As I said above, Gina, the article is about social media hashtags and public discussions of these issues–which is not the issue you want to focus on, but that set of issues would be another article altogether.
However, I’ll try to outline this a little more here, because I agree it’s important!
As that study suggests, it’s reasonable to conclude that the absolute rock-bottom number is one million people per year getting formally detained. Only a small percentage seem to be repeat hospitalizations. So… Where does that alone take us over years and decades?
Then, by way of another example: Cohen and Lee didn’t get numbers for Maryland, but I did. Maryland was in the middle of a big political and public campaign at the time to expand forced treatment. Cutting a long story short, the “official” civil commitment detention numbers, as I went back and forth with govt agencies over the course of several weeks and then months and finally a year, went from less than 100 people to 4,000 people to over 8,000 people per year. That’s the kind of spectrum we’re dealing with in lots of states, once one starts really digging. And it’s also very indicative of the kind of nonsense coming out from governments and pro-force advocates when they say — almost always without any numbers at all — that we need to forcibly hospitalize “more” people.
I just wrote an entire book which is in many ways a prolonged effort to grapple with the complete absence of any national numbers or any decent tracking of who is being detained, for how long, and why, and what’s happening to these people. My findings may still not satisfy you. But yes, when I added up, from many different studies and reports, how many Americans over the course of decades would have apparently at some point or other been formally psychiatrically detained, detained without any formal record of their detention (as was happening in Maryland for many years), subjected to coercion or threats while engaging with “voluntary” mental health services, forced into psychiatric evaluations in their workplaces, “voluntarily” drugged while under a guardianship, etc etc, I ultimately have no doubt when estimating that it’s millions of people.
I’m sorry I did not clarify this a little better in the article. Lee and Cohen’s numbers are basically good-ish, and would appear to be the absolute low end for the number of people detained annually alone. In my book — coming out in three weeks — I examine other sources and numbers, and also describe other ways of understanding what’s happening in Cohen’s numbers and across mental health care and society based on other social-circumstantial evidence we can gather. But yes, admittedly, “most reliable data available” is, to some degree, as you’ll see if you read the book, literally just that — something between reliable and not so reliable, but the best we can do given a widespread lack of hard data (and yeah, I searched!).
The above was an article specifically about hashtags and social media. The issue of lobbying is very important, too, though, and I do examine it in my book. And specifically lobbying for governments to better collect and share the data — yes, absolutely needed! I also TRIED that in my way for my book, and you can read what happened…
Thoroughly enjoy your writing as always, Phil — for me it’s often like some sort of intellectual-satirical-political dark comedy! 🙂
And can anyone please tell me how Pies has managed to miss the fact that, still today, he’s one of a very tiny percentage of psychiatrists who actively and publicly renounce the biochemical imbalance theory??!!
On the particular issue being raised in these comments right here, though, I want to say, perhaps some confusion/disagreement is arising for good reason. Because, I think it’s important to note, mainstream medicine is actually becoming increasingly like bad psychiatry and not vice versa. Witness the themes of the “Selling Sickness” conferences etc, where profound questions are raised about “the cholesterol hypothesis” and statin drugs, and about over-screening, over-diagnosing, and over-treating of nebulously defined “hypertension” and “gastrointestinal disorders” etc etc. And these are some of the most common diagnoses and top-selling drugs today.
So I think it’s becoming increasingly unclear in our culture what “real” medicine actually is or involves, and more and more difficult to use the idea as a self-evident counterpoint to the excesses of psychiatry.
“Using 31 exclusion criteria, matching factors, and covariates, the researchers formed a matched control cohort of non–AP users. They compared 180-day mortality of AP users with that of nonusers, from which hazard ratios were calculated. There were 7877 matched pairs.”
“Whether the analysis was done by intention to treat or by exposure to drug, the patterns were largely the same. Adjustments were made for measurable confounders related to PD severity and comorbidities.”
“The researchers found similar results when they excluded patients who died within the first 2 weeks or 4 weeks of AP exposure to eliminate patients who were at imminent risk for death when therapy was initiated.”
“Dr Okun noted that the increased mortality with AP use in patients with PD psychosis parallels findings of their use in non-PD patients with psychosis.”
Mr. Smith: The critical study did not suggest that the information was nowhere available in the original studies to determine the correct numbers; indeed, the presence of the correct information is what allowed them to do their own supplementary analysis. However, the authors noted that, in the original studies, the suicidal events placebo-to-drug comparison for the entire duration of the trial was never directly and clearly presented alongside relevant analyses as to its overall significance.
Generally from what I have seen in the literature on suicide, researchers interchangeably use terms like suicidal behavior, suicidal ideation, suicidal feelings, and suicidal thoughts. They do however usually distinguish between thoughts and feelings related to suicide, and actual concrete plans — but that is not relevant to this study.
The actual question in this study was “Have you ever been willing to die during the past year?” Response options for this question were “yes” and “no.” So to me that seems ambiguous about whether a person would be responding based on thoughts or feelings, plans or general emotions, despair or philosophical open-mindedness etc… A criticism of the study’s conclusions might be that answers to this question would not necessarily truly reflect “suicidal” thoughts or feelings. My interpretation was that, in the context of the kind of questionnaire that was being administered, the intent of the question to get at suicidal or despairing feelings was probably clear to the interviewees.
On a more general note, Merriam Webster has a long list of definitions for “feeling” which includes, “appreciative or responsive awareness or recognition”, “often unreasoned opinion or belief”, “the character ascribed to something”… http://www.merriam-webster.com/dictionary/feeling
I personally do not agree with — or do not understand — your attempt to distinguish between a feeling and a thought in this context. I would say that people do ‘feel’ the process of ‘thinking’ about a plan to do something, and conversely have ‘thoughts’ with feeling dimensions to them. To the point that I think/feel it is sometimes very difficult to distinguish between the two, particularly when the thought or feeling is intense or emotionally charged, like “I want to die right now.”
I’m not sure how the Szasz excerpt relates to these questions, although I always appreciate a deeper analysis of the complexity of what it really means to be suicidal, and why our culture has such a widespread, strong resistance or fear in relation to it.
Looks like you’re right. Du-oh! I wasn’t on the job back then. I also didn’t realize that different journals will sometimes run the same study in this way. Thanks for pointing it out. I added a note about it to the post. Though I guess it can’t hurt — I expect some people out there in the world missed it on the first go-around… 🙂
Rob
Thanks for saying so, Sa. And that reminds me of another way of saying what I mean. I didn’t mean to suggest above that my job is to be “Mr. Negative About Everything” just for the sake of it. There is, in my mind, a “positive” aspect to what I’m doing. My work with In the News is not to “take a side” and promote a particular agenda or particular approaches; rather I am choosing what I post in In the News largely based on whether I think it might contribute in some way to encouraging self-questioning and independent critical thinking about the mental health system, ourselves, our social world, our approaches to life, and what it is to be human and to experience all that is.
If you see really good studies about CBT as they appear — or indeed about anything else related to MIA’s mission — feel free to forward them to me.
You sort of cherry picked my posts by focusing only on CBT, though. MIA’s mandate is “rethinking” the mental health system, and I actually tend to focus a lot on studies in ALL areas of “mental health” that provide critiques, because of this mandate and because I often find many of the studies that end up promoting specific treatments in virtually all areas to be weak and/or too-obviously biased in comparison. Indeed, that’s what most of the meta-analyses that I have seen and that I do often post have been finding, too. Generally, if you look at the (relatively much smaller number of) “positive” studies about anything that I’ve posted, I think you’d find that most of them weren’t necessarily stellar studies, either, but indicated something I thought was somewhat ‘interesting’ and worthy of thought or discussion and possibly relatively innocuous (like studies into the benefits of moderate exercise and good nutrition). But even those I post sparingly. I think the issue you’re seeing here is that in the year I’ve been doing this I haven’t often seen really good studies demonstrating really strong “efficacy” of pretty well anything — have you? Again, if you do, please forward as you see them appear. But if I have a “bias,” I’d describe it myself as a combination of genuine journalistic interest and strong investigative skepticism in relation to just about everything.
