Very well put, IMHO. I find a lot of sanity in Loren Mosher's statement that he used meds at times in his psychiatric work, but he never found them to produce the Lazarus-like cures they've been purported to. As someone against long-term use of psych meds, he was labeled anti-med, but that wasn't his position. People can't seem to stand ambiguity.

Very well said, IMHO
Keep on pushing the envelope, please!

Could you post some of those emails, Philip? Authors' names aren't necessary but it might be interesting to read what the pro camp has to say. I guess for people who have a lot invested in the biochemical model common sense and contrary evidence seem pretty threatening. Some drugs work for some people, it's true, and that's great. Myself, I'd like to see a little more humility from the profession. A shrink could say "Some people do well on this one. Do you want to try it?" rather than "This is what you need."

I did find the black-and-white, all-or-nothing thinking expressed by some of the people writing in response to that posting quite striking.

That kind of thinking, as you know, is deemed a "cognitive distortion" by the CBTers. It's the sort of "if you ain't with me, yer agin me" thinking that starts wars. It's served the human race so very well over time, eh?

Philip.

This is hard. Bare with me.

My parents sound like Mr. Wallace's that if I take my meds, I will be fine. If I take my meds it won't make me suicidal. If I took ECT I won't be suicidal. If I complain about any side effects other than nausea they don't want to hear it and neither do the doctors. (Unless in my case, i got a rash from Lamictal).

What I find funny is my friends and family don't seem to understand that one med might work for someone and not work for someone else. My folks and friends understand when I was on the phone last night to my mom and I was complaining about menstrual cramps. She said "Take 2 Tylenol" and I replied "Tylenol doesn't work for me with this, neither does Advil, Motrin, Midol, etc". She was fine with that.

But if i say- in 23 years I have been on 37 meds, and only one of them seems to have done any thing, she will tell me it's all in my head, and I need to stay on them for the rest of my natural life.

Sigh.

David Foster Wallace's death is tragic, especially what Gawker published today- a tie between the autopsy report about his hands being bound, and Wallace confiding to someone that if anyone was to mess up a suicide, it would be him.

People left behind by a suicide feel hurt and angry, and I am sure his fans feel that way. Cheated out of another 40 years of this man's brilliant writing they will never read, and will never be written. But honestly, to quote another great American novel, "To Kill A Mockingbird", you really need to put yourself in some one else's shoes. Scout did that when she stepped on Boo Radley's porch and saved her brother's life.

We all need to put ourselves in Mr. Wallace's shoes if you cannot, and maybe, someone else's life will be saved by his tragic and too soon death.

If I never hear a statement introduced by the following it will be too soon, "Now with the new anti-depressants (or atypical antipsychotics) .....", The subsequent efficacy represented suggests that medication alone can provide all the answers, address every need, and foster meaning and purpose.

It is not surprising that these representations are often made by folks who may not have taken a psychotropic on a long term basis or have a personal agenda, ex. medication compliance, market expansion. Here the message may only serve the messenger rather then those of us who are coping with the challenges which are part and parcel of dealing with mental illnesses.

Philip, You showed courage in publishing the David Foster Wallace piece. If someone finds these drugs helpful, and the drugs are legally prescribed, then they have a right to take them even though the drug defenders have it backwards. The information stating that these drugs work is anecdotal and usually advertising copywriting. The information stating the drugs do more harm than good is scientifically validated.

It's bizarre to see how people who are hooked on psych drugs and treatments think they work even though their lives deteriorate while undergoing their various purported psych treatments. That's their serious disease these folks will say, if it wasn't for the meds, they think, they'd be even worse.

It reminds me of Time Magazine in the 70's running a piece on cocaine and how it was harmless and non addictive and then finally realizing a few years later that, while not addictive in the same sense as opiates, cocaine is indeed addictive. I can't wait for the backlash against psych drugs to come. It's likely these drugs will do much more harm to society and individuals than coke ever did.

