Allen Frances:  Still Blaming Everyone But Himself

by Phil Hickey on May 24, 2016

On May 7, Allen Frances, MD, posted an article on the HuffPost site.  The piece was titled Antidepressants Work, But Only For Really Depressed People.

Superficially, the article presents itself as a call to limit the prescribing of the so-called antidepressant drugs to severe cases; but the piece can, I suggest, be more accurately characterized as Dr. Frances’s latest attempt to distance himself, and psychiatry in general, from the pill-peddling frenzy that has characterized the profession for the past thirty or forty years

Here are some quotes, interspersed with my comments and observations.

DSM-III’S “BIGGEST MISTAKE”

“The biggest mistake in DSM III was introducing the very broad and heterogeneous category ‘Major Depressive Disorder’. This combined under one rubric what had previously been two separate and quite different presentations: 1) severe, melancholic, delusional, or incapacitating depressions, and 2) reactive to stress, mild, and often transient depressions. The result is that many people get the label Major Depressive Disorder, even though their presentation isn’t really ‘Major’, isn’t really ‘Depressive’, isn’t really ‘Disorder’. Mild sadness in reaction to stress and disappointment is lumped together with the most severe suffering known to man.”

At issue here is the old psychiatric distinction between endogenous depression and exogenous depression.  The later was conceptualized as a reaction to some external fact or circumstance, whereas the former was considered to have arisen from within the person – i.e. without any external loss or hurt.  The distinction was always problematic, in that it’s impossible to know, with certainty, that a person’s depression is not a response to some external loss, hurt, or circumstance, but the distinction was considered important within the psychiatric community generally.

In any event, the terms “exogenous” and “endogenous” went out of vogue, though the underlying concepts remained in place in DSM-III.  And, contrary to Dr. Frances’s assertion in the above quote, they remained in place as separate entities.  These were: “major depressive disorder”, and “adjustment disorder with depressed mood”.

In DSM-III, adjustment disorder is defined as “A reaction to an identifiable psychosocial stressor…”.  DSM-III made no provision for specifying severity of adjustment disorder (e.g. mild, moderate, severe), but in the text it states clearly that people may have “a more severe form of the disorder” or “only a mild form of the disorder”.  Major depressive disorder in DSM-III could be formally and explicitly coded as mild, moderate, and severe.

Now it’s no part of my agenda to defend any edition of the DSM, a document which in my view has all the scientific rigor and practical usefulness of a witch-hunter’s manual.  Rather, my purpose here is to point out that Dr. Frances’s assertion in the above quote is simply false.

Essentially what Dr. Frances is saying, or at least forcefully implying, is that since this great “error” in DSM-III, psychiatrists, misfortunate lambs that they are, have simply had no way to reflect in their “diagnostic assessments” that the individual’s depression “isn’t really ‘Major’, isn’t really ‘Depression’, isn’t really ‘Disorder’.”

And because of this truly arduous imposition, psychiatrists are constrained to lump “mild sadness in reaction to stress and disappointment” with “the most severe suffering known to man”.

It may well be that psychiatrists have been avoiding the use of “reaction to stress”, “mild” and “transient” qualifiers in their “diagnostic assessments”.  But this is emphatically not because such qualifiers were rendered impossible by DSM-III.  A much more likely explanation is that the use of these qualifiers militates against the notion, avidly promulgated by psychiatry for the past forty years, that depression, of whatever severity, is a chronic illness, (just like diabetes); a chemical imbalance in the brain, for which the “patient” must take so-called antidepressant drugs for an extended period, and possibly the rest of his/her life.  For all of this time, it has been an integral part of psychiatry’s informal, but avidly asserted, message that although depression might have been triggered by an external event, it is essentially an illness residing within the person’s neurochemistry.

But, even if we put all that aside; even if we acknowledge that Robert Spitzer and his DSM-III co-authors made a dreadful error, a critical question remains:  why did Dr. Frances himself and his DSM-IV co-authors, so uncritically follow suit?  And why has Dr. Frances not acknowledged his own perpetuation of this so-called error in the present paper?  It’s easy, and perhaps a little craven, to point fingers at the recently deceased Dr. Spitzer, when in fact, Dr. Frances himself followed precisely the same path.

And in fact, Dr. Spitzer was open enough to admit that he and his DSM-III co-workers had made a much more fundamental error.  Here’s a quote from an interview he gave to British film maker Adam Curtis.  The interview was screened by the BBC in 2007, and the 50 second excerpt can be viewed here, starting at minute 34:10.

Robert Spitzer, MD:

“What happened is that we made estimates of prevalence of mental disorders totally descriptively without considering that many of these conditions might be normal reactions which are not really disorders.  That’s the problem.  Because we were not looking at the context in which those conditions developed.”

Adam Curtis:

“So you have effectively medicalized much of ordinary human sadness, fear, ordinary experiences, you’ve medicalized them.”

Spitzer:

“Uh, I think we have, to some extent.  How serious a problem it is is not known.  I don’t know if it’s twenty percent, thirty percent, I don’t know.  But that’s a considerable amount if it is twenty or thirty percent.”

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

Back to the Huffington Post piece.

“Drug companies jumped on the opportunity to peddle a pill for every problem and misleadingly described all depressions as a chemical imbalance requiring a chemical solution. Treatment studies that previously showed clear superiority of medicine over placebo for severe depression showed little or no superiority with patients whose depression was mild or questionable. And biological marker studies that showed promise in tagging severe depression came up empty with the watered down Major Depressive Disorder.”

There it is again.  Those mean old opportunistic drug companies!  How could one ever trust them?

