Posts Tagged anxiety
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.
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
Anxiety Disorders
Posted by Phil in A Behavioral Approach to Mental Disorders on May 7, 2009
Fear is the normal human response to imminent danger. It is an adaptive response, in that it is helpful to survival, and it occurs in almost all animal species. When our cave-dwelling ancestors were attacked by mountain lions, they probably experienced acute fear. This fear gave them an extra burst of energy to flee the danger, or, if flight were impossible, to turn and fight.
Today in most parts of the world, there is little danger of attack from wild animals. As areas develop economically and culturally, these kinds of acute dangers are systematically eliminated or at least drastically reduced. Close encounters with tornadoes, hurricanes, rattlesnakes, car accidents, etc., can still arouse full-blown fear responses, but most people in developed countries can go months – even years – without experiencing these kinds of situations.
Anxiety, however, is a different matter. Anxiety is essentially a fear response that doesn’t quite take off. It is a constant feature of modern life. Just as industrial and commercial development entailed the systematic reduction of acute dangers, it involved an equally systematic increase in situations that provoke anxiety. Indeed, it could be argued that the production and maintenance of anxiety is an integral component of modern marketing.
The purpose of commercials is to generate within people feelings of insecurity and concern. The range of worries that are exploited in this way is limited only by the imaginations of the marketers. From all quarters we are bombarded with anxiety-producing messages, such as: you are not attractive; your television set is too small; your car is too old; your clothes are out of style; your hair is too gray (or oily, or dry); your libido is inadequate; your kitchen is outdated; your breasts are too small (female); your penis is too small (male); your computer is too old; your house needs to be painted; you have too little hair on your head; you have too much hair every where else, etc., etc… The purpose of these messages is to generate within us feelings of anxiety and insecurity so that we will buy more stuff. Of course the “fix” is only temporary, and the process continues pretty much from cradle to grave.
It is not being suggested that the marketers invented anxiety. Our ancestors in the caves probably experienced concern and anxiety if they heard unusual noises from outside the cave at night. This kind of anxiety is useful in that it increases vigilance and prepares the organism for a rapid response should this become necessary. In modern life there are many situations in which a certain amount of anxiety is appropriate and adaptive. On the highway, for instance, a sudden increase in the traffic density usually elicits a measure of anxiety. This anxiety sharpens our attention and helps us avoid mishaps. Similarly, most people will experience some anxiety if caught out in a severe storm, especially in tornado country. These are natural stressors and the anxiety they provoke is appropriate and helpful.
In addition, people who have had unpleasant experiences will likely feel some anxiety if exposed to similar circumstances later in life, and, in fact, will generally go to considerable pains to avoid such circumstances. People, for instance, who were teased and taunted during childhood will often in later life avoid situations where they might be exposed to criticism or ridicule.
What the marketers have done, however, is they have taken this natural adaptive mechanism and exploited it endlessly for their own gain and to the detriment of the public. In this they have been extraordinarily successful, so that at present we experience worry and anxiety – not only with regards to genuine concerns – but also with regards to an enormous range of matters which are truly trivial and inconsequential. What used to be the land of the free and the home of the brave has degenerated into a nation of worriers and fretters. But the fundamental point is that anxiety, in and of itself, is normal – it is an integral part of our normal day-to-day existence, and serves a useful purpose. What the American Psychiatric Association and the pharmaceutical companies have done, however, is redefine anxiety as a pathology – an illness – that needs to be treated by taking pills.
The DSM lists the following anxiety disorders:
Panic disorder without agoraphobia
Panic disorder with agoraphobia
Agoraphobia with out panic disorder
Specific phobia
Social phobia
Obsessive compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalized anxiety disorder
Anxiety disorder due to a general medical condition
Substance induced anxiety disorder
Separation anxiety disorder
Sexual aversion disorder
And of course,
Anxiety disorder not otherwise specified (n.o.s.)
