Monday, July 13, 2015

In Praise of Quick Fixes for Depression (And Possibly Other Psychiatric/Mood Disorders)

Yes, yes, I know. I just wrote a post deconstructing "quick fixes" for psychiatric and mood disorders

So why am I now posting an article praising quick fixes?

For a couple of reasons. One, I am a fair guy (all occasional appearances aside). Two, I'm bipolar. We bipolar peeps kind of roll this way. We'll feel and see things completely one way and then - days, hours, weeks, or at some point - see the exact same topic or idea or view in a completely different and opposite way. We'll go from wildly optimistic about something to being horrendously pessimistic about the same thing (I wrote about the neuronal basis for optimism and pessimism in my neuroscience blog a while back). Our minds just sort of tend to work that way - see things in alternating completely opposite ways. Actually, a lot of people will work this way (I'm sure some of you have observed this in someone close to you and were left scratching your head wondering "what the hell just happened there?"), it's just that bipolar minds work more regularly this way and more radically this way and for more prolonged periods (among other weird and wacky ways). 

This can be rather crazy making (trust me on this one) but it's not too bad if you sort of go with it and allow your mind to explore each side of whatever bee happens to be in the bonnet (like the topic of "quick fixes" for psychiatric and mood disorders for me lately) and can avoid the radical extremes of run away grandiosity and delusional belief positiveness on one end and dark pessimistic pits of despair negativity on the other (this ranks quite high on the Easier Said Than Done list for bipolar peeps, I must truthfully confess, however). 

My brain also just naturally has this habit of seeking all kinds of truths and poking at them to see which apply here and which apply there. I also try not to fall into confirmation bias traps and single view perspective traps. [people who are bored and/or have too much time on their hands and have read through my other blogs will know that, despite being a true blue atheist (or non-theist, if you will), I also wrote about the possible positive efficacy of prayer

Anyway, almost no sooner than I finished writing the previous post pouring cold water all over "quick fixes" than my mind started throwing up all kinds of reasons in favour of quick fixes. From past experience (lots of past experiences (many of them the aforementioned crazy making experiences)), I knew that these opposing thoughts would haunt me unless I worked them through and wrote them out for all to see (or at least those readers who trudge through all of this stuff of mine). 

Now everything I outlined in that previous post is absolutely true (or at least not absolutely false) but it's also true that there are other perspectives on the whole notion and approach of "quick (or easy) fixes". 

So in the interest of presenting alternate perspectives and truths (and easing my nagging conscience), here we go. This is rather neatly illustrated by this great image:

For the fun of it we'll say that the previous post was the warm orange square perspective (or is that a rectangle?) and this post will look at the soft blue circle perspective (and no, I'm not trying to mess with you psychologically by choosing them that way). 

Now I firmly, firmly believe in the science of my approaches to better mental health and a more stable mind (AKA: my Positive Difference Making Fundamentals which truly are very well backed by and grounded in solid science of numerous and varied approaches; I would genuinely not have used them nor advocated them if they weren't). But the truth is that they are all a) quite time consuming to properly practice and b) quite difficult to practice properly and effectively on one's own without a lot of support. Real brain changes are like that - hard work and lots of time with lots of support (from therapists or family or friends making sure you stay on track with them). 

And something that's haunted me (that word again) from the very beginning about all my approaches is the realization that not everyone is going to have the time and mental space to devote to working on their brain, mind and habits like I do, let alone the important understanding support of family and friends. For another truth is that, due to my condition being as chronic and as serious as it is, I became disabled, qualified for a pension and am now unemployed (and unemployable) for a great number of reasons associated with having and dealing with all the conditions I have. I make getting better and improving how my brain works a full time job. 

So what about the person who doesn't have that kind of time? What about the person who doesn't have that kind of dedication and devotion? The mega stressed university student balancing a job and school workload? What about the person who balances work, kids, family obligations and the like who's already stretched to the limit? (To name just two of dozens and dozens of possible examples)

They may simply not have time for all my stuff (as effective as it may well be in the long run). They may not be able to - for wide host of reasons - be able to make the critical lifestyle changes that I have been able to make. They have all this shit going on - maybe a dozen spinning plates up in the air - and they just need some damned thing to work and work fast. 

They need "magic bullets" and something they can just quickly take or do that will help straighten things out and let them cope with their lives in whatever way possible. 

And the truth is that these "quick fixes" (generally some sort of pharmaceutical drug) will work, at least for the short term. There is a good deal of literature showing the short term efficacy of pharmaceutical treatments (along with considerable anecdotal evidence). The truth is that all kinds of things may work. 

For here are a few more truths about severe episodes of depression, bipolar disorder or even schizophrenia - throughout history many of these cases just passed naturally. Things would be horribly horrible for a period of time and then somehow the ship would be righted, they'd return to normal (such as that may be) and that would be the end of it. Pulitzer Prize winning science writer Robert Whitaker explores all this and gives some interesting statistics and case studies in his fascinating and eye opening book Anatomy of an Epidemic, in which he very thoroughly explores the history of psychiatric illnesses and the pharmaceutical/psychiatric approach to their treatments. 

What this means is that it's entirely possible that whatever treatment one takes has no real bearing or effect at all and the condition just passes naturally as they often used to. But what happens is that the treatment - whatever it may be - helps a person cope with the short term crisis (of a few months to possibly a few years) until their brains sort everything out, right the ship, the crisis passes and on their lives go.

