Critical Psychiatry Textbook, Chapter 3: Are Psychiatric Disorders Detectable in a Brain Scan?

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Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he discusses how textbooks portray brain imaging data for psychiatric diagnoses and the flaws with that body of research. Each Monday, a new section of the book is published, and all chapters are archived here.

According to the psychiatric narrative, psychiatry is built on the biopsychosocial model of disease that takes biology, psychology, and socio-environmental factors into account when explaining why people fall ill.8

The reality is vastly different. Ever since the president of the US Society of Biological Psychiatry, Harold Himwich, in 1955 came up with the absurd idea that psychosis pills work like insulin for diabetes,4:46 biological psychiatry has been the predominant disease model.

Despite 15 years of intense studying, I have been unable to find any important contribution of biological psychiatry to our understanding of the causes of psychiatric disorders and how they should best be treated.

Photo of a young White boy with glasses looking at a giant sheet of brain imaging results, with a Black man smiling happily behind himThe strong belief in biological psychiatry is also dominant in the textbooks. There is a lot about brain scan studies and brain chemistry and comparatively little about traumas, other psychosocial factors, poverty, discrimination, and other poor life conditions, even though they are important determinants for psychiatric disorders.35,36,61

One textbook was particularly misleading as it noted that social causal factors such as poverty, loneliness, and housing shortages are of a more indirect nature and contribute to the maintenance of already established diseases.18:27

A little light shined through here and there. Elsewhere, in the same book, other psychiatrists contradicted this. They wrote that general improvements in housing standards, job opportunities, and family support have great importance for primary prevention, and that traumas, like losses and physical and emotional abuse, are important factors for development of psychopathology.18:293

Another book noted, with a reference,62 that childhood traumas are associated with elevated DNA methylation of brain-derived neurotrophic factor in patients with borderline personality disorder and that those who respond to psychotherapy have a decrease in DNA methylation.17:41 However, the quoted paper showed that, for all patients, psychotherapy significantly increased methylation. Thus, the information in the textbook was misleading, as one obviously cannot separate those who will respond beforehand from those that won’t respond. The authors of the paper even blamed the patients for the calamity: “Poor responders were mainly responsible [my emphasis] for the increase.”

The textbook authors went to great lengths to convince their readers that the origin of psychiatric problems should not primarily be sought in people’s living conditions but in the brain. Thereby they propagated the idea that psychiatric disorders are individual mishaps and not something that primarily comes from outside the individual and secondarily affects the brain.

We are told that biological psychiatry has created important results within genetics and psychopharmacology, and with imaging techniques,17:919 and that imaging studies in depression have led to increased knowledge of hippocampus’ role, which has produced clinically relevant results.17:910 Pretty conveniently, the authors “forgot” to tell us in what way the imaging studies have been useful for clinicians.

One of the textbooks explained that neuropsychiatry is a further development of what was formerly called biological psychiatry.17:207 But an erroneous idea does not become evidence-based or useful by giving it a new name, and to postulate that billions of people have wrong brains, which essentially is what biological psychiatry does, is as bad as it gets.

Schizophrenia and related disorders

The textbooks claimed it is indisputable that schizophrenia has a neurobiological background;20:401 that schizophrenia16:207,18:39,18:79 and affective disorders have an organic basis;18:39 and that MRI (magnetic resonance imaging) and PET (positron emission tomography) scans have shown brain atrophy and disturbed brain metabolism in patients with schizophrenia and depression.18:27

When declaring schizophrenia an organic disease, the psychiatrists focused on brain imaging studies and brain chemistry, and the information in the textbooks was often very detailed. For example, one textbook noted that patients with schizophrenia have enlarged ventricles, smaller temporal lobes (superior gyrus temporalis), smaller medial temporal structures (hippocampus, amygdala and parahippocampus) and smaller frontal lobes.19:227 In particular, the grey matter appeared to be affected. It was claimed that since several of these changes occur already at the onset of the disease, they are probably not a result of long-term medication.19:227

These claims are contradicted by studies that found that psychosis pills shrink the brain in a dose-related fashion and that the disease could not explain these changes,63,64 but the textbook authors avoided commenting on these well-known studies.

One of the textbooks admitted that some of the reduction in grey matter seen with PET scans or fMRI (functional magnetic resonance imaging, which measures the small changes in blood flow that occur with brain activity) may be caused by the use of psychosis pills but added that several changes occur already at the onset of the disease and that there are also brain changes in those who later develop psychosis.17:309 Another textbook noted that, although the brain changes were minor, they were also seen in people who have not received psychosis pills before.16:221

The problem with such statements is that brain scan studies are highly unreliable, as I shall explain in detail below. If any reliable studies had shown this, it would have been such a great triumph for biological psychiatry that we would have heard about them incessantly, but we do not, and in both cases, the authors did not give any references to their remarkable claims.

Another textbook claimed it was well substantiated that there are neuroanatomical changes; that psychotic patients have enlarged ventricles and 4% less grey matter than healthy people; and that first-episode patients also displayed this, albeit to a lesser degree than in chronic patients.20:405 On the other hand, the authors also noted that the findings were contradictory, with reference to a meta-analysis of over 18,000 subjects with schizophrenia,65 and they noted that, although there is a progressive loss of brain tissue over time, it is very difficult to separate causal factors, e.g. drugs and drug abuse.20:406

This honesty did not last long. The same authors claimed that untreated psychosis increases the loss of brain volume and that it is likely that psychosis pills can offer some protection. This has never been shown, and it is extremely unlikely. Psychosis pills do not protect the brain; they harm the brain in numerous ways (see Chapter 7). Many studies have shown that psychosis pills kill nerve cells,4:176,5:63 and they shrink the brain, too.63,64

Affective disorders

For affective disorders, the textbook authors’ opinions were more divided than for psychoses. Some were highly confident that the diseases are biological, while others had reservations.

