"trying" to do

[DTSDTO]

In response to the post by Bruce--

[From Bruce Gregory (971215.1245 EST)]

Mike Acree (971215.0836)
Sounds like a tough sell to persuade people they have 100% control over
their own perceptions and actions when you stand ready to force them
into treatment--lock them up for 23 hours--if they don't say the right
thing (agree to the treatment you want to give them). What do you see
suicidal persons as trying to control outside themselves that justifies
your forcible intervention? And your deception?

Mark:
Well Mike like I said in the prior post
There are 2 forms of control available --Cooperation and Coercion.

I am offering Cooperation First, if the person CHOOSES not to Cooperate (either
unwilling or unable to choose) and remains suicidal. Then it is my choice to
let the person kill their self or prevent the person from that course of
action. Also, it is common to believe that a person intent on suicide is not
in their right mind. Statistically it is not the Norm.

(There is, of course,
a trivial sense in which we can always be said to be in control of our
own perceptions and actions, even with a gun in our back; but that's >not a

sense of control that offers much comfort, or that anyone prizes.)

Even in the most Coercive of Acts the person being forced into a self directed
action has the choice to acquiesce or not. I don't see that as trivial

Bruce:
Good points. What does it even mean to say that one has 100%

control over one's own perceptions? Does it mean that I can
perceive anything I like? If I go to the parking lot and find
one of my tires is flat, can I simply perceive it to be filled
with air? Sounds great! Exactly how do I this, I wonder.

Mark:

Well Bruce,
I am sorry for the poor choice of words I used, I tend to rely on common sense
too much.
"100% control over one's own perceptions" Is not telekinesis.
What I mean by 100% control is - A person can choose any perception they want
and attempt to control for it. This does not guarantee successful control over
that perception, as in the case with your flat tire. But, one can still choose
to try to inflate the tire with the power of their mind, under the belief they
have enough air in their head to do so.

M. Lazare

DTSDTO@AOL.com

[DTSDTO]

In a message dated 97-12-15 15:47:57 EST, you write:

<< Mark>

Even in the most Coercive of Acts the person being forced into a self

directed

>action has the choice to acquiesce or not. I don't see that as trivial.

< Bruce >

But will someone who is suicidal appreciate this existential point? Will they

be empowered by it? Perhaps.
>>

I this existential point does not usually come up, I can only remember one
person raise it as an issue -- and she raised it as defense to validate her
choice to commit suicide. This was by far an exception. Most of the time the
focus is there issues with control. Most suicidal people have convinced their
selves that, they never had, currently don't have, nor expect to have, control
over anything of importance in their life. Their issues stated in their own
words are usually in effect "I not getting what I want." So, the focus that
works best is to, keep the CT in the present and looking foreword, because
that is where the control they have can be effective.
Mark

[Bill_Powers1]

[From Bill Powers (971216.0647 MST)]

Mark Lazare (971215) --

Most of the time the focus is their issues with control. Most suicidal
people have convinced their selves that, they never had, currently don't
have, nor expect to have, control over anything of importance in their

life.

This is an important point about your work. When a person tries to commit
suicide, the message is "Everything is so awful that I just want to end it
all." This message has two parts: everything is awful, and I want to end it
all. If you focus on the "end it all" part you get into direct conflict
with the person's immediate choice of action. But if you focus on
"everything is awful," you're really going up a level. The basic question
is, if everything weren't so awful would you still want to end it all?

Having flirted with lethal depression in my youth, I think I can predict
the immediate answer to that question in many cases: "Of course not, but
there's nothing anybody can do about it." In my case that answer was
predicated on the assumption that if I, with my giant intellect, couldn't
think of any way to make things better, nobody could. In other words, I had
a monumental ego problem -- in spite of the feeling of having lost control.

It seems to me that if one can persuade a potential suicide that perhaps
_someone_ can think of a way to make things better, the motive for wanting
to end it all will be considerably weakened. This doesn't amount to trying
to control the other person (without permission) -- if it does, then giving
anyone any information is a violation of the principle of self-determination.

There are definitely cases in which there is, in fact, nothing anyone can
do about the problem for which suicide seems the only acceptable answer. My
father, in his last ten years before dying at the age of 97, realized that
his mental faculties were waning; he could no longer remember what he had
written several days ago and had to keep re-reading what he had written to
maintain the thread. Then he had a stroke, and lost the power to
communicate intelligibly in words or writing. He had lost the main ability
to do all the things that made life interesting, and without the ability to
communicate freely he became very bored and lonely. His beloved wife and
most of his intellectual companions were long dead. He told my wife, "Mary,
you can skip this part." And he wanted to skip to the end. Of course in the
assisted living center this was not permissible, even though nobody could
restore what he had lost or make his life any more tolerable. He did try to
slit his wrists once, but a suspicious nurse's aide returned to his room
and interrupted him. After that, he was kept under surveillance and
realized that he had lost his last chance. Fortunately, his heart stopped a
few months later, so he didn't have to endure his situation very much longer.

I think that when you hold out hope to a person who is considering suicide,
or has tried it, you have to be very sure that there is, indeed, something
that can be done about the problems for which suicide seems the only
solution. But it's an enormous step for someone struggling to maintain a
scrap of control to give up the struggle enough to allow anyone else to try
to help. Suicide itself is the last act of control. To give up even that
possibility and throw yourself on the mercy of strangers is to experience
the ultimate failure of control. And of course to persuade a person to give
up that last vestige of control, and then _fail to solve the problem_, is
the ultimate betrayal.

The main problem I see with your present position as a consultant is that
if you decide there's nothing that can be done to help the person solve his
problem, the only choice is to turn the person over to the medical
profession for incarceration. The medical profession, barring some unusual
individuals, is not oriented toward solving the suicide's problems; it's
oriented toward minimizing the symptoms, most often with drugs, and
preventing another attempt to end it all. Sometimes this pays off, but it
also leaves many people in a state of both hopelessness and helplessness,
with no mercy for their suffering. Since the option of granting the
person's wish simply to be done with it is not legal in most places, the
person must be kept alive -- the most that can be done by way of mercy is
to suppress the complaints with drugs until at last the release can come.