And I will add a couple of thoughts to Robert Whitaker’s responses. I thought this study was important to cover because of the sheer brashness of the authors’ assertions in contrast to the somewhat disguised weaknesses of their methods and findings, and because it appeared in one of the world’s leading mainstream psychiatric journals, and because it is getting substantial coverage in other outlets as if there are no weaknesses. After we removed the somewhat mocking headline, I could have revised the opening or the headline to at least still have more of a hint of the qualifying sections at the end — which is normally what I try to do with these kinds of news stories. Because of course you’re right to suggest that some regular readers of MIA and certainly many in the general public might not be so quick to question the brash assertions of this study. On that count, I would say that I am guilty of assuming that most regular MIA readers would in any case suspect something questionable right away and read on to find out what was really going on with this study, and I was forgetful about “reminding” them and more general readers to be sure to do that.
That said, I also think statements like “the authors did note that their measurements may not have actually reflected serotonin levels in people’s brains” and “the authors stated that any potential ‘causal’ relationships between serotonin and anxiety were not actually examined and were a matter about which they could only ‘speculate'” seem to me to be pretty clear clarifications of the ridiculousness and attempted manipulation in what’s going on here. I don’t know if I want to start writing scientific summaries based on the assumption that readers will reach strong, potentially life-altering conclusions without even reading past the headline or without reading the entirety of the summaries — the problems with that kind of reading cannot be solved or eliminated by any sort of writing.
Rob
p.s. and in this context i thought the sheer meaninglessness of those accompanying images to the average human eye was funny.
Hi bpdtransformation, I’m responding here to your comment dated June 13, 2015 at 1:38 pm.
I find it easy to come up with different, better ways of describing the varieties of human experience. But the challenge with respect to In the News and Around the Web is different. Suppose I see a study where researchers state in their conclusions something like “the evidence shows that the mentally ill are more dangerous than the average person.” I could ignore this study entirely. Or, I could decide that I think MIA readers might want to know that this study was done, how it was done, and what it actually found. If I report it, I can remove the offensive term “the mentally ill” and paraphrase the wording to “the researchers concluded that people with mental illnesses tend to be more dangerous than the average person”, or “the researchers concluded that people diagnosed with mental disorders are ‘more dangerous’ than the average person.” I do this a lot in my MIA posts. I can also seek out and highlight details about the study that I think may help people better understand it or see it in a critical light — and I try to do that as much as I’m reasonably able to, especially if I think it’s a particularly questionable or inflammatory study. To some people, though, understandably, my use of those terms is still hurtful. However, I cannot write, “the researchers concluded that people undergoing emotional distress or experiences that some might term as psychotic more often do things that seem harmful to others, depending on the standard you use for evaluating violent acts in a fundamentally oppressive social context.” At that point, it is no longer responsible or accurate reporting. That is not how the researchers themselves used the terms in their study, that’s not what they found or said, and that’s not what they concluded; not even close. So, unfortunately, to accurately report on many studies or articles, I sometimes have to reproduce language and concepts that I know may be especially hurtful to some people.
I’m not sure what your main point for me is. Are you suggesting that “In the News” and “Around the Web”, as features on MIA, are causing more harm than good and should be stopped? If so, you may be right. I do worry and wonder about it every day.
Hi again, Isis — due to the limit on numbers of ‘nested replies’, I am replying here to your comment June 12, 2015 at 4:51 pm.
You write: “Many of us are seeking a safe space online that is free from pathologising language and stigmatised identities.” and “It begs the question of whether resources for user/refuser/survivors can ever successfully be curated and managed by by those with no lived experience of the issues involved.”
Those are and would be great things, and I encourage you or others to try to build them. But those are not what MIA is. MIA includes board members and bloggers who have had such experiences, but on the whole it is a platform for news, opinions and discussions for and among many diverse people who share an interest in “rethinking psychiatric care.” http://www.madinamerica.com/about-us/
And while I know that psychiatric labels can be very harmful, it is simply not possible to briefly summarize news and research about “mental illness” without frequently reiterating the dominant terms such as “mental illness” that are being used in that news and research. At least, I have yet to come up with many reliably effective ways to do it. I am always open to new suggestions. In the meantime, I just hope that, on the whole, for people who visit our site regularly, the items I post contribute towards helping keep people somewhat critically informed about what is going on in the field of “mental health” and also create a space wherein everyone feels that the dominant terms and ideas of “mental health” can be challenged.
I can’t speak to what someone else may have said to you. But as I said above, I do understand the “problematic” issue at play in this and it concerns me, too. However, it’s important to be clear about something: I have been managing “In the News” and “Around the Web” for the past year or so, and the whole main point and thrust of these two features of MIA is precisely to simply summarize or highlight aspects of what other people, researchers, or media are saying, more or less in their own words. MIA’s Blogs are where authors are free to opine about what other people are saying.
Incidentally, I chose to post a summary of the above study, notwithstanding my own personal lack of confidence in the scientific validity of the diagnosis, because I thought it was important how the study highlighted that most psychiatrists do not follow even their own best-practice guidelines.
I think you’re raising an accurate concern here. I changed the headline in response to your comment, from “professional” to “clinician.” The original source I link to you’ll see uses both terms, but overall I think they, and the source they were using, meant to refer to a specific subgroup of mental health professionals. That said, a more detailed analysis could end up sharpening the specificity even further — I certainly know many psychotherapists in private practice who don’t earn anywhere near that amount.
Thanks for raising the issue.
And btw, I do certainly try to check and vet everything I post in Around the Web and In the News at least to some degree, but with time constraints in part I am also simply linking and briefly summarizing things I think may be worthy of reading and further analysis — not always posting things I think are “accurate”. In fact, the majority of what I post here I think can still stand a critical analysis to parse out what’s truly important from what’s bordering on nonsense. So ultimately, no one should read my posts or MIA any less critically than anything else on the web or in the media. And in part we’re creating a ‘community’ at MIA so that we can help each other sharpen our critical approaches on all of these issues. So thanks for the feedback!
You rightly identify a question and challenge I face every day, with the vast majority of articles. In response to this challenge, I attempt to do the best job I can in fairly representing some aspect(s) of what the original study or article actually said, while trying not to imply or suggest that I or Mad in America necessarily “support” or “endorse” questionable language or underlying assumptions and beliefs that might be at work in the source material. If, conversely, I were to always function as a personal “filter” on such material, every In the News and Around the Web post would become long investigative journalism articles or personal opinion pieces or creative satirical renditions (and I like your suggested headline by the way), rather than what they currently are, which is mainly simply short news bites flagging stories that I think might be of interest to MIA readers for any of various reasons.
Just so you know, as author of the In the News items for the past year, I can confirm that your observation has validity. That is, for the In the News posts, I do my best to fairly and accurately present in summary form what I see in an article — but not the entirety of the article (which is next to impossible to do usually), and not always do I do it in a “mindless” fashion. That is to say, the part or parts that I select for summary presentation are not always the same as what the original article highlights. Sometimes, for example, I skip the press release and the abstract, and quote directly from a study, because they are saying different things and I will choose what I think is most important or may be most of interest to our readers.