We are told that depressive conditions are associated with neurobiological changes; that there is nonspecific white matter change;17:357 that cognitive difficulties in affective disorders may be related to neurodegeneration;17:358 that MRI and PET suggest a significant biological component;18:113,18:122 that prolonged untreated depression may explain the brain atrophy that can be measured;18:124 and that bipolar children have decreased amygdala volume and an altered connection between the prefrontal cortex, the basal ganglia, and the limbic system.19:216

One book one noted that recurrent or prolonged depression causes atrophy of the hippo-campus.16:267,16:557 In the same book, however, other authors wrote that it was not clear if white matter hyperintensities in bipolar were caused by the disease or the treatment or were present before any of these.16:295

This was one of the very rare admissions in the books that the changes observed on brain scans might be caused by the drugs. Usually, this possibility was totally ignored, as it also is in scientific articles. An editor of one of the textbooks,18 professor Poul Videbech, published a meta-analysis in 2004 of imaging studies66 that reported that depression causes a reduction of 9% in the size of the hippocampus, which one of the textbooks quoted.20:433 Discussing the limitations of his study, Videbech noted that cross-sectional studies such as those he had included in the meta-analysis cannot conclude about causality. He asked: “Does the depression cause shrinkage of the hippo-campus or are subjects with small hippocampi susceptible to depression?”

It did not occur to Videbech that people with depression are treated with depression pills, and that it could be the pills that caused brain atrophy. He did not mention this possibility, not even when discussing confounders where he included stress and alcohol abuse. He noted that, in three studies, a smaller volume in the right hippocampus or reduced density in the left “was linked to poor response to antidepressant medication,” and that, if this result is confirmed, “it is clinically very interesting as a potential predictor of treatment response.”

I cannot make any sense out of this sentence. It seems to me that Videbech suggested that, perhaps in future, all depressed people should have a brain scan. This won’t happen.

ADHD

Strangely, ADHD—one of the most controversial diagnoses in all of medicine—was claimed to be one of the psychiatric disorders with the strongest evidence for a neurobiological etiology.17:612 It was called a neurodevelopmental disorder,16:462 or a neuropsychiatric developmental disorder,17:610 characterised primarily by biological risk factors, and not primarily by exposure to psychosocial risk factors and stressful events in childhood.19:51 It was claimed that ADHD represents a cerebral organ dysfunction and that clinical and neuroradiological studies have shown dysfunctional activity in the frontal lobes.19:112

Historically, ADHD was called “minimal brain dysfunction” and the focus was on a structural brain damage no one had ever seen.17:610

The fact is that ADHD is a social construct and that no reliable studies have shown any biological origin for this construct, or that the brains of people with this diagnosis are different to the brains of other people.7,10 One textbook that noted that CT and MRI scans had shown less brain tissue and less white matter acknowledged that there are many methodological problems with imaging studies.17:612

In contrast, a chapter on ADHD written by two psychologists had no reservations.20:469 It claimed, with references, that patients diagnosed with ADHD have smaller size of especially the right caudate nucleus, cerebellum and the total volume of the brain;67 that they have less grey substance in the right caudate nucleus, ventromedial prefrontal cortex and rostral cingular gyrus, which are not related to the use of ADHD medication;68 and that fMRI scans have also shown differences to healthy people.69

It would be a waste of time to read these papers because the whole scanning literature is highly unreliable (see below on this page). But briefly, the first study was a meta-analysis of MRI studies that included all regions across all studies and found global reductions for ADHD subjects compared with control subjects, with an effect size of 0.41.67 An effect size this big is a measure of the amount of bias in the reviewed studies and not of true differences. In other words: garbage in, garbage out.

The second study was also a meta-analysis, of predominantly very small studies, which we know are highly unreliable.68 It included two datasets, and one had only 34 patients with ADHD in the studies, on average, the other only 16 patients.

The third study included 20 patients with ADHD.69

All three papers and similar ones should be ignored. The psychologists dressed themselves as serious scientists and then quoted pure garbage.

Anxiety disorders

A textbook noted that brain imaging studies had shown changes in amygdala in children with anxiety disorders but mentioned that it was not known if this was the cause of the disorder or a consequence of it.19:146

The other textbooks had no such reservations. Two psychologists wrote that patients with OCD have a dysfunction in the brain’s frontostriatal circuit, which is the connection between the frontal lobes and the basal ganglia and thalamus, and that the metabolism in the right caudate nucleus was reduced if the patients had taken depression pills or had received cognitive behavioural therapy.20:479

Other authors wrote that patients with OCD had brain atrophy and increased grey matter but offered no references in support of this astonishing claim.17:418

We are told that the basal ganglia, thalamus and orbitofrontal part of the cortex are involv-ed;19:162 that some studies have shown normalisation of dopaminergic hyperactivity in striatum after treatment with depression pills or cognitive behavioural therapy;17:419 that imaging studies have shown overactivity of the orbitofrontal cortex and caudate nucleus in patients with OCD that disappeared on successful treatment with drugs or psychotherapy;16:364 and that effective drug or behavioural therapy can normalise the affected brain areas.19:162

The last two sentences are tautologies. They contain empty information like in the sentence: It will either rain tomorrow or it will not rain. If “effective” or “successful” treatment is used, the brain changes are normalised. If they are not normalised, the treatment was not effective, or the patient was treatment resistant. This is a win-win situation that seems to confirm something that is not correct, namely that there are brain changes in the first place.

Brain scan studies are highly unreliable

We should be highly sceptical towards the results of imaging studies. The textbooks did not convey much doubt but the one where all three editors were psychologists noted that they were aware of the limitations of the methods used in imaging studies and they questioned the findings that had been made.20:10

Another textbook noted that the findings obtained with structural and functional scans were inconsistent and varying, especially those obtained with functional MR scans that measure small changes in blood flow to various areas of the brain while the patient is given various tasks.17:329

This whole area is a mess of highly unreliable research.7:233

A 2009 meta-analysis found that the false positive rate in neuroimaging studies is between 10% and 40%.70 And a 2012 report written for the American Psychiatric Association about neuroimaging biomarkers concluded that “no studies have been published in journals indexed by the National Library of Medicine examining the predictive ability of neuroimaging for psychiatric disorders for either adults or children.”71

One good research paper can sometimes make hundreds of poor studies redundant. This is the case for a 2012 systematic review by Joshua Carp that surveyed the methodological state of the art in a random sample of 241 fMRI studies.72

Carp found that many of the studies didn’t report on critical methodological details about experimental design, data acquisition, or analysis, and many studies were underpowered. Data collection and analysis methods were highly flexible. The researchers had used 32 unique software packages, and there were nearly as many unique analysis pipelines as there were studies. Carp concluded that because the rate of false positive results increases with the flexibility of the design, the field of functional neuroimaging may be particularly vulnerable to false positives. Fewer than half of the studies reported the number of people rejected from analysis and the reasons for rejection, and the median sample size per group was only 15, which generates an enormous risk of selective publication of those results that happened to agree with the investigators’ prejudices. The order of processing procedures also permits substantial flexibility in the analyses.

