Thursday, June 27, 2019

Comments by Steve McCrea

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  • I do think we’d agree on most points. My issue is the professionals pushing these “diagnoses” when we know they are BS. But they have permeated society, and some people do take offense or get confused when I communicate my disagreement with these concepts. I think it’s an inevitable part of the problem, and I blame the doctors and the profession for promoting ideas they know to be false for the bulk of the confusion.

    The most important part of helping anyone is, as you say, recognizing that everyone has different experiences. Unfortunately, the main thrust of the DSM (in my view) is to invalidate those differences and suggest that we can lump people together based on how they feel or behave rather than taking the time to actually find out what’s going on. I am guessing we’d be of a mind that the job of any helper should be to find out from the person they’re trying to help what works or doesn’t work for them, rather than forcing one’s own view of the situation down their throat (in some cases literally). As to how the average clinician views the situation, it might be interesting to do a survey and find out for sure.

  • I know what you’re talking about, as I trained as a chemist undergrad and have done some programming as well. The most important element of creating a functional model is feedback from the model in action. If the model doesn’t predict reality accurately, you have to start redefining your assumptions. And you’re right, the most basic assumptions affect the outcomes most significantly.

    So what I see here is that the psychiatric industry, for reasons of economics and prestige/power/status, made a decision to regard the brain as the source of all mental/emotional/behavioral distress or wide variance from the norm. We are seeing now a lot of the feedback from that model in application and it is not pretty. However, rather than doing what a good scientist would do, and understand that the original assumptions were erroneous or at a minimum simplistic and go back and start altering those assumptions, they have a financial and power-based investment in maintaining the original assumptions as true regardless of any feedback they might receive from the model’s outcomes.

    In other words, they have abandoned the scientific method and have decided to do what makes them the most money/power instead of what helps their clients.

  • I think you underestimate the importance of and the damage done by the DSM. To start with, there is no reason that we can’t say, “X has difficulty eating enough food” or “Y has a difficult relationship with food” or “Z has a very negative body image that she wants to change.” Not labeling something doesn’t mean denying the circumstances that prompted the labeling process. In fact, we can get a MUCH more accurate description of what is going on by simply asking the client to describe the circumstances they feel they are facing and having them identify their own description of the problem. So there is no need to tell someone “you have an eating disorder” to provide helpful intervention. Now if the person him/herself identifies that “I have an eating disorder,” I would certainly not invalidate that. But that’s very, very different than a professional telling you, “You have an eating disorder” and defining your reality for you. This is especially true when the doctors start telling you that you suffer from a “chemical imbalance” or that your “disorder” is hereditary or due to some kind of brain malfunction that no one has even come close to identifying as true. And if you don’t believe this happens, you need to read up on this site or talk to a lot more people who have engaged with the “MH” system.

    More importantly, the DSM is taken VERY seriously by both professionals and the society at large. Not all, but lots and lots. Saying that a person “has depression” implies that there is something wrong with THAT PERSON for feeling that way, that they have a “medical problem” and that they need “treatment.” A survey in the late 2000s showed that over 80% of Americans believed that “depression” was caused by “low serotonin.” This belief did not just happen – it was the result of a large and coordinated effort to convince Americans that “mental health problems” were, in fact, biological. There is plenty of documented evidence that the thrust of the DSM III, which prompted a huge expansion of biological explanations for “mental illnesses” defined in the book, was to expand psychiatry’s market share. It was, in fact, a quite cynical effort to position psychiatry as a “real branch of medicine” and to promote its practices as “scientific” and “proven effective.” Naturally, the pharmaceutical industry was happy to team up with psychiatry in this effort, and continues to provide most of the funding for the continued propaganda campaign to that end.

    It’s easy to think that those who made the DSM are just trying to understand better and refine their model, but the origins of the DSM series belie that suggestion. It is more than possible to provide good support to people who face mental and emotional suffering without the slightest reference to a “diagnosis.” Again, if an individual wants to view him/herself through that lens, they’re welcome to do so, but the profession has no right to promote the idea that these “diagnoses” represent real, biologically-distinct entities when they know absolutely that they do not and never will.

