There doesn’t need to be an “alternative” if the current paradigm is wrong. Sometimes we don’t know the right thing to do, but we do know that what IS happening is wrong. Should we continue to systematically do something damaging because we don’t have an “alternative?”
So it sounds like a pattern of behavior for you, not a “diagnosis.” That being the case, how can people be accused of not “diagnosing BPD correctly?”
I’d really prefer we dump the label and simply rely on accurate descriptions of people who are dangerous for one reason or another. What a psychiatrist thinks, or frankly what anyone thinks their “diagnosis” is, is of little to no value.
Why do you assume that all or even most medical professionals follow “science?” If you have not read Anatomy of an Epidemic, you have missed the primary explanation for why this website exists, which is specifically because psychiatry has REFUSED over time to use or rationally respond to the “algorithm” known as science. You seem to believe that it does without evidence and attack anyone who disagrees with your assumption. Why not do some listening and exploration toward the very scientific double-blind studies and long-term reviews of the literature on which Mr. Whitaker’s concerns are rationally founded?
I agree 100% that putting down religious beliefs and practices is out of bounds, and I apologize for missing any posts which did so. Please report to me at my email if any other posts of that nature come through and I will re-moderate them for appropriateness.
It is interesting to note how experimenters get mice or whatever into the proper “mental” state to test their drugs. They seem to always STRESS the poor little creatures until they are anxious or depressed or whatever.
See the Rat Park experiment or Harlow’s Monkeys. Environment completely alters animal behavior, for the better or the worse. Clearly should apply to humans…
But there ARE wrong answers! Forcing people capable of reasoning to go against their own wishes IS wrong, whatever might be “right.” The choice of “justice” as a focus implies without question that stopping unjust or “wrong” actions is the main thrust of the effort!
All of these are probabalistic statements. There is no clear connection between a particular genetic pattern and all or even most “cases” of “ADHD”. None of these genetic indicators have ever been used to “diagnose” ADHD, mainly because many people with a particular mutation do NOT “have ADHD,” while many who are diagnosed with “ADHD” don’t have the mutation in question.
Perhaps this begs the larger question: Even if there are genetic associations with SOME cases of “ADHD” that are predictable, why have we decided that these variations in human behavior are a “disorder” or disease condition? Why is there no “Attention excess hypoactivity disorder?” Why is only HYPERactivity considered a problem?
I think we know the answer. “Hyperactive” children are more difficult for adults to manage, as they don’t (by definition) tend to go along with the program, so we decide that the child is the problem rather than examining our own models of education and other societal expectations. This despite reliable research that so-called “ADHD” children are virtually indistinguishable from “normal” children in open classroom settings, and that “treated” children do not in general have any better outcomes than those who are left to their own devices. This doesn’t even begin to touch the other big issue, namely that abused/neglected children tend to have a much higher rate of “ADHD” diagnoses than the general populace. If it’s all genetic, why is it so much more common in the foster care population?
I have no doubt that some kids are genetically “programmed” to be more active than others (though this does NOT come close to explaining “cause” for the range of kids so diagnosed). Maybe a range of such people is necessary for success as a species. After all, species survival depends on sufficient genetic diversity. Or as one wise foster kid put it, “Maybe it’s OK for different people to have different brain chemistries.”
OK, I think we have sufficiently fleshed out this argument. Everyone made their positions clear, and it’s not going to be productive to continue along these lines. Let’s move on!
I’m not sure the system is “broken” so much as that it doesn’t really have the same objectives as it claims to have. Keeping folks under control is a big part of the agenda, and “healing” is something they gave up on a long time ago, if they ever really had that as a goal at all. Someone who thinks electrocuting people into having a grand mal seizure is good “treatment” for anything is not really interested in helping you get better!
The duty to inform is very often disregarded, especially in the “mental health” fields.
When did I advise a person who is depressed to study holy scriptures? I’m afraid you have literally no idea what I’m talking about. I understand you are a “physicalist” as you put it, and I believe that blinds you to the ability to understand that the CAUSES of any “mental disorder” are actually unknown, no matter how many scans you want to do. You are ASSUMING the cause is in the brain, and therefor the consequence is diddling with the brain. The results of such reasoning have so far been fairly disastrous, if you believe the literature (including Anatomy of an Epidemic). A true “duty of disclosure” would mean admitting “we are treating an entity we don’t really understand.” I doubt very much anyone hears this from their doctor.
You are, of course, welcome to express your own philosophy, however, scientific proof of such ideas remains a long way off, if we go by the literature on success rates and damage rates and even diagnostic consistency and so on. (If these scans are so great, why aren’t they being used for “diagnosis?”) You’re not going to convince me by repeating your beliefs over and over again without bothering to try and understand where I am coming from. Probably not worth further discussion, as you seem quite certain of your ‘rightness’ and I doubt will hear me, and I am certainly not going to be convinced by your kind of arguments.
You again conflate function with structure here: “This doesnāt change the fact that a depression is not a mental state you can invoke within a blink of an eye but structural or functional deficits of your brain and such malfunctioning parts of your brain can be exposed by imaging methods.” The fact that SPECT images of “depressed” brains are similar in some respects does not imply structural differences, nor does it imply malfunction. I certainly never would suggest that depression can be overcome by thinking of different events, but that’s not what I said. Depression is a very complicated condition. The brain is clearly involved but to imagine people only get depressed because of “bad brains” is not consistent with observation, otherwise, why would it be so much more common in people with abuse histories?
And you are right, avoiding psychiatry seems like the smart path to me. I don’t think being a “physicalist” is necessarily a more rational position, though you seem to imply those who aren’t are being foolish. Being a “physicalist” is a belief system or philosophy. You are welcome to your own philosophy, of course, but that doesn’t make it any less a belief system than any other philosophy. I would prefer working with people who recognize my agency as a human being rather than seeing me as some sort of chemical machine.
It sounds like we generally agree on all that. My only objection is that I don’t believe that “mental illness” as currently understood (or misunderstood and labeled) generally requires “treatment” of the brain per se. A person who is suffering can have a perfectly sound and functioning brain. Spiritual/emotional pain is something that I believe extends well beyond the brain, and “treating the brain” to handle most of it is like replacing memory chips to fix a computer programming error. Until we get away from seeing the brain as the problem, and start looking at social conditions, we aren’t going to get far with even the best technology, because I think we’re barking up the wrong tree!
Brain ACTIVITY is not the same as brain STRUCTURE. A brain may be DOING certain things while depressed and those ACTIONS may be reflected in measurements of activity (PET and SPECT scans, for instance). However, a) these scans say ABSOLUTELY NOTHING about the reason the brain is behaving in a certain way, only that it is and b) it has been shown that changing what one is thinking can change the PET scan, hence, thinking of a depressing topic creates a certain pattern, while the same person thinking of something cheerful changes the pattern instantly to something else.
All that being said, there is NO CONSISTENT PATTERN that is associated with all cases of depression, or even most. Same with ADHD or other “disorders.” This is why these are never used in diagnosis, except by charlatans who take advantage of people’s vulnerability. They simply fail completely in being able to understand or predict the CAUSE of any psychiatric “condition,” and this will not change, as they measure ACTIVITY alone.
Of course, these “disorders” are defined by social expectations and judgments in the first place, not scientific criteria, so why anyone would expect any brain measurement to “diagnose” them is puzzling. Clearly, we have the cart before the horse here – we are supposed to find the proximal cause of a condition before assuming we can “diagnose” it concretely. For all we know, there could be 25 different reasons people become depressed, all of which result in similar brain scans. As long as that’s the case, the idea of diagnosing by scans will remain a pipe dream, IMHO.
Please try to keep the condescension out of any response, it is not appropriate.
You are assuming that all “depression” comes from some biological failure of the brain. There is, of course, absolutely no evidence to show that claim to have any validity.
I’m going to let one more post stand on this topic. Larry, if you have any validated links or literature to share that Mark can read, please help us out and do so. If not, it sounds like you’ve answered Mark’s questions and I’d like to leave off with one more post. The discussion is really quite far off the original topic.
Any therapist who thinks it his/her job to “keep the conversation going” is an idiot. Silence is really important in a good, supportive conversation. It allows important things to surface!
Does knowledge of the brain even have a primary place in this discussion? Are we really talking about “illnesses” if these “illnesses” are socially defined?
They seem to mean that they expect people to get better but they get worse instead. A paradox only if there is a rational expectation that the initial “treatment” should work. That seems to be a large part of the “trick” of selling psych drugs. Make an open claim that they “work” and then call failures “resistance” or “paradoxical” instead of just admitting they were wrong!
