Anyone who spends time around this site (Mad In America) knows that there has been a lot of talk lately about neuroscience and the future of the medical model of “mental illness.” However, many people who are affected by mental health practice and policy, for whatever reason, may not be aware of the current controversy and concern regarding the recent decision by the National Institute of Mental Health (NIMH) to steer funding away from research that is rooted in the definitions and delineations of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In NIMH director Thomas Insel’s late-April statement, the DSM is characterized as having poor “validity.” This means, plainly, that there is no consistent evidence that the DSM classifications of experiences deemed “mental disorders” correlate to any specific or measurable process of disorder. The diagnostic categories of the DSM are based on subjective symptoms, for which there are often no identifiable causes.
The dominating reign of the DSM has been dealt what may well be a terminal blow. There may not be a DSM-VI. Our entire “mental health” system may need to begin considering vast revisions of coding and service. Because the DSM has been publicly declared (by a presumed authority, the NIMH) to lack validity, anyone who uses the book in practice or policy will have to think hard about the integrity of the ethics that govern their professional practice. In some ways, the NIMH announcement was a great boon to the efforts to build support for alternatives. In other ways it is an insult, given that advocates and activists have been criticizing the DSM as unreliable, inaccurate, distorting and ultimately useless for decades.
The DSM is on its way to being history. However, with the NIMH announcement came a new set of research domains that will affect the future of sciences pertaining to the human condition, with a specific focus on identifying neurobiological markers and processes that may be linked to manifest human difficulty that is currently seen as “mental illness.”
Yet, recent reports from the American Psychiatric Association clearly state that there is not a biological marker that can be identified using neuroimaging, indicating a vast abuse and squandering of funds that could have actually supported the research and development of additional evidence-based healing practices. Research that has purportedly identified variation in genetic or neural function or structure is minimally informative, as any phenomenon of the brain is:
A) dependent upon a great number of variables
B) likely to change, given the fact that we are in a constant state of growth and response
So, where does that leave us?
There is a fear that the research directions charted by the NIMH may lead to a hypermedicalized view of the human condition, and that many more billions of dollars will be spent developing invasive technologies designed to affect our neurobiological function, possibly in ways that may be toxic. Given the exploitative collusion that regularly happens among researchers and industry, this is a legitimate concern.
“Scientific” research has, historically, been the driving impetus for vast and insidious human rights abuses and the formal literature has contributed mightily to distortions in our conceptualizations of normative function and expression. This is not, of course, to dismiss “science” or present an “anti-intellectual” view of the existing body of literature. However, a systematic review of said literature will reveal vast reams of flawed methodology, theoretical bias, and a dearth of the simple logic that informs us that our lives are complex, messy, and dynamic, with multiple variables acting upon one another in ways that make it difficult to generalize any conclusions across large portions of the human population.
Two people (or 7 billion people) can be genetically related and be, within their subjective experiences, very different. They can go through the same tragic events and experience them uniquely. Even people who share tendencies of experience are not the same and what might be helpful for one person may prove to be unhelpful – or even harmful – to another.
However, in spite of the barriers to generalization, there are correlational trends among people who experience struggle between themselves and their life circumstances, with potential causal links between trauma, stress, and psychosocial dynamics as these factors relate to difficulty in experience. We are all affected differently by constructs of economy, opportunities for education, and the other factors which shape the landscapes of our lives, be they plush or war torn.
There are numerous psychosocial/emotional/existential/spiritual theories about what may cause difficulty in human experience. Entire fields of science and inquiry are based on hypotheses of the mind and musings on the heart. Obviously, we are more than our neural connections. Yet, we do have brains. We do have neurons and synapses, enzymes and chemicals, areas of tissue that mysteriously hold networks of memory, others that map our anticipations.
Do we need to know the specific neurological correlates of internal conflict?
How does the fear of being alone pass between our synapses?
Does hope light up our brains, or just our hearts?
Is it even possible to know? Is it important?
Perhaps it would be more useful for us to focus on what seems to help, rather than trying to identify some elusive shared trait among those who struggle for some reason or another with their human experience. By establishing evidence of the efficacy of alternatives, the “problem” may become less important than the possible (or obvious) solutions. It doesn’t take a Ph.D to know that when we are empowered, accepted and loved for who we are we tend to feel better and enjoy our lives more.
For the sake of fairness and acknowledgement of reality, there are some instances that neurological duress or wounding can be implicated in difficulty within our human experiences. The effects of chemicals and certain elements (such as illicit and pharmaceutical “drugs” and lead, for example) can wreak havoc on the functions of our brains, as can (actual and measurable) diseases like cancers of the brain. Even in the absence of drug effects, the neurological effects of an actual disease, or environmental toxins, some people do experience some significantly difficult recurring experiences. Sensory integration issues, distinct features of processing or thought tendency, and regulation of emotion and energy are genuine and very real struggles that many people often attribute to neurological differences.
First and foremost, difference is not disease. This cannot be said enough. Difference is not disease, by definition. Some differences are caused by diseases, but difference itself is not a disease. A disease requires an evident process, with indicators and predictable outcomes. Based on those exceedingly simple criteria, the bulk of challenging human experiences cannot be attributed to anything remotely resembling a disease.
Some people do have what they have found to be characteristics of experience that can be, in part, attributed to elements of our human function that are considered to be at least somewhat neurological, such as sensory integration. These differences – some of which can be experienced as disabling depending on the expectations that establish “normal ability,” contributing to severe sensitivities and learning differences, among other struggles – are often identified through neuropsychometric testing (e.g. IQ tests) of some sort. These measures are often problematic themselves. Yet, they do measure something, and those inventories of attribute do have the capacity to inform us of some aspect of our human experience, even if it is only whether or not we “test well.”
Acknowledging neurodiversity is in no way endorsing a biomedical disease model. There is an entire movement of people who identify with concepts relating to neurodiversity, which acknowledges that some people do fall well outside of the range of statistically normative neuropsychological features and that these variances from neurotypical function are a good thing, rather than a disease. The human species is diverse by nature, and rightfully so. We encompass artists, musicians, architects, astronomers, storytellers, engineers, farmers, cartographers and healers…and we all, as humans, struggle.
Yes, for some the struggle is tremendous.
Yet, just as we all struggle, we all also, as humans, have the capacity to live our lives well to the best of our abilities, which ought not be impeded or discouraged by circumstance or belief. We grow and change. We find out, through trial and error, who we are, what we like and what we are scared of. We learn what works for us and un-learn the belief that we can’t learn.
It ultimately may not be important for us to know the specific rate and content of exchange across neural networks. Even if we figure out how something works in one person, or even in a supposed group of people, the variables that shape our lives and experience are complex. It is difficult to conclusively generalize any broad truth about why we are human in the ways that we are and what the future may hold for any of us.
If the NIMH spent as much funding on accessible, trauma-informed, integrated, choice-driven community wellness centers and lobbying for better quality of life opportunities as they do trying to find evidence of elusive brain diseases, we would not have the “mental health” crisis that we currently have.
We would, perhaps, have more of what we deserve, not as people identified as having a “mental health disorder” or as people that could “qualify for disability” but as human beings with universal human rights.
Do we really need research to tell us that kindness and compassion are healing, that options are good and that the more perspectives we have access to the better able we are to figure out a meaning and strategy that may best work for us?
Due to the resources afforded to the pharmaceutical industry, state institutions and the military, research funding has been unequally distributed. Therefore, the ideas and theories that have been formalized as “science” are largely representative of the interests and paradigms that research institutions and grantors may ultimately profit from. In what directions will the NIMH fervor for a new nosology drive this science devoted to answering questions that don’t need answering, or which cannot be answered by a medical test? What good comes about from looking for a disease and what will they make of what they may find? Are so they so desperate to find something that they would be willing to create disease where there is none, simply so that they may find it?
So far, they have found, for all their sophisticated techniques, surprisingly little. There are no lesions, no consistent protuberances, no void grey areas of neurological scarring. Potential variations that have been identified could have been caused by anything, and may simply be the fact of human diversity in function and expression.
So, is there anything good or useful that could come out of new NIMH research directions?
Well, some innovative researchers may be able to secure some renewable research grants to conscientiously and strategically contribute to the body of literature on alternative non-invasive evidence-based practice, perhaps relating to the neurological benefits of naturally occurring micronutrients in delicious food or the measurable effects of mindfulness, stress reduction and life enjoyment programs. Perhaps someone could conduct research on the beneficial neurochemical effects of hanging out in fields with friends, laughing.
Researchers may gain insight into the effects of stress.
They may learn more about the specific ways that neuroleptics damage our brains.
All in all, we may not need research to tell us what we most need to know about human struggle and human healing, which is simply that both phenomena are intrinsically human and, by virtue of that, we are all different in what hurts and in what may help. It is, however, fair to conclude that for most people fear can be toxic and that love/acceptance/nurturance can be healing.
I do believe in the potential for bad ideas and dysfunctional systems to destroy themselves and I am hopeful for the development of an ethical science of the human condition. At the basis of this science would be a commitment to framing the human experience in a manner which is realistic and informed, with a resolution to not call things diseases which are not diseases. I am hopeful that young scientists paid attention in their philosophy of science classes, their ethics courses.
To me, it seems that it would be far more interesting and exciting to destroy a useless and harmful paradigm than it would be to try to prove evident mistruths. It would be a lot more fun to research the neurological characteristics of a life well lived than it would to be to spend life sitting in a laboratory looking at numbers about some poor little kid’s dopamine levels as they may be affected by neuroleptics.
*Laura Delano’s excellent recent post “Mental Illness,” the DSM-5, and Dreams for a Post-Psychiatry World explores the implications of recent shifts in the direction of formal understandings of human struggle as our realities relate to misinformation, oppression, and multisystemic trauma. In the comments is a really great discussion of the body, mind, heart, environment dynamic as it relates to potential hypermedicalization of our perspectives of human experience.
Here is a poem that I wrote about scientific paradigm shifts as such things may relate to brain research and a picture that I drew during a period of involuntary outpatient commitment, while I was thinking about how strange it sometimes is to be human.
The Scientist’s Lobotomy
Did you look inside her brain
at that place
where you imagined
all those demons, that disease?
Was her skull split open
like a shell
for its soft fruit
to be examined
by the stainless tines
of your science?
What did you find, in that shimmering inside?
Was it not so dark as you thought it might be?
Did you see, there in the folds, the pits that you had pictured?
Did you find
the small empires
you expected
in a chemical rot and lesion?
Did you swim
in the swamps
tucked into the coasts between
this region and that region?
Were there valleys and layers, tangles like cities on a roadmap?
Or was it softer, smoother…perfect?
Did the gentle pink edge remind you of a shell
that you once picked up from the shallows of the ocean?
Did the salt on your lips taste like waves?
There were patterns in the sand and you traced them
as mountains.
You saw the pools, your eyes reflected against the sky reflected and…
…you knew the truth.
You found it in that shell that held the sunset.
That soft slick bruise
of grey and blue
that felt, to you,
soft like your scalpels
could never be.
For a moment, the whole world was there
and you felt
the sound inside
like music.
It’s so easy to forget
that you wanted to live
inside that place
where the ocean roared
against your ear
for you alone to hear.
When you looked at her brain did you see
the landscape of her memory?
Was it a castle
a library
a junk store
a field?
Was the universe in there?
Did it look like sand?
Or did it look like stardust?
Does stardust look like sand?
…or did you only see a small grey region, asleep
and of a certain weight
that you carved out
and placed on a scale?
Was it barely alive at all?
Did you find, in her crenellated warmth, the place
where voice is born?
You never heard it.
She never spoke.
You never listened?
It doesn’t matter now.
You’ve forgotten
what it was
that you were looking for
in that space behind her eyes.
Do you see that, even sleeping, her mouth looks like a bow?
You have no way of knowing that as a child
she sang the same song
over and over again
because it made her happy.
Tell me, when you pulled
the two halves apart
did they make
any noise at all?
Tell me, what did you see inside?
Did you find God?
Or did God find you?
I suspect all this Nuerodiversity malarky, and all this, “Brain Science,” is the latest way society in general, and psychiatry in perticular is trying to avoid the psycho-social causes of mental distress.
Anything to avoid realising that some of us have messed up heads because we’ve had awful lives.
On Radio 4 to day on some programme or other there was a feature about using imaging techniques to look at teenagers brains to try to find out why teenagers are so moody. The theory being that brains are, “rewired,” during the teenage years. Nothing about growing independence leading to conflict with families and society or being overwheled by the challenges of the teenage years then?
The feature then said that a lot of mental health problems started in teenage years or early adulthood and studying brains might help understand what is going wrong with the brain. Nothing about the difficulties of making the transistion from a dependent child to an independant adult when you have had a difficult and tramatic childhood then?
It’s like the psychosocial evidence is being ignored all over again, only it’s not genes and bio-chemical imbalances now, it’s brain architecture.
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I suspect the lobotomist found what we all eventually find…
What he was *searching* for.
Duane
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I really enjoyed the poem.
Duane
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Hi Faith, I have been away from MIA for a bit and am just seeing your absolutely beautiful poem………
Love, Dorothy
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I agree with that John, there is avoidance of psychosocial [and political].
Neurodiversity is a term sometimes used by people who have been defined as autistic.
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Yes, neurodiversity is a term that is sometimes used by people that have been diagnosed as having autism or other processing/integration differences.
Is there a problem with the idea that some people may identify as being neurodivergent?
I resent that a term that is used as term of empowerment and affirmation of individual strengths is termed “malarkey.”
Interestingly, that is the same term that was once used here to characterize my assertion that the practice of defining another person’s experience for them was the precise mechanism that is used by psychiatry in their presumption of authority to impose meaning.
“Well, that’s just malarkey!”
It absolutely is not malarkey that millions of kids who are identified as having autism spectrum disorders, learning differences, and sensory integration issues are just as at risk (or moreso) for abusive psychiatry as psychosocially wounded adults in existential crisis who, once they escape psychiatry and have a chance to explore who they really are it turns out that they are absolutely fine and have no struggles outside of the usual challenges of being human?
Yes, the psychosocial element alwaysalwaysalways contributes to our human experience and the outcomes of our experience. Nonetheless, not everybody functions the same way (thank god) and not everybody can fit into the same little neurotypical paradigm…which is just as rampant in supposedly conscientious circles of dialogue as anywhere…with these suggestions that people are all the same and psychiatry messes us up or our emotional distress causes challenges for us or we are psychosocially maligned within our lives…but when those things are resolved, everything is hunky dory and *presto* recovery!
What about people who really, legitimately do experience the world in ways that are tough for them? Sensory integration challenges are real, as are learning differences…and both can cause a lot of struggle.
Do we tell these people (myself among them) that when they cannot hear things correctly if more than one person is talking or when they do not feel social attachments in ways that conform to social norms or when they cannot tolerate fluorescent lighting or when certain tonal qualities cause a total affect defensive mechanism…that their challenges are all a matter of emotional distress or spiritual discouragement?
That seems to me to not honor the reality of individual experiences, and to not respect the reality that many people do struggle with regulation and integration of information and stimuli. Autism and Asperger’s and ADHD and all the rest are in the DSM, just like bipolar and schizophrenia…and people with these ranges of experiences are just as vulnerable to misinformation, medicalization, and psychiatricization as any “depressed” adult whose experiences may well be attributed to social and psychological or existential, emotional causes.
“the psycho-social causes of mental distress” are not the end all be all. Even those experiences are not limited to subjective affective conceptualizations. People who have experienced significant emotional distress understand that with those experiences, stress is created. Stress is not an idea. As Laura noted in her last post, stress involves actual chemical processes that impact the functioning of our bodies…and brains.
Are people so appalled by what the industries of exploitative hypermedicalization have made of our experiences that they are loathe to even admit that we actually have brains and neurological systems?
Neurodiversity is a concept that has empowered a lot of people and it doesn’t seem particularly respectful to suggest that it is a pawn of the rhetoric that supports medicalization of our human condition. There is nothing within the ideas presented here that suggests that neurodiversity is a medical issue.
Quite the opposite…
Thanks for your comment and for reading. More and more, I find this reactive broadbrushing denial of the brain to be alienating and not particularly relevant to my experience as a human being who has a neurological system that impacts the way I experience and understand the world. I always feel a distinct chill around here when I acknowledge that we have brains…and that I personally find the brain to be a pretty amazing and complex part of our human existence, which does affect our subjective experiences, though it is no way solely responsible.
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some people would take the word neuro as meaning the brain
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The problem is that an analogy between autism and the major “mental illnesses” is misleading at worst and limited at best, since autism can– at least in theory if not in practice– be fairly reliably distinguished from (statistical) normality and therefore diagnosed in a scientifically valid way. None of this is true for “mental illnesses,” obviously. That is the entire problem with the DSM.
And if autistic people and science want to accept that autism has a biological substrate and that it is neurological, then fine. But this cannot be assumed to also be true of mental illnesses, just because we (autistic people and people with psychiatric labels) are different from “normal” in some way, and because we all have brains! I’m not trying to be rude, but that seems to be your line of reasoning here.
Engineers and circus clowns also have brains, and one could obviously not say that those brains do not “effect their subjective experiences,” nor shape their life choices, personalities, etc. But would anyone assert that the brain or some “neuro-“approach is appropriate to understanding whatever it is that distinguishes engineers from circus clowns? I think not.
There is something else problematic about the term “neurodiversity,” which is that it has given rise to the term “neurodiverse” as a descriptor of individual humans. Unfortunately this reduces it to merely a matter of identity, which actually reinstates something it thinks it is challenging: the notion that “normal” people should be or are the standard against which everyone else can be judged. A population can be diverse, a group of any kind can be diverse, not a single human or single anything. That’s just how English works. At least it was until we decided to label individuals who actually, as a group, would be an equal part of the diversity of that group, as the the location at which difference takes place. That just, again, reinstates what it claims to be attempting to displace: the centrality and presumed paradigmatic quality of “normal”, whatever we take normal to be.
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@meremortal
I somewhat get what you’re saying about the conditions that would make the word neurodiverse appropriate for an individual to use, at least enough to know that there likely could not be a determinant “location” of collective divergence for any group to identify itself by. I have to grin at the issue of individuals describing themselves as “neurodiverse” as being a grammatical problem in relation to object plurality. Most people don’t really seem to care how English works.
What about “neurodivergent” – as in, “I am neurodivergent.”
That sounds, right this minute, pretty hokey.
Yeah, you’re right, neurodiversity is a term that somewhat states the obvious, because we are all neurodiverse in some way. I have wondered about the utility of the word neurotypical. What does that even mean. There seems to be a lot of cultural associations with the word and culture is not neurology, though that could depend on how you define the scope of neurology. Cognition and meaning-making are both culture-bound, but those aspects of experience are related to what goes on in the brain, how we process and access prior knowledge. I think that attributes of culture can influence the way we process information and the way we respond to certain stimuli.
Soeaking of defining location in relation, even if our minds and spirit are ascended in a transcendental state, our brain and our relationship to our brain is still involved.
I guess neurodiversity is one of those words (like “mental illness”) that it doesn’t really say much of anything about anything, it just indicates some variation. While neurodiversity may not, ultimately, mean much, “mental illness” is somewhat more problematic, with it’s loaded content and the negative assumptions that lurk around it. Neurodiversity at least communicates some element of…what? Empowerment?
I do thank you for bringing to light the matter of orientation to the statistical norm as the being the axis off of which all things are measured. I think the bell-curvification of our thinking about how human attributes or tendencies are distributed has diminished our ability to visualize what might really go on within the macro-human condition…which probably looks less like points on a line and more like a pile of scatter graphs, perhaps surrounded by a mystical fog of some sort?
I would argue that there is a generally collectively agreed upon “normal” in many life domains, e.g. most people enjoy this or that and most people respond to X by doing Y or most people can tolerate this particular set of environmental conditions. I agree that normal is a somewhat mythical and that even if we are presumed normal in one setting, other contexts may find us bizarre. Also, we can be normal in one way but freakshow in another, all at the same time.
So, while normal isn’t really real, our conceptions of what normal might be are real and there are real world consequences for breaking social rules or not meeting normative expectations within the context you inhabit.
Re: “if autistic people and science want to accept that autism has a biological substrate and that it is neurological, then fine. But this cannot be assumed to also be true of mental illnesses, just because we (autistic people and people with psychiatric labels) are different from “normal” in some way, and because we all have brains! I’m not trying to be rude, but that seems to be your line of reasoning here”
I wasn’t at all suggesting that all people who end up with psychiatric labels have some underlying neurological something or other going on that may contribute to their experience. However, there are a lot of blurry lines between experiences and the factors that may contribute to them, as you identified in your “problem with the DSM” – which in my mind extends beyond the issue of validity and is ultimately a problem of framing human experiences and ways of being as disorders or diseases.
Yes, my line of reasoning did rely heavily on the obvious fact that we all have brains. You simply would not believe the number of people who would seem to prefer to not acknowledge that reality, so I really wanted to emphasize that.
Your comment has given me a lot to think about.
If we don’t orient to the norm, define ourselves in relation to it, how do we define ourselves?
I think there is something about sovereignty somewhere in there or some question about whether we need to define ourselves at all, or who has the power to define us.
Anyway, thanks again. No, I didn’t find you rude. In fact, if you hadn’t of said that, it would not have occurred to me that you may be offering friendly criticism.
I hope you have a nice evening.
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I know that for you “neurodivergent” or anything involving “neuro-” just doesn’t strike you the same way as it does many of us who are opposed to it. I accept that, but I still don’t fully understand how, since “neuro-” is (I would guess to 99.9% of people) basically the same as directly invoking “neurology.” And we are fighting the biopsych approach. The two are very closely linked, obviously. It just seems to confirm everything we don’t want to confirm, with one little prefix.
I think the basic question for me in this is the one I gestured at with the clown/engineer example. That question isn’t whether there is some role played by the brain but what justifies an an approach to mental illness that attends specifically to the brain? I don’t think that psychiatry, neurology, sociobiology can satisfactory answer that question (where x is the brain in all three cases). After a century of brain-focused approaches, what do we have to show for it? This approach can’t be justified. I would suggest that, on the other hand, something like Open Dialogue would be able to justify itself. It can justify an approach to “mental illness” that attends specifically to the social network of an individual (over-simplifying here for the sake of brevity), the justification is that it works (it leads to recovery, we do find it useful to understand the content of psychotic crises), is ethical (non-hierarchical, not by force, free, ongoing, involves informed consent), and causes no iatrogenic harm.
You asked, “If we don’t orient to the norm, define ourselves in relation to it, how do we define ourselves?” It is a good question. I’m not actually convinced that we need to identify ourselves as something any more related to the most stable core part of ourselves (to whatever degree one exists!) than “psychiatric survivors.” I think that this difference from “normal” people can logically be maintained because it is historical fact. We were abused by psychiatry, and that does in fact distinguish us from those who weren’t. On the other hand, I don’t think that there is anything “inside us,” i.e. that is not a matter of the vagaries of happenstance and contingent facts, that reliably distinguishes us from normal people. In other words, I’m not convinced that we need a word for “those more sensitive being thrown into extreme states of emotional distress by the problems of living.” Why not? Simply because there is no reliable or “valid” way to distinguish “those more sensitive.” The fact is that psychosis is a human thing, not something special to us who happen to have found the right set of circumstances to trigger ours. Any human will become psychotic given the right triggers/stressors/environment.
You said: “I think there is something about sovereignty somewhere in there or some question about whether we need to define ourselves at all, or who has the power to define us.” It seems like you and I are thinking along the same track here, based on us both suspecting that we don’t need to define ourselves at all. Also, I believe that sovereignty is part of the ideological apparatus that has made “normal” mean “not in need of SPECIAL help”… it is a definition for normality that already assumes a definition of normality, if that makes sense.
thanks to you also. It’s good to have a productive dialogue with people who truly do take into consideration what you are saying. You’re going above and beyond with your in-depth responses to comments… I’m not sure I’d have the fortitude to keep up on the comments as well as you have with this piece!
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A wonderful essay Faith, I really appreciate your openness to exploring the human condition and its functional nature, I particularly like;
“Do we need to know the specific neurological correlates of internal conflict?
How does the fear of being alone pass between our synapses?
Does hope light up our brains, or just our hearts?
Is it even possible to know? Is it important?”
In my own journey to understand the nature of my psychotic experiences, “how to know” seems to lie at the very heart of understanding. Should I be able to think my way to understanding, or is a combination of thoughtful knowledge and “felt sense” required?
Along the way to becoming totally medication free and independent, my self-interpretation (self-awareness & understanding) questions shifted from dependence on acceptance of the generalized brain disease medical model of a “treatment industry” approach based largely on ignorance, fear and historical accidents. Towards a more holistic sense of my profound nervous dis-ease, as involving my heart, lungs and gut, as much as my brain.
Put simply, my experience of manic psychosis is a NEED of appropriate orientation towards reality, of organism know to the social environment as David Bates. What has allowed me to understand this growth process involved in psychosis, is reading the kind of neuroscience which seeks to explore the reality of the human condition rather than defensively judge it, as in fearful assumptions about pathology.
Question! Can we really ‘assume’ that the experience we label “mind,” is all about what happens within the brain, alone?
I personally believe that we are on the verge of a paradigm shift in the perception of ourselves, and what really means to be human, to be a sentient species.
Please consider this important paper by the brilliant Stephen Porges, on the “Reciprocal Influences Between Body and Brain in the Perception and Expression of Affect”
EMOTIONS, AFFECT REGULATION, and interpersonal social behavior are psychological processes that describe basic human experiences in response to events, environmental challenges, and people. These processes shape our sense of self, contribute to our abilities to form relationships, and determine whether we feel safe in various contexts or with specific people. Although these processes can be objectively observed and subjectively described, they represent a complex interplay between our psychological experience and our physiological regulation. These psychological–physiological interactions are dependent on the dynamic bidirectional communication between peripheral organs and the central nervous system connecting the brain with these organs.
For example, the neural circuits, providing a bidirectional communication between the brain and heart, can trigger either a rapid increase in heart rate to support protective fight/flight behaviors, or a rapid decrease in heart rate to support social interactions. Peripheral physiological reactions can be initiated by the brain that detect features of danger in the environment, and alternatively, changes in our peripheral physiological state can feed back information to the brain and alter our perceptions of the world.
Thus, affect and interpersonal social behavior are more accurately described as biobehavioral than psychological processes, since our physiological state can profoundly influence the quality of these psychological processes, and our feelings can, in turn, determine dynamic changes in our physiology. Our nervous system functions as a sentry by continuously evaluating risk in the environment. Through neural surveillance mechanisms (i.e., neuroception—see below), our brain identifies features of risk or safety. Many of the features of risk and safety are not learned, but rather are hardwired into our nervous system and reflect adaptive strategies associated with our phylogenetic history. For example, low-frequency sounds elicit in mammals a sense of danger associated with an approaching predator.
Through exposure and associative learning, we can link these features with other events. Specific features in the environment recruit physiological states differentially associated with feelings of safety, danger, or ultimate demise (i.e., life threat). Each of these states is characterized by a specific set of capacities for affect regulation, social engagement, and communication (Porges, 2003). Current research in affective neuroscience focuses on brain structures and neural circuits related to specific motivational and emotional processes (e.g., Panksepp, 1998a).
These important discoveries emphasize cortical and sub-cortical structures in the emergence of the complex affective repertoire of humans and their contribution to social relationships (e.g., Schore, 1994, 2003a; Siegel, 2007). However, underlying these contributions are details of an important and often overlooked neurobiological substrate: the neural circuits mediating the reciprocal communication between body states and brainstem structures, which have an impact on the availability of these affective circuits. These underlying circuits not only promote feelings (e.g., Damasio, 1999), but also form a bidirectional circuit (e.g., Darwin, 1872/1965) that enables mental and psychological processes to influence body state, and to color and, at times, to distort our perception of the world.
