Allen Frances and the Spurious Medicalization of Everyday Problems

On April 5, Allen Frances MD, published an article on the Huffington Post blog.  The title is Can We Replace Misleading Terms Like ‘Mental Illness,’ ‘Patient,’ and ‘Schizophrenia’  It’s an interesting piece, and it raises some fundamental issues.

Here are some quotes from the article, interspersed with my comments.

“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 fact that words can acquire multiple, and even contradictory, meanings is well known to most high school graduates.  People of all walks of life are generally sensitive to this reality, and take steps to clarify their meanings, especially with regards to words that are known to be ambiguous.

In the above quote, Dr. Frances is, I believe, implying that he and the other members of the DSM-IV work group chose their words carefully, but that their meanings were corrupted in “damaging daily use”.  Additionally, he appears to ascribe blame for this process to the drive for profits, presumably on the part of pharma.

But this is not consistent with the fact that ambiguity and a general lack of verbal precision are primary characteristics of successive revisions of the DSM, including DSM-IV.  In DSM-IV’s criteria for attention deficit hyperactivity disorder, for instance, the term “often” occurs in every criterion item, even though its lack of clarity, and its potential for abuse, are obvious.

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

“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.”  [Emphasis added]

Here again, the impression being given is that Dr. Frances and his team defined these various terms judiciously and with precision, but that others came along afterwards and “misused” these carefully crafted definitions for their unstated, but presumably venal, purposes, while the injured innocents of the DSM-IV work groups could only watch in dismay from the sidelines.

The reality, of course, is quite different.  All of the definitions, in every edition of the DSM, are notoriously vague, and are subject to diverse interpretation.  This vagueness has consistently served the interests of psychiatry in expanding its scope and influence.  DSM-IV was simply one of the steps in this process, and the notion that Dr. Frances and/or other members of the work group were naïve to this dynamic is simply not credible.

. . . . . . . . . . . . . . . . 

“‘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.”

This is in marked contrast to what Dr. Frances and his task force wrote in the DSM-IV section on schizophrenia:

 “The essential features of Schizophrenia are a mixture of characteristic signs and symptoms (both positive and negative) that have been present for a significant portion of time during a 1-month period (or for a shorter time if successfully treated), with some signs of the disorder persisting for at least 6 months (Criteria A and C).” (p 274)

The clear implication here is that “Schizophrenia” (with a capital S!) is a single unified entity that can be recognized by its characteristic signs and symptoms.

In addition there are numerous phrases and sentences that imply clearly that, as far as the authors were concerned, schizophrenia is a unified condition.  These include “The individual with Schizophrenia…”; “Individuals with Schizophrenia…”; “The onset of Schizophrenia…”; “…the symptoms of Schizophrenia…”; ”…prevalence of Schizophrenia…”; “…age of onset for the first psychotic episode in Schizophrenia…”; “…course and outcome in Schizophrenia…”; etc…  In no part of the DSM-IV entry is there the slightest intimation that “schizophrenia” is anything other than a single unified “disorder”.

So again, it seems reasonable to ask:  what has changed?  Is there some new science that has debunked the old unified illness notion?  Or is it simply the case, as many of us on this side of the issue have maintained for years, that the unified illness notion was never more than a convenient psychiatric fiction, devoid of any scientific underpinning, which Dr. Frances is now disavowing.

Note particularly in the above quote from Dr. Frances’ current paper, the phrase:  “…it [schizophrenia] doesn’t at all explain them [the problematic experiences and behaviors]…”

Here again, this represents a marked departure from DSM-IV, where schizophrenia (the unified disorder) is clearly presented as the cause of the so-called symptoms.  In the section on schizophrenia (p 277) it states:

“Although quite ubiquitous in Schizophrenia, negative symptoms are difficult to evaluate because they occur on a continuum with normality, are nonspecific, and may be due to a variety of other factors (e.g., as a consequence of positive symptoms, medication side effects, a Mood Disorder, environmental understimulation, or demoralization).”

The statement that negative symptoms may be due to “other factors” clearly implies that in other cases, they are due to (i.e. caused by) schizophrenia.  Note, incidentally, that one of the other factors that is given as causative of negative symptoms is “a Mood Disorder”, again clearly implying that those “disorders” also are being conceptualized and presented as the causes of the “negative symptoms”.

. . . . . . . . . . . . . . . . 

“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.”

The DSM-IV entry on Schizophrenia runs to 16 pages – p 274-290.  In all of that text, there is only one reference to environmental factors:

“Although much evidence suggests the importance of genetic factors in the etiology of Schizophrenia, the existence of a substantial discordance rate in monozygotic twins also indicates the importance of environmental factors.” (p 283)

and there is no specific reference to “…psychological and social factors that are crucial in understanding anyone’s problems.”  Additionally, on page 275, DSM-IV states:

“…positive symptoms may comprise two distinct dimensions, which may in turn be related to different underlying neural mechanisms…”

which at the very least suggests a “simple-minded biological reductionism”.  So, again, what we have is Dr. Frances lamenting a situation of which he and his colleagues were some of the primary architects.

And the old chestnut —we all hate the term “mental illness, but alas, nobody has come up with a better substitute.”  This, I suggest, is less than candid.  There are lots of better (i.e. more accurate) terms, e.g., problems of thinking, feeling, and/or behaving.  It is difficult to avoid the conclusion that psychiatrists cling to the term “mental illness”, not because they can’t come up with anything better, but rather because it serves as an integral part of the spurious medicalization of these problems.  If the concept of “mental illness” were to be eliminated, as it should be, then psychiatry’s justification for its role in this area would also go.  The notion that the APA, with all its talent and its prestigious PR company, couldn’t come up with a better term if they wanted to, is simply not remotely credible.

