The "Psychiatrix.com" View Of Mental Disorders
Dennis B. Kottler, MD
Westlake Village, CA
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Warning: This section is long and tedious. The more there is written on a subject, the less it is understood. Proceed at your own risk.
This is the question psychiatrists seem to face the most often: "Doctor, is my depression, anxiety, etc., due to a 'chemical imbalance' or is it all 'mental?'"
"Mental" commonly implies the opposite of physical, and involves such activities as thinking, feeling, and behaving. People often associate "mental" problems with psychotherapy, or "talk" therapy, and "physical" problems with "medication" treatment. The distinction between "mental" and "physical" may not have scientific validity.
Machines that Experience Themselves
Human beings are a marvel of physical infrastructure combined with self-awareness. We are "machines" that experience ourselves, "machines" that are self-aware. Although we live in the "experiential" domain, the "I," every experience, every thought, feeling, or behavior, cannot survive without the physical infrastructure. We are not "disembodied spirits." How this works, no one has yet been able to explain.
(A cyberworld sidebar: Some have compared the brain to computer "hardware" and "software." The computer is useless without software. Add software, in a loose sense comparable to human experiential input, and the computer springs to "life." In both the brain and the computer, the software "code" is implemented by microscopic changes occurring in the hardware. In the computer this involves changes in current or electrical charge; in the case of the human brain this might involve changes in chemical structures. In both cases, the software "becomes" the hardware, by effecting some form of change in the latter. Yet for all this analogizing, the computer is not aware of itself.)
And the Answer Is?
Returning to the patient's question: "Is it physical or mental?" The answer is, it is both. Whether we are having a "normal" thought or feeling or a clinically depressed thought or feeling, we are operating simultaneously as a physical, chemical entity and an experiential (thinking, feeling and behaving) being. Anything that produces an experiential effect has also produced some chemical change in the person as well, although this change may be beyond current abilities to measure it. All of the various states of being, "normal," depressed, elated, anxious, psychotic, angry, frustrated, jealous, resentful, are both physical and experiential.
Psychiatric disorders can be treated both physically (medication) as well as experientially (psychotherapeutically) or frequently, by some combination of the two. However, the currently preferred treatment of some disorders, for example major depressive disorder, emphasizes medication, whereas the treatment of other problems, for example a personality disturbance, favors the use of psychotherapy. As the science advances this could change. (Note: We are already using medications to help some individuals deal with explosive anger, impulsivity, and shyness, all of which were traditionally thought of as personality issues requiring long-term psychotherapy).
The important treatment issue is not whether a given psychiatric disorder is physical or mental, for as we have seen it is both, but rather which form of treatment or combination of treatments is most effective. This latter issue gets decided by the judgment and experience of the physician, as well as by the personal preferences of the patient. There are no rigid formulas which apply in all situations, since each individual is unique.
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