Wednesday, September 20, 2017

Comments by Steve McCrea

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  • This is exactly what happens when you create “diagnoses” that are based on subjective criteria. People “diagnose” what they don’t like or don’t understand. The DSM can say whatever it wants about how it “should” be used. People will use it in the same way people use most things – they will act in ways that are self-centered and that avoid discomfort. There will be exceptions, of course, but the incentive is there to blame the victim, and the DSM makes it very comfortable to do so. It needs to be banned!

  • Amazing clarity as usual, Sera. Power dynamics lie at the center of why there is an antipsychiatry movement. Embedding “peers” in the system and then taking away their ability to proceed from an empowering viewpoint is cooptation at its most pernicious. I would ask Patrick to look at some of the comments of Stephen Gilbert, a peer worker of great integrity, who is constantly barraged with complaints and threats and disrespect when he stands up for his peers in a truly peer-like way. Certification per se is not the problem – the problem is that the professional “mental health” workers don’t want to give up their power over their clients. A true peer-to-peer model means clients get to make their own decisions and have those decisions respected, even if if those decisions are now what the peer would decide for him/herself. Those currently in charge of the mental health system will never stand for it, and that’s why certification is popular amongst the professionals – it enables them to disempower the peer movement and make it the handmaiden of their own need for control.

    Thanks for your courageous response!

    — Steve

  • Actually, my experience is that good, active listening does, in fact, provide something practical – it removes the barriers of confusion and overwhelming emotional intensity and helps the person involved get to a place of doing their own practical problem-solving process. I’ve done this with dozens and dozens of suicidal people, and had excellent success in helping them achieve some sense of greater control over their lives, and sometimes even a plan for moving to a better way of surviving and thriving in their lives. I could share a story or two. The truth is, no one can really develop a practical plan for someone else – they can only help that person develop perspectives that enable the person him/herself to come up with such a practical plan. At least, that’s my experience.

  • That is an excellent point! A lot of kids are “oppositional” to things that don’t make sense, or they are generally opposed to being bossed around arbitrarily. When given more control of their environment, they seem oddly enough to be a lot more cooperative.

  • The many psych patients I worked with (mostly foster youth) were not even screened for CURRENT stress and trauma. None were EVER screened for nutritional issues nor were 98% even screened for physical conditions that might lead to their symptoms. All the psychiatrists were primarily interested in was a list of symptoms and their severity so they could decide what drug to prescribe.

  • It doesn’t sound like we disagree much, except on terminology. I have never been opposed to people choosing to try drugs if they seem to work for them. I am opposed to psychiatrists lying about what they know and pretending that all cases of “mental illness” are caused by faulty brain chemistry or wiring or and that the drugs are specific “treatments” for specific “conditions” which they supposedly understand. Beyond that point, we seem to be in agreement on each person needing their own approach. “You use what helps.”

    As for science, I’m afraid the inability to make a distinction between who “has” and “doesn’t have” “schizophrenia” makes any kind of scientific conclusions absolutely impossible. The first job of science is to distinguish an experimental group from a control group. If we are unable to consistently parse these two groups, any scientific conclusion is meaningless.

    For instance, let’s say that 10% of cases of “ADHD” are due to low iron (a known cause of “ADHD” symptoms). If we treat 100% of “ADHD”-labeled kids with iron, only 10% get better. If you compare this treatment to stimulants, which at least temporarily reduce symptoms in 70% or so, stimulants look like the better “treatment,” even though there is no specific understanding of what is being “treated” and even though people without “ADHD” diagnoses react to the drugs in the same way.

    So we conclude (erroneously) that stimulants are a better “treatment for ADHD” than iron, even though 10% of subjects would be cured by being given iron alone. The 10% should not be diagnosed with ADHD, they should be diagnosed with iron deficiency.

    So you see, if you can’t properly divide your participants into objectively discernible groups, your research leads to meaningless or misleading results. If you grouped them into “hyperactive – low iron” and “hyperactive – normal iron”, you’d have gotten 100% success, but when you call it “ADHD,” 10% of your population never gets the help they really need.

    Hope that makes sense!

  • Intimidated? Seriously? I have given you plenty of coherent replies. The most relevant here is the question you were already asked: if some cases of depression/psychosis are caused by biology alone, how specifically do you distinguish which cases are or are not? Drug response is not an adequate answer, not even close – all of these drugs have similar effects of those diagnosed vs. not diagnosed. Just like alcohol relaxes most and removes inhibitions, these drugs have effects on people’s brains that are not specific to a “disorder.” Until you can sort out the conundrum of diagnosing which people have which condition, your theories remain theoretical.

    You also appear to forget that while the best correlation with genes and any “mental disorder” is about 15%, the correlation with trauma is more like 85%. Which seems more likely to be the relevant causal factor?

    Please knock off the insults. They diminish the credibility of your presentation.

  • I completely understand your objections to certification – it is simply an invitation to co-optation and control by the system. I would also be very interested in hearing if there are some areas where the two of you agree. Maybe there isn’t anything, but it’s hard to build a movement with so much fragmentation! I guess that’s the point of co-optation, isn’t it?

