medicalcondition:syndrome

The Challenge of Going Off Psychiatric Drugs | The New Yorker
▻https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs

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Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence. Genetics plays a role in mental disorder, as do environmental influences, but the drugs do not have the specificity to target the causes of an illness. Wayne Goodman, a former chair of the F.D.A.’s Psychopharmacologic Drugs Advisory Committee, has called the idea that pills fix chemical imbalances a “useful metaphor” that he would never use with his patients. Ronald Pies, a former editor of Psychiatric Times, has said, “My impression is that most psychiatrists who use this expression”—that the pills fix chemical imbalances—“feel uncomfortable and a little embarrassed when they do so. It’s kind of a bumper-sticker phrase that saves time.”

Dorian Deshauer, a psychiatrist and historian at the University of Toronto, has written that the chemical-imbalance theory, popularized in the eighties and nineties, “created the perception that the long term, even life-long use of psychiatric drugs made sense as a logical step.” But psychiatric drugs are brought to market in clinical trials that typically last less than twelve weeks. Few studies follow patients who take the medications for more than a year. Allen Frances, an emeritus professor of psychiatry at Duke, who chaired the task force for the fourth edition of the DSM, in 1994, told me that the field has neglected questions about how to take patients off drugs—a practice known as “de-prescribing.” He said that “de-prescribing requires a great deal more skill, time, commitment, and knowledge of the patient than prescribing does.” He emphasizes what he called a “cruel paradox: there’s a large population on the severe end of the spectrum who really need the medicine” and either don’t have access to treatment or avoid it because it is stigmatized in their community. At the same time, many others are “being overprescribed and then stay on the medications for years.” There are almost no studies on how or when to go off psychiatric medications, a situation that has created what he calls a “national public-health experiment.”

Roland Kuhn, a Swiss psychiatrist credited with discovering one of the first antidepressants, imipramine, in 1956, later warned that many doctors would be incapable of using antidepressants properly, “because they largely or entirely neglect the patient’s own experiences.” The drugs could only work, he wrote, if a doctor is “fully aware of the fact that he is not dealing with a self-contained, rigid object, but with an individual who is involved in constant movement and change.”

A decade after the invention of antidepressants, randomized clinical studies emerged as the most trusted form of medical knowledge, supplanting the authority of individual case studies. By necessity, clinical studies cannot capture fluctuations in mood that may be meaningful to the patient but do not fit into the study’s categories. This methodology has led to a far more reliable body of evidence, but it also subtly changed our conception of mental health, which has become synonymous with the absence of symptoms, rather than with a return to a patient’s baseline of functioning, her mood or personality before and between episodes of illness.

Antidepressants are now taken by roughly one in eight adults and adolescents in the U.S., and a quarter of them have been doing so for more than ten years. Industry money often determines the questions posed by pharmacological studies, and research about stopping drugs has never been a priority.

Barbiturates, a class of sedatives that helped hundreds of thousands of people to feel calmer, were among the first popular psychiatric drugs. Although leading medical journals asserted that barbiturate addiction was rare, within a few years it was evident that people withdrawing from barbiturates could become more anxious than they were before they began taking the drugs. (They could also hallucinate, have convulsions, and even die.)

Valium and other benzodiazepines were introduced in the early sixties, as a safer option. By the seventies, one in ten Americans was taking Valium. The chief of clinical pharmacology at Massachusetts General Hospital declared, in 1976, “I have never seen a case of benzodiazepine dependence” and described it as “an astonishingly unusual event.” Later, though, the F.D.A. acknowledged that people can become dependent on benzodiazepines, experiencing intense agitation when they stop taking them.

In the fifth edition of the DSM, published in 2013, the editors added an entry for “antidepressant discontinuation syndrome”—a condition also mentioned on drug labels—but the description is vague and speculative, noting that “longitudinal studies are lacking” and that little is known about the course of the syndrome. “Symptoms appear to abate over time,” the manual explains, while noting that “some individuals may prefer to resume medication indefinitely.”

