- To Change Your Mind - Details Matter
Mind Science – Critical Thinking Matters
Moneyball Brain – From Content To Process
October 18, 2011Parker, CorePsych At CHADD
October 25, 2011Brain Meds Require More Critical Thinking
Brain Trekking On Everest | Image – Wikipedia
An interesting mind-science phenomena that continues to befuddle me everyday with almost every new psychiatric office consult: Why do so many practitioners write for so many different psych meds without thinking about the body that the meds must pass through before reaching the brain. Now do I, dear reader, need to repeat that? This in-your-face-fact of biomedical passage is so obvious that it defies dutiful repetition.
Why are we traveling up the mountain without looking for a moment at the path? The Sherpas would call such travel crazy.
Meds go through the stomach, the gut, the liver, and some, dear readers, like Vyvanse, through the red blood cells, before they are metabolized sufficiently to reach the brain. They have to travel through the marshes, they don't just pop up there to the top of Everest.
Target Certification
And don't answer that question by insisting that “the public demands it…”
No, the key culprit in this cloud of unmet medical-mind Great Expectations is the overlooked detail that psych labels, diagnosis itself, and psych medications [the targets and the ammo] have significantly devolved into operationally ineffective platitudes – words on paper. The profound absence of applied critical thinking about targets and medication management, the “medical standard,” the Sargasso Sea of cookie-cutter solutions is simply appalling. Too frequently observed from this outpost, Nonscience is quite alive and well in everyday mental health practice. As illusory as dreams in psychoanalysis, and as meaningless as a Philly Cheese Steak Hoagie, from ADHD to depression, the customary approach to mind-science and critical thinking is surprisingly superficial – and, most importantly, apparently without self-examination or remote self reflective-inquiry, even when the entire ‘clinical situation' turns inside-out [read: the patient dramatically deteriorates].
Unmanaged care loves this mind confusion, and, like candida in the gut, thrives on sugar-coated impressions. Everyone knows this, but, while we get paid to help, they get better paid to neglect and dance around imperative details. Unmanaged care rapidly becomes the standard of care.
Refractory responses to psych meds are pandemic and remarkably unexamined. But the subsequent questions, the essential critical inquiry that should follow these clinical confusions and catastrophes, vaporizes more rapidly than morning summer fog.
Let me ask you… does Adderall = Aspirin?
The Mind Altering Temptation
And, moreover, an additional, somewhat seductive problem: the psych meds have a certain redemptive, almost spiritual power if they work right – and the operant word there, as you may have surmised: IF they work as easily as expected, without additional critical thought. You can see the healing in a day or two – so why not press on without question? Lemme think: those details don't do matter. It's too easy for a well-meaning provider chase that apparent mind-magic.
Check out this comment from an interesting article at Critical Thinking.org on moral integrity and citizenship.
Critical thinking, in its most defensible sense, is not simply a matter of cognitive skills. Moral integrity and responsible citizenship are, in turn, not simply a matter of good-heartedness or good intentions. Many good-hearted people cannot see through and critique propaganda and mass manipulation, and most good-hearted people fall prey at times to the powerful tendency to engage in self-deception, especially when their own egocentric interests and desires are at stake. One can be good-hearted and intellectually egocentric at the same time.
On A Personal Note
Personally I don't write for any meds I don't know enough about, period. Antibiotics, no. Cold formulas, no. Antihistamines, no. Birth control, no. The days when we used to think the brain, like the heart, was in some mysterious high Everest-like place are long gone. Now the brain and mind too often present problems scanned briefly like a troublesome hangnail… “Just take some of this and see what it does. – It looks like you may need a manicure.”
Yet a bit of good news about this absence of critical thinking: some new medical education is changing to include Critical Thinking in the curriculum.
A Part Of The Solution: CoreBrain Training
CoreBrain, our new training site [yes it's just under construction] plans to contribute to the resolution of these problems – why not show your interest, for example in the ADHD epidemic, and investigate some CME Training for the biomedical details? Sign up over there to keep informed on the evolving application of science – and just how simple critical thinking can both change your medical intervention systems, and take you away from unmanaged care, which thrives on Nonscience and cookie cutters solutions.
Informed medical citizenry, those following the rapid evolution of mind science, should take note: critical thinking, such as I have been encouraging at CorePsych is well underway. Let's work together at CoreBrain to move the details to the streets,
cp
Dr Charles Parker
Author: New ADHD Medication Rules – Brain Science & Common Sense
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Thanks so much Madelyn, – love your blog and postings! You bring so much experience and insight, and imaginative options to the ADHD table, it’s a privilege to work with you out here!
cp
Ok. Question for you – can you use previous responses to medications to inform future possibilities?
Over the years —
I’ve taken the following with very negative results: paxil, celexa, abilify
I’ve taken these with little or no result either way: prozac
I’ve taken these with slightly positive results: wellbutrin, vyvanse, adderall xr, effexor, lorazepam and zyprexa (but only short term obviously due to its relation to diabetes – I think that’s right, can’t remember)
I’ve taken this with very good results: adderall
current medications: adderall 30 bid, effexor 225, lorazepam 1-2 as needed in pm
I’ve been on this combo with effexor @150:disqus or higher for 2.5 months. And I’ve been stable on the adderall with no changes to it for a year. In the last month I’ve additionally experienced significant, unexpected life stressors and have managed quite well considering. I’m always resistant to change when environmental factors are all over the map.
Thoughts?
Elizabeth
Elizabeth,
I’m with you on your overview: hang tight until reality does what it often does – swings back around to tolerable limits.
At first I was going to point out that you likely need metabolic testing as you appear to have either a “Narrow Therapeutic Window,” or a “Roving TW,” depending upon the med. My reaction to that early part of the comment : get the testing.
But as i read on, I’m with you, I would simply call it idiosyncratic and leave it alone as long as it’s working… but if it falls apart again I strongly suggest careful metabolic testing with IgG and neurotransmitters as you are likely suffering with too few chickens in your ranch.
See: http://www.corepsychblog.com/2011/01/adhd-and-pea/
cp
Yes. The effexor basically seems to help some of the same things as the adderall, though no where near as effectively. So far, that’s the only benefit. I think the goal is to find something to even out my moods and reduce anxiety. I can manage both much better with the adderall than without, in that I an process it and then stay focused in the present moment. But overall, the moods, the anxiety, the doubt and guilt are all still very much interfering even though I can certainly manage better now than I could before.
So the short answer is, yes this part is working pretty well. But the effort to find the other part of the seesaw is not so easy.
Elizabeth,
The devil is in the mixing details and the background noise that is almost always present from metabolic issues not resolved or even considered.
cp
That’s a vague response that doesn’t add much or answer my questions. I have had testing done and have not been found overly off one way or the other. Even then, as you say, they are biomarkers to guide supplemental treatment/lifestyle changes (which I’ve gotten and am doing). All I’m asking for is (not medical advice) but rather any ideas of what I could look into to maybe suggest to my dr. That’s it.
Elizabeth,
1. Sometimes the reading, seen with other reports and interventions, appears insufficient. I have seen docs interpret IgG testing quite differently, and you may need to look more carefully into that interpretive conclusion.
2. As i have indicated frequently – the next easy step in testing is two-fold: Toxic elements, including heavy metals, and trace elements. Each can cause low grade chronic failure on the treatment side with any meds. http://www.traceelements.com/EducationalResources/HTMA.aspx
cp