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11 COMMENTS

  1. “But many of the most severely ill people never even seek treatment — the majority of them because they don’t believe they have a problem that needs treating.”

    You think?

    This is paternalistic rubbish. No wonder it references E. Fuller Torrey. Need versus Liberty, huh? How about a person’s need for liberty? Obviously “need”, in this instance, is going to be determined by some outside party.

    It’s a crying shame to find people on this site playing “mental health” cop. When it comes to “news”, you can do better.

    • I pointed out this 3-article series to the news editor a few days ago, which might be why it’s here. I did not point it out because I endorse it or thought MIA would. It’s of interest because it’s by the cardiologist who wrote a manipulative, illogical series for NEJM last year, saying conflicts of interest really aren’t anything to worry about. She was the darling of the Ivy League careerist MDs on Twitter for a few weeks; the fawning was close to obscene. Then critics started in, and opposition and opprobrium were delivered by the bushel.

      I found the piece lacking in impact and insight. Sort of a nothing. No firestorm of criticism on Twitter yet, which is probably a disappointment to the author.

      Matt S. picks it apart below.

      • It might help if somebody would publish a piece critical of this kind of garbage. “Liberty versus Need” is an excuse for depriving people of liberty. It’s good people are picking it apart, on the one hand, it’s annoying that it’s here at all on the other. I imagine there are arguments for treating adults like children, if adult children is a outcome you find desirable, however then what do we do with the adult world? The world in which people are accountable for their actions? One group, I suspect, is arguing against the liberty of another group, while hanging onto their own freedoms, and pleading personally “not needy”. It is the “needy”, in their view, who should have no “need” of liberty. There is a sort of standard argument that freedom for people deemed “mentally ill” isn’t really freedom, and that freedom for them is confinement, until they get their wits back. Well, I’m as content with my liberty now, and of a sound frame of mind, as I was distressed at my confinement, when I was in a state of mind that could have been described as “psychotic”. I’m not congratulating anybody for having taken my liberty away and for having tortured me. I believe the real contrast was always between free men and slaves, wasn’t it? It doesn’t seem that you’ve got many descendants of slaves who are nostalgic for slavery. Are they, perhaps, deluded, or is it just that they haven’t, universally anyway, been given psychiatric diagnoses? I suspect somebody must be dealing from the bottom of the deck, that is, somebody is being deceptive.

    • It is paternalistic rubbish.
      “Although these medications are “clearly effective,” and many patients who are unable to take one drug fare better on another, we do need better drugs.”
      –Guess who she quoted for “clearly effective?” Jeffrey Lieberman. Why did she put the term in quotes? Because she knows it isn’t true. The sentence is a typical jumble of ideas. If the drugs are clearly effective, why do we need better ones? And who is “we”? Doesn’t she mean “they,” the people who receive the prescriptions? If many who can’t take a drug fare better on another drug, what about those who do not?

      “Such good and compassionate care is possible, but only if we […] are willing to accept, not deny, their differences.”
      –She’s saying that political correctness gets in the way of good “care.” She doesn’t understand that if there were good care, nothing would get in its way.

      “Why should schizophrenic delusions be left alone when we’d consider such an omission to be negligence in someone with psychosis from toxic metabolic encephalopathy?”
      –A classic Rosenbaum illogic. Answer: Because they are not caused by toxic metabolic encephalopathy.

      How’s this for a reference?
      “What is anosognosia? — backgrounder”
      Treatment Advocacy Center, June 2016.

      Despite the recent date, the link is dead:
      http://www.treatmentadvocacycenter.org/about-us/our-reports-and-studies/2098

  2. This was my critique of the Rosenbaum NEJM article on another forum. It’s a bit harsh on psychiatrists, but writing like this, they surely deserve some stern criticism:

    —————
    I’m going to quote here some parts of an article which exemplifies why psychiatrists are so poorly regarded relative to other medical doctors.

    The certainty of being correct about “severe mental illness”, sense of looking down from a cool Olympian height on “patients”, and lack of understanding of the subjectivity recovery is all there.

    It is no wonder that people are turning against such white, wealthy elites, as exemplified by recent events such as Brexit and Trump’s election, when so many experts such as this (white, wealthy) psychiatrist think they can impose their view about who is right on common people and their families.

    And this is from the New England Journal of Medicine – a supposedly prestigious medical journal.

    I am going to critique selected parts below.

    http://www.nejm.org/doi/full/10.1056/NEJMms1610124

    ————

    Quote: “Despite their conflicting messages, both stories reflect the pervasiveness and fallout of undertreatment. Approximately one quarter of homeless people in the United States have serious mental illness — a category comprising diseases such as schizophrenia, bipolar disorder, and major depression that cause substantial impairment.2 Most are not receiving regular psychiatric treatment, but undertreatment isn’t limited to the homeless. Of 9.8 million U.S. adults with serious mental illness, an estimated 40% receive no treatment in any given year.3 Those who get care often face protracted delays: the average lag between onset and treatment of major depressive disorder, for instance, is 8 years.”

