Inkwell: Authors and Artists

    
Oooh, I want to hear it.. what's the link for the replay? All I found was a
text chat summary...
  

    

<http://green960.com/cc-common/podcast/single_podcast.html?podcast=greenshow.xm
l>
  

    
The trouble with the hot-salsa technique is that Gary wouldn't be able to
talk.
  

    
So Gary, our wonderful conversation here is drawing to a close tomorrow.  
Is there anything you'd like to add, or wish I'd asked?  Feel free to ask 
yourself and answer -- we're listening.
  

    

This has been such an excellent discussion!
  

    
It's been really good for me too. During the interview, Angie read
back to me something I wrote here, something I'd forgotten already, and
I realized that you all pushed me to put some thoughts that have been
kicking around my attic into words. 

I do think that the most important thing to say, and I've probably
said it, is that we should get in the habit of thinking about diseases
as social and political phenomena, rather than as strictly biochemical
ones. Even outside the realm of consciousness-related diseases, the
ones I mostly focus on, this is crucial. Consider type 2 diabetes as a
paradigm case. It's got a biochemical component, but it's so clearly a
social and political problem, both in terms of how we get it (high
fructose corn syrup, which itself is a product of corporate farming;
fast food, which is often the only food available in poor
neighborhoods; sedentary lives, common among people who have to work
two or three jobs to stay afloat; and so on) and how we treat it
(drugs, amputations, dialysis, rather than education, prevention, and
self-care--which, as the NY Times series last year showed, is too
unprofitable to be of much interest to the HealthCareSystem). So if you
think of disease as a way to make a claim on social resources, rather
than as a purely internal problem, alternatives open up.

And thanks so much, Steve, for an excellent interview, for all the
time and thought you put in.
  

    
This has been flat-out fascinating.  Thanks to all the participants.  
  

    
Thank you all, and Gary, particularly to you for creating such a 
thought-provoking -- and brilliantly written! -- book.
  

    
More kudos from here. This topic has been a great read.
  

    
Damn. I was called away due to an illness in the family, just began
the book today, and all of this is fascinating to me. 

Can't we just keep going for another week? So much here...

One thing -- the 'alcoholism as a family disease' -- a few years ago I
worked for a local National Council on Alcoholism office, and had an
intense discussion with my colleagues about this. My argument was that
it's either a disease -- in which case, only the person who is
alcoholic has it -- or it isn't. If it's a metaphor, it doesn't work. 

Evil, therapy, illness, ... 

I'm so sorry I missed this, and I'm loving the book.
  

    
Disease works as a metaphor, or a narrative device, maybe better than
it does as a biological category. Unless it's the idea of metaphor that
Susan Sontag demolishes in her book Illness as Metaphor. But when the
doctors try to have it both ways--the authority of science, the power
of myth--they overstep. 
  

    
We don't speak of diabetes as 'a family disease', even though the
family must be involved in treatment. We accept that the disease itself
is in one person, though the effects may be felt by the whole family.
Shouldn't the same be true of addiction, if it really is a disease? 

I have a similar problem with the concept of 'codependency' -- which
you don't speak to in your book, but I bet you could. I think if we
took any 100 women, all from different backgrounds and with different
psychological profiles, and married them off to alcoholics -- in ten
years, they would look very alike. 

Wait -- we *are* doing that study...
  

    
Heh.
  

    

When I was at the pharmacy recently, I asked how I could find out if any 
of the medications I take are placebos.  They said that the pharmacist was 
not allowed to tell me, but that if I asked my physician they were 
required to, by law.

Do you know if that's true, Gary?
  

    
The best studies, I thought, were double-blind, because of the
evidence that doctor's can subtly affect people when doctors know which
are placebos.  
  

    
I don't think any of the drugs that you get at the pharmacy are
placebos unless you are on a clinical trial, in which case it is true
that they can't tell you. But if you're a research subject in a double
blind, placebo controlled study, you signed a paper consenting to
remaining in the dark. 

