Wow. I've always been told that when you realize you're in a hole, the first rule of holes is stop digging.

And yet the people who are arguing for increasingly dubious disorders seem to have learned that the first rule of holes is lease a backhoe so you can dig faster and deeper.

Don't get me wrong I agree with you. I just think you warm and fuzzy folk who believe that mental illness is real but psychiatrists are mean have hit the logical wall in your argument.

Whoah there, isn't the entire point of the warm and fuzzy mental illnesses are real diseases movement supposed to be that there should not be any stigma in having a mental illness but that labels like bipolar disorder and schizophrenia and depression and even adhd denote real live illnesses that are the fault of biology and thus the sufferers from these maladies should get special treatment?

If that is the case, then why does Lane write:

"But it feels positively insulting to have our justified anger at such incompetence discussed as a sign of mental illness,"

Why is it insulting to be called mentally ill? When someone says "I'm so worried about my house being foreclosed it's making me sick?" why would this person be insulted to be labeled mentally ill? Is it insulting to be diagnosed with cancer? Syphilis? See...

When you realize the answers to these question are not rhetorical, I think you'll have a better understanding of those of us who are anti psych as opposed to those of you who want psychiatric "reform?"

Sally, how would you like it if I told you that your deeply held beliefs that make you who you are, were nothing more than a mental disorder? Be careful what you wish for: You don't want to take responsibility for your herpes, your bad credit, your alienated friends? Congratulations, you're not irresponsible, you're bipolar. But if you think you caught a break, that you get to give up the things you hate about yourself to a psychiatric label, you're kidding yourself, because you don't get to choose which of your actions, your thoughts, and your emotions, get filed under "Mental Illness." Your psychiatrist does. And about anything that he sees, he can say: It's not you, it's your disorder.

The existence of "post-traumatic embitterment disorder" will serve to help psychiatrists deny the legitimacy of their patients' emotions. It will do little to help heal their patients' minds.

I've been struggling with Treatment Resistant Bitterness, NOS since leaving psychiatric care several years ago. The doctors tell me that Cadbury's chocolate is my only hope.

The docs who came up with this latest bit of goofiness clearly suffer from Dumbass Disorder.

Wow, is there really anyone right now that is some way, shape or form is not suffering some sort of bitterness with the State of our Nation? I love Lisa's comment and agree, yes, the docs are suffering from Dumbass Disorder. That is awesome....Thanks for the post Philip and thanks for the laugh Lisa.

Is the issue really labelling certain emotional and behavioral patterns in an individual as illnesses, which even Buddhists do? Or is the issue more the associated POWER that psychiatrists have to involuntarily treat those who they have labelled as having such illnesses?

What if involuntary treatment was no longer present? Would the objections to the labelling still exist? And if so, then where are the howls of outrage against the Buddhist tradition?

Dguller,

You make an interesting point, if the idea of mental illness were recognized as a religion and not a science, I don't think you'd hear any more howls of outrage against it than you hear against the Buddhist tradition. If you want to see folks threatened by and oppressing Buddhism, go to China and Tibet where Buddhists are oppressed by malevolent psychiatrists who label them as "schizophrenic" and lock them away, forced treatment to "help," perhaps Fuller Torrey should consider immigration, psychiatry being a "modern" solution to the old ways.

acute-mania you write:

"Sally, how would you like it if I told you that your deeply held beliefs that make you who you are, were nothing more than a mental disorder? Be careful what you wish for: You don't want to take responsibility for your herpes, your bad credit, your alienated friends? Congratulations, you're not irresponsible, you're bipolar."

When told my deeply held beliefs were symptoms, I in fact didn't like it very much. And you're right labels like bipolar are a value judgment and sometimes an excuse but never a disease.

How about solutions targeted to feelings instead of labels? So, someone feels bitter? Were they born with it or did they learn it? If they learned it, then there is a cause and the solution is that they have to let it go. It's not that complicated.




But, if it is a labeled mental disorder, well, now there is huge profit potential with more client sessions and more prescription sales (via medication approval by the medical insurance machine).

dguller, even if involuntary treatment were abolished, I would still be opposed to psychiatric labelling as it is of no benefit to the people it purports to help. And, even where treatment isn't forced, there's a huge grey area of subtle and not-so-subtle coercion, often involving sick family dynamics.

I have next to no knowledge of Buddhism but, if what you say is true, I would guess the reason why it's not an issue is that Buddhism isn't big business in bed with Big Pharma.

Another revenant, can't keep 'em dead for some reason.

Psychiatry needs labelling to exist, to function, to embrace and extend its influence. It is essential. Labelling in Buddhism is not essential to it or its practice. Yes, they both label, but the labels and the acts of labelling are not ontologically synonymous between Psychiatry and Buddhism.

If Buddhism labelled (and it names many, many things) and such labelling was necessary to achieve enlightenment, then you might have a comparable set. Too bad, the Buddha wasn't much concerned with what you call something versus what you do, nor the are the vast majority of practitioners. Furthermore, the actual labels don't convey any special attribution. They are descriptors, no more no less. Psychiatric labels are not descriptors, they are actors.

The underlying premise is false and so is the comparison.

I truly hope we don't have to repeat this entire debate in yet another thread.

I'm really tired of the criticism regarding social anxiety disorder! It is VERY REAL--I say that because I have it and have had it ever since I was 5--I'm now 23. I have no friends and never have had any. I can't make phone calls or answer the phone. Basically, I'm low-functioning because of my severe anxiety (actually, the word phobia is more apt) and a lot of people think it's some petty, made-up disorder--far from it! It's disabling and affects every facet, every aspect of my life. It's far from normal to be 23 and have no friends not out of choice but because the fear--of judgment, of being rejected, of saying something stupid--is so strong. Social anxiety disorder is overdiagnosed, I agree with that. Being afraid to speak in public is not a mental disorder. Neither is being anxious when meeting new people at a party. But you won't see me giving a speech, let alone going to a party. It is not a trivial diagnosis, there are a lot of people out there who suffer from it. I also have bipolar disorder as well. I definitely think the social phobia is far more disabling and impacts my life to a greater degree than the bipolar disorder. If I could get rid of either my bipolar or social phobia, I would ditch the social phobia. Because while I'd still have mood swings, at least I'd be free of the constant anxiety and feeling that I've missed out on life all because of fear I can't surmount.

I do think psychiatry and Buddhism are similar in that they are both religions and the comparison is valid. Like people have a right to practice Buddhism, people have a right to practice psychiatry. Both religions are about unproven beliefs and extra legal moral codes as are all religions.

The problem is when a religion goes beyond the bounds of religion and tries to establish itself as the only way to see the world, tries to get the legal system of a society to enforce it's beliefs as law and truth. This is the main problem I see with psychiatry. Dguller uses the argument that because biochemistry exists and because feelings and behavior and thoughts exists, then obviously bio psychiatry is factually correct. This argument is flawed in the same way that the argument that because both men and wolves exist, werewolves are real creatures. It's a logical fallacy. Still, I believe he should be able to practice his religion and even proselytize, but just not hold his religion out as science or pretend that he's a medical doctor or god forbid have prescribing priviledges. Other medical fields realize the premise upon which psychiatry is built is invalid.

"I truly hope we don't have to repeat this entire debate in yet another thread." Ha, ha, of course you will, Paul. Resistance is futile. You'll repeat it until you capitulate or get tired enough to stop playing the game.

