A Behavioral Approach to Mental Disorders

Steven Reidbord MD is a board-certified psychiatrist who practices in San Francisco. He writes a blog called Reidbord’s Reflections. On December 12, 2015, he posted an article titled Are psychiatric disorders brain diseases? It’s an interesting and thought-provoking piece, with many twists and turns. Here are some quotes, interspersed with my comments and reflections. "Of the conditions deemed inherently psychiatric, some seem rooted in biological brain dysfunction. Schizophrenia, autism, bipolar disorder, and severe forms of obsessive compulsive disorder and melancholic depression are often cited. It’s important to note that their apparently biological nature derives from natural history and clinical presentation, not from diagnostic tests, and not because we know their root causes. Schizophrenia, for example, runs in families, usually appears at a characteristic age, severely affects a diverse array of mental functions, looks very similar across cultures, and brings with it reliable if non-specific neuroanatomical changes. Even though schizophrenia cannot be diagnosed under the microscope or on brain imaging, it is plausible that a biological mechanism eventually will be found. (The same type of reasoning applied to AIDS before the discovery of HIV, and to many other medical diseases.) A similar argument can be made for other putatively biological psychiatric disorders." ...

On December 3, 2015, Ronald Pies, MD, published Campus Protests, Narcissism, and the Dearth of Civility on Psychiatric Times. The article is subtitled: What can we do, as a society, to reduce the levels of incivility and narcissism that appear to be on the rise? Here are some quotes: "…I believe we are witnessing the gradual but steady erosion of civility in American culture." "As a psychiatrist, however, I am also interested in the psychological development of the child, and why some children seem to develop along a trajectory that leads to intense narcissism—the fertile soil, in my view, upon which incivility thrives. Indeed, there is good evidence that narcissism has been increasing among our young people in recent decades—a factor that cannot be overlooked as we view incivility on the college campus. Leaving aside various technical and psychoanalytic definitions of the term, we can think of narcissism, broadly, as the attitude that proclaims, 'I should be able to do whatever the hell I please, and if other people don’t like it, that’s just too bad!'" ...

Robert Spitzer, MD, the architect of DSM-III (1980), died of heart disease on Christmas Day, 2015, at age 83. Most major media outlets published obituaries in which Dr. Spitzer was praised on the grounds that he had brought scientific rigor to psychiatry by naming and defining the various psychiatric illnesses. Here are a few illustrative quotes: "Dr. Robert L. Spitzer, who gave psychiatry its first set of rigorous standards to describe mental disorders, providing a framework for diagnosis, research and legal judgments — as well as a lingua franca for the endless social debate over where to draw the line between normal and abnormal behavior — died on Friday in Seattle." (New York Times, December 26) ...

In DSM-III-R, the APA defined a mental disorder as: "…a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and that is associated with present distress (a painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable response to a particular event, e.g., the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the person. Neither deviant behavior, e.g., political, religious, or sexual, nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the person as described above." (p xxii) ...

On December 27, 2015, Richard Lewis, a regular contributor to Mad In America, posted on that site Deafening Silence: What Happens When the Whistle Blows and Nobody Hears? Here are the first two paragraphs: "What happens when someone finally 'blows the whistle,' exposing potential harm and possible death caused by today’s mental health system? Is there any government agency or designated persons who are prepared to hear the whistle or even investigate and/or act on the nature of a serious complaint? Are all whistle blowers fired, or are some just ignored and easily dismissed as just an isolated voice in the wilderness? Just how broken is 'Broken'? Is it even worth the effort of going through official channels to file formal complaints within the current ‘System’? Here is my story and I will let you ponder some of the possible answers to these provocative questions. ...

On November 9, 2015, Allen Frances, MD, posted an interesting article on the Huffington Post’s Blog. The article is titled Why Are So Many College and High School Kids Abusing Adderall. The gist of the article is that the “excessive use of ADHD medication” is a more legitimate target for a war on drugs than the ongoing war with the drug cartels. The Huffington Post article is unusual, in that most of it is written by Gretchen LeFever Watson, PhD. Dr. Frances wrote the introduction, ending with “I have invited Dr Gretchen LeFever Watson, a clinical psychologist and public health researcher, to describe this growing problem.” Dr. Watson wrote the main body of the piece; and Dr. Frances finished up with some brief concluding remarks. ...

On November 18, 2015, Dr. Pies sent his response to my November 17 article to MIA. MIA posted it, and forwarded a copy to me. It reads: “I have read Dr. Philip Hickey’s 8400+ word treatise, and I have only the following to say with regard to the two key points at issue: Notwithstanding my omission of quotation marks in my original Medscape article [1]—for which I take responsibility—the fact remains: I have never believed or argued that the so-called chemical imbalance theory (which was never really a theory) is merely a “little white lie.” It is that point of view—not merely typed words on the page—that has been falsely and carelessly attributed to me. I have never received a dime from any pharmaceutical company or private agency with any verbal or written understanding that I would “promote” (elevate, popularize, hype, etc.) a particular drug. If any of the papers I wrote or co-authored over a decade ago had the effect of putting a drug in a favorable light, it was because the best scientific evidence available at that time supported the drug’s benefit. Nothing in Philip Hickey’s belaboring of half-truths, innuendos and guilt by association demonstrates otherwise.   Sincerely, ...

This morning, I received, by way of a forward from MIA, the following from Dr. Pies. . . . . . . . . . . . . . . . .   I have read Dr. Philip Hickey’s 8400+ word treatise, and I have only the following to say with regard to the two key points at issue: 1. Notwithstanding my omission of quotation marks in my original Medscape article [1]—for which I take responsibility—the fact remains: I have never believed or argued that the so-called chemical imbalance theory (which was never really a theory) is merely a “little white lie.” It is that point of view—not merely typed words on the page—that has been falsely and carelessly attributed to me. 2. I have never received a dime from any pharmaceutical company or private agency with any verbal or written understanding that I would “promote” (elevate, popularize, hype, etc.) a particular drug. If any of the papers I wrote or co-authored over a decade ago had the effect of putting a drug in a favorable light, it was because the best scientific evidence available at that time supported the drug’s benefit. Nothing in Philip Hickey’s belaboring of half-truths, innuendos and guilt by association demonstrates otherwise.   Sincerely, ...

In the October 2015 issue of the Behavior Therapist (pages 206-213), Jeffrey Lacasse, PhD, and Jonathan Leo, PhD, published an article titled Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse, I thought the article had particular merit, and I drew attention to it in a post dated November 2. The post, More on the Chemical Imbalance Theory, was also published on Mad in America. In that post, I quoted a number of passages from the Behavior Therapist article, including: ...

On November 5, Kermit Cole, Front Page Editor at Mad in America, forwarded to me the following email which he had received from Ronald Pies, MD. . . . . . . . . . . . . . . . .   From: Ronald Pies MD <contact-page@madinamerica.com> Date: November 4, 2015 at 2:17:53 PM EST To: kcole@madinamerica.com Subject: Misstatements in Philip Hickey\'s blog Echo Misstatements by Lacasse & Leo ...