Psychiatry Is Not Based On Valid Science

by Phil on January 9, 2014

BACKGROUND

On December 23, I wrote a post called DSM-5 – Dimensional Diagnoses – More Conflicts of Interest?  In the article I sketched out the role of David Kupfer, MD, in promoting the concept of dimensional assessment in DSM-5, and I speculated that at least part of his motivation in this regard might have stemmed from the fact that he is a major shareholder in a company that is developing a computerized assessment instrument.  I ended the piece with a general criticism of psychiatry:

“There is only one agenda item in modern American psychiatry:  the relentless expansion of psychiatric turf and drug sales.  They’ve promoted categorical diagnoses and chemical imbalances strenuously for the past five decades.  Now that these spurious notions are on the point of expiration, psychiatry is developing dimensional diagnoses and neurocircuitry malfunctions as the rallying points of the ‘new and improved’ psychiatry.

But the bottom line is always the same:  turf and money.  Something is truly rotten in the state of psychiatry.”

The article precipitated a fairly lengthy debate in the comments section.  The discussion was wide ranging, and some of the issues addressed were fundamental to the entire psychiatric debate, in particular:  whether or not psychiatry is based on valid science.

My own position is that the foundations of psychiatry are spurious, and the purpose of this post is to set out my position on this matter.

PSYCHIATRY’S USE OF THE TERM “ILLNESS”

Psychiatry’s most fundamental tenet is that virtually all significant problems of thinking, feeling, and/or behaving are illnesses that need to be studied and treated from a medical perspective.  What’s not usually acknowledged, however, is that this is an arbitrary assumption.

In common speech and within the medical profession, the word “illness” indicates the presence of organic pathology: i.e. damage or malfunction in an organ.  Historically, mental illnesses came into being, not because some scientist or group of scientists had recognized and established that problems of thinking, feeling, and/or behaving are caused by an organic malfunction, but rather because the APA had simply decided to extend the concept of illness to embrace these kinds of problems.  For the record, some problems of thinking, feeling, and/or behaving are known to be caused by organic pathology, and I exclude those from the present discussion.

It is not superficially obvious that other problems of thinking, feeling, and/or behaving are actually illnesses, and there is a strong burden of proof on those who adopt this position.  Psychiatry, however, has never proved this assertion, but nevertheless continues to expand its diagnostic net in the same way that it started – by fiat.  A particular pattern of thinking, feeling and/or behaving becomes a mental illness/disorder because the APA says so!

Obviously I can’t dictate to psychiatrists how they should and should not use words.  If they choose to call problems of this sort illnesses, then that’s their business.  But they should also acknowledge that they are using the word illness in a distorted and misleading sense of the term.

They are also deviating from the ordinary standards and procedures of medical science.  In the 1930′s, a German pathologist named Friederich Wegener discovered a “new” disease, which is now called Wegener’s Granulomatosis.  He discovered this disease the old-fashioned way – by years of diligent post-mortem examinations and hundreds (thousands?) of microscope hours.  The history of medical progress is the history of these kinds of discoveries.

By contrast, psychiatry produces their “diagnoses,” (e.g. ADHD, disruptive mood dysregulation disorder, conduct disorder, etc., etc.), simply by voting.  They cling to the unacknowledged extended use of the term illness in these kinds of deliberations and decisions, whilst maintaining the pretense in their practices and promotional literature that the word is being used in its classical sense of organic pathology.

The reason that several psychoactive drugs have become blockbusters in recent years is that psychiatry has the advantage, unique in the medical field, that it can invent illnesses, and relax the criteria for these illnesses, more or less at will.  Psychiatry, unlike other medical specialties, has no natural limits to its growth potential.  They can continue to expand the diagnostic net until everybody in the world has a diagnosis.  But it doesn’t even have to stop there.  They can go for everybody having two, three, four, etc., diagnoses.  If organized psychiatry votes an illness into being, there is no reality that can act as a brake or a check on this activity.

PSYCHIATRY AND SCIENCE

Despite this confusion in terminology, psychiatry routinely contends that its diagnoses are based on science.  In the Introduction to DSM-IV, the APA wrote:

“More than any other nomenclature of mental disorders, DSM-IV is grounded in empirical evidence.” (p xvi)

And, of course, an enormous number of studies had been done.  But, to the best of my knowledge, there wasn’t a single study on any “diagnosis” that addressed the fundamental question:  is there any logical reason why this particular problem of thinking, feeling, and/or behaving should be conceptualized as an illness?  This, in every case, was simply assumed, despite the fact that there are better, more productive, more parsimonious, and more logically sound ways to conceptualize these problems.

As a companion to DSM-IV, the APA published a five-volume sourcebook of references.  There were prevalence studies, correlation studies, data re-analyses, field trials, etc… All of which was wonderful.  But on the fundamental question:  is there any rational reason for conceptualizing these conditions as illnesses? –  there was nothing.  Which was not surprising, because there had been nothing along those lines in the earlier manuals.