Thus, the study of affective processes, especially in their prosocial and healing roles, requires an understanding of the neural circuits both between higher brain structures and the brainstem and between the brainstem and the visceral organs (e.g., the heart) mediated through the autonomic nervous system. All affective or emotional states are dependent upon lower brain regulation of the visceral state and the important visceral, tactile, and nocioceptive cues that travel to the brain from the periphery. Moreover, there are distinct visceral regulatory states that foster different domains of behavior. These states do not preclude the important bidirectional information from higher brain structures.
Emotion, Motion, and Visceral State: Features of Mental Health
Regardless of the operational, and often arbitrary, distinction between emotion and affect or between emotional expressions and feelings, the measurement of physiological states (e.g., autonomic, endocrine, and muscle activity) needs to be embraced in affective neuroscience, particularly if there is to be a functional dialogue with experiential clinicians. In most cases, physiological state has been conceptualized as a correlate or a consequence of higher brain structures (e.g., cortex) presumed to be driving emotion and affect.
However, it would be naïve not to explore the connections and potential bidirectional influences between peripheral physiological states and the brain circuits related to affective processes. Physiological state is an implicit component of the subjective experiences associated with specific psychological constructs such as anxiety, fear, panic, and pain. The convergence between physiological state and emotional experience is neurophysiologically determined, since the metabolic requirements necessary to modulate the muscles of the face and body require supporting changes in autonomic state.
All emotional and affective states require specific physiological shifts to facilitate their expression and to reach their implicit goals (e.g., fight, flight, freeze, proximity). Through the study of phylogenetic shifts in the vertebrate autonomic nervous system, it is possible to link the different expressive features of emotion in humans with the phylogenetic transitions in visceral regulation observed in vertebrates. Physiological monitoring provides an important portal to monitor these reactions, since some affective responses are often not observable in overt behavior.
There is a rich history of research linking the neural regulation of face and viscera (e.g., heart) with brain circuits. Gellhorn (1964) elaborated on how proprioceptive discharges from facial muscles influence brain function and promote changes in visceral state, thus providing an example of the bidirectionality between peripheral and central structures as well as a neurophysiological basis for the assumed relation between facial expression and body feelings. Even earlier, Darwin (1872/1965) acknowledged the important and often neglected bidirectional relation between the brain and the heart in The Expression of Emotions in Man and Animals: “When the heart is affected it reacts on the brain; and the state of the brain again reacts through the pneumo-gastric [vagus] nerve on the heart; so that under any excitement there will be much mutual action and reaction between these, the two most important organs of the body” (p. 69).”
In this paper Porges points out the historical assumptions which gave rise to our current paradigm of ineffective treatment for those suffering a presumed “mental illness,” underlining just how much the human heart has been left out of the equation, when comes to understanding mental health. Please consider;
“Within the field of mental health, there is a similar acceptance of a disease model without a focus on the intervening feedback circuits that mediate the features of the disorder. Within psychiatry, anxiety and depression are defined by clinical features and not by a measurable physiological substrate. The prevalent strategies in mental health research that use neurophysiological variables (e.g., imaging, autonomic measures) are not directed at defining anxiety or depression, but use neurophysiological variables as correlates of a clinical diagnosis.
The value of taking a different perspective can be illustrated with the construct of anxiety. If anxiety were viewed as dependent on a shift in autonomic state in which an individual’s physiological state is dominated by the sympathetic nervous system, new clinical research strategies might emerge that focus on characterizing how states of anxiety and a vulnerability to being anxious would be potentiated or dampened by different autonomic states. Treatments would then be developed either to (1) dampen sympathetic tone or (2) enable the individual to move to environments or shift contexts that are less likely to trigger the increased reactivity associated with higher sympathetic excitation.
Unfortunately, most researchers in psychiatry and psychology express little interest in the mapping autonomic regulation as a “vulnerability” dimension for various psychiatric disorders and behavioral problems, even though visceral features are often symptoms of the disorders they are treating. Clinical disciplines rarely acknowledge the proximal functions of the visceral state. Likewise, clinicians seldom monitor the expression of vagal withdrawal or sympathetic excitation in their patients.
Such a shift in autonomic state would be manifested in several physical and psychiatric symptoms, including flat affect, difficulties in auditory processing, hyperacusis (i.e., auditory hypersensivities), tachycardia, and constipation. In addition, conventional models of mental disorders neglect the contribution of neurophysiological mechanisms in dynamic interaction with contextual cues in the environment. In contrast, these disciplines have embraced distal constructs related to the functions of receptors within the brain that lead almost reflexively to drug treatment, while generally failing to recognize the important role of visceral state and visceral afferent feedback on the global functioning of the brain.
This strategy is far from parsimonious and does not take into account either the phylogeny of the mammalian nervous system or the intervening neurophysiological and biobehavioral systems along a continuum from genes to behavior. Rather these disciplines have assumed that clusters of observable behaviors or subjective experiences are linked parsimoniously and directly to neurochemical levels in specific brain circuits. Thus, they overlook the important potential of psychological and behavioral interventions (including changes in environment) that would be therapeutic by virtue of their direct influence on physiological state, without necessitating pharmacological treatments.”
http://austininconnection.org/documents/Reciprocalinfluencesbetweenbodyandbrain-inpress-1.pdf
Porges “Polyvagal Theory,” gives a solid science perspective on the “how” and “why” person centered approaches like eCPR work.
From my own reading of neuroscience outside the “treatment industry” I’ve come to know by way of a more balanced thought/felt sense, just how much I function with an ‘autonomic’ expectation about the external environment, and how this unconscious process leads me into “assumptions” that I tend to take for granted. Especially when I NEED to embrace my attachment processes and trust the “group think.”
Please keep up the great work of “open hearted” exploration that you do, Faith.
Best wishes
David Bates.
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David,
You’ve been a stranger to this site for a while. It’s good to read your comment and to have you back.
Be well,
Duane
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Yeah, I’m stoked that Batesy came back! I was really happy to see his thoughts here.
Thank you, Duane, for liking the poem. That means a lot to me. I felt a lot when I was writing it, picturing it all.
I hope you have a good night and thanks for being out there.
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David, I really can’t begin to express how much I appreciate your recognition of the reality of these functions and features as meaningful within people’s lives and experiences. I always pick up a substantial reading list from your comments and good insight into the existing articulations of ideas which are complementary to my own formulations of figuring. I appreciate you.
I don’t know why more people aren’t interested in this topic, how the brain and body relate to our subjective realities of experience. That doesn’t make sense to me.
It’s alright though, I just spent the last hour on the porch talking to a friend of mine about the possibility of particular styles of cognition relating to the spectrum of human distress, frustration and despair. Here is my investment in neurodiversity: I know that I process information differently. I am extremely analytical and exceedingly logical. Although, as I mentioned, psychometric testing is fraught with complications, limitations, and grey areas, consistent placement at the far end of the spectrum on some processing related measures – across a span of decades – indicates to me that I am a verified, certifiable problem solver and synthesizer of information. That is just how my brain works.
So, I was just sitting out on the porch and talking with my friend, about neurodiversity and the dis-connect between the fact that we have brains (and bodies) and our idea about our experience. We came to all sorts of conclusions, including a theory that people with analytical tendencies who are denied the opportunity to be affirmed in the positive aspects of their innate propensities and who have no context for understanding or outlet for utilizing their inclinations and interests may experience manifest distress in the form of frustrations, anxieties, obsessions, and in cases of severe and protracted limitation of self expression, may experience a crises of analytical impulse, stemming from an intolerance for cognitive dissonance and the profound grief of not having any space in our lives where we are understood, believed in, or empowered to be who we are to think as we think. Of course, that’s just a theoretical neuropsychological theory of human distress that pertains to why, perhaps, neurodiversity is worthy of consideration if we genuinely care to understand why people struggle and the nuances of the ways that they may struggle. Nothing is ever so simple as one factor or attribute.
I work with a lot of very poor and isolated people who have never in their lives had a chance to explore their intelligence or their personal relationship with how they experience the world. Many of them are homeless and struggle with substance use/abuse. They have diagnoses ranging from depression to schizophrenia to ADHD to Asperger’s to bipolar…and you know what, they are – by and large – all brilliant thinkers and deeply sensitive people, who notice details and ask questions and struggle to find resolution in the meanings that they make of their lives.
It is amazing how much recovery occurs when people are empowered to reflect on how they think about things, how they process information, how they learn and sense, react and respond. Because we use WRAP as a core curriculum option, many people do figure out what they need to do to stay well and learn what supports them feeling the way they want to feel, do the things that they have decided are important to them. They are able to self-identify what works for them and what doesn’t…and they get better, as measured by the fact that they are able to express happiness and gratitude for what is.
This is probably a little rambling. It feels that way. It’s been a long day.
Again, I do appreciate that you seem to understand where I am coming from with this and why it is important to me. A lot of people have similar experiences and a great many of us are psychiatricized. I know that meaning making and analysis is a huge part of my experiences of madness. Yes, emotional distress plays a role, and yes spirituality was key to me this last go around…but the way I process information contributes mightily to how I experience the world, including spirituality and emotion, because none of these realms exists in isolation from another.
You have a very eloquent understanding of stress mechanisms and the interplay of perception of risk/safety and stress reactions. Again, I don’t understand the dis-connect between subjective fear rooted in real or perceived threat, the neurochemical havoc of acute or chronic stress, and the manifestations of hypervigilant, “paranoid,” or “delusional” states. For analytical thinkers, I think that stress/fear can trigger a state of extreme attunement to one’s environment or to persistently troubling or saving ideas, as a protective mechanism and a means to try to resolve the sense of threat.
I agree that the mind is far more than the brain. I think that the mind resides in conjunction with whatever it is we call spirit…somewhere in our matrices of electrical impulse, frequency, and vibration…which don’t exist in a vacuum, but rather are connected to all things living.
I am actually a little worried that the NIMH may find a genetic “marker” that can be tested for re: autistic spectrum disorders or other modes of neurodivergence. It makes me feel sick to think that if they found such a thing, that they would somehow try to disable it.
Can you imagine a world with no analytical thinkers, pattern finders, or sensitive problem solvers?
Yikes.
Thank you again for commenting and for appreciating these perspectives for what they are…my understanding of who I am and how I work, which I know does not stay the same.
For example, after my last crisis, with all the medication and the stunned trauma…well, I literally could barely think at all.
Thank goodness for neuroplasticity, healing, our ability to make new paths for ourselves.
Thanks again!
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Faith, “Keep the Faith” http://www.youtube.com/watch?v=eZQyVUTcpM4 :D.
It is true that many misgivings have been committed in the past “in the name of science”. The most obvious that comes to mind is eugenics. The problem is that science is agnostic to those misgivings; it’s only those who twist science to push for despicable agendas that are to blame.
What science gives us that is not available to confront misgivings perpetrated in the name of other areas of knowledge (such as theology) is the ability to falsify them. You cannot falsify “everybody has to believe in Allah”, but you certainly can falsify “bio marker X is the cause of disease Y”.
We should become fans of the NIMH approach, not because it is going to be successful (in fact, studies of genetically identical twins in which one of them has been labelled as “mentally ill” while the other didn’t already predict its utmost failure). It’s precisely because it is doomed to fail that we must embrace it. That is not to say that the powers that be will not try to invent something else to do social control, however, psychiatry is finished.
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What about studies of identical twins separated at birth who end up having exactly the same rate of a mental illness despite having been raised in completely different environments?
I say mental illness, but you can call it what you want. I think it is reasonable to call it this way because whatever it is causes serious problems in the lives of people with the difficulty. Difference is fine, but disorder only connotes that the difference leads to function that is less healthy. When people’s kidneys don’t function within the range of normal we say that they have kidney disease we don’t say that it is a manifestation of renal diversity.
I can understand not wanting to uniformly label all these states as diseases so I’ll call them whatever you want. I’m not meaning to be disrespectful. It seems you all still call it the same thing, you usually just up quote marks around it. So it seems you are having the same difficulty. I just don’t understand why when we talk about the mind a completely different terminology should apply.
When I see someone with severe psychosis, disheveled, unable to speak, unable to take care of their basic human needs I do think they are sick. They certainly seem more sick than someone with a mild kidney disease. Why is it so wrong to say they are sick? When in that state the person could easily look indistinguishable from other “real illness” states. Alternative explanations would include delirium or a brain tumor for example.
I’d also point out that these “mental illnesses” can also have physical findings similar to other “real diseases”. For example, schizophrenic catatonia which has motor findings like rigidity (similar to Parkinson’s disease), sometimes can have fever and can even be fatal in the absence of intervention. How can that not be a disease? I understand these are relatively extreme examples, but I think the movement here does damage to itself by not recognizing that things are not so black and white. Maybe some people that hear voices are neurodiverse or having a response to severe struggles in life that should be considered within the range of normal human experience. I can see the viewpoint that labeling that as a disease is misleading or does a disservice to the person. But surely there is a range of severity and on one end some of this is organic disease. The question in my mind is where to draw the line and I agree that it is not clear. But then again maybe everyone here disagrees that there is a line at all.
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Yes, what about those studies? I want to see at least one of those!
Good to see you, ScottW
🙂
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Oh, there’s definitely a line. I really appreciate your comment and questions. I know that you weren’t intending to be disrespectful and I think it’s really important that people try to clarify their thinking on this.
So, thanks for asking questions and offering up some examples of how the words function in your mind.
A disease requires a process or something which causes the disease. As the noted invalidity of many DSM categories establishes, there is not process, nor is there a specific “treatment” that seems to correct difficulty, only “treatments” that suppress “symptoms.”
What if we weren’t all supposed to have the same mid-line brainstates and ways of experiencing the world? What about kids with learning differences or the so called “developmental disorders” – do they have a disease?
No. I think it would actually be more appropriate to say renal disfunction or impairment in renal processing, rather than just kidney disease – though whatever causes that impairment may or may not be a disease and many cases of kidney disease are actually caused by things we put into our bodies. I guess you could say things like “His kidney disease was caused by years of taking lithium carbonate.”
With actual diseases there are actual causes and actual medical treatments (without quotations) that treat the specific dysfunction that is identified.
I understand that this is the goal of the NIMH, to develop ways and means to identify markers that correlate with what we term to be “mental illness.” They will then assume that the marker is part of a disease process and develop pharmaceutical, electrical, or (oh, woe!) surgical methods to “treat” what they have determined to be the “root of the disease.”
Unfortunately, for the reasons I expressed above (in this essay)
– that anything having to do with our brains is dependent upon a great many variables and that
– our brains change
…the “This appears to be a trait linked to experiences that are considered to be the result of what we call mental illness, so this trait must be a part of the disease and must therefore be treated or (oh, woe! ) eliminated.” approach to consistent differences in human modes of experience is a very dangerous direction for science to take.
None of this to say that people do not sometimes have tremendously challenging states of being or recurrent difficulties with stress regulation, processing, or any number of other things. It is to say that it is not helpful to think of our ways of experiencing the world as a disease, when there is no disease, and that medical intervention is not – in the vast majority of cases – going to “fix us.”
In the cases of disorders such as those on the autistic spectrum or ADHD or learning differences (which many people with bipolar and schizophrenia diagnoses often “have”) it is absolutely not appropriate to deem difficult elements of experience to be a disease or to attribute poor prognosis on the basis of presentation at any particular point in time.
When I look over my medical records from my last forced hospitalization, I see that they noted that I was “unkempt, and smelled of body odor…that I was speaking rapidly and expressing grandiose beliefs, patient made statement that she ‘just processes things differently and that it is sometimes difficult for people to understand her…patient became agitated in requesting an item from staff (my bra, because the hospital shirt – which left my arms uncovered which I hate – was transparent and I did not like the feeling that male hospital staff were looking at my nipples) and had to be forcibly medicated (which required the same male hospital staff to pull down my pants)
(I remember all this quite clearly, in a multimodal style of visual memory, sound, and my conscious reality (that I was in the hospital because following a period of grief and an increase in a serotonin reuptake inhibitor and in the context of severe and persistent psychosocial duress in the form of threats to my child custody in the wake of a not-great divorce, I experienced a protracted extreme state characterized by hyperanalysis and heightened sensory attunement (all supported by the neurochemical effects of fear and autonomic responses) that resulted in a complete and total deconstruction of the world as I know it and all sorts of (fear driven) thoughts and inspirations ensued…and that I wasn’t dangerous. I was scared and sad because my family – who “gets nervous” when I talk about postmodern deconstruction or anything having to do with the word meta or really anything all, because I trade in big ideas that are not appropriately sized for the context and ascribed purpose of my life. They had sent 3 men to my house to wake me up in the evening and put handcuffs on me and take me to the hospital and my wonderful sensitive brilliant children were scared and I could not tell them that I was okay. I knew what consensus reality was and I knew that it was terrible.)
So, I remember all this quite clearly and I have to say, it’s all in what is made of it…of who we are and why we are and what is and is not okay in our lives, what we must tolerate and what we must suppress.
Psychosis (unless it is drug induced) does not happen out of nowhere. It is a complex state. I was not sick. I was scared and stressed. I appeared sick, because that is what was seen.
I am not one who “had an episode” but before that was “okay” and now is “okay” – I have been dealing with this thinking feeling contextualizing stuff since I was very young.
To get back to your observation of catatonic schizophrenia. In my opinion, catatonia should not even be considered to be schizophrenia. Maybe it’s a variant of Tourette’s in mechanism, which is quite possibly exacerbated by a profound death of hope and an inability to be consciously present in one’s life without experiencing an enormous amount of pain and confusion.
I think trauma causes catatonia. As for the fever. Hmm, I don’t know that that happens. Maybe the heat was too high up or maybe it indicates a breakdown in regulatory systems, due to duress or stress reinforced rigidity in neurological activity.
All of the horrific things that we associate with mental illness can largely – for most people – be avoided….if these experiences are diseases they are afflictions caused by abuse and trauma. Yes, some people do have actual and real troubles with their brains.
I know a person who “has Tourette’s”. He is homeless and extremely affected by his condition. To be honest, his presentation appears similar to what we typically think of as “being insane” – incoherence, tics, intensity and communication that is completely out of context…but he’s not insane.
He knows that he has to stay to the edges of things or he gets too agitated and his Tourette’s is triggered.
He’s got a lot of struggles.
He does not have a disease, however. He has a brain, that is likely quite sensitive and complex around the sound and language processing areas. I really don’t know.
I do know that difference is not disease and that madness – like any human experience – has many dynamic algorithms that can be applied in efforts to map its causes and outcomes. However, it is impossible to conclusively determine causes and outcomes across individual experiences, because life (like “mental illness”) is so mysterious. (It’s not really, but the specific odds and ratios are statistically difficult to specifically determine in causal analysis and extrapolation of potential events, due to the multivariate nature of the human condition across different life domains.)
I do not think that we have diseases or illnesses. We have experiences that can make us appear and feel sick, but that does not mean that there is an underlying disease process. Given the adequate opportunities, resources, and support, the dysfunction or overload or dysregulation that may or may not be associated with manifest psychosis can return, quite quickly to baseline homeostatic states…which may or may not include interesting thinking, differences in feeling, sensory issues, and/or social and occupational difficulty…all of which can be attributed to individuation in feature and function as such things relate to the social, cultural, and economic context and unique life/self circumstances in development.
So, there are a hundred different ways to look at what the significance of neurodiversity may be as it relates to mental illness. What I do know is that it is a grave injustice to assume that there is no good that can come of experiencing the world differently and that the struggles we may have are the result of a disease.
The struggles I have are a result of living in a cruel, dysfunctional, beautiful and alive and growing changing world that makes so much sense to me, but that makes no sense at all when people keep talking about being human as a disease.
Last night, I made the observation that “You have a very sick brain.” (Medical model psychiatry) and “Your brain has nothing to do with anything.” (Psychology) are equally flawed worldviews.
Like that’s some kind of choice…
Thanks again for commenting. Sorry this is long and somewhat non-linear. Actually, I’m not sorry at all.
Feel free to post any citations regarding fevers and catatonia. I will destroy the validity of whatever findings they found, unless the methodology and research design indicate that findings may be reliable, which – in brain behavior research – is extremely rare. Far more rare, even, than schizophrenia itself…which, if Smoller’s research indicates anything, it indicates that a sizeable portion of the American population (the aggregate of those with diagnoses of schizophrenia, depression, bipolar, and people with ADHD and everyone on the autistic spectrum)may be impacted by similar processes. Of course, as I have said, the epigenetic variance that was observed by Smoller could just as easily be attributed to trauma or neuroleptics, which are other traits shared across these diagnostic categories.
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Well I can’t address all that, but here are a few points:
1) Saying that DSM diagnoses have poor validity does not mean that there is not a process underlying the phenomenon.
2) If you want to say renal dysfunction or impairment instead of kidney disease I think that’s fine. I do think you are mistaken that “actual diseases” have medical treatments that correct the actual underlying dysfunction. In reality I would say almost all medications only correct problems symptomatically. Often the underlying cause of the disease is unknown or it cannot be corrected. Surgery is one of the few fields in medicine where causes of disease are actually fixed.
3) The variant of catatonia I alluded to is a clinically reported phenomena which is called malignant or lethal catatonia. Feel free to destroy the validity of this. (Am J Psychiatry 1989;146:324-328, for example) I am concerned though that the comment about destroying the validity of anything I bring up indicates that your position is that you cannot be wrong about any of this no matter what I reference.
I understand this is a very personal issue for you and I’m truly sorry that you’ve had such horrible experiences. I’m certainly not saying any of this to trivialize anyone’s experience with “mental illness”. I’m mostly just curious.
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Please clarify Morias. You dispute that such studies exist? Or you think that they are fatally flawed and do not bear on the question?
I’m not so dull as to think there is not a pre-packaged answer as to why twins reared apart data do not demonstrate anything useful. I’m just curious what flaw is supposed to be.
The real problem here is that I don’t think equal skepticism is being applied on both sides of the problem. Where are the studies that prove that there is no heritability for psychiatric disorders?
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Here is your problem Scott, to disprove the statement “so called mental illness is caused by genetics”, I only need one counter example of a couple of identical twins in which one has been labelled while the other has been spared from the label. Those studies abound in the literature (see Suzanne below). That is how science works. In the pseudo scientific world of psychiatry, anecdotal cases of identical twins that have been both labelled might account so something, but in science that is irrelevant to the proposition.
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Hi Scott, thanks for that reference. I’ll pull it up sometime. For now, I am pretty content to assume this clinical brain fever catatonia thing is probably not something that affects the vast majority of people who are diagnosed as having schizophrenia. This is not to say that people who have brain fever and catatonia do not matter, they very much do. In fact, I would love to work with people who are prone to catatonia. I’ll check out the article at some point.
Yes, it was a bit arrogant and immature of me to threaten to destroy the validity of formal literature. I did also say, “…unless the methodology and research design indicate that findings may be reliable, which – in brain behavior research – is extremely rare.”
So, there is that word, unless…
In any event, as soon as I read your little extreme case scenario about brain fever and catatonia, I immediately thought of Neuroleptic Malignant Syndrome, which basically is what you are describing, with the fever and rigidity.
http://en.wikipedia.org/wiki/Neuroleptic_malignant_syndrome
“Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. NMS typically consists of muscle rigidity, fever, autonomic instability,[1] and cognitive changes such as delirium, and is associated with elevated plasma creatine phosphokinase.[2] The incidence of neuroleptic malignant syndrome has decreased since it was first described, due to changes in prescribing habits, but NMS is still a potential danger to patients being treated with antipsychotic medication. Because of the unpredictability of NMS, treatment may vary substantially but is generally based on supportive care and removal of the offending antipsychotic drug.”
Yeah, good ol’ wikipedia. Given that your citation is from the late 80s, it likely will not be valid…as ideas and understanding of causality have become more clear.
It seems neuroleptics may cause neurological damage. Isn’t it ironic that they are proposing research to identify neurological problems and yet are simultaneously prescribing neuroleptic drugs that cause neurological damage?
Thanks again for asking a few questions. I feel that the logic being presented here is pretty clear, so I hope that you will consider these persectives with a mind that is open to the possibility that maybe what we’ve been told simply is not true.
Thank you, by the way, for being “truly sorry” for the things I experienced. Right this very minute the same barbaric and inappropriate “treatment” is being roughly bestowed upon a lot of people.
So, I really do hope you are really truly sorry for them, too.
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“studies of identical twins separated at birth who end up having exactly the same rate of a mental illness”
That’s laughable, ridiculous, and just plain false.
http://isp.sagepub.com/content/28/3/175.abstract
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Thanks for saving me time :-). Psychiatry, given its unscientific nature, lives by mantras. They need to keep repeating them, as Scott did, to convince themselves of their own lies. It’s like the mantra that SSRIs save lives. How is that they keep repeating it in spite of a) evidence that they are no better than placebos, b) they are known to increase violent behavior and c) the CDC data on suicide correlates high usage of antidepressants with a 28% increase in the suicide rate is BEYOND me. Yet, they keep repeating the mantra.
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@ CannotSay,
Why should they let the facts get in their way of their mantras?
Duane
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To clarify,
My comment was directed at psychiatry and the mantra of “antidepressants saving lives” and *not* toward Scott.
Scott, I think that genetics is never 100% of the reason a person ends up with a real disease, and you seem to be saying the same thing. I’m fascinated with *epigenetics* and the way genes end up *expressing* themselves.
These things appear to have a lot to do with how we think, what we eat, the way we choose to live, which is good news, IMO.
Also, I’m not implying that “mental” illnesses are the same as others. At the risk of being tarred and feathered, I’m saying that in some cases there may be underlying physical conditions, such as poor thyroid function, absorption difficulties, etc that end up being falsely diagnosed as “severe mental illness.”
And, IMO these conditions might involve genetics. However, I refuse to believe a person is ever a *victim* of genetics, because any of us can change the ways our genes are *expressed*.
I hope this makes some sense, as I’m often misunderstood on this subject.
Duane
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Perhaps I was unclear… I guess I have to spell everything out carefully.
I do not think nor was I saying that genetics causes schizophrenia or any other mental illness. If I was trying to say that I would have said that identical twins are always concordant for schizophrenia. What I’m suggesting is that if one identical twin has schizophrenia then the other one is more likely to have schizophrenia than would be expected based on the rate of schizophrenia in the general population. If this is true it suggests the presence of a heritable factor. NOT that it is caused by genetics or that it is 100% inheritable. In fact that it is something like if one twin has schizophrenia then 50% of the time the other twin also has schizophrenia. Doesn’t really matter what the actual number is as long as it is higher than the rate of schizophrenia in the general population. If this is true for identical twins separated at birth it largely eliminates the potential confounder of a shared schizophrenia inducing environment.
I do not discount the influence of social or environmental causes on the development of schizophrenia or any other mental illness. These are obviously huge influences on the development of mental illness. The presence of heritable factors does not mean anything about being pre-determined or there not being an influence of environment.
The article you reference is a brief review from 1982 which is not particularly well written for one thing. The article also finds 50% concordance in referencing a very few small comparisons of twins reared apart, similar to the number I mention above and suggesting heritable factors. They appear to find a way to discount from the data set most of the concordant twin pairs for methodological reasons. It seems like they think they weren’t separated from each other early enough to be valid. I still think these data strongly suggest heritable factors. Regardless, it is a minority opinion in the field to say the least. There are much larger studies which address similar questions of heritability in mental illness and other traits which I think overall strongly implicate heritable factors. The reference definitely comes nowhere close to proving that heritable factors play no role in mental illness whatsoever. I will wait anxiously for a study that provides evidence in that regard and not just an opinion that the idea is false or an explanation of why other people’s work is invalid.