If, on the other hand, the question is whether you were prescribed,
say, an analgesic or an antibiotic as a placebo (as more than half the
doctors queried in a recent NIH study admitted to doing), then the
pharmacist wouldn't know. Only your doctor would. 

And if you were prescribed, say, dextrose (very rare if ever done),
the label would have to say so, or at least give a brand name that a
quick glance at the pdr would reveal as placebo.

The double-blind study is considered the "gold standard" for medical
research. It is not without its problems, however. An example of one of
them is in my book. The short version is that when I finished my
trial, I asked whether I'd been on placebo. They wouldn't tell me. The
latest protocol is that you don't reveal it so that the doctors don't
start figuring out who's in which group by associating responses that
they've observed with the knowledge they get when thy unblind the
subject. But then they offered me more medication. Why? Because I had
improved. So whenever they think someone is improving, they assume
they're on the med. Which, of couse, has an influence on the placebo
effect. Only it comes from ignorance, which is probably worse than
coming from knowledge.

I once did a story about a woman who had a strong placebo response on
an antidepressant trial. After they unblinded (which they did in those
days) and they discovered she was on placebo, they offered her the drug
(Effexor) free for a year, her payment for the study. If she did well
on placebo, they told her, she'd do even better on drug. 
  

    
As for codependency, I wrote a whole book about it. I wouldn't
recommend it. It's a long slog through the groves of postmodern
literary deconstruction, and a lot of swatting flies with
sledgehammers. I mean, critiquing Melody Beattie with martin Heidegger
is just plain unfair. 

The bottom line is that the idea of codependence--and I mean the
expanded version, the one that cropped up in the 80s that said that
anyone who sufered what Beattie called "the agony of entanglement" is
sick-- is what comes up when you get as confused as we are about how to
lose ourselves in love. Which doesn't mean that alcoholism isn't a
family problem, just that the solution may not be to pathologize
everyone. 
  

    

> Can't we just keep going for another week? So much here...

<gberg> has been a WELL member for years, and so of course  is <digaman>, so
I would assume they'll both keep visiting this topic.
  

    

I hope they do because it seems like we've barely scratched the surface.
  

    
Is that why I'm itchy?
  

    
I'll be around.
  

    

Good!  I ordered the book, but it hasn't arrived yet.  I've been utterly
fascinated by this discussion.

I do have a question:  do you classify clinicians as scientists?
  

    
Some clinicians classify themselves that way. Psychiatrists, most
obviously, and psychologists, who officially adhere to something called
the scientist/practitioner model, unless you have a Psy.D. instead of
a Ph.D., in which case you are a practitioner/scientist. 

In real life, of course, most practicing therapists wouldn't claim to
be scientists. But they have to engage in a scientific discourse if
they want to be licensed and insured and collect money from insurance
companies. That is, they ahve to take licensing exams in which their
knowledge about supposedly objective facts is assessed, fill out
treatment reports and render diagnoses. So to make a good living, you
have to give lip service to science, even if you are denying it out of
the other side of yoru mouth. Best of both worlds, I suppose, otherwise
known as bad faith. 

And if you want to see just how ridiculous it is to think of the
therapy profession as a scientific one, just read the article on the
front page of today's Times, in which the whole unfolding debacle of
the DSM-V is described. 

http://www.nytimes.com/2008/12/18/health/18psych.html?_r=1&ref=todayspaper

  

    

I think that the amount of money they are allowed to accept from 
pharmaceutical companies should be dropped to zero.  $10,000 is still way 
too much.
  

    

Thanks for the article.  That certainly confirms my objection to therapists
(psychiatrists as well as psychologists, PhDs and PsyDs) as scientists.  I
call them all paradigmologists embedded in social subjectivity and power 
(money) conflicts.

I also question whether medical clinicians are scientists.

To take an example, my neurologist treats a lot of patients with both 
lupus and multiple sclerosis.  She would love to interest a medical 
researcher to comb through her files, set up parameters, and compare with 
other cadres of patients to find interlinkages or perhaps a more accurate 
grouping of criteria that could lead to more accurate disagnosis and 
treatment.