In a message dated 97-12-17 13:21:32 EST, Billl writes:
<<
What is so intolerant about asking someone who presumes to intervene in
another person's life to know what he or she is doing? I would like to see
a little more hesitancy, a little less hubris, among those who assume the
right to decide what is good for others. I would like to see a little more
effort to determine why a potential suicide wishes to depart this life,
before making the blanket assumption that all such attempts should be
frustrated. Some people plead for release; those who deny it to them should
have something at risk, too, if they can't bring intellectual honesty to
the situation.
Best, >>
Well Bill,
here is your wish -- a real "life" example
ALTCS (Arizona Long Term Care Systems) call me out for a MSE (Mental Status
Exam) on a Male Client.
Ct History: Ct is a 36 yr white male, 2 yrs ago he was working on a Ranch in
FL. Coming home one evening at dusk in his pickup he tops the crests the top
of a hill, and runs into a cow, the cow proceeds through his windshield and
into him crushing his C1 vertebrate into his skull. The Ct has been bed
ridden ever since. The Ct could speak softly in simple short words, but
preferred to communicate using clicking noises generated by his mouth.
Presenting Circumstances: for the past 2 mouth Ct has refused pain meds and
food, staff was giving needed nutrients and meds through IV's. Also, Ct was
believed to have a "DO NOT RESUSCITATE ORDER" Staff reported Ct over the past
few months expressed a strong wish to die. That is why the staff believed
the Ct was refusing food and meds. Also Ct breaths by the aid of a
ventilator. Earlier that day the Ct coded, and the nurses brought him
"back." But not all the way back, now all he could do is stare blankly in to
space and make continuing clicking noises with his mouth. CT's mother,
father and sister were on scene.
My objective: ALTCS wanted to know -- was there a body in the bed or a person
in the bed.
If my determination was it is just a body - the family would turn the vent
off.
Using the basics of PCT testing for controlled variables, I reported to the
family their best course of action was to remove the vent.
It was the first time I gave advise on ending life.
Mark Lazare said:
<It was the first time I gave advise on ending life.>
It is not clear to me that you did that. You may perceive that, though.
Didn't the family have a chance to keep the ventilator on despite your
professional opinion? Even when they appeared to act on your advice,
didn't they really behave to get what *they wanted* considering your input
in light of many things? They made the decision on the best course of
action, not you.
Are you saying that had you responded favorably, or as factually as
possible medically but indeterminently on what they should do, that the
family would have kept the intervention going? Do you *know* that?
It seems to me that what they ended was artifical life support. His life
was unsustainable naturally. He died, as we all will.
I have three other questions. On what basis was the decision to put the Ct
on the ventilator in the first place made? Why do you have to put yourself
in the role of advising death or life? Why can't you simply give a
professional medical decision and let the family or person responsible for
the Ct decide what to do? I think that is more what happened anyway and
why should you put yourself in the "live or die" chair. That is a judgment
seat reserved to someone else.
Thanks for the "real life" event. It blows me away.
It was the first time I gave advise on ending life.
Thanks for taking us through that. You sparked a thought that I want to ask
David Goldstein about, to wit;
Is it possible to detect, with an EEG, a concerted attempt to imagine a
sensation or other experience? The problem I'm addressing is probably not a
frequent one, but it's the case in which a person is fully aware, yet
unable to generate any motor acts. I'm thinking of a "dialogue" with a
person like the one Mark describes, that would go something like this:
"If you can hear me, please communicate by imagining a very bright blue
light. I will be able to see the change in your brain activity."
[If this works, the EEG produces an indication].
"I detected that with an electronic instrument. Now let's try it again to
make sure it's really working. Imagine the bright blue light again."
[EEG again, and repeatedly, produces the indication].
"We have a way to communicate. Let's agree that when you imagine the blue
light once, that means 'yes,' and when you imagine it twice in a row, with
a pause between, that means 'no.' If you understand, please imagine the
blue light once."
And so forth. I know that people have learned to operate the controls of an
airplane and a sailboat by simply thinking, with an EEG picking up the
different patterns which are then translated into simple directional
commands. Whether this can be done with an apparently comatose and
unpractice person I do not know.
