Thoughts on the Meaning of Neuroscience

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Judith Shulevitz, the science editor for The New Republic recently wrote an interesting article on loneliness (here).

It caught my eye because it started with a nod to Frieda Fromm-Reichmann, the psychoanalyst who was immortalized in Joanne Greenberg’s fictionalize memoir of her recovery from psychosis, I Never Promised You a Rose Garden.  Ms. Shulevitz goes on to describe the field of loneliness studies from a psychological to a neuroscience perspective.

I have been struggling with the notion of the medical model as it applies to human suffering as well as the ability of basic science research to inform the work we do.  There has been a lively discussion on this website about this (here, here, and here).

For me there are at least four separate questions to be addressed. The first is whether neuroscience is capable of understanding human emotion and higher level cognitive experiences.  The second is the extent to which that understanding – even if it is achievable – is critical to our being able to help people in distress.  The third is whether  it is correct to assume, as many people seem to do, that if we come to some basic understanding of brain function as it pertains to core human emotion and suffering that this will automatically translate into treatments that are commonly thought of as “biological,” such as drug treatment. The fourth relates to the limitations and relevance of studying the brain in isolation when we are constantly in interaction with our environment.

The Shulevitz article provides a good platform from which one can address these questions.  She begins with a discussion of Fromm-Reichmann’s assertion that loneliness – and by this she meant the subjective experience of want of intimacy – was “at the heart of nearly all mental illness”.  She then reviews all of the effects loneliness has not only on the psyche but the body. This is followed by a review of modern research into this field which traces the effects of loneliness in humans from a social perspective to the effects of social isolation and rejection on brain functioning.

I found the article and the studies described to be of interest but inherent in the narrative is the notion that we needed the evidence of brain changes to legitimize Fromm-Riechmanns’s initial observations. The recommended “solutions” are primarily social; the author describes studies that showed the benefits of providing enrichment to young children and their families and she reports on an ongoing study in which researchers are teaching soldiers about social cognition with the hope of reducing post-traumatic stress.  The implication, however, is that the basic science data were necessary to legitimize this area of inquiry.

For those of you who reject the notion that neuroscience research might inform our understanding of human distress, I suggest this thought experiment. I was talking recently to a colleague who studies headache. He explained how researchers in this field worked for years without being able to find biomarkers. They then decided to model a diagnostic system after the DSM. This allowed them to do research that provided preliminary data which they hope will improve their funding.  They propose that understanding the neural substrates of head-ache will yield clues on how to provide more benefit to those who suffer from what for many is a debilitating affliction.   At the same time, he understands how the experience of headache is not based entirely within the person; that the experience can be modified by external experiences.  He is not entirely wedded to finding drugs that will reduce headache; he understands that altered environments might also help. But he nevertheless, believes that this basic research will be informative.

If this seems legitimate, I would ask how in any way this differs from a similar approach to something like anxiety?  Anxiety is an experience that can range from mild and transient to persistent and debilitating. It is experienced in the subjective realm and it has correlates throughout the body.  It can sometimes be reduced dramatically with drugs but it can also be exquisitely impacted by environmental changes.  If basic neuroscience research is legitimate to further our understanding of headache, why is it less important to further our understanding of anxiety?

I find it interesting to learn of the neural correlates of core human experience. In the true spirit of science, we do not know where the research will lead.  I think it is incorrect to assume that neuroscience research will only result in treatments approaches that are “biological”; i.e., contained in a capsule. However, I am not convinced this work is required to legitimize investigation into the value of social connections on our well-being and I do not think we need to wait until we have mapped out the brain before we invest time and money into learning more about this.

That to me is the crux of the issue. I do not dismiss, a priori, that we might someday completely untwist the fundamental workings of the brain.  However, I do not think this is where all of our research dollars should go.  For me, there is ample evidence that social connections matter.  We can invest money into understanding why some of us struggle more and how those of who struggle might learn to make more connections. We can try to understand how our social system maximizes health and well being.  We can invest in understanding treatment approaches that appear to have had good outcomes even if they are not premised on the fundamental biological paradigms of the day.

At the same time, I think it benefits all of us to listen openly to as many perspectives as possible as we join together in re-imagining how best to engage with people who are struggling with extreme states.  I do not want to be privileged in my authority to speak  merely because I am a physician; my experience has taught me the profound limitations of my knowledge.  But we will not know until we know what neuroscience can and can not teach us.  I am hesitant to walk away. I think I write this in the spirit of Robert Whitaker’s work; honest and open inquiry is what should be privileged not an authority or the particular framework from where that inquiry emanates.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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99 COMMENTS

  1. Dear Dr. Steingard,

    This is a great post! I also seek an exploration of mental distress on all fronts. I am not afraid of neuroscience; I contend that we can understand human nature with empirical neuroscience and that it proves that mental distress is the normal biology of distressful experiences. Consistently, I support a social science perspective of psychology; we currently have little understanding of others’ unique, personal experiences (distressful experiences cause mental distress).

    Thank you again for your open-minded search for the truth.

    Best regards, Steve Spiegel

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  2. Dear Dr. Steingard,

    Thank you for this thoughtful article. We already know much of what hurts and what helps people in emotional distress. I think that we need to be honest about what we know and what we don’t know as we continue to search for answers.

    One of my concerns is that psychiatric research (the medical model) is often very biased by moneyed interests and corporate influence, so we lose scientific objectivity and credibility. In addition, scientific inquiry is based on the assumption that we can derive answers using the scientific method and our senses with the help of technology to examine data and find answers. In the case of psychology and psychiatry we are studying the brain (with all it’s emotions, existential and spiritual dilemmas, pain and biological structures) with our brains…something unique when compared to all other fields of study. Perhaps it’s difficult to be ‘objective’ about something so ‘subjective,’ and close to home.

    When dealing with mental and emotional phenomena, it’s hard to separate the observed from the observer. The way we define and understand psychic experiences and emotional pain depends very much on our varying world views and then leads to what we then prescribe to ease others’ mental anguish. Thus, given the enormous complexity and challenges of our field, I think it’s important that mental health professionals be very careful not to impose their (scientific, spiritual or otherwise) answers on others, but instead keep open and humble minds as they continue to search for what causes and what helps people in distress. I also think we absolutely need to protect the human rights, (including the right to choose what helps and reject what hurts) of those who receive any kind of mental health services.

    Again, I am thankful for your article and perspective.

    Cindy

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      • Immune? No. But I don’t have anything to lose if future evidence conclusively demonstrates that neurbiological factors are the primary or exclusive cause of “mental illness.” I would simply be grateful for the information and clarity and hope that it will facilitate better “treatments” that accurately target the root issues without the immense negative effects.

        On the other hand, groups like the APA and industries like pharmaceuticals have everything to lose. Their power and dominance are long the line. Their financial interests are on the line. That is why they are already fully willing to lie about what we know and don’t know on a regular basis. That’s why they are happy to threaten and punish professionals that point out when the emperor has no clothes. That’s why they have no problem spinning the facts, and hiring PR firms to help them “sell” a propaganda version of reality.

        The worst fallacy for us is the fallacy that holds “everyone’s to blame so no one is responsible.” We are not the same. That no one is immune does not mean that everyone has the same conflicts of interest or that everyone engages in the same dishonest activities to make their case.

        There’s little fruit and a conciliatory attitude toward partners who do not act in good faith. That is the required foundation for any dialogue – two parties operating in good faith.

        Those perpetuating misinformation or outright lies, distorting evidence and threatening those who present contrary claims are not acting in good faith.

        That means that right now, we can privately remember the limits of our knowledge – I do this by trying to make sure I don’t speak beyond the scope of what is supported by direct clinical experience and clear and extensive bodies of evidence. But hand holding with liars and bullies, no, that’s not something we need do.

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      • Hi Sandy,

        I did not mean to imply that any of us are immune to conflicts of interest. That said, we also know that our field is dominated by certain corporate interests that far outweigh the influence of others with less financial influence over research and treatment. We need government regulation of corporations so that the FDA can do a proper job informing us of the risks and benefits of any given treatment and science that has no ties to those hoping to profit from research outcomes. Perhaps overturning Citizen’s United would be a place to start with this.

        Thanks again for the great discussion!

        Cindy

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  3. The problem as I see it is that we are not “working in good faith” as we seek to keep our minds open. Those most loudly championing a medical model as doing so dogmatically, asserting that mental illness is an already-proven neurobiological disease, that it is a chronic condition from which one will never recover (at least in the more “severe” forms) and that the first, best and primary treatment is massive drugging.

    There is a complete lack of honesty from the biggest proponents of this reductionist attitude toward emotional health. Critics are, no matter how well-researched or well-articulated their arguments, punished professionally for telling the truth. Even if that truth is as simple as saying that the picture is not so clear-cut. Researchers are denied funding, often can’t get their findings published. Professionals lose their positions, are shut out of professional opportunities to share their information, and on and on.

    If every single dogmatic belief of neurological reductionists was conclusively proven true, what do I lose? Nothing. I will welcome the scientific clarity and be greatful for how this understanding might help real people in need while doing less harm.

    In contrast, if these beliefs continue to lack evidence or are one day proven completely off base, what does the APA and pharmaceutical companies lose? Everything. Their entire power and dominance is based on diagnosis and a medical model of mental “illness.”

    Over and over again it has been made clear that they will lie, cheat and bully anyone who challenges their power. While intellectually, I concede an openness to new information and personally tend to believe that biological elements are one (small) part of the full picture of lived experiences of extreme emotional states, I’m not particularly interested in focusing on a reconciliatory mindset. Not when I have few good-faith partners to work with, not when the media and culture is dominated by propaganda that is categorically false (chemical imbalance, anyone?) and now while the current power brokers are waging an all out war against people trying to tell the full truth.

    Right now, the voice of those saying, “there is no evidence to support a diagnostic model, many of the claims of medical model adherence are demonstrably false, and when pressed they even acknowledge this, public information about the great harms of neuroleptics, their limited benefits short term, and their huge harms long term are all swept under the rug, minimized or lied about by those currently holding all the power when it comes to “mental health” in the united states.

    One day, a more collaborative attitude may be warranted. But right now, its time to fight. Fight with truth, with a loud voice, and without fear.

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  4. Dr. Steingard, Your courage to be conscientiously concerned about doing good by your patients has put you on the right side, the leading edge of this transition for which NIMH is preparing the nation. As for harmonious social interactions, technology can also prove they’re healthy. Brain areas are lonely, or rather isolated from each other, until they all coordinate. Brainwave technology can already enable them to do this. Then one sees the problem and solution as holistic, coordinating the whole brain, rather than segmenting the problem and solution into separate bits. The person and environment then also interact wholly — a coordinated brain interacts more harmoniously with its environment, and seeks and arranges more harmonious situations for itself and others. The harmonizing is done by creating a harmonious environment around the brain which mirrors the brain’s inner harmony. So, the outer and inner become one. Thanks for the good work!

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  5. Thanks for a great post as usual.

    It seems important to always be able to consider any mental aspect under both the mind and the body perspective, as well as the social dimension. It is refreshing to read from somebody like you (or many others on MIA) who can hold those different perspectives without dismissing any of them.

