Although I'm obviously not TDX, I will respond to your post nonetheless.
You've wasted the last 10 years of your life visiting this forum (and many others) day after day, spreading negativity and eloquently packaged baseless criticism of Michal and others.
I joined this forum on Jun 25, 2018 and wrote 197 replies, which would amount to 197/1782 = 0.11 posts per day. Looks like only a tiny fraction of the last 5 years.
Can you prove this?
, just a mixture of Narcissistic Personality Disorder (or at least tremendous arrogance)
Remote diagnosing is a big no-no in psychology. For example if you were a psychologist and member of the german Society for Psychology you would violate their code of conduct
"10.4 Auftreten in der Öffentlichkeit
Psychologinnen und Psychologen können in der Öffentlichkeit mündlich und schriftlich, durch die Versendung von Materialien per Post, Fax und E-Mail, über das Internet oder mittels anderer Medien etc. beratend oder kommentierend tätig werden. Sie:
(1) gründen ihre Aussagen und Ratschläge auf zuverlässigem, validem, wissenschaftlich fundiertem Wissen und anerkannter psychologischer Praxis;
(2) begrenzen ihre Aussagen auf sachliche Information, wobei die eigene Person und Praxis nicht werbend hervorgehoben werden;
(3) achten darauf, dass die Persönlichkeitsrechte aller Menschen in der Öffentlichkeit gewahrt bleiben, und enthalten sich diagnostischer Beurteilungen über einzelne Personen ohne deren ausdrückliche Aufforderung."
Moreover Narcissistic Personality Disorder isn't even included in ICD-11, so it was for the most part abolished like half of the other personality disorders.
low self-esteem (which is why you're quite comfortable in the anonymity of the internet)
Most people on the internet are anoymous including yourself. Do all of them have low self-esteem?
and a little bit of depression (or rather dysthymia)
Actually I scored consistently above 30 on the BDI throughout the years, so that part is a little bit more than a little bit.
You also seem to have a massive secondary benefit of illness because, while you don't even have DPDR, you nevertheless seem to really enjoy playing the role of the pessimistic, psychiatric-abandoned hopeless case.
Reminds me to chronic fatigue syndrome, where psychosomatics also claimed that people with a disease often worse than death were enjoying benefits from it. I havent't come across sound scientific evidence yet that secondary gain really exists the way it's proponents claim. Especially the effects of severe disease outweight any possible "secondary gain".
You don't feel like you're living in a dream (lucky you!), but (due to your self-loathing) you probably feel some kind of inner detachment from yourself, which you (wrongfully) call "depersonalization", so you can spend time on this forum and have discussions.
I did not really do much of anything on depersonalization forums or even other mental health forums in the last months or even the previous years. My net acticity probably amounts to just a few minutes per day. But still you claim that I "fake" depersonalization just for being able to take in part on depersonalization forums?
Not even after 10 years did you realize that there is (of course) no medication that will ever fix your severely pathological personality, cure your hidden fears, give you true self-esteem etc.
I could very well live with all that stuff. I won't confirm to you that I have "hidden fears", lack self-esteem or whatever, but I can say so far that I never ever thought about seeking drug treatment for any of that. The goal of all of my drug trials was to gain relief from my depersonalization.
You are - and there is no doubt about it - mentally (and not biologically or idiopathically) ill.
So my tinnitus, GERD, retinal damage and so on are not biological?
I wish you with all my heart that at some point you will overcome your heavy defense mechanisms and become willing to seek serious psychotherapeutic help.
Apart from having tried psychotherapy in the past, why should I try psychotherapy, although there is currently no indication that it works for depersonalization disorder?
This is the only key; because arrogance, secondary benefit of illness, fear of vulnerabilty and fear of social connectedness cannot be cured by any medication.
Even if we take this premise for granted, there would still be the problem that there is no solid evidence that psychotherapy works for those things either. You are massively overstating the limited benefits of psychotherapy.
This is simply not true. In the guideline as well as in his book, he writes with regard to both opioid antagonists and Lamotrigine that after a thorough cost-benefit analysis, a treatment attempt with these drugs can be made.
Regarding the guideline I repeat what I said above:
He says that Lamotrigine and Naltrexone should only be used in "single cases". This wording implies that they shouldn't be used in the majority. This has a real effect on sufferers: Both Lamotrigine and Naltrexone aren't approved for depersonalization disorder. You can only get them prescribed off-label for depersonalization disorder, which means health insurance is not obliged to pay for it. However there are certain rules under which health insurance is willing to cover off-label drugs. And one of them is that guidelines recommend them. This is something which can't be said about the depersonalization guideline. Effectively Michal blocked sufferers from getting Lamotrigine and Naltrexone covered by health insurance.
