Psychiatric Regret

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As I was researching my book A Disease called Childhood: Why A.D.H.D. Became an American Epidemic, I came across an interesting pattern in the history of psychiatry. In my mind I made up a name for this pattern and called it “neo-Kraepelinian Regret,” named after the 19th century German psychiatrist Emil Kraepelin. Kraepelin was interested in classifying mental disorders by their symptoms so that psychiatrists would have a common language with which to communicate. His most famous contribution is his classification of the different forms of psychosis into manic depression, dementia praecox (which later became known as schizophrenia), and paranoia.

Kraepelin also speculated, but could not prove, that mental disorders had biological causes. Toward the end of his life, however, Kraepelin began to have second thoughts. He came to believe that that the line differentiating the psychotic disorders, and even the line differentiating mental health and mental illness, were not as sharp as he had previously believed.

Why is this relevant today? For most of the twentieth century, Kraepelin’s views about psychiatry were overshadowed by the ideas of his more famous contemporary Sigmund Freud. Unlike Kraepelin, Freud theorized that there was a continuum between mental health and mental illness, with no sharp line differentiating them. All of us could become mentally disturbed given certain life circumstances. But in 1980, Kraepelin’s ideas resurfaced with full force, embodied in the neo-Kraepelinian manual known as the DSM-III.

We are all familiar with what happened next. Kraepelin’s interest in classification and speculation about biological causes of emotional problems has dominated American psychiatry and our lives ever since the publication of the DSM-III and its successors.

But here’s the interesting thing. Along with Kraepelin’s ideas came, in time, a deluge of neo-Kraepelinian regret. Robert Spitzer, the author of the neo-Kraepelinian DSM-III, acknowledged that no biological markers have ever been identified for the mental disorders in his manual (other than organic disorders like epilepsy and Alzheimer’s disease). Psychiatrist Allen Frances, lead author of the DSM-IV, has admitted that his manual cast too wide a net for the A.D.H.D. diagnosis. Psychiatrist Edward Hallowell, whose books promoted the A.D.H.D. diagnosis and stimulant treatment for both children and adults, has his own regrets. He says he is sorry that he told parents that stimulant drugs were “as safe as aspirin.”

And, according to a recent New York Times article (Feb 2, 2015), even Dr. Peter Jensen, former head of child psychiatry at the National Institute of Mental Health and a longtime outspoken advocate for medication treatment of A.D.H.D., is starting to backpedal. In a small study of parents of A.D.H.D. kids, Jensen found that parental love and advocacy for one’s child produced the best outcome, with few parents mentioning medication. As I was reading the article in the Times yesterday, I reflected that here was yet another case of neo-Kraepelinian regret.

Thomas Insel, too, has retreated from the most recent neo-Kraepelinian manual, the DSM-5, calling it a set of definitions much like a dictionary. According to Insel, the manual’s weakness is a lack of “validity” since there are no objective laboratory tests for the various diagnoses. In other areas of medicine, Insel observes, “symptoms alone rarely indicate the best choice of treatment.”

However, we cannot include Insel among the those doctors who experience neo-Kraepelinian regret. Insel has not yet given up on the biological model of mental illnesses or the idea that mental disorders are discrete entities. On the contrary, in launching the Research Domain Criteria Project, he hopes that genetics, brain imaging and neuroscience will unlock the biological causes of mental illness. Only time will tell if this endeavor will lead to yet another wave of neo-Kraepelinian regret.

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

23 COMMENTS

  1. ” Insel has not yet given up on the biological model of mental illnesses or the idea that mental disorders are discrete entities. On the contrary, in launching the Research Domain Criteria Project, he hopes that genetics, brain imaging and neuroscience will unlock the biological causes of mental illness. ”

    Of course, he has to. Because without that, he is not only out of a job, but he’s responsible for lots of damage to millions upon millions of people…

  3. Frieda Fromm-Reichmann is gone, but her legend lives on and on. Joanne Greenberg was a fortunate patient and Dr. Frieda was fortunate, also. Fortunate that in Joanne she found a bright, witty, well read young lady with a passion for life. Many of her patients were older and lacked Joanne’s zest for life.

    If Dr. Frieda had not been Joanne’s therapist, she may have remained sick. Today, with the help of modern science’s most advanced medicine, someone like her, without the intervention of a Dr. F., still might enjoy a measure of mental health undreamed of just a century ago.

