Thursday, March 23, 2017

Comments by Steve McCrea

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  • They are missing another important aspect of this finding: part of the reason antidepressants come out with positive results is BECAUSE so many people drop out. Dropouts are commonly NOT counted in figuring the final success figures, but most people drop out because of ineffectiveness or bad side effects, so discounting those people skews the results (quite intentionally) toward a positive outcome. Combine this with the nefarious “placebo washout” protocol (where they test people for placebo response and remove them from the study before starting), and it’s easy to see how and why antidepressants are reported to be a lot more effective in treatment studies than they are in the actual reality of life.

  • This is an excellent point. Many more privileged people engage freely in oppression of lower-status groups in order to project their own feelings of inadequacy onto someone else. This is particularly obvious in domestic abuse situations, where the person who has all the power seems to NEED to confuse, oppress and control their partner, even when the partner is doing everything she can to accommodate. I think it’s wrong to think that the powerful have no anxiety. They just have more options on how to deal with it, including making others feel even more anxious than them.

  • You didn’t answer my last question, though. Is it possible that a human being has a significant level of control over how and what fires in the brain? Is not the simple expedient of breathing slowly and deeply universally understood to alter pulse and blood pressure and to calm the body and reduce anxiety? There is also excellent evidence that long-term Buddhist monks, when their brains are studied, have built up certain regions of the brain associated with calmness and focus through their meditative practice – they can change the actual PHYSICAL STRUCTURE of the brain through meditation!

    Everything human has a “biological component.” That doesn’t leave us in a situation where we are dependent on chemical or physiological interventions to alter our psyches. A smart man once drew the analogy of hardware and software – a computer is totally dependent on its electrical structure, but without a program it’s totally useless. The programs have an “electrical component,” but if you try to solve a software problem by altering the hardware, you’ll be in big trouble.

    So far, there is neither proof of any specific hardware problem, nor any specific universally effective solution, for ANY of the so-called “mental illnesses.” It seems to me that psychiatry would do very well to be a hell of a lot more humble about their pronouncements, especially as they are completely and utterly unable to explain the John Nashes or Elanor Longdens of this world.

    So sure, drugs may “work” for some people by creating what they consider positive effects, but that’s a long, long way from your claim that schizophrenia (and what is that, really) or any other “mental illness” is caused by misfiring neurons. I think we have a lot more to say about which neurons fire or don’t fire than you’re giving us credit for.

    —- Steve

  • If that’s the case, how do folks like John Nash or Elenor Longden or Will Hall recover without any drug interventions, in your view? Why do their nerves suddenly start firing differently? Could it have something to do with how they respond to their situations? Do we as human beings have the ability to alter how our nerves fire?

  • It seems you are confusing your own personal experience with scientific data. You may have found these drugs to be helpful, even life saving. This doesn’t mean that others have the same experience you did. The data show the likelihood that any particular person may or may not benefit, and people can make their choices based on that data. I think it is important to acknowledge that some people do report benefits, even very strong benefits, from taking antidepressants. However, it is JUST as important to acknowledge that some people have damage, even very strong damage, from taking these very same drugs. I think it should be very clear from the postings here that doctors not only don’t share this information with their clients, they go out of their way to deny it or blame their patients for not reacting the way the doctors want them to.

    The DATA say that antidepressants should not be recommended for everyone, and that each case should be treated differently. They also say that we should be very aware of the possibility of serious side effects in every case, and remove people immediately if they emerge. I’d venture to say also that the data tell us that antidepressants alone are VERY unlikely to make things better for most people, and in fact may make things worse ON THE AVERAGE over the long run. So kudos for you for finding your own path that works for you, but it feels quite disrespectful to suggest that everyone having a different experiences should shut up, especially in light of this kind of study.

    As to Robin Williams, I would suggest you study up on his childhood before you attribute his long-term depression to biological causes alone. It appears he had a miserable upbringing and used comedy as a way of coping with feelings of inadequacy that went back to his earliest childhood. I don’t want to pretend that biology doesn’t play a role, because it most likely always does, but I am saying that we DO NOT KNOW the degree to which biology affects someone’s reaction to abuse and neglect, and we DO no for sure the impact of abusive behavior on a range of behaviors and emotions. EVERY “mental health” diagnosis is correlated with early childhood trauma and abuse. And since there is nothing we can do about genetics, and there is LOTS we can do about childhood abuse, it appears the conversation has been badly, badly skewed in the direction of biological causation. This site provides the rest of the story. You can call it biased, but it is vital for you and others to understand that the standard viewpoint on “mental health” is badly biased in the other direction. It is an absolutely vital counter-narrative to the constant droning on about how it’s all biological and antidepressants are the only answer.

    I hope that clarifies things. You’re entitled to your viewpoint and experience, but I strongly urge you to remember that others have had dramatically different experiences and they are just as valid. And beyond that, I want you to respect that conveying scientific data is never wrong, even if it conflicts with your personal experience, as decisions depend on good data and everyone is entitled to it, even if it messes with the accepted “take your drugs forever” narrative.