Note also that Dr. Frances’ concern about the term “mental illness” is because “…it lends itself to a simple-minded biological reductionism that pays insufficient attention to the psychological and social factors…”.  And this, of course, is a valid concern.  But it is not the core concern.  The core concern with the term “mental illness” is that the problems it purports to delineate are not illnesses at all.  The spurious medicalization of these problems is the fundamental error from which all of psychiatry’s excesses and venality flow.  It is also the issue that they simply refuse to address.

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

Dr. Frances expresses some reservations about the use of the term “patient”, because it implies  “…participation in a hierarchical relationship that brings with it little responsibility for shared decision making.”  Then he continues:

“But I have also never been comfortable with cold, market-sounding terms like ‘client,’ ‘consumer,’ ‘customer’ or ‘service user.’ These are business terms and lack the connotation of caring and responsibility associated with helping a ‘patient.’…Unless someone comes up with a better term, I think it would be better to rehabilitate the connotation of ‘patient’ rather than replace it, making clear that it implies full partnership in a therapeutic relationship.”

Here again, I suggest that Dr. Frances is being less than candid.  Social workers refer to the people they serve as “clients”, and the word has never suggested connotations of coldness or market place values in that context.  In fact, in my experience, social workers, other than those who have been co-opted by psychiatry, are arguably the most compassionate and client-centered professional group in this field.  And there are lots of other words, e.g. – and this is pretty radical –”person”.  And in fact, Dr. Frances’ own DSM-IV routinely uses the word “individual”.

If, as appears to be the case, Dr. Frances is arguing that psychiatrists cling to the term “patient” because it reflects their values of caring and warmth, all I can say is that I find this difficult to reconcile with the fact that the 15-minute med check has become psychiatry’s standard practice, and that the psychiatric falsehood – “a chemical imbalance just like diabetes” has been, and continues to be told to countless millions of psychiatric “patients”.

Dr. Frances expresses the belief that the word “patient” should be rehabilitated to make it clear that the term implies “full partnership in a therapeutic relationship”.  But he’s neglecting the fact that the term “patient” already has a perfectly valid and generally accepted meaning:  a person who is sick and who goes to a physician for assessment and/or healing.  And this, I suggest, is precisely why psychiatrists, including Dr. Frances, cling to the term – because when used in the psychiatric context, it embodies within its meaning the fiction that the problems “treated” by psychiatrists are illnesses requiring medical intervention.

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

 Dr. Frances then quotes from a debate that he had with Anne Cooke PhD, editor of the BPS report Understanding Psychosis.  He notes that they are in agreement on some issues.

“We certainly join forces in worrying that loose usage and commercial gain have extended the terminology of mental ‘illness’ to many expectable problems of everyday living that are much better explained by psychological factors and social context and better described using everyday language.”

But:

“…we part company when you suggest that all diagnostic labels can be easily and safely. Your suggestion would have disastrous consequences for those who have severe psychiatric problems.”

There’s an obvious typo here, but it seems clear that Dr. Frances is stating that there would be disastrous consequences if diagnostic labels were dispensed with in the case of people with “severe psychiatric problems”.

There are two noteworthy points here.  Firstly, Dr. Frances has started referring to the DSM “diagnoses” as “diagnostic labels“, which is interesting.  Secondly, his use of the term “severe psychiatric problems” implies the existence of a discreet, identifiable set of problems, in the same way as the phrases “severe cardiac problems” or “severe kidney problems”.  In fact, this is not the case.  The DSM-IV definition of a mental disorder embraces all significant problems of thinking, feeling, and/or behaving, including expectable problems of everyday living.  If an expectable problem of everyday living, e.g., bereavement, crosses a  vaguely defined threshold of significance, then it is, by Dr. Frances’ own DSM-IV definition, a psychiatric problem.  And if it crosses an equally vaguely defined threshold of severity, then it becomes a severe psychiatric problem.

But even if we set that issue aside, the question still remains as to why dispensing with psychiatric “diagnoses” would result in disastrous consequences.  Dr, Frances tells us why.

“Here’s why: An adequate differential diagnosis of delusions and hallucinations requires full consideration of whether the problems are best described as: ‘Substance Induced Psychotic Disorder’, ‘Psychotic Disorder Due To A General Medical Condition’, “Delirium’, ‘Dementia’, ‘Schizophrenia’, Brief Psychosis’, Delusional Disorder’, ‘Bipolar Disorder’, ‘Major Depressive Disorder’, ‘Catatonia’, Obsessive Compulsive Disorder’, or ‘Sleep Disorder’. Each of this has different implications and calls for different actions. Only when all have been ruled out, can one conclude before that the experiences have no clinical significance and can be described adequately with everyday language.”

So in plain “everyday language”, what Dr. Frances is saying is this:  If a person is expressing delusional beliefs and hallucinating, we need to explore the nature and causes of the delusions and hallucinations if we want to adequately define and identify the problem.  So we have to compare the precise details of the individual’s presentation with the various DSM entities mentioned in order to get the correct “diagnosis”.  But he’s already told us that one of the “diagnoses” (schizophrenia) is merely a heterogeneous set of experiences and behaviors.  So it’s difficult to imagine what benefits would accrue from this kind of “differential diagnosis”, over and above a description of the problem in plain language.  Is Dr. Frances suggesting that the statement:  John is hallucinating and paranoid because he has been using PCP, is less informative than the statement:  John has Substance-Induced Psychotic Disorder?  It’s also difficult to imagine what “disastrous consequences” might result from the observation that Mary is expressing delusional beliefs because of a brain tumor, that would be averted by the formula Mary has Psychotic Disorder due to a general medical condition.

In fact, it is a general contention on this side of the issue that psychiatric “diagnoses” militate against the exploration of the nature and causes of the presenting problems, in that psychiatrists routinely terminate this kind of enquiry once they have determined the “diagnosis”.  And these are the very “diagnoses” that Dr. Frances earlier conceded are purely descriptive with no explanatory significance.

. . . . . . . . . . . . . . . . 