"even where treatment isn't forced, there's a huge grey area of subtle and not-so-subtle coercion" It's been my experience, and that of many other people, that very little "voluntary" treatment is voluntary. How voluntary is it when you're told "You'll be sent to the state hospital if you don't co-operate"? There's also the rampant withholding of information, The lies, the collusion with trusted family members--in my case achieved by scaring the bejeebers out of them, the subtle and not so subtle threats, etc., etc.

But what do I know? I'm mentally ill so my voice has been rendered insignificant by my "helpers". Thanks so very much, y'all.

Paul:

Just to warn you, this is a long post. :P

I reviewed our previous discussion on the difference between labelling in psychiatry versus Buddhism in January '09. We did begin to have a discussion about these issues at that time, and after a couple of comments, you unilaterally withdrew from the conversation. We did not resolve these issues then. We might have more luck now. :)

There -- as here -- I argued that labelling a group of emotional, cognitive and behavioural patterns an "illness" or "disease" in and of itself is not a problem, because Buddhists -- as well as other religious and spiritual traditions -- do it all the time, but do not provoke the hostility that psychiatry does.

You argued that in Buddhism the labels are just descriptions with any prescriptive or practical implications in terms of action. I said that that is wrong, because in Buddhism, every afflictive mental state has a corresponding antidote that requires correct identification and labelling for treatment purposes. That is why Buddhist practitioners in the past painstakingly labelled 84,000 different mental states. I mean, they didn’t do it for kicks! So, Buddhist labels are not action-neutral and without any practical implications, but rather are used therapeutically in the treatment of mental afflictions within their system.

You argued then that the Buddha did not make such an extensive categorization and put a priority in one’s actions over one’s beliefs. You are right in the former, but how that disqualifies all the work of his followers is beyond me. He believed that he was just one Enlightened Being, and that there would be many others following him. There is no need to ignore their work to idolize the work of the founder.

And in terms of the latter, you are only partially correct, because the Buddha DID state that one’s beliefs were essential (e.g. Right View as part of the Eightfold Path), and that such beliefs could be changed through actions, whether one had theoretical understanding or not. As a good proto-CBT therapist, he realized that our cognitions-emotions-behaviours formed a complex system in which altering any part would alter the whole complex.

You also argued that all that extra stuff was unnecessary, and you are right that one can find a measure of inner peace and harmony without such a detailed understanding of the multitudes of psychological states that Buddhism has labelled. However, to use one of your previous analogies, one could find a decent curry in New York, but it wouldn’t compare to the curry in Mumbai. ;)

So, no need to criticize labelling mental states as illnesses, because the Buddhists do it all the time. Such labelling is not the issue, anyway.

My contention then, as now, is that the real problem that critics have with these labels or diagnoses is what they are USED for, and not the labelling per se. The use that they criticize is the involuntary control of others using the labels. Without that feature, most of the criticism would disappear, I believe.

You argued -- then and now -- that it is an essential core of psychiatric labelling that the diagnosis is fundamentally a vehicle for controlling the patient, whereas in Buddhism, there is no such control as each individual is free to accept or reject the label of their difficulties.

I disagreed, saying that although there is a group of practices within psychiatry in which involuntary treatment is enforced, this does not represent the vast majority of cases. In the latter, a patient is free to reject the diagnosis and proposed treatment without repercussions to them. I have had this happen to me from time to time, and I do not certify and enforce my opinions through legal mechanisms upon the patients.

You can justly criticize the former cases in which the power of the state is utilized to compel treatment in an involuntary fashion in some patients who are declared to be dangers to themselves or others. However, I still have to disagree that this represents the majority of what psychiatry is about.

Two reasons why.

First, it is an extreme practice that becomes necessary in certain conditions. If you want to criticize this practice for its involuntary and coercive features, then feel free to critique internal medicine when it involuntarily treats those in the throes of a delirium, which are equally coercive.

Second, it is an unfair overgeneralization similar to declaring that if someone has told lies in their life, then it is forever part of their fundamental essence to be distrusted as a liar. A practice that is sometimes done by a group of people is not necessarily a defining element of that group of people.

Perhaps the issue is neither the general use of labelling mental states as illnesses nor the use of involuntary and measures of coercive control to treat people with such labels? Rather, the issue is the lack of diagnostic validity in psychiatric labels and the enforced treatment for illusory conditions that often leads to harmful consequences. Now, THAT is a legitimate critique!

To begin to deal with this issue, I would like someone to answer whether involuntary treatment of delirium is appropriate, and if so, then what the biological markers are to conclusively make the diagnosis of delirium. I mean, without biomarkers to ground our diagnoses, they are illusory and fictional, right?

Sally:

First, I think Buddhists would dispute your claim that Buddhism is a religion. It is viewed as a science of the mind that is based upon empirical observations and the testing of hypotheses. There is no blind faith, which most people would ascribe to a religion.

Second, I did not say that biological psychiatry's current theories are necessarily CORRECT, because all our mental life must be rooted in the brain. I just said that it makes sense to study the brain in order to get a better understanding of our mental life. A complete theory of neurobiology will not be a complete theory of humanity, though, but it will likely be a very important piece of the puzzle.

Sally,

I agree there are many parallels between religion and Psychiatry. You're absolutely correct - the logic is flawed:

Buddhism uses labels
Psychiatry uses labels
People don't howl at Buddhism's use of labels
Therefore people shouldn't howl at Psychiatry for doing the same.

The stake I am driving is that Psychiatry's labels and Buddhism's labels are not the same thing at all, and therefore this logic fails. the same word may be used to describe or mean very different things, and unless the meaning is reasonably the same you run the risk of logical fallacy - which is what Guller is doing now and did the same previously.

I completely agree that Psychiatry is a belief system, complete with self-fulfilling prophecies, priesthood, dogma, and heresy. I admit I'm a bit of a heretic, that's the physicist in me.

Paul:

All I'm saying is that one shouldn't criticize psychiatry for labelling various mental conditions as illnesses and diseases, unless one is ready to do the same with Buddhism. They BOTH use labels, but simply using labels in such a way is NOT the problem.

This is not just about using labels that declare that some mental states are diseases, but about the TYPE of labels (i.e. true versus false labels) and what they are USED for (i.e. voluntary versus involuntary treatment). Therefore, feel free to criticize psychiatry for using illusory labels and diagnoses, and forcing people to receive harmful treatment based upon them. THAT is a legitimate critique with some teeth in it.

But for those who say, "How dare psychiatry pathologize human feelings!", they must also critique Buddhism for the sake of consistency. YES, the labels are used differently, but that is not the point of that criticism, but rather the use of ANY form of labels for human thoughts and behavior that utilizes any kind of JUDGMENT about their APPROPRIATENESS. In other words, it says that any belief system that labels some human thoughts and feelings as pathological must be false.

THAT is the criticism that I believe is invalid. However, that does not mean that there are others which are more valid. :)

Involuntary treatment is not not a rare nor exceptional thing in Psychiatry. It's rather bread and butter. Patients are only free, in a theoretical sense, to reject treatment. You're a moron if you think that patients aren't coerced through fear and intimidation. I hate to be so blunt, but there it is. If your experience is otherwise, you need to get out because that's not the real world. I wish people treated doctors as used car salesmen and shopped around a bit more...

Delirium? Another setup? If one accepts involuntary treatment of delirium, for any reason, must we accept it for any Psychiatric diagnoses? Of course not. No one is going to fall for such a simplistic trap.