Walter, if you read carefully, you will see I am not generalizing, merely pointing out that the Deaf community IN MY EXPERIENCE is not monolithic in its views on “normalcy.” I am advocating for listening TO the Deaf community and its individual members to understand, rather than using “ableist assumptions” (including assuming that a member does or does not view him/herself as disabled) to characterize its members. Some do and some don’t view themselves as disabled. I’m not even disagreeing with the prior poster. This is true whether or not the prior poster identifies as part of the Deaf community.
How can the author state there have been “advances in treatment options” when it is clear that the “treatment options” are not resolving the problem? Wouldn’t an “advance” in treatment mean a DECREASE in the number of sufferers??? I think the authors miss the point. As Robert’s research demonstrates, the ADs tend to be COUNTERPRODUCTIVE, a form of ANTI-TREATMENT for many people. When the best estimates of “success” show rates of 30%, and even then with very small improvements that may not even be clinically significant, it’s hardly appropriate to call “treatment failures” a “paradox.” They are evidence that the treatment doesn’t work!
It’s not a “paradox” unless there is reason to expect the “treatments” to be effective. In this case, it’s simply evidence of either treatment failure, or a hidden agenda to create more customers!
Please email me at [email protected] and let me know the details. A delay of one day is normal, as there is only one of me and I don’t always get to this more than once a day. If I said something was duplication, it means you made another comment saying something the same or very similar. If that’s not the case, I can fix it, but I need to know the thread, preferably the date, and the first sentence or so, so I can make sure I identify the correct comments.
Unfortunately for your theory, it appears that these drugs “sculpt” the brain in most unfortunate ways that are not always repairable. We also know from experiment that activities we engage in, such as meditation, do literally alter the structure of the brain, possibly in just the ways needed. Buddhist monks, for instance, have been shown to have certain parts of the brain associated with calmness and focus are more active than the average person.
Neuroplasticity has been shown throughout the brain, namely that brains are altered by experience, both in the negative AND in the positive. And as I recall, the most healing thing for a child damaged by abuse/neglect is not a drug, but a healthy relationship with caring adults. It literally heals the brain.
So the idea that those damaged in their brain region by abuse/neglect are not capable of healing and need drugs to survive is not supported by science. Whitaker’s work demonstrates that in the long run, psych drug use does more damage than good. Have you read Anatomy of an Epidemic?
I have worked with foster kids, and many of them are remarkably calm in a crisis. I think it’s something you learn if you live in a chaotic environment as a survival technique. But of course, not everyone has that skill. It amazes me how clinical people with experience still believe you can predict someone’s behavior reliably based solely on their “diagnosis.” There are LOTS of differing reaction to stressful events, and no one should get to tell another person, “Your event isn’t stressful enough to be called a trauma.” The client is the one who knows what is bothering him/her and ultimately holds any solutions to problems that exist.
BTW, I was also a social worker, very calm in a crisis, but I sort of thrive when crisis comes compared to regular life. Used to manage a crisis line – go figure!
After reading over the article in full, my sense is that the author puts a lot of time into “differential diagnosis” despite recognizing that it is objectively not possible with the subjective DSM criteria. For me, the key to success is adapting therapy to the person in front of me, and “diagnosis” per se had very little to do with that. If someone works well with a CBT (change your thinking to change your emotions and behavior) kind of approach, I’d use that approach, whether they had a “PTSD” or “BPD” or “ADHD” or no diagnosis at all. If it didn’t work, I’d use something else. I certainly wouldn’t waste my time convincing my client we needed a new “diagnosis.” I’d simply say, “Let’s try something different. Sometimes practicing skills can be more effective than going over past events. Are you OK giving that a try?” Or, God help us, I might ask the client what they’ve found to be helpful or not. After all, they are the ones who are defining “helpful” for us! If we think we’re helping and they don’t, we’re not.
So maybe the cultural references have some validity, though I see little to no scientific data to indicate that one way or the other, just anecdotes, really. But when it comes to providing therapy to a specific client, I think we do well not to call their recollections into question (particularly by asking their parents right in front of them!) but instead to apply the widest range of skills based on what actually works for the client, regardless of their ‘diagnosis.’ After all, even if CBT worked on 90% of depressed clients, there are still 10% who will fail unless you do something different. Forget “differential diagnosis” and do what works.
Milton Erickson reportedly said we have to re-invent therapy for every client. I think he got it right!
I can’t imagine a more incompetent attempt to verify developmental trauma than asking the parents! They OF COURSE will almost always deny or minimize any harm done, and are happy to blame the child if they HAVE done some damage, as it lets them off the hook. Moreover, parents can be perfectly well intended and still do a lot of harm, of which they will not be consciously aware. They are the last people in the world to ask, “Was your child traumatized in your care?” Very often, the parents have contributed or facilitated the trauma themselves.
Beyond this, “Borderline Personality” diagnosis is HIGHLY associated with developmental trauma. I don’t think I ever encountered a person diagnosed with “BPD”(which I consider to be a diagnosis of little use except as a means of distancing oneself as a clinician from his/her client) who did NOT experience significant trauma as a child, especially when intermittent EMOTIONAL abuse is included. To diagnose BPD as an EXCLUSION for people whose parents deny they were traumatized is truly a bizarre choice, even within the confines of accepted psychiatric “differential diagnosis.”
Very odd thinking behind this kind of analysis, IMHO.
I agree 100%. Techniques are secondary, handy “tricks” that can help smooth the path sometimes. But what is really healing is having someone care enough to be open to hearing and listening deeply to what is happening for another person. It requires courage, empathy, and an ability to hold others’ pain without reaction or withdrawing or advising. These things can be learned but not “trained” in the sense of classroom instruction. And a person can spend decades “studying” human psychology and yet be completely clueless as a therapist.
I used to work managing a volunteer crisis line. Some of my best counselors were computer programmers. Some of the worst had doctorates in psychology. I can find literally no correlation between “training” and competence as a therapist.
I recall reading a study of kids in a residential program. Over 80% reported overt trauma. Less than 20% had it noted in their charts. So either the clinicians didn’t bother asking about trauma, or they didn’t consider it important enough to write down! This in a residential program for teens with behavior problems. How they can be sooo off base is beyond my comprehension.
It’s hard for me to imagine how they can see case after case, like yours, where the person remains “ill” despite or even because of their “treatments,” never really gets “better” or actually gets worse, and yet somehow continue to believe their approach works! It is somehow always the patient/client’s fault when THEIR “treatment” fails, always their own doing if they get better somehow despite their “treatment.” How can they believe this themselves, let alone perpetrate it on their victims aka “patients?”
As I suspected, your references are only talking about probabilities and associations. There is no inkling of a biological CAUSE that would apply to all situations. Valuable information, to be sure, but nothing to do with validating “depression” as a legitimate diagnosis with a unitary cause. So for sure, Vitamin D and folate should be considered viable interventions for people experiencing mood problems, but this certainly allows for a HUGE range of possible causes, and also doesn’t eliminate the possibility of low folate or low Vitamin D cases NOT being depressed or suicidal, which would also kill off any fantasies about a causal role for any one biological condition in depression or suicidality.
I have no specific objection to therapy at a distance. I used to be very successful with phone counseling at a crisis line many years back. There are some advantages to NOT being able to see one’s client – visual biases are virtually eliminated, for instance – I have no idea if I’m counseling a fat person or a black person or an old or young person.
The real question is, of course, effectiveness. I’m betting that has a lot more to do with WHO is the counselor and HOW they relate to their clients than it does with WHERE the counselor or client are during the process. In-person therapy certainly hasn’t got a fantastic record to beat!
I’m not sure we can talk about “misdiagnosis” when there is no actual way to determine objectively who does or doesn’t have a given “diagnosis.” How would anyone know they were “misdiagnosed?” More proper to say you were misunderstood and mistreated!
What exactly does that mean – a “neurometabolic condition?” Sounds like something he CONCLUDED rather than proved scientifically. I’d be willing to bet that he is talking about averages rather than finding a cause of all or most “depression.” He no doubt found that changes in neurons and metabolism are involved when people are depressed, and that certain changes are more common. Not a big revelation. But I’m willing to be enlightened. What does he imagine CAUSES most or all cases of depression, regardless of experience? What do all or most “depressed” people have in common that almost no one not “depressed” experiences? I am interested in this research. Let me know what you’ve got.
Labels certainly meet a lot of societal needs, especially related to avoidance of discomfort. Of course, those who are “loyal” to parents despite abuse are presenting a competent therapist with the very thing they need to start working on, rather than promoting avoiding it by blaming one’s brain. Additionally, while the CLIENT may initially “feel better” because they’ve been blaming themselves, the studies I referred to show that OTHERS actually are more likely to stigmatize the client, including their own therapists and “mental health professionals.” Finally, it’s not the job of a diagnosis to make the person feel better, it’s to get them on the road to healing. What if we didn’t tell people they have cancer or heart disease because it made them uncomfortable? This is what happens when “diagnoses” are tossed about without regard to scientific validity. No one should be told they have a “brain dysfunction” unless the doctor KNOWS they have one, regardless of how it “feels” to get diagnosed. It is this kind of shady “reasoning” that proves psychiatry to be based on a fraudulent premise. For REAL diseases, no one gets to pick out the diagnosis that makes them feel best!
