May 6, 2002

10:56 PM

The mind-body divide in medicine, whether having medicine embrace the understanding of the psychological aspects of symptoms of pain, for example, is simply a matter of working toward medicalizing psychology. How much is the brain and psychology taken into account in the medical profession?
posted by semmi (8 comments total)

well... psychiatrists are technically M.D.s and do have the power to prescribe medicine.
posted by moz at 11:06 PM on May 6, 2002

Closely related: Placebos Improve Mood, Change Brain Chemistry in Majority of Trials of Antidepressants

If you’re depressed, taking a sugar pill will be just as effective as taking Paxil — as long as you think you’re taking Paxil.
posted by raaka at 2:47 AM on May 7, 2002

May be as effective. Sugar works for some people, and not others; Paxil works for some and not others; neither works for some; and others would have either work on them.
posted by five fresh fish at 9:03 AM on May 7, 2002

Actually, more effective than the scripts, raaka:

The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against Zoloft. St. John's wort fully cured 24 percent of the depressed people who received it, and Zoloft cured 25 percent -- but the placebo fully cured 32 percent.

posted by NortonDC at 9:40 AM on May 7, 2002

Its interesting when something that is perceived as "noise" such as the placebo effect can become more prominent than the "signal", in this case the prescribed medicine. Does this make alternative healing methods (homeopathy, faith healing, voodoo) viable as long as the patients believe in them? For physchological illnesses the answer may be yes. Although, if I fracture my leg I'm still going to a medical doctor.

A counterpoint to the placebo effect was also written up recently in the Post. The Nocebo effect describes psychological immunity.

but the placebo fully cured 32 percent.

I wonder - what were these patients told they were getting?
posted by vacapinta at 10:58 AM on May 7, 2002

Physicians are routinely taught that placebos will be effective in a third of the cases where they are given (drug trials, for example). Interestingly, however, most physicians are taught that prescribing a placebo is unethical.

Fascinating stuff, with some possible mechanisms hypothesized. For example, patients are given placebo for pain control, and a third get good relief. That group is then given narcan, a drug that reverses the effects of opioids like morphine. The pain returns. Hypothesis: placebos somehow work (at least in this case) using some of the same receptors that bind the endorphins. But how did the placebo potentiate endorphin release, if that is what is occuring? The same phenomenon has been supposedly observed in some trials of acupuncture.

Medicine is becoming more and more interested in mind, with an increasing emphasis in many medical curriculums. Frankly, from my perspective, the body ain't nothing but plumbing, and the mind is where the only mystery lies (witness Metafilter...wink...)

One paradigm currently in vogue in medical education is the biopsychosocial model. In this view, medicine intervenes as necessary at the level of the molecule, the cell, the organ, the individual, and (in the case of public health) populations. A related tenet of this model is that the "mind" has a direct effect on health at most if not all these levels. For example, several studies show that markers of immune response change with mood, resulting in demonstrable level changes in neurotransmitters and even individual cell lines. Individual psychotherapy has been shown to result in fewer days of hospitalization for patients on medical and surgical services; and brief psychotherapy decreases the number of visits to primary health care providers, reduces the number of lab and radiographic studies, decreases the number of prescriptions given, and reduces direct health care costs (Longobardi 1981, Sharfstein et al 1984).

Scott Peck points out that we can probably culture active meningococcus from every last nasopharynx in town. Why, then, do some come down with meningitis, and others do not? He thinks it has everything to do with mind (and "spirit").

At some level, of course, it's all plumbing. We just don't have the tools to fix some of the more mysterious, uh, drips, yet.
posted by fold_and_mutilate at 1:31 PM on May 7, 2002

Boy, we all wish you posted like this more often.
posted by darukaru at 10:43 PM on May 7, 2002

I always thought (imagined) that to a large extent illnesses are metaphorical expressions of the individual's conflicts with his/her living conditions.
posted by semmi at 11:07 PM on May 7, 2002