Obviously, if it were possible to establish simple yes-no communication
with a person who can't produce any visible motor acts, some very critical
questions could be asked, such as "Do you wish to be allowed to die?"
...
Obviously, if it were possible to establish simple yes-no communication
with a person who can't produce any visible motor acts, some very critical
questions could be asked, such as "Do you wish to be allowed to die?"
But with this kind of technology developing, the rationale for the
`yes' answer would also start to erode.
Liquid Prozac
Thanks to Jim Broatch at OCF for the following article.
···
By Leo Kay
The absence of hell is my closest experience of heaven…and for this
“small favor” I am indebted to Liquid Prozac and to Dr. Michael
R. Liebowitz, psychiatrist and researcher. Dr. Liebowitz was involved in
convincing the Eli Lilly Corp. to produce this formulation, and
subsequently prescribed it for me.
Liquid Prozac, which can also be duplicated by dissolving Prozac capsules
in orange juice and other beverages, is the only serotonin-specific
medicine available in low-dose form. For the sake of the millions
worldwide who are hypersensitive to sudden serotonin increase, I hope the
makers of Zoloft, Paxil, Luvox and other Selective Serotonin Reuptake
Inhibitors (SSRIs) will be encouraged to follow Lilly’s example.
For more than four decades I literally ran the gamut of alphaet soup
disorders, i.e., OCD, TS, PD, ADD and ADHD …generously mixed with chronic
anxiety, feelings of persecution, phobias, agitated depression and
paralyzing ruminations. While some but not all of the above were visited
on family members, I seem to have made a specialty of running the full
range. (Looking back, I have a sneaking suspicion this was the function of
a competitive nature.)
With a respectable IQ and a flair for writing I nevertheless quit college
after one year. Among other difficulties (also experienced in high school)
I was incapable of making a presentation in my journalism classes – a
phobia that proved much more devastating than ordinary stage fright. From
then on it was pretty much downhill. I managed to struggle through 18
months of army service as a draftee, then later settled on a position as a
travel planner – retiring after 40 years. Usually, through intense
effort and the kind of diversionary tactics best known to OCD and Tourette
Syndrome sufferers, I could effect a reasonably calm, in-control
appearance. Then at quitting time I would go home to discharge assorted
tics, twitches, anxiety attacks, depression, etc.
I lasted all those years on the job not because of staying power, but
rather due to an inability to pursue natural ambitions. Whenever I tried
to do so my symptoms would return with a vengeance.
Though struggling with a persistent writer’s block, I managed,
occasionally, to sell free-lance humor and information pieces to newspapers
and magazines. But an inability to organize my thoughts would dog me
constantly, accompanied by a debilitating attention deficit disorder.
I tried years of analysis and psychotherapy to little avail and much
expense. I took the est training and similar self-discovery
techniques. Over the years I managed to consume a range of herbs,
tranquilizers, stimulants and antidepressants, many of which first appeared
in the 1950’s. I was variously on MAO inhibitors, tricyclics, unicyclics,
etc. – with neither therapeutic response nor side effects other than dry
mouth.
In the 80’s and 90’s I moved on to the serotonin-specific meds: Prozac,
Zoloft and Paxil. I finally felt something: swift, intense,
unbearable, paradoxical anxiety. I was, as it is said, crawling out of my
skin and up the walls. Curiously – that piqued my interest! It promised
the possibility of some bona fide chemical gurgling going on in my
previously unflappable brain cells. I backed off the pills posthaste,
alleviated the skin-crawling (fortunately a reversible side effect), and
followed up with months of personal SSRI research in medical and public
libraries – not easy for a person with ADD, and of limited scientific
bent.
Yet, I found this investigation to be fascinating and hopeful, and I
intuitively sensed a light at the end of the tunnel. I learned that for
those who could somehow endure or bypass SSRI anxiety reactions, positive
results could be in the offing. I also read a journal article which
proposed that hypersensitivity to these medications could be a predictor of ultimate success. This supported my suspicions.
It was then that I went to see Dr. Liebowitz. Unmedicated at the time, I
was in the midst of another siege of panic disorder and paralyzing
obsessions, and could barely make it to his office. After an unsuccessful
trial of the new SSRI, Paxil (which caused me the usual reactions) the
doctor suggested I resume Prozac at a low liquid dosage, increasing
it very gradually. I was told that this liquid form, besides making Prozac
easier for some to ingest, allowed for small initial daily dosing. The
standard Prozac capsules comes in 10 and 20 mg amounts, often too
anxiety-provoking for hypersensitives such as myself, even if taken on an
alternate-day schedule.