Enough already. Write a poem or something.

Paul:

First, does that mean that whenever any physician tells any patient that they have an illnes that requires treatment, that they are using fear and coercion? If you are correct, then fear and coercion are not just present in psychiatry, but also in all of medicine and surgery, too. Or is there a specific difference in the type of coercision that psychiatrists regularly use with their patients? I mean, do psychiatrists regularly threaten their patients with involuntary admission and treatment, even in outpatient settings? That certainly hasn't been my experience.

Second, my point about delirium is not a "setup", but only designed to flesh out more details about this line of criticism. Namely, that any diagnostic entity in medicine without unambiguous biomarkers to ground it is essentially bogus and illusory, and should not be used to justify using treatments that can result in harm to the patient, especially without their expressly given consent. Now, if that critique is valid, then it must be valid for other areas of medicine, as well, unless you want to add, "but this only applies to psychiatry", which I think will take much of the bite of out it.

So, if I have stated the criticism correctly, then the diagnosis and treatment of delirium should also be included. That is especially the case when the medical work-up in negative, mainly because whatever caused the delirium has cleared up, but the residual effects are ongoing, which I can assure you happens quite often. The point is that there should not be a double standard on this issue.

Does this mean that you have to accept psychiatric diagnoses? Of course not. That's just basic logic. But it does mean that you cannot use that argument against it (assuming you have accepted the validity of delirium and the need for involuntary treatment).

Fortunately, there are still many other valid criticisms of psychiatry. :)

Oh, and please don't call me a moron. Unless you have absolute certainty that you have the Truth about this issue, then you have to be open to the possibility that you may be incorrect, even if you cannot see it. I certainly am, which is why I am engaging in this dialogue with you. I don't know everything and do want to learn. I simply am unpersuaded by the points that you are making, which does not necessarily make me stupid.

Paul:

Also, this is something that you never answered before, but I wondered if you ever referred the patients in your medical practice to psychiatry?

Maybe you missed it before. :)

Paul,
Phew.

I simply can't be bothered any more responding to someone who can make such silly statements as:
"although there is a group of practices within psychiatry in which involuntary treatment is enforced, this does not represent the vast majority of cases."

Now that's a person who can't listen, can't hear and continues on their own little gratifying ego trip. For which he either is or will be handsomely paid.
Sherry

Quickly,

Dguller,

You write:

"First, I think Buddhists would dispute your claim that Buddhism is a religion. "

Now we're getting somewhere. This really would be something Buddhists have in common with psychiatrists. Regardless of what Buddhists think, in the US, and maybe up there in Canada where I think you are, Buddhism is accorded the legal protections of religion and generally regarded as a religion. This is what I think should happen to psychiatry, as opposed to say China, infra, where psychiatrists have labeled buddhism as a mental illness.

Paul, Thanks for teaching me the word revenant...about labeling, again, dguller is off the mark. Astrologers and anthropologists also label people.

Dguller writes:

"How dare psychiatry pathologize human feelings!", they must also critique Buddhism for the sake of consistency. YES, the labels are used differently, but that is not the point of that criticism, but rather the use of ANY form of labels for human thoughts and behavior that utilizes any kind of JUDGMENT about their APPROPRIATENESS. In other words, it says that any belief system that labels some human thoughts and feelings as pathological must be false."

These rantings are odd. He doesn't get it. If I were his pshrink I'd write in his chart, "overgeneralizes when belief system threatened. Unable to think clearly." He might get a psychotic label. Lucky for him I don't believe in that label.

Sherry:

You claim that the vast majority of interactions between psychiatrists and their patients involve involuntary treatment. I know of no data that endorses that view, and if you have some, then I would be interested to read it.

I can tell you about a report of a survey of 432 psychiatrists in Illinois during 2002 that found that 38% of them had not filled out papers to involuntarily admit a patient to hospital within the last five years, 32% did so once or twice a year, and the remaining 31% did so over three times per year (Psychiatric Services 55:1058-1060, September 2004).

That does not sound like a pervasive pattern of involuntary confinement and treatment to me. Again, if you know of other evidence that shows that the practice is regularly done by the vast majority of clinicians in their daily practice, then that would be most helpful to this discussion.

dguller: "Or is there a specific difference in the type of coercision that psychiatrists regularly use with their patients?"

Yes, it is a specific type of coercion, the main difference being that they have the force of law to back it up. Beyond that, there are value judgements to psychiatry that don't apply elsewhere. People have cancer, they are not referred to as cancerous but a psych label involves a permanent, negative, personal judgement. Yet another difference between psychiatry and real medicine is that psychiatry is the only specialty where outcomes are better without intervention.

dguller: "I mean, do psychiatrists regularly threaten their patients with involuntary admission and treatment, even in outpatient settings?"

Yes, regularly. This might be a direct threat (take this medication or you will be hospitalized) but more commonly it is softer coercion. It's really important that patients be aware of what their limited legal rights are and enforce them. When your case manager claims she "needs" to see your apartment, it's appropriate to correct her.

Sally:

Trust me, I do “get it”, but I think that we are all discussing different issues. Let me clarify exactly what my point has been, instead of what others believe I am trying to show. I am NOT trying to show that psychiatric labeling is correct in this discussion. So, accepting that I may have reasonable points here do not imply that the DSM-IV is now authentic and correct. That does not follow at all.

The issue is NOT about labeling in general, and so your citation of astrology and anthropology is a bit off the mark. The issue is a specific one about whether it is EVER appropriate to label someone’s thoughts, feelings and behaviors as an illness or disease. That’s all.

I’ll tell you why I focused on this issue. One of the criticisms of psychiatry here is that identifying mental states as diseased results in pathologizing what should be considered normal. There are those here who believe that all mental states are fully authentic manifestations of our deeper selves, and that any identification of them as a form of illness would result in a fragmentation of our self-identity, as well as other deleterious consequences.

It is to that SPECIFIC claim that I made my comments about Buddhism’s labeling of mental states as illnesses and diseases requiring treatment. If they truly believe that it is NEVER acceptable to label mental states as illnesses, then they must also reject Buddhism. Since they do not do so, it follows that it is SOMETIMES okay to label mental states as illnesses. That’s ALL. It does NOT imply that psychiatry’s use of that diagnostic classification is suddenly correct. That is a SEPARATE issue.

So, agreeing with me does not mean accepting the DSM-IV. It just means that you cannot criticize it based upon the position that ANY system that identifies mental states as diseases must be rejected, unless you want to jettison Buddhism, as well. Fortunately, there are plenty of other criticisms that are more valid that you can rely upon to skewer the DSM-IV. :)

If we can agree upon these points, then we can stop this discussion.

What do you think?

Is it sometimes okay to label mental states as illnesses? Yes or no?

Francesca:

You make fair points, as always.

First, yes, psychiatrists always have the implicit possibility of utilizing government authority in order to involuntarily treat their patients. But if X is a possible outcome in a scenario, then does that mean that it is a pervasive and commonly present feature? I mean, it is always possible that I could be struck with encephalitis, but does it follow that that possibility is an essential feature of who I am? And, what about encounters between physicians and patients in which that possibility is not actualized, or even mentioned? Is that encounter STILL essentially one defined by that possibility?