Perhaps surprisingly, research has shown that people judge others MORE HARSHLY when their problems are attributed to “brain chemistry.” Talking about trauma and life difficulties creates empathy. If someone’s brain is blamed, it appears it’s easier for others to distance themselves, to say, “Oh, he’s ‘mentally ill,’ he’s got a brain problem, he’s not like me!”
“Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from ānormalā people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce cliniciansā empathy. This is alarming because cliniciansā empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.”
I guess my sense is that anyone who was genuinely focused on making their clients’ lives better would notice if their interventions made them worse. Sure they WANT their clients to “get better,” but most seem to not deeply believe that is possible, and view “better” as meaning “less” x or y or z. Reducing one’s depressed feelings is not the same to me as improving quality or life, and even less the same as actually improving their sense of control of their lives. And if evidence came in that my approach didn’t work or was based on false premises, I would chance my approach rather than blaming my clients or insisting I was right regardless of the evidence.
But incompetent or ill-intended, it doesn’t much matter to the clients. There needs to be a real intent to find the best path. Some exceptional practitioners do have that, and get results. But I find them very much in the minority, especially in the psychiatric industry. The proof is in the pudding. And some really crappy pudding is being handed out!
Wow, that person hasn’t got a clue if he thinks his job in therapy is to come up with things to talk about! Shocking that any insurance company would pay good money for such crappy treatment!
Excellent summary about what therapists do to protect themselves at their clients’ expense. C) is particularly damaging – to state or imply that you should NOT feel depressed/anxious/etc. and that YOU are the one with the problem for feeling that way. And I agree, therapists being uncomfortable with their clients’ feelings and experiences provide the OPPOSITE of therapy, and are very hurtful!
So you are not engaged in the practice of medical science, you’re involved in the practice of perpetuating your and your colleagues’ psychiatric belief system. That’s my point. Psychiatry depends heavily on the belief systems of the mental health professionals involved, and what kind of treatment one receives is very dependent on their “philosophy.”
Of course, most people have no clue that is what is going on. They don’t think psychiatry (or alternative medicine or whatever) is something you BELIEVE IN, they think it’s some kind of scientific study that can specifically identify what is “wrong” with their brains and fix it with drugs. This despite recent reviews showing that serotonin deficits are not associated with depression, nor is excess dopamine a causal agent in “schizophrenia.” You should also keep in mind that some “clients” of psychiatry have no choice about it, whether they believe in it or not.
To compare Whitaker’s well-researched reporting to Samuel Butler or Shostakovich is an extremely weak analogy to say the least. But you don’t appear to be interested in expanding your viewpoint based on such research, so there is probably no point.
However, that still does not excuse blaming your patients for responding in predictable ways to the propaganda they’ve been exposed to. They are patients. If you don’t want to treat them, I’d say you need to get yourself a new profession. I don’t believe “psychiatrists are brainwashed,” and of course, I never said any such thing, so such strawman arguments are merely distractions. I’m not hostile toward psychiatrists, I simply don’t respect professionals who blame their clients for annoying them. They’re clients. They’re not there to make you feel good or to validate your belief systems. They are looking for help. If they don’t find your “help” helpful, it’s not their fault. You’re the professional and it’s your job to care for them. Why would you take on clients if they annoy you so much? I’ve worked with plenty of psychiatrists whom I respect, even when we disagreed about how to approach most of our clientele. I only ask for basic respect for and compassion for the client. That is what seems absent in your case. And that’s an observation, not an attack.
Why not do what one psychiatrist I respected greatly did: Say, “I know you are hearing voices that you are not happy about. I have a drug that can help you not hear them as much. They don’t work for everyone, and they can have really intense side effects, but many of my clients find it’s well worth the exchange. If the first effort doesn’t work for you, we have several options available to try. Does this sound like something you would like to try?” Or words to that effect. Of course, he did get some interesting responses. One Native American guy said, “You white folk are all the same. You hear voices, you try to make them go away. We hear voices, we go someplace quiet and listen and see if they have anything interesting to say!”
I’m sure you’d have found that client quite annoying. I find him amusingly insightful.
Do you want us to feel sorry for you that you have to deal with actual patients? You do understand that these “diagnoses” are all “clinical opinions,” that there is no way to say for sure that someone “has schizophrenia” in the same sense that they “Have a broken leg?” Is it any surprise given the sketchy marketing techniques out there (selling “disorders” rather than treatments) that people self-diagnose in massive numbers? How do you let the pharmaceutical industry and the psychiatric industry itself off the hook for convincing people they “have” diagnoses that don’t have any concrete or objective definitions?
Have you ever read “Anatomy of an Epidemic?” I very much doubt you have. If you did, you’d have a much better understanding why people behave the way they do regarding “diagnoses.” I will simply end by saying its hard to respect someone who bears such hostility and disrespect for his own clients. You are laying in a bed that your profession has made for you, and blaming the patient is not a mature reaction, IMHO. The phenomenon is the natural outgrowth of the basic (IMHO faulty) assumptions of your system combined with an essential disrespect for the experiences of your clients, which your comments very much demonstrate to me.
How and why would psychiatrists do any of the recommended things in the essay? There is no financial or professional incentives to do any of them, and in fact involves massive incentives to maintain the status quo, which meets most of the needs of most of the psychiatric workers with no change whatsoever. Those who DO challenge the status quo are generally attacked and humiliated and threatened with loss of status or income or both if they continue their sacrilegious ways.
Psychiatry will continue to oppose any sane efforts at reform. I don’t believe it is reformable, as it is at its core based on faulty assumptions that are self-serving and self-perpetuating, and no one will be able to change its basic purpose, which is NOT to help its clients have better lives!
Remember that these “diagnoses” are almost entirely invented and mean next to nothing. They are mostly just descriptions of annoying behavior and difficult emotion that tend to occur together. Saying he “has bipolar disorder” is not a scientific fact – it’s just someone’s “clinical impression,” AKA someone’s opinion based on their own biases and social values. There is no science to it whatsoever. So don’t let them convince you they know what they are talking about. Do what makes sense and what seems to work, even if they don’t agree with you. Your husband and you know far better what is going on than any psychiatrist!
Stimulants can also induce OCD behavior. It often leads to other diagnoses when folks have adverse reactions to stimulants. Especially Bipolar Disorder. It can be dead obvious what happened, but try to get them to quit giving the kid Ritalin and they freak out. Once had a kid I advocated for who had an eating disorder diagnosis. They gave her stimulants, and lo and behold, her appetite was reduced! They of course attributed it to a “relapse” in her “eating disorder” rather than realizing that stimulants were a bad idea for someone with that condition!
Actually, Irving Kirsch’s work fully supports Peter’s statements. There is more, and I do agree he would do well to include such proof.
But that doesn’t change what I said. The manufacturers can’t claim that ADs reduce suicide rates unless they have evidence that they do. No one has to “disprove” an unsupported claim. The “null hypothesis” is assumed to be true unless proven otherwise!
Just for the record, it is the job of those claiming an effect to prove it. No one has to “disprove” that ADs decrease suicide. If that claim is not supported by evidence, it is considered FALSE regardless of counter-evidence. In other words, I don’t have to prove that something doesn’t happen just because someone claims it does. The burden of proof is on the person claiming it works.
Yes, but we also have to consider that the response of the clients is the only valid measure of success. But remember, it is the quality of the relationship with the therapist/counselor which appears to be the most important variable. How can we measure that, other than by how they are perceived by the client?
While DBT has some useful skills that can be learned by anyone who wants to use them, to suggest it is a “treatment for BPD” is problematic, as there is absolutely no objective way to say who “has BPD” or “doesn’t have BPD.” As such, all we can really say is that some people find it useful and some do not, just like any other set of “therapy skills.” Until it is possible to actually define these “disorders” objectively, there is no way that “clinical research” can prove anything relating to a “disorder” that is defined by social biases rather than scientific measures.
I can’t really agree with you here. It seems to me that providing therapy is more of an art, though it should be informed by science. There is no way to train someone reliably to be a “good therapist,” and I have seen many competent counselors who have little to no formal training. There is an element of having “Done one’s own work” to be emotionally available to a client which is simply not a factor of hours of training or scientific findings. The proof is in the pudding, and many therapists with advanced degrees are mediocre to poor therapists, and many of the best therapists have come to it via alternative routes (I had an undergrad in Chemistry and a MS in Education, as an example). It is not such a black and white “scientific” question!
