Archive for category A Behavioral Approach to Mental Disorders
Diagnosis
Posted by Phil in A Behavioral Approach to Mental Disorders on March 6, 2011
I am writing this post as a response to a comment posted by medical blog in my previous post, More on So-called Bipolar Disorder.
In the summer of 2001 I became very ill. The symptoms were exhaustion and mild nosebleeds. I went to three different practitioners, but they all were dismissive of my concerns, assured me that I was in good health, and sent me on my way. On August 8th of that year I was admitted to the hospital in Greeley, Colorado with complete kidney failure. The nephrologist at the hospital gave me the diagnosis that had eluded the earlier doctors: Wegener’s Granulomatosis – a rare autoimmune disease that attacks lungs, kidneys, and airways. I have been on dialysis every since.
The reason I tell this story is to illustrate the meaning and significance of a medical diagnosis. In my case there were certain signs and symptoms. For instance, I told the doctors that I was tired and that this was not characteristic of me. I told them of the nosebleeds. And they could see that I was dragging. By the time I got to the second doctor, I was also vomiting and having difficulty sleeping.
Now the point is that until I got to the hospital in Greeley, there had been no diagnosis. One doctor said: “maybe you’ve got the flu?” But it didn’t feel like flu, and this tentative diagnosis wasn’t very convincing.
When we ask for a diagnosis we are asking for an explanation. So if you‘re very tired and you’re spitting up dreadful-looking phlegm, a doctor might diagnose pneumonia and would be able to substantiate this diagnosis through observation and lab tests. And – and this is critical – he would be able to show a clear causal link between the pathology and the symptoms.
In my case, the diagnosis of Wegener’s Granulomatosis explained the exhaustion (increased toxicity due to kidney failure) and the nosebleeds (Wegener’s Granulomatosis is believed to be triggered by an airborne pathogen and so the immune system becomes particularly active in this area).
The key is explanation. A good diagnosis pinpoints the pathology, explains the symptoms, and directs treatment. This is the model that has lifted Western medicine out of the charlatanistic quackery that predominated prior to about 1880. Modern medicine is remarkably successful precisely because it is based on an understanding of the pathology involved. Now obviously, as in my case, it sometimes isn’t easy to make a diagnosis, but in the vast majority of cases, people seeking medical help receive an accurate diagnosis early in the process, and this diagnosis guides and directs treatment, usually with a good deal of success.
Now let’s consider the so-called mental health diagnoses. Take the condition known as Attention Deficit Hyperactivity Disorder. The American Psychiatric Association says that this is a mental illness. In other words, ADHD is a diagnosis. And they list the symptoms of this diagnosis. I have reproduced these so-called symptoms in an earlier post, and it’s not necessary to reproduce them here, but here are three fairly typical items from the list:
- often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often leaves seat in classroom or in other situations in which remaining seated is expected.
- often runs about or climbs excessively in situations in which it is inappropriate…
Now what the APA have done is this: they have asserted that these are the symptoms of the mental illness that they call ADHD. Now if this means anything, it should mean that ADHD is the explanation of these misbehaviors. And this is precisely how the so-called diagnosis is used in practice. When a parent asks why his child is so unruly and undisciplined, the reply he is given is: because he has ADHD. The putative mental illness is routinely proffered as the explanation – as the underlying pathology which explains why the child is so misbehaved.
But in fact if one examines the matter further, one finds no substance to this so-called diagnosis. ADHD is nothing more than a name for this kind of misbehavior. The acid test here is the question: how do you know he has ADHD? And the only possible answer is: because he is so unruly and undisciplined. The only evidence for the so-called diagnosis is the very behavior it is supposed to explain.
Real diagnoses involve real pathology that one can identify, test for, and hopefully ameliorate. Wegener’s Granulomatosis, for instance is a real disease. And it is recognized as a diagnosis today because Dr. Wegener, a research pathologist working in Germany in the 1930’s, noticed certain microscopic anomalies in corpses he was dissecting. He began to tie these anomalies with symptoms observed before the individuals had died. His work was interrupted by the war, but after the war he refined his observations, and the diagnosis was firmly established. At first there was no treatment for WG – it was effectively a death sentence – but gradually drugs became available, and today the disease is eminently treatable, though because of its rarity, the diagnosis is often missed (as in my case).
In contrast, consider the so-called diagnosis ADHD. Prior to 1950 this diagnosis did not exist. Today it is deeply embedded in psychiatric practice, and indeed in our collective consciousness. This change occurred – not because of a discovery – but because an APA committee decided that ADHD is an illness. As preposterous as this sounds, it is exactly what has happened. In the six decades from 1950 to the present, the primary business of the APA has been redefining the ordinary everyday problems of living (that our ancestors tackled using ordinary time-worn tactics) as mental illnesses. And this has been done in collaboration with the pharmaceutical companies for one reason: profit - the selling of prescription slips and the selling of drugs. Psychiatry has degenerated into nothing more than drug-pushing. And the process of pathologizing normal problems of living continues. The much-heralded DSM-5 promises even further inroads in this direction.
The fundamental problem with the APA’s approach emerges from their definition of a mental disorder:
… a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. (DSM-IV-TR, p xxxi)
If you examine this definition carefully, it is clear that it means nothing more than: any significant human problem.
It’s a castle built from sand. The logic is as follows:
- Any human problem is a mental disorder.
- X is a human problem
- Therefore X is a mental disorder!
As facile and ridiculous as this sounds, it is exactly what has happened. The simple assertion that childhood misbehavior is a mental illness explains nothing. It is simply a device used to legitimize drugging these children.
And the real causes underlying these problems are never even pursued. Parents are off the hook; the school is off the hook; the community is off the hook. And the cash registers at the pharmacy go ker-chung.
