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!
I mean this idea that telling people “it’s a chemical imbalance” is somehow good for clients, which you refer to in your comment. Many say, “people like their diagnoses” or “the biological explanation reduces stigma.” Very tiring arguments, indeed!
I agree. Blaming women for being unwilling to be your partner is childish and unproductive. Blaming feminism for women being unwilling to be your partner is childish, unproductive AND bigoted!
There are scientific studies showing that blaming a “chemical imbalance” or brain problem leads to LESS empathy for the “mentally ill.” People relate better and are more compassionate when their issues are framed as a result of trauma or difficult life circumstances. This is science, not my opinion. I’d also suggest that lying to patients for some social reason is not the doctor’s job. You should not try and alter attitudes by lying about the science behind a “disorder.”
I think the author would be wise to avoid the word “incel.” It has taken on some other connotations than an inability to engage in sexual activities, and is associated with misogyny and violence.
I’m amazed anyone gets away with making that argument. They systematically RULE OUT suicidal people before doing these studies. Anyone who is suicidal during the study period became that way AFTER starting the study. If more on antidepressants are suicidal, it’s caused by antidepressants. That’s what double blind studies are for!
Which suggests we should be looking at nutritional/macronutritional solutions, which should help SOME people, but certainly not ALL people. Depression is a VERY complicated experience that is generally more than just physiology, at least in many, many cases.
No, I didn’t miss that part. I’m pointing out that if 55% of females have lipid abnormalities, it means 45% of them do not and are yet still depressed. Depression has multiple causes, and to try and establish ONE cause, biological or otherwise, is a fool’s errands. It’s like trying to say, “What causes a rash?” A LOT of things can cause a rash, and they require different responses. Treating all rashes with one treatment will never work. Same with depression. There will never be one “treatment” because there is never one cause. If addressing lipid abnormalities helps a good percentage, that’s wonderful, but don’t expect it to work for everyone.
1) What do you mean “a real illness like any other?” How do you define “illness?”
2) If you are “ill” both on and off “meds,” and experienced “no success,” why are you so sure that “without meds patients are worse off?”
3) Is it possible in your mind for some people to be better “on meds” and others to be better “off meds?”
You hit the nail on the head. Unfortunately, there is ABSOLUTELY NO WAY to distinguish “real ADHD” from any of these other conditions or no condition at all, and the DSM itself admits this quite bluntly in its introduction. That you feel you BENEFITTED from stimulants is not a reflection that you have “real ADHD,” it’s a reflection that stimulants work for YOU personally. While I never want to take this away from you, it’s a very large leap from saying that “stimulants makes it so I can complete tasks, etc.” and “I have a diagnosable neurological condition that is objectively distinguishable from normal or other such conditions in me and any other person.” Unless you can reflect an objective way to do that, all you’re really saying is that stimulants have worked well for you. And more power to you for that. Just don’t assume others who act or feel similarly will have the same results, because experience and science says that most kids who take stimulants do no better in the long run than those that don’t.
“They work for me” is about all we can say for sure.
Remember when tey say that these receptors were “chronically decreased,” they are talking about AVERAGES. I am sure you will find many who are suicidal that do not have this condition, and many who have it who never become suicidal. If there were a way to isolate this SUBGROUP of people who happen to have this issue AND are “depressed”, by all means, we should do so, but to suggest that ALL cases of suicidal ideation or action are attributable to this is not even vaguely supported by the data presented.
A) Szaz was not a Scientologist. He just worked with them.
B) If he is, why does that matter to you, Marcus? Why not judge a person by their evidence rather than bringing in irrelevant points like religion? A person’s argument for or against abortion, for instance, should be considered independently of whether they are Catholic, don’t you think?
With all due respect, there is not one single “mental disorder” that has a recognized “underlying brain pathology.” You should read Anatomy of an Epidemic so you will better understand why people feel they have been fooled. And people are STILL deemed “abnormal” for any negative or strong emotion they may experience. I don’t see the current system as any improvement from the viewpoint of pathologization. They are still calling you “crazy” but now have broken it down into brands of “crazy.”
There is also now evidence that making the BRAIN the focus of the “disorder” actually increases stigma and decreases empathy for the so-called “mentally ill.” Especially when you consider that the DSM “disorders” are all entirely invented in committees and have no scientific basis in brain pathology, they can keep their labels and stuff them someplace dark and stinky!
