Monday, February 24, 2014

Fix What's Really Broken

by SandWyrm


Not too long ago, SinSynn posted an article over on House of Paincakes where he told the story of his struggle with drug addiction. Because he wanted to cut through the bullshit and tell people the truth about what it's really like to go through that experience. Well now, because of a comment on my last post, I've got my own real-life story to share. Not about drug addiction, but about how the confusion of psychology with science skews our perceptions of health. Which, for reasons you'll see, is one of my major pet peeves. Because it has affected me personally time and again.


My last post speculated on some addiction-like patterns that I see as common to both drugs and hard-core game playing. With the stated assumption that advances in Neuroscience (particularly in real-time imaging of brain activity) would eventually allow us to quantify these effects.

This led to some disparaging comments about neuroscience from someone hiding behind an OpenID serial number. For the sake of this article, I'll assume that he's male and call him '000B'. Hi 000B!

Now according to 000B, neuroscience is next to useless, and both biology and psychology are far superior as scientific tools.
Biology is, of course, a long-established and respected science. One whose sub-branches includes the work of those studying the functioning of the human nervous system. So calling biology superior to neuroscience is like say that cars are superior to Fords. Or that Fords are superior to Mustangs. Uh... OK. Whatever.

But then I twisted 000B's panties and pointed out that psychology was not a science, and this is where he went full-scoff on me. Because he doesn't understand the difference between a scientific discipline, and a philosophical one.

Observe:
"Your contempt for psychology is surprising, and your faith in fancy machines endearing. Your explanation for what you believe psychology to be, helps explain both. Do you believe "descriptive disciplines" to be non-scientific? Do you share similar contempt for geology, or understand that biology is very similar? Regardless, this is far afield, and an on-going theme -- expressed interest in science, but contempt for the actual sciences that might be able to answer the specific questions you pose.

Best of luck waiting for neuroscience to get around to confirming what sociology, psychology, psychiatry, and biology have already "described". I anticipate they'll have fairly conclusive answers for you in the next two or three decades, assuming they actually embrace science (and not just the trappings). Or you could ask a scientist in a different field, who might have several decades of both descriptive and experimental evidence and a fairly well-supported set of answers."
And here is my overly-detailed reply...

000B, I’m counter-amused by your lack of respect for those who develop and use scientific measurement tools. Do you hold the same scorn for blood pressure cuffs and microscopes? Probably. Since you are fundamentally confused as to the differences between science and philosophy.

Science is not a thing, but a process. One where knowledge is built and organized in the form of *testable* explanations about nature. If a theory cannot be proven or disproven, then it is not scientific. Nor is the validity of a scientific finding dependent on how many people, even if they call themselves scientists, believe in it.

Philosophy, on the other hand, is the study of general and fundamental problems. Philosophers can follow a systemic and disciplined approach in their work, and even hold rational arguments that incorporate scientific evidence. But a philosophical theory cannot be objectively proven or disproven. Hence, the only possible measure of its success is how many people come to believe in it.

Psychology, as a study of the general and fundamental problems of the mind, is thus a branch of philosophy, not science. Because even 75 years after Freud, the disorders it seeks to treat still have no objective test for their diagnosis. Nor are they even clearly defined in the DSM, it’s primary manual. Where the inclusion and description of each ‘disorder’ are primarily decided upon by culture and politics, not objective biological measurements.


Now… I have a great deal of respect for both science and philosophy, properly applied. Both are essential to society, and science cannot pave a road without philosophy first blazing the trail. Establishing the conceptual framework within which the objective observations of science, and their resulting theories, can be made. In this way, the insights produced by philosophy are vital to good science.

But when people confuse the two disciplines, all sorts of bad things happen, and nowhere does this confusion do more damage to everyday people than in psychology. Which has become an easy substitute for the words “I don’t know” across the entire medical profession. Encouraging  psychoactive drugs to be thrown at problems which are usually better addressed by other medical disciplines.

Want a personal example? Because I have one. Actually I have three or four, but I'll keep it simple and just relate the latest.

Last fall I went into the ER with complete paralysis of the lower half of my face. I couldn’t talk, I couldn’t even smile. But I could write just fine. This was my third visit to that ER in 2 months, as I increasingly suffered from muscle spasms, all-over pains, uncontrolled sweating, insomnia, and ‘crashes’ where I’d go into a half-sleep state multiple times a day. Even as my heart felt like it would pound its way out of my chest. I worried about this… A LOT. So did my wife.

The doctors scratched their heads, because it obviously wasn't a stroke (duh). Yet I couldn't make a sound. The signals from my brain simply weren't making their way to my face and throat. As they ran the blood work, finding nothing obvious, I slowly regained the ability to move my lips and mouth. Until, an hour later, I could talk well enough to be understood. After an hour and a half, I could talk normally.

That's when the ER doctor sat down and patiently told me that I was crazy.

He was very nice about it, as were the previous 2 ER docs. My GP... not so much. But the message was clear. It's all in your head. Go see a psychiatrist. You're suffering from anxiety.

I went home, slept badly, and the next morning the muscle spasms started again. Then, quite by accident, I took a magnesium supplement. Within half an hour the spasms, tingling, and numbness  were completely gone. You can imagine how pissed off I felt at all those docs. But the best was yet to come.

The rest of the anxiety symptoms were still there. It's not like I had placebo-ed my problems away. But my facial paralysis had quite obviously been caused by a severe lack of a key electrolyte (the minerals you need to transmit nerve impulses around), and the only time I get muscle spasms or tingling anymore is when I forget to take my daily magnesium.

Continuing the story... I ended up back in the ER again a few months later, after my heart pounded so hard that my chest ached for hours afterward, and suffered through yet another lecture by a doctor who couldn't bring himself to say "I don't know". So he told me as authoritatively as he could that he's been doing this for 20 years, and it was all in my head. Then he asked me if I'd ever been diagnosed with bipolar disorder (nope), wrote me a scrip for Xanex (which I tore up), and sent me on my way.

This is supposed to be where I decided to be a good little patient and did as I was told. Problem is, I knew better. Not only does my family have actual bipolar people in it, but I went to art school. So trust me when I say that I know what real mental illness looks like first hand. I also know very well how psychiatry works. Because I was run through that mill (uselessly) as a kid. Nor was this the first time a doctor told me a problem was in my head, which later turned out to have a physical cause.

