I like the comment because there is always a continuum of severity, not always black and white, and for damn sure a ton of tingey Asperger's stuff is out there, imo. And sometimes its intense in some of its elements and mild in the more noticeable ones ... so gets overlooked. You don't have to be playing Mozart's symphonies by memory upon first hearing and unable to have a conversation or find your way home, to be on the scale.

The Asperger category is fascinating. Of course there is already a backlash against it. But I think it's on to something critical. The person is afraid, the person does not open his or her consciousness to the world, the person in effect wears blinders, the person tunnels their consciousness into some narrow pursuit producing prodigious results (avoiding the world at large) ... all this little doubt being influenced by actual actual wiring of the brain. What they can do gets mystical looking and bears on theories of knowledge.

When this was all happening I thought I was completely normal and that everyone else was ****ed up. I was admitted to the hospital not because I thought something was wrong, it was my mom who called the police because I was a threat to myself and others, so the police brought me to the hospital.

All the more laudable that you are making such a good recovery. That doesn't sound like minor trouble at all ... so more power to you. Do you feel like it was simply the meds that changed it all???

Thank you. And to answer your question, yes, it was definitely the meds that changed it all. It took a few months to find out what meds worked best, a lot of trial and error (which isn't fun at all), but eventually we got there. I did take some CBT courses, but they did nothing at all for me, it was just really trying to find the right cocktail.

When it's a chemical issue, no therapy modality can be truly effective. Now that you've found the right cocktail, have you considered getting back into therapy? Once the chemical issue is sorted out, talk therapy becomes much more effective and can add additional tools to your toolchest to address any issues you might have in the future.

I have been to a few sessions with a counsellor a couple of years ago. I also do a lot of writing on my own which helps me with different things. I'm lucky too because I have a job that offers therapy for a variety of reasons.

There's no evidence that this is true, and it contains 2 errors in the thought process:

1) we don't have evidence that there are 'chemical imbalances' in mental illnesses. Even brain imaging studies seem poor; all the studies basically implicate the same regions regardless of which disorder is being studied, and there's wide inter-individual variability.

2) therapy can change the brain physically.

100% incorrect. Except maybe #2. Have you ever tried giving talk therapy to someone with active psychosis and no medication with positive results? Yeah, I didn't think so.

Explain how that being true would make me 100% incorrect, please. I believe you are making at least one unsupported logical assumption to get from the above quoted assertion to the previous one I quoted.

I suppose 50% incorrect would be fair. I have no idea what you're alluding to in the second half of your post.

This. While I have only a passing interesting in clinical issues, I'm aware of several meta-analysis that suggest drugs+therapy tend to be more effective than either of these alone.

I assume this is because drugs only address catecholamine imbalances (e.g. SSRI's). They do not address the root cause, which is where therapy becomes effective.

Sigh. Yes, therapy and medication is best. Therapy outcomes are similar to medication outcomes but combined gets better results. I'm not disputing that.

However, this guy is talking about psychosis. No amount of talk therapy helps with this unless the patient is medicated properly. Hence the reason I said in cases involving chemical imbalances. And yes, that is what they are.

I'm a psychologist in a mental hospital and deal with psychosis on a daily basis. When you have a guy bashing his teeth into the concrete wall to get rid of the radios in his fillings, you can't have an insightful conversation with him. He won't be able to identify cognitive distortions or core beliefs to save his life. So yes, in cases where it is a chemical imbalance, medication is key before any talk therapy.

Here's what I see you saying:

P1: A patient with psychosis will improve with medications.
P2: A patient with psychosis will not improve with psychotherapy.
P3: Medications change brain chemistry.
C: Therefore, a patient with psychosis has a problem with brain chemistry.

My point is that this conclusion does not flow logically from the premises. It sounds reasonable but doesn't need to be true. We know that meds can improve psychotic symptoms, but that doesn't mean that the psychosis was caused by some neurochemical imbalance.

This is not what I was saying, btw, and I don't believe it's something we know to be true either. Certainly the idea that SSRIs treat a chemical imbalances is outdated and not well supported.

Concerning therapy, different therapeutic modalities are based on different psychological models of what's caused or is perpetuating the issue. Based on these models, a treatment would then be implemented, but the success of these treatments should not be mistaken for the validity of these models. That is, just because a therapy works doesn't mean it actually addressed or even illuminated the actual underlying cause.