And similar considerations apply to all the other DSM creations. Depression is not an illness. It is a feeling we get in response to a major loss or when things are not going well for us. It has been pathologized by the APA and the pharmaceutical companies for gain. The so-called bipolar disorder is not an illness – it is largely rudeness and irresponsible behavior – again pathologized for gain.
It is said that the drugs work, so why quibble? Well the simple answer is that they don’t work nearly as well as the psychiatric hype would have us believe. But this post is already too long; perhaps we can pursue this another time.
Once again, apologies to my regular readers for the repetition. Medical blog, if you’re still reading, I can appreciate how a medic, schooled in the rigors of scientific research, might view all this with a measure of skepticism. It’s a great deal easier to dismiss me as a crank than to face the alternative: that modern psychiatry is an enormous hoax which is draining dollars from genuinely needed services and undermining notions of self-help and personal responsibility that are keystones of a thriving society. Please feel free to come back on any of these issues. It’s not just a question of trying “harder and smarter.” Some of the problems that confront people are truly overwhelming and require outside help. But they are not illnesses and the help needed is not drugs.
More on So-called Bipolar Disorder
Posted by Phil in A Behavioral Approach to Mental Disorders on February 24, 2011
A few days ago, I received the following email:
Hi Phil,
I would like to hear from you how we can survive the bipolar disorder, as I understand bipolar is a very serious disease.
Regards,
[Name]
The question seems important enough to warrant a more public response, though I have omitted the writer’s name to safeguard confidentiality.
So here’s my reply.
Firstly, the condition known as “bipolar disorder” is emphatically NOT a disease. Rather, it is a loose cluster of behaviors which psychiatrists – in concert with the pharmaceutical companies – have called an illness with the purpose of selling drugs.
The DSM criteria for this so-called diagnosis are set out in my earlier post on this subject.
In practice, the behaviors likely to attract a “diagnosis” of bipolar are:
- Hyperactivity of any kind for an extended period
- Marked irritability; grouchiness; snapping at family, co-workers, etc.
- Marked boastfulness; expressions of grandiosity
- Pronounced sleeplessness
- Excessive talk; rapid shifting from topic to topic
- Temper tantrums
- Behavior that would normally be called “irresponsible,” e.g. sexually reckless activity; buying sprees; gambling; risky ventures; etc.
Traditional psychiatry says that if you’re functioning in this fashion, you have an illness called “bipolar disorder.” The formal criteria call for a certain number of behaviors within certain time frames. Also, a measure of oscillation is required – i.e. the “symptoms” abate periodically, then resurge. And so on. In practice, any of the behaviors listed above will attract this “diagnosis.” And the “treatment,” of course, is: drugs. Usually lithium carbonate – but in the past decade or so other drugs are being used to impact these behaviors. Especially worrying in this regard is the prescription of these drugs to very young children to treat tempter tantrums. (I am aware that temper tantrums as such are not included in the DSM criteria list, but over the past decade or two, proneness to temper tantrums has been conceptualized as “mood swings,” and has become a kind of backdoor feature of this so-called mental illness.)
But, back to the question in the email. What should one do?
Well the answer, of course, depends on what kind of problem behavior we are talking about.
Let’s say that the problem behavior is irritability and temper tantrums.
The first requirement is to describe the problem clearly and completely. “Temper tantrum” can mean different things – everything from stomping one’s foot and saying “drat,” to throwing the furniture out the window. So if a person feels that he/she has problems with anger control, the first thing is to write down exactly what kind of behaviors are occurring and with what frequency (Daily? Weekly? Monthly? etc..)
Duration is important. Has it been going on for years or just in the past few days?
Context is also critical. Where does the problem behavior occur? At home? Work? When visiting in-laws? etc.. Or perhaps everywhere?
And triggers. What kind of situations seem to “trigger” the anger response? Other people’s driving? People talking on cell phones? Outbursts of anger usually occur when we feel frustrated or attacked. Frustration arises when we are trying to do something but can’t manage to do it. And attacks may be real or imaginary.
And substance abuse. Is there a problem with alcohol or other drugs?
And so on. The point being that a simple phrase like “temper tantrums’ or “bipolar disorder” tells us nothing. What’s needed is a detailed written statement of the problem.
I do not know the enquirer personally, so it would not be proper for me to give him/her specific advice. And I don’t know if temper tantrums is the issue or what – but the point is this: specify the problem as honestly as possible and with as much detail as possible.
Often at this point the solutions start to suggest themselves. For instance, if a person is routinely throwing temper tantrums when the car breaks down, then maybe it’s time to get some repairs done or get a new car – or even just decide to get stoical about it – try to let it wash over one.
The point here is that finding solutions to behavioral problems is not quantum physics – usually if one has done a thorough and honest job identifying the problem, then the solutions are forthcoming.
In this regard it is often helpful to break problems down into components and tackle them one at a time. Or to set intermediate goals. A person who identified over-talkativeness as a problem might initially aim to sit silent for one minute, then two, and so on.
I have mentioned elsewhere in this blog the importance – indeed I would say the necessity – of having at least one good friend – someone with whom one can be completely honest. Often the kinds of problems we are talking about here benefit from a second perspective. Other people often see us more accurately than we see ourselves. A best friend can be a spouse, a brother, sister, or just the guy who lives next door. The point is that if I have a significant behavioral problem and if I genuinely want to change this, then asking for help is clearly a positive step.
Some other pointers:
- Try to find and pursue an activity that is incompatible with the target activity. For instance if you feel a temper tantrum coming on, start singing or whistling. It’s difficult to have a temper tantrum while singing a happy tune.
- Acknowledge successes. If you had been having daily temper tantrums and you’ve got it down to one per week – that’s great – acknowledge the gain, but keep working.
- Avoid triggers as much as possible. If a person finds that he has temper tantrums whenever the dog starts barking, then maybe it’s time to get rid of the dog – or get one of those bark suppression collars.