Replication is essential for the trustworthiness of science, and scientific papers must report experimental procedures in sufficient detail that allows independent investigators to reproduce the experiments. This is far from the case in imaging studies.72

Carp published another important study in 2012.73 He sought to estimate the flexibility of neuroimaging analysis by submitting a single fMRI experiment to the many unique analysis procedures described in the literature. Considering all possible combinations of these strategies, he came up with 6,912 unique analysis pipelines.

“Nearly every voxel in the brain showed significant activation under at least one analysis pipeline. In other words, a sufficiently persistent researcher determined to find significant activation in virtually any brain region is quite likely to succeed. By the same token, no voxels were significantly activated across all pipelines. Thus, a researcher who hopes not to find any activation in a particular region (e.g., to rebut a competing hypothesis) can surely find a methodological strategy that will yield the desired null result … Selective analysis reporting may occur without the intention or even the awareness of the investigator. For example, if the results of a new experiment do not concord with prior studies, researchers may adjust analysis parameters until the ‘correct’ results are observed.”

In a multiple observer study published in 2020, the researchers had asked 70 independent teams to analyse the same dataset, testing the same 9 ex-ante hypotheses.74 The dataset included fMRI data from 108 individuals, each performing one of two versions of a task that was previously used to study decision-making under risk. The teams were asked whether each hypothesis was supported based on a whole-brain-corrected analysis (yes or no). On average across the 9 hypotheses, 20% of teams reported a result that differed from most teams, which was midway between complete consistency across teams and completely random results. This study demonstrated that analytical choices have a major effect on the reported results.

In 2021, researchers reported that after they cautioned in 2016 that there are so many sources or error in imaging studies that findings should not be considered definitive but only suggestive, 24 MRI studies had appeared in JAMA Psychiatry and 22 in the American Journal of Psychiatry describing differences in such scans in samples of psychiatric patients.75 All 46 studies concluded that their findings are evidence of changes in brain structure.

In 2022, other researchers used three of the largest neuroimaging datasets available including a total of around 50,000 individuals to quantify brain-wide association studies’ (BWAS) effect sizes and reproducibility as a function of sample size.76 The median sample size was only 23 people. The researchers found that BWAS reproducibility requires samples with thousands of people.

As a commentator wrote, the study showed that almost every person diagnosed with depression will have the same brain connectivity as someone without the diagnosis, and almost every person diagnosed with ADHD will have the same brain volume as someone without ADHD.77 Yet, in the small studies, correlations were almost always greater than 0.2 and sometimes much larger, which, as the researchers wrote, should not be believed.

The conventional method for dealing with this problem is to increase the threshold for statistical significance. However, this will backfire in these small MRI studies because it inadvertently ensures that only the largest—and thus the least likely to be true—brain differences end up passing the significance test and being published.

The experience of the Editor-in-Chief of Molecular Brain is also relevant to consider when assessing the merits of brain scanning studies in psychiatry. In 2020, he described what happened when he requested to see the raw data in 41 of the 180 manuscripts he had handled.78 Upon his requests, 21 of the 41 manuscripts were withdrawn by the authors, and he rejected a further 19 “because of insufficient raw data,” which suggested that the raw data might not exist, at least for some of the cases. Thus, only 1 of 41 papers (2%) passed his reasonable test.

Unfortunately, brain scan studies have a psychological component. People are more prone to believe what they do not understand, which means that the more the result is imbedded in unintelligible but seemingly advanced statistics, the more likely it is that the readers will believe it.

Researchers have coined the term “seductive allure of neuroscience explanations” (SANE), which is a real phenomenon. Several studies have shown that people show greater trust in studies with neuroscience language and graphs, especially if there are brain images.79,80

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To see the list of all references cited, click here.

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

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32 COMMENTS

  1. I am enjoying reading Critical Psychiatry Textbook very much, but would like to confirm how many times Peter C. Gøtzsche’s works have been cited. I have seen on Google 30,000, and here it is 150,000. However any citations there are, ideally the book would be required reading for anyone working in the so-called “mental health” (aka mental illness) field. Then perhaps we could dispense with putting people into categories manufactured by u.s. psychiatrists and adopt something more reality-based, such as, the Power Threat Meaning Framework. And perhaps further down the trail we might be able to dispense altogether with “frameworks” of any kind… https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework

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  2. If I understand what I’ve just read [twice]:
    To create the marketing of brain scans, they bypass true science by
    1) not reporting methodology or how many people were dismissed from the data
    2) having very small sized groups where there is more chance of finding correlation
    3) use of enough analyses pipelines that by changing the criteria or analyses parameters one eventually finds a correlation, but this is based on adjusting the parameters until one of the pipelines find a correlation.
    4) and then there is the tautology of there is this concordance with people who we find in remission, but with those who aren’t there isn’t such a concordance, which works with anything. This person did that, and they are in remission, everyone else lacks that. Added to this, those not treated with the biological ideology, they are more likely to have chronic problems, so in reality the correlation is with those where there is no correlation with their method.

    How many people have had this kind of stuff thrown at them?
    When a clinician, even in a setting that they aren’t there to give a diagnosis, that any behavior can suddenly be misinterpreted to be a symptom.