THE CHANGE FROM DSM-I TO DSM-II

And speaking of the earlier manuals, it needs to be noted that a major shift in underlying theory occurred between DSM-I and DSM-II.  In DSM-I, most of the diagnostic terms contained the word “reaction” (e.g. schizophrenic reaction), the implication being that the problem in question was to be conceptualized as a reaction to something.  In DSM-II, the word reaction was dropped.  In the Foreword to DSM-II the drafting committee stated that the purpose of this change was to avoid terms that implied any particular causal theory.  This notion was repeated in the Introduction to DSM-III-R:

“The use of the term reaction throughout the classification [in DSM-I] reflected the influence of Adolf Meyer’s psychobiologic view that mental disorders represented reactions of the personality to psychological, social, and biological factors.”  (Adolf Meyer was an eminent Swiss-American psychiatrist, 1866-1950)

And

“The DSM-II classification did not use the term reaction, and except for the use of the term neuroses, used the diagnostic terms that, by and large, did not imply a particular theoretical framework for understanding the nonorganic mental disorders.” (p xviii)

All of this sounds fairly reasonable, but ignores the fact that the omission of the term “reaction” inevitably conveys the impression that the categories listed are to be conceptualized as primary illness entities.  Despite their proffered justification for the claim, it is more plausible that the term was dropped in a deliberate attempt to oust Adolf Meyer’s notion of mental disorders as reactions to biopsychosocial stressors, especially his reformulation of schizophrenia as a cluster of maladaptive habits acquired in response to such stressors.  It is also plausible that it was an attempt to return psychiatry to a Kraepelinian nosology of biologically-specifiable illnesses.  In any event, that is exactly what has happened.

PSYCHIATRY’S “NOSOLOGY”

Many eminent psychiatrists today refer to the DSM as a psychiatric nosology.  These include:

The word nosology (from the Greek word nosos, meaning disease) means classification of illnesses, and by using this term in this context, psychiatrists are implying, without valid reason, that all significant problems of thinking, feeling, and/or behaving are illnesses, even though there is no evidence that this is a valid or helpful stance.  In fact, as we’ve seen above, an alternative perspective (Adolf Meyer’s “reactions”) actually constituted psychiatric orthodoxy from 1952 to 1968.  What is also clear and noteworthy in this matter is that Adolf Meyer’s theoretical/explanatory concepts were not abandoned on the grounds that they had been scientifically discredited or disproven.  They were abandoned as part of an arbitrary decision by the DSM-II committee  to medicalize problems of thinking, feeling, and/or behaving.

DSM-II’s decision to drop the word “reaction” was not, as claimed, a move to an atheoretical classification.  Rather, it replaced a genuinely biopsychosocial causal framework with one that was purely biological:  i.e. that all problems of thinking, feeling, and/or behaving are by definition primary disease entities.  Under the present DSM system, psychiatry doesn’t have to prove that a problem is an illness, because that assertion is built into their definitions.  If the DSM is a nosology, then every item listed must be an illness.  This is not science.  It is intellectual chicanery.

Having demonstrated that they could do this without much opposition in DSM-II, the APA solidified the arrangement in DSM-III, and expanded it to the point of travesty in DSM-IV and 5.  In fact, in DSM-5, the disease notion is injected even more explicitly and more clearly than in the earlier manuals.  In the Introduction chapter, following a discussion on the value of dimensional assessment, the APA states:

“These findings mean that DSM, like other medical disease-classifications, should accommodate ways to introduce dimensional approaches…” (p 5) [emphasis added]

EXPLANATORY VALUE OF PSYCHIATRIC DIAGNOSES

The notion that all problems of thinking, feeling, and/or behaving are illnesses has no explanatory value.  Consider the following conversation.

Client’s daughter:  “Why is my mother so depressed?”
Psychiatrist:  “Because she has an illness called major depression.”
Client’s daughter:  “How do you know she has this illness?
Psychiatrist:  “Because she is so depressed.”

The only evidence for the illness is the very behavior it purports to explain.  Unlike diagnoses in real medicine, there is no actual illness behind the DSM symptom lists to provide genuine explanatory value.  Those of us on this side of the debate have been pointing out this kind of circular reasoning for decades, but I have never seen or heard a convincing response from psychiatry.  Instead, they continue to promote their “diagnoses” to their clients, the media, and the general public as if they had explanatory value – when in fact they have none.

Psychiatry sometimes counters this particular criticism by denying that they ever promoted mental illnesses as causes or explanations of the symptoms.  But in fact, causative language permeates DSM-III, IV, and 5.  In almost every section of DSM-5, one can find exclusion clauses like:  “The disturbance is not better explained by another mental disorder,” the clear implication being that mental disorders are being presented as explanations of the problems listed in the criteria sets.  Additionally, the notion of a disorder/illness as the cause of its symptoms is standard in general medicine.  For instance, the illness pneumonia causes the symptoms of coughing, weakness, etc.,.  By using this kind of language in DSM, the APA is promoting the notion that their putative illnesses are indeed the causes of the symptoms.  For instance, the behavior of running around the classroom and failing to pay attention to the teacher is routinely presented by psychiatry as being caused by the “illness” ADHD, and this is precisely how the notion of “mental illness” is perceived by clients, the media, and the general public.  If it is not psychiatry’s intention to create this impression, then they need to make a concerted effort to correct the misunderstanding.  I am not aware of any moves in this direction by the APA or by psychiatric opinion leaders.