    — Steve

  • The first problem is, how would you be able to tell who “needed them” and who didn’t. The second problem is that when they DON’T work, which (looking at the data above) appears to be very frequently, are the doctors able to notice and admit that they are making people worse? My experience, and I have lots of it over 20 years working with foster kids and ten more working as a counselor, is that they don’t.

    The bloggers here appear to me for the most part to be trying to tell a story that the “mental health” industry doesn’t want told, and this article says it well – most of the time, drugs do more harm than good, and doctors are just plain incapable of being objective enough to sort out who they do and don’t work for, or to even bother to ask. The data in this study basically say that if there is a group the antidepressants work for, it is either very, very small, or thoroughly offset by an equally large group who are made worse. This is important information. I have no idea why you would not want folks to share it. Perhaps you can explain why asking these questions or sharing this data is bad?

  • A change of venue can be an excellent “treatment,”especially when the old environment has assholes in it who are committed to making you miserable. But none of that counts in psychiatry. You’re supposed to be happy and effective regardless of whatever abuse you may be experiencing, and if you’re not, it’s your brain that needs fixing, not the bully. Idiocy, but that’s “modern” psychiatry for you.

  • Two answers: one – too much money being made to allow any critique, however rational, to stand. Two: the narrative fits a lot of cultural needs, such as blaming the poor for their poverty or black people for objecting to their subjugation, or blaming children for asserting their needs when we’d rather control and abuse them. In short, the powerful elite love the idea that “mental illness” is a physiological thing, because they get to make money and resist any inkling that we might have to make changes to our system rather than blaming the victims.

    — Steve

  • Wow, so legalizing same-sex marriage apparently improves “neurotransmitter imbalances” all by itself! Nah, can’t be. Must be that the populations in same-sex-marriage states share some genetic commonalities that make them more sensitive to changes in political climate. Need to do a study there…

    (NOTE: SARCASM ABOVE)

    —- Steve

  • “Overdiagnosis” is kind of an oxymoron when it is impossible to actually determine who merits a diagnosis by any kind of objective criteria. There is no objective standard for diagnosis, therefore, no standard for “overdiagnosis,” which is a fundamental problem with the entire idea of diagnosing “mental illness” based on social constructs that have no valid, objective indicators of their presence or absence.

    — Steve

  • Real science does everything it can to DISPROVE any hypothesis before accepting it as truth. Science is crappy at proving things true, but very good at proving things false. Every other reasonable hypothesis or explanation needs to be considered and eliminated before a model is accepted as “truth.” And then it’s only true until further data invalidates or modifies it.

    Unfortunately, these days “scientists” are allowed to run with biased data and positive results are published and studies disproving popular theories are buried as deep as possible and those profiting from the current “truth” spend time and money discrediting known facts. Even in physical medicine, we’re getting increasingly crappy results, and as for psychiatry, it left the vaguest impression of scientific integrity in the dust decades ago.

  • As I said, “PPD” is an invention like any other diagnosis. Most “PPD” is caused by high levels of stress – loss of income, deteriorated body image, interrupted sex life, changes in relationship due to change in status to “mother,” loss of friendships, increased isolation, loss of sleep, and on and on. Not to mention that a huge percentage of domestic abuse starts during pregnancy or right after birth. To suggest that “postpartum depression” is a disease state is rank ignorance or else intentional greed and manipulation. As I stated above, there are cultures where “PPD” DOES NOT HAPPEN AT ALL. If it is “biological,” why is it so much more common in modern industrial societies and so rare in tribal cultures?

  • My wife saved her dad from a similar fate. I wrote a blog about it a while back. He was put on Risperdal and became rigid and tense and unable to sit up or talk. After she got him off, in three days he was chatting and laughing and trying to feed himself. And yet somehow, none of the staff seem to have noticed that the drugs had almost completely disabled him. Or more likely, they considered it a “successful treatment.” Honestly, it would be kinder to kill the people outright, but I guess they couldn’t collect insurance for them if they were dead.

    The normal psych world is dark enough, but what they do to senior without even the pretense of something actually medically wrong with them is downright evil.

    — Steve

  • “Encouraged” to discuss the realities with their patients???? Why aren’t the authors calling for doctors engaging in these practices to have sanctions on their licenses? Why should there not be class action lawsuits against doctors for ignoring the most basic instructions for the use of Benzos?

    And I agree with Richard – the problem is not failing to provide psychotherapy alongside benzos, it is ignoring the fact that Benzos are not recommended for us for more than two weeks due to the risk of dependency, and that they are simply not appropriate for the uses they’re being prescribed. The only potential legitimate use (and I find this questionable) is for short-term use in anxiety attacks. These doctors are engaging in MALPRACTICE and should be called to account for it.

  • I agree. “Postpartum depression” is an invention to cover the fact that we set up mothers for stress and disappointment in our oppressive society. It is a fact that certain cultures have essentially ZERO cases of “postpartum depression.” mostly because they provide continuous and ongoing support for the mom and baby after birth. “Postpartum depression” is a Western industrial society disease that is a function of how we treat new moms and babies. It is NOT because of hormones – it’s because of unresolved stress in 99% of cases.

    — Steve

  • Odd that they identify increased contact with providers as a confounding factor. Isn’t that the point? That contact with caring people reduces feelings of isolation and hopelessness?