On the 4th edition of his book it says about Lamotrigine:
"Auf Grundlage dieser Studien kann es in sehr seltenen Einzelfällen und nach gründlicher Abwägung der Vor- und Nachteile gerechtfertigt sein, einen Off-Label-Therapieversuch mit Lamotrigin als alleiniger Substanz oder in Kombination mit einem Antidepressivum durchzuführen. Ich selbst verordne Lamotrigin aufgrund der dünnen Datenlage und meiner eigenen Erfahrungen aber nicht mehr. "
Furthermore he says about Naltrexone:
"Naltrexon ist ein Opiatantagonist, der zur unterstützenden Behandlung bei der Rückfallprävention von Patienten mit Opiat- und Alkoholabhängigkeit eingesetzt wird. Vereinzelt berichteten DDS-Patienten nach Einnahme von 100–250 mg Naltrexon/Tag von einer deutlichen Abnahme der DDS-Symptomatik. Dies kann bei alkoholkranken Patienten, bei denen sowieso eine medikamentöse Rückfallprophylaxe mit Naltrexon sinnvoll ist, oder in seltenen Einzelfällen auch bei Patienten ohne eine Alkoholerkrankung und nach gründlicher Abwägung einen Off-Label-Therapieversuch mit Naltrexon rechtfertigen."
So in his opinion Lamotrigine should only be used in "very rare cases" and Naltrexone when there is co-morbid alcoholism or in "rare cases". Does this sound like a recommendation to you?
The studies on Lamotrigine as well as on opioid antagonists have (as you know) yielded conflicting results, so it goes without saying that Michal cannot define treatment with these drugs as the therapy of choice.
They aren't really conficting. Apart from the randomized-controlled trial studies showed consistent benefit for Lamotrigine. The randomized-controlled trial does not disprove this as placebo-effect, because there wasn't a placebo-effect in this trial. Most studies for opioid-antagonists also demonstrated beneficial effects.
Even if we assume that these studies are not sufficient to declare Lamotrigine and Naltrexone as "therapy of choice", the question remains why he can make psychotherapy treatment of choice, although it's evidence-base is much lower
and for his own treatment approach virtually non-existent
? Basically there is just a very questionable non-controlled clinical trial on a cognitive-behavioral therapy with serious flaws based on a model that is illogical and inconsistent with empirical evidence.
Under these preconditions, why does he actively discourage the use of drug treatments, while pushing psychotherapy as the treatment of choice? Shouldn't it be the other way round?
You make it seem like there is a drug that has been convincingly shown to be particularly helpful in the treatment of DPDR, but that Michal (maliciously) wants to withhold. That is simply not the case.
In a book that was recently published
Michal says "Die Therapie der Wahl ist Psychotherapie, eine medikamentöse Behandlung existiert derzeit nicht." (which translates to: "The treatment of choice is psychotherapy, a drug treatment currently does not exist").
What do you think about him literally stating that drug treatments don't exist?
Second, he explicitly states in his book that he usually does not recommend any particular line of therapy (psychodynamic therapy, psychoanalysis, CBT, etc.) to patients.
Still he describes his treatment approach in great detail in his book and it's clear that it's psychodynamic to the core and that he is a big proponent of psychoanalysis. Here is one example:
"Entscheidend ist es, die Depersonalisations-Derealisationsstörung als eine seelische Erkrankung zu akzeptieren. Das heißt anzuerkennen, dass die Beschwerden auch eine Folge der eigenen Lebens- und Beziehungsgeschichte, des eigenen Verhaltens und der eigenen Vorstellungen über sich selbst und andere Menschen sind. Man muss den Mut aufbringen, sich mit den Verhaltensweisen, Vorstellungen und unverarbeiteten Gefühlen zu beschäftigen, die die Entfremdung verursachen (Freud 1914). Man muss sich um ein liebevolles Interesse für die eigene Person, die eigenen Wünsche, Hemmungen und Ängste bemühen. Und man muss den Mut aufbringen, unangemessene Hemmungen, Ängste und falsche Vorstellungen, die die Entfremdung verursachen, als Probleme anzuerkennen, die man letztendlich besser lösen und überwinden kann."
He even refers to Freud, who is discredit by almost all of today's psychology and even by many psychoanalysts.
Third, you are right that there are no randomized controlled studies on the effectiveness of psychotherapy in the treatment of DPDR (and Michal even says that explicitly in the guideline).
But still he is making psychotherapy the first-line treatment, although it's evidence is far worse than those for drug treatments
Nevertheless, Michal's 20+ years of experience as a clinician who sees DPDR patients on a daily basis as well as the clinical experience of all the other DPDR experts can, in my view, justifiably be counted as a form of evidence for the effectiveness of psychotherapy treatment.
