to both the natural progression of the illness and use of antipsychotic medication.

They gathered 34 patients labeled with schizophrenia who had been taking medication for 0-16 weeks and compared them, over a year span, to a control group of “healthy” participants. 24 had never taken medication. Those who had taken medication had been taking them for 16 weeks or less. In their conclusion, they admit their findings are in agreement with some studies, but not others, perhaps due to rating differences, group differences, focus differences, and even mental state; some studies, they said, found that the patient’s mental state may have influenced the outcome of the brain volume measurements–those studies I’d like to read too.

I’ve spent the last three hours painstakingly reading variables, reading evidence for grey matter changes, against grey matter changes, for ventricle changes, against ventricle changes, longitudinal studies, short studies, childhood-onset schizophrenia studies, chronic schizophrenia studies, and studies which measured whether or not medication is destroying brain matter.

This was hard to write because I knew there was no definitive answer. And I wanted the answer to be an obvious, valid, no.

But the reality of science is that your wants don’t matter. The reality of science is you read the facts and you either accept them or you start a basic-bitch advocacy site.

What it seems, at this day and age, is that we’ve accepted a bunch of opinion and ignored the facts. My hypothesis? Even as we continue to study this, we will only conclude the same thing as the grief studies in Europe: individual variation is the only certain thing with schizophrenia.

Grief studies showed that some people recovered better by distracting themselves, and others by going into therapy. Both recovered at the same rate when allowed to choose what was best for them.

I purport we’ll find the same for psychosis. Some will do better with medication. Others will do better without medication. We’ll find that medication isn’t the only factor playing the game here, especially if mindset has any influence on brain measurement.

So, is Schizophrenia a disease? As of right now?

There’s no solid evidence pointing in either direction.

What does that mean?

Well, for me it means I need to keep doing what I’m doing, caring for myself in the way that’s been working. Because there’s no study which has proved that won’t help me recover.

For the general public, it probably means ignore all the evidence and keep fighting for mental health to be treated like physical health, as if it isn’t already: in the doctor’s door, out the doctor’s door, five minutes tops.

Posted in Peer Support, psychology, science, Therapy

Is Psychology A Science? Part 3

Posted on by alidware

You’re here–great! This post would have been here yesterday, but I took an extra two shifts at work this week and am worn out for other reasons.

In the last post, we talked about the Clinical Method and the Actuarial method, and declared the Actuarial method more accurate. We are still under bullet point number 1: practitioners and their intuition/expertise, or what I’ve been calling Clinical Arrogance for years.

Now, why is there such a level of clinical arrogance out there? Well, it probably has something to do with the lack of push for randomized clinical trials in psychology and this idea that case studies are the best way to identify/predict other client’s behavior.

For example, Ronald Fox, a previous president of the APA is quoted with:

“Psychologists do not have to apologize for their treatments. Nor is there any actual need to prove their effectiveness.”

Why Many People Perceive the Study of Human Behavior Unscientific

For those unaware, the APA is the American Psychological Association. They argue over the DSM and other irrelevant things.

There was a push for randomized clinical trials to become a staple for the understanding of the mind, for understanding better avenues of treatment for mental health adversities, but this would have sprung detailed instructions for treatments (backed by the research) and standardized treatments. Psychologists had a somewhat valid argument, that there needs to be some flexibility in treatment. Standardized tests are shit, and I believe there’s probably a huge chance standardized treatment could end in the same category. However, I’m not sure if the standardized tests given in school are backed by any research saying they are accurate predictors of a student’s knowledge. These standardized treatments would be developed based solely on the research.

But clinical psychologists disagreed for other really stupid reasons too, rest assured. They believed psychology is an art, not a science. It doesn’t need to measure variables. Intensive case study analysis gives better understanding and insight anyway.

They’re quoted with:

“Alternative ways of knowing [case study, intuition], for which the scientific method is irrelevant, should be valued and supported in the practice of clinical psychology.”

Defining Psychology: is it worth the trouble?

Another APA president was found to say starting up randomized clinical trials would be “fundamentally insane” .

Why is this a thing? Well, I could think of many reasons. Some reasons revolve around the fact that psychologists are educated in psychology minus research. They take a couple courses maybe in their career, but there is no effort put into helping them really understand the value research has in their practice, and so we have many clinical psychologists who firmly believe psychotherapy techniques emerge from experience. Research says differently: there are certain techniques, like CBT, that work better for certain adversities, but because no one reads the research, no one implements the technique when it’s most appropriate.

This provides for a very naive group of professionals. And what does naivete strengthen?

Well, drug companies for one. They could have research that says a medication has zero efficacy and it will still be prescribed by practitioners.

For example, Abilify has no efficacy above 10mg. It’s in the physicians desk reference. I read it. Back when I was on medication, my psychiatrist kept pushing me to 20mg because it would “help my voices”.

She obviously doesn’t read, obviously doesn’t know much about Abilify, and obviously doesn’t understand anything about the spectrum of voices.

It’s a well known fact that insurance companies, drug companies, and the APA are all very connected. That can be another series I’ll push out when I’m less worn out. It’s a very tangled web.

The issue with ignoring research which says certain treatments are more likely to have an effect over others is that psychologists never learn from their mistakes–mostly because they don’t know they’re making any mistakes. If a treatment doesn’t work, it’s because the client isn’t focused. The client isn’t “putting in the work”. While that can be the case, it can also be the case that the psychologist hasn’t kept updated with the information in their field and therefore has some build up clinical arrogance.

There was a push in 1990 for evidence based practices to be the center of psychological practice. The APA’s response? Let’s lower what it means to have “evidence”; more things will be approved and more treatments will be made.

A group of scientists and researchers realized their efforts to drill logic and intelligence into the APA was vain. They then formed the APS, the Association for Psychological Science.

In the same way that Peer Respites and peer alternative programs were started out of the need for compassion in mental health care, the APS was started out of the need for competent practitioners and valid research in psychology. They sponsor science-based clinical psychology and there are many universities in the united states which hold their Psychological Clinical Science Accreditation. More are being accredited each year. UC Berkeley is one. I mention them only because I plan to attend that program for graduate school assuming I continue with psychological research.

So there are many elements of science within psychology. The issue isn’t with whether or not it’s a science. The issue is with whether or not the science is embraced and whether or not we are too limited in our human ability to learn anything worth while. Is human variation too much of an obstacle? Is that what pushes clinical psychologists to believe their intuition can outsmart a math formula? Math formulas, after all, can only describe what we observe and what we observe is inherently limited. We can generalize behavior from a sample size, we can generate neurological predictions when observing the behavior of neurotransmitters but none of it ever seems to be certain; even what we’ve studied, the effects we see, are simply based in probability.

Sound familiar?

Tomorrow we’ll talk about bullet point number 2: how this probability relates to other sciences and why I call psychology the quantum physics of human study.