    And notice we’re talking about 6 group sessions, four before and two after the birth. There is no specific intervention based on the needs of the specific mother in question. And despite this, double the number in the control group fell into deep depression in the control group.

    Given the anemic response level for antidepressants, the broad side effect profile, and the lack of any evidence of long-term advantage, even within psychiatry’s own warped viewpoint, this intervention is clearly superior. What would happen if someone actually paid some individual attention to the mothers’ specific stressors and helped them plan for their families’ futures?

    — Steve

  • Never heard of the HOD or the EWI. I personally never bothered with testing of any kind when I worked with people in distress. I generally found that asking them the questions instead of having a test do it for me allowed a lot more nuanced approach. The challenge is maintaining sufficient objectivity and being OK not knowing what you have to do until you get enough information. I wish there were some “objective test” but I haven’t seen one yet that even comes close. I will look into those, though.

  • Do you really think that assigning a DSM diagnosis improves one’s understanding of the problem? I totally disagree. Even mainstream psychiatrists like Insel have acknowledged that the DSM categories don’t relate to any particular physical anomaly or problem, and that in fact we are clumping together heterogeneous groups and assuming they have the same causes and effective treatments. If a mainstreamer like Insel is saying this, please explain how lumping people into subjective categories like this helps us understand them better? Isn’t it more effective just to talk about what behavior they engage in that is distressing or problematic? Wouldn’t we understand more if we asked the client about his/her perspective on what the problem is in their terms, rather than trying to force them into our artificial frame of reference?

  • So are you going to the “brain problem” model here? Do you think Trump is an asshole because he has a “brain problem?” Or do you think he’s learned to be an asshole because it’s gotten him power and control in the past and he continues to use what works?

  • Not to mention the people who are depressed because they are trapped in a dead-end job or an unhappy or dangerous marriage or kids (like me) who are forced to attend school every day for 13 years in a soul-crushing environment and have no sense of self-efficacy. Sometimes depression is not due to bad nutrition, it’s because depression is a normal expression of distress when in distressing circumstances, regardless of someone’s nutritional state.

    It is just too much work for them to figure out what’s actually going on. Much easier to blame the patient and drug them into submission!

  • When you say “mentally ill,” I think you mean what I would call “irrational.” He is most definitely irrational and makes decisions based on emotions and biases. But that doesn’t really address what Sera is saying here – that using labels to identify his irrationality both validates these subjective and irrational labels AND minimizes our ability to truly analyze what is not working about Trump as President. It is his irrationality and dedication to being RIGHT at all costs that leads to many of his bad decisions and allows him to be manipulated by others who are “handling” him to their own advantage. It seems far better to me to describe what he’s doing that is dangerous or irrational than simply labeling him as “mentally ill.”

  • Great article! The one thing I think is missing, though, is a recognition that OF COURSE not all instances of depression are caused by poor diet or will be remediated by improved diet, because DEPRESSION IS NOT A LEGITIMATE DIAGNOSTIC CATEGORY. But we DO see that at least a third of depressed people could be dramatically improved in their mood by eating better. What is going on with the other two-thirds should be investigated, of course, but we would expect that not all of them will improve with ANY particular intervention, because DEPRESSED PEOPLE NEED DIFFERENT THINGS.

    This is vitally important, because analysis of this kind of study is dramatically hampered by the categorical clumping of depressed people into one group. This subjective grouping serves the interests of the drug companies, because they can say, “Well, nutritional counseling only helped a third of depressed patients, while antidepressants helped 45%, so antidepressants are better.” I strongly encourage you to write unequivocally on this point, as it is a very important argument to undercut any efforts by mainstream psychiatry to minimize the importance of these results.

  • Well, that’s a bit deeper analysis. Our economic dominance is, of course, based on stealing our land from the native inhabitants and enslaving both them and Africans and profiting off of their free labor. And so on and so on. But most people are not willing to ever go there, are they?

  • Sorry, Cat, but bolstering the stock market has not helped the common laborer one iota. The stock market broke 2000 sometime in the early 80s, as I recall. The gap between rich and poor was MUCH lower back then than it is now, as the stock market just broke 20,000. The stock market is a measure of how the wealthy are doing. Meanwhile, the middle class has shrunk and our long-term prospects as a country have shrunk with it. Our greatness economically was based on a large and prosperous middle class. Both parties have worked for big businesses and against small businesses and local workers since Reagan, and Trump is just doubling down on the failed policies that got us here. As Sera suggests, Trump isn’t “crazy,” he’s just entitled and will be the advocate for the other entitled folks he hangs with. The rest of us will continue to suffer.

  • The fact that we are even having this discussion on a national level shows just how bankrupt the idea of DSM diagnoses are. Would there be a national argument on whether Trump had cancer? Over what his cholesterol levels were or whether his blood pressure exceeded 140/90? Could there be a pro/con discussion over whether or not he had AIDS or syphilis?

    Only in the world of “mental health” can such an idiotic discussion be conducted by laypeople arguing with professionals. Any other medical profession could answer this question quickly by providing actual evidence that something was or was not wrong, or at least that some measurement indicated that he did or did not have a condition. Even something as vague as “obesity” has some kind of measurable standard. Only “mental health” disorders can be diagnosed solely by opinion, because there is no way to actually determine ANYTHING objectively in the “mental health” world of smoke and mirrors.