It took weeks to reach the traditional 20 mg daily, but this time I
experienced no troubling side effects. Apparently my brain
receptors, not used to sudden intrusions of serotonin, were no longer
insulted! They were at last confronting this neurotransmitter at a
comfortable pace.
I leveled off when reaching 20 mg, and continued to be side-effect free.
After some weeks at that dose my decades-long panic disorder had vanished.
This remarkable change was hardly perceptible in its day-to-day
progression. It felt not like a euphoric “buzz”, but rather like
a gradual correction… a normalization of my thoughts and behavior.
I no longer obsessed on the morbid, crippling thoughts that had dogged me
for years, and I became much more responsive to the world around me.
Tourette-like facial tics and throat-clearing almost totally disappeared,
though I still have some on occasion. Tic disorder was the syndrome most
difficult to deal with. I had gotten contradictory diagnoses on it from
different doctors. One highly regarded psychiatrist diagnosed it as OCD.
Another insisted it was Tourette Syndrome, and a third said the two were in
the same family anyway. I still don’t know for sure which I have,
assuming nature ever intended separate names for these conditions.
But nomenclature notwithstanding, I do know that on my present
“window” of Prozac dosage most of my symptoms have been
eliminated or dramatically reduced. I take one 20 mg capsule each morning,
having gone as high as 40 in the initial, liquid-assisted search for my
proper dosage. Many uninformed SSRI users – especially those on capsules
or tabs – unwittingly jump past their personal window, which can result in
“serotonergic overstimulation,” from which they may revert to
their original symptoms. Finding one’s ideal window is a delicate
balancing act. It is best achieved with slow-dose Liquid Prozac, which
usually bypasses most or all side effects at the very worthwhile price of a
longer response time – generally a few months.
I suspect that many of the successes reported with tricyclics and MAO
inhibitors (Anafranil, Pamelor, Nardil, etc.) result from their limited
serotonin action, which may effectively mimic the slow, gradual dosage
buildup of Liquid Prozac.
I personally believe that despite the traditional definitions for the above
disorders, they are largly obsessional and serotonin-based.
Properly balanced levels of this neurotransmitter appear to break a circle
of obsession that causes people to ruminate on anything from
“pure” OCD symptoms to depression, anxiety, eating disorders,
etc. In my experience it is not the content of these thoughts, but
rather their “don’t-go-awayness” that causes such great
distress.
The SSRIs have shown an unprecedented ability to undo such awful persistence
of thought as well as the coping behaviors it engenders. Though I still
have the old obsessional thoughts “available” to me, I find that
I have neither the desire nor the psychic energy to summon them up and
dwell on them. My mind is too absorbed with legitimate life concerns and
interests. On occasion I have tried, intentionally, to call up my former
obsessions, only to discover that I have little patience for them. (The
good news is that the human brain, when in proper chemical balance, may be
just as bent on dismissing negative ideas as on becoming imprisoned by
them.)
Most humans have, at one time or another, experienced nearly every sort of
unpleasant thought or emotion. We are much more alike in our ideation than
we suspect. For those of us afflicted with these chronic disorders,
however, the unwelcome thoughts/emotions simply do not go away. To the
unafflicted, they may be so fleeting as to even be unrecallable. Their
content, I am convinced, is not the real culprit. It is their
“don’t-go-awayness” that makes them so difficult to bear, and
which can wreak havoc on one’s existence.
Attention Deficit Disorder (ADD) has been assigned all manner of causes.
But I believe that the ADDer, too, is an obsessor, trapped in a circle of
his own inner reflections to the exclusion of outside influences.
Serotonin meds are often helpful with ADD because they break that circle,
and I feel the same to be true of several other disorders not normally
associated with obsessiveness.
This year I bought a computer, with an eye to resuming my writing, and
signed on to the Prodigy infomation service. I noticed several support
bulletin-boards and “chat” groups, and began to read the personal
accounts of others who had symptoms similar to my own. I was stunned to
learn that few of the boards’ participants or their family doctors had ever
heard of Liquid Prozac.