  • What if the “diagnoses” are known to be manufactured and to not represent any kind of medical problem? Is it not a fraud to pretend one is practicing “medicine” beyond “symptom management” when “treating diagnoses” that are known not to be scientifically definable? What’s to stop someone from inventing “nose-picking disorder” or “excessive skipping disorder” or “unreasonable political protest disorder?” If we can just invent “disorders” out of anything we don’t like or find uncomfortable or confusing, where does it end? Hell, they’re prescribing STIMULANTS for “Binge Eating Disorder” now! As if the person is suffering from excessive appetite and suppressing the desire to eat is “treating” the problem! I’m sorry, but these utterly unscientific “disorders” are not advancing the understanding of people’s mental/emotional distress or well being, but is instead creating further confusion.

  • You are absolutely right, the proof is in the pudding, and so far the psychiatric pudding is falling pretty flat. Making more people disabled, reducing people’s lifespan, reducing hope and increasing stigmatization and discrimination – nothing that could be called a success in any sense.

    Real science makes things simpler and more effective over time. The psychiatric model makes things more complex and more confusing and is ultimately very ineffective.

    I agree that people are programmed to categorize, but categories are only as useful as they create better understanding. And any real scientist knows that categories are always approximations and that incoming data has to be considered to improve the model of reality over time. A model is not reality, but psychiatry seems to think the model is more important than the results. Unless you count financial results for their corporate buddies.

  • I’m not going to try and explain myself again. You seem to have difficulty following what I’m saying for some reason. I never assumed that bad brain chemistry causes anything – to the contrary, I think the whole thing is a bunch of pseudoscientific chicanery invented to sell drugs. Anyone who has ever read anything I wrote knows this about me. All I’m saying is that sometimes having hard scientific data proving such assumptions FALSE is helpful in counteracting pseudoscientific propaganda put out by the proponents of the DSM “model” toward their potential victims. You’re free to disagree with me, but not to put words in my mouth that I not only didn’t say, but which are in direct contradiction to what I’ve clearly expressed myself to believe over and over again on this forum.

  • I think you misunderstand me. The only research I’m talking about it that which debunks any idea that there is some medical issue at play. For instance, I have found it extremely valuable to read decades of reviews of the literature on “ADHD,” not because I believe in that bogus concept, but because those decades of research prove what we all intuitively know to be true: giving kids stimulants doesn’t improve their grades, their academic test scores, their social skills, their high school dropout rates, their rates of delinquency, or even their “self esteem,” however they measure that subjective concept. This is very useful to me when someone tries to explain to a parent how “untreated ADHD” leads to high school dropout and delinquency, and I can say, “What most people don’t seem to know is that 50 years of research have shown that “treating ADHD” with stimulants does not change those outcomes one iota, and in some studies it makes them worse.”

    I’m certainly not in favor of wasting good money on studying these idiotic constructs. But I do value people (like Giovanni Fava or Jonathan Leo or Peter Breggin) who do or assemble research showing that the institution of psychiatry has its collective head in a very dark place. Yes, even if they use “those terms.” Because sometimes people just need to hear that psychiatry is lying to them as a place to start their journey to understanding how deeply harmful the industry really is.

  • I agree absolutely. I’ve said to people that even if they DID prove that people “with ADHD” have a difference in their brains from the average person, it would not mean that there was anything wrong with them. After all, genetic diversity is the key to species survival! Or as one foster youth once wisely said to me, “Maybe different people should be allowed to have different brain chemicals.”

  • That is my general practice, and I think it says what needs to be said. This particular use of quotation marks is meant to indicate that this term is used by others but is considered by the “quoter” to have a different value, and usually indicates a degree of disrespect or scorn for the term. Kind of like saying, “So-called schizophrenia.” I have also used “persons who have been labeled as” when talking about research. This allows us to communicate the intent of the researchers without buying into the terminology. That’s just my personal take on it, but I agree with Oldhead here that the quotation marks are the easiest way to show disagreement while still using the recognized term for those who are new to the idea of critiquing the DSM “diagnoses.” (See, it works!)

  • I don’t think that it’s possible to be truly “trauma informed” as long as you are relying on the DSM-driven standard “mental health” system. The only “trauma informed” thing to do is to erase everything people claim to know about “mental illness” and start over from scratch, and rebuild from the viewpoint that the people who have been traumatized are the ones who actually know what they need.