The list is self-explanatory and is designed to cover as wide a range of anxiety-provoking situations as possible. The inclusion of the n.o.s. diagnosis at the end of the list ensures that anyone experiencing anxiety or worry concerning any matter whatsoever can be assigned a diagnosis and can enter the ranks of the “mentally ill.” DSM specifies that for a diagnosis to be made, the anxiety has to “interfere with the person’s functioning” or “cause marked distress”. In practice, these qualifiers are sufficiently vague that virtually anyone can be given an anxiety diagnosis. People who go to counselors for help with stress or life choices are often assigned a diagnosis of Generalized Anxiety Disorder. They are “enrolled” in the ranks of the mentally ill, and their numbers swell the already inflated statistics quoted in the first post (Proliferation of Mental Disorders)
Consider, for instance, a person who for several years has succumbed to the Madison Avenue hype. This individual has bought a new house, a big car, an entertainment center, membership at an expensive country club, etc. Although apparently wealthy, he actually has no money in the bank and is completely dependent on his paycheck to remain solvent. He now receives information that his company is considering lay-offs, and he fears that his name may be on the list. Meanwhile, he discovers that his sixteen-year-old son is doing drugs, his fourteen-year-old daughter is sexually active, and his wife has been “seeing” someone else. Understandably, he is becoming somewhat anxious. In fact, he is beside himself with worry. He’s not sleeping well. He’s gone off his food, and he’s beginning to make serious mistakes in his work. He doesn’t actually see much of his family, but when he does, he finds himself being increasingly irritable and grouchy.
Although this is a purely hypothetical case, there are a great number of people in our society who are living variations of this kind of scenario – sometimes for years on end. Their lives have become untenable, and their anxiety and worry are entirely appropriate. Things are out of control. They need to be worried, and they need to be taking corrective action.
If our hypothetical worrier goes to a mental health practitioner, however, he will be given a diagnosis of Generalized Anxiety Disorder (an invented illness) and a prescription for anti-anxiety pills. He is given the false and destructive message that the problem is simply an illness – a chemical imbalance – and that taking the pills will correct the imbalance in the same way that insulin injections enable a diabetic to function normally. The notion that his life is out of control and that certain fundamental changes need to be made is seldom even addressed.
For an excellent account of how a drug manufacturer promoted generalized anxiety disorder to market a new drug, see Brendan Koerner’s article “Disorders Made to Order” in the July/August 2002 issue of Mother Jones.
The APA’s criteria for a diagnosis of Generalized Anxiety Disorder are listed below:
A. Excessive anxiety and worry (apprehensive expectations), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
D. The focus of the anxiety and worry is not confined to features of [another mental disorder]
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiological effects of a substance…. or a general medical condition ….or [another mental disorder].
The reader will readily appreciate that our hypothetical worrier described above, and the millions more in the same boat, are easily embraced within the above criteria. If this individual goes to a mental health center, he will be given a “diagnosis” and a prescription for an anxiolytic. The chances are slim that he will receive any counseling with regards to stress reduction, relationships, or lifestyle. The essential message he receives is that his life and his habits are fine, but that he has a “chemical imbalance” in his brain that is causing him to feel upset and worried, and that the pills will take care of it.
In this context, it is important to remember that the vast majority of mental health diagnosing is based on the uncorroborated self-reports of the patient. If you tell a psychiatrist that you are very tense and anxious and that you can’t sleep, can’t focus on your work, and are irritable with your family – and if you make it sound convincing – you will be given a diagnosis of Generalized Anxiety Disorder and a prescription for an anxiety-reducing drug.
The APA and the pharmaceutical companies have jointly developed this spurious system in which all human problems, including normal reactions to stress, are declared mental illnesses which need to be “treated” with drugs. These tactics are focussed on people of all ages and all walks of life. Notice in the criteria for generalized anxiety disorder cited above, how much easier it is to assign this diagnosis to a child (one item instead of three).
Next Post: Posttraumatic Stress Disorder
