Thursday, September 24, 2020

Comments by Steve McCrea

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  • I think the biggest problem with even quality therapy is that it is not really the proper mode to deal with current or ongoing abuse or oppression. It can be valuable for a person to discuss the pain of living with a dead-end job, and may even help motivate a person to seek a better one, but it can’t take care of the question of why so many jobs are dull and lifeless and why so many people are forced to work in them for inadequate pay in order to merely survive to face another day. Therapy can be valuable, but it is limited and can’t really handle the bigger social issues with which our current Western society is riddled.

  • Yeah, I think I’d volunteer for that one. Except if you’re a kid, they might lock you in a “residential treatment home” until you learn to knuckle under.

    The best diagnosis is “don’t know what happened to that guy – he seems to have disappeared.”

  • Lack of long-term outcome data means you have no idea if your “treatment” is actually effective. Which means from a purely scientific viewpoint, your “treatment” is not legitimate. We assume something doesn’t work until proven that it does, not the other way around. That’s how science is supposed to work. Anything else is marketing.

  • Well, of course, the algorithm is only as good as the programmer. I’m sure someone could program a discriminatory app. But at least they won’t have to manage their emotional reactions to our statements, appearance, etc. I’m sure they’d totally suck, because they’d be made by people who have no comprehension of what is helpful, otherwise, they’d realize that a computer can’t provide what is needed.

  • Hey, people do it all the time. I was just making it clear that there is a difference between people calling someone names because they don’t like their behavior vs. calling someone official names with the power of a medical degree behind it. It’s still name calling, and I am generally opposed to name calling, as it is usually very unproductive and avoids planning to overcome the problem. But there is a very important difference in quality between being called a name by someone who is no more or less powerful than you are vs. being officially sanctioned by the medical profession to call people names as “medical diagnoses.” The second is far more insidious and destructive.

    Hope that makes my point clearer. At least in the colloquial situation, we KNOW it’s a matter of name calling or generalizations with no scientific basis. No one is pretending that the other person “has” some brain problem or whatever. They’re just saying the othe person is a jerk.

  • Nah, they just liked high school for some inexplicable reason. I guess maybe they would miss their friends, but I didn’t have that many, and in any case, I could still be friends with them absent the authoritarian regime. And that was in the days when we had MORE freedom in high schools, right at the end of the 60s “student rights” movements. Student rights have massively deteriorated since that time, in my observation, other than that physical abuse has been MOSTLY outlawed.

    My high school was in suburban Philadelphia. Supposedly one of the top 10 public high schools in the country. And there were a lot of good teachers. But it was still school.

    And there were still a few, like Mr. Mims, who probably belonged in jail. Even as naive as I was back then, I suspected he was sleeping with at least one of the students.

    I guess I’m impatient with injustice and authoritarianism. Probably a “mental illness” of some sort. Otherwise, I would have loved being pushed around and bored and bullied and neglected and prevented from exploring anything not on the curriculum. What was wrong with me?

  • “Narcissistic” is a colloquial description of a certain kind of behavior, kind of like “cowardly” or “noble” or “conscientious.” “Narcissistic Personality Disorder” is an alleged “mental disorder” that can purportedly be “diagnosed” by people with a “professional background.” What would you think if they diagnosed someone with “Cowardly Personality Disorder?” Wouldn’t that seem pretty far out there, to take a set of personality characteristics and call it a name and then claim it is somehow a “diagnosis?”

    You could replace “narcissistic” with “childish” or “selfish” or “ill tempered” or “thoughtless” or “mean-spirited” and it would still just be a description of a person’s behavior. A description of a person’s behavior can not logically be a medical “diagnosis.” That’s the difference.

  • I remember they had an overnight party the day of graduation, with a hypnotist and dancing and punch and the usual entertainments. I saw different clutches of kids hugging each other, some with tears in their eyes, talking about how sad they were it was all over. I was thinking, “What high school did YOU go to?” I am sure that their experiences were very real to them and I admire them for being able to emote about them publicly, but it was TOTALLY unreal to me. I felt a huge weight off of me, along with the thought, “Wow, I’m free! Now what am I going to do with my life?”

  • I think you’re making total sense. My point is only that there are, in fact, any number of imponderables, and it is possible, even likely, that some measures in place are not particularly helpful while there are others we will later learn we ought to be doing. We’re flying blind to a large extent, as there is not much prior experience to draw on, and we don’t have time to do controlled experiments. So “playing it safe” and reducing risk is probably the best we can do. But I do think it’s important to acknowledge (not saying that you aren’t) that our knowledge is limited and to some extent we’re making educated guesses as to what will be most helpful, which explains at least in part why at first we were told no masks, then we were told to mask up. New information is coming in and best practices will change as we learn more.