  • The problem is that there is no profit in it for any big corporations, so there is no motivation to do anything different than what is being done. If Maori methods actually help “cure” people of their ostensible “disorders,” that would be a strong reason for many in the industry to try and bury the idea as deeply as possible so they don’t start losing “customers,” whether voluntary or not.

  • I am impressed at how complex and confusing they have made a very simple correlation. Burnout and depression “overlap” because they are both descriptions of how people feel and act when they are overwhelmed, stuck,hopeless, and/or disconnected or unsupported by their communities. Making it seem like they are somehow different things that “overlap” is just a sleazy way to continue to legitimize their medicalization of “depression.” I found it particularly amusing that they assert that “burnout” is a syndrome that can’t be clearly defined, as if “depression” were somehow different.

    Anyway, you can tell when someone’s explanation doesn’t hold water if it continues to make the situation seem more and more complicated instead of simpler.

  • Thanks for your kind words. It baffles me beyond belief that a person who knows they feel lonely and unloved would be secluded in a room and put in a straight jacket and drugged!!!! How could ANYONE think that would help you feel LESS lonely and unloved? Seems like the best way I could think of to make you feel MORE lonely and unloved?

    I can only surmise that a lot of these people don’t really understand or care how other people feel. The lack of empathy is astounding to me. There is nothing wrong with a person who is feeling lonely and unloved! Maybe what they need is connection and love? Radical thought!

  • The system itself is organized along racist/classist/sexist lines, and unless the field suddenly and miraculously divorces itself from the DSM and all the attendant “diagnoses” and similar medicalized language toward people in distress, it will continue to function as an agent of oppression, despite the scattered patches of sanity that one finds here and there fighting for their own survival. The fact that the psychiatrist could make that incredibly racist statement without an outcry from the entire staff shows how completely accepted it is that psychiatrists get to do whatever they want and the rest of the staff either go along with the bully or get bullied themselves. How anyone could get “saner” in such an environment is a miracle that occurs in spite of rather than because of the system itself.

  • Way to get complex about it, researchers. The explanation is both simple and obvious: ADHD is diagnosed based on the degree to which the child creates problems for the teacher. Younger kids are more likely to create problems for the teacher, and are therefore more likely to get a referral or pressure to get diagnosed and “medicated.” The other explanations (2-4) are clearly just attempts to rationalize continuing to drug kids because they are annoying.

  • The first problem is grouping all people who fit the “PTSD” criteria into one group and trying to find one intervention that helps everyone. Some people may like “exposure therapy,” some hate it. Some people find meditation to be a very difficult experience, I personally found it very helpful. People are all different, and different approaches help different people. Why anyone would try to force a “therapy” on someone who said it didn’t feel right is beyond my comprehension.

  • I recall doing an excellent exercise on distinguishing facts from opinions/projections. A person would be asked to look at a picture and say what they know about the person in the picture. People would say things like, “He’s sad.” The facilitator would say, “Do you KNOW he’s sad? What do you actually see that you know to be true?” “Well, he looks sad.” “Looks sad to you – that’s your opinion, too. What do you SEE?” “Well, his face looks sad.” “What about his face looks sad?” “He’s frowning.” “How do you know he’s frowning?” “Well, his lips are turning down at the edges.” “THAT is a fact. The rest of the things we think we “know” are assumptions or judgments.” It was a sobering exercise. Most of what we “observe” is not really an observation at all, it’s a judgment. I would also submit that any “observation” made would need to be checked back with the person being “observed” for accuracy, but far better for the person to make his/her own observations without any suggestions from the “helper.”

  • Solid advice. I’d add that there are some “patients” who have bought into the system as it is and will be difficult to engage on these points. I’d also add that the system personnel will sometimes ask if you are “antipsychiatry” or “a Scientologist” or “anti-science.” You want to be prepared not to engage with this kind of attack, and I’d suggest responding by asking, “Why are you changing the subject? I thought we were talking about whether or not psychiatry works?” But of course, anyone who attacks you in that way is probably not really worth trying to convince, as they are invested in the status quo and maybe even making money off of it.

  • I actually agree with you, and efforts to be “objective” are often a big barrier to helpers connecting emotionally with the people they are trying to help. Perhaps a better description is for the helper to understand that s/he is NOT objective, and to make strong efforts to double and triple check his/her observations and ideas with the person whom they are supposed to be helping.