In this case, it seemed to me that both the articles I was quoting had included very pertinent information which they chose not to highlight and instead to re-interpret; I chose to highlight it. As you correctly observed, they “implied” certain things for which they had no evidence, and in this case I stated simply what the evidence currently shows. Links to the original sources are always included so anyone can quickly see the entire context for themselves.
Scott Alexander: Your post is extremely long and covers a lot; I do not claim in my post to be providing a complete summary of every issue and point. I also encourage people to read it themselves, which is why I posted a link to it.
Yes, you’re right, many psychiatrists, media, pharmaceutical companies and others promoting the serotonin deficiency theory of depression have often included generalized, softening “qualifiers” and “equivocations” such as the ones you quoted, even as they have also made those very bold, unequivocal claims explicitly intended to persuade that I quoted. Taken in full context, then how are such qualifiers different than brash infomercials on television with legal disclaimers like, “not all results will be the same for all people”?
I know of no one (certainly not me) who has ever said that there were never any studies making tenuous, feeble attempts to draw links between serotonin levels and depression in different ways — there were hundreds, I believe (I haven’t counted) as the psychiatric community and pharmaceutical industry made enormous efforts to try to prove the theory or buttress its apparent validity in the public eye. And as I note, those are still being produced today. What critics have often correctly pointed out, however, is that the main, strongest argument that psychiatrists have often used in support of the low-serotonin theory has always been that SSRIs allegedly boost serotonin levels. Of course, most of the public has never known that SSRIs have barely beaten placebos in clinical trials, so they’ve not been able to understand the true spuriousness of even that argument.
I notice that your argument has now changed to “far fewer people” and “less important” psychiatrists made such claims, rather than none at all made such claims. Very well; apparently we would now only potentially disagree on subjective notions such as how many is “fewer” and how unimportant is “less important”, rather than disagreeing on the main issue at hand. And then Leo and Lacasse’s question becomes all the more significant: Where is the evidence that the “important” psychiatrists were vigorously trying to correct the public record and clarifying that these were only weak hypotheses with no compelling evidence to support them instead of weighty theories with ever mounting evidence to support them?
And that brings us to the critical factual gap in your whole argument: How do you account for the fact that the vast majority of media and the public for many years believed that low serotonin could cause depression? Did they just make it up on their own, without ever consulting any “important” psychiatrists?
Hi Sandra — The quote is actually correct from Friedman’s article via Horgan’s article. Horgan compared Friedman’s article to the older article about the alcoholism gene. However, I guess with the way the quote is extracted by me out of context from Horgan’s article that some readers might misconstrue that Horgan was suggesting Friedman wrote both articles. Horgan wasn’t suggesting that. But I can see how that might confuse some people, so thanks for pointing it out — I’ve slipped a bracketed clarification in.
Thanks for your thoughts. I see the problem with the “the” in that context! Although, like you, I can’t readily figure out why that doesn’t sound good, other than that it’s grammatically superfluous to use the “the” in that context… I would never use such titles for that reason, but if I did…
Headline: How many of “the blacks” are really in prison?
— That’s very odd, and I don’t think that’s what you’re after, is it?
And of course without the “the”, it’s common to say or write “Gays Speak Out” or “Blacks Concerned about Racist Policing.”
But does that mean you’d be okay with “How Many Mentally Ill are in Prison?” and “How Many Blacks are in Prison?”
And of course the phrase is actually in the title of the book after which this website is named… “Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.” Does it sound equally bad to you there?
I’ll probably never use the phrase again merely because I’ll be even more aware of it now after our exchange! 🙂 But still, I’m not sure I really know why you would think it so much worse than so many other of the examples… All of which also concern me, of course, don’t get me wrong.
Alternatively, if you look, you’ll see many of the Around the Web titles are entirely in quotes, if I’m taking a quote or title from the source. Would that have been better?
This is a challenge I thnk we all face all day every day in all of our dialogues, blog posts and reporting. I won’t try to speak for anyone else, but here’s my challenge: If I was strict about this, I would be putting virtually every second word in “quotes”. The terms “mental health” and “normal” and “average” and “not mentally ill” are laden with assumptions, too (And let’s not forget, there are some people who argue quite eloquently that perhaps in some ways “everyone” is indeed “mentally ill” because our society is fundamentally “sick”.). Many people find “consumer” or “survivor” offensive, while others embrace one of those labels but rarely both. Some would call themselves “patients” or “ex-patients”, while others find even the implied suggestion of a person with an illness being treated to be offensive. The words “schizophrenia” and “psychotic” carry very powerful, often negative connotations. Do antidepressant drugs actually have proven “anti-depressant” qualities, or should that word also be in quotes? How about “antipsychotics”? The word “criminal” also has both a literal, factual dimension (‘person who has been found guilty of a crime under a jurisdiction’s laws’) and a very derogatory one, so one could reasonably argue that word should always be in quotes, too.
In practical terms, all of that becomes difficult to manage in the context of putting out multiple stories every day. So the ‘rule’ I tend to go with is, when I’m trying to reasonably neutrally summarize or report on someone else’s writing, I tend to use the terms that writer used. If they put something in quotes, then I usually do. If they did not, then I do not. Sometimes, it may not be immediately obvious, so I might try to understand if the writer seems to be raising particular terms or ideas into question or not, and then make my own decision from there about how to summarize it. Or if the particular context for the word or label seems particularly unusually inflammatory, then that may prompt me to put it in quotes regardless. If you read a lot of my articles, you may notice that I frequently write “people diagnosed with…” as opposed to “people with…”, but the reality is, that too becomes difficult to manage in pithy headlines or grammatical sentence structures and I start to wonder if it really makes any fundamental difference to most readers. Besides, “diagnose” also implies illness, and so others would suggest going with “labeled with…”; however, writing “people labeled as having mental illnesses” is a phrase that would make many “ordinary” readers immediately doubt the “neutrality” of the author…
In the case of this particular headline, I think Uprising’s alternative is good. However, 1 Boring Old Man does use the term mental illness without quotes. And I also felt that putting the headline in the frame of a question, and noting that 1 Boring Old Man’s articles were fundamentally questioning all the methodologies at work, sufficiently flagged that ‘all may not be as it seems in the world of mental disorders and criminals.’
None of this is excusing myself of anything, by the way. Just an explanation, for your interest. It’s a delicate balancing act for all of us, trying to communicate effectively with a broad readership about these complex, highly sensitive issues.
First, everyone, the links are all still working. And just to clarify the ‘meaning’ of this post… Sedgwick apparently used the terms disease and illness interchangeably and deliberately, according to the authors of the essay linked to from Duncan’s original post mentioned in the article above. See http://www.studymore.org.uk/crespa.pdf
Hence, for Sedgwick, all illness ‘is essentially deviancy’ (1982, p. 32, original emphasis) and, therefore, equally laden with value:
“[q]uite correctly, the anti-psychiatrists have pointed out that psychopathological categories refer to value judgements and that mental illness is deviancy. On the other hand, the anti-psychiatric critics themselves are wrong when they imagine physical medicine to be essentially different in its logic from psychiatry… mental illnesses can be conceptualized within the disease framework just as easily as physical maladies.”
