[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.