Wow, so being TOO empathetic and TOO concerned with justice is now a mental problem? I guess I’m pretty messed up then. Exactly HOW much justice are we supposed to be satisfied with? And when should we be learning to be less concerned about others feelings? Is there now an optimum level of selfishness to which we should aspire?
How do we determine what is a “valid form of psychiatric nosology?” The fact that we can create a description of certain behavior and find that some people fit that description is hardly proof of validity.
The head of NIMH (Tom Insel) once stated that the DSM “diagnoses” lacked validity, and were similar to “diagnosing” people based on the quality of chest pain. Another previous NIMH head (Stephen Hyman) criticized the DSM on similar grounds. Are they raging antipsychiatry radicals in your mind? Or do two of the leading psychiatrists who headed up research on psychiatric conditions in the USA perhaps have the right to challenge your claims?
Any “positive results” are temporary and most likely come from the euphoric effects of a closed head injury. Short-term memory loss is universal, and severe long term memory loss is common. Suicide rates increase as I recall. Death rate overall increases after “ECT.”
Generally speaking, doctors do whatever they can to AVOID seizures because they damage the brain. Why anyone imagines that INDUCING a seizure would be less damaging or somehow helpful is delusional.
Your comments don’t support what you just said. Besides which, two people can be “diagnosed with schizophrenia” and have nothing in common with each other. Japan and other places are talking about dropping the concept altogether. There is no way something that is that diverse can be “caused” by one thing. Is there a biological component? No doubt. But that doesn’t make the diagnostic criteria any less subjective and misleading.
Not really. It’s a matter of human interaction, and therapists may or may not be any good at it, as research has clearly shown. There are a lot of societal changes that would improve outcomes a lot more than more therapy, much more than half of which probably makes things worse.
I’m not sure why this is a “crisis.” It’s just information, important information. I tend to agree with the author that failure of therapists to prioritize genuine relationships with their clients is probably a main driver of therapy dropouts. And shorter courses of therapy are also less likely to lead to lasting change. But the very idea of “therapy” comes out of damage done by our society and its institutions, and it is a rare therapist who actually brings this kind of perspective into their sessions.
It is interesting, however, to see that the standard applied is a 50% reduction in symptoms. I wonder how many antidepressant trials even come close to that kind of a standard.
This immediately made me think of how we program our young people’s experiences. At 5 or 8 or 10, my brothers or my friends and I used to go down to the park and play or invent games in the streets or back yards or climb trees and fences and play along the edge of the train tracks until we heard a train coming and climbed up the banks to watch. No rules, no referees, no fixed teams or season records or playoffs. Just playing, interacting, arguing, suggesting, collaborating… Lots of skills we have lost.
It’s a shame that such proof is necessary. Criminals have to be convicted “beyond a reasonable doubt.” But the so-called “mentally ill” are guilty until proven innocent!
You have no idea what I’m talking about. Your response has nothing to do with what I am saying. I’m not talking about being against psychiatry, I’m talking about the requirements of science. There are social definitions if all sorts of things that don’t pretend to be scientific. The objection is not to the words but to the pretense of scientific validity.
What other medical specialty votes on what is or isn’t a disease state? What other medical specialty argues that they should include “diagnoses” because “people find it helpful, makes them feel their suffering is legitimate.” Either you have cancer or you don’t. You can’t vote on it, and you get the diagnosis whether you feel it’s helpful or not.
Please stop using the blanket “you anti psychiatry people” meme to address the concerns I raised. They are not ideological. They are the very practical concerns of a trained scientist regarding how psych diagnoses prevent legitimate research and possible resolution for a good proportion of those so diagnosed.
And not one of those categories is identified by anything but a list of “criteria” voted on in a committee. Making up names doesn’t convey understanding.
I don’t think you’re really understanding what I’m saying. That’s OK. Let’s leave it that you’re very committed to believing in these “disorders,” and I think they are nonsense. We don’t have to agree.
You call something “arthritis” because it describes a distinct causal relationship between the condition and the treatment. There IS no causal relationship between “depression” and any specific treatment, because it doesn’t have a singular cause.
“Cancer” is actually a good example to work from. Cancer is an IDENTIFIABLE GROWTH of abnormal tissue. We can objectively tell if someone has or does not have cancer by scans and blood tests and biopsy. However, saying someone “has cancer” is not sufficient! It doesn’t tell us the treatment we need because there are different cancers, and we have to hone it down even further into “colorectal cancer” or “lung cancer” or whatever. Now we’re even better able to break THOSE cancers down by genetic markers and create treatments specific to subsets of a certain kind of cancer.
“Major depression” isn’t even close to as specific as cancer. There is NO test to see who has or doesn’t have depression like there is for cancer. Moreover, there are dozens if not hundreds of potential causes for depression that would require completely different treatment approaches. Would you treat someone who is depressed due to coming home to a violent husband every night the same as someone depressed because they lost their spouse of many years or as someone who is stuck in a dead-end job and feels trapped or as someone who was abused and neglected early in life and learned depression as a coping tool for a bad environment? Yet psychiatrist try to “treat” all of these situations as if the problem is the “depression,” and the solution to make the person “less depressed.” This is very much akin to giving someone opioids for their knee pain instead of treating their arthritis. No one’s saying that pain killers are bad. But we’re not “treating pain” as a “disorder.” Pain is the normal reaction of the body to the arthritic process.
We call things by a name to distinguish them from other things that are different and associate them with things that are similar. “Depression” doesn’t do that. It lumps things together that are different and acts like they are the same.
Did you read the example I gave suggesting a certain percentage of people are depressed due to a thyroid condition? Should we treat “depression” or the thyroid condition? We should be “treating” domestic abuse, childhood trauma, poor work environments, or grief. We are never treating “depression” because it’s a phenomenon, like pain. It’s not a DISORDER or DISEASE that can be treated because it is caused by many different things requiring many different responses. It is not at all like cancer. Cancer is an identifiable, specific, testable problem that we can see, measure and analyze. Depression is a description of a certain state of mind that can have dozens of causes and dozens of “treatments.” They could not be more different.
The devastation caused by psychosis has nothing to do with what I’m talking about. I have never denied the reality of suffering. I’m explaining to you why classifying suffering by “type of suffering” is not scientifically valid or helpful. I think pain is real and we ought to help people in pain and have treatments for pain, including drugs. But asking the question, “What causes knee pain?” is a scientifically stupid question. There are many, many causes. We should study bruising, ACL tears, meniscus deterioration, arthritis, biomechanical knee misalignment, flat feet, dislocation. If we “diagnosed” someone with “knee pain disorder” and spent billions of dollars researching “knee pain disorder” without trying to establish the different causes and differential treatment, you’d properly think we’d lost our minds.
Better treatment will occur if we stop pretending that all people experiencing the same phenomenon are the same. The DSM itself says it’s not true. The head of the NIMH in 2010 or so agreed completely with what I just said. It has NOTHING to do with pretending people don’t suffer from the circumstances outlined in the DSM. It has to do with actually trying to understand them instead of pretending we do in order to justify continuing the ineffective services that re currently in place. I want BETTER INTERVENTIONS. This will NOT happen if we keep pretending everyone who feels depressed has the same problem. The classifications don’t enable us to study these things. They prevent us from really doing so.