Sedgwick’s conception is subtle and needs to be carefully rendered. In stressing the value-laden-ness of medicine, it is not his intention to disregard its scientific credentials. At the same time, in subsuming a diagnosis of ‘schizophrenia’ within the illness framework, neither is he endorsing psychiatry’s epistemological claims. Sedgwick is pro-medicine precisely to the extent that he envisages a radically socialized medicine applicable equally to physical and mental health. Such examples of socialized medicine include, ‘[t]he insertion of windows into working-class houses’ (ibid., p. 39) and ‘the provision of a pure water supply and an efficient sewage disposal’ (ibid.).
Tusu: A number of your assumptions are incorrect. I do in fact put thought into what I post on MIA. First, I am guided by MIA’s mission, which is to engage people in “rethinking” psychiatry while critically questioning dominant points of view in “mental health.” Second, I am guided by whether or not I think the point of view, opinion, news story, or scientific research that I am summarizing and linking to seems to me to be interesting, reasonably well formed, and something that MIA readers may wish to read and consider for themselves. And while doing that, I generally do not provide my own commentaries on or evaluations of those articles — “In the News” and “Around the Web” are to be distinguished from the MIA blogs in that way. (Though of course it is impossible to be completely neutral in how one summarizes someone else’s writing, so again, I am guided by MIA’s mission.)
In this particular case, Mind Hacks seemed to me to be raising reasonable questions about some interesting extant facts, opinions and research on this topic, and about what they could mean. The original study cited by Mind Hacks also clearly raises many questions, while citing papers from a number of influential psychiatry, psychology and neuroscience journals. So that is just to say, if you think that I am not reflecting critically enough before I decide to relay for MIA readers’ consideration some people’s arguments that “congenital blindness seems to be protective against schizophrenia,” then I surmise you are by extension leveling the same criticism against the journals Frontiers in Psychology, Frontiers in Human Neuroscience, Behavioral and Brain Sciences, Schizophrenia Research etc, all of whom have published studies and discussions of that topic. If you are indeed meaning to criticize those journals as well for too often rashly rushing to publish spurious psychiatric research without sufficient critical thought, then on that we are in agreement — our society generally does not think critically enough about psychiatry. That said, though, the counter-evidence that you yourself have so far presented to make the argument that I should never have posted a link to this article — several cases that you personally diagnosed and a statistical analysis that should actually give us thousands of cases around the world if we could but find them — does not seem to me yet to be better than the evidence presented in some of those journal articles. Though you may want to consider writing your case studies up and publishing them? (Although on second thought, I realize your 1 in 10,000 number would actually translate into tens of thousands of cases of combined congenital blindness and schizophrenia in the US alone, wouldn’t it? — perhaps explaining why most people are expecting to find more than just a small number of cases here and there in the literature.)
You raise some good points and suggestions Richard and B. We have some similar challenges when we attempt to define whether or not antidepressants or antipsychotics are “addictive,” don’t we? By some people’s accounts, it’s more difficult to get off antidepressants after many years of taking them than heroin.
In essence, though, there are some meaningful distinctions that can be made between the type of physical-psychological ‘addiction/dependence’ that one knows is possible and that comes about as a result of active pursuit on a regular basis of a particular kind of ‘positive high,’ and the type of ‘addiction/dependence’ that one doesn’t know is possible and that comes about as one attempts to avoid ‘negative experiences or effects.’ There are a lot of similarities between those, too, of course, especially when we start delving into the psychology behind it all. But there are enough differences that it seems worth distinguishing them at least in some way. And having a single word for it, instead of a lengthy explanation, is sometimes handy for journalism. 🙂 If also sometimes misleading… (btw I don’t like “iatrogenic addiction” because I think only a tiny percentage of the general public would know what that word iatrogenic means.)
I’ve always found the “mental health” field to be very fraught with language problems of these kinds, because there are so many interests pushing for control of the ideas and the words circulating in the public consciousness, and the whole field is already embedded in such profound philosophical and psychological complexities, conundrums and manipulated language.
Incidentally, if you haven’t seen them, in the area of defining what addiction even is or what causes it, I’ve always enjoyed pondering these ideas that emerged from the “Rat Park” experiments: http://thewalrus.ca/2007-12-health/
Okay, you convinced me, elocin! I normally wouldn’t make a change to an article based on any comments, but in this case I think you’re right and it is a specific point of factual accuracy, not interpretation or opinion. It wasn’t the correct, most accurate word to use. And I also did not represent accurately how the Boston Globe article described it — which sometimes is an issue, i.e. I always try to remain fair or true to how an article I’m summarizing described something, even if it’s not representative of what I personally think or believe. But then usually I would try to put something like that in quotes or something. So thank you, and I stand corrected, and I’ve corrected it in the text.
That’s interesting, Oldhead, I didn’t know that. And I’ve been thinking for a long time about writing something about these strange political divides and alliances on psychiatric issues. So what are your perspectives on when/why/how that change you describe occurred? (Though I belatedly see B was starting to answer my question in a follow-up at the same time… Any more thoughts?)
The articles of mine that have been most widely read were forwarded and/or re-posted by readers to their own friends, to email list groups, to other websites like reddit, or to relevant discussion forums, etc. So you can play an important role, if you like, in trying to broaden the readership.
That said, I’m always interested in publishing where I can, but I have found that many publications are not particularly open to articles that are extremely critical of popular ideas about mental health. Feel free to email me any specific suggestions of publications that you believe might be open.
As I indicated in the article, yes, Freya was in a program for gifted students and had a long and complex history involving school staff and mental health professionals. Some more details of that history, and of the specifics leading up to her death, are available in the coroner’s report. In addition, I know a lot more of the details through conversations with her mother. For the purposes of my article, though — which is primarily about the PSP-CYMH, not about Freya’s story — I decided that many of those details were not as important as simply noting that Freya had certainly been understood by all involved to have been struggling for years, and that inappropriate mental health interventions (and to some degree unaccommodating school staff responses as is discussed in part two) seemed to play a role in Freya’s death. What were the real “reasons” for Freya’s struggles? I don’t know if anyone can answer that definitively, or even if we should be trying to whittle that down to simplistic answers.
It is challenging to see a ‘bright side’ to such movements. Like you, I derive some encouragement from the people who are willing to learn about what is going on and speak about it honestly, critically, and with social and personal self-questioning.
I think growing awareness and concerns about surveillance and privacy could help — it’s really not that hard to start preventing this kind of broad-based sharing of personal information that’s going on, if governments become committed to creating and enforcing appropriate privacy laws.
Breaking society’s deeply embedded faith in “the science” of psychiatry and psychology is, as you know, proving to be a hard nut to crack. But truth is its own inspiration, right?
Hmm, I guess it’s probably a whole other, three-part article this question! Or more likely a book… or two…
To my knowledge the effort continues. Though I don’t know of any government that has yet implemented the recommendations. That said, the recommendations were arguably already in place in many respects.
In reply to your question, I know of nowhere with a better “system” overall. And BC is from a legal civil rights perspective almost certainly the most regressive jurisdiction in all of North America for people who’ve been psychiatrically certified. There has been very intense and very successful lobbying in BC to expand the criteria for committal and to make it impossible to refuse forced treatment. In Ontario, Yukon and Alberta, at least, a separate, second-stage process is required to declare you “incompetent” to make decisions about treatment. The Yukon has also developed some legal options that allow people to develop Advance Directives about their care if they are ever declared incompetent. BC does not allow advance directives for mental health care, nor substitute decision makers, nor any fundamentally protected right for anyone to refuse treatment under any conditions, and a person can be committed if the person is simply “at risk of substantial mental or physical deterioration.” Also, the appeal process occurs before administrative tribunals, not even courts with judges.