I don't envy the choices you have to make.

Best,

Bill P.

Their issues stated in their own

···

words are usually in effect "I not getting what I want." So, the focus that
works best is to, keep the CT in the present and looking foreword, because
that is where the control they have can be effective.
Mark

[David1]

Bill Powers wrote in his post of 12/16/97:

The medical profession, barring some unusual
individuals, is not oriented toward solving the suicide's problems; it's
oriented toward minimizing the symptoms, most often with drugs, and
preventing another attempt to end it all.

I think this is an unfair description. The medical view on this is that
a person's brain may not be working well because of a biochemical
imbalance. Medication is given to correct the chemical imbalance. A
person is then in a much better position to solve life problems.

Preventing a person from attempting suicide simply buys time. Again,
this allows a person, perhaps with the help of others, to solve life
problems.

A medical view on OCD (Obsessive Compulsive Disorder) is interesting and
revealing. Recently, I read a book by Schwartz called "Brainlocked. "
This book attempts to provide a self-directed program of therapy for a
person with OCD. There are four steps: (a) recognize that what you are
experiencing is an obsession or compulsion, (b) say to yourself: it is
my OCD not me, therefore it is OK to ignore the symptom, (c) redirect
awareness onto any activity which is enjoyable for 15 minutes or so, (d)
reexamine the obsession or compulsion to see if the intensity of the
experience reduced.

Schwartz, a psychiatrist at UCLA, found that this therapy produced the
same changes in the brain as measured by PET scan. He looks at the role
of medication as helping a person find it easier to do the above
program. He sees that this program helps a person develop a mindfulness,
increased self-awarenes which he calls the Impartial Spectator. In PCT,
we might say that a person is going up from the program or principle
level to the system level self-image systems.

Why should the above program result in the reorganziation of the brain?
A person is not dealing with the content directly. Perhaps by allowing
the error signal to continue, not giving in and doing something
compulsive to reduce the anxiety, the reorganization system is allowed
to work. By doing something enjoyable, the error signal occurs in a
context in which something enjoyable is happening. This makes it
tolerable.

It seems that by not allowing a person to commit suicide is doing the
same thing. This allows the reorganization system to work the problem.
A dead person has a dead reorganization system.

···

From: David M. Goldstein, Ph.D.
Subject: Re: "trying" to do
Date: 12/16/97

[Bill_Powers1]

[FRom Bill Powers (971217.1539 MST)]

From: David M. Goldstein, Ph.D.
Subject: Re: "trying" to do
Date: 12/16/97

[Bill]

The medical profession, barring some unusual
individuals, is not oriented toward solving the suicide's problems; it's
oriented toward minimizing the symptoms, most often with drugs, and
preventing another attempt to end it all.

[David]

I think this is an unfair description. The medical view on this is that
a person's brain may not be working well because of a biochemical
imbalance. Medication is given to correct the chemical imbalance. A
person is then in a much better position to solve life problems.

I agree that a medically-oriented person would prefer that description.
However, what would such a person say when asked what is producing the
"chemical imbalance?"

Your rather simplistic statement assumes that giving "medication" never
ameliorates a person's symptoms while making it more difficult to solve
life problems. As you know, I have come around to your view that there are
extreme situations in which a person needs chemical aids to reduce the
problem to a level where there is some hope of solving it. But considering
our ignorance of the interlocking chemical systems of the body and brain, I
think it is irresponsible to make the blanket assumption that "chemical
imbalances" are causes rather than effects. The term really means nothing
-- exactly what is "out of balance" with what else? Naturopaths say that
"impurities in the blood" cause diseases. I don't think that "chemical
imbalances" is much of an improvement over that.

Preventing a person from attempting suicide simply buys time. Again,
this allows a person, perhaps with the help of others, to solve life
problems.

I think you have to consider very carefully what you are buying time FOR.
If a person is in intractable pain, at best you're buying time to live in a
drug-induced stupor for a little longer. If that's what the person wants,
OK, but what if it's not? It's easy to say that there's something wrong
with the person's brain because his preferences differ from yours. In fact,
that's the general medical assumption, isn't it? Doctor knows best. Anyone
who disagrees must have a damaged brain.

A medical view on OCD (Obsessive Compulsive Disorder) is interesting and
revealing. Recently, I read a book by Schwartz called "Brainlocked. "
This book attempts to provide a self-directed program of therapy for a
person with OCD. There are four steps: (a) recognize that what you are
experiencing is an obsession or compulsion, (b) say to yourself: it is
my OCD not me, therefore it is OK to ignore the symptom, (c) redirect
awareness onto any activity which is enjoyable for 15 minutes or so, (d)
reexamine the obsession or compulsion to see if the intensity of the
experience reduced.

Why should this approach have any effect if the real problem is a chemical
imbalance in the brain? If all deviant behavior is caused by a surplus or a
deficit in certain neurotransmitters, what is the point of encouraging a
person to change his awareness or tell things to himself? Words and
thoughts are just secretions of the brain; when the brain is set right
chemically, the proper words and thoughts will result. Isn't that pretty
much the medical view?

Schwartz, a psychiatrist at UCLA, found that this therapy produced the
same changes in the brain as measured by PET scan.

The same changes as what? You forgot to say.

He looks at the role
of medication as helping a person find it easier to do the above
program. He sees that this program helps a person develop a mindfulness,
increased self-awarenes which he calls the Impartial Spectator. In PCT,
we might say that a person is going up from the program or principle
level to the system level self-image systems.