    I could go over a whole list of them myself. And it’s quite baffling. In fact a voice told me, while taking a parks and recreation yoga class from a person who also was a social worker, to not even ask her questions, or anything, to just go to class and leave, and I knew there was no concern, and didn’t heed the voice. And then I found out that ANYTHING could be misinterpreted, was she paranoid or suspicious, literally ANYTHING, and then she also lied added to that:

    1) If I shared stuff that I shared with all sorts of people (I have nice CDs of my own compositions I play on the piano, which I had given the yoga teacher in the prior class, who said it was good music, other people love it, one lady gave it to her sister who wouldn’t give it back being that it was the only thing that got her to go to sleep at night), and suddenly I was giving her “special” gifts and psychotically in love with her (I’m gay, I was in no way in love with her, I found her quite repulsive pretentious and coy, but she had a commitment to yoga I at that time admired, which I no longer do).
    2) When she thought something was going on with me, and it wasn’t, and she had asked friends of hers to walk to her car, I supposedly was stalking, harassing and trying to intimidate her. All I did was after class have to settle down, I also rode a bike, and so had to put warm clothes over my sweat suite, and also her classes weren’t really good yoga, too fast, and so I had to come down from that as well. I never did anything but get ready, and then leave, which usually was after she had left already completely, car and all, I never had any intention of having anything to do with her after class, had no interest in her other than taking yoga, I never made any approach towards her while she was going to her car, etc. But that she had suspicions about something not going on, and she had friends walking her to her car, this could be seen as if I was stalking her etc. It was completely not true. In fact ANYBODY she had suspicions about enough to ask others to walk her to her car could suddenly find themselves accused of such nonsense. I remember also that she said anyone could ask questions after the first class. So, I had mentioned how much yoga helped me, and then offered one of my CDs, she wanted to play that in class, but I didn’t know if I could concentrate with my own music playing, and I might have ideas of how to change something. That REALLY was all, other than I noticed that she slumped a bit, and her posture wasn’t good, so myself in contrast straightened up. Nothing more than that. She then made out of this that I was two inches higher than I am, about 30 pounds heavier, and that I was looming over her trying to intimidate her. Absolute nonsense.
    3) Sometimes, after class while I was getting ready, she might be talking to someone, and I’m not deaf, so I would hear what she was saying. It also was sometimes interesting, because she was so different from my friends, and it was like reading a book, and taking in a characterization. She instead thought I was listening intently to what she was saying, as if I don’t know what.
    4) I once had a brief discussion regarding vaccines. She had been complaining about the pain in her arm, because working as a social worker in a hospital she is required to have them, and I simply asked: “do they really help as much as they say they do?” I think beyond any discussion about vaccines, that this doesn’t mean you are safe of the rest of the world is safe from you, you STILL have to take care of your health, eat healthy, rest, not get stressed out etc. I was really calm, but she got snippy, and then when I didn’t show up for the next class, she said I was resentful because of a disagreement. Which AGAIN she was trying to make out I had some fixation I didn’t have. It also wasn’t true at all that that had anything to do with me showing up for class or not, I had actually gone to the bus with my bike (there’s a rack on the bus for bikes, so you can travel with them) but the rack was full, and I had really bad eczema and riding that far on my bike rather than the couple of blocks to the bus, this would cause sweating, and it was cold weather, I had to wear gloves, and that with the eczema would be like torture, as if someone is tearing your skin off, and so I didn’t ride my bike to the class. It was simply because the bus rack was full. No other reason. But then if I showed up for class, she felt free to make a multitude of incorrect diagnosis, and if I didn’t the same. Same sort of corrupt tautology.

    I could go on for quite awhile, for pages, with a whole bizarre relay of pin the tail on the donkey, how she would see something, decide this was a sign of something, and make erroneous interpretations. But I won’t right now. She also lied, or she was completely non reality based herself. She said that she said things she hadn’t, supposedly she told me to back off when I tried to share something, and she never had. She said that I stepped on her yoga mat, which I’m quite sure I never did. When I had a bad back and couldn’t do maybe 10% of the poses, and instead did the child pose (which she announced to the whole class, noticing it, that that is what you do when you can’t do a pose) or rested my head on my hand. THIS became that I supposedly spent 80% of the class with my head on my hand looking at her. And then there were more lies I won’t get into, it’s so sordid. The one thing I should point out is that at one point she actually maintained this following statement: “I know, he doesn’t hear voices, he sees things that aren’t there, it’s non reality based.” I had heard a very clear voice telling me to avoid her completely, and she proved there was complete reason for that. And this really proves she doesn’t know what she’s going on about. It only sounds good to make reference to specific supposed symptoms, and that this is there, but the other not, and make it sound like it’s whatever it’s supposed to be, but…. In fact, for the first time I realize how ridiculous such a statement is (she had gotten a restraining order, and she said this to a judge), because she didn’t, doesn’t, and wouldn’t know me well enough to make ANY of such a statement. It was totally pretentious. She didn’t know me, she doesn’t know me, she actually used what clearly pointed out her paranoia as something that wasn’t going on (I do hear voices, and they are accurate, not a sign of an illness)…..

    And what happened is that I was trying to communicate something that was impelling enough that it came in out of “nowhere,” but I didn’t see the context yet. So that was labeled non reality based, same as anything people are unfamiliar with, it supposedly can’t exist. I did have a bit of symbolic stuff going on, but that has resolved itself, actually. In fact the next day I knew I had been off, but then it was too late

