Thursday, August 11, 2022

Comments by Phil Nolin

Showing 33 of 33 comments.

  • Freud, as I also understand him, did not work to make his patients “whole.” Psychoanalysis as practiced by Freud was a negative psychology, that is, it saw the analysand as injured and aimed only to help him overcome learned neurosis. Freud’s patients had more immediate problems than being unhappy or not feeling whole. They were crippled by inner turmoil.

    If a positive psychiatry seeks to put someone in touch with his creativity to better actualize his unique self, Freud’s interest — imo — was more focused on revealing the contradictions in the patient’s thinking and in revealing the paradoxes that prevented the analysand from functioning better in the world. It was this functional aspect that interested Freud most. Freud, of course, had ideas about the structure of society but his concern as a doctor was to help the patient function as painlessly as possible within that structure, such as it was.

    I don’t know enough about Buddhism to comment on its similarities with psychoanalysis. It is certainly much older than the latter and, like psychoanalysis, came to take on many forms these often contradicting what I understand to be Buddhism’s basic tenets as a secular belief system. Capitalism was also a later development and Yes Buddhism must certainly reject consumerism as a means to happiness.

    Interesting attempt by the authors to flesh out the similarities between Freud and Buddha.

  • Reading both the article and the comments again has impressed on me even more the problematic character of the medical model in psychiatry. Psychiatry, such as it is, is premised on certain assumptions. Yes it is materialist but at the same time it is the least empirical of the sciences. It gambles that the benefits will outweigh the costs. When these do not, it is the patient who pays the costs. Akathisia is the apotheosis of this philosophy. To suffer its depredations is to be acutely aware of the implications of the “medical model” for the object of its interest. And the onus is too often on the patient to prove the cost (in the case of akathisia it is often visible indeed palpable though not always).

    The fact that doctors speak in terms of costs and benefits is telling. It is only over time that these become evident. SSRIs, of course, are still routinely prescribed. When insurance companies refuse to pay for SSRIs because they are deemed inefficient, doctors will stop prescribing them so Yes the medical model has important economic aspects.

  • Where to start. I hesitate to give a medical opinion but will anyway. So what does the DSM in psychiatry serve? Having a psychiatric diagnosis can absolve someone of a bad conscience. In that regard it serves a patient’s interests (if he indeed regrets something). So Yes, as the authors note, some patients are comfortable with a DSM label. At the same time, a DSM label can be used against a patient. For instance, because the patient has been diagnosed as unstable and a potential threat, the courts can treat him as such though he has committed no crime. So a DSM label morally can cut both ways.

    Like crime has penalties and these are circumscribed by the State, having a psychiatric diagnosis means taking one’s medicine — this at the discretion of the courts for a patient who rejects his diagnosis.

    So where does the hospital end and the State begin? When does the caregiver become the prosecutor? I have seen doctors rush from one role to the other without literally giving one thought for the rights of the patient. (Instead of jail, patients are condemned to years of forcible injections and with this the problems that come with exposure to powerful neuroleptics, metabolic syndrome, etc.)

    An interesting article. It raises so many questions. When does the evaluative authority of a psychiatrist become invested in convincing the patient that his troubles conform to a DSM diagnosed delusional system and are not real. A victim of online harassment can currently be diagnosed as bipolar two with ‘ideas of reference.’ This is gaslighting. ADHD can also have many false positives.

    Hello DW. Glad you are back.

  • Re Freud, Marx anticipates Freud when he says in Capital that “fetishization” of commodities is central to capitalism. He doesn’t expound but there are perhaps two implications, that the commodity is like a totem or that its qualities are limited to a single aspect — its surplus value. Psychoanalysis insofar as it has a political component could if nothing else expound on this fetishistic quality of capitalist economics.

    Psychoanalysis doesn’t cause brain atrophy, metabolic syndrome, dyskinesia… This makes it preferable to much of the current “therapies.” If capitalism was a psychoanalytic patient — capitalism was on the couch so to speak — it would certainly do no harm. Of course, the implication would be that capitalism was sick and needed help. This would make many capitalists reluctant patients.

    Yes Cultural values and ideologies are part of the problem facing anyone attempting to extricate psychological from economic issues. But it is technology that changes and the user is changed by technology — this is evident in medicine. Technological change may account for how economic systems function in a more important way than psychological factors.