Audrey Bahrick, a psychologist at the University of Iowa Counseling Service, who has published papers on the way that S.S.R.I.s affect sexuality, told me that, a decade ago, after someone close to her lost sexual function on S.S.R.I.s, “I became pretty obsessive about researching the issue, but the actual qualitative experience of patients was never documented. There was this assumption that the symptoms would resolve once you stop the medication. I just kept thinking, Where is the data? Where is the data?” In her role as a counsellor, Bahrick sees hundreds of college students each year, many of whom have been taking S.S.R.I.s since adolescence. She told me, “I seem to have the expectation that young people would be quite distressed about the sexual side effects, but my observation clinically is that these young people don’t yet know what sexuality really means, or why it is such a driving force.”

#Psychiatrie #Big_Pharma #Addiction #Anti_depresseurs #Valium

Neurocapitalism | openDemocracy
▻https://www.opendemocracy.net/ewa-hess-hennric-jokeit/neurocapitalism

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There is good reason to assert the existence, or at least the emergence, of a new type of capitalism: neurocapitalism. After all, the capitalist economy, as the foundation of modern liberal societies, has shown itself to be not only exceptionally adaptable and crisis-resistant, but also, in every phase of its dominance, capable of producing the scientific and technological wherewithal to analyse and mitigate the self-generated “malfunctioning” to which its constituent subjects are prone. In doing so – and this too is one of capitalism’s algorithms – it involves them in the inexorably effective cycle of supply and demand.

Just as globalisation is a consequence of optimising the means of production and paths of communication (as Karl Marx and Friedrich Engels predicted), so the brain, as the command centre of the modern human being, finally appears to be within reach of the humanities, a field closely associated with capitalism. It may seem uncanny just how closely the narrow path to scientific supremacy over the brain runs to the broad highway along which capitalism has been speeding for over 150 years. The relationship remains dynamic, yet what links capitalism with neuroscience is not so much strict regulation as a complex syndrome of systemic flaws.

At this point, if not before, the unequal duo of capitalism and neuroscience was joined by a third partner. From now on, the blossoming pharmaceutical industry was to function as a kind of transmission belt connecting the two wheels and making them turn faster. In the first half of the twentieth century, mental disorders were treated mainly with sedative barbiturates, electric shock therapy and psychosurgery. But by the 1930s, neuro-psychopharmacology was already winning the day, as Freud had predicted it would.

Is it a paradox, or one of those things that are so obvious they remain unobserved, that the success of Freud’s psychoanalysis and that of modern neuroscience are based on similar premises? Psychoanalysis was successful because it wove together medically relevant disciplines like psychiatry and psychology with art, culture, education, economics and politics, allowing it to penetrate important areas of social life. At the beginning of the twenty-first century, the neurosciences seem to be in a position to take on a comparable role in the future.

The ten top-selling psychotropic substances in the USA include anti-depressants, neuroleptics (antipsychotics), stimulants and drugs for treating dementia. In 2007 one hundred million prescriptions were issued for these drugs with sales worth more than sixteen billion dollars. These figures illustrate how, in an environment that is regulated but difficult to control, supply and subjectively perceived need can create a market turning over billions of dollars. What is more, it is a market that is likely to expand into those areas in which a performance-driven society confronts the post-postmodern self with its own shortcomings: in others words in schools and further education, at work, in relationships, and in old age. Among the best-selling neuro-psychotropic drugs are those that modulate the way people experience emotions and those that improve their capacity to pay attention and to concentrate, in most cases regardless of whether there is a clinically definable impairment of these functions.

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Neurocapitalism
Ewa Hess and Hennric Jokeit 3 March 2010
Despite the immense costs for healthcare systems, the fear of depression, dementia and attention deficit disorder legitimises the boom in neuro-psychotropic drugs. In a performance-driven society that confronts the self with its own shortcomings, neuroscience serves an expanding market

Today, the phenomenology of the mind is stepping indignantly aside for a host of hyphenated disciplines such as neuro-anthropology, neuro-pedagogy, neuro-theology, neuro-aesthetics and neuro-economics. Their self-assurance reveals the neurosciences’ usurpatory tendency to become not only the humanities of science, but the leading science of the twenty-first century. The legitimacy, impetus and promise of this claim derive from the maxim that all human behaviour is determined by the laws governing neuronal activity and the way it is organised in the brain.