You might say that, but on what basis? The "Impartial Spectator" sounds
like what we have called the Observer, in the Method of Levels. But how
could disturbing the chemical systems that support brain activity have any
such specific effects? This sort of empty theorizing doesn't impress me at
all. It impresses me all the less when it's expressed in pseudo-PCT terms.

Why should the above program result in the reorganization of the brain?
A person is not dealing with the content directly. Perhaps by allowing
the error signal to continue, not giving in and doing something
compulsive to reduce the anxiety, the reorganization system is allowed
to work.

But this is also an argument against indiscriminate drug treatment. If you
remove (by ANY means) the signals that drive reorganization, reorganization
is less likely to occur. And because the effects of drugs are not dependent
on behavior, there is no reason to expect any reorganization that does
occur to be relevant to the experienced problem -- which is no longer being
experienced because the drugs have suppressed it. In talking therapies, we
encourage clients to experience the distress and see how it relates to the
way they think and live. Would you give a client suffering from anxiety a
drug that removes the capacity to feel anxiety? If you just wanted to
relieve the symptom, of course you would. But if you wanted this person to
reorganize so that anxiety no longer occurred, you would have prevented any
useful progress in that direction.

It seems that by not allowing a person to commit suicide is doing the
same thing. This allows the reorganization system to work the problem.
A dead person has a dead reorganization system.

If you are prepared to offer a warrantee stating that the person will in
fact be better off by staying alive, then you have some excuse for
preventing suicide. I suggest a $100,000 bond, secured by your house, to be
paid in case the client finds that life is no more tolerable than before.
After all, you are risking only money, while the client, in agreeing to
stay alive, is risking something so distasteful that death seems a
preferable alternative.
Do you really think that all suicides are alike?

Best,

Bill P.

[Bruce_Gregory9]

[From bruce Gregory (971217.1100 EST)]

Bill Powers (971217.1539 MST)]

I think you have to consider very carefully what you are buying time FOR.
If a person is in intractable pain, at best you're buying time to live in a
drug-induced stupor for a little longer. If that's what the person wants,
OK, but what if it's not? It's easy to say that there's something wrong
with the person's brain because his preferences differ from yours. In fact,
that's the general medical assumption, isn't it? Doctor knows best. Anyone
who disagrees must have a damaged brain.

A cheap shot. Sounds like LRH speaking.

Why should this approach have any effect if the real problem is a chemical
imbalance in the brain? If all deviant behavior is caused by a surplus or a
deficit in certain neurotransmitters, what is the point of encouraging a
person to change his awareness or tell things to himself? Words and
thoughts are just secretions of the brain; when the brain is set right
chemically, the proper words and thoughts will result. Isn't that pretty
much the medical view?

More cheap shots. I'm surprised. Neurotransmitters are part of
the machinery of a living control system. Why are you trying to
force David into a cause-effect model? I sense your involvement
here is not dispassionate and therefore not up to your usual
standards. Possibly memories of your father's end are too vivid
to allow you to take a more objective view.

You might say that, but on what basis? The "Impartial Spectator" sounds
like what we have called the Observer, in the Method of Levels. But how
could disturbing the chemical systems that support brain activity have any
such specific effects? This sort of empty theorizing doesn't impress me at
all. It impresses me all the less when it's expressed in pseudo-PCT terms.

As one who has a direct experience of the effects of SSRI's I am
unimpressed with your analysis. My views are not based on "empty
theorizing" any more than your descriptions of your own
experience are.

But this is also an argument against indiscriminate drug treatment.

Who on CSGNet _is_ in favor of "indiscriminate drug treatment"?

If you
remove (by ANY means) the signals that drive reorganization, reorganization
is less likely to occur. And because the effects of drugs are not dependent
on behavior, there is no reason to expect any reorganization that does
occur to be relevant to the experienced problem -- which is no longer being
experienced because the drugs have suppressed it. In talking therapies, we
encourage clients to experience the distress and see how it relates to the
way they think and live. Would you give a client suffering from anxiety a
drug that removes the capacity to feel anxiety? If you just wanted to
relieve the symptom, of course you would. But if you wanted this person to
reorganize so that anxiety no longer occurred, you would have prevented any
useful progress in that direction.

Talk about "empty theorizing"! How's this for a "pseudo-PCT"
explanation: Sometimes error signals are so large that they
incapacitate people rather than allowing reorganization to take
place. Perhaps diminishing the intensity of the signals is
exactly what is needed to allow "useful progress" to be made.

If you are prepared to offer a warrantee stating that the person will in
fact be better off by staying alive, then you have some excuse for
preventing suicide. I suggest a $100,000 bond, secured by your house, to be
paid in case the client finds that life is no more tolerable than before.
After all, you are risking only money, while the client, in agreeing to
stay alive, is risking something so distasteful that death seems a
preferable alternative.

Wow! You obviously have little tolerance for any departure from
your reference level here.

Do you really think that all suicides are alike?

Again, who said they were?

Bruce

[David1]

In a post dated 12/17/97, Bill Powers asked a number of questions about
my post of 12/16/97:

I agree that a medically-oriented person would prefer that description.
However, what would such a person say when asked what is producing the
"chemical imbalance?"

I think that they would admit their ignorance. Perhaps they would
speculate on possible causes. The strategy which seems to be followed
nowadays is that they try to identify what parts of the brain are
involved in some condition (say OCD) via a brain imaging technique,
then they try to identify the receptors present in the neurons present
in the abnormal areas, and then they select or design a drug which will
alter the concentration of the neurotransmitters active in the area.

Your rather simplistic statement assumes that giving "medication" never
ameliorates a person's symptoms while making it more difficult to solve
life problems.

I don't think I am assuming this. I know that if a person is
experiencing too severe symptoms, they are unable to work on the life
problems. I have obsevered this in others and experienced it myself. A
person who is drowning, can hang onto a floatation device and learn to
swim or be satisfied with a life of hanging onto the floatation device,
if that is his choice. Do you think it is right to withhold the
floatation device if you have one?