I’m not too sure about where you live, but in Ontario, all physicians have the legal authority to declare someone incapable to consent to treatment and to treat them involuntarily if their life is in danger. That is why physicians can treat those in the throes of a delirium against their will. So, even ordinary physicians have the possibility that you criticize psychiatry for having. Does that mean that even ordinary medicine is inherently coercive?

Second, you are absolutely correct about the negative stigma associated with psychiatric diagnosis. But again, I wonder if prior to the onset of psychiatric diagnoses, did those who suffered from psychosis, mania and melancholia, for example, not suffer any stigma from their community? Were they looked upon as equal and ordinary citizens until evil psychiatry created a group of social pariahs? And this occurs in the medical community, as well. Remember AIDS? That was a medical condition in which those infected with it were also ostracized and stigmatized. Again, also present in medicine.

I think that stigma is present with or without psychiatric diagnosis, and will be present as long as human beings judge people as being strange and Other. That is the sad reality of the human condition, which cannot be blamed upon psychiatry.

Third, I would need more information about what you mean by “outcome” and “better” without treatment. Could you give more details here? Thanks.

Fourth, you are correct that patients should know about their rights, as should everyone, as well.

As usual, I end up agreeing with most of what you wrote. :)

guller,
Jesus, you just DON'T get it. My guess is you simply do not want to.

While comparing psychiatry to surgery and other branches of regular medicine you said: "do psychiatrists regularly threaten their patients with involuntary admission and treatment, even in outpatient settings?"

Well yes, yes, YES you moron. Surgeons do NOT have the force of law to implement involuntary compliance. Whether YOU see that force of law as being pervasive and omnipresent is actually quite irrelevant to your patients and to their care. Your opinion doesn't matter a whit, although your deliberate obtuseness certainly does.

The force of law is ALWAYS there in any psychiatric contact, always present. The fact you can actually deny its presence in the room with you each and every time you meet and with each and every patient with whom you meet is a breathtaking admission of insensitivity and incompetence.

There is never, ever a level playing field when one party can lock another party up, medicate them and fry their brains against their will. It's like having a conversation with someone who's smiling as they hold a baseball bat behind their back. And you're such an everlasting twit you cannot even acknowledge this basic fact of your profession.

Can you imagine going to a surgeon to discuss a biopsy or wart removal KNOWING s/he has the ability to force your compliance? No, I didn't think so.

Try going to a surgeon after you've watched his colleagues force surgical "treatment", including anesthesia and incarceration on people you know, nice people, people who didn't deserve to be hauled away like criminals by five or six large men. Then tell me his diagnosis and "suggested" treatment is purely "voluntary." You won't be able to, but you don't want to see that so you deny it vigorously.

There really are none so blind as those who will not see. Happy stumbling about in the darkness, doc. Try not to trip over too many patients.

Revenant is a great word. I like pedestrian as well and pedantic; other favorites include noisome, miasma, and most uses of double negatives.

Yep, there's no point.

Guller,

What I said:

You're a moron if you think that patients aren't coerced through fear and intimidation.

Where did I call you a moron? Clearly you think there are times and situations where patients are coerced. I'm expecting a retraction unless you plan to retreat from your prior statement in which case I would have called you a moron - my apologies in advance...

"...is [it] EVER appropriate to label someone’s thoughts, feelings and behaviors as an illness or disease"[?]

I would say NO if the label is a Psychiatric label.

I would say yes if a person's thoughts, feelings, and behaviours could be proven to be caused or resulting of a bona fide illness or disease.

I would say yes if by "label" you mean to give a name to a thing most people would recognize so as to facilitate communication: a banana is a banana - note this is not what a Psychiatric label is.

The problem is that Guller ascribes the term "label" to Buddhism whilst not acknowledging that this word would no long maintain the same meaning as it has in Psychiatry. The meaning of the word has been changed, but he's still using it under a different meaning to make a logical argument. This is logically impermissible.

As is: I feel like a banana. Am I going to eat it or turn into one? You can't have it both ways.

Buddhism does not label in the Psychiatric sense. It names as would an encyclopedist. Secondly, naming is ancillary to Buddhism. Labeling is necessary to Psychiatry. This distinction alone renders his logical comparison void. Comparisons between objects must be in the same domain or you end up with either false or indeterminate conclusions.

If "label" is used unqualified or sloppily then I might understand how one might arrive at such an argument. I think it's fairly plain what is meant and understood as a label, however. I don't think many who have crossed paths with Psychiatry would make this mistake.

This bogus argument is a trap used to ensnare people into agreeing with something that is, in fact, wrong. What's worrisome is that Guller might actually believe they are the same.

There is a new article today about the subject of bitterness being included in the DSM-V as a new mental illness. In this article, it also states that "apathy" is a side-effect of antidepressants.

Here is the story [in part].

http://www.ssristories.com/show.php?item=3381

Paragraph 20 reads: "Apathy disorder also has been suggested for inclusion in the DMS. Experts have argued apathy can occur alone, or in conjunction with such other conditions as Huntington’s disease, Alzheimer’s, Parkinson’s and stroke. It is also a side-effect of antidepressants, sedatives and other psychotropic drugs."

http://www.windsorstar.com/Health/Bitterness+touted+sanctioned+mental+disorder/1650895/story.html

Bitterness touted as sanctioned mental disorder

By Sharon Kirkey , Canwest News Service

Bitterness should be classified an official brain illness, according to psychiatrists who say people who experience prolonged bitterness over a breakup or conflict at work are "ill" and need treatment.
Bitterness should be classified an official brain illness, according to psychiatrists who say people who experience prolonged bitterness over a breakup or conflict at work are "ill" and need treatment.

They are proposing that “post traumatic embitterment disorder” be included in the Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s official catalogue of mental dysfunction.

Paul:

First, Buddhist labels are used to identify afflictive mental states in order to match them with their respective antidotes. You can assert again and again that Buddhist labels are simply descriptive without any prescriptive or practical component, but this is not true. If you disagree with this, then feel free to cite your quotes and references. In the end, I think that you will have to accept that when a Buddhist sage labels a mental state as a diseased state, then that label brings with it the implication that the diseased state should be healed through the different antidotes that Buddhism claims to provide. He or she is not just doing it for kicks.

And if you believe that Buddhist labels of mental states is secondary in importance to Buddhist practice, then why is it that the masters have spent years mastering these distinctions, and are questioned and grilled about them in order to attain the level of proficiency that allows them to train others? If you read the Dalai Lama’s biography, then you will see his rigorous training in these distinctions.

Also, if you read the Dalai Lama’s discussions with Western scientists during the Mind and Life conferences, then you will see him painstakingly identify various mental states and differentiate them. If this is secondary and unimportant to the essence of Buddhism, then why would he make the point of making such clarifications? Why would he have spent his life studying Buddhist texts that go into such mental states in so much detail? Life is too short to waste it on useless pursuits.

Again, if you dispute this, then I would appreciate your quotes and references.

Second, I am happy to see that you accept that SOME labels of mental states as illnesses are acceptable, and thus reject the extreme position that any system that asserts that some mental states are diseased and require treatment must be automatically rejected as false. I will remember that the next time someone here criticizes the pathologizing of normal behaviour when some aspects of it are called diseased.

Third, you are just wrong about my committing the fallacy of equivocation. I was using the term “label” in the sense of the use of a symbol to represent another entity. That is all. Your argument that I am using the word “label” in two different senses is false. What exactly are the two different senses that I am using that are mutually incompatible? And remember, the senses have to be the minimal content needed for the argument to be coherent. It doesn’t count to add extra information that isn’t salient to the semantics of the argument.

