Talk:Bipolar disorder/Archive 6

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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Contents 1 Off Label Use of APs 2 bipolar disorder caused by antidepressants 3 List of bipolar notables? 4 Editor 5 What contributions are needed? 6 Your recent edit seems to be to POV, please explain

Off Label Use of APs

I have a concern about smkatz edit of the first paragraph.

Treatment of disabling bipolar disorder is with mood stabilizers, prominently lithium salts and/or some anticonvulsants and/or anti-psychotic (also known as neuroleptic medications). When antipsychotic medications are indicated, they are often used "off-label". Such off-label usage is controversial. Some antipsychotics have recently been approved for management of acute bipolar mania crises.

To the best of my knowledge, the use of antipsychotic medications for Bipolar is not off label any more than anticonvusants. In most cases AP and AC use is in line with all of the current major treatment guideline publications in the scientific literature. For example, the American Psychiatric Asociation http://www.psych.org/psych_pract/treatg/pg/bipolar_revisebook_index.cfm I'd be very interested in seeing any other information you may have. Curlywhirly 23:56, 21 December 2005 (UTC)

bipolar disorder caused by antidepressants

This is a fairly common phenomenon which should be addressed in the article. When mania occurs as a result of antidepressant use (particularly SSRIs), the psychiatrist typically responds by labelling the patient bipolar and adding mood stabilizers into the mix. A more appropriate course of action would be to treat the patient for what he/she is actually undergoing: a toxic reaction to psychotropic medication. Francesca Allan of MindFreedomBC 04:16, 22 December 2005 (UTC)

Actually, when a psychiatrist diagnoses Bipolar disorder based on a manic or bad reaction to an antidepressant (or any med) they are mistaken. The DSM-IV specifically states that if the manic symptoms can be traced to any other cause, then Bipolar is not an appropriate diagnosis. You are right though, this happens all too frequently. Curlywhirly 05:44, 22 December 2005 (UTC)

Bipolar disorder is a real disorder that affects millions. Individuals are not treated with medications unless they display symptoms. Bipolar symptoms that are caused by an antidepressant would be infrequent occurances if they occur at all. If it is so common and frequent, it would be great to see citations. --24.55.228.56 13:14, 22 December 2005 (UTC)

It happens frequently and it certainly happened to me. It's a common enough occurrence that NAMI and others recommend mood stabilizers in addition to antidepressants. If you're truly interested, you could search the internet under "latent bipolar disorder" because that's what psychiatrists fraudulently try to attribute it to. Francesca Allan of MindFreedomBC 15:44, 22 December 2005 (UTC)

24.55.228.56, Yes of course Bipolar is real. However I must say that manic or manic type reactions to antidepressants are not as rare as we could wish. And the DSM-IV does specifically state that reaction to meds negates the BP diagnosis. Of course, the DSM-IV is not the perfect answer to everything, but it is the standard used by psychiatry at this time and so it does have relevance. In the Paxil prescribing information http://us.gsk.com/products/assets/us_paxil.pdf I found the following list of possible adverse reactions that could be or appear to be or may be related to manic/psychiatric reactions; Insomnia, Agitation, Nervousness, Anxiety, Hallucinations, Emotional Lability, Abnormal Thinking, Euphoria, Hostility, Manic Reaction, Paranoid Reaction, Antisocial Reaction, Delusions, Manic Depressive Reaction, Psychotic Depression, Psychosis. Other SSRI medications have similar adverse reaction profiles according to the manufacturers. I can list their PI pages if necessary so we can look at them individually if you wish. I think this may be an important issue to discuss in the article. Curlywhirly 18:14, 22 December 2005 (UTC)

Francesca, I am going to assume good faith, but I must say your comments come across very angry and condescending and my initial reaction was very negative. From what you have said you had a rough experience with medications and I think I understand having BTDT with multiple family members. However, it might be more useful in this Wikipedia arena and to helping others avoid the same pitfalls if we all provide fact based evidence to back up our concerns so that we can focus on writing the best article on BP to help the most people. Respectfully, Curlywhirly 18:14, 22 December 2005 (UTC)

Hi, Curlywhirly. You might be responding to my own response to some very condescending pro-psychiatry editors. I am endeavouring to provide further information so that others can be spared what I went through. Regardless of what the DSM says, the fact is that many depressed patients are treated with antidepressants, become manic as a result, and are forever afterwards treated as bipolar. Francesca Allan of MindFreedomBC 01:16, 23 December 2005 (UTC)