I’ve picked the example of temper tantrums and used it in this reply. But I’m conscious of the fact that this might not be the issue of the enquirer. That’s one of the problems with the term “bipolar disorder.” It simply is not specific enough. But the essential point here is that whatever the behavior is that attracted the diagnosis of bipolar disorder, this behavior can be identified, specified clearly, and remediated. And in this regard you have to do what we all have to do with life’s problems – exploit your strengths to counter your weaknesses. In other words – use your ingenuity. Find solutions to the problem. Don’t give in. Don’t go on doing things the same. Break patterns, etc..
If your problem behavior, in fact, lies in some other direction and you would like further thoughts, don’t hesitate to come back and let me know the specific behaviors that are causing concern.
Now, of course, having said all this, I should add that you can take the conventional step: go see a psychiatrist and take the “happy pills.” I’m not recommending this course of action, but I’m sure you realize that it is an option. Drugs can be effective in suppressing certain kinds of behavior. However, they always have negative side effects, and although they may suppress the worst aspects of the problem behavior, the result is a far cry from normal human existence.
More On Disability
Posted by Phil in A Behavioral Approach to Mental Disorders on February 16, 2011
In his book Anatomy of an Epidemic, Robert Whitaker drew attention to the increasing numbers on the Social Security disability rolls due to so-called mental illness. Robert raises the possibility that the drugs routinely used to “treat” depression may be contributing to the problem. In a recent post, he discusses this matter further.
I think the reasons for the increase in the disability rolls are as follows:
1. People who seek psychiatric help are being told routinely that they have brain abnormalities and that they need to take drugs for the rest of their lives –“just like diabetics.” This promotes a disability mindset which often translates into a disability application.
2. Applicants for disability based on the so-called mental illnesses are screened by either a psychiatrist or a psychologist. Both of these professional groups are immersed and heavily invested in the conceptualization of ordinary living problems as illnesses, and tend to accept uncritically the applicants’ claims that they “just can’t do anything.”
3. In the mid 1990’s there was a great groundswell in political circles to get people off the welfare rolls. It was pretty much an open secret (at least in my area) that Social Services Department caseworkers were referring their welfare recipients “across the road” to the mental health center, so that they could establish a treatment record for mental illness, with a view to applying for disability.
4. Mental health clients routinely share information concerning which “symptoms” to emphasize, what to say, etc., during the evaluation. Clients whose application for disability has been successful are often seen as resources for those coming behind.
5. Mental health workers inadvertently teach their clients how to qualify for a “diagnosis.” When the worker asks the client if he/she has been having trouble sleeping and writes down the answer in a case file, the client realizes that sleeplessness is a factor in determining disability. Similarly for “loss of energy,” “poor concentration,” “recurrent thoughts of suicide,” etc.. An even moderately motivated client can readily identify the criteria questions for whichever “diagnosis” is being pursued. This is because the worker’s primary objective is not to get to know and understand the client, but rather to assign a diagnosis – to get the client into a billable pigeonhole.
6. The APA’s infinitely flexible definition of a mental disorder and the equally flexible criteria for each particular “disability” make it possible for virtually anybody to receive a diagnosis. All that the client has to do then is leave a trail of disasters in his wake and make sure it is adequately documented. I knew a man one time who was receiving disability benefits for alcoholism (I think from the VA). This puzzled me because I had never seen him drunk or even drinking. But later his wife told me that three or four times a year he would go into town, have a few drinks, make a nuisance of himself, get arrested, and spend the night in jail. The ensuing paper trail was sufficient to sustain his disability status and income. You can’t fake kidney failure, but you can fake every DSM diagnosis.
7. And of course, the drugs themselves are causing damage which contributes to genuine disability. There is evidence that benzodiazepines shrink brain tissue. See my post Business as Usual. And an article by Nancy Andreasen (Long-term Antipsychotic Treatment and Brain Volumes) indicates that the major tranquilizers (or “antipsychotics” as the bio-pharma-psychiatric bloc likes to call them) also shrink brain tissue. Obviously as brains shrink, disability rolls expand!
There are no mental illnesses. “Mental illness” is a spurious explanatory concept whose purpose is to medicalize for profit the ordinary problems of human existence which our ancestors tackled and resolved without drugs for thousands of years. The bio-pharma-psychiatric system is nothing more than a façade for legalized drug-dealing which is eating away at the quality of life and the fabric of our society.
Business As Usual
Posted by Phil in A Behavioral Approach to Mental Disorders on February 12, 2011
Christopher Lane, author of Shyness has written an interesting post. The gist of the matter is as follows.
There’s a class of drugs known as benzodiazepines (benzos for short) that are promoted by Pharma and prescribed by psychiatrists to “treat” anxiety. (As if anxiety were an illness!) See my post on the So-called Anxiety Disorders.
Benzos include such household names as Valium, Librium, Ativan, Xanax, etc.. When introduced in the 1960’s, these drugs were widely touted as “safe” tranquilizers. Readers may remember Valium as “mother’s little helper,” so called because it was marketed to millions of harried housewives as they struggled to adapt to an increasingly complex and multi-faceted lifestyle.
Almost immediately it began to be recognized in certain circles that these products were strongly addictive, but Pharma consistently denied this, and the psychiatrists went on prescribing. A psychiatrist I met in the 80’s once remarked: “You don’t take people off Xanax. Once you’re on it, you’re on it.” About the same time, I heard another psychiatrist say: “The only difference between Xanax and true love is that Xanax is forever.”
Within the addiction “treatment” field, benzos are described as “dry alcohol.” And indeed, they resemble alcohol in many ways. They have a sedating effect, they produce intoxication, and in fact, in hospital settings benzos are widely used to detox cases of chronic alcohol abuse.