  • “Why is my car not running?”

    “There is no way of knowing – there are too many factors involved.”

    “So if you don’t know why it’s not working, why should I pay you to fix it?”

    “Trust me, I have 25 years of experience working on problems that I don’t actually understand.”

    Time to get a new mechanic?

  • It is possible, but it is my firm belief that only a tiny percentage of people who are suffering will have any kind of neurological difficulties at all. Because being scared, or angry, or depressed, or bored, or even having fantasies are all completely normal activities that every human being experiences at one time or another. It makes no sense at all that 20% of the population is “mentally ill” – they are in the vast majority just people having normal reactions to life. The idea that there will be some physiological cure for something like “depression” is a fantasy. It’s just as likely as curing something like “pain.” It isn’t going to happen, because pain is a part of life, and so is depression and anxiety and all of it.

  • Actually, beyond direct force there is a lot of manipulation using parental fears. For instance, they tell parents that “untreated ‘ADHD’ leads to delinquency and school dropouts and etc etc.” Of course, they don’t bother to tell them that the “treatment” doesn’t do anything to improve any of those outcomes, nor that most “ADHD” diagnosed kids turn out just fine as adults. So parents are afraid if they don’t “medicate” their child, the child will suffer these awful outcomes that the “treatment” doesn’t even touch. It’s pretty evil!

  • Though it is true that many capitalists claim to be “libertarians” in order to justify their opposition to anything that might help the working stiff have a chance at a better quality of life. The Koch brothers are a great example – they claim to be libertarians who are in favor of minimizing regulations and supporting the “free market,” but when rooftop solar started to out-compete other energy providers in sunny places like Oklahoma, they were first in line to propose a tax on rooftop solar. So much for the free market, guys…

  • He clearly states that the use of the term “illness” to refer to a state of mental or emotional suffering is not a proper use of the term. He (and I) believed that some illnesses could have impacts on thoughts and emotions, such as low thyroid or anemia or a head injury. But those are identified as real illnesses and treated by real branches of medicine. He always was clear that if there is no known physical cause, it’s not an illness. I wanted to make sure you knew I wasn’t denying that things like loss of sleep or the side effects of certain drugs or poor nutrition can cause mental/emotional problems. But to call something like “depression” an “illness” doesn’t make sense to me (or to Szaz), because it assumes that everyone who is feeling depressed has something wrong with them. Indeed, it assumes that all people who are depressed have the same problem. This is about as silly as saying that all people who feel pain have “pain disorder” without bothering to see what is actually causing the pain. Actually, it’s even more silly, because feeling depressed is a normal part of living, it’s not even an indicator of something physically wrong, as pain most often is.

    So to be clear: “Major Depression” is not caused by a physical problem. It is an invented category that does not correlate to any physical abnormality. It is just a label for a phenomenon that could have many different causes. Low thyroid IS a physical problem that can cause a particular person to feel depressed. In this case, “depression” is just an indicator of the problem, no different than weight loss/gain or tingling in the hands and feet. So “depression” is never the “illness.” It is just an emotional experience people have, which in rare cases can be caused by a physiological problem of some sort, but which in most cases is simply a normal emotional response to a difficult environment where one has difficulty figuring out what to do.

    I hope that makes things clearer. But Oldhead is right – Szaz did not believe that “depression” was or could be a “disease” or “mental illness.” He wasn’t opposed to treating actual illnesses that might cause a person to feel depressed, but he was very much against any kind of idea that “depression” as a whole was or could ever be the result of a biological problem.

  • That is exactly what I mean. He is pretty clear about saying that if something is discovered to have a real physiological cause, it is moved into one of the actual medical categories, like neurology or nutrition or internal medicine. Psychiatric “illness” is only reserved for those manifestations that DON’T have an actual known physiological cause, which he properly identifies as a metaphorical use of the term “illness,” since there is no reason to believe there is anything physiologically wrong with the person in question. I’d say his take is, “If you know it’s an actual physical ailment, show me the test and treat it as such. If you can’t show it to be physiological, stop calling it an ‘illness,’ because it isn’t.” I’m no Szaz expert, but that’s what I most recall of his writings.