Francesca, your statements provide all the more reason to write the best, most fact based article possible for Wikipedia. If we hold to the standard of factual evidence rather than opinion it won't matter if the editor is pro- or anti- psychiatry. Facts are facts. Now, instead of telling people to look it up on Google for themselves, please provide evidence to back up your statements and refrain from making accusations, rather assume good faith just as I am doing with you. If you feel that BP caused by ADs is an issue that should be in the article, then please write it up, cite your sources and post it here for interested parties to discuss. Curlywhirly 06:38, 23 December 2005 (UTC)

Here is an article that deals with various adverse effects of SSRI treatment, including mania: http://www.mcmanweb.com/article-19.htm Francesca Allan of MindFreedomBC 01:51, 28 December 2005 (UTC)

I am very familiar with that article and the information therein. It does point out some serious problems with SSRI medications when given to someone with Bipolar disorder or other genetic vunerability to negative effects. However that is a very one sided article as the author did not cite ebven one bit of evidence of the *benefits* of these meds and the hundreds and even thousands of people who have been helped. I have no doubt about the problems associated with these meds OR the benefits, which is why we need to get fair and balanced information out, so that people can make informed choices. Curlywhirly 05:01, 28 December 2005 (UTC)

Hey, Curlywhirly. Most articles do present one side over the other, don't they? You won't find an article of Torrey's acknowledging the horrendous effects of psych meds, for instance. It's important that you understand that SSRIs can cause mania in someone who has never before had mania so a "genetic vulnerability" in such a case is very unclear and is more likely a psychiatrist attempting to cover up the harm done (by blaming it on pre-existing but invisible illness). As far as informed choices, the vast, vast majority of information on the internet and elsewhere is backed by Big Pharma so I think it's important that the other side gets heard. And, just so you know, I do think there's a place for medication but treatment has to be collaborative and not forced. Francesca Allan of MindFreedomBC 05:11, 28 December 2005 (UTC)

Yes, most everything you find will have the bias and POV of the author or whomever is paying for the article to be written. That is why an article with NPOV is so important on Wikipedia. Do you have any facts to back up your claims about psychiatry? I have yet to see you post a citation that directly supports any of your disputed statements. Instead you post innuendos and cast allegations. If you care to discuss facts then I am your gal, otherwise I have other things to do with my time and energy. Curlywhirly

I've posted several links to good information -- articles by Dr. Peter Breggin and journalist Robert Whitaker, just to name a couple. I've also posted links to organizations such as PsychRights and the International Center for the Study of Psychiatry and Psychology. In some cases, my links are deleted by pro-psychiatry editors. Most of the related articles on wiki aren't NPOV but rather heavily slanted in favour of biomedical psychiatry. Francesca Allan of MindFreedomBC 15:46, 28 December 2005 (UTC)

The problem with BP is that the psychiatric profession is based upon as much opinion as fact (for example, Neurontin was until recently thought to be an anti-depressant, but is actually just a placebo). Also, and not surpisingly, the psychiatric profession does little research on how inaccurate their diagnoses are (or are not). Anarchist42 15:59, 23 December 2005 (UTC)

Anarchist, can you provide some evidence to back up your assertions that psychiatry is based on opinion as much as fact? There are in fact thousands of studies working on finding the best information even as we speak. It is true that there is a tremendous lack of understanding of the brain and how it effects behavior and emotions. However the lack of complete information has never prevented the medical profession from attempting to help people, and new areas on understanding have often not been well received or trusted by the general population. Note: Neurontin was developed by the pharmaceutical companies as an anticonvulsant. It was then heavily marketed for Bipolar, but it proved to be ineffective and to even cause some people to become manic. There is a lawsuit over this issue. Experience and further research has shown Neurontin to be effective for certain types of pain, anxiety, and possibly migraines. http://www.pfizer.com/pfizer/download/uspi_neurontin.pdf http://bipolar.about.com/cs/neurontin/a/neurontin_suit.htm Curlywhirly 19:37, 23 December 2005 (UTC)