It is true that antipsychotics can be useful in the short run to help people get under control. I’m just saying that calling it a “treatment” is a lot like saying morphine is a “treatment” for a broken bone. Might make you feel better and be helpful, but it’s not going to help to simply prescribe morphine without finding out what’s really going on.
I can’t consider electrocuting someone into a seizure a “treatment,” last resort or not. And who gave the doctors the right to “see fit” when electrocuting someone is “therapeutic?”
Actually, that’s NOT the question, with all due respect. It makes the assumption that A. these drugs are “medicines” for “diseases,” and B. that it’s always better to do something than nothing. If doing something wastes money and has no positive benefit, we are better off doing nothing than pretending we are “treating” a “disease” that we clearly do not understand!
You are so right! The “Depression” can’t “resist treatment.” It just means their treatment didn’t work or made things worse. No other profession gets this kind of latitude! What if your mechanic said that you had “repair-resistant fuel injectors?” Would you bring your car back for another “treatment?” No, you’d know it did not work and your car was better off in the care of someone who knows what the f*&k they’re doing!
“Subconscious” is not synonymous with “unintentional.” It just means you’re not willing to acknowledge those intentions. Most “professionals” ARE covering up intentionally, even if it is not something they are consciously aware of doing. Any time someone gets defensive when presented with contrary evidence, they are intending to cover up.
Exactly! As long as the status quo is an easy way to financial success, as long as big corporations are making buckets of money, any “reform” will be considered threatening to those piggies with their snoots in the trough. Stop feeding the piggies and you may have a chance at real change. We need to stop rewarding failure with more money!
I am sorry if I misinterpreted your comments. I have seen OD trainings and participated in one myself. It seems like a great approach. I’m also not opposed to the availability of drugs to assist anyone who finds them helpful. My point would be more that Dr. Jureidini should not expect to be congratulated for his success. As has been clearly demonstrated with many examples, successful healing of patients is threatening to the status quo, and anyone who is successful can expect to be attacked as a quack, a religious nut, or an irrationally hostile force. Initial reactions to Bob’s book are more proof. No one can really undermine his basic premises, yet he’s seen as a kook or an antipsychiatry nut or a “Scientologist,” as if any of those are scientific analyses of his work. And such tactics are generally successful, and will be until the public catches on that the mainstream of psychiatry does NOT have our best interests at heart.
David didn’t “reform” Goliath and convince him not to attack. He beat him physically and defeated him. Peer workers are a great option, but they need to understand that their efforts will be OPPOSED by the mainstream system, and that system must be DEFEATED in terms of losing its power before any peer “reforms” can become mainstream and the label-and-drug model dies a well-deserved death.
That’s why I recommend self-directed reality checking. The person him/herself has to decide if it’s real, and our efforts should focus on helping them evaluate the evidence rather than telling them what to think. I sometimes thing psychosis itself is a rebellion against being required to think a certain way. In any case, I never found telling people “what’s true” to be particularly helpful, though I did sometimes challenge them to ask themselves if their beliefs are “true” or opinions they held. Challenging thinking can be really good, but trying to substitute our thinking or society’s thinking for someone else’s own evaluation – probably not going to be helpful!
Hey, that’s what ECT is all about – inducing seizures! Why could a spontaneous seizure not cause improvement? Of course, both cause brain damage, at least potentially, but if the docs are INDUCING seizures, I suppose brain damage is potentially therapeutic!
I think the best response is, “What evidence do you have that makes you think the CIA is watching you?” Just saying someone’s wrong is rarely therapeutic in the least. But there are people who have expertise in this area whom you might want to consult.
I LOVE the “Stop it!” skit! But you are right. The problem is opposing goals. The peer movement’s intentions were contrary to those of the main MH system, and so they had to be coopted or snuffed out. And the MH system was very effective in doing so. You can’t change the basic purpose of the MH system. It’s built in.
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Again, I think you are playing fast and loose with the stats here. There is not a 30% complete remission with ADs. 30% beat out placebo by a significant margin. This does NOT suggest complete remission, in fact, a whole industry has developed around supplementary “AD” treatment for those with only “partial remission.” There is not a record of consistent benefit. 30% improving compared to placebo also means 70% do not. That’s a pretty crappy track record from any kind of treatment.
Mark, you have not contacted me by email or responded to my emails. I’m not sure you even received them at this point. I will no longer be able to post your comments until you contact me and we can have a conversation. Again, my email is [email protected] or [email protected]. It’s also listed in the “About” section of your home screen. Meanwhile, all of your posts will simply stay as “pending” until I hear from you. I’m not sure what else to do to get a response from you.