  • Because traditional meditation approaches are grounded in Hindu and Buddhist spirituality, I see meditation as being utterly incompatible with psychiatry. “Mindfulness” is something appropriated from Buddhism without the nasty entanglements of silly questions like “What is a person?” and “How should I conduct myself on Earth?” and “What happens when I die?” Buddhism is based on the assumption that we are spiritual beings who suffer because of our own attitudes toward life, and offers a means of attaining greater peace and satisfaction through expanded use and understanding of our minds. Psychiatry teaches us that we are bodies, that there is no spiritual existence, that the mind is just a function of the brain, and that the mind is incapable of having more than a marginal influence on a person’s “mental health.” Meditation in every way contradicts the basic tenets of psychiatry, unless you go for “McMindfulness” that says you can sit there and breathe and it can calm you down. Which can be true, but it certainly misses the point, especially when people are told they HAVE to meditate or are shamed for failing to “succeed” at it.

  • Do we know that reduction of droplets extruded reduces the likelihood of infection when distancing and surface sanatiziation and hand washing are all in effect? A recent study showed that outdoor transmission almost never has been shown to occur. So maybe we should only wear masks indoors? There are lots of imponderables, which is my point.

  • It seems that only a certain number of comments in a thread can “nest” as replies, after which they are just listed one after the other, with no “reply” button. You have to go back up the chain to the last one that had a “reply” button on it if you want to continue on this thread.

    I agree that there are things which are concretely known and some which are purely speculative, but there are also partly-knowns which have to be evaluated, and that’s where a lot of conflict occurs. For instance, it is known that COVID19 virus can be found in droplets in the air 2-3 hours after they have been deposited. But what does that mean? Are they still infectious at that point? Do ACTUAL cases get passed that way or don’t they? Is this important for people who are infected to prevent spread, or people who are trying to prevent infection in themselves? These are all questions that people are willing to weigh in on heavily, either shaming people for not wearing masks or dismissing the possible risks as nothing but hype. The truth is, we don’t know if masks help or not, or how much, or on whom. A lot of this stuff is guessing.

    As to how Trump is handling all this, again, I think this subject is pretty well pooped out, and I’m going to ask more directly that the two of you move on from this subject, as it is now deteriorating into a more personal “thing” that is not productive.

  • Posting as moderator:

    I agree that this exchange has been interesting, but has perhaps reached as far as it can go. I think we’ve seen both perspectives fleshed out pretty thoroughly, and I doubt very much if either of you will sway the other. Part of the challenge of this set of events is the inability to know what information is reliable or not. I think this exchange makes that point very clear.

  • “The problem is that common approaches to deploying AI tools are not improving outcomes.”

    No, the problem is that common approaches to “helping” with mental/emotional/spiritual distress don’t improve outcomes, and no amount of AI is going to change the fact that the basic model of distress and helping is fatally flawed. Well, flawed unless your “outcome” is increased profits. Maybe that’s what they mean – AI isn’t improving income, therefore, it isn’t working?

  • I wasn’t so much bullied by peers as by teachers (we had some mean ones!), plus very lonely and bored out of my mind. I hated taking arbitrary orders from anyone, and still do. Particularly when I was smarter than most of the teachers and was always way ahead in almost every subject, which instead of counting as a positive made me a problem for them. The kids who liked school were the ones who had lots of friends, mostly, or the ones whose home lives were so bad that school seemed like a big step up. I was neither, and I hated every minute of elementary school. Junior high was only better because they had sports and I was a good athlete, and so finally got a few friends, too. When I graduated high school, I felt like the allied troops had freed us from the POW camp!

  • Well, we wouldn’t want to get in the way of commerce, now, would we? What about the danger to the individual of a poorly-programmed driverless truck? Oh, but I guess actual PEOPLE would be expendable in this futuristic world.

  • That’s been my experience, both as a helper and as a “helpee.” These “disorders” are just a way of experiencing the world, and we have to be the ones to decide what is and isn’t the best way to approach it. Most of the time, people have adapted to difficult circumstances by developing a way of thinking about the world or interacting with the world that seemed to work at the time. So accepting that these thoughts/behaviors/emotions have served a purpose, and then asking oneself what purpose they continue to serve, has been a successful path for me. Others would frame that differently. But in any case, what is helpful is NORMALIZING the experience as part of your own process, rather than externalizing it and making it seem like “OCD” or “ED” is some external agent that is attacking you! It reminds me a lot of demon possession. Not saying some people might not find it helpful, but it sure seems counterproductive to me.

  • A lot of science is also rooted in what is known NOT to be true. It’s a lot easier to disprove a hypothesis than it is to prove one unequivocally. The most certain data in science are which theories are absolutley wrong. Unfortunately, these days such vital information is often buried or at least not published. Especially when conflicts of interest are involved. Peer review’s job ought to be to poke holes in the methods or conclusions of the researcher based on the data. Unfortunately, that role is not always played fully by the reviewers these days.

  • I think calling it a “disorder” IS shaming! THe non-shaming approach is to assume that it is a normal reaction to circumstances, or else a manifestation of a legitimate and observable physiological problem (lack of sleep, thyroid problems, etc.) It is hard to think of a much more shaming approach than to say your emotions mean nothing, your brain is broken, but there’s nothing anyone can do to actually fix the problem, it’s just you have an inherently bad brain. Tough luck!

