[Paul]

Hey Matt,

Thanks for creating this group and posting up. I thought I’d have a pop at a reply here but my thoughts would apply equally to most of your other topics in the section. Note, I am fairly new to Iain’s ideas and and have yet to even start his latest.

As someone interested in psychology and philosophy I find this area of medicine both interesting and confusing at the same time. For example, it is clear to me that the efficacy and the effectiveness of SSRIs in the treatment of depression (for example) is widely disputed. Yet, in Western cultures certainly, they still represent the front line and default treatment of this disorder.

The model for depression being employed here is one in which the patient presents with a serotonin deficit and I am yet to be convinced that there is any evidence for this. One recent meta analysis (Moncrieff et al July 2021) seems to suggest that there is no association really at all.

Further, I find it hard to understand why this particular aspect of bodily functioning should be considered causal, even if it could be demonstrated that there is a concurrent deficit in serotonin that correlates to depression.

So, the radical in me feels the urge to critique the whole idea rather than to engage with the detail. I do hope this is ok.

It seems to me that there are some pretty big assumptions made in this field generally. First, that the brain is the seat of psychological disturbance and second that modifying levels of neurotransmitters will have a desirable and long term effect.

Of course, there are some features of orally consumable drugs that are worth considering: they are easy to manufacture at scale (once you have the technology in place to do so) and they represent an easily standardised and inexpensive treatment for large populations (in contrast, for example, to psychotherapy).

This view might be a bit ‘meta’ but it seems to me this is at least one other crossover with Ian’s ideas: that the theoretical modelling, diagnosis and treatment of depression in Medicine follows a pattern that is convenient for mass treatment but which ultimately doesn’t work very well and is based on ungrounded (some might say false) causal pathways. We might say it is a very left brain way of understanding and treating depression. I could say the same seems to be the case for the psychoses.

In saying all of this I do not even slightly reject the idea that things we consume have effects on the body and mind or that there are not people (perhaps even a large number overall) who are assisted by them. In contrast, the right brain therapeutically attempting to make sense of the whole when assisting someone with a mental health problem might find they don’t have the time to really understand the problem or that the person will not or cannot engage.

Of course, appreciating the whole of something in its context and fully understanding it is not what is happening when we agree with our doctor to take an SSRI. Is it a stopgap measure that we have come to rely upon as a culture? Has doing so distorted our willingness to think about more labour intensive ways of helping those in distress?

Are we simply, as a culture, missing the point?

I do find it interesting, this left brain notion that we are examining and understanding a fairly static system in which diseases of the same kind present now as they always have but we simply understand and name them better than we did.

The contrary view is that we really don’t understand them at all now (just as we didn’t in the past), but have simply constructed a more plausible narrative for accounting for them, one which opens up simple, cheap, standardised treatments for large populations.

Perhaps my bias as a psychologically minded person drives me towards the latter but I think this is where I chime with Iain’s positions on consciousness and the mind.

Of course, these positions may simply be outliers in a much messier dynamic reality where even the underlying conditions we are discussing come and go… If I remember correctly melancholia and post-partum psychosis have almost disappeared when controlling for diagnostic variability whereas non-melancholic depression is at pandemic levels.

Anyway, I hope the above s food for though Matt.

[Diana Koenraadt]

Does anyone here know how the birth control pill fits into this? I’ve heard similar claims about oral contraceptives making women less “attuned” to themselves and others. I also read that the pill affects serotonin

[Gary]

It is important to put this video into an appropriate neuropsychopharmacological context with respect to the operation of the very important, massive, and complex serotonin system of the brain which includes multiple subsystems based on a variety of different serotonin receptor subtypes. One important hypothesis relates to a division of serotonin action into two major subsystems based on 5HT1A and 5HT2A serotonin receptors and is developed in this paper by cognitive neuroscientists, Robin Carhart-Harris and David Nutt…

https://pubmed.ncbi.nlm.nih.gov/28858536/

…which associates the 5HT1A system with passive adaptation to stress, mostly through the generation and experience of anxiety and discomfort, and 5HT2A system with active adaptation to stress, which involves a more radical approach to the underlying problem, in terms of a fundamental shift in ‘priors.’ Consistent Carhart-Harris and Friston in their REBUS hypothesis ( RElaxed Beliefs Under pSychedelics; See: https://pharmrev.aspetjournals.org/content/71/3/316?fbclid=IwAR36UzFla5Lfx7-4LTr6R8N0XdUSOnbg3gnRPXn806cPKO7Zsas2EsJJhDs )

The SSRI agents are active in BLOCKING the 5HT1A system by blocking these receptors, while the psychedelic agents such as LSD and psilocybin are active in FACILITATING the 5HT2A system by activating these serotoninergic receptors.