On the other hand, it’s true that there are a lot of alternative types of practitioners in Victoria and Vancouver. None of them can be accessed through public health care, though. There are always a few more thoughtful psychiatrists around just about anywhere, but they don’t advertise their non-mainstream thinking for fear of reprisals and marginalization, so you have to find your way to them through talking to people and the quiet back doors or purely accidentally.
As I said above, Gina, the article is about social media hashtags and public discussions of these issues–which is not the issue you want to focus on, but that set of issues would be another article altogether.
However, I’ll try to outline this a little more here, because I agree it’s important!
As that study suggests, it’s reasonable to conclude that the absolute rock-bottom number is one million people per year getting formally detained. Only a small percentage seem to be repeat hospitalizations. So… Where does that alone take us over years and decades?
Then, by way of another example: Cohen and Lee didn’t get numbers for Maryland, but I did. Maryland was in the middle of a big political and public campaign at the time to expand forced treatment. Cutting a long story short, the “official” civil commitment detention numbers, as I went back and forth with govt agencies over the course of several weeks and then months and finally a year, went from less than 100 people to 4,000 people to over 8,000 people per year. That’s the kind of spectrum we’re dealing with in lots of states, once one starts really digging. And it’s also very indicative of the kind of nonsense coming out from governments and pro-force advocates when they say — almost always without any numbers at all — that we need to forcibly hospitalize “more” people.
I just wrote an entire book which is in many ways a prolonged effort to grapple with the complete absence of any national numbers or any decent tracking of who is being detained, for how long, and why, and what’s happening to these people. My findings may still not satisfy you. But yes, when I added up, from many different studies and reports, how many Americans over the course of decades would have apparently at some point or other been formally psychiatrically detained, detained without any formal record of their detention (as was happening in Maryland for many years), subjected to coercion or threats while engaging with “voluntary” mental health services, forced into psychiatric evaluations in their workplaces, “voluntarily” drugged while under a guardianship, etc etc, I ultimately have no doubt when estimating that it’s millions of people.
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Thanks for your thoughts and questions, Gina.
I’m sorry I did not clarify this a little better in the article. Lee and Cohen’s numbers are basically good-ish, and would appear to be the absolute low end for the number of people detained annually alone. In my book — coming out in three weeks — I examine other sources and numbers, and also describe other ways of understanding what’s happening in Cohen’s numbers and across mental health care and society based on other social-circumstantial evidence we can gather. But yes, admittedly, “most reliable data available” is, to some degree, as you’ll see if you read the book, literally just that — something between reliable and not so reliable, but the best we can do given a widespread lack of hard data (and yeah, I searched!).
The above was an article specifically about hashtags and social media. The issue of lobbying is very important, too, though, and I do examine it in my book. And specifically lobbying for governments to better collect and share the data — yes, absolutely needed! I also TRIED that in my way for my book, and you can read what happened…
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Thoroughly enjoy your writing as always, Phil — for me it’s often like some sort of intellectual-satirical-political dark comedy! 🙂
And can anyone please tell me how Pies has managed to miss the fact that, still today, he’s one of a very tiny percentage of psychiatrists who actively and publicly renounce the biochemical imbalance theory??!!
On the particular issue being raised in these comments right here, though, I want to say, perhaps some confusion/disagreement is arising for good reason. Because, I think it’s important to note, mainstream medicine is actually becoming increasingly like bad psychiatry and not vice versa. Witness the themes of the “Selling Sickness” conferences etc, where profound questions are raised about “the cholesterol hypothesis” and statin drugs, and about over-screening, over-diagnosing, and over-treating of nebulously defined “hypertension” and “gastrointestinal disorders” etc etc. And these are some of the most common diagnoses and top-selling drugs today.
So I think it’s becoming increasingly unclear in our culture what “real” medicine actually is or involves, and more and more difficult to use the idea as a self-evident counterpoint to the excesses of psychiatry.
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According to the Medscape article linked to:
“Using 31 exclusion criteria, matching factors, and covariates, the researchers formed a matched control cohort of non–AP users. They compared 180-day mortality of AP users with that of nonusers, from which hazard ratios were calculated. There were 7877 matched pairs.”
“Whether the analysis was done by intention to treat or by exposure to drug, the patterns were largely the same. Adjustments were made for measurable confounders related to PD severity and comorbidities.”
“The researchers found similar results when they excluded patients who died within the first 2 weeks or 4 weeks of AP exposure to eliminate patients who were at imminent risk for death when therapy was initiated.”
“Dr Okun noted that the increased mortality with AP use in patients with PD psychosis parallels findings of their use in non-PD patients with psychosis.”
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Mr. Smith: The critical study did not suggest that the information was nowhere available in the original studies to determine the correct numbers; indeed, the presence of the correct information is what allowed them to do their own supplementary analysis. However, the authors noted that, in the original studies, the suicidal events placebo-to-drug comparison for the entire duration of the trial was never directly and clearly presented alongside relevant analyses as to its overall significance.
Rob Wipond
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Generally from what I have seen in the literature on suicide, researchers interchangeably use terms like suicidal behavior, suicidal ideation, suicidal feelings, and suicidal thoughts. They do however usually distinguish between thoughts and feelings related to suicide, and actual concrete plans — but that is not relevant to this study.
The actual question in this study was “Have you ever been willing to die during the past year?” Response options for this question were “yes” and “no.” So to me that seems ambiguous about whether a person would be responding based on thoughts or feelings, plans or general emotions, despair or philosophical open-mindedness etc… A criticism of the study’s conclusions might be that answers to this question would not necessarily truly reflect “suicidal” thoughts or feelings. My interpretation was that, in the context of the kind of questionnaire that was being administered, the intent of the question to get at suicidal or despairing feelings was probably clear to the interviewees.
On a more general note, Merriam Webster has a long list of definitions for “feeling” which includes, “appreciative or responsive awareness or recognition”, “often unreasoned opinion or belief”, “the character ascribed to something”…
http://www.merriam-webster.com/dictionary/feeling
I personally do not agree with — or do not understand — your attempt to distinguish between a feeling and a thought in this context. I would say that people do ‘feel’ the process of ‘thinking’ about a plan to do something, and conversely have ‘thoughts’ with feeling dimensions to them. To the point that I think/feel it is sometimes very difficult to distinguish between the two, particularly when the thought or feeling is intense or emotionally charged, like “I want to die right now.”
I’m not sure how the Szasz excerpt relates to these questions, although I always appreciate a deeper analysis of the complexity of what it really means to be suicidal, and why our culture has such a widespread, strong resistance or fear in relation to it.
Rob
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Looks like you’re right. Du-oh! I wasn’t on the job back then. I also didn’t realize that different journals will sometimes run the same study in this way. Thanks for pointing it out. I added a note about it to the post. Though I guess it can’t hurt — I expect some people out there in the world missed it on the first go-around… 🙂
Rob
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Thanks for saying so, Sa. And that reminds me of another way of saying what I mean. I didn’t mean to suggest above that my job is to be “Mr. Negative About Everything” just for the sake of it. There is, in my mind, a “positive” aspect to what I’m doing. My work with In the News is not to “take a side” and promote a particular agenda or particular approaches; rather I am choosing what I post in In the News largely based on whether I think it might contribute in some way to encouraging self-questioning and independent critical thinking about the mental health system, ourselves, our social world, our approaches to life, and what it is to be human and to experience all that is.
Rob
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Hi Academic,
If you see really good studies about CBT as they appear — or indeed about anything else related to MIA’s mission — feel free to forward them to me.