  • A point I have always shared and agreed with. Corporations are a force of their own and are often subject to no government at all, yet can do as much ore more damage than any government, and many of the problems with government (though certainly not all) are due to their being in bed with Corporations and/or Crime. And I do see an increasing crossover between Corporate and Crime that also needs to be addressed.

  • I stand by what I said. And it does appear that you misinterpreted my comment. While it does come across as rather flippant, nothing in that comment says that JWR or beer or “antipsychotics” have no effect. All I am saying in this comment is that just because something DOES have an effect that someone likes does not make that something a “treatment” for a “disorder.” Alcohol reduces anxiety significantly. It’s a fact. Why isn’t it considered a “treatment” for “anxiety disorders?” I certainly used it as a teen and young adult to reduce my anxiety in social groups, and so do lots of other people. How is this different from taking Xanax?

    You say “APs” saved your life. I have no desire or data to disagree with or refute your reality on that point. Other people say “APs” ruined their lives, including ruining their health. Neither you nor I have any data to disagree with or refute their reality, either.

    The only real point here is not to confuse a drug’s effects, which may be perceived as positive, negative or neutral, as evidence of any particular “mental health” issue being present or absent. We don’t diagnose cancer based on whether people feel like cancer treatment worked. We don’t diagnose a skin rash based on whether steroid cream makes it go away or not. We look for the CAUSE.

    We should not diagnose “mental disorders” based on people’s reaction to drugs. I don’t want to prevent people from using substances they find helpful. I just want to keep doctors away from “diagnosing” people with speculative “diseases” that no one can objectively observe to exist.

    OK, I broke my vow. That’s really it, Martin. No more.

  • I absolutely agree, Trump is NOT the problem. Which is why simply removing him is NOT the answer. He’s a symptom of a much larger, more difficult problem that besets our whole society. But it’s easier to blame Trump and imagine that somehow if Biden gets elected things will magically improve. I hope people aren’t holding their breath for that one.

  • Sometimes we believe we can change things, or the pile of data doesn’t reach critical mass until a certain point. There are many of us here who had “epiphanies” at one time or another in our lives/careers. At a certain point, I think a person comes to see that it’s not just a matter of confusion or needing training, it is the intention of the SYSTEM that is wrong headed. I’d guess a DSM IV conference would make that point pretty clear to anyone who was participating.

  • So you can’t see the difference between, “The majority (defined as more than half) of scientific studies can’t be replicated” and “Scientific data is not replicable?” Even when I stated clearly that TRUE scientific data IS replicable (around half of the studies I’m talking about), and that this is the only way we can tell if it is true? To put it another way, half of what is put forward in journals as “scientific data” later turns out to be false. Does that state it more clearly? Data that can be replicated are true, those which cannot are false, scientifically speaking. So SOME scientific studies can be validated, but according to the article, more than half cannot be replicated. Which leaves us with plenty of valid scientific data, it’s just a lot less than we’ve been led to believe by leaders in the medical/psychiatric industries. I refer you again to the Viiox scandal. We were told that it was safe, when there were plenty of studies saying that it wasn’t. But those studies were hidden and not published. The studies used to promote its safety could not be replicated, and the drug company promoting Viiox knew this but chose not to share. The studies they used were false. They were put forward as if they were true by people who knew they were false, but who had an interest in profiting off of Viiox’s sale and use. That seems pretty simple to me.

    You never did read the article, did you? It would really help if you did.

    We really need to end this. It seems we are unable to listen to or understand each other’s viewpoints. For you to suggest that I have ever said that antipsychotic medication has no effect on people shows how far we are from being able to communicate.

    I am not going to respond to further comments from you on this topic. I would suggest that if you find the comments here offensive, you might do better to seek another community that is more comfortable for you and aligns more closely with your values. I certainly have no intent to frustrate you, but it is apparent from our conversation that you are not getting what I’m saying, and I’m sure you feel the same way. So let’s just stop, OK?

  • There is nothing in the first statement that contradicts the second. Both say that the majority of today’s scientific research is not replicable. Majority means more than half. If you read the article, you’d perhaps understand why I’m saying that. Scientific analysis of the data says that over half of scientific studies are not replicable. I suppose that study could be wrong as well. But that’s why I read them, so I can make up my own mind. I wouldn’t believe the article unless I read and analyzed it myself. Which is the real point here.

  • Again, I did not say that scientific data is not replicable – you are putting words in my mouth. You either did not read the article, or did not get the main points it makes. The point is that TRUE scientific data IS replicable. But data that is NOT replicable is, BY DEFINITION, not scientifically true. Just because one study shows that X drug has Y effect, that doesn’t make it scientifically factual. Other studies would have to be done testing this hypothesis, and actually working hard to look for other explanations (like the placebo effect, selection bias, statistical manipulations, etc.) to undermine the result that the original researchers may WANT to be true. Only when a theory can withstand the rigors of repeated testing with intent to DISPROVE it or provide an alternate explanation, and yet continue provide the same result, is it regarded to be scientifically “true,” and then only as long as conflicting data don’t come in to create more questions. Unfortunately, this re-testing seldom happens today, largely because it is rarely funded. And even when it does occur, such retesting results are rarely published. This is especially true when these studies clash with the preliminary results that have been shared worldwide as if they were a new and amazing breakthrough rather than just a promising lead, or when some person or corporation stands to reel in healthy profits from the preferred “truth” reported in the initial study.