Another thing to consider is that if studies show that a given treatment is only equally as effective as a placebo or dummy treatment (and the ratio often seems to be in the fifty/fifty range), what about those that showed positive effects? If people report feeling better, what's going on there? 

We actually don't know what's going on when people report feeling better. Was it placebo? Was the drug treatment actually "fixing" something? (highly unlikely not, but I'll outline that another time). We actually don't know why a lot of treatments seem to work, only that there is an observable and reportable improvement of conditions. 

And does it really matter how it "works"? 

Here's one of the great truths about people - they don't actually give a shit how it works. They don't give a shit if it really works. People by and large don't give a shit about the science behind it or science at all. People just want one thing - to feel better and cope with or get on with their lives. People could not care less if it's an illusion, a trick of the light, a sham or whatever. They care about feeling better and carrying on with their lives in some sort of improved fashion and that's it. 

For here's another truth - and perhaps the biggest Grand Poobah truth - about the human brain: it is very, very possible that whatever it deeply believes in may well "work". 

There are actually some very interesting studies and data about this; whatever treatment you believe in has the greatest chance of working. 

What this means (apparently) is that if you believe in drug therapy, that may well work best for you. 

If you believe in Cognitive Behaviour Therapy, that may well work best for you. 

If you believe in herbal remedies (and St John's Wort was very popular for some time), that may well work best for you. 

I know practitioners of hypnosis who report excellent results (however problematic self-reporting on such outcomes may be) and the truth is that many people do believe in hypnosis and for them maybe that is the best way to go. 

There are people who believe in astrology and tea leaf readings and all kinds of other similar ways for "understanding" their lives and minds. For them, perhaps those things may work and help them straighten out their mind and lives. 

In truth, you could go around the world and find that all kinds of strange and wacky "treatments" may "work" or - and perhaps just as importantly - appear to work. 

I have many Filipino friends and one evening they told me all kinds of stories about what they colloquially referred to as "Dr Quack-Quack" (yes, they were serious). These are local "doctors" that amount to something like shamans. If western medical doctors couldn't fix something, they'd bring in a Dr Quack-Quack. Incantations and perhaps some herbal concoctions would be applied and boom, the condition would disappear. Weird psychotic behaviour, physical ailments, all kinds of things, you name it; it worked for them and they couldn't care less if we westerners laugh and scoff at it. They believed it, they experienced a relief of or disappearance of their symptoms and that was all they cared about. And you could go find similar traditional medicine people in different cultures around the world whose methods may work for those who were raised and conditioned to believe in them.

People have turned to religion (or discovered it) and had severe episodes of psychiatric disorders turn around and just fade from memory. Some people just got into different environments, got better more satisfying jobs and things all turned around and the disorder faded into the past (again, Whitaker details some fascinating case studies on this). 

For perhaps one of the biggest truths about the brain is the incredibly powerful effects belief will have on it one way or the other (placebo for positive, nocebo for negative - the neuroscientist Mario Beuregard's book Brain Wars is an excellent place to start in understanding these mind phenomenon). Belief can change our biology and neurology and physiology. This has been tremendously well studied and documented for many, many years (though no one in the psychiatric or psychology professions who deal with mood, emotional or psychiatric disorders wants to talk about this). So if whatever "fix" you believe in works, if that's what you deeply believe in (for whatever reason), that could well have the best chance of working for you. Belief can turn all kinds of things around in the brain.

So back to "quick fixes", many - if not most - people could give two figs how or why they work. They just want to feel that they work. If they are lucky enough not to be affected by the side effects (quite possible with most anti-depressants, something unlikely to be escaped with anti-psychotics and mood stabilizers), then who cares? Who am I - or anyone - to throw cold water on that? If it works for them, then all the power to them. They have busy chaotic lives and if a pill or pills helps them manage and get through life, that's all that basically counts. There are no bonus points for how we get through life, only that we do get through life. 

So yes, for a certain percentage of people (and what that percentage is is rather fuzzy but it is not inconsiderable, it seems) "quick fixes" could appear to work. And for how the human brain works, appearing to work may be all that matters, may be all that makes the critical difference. How and why they appear to work really and truly doesn't matter. People are busy, frazzled and experience periods of great distress or depression or anxiety or perhaps psychosis and if pills or a ECT or some other kind of quick fix treatment seems to work for them, it doesn't matter what competing sciences (nor I) say about that. 

For my part, I (sort of) don't care either. If someone I care about feels better taking medications, I'm going to support that. My positions on medications and the psychiatric and pharmaceutical industries become irrelevant; what matters is that they feel better and can cope. 

If this all seems rather odd and confusing, it is. But welcome to the world of the brain and of all the weird and wacky things that can go wrong in there, why it can go wrong and what may or may not get it back on track. 

I maintain that we have to work on certain core issues and work to attain and maintain better brain and body health to truly have a chance at and enjoy optimal mental health and sense of well being (relative to each individual's circumstances). But it is undeniable that what may appear to be "quick fixes" can indeed help a good percentage of people. 

I am more than extremely familiar with going through a life crisis and having everything fall apart around me while my mind was simultaneously falling apart and experiencing the ensuing horrendous mental madness. I am, therefore, extremely empathetic to what people go through during life and mental health crises. I deeply understand that people just need to get help in whatever form and get through that crisis and survive (IE: not lose their lives to suicide or descend into a life of homelessness and substance abuse). I deeply understand that people need to do whatever they can to get on with their lives and cope. 

And the ultimate truth (regarding mental health and life) is that that is the bottom line. 

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