Psychiatric Diagnoses:  Labels, Not Explanations

On March 16, Ronald Pies, MD, published an article in the Psychiatric Times.  The article is titled The War on Psychiatric Diagnosis, and the sub-title synopsis on the pdf version reads:  “A recent report that argues against descriptive diagnosis in medicine is historically ill-informed and medically naive, in the opinion of this psychiatrist.”

Dr. Pies is a very prestigious and eminent psychiatrist.  He is a professor of psychiatry at both Syracuse and Tufts.  He was the first editor of Psychiatric Times, which, by its own account, provides “News, Special Reports, and clinical content related to psychiatry” for “…psychiatrists and allied mental health professionals who treat mental disorders…Circulation of the monthly print publication is approximately 40,000.”

The report that Dr. Pies considers “historically ill-informed and medically naïve”, is the BPS November 2014 paper Understanding Psychosis and Schizophrenia, which has been widely discussed in recent weeks.

. . . . . . . . . . . . . . . . 

There is much in Dr. Pies’ paper that warrants critical examination, but I would like to focus here on just one topic:  the explanatory value of diagnoses.

Dr. Pies himself acknowledges the centrality of this matter, and writes:

“But there is a larger issue raised in the BPS report that goes to the very heart of psychiatric diagnosis, which the report tries to discredit with the following argument:

We normally expect medical diagnoses to tell us something about what has caused a certain problem, what the person can expect in future (‘prognosis’) and what is likely to help. However, this is not the case with mental health ‘diagnoses,’ which rather than being explanations are just ways of categorizing experiences based on what people tell clinicians. . . . For example, someone who says that they are hearing voices might be given a diagnosis of schizophrenia. Since this says nothing about cause, it makes little sense to say that the person hears the voices ‘because of ‘ the schizophrenia.

Actually, it makes a good deal of sense, in precisely the same way it makes sense to say, ‘Mr Jones has severe facial pain because he has tic douloureux;’ or ‘Smith has severe left-sided head pain and nausea because he has migraines.’ We still do not know the precise causes of these conditions; moreover, the diagnosis of  tic douloureux (literally, ‘painful tic’) or migraine headache (etymologically, headache ‘in half the cranium’) is made almost entirely on the basis of ‘what people tell clinicians’—not on the basis of an abnormal laboratory value, x-ray film, or anatomical finding. (Of course, certain tests, such as a CT scan of the head, can help rule out other diagnostic possibilities, such as a brain tumor.)”

The essence of Dr. Pies’ contention here is that psychiatric diagnoses are just as valid as diagnoses in general medicine, and that, in particular, the absence of knowledge concerning causes does not diminish their status or usefulness.

It has long been my contention that psychiatric “diagnoses” have no explanatory value, and in fact constitute nothing more than vague, unreliable re-labeling of the presenting problems.

This is clearly demonstrated in the hypothetical conversation:

Client’s parent:  Why is my son so paranoid?  Why does he just sit in his room all day?  Why won’t he do anything?

Psychiatrist:  Because he has an illness called schizophrenia.

Parent:  How do you know he has this illness?

Psychiatrist:  Because he is so paranoid, sits in his room all day, and won’t do anything.

The only evidence, and I stress the only evidence, for the so-called illness is the very behavior that it purports to explain.  The psychiatric explanation essentially comes down to:  he is paranoid, sits in his room all day, and won’t do anything, because he’s paranoid, sits in his room all day, and won’t do anything.  There is nothing more to it than that.

I realize that I’ve labored this matter to the point of tedium. But I’ve done so for two reasons.  Firstly, because it is one of the core flaws in psychiatry.  Its diagnoses have no explanatory value.  They are nothing more than labels.  Secondly, because psychiatry consistently fails to respond to this particular criticism, and with equal consistency presents these labels as if they did have explanatory value.

The present article by Dr. Pies is a perfect example of the second point, because although Dr. Pies appears to address the issue, he actually side-steps it.

Let’s go back to the quote from the BPS article.

We normally expect medical diagnoses to tell us something about what has caused a certain problem…

This is absolutely accurate.  When a person consults a physician concerning a medical problem or concern, there is a general expectation that the diagnosis, if forthcoming, will provide an explanation of the problem.  And in practice, this is normally the case.  If a person reports exhaustion, pulmonary congestion, elevated temperature, pain in the chest, and nasty-looking phlegm, his diagnosis might be pneumonia.  Pneumonia is a viral or bacterial infection of the lung tissue.

What is noteworthy here, in the present context, is that we have two distinct elements:  the symptoms and the cause of the symptoms.  The person consults a physician because of the symptoms, and, from the physician, he learns the cause of these symptoms.  This is what diagnosis means:  determining the cause and nature of a pathological condition.  Wikipedia gives the following definition:

“Medical diagnosis…is the process of determining which disease or condition explains a person’s symptoms and signs.” [Emphasis added]

Another critical factor in this issue is that there has to be a clear logical link between the symptoms and the diagnosis.  If, for instance, the physician’s diagnosis in the above scenario were “incorrect curvature of the spine”, there would, I suggest, be an enormous burden of proof as to how this particular pathology could cause these particular symptoms.  But with a diagnosis of pneumonia, the logical link is clear:  the infection causes exudation of blood and other fluid into the lung tissue; the immune system triggers an increase in temperature, etc..

So let’s see how our consultation conversation might run in this case.

Patient:  Why am I so tired; why did my temperature spike; why am I spitting up such dreadful-looking phlegm?

Physician:  Because you have pneumonia.

Patient:  How do you know I have pneumonia?

Physician:  Because I can hear characteristic sounds through the stethoscope; your chest X-ray shows large quantities of fluid in both lungs; your sputum labs are positive for pneumococcus; and because everything you have told me is consistent with this diagnosis.  I can show you the X-rays if you like.

The difference between this kind of conversation and the psychiatric conversation is obvious.  In the pneumonia case, the physician has progressed from the symptoms to the essential underlying nature of the illness.  In psychiatry, no such progress has occurred or can occur.  In psychiatry, the so-called symptoms are the essence of the problem.  There is no underlying reality to which the symptoms point.  The “symptoms” and the “illness” are identical.

Back to the BPS quote:

“For example, someone who says that they are hearing voices might be given a diagnosis of schizophrenia. Since this says nothing about cause, it makes little sense to say that the person hears the voices ‘because of ‘ the schizophrenia.”

Again, this is accurate.  “Schizophrenia” is a label, not an underlying explanatory entity that enables us to understand the symptoms.  The phrase  “…because he has schizophrenia” is a form of words that looks like an explanation, but in fact isn’t.

To illustrate this, let’s consider another example.  Imagine a small child running tearfully to his mother with the complaint that another child has been hitting him.  Mother gathers the victim to her arms and soothes him.

Mother:  It’s OK.  I’ve got you.  It’s OK. etc.

Child:  Why does he keep hitting me?

Mother:  Because he’s a bully.  Don’t mind him.

The phrase “because he’s bully” looks like an explanation, and will be accepted by the child as an explanation, but in fact it has no explanatory value.  All we have to do to see this is ask the question:  “How do you know he’s a bully?”, and the only possible answer is “because he keeps hitting you”.

The statement “he beats you because he is a bully” is logically equivalent to the statement:  “He beats you because he beats you.”  It contains no explanatory insights into the aggressor’s action.  And psychiatric explanations are exactly of this kind.

Now, please don’t misunderstand me.  This is not a logical critique of mothers who try to comfort their children.  As parents, we do what we can to comfort our children, and there is no great onus with regards to logic or science.  But psychiatric concepts and assertions do need to pass the tests of logic and science.

The statement:  “Your son hears voices because he has schizophrenia” is logically equivalent to “Your son hears voices because he hears voices.”  Schizophrenia is nothing more than the label that psychiatry gives to that loose cluster of vaguely defined thoughts, feelings, and/or behaviors that are listed on page 99 of DSM-5.  These are:

  1. Delusions
  2. Hallucinations.
  3. Disorganized speech (e.g., frequent derailment or incoherence).
  4. Grossly disorganized or catatonic behavior.
  5. Negative symptoms (i.e., diminished emotional expression or avolition)

The simple fact of the matter is that the reasons underlying these thoughts, feelings, and behaviors are as varied as the individuals who experience them.  But psychiatrists make no attempt to explore these reasons.  Instead, they rely on the medical-sounding, but facile,  “because-he-has-schizophrenia” form of words.  As in so many areas, psychiatry has become intoxicated by its own rhetoric, and individual practitioners seem to believe that this form of words actually has some explanatory value.

Back to Dr. Pies:

“Actually, it makes a good deal of sense, in precisely the same way it makes sense to say, ‘Mr Jones has severe facial pain because he has tic douloureux;’ or ‘Smith has severe left-sided head pain and nausea because he has migraines.’  We still do not know the precise causes of these conditions; moreover, the diagnosis of  tic douloureux (literally, ‘painful tic’) or migraine headache (etymologically, headache ‘in half the cranium’) is made almost entirely on the basis of ‘what people tell clinicians’—not on the basis of an abnormal laboratory value, x-ray film, or anatomical finding.”

So there is a fairly profound disagreement.  The BPS say that the explanation “because he has schizophrenia” makes little sense.  Dr. Pies says it makes a good deal of sense. Let’s take a closer look.  First, let’s go back to the BPS statement which Dr. Pies quoted and which I reproduced above.  Although there are no quotation marks around this passage, it is actually a verbatim quote from the BPS paper, but a crucial piece of the quote has been omitted.  (The omission is indicated by an ellipsis in the regular online version, but there is no ellipsis in the pdf version.)

The omitted passage is:

“The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) explicitly states that its categories say nothing about cause – in its own words it is ‘neutral with respect to theories of aetiology’.”

So a summary of the BPS passage might look something like this:

  1. medical diagnoses give us the cause or explanation of a problem
  2. psychiatric diagnoses, by contrast, do not give causes or explanations
  3. psychiatric diagnoses are just ways of categorizing clients’ reports
  4. the APA acknowledges that its diagnoses say nothing about cause
  5. therefore the label schizophrenia has no explanatory value
  6. so, to say that a person hears voices because he has schizophrenia makes little sense

What Dr. Pies has omitted is item 4 arguably the most important part of the passage.  So Dr. Pies is accusing the BPS of leaping from

psychiatric diagnoses are just ways of categorizing clients’ reports

to

therefore the label schizophrenia has no explanatory value

and ignores the interim premise which is crucial to the issue.  Dr. Pies then uses this distortion to make the point that some diagnoses in general medicine are based entirely on patient report but are nevertheless considered valid and useful.  This, of course, is non-contentious.  There are, indeed, genuine medical conditions which are diagnosed largely on the basis of patient report. Dr. Pies mentions tic douloureux as an example, and states that the precise cause of this illness is unknown. But he is, I suggest, being less than candid, because a great deal is known, and has been known for decades, about the cause of tic douloureux, which, incidentally, is now usually called trigeminal neuralgia.  Here’s the entry for this illness in the 1963 edition of Taber’s Cyclopedic Medical Dictionary:

“Degeneration of or pressure on the trigeminal nerve, resulting in neuralgia of that nerve…The pain is excruciating.  Usually occurs after forty.  Pain is paroxysmal, radiating from angle of the jaw along one of the involved branches.  If the first branch, a shocklike pain is felt along the eye and back over the forehead.  If it is the middle fiber, the upper lip, nose, and cheek under the eye are affected.  If it is the third branch, pain is in the lower lip and outer border of tongue on affected side.  Pain is momentary but returns again and again.” (p T-30)

More up-to-date information is provided by drugs.com, a service of Harvard Health Publications:

“In some cases, the cause of trigeminal neuralgia is unknown. In many people, however, something seems to be irritating the trigeminal nerve, usually in the area of the nerve’s origin deep within the skull. In most cases, the irritation is believed to be caused by an abnormal blood vessel pressing on the nerve. Less often, the nerve is being irritated by a tumor in the brain or nerves. Sometimes, the problem is related to a rare type of stroke. In addition, up to 8% of patients who have multiple sclerosis (MS) eventually develop trigeminal neuralgia as a result of MS-related nerve damage.”