I’m not assuming anything. I’m observing that claiming these categories are valid when they are only a list of subjective observations PREVENTS us finding out what IS true. It’s one thing to use them to bill the insurance company. But pretending all people who are depressed have the same problem and need the same kind of help is unquestionably false. If we DO actually want to know what is causing what, we have to start by being honest and not pretending to know what we don’t know. That’s not an assumption, it’s the basis of legitimate scientific inquiry.
I answered your question. There is absolutely widespread damage done by the very fact of using DSM labels in lieu of actually analyzing what the difficulty really is.
What’s wrong is that these “diagnoses” give the impression of knowledge that is not true.
Let’s say 20% of people diagnosed with depression get better when receiving thyroid treatment. If we do a study of “major depression,” we group the people with thyroid problems together with the people with early childhood deprivation and with those who are being abused by a partner and those who are recovering from the loss of a relationship and with those who are struggling with the existential question of what they are alive for. Of course, those without thyroid problems don’t respond to thyroid treatment, so thyroid treatment is considered “ineffective for major depression.” But 20% of those people will be OK if they get thyroid treatment! By lumping them together with people who don’t have the same problem, their problem is obscured.
An obvious example is “ADHD.” Did you know that 30% of kids who qualify for the “ADHD” diagnosis no longer qualify if they wait a year to enter school? How are these kids being “treated” similarly to kids who are acting out because of poor discipline at home, or those who are very bright and easily bored, or those in classrooms that are overly rigid? Abused kids are diagnosed at a much higher rate than non-abused kids. How many of them are really suffering from extreme anxiety?
I could go on. But if you can set aside your own bias for a moment and think about what I’m saying, you’ll see that false “diagnoses” that group people together who have very different needs leads to scientific confusion. You can’t do good science without establishing legitimate means to select a group who are actually similar in some way. Research in “major depression” is the equivalent of doing research on the cause of “pain.” Guess what, there isn’t one cause! And the only thing that will “treat” pain in general is drugs. Sane goes for depression. Except that pain relievers work for most of the population, while antidepressants improve symptoms for a minority.
I’ve worked in the mental health field, including doing involuntary hospital detention evaluations. Also used to work on a crisis line. So I’ve talked to plenty of floridly psychotic people, and even felt forced to hold a few involuntarily in the psych ward.
I’ve never claimed to be an expert in the area, but I’m not arguing from ignorance either. You are confusing the obvious fact that some people experience psychosis and require help with the idea that psychiatric diagnosis is somehow useful or necessary in the process of helping. As I’ve pointed out before, two people diagnosed with “schizophrenia” can have ZERO symptoms in common. There’s no way all people so diagnosed have the same problem or need the same help. But you don’t seem to understand that I’m not opposing drugs if they are found to be helpful. Drugs can be prescribed without misleading people into thinking we know things that are simply not true. Why do we have to “diagnose” someone with a “disorder” before we’re allowed to help them?
The omission is telling. But are you really surprised? A profession that can’t even agree on INCLUDING patients’ opinions on their own care let alone respect their rights to informed consent is clearly predicated on power. And based on the PTM approach, this makes them agents of trauma, not of healing. Small wonder they resist the idea of “power over” being problematic!
I don’t disagree with the complexity of what we call “mental illness.” I’m criticizing the system that in fact attempts to reduce these phenomena to brain chemistry problems.
You’re the one who suggested the solution is to create a utopian environment. I don’t think humans are capable of doing it. Honestly, we need to be voted off the planet.
If it’s an art form, it needs to stop pretending it’s a science. And we’re not going to make much progress when actual facts are intentionally obscured in order to make money or protect professional status.
There is absolutely no biological/genetic cause or even correlation for any DSM disorder that is more than trivial. The psychiatric classifications are entirely socially constructed based on our perceptions of what is and is not acceptable behavior in society. There is no more biological underpinning to any so-called psychiatric “disorder” in the DSM than there is for having a sense of humor or disliking vanilla ice cream. Which is to say, we all have differing biologies but they do NOT map onto DSM “disorder” in any meaningful way. ALL the DSM “disorders” are identified by a subjective list of thoughts/behaviors/emotions that could be caused by almost anything. The DSM itself admits this in its introduction, stating that people with the same “disorder” are not assumed to “be alike in all important ways.” That’s an obscure way of saying that people diagnosed with the same “disorder” may have nothing in common with each other at all. This is the DSM’s own description of its “disorders.” There is not even the assumption that all people with the “disorder” have the same problem, let alone the same cause.
Yes, things can go wrong with our biology. But until it is understood exactly WHAT is wrong and we’re able to identify WHO has this problem, assuming everyone with “schizophrenia” is the same is foolish. Heck, you can have two people “diagnosed” with schizophrenia who have NO symptoms in common with each other! How can both cases be caused by the same thing?
Using drugs to alter brain chemistry can be perceived as helpful to many people, but the idea that this means they “have” a certain “diagnosis” does not follow. It means they find the drugs helpful. This is not a new phenomenon. People have used substances to alter their perceptions and emotions since the beginning of human history. Psychiatry doesn’t have some special understanding of which people “need” which drugs due to their biological differences. Every case is an experiment. Throwing spaghetti against the wall and hoping some of it sticks. It’s not remotely scientific, except to the degree they know which brain processes they are messing with.
Look back on what I said. Did I speak against the usefulness of drugs for some people? Did I imply that psychiatrists are engaged in some nefarious plot to ruin our lives? No. Everything I stated above is simply factual. All verifiable. None emotionally based. Psychiatry does not rest on a scientific basis. That’s just the facts. The Truth of it all.
I don’t think the answer is compromise, it’s commitment to the TRUTH, even if it’s inconvenient. There’s no way to compromise between the Truth and something that’s just plain wrong.
Talk therapists still use “diagnosis” to bill insurance companies, even if they don’t discuss it with the client. The only ones in the USA at least who don’t are the ones who don’t take insurance.
IMHO, therapists should not be interpreting anything for the client, though I know most probably do. It’s the clients’ job to interpret. Both the therapists I’ve had held that belief.
So you are NOT concerned about corruption and the denial of scientific facts that conflict with the interests of insiders? And it is NOT a concern to you that psychiatrists lie to their patients to achieve “compliance,” and that “patient-centered care” is a phenomenon that most psychiatrists seem to find threatening? Do you NOT believe that informed consent is important?
It is a complex question how best to treat and support people with emotional/mental/spiritual challenges. But what I’m raising above has nothing to do with that. It has to do with corruption and dishonesty and manipulation of the public in order to achieve maximum profits. How can different perspectives be integrated if one perspective is opposed to any other perspective that undermines their power or income?
There’s nothing “antipsychiatry” about demanding accountability to scientific norms, nor calling out corruption when it exists. Unless you think opposing corruption and lack of accountability IS inherently opposing psychiatry?
I think you sometimes mistake the sometimes usefulness of drugs for the potential usefulness of the general practice of psychiatry. Most people here acknowledge that some people find the drugs useful for their situation. This doesn’t address the massive pseudoscience and propaganda people are exposed to by the ostensibly “scientific” field of psychiatry. Psychiatry has to be arm twisted into considering clients PARTICIPATING in decisions about their own care. They promote DSM diagnoses as if they are indicators of biological dysfunction rather than subjective labels about phenomena they don’t actually understand. They actively oppose efforts to ensure informed consent, and twist or deny actual scientific data that threaten their control of the narrative or their bottom line. Many “thought leaders” are corrupted by pharmaceutical company funds and provide biased views as fact. Consider how many people believe that low serotonin causes depression, even though there’s no evidence that this is the case. Or how violently the black box warning on antidepressants was opposed, not because it was false, but because it resulted in fewer prescriptions being written.