So, this all makes a good deal of sense if we recognize that the blocking of the anxiety and discomfort associated with passive adaptation to stress by the SSRIs is to basically boost the ‘I don’t give a f*ck’ euphoric attitude through anxiolysis, which is consistent with a general ‘toning down’ of the emotional responses of passive adaptation to stress, both their important beneficial and unhelpful aspects. Which can be helpful up to a point, but which clearly has a huge down side, which relates to a general blunting of emotional response and a diminishment of a stimulus to creative thought as well as the capacity for enjoyment that depends on affective activation (like, for example, achieving an orgasm, or generating a piece of art). Leonard Cohen has a great little poem called ‘Grateful’ in the book ‘The Flame’ which is a very nice description of the superficial pleasantness of the experience of being on an SSRI and not experiencing the anxiety and emotional activation that would otherwise be appropriate.

The problem with SSRIs in blunting anxiety is when the anxiety is an appropriate indicator of significant maladaptation to one’s circumstances. So while one may be anxious and spiraling down for an appropriate reason, the SSRI blocks that signal. In which case what one needs to do is to move toward an ‘active approach’ to adaptation, which involves a fundamental change in one’s ‘priors’ or basic beliefs about how things operate. Which is the process that is facilitated through the appropriate and carefully managed therapeutic use of psychedelic agents.

[Gary]

Correcting: The 5HT1A system FACILITATES the passive adaptation to stress, which involves a REDUCTION in anxiety and emotional response to stress and the SSRIs selectively FACILITATE (not block) this part of the serotonin system, thus blunting the passive emotional response to stress while also blunting affective response to experience in general, which undermines those functions which depend on a fully developed emotional activation. The 5HT2A system FACILITATES the active adaptation to stress which involves a significant relaxation or questioning of the underlying ‘priors’, or basic beliefs of the person that are associated with the development of the stress. And the psychedelic agents FACILITATE the 5HT2A system, thus permitting an active restructuring of basic beliefs through suggestion that can be provided in a carefully constructed psychotherapeutic experiential process while the person is experiencing ReBUS while under the influence of psychedelics.

[Don Salmon]

Hi folks:

Clinical Psychologist (non-prescribing) here.

To the best of my knowledge, the current stats regarding effectiveness of treatments is this:

40% cure rate for severe clinical depression: placebo

41-44% cure rate: medication alone or CBT/interpersonal therapy alone

45-50% cure rate: medication + therapy

Philosophically, the most interesting stat here, to me, is the equal effectiveness of meds alone vs therapy alone.

This means decades of research continues to show that virtually all of the physiological effects that Gary describes may occur through therapy alone.

Now, another even more interesting philosophic point: nearly all the therapies they test are TALK therapies.

I haven’t seen much research on it, but I’d be willing to bet, if you included somatic therapies (I mean based in body awareness, not more meds) in the comparisons with meds, you’d see somatic therapies + mindfulness + contemplative heart-fulness + CBT alone would be far superior to meds alone, with an over 50% cure rate (and probably higher if you add meds)

To understand BOTH Iain’s hemispheric theories and the mind-body relationship in general, we really need to radically shift from our customary way of seeing things.

Here’s something to ponder:

Sri Krishna Prem (a British man who was the first non-Indian to be accepted into the Vaishnava order in India – the monastic worshippers of Krishna) once wrote:

we tend to think of Apollo as a myth about the sun.

A more accurate understanding of this is to consider the sun to be a myth of Apollo.

That’s a good start in understanding the relationship between the mind, the body and the Consciousness within which both exist.

[Don Salmon]

Sorry, for effective therapy for depression probably by far the most successful would be an integrated implementation of appropriate supportive social structures – thus fulfilling the declared “Biopsychosocial” model of treatment:

Bio: meds, healthy sleep, eating and exercise, living in tune with one’s circadian rhythms, daily immersion in natural settings, etc

Psycho: CBT, interpersonal therapy, mindfulness, heart-fulness, somatic therapies

Social: a deep connected, caring community in which education and healthcare are provided and meaningful work is available to all.

I would add Bio-psycho-social-spiritual. Then you have the whole thing. I expect to see this well implemented at least by some time in early 2551.