    I don’t think talk therapy, human relationships, unconditional love, skilled and devoted health care professional/loved ones on the one hand and drug therapy on the other are necessarily mutually exclusive.

        • “Are any valid scientific studies supporting the long term benefits of SSRIs, for example?”
          None that I know of.
          “If reduced dosages are effective in the short term and are not harmful, should they be used?”
          Well, first of all even the short-term effectiveness is being disputed (look up meta-analysis of anti-depressants by I. Kirsch). Secondly, even if there is some limited short term benefit the problem is:
          a) how is this benefit assessed (is the fact that someone is slightly less anxious and has therefore scored 2 points less on adeprssion scale or something good enough to tell that these drugs do something valuable?)
          b) is it ethical to put people on these drugs short-term even when it’s known they have severe withdrawal effects and some people may not be able to come off them and suffer sometimes irreversible, life-long adverse consequences?
          c) is it a good idea to use drugs which even if have some slight benefit come with a range of unpredictable short-term adverse effects which can lead to death (suicidal ideation, serotonin syndrome) and which are impossible to predict prior to drugs use?
          In my mind these drugs should not be used except for in very rare cases and always voluntarily upon full informed consent. That is not the case today.

      • “Unfortunately, the real, scientific studies do not support your claim. True, the drugs seem to be helpful short-term, in smaller doses than most psychiatrists prescribe; but over the long term the neuroleptics take away most peoples’ chances of living a rich and fulfilling life.” Mr. Gilbert

        Can you point to the sources for the opinions you have shared here? Thank you

        • As far as the junk science, invented, voted in ADHD life destroying stigma to push the vile kiddie cocaine drugs to a make a literal killing by biopsychiatry when it sold out to Big Pharma in the 1980’s, I will trust Dr. Fred Baughman, lifelong Child Neurologist, and author of ADHD Fraud any day of the week when he speaks of such psychiatric fraud as the worst medical crimes ever perpetrated against humanity. We can thank Dr. Joseph Biederman for such crimes against children when he personally sold out the nation’s children to the drug companies he was truly serving when he almost single handedly created both the ADHD and bipolar epidemics in children just like DSM III and IV perpetrators created the adult bipolar epidemic in adults and now the DSM V perpetrators are pushing for adult ADHD. This Dr. Mengele like psychiatric monstrosity never ends. And ADHD drugs are now being promoted for the brand new DSM bogus stigma of “binge eating disorder” with an article about it posted in the news section of MIA with many upset because these toxic drugs put people at risk for heart attacks and other lethal effects with children far from immune as many children have died from these dangerous drugs.

          And the real experts have exposed that any supposed differences in the brains of so called ADHD and normal kids are due to the toxic drugs given to those stuck with a junk science ADHD stigma due to abusive families, bullies and other social stressors and certainly not any faulty brains. Diet may be a factor especially today, but the current model is always blame the victims for any lethal effects inflicted by the current robber barons of our time, the real “patients” of psychiatry today as was the case with the robber barons of the 1930’s who along with psychiatry created the eugenics theories that led to the Nazi Holocaust after psychiatrists practiced by gassing to death those they stigmatized as “mentally ill.” Today, they just drug and shock children and adults to early death by about 25 years after torturing and profiting from them during their greatly shortened lives thanks to the biopsychiatry/Big Pharma cartel.

          And Dr. Thomas Insel, Head of the NIMH, has admitted recently that all DSM junk science stigmas that would include ADHD, bipolar and other recent voted in fad frauds of psychiatry are totally INVALID and lacking any science, medical or other evidence whatsoever.

          Thus, I think that despite blakeacake’s attempts to “educate” MIA members about all the great science behind the bogus invented ADHD stigma created to push amphetamines on innocent children that have been proven to cause much harm and little help or positive results after about three years and often ending up with an even worse bipolar assault due to the lethal effects of the kiddie cocaine pretense of help, MIA members and many others are all too well informed about the total junk science behind ADHD, bipolar and any other life destroying degradation rituals perpetrated by psychiatry/Big Pharma to force their brain disabling treatments on a literally brain washed public. But, the cat is out of the bag and more and more people are catching on thanks to all the corruption exposed in both psychiatry and Big Pharma not to mention all the destroyed, disabled lives exposed by Robert Whitaker in his many articles and books like Mad in America and Anatomy of an Epidemic.