    Freud is largely treated as an anachronism. Perhaps it is better we see Freud as he is now seen warts and all. His ideas once prevailed, however. If you trained in the 1950s, you were a Freudian psychoanalyst. I have known a few and even read some of their papers. Some of the writing treats politics and only tangentially economics, though these two are inextricably mixed. The Oedipal conflict and the sons and father in Totem and Taboo were invoked in these writings. Concepts like “sublimation” appeared. Freudian theory provided a jargon with which otherwise nebulous ideas could be expressed. So Yes there is a method to its madness.

  • Attributing psychological causes to substance intoxication or brain bleeding due to a viral infection is a medical error. The refusal to consider intoxication or bleeding as possible causes, however, is gas-lighting. Gas-lighting is a pernicious and insidious form of bullying. Akithisia Alliance has documented the stories of people whose akathisia was wrongly attributed to psychological causes.

    I have had akathisia after being prescribed myriad drugs. I know what it feels like. It is a chemical imbalance and not an emotional disturbance. Thos who have suffered its agony know the difference. The common thread was that I was told that I was lying about the side effects (akathisia) of a drug I was compelled to take and that what I was suffering from was anxiety about some existential situation (I was psychoanalyzed) — this, of course, by the very same people that had compelled me to take the drug in question.

    I can only surmise from my own experience that this problem of gas-lighting is much more prevalent than people acknowledge. People with pre-existing “comorbid” conditions (an outstanding psychiatric diagnosis) are most susceptible to having the side effects induced by a substance attributed to psychological causes. It is if they are damaged goods. Their warranty has run out.

    MIA does a great service in publishing personal, that is, anecdotal, accounts of gas-lighting like that above. With the comments, these ‘stories’ receive corroboration. Perhaps this is where changing things begins.

  • It is interesting to note that we are only now learning that the latest pesticides ( cf. imidacloprid) are toxic not just for bees but for mammals too. Yet ALL agriculture is now based on this single kind of pesticide and we continue to use it indoors because there is no cost-effective alternative. The same FDA that approves drugs approved these pesticides. But what is the real toxicity of the pharmaceuticals we now also consume in the tons? Even if depression was indeed treatable with drugs, do we have the drugs to treat it safely and effectively? Is it not healthy to be a bit wary about these very powerful drugs that can induce such horrific side effects as akathisia and severe depression (and I speak from experience here)?

  • Thanks Steve for the feedback and link. Depression is a terrible thing. My depression in 1995 was induced. It was chemical. i will always remember the feeling. I had terrible akathisia. At the same time, there was a part of me that was able to observe what I was feeling from a distance. The mind body separation was a very real thing for me. I was not my physical sensations. Nor was I my emotions. These were tortured. All i felt was shame and regret. Yet another part of me knew these were a side effect.

    It was expected that the depression would pass and my body became accustomed to the drugs — neuroleptics and an anti-depressant (which ironically triggered a depression). It never did. I had to finally change medications. Other patients didn’t have that separation between what they were feeling and what they were thinking and succumbed to the effects of the depression.

    The doctor,Yves Dion, at least had the professional integrity to write an article warning of the possible side effects of the drug therapy that he had prescribed, this after he had refused to believe patients’ when they tried to report to him what they were feeling.

    “Depression and dysphoria in adults and adolescents with Tourette’s disorder treated with Risperidone,” Journal of Clinical Psychiatry; 2002, vol.63

  • I seem to remember when the distinction was between endogenous and exogenous depressions. The latter were indeed caused by a chemical imbalance while the former were the result of exterior forces. Have we now dropped these distinctions?

    In 1995, I was part of a sample of Tourette’s patients who, because we were so “predisposed,” developed a severe depressions after taking Risperdal and an antidepressant that were prescribed to reduce the severity of our tics. (15% of patients who were prescribed the drug regimen developed severe depression.)

    What I understood was that there was an endogenous component to our depression insofar as we were “predisposed.” My question is how does this jibe with the conclusions of the above article? To reiterate, the depression I suffered was chemically induced but not all patients under the drug regimen developed depression. Only those so predisposed supposedly got depressed (and this was very depressed, there were suicides among the 15% of patients predisposed). Are some people because of their genetics more likely to develop depression and how does this jibe with the chemical theory of depression if certain people are more likely to develop depression than others?

  • It is well worth reading Dr. Moncrieff’s article. Below is a bit of what I took away:

    ” [Michel] Foucault suggested that the medical framework was superimposed onto the [psychiatric] system in order to give it the legitimacy associated with science… [He] referred to psychiatry as a ‘moral enterprise overlaid by the myths of positivism.'”