    So the point of the article is not that scientific studies can’t be replicated. It’s that people often have preexisting biases that make them WANT a certain result, and that they regard studies that don’t provide that result as “failure” and therefore unworthy of pubication, or in need of overt suppression. It is also a problem that many “positive” studies are only positive because of intentional design changes (like “placebo washouts” or not counting dropouts as failures or changing the primary outcome measure when a secondary measure gives you the answer you want) or sometimes outright dishonesty in reporting the data. THOSE are the studies that are not replicable, the biased studies that DON’T follow true scientific method, and they are not replicable because their underlying hypothesis IS NOT TRUE, and for no other reason.

    So those area my views on the finer points of the scientific method, and I ask that you respect what I am saying as what I really mean and not try to “interpret” some other meaning that is not contained in these words.

    Suffice it to say, I think we’ve had our talk, and it’s starting to deteriorate into a more negative exchange. I think we should leave it at this point, and agree to disagree. It seems unlikely that further discussion will be productive.

  • Well, you were very fortunate. Bullying was common in the schools I attended. There were plenty of good teachers, but also some totally crazy ones. My second grade teacher was screaming and yelling at us one day and tossed a book over our heads against the back wall of the classroom. When I stood up to object (and I NEVER talked back or did ANYTHING to get in trouble, but this was just too much even for me), she came down the aisle and smacked me in the back of the head and took me and another kid who was crying and tossed us out in the hallway. I never even told my mom, it was so NOT surprising that such things happened. A friend of mine was shoved down onto the gravel track by Miss Cooper at the end of recess in front of 100 kids and some staff. Yelling at kids and forcing them to stand at attention for a half hour, flicking them in the head with fingers – all of these were totally normal and accepted by the school staff.

    I think it is pretty biased to say that homeschooling automatically deprives kids of anything. It obviously depends on how it is done.

  • Wow, you REALLY need to stop projecting your assumptions onto me, dude! I AM a scientist (chemist) by training and I would be DEAD at the age of 8 from a ruptured appendix and peritonitis without modern medicine. I am ABSOLUTELY a full supporter of modern medical science, and I fully understand what good and bad research looks like. Where we appear to disagree is that you believe psychiatrists are scientists. I think there is massive SCIENTIFIC evidence that the vast majority are not, and that the entire edifice of psychiatry is built on a foundation of sand and wishes. This does extend to medicine as a whole to some extent, but psychiatry is entirely based on unscientific or antiscientific premises. Look into how those DSM categories are determined, and if you have any degree of intellectual honesty, you will agree with me.

    And in case you think my skepticism re: modern medical research is misplaced or based on emotion, try reading the following, which outlines why the majority of scientific research done today is not replicable, which from a REAL scientific perspective, means it is scientifically untrue:

    https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124

    Again, I am NOT saying that the drugs prescribed for “psychiatric conditions” can’t be perceived as helpful by those taking them, even life-saving by some. But you and I both know that anecdotes don’t make science, and there is a lot of good science out there that is buried because monied interests don’t want it to come to light. This is covered in the article. Please read it before you come back and try to imply that I am antiscientific again.

  • Yeah, I would have felt the same way! I’d have been SOOOO happy to be at home and able to pursue what made sense to me instead of being bossed around by bullies and teacher/bullies and forced to be together with people I didn’t choose doing activities I had mostly no interest in at all. Homeschooling must be a Godsend for a good percentage of kids, at least the ones who don’t need to escape from their parents/siblings.

  • Maybe they should just get the drug companies to buy them coats, and they can wear the “colors” of their sponsors, kind of like race car drivers. “And now, in the southeast corner, in the bright red coat, representing Eli Lilly, Dr. JO-seph… LIEEEEBERMAAAAAN!”

  • Given the widespread agreement amongst professionals and informed laypeople that “scientific” studies are massively affected by economic and professional conflicts of interest, I’d rather trust my own ability to judge amongst the many stories that told, both by journalists and by professionals, and by those who have experienced the effects of the drugs directly. If we start with the rather obvious and undeniable facts that these drugs cause huge weight gain, diabetes, and heart problems, and knowing that any number of studies have shown extremely shortened lifespans in those diagnosed with “serious mental illnesses” since the pre-drug era, and actually KNOWING people who have died early directly as a result of taking these drugs, the prospect that they shorten lives seems by far the more believable story. Scientists who are schooled in analysis and methodology are also those most capable of abusing their abilities, and recent history is replete with examples of their having done so (Bidedermann’s “juvenile bipolar disorder,” the Viiox scandal, the lies about antidepressants and suicide, the lies about Benzedrine, then Valium, then Xanax being “non-habit forming,” the denial that Tardive Dyskinesia is caused by neruoleptic drugs – shall I go on?) So someone being a scientist does not convince me of their superior reasoning ability OR superior ethics. Maybe that’s where you and I differ here. You trust psychiatrists to be legitimate scientists. I don’t. You believe you have very good reasons for trusting them. And I have very good reasons for not doing so.