Whether or not one accepts the universal validity of this maxim, it is fair to assume that a science that aggressively seeks to establish hermeneutic supremacy will change everyday capitalist reality via its discoveries and products. Or, to put it more cautiously, that its triumph is legitimated, if not enabled, by a significant shift in the capitalist world order.

There is good reason to assert the existence, or at least the emergence, of a new type of capitalism: neurocapitalism. After all, the capitalist economy, as the foundation of modern liberal societies, has shown itself to be not only exceptionally adaptable and crisis-resistant, but also, in every phase of its dominance, capable of producing the scientific and technological wherewithal to analyse and mitigate the self-generated “malfunctioning” to which its constituent subjects are prone. In doing so – and this too is one of capitalism’s algorithms – it involves them in the inexorably effective cycle of supply and demand.

Just as globalisation is a consequence of optimising the means of production and paths of communication (as Karl Marx and Friedrich Engels predicted), so the brain, as the command centre of the modern human being, finally appears to be within reach of the humanities, a field closely associated with capitalism. It may seem uncanny just how closely the narrow path to scientific supremacy over the brain runs to the broad highway along which capitalism has been speeding for over 150 years. The relationship remains dynamic, yet what links capitalism with neuroscience is not so much strict regulation as a complex syndrome of systemic flaws.

Repressive late nineteenth-century capitalism, with its exploitative moral dictates, proscriptions and social injustices, was a breeding ground for the neurosis diagnosed by scientists in the early twentieth century as a spiritual epidemic. This mysterious scourge of the bourgeoisie, a class which according to Marx, “through the rapid improvement of all instruments of production [...] draws all, even the most barbarian nations, into civilisation”, expressed the silent rebellion of the abused creature in human beings. It was, in other words, the expression of resistance – as defiant as it was futile – of people’s inner “barbarian nation” to forceful modernisation and civilisation.

To introduce here the inventor of psychoanalysis and neurosis researcher Sigmund Freud as the first neurocapitalist practitioner and thinker might be thought to be overstepping the mark. Yet people tend to forget that Freud was a neuro-anatomist and neurologist by training, and saw himself primarily as a neuroscientist. What distinguished him from his colleagues was that he was more aware of the limitations of the methods available for studying the brain at the end of the nineteenth century. Having identified neurosis as an acquired pathology of the nervous system for which there was no known treatment or way to localise, he decided instead to take an indirect route. The means he invented in order both to research and to cure this mysterious illness was psychoanalysis. Fellow researchers like Oskar Vogt, who continued to search for the key to psychopathology and genius in the anatomy of the brain, were doomed to fail. From then on, psychology served the requirements of everyday life in a constantly changing capitalist reality. As a method based on communication, psychoanalysis penetrated all spheres of social interaction, from the intimate and private to the economic and cultural. In doing so, it created new markets: a repair market for mental illness and a coaching market for those seeking to optimise capitalist production and reproduction.

Delayed by the Second World War, the repressive capitalism of the nineteenth century was eventually replaced by libertarian, affluent capitalism. Conformity, discipline and feelings of guilt – the symptoms of failure to cope with a system of moral dictates and proscriptions – gave way to the new imperative of self-realisation. The psychic ideal of the successful individual was characterised by dynamically renewable readiness for self-expansion, which for the subject meant having a capacity for self-motivation that could be activated at any time and that was immune to frustration. Failure now meant not being able to exhaust the full potential of one’s options. This development brought a diametric change in the character of mental illness. Neurosis, a disorder born of guilt, powerlessness and lack of discipline, lost its significance. Attention shifted to the self’s failure to realise itself. Depression, the syndrome described by Alain Ehrenberg in The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age, began its triumphal march.

