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SSRI’s not working

1461 Views 20 Replies 6 Participants Last post by  Chip1021
I was on Zoloft for around 12-13 years. It worked amazing at first when I was a teenager. Over the years I’d have to up my dose cause my symptoms would return. I got to a point months ago where my symptoms returned heavily and I went to the max dose but no change. I tapered off and now I’ve tried Prozac which seemed to make symptoms worse and no I’m trying lexapro and I feel like the same thing is happening, symptoms getting worse. I’d love to hear others experience with medication and what helps.
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Something that hasn't been looked much into by sufferers of depersonalization disorder in regards to fighting is the target. Most sufferers appear to regard this as an internal problem. But maybe it would be more productive to target the external factors keeping depersonalization disorder from being recognized. Maybe sufferers should stop to fight themselves, but to fight the people who are undeniably responsible for their situation: The psychiatrists. People with depersonalization disorder might benefit from getting a lot more noisy and annoying to the public and especially to psychiatrists.

As I said above, part of the problem might be that people with depersonalization disorder are not crazy enough. Maybe they must become more crazy.
You make many good points, but I’m skeptical that this proposal is likely to achieve the desired result. Protesting / attacking those in charge doesn’t tend to work well in my view unless we already have significant institutional support. And it tends to be even worse when the people protesting have already been labeled as “mentally ill.”

I’m reminded of the Lyme Disease wars here in the United States especially. In the early years, Lyme patients who felt their issues were not being addressed protested the IDSA for their failures. And what was their response? To construct the diagnosis of PLDTS: Post-Lyme Disease Treatment Syndrome, which was conceptualized as a sort of Lyme-specific combination of hysteria and Munchausen Syndrome. This set back good research into the actual issues these people were suffering from for years.

I fear it will be too easy to dismiss our complaints. And based on some of your earlier posts, my biggest fear would be that those psychiatrists interpret our “getting crazy about things” as positive symptoms of our mental illness, justifying either coercive control, or simply ignoring us as crazy.

In my view, “acting crazy” or hostile mostly tends to just harden people’s current views, making them more extreme and less likely to come to our aid.

Perhaps this is a bit defeatist of me, but I don’t think we will find assistance in organic psychiatry regardless of how much we protest or ask politely, and I think you pointed out the reasons why earlier in this thread: psychiatry’s focus on positive over negative “symptoms.” Part of it is due to the reasons you presented, but I think a lot of has to do with what “positive” and “negative” actually mean in this context. According to psychiatric thinking, “positive symptoms” are behaviors or experiences that a person has that are undesirable, whereas “negative symptoms” represent a person’s complaint about a failure to experience or behave in a desirable way. It’s relatively easy to develop a drug that helps with the former, but much more difficult for the latter. If I have a kid who is just learning to play the saxophone and is just awful, I could develop a drug that effectively stops him from playing the saxophone. But I could not develop a drug that (reliably) makes him play the saxophone well.
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People with negative symptoms have lost mental functions, especially in terms of affectivity, so they include people with emotional numbness and depersonalization. But these symptoms are for the most part subjective and people are already calm and look normal. That's their misfortune, because now they are outside of psychiatry's loot scheme. The idea of "insanity" in psychiatry is of people delivering a show of profound objective behavioral abnormalities, but not of an disruption of their subjective inner world. That's the bitter irony: Many people with depersonalization disorder are afraid of getting crazy, but the fact that they are not "crazy" in the traditional sense is the reason why their disorder is not taken seriously.

It isn't "science" that is at fault here much in the same way a wrench isn't at fault, when you try to repair a toaster, but it breaks apart once you turn it on. Certain cultural values inside psychiatry prevent depersonalization disorder from getting the recognition it deserves. It's human error.
I both agree and disagree with you here. I think your first paragraph hits the nail on the head, but in your second paragraph, you claim that it is not “science” that is the problem, but rather, human error.

