A Behavioral Approach to Mental Disorders

On June 13, 2014, Psychiatric Times published an article by Steve Balt, MD. The article is titled Assessing and Enhancing the Effectiveness of Antidepressants, and is a good deal more candid as to the efficacy of antidepressants than one normally encounters from psychiatry. Dr. Balt is a private practice psychiatrist in California. He is the editor-in-chief of The Carlat Psychiatry Report. The article opens with the observation that despite the large number of antidepressants on the market, and decades of clinical experience, no particular product seems to have emerged as substantially better than the rest. ...

On December 29, Nassir Ghaemi, MD, a psychiatrist and a professor at Tufts Medical Center, published on Medscape an article titled Psychiatry Prospects for 2015: Out With the Old, In With the New? The article opens: "With the new year reviving old desires, one may wonder what, if anything, new will be in store for the practice of psychiatry. Will there be anything practice-changing?" Under the heading "Toward More Effective Psychotherapy", Dr. Ghaemi states: "Besides medications, an important change for practice is happening that involves psychotherapies." ...

It is generally recognized in antipsychiatry circles that antidepressant drugs induce manic or hypomanic episodes in some of the individuals who take them. Psychiatry’s usual response to this is to assert that the individual must have had an underlying latent bipolar disorder that has “emerged” in response to the improvement in mood. The problem with such a notion is that it is fundamentally unverifiable. Psychiatry defines “bipolar disorder” by the presence of certain behaviors and feelings. If a person meets these criteria, he/she is said to have bipolar disorder. What immediately needs to be noted is that bipolar disorder, in common with psychiatry’s other “disorders” has no explanatory value. To illustrate this, consider the following hypothetical conversation. ...

The current issue of Acta Psychiatrica Scandinavica is devoted to the topic of psychiatry’s poor image, and what steps might be taken to improve it. Central to the discussion is a study Images of psychiatry and psychiatrists, by H. Stuart et al, - and seven commentaries on this study by various authors. The Stuart et al paper describes a survey of 1057 teaching medical faculty members from 15 sites in Europe and Asia. The overall response rate was 65%, and the results indicate clearly that general medical teaching staff have a poor opinion of psychiatry and psychiatrists. For instance, 90% of respondents endorsed the item “Most psychiatrists are not good role models for medical students.” ...

On March 17, 2013, I wrote a post titled Withdrawal from Benzodiazepines. In that post I wrote: "Withdrawal from these drugs is potentially dangerous, incidentally, and medical supervision is a good idea, especially if the dependence is marked. Try to find a physician other than the one who got you hooked on them in the first place. In severe cases, hospitalization is required." On December 27, 2014, a reader (Nancy Rubenstein) left a comment which stated that this is dangerous advice in that "…there are literally less than a handful of doctors nationwide who have proven they can handle this. There is no safe hospitalisation for people in psych drug withdrawal…" Nancy also pointed out that when people do go to hospital for emergency withdrawal problems, they are often met with disbelief, and that this disbelief can result in further problems, e.g. diagnosis of a "mental illness", further drugging, etc… All of these points are well taken, and I appreciate Nancy’s feedback. I received similar feedback from Monica Cassani (Beyond Meds) in March of 2013. ...

On May 16, 2014, the International Journal of Geriatric Psychiatry published an article by Deepa Archarya, PhD, et al. The article is titled Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia. Here are the authors’ conclusions: "Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management." In their Introduction section, the authors write: "Despite the high prevalence of these agitated and aggressive behaviors, there are currently no treatment options approved by US Food and Drug Administration for this indication. Nonpharmacological interventions, including environmental and behavioral modification, are difficult to implement in nursing home settings because of low staff-to-resident ratios." ...

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. It challenges the psychiatric medical model that dominates mental health practice in Britain and throughout the world, and offers an alternative perspective on psychosis and on the condition known as schizophrenia. On December 15, Psychology Today published a pro/con article on the BPS’s paper. Allen Frances, chair of the DSM-IV Task Force, critiqued the paper, while Anne Cooke presented the pro side. Anne’s opening paragraphs were: ...

On November 19, 2014, the Australian and New Zealand Journal of Psychiatry published Benzodiazepine use and aggressive behaviour: A systematic review, by Bonnie Albrecht et al, from Deakin University, Melbourne, Australia. Here are the authors’ conclusions: "There appears to be a moderate association between some benzodiazepines and subsequent aggressive behaviour in humans. The circumstances under which aggressive responding may be more likely to follow benzodiazepine use remain unclear, although some evidence suggests dose and/or personality factors may influence this effect." ...

PCCS Books Ltd has recently published A Straight Talking Introduction to Psychiatric Diagnosis, by Lucy Johnstone, PhD. Lucy is a consultant psychologist working in Wales, and has been an outspoken critic of psychiatry’s medical model. Here are some quotes: "…my own conclusion, based on extensive reading and clinical work and many enlightening discussions with service users, is that psychiatric diagnosis is not a valid or evidence-based way of understanding the difficulties and distress that people experience." ...

On December 1, Mad in America published an article titled When Homosexuality Came Out (of the DSM). The author is Vivek Datta, MD, MPH, a British physician who is currently a second year psychiatry resident at the University of Washington, Seattle. The article was also published the same day on Dr. Datta’s blog site, Medicine and Society. The article focuses on the removal of homosexuality from the DSM, which occurred in 1973. Dr. Datta discusses this issue and various related themes, and he draws some conclusions that, in my opinion, are unwarranted and misleading. ...