Fight them with logic and they go ad hominem. I have a friend who really believes that bipolar disorder can be diagnosed with an MRI and she of course lives off of SSDI not, she claims for the mental impairment, but for the kidney disease the meds cause. This person has a master's degree and still believes this crap. Her psychiatrist told her that her bipolar brain was structured differently from that of normal people and she believes him. I ask her for some study or proof of this and she says, "oh it's common knowledge."

The drugs will kill her before she's 50. Very sad, but being bipolar is an integral part of her identity. She thinks it explains everything about her and entitles her to special treatment, sort of like the folks here who cling desperately to their psych diagnoses. You can't fault them for believing what a doctor told them but each time such a person leaves even the most hostile, scientifically false pro psych post here, it means they are reading the sight, that a seed of doubt has at least been planted in their minds.

you do an awesome job Philip...

and Sophia,
what you said about people not being able to deal with ambiguity is so totally right on.

And because of it they want to shove everyone into a black and white world whether we perceive things that way or not...

I know I get people assuming a lot of crap about me based on what I say on my blog because I don't like drugs in general, but people don't care to look at the subtleties in my thinking...they want to categorize and label...kinda just like psychiatrists...huh, that's funny.

Mosher, at Soteria House, used drugs about 3% of the time generally very short term...this was with people who would otherwise been hospitalized and heavily drugged---but only 3% of them got drugged...yeah..that is sanity...and like you said he get's labeled anti-drug when he made no bones about using drugs occasionally...

people are afraid of anything that might make them change their world view even in the slightest...

You keep at it Philip...we need you...

Haha, good one Philip. It's tiring to hear the Scientology thing pulled out over and over again. It's like an amalgam between a red herring and straw man argument. It's basically propoganda. Who the hell is really a "Scientologist" -- whatever the hell that is? Does anyone know what they believe?

I think you were very fair in that post. And while you "cut throught the bullshit", you are always respectful.

I support you 100% Philip.

Take care.

I agree Philip (and Sophia). This is well said and you do a very fair job of presenting the issues. Anyone who says otherwise is kidding themselves and too deeply invested in the current paradigms probably to think critically (or even logically) about them.

I know you thought that was a point that didn't need to be clarified, Philip. But it really did.

Thank you.

Dear Philip:

