Reconciling Psychiatry with Psychotherapy

[Little_Sticks]

*mental-illness here is to mean what the DSM categorizes as a mental-illness and not that I believe all mental-illnesses are actual illnesses.

Psychiatry - Seems to believe that causation of a *mental-illness can be ignored in curing it; uses directly obtrusive brain altering methods and medications to cure.
Psychotherapy - Seems to believe that causation of a *mental-illness should not be ignored in curing it; uses an understanding of causation to indirectly cause the *mental-illness to disappear.

Given the above, when do you think it is wrong for psychiatry to directly alter someone's brain? And when do you think it is wrong for psychotherapy to try and change someone indirectly? When is it right? And how can or should they be reconciled?

 

[Within]

*mental-illness here is to mean what the DSM categorizes as a mental-illness and not that I believe all mental-illnesses are actual illnesses.

Psychiatry - Seems to believe that causation of a *mental-illness can be ignored in curing it; uses directly obtrusive brain altering methods and medications to cure.
Psychotherapy - Seems to believe that causation of a *mental-illness should not be ignored in curing it; uses an understanding of causation to indirectly cause the *mental-illness to disappear.

Given the above, when do you think it is wrong for psychiatry to directly alter someone's brain? And when do you think it is wrong for psychotherapy to try and change someone indirectly? When is it right? And how can or should they be reconciled?

It all comes down to what issue one is dealing with. For instance, a moneygrubbing biological psychiatrist with questionable morals/intellect wouldn't hesitate to treat the existential angst a homosexual christian experiences with anxiolytics. Instead of referring him to a psychologist. Simply because from this particular point of view, the patient is obviously suffering from an anxiety disorder that is caused by how your neurotransmitters interact with each other. Here- We'll just prescribe this medication that blocks off that connection, which will result in the patient not feeling anxiety anymore.

Doing so would be equally insane as to treat a paranoid schizophrenics delusion with psychotherapy alone. Seeing how from a purely psychoanalytical point of view the psychotic behavior and paranoid delusions are caused by a traumatic event in the childhood of the patient, and not an overflow of dopamine.

It's moronic to juxtaposed one with the other for the reason of wanting to separate them. Luckily, that's not how it's conducted today for the majority of cases. Sadly financial concerns tend to be involved what stance practitioners take on these issues.

The reason that there's schisms in the different schools of thought regarding a biological perspective is that with today's knowledge it's unknown if the neurotransmitters (noradrenaline, dopamine & serotonin) is the reason for let's say depression or if the depression is what causes them to change accordingly in side the brain.

 

[nortia]

I don't know how it is taken care of south of the boarder (although recent days have shown very large cracks in the surface of mental health care in the US), but in Canada both aspects are combined. My psychiatrist keeps an eye on my blood level of Lithium (which he prescribes), and in between blood tests we do Cognitive Behavioral Therapy. I currently see him every week, as well as a therapist every 2 weeks. Both kinds of care are stressed as important to each other by every doctor I have seen, basically because your chances of recovery improve substantially if you combine them (along with diet and exercise). Thus, that is now the standard approach, lumped under the moniker "mental health care".

Perhaps we're just lucky we have public health care...

 

[sprinkles]

I don't know how it is taken care of south of the boarder (although recent days have shown very large cracks in the surface of mental health care in the US), but in Canada both aspects are combined. My psychiatrist keeps an eye on my blood level of Lithium (which he prescribes), and in between blood tests we do Cognitive Behavioral Therapy. I currently see him every week, as well as a therapist every 2 weeks. Both kinds of care are stressed as important to each other by every doctor I have seen, basically because your chances of recovery improve substantially if you combine them (along with diet and exercise). Thus, that is now the standard approach, lumped under the moniker "mental health care".

Perhaps we're just lucky we have public health care...

They're starting to do both here, too.

I think both are needed. I know that in my case both were needed. I was so messed up that there was no way I was going to fix myself and no way that they were getting in with therapy.

I mean your mind is your mind and if there's a problem then it effects everything, including coping mechanisms and response to therapy. I needed medication to even get me to the point where they could actually get in to do anything meaningful.

Once I was somewhat normalized by the medication I became more responsive to therapy. I'm now at the point where I can get by on my own without either. I'm still a little loopy at times but for the most part I'm well adjusted.

I don't think that would be the case if they tried only one or the other.

 

[Lark]

*mental-illness here is to mean what the DSM categorizes as a mental-illness and not that I believe all mental-illnesses are actual illnesses.

Psychiatry - Seems to believe that causation of a *mental-illness can be ignored in curing it; uses directly obtrusive brain altering methods and medications to cure.
Psychotherapy - Seems to believe that causation of a *mental-illness should not be ignored in curing it; uses an understanding of causation to indirectly cause the *mental-illness to disappear.

Given the above, when do you think it is wrong for psychiatry to directly alter someone's brain? And when do you think it is wrong for psychotherapy to try and change someone indirectly? When is it right? And how can or should they be reconciled?