So here's what would have happened if I had taken their advice: A very nice psychiatric professional would have listened to me describe my problems, asked me some questions, considered them at some length, and then diagnosed me with General Anxiety Disorder. Putting me on either an SSRI, or a Benzodiazepine (or both) to calm me down. After a few months of tweaking the dosages, I would have reached a somewhat less anxious steady-state. Though I would still have felt miserable, with a complete lack of energy.

Now pay attention 000B, because this is the part that you may not grok in your confusion of science with philosophy.

This diagnosis of general anxiety would have been spot on. I WAS suffering from general anxiousness, and those drugs would have helped calm me. If not to a ‘happy’ state, then at least into a state where I could go about my daily life more easily. From a psychological standpoint, this course of action would have been both reasonable and correct. By any established psychological measure, I would have been successfully treated.

But that is the trap 000B. Because psychology, due to its being a philosophy instead of a science, assumes that the 'mind', a purely conceptual construction, is somehow separate from the bodily processes that support the brain and nervous system. Leading those in the psychological disciplines to believe that they are treating 'the mind', when what they're really doing is addressing a complex system of interconnected biological processes.

In short, they only notice and modify the most obvious aspects of a person's behavior. Without considering what the underlying causes of that behavior might be. Which is the equivalent of trying to remove the rust from a car by painting over it.

So I persisted in looking for what was really wrong. Which, as it finally turned out, was my sinuses.


The above pic is one of 52 image slices of my sinus cavities produced by an MRI machine. This particular slice shows a little of everything that was wrong. From the various structural problems, to the presence of chronic infections in each cavity that went back at least a year and a half, and possibly much longer.

For reference, the illustration to the right shows how open those sinuses were supposed to be.

In total, I had something like 25% of the airflow that I was supposed to have normally, and none at all when I was sick. That plus the long-term chronic infection were the source of most of the anxiety that had appeared in the months previous. That is, the majority of the added stress I was under wasn't mental. It was physical in nature, and no amount of positive thinking or verbal therapy was going to make it go away.

So I had the surgery done, and now I'm breathing as easily as most people do. As I've recovered from the procedure these last couple of months, the anxiety has gone way, way down. Along with it, the aches and crashes have disappeared. Even as the real mental stresses in my life have increased due to family troubles.

As a measure of how hyperactive my immune system had become battling that infection for months or years, consider that my kids have brought home colds, stomach flu, and strep throat since Christmas. Normally, I would catch everything. Yet I'm the only one in the family that didn't catch any of these. I got a little sniffy for a couple of days, and snored a bit more. But that was it.

So Consider...

If this had all happened in the 1950's, then there would have been no MRI to tell my ENT that what seemed like a minor routine sinus issue was actually quite severe. Because there would have been no good way, short of cutting into my face, to know what was happening inside the center of my head. In that case, the only logical recourse would have been psychological or psychiatric treatment for the behavioral symptoms of my anxiety. In an attempt to paint over the rust of my condition.

But this isn't the 1950's, and thanks to a "fancy" technology whose clinical use only goes back 34 years, and which only really matured in the last 10 or so, I was able to get the physical cause of my anxiety properly diagnosed and treated. Rather than just throwing drugs at my behavioral symptoms, as 2/3rds of the doctors that I talked to over the course of this journey urged me to do. Which would have resulted in my overall physical and mental condition deteriorating from the ongoing infection plus drug side-effects.

So that is why I'm contemptuous of psychology. Not because the people that practice it are evil, don't work hard, aren't disciplined, or don't honestly want to help people. Not because psychology hasn't amassed a great deal of useful information about human behavior. But because the underlying assumptions of psychology are flawed, and these flawed assumptions infect the entire medical profession, due to psychology's confusion with real science. Polluting the attitudes of physicians towards patients with conditions that aren't easily diagnosed in a 10-minute office visit.

Which, if you're not a stubborn, opinionated, a-hole like me, can destroy you both mentally and physically. I've seen way too many of my friends and family struggle with this crap not to care.


Now there are certainly some conditions, such as Bipolar, that only psychology and/or psychiatry can currently be used diagnose and treat. But this is only because, until very recently, we had no other decent diagnostic tools beyond "Tell me how you feel...". And we still have no good guide to treatment beyond "This drug usually works for what I think you have...".  As someone whose loved ones deal with Bipolar, I know that there is no steady-state in the long term. The drug that works today may not work next month, and nobody knows the underlying reasons why. So treatment is a currently a guessing game with no end.

But... As these new technological tools (imaging, genetic testing, biochemistry) improve over the coming decades, we'll not only be able to diagnose these conditions more accurately. But we'll also be able to make better guesses about what treatment paths to follow. Based on the specific brain regions that need to be dulled or enhanced in function. Along the way, we'll discover that what seemed like 3-4 separate conditions are actually just minor variations on one. While what seemed like one condition actually has multiple distinct causes. Because that's what happens when a philosophy is displaced by scientific observation. But when a philosophy instead pretends to be science, people mistake the path for a paved road.

End of rant. :)

30 comments:

  1. I came here thinking this was going to be a GW rant.

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    1. Heh, sorry to disappoint....

      "The Knight Titan Is too damn expensive for something without pose-able legs!!!"

      ...There ya go. ;)

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    2. and if you break them you have to fix them.

      It was just the title that I saw in the bloglist. Glad to hear that the surgery has helped you out.

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  2. It's a bit unfair to juxtapose philosophy as being somehow against science. Science IS philosophy, a Phd is a doctor of philosophy. It's an evolution of natural philosophy and empiricism.

    Freud's flaw was that he wanted it all. The way he presented his theory made it clear - he had either solved psychology entirely or his theory was worthless. Modern psychology has said - well he was unscientific, his theory doesn't work, therefore it's wrong and we need a new approach. He was wrong about having a theory of everything, but he did have a lot of profound and interesting observations. I think modern psychology has dismissed Freud but has suffered a fundamental and profound methodological crisis in the process.

    While it may be painting over the rust to give a patient with a blocked sinus a bunch of SSRIs it's also wrong to treat someone who has suffered a traumatic event as though they have some kind of physiological problem that can be treated by addressing the brain chemicals. This was what led to the SSRI debacle in the first place. Trying to become more medicalised has really hurt psychology as a discipline.


    It's not big or sexy and you don't need a university degree but common, everyday counselling is really valuable even in modern super-medicine. The biggest scanner in the world may tell you exactly what group of nerves is working when you feel something, but it won't tell you what it's like to feel that.
    At the end of the day medicine deals with real people, and having people to help with anxiety and worries around illness has a massive impact on health outcomes because these are significant components of what is making the person feel ill.

