Blogcritics Author: Dr Michael Benjamin

Announcement: Short-content feeds

Phillip Winn — Sun, 26 Aug 2007 12:00:00 EDT

Sunday, August 26, 2007, marks the switch of all Blogcritics.org article feeds from full-content to short-content. This is the result of several converging factors, and is unfortunately a permanent decision (as permanent as any decision can be on the web, that is). We are aware of all of the reasons that this is a Bad Idea, and we are aware that some of you will be quite upset about having to click on something to read the free content, and we're sorry. Unfortunately, despite great effort, full-content feeds are not currently economically viable. Two other factors are involved: full-content feeds have resulted in an unprecedented level of content theft, with BC content appearing on many websites, usually spam sites, without attribution or permission. This duplicate content causes a cascading set of problems, not the least of which is that search engines generally aren't favorable to duplicate content, and don't always guess correctly. Finally, our RSS advertising partner is strongly in favor of short-content feeds. We hope that you'll continue to subscribe to BC via RSS, and when an article grabs your eye, it's only a click away, still free on the BC website. Thank you for your understanding.

The Tree Of Knowledge

Dr Michael Benjamin — Sat, 18 Aug 2007 16:49:32 EDT

WHAT IS PSYCHOSIS?A conventional definition is 'A disorder in Reality Testing and Judgment'. Psychotics are unable to place time and space on a continuum. Places, objects, boundary and time become fractured, jumbled and confused. But what is reality and what is judgment? Both are subjective. They are based on experience. Reality is a linking and amalgamation of a present experience to a previous or accepted event. Judgment monitors the bonding as acceptable or not. Reality testing and judgment are ways of coherently storing and monitoring experience. We are now postulating that the mind is forever increasing its experiences. It does so by adding onto previous experience. To do this the mind must possess a very powerful and accurate filing system. It must be able to recognize the ‘new input’ by categorizing it. Then by use of the category it is able to run a quick match. Finally it incorporates the two. The mind has a new experience .HOW IS KNOWLEDGE STORED?In a previous article I described how thinking and thoughts are interrelated. Briefly we postulated thoughts are mere predictions. The one to get closest to correct prediction is kept. In other words thoughts are in competition. Only the fittest survive. Initially thoughts are like buds on a tree. They store a prediction and an emotion. If the thought is maintained it can be the starting point of a new bud. It is as if it has become a twig. A twig becomes a branch. Each has its own emotion. Each has its ever present buds competing to survive. This way thinking can be done more quickly. But we are faced with a new problem. How does the sorting process work so quickly? There must be a mapping or registry. I believe that this is a fair assumption. As far as technology is concerned man tends to unconsciously imitate himself. Today information is stored by use of registries that inform where the information is. There is a similar mapping process in the brain. Our brains contain distinct areas which map sensation and muscular activity. They are called homunculi. I propose that the 'Knowledge Tree' that we are all perpetually building is ordered so to maintain spatial, temporal and experiential integrity of experience. We are capable of 'turning off' this process. We do so when we daydream or use our imagination. This is an important process that allows us to voluntarily 'place buds' in locations on the tree that otherwise would not be placed there. But this process is voluntary and can be turned on and off at will.EXPLAINING PSYCHOSIS:Using the paradigm 'Tree of Knowledge' we can describe and explain psychosis. The psychotic cannot correctly maneuver through different branches and twigs. He gets to the wrong place. He associates the wrong things. He experiences the wrong emotions. He hears or sees what is on the tree not that what he really is hearing or seeing. Often I have heard patients tell me it as if they were dead. They cannot 'get in touch' with their inner world or experiences. They are there but as if cut off. The psychosis of misplacement generally passes. In this we see things that were not there before like delusions and hallucinations. In other words the psychotic builds a bud which is not related to what is happening. He will think of things that are not real. He will relate to an 'internal world' not associated with the event. The wrong bud on the wrong twig. Often we see the same psychotic symptoms re-occurring. It as if there is a learned wrong response. We call these the positive symptoms. Unfortunately the loss of contact with the inner world is more lasting and often permanent. It as if the the contact between the inner and outer experience is under responsive. We call these negative symptoms. The phenomenon of 'loss of responsiveness' is not unknown. There are at least two illnesses with a similar mechanism. The root cause of diabetes and one of the causes of thyroid disease is a basic lack of responsiveness. In both cases there is a compensatory process. The compensatory processes are inefficient and cause symptoms. The symptoms are in fact an overloading or overcompensation. One thyroid disease is caused by an under responsiveness to thyroid hormone. Initially we see an overcompensation. The thyroid 'does too much'. It looks as if it is hyperactive. Are the positive symptoms a similar unsuccessful compensatory process? Is the basic defect the negative symptoms? Is the core symptom of psychosis a lack of responsiveness between the previous and the present experience? We do know that we can teach a psychotic to recognise and ignore his positive symptoms. But we have not been quite as successful treating with negative signs.