I

think it is irresponsible to make the blanket assumption that "chemical
imbalances" are causes rather than effects.

If giving a person a drug, reduces error signals, it seems reasonable
to assume that a person is being moved closer to some reference
condition. Are not reference conditions one of the independent
variables(causes)?

I think you have to consider very carefully what you are buying time FOR.
If a person is in intractable pain, at best you're buying time to live in a
drug-induced stupor for a little longer. If that's what the person wants,
OK, but what if it's not? It's easy to say that there's something wrong
with the person's brain because his preferences differ from yours. In fact,
that's the general medical assumption, isn't it? Doctor knows best. Anyone
who disagrees must have a damaged brain.

I actually agree that there is a case for assisted suicide. We have to
proceed very carefully. There are a many people who would object on
religious grounds.

About the therapy strategy in Brainlocked, Bill says:

Why should this approach have any effect if the real problem is a chemical
imbalance in the brain? If all deviant behavior is caused by a surplus or a
deficit in certain neurotransmitters, what is the point of encouraging a
person to change his awareness or tell things to himself? Words and
thoughts are just secretions of the brain; when the brain is set right
chemically, the proper words and thoughts will result. Isn't that pretty
much the medical view?

In the case of OCD, the effective drugs seem to involve the
neurotransmitter Serotonin. People with OCD say that the drug helps
them to follow this strategy. If the urge is too strong, they find it
hard to ignore the obsession or compulsion. Some people say things like
my mind is not strong enough to ignore the symptoms. The symptoms are
exhausting. They reach a point in which suicide ideas occurs.

>Schwartz, a psychiatrist at UCLA, found that this therapy produced the
>same changes in the brain as measured by PET scan.

The same changes as what? You forgot to say.

There is a decrease in activity in the orbital frontal cortex and the
caudate nucleus, and a decrease in the degree of coupling in these
areas.

>He looks at the role
>of medication as helping a person find it easier to do the above
>program. He sees that this program helps a person develop a mindfulness,
>increased self-awarenes which he calls the Impartial Spectator. In PCT,
>we might say that a person is going up from the program or principle
>level to the system level self-image systems.

You might say that, but on what basis? The "Impartial Spectator" sounds
like what we have called the Observer, in the Method of Levels. But how
could disturbing the chemical systems that support brain activity have any
such specific effects? This sort of empty theorizing doesn't impress me at
all. It impresses me all the less when it's expressed in pseudo-PCT terms.

The content of the OCD symptoms seems to be unimportant. Previous
therapy attempts which addressed the specific content go no place. A
person keeps on repeating and repeating and repeating. Saying things
like: It is a false alarm. It is my OCD. helps a person do something
very difficult. It is very difficult to ignore an error signal. If one
comes to believe that the error signal is false, one may be willing,
able to ignore it.

But this is also an argument against indiscriminate drug treatment. If you
remove (by ANY means) the signals that drive reorganization, reorganization
is less likely to occur. And because the effects of drugs are not dependent
on behavior, there is no reason to expect any reorganization that does
occur to be relevant to the experienced problem -- which is no longer being
experienced because the drugs have suppressed it. In talking therapies, we
encourage clients to experience the distress and see how it relates to the
way they think and live. Would you give a client suffering from anxiety a
drug that removes the capacity to feel anxiety? If you just wanted to
relieve the symptom, of course you would. But if you wanted this person to
reorganize so that anxiety no longer occurred, you would have prevented any
useful progress in that direction.

In the case of OCD, the anxiety is not useful, functional. A person
temporarily relieves it by compulsing. As mentioned above, the content
is not important. A person may get over one obsession/compulsion at one
time only to have a different one appear at a later time.

If you are prepared to offer a warrantee stating that the person will in
fact be better off by staying alive, then you have some excuse for
preventing suicide. I suggest a $100,000 bond, secured by your house, to be
paid in case the client finds that life is no more tolerable than before.
After all, you are risking only money, while the client, in agreeing to
stay alive, is risking something so distasteful that death seems a
preferable alternative.
Do you really think that all suicides are alike?

A person always has the opportunity to suicide. As I mentioned, I
think there is a case for assisted suicide. I have known people who
have wanted to suicide but were glad that they were stopped. In a
sense, suicide is the ultimate drug. All error signals are reduced to
zero without further efforts. At least with drugs, one does not throw
out the baby with the bathwater.

···

From: David Goldstein
Subject: 12/17/97
Subject: Re: "trying" to do

[Bruce_Gregory9]

[From Bruce Gregory (971217.1315 EST)]

Bill Powers (971217.0929 MST)

I said I agreed that in extreme cases, using drugs can make it more
possible for a person to solve some problems. But it's a desperation
measure, because you haven't the slightest idea of what you're actually
doing to the person's brain. This process is like giving a child a
soldering iron and turning him loose on a mainframe computer.

Bill, are you smoking something stronger than your usual stuff?
We don't turn children lose with soldering irons on
mainframe computers because we have excellent reasons to
believe what the outcome would be. If most people crashed
and burned when they were given SSRI's we would treat
administering these medications in the same way. But they
don't crash and burn. Either they feel better and report
improvements or they don't. Sometimes they experience
side effects. When this happens, other similar
medications are tried. What _I_ find interesting is that
the SSRIs often _do_ work. Why is this the case? Why do
people feel better when the serotonin levels in their
blood streams increases? Why do they no longer feel
depressed? Why does it take ten days to two weeks for
this effect to show up? Is there something about being a
living control system that provides a clue to answering
any of these questions?

Peter Kramer's _Listening to Prozac_ is a very thoughtful
examination of the ethical dilemmas of "medicating" people who
are at one of the "normal" spectrum of moods in order to move
them closer to the other end of the spectrum. Now _that's_ an
interesting topic.