  • Fair enough, but still there is no actual way yet established to measure that difference, let alone studies that have actually done so. How many become suicidal coming off their “meds” and becoming psychotic? How many become suicidal going ONTO antipsychotics? How many because sucidal because they are WITHDRAWING FROM antipsychotics? How many would never have been suicidal in the first place if they’d taken another path? These are things we do not know the answers to, so claiming that “lives are saved” when we also know that lives are lost is very, very premature at this point. We don’t know the cost/benefit analysis and will never really find out what it is when so-called “scientists” are dishonest and manipulate data to serve their own interests instead of the interests of the public.

  • Nothing is more stunningly idiotic in recent years than the idea of giving stimulants for “Binge Eating Disorder.” The disorder itself is laughable, clearly invented solely to sell more drugs (not saying that people don’t binge eat, but the “disorder” is defined in the usual superficial, blameful manner). But to “treat” it with stimulants is ridiculous. As if the problem is appetite. And of course, there is no effort to actually look at WHY the person may be eating in this way, only an attempt to bludgeon the body into submission. I find stomach stapling more rational.

  • I would submit that the moment when we are “two people talking” is when real therapy can take place. As for “countertransference,” it is totally and completely normal for therapist and client to form a bond, and for them each to have feelings about the other. The difference SHOULD be that the therapist uses his/her feelings in the service of therapy, and does not take advantage of the client’s vulnerability in even the slightest way. I often found it helpful to share my feelings of the moment with the client when it seemed likely to increase trust or open up a new perspective. After all, they’re sharing their feelings with me, shouldn’t they get to know that they are having an impact, that I’m not a block of wood trained to say, “Go on” every three sentences? People want to talk to another PERSON, a REAL PERSON who interacts with them in a meaningful way. Nobody wants to talk to a “blank slate.”

    That’s my experience, anyway, but I was not a DSM-trained standard therapist. I pretty much made it up as I went along, depending on the client. Kind of Milton Ericson style. I’d probably be fired in a second from most places nowadays.

  • It sounds like you agree that antipsychotics do play a role in shortening lifespan, but that poverty’s role is greater. This is possible but certainly we don’t have data to prove or disprove this hypothesis. But saying “studies show you live longer if you stay on your medication” is a misstatement of fact, and actually contradicts your earlier statements that antipsychotics do, in fact, contribute to the undeniably shortened lifespans that have been reported. The truth is, there are studies claiming one and the other, and the question as to why lifespans for the so-called “SMI” and the role that antipsychotics play is at this point is very complex and can not definitively be answered as you claim.

    The point of this article is that the claims that people live longer on “APs” put forward in THIS set of studies are based on manipulation of data. I think you should be able to admit that there is a major conflict of interest when people who make their money selling drugs and drug prescriptions do such research, and that intentional manipulation of data has been shown to be extremely common in all branches of medicine. The studies in question clearly don’t prove anything, especially given the basis of “person-years” on medication, which even a layperson can see is a pretty poor substitute for the actual lifspans of actual human beings who are on/off antipsychotic drugs.

  • I think there is a big difference between saying, “Corporal punishment won’t destroy kids’ psyches in and of itself” and “It’s really no problem for parents to use corporal punishment.” It’s one of those things where the truth sometimes hurts, and it feels like a criticism of the person who has used spanking, but it’s still the truth. I think it’s fine to say, “You don’t have to worry that you’ve destroyed your kids’ lives just because you spanked them now and then,” and certainly removing kids to foster care for spanking is massive overkill (given the incredible damage done by the very act of foster care placement), but I think it is important to be honest and say that spanking has been shown to be ineffective and potentially damaging, and that there are more child-friendly ways that work better in accomplishing the same goals.

  • Poverty is, of course, a factor in the lifespan differential. But even between the most rich and the most poor, the differential does not even begin to approach 20 years.

    “More precisely, the study shows that in the U.S., the richest 1 percent of men lives 14.6 years longer on average than the poorest 1 percent of men, while among women in those wealth percentiles, the difference is 10.1 years on average.”

    http://news.mit.edu/2016/study-rich-poor-huge-mortality-gap-us-0411

    Why is it difficult to believe that drugs which cause obesity, diabetes, and heart disease would be responsible for shortening the lifespan of those who take them? I should think it would be almost impossible to believe they would NOT shorten lifespans, as heart disease and diabetes are very high on the list of killing diseases in the USA and around the world. I find it difficult to take anyone seriously who doesn’t see the almost certain impact of these drugs on lifespan.

    Of course, we should also be asking why our “mental health” system is leaving the huge majority of its “seriously mentally ill” in lifetime poverty. Does that not convey a responsibility for decreasing lifespans, when our “treatment” fails to take into account the quality of life of those being “helped?”