Doctor Michael Benjamin is a Psychiatrist with 38 years experience. An active proponent of Online Self-Help Cognitive Behavior Therapy (CBT). He has a free Online CBT program at http://www.myRay.com.

Lessons From Harry: How We Get It Wrong, But Very Cleverly

Dr Michael Benjamin — Mon, 13 Aug 2007 05:50:02 EDT

A new born infant is born with potential. It has the potential to think. The child thinks and has thoughts. They are two parallel processes. Software and hardware are in synergy. They are mutually developing as one. Piaget described it by saying that the child is developing and testing theories. There is another similar explanation. It is more dynamic. It seems to be an admixture of two ideas. The ideas are those of Darwin and the Theories of Complexity. Basically the new description goes like this. Thoughts are merely a series of circuits. But not the electrical circuits we used to picturing. We are now asked to imagine it like a tree. Think of a possible idea as a bud. At any one time this bud is in competition with other buds next to it. Which bud will win? The bud that is the 'fittest'. But this now begs a new question. What defines fitness? A fit bud does best at what thinking supposed to do. Thinking is merely the making of predictions. Our ability to think is our ability to predict what will happen. It is associated with a label which tells us if this is pleasant or unpleasant. We are asking what will happen and is it good? In other words we have explained thoughts and associated emotion. The fittest thought or bud is the one that is closest to getting it right. We can carry our tree analogy further. Buds eventually becomes twigs. Each twig has its own buds competing. Twigs become branches. Each branch has its own twigs. Let us use an example of a game I played with my grandchild, Harry. The game was extremely simple. He sat in his pram and I hid first I hid my face and exposed it either above or below him. Harry looked and eventually predicted where I may be. He liked that a lot and was happy. But then I changed the rules. I added right and left. Harry added looking right and left to his repertoire. He did this more rapidly and he enjoyed himself even more. What are we seeing here? Harry developed a series of buds. One was right. This in itself developed into twig and with its own buds. Twigs and branches direct to the appropriate bud. In other words Harry was better solving the more complex problem because he had learned how to solve the easier one. We now see how that the current thought affects the future thinking process. We call this experience. We also see the emergence of a dyad of thoughts and feelings. We can also see that there is an element of choice. We can also see how important early development and parenting is. Harry had learned how to do something good and not how to avoid something bad. We know that things can go wrong. Very often buds, twigs and even branches go the inappropriate places. We can react ‘as if’ this was a specific situation. Often this is not the case. When this occurs there is a feeling of frustration as the expected results are not realized. But the person finds it hard to correct his basic error. Psychotherapy helps undo this fault. Conventional therapy tries to understand how this 'came about'. They virtually retrace the antecedents of the twig or branch. If the 'bud' is indeed on the wrong branch then it probably justified to go these lengths. In all probability best results achieved in more deeply seated pathologies are after the use of conventional therapy. Latter day therapies in particular Cognitive Behavioral Therapy will simply undo the placement of the 'bud' on a particular twig. There is no attempt to learn why it is there. Not surprisingly we can offer therapy as a learning process using learning techniques. These therapies are more than adequate for 'simple mistakes'. The patient is enabled to 'place the bud' in a more appropriate place.