    Looking forward to your response!

  • The challenge here is that many of his supporters don’t recognize even his bald-faced manipulations and support for the corporate-capitalist status quo. This hard core of supporters genuinely believe he will change things for the better by chasing away dark-skinned immigrants and magically bringing back anachronistic industries like coal, as well as somehow increasing salaries while he does all he can do make sure workers are unable to organize and that employers get to set the standard for what they feel like paying. I could go on, but the point is, Trump supporters (the poor and working class type) don’t appear to understand that he is completely antithetical to their interests, even though it is “out of the closet,” as you say. It’s a conundrum!

  • I would more put it that “care” in the context of schools comes from an adult viewpoint and denies the legitimacy of kids’ actual, valid complaints about the injustice that occurs so frequently and for which they have no recourse whatsoever. The huge controversy over the TV series, “13 Reasons,” proves the point. It’s OK to “care” about kids as long as you don’t talk about what’s really going on, especially when the cause of their distress is the adults running the system they are forced to comply with. The problem is a chronic power imbalance that allows adults to act with impunity while punishing kids for objecting to their mistreatment.

  • This is some tortured reasoning. The fact that people with food issues latch onto the “clean food” movement doesn’t mean the movement itself has any causal relationship to eating disorders. Clear case of correlation not meaning causation. Some people use nursing a baby continuously as a means of “purging.” But nursing babies doesn’t cause bulimia. Total logical fallacy.

  • I agree 100% that the DSM is at the core of the evil rot that is being perpetrated across the world. Unfortunately, the DSM’s claptrap is supported by a general belief, almost religious in nature, that doctors are smart and ethical and can be trusted. How do we accomplish undermining the DSM without running afoul of the worship of “medical science” as a stable point for many people’s security?

  • “Freeman and Honkasilta note that the DSM-5 itself requires that a disorder not be comprised of cultural difference, or socially deviant behavior that is not harmful.”

    And how exactly does that differ from any other “disorder” in the DSM? If the DSM really required that a “disorder” not be comprised of cultural difference or deviant behavior, it would be a VERY thin manual! It would, in fact, be essentially EMPTY!

    —- Steve

  • It invalidates the child’s voice completely. But that’s what school was all about, as far as I recall. My voice was rarely if ever of interest to anybody there. When I graduated high school, I felt like I’d been released from a POW camp. It was 13 years of torture for me. But nobody ever bothered to ask how I felt about it.

  • #1: Don’t send your kid to a school that scares them!

    This is a fantastic example of ignoring your child’s cues. If a preschooler cried and tantrumed and told you they were afraid to go to preschool, you wouldn’t just force them to go, would you? You’d at least look into it and find out what was bothering him/her. But somehow we’re supposed to assume that school is a great place and that any kid wanting to avoid it is malfunctioning. Maybe the kid wants to avoid school because school is a place of fear, abuse, disrespect, and humiliation. Maybe you should take a good look at what’s happening in your child’s school before you decide that his/her complaints are lacking in substance!

    —- Steve

  • I think you’re missing the point. I am certainly very concerned about addiction to street drugs and think it reflects major failings in our society that so many people feel they have to drug away their feelings of anxiety, rage and hopelessness. My point is that using psychiatric drugs is not at all a different approach, and implies that there is something WRONG with the people who choose drugs as a means of coping with that distress. It also implies that “medication” will somehow be a BETTER means of dealing with their “disabilities.”

    I would also love to see your response to my other points. How we talk about these issues has a very significant impact on how people themselves think of their own distress and the kind of “solutions” proposed by our social system is willing to propose or support. Most importantly, it absolves our society for creating these conditions in the first place. For instance, “ADHD” is simply a critical description of a child who doesn’t fit into a standard classroom environment. By calling them “ADHD,” we prevent any research into the following questions: Are our classrooms failing to meet the needs of kids in general, or these kids in particular? What is causing this behavior for the child? Are there multiple causes? Are we expecting more from our kids than is reasonable for their age? Is it sometimes a function of variable development rates? (A third of ADHD diagnoses appear to evaporate if you wait a year before sending your kid to school!) Boring classrooms? Stress in the home environment? Poor parenting or poor classroom management? Poor diet or dietary deficiencies? Poor sleep? Calling it ADHD prevents ANY research into these potential difficulties!

    And the issue of testing stands on its own: how can you propose testing for a “disorder” that is defined with completely subjective and unmeasurable criteria? And without objective criteria, how would “overmedication” ever be determined? Are not the subjective criteria the reason why “overmedication” can’t be defined, leading to ever-increasing levels of drugging for the convenience of the authorities in charge?

    Thanks for your reply!

    — Steve

  • With all due respect, Joel, the diabetes analogy is an anachronism, or should be for an educated person by this point. Diabetes results from the measurable lack of insulin leading to a measurable increase in blood sugar levels. Successful treatment by diet can be achieved and measured by observing blood sugar and HA1c levels, and if unsuccessful, can be augmented by providing the NATURAL SUBSTANCE (Insulin) which is known to be missing.