“Labels can help a great deal. They can hurt a great deal. They can provide clarity, but they can also badly mislead. The words we use in mental health all carry the heavy baggage of misleading and potentially stigmatizing connotation. They are vastly overused to describe mild problems of everyday life better described with everyday language. But we need diagnostic labels for the ‘severely ill’ and all suggested replacements are much more harmful than helpful.”

So Dr. Frances concedes that the words used in mental health are vastly over-used to describe “mild problems of everyday life”, but once again, he doesn’t seem to be acknowledging that his own DSM-IV was one of the great contributors to this process.  Psychiatric proliferation and expansion were both well under way by the time he convened his work force, but his final product endorsed every single aspect of DSM-III that had enabled and facilitated the expansion, e.g.:

  • the adoption, with only minor, inconsequential changes, of DSM-III’s all-embracing definition of a mental disorder;
  • the use of inherently vague language in the criteria sets;
  • the use of polythetic (two out of five, six out of nine, etc.) criteria sets;
  • the decision not to revert to DSM-I’s widespread use of the term “reaction”, which recognized that the problems being addressed were reactions of the individual to psychological, social, and biological factors;
  • the insistence, in the definition of a mental disorder, that the problems reside “in an individual”, as opposed to the person’s circumstances or environment;
  • the extensive use of the “not otherwise specified” (NOS) category, which essentially enabled psychiatrists to expand the so-called nosology more or less as they wished.

In addition to this, DSM-IV introduced specific innovations that also facilitated expansion of psychiatric turf into “the problems of everyday life.”

Firstly, it was DSM-IV that made it possible for an individual to be labeled “bipolar” without ever having displayed a manic episode.

Secondly, there occurred in DSM-IV a general liberalizing of the criteria for many of the so-called diagnoses.  “ADHD” is a good example.  DSM-III listed 14 criteria items for this label; DSM-IV listed 18.  One DSM-III item was dropped.  The additional five items in DSM-IV are:

“1 (a)  often fails to give close attention to details or makes careless mistakes in  schoolwork, work, or other activities.” (p 83)

This is almost a defining feature of early childhood.

    “1 (e)  often has difficulty organizing tasks and activities”

Again, a fairly common attribute of young children.

    “1 (f)  often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such  as schoolwork or homework)”

Note the use of the word “or”.  So if the child avoids, dislikes or is reluctant to do his/her homework, this criterion is endorsed.  I suggest that very few children actually like doing homework!

    “1 (i)  is often forgetful in daily activities” (p 84)

Again, the pathologizing of the normal.

         “2 (c)  is often ‘on the go’ or often acts as if driven ‘by a motor'”

The use of colloquialisms here is especially interesting, in that expressions like “always on the go” and “like he’s driven by a motor” are things that parents often say about their young children without any pathologizing connotations or intent.  By including these expressions in this list of “symptoms”, Dr. Frances and his team have effectively pathologized these descriptors, and brought psychiatric scrutiny to bear on children so characterized.

In addition, the following fairly extreme item in DSM-III

    “(14)  often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking” (p 53) [Emphasis added]

was liberalized in DSM-IV to the much more banal

     “2 (c)  often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)” (p 84)

In DSM-III, the “age of onset” had to be before the age of seven.  In DSM-IV, this requirement has been eased to “Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.” [Emphasis added] (p 84)

And, perhaps most significantly of all, in DSM-III the label ADHD is clearly conceptualized as pertaining to childhood.  DSM-IV, however, states:

“In most individuals, symptoms attenuate during late adolescence and adulthood, although a minority experience the full complement of symptoms of Attention-Deficit/Hyperactivity Disorder into mid-adulthood.  Other adults may retain only some of the symptoms, in which case the diagnosis of Attention-Deficit/Hyperactivity Disorder, In Partial Remission, should be used.  This diagnosis applies to individuals who no longer have the full disorder but still retain some symptoms that cause functional impairment.” (p 82)

In the light of all this, it is difficult to accept Dr. Frances’ contention that the proliferation and expansion of psychiatric “diagnoses” was not an integral part of his, and psychiatry’s overall plan.

And incidentally, psychiatry’s usual response to this particular criticism is that they must update the criteria, as more knowledge is gained about the “illnesses”. But this is untenable.  The only definition of the “illness” is the one given in the DSM.  There is no deeper entity to which the criteria refer.  What psychiatrists call ADHD is nothing more than a loose clustering of vaguely described habitual behaviors and omissions.  Psychiatry can add to, or modify, the list at will.  In stark contrast to real medicine, there is no reality to which these additions or modifications must conform.  If the APA decides that  “…is often forgetful in daily activities” is a “symptom” of the “illness” known as ADHD, then that decision makes it so.  And if the decision represents a liberalization of the criteria, then, literally overnight, more people will now “have” the “illness”.  And given that this process has been going on for the past fifty years, it is difficult to avoid the conclusion that it is intentional.

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

Dr. Frances’ position in this and other recent papers appears to be that in general, psychiatric “diagnoses” and “treatment” are OK, but that they are being overused by unscrupulous practitioners with the encouragement of pharma, and perhaps other monied interests.

And of course the expansion of psychiatric “treatment” is indeed a huge problem.  But it is a problem of Dr. Frances’ own making – a fact which, to the best of my knowledge, he has never conceded.

But, even more importantly, the expansion is not the critical issue.  The central issue is the spurious medicalization of non-medical problems in the first place.  There are no more grounds for considering severe depression an illness than there are for mild depression.  Severe and persistent inattentiveness is no more an illness than mild or transient inattentiveness.

It is from this spurious medicalization that all of psychiatry’s excesses flow.  Once psychiatry recognized that they could create illnesses by fiat, then the door was opened, and remains open, for unlimited expansion and pathologizing.  And Dr. Frances’ DSM-IV was a major – and perhaps the major – step in this process.

