04 octubre, 2011

I just want permission to be ill': towards a sociology of medically unexplained symptoms

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Soc Sci Med. 2006 Mar;62(5):1167-78. Epub 2005 Aug 30.

'I just want permission to be ill': towards a sociology of medically unexplained symptoms.

Nettleton S.

Source

University of York, York, UK. sjn2@york.ac.uk

Abstract

A significant proportion of symptoms are medically unexplained. People experience illness but no pathological basis for the symptoms can be discerned by the medical profession. Living without a clinical diagnosis or medical explanation has consequences for such patients. This paper reports on a small qualitative interview-based study of 18 neurology outpatients in England who live with such medically unexplained symptoms (MUS). The findings broadly concur with those identified in the related literatures on medically unexplained syndromes and unexplained pain: the difficulties of living with uncertainty; dealing with legitimacy; and a resistance to psychological explanations of their suffering. From a thematic analysis of the interview data we identify and elaborate on three related issues, which we refer to as: 'morality'; 'chaos'; and 'ambivalence'. Although this article presents empirical data its aim is primarily conceptual; it integrates the findings of the empirical analysis with the existing literature in order to try to make some sociological sense of the emergent themes by drawing on sociological and cultural analyses of risk and the body. We draw on Bauman's concept of ambivalence to suggest that the very processes associated with more precise 'problem solving' and 'classification' do, in fact, generate even more uncertainty and anxiety. On the one hand, we seek closure and certainty and yet this leaves no means of living with uncertainty. Indeed, society does not readily grant permission to be ill in the absence of disease. We conclude by suggesting that an appreciation of the experience of such embodied doubt articulated by people who live with MUS may have a more general applicability to the analysis of social life under conditions of late modernity.

PMID:: 16135395; [PubMed - indexed for MEDLINE]

17 septiembre, 2011

The Good Drug Guide : new mood-brighteners and antidepressants

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Source: http://www.biopsychiatry.com/

The Good Drug Guide : new mood-brighteners and antidepressants:

'via Blog this'

Could we live happily ever after? Perhaps. One's interest in the genetically pre-programmed states of sublimity sketched in The Hedonistic Imperative is tempered by the knowledge that one is unlikely to be around to enjoy them. It's all very well being told our descendants will experience every moment of their lives as a magical epiphany. For emotional primitives and our loved ones at present, most of life's moments bring nothing of the sort. In centuries to come, our emotional well-being may indeed surpass anything that human legacy wetware can even contemplate. Right now, however, any future Post-Darwinian Era of paradise-engineering can seem an awfully long way off. Mainstream society today has a desperately underdeveloped conception of mental health.
        There's clearly a strong causal link between the raw biological capacity to experience happiness and the extent to which one's life is felt to be worthwhile. High-minded philosophy treatises should complicate but not confuse the primacy of the pleasure-pain axis. So one very practical method of life-enrichment consists in chemically engineering happier brains for all in the here-and-now. Yet how can this best be done?
         Any strategy which doesn't subvert our inbuilt hedonic treadmill of inhibitory feedback mechanisms in the CNS will fail. Political and socio-economic reforms offer at best a lame stopgap. To the scientific naturalist, all routes to happiness must ultimately be biological - "culture" and "talk-therapy" alike must be neurochemically encoded to exert any effect on the psyche. Some of these routes to happiness involve the traditional environmental detours. They are too technical, diverse and futile to tackle here. If the quality of our lives is to be significantly enhanced in the long term, then the genetically predisposed set-point of our emotional thermostats needs to be recalibrated. The malaise-ridden norm typically adaptive in humanity's ancestral environment must be scrapped. So while we wait until germ-line gene-therapy to promote mental super-health can become standard, it's worth considering instead how ordinary early 21st Century Homo sapiens can sustainably maximise emotional well-being with only present-day pharmacology to rely on. No less importantly, how is it possible to combine staying continuously "better than well" with retaining one's sense of social and ethical responsibility to other people and life-forms?
        Extracting reliable information on this topic is extraordinarily difficult for laity and professionals alike. The layman is more likely to be given heavily slanted propaganda. Unvarnished fact might confuse his supposedly uneducated and functionally diminutive brain. Career-scientists, on the other hand, are bedevilled by a different problem. Access to funds, laboratories, raw materials, journal publication, professional preferment, and licenses to conduct experimental trials is all dependent on researchers delivering results their paymasters want to hear. The disincentives to intellectual integritycould scarcely be greater; and they are cloaked in such reputable disguise.
        By way of illustration, it's worth contemplating one far-fetched scenario. How might an everlasting-happiness drug - a drug which (implausibly!) left someone who tried it once living happily-ever-after - find itself described in the literature?

"Substance x induces severe, irreversible structural damage to neurotransmitter subsystem y. Its sequelae include mood-congruent cognitive delusions, treatment-resistant euphoria, and toxic affective psychosis."

Eeek! Needless to say, no responsible adult would mess around with a potent neurotoxin under this description.
Several excellent researchers play the game by the rules. They keep their heterodox opinions to themselves. Others find such cognitive dissonancetoo unpleasant. So they gradually internalise the puritanical role and tendency to warped scientific prose expected of them. [Whereas tortured non-humanexperimental animals, for instance, blandly get "used" and "sacrificed", certain socially taboo drugs always get "abused" by "drug-abusers"] On the other hand, some of the most original and productive minds in the field of psychopharmacology - pre-eminently Alexander Shulgin - have already been silenced. Many more careers have been intellectually strangled at birth or consigned to professional oblivion. The danger of poisoning the wells of information, for whatever motives, is straightforward. When young people discover they have been lied to or deceived, over cannabis for instance, they will pardonably assume that they have been lied to or deceived over the dangers of other illegals too. And this, to put it mildly, would be exceedingly rash.
Most recently, the Internet daily delivers up an uncontrollable flood-tide of fresh ideas to counter official misinformation. Some of the online literature, for instance Erowid, is first-rate. At its best, Wikipedia puts print publications to shame. Unfortunately, a lot of web-published material isn't much more objective in content or style than the professional journals it complements. Medical ghostwriting, unacknowledged conflicts of interest and publication bias are endemic to "peer-reviewed" academic journals; but methodological rigour is scarce in the scientific counter-culture too. Devising one's own system of filtering and quality-control to drown out the noise is a challenging task for anybody.....read more in the original post.

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04 octubre, 2011