Thank you for taking such time giving me feedback and sharing your perception of my comments. All I can say is that you’ve given me a lot to think about. Or FEEL about?
You may be taking my comments re: euthanasia a bit too far, though. I was really just trying to get an agreed-upon definition. Whether it SEEMS like suicide or not must certainly be an individual decision!
You may be missing the point here. If there IS science to be debated, it ought to be respected. Using name calling (like “climate change deniers”) does not mean that’s true, but is a great way to distract from the fact they are avoiding talking about the real issues. The fact that antidepressants do NOT decrease suicide attempts or thinking is very well established by mainstream scientific studies. There is no evidence that any drug decreases suicide attempts except for a very thin support for Lithium which has been called into doubt. If the reviewers can’t provide any science demonstrating a reduction in suicidal thinking or attempts, it is they who have more in common with “climate change deniers.”
Yup! You can always get some tramadol paid for, but a massage comes out of your own pocket! How much in Tramadol sales could be saved by prescribing a lot more massages?
I found the idea of intentionally inducing anxiety, depression, etc. to be somewhat disturbing. Is there no sense of possible long-term damage from this process? Doesn’t life already teach us that difficult situations bring on difficult feelings? Why does that need to be “proven” by potentially harming people?
That being said, I agree completely that normalizing anxiety, depression, even delusions and hallucinations is the best path forward, along with some REAL medical care for real, objectively observable conditions (like drug adverse effects). There is no benefit to lying to people to stop them from blaming themselves. In fact, normalizing blaming yourself may be the very first step to moving beyond it!
This is a HUGE problem, for psychologists/therapists as well as psychiatrists and psych nurses. They may often feel uncomfortable and want their own discomfort to go away, so they project it onto the client and either try to drug the feelings into submission or talk the person out of it, sometimes resulting in involuntary holds (aka incarceration) in hospital wards. I can’t tell you how many times I saw foster kids or others sent to the hospital for cutting on themselves (not suicidal) or for talking about suicide. One person said she called the suicide hotline because it was not safe to talk to her therapist when she felt like cutting, because she would always send her to the hospital. The are many smaller cases where the therapist wants the client to do something in order to reduce their own discomfort.
One of my basic principles of “therapy” such as I did was that when I felt uncomfortable, I assumed the client was probably getting to something really important, and the most important thing for me was to sit with that discomfort as they had to and see what was behind it. It requires a lot of courage and willingness to experience the pain of others to be of any use to another person in distress. You have to have “done your own work,” and the vast majority of “mental health professionals” have not done that, and are therefore useless or dangerous to their own clients, IMHO. It really isn’t something you can train for – it’s an attitude one has to adopt, and most don’t even realize they need to let alone have the capability of sitting with another’s pain.
There are also plenty of untrained “amateurs” who DO have that skill, as I found out running a volunteer crisis line shift. You are often better off with a well-supervised computer programmer than a trained “mental health professional!”
Ah, but they rarely do fund this sort of study! The heavily moneyed biopsych advocates have a lot of sayso about what is studied, and protest when their pet drugs and companies get short shrift. Besides which, most studies theses days are funded by drug companies, not government entities. There’s little chance non-drug interventions will ever establish a sufficient “evidence base” to match those the drug companies can muster up!
And of course the “evidence base” depends on what gets researched, and drug company money determines what gets researched. So there is never an “evidence base” for anything but drugs!!
I read Pies and Ruffalo’s response. It is as nonsensical as I expected. They compare “schizophrenia” causing hallucinations to a volcano destroying Pompeii. Well hey, guys, a volcano is obviously THERE and concrete and erupts lava that can level a town. How is that in any way like “schizophrenia,” which cannot be seen, felt, or otherwise observed except by its purported effects? The analogy would be more like Pompeii was destroyed by a “City destroyer.” The proof is that the city was destroyed.
That trained academics engage in such childish arguments to defend an indefensible concept is beyond my comprehension!
Here is the Mirriam-Webster dictionary definition of “euthanasia:”
“the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy”
I’d say that whether it constitutes murder or not depends on the desires of the subject and the intentions of the one helping them die. To put it another way, is the person truly helping the subject accomplish his/her goals or simply helping themselves at the subject’s expense. In the latter case, I’d call it murder.
There is, of course, no possible way to objectively establish “the truth” in “mental health” diagnoses, as there is no way to determine ANY diagnosis beyond simply describing it. If there is ever even ONE test to determine ANY “mental health” diagnosis, I will be shocked.
“Reduce the core symptoms” is code for “doesn’t make any difference in long-term outcomes.” In “ADHD”, “reducing the core symptoms” simply means making the person less fidgety and more willing to sit through dull or unmotivating exercises. Stimulants, of course, will do this for anyone who takes them. While this might be viewed as helpful for some who take the stimulants, the idea that this is somehow a “treatment” for a “disorder” is delusional.
There is some evidence that accidents may be reduced, but crime involvement is not reduced by stimulants according to my research. They CERTAINLY do not die 5 years earlier on the average!!!
I will no longer be approving any comments on this article. The topic has been well aired and the comments are repetitive and not moving forward as a conversation. Please don’t add any further comments to this thread!
I’m not sure where you got the idea I disagree with you. I used to be a therapist myself, and 99% of what I did was to have people describe their experiences and what those experiences mean to them. I’m simply disagreeing with you on the definition of “taking responsibility”. I don’t think you are understanding it the same way I am. The more we know about ourselves and our emotional history, the more we understand the REASONS for our “irrational behavior” (as others choose to see it, or as we choose to see it), the more we can take responsibility for deciding whether or not we are going to continue to react/respond in the same way we did before or try something new. Mostly we develop habits of thought and behavior based on what happened to us, and I saw counseling as primarily the opportunity to question whether or not those habits continued to serve us, and if not, find out what needs they are serving and find another, better way to meet those needs. So there is no blaming oneself for what happened – only responsibility for deciding how to act NOW and in the future.
That’s MY lived experience, both as a client and as a therapist. I don’t think I’m really disagreeing with you about much here. Let me know if that raises more questions/issues.
And no, I did not read the blog. I did read your comments. I’m speaking from my own direct experiences.
I’m with Bill on this one – taking responsibility means recognizing that one’s own behavior is a choice despite past traumatic events. It’s not the same as taking the blame, which is very damaging. One can take responsibility AND be aware of and process emotion, in fact, one almost HAS to be aware to really take full responsibility.
There are also group cultural insults that are traumatic, such as the generation of Jews whose parents were in concentration camps. There are also lots of ways that parents and other adults can hurt their kids without realizing they are doing so. School was a great example for me – daily torture, but no one seemed to notice or care, I kept having to go back every day for 13 years. There are lots of ways people get hurt and traumatized as children.
We know at least that the AI does not dislike or judge us for our name, gender, sex, race, beliefs, etc. AI doesn’t have a subconscious, as far as I can tell!
I remember a study where they let students log into an AI program, this was decades ago, and it was programmed to listen and ask pertinent open-ended questions. Students reported feeling better after talking to the AI!
I think it goes back to “male privilege,” the broad teaching that men deserve more than women and that women’s job is to keep men happy. We are taught this all the time in our media and other parts of society. It seems it’s women’s job to make sure everything works out for men, and when it doesn’t, women are to blame!
Sorry, I wasn’t suggesting YOU believe those things, I was just pointing out the failure of those arguments you alluded to made by others. I understand you are NOT a supporter of the DSM or the Medical Model. Sorry if there was some confusion there!
There doesn’t need to be an “alternative” if the current paradigm is wrong. Sometimes we don’t know the right thing to do, but we do know that what IS happening is wrong. Should we continue to systematically do something damaging because we don’t have an “alternative?”
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“Behavioral health” always seemed like a bizarre term to me. Behavior doesn’t have health. Beings have health, not actions!
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So it sounds like a pattern of behavior for you, not a “diagnosis.” That being the case, how can people be accused of not “diagnosing BPD correctly?”
I’d really prefer we dump the label and simply rely on accurate descriptions of people who are dangerous for one reason or another. What a psychiatrist thinks, or frankly what anyone thinks their “diagnosis” is, is of little to no value.
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Why do you assume that all or even most medical professionals follow “science?” If you have not read Anatomy of an Epidemic, you have missed the primary explanation for why this website exists, which is specifically because psychiatry has REFUSED over time to use or rationally respond to the “algorithm” known as science. You seem to believe that it does without evidence and attack anyone who disagrees with your assumption. Why not do some listening and exploration toward the very scientific double-blind studies and long-term reviews of the literature on which Mr. Whitaker’s concerns are rationally founded?