There always are those out there that believe these drugs are a good thing, and maybe even take them and say they work as if they were spouting off some spiritual and scientific miracle. But the cold hard reality is I have both experienced and witnessed the unspeakable horror and suffering these treatments do and can bring into people’s lives { that’s called real life experience and undistorted observation}.
It is without much debate now as we start to count up the causalities and victims that psychotropic drugs are dangerous, damaging, most often ineffective, and should only be used in the most extreme short term situations with patients that have absolutely no other options available.
There are those that will argue against my point of view; maybe because they believe there are no other options for themselves, or just maybe because they are the rare ones where they gain benefits and have limited side effects from these under tested and over promoted poisons. Pharmaceutical companies like many other corporate entities today have lost their way. I’m a believer in capitalistic opportunities; but with great wealth and power comes great responsibility. It appears there is little doubt they and we as a people have lost our ethically barriers, morals bearings, and humane boundaries when it comes to the lengths some will go to for profit and power. It’s always the most weak and least able majority that suffers under the crimes and tyranny of these powers running out of control and amuck.
Some will also say we have now gained parity finally through legislation and are making real progress; but this isn’t really the truth in its entirety, because we are using a flawed system and plan which has no concrete science or basis from to draw the truth in all actuality. They can only make so called educated guesses to the cause of this cherished thing we can call many things, but throughout history and civilization it has been referred to as Madness. It could be bio-chemical, organic, genetic, environmental, learned or subconscious behavioral, event oriented, and a thousand other factors yet to be discovered or determined. I would say it’s more than likely a combination of all of the above. I am honestly more than suspect of all these pharmaceutical claims and drugs, the Doctors that prescribe them, the research, and psychiatry profession as a whole. They have proven to me nothing, while offering something that was not there to begin with. Some would say that is called a LIE!
Now we could make new laws that would limit the corruption and try to create a better system of management if we had the motivation to do so; but even then those laws would have to be enforced and we as a people would have to hold the perpetrators responsible for their actions. Is anyone out there holding their breath on that happening?
So we have our voice! Philip at least gives us a voice of reason and questions the powers at the reins of many of our lives. I would say he is probably a liberal at heart politically, but as the true professional he has shown to me time and time again; he is able to place his personal views to the side and report the news as it is { when he does make commentary, he states quite clearly that it’s commentary and his opinion}.
That’s the funny thing about the news, everyone is crying out for it; but when they actually hear it, they are applauded and wish to bury the messenger. We have all seen how the main stream media has gone from some tainted and commentary driven news, to out and out sensationalized tabloid journalism. That’s one of the reasons and why I’m not all that surprised Philip has trouble getting some real truth and stories out there in the print medium today.
I even read an article where many of our mighty news corporations are out sourcing the news we receive to foreign countries to save the all mighty dollar and reap more profit. I guess you are either blind or just maybe can see that we are caught in a societal pickle at this time in our history.
I’m sure, since the Huge pharmaceutical companies have unlimited resources to promote and peddle their drugs to us {advertizing budgets and promotion campaigns that go into the billions of dollars; you would have to wonder if these drugs and products were so damned good and effective, why would they have to spend all this money convincing Joe Public through unrealistic claims on TV and in magazine ads, as well as buying off the Doctor’s prescribing these poisons, and meddling in the research and clinical studies to make the outcome appear benign and weighed strongly in their favor} , they have probably even placed a few plants in this blog just to keep things unruly, and take always from the real message that something is very wrong, and nothing or very little is being done to change it.
I have taken these drugs, I have felt their damage, I have lived their damage, and I have seen the damage caused to real human beings in countless institutions and care facilities. And yet we struggle still to this day to get the message out that the model we are using is an utter failure; not unlike many that preceded it through history. I may not know much; but I do know you can’t fix a problem until you’re willing to admit there is a problem!
I believe it was a wise man that said, “Once I had realized I knew very little! It was only then when I could realize that learning, knowledge, and wisdom was an infinite endeavor to be pursued throughout many life times. I was just one very minuscule and insignificant piece of this massive puzzle of mankind in its uncounted and unseen mysteries”
Yours truly,
Stan

..."when we get to the day that this country isn't spending $40 billion or so a year on meds, I'll chill out. When this country gets off its game of medicating little boys for being little boys, then I'll relax. When we stop killing people diagnosed with schizophrenia with antipsychotics, I'll shut up. When my colleagues in the media start doing a better job, I'll walk into the sunset...."--Dawdy

Bravo Philip, Bravo.

I'm so tired of these "Scientologists" accusations that I stop discussing whenever it appears.
I consider it a complete lack of respect and I believe that these people don't deserve to be taken seriously. They don't want a discussion specially because it's getting harder and harder to claim that antidepressants even WORK.
Don't bother Philip!

Put your John Wayne spurs on, Phil. Saddle up.

"My own view is that that number is closer to 30 percent--and there is gobs of clinical evidence to back that assertion. STAR-D, STEP-BD, CATIE, CUTLASS and on and on."

Much other evidence to add, but this notable quote, regarding the high-profile SADHART study: [Joynt 2005 PMID: 15953805], "Unexpectedly, sertraline was not extremely effective for the treatment of depression in this population....One possible confounder for the overall sample was the placebo response rate of 53%, considerably higher than the rates of 25% to 35% typically seen in antidepressant trials (21)." [That ref, "21," is PMID 11939870.] -SADHART was supposed to take the wonderful efficacy of SSRIs for deprssion, and see if it translated into decreased rates of depression in post-heart attack pts., a group with high depressive episode incidence. My thought is that it was NOT directly a test of SSRI for dep in a Pharma-sponsored clincal trial, but was more like a real-world test of the antidepressant effects - thus the real result, not the Pharma-fudged result, appeared.