  • Not at all, and neither does Szaz. The important point is that you can’t DIAGNOSE A DISEASE STATE by looking at HOW SOMEONE ACTS OR FEELS. There is no question that certain physiological conditions can cause mental/emotional symptoms or adverse effects. The problem is claiming that a person has such a condition BECAUSE they have certain mental/emotional effects. For instance, it’s legitimate to say that a person might be depressed because he’s had insufficient sleep, but it’s not legitimate to say that you know he has insufficient sleep because he’s depressed. He MIGHT be depressed due to lack of sleep or due to having a dead end job or because he was abused as a child or because he is lonely and has no connections or because his wife just left him or he lost his job or etc., etc, etc.

    An analogy might be diagnosing a person with “knee pain disorder.” It is meaningless to say that a person has “knee pain disorder” because their knee hurts. You’d have to know WHY the knee was hurting. Maybe it’s arthritis, maybe it’s a muscle cramp, maybe it’s a bruise, maybe it’s nerve damage, who knows? You’d have to analyze it further to find out what was the cause before you made a diagnosis.

    Same with “depression.” Saying “he has depression” tells you nothing at all, except that he’s feeling depressed at that particular time. It may be physical, mental, emotional, social, spiritual, political, or any mix of the above. So calling “depression” a “disorder” is not only meaningless, it is destructive, because it gives people the idea that the psychiatrists have some understanding that they actually don’t have.

  • You should read his books. Essentially, he says that the idea of “mental illnesses” is only metaphorical – they are not really “illnesses” but “difficulties in living” that have been labeled as such for the purposes of those in positions of power in society. That’s all I’ll say for now – you should read some of his writings. I think they would be very helpful for you to understand why some people say “mental illnesses don’t exist” – very different meaning than “people don’t suffer mentally/emotionally.”

  • They say a lot, but it’s mostly speculation and nonsense. The one thing we do know is that brain chemistry is constantly changing as we encounter different stresses and needs. So to suggest someone’s brain is “chemically imbalanced” means practically nothing. We also now know that the actual physical structure of the brain is changed by experience. So it seems to me we waste a lot of time studying genetics, which can’t be changed, instead of studying which EXPERIENCES help people feel more strong and capable.

  • All of those elements are involved in creating or alleviating distress, for sure. For instance, loss of sleep definitely increases my feelings of hopelessness or anxiety and reduces my ability to communicate effectively. So sleeping could be said to be a “treatment” for my negative feelings, but really, all they are “symptoms” of is a lack of sleep.

    So by all means, we should be addressing deficiencies in our social environment, eating better food, working on our own attitudes, working to improve the economic situation, etc. The problem is that my reacting badly to, say, a very oppressive school environment as a child (I was deeply depressed, did act out one time, had a psychological evaluation, etc.) meant that I had a “disorder” or “disease” or “condition” – it meant that the school’s rules, expectations, and processes and the complete lack of recourse that I or any of the other students had to address any kind of injustice or arbitrariness provided a horrible environment for me to grow in. The real answer wasn’t to ‘treat’ me, but to get me the heck out of there or to change the environment so I didn’t feel so hopeless about having to go there and be bored and lonely and angry and frustrated 5 days a week, 6 hours a day.

    Do I have a tendency more than other people to be anxious or depressed? Yes, I do. Could some of this tendency be built into my personality? Sure, it could. But so is empathy, compassion, willingness to fight for justice, humor, and lots of other things that go along with being “sensitive.” I don’t think I needed to be “assessed” or “evaluated” or “treated,” I needed to be loved and listened to and provided more opportunities to take more control of my own life.

    So I’m all for looking at all the factors that contribute to someone’s distress. I’m just opposed to the idea that being distressed in a particular way that is inconvenient for those in charge means that I have a “disorder.” I think it means I’m human, and we humans are all different and unique in our needs and goals and values and deserve to be treated that way. We don’t deserve to be slotted into categories of “wrongness” for the convenience of those who want to pretend that life is a garden of delights and that anyone who is not loving every minute of it needs to be “fixed.”