    Sometimes the psychological component is the entire problem. Deep existential crises or severe traumas can put people into a psychological state that is profoundly troubling for them. Overcoming it requires leaps of insight and knowledge that, at times, therapy is very helpful with. Trouble is, you can't put insight and self knowledge into a pill and sell it. It's completely incompatible with modern medicine.



    Plus I think the Knight Titans are awesome

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    1. I’m not trying to assert that science and philosophy are opposed. Each needs the other. But they should never be confused. Psychology is no more a scientific discipline than Economics, and both its study and practice should be approached with the same degree of healthy skepticism that we reserve for people spouting new economic theories.

      Psychology is in a methodological crisis post-Freud, for the same reason that mainstream Economics can’t move past Keynes. The philosophic theories of the early 20th century are obviously not working for us anymore. But all that can replace them are new theories which will be found wanting in return. Because you can inject all of the scientific observation that you want into a philosophy, but you can’t prove (in a scientific sense) whether option A is really better than option B.

      Is Capitalism ‘better’ than Communism? Depends on the time and place. Depends on the people and resources available. Depends on your very definition of ‘better’.

      Traumatic events have a physical basis within the brain. It’s just that we don’t know yet what those physical mechanisms are. Any more than a Roman doctor had any conception of bacteria and viruses.

      So, like the Romans, we have to fall back on philosophical theories. Thinking in terms of vapors and humors seems crazy to us now, as does the entire idea of bleeding a patient. But it was the best framework that the Romans had for thinking about disease at the time, and it worked better than what came before.

      I agree with you about counseling having great value. But you don’t need a psychologist for that. Any priest can offer advice, with the benefit of being able to reference a tradition going back thousands of years to help guide them. They key is having a framework within which learning and structured thought can take place.

      And I would buy a Knight Titan just to have one if it were half the price.

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    2. Well science is the fruits of the application of empiricism. If you think there's no real way to prove opinion A is better than opinion B then you're prompting the question; "why is empiricism better than, say, Plato's theory of the spheres?"
      Surely there's more that we can say to a committed Platonist than simply "hey try empiricism - it'll 'feel' better"?


      Capitalism VS Communism does depend on contingent issues like social context and, ultimately, what your objectives are. That doesn't mean that the answers are all hopelessly self-referential and subjective. We can judge capitalism and communism (the answer most modern countries seem to have made is "a bit of both please").
      But this is also true in medicine - a question like "do we go with drugs or surgery?" often comes down to contingent circumstances and the overall goals of the treatment. At the end of the day we still come up with a decision, sometimes it's even "a bit of both" too.

      I don't think that there is the hard divide between empirical science and other disciplines. The types of questions are different so the way you answer them has to be different too. That doesn't mean they're not precise or that there's no way to judge the relative merit of different ideas just because they have subjective factors. You might as well say there's no way to judge the relative merits of two different artists. Or modelling companies... ;)


      Talking about trauma in terms of brain events doesn't necessarily do them any justice. For example a pin in the foot causes pain and that pain has brain events that "cause" it or play a large role in our sensation of pain. We could get a really huge machine and analyse the brain in beautiful detail but brain analysis wouldn't really be much good for establishing a cure for the pin-in-foot pain.

      I could imagine a world where you go to the doctor and say "I feel depressed and I don't know why" and they scan your head and find "oh hey area 67 of your brain has this defective connection, we can fix that with the super lasers..." or something like that.
      But what if the depression is caused by factors outside of the inherent health of the brain? A bad memory for example? Or life circumstances? Often psychological problems are due to a person not having the life skills to handle troubling issues. Treating this kind of problem as a medical issue actually does it an injustice.

      I do think that the "humble" types of psychological help are often the best and that modern psychology would do well to move back to this type of therapy rather than obsessing with brain scans and pills. It all seems to have hopelessly missed the point to me.

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    3. When option A *can* be proven to be better than option B, that’s science. When they can’t, that’s philosophy.

      Good philosophies tend to propagate because the people practicing them are better at winning wars or dominating in business. Keynes won out over Friedman because it opened the door to massive government ‘stimulus’ spending. Giving those economies (both socialist and capitalist) a big boost while the credit lasted. Now, Friedman gets reconsidered as we experience the downside of that.

      Communism faded when it’s poster-child, the Soviet Union, collapsed. Now, as Capitalism struggles, it’s resurging in various different forms.

      But while an economist can make objective observations of economic measures such as GDP, they can’t tell you whether GDP or economic growth is worth chasing in the first place. They may conduct a lot of science in his or her day-to-day work. But the field itself is not a science, and can never be.

      Whereas a scientist may use philosophical tools in his or her everyday work, but ultimately their work is about proving theories to be objectively right or wrong.

      You’re right that we shouldn’t focus solely on the brain. Part of recent discoveries in neuroscience is that roughly 10% of the body’s neurons are not located in the brain. There’s a whole parallel nervous system that’s mostly located around our intestinal tracts.

      You’re also right that feeling depressed or anxious is not just about your physicality. But by the same token, a ‘scan’ might reveal that your depressive or anxious pattern is consistent with either an external social cause, or something physical. Allowing treatment to be more objectively focused.

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    4. Haha do you just reject the idea that science is a practical application of a philosophy (empiricism)? I don't know where it comes from but this philosophy/science divide seems like something cooked up.


      Anyway I guess my pin-in-foot analogy was pretty bad. What I was trying to say is that focussing on brain scans is going to focus on the symptom rather than the cause.

      Of course, you can expand the concept of the machine and say it's so amazing that it can even tell you the cause of the pain. "hey that's pin in the foot pain!". A perfect diagnostic tool.
      Okay, sure, but the important thing isn't really the brain state. You can get to the cause through this roundabout method of brain scanning but there are much more straightforward methods to diagnose the problem.

      The issue in psychology doesn't really seem to be the diagnosis, it's the borked therapies they offer as a solution. The pharmacological approach is just wrongheaded on so many levels. In the analogy it'd be like prescribing pain killers to cure a pin in the foot. Sure the pain is gone, kind of, but it's soooo misguided.
      It's not that they don't know that the pin is causing the pain even, they just seem geared up to treating symptoms rather than causes.

      note: I don't think we're actually disagreeing.