Doctor Michael Benjamin is a Psychiatrist with 38 years experience. An active proponent of Online Self-Help Cognitive Behavior Therapy (CBT). He has a free Online CBT program at http://www.myRay.com.

Minus Ten: Prevention And Early Intervention

Dr Michael Benjamin — Sat, 11 Aug 2007 13:54:48 EDT

Medicine is always looking for the magic bullet. Unfortunately it does not exist. But there are even more dramatic forms of cure. They are prevention and early intervention.No surgical technique has been more successful than having surgeons wash their hands. The most dramatic medicine of the last century was the virtual eradication of smallpox and poliomyelitis. The cessation of smoking, healthy eating and exercise have all helped to prolong life. Quality of life has also improved. Social intervention and rapid intervention have helped enormously in our fight against AIDS. We have delayed and prevented onset of diabetes and hypertension. When they occur they are dealt with rapidly and effectively. We are screening for cancer of the breast, bowel and pancreas with great success. Modern medicine knows what causes an illness. Modern medicine can take steps to prevent it. It seems that if we act ten years 'in front' we can eliminate or minimize the diseases that the most expensive of medications do not cure effectively.Can psychiatry perform similarly? It would seem that mental health has not even changed its approach. We know that over twenty percent of the population will suffer from anxiety, panic and depression. These illness can last a month or more. It will return, on average three times or more times.We know that approximately two percent will have serious debilitating psychotic disorders; the majority of which are schizophrenics. The majority of the schizophrenics will never return to what they were. They will need support and care for large part of their remaining lives. This is even more distressing as the illness tends to start relatively early in life. Mental illnesses start earlier than other illnesses. Yet we treat them as we treated depression and diabetes twenty years ago. We are waiting for the disease to develop, waiting for the damage to occur and then apply rehabilitation and damage control. Are there steps that we can take that prevent, delay onset and intervene at an early stage?It is universally accepted by professionals that the use of addictive drugs including the 'safe drugs' can and does precipitate psychosis. There is alarm at that use of Ritalin. All in the profession agree that Ritalin is prescribed far too easily. People are not given Ritalin in accordance with 'accepted practice'. It would seem that people who have received Ritalin are more liable to later be treated with medication used in psychosis than people who did not receive Ritalin. Strangely the same group, who received Ritalin, receives fewer medications for Depression than those who did not receive Ritalin. We know that children brought up in social stress and with a poor family support system are more prone to mental illness. We know that schizophrenia has genetic loading. We know that certain behavior traits in childhood are prone to develop psychoses. We have a good idea who is prone to develop Schizophrenia. We know what the prodromal signs occur before the first psychotic breakdown. Psychotic breakdowns do not occur overnight. They are festering for weeks before the break. More distressingly we can prevent a psychotic breakdown if we intervene at the right time. Yet we do nothing.We know that not everyone will develop depression or anxiety. The family doctor is never surprised when one of his patients does develop theses illnesses. We know who is going to develop the illnesses. He or she is typically of two types. They are either the rigid worrier or the very dependent personality. They have in common a defect. Their coping style is inadequate. We can readily and easily correct this defect. Cognitive Behavioral Therapy, CBT, can improve coping. Over forty percent of people feel that they want to improve the way that they cope. By doing so they would prevent depression and anxiety and improve significantly their quality of life.It would seem that mental health should re-align itself with the rest of medicine. We can reasonably hope that prevention and early intervention in mental health issues will become as important as they are in the other fields of medicine.

Doctor Michael Benjamin is a Psychiatrist with 38 years experience. An active proponent of Online Self-Help Cognitive Behavior Therapy (CBT). He has a free Online CBT program at http://www.myRay.com.

Partnership or Mutually Assured Destruction?

