Friday, March 14, 2008


Sharon Begley writing in the March 17th issue of Newsweek wrote, “When you write about science there is no shortage of topics that incite the wrath of readers.” I may be fixing to do that with this blog, but please stay with me till the end before you dismiss me as a total nut.
She went on to write in the article , “In a bizarre finding, sham surgery of the knee, in which patients got sedation and an incision but no actual procedure, relieved the pain of osteoarthritis better than actual arthroscopy—and produced an equal improvement in joint function, scientists reported in 2002. And last month an analysis of clinical trials of a range of antidepressants found that, except in the most severe cases, placebos lifted the black cloud as well as meds did. To be sure, no study is perfect. In the antidepressant one, the placebo might not have looked as effective if it had been compared with the drug that worked best for each patient, rather than with the one that happened to be chosen for the clinical trial. (Some patients respond better to Paxil, some to Effexor or others, for reasons that remain murky.) But the fact remains that placebos are at least somewhat effective and sometimes very effective for some patients. Rather than railing against that finding or pretending it doesn't exist, what we should be doing is learning how brain activity that corresponds to the expectation of cure translates into clinical improvement. As Dan Ariely of Duke University says, "It's not that medicines are crummy, but that the placebo effect is so powerful."
The consumer movement and the recovery concept as a whole have been saying for years that expectations play a key role in the whole process. The fight for a bio-psycho-social-spiritual model or way of seeing the whole person is to get away from labels and low expectations and into the realm of hope and being able to dream again.
The medications I am on now are causing trouble with my kidneys. The ones before that my liver. Now they are trying to figure out what medication to use to control my bipolar illness. I am going from one doctor to another. There is not a team working with me. There is no such thing as a bio-psycho-social-spiritual specialist or a bio-psycho-social-spiritualist team that I am aware of anywhere. Why not?
If the whole person needs to be treated where is the team? Where can we go? I was sitting in a planning session the other night here in North Carolina and the subject of barriers to treatment came up. I said I thought stigma was a major barrier. A member of NAMI said a great deal of progress had been made in that area. My reply was that she must not have filled out a form at a doctor’s office lately and that asked what meds you were taking and listed a bunch of psych meds. I am and have been since 1989 a member of NAMI. I am proud of the work they have done, but the fact remains stigma is well and alive for all of us with a mental illness in this country and to think anything else is simply being an ostrich with your head buried in the sand.
Our only true hope in my humble opinion is when more folks buy into the concept of the bio-psycho-social-spiritual concept and recovery, hope and being able to dream again are the norms. Medications play a role, but they can’t hug you. They can’t listen to you. They can’t love you. They can’t dream with you. They can’t ……….
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