Depression, however, was also the first widespread mental illness for which modern neuroscience promptly found a remedy. Depression and anxiety were located in the gaps between the synapses, which is precisely where they were treated. Where previously there had only been reflexive psychotherapy, an interface had now been identified where suffering induced by the self and the world could now be alleviated directly and pre-reflexively.

At this point, if not before, the unequal duo of capitalism and neuroscience was joined by a third partner. From now on, the blossoming pharmaceutical industry was to function as a kind of transmission belt connecting the two wheels and making them turn faster. In the first half of the twentieth century, mental disorders were treated mainly with sedative barbiturates, electric shock therapy and psychosurgery. But by the 1930s, neuro-psychopharmacology was already winning the day, as Freud had predicted it would.

Is it a paradox, or one of those things that are so obvious they remain unobserved, that the success of Freud’s psychoanalysis and that of modern neuroscience are based on similar premises? Psychoanalysis was successful because it wove together medically relevant disciplines like psychiatry and psychology with art, culture, education, economics and politics, allowing it to penetrate important areas of social life. At the beginning of the twenty-first century, the neurosciences seem to be in a position to take on a comparable role in the future.

What cannot be overlooked is that the methodological anchoring of the neurosciences in pure science, combined with the ethical legitimacy ascribed to them as a branch of medicine, gives them a privileged position similar to that enjoyed by psychoanalysis in the early twentieth century. Unlike the latter, however, the neurosciences are extremely well funded by the state and even more so by private investment from the pharmaceutical industry. Their prominent status can be explained both by the number and significance of the problems they are attempting to solve, as well as the broad public recognition of these problems, and by the respectable profits to be made should they succeed. In other words, they are driven by economic and epistemic forces that emanate from the capitalism of today, and that will shape the capitalism of tomorrow – whatever that might look like.
II

In Germany, the USA and many western European countries, it is neither painkillers nor cardiovascular drugs that now put the greatest strain on health budgets, but rather neuro-psychotropic drugs. The huge market for this group of drugs will grow rapidly as life expectancy continues to rise, since age is the biggest risk factor for neurological and psychiatric illness. All over the world, whole armies of neuroscientists are engaged in research in universities, in projects often funded by the pharmaceuticals industry, and to an even greater extent in the industry’s own facilities, to find more effective and more profitable drugs to bring onto the market. The engine driving the huge advances being made in the neurosciences is capital, while the market seems both to unleash and to constrain the potential of this development.

Depression, anxiety or attention deficit disorders are now regarded by researchers and clinical practitioners alike as products of neuro-chemical dysregulation in interconnected systems of neurotransmitters. They are therefore treated with substances that intervene either directly or indirectly in the regulation of neurotransmitters. Given that the body’s neuro-chemical systems are highly sensitive and inter-reactive, the art of successful treatment resides in a process of fine-tuning. New and more expensive drugs are able to do this increasingly effectively and selectively, thus reducing undesirable side effects. Despite the immense costs for healthcare systems, the high incidence of mental disorders and the fear of anxiety, depression and dementia make the development of ever better neuro-psychotropic drugs desirable and legitimate.

However, the development and approval of drugs designed to alleviate the symptoms of mental disorders also open the gates to substances that can be used to deliberately alter non-pathological brain functions or mental states. The rigid ethical conventions in the USA and the European Union – today the most profitable markets for neuro-psychotropic drugs – mean that drug development, whether funded by the state or by the pharmaceuticals industry, is strictly geared towards the prevention and treatment of illness. Few pharmaceutical companies are therefore willing to make public their interest in studying and developing substances designed to increase the cognitive performance or psychological wellbeing of healthy people. The reason is simple: there is no legal market for these so-called “neuro-enhancers”. Taking such drugs to perform better in examinations, for example, is a punishable offence in the USA. Yet sales figures for certain neuro-psychotropic drugs are considerably higher than the incidence of the illnesses for which they are indicated would lead one to expect. This apparent paradox applies above all to neuropsychotropic drugs that have neuro-enhancement properties. The most likely explanation is that neuro-enhancers are currently undergoing millions of self-trials, including in universities – albeit probably not in their laboratories.