Dr Michael Benjamin — Sun, 22 Jul 2007 14:42:57 EDT

Can medical services and drug companies survive each other? Let take a look at two very strange bedfellows.The drug companies represent rampant capitalism at its best and worst. Medical services are the epitome of the socialism at its best and worst. The two opposing concepts exist in tandem and are mutually dependent. Both are being criticized. The criticisms are almost stereotyped. The companies are accused of being manipulative and profit driven and the services profligate and mismanaged. Services are badly run. The core phrases are “cost management” and “risk management”. The core sentiments are how to avoid being caught out: Caught out mishandling money or caught out legally. The guiding principle of helping and healing the patient does not appear. It’s obscurity enshrined in goals, benchmarks and constant measurements. Medical management has refused to manage. It has failed to say what it can and cannot do. It has failed to prioritize its role and function. It has failed to look at the best and cheapest ways of achieving what it is supposed to do. As a result the public expect both everything and nothing. Doctors have become the recipients of the latest managerial fad and demand. It's as if the doctor is there to satisfy the needs of the managerial class and not his patient. Third party payment however puts a lot of money in the hands of the managers and who better to relieve them of this burden than the drug companies? The companies have convinced themselves that medication is the “only game in town”. The Services went along, as that was the line of least resistance. A lot of pressure is exerted through self-serving” research” and its funding by the drug companies. This pressure points in one direction. Medication is best. Funding must be found.This is very wrong.Medicine is based on prevention, rehabilitation and cure. Drug companies are only selling the “Magic Bullet”, namely cures. Today’s medicine is being dragged along for the ride. Drug companies search for new ways of selling drugs. They create a sense of need. This is the capitalistic ethic. But it is swallowing up money needed for prevention and rehabilitation. Even more dangerous are the manipulations of the generic drug market. The generic market means that one patent beating drug company can sell a package of drugs and manipulate the market. This may eventually threaten research.The machinations of the drug companies and medical services have had catastrophic affects. The basic unit, the doctor-patient relationship has been discarded. The doctor is overburdened and dissatisfied, the patient alienated and confused. The result is a new alliance between them, which threatens politically the basic concepts of third party payment. Third party payment, which was conceived in politics, can be aborted politically. Medical management must wean itself off the “market model”. It must provide a service structure that allows accountability in its core functions. Drug companies will have to realize that they must provide a service that is felt to be genuine even though it may “compete “ with their medications. This service must include cheaper, yet less attractive , to the drug companies, prevention & rehabilitation. The ideal and maybe only answer is for the drug companies to enter the fields that are needed. This would mean offering managerial services, training, managing, prevention, and rehabilitation programs. They should do this not as a fob or gimmick but to enter the field to make money. That is their real “raison d’etre” and there is no shame in being true to this. This is a profitable exercise because in many instances the three fields, prevention, rehabilitation and cure are not mutually exclusive. In all probability the medical services could harness the managerial skills found in the drug companies. The services should be sold as economic packages. An ideal solution would involve that both the services and the companies realizing that they have to either “hang together” or be “hung together”. Only by utilizing the positive aspects in both will they overcome the threat that has arisen from the synchronization of their weaknesses.

Doctor Michael Benjamin is a Psychiatrist with 38 years experience. An active proponent of Online Self-Help Cognitive Behavior Therapy (CBT). He has a free Online CBT program at http://www.myRay.com.