    There is no “mental disorder” which has a comparable known missing substance, nor is there any “mental disorder” with a known means of measuring success objectively, nor is any psychiatric drug a naturally-occurring brain chemical that is being replaced in measured amounts. There is literally no point at which diabetes and “mental disorders” have the slightest similarity, other than the fact that drug companies sell drugs that are supposed to treat them.

    And while I will agree with you that there are acute situations where the use of psychiatric drugs may have application, it should be clear to one as educated as you that there is not one such drug that does anything but disrupt normal brain processes (as well as similar processes elsewhere in the body) in a manner no different than using alcohol or street drugs used to achieve similar purposes. The similarities between drinking alcohol and taking benzodiazepines are MUCH greater than any purported similarity between taking psychiatric drugs and the treatment of an identifiable deficiency with insulin. If you want to be taken seriously in an educated community critiquing psychiatry, you’d do very well to leave the “insulin for diabetes” analogy in the dustbin of history where it belongs.

    — Steve

  • I agree with the general sentiments expressed here, namely, that a one-size-fits-all inflexible approach to life leads to higher levels of distress and sometimes to emotional collapse in youth. I’m also glad you mentioned that not everyone goes to college, or needs to.

    That said, there are some distortions in the article that I need to point out. First off, a person who reacts badly to this tracking and enforced life schedule is not DISABLED or suffering from any disorder. They are reacting NORMALLY to an abnormal set of expectations, as the author’s original presentation suggests. It’s important to use that kind of language and to avoid “disability” language or we play into the medical model concept that everyone should “adjust” to whatever expectations society throws at them and that anyone who doesn’t is a failure or is “disabled” by definition.

    Second, you mention “self-medication” (I HATE that term – it implies again that they are deficient or “disordered”) without mentioning the huge and increasing numbers who are legally drugged by their doctors, and the damage done by such legal drugs is not discussed, but is a very important part of the equation. The use of drugs to delete the negative emotions mentioned in my first paragraph is simply one more way to keep our young people “on track” to do the proper things at the proper times and to avoid any discussion of whether such tracking is healthy or destructive.

    Third, and most important, giving counselors more power to “emotionally test” our youth is an EXTREMELY misguided concept! We have already seen that 1) there is no kind of “emotional test” that gives any kind of useful, objective data that would help modify the bizarre expectations of our modern world, and 2) people given this kind of power have been coopted by drug companies into “screening” youth for “disorders” and into routing them to psychiatrists so they can be identified with the proper labels and forced to take the proper drugs, all in the name of keeping them “on track” with the very social expectations you so properly criticize as you open your essay.

    The proper thing to do is not to scan for “disabilities,” but to alter the expectation that every kid goes to college and to re-focus our efforts on providing a wide range of options for youth, and to convey an understanding of and compassion for the very real challenges of moving from youth to adulthood in our screwed-up society. There is no simple “test” that can do this – it requires compassionate, caring, supportive human interaction, starting with overtly stating and recognizing that the world they are entering is, in fact, a bizarre one that provokes anxiety in almost all of us who live in it. Honesty goes a lot further than testing in helping kids cope, though of course, the BEST solution would be to work at revising our society in ways that don’t make its participants quite so “crazy” by expecting abnormal things and pretending they are normal.

  • I would also challenge the author to define “overdiagnosis” when the ADHD diagnosis is totally subjective. The reason the diagnostic boundaries can expand is because they are simply made up by a committee of psychiatrists who vote on what they should be. There can be no “overdiagnosis” without an objective standard, and lacking one, the whole concept of diagnosis becomes meaningless.

  • As for the “paedogogical” effectiveness of stimulants, this is an illusion. Every review of long-term literature on stimulants confirms that there is NO academic or social benefit from long-term stimulant use, including completion of grades, academic test scores, dropout rates, and college enrollment. While I appreciate your description of the many possible causes and alternative approaches for this particular behavioral syndrome, you do your readers a grave disservice not to mention that any academic benefits that may accrue are small and fleeting, according to the Raine study, the MTA study, the Quebec ADHD study, the Oregon State University Medication Effectiveness study, and the Finnish/US comparison study, just to name a few. The very best reason NOT to consider stimulants for your kids is that in the long run, THEY SIMPLY DO NOT WORK, at least not if you care about outcomes beyond reducing adult frustration.

  • There has been a frantic (dare I say “manic?”) search for “genetic or chemical predispositions” to “bipolar disorder” and any other “mental illness” you care to name. The success has, to put it mildly, been “disappointing.” The BEST correlation they’ve come up with is about a 15% correlation of people having SOME of a range of about 100 genetic markers being diagnosed with a RANGE of “mental illnesses,” including ADHD, depression, and schizophrenia.