    Psychiatry “presents itself as a technical activity that is immune to political considerations.”

    “The medical nature of psychiatric terminology and knowledge obscures the values and judgements that are embedded in its practical execution.”

    “It enables interventions that are designed to curb or control unwanted behaviour to be conceptualized as medical treatment intended to benefit the recipient rather than the people who are disturbed by the individual’s behaviour.”

    “Underpinning the previously described functions of the mental health system is the idea that the situations concerned are medical conditions … and thus absolve individuals of responsibility for their own behaviour,and justify the forcible modification of that behaviour by others.”

    “The language of mental health … can be thought of, therefore, as an ideology in the Marxist sense that those concepts help to obscure real underlying tensions or concepts, and render the population amenable to viewing them as relatively simple, technical problems that should be left to experts.”

  • Steve, I am always wary to assign people motives. Did Freud say explicitly what you claim? If so, where? I am very interested. It is a simple observation that all neurosis is not caused by sexual abuse, whatever its incidence.

    Freud’s patients came largely from a certain segment of Viennese society. What do we know about the incidence of abuse in that particular part of Vienna? (Horrifically, many of Freud’s patients perished in the Holocaust.) Are there patients who came forward with claims against Freud? I would be very interested in reading these claims. Freud’s understanding of women was limited by being a man but many brilliant women have contributed in important ways to his theories.

    What we do know is that Freud did get involved in covering up Jung’s sexual abuse of a patient and that is indeed criminal and well known. There is no controversy there. The record is clear. And Yes this occurs still today.

  • Bradford, Freud started out believing all neurosis was caused by sexual abuse. He later moderated this view. And Yes, with Wilhelm Fleiss Freud quite literally did much “damage” to a woman. You evidently have your ideas on Freud. Others have drawn different conclusions. Freud was quick to acknowledge his limitations as a man in understanding women. But as you say, Freudian theory has indeed been applied wrongly by people like Bruno Bettelheim and his treatment of autism. And Yes Freud’s 1905 book Three Theories of Sexuality does continue to influence much thought in psychiatry and elsewhere.

  • Bradford, thanks for your reply. As I said, Freud was flawed. That far we agree. And Yes my childhood experiences are anecdotal and not proof of anything. It is a fluke that I remember them at all. I doubt however that Freud was malicious in the manner you suggest.

    At a time when women had few prerogatives, Lou Andreas-Salome and Helene Deutsch were brilliant Freudian psychoanalysts. Their take on Freud is insightful and not dogmatic at all. I have read and re-read Lou Andreas-Salome. Deutsch’s work anticipated much of the feminist thought that would come in the ’60s. She was the director of a clinic in Vienna in the 1930s. Truly groundbreaking people and students of Freud.

  • Bradford, Thanks for commenting. I remember having an Oedipal complex as a boy only because my parents had a bad car accident. My sister and I were informed of this by telephone. My first reaction was to wish that my father, who I loved dearly,had died in the accident so that I could take his place in my mother’s affections. So Yes the ambivalence I felt was, as you say and Freud would agree, highly subjective.

    There is a David Kronenberg film about Freud and Jung. It is based on fact. Jung slept with his patients. This caused them great grief. Today he would lose his license to practice.

    As for Freud and cocaine, Freud regretted his dalliance with cocaine. He lost a close friend to cocaine addiction. So Yes he was also very human and fallible. He had though a gift for listening and is attributed with being the originator of the “talking cure.” So No he took the time to listen and wasn’t a pill pusher.

    Much more could be said about the questions you raise. If I remember right, the neuroscientist Norman Doidge has written about the physiological basis for some of Freud’s ideas. And the French are still taken with much of Freudian theory but Yes here in the U.S. he has fallen out of fashion.

  • Bradford, sorry about your friend. I didn’t know the meaning of gas-lighting until it was done to me. Incredibly, it was systemic and I encountered it everywhere. It took over my waking life. I was continually told that what I was living was not real and that I had imagined it all. Everyone from the orderlies to the doctors took part in this. You have to live it to believe it. I was completely isolated. I am only beginning to be able to talk about it now. Thank you for your comment. There is solace in knowing that you are not alone. Again, I am so sorry for your loss.

  • I’m afraid that Jung wrote antisemitic editorials when he was editor of the German language psychoanalytical journal — this at the height of nazi antisemitism — during the 1930s. he referred to Jews as “parasites” and made other such statements which don’t bear repeating. Hitler was a “shaman,” according to Jung, who embodied the Aryan unconscious and other such nonsense. Some of these writings have been translated into english. Of course, Jung has his apologists. Google “Jung and antisemitism.” You will find there is some debate about this. I have reached my own conclusions but it is a very uncomfortable question for Jungians, particularly Jewish Jungians.