I launched a personal campaign to inform Prodigy participants of this
medication and its potential value to many of them. I scanned one
anecdotal note after another in which the writers said they’d tried SSRIs,
gotten frightening side effects, and were scared off them
“forever.” Many of them were missing the opportunity, I felt, to
rid themselves of years-long, debilitating distress.
Wendy Mueller, a serotonin-hypersensitive OCDer from California, was my
first “believer.” It took several months and tons of patience as
I had cautioned it would…and today Wendy is known as our Liquid Prozac
Poster Lady! Her virtual recovery from years-long OCD, anxiety and
depression was, by her own description, little short of miraculous. She
now frequently posts her Liquid Prozac experience on the bulletin board, as
do I and several others, to encourage other SSRI hypersensitives. More and
more of the board’s members are hopping on our “LP bandwagon,”
and we look forward to seeing detailed reports on their slow/low titration
in the months to come.
During my psychoanalysis I had acquired many insights about myself, yet was
unable to put them to use. My analyst would lament that I had acquired all
the intellectual awareness I needed, but never “took the next
step.” Looking back, I don’t fault myself for my inability to do so.
I made desperate, vain efforts to do so, and now suspect that my serotonin
transmitters were sitting back laughing uproariously at all my
hand-wringing and mind-shrinking. They knew full well that they were in
control, and that they were capable at will, of zapping my self-discoveries
and rendering them unsustainable!
Freud, Jung and others were remarkable in their ability to chart our
psychological pathways and elaborate emotional defense mechanisms. But
these are merely the content or rationale of our disordered
thinking processes. Ultimately, as Freud himself speculated, it is
chemistry that powers such thought patterns, irrespective of their content.
When our neurotransmitters achieve proper balance we become much more
capable of successfully taking that next step, with what we’ve learned
about ourselves. As my own serotonin remains in balance, I notice that I
am much more adept at converting psychological insights to legitimate
growth-enhancing feelings and actions.
From reading thousands of personal accounts on Prodigy, it is clear to me
that there are deep-seated reasons why people fear medication. I’ve
encouraged several “mediphobes” to try liquid Prozac, starting
with the tiniest, least threatening amounts. Their first week or two
oftens rewards them with a welcome surprise…little or no side effects.
With gradual dosage increase, their optimism may grow, resulting in a
placebo-like elation. A common early reaction is, “I don’t feel I’ve
been cured of anything, but I just can’t believe I’m walking around
with 15 milligrams in me and no side effects!” As the weeks or months
continue, subtle, welcoming changes may begin to occur, especially after
levelling off at 15, 20, 30 or 40 mg stages – then dramatic reduction of
years-long distress often becomes manifest.
For relief of contamination fears, checking, hoarding and other
“pure” OCD symptoms, the effective therapeutic window may be as
high as 60 or 80 mg. In Wendy Mueller’s case, anxiety and depression were
relieved at the 20-30 mg range, while OCD relief didn’t occur until
reaching 60 mg. She has levelled off very satisfactorily at that
dosage.
No matter how exhilirating, even the most dramatic SSRI success story is a
beginning, not an end in the struggle for growth. For the first time one
becomes capable of taking the “next steps.” They are
chemically reborn, and it is at this point that the traditional cognitive
therapies can best their magic. There are lifelong psychological
maladaptations and defense patterns that may need to be undone. That
unraveling could be a key to reducing or eventually getting off the
medication, I suspect. But I must restate my belief that serotonin
correction remains a first priority for those who have suffered
chronically from any of the above-mentioned disorders.
Is it not better to find one’s workable window than to obsess – literally
or figuratively – on jumping out of one?
Systematic Changes in Cerebral Glucose Metabolic Rate After Successful Behavior Modification
Treatment of Obsessive-Compulsive Disorder.