I realize that you didn't address your question to me but I'd like to point out anyway that psychiatry not being based on fact is patently obvious by the way psychiatrists approach the subject. The DSM contains detailed lists of symptoms with no regard to etiology. Psychiatrists match up their patients to the symptom lists and a psychiatric label is born. Without any evidence for underlying pathology, psychiatrists confidently pretend that the needed discovery that would legitimize psychiatry is "just around the corner" and in the meantime cheerfully inflict damage on their patients, many of whom do not even have the right to reject treatment. As unwanted effects arise from these medications, psychiatrists just expand the diagnostic spectrum. Treat a unipolar with SSRIs and create a bipolar. Great, because we've got even more drugs to prescribe for that one. Psychiatry, as a branch of medicine, is a sham and forced psychiatry is a severe human rights violation. Francesca Allan of MindFreedomBC 02:00, 28 December 2005 (UTC)

Back in the dark ages standard medical treatment consisted of blood letting and various other practices that seem crazy today. Would you suggest that doctors back then should have thrown in the towel and not done the best they could with the tools and knowledge they had? If not, then what are suggesting now? So far psychiatry has managed to start categorizing different problems and to figure out that something in neurotransmitters and/or structure of the brain is causing the suffering and illness people are experiencing. That's a heck of a lot further than medical science was around 1700. It is taking tremendous study and research to try to find the answers. Does everyone conducting the research have the best motive? Probably not.... but would you suggest that we not do the best we can with the tools we have? Rather than throw around accusations why don't you write up something positive and helpful, cite your sources, and post it so we can discuss how to make the best article possible to help the most people. My family has suffered doubly from the illness and from the treatments, but we can't just give up. And my family members *do* have their lives back, despite the difficulties. We have to keep trying to find the answers, and bitterness and anger won't help. Curlywhirly 05:01, 28 December 2005 (UTC)

Actually, in psychiatry, not much has changed. Treatment is still violent but perhaps slightly less barbaric. As for your question, my answer is Yes! It would have been much better if doctors had backed off and said Hey, we don't know what we're doing, let's try to make these patients comfortable, let's stop submersing them in freezing water and putting them into insulin comas. The neurotransmitter theory is bunk (so far, anyway). We know next to nothing about how emotions affect the brain and vice versa. I'm not "throwing around accusations." I'm just pointing out the abuses that psychiatric patients face every day and questioning people when they make unproven statements such as "mental illness is a neurological disorder." As for "positive and helpful," the best advice I could ever give anyone is to run, not walk, away from psychiatric treatment. Mental illess is real and sometimes disabling. Get real help with the underlying issues and don't rely on masking symptoms. Francesca Allan of MindFreedomBC 05:19, 28 December 2005 (UTC)

Not much has changed... yet. That's my point! They didn't start really working on this til 50 years ago or so. Medical science has been in process of finding cure for somatic problems for thousands of years. Cite a source for the neurotransmitter theory being bunk? Cite a source on what the "real underlying issues" are? Cite your sources or else all you are doing is making baseless accusations. Curlywhirly 17:48, 29 December 2005 (UTC)

Nonsense. Society has been torturing the mentally ill since the beginning of time. I can't give you the one source that would open your mind but please consider checking out www.icspp.org, www.psychrights.org, www.mindfreedom.org, etc. and see for yourself what researchers are working on. Read Robert Whitaker's "Mad in America." Read about Dr. Loren Mosher's work at Soteria House. There's not one "real, underlying issue" behind mental illness and the fact that you demand an answer in that form shows your bias. You're demanding a simple medical answer to a complex human question. The causes of mental suffering are extremely varied and psychiatry does mental patients a huge disservice by their one size fits all theories such as trying to pathologize the huge spectrum of human emotions by simplistic models (e.g. depression = low serotonin). In my opinion, people "go crazy" because reality is too painful to bear. I am not making baseless accusations. I have been the recipient of involuntary psych treatment and was almost killed by it. I have a "severe mental disorder" yet I found my own methods of coping that don't involve toxic drugs. I don't have to prove that to anybody by citing a medical source as I am living proof that psychiatry can be rejected and I am certainly not alone in my experience. Francesca Allan of MindFreedomBC 01:25, 30 December 2005 (UTC)

Your reference to Neurontin proves my point: there were no facts to show that Neurontin did anything at all for BP, yet all it took was the opinion of drug salesmen to convince psychiatrists that their patients should buy it(note that none of us have yet received a refund from the manufactured nor an appology from our psychiatrist). Anarchist42 20:02, 23 December 2005 (UTC)