    Meanwhile, correlations with early life traumatic events such as abuse and neglect or loss of parental figures, etc., reaches well over 80%. PHYSICAL illnesses are also correlated highly with early childhood traumatic experiences. Epigenetic changes have been proven to occur when people are traumatized, especially in childhood. So 15% AT MOST correlation with genetics, 80+% correlation with environmental trauma, not even considering larger scale social stresses like bad jobs, racism, poverty, etc…. So what exactly makes you believe that “genetic or chemical predispositions” are the main cause of “bipolar disorder?”

  • Sounds like she may have been having delusional adverse effects, which either stimulants or SSRIs can cause. The commercials may have provided the material (most commercials are very much anxiety based), but I doubt she’d have had this reaction without the “help” of the drugs. And as usual, the doctor completely discounts the idea that the drugs could be causing this, despite it being on the label and despite this behavior never occurring before the drugs. Wouldn’t you expect to get BETTER with the right treatment, even if you totally buy into the “medical model?” Baffling!

  • This sounds like what therapy should be about. It should be flexible, focused on developing options rather than “reducing symptoms,” and should change based on direct feedback from clients. The therapists should LEARN from the family what is happening, what works, and what doesn’t, rather than following some pre-digested set of “techniques” approved by someone else based on some statistical probabilities about outcomes that may be of no interest to the family involved.

    Thanks for the inspiring article. If only this would develop into the standard of care!

  • Wow, they seriously think that life conditions might affect a person’s “mental health?” Dude, what a radical concept! Next thing you know, they’ll discover that running into something causes pain in the parts of the body that are impacted! Or that hunger can be alleviated by eating food!

    We’re in a bad place when this obvious fact comes as a revelation to the field. What’s sadder is that it will be ignored by the psychiatric mainstream.

  • I agree in large part with the author’s assertions. The very fact of being told you have a “chemical imbalance” that you can do nothing about is demoralizing, and it’s far worse if you’ve tried their magic pills and found no improvement, because this suggests that you are DOOMED to permanent depression!

    I used to work a crisis line and handled a call where the person was absolutely frantic. She had tried a half a dozen or more drugs over a year or more and had gotten no relief. She was absolutely desperate and terrified that nothing would ever help. I asked her, “Has anyone ever told you that there are other things you can do for depression besides drugs?” She stopped, seeming kind of stunned. “No,” she said. “Well, there are.” I said. “Oh. Well, that’s good,” she said. She was 90% calmer just knowing that she might be able to take some kind of action, without even exploring what action was possible! The idea that she was limited by her “chemical imbalance” and had no power to do anything herself to stop it. The concept is more depressing than anything that might have brought on the depression in the first place!

    — Steve

  • I agree 100%. There is proof that our Western society makes people ill. Some group did a study over three generations on health outcomes for immigrants to the USA. At the start, their health outcomes were all over the place, but after the third generation, they had American problems like heart disease, cancer, anxiety and depression in numbers similar to those who had been here many generations. Part of psychiatry’s job is to keep the focus off of “the system” so the rich can get richer and the powerful more powerful. But I fear I am preaching to the choir now!

    — Steve

  • This is a powerful case study and a startling indictment not only of Prozac, but more importantly, of the damage our “label-and-drug” system does to real human beings, minimizing what is important and isolating those suffering from any possibility of real help. What would have happened if people had TALKED to these kids instead of giving them the message that their brains were messed up and that these drugs would somehow magically make everything all better? What kind of message does it send to say that being upset about your grandparents dying in succession is something “normal” people don’t get upset about, or that your problems are all in your brain so don’t bother telling us what you’re thinking because none of it means anything?

    Thanks to Peter Breggin for this lucid and disturbing account of the poor impact of this approach and the incredible disconnect between what the news media reports and what is really going on.

    —- Steve

  • Does anyone have to forbid armchair diagnosis of heart disease or cancer or a broken leg?

    This is merely reflective of the negative power of psychiatric “diagnosis” in society at large. People make “armchair diagnoses” all the time, all over TV and movies and in cafes and living rooms around the country. The very subjective and judgmental nature of these labels play into the human desire to lump people into “us” and “them” and to spread blame and hostility toward someone we want to downgrade or humiliate or feel superior to.

    While I personally can’t stand Trump due to his immaturity and his deep involvement in corruption, slapping a “diagnosis” on him is simply a childish exercise of acting out against the “bad daddy.” Not only should psychiatrists and psychoanalysts be forbidden from diagnosing public figures, the whole concept of “diagnosis” based on behavior and emotional state should be scrapped, because it serves no real purpose besides stigmatizing and distancing us from those who are so labeled.

  • Appalling article. They spend most of the article talking about “depression genes” and “treatment-resistant depression” and the “new breakthroughs” that are “just around the corner,” just as we’ve heard since Benzedrine came to the market back in the 60s. They toss in a few “other things you can do” at the end but they feel like an afterthought. They also comment on the STAR-D study as if there were no methodological issues with it, despite lots of criticism even from the mainstream. No comment section, either. I wonder of one of our respected professionals can write a letter to the editor to complain of the one-sided and disingenuous treatment of the subject?