But again, a major distortion of reality.  Drug companies can’t sell these products without FDA approval, and a physician’s prescription.  It was psychiatrists who created and promulgated the questionable research that elicited FDA approval and legitimized the wholesale use of these products.  Admittedly, these psychiatrists were handsomely paid by pharma, but they were not constrained.  Dr. Frances is surely familiar with this process.  In 1995, he and his two colleagues Drs. John Docherty and David Kahn, reportedly accepted $515,000 from Johnson & Johnson to write “Schizophrenia Practice Guidelines”, which blatantly promoted Risperdal (risperidone), a drug manufactured by Johnson & Johnson.  For a full and compelling account of this sordid tale, see Paula Caplan’s very thorough exposé here.

The notion that psychiatric research would clearly support the use of the drugs and would identify biological markers for depression, if only the “mild or questionable” depressions were excluded, is fanciful.  Depression has been extensively researched for decades, by psychiatrists, highly motivated by pharma largesse to find significant positive results.  These studies routinely report that “diagnoses” were confirmed by scrupulously careful evaluations using psychiatric interviews and validated screening tools.  So why would there by “questionable” cases in the studied samples?  In fact, in his Introduction to DSM-IV (1984), Dr. Frances explicitly acknowledged DSM-III’s contribution in this area.

“The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) represented a major advance in the diagnosis of mental disorders and greatly facilitated empirical research.  The development of DSM-IV has benefited from the substantial increase in the research on diagnosis that was generated in part by DSM-III and DSM-III-R.” (p. xviii) [Boldface added]

An identical passage was included on page xxvi in DSM-IV-TR six years later (2000)

And furthermore, individuals whose depression is mild can be eliminated readily and legitimately from a study by limiting the scope to moderate and severe cases.

PSYCHIATRY DID PROMOTE THE CHEMICAL IMBALANCE THEORY

And what are we to make of Dr. Frances’s assertion that the drug companies “…misleadingly described all depressions as a chemical imbalance requiring a chemical solution”? In fact, it was psychiatry who promoted the chemical imbalance hoax.  Pharma certainly tagged along, with their blatantly false commercials, but psychiatry could have stopped this fraudulent inanity in its tracks at any time, by issuing a clear and definitive press release disavowing the hoax, and by filing a formal complaint of false advertising with the Federal Trade Commission.

But psychiatry took no such action.  Psychiatry blatantly, and without compunction, foisted this falsehood on their “patients”, on the public, and on other practitioners – knowing it to be false – for the purpose of promoting their own guild interests, and selling more drugs.  It is simply beyond comprehension that Dr. Frances continues to try to slough off the responsibility for this hoax, this gross violation of the public trust, onto his erstwhile pharma benefactors.

If Dr. Frances has any residual doubts as to psychiatry’s role in the dissemination of this falsehood, he might usefully take a look at Terry Lynch’s book Depression Delusion or my post Psychiatry DID Promote the Chemical Imbalance Theory

Or … he might want to revisit something he himself wrote in 1998.  Here’s a quote from Am I Okay? by Allen Frances, MD, and Michael B First, MD:

“Depression is really no different than hypertension.  Medicines that treat high blood pressure are taken to reestablish the body’s ability to maintain a normal blood pressure.  Antidepressants work in the same way—restoring brain neurochemistry to its original natural state.  In contrast to drugs like heroin and cocaine, which make virtually everyone feel euphoric, an antidepressant does nothing for a person without depression except produce unpleasant side effects.  There is no street market for antidepressants and they are not addictive.  Finally, in the same way that it would be ludicrous to think that someone can simply will their elevated blood pressure down to normal, true grit is not by itself sufficient to cure clinical depression.” (p 49-50)  [Emphasis added]

Incidentally, Dr. Frances’s promotion of the now defunct chemical imbalance theory of depression in the above quote is particularly interesting in the light of the statement made by the very eminent psychiatrist Ronald Pies, MD in his April 2014 article Nuances, Narratives, and the Chemical Imbalance Debate:

“To the extent the ‘chemical imbalance’ notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.”

Dr. Pies, meet Dr. Frances.

With regards to Dr. Frances’s assertion that there is no street market for antidepressants, here is a letter in the February 2007 issue of the American Journal of Psychiatry.  The letter is from Greg Tarasoff, MD, a psychiatrist, and Kathryn Osti, and is titled Black-Market Value of Antipsychotics, Antidepressants, and Hypnotics in Las Vegas, Nevada. The letter reports that, at that time, antidepressants were selling on the street for $3-$5 per dose.

Also, here’s a 2013 article from globalnews.ca, Toronto, which describes an active street market in Wellbutrin.  The article was written by Jennifer Tryon and Nick Logan, and it reports that Wellbutrin is referred to as “the poor man’s cocaine”.

I realize, of course, that Am I Okay was written before these articles, but here are two studies that predate the book:

Abuse of Amitriptyline by Cohen, Hanbury, and Stimmel: JAMA, Sept 1978:

“A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria.”

And Identification of misused drugs in the clinical laboratory. I. Tricyclics, by Vasiliades, J; Clinical Biochemistry, February 1980:

“A systematic approach evaluating the abuse of tricyclic drugs in the hospital emergency room from the laboratory point of view is presented…Increasing misuse of tricyclic antidepressants requires that the clinical laboratory have a systematic approach to identify and confirm the presence of these drugs in emergency room patients.” [Emphasis added]

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

FRANCES PROMOTED THE DRUGS

Back to Am I Okay?  Here’s a quote in which Drs. Frances and First promoted the drugs as “very effective” in the treatment of “major depressive disorder”:

“For those suffering from Major Depressive Disorder, antidepressant medications are very effective—the overall odds that an antidepressant treatment will work eventually are probably at least 90 percent.  But you have to be patient and forbearing along the way.  It usually takes at least several weeks for the medication to begin working, and a couple of months before it has reached its maximum effect.  It might also take time and effort to find the most effective medication for you and to determine its proper dose.  Some people must endure several trials of different antidepressants until they find the one that is a winner for them.  To give you some perspective, two thirds of depressed patients will have a good response to the first medicine that is tried. For those who do not respond initially, the odds of a second antidepressant working are about fifty-fifty—this gets us to about 80 percent total response rate.  If you have still not yet responded after two tries, a third or fourth or even a fifth try may be necessary to find the medicine or combination of medicines that will eventually work.  The good news is that there are close to thirty available antidepressants on the market and new ones are being developed all the time.  Hopefully sooner, but almost certainly eventually, one of these or some combination will work for you.