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  6. Hi Sandra,

    I’ll start by saying that I believe in the identity between mental processes and brain physiology/morphology, so in theory I’m very keen on neuroscience. But as other commentators have pointed out, we do not live in an ideal world and research into this field is not driven by scientific curiosity but by a ruthless industry seeking to increase their profits by any means.

    Rather than speak in generalities I’d ask you to please take the time to look at this study by way of an example:

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057357

    It is not a particularly substantial study but it is recent and freely available (and I had it handy from a previous comment in MIA)

    In particular I’d draw your attention to this: “Controls who developed a mood disorder were also excluded (n = 4, all MDD)”

    Now, you tell me: in a study that claims to have found a hereditary difference of brain morphology linked to MDD, is it not imperative that the 4 members of the control group who develop MMD are given a second round of fMRIs to see if they also exhibit said brain morphology – thereby showing that it is the result of neuroplasticity and not genetics? Particularly since those members of the study group who did develop MMD and show atypical morphology already had signs of incipient depression at baseline?

    Notice how carefully the authors word their conclusions to divert attention from those 4 controls: “These findings offer the potential of future risk stratification in individuals at risk of mood disorder for FAMILIAL reasons.” (capitals mine). You might also want to pay close attention to the Competing Interests section, and wonder why the study has 10 different authors.

    I’ll tell you what I make of it: this is a dishonest study (one of many), part of a well-orchestrated push to advance an agenda of “preventive interventions”, “early detection” and “screenings of at-risk groups” (see this recent item of news from the UK, for example: http://www.bbc.co.uk/news/health-22478706 ). This is something very dark and very dangerous, and neuroscience – or rather bad neuroscience – plays a big role in this push. You cannot just pretend it isn’t happening or “it’s not as bad as all that”. It’s worse.

    No offence, but if you really think you are playing with nice guys on a level playing field you are very naive. And I don’t think the people you are trying to help can afford that naivete.

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    • Thank you for your comments.
      You raise important points. I would also want to know if the controls who developed MDD had similar findings. I assume their use of the word familial is because this was a study that specifically focsued on individuals who had family members with a mood disorder.
      Maybe I am naive -and some of my colleagues might use that same accusation regarding my decision to blog on MIA- but I am skeptical about the well orchestrated component of your argument. I just do not think there is much in our world that is well orchestrated.
      What I find more worrisome is that neuroscience is not likely to find answers that are neat or simple or even understandable. I once heard a philosopher of science speak and she mentioned that her young son had asked, “What if the brain is more complicated than it is smart?” I suspect my own brain is.
      The decade of the brain did not reveal clear answers but it is did reveal increasing complexity. I think there will be a tendency to take this complexity and reduce it to pieces that form a coherent narrative that people can grasp. That is where I see danger and room for exploitation of the data for a host of reasons and goals.
      But to be clear, I have no argument with the assertion that there are people out there who will exploit data for commercial interests. It has happened before and it will happen again. Of that I have no doubt.
      Sandy

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      • Of course the study focuses on individuals with a family history of mood disorder, that’s the first problem: the study assumes the genetic origin of mood disorders and simply discards any data that might have contradicted their starting hypothesis. And then tries to justify this by saying “yes, but we did not set out to study those other things in the first place”. I’m sorry Sandra, but I do hope you realize that this is just not the way scientific research works; if you don’t you may have to go to more talks on philosophy of science.

        There is actually a funny side to this study if you can be bothered to read it:

        Notice that it studies close relatives of people with Bipolar Disorder, not MDD, who go on to develop MDD, not BD. The authors justify this peculiarity with the sweeping statement that BD and MDD have an “overlapping genetic architecture”. But if you look at the figures you will see that despite their own claim that first-degree relatives of individuals affected by BD: “have a more than a ten-fold increased risk of developing bipolar disorder (BD), and a three-fold risk of developing major depressive disorder (MDD)”, in their study group of close relatives of people with BD only 2 people actually developed BD! So: “Since only 2 individuals had developed a mood disorder with a manic component, the main analysis focussed on individuals who had developed MDD only.” In other words, they had to shift the focus of their study because otherwise they would have had no study… thank heavens for overlapping genetic architectures!

        As for the conspiracy side of things, I agree not much in the world is well-orchestrated, perhaps I should have said badly-orchestrated, but orchestrated nonetheless. Look at this study, follow the studies referenced in it, look at the funding, the competing interests. Do you not see a card-castle of bad studies building up, one bad study propping the next? Is it not clear which companies and organizations support this whole “research industry”? Or the influence they have on professional organizations? If you want to write “in the spirit of Robert Whitaker’s work” you have to start following things up to see where they take you. To a large extent we are talking about your colleagues and your profession, so you share a portion of responsibility in this. It is not enough to look the other way and say, “oh, I just didn’t know”. Remember that bad things happen because good people allow them to happen.

        This reminds me of something a French philosopher whose name escapes me just now said: “I don’t believe in conspiracies of men, but I believe in conspiracies of devils”. By which he meant, greed, arrogance, incompetence and fear of losing one’s well-respected career – or one’s well-respected profession, for that matter.

        (I notice in my previous comment I wrote MMD instead of MDD a couple of times, sorry about that)

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        • I have no doubt I could benefit from many more lectures on philosophy of the mind.
          I agree that there is a serious flaw in studies that are premised on faulty diagnostic categories. We are sort of chasing our tales with those kinds of approaches. I think this is what Insel is trying to get at with the newly proposed categories. But when I reference neuroscience, I am referencing something much more basic than DSM categories since I think all of human experience is likely dimensional rather than categorical. I found the studies of social isolation to be of interest (although I am not offering a critique of those specific studies).
          I realize I may be saying two things. I do not think that the lonliness research is flawed from a conceptual perspective. At the same time, as I write above, I am bothered by “the notion that we needed the evidence of brain changes to legitimize Fromm-Riechmann’s initial observations”. For me,it is a problem that we are putting all of our eggs in the basket of basic neuroscience research and I think that is a mistake.
          I have a question for you. You say you are keen on neuroscience. What area of research do you find to be of value?
          Sandy

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          • Neuroplasticity. As in life-long neuroplasticity. But bear in mind I’m not a scientist.

            I said philosophy of science (to better understand why that study is a parody of a farce), not philosophy of mind. Not that philosophy of mind is not extremely relevant to all this, although I’m afraid that field is a bit of a mess in itself – still, you might find interesting reading up on the problems associated with epiphenomenalism: http://plato.stanford.edu/entries/epiphenomenalism/#ArgAgeMat

            The flaws I point out in the study have absolutely nothing whatever to do with DSM categories, please do not try to explain them away with that easy argument. They do however have EVERYTHING to do with what Insel is trying to do. The card-castle of bad studies I mentioned is precisely this RDoC of his; it is already half-built (I realize this study still uses DSM categories, but actually what it shows is how you can transition from DSM to RDoC). This study is, so to speak, a building block of the RDoC; one brick of many. The RDoC is not an improvement on the DSM, it is something far far more damaging and pernicious. And it is more damaging and pernicious because these research papers are simply not honest. There is not way these “flaws” are accidental – this is flagrant, intentional dishonesty. And it is getting through. And professionals like yourself are looking the other way while this monstrosity is taking shape.

            Please forgive me if I sound harsh, but I cannot emphasize enough how damaging this could be if it is not questioned and nipped in the bud. The RDoC is a wolf in sheep’s clothing, and potentially a much bigger and hungrier wolf than the DSM: it is not only after people with symptoms of emotional distress but after their children too.

            From wht you say I get a sense that your heart is in the right place (unless you are a very cynical person, but I’ll chose not to believe that). You need to start asking some difficult questions or before you know it you could unwittingly be part of something very bad indeed.

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      • Actually, the Decade of the Brain did reveal some very clear answers, which I think the works of Bruce Perry capture very well. First, it showed that the brain is dramatically modified by the environment – we are NOT given a genetic substrate that determines our ultimate mental health. This in and of itself undermines many of the biological model’s underpinnings. Second, it showed that the brain can be healed even if injured early in life, and that the most healing factor is – wait for it – healthy relationships with other healthy human adults! Which is 100% contrary to the psychiatric worldview that we’re being sold, namely, that biology is destiny and that medical interventions are the only way to help someone who is biologically compromised.

        It also showed that there are specific physical exercises that can address specific areas of physiological dysfunction in the brain.

        Not surprisingly, this seminal research spanning 10 years has been almost entirely ignored in the psychiatric community, because it wasn’t what was desired or expected. But anyone who takes an honest look at what is and is not successful in the human services realm can see that good relationships are critical to healing, whatever else may be going on, and that the vast majority of the time, human relationships are the PRIMARY means by which mental and emotional distress are recovered from or understood or embraced by the sufferer.

        I have no objection to neuroscience. But to be scientific is to be honest and to be skeptical and to be prepared to alter one’s theory based on the results of real experiments. Instead, we have rigged experiments and a slavish adherence to a set of quasi-religious dogma that actual science seems to be completely unable to make a dent in.

        The public’s big confusion is to believe that psychiatry has the slightest thing to do with neuroscience. The new information on the DSM controversy may help to clarify this gross misunderstanding. I’m all about science, but organized psychiatry left science behind many years ago and is doing all it can right now to fight off what it knows to be the actual truth.

        I agree, unlikely to be an organized conspiracy. It’s more like a religious faith under attack – the members know they have to defend themselves or their faith will go under.

        I’m not putting you in that category at all. If all psychiatrists were like you, we’d long ago have been looking at a different paradigm. But I don’t think your colleagues, especially those at the highest levels of the APA, are as willing to hear the truth. Look at what happened to Open Dialog. Even in Finland, it came under attack, despite the best outcomes in the history of psychiatry.

        Clearly, in psychiatry, politics and money trump science every time.

        — Steve

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          • Humbly and humorously stated!

            I actually believe humility is the #1 requirement for being a helping professional If you’re humble enough, wisdom will come to you through observing and learning from your clients. If you’re not, no amount of training will make you anything but dangerous. I’m glad you’re in the humble category, and I really appreciate what you bring to this discussion. Would that all psychiatrists would model after you!

            —– Steve

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  7. I’ll add here something to my last comment above. Perhaps a lot of people will disagree with this, but in a way there’s nothing wrong with DSM categories themselves. The problem is what psychiatry and Big Pharma have done with them. To give a collection of symptoms a name is nothing particularly bad. On the other hand, to carry out a skewed research study which incorrectly claims to show that a particular DSM category has a genetic etiology is very bad. To claim that a research paper shows that a drug is effective in the treatment of a DSM category when in fact the data shows the drug to be completely ineffective and dangerous, is very bad indeed.

    The problem is not in the DSM or its categories but in the scientific studies themselves. And this will not change with RDoC. On the contrary it seems to be getting worse.

    Dropping the DSM is a smoke-screen to try to silence mounting doubts over psychiatry as a profession and its biological model. A scapegoat; a bone thrown to the dogs to quieten them. Like Tomasi di Lampedusa says in The Leopard: “everything needs to change, so everything can stay the same”.