For most ideas it is not hard to dig something like this up (see global warming). It is the weight of the evidence taken as a whole which must be interpreted. That is how science works “cannot say 2013”. If I were saying something as ridiculous as schizophrenia is a 100% genetically determined and 100% penetrant condition, then all it would take is one counter example to prove me wrong. That is not what I’m saying and it is not that simple.
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ScottW,
Left a response in the wrong place.
See above.
Best,
Duane
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Problem is that the defenders of psychiatry make it sound as if their invented diseases are like truly genetic diseases, such as Down syndrome. The latter passes the identical twin test. None of the invented diseases does. This “probability” /”predisposition” argument is very dangerous. By genes alone, children of violent parents are more likely to be violent. Should all the children of convicted killers be preemptively locked in, just in case? Since so called “mental illnesses” are not real ones, not Down syndrome type of real, we should get rid of coercive psychiatry period :-).
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Final thought, that is not how science works, what you describe is how “fake” science works, such as economics or catastrophic global warming. If what you are trying to say is that psychiatry is fake science, then yes, I agree with that. In some quarters the type of science you are describing is also known as “dismal science” or “pseudo science” :-).
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ScottW began his comments here by making a reference to studies of identical twins separated at birth who end up having EXACTLY the same rate of a mental illness despite having been raised in completely different environments. Then when I provide a link to a study which refutes that preposterous claim, he dismisses it by virtue of his own subjective judgment of it being “poorly written.” LOL!
Can ScottW provide ONE SINGLE link or citation which supports the ludicrous statemt about twins separated at birth who end up having EXACTLY the same rate of mental illness? No? I didn’t think so.
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ScottW,
The so called gene studies supposedly proving bogus DSM stigmas have been totally debunked by many experts for a long time like most if not all so called research to give psychiatry the illusion of something medical and scientific to cover up the fact that they serve as a mere funnel for BIG PHARMA to push the latest lethal poisons on patent.
Anyway, I suggest you read Dr. Jay Joseph’s THE GENE ILLUSION and THE MISSING GENE along with many of his articles including ones he posted on this web site. He does a great job debunking the bogus twin studies you cite as well as the great heritability and other bogus eugenics claims psychiatry has been pushing since they used them to gas to death those they stigmatized as “mentally ill” before and after Hitler came to power. Then, they transferred this gassing apparatus to the concentration camps to get rid of other so called “inferior” people.
Dr. Joseph also does a great job exposing that just like Rockefeller funding the evil eugenics research to justify robber barons like himself stealing far more of the world’s resources for their malignant, greedy selves due to their supposed superior genes while preying on and devaluing/stigmatizing those they exploited and destroyed due to their supposed inferior genes, today right wing neoconservatives are doing the same thing to justify their own psychopathic global hijacking agenda as explained in the book and web site POLITICAL PONEROLOGY and by Dr. Robert Hare, world authority on psychopaths.
So, no surprise that most of us have little tolerance or patience with the ongoing bogus claims of the supposed latest “neuro” findings by the mental death profession for its junk science VOTE IN stigmas just like those dealing with the boy who cried wolf eventually got fed up with his constant lies to the point this liar became a victim of his own deceit and selfishness.
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http://hiddenmurder.blogspot.co.uk/
our country practises this too
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Joanna,
Thanks for the great link, which coincides with what I said and other resources I read, but I haven’t seen this excellent source.
I agree that the U.S. is probably the chief KOL of hidden or not so hidden murder with the mental death profession being one of the top psychopathic intraspecies predators stigmatizing, demonizing, dehumanizing and poisoning those they and others target for earlier and earlier death now that they are targeting even babies in the womb and toddlers for their bogus stigmas and poison drugs.
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Donna, yes it’s a great piece isn’t it.
Psychiatry is up there at the top of the list but it doesn’t exist in a vacuum it’s readily facilitated by Capitalism.
It’s a dog eat dog system which hurts the vulnerable, and inequality causes and maintains mental distress. Wealth creation doesn’t cascade down, the very rich and powerful happily feed off and even make money out of those very inequalities which can drive us mad.
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Those studies do not exist. Also, cf. Jay Joseph’s books on the genetics (or lack thereof) of psychiatric illnesses.
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Hi @cannotsay, I agree. I was quite pleased thinking about how completely it may fail as I wrote this.
It may behoove “us” to become involved in what’s happening at the NIMH, not because we approve or even because we want to feel self-satisfied when they find nothing, but because the NIMH approach is what is happening and the most effective way to influence or mitigate something that is happening is to participate in it…somehow? Maybe I’ll just send Insel a link to this blog and tell him to please stop referring to epigenetic variations
(such as those found by Smoller, et al – which suggest an epigenetic trait related to calcium channels that is purportedly shared across FIVE major DSM diagnostic categories)
as “aberrations” or “mutations” and to kindly remind him that we are constantly evolving and it is infinitely possible that the neuroleptics prescribed across diagnostic categories create atypical genetic features…or something like that. Advise him that our brains are not diseased and that what is expressed at one point in time may not necessarily be our fixed genomic content.
That sounds like a fun little email to send before I pick the kids up from school.
I wonder how much of what is manifested in madness is the need to feel a sense of small power to impact circumstances that affect our lives. I guess that’d vary from person to person, like everything.
Anyway, thanks for the song link and for hangin’ out ’round here. Definitely keeping the faith.
Truth will prevail…and then we just have to worry about what sort of dreadful potentially eugenic tragedy they may make of it.
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Faith,
I wonder what genes or faulty brain wiring influenced Dr. Thomas Insel and Dr. Charles Nemeroff to engage in mutual coverups of their typical fraud to push toxic psych drugs for big payments from BIG PHARMA and other old boy networking for their mutual fraud and self serving benefit at the horrific expense of their so called clients.
I have no doubt that under Dr. Insel’s mob like leadership, we will be hearing about the latest eugenics BS with everyone on the planet subjected to forced bogus testing to determine their eugenics “mental illness” and what toxic cocktail of poison drugs will be forced on them to damage their brains/shorten their lives and make them docile enough so they won’t be interested or able to challenge or fight the psychopaths of psychiatry serving the psychopaths of the power elite hijacking the globe to make slaves of the rest of us. See book, THE SHOCK DOCTRINE.
Dr. Insel has quite a history and it does not bode well for those at risk from the mental death profession:
http://chronicle.com/article/While-Revising-Ethics-Rules/65800/
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Addendum of sorts…
This came out in an email to a friend, and for me it is an important statement to make, for myself. I feel good making it here, because many of the people here have been my friends and I love and respect them.
->
“…so, it’s all been very *illuminating* and has definitely shifted some things in my relations.
I am, first and foremost, an extremely sensitive unidentified genius, who flexes her wrists when she’s agitated and didn’t know how to speak correctly when I was a kid…before the existential crisis, before the trauma, before the psych meds, and trying to be something – anything! – that someone might love, I was…what I am now, which is just myself…who is a person who will never ever deny the existence of her brain…because I love my brain and I am not ashamed of it and I do not hate it and I am not afraid of it and I am so glad that I am who I am, in large part because my wonderful brain helped me to figure out how to stay alive.
Note: I do not deny the role of my heart in staying alive. However, when my heart wasn’t in it, my brain moved me through the day, helped me figure out how to get through it. One could say that this is the mind, but the mind (in my mind) is intrinsically linked to the brain, as well as other aspects of our physical selves. If the mind is, in part, as we imagine it to be, then this may well be true…for me.
Note: I do not deny the role of metaversal forces of knowledge, benevolence and cleverness in my life and narrow escapes. However, I appreciate how well my brain made sense of all those little inklings and impulses and paths quickly crossed.”
So, that’s that. I love my brain…and it is a really wonky brain sometimes. It’s a good brain though. It holds my whole current big huge moment-to-moment life and a hundred different possible futures and almost everything I’ve ever paused to consider, as well as vast stretches of learned history and imagined pasts. It can think about 4 different things at once and maintain multiple orientations to reality and perspective. It’s an awesome brain, even it is pretty bad with names.
I never really got to appreciate my brain much, because I was too busy being angry at it, or hating it and nobody ever told me much of anything about it, other than it was a shame that I was “so smart, but had so many problems…with the, you know, chemical imbalance.”
So, I’m sorry if anything “neuro” related is upsetting for people. I understand that some negative associations have been forged, and that the emotional reaction caused by attentive and compassionate knowledge of the effects of brutal, invasive, grossly experimental “brain science” may create a rigid associative meaning that makes neuro a deeply unsettling term.
I’m sorry, but what Insel does not determine the definition of a word to me. He can’t make words like “brain” ugly, just because he uses them in a flat, ugly, menacing way.
I do have serious concerns about investing in a worldview that assumes that our brains do not impact our experiences in some ways, which are highly individuated and which are variable in their effects and in their outcomes, given culture and privilege.
So, anyway, thanks for letting me post my casual I Love My Brain manifesto here.
I hope you all have a great night. I have got to go to sleep, or tomorrow my brain may not function so well as it otherwise might.
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Addendum:
http://www.madinamerica.com/2013/05/nimh-doubles-back-on-backing-away-from-dsm-5/
They have no idea what they are doing. This is the chaotic and confused part of the paradigm shift, the crisis of ideas and the incommensurability between fact an fiction…where anything could happen and nobody is certain what’s real or what they should do next.
…there is nothing quite like a system of ideas in crisis.
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I’m jumping onto this thread and want to preface my comments by saying thank you to Faith, ScottW, and David, Duane, Susan, Cannotsay, and everyone for generating ideas, emotion, and dialogue. I’v been away from the reply section for a while but have enjoyed reading your contributions….My comments to ScottW (below) are my own. If you do read them, ScottW, keep in mind that I don’t and could never speak for Faith, at whom you’re comments were directed.
Here goes: you wrote, “In reality I would say almost all medications only correct problems symptomatically. Often the underlying cause of the disease is unknown or it cannot be corrected. Surgery is one of the few fields in medicine where causes of disease are actually fixed.”
Yes! Ninety-nine percent of all drugs on the market do not treat a disease process. Of course, this includes all psychiatric medications. Thank you for raising this point. It’s important and is often missed completely. Unfortunately, it seems that pharma’s marketing techniques greatly exaggerate the benefits and downplay the risks, while intentionally making the mechanism of action and inserts confusing for potential consumers/users/people seeking help. However, you say drugs “correct problems symptomatically”, which is not true. They can mask a particular symptom, often for a finite period of time, and often while creating a new problem (there’s no such thing as a selective drugs) or taxing the body in some other way. So, a simple “correction of symptoms” is impossible.
But more importantly, it’s seems you’re missing the most fundamental message with has nothing to do with studies or semantics. Faith, who wrote this absolutely beautiful and thoughtful piece, and I, and rest of the people in this movement are saying that being called sick or ill by the medical establishment for being neurodivergent or experiencing altered or extreme states of consciousness feels hurtful, insulting, and is actually harmful. And, if the medical establishment is working with people in such a way that feels hurtful and is harmful, while claiming to know something about a mysterious disease process at the root of the person’s suffering when they don’t, why operate in this way? Why not listen to the people they aspire to serve, and take note? Why not call it ‘distress’. Why not say, loudly and without shame, “We don’t know why you are suffering in this way. But we can work with you, if you’d like, to identify ways to work through this, or to make meaning out of it, or to change what can be changed, or to explore the use of a drug which might help (and/or hurt) you….” Why not use language which reflects honestly, respect, and a little humility about what we don’t know?
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Hi Vanessa! Great to “see you” around! Thanks for your thoughtful response.
This ->
“Yes! Ninety-nine percent of all drugs on the market do not treat a disease process. Of course, this includes all psychiatric medications. Thank you for raising this point. It’s important and is often missed completely.”
*facepalm* I had no idea that so much of what pharma produces do not actually treat a disease process. Why do we have so many medicines then?
(Yes, I think I know the answer.)
(It’s all such a racket.)
“Why not listen to the people they aspire to serve, and take note?”
…it’s the authoritarian psychoanalytic expert syndrome, characterized by an inability to understand other’s viewpoints and a severe and persistent insistence that the expert is always right.
Thanks again for being around!
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“I, and rest of the people in this movement are saying that being called sick or ill by the medical establishment for being neurodivergent or experiencing altered or extreme states of consciousness feels hurtful, insulting, and is actually harmful. ”
This is cannotsay2013 and I approve this message :D!
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Hi you all –
I have, again, been reading these comments throughout the day. I am actually feeling pretty tired this evening and not very inclined to delve into the finer points of this discussion. It’s actually sometimes difficult for me to absorb information from text on a computer screen and so I am sure that I will miss someone’s really excellent point…there are so many.
This morning, I thought a lot about the water theme…the worst case scenario of the person who will not drink water, Joanna’s friend who needed water, the Hippocrates quote about if water was all we needed.
Suzanne, I’ve neglected to say that I appreciated your comments and the twin study break down. I actually used information from that comment to respond to a question in class today.
I’m sorry you lost your son. I can’t quite ever know what to say about losses like that, other than I’m sorry. I don’t know if I mentioned this around here, but I wrote that poem thinking about the people who have died under the helping hand of science, the imprecise brutality of treatment. I really do think, some days, that the reasons I am trying to change these ideas that poorly define our lives are based not only in the fact that those ideas almost killed something in me, and caused a great deal of pain in my life, and not only for my children, who these ideas affect, because I am their mother, and not only for the people I work with who have lost decades in these ideas, who have been damaged by tardive dyskinesia and the trauma of alienation, but for all the people who have died, both known to me and unknown, and all the little kids sitting on locked wards right now, having their Zyprexa as sprinkles on ice cream in small sterile cups.
More and more, it makes me angry that we should even have to debate such things as whether or not people must be locked up, held in containment, or deemed ill.
The criminal justice system is brutal and abusive. For people who are already vulnerable, jail can be terrible. I go visit people in jail every Thursday. It’s a nice, new clean jail and it is a terrible place.
People do not, ever, out of nowhere wander into malls with swords, unkempt and covered in their own feces. It takes a long time to get to a point like that (unless drugs are involved) and if we existed in a caring society that ensured people’s human needs for shelter, meaningful vocation, and friendship of some sort, no matter how small then maybe we would not have the problems we do.
I was once so lucky as to have no friends at all for a long little bit of time and so I was able to learn how truly nurturing the small kindnesses of strangers can be. You know what I’d do about the fellow with the sword in a mall? I’d ask him why he was carrying it. If he said he was going to battle, I would ask him with whom he intended to fight. I might look around the mall and laugh. I’d just talk with him. I might tell him he ought to be careful with swords in malls. Because I am nice and because I am non-threatening, most people like talking with me. I talk to a lot of people who are out of sorts, mostly out on the street, because I have always talked to strangers. Sometimes people really aren’t very alright in the state they are in, not because it is inherently wrong, but because it could get them in trouble or locked up, or possibly hurt someone, especially if drugs are involved. I actually don’t feel very safe talking with people who are clearly drug-affected and out of their minds, but most people – if you approach them in a way that is not fear creating – are usually pretty alright to talk with and, usually, they are happy to have someone listen to them, to not pretend they are invisible or act like they simply are not there or like what they have to say is not important or interesting. Usually it is very interesting, but I like stories a lot and so that might just be me.
Most people experiencing the sort of madness that impels one to enter a mall with a sword or to try to otherwise defeat or bring justice to some sort of enemy, or to otherwise prove oneself are (conjecture and anecdote) conceivably under the impression that they are doing the right thing, that is why they are doing it. Usually the stories that people tell about what they are doing and why they are doing it are pretty fascinating and tragic. Sometimes it’s cool to talk about other things that a person might be able to do if they can manage to not get locked up or thrown in jail for having a sword and being stinky in the mall.
Like Joanna said, sometimes starting a fire or screaming or making a scene is the only way to make yourself heard. Sad that people are driven to such desperation. I wonder what would happen if every town and city had a known and awesome open community support and wellness space, where people were always available to talk and where there were art supplies and showers, a clothes closet, water, people to help sort things out, a place to rest…what if towns and cities had these places? Would the people who might end up really going off the deep end possibly show up there at some point prior, knowing they could go there for help and human connection?
It’d probably end up being a lot cheaper than hospitalizations and jails. I wonder how much a forced injection costs the state?
I liked Morias’ color and blending model of factors that affect our lives as they may relate to our states of being and agree that we can always heal. I think that’d make a nice series of paintings, those colors.
As for non-medical containment, all I can say is skilled peer respite. I guess it’s difficult, because sometimes (according to the Treatment Advocacy Center and other such pro-force entities) people don’t “want to get help” or “don’t know they need help” –
I think it is a person’s right to decide if they want help or need help and to let them bear the consequences of those actions. I know that DJ Jaffe would pipe up with some horrible story about someone getting killed because a random person with an uncertain (but certainly horrible) history was not forcibly “treated.” That is very unfortunate. So is suicide. However, it is so weird to me that this country regularly kills people (in war, for example) and institutional and systemic violence are rampant and yet we so concerned about the well-being of people who are deemed “mentally ill” – why do we care so much that they get “what they need” or “what they deserve” – ugh. makes me feel sick, thinking about Torrey’s party line and all the collective NAMI matriarchs.
People are scared of people that are said to be “mentally ill” or who present in a way that has been media characterized as “insane” – people don’t want to protect the “mentally ill,” they want to protect themselves from the threat they imagine, which exists in the form of both fear that a person will harm someone else or fear that a person will harm themselves. It’s all based on fear, not compassion…and in cases where people really do care, it seems like a lot of that caring is from a very odd place of paternalistic protection, like one’s own identity is caught up in the role that one plays in “helping somebody.” For doctors and providers, this sort of responsibility for other people’s lives and decisions is written into the expectations of their professions. It’s a matter of relational boundaries.
Alright, I might go paint some colors…yellow, green, blue.
Thanks for contributing to this thread. It’s amazing how thoroughly busted the broadbrush medical model is at this point. I wonder how long til it breaks completely. Are there any examples of other big shifts in scientific paradigm that people can think of…I guess the earth not being flat would be one or the understanding that humans have a brain. It is so amazing to me that at some point in history, we had no idea how we worked or what we even are, or how we relate to any other living thing. That wasn’t so long ago. Everything we know about humans was learned by researching humans, and experimenting on humans and observing humans, classifying what we see and giving it some meaning. A lot of human science is arbitrary and mislead, based on fundamentally flawed premises, like that anything about our current little definition of normal is anything more than a blip or that any of us were ever meant to spend our lives indoors, under fluorescent lights, doing things we don’t enjoy for paychecks to buy things we don’t even want.
I hope you all have a good night and thanks again for talking about this stuff. It feels like we’ve taken into account a couple of realities that haven’t been broadly well-accounted for, extreme state scenarios and underlying medical diseases. What’s cool is that through most of this thread there is a consistent assertion that difference is not disease.
I do want to take a minute and note, again, that kids on the autism spectrum are extremely vulnerable to psychiatric abuse, particularly after poor media related to tragic events. Sometimes, Mad in America is really so all about psychosis and what is psychosis and whatM/b> do we do about psychosis? However, Whitaker’s first book, Mad In America, and other books that look at the history of institutional psychiatry are pretty clear that it’s not just people with psychosis or profound depression that are at risk of medical and psychological harm under the guise of treatment…it’s also people with all sorts of different ways of being, experience, and learning.
I think that human rights is a golden thread.
Thanks and sorry if this was long, disjointed and with possible typos. I think my brain is tired of text. I’ve been looking at screens all day. I want to go draw.
Much Appreciation to y’all.
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Thanks Vanessa. I don’t think I missed that point or at least I’d like to make it clear that I’m not missing that point. I have a different view intellectually about whether it is accurate to call these phenomena illnesses or not. But, I acknowledge what you and Faith are saying about feeling hurt by those labels.
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Dear Suzanne,
I think you’re being unfair. I admitted that I may have been unclear in my original statement. Then I clarified what I meant. You seem to be ignoring that.
I didn’t dismiss the article because it was poorly written. I summarized my interpretation of what they were saying and explained why I don’t agree that this disproves my point. I thought it was pretty clear and reasonable.
The reason I said it was poorly written is because I noticed in the abstract it says something like, “people with schizophrenic.” I just thought it was kind of a blatant typo for a published article. I guess I should have said it was poorly edited. Anyway I guess I set myself up for that.
Your study actually supports my clarified point which is that the rate of concordance is 50% in identical twins reared apart. They interpret that data a little differently than I would, but now I’m repeating myself again. It’s unfortunate I wasn’t more clear in my original statement – I’ve read it over again several times and I think I meant to say something like ‘RISK’ instead of ‘RATE’. Anyway, I think I’ve clarified what I really meant.
I’m not getting the sense that you really want to reasonably debate the idea. My final point is that what you referenced is not “a study” it is a review which does not present new data, but provides an interpretation of previous data.
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ScottW,
You started out your comments here with a blatant lie, and I called you on it. How is that “unfair?” Then you try to backpedal and excuse the blatant lie by reframing it as being “unclear.” Whatever.
You are correct that I don’t want to “debate” you. You seem to be way more attracted to obfuscation than truth. I just want the lies about so-called mental illness to stop. As anyone can see from the many personal accounts on this site, from the data shared by Robert Whitaker, from the fact that “mental disorders” are THE leading cause of disability in North America, and as I know from my own personal experience – the lies are killing people and destroying lives.
Regarding your “final point,” who cares if what I referenced is called a “study,” a “review,” a “meta study,” a “meta analysis,” or “evidenced-based-ultimate-last-word-on-the-actual-truth?” Your side-stepping into the realm of semantics was a nice attempt at dragging a red herring into the mix, though. Nice try.
Be well. And please stop lying. It’s not nice.
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Semantics, red herrings, pseudo science, scientifically unsound mantras that are repeated even when they are demonstrably false (even by those who admit to their falsehood, such as Insel did this week). This is how the psychiatric scam operates :-).
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Agreed! And I am incensed by the “unsound mantras that are repeated even when they are demonstrably false” a.k.a the repeated LIES. This lack of truth telling is a big part of what inevitably killed my son. The lying must stop.
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That is the tragic part and why psychiatry is such an evil endeavor. If it weren’t because of the misery psychiatry has caused, it would be just a bad joke. The problem is that psychiatry ruins lives and, in the worst cases, such as your son’s, it kills innocent people. My prayers are with you.
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Thanks for the prayers, cannotsay. I need them, for sure.
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Hi ScottW,
As I’m sure you realize now my first reply to your first comment referred to “exactly the SAME rate of…” Anyway, I don’t think I need to comment on that anymore…
Regarding twin-adoption studies, I think their two greatest flaws are a) the absolutely ridiculously tiny sample size (nobody’s fault, there just aren’t that many identical twins separated at birth into different adoptive families who go on to develop “schizophrenia”), and b) the fact that, given the problems associated with such small samples, the studies do not control for the possibility that higher rate of schizophrenia in the twin group is simply due to chance – I know this might sound ridiculous to you if you are used to studies with much larger samples where this kind of thing simply does not happen, but when you are dealing with sample sizes so small the possibility of simple chance cannot be ignored; a seemingly impressive higher rate of concordance might come down to two or three extra twin pairs. Perhaps I remember this incorrectly, but I think that in some Finnish study where a database exists which allows to look at the adoptive family environments of the study’s subjects (which had not been looked at when the studies where published) this chance difference in family environments could account for a lot of the difference between twins and non-twins: by chance more twins than non-twins had ended up in “dysfunctional” families.
The point is that these studies should look at the adoptive family environments as part of the study, and they do not.
But all that aside, let’s say that in the end you do find a higher rate of concordance in twins than in non-twins (adopted non-twins, you cannot compare with rates in general population since the adoption itself could play a part in schizophrenia). I get your point that this seems to point to a “genetic component” and to some extent I agree, but only to some extent, since to me that genetic component is of no importance whatsoever from a therapeutic perspective and cannot be said to form part of the “disease”. I know this all sounds a bit convoluted; perhaps a good way to explain it is this:
Let’s say for the sake of argument that you do find that 50% of adopted monozygotic twins develop “schizophrenia” and only 10% of adopted non-twins develop it. I say you can still interpret that as evidence of a 100% environmental disorder. But what could this possibly mean other than I’m a sore loser? It means that the 40% non-twins who are not developing schizophrenia but who, for the disease to be environmental should develop it, are in fact developing something else – another “disorder” which goes under the radar of the study because it does not fall within the conceptual framework of a “medical disease”. And it is not one single disorder either, but many, and just as “bad” if not worse that schizophrenia. The pathogen is in the environment, and it causes damage to all who are exposed to it (to 50% of both twins and non-twins) but depending on very complex genetic differences (what in the good old days of common-sense used to be called “temperament”) this damage expresses itself as “schizophrenia” in some cases and as other “non-medical disorders” in other cases.
What could these “non-medical disorders” be? Let’s use an example: imagine a person “S” with temperament “s” (coded by many genes spread throughout their chromosomes) suffers repeated sexual abuse as a child and as a consequence develops “schizophrenia”. A different person “P” with temperament “p” suffers the same sexual abuse and does not develop “schizophrenia” Aha! “S” has a vulnerability for schizophrenia! No, not quite; here is the catch: “P” becomes a paedophile and a violent sexual predator. Furthermore, “P” is quite clever and escapes detection so his disorder is never noticed. This is a very crude example but I think you’ll get the idea of what I mean. One environmental “pathogen”, 2 genetically-determined temperaments and two different disorders, one “medical” the other not quite (a lot of debate about that). One, schizophrenia, will be very visible whereas the other can go unnoticed for a long time and continue “infecting” other people. Which one would you say is “worse”? Is there any point other than academic curiosity in finding out what the genetic variations which code for temperament “s” (or “p”) are? Particularly if it turns out that temperament “s”, in the absence of abuse, results in particularly intelligent well-adjusted people? Are you going to “correct” their genes in case they are sexually abused later on in life? Your target, obviously, should not be “s” or “p”, but sexual abuse.
But does this hypothesis obtain in the real world? The great difficulty is to know what these “non-medical disorders” are, and also what “abuse” or “trauma” is, because of course it is not always going to be something as obvious as paedophilia and sexual abuse. I’ll just say this: take a look at the world. Do you see poverty, crime, random violence, war, pettiness, anxiety, insecurity, substance addiction, human trafficking, selfishness of all kinds and shapes? I walk past the same homeless man everyday and sometimes he catches my eye and smiles, and you know what I do? I look somewhere else. Is that the response of a “healthy” human being?
I know, this is not the nice, clean and simple science where “diseases” are simple discrete entities; it sounds too much like philosophy and too much like politics and almost like religion, but I’m afraid reality is not nice, clean and simple but very, very complex (and in its complexity very beautiful too). The “mind” sciences are not going to go anywhere if they continue to think within the little boxes of XIX century scientific disciplines… whatever happened to the interdisciplinary revolution?
Oh! And next time you “see someone with severe psychosis, disheveled, unable to speak, unable to take care of their basic human needs” please try to find out what medications he or she is on and for how long he or she has been on it; that might have something to do with it… (did you get around to reading “Anatomy of an Epidemic” yet?)
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Hey Morias – Always a pleasure… Thank you so much for your very reasonable and substantive reply. I was thinking about going underground and observing from afar again. I realize I have to be meticulously careful about what I say here as it isn’t my intention to anger people or hurt feelings.