    —- Steve

  • Why the focus on homeopathy, when so many approved drugs kill so many people? At least homeopathy has next to no adverse effects, while Risperdal can and does kill many people. Where’s the effort to debunk Big Pharma’s scamming? Referring to Thalidomide as the reason Big Pharma isn’t trusted is pretty disingenuous, with Viiox and many other more recent examples to refer to.

  • They overlook the obvious reason for the inconsistent findings: THERE IS NO CONSISTENT FINDING TO BE MADE! IN other words, there is no correlation between depression and a particular “aberrant” brain function. This is the clear SCIENTIFIC conclusion when multiple experiments lead to no result. It is only the lack of a scientific intent that allows these experiments to continue to be funded. Any real scientist wouldn’t be blathering on about methodology and statistical issues. If 50% of experiments point to increased activity and 50% point to decreased activity, you have your answer – there is no effect to be measured. Why is that not the conclusion of the study???

    — Steve

  • I agree. It is only an assumption that we are all chemicals and nothing more. Lots of cultural traditions, indeed almost every cultural tradition, posits that we are more than that. The concept that we are only material is a PHILOSOPHICAL assumption, not a scientific fact. The mind is a mystery that science has not even begun to unravel in the slightest degree.

    That being said, the author recognizes that “we” (the entity possessing the mind in charge of the body) can cause things to happen, and that biochemical changes are the response. That’s the most important starting point, regardless of what we believe “mind” to be or how we believe it to be generated. The latter question is one of metaphysics, and I doubt hard science will ever be able to find a concrete answer to it.

  • The other problem with this kind of research is that it only establishes probability. Some people with less white matter are not depressed, and some people with more white matter are. Unless EVERY depressed person presents with reduced white matter, there is no possibility of even a high correlational link, let alone a causal one. It’s really an idiotic conclusion to draw when 80-90% of your sample overlaps with “normal.”

  • So not counting the large number of dropouts, . which would no doubt lower the response rate, still half of the users didn’t have a strong response, and 30% barely had a response at all. This also doesn’t include placebo response. This suggests that probably half of the users didn’t benefit even in the short run. Not a very impressive display of effectiveness, was it?

  • I agree that attachment-based therapies get to the core of what’s going on much more effectively for those with long-term trauma. CBT is favored largely because it avoids such issues, as there is a huge “don’t blame the parents” meme that is central to the biological viewpoint. EMDR I think has sensible components to it, including recognizing that traumatic events are the core of the person’s suffering, and I am guessing it’s much more effective than what most people get as therapy or “case management.” I do agree that the eye-movements and tapping and other stuff seem hokey, and I’m guessing they’re probably somewhat ancillary, but telling a narrative of the events in question is no doubt therapeutic for those with specific traumatic events to process. And let’s face it, most people in “the system” have plenty of traumatic events to process. So if it’s a choice between EMDR and treatment as usual, I’d go for EMDR every time, even though I believe attachment-based therapeutic interventions will have more long-lasting results. The other difficulty with attachment-centered therapies is that the therapist has to have their attachment issues under control, and most therapists do not, and engaging in that kind of approach can do a lot of damage with an unenlightened therapist.

  • So more than half are able to discontinue successfully, and are happy with their decisions to do so, despite an almost complete lack of support by professionals. If half of your cohort can discontinue and are happy with the results, why the f*&k would you not be encouraging folks to try it? Kickbacks or meeting one’s own security needs at the expense of the client seem the only reasonable explanations.

    —- Steve

  • A Science Court for psychiatry would have to be staffed by totally disinterested citizens. Best to select people from totally different professional backgrounds, like a sociologist or ecologist or computer scientist, and an equal number of consumers, selected by random or from consumer-based (NOT parent-based) support organizations. No psychiatrists or psychologists allowed!

  • Obstetrics is an area with similar ignoring of evidence in order to maintain the status quo. The national Caesarian rate is around 30% or higher and no one bats an eyelash, while midwives have as good or better of a safety record with rates under 10%.

    Another great example is Semmelweis. He introduced handwashing into labor and delivery wards and reduced the childbed fever rates from very high to almost nothing. He was fired because the doctors were insulted he thought their hands were dirty, and his successor eliminated the practice and rates soared again, sending Semmelweis to the mental ward with frustration.

    Freud himself was intimidated away from his original finding that many adult women had been sexually molested, and completely changed his “trauma theory” and developed the “drive theory” in order to accommodate the community’s need not to admit what was going on. A hundred years later, it was shown that his observations were absolutely correct, but psychiatry remains committed not to look at abuse and trauma as the main cause of “mental disorders.” Not much money in trauma, I guess.

  • True dat! I also rarely see the disheartening social and political consequences of our current “system” identified as contributing factors. Interestingly, these factors also massively contribute to the food-based environmental issues to which you so rightly refer.

    —- Steve

  • Thanks for telling a great story so effectively! It sounds like the last therapist you saw was the only one who got what was going on. It kind of sounds like your need to go along with what others were suggesting was a big part of your struggle, but “the system” saw that compliance as the ultimate in good patient behavior. Does that sound right? I say this as a person who worked years to overcome my need to keep everyone but me happy. I was very fortunate to strike gold on my first therapist, but this was back in the 80s before the DSM was in place. It was particularly disheartening to hear how much time they spent trying to figure out which DSM box you should be fit into and so little time actually listening to your view of things. It seems they actually did the exact OPPOSITE of what you really needed, and it predictably made things worse.

