h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Thanks

I will stick at this article, however difficult it is. Mainly because the fact that so many people have been interested enough to post suggestions shows that I should stick at it.

etc.

pedboy

Just because I haven't changed it doesn't mean I'm not activly thinking about where to go with this entry. I'm trying to think of ways of making it less pro one side in the debate or another, which is difficult because this is an emotive debate.

Hey there! Just wanted to let you know that I really haven't forgotten about this, am just insanely busy at the moment. I will definitely aim at having a more detailed post for you by the end of the weekend, or Monday at the very latest.


Mikey

It's I'm glad you're thinking about it, I have my psychiarty viva in about an hour and a half so I have other things on my mind, I've been thinking of removing the section on how a psychiartrist would treat Anna, to make it less cultrarally bound. I'm also going to try and find more abuot pscyhological models and therapies. I might pop into the library at the psychiartric hospital today. But to be honest I'll be so relieved it's over I'll probably go straight to the pub.

Hi Z,

This is what I said I'd written offline, and would post here. I haven't read the backlog since I posted that, so I don't know if what I've said has already been covered. Anyway, at least I've read the entry now.

Think I posted as Elephants before, sorry...



IMHO this entry contains some very interesting ideas. Unfortunately I don't know much about it so they only comments I can make are rather nitpicky ones about your writing.

"The fact that at sometime in the future it may be disproved doesn't make the model invalid, we can still use it at the moment to spot swans; as long as we keep the fact that there may be swans of other colours around."

I'm not sure the last part of that sentence makes sense. I think it should be something like "as long as we keep in mind the fact that there may be..." etc.

I really like the swan analogy! I found it easy to understand.

Minor typo: afriad --> afraid (it's in the first Anna paragraph)

"These generally include theories that mental illness is caused by chemicals, these may be neurotransmitters, the chemicals that are involved in transmitting a nerve signal from one nerve to another nerve, they also include theories that illness are caused by genetic factors or by hormonal imbalance."

I don't really like that paragraph - it's one sentence! It would be much nicer if you broke it up into two sentences, or made a footnote/brackets out of "the chemicals that are involved in transmitting a nerve signal from one nerve to another nerve".

Adrenaline is adrenalin in the U.K., and you might like to mention that it's also referred to as epinephrine, seeing as you've used other biochemical () terms.

"can't carry about a double blind" --> "can't carry out a double blind" (I think ) *imagines holding a double blind experiment in arms and carrying it about*

I think that footnotes should have fullstops at the end. You're also missing some fullstops at the end of sentences in the "Social Models" paragraph.

"persons identify" --> person's identity ( apostrophe?)

The conclusion is okay, I think it's missing a final sentence though. (Don't ask me what, I'm crap at conclusions, but the way this entry is now it's like something's missing. )

When you say that in most countries the shrink is more likely to be a woman than a man, is that because there are more women than men psychiatrists, or because Anna would go to a woman? (Just wondering out of interest; I'd never really thought about which gender the majority of psychiatrists are.)



Niwt

Right, I've had a bit of a re write, I say re write, it mainly involves cutting out points that I've decided aren't really necessary, hopefully it appears less culturaly bound now, as I've cut out the entire section about how a psychiatrist would approach the patient. I've merely replaced it with a section on how in reality most therapists use a combination of inventions and models.

Niwt, thanks for all your points, I've made all the corrections. I used refered to the psychiartist as female becauset there are slightly more female psychiatrists, but I've cut that section out now anyway.

So what do you all think

Will read it again tomorrow.

I liked this entry Below is a paragraph that I think would summarise some of the points you are making more simply. What do you think?

This entry discusses three general approaches to treating mental illness. While each can be argued to identify and treat the 'cause' it is fair to say there is no general agreement which cause is the most relevant to treat. This is particularly true when it comes to biological causes, which may in turn have been caused by something else, so in effect the medical treatment is only affecting a symptom of something more basic, and is not curing the problem.

Listed below are some typos/suggestions, going through the entry in order:

But not everyone who has such a stressful event will become mentally ill, there must be other factors which lead to the illness. >
But since not everyone who has such a stressful event becomes mentally ill, there must be other factors which lead to the illness.