    — Steve

  • Inertia to me implies continuing to move in a direction already selected due to lack of sufficient force to divert one from this course. It’s very passive. Whereas active opposition is a force that attempts to push the profession in a certain direction in opposition to other forces. Inertia certainly comes into play, but there’s a lot more going on. And yes, it sounds like we agree on most all points, which doesn’t surprise me at all.

    Thanks for the response!

    — Steve

  • Right, reminds me of Rudolph Semmelweiss, who cured childbed fever in the 1800s by having doctors wash their hands before before “helping” deliver babies (some apparently came straight from cadavers to the maternity ward!) He reduced the rate to almost zero and then was fired from his hospital for insulting doctors by implying that they were killing their patients with their dirty hands (which, of course, was 100% true!) He spent some time in the asylums of the time because it infuriated him so much to be proven 100% correct but to be stopped by convention, arrogance, and lack of concern for the patients’ welfare.

    It’s not a new problem.

  • Yeah, I just love that one. The child simply provoked the poor parents into abusing them! This is also a disingenuous “explanation” for why abuse is more common in homes with kids diagnosed with “ADHD” (by a significant margin, BTW – diagnosed like 4-5 times more frequently in foster kids). The kid was so obnoxious it increased the odds of the parent abusing it because it HAD “ADHD.” Makes me sick. I’ve also heard it said that soldiers who develop PTSD must have something “different” (AKA wrong) about their brains, because not everyone who fights in a war develops PTSD! Pretty outrageous stuff, but if you need to believe something, you’ll come up with a way to justify continuing to believe it.

  • Humility is the key. Real scientists understand that science is intended to undermine their confirmation bias, and want to know the truth, even if it is not convenient. Wolfgang Pauli, one of the founders of the theories of quantum mechanics, said that he really WANTED his findings to be false and did everything he could to try and falsify his findings, but could not. He begrudgingly admitted his original hypothesis was wrong. That is what a real scientist does, but we don’t have a lot of real scientists at work any longer, because they have other priorities, including making money.

  • This is good stuff. I just find it too bad we have to call it something. I’d call it “being with someone in a caring way.” But I guess it would be hard to get research money with a mundane name like that! Anyway, the point that the “help-ee” has to make the “helper” feel better is fundamental to the weird relationship that psychiatry has with its clients. The psychiatrist gets to define the problem, and the patient needs to reassure him/her that a) s/he will do as instructed, and b) the patient will at least say they feel better. It’s most extremely disempowering! And a lot of therapists are just as bad.

    Learning to be with a person in their pain and NOT try to make it go away, and NOT know what you are going to say or do but helping the client look around in the swamp, that is what makes therapy or whatever you call it really work.

    Thanks for sharing!

  • I agree, This goes well beyond inertia – there is active resistance to the very idea that non-drug therapies can ever be anything more than ancillary support. This is true because the drug and psychiatric industries DON’T WANT PEOPLE TO GET BETTER OR EVEN CONSIDER OTHER OPTIONS BECAUSE THEY LOSE CUSTOMERS! The medical profession in general practices similarly, but they are at least required to show some kind of physiological indication that the body isn’t working properly, whereas psychiatry has been allowed to simply invent “disorders” and re-define the entire field and control the terms of discussion in very self-serving ways.

    And there ARE absolutely nefarious bad guys. There may not be that many, but they are in positions of huge power and influence, including the ability to spread dollars around to support their model of reality, despite all evidence for better ways of understanding the truth.

    Consider the “Open Dialog” model. It’s been around since the 70s! It has much better outcomes than any other approach, even if you accept psychiatry’s subjective definitions of “schizophrenia.” But efforts to promote this approach led to nothing, even in Finland where the approach was well known. This isn’t inertia – they intentionally suppressed this information and removed the effective approach from most Finnish hospitals. Same thing happened to Loren Mosher. These are not benign forces. They actively suppress any attempt to redefine “mental health” in any way that cuts into their profits and their control of the “mental health” market.

  • It is interesting that you posit that the scientific method can lead to errors. However, the scientific method was devised specifically to avoid the kind of confirmation bias you and the earlier author are reporting on. Hence, the errors in psychiatry are not errors of the scientific method, but errors that arose from failing to apply it in favor of personal, institutional, and/or financial conflicts of interest.

    I think it is VERY important to stress that good science had already invalidated many of bio-psychiatry’s main premises in the 1980s, and any serious application of the scientific method at this point would completely destroy the idea that giving people drugs for life for “schizophrenia” is completely invalid, not only because it doesn’t help in the collective over time, but also because the category of schizophrenia, like almost every artificial “diagnosis” in the DSM, has no scientific legitimacy whatsoever.

    Thanks for your intellectual honesty and your willingness to tolerate the masses of feedback and emotion your posts sometimes stir up. It’s a sure sign that you’re on the right track when lots of people want to comment on your discussion!