The use of antidepressant medication has risen dramatically over the past several years, but many people who might benefit have misconceptions that make them reluctant to give one a try.  One common concern is that the changes resulting from antidepressant use are artificial and, by implication, somehow illegitimate.  Others worry that they will become physically dependent on antidepressants in the same way that a heroin addict cannot function without his daily fix.  Yet others feel that having to rely on antidepressant medications to maintain one’s mood (and productivity) represents a weakness in moral fiber—that you should be able to get rid of the depression by sheer will power alone.” (p 49)

There are several noteworthy points in this quote.

Firstly, Dr. Frances does not limit his assertions to cases of “severe, melancholic, delusional, or incapacitating depressions“, even though such options were available within the psychiatric “diagnostic” system.  The phrase “…those suffering from Major Depressive Disorder” clearly embraces mild, moderate, and severe unless otherwise delineated.  In fairness to Dr. Frances, he does acknowledge elsewhere in the text that the drugs are not always necessary, but his assertions in this regard are generally less compelling, e.g., “antidepressant medications are probably overused.” (p 50) [Emphasis added]

Secondly, the tone of the quote with regards to taking the drugs is upbeat and optimistic.  The drugs “…are very effective”; “the odds of successful treatment…are probably at least 90 percent”; “…there are close to thirty available antidepressants on the market…”; “…one of these or some combination will work for you.”

Thirdly, the authors acknowledge that antidepressant use has risen “dramatically”, but then go on to encourage further use.

Fourthly, there are clear efforts on the part of the authors to undermine people’s resistance to drug-taking. The authors dismiss concerns that the effects of the drugs are “artificial” and that the drugs might be addictive.  Bearing in mind that the book was written for general audiences (A Layman’s Guide to the Psychiatrist’s Bible), the assertion that antidepressants restore “…neurochemistry to its original natural state”, with its almost Edenic connotations, is nothing short of outrageous.

And incidentally, here’s another quote from the same chapter:

“ECT is a terrifically effective treatment  that is also relatively safe considering the great benefits that can often be gained.  ECT is especially useful for psychotic mood disorders, people who need a really fast response, medication nonresponders, and for those who cannot tolerate antidepressant medication.  Electroconvulsive therapy has a higher response rate (80 to 90 percent versus the 65 to 70 percent achieved by medication combinations) and also works more rapidly.  However, it has the disadvantage of providing fewer clues as to what type of medication is likely to work to prevent recurrences in the maintenance phase.  Due to misguided fears, ECT has been most typically considered a treatment of last resort when nothing else works.  It probably deserves to be used earlier and more often.” (p 51-52)

Note that the success rate of antidepressants which on page 49 was given as “at least 90 percent”, is now, two pages later, given as “65 to 70 percent”.

Note also that Dr. Frances is advocating an expansion of the use of high voltage electric shocks to the brain as a “treatment” for depression, and makes no mention of the permanent memory damage that this “treatment” entails.

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

Back to the HuffPost article:

“Critics of medication jumped on this to argue misleadingly that depression is a myth and/or that medication treatment for depression doesn’t work.”

I don’t know of anyone on this side of the debate who argues that “depression is a myth”.  I myself argue – as do a great many others – that depression is not an illness.  But depression is real, and I don’t believe that I’ve ever heard anyone suggest otherwise.  My own position is that depression is the natural human reaction to loss or to ongoing hardship/drudgery, and that severe depression is the normal reaction to a major loss or to ongoing hardship/drudgery that is particularly arduous.  It is not something that needs to be “treated”; rather, it can be alleviated, either by supporting individuals through their loss, or actively helping them identify and extricate themselves from the depressing circumstances.  What the pills do, in some cases, is provide an altered mental state, which some people find preferable to the depression.  But the pills produce no lasting benefits, and usually do a great deal more harm than good.  The issue here is not whether people should or shouldn’t take these pills.  That’s each person’s individual choice.  The issue is psychiatry pushing these dangerous serotonin-disruptive chemicals on people, under the pretense that they have an illness, for which the pills are an effective and safe treatment.

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

At this point in the article, Dr. Frances introduces Mark Kramer, MD, PhD.  Dr. Kramer restates and elaborates on some of the points made by Dr. Frances, who in turn closes the article with some concluding remarks, including:

“The next point seems too obvious to be stated, but nonetheless desperately needs stating. Only people who are clearly clinically depressed and clearly need antidepressants should be included in research studies and should be taking antidepressants in everyday clinical practice. Depression has been too carelessly diagnosed- encouraged by the loose DSM definition, by Pharma’s desire to push product; by rushed doctors; and by people’s hope for a quick fix for life’s problems.”

It should be noted that the term “clinically depressed”, despite its widespread usage, has no formal meaning in psychiatry.  In practice, it is used to mean having a “diagnosis” of major depressive disorder or dysthymia, but because of the medical connotations of the word “clinical”, it is also used to convey and promote the notion that depression is an illness.  So Dr. Frances is telling us that only people who clearly meet the criteria for major depressive disorder or dysthymia, and who clearly need antidepressants, should be taking antidepressants.  But this is nothing more than an empty platitude.  What’s the alternative?  Take antidepressants even though you don’t really need them?  Who is suggesting that? And anyway, wasn’t the whole point of the DSM to provide rigorous definitions of the various “mental disorders”?  Hasn’t this been the standard psychiatry patter since DSM-III?  In fact, here’s the opening paragraph from the Introduction to Dr. Frances’s own DSM-IV:

“This is the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV.  The utility and credibility of DSM-IV require that it focus on its clinical, research, and educational purposes and be supported by an extensive empirical foundation.  Our highest priority has been to provide a helpful guide to clinical practice.  We hoped to make DSM-IV practical and useful for clinicians by striving for brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria.  An additional goal was to facilitate research and improve communication among clinicians and researchers.  We were also mindful of the use of DSM-IV for improving the collection of clinical information and as an education tool for teaching psychopathology.” (p xv)

and later, concerning DSM-III:

“DSM-III introduced a number of important methodological innovations, including explicit diagnostic criteria, a multiaxial system, and a descriptive approach that attempted to be neutral with respect to theories of etiology.” (p xvii-xviii)

So if the problem is “loose DSM definitions”, Dr. Frances needs to direct at least some of the responsibility for the present state of affairs in his own direction; firstly for drafting a document that slavishly followed the errors he now ascribes to DSM-III, and secondly for  falsely hyping DSM-IV in that edition’s Introduction.