So, if a patient were to ask his physician why he is experiencing excruciating stabbing pains in his face, the response “because you have tic douloureux” is a perfectly logical explanation.  It might, or might not, be correct – that is not the issue.  But it is a coherent, valid explanation, and is not simply a relabeling of the presenting problems, which is  the essential status of all psychiatric diagnoses, other than those specified as being “due to a general medical condition”.

What’s particularly interesting here is that the BPS document is in fact very clear on this matter.  The sentence following the passage quoted by Dr. Pies reads:

“An analogy with physical medicine might be a label such as ‘idiopathic pain’, which merely means that a person is reporting pain, but a cause of that pain cannot be identified.”

Idiopathic means “of unknown cause, as a disease.”  (Random House Webster’s College Dictionary, 1992).  So if a patient were to ask a physician why he was experiencing severe facial pain, the response “because you have idiopathic pain” would simply be a restatement of the presenting problem, and would have no explanatory value.  The point being made in the BPS report is that a relabeling of the presenting problem that entails no understanding of cause has no explanatory value.  The phrase “because you have schizophrenia” is precisely on a par, logically, with “because you have idiopathic pain.”  Dr. Pies’ introduction of, and comparison to, “because you have tic douloureux” is an enormous red herring.  His use of the etymological annotation “painful tic” is also a red herring, in that etymology is a poor guide to current meaning.  The etymology of the word “mortgage”, for instance, is “death pledge”, because the original meaning of a mortgage was a pledge that a debt would be repaid from one’s estate after one’s death.  This is interesting, of course, but has no relevance to the current meaning of the term.

Certainly there are disease entities that general medicine has named, and can identify with reasonable accuracy, prior to establishing the etiology or cause of these illnesses.  But this is fundamentally different to the situation that prevails in psychiatry.  Firstly, in general medicine there are always prima facie reasons for believing that the condition is an organic pathology.  Secondly, the quest of general medicine for explanations and causes has been remarkably successful.

Neither of these conditions exists in psychiatry.  In fact, despite an enormous amount of highly motivated research in this area, no psychiatric “illness” has ever been reliably established to be the result of a specific neural pathology.  Even Thomas Insel, MD, Director of NIMH, wrote on April 29, 2013:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

Whilst I don’t agree with Dr. Insel in all areas, on this matter he has hit the nail squarely on the head.

The bottom line is this:  if one doesn’t know the cause of something, then one can’t explain it.  Explanation is the presentation of causes.  And despite their frequent claims to the contrary, psychiatrists do not know the cause of the loose collection of thoughts, feelings, and/or behaviors that they call schizophrenia.  They assume that any decade now they will discover this cause in the form of some neural pathology.  Meanwhile, they go on telling their clients the falsehood that they have chemical imbalances, or neural circuitry anomalies or whatever is the latest fashion, and that these putative illnesses can be corrected by drugs or electric shocks to the brain.  And they ignore the reality:  that the best (indeed only) way to understand people is to talk to them patiently, compassionately, and with humility, and without the assumption that one already knows the source of their troubles.  It is only in this way that we discover that people’s so-called symptoms are understandable within the context of each person’s unique history and current circumstances, and that the facile labels cataloged so conveniently by the APA are an irrelevant travesty.

And, indeed, Dr. Pies himself, even though he clings tenaciously to the need for psychiatric “diagnoses”, acknowledges the additional need to take the time to get to know clients:

“Finally, while diagnosis is a necessary first step in helping the patient with emotional, cognitive, or behavioral problems, it is far from sufficient. We must enter empathically into the patient’s ‘inner world,’ and provide a safe, trustworthy environment for the exploration of the patient’s troubles. This takes time—it can’t be done in 15 minutes!—and it requires what psychoanalyst Theodor Reik eloquently called, ‘listening with the third ear.’ “

But what Dr. Pies neglects to add is that the 15-minute med check has become standard practice in psychiatric care.  Douglas Mossman, MD, Professor of Psychiatry at the University of Cincinnati, has written unambiguously:

“Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”

Glen Gabbard, MD, a widely published professor of psychiatry at Baylor and Syracuse, has written on Psychiatric Times:

“There can be little doubt in our current era that the brief ‘med check’ is becoming standard practice in psychiatry.”

Dr. Pies himself, in an earlier paper (Psychiatrists, Physicians, and the Prescriptive Bond) has written:

“Unfortunately, many prescriptions for psychotropics are written in haste—often after the infamous ’15-minute med check’ – and without any real understanding of the patient’s inner life or psychopathology.”

Dr. Pies, incidentally, also failed to mention that Theodor Reik (1888-1969) was a psychologist, not a psychiatrist, and in fact, had to fight a lawsuit against the medical community in order to establish the principle that psychoanalysis could be practiced by non-physicians.

Nor does Dr. Pies seem to recognize that psychiatry’s contention, that the DSM entities are bona fide illnesses, is, in fact, the primary driving force behind the cursory treatment which he decries so ardently.  After all, if people’s problems are caused by brain malfunctions, and if psychiatric drugs correct these malfunctions, what need is there for dialogue or understanding?

There is no factual or logical evidence that the loose collection of vaguely defined thoughts, feelings, and/or behaviors that psychiatrists call schizophrenia is a coherent entity, much less an illness.  Nevertheless, psychiatrists continue, not only to make this groundless assertion, but also to prescribe neurotoxic chemicals to “treat” this pseudo-illness, often against the vehemently expressed wishes of the victims.  This is not the practice of medicine.  It is a travesty which no amount of Dr. Pies’ sophistry can mitigate.

. . . . . . . . . . . . . . . . .

With regards to the title of his piece –  The War on Psychiatric Diagnosis – Dr. Pies has this to say:

“If ‘war’ seems a somewhat overheated term in the title of this piece, I would recommend perusal of some of the anti-psychiatry Web sites, on which the ritual evisceration of psychiatry and psychiatrists is unapologetic and unrelenting.*”

The asterisk refers to a footnote:

“*In my view, the Web site of ‘Mad in America’ is particularly abusive toward psychiatrists, though it is far from the worst of the bunch”

Well, of course, there’s anger and vitriol on both sides of this issue, though I must say that MIA has always struck me as the epitome of civility and restraint.  But it’s important in this, as in any human endeavor, to rise above the rhetoric, and deal honestly and squarely with the issues.  And the issue on the table here is that psychiatric diagnoses – other than those clearly identified as “due to a general medical condition” – have no explanatory value, but are routinely and deceptively presented by psychiatrists as if they did.

And, Dr. Pies has not addressed that issue. 

Psychiatry is under criticism because its concepts are spurious, and its treatments are destructive.  The problems that psychiatry guards tenaciously as its turf are not medical in nature, but for the sake of that turf, are shoe-horned shamelessly into psychiatry’s bogus nomenclature, and are “treated” with neurotoxic drugs and electric shocks to the brain.  Petulant complaining about the “ritual evisceration of psychiatry and psychiatrists”, is no substitute for rational, honest, and informed debate.

  • all too easy

    I don’t expect my orthopedic surgeon to explain to me what it is about bone that lets it crack. I don’t expect her to tell me why an open wound bleeds or is vulnerable to infection. Helpful, healing medicine is not contingent upon an understanding of the illness, or break, or injury. We can’t explain the placebo effect! We don’t know what triggers out-of-control cell division and mutations. We don’t understand the common cold, yet we treat these conditions the best we can based on the best information we do have. It is no sin to stop someone from bleeding to death even though we may not know what is causing the bleeding.
    Antis seem slow to apply common sense and quick to find evil in everything “psychiatric.” As a result, they wind up so far afield from reality, it is astonishing.
    Phil, how many undisciplined, misbehaving kids responded favorably to your attempts to intervene with your medical approach? If there is literature published anywhere that confirms your beliefs, let us know.

  • S Randolph Kretchmar

    Another brilliant shot Phil, thanks for your continuing efforts to say what has to be said. I’d love to know how this one strikes you: http://www.psychiatrictimes.com/special-reports/intermittent-explosive-disorder/page/0/1?GUID=1BB3C6CB-66A3-4FED-ABBB-BE03D78F9CD4&rememberme=1&ts=02042015

    Seems to me “Intermittent Explosive Disorder” and Dr. Coccaro should be right up there, as examples in your analysis.

  • S Randolph Kretchmar

    No doubt I am among those “antis” or “undisciplined, misbehaving kids” whom you credit with a common sense deficit and too-quick awareness of evil, all too easy…. But my connection to reality actually comes from spending thousands of days over thirteen years inside state psychiatric institutions, working directly with violent psychotics, their slavemaster psychs, and the useless bureaucrats who get paid from my taxes.

    If you had any comparable connection to reality, you would surely know that stopping people from bleeding to death is not what they do in those places. What they really do is torture and degrade human beings, and pretend to be “helping” individuals and society by doing that. The so-called forensic psychiatric system is an anti-human obscenity. We must abolish it, even as American slavery had to be abolished, to have any aspirations at all toward freedom and dignity.

    I celebrate Phil Hickey’s valuable contribution for abolition.

  • Phil, et al,

    The discussion on Psychiatry Today in response to Dr Pies article has been wide ranging and contentious. Like you, I immediately spotted the comparisons of apples to oranges in Pies’ logic. In part, I offered the following thoughts in contradiction:

    ===========

    Dr Pies,

    There is much in your article over which people of good will can complain. I’ll stick primarily to what I know best:

    You write of a criticism in the BPS report:>>>

    [original quote]

    We normally expect medical diagnoses to tell us something about what
    has caused a certain problem, what the person can expect in future
    (“prognosis”) and what is likely to help. However, this is not the case
    with mental health “diagnoses,” which rather than being explanations are
    just ways of categorizing experiences based on what people tell
    clinicians. For example, someone who says that they are hearing voices
    might be given a diagnosis of schizophrenia. Since this says nothing
    about cause, it makes little sense to say that the person hears the
    voices “because of” the schizophrenia.1

    [your comment]

    Actually, it makes a good deal of sense, in precisely the same way it
    makes sense to say, “Mr. Jones has severe facial pain because he has
    tic douloureux;” or “Smith has severe left-sided head pain and nausea
    because he has migraines.” We still do not know the precise causes of
    these conditions; moreover, the diagnosis of both tic douloureux
    (literally, “painful tic”) and migraine headache (etymologically,
    headache “in half the cranium”) is made almost entirely on the basis of
    “what people tell clinicians”—not on the basis of an abnormal laboratory
    value, X-ray, or anatomical finding. (Of course, certain tests, such as
    a CT of the head, can help rule out other diagnostic possibilities,
    such as a brain tumor).