    Thanks again for sharing your story. It’s very important for people in similar situations to see that there really IS a way out, but that finding the right label is not part of the path to a better life.

    —- Steve

  • Too true. I am familiar with some of Connors’ work and can attest that the “objective” screening tools he developed are totally based on teacher and parent ratings of children’s behavior as it affected them or their classrooms, and zero consideration was given to family stress or personal trauma history. You do the checklist, the kid gets a score, and no one ever even talks to the kid to find out why they might be acting the way they are. It’s a joke.

    I’m glad he came to the conclusions he did toward the end of his life, but it’s telling that neither he nor many like Allen Frances who decry the “over-diagnosis” of this or that “disorder” appear to understand that the “diagnostic” process itself leads to this result inevitably. As soon as you have a subjective element in diagnosis, especially when it involves people in a relationship with a significant power differential, the victims of abuse and neglect will be subjected to ever-increasing criticism in the form of “diagnosis” of anything they do that is inconvenient or uncomfortable. Allowing subjective “diagnosis” based on the opinions of parents or professionals opens the door wide to blaming the powerless victims of their irresponsible behavior, and given the opportunity, I’d say the majority of adults in the power-up situation are only to happy to open that door the moment a crack of light shows a possibility of passing through.

  • I agree. I can only speculate that mania may be harder for the person him/herself to notice, as it doesn’t necessarily feel bad to the person experiencing it at the time it’s occurring. I also wonder what kind of questions they asked – if they were very open ended, a person might report, say, agitation and feelings of restlessness and loss of sleep and suicidal thoughts, but not put them all together and call it “mania.” We know mania is a reasonably common reaction, and it is puzzling that it doesn’t appear in the manuscript.

  • There is no drug war against the recipients of ANY of these drugs. The war (if that is the right term) is against the PURVEYORS OF LIES who pretend that these drugs aren’t addictive or that they have no adverse effects or that anxiety is “treated” by giving these drugs over the long term. Informed consent merely gives people like you the information needed to decide if you want to or don’t want to use them. There is no hostility intended toward the users of these substances.

  • The basic problem starts from treating “symptoms” as “disorders.” Giving up on the idea that we can “treat” an emotional condition without figuring out what’s behind it, whether mental, physical, or spiritual, would be a great first step toward a rational approach. I guess this is better in that it at least doesn’t denigrate the person with the “symptoms,” but you’d think the lack of results for “causes” would lead an intelligent person to abandon the labeling process that gave us “disorders” that don’t have unitary or even similar causes.

  • Missing the #1 reason these evaluations are unreliable – they are relying on subjective “diagnoses” and sketchy “objective” tests that aren’t the least bit objective, because they’re “measuring” things like risk of violence that are not actually measurable in any real sense. Admitting this will help us realize that the courtroom is a place of moral judgment, not medical, except as far as medical expertise can objectively shed light on guilt or innocence. As such, psychological/psychiatric pseudo-experts should not be considered to provide valid testimony, and the judge should consider the case on more objective facts. For instance, instead of testimony on whether someone is “mentally ill,” why not hear testimony from people who know the person in question as to his/her volatility/violence potential in their direct observation? A person’s actions are a much better predictor of their future actions than some “expert” who barely knows the person and tosses a few Mickey-Mouse “tests” at them.

  • No one is suggesting that people don’t act the way BPD and others are described in the DSM. We’re only saying that it’s a DESCRIPTION, not a DIAGNOSIS. The “diagnosis” (though I don’t think that’s the right word at all) for most BPD people should really be childhood abuse and neglect, because it’s present in almost all cases. This way, we’re looking at actual causes instead of blaming victims. Saying someone “has BPD” places the problem within the person who was abused, and lets the parents and/or cultural institutions and/or other perpetrators off the hook for their destructive behavior.

    You say that people with these “disorders” come for help. So I guess there are two questions: one, is it really OK to “diagnose” a person with a “disorder” that is simply an observation of how someone acts and has no connection to any kind of objective physical cause or measurement, just because it allows them to get insurance reimbursement? And two, is “diagnosing” someone with BPD actually helpful TO THE PERSON who is diagnosed?

    I think on the latter, the concerns are pretty obvious. As a person who has worked in the field, I can tell you that people with a BPD diagnosis are commonly feared and even reviled by mental health “professionals” in the system. People find their behavior frustrating, and the label BPD allows them to blame the client for his/her frustrating behavior and allows clinicians to act out their anger punitively with the support of their fellow professionals while denying any kind of real connection or empathy with the client. It also often disqualifies a person for therapeutic support, since “BPD” is considered by some to be “untreatable.” So I think the answer to the second question is a resounding NO in most cases.