THE IMPORTANCE OF VALID THEORIES

Organized psychiatry tends to dismiss this entire issue of the ontological status of the “mental illnesses” as academic or philosophical, and as having no real bearing on practice.  But imagine how different psychiatry would be today if it had retained Adolf Meyer’s formulations.  Research would probably not have been hijacked by pharma, and would be focused on social and environmental factors rather than on drug responses.  Psychiatrists would take detailed histories in an attempt to understand their clients, rather than gathering just enough information to clinch the “diagnosis.”  There would be no fifteen-minute med checks, and social skills training would be the dominant treatment modality.

Causal theories are not ivory tower abstractions.  In any systematic human activity, they are the pillars that support and drive practice.  And when they are spurious, as in the case of psychiatry, practices and procedures inevitably drift into error.  The legitimacy of a profession depends on the validity and adequacy of its underlying causal theories.  Indeed, the theories are the formal expression of the knowledge accumulated by the science at a given point in time.  This applies particularly to those concepts that are very basic and fundamental. A shipping industry, for instance, that was working on the assumption that the Earth is flat, other things being equal, would probably not be noted for excellence of service.  Similarly, a geo-centered astronomy would be a shaky foundation for the development of space travel.  Human endeavors that are based on valid theories are more likely to yield success than those based on invalid theories.

To guard against misunderstanding, I’m not saying that good theories are sufficient.  One also needs techniques, tools, skills, etc…  But working without valid theories, or worse, working with invalid theories, inevitably leads practitioners astray.  Which is exactly what has happened in the case of psychiatry.  By assuming that all significant problems of thinking, feeling, and/or behaving are illnesses, they have, very naturally, been drawn into seeing these problems as entities that they (the physicians) have to fix by means of medical-type techniques, and seeing the owners of the problems as “patients” – i.e. people who have to be fixed.  The illness theory also, because it conveys the false impression that the matter has been explained, has a dampening effect on practitioners’ curiosity as to genuine explanations.

Modern psychiatry has been plugging away at its so-called nosology for more than a hundred years, and the APA, in their successive revisions of the DSM, assure us that the classifications are scientific.  Thought leaders and individual psychiatrists, with few exceptions, assure us that the “illnesses” listed in the manuals are scientifically established, ontologically valid entities that provide the framework for understanding and ameliorating problems of thinking, feeling, and/or behaving.  But seldom is it acknowledged that this stance is nothing more than an assumption, the purpose of which was to establish psychiatric turf in a non-medical field.

“PSYCHIATRY IS VALID BECAUSE ITS TREATMENTS WORK”

It is sometimes argued that psychiatry derives validity and legitimacy from the fact that its treatments (i.e. drugs) work.  In rebuttal, many writers on this side of the debate have pointed out that small quantities of alcohol help a person overcome shyness, but that nobody would conclude from this either that shyness is an illness, or that alcohol is a medicine.  Drugs, whether they’re of the street, liquor store, or pharmaceutical variety, alter people’s thoughts, feelings, and/or behaviors.  In some cases, the users of these products and their families express themselves pleased with the alteration.

I have known a good many marijuana users who maintained, with, I think, good credibility, that pot helped them control their anger – made them mellow.  Over the years I have worked with several women who always kept a twelve-pack of beer in the refrigerator in case their husbands became angry or upset.  In these cases, the pot and the alcohol “worked” in the sense that they forestalled the anger and rage.  And psychopharmaceutical products sometimes “work” in this same pragmatic use of the term.  But there is no evidence that any psychopharmaceutical product fixes or alleviates any pathological process.  Indeed, what seems to be the case is that these drugs “work” by producing abnormal neurological states.  From a pragmatic point of view the abnormal state may seem better to the client, and/or his family, and/or the authorities.  But this does not establish that the original condition was an illness or that the drug is a medicine.  

CLARIFICATION

Obviously the problems listed in the DSM are real.  That’s not the issue.  What’s being challenged here is the contention that the clusters of problems set out in the manual can be validly conceptualized as symptoms of medical disease entities.  It is my position that such a conceptualization does violence to the subject matter, and has led psychiatry seriously astray.

For instance, at the present time there is a great deal of concern in professional and official circles about the rapidly increasing use of neuroleptic drugs to “treat” childhood temper tantrums and aggression.  What’s not usually acknowledged, however, is that these practices are a direct consequence of the spurious notion that all problems of thinking, feeling, and/or behaving are illnesses that warrant medical intervention.  In the “old days” parents who brought a child to a physician for temper tantrums or aggression would have been told that this, in the absence of some very obvious and compelling indications to the contrary, was not a medical problem.  Today it is a medical problem, not because there has been some breakthrough medical discovery, but simply because the APA says so, and because psychiatrists prescribe neurotoxic drugs that act as chemical strait-jackets and dampen the problem behavior.  Contrary to the congratulatory self-talk of Dr. Lieberman and his like-minded “opinion leaders,” this is not medical progress.