'The Nature of Swan-ess' > 'The Nature of Swan-ness'

You see that every swan you have ever seen is swan shaped and white, therefore for something to be a swan it must be swan shaped and white. You could publish this theory in a book, people could use the book to identify swans. This works well until, sooner or later, someone spots a black swan. Then they create a new model, saying 'all swans are swan shaped and coloured black or white.' The new model takes the place of the previous model; however we cannot be sure that it is the truth until we see every swan in the world.
>
You see that every swan is swan-shaped and white, therefore for something to be a swan it must be swan-shaped and white. You could publish this theory in a book, people could use the book to identify swans. This works well until, sooner or later, someone spots a black swan. Then they create a new model, saying 'all swans are swan-shaped and coloured black or white.' The new model takes the place of the previous model; however we cannot be sure that it is the truth until we see every swan in the world.

she is afraid to to leave her house > she is afraid to leave her house

Usualy eurotransmitters > Often the chemicals proposed as causes of mental illness are neurotransmitters

Adrenaline/adrenalin – both acceptable spellings I think but use one rather than both

A psychoanalysist would spent time listening to Anna whist she talked about her fear of spiders, and examining where her fear originated from >
A psychoanalyst would spend time listening to Anna while she talked about her fear of spiders, and try to determine where the fear originated.

loosing status in society, for example loosing their job. People who use this theory would think that the use of medication was unnessercary, as the problem was society's defination
>
losing status in society, for example losing their job. People who use this theory would think that the use of medication was unnecessary, as the problem was society's definition

social situations lead to a mental illness > social situations can lead to mental illness

When advising a patient whether a biological, psychological or social intervention is likely to be more effective they would look at which intervention was likely to be more effective.
>
When advising a patient whether a biological, psychological or social intervention is likely to be most effective the doctor would have to weigh each case on its merits.

Pimmsaloonie

Phew, I've done another rewrite, I'd like to thank you all for all your help, and I feel that you all deserve co-authourship of this entry, now if any of you would like me to add it then I will do

I've paid special attention to Mickeys comments, and removed a large section becuase i couldn't see how not to make cultrally bound. I've added a paragraph explaining that the models are not mutally exculsive.

I've taken up all of the points you all made I think.

*erects abestos screen*

Is there anything else I should include?

Okay, here's some more comments (note: I am not even going to pretend that they will be in any logical order )

P2S1 (paragraph 2, sentence 1) - "It’s also difficult for people who are trying to help people with mental illness..." I would suggest substituting something else in front of the first "people" in order to make this sentence a little cleared. Perhaps 'care providers' or 'mental health care providers' would work?

I also think the introduction includes perhaps a bit more on "mental illness in general" than this entry needs. Personally, I would keep the first two paragraphs and lose the second two -- while they are interesting, they start leading my head down a different track than were this entry is going.

On the other hand, I think you need a little bit more in the section where you explain what a model is. What you describe there isn't what I think of as a model, nor do I think it sets people up as well as you would like for the models to come. I think of a model as being a group of linked theories that are used to explain the cause of a disorder and use that information to predict the most appropriate treatment. I don't think of models as necessarily being evidence-based (although some are), nor do I think of them as being able to predict treatment outcomes (although you can sometimes do that if you have real data about how your theoretical model works in practice -- again, back to the evidence base).

'The Nature of Swan-ess' -- I think the latter 'word' should probably be 'Swan-ness' if you're going to use the hyphen (which I think you should, as it's awfully confusing without it).

'A Example of A2 Case - Anna' -- I find where the footnote is placed here to be incredibly distracting. My suggestion would be to put the footnote, not in the header, but in the paragraph the first time you say Anna's name -- i.e., "Anna is a 33 year old woman who has always been scared of spiders."

Also, if you're going to use a phobia as your case discussion, you should probably make it clear up at the beginning that you are including both psychologic and psychiatric disorders, and of all severity levels, in your definition of mental illness. There are people out there who restrict the use of the term "mental illness" to either psychiatric conditions only (i.e., those for which there is obviously a biologic etiology, such as ADHD, bipolar disorder, schizophrenia), and also others who restrict the term to severe conditions only (i.e., including bipolar and schizophrenia, but excluding ADHD and generalized anxiety disorder).

Given that you wanted to go into how each of the models would treat a case, I'm not really sure this is the right case to use -- it makes the entry more biased than I think is necessary. I would suggest using a disorder for which each of the models truly could be appropriate. In the case of phobia, most providers would consider the biologic model useful for explaining symptoms to a patient, but probably not the best to guide treatment. Something like mild depression or generalized anxiety disorder might work a little better.