The ten top-selling psychotropic substances in the USA include anti-depressants, neuroleptics (antipsychotics), stimulants and drugs for treating dementia. In 2007 one hundred million prescriptions were issued for these drugs with sales worth more than sixteen billion dollars. These figures illustrate how, in an environment that is regulated but difficult to control, supply and subjectively perceived need can create a market turning over billions of dollars. What is more, it is a market that is likely to expand into those areas in which a performance-driven society confronts the post-postmodern self with its own shortcomings: in others words in schools and further education, at work, in relationships, and in old age. Among the best-selling neuro-psychotropic drugs are those that modulate the way people experience emotions and those that improve their capacity to pay attention and to concentrate, in most cases regardless of whether there is a clinically definable impairment of these functions.

Attempts to offset naturally occurring, non-pathological deviations from the norm are referred to as “compensatory” or “moderate enhancement” – in the same way that glasses are worn to correct the eyes’ decreasing ability to focus. The term describes a gradual improvement in function to a degree that is still physiologically natural. By contrast, “progressive” or “radical enhancement” denotes a qualitative improvement in function that exceeds natural boundaries. To return to the optical metaphor, we could say that the difference between these forms of performance enhancement is like that between wearing spectacles and night-vision glasses.

In all ages and cultures, producers and purveyors of drugs and potions purported to enhance the individual’s cognitive state have been able to do a tidy trade, as the many references to magic potions and fountains of youth in literature and the fine arts testify. Nowadays, one substance with this kind of mythical status is ginkgo. Billions of dollars worth of ginkgo-biloba preparations are sold in the USA every year; and if ginkgo really did have any significant effect on cognition or memory, it would be a classic case of the widespread, unchecked use of a compensatory neuro-enhancer. As it is, however, the myth and commercial success of ginkgo are more a testament to the perhaps universal human need for a better attention span, memory and mental powers, and to the willingness to pay good money to preserve and enhance them.

For the attainment of happiness as the aim of a good life, Aristotle recommended cultivating a virtuous mind and virtuous character. This is precisely what some neuro-psychotropic drugs are designed to do. The virtues of the mind are generally understood to be instrumental traits like memory and attention span. The extent to which these traits are innate or acquired varies from person to person. After adolescence, their efficiency gradually goes into decline at individually varying rates. Inequality and the threat of loss are strong motivations for action. The current consensus on the ethics of neuro-enhancement seems to be that as long as the fundamental medical principles of self-determination, non-harm (nil nocere) and benefit (salus aegroti) are adhered to, rejecting pharmacological intervention in the instrumental traits of the brain would be at odds with a liberal understanding of democracy.

A more complex ethical problem would seem to be the improvement of so-called character virtues, which we shall refer to here as socio-affective traits. Unlike instrumental traits such as attention span and memory, traits like temperament, self-confidence, trust, willingness to take risks, authenticity and so on are considered to be crucial to the personality. Pharmacological intervention that alters these traits therefore affects a person’s psychological integrity. While such interventions may facilitate and accelerate self-discovery and self-realisation (see the large body of literature on experience with Prozac, e.g. Peter D. Kramer, Listening to Prozac: Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self , they may also do the exact opposite. We will never be able to predict with any certainty how altering instrumental and socio-affective traits will ultimately affect the reflexively structured human personality as a whole. Today’s tacit assumption that neuro-psychotropic interventions are reversible is leading individuals to experiment on themselves. Yet even if certain mental states are indeed reversible, the memory of them may not be.

The barriers to neuro-enhancement actually fell some time ago, albeit in ways that for a long time went unnoticed. Jet-lag-free short breaks to Bali, working for global companies with a twenty-four hour information flow from headquarters in Tokyo, Brussels and San Francisco, exams and assessments, medical emergency services – in all of these situations it has become routine for people with no medical knowledge to use chemical substances to influence their ability to pay attention. The technologies that have sped up our lives in the era of globalisation – the Internet, mobile phones, aeroplanes – are already a daily reality for large numbers of people and are interfering with their biologically and culturally determined cycles of activity and rest.