For example:

(1) Anyone who believes that Mars is a planet is correct.
(2) John believes that Mars is a planet.
(3) John is correct.
(4) David believes that Mars is a planet.
(5) David is correct.

It is nonsense to argue that the sense of “believes” is different in (1), (2) and (4), because our beliefs carry different connotations depending upon our different backgrounds. In other words, John might believe that “Mars is a planet” in which Mars stands for a fearful planet and David might believe that “Mars is a planet” in which Mars is an exciting planet, making their beliefs different. Yes, those are differences, but the fundamental sense of “believes” is the same, and that is all that necessary for the argument.

So, your claim that in one belief system labelling is essential and in another it is ancillary is IRRELEVANT to the argument. That is an extra detail that is unnecessary for my argument. If you want to make your argument, then my major premise will have to be revised to something like, “Any belief system that labels some mental states as manifestations of illness or disease AND those labels are essential components of that belief system, is false.”

Again, all I need for this argument to be valid is that the word “label” means “a symbol used to represent another entity”. Nothing more, nothing less.

Just to help you out, here is the argument:

(1) Any belief system that labels some mental states as manifestations of illness or disease is false.
(2) Buddhism is a belief system that labels some mental states as manifestations of illness or disease.
(3) Buddhism is false (by (1), (2)).
(4) Psychiatry is a belief system that labels some mental states as manifestations of illness or disease.
(5) Psychiatry is false (by (1), (4)).

So, again, what are the two mutually incompatible senses of “label” that I am using? And remember, you have to show that the above argument CANNOT make sense using my sense of the word “label”.

Have fun.

Sherry:

Actually, surgeons DO have the potential capacity to involuntarily contain and treat their patients, at least in Ontario. They have the capacity to fill out documents that require the patient to remain in hospital for up to three days for a psychiatric assessment if they are at risk of harming themselves or others. They also have the capacity to declare patients incapable to consent to treatment and then to treat them, if their life is immediately in danger, and there are no other documents that show that they would refuse such treatment in such a situation. The latter situation can occur if the patient is in the midst of a delirium, for example, and requires surgery to save their lives.

So, it is an essential part of every interaction with a surgeon that under certain conditions, their patients can be constrained against their will in the hospital, and even be forcibly treated without their consent. According to your criteria, at least as I understand them, that would mean that it is an essential part of surgery to coerce and use fear, because involuntary treatment remains looming the background as a sinister threat.

Or maybe you think that the difference is that involuntary treatment is more common in psychiatry, which is likely true, even though I do not know the precise figures. Okay, let’s grant you that, but if you’re going down that road, then the difference is not one of kind, but of degree, and then the onus is upon you to state how often involuntary treatment has to occur before its potential use becomes an essential part of a practice. And I sure hope you won’t be engaging in the same arbitrary limit setting that you criticize the DSM-IV for participating in.

Again, your position, as I understand it, is that if the potential for involuntary containment and treatment is present in an interaction between a physician and a patient, then involuntary containment and treatment are essential features of that physician’s specialty. If that is true, then I’m afraid that you have condemned all of medicine, at least as it is practiced in Ontario. But I’m pretty sure that the rules are similar wherever you live.

All you can say is that involuntary treatment does happen, perhaps more frequently than you and I like, but the fact that X sometimes happens while doing Y does not imply that X is an essential feature of Y. X would have to ALWAYS happen while doing Y. I suppose that you can argue that if X sometimes happens during Y, then X always has the POTENTIAL to happen during Y, but it does not follow that X is an essential feature of Y. If it did, then it would lead to all kinds of absurd inferences.

For example, if death sometimes happens during flights, then death always has the potential to happen during flights, and therefore, death is an essential feature of flights. See? It just doesn’t work.

I can appreciate that given your horrific experiences with psychiatry, as well as those of dear friends of yours who were involuntarily treated with harmful consequences, you see psychiatry through the prism of disgust and revulsion. I would probably see it that way, too, if I went through what you and your friends did.

But I’m afraid that does not justify any and all pronouncements you make about my field, because they require independent argumentation and evidence. Unfortunately, your current criticism that it is the essence of psychiatry to utilize coercion and force in all its interactions with patients is just not true, and you have not provided any good evidence for your position.

Before you start hurling insults at me, I would like to ask instead that you just point out the errors in my logic above, and if possible, provide me with an argument for your position with the premises exposed. I think that that would give your position the best possible presentation.

Sigh... Where to be begin...?

The exhaustive extent of Buddhisms naming convention does nothing to alter the fact that these are but names. You can't/won't/don't accept this - fine, that's your problem. A descriptor does not imply it's done for kicks - that's your own invention and it's wrong.

I said names were ancillary not necessary in Buddhism. Again, the exhaustive extent does not undermine the basis of what Buddhism is. One could completely remove this aspect altogether and one could happily practice Buddhism, even if one were illiterate. A Buddhist healer would not even need to name the affliction to the one that is ill - it doesn't matter to the "patient". The actual words convey nothing other than a name. I can't give you an example of otherwise - there just aren't any because they are just names.

One can not say the same for Psychiatry. It is bound to its labels without which it could not exist presently. The labels are used as both tools and weapons to control and subjugate thought and behaviour - not merely describe it. It asserts power to preserve itself, institutionally, through its labels. Oh, it's a very different thing altogether. I state the obvious.

The question of necessity is germane. It affects the domain of relations and meaning. If I have two different lab test results with the value of "1" does "1" mean the same thing? Does 1=1 in this comparison? Of course not. So clearly, the domain and domain ranges must be considered. You're just assuming they are the same because it supports your desired conclusion. Unfortunately, even a lay understanding of the terms shows that they do not mean the same thing. You can debate the extent of the disparity, but it's there in bright lights for all to see.

Secondly, you misrepresented my position which is:

"I would say NO if the label is a Psychiatric label." --- this mean NO

"I would say yes if a person's thoughts, feelings, and behaviours could be proven to be caused or resulting of a bona fide illness or disease." --- This is also NO, but might possibly be yes in a distant future - very hard to prove methinks.

"I would say yes if by "label" you mean to give a name to a thing most people would recognize so as to facilitate communication: a banana is a banana - note this is not what a Psychiatric label is."
--- This is also NO because I don't consider the naming of a thing, by default, indicative of anything - note this is not what a Psychiatric label is. If words are just words then yes, otherwise no - which still means NO in this context. If you are arguing that any use of words would be prohibited, then that's plain silly and not what people are objecting to.

Be sure to include this if you try to reference my view as supporting yours.

Lastly, your logic is underwhelming. Your example is flawed because you're missing postulates that say names in Buddhism and labels in Psychiatry are and mean the same thing ontologically, that Buddhism and Psychiatry are not orthogonal, and overlap in this domain specifically in a non-prohibitive way. The rest of your argument then follows. Too bad, that first postulate is demonstrably false as does the third for many things and so goes the rest. Given some parts of Psychiatry deem Buddhism a mental disease you might be concerned with any overlap. One might try to make the argument that Psychiatry is also a mental disorder by proxy... Something to consider.

Lastly, if you use the same symbol to represent similar but disparate entities then you end up with crap. So, you MUST prove that these entities are the same, not just similar, in order to use the same symbol. They aren't, so your argument fails on these grounds as well.