    As to the first, I again ask you if it makes sense to “diagnose” someone with a description? To get more concrete, would it make sense to diagnose someone with “a rash” and leave it at that? A rash is an indication that something might be wrong and that further investigation into causes is needed. If we diagnosed a rash like we do BPD, we’d give everyone topical steroids. It would work for some cases, would do nothing in others, and make it worse in yet other cases. Some cases would really be caused by poison ivy, others by measles, others by syphilis. The ones with poison ivy would resolve better with the steroids, the measles would be unaffected. The syphilis rash would go away, too, but the person would later die an excruciating death as the bacteria ate up his/her brain. We’d say that the syphilitic person was “treatment resistant,” and no one would ever suspect that the problem was with the diagnosis itself, or rather the pretension of diagnosis that prevents actual diagnosis from ever happening.

    It would be a lot easier for people to be “diagnosed” with “Badly mistreated by parents and learned coping measures that are ineffective in current life” than “BPD.” They could still get help without someone blaming and denigrating them for having what is a very common reaction to very poor conditions in early life.

    Hope that clears things up a bit!

    —- Steve

  • What a great treatise on the realities of privilege! Privileged people DO get abused and otherwise traumatized, but they have many more opportunities to have alternative outcomes, because they have funds, more connections to other privileged people, more sympathy, better educations, and so on. I have compassion for all folks who have been traumatized, but it is very important for privileged folks (like me) to recognize that trauma for those less privileged are more constant, more systematic, less avoidable, and less recoverable. Reducing poverty is probably the #1 way to reduce what is so laughably called “mental disorders” by our cold and unforgiving system.

  • True enough. And it happened under Democrats and under Republicans. When push comes to shove, they all hang together to support corporate power over human rights, and the further from US soil you get, the less we give a crap about the human rights of the citizens involved.

    As to Sanders, one of the great things about him is that he IS open to being educated about things he is not fully informed of. If there is one politician who might be able to be influenced to take a stand contrary to Big Pharma, Bernie is that guy.

  • I wish I did! We could perhaps start by supporting efforts to end corporate contributions to political campaigns, shorten those campaigns, and massively reduce the cost of running for office. Physician groups have already come out against DTC advertising – perhaps that’s a good place to start? I suppose another goal might be to make it so that lobbying expenses can’t be taken off on a corporation’s taxes, but I’m guessing we’d get ENORMOUS resistance to that kind of idea!

  • I like the focus on finding points of agreement, Gary, and I found the points you mentioned excellent. I believe you are, however, missing one of the most, if not THE most important one. Financial corruption! I think we can get strong agreement that pharmaceutical companies purchasing influence in various ways, including sponsoring “educational” seminars promoting their products, ghostwriting articles, and engaging in DTC advertising and promotion to doctors which massively impacts prescribing habits and research priorities, is an evil that needs to be eliminated in the service of accomplishing any of the other goals you mention. Corporate malfeasance is also an area where many who occupy different ends of the left-right political spectrum can find solid agreement.

    Thanks for a timely article!

    — Steve

  • It is truly a religious system. The doctors are the holy priests, and people go to them for magical cures. They even have holy vestments. Nurses could be considered “vestal virgins” of a sort. The Holy Scriptures, in psychiatrists’ case, are the pages of the DSM, which ironically enough is often called the “psychiatrists’ Bible.” Doctors are the priests of Scientism, the belief that Science will provide us with Ultimate Truth. Hence, doctors are believed regardless of the sense of anything they say, and those who speak ill of them are considered apostate or heathen. Real science often inconveniently undercuts many Scientist dogma, but that doesn’t seem to bother the True Believers. Hence, we have electronic fetal monitoring as a standard of care (increases Caesarian rates massively with actual reduction in outcomes), cholesterol drugs massively prescribed with little to no improvement in outcomes, and of course, the entire field of psychiatry, whose clients are sicker and die younger than those who manage to escape their notice.

    It is very hard to undercut basic mythology in any society.

    — Steve

  • Once again, the intervention is wrong-headed – it is focused on trying to stop self-harming behaviors instead of trying to figure out why they’re happening and addressing the underlying causes. The first thing I learned as a counselor about self-harming behaviors (and I learned this from the clients, not any training I had) was that self-harming behaviors served a purpose, and understanding the purpose was the key to moving forward, regardless of whether the person continued to self-harm or not. The very concept of hospitalizing someone for self-harming (non-suicidal) behavior is stupid in the extreme. Most self-harming behavior is not intended to be lethal or anything close to it, but “professionals” end up punishing the coping measure instead of looking for what the client is coping with. When I worked a crisis line for 3 1/2 years, we had many cutters call us instead of their therapists, because they knew telling their therapists meant either shaming of them (you know you’re not supposed to do that) or being sent to the hospital. As long as we’re studying how to “stop self-harming behaviors,” we will continue to create “interventions” that do more harm than good.

    —- Steve

  • Well, your fear seems rational to me. I’m sorry no form of therapy has seemed helpful, either. It sounds from your story that your early life experiences lie at the core of your distress most likely. There is no drug for that.