  • Bed

    The fact that men who have committed such evil as him are not in prison, will make me feel better about leaving this Earth when I’m old and sick and dying.

  • all too easy

    Phil did it again. After misrepresenting the complete picture, he makes “spurious” conclusions that bear little if any resemblance to the topic he attacks.

    Twist and shout Phil.

  • all too easy

    Have a nice trip. Knowing you have found such evil in the wonderful people who have devoted their entire lives to rescue the mentally ill from the ravages of their experiences will make me happy when you say goodbye, too.

  • all too easy

    “Severe and persistent inattentiveness is no more an illness than mild or transient inattentiveness.” guess who?

    Neither is blindness. Or deafness. They are Christmas presents.

    Phil has dedicated his handful of remaining moments on this blue orb to try to sabotage, through his misuse of language, a devastating “problem”, that is treatable through caffeine-like medication. Instead of confessing and repenting of his despicable habit of poisoning and killing his brain cells through the abuse of a metal cleaner, he hopes to assuage his guilt through deception and subtle manipulation of language. It is called Denial.

    May I recommend that upon his confirmed, successful abstinence from alcohol for 2 years, he return to the pulpit of judgement and renew his fascination with finding fault with everyone but his fellow haters and himself.

    Dearest Phil Baby, for the poor slob who suffers from severe, persistent, disabling distractability, what would You recommend, my friend? Come on doc! Let’s see your vast experience and expertise in the healing arts applied to this non-illness. Give it your best shot. You have a little fella in your office, with his mom and dad, who you know will be doomed to decades of failure, trauma, criticism, crushed self-esteem, inability to learn, seconds, minutes, hours, days, weeks, months, years and years of agonizing self-hatred, boredom, misunderstanding and humiliation. Please doc, his life is in your hands. Would would you do, doc? Your entire career boils down your professional intervention/advice/guidance to this kid with severe, persistent, disabling inattentiveness. GO!

  • all too easy

    Poor Phil. He believes he is convincing. Phillip, my friend, you’ve got to reach beyond the pews, pal. The choir and church folk are already all yours. You can simply re-post your old posts if you’d like to save time. You say exactly the same things you did once upon a time; your best arguments fell flat then and do so now.

    Folks, it is simple as pie. He will spin everything he possibly can to denounce all psychiatrists and the psychiatric profession. Our beloved wolf in sheep’s clothing insists, as do his heroes Baughman, Breggin and Whitaker, that there is not one single objective test proving that ADHD is a true *disorder. (He calls it a *disease. He intends to get extra mileage from that misnomer. Just remember, poor eyesight isn’t a disease either, but you wouldn’t refuse corrective lenses over that would you?)

    People misbehave. No kidding. However, Phil cannot produce one objective test that proves ADHDers misbehave as a result of poor parenting or a lack of self-discipline. In fact, he hopes you won’t notice he is guilty of exactly the same kinds of things for which he condemns every psychiatrist in the world. The difference is he is guilty of creating reasons for things, where dedicated psychiatrists stick to scientific guidelines.

    IOW, Phil would not offer proven, safe, medical assistance (even if he was a qualified M.D.) to anyone, even if the individual had been tortured all her days due to her ADHD. That, my friends, says everything you need to know about him and his Klan.

  • all too easy

    see what i mean?

  • cledwyn “corpse in the making”

    I think Allen’s criticisms of psychiatric diagnosis, and the expansion thereof to more and more areas of human experience, are laregly born of a fear that he and his “sane” brethren (fanatical lunatics the lot of them) may end up, like a spider caught up in its own web, becoming ensnared by the very contrivances they use to trap others.

    People like he seem very defensive of the sane/insane divide, and no doubt of the dividends reaped therefrom.

    Sadly, I don’t think his article can be seen as inaugurating a series examining the relation between words and reality in psychiatry, and the immense gulf that exists therebetween. I can’t imagine ever reading an article penned by Mr Frances exposing, for example, the discrepancy between what psychiatrists say they do and what they actually do

  • Sweet63
  • Phil_Hickey

    Cledwyn,

    No; I don’t think we’ll be seeing articles of that sort any time soon.

  • cledwyn bulbs

    One of the big problems with the use of these diagnoses, amongst lay people and professionals, is the corrupt usage to which they are put in camouflaging injustice. Human beings, whether individually or collectively, are, it would seem, eternally predisposed in favor of ideas that put the blame either on individuals themselves, or on impersonal forces that are deemed, often quite rightly, to reside therein, in order that by this stubborn predetermination people may absolve themselves of any blame.

    One would be tempted to call this a conspiracy of silence if there were an exact correspondence between this expression and the reality it points to, but alas, even often by dint of reflection, we are largely blind to the occult springs and motives of our thought and behavior, to those stirrings of the subconscious (which is really just a spatial metaphor referring to our desires, passions, repressed memories, appetites etc., operating below the threshold of consciousness wherefrom they exert their despotic influence over the faculties, in the supremacy of which we repose so much misguided faith, perhaps I would surmise because of the existential profit those possessed of the delusion of their own sanity stand to gain thereby, be it in their conflicts with others, be it professionally and financially, be it psychologically) upon which so much of our conscious thought rests, for which reason the term “conspiracy” is largely useless to explain the wicked ways of the world, stemming as they do largely from a want of reflection upon ourselves, self-deception, and the limitations of self-knowledge.

    The grip of the furor diagnosticus (a specimen of lunacy obviously nonetheless real for its not being recognized as such) on the minds of so many people can perhaps be attributed to its immense serviceability in concealing the workings of corruption and injustice in human relationships, and in drawing attention away from the wider context of severe human distress; that is, from social prejudice; from the institutional grounds of human suffering; from the demeaning molds we press people into and degrading roles them to play; from the sometimes unfortunate and other times unjust circumstances that hedge the individual about and stunt his development at various levels of his being; from the administration and arrangement of society, both of which privilege the interests of some at the expense and to the detriment of those of others; and from the widespread failure of society as concerns many of its citizens.

