
© Shrew Views
I have written about this many times, but I don't think I have ever written a whole article about it. If I am, indeed, repeating myself, my apologies to my long-time readers. That said, it deserves repeating.
Let me first explain what I mean by "top-down and bottom-up." I use this phrase often in my psychotherapy work. I believe
most therapy is designed to be top-down. This is where symptoms are treated, but not the cause of the symptoms. The first culprit on this list is typical psychiatry, where a 15-minute assessment determines a diagnosis, and a diagnosis determines medication protocol. If this modality of mental illness treatment worked, it would be an effective means of treatment. But like most things in life, determining the efficacy of this approach is not black and white; it actually does work in certain situations, for various reasons, but doesn't in others.
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Some of the serious mental illnesses, such as psychosis, suicidal depression, and mind-numbing anxiety, treating the symptoms will often quell what is considered pathological about the underlying disease. It still doesn't cure the cause, but it keeps the person contained, non-violent, so they don't hurt others, and stable enough that they can proceed with a life that otherwise would be impossible to pursue.
There is also the placebo effect, which very often is the prime reason people seem to get better.
Then, of course, there are the people who are taking their prescribed drug and also going to psychotherapy. If they feel better, they will invariably point to the drug as the reason, rather than the therapy — that seems a more scientific approach.I could go on with this, but I don't want to crowd the article. Top-down methods are not limited to psychiatry; we see them in regular talk therapy as well. Treating the symptoms rather than the root cause is the primary approach of CBT (Cognitive Behavioural Therapy). To be fair, there are certainly legitimate success stories with this method. However, if we continue feeding the monster (the underlying cause) through our aberrant behaviour, it will continue to wreak havoc. But if we simply stop the symptom (the behaviour) we can, over time, often kill the monster — if it is weak or small enough. So CBT can be successful, but more likely than not, we merely put the monster to sleep, only for it to raise its ugly head again once the CBT tactics cease.
Comment: 8/10. Good advice in the main, but one should not close one's mind to the possibilities at the edges of reality.