You sort of cherry picked my posts by focusing only on CBT, though. MIA’s mandate is “rethinking” the mental health system, and I actually tend to focus a lot on studies in ALL areas of “mental health” that provide critiques, because of this mandate and because I often find many of the studies that end up promoting specific treatments in virtually all areas to be weak and/or too-obviously biased in comparison. Indeed, that’s what most of the meta-analyses that I have seen and that I do often post have been finding, too. Generally, if you look at the (relatively much smaller number of) “positive” studies about anything that I’ve posted, I think you’d find that most of them weren’t necessarily stellar studies, either, but indicated something I thought was somewhat ‘interesting’ and worthy of thought or discussion and possibly relatively innocuous (like studies into the benefits of moderate exercise and good nutrition). But even those I post sparingly. I think the issue you’re seeing here is that in the year I’ve been doing this I haven’t often seen really good studies demonstrating really strong “efficacy” of pretty well anything — have you? Again, if you do, please forward as you see them appear. But if I have a “bias,” I’d describe it myself as a combination of genuine journalistic interest and strong investigative skepticism in relation to just about everything.
Rob
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And I will add a couple of thoughts to Robert Whitaker’s responses. I thought this study was important to cover because of the sheer brashness of the authors’ assertions in contrast to the somewhat disguised weaknesses of their methods and findings, and because it appeared in one of the world’s leading mainstream psychiatric journals, and because it is getting substantial coverage in other outlets as if there are no weaknesses. After we removed the somewhat mocking headline, I could have revised the opening or the headline to at least still have more of a hint of the qualifying sections at the end — which is normally what I try to do with these kinds of news stories. Because of course you’re right to suggest that some regular readers of MIA and certainly many in the general public might not be so quick to question the brash assertions of this study. On that count, I would say that I am guilty of assuming that most regular MIA readers would in any case suspect something questionable right away and read on to find out what was really going on with this study, and I was forgetful about “reminding” them and more general readers to be sure to do that.
That said, I also think statements like “the authors did note that their measurements may not have actually reflected serotonin levels in people’s brains” and “the authors stated that any potential ‘causal’ relationships between serotonin and anxiety were not actually examined and were a matter about which they could only ‘speculate'” seem to me to be pretty clear clarifications of the ridiculousness and attempted manipulation in what’s going on here. I don’t know if I want to start writing scientific summaries based on the assumption that readers will reach strong, potentially life-altering conclusions without even reading past the headline or without reading the entirety of the summaries — the problems with that kind of reading cannot be solved or eliminated by any sort of writing.
Rob
p.s. and in this context i thought the sheer meaninglessness of those accompanying images to the average human eye was funny.
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Hi bpdtransformation, I’m responding here to your comment dated June 13, 2015 at 1:38 pm.
I find it easy to come up with different, better ways of describing the varieties of human experience. But the challenge with respect to In the News and Around the Web is different. Suppose I see a study where researchers state in their conclusions something like “the evidence shows that the mentally ill are more dangerous than the average person.” I could ignore this study entirely. Or, I could decide that I think MIA readers might want to know that this study was done, how it was done, and what it actually found. If I report it, I can remove the offensive term “the mentally ill” and paraphrase the wording to “the researchers concluded that people with mental illnesses tend to be more dangerous than the average person”, or “the researchers concluded that people diagnosed with mental disorders are ‘more dangerous’ than the average person.” I do this a lot in my MIA posts. I can also seek out and highlight details about the study that I think may help people better understand it or see it in a critical light — and I try to do that as much as I’m reasonably able to, especially if I think it’s a particularly questionable or inflammatory study. To some people, though, understandably, my use of those terms is still hurtful. However, I cannot write, “the researchers concluded that people undergoing emotional distress or experiences that some might term as psychotic more often do things that seem harmful to others, depending on the standard you use for evaluating violent acts in a fundamentally oppressive social context.” At that point, it is no longer responsible or accurate reporting. That is not how the researchers themselves used the terms in their study, that’s not what they found or said, and that’s not what they concluded; not even close. So, unfortunately, to accurately report on many studies or articles, I sometimes have to reproduce language and concepts that I know may be especially hurtful to some people.
Rob
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I’m not sure what your main point for me is. Are you suggesting that “In the News” and “Around the Web”, as features on MIA, are causing more harm than good and should be stopped? If so, you may be right. I do worry and wonder about it every day.
Rob
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Hi again, Isis — due to the limit on numbers of ‘nested replies’, I am replying here to your comment June 12, 2015 at 4:51 pm.
You write: “Many of us are seeking a safe space online that is free from pathologising language and stigmatised identities.” and “It begs the question of whether resources for user/refuser/survivors can ever successfully be curated and managed by by those with no lived experience of the issues involved.”
Those are and would be great things, and I encourage you or others to try to build them. But those are not what MIA is. MIA includes board members and bloggers who have had such experiences, but on the whole it is a platform for news, opinions and discussions for and among many diverse people who share an interest in “rethinking psychiatric care.”
http://www.madinamerica.com/about-us/
And while I know that psychiatric labels can be very harmful, it is simply not possible to briefly summarize news and research about “mental illness” without frequently reiterating the dominant terms such as “mental illness” that are being used in that news and research. At least, I have yet to come up with many reliably effective ways to do it. I am always open to new suggestions. In the meantime, I just hope that, on the whole, for people who visit our site regularly, the items I post contribute towards helping keep people somewhat critically informed about what is going on in the field of “mental health” and also create a space wherein everyone feels that the dominant terms and ideas of “mental health” can be challenged.
Rob
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Hi Isis,
I can’t speak to what someone else may have said to you. But as I said above, I do understand the “problematic” issue at play in this and it concerns me, too. However, it’s important to be clear about something: I have been managing “In the News” and “Around the Web” for the past year or so, and the whole main point and thrust of these two features of MIA is precisely to simply summarize or highlight aspects of what other people, researchers, or media are saying, more or less in their own words. MIA’s Blogs are where authors are free to opine about what other people are saying.
Incidentally, I chose to post a summary of the above study, notwithstanding my own personal lack of confidence in the scientific validity of the diagnosis, because I thought it was important how the study highlighted that most psychiatrists do not follow even their own best-practice guidelines.
Rob
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Hi Andrew,
I think you’re raising an accurate concern here. I changed the headline in response to your comment, from “professional” to “clinician.” The original source I link to you’ll see uses both terms, but overall I think they, and the source they were using, meant to refer to a specific subgroup of mental health professionals. That said, a more detailed analysis could end up sharpening the specificity even further — I certainly know many psychotherapists in private practice who don’t earn anywhere near that amount.
Thanks for raising the issue.
And btw, I do certainly try to check and vet everything I post in Around the Web and In the News at least to some degree, but with time constraints in part I am also simply linking and briefly summarizing things I think may be worthy of reading and further analysis — not always posting things I think are “accurate”. In fact, the majority of what I post here I think can still stand a critical analysis to parse out what’s truly important from what’s bordering on nonsense. So ultimately, no one should read my posts or MIA any less critically than anything else on the web or in the media. And in part we’re creating a ‘community’ at MIA so that we can help each other sharpen our critical approaches on all of these issues. So thanks for the feedback!
best,
Rob
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Hi bpdransformation,
You rightly identify a question and challenge I face every day, with the vast majority of articles. In response to this challenge, I attempt to do the best job I can in fairly representing some aspect(s) of what the original study or article actually said, while trying not to imply or suggest that I or Mad in America necessarily “support” or “endorse” questionable language or underlying assumptions and beliefs that might be at work in the source material. If, conversely, I were to always function as a personal “filter” on such material, every In the News and Around the Web post would become long investigative journalism articles or personal opinion pieces or creative satirical renditions (and I like your suggested headline by the way), rather than what they currently are, which is mainly simply short news bites flagging stories that I think might be of interest to MIA readers for any of various reasons.
