Great interview! Fantastic guest! Listening to the interview, I had a few thoughts: -Regarding treatment resistance. I believe it was either Dr. Allen Frances or Dr. Michael Garrett (who is coincidentally at SUNY *Downstate* Medical Center, and who was a past guest on your show) who once said " _Treatment-resistance_ _could_ _just_ _as_ _easily_ _be_ _framed_ _as_ _treatment_ _inadequacy_ ". Similarly, Milton Erickson was quoted as saying “ _There_ _is_ _no_ _such_ _thing_ _as_ _resistant_ _clients_ , _only_ _inflexible_ _therapists_ ” 😀 - I loved your "tweak" as Dr. Pies put it, on the metaphor of medications being the bridge, and your suggestion that another alternative route the patient might take is to "swim", rather than walk over the bridge (i.e., taking meds) 🏊♀🙂 -I like how Dr. Pies included spirituality in his view of the Biopsychosocial Model. In fact I have seen many people amend that model to be more commonly referred to now as the Biopsychosocialspiritual Model. -I could hear Dr. Jonathan Shedler scream into his computer when Dr. Pies mentioned "personality disorder" at one point. As I know Dr. Shedler (and others like Dr. Nancy McWilliams) are of a firm belief that "one's personality cannot be a disorder". Mind you, they are of course drawing from Kernberg's level of personality organization to make sense of an individual's personality in the context of their level of functioning. Moreover, as they point out, after DSMIII, with the neo-kraepelinians and wanting to quantify/measure/operationally define things, they ended up taking well known, clinically accrued and observed personality "styles" and ratcheting them up in their severity (often times to the point of caricature) and slapping a label of disorder on it. -Finally, not sure if you know how Dr. Jordan Pedersen got off his benzo addiction, but he ended up going to Russia and getting some pretty "unorthodox" treatments over there, and then coming back. But ya he was suffering for quite a while. Great work man, this channel is a gem!
I always appreciate your thoughts and comments. I like that quote you attributed to Milton Erickson. The art there would entail being flexible while also staying in your lane haha I have recently read critiques of the biopsychosocial model, in that it isn’t a “model” at all, let alone a scientific one, and that it has no real explanatory power outside of saying “these three (perhaps four with adding spiritual) broad factors may have something to do with the illness.” You might enjoy reading Alex Roberts’ article, The biopsychosocial model: Its use and abuse.” I wanted to ask Dr Pies his thoughts on it but just did not have the time. And i appreciate you bringing the psychodynamic lens into this in that personality cannot be disordered :)
@@daniel.t.bourne I agree that at its heart, the biopsychosocial "model" is not actually a model, but rather 3 influencing forces that shape and contour people into who they are in any given moment. To take an even further step back, we might actually distill all of who we are in any given moment to Nature + Nurture. As Dr. Robert Sapolsky notes, its hard for people to see "distributed causation", in other words, all the little things throughout ones lifespan (and even before) that lead them to be who they are in any given moment. I agree with his (and the determinists) analysis that we don't have free will, and its luck all the way down. From this perspective, nobody has control of the genes they inherit (Nature) and the environments they are exposed to (nurture). This has duel implications that one cannot blame one's self for anything, but also they cant take credit for any of their accomplishments (because both were the result of luck, with no free will). Nobody "chooses" to become who they become. But that's just my take 🤣
My thanks to Daniel Bourne for his interest in these important issues, and for his effort in bringing this discussion to fruition!--Ronald W. Pies, MD
Great interview! Fantastic guest! Listening to the interview, I had a few thoughts:
-Regarding treatment resistance. I believe it was either Dr. Allen Frances or Dr. Michael Garrett (who is coincidentally at SUNY *Downstate* Medical Center, and who was a past guest on your show) who once said " _Treatment-resistance_ _could_ _just_ _as_ _easily_ _be_ _framed_ _as_ _treatment_ _inadequacy_ ". Similarly, Milton Erickson was quoted as saying “ _There_ _is_ _no_ _such_ _thing_ _as_ _resistant_ _clients_ , _only_ _inflexible_ _therapists_ ” 😀
- I loved your "tweak" as Dr. Pies put it, on the metaphor of medications being the bridge, and your suggestion that another alternative route the patient might take is to "swim", rather than walk over the bridge (i.e., taking meds) 🏊♀🙂
-I like how Dr. Pies included spirituality in his view of the Biopsychosocial Model. In fact I have seen many people amend that model to be more commonly referred to now as the Biopsychosocialspiritual Model.
-I could hear Dr. Jonathan Shedler scream into his computer when Dr. Pies mentioned "personality disorder" at one point. As I know Dr. Shedler (and others like Dr. Nancy McWilliams) are of a firm belief that "one's personality cannot be a disorder". Mind you, they are of course drawing from Kernberg's level of personality organization to make sense of an individual's personality in the context of their level of functioning. Moreover, as they point out, after DSMIII, with the neo-kraepelinians and wanting to quantify/measure/operationally define things, they ended up taking well known, clinically accrued and observed personality "styles" and ratcheting them up in their severity (often times to the point of caricature) and slapping a label of disorder on it.
-Finally, not sure if you know how Dr. Jordan Pedersen got off his benzo addiction, but he ended up going to Russia and getting some pretty "unorthodox" treatments over there, and then coming back. But ya he was suffering for quite a while.
Great work man, this channel is a gem!
I always appreciate your thoughts and comments.
I like that quote you attributed to Milton Erickson. The art there would entail being flexible while also staying in your lane haha
I have recently read critiques of the biopsychosocial model, in that it isn’t a “model” at all, let alone a scientific one, and that it has no real explanatory power outside of saying “these three (perhaps four with adding spiritual) broad factors may have something to do with the illness.” You might enjoy reading Alex Roberts’ article, The biopsychosocial model: Its use and abuse.” I wanted to ask Dr Pies his thoughts on it but just did not have the time.
And i appreciate you bringing the psychodynamic lens into this in that personality cannot be disordered :)
@@daniel.t.bourne I agree that at its heart, the biopsychosocial "model" is not actually a model, but rather 3 influencing forces that shape and contour people into who they are in any given moment. To take an even further step back, we might actually distill all of who we are in any given moment to Nature + Nurture.
As Dr. Robert Sapolsky notes, its hard for people to see "distributed causation", in other words, all the little things throughout ones lifespan (and even before) that lead them to be who they are in any given moment. I agree with his (and the determinists) analysis that we don't have free will, and its luck all the way down. From this perspective, nobody has control of the genes they inherit (Nature) and the environments they are exposed to (nurture).
This has duel implications that one cannot blame one's self for anything, but also they cant take credit for any of their accomplishments (because both were the result of luck, with no free will). Nobody "chooses" to become who they become. But that's just my take 🤣