Bruce

[Bill_Powers1]

[From Bill Powers (971217.0929 MST)]

From: David Goldstein
Subject: 12/17/97
Subject: Re: "trying" to do

The strategy which seems to be followed
nowadays is that they try to identify what parts of the brain are
involved in some condition (say OCD) via a brain imaging technique,
then they try to identify the receptors present in the neurons present
in the abnormal areas, and then they select or design a drug which will
alter the concentration of the neurotransmitters active in the area.

Sounds simple enough for any child to understand. And about reasonable enough.

Your rather simplistic statement assumes that giving "medication" never
ameliorates a person's symptoms while making it more difficult to solve
life problems.

I don't think I am assuming this. I know that if a person is
experiencing too severe symptoms, they are unable to work on the life
problems. I have obsevered this in others and experienced it myself. A
person who is drowning, can hang onto a floatation device and learn to
swim or be satisfied with a life of hanging onto the floatation device,
if that is his choice. Do you think it is right to withhold the
floatation device if you have one?

I said I agreed that in extreme cases, using drugs can make it more
possible for a person to solve some problems. But it's a desperation
measure, because you haven't the slightest idea of what you're actually
doing to the person's brain. This process is like giving a child a
soldering iron and turning him loose on a mainframe computer.

I

think it is irresponsible to make the blanket assumption that "chemical
imbalances" are causes rather than effects.

If giving a person a drug, reduces error signals, it seems reasonable
to assume that a person is being moved closer to some reference
condition. Are not reference conditions one of the independent
variables(causes)?

Relative to a single control system, yes. In the whole brain, no. What sets
reference signals? What if the reference signal is set so there is a
conflict with satisfying some other reference condition? What if the
problem is not the error signal, but an unresponsive output function? What
if the perceptual signal no longer represents the lower-order world in a
way consistent with other perceptions? Who says that the reference signal
is set where it ought to be for the good of the whole system? Who says
you're even looking at the right problem?

There's a condition which some old people get that is very dangerous. They
lose the ability to feel pain in their limbs. As a result they can injure
themselves very seriously and not notice the injury until it has become
infected, or caused a major loss of blood. So is arbitrarily correcting
error signals without correcting the condition that is causing them really
a good idea? I would say it is to be avoided at almost all costs -- the
only exception being when the error signal is so large that it's preventing
any other effective actions.

I think you have to consider very carefully what you are buying time FOR.
If a person is in intractable pain, at best you're buying time to live in a
drug-induced stupor for a little longer. If that's what the person wants,
OK, but what if it's not? It's easy to say that there's something wrong
with the person's brain because his preferences differ from yours. In fact,
that's the general medical assumption, isn't it? Doctor knows best. Anyone
who disagrees must have a damaged brain.

I actually agree that there is a case for assisted suicide. We have to
proceed very carefully. There are a many people who would object on
religious grounds.

If it's their own suicide they're rejecting on such grounds, you'll hear no
objection from me. But that's not a decision they can make for anyone else.

About the therapy strategy in Brainlocked, Bill says:

Why should this approach have any effect if the real problem is a chemical
imbalance in the brain? If all deviant behavior is caused by a surplus or a
deficit in certain neurotransmitters, what is the point of encouraging a
person to change his awareness or tell things to himself? Words and
thoughts are just secretions of the brain; when the brain is set right
chemically, the proper words and thoughts will result. Isn't that pretty
much the medical view?

In the case of OCD, the effective drugs seem to involve the
neurotransmitter Serotonin. People with OCD say that the drug helps
them to follow this strategy. If the urge is too strong, they find it
hard to ignore the obsession or compulsion. Some people say things like
my mind is not strong enough to ignore the symptoms. The symptoms are
exhausting. They reach a point in which suicide ideas occurs.

Could you come up with a list of all the disorders that "involve"
serotonin? Serotonin is just a neurotransmitter; it is part of the process
of neural computation, and has nothing to do with the _meaning_ of any
particular computation. Implicating seretonin is like implicating a
shortage or excess of electrons in a computer bug. Such a shortage or
excess is certainly involved, but it's not the cause of the problem -- the
problem is that the program is setting ones where it should be setting
zeros or vice versa. If you found an overheating resistor in a radio, would
you fix the problem by installing a fan to blow on it?

Even if seretonin were involved in the operation of only one part of the
brain (which is not true), a part big enough to see in a brain scan
probably is made of millions of neurons, which are performing hundreds or
thousands of different kinds of computations. How do you know whether the
software or the hardware is defective? How do you know that the change in
seretonin level is not part of an attempt to correct an error that's being
caused elsewhere?

>Schwartz, a psychiatrist at UCLA, found that this therapy produced the

>same changes in the brain as measured by PET scan.

The same changes as what? You forgot to say.

There is a decrease in activity in the orbital frontal cortex and the
caudate nucleus, and a decrease in the degree of coupling in these
areas.

You still didn't say what the change is the same as. The change produced by
a pure drug treatment? Some other form of therapy? The PET scan just tells
you where there is activity. It doesn't tell you what the activity is
doing, or whether a change is good or bad for the person.

>He looks at the role
>of medication as helping a person find it easier to do the above
>program. He sees that this program helps a person develop a mindfulness,
>increased self-awarenes which he calls the Impartial Spectator. In PCT,
>we might say that a person is going up from the program or principle
>level to the system level self-image systems.

You might say that, but on what basis? The "Impartial Spectator" sounds
like what we have called the Observer, in the Method of Levels. But how
could disturbing the chemical systems that support brain activity have any
such specific effects? This sort of empty theorizing doesn't impress me at
all. It impresses me all the less when it's expressed in pseudo-PCT terms.

The content of the OCD symptoms seems to be unimportant.

That's what people say when they don't understand what is going on. If they
don't understand it, it must be unimportant.