A SECOND CLARIFICATION

Again, to guard against misunderstanding, let me state very clearly that if psychiatry could produce convincing evidence that the myriad problems of thinking, feeling, and/or behaving listed in the DSM are in fact caused by specific illnesses/diseases of the brain or other organs, then my objections are moot.  And if that day comes, as I’ve said many times, I will fold my tent, apologize to all concerned, and end my days writing poetry, growing vegetables, and playing with my grandchildren.  In the meantime, I will continue to state as vigorously and as frequently as I can, that psychiatry’s most fundamental tenet is nothing more than a self-serving assumption which despite decades of highly motivated research, numerous premature, yet confidently asserted, eurekas, and virtually endless promises that the definitive evidence is just around the proverbial corner, remains nothing more than a false and destructive assumption.

 

Last updated by at .

  • cannotsay

    I am cannotsay and I endorse every word of this message :-). I also echo the point that if one day psychiatry produces evidence to back the illness model for any one of its labels, by the standards required in real science, I will personally apologize for doubting them.

  • Francesca Allan

    This is a very good article, Phil, which neatly summarizes the
    fundamental problem that psychiatrists need to acknowledge. I see a very
    good psychiatrist and I say that because he is respectful and genuinely
    wants me to succeed. Even so, he is steeped in the psychiatric group
    think and cannot *conceive* of mental illness as anything except
    neurological.

    I have tried to point out to him innumerable times
    the folly of his assumptions. To his credit, he doesn’t automatically
    label this “lack of insight” (or at least he doesn’t say so to me) but
    he does call it misguided and encouraged me to attain my medical records
    so that I could see the light. Well, I have now reviewed my medical
    records and they only confirm what I have been saying all along.
    Problems in living –> psychiatric diagnosis –> drug treatment –>
    bad
    reaction to drug treatment –> hospitalization –> further diagnosis
    –>
    further drugs –> further bad reaction –> [on and on for over a
    decade] –> rejection of psychiatric diagnosis –> rejection of
    psychiatric treatment –> disappearance of mental “illness.”

    It
    might also be worth noting another reason for skepticism of the status
    quo is that it requires psychiatry to account for the explosion of
    psychiatric diagnosis in our culture. Could anyone really with a
    straight face assert that up to 25% of the population now suffers from
    neurological disease?

  • Karen Butler

    This is excellent. I have been reading you for some time, and hope, as much as I love poetry and gardening, and long for grandchildren to dandle, that you will stick to your clear and articulate campaign to reform mental health practice. You help me understand these issues better than any other writer. You are serving our community well.

    So I come out of lurking on your site to suggest two improvements to this article. Neuroleptics aren’t just chemical straightjackets, they are chemical lobotomies. They do real damage to brains. By using this term instead, perhaps you can capitalize on the gruesome imagery of the WSJ articles that recently were published, describing soldiers forcibly lobotomized by lionized quacks upon their return from WW2. http://projects.wsj.com/lobotomyfiles/?ch=two

    Also, perhaps you can use the Retts disorder deletion from the DSM-5 as LaCasse has done, as an example of the unsupported nature of diagnoses. To me, it is powerful evidence of the fictive nature of psychiatry’s illnesses. He writes:
    “Thus, the DSM-5 only
    includes mental disorders for which we lack information regard-
    ing etiology, which may or may not turn out to be diseases in the
    long run; but if their etiology is discovered, confirming that they
    are diseases, apparently they cease to be mental disorders—
    although the DSM also claims that mental disorders are diseases.
    This confusion and discordance obviously casts doubt on the
    idea that all DSM-5 disorders represent medical diseases.”

  • cannotsay

    Phil,

    And something else I want to add that I didn’t have time for earlier. Your greatest gift is, in my opinion, your ability to write in clear terms what the issues are all about. I hope that you take this as a compliment, but you remind me of the way Thomas Szasz criticized psychiatry. He did it for 50 years, putting his career in the line and only now, with the DSM-5 folly is his work being given the value it deserves. Too bad he didn’t live one extra year to see what happened in 2013.

    Anyhow, what I wanted to say is that in addition of being clear, it is obvious that you know the history of psychiatry pretty well. For instance, I had never heard of Adolf Meyer before and the impact of his model on previous editions of the DSM.

    You also say something very important, namely, that the ontological discussion matters. When Robert Whitaker published “Anatomy of an Epidemic” his overall point was precisely that: how is it possible that in those contexts in which psychiatric diagnoses and drugging are most widely available (be it in the US today compared to past years, be it comparing the US/developed countries with developing countries), the outcomes are worse, be it in the number of suicides or things like the people who become disabled (or who live 25 less than those who do not seek treatment).