I am with ya. You are really "on" to a hot topic, including sketching out the "blame the victim" response when meds sdon't work like the tv commercials say they should. Keep it up. I have been involved in various ways with mental health treatment since the 80s, before the meds were so widespread as now - not every idea you have is totally an indication of absolute truth, but you are way closer than these people who are harrassing you and flying off the handle. Just keep moderating the comments when they get personal.

Psych meds nearly ended my grandfather and grandmother's lives. 12 days in to a 14 day trial of some medication (first of the sort he'd ever taken in 84 years of life), he tried to kill his wife of 60 years and himself. They both survived, and three years later our family is still rocked by this. I will never forgive the drug companies for this.

Thank you for your writing as you do.

Hey man it's nice to see that you got some spin working on this found this article on reddit so you must have been making something stink to someone... Love it.

I agree with a lot of what you're saying. I'll add one thing on top of what you wrote though. Meds aren't a cure all and that means that some where along the road there has to be personal accountability for things that happen to a person even if they are medicated. Being on meds seems to be societies fix for everything.

If I was to look at my life with meds (which I am still on a long term cocktail of what does seem to keep me stable though I have cut back the dosages from what I am prescribed) I look at it as 30-50% of my issues come from things my meds fix and the other 50-70% get's taken care of through lifestyle changes and restructuring of my thinking and how I view things in the world. It's amazing what having a healthy routine and keeping a clean home can do for ones self in how the world is viewed.

Well I could go on but I just wanted to drop by and say "HI".

Hopefully I'll start posting more again once I get the rest of my blog transcribed and weeded through all the junk post I got for a small book I want to get printed off to keep on hand.

Peace.

As someone who works in psychiatric research and has also been a psychiatric patient, I agree with many of your criticisms about research biases and corruption in pharmaceutical companies that leads to corruption of the entire health care system and disservices patients greatly. This is not unique to psychiatry, of course. [For a more comprehensive view of how this occurs in all areas of medicine, I recommend: "On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health," "The Truth About the Drug Companies: How They Deceive Us and What to Do About It," and "Snake Oil Science: The Truth about Complementary and Alternative Medicine".]

The problem, as I see it, is that you are using someone's death to exploit your agenda without revealing all of the facts. For example, I know several people on the DSM-V task force. They have no AGENDA with Big Pharma. Think about it: most psychiatric medications are written off-label as it is, which means that there is no need to prove medical necessity in prescribing them - and publications in the medical literature begin to appear LONG before any diagnosis is expanded, which means that off-label use increases.

Do you want to know the REAL DSM agenda? To increase access to psychotherapy. There is a big push to add Borderline Personality Disorder to Axis I because most insurance companies will not cover psychotherapy if BPD is the primary diagnosis. In the DSM-III-R, anorexia nervosa could only be diagnosed at 25% below normal body weight. This weight criteria prevented many anorectics from receiving adequate treatment, so it was changed to 15% under normal body weight. Most eating disorders are diagnosed as ED-NOS (not otherwise specified), which means that: if you're not that underweight, your problem must not be that bad, and your psychotherapy will be denied.

Similarly, Big Pharma has no agenda in promoting MAOIs. If you've read STAR*D carefully, you'll notice that the last phase (Effexor + Remeron vs. Parnate, a MAOI) had flawed and biased methodology, designed to favor the brand-name drugs - or, in the case of Effexor, the drug that's first in a series of "me too" drugs. Parnate was under-dosed; most patients - especially severely treatment resistant ones - require a range of 60 mg to 90 mg a day, which was one of the criticisms raised in the Letters to the Editor following the publication of the last STAR*D phase in AmJPsych. Also, the Parnate patients had to undergo a 2-week washout period prior to starting the drug and had to follow the MAOI diet, whereas the other group had no wash-out and didn't have to follow any dietary regimen. STAR*D was unquestionably biased. Psychiatric research is unquestionably biased.

But don't exploit someone's death to further your anti-psychiatry agenda. This wasn't some teenager who was prescribed Zoloft after a breakup because she felt "sad." This is someone with a very long and very troubled history. MAOIs probably *do* have success rates as high as those numbers you mock, but we'll never know. We'll never know because no one wants to hear that generic drugs from the 1960's are more effective than brand-name drugs with millions of dollars of advertising poured into their marketing.

