#thingswithtags

[eligalilei]

αυτoποίησις, θέλημα, and γνῶσις

What exactly 'Γνῶθι σαυτόν' means in light of the emptiness of all phenomena, especially the self, as Divine and Universal Mirror, by virtue of their non-independent co-origination is, I think, very much the absolute core of my religious project, and that of the twentieth century in general, which, was indeed, pretty freaking Deleuzian.

[eligalilei]

Diagnosis vs Symptomatology as Guide to Treatment

OP:

It's a view within psychiatry that diagnoses are not that helpful and we should look at symptoms or symptom clusters and treat those. I don't share that view, but it is a view.

If you don't want medication then you likely don't want a long term therapeutic relationship with a prescriber.

You may need to see someone different to get the clear diagnosis that you want. Me:

In what way is this an insufficient perspective? There are for sure some clear clinical entities, but regardless of whether you call them 'symptom clusters' or 'diseases,' the world contains plenty of limit cases and statistical 'long tails.' This seems to be a way to deal with feeling like you're locked in to a particular set of solutions based on a term that might or might not fit the totality of the clinical presentation.

Regardless, someone is going to have to put something down for insurance at some point, so at the end of the day this all may be moot. OP: I feel that the major issue is that medications are tested against diagnoses. So eg throwing antidepressants against all low mood when they have only been tested against (episodic mood associated with fatiguability and anhedonia) mdd is not ideal. For instance for the chronic low mood associated with borderline, they either haven't been tested or possibly worse, they've been small scale tested and failed. Me:

As I said, there are relatively concrete disease entities; they can be seen to consist of possible sets of transformations of states which are defined in contrast. You're right, you can't just treat symptoms, but you can recognize continua and patterns from one state set in other presentations, and thus, even, treat aspects of a patient that don't fit with the clinical picture as a whole, but don't neatly fit into another diagnosis either.

Borderline is a particularly good example, since one can have borderline features in many senses, especially in crisis, and even view yourself through the lense of these criteria while in a crisis state, without necessarily meeting the five requisites. This could reason to give us pause in using, hypothetically, more activating meds in people who present with affective switching, or use an antimanic in someone who tends toward activation and psychotic intrusions, but doesn't meet duration criteria for BP. Possible cyclothymia with some borderline features would present as another point of connection between BP and BPD, for instance, and might merit consideration of a stabilizer on either side. Is this tested? No. But it's no more an unreasonable of a leap as that of assuming that another clinician took a good patient history that wasn't biased by the confounds of the particular moment and context of presentation. Btw, is the suggestion that BPD's instability is aggrivable by ADs? I could buy that. And, like, while we might be able to conceive of BPD as a distinct category... we have at least some biomarkers for TRD that suggest there's utilable subtypes in depression, some of which interlap with BPD (inflammatory cytokines, cortisol abnormalities) so even if BPD is distinct as a system of behaviours and states, options within the MDD formulary with antiinflammatory properties might be worth keeping on the table due to lack of options .

There's also, then, the issue of the repeatability of diagnosis, which, while not null, is sometimes questionable. By using the data from studies, you implicitly trust that some random guy (never the people doing the studies, not uncommonly a rushed ward doc with hundreds of patients) was able to render a sufficient picture of the patient so as to be actually rule out all other possible codings. Patholognomes don't always perform on command, some are probably even shy characteristically; yet others may prefer the stage of the ward, and be otherwise reclusive.

I doubt the brain has some quantitative gauge such that a system of affects becomes some totally new thing after a requisite time has passed symptomatic. And who is to say that one couldn't have MDD and BPD, if they are indeed semi-discrete entities. Or does the BPD eat the MDD?

Basically, I'm just saying you should look at the clinical picture as focused on relations between states and their possible factors, since that's more logical than a list of symptoms. The numbers on AD efficacy are already not so great. If you'll take a chance on giving someone a drug at all, you might as well take a chance on getting a treatment for them specifically, the nature of which is literally nothing you'll be able to discern from a study, though occasionally a case. I kind of think both sides of the aisle strawman each other, but at least the symptoms side has the advantage of appearing to acknowledge complexity and individuality, though it refuses the patient the sacrament of symbolic suture which is specification.

[eligalilei]

Gnosticism sanctifies and sacramentalizes the act of waking up every morning and deciding that today will be the day I kill God.

The demiurge is a 'position,' like 'the accuser (ha-satan), or a kind of cybernetic 'knot' or 'impasse.' 'To demiurge' (in fact, to 'middle manage') is to fail to see the Logos and Arche, to forget the unity of Hyle and Morphe, and in so failing, jumble and entrap the little tag-end of the world by you entaken, and with which you believe yourself to have been charged, duty or strength bound, by some artifice, to be the whole, and mere passive matter. In this, the core of Samael's blindness is to the nature and totality of Logos. In this mis-take, the demiurge per and insists as repetition unknowing, self-perceived as free act: in a misrecognition of cosmic and hylomorphic metaxy, virally in the subject-core of the Demiurge's own glimmer, informatically as the cast repetitions, in and as form, both victim and saviour, disjunct, the Demiurge traps, constitutes, and in-forms the confused jumble of the 'spark' and its soul-as-prison. The Demiourgical position is that of one who has themselves fallen apart from the whole, into a poor map: .....a picture or a copy, an echo, or an iteration, ..... and cannot look up. The Demiurge's deficiency is not material, but is rather informatic or gnostic. Having dimensions N, they constitute by their deficient knowing and control a domain containing only their exterior: N-x, subjugating depth to shadows, one of which they are themselves.