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raymond vazquez

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Overthrow of DSM -V

Great talk and badly needed ideas to stem out-of-control cost of mental health diagnosis and treatment, made worse by reluctance of profession to incorporate latest neuroscience findings. My nonprofit "Neuroscience - Now" is focused on carrying out Dr. Patel's ideas..

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Closing Statement from raymond vazquez

Yes, it is time for a revolution in the diagnosis and treatment of the major forms of Mental Disorders but the revolution must start both within the field of psychiatry and from the neurosciences pushing from the out side. Either way BIG PHARMA cannot dictate the direction of this revolution it should play a role as facilitator of innovative ideas from academia and professional psychiatric associations.

I do not want to "throw out the baby out with the bath water" therapist on the front lines dealing with mental disorders have acquired vast store houses of empirical evidence on what forms of treatment work for a given individual. On the other hand, major organizations like the "Society of Neuroscience" in contact with mental health professional, congress and nonprofits must play a role in any grass roots effort to upgrade the entire field of Mental Health treatment, the results will be reduction in cost, suffering and increased compassion for those in need based on the scientific method. Please take a look at my website "http://neurosciencenow.org/" it takes a practical approach in making my prior points real...thanks a lot for all the thoughtful comments...

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    Sep 13 2012: Times change and so do our assessments. I can tell you from experience that drugs are not always the answer. They should be an adjunct to therapists' ability to teach coping skills and the art of loving.
    • Sep 15 2012: Yes, psychiatric drugs never heal people, they just suppress symptoms and so you have to keep taking them for the rest of your life. Sometimes that's all that can be done, but often times problems can be solved in another way, through therapy or just time because the brain can be molded.
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        Sep 16 2012: I want to add that the research on adult Neurogenesis has the potential to revolutionize how we treat almost all the major mental disorders. Please look below for expansion of my answer to your concerns.
        • Sep 16 2012: Yup, the brain can rewire itself constantly. That's the cause of most mental disorders (something is wired the wrong way during childhood) but with effort (like the right therapy) it can also "cure" most mental disorders. It's a shame so much of current therapy is a sham, but one day we will know more about the brain and some therapies will prove to be incredibly effective (just playing non-violent videogames is apparently more effective against PTSD than pills and it doesn't have the side effects). And sometimes it just takes a someone to listen to you , like the priest of old or the modern psychologist, both don't really know what they're doing but just them listening to a patient who believes in there neutrality, respectability and authority can do wonders.
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      Sep 16 2012: I have no disagreement with your positions ( Hupe & Smith). As a researcher in all phases of neuroscience over the last 20 years and experience both in clinical and office environments we are no where near incorporating the vast knowledge acquired over the last 20 years of research on the complexity of human neural networks and the pharmacology underlying these systems. The problem is that Big Pharma and the psychiatric association have made an unholy alliance which has drowned out any balance between talk therapy and pharmacology. Mental disorder diagnosis and treatment MUST take into account the biological specifics of each individual.
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    Sep 16 2012: Trainee Counsellor and Mental Health service survivor. Recent neurosurgery for cervical myelopathy, delayed due to psych. labels. DSM-IV and ICD-10 products of arrogant doctors looking to make work for themselves, reinforced by pharmaceutical industry looking for profits. Family history essential tremor and brittle bone syndrome. Should never have been put on lithium, took for seven years. Ended up on Thyroxine. Always in trouble for not complying. Meds do shorten life- mess up kidneys and excretory organs. Get a psych label and if you don't kill yourself, end up with a slow death due to psych meds. Hence so very keen to support talking therapies. Most mental health issues due to abuse and neglect. If early enough affect development of identity then nasty little label personality disorder 'untreatable' according psychologists but eminently treatable with love and kindness and respect. Huge waste of potential in not supporting 'mentally ill'. Very keen to write paper about cultural impact of mental illness referencing Jung's book 'Man and his symbols'. Very keen to support holistic talking therapies by making sure people correctly assessed in first place. No more short term CBT type interventions that strip away a person's coping mechanisms and leave them vulnerable. More holistic relationship talking therapy interventions eg Clarksons Five Relational Model. Not just mind and body idea from Enlightenment. Mind supported by body. Mind influenced by hormones and electro messages from nervous system. Got much more to say on this subject but do not want to detract from focus of talk so what would you like to chat about Mr Vazquez.