  • Well, of course. I was responding with the idea of “psychiatry” as “carers for the spirit,” psychiatry as it COULD be if they started off by actually believing that such a thing as a human spirit exists.

    Psychiatry is worse than nonsense, or it would already be interested in all the above things I mentioned. The “ADHD” example alone proves that they will bury useful evidence that would reduce the number of diagnosed/drugged kids and promote things that will sell more stimulants. They are a bankrupt profession.

  • For example, looking at indigenous healing practices and indigenous cultures and seeing what they do for “mental health problems.”
    -Looking into why people diagnosed who hear voices have more positive content in countries where culture supports voice healing as a normative experience, and exploring how altering our cultural attitude toward voices might help those suffering right now.
    – Looking at different classroom settings and observing that “ADHD”-diagnosed children do so much better in “open classrooms” than those who are in standard classrooms that they are indistinguishable from “normal” children, and then advocating for revisions in classroom settings instead of drugging the kids who don’t “fit in.”
    – Looking at why it is that certain cultures have almost ZERO incidence of “postpartum depression” while in our culture, it is almost epidemic. Helping move our culture in a direction that emulates those who support new moms in a way that they don’t suffer, based on the evidence of the absence of this suffering in their culture.
    – Studying the interesting phenomenon whereby immigrants develop Western maladies, both “mental” and “physical,” by three generations living in a Western culture. See what it is about Western culture that makes them ill and see if we can stop it.
    – Look at the impact of racism on group experience in terms of emotional experience and behavior.
    – Examine the connection of job satisfaction/”stuckness” to other life indicators, such as mood, marriage success, etc.

    The list is endless. These are things that could be studied using social science methods and might lead to improvements in our social welfare. None of them require labeling anyone as “ill” or “bad” for diverging from what the society considers “normal.” In fact, a real “doctor of the spirit” would dbe working to redefine “normal” toward what works for people instead of what works for the institutions of society. Psychiatry appears to be doing the opposite. If you don’t “fit in,” you’re abnormal and need to be “fixed.” Those who don’t create any problems for the status quo are “normal” and don’t need fixing. “Fixed” is defined as being happy with the status quo (but not TOO happy – then you’d be manic!) It is not working in the interests of improving people’s lives, unless you count the people who are making big bucks out of the enterprise. Sure, there are a number of people who feel better taking their drugs. But people also feel better smoking dope or drinking beer every day. Drinking beer to feel better can be helpful for some, but it’s not a medical treatment.

    So there’s lots to do, but drugging people unhappy with their lives is not particularly productive, IMHO. Especially if you label them as “abnormal” for feeling, thinking or behaving the way they do.

  • Once we allow for subjective “diagnosis” based on observer opinions, there is no end to who and what may get “diagnosed.” I think that’s the clear and obvious conclusion from this observation – when there is no objectively definable line of “normal,” sooner or later, everyone is diagnosable. Which, as you say, makes “abnormal” the new normal!

  • Thanks for your passionate reply.

    There are a couple of things you say that I have to take issue with. First, there is plenty of evidence of significant brain changes due to trauma. This was the primary finding of the “Decade of the Brain” research, which was actually quite different than what was anticipated. More importantly, and less well known, are the findings that the brain can continue to change in a POSITIVE direction when a traumatized person is supported by a healthy adult caretaker or support system. Dr. Bruce Perry is one of the best resources for this. Easy internet searches for these items. Here is one just to get you started: https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/how-ptsd-and-trauma-affect-your-brain-functioning

    You also seem to conflate “cognitive disability” with “mental illness.” You suggest that most of those severely affected by the syndrome called “schizophrenia” are affected by brain damage. I know of no evidence that this would be true in most cases – there has been a long, intense and frankly biased search for brain damage associations with “schizophrenia” and many other “mental disorders” with little to no results. There is evidence of brain matter loss in people diagnosed with “schizophrenia” over the long term, but Nancy Andreasen’s own research, which she really didn’t WANT to believe at first, showed that antipsychotic drugs cause loss of brain matter when used over the long term, so such studies are meaningless unless controlling for AP use, which is almost never done.

    Finally, you also assume that the “schizophrenia syndrome” is due to different types of “brain malfunction.” As I’m sure you are aware, science proceeds from hypothesis to proof, and it doesn’t work to assume the conclusion that brain malfunction is the cause when that has not been shown to be the case. And your suggestion that the fact that certain drugs “work” to decrease these loosely defined groups of “symptoms” proves an underlying disorder is similarly flawed. Under that reasoning, alcohol must be addressing an underlying “brain malfunction” because anxious people feel better when they get mildly intoxicated. Correlation can’t be used to diagnose anything.

