Homework for E. Fuller Torrey and Xavier Amador

Greg Benson
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In an Op-ed in the Hartford Courant Larry Davidson argued that denial of “mental illness” is not neurological. E. Fuller Torrey and Xavier Amador promptly wrote letters to the Courant claiming that data exist which prove that there is a neurological basis for denying “mental illness.” Torrey and Amador throw around the term anosognosia – the original usage of which described ignorance of disease due to lobe lesions. Amador wrote, “Anosognosia exists and AOT provides a workaround that can save lives”

Disseminating subjective observation disguised as scientific fact is harmful. The original usage of the word anosognosia described something that is much more of a disease and far more tangible than what the new usage psychiatry has introduced into the lexicon describes. Psychiatry is posing a danger to society via an incorrect and largely unchecked usage of this term. It is important to discredit this usage of the aforementioned word because it is invoked in order to justify forcing people into “treatment” which is incredibly harmful.

No data indicate the existence of a neurological basis for the denial of one’s so called “mental illness.” As someone who has been labeled “schizophrenic” I want to assure society that it is impossible to lack insight into whether or not one has a chemical imbalance of the brain when supposed condition has never been specifically or clearly explained, let alone empirically proven to exist. For a homework assignment I would like E. Fuller Torrey and Xavier Amador to summarize or quote any neurological description of all of the present chemicals, proportions of said chemicals, and dynamic interactions between chemical ratios which constitute the composition and activity of human brains lacking all DSM disorders.

Then I would like the above mentioned believers to respond to my assessment that what psychiatry deems anosognosia is rather what happens when an individual\’s perception of the world differs from a psych industry provider’s perception of the world – or when an individual’s perception of what their experience of the world results from, differs from what a psych industry provider thinks said person’s experience results from. If an individual’s perception of whether or not their experience of the world is problematic differs from the value psychiatry places on said experience – then this difference of opinion is also often framed as the “patient” being wrong due to a neurological basis for denying “mental illness.”

In his letter to the Hartford Courant, Xavier Amador wrote, “…Page 304 of the DSM IV… summarizes the anosognosia research”. In his letter to the Courant  E. Fuller Torrey wrote, “This condition, anosognosia, was described by neurologists more than a century ago and affects approximately half of individuals with schizophrenia… Dr. Davidson should be assigned to read Amador and David’s “Insight and Psychosis,” Prigatano and Schacter’s “Awareness of Deficits after Brain Injury,” or the 17 published studies showing anatomical brain differences between individuals with schizophrenia with and without anosognosia”.

I encourage Torrey and Amador to read Thomas Insel’s post “Transforming Diagnosis.” On April 29th 2013 Insel, the director of NIMH, wrote

“ …we cannot design a system based on biomarkers or cognitive performance because we lack the data… While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment”.

I do not appreciate that Insel has decided to initiate finding neurological and genetic data that truly pinpoint the causes of so called mental illness – in response to the conclusion that psychiatry has been utilizing the flawed method of responding to subjective observations. I don’t appreciate this because I feel that it is irrational to think that science can isolate in the complex dynamic interworkings of the mind cause-and-effect relationships for the full range of human emotion and perception . And – hypothetically – if science did isolate the causes of spedific human experiences, I think that the last one hundred years has proven that supportive and experiential human engagement and activity decreases and replaces suffering more, and more effectively and safely, than drugs or “medical model treatment.”

That said, I appreciate what I think is commendable intellectual honesty on the part of Thomas Insel. Insel argues the historic failure of validity in trying to understand “mental disorders” as medical conditions; I reference his recent post in order to suggest that Torrey and Amador are not credible and are rapidly becoming lonely proponents of “unpopular” conjecture about reality – even within institutions wedded to pharmaceuticals and “medical model treatment” of “mental illness.”

There is no proof of anosognosia, just subjective perceptions within the context of the intrinsic power imbalances of the psych industry in relation to its “target market”. Merely saying that data suggest something – doesn’t mean that data actually suggest it. If data suggest something one must always consider whether or not those data are flawed or whether or not the methodology which produced those data were flawed.