"For instance drugs which are used for depression, such as Prozac, increase the availability of a chemical called 5HT3, or serotonin in the US." I think this sentence might mislead people into believing that all antidepressants work via serotonin, which clearly isn't the case. I would add the word "some" before drugs, myself.

Actually, throughout that section, I would suggest using the word 'medication' rather than 'drug', as it has a more neurtral connotation.

Onto the psychological model section.

You say that psychological therapies are grouped into 3 main categories, but only describe 2 in the section. Frankly, I don't know that I would agree that there are 3 categories -- it's much more of a spectrum than anything else.

There's cognitive therapy, behavioral therapy, and cognitive-behavioral therapy, all of which have their own methodologies, with the latter combining aspects of the first two. You don't mention cognitive or behavioral therapies as existing on their own, and what you describe for it is actually a description of *behavioral* therapy. The cognitive aspect of cognitive-behavioral therapy does indeed examine causes, although in a very different way than in psychoanalysis. Whereas psychoanalysis tends to look for causes in the past (i.e., your mother abused you), cognitive therapy looks at causes in the present (i.e., you use negative self-talk). Advocates of cognitive therapy will tell you that the advantage of cognitive therapy over psychoanalysis is that cognitive therapy focuses on causes which still have the ability to be changed -- i.e., you can learn to decrease your negative self-talk.

Your bias in this section comes through pretty clearly. And while, as an epidemiologist, I know that there's far more evidence for cognitive-behavioral therapy than for psychoanalysis, I think that if you want to say such things, you should say it straight out rather than using loaded sentences such as "The therapist remains passive and helps the patient work through the unconscious basis of their problems instead of providing solutions." (Note -- while CBT has been shown to be more effective than psychoanalysis, there's no evidence that CBT is more effective than behavioral or cognitive therapies alone for most conditions.)

The social model just really doesn't fit with this case at all -- another reason for perhaps using a different case study. As it is presented, it just really doesn't make sense. It also comes across as very odd to me, because much more so than the other two, the social model is really *never* used in isolation. It's used much more in the prevention of mental illness than in the treatment.

"most researchers use the Registrar Generals classification system"

I have absolutely no idea what this is. If you need to mention this, I would say that most *British* researchers use that (although even that I'm not entirely sure on, as all the British papers I have use a combination of ICD-9 codes and DSM-IV diagnoses for their classifications. The DSM-IV diagnoses *do* have a way to code for social issues that cause a condition, as do ICD-9 codes). However, these codes are very rarely used in general practice, in my experience.

The last paragraph of each of these sections really does give the impression that providers are either all A, all B, or all C. I really don't think you need to wait until the next suggestion to fix that.

Perhaps instead of saying: "Biological treatments often involve the use of drugs. As people who use the biological model see the cause of the problem as a chemical imbalance, a drug that fixes the chemical imbalance would fix the problem."

You could say something like: "Providers who favor the biologic model often view disorders as being the result of flawed physiologic processes. As a result, these providers tend to focus their treatment efforts on finding the most appropriate medication for a patient."

(note: the biologic model is *not* only about chemical imbalances, although this is a common misperception.)

"Doctors and therapists who are helping people with mental illness, don't subscribe to any model in particular."

I think this goes too far to the other extreme. Yes, therapists and doctors *do* have their own models that guide them in both diagnosis and treatment. What I think is the important point to get across is that for any given provider, their personal model likely draws on some combination of the biologic, psychologic, and social models -- the difference between providers is in part how they weight those components in their personal model, and the degree to which they vary their personal model based on the patient.

"When advising a patient whether a biological, psychological or social intervention is likely to be more effective a doctor would look at which intervention was likely to be more effective." Yikes! I'm sorry, but this sentence is just really hard to read. I might simplify it to say something more like "When advising a patient on choosing an intervention, a doctor tries to look at which intervention(s) are likely to work best for that particular patient, with those symptoms, and in those circumstances." Or something like that.

Okay, I think I've babbled enough for now.


Mikey

P2S1 (paragraph 2, sentence 1) - "It’s also difficult for people who are trying to help people with mental illness..." I would suggest substituting something else in front of the first "people" in order to make this sentence a little cleared. Perhaps 'care providers' or 'mental health care providers' would work? --> Changed to "Mental Health care providers"


"I also think the introduction includes perhaps a bit more on "mental illness in general" than this entry needs. Personally, I would keep the first two paragraphs and lose the second two -- while they are interesting, they start leading my head down a different track than were this entry is going. "---> I've removed the paragraphs that you suggested, I agree it does look a lot better now.