Now all of this is well known. What’s new?
Well apparently in 1982, Malcolm H. Lader, Professor of Clinical Psychopharmacology, Institute of Psychiatry, University of London, demonstrated measurable brain shrinkage in individuals who had taken these products, and that the shrinkage was similar to that found in long-term alcohol abusers. Surprise!
But the plot thickens. It has recently come to public attention that Britain’s Medical Research Council (MRC) agreed – back in 1982 – that further large-scale studies were needed to explore and confirm Dr. Lader’s findings. But – and this is almost beyond belief – they marked the file “closed until 2014”! And the further investigations were never done.
Why not, you might ask?
Well here’s a clue. Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA) is funded entirely by fees derived from the very industries they are supposed to regulate.
Remember – there are no mental illnesses, and the products sold to “treat” these fictitious illnesses are drugs. And the one abiding feature of all drugs – no matter how pleasant they may seem in the short run – is that they are dangerous. Drug dealing – whether it’s on the streets or in the local mental health center – is a dirty business where human life and human welfare are routinely sacrificed on the altar of corporate profit.
Overeating Is Not An Illness
Posted by Phil in A Behavioral Approach to Mental Disorders on February 7, 2011
DSM lists two principal “illnesses” under the heading Eating Disorders: anorexia nervosa and bulimia.
Anorexia Nervosa means chronic and pernicious fasting even though food is readily available. “Anorexia” is Greek for lack of appetite. “Nervosa” is Greek for nervous.
Bulimia means recurrent episodes of binge eating followed by self-induced vomiting or other methods of purging. “Bulimia” is Greek for “the hunger of an ox.”
Neither anorexia nor bulimia is an illness in any correct sense of the word. But my concern today is not with either of these issues, but rather with common, everyday overeating.
Many people are unaware that overeating is listed in the DSM, but if you go to the section headed Eating Disorder Not Otherwise Specified you will find the following:
“Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa”(DSM-IV-TR, p 595)
In other words: habitual overeating.
Elsewhere in the text (p 785) the APA offer more detailed criteria for further study, and it is likely that overeating will be included as a free-standing “diagnosis” in DSM 5. And that, of course, will be very good for business.
But regardless of what the APA claim, overeating is not an illness, although, of course, it causes a great many physical illnesses, including diabetes.
SOME BASICS
The human body is a biological machine, and like all machines, it needs a source of energy. And by energy, I mean movement and heat. Not “psychic” energy or “spiritual” energy or “cosmic” energy or whatever. Just plain old calories and watts. A car gets its energy from gasoline; people get their energy from food.
The human body needs the energy content of food to supply heat and movement. And movement includes not only walking around, but every kind of movement that occurs within the body: the beating of the heart, the movement of the lungs, the pulsing of nerves, etc., etc.. In order for any of these activities to take place, food has to be burned in the same way that the car burns gasoline. Biological burning is slower and cooler than automotive burning, but the process is essentially similar.
If you put more food into your body than you use, the body stores some of the excess as fat. This is an adaptive device that mammals developed millions of years ago, and it gave our ancestors a better chance of surviving food shortages. By overeating in times of plenty, they could – to some extent – live off their own fat through times of famine. Today, of course, at least in North America and Western Europe, the food supply is steady, and so we don’t have periods of famine. But the basic facts of physics and biology are the same: if you eat more than you use, some of the excess will be stored as fat.
OBESITY
We are creatures of habit. We tend to do the same things day after day – sometimes for years. My daily routine requires the expenditure of a certain quantity of energy – say 2000 calories. If I eat less than 2000 calories per day, then I will start to lose weight as my body consumes all my fat reserves. Then my body will start consuming muscle and other tissue in a desperate attempt to stay alive.
If I routinely eat more than 2000 calories, however, my body will store some of the excess as fat. So I go on with my daily routine – doing the same things I do every day, but – and this is critical – getting a little heavier every day. Now basic physics (and common sense) tells us that it takes more energy to move a heavier body than a lighter one. So even though I’m not doing anything extra in the way of exercises, etc., I am burning more calories simply because I’m getting heavier. Until finally equilibrium is reached in which my caloric intake is balanced by my output. The precise point at which this balance is reached, of course, varies from person to person. Some people will reach equilibrium at 200 pounds, others at 400 pounds. But the balance in all cases depends on two factors: habitual energy intake versus habitual energy output. And this is the key to understanding obesity.
Everything else is a side-show. Genetic pre-dispositions and metabolism rates are all interesting facets of the matter, but at the end of the day, if your intake exceeds your output, you will be gaining weight. And if you want to lose weight, you need to eat less and move around more.
So why don’t people just do this? Why is obesity such a problem? And the answer is simple – because it’s difficult. Food is so wonderful and we have such a variety readily available and such convenient methods of preparation, etc.. And moving around doing things is more difficult than sitting on the recliner watching a movie. I’ll discuss this further next post – but for now, back to DSM.
DSM AND OBESITY
As things stand today, overeating is already a “diagnosis” in the DSM. But it’s a concealed diagnosis. Its formal designation is: 307.50 Eating Disorder Not Otherwise Specified (binge eating disorder).
It also meets the APA’s definition of a mental disorder, which can be paraphrased as: any significant problem of human living. Well overeating is certainly a problem, and therefore there should be little difficulty making it a mental illness. But the APA recognizes the need to proceed cautiously in the business of re-defining ordinary human problems as so-called mental illnesses. If their claims seem too ridiculous, they will lose credibility, so there has to be a gradual process – a “softening-up” period so to speak – during which the public is introduced to the notion that what we had thought of as a normal human problem is really a mental illness.
In DSM-III (1987), overeating was not listed specifically. In DSM-IV (1994) it was sneaked in under the ever-elastic NOS category. And by DSM 5, I predict the process will be complete and habitual overeating will be a fully-fledged mental illness.