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    5. Yes, I reject the idea that science is the practical application of a philosophy. Is an artist that uses scientifically derived paint-mixing methods or computer software a scientist? No.

      Remember my definition, which did not originate with me:

      “Science is not a thing, but a process. One where knowledge is built and organized in the form of *testable* explanations about nature.”

      If you’re building testable knowledge about something, that’s science. If you use scientific knowledge to make something or help people, that’s engineering, design, or art. If you’re thinking deeply about something, but your theories can’t be proven or disproven, that’s philosophy.

      It might seem cooked up to someone who’s used to these concepts being routinely confused. But it’s the proper logical definition.

      As for brain scanning…

      Diagnosing something like ‘pain’ isn’t about just one area lighting up in a scan. It’s about ALL the areas that light up in a scan. A dot in the pain area is one thing, but a dot in the pain area AND a dot in the memory area tells you something else entirely. That’s the concept I’m getting at.

      Not saying we’re there yet, but the potential probably is there to make routine first-pass diagnosis using such a scan in the future. Which can then be followed up and confirmed/falsified by additional non-scan methods.

      The issue in psychology isn’t the diagnosis, methodology, or even the treatment. Rather, it’s the underlying assumptions at work. Because only behavior is studied or modified.

      I once had a toothache, and my dentist sent me to a root canal specialist. Where I started asking questions about other ways I might deal with that tooth. What he told me was this: “Well, I can talk to you about whatever you want, but I only do root canals. Do you want one or not?”

      Walk into a psychologist or psychiatrist’s office and the given assumption is that something is wrong with your ‘mind’. Which is a an abstract *concept*, not an actual thing. At that point, it doesn’t matter what else might be wrong with you, because they only study and treat ‘minds’. Not the body as a whole.

      So do you want your mind treated or not? If not, why did you walk in? It's not like they're going to look for anything that they're not trained to look for.

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    6. Science is a process. But it has an epistemological basis for why we do it. That is to say, a theory about what information about the world should look like and how to get it. That is something separate and distinct from the Science itself - but it still doesn't get Science off the philosophical hook - it's dependent on its philosophical base.
      If you're doing science you're implicitly accepting empiricism as axiomatic to your activity, even if you never question it or even explicitly acknowledge it.
      This isn't a problem...


      It's not that science is wishy washy. Rather that philosophical theories are based on reason. Philosophical theories, regardless of topic, die off or are accepted on basically rational grounds. Fashion and so on may have a role to play in a theory becoming popular but an unsound theory won't stand the test of time.
      Going back to the Greeks, if we want to disprove Plato we use rational arguments. By the same token 2500 years on we can still use his ideas like the Euthephro dilemma because it's a (good) rational argument.

      So just because something is philosophical doesn't mean it's not rational, or sound, or down to the direction the wind is blowing.



      Anyway, maybe some psychologists believe that the mind and body are separate, but I don't think they do for the most part. Doesn't the prescription of drugs to treat psychological disorders run contrary to that idea?
      Psychologists treat minds, but that doesn't preclude them from also being interested in the body any more than abstract ideas in science (probability waveforms etc.) hamstring scientists.

      The issue with psychological problems is that they are so inter-related, complex and often uniquely personal. Even if you had a brain scanner and even if it told you exactly what was happening in someone's brain, how do you interpret the scans? They have troubling memories, is this the cause of their anxiety? Is their coping mechanism strong enough? A person could be coping through something ultimately destructive, so that they seem calm in the brain scanner but they're going home and devouring three buckets of ice cream every evening. How would you work that out other than by talking to them?

      As messy as it often seems, talking to people is often a good if not the only way to really get a picture of their mental health. A brain machine sounds fantastic but it removes the subjective element. For a lot of science that's useful. A heart problem doesn't care what you feel about it.
      A psychological disorder is intrinsically linked to how you feel and so you can't sidestep that subjective aspect to the diagnosis.

      Diagnostic failures or small minded doctors are a problem but I think a separate one. I can't really speak about bad doctors but I don't think a super-brain-scanner would do anything to help you if your doctor is a fundamentally a fool.

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    7. I never said that philosophy couldn’t be rational. It just can’t be objective. Which I think you’re agreeing with. :)

      Psychoactive drugs, for the most part, get prescribed to treat problems of the ‘mind’. But the very definition of what a ‘mind’ is, defies objective description. Is it an abstraction of what happens in the brain, or the whole body? Psychology has mostly concerned itself with the former definition. While neurological findings are increasingly favoring the latter. But both are still abstractions that ignore the complexity of the system being discussed.

      There’s certainly nothing wrong with using abstractions. In fact, they’re unavoidable. But you always have to remember that an abstraction is not a real “thing”. The “Mind” is no more of a physical thing than “Time”, “Color”, “Fields”, “Wave-Forms”, or “Gravity” are. All are human mental constructs that far too many scientists and non-scientists have come to see as real physical things. Confounding both our ability to investigate the actual details of mechanical reality, and our desire to do so.

      You’re right that a brain-scanning-thingy can’t completely replace talking or the professional judgement of a doctor/clinician. But it can provide a more objective basis for diagnosis, and a more objective measure of success in treatment. It’s also reasonable to assume that the scanning technology will improve beyond just what can be provided in a single clinic visit.

      Using sleep medicine as an example… You’ll have that initial 6-hour study done in a controlled environment, with electrodes and whatnot placed all over your body. But that’s not the end of the data collection. Because if you end up on a CPAP machine for Sleep Apnea, that machine will record data too. Telling your neurologist (when you bring the SD Card in) how many times you stopped breathing per night, how long you slept, and when, etc.

      Heart patients can also be given wearable monitors to track their status 24/7 for up to a week.

      So while, in the future, you might have a detailed brain (and/or body) scan done as a first diagnostic step for depression or whatever… You’ll probably also end up with a Google-glassish headband or cap that can record a less detailed set of measures. To help provide the big picture of what’s happening in your head (or not) at any given time. That still won’t bring about diagnostic perfection, because you can’t find what you’re not looking for. But it will reduce the number of subjective observations involved in the whole process.

      There are many foolish doctors, just as there are fools in every profession. But effective technologies can reduce the need for a medical professional to be “the best” in order to treat a given condition effectively.

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  3. SandWyrm, I enjoy following your blog and I have a great deal of respect for you. I read your augment and I could have easily let it be, but I wanted to tell you (as companionably as I can) that your beef is with medicine not psychology.