    Tom Insel, who obviously has very different motivations than mine, brought this point home in this talk he gave last year shortly before his explosive admission https://www.youtube.com/watch?v=PeZ-U0pj9LI .

    If the objective of this psychiatric travesty of inventing illnesses out of thin air is to have less suffering, it seems that the outcomes are just the opposite when their illness conceptualization is adopted.

  • cannotsay

    Waiting to hear what our friend Bernard Carroll will have to say about this post. I want a point by point rebuttal, not just a generic dismissal that we are nut jobs who don’t know what we are talking about :D.

  • Phil_Hickey

    Francesca,

    I couldn’t, especially when they also claim that the life-time prevalence is 50%! The agenda is to promote the notion that every problem is an illness, and for every illness there’s a pill.

  • Phil_Hickey

    Karen,

    Thanks for coming in, and for your encouraging words. Chemical lobotomy is a good term with a lot of validity and descriptive impact. Thanks for the WW2 link.

    The handling of the Rett’s disorder issue is a perfect illustration of the “tangled web” in which psychiatry finds itself after 100 years of systematic deception.

    Again, thanks for the encouragement. Best wishes.

  • Phil_Hickey

    cannotsay,

    Thanks for the complimentary words. I also find it sad that Dr. Szasz didn’t live to see the groundswell movement that exists today. I have heard that he was pessimistic with regards to any prospect of a serious challenge to psychiatric hegemony.

    On the ontological issues, I agree with you. One of my favorite phrases, which I had included in this post but then edited out, is: There’s nothing as practical as a valid theory.

    Again, thanks for your support.

  • cannotsay

    If only Szasz had managed to live an extra year, he would have been astonished that Tom Insel echoed talking points from his “Myth of Mental Illness” paper or that Kupfer went on to agree to that as well or that both Insel and the APA finally conceded that neuroleptics are overused and that what they call “schizophrenia” is not really something real. Not to mention the fact that 2013 produced so many books bashing DSM-5 that some speak that a whole industry has been created around the bashing of DSM-5.

    I truly think that when psychiatry finally goes the way of eugenics, the legacy of Thomas Szasz will be seen very differently from the scorn he received when he was alive. He was one of the intellectual giants of the XX-th century in the field of so called “mental health”, whatever that means.

    Hope you saw that Bernard Carroll finally went personal against you and me. Sadly, it has always been my experience that psychiatrists all go ad-hominem when their nonsense is debunked as clearly as you did today.

  • Bernard Carroll

    You are the one who went ad hominem and in bad faith when you insinuated I am a liar. Have you no shame?

  • cannotsay

    I am sorry, but I DID NOT call you a liar. I said that psychiatrists regularly lie to exaggerate their case. I stand by that statement. This an example of what can happen when parents try to game the system to have their children drugged against their will http://www.cnn.com/2014/01/10/us/north-carolina-teen-killed/index.html?hpt=hp_t1 . NAMI teaches people to lie to the police (I know because my ex wife was told such things when she attended their meetings) as a way to bring their obnoxious/eccentric family members into compliance with drugging. This is the advise psychiatrists propagate among NAMI parents.

    I gave you that the situation you describe could have happened for the sake of the discussion and I gave you my solution. This is one area of disagreement between Francesca and myself, for instance. I do not believe that coercive psychiatry is warranted under any circumstances. She accepts it in some “narrow circumstances”. I am like Thomas Szasz, a complete abolitionist. Somethings are truly black and white in life, and the issue of psychiatric coercion, is, from my point of view, one of them.

    If society wants to criminalize certain behaviors, as it did officially with homosexuality until 2003, that’s one thing. But to have a group of self appointed mind guardians with their own parallel system of coercion outside the criminal justice system is simply preposterous. The criminal justice system, by design, is all about behavioral control. As such, there are many mechanisms in place to prevent abuse (and even with those, abuses and miscarriages of justice do happen). Psychiatric coercion is a travesty on every level.

  • Bernard Carroll

    Well, try this: “…psychiatrists regularly
    lie, and thus we need to be cautious before we take Bernard’s account at face
    value.” That’s a blatant, bad faith insinuation that I am a liar. Now
    you want to walk it back? You have forfeited your credibility, cannotsay. Good
    riddance.

  • cannotsay

    Still didn’t call you a liar. If what you are trying to do is to prove my point that psychiatrists are unable to make a good intellectual case for psychiatry and that they prefer to waste time with red herrings, you are doing a great job!

  • Phil_Hickey

    Guest,

    I had hoped that Dr. Carroll would stay in the debate, but that’s how it goes.

  • ssenerch

    Yes, lots of luck to them! I hope no one’s holding their breath.

  • Guest

    Certainly, I am not :D. Ontologically speaking, psychiatry is a fraud. But you have to give them the benefit of the doubt!

  • cannotsay

    OK Bernard, what are you up to? Are you going to come back to defend your profession or what?