    It’s a whole other world to get into what they saw as “non-reality based.” But I can simplify it that it was about investments, and she was investing in nothing but paranoia, and trying to validate something was going on that wasn’t. And I actually had picked that up because of a spirit friend of mine, and her youth. I talked with Mozart’s mother Anna a lot 30 plus years ago through a medium. In fact, during one pose in one of those classes, I saw Anna in my mind, but she was this rather wilted looking girl. In her youth. As if she was held back from just being there. It had been difficult talking to her through a medium, and I had asked her why there were the difficulties (did this in my mind, not through a medium) and she broke down and said she always wanted a family. Her father then had lost everything BECAUSE of investments. He wasn’t there anymore in her youth. But all this PARANOIA of this ridiculously suspicious social worker, that’s the kind of stuff that takes away a person’s ability to simply respond naturally. And then even, when I saw Anna, as an uncomfortable girl in that class, and teared up a bit, ONE OF that “social worker’s” friends saw me, and said: “and he starts crying.” At that time, I didn’t know what that was, not till afterwards I found that it was THAT friend that had suggested I was in her personal space (really just because I was interested in yoga, which she was supposed to be teaching), and she ACTUALLY thought that I was crying because I was in love with this person. Literally ANYTHING I did could be misinterpreted. And as soon as you say something they don’t understand, that they can list as psychotic, then all their “interpretations” are excused. It was completely the opposite also. It had nothing to do with it other than I was picking up what that kind of paranoia does to someone, the paranoia I didn’t know was going on, already. I was disassociating from it. What I thought, actually was that this paranoid social worker had been that father (if anything, I realized later she was the mother that made her daughter that uncomfortable, until Leopold came along), and picking stuff up from the place of no time didn’t make sense to whoever I tried to communicate that to. Investments are investments, whether bad financially are bad regarding paranoia that something is going on that isn’t. EVEN when corrupt people make money off of the bubble that later bursts and leaves many others in poverty, or that anyone gets a whole salary from what put other vulnerable people in an impossible position, where they are disenfranchised, misrepresented and discriminated against. This then was seen as crazy, what I tried to communicate regarding investment, and considering how I was disassociating from truly paranoia discriminatory stuff going on it wasn’t understood, although it DID get me out of that situations. But years pass and I did run into this father, according to me, the father Anna had lost, and investing in something else brought a miracle into my life. I had a tooth infection, basically because of the dental clinic doing work that wasn’t necessary, because there were students there, causing distress, causing me to grind at night, causing the infection in the end (and they didn’t tell me I was grinding at the beginning or ever that I needed a bit, or that I had traumatized the ligatures connecting the tooth to the jaw, they wanted to give me a root canal which I know better than to go for) and things got so bad I won’t mention it, but I didn’t give up on my miracle, and then there was a dentist, who I noticed wasn’t making the right kind of investments in treatment beyond standard approaches, but when I mentioned spiritual healing, he softened, and I recognized him as the “reincarnation” of that father, and I was showing what a good investment is. The simple acknowledging such a possibility. And I knew the tooth would heal, and after that I found a healer, who within a few months got it to be so much better that it wasn’t bothering me beyond being being annoying, in fact I had to laugh noticing I could do things I hadn’t been able to before, and two years later there is no infection (although it HAD been there for like FIVE years). Now, you can talk about investments, you can actually say there’s no such thing as reincarnation, or those people weren’t who I thought, but still the symbolism remains.

    And when one is dealing with reflexes towards life, what determines the future, so strongly that you can’t pin it down at all (can’t be “reality” based it depends on potential), it’s not inaccurate to say what they thought was dangerous psychotic (I actually had to deal with a person from parks and recreation saying to a group of people: “she says he could become violent” as if this was some serious concern, when given the whole PLETHORA of misinterpretations and paranoia, and lies, SHE is the one showing signs of that, no one else), I wasn’t a dangerous psychotic at all, I was picking up stuff from the place of no time, from a logic beyond linear time, a logic that envelops another potential to life not devoid or miracles, and that might be more objective than what they call reality based.

    Regardless of all of that, which I’ve just shortly tried to explain, that I wouldn’t feel anyone needs to believe or not, she was COMPLETELY wrong. I NEVER was in love with her. I didn’t really do anything that was harassing, intimidating or stalking at all, I certainly am not some dangerous psychotic that could become violent; but as soon as something happened that THEY dismiss as “crazy” all those misinterpretations aren’t even questioned anymore. Same as the plethora of pipelines and changing of parameters that could connect someone picking their nose with a sign of a serious psychiatric disease, that MUST BE biological in origin. https://pubmed.ncbi.nlm.nih.gov/7852253/

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  3. I’d like to see something added about how even if biological diferences exist, they are completely useless for any practical purpose.

    I remember a study that found quite a large difference in dopamine production in some part of the brain in people labeled as schizophrenic. A 1-sigma difference.

    Now that is completely useless in diagnosis. A test based on that with a sensitivity of 0.5 would have a specificity of 0.84 and – assuming a 1/100 prevalance – would produce over 30 false positives per true positive and label 16% [!] of the population as schizophrenic.

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    • Yup. You can’t diagnose a “disorder” from averages. Just because something is more common in a particular population doesn’t make it a causal factor, as many in the non-identified population still have the same “something,” just in somewhat smaller numbers. This is the big problem with both brain scans and “genomic” studies – they rely heavily on correlations, but as any beginning scientist knows, “Correlation is not causation.”

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    • beokay, I’m trying to look up those terms you use, but could you explain what these terms refer to:
      A 1-sigma difference

      a sensitivity of 0.5

      a specificity of 0.84

      a 1/100 prevalance

      And how this then ends up: “A test based on that with a sensitivity of 0.5 would have a specificity of 0.84 and – assuming a 1/100 prevalance – would produce over 30 false positives per true positive and label 16% [!] of the population as schizophrenic.”

      Because I believe you, and wish I could follow it, how such a result comes about.

      Even though we are talking about a mental construct that something is a disease, not even about a real disease. A condition from an environment, a normal response to an abnormal situation not acknowledged, these aren’t diseases. Poverty isn’t a disease. Living through a war isn’t a disease. etc. Having to deal with a brainwashed society isn’t even a disease….. to throw “disease” out the window, because where is it then?

      The disease of saying people are “diseased.” Sort of like school yard bullying, stereotyping, discrimination and eugenics.

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      • Please, watch this: https://www.youtube.com/watch?v=Z5TtopYX1Gc

        That’s basically the same way, I would explain it.

        In the second part he has two curves corresponding to the no-desease/desease states. An x-sigma difference refers to how far the peaks of the curves are apart. 0-sigma would mean the curves are identical. The height difference between men and women is around 2-sigma, to give you an example.

        Prevalence is the ratio of people with the desease in the total population. In the graph with the two curves that would scale the size of the deseased state curve.

        Hope that helps.

