I read a friend's blog post today about how scientifically minded people often take a long time to recover from illness, whether that be physical or mental. She gave several reasons for this, but a big one was that scientifically minded people are unwilling to try anything that's unproven. The evidence has to be clear cut.
I'm one of these people who reads studies in medical journals every time that I consider taking almost any medication, supplement, or herb. (Well, I do tend to just trust my doctor on short-course antibiotics for strep or UTIs. And pain meds, because I'm in a lot of pain and desperate when I have asked for them.)
But I think this is problematic. Medical research is rarely definitive. Medications can be around for decades before we fully understand their side-effects, contraindications, and the situations in which they are effective. There are plenty of substances whose long-term efficacy we don't understand because either the research isn't there or the research is only being selectively presented.
Furthermore, relying on medical data, I miss out on any sort of experiential knowledge that may exist. I keep wondering why my therapist suggests SSRIs for me. The data says that SSRIs take a long time to improve OCD symptoms (2-3 months versus 2-3 weeks for depression) and as far as I can tell are completely ineffective for treating hair pulling and skin picking. And I should point out that there is new data coming to light that's showing that SSRIs are barely more effective than a placebo and equally effective to an active placebo for treating depression. So, given that they seem to take longer to help with OCD, it wouldn't surprise me if they didn't work at all for it. But that's supposition.
Given this, I have a couple of theories as to why my therapist recommends them. First, he may have been brainwashed. Second, his experiential knowledge may contradict the data. His patients seem to improve on them or claim to improve on them. But, as any good scientist knows, anecdotal evidence can be flawed.
On the other hand, particularly for mental illness, I think the experience matters a great deal and perhaps more than efficacy. To get through a difficult experience you have to be able to form some sort of useful narrative around it that might include the reasons it happened, what you learned from it, how you will carry it with you. If SSRIs can positively contribute to such narratives, there is where their efficacy might lie. And this cannot be measured in any study.
But I know that the experience of SSRIs isn't black and white. Lots of people on OCD forums talk about trying to get off of them--and it's a struggle. The friend I talked to last week said that they interfered with his artwork. Other people say that they find that drugs make them fell emotionally dull or have debilitating side-effects.
I recognize the value of experiential knowledge, but I'm a scientist at heart and I don't think I can throw away my scientific understanding of psychopharmacology just because my therapist and mom say I should. I tend to trust scientific knowledge much more than anecdotal evidence when the two don't match up. The thing is it's not always possible to cohesively integrate experiential and authoritative (scientific) knowledge. So where does that leave us? We have to pick one approach and neither approach is truly holistic. Either that, or make a random decision and hope for the best.
I'm one of these people who reads studies in medical journals every time that I consider taking almost any medication, supplement, or herb. (Well, I do tend to just trust my doctor on short-course antibiotics for strep or UTIs. And pain meds, because I'm in a lot of pain and desperate when I have asked for them.)
But I think this is problematic. Medical research is rarely definitive. Medications can be around for decades before we fully understand their side-effects, contraindications, and the situations in which they are effective. There are plenty of substances whose long-term efficacy we don't understand because either the research isn't there or the research is only being selectively presented.
Furthermore, relying on medical data, I miss out on any sort of experiential knowledge that may exist. I keep wondering why my therapist suggests SSRIs for me. The data says that SSRIs take a long time to improve OCD symptoms (2-3 months versus 2-3 weeks for depression) and as far as I can tell are completely ineffective for treating hair pulling and skin picking. And I should point out that there is new data coming to light that's showing that SSRIs are barely more effective than a placebo and equally effective to an active placebo for treating depression. So, given that they seem to take longer to help with OCD, it wouldn't surprise me if they didn't work at all for it. But that's supposition.
Given this, I have a couple of theories as to why my therapist recommends them. First, he may have been brainwashed. Second, his experiential knowledge may contradict the data. His patients seem to improve on them or claim to improve on them. But, as any good scientist knows, anecdotal evidence can be flawed.
On the other hand, particularly for mental illness, I think the experience matters a great deal and perhaps more than efficacy. To get through a difficult experience you have to be able to form some sort of useful narrative around it that might include the reasons it happened, what you learned from it, how you will carry it with you. If SSRIs can positively contribute to such narratives, there is where their efficacy might lie. And this cannot be measured in any study.
But I know that the experience of SSRIs isn't black and white. Lots of people on OCD forums talk about trying to get off of them--and it's a struggle. The friend I talked to last week said that they interfered with his artwork. Other people say that they find that drugs make them fell emotionally dull or have debilitating side-effects.
I recognize the value of experiential knowledge, but I'm a scientist at heart and I don't think I can throw away my scientific understanding of psychopharmacology just because my therapist and mom say I should. I tend to trust scientific knowledge much more than anecdotal evidence when the two don't match up. The thing is it's not always possible to cohesively integrate experiential and authoritative (scientific) knowledge. So where does that leave us? We have to pick one approach and neither approach is truly holistic. Either that, or make a random decision and hope for the best.
No comments:
Post a Comment