**
Systematic Changes in Cerebral Glucose Metabolic Rate After Successful Behavior Modification
Treatment of Obsessive-Compulsive Disorder.**
Abstract
Obsessive-compulsive disorder (OCD) is a common, debilitating psychiatric illness characterized
by recurrent, unwanted thoughts (obsessions) and conscious, ritualized acts (compulsions),
usually attributed to attempts to deal with anxiety generated by the obsessions. Medications that
are strong serotonin reuptake inhibitors and specific behavioral therapies that use the principles of
exposure and response prevention (deconditioning) are effective in reducing the symptoms of
OCD in many patients. Although the cause is uncertain, recently many investigators have
postulated a role for a corticostriato-thalamic brain system in the mediation of OCD symptoms.
Background: We sought to determine in a new patient sample whether symptomatic
improvement in obsessive-compulsive disorder treated with behavior modification is accompanied
by significant changes in glucose metabolic rates in the caudate nucleus, measured with positron
emission tomography, a seen in a previous study. Second, by combining samples from this and
the previous study, we also examined whether there were pathologic correlational relationships
among brain activity in the orbital cortex, caudate nucleus, and thalamus that obtained before
behavioral treatment of obsessive-compulsive disorder, but that decreased significantly with
symptom improvement.
Methods: Nine patients with obsessive-compulsive disorder were studied with positron emission
tomography before and after 10 weeks of structured exposure and response prevention behavioral
and cognitive treatment. Results were analyzed both alone and combined with those from nine
similar subjects from the previous study.
For more information on this study you are referred to the original journal article. The journal
may be found in the periodical or reference department of major medical, university, or large
public libraries. The reference librarian can be of assistance. The complete article citation
follows:
Title: The Systematic Changes in Cerebral Glucose Metabolic Rate After Successful Behavior
Modification Treatment of Obsessive-Compulsive Disorder. Authors: Jeffrey M. Schwartz, MD; Paula W. Stoessel, PhD; Lewis R. Batxer, Jr. MD; Karron
M. Martin, RN; and Michael E. Phelps, PhD Source: Archives of General Psychiatry, Vol. 53: pgs. 109-113, February 1996.
Posted: January 12, 1997
From ???@??? Thu Dec 18 10:50:18 1997
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Reply-To: “Control Systems Group Network (CSGnet)”
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From: Bruce Abbott
Subject: More psychologists
To: Multiple recipients of list CSGNET
X-UIDL: e651f2d58100da1da16da3f44994811d
[From Bruce Abbott (971218.1010 EST)]
i.kurtzer (971217) –
Also Tom Bourbon does not consider himself a psychologist, he considers himself
a Perceptual Control Theorist. He feels the distinction important enough that
he has voiced this publically and in private on many occassions.
And one little last point…I think Dr. Runkel could also be included if the
list was liberal enough to include Rick!–imagine a happy face.
Ah, yes, more for the list. (I did ask whether I forgot anyone!) Whether the
individual views himself as a psychologist post PCT, the point is that he
came from those ranks.
Sorry to hear that Tom feels that PCT has nothing to do with mind or
behavior – the subject matter of the field of psychology. What’s he study
these days – robots?
Regards,
Bruce
Results: Behavior Therapy responders had significant (p Conclusions: These results replicate and extend previous findings of changes in caudate nucleus
function with behavior therapy for obsessive-compulsive disorder. A prefrontal cortico-striato-thalamic brain system is implicated in mediation of symptoms of obsessive-compulsive disorder.
From: David Goldstein
Subject: Re: advise on ending life
Date: 12/18/97
In a post dated 12/17/97, Bill Powers asks whether a person can answer
yes/no questions using some kind of EEG activity change. This person is
supposed to be aware (how do we know?) but is unable to make any kind of
motor response. Bill would then want to ask the person the question: Do
you want to live?
Bill, you are joking, right?
Not at all. The dilemma facing Mark was whether this client was still a
human being with the capacity to at least want to control his life, or was
now simply an inert piece of protoplasm. There was no way to tell. The
procedure I was asking about would be a way to find out whether a conscious
entity capable of having intentions still existed in that brain, but was
simply cut off from all ability to produce evidence in the form of visible
behavior. I have read reports of people emerging from comas to report that
they were quite aware of what was said around them and to them, and
understood it, and wished to communicate, but were unable so much as to
blink or twitch a finger.