    Don’t get me wrong, it isn’t as though I want to keep the DSM, but to have it replaced with something worse is not good news. The problem is Big Pharma, dishonest research scientists, psychiatrists (honest and dishonest, since the foundations of their profession are just plain wrong).

    Getting rid of the DSM would be a victory, but still a small victory. Only a battle in a much greater war.

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    • I disagree.

      The injury *begins* with a diagnosis.

      It takes nothing more than one of these subjective, arbitrary, meaningless labels for a person to lose many of their civil rights.

      Other areas of a person’s life are affected as well – health insurance, life insurance, commercial driving and others.

      All based on a psychiatric label.
      In other words, all based on *nothing*.

      Duane

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      • But what I am saying Duane, is that those psychiatric labels are not based on nothing as you say, they are actually based on lies (when I am feeling diplomatic I call them “mistakes”, but to call things by their name, they are lies)

        So if you concentrate only on the label and leave the lies behind the label untouched, you are only replacing one labelling system with another. What we need to challenge is the lies in the science.

        Anyway, I am not defending DSM labels, in a alternative world, without the lies that have gone into them to give them concrete shape, they might not have been a bad thing in themselves, but in this real world we live in of course they are bad. So yes, off with the DSM, but don’t buy into the RDoC or anything along those lines either. It’s just switching one label with another.

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        • If we were to leave the lies behind, we would have to start by acknowledging that the DSM categories aren’t illness, disease and/or disorder categories, i.e. that they are not collections of symptoms. They are collections of certain behaviors, emotions, ways of understanding oneself and the world. The moment we judge and define these behaviors, emotions, and ways of understanding oneself and the world as ill, sick and/or disordered, we’re already telling a lie.

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          • Marian,
            This is an important point and one that I have had a hard time understanding since I am so immersed in the culture of “symptoms”. Although I do not think the DSM categories stand for descrete conditions, I still use the word symptom. I see that you object to that because it leads the next question: symptom of what? I guess I have used symptoms synonymously with “certain behaviors, emotions.” Many people, I see are bothered by particular behaviors and emotions. They feel “sick” even before I suggest this to them. I think I understand the objection to labeling something as a disease when we do not have any understanding of what that means but I do not think it is bad to reflect back to a person that I see her distress.
            If someone has a head-ache and I do not know what this signifies (i.e., what causes it), I have no objective measure, is it incorrect to call that a symptom?
            Sandy

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          • Good questions, Sandy. What I tend to do is simply describe what I’m seeing, or better yet, have them do it from their viewpoint. Rather than saying, “You have symptoms of borderline personality disorder,” I might say, “You’ve told me you cut on yourself. Can you tell me what it is about cutting on yourself that is appealing to you? What do you think it does for you?” Most “symptoms” have a purpose, and I consider finding that purpose the key to making progress. Sometimes good therapy even makes the “symptoms” worse. I think focusing on the “symptoms” leads down the wrong path. The repeated behaviors of the client tell you something. The DSM/Medical Model approach says that the behavior has no meaning, it’s just brain chemicals. I say that the meaning is way more important than the behavior itself.

            One of the first things I learned in the world of social work was the saying, “All behavior meets a need.” Help the client find the need the behavior meets, and you can start working with them on alternatives. But stopping the behavior stops the need being met and leads to more distress. Psychiatrists need to shift their focus away from the distressing behavior to the distress that is behind it.

            I hope that makes sense!

            — Steve

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          • (I hope, this comment ends up in the right place, beneath Steve’s where there’s no reply button.)

            Sandy, I want to add to what Steve has said — and I couldn’t agree more to everything he’s said — that I meet people who tell me they feel sick all the time. But there’s a huge difference, although it may not be that obvious, between feeling sick with sadness, anger, confusion on the one hand, and calling the sadness, anger, confusion a symptom of some alleged illness on the other.

            I can feel sick with sadness (or anger, or confusion, or hearing voices, or or or), and still know that there probably is a good reason why I have this intense experience of sadness. And knowing this, I will focus on the reason, trying to find out what it is, to understand it, and, if possible, act upon it so that it won’t cause me more sickening sadness. At the end of the day, my ability to feel sick with sadness actually has taught me something about myself and my life, helped me to make wiser decisions, and improve my life circumstances. So, basically, it turned out that my sadness was my ally in terms of my survival and wellbeing.

            If I refer to my sadness as a symptom of some alleged illness on the other hand, my quest is over. My sadness will be my declared enemy, which I will fight to the bitter end. Without ever realizing that what I’m fighting against actually is myself, my own vitality and survival capacity. So, whenever I meet people who not only tell me that they feel sick with sadness (or or or), but actually symptomatic with sadness (or or or), it’s pretty clear to me that somebody (a professional, a relative, the media,… ) sadly has managed to turn the person against herself.

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          • Marian and Steve,

            I apologize for using the word “symptom” above – I never meant it in a biological or even psychological sense. I’m afraid that because I often use (in my own head) the terms “disease” and “symptoms” to mean the “social disease” and “social symptoms” of groups rather than individuals, I used the word very carelessly.

            I could not agree more with what you both say. For me one of the most important aspects of “mental health” is precisely the recognition that all these behaviours, the “symptoms” of “mental illnesses”, are in fact RATIONAL behaviours – as Steve says “all behaviours meet a need”. Similarly, the “delusions” of “psychotics” are not in any way irrational but convey a rational meaning in symbolic form; they make perfect sense and are always true, even if that truth requires careful interpretation (but then again, all communication is symbolic – the difference is only in that in “psychotic” communication the symbols are not as shared as in other forms of communication).

            To me, classifying a behaviour as “irrational” necessarily denies the humanity of that behaviour. If you then spuriously link that “irrational” behaviour with a person’s genes, with their unchangeable biological “essence”, you are denying their very humanity. This is not to say that there are no genuine irrational behaviours: it is precisely the abusive behaviours which cause amongst other things the distress of “mental illness” that can be described as irrational – that is to say, inhuman behaviours.

            This might sound extreme, but I think it is correct to say that, just like by denying the humanity of the Jews the Nazis became themselves inhuman, psychiatry, by denying the rationality of the “mentally ill” has become itself irrational. There can be no progress until psychiatry recognizes the rationality of the “mentally ill”, but in order to do this psychiatry needs to deny its basic premises – it needs to deny its own validity. Psychiatry, quite simply, needs to disappear.

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      • Hi Sandra,

        If I am still to answer this question it is only because you have never asked it before. You asked me “What AREA of research do you find to be of value?” And so I answered that: life-long neuroplasticity

        I don’t like to make personal comments but I have to say that from our short exchange you seem to have a bad habit of “changing the past”. If I mention philosophy of science you turn it into philosophy of mind; if I talk about dishonesty in a research paper you turn it into a question of DSM categories. If I answer one question you slightly change the question I just answered. I’ll put it down to carelessness and not a conscious or unconscious attempt to change the meaning of your interlocutor’s statements so that you don’t have to engage with them while appearing to do so. But please do watch out for it; it’s enough to drive anyone crazy (pun intended – in fact Gregory Bateson referred to a pattern of communication not dissimilar from this when he formulated his double-bind theory for schizophrenia).

        Steve above expands a bit on neuroplasticity, Bruce Perry, etc. Needless to say I agree with everything he says. Neuroplasticity is not just “another thing” that you can take or leave – it’s a game changer; it is, to use Kuhn’s terminology, a paradigm shift. The failure of psychiatry to engage with this shift is nothing short of scandalous, and inexplicable if you don’t factor in very powerful commercial interests and a great dearth of professional ethics.

        So how would I approach it? Very simply by factoring in neuroplasticity and making sure the design of these studies takes neuroplasticity into account. I don’t want to repeat myself, but in the sample study I linked in my first comment it is obvious that -given neuroplasticity- the 4 members of the control group who developed MDD should have been given a second set of fMRIs, and those results compared with the baseline fMRIs of those members of the study group who went on to develop MDD. Particularly since “There were however significant differences between the groups for baseline clinical measures of depression from the HAM-D (p = 0.004). There were also significant differences at baseline between the groups for measures of cyclothymia (p = 0.001). For both these measures the HR who developed MDD scored the highest.” [HR = high risk; the study group]. I don’t think I need to spell it out.

        In a recent comment on a different post I said half-jokingly that I’m waiting for the longitudinal study on a random sample of 100,000 subjects who are given a complete battery of fMRIs every 5 years from birth to death. Actually, make that a 500,000 random sample and add complete genome sequencing and a detailed assessment of environmental factors at each 5 year interval. Does this sound absurdly far-fetched? I don’t know, look at the Large Hadron Collider; if the will was there on the side of the psychiatric profession, funding for meaningful large-scale studies would be found.

        Meanwhile, back in the real world, if you want to see studies that I “condone” (not a word I would use; makes it sound like a crime) you can check some of the studies in “Human Neuroplasticity and Education” (2011) edited by the Pontifical Academy of Sciences (again this is something I just referenced on another comment so I have it fresh in my memory) you can access it for free here:
        http://www.casinapioiv.va/content/accademia/en/publications/scriptavaria/neuroplasticity.html

        You’ll see that it is a mixed bag of many different studies (or presentation papers), and I don’t think everything in them is correct, but I think they are all honest, methodologically correct approaches. In other words: these people are at least trying, something that cannot be said for most of what passes for research in psychiatry these days.

        And one last thing since you ask me how I would approach things; I would certainly like to see the end of researchers treating the “Conclusions” section as the section in which they speculate freely about the data. I’m sick to death of results that “suggest”, “point in the direction of”, “seem to”… It’d be much better for everybody if researches confined themselves to what the data does or does not say. Research papers should not be works of speculative fiction.

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        • Thank you for your comments. I am sorry if I missed your main points (and I see now that you did mention neuroplasticity earlier). I was not intentionally shfitng the topic. I was doing my best to respond. I am sorry if this was frustrating for you; that was not my intent. I have appreciated this exchange and I think you make important and valid points.
          Sandy

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          • What I would question above in the most recent comments is the sense of uncertainty about the meaning of these experiences. For me, this is a hypothesis. I accept that hypothesis but I do not think we have any more reason to accept this as certainty than we can accept some other hypothesese about which you are so critical. I also do not think it is correct to say that linking something to genes means that we are linking it to some unchangable biological essence. The neuroplasticity that you (and I) find so intriguing is likely based on an altered gene environment. In the loneliness studies, they find that genes can be turned on and off and this is likely involved in the ability for people to change in response to a changing environment.
            This is not to defend faulty studies and faulty interpretations of these studies but to defend uncertainty in our interpreation of peoples’ experiences.

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          • Replying to your second of these paired comments. I think where we can find much shared agreement is in the rejection of reductionism.

            So for example, if someone were to assert as dogmatic fact that biological factors play no role in a persons emotional experiences, and/or assert as dogmatic fact that only environmental, social/relational factors are involved – I could not agree. I could not agree, because that speaks beyond what limited and finite evidence we have to a conclusion that can’t be substantiated.