I follow what you are saying and it is quite clever. I would still say if the twins with temperament “s” are ending up with “S”, schizophrenia at a higher rate than the rest of the adoptees then it indicates heritable factors influence the development of schizophrenia. In other words, heritable factors influences the form of the dysfunction in the setting of the environmental stressor. In your model the causality is 100% environmental regardless of this and it is internally consistent. I guess my main thought is that it strikes me as quite a bit of mental gymnastics to put the causality 100% in the environment. I’ve been trying to avoid the word “cause” because, as you know, I don’t think the causality is 100% genetic or 100% environmental. So, my personal opinion is that the model you propose isn’t likely, but it’s definitely possible and I appreciate that it is at least in theory falsifiable.
As you know there isn’t going to be a study in the past or future that is perfect and indisputable. My interpretation of the data would just be that if the if the separated twins are 50% concordant and only 10% of the adopted non-twins develop the disorder it really seems a striking result to me. Sounds like maybe you agree, but just put the causality regardless entirely in the environment and the genetic background just influences the form the dysfunction will take. I will have to look more into the size of some of the more recent twin studies. I know there are some really large and detailed data sets from Sweden which people have been looking at recently. It might be that schizophrenia isn’t the best set of phenotypes to look at in addressing the question. There is one recent large study of twins (hundreds of twin pairs) reared apart that looked at the heritability of regular tobacco use which is interesting (Arch Gen Psychiatry. 2000 Sep;57(9):886-92). http://www.ncbi.nlm.nih.gov/pubmed/10986552.
I do think the issue is of more than simply academic interest, but I think we will have to save that discussion for another thread. Good discussion.
Also: I think that psychosis of the severe form I described has been around a lot longer than antipsychotics. So I understand that you have a concern that medication in the long run could worsen psychosis, but psychosis is also still a real thing that can be profoundly disabling. Anyway, I brought the example to bear on a point I was trying to make about whether the person could be considered sick or not.
Haven’t read AoE yet… Don’t tar and feather me, I still plan to read the bible. 😉
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All that elaboration so that we can agree to,
– Psychiatry’s invented diseases ARE NOT genetic diseases such as Down Syndrome is.
– People’s behavior is a combination of their genes (“predisposition” of their biology if you will), their environment and I would add (from a Christian perspective), their soul/free will.
If we agree on this, then we should all agree that all coercive psychiatry should be abolished. Why do we punish DSM-5 behaviors but not others like homosexuality that have exactly the same origin (the same type of studies with self described homosexuals have been performed on identical twins with similar results as those who performed on so called “schizophrenia”). What makes behavior described as “schizophrenic” pathological but, in this day and age, “homosexuality” non pathological?
We already have the criminal justice system to deal with those who misbehaved in ways agreed upon by society via the democratic process. Note that I say ALL, not “all except case a, b, c, d, etc”. ALL.
This is perfectly consistent with dealing appropriately with disabilities due to “real” diseases such as Down Syndrome, Alzheimer’s, etc.
Psychiatry is not a scientific endeavor, is a pseudo scientific scam that is used for the purposes of social control by governments worldwide with the coordination of psychiatrists and Big Pharma companies are are too willing to comply with the scam while they enrich themselves in the process.
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I worry about all misbehaviour being dealt with by the criminal justice system, I’m thinking of women I’ve met in High Secure psych services convicted of crimes where no one was hurt but property was damaged i.e. arson. Psych forensic services are vile, really bad, really scary terrible places, but equally prison wouldn’t be appropriate neither. What I learnt from listening to those women was that there was typically never any intention to hurt anyone, but it was sadly the only way they could ask for help, and they’d had the most awful lives, filled with abuse, trauma and neglect. I know it’s an offense to start a fire but I just wouldn’t want to see those women in prison for years as much as I would not want to see them in high secure psychiatric forensic services.
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Have people ever considered short term holding/containment WITHOUT forced treatment?
I ask because of knowledge of a couple of rare psych’s who would do that with people at risk of serious harm to put a ‘pause’ into things.
I’d like to know what you think of that.
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You must have misunderstood me.
When I say “the criminal system” what I mean is to have the same rights as criminal defendants.
Right now in the US we have the double standard that if you are labeled with one those DSM fictitious “diseases” you can be locked in under the “dangerousness” standard providing so called “clear and convincing evidence”, which is a standard in legal procedure that is weaker than “beyond reasonable doubt”, the standard used in criminal proceedings. Also, most judges refer to the opinion of the psychiatrists, so in practice if a psychiatrist says you are dangerous, you are locked in. In criminal proceedings, to be locked in you must be proved dangerous “beyond reasonable doubt” and you have the right to “trial by jury” who has to agree anonymously to locking you in.
What I mean is that if society finds some behavior objectionable, it should object to it via the criminal proceedings, not by giving the DSM shrinks the right to decide, as they did with homosexuality, who deserves to be locked in without those safeguards.
This homosexuality example is very relevant, because it illustrates very well that “reliability” (there is no doubt that homosexuality exists) is not the same as “validity” (the decision as to whether homosexuality was a “mental illness” was a political one because psychiatric diagnosis is scientifically invalid).
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cannotsay2013,
You’ll have to forgive my lack of knowledge about your criminal justice system, I am keen to learn.
So is it the case in the US that a person deemed to be mentally ill can be locked up in prison as opposed to a psych hospital without having been convicted of a crime ‘in case’ they do?
What I worry about are distressed people who have committed a crime being imprisoned when that would be the worst place for them like the women in our high secure psych services I referred to. Hospital isn’t right but neither is prison.
Like you, I don’t want people locked up [anywhere] on the say so of a DSM diagnosis..I don’t have the answers, but there is some psych/criminal justice overlap which isn’t clear cut.
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Hi Faith, I wanted to respond to the catatonia thing briefly and no room above.
You are exactly right, what I’m describing is exactly like neuroleptic malignant syndrome except that it was described long before neuroleptics existed. There is also neuroleptic malignant syndrome a rare but severe side effect of antipsychotics. Fascinating that the disorder and the a medication can both lead to such similar phenomena. You are also right that at least in this extreme form called ‘lethal catatonia’ or ‘malignant catatonia’ it is rare. I was just, as an exercise, trying to think of an example of a psychiatric condition which would be difficult to say was not an illness. I thought this might qualify because of it’s physical findings and potential lethality.
I’m not sure I agree with you that because the reference is from the late 80s it is going to be invalid. I mean it is a reported phenomena, it’s not a reference which posits a mechanism or something that might be out of date. The reports could be false I guess, but we aren’t talking about one report and it seems pretty widely accepted that this is an extreme presentation of schizophrenia.
Anyway, thanks for your civil responses, I’m enjoying the conversation.
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What ScottW is describing as “catatonic schizophrenia” is probably not a psychiatric condition at all (whatever THAT is), but rather a physiological problem or illness, like perhaps encephalitis lethargica.
http://news.bbc.co.uk/2/hi/health/3930727.stm
Robert Whitaker writes that neuroleptics (a.k.a. antipsychotics) can induce “deficits similar to those seen in patients ill with encephalitis lethargica.” Hence the similarity in symptoms between patients suffering with “neuroleptic malignant syndrome” and Scott’s version of “catatonic schizophrenia.”
Susannah Cahalan recently wrote a book, Brain on Fire, about her “month of madness.” Even though she was at one of the best hospitals in the world and had access to some of the best doctors on earth, she was misdiagnosed with mental “illness,” as she had symptoms which looked exactly like “schizophrenia.” What was actually afflicting her was a rare disease, anti NMDA receptor autoimmune encephalitis. Fortunately for Susannah, a neurologist caught it at the catatonic stage that “precedes breathing failure, coma and sometimes death.”
http://www.guardian.co.uk/books/2013/jan/13/susannah-cahalan-brain-fire-interview
There is a network of British psychiatrists (the Critial Psychiatry Network) who favor the abolition of the “schizophrenia” diagnosis because it has no basis in science, it is harmful, and it promotes stigma. I think I’ve seen somebody comment on this site that a diagnosis of “psychosis” is about as useful as a diagnosis of “rash.”
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Here is a link to a really interesting article on catatonia, http://archpsyc.jamanetwork.com/article.aspx?articleid=210437
I don’t think the phenomena of catatonia can be dismissed, at least not entirely, like that given that it is quite common in “psychiatric illness”. The variant I described is called malignant or lethal catatonia. I think you could be right though! and maybe it is something like encephalitis lethargica. I think it’s a good thought.
I’m also glad you brought up NMDA receptor encephalitis as I was just thinking about that. It is a very interesting condition which was only “discovered” about 6 years ago. It was around before that of course, but probably often got labeled as schizophrenia or brief psychotic disorder or catatonia or whatever. Was it a mental illness and now it is not? I think it is still a “mental illness”, just the same as it was before, now we just know something about the physiology.
The thing is that I think you’re really making my point for me. Here we are shaving away at the impenetrable block of “the so called mental illnesses” which are not illnesses and supposedly do not have a physiologic basis. Maybe some catatonia is encephalitis lethargica and maybe some schizophrenia is NMDAR encephalitis. I still say it is a “mental illness” or whatever I’m allowed to call the things that we’re talking about. How much of “mental illness” have we accounted for with these two things? I don’t really know, not a lot obviously.
Then again NMDAR encephalitis has opened the doors to a whole new class of mechanisms that could explain some mental illness. Since that time there have been discoveries of a number of other autoantibodies that cause neurological or psychiatric disease. How much of “so called mental illness” will ultimately be accounted for by this type of mechanism? who knows… maybe it could be 2%, 5%, 10%. We will really won’t know for a while.
Here is my point though: If these things were psychiatric illnesses and now we know something about how they work, how can you be so sure that a physiologic basis won’t eventually be discovered for 25% or 50% or even more of what we are calling “so called mental illness”. Will they no longer be psychiatric illnesses? I say they still are, but if people are uncomfortable with that, fine maybe they can be neurological illnesses now or we can invent a new category of medicine to treat the illnesses that psychiatry treats now because psychiatry is too contentious of a name. It’s a little like doing away with the term schizophrenia which is fine too since we all know that schizophrenia is actually many different disorders (one of which is perhaps NMDAR encephalitis). This is what Tom Insel meant when he said DSM categories lack validity – schizophrenia is not a term that really does much to distinguish meaningful categories of disorders. It just lumps everything together and obscures the fact that there are many versions with different underlying mechanisms.
Anyway, I’m just going to say this again. I just don’t understand how anyone can be so certain that other psychiatric phenomena won’t eventually have a physiological cause identified. I’m not saying they will all be autoimmune encephalitis type disorders, but something, anything. Something you don’t even know about yet. And that doesn’t mean the social environment isn’t going to matter we already know that social influences and trauma are critical, but that could interact with whatever the “disease” mechanism ends up being. Or induce the mechanism directly for that matter.
So I’m not wedded to any of the names really. If, theoretically, I could prove that 50% of psychiatric illnesses had a physiological cause then I could rename them all and take some doctors and train them up in the new treatments for these new disorders and then call them “Mental Neurologists” or something. Sorry, I’m getting a little silly. Time to get some sleep.
Peace 🙂
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Hey Scott,
I am pleased that we are at a place now where we can at least have a discussion. I don’t think I’m making your point for you, but I think we may be closer to sharing some sort of consensual reality. ha ha
More later . . . Gotta run.
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Biology and brain probably is involved with almost everything that goes in our normal mind. I don’t know how the brain/body creates the conscious experience, but every time we even think a mundane thing such as “should I get a coffee”, neurons are certainly part of that process.
I don’t know about mental illness, that seems like a pretty general term and it’s part semantics, etc, if it should be used or not.
However, the thing that psychiatrists currently often say it that, for instance, schizophrenia is currently considered a cell level brain disease which causes atrophy in brain (I took that definition straight from an “official” schizophrenia guide site for patients funded by a pharma company). This is not true. As you said, schizophrenia is an umbrella term and there are many different kinds of patients with that label. Maybe some have some kind of an encephalitis or virus or whatever which causes them visions despite psychological, social, etc, stuff. Maybe this is a brain disease.
However, at the same time there probably is a huge number of people with the same label whose symptoms are caused by social issues, trauma, poverty, lack of sleep, prolonged stress, exploitation, etc. All of these things can change the way brain and body operates and the operation of the brain and body can cause psychotic symptoms. I still wouldn’t call it a brain disease. For instance, if you stay up for four days without sleeping, your brain will probably operate in an abnormal manner, maybe it’s flooding with stress hormones an so on. If you have a trauma, your mind or body may go to a stressed up state regularly from different cues and prolonged stress without rest can “wear out” healthy bodily functions. Etc, etc.
I think there’s a difference here, one is caused by a cellular level pathology and you can’t much help it psychological means, other is a natural response of body/brain/mind to certain conditions. In this sense, often for instance neuroleptics resemble a brain disease much better than schizophrenia. 😉
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Hermes, what a brilliant summary of a very complex topic. I agree with everything you’ve just said here. Especially the bit about neuroleptic “treatment” of a natural response to extraordinarily stressful conditions. Neuroleptic “treatment” can be truly sickening – in both the literal and figurative sense of the word.
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Encephalitis is not a “mental illness.” A psychiatrist is not qualified to treat encephalitis (or stroke or aneurysm, end-stage syphilis, rabies or any other medical condition which may present as a “mental illness”). If a supposed “mental illness” has an actual physiological cause, then it is not a “mental illness” or a “psychiatric illness.” Illnesses with physiological causes should be treated by real doctors or medical specialists, not psychiatrists.
To quote E. Fuller Torrey about the term “mental illness,” he says, “The very term itself is nonsensical, a semantic mistake. The two words cannot go together except metaphorically; you can no more have a mental ‘disease’ than you can have a purple idea or a wise space.” (from Torrey’s seminal work, “The Death of Psychiatry”)
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The Japanese renamed it:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472254/
You’re right in your observation of the British alternative of ‘psychosis’, this is in common usage not only within psychiatry but also outside of it, and within HV activism, this is why descriptive plain English words work better like ‘voice hearer’.
The DX summit is really interesting, I’ll be keen to learn what descriptions people want to use
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The clinical description:
Catatonia F20.2 ICD-10
Catatonic Schizophrenia is dominated by extreme loss of movement of the body parts.
The Catatonic Stupor is a motionless apathetic state in which the patient does not react to external stimuli.
Individuals may be mute, rigid, show “waxy flexibility” in which they maintain positions after being placed in them by someone else for hours. Or, they resist movement in proportion to the force applied by the examiner.The catatonic phenomena may be combined with a dream-like state with vivid hallucinations.
When I was diagnosed as having Schizophrenia in my youth I also had the diagnosis at one point of Catatonia. This is my description from my experience:
Imagine fear and distress so great that your mind and body completely shut down. This is where I went when my voices attacked me.
Imagine a retreat to the core of yourself where you are untouchable. Where you remain till it feels safer to be in the world.
Look at how gracefully a bird glides across a lake, it’s head and upper body almost motionless, yet underneath the stillness, it’s feet vigorously paddle, unseen.
This is Catatonia from the inside. You can see and hear but you can’t cry out or break free. You are encased in an extreme concentration of fear.
I don’t view that experience as illness, I just wanted to share my personal description to contrast the clinical
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I have a problem with this Nuerodiversity malarky.
We all have different brains. For one thing they change as we accumulate new expereinces. I remember a radio programme that said that people who learn a new language produce more brain tissue in the part of the brain responsible for language. When we learn something new nueral connections are made – or that is how I understand it.
So gay people have different brains from straight people, people from the USA have different brains from people in the UK, people who love Mozart have subtle different brains from those that like Queer Core. Not because of anything innate but because brains change as experience accumulates. But I’m not sure how that relates to mental distress or anything else on this website. I’m not aware of any other explanations of, “nuerodiversity.”
What people who talk about nuerodiversity seem to be talking about are the different ways people think and communicate. I can see how people who think and communicate in ways that are not popular or mainstream can find themselves feeling on the outside of society and how this can be distressing. I can also see how being with people who are accepting of minority ways of thinking and communicating can be helpful and reasuring. I can also see how discussing how ones styles of thinking and commuincating that are considered unusual so as to better negotiate a social world that is intolerant would be extremely useful. However I see no reason other than fashion to couch such ideas in terms of nuerodiversity unless there are reputable studies of brain scans to show that they actually exist and have some signficance other than they reflect the way the person has come to make sense of thier world.
I know people who think and communicate in ways than many would consider unusual. Sometimes I put the time in to try to understand them, sometiems I don’t. I also know people who have different political believes than me. Sometimes I try to undersatand them, sometimes I don’t. I even know people who have different musical tastes from me and sometimes I put the time in to try to understand thier tastes and sometimes I just quietly despise them for being tasteless philistiens, because that’s me, a bit of a shallow bitch at times but at others incredibly caring and compassionate.
My position may seem a tad extreme and to some insensitive but I wonder if I am merely exhibiting an insentive and rough interpretation of Sami Timimi’s opinions?
http://us.macmillan.com/themythofautism/SamiTimimi
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I feel a tad uneasy about the term neurodiversity, whilst respecting anyone’s right to choose that description for themselves it’s not one I would use for myself as it sounds too biological. I would feel I’d need a brain scan with rainbow colours or something like that to demonstrably show my difference was neuro. Within the HV movement voice hearing has been referred to as a difference, like being left handed, I accept that description although for myself it doesn’t quite sit right because at times my voices feel quite removed from being left handed and more like no hands or hundreds of hands.
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ScottW. Thanks for reading and responding. You say you understand the point that labels are hurtful (and probably contribute to chronicity of the distress which psychiatry ostensibly seeks to alleviate) but that you, “…have a different view intellectually about whether it is accurate to call these phenomena illnesses or not”.
Your self-proclaimed “intellectual understanding” of someone’s own experience (!!) is called a moral judgment, which has nothing to do with intellect.
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Exactly, such as calling homosexuality a “disease”. It’s basically a moral judgement about people the DSM committee members do not like. Just as they do not like people whose behavior falls into one of the 400 + patterns they call “mental illness”.
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This is a good discussion.
I have been, in between work and home and this and that, reading the comments as they link to my phone and so I was driving home and thinking about Joanna’s comment about catatonia, and really appreciating the privilege of hearing about someone’s life and experience.
“Imagine fear and distress so great that your mind and body completely shut down. This is where I went when my voices attacked me.
Imagine a retreat to the core of yourself where you are untouchable. Where you remain till it feels safer to be in the world.
Look at how gracefully a bird glides across a lake, it’s head and upper body almost motionless, yet underneath the stillness, it’s feet vigorously paddle, unseen.
This is Catatonia from the inside. You can see and hear but you can’t cry out or break free. You are encased in an extreme concentration of fear.”
I really appreciate you offering your informed perspective, Joanna. Thank you.
There have been times I have gotten stuck, with my mind and body disconnected, related to trauma, dissociation. During one particularly bad stretch of sitting and staring, not being able to move or speak even if I willed myself, I wondered, with something that felt like dull terror, if “this is what it feels like to be catatonic.”
I still, especially under duress, sometimes get “stuck” – where it feels like “all systems overload” and I just can’t even speak. I actually don’t think this is particularly extreme human experience. I have seen scenes in movies where a person is just stunned by what is happening to them.
Thank you for talking about your experience, Joanna. It was a really powerful description of that place in the internal world, which I guess is different for everyone.
Which brings me to John’s concern re: the viability of the term neurodiversity as a word that is apt in relation to “mental health” – I could probably write a bunch of words detailing the semantics of it, it’s limitations and its usage, but I don’t actually feel like we necessarily agree. I think you’re spot on in your observation that it is a little like an unnecessary distinction to make if it is used simply to denote that we all have different brains, and of course those brains change over time. On the other hand, it is used by a movement of people who self-identify as having differences that are far removed from neuro-normative range. Neurology isn’t only about genetics and eugenics and brain structure. It is also about the function of certain aspects of our experience known to be (or at least widely accepted as being) related to our brain, such as our sensory systems or our cognitive processing, so it’s not all blood tests and brain scans.
I do think that NIMH research has the potential to be eugenic in its outcomes, if they seek to repress or “cure” certain human ways of being. That is why I’m stoked to see these dialogues. I think that not only is difference not disease, I think that difference is important in regard to the function of our species.
Yeah, Vanessa, it’s really interesting how there is this “I’m really sorry these ideas are hurtful, but…” thing that happens. It’s like the ideas take precedent over our personal, experiential truth and when that truth threatens the ideas, people clamor for the familiarity of what they have been told, even if it really doesn’t make that much sense. Some people have a higher tolerance for operational invalidity and problems with words that don’t well describe or define what they are intended to.
One of the biggest issues I have with “mental illness” (aside from the fact that it is very flawed in meaning)is that there is an inherent value judgment, as illnesses are generally thought to be bad and undesirable.
You know what I don’t get, why some people are so in love with the idea of mental illness? I mean, it would seem like if a person had to choose between the medical model and the alternative model – with all its choices and approaches and potentiall positive outcomes – well, why choose “illness”?
Thanks to you all for helping me to think more about all this…
Here’s a blogpost from Ruminations on Madness re: Neurodiversity, with a little info on the use of the term within the ND movement. http://phenomenologyofmadness.wordpress.com/2012/07/
…as well as a somewhat narrow definition as offered by Syracuse University’s Symposium on Neurodiversity. It is a term of empowerment along the lines of Mad Pride. http://neurodiversitysymposium.wordpress.com/what-is-neurodiversity/
I don’t really care if people appreciate or use or even approve of the term. I find it useful, because it undermines the
idea of pathology in difference and yet does not seek to make us all fine and well, functioning on keel and in sync with whatever the majority of people may be doing or how they may be doing it. Do all differences have a neurological nature? No. That’d be malarkey.
Do some?
I think that is fair.
…but, difference is not disease.
Thanks Scott W. and Morias for offering other perspectives, though advocating for the viability of mental illness as construct of integrity is, at this point, really problematic. Would it be so hard to just appreciate other people’s own personal stories, and to accept that when they have experienced somehing very bad and hurtful due to a particular idea about who they are or what is going on with them and they have spent literally hundreds of hours working out their thinking about what means what and why that it is not respectful to same, “But, wait, it is an illness because…”
People who believe in mental illness miss a lot of good perspectives, a lot of interesting stories.
Thanks again though for commenting, if for no reason other than you did help to prove a few points I was seeking to make.
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Yes faith, you could view it as a ‘prolonged stunning’!
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Exactly. Why would anyone want to see the “problem” as being within them and as something that can never be cured, as opposed to experiences and trauma that impinge on us from society and which cause us extreme distress? Why would anyone choose to see themselvees as “broken” when there are so many other alternative ways of explaining the situation?
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Some people see themselves as broken because of what psychiatry has done to them, and some people do see the social, environmental and trauma, but still locate the problem or the fall out as residing within them. This is one of challenges, to engage people with very different outlooks and accept they may not always move to being unmedicated and/or not using services.
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Some people despite having quite severe and disabling mental phenomena or “psychiatric disorders” don’t have the experience of having a lot of trauma in their lives. They know something is wrong, but they just don’t see it as having been the result of something that happened to them. Some of those people still want a name for what they are experiencing and to try to have an understanding of it.
I’m just pointing out that there are other opinions amongst those who have “so called mental illness”. MIA is not the unanimous voice of everyone who has these types of experiences. Not discounting the feelings and beliefs of those on here… just saying some people feel differently.
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also, I think we need to realize that it isn’t “trauma affected me” or “nothing affected me but my genes / internal stuff”…. trauma suggests something more “acute” (like an attack, or even attacks that go on over a long period of time but are nonetheless recognizable as distinct events) but I think it is very possible to be “traumatized” but in a more global way by our sick culture(s). And that needs to be recognized more.
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Hi Faith, Vanessa and Cannotsay,
I just wanted to say that I’m not proposing to label anyone here or everyone with diverse experiences or extreme mental states as having an illness. I wouldn’t say that about anyone unless they were someone I knew well. I really don’t know where to draw the line on what is a mental illness and what isn’t. It just seemed like I was hearing that no matter what the experience or how disabling it might be it could never be considered as the person being sick.
I don’t agree with that because I think people can have illnesses that affect their mind. Some of them are things like Huntington’s disease which I think most people would agree is a real illness. A person with Huntington’s disease can develop psychosis and really no one understands the mechanism. On the other hand someone can develop psychosis and become catatonic and we know even less about that than we do about Huntington’s disease. Then again some people hear voices and maybe they kind of keep to themselves but are otherwise OK or maybe someone just lives their life in a completely different way than I can understand. I’m perfectly comfortable with saying some of that isn’t illness.
When it comes down to what is and what isn’t it shouldn’t have to do with “normal” it should have to do with suffering and not functioning well. In my opinion somewhere along that continuum there is profound suffering and dysfunction and it is reasonable to say the person is sick. If the person doesn’t want to say they are sick then I guess that’s OK, but in the severe cases they probably still need help (in whatever form) and I think they should get it. I really don’t see that as a moral judgement either, I see it as a compassionate perspective. In my mind if you are sick you need help to get better, it doesn’t mean you are bad or defective. And that goes for me too if I am sick.
I can understand that some people think the label is unproductive because it connotes that something is defective and you’re stuck that way. That isn’t how I think of it, but I get it. I don’t like the idea that there is something defective about me either. That’s a personal thing, how you view the circumstance if you find yourself in it. For a lot of people it probably does help recovery to have an alternative perspective. But many are suffering and their mind is clearly not functioning well. Many are at risk of hurting themselves or other people or dying because they’re not drinking water even. If that person says I’m not sick I’m just fine this way, leave me alone – how can I in good conscience go along with that? I have to say I disagree.
*** I want to propose one final scenario – at the risk of people here calling for my beheading. And it’s a serious question and I really want to know what people think. Let’s say a someone walks into a crowded mall, they are swinging around a large sword and they are dirty, covered in their own feces. People are freaked out and the police are called. The person isn’t aggressive, but they are confused, talking nonsense. They seem frightened and unpredictable. The police believe that people can have illnesses of the mind and so they don’t arrest the person, they take him to the local emergency room which seems like the right thing to do to them. A doctor sees the person and determines that they aren’t on drugs and there is no evidence of “medical” illness except dehydration and malnutrition. The person is trying to leave. What should we as a society do in this situation? ***
I’m curious about two types of answers, 1) practically given the reality of our world as it is and 2) in an ideal world with limitless resources. It’s a fairly extreme case and I know it doesn’t match everyone’s experiences. Still, this type of stuff happens a lot at public hospitals in urban areas and I think it is a reasonable question. It ignores all the distraction about illness, and DSM and mental death industry and biological causes and neurodiversity. It is just a practical question.
It’s a tough call. You can let them go, but they might hurt someone or get beat up or die from exposure. Who knows. You could keep them, but not give them any medication as someone suggested. What if they don’t get better? What’s the humanitarian thing to do? I’m not posing it as an impossible question, I know people have ideas and I’m really curious to hear them.
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Hi Scott – I really do appreciate that you ask questions that represent the thinking of the existing paradigm. It’s important. Not everyone is going to immediately agree, and the goal is not agreeance. The goal is to figure out some perspective that may be closer to a humane truth in our thinking about what it means to be human and what the implications and consequences of our experiences may be.
I am now running late for work, but did want to say thanks for being willing to put forth unpopular (around here) perspectives…because, for many people, those perspectives are reality. My goal is not to have all my friends agree with me, my goal is to constructively figure out what’s going on with all this “mental illness” business in people’s minds…and, toward that end, it is helpful to talk with people who may have different views than those I hold. So, thank you.
More later…really running late now.
Hope that everyone has a good day.
“I really don’t see that as a moral judgement either, I see it as a compassionate perspective. In my mind if you are sick you need help to get better, it doesn’t mean you are bad or defective. And that goes for me too if I am sick.” <- there is a lot to discuss in this, a lot to think about. Thanks again. Report comment
Scot, I posed the question about the validity of short term containment without forced treatment as I have known a couple of psychiatrists who have done that with people at grave risk to put a ‘pause’ into what’s happening for them.