My understanding is that the division is more along the lines that psychiatry is medical model in diagnosis and treatment solutions, therefore they examine brain lesions, body and brain chemistry, determine symptoms based upon organic illness.

Psythotherapy considers learning, environment, systems and adaptation and/or adjustment when making diagnosis and prescribing treatment.

They examine different things but there's less division than their was, definitions of illness and disorder are more consensus bound now, they involve behaviour which is maladjusted or maladaptive in specific cultural contexts and the crucial criterion of personal distress.

To be honest the greater division is between past and problem focused interventions and future and solution focused if you ask me, some practitioners on the basis of high minded principles about truth and occasionally rants about years of practice norms they dont want to be associated with will say that focusing upon a problem, defining it, knowing it, discovering its origins, undoing repression is totally necessary, even if it involves retraumatisation of patients by destroying myths and rationalisations which have been heretofore stabilising and providing some esteem, like myths about incapable or neglectful parenting, while others will say well, what is the solution instead.

One of the greatest disputes about it I know involved a paper presented to a conference on a patient presenting with sleep problems who states they believe that their upstairs neighbour is beaming lights down into their head while they sleep and stealing their thoughts, the therapist listens to that and never mentions it again, they counsel and work with the patient to get sleep, who does, the patient is when happy, fit and well, they state that they themselves believe that sleep deprivation caused them to think and say odd things. Now more than half the assembled practitioners left that conference and condemned that paper because they said that no work had actually been done on the underlying personality structure which they believed was probably paranoid or schizoid.

Personally I dont believe its the place of anyone interested in genuine caring, cure and recovery from distressed or disordered thinking to engage in endless muck racking, opening and reopening old wounds, confronting already troubled people with more troubling information.

I've seen that shit abused in the context of troubled teens repeatedly confronted with the reality of their family background and parents short comings, sometimes it increases resistance to change or help, sometimes it just causes despair, a lot of the time the only person its satisfying is the practitioner or professional who has some shit wrong with their empathy, slavishly adheres to theory or has some unconscious need for self-regard and self-congratulation through comparison of their own familial back story with that of less fortunate persons.

OK, I'm a bore about this but anyway.

 

[nortia]

My understanding is that the division is more along the lines that psychiatry is medical model in diagnosis and treatment solutions, therefore they examine brain lesions, body and brain chemistry, determine symptoms based upon organic illness.

Psythotherapy considers learning, environment, systems and adaptation and/or adjustment when making diagnosis and prescribing treatment.

They examine different things but there's less division than their was, definitions of illness and disorder are more consensus bound now, they involve behaviour which is maladjusted or maladaptive in specific cultural contexts and the crucial criterion of personal distress.

To be honest the greater division is between past and problem focused interventions and future and solution focused if you ask me, some practitioners on the basis of high minded principles about truth and occasionally rants about years of practice norms they dont want to be associated with will say that focusing upon a problem, defining it, knowing it, discovering its origins, undoing repression is totally necessary, even if it involves retraumatisation of patients by destroying myths and rationalisations which have been heretofore stabilising and providing some esteem, like myths about incapable or neglectful parenting, while others will say well, what is the solution instead.

One of the greatest disputes about it I know involved a paper presented to a conference on a patient presenting with sleep problems who states they believe that their upstairs neighbour is beaming lights down into their head while they sleep and stealing their thoughts, the therapist listens to that and never mentions it again, they counsel and work with the patient to get sleep, who does, the patient is when happy, fit and well, they state that they themselves believe that sleep deprivation caused them to think and say odd things. Now more than half the assembled practitioners left that conference and condemned that paper because they said that no work had actually been done on the underlying personality structure which they believed was probably paranoid or schizoid.

Personally I dont believe its the place of anyone interested in genuine caring, cure and recovery from distressed or disordered thinking to engage in endless muck racking, opening and reopening old wounds, confronting already troubled people with more troubling information.

I've seen that shit abused in the context of troubled teens repeatedly confronted with the reality of their family background and parents short comings, sometimes it increases resistance to change or help, sometimes it just causes despair, a lot of the time the only person its satisfying is the practitioner or professional who has some shit wrong with their empathy, slavishly adheres to theory or has some unconscious need for self-regard and self-congratulation through comparison of their own familial back story with that of less fortunate persons.

OK, I'm a bore about this but anyway.

That is a very interesting example, I'd love to be able to read the article. Do you have a link?

The breaking down of people's worst moments is a very controversial method of psychotherapy (at least in my mind), and your probably right that it ends up doing more harm than good in a lot of cases, but not all psychotherapists employ this method. The great thing about Cognative Behavioral Therapy, which I think gets lost on a lot of the older generation psychotherapists, is that it only takes a small change in how you react to situations, and how you think about the world around you. Its as simple as bringing logic in to every thought, even the most banal. You don't need to find the root of every problem for CBT to have a noticeable effect on your life.

http://moodgym.anu.edu.au/ is a website that psychiatrists use for patients when there have been cutbacks to personnel. At first I thought it was the hokiest crap, but once I got past that it really did become my lifesaver.