  • Given what the “mental health” world has done with ‘mindfulness’ by abstracting it from the Buddhist philosophy that underpins it and in some cases making it a requirement in someone’s “treatment plan,” I am very skeptical that Western Psychiatry will do anything but distort and ruin any helpful practice the Maori may have developed. Maybe we should skip reforming psychiatry and instead pay the Maori what we used to pay the psychiatrists rather than expropriating their spiritual practices and turning them into yet another bastardized western product for sale?

  • I don’t think anyone should invalidate your own perception of what works for you. Certainly, lots of people report finding psych drugs helpful. But that does not make psych diagnoses legitimate. They are not discovered, but literally voted on by committee. Read “So They Say You’re Crazy” by Paula Caplan, who served on the DSM IV task force.

    And yes, they do invent “disorders”. Look at the cases if Juvenile Bipolar or Social Anxiety Disorder or Binge Eating Disorder. Not that such things are not issues for some people, but there is solid documentation that pharmaceutical companies conspired with leading psychiatrists to create these “disorders” in the DSM to sell pharmaceuticals and psychiatric “services.” I know it’s hard to believe, but it is true.

  • But it is important to acknowledge that people DO suffer in various ways, and often need help dealing with their emotions and their experiences. This doesn’t make them ill, but I think it is important to distinguish that these “diagnoses” are crap, in that they are social inventions, but that suffering is real and that we need to get together as a community and look for solutions that actually help but don’t blame the sufferer for suffering too much or in the “wrong” manner.

  • I do see what you’re saying. I think it involves a confusion about language. When people say, “There is no such thing as ‘Bipolar Disorder,'” I think they mostly mean that “Bipolar Disorder” is an invention that doesn’t have a scientific basis as a medical diagnosis. I don’t think people mostly believe that those behaviors defined as “bipolar disorder” don’t occur, or that they don’t cause distress, or that help is not sometimes required. I think the objection is that someone with medical authority is DEFINING these behaviors as a “medical disorder” without cause. But it is often intepreted by readers as meaning that people don’t have these feelings or behaviors, which leads to lots of confusion and, as you say, distraction from the key points. At the same time, I really do understand why people who have survived the system often are very strongly against using these terms, which is why I put them in quotation marks whenever I use them. These generalizations have been used to harm people, often intentionally, and if that had happened to me, and I later found out the “disorder” I was assigned was voted into existence by a committee, I’d never want to see that word in print again!

  • I mean the goal of being “normal” as defined by the social norms promoted by our cultural system of values. It is the slavish adherence to this artificial “normalcy” and its conflict with people’s actual reality that is behind many cases of “mental illness.” This is very different from accomplishing what the client personally wants to create as their own “normal” mode of operation. What I find abhorrent is when therapists/counselors/psychiatrists define “normal” for the client and feel their job is to make them “fit in” better to society, rather than finding their own definition of “normal” that allows them to be comfortable in their own skins.

    As for pissing of psychiatrists, it depends if the psychiatrist is in a position to influence your reputation or your employment potential. There are definitely situations where one’s survival as a therapist in a particular institution depends on not being too vocal about critiques of the DSM or “medication” use. I respect anyone who can operate “behind the lines” without being beaten down or giving up. You appear to have established a certain level of respect and independence that has allowed you to be a maverick with limited consequences, but that takes time and skill to develop, and for some, it appears to be beyond their capacity. Working in a psychiatric institution or one controlled by psychiatric thinking can be extremely oppressive toward the workers as well. It takes a lot of courage not to pass on that oppression to the clients.

  • I never really thought about it, but you’re right, the concept of “baseline” is totally bogus. It assumes a person is a fixed entity that is only temporarily impacted by life circumstances. This is rot, of course. People are always developing, and the whole idea of “therapy” ought to be to help someone move onward to their next step in life, rather than returning to some “baseline” equilibrium defined by another person.

  • I think there is a big difference between a person preferring a particular framing of their situation and a doctor claiming that everyone having a particular behavioral manifestation is suffering from “X disorder.” We are all entitled to view our circumstances in a way that makes sense, but doctors are claiming to have some superior knowledge of the situation. Making unsubstantiated claims of understanding situations that are scientifically inconsistent or mysterious or invalid is something no professional should be allowed to do. I see it as extremely damaging to our society as a whole to allow these false claims to be viewed as some kind of scientific truth. At the same time, I have no problem with anyone choosing to view their own problem as a “mental disorder.” I just don’t support doctors making this kind of assertion unless there is actually evidence it is true. Medical diagnoses should not be something people choose because they prefer them. They should be objectively measurable conditions that can be reliably identified and treated. OCD certainly does not meet those criteria, nor does essentially any other “mental disorder” in the DSM.