Tellingly, there was a study comparing Lamictal to Parnate in bipolar II disorder. [And, given the very distinct side effect profiles of these two drugs, it's difficult to be "blinded" as to who is receiving which drug.] The Parnate patients were doing astonishingly well ... shockingly, they were doing much better than the Lamictal patients and had remission rates far exceeding that of typical bipolar II remission rates in research studies. What happened? Well, funding was pulled from the study. The "official" story is that patient recruitment was insufficient. The real story is that Lamictal is the brand-name gold-standard drug for bipolar II disorder, and neither the institution nor the pharmaceutical company wanted to watch its status destroyed by Parnate, a completely unmarketable drug. So they published the existing data and noted that "more studies on MAOIs for bipolar disorder are warranted." None of these studies will ever be done.

So before you start blaming the DSM and Big Pharma for someone's death, consider the facts. And consider how they're linked together. And while I understand that there needs to be an "extreme" sector of society pushing against the "extreme" biases and corrupt practices in medicine (ALL branches of medicine), you'd really be able to get your message across in a far more effective way if you took the blinders off for a minute.

Kat, i agree with your points about the DSM V, and have respect for Dr. Kupher. But- if your statement about Borderline is correct, and I don't doubt it is, it scares me because I know someone on that same board who thinks everyone is borderline, even when they only meet one or two of the criteria! And can prove it!

I am worried that people will be over diagnosed with this, if it goes to Axis One. It is bad enough I have heard from several sources, that Bipolar will go from 3 to 5 sub sets, and Unipolar will now be a subset of Bipolar. Although, with a publishing date of 2011 or 2012 anything can change.

I am not opposed to Psychiatry. I am opposed to witch hunts on the vunerable, and I do believe in my heart of hearts, if what you said is true, then it's going to be a massacre like Salem on single women.

I still don't see what Mr. Dawdy said that is so bad here.I cannot help but wonder if the internet was what it is now when Hemingway suicided, would all you folks be tying Philip up to the pillory for quoting Papa himself "It was a great cure,but we lost the patient". Of course not!!!!!!!

Dear Kat:

I'm not sure what planet you’re writing from! But you’re entitled to your own opinion, though I disagree entirely. To start with, you’re killing the messenger, when all Philip did was provide the information and some facts behind the tragic incident.

Now I’m so glad you’re an ardent supporter of the DSM and it’s subjective/left up to human interruption bought and paid for by whom else! Those nice caring professional people who are holding tons of shares in Big Pharmaceutical Companies and medical provider corporations {how much stock do you hold in a major pharmaceutical company's or medial provider? The folks writing the DSM hold a lot! I would call that a CONFLICT OF INTEREST}.

Do you actually believe they are trying to write in a new or change an axis diagnosis to provide therapy and honest treatment?

They will do as they always do in psychiatry land; they will drug them with whatever is popular and making them money at the time, and provide a little bit of therapy on the side to make it look like they are actually providing a well rounded course of treatment.
The good old rope’em, dope’em, and label them for life theory. Works great for you, doesn’t it?

OK, I can already hear you say they have placed standards and rules in the structure so that doesn't happen again! All I can say is; that it’s the fools policing and patting the backs of other fools!

Who are the mighty ones actually policing those rules; the same people writing the new and improved diagnostic myth called DSM5?

Do you actually expect that people are going to trust anything coming out of the professional psychiatric community after the crimes they have committed, all the fraud, lie upon lie stacked up and shoved down the consumer’s throats, continued scholastic misrepresentation, greed, and bad science; as this behavior continues unabated to this very day.

I can give you a little hint on who should be taking these poisons, and sit in therapy sessions! Or should I just let you guess on that one? Maybe you should look it up in your DSM fortune teller book and tell me what you find?