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        • Thanks. Thanks so much for sharing something I might enlighten myself, I couldn’t follow the terminology at all. Thanks for that! But this video actually explained it that I could understand: https://www.youtube.com/watch?v=vtYDyGGeQyo the one you shared works for someone already familiar with the terms, but hadn’t grasped them yet, perhaps. With the video you shared, the graph also seems to be incomplete, as it has no number showing at what level you get a positive test result as it moves to the right, in fact without numbers you wouldn’t know whether it was moving into the negative as it goes right, whether zero started somewhere in the middle, or who knows what. Anyhow, I couldn’t follow that at that point, but the other video helped.

          It does become something, when we are talking about sigma differences, and at what point someone is decided to have the disease (I imagine how many “symptoms”), but we aren’t talking about a real diagnosis. We are talking about when the system, or the psychiatrist, would decide they have the disease, at which point statistically, they are likely not to recover, if they get treated, or convinced by the system, that they need such.

          That DOES become a bit bizarre, that when you completely have no positive diagnosis of the disease, you have more recovery! What does that say about false positives!?

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          • What I was saying was the video you shared helped me to understand what specificity and sensitivity meant, but then I lost context, but the other video cleared that up. Thank you for directing me to somewhere I could enlighten myself to how such things are done.

            It’s quite bizarre to even look into this, because of schizophrenia, or dopamine hyperactivity is the symptoms of a disease, isn’t that most likely caused by the medications preventing the dopamine from being able to attach to the synapse, because something else has put itself there, and thus the brain starts making more dopamine. So, it’s actually AGAIN the diagnosis, and the treatment, that causes this symptoms they are testing for, which you pointed out when found isn’t even specific to the “disease.”

            Then it does become, just drug up all these people, and you have the “disease.” WELL! That was a Freudian, I first typed dosease, rather than disease. I corrected it though (!?)

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  4. https://youtu.be/GEwktv-AGEw

    Nice article Peter. I agree with much of it.

    However…if I may say so to you and you alone…

    I still believe the nuanced things I did believe before about the brain and body and mind and psyche all being impactful of each other in ways we do not yet have full understandings of. I still believe I have schizophrenia for sure and I still believe it has no good treatments. I still believe my brain is quirky and not made in a factory and therefore cannot be concluded well or not well, one way or the other way by outsiders of said brain. I still believe MRI’s are limited and that perhaps learning more about natural brain wave variations might be revealling. We all have many different kinds of brain waves. I still believe that since brain perceptions go quirky in schizophrenia that we should not do anything to the brain but give it a chance to heal itself with lots of people support. I still believe that people who have never had a schizophrenic hallucination or delusion should be telling people who do have such an illness that they do not have such an illness. I still believe that if you do have a diagnosis of schizophrenia and you despise it and refute it then you ought to be entirely free to dispense with it without repercussion.

    I am still an MIA heretic in as much as heresy involves being closely aligned to most of the beliefs in MIA, just not all of them. I still believe a healthy website should welcome the enquiring mind and not just the logical set mind. I still believe no science is foolproof. I still believe nurturing of illness by natural means is the best form of healing. I still believe that no one should be judgemental of poor people desperate enough to try pills when there really are no prevallent alternatives for them. I still believe that it is wrong to smear antipsychotic clutchers and imbibers as if they are drug addicts who should have moral scruples one day and just quit cold turkey. We dot regard alcoholics or heroin addicts as too slow to realize that what they are imbibing might not be good for them, but rather infinite compassion is shown towards their limited life choices. I still believe MIA gets many things right but some things quite wrong. I shall not say more…

    For my own part I am currently working on seeing if my schizophrenic hallucinations and delusions are caused by a mysterious mishap in my quirky brain, past trauma, stress imbalance and zany sleep disturbance. I am studying whether my schizophrenia might be a type of dreamstate. Research has proven that when humans sleep and enter into dream sleep there are indeed parts of their brain that wake up. It is not true to say that in dreaming the rest of us is out cold. Given that this being awake whilst dreaming can occur and nobody knows why, I believe it may also be possible to be dreaming whilst awake. I am seeing my schizophrenia as like a stuck lucid dreamstate or nightmare state that keeps happening repeatedly throughout the day and my hallucinations of touch form part of that brief altered state, just like in some forms of aura in temporal epilespy. There is then, by way of reaction to that influx of weirdness, an intellectual part of me who tries to “make sense” of that waking dreamstate, and it is this intellect that “feeds” the occurance with absurdly rational reasons for those bizarre sensations.

    Anyway Peter…The enclosed video link is interesting regards the covid debacle.

    So here, in the link above, is another stunning expose of the medical pharma treatment of covid. Spoiler alert…Haldol is mentioned.

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  5. Ps…typo mistake corrected…I meant in my previous comment that those people who have not had a schizophrenic hallucination or delusion should NOT be telling people with those experiences what those experiences are. Its a bit like people with no experience of dysphoria telling persons with it what those experiences are. I am against judgement. Which is what you seem also to be against, in being against snap medical judgement.

    I would have editted my comment but that facility was not there just now. Thus this add on.

    I am not up for reading or replying to further comments.

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    • I, for one, totally support your right to self describe as having schizophrenia, Daiphanous Weeping….
      And, how does anybody KNOW, FOR SURE, whether or not their hallucinations, and/or delusions, are normal, everyday, garden variety hallucinations and delusions, or “schizophrenic” delusions & hallucinations?….
      My VISIONS are NEITHER “hallucinations”, nor are they “delusions”….and they are certainly NOT “schizophrenic”….
      Feel free to reply, or not, but I certainly don’t expect you to, Daiphanous Weeping….

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      • No you misjudge me. I am delighted that you call your experiences Visions. Please continue to call what you believe is going on with you completely whatever you like. I am “for” everyone having this freedom.
        I don’t even mind if you respectfully believe that my experiences are visions.

        We must call whatever we feel we have what we want to call it. I just happen to feel okay about knowing my condition is schizophrenia for now. I am not in a hurry to change that just because someone else who is not me tells me I have to. But I might, with my freedom of choice, choose to change my mind tomorrow about referring to my own ailment as schizophrenia. Tomorrow I might call it visions. And on the day after call it schizophrenia. And on the day after that visions…and so on…because it is ALL UP TO ME what I call my interior experiences just as it is ALL UP TO YOU what you call your interior experiences…and this freedom is a good thing for each and every one of us.