    I very much respect your reframing of “schizophrenia” as a syndrome, something which would really help if we all operated from that assumption. Unfortunately, the current reality in “mental health” research is that these syndromes are being treated as unitary entities for investigation, and that leads to a lot of misleading, trivial and/or meaningless results. I also agree that it is easy to “throw the baby out with the bathwater” if one is too committed to dogma on either side of these questions. I’m a scientist in the end, and at this point, I see no science that really proves that “schizophrenia” is caused by any kind of a brain malfunction, and I am doubtful that continued research will prove any such thing. Partly because, as you say, it is a syndrome, and there may be (probably are) some subgroups that DO have biological causation, but these will never be discovered as long as research is done on “schizophrenia” with the assumption that all cases have the same cause and that this cause is necessarily biological in nature. It is clear from research that trauma has a very high correlation with the syndrome in question, as does urbanization and migration to a foreign culture. It’s also very clear that the manifestations of this “disorder” vary widely depending on the culture in which they occur and how the culture in question responds to such issues. It is, as you suggest, a much more nuanced picture, and until proven otherwise, I think it makes a lot of sense to assume that both nature AND nurture are involved.

  • No, I don’t disagree that we can make factual observations about what people believe. My only point is that science can’t determine “what is right” by the scientific method, and it appears we agree on that point. Sorry if my post sounded dismissive – I was kind of in a hurry last night! And I do think qualitative research is a valid means of studying ethics, though it gets more into sociology/anthropology and is a far distance from medicine. I guess that’s what I’m really getting at here – we can study history and use scientific means to determine certain things about history, but using those methods to make claims about medical treatment of one’s body would be ludicrous. Medicine can be studied from an anthropological/sociological viewpoint, and it has been (“Medicine and Culture” was a great read, comparing medical practices in France, England, Germany and the USA and demonstrating how much of even non-psychiatric medical decisions are made based on cultural beliefs), but this is not a way to determine what is actually wrong with someone or what kind of treatments are effective. Psychiatry would be FAR better off if it viewed itself as a sociological/anthropological soft science and proceeded accordingly, but there’s a lot less drug company money in such an approach.

  • I love your last paragraph! I think it gets to the core of why very few within the ranks question the basic assumptions of psychiatry. I was a dissident voice in the “mental health” field and I can tell you, it is not a comfortable position!

    I do take issue, though, with your assertion that “there is absolutely no possibility that eventually a psychiatrist could not come to the conclusion that it is all a lie.” There are certainly psychiatrists and other “mental health” workers who have come to this conclusion from observing the fact, though admittedly, it is a small minority by my observation. I would suggest that it is very difficult to work in this field at all after having drawing such a conclusion, and most who do so will be unable to live with themselves if they continue to practice as they have done in the past. So they mostly leave an do private work or find another profession. Very few remain in the public “mental health” system once they see what it is actually doing, and those that do, I admire for their courage.

  • It is pretty common for people recovering from a traumatic experience to want to help others do the same. I’d say you’re on the right track in contacting people who have experienced similar things. I wouldn’t waste a lot of time on the “true believers” who can’t consider anything but their own rigid beliefs for fear of their world collapsing, but there are plenty of people who are “on the fence” or who haven’t been helped as promised or who have deteriorated in “psychiatric care” who need people like you to help them out. It’s just a matter of connecting with such people, which isn’t always easy. I also think it’s very important to stay connected with others who agree with your view of things so you don’t start feeling like you’re the “only one.” MIA is really good for that.

    I hope someone who has been exactly where you are can chime in and share how they managed to move forward after this kind of trauma.

  • Ethics is a branch of philosophy. Philosophy is senior to science. Science depends upon a certain philosophy of what is true vs. not true. Ethics has to do with what is GOOD or NOT GOOD. Science can’t answer those questions, except in a mechanical way of measuring X outcome when ethic Y is agreed upon by a society. The decision of what is good or bad is both an individual and a social one and is not really subject to scientific analysis, as it does not provide measurable inputs or outcomes.

    Read Zen and the Art of Motorcycle Maintenance for an incredible exploration of this very subject. It is one of my favorite books of all time.

  • Consensus is completely unrelated to scientific truth. Scientific truth requires proof, usually in the form of vigorous efforts to DISPROVE a particular hypothesis repeatedly failing. The fact that “scientists agree” to something does not make it true or untrue – opinion is not science. And while “beyond a reasonable doubt” certainty is not always attainable, it should be the goal. Instead, what we see is so-called ‘scientists’ collecting evidence to support their own views and hiding things that would cause doubt. That is not science. That is marketing.

  • Hi, William,

    Doctors can prescribe drugs for any indication. It is not a requirement that they have a DSM “diagnosis.” Lots of people get antipsychotic drugs prescribed with no DSM “diagnosis” at all. They prescribe them for sleep problems, for “behavioral disorders,” to “augment antidepressants,” etc.