    =================

    As a technically trained layman site moderator who supports over
    6,000 trigeminal neuralgia patients in 110+ countries, I must suggest
    that you got this one at least half wrong. Tic douloureux is a useful
    diagnostic label for chronic unilateral (or variable bilateral) face
    pain of neurological origin. Whether etiology is precisely established
    or not (and in a substantial proportion of cases it is), this diagnosis
    often leads to a successful program of medication management or surgery
    which substantially improves the quality of the patient’s life.
    Diagnosis of migraine may have the same outcomes for others.

    I profoundly doubt that the same can be said in any consistent way
    for diagnoses of psychosis or schizophrenia — or for that matter of
    mild to moderate depression. Psychiatric diagnosis is notoriously
    imprecise and arbitrary, and the DSM process itself has been corrupted
    by pharmaceutical company money.

    What is known of neuroleptic drugs is that they numb out severely
    distressed people and make them more compliant or “manageable”, while
    creating significant long term risk of permanent damage in tardive
    dyskinesia, increased rates of suicide and lowered life expectancy.
    Likewise, less obviously destructive anti-depressant drugs work no
    better than placebos for mild to moderate depression. There is simply
    no reliable evidence that either class of drugs actually corrects a
    measurable or real imbalance of brain chemistry. And all of this
    despite a long record of drug company frauds in the promotion of their
    ineffective nostrums.

    You seem to take particular umbrage with “Mad In America” for
    challenging prevailing dogmas on biological psychiatry. I’m not always
    comfortable with some of the things I read in MIA, myself. But please do
    not forget that MIA represents the real-world experience of thousands
    of people who have been misdiagnosed, mistreated, and materially harmed
    by others in your profession. Reasonable people can and will disagree
    on some of the premises of the BPS report. But everyone should be
    listening to these thousands of people, for the profession of psychiatry
    has categorically failed them and their families.

    Richard A. Lawhern, Ph.D.

    Resident Research Analyst

    “Living With TN” – an online community within the Ben’s Friends cluster for patients with rare medical disorders.

    =============================

    I later added the following to the thread:

    If I may add further thoughts: Unlike many of those who subscribe to
    [Psychiatric Times], I am neither a psychiatrist nor a psychologist. My
    doctorate is in systems engineering and much of my professional
    experience was with control systems. I read the medical literature on
    behalf of chronic pain patients, and I’ve done online surveys of
    outcomes in patients referred by a medical doctor for psychiatric
    evaluation under a presumption of psychosomatic illness. I am doubtless a
    layman in your fields, but hopefully a thoughtful layman.

    In 40+ years of professional work in operations research and systems
    technology, I’ve brushed up against the human factors field multiple
    times, and done a fair amount of reading in the literature of perception
    and personality. One of my most formative books is now quite old and
    hard to find: Martin L. Gross’ “The Psychological Society — the impact
    and the failure of psychiatry, psychotherapy, psychoanalysis and the
    psychological revolution” (NY, Random House, 1978). In that book, Gross
    traced what appears to be the same guild cat-fight that we’re still
    observing today, between proponents of the brain-disorder model of human
    distress, and those convinced that psychosis and schizophrenia proceed
    directly from childhood trauma. The conclusion Gross reaches might be
    characterized as “a pox on both your houses”. I’m inclined to agree.
    You guys are simply missing the point, and doing your patients a major
    disservice [by] persisting [in] largely specious arguments.

    Gross discusses multiple studies going back as far as the 1950s, in
    which outcomes were compared between patients who underwent
    psychoanalysis and psychotherapy in residence beds of mental health
    treatment centers, versus patients evaluated for depression or cognitive
    disturbance and then placed on admissions wait lists. After six
    months, about half of both groups reported themselves and their
    difficulties “improved”. There was no statistically significant
    difference between the two groups, or between resident patients who
    underwent different talking therapies or different frequencies of the
    same therapies. NONE. But psychiatrists went right on believing in
    their dogmas and treating patients in the same ineffectual protocols.

    I’ve also followed some of the fracas over last year’s declaration by
    the US NINDS that the DSM will no longer be used as a primary
    organizing principle for research. DSM has been dropped in favor of a
    research framework focused on understanding the physical/neurological
    brain and its processes — a program which is at least daunting, given
    the abject failure of such research up to now, in generating useful
    therapies for human cognitive disorder or emotional distress.

    As a technologist, I know just a little about the wonderful computer
    which resides in the human skull. It can aptly be described as a highly
    parallel multilevel processor with redundant distributed memory and
    self-configuring neurological sub-processors. Many of its internal
    workings are “stochastic” in nature (multiple signals share common
    channels that are often obscured by noise and channel cross-talk).

    Although some interesting work is being done with functional MRI
    these days, it seems to me that any real knowledge of the multitude of
    ways that the brain “works” is still at the level of a child’s
    construction of tinker toys in the midst of an oil refinery. We may see
    how various “centers” of the brain light up under various conditions —
    but the significance of that activity is still very much unknown.

    In light of this background, and strictly as a layman, I would call
    upon my betters in your profession to exercise some humility while they
    argue the merits of their respective cases. You are working with very
    little hard data and an abundance of financially or academically
    self-interested opinion. And a lot of the data you do have indicates
    pretty strongly that what you’re doing has brought real harm to
    thousands of your patients.

    Sincerely,

    Richard A. Lawhern, Ph.D.

    Systems Engineer and Chronic Pain Site Moderator

  • cledwyn bulbs

    An article about doctor Pies, eh? I’m going to have to go and be sick in advance before ocular inspection of his latest unrestrained outpouring of matter of colonic origin (I thought I’d refrain from calling it excrement, in deference to the sensitivities of my precious Ronnniepoos).

    Lots of kisses,

    Cledwyn

  • cledwyn bulbs

    He keeps on complaining about how supposedly abusive critics and survivors of psychiatry are. I would say that you live by the sword, you die by the sword, but of course, we don’t perpetrate violence against psychiatrists, but any practitioner or proponent of psychiatric torture certainly can’t expect their victims to make concessions to the oh-so delicate sensitivities of their tormentors.

    Then again, Pies doesn’t see himself as a victimizer, or as a casuist for one of the foremost abuses of the past god knows how many years. No, he sees himself as a healer, consecrated to human suffering and the amelioration thereof, just like politicians don’t see the work they are engaged in as providing a vehicle for the will-to-power, but as serving the people; just like our soldiers don’t see themselves as violent enforcers of the interests of the bullies on the geopolitical scene, but as agents of democracy, liberty, and other glittering generalities that lull the conscience to sleep

    Psychiatrists like himself conceptualize the work they do in terms of healing the sick. They talk of psychiatry, the healing profession. To paraphrase Robert Musil, the image the practitioners of a profession have of the work they do is rarely a reliable indicator of the truth.

    You are not a healer Mr Pies; you are a mountebank.

    In psychiatric rhetoric, a bizarre transposition seems to have taken place; the victims have exchanged places with the victmizers. This can be seen on the very site that Mr Pies accuses of being particularly abusive towards psychiatrists, even though its absurd posting guidelines (which seems to be in a state of perpetual accretion as Mr Whitaker, and the people who run that site, fall deeper and deeper into the bottomless pit of intolerance) seem to have been specifically tailored to appease certain practitioners of psychiatric torture, who have been made to feel very welcome on that site, just as the victims of such people have been, to a proportionate extent, made to feel unwelcome.

    Nevertheless, I’ll refrain from further criticism of Mr Whitaker who, having been transfigured by the power of celebrity, is carefully protected by his legions of votaries, in whose imaginations any slight aimed in his direction assumes the proportions of an affront against regal authority, or of an act of heinous victimization to be tolerated by no man in whom the nobler sentiments are found to stir, no more to be countenanced than those evil people who weren’t wracked with grief when Saint Diana died in a car crash.

  • cledwyn bulbs

    Evisceration? Either he’s saying we disembowel psychiatrists, or that we destroy and damage them, or deprive them of vitality or force. Hmmmmm……

  • all too easy

    You kill me. Thanks buddy

  • all too easy

    Did you ever visit Greystone near Morristown, N.J.? Bob Dylan visited his idol Woody Guthrie there once upon a time. It housed the mentally ill.
    BTW, Phil and his gang are the antis. I am a misbehaving, undisciplined naughty fella who refused to pay attention most of his life in school, in scouts, socially and in athletics. My parents are to blame and so are my teachers (who were among the finest in the world). They didn’t tell me to pay attention often enough. If only they had! I would have avoided a lifetime of excruciating pain, humiliation, embarrassment and failure. Just ask Phil. Having never met me, he nevertheless knows that’s all I ever needed.
    Psychiatric meds work wonders now and In 25 years, our best drugs will seem like machetes compared to the razor like meds to come. They will be incredibly precise, targeting very specific molecules within the brain with far fewer side effects.

  • all too easy

    Got that right doc. Our understanding of the human brain is primitive compared to what our descendants will know in as little as one hundred years. We are making progress, however, and this new information gleaned contributes to the massive foundation upon which future achievements will emerge.
    “…exercise some humility while they
    argue the merits of their respective cases. You are working with very
    little hard data and an abundance of financially or academically
    self-interested opinion. And a lot of the data you do have indicates
    pretty strongly that what you’re doing has brought real harm to
    thousands of your patients.”
    There is more than an abundance of very hard data right now.

  • Phil_Hickey

    Randolph,

    Thanks for coming in. I’ll take a look at the intermittent explosive disorder article.

  • Phil_Hickey

    Randolph,

    Well said. Thanks for your support.

  • Phil_Hickey

    Red,

    Thanks for this very nicely worded and sound rebuttal. Whenever I meet someone who has been studying neurology, I always ask: Is it known what precisely occurs in a child’s brain when he/she learns that 2 + 2 = 4? So far the answer has always been “no”.

    Best wishes.

  • If there is such an abundance of hard data, then show us, please, a single FDA-approved or medicare-reimbursable therapy that is grounded on neurological studies of brain function. You’ll be hard-pressed, I think.

    Yours seems to be the same “it’s just around the corner” message that we’ve been hearing from the proponents of the brain disorder theory of human distress. And that message has been sounding for over 20 years with astoundingly negative results in drug-induced destructive side effects, suicide, and death. Examples abound. How popular these days are Prozac, SSRI therapy, benzodiazepines, electro-convulsive shock or lobotomy? But all were advertized in their day as unalloyed benefits to the people they often irreparably harmed.