  • Sep 15 2012: The major problem with the book is the labeling issue. If I were to be label as a person with a mental disorder, I would be treated in a completely different way. This treatment, may in fact, be detrimental to the individual. However, I think the DSM- V is useful as background information. In other words, it should not be the key diagnostic tool to evaluate the patient.
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      Sep 16 2012: I fully agree with you. The larger problem is that DSM logic does not incorporate cause as part of its diagnosis. Therefore, mental disorders can replicate out of control. BIOMARKERS (e.g. level of neurotransmitters, cortisol concentration,gene variants coding important proteins in the nervous system etc.) are absolutely critical for diagnosis and treatment. Furthermore, neuroscience cannot precisely relate biological markers with human psychological states at this time but wait in combination with DSM logic we will make tremendous strides in treating mental disorders.
      • Sep 17 2012: If you want to apply this biological component, you have to ask yourself how can it be added?
  • Sep 16 2012: DSM manuals compartmentalize individuals by various identifying features of personality, which are looked at as abnormal. I believe that it is a usefull tool, but it is hardly used successfully. There are two doctors worth noting who's theories could be applied to much advance the application. Dr. Gary Knull, who points out holistic treatments for mental illness, often using diet changes, and Albert Ellis, who's Rational Emotive Behavior Therapy teaches the individual to address their own irrational thoughts that lead to anxiety and depression.
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      Sep 16 2012: You are right on target, the brain/mind dynamic is far more intricate than we could have ever imagined. Please look at my reply to the issues you bring up below. Only by driving to understand the causes of mental disorders can we rationally bring to bear the 1000's of years of practical knowledge we have acquired as a species.
      • Sep 17 2012: Yeah man, YOU are right on target. It's a way bigger picture than going to a shrink and getting an SSRR and/or Seroquil and next patient. Gary Knull cites many researched sources in his work. One person with schizophrenia, a serious disorder, was documented to improve greatly, after drugs failed, with heavy doses of vitamins. Thomas Szasz is another important name drop. His writing get's to the root of what's so "abnormal" about patients in the first place. Often people are just a little shall we say unconventional, or nonconformist, and the business labels them mentally ill. Great thread, bravo.
  • Sep 14 2012: Raymond, I understand the reluctance to accept the DSM -5. The critism i hear is that there are too many diagnosis'. Is this because the industry is creating more digagnosis'? Or are we just learning more? I do know that Big Pharma creates conditions, my favorite, "do you suffer from low T?" They are referring to the natural decrease in Testosterone as a man gets older. My Doc says every time one of those commercials air, he get at least three calls about it the next day.

    At its core the DSM is a guide. Doesn't it really rely on the practioner? I've been in and around the psychology world all my life. My mom & 2 aunts all psychologists. The hype is that their are fundamental changes in diagnosis this time around. I can't wait to see if is progress or more illnesses.
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      Sep 16 2012: Here is the problem, DSM does not make any judgement on the CAUSE of one's mental disorder, just a diagnosis. If you look at my website you will see the "light years" of advancement we have made in Neuroscience not even peripherally incorporated into DSM logic. Mental disorder and treatment MUST take into account the biological specifics of each individual. Email if you want specific mental disorder insights from the last 10 years of neuroscience research.

      I want to add that the research on adult Neurogenesis has the potential to revolutionize how we treat almost all the major mental disorders.
  • Sep 13 2012: From what I understand DSM-V has essentially changed diagnoses into ones that are only treatable through the use of medications, which of course are manufactured by major pharmaceutical companies. I do know they are discontinuing more than a few hard to treat personality disorders. I also know that they have changed the criteria for addiction and made it much easier for those with very minor substance issues to be treated as addicts.