Previous
therapy attempts which addressed the specific content go no place. A
person keeps on repeating and repeating and repeating. Saying things
like: It is a false alarm. It is my OCD. helps a person do something
very difficult. It is very difficult to ignore an error signal. If one
comes to believe that the error signal is false, one may be willing,
able to ignore it.

Fine. How does a drug instil that understanding? And whose previous therapy
attempts were considered?

But this is also an argument against indiscriminate drug treatment. If you
remove (by ANY means) the signals that drive reorganization, reorganization
is less likely to occur. And because the effects of drugs are not dependent
on behavior, there is no reason to expect any reorganization that does
occur to be relevant to the experienced problem -- which is no longer being
experienced because the drugs have suppressed it. In talking therapies, we
encourage clients to experience the distress and see how it relates to the
way they think and live. Would you give a client suffering from anxiety a
drug that removes the capacity to feel anxiety? If you just wanted to
relieve the symptom, of course you would. But if you wanted this person to
reorganize so that anxiety no longer occurred, you would have prevented any
useful progress in that direction.

In the case of OCD, the anxiety is not useful, functional.

How the hell do you know that? Are you saying that returning to your house
to see if you shut off the gas is not useful or functional?

A person
temporarily relieves it by compulsing. As mentioned above, the content
is not important. A person may get over one obsession/compulsion at one
time only to have a different one appear at a later time.

But you were just describing a treatment that involved saying things to
yourself, learning to perceive the OCD process differently, and so on. If
all problems are caused by chemical imbalances, what possible effect could
such software solutions have? You seem to be believing two contradictory
arguments at once.

If you are prepared to offer a warrantee stating that the person will in
fact be better off by staying alive, then you have some excuse for
preventing suicide. I suggest a $100,000 bond, secured by your house, to be
paid in case the client finds that life is no more tolerable than before.
After all, you are risking only money, while the client, in agreeing to
stay alive, is risking something so distasteful that death seems a
preferable alternative.
Do you really think that all suicides are alike?

A person always has the opportunity to suicide. As I mentioned, I
think there is a case for assisted suicide. I have known people who
have wanted to suicide but were glad that they were stopped. In a
sense, suicide is the ultimate drug. All error signals are reduced to
zero without further efforts. At least with drugs, one does not throw
out the baby with the bathwater.

Nor does one separate those who would benefit from intervention from those
one cannot help. If all you're concerned about is your own track record as
a therapist, then you're safe in giving the drugs; all you nee3d is for the
successes to outweigh the failures. Then you need to remember only the
successes. But if you had a stake in the outcome equal to that of the
person you're dealing with, you might not be so sure you were right in any
individual case. That's why I mentioned the warrantee. If you can't go by
the Hippocratic principle (First, do no harm), then perhaps you might go
for a monetary principle (First, don't go broke).

Best,

Bill P.

[Bruce_Gregory9]

[From Bruce Gregory (971217.1345 EST)]

Bill Powers (971217.1036 MST)]

And
who are you to mention the name of Saint Ron in such a context?

Sorry, I lost my head.

Because he's using one, and a particularly simple-minded one at that. If
the serotonin levels in some part of the brain are low, beef them up and
the problem will be fixed. Electrons are part of the machinery of a
computer, but they do not play a causative role in computer operations. If
you notice a shortage of electrons somewhere, you don't just pour some more
in. You try to find out what is causing the shortage.

My point is that this simple-minded approach often works.
further we have little evidence that when it does not work it is
destructive in any way.

I don't know what an SSRI is.

Sorry. A Selective Serotonin Re-uptake Inhibitor. Prozac,
Zoloft, Paxil and several new drugs that slow the re-absorption
of serotonin and in the process increase the levels of
serotonin in the bloodstream.

I agree that in desperate circumstances, drugs can
help. But I am also pointing out that if you suppress what the brain is
trying to do about some problem, that problem will remain unresolved. Maybe
it's sometimes important to solve some other problem first, but the price
is still there and will be paid.

You are making the assumption that a depressed person's brain
"is trying to solve some problem." I have no evidence that
this is always the case. Sometimes the problem _seems_ to be the
error signal itself. Grief that seems to never end is not going
to be "solved" by ignoring the problem and saying that someday
the system will reorganize. You know what Keynes noted about "in
the long run."

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.

Keeping them alive may be the first step in learning why they
are trying to kill themselves.

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.

I agree.

Bruce

[Bill_Powers1]

[From Bill Powers (971217.1036 MST)]

[From Bruce Gregory (971217.1100 EST)]

Bill Powers (971217.1539 MST)]

I think you have to consider very carefully what you are buying time FOR.
If a person is in intractable pain, at best you're buying time to live in a
drug-induced stupor for a little longer. If that's what the person wants,
OK, but what if it's not? It's easy to say that there's something wrong
with the person's brain because his preferences differ from yours. In fact,
that's the general medical assumption, isn't it? Doctor knows best. Anyone
who disagrees must have a damaged brain.

A cheap shot. Sounds like LRH speaking.

I don't think it's a cheap shot. Tom Bourbon told us about the latest
psychoatric "disorder", ODD: obstructive-defiant disorder. There are lots
of other disorders like that, which are customarily treated with drugs. And
who are you to mention the name of Saint Ron in such a context?

Why should this approach have any effect if the real problem is a chemical
imbalance in the brain? If all deviant behavior is caused by a surplus or a
deficit in certain neurotransmitters, what is the point of encouraging a
person to change his awareness or tell things to himself? Words and
thoughts are just secretions of the brain; when the brain is set right
chemically, the proper words and thoughts will result. Isn't that pretty
much the medical view?

More cheap shots. I'm surprised. Neurotransmitters are part of
the machinery of a living control system. Why are you trying to
force David into a cause-effect model?

Because he's using one, and a particularly simple-minded one at that. If
the serotonin levels in some part of the brain are low, beef them up and
the problem will be fixed. Electrons are part of the machinery of a
computer, but they do not play a causative role in computer operations. If
you notice a shortage of electrons somewhere, you don't just pour some more
in. You try to find out what is causing the shortage.