  • all too easy

    I am delighted and honored that you asked to see the proof. As I said, it is not only available but overflowing.
    The moment Dr. Phil releases the proof that ADHD is purely a disciplinary problem, I promise to reveal the evidence I refer to.
    In the meantime what you have shown, unintentionally and quite foolishly (if you had hoped to continue in your fraudulent caper) is fascinating. Just think, no one has asked for or seen the evidence Dr. Phil claims proves ADHD is a problem of misbehaving, and he has been posting that assertion for a long time. I, a newcomer, am asked to back up my claims after just a few weeks. Stunning. Amazing, isn’t it, how antis fail to question their own version of reality, while demanding others prove theirs?
    What is more astounding is this: even after revealing their lack of due diligence, I know, beyond a shadow of turning, they will remain unmoved, unconcerned and absolutely unfazed by the disparity that blasts their entire belief system into pieces.

  • “ATE,” you are asked to offer evidence of the validity of your claims. Phil Hickey already has, in the work of multiple investigators. He is also not the only qualified professional to note that ADHD is a fad. No less a figure than Dr. Allen Frances, MD, former chair of the DSM-IV Working Groups under the APA has also written widely to this effect. There are other issues with some of Frances’ public positions, but he makes a lot more sense than you do on the questions surrounding ADHD.

    Unlike you, I choose to write in my own real-world identity and to acknowledge limitations of my background, rather than sniping anonymously from the shadows. I find your postings border on childish, to tell the truth. But that’s just my personal reaction. You’re not helping your case by dodging and weaving. So put up or shut up.

  • all too easy

    There ya be. Just like I said. I would like to say, “See! I am brilliant!” However, accurately predicting what the antis will do next doesn’t take much. Thank you for once again exposing your foolishness.

    Phil, you got egg on your face, again, and it doesn’t bother you one bit. Anyone who devotes his remaining few moments on this earth, (during retirement, especially, when he can enjoy his free time any way he wishes) trying to disrupt and destroy modern medicine without a solid foundation he can rely upon for established, researched, peer reviewed, easily cited facts, is, rather tragically, throwing away the brief amount of time he has left.

    “I don’t know of any reliable natural treatment for ADD.”

    “Children with ADHD are often subject to almost constant ongoing criticism.” (Thanks, Phil, for doing your part as a chronic critic.)

    “ADD in adults may be treated by counseling along with the same type of stimulant medication prescribed for children. Alternatively, certain antidepressants may be recommended. Conventional treatment also includes teaching behavior skills (such as list-making, day planners, filing systems, and other organizational methods).”

    Andrew Weil, M.D.
    Listen Red, (my dad’s nick name) I appreciate your passion, but we really have nothing to discuss. If and when Phil decides to post the research you say he has, to defend his misbehaving cure for ADHD, I’ll be more than happy to refute it.
    You take care bro

  • Zoe

    Wonderful! I enjoyed reading this article! By offering examples, it has a great deal of impact!

    So often when people write articles about this topic, arguments are lost within jargon, and veer-from-the-point. The message within this article couldn’t be any clearer.

    For those who cannot accept that psychiatry is flawed, after reading this article, I would argue that you are either stubborn, or that your belief in psychiatry is now so engrained, that it’s comparible to religion (it doesn’t matter how good an argument you put in front of a religious person, if that evidence questions their religion, the chances are they will dismiss it).

  • Zoe

    “rather than sniping anonymously from the shadows. I find your postings border on childish, to tell the truth … You’re not helping your case by dodging and weaving. So put up or shut up.”

    I second this, Red Lawhern. This mirrors my own thoughts, and your above response has made me smile.

  • all too easy

    “It is no sin to stop someone from bleeding to death even though we may not know what is causing the bleeding.” ate

    “If you had any comparable connection to reality, you would surely know that stopping people from bleeding to death is not what they do in those places.” RED

    “Well said” Dr. Phil
    Although Phil agrees with you, SRK, I assure you without doubt or hesitation, I know what its like to bleed to death, daily, for years and years. I suffered alone without the intervention of psychiatry and the wonderful psychiatrists I’ve come to know. Phil and his gang deny what I and many others endured as kids and adults. He and his pals call us liars, lazy, undisciplined, addicted and duped fools, victims of a massive conspiracy. They do so without ever offering one single shred of proof.
    They do not bother to interview adults with ADHD, those successfully treated, relieved of the damnable traits of a damnable disorder. Odd isn’t it, they don’t ask us about our experiences, our first hand accounts. But they do accuse. They thrive on deprecating a group of people who have been bludgeoned with criticism, many for most of their lives. They encourage you to do the same. Like we haven’t been ganged-up upon most of our lives. Do you suppose it is easy to walk through life with ADHD and not be confronted constantly with all the errors and gaffs you make all day, every day, no matter how hard you try?
    Pour it on, Phil and company. You have no evidence that we were bad kids or lazy or undisciplined. But now, we are equipped to stand up for ourselves and all the children without voices and to speak our truth. Meds have made it possible for us to articulate our struggle and to organize. Meds have empowered us. Meds and our beloved doctors have given us the rare opportunity to combine our utter despair with radiant hope and to forge ahead, to live, TO LIVE-TO LIVE and to ensure that everyone cursed with this thing can grasp ahold of life, tapping into the full range of all that modern medicine has to offer.

  • all too easy

    Got to love it. Who was it, Clodhopper I think, who said psychiatrists were like Nazis?
    Hilarious.
    Phil, your fans want you to shut me up because I am waiting for you to prove discipline is the cure for ADHD. You cannot. I know it and you know it, but your devotees, hoping against hope, are scared to death you may in fact have nothing. Where’s Goebbels when you desperately need some instant propaganda?
    I third this Red. Right on!

  • ATE — what are your academic or personal study qualifications? Why should anyone take you or your unsupported assertions seriously?

  • all too easy

    “I find your postings border on childish, to tell the truth.” Big Red

    Me 2. to be honest.

    She is wearing rags and feathers
    From Salvation Army counters
    And the sun pours down like honey
    On our lady of the harbour

    And she shows you where to look
    Among the garbage and the flowers
    There are heroes in the seaweed
    There are children in the morning
    They are leaning out for love
    And they will lean that way forever
    Cohen
    Where are the heroes?

  • cledwyn bulbs

    I like how at the start of that article Pies refers to a supposedly seriously mentally ill patient who is burrowing through the wall of his room, presumably in a so-called hospital, that in fact bears only a cosmetic relation thereto.

    Now, assuming that what Dr Pies says is true, is he suggesting that such a person should be forced “treated”, simply because he is so desperate to escape from these masses of bricks in which torture and hypocrisy are found to often reside?

    He speaks with the confidence of a man emboldened by his own stupidity. He says,

    “Now, after reading the British Psychological Society’s report on psychosis, one might conclude that the way to help such a patient is to sit down with the poor chap over lemon tea; guide him toward a mature understanding of his problem; and allow him to decide what, if any, treatment, he wants.”

    What problem? Maybe he’s trying to escape. If this isn’t his intention (and one would have to be very naive to assume that Mr Pies would be entirely honest in this regards if he had an incentive to bend the truth, given that the profession is something of a blackhole of scruples, in which mendacity is found to be no less common than it is in politics and advertising, and other fields of endeavor I would group under the heading, “the lying professions”), then it would seem likely that he is badly sleep deprived and/or suffering from amphetamine toxicity or something.

    Yet this is of no importance. What really matters here is the telling suggestion that such a person should be forced “treated”, and the implication, inherent in his mocking tone, that anything other than this would be utterly absurd. What a truly warped individual!

    Yet he has the temerity to question why it is psychiatrists like he, who engage in this particular specimen of violence, about which a web of deceit and casuistry has been cunningly woven, are being “ritually eviscerated”, or whatever it is that in his confusion he is trying to say, which admittedly escapes this writer, who fails to understand how holding up psychiatrists to ridicule constitutes either literally or figuratively eviscerating them, perhaps because I still consult the dictionary, something Mr Pies perhaps stopped doing years ago when he fell into the habit of making up his own meanings for words whose actual semantic content runs athwart the designs and interests of institutional psychiatrists.

    He speaks here with the confidence of a man who believes his position unassailable. In his love affair with force and violence, the poor chap has lost the ability to conceive of the many choices open to him. In proportion as men desire to do something, do they deceive themselves of the capacity to do otherwise.

    Part of the problem here is that there is no reason to assume that that bloke has to be detained, but assuming this was a truly dangerous individual whose liberty might encroach upon and imperil the lives and liberties of others, there are far less invasive ways of dealing with such people, which psychiatrists like he studiously ignore in their love of force and their seeming addiction thereto.

    If he is a danger to himself, then I fail to see what business that is of dangerous quacks like he. Psychiatry’s contribution to the sum total of human misery greatly preponderates over its contribution to the sum total of human happiness, a claim for which there is no dearth of evidence.

    There is no evidence that its nostrums cure any disease, yet tens of millions of mutilated brains bear eloquent testimony to the harm psychiatry has authored on a scale that would impress even a president, the foremost “beneficiaries” of which are we “psychotics”, the objects of the institutional psychiatrist’s greatest concern and sympathy, the depth thereof, when they abuse us, they furnish proof of.

    Sadly, the situation of psychiatric slaves is pretty bleak. Most people are blind to this particular species of institutional violence, directed as it is against outsiders, the persecution of which is something of a centripetal force in society, a veritable principle of social cohesion, not forgetting the role of propagandists for psychiatric violence and certain moral entrepreneurs of the mental health movement. What makes this even worst is that many of the people who claim to be opposed to this, such as many members of the MIA community, have within their circle of acquaintance practitioners of the very evil they claim to be against.

    Only when a man’s principles have been put to the proof should the genuineness thereof be decided, though nothing could be more opposed to this than the attitude, regarding this, that prevails in our age, where men need only balance their so-called principles on the ends of their tongues ostentatiously to convince others of the depth thereof.

    The most ridiculous part of his article (and its up against some pretty strong opposition from just about every other part), I would say, is where he talks of stigma. Typical of the institutionalized denialism of the profession, responsibility for this stigma is projected onto society. It has nothing to do with the biogenetic model, which frames the patient as conditioned by the impersonal forces of genes and biology; nor does it have anything to do with the profession’s use of media outlets to menace an ever-hysterical public with specter of the madman. No.

    Mr Pies is a nonpareil spin doctor. He should get an award.

  • cledwyn bulbs

    That should be “the specter”.

  • all too easy

    You are too funny.

    “If he is a danger to himself, then I fail to see what business that is of dangerous quacks like he. Psychiatry’s contribution to the sum total of human misery greatly preponderates over its contribution to the sum total of human happiness, a claim for which there is no dearth of evidence.” Clodapuss–, my brother, even for you, that is quite the leap. Since Antieverything conspirators rarely offer double blind, controlled studies to back up all their silliness, the chances are good you won’t either. I predicted it here first.

    However, if an anti is so inclined, I’d love to see the evidence for, “tens of millions of mutilated brains bear eloquent testimony to the harm psychiatry has authored…” Good luck with that.