So you only find out if it “works” after the fact. There is no evaluation that can predict the outcome of ECT, and I believe you know this is true. “Evaluations” in the “mental health” world rarely produce anything concrete that could be counted on to relate to predicted results. 30% of SSRI recipients improve in the short term (at best). How do we know which 30% will improve? We have no clue whatsoever. And that is typical.
POSTING AS MODERATOR: I honestly don’t have any idea how to unsubscribe you. Perhaps one of our tech staff can help? You can find them in the “About” section under “Staff.”
Motivational Interviewing has a lot of useful techniques and is or should be very much client directed. The coach or “therapist” finds out what motivates the CLIENT from their own viewpoint and then helps examine which current behavior gets them closer to that goal FROM THE CLIENT’S POINT OF VIEW.
How would one know in advance who fits into this “sliver?” And with the attendant risks of severe congnitive symptoms DEVELOPING as a result of ECT, even in people who had none to start with, how can this possibly be consistent with a “first, do no harm” approach to medicine? Sounds more like Las Vegas “medicine” to me – “Come on, baby, give me a 7, give me a 7…”
And no, “everyone” does not accept that ECT comes with “real cognitive risks,” based on my reading of the literature, in fact, the idea is denied or minimized chronically. Nor are patients almost ever informed of these cognitive risks even if the doctors do acknowledge them. You seem to have a very rosy view of how “informed consent” is handled in the “mental health” fields!
Mark, I am giving you until the end of today to respond to my emails or give me a working email address. If this does not occur, I will be forced to remove your right to post here, as having a working email is part of the posting guidelines.
Sorry, I don’t have the context here. What did I say? Most likely I was not referring to you, as I generally avoid referring to individuals and if I do so I make it quite clear. I don’t remember directing anything toward you recently. Can you remind me what I said?
You do realize that many women are unable to establish positive sexual relationships as well, don’t you? I would love to see you address this issue as part of your presentation.
Posting as moderator: MARK, PLEASE CHECK YOUR EMAIL. I have sent several messages. If you are unable/unwilling to respond to emails, you are not allowed to post at MIA. Please write me back so we can discuss your prior posts. It’s not OK to keep saying you are waiting for them to be posted when I’ve told you my concerns and you have failed to respond.
Please write me back or I will have to stop posting your comments. If that email doesn’t work, please get me one that does ASAP.
Your email does not seem to have worked, it bounced back as not existing. I need a functioning email to have continued posts be published. I edited this one and removed the parts violating our Guidelines, but I can’t continue to do that. Please get back to me with a functioning email – it is an official requirement to post at MIA.
You are denying Kirsch’s reviews of the literature clearly showing an increase in suicidal thinking when taking SSRIs? I am also not aware of ANY review suggesting that suicide rates are reduced by SSRI or other antidepressants? Lithium is the only drug I know of that has evidence supporting this possibility, and that has more recently been called into doubt.
Your willingness to make claims unsupported by literature reviews makes it hard to take your comments as unbiased.
They should not be “involved,” they should be the central architects of any such effort. Who knows better than those with “lived experience” what actually does and does not help???
Any of these things can be helpful if practiced by someone who has the proper attitude and has dealt with his/her own issues. The big problem is that there is no way to measure therapeutic competence, nor any training that assures it will be developed. Having clients/users themselves decide what works for them seems like the best solution. Dubbing someone a “therapist” because they completed a certain set of courses or a supervised internship with another person who may or may not have those skills and attitudes is simply misleading.
I agree that simplifying and “common-izing” our helping approaches is the way to go.
When advocating for foster youth for 20 years, I saw many who became aggressive on stimulants and were then re-diagnosed with “bipolar disorder” instead of stopping the stimulants. It was extremely common but very hard to get anyone to discuss seriously, even though a good number of the psychiatrists I worked with admitted it occurred.
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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I mean this idea that telling people “it’s a chemical imbalance” is somehow good for clients, which you refer to in your comment. Many say, “people like their diagnoses” or “the biological explanation reduces stigma.” Very tiring arguments, indeed!
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I agree. Blaming women for being unwilling to be your partner is childish and unproductive. Blaming feminism for women being unwilling to be your partner is childish, unproductive AND bigoted!