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Posting as moderator:
I agree 100% that putting down religious beliefs and practices is out of bounds, and I apologize for missing any posts which did so. Please report to me at my email if any other posts of that nature come through and I will re-moderate them for appropriateness.
[email protected].
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It is interesting to note how experimenters get mice or whatever into the proper “mental” state to test their drugs. They seem to always STRESS the poor little creatures until they are anxious or depressed or whatever.
See the Rat Park experiment or Harlow’s Monkeys. Environment completely alters animal behavior, for the better or the worse. Clearly should apply to humans…
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But there ARE wrong answers! Forcing people capable of reasoning to go against their own wishes IS wrong, whatever might be “right.” The choice of “justice” as a focus implies without question that stopping unjust or “wrong” actions is the main thrust of the effort!
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Dang, how can a guy make money selling cures when people keep getting better on their own?
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“High rate,” “associated,” “potentially,” “often linked,” “may impact…”
All of these are probabalistic statements. There is no clear connection between a particular genetic pattern and all or even most “cases” of “ADHD”. None of these genetic indicators have ever been used to “diagnose” ADHD, mainly because many people with a particular mutation do NOT “have ADHD,” while many who are diagnosed with “ADHD” don’t have the mutation in question.
Perhaps this begs the larger question: Even if there are genetic associations with SOME cases of “ADHD” that are predictable, why have we decided that these variations in human behavior are a “disorder” or disease condition? Why is there no “Attention excess hypoactivity disorder?” Why is only HYPERactivity considered a problem?
I think we know the answer. “Hyperactive” children are more difficult for adults to manage, as they don’t (by definition) tend to go along with the program, so we decide that the child is the problem rather than examining our own models of education and other societal expectations. This despite reliable research that so-called “ADHD” children are virtually indistinguishable from “normal” children in open classroom settings, and that “treated” children do not in general have any better outcomes than those who are left to their own devices. This doesn’t even begin to touch the other big issue, namely that abused/neglected children tend to have a much higher rate of “ADHD” diagnoses than the general populace. If it’s all genetic, why is it so much more common in the foster care population?
I have no doubt that some kids are genetically “programmed” to be more active than others (though this does NOT come close to explaining “cause” for the range of kids so diagnosed). Maybe a range of such people is necessary for success as a species. After all, species survival depends on sufficient genetic diversity. Or as one wise foster kid put it, “Maybe it’s OK for different people to have different brain chemistries.”
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Posting as moderator:
OK, I think we have sufficiently fleshed out this argument. Everyone made their positions clear, and it’s not going to be productive to continue along these lines. Let’s move on!
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I’m not sure the system is “broken” so much as that it doesn’t really have the same objectives as it claims to have. Keeping folks under control is a big part of the agenda, and “healing” is something they gave up on a long time ago, if they ever really had that as a goal at all. Someone who thinks electrocuting people into having a grand mal seizure is good “treatment” for anything is not really interested in helping you get better!
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I guess I was correct.
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The duty to inform is very often disregarded, especially in the “mental health” fields.
When did I advise a person who is depressed to study holy scriptures? I’m afraid you have literally no idea what I’m talking about. I understand you are a “physicalist” as you put it, and I believe that blinds you to the ability to understand that the CAUSES of any “mental disorder” are actually unknown, no matter how many scans you want to do. You are ASSUMING the cause is in the brain, and therefor the consequence is diddling with the brain. The results of such reasoning have so far been fairly disastrous, if you believe the literature (including Anatomy of an Epidemic). A true “duty of disclosure” would mean admitting “we are treating an entity we don’t really understand.” I doubt very much anyone hears this from their doctor.
You are, of course, welcome to express your own philosophy, however, scientific proof of such ideas remains a long way off, if we go by the literature on success rates and damage rates and even diagnostic consistency and so on. (If these scans are so great, why aren’t they being used for “diagnosis?”) You’re not going to convince me by repeating your beliefs over and over again without bothering to try and understand where I am coming from. Probably not worth further discussion, as you seem quite certain of your ‘rightness’ and I doubt will hear me, and I am certainly not going to be convinced by your kind of arguments.
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You again conflate function with structure here: “This doesnāt change the fact that a depression is not a mental state you can invoke within a blink of an eye but structural or functional deficits of your brain and such malfunctioning parts of your brain can be exposed by imaging methods.” The fact that SPECT images of “depressed” brains are similar in some respects does not imply structural differences, nor does it imply malfunction. I certainly never would suggest that depression can be overcome by thinking of different events, but that’s not what I said. Depression is a very complicated condition. The brain is clearly involved but to imagine people only get depressed because of “bad brains” is not consistent with observation, otherwise, why would it be so much more common in people with abuse histories?
And you are right, avoiding psychiatry seems like the smart path to me. I don’t think being a “physicalist” is necessarily a more rational position, though you seem to imply those who aren’t are being foolish. Being a “physicalist” is a belief system or philosophy. You are welcome to your own philosophy, of course, but that doesn’t make it any less a belief system than any other philosophy. I would prefer working with people who recognize my agency as a human being rather than seeing me as some sort of chemical machine.
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It sounds like we generally agree on all that. My only objection is that I don’t believe that “mental illness” as currently understood (or misunderstood and labeled) generally requires “treatment” of the brain per se. A person who is suffering can have a perfectly sound and functioning brain. Spiritual/emotional pain is something that I believe extends well beyond the brain, and “treating the brain” to handle most of it is like replacing memory chips to fix a computer programming error. Until we get away from seeing the brain as the problem, and start looking at social conditions, we aren’t going to get far with even the best technology, because I think we’re barking up the wrong tree!
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Brain ACTIVITY is not the same as brain STRUCTURE. A brain may be DOING certain things while depressed and those ACTIONS may be reflected in measurements of activity (PET and SPECT scans, for instance). However, a) these scans say ABSOLUTELY NOTHING about the reason the brain is behaving in a certain way, only that it is and b) it has been shown that changing what one is thinking can change the PET scan, hence, thinking of a depressing topic creates a certain pattern, while the same person thinking of something cheerful changes the pattern instantly to something else.
All that being said, there is NO CONSISTENT PATTERN that is associated with all cases of depression, or even most. Same with ADHD or other “disorders.” This is why these are never used in diagnosis, except by charlatans who take advantage of people’s vulnerability. They simply fail completely in being able to understand or predict the CAUSE of any psychiatric “condition,” and this will not change, as they measure ACTIVITY alone.
Of course, these “disorders” are defined by social expectations and judgments in the first place, not scientific criteria, so why anyone would expect any brain measurement to “diagnose” them is puzzling. Clearly, we have the cart before the horse here – we are supposed to find the proximal cause of a condition before assuming we can “diagnose” it concretely. For all we know, there could be 25 different reasons people become depressed, all of which result in similar brain scans. As long as that’s the case, the idea of diagnosing by scans will remain a pipe dream, IMHO.
Please try to keep the condescension out of any response, it is not appropriate.
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You are assuming that all “depression” comes from some biological failure of the brain. There is, of course, absolutely no evidence to show that claim to have any validity.
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I’m going to let one more post stand on this topic. Larry, if you have any validated links or literature to share that Mark can read, please help us out and do so. If not, it sounds like you’ve answered Mark’s questions and I’d like to leave off with one more post. The discussion is really quite far off the original topic.
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Any therapist who thinks it his/her job to “keep the conversation going” is an idiot. Silence is really important in a good, supportive conversation. It allows important things to surface!
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Does knowledge of the brain even have a primary place in this discussion? Are we really talking about “illnesses” if these “illnesses” are socially defined?
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They seem to mean that they expect people to get better but they get worse instead. A paradox only if there is a rational expectation that the initial “treatment” should work. That seems to be a large part of the “trick” of selling psych drugs. Make an open claim that they “work” and then call failures “resistance” or “paradoxical” instead of just admitting they were wrong!
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Walter, if you read carefully, you will see I am not generalizing, merely pointing out that the Deaf community IN MY EXPERIENCE is not monolithic in its views on “normalcy.” I am advocating for listening TO the Deaf community and its individual members to understand, rather than using “ableist assumptions” (including assuming that a member does or does not view him/herself as disabled) to characterize its members. Some do and some don’t view themselves as disabled. I’m not even disagreeing with the prior poster. This is true whether or not the prior poster identifies as part of the Deaf community.
Not sure what your point is.
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Agreed!
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How can the author state there have been “advances in treatment options” when it is clear that the “treatment options” are not resolving the problem? Wouldn’t an “advance” in treatment mean a DECREASE in the number of sufferers??? I think the authors miss the point. As Robert’s research demonstrates, the ADs tend to be COUNTERPRODUCTIVE, a form of ANTI-TREATMENT for many people. When the best estimates of “success” show rates of 30%, and even then with very small improvements that may not even be clinically significant, it’s hardly appropriate to call “treatment failures” a “paradox.” They are evidence that the treatment doesn’t work!
