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OnlineKickleM
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An interesting case study * 1
    #22192892 - 09/05/15 02:04 PM (8 years, 4 months ago)

I see often a split in thought between biology and psychology. Between physiological causes for disorders and psychological. As if, if it is psychological then it can not be biological. Or if it it's biological then it must not be psychological. And subsequently the treatments prescribed for any given pathology are similarly split.

I have a great fondness for the late neurologist Oliver Saks. And a case he writes about in his book The Man Who MistoIok His Wife For A Hat revolving around Tourette's syndrome, illustrates the folly of this split well imo. This particular case occurred in the mid sixties and was written about in the mid seventies, as a context for the state of neurology. At the time Tourettes syndrome was largely unexplored, mysterious, and under the medical radar.

But Saks treated an individual. The patient sought treatment due to not being able to hold a job, as well as marital problems stemming from crude outbursts which occurred when he became aroused. Despite these short comings the patient had also managed to use tourettes to his advantage. As a jazz musician his outbursts gave him an atypical energy and spontaneity. He was quite successful on this front. As well in ping pong his spontaneous but powerful bursts often gave an edge, being unpredictable.

Saks prescribed a precursor to dopamine, el dopa. This medication is used to treat Parkinson's typically. But it had shown promise in marginalizing or removing entirely the compulsive "tiks" of tourettes. So for a week Saks put this patient on a tiny dose of el dopa.

At the end of the week the patient returned with a black eye and bruised cheek. "So much for that fucking el dopa" he exclaimed.

Turned out that many with tourettes are drawn to revolving doors. Something about the spinning. And this patient was used to playing, in a way, with the doors. Darting in as they move and then out again. But on the el dopa he was slowed. He smashed into the door instead of dodging it.

His tiks in turn did not disappear but rather they elongated, slowed. This was not an improvement. He lost his advantages but did not rid himself of the consequences of the tiks. At this juncture the patient began to worry about the loss of his advantages. He queried Saks, "without my tiks, what will I do?"

Remember now that tourettes was not mainstream. If was just being rediscovered. And this fellow had lived from an early age into adulthood with only himself to rely on. Himself with tourettes. There was no conception for him what his life without tourettes might look like. It was uncharted territory. Daunting territory. Uncertain and after the recent experience, forboding.

Saks suggested that they meet for the next 3 months to discuss and explore the man's qualities. Both those linked to tourettes as well as those not. To examine his options and actively decide what move to make. To work on gaining a sense of identity separate from tourettes and determining whether it is in fact desirable.

After the three months, another course of el dopa. The exact same dosage. This time the tiks disappeared entirely. This time he became steadied.


--------------------
Why shouldn't the truth be stranger than fiction?
Fiction, after all, has to make sense. -- Mark Twain


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OfflineHippocampus
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Re: An interesting case study [Re: Kickle]
    #22193004 - 09/05/15 02:32 PM (8 years, 4 months ago)

I don't see it as a split in biology vs psychology as to the causes of brain problems.  Or neurology, Saks was a neurologist, and psychology.  The split comes from the two science's differing backgrounds and approaches.  The brain is extremely complex, and neurology simply does not yet have sufficient knowledge to explain everything biologically.  Psychology has been filling in that gap.  But psychology is limited because they don't know the biological explanations for what is going on.  They looked at the thoughts people were having and tried to understand them.  Or nowadays, more looking at the behavior of people and understanding that.  They can't fathom the root biological causes.  But someday maybe.  It's my dream that neurology and psychiatry become the same specialty.


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OnlineKickleM
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Re: An interesting case study [Re: Hippocampus]
    #22193861 - 09/05/15 06:04 PM (8 years, 4 months ago)

You may not see the unfounded assumptions in your assertions but there are some monsters.


--------------------
Why shouldn't the truth be stranger than fiction?
Fiction, after all, has to make sense. -- Mark Twain


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InvisibleLunarEclipse
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Re: An interesting case study [Re: Kickle]
    #22193992 - 09/05/15 06:42 PM (8 years, 4 months ago)

So you can say that after the initial shock, the patient learned how to deal with being tiked off?


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Anxiety is what you make it.


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Offlinenuentoter
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Re: An interesting case study [Re: Hippocampus]
    #22194069 - 09/05/15 07:05 PM (8 years, 4 months ago)

They are the same specialty. We just all suck at it.


--------------------

The geometry of us is no chance. We are antennae, we are tuning forks, we are receiver and transmitters of all energy. We are more than we know.  - @entheolove

"I found I could say things with color and shapes that I couldn't say any other way - things I had no words for"  - Georgia O'Keefe

I think the word is vagina


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OfflineHippocampus
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Re: An interesting case study [Re: Kickle]
    #22195535 - 09/06/15 02:04 AM (8 years, 4 months ago)

Quote:

Kickle said:
You may not see the unfounded assumptions in your assertions but there are some monsters.




ok, I'll just take your unfounded word for it :rolleyes:


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OnlineKickleM
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Re: An interesting case study [Re: Hippocampus]
    #22202260 - 09/07/15 01:51 PM (8 years, 4 months ago)

Well your post was what I founded it on. I'd like to go into specifics with you if you're willing though :smile:

Quote:

The split comes from the two science's differing backgrounds




1. https://en.wikipedia.org/wiki/Jean-Martin_Charcot

"[1] Charcot has been referred to as "the father of French neurology and one of the world's pioneers of neurology".[3] His work greatly influenced the developing fields of neurology and psychology;"

Most outside the field of neurology remember him for his studies on hypnosis.