    I think this is one of the prime motivators of the medicalization of suicide, a subject over which men profess their compassion and concern all the more the less interested they are in it, and also the less they actually feel it, something that should occasion no surprise if one is apprised of the fact that amongst humans a man’s avowed as opposed to real virtues generally stand in inverse ratio to each other, the forming increasing as the other decreases, as can be seen with the fanatical faithful in the mental health movement, amongst whom the virtue of compassion is regularly honored in speech, yet I would say rarely in feeling, beating their breasts as they do theatrically, seemingly as a matter of convention, over the tragedy of the plight of the “mentally ill”, a tragedy abruptly terminated by its protagonist before the final act often in order to find refuge, in that sanctum sanctorum (and in modern society, it’s just about the only one, now that psychiatrists can come into your own home and coercively drug you), the grave, from the predations of others, which is just about the only place that a man is safe from his fellow wolves, sorry, I mean men.

    Recently, a poor girl, who had the misfortune of being the daughter of a fanatical lunatic and executive director of the Torture Advocacy Center, Doris Fuller, unsurprisingly killed herself, for reasons unknown to any but the enlightened faithful, who have performed their own little inquest, and pronounced their verdict that this is another life lost to mental illness.

    The mother recently penned an article, perhaps looking for some support that might help assuage her sense of guilt and lull her conscience to sleep for her own role in driving her daughter to her own self-administered death, though this is conjecture.

    In it, she said the demons got her daughter (yes, the demons did get her indeed, real demons of real flesh and blood, I would say).

    Reading the article and the comments beneath it is, in its effect, similar to attending a congregation presided over by an evangelical preacher; in other words, it’s terrifying and embarrassing in equal measure.

    The fanatical lunacy of the comments made by the faithful beneath it are what disturbs the most, whose faith, to borrow from Mencken, has taken on the virulence of a chronic infection it would seem. Upon reading these comments, one becomes paralyzed with fear, and a sense of hopelessness and powerlessness withal, a state in which the fight-or-flight mechanism is triggered, leaving you looking around frantically for a cliff to hurl yourself off of, anything to escape the insight you have just gained into the irremediable stupidity and lunacy of men, and the illusory nature of progress, the cornerstone of faith in which being belief in man’s sublunary salvation and redemption through reason, a delusion if ever there were one.

    Make sure there aren’t any shotguns near you whilst reading it, that is unless you would like to kill yourself but are finding it difficult to muster the courage to do so, in which case this article might be the solution to your problem.

    One encounters the usual conventional pieties of the mental health movement in the article. Yet what you won’t see is anyone acknowledging that, given the messages we convey to the people we label “mentally ill”, and the way in which we treat such people, maybe, just maybe, people are killing themselves to escape a society who, in its verdict, are mentally diseased, with all that that implies. Nor is there any mention of the wider failure of society to give many of its citizens no reason not to kill themselves generally, and not even of the unalterable conditions of life. Instead, she killed herself because she was mentally ill. The proof of this? A psychiatrist labelled her mentally ill, and if a mentally ill person kills himself, it must be the mental illness (and certainly not anyone in that person’s life, or the general shittiness of life).

    Whilst no doubt ignorance plays a role, and sometimes people just find themselves caught up in the web of superstitions, prejudices, and assumptions peculiar to their age, I think it is easy to see why psychiatric explanations are preferred over philosophical, sociological, and cultural explanations, given how much more amenable they are to our desires and interests collectively as a society or as individuals.

  • heartofatum

    i do understand what Szasz was saying & the anti-psychiatry
    argument – that psychiatry is Myth making in relation to mental illness –
    that it is metaphor – Diagnostic labels are categories of ranges of
    observed symptomatology, behaviours/experiences. But i also understand
    the other side of the argument as well, & i think there are a number
    of understandings that do, to my mind, refute Szasz.

    i’m more critical of psychiatry – & in favour of a
    Jungian/Laingian view – that madness/mental illness exists, but to take a
    more comprehensive view on it all that incorporates the idea of the
    psyche. The facts are that people are emotionally & mentally unwell
    in different ways & to different degrees, & there is a
    physiology to it all.

    Leaving aside all the polemics & semantics – the focus i feel
    should be how can people best be helped – the focus should be on how to
    best heal people & support them – Not an idealogical argument – i’m
    not sure that this argument really matters in the context of working
    towards a more humane & effective system/society in the treatment of
    the ‘mad’. Although some of this argument does appear to revolve around
    theorised aetiology – But the facts are we don’t know – no one does.
    Madness is as much a mystery as it ever was.

    My personal view is to take an integral/holistic approach – bio/psycho/social (i’d also add the spiritual).

    Very hard if not impossible to solve the mind/body dualism question,
    & it’s not been solved. The problem is very well elucidated here –

    https://www.youtube.com/watch?v=y7RL__ZgdEw

    Within mental health i think it’s also hard to impossible to separate
    physiology (biology) from environment [& psychology]. Hence why i
    think it’s logical to take a more comprehensive view.