    First of all in your example you seem to have mixed psychiatry and psychology. Psychiatrists are medical doctors, psychologists are scientists. In your example you said you saw a psychiatrists.

    Secondly, within the science of psychology is the field of clinical psychology. Clinical psychologists are ‘clinicians’ but they come from a science base rather than a medicine base. I have many friends that are clinical psychologists and I like to tease them about the science that they do, but it doesn’t mean that wider field of psychology isn’t a science. If someone argued that theoretical physics is not science because it is all just maths and thinking, it would not follow that physics is not a science would it?

    Let me tell you about where I am coming from and what I do.
    I have always loved science and scientific methods so when I left school I started a science degree at university. After a year of psychics, chemistry, maths and all the other hard science that I could cram into a year, I left Uni and joined the Navy. My job entailed hunting submarines from a helicopter using lots of cool groovy technology and physics principals. Due to a number of personal reasons I left the navy after several years and went back to my science degree at uni. My time in the military had taught me that while technology is really cool, in most cases the human using the technology is far more important. From that prospective I fell into the scientific fields of psychology and physiology. Since then I have obtained a Bachelor of Science in Psychology, an Honours degree in Psychology and I have just finished a PhD in Psychology. The only job title that fits what I do is ‘scientist’ seeing that I use scientific methods to solve problems.

    A problem that I have recently been working on was that our firefighters (fighting bush fires) have recently made poor decisions in the field which lead to loss of property and life. The science that deals with the ‘behaviour’ of decision making is psychology so we are the people to investigate it. Though a number of extensive experiments we found that the high levels of heat and smoke (carbon monoxide) fatigues the body quicker than had been thought (not an amazing finding). Then through many nights spent awake viewing peoples brain waves we found that the carbon monoxide was affecting their sleep processes (a way more interesting finding). We also already knew a lot about cognitive performance at different times of the day and under reduced amount of sleep. From all of this we began to map performance and decision making under all of these influences (using data and statistics) to work out how we could enable fire commanders to do their job. You can see in this brief example that psychologist do consider how the ‘body’ and ‘mind’ and environment all interact to produce a behavioural output.

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    1. Another problem that we have solved was drivers moving livestock out of the centre of Australia. The livestock is only allowed to be on a truck for a limited amount of time due to welfare regulations. But they can also only drive for a limited amount of time due to fatigue regulations. If they stop and sleep they break the animal welfare regulations, but if they drive to the next cattle station they break the fatigue regulations. So we ran a heap of driving experiments with the truckies and used scientific methods to develop a driving roster that allowed the drivers to make the run safely. It also included devises that monitored sleep and other checking systems. Once the truckies realised that we were on ‘their side’ they were very honest with us about what they were doing.

      In another case we shifted the body clocks of Olympic swimmers so they could fly to the other side of the world and compete the next day with no jet lag. We have also worked on problems related to airline pilots, medical doctors, military personal, miners and other shift workers. In all cases I have used science to solve a ‘human’ problem rather than anything that could resemble philosophy.I have work in various teams to solve problems too. A team might have an engineer, an anthropologist, a legislation lawyer, and me – a psychologist who is there to bring scientific methods to the table. I am included as ‘the scientist’.

      So what I’m saying is, I am a psychologist and what I do is science. Freud was a psychiatrist, Dr Phil is a TV host but what I do is clearly science.
      In my work as a psychologist I have never considered the 'mind' as a purely conceptual construction separate from the bodily processes. In fact my whole career is based on understand that it isn’t. I am always dealing with a complex system of interconnected psyco-physiological processes.

      Anyway, cheers for reading about what I do as a psychologist. I sincerely meant no offence here.
      This ‘OOOB’ seems to be trying to wind you up, I don’t want to do that, I just wanted to you what my experiences have been as a scientist. I have from time to time argued the difference between the fields of science and medicine. If you were to say that there is philosophy in medicine I would agree with you.

      Delete
    2. Sorry for the long post. I had to split it because it was so long! LOL One thing I never actually said ways that I thought you raised some interesting ideas. It's just that you are talking about medicine and psychiatry rather than psychology.

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    3. Love the long post!

      Psychologists and Psychiatrists do differ. But both are branches on the same Psychology tree. They use different means to treat patients, but the core assumptions of both disciplines are much the same. That they’re treating a ‘mind’ instead of a collection of physical processes. One uses words, the other uses drugs.

      I do think that there’s some messy overlap between ‘Neurology’ and some of the Psychiatric disciplines. Where the labels depend more on the academic path that brought you to that research, than the nature of the research itself. But that’s also indicative of the confusion I’m talking about.

      I get your example on theoretical physics vs. physics, and you have a point.

      But to diverge a bit… the problem isn’t the philosophical nature of TP. Physics *needs* that, as do all the sciences. The problem is when TP is confused with real physics. When black holes, space-time, the big bang, dark matter, so so-forth stop being just theories or conceptual visualizations, and get asserted as proven fact. As real. Because when philosophy gets confused with science, you get dogma.

      The big-bang, for instance, is just a mathematical extrapolation based on an observation. We think we see the universe expanding now, so if we run the math backwards we get everything compressed into a point X billion years ago.

      Cool. But can we really know that this happened? We’re talking about billions of years here, and we’ve only been noticing that expansion for 141 years. Maybe the universe expands and contracts at different times. Maybe that much matter can’t be compressed to a nice clean point. Maybe it was a collection of points. But that’s a philosophical argument, and rational people don’t get hysterical about philosophical what-ifs that can never be proven or disproven.

      Along the way though, the Big Bang got snatched up by those that wanted a ‘scientific’ alternative to religion and its creation myths (another science/philosophy confusion). So for political reasons, the Big Bang became a ‘scientific fact’ that can’t be questioned. Stopping cold any questioning of the ‘facts’, like redshift theory, that are used to ‘prove’ it. Hence dogma.

      There are many parallels to this in Psychology, which has been used politically to try and displace the social moralities of religion with ‘science’. Result: More dogma. More ‘facts’ that can’t be questioned.

      You’re definitely on the science end of the spectrum. Though it sounds like you could easily be called a neurologist too.

      I don’t think that 000B was trying to wind me up or he would have gone full-troll. He was just a bit arrogant about his profession, and wanted to ‘correct’ what he saw as sloppy thinking about a competing upstart discipline.