"think of a model as being a group of linked theories that are used to explain the cause of a disorder and use that information to predict the most appropriate treatment. " -

you describe it much better than I do, so I've done a straight cut and paste job. "

- I do get your point about using phobia, thinking about it, then I think I will use a mild depression, it is after all much commoner.
"
For instance drugs which are used for depression, such as Prozac, increase the availability of a chemical called 5HT3, or serotonin in the US." I think this sentence might mislead people into believing that all antidepressants work via serotonin, which clearly isn't the case. I would add the word "some" before drugs, myself." ---> done



Actually, throughout that section, I would suggest using the word 'medication' rather than 'drug', as it has a more neurtral connotation. ---> ok that's done, though the wonders of the "find and replace function"



"There's cognitive therapy, behavioral therapy, and cognitive-behavioral therapy, all of which have their own methodologies, with the latter combining aspects of the first two. You don't mention cognitive or behavioral therapies as existing on their own, and what you describe for it is actually a description of *behavioral* therapy. The cognitive aspect of cognitive-behavioral therapy does indeed examine causes, although in a very different way than in psychoanalysis. Whereas psychoanalysis tends to look for causes in the past (i.e., your mother abused you), cognitive therapy looks at causes in the present (i.e., you use negative self-talk). Advocates of cognitive therapy will tell you that the advantage of cognitive therapy over psychoanalysis is that cognitive therapy focuses on causes which still have the ability to be changed -- i.e., you can learn to decrease your negative self-talk. "
---> I'll hold my hand up and admit that I know very very little about psychological therapies, however in the textbooks, and lecture from a clinical pscyhologist, that I had only Cognitive behavioural therapy was mentioned. I've just done a brief description of what they are based on your sentance.


"Your bias in this section comes through pretty clearly. And while, as an epidemiologist, I know that there's far more evidence for cognitive-behavioral therapy than for psychoanalysis, I think that if you want to say such things, you should say it straight out rather than using loaded sentences such as "The therapist remains passive and helps the patient work through the unconscious basis of their problems instead of providing solutions." (Note -- while CBT has been shown to be more effective than psychoanalysis, there's no evidence that CBT is more effective than behavioral or cognitive therapies alone for most conditions.) "

I don't actually have any bias either way, and I haven't read any of the research concerned, the sentance concerned is actualy paraphrased from one of my textbooks. Incidently I was told in a lecture, that whilst there is less evidence for psychoanalysis than CBT there is not eveidence that for minor depression CBT is more effective that drugs. I don't know if this is true, as I haven't read the evidence myself, and I know better that to believe everything taught to me in medical school as gospel.


The social model just really doesn't fit with this case at all -- another reason for perhaps using a different case study. As it is presented, it just really doesn't make sense. It also comes across as very odd to me, because much more so than the other two, the social model is really *never* used in isolation. It's used much more in the prevention of mental illness than in the treatment - I've tried to include your point,though now i've changed the case I think it fits better.


"most researchers use the Registrar Generals classification system"

I have absolutely no idea what this is. If you need to mention this, I would say that most *British* researchers use that (although even that I'm not entirely sure on, as all the British papers I have use a combination of ICD-9 codes and DSM-IV diagnoses for their classifications. The DSM-IV diagnoses *do* have a way to code for social issues that cause a condition, as do ICD-9 codes). However, these codes are very rarely used in general practice, in my experience.

This was taught to us is our first year, and is now dropped into lectures and tutourials and textbooks without futher explanation - I have removed the reference though.

The last paragraph of each of these sections really does give the impression that providers are either all A, all B, or all C. I really don't think you need to wait until the next suggestion to fix that.


I've removed, and modified two of the last sections, though I have left the last sentance relating to psychological methods and drugs.

(note: the biologic model is *not* only about chemical imbalances, although this is a common misperception

I hopped that this sentance would modify that --> Other biological models suggest that illnesses are caused by genetic factors or by hormonal imbalances.



"Doctors and therapists who are helping people with mental illness, don't subscribe to any model in particular."


I think this goes too far to the other extreme. Yes, therapists and doctors *do* have their own models that guide them in both diagnosis and treatment. What I think is the important point to get across is that for any given provider, their personal model likely draws on some combination of the biologic, psychologic, and social models -- the difference between providers is in part how they weight those components in their personal model, and the degree to which they vary their personal model based on the patient.