            I would also be reluctant to agree, because this kind of reductionism seems contradictory to my professional experience working directly with persons experiencing (by their own identification) very severe distress. It also seems contradictory to my own personal lived experiences. Now those “it just feels wrong” statements can be dangerous if held too tightly, but it is just as much a mistake to ignore those experiences fully.

            The thing that is frustrating for me at the moment, is when I consider the content produced at MIA, and the voices of others on the consumer/survivor movement I feel like much of what has been discussed in this thread are responses to red herrings or straw men.

            I do not find MIA to be dominated by voices making reductionist dogmatic claims. Instead, the overwhelming bulk of discussion centers on defending against and countering falsehoods, distortions, logical fallacies, cognitive biases, and the insidious effect of power on institutions that hold it.

            I don’t experience many people in the movement, and certainly not at MIA, saying that as absolute fact that neurobiology has no relevance whatsoever to our experiences of cognitive and emotional distress. What I experience instead is an atmosphere of critical thinking and rational deconstruction of the myriad of ways professional institutions perpetuate distorted messages that serve their power interests.

            People who find this criticism unsettling are usually professionals functioning as part of an institution that is being strongly criticized. The claims itself are not mainstream in a society in which psychiatry and drug companies dominate the discourse and shape the message. And it can be difficult to deal with feelings of defensiveness when such pointed critiques are made – especially when those critiques stand up to scrutiny and becoming ever-more difficult to dismiss.

            There are two very common natural responses to this cognitive and emotional dissonance when someone is exposed to critical challenges that threaten there previously unquestioned paradigms. The first is emotions like anger anger and dismissivness and efforts to marginalize and discredit those who created fear and anxiety that ones favored way of viewing things just might be questionable.

            The second very common response, while more subtle and may even be unconscious on the part of the one doing it, is no less damaging. A person can choose to attempt to weaken, discredit or soften the claims that threaten his/her worldview by challenging the character, style, tone, personality or context in which the critiques are made. A person can attempt false equivocations, such as “hey we’re all flawed, no one knows any more than anyone else, we’re all right and wrong, up is down, left is right, and you really don’t have any right to be critical.” A person can create straw men such as “I don’t think its helpful when you claim that every psychiatrist practicing is evil” when noone ever said that or, “I don’t think it helps your cause when you claim that there is nothing that can be learned from neurobiology” when noone ever said that either.

            Both of these styles of responses are defensive and reactionary.

            I’m not interested in speculating on what we don’t know, or what we might know at some future time. I’m interested in challenging disinformation and distortion that is produced to maintain the prevailing narrative and power balance in the fields of psychiatry and mental health. I’m interested in what we can show to be faulty or misleading science, what we can prove to be deceptive claims, and what we can demonstrate to be false.

            But I can’t prove the notion that neurobiology plays a role in our distress experiences false, nor would I ever want to! I’m not scared of the implications of neurology and as we have more actual concrete data (rather than the wild speculation and dis-ingenuousness that dominates what passes for scientific research in psychiatry today)I will be excited to incorporate more understanding into my professional work. But I’m not interested in fearfully trying to “beat down” and idea for which there is presently no conclusive data. And I don’t know to many of my partners – consumers or professionals – who are interested in that.

            I am interested in challenging those who claim to have conclusive data when they don’t, equate wild speculation instead of hard science (“the data may suggest that in the future….” should be a phrase banned from the conclusions section of every research article”)

            What I can prove false are claims such as “mental illness is a product of chemical imbalances in the brain” – an assertion disproved through clear, repeatable, peer-reviewed, scientific evidence where even the people who still say it to the public acknowledge when pressed that it is a fiction (but claim it to be a useful falsehood for the public.)

            That’s not dogmatic. That’s not emotional, its not reductionist. It’s simply a rational willingness to go where the data takes us. It’s a shame that the institutions of psychiatry and drugs have not been more willing to show similar good faith.

            I believe that institutions willing to lie and distort truth in order to protect their own power and privilege are dangerous and harmful. Those institutions offend the very core values that define my efforts as a human being on this good earth. And until those “behaviors” of these institutions change, there will be a need for honest skeptics versed in critical thinking to challenge these prevailing narratives that are, in my opinion, accurately described as propaganda.

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        • Sandra,

          Of course it is an hypothesis, wouldn’t dream of claiming anything else – and in fact I’m sure it is incomplete and parts of it are probably just plain wrong. In order to be more than a hypothesis it will need confirmation from research – and I will also admit that this presents its own challenges since it is a hypothesis that bleeds into philosophy and so not all aspects of it are subject to falsification, but some certainly are.

          My problem with the other hypotheses I’m so critical about (let’s call it the “biological model” for short) is precisely that the research that supports this hypothesis is for the most part flawed or just plain fraudulent. In other words, that the biological model is treated as a validated theory when it is nothing more than a hypothesis, and one that it is full of holes and “mysteries”. I don’t have a problem with genuine research into hypotheses I think are wrong, but I do have a problem with bad research into any hypothesis being passed off as good. And when it comes to psychiatry bad research is not the exception but the rule.

          And let’s not be disingenuous here, this is not just an academic discussion. We’ve had 40 years of therapies based on the “biological” hypothesis, with immense resources thrown into it and the result is the situation described in Anatomy of an Epidemic. On the other hand you have very small initiatives like the Hearing Voices movement based on the “non-biological” hypothesis (which admittedly is still to be formulated in a rigorous way) and which despite the difficulties they face are producing great results. When you have two competing hypotheses the proof is, as they say, in the pudding.

          As for genome as “unchangeable biological essence” I think it is correct to say this in the context of the current practice of psychiatry. Whether it is or it isn’t in actual fact is not so much the question; the question is whether it is assumed to be so by mainstream psychiatry and whether this is the narrative that is presented to patients: or are you going to say that psychiatry does not operate from the assumption that these “genetic” conditions are life-long conditions which require life-long treatment of one kind of another? How many of your colleges have you seen taking an interest in neuroplasticity? Also, bear in mind that neuroplasticity is not magic – it does have its limits, so it does not render irrelevant the question of genetic determination.

          But of course in the end the question is whether conditions such as “schizophrenia” -or better, voice hearing-have a genetic etiology or not. And they don’t; and they cannot have it – to explain why we would need to get into evolutionary theory: the evolution of genetic traits which reduce survival is a tricky thing, and as far as I know no-one has even proposed a theoretical model of how something with the complex genetic architecture which voice hearing would need to have (or else we would have found those elusive genes already) could possibly have evolved. I’ve tried before to get into this subjects in other comments and things get too long, so I won’t go into it here; I will only say that if indeed there’s a genetic component to voice hearing it will need to have been positively selected, so it is likely to be a different variant of intelligence. Of course this is only a hypothesis, but at least it tries to account for all the facts rather than cherry-picking them.

          About genes that turn on and off and all this epigenetic stuff that seems to have become so fashionable lately, like neuroplasticty, it is not magic. You can’t use epigenetics to cover up all the holes in the biological model. Epigenetics won’t turn an environmental etiology into a genetic one.

          But to get back to basics: my greatest objection to psychiatry is that the vast majority of research which appears to validate its “biological model” is deeply flawed. The only reason it is not exposed as flawed is that it is backed by very powerful economic interests. And the drug therapies which have been developed based on this flawed research are extremely harmful. And the proof is in the pudding. So I invite you to take a good hard look at your pudding.

          Psychiatry is like a mythical land which is supposed to exist between the kingdoms of neurology, psychology and pharmacology, but it just isn’t there. There’s nothing between those three kingdoms, only foetid hot air.

          It’s been a pleasure exchanging ideas with you, Sandra, I hope I have not given too much offence. Unfortunately I won’t be able to comment any longer as I am pressed for time with work, and try as I may, I just don’t seem to be able to keep my comments brief. I hope some of this will make you reflect on the state of affairs in your profession.

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          • To Morias and Political Heretic,
            I think that we largely agree. If my responses seem brief and superficial it is at least in part a reflection of limited time for me as well.
            I hope I am not seeming defensive of an apparatus (organized psychiatry)about which I have my own serious criticisms. I am just trying to have an interchange and to understand what others are saying.
            Just when I think that perhaps people are being unfair, I attend a talk (as I did recently) in which I hear a colleague using the worst sort of reductionism to explain these faulty contructs that we call psychiatric diagnosese. Or I read an article by the current APA president (link on this site) that dismisses all critics of psychiatry and having nefarious and hidden agendas.
            Thank you for this exchange.
            Sandy

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  8. Sandra, thanks for sharing your perspective on this topic. I am always so appreciative of your honesty, knowing that you are perhaps not as “doctrinaire” as some on this site would prefer. It would be much easier to posture on on side or another of the many issues you address if you were not “in the trenches”, dealing with real people and no easy answers. We would be so much better off, in my opinion, if we had even a small fraction of psychiatrists with your melding of meticulous rationality, honesty, humility and commitment to what is best for each individual.

    Now for a switcheroo…I want you to be aware of a teleconference coming up this Thursday that i plan to “tune in” to. It is hosted by NAMI, as part of their “Ask the Doctor” series, and the special guest this week is Dr. Xavier Amador, who will be speaking on anosognosia. I think your own article on this was the first of yours i read on this site. I am desperately hoping you’ll be able to join the conversation, even though i know that may be impossible due to your work schedule. I have rejoined our local NAMI chapter mainly to be a “different voice” in this organization, since so many people get channeled to NAMI and then get indoctrinated into the very heavily “pro-biopsychiatry” mindset that prevails. On the other hand, it is hopeful and heartening sign to me that Keris Myrick was elected national board president of NAMI, and that Robert Whitaker is speaking at the upcoming convention in Dallas (Amazing…Praise the Lord!)

    At any rate, here’s specific information on the teleconference:

    ***Conference Call with Dr. Xavier Amador on Anosognosia

    Thursday, May 24 at 11:00 am, EST

    To access these calls, dial 1 (888) 858-6021 and enter pass code 309918#.

    Please…I urge any and all MIA readers to tune in and have input in this discussion. The concept of “Anosagnosia” has been used by folks like Dr. Amador and Dr. E. Fuller Torrey to justify forced drugging and other highly coercive measures in psychiatry.

    I would also LOVE to have the host of this website, Robert Whitaker, in on this conversation!

    Russ

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    • Thanks, Russerford, and thank you for alerting us to this teleconference. I am also involved with my local NAMI organization and they have been very receptive to my particpiation. I am speaking at their annual conference today! I will be presenting my talk on Optimal Use of Neuroleptics. They have invited another psychiatrist to offer a different perspective but at least we are discussing this.
      Sandy

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  9. Sandra,

    Superficial?

    How did you come up with that term to describe how you *might* be perceived?

    You come across as someone who is anything but superficial. I don’t agree with each and every one of your comments, but you listen and learn from others – seemingly to be in a constant search for answers, facts, truth.

    Superficial?

    Give me a break.
    More importantly, please give yourself a break!

    With gratitude,

    Duane

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  10. Thanks for the article Sandra, I think you are very brave, balanced and patient. I’m certain you are a fantastic caregiver. I have so many thoughts and like those here so little time. However, I think I have to say something, at least on this thread.

