Our entire medical system is based on conjuring up labels to represent clinical problems, then treating these labels instead of the processes which drive them or the patient who experiences them. In psychiatry this is a particular problem because a public that thinks of the body as a real and the mind, because it isn't physical or tangible, as unreal, cannot approach mind-related illnesses in a rational, objective manner, particularly when they are elusively dynamic & cannot be pinned down.

A:  Even today our professional ignorance of brain and mental function is profound despite all the modern advances in neurobiology over the last several decades, and believe me they are impressive. In comparison with neurobiologists, society at large is vastly more ignorant and its model of mind action is primitive. Modern society deals very poorly on both an individual and a mass level with those who are victims of mental illness, witness our treatment of homeless people. We don't appreciate that their problems are just us real, & just as concrete as those of the blind, deaf or crippled individual, and deserve respect, sympathy,insight & support.  Unfortunately the mentally ill are the worst equipped to exploit our health & social support systems. 

A: One of the bad habits of modern medicine is its tendency to be dualistic, meaning its tendency to look at things in black or white instead of on a gray scale. This is a common human failing, witness the legal profession which defines people as totally innocent or totally guilty. Using this extreme approach, we then make labels to represent the extremes, such as normal v diseased, sane v insane, guilty v not guilty and so forth. These man-made, digital concepts are not accurate representations of nature, which is analog.  Normality seems like a simple concept from the reductionistic, oversimplified, black or white point of view but in reality, normality is a far more complex entity.

A: The body is solid, tangible, capable of being imaged, even dissected into its component structures which can be examined in increasing detail. In contrast, the mind is an entity of pure process & zero state. It seems so nebulous but without the mind, nothing is really real to us. It is our window on what we believe to be reality or at least on one reality out of many.

A: It makes little sense to me that drug companies should be permitted to advertise their psychoactive drugs directly to the public who may then put pressure on their physicians to try them on this or that drug. In patients with uncomplicated depression, sometimes more powerful mind drugs such as the anti-psychotics, may be added in response to situations such as treatment resistance and treatment failure. Some drugs may be aimed at a specific symptom such as insomnia. What's basically going on is that symptomatic care is an example of barking up the wrong tree, and is an external, forceful therapy perpetually trying to reduce symptoms. It would be better to identify and eliminate the driving force that perpetuates the patient's problems.  Medical hucksterism on behalf of pharmaceutical companies contributes to our sciety-wide trend toward psychiatric over-medication. 

A: Partially I blame direct marketing to the consumer.  But a large part of the problem is the pervasive tendency to treat symptoms instead of their drivers.  So the government insists that women over 60 should never take estrogen because it increases the risk for stroke.  This is untrue.  Only oral estrogens, which progressive doctors never use anymore, amplify the risk for strike.  The government promotes antidepressants for the treatment of menopausal symptoms instead, despite their scientifically reported tendency to increase stroke risk!  It make's one wonder who exactly is running the asylum. And too many consumers expect to be elated all the time & reject the normal ups & downs of life. Where is their moral fibre? 

A:  Because mental health professionals are barking up the wrong tree, as they continue to treat labels & symptoms instead of the dynamic, difficult to pin-down processes that underlie them, including the strategically & potently hormonal ones that so massively control our brain cell populations & the balance between cell loss & cell renewal. As psychiatry embraces neurobiologic science more & more, this will change.  Hormone therapy will become an inevitable, even prominent component of great power & promise in the treatment of mental illnesses. 

No, I don't believe so.  There is a textbook called "Organic Psychiatry" dealing with mental problems complicating medical illnesses, in a sense what we could call "somatogenic" mental dysfunctions.  Does this mean that there is a "psychogenic" component to mental illness that originates in one's mind, to be called non-organic mental illness?  Of course not.  We need to consider mental illness using a medical instead of a psychological model, particularly in this age of neuroplasticity, dynamically fluctuating brain cell populations & dynamic neuro-imaging.

A:  As part of cost-reduction measures some medical systems have afforded their patients an average of just 5 to 10 minutes of psychiatric evaluation prior to being initiated on long-term psychoactive medicines, even the powerful ones such as anti-psychotic drugs, after which family practitioners are permitted to prescribe & monitor these patients.  Imagine the uproar if surgeries were being performed by physicans assistants!  I think that because we disrespect the mind & its problems so much, we are willing for any Tom, Dick or Harriet to play psychiatrist, often allowing them to prescribe long-term, potent, mind-altering, personality-altering psychoactive drugs after little more than cursory evaluation. 

A: From what we have seen in the stories of real women treated for PMDD, post-partum depression & post-partum psychosis as well as the frequent anxiety, depression, even bipolarity associated with the years surrounding the menopause, both estrogen and low dose testosterone are powerful anti-depressants in their own right, although only when administered expertly.  Tossing a patient crudely on a few estradiol oral pills in standard dosage isn't going to help however. And remember, these hormones, while avoiding the risks & side-effects of psychoactive drugs, are at the same time protecting you from dementia, heart disease & so forth.

A: The small hormones from the thyroid, adrenal & reproductive organs as well as the large hormone insulin are major movers for the determination of cognitive function, the mood disorders, anxiety, panic attack, bipolarity, drug dependency, alcoholism, psychosis & migraine syndrome.  So progesterone & synthetic progestins can drive depression & fatigue, while disturbances in the adrenal hormone cortisol are at the core of the majority of mental illnesses, by regulating the cash flow between limbic cell destruction & cell renewal in a critical way.  It follows that correcting hormonal disturbances would equally have the power to cure mental illness.  

Depression prevalence in women is driven by estrogen flux rather than by estrogen prevalence or dominance.  Estradiol withdrawal is a major driving force behind anxiety, depression & specifically the agitated form of uni-polar depression in women. 

A:  Absolutely.  Migraines, seizures, anxiety, even psychosis are paroxsmal conditions that come & go & they are driven by abnormalities in cortisol as well as by the process of estradiol withdrawal, which progesterone therapy may trigger.  Insulin & blood sugar levels & their patterns may also be involved with these processes, some of which, like migraine headaches, may be of  metabolic origin. 

A: These hormone-sensitive conditions are usually treated heavy-handedly with psycho-active drugs despite being hormone-driven & hormone-sensitive.  Why not hormone therapy instead?  Probably because oral estrogens have been tried but without success.  This should not be surprising.  Oral equine estrogens & the synthetic estrogen (ethinyl estradiol) of birth control pills paradoxically lower rather than raising brain levels of both estradiol & testosterone.  And even when estradiol patches are used they will often fail to bring benefit because the doses are far too weak and because the estradiol levels so generated are too erratic.  This is particularly true in my experience in women who have been treated with so called bioidentical hormone therapy, whose delivery patterns tend to be highly, even dangerously erratic.  

A; It has been demonstrated that estradiol therapy when applied in the right, non-erratic manner & in appropriate, adequate dosage, can prevent & effectively rein-in psychosis, as long as other hormone therapies such as potent progestins are not allowed to run interference on this wonderfully benevolent mechanism.  So the answer is an undoubted YES, & our clinical experience bears this theory out.