If an EEG could allow people in such a situation to communicate even in a
simple yes-no format, not only would some terrible mistakes be avoided, but
the responsibility of the caregivers would be dramatically relieved when it
came to making a life or death decision with inadequate data. If it were
known that even an untrained person could make his or her conscious
existence evident by this means, then lack of any observable response would
go a long way toward showing that the body in question was just that; a
body and no longer a person. If communication could be established, then at
least the person could be consulted about his desire to continue in the
same state. That would not remove all responsibility from the caregivers;
one would still have to ask if the person is capable of making such a
decision. And if no improvement in the situation were possible, even the
client's expressed desire might have to go unfulfilled.
I would expect that in most cases, there would be no ability to communicate
coherently or consistently, if at all, even through the EEG. But I think
that many people would be relieved of worry and guilt if such a test existed.
When my mother was dying from incurable pancreatic cancer, I had no
problem with the easing her pain with drugs, and had no problem with
the possibility that the increased dosage of drugs resulted in her
leaving her painful living experience. In the last days of her life,
the pain was continuous and stuff was coming out of both ends, She was
ready. As I said, I think there is a role for assisted suicide under
some circumstances.
Right. We agree.
Back to the discussion on drugs and OCD. Martin Taylor makes an
interesting point. I am attaching a first person account of a person
with OCD who was helped with Prosac, a drug which alters Serotonin
levels.
That was a wonderfully educational document for me, David. Obviously we're
seeing here some major "hardware" problem, and a method of dealing with it
that restores the system to normal functioning. I thought that the writer's
observation about what happens after restoration to normal operation was
what convinced me. He said that the _psychological_ problems still remained
to be solved, the difference being that now they could be approached as any
normal person would approach them.
So now the question is, how do you find the line between conditions that
signal a basic chemical problem and those that are in the range of normal
operation? I'm sold on the idea that there are basic chemical problems and
that there is (often) something that can be done about them. I'm not sold
on the idea that better living is always attained through chemistry.
So now the question is, how do you find the line between conditions that
signal a basic chemical problem and those that are in the range of normal
operation? I'm sold on the idea that there are basic chemical problems
and
that there is (often) something that can be done about them. I'm not sold
on the idea that better living is always attained through chemistry.
I won't be sold on the idea of medication until these problems are
investigated from a PCT perspective. I have not a problem believing that
there are indeed some hardware problems but until these problems are viewed
as problems of control rather than problems with the production of certain
actions I think the benefits that some people experience are serendipitous.
David, what your two accounts demonstrated to me more than anything is how
entrenched the idea of behaviour as output is in the psychological
community. I don't think we have any idea yet of the possible results we
might achieve if we viewed behaviour (actions) as the means to the end
rather than the end. Does anyone have any idea of what variables someone
with OCD might be controlling for? These people are still living control
systems, they are controlling perceptions _not_ producing actions. I could
go on but I think you get my drift!!
And I'd like to counter you accounts with one of my own. It's anecdotal
though, so perhaps not as weighty as a journal article ;-). At the end of
my undergraduate degree in psychology, one of the last classes I took was
neuropsychology. About half way through the course we had a guest lecture
from a lady who had just obtained her PhD in neuropsychology and was now
working at one of the state mental hospitals. Her accounts were horrific
and too many to mention all of them. This may also, only be applicable in
Australia so bear with me. One account that particularly sticks in my mind
was a patient who complained of tooth pain. She was diagnosed as OCD and
this complaining was just seen as part of her disorder. Her complaints had
lasted about 6 years when finally a new intern suggested she be checked out
by a dentist, she was and the end to the story was that she had a 4 hour
orthodontal operation, the dentist reported that she would have been in
excruciating pain during the time she had this dental problem.
But my "favourite" story was how this lady reported to us how often people
are rediagnosed whenever a new drug came on the market. Apparently in the
60's and 70's a new wonder drug came out for schizphrenia and she said
that a lot of the patients in this hospital who were diagnosed
manic-depressive were rediagnosed schizophrenic so they could receive this
drug. She then said in the late 80's a lot of them were rediagnosed back to
manic-depressive (bipolar disorder) so they could receive the new drug
treatment for this disorder.