2. https://en.wikipedia.org/wiki/Sigmund_Freud

"Freud began his career as research scientist in the field of biological neurophysiology, before moving into medicine upon his marriage to Martha Bernays, and wrote a treatise based in his work from this period which attempted to put Psychology on a Scientific footing, titled "Project for a Scientific Psychology."[3][4][5] He qualified as a doctor of medicine at the University of Vienna in 1881,[6] and then carried out research into cerebral palsy, aphasia and microscopic neuroanatomy at the Vienna General Hospital.[7] Upon completing his habilitation in 1885, he was appointed a docent in neuropathology in the same year and became an affiliated professor (professor extraordinarius) in 1902.[8][9]"

3. https://en.wikipedia.org/wiki/William_James#Early_life

" "I originally studied medicine in order to be a physiologist, but I drifted into psychology and philosophy from a sort of fatality. I never had any philosophic instruction, the first lecture on psychology I ever heard being the first I ever gave"."

4. https://en.wikipedia.org/wiki/John_Hughlings_Jackson

Freud as a contemporary of Jackson often cites his work and refers to him as a great thinker.

So where is the differing backgrounds? The "father's" of neurology and psychology are all trained around the same time in medicine. Their work also influenced one another. That's a nearly identical background as far as I can tell and why I would say your claim is unfounded.



Quote:

The brain is extremely complex, and neurology simply does not yet have sufficient knowledge to explain everything biologically.




Speculation on the future is largely unfounded. Educated guesswork at best. And absolute speculation such as, "explaining everything biological" is highly improbable and without any basis in history, aka, unfounded.



Quote:

But psychology is limited because they don't know the biological explanations for what is going on.




As a graduate from a psychology program, I was given several neurobiology courses. Even courses not specifically relating to neuroanatomy or clinical neurology brought relevant neurological findings into the course. For example a child psychology course will be negligent if it does not include the PTA-axis when discussing early childhood trauma. Anyone with a Ph. D in psychology will have taken far more courses surrounding neurology still. So I don't know where you've gotten this idea from. A psychologist is not a surgeon, no, but they do have a professional responsibility to understand neuropsych - aka how neurology effects the psyche.


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OnlineKickleM
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Re: An interesting case study [Re: Kickle]
    #22202356 - 09/07/15 02:10 PM (8 years, 4 months ago)

To bring this back to the OP,

what I find interesting about the case study is that not only does it suggest that the psychological state of one with Tourette's is related to their biology, but also that their biology is related to their psychological state. It does not appear to be a one-way-street whereby only the biology is important or only the psychological state is important. And as common-sense as I think this is, I also see it neglected in all-or-none thinking often enough around here to want to post about it.


--------------------
Why shouldn't the truth be stranger than fiction?
Fiction, after all, has to make sense. -- Mark Twain


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InvisibleKurt
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Re: An interesting case study [Re: Kickle]
    #22202631 - 09/07/15 03:16 PM (8 years, 4 months ago)

It has been argued today that empirical (trial based) approaches per se, are largely found in embodied practices, rather than upon a "clean slate".

If you do some digging in the history of philosophy, the first historically recorded endorsement of empiricism, which is to say, a scientific approach, was among practicing physicians, like Philinis of Cos, and the "empiric school". The notion of what is found "in trial", or experiment was working actively and spontaneously with living, organic, and whole subjects.

Pragmatism is arguably key today too. Here's to William James, a key founder of a novel and enduring American philosophy. Also I always suggest tneo-pragmatist W.O. Quine's epistemological holism as being relavent to contemporary fields of research. I'd be curious if you find this philosophical thesis gels with your methodology. As he put it in the abstract of his essay "Two Dogmas of Empiricism":

Quote:

Modern empiricism has been conditioned in large part by two dogmas. One is a belief in some fundamental cleavage between truths which are analytic, or grounded in meanings independently of matters of fact and truths which are synthetic, or grounded in fact. The other dogma is reductionism: the belief that each meaningful statement is equivalent to some logical construct upon terms which refer to immediate experience. Both dogmas, I shall argue, are ill founded. One effect of abandoning them is, as we shall see, a blurring of the supposed boundary between speculative metaphysics and natural science. Another effect is a shift toward pragmatism.




The ancient "empiric school" of medicine was essentially related to and in dialogue with Hippocratean "rationalist" school. Hippocrates believed mainly in a notion of native balance to the body (the notion then was "humours") whereas, of course, the empirical approach is in prescriptions of trial, ie. bringing something extraneous, a natural substance, medicine, to treat the patient.

It may seem very blunt to think about this difference in priorities, but I would say it is essential. The suggestiveness of a dialogue which is sufficiently broad and yet also specific in highlighting an essential focus on approach, or practice, may be a way of addressing the apparent crisis with a corrupt institution of medicine today.

It's all about balance, and knowing what that is.


Edited by Kurt (09/07/15 05:05 PM)


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