Tuesday, June 23, 2009

Wanderers 2009.6.23

George Weissmann and Joe Arnold
:: george and joe ::

Joe Arnold is giving a talk on psychiatry, looking back on close to 40 years of experience. He noted Ed McMahon's passing (also on CBS News), using this milestone to register some disappointment and/or disillusionment regarding our progress in the science of mind.

Going into it, he expected grand revelations. Looking back, he's seeing a lot of the same tired old views, such as "depression is a chemical imbalance". These statements are close to meaningless. One may practice in a bubble, surrounded by fog, such is life.

His focus will be biological however. The guy is a careful thinker. He has his references stacked up, a Synopsis of Psychiatry, a Textbook of Medical Physiology, both with venerable traditions. The National Library of Medicine on the Internet is a good on-line source. His hand-outs help us navigate to our evening's core topic: depression.

Genomics has come a long way in 40 years, but so far not a great deal has come from it, where psychiatry is concerned. The control of the gene and its products has to do with its complementary environment, i.e. isolating DNA sequences doesn't "explain everything" (whatever that means).

DSM4 defines some five dimensional space (five axes) which Joe accepts with a grain of salt, thinking "axis" is somewhat high-minded, over-inflated (faux precision, a kind of marketing). Psychiatrists enjoy inordinately high-flown language, helps them specialize and gain niche markets.

David Feinstein jumped all over this, bringing his five dimensional math thinking to bear. "He's saying it's bullshit" I translated. But David wanted to know in exactly what sense. We spent several minutes on this. For Joe, it's about nomenclature.

Psychotherapy is about the restoration of morale. Some people are intrinsically comforting. You should never underestimate the power of encouragement (or the power of negativity -- both are contagious).

Psycho-pharmacology: we went through a run-down of some of the drugs, which have been getting better.

Worry warts, perfectionists, people into world domination, are among the prime candidates for depression.

Sometimes artists traffic in the kinds of imagery associated with psychosis, so we might think of them as being so. That might be a hasty judgment in some cases. Explorers of psychological worlds, including psychologists, have these occupational hazards, sure, but they go with the territory (tantric thinkers take a similar view i.e. if you're not wrestling with angels on occasion, then you're just being lazy (or are wisely hanging back, not having any relevant training or coaching, not unusual in some cultures)).

The discussion of cell biology was fun. There's a clear API such as we might code in Python. The better understood drugs (tri-cyclics, SSRIs) are usually explained with reference to this diagram, although there's lots more going on, lots of incomplete theories.

We had a great turnout tonight. Jon Bunce is back, woo hoo! And Steve Mastin, haven't seen that guy in years. Our questions seemed pretty smart.

Psychiatry is still a lot like working on a Swiss watch with a sledge hammer, and it's easy to make people worse instead of better. It's not a futuristic Star Trek world in which we really know a lot about the mind, though some docs may act like Spock sometimes, perhaps as a part of their bed- and/or couch-side manner. Vulcans can be inspiring sometimes.

likes Steve Weinberg's writings on consciousness, read aloud from The First Three Minutes. I was able to confirm Steve had been an ISEPP speaker, calling up my new isepp.py.

My question was whether medical ethics permitted subcultures of psychiatrists to test drugs on themselves as human subjects, sort of like "first person physics", some branches of anthropology. Of course Timothy Leary got in trouble for doing this. The answer was not surprising: playing it safe is more the name of the game. We live in a risk-averse culture (probably what makes it so dangerous, given the way human psychology seems to work).

Actually, I read the above paragraph aloud, as my way of asking the question, the answer already guessed. Joe's answer was more nuanced: in his own training, practitioners were allowed to take small doses of stuff, and as one goes further back, the case literature is full of good doctors self dosing. Coming forward, he doesn't see off hand how self testing would be that useful, although we didn't brainstorm too extensively.