    I think the headache analogy is apt. In science one has to categorize in order to attempt to reduce a problem of inordinate complexity into units which can be understood. That’s science, it isn’t people. However, neuroscience finds itself in a difficult place because it’s really trying to understand people, or rather human behavior. This same scientific model yielded a detailed understanding of molecular genetics in our lifetimes and has and continues to revolutionize treatment of human cancer. By trying to apply this model to understanding psychiatric disorders, neuroscience finds itself in conflict with people who suffer from the conditions in a way that cancer biologists could never have imagined. Reductionism in the scientific process though should not be mistaken for reducing or labeling people or their suffering. Reductionism is a tool and only one way to understand, but it has been an effective way to gain mechanistic understanding of natural phenomena.

    I think there are several ways in which the issue gets confused here and elsewhere.

    1) Psychiatrists are not neuroscientists, or at least the vast majority are not. Their understanding of neuroscience is often as weak as that of the general public. It is a huge problem for the field because the principles of basic neuroscience which could be used to build an understanding of psychiatric disorders are largely mysterious to them. So, when a psychiatrist tries to explain or justify biologic underpinnings of the disorders they treat or how drugs might work, their explanation is often woefully misguided, inaccurate and even potentially absurd. This has led to often simplistic explanations which have been stated as facts such as ideas of chemical imbalance. It is worth noting that there is a vast field of basic, academic neuroscience which is founded on understanding how the brain works normally. Many, many of these scientists are academics without ties to pharma or other undue sources of influence. Ideas from these neuroscience fields, largely from non-human research, form the true evidence base from which one could argue that neuroscience offers significant potential to understand psychiatric disorders.

    2) Neuroscience or “biological explanations” of psychiatric disorders should not be set up as deterministic. I agree that the profound plasticity of the brain is amongst the most important insights of neuroscience. This cannot be stated too clearly or too often. The issue keeps getting lost in a false nature vs. nurture dichotomy which infuses the way people think about this issue as much as the false concept of mind-brain dualism. These ways of thinking are so deeply ingrained in our psyches that it is difficult to think clearly about them even when one is trying to. The environment is constantly in interaction with the underlying structures of the brain from the moment the first neuron is born until the existential realization that takes place at the moment of death 80 years later. Anyone who talks about this purely from one or the other perspective should likely be mistrusted. However, I don’t think it is really accurate to say that psychiatry as a field has rejected this idea. It is true that pharmacotherapy has come to dominate modern psychiatry, but many psychiatrists lament this fact. The principles of therapeutic relationship, psychotherapy, influence of trauma and impact of psychological and social environment are still central principles.

    3) Current psychiatric medications are not the result of neuroscientific inquiry in psychiatry. They do work via mechanisms that exist in the brain and perhaps neuroscience has been used to justify their use. However, they were discovered by accident. They were not found or designed based on any neuroscience understanding of the biology of psychiatric disorders. Some of them have been modified by organic chemists to develop new versions, but this isn’t neuroscience either really. The search for neurobiological mechanisms is really motivated by the well documented inadequacy of current treatments (including drugs) and founded on the hope that understanding how the condition develops, persists AND RESOLVES in the brain will provide insight for new treatments. The new treatments could be drugs or psychotherapies or environmental manipulations or biofeedback or any number of things. That is the neuroscience approach, that the better we understand the brain, the better positioned we will be influence the course of mental suffering. The full understanding being that this includes both the underlying substrate of the brain and the environmental impacts on it.

    Okay I’m burnt out now. I apologize for using the medicalized terminology of mental suffering, I know that gets people upset. I feel kind of stuck about this, because it is hard to talk without using these terms, at least for me. I think it’s hard for others here too because we are often just using the same words and putting quotes around them which I think speaks to the lack of alternatives. To say “human distress” also seems not right to me though because it seems to put me in a place where I’m saying all human distress is a psychiatric illness which I don’t at all think. Anyway I get distracted on this topic.

    Thank you again Sandra, I support your efforts to explore alternative models from within psychiatry.

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    • This was a great comment on “perspective” Scott. I really liked “The environment is constantly in interaction with the underlying structures of the brain from the moment the first neuron is born.”

      Yet I wonder, in terms of human development whether we just “assume” that all neurons are born within the brain? In embryology, I believe there an understanding that the first neurons develop within the heart & nervous systems. Please consider a more holistic view of our pesky neurons, from a body-brain-mind perspective which suggests to me at least, that while the brain may be the “driver” of human motivation, the heart is the engine of our motivation.

      http://www.rcpsych.ac.uk/pdf/Heart,%20Mind%20and%20Spirit%20%20Mohamed%20Salem.pdf

      Sorry about the motorcar analogy, I guess its a mechanically minded “male” perspective? A bit like the patriarch’s of the APA, perhaps?

      Regards,

      David Bates.

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  11. Also, I may not be able to keep replying to this thread. My passion for this topic has gotten in the way of my normal life before and I’ve pledged to myself not to spend 5-6 hours at a time on MIA anymore.

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  12. Oops! I have to correct the information i gave about that teleconference with Dr. Xavier Amador. It’s this FRIDAY, not Thursday.

    Here’s the info again:

    ***Conference Call with Dr. Xavier Amador on Anosognosia

    Friday, May 24 at 11:00 am, EST

    To access these calls, dial 1 (888) 858-6021 and enter pass code 309918#.

    Please…I urge any and all MIA readers to tune in and have input in this discussion. The concept of “Anosagnosia” has been used by folks like Dr. Amador and Dr. E. Fuller Torrey to justify forced drugging and other highly coercive measures in psychiatry.

    I would also LOVE to have the host of this website, Robert Whitaker, in on this conversation!

    Russ

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  13. @Russeford I hope some folks can attend that conference call!

    I appreciate you writing about this, Sandy.

    Did you see this:

    http://www.newscientist.com/article/dn23566-suicidal-behaviour-is-a-disease-psychiatrists-argue.html?full=true
    New Scientist, “Suicidal behaviour is a disease, psychiatrists argue”

    ugh. I share your appreciation for trying to clearly identify the limitations and implications of neuroscience and I hope we’ll keep talking about this topic on MIA.

    I think that, regardless of what we think, it would behoove us all to stay abreast of research directions and to try to mediate some of this rhetoric about aberrations, epigenetic variations, and diseases.

    I wish the NIMH was clearly thinking as much about the ethics of neuroscience as we all seem to be. Of course, they are operating from the worldview that our brains control almost everything and that our brains must surely be diseased.

    Did I already say “Ugh”?

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  14. Hi Sandy,

    You may recall that Bob Whitaker wrote an article on the latest eugenics agenda of the NIMH in keeping with psychiatry’s ongoing abuse of so called neuroscience to prove invalidated labels in the DSM.

    I find psychiatry’s long term abuse of so called science such as their horrific eugenics agenda created for and by the power elite that caused the German Holocaust as well as the latest Holocaust that tries to target just about everyone from womb to grave with the constantly expanding DSM appalling. Therefore, given psychiatry’s large amount of junk science created with BIG PHARMA for ongoing disguised eugenics theories to blame the victims of oppression and abuse by the power elite making billions with this scam, like the boy who cried wolf and/or the emperor’s new clothes I could never trust much of what they say ever again. I also think that tacking on the term “neuro” to everything psychiatric in recent times is another scam to give BIG PHARMA KOL’s a false aura of brain or neurological expertise, so I believe that is another cause of grave concern.

    I realize that we may not agree on this and other things, but I thought of you while we were all very demoralized by Jeffrey Lieberman’s latest article at MIA touting the many advances of psychiatry. You noted that you were not pleased with the article either if I understood you correctly.

    I recalled you had posted an article about Dr. Lieberman a while back whereby he indicates that for those who hang in there, many lucrative opportunities await them.

    http://www.madinamerica.com/2012/09/on-drug-development-lucrative-markets-and-the-future-of-psychiatry/

    I give you a great deal of credit for your bravery for posting this article and your astute observations about it and Jeffrey Lieberman, new APA president. The posts under his most recent articles listing his many, many ties to drug companies says it all about his agenda like that of the NIMH, APA and others trying to seduce BIG PHARMA back into the fold to keep the gravy train going at the ongoing expense of so called patients as exposed by 1boringold man and others.

    I would be interested in your thoughts on this. Do you think I could get a paranoia label?

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  15. Hi Donna,
    Thanks for reading and commenting. Good to hear from you.
    You are correct that I was chagrined, although not surprised, by Dr. Lieberman’s post. I did not have much to add to the many fine commentaries as well as the post from 1boringoldman who has become my role model in psychiatry:
    http://1boringoldman.com/index.php/2013/05/21/off-the-cuff/

    I am not going to comment on whether you could get a paranoia label other than to say, if you got it, so would I.

    However at the same time, I did not fully agree with Whitaker in his eugenics post nor am I comfortable equating modern psychiatry with the Holocaust (although on close reading, I get that this is not exactly what you are saying). What I worry about is that if the rhetoric gets too heated, this is what allows Lieberman to dismiss all of as us extremists who are motivated by nefarious forces as he does in his post.

    I am familiar with Dr. Philips and a a big fan of the UK Critical Psychiatry Network. When I have time I want to read his latest post more carefully. I respect him but I think our views to not entirely overlap. Not that they need to. I just want to read his post carefully before I comment.

    Sandy

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    • Sandy, l

      Like many of the readers on this site, I’m not anti-science. In that sense, I have no problem with more research into neuroscience.

      In fact, I would be for studying how sleep (lack thereof); prolonged stress; trauma; nutrient deficiencies may have an effect on brain chemistry.

      I have no problem with the scientific study of any of this, to include the neuroscience behind emotions. What frightens me is a pattern – of less than genuine research; the further promotion of a failed model; and the targeting of vulnerable people to build these theories.

      In short, repeating history.
      So, count me in as part of the paranoid group.

      Duane

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      • Especially, sleep.
        A common denominator.

        It’s been mentioned before, on this site and elsewhere that sleep disorders may be at the root of many “severe mental illnesses.”

        A majority may quickly point to trauma as the issue behind the sleep disorder.

        I say not *everything* is necessarily due to trauma… Maybe something else is going on with a person – in the body, or dare I say, in the brain.

        If psychiatry had spent more time with some of this, the past fifty years, rather than forming an unholy alliance with pharma; if the profession had not been so brutal to so many, for so long… we might be in a place to have learned a few things.

        We are where we are, I guess.

        Duane

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    • I don’t see that Robert Whitaker does anything but clearly point out how “psychiatry’s” methods have promoted people who are considered “mentally ill” as being appropriate targets for methods that correlate with an increase in mental illness, and that also promote them as beings who are better off having their brains damaged (which increases mental illness) and that when they can’t express themselves thanks to this brain damage this is an improvement, because expressing themselves would be a biological disease (which they didn’t have until they were treated, which is why they are supposedly healed, and why they should receive brain damage and call it healing).

      To treat a whole population as needing healing, by giving them a biological disease (and this is the science of what’s going on AS IT STANDS no matter what you call it)…

      And one is supposed to excuse all this, or speak mildly of it (because you know those people handing out the pills and acting sorry for those “suffering” mean it well, have good intentions, suffered themselves through years of “schooling” because then “truly wanted to” help….)