A Psychiatrist Airs His Professional Doubts

Dr Michael Benjamin — Sun, 22 Jul 2007 14:18:24 EDT

Did you ever stop to wonder or ask yourself 'what am I doing?' I did and in many ways I wish I had not. As a Psychiatrist, I still do not know what our profession is trying to do. It seems we have a series of solutions and now we are trying to find the problems that they can solve. My observations are either anecdotal or part of research that I have done as a Psychiatric Auditor and are based on my 38 years experience in the field of Psychiatry.Psychiatrists are treating two major populations: Adults and Juveniles. These populations are further subdivided into severe and mild disturbances.I am not a Juvenile Psychiatrist, but I speak from impressions and my readings in the field. There is nothing more heart breaking than the severely mentally ill juvenile. We have increased our arsenal of medications, but in results and understanding, compared to other medical professions, our success rate is poor. Prevention is a distant dream. The mildly mentally ill juveniles are a cause of concern to me. Psychiatry has waltzed into learning disorders with the crusading gusto that only psychiatrists seem to have. We are witnessing the 'medicinization' of a former outlawed drug. The criteria for using Ritalin far too often go unmet. There is no doubt in my mind that children that would not be given Ritalin by experts in the field are receiving it. No one can say with honesty and certainty what the effect of Ritalin use in juveniles will have on their brains as they age. Yet the Ritalin pushers have an almost messianic fervor for their 'solution'. In the adult population, generally speaking, the influence of the Drug Companies is terrifying. Very few research projects disprove the efficacy of a drug when the trial is sponsored by the drug's manufacturer. Harmful facts that may be discovered are not disclosed. When they are, their importance and significance are downplayed. For example, one of the major, popular, new anti psychotic drugs actively and substantially increases the risk factors for heart attacks or CVAs. In all the adult population the major medical goal is to reduce these risk factors. Only severely mentally ill psychiatric patients are the exception. It has been shown that after 10 years of illness a psychotic not taking medications is four times more likely to be symptom free than one that is taking medications. Read that again. You would expect the complete opposite. In spite of the hype, the quality of life in patients using the older medications are better than the new. So we are paying more, endangering more and getting less. Not very impressive is it? The mantra of today's Psychiatric Services are something like this: A patient gets ill. He goes to the emergency room where he is admitted or referred to community service organizations. On admission he is diagnosed, medicated and sent home to continue care in the community. He continues his therapy in the community. He is only re-referred if the community cannot cope. What happens in reality? There are no hard and fast rules or consistency as to who is received and why. A large proportion of first time hospitalized patients will never re-appear in the Mental-Health system. Why were they hospitalized in the first place? Referrals to community care from the ER are done badly, if at all. The vast majority of hospitalized patients remain unknown to community care after discharge.A large proportion of the patients are no longer taking medications in a meaningful way three months after discharge from hospital. Most of the patients seen in community care were not hospitalized. Grim reading indeed. Over 30% of the adult population will visit their Family Doctor in any year. 30% of them, 10% of the population, are considered to have emotional problems. For some reason these emotional disturbances are treated as if they are mild forms of mental illness. They are not. Very often we are seeing stress caused by poor coping styles or skills. They are treated as if they have, or about to have depression, anxiety, or panic. The vast majority are offered medication. They should be offered alternative drug-free modalities such as Cognitive Behavioral Therapy or Psychotherapy. Of those referred to psychotherapy much less than half will get past three visits. The major explanation of 'file closure' in these cases is drop-out. 'Completion of therapy' ranks as one of the least given reasons. Are there any bright points? Yes there are: CBT: Cognitive Behavioral Therapy is causing a rethink of treatment. It asks a patient to think about their feelings and behavior and thus influence subsequent behavior. This is a good answer for the patients with emotional problems in primary care. It enhances coping skills. This is a different approach from the attempt to cure an illness that does not exist. We can now offer Online CBT in a Self-Help format over the Internet. Compliance and adherence: This is not a problem inherent only to Psychiatry. Doctors are not trained to explain and ensure compliance. They do not have the time to do simple weekly follow ups. This is easily done using the Internet web sites.Medical Management: Uniform systematic treatment is essential. It is possible to ascertain accurately patient needs and utilization. It is possible to follow the two parameters in real time. Thus ensuring efficient performance of the Mental-Health system as a unit. Alongside this, the individual patient is never unknowingly lost. This can be done in real time and online.Yes there is a lot of criticism here. Is it justified? It certainly is honest and based on my clinical experience. I have hopefully done my part by initiating a discussion and providing solutions, as I see them to the problems as I saw them.

Doctor Michael Benjamin is a Psychiatrist with 38 years experience. An active proponent of Online Self-Help Cognitive Behavior Therapy (CBT). He has a free Online CBT program at http://www.myRay.com.