Wednesday, November 20, 2019

Comments by Pablo Calderon

Showing 13 of 13 comments.

  • Sorry to bother you on this, Connor, but what is the distinction between, let’s say, seeking damages for being disabled in a car accident caused by a manufacturing defect (which is pretty common), and the plaintiffs here, that seek damages for disability caused by ECT injury? I’m just trying to understand why this complaint is “rare.”

  • Thanks Connor. I guess that in general the remedy sought is damages for economic injury that in turn was caused by physical injury. Here the plaintiffs aren’t seeking damages? The only remedy sought is that the defendants cease producing? Then what is the plaintiffs’ standing?

  • I have two questions. You say “this case presents the *rare* situation…” (Emphasis added) Aren’t many class action suits about personal physical injury? What makes this case rare? You also say “the proper way to proceed is as a bifurcated class action”. What is a bifurcated class action?

    Thanks.

  • It’s generally straightforward to define the boundaries of medicine. When there is a blood or imaging test, or a biopsy that distinguishes “normal” from not normal, then that pertains to medicine. If a specific technique is required to affect a certifiably physiological condition, like highly toxic drugs for cancer, that pertains to medicine. If the state of consciousness needs to be altered to facilitate a physical intervention, like anesthesia for surgery, that pertains to medicine. The boundaries are less clear when using anesthetics like morphine to manage acute physical pain or tranquilizers like haldol to manage a mental crisis. The short term benefits are as clear as the long term harm. Where to draw the line?

    An over-simplistic way to abolish psychiatry is just to eliminate the license. Let psychiatrists switch to either neurology or anesthesiology, or both, and become “real” doctors. OK, I don’t believe that’s going to happen anytime soon, no matter how successful the abolitionists are. But just because a concept is not realistic, doesn’t mean it’s not valuable. As Eric points out the abolition of slavery did not eliminate racial discrimination, and the Civil Rights Act did not eliminate the ethnic component of social injustice. Those landmarks, however, did fundamentally improve the situation of the oppressed. The underlying forces that changes society for the better are always those same immutable principles, that all humans have equal rights and that injustice in all its institutionalized forms must be eliminated. I believe the abolitionism Bonnie is talking about falls in that category.

  • Hi Monica, thank you for this post. Like the many of things you write about, I find them very relevant. I, too, was “damn lucky” to find a psychiatrist who helped us. She is one in twenty, heck, one in a hundred! Fifteen years ago she would have been one in a thousand. She not only prescribed the taper but helped us talk about the whole experience, what lead to the drugs and what the drugs did. Her support was critical for us to gain the confidence we were on the right track. We also benefited immensely from all that is recently available, like the arrival of the Hearing Voices Network here in the US; the easily accessible exchange of critical ideas like at Mad in America; and the blogs of the real experts — people with experience, like you. We were even luckier than you because we learned from your writing and others’.

    However, talking to the psychiatrists who preceded the last one, would be like talking to the rapist, had a daughter of mine been raped. The only way I’d want to see them is as defendants in criminal court.

    I’ve thought about talking to three psychologists who encouraged me to embrace the psycho-pharmacologists (two of them are professors at an Ivy League school). I’m not ready yet, though. How could a psychologist ever do that? What am I missing?

  • Sandy, Thank you for your comments.

    I am trying to synthesize your train of thought in this post. Here’s what I come up with:
    1. Some of the behaviors/mental states modern psychiatry addresses sometimes have physiological causes.
    2. In many circumstances physiology fails both as an explanatory theory of, and as a therapeutic approach to, such behaviors/mental states.
    There is no controversy on the first point, it is a fact that psychiatrists and anti-psychiatrists can agree on. Should persons displaying DSM behaviors be routinely screened for infections and endocrine disturbances? Sure. Should there be a separate medical branch that specializes in analyzing lab tests for possible mental ramifications and then refer patients to other pertinent specialists to address root causes? Why not? That branch might be appropriately called psychiatry. I don’t know of any UTI deniers and if there are, they’re really fringe (I find Jill’s 35% very hard to believe though).

