A model for self-treatment of four sub-types of symptomatic 'depression' using non-prescription agents: neuroticism (anxiety and emotional instability); malaise (fatigue and painful symptoms); demotivation (anhedonia) and seasonal affective disorder 'SAD'.

This article will present a model for how 'depression' (i.e. depressive symptoms) can be divided into four self-diagnosed sub-types or causes which might then be self-treated using agents available without prescription. (Another, much rarer, cause of depressed symptoms is the classical illness of 'melancholia', which when severe cannot be self-treated and typically requires hospitalization.) A self-management option and alternative is now needed due to the an inappropriate emphasis of modern psychiatry on treatment of imprecise syndromal 'disorders' which may entail treating 'depression' at the cost of making the patient feel and function worse. By contrast, the basic theoretical stance of self-management is that depressed mood should be seen as a result of unpleasant symptoms - and it is the symptoms that require treatment, not the mood itself. Furthermore, drugs (or other interventions) need to be classified in terms of their potential therapeutic effects on these symptoms that may cause depressed mood. The four common causes of depressed mood considered here are the personality trait of Neuroticism; the state of malaise (fatigue, aching etc) which accompanies an illness with an activated immune system; demotivation due to lack of positive emotions (anhedonia); and the syndrome of seasonal affective disorder (SAD). Each of the four sub-types is then 'matched' with a first-line non-prescription agent. The 'stabilizing' agents such as St John's Wort and the antihistamines chlorpheniramine and diphenhydramine are used for treatment of Neuroticism; analgesics/pain killers such as aspirin, ibuprofen, paracetamol/acetaminophen and the opiates are used to treat malaise; energizing agents such as caffeine and nicotine are used for the treatment of demotivation; and bright light used in the early morning to treat SAD. Self-treatments are intended to be used after research and experimentally, on a trial-and-error basis; with self-monitoring of beneficial and harmful effects, and a willingness to stop and switch treatments. The model of S-DTM (self-diagnosis, self-treatment and self-monitoring) is suggested as potentially applicable more widely within psychiatry and medicine.

Genospirituality: genetic engineering for spiritual and religious enhancement.

The most frequently discussed role for genetic engineering is in relation to medicine, and a second area which provokes discussion is the use of genetic engineering as an enhancement technology. But one neglected area is the potential use of genetic engineering to increase human spiritual and religious experience - or genospirituality. If technologies are devised which can conveniently and safely engineer genes causal of spiritual and religious behaviours, then people may become able to choose their degree of religiosity or spiritual sensitivity. For instance, it may become possible to increase the likelihood of direct religious experience - i.e. 'revelation': the subjective experience of communication from the deity. Or, people may be able to engineer 'animistic' thinking, a mode of cognition in which the significant features of the world - such as large animals, trees, distinctive landscape features - are regarded as sentient and intentional beings; so that the individual experiences a personal relationship with the world. Another potentially popular spiritual ability would probably be shamanism; in which states of altered consciousness (e.g. trances, delirium or dreams) are induced and the shaman may undergo the experience of transformations, 'soul journeys' and contact with a spirit realm. Ideally, shamanistic consciousness could be modulated such that trances were self-induced only when wanted and when it was safe and convenient; and then switched-off again completely when full alertness and concentration are necessary. It seems likely that there will be trade-offs for increased spirituality; such as people becoming less 'driven' to seek status and monetary rewards - as a result of being more spiritually fulfilled people might work less hard and take more leisure. On the other hand, it is also possible that highly moral, altruistic, peaceable and principled behaviours might become more prevalent; and the energy and joyousness of the best churches might spread and be strengthened. Overall, genospirituality would probably be used by people who were unable to have the kind of spiritual or religious experiences which they wanted (or perhaps even needed) in order to lead the kind of life to which they aspired.

Despite their inevitable conflicts--science, religion and New Age spirituality are essentially compatible and complementary activities.

Until recently it seemed that the continued expansion of scientific ways of thinking was destined to render religion extinct and spirituality unfeasible. But the example of the United States disproves this, since America is the most successful scientific nation of this era, church-going remains strong and New Age spiritualities are thriving. Therefore, despite the obvious conflicts; science, religion and spirituality are essentially compatible. Future science will continue to win territory from religion since its validation procedures are more objective and reliable. However, churches can survive and grow by dropping those aspects of doctrine which clash with science, and expanding their social functions. The fast-growing US 'mega-church' movement shows the way - since these organizations are minimally dogmatic but instead provide a family-orientated and morally-cohesive social milieu. Like organized religion, New Age spirituality comes into conflict with science when it makes incredible or bizarre factual claims. However, in practice modern spirituality is based on subjective evaluations which do not clash with the procedures of science. Indeed, the reliance upon individual, emotion-based evaluations (e.g., 'my truth', 'whatever works for you') renders New Age spirituality 'science-proof', and has enabled it to expand massively in an age of science. Science, religion and spirituality perform different functions in the modern world, and their relationship is therefore one of mutual-dependence. Borderline disputes will inevitably occur, but as part of a broader context of complementarity. Science, 'social' churches and New Age spirituality all have a bright future.

Self-management of psychiatric symptoms using over-the-counter (OTC) psychopharmacology: the S-DTM therapeutic model--Self-diagnosis, self-treatment, self-monitoring.

Pharmacological self-management is becoming more widespread in modernizing societies, as part of a general expansion of health care. This may exert a vital corrective balance to the professionalization of health by ensuring that the individual perspective of patients is not neglected. There are many 'good ideas' for new treatments being published which have a plausible scientific rationale for effectiveness and a low likelihood of harm, yet are essentially ignored by mainstream medical research. The most likely avenue for progress is probably the spread of self-management, together with increased sharing of experience via the internet. There is considerable scope for self-management of psychiatric symptoms with psychoactive medication purchased 'over-the-counter' (OTC) and without prescription. A surprisingly wide range of effective psychoactive agents are available with the potential to self-treat many of the common psychiatric problems. These include 'medical' psychopharmacological agents such as analgesics and antihistamines, a plant extract called St. John's Wort (Hypericum), and physical treatments such as early morning bright light therapy. But self-management currently lacks an explicit therapeutic model. A three stage process of S-DTM - self-diagnosis, self-treatment and self-monitoring is proposed and described in relation to psychiatric symptoms. Self-diagnosis describes the skill of introspection to develop awareness of inner bodily states and emotions. A specific sensation is identified and isolated as the 'focal symptom' for subsequent treatment and monitoring. Self-treatment involves choosing a drug (or other therapy) which is intended to alleviate the focal symptom. Self-monitoring entails a continued awareness of the focal system and of general well-being in order to evaluate effect of therapy. Self-monitoring could involve repeated cycles of dose-adjustment, and on-off ('challenge-dechallenge-rechallenge') therapeutic trials. An example of S-DTM applied to psychiatry might include the attempt to alleviate the fatigue and malaise symptoms underlying a 'depressed' mood by using OTC analgesics such as aspirin, paracetamol/acetaminophen, ibuprofen or codeine. Anxiety symptoms might be self-managed either using an 'unofficial SSRI' (selective serotonin-reuptake inhibitor) such as the antihistamines diphenhydramine or chlorpheniramine; or with St John's Wort/hypericum.