Opposition to psychiatry has not that much of to do with the drugs. It has to do with how we look at what is called “mental illness” and how we can prioritize the needs of the clients instead of the needs of the “professionals.”
First off, I wince every time I hear the phrase, “overmedication.” This implies there is some “right” amount of drugs that is optimum, and that the problem is finding that level. But when you read the data, it’s clear that the prescribers are not optimizing, they are drugging inappropriately with poor results and no accountability. Additionally, given that utterly subjective nature of “personality disorder diagnosis,” there can BE no way to determine the “right level” of drugs.
It’s also notable that the subjects in the second and third studies got the impression that their clinicians were guessing. They were, if course, completely correct.
I agree. I just object to those tools being removed from the realm of normal human operations and being somehow reframed as “therapy,” as if some kind of professional evaluation or supervision were required, or that the person must be “treating” something rather than just finding ways to make their lives work for them. And I don’t want to have people start charging money for going on a hike with someone and calling it “nature therapy!”
Heart disease and diabetes rates are massively increased by antipsychotics. And if course suicide rates are also elevated. These connections need to be sussed out and explicitly named.
Apparently, a lot of depressed people like to dance. I’d bet that other depressed people like different things. I’ve been depressed a lot. I love hiking and find it helps me feel better. It’s not a “treatment,” it’s just something I can enjoy.
The use of clinical language to characterize these “interventions” is fascinating and a little disturbing. What if the title had been “Salsa dancing is fun for some people!” Maybe it’s not a “treatment,” it’s just something some people enjoy, while others enjoy other things. Does EVERYONE have to feel better from salsa dancing for it to be considered a “legitimate intervention?” Or do different people get to find different things fun?
Maybe the title needs further revision: “People feel better when they get to do things they enjoy!” But why do we need a study to prove that?
I don’t actually think it is a null result. The same level of “relapse” with reduced hospitalizations and reduced potential harm from heavy medication use is a positive result. The same result with significantly reduced risk is NOT the same result at all!
Thank you for sharing this powerful writing. It’s a shame that I had to look so hard to find it. It should have a prominent link. I think a lot of survivors will feel the experiences the song brings to light.
So if you want to do what you want to do, how do you propose overcoming these divisions and conflicts of interest? Bottom line, if we don’t get the cooperation of those in authority, no collaboration will ever occur. How do you propose we convince them to let go of their self-interested control and start working with clients as the central focus?
I guess I’m saying that part of “getting there” involves taking the power to define these “illnesses” and their “treatments” away from people whose primary interest is protecting the status quo and thereby their income and power.
But you avoided my point. How can there be any “working together” when the mainstream, who hold the power to change, insist on prioritizing their own power and profits over doing what works?
Problem is, I don’t see the slightest interest in working together coming from the psychiatric field. While judicious use of drugs is something that could be considered (as they do in the Open Dialogue approach), mainstream psychiatry has vehemently attacked any attempt to undermine their unquestioned authority. They give lip service to the “biopsychosocial model,” but in practice, it’s bio-bio-bio regardless of the data telling us that this just makes things worse in the long term.
Interesting that none of the professionals in the discussion seem to have mentioned this at all. Don’t you think they would have used this in support of their arguments?
Perhaps you can provide an actual link to the place you got this information. I have a feeling it does not say what you claim it says.
And BTW, extended use of stimulants causes brain cell loss. Any claims about brain volume and “ADHD” need to be on medication-naive “patients,” who are very hard to find these days. I’d bet my mortgage that if there even IS such a study, it doesn’t control for stimulant use over time.
Or put your stimulant-seeking children in more stimulating classrooms. It’s been known since the 70s that so-called “ADHD” kids are indistinguishable from “normal” kids in an open classroom environment. The biggest cause of “ADHD” is developmentally inappropriate expectations from adults.
Sounds like it isn’t about “clinical need” at all. If they were focused on “clinical need,” they’d clearly avoid detention in any way possible and focus instead on making quality services available. Of course they’d also have to figure out what “quality services” really are, which would mean a complete deconstruction of the current model and starting over from scratch. I won’t be holding my breath…
It is beyond irksome to have people talking about “the benefits of shared decision making” as if it’s just a nice idea to be tried out. It’s unethical for a medical professional NOT to provide informed consent and respect their patients’ right to autonomy! It sounds like we’re saying, “We need to study whether malpractice is the better option!”
I agree completely! They are trying to pin the problem on “postpartum psychosis” when it seems clear she BECAME psychotic after taking the drugs! I feel very frustrated that again the victim gets the blame instead of those “treating” her who so obviously failed!
How can we assure that “diagnosis is accurate” when there is no objective way to determine who qualifies for the “diagnosis?” What “diagnostic tools” can possibly test for something whose criteria include “has difficulty waiting his turn” or “does not seem to listen when spoken to directly?” What are the objective tests for turn-waiting, and what are the threshold criteria for excessive “turn impatience?” The concept is so vague and subjective that the idea of testing for it is laughable for any real scientist. Of course, psychiatry has little to do with science and a lot to do with marketing.
Yeah, I don’t entirely buy the “that’s how they were trained” trope. At some point, as a professional, you ought to start noticing that your “help” is not helping or doing harm in too many cases, and start thinking about what you’re really doing and what options might be better for your clients. Humans are not computers. We can do more than what we’re trained to do.
I don’t consider CBT to be a therapy by itself. It’s a technique, helpful for some situations, useless in others, and destructive in some circumstances. A therapist needs to understand the person in front of them and use the approach that works for the client at that time. Anyone who only does CBT is someone to steer clear of!
An excellent point. It is, of course, absurd that “financial stress” should be a “mental health” problem. It’s a financial problem! And endemic to our economic system, as it seems. It’s like saying that kids who get hit by cars and break their legs have “weak leg bone syndrome” because not EVERYONE who gets hit by a car breaks their leg! Perhaps instead of figuring out how to strengthen their bones, we ought to figure out how to keep kids from getting hit by cars!
The current Lindsay Clancy trial in the USA appears to be another case in point. Killed her children after reporting psychotic adverse effects of a huge ploypharmacy of drugs, spoke of thoughts of homicide to her practitioners, said the drugs were making her worse, asked to be taken off, etc. No action taken by the psychiatric “professionals.” She will probably be convicted and the psych industry get off scot free, as usual.
Hoping MIA will do an analysis of this case. The comments I’ve seen on articles are almost universally condemnatory of the mother without consideration of the impact of the so-called “treatment.”
In my view, there’s no such thing as a “correct diagnosis” since there are no objective criteria to determine who qualifies. All diagnoses are fictional.
Fascinating that the parents in the one case weren’t worried about their child’s welfare so much as what others would think if he had another incident!
OK, things are getting too personal and I’m pulling the plug on this discussion. You two can continue off line if you want to. I’m no going to publish any more comments directed at each other. Please comment only on the article.
I’m unclear on your intent here? Are you criticizing his lack of evidence for neuroplasticity around “disorders” that you assert to be “bio” problems with no evidence to support your own claims?
At this point, we seem to be drifting away from the topic of the article and getting into a more personal political disagreement. I would like to ask that if the participants wish to continue this discussion, they do it off line. I’d like to get back to the subjects explored in the article!
I don’t charge anyone anything these days. I interact differently with each person, no “school of thought”, no manual. Truth to tell, I have had very little formal training in counseling, my MS is in education. I’m essentially self-taught, or more properly I have been taught by the people I have worked with, the “clients” have taught me everything I know about what works.
