A Behavioral Approach to Mental Disorders

On February 27, 2015, European Psychiatry published a paper titled EPA guidance on how to improve the image of psychiatry and of the psychiatrist. The paper was authored by D. Bhugra et al. EPA is the European Psychiatric Association. Dr. Bhugra is a psychiatrist who works at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, and is also President of the World Psychiatric Association. There are thirteen co-authors, most of whom are also psychiatrists. ...

In this truly remarkable, and meticulously researched, volume, Dr. Lynch annihilates psychiatry’s cherished chemical imbalance theory of depression. Every facet of this theory, which the author correctly calls a delusion, is critically analyzed and found wanting. Example after example is provided of psychiatrists promoting this fiction, the factual and logical errors of which are clearly exposed in Dr. Lynch’s lucid, seamless, and highly readable prose. The book runs to 343 pages, and is laden with factual details, case studies, alternative perspectives, and hard-hitting commentary. Dr. Lynch does not sit on the sidelines, nor does he seek any kind of collegial compromise with the chemical imbalance theory, which he unambiguously denounces as a groundless and destructive falsehood. Here are some quotes that I think will convey something of the content, style, and cogency of this vitally important work. ...

BACKGROUND DSM-5 defines delusions as “…fixed beliefs that are not amenable to change in the light of conflicting evidence.” (p 87). The manual lists six kinds of delusions: persecutory; referential; grandiose; erotomanic; nihilistic; and somatic. The APA provides another definition of delusions on p 819. It’s substantially the same as the one above, but offers the additional varieties: bizarre; delusional jealousy; mixed type; mood-congruent; mood-incongruent; of being controlled; thought broadcasting; and thought insertion. Interestingly, nihilistic delusions are omitted from the second list. These, we are told on page 87, “…involve the conviction that a major catastrophe will occur.” ...

Imagine that you’re not feeling well, and you visit Dr. Ducknoise. The doctor asks you questions, nods knowingly at your answers, asks more questions, perhaps jots down some notes. Finally, he nods gravely. "What is it, doc?" you ask. "You've got UTW disorder," he replies grimly. "What's that?" "Under-the-weather disorder. It's a serious illness. It's why you have been feeling poorly." "What causes it?" you ask. "Imbalances in the blood." "How do you know I've got it?" "Because you have been feeling poorly." "Can you help?" ...

Yesterday I received the following tweet from Dr. Huda: "funnily enough my time availability hasn't changed in 24 hours. I have however written one more page. Are u ever in UK?" From which I must conclude, sadly, that the debate, to which I had been so looking forward, seems unlikely to materialize. For the benefit of readers who might have come late to this interaction, here is a brief summary of what happened. ...

Yesterday I received the following comment from Dr. Huda, who, believe it or not, still seems to be under the impression that I want to debate him on Twitter! "Hi I don't read your blog so only found out about this from someone else Debates on social media are usually a non meeting of minds and a waste of time In any case they don't demonstrate your understanding of psychiatry just debating skills ...

After Monday’s post, I received the following tweet from Dr. Huda: "Dear @BigPhilHickey I find debates over Twitter r largely pointless I am (slowly) writing a book outlining my views" To which I reply: I never suggested a debate over Twitter. In fact, I stated very clearly that "… Twitter, while an excellent medium for certain kinds of communication, is not a suitable vehicle for serious debate." This entire matter was started by Dr. Huda's assertion on Twitter that I hate psychiatry, and that I get its concepts wrong. In response, I invited Dr. Huda "… to critique any of my writings – to set out which of psychiatry’s concepts I 'get wrong', and to point out the flaws in my analysis." I also made the point that Dr. Huda's original tweet was a way of avoiding the issues. Today's follow-up tweet strikes me as more of the same. So, at the risk of laboring the point, let me make myself perfectly clear. I am inviting – indeed encouraging – Dr. Huda to critique any of my writings. They can be found at Behaviorism and Mental Health. He may write his critique anywhere he chooses, and if he will let me know where it can be found, I promise to reply. ...

A few days ago, I received notification via Tweetdeck that my handle (@BigPhilHickey) had appeared in a Twitter conversation between one of my Twitter followers and Samei Huda, MD. My follower had mentioned me, and had pointed out that I critique “… the ideas, value systems, politics, practice etc of psychiatry…” To which Dr. Huda replied: "he hates psychiatry and gets its concepts wrong. Anyway I am busy today so will have to ciao :-) " ...

According to the APA, intermittent explosive disorder is characterized by angry aggressive outbursts that occur in response to relatively minor provocation. This particular label has an interesting history in successive editions of the DSM. DSM I (1952) Intermittent explosive disorder does not appear as such in the first edition of DSM, but the general concept is clearly discernible in “passive-aggressive personality, aggressive type”: "A persistent reaction to frustration with irritability, temper tantrums, and destructive behavior is the dominant manifestation." (p 37) ...

In recent years, we’ve seen an increasing number of articles and papers from psychiatrists in which they seem to be accepting at least some of the antipsychiatry criticisms, and appear interested in reforms. It is tempting to see this development as an indication of progress, but as in many aspects of life, things aren’t always what they seem. Last month (June 2015), The Lancet Psychiatry published a paper online in their Personal View series. The paper is titled Childhood: a suitable case for treatment?, and the authors are Ilina Singh and Simon Wessely. Dr. Singh is Professor of Science, Ethics & Society at King’s College London, and is cross-appointed to the Institute of Psychiatry. Dr. Wessely is professor of psychological medicine at the Institute of Psychiatry, King’s College London, and President of the Royal College of Psychiatrists. ...