Wednesday, March 22, 2023

Comments by Steve McCrea

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  • I appreciate you sharing your experience, and I agree that lived experience should include everyone who has such experience, regardless of what that experience is.

    I do wonder, however, where you get the idea that if alternative approaches were identified, they would have been identified by psychiatry and adopted. I just finished posting on the article about Martin Harrow, who was apparently castigated and attacked for publishing research that did not agree with the psychiatric mainstream position that all “schizophrenic” diagnosed people must be maintained on antipsychotics for the rest of their lives. Harrow was no radical, he was a mainstream researcher who simply reported his findings of a very well-designed study. They attacked him simply because he challenged the status quo belief system and threatened the hierarchy’s control of the narrative. It seems very likely that the very best evidence of any alternative approach would be attacked and buried, rather than identified and accepted. That’s my view of it anyway, and I think that’s what the evidence tells us. Mainstream psychiatry is not particularly interested in alternative viewpoints.

  • It says a lot that Harrow, who before his research was very much a mainstream researcher, was vilified for simply presenting the results of his research. It goes to show the lack of integrity pervading the psychiatric industry, and the lengths to which their leaders will go to stifle any attempt to undermine their cash flow, regardless of the truth of the data presented.

  • All very well said.

    RE: iron deficiency and “ADHD”:

    “The lower the levels of ferritin — a protein found inside cells that store iron — the more severe the symptoms. A small study, published in Pediatric Neurology, showed that symptoms improved when iron-deficient children with ADHD took an iron supplement.”,the%20more%20severe%20the%20symptoms.&text=A%20small%20study%2C%20published%20in,ADHD%20took%20an%20iron%20supplement.

    This is from ADDitude Magazine, hardly a bunch of antipsychiatry rebels!

    Of course, some “true believers” try to claim that “ADHD reduces iron levels!” No accounting for human stupidity, I guess.

  • POSTING AS MODERATOR: I just want to be clear in approving the above comment that I am assuming the author means the abusive families of those “Mad people” who HAVE abusive families, as there are plenty of “Mad people’ who don’t have abusive families, though there are also plenty who do.

  • That’s exactly my reaction! If you have two options, one of which is completely safe and without notable adverse effects, while the other has all sorts of possible damage AND stops working as soon as you stop it, and both are “equally effective,” clearly, the first is FAR preferable! But the researchers never seem to say this. Maybe they’re not “allowed” to!

  • My point is that “mad” and “crazy” have both been used historically as more or less synonymous. There is nothing about “mad” that implies “mentally ill” in the modern sense. In fact, it is also synonymous for kind of wildly creative and spontaneous. There is also the usage of “mad skills,” meaning incredibly fantastic. And of course, “mad” also has the meaning of “angry,” which makes the choice of the word “mad” kind of interesting for a website like “Mad in America” – it can reflect any of the above meanings, including having difficulty with the weird expectations of modern society AND pissed off that we are expected to “be OK” with all that AND angry at the “system” for driving us all “mad!”

    So I think it’s a very rich word with a lot of nuances, very, very different from the extremely specific word, “Mentally ill,” which was created for the very purpose of “othering” folks by the “professionals” or “experts” claiming they have some authority to determine who is or is not “normal.”

    Anyway, that’s my take on it. And I’m not making comments as moderator here, just me as a person expressing my views on the point. I see no reason not to have “Mad Camp” as long as the more empowered uses of the term “mad” are intended and understood. The problem to me is not the word, it’s the intention behind the word, and I don’t see “mad” as necessarily having the the intent to disempower or other a person, especially if that person chooses to identify with “madness” as a means of empowering him/herself.

  • As I think I’ve said before, we’ve kind of aired this out pretty thoroughly. There are people who want to “reclaim” the word “mad” from the psychiatric profession, and those who consider it unredeemably contaminated. I think everyone is entitled to their own view on that point. “Peer” is a different issue to me, as I believe it’s fair to say the term was invented BY the psychiatric profession for the purpose of “defanging” the antipsychiatry movement, and has some associations that are hard to shake. But the term “mad” (like the word “crazy”) has a long and varied history of use over centuries. In fact, I have seldom if ever heard psychiatrists or psychologists using the term “mad” at all. They usually eschew it for terms like “mentally ill” or “mentally disordered” or even “consumers.”

    But in any case, I think “mad” is going to remain an interesting and ambiguous term, and I can’t see these ambiguities being resolved in the MIA comments section any time soon!

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

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

  • I will once again point out that fearing retaliation from one’s peers or superiors for reporting abuse is not STIGMA. It is DISCRIMINATION, plain and simple. The person is not ashamed of reporting, s/he is AFRAID of the consequences of reporting the event, and for very concrete and real reasons. They are being treated in a violent and threatening manner for seeking justice. VERY different from the concept of “stigma,” if it ever actually does apply to any kind of violent victimization such as rape or sexual assault.

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

  • I do get that. But most of that is in the context of “diagnosis.” I’ve heard lots of arguments about whether someone qualifies for a “PTSD diagnosis” based on whether or not their experience could really be called “traumatic.” I think this is very damaging. Traumatic experiences are at the discretion of the person feeling traumatized. Minimization is another act of discrimination that is unfortunately encouraged by the whole idea of dividing people into the “mentally ill” and the “sane,” which as we both know is not a scientifically valid distinction.