    I don’t see what’s the big deal. Not even Torrey, the most famous of psychiatric abusers, denies that psychiatrists regularly lie or exaggerate http://psychrights.org/force_of_law.htm#Corruption ,

    “It would probably be difficult to find any American Psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person’s behavior to obtain a judicial order for commitment.”

    This issue of psychiatrists lying is, in addition, very pertinent to the subject of this thread. You can pretend that the acceleration of gravity is not 9.8 m/s^2, say, 9 m/s^2, and there would be severe consequences: planes would crash. You can similarly pretend that a cholesterol level isn’t 300. There would be severe consequences as well. Finally you can be an AIDS denialist, there are severe consequences associated with that too: http://www.aidstruth.org/denialism/dead_denialists . And yet, psychiatry can lie about any of their invented diseases or symptoms. There is no objective empirical test to refute it. It’s all the “expert’s opinion”.

    So you bailing out of the debate at this point does nothing but confirming that psychiatry is fundamentally a dishonest endeavor.

  • cannotsay

    Phil (this is cannotsay, I regularly remove my association to my posts
    to increase my anonymity :D; “Guest” is disqus’ way of marking said
    posts),

    I never expected much from Dr Carroll (I call him Bernard
    because I do not like titles in general). All psychiatrists I have
    seriously engaged in similar debates, end the debate in similar terms.
    They find some kind of tangential red herring to accuse me of things
    that I am not. In case of Bernard, it was my statement that
    psychiatrists lie. That was an unusual -and original- way out, I must
    admit. In past debates my psychiatrist opponent usually inevitably ended
    the debate by accusing me of being “heartless” with respect the so
    called “seriously mentally ill”.

    Now, take the case that Bernard
    brought. Does anybody seriously think that the individual in question is
    better served by being involuntarily committed, forcibly drugged and,
    more importantly, being labelled as “insane” for life than by having the
    situation resolved by the criminal justice system? If the guy did what
    Bernard said, and the guy was a first time offender, the most likely
    result would have been no jail time, with mandatory assistance to some
    diversion/probation program like community service. Said contact with
    the criminal justice system is far less damaging than the life long
    stigmatization that comes with involuntary commitment.

  • Guest

    I sent the email below to [email protected] . Not sure if we will be lucky returning Bernard to the debate, but I had to give it a try!

    ======================================

    Bernard,

    Since I am not sure you got my reply to your last tirade, I decided to send you an email. I found your email address here http://www.blackdoginstitute.org.au/docs/bernardcarrollbio.pdf .

    Let’s
    be clear that I didn’t accuse you personally of lying. I said, and I
    stand by that, that psychiatrists regularly lie in court to get their
    way. You can read about that more here http://psychrights.org/force_of_law.htm#Corruption
    . The admission of exaggeration of danger to get commitment orders
    comes, among others, from Torrey who is the master liar. I could show
    you the slandering that was used to commit me as another example as well
    . Threats were made that if “left untreated” I was destined to become
    “homeless” in less than one year. Several years later, most of which I
    have been free of psychiatric oppression, my standard of living is
    higher than it has ever been. And, if things continue its normal course,
    I will only get wealthier over time. Wealth, by the way, that I will
    invest in destroying psychiatry, but that’s a different matter :D.

    I remind you of my story here http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770
    . The notion that a psychiatrist who knows nothing about you can make
    “deterministic predictions” about what you, informed by your free will,
    will do or will not do is preposterous. Yet this is the sad state of
    affairs. Psychiatrists regularly lying and exaggerating to get their
    way.

    With respect to case that you brought. Do you seriously
    think that the individual in question was better served by being
    involuntarily committed, forcibly drugged and, more importantly, being
    labelled as “insane” for life than by having the situation being
    resolved by the criminal justice system? If the guy did what you said,
    and the guy was a first time offender, the most likely result would have
    been no jail time, with mandatory assistance to some
    diversion/probation program like community service. Said contact with
    the criminal justice system is far less damaging than the life long
    stigmatization that comes with involuntary commitment. If you are
    honestly convinced that the coercive psychiatric intervention was
    warranted or preferable to a diversion program in the criminal system,
    you are, with all due respect, a nut job, representative of the vicious
    thinking that affects the average psychiatrist.

    Take my own
    case. I might have ended up divorced and estranged from my parents
    anyway, but what forced psychiatry has brought me in addition is
    humiliation and stigma for the rest of my life. It also altered the
    course of my life preventing me from working in capacities that would
    expose me to high scrutiny, like jobs that require security clearances
    (which are among the most lucrative in my line of work) or managerial
    jobs that involve heavy public scrutiny.

    Bailing out of the
    debate using a red herring is, unfortunately, something that has
    happened to me a lot since I started to engage with psychiatrists. Your
    red herring was original, I admit, because in the majority of cases,
    accusations that I am heartless for not accepting that coercive
    psychiatric treatment is warranted in cases like the one that you
    brought are usually what causes my psychiatrist opponent to bail out.