    — Steve

  • Wow, way to make something simple insanely complex! What they’re really saying here is that human thought and behavior can make the brain do different things. Big news. The REAL news is that using drugs to alter the human brain is not only unnecessary but ultimately totally destructive. But I guess the authors have to kowtow to the “neurobiology” gods in order to get funding. Kind of disturbing, but I’m glad they are proving what anyone with common sense already knows.

  • Sera,

    Great blog, as always! I have known several multiples and have provided brief counseling to one for about 6 weeks, and I can say that your description of their reality is SO much more accurate than the stupidity this movie represents. In particular, the movie plot seems to represent that calm and rational alters can suddenly become violent, which I have never seen (alters seem VERY consistent in their presentation, and I think they have to be for the whole system to work properly), and it was also very common for such people to be diagnosed as Borderline and treated as such. (The one I did the most work with had a ‘teenager’ personality with a major attitude that she pulled out for dealing with threatening people, which she used with the psychiatrist who evaluated her. Not surprisingly, he diagnosed this alter with ‘BPD’ and that was that.)

    I so appreciate the reality you are able to create for people who get these diagnoses of whatever type. You really have a gift for portraying others’ reality in a compassionate way. Thanks for being you and for sharing!

  • Believe me, I feel your pain. My oldest put us through the ringer! We had to create our own plan as we went along, as no one really had a great approach that respected our values. I was fortunate to get training in intensive behavior management for my work, but most of that still didn’t work unless we adapted it to his unique needs and strengths.

    Thanks for your positive words!

  • This article really bugged me for a number of reasons. The most disturbing is the apparent bafflement of the psychiatric community as to why antipsychotics are being prescribed to kids with “ADHD” diagnoses. The answer is obvious to anyone who knows the biochemistry of stimulants and antipsychotics. The reason is because the kids are taking stimulants.

    Stimulants’ main effect is to INCREASE the amount of available dopamine in the brain. It is well known that increasing dopamine is associated with increases in aggression and moodiness (anyone who has ever worked with meth addicts can attest to this). Sufficient dosages of stimulants can lead to frank psychosis in otherwise healthy adults or kids. Some kids who take stimulants predictably become aggressive at “therapeutic” doses.

    Antipsychotics’ main effect is to DECREASE the amount of available dopamine in the brain. Note that this is the OPPOSITE effect of the stimulants. So the obvious reason for so many prescriptions for Risperdal et al is because they are making these kids aggressive with stimulants, and then “treating” the resulting aggression with antipsychotics. In chemical terms, they are upping dopamine with stimulants and then decreasing dopamine with antipsychotics. There is nothing surprising about it.

    What SHOULD be disturbing is that psychiatrists are so corrupt and/or ignorant not to recognize or acknowledge that their own “treatment” is causing the secondary problem they are “treating” with the antipsychotics. If they really wanted less dopamine in the brain, why don’t they just stop increasing it by reducing or eliminating the stimulants???? But that would require logic, something noticeably lacking in most psychiatric settings.

    To add insult to injury, the authors separate amphetamines from “methylphenidates,” when the mechanism of action is so similar as to be essentially identical. Ritalin is an amphetamine in both structure and action.

    None of this even begins to address the infinite stupidity of using behavioral variables to diagnose a “disease” that is then “treated” in this ham-handed fashion. This article is a complete repudiation of psychiatry’s approach to kids who are active and don’t like to sit still or follow directions. They can’t even evaluate the effects of their own interventions, and are baffled by something so obvious that a college biochem student could figure it out in their spare time.

    — Steve

  • Your point is very well taken. I have written on this topic in the past for MIA, maybe it’s time for me to take another swing at it. There have been some articles about foster kids, but regular old kids like yours and mine who just happen to be very inconvenient and difficult for adults to manage just don’t have sufficient cache to pull in big numbers of readers.

    Do you have any thoughts as to a better venue to get the attention of parents who are loving and well-intended but need some help figuring out their options?

  • Shook,

    You state with confience that “Antipsychotics decrease the length of psychosis.” However, you provide no evidence to support this. Studies by Harrow, Wunderlink and others show the opposite – short use or no use of antipsychotics is associated with shorter length of “schizophrenia,”even if short-term use does decrease psychotic symptoms.

    You also clam that they reduce mortality. However, the mortality rate among the “chronically mentally ill” is MUCH higher than the general population, 25 or so years earlier, often due to medication-induced diabetes and heart disease. I think you’re believing what you’ve been told, but not looking at the totality of the evidence showing that long-term use of antipsychotics has very negative consequences that outweigh the benefits more and more significantly as length of use continues.

  • Thanks for the good article. I’d add that your argument will be strengthened by noting that psychiatric patients are more likely to kill themselves AFTER a psych hospitalization than before. You might also want to note that the psych drugs sometimes make non-suicidal people suicidal, and a non-drug alternative is essential for people for whom the drugs either don’t work very well (a solid majority) or for whom drugs make the situation even more dire.

    Of course, the real problem is that to fund these initiatives, money must be redirected from the ruling elite of psychiatrists and drug companies, and this will never be tolerated without a big fight. Sadly, the benefit of our rich elite is more important than the benefit of the patients they are supposed to be helping.