It’s true of course that there are levels of connection, just like with any pair of humans. The proof is not in the relationship itself, but in the effect on the client. That said, one of the most common pieces of feedback I got was that I was very real with people. They feel safe because I don’t shine them on.
I don’t, though I’m not sure where Bob comes down on that question. I try to always put “mental health” in quotes if I do need to use the term. “Behavioral health” is even worse.
Of course, in the psych world, there’s no such thing as an accurate diagnosis. They are all as subjective as saying someone is brave or mean or active. They have no medical validity.
Receiving medical care is the third leading cause of death in the USA. Not errors, but receiving medical care of any sort. The majority of the deaths (over 120,000, as I recall) were from side effects of properly prescribed and properly administered drugs.
I don’t think it reflects a lack of clinical judgement. I think it reflects an utter lack of empathy and the moral bankruptcy of any system that thinks electrocuting someone to induce a grand male seizure could possibly be “therapeutic!”
“Misdiagnosis” is a highly problematic term in psychiatry, as there is no way to objectively establish who “has” or “doesn’t have” a particular diagnosis. As a result, legal action is almost impossible, because it is almost impossible to prove misdiagnosis when diagnosis is utterly subjective. The answer begins with rejecting ALL psych “diagnoses” as fraudulent and instead focus any legal action on the actual impact of the intervention compared to what was promised. Diagnoses are intended to obfuscate the fact that these people don’t have any idea what they are doing.
Comparing Abilify to Advil? That’s rank malpractice!
I’m sorry this happened to you. This kind of story reinforces my belief that it’s not just bad practitioners, the system is designed to serve the professionals and the stockholders rather than the clients.
Yeah, isn’t it kind of indicative that so many psychiatrists are OPPOSED to “shared decision making,” like it’s some sort of radical and dangerous new idea?
I so completely agree! We need to lose the “neuro” and just call it being “diverse.” I am sure I fit the “neurodiversity” paradigm but I’d much rather just be thought of as “diverse.” Or even just “weird.” I don’t want to be labeled based on some assumed neurological distinction that no one has ever shown really exists. It’s a subtle back-door opening to more discrimination. It’s not a question of who qualifies as “diverse,” it’s a question of why it’s OK to discriminate against ANY people just because they are who they are!
And again, I will reiterate that ALL psychiatric labeling is “mislabeling,” and serves primarily as a means to make money and exert power over clients/patients. You may identify with a particular label, and that is your right, but no one else has the right to do that for you, IMHO. Allowing labeling allows all the other things that happened to you to be justified and prevents any level of accountability, since exactly NONE of these labels is objectively verifiable or falsifiable. So they can say whatever they want, and if their “treatment” is a disaster, say “Oh, she was misdiagnosed!” It’s a bunch of crap, and the DSM makes it all possible.
Again, not criticizing YOUR identification with that particular label. I’m saying that getting the “right label” has absolutely no correlation with getting anything approaching helpful treatment. I’d say the reason you are getting better help now is because YOU are more empowered, not because they finally got the right label on you!
That wasn’t quite what I said. I’m saying it’s impossible to be ” misdiagnosed” because the diagnoses themselves are so arbitrary and subjective that you could “meet the criteria” for half a dozen “diagnoses” and still get no different treatment regardless of what labels they choose to apply to you.
I understand that YOU identify with the ASD label, and I fully support your right to label yourself any way that makes sense to you. But I don’t want to accidentally give credence to the idea that THEY get to label you or anyone else with anything, even if someone “fits the criteria,” because the criteria are nonsense and true informed consent would include the clinician admitting that the only real meaning of their “diagnoses” is to get insurance reimbursement.
Ellen, thank you for taking the risk and telling your story so this others can see it’s not just them, they really ARE being mistreated and abused! I wish your story were an outlier. Unfortunately, it is extremely common, maybe even the expected result.
One issue I want to raise is the issue of “misdiagnosis.” I try really hard never to use that term, because it grants the unstated proposition that SOME people really DO “have bipolar” and therefore merit the “treatment” that was so destructive to you. It’s not less destructive because someone “meets the criteria” for “bipolar.” The criteria and the “diagnoses” themselves are a huge part of the problem!
Keep on telling your story. People need to hear that this is what standard psychiatric “treatment” looks like. And it’s not pretty!
I agree. There are some extra sensitive people who CAN’T handle the oppressive conditions in school, for example, but that doesn’t make it any less oppressive for the average child. We should view such people as “canaries in the coal mine,” indicating that bad things are happening that are affecting EVERYONE, but that these kids are the ones who let us know when it’s beyond the pale. Instead, these kids are made to feel they are weird or different and the environment won’t adapt to them and they need to adapt to the environment. They have to be “diagnosed” as “disordered” before any changes can be made. This is simply ignoring the obvious – kids exist on a spectrum, and if the ones at the end can’t handle the stress, the others are being stressed as well but are simply better equipped to tolerate the oppressive conditions.
Given your “handle,” I assume you are a psychiatrist. I’m interested how you found out about and got into reading MIA, and how it has changed your practice, if it has. What’s your take on the state of the DSM and psychiatry today?
I don’t see systems struggling to make these services available. I see systems struggling to make sure they are minimized or eliminated as options. The idea that psych systems are just misguided and need more training and funding is just plain wrong. These systems have financial and institutional conflicts of interest such that a less medicalized model of care is a threat to their professional reputations and their incomes. Real change will not occur until these perverse incentives are identified and removed.
Wow, so being TOO empathetic and TOO concerned with justice is now a mental problem? I guess I’m pretty messed up then. Exactly HOW much justice are we supposed to be satisfied with? And when should we be learning to be less concerned about others feelings? Is there now an optimum level of selfishness to which we should aspire?
Report comment
How do we determine what is a “valid form of psychiatric nosology?” The fact that we can create a description of certain behavior and find that some people fit that description is hardly proof of validity.
The head of NIMH (Tom Insel) once stated that the DSM “diagnoses” lacked validity, and were similar to “diagnosing” people based on the quality of chest pain. Another previous NIMH head (Stephen Hyman) criticized the DSM on similar grounds. Are they raging antipsychiatry radicals in your mind? Or do two of the leading psychiatrists who headed up research on psychiatric conditions in the USA perhaps have the right to challenge your claims?
Report comment
“Epistemic humility” – sounds great. Let’s just say I’m not holding my breath on this one!
Report comment
No, I don’t!!! /s
Report comment
Well stated!
Report comment
Any “positive results” are temporary and most likely come from the euphoric effects of a closed head injury. Short-term memory loss is universal, and severe long term memory loss is common. Suicide rates increase as I recall. Death rate overall increases after “ECT.”
Generally speaking, doctors do whatever they can to AVOID seizures because they damage the brain. Why anyone imagines that INDUCING a seizure would be less damaging or somehow helpful is delusional.
Report comment
You are, of course, correct. Thanks for the clarification!
Report comment
Your comments don’t support what you just said. Besides which, two people can be “diagnosed with schizophrenia” and have nothing in common with each other. Japan and other places are talking about dropping the concept altogether. There is no way something that is that diverse can be “caused” by one thing. Is there a biological component? No doubt. But that doesn’t make the diagnostic criteria any less subjective and misleading.
Report comment
Not really. It’s a matter of human interaction, and therapists may or may not be any good at it, as research has clearly shown. There are a lot of societal changes that would improve outcomes a lot more than more therapy, much more than half of which probably makes things worse.