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There are scientific studies showing that blaming a “chemical imbalance” or brain problem leads to LESS empathy for the “mentally ill.” People relate better and are more compassionate when their issues are framed as a result of trauma or difficult life circumstances. This is science, not my opinion. I’d also suggest that lying to patients for some social reason is not the doctor’s job. You should not try and alter attitudes by lying about the science behind a “disorder.”
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I think the author would be wise to avoid the word “incel.” It has taken on some other connotations than an inability to engage in sexual activities, and is associated with misogyny and violence.
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I’m amazed anyone gets away with making that argument. They systematically RULE OUT suicidal people before doing these studies. Anyone who is suicidal during the study period became that way AFTER starting the study. If more on antidepressants are suicidal, it’s caused by antidepressants. That’s what double blind studies are for!
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Which suggests we should be looking at nutritional/macronutritional solutions, which should help SOME people, but certainly not ALL people. Depression is a VERY complicated experience that is generally more than just physiology, at least in many, many cases.
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I’m not sure I got it. What would I be looking for?
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No, I didn’t miss that part. I’m pointing out that if 55% of females have lipid abnormalities, it means 45% of them do not and are yet still depressed. Depression has multiple causes, and to try and establish ONE cause, biological or otherwise, is a fool’s errands. It’s like trying to say, “What causes a rash?” A LOT of things can cause a rash, and they require different responses. Treating all rashes with one treatment will never work. Same with depression. There will never be one “treatment” because there is never one cause. If addressing lipid abnormalities helps a good percentage, that’s wonderful, but don’t expect it to work for everyone.
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A couple of questions:
1) What do you mean “a real illness like any other?” How do you define “illness?”
2) If you are “ill” both on and off “meds,” and experienced “no success,” why are you so sure that “without meds patients are worse off?”
3) Is it possible in your mind for some people to be better “on meds” and others to be better “off meds?”
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You hit the nail on the head. Unfortunately, there is ABSOLUTELY NO WAY to distinguish “real ADHD” from any of these other conditions or no condition at all, and the DSM itself admits this quite bluntly in its introduction. That you feel you BENEFITTED from stimulants is not a reflection that you have “real ADHD,” it’s a reflection that stimulants work for YOU personally. While I never want to take this away from you, it’s a very large leap from saying that “stimulants makes it so I can complete tasks, etc.” and “I have a diagnosable neurological condition that is objectively distinguishable from normal or other such conditions in me and any other person.” Unless you can reflect an objective way to do that, all you’re really saying is that stimulants have worked well for you. And more power to you for that. Just don’t assume others who act or feel similarly will have the same results, because experience and science says that most kids who take stimulants do no better in the long run than those that don’t.
“They work for me” is about all we can say for sure.
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Remember when tey say that these receptors were “chronically decreased,” they are talking about AVERAGES. I am sure you will find many who are suicidal that do not have this condition, and many who have it who never become suicidal. If there were a way to isolate this SUBGROUP of people who happen to have this issue AND are “depressed”, by all means, we should do so, but to suggest that ALL cases of suicidal ideation or action are attributable to this is not even vaguely supported by the data presented.
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Clients are the only really valid source of feedback re: therapy. There is no “clinical measure” of how you’re feeling or what your life means to you!
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A) Szaz was not a Scientologist. He just worked with them.
B) If he is, why does that matter to you, Marcus? Why not judge a person by their evidence rather than bringing in irrelevant points like religion? A person’s argument for or against abortion, for instance, should be considered independently of whether they are Catholic, don’t you think?
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So who gets to decide what emotions are “maladaptive and pathological,” Mich? And based on what?
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With all due respect, there is not one single “mental disorder” that has a recognized “underlying brain pathology.” You should read Anatomy of an Epidemic so you will better understand why people feel they have been fooled. And people are STILL deemed “abnormal” for any negative or strong emotion they may experience. I don’t see the current system as any improvement from the viewpoint of pathologization. They are still calling you “crazy” but now have broken it down into brands of “crazy.”
There is also now evidence that making the BRAIN the focus of the “disorder” actually increases stigma and decreases empathy for the so-called “mentally ill.” Especially when you consider that the DSM “disorders” are all entirely invented in committees and have no scientific basis in brain pathology, they can keep their labels and stuff them someplace dark and stinky!
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That seems to be how they work – by down-regulating serotonin!
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It is true that antipsychotics can be useful in the short run to help people get under control. I’m just saying that calling it a “treatment” is a lot like saying morphine is a “treatment” for a broken bone. Might make you feel better and be helpful, but it’s not going to help to simply prescribe morphine without finding out what’s really going on.
