If you think this newsletter is running late, you are right. Life has
been very busy here at Mental Meds HQ, and your editor has been
distracted by painful issues involving kidney stones (due to which he
has developed a profound appreciation for intravenous pain medications).
Last issue's article focused on the meaning and limitations of the concept of diagnosis
as it is currently used in medicine. This issue's article follows up on
the same theme, and introduces a new approach to determining how to
treat patients who have mental illness. The remarkable thing about the
new approach is that it does not involve the concept of diagnosis at
all, but is based on an alternative paradigm. While any article that
contains words such as paradigm
may seem too abstract to be practical, we'll see that the
reasoning leads to a very practical, and very exciting, new technique
for treating mental illness, and which is available now.
On the lighter side, the humor section contains new jokes that do not
follow any particular paradigm, but which may cause the reader to emit
loud repetitive sounds that can be diagnosed as laughter
Kevin Thompson, Ph.D.
P.S. As always, if you do not wish to receive email from me, please let
know, and I will remove your name from my list.
Do you have experiences you would like to share about how you have
coped with mental illness? Uplifting stories? Educational stories?
Email me with your idea, and if it makes sense, I will be happy to
include it in a future issue.
Funny stuff from around the Internet.
A Little Known Fact about the Catholic Church,
from the RunningForums.com
There are more churches in Las Vegas than casinos. During Sunday
services at the offertory, some worshippers contribute casino chips as
opposed to cash. Some are sharing their winnings - some are hoping to
win. Since they get chips from so many different casinos, and they are
worth money, the Catholic churches are required to send all of the
chips to the diocese for sorting.
Once sorted into the respective casino chips, one
junior priest takes the chips and makes the rounds to the casinos
turning chips into cash. And he is known as.......
The Chip Monk
On the Couch
, also from RunningForums.com
A man walked into the office of the eminent psychiatrist Dr. Heidberg,
and sat down to explain his problem. "Doctor, doctor! I've got this
problem," the man said. "I keep hallucinating that I'm a dog. It's
crazy. I don't know what to do!"
"A common canine complex," said the doctor soothingly. "Relax. Come here and lie down on the couch."
"Oh no, Doctor," the man said nervously, "I'm not allowed up on the furniture."
The Assertive Patient
, also from RunningForums.com
A husband is advised by a psychiatrist to assert himself.
"You don't have to let your wife henpeck you! Go home and show her you are the boss!"
Of course, the husband takes the doctor's advice. He rushes home, slams
the door, shakes his fist in his wife's face, and growls, "From now on,
you're taking orders from me!
I want my supper right now, and when you get it on the table, go upstairs, and lay out my best clothes.
Tonight, I'm going out with the boys, and you are going to stay at home where you belong!
And another thing -- guess who's going to comb my hair, give me a shave, and tie my necktie. . .???"
His wife says calmly, "The undertaker."
The Pony Joke,
from Pony in Here Somewhere Blog
The joke concerns twin boys of five or six. Worried that the boys had
developed extreme personalities -- one was a total pessimist, the other
a total optimist -- their parents took them to a psychiatrist.
the psychiatrist treated the pessimist. Trying to brighten his outlook,
the psychiatrist took him to a room piled to the ceiling with brand-new
toys. But instead of yelping with delight, the little boy burst into
tears. "What's the matter?" the psychiatrist asked, baffled. "Don't you
want to play with any of the toys?" "Yes," the little boy bawled, "but
if I did I'd only break them."
Next the psychiatrist treated
the optimist. Trying to dampen his outlook, the psychiatrist took him
to a room piled to the ceiling with horse manure. But instead of
wrinkling his nose in disgust, the optimist emitted just the yelp of
delight the psychiatrist had been hoping to hear from his brother, the
pessimist. Then he clambered to the top of the pile, dropped to his
knees, and began gleefully digging out scoop after scoop with his bare
hands. "What do you think you're doing?" the psychiatrist asked, just
as baffled by the optimist as he had been by the pessimist. "With all
this manure," the little boy replied, beaming, "there must be a pony in
Send me your
favorite joke, funny story, or amusing picture, as long as
it is related to mental illness. Keep it upbeat, please! Jokes
involving mental illness are welcome, but jokes that demean mental
illness are not. If it's appropriate, I'll put it up on the humor page.
Beyond Diagnosis: Time for a New Paradigm
The Meaning of Diagnosis
In the last issue, we reviewed the concept of diagnosis
, and discovered
that the popular conception of diagnosis does not correspond very
clostly to the reality. The popular understanding is that a diagnosis
describes the cause of an illness (such as a particular bacterial
infection), and provides guidance about the best type of treatment.
While this description is sometimes correct (such as for strep throat),
it often is not. Instead, a diagnosis is often a label applied to a set
of symptoms, such as bronchitis. Bronchitis
simply means an inflammation of the bronchi (the major passages leading
to the lungs), but says nothing about the cause of this inflammation.
The term doesn't even specify whether the inflammation is due to
a bacterial or viral infection, which is an important distinction,
given that antibiotics are useful for the former, but not the latter. A
physician may have reasons to suspect viral or bacterial origins, but
will not be able to identify a specific viral or bacterial strain.