    Im also interested in what findings you are referring to?

    heres an interesting discussion that touches on DSM-V by Dr Allen Frances http://www.youtube.com/watch?v=c2tOp7OxyQ8
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    Sep 12 2012: HI Raymond,

    What is DSM -V?

    Can you expand on the latest neuroscience findings that are relevant?

    I aplaud your non-profit initiative - it's great to see someone do more than just talk!
    • Sep 13 2012: Mitch, DSM-V is the 5th edition of the Diagnostic and Statistic Manual of Mental Disorders. This includes descriptions and codes of every mental disorder. I believe DSM-4 came out in 1994 so its been some time since there has been an update.
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        Sep 13 2012: Ah - I got it now.

        Yes - it's somewhat contentious. I recall some problem with a phenomenon of over-diagnosis.
        Robert Sapolski has a bit to say about the foggy line between individuality and psychological dissorder at a certain point of classification.
        However, there certainly are a host of debilitating conditions that require no philosophical arguement to classify.
        Having personal experience with family and friends suffering from this and that, I can see that we are far more advanced than was the case only 100 years ago - and this is comforting.
        The discussion now should revolve around taking the snake-oil and sharlitanry out of the field. Certainly there is a case for constraining the drug companies who are in the business of sickness, not wellness - but this is a factor of the money game, not psychiatry, an dis another subject.
        In this, Dr. Patel's initiative is a significant step in the right direction.
        Judging from some of the wildly eroneous comments in the video discussion, I can see where such lay-education is a matter of priority.
        I think people get off the track when they fail to understand that human behaviour is not a result of machinery in their heads - but is an emergent factor based on the machinery, genetics, environment and experience - in that emergent continuum there is no linear causality. And I defy anyone to properly understand that until they have been through, at least, the elementary principles of all these as a gestault. If such awareness is not propagated, then the witch-doctors and snake-oil merchants will abound - and therein lies the rub.
        • Sep 13 2012: Mitch, I completely agree that there are disorders which become glaringly obvious as maladaptive and our understanding of them, which has grown exponentially, is very comforting. To go from lobotomys up to modern neuroscience has been an astonishing and triumphant victory for the field of psychiatry. However the rampant spread of medication as the quick and simple fix is doing damage to patients. It seems as though once a month i look and see pharmaceutical companies being sued for misrepresenting products as being effective for treating x,y,z. and as a result people end up with awful side affects and withdrawals

          "Certainly there is a case for constraining the drug companies who are in the business of sickness, not wellness - but this is a factor of the money game, not psychiatry, an dis another subject."
          I wish this were so, but even as much as i enjoy and plan devote my life to the field there seems to be some very serious questions that need answering.

          http://www.cchrint.org/2010/05/21/dsm-panel-members-still-getting-pharma-funds/

          Like Sapolsky speaks of, you cannot try to unravel and explain and individuals behavior from one categorial bucket. I completely agree that behavior is a finality of synchronized interactions between "the machinery, genetics, environment and experience". Trying to treat an individual without looking at these causes as a whole or purposely ignoring some for whatever reason is where you see deception in the field of psychiatry. It seems as though DSM-V wishes to throw talk therapy to the wind and instead just hand out medication. In my opinion they have attempted to help the patient solely by offering a change in brain chemistry. Now theres no doubt that there are many medications that work and have done and will continue to do wonders for people. Unfortunately they have side affects and I believe psychiatric medications should be reserved for those who have not responded to other forms of treatment first. continued..
        • Sep 13 2012: Then you have to consider questions like, well if im a psychiatrist and I know x medication relieves y symptom and this person seems to be suffering who am I to not prescribe the medication? The point is this medications are a double edged sword (like everything else) there a god send for some , for others there a path to complications and misery.

          Have you seen Elyn Saks Ted Talk, medication helped her greatly

          .http://www.ted.com/talks/elyn_saks_seeing_mental_illness.html

          There are also others in the field who claim that medication saved their life, like Kay Jamison, who could be considered the foremost authority on Bipolar Disorder and also suffers from the illness.

