Greg’s dilemma is one we all share – even John Junig.
The easy bit of the dilemma has to do with dependence and withdrawal. Dr Junig’s line that he’s trained in neuroscience and behavior and can confidently say that Greg’s – or anyone else’s – difficulties on treatment with benzodiazepines, antidepressants or mood stabilizers, are just in their mind, just a matter of conditioning, is just wrong.
Anyone who’s ever ridden a bike as a kid will know you can ride it backwards also. This is the image in last week’s post – Riding a Bike Backwards. This is a matter of conditioning. It’s relatively easy to re-organize conditioned reflexes to make this possible.
But the problem facing many people when psychotropic drugs go wrong is much more like riding a Backwards Bike. Click Here to see the problem. No amount of deconditioning and reconditioning fixes this problem. The original pathways no longer work. There is nothing for it but to build up a new skill set and this is harder than acquiring an entirely new skill because the old skill set interferes badly.
Among the problems whatever it is that happens on withdrawal gives rise to are a set of cognitive problems that are outlined in the new Complex Withdrawal section where they are discussed in terms of muscle memory. These problems clearly overlap with the Backwards Bike problem – but they remain problems largely unrecognized by mainstream psychology at the moment.
Our hunch is that dependence and withdrawal problems are linked to a neuropathy. Most people figure that any malfunction that is happening is happening in the brain but there is a case to be made that a good deal of what goes wrong happens in the periphery – in the nerves to our guts, skin and genitals.
Wherever the problem is, riding a Backwards Bike does throw up conditioning problems. Getting thrown off the bike and hurting yourself would make anyone phobic and nervous. When things that should work no longer work the way they should most of us can be reduced to gibbering wrecks pretty quickly. It takes extraordinary courage and patience to endure.
Greg’s trickier dilemma
Which brings me to the trickier bit of Greg’s dilemma.
RxISK is powered by a growing number of people who have shown amazing courage and patience. People like Anne Marie who was convinced that her SSRI was causing her to crave and abuse alcohol and who with no background in this area spent years researching how this could happen and brought her ideas to me – a Serotonin expert. See Driven to Drink. It was pretty clear to me that she was right and also clear that she was extraordinary in her ability to hang on to her insight through years of condescension and sometimes abuse.
It is now also clear that while most doctors still find it impossible to believe her, and would likely use words like Dr Junig used in the last post, the pharmaceutical industry agreed with Anne Marie several years ago and have been quietly making treatments for alcoholism on exactly the basis she suggested. If these treatments make it to the clinic, with a little bit of marketing, people like Dr Junig will somehow (maybe its the neuroscience training) pretty quickly come to regard anyone who doesn’t understand this – as nuts.
There are any number of others who have insisted on the reality of Post-SSRI Sexual Dysfunction (PSSD) in the face of ridicule or disbelief. Just recently Lilly slipped into a difficult to spot corner of the fluoxetine label a concession that PSSD happens.
Quite aside from the intriguing perspectives that can open up when treatment with statins, psychotropics, antibiotics or hormones go wrong, there is a simple matter of clinical pharmacology – nothing to do with neuroscience. There is variation in how we are wired so that some of us for instance given a beta-blocker, which slows the heart in nineteen cases out of twenty, will see our heart rate increase. This is not a matter of conditioning. We cannot be deconditioned. If you don’t recognize this possibility it’s not clear you should be prescribing or doing any kind of therapy with people who are on meds.
So why is it so difficult for doctors like Dr Junig or therapists like Margaret Altman, who seem to misread Greg’s dilemma so badly, to appreciate this? Why do they forego the opportunity to make their own jobs more interesting and help their patients at the same time. It’s not every day of the week that we get the chance to pull on a thread that tells us more about how the human body hangs together or the wider economy of healthcare works.
The answer I think is because Dr Junig and Ms Altman are not talking as scientists or therapists but as believers.
They hear Greg or Anne Marie or anyone with a problem like PSSD as saying “hey you don’t want to believe in God – I said my prayers and took his Sacraments and look I’m crocked”.