Expert opinions are very unreliable, the least worthwhile piece of evidence in evidence-based medicine and it's obvious that Michal's bias is extreme.
Elaine Hunter, Anthony David, Mauricio Sierra, Daphne Simeon etc. all agree that psychotherapy is the treatment of choice.
Clinicians agreeing about a certain treatment approach is the weakest possible evidence and has often been proven wrong, especially when the level of bias is so high. Example: In chronic fatigue syndrome, a much higher number of clinicians pushed a psychotherapeutic treatment approach, which not only did not work, but made people worse, in many cases permanently and in some cases even led to suicide.
And by the way, Daphne Simeon (who is, and I think you can agree with me, the world's leading expert on DPDR)
She isn't that good in my opinion and far behind Sierra. In my opinion we must look at the arguments and they are not really convincing.
completely agrees with Michal's "Affect Phobia Therapy" approach.
Which is basically your whole argument for Affect Phobia Therapy, although there is not only zero evidence that it works, but there is also no empirical evidence that affect phobia causes depersonalization or people with depersonalization even have affect phobia. I would even go as far as to say, that there isn't even sound evidence that "affect phobia" exists the way it's proponents claim.
Although Simeon has not conducted randomized controlled trials on this, given her many years of experience with DPDR patients, I think it's pretty reasonable to trust what she says. Don't you think?
Basically your whole argument reduces to argumentum ad verecundiam, which is not convincing and clearly much lower evidence for psychotherapy than the clinical trials for Lamotrigine and Naltrexone.
Mindfulness meditation is recommended for DPDR patients not only by Michal, but by all DPDR experts, including Simeon, Hunter, David and Sierra.
Mindfulness was featured in one or two of their studies, but I can't remember anyone else other than Michal consistently pushing mindfulness meditation as a treatment for depersonalization disorder. So far Mindfulness meditation is just a Michal-thing.
Yes, there are, again, no randomized controlled trials on the effectiveness of mindfulness meditation on DPDR, but there are pretty good theoretical reasons, and Michal explains them in his book (insula activation, getting in touch with your feelings instead of being detached from them etc.).
I have some counter-arguments:
- He claims that mindfulness was the "antithesis of depersonalization", but he doesn't really say what this "antithesis" is (lack of something is not necessaily the antithesis of something) and his study showing a negative association is clouded by shared item-content between depersonalization and mindfulness questionnaires.
- Michal doesn't mention in his book that there are also studies, where mindfulness meditation induced brain activity consistent with depersonalization, like increased activation of prefrontal areas or the temporoparietal junction.
- There is no plausible reason why attending to bodily perceptions should return emotions or reduce depersonalization. While it is generally belived that recognizing bodily arousal is necessary for emotional experience, Michal showed in one of his own studies that the interoceptive sensitivity of patients with depersonalization disorder is normal. Mindfulness meditation doesn't seem to improve interoceptive sensitivity anyway.
- His argument that mindfulness meditation might work by reducing self-observation seems questionable, given that there is no evidence that self-observation causes or maintains depersonalization disorder and mindfulness meditation is self-observation by itself.
I know that there is indeed at least one small study (Castillo 1990) that describes how meditation appears to have facilitated the emergence of DPDR. But I think it depends a lot on how you practice mindfulness meditation though.
This study features transcendental meditation, which is much more dangerous than mindfulness meditation.
One can also meditate in such a way that one separates oneself even more from one's feelings. But that's not what the exercises that Michal recommends are about, so I don't think there's anything to worry about here.
So the blame is put on the patient, by claming without any evidence that he practiced meditation in a wrong way?
I have the impression that, for whatever reason, you are simply projecting some kind of malevolence into Michal and his work. You should be happy for all DPDR patients (to which you are not one) that there is someone in Germany who knows this disease so well, does research on it and has established a special unit at a university hospital.
I have read a lot of accounts on what is going on in his so-called "special unit". There are some positive experiences, but many of the reports are quite shocking, especially regarding Michal's conduct. Importantly it appears to be very rare that people improve in this clinic.
And just in case you didn’t know: Peter‘s former user name was TDX, and he was banned from this forum because he gave someone advice on how to commit suicide.
Do you have evidence for this?
It‘s a shame that he‘s still allowed to participate in discussions on this side.
You don't like my (or TDX's) opinion, so you want to cancel me or him or whatever. It's also quite evident from your post that you have a lot of resentment for TDX.
It even went so far that you chased TDX down some obscure Podcast site and smeared him in the comments:
Depersonalisation - Wer bin ich? | TALK - der Podcast | NRWision
I can't really see what he might have done to you to justify such a reaction, which seems a bit overblown, especially with all those insults disguised as psychiatric diagnoses.