If you want to defend Psychiatry's use of labels you'll have to find something else, not Buddhism, to try to justify its use. Look for similar patterns with more overlap that involve force, coercion, subterfuge, pretense, pseudoscience, a money trail - try.... Scientology! Psychiatry has much in common with this organization at many levels. Perhaps, the use of the e-meter might provide you ample justification for ECT? I think if you put your mind to it, you might actually be able to do it.

I'm also still awaiting your retraction.

Paul:

Oh, and you are right that I misread your statement above. Since you were arguing that coercion is an essential feature of every interaction between a psychiatrist and a patient, I thought that your statement referred to EVERY clinical encounter, and not just to the fact that in MANY encounters there is obvious fear and intimidation occurring.

dguller, what type of treatment do you recommend for those suffering from Bitterness Disease? How long must someone be bitter before it needs treatment? 2 weeks? Can it be treated outpatient? Do you think Abilify will help?

dguller, I've worked in the health care field for many years and I've never known of a surgeon having a person who is oriented X 4 treated involuntarily. Maybe surgeons are different over in Ontario.

dguller,

Psychiatric labels are permanent judgments of temporary conditions.

You say the issue isn't labeling but that's what you come back to. Your only argument seems to be that because Buddhism labels you have to deny the validity of Buddhism if you deny the validity of psychiatry. That's like saying that if you don't like steak tartar you can't like cooked beef. I'd be silly if your subjective labels didn't have the force of law, but they do.

You write:

"(1) Any belief system that labels some mental states as manifestations of illness or disease is false.
(2) Buddhism is a belief system that labels some mental states as manifestations of illness or disease.
(3) Buddhism is false (by (1), (2)).
(4) Psychiatry is a belief system that labels some mental states as manifestations of illness or disease.
(5) Psychiatry is false (by (1), (4))."

Your (1) is flawed here. What is being said, at least by me, is that I don't know what belief systems are true or false to each individual, but any organized system of classifying and controlling people should not be based solely on any belief system.

Still, you're in a classic syllogism. Assuming that one person or group has a problem with one belief system that labels, they have no duty or obligation or necessary tendency to reject all other systems that do so.

Your argument is like this, if you think that one woman is beautiful then you have to think all women are beautiful, in fact you must really think that or be lying.

No wonder you went with psychiatry instead of brain surgery.

DSM, do you use it in your practice or not?

dguller: "First, yes, psychiatrists always have the implicit possibility of utilizing government authority in order to involuntarily treat their patients. But if X is a possible outcome in a scenario, then does that mean that it is a pervasive and commonly present feature?"

Unfortunately, yes, in a situation where that power differential is regularly displayed. In our local hospital, I think it's something like 30% of inpatients are officially involuntary. That doesn't include, however, the large number of people that are voluntary on paper but are encouraged not to try to leave or those who buy their "voluntary" status with compliance. Coercion versus force.

dguller: "And, what about encounters between physicians and patients in which that possibility is not actualized, or even mentioned? Is that encounter STILL essentially one defined by that possibility?"

For me, it is defined that way. It's a difficult feature of a relationship to overlook. I happen to have a fairly good rapport with my current psychiatrist but my knowledge of the Mental Health Act means I will never fully trust him.

dguller: "I’m not too sure about where you live, but in Ontario, all physicians have the legal authority to declare someone incapable to consent to treatment and to treat them involuntarily if their life is in danger."

I'm in BC and, as far as I know, the only real (i.e. physical) illnesses that can be treated are those which impact public safety. And even then, I believe, that someone with tuberculosis, for example, can only be isolated but not treated against their will. It's generally only psychiatry that's involved where people are deemed a danger to themselves. Why is that? Why aren't smokers rounded up and forcibly treated? Why are people allowed to drink to excess? Eat junk food? Watch garbage on television?

dguller: "So, even ordinary physicians have the possibility that you criticize psychiatry for having. Does that mean that even ordinary medicine is inherently coercive?"

No, and I think that has to do with the likelihood of involuntary treatment occurring. We crazies even have our own legislation. I imagine there are oddball circumstances like the delirium example you described but they're few and far between.

dguller: "Second, you are absolutely correct about the negative stigma associated with psychiatric diagnosis. But again, I wonder if prior to the onset of psychiatric diagnoses, did those who suffered from psychosis, mania and melancholia, for example, not suffer any stigma from their community? Were they looked upon as equal and ordinary citizens until evil psychiatry created a group of social pariahs?"

Seems to me that before psychiatry took off, society had more tolerance for the unusual. But I agree that "odd" people have always had a tough time. I just don't see the benefit in saddling someone with a lifelong label. I'm aware that I can get very depressed and also manic when treated for depression. And I'm aware that this means I have to be very aware and careful to avoid another episode. But how does it assist me to judge me bipolar, and therefore defective, and force me to take drugs? How does it help me to be treated like an imbecile by the system? I told my case manager that I wanted to write about my experiences and she advised that "people like [me]" are better off writing poetry. I've survived human rights abuses but I'm supposed to write about bunnies and fluffy clouds. Stupid bitch!

dguller: "I think that stigma is present with or without psychiatric diagnosis, and will be present as long as human beings judge people as being strange and Other. That is the sad reality of the human condition, which cannot be blamed upon psychiatry."

But it's psychiatry that maintains that the afflicted need drugs. And it's psychiatry that creates differing levels of humanity based on the DSM. And it's psychiatry that wants to affix the labels that have profound consequences and follow people wherever they go.

dguller: "Third, I would need more information about what you mean by “outcome” and “better” without treatment. Could you give more details here? Thanks."

In part, I was thinking along the lines of the World Health Organization's two studies comparing our outcomes with those of third world countries and also Robert Whitaker's "Anatomy of an Epidemic." On a more personal note, I was also thinking of the overweight and glassy-eyed zombies I see at the mental health centre, shuffling in for their weekly antipsychotic injections.

dguller: "Fourth, you are correct that patients should know about their rights, as should everyone, as well."

I think every mental patient should be provided with a legal advocate. There's just too much room for abuse.

Paul:

I reread my previous post, and there were elements of it that were unclear. So, I want to restate my position in a clearer fashion. :)

For me to have committed the fallacy of equivocation, you would have to show that the labelling of some emotional states as illnesses is fundamentally different between psychiatry and Buddhism. You have advanced two arguments for this position, at least on this thread.

First, you claim that psychiatry requires labelling in order to exist, but Buddhism does not. This is false.

As I mentioned on numerous occasions, Buddhism has painstakingly labelled a multitude of mental states, categorized them as healthy or sick, and then proceeded to devise treatments in order to enhance the healthy and cure the sick mental states. In fact, according to Buddhist legend, it was the Buddha himself who described 84,000 practices (or Dharma) for the 84,000 mental afflictions (or Klesha). Look it up. So, the Buddha DID prioritize categorizing our mental life for the sake of treating its illnesses, implying that it is an essential component of Buddhism.

Second, you claim that Buddhist labels are purely descriptive without any prescriptive components whereas psychiatric labels are fundamentally prescriptive and action-driven. This is false.

Both are descriptive and prescriptive. It is a fundamental misunderstanding of Buddhist mental classification to believe that its elucidation of the various mental afflictions and sicknesses are just descriptive without any corresponding impulse to correct the affliction. The whole point of the Four Noble Truths is not only that suffering is an inherent part of life (i.e. the descriptive part), but that there is a Way to minimize it (i.e. the prescriptive part). Buddhism is essentially action-oriented.