    — Steve

  • Actually, defunding SAMHSA is attacking the wrong target. What needs to be defunded is enforced involuntary “treatment” with drugs, as well as the constant flow of money to drug “research.” Such money should be redirected toward psychosocial interventions, especially peer-based services. SAMHSA is actually the only federal agency I am aware of who has ever supported peer-based services. The NIMH would be a better place to start.

  • The problem is that there are so many variables that affect “mental health” that none of them will ever be “the cause,” but if a researcher wants to create a study to suggest a correlation, they can often find one. I am sure green space improves “mental health” variables, but so does good nutrition, sex, having parents who love you, having current positive relationships, being in chronic pain, the list goes on and on. Bottom line, it is pointless to look at the brain as the cause of any “mental health condition,” as they are all made up from social biases anyway and there is no reason to think any of them has one single cause.

  • You need to read more carefully. The author clearly states that there are ASSOCIATIONS of particular brain states with particular identified psychiatric “conditions” or “disorders”, but a) there is no real evidence that such brain states are in any way abnormal, and more importantly b) there are many people showing the same brain state who do NOT qualify as “disordered,” even by the DSM’s own subjective rules, and there are many people who qualify as “disordered” who don’t have the brain condition. EVERYONE who has malaria has a malaria virus, and almost everyone who gets infected gets malaria. Saying that 15% of “schizophrenia” cases are associated with a handful or more likely an armload of genes leaves 85% of schizophrenia sufferers with no such influence. Any REAL scientist would recognize that this is a dishonest attempt to get a result when no result exists. Hence, “pseudoscience” is most definitely an applicable term.

  • This line struck me especially:

    “That is, beyond improving the psychological health of the patient, the HAP intervention appears to actually improve the context of the patient’s life, particularly for women.”

    This statement seems to suggest that the psychological health is somehow an unrelated variable to the context of the person’s life! Really? Do the authors think it’s POSSIBLE that the reason they were less depressed is BECAUSE THE CONTEXT OF THEIR LIFE IMPROVED????? What a radical concept!

    Glad someone’s doing this work, but this should not have to be proven. It shows how far we’ve moved away from “common sense” that someone’s psychological well-being is not seen as directly resulting from the conditions of his/her life, or that talking to someone about how to improve those conditions, even a fairly untrained person, is the best way to improve psychological welfare.

  • This is scientific reductionism at its very worst. The obvious hypothesis to explore is what the prior living conditions of the people in the studies were like to find correlations that really connect physical and emotional difficulties. For instance, the ACE studies at Kaiser showed that kid who experienced abuse and neglect or other childhood trauma were more likely to have both physical AND emotional difficulties in adulthood. Additionally, physiological insults like lead poisoning and other pollution effects have also been shown to associate with both physical and emotional difficulties as life progresses. They are looking at effects instead of causes, and postulating that two effects which occur more likely together are somehow causing each other. This is particularly idiotic, since of course not all depressed people have the physiological difficulties nor do all with the physical difficulties have the correlated emotional problems. It should be clear that looking for an earlier cause for both conditions is the simplest explanation if you want to be scientific. But these folks either don’t understand that or don’t want to. Baffling, disappointing, but not really that surprising. The level of scientific integrity in the psychiatric world is remarkably low.

  • Right – CBT didn’t really work much, but Prozac actually made it worse. It’s hard to understand how a comparative study overlooks the fact that neither intervention is significantly helpful more than randomly selecting a person to talk to, and of course, the Prozac was worse than doing nothing overall. We are living in a world of marketing and mythology and actual fact seem to have little to no effect on people’s views!

  • So let me get this straight. Non-drug treatments are minimally effective overall. However, when compared to “antidepressants,” they are AS effective, or MORE effective, and have many fewer side effects. So if they are minimally effective, but MORE effective than “antidepressants,”what does that say about “antidepressants?” They are obviously barely more than useless, and expose people to a wide range of risks when the same or better benefit are available from homeopathy, individual therapy, or exercise. What a fraud!!!!

    — Steve

  • I saw this in residential “treatment” homes for teens with behavior problems. The staff not only didn’t screen for side effects, they had not even been trained on what the side effects were. In one case, the therapist readily acknowledged that they never told the teens about the side effects because they were afraid the teens would then refuse to take the drugs (definition of “informed consent,” please?) One girl in this facility had a constant hand tremor, was taking FOUR drugs that cause involuntary movements (TWO “antipsychotics” and TWO “mood stabilizers), two of which specifically noted HAND TREMORS as an adverse effect. They told her that her hand shaking was because she was “nervous!” I was never quite so appalled in my sometimes quite appalling career working with kids. So no, this doesn’t surprise me one bit. Most doctors and facilities approach adverse effects with either minimization or complete denial. To actually screen for them would be most out of character for most facilities I’ve seen.

  • Until a pet can be patented and hundreds of dollars charged for a “pet therapy” prescription, they will be viewed as a marginal contributor in the field, regardless of the actual data. The term “Animal Assisted Therapy” kind of turned my stomach a bit. Why don’t we just call it “Getting a pet whom you know loves you and gives you lots of affection?” Nothing fancy, really. People need to be loved.