In should also be noted, that the “diagnostic” definitions in all editions of the DSM are notoriously vague and “loose”.  But in addition, Dr. Frances’s own DSM-IV added an entire layer of looseness:

“The specific diagnostic criteria included in DSM-IV are meant to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion.  For example, the exercise of clinical judgment may justify giving a certain diagnosis to an individual even though the clinical presentation falls just short of meeting the full criteria for the diagnosis as long as the symptoms that are present are persistent and severe.” (p xxiii) [Emphasis added]

How short is “just short”?  What duration would be considered persistent?  In the case of “major depressive disorder”, we know that “persistent” means two weeks!

Dr. Frances tells us that depression (by which he clearly means the mythical illness) has been too carelessly diagnosed by

– pharma’s desire to push product;
– rushed doctors (note, not specifically psychiatrists); and
– people’s hope for a quick fix for life’s problems

In short:  everyone is to blame for the drug-pushing except psychiatry; that dauntless and noble pillar of compassionate rectitude, standing valiantly alone against the surging tide of venality, corruption, disease-mongering, slovenliness, and disempowerment that characterizes all the other players in this epic tragedy.

The notion that the loose definitions, the inexorable expansion of the “diagnostic” net, and the broadening of “indications” for the drugs were errors, is simply not credible.  If these were errors, then psychiatrists must surely be a most inept group of people.  Rather, these developments were, and still are, an integral part of psychiatry’s plan to expand its scope and to strengthen its hegemony.  And this plan, in the implementation of which Dr. Frances played a leading part, is still in place.  Psychiatry, with the help of their pharma allies, is actively promoting early screening for various “diagnoses”.  Active steps are being taken to have mental health services embedded in every school and in every GP’s office.  Children as young as three years old are being given major tranquilizers to “treat” temper tantrums, and vulnerable individuals in nursing homes, foster care, and group homes are being drugged at unprecedented levels.

If Dr. Frances genuinely wants to distance himself from this institutional degeneracy, he must first acknowledge the role that he himself played in its creation.

THE FUNDAMENTAL PROBLEM

Important as all these issues are, there is a fundamental, over-riding issue that is much more critical.

The assertion that the so-called antidepressants are being over-prescribed implies that there is a correct and appropriate level of prescribing towards which reformative efforts should be directed.

And this premise is false, for three reasons.  Firstly, because depression, regardless of its severity or persistence, is not an illness which needs to be treated with medication.  Secondly, because the drugs, despite the psychiatric-pharma hype, are not particularly effective in ameliorating depression.  And, thirdly, because these serotonin-disruptive drugs have a wide range of adverse effects, the seriousness of which has been routinely downplayed by pharma and by psychiatry.

The widespread and increasing use of the so-called antidepressant drugs is certainly a matter for concern, as is the assignment of depression “diagnoses” to more and more people.  But these problems stem directly and inevitably from the fact that psychiatry invented these spurious illnesses and generated the bogus research to legitimize the use of the pills as safe and effective “treatments”.  Given the inherent vagueness of the criteria and the absence of an identified and confirmable biological pathology, it was inevitable and predictable that “diagnosing” and pill-pushing would increase. To put the matter briefly, there is no way to determine who has the illness called depression and who doesn’t, because no such illness exists.  Psychiatry invented this entity, concocted an inane checklist of “symptoms” to create the appearance of medical legitimacy, peddled the pills with abandon, and reaped the profits.

Allen Frances’s bemoaning the “over-prescribing” at this late stage in the game is not only hypocritical.  It also serves to distract his readers from the real issue:  that psychiatry is, at its very core, an enormous and destructive hoax, and cannot be saved from its own self-serving excesses by these kinds of platitudinous calls to clean house.

  • S Randolph Kretchmar

    Nice, Phil! Perfect targeting once again.

    I get admonished all the time (even, or especially, by my wife), not to alienate much of my potential audience by being such a bomb-throwing extremist… But you manage to say everything I think, and still make it socially acceptable.

  • Cledwyn’s Pus Poetry

    What a mountebank.

    Seeing through all the outpourings of bathos and breast-beating about “the mentally ill”, misery is still viewed as a mark of disgrace, so that like the Spartan of which Turgenev wrote, who let the vixen he stole gnaw away at his entrails rather than admit his disgrace; likewise the person who is depressed must hide his misery whilst it tears away at his guts, lest he fall foul of the psychiatric thought police, or of the positivity police and all those who sit in smug judgement upon misery; lest he is excommunicated for the impropriety a man commits when he fails to properly dissimulate or sublimate his depths, in deference to the requirements of polite society.

    I think any analysis of depression that doesn’t stress the reciprocal relations between mind, body, and experience will never suffice to explain why people are depressed, though even then we must proceed with humility, since a precise identification of all the ingredients that go into making a man what he becomes, and a full understanding of the peculiar mold into which their mixture is poured, is a veritable impossibility, owing to the unbridgeable gulf that separates any two lives and – omitting other reasons – the many terrae incognitae of the human heart and human experience, for the human understanding, like the moon, emits only a very weak light, and though it may betimes penetrate through the rapidly shifting rents of the passions, desires, and hopes that becloud it and that block the passage of its feeble beams, it still leaves the world mostly enshrouded in darkness and with it the landscape of human experience, so that when it comes to trying to make sense of why a man is the way he is, labor in darkness we must.