    That’s my take on it anyway. Everyone on Earth has experienced trauma of one sort or another. Who is to say that being abandoned temporarily by one’s parents at the age of 6 is more or less of a trauma than being sexually molested by the babysitter or being told day after day that you’re too stupid to succeed? Something is as traumatic as the effect it has on the person being affected. No one else is really in a position to judge.

  • Psychiatric drugs and demon dispossession have some common roots back there historically. Both identify a vague and unidentifiable “something” that has “taken over” the victim and needs to be “driven out” by physical and or psychological means, even when the ‘exorcists’ have no actual comprehension of what the entity that has “taken over” actually might be. On the whole, I’d be more in favor of demon dispossession, though – fewer ill effects on the body in general!


    The use and meaning of the word “Mad” has been a constant controversy here for years. I totally understand the conflict from both sides. I hope we can all accept and understand that others’ use of the word is for their intended meaning, even if it means something else to us as individuals. I find “all or nothing” statements about this unproductive, and hope we can own our own beliefs and meanings without having to accuse everyone who doesn’t agree with us of some sort of misbehavior. As the prior poster says, “language is a tricky beast,” and I think we are best served by discussing how we find the word “mad” affects us or how we might seeing it affect others without the assumption that everyone has to see it the same way.

    Hope that makes sense. I don’t think we’re going to come up with a black and white answer to this nuanced question!

    P.S. I just came across this from Laura O posting earlier on this same thread. I hope she doesn’t mind my using it as a model. It is a perfect example of how to critique the use of this word without attacking others who see it differently:

    “I, too, would never label myself or others as “Mad”. For me, it’s a condescending, disparaging word that minimizes the very real suffering survivors experience in their lives.”

  • The biggest problem with Freud is that he chickened out. He had it right at first, that many young women were being sexually abused by their relatives or others, and that their “Mental health issues” were largely caused by this. But his colleagues attacked him and he backed down, deciding that these recollections were “fantasies” in order to protect the men of the day from scrutiny. It took another hundred years before we finally came back to the point, and there is still a TON of resistance to the idea to this day. A large part of the effort to blame “mental illness” on the victim’s brain is that it deflects attention from the real causes, which are generally abuse/neglect, poverty and social dysfunction.

  • I agree 100%. I had a dog who was neglected in her early life – she was constantly anxious and needed to be petted all the time to keep from freaking out. She also used to compulsively run away, much like abused/neglected teens in foster care often do. My friend also had a parrot who behaved quite “normally” most of the time, but whenever a wooden stick or rod was brought near him, he totally freaked out, going back and forth between attacking the stick and trying to hide from it. Sounds a lot like “PTSD” to me! (I mean the parrot, not my friend!)


    To yinyang: I have revised this comment slightly so it will pass our Posting Guidelines. I was unable to send you an email to discuss it, not sure exactly why, . If you want to be informed of or have feedback into moderation decisions, I’ll need a functioning email address from you. Thanks!

  • It has always been my belief from observation that the main action of “antidepressants” was a general blunting of emotion. That result is described by many who take the SSRIs in particular, and fits with both the “positive” and “negative” reported effects. If one is very anxious all the time, a blunting of emotions can be associated with reduces anxiety, which might seem positive. If one is being held back from doing impulsive things (including killing oneself or harming others) by fear of the consequences, blunting may result in manic episodes, increase in suicidality, or increase in impulsive violence, including those occasional murderous acts we all have heard about. Loss of sexual function is also consistent with blunting of physiological sensations and with impairment of the motivational system to rewards (rewards are less rewarding, hence not as much worth pursuing, or sometimes not even physiologically feasible). There isn’t much that the SSRIs do that isn’t explained by emotional blunting. I think that is their main mechanism of action. And I think it is well worth recognizing that these are not “antidepressants” but “antiemotion” pills, and to ask whether this is really something that society as a whole really wants to be promoting as a benefit.

  • That is exactly how I used to work. I always used the client’s exact words or as close as I could get in framing the problem. The only purpose for DSM “diagnoses” was to obtain reimbursement, and if the topic of “diagnosis” ever came up in discussion (and it usually did not), I would tell them exactly that. I’d say I gave them the best “diagnosis” I could to get them the kind of help they were needing/asking for, and that the “diagnosis” meant nothing else but that. I always told folks that they were the only ones who knew what, if anything, was “wrong” and what would work. I was just helping them to sort that out for themselves.

  • You are not taking responsibility for the impact of your invalidation of others. You have not demystified anything that I can see, it comes across that you have simply told another poster they were too stupid to figure out how to get EMDR paid for. It came across as condescending and had a hurtful effect. I would hope that you as a professional carer would want to know that so as to avoid doing similar harm in the future. At a minimum, you could own your own experience (“I personally haven’t had that problem” or “It’s my understanding that most insurance will pay for EMDR”) without telling the other person they were wrong for saying otherwise. You don’t know enough about their situation to presume to tell them what can and can’t be covered in their context, and I think you’d be well served to remember that next time you comment on another person’s experience.