That is not to say that the popularisation of these findings has had no effect at all. Reconceptualising joy as dopamine activity in the brain’s reward centres, melancholy as serotonin deficiency, attention as the noradrenalin-induced modulation of stimulus-processing, and, not least, love as a consequence of the secretion of centrally acting bonding hormones, changes not only our perspective on emotional and mental states, but also our subjective experience of self. That does not mean that we experience the physiological side of feelings like love or guilt any differently, but it does make us think about them differently. This, in turn, changes the way we perceive, interpret and order them, and hence the effect they have on our behaviour. By viewing emotions in general terms rather than as singular events taking place in a unique temporal and spatial context, the neurosciences have created a rational justification for trying to influence them in ways other than by individual and mutual care.

The possibility of pharmacological intervention thus expands the subjective autonomy of people to act in their own best interests or to their own detriment. This in turn is accompanied by a new form of self-reflection, which encompasses both structural images of the brain and the ability to imagine the neuro-chemical activity that goes on there. What is alarming is that many of the neuroscientific findings that have triggered a transformation in our perception of ourselves are linked with commercial interests.

It is already clear that global capitalism will make excessive demands on our material, and even more so on our human-mental resources. This is evident from the oft-used term “information society”, since information can only function as a commodity if it changes human behaviour, and it can only do this if we accord it our attention and engage with it emotionally.

#Neurocapitalisme #Neurosciences

PLOS Neglected Tropical Diseases: Diseases Neglected by the Media in Espírito Santo, Brazil in 2011–2012
▻http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004662

Abstract

Background
The aims of the present study were to identify and analyse the Diseases Neglected by the Media (DNMs) via a comparison between the most important health issues to the population of Espírito Santo, Brazil, from the epidemiological perspective (health value) and their effective coverage by the print media, and to analyse the DNMs considering the perspective of key journalists involved in the dissemination of health topics in the state media.

Methodology
Morbidity and mortality data were collected from official documents and from Health Information Systems. In parallel, the diseases reported in the two major newspapers of Espírito Santo in 2011–2012 were identified from 10,771 news articles. Concomitantly, eight interviews were conducted with reporters from the two newspapers to understand the journalists’ reasons for the coverage or neglect of certain health/disease topics.

Principal Findings
Quantitatively, the DNMs identified diseases associated with poverty, including tuberculosis, leprosy, schistosomiasis, leishmaniasis, and trachoma. Apart from these, diseases with outbreaks in the period evaluated, including whooping cough and meningitis, some cancers, respiratory diseases, ischaemic heart disease, and stroke, were also seldom addressed by the media. In contrast, dengue fever, acquired immune deficiency syndrome (AIDS), diabetes, breast cancer, prostate cancer, tracheal cancer, and bronchial and lung cancers were broadly covered in the period analysed, corroborating the tradition of media disclosure of these diseases. Qualitatively, the DNMs included rare diseases, such as amyotrophic lateral sclerosis (ALS), leishmaniasis, Down syndrome, and verminoses. The reasons for the neglect of these topics by the media included the political and economic interests of the newspapers, their editorial line, and the organizational routine of the newsrooms.

Conclusions
Media visibility acts as a strategy for legitimising priorities and contextualizing various realities. Therefore, we propose that the health problems identified should enter the public agenda and begin to be recognized as legitimate demands.

The ‘Big Man’ Syndrome in Africa
▻http://africasacountry.com/2016/03/the-big-man-syndrome-in-africa

Why do so many African leaders overstay their welcome or break electoral rules? In the aftermath of recent #elections in Uganda, where Yoweri Museveni won a fifth five-year term and opposition activists contest the results, has again brought up that eternal post-independence question. Museveni is seventy-one years old and has governed since he took power in […]

#FRONT_PAGE #Big_Man #Politics

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