Rob
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Hi Jeffrey,
Just so you know, as author of the In the News items for the past year, I can confirm that your observation has validity. That is, for the In the News posts, I do my best to fairly and accurately present in summary form what I see in an article — but not the entirety of the article (which is next to impossible to do usually), and not always do I do it in a “mindless” fashion. That is to say, the part or parts that I select for summary presentation are not always the same as what the original article highlights. Sometimes, for example, I skip the press release and the abstract, and quote directly from a study, because they are saying different things and I will choose what I think is most important or may be most of interest to our readers.
In this case, it seemed to me that both the articles I was quoting had included very pertinent information which they chose not to highlight and instead to re-interpret; I chose to highlight it. As you correctly observed, they “implied” certain things for which they had no evidence, and in this case I stated simply what the evidence currently shows. Links to the original sources are always included so anyone can quickly see the entire context for themselves.
Rob Wipond
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Scott Alexander: Your post is extremely long and covers a lot; I do not claim in my post to be providing a complete summary of every issue and point. I also encourage people to read it themselves, which is why I posted a link to it.
Yes, you’re right, many psychiatrists, media, pharmaceutical companies and others promoting the serotonin deficiency theory of depression have often included generalized, softening “qualifiers” and “equivocations” such as the ones you quoted, even as they have also made those very bold, unequivocal claims explicitly intended to persuade that I quoted. Taken in full context, then how are such qualifiers different than brash infomercials on television with legal disclaimers like, “not all results will be the same for all people”?
I know of no one (certainly not me) who has ever said that there were never any studies making tenuous, feeble attempts to draw links between serotonin levels and depression in different ways — there were hundreds, I believe (I haven’t counted) as the psychiatric community and pharmaceutical industry made enormous efforts to try to prove the theory or buttress its apparent validity in the public eye. And as I note, those are still being produced today. What critics have often correctly pointed out, however, is that the main, strongest argument that psychiatrists have often used in support of the low-serotonin theory has always been that SSRIs allegedly boost serotonin levels. Of course, most of the public has never known that SSRIs have barely beaten placebos in clinical trials, so they’ve not been able to understand the true spuriousness of even that argument.
I notice that your argument has now changed to “far fewer people” and “less important” psychiatrists made such claims, rather than none at all made such claims. Very well; apparently we would now only potentially disagree on subjective notions such as how many is “fewer” and how unimportant is “less important”, rather than disagreeing on the main issue at hand. And then Leo and Lacasse’s question becomes all the more significant: Where is the evidence that the “important” psychiatrists were vigorously trying to correct the public record and clarifying that these were only weak hypotheses with no compelling evidence to support them instead of weighty theories with ever mounting evidence to support them?
And that brings us to the critical factual gap in your whole argument: How do you account for the fact that the vast majority of media and the public for many years believed that low serotonin could cause depression? Did they just make it up on their own, without ever consulting any “important” psychiatrists?
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Hi Sandra — The quote is actually correct from Friedman’s article via Horgan’s article. Horgan compared Friedman’s article to the older article about the alcoholism gene. However, I guess with the way the quote is extracted by me out of context from Horgan’s article that some readers might misconstrue that Horgan was suggesting Friedman wrote both articles. Horgan wasn’t suggesting that. But I can see how that might confuse some people, so thanks for pointing it out — I’ve slipped a bracketed clarification in.
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Sorry re other link. Correct link now posted.
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Hey Uprising,
Thanks for your thoughts. I see the problem with the “the” in that context! Although, like you, I can’t readily figure out why that doesn’t sound good, other than that it’s grammatically superfluous to use the “the” in that context… I would never use such titles for that reason, but if I did…
Headline: How many of “the blacks” are really in prison?
— That’s very odd, and I don’t think that’s what you’re after, is it?
And of course without the “the”, it’s common to say or write “Gays Speak Out” or “Blacks Concerned about Racist Policing.”
But does that mean you’d be okay with “How Many Mentally Ill are in Prison?” and “How Many Blacks are in Prison?”
And of course the phrase is actually in the title of the book after which this website is named… “Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.” Does it sound equally bad to you there?
I’ll probably never use the phrase again merely because I’ll be even more aware of it now after our exchange! 🙂 But still, I’m not sure I really know why you would think it so much worse than so many other of the examples… All of which also concern me, of course, don’t get me wrong.
Alternatively, if you look, you’ll see many of the Around the Web titles are entirely in quotes, if I’m taking a quote or title from the source. Would that have been better?
Rob
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Hi Darby and Uprising,
This is a challenge I thnk we all face all day every day in all of our dialogues, blog posts and reporting. I won’t try to speak for anyone else, but here’s my challenge: If I was strict about this, I would be putting virtually every second word in “quotes”. The terms “mental health” and “normal” and “average” and “not mentally ill” are laden with assumptions, too (And let’s not forget, there are some people who argue quite eloquently that perhaps in some ways “everyone” is indeed “mentally ill” because our society is fundamentally “sick”.). Many people find “consumer” or “survivor” offensive, while others embrace one of those labels but rarely both. Some would call themselves “patients” or “ex-patients”, while others find even the implied suggestion of a person with an illness being treated to be offensive. The words “schizophrenia” and “psychotic” carry very powerful, often negative connotations. Do antidepressant drugs actually have proven “anti-depressant” qualities, or should that word also be in quotes? How about “antipsychotics”? The word “criminal” also has both a literal, factual dimension (‘person who has been found guilty of a crime under a jurisdiction’s laws’) and a very derogatory one, so one could reasonably argue that word should always be in quotes, too.
In practical terms, all of that becomes difficult to manage in the context of putting out multiple stories every day. So the ‘rule’ I tend to go with is, when I’m trying to reasonably neutrally summarize or report on someone else’s writing, I tend to use the terms that writer used. If they put something in quotes, then I usually do. If they did not, then I do not. Sometimes, it may not be immediately obvious, so I might try to understand if the writer seems to be raising particular terms or ideas into question or not, and then make my own decision from there about how to summarize it. Or if the particular context for the word or label seems particularly unusually inflammatory, then that may prompt me to put it in quotes regardless. If you read a lot of my articles, you may notice that I frequently write “people diagnosed with…” as opposed to “people with…”, but the reality is, that too becomes difficult to manage in pithy headlines or grammatical sentence structures and I start to wonder if it really makes any fundamental difference to most readers. Besides, “diagnose” also implies illness, and so others would suggest going with “labeled with…”; however, writing “people labeled as having mental illnesses” is a phrase that would make many “ordinary” readers immediately doubt the “neutrality” of the author…
In the case of this particular headline, I think Uprising’s alternative is good. However, 1 Boring Old Man does use the term mental illness without quotes. And I also felt that putting the headline in the frame of a question, and noting that 1 Boring Old Man’s articles were fundamentally questioning all the methodologies at work, sufficiently flagged that ‘all may not be as it seems in the world of mental disorders and criminals.’
None of this is excusing myself of anything, by the way. Just an explanation, for your interest. It’s a delicate balancing act for all of us, trying to communicate effectively with a broad readership about these complex, highly sensitive issues.
Thanks for reading!