    – The usual illusion operates that if only more treatment were available, outcomes would be significantly better. Those leading the system such as this psychiatrist cannot consider that their attitudes and treatments might be causing more harm than good. It’s tragic to see statements that show how removed psychiatry as a profession is from seeing its patients as human beings with subjectivity: “one quarter of homeless people… have serious mental illness”… “diseases such as schizophrenia… that cause impairment”…. “undertreatment”… “onset of major depressive disorder”…. as if giving someone a label explains what is causing “impairment”, as if these disjunctive entities actually existed as valid disease entities, as if one quarter of people had a disease and the other three-quarters don’t, as if undertreatment were the main problem, and so on. It really is like Alice through the Looking Glass.

    Quote: “Beyond homelessness, the clear consequences of undertreatment include fractured relationships, joblessness, victimization, substance abuse, incarceration, and early death. The causes of undertreatment, however, are less obvious. We tend to focus on structural problems, which are objective and often quantifiable. But the structural impediments to care can’t be addressed without reconciling the conflicting ideals underlying them.”

    There it is again – the idea that the “care” (is that the right word?) that psychiatrists have to offer should be given automatically and indeed forced, as if it is the only option. And the notion that undertreatment by the system leads to all sorts of bad outcomes, without any evidence offered as support of this statement. And by care, let’s be clear that they mean drugging, confinement, and then being monitored in the community while on drugs. Meanwhile, intensive psychotherapy or family therapy without drugs is not considered, despite the evidence for it in Gottdiener and Open Dialogue .

    Quote: “But early, consistent treatment requires stable community environments and available psychiatrists.”

    One cannot deal effectively with reality when illusions like this persist – such as the notion that available psychiatrists are necessary for consistent, adequate “treatment”.

    Psychiatrists have nothing to offer that other mental health professionals and peers do not.

    As I explained in my MIA article, there is no biological disease entity to treat with people labeled “schizophrenic”, despite all the colorful pictures of brain differences in those labeled which may be primarily explained by adverse psychosocial factors. Psychiatrists are not required to treat problems which do not have primarily biogenetic causes, but are instead most likely caused primarily by adverse social experiences and stress of all kinds.

    Quote: “One is that the side effects of antipsychosis medications may be unacceptable.
    Although these medications are “clearly effective,”8 and many patients who are unable to take one drug fare better on another, we do need better drugs.”

    The psychiatrist neglects to say, conveniently, that there is no evidence base for use of these drugs beyond one year, while citing a single quasi-experimental study as support of their contention. And effective at doing what? Any tranquilizer will be “effective” at quieting someone down and reducing their distress temporarily. That doesn’t mean it is treating an illness, let alone addressing the personality problems and primitive defenses that underlie their longer-term emoptional issues. And better drugs are not coming, since Pharma companies have seen the writing on the wall and are starting to lessen their investment in new psychiatric drugs.

    “Quote: But many of the most severely ill people never even seek treatment — the majority of them because they don’t believe they have a problem that needs treating.9 Because this self-perception makes them unlikely to identify themselves to researchers trying to understand their motivations, it’s difficult to quantify the contribution to undertreatment of such anosognosia”

    This idea represents the zenith of hubris in the psychiatric profession – the notion that by assigning “anosognosia” as a label to people who disagree with their approach, that this justifies the use and effectiveness of psychiatric treatment. As Auntie Psychiatry explained in pictures: http://www.auntiepsychiatry.com/Auntie%20Psychiatry.html#anosognosia

    “Quote: No matter how advanced mental illness is, however, without treatment, social unraveling seems inevitable.”

    Does 1 plus 1 equal 3 because I say so? What a bunch of bullcrap!! This made me laugh out loud this morning.

    Quote: “In the 1970s, Alan Stone, a psychiatrist and Harvard law professor, conceived the “thank-you theory of paternalistic intervention,” arguing that when someone with serious mental illness declined treatment, need ought to trump liberty if, once psychiatrically stabilized, the person was likely to be grateful for the intervention.”

    The “Thank you theory of paternalistic intervention” – another example of why so many in the general public do not trust psychiatrists.

    Quote: “Because language shapes our perceptions of the world, the insistence that we call people with serious mental illness not “patients” but “survivors,” “clients,” or “consumers” perpetuates underappreciation of their needs. “Survivor,” as Torrey notes, implies “survival of a traumatic event, specifically in this case involuntary treatment.” Words such as “client” and “consumer” emphasize that people with mental illness should participate in decision making15 — ignoring the impaired insight that may render that impossible.”

    How true that is – language shapes our perceptions of the world. “Underappreciation of their needs”, meaning what we, the psychiatrists, think they need (and force on them). Meanwhile, back in the reality that most non-professionals live in, it is in fact scientifically incorrect to call a person with “schizophrenia” a “patient”, since no serious scientist or doctor would ever do that, knowing that a disjunctive, unreliable label such as “schizophrenia” is not a valid illness category, and that psychoses occur with great variability along different continua and dimensions.