Greg and Anne Marie may not in fact be saying that they don’t believe in God. They will often be much more like the many who wonder – without necessarily disbelieving – how a just God can let six million Jews be gassed. But this makes many believers uncomfortable and gets read as incipient atheism.
When passers-by see the Experts diss Greg and Anne Marie, for 99% of them this makes Greg and his problems and Anne Marie and hers become invisible.
There are some experts who figure Greg and Anne Marie are right and that there is an issue – this doesn’t mean that these agnostic experts know exactly what the issue or its answer is.
Some of experts do in fact become atheists. They preach to the 1% who will listen that the drugs don’t work – dooming themselves to irrelevance in the process.
The 99% of passers-by see these agnostic and atheistic experts as the monster raving loony party. We all know that for every scientific position there are always Flat Earthers and of course there are conspiracy theorists who figure we never got to the moon – but for the rest of us we see the rockets go up and every time we get on a plane and it takes off it tells us that mainstream science is right.
Unless something out of the ordinary happens, the 99% aren’t going to look any closer.
Greg’s bigger dilemma is how does he – how do we – engage the 99%.
Mad in America
While these posts on Greg’s Dilemma were running on RxISK, a post ran on davidhealy.org – Antidepressants and the Undead – that was cross-posted on Mad in America. After the usual MIA response that no-one knew what Healy was saying – what the hell has Buffy the Vampire Slayer got to do with anything – one of the contributors waded in with Hey Guys don’t you know this Healy dude is the biggest promoter of ECT in the entire universe.
The comment came from someone who knows nothing about Healy, who skimmed a Healy blog post and figured he wasn’t going to read any more, who knows nothing about what Healy thinks or feels about ECT, who was going totally on the basis of an article Peter Breggin had written about Healy 3 years ago – See Breggin.
This comment triggered thirty or forty comments – they’re still coming in. Things got heated and some of the comments have now been deleted. A variety of people wondered why Healy was let post on MIA given his views about ECT and the medical model. Anyone who came to his defense was attacked.
This is what happens when people have been abused – when they have lost out to the System. When Ireland was struggling for its independence from England, the joke was that the first item on the agenda for any new political party was “The Split”.
In the midst of the MIA comments there was one that brought out the issues nicely – appropriately perhaps from someone calling themselves UngodlyOutraged.
Comment Link: https://www.madinamerica.com/2015/12/antidepressants-the-undead/#comment-79846
It’s weird because everyone has to be right and in order to be right, each individual clings to a pedantic shade of meaning, hoping that if the slice of meaning gets small enough, it will become intellectually unassailable. It is the same reason that the horrors perpetrated on labeled persons are usually no longer discussed in their full, disgusting, bloody, body counting horror. Everybody wants their little slice that they can be “famous” for, whatever famous means in a community of people generally unknown to the public at large. No one stands for the big picture anymore because it is TOO big. It is, by its size, inherently indefensible against those who choose to make their fortunes and names carving out a little piece of it upon which they can become a “well known expert”. That is why this discussion is so weird.
Engaging the 99%
This is the dilemma. It doesn’t need an expert these days to tell us the world is round. It was once common sense that any medical treatments or procedures, including ECT, can go badly wrong for a number of reasons. If we now have to turn to some expert to say this we’ve lost.
We have to find a way to make it an article of common sense once again that medical procedures are inherently damaging – as the Courts insist they are – so that when someone raises a problem as a result of treatment they are not dismissed out of hand. We may in fact be wrong to make a link between treatment and what’s happening to us but the onus should be on the therapists or pharmaceutical companies to prove this rather than the other way around.
But if we turn to experts who deny that any benefit, any magic, can be brought out of these mutilations, shocks and poisons used judiciously and in a relationship, we will have lost in the act of turning.
RxISK is about building communities, about supporting Relationship Based Medicine, about figuring that people like Greg and Anne Marie are mostly right and the way forward is trying to build on their testimony about what has happened rather than denying it. And also building on their testimony as to who is listening and who isn’t. Almost by definition it takes a community to bring an outsider in from the cold. It doesn’t happen the other way around.
This post is continued in Greg’s Dilemma: Feeling Blue.