NY Times Sunday Dialogue: Defining Mental Illness

Kermit Cole
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Letters from MIA bloggers Sera Davidow and Laura Delano appear in the New York Times‘ Sunday Dialogue today, responding to Ronald Pies commentary about diagnosis and the DSM-5. A few letters from MIA readers and bloggers that the Times chose not to run appear below.

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MIA readers, bloggers and others respond to Ronald Pies’ letter in the New York Times:

To the New York Times:
Dr. Pies’s letter is timely, coming just before the impending release of the Diagnostic and Statistical Manual 5 or DSM 5 in May. The new manual dangerously expands the pathological definition of behaviors once considered understandable parts of life.  One of the most egregious expansions is the reclassification of grief exceeding two weeks as a depressive illness. This expansion of an illness model of life is a continuation of the medicalization of life processes and their primary treatment with medication.

Personally I am frightened by the prospect of more realms of life being described as pathological. As a person who was diagnosed with schizophrenia before becoming a psychiatrist, I can attest to the dehumanizing and discriminating effects of psychiatric diagnoses. For many years my diagnosis became my identity and was the reason I was denied life insurance, education, and hope. My recovery was promoted by psychotherapy that saw me as a person with a future not as a diagnosis. I would agree with what Dr. Pies himself wrote last year: “In my view, psychiatry needs to scrap the present diagnostic system and begin afresh, with its core ethical and clinical mission firmly in mind.”

We need to transform the world-view upon which the DSM is based. Instead of the present medical model of behavior, which reduces every manifestation of distress to a hypothetical set of chemical imbalances, we need to understand the human being who is suffering. In place of DSM’s checklist of symptoms, we need descriptions of the whole person in their world, authored as much by the person as the professional. We need to understand the subjective experience as well as the social context of distress. Such descriptions need to carry the hopes and dreams that make us human and motivated to live. We also need to value aspects of distress as attempts to solve problems and not symptoms of illness. I personally recovered when my psychiatrist invested trust in my capacity to describe and understand my world, rather than see me as a diagnostic category.

Daniel B. Fisher, MD, PhD
Commissioner, Presidential New Freedom Commission on Mental Health

To The Editor, New York Times:
RESPONSE TO RONALD PIES LETTER
Pies states: “Diagnoses in other medical specialties rarely provoke such a reaction.”
That is because, in other medical specialties, there are direct testable physical correlates
that define a disease. A simple example is diabetes, which is diagnosed and defined as
high blood sugar, and is measurable by a blood test. The DSMs diagnoses were all created by a group of psychiatrists with a vested monetary interest in the pharmaceutical industry, who sat on committees and created diagnoses based upon discussions with their colleagues.None of these “diagnoses” have any measureable physical correlates. To provide an example, can someone experience a feeling that we call depression? Of Course. But does someone have a “disease” called depression? Only if you believe a group of psychiatrists with strong pharmaceutical company ties who created this “disease” in a committee meeting.
Sorry professor Pies; Psychiatric diagnoses are not castigated “because society fears,
misunderstands, and often reviles mental illness.” Psychiatric diagnoses are castigated because they have no scientific validity, reliability, or even standardization and are created by a committee of vested interest psychiatrists with the primary purpose of selling more drugs. Most professionals, patients, and people in the general public know this.
Finally, may I ask professor Pies: “What are your financial ties to the pharmaceutical
industry?”
Sincerely
Lloyd Ross, Ph,D., FACAPP., P.A.
New York Times

The following comments are from a writer who wishes to remain anonymous because of the harm that could come back to her if she were to reveal her name.   Her reaction to Dr. Pies is as follows:

‘Diagnosis?!’   I withdrew from a benzodiazepine which was to help me sleep after my mother died. I became jittery.  It was benzodiazepine withdrawal syndrome.   A psychiatrist gave me an antidepressant.  I became agitated.  I was diagnosed withAgitated Depression but it was akathisia – a drug effect of extreme torment and agitation.