I guess we could go on swapping story after story to support our own
positions and at the end of the day, all we will probably demonstrate is
that we too are living control systems who are controlling certain
perceptions. I think though, that the change in focus I mentioned at the
beginning, from seeing actions as output to seeing actions as the means by
which we control perceptions, would result in changes to psychotherapy that
we can't even imagine yet. I say this with some validity because it is
already happening in schools that have adopted Ed Ford's RTP approach. This
approach has had amazing results with all kinds of kids, even kids with
labels such as Attention Deficit Disorder .... whoops I'm getting into
another story
I've prattled on now for long enough but on closing I'd like to say how
valuable I think the PCT Golden Rule is: Treat others the way they want to
be treated. One cannot assume that everyone has uniform goals. (found in
Intro to Modern Psychology)
So now the question is, how do you find the line between conditions that
signal a basic chemical problem and those that are in the range of normal
operation? I'm sold on the idea that there are basic chemical problems and
that there is (often) something that can be done about them. I'm not sold
on the idea that better living is always attained through chemistry.
This is a very good question. I really don't know the answer. I know
that in many complicated psychopathological conditions, the answer is
that both medicine and talking therapy are helpful to a person, in
different ways, but even both are often inadequate to restore the
person to the way he/she was before the pathology onset. Sad but true.
Following a conservative approach, one can start with talking therapy
of his choice (mine would by PCT based) and see where that goes. If that
does the trick, great. Next!
At the same time, one can be open to the possibility that one is
dealing with a hardware problem to some extent. This can be explored by
reading the literature and talking to people who use biologically
oriented treatments. If there is some evidence that this is the case,
inform the person about the known biologically oriented treatment
options.
One of the reasons I do QEEGs on people is because that is one way that
I can find out if the person's brain is extremely different from the
average bear. If it is not, it makes me work even harder on the verbal
therapy approach. If it is extremly different, it makes me look harder
at biological treatment approaches, one of which is EEG Biofeedback
(Neurofeedback) which I offer.
About the "Nice but let us get back to PCT" slogan. This is cute but
may cut off people who are trying to be creative about PCT and explore
it, play with it. For example, someone going to graduate school in
Psychology today may be told: Stop playing around with this PCT stuff
and get back to real Psychology. The only appropriate answer is: Yes
boss (but secretly "F" you).
···
From: David Goldstein
Subject: Re: advise on ending life
Date: 12/18/97
From: David Goldstein
Subject: Re: advise on ending life
Date: 12/18/97
About the "Nice but let us get back to PCT" slogan. This is cute but
may cut off people who are trying to be creative about PCT and explore
it, play with it. For example, someone going to graduate school in
Psychology today may be told: Stop playing around with this PCT stuff
and get back to real Psychology. The only appropriate answer is: Yes
boss (but secretly "F" you).
No problem with that. But real progress in PCT can't come until a student
can go to his advisor and say "I think I want to find out what kind of
relational variables a person can control," and have the advisor say "Sure,
why not?"
Thanks Tim, I enjoyed your message, especially the stories from your
neuropsych class visitor.
[From Tim Carey (971219.0545)]
snipped
David, what your two accounts demonstrated to me more than anything is how
entrenched the idea of behaviour as output is in the psychological
community. I don't think we have any idea yet of the possible results we
might achieve if we viewed behaviour (actions) as the means to the end
rather than the end. Does anyone have any idea of what variables someone
with OCD might be controlling for? These people are still living control
systems, they are controlling perceptions _not_ producing actions. I could
go on but I think you get my drift!!
My dim memory of the approach of R. D. Laing, in the U.K., was that he came
as close as any psychiatrist to treating his schizophrenic patients as
control systems. He felt they needed time to use their symptomatology as
the stepping stone to a reorganisation that would lead to improvement.
Naturally he was shunned by his peers despite reports of success.
He also wrote a marvellous collection of poems, titled KNOTS, which I used
in my teaching. They communicated very well with the 16-17 year old
students. Its so many years ago, pre-PCT for me, and I can't find my copy
tonight. But I do think they are pretty good illustrations of PCT.
David W.
Victoria, BC Canada
···
at 21:35 PST 971219 David Wolsk wrote:
At 06:07 19/12/97 +1000, you wrote:
My dim memory of the approach of R. D. Laing, in the U.K., was that he came
as close as any psychiatrist to treating his schizophrenic patients as
control systems. He felt they needed time to use their symptomatology as
the stepping stone to a reorganisation that would lead to improvement.