The DSM is a tool so called educated professionals use with complete irresponsibility to interpret symptoms and make judgment calls. It's almost completely subjective, which means it's pretty much worthless as a scientific diagnosis tool. I would compare it to driving down the HWY with a map that had no streets marked on it.

So you want come here and bark out to everyone about how unfair Philip and the so called anti-psychiatry folks are {let me note here quite clearly for you; that I do not believe Philip is anti psychiatry as he has stated in many post and articles on this site}.

Just maybe you need to go spend a day with someone misdiagnosed, drugged into Hell and back, and is sitting as a zombie in some institution forgotten and discarded.

I would say you must have a stake in the game and are rolling the dice to come across the way you did in your comment. But that’s just my opinion!

Yours truly
Stan

Stan,

Those nice caring professional people who are holding tons of shares in Big Pharmaceutical Companies and medical provider corporations {how much stock do you hold in a major pharmaceutical company's or medial provider? The folks writing the DSM hold a lot! I would call that a CONFLICT OF INTEREST}.

Oh, absolutely. Adding "adult-onset ADHD" (one consideration by the DSM-V task force) means that more adults will be diagnosed with ADHD in the absence of childhood symptoms, and as insurance companies continue to tighten restrictions on which drugs can be prescribed to which patients for which documented conditions, it will be beneficial to pharmaceutical companies to increase the numbers of those being officially diagnosed.

However, we're all aware that - by far - the majority of psychiatric medications are prescribed off-label. Sometimes insurance won't cover newer medications or will put restrictions on amount of newer medications that can be obtained. Atypical antipsychotics are a major example of this; nearly all remain brand-name drugs and nearly all are prescribed frequently for off-label purposes. Given that typical antipsychotics are equally as efficacious as atypicals for the condition that they were initially created for - schizophrenia - these restrictions are not quite as damaging to those who truly need them. Moreover, the most effective atypical for schizophrenia - clozapine - has been generic for years.

But typical antipsychotics (as well as clozapine) are not considered to be "worth the risk" for conditions like insomnia, anorexia nervosa, anxiety disorders, depressive disorders, and substance use disorders. So of course it is in the best interests of Big Pharma to both expand the diagnostic spectrum AND to pursue indications for these off-label uses.

My point is that it isn't only about "Big Pharma." Psychiatrists who practice psychotherapy as well as pharmacotherapy are becoming more and more scarce, for the very reason that managed care will not cover psychotherapy and (unless the clinician is located in an area where he/she has the luxury of taking only private-pay patients), psychiatrists who are in private practice and who do not take money from pharmaceutical companies and are not involved in psychiatric research face rising malpractice costs, lower insurance reimbursements, and the inability to conduct long-term psychotherapy due to insurance restrictions. PhD-level psychologists (who also sit on the DSM task forces, as this is NOT only about Big Pharma) face the same dilemma - except they don't have the option of reducing or eliminating their psychotherapy caseload in favor of a pharmacotherapy caseload.

Did I ever say that those sitting on the task forces are altruistic angels who only want the best treatment for patients? Absolutely not. But for many of them, their self-interest isn't tied to Big Pharma. It's tied to expanding diagnostic criteria so that insurance companies are FORCED to cover conditions that are presently excluded from mental health coverage.

As far as changing Borderline Personality Disorder to an Axis I diagnosis - and I can say this with definitive certainty: it is a matter of trying to get highly-specialized and extremely expensive psychotherapies covered by insurance. Dialectical Behavior Therapy, Transference-Focused Psychotherapy, and Schema Therapy are all types of therapy that require more than the mere 20 sessions permitted by insurance companies, often requiring at least one year of continuous treatment. If you specialize in BPD, you can: refuse to take any insurance and only take private-pay patients (unrealistic for 90% of the country) or you can diagnose Bipolar II (hey, they're close on the affective spectrum, right?) and argue "severe - and, of course, biologically-based - condition" to the insurance company or you can follow all of the rules and simply abandon your patients if insurance won't allow extra sessions and they can no longer pay for treatment.