Any data that impute a medical condition to a failure to be aware of and/or accept the reality of something that cannot be described with enough clarity, specificity, and evidence to prove its existence – whether a chemical imbalance of the brain, or a unicorn – are flawed.

Psychiatry has not proven anything medically about the neologism “anosognosia.” The only thing the psychiatric industry has proven when they label someone as anosognosic is that they do not agree with said person’s sense of reality, which differs from the consensus reality. A person believing an “unpopular” reality, could correctly state that the psych-industry has no proof of the validity of consensus reality and that a disagreement about whether or not there are “fountains of youth” for example, when neither the absence nor presence of “fountains of youth” can be proven – does not prove lack of insight on the part of the person with whom psych-providers disagree.

Let us also entertain the hypothetical situation in which a person interprets their perception of “the existence of fountains of youth” as less valid than the equally unproven reality of “an absence of fountains of youth” – but doesn’t attribute their “unpopular” perception to sickness of the brain. In this case, psychiatry’s disagreement with the individual’s interpretation of the cause of the experience they are experiencing – given that the chemical imbalance theory is completely unsupported by evidence and even acknowledged as metaphorical by many psychiatrists, psych pharmacologists, and neurologists – does not prove that the person in question is sick and lacks the insight to know that they are sick.

What it proves is

“western ma focnw” <[email protected]>, <[email protected]>, <[email protected]>, “clima

that psychiatry subjectively and erroneously believes that said person’s experience of the world results from a brain disease and that said person believes that what they are experiencing results from something that thousands of years of empirical evidence suggest is  universally fundamental and innately human – that individuals are transiently more sensitive than others, transiently experience more intensely than others, or transiently experience as more overwhelming – relative to the mainstream – societal daily routines (Paraphrased from Paris Williams’ blog post “The “Mental Illness” Paradigm: An “Illness” That is out of Control”. While these “extreme” responses to tendencies and desires that all humans have in common, can be and sometimes are problematic for those experiencing them and those they interact with – there is nothing inherently negative or problematic – or prove of a fundamental lesion or deficit – about these “extreme states”; they are well within the range of “normal” human and mental diversity.

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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.

3 COMMENTS

  1. Greg,

    IMO, we are so multi-dimensional and complex, that it’s hard to know if we really “know” anything -about how we think, feel, act, relate to each other. Then there’s the connections to the natural world, and the supernatural (spiritual) world.

    To the “experts” – Anosognosia?

    Really?
    What is that?

    Would it be too much for these folks to allow a little humility to take place in their hearts and minds? To admit they simply don’t know?

    This seems like the *sane* thing to do.

    Duane

  2. Dr. Davidson posted a hum-dinger of a response to Torrey’s and Amador’s attacks, as follows:

    “I can reassure Drs. E. Fuller Torrey and Xavier Amador that I know of their theory linking anosognosia to schizophrenia [May 1, letter, “Neurological Basis For Denying Illness”; and May 3, letter, “Condition Obscures Mental Illness”]. Anosognosia is a neurological condition in patients with nondominant parietal lobe lesions, who deny their partial paralysis.”

    “I can understand wanting to apply this notion to mentally ill persons who refuse treatment, but there are at least five reasons not to:
    1) No such lesions have been found in schizophrenia, despite over 200 years of research looking for them. What Drs. Amador and Torrey have is a theory, not a fact. Other than justifying outpatient commitment, this theory has led to no breakthroughs in treatment. ”

    “Not only are such theories dangerous, but they 2) do not explain how so many people with schizophrenia gain insight and recover over time; 3) do not take into account the power of stigma, which persons with mental illnesses identify as the major barrier to accessing care; 4) do not take into account the limited effectiveness and responsiveness of much mental health care; and 5) do not support outpatient commitment because schizophrenia is the least likely condition among the mental illnesses to be implicated in the extremely rare acts of violence that occur.”

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