More incorrect DSM-4 labels followed: Generalized Anxiety DisorderAdjustment DisorderBipolar DisorderVegetative DepressionPsychotic Depression,DementiaDissociative Identity DisorderSomatization Disorder, Paranoid  IdeationDrug effects equaled mental illnesses.

Within 8 months – 35 drugs, forcibly hospitalized for 2 ½ months, forcibly given 25 rounds of bilateral electroconvulsive therapy.

I had a ‘spontaneous recovery’ from all DSM labels when I tapered off all drugs.

My story has been widely circulated (print/electronic) as ‘An Open Letter to Doctors’ ‘You Call Yourselves Doctors’ and ‘Iatrogenic Insanity.’ Youtube: ‘The Stories of Harm that the APA Refused to Hear‘:  http://www.youtube.com/watch?v=S83aAvWoJMk

Name Withheld
Toronto, Ontario, Canada


NYT DSM Dialogue/Response:

I’ve worked in the traditional Mental Health system since the late 1970s. Starting my career in a research program called Soteria House, for “first breaks”, developed by a psychiatrist named Lauren Mosher who in the ’70s was the head of NIMH’s research unit on schizophrenia. Dr. Mosher realized that people were going through a life crisis and needed a safe place to sort through some overwhelming feelings.   I became a licensed therapist in the mid 1980’s.  I worked in a locked acute psychiatric hospital for 20 years.  I did all the assessments on people (I was the “gatekeeper”) being brought in by law enforcement on 72 hour holds and those who came in voluntarily, in psychic distress, seeking help. In order to complete my paperwork I was required to give each person a diagnosis.  I would read through the DSM attempting to match broad descriptions, labels to a human experience.  They never quite captured the individual, but one could find some catch all label that might fit, close enough.

It was a challenge and sometimes just a game.  When someone had a psychiatric history I would typically see 4, 5, 6 different diagnosis made by each psychiatrist both out patient and in patient who had met with the individual.  Rarely did anyone have the same diagnosis.

Dr. Pies wrote: “‘Diagnosis’ means knowing the difference between one condition and another. For many patients, learning the name of their disorder may relieve years of anxious uncertainty. So long as diagnosis is carried out carefully and respectfully, it may be eminently humanizing. Indeed, diagnosis remains the gateway to psychiatry’s pre-eminent goal of relieving the patient’s suffering.”

I never once saw relief on a persons face when I told them the diagnosis they were given.  This didnt bring relief from their suffering,  instead it triggered deep distress and agony.  I would need to walk them through the “decision tree”, attempting together to make sense of these labels, stereotypes that of course never really captured the uniqueness of each individual.  Instead these labels or “diagnosis” only brought pain and suffering.  I would reassure the person that these are only labels, or short cuts to communication that describe a set of symptoms, we used them to communicate with our colleagues, a shorthand, for telling their story.

Mental Health diagnosis are stigmatizing and only create more harm and pain as one struggles to find a way to come to terms with and live with the label.  Alienation, the fear from others who know you  are “mentally ill” is a unique reaction to these “diagnostic” terms.  No one reacts with fear when someone is labeled diabetic.

Label someone Schizophrenic and there is an immediate fear reaction in our culture.  Its a death sentence, the end of being “normal”.  Furthermore, I would estimate that at least 75% if not more of the people who get diagnosed with a DSM label are actually misdiagnosed, this is quite evident in the stories you hear from people who manage to “survive” the psychiatric system  and come forward to tell their story.  Most people exhibit extreme emotional states as a result of trauma or the trials and tribulations of moving from childhood into adulthood. These people are brought to hospital for help.  And they are told they have a disease and are given a nice neatly packaged diagnosis that describes all their symptoms…and medications that are linked to the diagnosis are then administered by force or coercion to take voluntarily.  Without first informing the patient or explaining all the side effects and damages that the drugs will cause over years of taking them.