    Quote: “The risk arises when “recovery” becomes antagonistic to psychiatry. Although the message that everyone can recover may empower people with mental illness, it is simultaneously a subtle rebuke of psychiatrists, who are perceived as having acted solely out of self-interest in insisting that people with serious mental illness have a lifelong need for psychiatric care. But that belief flips causality: psychiatrists are no more responsible for the chronic needs often associated with schizophrenia, for instance, than medical doctors are for those associated with HIV. If a revolution is needed, surely it lies in more support, not less.”

    Recovery can and should be antagonistic to psychiatry, at least the psychiatry we have now. The public, including especially former people who escaped the system such as myself, can and should oppose psychiatry at every turn. It is not a subtle rebuke to psychiatrists, but a rebuke outlined in bright neon letters.

    As for “chronic needs associated with schizophrenia”, psychiatrists apparently continue to evidence no insight as to how their treatment and their reductionist attitudes about “illness” create the poor outcomes which then lead them to think that “schizophrenia” is a chronic disease. Talk about anosognosia in professionals…

    Quote: “Some recovery advocates use the vague ideals of the movement to sidestep scientific rigor. Regarding the absence of recovery-oriented commentary in scientific journals, for instance, psychologist and advocate Patricia Deegan, who was diagnosed with schizophrenia in her teens, writes, “Although the phenomenon will not fit neatly into natural scientific paradigms, those of us who have been disabled know that recovery is real because we have lived it. Such reasoning stifles dissent (who can argue with someone’s “lived experience”?) while justifying a lack of evidentiary standards. ”19

    It is amusing to hear a psychiatrist talk about scientific rigor, when their leading figures in the NIMH and APA such as Insel, Kupfer, Hyman, and Frances admitted that their diagnoses have no clothes in the past few years. And if psychiatrists wonder whether “scientific rigor” is effective in promoting recovery, they should look at the state of their profession, its fading respectability, and the woeful rates of recovery among people they have treated.

    Quote: “Questions about the role of treatment in recovery have been reinforced . . . by studies suggesting that some people with long-term use of antipsychotic medications do less well over time than those who are not on long-term medications”20 — an observation that’s as confounded by severity of illness as a conclusion that cancer chemotherapy is harmful because patients who receive more of it die sooner.

    The psychiatrist here predictably twists the Wunderink and Harrow data to fit their preconceived theory.

    Quote: “Another argument that questions the role of formal treatment derives from a 1988 review that suggests that people with schizophrenia in developing countries have better outcomes than those in Western societies.21 But the review acknowledges its methodologic limitations, including non-Western definitions of schizophrenia that may include more benign disorders.”

    And they do the same with the Hopper and Sartorius data, even when the re-analysis of that data came to the same conclusions.

    • To add to your critique: not only does the author not provide any data supporting that people off drugs have worse social and medical outcomes. The author does not provide any data suggesting that “treatment” leads to improved outcomes for those who receive it. This is psychiatry’s biggest dirty secret of all – people on the average don’t improve in key outcomes for any psychiatric intervention that have been studies. This should not surprise anyone – taking mind-altering drugs is known to have bad outcomes in the long term, but for some reason, folks want to believe that somehow the fact that a doctor prescribes the drug protects from the predictable long-term deterioration that messing with the brain inevitably creates.

      And I have to say, I’m impressed by their utter hubris in comparing Wunderlink and Harrow to cancer treatment! How is it that folks can’t see through this kind of smoke and mirror chicanery?

      — Steve

  3. From the cited article:

    a survey of patients in New York showed that 81% of them thought it helped them to get and stay well… Another study showed that patients who were receiving assisted outpatient treatment had better adherence to their medication regimens, better overall function, and less frequent and shorter readmissions.”

    I should have guessed sooner that this shameless propaganda piece would be a paean to AOT. Arguing with it too long gives it legitimacy, as would arguing the finer points of Mein Kamp. We see what they’re getting at and the totalitarian logic they’re trying to sell people on. The merger of physical (real) health and “mental health.”

    If someone has the time to check out footnotes 24-25 (I don’t) they might discover more about HOW those ridiculous “survey” results were derived. Maybe agreeing that AOT helped you is a required indication that you have recovered sufficiently to have the court order lifted: “I’LL SAY ANYTHING, NO MORE INJECTIONS PLEASE!!!”

      • Me too. And notice that all of the illustrative examples were the hard cases, living outdoors in the northeast. That’s the thing about Rosenbaum. She paints pictures for those who are willing to forget that there’s a world outside her words. She’s quite the menace in that her fantasies are published by an august journal where they reinforce the worst instincts of the worst doctors, and it all goes on where the general public would never think it possible.

        I assume you read “Re-connecting the dots.” If not, you must. But have someone you can rant to handy!
        http://www.nejm.org/doi/full/10.1056/NEJMms1502493

  4. There is no such thing as mental illness.

    Forced treatment must be outlawed.

    Giving psych meds to children must be outlawed.

    When a doctor is going to see a child, he must report to Child Protection, otherwise he is becoming an accomplice child abuser.

    Parents must be held fully financially accountable for harming their children, intentionally or otherwise, and disinheritance must be prohibited.

    Nomadic