A Behavioral Approach to Mental Disorders

The recent publicity surrounding the Justina Pelletier case has focused attention, not only on the spurious and arbitrary nature of psychiatric diagnoses, but also on the legitimacy and appropriateness of mental health commitments. It is being widely asserted that these archaic statutes are fundamentally incompatible with current civil rights standards, and the question “should mental health commitments be abolished?” is being raised in a variety of contexts. CRITERIA ...

Under DSM-IV, a “diagnosis” of somatization disorder entailed a history of physical symptoms for which, despite thorough medical evaluation, no satisfactory physical etiology could be established. In DSM-5, this “diagnosis” was replaced by somatic symptom disorder. This is essentially similar to DSM-IV’s somatization disorder – with one critical difference. The newer “diagnosis” can be assigned even if there is an identifiable physical illness. The essential requirement for the new “diagnosis” – indeed the only requirement – is that the individual is excessively or disproportionately preoccupied with the symptoms. And who, one might ask, decides if a person’s preoccupation is excessive? A psychiatrist, of course, whose vast training in drugs and ECT equips him with the wisdom, empathy, and insight to make such judgments. As the eminent Dr. Biederman proclaimed in a public courtroom on February 26, 2009, a psychiatry professor is second only to God in status and ability! ...

On February 28, Awais Aftab, MD, a psychiatrist working in Qatar, published an interesting article on Psychiatric Times. The article, which is titled Mental Illness vs Brain Disorders: From Szasz to DSM-5, is an attempt to validate the concept of “mental illness” and, in particular, claims to refute the position of the late Thomas Szasz, MD, that mental illness is a spurious concept. The validity or otherwise of the concept of mental illness is fundamental to psychiatry’s claim to legitimacy, and for this reason, Dr. Aftab’s article deserves close scrutiny. ...

On February 25, Kristina Fiore published an article on MedPage today. It’s titled Killing Pain: Xanax Tops Charts. The article is based on a study conducted by Jann M et al, and published in the February 2014 issue of the Journal of Pharmacy Practice. The study is titled Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. Here’s a quote: "During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression." ...

On February 28, our good friend, the eminent Jeffrey Lieberman, MD, President of the APA, published Politics of Psychiatry and Mental Health Care on Psychiatric News, the APA’s online bulletin. His co-author on this occasion is Patrick Kennedy, former Congressman from Rhode Island and co-sponsor of the Mental Health Parity and Addiction Equity Act. The piece is fluff and cheerleading, which have become Dr. Lieberman’s areas of specialty. ...

Justina Pelletier is the 15-year-old girl who is at the center of a dispute between her parents and the Psychiatry Department at Boston Children’s Hospital. Justina, who lived with her parents in Connecticut, had been diagnosed with mitochondrial disease, a rare and debilitating illness, and had been receiving treatment for this from Mark Korson, MD, Chief of Metabolism Services at Tufts Medical Center in Boston. In February of last year, Justina’s parents took her to Boston Children’s Hospital with flu-like symptoms. Dr. Korson had recommended an admission to Boston Children’s so that Justina could be seen by Alex Flores, MD, a gastrointestinal specialist who had recently transferred from Tufts to BCH. ...

INTRODUCTION An NBC online News article dated October 15, 2010, carried the noteworthy title New blood test may help detect schizophrenia. Thanks to Francesca for the link. The article was written by Natasha Allen, a freelance medical journalist. The gist of the article is that there is a new blood test called VeriPsych which “researchers say” is 83% accurate in discriminating people who are “schizophrenic” from people who are not. ...

There’s an interesting February 11, 2014, article on Peter Breggin’s website: $1.5 Million Award in Child Tardive Dyskinesia Malpractice. Thanks to Mad in America for the link. Here’s the opening paragraph: "On February 11, 2014 a Chicago jury awarded $1.5 million to an autistic child who developed a severe case of tardive dyskinesia and tardive akathisia while being treated by psychiatrists with Risperdal and then Zyprexa between 2002 and 2007. The drug-induced disorder was diagnosed when he was fifteen years old and by then had become disabling and irreversible." ...

There’s a truly delightful little piece in February’s Current Psychiatry. It’s written by Henry Nasrallah, MD, and is titled Psychiatry’s future shock. Dr. Nasrallah is Editor-in-Chief of Current Psychiatry. The gist of the article is that “transformative” changes are occurring in the psychiatric field, and psychiatrists had better get on board, or they will be left behind. Here are some quotes: "The 'neuroscientification' of psychiatry, ongoing for more than 3 decades, is now approaching a tipping point: The specialty is on the verge of an unprecedented denouement of the old tenets and assumptions." ...

TMS is a psychiatric treatment that uses a rapidly alternating magnetic field to induce electric currents in the brain. These currents stimulate neurons, causing them to “fire.” When used repetitively, TMS is said to alter the excitability of the brain area that has been stimulated. In the psychiatric field, TMS is being used increasingly as a treatment for depression, particularly with so-called treatment-resistant clients. I Googled the string “TMS + depression” and got 1.35 million hits. So the idea is attracting attention. ...