Now, years later people who are the lucky ones come out of the fog of their childhood trauma, stop taking the numbing medications that stop all feelings and begin to sort out their lives, and surprise!  They are no longer  schizophrenic or bi-polar!  Then they spend years trying to undue the harm and damages of being told they are diseased, broken and must take mediations the rest of their life that they have a disability and can’t work, they often have spent years in supervised settings and never learn how to cook or shop and do the basic functions that we learn to do in adulthood.

So I must disagree with Dr. Pies, there is no applicable science in this field of mental health, no blood test that one can take to determine their “illness”.  So lets stop the fallacy that the DSM is a bible that holds the truths.

But instead, lets learn to “be with” people when they are suffering and not hide behind the labels, but rather allow the intuitive compassionate ones who entered this “field” to assist in the discovery and wonderment of the vast human condition, to actually help others is to connect and be with.

Stop the labeling of people, and embrace the fact that no two human beings are alike.  I celebrate our differences and learn from each connection I make.

Thanks
Yana Jacobs
San Cruz, CA
New York Times:

I am grateful for this invitation for public dialogue about psychiatric diagnoses as the APA moves out of its own contentious dialogue and into practice with a newly expanded set of diagnostic criteria that I fear will rob our children of their most precious right, the right to fail, to explore limits and make mistakes, to test the boundaries of their emotional capacities, not to mention our capacities as parents, caregivers and teachers. Growing up, by its very nature, can be a messy, uncertain and sometimes painful process for all involved, particularly in adolescence. This is a time-honored truth.

Growing up without labels isn’t easy. But the new DSM-5 makes labels and disability more available to ever-younger populations of “patients.” Parents and school systems, both overworked, are not only tempted, but encouraged to get diagnoses for their children to receive additional school supports. But at what cost to our children’s health, self-image and ability to develop resilience and coping skills in the face of adversity?

Diagnoses can make concrete processes that are fluid and rapidly changing (like growing up, for instance). They can create overarching identities when children should be trying on, discarding and discovering their many identities. Make no mistake. Growing up in our culture is not easy. And when violence invades our classrooms, we are demanding children grow up faster than ever before.

Well-meaning psychiatrists and general practitioners can’t easily fix our cultural and familial traumas, broken homes, one-size-fits-all underfunded school systems, or poverty, but they can prescribe diagnoses and the medications that all too often go with them. And, with the best of intentions, they often do — despite adequate research on the safety or efficacy of either labeling or medicating children under 18.

We can do better by our children than to label and medicate them. And we must. Please keep the DSMs (1 through 5) in the adult book section, and only check them out when absolutely necessary.

Jennifer Maurer
Asheville, NC
Parent of two school-aged children and managing director, Mother Bear CAN: Families for Mental Health, www.motherbearcan.org

New York Times:

Dr. Ronald Pies provides a compelling argument that psychiatric diagnoses are not stigmatizing, but, rather, the label is relieving to patients. More, he claims that psychiatry is much more like the other branches of medicine in which physicians diagnose based on symptom clusters and do not require the use of objective data (i.e., biomarkers) to support their diagnoses.

His argument about stigma vis-a-vis mental health diagnoses is not supported by the research. Researchers like Danny Lam, Paul Salkovskis, Hillary Warwick, John Read, and Niki Harre have consistently found a link between stigma and societies’ belief that psychiatric diagnoses are a “disease like any other.” In other words, the more we promote this unfounded notion that psychiatric diagnoses are caused by some genetic, biochemical or structural abnormality in the brain, the more likely patients will experience the effects of stigma. Conversely, when symptoms are explained psychologically, say as a function of a traumatic history, the more compassionate people feel towards those with these symptoms. An NIMH study found the same: clinicians who emphasized a psychological view of mental distress were more effective than those who viewed clients’ symptoms through a disease-model lens.

To his credit, there is limited data that support his observation of an improvement in self-perception immediately after receiving a diagnoses. However, this improvement is short-lived. Since most psychiatrists prescribe medications, many patients eventually must accept a belief of being dysfunctional, diseased, disordered or disabled in order to convince themselves of the rightness of swallowing the next pill.