And this “diagnosis” is the mother-lode of all diagnoses. The psychiatrists are carefully and systematically engineering themselves to center stage in the war on fat. The answer, of course, will be to eat more pills, and the winners will be the pharmaceutical companies and, of course, the psychiatrists themselves.
More on overeating next post.
The Drugging of Children
Posted by Phil in A Behavioral Approach to Mental Disorders on January 17, 2011
Babies are born selfish. Not only has the newborn no consideration for others, he isn’t even aware of others. For the newborn, the universe is him/herself.
Babies are born bad-tempered. When their needs are not immediately met, they cry. If they are still not met, they scream, turn red, and thrash their arms and legs. This is raw, unmitigated anger.
Babies are born rude and ill-mannered. They vomit and urinate on other people’s clothes. They defecate in inappropriate places. They spit and drool. They grab people’s hair and poke their fingers in people’s eyes.
It is often assumed that children simply “grow out” of these childish self-centered practices. This is simply not the case. Children leave these practices behind and adopt what we would call civilized behaviors because their parents or other caregivers provide the appropriate training. This can’t be emphasized enough! When we see children who are not reaching age-appropriate norms with regards to these areas, what’s almost always lacking is appropriate parental training. When you see a five-year-old throwing a temper tantrum in a store because he wants a toy or a candy bar, the chances that there is something wrong with the child are minimal. He is simply behaving the same way he did when he was born. He hasn’t been properly trained. Often his parents will tell you that they have “tried everything,” but without success. I have worked with a great many of these families, and it is my observation that in practice they usually have tried almost nothing. Many people object to this kind of reasoning because they feel that it involves “blaming the parents.” Well perhaps it does. But if they’re not training and disciplining the child appropriately – surely it is important to acknowledge that and try to steer them towards appropriate help – rather than give them the false and spurious message that the child has a so-called mental illness such as oppositional-defiant disorder or conduct disorder or attention deficient hyperactivity disorder or (and these are the ones that are on the rise in recent years) – childhood bipolar or childhood schizophrenia.
These families often come within the orbit of Social Services Departments and the case workers at Social Services usually make a referral to the mental health center in the mistaken belief that there the family will receive some real help. Unfortunately the mental health centers have degenerated into store-fronts for the bio-pharma-psychiatric bloc, and all that happens in most cases is that the child is “diagnosed” with a so-called mental illness and given drugs.
I have touched on these issues in earlier posts (Attention Deficit/Hyperactivity Disorder and Conduct Disorder and Oppositional Defiant Disorder).
SOME STATISTICS
These statistics are from the FDA and can be checked at their website.
Prescriptions (million prescriptions dispensed) for Atypical Antipsychotics Through O.P. Pharmacies 2004-2008 (US)
| Drug | 2004 | 2008 | % increase |
|---|---|---|---|
| Quetiapine | 7.2 | 11.9 | 65% |
| Risperidone | 7.7 | 7.9 | 2% |
| Aripiprazole | 2.2 | 5.2 | 135% |
| Olanzapine | 6.0 | 4.0 | 33% |
| Zipcasidone | 1.4 | 2.3 | 71% |
| Total | 24.4 | 32.0 | 31% |
In previous decades there was a good deal of child drugging in mental health circles. The drugs used, however, were usually stimulants, anti-depressants, and anti-anxiety products. This was bad enough! But the growing trend in the past decade to prescribe anti-psychotics to young children is alarming, in that these drugs have even more serious side-effects.
ANTI-PSYCHOTIC DRUGS
The term “anti-psychotic” is misleading, in that it conveys the impression that the drug somehow eliminates “craziness” with surgical precision. Indeed this is the impression that the bio-pharma-psychiatric bloc would like to promote. But it simply isn’t so. These drugs were originally called “major tranquilizers” – which is an accurate description of what they do. They suppress all activity.
The early major tranquilizers were marketed under such names as Thorazine, Haldol, Mellaril, Stelazine, etc.. They were administered extensively in mental hospitals – and in outpatient mental health centers. The side effects were horrific. The most obvious side effect was tardive dyskinesia – grotesque disfiguring involving involuntary movements of the face, mouth, and tongue. If you visit a mental hospital, even to this day, you will very likely encounter individuals in the grounds and in the day rooms whose presentation is marked by this condition. They appear to be chewing continuously with pronounced and distorted jaw movements. Their mouths are frequently open and their tongues protrude. Many visitors believe that this is somehow related to the reason they were confined in the first place – that this condition is a part of their “craziness.” In reality, it is one of the toxic side effects of the drugs they have been given over a period of years.
The second generation of so-called anti-psychotics seems to involve less risk for tardive dyskinesia, but the risk is still considerable for this condition and other serious side effects. In addition, the risk that these products pose for the developing brains of children is simply unknown. Psychiatrists nevertheless are prescribing these products for children at an increasing rate. These practices are the more questionable when we remember that the presenting problems are almost entirely the result of ineffective parenting. There is nothing intrinsically wrong with the children. They simply haven’t been adequately trained and disciplined. But the APA has no way of conceptualizing these kinds of issues. When a psychiatrist sees a child in these kinds of contexts, if he wants to get paid for his work by Medicaid, Medicare, or private insurance, he must assign a diagnosis to the child. In other words, he has to fabricate the notion that the child is somehow sick (with a “mental illness”). The APA (through its DSM) abets this destructive deception and the pharmaceutical companies go on making billions of dollars.
Most psychiatrists have bought into this charade so thoroughly that they don’t even see the issues. Some (a few) recognize the nonsense for what it is, but they say: What can we do? We have to provide such help as we can.