      Same as one can’t speak against a military intervention which has made everything worse, excuses the use of violence… all because the people meant it well, and believe in what they were doing.

      I think that those waging the holocaust also believed in what they were doing, and that they would change the world.

      Overlooking this in order to not be called “extremists who are motivated by nefarious forces,” as if that means anything other than it exposes the state of mind of the person making such claims, this gets to be real “politics”….

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      • Nijinsky,

        I don’t think we disagree on anything you said.

        All I’m saying is that if trauma can cause a heart attack, surely, it may have an impact on a person’s brain. That is not the same as saying someone has a disease or lifelong, incurable disorder.

        There has been some good research on how mindfulness training can increase gray matter; how hyperbaric oxygen therapy can help a person heal from both trauma and brain injury.

        Prolonged stress and trauma appear to influence the brain – the role of nutrients, and the need for more of them for good brain function. Psychiatric drugs, taken for the long-term can be nutrient depleting.

        There are neurons throughout our body – in our heart and intestines. Our emotions are tied to not only our brain, but the rest of our body and vice-versa.

        I understand the fear based upon what’s happened in the past with psychiatry. But I’m not for throwing out science altogether, from learning more about some holistic solutions that could really be useful.

        And, to clarify, I’m not for creating environments of prolonged stress or trauma for the purpose of conducting research. Unfortunately, we have plenty of those already. I’m for conducting studies to determine how the brain can best heal, recover.

        This would involve not only research with healing relationships and communities, but also other holistic modalities. We simply have not studied these things, and IMO, we need to.

        Duane

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        • All this stuff has been studied, and been implemented to promote healing. WHY “psychiatry” is supposed to have something to do with it, when it’s psychiatry that does the most to deny the healing that occurs, I don’t know!?

          Neither do I believe being able to blow up the planet 20 times with nuclear weapons promotes peace (this is overkill, if you can kill all humans on the planet 20 times you can be sure the “enemy” is dead, along with every other human life form); I also don’t believe that threatening people with eternal damnation in order to control their behavior teaches them what love is, what spirit is, what possibility is, what freedom is, what growth is, what being human is, what creativity is, or what reality is.

          And I’m not interested in having some ideological conversation about what could be studied in “psychiatry” or mainstream “science” when these things ARE studied but denied by both “disciplines”.

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          • Nijinksy,

            You raise some good points.

            These studies are taking place (at least to some extent), and psychiatry does deny the healing.

            I’ll pass on the topic of the nuclear arms race and religion. Other than to say, I believe “God is love” and “perfect love casts out fear.” (not my words, by the way).

            Be well,

            Duane

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  16. Dr. Steingard, I’m someone who is more ambivalent about some of the ideas that have been expressed on this site than some. I believe that I suffer from a serious mental illness, and while I do not discount the possibility that improper use of anti-depressants and cannibis may have precipitated my first significant symptoms rather than it having been a fully organic process, I still can very confidently say that treatment with psychiatric drugs, including neuroleptics, helped to turn my life around. I have remained high-functioning and achieved many goals while on neuroleptics, for many years, after a series of episodes that resulted in my losing everything, at great cost. I rebuilt my life and accomplished more than I had previously, all while on neuroleptics. But after nearly a decade, I still found myself missing and longing for a self that had been lost, and which I had dismissed as a hypomanic fantasy. Nine years in, and I still could not shake the feeling that something fundamental was not right with me. So, tired of being told in no uncertain terms for years by the psychiatrist who had finally stabilized me that I needed to be on a therapeutic dose of neuroleptics for life, causing me to perpetually live in fear for the loss of my livelihood and my family, I had to try something different. I sought the aid of a very difficult to find psychiatrist with a track record of helping appropriate patients to successfully taper off of neuroleptic drugs, by at least some measure, or do the work necessary to confirm for the patient that it could not be done without unacceptable risk. The result has been transformative. I gained the courage to make this change in no small part by reading things you have written over the past year, as well as the writings of others on this site and elsewhere (e.g. Whitaker and Breggin). I am only 1/3 down from the dose I had been on for several years, and I recognize myself again, in a way that I’ve not for over a decade. I don’t know whether I’ll go down further; I have an open mind but I am committed to remaining vigilant. But even this small reduction in dose has had a soberingly profound effect on my cognitive and emotional functioning. There is little doubt in my mind that the neuroleptic I have been on has been causing me to experience negative symptoms of schizophrenia (I was misdiagnosed as within the schizophrenia spectrum, i.e. schizo-affective/bipolar type). I share the pain and outrage that so many on this site have expressed so eloquently, even if I disagree with conclusions that have been reached by some. My experience is a sample size of one, and cannot serve as a rationale for any other person’s medical decisions. But folks out there should know that you don’t have to disbelieve in neuroscience or dismiss the entirety of the mental health industry in order to recognize that psychiatry and the pharmaceutical industry have a lot more to answer for than most of their spokespeople will ever admit, or even acknowledge. This is for real. But those of us who have fallen victim can’t be the only ones to speak out — we neither have power, nor can afford to lose our anonymity. But thank you Dr. Steingard, for risking your livelihood and reputation and speaking out. It’s shameful that greed and inertia can operate to thwart important clinical work which is based upon scientific evidence and is directed at helping patients live better lives.

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    • Hi N.I.-
      Of the many comments I have received, this is one of the most powerful and meaningful to me. I am glad you have felt better as you slowly reduce the drug dose. I completely understand and share your caution and I would also caution those who label your perspective as a manefestation of some sort of psychological “buy in” to the prevailing medical model.
      I would love to hear from you again. I wish you the best. Your voice is important in this ongoing discussion.
      Thank you so much for sharing your experience with us.
      Sandy

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      • There are survivors who don’t receive state support who choose to use services, take medication and are comfortable with their diagnosis. They are not brainwashed, suffering from Stockholm syndrome, and have high intelligence, it really is a choice for them, and some are activists who fight against forced treatment.
        I’ve known people who use cannabis to help with medication side effects and also to manage differences in perception and this has been after diagnosis.

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      • Thank you. I should clarify that I have every intention of trying to come off of the neuroleptic, entirely, and the open mind I have is to staying on some minimum necessary dose. My strong bias, after having read what I have read about potential long term effects and after witnessing the profoundly detrimental cognitive, emotional and social effects that they have had on me specifically, is to get off of them entirely. But I accept that I might not be able to, and, for me, the reasons for it would be less important than the fact of it. I’ll add as well that I have no intention of coming off of the mood stabilizer I’m on, an anti-convulsant, which I take with Omega-3, the safety and efficacy evidentiary record for which I find far less controversial. I have been aware from your writings and your research of your caution in regard to neuroleptic tapering, and I appreciate your supporting mine here. Something someone else said on this string also resonates with me, i.e. that the classification of so called mood disorders via DSM-V or otherwise is far less troubling than are efforts to promote the use of psychotropic medications to address them. I’m also mindful of what, in honor of the late Christopher Hitchens, is referred to as the “Hitchins Razor” principle: “What can be asserted without evidence can be dismissed without evidence.” Whitaker has elegantly chronicled occurrences thoughout history upon which psychiatry and pharma have made baseless claims regarding the safety and/or efficacy of psychotropic drugs. The trick here, though, is to sort through, with rigor and integrity, what claims by psychiatry pharma can be said to amount to evidence, even if imperfectly, and what cannot. I don’t believe that activists can get very far with a wholesale dismissal of the entire body of science, including diagnoses and scientific bases of all drug use for mood disorders. Finally, I’ll add, consistent with what many have promoted on this site, I’ve found that, for me, a multi-disciplinary therapeutic approach taken *by the same provider* has been far more beneficial than working with two or providers, i.e. a psychiatrist and a psychoanalyst. Even better than having providers work closely together is a provider who can consider and address each of the interdependent sources and causes of moods, at once. When I work with a provider I’d like them to have the tools and knowledge to understand the differences and relationships among perceived mood symptoms, efficacy or non-efficacy of medications, side-effects, neuroses, ordinary reactions to circumstances. The should also be willing to address the *content* of delusions and hallucinations for therapeutic purposes rather than to dismiss them outright as irrelevant because irrational. Also consistent with innovations supported here, the provider should also have access to and should actively involve family members in therapy.

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        • Before I’m misunderstood on the Hitchens Razor point, the point is not that there does not exist compelling evidence contrary to the claims made by paychiatry and pharma. You yourself have highlighted much of it here, particularly in regard to neuroleptics, as have others on that and other subjects. My point instead is that I think psychiatry and pharma often demand more evidence contrary to theirs than is warranted, because the validity of their own evidence is often overstated.

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        • ” I don’t believe that activists can get very far with a wholesale dismissal of the entire body of science, including diagnoses and scientific bases of all drug use for mood disorders.”

          To accept that a mood is “medically” “out of order” one has to take a leap of faith. Psychiatry has merely defined these moods as something imposed by nature and biology on the human experience. It hasn’t proven this. All psychotropic drugs can act on mood, if someone chooses to do things to their mood with drugs, whether it be a rock bottom junkie or someone under “science’s” justification, nobody can demonstrate a bona fide brain disease is being “treated”.

          I think there is a lot of evidence that long term use of any psychiatric drug is harmful, including the agents dubbed “mood stabilizers” (one could label any mood affecting drug a ‘mood stablizer’ it is really just an arbitrary classification they even purport to use neuroleptics in this fashion). There’s a ton of evidence lithium is toxic as all hell.

          “Dr. Steingard, I’m someone who is more ambivalent about some of the ideas that have been expressed on this site than some.”

          I’d be interested to hear some examples.

          ” I share the pain and outrage that so many on this site have expressed so eloquently, even if I disagree with conclusions that have been reached by some.”

          What conclusions?

          “(I was misdiagnosed as within the schizophrenia spectrum, i.e. schizo-affective/bipolar type).”

          Gay people in the 1970s were “diagnosed” using the same “technology” the “schizo-affective” label is applied using, that is, a paper book full of pages. If the “body of science” has “progressed” from 100 years ago a quack slapping a label on a strange person to in 2013 a quack opening a book of labels slapping a label on a person than the “body of science” is pretty pathetic and amounts to nothing but noise, the impression of progress. Pipe enough talk of biology and genes into the press for enough decades and the world won’t notice the sleight of hand at play when in 2013 a psychiatrist investigates nobody’s biology in “clinical practice”.

          I went through a “misdiagnosis” period where that is how I understood my situation. Now I have concluded psychiatric “diagnosis”, all of it, is merely an exercise in aping what real doctors do and psychiatry hasn’t even earned the right to use the word “diagnosis”. It is an affront to real medicine. All part of the word magic of psychiatry. Psychiatry’s contempt for the Hippocratic oath and informed consent just compound the situation for the unfortunate people forced to interact with it.

          “Hospital”, “doctor”, “nurse”, “condition”, “disease”, “diagnosis”, “medication”, “treatment”, “prognosis”, “evaluation”, “therapy”, “clinical”, all of these terms, borrowed from what bona fide biomedical physicians do, coalesce to create the reification of psychiatry’s fiat “disorders” turning the extremes of human life into a false consciousness of quack medicalization that has no basis in demonstrable biological pathology.