  • Hi, PD,

    I have to respectfully disagree with your assertion regarding therapists not being allowed to practice if they don’t follow the priorities you mention above. I have tons of experience with therapists, both as a part of the MH system and as an advocate for foster youth for 20 years. I can assure you that therapists are all over the place in terms of practice, and any generalization you’d like to make is not going to be accurate. Some are unwilling to give any direction at all to the client, no matter how bogged down they get, others think they know everything and constantly tell the client what to do. Some believe that everyone’s issues come from poor parenting, others believe that nothing in the past has any impact on the present. Some have people go over past traumatic events in detail, others avoid them like the plague. Some believe religiously in the DSM, others consider it ridiculously simplistic and only use it for billing purposes. Some seek to be empowering, others seek to define and solve the client’s problems for them. Some feel that sharing personal details of their lives is essential to a successful relationship, others consider any sharing a violation of “professional boundaries.” The only generalization that can be made about therapists is that there is no consistency regarding expectations or results.

    I do get that the CONCEPT behind therapy suggests that fixing the person to make them more “normal” is the goal, and I of course find such a goal abhorrent. But therapy for the most part can be whatever the therapist and client make it, and some people report very positive experiences with therapists that have helped them change their lives for the better. (Though I have to admit that such reports seem to have become rarer over the decades.)

    Bottom line, I think comments about the therapy industry as a whole can be reliably made, but generalizations about what would happen to a particular therapist if they didn’t toe some imaginary party line do not line up with what I’ve seen. Therapists can generally do whatever the heck they want, as long as they can bill the insurance company for their work, and as long as they don’t piss off any psychiatrists they have to answer to by threatening their label-and-drug gravy train.

  • Once again, I think we see how the labeling process actually does as much or more harm than the drugs themselves. What if we just said, “Here are some strategies for those who want to figure out a way to reduce unwanted compulsions” or something like that. Why not just describe the problem in terms that are meaningful for the client, and work toward the client’s goals? Why do we have to ascribe some critical label to the behavior, rather than just identifying that it’s something the client wants to change?

    It is unfortunate that some good tips and ideas can be obscured by these medicalizing terms. I hope we as a community can work to tell the difference between our cultural training to use medicalized terms and the actual potential of the interventions being discussed. Some people with good ideas haven’t yet figured out the problematic nature of these terms just yet.

  • Not sure I agree with you, Ron. I think of survivors of domestic abuse – they are or should be proud that they have survived such horrific abuse and continue to lead semi-functional lives in the wake of it, even if they fully know and understand that they have to continue to work on overcoming the damage done to them. It’s possible to be proud that you came up with ways to get through something difficult while still recognizing that one’s life can be improved yet further by continuing efforts.

  • They will always tell parents that “untreated ADHD” is associated with higher rates of delinquency, school dropout, drug use, lower test scores, lower college enrollment rates, lower self-esteem and so forth. What they DON’T ever tell them is that “treatment” in the form of stimulant drugs has never been shown to improve ANY of these outcomes! It’s a real flim-flam job, though I sometimes think the teachers themselves have mostly been flim-flammed and don’t even really realize what they are saying. It’s like a robot or computerized message, they just all say it because they’re programmed to do so.

  • Posting as moderator: I would also add to Emmeline’s comments that choosing to publish a summary and link to a research article in no way implies that MIA approves of the research or supports the conclusions. It is simply a summary of research that some readers might find helpful. If you don’t, it’s fine to ignore it. I personally find MIA to be the best place to gather ammunition if I’m trying to influence a professional person to take another look at their belief system. Some people make up their minds based on research, and this kind of information is sometimes essential to counteract their narrative.

  • And I think the challenge for me is that the degree confers some kind of confidence in people that this person knows what they are doing. If therapists are to be licensed, there ought to be a much more practical way to do so that is based primarily on the person’s actual impact on the client(s) s/he serves, rather than how many years of education s/he may have consumed.