This is incredibly rare because 99.9% of psychiatrists would compel physical treatments. I would like to know what people think about this.
The example you offer – I remember going to a friends house after being alarmed by his answerphone message which clearly indicated him to be at risk, so I raced around and found him in a completely disheveled incoherent state. I put water to his lips and progressed to feeding him. He went from being unable to speak a sentence to conversing with me no problem. This was a man who had been dosed up at maximum “therapeutic dosages” of a depot injection AND oral ‘antipsychotics’ for 12 years who went cold turkey and got off the lot which was hellishly difficult but he did it and never looked back.
He told me that he realised that most of the times he had been sectioned [committed] he had been in that state. So he been subjected to all of that for want of food and drink. I could see how he would have appeared “sectionable” to others.
Now in terms of ‘getting better’ beyond hydration/nutrition he would in no way fit any psychiatric definition of ‘better’. He lives with enduring difficulties, he isn’t ‘recovered’, he wouldn’t view things in terms of ‘recovery’ anyhow, but he chooses to live with his differences unmedicated and I fully support that.
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“validity of short term containment without forced treatment as I have known a couple of psychiatrists who have done that with people at grave risk to put a ‘pause’ into what’s happening for them.
This is incredibly rare because 99.9% of psychiatrists would compel physical treatments. I would like to know what people think about this.”
I want to talk about this. Must go to work. Thank you for bringing this back up, Joanna!
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This reminds me of a situation I witnessed as a chaplain in a medical hospital. A middle aged woman who’d been married for 30 years was admitted to one of my units. I was called to see her because she was causing numerous problems for the staff and had to be constantly watched. She’d set fire to the contents of her trash can, run up and down the hall screaming, cursing like a sailor with language that curled your toenails, jumped over the wall into the nurses’ station, you name it and she’d done it. She took one look at her husband of 30 years and claimed that she’d never seen the man in her entire life and that he looked like a pervert to her. The nurses called the admitting doctor, suggesting that she be transferred to the psych unit. The doctor came to the unit, spoke with the woman for two minutes, and stated that she was not going anywhere, especially not to the psych unit. He then asked for a large hypodermic full of glucose. He predicted that the woman would be perfectly fine in a matter of five minustes after receiving the shot. The nurses were extremely dubious but had to eat crow when things turned out exactly as the doctor predicted. She was having terrible problems with her blood glucose levels, which had sent her into behavior that looked like “mental illness.” It proved to me then and there that we are much too quick to jump to unfounded conclusions and assumptions concerning peoples’ behavior, especially when it makes us uncomfortable or upset.
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Stephen,
Thank you!
Of *course* there can be underlying physical causes for what shrinks call “psychosis”…
From the British Medical Journal –
Best Practice Assessment of Psychosis –
http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/
These conditions, “altered states of consciousness”, whatever term(s) we have for them can have multiple root causes(s)…
They are not *always* linked to trauma!
Duane
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Scott, I stand by General’s Patton quote “God deliver us from our friends, we can handle the enemy” :-). The idea that somebody should be forcibly “helped” because some shrink says so illustrates the type of totalitarian attitude that pervades psychiatry. 40 years ago, gays were forcibly “helped”. We already have the criminal system to “help” to go to jail those who misbehave in ways determined by the democratic process with the “beyond reasonable doubt” and trial by jury of peers safeguards. Everything else is social control no matter how you spin, twist and try to “nuance” your arguments.
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Cannotsay, I take it then that you would let the person I described walk out the door?
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This is not a very hard question. Either the person was committing a crime -and that would depend on the jurisdiction where that person was doing that- (thus, there was probable cause for his/her arrest, and then that person is protected by the laws that protect criminal defendants) or the person was not committing any crime whatsoever and should be let go. Period, end of the story.
What you propose is, under the excuse of “helping”, that some shrink locks in that person indefinitely, regardless of whether that person had committed any crime whatsoever, forcibly drugs that person with poisonous drugs and labels that person “crazy” for the rest of his/her life.
Having been at the receiving end of involuntary commitment/drugging, I take the “treat me as criminal defendant” approach anytime. Since I had not committed any crime, I would have been spared of the most humiliating and stigmatizing experience of my life.
So, I repeat, I stand by General’s Patton quote “God deliver us from our friends, we can handle the enemy”. I can handle being treated as criminal defendant; it is very hard to handle one of these “helping zealots” :D.
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I wouldn’t want to see anyone indefinitely locked up and drugged, but the memory of those women simply doesn’t fit the committed a crime or not scenario.
Yes technically they have committed a crime, but it’s almost like the difference between premeditated murder and self-defence.
For them starting a fire in a building where no one was inside was their ‘self-defence’ against a world where sometimes many people had committed violent crimes against them. Crimes such as arson can carry heavy sentences and distressed people don’t have a good time in jail.
They do need help, not psychiatric, and not in the name of a DSM diagnosis but as hurt traumatised people. I don’t have the answers but it’s one of many questions which don’t easily fit into a post psychiatric world where everyone is totally ‘responsible’ all of the time. Our prisons are filled with people who shouldn’t be there because they are distressed and our high secure hospitals have contained some women who have never committed any offence [they are supposed to be for people who represent a serious risk to others]. I don’t even think they should be in a high secure hospital, prison yes. What shocked me more than anything, seeing a few women in high secure hospitals for no other reason than local services couldn’t cope with their self-harm. Forensic psych services and prisons are a shade of grey when it comes to those who have committed crimes but are clearly very distressed. Do they need special pleading – yes. Do you need some help – yes. So what help do we offer which is isn’t being drugged up in hospital or drugged up in prison?
A post psychiatric world would have to consider these issues.
None of us know with certainty if we *might* be in a position of being distressed and end up committing a crime – I remember my voices telling me certain things about the pet shop [containing animals which distress me], that they were going to escape and hurt me, I was close to going into that shop with petrol and a match, if I had I wouldn’t be here now. I had friends to talk to who helped stop me, but what if I hadn’t? Would you want to see me in prison anymore than drugged up in hospital?
Young people with ‘anorexia’ is another tricky area. Imagine you’ve got a 4 stone 15 yr old daughter who is at deaths door, do you let her die or if there’s no amount of persuading, do you allow an IV or NG to be put in against her wishes for the shortest possible time?
Now I detest the EDU regimes with a vengeance, I’ve seen what long term iatrogenic damage they do, there is no justification for years of relentless forced feeding using behavioural techniques [reward & punishment], I’ve seen some young women self-harm in response to that because when in an environment where you cannot express dissent it can sometimes be the sanest act. But could I watch a young person die in the name of their personal freedom, no I couldn’t, but I wouldn’t go beyond literally saving life and wouldn’t push anyone through those refeeding regimes over and over again.
We’ve had a couple of high profile cases of older women taking their cases to the high court to stop forced feeding because they’ve had enough of ‘re-feeding’ and enough of their eating distress and want palliative care – I support them in doing so, as I support assisted dying for those who are terminally ill or suffering from a degenerative condition, I believe in the work of Dignitas – but they won’t see anyone on ‘psychiatric’ grounds.
As for Scotts example, I’d offer some time to get physically well and have some support – non-medical sanctuary [like Soteria] but if he wanted to leave still experiencing differences in perception I wouldn’t stop him.
Self-harm and suicide, really muddies the waters because if you’re admitted to Emergency after an OD you will be treated whether you want it or not but this isn’t fixed. There was case here of a women who drank antifreeze and went to hospital with an advance directive and her wishes were respected and she died.
Why didn’t they forcibly treat her is a question many asked – others argued because of her diagnosis – ‘PD’. There are indications that people assigned that diagnosis are less likely to be saved than someone with a diagnosis of ‘psychosis’, because of their difference in perceived value.
Self-harm without stated suicidal intent no matter how serious is readily ignored here, you can attend hospital repeatedly and go through a cursory psych assessment [5-10 mins] and that’s it you can go. A friend self-harmed over many months each week until she died, staff have given up on her.
Taking away legislation to detain people and forcibly treat them doesn’t remove all the uncomfortable questions, they would still be there.
We could take the position that anyone is free to kill themselves or others and take the consequences of that, but what if any were preventable with some assistance?
I’ve known someone who was sectioned [committed] for a short period by a rare and deeply committed psychiatrist with no forced treatment. He did that to put a ‘pause’ into what was happening for her. I know he’s not common, but if he hadn’t done that I doubt she’d be here, I feel certain she would have died by suicide. He forced no treatment but she was away from her home for a short period where accessibility would have been easier.
Now the another side of this is when enlightened practitioners have worked with people self-harming [without suicidal intent] as voluntary patients or in their homes where self-harm hasn’t been prevented but harm-minimisation approaches have been used [even with dangerous methods]. A psychologist had to teach support workers how to cut down a young woman’s ligatures and persuaded her to use a less dangerous ligature [stretchy socks]. Harm-minimisations has even been used with children as young as 8. HM is highly controversial for some survivors and staff alike but it is something I support and have taught to peers and health workers.
I don’t have the answers, but I don’t believe in forced treatment other than in very time limited specific scenarios like a young person dying of starvation, but I think there may be a case for time limited containment without forced treatment to prevent serious risk [death]. My views may be contradictory and may not make sense, but they’re not fixed, I’m open to anything..I’m open to evolving and changing.
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So we as a society could do it the way you suggest. Despite a reasonable concern that the person may harm someone else, die because of not taking care of themselves or at least continue to lead a miserable existence of suffering – We can say just let them be until they break the law.
I really disagree that it is “not a very hard question” though. I think it is an incredibly challenging question. For one thing that guy in the mall with the sword is going to get arrested. If there is no other option, law enforcement will act and they will take him to jail. The jail has their own psychiatric evaluation system, but let’s say that doesn’t exist. He hasn’t committed a crime yet (though I’m sure the police can come up with a crime – weapon in public, resisting arrest, threatening in public). Anyway, it’s not a “real crime” and he would eventually be released from jail.
But, I would also argue that there is a good chance he ends up back in the mall with the sword or somewhere else. Then the whole thing starts over again which sucks. He also then might eventually commit an actual crime. Hopefully he doesn’t chop someone with the sword, but he could. Probably more likely he trespasses or assaults someone or breaks something and then he really is going to be in trouble…
Now, he could spontaneously get better or maybe he has a friend who nurses him and he recovers somewhat. But I don’t think it is the most likely scenario. He may stay that way chronically or he could get attacked because he is so vulnerable. Maybe he lives a miserable life for the next 5 years and one day gets hit by a bus and dies.
You can most definitely argue that if he doesn’t want help, leave him alone. You can say that there is no higher principle than human autonomy. But, you really have to be OK with the possibilities I described. If you are, then that’s fine I understand where you’re coming from. I just don’t think that’s an easy or obvious choice at all.
Now, you say that I “propose” that:
“some shrink locks in that person indefinitely, regardless of whether that person had committed any crime whatsoever, forcibly drugs that person with poisonous drugs and labels that person “crazy” for the rest of his/her life.”
But I didn’t really propose that. I understand you might have been assuming that is what I propose or you’re just saying that is what people propose on the extreme opposite end of the spectrum from you. I’m not trying to be snarky, I’m asking please not to typecast me to everyone unfairly.
I also understand what I’m hearing from most people, which is what they don’t want. They don’t want the person ending up in the hands of evil psychiatrists. They don’t want them forcibly drugged with poison. They don’t want them labeled or locked away for the rest of their lives. Of course I get that.
There are a lot of other options and I have heard a few ideas. I’m just trying to figure out from a practical perspective what people think should happen. I do think there has to be some intervention though. I understand that forcing anything is a really concerning concept and humiliating and stigmatizing people is horrible. But, I don’t think a compassionate society allows people to suffer like that. I don’t want to force anyone to do anything, but at some point, for people’s safety and out of human compassion I think you do have to do something. And I think most people outside of this site think so too. A lot of people with “so called mental illnesses” already end up in prison. If there isn’t an alternative, then how is that any different than criminalizing “mental illness”?
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PLEASE NOTE: The reply I just left which starts, “So we as a society could do it the way you suggest.” IS NOT a direct reply to Joanna, it was meant as a direct reply to Cannotsay, though it appears in a confusing spot.
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But it’s not clear cut all of the time – I don’t want to see severely traumatised women go to high secure hospitals or prisons for low level arson where no one was hurt, whether the distress they experienced which led them to that place is described by DSM or Formulation
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[[personal attacks removed]]
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I see identifying the so called mentally ill as either covered with feces per Scott or slinging feces per Sally Satel both a personal and global attack on those given bogus DSM stigmas to degrade and dehumanize them so much that society will be more than happy to have such subhumans forcefully drugged, committed and robbed of all human, civil, democratic rights in the guise of mental health.
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Here is a great MIA article on Fuller Torrey & Sally Satel, forced drugging/commitment advocate twins. You can watch the video and see how Sally Satel like Scott here defends what she euphemistically calls “benign paternalism” or forced drugging, commitment and loss of all human rights in the guise of mental health.
Not only do we have to put up with the out and out lies about bogus DSM stigmas being genetic or brain chemical imbalances and the supposed efficacy and safety of useless, lethal forced “treatments,” but we have to hear the lies that those falsely accused of being “mentally ill” are inclined to be either covered with feces or slinging feces in public!!!???
I have been around for quite some time and I have NEVER EVER seen anyone covered with or slinging feces in public or elsewhere no matter how weird they looked or acted!!
But, anything goes in the world of the psychiatry/neurology/BIG PHARMA cartel to keep forcing those bogus stigmas, lethal drugs and other torture treatments on those they make appear subhuman to incite the public to think these dangerous crazies need to be locked up and forcibly drugged and controlled! Ironically, the most crazy behavior done by many people was because they were on psychiatric drugs per Dr. Peter Breggin, Dr. David Healy and many others.
See video for Sally Satel’s throwing feces statement when describing the so called “mentally ill” while pushing her fascist “benign paternalism.”
http://www.madinamerica.com/2012/07/conquering-benign-paternalism/
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This is a trick question. No “mentally ill” person will be seen covered with feces or wielding a sword in a public place, etc.
Trick answer: Even if such an outrageous event could occur, the police would not be inclined to let the person go free.
I believe there are laws against certain lewd or gross behavior that have nothing to do with “mental illness,” but let’s make it as gross, vile and disgusting as possible to make sure everyone gets it that those stigmatized as “mentally ill” are subhuman, disgusting, vile, vermin and all the other types of language used to incite people to allow or advocate for such people to be robbed of all human, civil rights and forcibly committed and tortured with lethal drugs, abuse and false accusations. This has been typical of all ethnic cleansings, the Holocaust, racism, sexism and other ism’s to promote and justify treating others as inferiors and less than human.
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Hi Donna. I believe a careful reading of what I have already said will answer most of the questions that you raise in regards to my opinion. You’re mischaracterizing me though because I’ve said that I do not think of anyone in this state is vile or subhuman. I’ve also I think over and over pointed out that I did not advocate to “rob people of all human rights” or “torture with lethal drugs”.
I said that the example I gave is relatively extreme, but I don’t agree that it is impossible. I’ve personally seen people in that state many times and not just because of “mental illness” but also because of deliirium or traumatic brain injury or dementia, etc. These types of things do happen with some regularity and there have to be practical solutions. I definitely understand that the vast majority of people labeled with mental illness don’t look like this, but it does happen. When it does I do see it as evidence that the person may be gravely disabled and potentially viewed as needing help. Just because I say that does not mean that I advocate to rob them of all human dignity, forcibly poison them or lock them up forever. I’m not going to get into another debate about this, so let’s just agree to disagree about what I mean or advocate for.
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[[personal attacks removed]]
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Scott,
I will never agree with you on this topic or many others including to agree to disagree.
Whether you are a neurologist or psychiatrist or in another profession is pretty meaningless now. Dr. Fred Baughman, Neurologist, author of ADHD FRAUD and many excellent articles on the web has lamented that his own field has sold out to the biopsychiatry/BIG PHARMA cartel. He exposes bogus DSM stigmas including ADHD and bipolar as 100% fraud and the worst medical crimes ever perpetrated against humanity.
Yes, you did use the most extreme, imaginary example to deliberately violate the so called mentally ill as do many like Sally Satel and Fuller Torrey who admit they even advise forced treatment advocates to turn over furniture when calling the police to falsely accuse their victims of violence, another ploy to rob people in emotional distress of all human rights by vilifying them as insane dangerous villains deserving the human rights abuses they advocate to pander to BIG PHARMA and the power elite they really serve.
I have seen many people with Alzheimer’s and similar mindless states and NEVER EVER saw them covered in feces since they are in diapers. Further, most decent, modest people do not wish to discuss publicly the less than noble aspects of all of humanity. But, anything goes when it comes to making the so called “mentally ill” appear as deranged and disgusting as possible, which you did quite well. You are well trained because the feces slinging and covering appear as the ultimate in human depravity to accomplish this goal whether you claim to intend that or not.
Anyway, based on my many years of research about bogus psychiatry, I believe that most if not all of your posts push the current biomedical DSM model with all of its BIG PHARMA ad ploys to maintain the status quo even though Dr. Thomas Insel of the NIMH has admitted the DSM is junk science with no validity whatsoever. Of course, anyone who has had the misfortune to encounter biopsychiatry when seeking help for typical life problems learned about this dangerous fraud the hard way as warned by Dr. Peter Breggin in his great books, TOXIC PSYCHIATRY and YOUR DRUG MAY BE YOUR PROBLEM with Robert Whitaker finding the same evidence and more in MAD IN AMERICA and ANATOMY OF AN EPIDEMIC.
You claim there must be some biomedical cause underneath these bogus stigmas, but fail to admit or realize that many suffering typical human distress and/or trauma from many forms of abuse were subjected to deliberate updiagnosing of the bipolar fraud fad to exploit the victims’ health insurance and make them permanent disabled patients on a cocktail of lethal drugs while totally refusing to acknowledge the abuse/bullying or real problem as dictated by the DSM only focusing on outer symptoms while ignoring all social/environmental stressors to blame and stigmatize the victims to push the latest lethal drugs on patent. See Dr. David Healy’s great book on the bipolar fraud fad, MANIA.
Finally, I don’t think there is ever any excuse whatsoever to portray ANY of the so called mentally ill as covered with or slinging feces when the bulk of people so stigmatized and vilified are perfectly normal people victimized by the latest bipolar, ADHD and other fad frauds when suffering trauma or extreme stress from domestic, school, work, community and other violence, bullying, mobbing and abuse per Dr. Carol Warshaw, Dr. Judith Herman, Dr. Frank Ochberg, Dr. Peter Breggin and countless others.
Psychiatry/neurology/medicine basically serve the power elite to exert illegal social control on anyone challenging these powerful people who wish to maintain the status quo of their stealing a grossly huge unfair share of the world’s resources while exploiting and enslaving the majority in the guise of medicine and mental health. Dr. Joanna Montcrieff and many of her colleagues expose this travesty in the books, De-medicalizing Misery and articles like Psychiatric Imperialism you can find online.
So, despite your claims to the contrary, you used the vile feces defense to justify your forcing your unwanted treatment on one and all. “Power corrupts and absolute power corrupts absolutely.
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Donna,
Who put the diapers on the people with Alzheimer’s you’ve seen NOT covered in feces? I’d be willing to bet they didn’t diaper themselves. If they were wandering the streets or left alone, you can bet they would have trouble caring for their basic human needs.
Those individuals because of their illness were unable to care for themselves and thus society or their families were forced to take away some of their autonomy out of compassion. You are providing an example of the same approach I would advocate for anyone who for ANY reason reached this degree of inability to care for themselves. I DO NOT suggest that anyone in that state is disgusting, depraved or deranged as you rigidly insist, I do not think that and it is not the point. I do think that it suggests a profound disability, easily recognized by anyone. I do think that by even the loosest standards of human decency and compassion one is obligated to do something to help that person.
As to whether this happens or not? Ask a social worker if you don’t trust anyone in medicine. It is convenient to ignore the fact that people suffering from extreme mental experiences can SOMETIMES reach an extreme inability to care for themselves. You suggest I should not bring this up out of decency, but how does one decently or compassionately ignore it? Most people with psychiatry related problems won’t have this issue, thank god. Those that do are likely unable to voice their opinions on this blog. However, they do deserve to be incorporated into any model of “so called mental illness” and what to do about it. Whatever you think about psychiatry, this issue must be addressed by any alternative model. It may feel good to focus ONLY on denouncing psychiatry, but it is not particularly constructive.
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Scott,
You may be making the false assumption that a psychiatric hospital is a safe place. They are not.
You asked for alternative options. If you go to the ‘Resources’ tab at the top of this site, you’ll find some.
Obviously, there are not enough facilities, such as peer-run respites, Soterias, etc. But a person would be much better off staying in a safe place of some kind – out on a farm or ranch; in the home of a friend or relative with some support on place until the psychosis passes.
If psychiatric hospitals addressed underlying medical conditions, root causes of psychosis; if they offered safety – physically and emotionally, you might have an argument, but they do nothing of the sort.
Jim Gottstein, Attorney makes some good arguments against the use of forced treatments. –
http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1059&context=alr
Duane
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From Gottstein’s article:
The United States Supreme Court has unequivocally declared involuntary commitment a “massive curtailment of liberty” requiring due process protection.94 While the government does not have to prove its case beyond a reasonable doubt, it does have to prove it with more than a preponderance of the evidence.95 Further, involuntary commitments are constitutional only when: “(1) ‘the confinement takes place pursuant to proper procedures and evidentiary standards;’ (2) there is a finding of ‘dangerousness either to one’s self or to others;’ and (3) proof of
dangerousness is ‘coupled . . . with the proof of some additional factor,
such as a “mental illness” or “mental abnormality.’’”96
The Court has suggested that the inability to take care of oneself cannot
be considered a sufficient finding of dangerousness, unless survival is at
stake: “a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”97 In addition, “although never specifically endorsed by the [United States] Supreme Court in a case involving persons with mental
disabilities,” it also seems people may not constitutionally be involuntarily
committed if there is a less restrictive alternative.
And from C.S. Lewis:
“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”
Be well,
Duane
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Hi Duane,
I agree that there should be a high threshold for sure. dangerousness to others, dangerousness to self or inability to care for oneself to the point where life and limb are at risk seem reasonable to me. I also of course believe that due process, evidentiary standards and legal rights should be very carefully respected and followed without exception.
I’m not really making the argument for specific places to put people or interventions here. Just trying to make the point that I think at some point it becomes reasonable to intervene. People keep trying to say that I’m therefore advocating for all sorts of horrible evils (I’m not saying that you are). I’m not saying that the current state of matters is ideal or correct at all – I’m not advocating for that here. Though some will still say that I am no matter what I say.
I just think it is an important point that we are not just talking about people who are depressed or manic or have psychosis and are acting unusually. These sometimes are not benign states and people can hurt others or themselves. I’m not trying to say there is no alternative either and I’m learning about those alternatives here.
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Scott,
Thank you for clarifying your position. We’re all learning.
Duane
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Hi Faith, Hi ScottW,
First of all, Faith, to clarify, I agree with you, not with ScottW (no offence, Scott). I don’t know if my arguments sometimes sound like I’m rooting for “the other camp”, but unless I misunderstand myself (and I don’t think I do) I am definitely not.
What I am saying is that if you are going to call “schizophrenia” (and I don’t think that word means anything, but it’s shorter than discussing separate symptoms which is what we should really be doing), if you are going to call “schizophrenia” a “mental illness” then everybody in the world without exception is “mentally ill”. There is no essential difference between a schizophrenic and a non-schizophrenic – the difference is one of quantity, not of quality, and nobody gets a completely free ride. Do I believe in “mental illness”? No, not unless you are happy calling something that is present in every single person’s personal make-up an “illness”.
Perhaps another analogy might be helpful to explain what I mean:
If you mix yellow and blue you get green, if you mix yellow and red you get orange, right? If you have a gradation from red to blue (a long row of boxes with different mixes of red and blue, with pure red at one end and pure blue at the other) and you mix yellow into that gradation you’ll get a different gradation from orange to green. A given amount of yellow will change the whole red-blue gradation. It won’t change one box more than another; the change throughout all the boxes will be uniform. If you add more yellow the whole gradation will change more, if you add less yellow it will change less.
Now, say yellow is “trauma” and the red-blue gradation represents all possible human phenotypes (expressed genomes). If you apply the same amount of trauma you’ll get the same amount of change in all different phenotypes, but of course this change will look different for each phenotype; even though the yellow is the same, each box has a different colour to begin with, so obviously each resultant colour will also be different. But the rate of change will be the same. Given the same amount of trauma, the magnitude of effect on each phenotype will be the same. Since the amount of trauma (yellow) depends on the environment and each individual’s environment is in some respects different from any other individual’s, no two individuals actually receive the exact same amount of trauma (of yellow) so their actual rates of change are different, but this is because the input of trauma is different, not because they respond differently to the same input.
Now imagine an observer -“society”- labels the shades that are more obviously green as “mental illnesses”; a particular cluster of shades of green is labelled “schizophrenia”. There is however no reason to say that the original shades of blue had a “propensity” or “vulnerability” for “mental illness”. For this to be true, blue would have to change more than red when it is mixed with the same amount of yellow; the rate of change would have to be different, and it isn’t (or that’s what I think and how I interpret adoption studies).
I know Scott will be thinking, OK, maybe, but green would still be a “disease” because it makes the “green people” less able to cope with their environment; it decreases their capacity to adapt and “survive” whereas orange people do fine, so “oranges” are not ill. But what I’m saying is that orange people don’t do fine either, and here is where we have to question a bit what a disease actually is.
A disease is something which lowers survival, yes, but when it comes to “mental illnesses” we have to take into account that the human mind is in constant interaction with the environment and very particularly with the social group, with “society”. In this context survival cannot just mean survival of the individual, but must also mean survival of the group as a group. What I am suggesting is that the disease of the “oranges” who seem to be doing fine is a “social disease”; a disease which affects the survival of their social group rather than their own individual biological survival.
So for example: an “orange” might be a very successful executive of a pharmaceutical company, and the lack of empathy and obsession with personal success which are the result of the “trauma” he’s received in his upbringing does not have a negative impact on his life as far as anyone can see. But this lack of empathy and obsession with personal success makes him cover up the fact that one drug his company manufactures has very bad unreported side-effects and 0 effect on the condition it’s supposed to treat (let’s call this hypothetical drug “Proxac”). What he is doing might no even be illegal and it has no negative effect in his life: his employers love him, he makes more money; life’s good. But in the meantime “Proxac” is causing havoc in his social group, his country, culture, by disabling an increasingly large number of people, putting stress on resources, damaging the economy, etc. His actions are having a detrimental effect on the survival of his group: they are a “social disease”. Like the body is made up of cells, the social body is made up of individuals, and you can (you must) apply the concept of disease to both bodies to get the full picture.
That’s more or less it in a nutshell, although obviously this is a gross oversimplification and there are other fundamental aspects to this I’m not touching on, such as Free Will (yes, it exists). The only other thing I’d mention is that I think we are all exposed to certain amount of trauma, so everyone has a certain amount of “yellow” in them. As you can see, this hypothesis crosses over from science into philosophy and so I’m not sure to what extent it is falsifiable in a strict sense, although certainly parts of it are.
Also, Scott, although I don’t want to go into it in detail I’ll just mention because I think it might interest you that in other comments I have written about psychosis being a defence mechanism, not a symptom of the disease but part of the healing process; much like fever which is part of the body’s immune response to a pathogen and not just a symptom of a “disease”. Of course, just like fever can in extreme cases be harmful in itself and an intervention is needed to stabilize the patient, the same is true of psychosis, but the emphasis is on the fact that this is only justified in extreme cases and, crucially, the intervention must actually stabilize the patient and not just appear to do so while in fact adding wood to the fire, so to speak. In this I’d say that current psychiatric interventions are catastrophic; the only good thing you can say about them is that they are better than a bullet to the head, which is not really something to be proud of. To follow the fever analogy, they are like trying to lower a fever by blood-letting (actually, blood-letting for fever has a sounder scientific rationale).