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          • Anon, I salute your passion. But I’m neither a scientist, nor a physician, nor an historian. I know only that I’m a person who found himself chronically suffering from mood fluctuations that had the collective effect of making me unable to function effectively in the world, including an inability to hold a job, notwithstanding a stellar education and support from his community. Most significant of these were wildly outlandish, and patently false, delusions and spiralingly suicidal depressions, neither of which were even remotely rational or in proportion to my actual circumstances at the time. These experiences ceased, and my ability to function in the world accelerated in all the important ways, when I agreed, not without a terrible sense of defeat, to take and did in fact, with discipline, take pharma drugs. I must rely upon people who are trained in psychiatry and/or are otherwise reliably knowledgeable of the evidence supporting and contesting the safety and efficacy of the drugs that I choose and choose not to take. My purpose using pharma drugs is to maintain the positive trajectory that my life has taken, and to prevent at all costs another reversal that I and my family cannot afford. What I need to understand better than I have understood to date, is, what resources can I draw upon (other than primary sources, because I’m not a doctor or scientist) in order to determine whom to rely upon for this information?

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          • The problematic thoughts, beliefs, moods, and feelings you describe are things I’ve experienced approximately too.

            “neither of which were even remotely rational or in proportion to my actual circumstances at the time.”

            I try to remember that “rationality” and “proportion” are normative judgments and not positive facts about the universe, positive facts about the universe being what science is set up to discover. All in all, many have come to the conclusion that modern life, and accumulated stress goes a lot of the way to explaining these phenomena regardless of any one individual’s assertion that something is “out of proportion” to some assessment of one’s life circumstances at the time.

            I would never dispute that drugging one’s consciousness can contribute to finding a way through, temporarily or permanently, problematic thoughts, feelings or behaviors.

            I dispute that doing so is “treating” a bona fide medical disease of the body. If you found relief with your drugs of choice then that is a good outcome.

            With problems in life one has to find a solution that works best for them. I fell into the trap for a long time of conceiving of psychiatric drugs being a prophylactic against disaster striking, I came to know this was just a narrative that I’d been led to believe at the hands of ideologues in psychiatry.

            If you want to safely as possible use drugs of any kind, a technical expert in the human body is a smart way to go. The trouble arises when that pool of technical expertise is a hybrid of pharmacology expertise and quackery brain disease faith based fanatics.

            In any problem in life, a problem more complex than bodily function for sure, wise counsel, learning from and interacting with people who have solved that problem and lived it, is also a good move I think. I think books, nonfiction books, many blogs like this, networking with other individuals, and understanding the alternatives to psychiatry’s narrative is a good start.

            I am alarmed to hear you say you felt “defeated” or something, by taking psychiatric drugs. I don’t anybody to feel shame for finding something that works for them. Nor do I want you to feel like you should pull the drug based rug from under yourself if it’s not something you’d be ready to do.

            There is every reason to believe that a physician’s broad-based training in physiology etc. gives them the knowledge to administer a drug safely at least short term. Unfortunately life is more complicated than the organs under our skin, and all the slicing up of dead bodies donated to science in anatomy class at college is not going to give someone an understanding of why someone’s life became overwhelmed with extreme thoughts and emotions.

            A problematic person and their thoughts, can always be dealt with in a number of ways. For a very long time now, psychiatry’s approach has been to disable and meddle with the brain, rather than try to understand the person. Medical training and psychiatric ideology cannot help but produce professionals who view human beings as objects, objects to be tinkered with. This is, quite correctly, one way of solving the problem.

            At its most stark, we see psychiatrists sign commitment papers, have the person taken down to the ground, injected with tranquilizer drugs by force and rendered unconscious. The person’s thoughts were considered so “out of order” that the person’s consciousness is erased from existence for a time. Starker still, surgical lobotomy and electroshock. Think of that as the fuel tank of brain disablement being 100% full, and the average consumer “antidepressant” fan engaging in like 8% brain disablement. Various mixes of brain disablement eradicate various levels of higher order cognitive function considered problematic.

            Don’t discount the concurrent occurrences that have been a feature of this good trajectory your life has taken. I know with me, I ascribed “stability” to drugs at some points, but I know I was biased against considering other concurrent, equally as powerful factors such as the passing of time, the asylum quality of time-out spaces, growing maturity, increased self-mastery and solidity, confidence and understanding of my experiences.

            These extraordinarily complex phenomena that go into the mix of a life improving, stand in stark contrast to a medical “expert” whose only tools are varying degrees of hacking away at the brain organ. The same logic behind the icepick lobotomy applies even in the most benign interaction with the family doctor prescribing SSRIs… the scientism of blaming the brain for life’s extremes.

            One *can* blame the brain, one *can* blame the God Zeus, but what one considers a credible interpretation of a mental phenomenon / life phenomenon has unfortunately I believe been monopolized by a quack ideology. That is not to say drugs can’t be helpful, but that is not to say a vending machine couldn’t do a psychiatrist’s job either.

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          • “It is an affront to real medicine.”

            You really destroyed it with this.

            I think it is an affront to science in general, which is why rhetoric that portrays people who are critical of psychiatry (and other industries that exploit and manipulate the word “science” for power and profit) as being “anti-science” is so frustrating.

            What psychiatry calls science is actually offensive to the integrity of science.

            So, in some fairly clear ways, anti-psychiatry is pro-science.

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          • Thanks Faith, I agree it is an affront to science. It’s press release science. Payola science. Further, it is a chilling, and I mean CHILLING! spine chilling example of how shallow the modern science education can be. Where is the philosophy of science, where is the depth in understanding in the average med school student who goes to their first psych lecture and just glibly, mindlessly swallows the life altering lie that “people who act a certain way, believe certain things, have a brain disease”?!!!

            One of the things that chills me to my spine and makes me despair for the future of humanity is that med school students who choose psychiatry as a specialization actually come fresh from 95% of their med school education being about real diseases, and then fall into line into this ideology. It’s just stunning. Stunning. The rote regurgitating of “facts” for standardized, multiple-choice examination, followed by the legal power to enter the body of every man, woman and child by force if they decide to. Terrifying. The right to rape brains. The right to rape the very humanity and personhood of the humans they treat as “brain diseased” non-humans.

            Nobody has earned that power. Nobody should have the moral right to wield a needle and command a swarm of so-called “nurses” to inject the unwilling. It is an unjustifiable act of inhuman debasement on par with the most dehumanizing violence in human history, especially considering it has been industrialized and systematized and people pat their dog, kiss someone goodbye, and go to work and do it for a living. Unjustifiable in Every. Single. Case. The integrity of the consciousness and bodies of your fellow human beings should be sacrosanct. To violate that, in the name of medicine, in the name of science, is to violate not only every ideal medicine and science have ever had, it is to behave as a medical criminal.

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  17. N.I. and Anon,

    I think there is a difference between minimizing or denying an individual’s experience and questioning the authority and evidence by which institutions have made certain assertions.

    So for example, when research shows that the long held popular language of “chemical imbalance” used to describe certain experiences is actually false (not just lacking in evidence but having evidence to the contrary) that is not the same thing as denying the real experience of persons experiencing very difficult emotional states that cause immense suffering.

    Challenging the conclusions asserted by certain professionals and institutional bodies, when those groups are claiming that science backs them, should not at all be equated with taking something “away” from a persons direct lived experiences.

    So if you or someone else experienced extreme states of mental or emotional turmoil, and you found that medications, therapy or anything else were part of a healing process which led to a richer life – that’s wonderful, and I don’t think you would find many who would feel anything other than joy at whatever has led to a person finding a way out of suffering.

    But what no one has to do (and should not do) is call things fact when they are not, lay claims to science when no such science exists, or misrepresent what we know and what we don’t know about how the brain works. That is something entirely different than denying another individuals personal experience with suffering and healing.

    I would suggest that one is not required to reject the language of mental illness or diagnosis, especially if that has been somehow part of a positive process of hope and meaning-making for a person. Just as long as we remember that “mental illness” is a metaphor, and diagnosis are labels for a collection of behaviors. That is a very, very different thing then diagnosing biological diseases. As of this moment, there is no known biological marker than can accurately predict or point to any mental “disease” category. That does not mean that neurobiology plays no role in our emotional experiences – it only means we don’t know what that role is, and anyone trying to say more and claim that it is based on conclusive science is lying.

    My attempt to understand the truth of what we do and do not know does not require me to take dogmatic stances about the experiences of others. If you have found medications to be a helpful part of your journey, I would not try to discourage you from that experience. I would only wish to make sure that you are fully informed about all benefits and risks associated with any medication you are given, that you take it with full understanding and informed consent, that you are completely empowered to change or discontinue any medication you are prescribed with the full support and assistance of your prescriber.

    Likewise, I would not try to discourage you from identifying your experience by way of a label such as a psychiatric diagnosis. I would only remind you of the reality that, at present such a label is a metaphor, not a literal concrete thing. It does not represent a clear and known malfunctioning brain part – it represents a collection of behaviors organized under certain categories. Metaphors can be very powerful and helpful things for some. For many, it is not helpful and has in fact been a source of tremendous abuse and pain. So its important for me to try and remain open to all these varied experiences in others.

    When people criticize evidence-absent claims made by the dominant institutions of psychiatry and pharmaceuticals, we are not questioning the reality of your lived experiences. We are question the way reductionist attitudes, power and profit motives and deliberate bastardization of science and research have led to false information dominating the field of mental health.

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    • “popular language of “chemical imbalance” used to describe certain experiences is actually false (not just lacking in evidence but having evidence to the contrary) that is not the same thing as denying the real experience of persons experiencing very difficult emotional states that cause immense suffering.”

      I think this is great and I’ve often came up against people who think the alternatives movement is just playing semantics, and when I hear this, I say we are not just using other words for the same things, in fact when a brain disease true believer uses a word, and I talk about life experiences and problems, we are talking about two different things, so I do think you’re right to support as I do, people’s right to seek out whatever solution including drugs that works for them. And I agree we shouldn’t have dogmatic takes on the experiences of others.

      On the issue of legally forced psychiatry though, I simply have to be an abolitionist because my life depends on it. Lives are in mortal danger every day laws exist that allow psychiatry to enter peoples bodies without consent. It’s a political and human rights issue, not equated to any thoughts I may offer on the experiences of others. I believe if NI’s worldview and way of making meaning of his/her life and problems is working for them then why change it? I believe in informed consent not just about drugs, but about models and narratives and where they came from. There’s a lot of focus on the safety of drugs and very little on the safety of telling some distressed person they are as Rufus May says “a passive victim of an active brain disease”.