After reading his piece, I imagine that Dr. Pies believes that science is about consensus–if the psychiatric community agrees that a diagnosis is valid and reliably measured, it must be right. However, science is not about consensus; it’s about the truth. Unfortunately, unlike other branches of medicine, virtually none of the DSM diagnoses can be independently verified by the presence of any biomarkers (despite repeated claims that such findings are “right around the corner”). Pseudoscience makes claims that cannot be discounted or verified. If a doctor claims that I have a broken leg, I can demonstrate through x-rays that I do not. This cannot be said about psychiatric diagnoses, claims can not be independently verified or nullified. Claims are 100% based on the subjective impression of the diagnostician. Once again, research finds that this process has proven ineffectual. Learning can only happen through the process of finding out that one is wrong, not by consistently believing that one is right.

Albeit, his article was an op-ed and not a scholarly work, but I become nervous when professionals tout opinion as scientific fact. Within the mental health field, there is no evidence that years of experience and credentials contribute to effectiveness. In fact, psychiatry is no more effective today in curing and preventing “diseases” than 50 years ago. (Some data seems to suggest that patients are worse off.) More, I am chagrined that he is unwilling to consider that the suppositions of biological psychiatry may, in fact, iatrogenically contribute to the very concerns he observes.

______________________________________
Thomas L. Murray, Jr., PhD, LMFT, LPC-S
Director, Counseling & Testing Services (IACS Accredited), UNCSA
Clinical Assistant Professor, Department of Psychiatry and
Behavioral Medicine, Wake Forest University

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

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12 COMMENTS

  1. I sent 2 responses of my own. One prior to publication of the “dialogue”, and one after.

    Dr. Pies is wrong when he says, “there is nothing inherently dehumanizing or “stigmatizing” about a psychiatric diagnosis.” Who speaks of any “stigma” associated with mental wellness? People are not discriminated against because of a lack of a psychiatric treatment history anywhere that I know of. The assumption behind a psychiatric diagnosis is that there is something innately wrong with the person being diagnosed.

    The way to cure a person of bad circumstance is to change his or her circumstances for the better. This is precisely what labeling, warehousing, and drugging people does not do. Before labeling, there is no prejudice. After labeling, you’ve got prejudice. This prejudice consists in treating fully grown people like children rather than responsible adults. This prejudice can follow a person around until the end of his or her days.

    Even psychiatrists make mistakes. Sometimes those mistakes aren’t misdiagnoses. Sometimes those mistakes are diagnoses.

    Frank Blankenship,
    Gainesville, Fl, 20 Mar 2013

    Today I sent the following response to the published “dialogue”.

    Psychiatry, as a general rule, doesn’t want true dialogue and debate. Not so benevolent dictator Dr. Pies proves my point. We have him open and close the would-be dialogue with his own
    defense of diagnostic labeling.

    As to his cherry picked responses, alright, let’s go there.

    Shoddy diagnosis is going to be a problem where the diagnostic categories are decided by committee vote rather than by science.

    We’re not talking about excesses of Big Pharma. Big Pharma doesn’t apply diagnostic labels and prescribe drugs, psychiatrists do that. If they were governed by law there would be much less iatrogenic damage than there presently is in the world.

    Are we talking suffering or “disease”? If the problem is psychological, the solution is not going to come from a medicine chest. I think I dealt with ethical callousness in the previous
    paragraph.

    Physicians are always going to have trouble treating imaginary diseases.

    This writer is a survivor of psychiatric maltreatment and an activist for social justice and human rights.

    Frank Blankenship
    Gainesville Fl, March 24, 2013

    • I’m not surprised they didn’t print your letter. You absolutely demolished his claim about psychiatric diagniosis in the first paragraph, and I don’t think the New York Times are looking for such a demolition.