    As for Freud, the Oedipal complex is very real. I had one. But Yes there is much debate about Freud’s theories. Karl Popper dismissed them all as unprovable…

  • Bias as you say or Confirmation bias is an unavoidable part of any hypothesis. In the example of people of a certain social standing, there is the added problem of assigning motives. Much of the soft sciences in this regard suffers from a form of omniscience that its authors impute to themselves. Here the solution is simple: avoid the arrogance that underpins confirmation bias and practice an agnostic humility

    Psychology started as an empirical science. Freud began as a neurologist. Jung’s early work was based on observations. he coined the terms extraversion and introversion. The 20th Century took a more theoretical turn. The apotheosis of this is seen in Jung’s writings in the Nazified German psychoanalytical journal.

    The dangers inherent in theory cannot be overstated. Perhaps, as the authors conclude, a more empirical psychology would avoid the bias inherent in theory. There is much to be learned without rushing to specious conclusions. We must acknowledge to what point what we know is only a collection of “discrete’ data.

    But then we are “rational” animals and what we do know began with an induction, a hunch… At one extreme is Karl Popper and the idea that all knowledge is contingent. At the other extreme are the many of the prevailing theories in psychology. Perhaps these are empirical insofar as they are results-based. The bigger question is what can we take pragmatically-speaking from clinical psychology that will inform the practice of psychology.

  • regsiteredforthissite, the “kindness” shown vulnerable people by psychiatrists that you speak of is of a very particular kind. Someone in need, someone who is vulnerable, can mistake the “interest” shown by a clinician as genuine, sincere, authentic. But it is often a ruse, a means to an end. It is only when you obtain your medical records and read a psychiatrist’s observations that you can fully appreciate the character of that interest.

    For someone who is isolated, the interest of a clinician in their thoughts on something, their feelings about something that compels and preoccupies them, can be welcome. It can even be felt as a kind of validation or vindication. This was once known in more innocent times as the “talking cure.” But now it is often just the prelude to the invocation of the evaluative authority of the clinician. What is said in the context of an assumedly private medical appointment becomes grounds in a court record — grounds for an invasive procedure and forced drugging.

    The transference a patient experiences in his relationship with a physician is very real. It is well known that stomach ailments can return after the patient no longer sees their gastroenterologist. An astute psychiatrist exploits this transference. The patient that does not understand the implications of this for him — the legal contingencies that devolve from this “therapeutic” relationship — labours under a delusion.

  • Antonia, I was able to listen to your podcast with Tara Bixby. You speak eloquently about the depredations of over-medicalizing psychiatric practices. As you say, doctors need to listen more to their patients and not dismiss outright their reports of adverse side effects. Medical gaslighting is a very real problem.

    I also learned from your podcast a few things about being a woman, things men can only learn by listening and feel wiser for it.

    On a technical note, your link above requires a more updated browser than my PC can download, which is unfortunate. My computer is an artefact of the past (like its owner).

    I laud your initiative to try and get more stories out there about the experiences of people with the panoply of medications that are so liberally prescribed today. Making these stories accessible on line would go a long way to ending the isolation many people feel. And of course inform people.

  • So good to read something positive and how difficulties have brought your family together. Anyone can be overwhelmed by circumstances. Being misunderstood and isolated can compound an already trying situation. The people around us can feel confused and overwhelmed too by seeing someone they care about at the end of their wits. But it can be a serious mistake to medicalize someone’s failure to surmount their difficulties. Yet that is what we too often do seeking a quick fix. This is what I took away from your story.

    Though I was diagnosed with psychosis, I never lost touch with reality. Reality just became too real and inescapable. That is to say that I know little about psychosis. I still struggle with coming to terms with what became for me more than I could cope with.

    I suspect that what was once called neurosis — self defeating behaviour and a failure to adapt — has now been given an entire spectrum of clinical labels, like schizo-affective and bipolar II. And that millions of the children that are medicated are, as you write, false positives. I am afraid that the cost and benefit of pharmaceutical treatment is not being represented as it is to parents. We need articles like yours to tell parents that there are no simple solutions. And Yes that listening and forbearance can be a medication in themselves.

    I learned much from your story. About being a mother and that life continues after a diagnosis. I always cry when i read about family members caring for each other. And I cried when I read your story.

