Lithium, as medication, has been a benchmark of my life, though in a different way than portrayed in the nicely written article.
When I was in school back in the 60's, I had the chance to see the healing effects of lithium before it was approved here in the US in 1970. I saw a man in a florid manic state dramatically improve in two week's time, kind of magical and it left a lasting impression on me.
A few years later I happened to be walking in town, and a man stopped me. "I know you. You were one of those students there when I was in the hospital." Only then did I know who he was. I asked how he was doing. He said "I'm doing quite well. Lithium saved my life and I'm still taking it."
Since then I've had the responsibility of treating many people with mood disorders, and I didn't forget what I'd learned. Anyway, lithium is still a godsend for many people, but of course it really isn't a magic bullet, nothing is.
Like all medications it can produce bad effects. I've seen that happen too. Renal failure is a risk as the article points out. Careful monitoring can prevent some bad outcomes, though not all. Doing whats best requires utmost dedication by patient and doctor to the cause of stability and quality of life.
In the words of Spinoza, "all things excellent are as difficult as they are rare." Success is possible, we just have to find the courage and strive to get there.
> ... what a pleasant surprise to another Portland psychiatrist on HN. Small world.
Pleasant surprise indeed, what are the odds? Obviously writing here is motivated by interests in computing as well as brains. Your comment a few weeks ago about SICP strongly resonates.
Scheme has been a productive language for me, I've done useful things with it. Curiously along the way it's taught me subtle lessons applicable in my other work.
That's not every doc's taste to be sure, no doubt an angled view among a quirky subset. Maybe not so strange finding unusual souls in a place known for its weirdness.
OK. Being subtle it's hard to put into words, but I'll try.
Scheme has a certain beauty, and symmetry when well-expressed. Paradoxically, a seemingly simple application can be perplexing on first glance, its meaning not immediately clear. Sure, the formal elegance is there, but how does it work?
The Lispy recursion vital to Scheme won't easily yield to cognitive brute force, when it's obscure to me, it has to sink in over some time.
It's not pure thought, one has to see it or feel it. More than just understanding, it has to make sense to me, that is, achieve a higher level of integration among my internal processes than the term "understanding" implies.
But once I "got it", it seems simple, a mystery whatever made it hard in the first place. Creating a useful program it's necessary to make sense of the tasks in order to translate into compilable expressions. It really is a kind of conversation in a peculiar language.
As I see it, there's a parallel in approaching human illness as a set of algorithmic processes, albeit extremely complex. Here we can apply a lesson, avoiding the temptation to force fit signs and symptoms into some preconceived template vs. what is learned during interaction, a more accurate, nuanced picture of the problems can emerge.
The work of healing is recursive, similar elements occur again and again. But as in a Scheme loop, recursion can end by trapping the right conditions. Wait, there's a clue. What is the condition that ends, at least damps, the troublesome recurring behaviors? Most of the time a "handle" can be found, an opening for intervention.
Programming teaches there's no universal solution to problems, solutions have to vary according to the situation. Each person with an illness has a unique disease, no two diseases are alike. Each person speaks a different language, we have to develop fluency in that language to be able to help. Skilled healers learn to build "macros" that shape the tools to the problem, sort of like evolving a DSL in Lisp/Scheme. Not exactly the same, but an element of the "mental models" that support effective treatment decisions.
Wow, that's pretty long. I don't know how good an answer it is, though a worthy question.
I'm on board with you with your sentiments on Lisp. I like this statement, "Scheme has a certain beauty, and symmetry when well-expressed."
As to comparing programming to the current state of Psychiatry(I'm assuming you're a Psychiatrist?) in 2015; I don't see any similarities?
Personally, I don't find much beauty, symmetry, or even much logic in the practice of Psychiatry these days. What I have witnessed is give a drug the FDA approved, and hope for the best, and this is what the better Psychiatrists do. The lousy ones don't take risks, and just blame the non-responsive patients--on the art of the profession, and "That's all I can do--sorry--and my fee is going up next visit. I can see you in three months from now?"
Don't get me wrong, I glad your are practicing, but this speciality has taken a beating in the last decade. We were all lied to by the drug companies! It took a Psychologist to expose the hidden lies in the excluded meta data in those studies? It seems like lately, another study comes out questioning the use of a particular class of drugs.(The latest study that comes to mind is the one that found Schizophrenic's might have a better quality of life if Not put on medication long term.)
That said, I'm not attacking your profession, but right now it is as much of an art as it was 50 years ago. Because the medical speciality is such an art right now; I don't find any irony in the fact you like programming. If I had to dole out dubious(cure rates, in so many instances, close to placebo) expensive, addictive drugs to alling patients, I would cherish my alone time programming. I have a feeling HN probally has more Psychiatrists interested in Programming than any other medical speciality?
(I am not bashing the Psychiatry profession. I just don't see the beauty/magic in it anymore. I do think it's one of the harder jobs out there--if done right? Doing it right is taking on a few Medi-cal patients, when no one is looking? And, not charging out of pocket patients $300-400 hr.; especially the patients that are just addicted to said dubious psychotropic drugs. I probally sound angry? It's more like disappointment?)
I think it's fine to bash the Psychiatry profession; it doesn't mean you can't appreciate the work of good psychiatrists when you meet them, and there are probably a lot of psychiatrists who would join you.
I've never taken lithium nor am I am psychiatrist, however it isn't known yet how lithium works - is it? I know they're better at understand the impact it has on the brain and function - but not the why it causes that?
Spinoza is hard to distil, but I'll give it a try:
He basically said that there was a human soul, but that it wasn't made up of things that couldn't be measured. He thought that the soul was just as profound, or even more profound, if it obeyed laws of physics. My amusement was that a thread on something like the altering of mental state due to artificially introducing lithium into ones diet is amusing, since a philosopher that was very concerned with the philosophy of mind and soul (Spinoza) would have been fascinated by this type of intentional soul alteration.
When I was in school back in the 60's, I had the chance to see the healing effects of lithium before it was approved here in the US in 1970. I saw a man in a florid manic state dramatically improve in two week's time, kind of magical and it left a lasting impression on me.
A few years later I happened to be walking in town, and a man stopped me. "I know you. You were one of those students there when I was in the hospital." Only then did I know who he was. I asked how he was doing. He said "I'm doing quite well. Lithium saved my life and I'm still taking it."
Since then I've had the responsibility of treating many people with mood disorders, and I didn't forget what I'd learned. Anyway, lithium is still a godsend for many people, but of course it really isn't a magic bullet, nothing is.
Like all medications it can produce bad effects. I've seen that happen too. Renal failure is a risk as the article points out. Careful monitoring can prevent some bad outcomes, though not all. Doing whats best requires utmost dedication by patient and doctor to the cause of stability and quality of life.
In the words of Spinoza, "all things excellent are as difficult as they are rare." Success is possible, we just have to find the courage and strive to get there.