which of these have you read then, clever clogs?

Sorry, but just to drag this back to Freud/psychoanalysis for a moment...I've just been having a quick perusal of the Cochrane database, and found a Cochrane review of treatments for borderline personality disorder where psychoanalyis oriented treatment comes out quite favourably

I don't pretend to understand the techincal statistical info, but it seems to suggest that it has a place, the plain language summary says this

(my bold)

although the conculsion states this

from
Psychological therapies for people with borderline personality disorder Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Interesting. I'm going to come back to this later when I can give it a full answer. I think we had our wires crossed earlier because we were talking past each other about two different things. In effect, I think there is a sense in which we are both right! Will return later to explain - it's not quite a 'three Jesuses' we're both right situation, either.

Psychoanalytic orientated day hospital therapy doesn't need to have a basis in solid science in order to be effective for some people. There are all sorts of reasons it might be effective. For example, people taking the time to be interested in you probably helps with a lot. Placebo also has real effects. (Reiki is probably very relaxing, and probably feels very nice). I'm not going to be dismissive about "psychoanalytic orientated day hospital therapy" without knowing exactly what it entails, especially not if it "seems to decrease admission and use of prescribed medication and to increase social improvement and social adjustment". Just pointing out that these findings - especially where the researchers say there are too few data to be very confident - don't actually necessarily mean anything supportive about Freud's work.

No, I agree, they don't neccesarily say anything supportive - but they are also a reason not to dismiss out of hand, like some people do.

No they're not. No more than acupuncture or anything else that can display a definite placebo effect.Or reiki, as danny says.

Also, just having someone to sit there and listen to you talk is valuable in itself. A therapist with no training in any field could produce positive results just by being kind and listening. Unless you have some control against that, the results are not a reason not to dismiss Freud's ideas specifically.

One of the things your link demonstrates to me is the often limited value of the medical model when it comes to treating mental illness, and the value of engaging with the patient's own take on their illness at face value and working with it, no matter how mad it may be. Conventional medicine often will not do that - therapists who will, whether or not they are Freudian, producing better results than conventional psychiatry doesn't surprise me.

all stuff that came from Freud...

Ok, fair enough. If that is true - and I have no reason to doubt it - then that is a good thing that has come from Freud. I will grant you that.

you can't reduce psychoanalysis to a placebo because mental health shouldn't be understood under a disease paradigm.

It was referred to "the talking cure" ffs.

This also highlights the difficulty of designing studies to compare therapies. If "just having someone to sit there and listen to you talk is valuable in itself", then how do you design a study which differentiates between someone sitting and talking to you using CBT and someone sitting and talking to you using a psychodynamic therapy.

Well I didn't actually. There were two parts to that - one, the placebo effect, which is a real effect! and often a good one, and two, the value of being listened to and having your point of view taken seriously, which goes beyond the placebo effect, imo.

I agree with you that understanding mental health under a disease paradigm is massively problematic. The problem is that to an extent the disease paradigm is also valid - nobody can deny that a person suffering delusions has a brain that is not working properly, and that malfunctioning of the brain has a physical basis, one that can be affected through all kinds of interventions. I've said this before on here - imo, the current state of mental health 'medicine' is shockingly primitive compared to other areas of medicine. Honest psychiatrists admit this - dishonest ones pretend they know more than they really do, and hide their lack of knowledge behind jargon and drugs.

well, yes...but that doesn't necessarily mean that the "malfunctioning" is caused by the physical. The social effects the physical structure of the brain...and vice versa.

That is difficult, yes. Red Cat and ymu (sorry, probably shouldn't mention them together, but ymu's properly good on this subject - it's her profession after all) have talked about this on here. I must admit that I err towards ymu's position, which says that if you can't demonstrate to others that you're doing good in some kind of empirical way (and it can be a pretty fuzzy way) - and that your way of doing good is better than other ways of doing good - then you have no business saying that you are doing good.

ymu's a fucking idiot

Well, yes and no. If you don't accept any kind of duality - which I don't, there's simply no evidence for it - then you have to say something slightly different - which is that there are different levels of explanation for the same thing. And depending on what you want to achieve, different levels may or may not be appropriate. And often a 'higher' social level is far more appropriate and valuable than, for instance, a biochemical level.