    Note
    though that whether you felt offended that I accused you of lying or
    whether I am truly heartless, neither has any bearing on the matter that
    psychiatry is fundamentally an unscientific, intellectually dishonest
    endeavor that results in more lives being ruined in those contexts where
    its prescriptions are widely adopted, as Bob Whitaker documented in
    Anatomy of an Epidemic or Tom Insel explained in this talk he delivered
    shortly before he made his explosive comments last year https://www.youtube.com/watch?v=PeZ-U0pj9LI .

    I hope you reconsider and have the guts to come back and defend your stuff.

  • Francesca Allan

    I know that when I was charged with assault (threw a cup of coffee at a very bitchy, condescending [or am I repeating myself] psych nurse), I was offered NCRMD (not criminally responsible) but I declined and decided to roll the dice with the Court. It was a good decision: 18 months probation rather than an indefinite stay on a psych ward. I know it’s a stale old joke but it’s still accurate: You’d have to be crazy to plead insanity.

  • cannotsay

    Indeed. People who say that “innocent for reason of insanity” is a better option than a diversion program they don’t really know what they are talking about. The social stigma associated to innocent by reason of insanity is several orders of magnitude worse than a probation term like the one you describe.

    A few months a back I listened to this talk by Jon Ronson, a writer who spoke about the experience of a guy he identifies as “Tony” who accepted an insanity defense instead of jail time for what would have been a way shorter sentence had he been convicted of the original crime https://www.youtube.com/watch?v=ZrQFsNom5eo (starts around 5:20). To keep the story short, “Tony” was arrested for involuntary manslaughter. If he had pleaded guilty for that, he would have spent 5-7 year in jail per UK’s guidelines. Instead, he “faked” madness to escape his conviction. He ended up spending 12 years involuntarily committed and he was only freed after a lengthy appeals process in which he got help from CCHR UK.

    In my case, I had committed no crimes whatsoever nor was a danger to anybody (not even myself). Some psychiatrist said: you have a severe case of OCD and you need to be forcibly drugged to treat it. This is why I am so up in arms against the Murphy bill. It would make this type of abuse legal, at least while the law is challenged since it is in all likelihood unconstitutional, in the US states that adopt the civil commitment standard pushed forward by the bill.

  • Phil_Hickey

    Francesca,

    Certainly a person has more rights and safeguards in the criminal justice system than in a mental health hearing.

  • Francesca Allan

    The only mystery is why the public seems to feel that the insanity defence is some kind of “deal”? Perhaps they’re not aware of the reality of psych wards and forced treatment?

  • cannotsay

    Most likely, ignorance. When I was civilly committed I wasn’t aware of the negative consequences of having been assigned a psychiatric label. That’s why upon my return to the US I continued the charade, in order to save my marriage.

    That was a huge mistake because now a hospital in the US has 1 year of me being so called “treated”, psychotherapy notes included. After I decided to cut ties with psychiatry, I ordered a copy of my complete record to prepare for the worst case that somebody releases that information as a result of a mistake. That is one of the major concerns that I have. And no, I am not being overly paranoid. Now, US law forces providers to report breaches involving 500 medical records or more, and as you can see there are quite a few of those breaches that have happened since providers are mandated to report them: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html . Note that that’s only the breaches that have happened since 2010 and those involving 500 or more people at the time. We know nothing of breaches that involve less than 500 people or that happened prior to 2010.

    Had I know about the consequences of a psychiatric label, upon my return to the US, I would have filed for divorce from my wife and I would have been spared of having any US entity knowing about the thing that happened in Europe.

    Now I have to live with the added tension that my medical information might be released “by accident”. To add more complication to the matter, in the US providers are moving increasingly to facilitate the sharing of medical information online. Although I have since quitted the provider that I used for psychiatric services altogether and have filed paperwork with them that I explicitly deny them the right to share my information with anybody other than myself, the HIPAA rules allow providers to use your medical data without your authorization for what is is called generically as “research”. In practice, what this means is that they can datamine your medical records for any purpose they want without your permission. In fact, the majority of the breaches reported above are the result of somebody doing some datamining and not following appropriate privacy procedures.

  • aaaaaaaaaaaaaaaaaaaaaa

    The exact cause of breast cancer (and many other diseases) isn’t know, ego it isn’t real. This is the exact kind of logic Dr. Hickey employs. He argues just like an AIDS denialist.

    There is a lot of neuroscience and genetics that correspond to mental disorders. It’s just a matter of time before the gap closes between neuroscience and psychiatry.

  • aaaaaaaaaaaaaaaaaaaaaa

    known*
    ergo*

  • cannotsay

    Actually you are getting confused here. We do know how to biologically diagnose breast cancer. We also now the type of tissue/organic malfunction that is called cancer. A diagnosis of cancer requires a biopsy. It cannot make out of subjective impressions alone.

    In your second paragraph you say that there is neuroscience and genetics that have been indisputably mapped to so called “mental disorders”. I am not aware of any such finding.

    All the studies I am aware of along those lines are of the type that confuse correlation with causation which in addition are not reproducible.