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It’s not a “paradox” unless there is reason to expect the “treatments” to be effective. In this case, it’s simply evidence of either treatment failure, or a hidden agenda to create more customers!
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That was intended to be a humorous remark! But the engineering team (if there was one) still missed the boat on that one.
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Any deity who came up with the human childbirth process can hardly be accused of “intelligent” design!!!
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I actually just found this comment, I think. I published an identical comment one minute later.
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Please email me at [email protected] and let me know the details. A delay of one day is normal, as there is only one of me and I don’t always get to this more than once a day. If I said something was duplication, it means you made another comment saying something the same or very similar. If that’s not the case, I can fix it, but I need to know the thread, preferably the date, and the first sentence or so, so I can make sure I identify the correct comments.
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Completely agree.
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Unfortunately for your theory, it appears that these drugs “sculpt” the brain in most unfortunate ways that are not always repairable. We also know from experiment that activities we engage in, such as meditation, do literally alter the structure of the brain, possibly in just the ways needed. Buddhist monks, for instance, have been shown to have certain parts of the brain associated with calmness and focus are more active than the average person.
https://www.reddit.com/r/Buddhism/comments/11105s/scans_of_monks_brains_show_meditation_alters/
Neuroplasticity has been shown throughout the brain, namely that brains are altered by experience, both in the negative AND in the positive. And as I recall, the most healing thing for a child damaged by abuse/neglect is not a drug, but a healthy relationship with caring adults. It literally heals the brain.
So the idea that those damaged in their brain region by abuse/neglect are not capable of healing and need drugs to survive is not supported by science. Whitaker’s work demonstrates that in the long run, psych drug use does more damage than good. Have you read Anatomy of an Epidemic?
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I have worked with foster kids, and many of them are remarkably calm in a crisis. I think it’s something you learn if you live in a chaotic environment as a survival technique. But of course, not everyone has that skill. It amazes me how clinical people with experience still believe you can predict someone’s behavior reliably based solely on their “diagnosis.” There are LOTS of differing reaction to stressful events, and no one should get to tell another person, “Your event isn’t stressful enough to be called a trauma.” The client is the one who knows what is bothering him/her and ultimately holds any solutions to problems that exist.
BTW, I was also a social worker, very calm in a crisis, but I sort of thrive when crisis comes compared to regular life. Used to manage a crisis line – go figure!
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After reading over the article in full, my sense is that the author puts a lot of time into “differential diagnosis” despite recognizing that it is objectively not possible with the subjective DSM criteria. For me, the key to success is adapting therapy to the person in front of me, and “diagnosis” per se had very little to do with that. If someone works well with a CBT (change your thinking to change your emotions and behavior) kind of approach, I’d use that approach, whether they had a “PTSD” or “BPD” or “ADHD” or no diagnosis at all. If it didn’t work, I’d use something else. I certainly wouldn’t waste my time convincing my client we needed a new “diagnosis.” I’d simply say, “Let’s try something different. Sometimes practicing skills can be more effective than going over past events. Are you OK giving that a try?” Or, God help us, I might ask the client what they’ve found to be helpful or not. After all, they are the ones who are defining “helpful” for us! If we think we’re helping and they don’t, we’re not.
So maybe the cultural references have some validity, though I see little to no scientific data to indicate that one way or the other, just anecdotes, really. But when it comes to providing therapy to a specific client, I think we do well not to call their recollections into question (particularly by asking their parents right in front of them!) but instead to apply the widest range of skills based on what actually works for the client, regardless of their ‘diagnosis.’ After all, even if CBT worked on 90% of depressed clients, there are still 10% who will fail unless you do something different. Forget “differential diagnosis” and do what works.
Milton Erickson reportedly said we have to re-invent therapy for every client. I think he got it right!
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“May cause?” How much evidence is needed to move to “DO cause!?!”
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I can’t imagine a more incompetent attempt to verify developmental trauma than asking the parents! They OF COURSE will almost always deny or minimize any harm done, and are happy to blame the child if they HAVE done some damage, as it lets them off the hook. Moreover, parents can be perfectly well intended and still do a lot of harm, of which they will not be consciously aware. They are the last people in the world to ask, “Was your child traumatized in your care?” Very often, the parents have contributed or facilitated the trauma themselves.
Beyond this, “Borderline Personality” diagnosis is HIGHLY associated with developmental trauma. I don’t think I ever encountered a person diagnosed with “BPD”(which I consider to be a diagnosis of little use except as a means of distancing oneself as a clinician from his/her client) who did NOT experience significant trauma as a child, especially when intermittent EMOTIONAL abuse is included. To diagnose BPD as an EXCLUSION for people whose parents deny they were traumatized is truly a bizarre choice, even within the confines of accepted psychiatric “differential diagnosis.”
Very odd thinking behind this kind of analysis, IMHO.
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I agree 100%. Techniques are secondary, handy “tricks” that can help smooth the path sometimes. But what is really healing is having someone care enough to be open to hearing and listening deeply to what is happening for another person. It requires courage, empathy, and an ability to hold others’ pain without reaction or withdrawing or advising. These things can be learned but not “trained” in the sense of classroom instruction. And a person can spend decades “studying” human psychology and yet be completely clueless as a therapist.
I used to work managing a volunteer crisis line. Some of my best counselors were computer programmers. Some of the worst had doctorates in psychology. I can find literally no correlation between “training” and competence as a therapist.
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I recall reading a study of kids in a residential program. Over 80% reported overt trauma. Less than 20% had it noted in their charts. So either the clinicians didn’t bother asking about trauma, or they didn’t consider it important enough to write down! This in a residential program for teens with behavior problems. How they can be sooo off base is beyond my comprehension.
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It’s hard for me to imagine how they can see case after case, like yours, where the person remains “ill” despite or even because of their “treatments,” never really gets “better” or actually gets worse, and yet somehow continue to believe their approach works! It is somehow always the patient/client’s fault when THEIR “treatment” fails, always their own doing if they get better somehow despite their “treatment.” How can they believe this themselves, let alone perpetrate it on their victims aka “patients?”
Well done to you for finding your way out!
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As I suspected, your references are only talking about probabilities and associations. There is no inkling of a biological CAUSE that would apply to all situations. Valuable information, to be sure, but nothing to do with validating “depression” as a legitimate diagnosis with a unitary cause. So for sure, Vitamin D and folate should be considered viable interventions for people experiencing mood problems, but this certainly allows for a HUGE range of possible causes, and also doesn’t eliminate the possibility of low folate or low Vitamin D cases NOT being depressed or suicidal, which would also kill off any fantasies about a causal role for any one biological condition in depression or suicidality.
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Makes sense to me!
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I have no specific objection to therapy at a distance. I used to be very successful with phone counseling at a crisis line many years back. There are some advantages to NOT being able to see one’s client – visual biases are virtually eliminated, for instance – I have no idea if I’m counseling a fat person or a black person or an old or young person.
The real question is, of course, effectiveness. I’m betting that has a lot more to do with WHO is the counselor and HOW they relate to their clients than it does with WHERE the counselor or client are during the process. In-person therapy certainly hasn’t got a fantastic record to beat!
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I’m not sure we can talk about “misdiagnosis” when there is no actual way to determine objectively who does or doesn’t have a given “diagnosis.” How would anyone know they were “misdiagnosed?” More proper to say you were misunderstood and mistreated!
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What exactly does that mean – a “neurometabolic condition?” Sounds like something he CONCLUDED rather than proved scientifically. I’d be willing to bet that he is talking about averages rather than finding a cause of all or most “depression.” He no doubt found that changes in neurons and metabolism are involved when people are depressed, and that certain changes are more common. Not a big revelation. But I’m willing to be enlightened. What does he imagine CAUSES most or all cases of depression, regardless of experience? What do all or most “depressed” people have in common that almost no one not “depressed” experiences? I am interested in this research. Let me know what you’ve got.
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Labels certainly meet a lot of societal needs, especially related to avoidance of discomfort. Of course, those who are “loyal” to parents despite abuse are presenting a competent therapist with the very thing they need to start working on, rather than promoting avoiding it by blaming one’s brain. Additionally, while the CLIENT may initially “feel better” because they’ve been blaming themselves, the studies I referred to show that OTHERS actually are more likely to stigmatize the client, including their own therapists and “mental health professionals.” Finally, it’s not the job of a diagnosis to make the person feel better, it’s to get them on the road to healing. What if we didn’t tell people they have cancer or heart disease because it made them uncomfortable? This is what happens when “diagnoses” are tossed about without regard to scientific validity. No one should be told they have a “brain dysfunction” unless the doctor KNOWS they have one, regardless of how it “feels” to get diagnosed. It is this kind of shady “reasoning” that proves psychiatry to be based on a fraudulent premise. For REAL diseases, no one gets to pick out the diagnosis that makes them feel best!