        I will defend the right of the different, which means everyone, to HOLD THEIR OWN OPINION of whatever they believe about themselves.

        A belief about yourself is not a problem in the world. You can have any or as many beliefs as you like. Beliefs are not harmful. They are just feelings and opinions. Bullying IS harmful. A bully may USE the tenets of a belief to legitimate oppressing others but the act of bullying is independant of the harmless belief. Just as a bully may use the ideas in politics instead of a belief’s tenets to carry out bullying acts. The politics are intrinsically harmless. Just a bunch of abstract verbose ideas. The ideas, like tenets, may be inspiring or not, but they are a bit like inanimate books, they cannot fly across a room or do the legwork of actual bullying. I may not like the belief that a person might have in the Virgin Birth. It may seem peculiar and disturbing and nightmarish to me, yet I am more than happy for anyone to freely choose that belief for themselves. I am content to let many, many people believe preposterous things, even alarming things, unsettling things…if they choose to. I am clear that I do not “have to” believe such things just because they do. I am free to believe that my ailment is from the tooth fairy or a punishment from a wrathful God or from a bottle of fizzy soda or from oceanic pollution or my late father or inherited from a curse from Pharoh Rameses the third. It is ALL UP TO ME. Anyone can come with “their” belief and call me mad for believing I am mad. Anyone can impose their belief that I am unwell because I do not pray enough to the Virgin Mary or because I ought to read a better book on the pharoh or because I ought to filter my oceanic water or because because because! At some stage people ought to just let each other get on with believing whatever they like. And when people really do believe one hundred percent whatever they want to about themselves they will be less prone to having a worried need to defend their belief. It will become emphatic and secure within them. No need to squabble over it.
        The more “variety” of beliefs that people have the more enriching and exotic and diverse becomes our sharing of our harmless differences.

        The trouble in these times is…
        daring to be different is deemed dangerous by those in dominant groups. When that occurs you are NOT ALLOWED to call yourself a Visionary but must call yourself something the dominant group insists you call your own inner experiences…and I am NOT ALLOWED to call my own inner experiences schizophrenic anymore but am ordered to call myself what the dominant group insists I call my inner turmoil. We are told we are NOT ALLOWED to believe about ourselves whatever we find supportive for us to believe.

        I am against that pushy NOT ALLOWED TO…imposed “rule”. A person may come to me with stacks of new books from their belief, maybe a fresh scientific perspective, and proceed to tell me that what I believe of my own experience is “indoctrination”, just as that same person can go to someone who believes that the Virgin Mary has given them an experience of sorrows, and that person can try to persuade that believer that their cherished view about themselves is unscientific hogwash.
        I do not want to live in only a “science world” but much prefer that there are millions of optional beliefs one can hold about oneself. Loads of free choices. You might baulk at my using a rather sciency term for my ailment and inner experience but to me there is no such thing as reliable, absolutely true, absolutely irrefitable wisdom. It cannot be found in any belief or politics or religion or science. All of these ways of looking at things can only grasp an element of “the truth”, for that reason I consider “new science” to be just as bogus as “former science” and that both versions of science do not contain a perfect explanation of exactly why I hallucinate and have delusions but neither does the Virgin Mary or ANY belief. I regard therefore science as being a belief, about what we believe we know so far. And as a belief I do not take any of it THAT seriously beyond liking bits or it or not liking bits of it. I do take seriously WHAT I LIKE. And I feel you should take seriously WHAT YOU LIKE. Which is that you are a magnificent Visionary.

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  6. This is a very important topic and one of the biggest cards that is pulled out by both mental health workers and their patient/caretaker supporters to silence anyone who goes against their teachings. Most of us do not know how to read imaging, are not well-versed in statistics and are beholden to the mercy and charity of people who have those skills for truthful information.

    Over a decade ago, I was going through a phase of suffering where I was incapacitated by intrusive thoughts, a low mood and anxiety. Yes, my suffering was real (as is that of most other people). Yes, I sought help out of helplessness from psychiatrists because I didn’t know what else to do. Even if it was a terrible option, it was the only option available to me.

    Though I wanted help, I was skeptical about their field and their explanations to problems. I grew up in a medical/surgical household and the common lines which were uttered on phone calls were “What does the CT scan show? What are the results of the biopsy? What do the blood test results say? What is his creatinine level?” etc. There was no such thing here.

    A resident psychiatrist (I still remember his name), who was clearly offended at me questioning Psychiatry, told me rather pompously and adamantly “do you believe in MRIs and fMRIs? Let us read some literature first.” I thought maybe I was ignorant and I should go along. Psychiatrists also start giving you examples like hypertension and diabetes as analogies to the issues for which people end up in psychiatrists’ offices. “There is no blood tests to detect hypertension, it is just observation”. These are poor examples which have nothing to do with a person’s character, conduct, personality or sanity. They tell people that “there is nothing derogatory about psychiatric labelling, it is like saying you have diabetes”.

    Whatever treatments followed later had absolutely NOTHING to do with medical imaging. People bring up imaging to silence patients who ask too many questions or go against the teachings of psychiatrists. Even then, what they will show is journal publications and pictures in textbooks. NOTHING from the brain of the person they’re actually purportedly helping. If I have COVID-19, I see the results of my PCR test. If I have cancer, I see the results of the biopsy of my tissue. Not the results of someone else’s PCR test or biopsy in a journal publication or textbook.

    Psychiatrists and their patient supporters (and families) keep throwing around the excuse of “they are working on it”, which is rubbish that keeps people in the anticipation that someone breakthrough will come and that meanwhile they are getting the “best possible treatment known to ‘science’”. This anticipation is another thing that makes people go along with whatever psychiatrists say. This anticipation is similar to the religious anticipation people are fed about going to heaven if they don’t commit sin. In the mean time, patients are supposed to “take their meds and regularly attend ‘therapy’” which isn’t something that necessarily benefits the person sitting opposite to the mental health worker, but disproportionately helps the mental health worker himself in getting training, employment and research credentials (purely private practice psychiatrists/psychologists with small clinics are a different matter I think).

