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|Clinicians Digest Nov/Dec 2008 - Page 2|
The study, in the June Clinical Psychology Review, finds no significant differences in effectiveness among treatments for PTSD, whether group or individual, EMDR, exposure, trauma desensitization, stress inoculation, cognitive-behavioral, psychodynamic, imaging, or hypnotherapy. While that may be bad news for the staunchest proponents of any individual treatment, the study offers good news for people suffering from PTSD: any approach has a reasonable chance of being effective.
The metanalysis isn't going to end the search for the best method, and has already drawn criticism from some therapists and researchers convinced of the superiority of their own approach. Its authors, Steven Benish, Zac Imel, and Bruce Wampold, admit that the 15 studies comprising their review are a relatively small number, because they excluded studies that included placebo treatments or were poorly defined. Yet they're convinced that the study's outcome is valid.
So why does the dodo bird win again? Benish suspects that attempts to identify unique aspects of any particular therapy create an artificial taxonomy that obscures some common factors that all effective treatments share. It calls to mind Harvard psychologist Richard McNally's famous assessment of EMDR that what's effective about EMDR isn't new and what's new about it isn't effective.
Ultimately, Benish speculates, all PTSD treatments help create a relatively safe environment in which clients can reexperience and emotionally digest their trauma. That process is probably one of the common factors of successful therapies for many disorders.
Do Antidepressants Blunt Love?
We've heard for years about the various side effects of SSRI antidepressants, especially that they often dampen sexual drive. But Rutgers University anthropologist Helen Fisher, who's been researching the biological basis of love around the world for decades, has attracted increasing attention with her argument from her book Evolutionary Cognitive Neuroscience that SSRIs not only blunt sexual interest, but also the ability to love. If she's right, millions of people may be suffering from a side effect that clinical trials haven't even considered.
As our understanding of neurochemistry has grown, it's become apparent that when one neurotransmitter is affected, it sets off a chain reaction affecting other neurotransmitters and hormones. Thus, SSRIs not only elevate serotonin levels, but also create a decrease in dopamine levels, which leads to decreases in the levels of the testosterone and estrogen that fuel the sex drive. Dopamine is also connected with hormones that create feelings of calm, security, trust, and social attachment. So the sexual dysfunction often associated with SSRIs, Fisher argues, is about much more than an increased difficulty in maintaining an erection or reaching orgasm: it's about a decreased ability to feel love and attachment.
Fisher's crosscultural studies have led her to postulate that lust is inextricably interrelated with romantic love and long-term attachment, and just as you can't affect serotonin without affecting other brain chemicals, you can't dampen lust at the beginning of a relationship, or the romantic love that often develops out of lust, without also damping the desire for long-term attachment. Across cultures, she finds the same lust, romantic love, and long-term attachment cycle. A Bushman woman Fisher writes about describes a progression we all know: "When two people are first together their hearts are on fire. After a while, the fire cools, and that's how it stays. They continue to love each other, but in a different way—warm and dependable."
Fisher points out that some of the feelings and conditions that SSRIs "cure" are the same qualities associated in every culture with romantic love: intense energy, mood swings between despair and ecstasy, obsessional thinking, craving for emotional union, and intense motivation to win the preferred mating partner. In her talks, she sometimes quotes W. H. Auden's definition of love as "an intolerable neural itch." SSRI antidepressants, she believes, might scratch that itch so strongly that we scrape off the layer of our brains that's driven us to lust, love, and bond with each other.
People like Rosalynn Carter, Betty Ford, and Tipper Gore, and organizations like the National Institute of Mental Health have tried for years to destigmatize mental illness, with limited success. Now a growing international movement of people with serious mental or neurological disorders, gathering under the banner of Mad Pride, has taken up the cause.
Much of the movement's activities centers around having fun and bringing people with serious mental disorders out of the shadows and into the city streets. Last October, the Mad Hatters of Bath invited passers-by to try their Normality Testing Machine and join them in "insane" activities like playing air guitars, dancing, and talking on imaginary telephones. In May, another Mad Pride group held a Normathon in Eugene, Oregon. (Go to YouTube and search for "Mad Hatters" to see videotapes).
Many in the Mad Pride movement not only celebrate their differentness, but make the same assertion as novels and movies like King of Hearts or One Flew Over the Cuckoo's Nest: people with serious mental disorders like bipolar disorder or schizophrenia may be healthier and wiser than those who try to keep them locked up or the "normal" people who fight wars.
At the website of the Institute for the Study of the Neurologically Typical (www.isnt.autistics.org), you can learn about Neurotypical Syndrome (NS), an extremely common disorder which afflicts an estimated 9,625 out of every 10,000 people. The Diagnostic and Statistical Manual of Normal Disorders (DSMND) on the site describes NS as a "neurobiological disorder characterized by preoccupation with social concerns . . . and obsession with conformity." Unfortunately, there's no known cure, although many people learn to compensate for it. It's possible that you yourself have NS and may wish to take the online screening test to find out.