    Two things you didn’t mention that some people have found helpful: 1) support groups of people who have had similar past experiences, and 2) mindfulness/meditation. Now I know the latter has been commodified and mutated so as to remove any spiritual significance, and I know that some support groups have been coopted by the authorities and are no longer worth going. But if you find something through a YWCA or a women’s program, you can probably find a support group for survivors of childhood abuse, and there are plenty of genuine meditation practitioners out there who have no association with the so-called “mental health” system. I’ve personally used meditation practices to handle high-anxiety situations with lots of success. Of course, nothing works for everyone, and you have to find your own path, but both of those I’ve seen work for many people.

    I’m so sorry you’ve gone through such horrors! It sounds like almost every authority figure you’ve ever known has betrayed you. I hope you are able to find some comfort and support from others like you, because your suffering is by no means unusual, though your particular experiences may be unique. It’s a crappy world sometimes, and we have to be careful whom we trust, but there ARE trustable people out there. Just not a lot in the places we’re told to look.

    —- Steve

  • I agree. However, these syndromes should be called syndromes, not “disorders.” And the explanations given for them claim that they are something a lot more than syndromes. Clients are frequently told that they “have a chemical imbalance” or “their brain doesn’t work quite right” or “I know you want to pay attention, but your brain won’t let you” or “mental illness is a neurobiological disorder of the brain.” I could riff off half a dozen more “explanations” that are simply lies, given out of ignorance or malfeasance, it doesn’t matter. I have no objection to people using shortcut terms to communicate, but syndromes are syndromes, and when they’re treated as if they are something else, you get idiocy and destruction as a result.

  • Not to mention doctors doing a RIDICULOUS number of Caesarian sections in the first place – over 30% of babies in the USA are delivered by Caesarian. WHO recommendations say no more than 15%, which I think is very high. Midwifes often sport figures like 2-5%. US Obstetrics is almost as irrational as US psychiatry.

  • The video is an anecdote. It’s one story about one person. We should never make decisions based solely on personal anecdotes. We should look at hard data gathered from many people over time. And the data says that people exposed to electric shocks to their brains have brain damage, lose important memories, sometimes feel despairing and hopeless, and lose whatever “benefits” they gain within days or weeks of the “treatment.” I would never use ECT even if I thought I had no other options.

    What else have you tried before?

    — Steve

  • I have no problem with diagnosis as a means of getting insurance reimbursement. When I had to do psych diagnosis, I told the clients exactly what the diagnosis meant – essentially a description of what seemed to be happening on the outside, chosen for the purpose of getting the insurance company to pay for the needed services. I assured them that I was not in the least concerned with this label, which had to do with payment, and was very much more interested in what the client has to say about what’s going on, when it started, when it stops, what THEY thought it was related to, what has helped in the past, what has made it worse, etc.

    As for psychometrics, sure, you can give someone the HAM-D and count up points and some will have higher scores than others, but what does it mean? I never, ever bothered with such silly nonsense, but instead simply asked the person the kind of questions that might be on such a questionnaire in the context of a normal conversation. As to whether they improved or not, well, they were of course the best and in many ways the only way to make that determination. I feel the same way about IQ tests (somewhat more reliable, but still, what the heck are you really measuring?) and any other psychometric tests. They are mostly very unscientific, because they measure undefined and undefinable entities. To compare a HAM-D scale score to a blood sugar measurement is absurd. One measures a physically determinable quantity. The other “measures” a concept. Measuring depression is as ridiculous as measuring courage or shyness or integrity. They are not measurable entities – they are social constructs that have meaning that varies widely based on both the reporter and the “measurer,” and can’t ever be standardized. They can be “normed,” but of course, “norming” makes the assumption that the average of scores on a questionnaire establish how things ought to be. There is no objective norm possible.

    Diabetes is of course BASED on signs and symptoms, but it is not itself a SIGN or SYMPTOM – it is a concept or model that EXPLAINS why low blood sugar and other signs and symptoms are happening, and PREDICTS with some accuracy what kind of intervention will help. As I outlined very clearly above, an “ADHD” diagnosis does neither of these things – it provides no explanation as to cause, nor does it accurately predict what will help, because of course the same thing will not help all members of an utterly heterogeneous group. So what’s the point of saying someone “has ADHD” when it tells you neither the cause nor the treatment for the “disorder?”

    As for psychiatrists, I defy you to name where I said they were all evil bastards. I believe there ARE some evil bastards at the higher levels of the hierarchy, and a smattering of evil bastards lower in the ranks, but most are simply grossly misinformed, and are committed (as you appear to be) to believing in these subjective and misleading categories of “disorders” which don’t serve them or their clients well.

    I could go on all night, but I’ll stop here. You’re simply stating things without addressing my clearly expressed concerns with the system. You admit that psych diagnosis creates heterogeneous categories, and yet still feel the diabetes-insulin analogy is appropriate? It’s very hard to fathom how an obviously bright person as you appear to be can’t see how very different answering a questionnaire is from having one’s blood sugar measured. I’ll leave it at that.