    Regarding the second point I don’t think any commenter on MIA will argue that you are wrong. However, I sense many of the comments have a disapproving undertone – including my own – even if we agree with you on the fact. Szasz defined the medical model paradigm as a construct whose ultimate goal is not to improve the human condition but rather to serve as an amoral instrument of social control. To the many readers of MIA who have been profoundly abused by the psychiatric system, there is an extermination campaign going on out there. A statement like “People are very confused about what psychiatry is” can easily taken as not only condescending but offensive. Sandy, I know it is not your intention to offend and I truly respect your honesty and don’t doubt for a second your value as a practitioner. But what you describe in this post is a highly utopian image of psychiatry which is beyond reproach, and like all utopians, you seem oblivious to the reality of the ideological war in our midst.

  • Fair enough, you reserve the word psychiatry for the study of the physiological causes of DSM phenomena. A branch of medicine. But if the goal is to understand the causes of DSM phenomena broadly – and it certainly is – then we all agree that medicine is sorely inadequate. We agree that medicine is a very narrow portion of what mental “health” services should be about. For every case of urinary tract infection there are ten, or fifty, cases of childhood sexual abuse. That is why the HVN is spreading like wildfire. And it explains the success of Open Dialogue, if you wish.

    If not psychiatry, what word should we use to designate the study of DSM behaviors?

    I don’t think it was a coincidence at all that Freud started out as a neurologist. Kraepelin’s idea – to systematically classify and to search for medical cures to psychic conditions – was foundational and fit perfectly well with the mission of medicine. At that time I don’t think there existed a distinction between psychiatry and neurology. And psychology didn’t exist as a “therapeutic” discipline. Freud was neurologist who set out and pursued the goal of his profession: to cure “nervous disorders” which were thought to be physiological in nature. That’s where he diverged from medicine.

    BTW, I hate the word “therapy” or “therapeutic”, because it presumes the existence of a disease. I think “conflict resolution” is a lot closer to reality. Just like from a social perspective, war is not considered an “illness” for all its destruction and misery, but, on the contrary, natural to the human condition, so it is with the mind when it is at war with itself.

  • As far as I can see, current practice and formation makes psychiatrists more qualified to be absorbed by anesthesiology than by neurology. The worry that modern psychiatry will become merely applied psychopharmacology is moot – as a branch of medicine it has never been anything else. Current psychiatry – as is overwhelming practiced either in the hospital setting or in private practice – is to ask a few questions and then to prescribe a tranquilizer – major or minor -, a mood stabilizer, an anti-depressant. Whatever is needed to achieve a desirable type/level of numbness. It is undeniable that calming extreme or even moderate agitation can be beneficial. As is the administration of analgesics in the case of physical pain. However the fundamental fact is that the chemicals that psychiatrists prescribe do not cure; just like morphine doesn’t cure anything. At the very least, an honest scientific assessment can’t prove the contrary. That, in fact, is what the core of psychopharmacology and of anesthesiology have in common. I don’t see any real contribution of psychopharmacology to the scientific basis of neurology – the reverse seems to be true for the use of anti-convulsants. If anybody can enlighten me on the subject, please do.

    Sandy, I disagree with your description of psychoanalysis as a detour in the history psychiatry. The disagreement probably stems from different definitions of psychiatry. If psychiatry is to denote the study of the physiological causes of disorders, as classified by the DSM, then you’re right, psychoanalysis contributes nothing to psychiatry. But if psychiatry is the discipline of understanding the phenomena so thoroughly enumerated in the DSM, then Freud was, with Kraepelin, one of the founding fathers. In my opinion, though Freud and Kraepelin had extremely primitive conceptualizations, they laid down the two basic ways of understanding variations of the psyche. Psychosis can be caused equally by syphilis or by trauma. Same symptom, radically different causes. Freud was the first to promote the insight that extreme mental states can be the result of a normally functioning mind. The validity – or lack – of his explanatory theories is secondary, it is the psychological approach which matters.

    What I consider a “detour” in psychiatry is the evolution of the current ideology espoused by the American Psychiatric Association, NAMI, the pharmaceutical industry, or even the NIMH; what is called bio-psychiatry. Even though science has made enormous progress in understanding some basic biochemical processes of the nervous system, the relation to DSM phenomena continues to be pure speculation. How much longer should we sustain faith and commit so many resources to a project that has so little to show. A project which has been the ideological basis for such disastrous and massive harm to society?

  • Robert,
    As many readers of MIA will agree, psychiatry never was and never will be an authentic branch of medicine or science. The future of the guild with respect to medicine is to be subsumed into either neurology or anesthesiology. From that position medicine can “become the profession that provides a critical view of psychiatric drugs”, as you say. In the future they will be called psychotropic – not psychiatric – drugs.