          • psychiatry created the eugenics theories that led to the Nazi Holocaust after psychiatrists practiced by gassing to death those they stigmatized as “mentally ill.”

            Well Donna, I don’t think we should be too concerned that we are going to be gassed by Dr. Hallowell or Dr. Ratey. Besides, I think our government officials would be at much greater risk if a new wave of persecutions targeted the mentally ill.

  4. “Unfortunately, the real, scientific studies do not support your claim. True, the drugs seem to be helpful short-term, in smaller doses than most psychiatrists prescribe; but over the long term the neuroleptics take away most peoples’ chances of living a rich and fulfilling life.” Mr. Gilbert

    Can you point to the sources for the opinions you have shared here?

    Hello Mr. Gilbert. I am still interested in your response. Thanks

  5. What is so interesting about ADHD is the way those who are afflicted with deficits attending can hyper- focus on those things that stimulate their interest. Confounding is another appropriate term. Just the novelty of a first interview with a health care professional for an assessment often masks the ADHD. Novelty often triggers the attending “apparatus” in our brains.

    Considering the complexity of the human brain, it makes sense that it will not function perfectly at all times. Composed of roughly 1oo billion neurons, it is a marvel without competition. It is amazing that it works at all. It is susceptible to the full range of weaknesses, injuries, deformities, diseases, etc. common to the human condition. Even the blood brain barrier cannot protect the brain from all forms of assault. If it was capable of perfection, if everyone could pay attention perfectly, all the time, for example, we would be advanced beyond comprehension. Being flesh and blood, perfection isn’t possible. It would be nice! Don’t get me wrong.

    • blakeacake,

      So, in other words, your alleged ADHD supposedly enables you to hyper-focus on the confusion on your part generated by novelty, instead of the ‘nature’ and the content of that same novelty? Well yeah, definitely gotta take a pill to further enhance the confounding element to this effect.

      “What is so interesting about ADHD is the way those who are afflicted with deficits attending can hyper- focus on those things that stimulate their interest. Confounding is another appropriate term. Just the novelty of a first interview with a health care professional for an assessment often masks the ADHD. Novelty often triggers the attending “apparatus” in our brains.” – blakeacake

      Please feel free to correct my reading of your comment, blakeacake, could very well be that the confusion is all mine, naturally.

      Britta

    • “What is so interesting about ADHD is the way those who are afflicted with deficits attending can hyper- focus on those things that stimulate their interest.”
      So like regular people. Everyone is able to concentrate better on new things, especially if they appear interesting. Even rodents do that. It’s not some spacial feature of ADHD-stricken people, it’s like this for everyone.

  6. “True, the drugs seem to be helpful short-term…” Gilbert

    “you are aware that stimulants cause a manic reaction…” AA

    My ability to sustain my attention is good (a miracle) and has been ever since I started taking my meds years ago without increasing the dosage.

    • blakeacake,

      You took my quote totally out of context when I mentioned that a parent you had quote about his son being treated for ADHD and bipolar might have had a manic reaction to stimulants since they are known to cause mania.

      Please stop doing that and respond to what commentators said which you never did with my post. That is great you haven’t had side effects but many people who take stimulants do, including me who had severe adverse affects many years ago that set me on path of what I call psych med hell.

      Anyway, I probably need to stop responding to your posts because you seem to not want to have any type of discussion.

    • Almost everyone’s attention will increase on these drugs – that’s the general effect they have. There’s a reason why students take amphetamines before exam sessions and so do the soldiers when they have to stay awake and focused for a long time. There is nothing that these drugs specifically treat in “ADHD patients” – they are at best performance enhancing agents. It also does not change the fact that these drugs are as healthy as steroids taken by athletes – they may “help” you concentrate but they won’t give you a talent you do not have and they come with a whole range of nasty side effects (including death) and the chance of really bad stuff happening to your health increases with dose and time for which you take them

  7. “Are stimulants safer than aspirin? Unequivocally, yes. Web MD lists 38 side effects of aspirin and many of them are potentially fatal. Taken daily as many do for various ailments, aspirin’s most lethal side effect is bleeding. It can lead to brain hemorrhage, bleeding in the stomach, hepatitis hemolytic anemia, decreased platelet cell ability to clot. Kidney difficulties, seizures, and life threatening allergic reactions are amongst other difficulties.”

    Stuart L. Kaplan, M.D., is a clinical professor of psychiatry at the Penn State College of Medicine.