Anarchist, the purpose of the lawsuit is to right the wrongs you mentioned. My point in mentioning Neurontin is to provide the accurate facts about the medication. I do know and understand that there is some truth in what you say, but I still don't see you providing any factual evidence for any of your claims. Why don't you write up what you think needs to be in the article, cite your sources, and post it here and we can discuss it and get the best information into the article? I have no interest in debating opinions and accusations but would appreciate discussing factual evidence. Curlywhirly 20:12, 23 December 2005 (UTC)

(Actually, since all patients did not benefited from the lawsuit, it didn't really right all the wrongs) The factual evidence was provided in court, where the drug corporation admitted to lying to and bribing psychiatrists. In addition, since there were no actual peer-reviewed studies to show that Neutontin helped BP, the only logical conclusion is that psychiatrists relied solely upon opinion rather than actual facts. Anarchist42 20:27, 23 December 2005 (UTC)

List of bipolar notables?

What would anyone think about the addition of a list or a category of famous, notable and brilliant folks in history who were bipolar, like Mozart? Chris 19:15, 30 December 2005 (UTC)

There is a start the external links section. I think this would be a great addition. if you wanna write it up. *smiles* Curlywhirly 19:48, 30 December 2005 (UTC)

I think posthumous psychiatric diagnosis is ridiculous and serves no purpose whatever. Francesca Allan of MindFreedomBC 02:53, 31 December 2005 (UTC)

Although definitive diagnosis of the dead is impossible, there are some cases (George Gordon Byron is an example in point), where it seems very likely from their detailed life history, that the person suffered from bipolar disorder. Our modern post-Kraepelin understanding of bipolar disorder and its highs, lows, and vicissitudes can illuminate Byron's life far more than regarding his behaviour as inexplicable, or assuming that poets and romantic geniuses are simply different from the rest of us, or merely saying "Byron was bonkers".

However, this article is not the place for stamp-collecting famous bipolar people; this article is long enough as it is. Probably the best thing to do is to put it in a separate list, and list it in "see also". -- Karada 01:15, 2 January 2006 (UTC)

Since definitive diagnosis of the living is also impossible, I concur with your very first point. Francesca Allan of MindFreedomBC 01:56, 2 January 2006 (UTC)

Editor

I've been reading this entire discussion as a non-involved outsider. I have bipolar one, and have dealt with issues of medication, misdiagnosis, genetics - the same as many here. However, my personal experience is not relevant to this article. And were I not informed about my condition, I would be pretty confused by this article right now.

Agreed, this article has become more confusing and disorganized recently. Anarchist42 19:40, 6 January 2006 (UTC)

From the NPOV policy:

"The neutral point of view attempts to present ideas and facts in such a fashion that both supporters and opponents can agree.

The NPOV of wikipedia is what makes it so usefull (knowing all sides of a topic make it much easier for readers to form their own informed opinion). Anarchist42 19:40, 6 January 2006 (UTC)

Some examples may help to drive home the point I am trying to make:

1. An encyclopedic article should not argue that corporations are criminals, even if the author believes it to be so. It should instead present the fact that some people believe it, and what their reasons are, and then as well it should present what the other side says.

LOL. The gap between what the psychiatric industry believe and what their patients believe is huge, a fact which should be made clear while presenting both views in a reasonable manner. (Note that at least one drug corporation admitted in court to the massive scam of selling a placebo called Neurontin to BPs) Anarchist42 19:40, 6 January 2006 (UTC)

Perhaps the easiest way to make your writing more encyclopedic is to write about what people believe, rather than what is so. What people believe is a matter of objective fact, and we can present that quite easily from the neutral point of view."

I am an editor by profession, and I would love to take a crack at this article...not so much the content as removing some redundencies. But honestly, I am hesitant to do so because there seem to be NPOV issues right now with this topic. And I think we can ALL get both accepted body of knowledge (whether we agree with it or not) and alternative views expressed here. But to do that, we have to say "this is the currently accepted body of work." And "however, some believe that X is true."