By the way, in case I cause confusion: the 50%-10% figure in my previous comment was completely made up as a hypothetical example; it does not come from an actual study.
And Faith, I never got around congratulating you for your article, I thought it was very good. But your responses to ScottW are even better; I think it’s good of ScottW to pop up from the underground from time to time.
Thank you ScottW for being the “devil’s advocate” here (and please do read AoE; it’s not the bible, but it condenses a lot of information in a clear format – and don’t forget “The Emperor’s New Drugs” either).
Now I really have to get back to work; might not be able to comment/answer for a while (collective sigh of relief?)
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Thanks, Morias, not just for “agreeing” with me ( 🙂 ) and for liking the essay, but for contributing to this dialogue. I haven’t been able to respond at length to everything that I want to respond to here, due to time constraints, but definitely appreciate what has been brought up.
I have to leave for work in 6 minutes, but want to come back a little later today and address Scott’s questions re: sword bearing in malls, etc. as a sickness.
For now, I am going to leave a copy/paste of a very recent essay by Ronald Pies (whose name has graced these pages in the past)that was just posted on DxSummit http://www.dxsummit.org, which is an endeavor to explore diagnostic integrity – you can learn more about the initiative on the site.
Also, just a quick thought that occurred to me: I wonder if, in many cases, it would not be more appropriate to say that, instead of sick, a person is hurt.
Here’s the Pies essay, which does bring up some interesting aspects of the ontological challenge of determining what is healthy and what is not, from the perspective of someone who is actively involved in shaping the field and practice of psychiatry.
http://dxsummit.org/archives/402
What is “Medicalizing”? What is “Normality”? (Part 2)
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If sick men fared just as well eating and drinking and living exactly as healthy men do…there would be little need for the science [of medicine].—Hippocrates
For the proposition, “Psychiatry is medicalizing normality” to be true, we would need, first; adequate definitions of the terms “medicalizing” and “normality”; and second, convincing evidence that psychiatry is actually doing what the proposition asserts. Yet both elements of “truth” turn out to be complex and problematic. Based on my reading of many posts and articles critical of psychiatry, the term “medicalizing” (or “medicalize”) seems to be used in at least four ways; e.g., to denote
1.the inappropriate labeling of a “normal” condition or “problem of living” as a disease, disorder, or illness;
2.the assertion that a condition or state of affairs requires the services of a nurse or physician;
3.the assertion that a condition is due to disturbed physiology, a “chemical imbalance”, or some other bodily defect; or
4.the assertion that a condition requires a somatic treatment, such as a medication, ECT, etc., or
We are not greatly helped very much by scholars who have attempted a definition of “medicalization”. For example, the medical sociologist, Peter Conrad, in his book, The Medicalization of Society, 2007, writes:
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“Medicalization” describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders. (p. 4)
But this definition is transparently circular; i.e., the definition assumes that a certain class of conditions are “non-medical”, but then—for whatever reason—come to be viewed as “medical.” But the author provides no necessary and sufficient criteria by which these two classes—non-medical and medical—are defined. Moreover, the author states, “I am not interested in adjudicating whether any particular problem is really a medical problem. This is far beyond the scope of my expertise…” Thus, the author acknowledges his inability to adjudicate the ontological validity of the claim “X is really a medical problem” while simultaneously defining “medicalization” in terms of conditions that are “nonmedical!”
That famous critic of psychiatry—the late Dr. Thomas Szasz—highlights the fundamental philosophical problem Conrad’s formulation raises. Szasz writes,
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The concept of medicalization rests on the assumption that some phenomena belong in the domain of medicine and some do not. Accordingly, unless we agree on clearly defined criteria that define membership in the class called “disease” or “medical problem” it is fruitless to debate whether any particular act of medicalization is “valid” or not.”1
While Szasz and I have radically divergent views on “mental illness,” I believe he was entirely correct in this particular claim. Indeed, the problem for those who argue that psychiatry is “medicalizing” normal human conditions is precisely what Szasz anticipates: there has never been, nor is there now, any universal agreement on the “membership” of the class called “disease.” The denotation of the term “disease” has always been in flux, if not in overt dispute, even during the time of Hippocrates. (Szasz would not agree, of course, invoking his probably mistaken interpretation of pathologist Rudolf Virchow). See, e.g., this rather breathtakingly broad definition of ”disease” from the 8th edition of Harrison’s Textbook of Medicine (1977):
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The clinical method has as its object the collection of accurate data concerning all the diseases to which human beings are subject; namely, all conditions that limit life in its powers, enjoyment, and duration.” (bold mine).
The editors go on to say that the physician’s “…primary and traditional objectives are utilitarian—the prevention and cure of disease and the relief of suffering, whether of body or of mind…” (Isselbacher, 1977, p. 1).
Note that in this description of disease, there is no implication that it refers to “bodily” pathology alone—as against the position taken by Szasz and other critics of psychiatry. The emphasis, rather, is on the presence of suffering and incapacity (“…conditions that limit life in its powers…”). It is fascinating to note that in the 14th edition of Harrison’s Principles of Internal Medicine (1997), the unmodified term “disease” does not even appear in the index, nor—so far as I can tell—is the term actually defined in the entire text.
Now, all this leads us to an inescapable conclusion: unless we have a universally recognized “taxon”–a set whose membership is defined by necessary and sufficient criteria–there is no veridical “test” to determine what does or does not lie within the bounds of the category “disease.” Therefore, arguments about psychiatry’s “medicalizing” normality cannot be settled through the empirical methods of science. Such debates are essentially political-rhetorical exercises—or philosophical explorations–not arguments about ontologically verifiable claims. Of course, this doesn’t mean that the debate is unimportant, or without practical implications for our classification of psychiatric “diseases.”
Paradoxically, those who argue that psychiatry “medicalizes” normality but who simultaneously assert that there is no clear demarcation between normality and abnormality effectively refute their own argument. For if there are no absolute, categorical boundaries separating normal from abnormal, then the claim “psychiatry is medicalizing normality” cannot logically be sustained: the argument is devoured by its own premise. That is: if normality has no precise boundary in the realm of disease—including psychiatric disease—then there can be no verifiable medicalization of normality. Neither can there be a veridical demonstration of psychiatry’s alleged diagnostic “imperialism” or its supposed creation of diagnostic “false positives.” Such claims are no more verifiable than a landowner’s complaint that someone has impermissibly planted a tree on his property, when there are no clearly established property lines. (This, however, doesn’t mean that we can’t make reasoned, empirically grounded judgments as to what conditions merit medical evaluation or treatment).
There is also a problem with the claim that psychiatry imposes “the medical model” on “perfectly normal problems of living.” When critics of psychiatry use the term “medical model” in a derisive way, they seem to have in mind what Shah and Mountain (2007) describe as a “…paternalistic, inhumane and reductionist” model of understanding illness. Yet as these authors point out, the “medical model” need not partake of these characteristics. When understood more broadly, the “medical model” may denote simply, “…a process whereby, informed by the best available evidence, doctors advise on, coordinate or deliver interventions for health improvement.”2
In any case, it seems clear that the term “medicalization” has many possible meanings; and that when critics accuse psychiatry of “medicalizing” normality, it is far from clear what they mean. But if “medicalization” is difficult to define, the term “normality” is far more problematic and elusive, if not hopelessly vague. It seems to have an almost limitless range of meanings; e.g., 1. the usual state of affairs in “healthy” or “normal” persons (whatever “healthy” and “normal” mean); 2. any condition or set of conditions that occur with high frequency, or more often than not, in most populations; 3. the inherent qualities and characteristics of most human beings. The philosopher Roger Aboud has highlighted the difficulties in defining “normality”, noting that it may be a mathematical, evaluative, or biological term. Specifically,
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…The biological concept of normality is problematic because it refers to the subjective meaning of ‘healthy’ and may not point to the average, majority, or ideal… Behavioral concepts of normality also suffer from subjective meaning and are contextually problematic related to definitions of average, majority, or ideal.3
In sum, the two “truth elements” in the claim, “Psychiatry is medicalizing normality” are so semantically diverse as to be nearly indecipherable. It is therefore nearly impossible, on an empirical basis, to determine whether psychiatry is actually doing what the proposition asserts.
On a purely numerical basis, it is noteworthy that the DSM-5 does not appreciably increase the number of diagnoses contained in DSM-IV, according to an official release by the American Psychiatric Association (Dec. 1, 2012). Indeed, a well-informed official connected with the DSM-5 informs me that the total number of disorders in DSM-5 will be fewer than contained in DSM-IV. Based on this fact alone, it is hard to make the charge of “medicalizing normality” stick. Moreover, while the DSM-5 does create some new and controversial categories—such as “Disruptive Mood Dysregulation Disorder”—it also turned down several proposed diagnostic entities, such as “Anxious depression”, “Hypersexual disorder”, and “Parental alienation syndrome”—diagnoses which might be interpreted as extending the reach of psychopathology into the realm of “normality.” Similarly, several conditions that had been proposed for inclusion –such as “Attenuated psychosis syndrome” and “Internet use gaming disorder”–were relegated to Section 3 of DSM-5; i.e., conditions that “require further research before their consideration as formal disorders.” Finally, the historical “subtypes” of schizophrenia—paranoid, catatonic, disorganized, etc.—have been eliminated. Overall, these trends do not point to increasing “medicalization” of normality.
That said, I believe that the diagnostic threshold for some DSM disorders continues to be set too low. For example, my colleagues and I believe that the 2-week, minimum duration criterion for diagnosing Major Depressive Disorder (MDD) is often too brief, giving clinicians too little time to judge the patient’s response to a major loss—whether in the context of recent bereavement, job loss, divorce, or any other major life stressor.4 Furthermore, the diagnostic criteria for MDD are so broad as to create an overly-heterogeneous population identified with the illness; for example, a patient with 2 weeks of MDD symptoms is grouped together with patients who have had symptoms for over a year.5
Conclusion
In my view, the term “medicalization” has become a kind of rhetorical Rorschach test: it evokes whatever political, social, or philosophical position the listener happens to hold or wants to advocate. It is not a scientific term, or one that can be defined according to widely accepted, empirically-derived principles. Futhermore, to the extent the term “medicalization” can be defined, it is by no means clear that physicians alone bear responsibility for the phenomenon. In this respect, Conrad and I are in agreement. He writes,
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Many of the earliest studies assumed that physicians were the key to understanding medicalization. Illich (1976) used the catchy but misleading phrase “medical imperialism.” It soon became clear, however, that medicalization was more complicated than the annexation of new problems by doctors and the medical profession. In cases like alcoholism, medicalization was primarily accomplished by a social movement. (Alchololics Anonymous)…(The Medicalization of Society, p. 6)
Furthermore, while it is arguably the case that many challenging aspects of the human condition lie outside the purview of medical diagnosis and treatment—everyday sadness or fleeting anxiety, for example—there is also a “flip-side” to the claim that too many conditions are being medicalized. This is nicely expressed by Vikki Stefans, MD, Associate Professor of Pediatrics and Associate Professor of Physical Medicine and Rehabilitation, at the University of Arkansas for Medical Sciences:
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… a person is labeled mean and hateful when they are really terribly depressed and irritable…or…a child is labeled lazy, considered the class clown, or seen as an academic problem–maybe even suspended or put in special education–when they have undiagnosed specific learning disability or [ADHD]…A child returning to school after a concussion or brain injury still has a good chance of being labeled lazy or uncooperative when they can’t perform at their previous level. Kids with spina bifida or [cerebral palsy] even have parents who think they are lazy for not maintaining their posture or turning a foot in or out because “they can do it when they want to.” And how about “she’s just a little shy” being applied to a case of elective mutism that is totally limiting and impairing a person’s life? Sometimes, people want to normalize pathology, too! (personal communication 4/29/13, and Psychiatric Times)
There may, indeed, be “good and bad” forms of medicalizing, as Erik Parens, a senior research scholar at The Hastings Center, has argued. For example, applying the medical model to alcohol addiction might be an example of “good” medicalizing; whereas applying it, say, to the feelings of sadness one experiences upon the break-up of an intimate relationship might be considered a “bad” form of medicalizing. In any case, as Parens rightly observes,
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…the idea of medicalization depends upon the notion that medicine has ‘proper’ goals, which are visible to those with knowledge of the essence of medicine…[but] one needs a narrow conception of those goals to get traction for the medicalization critique. Without a narrow conception, one can’t restrict the range of the targets that medicine ‘properly’ aims at. 6
And if, as I believe, the broad and overarching goal of medicine and psychiatry is the relief of certain forms of suffering and incapacity, it would seem that the range of “targets” for medical intervention is wide, indeed. While the term “medicalizing” may be useful in calling our attention to trends in medical diagnosis, it greatly oversimplifies the realities of medical care and human suffering.
Acknowledgments
My thanks to Eric Parens PhD, and to Vikki Stefans, MD, for their collegial assistance with aspects of this essay.
References
1.Szasz TS: The Medicalization of Everyday Life: Selected Essays, Syracuse University Press, 2007p. xiii
2.Shah P, Mountain D: The medical model is dead – long live the medical model. The British Journal of Psychiatry (2007) 191: 375-377 http://bjp.rcpsych.org/content/191/5/375.full
3.Aboud R: Wachbroit’s “Normality and the Significance of Difference.” September 18, 2008. Accessed at: http://driftingconsciousness.blogspot.com/2008/09/wachbroits-normality-and-significance.html
4.Lamb K, Pies R, Zisook S.The Bereavement Exclusion for the Diagnosis of Major Depression: To be, or not to be.Psychiatry (Edgmont). 2010 Jul: 7(7):19-25.
5.Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar Disord 2008: 10: 957–968
6.Parens E: On good and bad forms of medicalization. Bioethics. 2013 Jan;27(1):28-35
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I knew there was a reason why I found this essay horrific! It’s good old Dr. Pies defending the indefensible!
The major reason for such a debate about medicalizing normality is because individual psychiatrists even pushed the absurd ever expanding limits of the bogus DSM even further to justify bogus, destructive stigmas and toxic drugs for their own power hunger and greed.
Without psychiatry and BIG PHARMA colluding to get laws passed to rob citizens of their every human, civil, democratic rights to force such bogus, life destroying stigmas and torture treatments on as many vulnerable people that they could entrap in their web of deceit, there would not be such arguments about the medicalization of misery, psychiatric imperialism or the myth of mental illness. Dr. Szasz wasn’t so much against psychiatry helping people with typical problems of living, but rather this heinous violation of every human right by advocating for THE THERAPEUTIC STATE that has become a fascist, totalitarian source of terror and violation of every constitutional right of every citizen in the guise of medicine.
Dr. Pies never admits the huge fraud of deliberately giving normal people suffering grief over typical losses bogus stigmas even including “clinical depression,” a “mental illness” stigma that will follow that person for life not to mention the lethal effects of SSRI’s that may lead to an iatrogenic life destroying bipolar stigma and lethal drug cocktail.
Every human must have the right to decide what medical treatment they wish to receive if any especially now that the medicine/BIG PHARMA/BUSINESS cartel is out to make a profit regardless of the poor outcomes of their so called patients/clients as is obvious with all psych drugs, statins, etc. This is especially true given that many corrupt standards have been passed off as evidence based and force on both doctors and consumers for the sole purposed of big profits.
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YES! Thank you for this, Morias!
->
“…psychosis being a defence mechanism, not a symptom of the disease but part of the healing process; much like fever which is part of the body’s immune response to a pathogen and not just a symptom of a “disease”. Of course, just like fever can in extreme cases be harmful in itself and an intervention is needed to stabilize the patient, the same is true of psychosis, but the emphasis is on the fact that this is only justified in extreme cases and, crucially, the intervention must actually stabilize the patient and not just appear to do so while in fact adding wood to the fire, so to speak. In this I’d say that current psychiatric interventions are catastrophic; the only good thing you can say about them is that they are better than a bullet to the head, which is not really something to be proud of. To follow the fever analogy, they are like trying to lower a fever by blood-letting (actually, blood-letting for fever has a sounder scientific rationale).”
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I break my self-imposed silence to briefly clarify something from my comment above:
In my analogy of colours, just like yellow (trauma) goes in, it can also go out – it is not a one-way process. If you end up of a colour that is a “disease” (very bright green, or very bright orange) in the sense that it impairs your functioning in the world or in the sense that you are a nasty piece of work knowingly or unknowingly destroying the world, it does not mean that you cannot change and get rid of enough yellow (probably not all, true) to be a much better shade. Depending on the amount of yellow presents some will be able to do it on their own, some will need help (that is, real help and not abuse masquerading as help), but I am sure it is always possible.
Just wanted to clarify this because if you imagine the analogy with paints it might read like I’m describing an irreversible process. Imagine it with light rays and the analogy works better…
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I’m not even really sure we disagree all that much Morias. I mean, I’m not sure I entirely follow the whole colors thing, but it seems like you’re willing to accept that a person’s genetics sets up their brain or ‘temperament’ in a way that can predispose them to developing “so called mental illness” under the right circumstances. I understand that you’re saying that everyone is set up for success and only when exposed to the “environmental pathogen” do they get manifest whatever variation on dysfunction they are inclined to. I don’t really disagree with that, I just think that some brains are more resilient. If you expose 100 people to a moderate trauma some are going get severely dysfunctional like “schizophrenia”, some are going to get anxious or turn into a jerk and some will probably be fine. Maybe we part company there, not sure.
Where I’m pretty sure we part company is that I think some brains are really set up for something like schizophrenia. Or autism for that matter which is maybe cleaner because it happens so early that often there might not be time for anything that could possibly be construed as trauma. My basic point being that at least in some cases you don’t even need trauma or the trauma could be so subtle or minor as to almost defy the characterization of being traumatic.
Hmmm… Autism. Now I’m curious, how do you think about autism Morias?
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Yes I’d dearly appreciate some views on autism, I need help on this one as I’m struggling. I have a relative who although not formally diagnosed is viewed as being autistic.
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I’d say we disagree 100%, but at least we’re getting closer to understanding how we disagree. The colours thing is an attempt to explain in a simple way how a phenotype variant can be associated with a particular type of “disease” without this implying in any way that that phenotype predisposes for that disease. It answers, if you like, the “mystery” of adoption studies (a mystery that is not resolved by saying “there must be something genetic in schizophrenia, we just haven’t found what yet”). I know it all sounds a bit convoluted but it is extremely important in practical terms, particularly in connection with ‘preventive psychiatric interventions’ and the combined use of neuroimaging and genetics. If these “finer points” are not clearly understood we might be heading towards a very bad place (I’ll avoid mentioning the nazis).
Precisely my point is that I do not think some brains are more resilient than others, or rather: yes, brains as organs can (like the rest of the body) be more or less resilient to “material” pathogens (virus, etc), but MINDS are not. All minds are equally resilient or vulnerable to trauma. We are dealing with “mental” disorders, not brain disorders (that is the whole basic debate, isn’t it?) and the mind, the active brain, is not a brain-in-a-jar, but a system of interactions. Trauma or abuse is not a material pathogen but a relational -“immaterial”- pathogen, and psychosis is not a “disease” of the brain, but one of the ways in which the mind defends itself from this relational pathogen. If you are looking for a disease, a mental disease, you are looking for a relational disease -a disease of the system- and so you must look at the whole system of complex interactions around the ‘schizophrenic’ individual. To put it another way: one ‘schizophrenic’ individual is not a diseased individual but a symptom of a disease affecting the social group of that individual.
All minds (in your terms, all brains) are equally resilient and given the same trauma they all experience the same harm, but this harm is expressed in different ways – some more damaging for the group than others. And I’d say that “schizophrenia” is actually at the lower end in terms of harm to the group: “schizophrenia” is -for society- one of the least harmful responses to trauma. ‘Schizophrenics’, so to speak, ‘trap’ the harm done to them inside themselves and only pass on small amounts of it; they suffer so conspicuously because they don’t pass on the harm, they wrestle with it in their minds. Other responses to harm involve passing it on, such as in the extreme case of the sexually-abused who becomes a sexual abuser (just one example of many); these responses are far more harmful to the group. I don’t think anybody can be exposed to trauma and be “fine”, it is just that some ways of not being fine are less obvious or more socially accepted than others. And by the way, although this is too large a subject: the more socially accepted a way of not being fine is, the more harm it causes to a society; societies which accept too many ways of not being fine as ways of being fine collapse and “die”.
Of course all this is in many ways a very uncomfortable hypothesis; for one thing it implies that if ‘schizophrenics’ do not develop ‘schizophrenia’ because they have an innate vulnerability which makes them unable to deal with ordinary levels of stress, but on the contrary only abuse of one type or another can bring about ‘schizophrenia’ (as a defence mechanism against abuse), then for every ‘schizophrenic’ there must be one or more abusers. This hypothesis shifts the responsibility from the ‘schizophrenic’ to the surrounding group, and of course the group does not particularly like that.
About autism: the greatest problem with autism is that if ‘schizophrenia’ is a near meaningless term because it is just an umbrella term for some vaguely defined traits, ‘autism’ is ten times worse in that respect. If fact there’s no doubt that the term ‘autism’ applies to several disorders (and some non-disorders) with completely different etiologies, which is why it’s really called ‘autism spectrum disorder’, the ‘spectrum’ meaning: this is not just one thing but many. So it is impossible to discuss autism in general.
Some forms of ‘autism’ are in fact genetic disorders (or rather, behaviours associated with genetic disorders) but here is the catch: in these cases we have already identified the genes responsible for the disorder – there are no complicated mysteries, no elusive genetic ‘vulnerabilities’. A very different story from ‘disorders’ such a schizophrenia where the genes have not been found and the only evidence that there is a genetic component comes from those ridiculously limited and flawed twin and adoption studies. Studies which even if they were not flawed yield results which can be interpreted in different ways (I showed you one, there’s probably others I haven’t thought of). The situation could not be more absurd (and tragic).
But since you bring autism up, check this out:
http://www.casinapioiv.va/content/dam/accademia/pdf/sv117/sv117-bear.pdf
It isn’t a research paper but a presentation given at the Pontifical Academy of Sciences (which has a lot of very interesting material available for free – a little-known treasure-trove of references).
You’ll like this paper, it describes research into a drug to reduce cognitive dysfunction (‘autism’) in people with fragile X syndrome. It is 100% biological psychiatry – this is in fact how it starts:
“We have entered the era of ‘molecular medicine’ in which it is anticipated that the knowledge of the human genome will reveal causes and treatments for mental illnesses. This process begins with careful clinical identification of patients who can be distinguished by a common set of phenotypic traits, thus defining a syndrome. Molecular genetic studies are then undertaken to test the hypothesis that the syndrome has a shared genetic cause.”
Needless to say I think the author is working within the wrong conceptual framework but he is nonetheless an honest scientist going about things the right way; the paper shows good science at work. If drugs currently in use in psychiatry had been developed like this I can assure you not a single one of them would have ever reached the market or be in use.
I don’t think you are being quite honest with yourself, Scott… a good starting point would be reading AoE.
One last thing, this paper I link ends with this paragraph:
“It is important to add, however, that while drug therapies might correct disruptions in synaptic biochemistry, they will never substitute for quality sensory experience and education. We imagine the drug treatment will unlock the potential for substantial gains in cognitive and social behaviors. But this potential will only be realized when pharmacotherapy is combined with appropriate cognitive and behavioral therapies that exploit life-long neuroplasticity.”
‘Life-long neuroplasticity’, now that’s something worth talking about and of immense importance for all “mental illnesses” whatever their etiology; but we don’t hear a lot about it, in fact almost nothing, I wonder why?
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“..This hypothesis shifts the responsibility from the ‘schizophrenic’ to the surrounding group, and of course the group does not particularly like that”
Agree Morias, that’s one reason why Laing was so despised by family organisations wedded to the medical model.
“A very different story from ‘disorders’ such a schizophrenia where the genes have not been found and the only evidence that there is a genetic component comes from those ridiculously limited and flawed twin and adoption studies”
Absolutely agreed.
The debate here regarding autism seems to be around whether it’s a “brain processing” issue or “developmental”, I’m not finding either useful..
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Hi Joanna (I hope this comment ends in the right place)
I’m afraid I cannot say anything of help when it comes to specific therapies for autism, but I just wanted to thank you for posting your experience of catatonia which I think is incredibly valuable – I hope I’m not trivializing it by saying this.
I really just cannot understand how psychiatrists can ignore accounts such as yours and refuse to take them as their starting point. How can their minds be so closed? At one level I understand why, but I still find it hard to believe; it is so profoundly irrational, this inability to see what’s right in front of their faces. To me this irrationality of psychiatrists is something that rightly deserves the name “mental illness”.
Anyway, I’m sure you don’t need another rant; I’m sorry I cannot be of help and thanks again
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Hey Morias.
Fine we disagree 100%.
So schizophrenia cannot arise in the absence of trauma? It would be nice if you could provide data that substantiates this.
I’m glad you refer to your conceptual understanding as a hypothesis because I think that is exactly what it is. Not that mine isn’t a hypothesis too… I’ve tried to provide you some of the evidence that I see as supporting my hypothesis. It is not all twin studies and I’ll get back to that in a second. You’ve explained why you think the evidence is invalid and you’ve offered a set of philosophical analogies that describe alternative scenarios. In the end you’ve also got to provide evidence that what you are proposing is true. Not just that what I’m proposing is wrong.
For example what is the evidence that all minds are equally resilient? That nothing genetic predisposes to schizophrenia? That no one can experience even mild trauma and still be OK? I mean data, give me data. I get that you’ve got ideas and that you are very smart and thoughtful. You say that I’m being dishonest with myself, I don’t know what you mean, but to me it seems like your view is self-evident to you and I’m trying the one trying to provide data. Give me the data.
Yeah, we know autism is a bunch of things. I know schizophrenia is a bunch of things and it is a made up category which comprises a check list of behaviors that encompasses a Venn diagram of many overlapping syndromes or whatever. I’m so sick of this part of the discussion. Give me some credit – you know that I know that. There is no way to have a discussion using words in human language without using labels and saying autism is the only one I have that I know means something to you. You want to propose a different word or set of words then fine I’ll use those. I’m sick of having to delete words I’m writing so I can go back and put parentheses around them.
You say some forms of autism are genetic disorders where we have found the genes. Yeah, I guess. Fragile X has phenotypic overlap with autism spectrum disorders, just like Huntington’s disease has phenotypic overlap with schizophrenia spectrum disorders. How is it any different? They each account for a miniscule percentage of all disorders that fall within those categories. DiGeorge Syndrome is a genetic disorder with phenotypic overlap with schizophrenia. I can go on… Genes can cause symptoms indistinguishable from schizophrenia, genes can cause symptoms indistinguishable from autism. The vast majority of autism and schizophrenia we don’t know the genes or environmental factors responsible, but they both have high concordance amongst relatives based on the degree with which they share genetic material. There is so much more evidence about this than just twin studies.
The quotes you offer from this paper are EXACTLY what I’m advocating for… That type of scientific process rationally offers the greatest amount of hope for treatments that impact the underlying biology of the disease while limiting side effects or toxicities as much as possible. Problem is that thus far that process has yielded spectacularly few drugs that are in use in any area of modern medicine. Most medicines that we have in any area of medicine were not rationally designed… Doesn’t mean we shouldn’t try, I want us to try. That’s why the process they describe is EXACTLY what I’m advocating for.