Rob
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First, everyone, the links are all still working. And just to clarify the ‘meaning’ of this post… Sedgwick apparently used the terms disease and illness interchangeably and deliberately, according to the authors of the essay linked to from Duncan’s original post mentioned in the article above. See http://www.studymore.org.uk/crespa.pdf
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Tusu: A number of your assumptions are incorrect. I do in fact put thought into what I post on MIA. First, I am guided by MIA’s mission, which is to engage people in “rethinking” psychiatry while critically questioning dominant points of view in “mental health.” Second, I am guided by whether or not I think the point of view, opinion, news story, or scientific research that I am summarizing and linking to seems to me to be interesting, reasonably well formed, and something that MIA readers may wish to read and consider for themselves. And while doing that, I generally do not provide my own commentaries on or evaluations of those articles — “In the News” and “Around the Web” are to be distinguished from the MIA blogs in that way. (Though of course it is impossible to be completely neutral in how one summarizes someone else’s writing, so again, I am guided by MIA’s mission.)
In this particular case, Mind Hacks seemed to me to be raising reasonable questions about some interesting extant facts, opinions and research on this topic, and about what they could mean. The original study cited by Mind Hacks also clearly raises many questions, while citing papers from a number of influential psychiatry, psychology and neuroscience journals. So that is just to say, if you think that I am not reflecting critically enough before I decide to relay for MIA readers’ consideration some people’s arguments that “congenital blindness seems to be protective against schizophrenia,” then I surmise you are by extension leveling the same criticism against the journals Frontiers in Psychology, Frontiers in Human Neuroscience, Behavioral and Brain Sciences, Schizophrenia Research etc, all of whom have published studies and discussions of that topic. If you are indeed meaning to criticize those journals as well for too often rashly rushing to publish spurious psychiatric research without sufficient critical thought, then on that we are in agreement — our society generally does not think critically enough about psychiatry. That said, though, the counter-evidence that you yourself have so far presented to make the argument that I should never have posted a link to this article — several cases that you personally diagnosed and a statistical analysis that should actually give us thousands of cases around the world if we could but find them — does not seem to me yet to be better than the evidence presented in some of those journal articles. Though you may want to consider writing your case studies up and publishing them? (Although on second thought, I realize your 1 in 10,000 number would actually translate into tens of thousands of cases of combined congenital blindness and schizophrenia in the US alone, wouldn’t it? — perhaps explaining why most people are expecting to find more than just a small number of cases here and there in the literature.)
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You raise some good points and suggestions Richard and B. We have some similar challenges when we attempt to define whether or not antidepressants or antipsychotics are “addictive,” don’t we? By some people’s accounts, it’s more difficult to get off antidepressants after many years of taking them than heroin.
In essence, though, there are some meaningful distinctions that can be made between the type of physical-psychological ‘addiction/dependence’ that one knows is possible and that comes about as a result of active pursuit on a regular basis of a particular kind of ‘positive high,’ and the type of ‘addiction/dependence’ that one doesn’t know is possible and that comes about as one attempts to avoid ‘negative experiences or effects.’ There are a lot of similarities between those, too, of course, especially when we start delving into the psychology behind it all. But there are enough differences that it seems worth distinguishing them at least in some way. And having a single word for it, instead of a lengthy explanation, is sometimes handy for journalism. 🙂 If also sometimes misleading… (btw I don’t like “iatrogenic addiction” because I think only a tiny percentage of the general public would know what that word iatrogenic means.)
I’ve always found the “mental health” field to be very fraught with language problems of these kinds, because there are so many interests pushing for control of the ideas and the words circulating in the public consciousness, and the whole field is already embedded in such profound philosophical and psychological complexities, conundrums and manipulated language.
Incidentally, if you haven’t seen them, in the area of defining what addiction even is or what causes it, I’ve always enjoyed pondering these ideas that emerged from the “Rat Park” experiments:
http://thewalrus.ca/2007-12-health/
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Okay, you convinced me, elocin! I normally wouldn’t make a change to an article based on any comments, but in this case I think you’re right and it is a specific point of factual accuracy, not interpretation or opinion. It wasn’t the correct, most accurate word to use. And I also did not represent accurately how the Boston Globe article described it — which sometimes is an issue, i.e. I always try to remain fair or true to how an article I’m summarizing described something, even if it’s not representative of what I personally think or believe. But then usually I would try to put something like that in quotes or something. So thank you, and I stand corrected, and I’ve corrected it in the text.
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That’s interesting, Oldhead, I didn’t know that. And I’ve been thinking for a long time about writing something about these strange political divides and alliances on psychiatric issues. So what are your perspectives on when/why/how that change you describe occurred? (Though I belatedly see B was starting to answer my question in a follow-up at the same time… Any more thoughts?)
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Hi Oldhead,
The articles of mine that have been most widely read were forwarded and/or re-posted by readers to their own friends, to email list groups, to other websites like reddit, or to relevant discussion forums, etc. So you can play an important role, if you like, in trying to broaden the readership.
That said, I’m always interested in publishing where I can, but I have found that many publications are not particularly open to articles that are extremely critical of popular ideas about mental health. Feel free to email me any specific suggestions of publications that you believe might be open.
Rob
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As I indicated in the article, yes, Freya was in a program for gifted students and had a long and complex history involving school staff and mental health professionals. Some more details of that history, and of the specifics leading up to her death, are available in the coroner’s report. In addition, I know a lot more of the details through conversations with her mother. For the purposes of my article, though — which is primarily about the PSP-CYMH, not about Freya’s story — I decided that many of those details were not as important as simply noting that Freya had certainly been understood by all involved to have been struggling for years, and that inappropriate mental health interventions (and to some degree unaccommodating school staff responses as is discussed in part two) seemed to play a role in Freya’s death. What were the real “reasons” for Freya’s struggles? I don’t know if anyone can answer that definitively, or even if we should be trying to whittle that down to simplistic answers.
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Hi Donna,
It is challenging to see a ‘bright side’ to such movements. Like you, I derive some encouragement from the people who are willing to learn about what is going on and speak about it honestly, critically, and with social and personal self-questioning.
I think growing awareness and concerns about surveillance and privacy could help — it’s really not that hard to start preventing this kind of broad-based sharing of personal information that’s going on, if governments become committed to creating and enforcing appropriate privacy laws.
Breaking society’s deeply embedded faith in “the science” of psychiatry and psychology is, as you know, proving to be a hard nut to crack. But truth is its own inspiration, right?
Hmm, I guess it’s probably a whole other, three-part article this question! Or more likely a book… or two…
Rob
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To my knowledge the effort continues. Though I don’t know of any government that has yet implemented the recommendations. That said, the recommendations were arguably already in place in many respects.
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Hi S,
In reply to your question, I know of nowhere with a better “system” overall. And BC is from a legal civil rights perspective almost certainly the most regressive jurisdiction in all of North America for people who’ve been psychiatrically certified. There has been very intense and very successful lobbying in BC to expand the criteria for committal and to make it impossible to refuse forced treatment. In Ontario, Yukon and Alberta, at least, a separate, second-stage process is required to declare you “incompetent” to make decisions about treatment. The Yukon has also developed some legal options that allow people to develop Advance Directives about their care if they are ever declared incompetent. BC does not allow advance directives for mental health care, nor substitute decision makers, nor any fundamentally protected right for anyone to refuse treatment under any conditions, and a person can be committed if the person is simply “at risk of substantial mental or physical deterioration.” Also, the appeal process occurs before administrative tribunals, not even courts with judges.
On the other hand, it’s true that there are a lot of alternative types of practitioners in Victoria and Vancouver. None of them can be accessed through public health care, though. There are always a few more thoughtful psychiatrists around just about anywhere, but they don’t advertise their non-mainstream thinking for fear of reprisals and marginalization, so you have to find your way to them through talking to people and the quiet back doors or purely accidentally.
Rob Wipond
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