OK, I probably shouldn't have brought her up. In her field, she isn't an idiot.

she's fucking delusional

There's plenty of evidence for it. Google brain plasticity.

Evidence for duality? No there isn't. There is a whole school of philosophy that specifically denies its possibility. Many go too far, imo - Patricia Churchland, for instance - by claiming that there is no problem with subjective experience that needs explaining. But that doesn't mean I accept duality in any of the forms in which it is formulated.

Eh? You're the only one going on about duality!

I don't think you've quite understood me. I basically agree with you, but I was nit-picking a little about the way to look at it.

You're right, I haven't understood you - I still don't. Could you rephrase?

'social affects the physical and the physical affects the social'. Well, not really. That is dualism - supposing that there are two realms and there is a mechanism by which one can affect the other.

Instead, you have different levels of explanation for the same phenomenon. And different levels are needed depending on what you're trying to find out.

A person is angry. Why are they angry?

Explaining the various physical processes going on in their brain doesn't tell you why they are angry - it is merely a different way of describing what 'being angry' is.

They've just been stood up on a date. That's why they are angry. In this instance, probably the most useful level of explanation - the social. You could also chart the various changes at neuronal level that led the brain from its non-angry state to its angry state. That's unlikely to shed any light on the reason for the anger, though, as you'd need a tremendous amount of information at that level to even obtain an inkling. You could also chart the various changes at the molecular level, which would be even more futile.

Each level of explanation is describing the same event - but the reasons you are after are only visible at certain levels. Same thing applies in evolution, for instance, where it's no good looking at the level of gene mutation to find out what selection pressures have been acting on a species over time. You need to look at the things that those genes produce - at the level of the whole organism, which is the level that is being acted on by the selection pressure.

A criticism I would level at conventional medicine is that it often addresses the wrong level - in the case of mental health, the level of description addressed by drugs, for instance, is a level below the social, which may be useful and may not be, but often isn't the only level that needs to be looked at. But the point is that each level of description is describing the same thing.

Eh?

I'm not positing dualism at all. I'm stating that its absurd to consider the physical processes in the brain in isolation from the social context the person is in. A favourite explanation for depression is "a chemical imbalance in the brain" -which as an explanation is useless. Yes, a chemical imbalance, so what? Our brains do not develop in isolation from the world around us, the connections, pathways etc are influenced by our relationships with others and our environment. Why is someone prone to depression? A chemical imbalance, well maybe, but what happened to the brain pathways to make that more likely to happen? What is happening now in someone's life to cause an imbalance? That imbalance is also gonna then effect behaviour and relationships with others which will alter the imbalance of chemicals etc etc, in a big dynamic feedback system.

Yes, that was what I was saying too. We're talking past each other again. I think we should leave it amicably here.

ok fairynuff

I think I expressed concern about the difficulties in reducing evidence about psychotherapy to an RCT given the complexity of our minds and our relationships. I don't think I said anything goes.

ymu argued convincingly about designing tests in this area but she may have done even better if she'd actually paused for a moment to consider that I may have experience to share, to ponder, instead of steamrollering all over it.

I shouldn't really have bothered posting that, but it's been bugging me.

Sorry. Misjudgement to bring that up really. I can argue my own case without it.

Don't sit on the fence, mate. Say what you mean, FFS!

I finished it last week and its a monumental piece of work. He does end Adam Smith in Beijing on a fairly upbeat note, thinks that the rise of China and continued eclipse of America heralds something like a non-hegemonic system.This has been China's past and will, through burgeoning markets but without the state being in hoc to capitalist interests i.e. a capitalist state, be its future. He thinks that the CCP's mass links throughout the peasantry will ensure that it listens and responds to environmental and other social movements.

Anyway, that's just a poor summary of the more analytic-prophetic bits that relate to China towards the end. 'Adam Smith...' re-tells the substantiated Braudellian story hedescribes in Long 20th Century, bashes Brenner and - hence, imho - asks much more of political agency than in 'Long 20th...'

Fucking ace all round anyway