Well the answer is simple. If you called a plumber and told him that your car wouldn’t start, he would tell you that that is not his area of concern and would suggest that you talk to a mechanic. Similarly psychiatrists when approached with these problems need to say openly and honestly that drugs are not an appropriate remedy for indifferent parenting and should refer the family back to Social Services.
Of course, they would be turning away a good deal of business for themselves and for their friends in the pharmaceutical companies. And that’s the issue – business.
Psychiatrists and the ever-ready prescription pads have done a great deal of damage to our society. And this damage continues as they and their pharmaceutical colleagues continue to develop new markets for their drugs.
Another Good Book
Posted by Phil in A Behavioral Approach to Mental Disorders on December 12, 2010
Manufacturing Depression, by Gary Greenberg
An excellent account of the history of the psychiatric concept of depression. Dr. Greenberg provides a fairly unique perspective, as he is an experienced psychotherapist who has had some personal experience with depression. In his writing he draws material from both sides of the desk. He also identifies and discusses the logical fallacies inherent in the bio-psychiatric orthodoxy.
Dr. Greenberg concludes:
“Call your sorrow a disease or don’t. Take drugs or don’t. See a therapist or don’t. But whatever you do, when life drives you to your knees, which it is bound to do, which maybe it is meant to do, don’t settle for being sick in the brain. Remember that’s just a story. You can tell your own story about your discontents, and my guess is that it will be better than the one that the depression doctors have manufactured.” (p 367)
So we have another voice in the wilderness rejecting, or at last challenging, the bio-pharma-psychiatric dogmatic profit-driven simplification of the human condition.
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Gary Greenberg, Simon & Schuster, 2010 |
DSM and Disability
Posted by Phil in A Behavioral Approach to Mental Disorders on December 12, 2010
Every society in every generation makes errors. Some of the errors are minor. Some are major. One of the great errors of the 20th century was this: we accepted the spurious notion that a wide range of life’s problems were in fact illnesses. This spurious notion was initiated with good intentions – to provide shelter and humanitarian care for a relatively small number of individuals whose plight was truly dreadful. But then the concept of mental illness took off, fuelled largely by the efforts of psychiatrists to legitimize their status as “real” doctors.
And then came the drug companies, who formed an alliance with the psychiatrists. These mutually enchanted partners have been dancing heel-to-toe ever since, accumulating wealth and power to the great detriment of individuals and society.
Once it was firmly established that a wide range of ordinary problems of living were “really” diseases, it was a relatively easy step to conclude that individuals manifesting these problems might qualify for disability benefits under programs established by various governments. In the United States the government entity involved is the Social Security Administration, and at the present time the following “diagnostic” categories are grounds for a disability determination.
Organic mental disorders
Schizophrenic, paranoid, and other psychotic disorders
Affective disorders
Mental retardation and autism
Anxiety related disorders
Somatoform disorders
Personality disorders
Substance addiction disorders
Now it needs to be acknowledged that some of the problems embraced in the above list are genuine medical problems and are definitely disabling. These include: serious brain damage and mental retardation. But the vast majority of the so-called diagnoses listed are not genuine illnesses in any meaningful sense of the word. They are problems of living. They are problems of living that have been artificially medicalized for the benefit of psychiatrists and their allies the pharmaceutical companies. These spurious “diagnoses” include: schizophrenia, depression, bipolar disorder, anxiety disorders (including post-traumatic stress disorder), substance addiction, etc.. All of these problems are remediable, but under the bio-psychiatric system of pseudo-care, the individuals concerned receive little or nothing in the way of genuine help – in fact, they receive little more than a steady supply of mood-altering drugs.
Paying disability benefits to these individuals is an insult to the genuinely disabled people who have real medical problems which restrict so severely their ability to function.
In addition, the payment of disability benefits to the so-called mentally ill is a great disincentive for these individuals to try to resolve their problems and learn functional ways of living.
All of the “symptoms” of the so-called mental illnesses can be fabricated. A diagnosis of schizophrenia, for instance, is based entirely on what the individual says and does during an examination interview. There is no lab or clinical test for schizophrenia. Occasionally an examiner may question family members, but the “diagnosis” decision rests on the individual’s self-report. That’s how the system works. If you don’t mind the stigma of being considered “crazy,” you too can acquire a diagnosis, and with a little help from the mental health services, you can be awarded disability status and a modest monthly income.
And it doesn’t end there. If you go to college, you may qualify for a variety of academic accommodations. Michael Rose, PhD, writing in the July/August 2010 issue of the National Psychologist says:
“With the proper documentation, students may qualify for a wide range of learning aids, such as extra time to take tests, use of a private room for tests, word banks, use of a word processor with spell check and help from a proofreader. A specific documented disability, typically made within the past three years, has been the basis for approved accommodations at most institutions of higher learning.
Besides qualifying for extra help that will likely improve grades, students may qualify for a range of vocational rehabilitation services (paid tuition, books, dormitory costs, computers) that are not dependent on family or individual income.” (pg 18)
I cannot think of a better way of trapping people in a dysfunctional state than providing them with multiple rewards and benefits contingent on their continued dysfunctionality. As I have noted elsewhere: Is this a great country or what?
Back in the 1990’s there was a great push to get people off the welfare rolls. It is an open secret that Social Services departments in many areas were encouraging their welfare clients to enroll at the mental health center and establish a “diagnosis” so that they could then apply for a disability determination from Social Security.
I could never prove this, but I know of a number of parents who were actively coaching their children in attention-deficit and other kinds of dysfunctional behavior so that the child would qualify for a Social Security income. It’s a simple fact in America today that if you teach your child to misbehave seriously from an early age, and take him regularly to the mental health center for “help,” you stand an excellent chance of having him qualify for a Social Security income. I have known families with more than one child receiving Social Security “disability” payments for no other reason than chronic misbehavior and lack of discipline.