      As Szasz once pointed out, it is simply a term of derogation. Our culture bears witness to this, so that to not know this is either to be very stupid, or very voluntarily blind.

      No-one congratulates you on having a “mental illness”. No one says, “I love you, you are so schizophrenic!”. It’s an insult, masquerading as a diagnosis, which the more powerful party in an interpersonal conflict avails himself/herself of both for the psychological pain it inflicts and for its strategic function in various situational contexts as a weapon freighted with often disastrous consequences for the sod to whom the imputation of “mental illness” is made.

      • Thank you for your kind words. I’m not surprised my letter wasn’t printed either. I’m going to keep trying to contact the media when appropriate though. I believe we, present and former inmates of psychiatric institutions, should be included in any and all such discussions that concern us. Maybe someday the NY Times really will want to have a dialogue on the subject. Then again, maybe they’d prefer to have some condescending psychiatrist pretend whitewashing his profession was dialogue.

  2. Thank you for publishing these letters. This is such an important public dialogue and once which needs even more air time as these “bibles” hit physicians’ and clinicians’ desks with resounding thuds – which are, I fear, the sounds of countless hopes and dreams being crushed.

    • Jennifer,

      I think your letter was good with regard to children for the most part.

      But, claiming that most psychiatrists today are well meaning is naïve at best and dangerous at its worse. As I’ve pointed out elsewhere, psychiatric survivors were able to find many books and articles available in public libraries, Amazon and the web exposing the huge fraud and harm of biological psychiatry many years ago. This literature exposing the fraud and harm of biopsychiatry and the junk science DSM has only increased by the tons in recent years, so any psychiatrist just slapping on labels per one honest psychiatrist to push the latest lethal drugs and torture treatments on patent on victims of any age is anything but well meaning, not practicing anything close to any type of medicine and has completely abandoned the first dictate of a doctor of “FIRST DO NO HARM!”

      Dr. Fred Baughman, Neurologist, describes all psychiatric stigmas from the junk science of voted in disorders in the DSM as 100% fraud and maintains that stigmatizing and drugging children or anyone with psychiatry’s toxic drugs consists of the worst medical crimes against humanity in history. He has written many articles on the web and the book, ADHD FRAUD, exposing this menace to society.

      For you to say, leave the bogus, harmful DSM in the adult section implies that such damaging, toxic treatment and violation of all human, civil, democratic, informed consent and UN rights to be free of torture does not need to be applied to adults. I beg to differ with this implication since it is mostly these same adults who have to care for children and their bogus stigmas will be used by psychiatry with its bogus eugenics claims today to falsely claim their children have the same “disorder.” Dr. Jay Joseph exposes the fraud of psychiatry’s genetics and heritability claims for their bogus disorders in his blog on this web site and in his books, THE MISSING GENE and THE GENE ILLUSION. Such fraudulent claims are always used to justify the power elite robbing far more than their fair share of resources while doing all in their ill gotten power to make slaves of the rest of humanity as in the book, THE SHOCK DOCTRINE. Dr. Thomas Szasz, eminent psychiatrist exposes that involvement with modern psychiatry amounts to psychiatric slavery of the worst kind and often for life if one does not find a way to escape their evil predation.

      The so called disorder or “disease du jour” is the bogus bipolar stigma first perpetrated against adults to push the latest epileptic poison drugs like Depakote on patent repackaged as so called “mood stabilzers,” a bogus term invented by BIG PHARMA per Dr. David Healy in his most enlightening book, MANIA: A SHORT HISOTRY OF BIPOLAR DISORDER, and the horrific poison atypical antipsychotics along with other toxic drugs to form a deadly cocktail to make a literal killing for psychiatry in bed with BIG PHARMA. Dr. Healy points out that those stigmatized as bipolar would have been labeled with anxiety or depression as each of those useless but dangerous drugs came out like SSRI antidepressants and benzodiaopenes iatrogencically causing symptoms fraudulently stigmatized as bipolar when that became the latest fraud fad stigma of the mental death profession.