Fortunately, these limitations are not critical for bronchitis, as the
viral form usually goes away in time without treatment, and antibiotics
usually suffice to deal with the bacterial form independent of which
bacterium is responsible. Unfortunately, this limitation becomes more
severe when applied to mental illness.
Diagnosis in Mental Illness
Unlike bronchitis, mental illnesses rarely come with any physical
symptoms that can be observed by a physician. Symptoms are almost
entirely internal to the patient's subjective world
(perceptions, thoughts, feelings), or behavioral in nature (angry
outbursts, spending sprees). Worse, the causes of mental illness
(believed to be abnormalities in brain chemistry, receptor
concentrations, and so forth) are not known at a level that is
detailed enough to provide an obvious connection between symptoms and
causes. Worst of all, no standard medical tests exist to detect the
underlying causes anyway.
Given the scarcity of useful knowledge and diagnostic tests, it is not
surprising that diagnosis is solely symptomatic. It is also dismayingly
subjective, as different psychiatrists can justifiably interpret the
same symptoms as indicating such widely different diagnoses as anxiety
and bipolar disorders. The fault here is not the physician's, but
rather the arbitrariness of the diagnostic categories, and the lack of
any objective criteria for measurement.
The final "dirty secret" of psychiatry is that medications used to
treat mental illness have a relatively low probability of success. The
probability that someone with depression will response well to any
single antidepressant, for example, is around 30%. Thus the average
patient may have to try a few different antidepressants before he gets
Any concept of diagnosis as a precise
description of an illness, which serves as a useful
guide to treatment, has almost disappeared from this picture. In fact,
the picture is so poor that any reasonable person would shake his head
and wonder why the mental-health profession persists with its practice
of fuzzy diagnoses and low-reliability treatments.
The answer, of course, is one that psychiatrists understand all too
well: as inadequate as this approach to diagnosis and treatment
may seem, it is the best that medical science can do.
Or is it?
Correlation in the Treatment of Illness
Let's pull back and remember that what the patient really wants is to
feel better. He cares about a diagnosis primarily because he sees it as
a necessary step to feeling better. However, if we have reached the
point where diagnosis is an unsatisfactory guide to treatment, perhaps
it is time to look at alternative strategies for meeting the patient's
What we really want is a predictive model than can determine which
treatment will work best for each patient. If a classic diagnosis
assists this result, then so be it, but if not, we should not allow the
expectation that diagnosis is necessary to get in the way.
The concept of a predictive model is simple: Given an initial state,
the model predicts the effects of different treatments, and we select
the treatment that produces the best results. To do this, we need a
quantitative description of the patient's state, and a method for
predicting how his state changes based on treatment. In simpler terms,
we need to know what "sick" and "healthy" mean in terms that can be
measured, and how different treatments will affect the person.
Note that the concept of diagnosis
has disappeared, and been replaced by the concept of correlation
The nature of the illness is irrelevant, because what matters is how
results are correlated with the possible types of treatment.
The concept of correlation provides a completely different paradigm
(organizing strategy) for how we think about illness and medicine. What
we lose is the concept of a diagnosis, meaning an understanding of why
we are ill. What we gain is a strategy for treating problems that
cannot be diagnosed in any meaningful sense. (Is the loss a serious
one? No, it isn't, because correlation methods are additional to
strategies for discovering treatments, not a substitute for diagnostic
strategies that work.)
One Correlation Method: Referenced EEG
A company named CNS Response
pioneered a correlation method based on electroencephalogram
technology, called "Referenced EEG" (rEEG). At the heart of the rEEG
method is a database of EEG recordings from thousands of healthy
individuals, and individuals suffering from some common mental
illnesses, both before and after taking various psychiatric
medications. The company has created a predictive model based on
statistical analysis of how different people respond to medications,
which allows them to predict the response of a specific person to
The claim is a bold one, and seems too good to be true. However, the
company does not claim perfect success, only a better success rate than
alternative strategies for selecting medications. For
example, a study of patients with refractory depression
(treatment-resistant depression) showed that six out of seven patients
treated with the rEEG method improved, compared to one out of seven
whose treatment was not guided by this method. The company claims an
overall success rate of 70 - 95% in treating depression,
attention-deficit disorder, eating disorders, and addiction.
These studies are sufficiently new that researchers in
psychopharmacology have not confirmed or generally supported the
results at this time. However, the relatively inexpensive and
uninvasive nature of the technique, coupled with the reported success
rates, make rEEG a technique definitely worth exploring.
While the concept of diagnosis remains valuable, it is no longer the
sole paradigm for the selection of medical treatment. The new
concept of correlation, while perhaps less intellectually satisfying,
provides a very different approach to finding effective treatment for
medical problems. Correlation methods hold out the prospect of
successful treatments in areas where traditional diagnostic techniques
have proven inadequate. Those who suffer from depression, and other
types of mental illness, have reason to be glad that a new correlation
method, rEEG, is now available to them.
You Looking for Writers?
If you are looking for articles on mental-health and medication issues,
for an online or printed publication, send me a note. I write for
various publications, and may be able to help.
MentalMeds News --
Copyright © 2009 by Kevin Thompson
May be freely distributed in whole or in part, provided material is
attributed to Kevin Thompson, Ph.D. at www.MentalMeds.org