    There is another fundamental role that the guild has, which is important in relation to its future and which you don’t address in this interview. That role is to sanction and control socially “unacceptable” behavior. The mechanism society has to sanction illegal behavior is the law enforcement/judicial/penal system. Psychiatry catches everything else society needs to control but is not codified in law. Psychiatry is in the extraordinary position to wield the power of law without being subject to its constraints. The whole of society is responsible of empowering the psychiatric guild in its unique position of power under the guise of medical moral authority.

    I think most have faith in capacity of the human race to have much more humane ways – so to speak – to deal with the outliers of behavior and of respecting the fundamental rights of those who display them. As the WHO suggest to me, the “less developed” societies may be actually much more advanced in this regard. Maybe it’s because of the more stable and closely knit family and community environments that the institutions of developed societies cannot replace. Maybe the future lies in our “advanced” society catching up with the backward ones when it comes to community based solutions. Only when alternative ways reach a large enough scale can the role of the psychiatric guild as enforcer of social order disappear.

  • I agree Jonathan. The drug companies can do all the research and come up with all the new chemicals they want, but the clinical trials must absolutely be at arms length. The trials should be managed either by the government itself or by non-profit institutions with absolute transparency and subject to regulation or government supervision. And how would the trials be funded? Well, by a special tax/charge to the drug companies, of course.

    I can already see the initial reaction of horror to such idea by the libertarian crowd. But if you think about it a little, it’s not as radical a solution as it might appear. The drug companies would still have patent protection which enables them to monopolize their intellectual property and which incentivizes them to innovate. They would still control research/development, production and distribution, i.e. everything except the power to judge the safety of their own products.

    The current drug approval system is broken. The drug companies control the trials, cherry pick the ones the FDA can consider and hide any evidence against their product. I can think of plenty of good analogies to the current drug approval process. For example, companies could certify their own financial audits. The cop that makes an arrest could also be the judge at trial. The food safety inspector could be an employee of the meat packer. The list can go on and on with hypothetical situations like the all too real drug approval process and which the libertarian and the socialist would equally condemn.

    Letting the drug companies determine which trials can be considered for approval and hiding the rest is tantamount to letting their auditors only see and certify one side of their accounting ledger. Now, analogies with the financial system can be tricky, because, as the world has recently experienced, fraud is capable of jeopardizing the whole system. One can argue, however, that most legislators honestly try to make financial fraud illegal. Unfortunately, with regards to the pharmaceutical industry, they have no problems with a fraudulent drug approval process which is perfectly legal.

    The YODA project is a step in the right direction. It may even be an important step. But it will only be relevant if it ultimately contributes to a major shift in the balance between the interest of drug company shareholders and the broader public interest.

  • Hi Ted, I think it is important to stress, like you and cannotsay do, that the movement, though political, draws people from both ends of the spectrum, like all human rights causes should. I myself am “pretty far left” like you (except that I clarify to my foreign friends and relatives that it makes me center right in any other country.) I didn’t think I’d ever agree with the right wing of the US Supreme Court until I came across Indiana v. Edwards (2008). Edwards had been diagnosed schizophrenic and after being “treated” was found to be fit to stand trial but the court would not let him represent himself. On appeal Indiana Supreme Court determined Edwards had the right to forgo appointed counsel but the US Supreme Court didn’t agree. Scalia wrote the dissenting opinion and Thomas joined him. For me, the crux of Scalia’s argument is:

    “there is … little doubt that the loss of ‘dignity’ the right [of self-representation] is designed to prevent is not the defendant’s making a fool of himself by presenting an amateurish or even incoherent defense. Rather, the dignity at issue is the supreme human dignity of being master of one’s fate rather than a ward of the State—the dignity of individual choice.”

    The fact that Mr Edwards was drugged – I presume forcibly – to get him to be “competent to stand trail” is not at issue here. I paraphrase Scalia by saying that society’s perception of being “incoherent” does not trump the fundamental human dignity of “being master of one’s fate”. It is no leap to maintain that no DSM diagnosis trumps the fundamental right to refuse treatment. This is what Tina wants. I’m not so sure what side Scalia would take if or when Donaldson is challenged. Or what the side the liberal wing would take…