I can only conclude that your entire rationale behind saying that the labelling of psychiatry is fundamentally different from the labelling of Buddhism is incorrect, and that your case for my committing the fallacy of equivocation is therefore also false.

I have more questions about this Bitterness Disease.

1. How do patients know if they're in remission? If patients express gratitude to their psychiatrists for all their help and are careful to display only a sunny disposition is that a sign of remission?

2. Once in remission, what's the liklihood of a bitterness relapse? Do family gatherings during the holidays make one more susceptible to a relapse?

3. If a patient says, "Your treatment sucks," is that a sign a patient may be refractory to treatment?

4. Do children with bitterness disease have to actually have episodes of bitterness to qualify? Or can they just be a little disagreeable?

5. Do people with bitterness disease have more patchy blue areas on their PET scans?

Waiting for the retraction...

You're also continuing your pattern of misrepresenting my statements.

I said that Buddhism names afflictions and that the naming was not NECESSARY to BUDDHISM and that Psychiatry labels people and such labeling is NECESSARY to PSYCHIATRY. Both these assertions are not just logically defensible, you can see it practice for yourself.

I neither said nor implied anything wrt to any prescriptive components in Buddhism- you made that up.

The issue is whether or not because Buddhism "labels" you have to deny the validity of Buddhism if you deny the validity of psychiatric labels. Labels not prescriptions. You're confounding topics, but Sally said is best above.

The logical fallacy you rely on depends on equivalence of domains, terms, and construct. The domain equivalence isn't especially tight, but there are overlaps. I've already discussed, repeatedly, that the terms are not equivalent although you keep insisting they are. Lastly your grasp of logical constructs is uninspiring. Even your most basic attempt is flawed:

"For example:

(1) Anyone who believes that Mars is a planet is correct.
(2) John believes that Mars is a planet.
(3) John is correct.
(4) David believes that Mars is a planet.
(5) David is correct."

Can you not see what's missing or wrong? You made two huge presumptions that actually dovetail nicely with why you don't seem to grasp the difference between names and labels in this context.

You can't just say if A = C and B = C then A = B without a frame of reference. A, B, and C and their unions must not be orthogonal or disallowed in this frame. And when you are dealing with sets, as we are here, then you have to look at the domains as well.

In the end, it does not matter. You're not going to convince anyone that Psychiatric labels are valid with this sort of argument - the facts are not there to support it. Psychiatric labeling is not innocuous and all it entails must stand on its own without hiding behind "well, they do it too, so can I - besides I'm just following orders..." sophistry.

Oh, the action in Buddhism is what one does oneself, not what is done to you.

Interesting contrast to Psychiatry, no?

guller,
"the onus is upon you to state how often involuntary treatment has to occur before its potential use becomes an essential part of a practice"
Oh really? Says who? You? Who the hell elected you king? I've got news for you--there's no onus upon me at all. You don't set the terms of conversation around here. Deal with it.

We share our feelings and personal experiences and this is what we get back. You browbeat people with your arrogant demands for "proof" that will satisfy you. And somehow you are able to maintain the delusion you are a compassionate and helpful human being.

And, for your information, in the US surgeons--unlike psychiatrist--are not generally viewed as people who have legal coercive powers. I doubt it's all that different in Canada. It's hard to imagine Canadian surgeons wield this power all that often, unlike their peers in psychiatry. And no, I have no intention of "proving" this to you. As I said before, I'm not trying to prove anything, just trying to share the experience of the people you say your trying to help so I'm not about to be distracted by your power-mongering demands for proof. I'm on to your game, guller.

I worked in rehab in the US and had clients who refused surgical treatment all the time because a cure would deprive them of their disability checks. One guy parlayed a broken arm into 23 years of Social Security and there was nothing anyone could could do about it because you cannot force someone into real medical treatment in the US (although the right wing often seem to want to make exceptions for pregnant women).

You can scrounge around for "proof" all you want--apparently you have the luxury of unlimited time to engage in such intellectual masturbation. I have better things to do with my time than pander to your need for dominance.

Lisa,
"How do patients know if they're in remission? If patients express gratitude to their psychiatrists for all their help and are careful to display only a sunny disposition is that a sign of remission?"

Yes, yes, now you get it. It's all about boot licking and "power over."

And what about the diagnosis F62.1 in the ICD, "Enduring personality change after psychiatric illness": "Personality change, persisting for at least two years, attributable to the traumatic experience of suffering from a severe psychiatric illness. The change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery from an antecedent mental disorder. This disorder is characterized by an excessive dependence on and a demanding attitude towards others; conviction of being changed or stigmatized by the illness, leading to an inability to form and maintain close and confiding personal relationships and to social iso-lation; passivity, reduced interests, and diminished involvement in leisure activities; persistent complaints of being ill, which may be associated with hypochondriacal claims and illness behaviour; dysphoric or labile mood, not due to the presence of a current mental disorder or antecedent mental disorder with residual affective symptoms; and longstanding problems in social and occupational functioning." Http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gf60.htm+F62.1

Paul:

Okay, so let’s clarify things. You say that without the labels, Buddhism could still function. That is false. I wonder how far Buddhism would go without the idea that certain mental states are afflictive and result in human suffering. Oops, there goes the First and Second Noble Truths. I wonder how they could justify the endless hours of mindfulness meditation without using the cessation of destructive emotions as justification. Oops, there goes the Third and Fourth Noble Truths. Who knew? It is only when we remove the Four Noble Truths that we have reached the true core of Buddhism!

The best that you can say is that EXTENSIVE labeling is not necessary. This is true, but to say that labelling itself is unnecessary is false, because what is the point of meditation without being able to identify whether your mental states are shifting towards the positive end of the spectrum and away from the negative end? Also, remember your curry analogy? Some curries are better than others with respect to taste, and some types of Buddhism are better than others with respect to inner peace. Sure, you could follow a one page summary of Buddhism, but that wouldn’t be the same as immersing yourself in its tradition under a qualified master. Wasn’t that even your critique of DBT? The cookbook approach?

Sure, the Buddhist doesn’t necessarily have to tell YOU what affliction you have, but it would help you to know what you need to work on, and the point remains that the Buddhist has to know the affliction in order to recommend an antidote for it.

So, yes, it is possible for Buddhism to operate without the use of labels, but it would be a poor, shabby form of itself that I doubt anyone would bother wasting their time with. Without the descriptive and prescriptive labels, it becomes the practice of sitting patiently and watching one’s breath and thoughts, without really knowing why or what benefit to expect.

With regards to psychiatry, you say that its labels are fundamentally different, because without them, it would be unable to coerce and control others, which you argue is its primary purpose. You are correct that without its diagnoses, it could not control its patients, but it does not follow that that means that its diagnoses are primarily designed to control and coerce others. Yes, there are some circumstances in which coercion and control are used. But help me to see how you go from “coercion and control occur in some situations in psychiatry” to “coercion and control are at the very heart of psychiatry”. I think there are a few missing steps that are needed here.

Personally, I believe that psychiatry could continue without the control. Does psychoanalysis label mental illnesses? Yes. Does it force its treatment upon its patients? No. So, the use of psychiatric labeling does not necessarily imply that the labels are used to force treatment or control others. I mean, one could use the DSM-IV, if necessary, to guide treatment of patients, and patients would be free to accept or reject the treatment, but that would probably be conditional upon whether it would be helpful.