Finally, of course I advocate also for life long neuroplasticity, education, therapy and social interventions which will also alter the substrate that gives rise to psychiatric disorders (regardless of whether their cause is 100% environmental). And, further create an environment in which the organism can thrive given these new tools and the acute stabilization potentially offered by newly discovered medications.
Sheesh Morias, you know I like you, but we are like ships passing silently in the night sometimes. At least that’s what I think. Note that I did not edit or re-read this rant, please don’t hold me responsible for minor points lacking clarity.
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Scott,
Thinking doesn’t make it so. See Dr. Mary Boyle on Schizophrenia? A Scientific Delusion? and Dr. Colin Ross’ Pseudoscience in Biological Psychiatry among tons of others debunking the bogus genetic and other biological causes of so called schizophrenia, a hodgepodge of many different symptoms upon which nobody could agree.
As Dr. Thomas Szasz exposed, so called schizophrenia became the “sacred symbol” of psychiatry because without it they couldn’t justify their existence. Yet, psychiatry is infamous for using such bogus stigmas and junk science theories to stigmatize, disempower, humiliate, silence and remove/destroy those deemed a threat or even a nuisance to those in power just like Soviet Russia.
A perfect example is the book, THE PROTEST PSYCHOSIS, whereby the bogus schizophrenia stigma was redesigned to fit angry black men justly fighting for their human, civil and equal, rights, so they could be targeted, stigmatized, poisoned, discredited and removed from society also based on bogus eugenics theories that they had inferior intelligence as in the horrible book, THE BELL CURVE. This same evil has been perpetrated against women, gays and other minorities.
Of course, every time people/victims/society catch on to the latest psychiatry/BIG PHARMA fraud, they admit to its fallacy while pretending the best intentions while perpetrating new lies for the same purpose as Dr. Insel, the APA, BIG PHARMA and others are colluding with their latest bogus neuroscience to waste more billions and seduce BIG PHARMA back to the fold of their ongoing crimes against humanity.
This is the problem with this great neuro research in that eugenics from the Nazi era is alive and well under different names and guises, so I think any of this so called brain research proposed by the likes of Dr. Insel of the NIMH with like minded people in the APA, academia and BIG PHARMA poses a huge danger to a free, democratic society given the huge human rights abuses it continues to advocate with obvious junk science. Dr. Insel and his cohorts have made no secret of the fact they want BIG PHARMA to come back to the fold to invent new drugs to keep the gravy train going. As long as the latest pseudoscience keeps ahead of those exposing it, they will continue to profit very handsomely while continuing to destroy countless lives.
Those of us challenging your unproven neuroscience theories get quite upset because we bear in mind George Santayanna’s warning,
“Those who fail to remember the past are doomed to repeat it.”
NEVER FORGET!!
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Joanna Care,
I respond here because of lack of space above.
To me, the discussion about “involuntary commitment” and “forced drugging” is personal. I am not talking hearsay, I am talking about what happened to me and how having been at the receiving end of both has basically harmed me in ways that I was only able to appreciate over time. The question about “have you ever been interned in a psychiatric hospital” shows in all kinds of applications for jobs, security clearances, etc. Not to mention that it makes all potential social relationships toxic. It caused my divorce and it caused me to sever my relationship with my parents, who used the whole ordeal to exercise control over me. Needless to say, I haven’t had any more commutations with them, despite their repeated attempts to contact me via email/phone. I have just ignored them. And overtime, those attempts stopped for good.
It has also impacted my ability to date other women. I am not going to lie about what happened to a potential life partner, but the question is always about, “when should I tell her”? Not in the first date, but what if I wait 2 months, she learns, becomes ballistic (feeling “lied to”) and then worse, tells everybody else via Facebook and suddenly my life is ruined. So sorry, I am an absolutist on this matter, freedom should only be taken away if the person commits a crime, end of the story.
“We could take the position that anyone is free to kill themselves”
That is EXACTLY my position.
“or others and take the consequences of that,”
Actually, the crime of making “credible threats” already exists, at least in the US. If somebody has made “credible” (“credible” as in “beyond reasonable doubt” and determined as such by a jury of his/her “peers”) threats to another person, that somebody will go to jail but only after those threats have been determined to be credible. If you are labelled, those threats do not need to be “so credible” and the incarceration lasts for as long as a shrink determines to be necessary. That is the injustice I am talking about.
“but what if any were preventable with some assistance”
People should be free to kill themselves if the chose to. It is really that simple. The “right to kill oneself” is implicit to the “right to live”.
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It’s personal to me too, I’m not talking hearsay neither, and I’m agreed with you about the injustices, but I can’t wholly agree with you on suicide, having lost several friends, it’s not that simple for me to say we always let people die.
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There are many ways to help a person thinking about suicide. I don’t think that detaining that person against his/her will, and forcibly drug that person will improve matters. Had I had suicidal thoughts when I was committed, the whole experience would had made matters worse, not better.
The notion that a person is “helped” by being detained and forcibly drugged is deeply, deeply misguided.
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I was referring to the question of limited short term holding without forced drugging, I have repeated that several times to make it clear, so I cannot be clearer. Having attempted to die and lost several friends by suicide it’s very personal to me too. With my friends I’d say that for two of them it was the right decision for them, but the other three it’s not clear cut.
I’ve made it clear I respect people’s right to choose and support physician assisted dying, and I’d go even further and say that Dignitas should consider requests for unbearable long term mental distress as well terminal physical conditions because overdosing every week for months until all your organs pack it is a really shitty way to die, and one of my friends for whom is was the right decision for her should have had an easier way out than the hell she went through. On the other hand I first attempted when I was a teenager I don’t think I was in a position then by virtue of my age to see everything clearly – and yes the admission didn’t help me, although ironically sometimes you start fighting to live just to escape them! Suicide and people committing crimes whilst very distressed are not black and white, if I had torched the pet shop because of the reptiles within them which my voices told me were going to attack me, I would have gone to prison for a long time.
I think there would need to be lawyers who did plead for mental distress and somewhere to go, not hospital, not prison, not drugging where there was help to make sense of things.
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I agree with Joanna. I’m imagining if it were my choice to let a person leave and go to commit suicide. Let’s say it’s a 19 year old girl who has been traumatized and she says “I’ve got a gun in my car, I want to leave so I can end it all.”
If it was within my power, how could I let her go? How could I look her parents in the face and justify that if she went through with it. Would I say “well it’s her choice”?
I understand where you’re coming from Cannotsay with people having a right to end their lives if they want to. But isn’t there room to account for when people aren’t thinking clearly? I just disagree that this is black and white. I disagree that it is simple.
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A lot of people with “so called mental illnesses” already end up in prison. If there isn’t an alternative, then how is that any different than criminalizing “mental illness”?
I have to agree with that Scott, and I also agree that these questions are not remotely easy, they are challenging and so they should be. At this moment in time I’d like to see some alternative framework which doesn’t involve long term drugging/forced treatment of any kind but makes some provision for limited short term holding for specific circumstances such as the starving young or suicidal, and special pleading for those who have committed non-violent offences who were clearly distressed at the time, and alternative provision for them to go for a while to look at what’s happening [without forced drugging].
We’ll have to agree to differ cannotsay, I can respect that.
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Believe me Scott, you don’t have the slightest clue of what it is like to have been treated as a criminal without being one. You can keep your “false empathy” for yourself.
“But isn’t there room to account for when people aren’t thinking clearly? I just disagree that this is black and white. I disagree that it is simple.”
I am sorry, but this “life is not black and white” thing is the excuse psychiatry uses to abuse its power. If that 19 year old girl wants to end her life too bad for her and her family/friends.
Shrinks will not be able to prevent all bad things that happen in life even if they were to be given the totalitarian powers they dream of. “If only”, “if only”… If only shrinks minded their own business… For every so called “19 year old girl” that you claim to have been “helped” by psychiatry I can give you 10 whose lives have been ruined by psychiatry (many of them MIA readers), including people who have taken their own lives pushed by SSRIs and neuroleptics. On average psychiatry does more harm than good, that’s the fact: psychiatry’s treatment of choice (SSRIs) are no better than placebos and make people taking them violent. Only an evil mind could think that the solution to a suicidal person is to force that person into antidepressants. This explosive cocktail is confirmed by the CDC data that shows that from 1999 to 2009, the suicide rate increase 28%, a time during which more Americans were on antidepressants than ever. Giving shrinks more power will only make the amount of misery existing in society increase.
Life might not be “black and white” but science certainly is. Science is a totalitarian endeavor governed by the laws of nature and the laws of logic. If you want to preemptively lock in that 19 year old girl, do not use the excuse of “science” to do it (because there is no science behind psychiatry). Just openly say so. Say that psychiatrists want to have totalitarian powers because “they say so”.
I have nothing but contempt for people like you who bring these false analogies and false choices to justify your ever increasing demands for totalitarian social control powers.
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“If that 19 year old girl wants to end her life too bad for her and her family/friends”.
cannotsay, I can respectfully agree to differ but that’s quite a brittle statement, have you ever lost anyone close to you by suicide? [and I will stress again that I make no calls for forced detainment with forced drugging forevermore]. Would you take same view of the 15 yr old dying of starvation through eating distress?
“I have nothing but contempt for people like you who bring these false analogies and false choices to justify your ever increasing demands for totalitarian social control powers”.
I don’t know Scott, I’ve only just ‘met’ him/her these last few days [are you a psychiatrist Scott?]but whether you like or loathe Scott, views are being expressed which you would have to engage with if this were an open global debate with all our governments asking ok what shall we do? Let’s have the entire electorate decide. You would have to engage with these questions.
So Scott can I ask you, what do you think of the idea of people being detained for short periods for only a limited range of reasons with NO forced treatment?
And how about if psychiatrists didn’t make those decisions?
cannotsay – I would also point out that some people have advance directives which state what they do and don’t want in a crisis, so if some people did want things you wouldn’t want for yourself are we going to respect them or only respect what we approve of?
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I can see that you’re really angry at me, but I don’t feel like you’re being fair. Most of your anger seems to be directed at what some of the ideas I’m expressing represent to you. I don’t think it’s a fair characterization of what I’ve said. You don’t know me or what I’ve been through, but I can accept that the issue is a very emotional one for you. I’ve said that I can accept that your position is different than mine, but it doesn’t seem like you can accept that mine is different than yours. Perhaps it is time that our dialogue on this comes to an end.
I’ve been enjoying learning about how people think differently than me. I find it stimulating and my philosophy is plastic. The least you can give me is I’m here listening to what people have to say. I thought this was supposed to be an open place where people with different views could exchange ideas. I hadn’t gotten the idea that most here want me to leave, but if I do then I will.
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As a person who came extremely close to killing himself in his suicide attempt, I am very glad that someone intervened so that I am sitting here this morning typing this comment. My attempt happened during the most trying time in my life and I was out of balance and spinning into the void. I was rational. But I am glad that someone saved me so that I could go on to fight the good fight another day.
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[[personal attacks removed]]
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[[personal attacks removed]]
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I would never get anyone hospitalised unless they asked me to, I personally cannot act against a person’s wishes and wouldn’t want to be in a position where I was expected to.
I’ve written about this elsewhere,for me being pro-choice in my life means doing what a person wants irrespective of whether I agree or would want it for myself, that is the essence of advocacy.
I wasn’t sure if Scott was a psychologist or psychiatrist [sometimes it can be hard to tell in the UK I wanted to check] and there are many many people who can sell themselves as good, and that’s not the exclusive preserve of psychiatrists. Szasz is your guru not mine, we have some ‘good’ psychiatrists too, some of them have written here.
I enquired about the shades of grey not suggesting we leave unlimited powers to psychiatrists forevermore, I stressed this repeatedly so stop misrepresenting me, you devalue your own arguments by insisting I am saying something I’m not.
You’re wrong about advance directives, they are not always followed in general medicine just as they are not always disrespected in psychiatry, agreed it’s a much tougher battle with less success but some people’s directives on their choices within services are followed. Where we would agree is that directives on no admission/no treatment are not followed and are overridden, but overrall you make everything very black & white.
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I’ll let Scott declare what he is, but I have a sixth instinct to catch shrinks :D. I bet $100 that he is a shrink. Scott, could you openly say what you are?
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Lol I think it’s right people do declare who they are and what their bias is
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Bless you Moiras thank you.
I agree, our descriptions of ourselves and our experiences should be the starting point for anyone supporting us, it’s so simple isn’t it, not rocket science.
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“When it comes down to what is and what isn’t it shouldn’t have to do with “normal” it should have to do with suffering and not functioning well… In my mind if you are sick you need help to get better, it doesn’t mean you are bad or defective. And that goes for me too if I am sick.”
Thank you, Scott. Seems that we all share an interest in seeing that a person in severe distress gets help (assuming they want some kind of help), but that’s where it gets tricky. What does it mean to help someone? And this isn’t an impractical, philosophical question either. Usually “help” assumes a set of shared values, which in America is about, “how can we change or stop this as soon as possible?”, as opposed to staying curious and supportive by listening (to the person and/or body) for meaning. What is this “symptom” trying to communicate? In this way, a fever or ‘delusional’ beliefs, for example, are not a problem, but an important messenger. And often the mental health patient’s symptom not only carries an important message for him or herself, but also for the family and community. If we remain open, what we call mental illness is a profound opportunity for transformation and can a great gift the community.
About autism… I have lots of thoughts. For now I’ll say that I live with a close friend who carries a diagnosis of autism. He is mostly non-verbal, and cannot work or cook or use the bathroom himself. He has many ‘tantrums’, and in moments of acute frustration is aggressive. But he doesn’t consider himself diseased or sick. He’s keenly sensitive and funny and doesn’t care what anyone thinks of him. His differences have connected, challenged and grown hundreds of people over the course of his lifetime. And yes, he struggles very, very much. But he thinks ‘normal’ people do too. He’s written at length about we are hysterically (and tragically) self-obsessed and vain, and take ourselves and our ideas way too seriously.
On that note, I’m going outside to play!
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Vanessa I appreciate you speaking of your friend diagnosed as autistic, my relative is very verbal but struggles with the nuances of social interaction, i.e. give and take, takes things literally, and can have very explosive rages. I know she would not consider herself diseased or sick [neither do I], I do however worry greatly about what will happen to her when her parents are no longer here as she doesn’t have independent living skills and would need social security support and possibly a support worker of her choosing to assist her with cooking a meal etc, and our current welfare system is vicious and punishing.
Your friend is right about the rest of us taking ourselves too seriously so may I for one moment offer some light tongue-in-cheek humour ridiculing psychiatry’s approach to suicidal feelings.
The Ferguson Safety Smock for suicidal inmates and patients
Feast your eyes on this product:
http://www.preventsuicide.com/index.htm
That’s me on the right, first thing in the morning before a hairbrush, I’ve no idea who the hairy geezer beside me is [actually I’m told he’s the CEO of the company].
http://www.preventsuicide.com/faq.htm
Now I can’t take this smock off when wearing it [looks very fetching] because it’s made from incredibly strong fabric and apparently it’s “not designed to prevent exhibitionism. It’s for people who wish to be clothed, which is the majority of suicidal inmates”.
Nah not me, personally I prefer to be naked when I’m suicidal.
Now please look at this additional product – the sani-belt for suicidal and self-destructive females:
http://www.preventsuicide.com/products.htm
This does suggest that there are an extraordinary number of suicides as a result of using sanitary products as the method. I want to reassure readers that I have put this to the test under scientific conditions [I wore a white coat].
I placed two tampons up each nostril, and smothered my mouth with an Always Ultra [with wings]. I even had a medic on standby just in case of respiratory failure. The results of my scientific experiments were that suffocation by sanitary products is quite difficult achieve.
“The use of Ferguson products has enhanced our safety standards. It has reduced malingering by 100%.”
– Russ Ford,Senior Nursing Officer, Bermuda Dept. of Corrections
Ah yes he’s absolutely right of course wearing these smocks ensures there’s no ‘dramatic’ self-harm, no fake suicidal behaviour. These products really do make the jobs of Samaritan’s and psych services that much easier.
I am available for smock modelling please contact my agent for details of my fees.
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I have a vague sense that it’s wrong to laugh at this but I can’t help it, I’m laughing.
…I just re-read the last phrase and it cracked me up again.
Oh God, it happened again, it’s like a reflex.
my wife just came in to ask me what is wrong with me, I have to go now.
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no please DO laugh that was my aim!
Gee I look so good in my smock …
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oh man I’m laughing out loud at that! “Safety First– Ferguson Safety!”
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I’ve got a nice lipstick matching it today..
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(this got a little long)
Things got a little contentious around here for a bit there. I really appreciate the info from people’s lives about their experiences re: autism and how that spectrum relates to this topic. In truth, it was kids on the spectrum that I was thinking about when I decided that MIA needed to be more neuroinclusive, because kids that are different (in any way, really) are so vulnerable to denial of their human rights and in many cases may have difficulties that put them in the position of genuinely needing assistance of some sort.
(It is worth noting, though we all know this, that anyone with rights is vulnerable to having them violated, though some are more vulnerable than others and – across all demographic lines, those who are deemed “mentally” something or other are among the most vulnerable in any given group. Though some socially/culturally/economically/racially defined groups are far more vulnerable than others, in any group the mad (which over history could include people with any number of different difficulties, ranging from psychosis to what we used to call “retardation”) are routinely the most at risk of abuse in many forms.)
…and also because it is interesting that there are research directions that are seeking to explore potential epigenetic activity that may link so-called schizophrenia (and bipolar and depression and ADHD) to autism. I’m referring to the Smoller research, which nobody has discussed here. I haven’t read the paper, but read the abstract and heard the NPR blip.
http://www.npr.org/2013/03/01/173271247/-study-depression-autism-and-schizophrenia-share-genetic-links
In my situation, I am not entirely sure that genetics doesn’t play in a role in who I am and how my brain-mind works or the tendencies that have caused me difficulty – mostly in the form of being at odds with the “normal” world since I was young and having sensitivities that make some “normal” things difficult to tolerate. There is a familial phenotype that is evident in stories going back a hundred years. I don’t think we’re sick. I think we are smart and sensitive.
Anyway, while genetics are not the end all be all, nothing, as eloquently noted by Hermes and Morias, is written in stone. I mean, Temple Grandin (a popular example) had some significant difficulties growing up, but she is clearly able to do a great many things now. I know my brain has changed. I used principles of neuroplasticity to change the way my anxiety-stress response works, of course this involves my mind as much as my brain, but it’s all connected.
Anyway, my fear is that maybe they will find something, and that maybe – because they are looking for a disease – they will think it is an illness or an aberration and they will try to eliminate it from the population. This is not to sound paranoid or alarmist or eugenics-conspiracy-theorist, but it is a very real concern, because I really do think that most of the people I know who get pegged with mental illness are genuinely very special people, each with a rare gift of some sort, even if it is something so seemingly small as being incredibly kind to and concerned for animals, or having a way of seeing the world that not everybody has or being able to tell if something is just a little off center…not to mention the more extreme cases of skill and talent in arts and letters, social justice, and in creating new sciences.
Why do pro-“mentally ill people are potentially dangerous/dangerous people are mentally ill” folks always feel such liberty to present bombastically negative rarities as examples, with the swords in the mall and the feces, and yet we do not seem to be comfortable citing the real and numerous totally amazing cases of people who would meet diagnostic criteria and yet whose work and lives have changed the world?*
We’re a very humble bunch. “Give us our rights! We deserve our rights!” Yes, yes, we deserve our rights, but we also – as human beings who have experienced and seen and learned from our remarkable lives
(and noone can say that staying indoors alone for years is not a remarkable human experience, or that thinking the world is speaking to you in code and signal, divine transmission, finding patterns in everything and being heartbroken – absolutely heartbroken – by what we see in malls…it’s all remarkable)
…we deserve more than rights. We deserve to be seen and appreciated for the best of who we are. I think that people who get called mentally ill are actually very resilient, if they stay alive.
(What would a devil’s advocate, a eugenicist and a student of Darwin say about suicide rights? I won’t answer that, but I will say that I don’t think the world is – at this point – designed well for healthy human life.)
It kind of bums me out to see people arguing here, though I have argued here. Sometimes I find MIA to be very stress-producing and sort of socially toxic in ways. There are times I haven’t felt safe here, mostly because I don’t like being analyzed or having my intelligence or integrity called into question and that is something that seems to happen around here a fair amount. I don’t like being analyzed, especially because nobody here or in the whole wide world knows exactly what it is like to be me at any given point in time.
It’s been an argumentative kind of day. I don’t know if psychiatrists and the like (unless they are MIA blogger psychiatrists) are “safe” here, though it seems like having to face the attacks of survivors is not – as indicated by cannotsay – anything near the “not safe” that we – as survivors – have been in the company of psychiatrists. I think also, that because the events forced treatment and the language of psychiatry have been so traumatic for so many folks around here that it is triggering and that it is disrespectful, to be advocating for and justifying the very same practices that tore our lives apart in some way.
Even thinking about it for a split second, I want to light into some doctor, to say “Look! Look what you did to this person!” (meaning me) Of course, I know that the people who did what they did are not here. It’s interesting though, how I want to tell these things to Scott, who is playing the role of the “treatment advocate.” Some kind of transference dynamic.
I can’t accurately blame psychiatry for everything, well…maybe I can. If I hadn’t gotten locked up at age 13 and put through all that awful business of being left there and being away from home and being in the quiet room and having my first gynecological exam by the admitting psychiatrist because he did not believe that I had never had sex and had never done drugs, so they tested me for everything. Oh, outrage, outrage, that my family was frightened into paying for that.
Yes, I can blame every trouble in my adolescent and adult life on psychiatry and labeling and it makes me angry, because I am smart and I am a good person and I actually have skills but I live on less than 1,ooo dollars a month and haven’t had insurance in two and half years and though I am trying I am tired and still out of whack from staying alive through the worst of it and I really don’t know if I will ever have the potential I did have. That makes me angry and I just wish that the psychiatrists, etc. who visit this site would just care a little more about that and see what’s going on and start advocating for new job roles.
I think a lot of mental health workers (and I am a part-time peer in a state funded recovery education center, which actually is recovery oriented) are trapped in the expectations of their professional roles, many are probably a little deadened, because I am convinced that the system hurts them, too – though professional compassion fatigue and internal ethics conflicts are nowhere near the hurt that is inflicted by many people who are “just doing their jobs” or “just trying to help” –
Anyway, I am personally trying to stop thinking about psychiatrists as a blanket group, because it doesn’t make sense for me to say, “See me as an individual, see me clearly, trust that I am good and reasonable person who is trying to do the right thing!” …and then turn around and broadbrush all psychiatrists or other mental health related practitioners as horrible, evil, people. It conflicts with me spiritually and logically.
Also, it doesn’t, as observed by Joanna, seem to be the most diplomatic way of encouraging change.
By the way, Joanna, you’ve made me laugh twice this past week, with the Crunchy Nut Clusters and now the smock and the suicide by tampon. 😀
It does all get so, so serious. It’s a serious situation, life. I guess that depends on worldview.
Speaking of, it seems like it comes down to a fundamental difference in the view of being human. “They” reduce us to subhuman because in their minds, we are not fully human, because they don’t understand what we are communicating and in the modernist mind (built on the concept that “human” is tied to the concept that “I think therefore I am” and sanity has long been defined as “an ability to reason”) that means we are not – in a way – fully human, because they do not understand, they presume that there is nothing to understand and that we also do not understand.
It’s really offensive, that the value of my perceived humanity is measured against rubrics set by people external to me who, frankly, have a pretty distorted view of a great many things. It is offensive to me that someone who doesn’t know me, doesn’t love me, and doesn’t even get the world I live in (which is very real to a great many people) would have the power to make decisions about what is best for me.
Anyway, this continues to be an enlightening discussion and I appreciate you all helping me to get a better idea of the landscape around this topic of neurodiversity, “real difficulties” and human rights.
*yes, cannotsay, Jesus Christ would have definitely been institutionalized and probably would have been ruined…last summer the Church of England did a sermon on the possibility that Jesus and many of the saints and prophets may have had “mental health problems” – yet they did not make the connection that perhaps what makes people “saints” can look a lot like mental health problems and that maybe we ought to pay more attention to these people who go mad in ways that have to do with something like God.
Anyway, thanks again. It’s weird to read these messages through the day, to have this constant thread that I can’t respond to in real time because my mobile is just too clunky for that, but to be reading these words and thinking about what you all are saying.
Oh, Scott, if you’re still reading, here is a link to a good video that really is worth watching. The program director at work shared it with me and some clinicians watched it, too and felt the information was sound and well-presented, though it does present a narrow view of recovery.
Not Without Us: http://vimeo.com/62705552
Also, this is interesting:
NEW SOCIAL MEDIA CAMPAIGN FEATURES STORIES OF INDIVIDUALS WHO REJECTED PSYCHIATRIC DIAGNOSES
Campaign timed to coincide with rollout of American Psychiatric Association’s DSM-5
SAN FRANCISCO (5/18/13)– The Open Paradigm Project, in collaboration with MadinAmerica.com,Occupy Psychiatry, and leading organizations in the movement to reform mental health care, announces a social media campaign showcasing video testimonials by individuals negatively impacted by the traditional psychiatric model, which focuses on pathology and illness rather than wellness and recovery. The launch coincides with the American Psychiatric Association’s (APA) rollout of its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), taking place at the APA’s annual meeting in San Francisco this weekend. In light of National Institute of Mental Health (NIMH) director Thomas Insel’s move away from the DSM (“lack of validity… patients deserve better”) and DSM-5 task force chair David Kupfer’s admission of an absence of biological markers of mental illness (“we’re still waiting”), these stories starkly unveil the failure of, and harm done by, the prevailing model of mental health care.
These testimonials feature individuals whose meaningful, fulfilled lives – an outcome they attribute to rejecting psychiatric diagnoses they were told were incurable, and highly toxic treatments they were told would be life-long – demonstrate the dangers of a medicalized, manualized approach towards human suffering. Many reflect on years fruitlessly lost to “illnesses” they came to realize did not have a medical basis, and discuss alternative approaches that ultimately helped them embrace life’s challenges and integrate these experiences into their lives.
The stories take on even greater significance in light of the controversies surrounding the newest edition of the DSM, as international public and professional communities openly question the biomedical standard of care. Lucy Johnstone, member of the Division of Clinical Psychology of the British Psychological Association says,
“Traditionalists continue to claim that ‘We’re getting there – honestly!’In the meantime, the overwhelming amount of evidence for psychosocial causal factors (of distress) is once again relegated to a back seat.” Even so, the NIMH’s Research Domain Criteria (RDoC) and President Obama’s BRAIN initiative have announced they will continue to look for solutions in biology –an approach that, despite decades of acknowledged failure, Insel proposes to be only “ten years away.”
“Even the most painful struggles are part of the fabric of a meaningful life, not evidence of an illness,” Open Paradigm producer PJ Moynihan explains. “These stories clearly reinforce that.”
Lauren Spiro of Washington, D.C., said in her testimonial: “At 16, I was told that my brain was broken, and it was incurable. I felt like I would never be normal, that I would never have a life. So many people continue to be told this, and we have to stop it.”
The Open Paradigm Project will launch in conjunction with a protest of the APA at the Moscone Center in San Francisco at 11:30 a.m. PT on May 19th via YouTube, Twitter, and Facebook. For more information visit openparadigmproject.com
Sorry this got long and that there was some “personal” stuff in there…actually, I’m not really that sorry.