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Perhaps surprisingly, research has shown that people judge others MORE HARSHLY when their problems are attributed to “brain chemistry.” Talking about trauma and life difficulties creates empathy. If someone’s brain is blamed, it appears it’s easier for others to distance themselves, to say, “Oh, he’s ‘mentally ill,’ he’s got a brain problem, he’s not like me!”
“Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from ānormalā people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce cliniciansā empathy. This is alarming because cliniciansā empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC4273344/
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I guess my sense is that anyone who was genuinely focused on making their clients’ lives better would notice if their interventions made them worse. Sure they WANT their clients to “get better,” but most seem to not deeply believe that is possible, and view “better” as meaning “less” x or y or z. Reducing one’s depressed feelings is not the same to me as improving quality or life, and even less the same as actually improving their sense of control of their lives. And if evidence came in that my approach didn’t work or was based on false premises, I would chance my approach rather than blaming my clients or insisting I was right regardless of the evidence.
But incompetent or ill-intended, it doesn’t much matter to the clients. There needs to be a real intent to find the best path. Some exceptional practitioners do have that, and get results. But I find them very much in the minority, especially in the psychiatric industry. The proof is in the pudding. And some really crappy pudding is being handed out!
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Wow, that person hasn’t got a clue if he thinks his job in therapy is to come up with things to talk about! Shocking that any insurance company would pay good money for such crappy treatment!
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Nothing wrong with an emotional response in my mind. Besides, you’ve got plenty of factual backup for your points!
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Very well said!
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I always wonder how the “brain dysfunction” advocates account for that.
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Excellent summary about what therapists do to protect themselves at their clients’ expense. C) is particularly damaging – to state or imply that you should NOT feel depressed/anxious/etc. and that YOU are the one with the problem for feeling that way. And I agree, therapists being uncomfortable with their clients’ feelings and experiences provide the OPPOSITE of therapy, and are very hurtful!
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So you are not engaged in the practice of medical science, you’re involved in the practice of perpetuating your and your colleagues’ psychiatric belief system. That’s my point. Psychiatry depends heavily on the belief systems of the mental health professionals involved, and what kind of treatment one receives is very dependent on their “philosophy.”
Of course, most people have no clue that is what is going on. They don’t think psychiatry (or alternative medicine or whatever) is something you BELIEVE IN, they think it’s some kind of scientific study that can specifically identify what is “wrong” with their brains and fix it with drugs. This despite recent reviews showing that serotonin deficits are not associated with depression, nor is excess dopamine a causal agent in “schizophrenia.” You should also keep in mind that some “clients” of psychiatry have no choice about it, whether they believe in it or not.
To compare Whitaker’s well-researched reporting to Samuel Butler or Shostakovich is an extremely weak analogy to say the least. But you don’t appear to be interested in expanding your viewpoint based on such research, so there is probably no point.
However, that still does not excuse blaming your patients for responding in predictable ways to the propaganda they’ve been exposed to. They are patients. If you don’t want to treat them, I’d say you need to get yourself a new profession. I don’t believe “psychiatrists are brainwashed,” and of course, I never said any such thing, so such strawman arguments are merely distractions. I’m not hostile toward psychiatrists, I simply don’t respect professionals who blame their clients for annoying them. They’re clients. They’re not there to make you feel good or to validate your belief systems. They are looking for help. If they don’t find your “help” helpful, it’s not their fault. You’re the professional and it’s your job to care for them. Why would you take on clients if they annoy you so much? I’ve worked with plenty of psychiatrists whom I respect, even when we disagreed about how to approach most of our clientele. I only ask for basic respect for and compassion for the client. That is what seems absent in your case. And that’s an observation, not an attack.
Why not do what one psychiatrist I respected greatly did: Say, “I know you are hearing voices that you are not happy about. I have a drug that can help you not hear them as much. They don’t work for everyone, and they can have really intense side effects, but many of my clients find it’s well worth the exchange. If the first effort doesn’t work for you, we have several options available to try. Does this sound like something you would like to try?” Or words to that effect. Of course, he did get some interesting responses. One Native American guy said, “You white folk are all the same. You hear voices, you try to make them go away. We hear voices, we go someplace quiet and listen and see if they have anything interesting to say!”
I’m sure you’d have found that client quite annoying. I find him amusingly insightful.
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Do you want us to feel sorry for you that you have to deal with actual patients? You do understand that these “diagnoses” are all “clinical opinions,” that there is no way to say for sure that someone “has schizophrenia” in the same sense that they “Have a broken leg?” Is it any surprise given the sketchy marketing techniques out there (selling “disorders” rather than treatments) that people self-diagnose in massive numbers? How do you let the pharmaceutical industry and the psychiatric industry itself off the hook for convincing people they “have” diagnoses that don’t have any concrete or objective definitions?
Have you ever read “Anatomy of an Epidemic?” I very much doubt you have. If you did, you’d have a much better understanding why people behave the way they do regarding “diagnoses.” I will simply end by saying its hard to respect someone who bears such hostility and disrespect for his own clients. You are laying in a bed that your profession has made for you, and blaming the patient is not a mature reaction, IMHO. The phenomenon is the natural outgrowth of the basic (IMHO faulty) assumptions of your system combined with an essential disrespect for the experiences of your clients, which your comments very much demonstrate to me.
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They seem to be suggesting that “mental illness” creates itself somehow. It’s totally illogical.
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How and why would psychiatrists do any of the recommended things in the essay? There is no financial or professional incentives to do any of them, and in fact involves massive incentives to maintain the status quo, which meets most of the needs of most of the psychiatric workers with no change whatsoever. Those who DO challenge the status quo are generally attacked and humiliated and threatened with loss of status or income or both if they continue their sacrilegious ways.
Psychiatry will continue to oppose any sane efforts at reform. I don’t believe it is reformable, as it is at its core based on faulty assumptions that are self-serving and self-perpetuating, and no one will be able to change its basic purpose, which is NOT to help its clients have better lives!
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Remember that these “diagnoses” are almost entirely invented and mean next to nothing. They are mostly just descriptions of annoying behavior and difficult emotion that tend to occur together. Saying he “has bipolar disorder” is not a scientific fact – it’s just someone’s “clinical impression,” AKA someone’s opinion based on their own biases and social values. There is no science to it whatsoever. So don’t let them convince you they know what they are talking about. Do what makes sense and what seems to work, even if they don’t agree with you. Your husband and you know far better what is going on than any psychiatrist!
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Stimulants can also induce OCD behavior. It often leads to other diagnoses when folks have adverse reactions to stimulants. Especially Bipolar Disorder. It can be dead obvious what happened, but try to get them to quit giving the kid Ritalin and they freak out. Once had a kid I advocated for who had an eating disorder diagnosis. They gave her stimulants, and lo and behold, her appetite was reduced! They of course attributed it to a “relapse” in her “eating disorder” rather than realizing that stimulants were a bad idea for someone with that condition!
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I think Plato nailed THAT one!
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Actually, Irving Kirsch’s work fully supports Peter’s statements. There is more, and I do agree he would do well to include such proof.
But that doesn’t change what I said. The manufacturers can’t claim that ADs reduce suicide rates unless they have evidence that they do. No one has to “disprove” an unsupported claim. The “null hypothesis” is assumed to be true unless proven otherwise!
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Just for the record, it is the job of those claiming an effect to prove it. No one has to “disprove” that ADs decrease suicide. If that claim is not supported by evidence, it is considered FALSE regardless of counter-evidence. In other words, I don’t have to prove that something doesn’t happen just because someone claims it does. The burden of proof is on the person claiming it works.
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Yes, but we also have to consider that the response of the clients is the only valid measure of success. But remember, it is the quality of the relationship with the therapist/counselor which appears to be the most important variable. How can we measure that, other than by how they are perceived by the client?
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While DBT has some useful skills that can be learned by anyone who wants to use them, to suggest it is a “treatment for BPD” is problematic, as there is absolutely no objective way to say who “has BPD” or “doesn’t have BPD.” As such, all we can really say is that some people find it useful and some do not, just like any other set of “therapy skills.” Until it is possible to actually define these “disorders” objectively, there is no way that “clinical research” can prove anything relating to a “disorder” that is defined by social biases rather than scientific measures.
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I can’t really agree with you here. It seems to me that providing therapy is more of an art, though it should be informed by science. There is no way to train someone reliably to be a “good therapist,” and I have seen many competent counselors who have little to no formal training. There is an element of having “Done one’s own work” to be emotionally available to a client which is simply not a factor of hours of training or scientific findings. The proof is in the pudding, and many therapists with advanced degrees are mediocre to poor therapists, and many of the best therapists have come to it via alternative routes (I had an undergrad in Chemistry and a MS in Education, as an example). It is not such a black and white “scientific” question!