      Eh… It’s human nature. He just happened to hit a nerve. :)

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    4. There's a lot more evidence behind the big bang than just mathematical extrapolation. There is sufficient evidence backing it up such as measurements of cosmic background radiation, measurements of the expansion of space, distribution of galaxies and elements. This is stuff is pretty complex and it doesn't translate to the general public very well. Lets just say that there has been no sufficient evidence to contradict the theory.

      Your also working with a misunderstanding of scientific theory, Theories never really get turned into facts. Theories are just our best understanding of the mechanisms behind measured and observed phenomenon. Scientific laws are measured equivalences that seem to always hold true. Laws have nothing to say about the mechanisms that cause them to be true.

      For instance we can compute how much force gravity exerts on an object using Newton's Laws, but how gravity works is covered under things like Einstein's theories of general relativity. Which we know aren't perfect since they aren't compatible with Quantum Mechanics.

      That's what all the big fuss about the Big Hadron super collider is about. They're trying to find the evidence to support a more accurate theoretical model the the universe.

      Things like the big bang get questioned by scientist all the time. If you're scare quoting 'facts' and talking about scientific dogma, you're not really paying attention to how science works. If things are held true by the scientific community it's because the preponderance of evidence is there and there's no good evidence opposed to it. If someone came up with an alternate theory to the big gang, had good experimental evidence to support it, and made accurate predictions using it, the scientific community would take it seriously.

      How do I know that would happen? Because it has. Every current popular scientific theory in use has pushed aside it's predecessor in just the same way. And it's not like we went from thinking the universe was 6000 years old to 14 billion. There where intermediate theories. It came about because we where making observations that showed we live in a an old but not infinite universe.

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    5. There have been measurements done of cosmic background radiation. But calling that proof of The Big Bang™ is really nothing more than a philosophical leap.

      TBB proponents were expecting to find something at the outer reaches of known space, and did. But people looking for Bigfoot, Aliens, or Angels find ‘evidence’ that fits their expectations all the time. All that you can say scientifically is that a given observation is, or isn’t, consistent with the predictions of a given theory.

      Expansion of space is an interesting subject, and if you look, you’ll find fundamental scientific disagreements with it. Including, most damagingly, arguments over whether an object’s red-shift is an accurate measure of distance or not.

      I’ll even throw out a question that I’ve never seen anyone answer or even raise. When computing the distance of a given star using its red-shift, have the observers ever time-corrected that distance/position according to how long the light from that star would take to reach us? After all, we’re not looking into the present when we observe the night sky, but the past.

      A non-scientist would likely say “Yeah, sure! They must have corrected for that! It’s obvious!”, but you can’t assume this. Because there are all sorts of old-data holdovers from past research that philosophical dogmas get based on. We used to think, for instance, that all human brains shared the exact same structure. Why? Because only one brain (from an 80+ year old woman in the 60’s) had ever been dissected and analyzed in depth. Hence, that’s the only data that anyone had to use until MRIs came along.

      So if someone did think later to correct star positions for time, and this resulted in a non-spherical shape to the universe, would they dare tell anyone? Would they get published? TBB is dogma now, and you disprove it at the peril of your career.

      Which is not how science ‘should’ work. But science is done by human beings. Most of whom can’t help but confuse their objective observations with their philosophic values. It’s also funded by human beings who are only interested in certain subjects, with certain expected results.

      Is there anything wrong with TBB as a theory? Nope. It’s a useful idea to test observations against. But as a dogma, it’s worse than any religious creation myth.

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    6. If you think that Einstein explained gravity, then you don’t understand his work at all.

      Einstein (to step on another dogma) didn’t explain how gravity worked. What he gave us was a *visualization* (the ball on a rubber sheet) of gravity’s action. Which itself is only a 3D analogy of a proposed 4D spatial structure that has never been observed, nor can be. It can’t even be drawn on a computer.

      The real meat of space-time theory can be summed up as follows:

      “The action of gravity seems to be instantaneous, therefore it must derive from a static aspect or structure of the universe itself. Which material objects interact with. Otherwise there would be a time-delay in its effects.”

      To help explain this, Einstein used the rubber-sheet analogy. Cue awe.

      Visual metaphors are more powerful memes than logical statements though. So theoretical physics has become stuck playing with three dimensional geometric forms. In an attempt to pontificate on the structure of a four dimensional theory.

      Which has legitimized the metaphysical idea that unobservable ‘dimensions’ exist. Eventually leading everyone into magic fairy land. Where every arbitrary choice you make is now assumed to spawn new “dimensions”, where that choice is played out in 2 copies of your own personal reality.

      Know what a ‘dimension’ actually is? It’s a number. It’s whatever the observer wants to keep track of. Position requires 3 numbers to keep track of. Plot a position over time, and you have 4 dimensions (position + timestamp). Want more dimensions? Temperature, mass, albedo. There’s three more numbers that you can track on a graph, for a total of 7. Yawn. Oh, color. There’s 3 more numbers (Red, Green, and Blue components). Now we’re up to 10 dimensions. See how silly this is?

      Lost in all of this arbitrary philosophical nonsense is the search for the mechanical explanation of what gravity, as a collection of directional forces, actually is on a physical, chemical, and/or electrical level. We have wonderful mathematical models of gravity’s action, but no insight into what really causes it. Worse, nobody outside of the fringe sciences is even trying to find them.

      So don’t overrate Einstein.

      Delete
  4. Even among doctors, most people aren't very good at their jobs. Or at least don't have a great flair for problem solving. I think your experience is just a symptom of a very unsatisfying medical system in the US. I don't know if it's the cost or the fear of malpractice, but our system is pretty rotten. You don't get good healthcare outcomes in this country without pouring an unnecessary amount of money into the healthcare grinder.

    Like I said in the last post, I think Psychology is a valid scientific field. In its modern form it's not in any way philosophical naval gazing. Theories are made, evidence is collected, and conclusion are drawn. The scientific method is used. As I said before, it's working the same problems as neuroscience, just from a different direction. They are working from the effect backwards, instead of the cause forwards. And they are not mutually exclusive fields either. See the field of Neuropsychology for more info.

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    1. You’re right that the US medical system sucks. Even more so since Obama ‘fixed’ it. But I think the main problem here is one of physician egos, which is universal. They really, really, really don’t want to say “I don’t know…”, so they retreat into the easy-out of psychology for answers.