I sense your involvement
here is not dispassionate and therefore not up to your usual
standards. Possibly memories of your father's end are too vivid
to allow you to take a more objective view.

And I sense something similar in your reaction, considering:

As one who has a direct experience of the effects of SSRI's I am
unimpressed with your analysis. My views are not based on "empty
theorizing" any more than your descriptions of your own
experience are.

I don't know what an SSRI is.

The "empty theorizing" I was speaking about was the use of words like
"error signal" and "levels" in a situation where we have no idea what the
control systems were or what was wrong. The worst thing that can happen to
PCT is for people to start using its terminology in a glib and
unsupportable way, and turning out to be wrong more often than they are
right. That's a great way to turn it into just another fad.

But this is also an argument against indiscriminate drug treatment.

Who on CSGNet _is_ in favor of "indiscriminate drug treatment"?

Have you seem any numbers on how many children are currently going to
school doped up with Ritalin? There are _millions_. And how many people
take Valium, and other "mood-altering" prescription drugs every day? Have
you heard of the flap over antibiotics and the way they are creating
resistant bacteria? I would say that "indiscriminate drug treatment" is an
understatement; the medical profession has gone drug-crazy. If the hundreds
of billions of dollars that go annually into the development, promotion,
and distribution of new drugs were spent on trying to understand the whole
system, not only would we be a lot better off medically, but probably 95%
of the drugs now on the market would be yanked off the shelves and burned.

As to CSGnetters who are in favor of indiscriminate drug treatment, I can't
give you the results of a poll. I'm just replying to one of them who seems
to buy into the medical version of how the brain works.

If you
remove (by ANY means) the signals that drive reorganization, reorganization
is less likely to occur. And because the effects of drugs are not dependent
on behavior, there is no reason to expect any reorganization that does
occur to be relevant to the experienced problem -- which is no longer being
experienced because the drugs have suppressed it. In talking therapies, we
encourage clients to experience the distress and see how it relates to the
way they think and live. Would you give a client suffering from anxiety a
drug that removes the capacity to feel anxiety? If you just wanted to
relieve the symptom, of course you would. But if you wanted this person to
reorganize so that anxiety no longer occurred, you would have prevented any
useful progress in that direction.

Talk about "empty theorizing"! How's this for a "pseudo-PCT"
explanation: Sometimes error signals are so large that they
incapacitate people rather than allowing reorganization to take
place. Perhaps diminishing the intensity of the signals is
exactly what is needed to allow "useful progress" to be made.

I already said that. I agree that in desperate circumstances, drugs can
help. But I am also pointing out that if you suppress what the brain is
trying to do about some problem, that problem will remain unresolved. Maybe
it's sometimes important to solve some other problem first, but the price
is still there and will be paid.

If you are prepared to offer a warrantee stating that the person will in
fact be better off by staying alive, then you have some excuse for
preventing suicide. I suggest a $100,000 bond, secured by your house, to be
paid in case the client finds that life is no more tolerable than before.
After all, you are risking only money, while the client, in agreeing to
stay alive, is risking something so distasteful that death seems a
preferable alternative.

Wow! You obviously have little tolerance for any departure from
your reference level here.

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,

Bill P.

[Bruce_Gregory9]

[From Bruce Gregory (971217.1430 EST)]

Bill Powers (971217.1139 MST)

I can't explain, in theoretical terms, why something "often" works, unless
I can also explain why it doesn't work in the rest of the cases. As I think
of a theory, it's either true all of the time or it's wrong.

O.K. But aren't you the least bit curious that it works as often
as it does?

You are expressing how these treatments work on the basis of the "often",
not the remainder of the cases. The last series of statements above are all
statistical statements; they express, perhaps, the majority of effects, but
certainly not the effects on every individual. And don't ever forget who it
is that judges whether a treatment was successful.

Usually the patient. Unless the patient is hospitalized.

My argument here is exactly the same as my argument against using
population measures to characterize individuals. Even if the statements are
true in a majority of cases, you still have to consider the cases in which
they are false.

Sure. But if you're depressed, you _might_ think of trying
medication. It may not work, but if it doesn't the consequences
are not grave. On the other hand, the benefits can be great.

All
that would be needed to encourage the kind of respect Mike Acree is talking
about would be for intervenors to operate by the same code of ethics that
an auto mechanic usually follows: if my solution to your problem doesn't
work, I'll not charge you for finding one that does work - or refund your
money.

If you didn't live so far away, I'd certainly take my car to
your mechanic.

I still don't know what "SSRI" stands for.

I hope my last post answered this.

Bruce

[Bill_Powers1]

[From Bill Powers (971217.1139 MST)]

Bruce Gregory (971217.1315 EST)--

I said I agreed that in extreme cases, using drugs can make it more
possible for a person to solve some problems. But it's a desperation
measure, because you haven't the slightest idea of what you're actually
doing to the person's brain. This process is like giving a child a
soldering iron and turning him loose on a mainframe computer.

Bill, are you smoking something stronger than your usual stuff?
We don't turn children lose with soldering irons on
mainframe computers because we have excellent reasons to
believe what the outcome would be. If most people crashed
and burned when they were given SSRI's we would treat
administering these medications in the same way. But they
don't crash and burn. Either they feel better and report
improvements or they don't. Sometimes they experience
side effects. When this happens, other similar
medications are tried. What _I_ find interesting is that
the SSRIs often _do_ work. Why is this the case? Why do
people feel better when the serotonin levels in their
blood streams increases? Why do they no longer feel
depressed? Why does it take ten days to two weeks for
this effect to show up? Is there something about being a
living control system that provides a clue to answering
any of these questions?

I can't explain, in theoretical terms, why something "often" works, unless
I can also explain why it doesn't work in the rest of the cases. As I think
of a theory, it's either true all of the time or it's wrong.