Naturally he was shunned by his peers despite reports of success.
Laing did, indeed, used techniques consistent with PCT. Laing
thought that if schizophrenics were taken out of their schizophrenic
contexts, e.g., home or hospital, and placed in a supportive
community (Kingston Hall?) that the people would control in a
different and, perhaps, more conventional manner. Laing did not
believe that schizophrenics did not control, but rather that their
"symptoms" were, most often, behaviors that provided at least limited
control, although not control that others wanted.
One of my favorite stories of Laing was that when the hospital at
which he was an attending psychiatrist began using psychotropic drugs
to "control" the patients, he noted that the drugs had their most
profound effects on the staff. Laing noted that the staff perceived
the patients as shorter and lighter, and thus, easier to "control".
Laing was terrific at getting his readers out of the individualistic
box and looking at the interactions and social context in which
individual acts are constructed.
Reading Laing and Goffman in the 60s was what got me into social
psychology. As a student of symbolic interaction I was never
particularly obsessed with behaviorism as many are on this list. The
behaviorists and Freudians got to Laing, we don't need to let them
get us.
I think there is an additional approach ..... educating the client. Since
we can generally assume that clients are thoroughly indoctrinated into an
S-R view of themselves and the world, presenting a PCT approach may serve to
enhance whichever other treatment choices the professional and client try
out. Since there is abundant evidence that thought processes can shift a
wide variety of physiological processes, clients need to be brought into the
picture. If they are having some trouble accepting this, a reminder of the
role of their mind and visualization processes in masturbation may bring it
home to them.
David W.
···
at 11:00 PST 971220 David Wolsk wrote:
At 00:53 19/12/97 -0500, you wrote:
From: David Goldstein
In a post dated 12/18/97, Bill asks:
So now the question is, how do you find the line between conditions that
signal a basic chemical problem and those that are in the range of normal
operation? I'm sold on the idea that there are basic chemical problems and
that there is (often) something that can be done about them. I'm not sold
on the idea that better living is always attained through chemistry.
This is a very good question. I really don't know the answer. I know
that in many complicated psychopathological conditions, the answer is
that both medicine and talking therapy are helpful to a person, in
different ways, but even both are often inadequate to restore the
person to the way he/she was before the pathology onset. Sad but true.
I think there is an additional approach ..... educating the client. Since
we can generally assume that clients are thoroughly indoctrinated into an
S-R view of themselves and the world, presenting a PCT approach may serve to
enhance whichever other treatment choices the professional and client try
out. Since there is abundant evidence that thought processes can shift a
wide variety of physiological processes, clients need to be brought into the
picture. If they are having some trouble accepting this, a reminder of the
role of their mind and visualization processes in masturbation may bring it
home to them.
If the education process is done in a natural, entertaining way. If it
is short and relevant to the topic of the moment, this educational
approach can be helpful.
It can easily go astray. The therapist can talk too much, sound too
academic. This is a turn off and nonproductive.
David Wolsk wrote:
···
From: David Goldstein
Subject: Re: advise on ending life
Date: 12/20/97
at 11:00 PST 971220 David Wolsk wrote:
At 00:53 19/12/97 -0500, you wrote:
>From: David Goldstein
>In a post dated 12/18/97, Bill asks:
>> So now the question is, how do you find the line between conditions that
>> signal a basic chemical problem and those that are in the range of normal
>> operation? I'm sold on the idea that there are basic chemical problems and
>> that there is (often) something that can be done about them. I'm not sold
>> on the idea that better living is always attained through chemistry.
>>
>This is a very good question. I really don't know the answer. I know
>that in many complicated psychopathological conditions, the answer is
>that both medicine and talking therapy are helpful to a person, in
>different ways, but even both are often inadequate to restore the
>person to the way he/she was before the pathology onset. Sad but true.
>
I think there is an additional approach ..... educating the client. Since
we can generally assume that clients are thoroughly indoctrinated into an
S-R view of themselves and the world, presenting a PCT approach may serve to
enhance whichever other treatment choices the professional and client try
out. Since there is abundant evidence that thought processes can shift a
wide variety of physiological processes, clients need to be brought into the
picture. If they are having some trouble accepting this, a reminder of the
role of their mind and visualization processes in masturbation may bring it
home to them.