    I would have preferred to have Mark David Chapman drugged and placed in a secure psychiatric facility before he spent the day waiting for his Catcher In The Rye fantasy to play out. John Warnock Hinckley locked away and drugged was a better option than maiming Jim Brady, Regan’s press secretary, by shooting him in the head with an exploding bullet called the devastator.
    Ruge, a neurosurgeon, had been professor of surgery at Northwestern University when Kobrine took his residency there. (Ruge also had been a partner in practice with Loyal Davis, Nancy Reagan’s stepfather.) He was Reagan’s personal physician. Loyal Davis taught my grandfather, who became a surgeon, at Northwestern. Ruge told Kobrine to do what he had to to save the life of Jim Brady before he began to search, “for life tissue, excising blood clots and debris, removing abnormal tissue, cauterizing ruptured blood vessels, the doctors were able to extract the bullet fragments.”

    The bullet had exploded inside Brady’s head, the scattered pieces rebounding, opening cracks in the front and bottom of his skull. These were later to be the source of serious problems of leakage of air and cerebrospinal fluid. (Authorities found later that Hinckley had used “devastator” bullets that explode upon impact. The only devastator to explode that day was the one that hit Brady.)
    Five hours later, they were through. Yes indeed, drugs and confinement would have been a much, much better course of action.
    BTW, if someone accepts my challenge, please be sure to include Brady’s mutilated brain in your analysis, okay, clyderhoops?

  • cledwyn bulbs

    There’s no helping fools, and all too easy is one such fool.

    He really is an embarrassment. I wasn’t aware you could get the internet in a cave. Maybe one day he’ll stir that dormant organ he keeps between his ears from its slumber and develop a sense of shame.

    He spends most of his time conferring honours upon himself no-one else would, failing to understand that self-praise is no recommendation.

    Hopefully he’ll get bored soon and go and spread the detritus of his feckless existence somewhere else, instead of hanging around here like some giant internet slug, making a spectacle of his foolishness from which he no doubt derives his misplaced self-confidence.

  • all too easy

    Thanks my friend. To receive recognition from his royal highness is a thrill I cannot describe.

    It is true. I am patient. I have given you antis an abundance of time to demonstrate how discipline is the cure to the ADHD puzzle. No one has taken the challenge, even though I’m offering a glorious grand prize to the first one who can defend Phil’s undisputed claim to ADHD expertise–we are naughty. How did you know, Phil? And to think, all this time we’ve been making major bucks reselling our drugs. Well, those days are over. I was pullin in $2,500,000 a year on this contrived “disease”.

    BTW, THE GRAND PRIZE IS STILL AVAILABLE until next week. Don’t miss this once in a lifetime opportunity to relax with Clydepuss on the beautiful island of Manhatten next February on the shores of the magnificent Hudson River, where you will pay him to edit his historic writings on the joy of the life.

  • all too easy

    Oops. That should read, “I fourth this RED!”

  • cledwyn bulbs

    We can write as much about this issue as we want, but alas, falsehood is mighty, and will always prevail. In human society, the following law obtains, namely, that the respect and support apportioned to a man for his opinions do not run in direct ratio to the intrinsic worth thereof, but to their intrinsic worthlessness.

    Human history is a history of successive errors and follies, and the iniquities exercised thereupon. Why? Because man is insane (yet none are so insane as those who think they are not). The belief that he is not insane is merely one of the lunacies brought forth by Reason’s sempiternal slumber.

    Almost all of man’s thoughts lead back to error, like some fool lost in a forest whose every path leads back to the same spot.

    Falsehood is like a celebrity upon which all eyes converge. Truth, on the other hand, is like an inebriated tramp, sitting in the corner, reeking of urine, in relation to whom all are found to be either indifferent or just plain hostile.

    In every society you will find that falsehood holds court.

    Human beings are such delusional creatures because the truth is far too often found to be simply incompatible with life, and unfit for human consumption. It’s something of a “mental health” hazard. Men act towards it as if it were surrounded by a cordon sanitaire.

    People usually believe something in proportion as it is dubious, or in proportion as they shouldn’t, that is, assuming that the goal of existence isn’t to kill ourselves, which I would dispute.

    For every accepted truth there is a truth teller’s grave, tucked away next to the toilet in the corner of some graveyard, covered in thickets, which nobody visits. The persecution of the truth teller is a veritable principle of social cohesion, and his very existence encourages mob formation.

    Man’s love of falsehood is like a bottomless abyss; his love of truth is strictly circumscribed within, and extends no further than, the narrow sphere of his interests.

  • all too easy

    When I stop howling, I’ll respond. There. Better.

    As I said, no one can produce a shred of evidence that the ten million destroyed brains exist anywhere except in the brilliant brain of clydehopper. Sorry to hear your life is one long miserable moment after the next. Prozac is known to be of great value in relieving obsessive and depressive disorder. Although, trying it certainly could increase that number to ten million and one. Have you seen a good psychologist like Phil for some much needed relief?

    Prozac is also recognized as a wonderful tool for dispersing one’s anger.

  • The debate in Psychiatric Times continues concerning “The War on Psychiatric Diagnosis” My most recent commentary below:

    From the wide-ranging comments on this article, it seems evident that laymen like me are not the only dissenters from informed psychiatric opinion concerning the value and hazards of mental health diagnosis. Professionals have strong reservations too. And this debate is also occurring in other publication venues, some of them read by tens of thousands of patients and former patients and their families.

    Today’s article by Dr Allen Frances, MD in Huffington Post Science strikes me as pertinent to the debate here at Psychiatric Times. In “Can We Replace Misleading Terms Like ‘Mental Illness,’ ‘Patient,’ and ‘Schizophrenia'”, Frances offers the view that while some form of diagnosis seems needed as a guide for effective triage and treatment, the labels of the DSM are rather often unhelpful in that intended result. He also quotes extensively from his debate with Anne Cook, Ph.D. who led the project on “Understanding Psychosis”. Like Dr Pies, he criticizes the report of that project on multiple grounds. But some of the things he has to say in agreement with Cook also seem worthy of consideration.

    To quote from his article:

    =======Begin Extract========

    Those of us who worked on DSM IV learned first-hand and painfully the limitations of the written word and how it can be tortured and twisted in damaging daily usage, especially when there is a profit to be had.

    The DSM IV was intended to be a very conservative document — we rejected all but two of 94 suggested new diagnoses. We also field tested carefully to ensure there would not be dramatic and unexpected impacts on rates.

    This did not stop the widespread misuse of the terms Attention Deficit Disorder, Asperger’s Disorder, Bipolar Disorder, PTSD, Paraphilia and others. The lesson: If some wording in DSM can possibly be misused for any purpose, it almost certainly will be…

    …”Mental illness” is terribly misleading because the “mental disorders” we diagnose are no more than descriptions of what clinicians observe people do or say, not at all well established diseases. For example, the term “schizophrenia” just describes a heterogeneous set of experiences and behaviors; it doesn’t at all explain them and eventually there will be hundreds of different causes and dozens of different treatments. “Schizophrenia” is certainly is not one illness.

    The “mental illness” term also lends itself to a simple-minded biological reductionism that pays insufficient attention to the psychological and social factors that are crucial in understanding anyone’s problems. Everyone complains about “mental illness,” but nobody has come up with a better substitute….

    =======End extract =======

    It seems to me highly ironic that Dr. Pies would appeal for the credibility of his profession on the basis of published opinion by the US Surgeon General. At its best, the US Department of Health and Human Services can hardly be said to be an opinion leader in medicine. Nor does the US government speak with one voice on medical or mental health policy. As noted in other comments here, US NINDS last year dropped the DSM-5 as an organizing principle for research on human distress and cognitive disorganization. Thus it seems reasonable to conclude that while some consensus position is needed on diagnostic labels, the DSM-5 at least has significant deficiencies as a guide to research.

    I would personally go beyond that observation, of course, to suggest that the process of the DSM-5 was seriously corrupted by pharmaceutical company money. This is a position taken by Dr Frances and well explained in his book, “Chasing Normal”. There is also and separately, abundant evidence of Big Pharma deliberately cherry-picking research results and applying invalid analysis protocols to support the marketing of their products. And there is evidence for significant and sustained harms in the over-prescription of medications for both mild to moderate depression and more severe impairment in what are called psychosis and schizophrenia.

    None of this is to say that the “Understanding Psychosis” report has everything right. Pretty clearly they do not, particularly in their dismissal of the need for temporary interventions toward people whose thinking is so disordered that they cannot function or are otherwise a hazard to themselves or others. On balance, however, I believe a credible case can be made that diagnosis as a process needs to be significantly reconsidered and narrowed to apply terms and methods which actually have demonstrated value in helping people — at least proportionate to the harms that are done by diagnostic lack of precision and over-treatment of fictitious disorders better regarded as challenges to common sense and coping.

    Sincerely,
    Richard A. Lawhern, Ph.D.
    Patient Advocate

    See also:http://www.huffingtonpost.com/allen-frances/can-we-replace-misleading-terms-like-mental-illness-patient-schizophrenia_b_7000762.html

  • Phil_Hickey

    Red,

    Thanks for coming in, and for the quotes from Dr. Frances’ paper, which I will study.

  • Phil_Hickey

    Cledwyn,

    I agree with you that falsehood is mighty, but I believe that in this case, at least, it will not always prevail. The tide is lapping the edges of psychiatry’s
    sandcastle, and it will crumble. But then again, perhaps I’m just overly optimistic.

  • Neo

    Cledwyn, I forgot to mention, some of the responses to your comments make for great comedy.

  • Phil_Hickey

    Zoe,

    Thanks for coming in. Yes, indeed. Psychiatry is fundamentally flawed.

  • all too easy

    The July 1998 issue of The American Journal of Medicine explains it as follows:

    “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.” (Singh Gurkirpal, MD, “Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy”, The American Journal of Medicine, July 27, 1998, p. 31

  • all too easy

    Amen. That’s what I keep saying, too. Thank you! (and I’m not even chargin nothin neither– and this is all new material)

    This is a Fifth it RED!

  • all too easy

    Psychiatry is under attack because people who are mentally ill have found a convenient tool to express their self-pity and outrage for being sick, mentally. Everything they have suffered, and that is all they do all day, is due to psychiatry and psychiatrists. They bear no responsibility for anything. They continue to experience all the diseases that don’t exist incurred from the drugs that were forced upon them for no reason. All were misdiagnosed and all were horribly abused. They have none of the characteristics of violent, disturbed, deranged, dangerous out of control people. Son of Sam is a perfect example. Jim Jones wasn’t a narcissist. Saddam Hussein was perfectly normal.

    No. The truth is, the only really mentally sick people are those who believe there is such a thing.