  • Wow, way to hit ’em where they live! I was particularly struck by the story of the guy who has received standard psych treatment for decades and is still a mess, which any sane person would conclude was a story of complete and utter failure of the system and the paradigm that drives it, and yet they use that same story to argue for MORE “treatment” that we know has failed him! It’s hard to understand how people can’t see through this. I guess it goes back to Joseph Campbell and people’s need to believe in their own cultural mythology no matter what. I wish I knew what to do about it, because it’s obvious that logic is not a part of the support structure for the psychiatric myth.

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

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

    — Steve

  • The other question is: so what? Let’s say we discover some biomarker that is more frequent in people who have a “schizophrenia” diagnosis. How would that help? We can’t change their biology, and psychiatry has no “cure” for any “disorder” they identify. The only purpose of studying biomarkers appears to be to try and “prove” that “mental illnesses” are biological so we don’t have to face the myriad ways our society makes people crazy.

    —-Steve

  • NAMI is not a reliable source, nor is the NIMH necessarily, as they engage in lots of propaganda that simply is false (such as claiming that all mental illnesses are ‘brain diseases,” stated unapologetically on their website and in many of their publications and their courses. It should also be noted that a large segment of those “untreated” recover and are no longer counted as “mentally ill.”

    You really should read “Anatomy of an Epidemic” if you really want to have productive conversations on this site. I know a lot of what is said goes contrary to the “conventional wisdom,” but a lot of the “conventional wisdom” is shown to be false by psychiatry’s own scientific studies.

  • It remains a fact that more treatment leads to earlier death. What you say is, of course, important, but the author makes it very clear, with good research support, that dying 25 years younger on the AVERAGE can not be explained by “not understanding that they have a disease.” I would add that there are PLENTY of non-diagnosed people who deny or minimize diabetes or many other conditions and/or fail to seek or maintain treatment, so that factor would be even more reduced in overall impact with the general population.

    The fact is, the drugs given for “schizophrenia” and “bipolar disorder” DO cause diabetes, heart disease, and strokes, AND also encourage smoking and other drug use to compensate for adverse effects. This is NOT an arguable premise – it is known and published on the side of every bottle of the drugs. There is a black box warning regarding antipsychotics leading to early death in the elderly. This is NOT imaginary – it is a FACT.

    I will add that while your mom may not be willing to accept treatment for her medical conditions, if she is diagnosed with a “major mental illness,” I am guessing that the drugs she has been taking psych drugs for them. Am I wrong? If so, is it possible that she would not HAVE diabetes or congestive heart failure to be worried about if some other approach had been taken from day one?

    It is important to look at our own potential biases as well as any potential biases the authors may have before offering a critical analysis. I think things may be much more complex than your own description of your mom’s experience may suggest.

  • It remains baffling in the face of such strong evidence that the medical community in general has not been more accepting of this data. A needed–to-harm of 16 is pretty small, and means that almost every doctor with a sizable practice will see this effect dozens or potentially hundreds of times a year. And the fact that it’s seen with women with no psychiatric diagnosis or history cuts out any argument that it’s “the disease” causing the effect. The level of denial is quite astounding!

    Thanks for your excellent summary of the recent data!

    —- Steve

  • I guess I read this article differently. I think what it says is that while there are differences between males and females, they are AVERAGE differences and can’t be generalized to all members of either gender. I think it also says that researchers are biased in their interpretation of data based on their own cultural stereotypes. I don’t think it’s possible to deny the huge impact of large amounts of testosterone on the brain and body – it is, in fact, what makes a body turn out male rather than female. But it’s also very easy to ignore the huge impact of social and cultural training on how men vs. women act in a given culture.

    As is frequently the case in the nature vs. nurture argument, it’s not one or the other, but both.

    — Steve

  • It may be a relief, but it is misleading, and intentionally so, as you yourself indicate. Sure, it could be a relief for parents to feel like it’s “not their fault,” or for teachers to be told that the kids’ lack of progress in their class is not a result of poor teaching or lack of a stimulating environment or a child’s inappropriate or dangerous home environment, but if it is NOT TRUE, then the parent/teacher/psychologist is being let off the hook, as my son’s doctor was. And if you’re saying that only a “poor psychiatrist” would act upon a person without asking psychosocial screening questions, I would have to say that there are a lot more poor psychiatrists in practice than you seem to recognize.

    As for your other examples, you’re correct that “high cholesterol” is not a verifiable illness, either, and that many medical diagnoses are subjective and lack an understanding of cause. However, one IS able to establish that a person DOES have a specific cholesterol level and that all persons can be measured and compared and a standard set above which it is considered “high.” We all know that politics enters into both where that line is set and what recommended treatments are allowable, but that does not excuse psychiatry from engaging in the same unhelpful political nonsense, which again you seem to agree is the case with the DSM. But at least we can measure blood pressure and weight and cholesterol levels. What the heck are we measuring in psychiatry? How can we create “nose-picking disorder” without any measurement of what is supposedly wrong?