On the Personality Disorders Work Group for the DSM, 2 person have no conflicts-of-interest, 1 person has conflicts with pharmaceutical companies only, 4 people (including the head of the group) have conflicts with both BPD advocacy groups pushing for an Axis I diagnosis AND with pharmaceutical companies, and 4 people have only conflicts with BPD advocacy groups. This is not in order to prescribe on-label medications. It's doubtful that BPD would ever qualify for an indication even with an Axis I status simply because BPD presents such a complex clinical picture. But moving it to Axis I will ensure that therapy is covered, as described by this BPD advocacy group: > ... which was created by a woman who was overwhelmed by her daughter's out-of-control BPD and frustrated by her inability to obtain any affordable treatment for it.

Regardless of their motives - whether it's more money or more patients or less insurance hassle or coverage for their own children - I'd say that increased therapy coverage is always a good thing. Honestly, I wish that Big Pharma and Big Insurance would fight it out on their own and leave the rest of us out of it.

And as for this: Just maybe you need to go spend a day with someone misdiagnosed, drugged into Hell and back, and is sitting as a zombie in some institution forgotten and discarded.

What makes you think I haven't, Stan? What makes you think I haven't both spent days with "those people" and been one of "those people"? Because I disclosed my conflict-of-interest as someone who works in the field? Do you really think that those of us who work in the field have never seen the inside of a state hospital or a SRO or have never encountered someone who has been failed by the very system they've been legally doomed to? If anyone in this field hasn't seen someone like this, then they haven't had very much experience in the field. And do you really think that we are immune to severe and chronic psychiatric illnesses? That among all of us, there is not one who has ever been forcibly hospitalized or medicated or mislabeled?

Well, I can tell you directly that there IS one. There is, at the very least, one. And maybe that's my "stake in the game." Maybe that's my real conflict-of-interest. Maybe that's why I joined the game in the first place.

I'm so glad to find this blog. The most intelligent discussion I've yet found on the web about the plight of psychiatry today. I'm a psychiatrist. I prescribe meds every day. And I do lots of other stuff too, most of which I think is more important than the meds. Things like listening to people. And trying to put myself in their shoes. And thinking about their relationships with others, and with institutions, and with cultures, etc.

I'm sorry, I'm babbling. I'm just glad to have found so much thoughtful critical thinking in one place.

I've subscribed. You will be hearing more from me.

Psychotherapy done by psychiatrists are terrible and only few people are able to do both.
Both approaches require different knowledge.

Thank you Kate for your comment and retort. You have validated for me once again that the DSM is nothing more than a very limited and tainted diagnostic tool used for billing purposes and to label people. It really has nothing to do with actually patient care in the truest of realities.

It fact it's all about the almighty dollar when all is said and done. Whether that is in psychiatry, psychology, or other therapeutic professions related to its use {those writing the DSM5 are sitting in their offices having a pissing contest to see who can gain the most from its final hotly contested and debated version}.

In a very real sense it does make it pretty much what I have called it; a tool of flawed human interpretation that serves the patient with no real working options or treatments; since it's built on a medical model that has failed us time and time again.

I guess the question is now when will these so called leaders in the mental health profession admit that they have failed; and try/develop a different, novel, and new workable ideas to treatments and diagnostic approaches. I won't be holding my breath! But I thank you again for your view point and comments.

Yours Truly,
Stan

Kat,

Are you arguing that there is some scientific basis for the DSM? That borderline personality disorder is a medical disease? That purported borderline personality disorder can be "treated" with therapy and/or meds?

Right on Kat, welcome here. I've been a part of the BPD wars for almost a decade myself and you capture the issues to the bone. I will just say in my perfect world we'd ditch the BPD label altogether and stop throwing people into that wastebasket once and for all. These people overwhelmingly suffer from the developmental effects of multiple and severe childhood horror. It's something of a disgrace that the personality problems that result are so decontextualized. That's the ruling injustice as I see it.

Welcome Gene, just checked your site. I am a fan of narrative therapy, and oral histories in general We lost Studs Terkel this weekend, now that was a therapist.