> At 12:40 PM -0500 27/8/09, Jeffrey Fisher wrote:
>
> the definition of "worked" is the issue there, no?
>>
>
> We're getting somewhere, yes.
Please try to be a little more patronizing. You're disappointing me.
> The issue is, what do these medications do? We can understand how the
> lobotomy achieves the desired outcome, which is to make the problem person
> more easily manageable.
>
> Are the drugs simply a chemical way of doing the same thing?
I think some of them are. But is it necessarily a good thing to make people
> more manageable? Is it a good thing to have all these ready diagnoses at
> hand which justify drastic steps to make people more manageable.
Of course not (although it is still very much part of the question just how "drastic" the steps are). I quote me:
" I think for us the issue is making sure that (a) personality as such is not pathologized, (b) disagreement or disobedience as such is not pathologized,"
What do I have to do to be clearer about this?
Later on, I ask some questions: "Isn't treatment of something like ODD, besides being meant to make the parents' lives easier (a problematic motive, but not a horrible one, in principle), also meant to keep kids out of prison? I don't actually know that, but I'm imagining. Again, a problematic motive (pacification), but not a horrible one (prison is bad)." And then I gesture back to the (a) and (b) I just quoted. And incidentally, note that I say "treatment," not drugs. Drugs might be part of the treatment, or they might not, but it is a separate (although obviously related) question, just like with diagnosis and treatment of depression, say.
I'm sorry if this was so conflicted as to give the impression that I didn't think these things were problems. I even go further in a later post and forthrightly quote a cheesy cliche in an effort to make clear that in the case of children especially, they should be safeguarded against their parents (and society more broadly) on just these kinds of questions.
But I would say that saying you think these drugs are used in general for pacification doesn't make it so, doesn't make the drugs comparable to lobotomies, and doesn't mean the drugs don't work . . . in the sense of making people more functional. More on this below.
>
>
> I find the whole notion more than a little sinister. But perhaps this is
> just a symptom of me being a little ODD.
oh, snap.
I tried in my earlier post to gesture in a vague and non-self-indulgent way to my own experience with panic attacks. It is of course impossible to know with any certainty what would have happened had I not started on Paxil, since I did, but I can tell you I am perfectly happy with the decision, and I did feel a difference. I acknowledge that there may have been a placebo component to this, but there is no way of knowing in my particular case whether there was or wasn't. But, as I say, I felt back in control of myself. Not lobotomized or pacified (my employer will confirm: no pacification, much to their regret, I'm sure). My experience of SSRIs, both personally and with close friends, has been almost uniformly positive. Honestly, if you want to know my biggest concern, it's not that I was lobotomized or made "more manageable" when I was on Paxil (I wasn't, frankly, and neither has anyone I know been "lobotomized" or anything like it by an SSRI -- this seems to me distracting in its appeal to drama), but about long-term effects on brain chemistry of long-term, especially high-dosage SSRI regimens. I have begun to wonder if we're not in a position that people taking SSRIs for the long-term have committed to being on them essentially forever (or, at least, that that is yet another problem to solve, a problem created by the SSRIs). And that of course is something to be very, very concerned about. But I am not prepared to say it means we should simply stop prescribing SSRIs. Maybe we should. But I haven't yet seen the case for it. Much of the strongest, most consistent evidence I have seen on ineffectiveness and danger with SSRIs is with children -- Shag notes this sort of thing in her references to Petersen's book, and this is a lot of why I call out children in my thinking about this stuff.
So if you want to persuade me that SSRIs are part of a sinister plot, I'm not buying it. If you want to persuade me that there aren't people, indeed a lot of them, who are helped by some of these medications to get on with their lives and be happier people, then you have a lot more work to do. If you want to persuade me that these drugs can be (and surely sometimes are) used in ways they shouldn't be, or that they don't work and can even be dangerous for some people, your efforts were not required.
j