  • Public Service Announcement

    WARNING: This blog has been under attack by an obsessed comment troll for four weeks now. This troll’s name is “all too easy”. This individual has spent hours a day leaving agitated and amateurish comments on dozens if not hundreds of the blog posts on this site over the past month. The general consensus among frequenters of this site is to ignore and read around this troll’s comments. If you see “all too easy” in the name identifier title for a comment, your eyes should know to skip that one and read a comment from somebody who is worthy of your attention. This is a great site and there are some great commenters. Please do not be discouraged by the strange and bizarre trolling assaults that this site comes under from some of the more unskilled followers of this debate. It’s very sad that this individual has five hours a day, every day to troll this site, but we hope and expect this pitiable individual to tire of trolling this site eventually.

  • Neo

    Trolling should have been included in the DSM 5. 🙂

  • all too easy

    “The general consensus among frequenters of this site is to ignore and read around this troll’s comments.” WARNING

    I agree. (Did you take a scientific poll? I better see a psychoanalysis, but it may take 10 years before you see any improvement.) In the meantime, I have to agree with WARNING. DO NOT READ OR COMMENT ON ANYTHING REMOTELY CONNECTED TO PUBLIC ENEMY # 1 (all too easy) regardless how brilliantly he dismantles every argument made by the antis. He is a danger to all rational, sweet, good folks world-wide.

    Phillip, I told you no one could back you up with evidence (that doesn’t exist) that ADHD is a matter of poor parenting. I even promised you I’d go bye-bye if someone could. Now, I have to see a shrink to get better! A shrink! Dr. Phil, do you have any openings next Thursday at 9:15 am MST?

    (BTW, 5 hours daily? It takes that long to look up each 2 syllable word.)

  • all too easy

    Trolling will be in my DSM-5R.

    “…the first study to clearly demonstrate the associations between epigenetic markers and ADHD, shedding light on the preliminary diagnosis and etiological studies of this widespread disorder.”

    Multiple epigenetic factors predict the attention deficit/hyperactivity disorder among the Chinese Han children.

    Citation:Journal of psychiatric research, 22 March 2015, 1879-1379

    Author(s):Xu Y,Chen XT,Luo M,Tang Y,Zhang G,Wu ,Yang B,Ruan DY,Wang HL

    Abstract:Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood. Despite its prevalence, the critical factors involved in its development remain to be identified. It was recently suggested that epigenetic mechanisms probably contribute to the etiology of ADHD. The present study was designed to examine the associations of epigenetic markers with ADHD among Chinese Han children, aiming to establish the prediction model for this syndrome from the epigenetic perspective. We conducted a pair-matching case-control study, and the ADHD children were systematically evaluated via structured diagnostic interviews, including caregiver interviews, based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised criteria (DSM-IV-R). The expression levels of risk genes DAT1, DRD4, DRD5, as well as their promoter methylation, were determined respectively, followed by the expression profiles of histone-modifying genes p300, MYST4, HDAC1, MeCP2. The multivariate logistic regressions were performed to establish ADHD prediction models. All of the seven genes tested were identified as risk factors for ADHD. The methylation of one critical CpG site located upstream of DRD4 was shown to affect its transcription, suggesting a role in ADHD’s development. Aberrant DNA methylation and histone acetylation were indicated in ADHD patients. In addition, a prediction model was established using the combination of p300, MYST4 and HDAC1, with the accuracy of 0.9338. This is, to our knowledge, the first study to clearly demonstrate the associations between epigenetic markers and ADHD, shedding light on the preliminary diagnosis and etiological studies of this widespread disorder.

  • Public Service Announcement

    I would never pathologize this rude troll’s rude behavior. He comes to a blog filled with views and people he doesn’t like, when he knows people including the owner of this private digital property would rather he didn’t come. His behavior doesn’t belong in any pseudoscience “manual” but needs rather to simply be judged for the desperate and pathetic display that it is. Don’t worry about it, this clown who thinks pasting the abstract of a study from China proves his “disease” of not paying attention is somehow a real disease. It’s very sad.

  • all too easy

    Huge mistake bro. You violated your own law.

    I REPEAT: DO NOT UNDER ANY CIRCUMSTANCES READ OR RESPOND TO THIS DERANGED DISEASED TROLLING BOOB. HE IS VERY DANGEROUS. DO NOT, I REPEAT, DO NOT DO WHAT THE LAWGIVER HAS JUST DONE. HE BROKE THE LAW AND WILL BE DRUGGED AND DETAINED UNTIL SUCH TIME AS HE HAS LEARNED HIS LESSON. HE IS UNWORTHY, THE SICKO TROLL, TO BE ON THIS EARTH AND WE ALL HOPE HE SHALL SOON DISAPPEAR AND WE CAN GO BACK TO EXPRESSING OUR HATRED AND DISGUST AS WE HAVE BEEN UNINTERRUPTED FOR DECADES.

  • Zoe

    Smiling!

  • cledwyn goodpuddings

    The best Pies article though, I would say, is, “Is Suicide Immoral?”. Obviously, with suicide prevention being one of the pillars of psychiatric power, suicide is an issue much discussed by psychiatrists invested in the business of existential slavery, and who derive profit therefrom.

    So it’s hardly surprising that perhaps the nonpareil casuist for organized psychiatry has weighed in on this subject, in that style immediately identifiable by its indulgence in periphrasis and equivocation.

    The article is published on that misinformation outlet, The Psychiatric Times, and the comments by the eminent doctor of spin, pardon, I mean psychiatry, attached thereto, are actually of far more interest, so perhaps it wouldn’t be fair to say that this is his best article.

    People like Dr Pies seem incapable of distinguishing between meum et teum. My body is my property, not any scoundrel who wishes to use it as a means to their own ends, be their family members or mental health workers. If a person doesn’t have a proprietary right to his own person, and doesn’t have a right to dispose of his own person free from the encroachments thereupon, enshrined in custom, convention, and tradition, then these very concepts are rendered almost meaningless.

    For, given that it is incontestable that our life in this world comes from our being wrenched from nothingness a parte ante through no desire of our own, then it should be left entirely to our discretion when the time is right to relieve ourselves of our existential burden, that is, our load of misery, boredom, despair, and pain, which is all the world has to offer some people.

    Nevertheless, Mr Pies has a found way of circumventing this, by invoking the putative decisional incapacity of just about anyone whose desire to commit felo-de-se is deemed, because of the lack of any physical ailment, to spring from an irrational state of mind, especially those whose problems it is taken for granted are psychiatric in character and for whom, according to assumptions commonly made and almost never exposed to the light of critical scrutiny, a causal relation between their “illness” and any desire to commit suicide has been established.

    How do we know that the person is incapacitated mentally? Because of the ipse dixits of psychiatrists, people whose statements are not evaluated generally on the basis of any evidence, or even on the content of what they say, so much as they are upon the authority vested in them by law, culture, and the cult of the expert, to whose judgement the average man unthinkingly defers in order to evade the responsibility of exercising his own.

    This belief in a causal link between mental illness and violence, be it against the self or others, is, of course, as common as it is dubious (not that I’m NOT suggesting a link between the dubiousness of a belief and the fact of its being common). Any one would swear that such causal propositions admit of proofs as observable and ironclad as those furnished by the observation of two phenomena in space.

    You see this in reviews made in response to the documentary “the Bridge”, almost all of which seem to converge on the conviction that mental illness is usually the cause of suicide (although, strictly speaking, suicide, if it can be said to be “caused” by anything, it is by the will of the individual, and if “caused” by anything else, ceases to be suicide, I would say), after the fashion of explaining away in psychopathological terms, much like men used to in demonological terms, an assortment of problems, for which the solution thereof lies in reforming the mental health system and in treating these elusive illnesses that, much like happened with the concept of witchcraft, have taken on a life of their own in minds held in the grip of a contagion of madness, particularly difficult to “treat” because of the lack insight the afflicted possess thereinto.

    “For every complex problem there is an answer that is clear, simple, and wrong.”

    H.L. Mencken

    Suicide prohibition is a perfect illustration of this truth.

    This belief that there must always, outside of the problem of excruciating physical pain, be a solution to this most complex of problems is a great folly, nay, lunacy. Nevertheless, there is a partial solution, that is, one that might cut down the suicide rate, and it lies in all those scoundrels, who make a living out of stopping others from committing suicide, in doing so themselves, not because I’m saying they should do that, but, you know, because suicide prohibition is part of the problem, though Pies would have us believe that attaching stigmatizing labels to people and administering toxic nostrums, whilst reducing them to the status of will-less irrational beings whose experiences should be dismissed as “diseased” and whose capacity to make decisions should be deemed inadequate, with all the trauma, misery, and despair such degrading, disempowering treatment entails, is usually the solution to this problem.

    And yes, the word “usually” is accurate here, because in one comment he states that most people end their own lives within the context of psychiatric illness, which is his way of saying they do so because of psychiatric illness. This leaves psychiatrists like he with a mouth-wateringly, appetite-whettingly large pool of potential patients to be conscripted into the role of existential slave. I can just see him licking his lips!

    He also claims that mental illness can be fatal! Why? Because people so labelled often commit suicide. I’ll leave the reader to work out his logic here.

  • cledwyn bulbs

    That should be “not any scoundrel’S who wishes to use at as a means to their own ends, be THEY family members or mental health workers.”

  • cledwyn goodpuddings

    to use “it”, obviously.

  • cledwyn oodpoods

    Pies also says that suicide is a terrible waste. This is the common refrain of proponents of existential slavery.

    A waste of what exactly? A waste of cancer, perhaps? Or a waste of boredom? What about a waste of the opportunity to see the girl you love fall in love with the idiot you hate? A waste of humiliation, conflict with others, maybe? A waste of suffering? A waste of the opportunity to bear witness to the tragi-comedy of human existence, in which virtue hides and degeneracy thrives, in which mediocrity and stupidity hold court, in which bad people succeed where good people fail, in a world that is little more than a zoo run by the chimpanzees? Yeah, what a waste….. of the opportunity to inflict suffering upon yourself.

    He talks of a waste of potential. What he really means here is a waste of the potential to spend a lonely existence, vegetating in front of the tv on psychiatric drugs, while people like him feed parasitically on your misery; what he means is a waste of an opportunity of people like he to make money out of your suffering, and to build a career on it. If the best we can offer people who are suicidal is psychiatric labels and drugs, then there really is no debate.

    He bases his argument largely upon the immense suffering that the suicide of a loved one causes for the people left behind (I find that phrase very telling, “the people left behind”. It contradicts the notion that life is beautiful, after all, in saying that someone has been left behind, the implication is that the person who has left them behind has gone to a better place than they, that they have missed out on something!).

    So basically, a life of pointless suffering should be prolonged just so that the loved ones of the person suffering don’t suffer themselves. Yet people accuse the suicide of being selfish. But oh no, not the family members, who expect their loved ones to live just for their own amusement.

    If you are that stupid or blind as to bring someone into this world that simply ought never have been, to then expect them to go on living just for your own satisfaction is not good enough. I mean, on that documentary, “the Bridge”, which failed miserably in its attempt to prove that suicide is “a waste of a life”, one father talked of his suicidal son as not being allowed to kill himself, because he had invested so much time and money in him, as if he was a car, or a house, or something (this man’s son is still alive, and he is leading a lonely life on psychiatric drugs, by the way).