  • heartofatum

    An interesting book on the subject – http://josephpolimeni.com/

    [quote]Schizophrenia is one of the most enigmatic human experiences. While it can cause terrible distress, it doesn’t fit the mold of a classic medical disease. In Shamans Among Us, Joseph Polimeni shows that today’s schizophrenia patients are no less than the modern manifestation of tribal shamans, people vital to the success of early human cultures. Spanning human history and including discussions of evolution, the definition of disease, and the nature of psychosis, Shamans Among Us is the most detailed and comprehensive evolutionary theory yet assembled to explain a specific psychiatric diagnosis. “Joseph Polimeni’s scholarly book challenges several traditional concepts of both evolutionary biology and medicine. I strongly recommend it to all those who dare to think outside the box.” – Martin Brüne, MD, author of Textbook of Evolutionary Psychiatry.[/quote]

    Published on 25 Sep 2013

    A Video Lecture by Dr. Joseph Polimeni entitled “Shamanism and the Evolutionary Origins of Schizophrenia”

    https://www.youtube.com/watch?v=tJN3D8UhtGQ

  • all too easy

    “One would be tempted to call this a conspiracy of silence if there were an exact correspondence between this expression and the reality it points to, but alas, even often by dint of reflection, we are largely blind to the occult springs and motives of our thought and behavior, to those stirrings of the subconscious (which is really just a spatial metaphor referring to our desires, passions, repressed memories, appetites etc., operating below the threshold of consciousness wherefrom they exert their despotic influence over the faculties, in the supremacy of which we repose so much misguided faith, perhaps I would surmise because of the existential profit those possessed of the delusion of their own sanity stand to gain thereby, be it in their conflicts with others, be it professionally and financially, be it psychologically) upon which so much of our conscious thought rests, for which reason the term “conspiracy” is largely useless to explain the wicked ways of the world, stemming as they do largely from a want of reflection upon ourselves, self-deception, and the limitations of self-knowledge.” CLODWYNIUS THE BOOB

    Beautiful babe. sheer profundity. try taking a breath occasionally. when you get tired of sitting on your high and lofty perch where you enjoy looking down on those scary monsters called people, you might find a friend or two. up there, you’ve got you and your thoughts about how much better you are than all those boobs those down there. being perfectly free, you are a prison unto yourself.

    “The mother recently penned an article, perhaps looking for some support that might help assuage her sense of guilt and lull her conscience to sleep for her own role in driving her daughter to her own self-administered death, though this is conjecture.” clodiepuss

    What compassion. What a heart. What a guy.

  • heartofatum

    i’ve been through it all – a very extreme state of mind at the age of 17,
    & in response being very badly treated, violently sectioned against
    my will on a locked ward, forced injected with drugs, locked in strong
    rooms – the works. The system is no different today.

    There is very much a conspiracy of silence around the whole thing,
    & the treatment of the genuinely ‘mad’. What is going on with it
    all, all around the World, happening & has happened to millions of
    people, is a disgusting indictment on humanity.

    Yes, there are other bad thing in this World – But with this there is
    no real acknowledgement, nor validation, & understanding. Just
    denial, trivialisation & invalidation. Future humanity will look
    back in utter disgust, just as we do to past psychiatric
    abuses/practises (those that see & acknowledge them). We’re still in
    the dark ages with it all.

  • all too easy

    Well, keep working on getting it fixed. Good for you. We all need to find our passion and pour our hearts into it. Nothing is so good it can’t be made better

  • heartofatum

    It’s Evil.

  • all too easy

    Indicting everyone is a mistake. BTW, I for one don’t believe you were violently sectioned on a locked ward, drug injected against your will, locked in strong rooms. Too neatly packaged in the antipsychiatry jargon of pity me, I am a tortured survivor of those big meanies.
    If true, you could have sued their pants off. Few people, very few, are subjected to the kind of abuse you describe if they have not become violent or out of control. The antis thrive on extremes, expecting all to believe without question everything they claim. Bologna. Face the fact that some on your team are ill, severely ill, mentally, emotionally and spiritually and their credibility is shot. Sometimes, it seems that practically every anti believes she has suffered more injustice at the hands of psychiatry than all others for all reasons combined. They relish the horror. They love to describe it every chance they can and still hope to sound believable.

  • heartofatum

    Firstly i’m Not anti-psychiatry, i’m in favour of a far more comprehensive & humane psychiatry. i’m also Not anti-medication & see a very valid role for it’s wise use. The question of forced treatment/locking people up, is i think a very complex one. i do feel very strongly that there are far better ways of helping people.

    It matters Not if you believe me or Not – i accept the diagnosis & that i was severely ill, i was out of control & mildly violent – although the system responded with far more violence. i also believe i was raped by the staff during first admittance, & have very good reason for thinking that. Sexual & physical abuse of patients is common in such places/institutions.

    There isn’t a day that goes by where it isn’t all with me, & it happened 25 years ago.

    People need genuine understanding, care, help & support – Not the abuse & barbarity of the current system & it’s psychopaths.

  • All Too Easy Watch

    The fact that you are responding to the troll who has haunted this blog for seven or eight weeks, and responding to one of the most disgusting comments he has ever left here, is very disappointing. He’s better left ignored. He will go away one day.

  • heartofatum

    i’ve been posting on mainstream mental health forums for the past 10 years trying to raise awareness – i’m used to all the comments. i find ‘all too easy’ laughable more than anything.

  • all too easy

    Changed your tune a little.
    “A mental patient has no legal recourse against the system. It’s enshrined & justified in Law.” birdbrain
    Chapter and verse. Good luck. Mentally ill folks lie without understanding how easily they are exposed.
    My nemesis knows how to hurt a guy. If only he would keep reading my comments and following everything I do! I’d feel much better. It would prove to himself he can’t live without me.
    Stop lying about your psychiatric horror show. Statutes of Limitation on child abuse are changing because of Sandusky and the perverted priests. Sue your abusers. Oh, and BTW, name names. What institution locked you up and forcibly injected you? Hmm? Can’t quite recall? Slipped your mind?
    To prove my genius, I will guarantee you right now, this lying little zealot is not going to and will never, ever name names–ever never. Ever.

  • all too easy

    mildly violent
    Good one.
    Beautiful.
    mildly violent.

  • heartofatum

    The abuse happened at the Old Manor Psychiatric Hospital in 1991 (Sailsbury/UK). If you research the papers from around 1994 they ran reports on a large scale abuse case that had come to light, centered around that hospital, during a 6 year period where the worst of the abuse took place – they had found hundreds of home made sex videos that had been made by the staff, of them sexually abusing patients – & a number of complaints had been made, concerning the physical & sexual abuse of patients. The main director had done a runner at the time. The particular articles i read at the time were in the independent newspaper. The hospital has been long closed down.