    Drawing once again on an earlier figure, the tendency is to either neglect the mixture for the mold it is poured into, or vice versa. The way in which psychiatry is guilty of the former needs no further comment on a site like this, but a bit more scrutiny into the latter error I think is needed.

  • Phil_Hickey

    S. Randolph,

    It is a real dilemma, because the expression of outrage really demands an outraged tone. But psychiatry has so well disguised itself as a “respectable profession” that this is always seen as over-reaction. Former psychiatry clients tend to get barred from websites and forums because they express their disapproval in forceful terms. But when one recognizes the enormity of the hoax and the degree of destruction being perpetrated every day, who can blame them?

    Best wishes.

  • Cledwyn’s Pus Poetry

    Yet nothing could be more alien to the thinking of homo fanaticus than the considerations mentioned in my previous post about the limits of human knowledge; for men are fanatics as if by design.

    Science, the faith of an otherwise faithless age, has been so uncritically embraced by the herd and its bellwethers largely because, in providing for certain of the needs of men, it has managed to fill the space in the human heart vacated by the decline of spiritual religions. An example of this can be seen in all this rot about improving the human lot, accommodating the need for a soteriological narrative that renders more palatable the bitter pill of human misery and injustice.

    Yet I digress. Perhaps the greatest service that the new faith provides is in the illusion of certainty it affords for homo fanaticus, who is so constituted that he is mortfied by the mere thought that there might exist beyond the compass of his understanding, things that he simply cannot comprehend, which so wounds the vanity of men, the vanity so out-of-keeping with the reality of human insignificance, folly, stupidity, and frailty, that the very idea must be banished from consciousness, banished lest, horror of horrors, we lapse into lucidity, that is, the misery of the severely depressed, who so often lack the facility for self-deception allowing the average man to perform the heroical feat of getting out of bed in the morning, and to hurl himself into the activity with which he busies himself.

    The depressed person, I would surmise, is often one who simply cannot fool himself about the depressing farce into which he has been mindlessly, senselessly brought by his parents, incapable of the artful dodges by which men of no moment evade their own reflection in the mirror, the knowledge of their ridiculousness, and most importantly, the knowledge of the utter insignificance of their existence, of no more consequence than that of a worm wriggling on the surface of the earth, only we have a heart!

  • all too easy

    What a complete idiot. What a total and complete idiot. Could you please try harder to become a bigger horse’s rear-end, Palady?

  • Cledwyn Gallows Buffoon

    To paraphrase Thomas Hardy, the world resembles a stanza or melody composed in a dream; wonderfully excellent to the half aroused intelligence, but hopelessly absurd at the full waking.

    Owing to science and reason, life has come to take on about as much charm as a morgue waiting-room for prospective corpses. You have to be cut from a pretty coarse cloth to not find modern-life depressing, I would surmise.

    Some people are of the opinion that depression is a problem of thinking, and trumpeting their supposed triumph of will over adversity, draw the conclusion that any man may steel himself against the slings and arrows of outrageous fortune with an armor of positivity.

    The problem with such reasoning is that it postulates the existence of agency where, to my mind, we cannot be said to possess any. I would suggest such people are making an attribution error, tracing to their own willpower what I believe could be more readily attributed to the occult workings of chance, partly out of ignorance, and perhaps partly because of the heady stimulus such an error offers to our feelings.

    It is only natural for a man to abandon himself to the momentum our thoughts gather when swept away by the onrush of the emotional currents that move us, brought forth unbidden into human consciousness by the occult operations of the human heart.

    Nevertheless, the belief that through our thoughts we can inoculate ourselves against suffering has had little trouble gaining currency, as has any other belief that fosters the illusion of control.

    Such a way of thinking takes a heavy toll on a man’s humanity. In truth, the cult of positive thinking, like all believers in the supremacy of the will, is preserving a rich heritage of victim-blaming, a tradition of kicking people while they are down that flourishes in our age, notwithstanding the advance of knowledge and the promise, in contemporary soteriology, that this will bring about the betterment of the humanity, and straighten out the crooked timber of the human heart, which is patently absurd, for no matter how much science advances our understanding of the world and of ourselves, the human heart remains much the same, and recalcitrant to all that would reform it; hence the ongoing mistreatment of suffering humanity, which is but a spoke in the wheel of history, driven endlessly round and round by the eternal, implacable laws of the human heart, and of Nature itself, “unconsciously and inflexibly obedient to its laws”, knowing “neither art nor freedom nor the good.” (Turgenev)

    Does a man stop falling in love simply by subjecting it to scrutiny? Just as knowing about the composition of fire does nothing to stop one from burning to death, so with those fires that consume hearts.

    As if reason and knowledge could help us to cast off the tyrannical yoke of nature! What adolescent hubris! When the conflagration of human hearts known as ‘love’ – that terrible and destructive force majeure – spreads to our own, such tools avail a man little, and just as men go on living in spite of their better judgment, so do they go on loving.

    The same can be said of any other passion or desire that convulses the human heart.

  • all too easy

    “to not find modern-life” Palady

    While your fellating the mass phallus, I’m reporting you to Sheldon Cooper, your mirrored parody, your idol and hero of supercilious babbling fools. And to think, you keep splitting infinitives despite being reported to the King, and warned and humiliated in public for such mundane errors.
    You moron! LOL!!!

  • Cledwyn

    I think greater refinement contributes greatly to depression. In this world, the vulgar and the tasteless are as happy as the proverbial pigs in their own shit

    When I was young, making due allowance for other factors, I think I was happier largely because I had no taste.

