Regarding antipsychotics: As I've written about on my blog, we should trust people's self-reports unless there's reason NOT to. Looking at self-reports, antipsychotics have different effects on different people. Zooming in on those who get an effect in the first place, and their doc thinks the treatment is successful, some say it really just blunts their faculties and dumbs them down, whereas others report a more targeted effect on symptoms, and only get serious dumbing down on higher dosages.
Both the "it's no different from alcohol or opioids" crowd and the overoptimistic biologically oriented psychiatrists who think it fixes a flaw in the brain must ignore a lot of what people self-report, because it doesn't fit their narrative.
I'm not saying people can't be mistaken about their own experiences. As I've said before, if it turns out that I couldn't actually tell the difference between Haldol and Xanax in a blind test, that would support the claim that I was mistaken about their actual effects on me. But you shouldn't dismiss people's self-reports just because they don't fit your preferred narrative.
If medications “produce” or “decrease” something, they should consider they merely shrink the degrees of freedom of the phase-spaces of biopsychological systems (e.g., living bodies). I do not mean this merely descriptively but quantitatively.
Putnam (2016) is not the first psychiatrist to argue that medications shrink these phase-spaces. They decrease dynamics. He wants us to believe medications artificially restrict (minimize, decrease, subtract) the degrees of freedom (variance) that various biological processes can create – by artificially interrupting the economy of neurotransmitters – and through hysteresis (time-lag), it manifests phenomenologically as temporary simplicity. Just enough time for someone to change their behavior.
This quantitative minimization on the system allows a person to “focus” on a goal in the first place (e.g., collapsing hundreds of conscious contents into singular Gestalts in the meaning-making process). Because we have temporarily reduced biological complexity, by decreasing the degrees of freedom of the dynamical system, NOT because the drugs have literally directly decreased symptom scores on a diagnostic scale.
The "problem" with this view, he admits, is that this same process of a self pursuing increasingly complex states across the lifespan (e.g. melancholic habits, manic habits, psychotic habits etc), that is, of becoming “addicted to dynamics", is also the very process of learning, memory formation, narrative identity creation, and self-actualization. Living things only evolve because their survival depends on their metabolic capacity to define and push their own boundary conditions to their extremes and beyond (e.g. the size of the phase-spaces).
This is the tension between autopoietic enactivism and mechanistic psychiatry.
Putnam, F. W. (2016). The way we are: how states of mind influence our identities, personality, and potential for change. New York: International Psychoanalytic Books.
Superb analysis, many thanks Awais!
Really interesting, thanks!
Regarding antipsychotics: As I've written about on my blog, we should trust people's self-reports unless there's reason NOT to. Looking at self-reports, antipsychotics have different effects on different people. Zooming in on those who get an effect in the first place, and their doc thinks the treatment is successful, some say it really just blunts their faculties and dumbs them down, whereas others report a more targeted effect on symptoms, and only get serious dumbing down on higher dosages.
Both the "it's no different from alcohol or opioids" crowd and the overoptimistic biologically oriented psychiatrists who think it fixes a flaw in the brain must ignore a lot of what people self-report, because it doesn't fit their narrative.
I'm not saying people can't be mistaken about their own experiences. As I've said before, if it turns out that I couldn't actually tell the difference between Haldol and Xanax in a blind test, that would support the claim that I was mistaken about their actual effects on me. But you shouldn't dismiss people's self-reports just because they don't fit your preferred narrative.
Thanks! Thought provoking as ever
Thank you what a great summary. And yay for deprescribing!
Very impressive synthesis of a complex multigenerational project of missteps, science, and success.
Thank you Emily!
If medications “produce” or “decrease” something, they should consider they merely shrink the degrees of freedom of the phase-spaces of biopsychological systems (e.g., living bodies). I do not mean this merely descriptively but quantitatively.
Putnam (2016) is not the first psychiatrist to argue that medications shrink these phase-spaces. They decrease dynamics. He wants us to believe medications artificially restrict (minimize, decrease, subtract) the degrees of freedom (variance) that various biological processes can create – by artificially interrupting the economy of neurotransmitters – and through hysteresis (time-lag), it manifests phenomenologically as temporary simplicity. Just enough time for someone to change their behavior.
This quantitative minimization on the system allows a person to “focus” on a goal in the first place (e.g., collapsing hundreds of conscious contents into singular Gestalts in the meaning-making process). Because we have temporarily reduced biological complexity, by decreasing the degrees of freedom of the dynamical system, NOT because the drugs have literally directly decreased symptom scores on a diagnostic scale.
The "problem" with this view, he admits, is that this same process of a self pursuing increasingly complex states across the lifespan (e.g. melancholic habits, manic habits, psychotic habits etc), that is, of becoming “addicted to dynamics", is also the very process of learning, memory formation, narrative identity creation, and self-actualization. Living things only evolve because their survival depends on their metabolic capacity to define and push their own boundary conditions to their extremes and beyond (e.g. the size of the phase-spaces).
This is the tension between autopoietic enactivism and mechanistic psychiatry.
Putnam, F. W. (2016). The way we are: how states of mind influence our identities, personality, and potential for change. New York: International Psychoanalytic Books.