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Thank you for taking such time giving me feedback and sharing your perception of my comments. All I can say is that you’ve given me a lot to think about. Or FEEL about?
You may be taking my comments re: euthanasia a bit too far, though. I was really just trying to get an agreed-upon definition. Whether it SEEMS like suicide or not must certainly be an individual decision!
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Sounds like a much safe option than SSRIs!
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You may be missing the point here. If there IS science to be debated, it ought to be respected. Using name calling (like “climate change deniers”) does not mean that’s true, but is a great way to distract from the fact they are avoiding talking about the real issues. The fact that antidepressants do NOT decrease suicide attempts or thinking is very well established by mainstream scientific studies. There is no evidence that any drug decreases suicide attempts except for a very thin support for Lithium which has been called into doubt. If the reviewers can’t provide any science demonstrating a reduction in suicidal thinking or attempts, it is they who have more in common with “climate change deniers.”
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Yup! You can always get some tramadol paid for, but a massage comes out of your own pocket! How much in Tramadol sales could be saved by prescribing a lot more massages?
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I found the idea of intentionally inducing anxiety, depression, etc. to be somewhat disturbing. Is there no sense of possible long-term damage from this process? Doesn’t life already teach us that difficult situations bring on difficult feelings? Why does that need to be “proven” by potentially harming people?
That being said, I agree completely that normalizing anxiety, depression, even delusions and hallucinations is the best path forward, along with some REAL medical care for real, objectively observable conditions (like drug adverse effects). There is no benefit to lying to people to stop them from blaming themselves. In fact, normalizing blaming yourself may be the very first step to moving beyond it!
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This is a HUGE problem, for psychologists/therapists as well as psychiatrists and psych nurses. They may often feel uncomfortable and want their own discomfort to go away, so they project it onto the client and either try to drug the feelings into submission or talk the person out of it, sometimes resulting in involuntary holds (aka incarceration) in hospital wards. I can’t tell you how many times I saw foster kids or others sent to the hospital for cutting on themselves (not suicidal) or for talking about suicide. One person said she called the suicide hotline because it was not safe to talk to her therapist when she felt like cutting, because she would always send her to the hospital. The are many smaller cases where the therapist wants the client to do something in order to reduce their own discomfort.
One of my basic principles of “therapy” such as I did was that when I felt uncomfortable, I assumed the client was probably getting to something really important, and the most important thing for me was to sit with that discomfort as they had to and see what was behind it. It requires a lot of courage and willingness to experience the pain of others to be of any use to another person in distress. You have to have “done your own work,” and the vast majority of “mental health professionals” have not done that, and are therefore useless or dangerous to their own clients, IMHO. It really isn’t something you can train for – it’s an attitude one has to adopt, and most don’t even realize they need to let alone have the capability of sitting with another’s pain.
There are also plenty of untrained “amateurs” who DO have that skill, as I found out running a volunteer crisis line shift. You are often better off with a well-supervised computer programmer than a trained “mental health professional!”
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Ah, but they rarely do fund this sort of study! The heavily moneyed biopsych advocates have a lot of sayso about what is studied, and protest when their pet drugs and companies get short shrift. Besides which, most studies theses days are funded by drug companies, not government entities. There’s little chance non-drug interventions will ever establish a sufficient “evidence base” to match those the drug companies can muster up!
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And of course the “evidence base” depends on what gets researched, and drug company money determines what gets researched. So there is never an “evidence base” for anything but drugs!!
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Research into what? How to create “diseases” from social bias and behavioral checklists?
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How could anyone ever tell if someone “legitimately has BiPolar Disorder” when the only criteria are a list of behaviors and emotions?
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Hey, Laura, great to hear your voice and know you’re still around and doing your thing! Hope all is well with you!
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Shhhh! You’re going to hurt sales with such research!
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I read Pies and Ruffalo’s response. It is as nonsensical as I expected. They compare “schizophrenia” causing hallucinations to a volcano destroying Pompeii. Well hey, guys, a volcano is obviously THERE and concrete and erupts lava that can level a town. How is that in any way like “schizophrenia,” which cannot be seen, felt, or otherwise observed except by its purported effects? The analogy would be more like Pompeii was destroyed by a “City destroyer.” The proof is that the city was destroyed.
That trained academics engage in such childish arguments to defend an indefensible concept is beyond my comprehension!
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Here is the Mirriam-Webster dictionary definition of “euthanasia:”
“the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy”
I’d say that whether it constitutes murder or not depends on the desires of the subject and the intentions of the one helping them die. To put it another way, is the person truly helping the subject accomplish his/her goals or simply helping themselves at the subject’s expense. In the latter case, I’d call it murder.
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Makes total sense. I was not disagreeing with you, I was trying to emphasize your point!
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Well done cK!
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There is, of course, no possible way to objectively establish “the truth” in “mental health” diagnoses, as there is no way to determine ANY diagnosis beyond simply describing it. If there is ever even ONE test to determine ANY “mental health” diagnosis, I will be shocked.
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Wow, they really do talk like that, don’t they? “Should we consider” is already a tacit admission that they don’t know what they are talking about!
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A slight increase in probability of some event or condition on average is no way to “diagnose” anything.
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“Reduce the core symptoms” is code for “doesn’t make any difference in long-term outcomes.” In “ADHD”, “reducing the core symptoms” simply means making the person less fidgety and more willing to sit through dull or unmotivating exercises. Stimulants, of course, will do this for anyone who takes them. While this might be viewed as helpful for some who take the stimulants, the idea that this is somehow a “treatment” for a “disorder” is delusional.
There is some evidence that accidents may be reduced, but crime involvement is not reduced by stimulants according to my research. They CERTAINLY do not die 5 years earlier on the average!!!
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Good article! Nice work, Bob!!!
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Commenting as moderator:
I will no longer be approving any comments on this article. The topic has been well aired and the comments are repetitive and not moving forward as a conversation. Please don’t add any further comments to this thread!
—- Steve
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What’s really awful is that none of those things that “untreated ADHD” supposedly leads to are changed by stimulant “treatment!”
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I agree that we agree!
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All very well said!
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I’m not sure where you got the idea I disagree with you. I used to be a therapist myself, and 99% of what I did was to have people describe their experiences and what those experiences mean to them. I’m simply disagreeing with you on the definition of “taking responsibility”. I don’t think you are understanding it the same way I am. The more we know about ourselves and our emotional history, the more we understand the REASONS for our “irrational behavior” (as others choose to see it, or as we choose to see it), the more we can take responsibility for deciding whether or not we are going to continue to react/respond in the same way we did before or try something new. Mostly we develop habits of thought and behavior based on what happened to us, and I saw counseling as primarily the opportunity to question whether or not those habits continued to serve us, and if not, find out what needs they are serving and find another, better way to meet those needs. So there is no blaming oneself for what happened – only responsibility for deciding how to act NOW and in the future.
That’s MY lived experience, both as a client and as a therapist. I don’t think I’m really disagreeing with you about much here. Let me know if that raises more questions/issues.
And no, I did not read the blog. I did read your comments. I’m speaking from my own direct experiences.
Steve
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I’m with Bill on this one – taking responsibility means recognizing that one’s own behavior is a choice despite past traumatic events. It’s not the same as taking the blame, which is very damaging. One can take responsibility AND be aware of and process emotion, in fact, one almost HAS to be aware to really take full responsibility.
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There are also group cultural insults that are traumatic, such as the generation of Jews whose parents were in concentration camps. There are also lots of ways that parents and other adults can hurt their kids without realizing they are doing so. School was a great example for me – daily torture, but no one seemed to notice or care, I kept having to go back every day for 13 years. There are lots of ways people get hurt and traumatized as children.
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Not surprising!
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We know at least that the AI does not dislike or judge us for our name, gender, sex, race, beliefs, etc. AI doesn’t have a subconscious, as far as I can tell!
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I remember a study where they let students log into an AI program, this was decades ago, and it was programmed to listen and ask pertinent open-ended questions. Students reported feeling better after talking to the AI!
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I would not call it “tenuous.” I would call it completely speculative!
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Thx!
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I think it goes back to “male privilege,” the broad teaching that men deserve more than women and that women’s job is to keep men happy. We are taught this all the time in our media and other parts of society. It seems it’s women’s job to make sure everything works out for men, and when it doesn’t, women are to blame!
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Well done!
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Sorry, I wasn’t suggesting YOU believe those things, I was just pointing out the failure of those arguments you alluded to made by others. I understand you are NOT a supporter of the DSM or the Medical Model. Sorry if there was some confusion there!
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