    Now that I’m older, and after a decade and a half consecrated to the pursuit of beauty and the pleasures it affords (save in a woman, which is just depressing, given that the beauty which, like a mask to a beast, Nature vouchsafes to a woman, is granted almost always at the expense of the purity of her soul), what barren soil the world offers to the imagination! Now, only through the contemplation of the finest flowerings of the human imagination can one gain some brief respite from the incursions into consciousness of the vulgarity and banality of the world, its incessant sensory rape.

    Some people say “we’ve never had it so good”, based on a materialist account of well-being that completely ignores the lack of – for want of a better word – spiritual and aesthetic nourishment with which the world now presents those whose appetites in this regards are great.

    This is why walking – a kind of metaphor for life itself; time-consuming, boring, and unremunerative – does little to lift depression, and often makes it even worse. It is precisely this Antononian ennui-scape we call modern life, this tsunami of shit beating against the walls of my abode, engulfing you every time you step outside, turn on the TV or go on the internet; it is precisely this that some people are trying to escape, this revolting uniformity of shapes, textures, and buildings, this endless procession of flesh, of human peacocks, buffoons, and body snatchers, and animated corpses wandering with weary tread, all being swallowed up by Time’s slow-sand.

  • Rob Bishop

    “Anxiety is the dizziness of freedom” as Kierkegaard said

  • Cledwyn’s Pus Poetry

    As I’ve already said, depressed people are often those who cannot escape the knowledge of their own utter insignificance, lacking as they do the faith that sustains most men in their earthly travails, faiths furnished by religions spiritual and secular, such as the belief in the divine extraction of the species and its resettlement in pastures Elysian, or the belief which discerns some redeeming pattern in the senseless drift of events known as “progress”.

    Nevertheless, this knowledge can be turned to good account, for it helps us to develop a faculty for perceiving the vanity of human striving, and through the ironic complexion it casts on this, the self-importance of men, the comical gravity with which we treat ourselves and the business of life, and the absurdity of all things human; through all this, it offers redemption from the sin of solemnity, though levity and laughter are, admittedly, luxuries we often can’t afford.

    True, exercising one’s thoughts on such matters may serve to disabuse a man of the earthly hopes which, though always a passport to disappointment, nevertheless afford much pleasure in the journey thither; but to purchase present happiness at the expense of future suffering and disappointment is, in my experience, a bad bargain.

    Many people feel depressed because they feel like a failure, but what are concepts such as “success” and “failure” when we view things sub species aeternatatis, that is, under the aspect of eternity? All things ultimately perish to dust. Such concepts are for people who take the world and themselves way too seriously. The world is full of fools puffing themselves out with words such as “successful”, and peering down from the Olympian altitudes of their self-importance at “failures”, on whom they sit in smug judgment. What asses these people are! As if any of this matters! These people speak as if there were some consensus sapientium or body of evidence regarding how life ought to be lived, neither of which, of course, exists.

  • Rob Bishop

    Depression is fueled by taking life far too seriously.

  • verne

    Thank you very much for writing this and for all your effort.

  • The Right Honorable C. B’Stard

    Give me a good bum any day over the bullies, narcissists and tyrants who in every age are the objects of the admiration of the profanum vulgus, the admiration that is the eternal privilege of the powerful.

    Coming back to the point about just how insufferably ugly the modern world is, Mencken foresaw this when he wrote of a “libido for the ugly”. In modern society there is a war being prosecuted by the bourgeoisie and the booboisie, on various fronts, to root out beauty altogether, perhaps born in part of a collective nostalgia for a return to the filth and feculence of the dark ages, the spiritual home of the porcine rabble (alas, you cannot make a silk purse out of a sow’s ear), any critical voice against which – refusing to lend itself to the chorus of sanctimonious self-congratulation orchestrated under the baton of the mob’s many courtiers, sending swine into a swoon with all the crap they are filling their heads with – it has become impossible to get an audience for.

    Be it in architecture, literature, painting or cinema, anything that raises the spirit to a more rarefied plane, that gives the imagination a fertile field in which to wander, and stirs the nobler sentiments, is frowned upon.

    And such is the hostility towards the artist who would raise humanity out of the gutter in which it seems content to wallow, it has become increasingly difficult for such people to fulfill their true calling, wherein a man perhaps finds the greatest happiness in life.

    Yet what an amusing pretense of incensed humility and salt-o-the-earth goodness “the people” put on, and what cleanliness they affect to be a-quivering with, whenever the hostility they like to mete out is visited upon their own heads, such as when the man of culture, in requital of the animosity shown him, dares to invade the prerogative of “the people” to be as vile and intolerant towards others as they so choose.

    Sod the people. They are so inflated with the idea of their own sanctity, it’s a miracle they haven’t taken flight into the ether.

    And, I might add, as long as they’ve got their snouts in the trough, no injustice has yet been invented so monstrous that they will not support it, as long as it is, or seems to be, to their personal advantage; but when it isn’t, they invoke the principles and causes which to them are never ends desirable in themselves, but merely a means to whatever are their own ends, quick as they are to rescind their allegiance to them when they cease to be useful.

  • all too easy

    “to properly dissimulate”
    Naughty naughty you enormous boob.
    You savagely war against proper grammar. LOL. You idiot!
    Got to love this pompous know nothing, this self-righteous, self-pitying, bogus boob, trying to impress others in vain with repeatedly verbose rantings to the end if only the desperate and despicable mass of commoners would perchance heed your call to repentance from all things you frown upon, this world would burst forth in song in sunlit days of gratitude proclaiming the wonder that is thou, Paladapus.
    Go clean a toilet and then check in at that Swiss hospital where thousands can return to examining all the facets and phases of your innumerable mental illnesses. See what happens when you escape from the nuthouse?

  • Sarah

    A wonderfully researched and powerful article! I hadn’t had chance to read it until now.

    This reminds me of how politicians look to excuse themselves from decisions that have harmed society. How they rarely acknowledge their own mistakes, shift the blame elsewhere, and defend policies regardless of the damage they have caused.