    And of course, your assertion that there is no such thing as science is completely specious. Science does exist, even if many people practice it in a corrupt or distorted manner. A call for psychiatry to actually respect the findings of their own scientific literature, including, for instance, the fact that “ADHD” diagnosed kids are no better off in the long term whether medicated or not, is certainly not unreasonable, nor is calling them out when they repeatedly ignore known scientific findings in favor of their pet biological theories, which is what the DSM really encourages. We’d be far better off to drop the whole thing and start over if we really care about helping people instead of getting more insurance reimbursement for less time spent with the client.

    —- Steve

  • I reiterate, why is it important to defend labels that you yourself admit are arbitrary and socially determined, driven mostly by insurance reimbursement and irrelevant to treatment decisions?

    It sounds like you see the real point of these labels as justification for getting paid for treatment. That’s the only thing they are useful for, so we agree on that point.

    As for disempowerment, you are really not trying very hard if you can’t understand this. Your “good psychiatrist” may not use the labels to define a person’s condition, but if that’s the case, most are not good psychiatrists, because it appears very, very common in the folks I talk with. Best example is from multiple foster youth I’ve spoken with, most of whom have been through hell and back and have understandably difficult emotions and behavior to deal with. These kids are almost always told that the reason they are depressed or angry or anxious is because their brain isn’t working properly, and that medication will help “balance out” their brain chemistry. Psychiatrists as a rule have almost nothing to say or ask them about why they are acting the way they are or what their history is. They medicate based on symptoms and explain away any causal factors. The kids find this confusing and/or downright insulting. And I’m talking multiple examples from a fairly specific sample of people who do NOT respond well to that kind of treatment. So disempowerment is VERY real and damaging both to the kids’ desire to continue treatment of any kind and of their chances of success, since the actual reason for their “condition” is not examined or validated or directly addressed.

    Or for another example – my son went off the rails temporarily and was living a dangerous life for a couple of months, including taking drugs and ultimately being assaulted. He went to see a doctor and in a depression screening endorsed suicidality. The doctor went on a lecture about how depression is a “disease just like diabetes” and that “treatments are available” but never ONCE asked him why he might have considered killing himself! And he would certainly have told her what was going on, and it might just have been helpful, but the “MDD” label allowed the doctor to feel like she’d “diagnosed” him without bothering to even find out what was going on.

    You’ll try to tell me this is rare. In my experience, it is not. It is, in fact, extremely common, and the labeling process makes that possible for doctors to get away with.

    Of course, you are again being intentionally obtuse if you don’t recognize the difference between telling someone they have influenza, which is a verifiable fact that leads to a verifiable treatment that is almost uniformly effective, with diagnosing “Major Depressive Disorder,” which is nonspecific, non-verifiable, and does NOT lead to a uniformly effective treatment plan, since the wide range of people diagnosed with MDD are incredibly heterogeneous, and what works great for one person could actually ruin someone else’s life.

    I am afraid you are so committed to your position that you are unable to look at any other perspective. I am not going to bother trying to convince you further that other rational viewpoints are viable and have value. You can remain rigid if you want, but I am not going to accept that you are somehow more knowledgeable about this area than I am, because it just ain’t so.

  • Well, if it “doesn’t matter,” why is it so important to defend it? Obviously, words have meaning and meaning impacts behavior. If you don’t believe that, you have no business being around people. As I described above, it is DISEMPOWERING to a person who has been through a bunch of crap or who is just “different” in some way to be labeled as “abnormal” by some professional. Don’t you get that at all? And you have some nerve talking to ME about paying attention to categories over people – my entire argument is that categories are damaging and we should focus on people instead of labeling them. Is there something about this you don’t understand????

  • You seem to be suggesting that the only way to help someone with a problem is to diagnose them with a disease. I have helped hundreds, probably thousands of people professionally over many years without feeling the need to diagnose a single one of them. The only purpose psychiatric diagnosis served for me is to get insurance to pay for people to get certain kinds of help, and whenever I did so, I clearly explained to the person that the diagnosis was simply a description of what is going on with the purpose of getting insurance reimbursement, but that their conception of the problem is the only thing I was really concerned with.

    Psychiatric diagnosis, in my experience, tends to invalidate people’s own experience and takes away their ability to define their own problem and potential solutions, and is therefore extremely disempowering. It puts people in the position of having some “expert” tell them what’s wrong with them and what they have to do. This is particularly egregious when the “expert” has no real clue what is going on.

    As for “biological correlates,” well gosh, we all inhabit bodies and there are biological correlates for everything we do. So what? Are you intending to say that anger is “caused” by “excessive adrenaline and other neurotransmitters?” Or is it caused by someone deciding that something pisses them off and the body responds to their thought by preparing to fight?

    As for not diagnosing someone with “Nose-picking disorder” being somehow a barrier to helping him/her with that problem, you have now descended into the extremes of absurdity. I am thinking you are being perhaps intentionally obtuse in order to be “right” about your point. Perhaps you are suffering from “Irrational Need to Win an Argument Disorder.” It seems to be interfering with your ability to hear others’ viewpoints. Do you think there are biological correlates for your condition? Perhaps I can offer some kind of treatment?

    I hope you get my gentle jest above. Not meaning to be insulting, just to point out the absurdity of taking any condition you consider undesirable and labeling it as a disease. At a certain point, it reduces to total absurdity.

    — Steve