    The abuse centered around the locked ‘Bourne’ ward, & i stayed there during the middle of the 6 year period when the worst of the abuse took place.

    i was so heavily drugged on medications, & had been admitted in a very extreme/psychotic state – most of my stay there is a total blank. i do have a very clear memory of ‘coming to’ naked on a bed (in my room that used to be locked at night) with sheets covered in blood & shit, in a very distressed state & 4 nurses around me in a panicked state. i was taken to the bathroom, bathed & the sheets changed & put back into bed. There are other memories as well.

    Can i be categorically sure i was sexually abused on that ward? i don’t know – it was 25 years ago. i don’t remember the names of any of the staff – at the time i was in severe alcoholism/addiction & going through a lot of severe psychosis – that i didn’t properly address for another 10 years.

    i remember being regularly wrestled to the floor by 4 nurses, restrained, pants pulled down, injected with drugs, & being locked in the strong room – on many occasions. Sometimes being left without food for days & being so drugged that i became too weak to stand up.

    i know the reality of what has & does happen in such places. Systemic abuse cases are always coming to light in the UK in institutions – & such places have been & i expect still are often rife breeding grounds & very attractive for psychopaths & sexual deviants.

    i say mildly violent because that is the truth, i broke something & i pushed someone away from me – that is the sum total of it all. The violence given to me wasn’t warranted/justified.

  • heartofatum

    Anyway ‘alltooeasy’ what’s with the fanatical/blind defence of the horrors & barbarity of the current system/treatment of the ‘mad’? Something on your conscience maybe? You do realise that there is Divine Dispensation – if you don’t; one day you will 🙂

  • All Too Easy Watch

    See what did I tell you? What have you got from engaging with the troll? Nothing. The troll claims to have a brain disease that causes him to not be able to pay enough attention to things. The troll has been paying daily attention to this blog for 8 weeks or something so maybe his fake brain disease is healed. He’s a very sad character, highly concerned with the goings on around here, addicted to pitiable, attempts to snipe at the heels of the serious visitors to this blog. He will go away eventually.

  • heartofatum

    Whoever they are they are entitled to an opinion. There is far too much censorship & loss of genuine freedom of speech. To be honest i don’t really agree with any of the polemics of all this area, neither with ‘anti-psychiatry’, nor pro biomedical psychiatry – i think it’s all wrong. What i am in favour of is the comprehensive & humane understanding & caring approach to it all. & doing what is best to live in a far more civilised society. & that won’t happen until people become far more civilised.

    Simply trying to close down the free speech of people that disagree with us even if they are wrong, as they’re doing on MIA, just isn’t the way to go.

    However caused, maybe some people do have a brain condition – there is some good evidence for that. To say there is zero physiological aetiology within severe psychosis/schizophrenia is ridiculous.

  • all too easy

    The names of your abusers? Can’t remember 1?
    That’s what I guaranteed.
    How did I know? Told ya!

  • heartofatum

    How very clever of you, what a good boy you are – have a star.

  • all too easy

    “The mother recently penned an article, perhaps looking for some support that might help assuage her sense of guilt and lull her conscience to sleep for her own role in driving her daughter to her own self-administered death, though this is conjecture.” clodiepuss

    I simply noted that our precious oldpussclode was a dear sweetheart for his compassionate thoughts on a mother’s tragic loss of a child. (He who finds fault with everything/everyone but himself.)

    To his wonderfully sensitive response to a mother’s daughters suicide by the enormous boob oddpussclde, you said millions had been abused like you were in the mental health system: locked up, forcibly injected with drugs, starved, beaten, etc.
    Notice how our moral leader, Phil the Judge of All, jumped in immediately to rebuke oldclydeapuss!
    Then, the cowardly, self-righteous boob who can’t live without me and is glued to every word I write, jumped in with more jealous rantings about my magnificence,
    And you, my pretty, got caught with your pants down, again, as I predicted you would do exactly what you did. Not clever, my love. Genius! A True Prophet! (Well, okay, clever too, but mostly unbelievably, uncannily awesome and brilliant.)
    P.S. The antis are full of themselves. Their fan base consists of a few likeminded Pharisees like boobwoodlynpuss who knows nothing about life but nevertheless is convinced he is the mouthpiece for all melancholic, self-obsessed, introverted, melodramatic boobs who are terrified of actually sticking their toes in the water and experiencing life as it is. They don’t work but rather sit at their computers all day and dream of how things should be.

  • heartofatum

    We live in such a wonderful, advanced, humane & civilised society – where people are fucked up, abused & fed a load of poison because they have brain diseases that no one can find. What a bunch of retarded fucking idiots.

    We need to kill more immigrants as well, & perpetuate some more wars to keep the economy going – You know it all makes sense.

  • all too easy

    Thanks for proving how much being exposed as a liar threatens everything about you. Give these boobs something that angers them a little, when something doesn’t go exactly as they planned, or when they get tangled up in their shorts–like heartofdarkness here, and they show their true colors. BLACK. These lovely thoughts were expressed by our dear sweetheart, HEARTOFDARKNESS, who believes in free speech, until she’s caught in a million lies, “What is going on with it all, all around the World, happening & has happened to millions of people, is a disgusting indictment on humanity.” and although she doesn’t take what I say very seriously, she does have a temper! You go girlie! Go somewhere else where you have a chance of fooling somebody.

  • heartofatum

    Interesting that you assume i’m a woman? i’ve spoken the truth. i don’t feel threatened in the slightest – am content to shoot the breeze all day long – But this conversation is tiresome, like so many concerning this subject, & full of ignorant drugged deluded brain washed dullards who spout the same continual rubbish & lies like a load of automatons. Enjoy the foul World you perpetuate & have created – it’s the Century of the revenge of the stupid – & well on track for an immense amount of stupidity. i’ll respectfully bow out of this ‘conversation’ it bores me. Enjoy talking with yourself all too stupid.