    The language used within Dr. Frances statements to continue to promote antidepressants, and the medical model of unhappiness, is as you have shrewdly pointed out, positive and inviting…

    What’s I find fascinating, is that psychiatry focuses on the ‘disease’ model of human behaviour, and completely disregards the psychological model (which I believe accounts for the majority of mental health problems). Yet, when psychiatrists, and pharamceutical companies make positive statements such as “ECT is a terrifically effective treatment that is also relatively safe…”, and when they use positive language to promote medications and psychiatric diagnoses, they are ‘using psychology’ to appeal to individuals who are suffering from distress. They are using psychology to ‘sell their ideas’. They know very well that people who are distressed can be ‘reached’ without the use of medication.

    I hope this article finds it way to many people, and I look forward to reading your next one!

  • all too easy

    Thank goodness for modern medicine which has made available at affordable prices life saving anti-depressants which have done so much good for millions of sufferers.

  • Phil_Hickey

    Sarah,

    Thanks for coming in, and for your encouraging words. That’s a nice point about psychiatry using psychological tactics to market their concepts and their product.

    Best wishes.

  • anonymous

    Psychiatry is not a legitimate branch of medicine. And while a so-called patented “anti-depressant” chemical may be a drug, it is certainly not a medication, as it treats no illness. According to Dr. Brogan, “prescribing an antidepressant to someone who is suffering may be like holding out a knife to someone who is falling off a cliff.”
    http://www.madinamerica.com/2016/06/rising-rates-of-suicide-are-pills-the-problem/

  • all too easy

    no legitimate form of medicine exists. ck out “medicinesucksandain’treal.com”. Illness is in the minds of weak boobs, that’s all. (look at that hypochondriac Paladapuss) no legitimate test proves otherwise. broken bones don’t exist and they heal on their own. I says so. every doctor is in on the take, the money making sham promoted by the manufacturers of surgical tools, construction companies that build hospitals, every medical school and professor, all nurses and outfits that sell nursing outfits. I know. I’ve trained my two boys to reject all medical information. One is a trapeze artist and the other sells micronutrients with a PhD in why caffeine tastes good. Neither has gray hair. and I am brilliant beyond imagination. and I am totally in love with the biggest most handsome poster here who constantly humiliates me

  • anonymous

    Sadness (a.k.a. depression) is an emotion. An emotion is not an illness.

  • all too easy

    a cancer cell is a cell that grows and divides at an unregulated, quick pace.
    it is not a disease

  • anonymous

    Stupidity and foolishness are not diseases either. Popping ADHD amphetamines won’t cure you (and hasn’t cured you) of your stupidity and foolishness. Obviously. Go ask your pusher for some more meth. You can pretend you’re taking “medication” for your fake “medical condition.”

  • all too easy

    good point lil stevie wonder. like when your child dies of cancer, slowly, in agony, over the course of 6 months. taking her little life too seriously is nasty. you know, too. you are quite the expert on what everyone else needs, while you have absolutely no idea how to manage your own life. depression is being even vaguely familiar with the likes of you.

    stick with your lover boy, Paladapuss. he, too, knows what’s best for everyone. if you doubt it, just ask him. he loves to tell others what’s wrong with everything they do and everything they are and hope to be. he’s quite the scholar in nothing, in nihilism, in poop. if it is dreadful, awful, meaningless, boring or a waste of time, he can take forever to preach about it. on the other hand, if anything inspires hope, if anything hints of kindness or beauty or goodness, helpfulness, gratitude, generosity, or any other virtue, he perchance whilst fellating the mass phallus will wax eloquent (in his pea brain) for hours about the utter rot of it all. iow, your kind of guy, lil stevie

  • anonymous

    Thanks for mistaking me for Steve McCrea(?) What an honor! I do admire his wisdom and expertise.

  • anonymous

    Oops. I just realized that your comment was directed at Rob, not me. My mistake.

  • Cledwyn Bum Chutney

    There’s no reasoning with people like Frances. Without direct, first-hand acquaintance with the experience of those whom psychiatry oppresses, then there is no hope of redemption for him. Forced “treatment”, the hell of drug withdrawal, and all their associated torments, are but words to people like him, without experiential reference or resonance; and sometimes, in particularly coarse-grained natures, recalcitrant to that which would (somewhat) reform them, sometimes even direct experience of evil suffices not to make a man recant his endorsement of it.

    Frances must first travel the road traveled by Hidetora, the protagonist of Kurosawa’s “Ran”, who expiates through his madness the suffering he caused and that is visited upon his own head after the injudicious abdication of his throne, purchasing through bitter personal experience insight into the horror he authored.

    This is why, omitting other reasons, there will always be a fundamental breakdown in communication between an oppressor and those he oppresses, and why trying to dialogue with them is an exercise in futility.

  • Cledwyn Gallows Buffoon

    Overpopulation must play a huge role in the problems of some people.

    The most philoprogenitive people in society are always the worst, inasmuch as any truly sensitive, thoughtful people would never sow their seed or receive it with the kind of reckless abandon that the rabble do.

    Most people complain about the effects this has on the environment, but screw the environment; it is the toll we take on each other mentally that matters, and the astronomical quantities of psychological violence perpetrated against each other.

    People are like water.

    We need water, but too much of it is poisonous.

    Likewise, we need people, but too much of them is poisonous.

    And like a cumulative poison, the myriad grievances stemming from the proximity of so much fallen flesh build up beyond all manageable limits, corroding all that is good in us; even into the noblest of souls, hatred inevitably steals.

    So many are the wolves in society, a man’s exposing his soft underbelly borders on the suicidal.

    Every man steels himself against the hatred of his fellows, repaying each in his own coin; hatred and egotism have become veritable functional imperatives.