I discussed the spurious nature of Attention Deficit Hyperactivity disorder in an earlier post, but I’m repeating the diagnosis “symptoms” below for convenience.
The APA’s eighteen criteria for this fictitious illness are:
Inattention
a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b) often has difficulty sustaining attention in tasks or play activities
c) often does not seem to listen when spoken to directly
d) often does not follow through on instructions, and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
e) often has difficulty organizing tasks and activities
f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
h) is often easily distracted by extraneous stimuli
i) is often forgetful in daily activities
Hyperactivity/Impulsivity
a) often fidgets with hands or feet, or squirms in seat
b) often leaves seat in classroom or in other situations in which remaining seated is expected
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)
d) often has difficulty playing or engaging in leisure activities quietly
e) is often “on the go” or often acts as if “driven by a motor”
f) often talks excessively
g) often blurts out answers before questions have been completed
h) often has difficulty awaiting turn
i) often interrupts or intrudes on others (e.g., butts into conversations or games)
I have only one question for my readers. How hard would it be to train a child to function in this way?
Next Post: Another Interesting Book
The Psychiatrists, the Drug Reps, and the Green, Green, Dollars
Posted by Phil in A Behavioral Approach to Mental Disorders on November 24, 2010
We’ve known for years that drug companies give gifts to physicians. The gifts have taken many forms – pens, vacations, meals, free samples, etc… Physicians always insisted that these gifts didn’t influence their prescribing practice – that they always prescribed strictly in the best interests of their clients.
Two trends have been exposed in recent years which demonstrate just how depraved this hand-in-glove relationship has become.
Firstly, the “thought leader” ruse. Here’s how it works. A drug rep, usually an attractive young, perfectly groomed female, approaches a physician, usually male, and tells the physician that he has been identified as a thought leader in his area, and that they would like to recruit him to give presentations to groups of physicians and other healthcare workers. The physician, of course, will be paid generously for his time. He says “sure,” and the dance begins. The drug rep arranges the “training” sessions. The drug company provides the script and the refreshments. The mark – I mean the physician – delivers the script, in which the merits of the drug company’s product are lauded to the detriment of competitors. At the end of the session, the physician receives a check and goes away contented. Over the next few months more such sessions will be organized and the physician begins to think of his “speech” checks as regular income. He will also receive “coaching” from the drug rep if his presentation seems to lack the kind of conviction that the drug company feels warranted. (After all, they are paying the piper).
Now – physicians aren’t stupid – and our “thought leader” probably reckons that his speeches are resulting in more business for the drug company – i.e. that the audience he is addressing will prescribe more of the pills in question, and that this is the business rationale for the whole thing. In this he couldn’t be more wrong. The target of the exercise is the “thought leader” himself. It is his prescribing that the drug company is impacting. By getting him to extol the virtues of pill X to others, he comes to prescribe more of it himself. According to an NPR investigative piece, for every $1500 a drug company spends on a thought leader, he writes an extra $100,000 to $200,000 of prescriptions for that company’s product.
There are two dynamics at work. Firstly: gifts engender a sense of obligation to reciprocate. This has been clearly understood for thousands of years, but apparently not by a great many physicians. Secondly: what psychologists call cognitive dissonance. We like to be consistent. So our hapless “thought leader” ruminates: “If I’m pushing this product, then it must be good, therefore, I should be prescribing it myself.”
Now you’re probably wondering how could well-educated people like physicians be so naïve. Don’t they know anything about human interactions and manipulations? Good question. And very pertinent to the real scandal: the specialty that receives the most pharmaceutical money is psychiatry! What can one say?
The second disturbing trend is the hijacking of medical research by pharmaceutical companies. This happens in a number of ways. Pharmaceutical companies hire researchers to “evaluate” their products. If the results are positive, then publish; if negative, then suppress. Or massage the data until a positive result can be demonstrated. This kind of thing got so bad that most reputable journals required their authors to disclose any financial links they had to the products they were purportedly evaluating. But it seems even such strict rules don’t guarantee integrity. See the New York Times article “Medical Industry Ties Often Undisclosed in Journals.” In this article Dr. Marcia Angell, former editor of the New England Journal of Medicine, refers to:
“…the widespread corruption of the medical profession by industry money.”
She then goes on to say:
“The journals’ lax enforcement of disclosure policies probably reflects the fact that journals, too, are dependent on industry support.”
And there it is. The peer-reviewed journals – the point of contact between the practitioner and the research – are in the hands of the drug pushers. Is this a great country or what?
In my view, we have reached the point where all medical research has to be considered suspect until demonstrated otherwise. This is probably true across all specialties, but especially psychiatry.
Mental Illness: The History of a Mistake
Posted by Phil in A Behavioral Approach to Mental Disorders on November 17, 2010
The human brain is a pattern-seeking machine. Because of his brain, man strives to understand the world around him and uses this understanding to improve his lot. The brain looks for patterns and explanations. Our ancestors, for instance, discovered that certain rocks, through processing in certain ways, could be shaped to make sharp tools which they used to great advantage. Later it was discovered that other rocks when heated in certain ways produced iron. And so on.
The brain’s pattern-seeking activity is not confined to great discoveries. People use their brains every day to navigate through their environment and to find the procedures and practices that work to their best advantage. Commuters learn which routes have the fewest delays. Shoppers learn where they can find the best bargains. Politicians learn what to say to increase their chances of getting elected. Gardeners learn when is the best time to plant. And so on. In all aspects of daily life – great and small – the brain is storing and analyzing data, identifying patterns and explanations, seeking endlessly to optimize results.