  • all too easy

    “Make sure there aren’t any shotguns near you whilst reading it, that is unless you would like to kill yourself but are finding it difficult to muster the courage to do so, in which case this article might be the solution to your problem.” CLODHOPPERPUSS
    The above quote is this animal’s response to the loss of a child. She expresses her feelings below,
    “I lost my darling daughter Natalie to terminal mental illness last weekend. She killed herself one month short of her 29th birthday by stepping in front of a train in Baltimore. Natalie was the bravest person I ever knew, and her suicide doesn’t change that. The work to save other lives goes on. She wouldn’t have wanted it to be any other way.”

    -Doris Fuller, executive director of the Treatment Advocacy Center-
    This punk, clodhopperpuss, is fortunate he can hide behind a computer all day. In public, this nazi wouldn’t last. I realized instantly he was a profoundly sick and warped petty little coward, but even I wasn’t aware at first that there is nothing even the most advanced medical therapeutics can do to alleviate his pathetic perversions. This degenerate is disturbed beyond the healing power of anything known on earth. As Carl Jung told a desperate, desperate rummy years ago, this vile weed needs a spiritual awakening, a spiritual intervention that requires the complete deflation of its massive ego first, in order to be transformed from a putrid, disgusting virus into something useful to others. Without such a divine breakthrough, he can only get sicker.

  • heartofatum

    LOL – Very poetic. Thanks for the laugh.

  • Amy Smith

    do you know who all too easy is by any chance?

  • heartofatum

    Me? No idea – Another brain dead/brain washed fucking retard by the sounds of it. Do you know?

  • Amy Smith

    Nope, wish I did. Sounds like a big dog that wants to speak with impunity. Thanks.

  • all too easy

    What psychs call ADHD is nothing more than a loosely defined cluster of behaviors and commissions.

    It is stunning how your brain, biased as it is, cannot see what is perfectly obvious.

  • all too easy

    A French psychiatrist has been convicted of manslaughter six years after one of her patients hacked an elderly man to death.

    Danielle Canarelli, 58, was handed a one-year suspended prison sentence for her ‘grave error’ in failing to recognise that her paranoid schizophrenic patient Joël Gaillard posed a public risk.

    The doctor, who has over 30 years of experience and currently works at Marseille’s Edouard-Toulouse hospital, was also ordered to pay 8,500 euros to the victim’s children, in the groundbreaking case that could affect the way patients are treated.

    Gaillard hacked to death 80-year-old Germain Trabuc with an axe in March 2004 in Gap, in the Alps region of southeastern France, 20 days after fleeing a consultation with Canarelli at Marseilles’s Edouard Toulouse hospital.

    ‘If a psychiatrist lives in fear of being sentenced, it will have very real consequences and probably lead to harsher treatment of patients,’ said Canarelli’s lawyer, Sylvain Pontier.

    Antis take no heat when patients with severe mental disturbances flip out. They specialize in criticizing from the safe sidelines of no accountability and talk like they are invincible experts in medicine.

  • all too essy

    We need to be far more civilized before…

    Too bad this lying hypocrite holds back the kind of progress she says is necessary to bring about real changes in society to make mental well-being a reality. Pure delight. It requires about a sneeze-worth of explosive power to trigger her hairpin rage. Love ya babe.

  • Bleezit420

    You are either a troll, or extremely naive if you believe the people you refer to give a fuck about you or any other mentally ill person.

    If you wanna argue I’ll throw you a few scraps, prepare to look like a fool

    Phil is being as objective as possible with these articles, it’s not his fault all the evidence points to the so called ‘wonderful people’ being crooks in white coats.

  • Bleezit420

    Disabling inattentiveness? Agonizing boredom? DON’T YOU REALIZE MEDICATION ISN’T A VIABLE SOLUTION FOR THESE PROBLEMS? Long term medication is a way of making lifelong customers, mental disorders not caused by physical trauma require a mental cure. You learn to walk by trying and failing, then eventually succeeding. If you gave a child a mobility scooter he would never learn to stand by himself on his own 2 feet. If you give a child with adhd medication, he is crippled for life and requires that crutch to survive.

    Your brain is adaptable, it can overcome challenges as long as you don’t FUCK WITH the chemical balance too much, and that’s exactly what these medications do, stunting a child permanently. ADHD is a byproduct of a child’s environment, having instant stimulation available with very little effort required makes it so that they don’t have to flex their focusing muscles very often, causing them to atrophy.

    I’m already pretty sure you are a troll but I’m afraid I’m going to have to call you out and make it so all these nice people can see what a piece of shit you are and know why you are wrong.

    By the way for anyone following look how this troll conducts himself. A name like “all too easy” implies he has already won whatever argument he is engaging in (and he acts like he has, this is a common tactic of trolls and is extremely frustrating). He is also constantly belittling phil, calling him names, suggesting poor character through various slandering adjectives throughout his comments. Ad hominem much? But watch out kids! The troll is a clever beast. He will now proceed to accuse me of ad hominem for calling him out on ad hominem, thereby refuting my assertion of a logical fallacy on the very platform I used to disprove him. To the narrow mind, it may cancel me out, but the wise man will know that the troll did commit ad hominem several times, and most importantly, phil did not. Never trust the one who uses logical fallacies in their argument, even if they can still formulate a good sounding argument around it. Anybody wanna help beat down this troll?

  • Bleezit420

    hahaha I thought you were his alternate account trolls have those. I figured I’d throw him a few scraps and engage in a minor scuffle with the beast, but from the attitude of your comment I’m beginning to wonder if this one is too toxic to touch. I don’t want to let a single comment of his exist untarnished by our reminders that he is indeed a troll, every one must be debunked on the spot so that any naive new folks will know which path is right