  • Rachel, I’m baffled how many times you seem to have taken the exact opposite from my words that I am intending to communicate! I am a HUGE believer in the impact of environment and family upbringing as the MAJOR CAUSE of most of the DSM “diagnoses,” and science backs me up on this point. Where on earth did you get the idea I thought otherwise? I need to figure out what I’m saying that is not getting across to you. It’s really confusing to me how you are mistaking my meaning so frequently, even though I sense that you are doing your best to make sense of it!

  • Touche! It is fascinating that the psychiatric mainstream claims that these “mental illnesses” are all or mostly genetic, yet they have to use torture of animals to create similar circumstances. Wasn’t the “wire monkey” set of experiments sufficient to establish that early childhood mistreatment/neglect leads to a host of “mental illnesses” for adults? How many times do we have to do the same experiments and still fail to see the real results?

  • Quite so. But you and I are in no position to judge how easy or difficult it may be to find a provider willing to support/justify the treatment the client wants. I’m saying it’s important that folks with professional backgrounds, like you and I, learn to step down from our one-up power positions and listen to the people actually in the trenches seeking services. If someone says, “I can’t get a therapist who will provide EMDR because I have a BPD diagnosis,” it is our job to listen to and believe them, because we are not in their position. A more respectful approach would be to ask some questions, like, “What state are you in? What have the therapists said to you when you asked? Is it the therapist refusing to ask or the insurance company refusing to cover it? What kind of “reasons” are you getting from the insurance company?” Then maybe we can help that person find a path toward getting it covered. Just saying, “No, you’re wrong, it’s covered by your insurance” comes across as both condescending and invalidative of the very real experience of the poster. It is, for lack of a better word, a rather unprofessional approach, IMHO.

  • As I have always maintained, people act a certain way because on some level it seems necessary or wise for their own survival. To think that folks can simply “think away” their own history and the reasons for their fears and their insistence on or avoidance of certain situations is actually quite invalidative of their experience. And suggests simplistic answers, such as “Just think the right thoughts and you’ll feel better soon!” which are hardly realistic for people struggling with past and often current abuse, often by the very system that’s claiming to help them. And it provides cover for blaming the victim for “failing to think the right thoughts” or “failing to take the program seriously” when it doesn’t work for them.

    I’ve been told by several people that DBT practitioners sometimes FORCE people to engage in “mindfulness” activities. Nothing could show more ignorance of how mindfulness really works than thinking you can force someone to do it and expect any kind of results. These manualized “therapy programs” are of very little use in most cases, as what the person really needs is someone to LISTEN and UNDERSTAND them, and help THEM make their own minds up about what they want to be different and whether or not a certain approach is working for them.

    And your last comment is most important. There is no way to completely set one’s issues aside as a therapist. The best one can do is to be aware that you DO have issues and you WILL bring them to the session, and to be aware enough of them to distinguish between your own needs and the client’s needs. The number of people who can actually do this is incredibly small!

  • Not saying that at all. I’m saying to do legitimate scientific research, you need a legitimate research group of people who have something that makes them the same. Murderers don’t qualify as such a group, as they are selected by a specific kind of behavior AND by the fact that they got convicted. It could be an interesting subject that might LEAD to some scientific hypotheses, which could then be tested, but simply comparing brains of convicted murderers smacks of “phrenology,” where the head shapes of criminals were compared to conclude what commonalities criminals shared in order to predict criminality. It was, of course, a complete bust, but it all sounded very “scientific.” So far, brain scan research has been used to “explain” a lot of things that it doesn’t explain at all. I’m very skeptical based on the sketchy history of brain scan research as well as the obvious heterogeneity of the group of “convicted murderers” and would have to see the basis for the research to judge.

  • It’s always interesting to listen to these ideas, but they are mostly very unscientific, relying on the assumption that correlation = causation. The fact that there may be some similarities between brain scans of two people who happen to be murderers proves absolutely nothing at all. Until we can see that most or all murderers have the same brain activity/structures and that no one or almost no one who doesn’t murder doesn’t have them, we have nothing of use scientifically. Murder, like all human behavior, is extremely complex, and there is no reason to believe that it is “caused” by a particular physiological state.

    I just wanted to clarify where I was coming from. My main point is that you can’t vote diseases in and out of existence. There needs to be some sort of objective means of distinguishing between who does and does not “have” a particular “diagnosis,” and such means simply do not exist for ANY “DSM diagnosis.”

  • I think you are speaking in technical terms of what is theoretically possible, while the other posters are speaking in terms of what ACTUALLY HAPPENS in the real world. It’s probably neither possible nor appropriate for those of us who haven’t been in the position of seeking “treatment.” I defer to those who have been on that side of the table.

    That being said, I really do appreciate your efforts to destigmatize the BPD “diagnosis.” I think your framing of these “diagnoses” is about as sane as anyone working within the system can make it. But I do think it’s important to remember that you (and I) are/were outliers and that most clients of the “mental health system” are not treated with anything close to the degree of respect for their context than what you are describing.