Report comment
I agree on both counts.
Report comment
I’m not sure why this is a “crisis.” It’s just information, important information. I tend to agree with the author that failure of therapists to prioritize genuine relationships with their clients is probably a main driver of therapy dropouts. And shorter courses of therapy are also less likely to lead to lasting change. But the very idea of “therapy” comes out of damage done by our society and its institutions, and it is a rare therapist who actually brings this kind of perspective into their sessions.
It is interesting, however, to see that the standard applied is a 50% reduction in symptoms. I wonder how many antidepressant trials even come close to that kind of a standard.
Report comment
This immediately made me think of how we program our young people’s experiences. At 5 or 8 or 10, my brothers or my friends and I used to go down to the park and play or invent games in the streets or back yards or climb trees and fences and play along the edge of the train tracks until we heard a train coming and climbed up the banks to watch. No rules, no referees, no fixed teams or season records or playoffs. Just playing, interacting, arguing, suggesting, collaborating… Lots of skills we have lost.
Report comment
It’s a shame that such proof is necessary. Criminals have to be convicted “beyond a reasonable doubt.” But the so-called “mentally ill” are guilty until proven innocent!
Report comment
You have no idea what I’m talking about. Your response has nothing to do with what I am saying. I’m not talking about being against psychiatry, I’m talking about the requirements of science. There are social definitions if all sorts of things that don’t pretend to be scientific. The objection is not to the words but to the pretense of scientific validity.
What other medical specialty votes on what is or isn’t a disease state? What other medical specialty argues that they should include “diagnoses” because “people find it helpful, makes them feel their suffering is legitimate.” Either you have cancer or you don’t. You can’t vote on it, and you get the diagnosis whether you feel it’s helpful or not.
Please stop using the blanket “you anti psychiatry people” meme to address the concerns I raised. They are not ideological. They are the very practical concerns of a trained scientist regarding how psych diagnoses prevent legitimate research and possible resolution for a good proportion of those so diagnosed.
Report comment
And not one of those categories is identified by anything but a list of “criteria” voted on in a committee. Making up names doesn’t convey understanding.
I don’t think you’re really understanding what I’m saying. That’s OK. Let’s leave it that you’re very committed to believing in these “disorders,” and I think they are nonsense. We don’t have to agree.
Report comment
You call something “arthritis” because it describes a distinct causal relationship between the condition and the treatment. There IS no causal relationship between “depression” and any specific treatment, because it doesn’t have a singular cause.
“Cancer” is actually a good example to work from. Cancer is an IDENTIFIABLE GROWTH of abnormal tissue. We can objectively tell if someone has or does not have cancer by scans and blood tests and biopsy. However, saying someone “has cancer” is not sufficient! It doesn’t tell us the treatment we need because there are different cancers, and we have to hone it down even further into “colorectal cancer” or “lung cancer” or whatever. Now we’re even better able to break THOSE cancers down by genetic markers and create treatments specific to subsets of a certain kind of cancer.
“Major depression” isn’t even close to as specific as cancer. There is NO test to see who has or doesn’t have depression like there is for cancer. Moreover, there are dozens if not hundreds of potential causes for depression that would require completely different treatment approaches. Would you treat someone who is depressed due to coming home to a violent husband every night the same as someone depressed because they lost their spouse of many years or as someone who is stuck in a dead-end job and feels trapped or as someone who was abused and neglected early in life and learned depression as a coping tool for a bad environment? Yet psychiatrist try to “treat” all of these situations as if the problem is the “depression,” and the solution to make the person “less depressed.” This is very much akin to giving someone opioids for their knee pain instead of treating their arthritis. No one’s saying that pain killers are bad. But we’re not “treating pain” as a “disorder.” Pain is the normal reaction of the body to the arthritic process.
We call things by a name to distinguish them from other things that are different and associate them with things that are similar. “Depression” doesn’t do that. It lumps things together that are different and acts like they are the same.
Did you read the example I gave suggesting a certain percentage of people are depressed due to a thyroid condition? Should we treat “depression” or the thyroid condition? We should be “treating” domestic abuse, childhood trauma, poor work environments, or grief. We are never treating “depression” because it’s a phenomenon, like pain. It’s not a DISORDER or DISEASE that can be treated because it is caused by many different things requiring many different responses. It is not at all like cancer. Cancer is an identifiable, specific, testable problem that we can see, measure and analyze. Depression is a description of a certain state of mind that can have dozens of causes and dozens of “treatments.” They could not be more different.
Report comment
Their depression scores went WAAAY down!
Report comment
The devastation caused by psychosis has nothing to do with what I’m talking about. I have never denied the reality of suffering. I’m explaining to you why classifying suffering by “type of suffering” is not scientifically valid or helpful. I think pain is real and we ought to help people in pain and have treatments for pain, including drugs. But asking the question, “What causes knee pain?” is a scientifically stupid question. There are many, many causes. We should study bruising, ACL tears, meniscus deterioration, arthritis, biomechanical knee misalignment, flat feet, dislocation. If we “diagnosed” someone with “knee pain disorder” and spent billions of dollars researching “knee pain disorder” without trying to establish the different causes and differential treatment, you’d properly think we’d lost our minds.
Better treatment will occur if we stop pretending that all people experiencing the same phenomenon are the same. The DSM itself says it’s not true. The head of the NIMH in 2010 or so agreed completely with what I just said. It has NOTHING to do with pretending people don’t suffer from the circumstances outlined in the DSM. It has to do with actually trying to understand them instead of pretending we do in order to justify continuing the ineffective services that re currently in place. I want BETTER INTERVENTIONS. This will NOT happen if we keep pretending everyone who feels depressed has the same problem. The classifications don’t enable us to study these things. They prevent us from really doing so.
Report comment
I’m not assuming anything. I’m observing that claiming these categories are valid when they are only a list of subjective observations PREVENTS us finding out what IS true. It’s one thing to use them to bill the insurance company. But pretending all people who are depressed have the same problem and need the same kind of help is unquestionably false. If we DO actually want to know what is causing what, we have to start by being honest and not pretending to know what we don’t know. That’s not an assumption, it’s the basis of legitimate scientific inquiry.
Report comment
I answered your question. There is absolutely widespread damage done by the very fact of using DSM labels in lieu of actually analyzing what the difficulty really is.
Report comment
What’s wrong is that these “diagnoses” give the impression of knowledge that is not true.
Let’s say 20% of people diagnosed with depression get better when receiving thyroid treatment. If we do a study of “major depression,” we group the people with thyroid problems together with the people with early childhood deprivation and with those who are being abused by a partner and those who are recovering from the loss of a relationship and with those who are struggling with the existential question of what they are alive for. Of course, those without thyroid problems don’t respond to thyroid treatment, so thyroid treatment is considered “ineffective for major depression.” But 20% of those people will be OK if they get thyroid treatment! By lumping them together with people who don’t have the same problem, their problem is obscured.
An obvious example is “ADHD.” Did you know that 30% of kids who qualify for the “ADHD” diagnosis no longer qualify if they wait a year to enter school? How are these kids being “treated” similarly to kids who are acting out because of poor discipline at home, or those who are very bright and easily bored, or those in classrooms that are overly rigid? Abused kids are diagnosed at a much higher rate than non-abused kids. How many of them are really suffering from extreme anxiety?