  • Thank you everyone for the comments. Much time and thought has been put into your comments. I don’t know where to start.

    There is always a possibility of “solidarity” among psychiatric survivors. Evidently, from what you write this possibility has limits. Nonetheless it exists. The common cause you have found in your comments is a case in point.

    As to the comments on pharmacotherapy, I am told by doctors that my bipolar II causes me to be an imposition on others. The cure for this, they tell me, is more neuroleptics. And of course the solution to world peace, for these doctors, it would seem to me, is also neuroleptics.

    It is well known that psychoactive drugs are overprescribed and that diagnoses are so broad today that almost anyone can be diagnosed with suffering from some form of mental illness. But what are the prolonged effects of all these drugs? At the best they cause metabolic syndrome. At the worst, people can endure years of akathisia and other substance induced horrors.

    The cost and benefit of pharmacological treatment is often decided not by the individual but by the courts. We are told that the evidence must be overwhelming to compel a court order for forcible injection but often such rulings are based on little more than opinion. The defendant has broken no law. There are no victims. It is his “potential” that is in litigation. It is as if you find yourself before a parole board but have committed no crime. If psychiatry is evidence based, there is little to support the contention that such hearings protect anyone. And the costs to those who bear the brunt of such judicial discretion can be incalculable.

    All the comments — even with their differences — suggest to me a kind of solidarity and give me the hope that psychiatric survivors can find a sympathetic ear. I have found that in your comments and it is appreciated.

    My earlier replies were incomplete insofar as I did not say that it is possible obviously to file a complaint against a physician with his deontological society. That is one more route that is open to psychiatric survivors.

  • Steve, Yes I have seen doctors’ evaluations that speak explicitly about “control” and who controlled the evaluation. Psychiatry also shares much with the soft sciences. The personal philosophy of a physician often figures in a diagnosis. And then there is the collegial aspect where doctors are afraid to criticize a colleague. If they do, it can have legal and personal implications. A wrong diagnosis can be actionable. So there is also a question of money …

  • Joanna, it is extremely unfortunate that many rights exist only on paper. There are no consequences for their violation.
    In Quebec, Protecteur du citoyen is responsible for complaints against public entities like the ombudsman. When they close your file, that leaves only the courts. A consultation with a lawyer is several hundred dollars…

  • Bradford, there is always a danger of false positives — of being diagnosed with a disorder you don’t have. In court, a dr. needs the opinion of a second doctor to have a patient’s institutionalization prolonged. In my experience, these assessments are pro forma. You meet a dr., say a few words and he supports your treating doctor’s diagnosis based on a five minute evaluation. If the patient was reticent to talk or wary of doctors (after being involuntarily confined and drugged!),then he is “paranoid and delusional.” This has more to do with making a brief against the patient than caring for the patient as someone who may or may not require medical care…

  • Steve, it’s a Catch 22 — you are crazy if you don’t and crazy if you do. After I was poisoned with EPS and severe akathisia I became even warier of psychiatrists. This only further confirmed my diagnosis as paranoid.

  • Joanna, thanks for your comment. It was only after I was discharged that I finally talked to the ombudsman in any important way. All I could do was file a complaint against her with the State, her employer. As an inpatient, I did have a right to a lawyer. After four or five, paid by legal aid, I found one who took the time to know my file,which was admittedly a quite complex one. There are other resources for patient’s rights but most don’t deal with psychiatric patients. And many people on the outside don’t know and wouldn’t believe anyway what happens in a psychiatric ward if you told them. We need to get the message out. MIA does important work…

  • Thanks for the feedback. People do change. People who suffer from compulsions or impulse control do sometimes benefit from b. mod. Delusions are reputably less susceptible to modification…

  • Joshua,

    What I would want to change is the system of recourse for inpatients. I wrote to the Ombudsman after my experiences in the observation room. They refused to intervene. There are very limited recourses for an inpatient.

  • Joshua,

    I do not want to necessarily eradicate the mental health system.That would be a serious overstatement. As a young man I benefitted, particularly from the year I spent in group therapy at the Reddy Memorial, a Montreal hospital that no longer exists. I was helped by the psychiatrists, psychologists and nurses that worked there. I continue to benefit from what I learned there and certainly would not want such institutions to be “eradicated.”

  • Thanks for the comment. I am not sure what you mean by “eradiate the mental health system.” Perhaps it is a typo. If you meant eradicate, I agree but where to start? By contesting one’s diagnosis and hospitalization? Through the courts and the complaint system?