  • I refer to it only as a way that some people identify themselves. Of course, I don’t see psychiatry as a “product” in the same sense as a tube of toothpaste. First off, toothpaste doesn’t pretend to be more than it is. Second, no one can legally force you to accept their “toothpaste” as a “product” that they can force down your throat! I suppose the person is a “consumer” in the sense that they are forced to “consume” the drugs that are selected for them, but the social meaning of “consumer” suggests a person who can use their buying power to influence what products are available. That certainly does not apply to the bulk of psychiatric “participants,” willing or not.

  • It is extremely easy to describe a behavior without a label. Some examples: “I feel worried every time I go out of the house. I’m not afraid of anything specific, just have this big surge of anxiety.”

    “When Mary visits her mother, she sees things in the house that remind her of her sexual abuse as a child by her father, and she often experiences flashbacks of the event.”

    “Monique has never left her children with another caregiver in 5 years. She states that she is afraid that her children will be sexually abused. When asked, she relates that she was also sexually abused as a child.”

    These describe what is happening far more accurately than “I have agoraphobia” or “She suffers from PTSD” or “She’s got an adjustment disorder.” And they invite an exploration of why these things are happening, and what might be done about them. In the latter case, a very short intervention inviting her to find someone she knew would NOT sexually abuse her child and make a plan to get a break led to a COMPLETE TURNAROUND in her life, from suicidal to passionately pursuing a sexual abuse recovery program. I met her two weeks later and she was virtually unrecognizable, she was so pumped. So why did she need a “diagnosis?” She did not. She needed someone to be interested in her situation and to drill down as to her motivations and to help her take some sort of effective ACTION to challenge her unproductive but understandable fears.

    Some doctors THINK “mental illness” is a ‘misfiring of the brain,’ but no one really knows what that really means, even though they say that. There is no evidence of “proper firing” or “misfiring” that they can point to, no measurement of correct “chemical balances” that they can perform, no “normal brain” they can compare yours to and show some sort of abnormality. I find (and science supports me in this) that this kind of explanation leads many folks to feeling hopeless and disempowered, and deflects attention from the causes and possible interventions that might let the person herself take more control of her life.

    I am certain that different people have variations in their genetic makeup, and I don’t exclude the possibility that in SOME cases, this may create some kind of vulnerability. But that does NOT make the genetic differences a “disease” marker. First off, there is absolutely no reliable evidence that any “mental disorder” associates with any “genetic abnormality” in the brain. The best correlations are in the single digits for large groups of genes considered together, but none is even close to being able to predict ANY “mental disorder” in the entire manual. Whereas most “mental disorders” correlate at over 80% levels with childhood adversity and mistreatment. Since genes are the one thing in the entire equation we can NOT change, it seems pretty silly to spend billions researching genetic causes when we know that childhood adversity is a very ADDRESSABLE reason for these “disorders” occurring.

    In your case, you yourself identify that others with similar genetics have some similar behavioral tendencies, but your case became more severe because of the abuse you suffered. It seems if you need a “diagnosis” it ought to be “Victim of childhood violence,” which is at least observably true. Saying someone “has OCD” and trying to blame it on your brain is very typical psychiatric narrative, but it is pure speculation on their part, they know NOTHING about the actual causes of these behaviors and emotions.

    If their approach works for you, more power to you. I would never want to take that away from you. But your personally benefiting from what they did with you does not legitimize the DSM, which the head of the NIMH himself said “lacked validity” a few years back. The NIMH even stopped using the DSM diagnoses for research after that time. It is VERY legitimate to question the DSM categories scientifically, and it has nothing to do with believing or not believing that people in distress need assistance. I think everyone should do what works for them, but I am opposed to lying to people about what is known just so they’ll be more comfortable accepting whatever treatment is offered.

  • I am not calling you “brainwashed,” and I have never suggested eliminating all treatment, and I don’t know how you would draw that conclusion from what I wrote. My comments clearly criticize not TREATMENT but the idea that the DSM can “diagnose” people accurately of some kind of medical problem using checklists of problematic behaviors, thoughts, and emotions.

    Perhaps you are thinking that DSM “diagnoses” are the same as treatment? I understand that people benefit from getting outside help, and professional assistance CAN be quite useful to some folks if you have the right professional and the right approach.

    But pretending that somehow professionals can distinguish between “obsessive thoughts” and “intrusive thoughts” and normal thoughts is not scientific, and the DSM itself says it is unable to do that. I’ve helped lots of people over the years improve the condition of their lives, and never once did a “diagnosis” play any role in helping bring it about.

  • Most psych survivors were psych consumers at one time. I’d say it depends on the “consumer.” Those who are invested in promoting the current system need to be left alone, but there are many “consumers” who are confused, angry, frustrated, and beginning to doubt the veracity of the psychiatric narrative. Such people need to hear from survivors rather than those other promotors of the status quo referred to above.

    I consider it bigoted to assume that all “consumers” are the same.

  • I understand that you believe these “disorders” have some real scientific meaning. I do not. Being very familiar with the DSM, these “disorders” are very simply descriptions of behavior or thoughts or emotions a person might have which tend for whatever reason to occur together.

