On Fri, 8 Aug 2003, Carrol Cox wrote:
> For some sufferers from depression, the "it's all brain chemistry" is an
> effective placebo. Whenever I mentioned to my classes that I suffered
> from depression, there would be a flurry of students showing up in my
> office to discuss _their_ depression or the depression of family members
> or friends. Often they would introduce the conversation by saying (a
> particular example) "my fiance has a problem with brain chemistry." Look
> at that as a sort of half-way house to dealing with it.
>
That makes sense. People need to know why, and this does provide a reasonable, socially acceptable explanation.
> The last I knew, there was a great deal of agreement that there was a
> large element of genetics in bipolar affective disorder. I'm not
> familiar with recent research on schizophrenia.
>
Same deal. The concordance rate for schiz is about 50% for identical twins (much higher than for other sibling pairs). Genetics is a factor here.
> One other thing. Doublt-blind tests can compare a med to a placebo, but
> how do you compare therapy to a placebo? And how does one check _any_
> treatment, placebo, therapy, or med, against spontaneous recovery? After
> all, many people have one (more or less lengthy) seige of depression,
> then never are bothered again, without treatment. And fewer but still
> some have more than one seige, and then are never bothered again.
No blinds on the psychotherapy, but they do "placebo" therapy conditions where the therapist spends time with you but doesn't actively apply any therapeutic interventions. The spontaneous recovery phenomenon is a possible confound; however, researchers eliminate the problem by randomly assigning research participants to one of the experimental conditions (drug, therapy, or placebo). If people have been randomly assigned, there will be equal proportions of people who spontaneously recover in each group, so the mean differences between the experimental groups will not be skewed. Pretty clever.
Miles