I could go on. But if you can set aside your own bias for a moment and think about what I’m saying, you’ll see that false “diagnoses” that group people together who have very different needs leads to scientific confusion. You can’t do good science without establishing legitimate means to select a group who are actually similar in some way. Research in “major depression” is the equivalent of doing research on the cause of “pain.” Guess what, there isn’t one cause! And the only thing that will “treat” pain in general is drugs. Sane goes for depression. Except that pain relievers work for most of the population, while antidepressants improve symptoms for a minority.
Report comment
I’ve worked in the mental health field, including doing involuntary hospital detention evaluations. Also used to work on a crisis line. So I’ve talked to plenty of floridly psychotic people, and even felt forced to hold a few involuntarily in the psych ward.
I’ve never claimed to be an expert in the area, but I’m not arguing from ignorance either. You are confusing the obvious fact that some people experience psychosis and require help with the idea that psychiatric diagnosis is somehow useful or necessary in the process of helping. As I’ve pointed out before, two people diagnosed with “schizophrenia” can have ZERO symptoms in common. There’s no way all people so diagnosed have the same problem or need the same help. But you don’t seem to understand that I’m not opposing drugs if they are found to be helpful. Drugs can be prescribed without misleading people into thinking we know things that are simply not true. Why do we have to “diagnose” someone with a “disorder” before we’re allowed to help them?
Report comment
And if you like, I can get into why heterogenous DSM categories actually PREVENT legitimate scientific research from being conducted.
Report comment
We can name things for the purpose of communication without the pretense of knowing things we don’t know.
Report comment
The omission is telling. But are you really surprised? A profession that can’t even agree on INCLUDING patients’ opinions on their own care let alone respect their rights to informed consent is clearly predicated on power. And based on the PTM approach, this makes them agents of trauma, not of healing. Small wonder they resist the idea of “power over” being problematic!
Report comment
So it’s not objectively wrong that practitioners of what you acknowledge to be at best an art form pretend they are doing medical science?
Report comment
This is true. Cultures with high levels of maternal postnatal support have almost no incidence of “ppd.”
Report comment
I don’t disagree with the complexity of what we call “mental illness.” I’m criticizing the system that in fact attempts to reduce these phenomena to brain chemistry problems.
You’re the one who suggested the solution is to create a utopian environment. I don’t think humans are capable of doing it. Honestly, we need to be voted off the planet.
If it’s an art form, it needs to stop pretending it’s a science. And we’re not going to make much progress when actual facts are intentionally obscured in order to make money or protect professional status.
Report comment
Agreed. How do we bring it about?
Report comment
There is absolutely no biological/genetic cause or even correlation for any DSM disorder that is more than trivial. The psychiatric classifications are entirely socially constructed based on our perceptions of what is and is not acceptable behavior in society. There is no more biological underpinning to any so-called psychiatric “disorder” in the DSM than there is for having a sense of humor or disliking vanilla ice cream. Which is to say, we all have differing biologies but they do NOT map onto DSM “disorder” in any meaningful way. ALL the DSM “disorders” are identified by a subjective list of thoughts/behaviors/emotions that could be caused by almost anything. The DSM itself admits this in its introduction, stating that people with the same “disorder” are not assumed to “be alike in all important ways.” That’s an obscure way of saying that people diagnosed with the same “disorder” may have nothing in common with each other at all. This is the DSM’s own description of its “disorders.” There is not even the assumption that all people with the “disorder” have the same problem, let alone the same cause.
Yes, things can go wrong with our biology. But until it is understood exactly WHAT is wrong and we’re able to identify WHO has this problem, assuming everyone with “schizophrenia” is the same is foolish. Heck, you can have two people “diagnosed” with schizophrenia who have NO symptoms in common with each other! How can both cases be caused by the same thing?
Using drugs to alter brain chemistry can be perceived as helpful to many people, but the idea that this means they “have” a certain “diagnosis” does not follow. It means they find the drugs helpful. This is not a new phenomenon. People have used substances to alter their perceptions and emotions since the beginning of human history. Psychiatry doesn’t have some special understanding of which people “need” which drugs due to their biological differences. Every case is an experiment. Throwing spaghetti against the wall and hoping some of it sticks. It’s not remotely scientific, except to the degree they know which brain processes they are messing with.
Look back on what I said. Did I speak against the usefulness of drugs for some people? Did I imply that psychiatrists are engaged in some nefarious plot to ruin our lives? No. Everything I stated above is simply factual. All verifiable. None emotionally based. Psychiatry does not rest on a scientific basis. That’s just the facts. The Truth of it all.
Report comment
I don’t think the answer is compromise, it’s commitment to the TRUTH, even if it’s inconvenient. There’s no way to compromise between the Truth and something that’s just plain wrong.
Report comment
Talk therapists still use “diagnosis” to bill insurance companies, even if they don’t discuss it with the client. The only ones in the USA at least who don’t are the ones who don’t take insurance.
IMHO, therapists should not be interpreting anything for the client, though I know most probably do. It’s the clients’ job to interpret. Both the therapists I’ve had held that belief.
Report comment
Except when therapy is done without “diagnosis” or the attendant evaluation and invalidation. It can be done.
Report comment
So how does any of that happen without addressing the corruption and the power that opposes our green/socialist model (which I absolutely support)?
Report comment
So you are NOT concerned about corruption and the denial of scientific facts that conflict with the interests of insiders? And it is NOT a concern to you that psychiatrists lie to their patients to achieve “compliance,” and that “patient-centered care” is a phenomenon that most psychiatrists seem to find threatening? Do you NOT believe that informed consent is important?
It is a complex question how best to treat and support people with emotional/mental/spiritual challenges. But what I’m raising above has nothing to do with that. It has to do with corruption and dishonesty and manipulation of the public in order to achieve maximum profits. How can different perspectives be integrated if one perspective is opposed to any other perspective that undermines their power or income?
There’s nothing “antipsychiatry” about demanding accountability to scientific norms, nor calling out corruption when it exists. Unless you think opposing corruption and lack of accountability IS inherently opposing psychiatry?
Report comment
Hi, Mark,
I think you sometimes mistake the sometimes usefulness of drugs for the potential usefulness of the general practice of psychiatry. Most people here acknowledge that some people find the drugs useful for their situation. This doesn’t address the massive pseudoscience and propaganda people are exposed to by the ostensibly “scientific” field of psychiatry. Psychiatry has to be arm twisted into considering clients PARTICIPATING in decisions about their own care. They promote DSM diagnoses as if they are indicators of biological dysfunction rather than subjective labels about phenomena they don’t actually understand. They actively oppose efforts to ensure informed consent, and twist or deny actual scientific data that threaten their control of the narrative or their bottom line. Many “thought leaders” are corrupted by pharmaceutical company funds and provide biased views as fact. Consider how many people believe that low serotonin causes depression, even though there’s no evidence that this is the case. Or how violently the black box warning on antidepressants was opposed, not because it was false, but because it resulted in fewer prescriptions being written.
Opposition to psychiatry has not that much of to do with the drugs. It has to do with how we look at what is called “mental illness” and how we can prioritize the needs of the clients instead of the needs of the “professionals.”
Report comment
Maybe we can invent a new “diagnosis” – CADD: Compulsive Arbitrary Diagnosis Disorder!
Report comment
Actually, it IS a slur!
Report comment
First off, I wince every time I hear the phrase, “overmedication.” This implies there is some “right” amount of drugs that is optimum, and that the problem is finding that level. But when you read the data, it’s clear that the prescribers are not optimizing, they are drugging inappropriately with poor results and no accountability. Additionally, given that utterly subjective nature of “personality disorder diagnosis,” there can BE no way to determine the “right level” of drugs.