    Besides which, billing codes are not the same as actual medical diagnoses. If they need to invent a billing code, let them invent a billing code, but let’s not get confused and pretend that a billing code means anything more than that you get paid by the insurance company. The original DSM was, in fact, invented so they could bill insurance companies for “therapy.” The idea that these codes represented actual disease states is quite a distortion of their original purpose, and is utterly unscientific, as there is little to no evidence to suggest that any of these arbitrary groupings by symptom create groups who actually have anything physiologically relevant in common. It would be like billing for “stomach pain.” Sure, you can bill the insurance company for that, but is it indigestion? An ulcer? A gall stone? An intestinal blockage? Appendicitis? Bowel cancer? Each of the things I listed could cause “stomach pain.” So doctors neither diagnose nor treat “stomach pain,” not if they are in any way competent. They’d look for the CAUSE of the stomach pain and treat THAT.” Psychiatry as a profession makes no effort to differentiate between depression due to a loss vs. depression due to a bad boss vs. depression due to insomnia vs. depression due to a low thyroid condition vs. depression due to a long struggle in a dead-end, meaningless job vs. depression due to my husband beating me randomly and controlling everything I do and trying to drive me nuts on purpose. So saying someone “has depression” is pretty close to meaningless.

    I believe the same is true for “schizophrenia.” Many people in the psychiatric field even agree with me on this, and there have been proposals to scrap it as a concept altogether. The fact that professionals in the field disagree as to whether it exists should be reason enough to see that it is not a real scientific concept. Nobody argues about whether cancer or broken legs or syphilis actually exist.

    So if you need a “diagnosis” to get the drug that you feel is necessary, by all means, get a “diagnosis.” I just ask that you not confuse this with an actual, scientific analysis of what is happening that is causing this phenomenon, nor even what to do about it. Antipsychotics can diminish hallucinations, and to a lesser degree, delusions, at least temporarily and at least in some people. That’s about all you can say about it. It is not “treating” a known disease, because no one knows what causes “schizophrenia” or if it’s even a “thing” that has a cause, vs. a phenomenon that is associated with many different causes and possible interventions.

    I hope that clarifies my position on this.

  • I’ve seen kids put on a diet and told they need to exercise more as a response to “antipsychotic” weight gain. Of course, they almost never told the kids there was any relationship with the drugs. I saw one girl’s diabetes disappear within a week or two of discontinuing Seroquel. Crickets from the psychiatrists, of course. I saw one kind graduate from a year-plus long eating disorder program, only to be put on Adderall for “ADHD”. Strangely enough, she stopped eating again. If my CASA volunteer hadn’t intervened, no one would have noticed that the “treatment” for “ADHD” was eliminating her appetite, and would have said her “eating disorder” is “coming out of remission.”

    Not much real medicine being practiced by psychiatrists, at least for the kids in the foster care system.

  • I would even go so far as to say for some people, figuring out how to know what they want is the core job of therapy! So of course, such people won’t be certain what they want to start with, and a good therapist would know this. Sadly, there aren’t very many therapists out there whom I’d describe as good.

  • Exactly. It is abuse, yet if you have the nerve to call it out, then you are “treatment resistant.” There is no way to win that game except not to play.

    And it is totally “Caveat empor” (buyer beware) when it comes to counseling. If you don’t already know what you want, you get pot luck, and pot luck usually isn’t very lucky.

  • This is a great point, too. I was a “dissident mental health professional” in my day. It was obvious how quickly marginalized I would become if I just came right out and said “I don’t believe in all this DSM/drugging nonsense.” I had to learn to couch it all in proper “scientific language” and refer to studies and make it all into a big academic discussion. And mostly keep what I did in my own sessions pretty quiet. There is a lot of force brought onto any professional who won’t toe the party line, or at least that was my experience.

  • It is not always possible for people to choose to walk away from psychiatry – many are forced either by forced treatment orders, threats of hospitalization, threats of loss of children, decisions made by parents or relatives of people in nursing homes, and on and on. Additionally, the propaganda that has been spread regarding these DSM “diagnoses” has had other destructive effects, to the point that people are so confused they don’t even know they have another option.

    I had a caller on the crisis line I worked for one time who had been trying antidepressants for over a year with no success. She was frantic and thought that she’d never get any kind of relief and was condemned for life to suffer this kind of emotional distress. Then I asked her, “Did you know there are other things you can do besides drugs?” She was suddenly calm and said, “No.” I said, “Well, there are.” And she said, “Oh. Well. That’s good!” She had been asking for help for over a year and had NO IDEA there was any other option besides drugs. Nobody had even discussed that with her. THAT is what is wrong with the system. If people want to take a drug because it makes them feel better, I’m totally OK with that. I am opposed to a system that lies to people and pretend to know things they don’t know. I’m opposed to a system that profits from hurting people. Yes, people do have a level of responsibility for their own decisions, but the issue with psychiatry extends far, far beyond individual choices to participate or not.

    Hope that clarifies things from my viewpoint.

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  • I don’t disagree with your analysis. I just don’t see the path forward. Perhaps I’m just more cynical about humans changing how they are trained to behave. It does appear that our economic situation is going to be in the toilet for months at least, maybe longer, so people’s tolerance of the “status quo” may indeed reach a breaking point. It is also true that the need for socialist-oriented interventions has never been clearer. But I’ve already heard people in positions of power saying in effect that socialism is OK in a crisis but not for day to day living.

    I’m ready to act, but I still don’t see the path!