      Once the adult market was saturated, the poster boy of child psychiatry, “Dr.” Joseph Biederman, got the great idea to singlehandedly create another bogus bipolar epidemic for children after doing the same for ADHD by promising his real employers of BIG PHARMA IN ADVANCE that his studies on children would show that deadly neuroleptics are safe and effective for his newly created child bipolar stigma to push these lethal cocktails of drugs on them with horrific consequences. “Dr.” Biederman compared himself to God, exposing his malignant narcissism in the process. What is even more vile is that all of child psychiatry and pediatrics went along with this fraud as they did with pushing kiddie cocaine for ADHD to create new markets for BIG PHARMA and to line their own pockets especially for the key opinion leaders in the APA, academia and prestigious hospitals.

      When Senator Grassley exposed that “Dr.” Biederman and his cohorts in crime had received hidden millions he failed to report when getting government grants for this fraud, his cohorts in pediatrics and child psychiatry who fed at the trough pretended to cry fowl when they were just as guilty of this horrific fraud that caused the death and disability of many children including the infamous death of Rebecca Riley.

      Please reconsider attributing good intentions to those who are no better than any child predators who rightly earn our disgust and contempt as they also bamboozle the parents of these children with the same phony charm, cons and malice.

  3. Dr Pies is a figure in whom all the most sickening aspects of the psychiatric-totalitarian ethos are concentrated to an extreme degree. He’s like a cross between Iago (for his sliminess), Robespierre (for his insufferable messianism and pretensions to moral authority) and Tartuffe (for his hypocrisy). There is just no reasoning with the man.

    I like what one letter said about “touting opinion as scientific fact.” This has a very long pedigree, though such risible claims to the scientificity of opinion range especially widely over the historical landscape of psychiatry.

    Despots, people who worship at the altar of power, cannot afford to be intellectually humble. Their use of force in assimilating reality to their megalomaniacal fantasies demands an ideology that does not allow of scepticism or disagreement. The protestations of conscience can only be silenced through dogmatic assertions of righteousness and absolute intolerance of any view to the contrary. In the age when the dominant worldview was theological in character, the despot rationalised his Inquisitorial and despotic impulses in terms of some sort of apostolic mission conducted at the behest of god, giving himself freedom to tyrannize without let or hindrance through the invocation of such divine justifications. He was merely the vessel into which were poured the fruits of God’s sacred deliberations.

    In our age, where science and reason are the deified objects of mass veneration, the despot articulates the earlier mentioned impulses in a manner becoming to the age, acting as if he were a mere repository of scientific truth, who in tyrannizing his fellow man, does so not for his own psychological gratification or social and economic advancement, but out for respect for the absolute, incontestable truth, and out of a sense of his apostolic and historic mission to bring the light of reason where hitherto there has only been the darkness of unreason and lunacy.

    It is hardly surprising then that psychiatric totalitarians and Nazis encase their opinions in a carapace that fools themselves as well as others that their opinions are facts. The use of force and violence renders such arrogance inevitable. How else could they silence their conscience, other than through appeals, made for their own benefit as well as those whose thinking they seek to control, to the supposedly apodictic certainty of their beliefs, beliefs that in reality are mere ideological adjuncts justifying the acquisition and consolidation of power and the violent means they take recourse to in the pursuit and attainment of these ends?

  4. Thank you for sharing a few of the letters that were not published by the NYT. I was pleased to see that the Laura and Sera were not alone in their perspectives, that the Times opted to publish a few other letters that questioned the integrity and humanity of labeling.

    It is my hope that intelligence and compassion will prevail.

  5. This is a wonderful development for the MIA community! Well done Laura Delano, Sera Davidow, and Jennifer Maurer! Thank you for representing voices that truly rethink psychiatric paradigms in America.

    I don’t think for a second that the practice of psychiatry is going anywhere but bigger– and it is precisely this reason that alternatives and critics are so badly needed.