If we can agree to that format, I would like to really work on this article as an editor, not a content provider, because that's where I can really add value. JB

Perhaps we should take it one section at a time for now? Anarchist42 19:40, 6 January 2006 (UTC)

Sounds great to me.  :) Any section you want to look at first? I noticed this article is tagged as needing to be shortened. JB

Top down should work Anarchist42 18:34, 7 January 2006 (UTC)

I'm with JB, and you, too, A42. I've tried to begin creating a consistency in format through the psych pages, beginning with Overview, Diagnostic Criteria. That's about as far as I've gotten.

Content-wise, take a look at what I did last night. I re-wrote the intro, cleaned up Co-occurring conditions, removed redundancy and nonesense from Diagnostic criteria (which needs expansion to be compliant across pages...my DSM is in my office), consolidated some sections, and removed some sections (redundant one liners) completely.

Keep in mind that the DSM is outdated with respect to BP. Anarchist42 18:34, 7 January 2006 (UTC)

How so? Clinically speaking, the DSM-IV-TR is still valid, until the DSM V comes out in 2006. Anything else is POV, is it not? Help with this... --70.135.192.93 13:49, 8 January 2006 (UTC)

Mood Spectrum needs to be moved -- probably up, some work done, and some cites added...but [[User:Mcman|Mcman] wrote it and, moving forward, it appears that it would be prudent for me not to touch anything he's got his hand in. --Mjformica 17:19, 7 January 2006 (UTC)

What contributions are needed?

What type of contributions would add value to this link? We are adding video content to our site Bipolar Treatment, but really want find a way to make this site more helpful for those searching for Bipolar information. We do not want to spam the article but really think we have a professional opinion on the subject. Would very much appreciate any feedback.

It is a secondary source and hence not very useful compared to directly cited journal articles. Please review Wikipedia:Reliable sources. JFW | T@lk 22:28, 21 January 2006 (UTC)

Your recent edit seems to be to POV, please explain

I'm new to this so please excuse any procedural bumbles.

I do not believe my edit is POV. My intention was for the introduction to better reflect the large body of scientific opinion (and sufferer experience) which does not conceptualise mood problems as necessarily reflecting an 'illness' to be dealt with via a medical model.

The medical approach is of course just one of many that claim to scientifically address mental (dys)function. I believe it is misleading (although typical of official psychiatric sources) to exclusively assume medical axioms and terminology, especially in an introduction. Even the quote from the sufferer (obtained from/selected by the NIMH I believe) refers only to 'medical care' rather than any other kind of care or support.

For this reason, I would add that I disagree with the above suggestion that mental health pages should be structured like medical pages into "signs and symptoms, diagnosis, mechanisms of disease, treatment etc". This would be implicitly assuming a paradigm which developed to address distinct problems with the 'hardware' of the body, but applying it indiscriminately to an area which is also about higher-level functioning in a social context (rough analogy to software). Shouldn't the articles acknowledge the range of scientific and reasoned approaches as far as possible in the introduction - or at least adopt the lowest common demoninator initially, e.g. talking of mood problems rather than a mood illness - and then be clear within the article when taking the perspective of a medical model or another model or approach?

I do agree with the above suggestion that the spectrum view of these problems should be more prominent. It seems to be very clear (and acknowledged within psychiatry, though not usually highlighted) that there isn't a single bipolar disorder but a range of problems that merge imperceptibly into 'normal' mood variance. The same goes for many other mental health problems of course.

I would be interested to make further edits of mental health pages in line with this approach, backing up with citations, after any feedback. Franzio 18:53, 22 February 2006 (UTC)

p.s. The Wikipedia mental health pages seem to be based on public material from NIMH, National Institute for Mental Health. Yet every page on its website has the banner: "Working to improve mental health through biomedical research on mind, brain, and behavior" (emphasis mine). This is therefore not an impartial source, it is an organisation that works exclusively within a medical model (and it shows). NIMH is also exclusively American - under 'Facts about NIMH' and 'Mission Statement' it states 'we harness powerful scientific tools to achieve better understanding, treatment, and eventually, prevention of these disabling conditions that affect millions of Americans".

Franzio, your point is well taken. However, as I have learned, you must think like a journalist here, and not an academician or scholar. If a page surveys a particular topic, then we have to start with the common wisdom on that topic, and expand it from there.