          The point is this we need people in the field who are empathetic and care about their patients needs,quality of life, currently and in the future. This means understanding all facets of possible treatment and working with the patient to guide them through what would probably be most beneficial to THEM.(usually a combination of current treatments)

          Dr. Patels initiative is inspiring and needs proliferation badly.
        • Sep 13 2012: One of those links i sent you was from a somewhat radical website, I found a much more informative and reliable source

          http://www.tufts.edu/~skrimsky/PDF/DSM%20COI.PDF
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        Sep 13 2012: Hi Brian,

        We're pretty much on the same page.
        I've gotten a lot of insight into the problem through experience in trying to get help for close family, plus some pre-experience in neural net dynamics.
        In the instance of finding help for a bipolar sufferer, we followed the councellor trail through 4 or 5 practitioners (not including GP doctors) - all with degrees, sociologists, therapists and psychiatrists, and it wasn't till I shelled-out for the top psychiatrist in the country till we got the condition diagnosed and a suitable course of meds and talk-therapy. It took 5 years. ANd then the meds were progressed and followed up with blood tests.
        Bipolar is a hideous condition. If it were not for my embarasingly high income, she would probably not be alive today, and I was intensely aware of those who were out-of-range for any kind of help - for reasons of income, ethnicity or just ambiant ignorance, they are doomed.
        Autism was a bit easier to get diagnosed, no meds required there - just dedication and understanding.
        MS was also a nightmare - there is still no recognised treatment.
        All of these have a holistic source - genetics, enviro-chemical, in-utero conditions, early childhood experience, social stressors and genetic pre-disposition.
        It is the emergent nature of human behaviour that must be studied to get any grasp on these things.
        WE are now getting an idea of how neurons and synapses are involved in the process, things like neurotransmitters, re-uptake, degradation, receptors, ion dynamics, supressor neurons, glial cell, myelin etc etc. However, how do you detect a traumatic experience by looking at the machinery? This is nothing more than a certain complex configuration of synaptic potentials - that affect the synaptic potentials?
        It's this emergent state that needs identification - and we are a long way from codifying it.
        On top of that, there are not enough healers - and never will be in our current social model.
        SOmething's gotta give.
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        Sep 16 2012: Look below I have partially answered your first question, I want to add that the research on adult Neurogenesis has the potential to revolutionize how we treat almost all the major mental disorders.
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      Sep 16 2012: Sorry for late response, DSM-5 (previously known as DSM-V) is the planned fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental ...

      Almost every psychiatrist in this country uses it as sought of a checklist to narrow down the possible mental health diagnosis from a questionnaire and your discussions with the doctor. It is very useful for a first cut and makes use of the large number of cases in the psychiatric literature. Here is the problem, it does not make any judgement on the cause of one's mental disorder, just a diagnosis. If you look at my website you will see the "light years" of advancement we have made in Neuroscience not even peripherally incorporated into DSM logic. Mental disorder and treatment MUST take into account the biological specifics of each individual. Email if you want specific mental disorder insights form the last 10 years of neuroscience research.
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        Sep 16 2012: Hi Raymond,
        Many thanks1
        I'll send you an email.
        Communities take aeons to turn around. Even though we think of ourselves as moden and versatile, the deep attitudes tend to persist even when they are demonstrably wrong.
        I'll do ,my bit to help. I regularly write to my health minister and promote the great work being done by Damasio, Sapolski, Ramachandran et al.
        Coming from a more AI angle, it's a bit easier to understand what neurons are actually doing -.dynamic topology is a hard concept to digest, but when it does it's a bit of an epiphany .. so much becomes clear.
        Down on the practical trenches, you have to deal with the pathology, and that's way way beyond the root concept. One cannot expect the lay person to take on the task of understanding it - in many cases it wrecks their entire world-view - people get defensive when you do that to them - for good reason, it is damn hard to reconstruct an entire world view. It might help of it got quietly introduced into schools, but the teachers are all getting sick of teaching politics.
        I'll do what I can.