    Intrusive thoughts are VERY common with people recovering from traumatic experiences, and seem to actually be part of the DSM description for PTSD. So how can you tell if you have “covert OCD” or “PTSD” or simply have thoughts you don’t want to have that seem to come from the outside? I’m not against DESCRIBING things I just think putting a name on something one observes is not the same as “diagnosing.” A diagnosis ought to be aimed at establishing cause, distinguishing between seemingly similar presentations based on cause, and distinguishing between effective treatments/interventions for the situation. As a former counselor/therapist, I found little to no value in labeling a person’s experience based on the DSM. I simply went directly to “What are you experiencing?” and then looked for the underlying reasons the person may be experiencing these things. “Intrusive thoughts” can have many different origins, and I’d start by asking what the thoughts were and when they arose and go from there. No “diagnosis” is needed – all I needed to know was that the client was willing to share their experiences with me and help me understand what was happening to them. The only reason I ever gave a DSM diagnosis was for insurance reimbursement, and that’s about all they are good for, IMHO.

    I’m sorry if that clashes with your beliefs, and I don’t expect you to agree with me or think less of you if you don’t. But my opinion is based on decades of experience and I’m not likely to change it, as I feel I have a very good handle on exactly what these “diagnoses” really represent.

  • I don’t care how the DSM 5 “organizes” their fictional definitions of “disorders.” As I noted, the DSM itself admits it can’t clearly distinguish between someone who has Disorder A or Disorder B or Disorder A and nothing at all wrong with them. It goes on further to say that “There is also no assumption that two people with the same disorder are alike in all important ways.” In other words, two people with the same “disorder” may have very different needs and very different causes and very different approaches may be needed to help them, even though they have the same “diagnosis.”

    What is the point of “diagnosing” people with something that they may or may not have, when even those who fit the same “diagnosis” may have totally different problems requiring totally different solutions? It makes the concept of “comorbidity” more than a bit of a joke. Do I have “excessive digital-nasal insertion disorder” or do I have “itchy nasal passage disorder?” Maybe it’s comorbid, because my nose itches AND I pick my nose to relieve it? Or is the latter simply a consequence of the former diagnosis?

    The real question is, why should anyone care what label you put on my behavior? Why not just let me pick my nose, or help me with the itchiness or find something useful to do besides “diagnosing” something you have absolutely no understanding of?

  • It is so obvious how biased they are toward the evidence by how they talk about it. For abuse to have CAUSED “schizophrenia,” apparently we need proof beyond a reasonable doubt that EVERY case of “schizophrenia” is caused by abuse, despite there being no reason to assume all cases of “schizophrenia” are caused by any one thing, it being a behavioral syndrome that could have many causes. But for biological causation, a tiny correlation of hundreds of genes associated with less than a tenth of cases is evidence that “schizophrenia has a biological cause,” even though correlations with childhood abuse are ten or a hundred times stronger. How is it that the world of science and medicine is still willing to entertain and publish such obviously biased nonsense?

  • The very concept of “Comorbid disorders” presumes that the DSM is able to distinguish between one “disorder” and another, while the DSM itself asserts its own inability to do so.

    “In DSM, there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no disorder.”

    In other words, there is no clear line between “disorders,” so the concept of “comorbid disorders” is totally invalid.

  • I would also ask why we would assume that the woman would NOT have lay down on the bridge just because she was “medicated.” And the term “leaving [her] unmedicated” reflects a very paternalistic attitude, as if we have a right to “leave” or “not leave” her in a particular degree of “medicatedness.” As if she herself has no particular rights to decide her own course of action.

  • I think any medical diagnosis needs to be able to differentiate between a “normal” and a “diseased” state, objectively and consistently. Medicine is to treat the BODY. “Psychiatry” and “Psychology” are supposed to deal with the “psyche,” aka the Human Spirit. Attempts to treat spiritual issues with drugs and surgery and electric-shock-induced seizures are doomed for failure. So I think the “treatment” of any spiritual/emotional condition does not belong in the realm of medicine, and therefore the idea of “diagnosis” in the medical sense is irrelevant, and likely unavoidably destructive.

    I much prefer the use of descriptive language. “Mary hears voices speaking to her that others can’t hear. She is feeling very anxious and worried that the voices are going to tell her to kill herself, as they have done in the past. She feels safest at her sister’s house, who is good at calming her down.” That sort of thing is a LOT more helpful than saying, “She’s got schizophrenia!”

  • I never have agreed with almost anything Dr. Pies has said. He’s a marketing agent for psychiatry.

    What he’s saying in the article is technically true, but he is not taking into account HOW the DSM is used. The fact that someone has a “medical diagnosis” opens the door to stigmatization, which has been proven over and over again to be greater the more medically the causes of these “diagnoses” are viewed. A lot of the text he includes are from the introduction and clinical guidelines, which I’m sorry to say most clinicians don’t bother to read, or if they do, fail to put into practice. Pies also fails to give any reason, and in facts argues AGAINST it, for putting people into these “fuzzy categories” in the first place. Any reasoning he uses is more sociology/anthropology than medical in nature. By admitting there is no clear boundary between one “disorder” and another, and between having a “disorder” and having “no disorder,” he acknowledges that the whole house of cards blows down with the slightest puff of air.

    Here is an example in his own words: “When a patient presents with the complaint, “I hear threatening voices in my head,” we simply must diagnose—a word whose etymology means, “knowing the difference between.” For example, we must know the difference between “threatening voices” stemming from combat-related trauma, on the one hand, versus schizophrenia or anti-NMDA receptor encephalitis15 on the other. Otherwise, our treatment is likely to be misguided.”

    Note he gives NO real reason why he “MUST DIAGNOSE,” and defines diagnosis as “knowing the difference between.” But he just admitted above that the DSM itself asserts no ability to “know the difference” between being disordered or not, or between having one diagnosis or another! So giving a DSM diagnosis does NOT provide “the difference between,” it actually confuses such efforts by lumping people with widely differing problems into the same “diagnosis!”

    Notice also in his example that he is NOT talking about differentiating between “mental disorders,” but between causes (Combat trauma, encephalitis, or the mysterious and undefined “schizophrenia,” which is such a vague “diagnosis” that the Japanese are not even using it any longer.)

    In short, Pies and company talk a good game, but when you look at what he’s REALLY saying, it’s simply more marketing of ideas that don’t have any scientific basis at all.

  • Again, this would not be a “cause” of “ADHD,” as the large majority of those so diagnosed do NOT have this mutation, and there are apparently lots of people who have the mutation who DON’T get diagnosed with “ADHD.” There may be a VERY small subset of those diagnosed who have this problem, and I have no objection to folks testing for this anomaly and doing some sort of research on the tiny subgroup. But at that point, they are no longer diagnosed with “ADHD,” they are diagnosed with CDH2 mutation, which has to be made very clear in order to get any useful outcome.

    As to stimulant “treatment,” as I indicated earlier, there is little to no evidence that using stimulants in the long term improves overall outcomes for the “ADHD” cohort, and there are notable adverse effects, including growth retardation, loss of appetite, and psychotic symptoms in up to 10% or more of users at “therapeutic” dosages. But one would have to look at the CDH2 subgroup and look at them separately to really answer that question. In my book, if there are risks and no real long-term benefits, I don’t care if there IS a biological cause, there is nothing to recommend assuming the risk of drugging kids without a clear and substantial benefit.

    The other problem is who gets to define what is beneficial? If the teachers are telling the story, they might decide that being relatively inert and sitting quietly in a chair all day is a beneficial outcome. But what about from the kid’s point of view? Nobody bothers to ask what THEY find helpful in most cases. It’s an intervention for the benefit of the adults. As I said, why is there no “hypoactivity disorder?”

  • I agree, to be scientific, one must be skeptical and always open to new data that disconfirms your hypothesis. To the exact contrary, the psychiatric/psychological industries have a marketing approach, searching for and emphasizing every tiny snippet of data that supports their contentions, and going far out of the way to bury or discredit even bury data that disagrees with their preferred narrative. As soon as you start selecting which data you want to pay attention to, you’ve left the ship of science!

  • Exactly. It seems a gradual narrowing of “normal” is happening, and instead of “normal” we now have “acceptable” or “appropriate.” Which is of course defined by the authorities in charge. I think it crosses the line from puzzling into evil.

  • I would submit that Buddhism, for instance, does not require or teach conformity, except to the extent that certain practices are recommended to improve one’s understanding of one’s own spiritual nature. I’ve also been to Quaker meetings, where there is no preacher or designed program, but the attendees are encouraged to get in touch with their “intuition” and speak as they feel moved to speak. I don’t see much conformity there, except that you need to be quiet while others are speaking and not invalidate or criticize what they share.

    I definitely see that organized religion tends very strongly toward enforcing conformity of both belief and actions, and often uses fear to create compliance. I have never had any patience with such practices. I think we should all be in touch with our own inner sense of what is “right” and true, rather than following some outside interpretation of reality. That’s one of the reasons I love the Quaker approach. Nobody gets to tell you what God (or whatever spiritual reality a person might believe in) has to say to you. You get to seek those answers for yourself.

  • That’s the other good point – we know that healthy relationships can “heal” whatever changes to the brain occur as a result of trauma, at least to an extent. Why we waste time on all these biological cause studies when we KNOW that social conditions can be improved and result in improved outcomes is quite puzzling. Unless we postulate that those providing “treatment” aren’t really that concerned with people’s outcomes being improved?

  • I think we’re overgeneralizing a bit, though. Not ALL religious are about conformity. There are lots of brands of religions, and the same nominal religion can have sect with WILDLY different approaches! But I do agree that humans tend to turn any religious practice in the direction of conformity, and the more “organized” it is, the more authoritarian it seems to get. But that’s just my observation.

  • So are you saying that large pharmaceutical companies DON’T frequently promote their products by hiding data and lying to the public and overstating the benefits and downplaying the adverse effects of their product? Do you remember Vioxx? The lawsuits they “settle” out of court, like the one for falsely advertising antipsychotics for children? You don’t think that PharmA lobbyists are buying influence in Congress? And I’m not just talking about checking labeling – I’m talking about assuming that doctors are always telling the truth and have your best interests in mind.