"When advising a patient whether a biological, psychological or social intervention is likely to be more effective a doctor would look at which intervention was likely to be more effective." Yikes! I'm sorry, but this sentence is just really hard to read. I might simplify it to say something more like "When advising a patient on choosing an intervention, a doctor tries to look at which intervention(s) are likely to work best for that particular patient, with those symptoms, and in those circumstances." Or something like that.
Good sentance in fact I think i'll steal it if that's ok with you?


Okay, I think I've babbled enough for now. --not at all, feel free to babble away.

I don't know if the offer of collaborative credit applied to me, but I don't think I warrant it - most of my suggestions were merely style and typos .

Speaking of which a few have crept in:
I agree the second footnote in the header (fictional) is misplaced, and would be better in the text
deppression > depression (in footnote)
the use of medications makes > the use of medications to make
Some of the more common ones include ... ? unfinished sentence
Whereas psycholanalysis may concentrate on events from the past that may not be changed, other pscyhological therapies, such as conigitive > Whereas psychoanalysis may concentrate on events from the past that may not be changed, other psychological therapies, such as cognitive


The following summing up paragraph is a little unclear, and also negates your discalimer at the start that you are going to use 'doctor' to imply all health professionals throughout.
"Doctors and therapists who are helping people with mental illness, have their own models that guide them in both diagnosis and treatment. For any given provider's model of any illness, they will acknowledge a combination of biological, psychological and social factors. Though there will be some vairation in which factors they rate as the more important. When advising a patient on choosing an intervention, a doctor tries to look at which intervention(s) are likely to work best for that particular patient, with those symptoms, and in those circumstances. "

possibly could be summarised thus (I've tried to include as many of the nuances as you intended):
"Doctors helping people with mental illness have models to guide them in both diagnosis and treatment. Most models of mental illnesses will nowadays acknowledge a combination of biological, psychological and social factors. Different models will however vary which factors they rate as the most important. When advising a patient, a doctor tries to look at which intervention(s) are likely to work best for that particular patient, taking into account the patient's symptoms and circumstances."

While I won't be wanting a credit I do intend to link to it from the entry Cyzaki and I have in PR on John Forbes Nash

Pimms

Thanks Pimms, that entry actually inspired me to write this, i realised that biological v. pscyhological debate went far beyond the coffee room in psychiatric hospitals.

Give me a moment or two and I'll fix the errors.

Hey there, strong work so far!

A few points and suggestions.

1) The intro could be more artfully worded. I'm sorry not to get more specific here, but it seems choppier than the rest of the work. The MI example is strong, but the language seems off. i know you've done a bit of work here, and i'm sorry I'm not being more specific.

2) Just to pick nits you write: 'loosing' when you mean 'losing'. a few times.

3) There are several subsets of the psychological model, which can be used to help define your example better.
structuralism, behaviorism, gestalt, and psychoanalysis. Here's a nice website with some notes:
http://www.a2zpsychology.com/articles/schools_of_psychology.htm

There are differences in the treatments of psychological disorders based on the different schools or subsets of psychology (psychoanalysis, desensitization, pattern recognition, etc.). For that matter there are different theories for biolgical treatments too, but those are not so rigidly defined.

Anyway, i thought that while the article was good, you basically gave only a few paragraphs to the entire theory or school of psychology. I think a brief description of the theories will totally fit in this work.

Keep at it. it's lookin good!

Friar

I've been thinking about this a lot, I'll try and work on the intro.

I don't want to write about details of pscyhological theories of mental illness, because firstly I don't know a lot about it. There would still be scope for another entry.

What they do all share is that

- They believe that the real cause of mental illness, is not a physical one, it lies usually in events in the past.

- That the solution is some sort of "talking cure"

I haven't gone into details of the different biological or social theories either.

Hey there,

Just to let you know that this entry has been scouted - can you let me know when it is ready to rock and roll its merry way into the EG?

Many thanks

Ashley

Thanks Ashley, I was hoping that this would happen I personally think, for resons outlined above, that this entry is ready to go into the edited Guide. I have skimmed the section on psychological models, but they are dealt with in as much details as other models.

So could you press the red accept button please.

Your Guide Entry has just been picked from Peer Review by one of our Scouts, and is now heading off into the Editorial Process, which ends with publication in the Edited Guide. We've therefore moved this Review Conversation out of Peer Review and to the entry itself.

If you'd like to know what happens now, check out the page on 'What Happens after your Entry has been Recommended?' at EditedGuide-Process. We hope this explains everything.

Thanks for contributing to the Edited Guide!