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  18. Heretic and others,

    Thanks for your responses, which I don’t find offensive. In a number of ways I find them thought-provoking and well-reasoned. Still, I believe am able to embrace, all at once, my conclusion that what I have experienced is something that is not desired by me (whatever the causes), my experience that medication, while not a panacea, has assisted me (among other measures) in my efforts to rebuild and succeed in my life, and the fact that, to whatever extent may be the case, science is insufficiently advanced to prove that these experiences are caused by some physiological deviation from healthy biological functioning, even insofar as distress derived from those experiences may be aided with professional or other intervention (using whichever tools may be appropriate, including but not limited to medication). If I had the freedom, given the commitments I have willingly (and in ways unalterably) made in my life to family and career, to choose to live in a stress-free environment, in which I could, for instance, practice meditation, participate in innovative, several month therapeutic retreats, and pursue leisure activities, my level of acceptable risk associated with taking pharma drugs would decrease. I choose to consume processed and non-organic foods (though am more selective with my children), despite awareness of its scientifically *proven* detrimental physiological effects, and despite specious claims by the food industry to the contrary, using a cost-benefit analysis. I must engage in a cost-benefit analysis and arrive at an acceptable level of risk in all of my life decisions, balancing all knowns and unknowns with the aid of reliable resources. I most certainly do include folks referred to here as “survivors” as reliable sources, because I have experienced and experience every day the reality that no medical professional, family member, friend or other person can know what it means to suffer from the ill- (or beneficial or benign) effects of powerful psychotropic drugs unless they have suffered themselves. Equally important are the experiences of individuals who have suffered from experiences similar to those I’ve described — whether referred to as symptoms, manifestations of societal defects or any thing else — and have made decisions of all variations on how to reckon with them in all varieties of life circumstances (most significanlty, my own).

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    • “science is insufficiently advanced to prove that these experiences are caused by some physiological deviation”

      Or problems in living may not be a question for science at all.

      I like your post and I sense that you strongly value having the right to weigh the risks and benefits of what you feel works best for you both in terms of how to interpret the problems and what solutions to seek out. We all deserve that freedom.

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  19. Dr. Steingard, my question “what resources can I draw upon (other than primary sources, because I’m not a doctor or scientist) in order to determine whom to rely upon for [guidance regarding phrama drug use]” I pose to you. You are a medical professional, expertly trained in psychiatry and well versed in the relevant science. However valuable to me the insights of the sufferers and survivors who make this site such a valuable resource, with all due respect as I suspect some may take offense, I cannot rely upon this group, as such, for the rigorous medical and scientific knowledge that any understanding of the causes and non-causes said suffering and survival requires. Nor for the counsel and treatment provided by a physician to a patient. I speak only for myself, but I am not alone. I had an econ professor once during a time of great economic turmoil and disaffection among many towards economists who distorted flawed economic principles that had been canonized as “classical economic theory,” to aid and abet those who would exploit their work for monetary and political gain. The prof, despairing at the legions of self-styled liberal students who shunned careers as economists pleaded, know thine enemy, and defeat them with the very tools that have been used in the service of greed and corruption. Why leave these tools in the hands of those who’ve misused them, he asked. If psychiatry has lost its way — and I do not contest that it has, its the matter of degree that I might dispute with others here, but even if it has to that degree, indeed especially if it has to that degree — then, I don’t believe medical professionals and scientists should walk away from the study of application of neuroscience to address the emotional suffering of patients. Nor or the actual application, and even before everything is mapped out (which will take an eternity). What I think many in psychiatry may have walked away from — setting aside those (the many) who are corrupt and/or not free thinkers — most of all is the Hippocratic Oath. But when a surgeon amputates the a shrapnel victim on the battlefield the decision to cause that harm is based in part on the fact that technology fails us, as we do not have the tools to save the victim’s life without carrying out the amputation. But the life is saved, and orthopedic surgeons, scientists and engineers work to try to do better for future patients. All science is in its infancy, to a degree, all science is fallible, and we all realize how little we know the more we learn, probably in every context that matters. The suffering that some call symptoms and others call something else is real. No one disputes this, as I understand it. Ultimately the consequences that might result from good people rejecting and declining to pursue the study of psychiatry and neuroscience’s application to emotion in favor of the study of “real [better mapped out]” disease (and those who suffer from it) fall on those who suffer the most from these very serious manifestations of emotional distress, whatever their cause may be. This is true whether the cause of suffering is drug use (be it herion, xanax, or depakote) or something relatively more organic (be it human biology, modern living, or something else).

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    • ” as I suspect some may take offense, I cannot rely upon this group, as such, for the rigorous medical and scientific knowledge that any understanding of the causes and non-causes said suffering and survival requires”

      Psychiatry has for hundreds of years tried to prove its pre-judged and dogmatically originated hypotheses on the “causes” of these phenomena. Many confuse tens of thousands of research papers that haven’t discovered a THING, for the impression of a body of science. If you believe psychiatry and economics are real sciences, your preference is going to be for the perceived expertise you see. What extreme states of mind that get labeled “psychosis” teach one, is that people see what they want to see. I could make the argument that ultimately a lot of the suffering of people labeled “mental patients” by psychiatry is caused because these “good people” chose to pursue “the study of psychiatry”. It wasn’t through the “study of psychiatry” that gay people were able to be free from the stigma of being labeled mentally ill. No “mapping”, no scientific discoveries account for the inflation or deflation of the DSM labels.

      No science, or laughable facsimile of science, can tell us how to live. The economists of the world didn’t save us from the crash, and psychiatry, the science of hacking away at, and perturbing the brain function of brains that have never been proven diseased, in the name of numbing, drugging, and kicking the can along the road, essentially offers nothing more than a vending machine full of drugs, something a heroin dealer can offer. What was Michael Jackson’s doctor? Just a drug dealer with a little extra training and knowledge of the human body and what dose of a drug would kill the other person we all ritually name a “patient”.

      Numbness, not insight. Labels that stigmatize and lead to learned helplessness. If you as I do too, feel the need to be anonymous, that’s not because of “stigma against mental illness”, the world doesn’t recoil in alienation from us based upon our behavior and thoughts being weird alone, the world doesn’t even know us, they recoil because being an ex mental patient is seen as an UNunderstandable dangerous mystery, thanks to the mystification of the “good people” who’ve chosen for 200 years to set up a virtual dehumanization system of labeling us out of the human race.

      It’s not our thinking that has stigmatized us for the most part. In the absence of psychiatry’s 200 year reign of error you might have been seen by your work colleagues, family, and neighbors, as just a perfectly equal person who had a crisis at one time or another, became emotionally overwhelmed with life and your thoughts, and strayed from the cultural consensus of “rationality” for a time, a person with no reason to hide, no job or tenure to lose for openly solving your problems. No I don’t believe the stigma originated from your thoughts, it’s psychiatric thinking, the thinking, language, and dehumanization of people who come with moniker “Dr.” that has put your disparate and unique personal crises under the one banner of quackery to draw a direct line between you and James Holmes and Adam Lanza. We have psychiatry to thank for the stigma.

      You seem to respond to things that come with a patina of science. Maybe this paper, speaks your language. This is an economist on the extreme preferences of those labeled “insane”…

      http://econfaculty.gmu.edu/bcaplan/pdfs/szasz.pdf‎

      and

      http://econfaculty.gmu.edu/bcaplan/inecon.htm

      “In sum, while other disciplines regard insanity as a puzzle to be explained, the economic way of thinking inclines me to wonder what the puzzle is.”

      “Absurd beliefs shared by millions are
      ‘healthy’; equally absurd beliefs held by a lone individual are ‘sick’.
      While economists have only begun to study the demand for
      irrational beliefs (Akerlof 1989; Akerlof and Dickens 1982; Caplan
      2001), there is little if any reason to treat ‘popular’ and ‘niche’
      delusions asymmetrically”

      “It is wonderfully revealing of the nature of psychiatry that whereas in natural
      science there is a premium on the expert observer’s ability to understand what he
      observes . . . in psychiatry there is a premium on the expert’s inability to understand
      what he observes (and to understand it less well than the object he observes, which
      is typically another person eager to proffer his own understanding of his own
      behavior).”

      Just some of the wonderful contents of those two papers above.

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    • Hi N.I.-
      I do not have any clear answer for the question you pose to me. It is, for me, the same as asking, “How do I find a good doctor?” Although others here see a clear demarcation between psychiatry and the rest of medicine, I see a blurry one. All of medicine is corrupted to some extent by corporate influences and distortions of studies and as soon as I go out of the small area where I have tried to carefully review the literature, I find myself a bit adrift in how to weigh the evidence for and against various interventions. I want to find a doctor who understands these influences, who understands that randomized controled trials are just one bit of evidence but have their own limitations, a doctor who understands that personal values will influence why one person makes one choice and another person makes another.
      The statin drugs are widely promoted these days. They are the drugs that lower cholesterol. For me, this is a suspect area since everyone has cholesterol and there is no question that every time guidelines suggest a lower target cholesterol as optimal that the market share for these drugs goes up enormously. It would take me a long time to go through all of the literature to form my own opinion about this so I need to find a doctor I trust to guide me on making a choice about when I would take one of those drugs. My training and experience leaves me very skeptical of much of modern medicine and I try very hard to avoid seeing doctors. I have been lucky so far and I am not sure what will happen as I get older.
      I find this true of other areas in which I look for expertise beyond my own. Do I personally fundamentally understand climate change? Not really. I read a fair amount but in the end, I decide whom to believe. That is different from forming an opinion based on my own interpretation of the basic science involved.
      I am not sure this is helpful but maybe I am just stalling because I do not have a good answer. My blogs on optimal use of neurolpetics were based on my attempt to review that literature. It leaves many unanswered questions but in reading your comments here, it seems that you and I are very close on how we think about this. You have made some choices for yourself based on your experience, the risks for you, your current liefstyle, and the inherent uncertainty. This is the kind of discussion I try to have with the people who come into my office.
      But I do find myself discouraging people from pursuing psychiatry. I will send them to your comments above for another perspective on this.
      Thank you again for this discussion,
      Sandy

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  20. “the kind of discussion I try to have with the people who come into my office”

    Lets remember that many people who’ve had drugs enter their brains at your behest didn’t just walk past an “office” and see a sign “come into” it. They had no choice. Their brains commandeered by the state, with you as agent of the state, from which there was no escape.

    https://www.madinamerica.com/2012/05/coercion/

    *I read all the 130 comments again. I invested two hours of my time reading all the comments before linking to this above link. I maintain my position that you’re braver than most psychiatrists for writing that piece. I maintain that there is no human behavior can’t be controlled without assaulting the targeted person’s consciousness with forced drugging. I think if this community has evolved in the past 12 months since that piece, we need to be honest not all people just walk into your office. There are human bodies sitting in chairs in your office, that you own. I know you didn’t invent this practice. I have the wherewithal to get the exact same kind of job you have. The reason I wouldn’t be able to do it is because I’d vomit in the nearest toilet if I had do that.

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    • Typo. added the word ‘that’: “I maintain that there is no human behavior that can’t be controlled without assaulting the targeted person’s consciousness with forced drugging.”

      https://www.madinamerica.com/2012/05/coercion/

      I don’t think anyone that wound up morally/ethically compromised from getting involved in forced drugging set out to so. I do constantly ponder what kind of socialization goes on, what kind of justifications prevail upon the person involved in carrying out forced drugging to get past what I would have thought would be a natural revulsion to seeing and participating in such extreme violence against strangers. I mean psychiatry is after all, the profession that defines for the world what empathy is.

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