    Take the antidepressants as an example. It was a known fact that they caused aggression and suicidality in a small but significant number of recipients, way back in 1987. Prozac was initially banned in Germany for that very reason. But it took until something like 2003 for that warning to get onto the label. Why do you think that happened? Do you think no one NOTICED? Or perhaps they suppressed this information in the interests of making profits? Do you really think they are beyond this? Or that doctors are all above board and honest and well educated when they get a ton of their information from drug reps?
    I don’t think the regulation of the drug industry is any better than it was 40 years ago – in some ways it’s worse! Did you know that you can get a drug approved with just TWO studies that show it’s even marginally better than a placebo, even if there are 80 studies saying it doesn’t work or makes things worse? It used to be three were required. Hardly an improvement in the regulatory system.

    I’m really not sure why you seem to be making this into a black and white issue. The world isn’t divided into those who qualified to interpret medical information and those who are doomed to accept their judgment. I notice you have not acknowledged that an intelligent person CAN personally read scientific research and draw his/her own conclusions without the intervention of a “medical professional.” Do you think that is impossible? Are doctors automatically smarter than I am? Are there no incompetent or corrupt doctors out there who can’t be trusted with my body and my life? If I can’t decide that, who can? And how would I decide if I’m too dumb to do my own research?

  • Who said only trusting oneself? Clearly, I’m advising doing scientific research, speaking to other doctors and medical professionals for second opinions, looking at proven alternatives, etc. I’m saying that AUTOMATICALLY trusting that what a doctor is telling you is the truth just because they are a doctor is foolish and dangerous. It’s also bullshit that no one is smart enough to learn on their own a good bit of important information that doctors may or may not share with you. You don’t need qualifications to read scientific studies in many cases, or to simply read the patient handout for any drugs you are prescribed, especially when we’re talking about psychiatry/psychology. Not saying I would determine for myself what drugs (if any) to prescribe, but it’s not that hard to discover that your physician is talking through his/her hat with a little research.

    My dad was taking blood thinners after a heart attack. He went to a doctor, told him all about every drug he was taking, and was given a second prescription. Within a day or two, he was having instant bruising when he put his elbow on the table or pressed his finger into his arm. He looked up the second drug he was prescribed, and it said in BOLD LETTERS: CONTRAINDICATED WITH BLOOD THINNER X. DEATH COULD RESULT. He was hemorrhaging at the slightest touch. A minor car accident or a fall off a chair or small ladder would have certainly killed him on the spot. Yet the doctor knew all his medications and still prescribed this deadly combination. Are you suggesting he wasn’t “qualified” to look up the drug and discover it is contraindicated with the blood thinner he was prescribed, nor to conclude quickly that his subcutaneous bruising was almost certainly caused by the noted negative interaction between these two drugs?

    Every since that time, I NEVER take any drug until I’ve looked it up and examined side effects and contraindications. If my dad had fully trusted that doctor without question, he’d almost certainly have been dead at 40, instead of living until he was 85. Unquestioning trust in doctors is as dangerous as going it alone with no advice. In psychiatry in particular, going it alone may in fact be safer in many cases.

  • It is saying that you can’t trust that the doctors or Big Pharma are going to give you honest information. I don’t think it’s promoting the “untrained public” to “self medicate,” it’s promoting asking questions and doing one’s own research and getting multiple opinions before assuming that the “information” you have been given by the professionals is automatically to be trusted.

  • Yes, animals do appear to commit suicide:

    I think it is EXTREMELY damaging to “put thinking suicidal back in the closet.” This will make it MORE likely that people will kill themselves because they can’t talk about it! I used to work a suicide hotline and have talked to hundreds of people who said they were considering suicide. The vast majority were not “threatening,” they were simply desperate to end the pain they were experiencing and wanted some kind of help.

    I have heard of people, especially domestic abuse perpetrators or child molesters, threaten suicide when consequences ensue for their bad behavior. This is a different matter and should be dealt with much more harshly, I believe, as it is an attempt to use the threat of suicide to manipulate or control others and avoid accountability. But the vast majority of suicidal people are looking for someone to talk to and connect with.

    Of course, there are also those who rationally decide that suicide is the best next step in their lives, based on health conditions or something of that nature that has a very grim future prognosis. It would seem cruel to deny such people the right to talk over the pros and cons of their options, including suicide, so they can make the best decision they can.

  • I am saying all of those things. When “ADHD” is defined by a set of behaviors, most of which are based on school behavior, and none of which are even slightly objective observations, you’re going to get a group that has little to nothing in common with each other except the behavior. It could be totally normal for that child at that age and stage of development. It could be the result of nutritional deficiencies, particularly iron, or sleep problems. It could be an indicator of problems in the home that are not addressed, particularly domestic abuse. It could be an indicator of prior trauma and possible “PTSD” symptoms, where there is a huge overlap with “ADHD.” It could be an incompetent teacher who doesn’t know how to manage a class and provokes resistance from the more sensitive or the bolder kids. It could be the child is bored to death because s/he is way ahead of the class and isn’t being challenged at all. All of the above considerations could cause the “symptoms” described as “ADHD.”