It’s also notable that the subjects in the second and third studies got the impression that their clinicians were guessing. They were, if course, completely correct.
Report comment
I agree. I just object to those tools being removed from the realm of normal human operations and being somehow reframed as “therapy,” as if some kind of professional evaluation or supervision were required, or that the person must be “treating” something rather than just finding ways to make their lives work for them. And I don’t want to have people start charging money for going on a hike with someone and calling it “nature therapy!”
Report comment
Heart disease and diabetes rates are massively increased by antipsychotics. And if course suicide rates are also elevated. These connections need to be sussed out and explicitly named.
Report comment
Apparently, a lot of depressed people like to dance. I’d bet that other depressed people like different things. I’ve been depressed a lot. I love hiking and find it helps me feel better. It’s not a “treatment,” it’s just something I can enjoy.
Report comment
The use of clinical language to characterize these “interventions” is fascinating and a little disturbing. What if the title had been “Salsa dancing is fun for some people!” Maybe it’s not a “treatment,” it’s just something some people enjoy, while others enjoy other things. Does EVERYONE have to feel better from salsa dancing for it to be considered a “legitimate intervention?” Or do different people get to find different things fun?
Maybe the title needs further revision: “People feel better when they get to do things they enjoy!” But why do we need a study to prove that?
Report comment
I don’t actually think it is a null result. The same level of “relapse” with reduced hospitalizations and reduced potential harm from heavy medication use is a positive result. The same result with significantly reduced risk is NOT the same result at all!
Report comment
I agree such a plan is doable. What would be hard is convincing people who are profiting from the status quo to agree to do it!
Report comment
Drugs can make people psychotic. And the experience of akathesia is associated with suicide and violence toward others.
Report comment
Thank you for sharing this powerful writing. It’s a shame that I had to look so hard to find it. It should have a prominent link. I think a lot of survivors will feel the experiences the song brings to light.
Report comment
I have never understood how publicly “disclosing” whom you are bribing in any way mitigates the effects of bribery!
Report comment
So if you want to do what you want to do, how do you propose overcoming these divisions and conflicts of interest? Bottom line, if we don’t get the cooperation of those in authority, no collaboration will ever occur. How do you propose we convince them to let go of their self-interested control and start working with clients as the central focus?
Report comment
I guess I’m saying that part of “getting there” involves taking the power to define these “illnesses” and their “treatments” away from people whose primary interest is protecting the status quo and thereby their income and power.
Report comment
But you avoided my point. How can there be any “working together” when the mainstream, who hold the power to change, insist on prioritizing their own power and profits over doing what works?
Report comment
Problem is, I don’t see the slightest interest in working together coming from the psychiatric field. While judicious use of drugs is something that could be considered (as they do in the Open Dialogue approach), mainstream psychiatry has vehemently attacked any attempt to undermine their unquestioned authority. They give lip service to the “biopsychosocial model,” but in practice, it’s bio-bio-bio regardless of the data telling us that this just makes things worse in the long term.
Report comment
Interesting that none of the professionals in the discussion seem to have mentioned this at all. Don’t you think they would have used this in support of their arguments?
Perhaps you can provide an actual link to the place you got this information. I have a feeling it does not say what you claim it says.
And BTW, extended use of stimulants causes brain cell loss. Any claims about brain volume and “ADHD” need to be on medication-naive “patients,” who are very hard to find these days. I’d bet my mortgage that if there even IS such a study, it doesn’t control for stimulant use over time.
Report comment
“Scattered darkness, starting around sunset. Should clear up by morning!” George Carlin
Report comment
Or put your stimulant-seeking children in more stimulating classrooms. It’s been known since the 70s that so-called “ADHD” kids are indistinguishable from “normal” kids in an open classroom environment. The biggest cause of “ADHD” is developmentally inappropriate expectations from adults.
Report comment
I think “remission” means “you’re not making problems for us at the moment!”
Report comment
Sounds like it isn’t about “clinical need” at all. If they were focused on “clinical need,” they’d clearly avoid detention in any way possible and focus instead on making quality services available. Of course they’d also have to figure out what “quality services” really are, which would mean a complete deconstruction of the current model and starting over from scratch. I won’t be holding my breath…
Report comment
It is beyond irksome to have people talking about “the benefits of shared decision making” as if it’s just a nice idea to be tried out. It’s unethical for a medical professional NOT to provide informed consent and respect their patients’ right to autonomy! It sounds like we’re saying, “We need to study whether malpractice is the better option!”
Report comment
I agree completely! They are trying to pin the problem on “postpartum psychosis” when it seems clear she BECAME psychotic after taking the drugs! I feel very frustrated that again the victim gets the blame instead of those “treating” her who so obviously failed!
Report comment
Why don’t you start by telling us some of your story, David? Lots of people here have felt suicidal before. We can understand.
Report comment
I never heard that one! Thanks for sharing it with me!
I’m reminded of the Mark Twain quote: “I never let my schooling interfere with my education!”
Report comment
How can we assure that “diagnosis is accurate” when there is no objective way to determine who qualifies for the “diagnosis?” What “diagnostic tools” can possibly test for something whose criteria include “has difficulty waiting his turn” or “does not seem to listen when spoken to directly?” What are the objective tests for turn-waiting, and what are the threshold criteria for excessive “turn impatience?” The concept is so vague and subjective that the idea of testing for it is laughable for any real scientist. Of course, psychiatry has little to do with science and a lot to do with marketing.
Report comment
Yeah, I don’t entirely buy the “that’s how they were trained” trope. At some point, as a professional, you ought to start noticing that your “help” is not helping or doing harm in too many cases, and start thinking about what you’re really doing and what options might be better for your clients. Humans are not computers. We can do more than what we’re trained to do.
Report comment
Thanks for this. It’s what I really need to hear right now!
Report comment
I don’t consider CBT to be a therapy by itself. It’s a technique, helpful for some situations, useless in others, and destructive in some circumstances. A therapist needs to understand the person in front of them and use the approach that works for the client at that time. Anyone who only does CBT is someone to steer clear of!
Report comment
An excellent point. It is, of course, absurd that “financial stress” should be a “mental health” problem. It’s a financial problem! And endemic to our economic system, as it seems. It’s like saying that kids who get hit by cars and break their legs have “weak leg bone syndrome” because not EVERYONE who gets hit by a car breaks their leg! Perhaps instead of figuring out how to strengthen their bones, we ought to figure out how to keep kids from getting hit by cars!
Report comment
The current Lindsay Clancy trial in the USA appears to be another case in point. Killed her children after reporting psychotic adverse effects of a huge ploypharmacy of drugs, spoke of thoughts of homicide to her practitioners, said the drugs were making her worse, asked to be taken off, etc. No action taken by the psychiatric “professionals.” She will probably be convicted and the psych industry get off scot free, as usual.
Hoping MIA will do an analysis of this case. The comments I’ve seen on articles are almost universally condemnatory of the mother without consideration of the impact of the so-called “treatment.”
Report comment
Do you have a source for that figure? 90% seems high to me, even for immediate stabilization.
Report comment
If you’re well trained and experienced doing ineffective or destructive things, you’ll still be ineffective or destructive. Maybe moreso!
Report comment
In my view, there’s no such thing as a “correct diagnosis” since there are no objective criteria to determine who qualifies. All diagnoses are fictional.
