A Behavioral Approach to Mental Disorders

Years ago I was director of a county mental health center in an Eastern state. Shortly after taking the position, I became concerned that clients were being involuntarily committed too readily and without exploration of other options. I issued an instruction that all such activity had to be approved by a middle manager before it could proceed. This measure aroused enormous resistance from the front-line staff. There was one client – let’s call him Charlie – who was committed to the State Hospital every year, usually in July. Every July, he would become “agitated,” would scream profanities at his elderly mother, and break things around the house. He carried a “diagnosis” of schizophrenia. ...

I’ve recently come across an article from the Manchester Guardian on this topic. The article is by Sarah Boseley, and is a review of a UK study in the Journal of the American Geriatric Society written by Aideen Maguire, C. Hughes, Chris Cardwell, and Dermot O’Reilly. The researchers examined the Northern Ireland prescribing database and discovered that when people were admitted to nursing homes, the rate at which they were prescribed anti-psychotic drugs increased from 1.1% to 20.3%! ...

One of the central themes on this website is that psychiatric diagnoses are spurious and have no explanatory value. This contention is central to my entire argument, and for this reason I thought it might be useful to discuss the matter in some detail. Let’s start by examining what is meant by an explanation. Almost as soon as a child can talk, he begins to ask questions. He asks why does it rain; why does grass grow; why is the sun hot; why is iron hard; why does wood float on water; why do cats eat mice; and so on. What the child is doing is trying to find meaning and system in the world which he sees and feels and tastes and hears and smells. He is looking for explanations. So, for instance, if a child were to ask: “Why is iron hard?” a conscientious parent who had some scientific background might venture an explanation like this: “Because the molecules in the iron are bound together in a way which prevents them from moving around too much. By contrast, the molecules in soft substances, like water, are not bound as tightly, and so they move apart when you stick your finger in. The molecules in the iron won’t move apart easily – you would have to hit them with a hammer and chisel to get them apart.” ...

I came across an interesting article Psychiatric Medication or Play Therapy? by Bob Fiddaman, a New Zealand writer. The article compares the efficacy and dangers of play therapy vs. pharmaceutical products for children with various problems. Here are some quotes: "…play therapy outcome studies support the efficacy of this intervention with children suffering from various emotional and behavioral difficulties." "Pharmaceutical companies spend billions on marketing psychiatric medication." "Front groups that purport to fly the mental health flag are, in fact, nothing more than agents, pimps for the pharmaceutical industry." ...

When we were young, most of us devoted a good deal of time and energy to squabbling with other children. To the dismay of our parents, we because adept in the use of impolite language, and kept our stock of insulting words and phrases up-to-date. As adults we are more socially sophisticated. We no longer call one another rude names – at least not openly. Tragically, however, many people go through their entire adult lives calling themselves names, which although not as vulgar as the insults of childhood, are considerably more destructive. ...

Another interesting article: Academic Integrity in Ireland and the UK: Is there any such thing? at Leonie fennells’ Blog. It’s about financial ties between pharmaceutical companies and psychiatrists. Same old story; different location. It’s worth a look. Thanks to Becky @yobluemama2 on Twitter for drawing my attention to this.

Several of my recent posts have been about fundamental issues. Here's something a little lighter.   On the coast of Maine near the Machias Estuary, the Atlantic Ocean pounds the cliffs and beaches. The scenery is wild and beautiful, and there are lots of seagulls. One spring a seagull was born named Jimmy Brady. He was a fine little seagull, but his brothers picked on him something terrible, and he grew up feeling nervous and very unsure of himself. He thought he was ugly, and when it came time to jump off the cliff and fly, Jimmy just couldn’t do it. He didn’t believe that a seagull, as horrible and klutzy as he believed himself to be, could ever soar over the waves as a seagull should. ...

Until just a few years ago, the spurious nature of mental illness received little or no attention either in professional circles or in the general media. There were a few of us “cranks” who poked away at the issue, but peer condemnation was usually swift and outspoken. On one occasion I was called an “anti-science Nazi” for daring to suggest that the condition known as ADHD might have more to do with ineffective parental discipline than with brain chemistry. We were voices in the wilderness. ...

This post is a continuation of my post Steven Novella M.D. and Mental Illness Denial. In Mental Illness Denial Part I, Dr. Novella makes the point that various parts of the brain enable us to do certain things, and that if we are doing these things dysfunctionally, or not well, or perhaps not at all, then clearly there is something wrong with that part of the brain. The example he gives is the activity of paying attention – but I think this is provided as an example, and that Dr. Novella intended his comments to apply to the full range of problems embraced by the DSM. ...

As most readers of this website are aware, there is a great deal of resistance to the soon-to-be-released DSM-5. There is even a Boycott DSM-5 Committee established by Jack Carney, and many people are suggesting that practitioners use the World Health Organization’s (WHO’s) International Classification of Diseases (ICD) instead. In the general context of this debate, I have come across an article by Philip Thomas, M.D. – “Pinball Wizards and the Doomed Project of Psychiatric Diagnosis." Dr. Thomas points out that “…it’s hard to imagine that the criticisms raised about DSM-5 won’t also apply to the ICD.” ...