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  7. To revert to the general theme of PG’s “Psychiatric Disorders” series —

    The problem with thoroughly deconstructing psychiatry’s claim to legitimacy, then framing these discussions as being about “psychiatric disorders,” is that simply by labeling something a “psychiatric disorder” one is supporting the so called “medical model” — i.e. to call something “psychiatric” is to accept the premise that it is a medical issue. To practice psychiatry requires a medical degree, as opposed to a zillion forms of psychotherapy which do not consider themselves fields of medicine.

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    • I agree absolutely. The framing of these problems as “disorders” and the semi-arbitrary division of such issues as being some sort of unitary problems is in itself hugely problematic, and accepting that framing means we’ve lost 3/4 of the battle already. The DSM is the key to psychiatry’s claims of legitimacy, and I don’t think we can undermine psychiatry’s hegemony until we challenge the legitimacy of their bogus “nomenclature” and pretense of knowledge about things they have no real understanding of.

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      • There is a difference though between calling something “psychiatric” rather than saying “emotional” or “psychological,” as the latter two are not medical terms implying disease.

        The notion of “disorders” is a related but not identical issue; I think Szasz called “disorder” a “weasel word” designed to obscure the deception implied by “mental illness.”

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        • I agree. The drive to define things as “psychiatric” is as far from scientific as it could be. It’s a big-time marketing scheme, as the inventors of the DSM III have admitted out loud. And it of course is an effort to protect the status quo social dominance system from criticism by attacking anyone who isn’t “loving it” or at least keeping quiet about their objections as being “ill” rather than “damaged” or “oppressed” or simply “dissatisfied” with the current state of affairs. As in any “dysfunctional family,” those with the power are protected and those without power are blamed. The last thing anyone suffering from emotional stress and difficulties needs is to be blamed by those in power for their own distress!

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  8. I had a hunch that children who have trouble paying attention suffer from hypotension, probably exacerbated by sitting for more then a few minutes at a time. For somne children, intrinsic obedience has them remaining seated even as they are losing focus and even losing consciousness. For others, an attempt at self-remedy is probably beneficial: getting up and moving around (“hyperactive” type).

    The two types of drugs prescribed for ADHD (that must help some patients) have a prominent adverse effect in common: they raise blood pressure. So do some supposedly helpful supplements.

    1. Atomoxetine (STRATTERA) – risk of increased blood pressure and/or heart rate
    Safety advisory – Published 2 November 2011 (Australian Governmnent)
    2. Psychostimulants – Cardiovascular effect of stimulant medications. Stimulant medications can be associated with an increase in heart rate (1-2 beats per minute), systolic blood pressure (1-4 mmHg), and diastolic blood pressure (1-2 mmHg). Rarely, the increase in heart rate and blood pressure may reach above the 95th percentile (see Cortese, 2013).

    Others
    Zinc
    J Hypertens
    . 2004 Mar;22(3):543-50. doi: 10.1097/00004872-200403000-00017.
    Excessive zinc intake elevates systemic blood pressure levels in normotensive rats–potential role of superoxide-induced oxidative stress

    Iron
    Increased serum ferritin predicts the development of hypertension among middle-aged men
    Mee Kyoung Kim, Ki Hyun Baek, Ki-Ho Song, Moo Il Kang, Ji Hoon Choi, Ji Cheol Bae, Cheol Young Park, Won Young Lee, Ki Won Oh
    American Journal of Hypertension, Volume 25, Issue 4, April 2012, Pages 492–497, https://doi.org/10.1038/ajh.2011.241

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  9. As Dr. Gotzsche said in the first chapter of this book, “If we want to reform psychiatry, we will first of all need to change the psychiatric narrative and part of that narrative is the semantics.”

    And as I wrote, in part, in response to that chapter: politicians and the advertising industry know that to control the words we associate with a topic, is to control what we think about it. Hence, U.S. conservative politicians call inheritance taxes “death taxes.”

    Our referring to emotional and mental problems as issues of “mental health” concedes to psychiatry precisely the “mental problems as medical illness” premise which it has failed to prove, and on which the edifice of modern psychiatry rests. The same is true of DSM-defined “disorders” – “schizophrenia,” “depression” etc.: ten years ago, Thomas Insel, then Director of NIMH, acknowledged that the DSM lacked validity. Because of this, he directed that NIMH-funded research not be based on DSM’s diagnostic framework.

    Our linguistic concessions to psychiatry are like arguing that the emperor has no clothes, while still referring to the emperor’s “outfit.” If he has no clothes, he HAS no “outfit.” Psychiatry HAS no “disorders,” “mental illnesses,” “schizophrenias.” When they claim to have those things, we just say, “Prove it.” And they can’t even come close. All they have is immense financial power and an overwhelming PR budget.

    It is hard to call out psychiatry without using the “mental health” and DSM buzz words. Psychiatry and PhARMA spend more on PR than on research. Because public awareness is so shaped by their PR, wholesale rejection of their terminology in articles such as Dr. Getzsche’s invites both media and the public to tune them out.

    But we need to start now, putting psychiatry’s buzz words in quotes, to consistently show that those buzz words don’t reflect reality, any more than “unicorns” are real. And we can write articles persistently calling attention to the increasing evidence that the “mental health” industry’s made-up language diverts public and scientific attention from real human mental/emotional problems, and the real things that can be done about them.

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  10. The DSM-5 makes the most sense, when you realize that it is first intended as a catalog of billing codes. AND, EVERYTHING in the DSM-5 was either invented, or created. NOTHING in it was “discovered”. When we consider the distictions in meaning between “invented” & “created”, and “discovered”, the fraud becomes clear. So-called “mental illnesses” were invented & created to serve as excuses to prescribe DRUG$….and justify forced & coercive “social interventions”, such as “ACT”, and other medical-fascist abominations and violations of basic human righrts in the name of “healthcare”…. Hopefully, we will NOT SEE a “DSM-6”,….

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