I think that “science” is a huge part of the problem, and you told us why in the first paragraph. Psychiatry focuses so much on “positive symptoms” precisely because they can more easily define those problems according to objective, scientific criteria than they can with “negative symptoms,” which are more subjective experiences (or a lack thereof). However, even those so-called “objective” symptoms are not exactly viewed by psychiatry objectively. You yourself used the expression “behavioral abnormalities,” to describe these observations. Psychiatry also frequently uses terms like “dysfunctional behavior.” But these expressions prejudge what they ostensibly describe. Because all behavior has a function (that is, there is always a goal in mind), the term “dysfunctional behavior” is a scientific euphemism for “disapproved” or “undesirable.”

But all our behavior is ultimately the product of our inner (subjective) experiences too. This a problem I have with how psychiatrists, in their desire to be more scientific in their approach to their subject matter, have failed to offer a valid understanding of it. Consider the phenomenon called “akathesia.” Akathesia becomes objectively observable to the scientist when a person starts engaging in constantly moving his limbs. But these are not reflex movements or “dysfunctional behaviors.” These are actions that a person is performing in a (usually futile) attempt to relieve his subjective experience of inner restlessness. A similar analysis can be made with the facial movements characteristic of tardive dyskinesia. If we conceptualize the actions a person is doing as a disease (or as symptoms of a disease), then whatever effectively stops those movements will be seen, from the scientist’s perspective, as a treatment. And often, that treatment works by further hindering the body’s optimal functioning. I do think that leminaseri is making a valid point, though he often struggles to express himself well.

I take issue with the authoritarian way that we look at science in modern society, and nowhere is it more pernicious than in psychiatry, whose patients are often involuntarily treated or are otherwise people who are in extreme distress by appealing to the scientist’s supposed expertise about his patient’s innermost experiences of himself.

It has always been fairly clear to me that the key to understanding the phenomena we label as “mental illnesses” is predominantly semantic and teleological. Biology and other materialist aspects of a person’s environment certainly play a role, and for some people more so than others (after all, our “minds” are contingent on our structures). And I’m also not opposed to people using psych drugs if they find they help with their own self-defined problems. But I’m concerned that we readily accept the authority of science on such matters, and are expected to accept the proposition that positive science is always the best pathway to truth, thereby failing to even consider any other possible way to interpret and deal with these problems.
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Actually I do not a priori exclude other approaches. But before considering them I would like to hear why they should be superior to science. So far I haven't seen any convincing arguments why they should be prefered for mental illness in general, depersonalization disorder in particular or much of anything else, especially since science apparently outperformed them all. The step from the middle ages to our modern life was achieved by science. Of course this sets the bar for alternative approaches very high.
I apologize that this response isn’t going to be as well structured as yours was. I haven’t figured out how to do the whole multi-quote thing. And I might also just be too lazy.

I’m not sure what you mean by “high level functions,” or that I was referring to those when talking about negative symptoms. My example with the saxophone player was a bit tongue-and-cheek that was trying to accentuate the point I was trying to make.

You say that hallucinations and delusions are difficult to define. Well, they might be if we insist on interpreting them psychiatrically. But is there any other way to understand them?

What is a delusion? Well, Richard Dawkins wrote one book about a delusion. Of course, a lot of religious people might have a word about Dawkins’ idea of what truly is a delusion; many of them probably think Dawkins is the deluded one. Which is an important thing to remember when we use the term “delusion;” what counts as a delusion depends on whatever the speaker considers to be true, not necessarily what is actually true.

a delusion is not just any old false belief, but a stubbornly held false belief that the person is not interested in correcting, usually because it is valuable or meaningful to the person. Schizophrenic delusions differ from the delusions that everyone has in that they are idiosyncratic and often have a more subjectively bizarre or disturbing quality to them. I don’t see any reason why we should be positing a materialist explanation for a false belief. Why might a person develop such a crazy idea? Well, why are there conspiracy theories? Why are there flat earth believers in the modern world? Why does this forum contain thousands of “theories” as to the cause of DPDR? We are all seeking answers, trying to find meaning, and often construct alternative realities to resolve an internal conflict or to boost a damaged ego.

And what about hallucinations? By far the most common type of hallucination is the auditory hallucination: “hearing voices.” But do you think that language accurately describes what is actually happening? Do some people “hear voices?”