In fact, my view on medications and therapy can be explained in this analogy, which I thought of now while sick and medicated, so please excuse me if it's more terrible than I imagine. If you have a bug infestation in your house, say of ants or bees or termites, one solution is to call in the exterminator to spray your house with poisons. That will fix the problem, but that doesn't mean your home's air had a chemical imbalances before with too little poison. And while it worked, it didn't do so by fixing the root cause -- that your house wasn't fully sealed from the outside and had bug food inside.

Similarly, meds and therapy can both work for certain issues (and for other issues, either meds or therapy would work but not the other), and both can induce changes in the brain, but that doesn't mean either treatment is fixing the problem that led to the disorder in the first place. They might, but proving that would require evidence other than treatment efficacy.

Just to be clear, I'm a psychiatrist and so have worked in mental hospitals with these same patients. I've even prescribed them medications to treat their psychosis. But that's because there's evidence that these meds help, not because I'm convinced there's an underlying neurochemical imbalance that needs rebalancing.

With regards to my original post:

.

From first hand experience, if medication helped alleviate my symptoms due to it's properties, then how is it not clear that there is a chemical imbalance in my brain? How is that CBT didn't do anything for me, yet medication worked? In fact, I think CBT by itself might have actually made some of my symptoms worse, similar to taking the wrong medications which also made my symptoms worse. I was given Haldol which totally ****ed with my head and my body, then I was given Zyprexa which didn't help and then finally I was given Seroquel along with Clonazepam which worked (I also take Pristiq).

In fact I know that the reason for my condition is due to an imbalance in the dopamine levels in my brain. I also think a cause of this was due to the fact that I started smoking pot when I was 12 years old (although this may have just triggered something that was already present). I remember I used to become extremely paranoid when I smoked, but I didn't realize at the time that this wasn't normal. I haven't used any drugs since 2003 because I now know that these are triggers to my condition. All this happened to me when I was 23 y/o and now I'm 36 y/o and have gone 12 years without any major relapses.

See my above analogy about insects in your house. For a solution to work in solving a problem doesn't require it to address the cause of that problem.

Yeah, you're way over analyzing what I said and adding to it. I never said psychotropic medications can "cure" or "fix" someone with psychosis. I never even said the chemical imbalance caused the disorder. What I said is that unless the medications are in play to help balance the patient out and alleviate his psychotic symptoms, talk therapy won't work. You're putting too much on my statements.

Incidentally, the real irony here is that a psychologist is debating with a psychiatrist for the importance of medication while the psychiatrist is promoting talk therapy. It's like we're in The Twilight Zone.

Also, in regards to your analogy, it would be foolish for a person to seal off their house without first exterminating the bugs in their house. And if those bugs don't get exterminated or removed, they will continue to breed. Get rid of the immediate issues first, then address the underlying cause of the issue by sealing off the house.

You said this:

What I've been arguing against is that you are saying it's a chemical issue. That's certainly one option, but we don't really know it to be true.

Haha, I agree, sort of. I've not actually promoted talk therapy nor argued against the use of meds. I'm just not in agreement about the support for the underlying issues

It's was an analogy to illustrate one point. You can't stretch it out to apply to all of the situation under discussion. My analogy still shows that treatment efficacy does not imply the cause or real issue being treated.

While it may not be true for some cases, in my case that was indeed the truth.

And you know this how? This currently isn't something we can actually say with certainty unless you were actively high at the time of the psychosis.

I know this because I underwent numerous tests. And what do you mean by "actively high"? My psychosis was caused by numerous factors, marijuana being one of them and stress was another. If you mean was I high on drugs when it happened, no I wasn't, but the manic phase associated with my condition sure felt like I was.

There's is no test for a neurochemical imbalance, or at least none that's useful clinically. That is, we could look at blood, urine, or even CSF (if you're willing to undergo a spinal tap) levels of various neurotransmitters, but this just isn't a good enough test for mental disorders. So I don't know what testing you had done, but if either didn't involve actually looking for a chemical imbalance or it did and you were seeing a doctor practicing outside our current science-derived knowledge base.

Regarding the question of being high, I mean that if you were actively high then we do know what that drug is doing in your brain and what chemical pathways it's messing with to cause the psychosis and mania. Outside of that scenario, we don't have such a clear understanding of what's leading to a patient being psychotic or manic.