    Flaubert once said that the act of childbirth is arguably morally worse than murder. Yet inflicting the torment of existence on another soul takes on an even more dubious ethical dimension when you force someone to remain in that existence.

    Pies also questions the notion of “rational suicide”. I would as well, but for different reasons. I would question it because it seems to me to be a tautology, like talking of an unmarried bachelor. Given the way the world is, and the laws and conditions that obtain therein, what could be more rational than suicide?

    Schopenhauer rightly believed that life is a business whose dubious profits do not cover the immense costs in human suffering. A logical corollary of this view is that suicide, irrespective of any superficial differences between the different situations and mental states of the persons who consummate the act, is always in its essence rational, because it frees you from a life in which suffering is the only guarantee.

    He rightly understood that life is just one big protracted Via Dolorosa, leavened with a small mixture of happiness, and with a rich seam of black comedy and absurdity running through it, although, of course, the stupid and the wicked live do live in a state of comparative beatitude, who are as content in this world as a cock on his own dunghill whereas, for any man of real sensibility and imagination (that is, any man at the opposite end of the evolutionary scale to the kind of people comfortable in this world), equipped as we are with an elaborate mental torture apparatus wherewith we torment ourselves, there are three options open to such people;-

    1) to kill ourselves, which might be the wisest.
    2) to use our misery as grist for our creative mills.
    3) to become a psychiatric patient.

    Pies also claims that people with supposed psychiatric illnesses commit suicide irrationally and impulsively. This is typical of the rhetoric of slavery. The psychiatric slave is at the mercy of impersonal forces he cannot control, at the mercy of madness, into the darkness of which the psychiatrist, when he enslaves and “treats” his serf, shines the lumens naturale.

    Yes sometimes people commit suicide impulsively. But people do a lot of things impulsively. I mean, if a bear were running towards you, you would run away impulsively, and you would be right to do so, insofar as survival is your aim. Just because suicide is done impulsively sometimes, is no argument against it.

    As for its being irrational, if he wants to believe that, fine. But to impose that belief on others isn’t. He doesn’t know when it is rational or irrational to want to die. No doubt in theory he would concede his own fallibility, yet he does not take precautions against it in practice, instead acting as if he knows when it is rational or irrational to want to dispose of an existence much greater thinkers than he have convincingly argued is not worth the bother, irrespective of the particular circumstances of the individual.

    I think people at some level are aware of this, which is why the most profound works of art are tragedies, be they in the theatre, the cinema, or in literature. Tragedies, as Schopenhauer pointed out, hold up a mirror to the vanity of human striving, reflect back to us the pointless of human suffering and the injustice of the world, and thereby they discourage the kind of attachment to life the particular species of mindless Panglossian optimists (that Voltaire satirized in “Candide”, to no avail, it would seem) in the suicide prohibition brigade encourage.

    On the other hand, you have something like “It’s a wonderful life”, a film that departs so drastically from reality on just about every particular, it really is astonishing that people use this great work of fantasy as evidence that life is worth living, as if it in any way corresponded to the ugly reality of human existence.

  • cledwyn goodpuddings

    That should be “for”, not “of”, and “pointlessness”.

  • all too easy

    I hate to rain on the antis parade, but evidence is evidence.

    Suicide is highly prevalent in schizophrenia (SZ), yet it remains unclear how suicide risk factors such as past suicidal ideation or behavior relate to brain function. Circuits modulated by the prefrontal cortex (PFC) are altered in SZ, including in dorsal anterior cingulate cortex (dACC) during conflict-monitoring (an important component of cognitive control), and dACC changes are observed in post-mortem studies of heterogeneous suicide victims. We tested whether conflict-related dACC functional connectivity is associated with past suicidal ideation and behavior in SZ. 32 patients with recent-onset of DSM-IV-TR-defined SZ were evaluated with the Columbia Suicide Severity Rating Scale and functional MRI during cognitive control (AX-CPT) task performance. Group-level regression models relating past history of suicidal ideation or behavior to dACC-seeded functional connectivity during conflict-monitoring controlled for severity of depression, psychosis and impulsivity. Past suicidal ideation was associated with relatively higher functional connectivity of the dACC with the precuneus during conflict-monitoring. Intensity of worst-point past suicidal ideation was associated with relatively higher dACC functional connectivity in medial parietal lobe and striato-thalamic nuclei. In contrast, among those with past suicidal ideation (n=17), past suicidal behavior was associated with lower conflict-related dACC connectivity with multiple lateral and medial PFC regions, parietal and temporal cortical regions. This study provides unique evidence that recent-onset schizophrenia patients with past suicidal ideation or behavior show altered dACC-based circuit function during conflict-monitoring. Suicidal ideation and suicidal behavior have divergent patterns of associated dACC functional connectivity, suggesting a differing pattern of conflict-related brain dysfunction with these two distinct features of suicide phenomenology.

  • cledwyn goodpuddings

    Pies obviously thinks that he serves the cause of justice by reducing the problems of suicidal people to mental illness. Only the mental health faithful could entertain such nonsense.

    There can only be a serious debate about the abrogation of the individual’s right to commit suicide, at least in the cases of many people who actually do or wish to consummate the act, when society stops hiding behind psychiatric labels and begins the process of an honest reckoning with itself, because the facts of the matter are that a lot people commit suicide because of other people, because of man’s inhumanity to man. Yet in the warped thinking of proponents and practitioners of suicide prevention, the solution to this problem lies in pathologizing the individual, and subjecting him to the kind of inhumane treatment that makes people suicidal in the first place! Alas, man’s depravity is a bottomless abyss.

    It is often said that a society should be judged by how it treats its most vulnerable members. By that criterion, our society is worthy only of contempt. It’s one thing that society continues to fail so many of its citizens, but the self-serving conspiracy of silence regarding the truth about why such people often kill themselves is another thing all together.

    I mean, the truth is, people often kill themselves because other people drive you “nuts”. Attaching labels such as “paranoid schizophrenic” and “clinically depressed” to people merely obscures this, and what’s worse, it absolves society of its responsibility, in this regards.

    Some people might take issue with my use of the term “society”, but actually I think the use of the term is justified, because there are a number of concentric circles in which responsibility is to be found in greater concentrations the closer one gets to the center, where the greatest responsibility for the desire of so many citizens to top themselves is found, and these pretty much encompass society in its entirety, apart from those individuals who, like myself, speak out against the systematic policy of obscurantism as concerns the truth about why it is so many people are killing themselves (to wit, because in all societies there are to be found a large contingent of predators who prey upon others, and who get a free pass from other, so-called “good” people, who abandon these people to their fate, and most people, I would say, fall into these categories).

    Most people are admittedly in the outer circles, where responsibility for these problems is not as great. These are the people who remain silent, or who buy into the idiotic notion that people who commit suicide because of the inhumanity of others do so because they are “paranoid schizophrenia” or something, which in our confused, topsy-turvy age, is considered not only to be truthful, but compassionate also.

    One regularly encounters on the news stories of people who have been persecuted for years by a mob of cretins whose very existence is enough to make you physically sick, and no-one does anything to help them. For example, there was a big story a couple of years ago about a a woman with special needs and her mother whose lives were made unbearable by a gang of youths. They were abandoned. No one helped them. They ended up burning themselves alive. If they’d gone to see a psychiatrist they would have been dismissed as paranoid or something, and had poisonous substances thrown at them. Society failed them.

    Did this spur any great interest in the continuing problem of man’s inhumanity to man? Of course not. The only thing that people are less interested in than this subject is that of suicide, and human suffering generally, which the average man is very good at feigning an interest in, whilst attacking those of us who have devoted our lives to contemplation thereupon, and who refuse to buy into their inane, mindless conceptualizations thereof, conceptualizations born largely of the fact that when men have little passion for something, their beliefs in relation thereto are always found to be at best dubious and at worst transparently worthless, which explains why most people’s understanding of human suffering is weak as it is, but, as I say, people are very good at feigning an interest in the suffering of the species, the lack thereof they betray through their inability to contribute to the debate thereon beyond the simple parroting of the empty phraseology of the mental health movement.

    Man’s inhumanity to man, his intolerance, his cruelty, his ongoing persecution of the outsider is a problem that is seemingly ignored in proportion as it is found to be deserving of our attention. So many people are killing themselves because men are generally evil, yet rarely is he evil in the sense of some pure, demonic force, but because of his grotesque stupidity. It is not for nothing that Oscar Wilde said that stupidity is the one true sin, because stupidity and depravity are usually found in each other’s company.

    One of the great apercus of recent times is the insight furnished by Hannah Arendt in her book, “Eichmann in Jerusalem”, that of the concept of the banality of evil, a concept as misunderstood as it is well known. What Arendt really meant is that the source of so much of the world’s evil resides in stupidity and thoughtlessness, an insight that in democratic society must be suppressed, because it contradicts the notion that the ordinary man (a dullard, in the most depraved sense of the word), romanticized and poeticized in countless works of populist propaganda, isn’t the saint he is made out to be.

    Evil thrives on mindlessness, a mindlessness so common in the modern age, an age deeply suspicious of solitude, detachment and the contemplative life, that it is no wonder that some of us feel like we are in a production of “Invasion of the Body Snatchers” out there. Everywhere you find mindless people. You look into their eyes and there is nothing, just a void, a void of humanity. This is most observable in kids. Kids are often so mindlessly evil, appealing to their supposed better angels is about as useless as trying to extract gold from excrement, and the same applies to many adults.

    People are not tapping into their human potentialities, making use of their higher faculties, exploiting their human capacities, and in such a society men are worse than beasts, and it is no wonder so many people find life in such a society terrifying. Of course, such people congratulate themselves on their supposed superiority to beasts, just because they have these higher faculties, but the possession thereof does not amount to the same thing as their proper usage. Most people use them to descend to depths of stupidity and depravity no beast is capable of.

    But then again, anyone who doesn’t like what I’m saying can just dismiss me as a paranoid schizophrenic….

  • cledwyn goodpuddings

    Continuing my discussion of Pies and his article about suicide, Albert Camus once said that suicide is the only truly serious philosophical problem. No wonder people aren’t interested in it!

    One thing you see very little of in the writings of proponents of existential slavery, is any mention of the fundamentally unalterable and intractable conditions of existence, signified by the word “facticity” (as distinct from those things that fall within the sphere of human choice) in the work of Sarte, and the often insuperable obstacles people encounter in their quest for happiness. Because of this, immense, pointless suffering is inevitable.

    I mean, take a person who is born unattractive, for example. There is very little you can do to help that person deal with his/her unrequited longings, whereupon their pain is founded. The best you can do is to encourage them to try and convert that pain through the process of symbolization, by making use of the symbolic media at their disposal, wherewith they can experience some release of the pressure, and to try to use that pain as grist for their creative mill. But the facts are, the reality of being affected by that pain is inescapable. Yet such people are labelled with some such made-up disorder, and their desire for release from their pain is attributed to a disease process.

