A Behavioral Approach to Mental Disorders

Body Dysmorphic Disorder is one of the so-called mental disorders listed in the DSM-5. The manual lists the following diagnostic criteria, (p 242): A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others ) in response to the appearance concerns. C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Body Dysmorphic Disorder: The Illusion, discusses this "disorder" from the perspective of someone who has struggled with these issues herself. Zoe challenges the usefulness of diagnosis and standard psychiatric treatment – and provides an abundance of clearly-stated contributory factors, together with suggestions for self-help. The book reads nicely, and would be helpful for anyone who is troubled with these kinds of concerns, or for therapists/counselors who encounter these kinds of issues in their work. Here are some quotes: ...

On February 18, the eminent psychiatrist Jeffrey Lieberman, MD, former President of the APA, published a video and transcript on Medscape. The article was titled What Does the New York Times Have Against Psychiatry?, and was essentially a fatuous diatribe against Tanya Lurhmann, PhD, a Stanford anthropologist, who had written for the New York Times an op-ed article that was mildly critical of psychiatry. The essence of Dr. Lieberman's rebuttal was that an anthropologist had no business expressing any criticism of psychiatry, and he extended his denunciation to the editors of the NY Times. ...

It's no secret that here in America, foster children are being prescribed psychiatric drugs, especially neuroleptics, as a means of controlling their behavior. A great deal has been said and written on the matter. Politicians have declared the practice deplorable. Children's advocacy groups have expressed concern, and, of course, those of us in the antipsychiatry movement have screamed till we're hoarse. But the problem persists. For the past six months or so, the San Jose Mercury News, a California newspaper, has been running frequent articles on this topic, calling for oversight and corrective action. ...

On February 2, Robert Whitaker published an article on Mad in America. The title is Disability and Mood Disorders in the Age of Prozac. The article echoes and updates one of the themes of his 2010 book "Anatomy of an Epidemic": that the steady increase in the numbers of people receiving disability benefits for depression and mania is driven largely by the corresponding increase in the use of antidepressant drugs. ...

In 2010, Acta Psychiatrica Scandinavica published a study by Göran Isacsson et al. The paper was titled Antidepressant medication prevents suicide in depression. Here's the conclusion: "The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication." ...

On February 18, Jeffrey Lieberman, MD, Professor of Psychiatry at Columbia University, published a video lecture (with transcript) on Medscape. The article is titled What Does the New York Times Have Against Psychiatry?, but in his opening paragraph, Dr. Lieberman points out that the piece could be titled “Psychiatry Suffers Another Indignity.” The background to this is an article by Tanya Luhrmann, PhD, an anthropologist at Stanford University, which appeared a month earlier (Jan 17, 2015) in the New York Times. This article was titled Redefining Mental Illness, and developed some of the themes in the British Psychological Society’s earlier paper Understanding Psychosis and Schizophrenia. ...

Thomas Insel, MD, is the Director of the National Institute of Mental Health. In June of last year, he published, on the Director’s Blog, an article titled Are Children Overmedicated? The gist of the article is that children are not being overmedicated, but rather that there is an increase in “severe psychiatric problems” in this population. Here are some quotes, interspersed with my comments. "The latest estimate from the National Center for Health Statistics reports that 7.5 percent of U.S. children between ages 6 and 17 were taking medication for 'emotional or behavioral difficulties' in 2011-2012. The CDC reports a five-fold increase in the number of children under 18 on psychostimulants from 1988-1994 to 2007–2010, with the most recent rate of 4.2 percent. The same report estimates that 1.3 percent of children are on antidepressants. The rate of antipsychotic prescriptions for children has increased six-fold over this same period, according to a study of office visits within the National Ambulatory Medical Care Survey. In children under age 5, psychotropic prescription rates peaked at 1.45 percent in 2002-2005 and declined to 1.00 percent from 2006-2009." ...

On January 18, Thomas Insel, MD, published an article on The World Economic Forum Blog. The article is titled 4 things leaders need to know about mental health. Dr. Insel is the Director of the National Institute of Mental Health. The World Economic Forum “is an International Institution committed to improving the state of the world through public-private cooperation.” Dr. Insel’s paper makes a number of assertions, some of which are misleading. Here are some quotes, interspersed with my comments. ...

On November 27, 2014, the Division of Clinical Psychology of the British Psychological Society published a paper titled Understanding Psychosis and Schizophrenia. The paper was edited by Anne Cooke of Canterbury Christ Church University. The central theme of the paper is that the condition known as psychosis is better understood as a response to adverse life events rather than as a symptom of neurological pathology. The paper was wide ranging and insightful, and, predictably, drew support from most of us on this side of the issue and criticism from psychiatry. Section 12 of the paper is headed “Medication” and under the subheading “Key Points”, you’ll find this quote: ...

On December 21, 2014, Vivek Datta, MD, published an article on Mad in America. It’s titled Psychiatry and the Problem of the Medical Model –Part 1. The same article appeared the day before on Dr. Datta’s own website. Dr. Datta begins by stating unambiguously: "Psychiatry is a branch of medicine. As such, psychiatrists apply the medical model to problems of emotion, thought, behavior, human relations, and living." He describes this approach as a "narrow gaze" and expresses the belief that it has brought psychiatry "under severe criticism" both from within and without. Here are some quotes from Dr. Datta’s article, interspersed with my comments: ...