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It’s ok if you don’t feel comfortable here because your arguments will be subjected to rigorous analysis and questioning, but let’s not take the idea of a “safe space” too far– in this instance, “safe” is a metaphoric use that basically means “comfortable” (i’m assuming no one on MIA has actually threatened to do you bodily harm). And it is not anyone’s obligation to make everyone present comfortable or rather to avoid making anyone present uncomfortable. I sympathize with anyone who feels upset or sensitive to what goes on on the internet– I certainly do. I definitely can experience worry and upset when I get into it with people on the internet. But it isn’t fair to call MIA “toxic” because this happens to you. I don’t find it to be an especially antagonistic or rude environment at all, especially compared to the rest of the internet. I’m not saying we should allow the depressingly low (intellectually, emotionally, basically in every way) quality of, say, YouTube comments to set the standard and make anything less bad ok. But come on… I’ve read more heated (read: ruder, more explicitly antagonistic) book reviews in academic journals (not exaggerating, I used to collect them!). I think MIA is doing fine.
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…aaand, looking below I can see that I should’ve read farther down before making this comment. Although it is unfortunate when things get truly nasty, I think overall my comment above stands. Of course there are exceptions, but it is also thanks to people at MIA who are dedicating their time and effort that we have good moderation here to limit how far any conversation can sink.
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Re: toxic
…that’s why I try to make sure to put “I find…to be…at times”
which is not making a statement of assessment about the site, but rather citing my experience – at times – in this culture. I will be the first to tell you that I have some social acceptance issues that haven’t quite gotten worked out, and so sometimes just being around people at all can be toxic (whatever that means) to me.
Nobody has ever been mean around here, or even overly critical, most people are very nice. However, some people have tried to ensnare me in some pretty argumentative communications and have twisted some of what I have said in some pretty strange ways. I guess I have probably done the same thing to other people.
Oh, re: the comment above…I think that what I like about the word neurodiversity, is not that it communicates empowerment (alone, it doesn’t) but that it communicates difference with neutrality, so while it does still place an individual in relational distance from some imagined norm, it doesn’t say anything about to what extent an individual may be different or what that difference may entail.
Thanks again…
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Also, it doesn’t, as observed by Joanna, seem to be the most diplomatic way of encouraging change.
yes, when it becomes bloodsport it doesn’t illicit allies
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Wow, a lot of action. I’m going to start a new post.
I am not a psychiatrist. I am a neurologist. So you’re all wrong 😉
I have suffered myself with psychiatric forms of distress and so have those in my family. I’m probably not going to say too much more at this point because I’ll be honest in saying I don’t feel very safe in this space. I’m feeling some hatred for what I’ve said and I do feel uncomfortable.
Cannotsay: I’ll take the $100 in unmarked 5’s and 10’s, you can leave them at an address I will post as a comment on the next article published on MIA. Just kidding. I doubt it will make much difference to you that I’m not a psychiatrist. For the record though I have not boasted any academic credentials to you and I have never asked you to accept what I’m saying as the “word of god”. Nor have I said anything about “unlimited power”. Along the lines of what Joanna said, please stop continually mischaracterizing what I’ve said. I know that you didn’t ask me to leave, but you’ve used hurtful and severe language and tone. I am here engaging and listening, I think some people welcome that and I stand by what I said, if I think that most people don’t want me here then I will leave. I know you didn’t ask me to leave and I won’t leave just because you wish I wasn’t here. OK?
Joanna – I think the idea you propose is a good one and it might work well for some people. Probably it doesn’t happen enough. The truth is I really don’t know what to do in these situations which is part of the reason I’m here. I’m curious about these issues legally, experientially, scientificially, medically and philosophically. I do have some ideas, but I definitely don’t claim to know what the answers are.
As far as psychiatrists not making the decision, they often don’t. In many parts of the country law enforcement officers, paramedics, firefighters and emergency room doctors can also place people on temporary holds. Psychiatrists don’t go out looking for people to hold against their will, someone brings them in, often already legally held against their will. When it comes to forced medication, a lot of doctors will medicate someone against their will if they are thought to be acutely dangerous to themselves or others at that moment. Yeah it’s a judgement call and I’ve made it as a doctor. For example when delirious patients or those with brain injuries are flailing around and trying to leave the hospital. It is hard, and I’ve only done it when I thought someone was going to hurt other people or hurt themselves. I don’t feel good about it and if there is one reason I’m glad I’m not a psychiatrist it is because I’m thankful that is a rare situation in my specialty.
However, no doctor can just decide to force medications on someone regularly in non-acute situations, at least where I’m from. There are legal proceedings for determining if someone can have a medical procedure or medication given against their will. That is true no matter if we are talking about psych meds, surgery or antibiotics. So ultimately a judge decides. Maybe the judge just goes along with what the doctor says some will say and maybe there is some truth to that. However, the person is entitled to legal counsel and to appear in front of a judge. If we decide that this is wrong, we should decide to change the process from a legal perspective. As Joanna eludes to it is ultimately a political and legislative position change.
Vanessa – In my mind whether someone wants help or not is almost always the most important question. Sometimes in rare or extreme situations though, I do think people need help and cannot say or are unable to recognize it. Not everyone will agree with that and I can accept that. When I told cannotsay I accepted his/her position I meant it, I think it is extreme, I disagree, but I understand and respect it. I do think society needs to intervene at a certain point and I am NOT SURE what form that help should take. That’s why I asked the question I asked. Not because I thought I knew the answer, but because I don’t know the answer.
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[[personal attacks and uncivil remarks removed]]
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Quit putting things in quotes as though I’ve said them, like “European benign paternalism”, I’m not sure if you got that I’m from the US or not.
I didn’t ruin anyone’s life, I’ve saved lives and prevented morbidity. I’ve had people on my service delirious having suffered serious traumatic brain injury. Swinging at nurses, trying to pull their IVs out and tearing at bandages that cover scalp flaps overlying missing pieces of skull. What would you do? Let that person in a blind unthinking daze hurt other people, maim themselves and walk out onto the street to die? Get real. I’ve given emergency medication to sedate that person and they and their families have thanked me. How dare you with your contempt.
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[[personal attacks removed]]
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What is with the smiley faces is this just fun for you?
You can be damn sure I didn’t use an SSRI as that would be ridiculous. Yeah I asked the person or rather they have volunteered their thanks to me. Again I ask you what you would do?
I don’t know your situation at all and I’m not presuming the situation I’ve been put in as a doctor is anything like the situation you were in. In fact I think I’ve given you enough details to demonstrate that it wasn’t. I’m not the European psychiatrist that gave you an injection against your will. I’m sorry that happened and I don’t defend it. I’m just saying come on… be a little reasonable. I did what I would want someone to do to me if I was in that same situation. For what it is worth, I’m talking about a patient who had been hit by a car while riding his bike. He was out of his mind because he had a massive brain bleed.
Jesus Christ.
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And I’m quite certain that US shrinks are every bit as as bad European ones.
This sometimes looks like blood sport cannotsay, which has it’s limits in how effective it is
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“And I’m quite certain that US shrinks are every bit as as bad European ones.”
Sure, only in the US they are more under check. We have the legal protections against detention that I spelled out earlier plus a great system of medical malpractice -which can literally bankrupt them- that combined have them under control, much more under control than in Europe. Morally speaking though, I agree they are not better.
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[[personal attacks removed]]
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Something else Scott, following up on,
“I’ll be honest in saying I don’t feel very safe in this space. I’m feeling some hatred for what I’ve said and I do feel uncomfortable. ”
Let me elaborate on how different my perspective is from yours. After I decided to stop the drugs, I sent a very strongly worded message to the psychiatrists that committed me (message that of course went unanswered).
I then spoke spoke to the US citizens division of the US embassy of the country where this thing happened and their advise was that I should never go back to that country.
That if I were to be committed again, there is little they could do because the laws in that country are what they are (as I said, the same is true in all of Western Europe). They had had cases of natural born Americans who had been committed while on was supposed to be a short stay there (business/tourism), and that there was nothing that could be done to free them until the psychiatrist who ordered their commitment decided to free them.
I insisted with a question like “but is it relevant that in the US I could not have been committed under that standard?”, their answer was blunt: NO, IT ISN’T. So bottom line, I followed their advise and I have never been back there.
This is how different I see the issue of “feeling threatened” from you :D.
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Look Cannotsay, my intent was not to compare me feeling unsafe here to the feeling you had of being threatened in your experiences in psychiatric hospitals in this or any other country. You set it up that way, not me.
You’re insulted by me feeling unsafe by the hatred and vitriol I get from you? I really feeling like you’re picking a fight and I don’t see the need for it.
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[[personal attacks removed]]
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Typo,
“I get you are not one, but you are de fact defending the worldview of the average shrink”
it has an o missing,
“I get you are not one, but you are de FACTO defending the worldview of the average shrink”
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Scott thanks for confirming who you are, I wasn’t certain and that’s why it’s always worth asking who a person is, I hope you didn’t actually place that bet cannotsay.
Sometimes I don’t feel comfortable here either because; I don’t worship Szasz, do see Capitalism as contributing to mental distress, that it’s assumed I’m hating anyone who votes Conservative/Republican [which I don’t], that I’m telling lies about how government policies in the UK are impacting on people in my country purely to discredit a conservative government [which I’m not], that being ‘left’ leaning automatically means I want massive state intrusion in private life and no freedom [I don’t], that unless I sign up to all suicide/murder is fine in the name of freedom then I must be supporting lifelong drugging and detainment by psychiatrists in hospitals [which I don’t].
I accept that US psychiatry services are not the same as the UK, they are harder to get out of.
Equally,[and much more importantly] I’ve found many people here offering; enlightenment, willingness to engage and debate even when it’s painful and from very different positions,willingness to listen, great breadth of knowledge and experience which I’m learning from,willingness to consider my experiences and views, some shared thinking, humour, warmth, genuine curiosity [of the best kind],and inspiration.
It’s more than psychiatry which needs to change, it’s all our systems and structures, the social fabric of our societies, otherwise how will we get people on board who have never experienced psychiatry if we’re not willing to debate the difficult questions other than in a linear fashion.
Man on the street isn’t going to grasp any suicide tough shit, any crime go to jail, and I could bet £100 on that
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I sure wish the JW’s would stop knocking on my door asking me if I’d like to ‘let God into my life’..so tempted to go to the door with 666 on my forehead holding a chicken and bread knife saying ‘mmm, we needed a human for the next ceremony’ rolling my eyes
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2- The whole thing is fun in the sense that I know I could not have this dialogue with a shrink in the UK, or anywhere else in Western Europe for that matter.
I can think of critical thinking UK shrinks and ex shrinks who would happily debate with you, some of them have blogged here.
For the hard line medical model types, if you were at an event they would shut off from you relentlessly telling them they want everyone drugged and incarcerated – that’s not the best tactical strategy for gaining allies. There’s only a point to keep hammering it home if the other person is denying that reality
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Sure, only in the US they are more under check. We have the legal protections against detention that I spelled out earlier plus a great system of medical malpractice -which can literally bankrupt them- that combined have them under control, much more under control than in Europe. Morally speaking though, I agree they are not better.
that’s a fair point I accept that
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Hi Meremortal. On the balance I totally agree with you. In fact my overall experience at MIA has been one of really being impressed by the depth and thoughtfulness I’ve encountered. That’s the reason I’m still here, because I really think there are important things to learn here. At least from my perspective, people like Morias, Faith and Joanna have made important points that really have influenced the way that I think, I hope that they would say the same. That would be my goal, but I don’t know if they feel that way and it’s OK if they don’t.
It has been fixated on a bit that I said I felt unsafe, but no one has threatened me and I did not mean to imply that. There are obviously many ways to think about feeling safe and I didn’t say it to indicate I was afraid of bodily harm. I did not call MIA “toxic”, so again I hope that you didn’t mean the quotes as though you were quoting me. I’m fine with people disagreeing with me and I hope that this is clear from my comments. Truthfully, I’m here because I enjoy the feeling of expressing my ideas in an uncomfortable environment. However, that doesn’t extend to being asked for my address or feeling like I’m being attacked with abusive language or being repeatedly ascribed motivations that aren’t accurate. Mostly that has not been the case and again if I felt like that was the majority of what I experienced I wouldn’t be here.
It is awesome that MIA exists and it definitely counts as one of the most fascinating and intriguing communities I have ever encountered on the internet.
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Oh, hey, Scott – I was the one who used the word “toxic,”in reference to my subjective experience. See comment above.
Yeah, I have a big chip on my shoulder about being analyzed and criticized. I am getting more mature about that. I think it is a defense mechanism and also the result of being analyzed and criticized an awful lot and just being sort of tired of it at this particular point in time.
I had an icky personal analysis attack happen in another digital setting today and so I am sort of feeling like the whole internet is a little toxic right this very minute.
So, given that and the fact that it is now the middle of the night, goodnight.
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“It is awesome that MIA exists and it definitely counts as one of the most fascinating and intriguing communities I have ever encountered on the internet”.
agreed!
Faith, it is sometimes hard for some things to ‘translate’ on the net, in terms of communication, we can’t see each others faces, hear tone of voice, communication isn’t only about the content of what we say. The net is a wonderful thing but it also has it’s limitations [like anything] because it can get very heated in a way it might be different face to face.
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I agree with @meremortal that it doesn’t have to be either A) a person believes that neurology can play a role in our experience of X,Y, or Z or B) neurology doesn’t have anything to do with it
I do think that what the NIMH, the APA and proponents of “brain disease” theory have made of our brains is deeply misled and unfortunate – actually “unfortunate” is sort of the understatement of the year.
Given the principles of neuroplasticity, what goes on in our brains at one point is not necessarily written in stone and so it all becomes a bit of a moot point. I do think that some people – because the species is diverse and because of things like environmental toxicity – may have differences and that these differences may contribute to “distress.” However, except in the case of actual and measureable disease processes, these things are not medical issues.
I think that @meremortals statement re:
“…it is very possible to be “traumatized” but in a more global way by our sick culture(s). And that needs to be recognized more.”
…is something worth keeping in mind. For people who say, “But, some people have these issues and have never had trauma!” is to define what is and is not traumatic for people and to deny the everyday trauma that we sustain in simply being thinking and feeling humans in the modern world. So, even if we aren’t subjected to personal, direct violence or the trauma of being unloved or brutally controlled, we must still endure the trauma of seeing bloodshed every time we look at the paper, or witnessing (if not experiencing) the effects of inequity and discrimination. We have to look around the world and worry about climate crisis and food supply, warheads and guns. For thinking and feeling humans, it’s a very traumatic world.
I think this gets to “psychosis as a sane reaction to an insane world” and to Fromm’s idea of the “folie a millions” – collective delusion and repression of our natural human reactions to things that would logically seem to be very distressing. This is mentioned in the wikipedia entry on “sanity” – http://en.wikipedia.org/wiki/Sanity
On a more microlevel, is it traumatic to understand language or social norms differently and to be excluded or maligned, or to have to cope with a near constant assault on senses or to care deeply about things that aren’t seen as remotely important to those in your life?
So, acknowledging that – at certain points in our lives – neurology may play a role in how we mediate and make meaning of experiences is not to in any way endorse a neurological disease model.
For me, I was not able to really understand my experiences until I understood something about the basic way I process information. For me, it was the missing piece and I was able to then approach experiences with more insight into what may contribute to my reactions, how my brain-mind-heart work together.
As for identifying myself primarily as a psychiatric survivor, I prefer to not define myself on the basis of harms that have been done to me. While just last night I attributed most every difficult experience I had in adolescence and adulthood to psychiatry, either directly or indirectly, I don’t really like to think that the core of my identity rests in my relationship to psychiatry.
I think there might be something about liberation somewhere in there…
Thanks for hanging with me through these long comments and occasional misspeaks. I don’t always say the right thing, and sometimes what I say is just wrong, logically or otherwise. I am, like most people, just trying to figure out my own best truth and I’m realizing that it changes, depending on the perspective I apply or what may be happening on any given day.
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“…it is very possible to be “traumatized” but in a more global way by our sick culture(s). And that needs to be recognized more.”
“I don’t really like to think that the core of my identity rests in my relationship to psychiatry”.
Yes and yes.
I remember many years ago two of us going into a workshop with all our labels/descriptions written on card hanging around our necks and we went around the room with a box filled with sticky labels with psych diagnoses on them which they had to slap on each other and then describe without saying what it was and guess each others label. We also put in a few other words such as ‘football supporter’, ‘politician’, etc just to muddy the waters.
Then we offered our alternative descriptions of ourselves, so alongside voice hearer, I also had star trek geek prone to stropping around as a Borg, highly competent barker [I have a very realistic dog bark], etc you get the picture. It was a nice contrast to ‘incurable’ [I was once called that, is anyone else a member of the incurable club?!].
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I’m not sure if you understood what I meant when I said above that it would make sense to describe ourselves as psychiatric surivors RATHER THAN to describe ourselves with labels– like “neurotypical” or “schizophrenic”– that DO make the pretense of defining us wholly or at some “core” level.
My entire point was that it makes sense to describe ourselves– for the purposes of describing why we all belong in this movement against psychiatry together without recourse to diagnostic labels that we all know are bunk– as psychiatric survivors precisely because such a label makes NO pretense of defining us “wholly” or at some “core” level. No, instead it is very clear how and at what level it identifies us: it identifies us insofar as we have, as a matter of historical fact, been abused by psychiatry. This is a contingent fact, which means that it doesn’t pretend to get at some “core” of us. It merely reports on the facts of what happens to have been the case– we encountered psychiatry and were abused by it, and subsequently took it upon ourselves to oppose it.
I never suggested that we “identify ourselves primarily” (your words) as psychiatric survivors, if by “primarily” you mean in a way that assumes that it describes our identities, the core of us, the “primary” facts about us as humans. Not at all. My entire thing was to avoid any label that tries to do that because they are doomed.
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(some of this is gratuitous…obviously, I am foolishly trying to make sense of the human condition, which is admittedly beyond the scope of this comment thread…though maybe not. Anyway, a lot of this just me thinking to myself and trying to figure a few things out…so thanks for prompting thought.)
Thank you for making that clarification, #meremortal. You’re right, I was thinking along different lines, thinking about how we describe the core of us, describe ourselves, rather than how do we describe ourselves as a movement or define ourselves as a group with shared characteristics. So, it was a matter of us talking about two different things entirely.
I wonder a lot about who I am, about what makes me who I am. While what has happened to me does offer information about my experience and some evidence of my personality and character, based on:
what I make of my experience and who I spend my time with and in what ways, how I integrate those aspects of event and time into my identity
…I don’t know if those points of definition necessarily say a lot about who I am and what makes me who I am. Sure, they tell my story, and certain forces within that story act figuratively upon my expression of personhood and conceptualization of self, but my experience of what happens to me is dependent not just on prior experience and learning, but on some basic foundation of capacity and attribute that set(s) the framework for everything else to be built on.
This is obviously a much bigger question, more along the lines of “What makes us who we are?”
So, I guess I’m looking for a descriptor that captures more of the core, that says something about what makes me who I am. It’s a futile search, because even a word or set of terms resonates as accurate and encompassing of me, words get wrecked in the space between people, meaning is lost and twisted around. OUtside of nouns describing simple objects, very little means the same thing to anyone, and even in terms of simple objects, the words for these things elicit different image and sensation, different significance.
Words cannot, at the end of the day, say very much at all about who we are. Even if they speak to us, we cannot communicate the meaning reliably to others and we certainly cannot tell them anything of what it may mean to be us, to feel like to be us. We can churn out thousands of pages and even if anyone bothered to read they still wouldn’t know exactly how it *feels* to be us.
As an aside: Some days, I think that defining ourselves in relation to other members of our species is an okay thing to do. That’s what species, both simple and complex, do. I think Harvard entomologist Edward O. Wilson tried to say something about human diversity as a component of species function back in the 1970s and it caused a big uproar, with it’s implications of rank and purpose. People misunderstood. They did not grasp the point that all parts are vital.
So, getting back to your initial clarification, yes, as a movement it makes sense to define ourselves collectively as psychiatric survivors, but as individuals can any of us best be described by descriptors that only say something about what happened to us and how we relate to what happened to us, what groups we belong to.
Does that say much at all about who we are as people or how we experience the world? Should it? Given that this is a movement that is comprised of people who were harmed because of who they are and how they experience the world (or, rather, how that experience is expressed and interpreted) – it seems odd to me that we don’t celebrate the individual more…we do in terms of their work with the movement and in terms of what they survived, but isn’t there more to us than that?
The thing I have liked most about this thread has been people’s stories and the details that say something about who they are, with dog barks and the colors of harm and healing, which – Morias – I did understand and appreciate.
When I read (anything) I picture things and so I saw the yellow edge into green, in a way that looked like rivers, and it was a beautiful representation of healing.
Aside about the primacy of certain labels: One the things that I really can’t stand about psychiatric diagnosis is that it acts a super-definer, meaning that a psychiatric diagnosis has the capacity to supersede all other aspects of who we are, as it indicates something wrong at our core.
So, psychiatric survivor works for identification within the context of a movement, and offers a fair amount of information about what that means (“We survived psychiatry.”) It doesn’t recognize or affirm anything about individual experience or personal story. It can be distorting just like any other group name or collective group identification.
So, getting back to neurodiversity, it is a useful term to me, in some ways…because it does say something about what I believe of myself based on available evidence, and states a general human truth (we all have brains and all our brains are different and our brains contribute to our experience in various ways) affirming some basic, core characteristics that contribute to who I am and what factors mediate my experience.
Plus, it doesn’t really say much of anything at all and yet is kind of a science-y sounding word, leaving people to ask, “What does that mean?”
…and then we can have a conversation?
I think that I am just hungry to really know people.
“My entire thing was to avoid any label that tries to do that because they are doomed.”
@meremortal You’re right.
There is no label that could ever say enough.
Thanks again for being out there…
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One thing that comes to mind for me is that these labels or, rather, the attraction we all have in this time and place to labels that will somehow “capture” us once and for all, the true us, and communicate it to the world… such a thing is only necessary I think when we feel the need to project ourselves out to a mass audience, perhaps even a global audience. In any case, this impulse would largely disappear I think if we were to re-orient ourselves to the communities in which we actually reside and with which we actually interact on a daily, “in real life” basis. I feel no particular need to mobilize “schizophrenic” or “psychotic” to describe my experience to my best friend, because he knows me and he understands me in a way that makes labels like that just seem silly / superfluous / useless. On the other hand, with strangers or people on the internet I sometimes find myself feeling “forced” (by the situation) to use such words because I have no actual social, material bond with them…
I don’t know if I”m making sense. I’m not suggesting that we can will ourselves out of this globalized, highly technologically-intertwined social and material reality we live in just by eschewing labels. But I am saying that perhaps we need to re-orient ourselves within that context in order to resist certain of the ways of thinking, being, and conceptualizing ourselves that it promotes.
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meremortal,
‘… my best friend, because he knows me and he understands me …”
When it comes to the subject of labels, this is about the *only* thing that makes any sense to me.
Duane
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And I liked what you had to say about the real communities where we live and interact with others …
It makes perfect sense to me.
Best,
Duane
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I had a label that did not bode well, guaranteed me a life of struggle and the potential for incapacitation. “There is no cure, but treatment is available.” Anyway, your use of the word ‘incurable’ reminded me of this little passage below.
Awesome re: your barking skills. I have a child who regularly barks and emulates other dog behavior. She will be stoked to learn that some adults also maintain such skills.
The poem below the quote is from Andrew Boyd’s little book of Zen-like meditations called Daily Afflictions.
It goes like this:
When you look around you, it is easy to feel hopeless.
Things always seem to be getting worse, not better
Even those of us still working for a better tomorrow
can have a bad day, week, or lifetime, when all sems lost.
But such a lapse of faith should not be feared.
On the contrary, you should welcome it as a revelation.
Our situation is hopeless. Our cause is impossible.
You are faced with a stark choice.
Do you dedicate yourself to an impossible cause?
Or do you look after your own, making do as best you can?
The choice is clear: you must dedicate yourself to an impossible cause.
Why? Because we are all incurable. Because solidarity is a form of tenderness.
Because the simple act of caring for the world is itself a victory.
Take a stand – not because it will lead to anything,
but because it is the right thing to do.
We never know what can or can’t be done; only what must be done.
I dedicate myself to an impossible cause.”
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wags tail!
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Hi Scott,
I never thought you were a psychiatrist because you are too interested in psychiatry, and on the whole I find psychiatrists just don’t give a **** about their own subject.
Do you sound a bit angry in your last reply to me? That might be a good thing… believe me, I share your frustration re. ships in the night.
I myself am not an empirical scientist and I don’t work with data; the last data I handled was my income tax return. I’m more of an abstract theory type of person; that’s the kind of thing I do and what I can offer, for whatever’s worth. There is some of this data you ask for in AoE and Emperor’s New Drugs, (and I’m sure many other books I haven’t read), which is why I keep recommending them to you; I honestly think you will appreciate them. Of course their case is not 100%; they don’t offer proof in a strict sense, but they do present a lot of evidence in a fairly rigorous way – more evidence than the other side, I’d say. They’re worth the money.
But you do have to give them some time, you have to allow yourself to think for a moment, could this possibly be right? Can we interpret the available evidence in this way? This is what I meant when I said I don’t think you are being honest with yourself. You have to play devil’s advocate with yourself, not just with MIA. Isn’t this one of those basic rules of philosophy of science (which much to the world’s regret no research scientist actually follows)? Never set out to prove your hypothesis right, set out to prove it wrong; and if you can’t maybe it is right, but you must always be on the outlook for new ways to prove it wrong.
I do believe all minds are equally resilient to “immaterial” pathogens such as trauma. Do I have proof ? No, I have arguments and I think it fits better the available data (that I know of). In any case, to really talk about this kind of thing in detail we would have to first get into the relationship brain-mind, the organ and the mental processes, and I’m not going to go there here (I have to save something for the book I want to write when I retire, don’t I?)
I’ll sort of leave it here… I’m a bit washed out after my analogy of colours; I was so pleased with myself when I was writing it and I don’t think anybody got it…
I’m interested to hear that you do agree with the idea of life-long neuroplasticity. Where does that leave all these brain-imaging studies that look for differences in brain morphology in adults in order to stablish a “genetic component”? Isn’t it a bit too obviously absurd?
Me, I’m waiting for the longitudinal study on a random sample of 100.000 people who are given a battery of fMRIs at 5 year intervals from birth to their natural deaths. Maybe then we would have some data worth talking about.
Till next time.
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Hey, it’s been a while.
Brain activity and perception have been super phenomenal for me. My environment has changed “in the blink of an eye”. Transformation.
I understand this “kundalini” energy a bit better now. She is “reptilian”, her eyes blink with lenses and she clicks my ears and sinuses. We talk and communicate with each other. I’m not “crazy” and neither is she. She is not a hallucination or delusion. She is very real. I try to discern with the EXCLUSION of what hollywood and psychiatry would like to force feed. I like her.
I still fight “psychiatry” and their brainwash belief system.
There’s something about “tv” and manifesting / manifestation that gets my attention. My radio has been playing very, very unusual sounds. I believe it is galactic or something but when I get near the radio, I get that “feedback” sound.
I do not like this “cloud technology”. I know that something has managed to “break in” to my mind. It can be too controlling. Mind control is a real problem.
I am very different from you and you are very different from me.
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Hi Faith,
I just read this article and wanted to say thank you for the thought provoking perspective. I am gaining so much expansive and clarifying insight from reading the blogs on this website. I found yours particularly meaningful along with the discussion threads via the comments. Also, my mind and heart was deeply affected by your poem, I found it quite exquisite, powerful and moving. Do you by any chance have a book of poems published?
Yes words can never adequately describe who we are, or what makes us who we are, but sometimes they can evoke, with varying degress of clarity and feeling, the awesome mystery called you, me and us in relationship to life and each other.
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