Sunday, August 01, 2004

Capitol Hill Blue Critique

Inteeliseek's Blogpulse lists this the most-linked-to article:

Bush Using Drugs to Control Depression, Erratic Behavior
Editor, Capitol Hill Blue
Jul 28, 2004, 08:09

President George W. Bush is taking powerful anti-depressant drugs to control his erratic behavior, depression and paranoia, Capitol Hill Blue has learned.

The prescription drugs, administered by Col. Richard J. Tubb, the White House physician, can impair the President’s mental faculties and decrease both his physical capabilities and his ability to respond to a crisis, administration aides admit privately.

“It’s a double-edged sword,” says one aide. “We can’t have him flying off the handle at the slightest provocation but we also need a President who is alert mentally.” [...]

 After reading the article quoted above, I noticed that the same source has a similar article:

Sullen, Depressed President Retreats Into Private, Paranoid World
Capitol Hill Blue Staff
Jul 29, 2004, 09:08

A sullen President George W. Bush is withdrawing more and more from aides and senior staff, retreating into a private, paranoid world where only the ardent loyalists are welcome.

Cabinet officials, senior White House aides and leaders on Capitol Hill complain privately about the increasing lack of “face time” with the President and campaign advisors are worried the depressed President may not be up to the rigors of a tough re-election campaign.

“Yes, there are concerns,” a top Republican political advisor admitted privately Wednesday. “The George W. Bush we see today is not the same, gregarious, back-slapping President of old. He’s moody, distrustful and withdrawn.” [...]

I checked on the citations at Blogpulse, and they mostly just echo the article.  I did not see any thoughtful commentary.  Since this is a subject I happen to know something about, and I did not find any other informed commentary, I decided to chime in.   Although I tend to be critical of Mr. Bush, and do not think he should be re-elected, I hate to see incorrect information about any important topic.  This critique is not so much a defense of Mr. Bush, but an effort to clarify certain aspects of the two articles reported by Capitol Hill Blue.

Of course, I have no way of knowing if any of the information in the articles is correct or incorrect.  For the purpose of this critique, I will assume that the authors are reporting the truth as they know it.  I also will assume that they are correct in describing the specific medication used as an antidepressant.

First, the 7/28/04 article mentions "powerful antidepressant drugs."  This is a peculiar statement, as all antidepressant drugs are equally likely to have a beneficial effect, when used properly.  There really is not any meaningful way to rate some as more powerful than others. 

Second, the same article states that they medication "can impair the President's mental faculties and decrease both his physical capabilities and his ability to respond to a crisis."  While it is true that such medication can have adverse effects, normally one would not expect any significant impairment.  If such adverse effects occur, the physician ordinarily would address that by stopping the medication, changing the dose, or switching to something else.  There are times when it is advisable to continue the medication even in the face of adverse effects that result in impairment.  However, that would only be the case in the presence of severe, treatment-refractory illness.

Third, in a section of the 7/28 article that I did not include above, it is stated that "the reports were later confirmed by prominent George Washington University psychiatrist Dr. Justin Frank in his book Bush on the Couch: Inside the Mind of the President."  They do not tell us which reports were confirmed.  Does Dr. Frank have some way of knowing that Mr. Bush is taking medication?  Probably not.  What Dr. Frank allegedly confirms is not any report  about Mr. Bush; rather, what he confirms is the conclusion  that Mr. Bush has behavioral problems. 

Dr. Frank's book sounds interesting, but not enough so that I would actually spend money to buy it.  I did, however, read some of the reviews at Amazon.  It appears that Dr. Frank has written thoughtfully about Mr. Bush, but I would be cautious about drawing any specific conclusions from it.  Like any academic work, it requires a certain amount of training to be able to interpret it accurately.

Fourth, in the 7/29 article, it is stated that "Psychiatrists say the increasing paranoia at the White House is symptomatic of Bush’s 'paranoid, delusional personality'.” I do not know what meaning I can derive from a statement that says, essentially, the paranoia is symptomatic of paranoia.  Furthermore, it is not technically correct to refer to a 'paranoid , delusional personality."  I hope that there are not very many psychiatrists who would say that.  Technically, there are two levels of paranoia.  Paranoid Personality Disorder (DSM-IV 301.0) refers to a form of paranoia in which the person is excessively suspicious, but is not out of touch with reality.  Delusional Disorder (DSM-IV 297.1) refers to a condition in which a has paranoid delusions, meaning that the person really believes that he is being persecuted (as opposed to being excessively suspicious).  In Delusional Disorder, the suspiciousness is incongruent with reality.  By definition, then, there is no such thing as a paranoid delusional personality.  If a person has paranoid delusions, he or she does not have Paranoid Personality Disorder.

Fifth, in the 7/29 article, they mention, "Dr. Frank also concludes that Bush’s years of heavy drinking 'may have affected his brain function – and his decision to quit drinking without the help of a 12-step programs puts him at a far higher risk of relapse'.”  This is true -- the drinking may have  affected his brain function.  And it generally is true that those recovering alcoholics who attend AA are at lower risk for relapse than those who do not.  But again, I would be hesitant to present those as firm conclusions.  I happen to agree that some of the behaviors described in the Capitol Hill Blue articles often are seen in persons who have brain disease as a result of alcoholism.  (In fact, I said so myself, in my 2/16/2004 post.)  Without knowing more specifics, though, inferring a causal relationship is questionable.  Furthermore, if the behaviors are due to alcoholism, whether or not the person is drinking currently, it would not be correct to give a  diagnosis of either Paranoid Personality Disorder or Delusional Disorder.  Instead, one would use either the Personality Disorder Due to Alcohol Abuse diagnosis (310.1), or Psychotic Disorder due to Alcohol Abuse, with Delusions (293.81). 

Finally, in the 7/29 article, the authors state: "The doctors also worry about the wisdom of giving powerful anti-depressant drugs to a person with a history of chemical dependency."  This does not seem realistic.  Antidepressant medications do not have properties that would lead to abuse, and often are given to persons with chemical dependency.  Thirty years ago, such concerns were held widely, and even now, some of the more traditional AA adherents will say "a pill is a pill," meaning that all persons with chemical dependency should avoid all mind-altering substances.  This attitude is becoming much less prevalent, as we gain more experience with the medications.

In conclusion, I must say that that the inaccuracies and misperceptions in these two articles lead me to suspect that they were not researched very well, or they were deliberate attempts to criticize Mr. Bush, with a casual disregard for accuracy.  I still won't vote for the guy, but hate to see him criticized unfairly.  There are plenty of valid reasons to be critical; we do not need to rely on ones that are not verifiable. 

(Note: The Rest of the Story/Corpus Callosum has moved. Visit the new site here.)
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If you visit TBR News you will find that the Capitol Hill Blue stories echo some of the memos that have been sent in to the site; they are 'allegedly' from someone in the press pool & he has been sending these tips to TBR for some time.Not sure why they didn't credit the site. Some very disturbing memos there, & he/she says some of it is on tape. You may want to meander through the archives.
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