A Behavioral Approach to Mental Disorders

The human brain is a pattern-seeking machine. Because of his brain, man strives to understand the world around him and uses this understanding to improve his lot. The brain looks for patterns and explanations. Our ancestors, for instance, discovered that certain rocks, through processing in certain ways, could be shaped to make sharp tools which they used to great advantage. Later it was discovered that other rocks when heated in certain ways produced iron. And so on. ...

The notion of learning disorders gained momentum during the 50’s and 60’s, when it began to be appreciated in professional circles that there were a small number of individuals who, although quite bright, seemed to experience inordinate difficulty learning to read. They juxtaposed letters or did not seem to readily “see” the patterns of letters in words, and the term “dyslexia” was used to describe this condition, which was relatively rare in school-aged children. ...

Unhinged, by Daniel Carlat, MD Dr. Carlat is a psychiatrist who has written something of an exposé of the abuses that reside within the psychiatric profession. Many of his chapters echo topics that have been addressed frequently on this blog. Dr. Carlat still clings to the notion that problem behaviors can be accurately conceptualized as illnesses, but he does criticize the proliferation of “diagnoses” and the application of these “diagnoses” to increasing numbers of individuals. ...

This post was edited and updated on June 29 2014, to include additional thoughts. . . . . . . . . . . . . . . . . A Rational Policy on Drugs and Alcohol In my last post I argued against government prohibitions against drugs and alcohol. My position is that substances such as cocaine, heroin, methamphetamines, etc., should be legal in the same way that alcohol and tobacco are today. I believe, however, that the distribution and marketing of these substances should be brought under direct government control. All of the commonly abused addictive substances are dangerous, and they have taken - and continue to take - an enormous toll on society. This cost includes lives, health, lost opportunities, money and general suffering and anguish. But it’s difficult to put old heads on young shoulders, and it seems that each generation - indeed each individual - has to learn these lessons anew. I don’t believe we can ever eradicate substance abuse entirely. ...

In my previous post on this subject, I discussed addiction to alcohol and other drugs. I made the point that addiction to these substances is not an illness, but rather an extremely strong habit. Treatment Programs The notion that alcoholism is a disease gained popularity in the 50’s and 60’s. At about the same time, employers were beginning the practice of offering medical insurance to their staff, and insurance companies routinely included 30 days of treatment per year for alcoholism and/or drug addiction. At the time, there were very few treatment units for these problems, and little use was made of the drug and alcohol provisions in the insurance policies. ...

The APA’s DSM lists two broad categories of diagnoses in this area: dependence and abuse. So we have alcohol dependence and alcohol abuse; amphetamines dependence and amphetamines abuse; cocaine dependence and cocaine abuse. And so on. Dependence is defined by the presence of three or more of the following criteria: tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect markedly diminished effect with continued use of the same amount of the substance withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance … the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms the substance is often taken in larger amounts or over a longer period than was intended there is a persistent desire or unsuccessful efforts to cut down or control substance use a great deal of time is spent in activities necessary to obtain the substance… use the substance … or recovery from its effects important social, occupational, or recreational activities are given up or reduced because of substance use the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance … Abuse is defined as one or more of the following: recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home … recurrent substance use in situations in which it is physically hazardous … recurrent substance-related legal problems … continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effect of the substance … Let’s consider alcohol dependence, which to all intents and purposes is what most people would refer to as alcoholism. A person who drinks, say, half a bottle of whisky every day, who never appears particularly drunk, who becomes extremely sick if he stops drinking, who has made numerous unsuccessful efforts to quit, who has incurred some liver damage, and whose social life has been severely curtailed because of drinking, would normally be called an alcoholic. Some people prefer the term addicted and would describe him as addicted to alcohol. DSM would say that he has a mental disorder called alcohol dependence. The problem with all three terminologies is that they encourage us to blur the distinction between a description and an explanation. This distinction is the central theme of this blog. ...

I have recently read a very interesting book by Irving Kirsch, PhD. It’s called The Emperor’s New Drugs, and the central theme of the work is that antidepressants are only very slightly more effective than placebos (i.e. sugar pills), and that the difference is not clinically significant. The logic is cogent and the research is rigorous. Read the book and decide for yourself. Dr. Kirsch argues in favor of psychotherapy as a substitute for pills. And certainly talking is usually helpful. However, as long as depression is conceptualized as an illness, I don’t believe we will see real progress in this field. ...

In my last post I described frotteurism, which the APA lists as one of their mental disorders/illnesses. The central theme of this blog is that there are no mental illnesses – that mental illnesses are essentially psychiatrists’ ways of conceptualizing ordinary human problems for the purposes of consolidating turf and legitimizing the use of drugs to alter people’s behavior and mood. This is not to say that the behaviors in question are not problems. They certainly are. Frotteurism is a case in point. A man who uses the crowd cover of trains and buses to press his genitals against non-consenting females clearly has a problem. The question is: how can we explain this behavior? Why does he do it? ...

The central theme of this blog is that almost all the so-called mental illnesses listed in the APA’s Diagnostic and Statistical Manual are nothing more than the ordinary everyday challenges of human existence. The psychiatric profession has “elevated” these problems to the status of disorders and illnesses to justify and legitimize their involvement in these areas, and in particular to justify the use of drugs to alter people’s moods and actions. Psychiatry – once a respectable helping profession – has degenerated into something little better than drug pushing. The real winners, of course, are the pharmaceutical companies, who use the psychiatrists and other mental health professionals to promote the widespread drugging of the population. The DSM’s so-called sexual disorders represent a particularly blatant example of psychiatric invention. ...

Sorry I’ve been “off the air.” My wife, Nancy, fell and broke her thigh bone a couple of weeks ago. She is out of the hospital and recuperating well, but my days are filled with the minutiae of personal care and domestic management. Stay tuned. I still have lots to say concerning the spurious nature of DSM’s so-called mental illnesses.