      Of the six doctors involved in my story, only two didn’t fall back on psychology to avoid saying “I don’t know…”. Of those two, only one said the following:

      “Well…” (looking at an MRI with a weird blotch) “…part of being a good doctor is knowing what I do and don’t know. I really can’t say anything meaningful about what I’m looking at here, but I can give you the names of a couple of guys who can.”

      Awesome! She’s my favorite doctor by far. :)

      Psychology is a broad label, and I do agree that neuroscience and the more scientifically minded psychological disciplines are approaching the problem from different sides. The place where they meet will use both kinds of tools.

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  5. My wife has her PhD in Psychology (neuroscience). Her work involves obtaining and analyzing the data obtained from advanced imaging techniques (MRI most commonly). Several of our friends that we met while she was earning her degree do as well. I've been around the lingo for many years. While my degrees are in the plant & soil sciences, they at least grant me the scientific literacy to follow along and ask "the right questions" without sounding like too much of an idiot. The field of neuroscience is silly with actual, hard science. Structure and function of nerve tissue, chemical pathways, etc. Anyone who thinks otherwise has a deeply flawed world view.

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  6. My comment was way too long. Gotta break it up.
    Part One:

    Hey Sandy.
    Firstly- thank you fer linking my addiction post.
    That's THE ONLY POST I've ever written that I actually WANT in front of as many eyeballs as possible, cuz what most people know about drug addiction they've learned from Hollywood, and it's all like 99% WRONG.
    So, thanks.

    I continue to recover, and am doing well. I'm sorry I missed this post when you originally put it up, but one of my issues when I'm 'normalizing' is an inability to focus on stuffs fer more than 30 seconds at a time, like blog posts.
    This will continue for about 3 months. I know, cuz I've been through it before.
    I miss 'hitting the blogs' when I have finished everything that needs doing in my day- that was my 'wind down' activity, so I'm missing a lotta my regular haunts...but it is what it is, man. In another couple of months, all the lil' 'aches and pains' my body is sending as signals cuz it wants heroin (still, even though it's all outta my system, my brain and body is trying to weasel me), my ability to focus and retain a stream of thought will return, I'll be able to sleep like a normal Terran (right now I'm lucky to get 3 to 5 hours of uninterrupted sleep, cuz due to my addiction being so bad, I would hafta wake up at like 4am to use, and my body was on like, a schedule- it wanted that heroin every 6 hours or less, or I would start to withdraw.
    That means NO sleeping fer 8 uninterrupted hours- I would awake already suffer withdrawals, so I'd hafta get up and use.
    My body got so used to living like that, it'll take a long time to 'shake off.'
    And hey- I'm now going to the bathroom like a normal person. I won't get into details, but addiction, like many, many other 'conditions,' affects EVERY aspect of yer bodily processes. No one ever mentions these lil' details when discussing addiction.
    *shrug*
    Dunno why, but that's one of the main reasons I wrote that post. Normally, I kinda wanna keep my weird rambling between me an' my regular group of ever-so-beloved knuckleheads (yerself included), but that post...that post was different, and important to me.
    So thank you fer da linkie, my friend, and fer yer support.
    *Xenos Hugz...Extra-squishy ones*

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    1. Part Two:

      Secondly- wow, dude...
      Like yerself, I strated getting shuffled in an' out of psychiatrist's and psychologist's office at a very young age, and NONE of it helped me.
      I've sat on MANY couches, done the whole 'group therapy' thing...I've done it all.
      I'm sorry, but I don't buy into any of it.
      The Terran brain is...immeasurably complex.
      Everyone, even two people suffering THE EXACT SAME SYMPTOMS, arrived there via vastly different paths through life, so...to say this as simply as I can, I don't believe attempting to apply the same 'formulas' for diagnosis and assistance and possibly a cure for what ails them just isn't something I think will work.

      Every Terran is just too different for a simple, easy diagnosis using a set of 'troubleshooting' methods outlined in book somewhere, in my honest opinion.
      And like you said- they're just SO QUICK to dash off a prescription for this or that, and some of those things are worse than drugs from the steet, like Xanax, for instance. That drug is VERY popular on the black market, among drug users.
      No lie, that shit is BAD. I took a whole stick once (dunno, the MG's, but it was a whole 'stick' that is supposed to be breakable into four separate parts), passed out on a couch, and apparently people were so worried when I wouldn't wake up they started hitting and kicking me until I came to.
      I've never messed with Xanax much after that, but there have been times during my recovery I took half a stick just to get some sleep, cuz lack of sleep will really fuck you up after a while of living with it.

      I was VERY HAPPY to read you tore that 'scrip up, dude. Fucking GOOD FOR YOU, man.
      A lotta people just acept what they're told by medical 'professionals,' but a simple look at the numbers for 'malpractice lawsuits' should be enough to prove to ANYONE that there's a lotta doctors who are doing shit via blind guesswork...
      'Well, the last thing we gave him/her didn't work, so let's try THIS...'
      And the manufacturers of prescription drugs PUSH THESE THINGS, very heavily.
      I werk in the Hospitals here in NYC. I see it all the time. Every pen and notepad has the name of some prescription drug printed boldly on it.
      The whole thing is twisted, dude. I gibe you mad props for having the determination to refuse their 'easy way out' suggestions (which in reality, aren't 'easy' at all. Medicated people make me sad. I've seen way too much of it) and fighting until you got to the truth.

      In any other industry, when someone doesn't know something, they can pretty much just say it, reach out to the next person up the chain, make calls for advice, whatever.
      For whatever reason, the medical industry in the USA doesn't work that way, and like I said, a simple Google search for 'Malpractice' information will pretty much prove that things can and will go very, very awry.
      And quite frequently enough that it's downright scary.

      Farmpunk, bless his heart, REALLY hit me in the head with his lil' 'We're all broken' statement. SO hard that I had to go out there and actually try and COMMUNICATE with other, unfamiliar Terrans.
      This wasn't easy for me, trust. I'm a pretty quiet person when surrounded by 'The Normals.'
      But what I learned really surprised me- 'The Normals' ain't HALF as 'Normal' as I assumed they are, and not just that, but a lot of 'em are actually pretty cool, too.
      But they're all broken like I'm broken, just in different ways and on different levels.

      Delete
    2. Part the Third- please forgive the length of this reply, and the typos that AREN'T my usual 'SinSynn' speak:

      Thank you fer sharing yer story, it was mad deep, and now I've got a bunch more respect for you as a Terran. You fought a good fight, brother, when many would've happily taken that first 'scrip and hoped fer da best, you said, 'No, this ain't right,' and fought fer yours.
      That takes some balls. Medical types can apply pressure in a variety of unfriendly ways. I'm sure you know this.
      Respect, yo.