    So many people, so many occasions for anger, frustration, fear, depression, anxiety…

    So many faces; so many voices; so many incitements to violence…

    Every time we venture abroad, we must run the punishing gauntlet of stares with which modern society inevitably confronts is, and endure the countless ravages wrought on the soul through the proximity of so much flesh, flesh with designs on our own, designs on our dignity, designs even on those stray moments of happiness, in arriving at which, we wade through seeming oceans of shit (much of it our own, much other people’s), only to find our little islet of pleasure submerged in the tide of human feces ever beating at its shores.

    Faces, those natural instruments of torture, multiplying to the point of indecency, everywhere abound, proliferating like diseased cells in the conquest of faceless space, impertinent faces, sneering faces, smug faces – some so eminently slappable, they are begging us, importuning us, inciting us, to slap the smugness out of them -, faces that gang up and lynch you with their eyes, some cold and cast in stone, some contorted into a look of bottomless malice.

    Alas, you cannot legislate for the configurations a man’s features assume in the grip of blood-lust, save by legally banishing the face from public life altogether, and making the wearing of masks compulsory.

    The effects this would have on our “mental health” would be incalculable. Never to see the face of a beautiful woman again, wielding their beauty like a whip, exulting in the heady stimulus each lashing affords, luring us Siren-like with the spell they cast, and like spiders, spinning elaborate webs in which to ensnare the male, weaving wondrous melodies with their feminine charm, cunning and coquetry. No one more sadistic than a woman conscious of her beauty (mask of the beast), manipulating it for maximum destructive effect with the aids Art renders (Hardy).

    (Not that I think women are inferior, morally or intellectually, but nor do I think they are better, as certain partisan feminists, and men thinking with their willies and not their brains, would have us think.)

    What bliss! No wonder the blind look so much happier, so much nicer! It’s because they don’t have to look at anyone’s faces, faces which, like the smell of men, and the noise they make, almost invariably make us suffer, brings uppermost the worst human traits, and diverts the faculty of judgment from a more compassionate course.

    Any society that concerns itself with the betterment of the human lot must reckon with the human face. It is a but a vile canker. Ban it!

    O if only we couldn’t see each other, hear each other, smell each other, maybe then we wouldn’t all hate each other!

    At the very least, our sensory organs, if nothing else, must be attributed to the work of some malign agency, intent on sowing the seeds of discord between men, and making us suffer.

    But even were we to dam-up such an outlet, and ban the human face, the vileness of men would then merely be redirected into other channels, and spewing forth in previously unimaginable torrents of verbal excrement, society would no doubt soon find itself submerged, as if in a flood of its own feces.

    Moving on, the ever-burgeoning cumulus of grievances, deposited in the course of our unavoidable commerce with so much fallen flesh, exercise our thoughts to the point of monomania.

    That so many men manage to desist from slaying each other, and steeping their souls in their neighbor’s blood, given the amount of psychological and sometimes physical violence inflicted in the course of our much too numerous relations, can only be attributed to cowardice; but imagine the blood bath if the deterrents were suddenly removed!

    Every house should be fitted with self-service ECT machines for our twice daily dosage of electricity, so we can fry ourselves into a state of permanent oblivion, and drink blissfully of the fabled lethean waters.

    So filled to bursting with hatred and aggression are we, only people who excel in these terms command our homage, whereas their opposites feel like a reproach. Violent, bigoted thugs, monsters of arrogance, are exalted to the level of deities, Muhammad Ali being a case in point.

  • Rob Bishop

    People on drugs often celebrate the chemicals that saved them from misery. A friend says smoking weed increases his sense of well-being. He insists it helps him cope. But, he’s STONED! Of course his foggy mind is full of nonsense. Vodka reduces my anxiety and increases my sense of well-being. When will we acknowledge medicinal alcohol?

  • anonymous

    Ha ha. Right on. Psychiatric drugs are no more “medicine” than alcohol or street drugs. And ECT is no more a “medical” treatment than a whack on the head with a 2 x 4.

  • all too easy

    “But, he’s STONED! Of course his foggy mind is full of nonsense.”

    you have no proof that chemicals create a foggy mind. BTW, nothing impacts the mind except our willingness to believe that the mind can be drugged. our minds are always functioning within the normal range of accepted standards.

    when these horse’s rear ends prove that pain exists using our best, current, medical testing apparatus, then and only then will we allow them anesthetics or pain relievers of any kind. as true believers that only their medical model of illness of the mind justifies the introduction of chemicals to alter one’s consciousness, they really don’t want to be “knocked out” when undergoing open heart surgery or leg amputation. they truly are genuine heroes.

    no aspirin either

  • all too easy

    “If a child throws a temper tantrum, and the tantrum produces a positive result (e.g. a parent yielding to his demands), then, other things being equal, there is an increased probability that temper tantrums will become habitual, especially if they continue to produce the same kind of outcome. This is not a function of aberrant electrochemical events in the brain cells. In fact, it is exactly the opposite: a perfect example of the normal human learning apparatus operating flawlessly. It is not an example of something going wrong in the brain, rather it is an example of something going right. We humans learn from the results of our actions, an obvious fact that has been verified experimentally countless times, and in addition accords perfectly with common sense and general observation.” DDD [dumb, deluded, dimwits]

    this little treatise DOES NOT EXPLAIN all the various components that contribute to human behavior as much as our resident geniuses would like you to believe. it is partly true. it contains truth. it is an explanation for the tantrums of some people. it sounds pretty exhaustive, doesn’t it?

    what these total boobs always fail to admit is that there are illnesses that cannot be detected under a microscope–YET–but are not related to poor parenting. how can people be so dumb? truly! it is astounding. mind boggling.

    just think, before modern medicine could isolate and identify bacteria and viruses, tumors and lesions, they would have argued, to death, that behaviors that resulted directly from those kinds of maladies were all BOGUS. ALL based on bad parenting they would argue!. my friends, isn’t it obvious to anyone with half a brain that grand mal seizures have zilch to do with parenting? not to them. it is the same thing. they are cave men. they are ridiculous. they cannot think for themselves. they are zombies brain washed to reduce everything to their simple fictitious formula.

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