It is likely that our ancestors of a few thousand years ago were pretty much as bright as we are in terms of raw intellectual ability. But their store of valid knowledge was a great deal less. The ancients lacked our knowledge of electricity, atoms, sub-atomic particles, germs, cells, neurons, periodic table, gravity, galaxies, etc., etc.. They had no understanding of why people got sick, why crops failed, why the moon and sun stayed up in the sky, or why some substances burned and others did not. They didn’t even understand the true nature of fire – knowledge that is well within the scope of any high school student of today. But this lack of knowledge didn’t prevent their brains from working on these various questions. The drive to make sense of their environment was as strong in them as it is in us today. So they invented explanations – explanations that today seem primitive and naïve, but that made sense to them and helped them organize and systematize their experiences. So they said that the moon and sun manage to stay up in the sky because they are gods (or goddesses), and gods can stay up in the sky. Readers of this blog will readily recognize the fallacy in this reasoning.
- Why does the sun stay up in the sky?
- Because it is a god.
- How do you know it’s a god”?
- Because it stays up in the sky.
And, of course, this kind of simplistic logic can be found in psychiatric circles to this day.
But to get back to the main point: people in virtually every ancient culture invented explanations for phenomena that they didn’t understand. They then ignored data that contradicted their explanations and highlighted data that supported them.
One of their more significant errors of this kind was, of course, the anthropomorphic god.
- Thunderstorms: god is angry.
- Fine weather: god is happy.
- Famine: god is punishing
- Etc..
But where the ancient civilizations really erred is in the nature and workings of life. Today we know that all living organisms consist of cells, and these cells remain alive and multiply through complex microscopic processes involving nutrition, mitosis, etc.. We also know that death occurs when the cells’ DNA – through aging – is no longer able to split reliably and hence no longer able to replenish depleted material.
But the ancients knew nothing of this. So to explain the phenomenon of life, they invented the soul or mind. This explained a great deal. A dead body was one that the soul had left. In dreams the soul left the body temporarily and travelled to distant places, faint memories of which remained after the soul had returned and the body reawakened. If you dream about your dead father, it’s because the travelling soul has visited the spirit world and seen him.
This is noteworthy in that we today in the computer age are very familiar with the notion of stored data and even stored images. But the idea that all of our memories were somehow stored in our brains was foreign and incredible to the ancients. The storing of data of this sort, which we call memory, was completely baffling to them. And they “explained” it by the simple expedient of declaring it to be a spiritual activity and therefore, of course, the province of the soul or mind.
Historians of philosophy call this “faculty psychology.” It goes like this. Different parts (faculties) of the organism have specialized functions. The function emanates from the faculty. So people can think because they have a faculty called mind. People can feel because they have hearts, etc.. Today it sounds simplistic and naïve, but back then people found it helpful. Activities such as thinking, remembering, planning, hoping, believing, etc., were most baffling to our ancestors, and they explained these activities by asserting that the faculty from which they emanated (the mind) was a kind of nebulous, ephemeral or “spiritual” entity, which in the hands of many religious leaders became equated with the “soul.” So all was explained. The mind (or soul or anima) was inside the otherwise inanimate, insensitive body. Experience was channeled to the mind through various body parts (touch, sight, etc..), and the mind organized all this data and did the thinking, deciding, etc.. Today, of course, we recognize this as spurious, but for centuries it was central to all Western thinking.
In reality, the concept of mind was an error – an error prompted by an ignorance of the anatomy and physiology of the brain. This ignorance was prolonged by an establishment, steeped in dogmatism and certainty, and resistant to any form of genuine scientific enquiry.
Today we realize that “mind” is essentially a metaphor for “self.” When we say: “I changed my mind,” what we mean is: “I, myself, reversed my earlier decision.” And so on. But in former times people thought of “the mind” as a real “faculty” residing somewhere (?) within the body. And this kind of spurious psychology held sway throughout the Western world for centuries and is indeed current in some circles to this day.
The notion of madness or craziness has also been around for centuries and was conceptualized largely as an irremediable defect of “the mind.” Crazy people were cared for by their families and communities and sometimes by religious houses. Then came the industrial revolution. People were no longer needed to work the land, so they flocked to the cities, where they found unmitigated poverty and squalor. Individuals who weren’t productive were often abandoned. This included the “crazy” people, who begged in the streets and ended up in jails.
From this context a number of reformers, driven by humanitarian motives, started a movement to have these individuals housed in specialized institutions. The buildings would be clean and properly run, and to lend respectability to these places, they would be placed under the jurisdiction of a physician. From there it was a short leap to the notion that these places were hospitals (which they weren’t) and that the residents were sick (which they weren’t). And so was born the notion of mental illness. An illness of a non-existent faculty!
The sickness idea was deemed progressive. Prior to that, the current notion was that these individuals’ “minds” were defective in some way and this defect was regarded more as a morality issue than anything else. Great shame was attached to the person’s family. Many (perhaps most) of the individuals considered crazy were what today we would call retarded or intellectually handicapped – but this distinction was not clearly grasped even 200 years ago. So locking these people away in enormous buildings managed by medical superintendents was considered charitable. (It also got them off the streets, which was considered desirable).
The more recent history is well-known. From being a relatively small number of asylum superintendents, American psychiatry has burgeoned to the 45,500 strong that it is today. Mental illness (the spurious disease of the spurious faculty) has been creatively expanded by an increasingly rapacious APA to the point where it can embrace virtually anyone.
So we have institutionalized this error and turned it into a vast drug-pushing enterprise in which human welfare and human dignity are routinely sacrificed to the all-consuming maw of pharmaceutical psychiatry. There are no minds. And there are no mental illnesses. There are people and we people live in a complex world. And we have problems – sometimes little, sometimes large. And sometimes we lose our way and our thinking becomes distorted. But conceptualizing these problems of human existence as illnesses to be “treated” by self-styled experts has been a colossal historical error – an error fuelled and maintained by career-building and corporate greed. The most pressing need in this area today is the de-medicalization of these problems and the provision of concrete help, guidance, and support to the individuals concerned.
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