      I hope yer getting better an' whatnot.
      Actually, I came over here to riff on you fer being a bad influence regarding X Wing...and maybe I was looking fer a new X Wing post outta you...
      DON'T YOU JUDGE ME!
      X Wing is crazy fun, and maybe you did nudge me a bit, but I woulda done it anyway. Reading you talk about it, especially YOU, one of those bloggers on one of the sites I consider 'da awesome,' definitely helped me make the decision, cuz initially I wasn't interested at all, cuz of the pre-painted minis...it seemed weird, and kinda 'un-hobby-ish' to me.

      But, no...folks like yerself (mainly you. A hundred other folks could say it was cool and I'd be like 'meh,' but if YOU say it's cool I'll hafta pay attention, cuz yer da man like dat) kept talkin' 'bout it, and now I've got a week's worth of doggie walks as punishment for buying two starter sets after I told The Crazy Lady I'd spend maybe 40 bucks on my trip downtown...
      Lolz!
      But once I saw that lady stocking the shelves at Barnes and Noble with a ton of brand new X Wing boxes, I was all like, 'Oh- this is happening.'

      So...no riffing today (there WILL be riffing later, trust. But not today, after I read this).
      Thanks fer stepping up, dogz.
      I always say it's GOOD to talk about these things open and honestly. I know it helped me to gush it all out in that post, and I hope maybe it will help others when they read it.
      Farmpunk is VERY right- we ALL are broken, somehow, someway, but we CAN...if not 'fix' ourselves (I'll ALWAYS be an addict. I know that now. Living with it and overcoming it is my challenge to face, and hopefully overcome), the we can come to terms with ourselves, and our 'broken-ness' and learn to control and/or live with it in peace.
      Medical science CAN help, or they can put you on some chemical that makes you a zombie, but a zombie that doesn't 'hurt' from what ails him or her.
      That's NOT a cure. That's just medicating the issue, not FIXING it.

      Thanks fer this, bro.
      Fer realz.

      Delete
    3. eeesh- sorry 'bout da typos. Sometimes I get all amped and just click away and miss 'em.
      Fortunately, I can edit my posts at da House, but out here I can't. Lol.
      :D

      Delete
    4. The real kicker about Dr. Xanex is that he had, just a few minutes earlier, properly diagnosed my problem. It was 2 days after my surgery, and I was having an atypical reaction to the Vicodin I was given for the pain. Which, on top of a decongestant and another RX drug I was taking, had sent me over the edge into an anxiety attack.

      Plus… durp de-durp… I’d just had major sinus surgery. My surgeon had ground off a bone spur, stuck heated needles into my terbinates to shrink them through cauterization, cut out a Haller cell (malformed inter-sinus connection), pierced and drained my many bollas (air pockets in tissues), and used a high-pressure balloon catheter to forcibly rip open larger air passages at six points. Oh, and they’d pierced my septum so that they could fit all those orthoscopic tools up my nose. Then sewn it back up when they were done.

      I’d call that some objective physical stress. You can go see some examples of that surgery on YouTube if you have the stomach for it. :)

      So after ripping up the scrip, I stopped taking the Vicodin and the decongestants. Switching to high-dose Ibuprofen and Tylenol instead. 12 hours later I was fine. Sigh… dumbass.

      Of course I only knew that Xanex was some scary addictive shit because brave guys like you had told me so online. Even the hard-core, unapologetic heroin users were saying to stay the hell away from it.

      Sleep is still a problem for me (always has been), so I’m pretty much stuck with using Ambien for now. But being a little more sleepy in the morning is far better than tossing and turning all night long.

      What typos? ;)

      Welcome to X-Wing. I’ll get another post on it up soon.

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    5. Yer da best, Sandy.
      Percoset (I mighta spelled that wrong) is an Opiate Based drug, and is physically addicting. I know some perc addicts, and they will be prescribed Suboxone when they go for treatment. The withdrawal symptoms can be just as bad as Heroin withdrawal, if you're taking a bunch of 'em a day.

      I will admit to using Percoset when I am in INCREDIBLE pain, like a toothache, earache, or some kinda 'really hurts all the time' kinda pain, but I'll only take one or two at most, and will switch to regular painkillers (over the counter, or OTC, stuffs) for the next 72 hours or more....
      It does exactly what Heroin does, actually, just on a smaller scale- it takes away any physical pain, and puts me in a good mood.
      And since it's Opiate based, I can't mess with it too tough, obviously.

      I'm sure I've discussed working on a Hospital Psych floor in one of my posts...it really gives me the willies.
      Are these people so heavily medicated because they're really, honestly dangerous? Or did they just do something at the wrong place and time, get arrested and dragged to the psych ward (it happens, here), and now....now they're the walking dead....

      Fer realz, dude- tearing up dat scrip was a much smarter move than I prolly woulda done.
      My dumb ass would've maybe thought, 'Oh, I can barter these.'
      *facepalm*

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    6. I wish I could say it was brave of me to tear it up, but it was just anger. Even if I had wanted to barter it, I wouldn't have known how. Because I was never a part of that world, and I would struggle to find someone who was here locally.

      Delete
  7. Alright, let me throw my thoughts at this:
    1. Neurology is getting there, but where it is right now has some SERIOUS problems. Serious. Back in high school, I ended up on dangerously high doses of antidepressants because my Neurologist didn't realize that I was using the word 'depressed' to mean 'stressed out' or 'sad' rather than 'clinically depressed'.
    2. With those out of the way, I actually find psychology a pretty completable profession at the moment. Mostly because modern psychology hasn't disowned Ole Ivar Lovaas yet. Which is kind of just as bad as if modern physicians were running around saying "Oh, Mengele? Yeah, he was a cool guy." And don't even get me STARTED on how Simon Baron-Cohen is a hateful jackass that somehow manages to be a Big Deal in psychology instead of the pariah-hood he deserves.

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    1. 1. Agreed. But my neurologist checked my bloodwork and did a sleep study before we ever even discussed medication. When we found out that I had a serious sinus issue, he was glad to have a concrete physical explanation for my stress.

      2. Did you mean some other word besides 'completable'?

      Yeah, psychology has a lot of blood to answer for. Especially back in the 50's. Plus it's the favorite political smear method of dictators everywhere.

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