When we first developed some of our modern neuroimaging technology, psych researchers used that technology to see what was happening in the brains of people who “heard voices.” But they were shocked to discover that the part of the brain that was highly active was not Wernicke’s Area (associated with hearing) but Broca’s Area (associated with speaking). “Broca’s Area was a surprise” they said. Except, it should not have been a surprise, and it would not have been a surprise if they had not been deceived by their own misleading language. Because if Wernicke’s Area had significant activity, that would have been a monumental discovery; it would have strongly suggested that the psychotic was actually hearing something! But if course, he is not hearing anything, he is talking to himself (which was essentially Socrates’ definition of “thinking”). What do you think is the best explanation for Norman Bates’ behavior in the movie “Psycho?” Did he suffer from a brain abnormality that we have not yet discovered despite billions and billions of dollars of highly-motivated research (but nevertheless, definitely exists!) that was causing him to hear voices—voices that contained semantic content that was meaningful to Mr. Bates—telling him that the women he was seeing were skanky sluts? Or do you think that he was experiencing a conflict between his own romantic and sexual feelings for these women and some of the ideas that he had learned about what women are like, and disowned one of those voices of us self-conversation, “hearing” one of them in the voice of his dead mother, a figure to whom he had attributed a great deal of authority? (Yes, I know it’s fiction, lol, but I just wanted to give a well-known example).

Hallucinations are a form of self-conversation by a person who is particularly focused on his own internal experiences. Some psychotically depressed persons “hear” the voices of their dead loved ones to keep them company, a form of remembering. Other people disown their own thinking when they find it’s contents to be particularly disturbing. People generally don’t need encouragement to evade responsibility. Of course, psychiatrists make it easy when they insist on interpreting some experiences as “hearing voices” too. These interpretations receive further confirmation from the more common observations that these “voices” are reduced in intensity or go away entirely when the person is engaged in oral activity, such as eating or speaking.

Why do some people experience their own thinking with such extreme intensity? Brain damage could be a partial explanation for some, but that doesn’t necessarily have to be the case. The intensity (“loudness”) of our internal monologue depends greatly on the direction of our attention. When I’m having fun with friends, my thinking is quieter, when I’m trying to solve a challenging math problem, my thinking becomes quite a bit louder, and sometimes it gets to the point where I feel I might be going insane, so I take a break and focus on more worldly things, and return to the problem with a “refreshed” mind. That often worked for me when I was in school ;)

You ask me why some alternative approach should be superior for mental illness in general? Let me ask you: is there a difference between a wink and a blink? And if so, what is that difference? Ancient/medieval man might have acknowledged that the difference is that different agents are responsible: I am responsible for winking, and spirits/demons/God, etc, is responsible for the blink. Modern scientific man would conclude that the difference is in the precise muscles and regions of the brain responsible for each event. I believe that the difference is more fundamental: the blink requires a materialist-mechanistic explanation, and the wink requires a semantic-teleological one. A wink is a performance that is meaningful; it contains semantic content. And so, in my view, is the difference between physical and mental illnesses. Our science has done remarkable things when it comes to the understanding, diagnosis, and treatment of organic (physical) illnesses. How well have our positive mental sciences been working for us though? How many mental diseases have we cured? Can we reliably treat any of them with our medicines? Can we actually use this knowledge to explain how and why these meds work or don’t work? Genetic/neuroscientific research might have yielded some statistically significant results here and there, but nothing pathognomonic, and they struggle to actually link those correlations (let alone make any causal determinations) to these mental problems. But the model of mind that I am proposing can explain addiction, eating disorders, depression/anxiety/PTSD, ADHD…it can even explain psychosis, as I tried to do earlier in this post.

Why should we adopt a non-scientific approach to mental illness? Because it explains more and it works better, in my view. These issues are not unitary phenomena, they don’t occur in people the same way like many physical illnesses do. I keep hearing about there being many types of depression, and that more types keep being identified. I agree. There are as many types of depression as there are depressed persons in the world. Grouping them all together and trying to discover the source of their problem in the body is rather absurd in my view.

So where does that leave us with DPDR? Is this experience more like a wink or a blink? That’s the question I’ve been asking and trying to answer for the last two decades, and I still don’t know, though I suspect it’s probably a lot of both.
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