Report comment
As far as I know, even the most bio-bio of psychiatrists would admit there’s never an indication for three “antidepressants!”
Report comment
Amen, Sister!
Report comment
Sad, indeed!
Report comment
Fascinating that the parents in the one case weren’t worried about their child’s welfare so much as what others would think if he had another incident!
Report comment
Commenting as moderator:
OK, things are getting too personal and I’m pulling the plug on this discussion. You two can continue off line if you want to. I’m no going to publish any more comments directed at each other. Please comment only on the article.
Report comment
I’m unclear on your intent here? Are you criticizing his lack of evidence for neuroplasticity around “disorders” that you assert to be “bio” problems with no evidence to support your own claims?
Report comment
POSTING AS MODERATOR:
At this point, we seem to be drifting away from the topic of the article and getting into a more personal political disagreement. I would like to ask that if the participants wish to continue this discussion, they do it off line. I’d like to get back to the subjects explored in the article!
Report comment
🙂
Report comment
I don’t charge anyone anything these days. I interact differently with each person, no “school of thought”, no manual. Truth to tell, I have had very little formal training in counseling, my MS is in education. I’m essentially self-taught, or more properly I have been taught by the people I have worked with, the “clients” have taught me everything I know about what works.
It’s true of course that there are levels of connection, just like with any pair of humans. The proof is not in the relationship itself, but in the effect on the client. That said, one of the most common pieces of feedback I got was that I was very real with people. They feel safe because I don’t shine them on.
Hope that helps!
Report comment
I don’t, though I’m not sure where Bob comes down on that question. I try to always put “mental health” in quotes if I do need to use the term. “Behavioral health” is even worse.
Report comment
You’d think that would be obvious. Apparently not!
Report comment
Of course, in the psych world, there’s no such thing as an accurate diagnosis. They are all as subjective as saying someone is brave or mean or active. They have no medical validity.
Report comment
Happens to me all the time, in both directions! But I’m fairly selective whom I share with.
Report comment
Receiving medical care is the third leading cause of death in the USA. Not errors, but receiving medical care of any sort. The majority of the deaths (over 120,000, as I recall) were from side effects of properly prescribed and properly administered drugs.
Report comment
Of course, who knows what “the spirit” really is?
Report comment
I agree, failure to provide informed consent is the most vulnerable place to attack psychiatry. They really have no leg to stand on.
Report comment
I don’t think it reflects a lack of clinical judgement. I think it reflects an utter lack of empathy and the moral bankruptcy of any system that thinks electrocuting someone to induce a grand male seizure could possibly be “therapeutic!”
Report comment
“Misdiagnosis” is a highly problematic term in psychiatry, as there is no way to objectively establish who “has” or “doesn’t have” a particular diagnosis. As a result, legal action is almost impossible, because it is almost impossible to prove misdiagnosis when diagnosis is utterly subjective. The answer begins with rejecting ALL psych “diagnoses” as fraudulent and instead focus any legal action on the actual impact of the intervention compared to what was promised. Diagnoses are intended to obfuscate the fact that these people don’t have any idea what they are doing.
Report comment
Comparing Abilify to Advil? That’s rank malpractice!
I’m sorry this happened to you. This kind of story reinforces my belief that it’s not just bad practitioners, the system is designed to serve the professionals and the stockholders rather than the clients.
Report comment
I often wonder if the “neurotypical” person is simply someone who has been properly cowed into behaving as society expects them to?
Report comment
Yeah, isn’t it kind of indicative that so many psychiatrists are OPPOSED to “shared decision making,” like it’s some sort of radical and dangerous new idea?
Report comment
Not just your opinion, they literally agree on these “diagnoses” in committees! Can you imagine voting on what criteria to use to diagnose cancer???
We’re on the same page here!
Report comment
I so completely agree! We need to lose the “neuro” and just call it being “diverse.” I am sure I fit the “neurodiversity” paradigm but I’d much rather just be thought of as “diverse.” Or even just “weird.” I don’t want to be labeled based on some assumed neurological distinction that no one has ever shown really exists. It’s a subtle back-door opening to more discrimination. It’s not a question of who qualifies as “diverse,” it’s a question of why it’s OK to discriminate against ANY people just because they are who they are!
Report comment
And again, I will reiterate that ALL psychiatric labeling is “mislabeling,” and serves primarily as a means to make money and exert power over clients/patients. You may identify with a particular label, and that is your right, but no one else has the right to do that for you, IMHO. Allowing labeling allows all the other things that happened to you to be justified and prevents any level of accountability, since exactly NONE of these labels is objectively verifiable or falsifiable. So they can say whatever they want, and if their “treatment” is a disaster, say “Oh, she was misdiagnosed!” It’s a bunch of crap, and the DSM makes it all possible.
Again, not criticizing YOUR identification with that particular label. I’m saying that getting the “right label” has absolutely no correlation with getting anything approaching helpful treatment. I’d say the reason you are getting better help now is because YOU are more empowered, not because they finally got the right label on you!
Report comment
That wasn’t quite what I said. I’m saying it’s impossible to be ” misdiagnosed” because the diagnoses themselves are so arbitrary and subjective that you could “meet the criteria” for half a dozen “diagnoses” and still get no different treatment regardless of what labels they choose to apply to you.
I understand that YOU identify with the ASD label, and I fully support your right to label yourself any way that makes sense to you. But I don’t want to accidentally give credence to the idea that THEY get to label you or anyone else with anything, even if someone “fits the criteria,” because the criteria are nonsense and true informed consent would include the clinician admitting that the only real meaning of their “diagnoses” is to get insurance reimbursement.
Report comment
Ellen, thank you for taking the risk and telling your story so this others can see it’s not just them, they really ARE being mistreated and abused! I wish your story were an outlier. Unfortunately, it is extremely common, maybe even the expected result.
One issue I want to raise is the issue of “misdiagnosis.” I try really hard never to use that term, because it grants the unstated proposition that SOME people really DO “have bipolar” and therefore merit the “treatment” that was so destructive to you. It’s not less destructive because someone “meets the criteria” for “bipolar.” The criteria and the “diagnoses” themselves are a huge part of the problem!
Keep on telling your story. People need to hear that this is what standard psychiatric “treatment” looks like. And it’s not pretty!
Report comment
I agree. There are some extra sensitive people who CAN’T handle the oppressive conditions in school, for example, but that doesn’t make it any less oppressive for the average child. We should view such people as “canaries in the coal mine,” indicating that bad things are happening that are affecting EVERYONE, but that these kids are the ones who let us know when it’s beyond the pale. Instead, these kids are made to feel they are weird or different and the environment won’t adapt to them and they need to adapt to the environment. They have to be “diagnosed” as “disordered” before any changes can be made. This is simply ignoring the obvious – kids exist on a spectrum, and if the ones at the end can’t handle the stress, the others are being stressed as well but are simply better equipped to tolerate the oppressive conditions.
Report comment
Given your “handle,” I assume you are a psychiatrist. I’m interested how you found out about and got into reading MIA, and how it has changed your practice, if it has. What’s your take on the state of the DSM and psychiatry today?
Report comment
Good for you, Donna! And FU*K THEM!
Report comment
I don’t see systems struggling to make these services available. I see systems struggling to make sure they are minimized or eliminated as options. The idea that psych systems are just misguided and need more training and funding is just plain wrong. These systems have financial and institutional conflicts of interest such that a less medicalized model of care is a threat to their professional reputations and their incomes. Real change will not occur until these perverse incentives are identified and removed.
Report comment