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I can’t consider electrocuting someone into a seizure a “treatment,” last resort or not. And who gave the doctors the right to “see fit” when electrocuting someone is “therapeutic?”
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Actually, that’s NOT the question, with all due respect. It makes the assumption that A. these drugs are “medicines” for “diseases,” and B. that it’s always better to do something than nothing. If doing something wastes money and has no positive benefit, we are better off doing nothing than pretending we are “treating” a “disease” that we clearly do not understand!
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You should put “medicines” in quotes! The idea there is such a “medicine” is a deception!
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I know! That’s why it’s not really funny! How can these people take each other seriously?
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You are so right! The “Depression” can’t “resist treatment.” It just means their treatment didn’t work or made things worse. No other profession gets this kind of latitude! What if your mechanic said that you had “repair-resistant fuel injectors?” Would you bring your car back for another “treatment?” No, you’d know it did not work and your car was better off in the care of someone who knows what the f*&k they’re doing!
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Of course, I was being totally facetious. There is no benefit from electrocuting someone into a seizure!
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“Subconscious” is not synonymous with “unintentional.” It just means you’re not willing to acknowledge those intentions. Most “professionals” ARE covering up intentionally, even if it is not something they are consciously aware of doing. Any time someone gets defensive when presented with contrary evidence, they are intending to cover up.
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I wish I had a plan!
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Exactly! As long as the status quo is an easy way to financial success, as long as big corporations are making buckets of money, any “reform” will be considered threatening to those piggies with their snoots in the trough. Stop feeding the piggies and you may have a chance at real change. We need to stop rewarding failure with more money!
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And GO, ALEW!!!!
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I am sorry if I misinterpreted your comments. I have seen OD trainings and participated in one myself. It seems like a great approach. I’m also not opposed to the availability of drugs to assist anyone who finds them helpful. My point would be more that Dr. Jureidini should not expect to be congratulated for his success. As has been clearly demonstrated with many examples, successful healing of patients is threatening to the status quo, and anyone who is successful can expect to be attacked as a quack, a religious nut, or an irrationally hostile force. Initial reactions to Bob’s book are more proof. No one can really undermine his basic premises, yet he’s seen as a kook or an antipsychiatry nut or a “Scientologist,” as if any of those are scientific analyses of his work. And such tactics are generally successful, and will be until the public catches on that the mainstream of psychiatry does NOT have our best interests at heart.
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David didn’t “reform” Goliath and convince him not to attack. He beat him physically and defeated him. Peer workers are a great option, but they need to understand that their efforts will be OPPOSED by the mainstream system, and that system must be DEFEATED in terms of losing its power before any peer “reforms” can become mainstream and the label-and-drug model dies a well-deserved death.
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Exactly!
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That’s why I recommend self-directed reality checking. The person him/herself has to decide if it’s real, and our efforts should focus on helping them evaluate the evidence rather than telling them what to think. I sometimes thing psychosis itself is a rebellion against being required to think a certain way. In any case, I never found telling people “what’s true” to be particularly helpful, though I did sometimes challenge them to ask themselves if their beliefs are “true” or opinions they held. Challenging thinking can be really good, but trying to substitute our thinking or society’s thinking for someone else’s own evaluation – probably not going to be helpful!
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Hey, that’s what ECT is all about – inducing seizures! Why could a spontaneous seizure not cause improvement? Of course, both cause brain damage, at least potentially, but if the docs are INDUCING seizures, I suppose brain damage is potentially therapeutic!
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I think the best response is, “What evidence do you have that makes you think the CIA is watching you?” Just saying someone’s wrong is rarely therapeutic in the least. But there are people who have expertise in this area whom you might want to consult.
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Nice!
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I LOVE the “Stop it!” skit! But you are right. The problem is opposing goals. The peer movement’s intentions were contrary to those of the main MH system, and so they had to be coopted or snuffed out. And the MH system was very effective in doing so. You can’t change the basic purpose of the MH system. It’s built in.
‘
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They were actually initially banned in Germany for these very reasons. It’s a very real problem.
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Sure thing!
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Again, I think you are playing fast and loose with the stats here. There is not a 30% complete remission with ADs. 30% beat out placebo by a significant margin. This does NOT suggest complete remission, in fact, a whole industry has developed around supplementary “AD” treatment for those with only “partial remission.” There is not a record of consistent benefit. 30% improving compared to placebo also means 70% do not. That’s a pretty crappy track record from any kind of treatment.