    The innuendo about AIDS denialism says more about your own limitations when it comes to arguing than ours. You clearly don’t argue very effectively. Your only expertise is to repeat mantras as many times as necessary so to shut up us. Get this, psychiatry already ruined our lives. A “mantra repeating” guy is the least of our problems. We can counter your nonsense all day long if it comes to that.

  • Skorian

    I think the key to lambasting psychiatry is to look at what they are working to understand chemistry wise. What do they actually know about how biology influences behavior? It seems to me they know basically nothing. Take estrogen and testosterone as an example, how do these compounds influence behavior? One would think psychiatrists would be interested in how different blood levels of these compounds influence behavior. It would be my guess that any psychiatrists asked this question would not have a real answer. Nor can they actually answer most reasonable questions. A sane person would think these two compounds would be at the top of their list, when instead they most assuredly are utterly ignored right along with 99.99999999% of the rest of the human body.

    The simple fact of the matter is that psychiatry has no interest in really understanding or fixing anything real. How could they when they practice in the way that they do? As a profession they don’t generally even recognize medial illnesses that affect behavior, unless it is virtually forced upon them. The way these people practice is more akin to obsessive insanity, then it is a real medical practice, to the extent that they have more in common with street dealers, then doctors.

  • Skorian

    The fact that psychiatry attempts to balance brain chemistry via questionnaires is a dead giveaway that it’s practitioners are utterly incompetent. No attempt seems to be made to really look at chemistry in a useful or real way.

    Many psychiatrists compare mental illnesses to diabetes, yet no diabetic would attempt to balance their blood sugar via a questionnaire. I would assume that diabetes is a simpler and more straightforward illness then any mental illness, yet attempts to treat mental illnesses, treat them as if they are extremely simple in nature. This alone should result in people questioning psychiatry’s validity.

    To treat chemistry in the brain as if it has no relation to anything that can be tested is absolutely ridiculous. No attempt is made to work with chemistry.

    The solution to all of this is to give voice to all those whom have been injured by psychiatry. The real stigma that people should be concerned about is the stigma which keeps silent those whom have become psychiatry’s victims.

  • waltinseattle

    just discovered this place

    so, since these many , erroniously diagnosed as mentally ill, have no mental illness, nor brain disease, simce they are are not ill in your sense, could you please call off the rabid hounds who object to our calling them the “Worried Well”? what else to say that pits them out of the class “brain disease sufferers”? this leaves for latet wherher that bds set is empty or not. once these not oll and their behavioral, psychological issues are out of psychiatry and out of its treatment facilities, the better for all. So please tell them to quit whining that we are underestimating their suffering! tell them to buck up, life’s not that rose cushoned bed they thought they were promised.
    go find a behavioral health funding separate from medivine. start a u.s. dept. of psychologic wellness, whatever. and leave us to deal with those who dont get understanding or treatment, who get that so kind jail and prison time and die from blunt trauma force, from 2 cannisters of pepper spray at face to face distance. tell them they are lucky.

    i love how the past is projected to forever more. you decry the psychiatric science, but vontimue the older (western) religious theory of duality of mind And body, as if se mind occured aside from braingut. well, religion, dark ages, daemonology, the past is still recent here. you’re all still flat earthers in my opinion. my basis of cparison is traditional chinede meficine which i find more agile im cutting the bull of theory out of the pragmatics of practice. theory comes last. you have your theory turg, psy porponents have theirs. does not suppprt either being right.

  • Phil_Hickey

    Skorian,

    Yes. One doesn’t actually need a lot of technical know-how to be a drug-dealer. In fact, Daniel Carlat, MD, in his book Unhinged expressed the belief that all the knowledge and expertise that psychiatrists use in their day-to-day practice could be acquired by any intelligent graduate in two years of instruction. Even that may be an exaggeration.

  • Phil_Hickey

    Walt,

    Thanks for coming in. I don’t follow everything you say, but I guarantee you that you won’t find a single sentence in my writings that could even remotely be construed as dualistic.

    Best wishes.

  • waltinseattle

    thanks for greetings. hot under collar today. i will keep your reply in mind, and seek more to inform or reverse, as it might be. that said, and i too am guilty, writing requires some edits for brevity and those often have unnoted comprises of “my view, epistologically speaking”…that finally said, its a deep tradition of the west. and i have a big chip for the likes of decarte, much as his scratch pad design has helped us.

    p.s., another new fiscovety at nimh, and of course debate …RDoC, the matrix, criteria etc, most thoight provoking!

  • Francesca Allan

    If psychiatry were successful in its quest to reduce everything to biochemicals, the field would be transferred to real doctors, i.e. neurologists. The only work left for psychiatrists would be treating “lack of insight” of those who did not believe they were suffering from neurological disorders. Perhaps that would leave psychiatrists enough work to sustain the industry, I don’t know.

  • Francesca Allan

    I don’t think you even need a human being, never mind an educated one. You could fairly easily create a computer algorithm matching DSM criteria to drug prescriptions.

Previous post:

Next post: