In my short time at PSI this summer, I have seen many different psychiatric symptoms that are likely indicative of an underlying disorder. To name a few:
- Suicidal ideation. When I asked one of the patients how she was doing that day, she replied, "Still breathing, unfortunately." Concerned, I asked, "Do you really mean that?" She told me that she did.
- Grandiose delusions. One patient adamantly believes that HIV does not exist. He insists that it was invented by the Surgeon General to make money off of antiretroviral drugs sold by the pharmaceutical companies.
- Paranoid traits. One patient here always thinks the world is out to get her. She often refuses to reply to the journal questions in my class, asking, "Why are you trying to pick my brain?". More than once, she has referred to herself and other patients as "guinea pigs" that doctors are using to test out antiretroviral medication.
- Antisocial traits. One patient used to belong to a machete-wielding gang in Puerto Rico, and has done hard time in jail for having dismembered body parts in his car. Despite this, he has no remorse.
- Symptoms of Conduct Disorder. I had the privilege of observing the Anger Management group, in which several patients described the extreme satisfaction they get out of physical aggression towards others.
Thanks for mentioning that important word "traits".
ReplyDeleteSomeone may not be grandiose, paranoid or anti-social - or two out of the three - but if they're leaning in that direction, yes.
"Traits" you can't change, but "states" you can? (Yes, traits are subject to change).
Will read the Lancet
I'm not sure it's wise to put things purely in terms of "which came first..." It implies, but does not say, that if one of those things came first, the others were somehow caused by that first one. Rather, they could all be symptoms of something else (that is, they are all correlated, but not causal). Or they could all be covariant, statistically, in any measurement, and thus not meaningfully separable in terms of correlation.
ReplyDeleteI am not surprised the article calls for more funding of research. What journal does not call for more research in the arena in which it publishes papers? And thus demands more money for itself?
I am skeptical of the value of the research. I can only read the abstract currently, but, as a general statement, I question what positive result can be gained from such research. I view the system as far too complicated to be amenable to scientific study (that is rigorous) and not just a bunch of statistics on correlations improperly gauged to be causation.
I view so many journal publications as things published because the authors want to say they have a publication recently and advance their career goals.
I would be more interested in paying people to do exactly what you're doing, Marianne. I would be more interested in the money spent on working on the problem now. I don't really believe that money spent on "research" in this area will conclude anything; people are having the same arguments about how to help people that they have had for centuries. I don't believe that science can be easily applied to people.
I think people will go on having the same debates about the best way to help people. If a study comes out opposing that world-view, opponents will say that the statistics are correlation without causation, or they used voodoo statistics, and they will not be swayed by the evidence. They will then point to ten other studies which agree with their world view. Both sides will demand more money to do more research so they can go on and keep disagreeing with one another.
Give the money instead to people like you, who are making a difference here now...not funding debates that go nowhere.
Adelaide, yes, I was just talking about certain traits or symptoms. I hope I was clear in my post that I was not trying to diagnose the disorders in the patients, but rather making observations about their psychiatric symptoms. Definitely read the Lancet article if you have a chance!
ReplyDeleteDancing_Scientist, thanks for your insightful comments, as always. I also really appreciate how highly you regard my work this summer. I agree with you on the point that often statistics are skewed and research can sometimes be fruitless if it doesn't provide practical recommendations. I do think that research is a necessary part of the solution, however. See if you can access that article using your school's library website or something, because it has some valuable information. For example, it lists drug interactions between methadone (a drug given to treat opioid withdrawal symptoms), antiretroviral meds, and psychiatric meds. This could give physicians the insight to change doses of certain meds to make sure that they are all having their intended effect on the patient.
I find your statement "I don't believe that science can be easily applied to people" kind of funny, because after all, isn't that what medicine is? :)
Whether medicine is science will depend on the definition of the word. I don't know what your definition of medicine is.
ReplyDeleteIf medicine is defined to be whatever doctors do, no, medicine is not science, in my opinion. Doctors have a responsibility to help people, not to advance knowledge. Those represent very divergent paths, oftentimes (certainly sometimes the goal is similar). Doctors do not do controlled experiments except where it is convenient; doctors do not inject patients with a disease because they need a control group. Sometimes there happens to be a control group of sorts incidentally, sometimes not, and then everyone argues about whether it is fair. Everyone argues the extent to which the "control" group is really homogeneous and there is not significant variation in the group (and then begins the question of what variation is significant).
Science is about doing controlled experiments...controlling the variables, making observations, making models, testing models, eventually make a theory...but the key is that the experiment has to be unambiguously interpretable in the dependent variable, unambiguously controlled, and unambiguously repeatable. There's nothing controlled about people; I don't consider economics science, nor psychology, etc. There are just too many variables for which one does not control. Proponents of some model in one of those fields "claim" that the variables are controlled for, the opponents say they aren't, and no one really knows or gets anywhere.
This is less true the more we are talking in terms of pharmacy and drugs, and more true when we are talking behaviors. Interpreting causality in behavior and how to interpret behaviors of people still seems too complicated.
I would submit human nature is still too complicated for science. We're better than we were 50 years ago, certainly, but nowhere near the standards of science, in my opinion.
I would submit these are studies, closer to a paper analyzing the French revolution than a paper measuring the resistance in an electrical circuit. They are useful, but they are not definitive.
I clarify that the fact that I don't think of medicine as science in no way devalues medicine. That something is not science is not to say it is not valuable. I shouldn't need to say that, but I know to some people, my thoughts will sound as though I do not value non-scientific things. I simply mean to say that I question the ability for the study to make a conclusion (i.e., a conclusion which is undeniable, in whatever scope it chooses to make claims).
ReplyDeleteJust as no study on tax policy is definitively correct, nor can a question about what social behaviors give rise to HIV be definitively answered. Both are still valuable to study, but it's not as though the conclusion is undeniable.