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It sounds like you’ve had a lot who are that way. No therapist should believe they know more than the patient about their own situation!
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POSTING AS MODERATOR:
Mark, you have not contacted me by email or responded to my emails. I’m not sure you even received them at this point. I will no longer be able to post your comments until you contact me and we can have a conversation. Again, my email is [email protected] or [email protected]. It’s also listed in the “About” section of your home screen. Meanwhile, all of your posts will simply stay as “pending” until I hear from you. I’m not sure what else to do to get a response from you.
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So you only find out if it “works” after the fact. There is no evaluation that can predict the outcome of ECT, and I believe you know this is true. “Evaluations” in the “mental health” world rarely produce anything concrete that could be counted on to relate to predicted results. 30% of SSRI recipients improve in the short term (at best). How do we know which 30% will improve? We have no clue whatsoever. And that is typical.
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Motivational Interviewing has a lot of useful techniques and is or should be very much client directed. The coach or “therapist” finds out what motivates the CLIENT from their own viewpoint and then helps examine which current behavior gets them closer to that goal FROM THE CLIENT’S POINT OF VIEW.
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How would one know in advance who fits into this “sliver?” And with the attendant risks of severe congnitive symptoms DEVELOPING as a result of ECT, even in people who had none to start with, how can this possibly be consistent with a “first, do no harm” approach to medicine? Sounds more like Las Vegas “medicine” to me – “Come on, baby, give me a 7, give me a 7…”
And no, “everyone” does not accept that ECT comes with “real cognitive risks,” based on my reading of the literature, in fact, the idea is denied or minimized chronically. Nor are patients almost ever informed of these cognitive risks even if the doctors do acknowledge them. You seem to have a very rosy view of how “informed consent” is handled in the “mental health” fields!
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Posting as Moderator:
Mark, I am giving you until the end of today to respond to my emails or give me a working email address. If this does not occur, I will be forced to remove your right to post here, as having a working email is part of the posting guidelines.
My email is [email protected] or [email protected]. Please contact me TODAY.
Thanks.
— Steve
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I think you mean the one I wrote to Mark about his email not functioning?
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Sorry, I don’t have the context here. What did I say? Most likely I was not referring to you, as I generally avoid referring to individuals and if I do so I make it quite clear. I don’t remember directing anything toward you recently. Can you remind me what I said?
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You do realize that many women are unable to establish positive sexual relationships as well, don’t you? I would love to see you address this issue as part of your presentation.
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Posting as moderator: MARK, PLEASE CHECK YOUR EMAIL. I have sent several messages. If you are unable/unwilling to respond to emails, you are not allowed to post at MIA. Please write me back so we can discuss your prior posts. It’s not OK to keep saying you are waiting for them to be posted when I’ve told you my concerns and you have failed to respond.
Please write me back or I will have to stop posting your comments. If that email doesn’t work, please get me one that does ASAP.
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Posting as moderator:
Your email does not seem to have worked, it bounced back as not existing. I need a functioning email to have continued posts be published. I edited this one and removed the parts violating our Guidelines, but I can’t continue to do that. Please get back to me with a functioning email – it is an official requirement to post at MIA.
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You are denying Kirsch’s reviews of the literature clearly showing an increase in suicidal thinking when taking SSRIs? I am also not aware of ANY review suggesting that suicide rates are reduced by SSRI or other antidepressants? Lithium is the only drug I know of that has evidence supporting this possibility, and that has more recently been called into doubt.
Your willingness to make claims unsupported by literature reviews makes it hard to take your comments as unbiased.
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They should not be “involved,” they should be the central architects of any such effort. Who knows better than those with “lived experience” what actually does and does not help???
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Any of these things can be helpful if practiced by someone who has the proper attitude and has dealt with his/her own issues. The big problem is that there is no way to measure therapeutic competence, nor any training that assures it will be developed. Having clients/users themselves decide what works for them seems like the best solution. Dubbing someone a “therapist” because they completed a certain set of courses or a supervised internship with another person who may or may not have those skills and attitudes is simply misleading.
I agree that simplifying and “common-izing” our helping approaches is the way to go.
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But that would require a level of honesty the industry does not appear willing to exercise.
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When advocating for foster youth for 20 years, I saw many who became aggressive on stimulants and were then re-diagnosed with “bipolar disorder” instead of stopping the stimulants. It was extremely common but very hard to get anyone to discuss seriously, even though a good number of the psychiatrists I worked with admitted it occurred.
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