Since the average reader's exposure to, in this case, mental health, has likely been through a counselor, social worker, or school psychologist, and those individuals are trained from the medical model standpoint (no matter their personal position or style), it stands to reason that the average reader starts from that point. It is my feeling that this perspective is implicit in the presentation here.

Rough analogy -- if you go to your doctor with symptoms of Lyme disease, with the expectation of a 30 day anti-biotic regimin, and s/he starts talking about Spirokete, Lyme-D, Aloe Vera Juice, and Arnica Montana -- a legitimate non-traditional remedy -- right off the bat, it'd be awfully confusing. If s/he said, "This is what we usually do, but this is an alternative re-dress...", it's more palatable.

Further, Wikipedia is somewhat "authority poor", as one of our fellows put it, so there is a relience on available material that pales against InfoSeek or the Dissertation Abstracts International. No comment against our fellow writers, or their sources...it's all about perspective and doing our best with the tools we have available. --Mjformica 12:32, 2 March 2006 (UTC)

Hi, Mjformica tells me this in regard to the above: "Actually, a great deal of your work here has been, and continues to be, POV. Kindly bear in mind that this is venture is collaborative. Major edits are to be discussed. And minor edits should be just that. Further, as an example of your positionality, changing a single phrase that you consider to be "labrynthine" (nice word) is about you...that's POV. Changing it without the prejoratives would be just as effective."

My intention here was to provide you with some general guidelines, for which you asked. My intention was not to offend you in any way. Nor was I referring to anything specific. I was unclear in my presentation. This, "a great deal of your work here has been, and continues to be, POV" might have read, "a great deal of your work here might be perceived as POV." You have a strong hand, as do I, and it shows. I applaud that.

Please can I ask Mjformica to address these issues in this open forum where I was asked to address them. And can you be more specific. 'Major edits are to be discussed' - I agree and I am sorry if you are referring to my initial bipolar edit which you feel was major, it was my first attempt and trying to be bold. 'Minor edits should be just that' - if I have marked an edit as minor that you feel is not, please clarify otherwise I cannot learn (sometimes I have made a few edits of the same paragraph within a few minutes, despite previewing beforehand, and so marked the latter changes as minor thinking that would help, perhaps you refer to that).

As this was not referring to anything specific, hence your Talk page was the appropriate forum.

I'm not sure what your point is regarding 'changing a single phrase'? The word 'labyrinthine' was used by Vaughan, which I discussed with him on the Schizophrenia talk page.

My apologies...the history page made it appear that the word was yours, and I felt the comment was harsh. Notice, "I felt"...POV, mine.

I feel that you are erring towards being unfair and abrubt in this message and in your initial comments to me on the Borderline Personality Disorder talk page. If you feel I have made a POV edit or suggestion, please raise it. For the record, I am very clear that Wikipedia is a collaborative NPOV approach, something I very much admire and value, and I'm not sure how unspecified accusations of POV and 'positionality' help. Franzio 12:24, 2 March 2006 (UTC)

There was no accusation intended. And I am abrupt...much to the dismay of many here, but I'm working on it. If you read the post above, you will see that I am attempting to sheperd a valued asset here (you), as I have was sheperded by others here, with regard to the filtered application of our talents. It is, as I noted, one thing to write as an academician, and another to write as a provider of general information. --Mjformica 12:43, 2 March 2006 (UTC)

Well, thank you for clarifying your intentions and perceptions and for making sure I am aware of these issues. I posted my reply to your personal comments before I saw your reply to my general comments incidentally.

Regarding the substantive points about assuming a medical approach:

I wouldn't say that counsellors, social workers, or (school) psychologists are trained in a medical model, so we must be meaning different things by the term. The theories and approaches learned and applied by these professionals are often drawn from psychological and social fields without recourse to (and are often alternatives to) medical concepts and frameworks. Of course they also learn and work with those concepts and frameworks.

Your wider point that the public have a primarily medical perception of mental health and so expect this upfront - I agree to some extent, although I would say that much of the public do not, or are aware of alternative approaches. Your analogy concerns a medical doctor who would be expected to reflect the standard medical line, but in regard to issues of mental distress and function the situation is less clear-cut. I do recognise that the term being explained is primarily psychiatric in origin and common presentation, but I think the context of this can also be clear from the start.

I agree with your points about academics and source material, I think this applies equally to medical as to less medical approaches. Franzio 14:16, 2 March 2006 (UTC)