Wednesday, February 17, 2021

Trauma, Depression, Anxiety - New Treatments

There will be a few posts because there's a lot of info, but i don't think I will be making this a regular topic here.

I hesitate to bring them along, because I was never an expert, and in the last few years have begun slipping even below the level of talented amateur. I was only pressed into doing therapy a few times, when odd circumstances made it necessary, and it had to be kept quiet, as I was not technically allowed. I gave no signs of being any good at it. But when I was going in full-time I had professionals on my team who thought about these things a lot and read up on developments.  A few were fools, and perhaps even dangerous; many were competent and able to discuss the merits of various approaches; a precious few were brilliant and flexibly minded and their observations on the patient, what the outpatient therapist was doing, the new research in the literature and the various Grand Rounds, and the underlying theories was pure gold. We had little time to discuss each acute emergency every morning, with a deeper dive on one or two a day. The psychiatrists, neurologists, and residents (usually 2nd or 4th-year) would also discuss brain structure, what receptors are being targeted and so forth, which I had no need to know but paid attention, just in case. There was a lot of knowledge in the rooms. Let he who has ears listen, and I knew a bit in those days.

Much of this was new late in my career, or really got untracked for approved use only after I was semi-retired. I therefore only know what I read, but have some ability to detect unfounded claims or outright woo. A lot of what is happening in treatment now looks like woo, but some of it seems to be holding up in clinical practice. For example, I was sure that EMDR was going to turn out to be voodoo, then I thought that maybe there was something to the general idea of storing memories in a different form but rejected the eye-movement part as just decoration.  I now think the eye-movement part is likely to be at least one technique that does aid in storing of memories. 

Not all of the new stuff works, though.  Some of it is revealing itself to be indeed nothing more than cool-sounding alternative medicine stuff that does no lasting good or even harms. From the essay I am about to link

"This is a very pre-replication-crisis book. In these more cynical days, we know that the first few studies on any technique – usually done in an atmosphere of frothy excitement, by the technique’s most fervent early adapters – are always highly positive. And later studies – done in an atmosphere of boredom, by large multi-center consortia – are almost always disappointing."

Scott Alexander of Slate Star Codex, recently revealed (and he has embraced this now) as Dr. Scott Siskind of Astral Codex Ten  has built up a lot of credibility with me over the years on many subjects, and psychiatry is his specialty. Thus I am quite confident in passing along his review of the famous/notorious book The Body Keeps the Score, by the Dutch psychiatrist Bessel Van der Kolk. You won't need to read the book after reading the review. Van der Kolk is important in getting PTSD recognised as a legit diagnosis at all, both the military and child abuse forms. The VA wouldn't even listen to him in 1980, claiming that studying trauma had never shown any benefit to veterans.  The idea was still that you should just tough it out, it would go away in time, it was the weak pre-existing personality of the vet, etc.  But when your nightmares - over which you have no control - are depriving you of hours of sleep for years on end, that has powerful long-term effects.  Just one example.  Many symptoms can be managed by keeping yourself out of certain situations, but that does mean you have to limit your life in some way, and some costs are very high.

So Van der Kolk deserves credit for that, but Siskind doesn't think his work over the last 20 years shines as brightly. Sisking has always needed a friendly editor, but he is thorough and the information is good. 

I posted James Thompson's review of some research about trauma last weekend, with the thought that one's subjective impression of what trauma occurred is a stronger effect than both the extent of the actual trauma and the pre-existing personality of the victim, which have been the two primary foci of research until now. Thompson says "subjective impression" and Siskind says "schema," but I think there is a lot of shared meaning there. So as a first observation, we could say that The Schema Keeps the Score.

By the way I usually apologise for linking to Unz.  It has some very good people, like Thompson and Steve Sailer.  But it also is just chockablock full of antisemites, some of whom are very good at sounding measured and fact-based, but always come to the same conclusion about the Zionists regardless of the data. I would think they would find more welcome on left-wing sites at this point, but they clearly respond to much of the symbolism of the right, and they aren't noted for being flexible in their thinking.  So it likely won't happen, no matter how much they hate the conservatives that just don't see the obvious about the Jews. There are also a lot of Russian apologists, some good , some just crazy. So.  Sorry.

So I will just start with those two for now, before giving my own thoughts.  I will be covering coherence therapy and touch on the somatic therapies in upcoming posts, adding in some things that occurred to me while reading all these.  Plenty to keep you busy for a day or too, and much to think about on your long walks.  Oh, I'm sorry.  that's me, not you.  Lost my head.

1 comment:

Donna B. said...

No need to apologize for linking to Unz. I seldom (almost wrote never!) spend time there reading more than you specifically link to. Instead apologize for linking to the Codex files where I can spend hours and hours...