    Here are a few of these “symptoms:”

    making careless mistakes – for example, in schoolwork
    appearing forgetful or losing things
    being unable to stick to tasks that are tedious or time-consuming
    appearing to be unable to listen to or carry out instructions
    excessive physical movement
    excessive talking
    being unable to wait their turn
    acting without thinking
    interrupting conversations

    Not one of the above is in any way objectively measurable, and none require any kind of medical “explanation.” Most are just ways that kids act when they are young and less mature. Ever know a kid who acts without thinking, or interrupts conversations, or had a hard time waiting their turn? More importantly, how many kids do you know who do NOT engage in these behaviors at least some of the time? How could you possibly tell when a kid “interrupting conversations” reached some critical level that it becomes a “symptom?” And why would we assume that any of this is caused by some sort of “brain problem?”

    A very interesting study shed some light on the advantages this “ADHD” behavior actually conveys on kids and on society. They took groups of three kids and gave them a set of three problems to solve. One bunch had two “normal” and one “ADHD” kid in each group. The control groups had three “normal” kids in each group, no “ADHD” kids. They measured how often the group was “on task,” working on solving the problems. The control groups did significantly better on this measure, while the “ADHD” groups goofed off or screwed around more and spend a good deal less time working on the problems. But NONE of the control groups solved any of the problems, while all of the “ADHD” groups solved at least one and I believe a couple solved all three! So their goofiness and off-task behavior allowed for more creativity and outside the box thinking and meant these problems got solved.

    Now if they’d had groups with THREE “ADHD” kids, it’s quite possible nothing would have gotten done at all! But it shows that we NEED these “ADHD” types to help us solve problems, and that having ALL conventional thinkers in our society will most likely lead to stagnation and failure.

    It takes all kinds to make a world, as they say, but apparently psychiatry has no idea what that means, as they want to make all kids act in ways that keep the adults happy. And that’s what I believe “ADHD” is really all about.

    Notice there is no “Hypoactivity” disorder? I think that says a lot!

  • Some have claimed that “ADHD” brains are smaller on the average, but those studies did not take into account medication use, which shrinks the very parts of the brain they say are smaller, particularly the cingulate gyrus. Additionally, even if these studies were accurate, they are AVERAGES, which means that lots of people WITHOUT “ADHD” diagnoses have smaller brains and lots of people WITH “ADHD” diagnoses have larger brains. It is obvious that if these were “causes,” it would apply to all of them. There is no evidence that everyone with “ADHD” has any kind of similarity in brain structures, so that claim is BS.

    Of course, a lot of psychiatrists will tell you that your kid needs “treatment.” That’s just what they do. Until and unless they have some evidence that this “disorder” is actually a disease state, you are safe ignoring them. It’s also VERY important to note that kids who are “treated” with “ADHD” drugs do not do any better in the long run, academically, socially, or physically, than those who are “diagnosed” but don’t receive any stimulants. So the “treatment” is not worth anything much in the long run on the average, even if some seem to do better taking the drugs.

    My final point is that even if the “ADHD” child is in some way biologically different, difference is not the same as disease. Species survival depends on genetic diversity. There is no reason to think that being less patient with boring stuff and wanting to move around and not follow rules is evidence of anything “wrong” with the child. I think the main problem is that we try to expect kids to do things that are abnormal to expect kids to do. The strong evidence of this is that fully a THIRD of kids diagnosed “ADHD” in Kindergarten prove NOT to get that “diagnosis” if they wait a year later to enroll in school. A third grow out of it in one year. That’s not a “disease,” that’s a problem of inappropriate developmental expectations.

  • Who is trying to take away your Adderall? Certainly nobody here. If it works for you, that’s your decision. The problem is not with people taking Adderall if they feel it’s helpful, the problem is telling everyone that these difficulties are the result of a “disease state” despite having little to no evidence that such a “disease state” is valid and verifiable.

    It’s not about the drugs. It’s about the “diagnoses.”

  • I don’t think it’s broken. I think it serves a different purpose than it pretends to. It does quite well in making money for certain people and keeping other people under control or sufficiently diminished in capacity to not be threatening to the status quo.

  • Excellent counterexamples of the “need for forced treatment!” I’m so sorry you had to go through this kind of crap. And I think you are right, it remains invisible to most “insiders,” because those who have been essentially arrested and held against their wills are totally willing to say whatever they need to say to get the hell out of there. So if you ask a forcibly incarcerated person in a “mental” ward if they were OK with being detained, the smart ones will say, “Oh, yes, BLESS you, I’m SOOO lucky you put me in here, I’m SOOO much better now, can you please unlock the door and let me go home?” This is not even taking into account the phenomenon of “internalized oppression,” where some of the victims spend a lot of energy trying to explain why their abuse is “understandable” and somehow deserved, as a means of avoiding the conflict of being the adverse effect of an overwhelming power that they can’t possibly match. I’m usually all for asking the client to let us know the truth, but asking people in the hospital psych ward involuntarily if they agree they ought to have been detained is going to give you a very distorted picture of reality.

    Thanks for sharing your stories. I hope some of those “insiders” take a good look at the utter randomness of these events!