You are expressing how these treatments work on the basis of the "often",
not the remainder of the cases. The last series of statements above are all
statistical statements; they express, perhaps, the majority of effects, but
certainly not the effects on every individual. And don't ever forget who it
is that judges whether a treatment was successful.

My argument here is exactly the same as my argument against using
population measures to characterize individuals. Even if the statements are
true in a majority of cases, you still have to consider the cases in which
they are false.

This is a highly assymetrical situation. From the standpoint of the person
who deals with lots of cases, a clear majority of successes is enough to
justify the treatment. But from the standpoint of the person who must
undergo the treatment, the "long-run" effects are of precisely no interest:
all that matters is what I gain if it works, and what I lose if it doesn't.
I think that interveners might gain a better appreciation of the patient's
point of view if they had an even slightly similar payoff matrix to
consider. It probably wouldn't be necessary to demand a $100,000 bond. All
that would be needed to encourage the kind of respect Mike Acree is talking
about would be for intervenors to operate by the same code of ethics that
an auto mechanic usually follows: if my solution to your problem doesn't
work, I'll not charge you for finding one that does work - or refund your
money.

I still don't know what "SSRI" stands for.

Best,

Bill P.

[Bruce_Gregory9]

[From Bruce Gregory (971217.1520 EST)]

Bill Powers (971217.1212 MST)

Just one question:

Mary once got hold of the half of the descriptive pamphlet that pharmicists
are supposed to tear off, and found that one of the observed side-effects
of the drug she had been prescribed is sudden death. She didn't take it.

Why not? I'm sure the warning was based on a statistical study.
How could she possibly know it applied to her in any way?

Bruce

[Bill_Powers1]

[From Bill Powers (971217.1212 MST)]

Bruce Gregory (971217.1345 EST)--

My point is that this simple-minded approach often works.
further we have little evidence that when it does not work it is
destructive in any way.

I take the source into consideration. Do medical researchers check to see
whether a treatment has destroyed someone's ability to factor polynomials?
To categorize usefully? To control relationships? To grasp principles? Do
they measure loop gains before and after treatment, to see if simple or
complex control systems have lost some stability, or some bandwidth, or
some range of control? I think you know the answer to that: they do not;
such ideas mean nothing to them. They don't see destructive effects mainly
because their tests for system function are too primitive to pick up any
but the most obvious malfunctions. Not only that, but destructive effects
that are observed are termed "side-effects," which, unless they are
perceived as serious, are usually ignored. Effects which are entirely
subjective, such as a feeling of dullness or ennui, are not objectively
measurable, and the judgement of whether they are serious is heavily biased
against giving them much weight.

Mary once got hold of the half of the descriptive pamphlet that pharmicists
are supposed to tear off, and found that one of the observed side-effects
of the drug she had been prescribed is sudden death. She didn't take it.

I don't know what an SSRI is.

Sorry. A Selective Serotonin Re-uptake Inhibitor.

Thanks. Now I understand how it works. Don't I?

You are making the assumption that a depressed person's brain
"is trying to solve some problem." I have no evidence that
this is always the case.

No, you misunderstand me. I am NOT making the assumption that a depressed
person's brain is NOT trying to solve some problem. There is a big
difference. If called upon to treat such a person, I would leave the
question open, and see whether the least intrusive approach would work
before trying to alter the chemical state of that person by force. I would
not, for example, urge a tranquilizer on a person who has just lost a close
friend or relative. Grief is evidence of a normal attempt to come to terms
with loss. I would prescribe a funeral, not a drug.

Sometimes the problem _seems_ to be the
error signal itself. Grief that seems to never end is not going
to be "solved" by ignoring the problem and saying that someday
the system will reorganize. You know what Keynes noted about "in
the long run."

I quite agree -- when all else fails, drugs are the only thing we have to
use. But I certainly don't recommend "ignoring the problem" in any case, if
the person wants help. Even if the problem is _not_ a "chemical imbalance,"
I think it is worthy and noble to offer help to a person who wants it, or
to let a person who doesn't want it know that help is there if wanted. The
problem here is that you're taking the medical point of view: if you don't
offer a drug to fix the problem, you must be ignoring it. I look on drug
treatment as the last resort, precisely because we don't know what we're
doing to the person. Sometimes we are driven to last resorts, and I have no
argument with a doctor who looks at it that way. It's the doctors who try
the drugs first that I accuse of hubris, not to mention laziness and
ignorance.

What is so intolerant about asking someone who presumes to intervene in
another person's life to know what he or she is doing?

Keeping them alive may be the first step in learning why they
are trying to kill themselves.

Yes, I agree with that. I see no other choice that isn't as fraught with
error as too precipitous a drug therapy. If one is going to act at all, the
first step must be to get the facts as far as they can be known. But
getting the facts means nothing if you have already made up your mind that
you will not permit this person to die no matter what you find.

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.

I agree.

A good note to end on.

Best,

Bill P.

[Tim_Carey]

[From Tim Carey (971218.540)]

I think you have to consider very carefully what you are buying time FOR.

Do you really think that all suicides are alike?

Just jumping in to the suicide conversation as a couple of Bill's comments
struck a chord. If a counsellor was to work from a PCT perspective,
wouldn't the central theme be to help their clients control variables that
are important to the client? When clients are in conflict, doesn't this
suggest two competing reference perceptions? Wouldn't the MOL be
appropriate here?

There seems to be an assumption being made that when people attempt suicide
they are not in their "right mind". When are we in our right mind? Am I in
my right mind when I am head over heels in love with a new girlfriend, or
when I am deliriously happy because I just won a large sum of money?

For me, the issues are: control (that is being able to control perceptions
that are important to me .... not _being_ controlled); and conflict ... I
think we control better when we are not in conflict. If these two issues
are addressed and the client still chooses suicide as an attempt to control
then who am I to say that's wrong???

Regards,

Tim