    Perhaps the most important aspect in this regards is our dependence. We humans are consumed with desires and needs that as often as not aren’t met, to be loved, to have people to communicate with, to have our existence, our humanity, our dignity, acknowledged by others etc., without which, the felt lack in our lives makes life an almost unbearable burden. Yet you can’t force people to fall in love with other people, for example. Loneliness and emotional privation are unavoidable, though they do often admit of amelioration.

    The best you can do is try to create a society that minimizes exclusionary and discriminatory practices, wherein resides the source of so much human suffering.

    Yet what do people in the suicide prevention movement advise. The “diagnosis and treatment” of such people, and a reform of the mental health system. Yes, put them on drugs that alienate them further, and attach identity-spoiling labels to them, that’ll do the trick. And not just that, if they resist, inflict psychic pain upon them and subject them to the kind of treatment that they sought refuge from in the grave in the first place, which is the height of depravity.

    Of course, this facticity has many other aspects. For one, there is mortality, which casts a shadow over our whole existence and begs the question, why bloody bother?

    There is man’s inhumanity to man. Isn’t this just a fact of life? Yes, true, this involves a large element of choice on the part of the evil-doers, but can anyone really imagine a world in which men don’t prey upon each other? What can psychiatrists do to prevent the pain inflicted upon people by others in their daily lives (which they themselves are doing on an epic scale), to safeguard people against the predations of others, to truly combat the intolerance and hatred of the outsider? Homo homini lupus.

    The best you can do is try to wage war on the large contingent of vultures, the Neanderthal hordes, that exist in every society, but these people are everywhere, like some sort of cosmic disease, plaguing every generation, ensuring in every age that men will seek asylum in the grave, which is the only place you’ll find it.

    Yet most of this inevitable emotional pain gets ignored, for the sake of convenience. By all means, use the arts of persuasion, but to force people to go on living in such a world as this when you can do nothing to change the origins of so much suffering, is just cruel.

  • cledwyn goodpuddings

    Trying to unravel the skein of Pies’ thinking is hair-pullingly frustrating. One may as well try to unravel the Gordian knot.

    A case in point. Pies has been involved in a minor dispute with Duncan Double. He equivocates quite a bit, claiming that he doesn’t believe schizophrenia is a brain disease, which sounds promising, but then he basically goes on to explain why he actually does believe it, two statements whose incongruity he tries to circumvent by acting as if the terms “cerebral pathology” and “brain disease” signify two distinct entities.

    Yet cerebral pathology is an umbrella term for various diseases affecting the brain. So what he’s basically saying is is that “schizophrenics” don’t have a brain disease, but there is evidence of brain disease! Maybe I’m missing something here, but if I have, then the blame rests with Mr Pies, whose writing seems to me intentionally Byzantine and devious.

    Basically what he seems to be trying to say is that disease should only be predicated of persons, but that a person may have cellular pathology, to which he applies his own stipulative definition, as he does with “disease”.

    I see no reason to accept his stipulative definition, according to which the term pathology here does not denote “disease”, therefore meaning there is no contradiction between the terms he uses. What he is saying is that we should say of someone who has “cancer” is that he only he has a disease if it causes suffering and incapacity, otherwise we are dealing only with cellular pathology, which is not a manifestation of disease until the person is dysfunctional and suffers.

    Psychiatrists like he remind me of Humpty-Dumpty who, in Alice’s journeys “Through the Looking Glass”, says that he is free to assign whatever meanings he pleases to terms. When psychiatrists don’t like the lexical definitions of terms, they just stipulate their own, and sadly, they often fall into common usage, and become enshrined in the dictionary.

    Of course, psychiatrists are free to do this, but they can’t expect all of us to go along with this, especially when there are strong grounds for preferring the definition they seek to displace.

    I’m not even going to comment on the rest of his sophistry, I’ll just go and put my brain in a blender, which is a far less time-consuming method by which one can put one’s thoughts in a tangle, inflicting suffering upon oneself thereby.

    Pies isn’t content with just torturing people with whatever nostrum is fashionable in psychiatry. No; he also implicates language in his desire to make others suffer.

  • all too easy

    Study identifies biological mechanisms for schizophrenia, bipolar disorder and depression

    Common psychiatric disorders such as schizophrenia, bipolar disorder and major depression share genetic risk factors related to immune function and DNA regulation, according to new findings by a large collaborative research project from the Psychiatric Genomics Consortium involving UCLA, King’s College London, Cardiff University, Harvard and MIT.

    Thousands of genetic differences in the human genome act together to increase the risk for psychiatric conditions such as schizophrenia. However, until now, it has not been clear how these genetic changes affect biological processes that then go on to alter brain function.

    In the study the group analyzed genetic data from more than 60,000 participants, including individuals with schizophrenia, bipolar disorder, major depression, autism spectrum disorders and attention deficit hyperactivity disorder, as well as healthy individuals. The aim was to identify which biological and biochemical pathways caused risk for these disorders.

    By grouping the genetic data together, the consortium found that genes relating to immune function and histone methylation—molecular changes that alter DNA expression—are risk factors associated with the development of all the disorders. Such biological pathways are important, they noted, because they are much broader drug targets than single genes or proteins.

    “We took the hundreds of genes in the biological pathways identified by our collaborators and modeled them as a gene network,” said Daniel Geschwind, a UCLA professor of neurology, psychiatry, and genetics, and a study author.

    The study was published online by the journal Nature Neuroscience.

  • all too easy

    Do you suppose it is easy to walk through life with ADHD and not be confronted constantly with all the errors and gaffs you make all day, every day, no matter how hard you try?

    Who has the integrity and the courage to guess what it must be like to exist on on a sub-par level, daily, in public with not a soul in sight who gives a rip? How do you treat kids like that, Dr? Undisciplined, misbehaving lazy snot, right Dr?

  • all too easy

    “to often reside”
    split infinitive

  • George Nutman

    Dr Sandra Bloom suggested that when faced with behaviour that perplexes us we should not ask ‘What’s wrong with you’ but should ask ‘What has happened to you’. Psychiatry is guilty of sticking a label on the person rather than taking the time to understand what is happening in their life. A huge proportion of psychiatric patients have significant history of trauma (can’t prove it because nobody has a vested interest in researching this).
    Parents of a teenager who is acting in a distressing way, for example, are bound to look to the experts to provide an explanation, and if given a diagnosis(perhaps with a prescription) may feel appeased. It is much harder to say that we do not know why this behaviour is presenting and for someone to spend meaningful time with the ‘patient’ exploring this.
    In my early career I remember hearing of the Shizophrenegenic mother, this term has been abandoned, perhaps rightly it was seen as apportioning blame, if instead we seek to establish understanding we would provide a better service to people.
    As a worker with teenagers I have been particularly concerned with the increasing use of the ADHD label and associated meds, which I feel is applied to provide an explanation for behaviour without providing any actual help.

  • Phil_Hickey

    George,

    Thanks for coming in. What’s particularly interesting here is that throughout my career, I always found that if I listened carefully and patiently to what people told me, I was almost always able to get a pretty good understanding of how they had arrived at their present position. It’s not quantum physics. It’s just listening without preconceived ideas.

  • all too easy

    “The bottom line is this: if one doesn’t know the cause of something, then one can’t explain it. Explanation is the presentation of causes. And despite their frequent claims to the contrary, psychiatrists do not know the cause of the loose collection of thoughts, feelings, and/or behaviors that they call schizophrenia”
    Torn ligaments don’t exist. X-Rays cannot “see” them. Therefore, complaining about an unstable ankle is intended only to get shots of Demerol. Drug companies created Demerol for faked pain in non-broken bone ankles.
    “They assume that any decade now they will discover this cause in the form of some neural pathology. Meanwhile, they go on telling their clients the falsehood that they have chemical imbalances, or neural circuitry anomalies or whatever is the latest fashion, and that these putative illnesses can be corrected by drugs or electric shocks to the brain.”
    Science is unraveling the mysteries of the brains’ malfunctions continuously. Perhaps you fail to understand the data I’ve presented recently from the world’s most brilliant researchers. They suggest it may be due to a chemical imbalance and that drugs may alleviate some of the discomfort, symptoms, etc., through restoring balance. No cures.
    “And they ignore the reality that the best (indeed only) way to understand people is to talk to them patiently, compassionately, and with humility, and without the assumption that one already knows the source of their troubles.”
    Phil, you get a G in this category. You “listen” and don’t hear a thing. Then, you forbid medical intervention
    “is only in this way that we discover that people’s so-called symptoms are understandable within the context of each person’s unique history and current circumstances, and that the facile labels cataloged so conveniently by the APA are an irrelevant travesty.”
    That is silly, haughty, untrue and preposterous.

  • Harry hobbes

    You cannot blink without the brain. Cannot feel a mosquito bite without the brain. Can’t be sad, laugh, wink, hate, hurt, love, obsess, ruminate, hear, smell, cough without live, functioning neurons. Chemicals like ethyl alcohol interfere with neurons firing correctly and everything we do is warped accordingly. If the brain misfires due to other abnormalities, our conscious awareness is altered. If the channels through with sodium ions travel, a component of our brain’s “thinking” process, become brittle or short-circuited for any number of reasons, the brain stops functioning accordingly. The brain feels. We cannot feel the normal range of emotions without the physical, chemical, and electrical systems running as intended. There can be no other basis for abnormal thinking, feeling, perceiving.

  • HAAHAHAHA

    “There can be no other basis for abnormal thinking, feeling, perceiving.”

    HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHHAAHAHAHHAAHHAHAHAHAHAHAAHAHAHAHAHAHAHAHAHAHA

  • Harry hobbes

    Dear Dr. Phil,
    Did anyone benefit from your work with him? What did you do, specifically, that assisted a deeply troubled individual to get better?
    Nothing.

  • Rachel Evelyn Nichols

    Once you have a psychiatric “diagnosis” or label, you’re toast. It will ruin you socially, physically, financially, every way imaginable.
    There is talk now about helping the mentally ill commit suicide. I believe Dr. Pies is against it. Why? Our lives are over; we are nothing but so many rotting corpses; garbage the normals can’t wait to bury.
    I lead a very secluded life and avoid going out in public because of my damning diagnosis of bipolar. When someone smiles at me from behind a cash register I can barely keep from bursting into tears. Can’t he see that I am unclean? Defiled? Untouchable? Social outcast and leper?
    Have been a member of the walking dead for 23 years now. Hopeful that my life will end soon due to the “safe and effective treatment” I have endured. I now have have a heart arrhythmia my GP refuses to explain. It must be related to the drugs my psych had me on. The psychiatric industry has been poisoning my life for over 2 decades and killing me by degrees. Society actively wishes me dead or doesn’t care. Why don’t they euthanyze us at once and get it over quickly? That would be more humane and no more murderous than what has already been done,

  • Rachel Evelyn Nichols

    Gosh Harry. That is terribly profound. It must be, because it makes no sense whatever.
    As for me, I feel with my fingers.

  • Phil_Hickey

    Rachel,

    I’m sorry that you have incurred such tragic losses, and I hope that you will find a way back to a more fulfilling life.

    Best wishes.