A Behavioral Approach to Mental Disorders

INTRODUCTION On March 27, 2014, the University of North Carolina at Chapel Hill published a press release titled Dr. Cynthia Bulik of UNC leads multinational anorexia genetics project. Cynthia Bulik, PhD, according to Wikipedia, is the “Distinguished Professor of Eating Disorders in the Department of Psychiatry in the School of Medicine at the University of North Carolina at Chapel Hill, a Professor of Nutrition in the Gillings School of Global Public Health, and Founding Director of the UNC Center of Excellence for Eating Disorders. Dr. Bulik is also professor in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden and holds an adjunct appointment at the Norwegian Institute of Public Health. She is ranked #2 in the Expertscape list of world experts in eating disorders.” ...

Psychiatry is a hoax. Its fundamental concepts are spurious to the point of inanity. Much of its research is blatantly fraudulent. And its treatments are destructive, disempowering, and stigmatizing. Psychiatry has no coherent or logical response to the criticisms that it attracts, other than the repetition, mantra-style, of unsubstantiated assertions of safety and efficacy, coupled with unwarranted attacks on its critics. Psychiatry would long since have gone the way of phrenology and mesmerism but for the financial support it receives from the pharmaceutical industry. This support comes in two forms. Firstly, pharma provides generous largesse to psychiatric researchers and “key opinion leaders”, to provide a continuous stream of psychiatry-favorable copy. Secondly, and more importantly, pharma uses the clout of its enormous advertizing budget to effectively dissuade the mainstream media from exposing the truth about psychiatry. ...

To state the obvious, this is an anti-psychiatry site, and as such it attracts a fair measure of impassioned comment – some favorable, some unfavorable. From time to time the site gets “bombed”, by which I mean that someone who opposes my ideas “sits” on the site and expresses profound disapproval of anything and everything that I write, and of any favorable material from other commenters. In my early days as a blogger, I routinely tried to engage these individuals in dialogue, but, as I became busier, I was unable to maintain this level of response. Today I respond to comments as time and energy permit, but as a general rule I do not respond to comments that are fundamentally dishonest. The classic in this regard is: “You say that brains can’t malfunction, that’s just plain stupid.” I consider this a fundamentally dishonest line of discussion, because firstly, I have never made a statement even remotely like this, and secondly, the statement is obviously false and silly. ...

On March 24, 2015, a twenty-seven-year-old German pilot named Andreas Lubitz flew an Airbus A 320 into a French mountainside, killing himself and the 149 other people on board. Mr. Lubitz was co-piloting the flight, and he caused the aircraft to crash by locking the pilot out of the flight deck and setting the autopilot to descend to 100 feet. During the descent, he was contacted by civilian and military traffic controllers, and by the crew of another aircraft, but he made no response. He also ignored repeated and increasingly urgent requests from the captain to be readmitted to the flight deck. ...

On February 22, Allen Frances, MD, published an article titled: Psychiatry and Anti-Psychiatry on the HuffPost Blog. The general theme of the article is that psychiatry may have some problems, but it is basically sound, wholesome, and necessary. Here are some quotes, interspersed with my comments: "Psychiatry used to be a biopsychosocial profession that allowed time to get to know the person, not just treat the symptom. But drastic cuts in the funding of mental health services have dramatically reduced the quality of the service they can provide. Psychiatrists are now forced to follow very large panels of patients. Most of the limited time they are allowed with each is spent discussing symptoms, adjusting the meds, and determining side effects. Little time is left to forge a healing relationship, provide support, and teach skills through psychotherapy. And patients usually get to a psychiatrist- if at all- as a last resort, only after other things have failed- and with the expectation by the patient and referral source that the main purpose of the visit is just to prescribe medication." ...

On February 1, Allen Frances, MD, published an interesting article on the Huffington Post blog. The article is called Do Antipsychotics Help or Harm Psychotic Symptoms?, and is a response to Robert Whitaker’s post of January 27: “Me, Allen Frances, and Climbing Out of a Pigeonhole. This post, in turn, was a response to Dr. Frances’s Psychiatric Medicines Are Not All Good or All Bad, which was published in the Huffington Post on January 15. Readers may remember that I published a critique of this latter article on February 9. ...

Last month (February 2016), the British Journal of Psychiatry published an online bulletin titled BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students, by Ali Ajaz et al. Here’s the abstract: "Aims and method We used an online questionnaire to investigate medical students' perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments (‘badmouthing’ or ‘bashing’) against other specialists and whether this has had an effect on their career choice. ...

Readers may remember that a few weeks ago I became involved in an online debate with the very eminent and scholarly psychiatrist Ronald Pies, MD. That exchange was initiated by a post I wrote concerning a paper on the chemical imbalance theory that Jeffrey Lacasse, PhD, and Jonathan Leo, PhD, had published in the Behavior Therapist in October 2015. In that paper, Drs. Lacasse and Leo had drawn attention to certain aspects of Dr. Pies’ work, but they had also focused some attention on Daniel Carlat, MD, psychiatrist, and author of Unhinged: The Trouble with Psychiatry - A Doctor’s Revelations about a Profession in Crisis. ...

In their January 2016 issue, the journal Social Science and Medicine published Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders, by Jonathan Platt, MPH, Seth Prins, PhD candidate, Lisa Bates, PhD, and Katherine Keyes, PhD, MPH. All the authors work at Columbia’s Department of Public Health. Here’s the abstract: "Mood disorders, such as depression and anxiety, are more prevalent among women than men. This disparity may be partially due to the effects of structural gender discrimination in the work force, which acts to perpetuate gender differences in opportunities and resources and may manifest as the gender wage gap. We sought to quantify and operationalize the wage gap in order to explain the gender disparity in depression and anxiety disorders, using data from a 2001-2002 US nationally representative survey of 22,581 working adults ages 30-65. Using established Oaxaca-Blinder decomposition methods to account for gender differences in individual-level productivity, our models reduced the wage gap in our sample by 13.5%, from 54% of men's pay to 67.5% of men's pay. We created a propensity-score matched sample of productivity indicators to test if the direction of the wage gap moderated the effects of gender on depression or anxiety. Where female income was less than the matched male counterpart, odds of both disorders were significantly higher among women versus men (major depressive disorder OR: 2.43, 95% CI: 1.95-3.04; generalized anxiety disorder OR: 4.11, 95% CI: 2.80-6.02). Where female income was greater than the matched male, the higher odds ratios for women for both disorders were significantly attenuated (Major Depressive Disorder OR: 1.20; 95% CI: 0.96-1.52) (Generalized Anxiety Disorder OR: 1.5; 95% CI: 1.04-2.29). The test for effect modification by sex and wage gap direction was statistically significant for both disorders. Structural forms of discrimination may explain mental health disparities at the population level. Beyond prohibiting overt gender discrimination, policies must be created to address embedded inequalities in procedures surrounding labor markets and compensation in the workplace." ...

On January 15, 2016, Allen Frances, MD, Professor Emeritus at Duke University, published an article on the Huffington Post. The piece is titled: Psychiatric Medicines Are Not All Good or All Bad. The article denounces both the “medication fanatics” who prescribe psychiatric drugs when they are not needed, and the “die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful.” ...