Of course that would mean that we could not treat those in the midst of a psychotic or manic state, or who are so depressed that they are unable to see any hope for the future and do not want help, but those could be seen as acceptable casualties for the sake of the principle of non-coercion and human freedom. Those individuals would possibly come to treatment after their symptoms have subsided in order to understand them, to implement a plan to be administered by their family members when in the early stages of an acute episode, and possibly for relapse prevention. This could include medications, psychotherapy, or other interventions, but any treatment would require full consent.

I can see this as a possibility that would require giving up some elements of what psychiatry currently does. I mean, most patients are not hospitalized, and even less are certified and treated against their will. So, the majority of patients are outpatients and voluntary. Psychiatry could just focus upon those patients, and still chug happily along. The rest can make due. Nothing absolutely essential has been stripped to make it no longer considered psychiatry. It has become a different type of psychiatry, but still psychiatry. Or, am I missing something?

Of course, you are right that there are powerful institutional elements that would fight tooth and nail to prevent this from occurring, because it would result in big changes in psychiatry that would alter their current comfortable positions. That is an indisputable fact. However, my point is that just because that is how it is currently practiced does not imply that that is how it must be practiced. Hume’s law, no doubt.

Moving on our discussion of the fallacy of equivocation. Let me give you another example of why your use of it is incorrect. Look at the following argument:

(1) Any treatment that helps patients should be recommended.
(2) Medical treatment helps patients.
(3) Therefore, medical treatment should be recommended.
(4) Surgical treatment helps patients.
(5) Therefore, surgical treatment should be recommended.

But wait! Surgical treatment requires actually cutting into patients under anaesthesia, but medical treatment does not require that. And more, surgical treatment requires extensive scrubbing in and working in a sterile environment, but medical treatment does not. So, they are fundamentally different treatments, and the above argument falls by the mighty hand of the fallacy of equivocation.

See how easy it is to do what you did? Yes, there are key differences between surgical and medical treatment, but there are enough similarities between them that they both count as “treatment” in the sense of the term in the major premise, and that is all that is necessary for the argument to be valid. All that extra stuff is IRRELEVANT.

Here’s a good example of the fallacy of equivocation, using your word “orange”:

(1) Orange is my favorite color.
(2) I would like to eat an orange.
(3) I would like to eat my favorite color.

Now, THAT is the fallacy of equivocation. See the “ontological” difference between a COLOUR and a FRUIT? Totally different at a fundamental level! The issue is that one is a fruit with skin that requires peeling, and another is a fruit that does not require peeling. No, that would be IRRELEVANT, because they would still both be FRUIT. No, the issue is that one is a FRUIT and another is a COLOUR. Totally different!

With regards to “labels”, yes, there is a difference between labels that are value- and action-neutral and labels that are value- and action-laden, but they are still both LABELS, and the alleged differences are not important for this specific argument. This is true no less than the example about “treatment” above.

I’m sorry, but you are just wrong here. All I need for my argument to be valid is that the sense of the word “label” in the major premise is carried through the rest of the argument, and the only sense of the word “label” that I used was “a symbol used to represent something else”. That’s all. Sure, some symbols carry stigma, and carry the possibility of involuntary treatment, and some symbols are physical and others are psychological, but all that is IRELEVANT to the argument in question, because they are still LABELS. They carry the same sense from the major premise down through the argument.

Logic is fun, eh!

P.S. Still waiting to hear what you do with your patients who present with psychiatric symptoms in which they could harm themselves or others after a thorough medical work-up comes up negative. Do you send them home? Or do you consult psychiatry? What do you do?

Lisa:

I have no idea what Bitterness Disease is, nor how to treat it, if that is even possible.

Sorry.

Francesca:

First, I think that your criticism is especially valid for inpatient psychiatric units where there is an overabundance of subtle and obvious coercion saturating the environment. That is why I said that there are elements of psychiatry that are vulnerable to that critique, but I still stand by my claim that one cannot generalize to all of psychiatry, especially since most psychiatrists do not work on an inpatient unit and work in the community.

Second, I can understand how you and others here are particularly sensitive to the threat of force and coercion, especially given your personal experiences with psychiatry. However, I still have to insist that most psychiatric encounters, which happen to be on an outpatient basis, do not have the threat of involuntary treatment hanging in the air. I have been working on an outpatient basis for the past year, and I have never certified anyone for involuntary assessment and treatment in the course of those duties. Yes, it is a possibility, but as I have tried to argue, the fact that something is possible does not make it necessary, except for the vacuous “necessarily possible”.

Third, your points about consent are well taken. I think that as long as someone is able to understand and appreciate the consequences of their decision, then they are free to make their own decisions, even if most people would disagree with them. The issue of involuntary treatment only comes in when someone is unable to consent to treatment (i.e. understand and appreciate) AND is in immediate danger of harming themselves or someone else.

So, if someone infected with TB refuses treatment, but does so on the basis that they know that they have TB, that treatment could help them, but come with side effects, and that refusing treatment could mean that their TB would be fatal, then they are good to go. However, consent becomes a tricky thing when someone is psychotic, manic or so depressed that their thought processes are distorted to the point that they are unable to understand and appreciate the situation.

But I do acknowledge that it is a practice with much potential for abuse, and thus requires strict criteria for its use and a great deal of oversight and support for patients. There are definitely conflicting values underlying this issue (e.g. personal freedom versus personal health and safety) that will probably never be fully reconciled, but perhaps a stable dynamic equilibrium can be agreed upon to satisfy most people? I don’t know.

Fourth, even if the “oddball circumstances” that I mentioned, such as involuntarily treating someone with delirium, are uncommon, the fact remains that they do occur. The statement “all swans are white” can be falsified by a single black swan. The point is that those who criticize psychiatry for its use of involuntary confinement and treatment do so on the basis that ALL such circumstances are unethical and to be condemned. There are no qualifications that they have made that I am aware of.

The existence of the “oddball circumstances” means that it is not an all-or-nothing issue, but admits various gradations of possibility. It is not a matter of kind, but of degree, and the question then becomes where to draw the line. When are involuntary confinement and treatment appropriate? Because obviously there are cases, no matter how uncommon, when it is fully acceptable.

Fifth, I doubt that people viewed as strange and odd were viewed in more positive light before psychiatry than after. In all likelihood, they are looked upon equally as social pariahs. I believe that stigma of all kinds, like a phobia, can be overcome through exposure. It is only through repeated contact with what we fear that we can see that there is nothing to be afraid of.

Sixth, you are correct that it does not help anyone to be labeled with a psychiatric illness and to be treated as an “imbecile”. Again, I do not believe that you can fault the labels themselves, but rather how they are used by practitioners.

According to the DSM-IV, “It is precisely because impairments, abilities, and disabilities vary widely within each diagnostic category that assignment of a particular diagnosis does not imply a specific level of impairment or disability” (p. xxxiii). In other words, people are not supposed to infer a person’s level of function based solely upon their diagnosis.

Sometimes it is helpful to recall that the DSM-IV is not the “Bible” of psychiatry, as in the infallible source of all truth about mental illness. It actually explicitly says:

“It must be noted that DSM-IV reflects a consensus about the classification and diagnosis of mental disorders derived at the time of its initial publication. New knowledge generated by research or clinical experience will undoubtedly lead to an increased understanding of the disorders included in DSM-IV, to the identification of new disorders, and to the removal of some disorders in future classifications. The text and criteria sets included in DSM-IV will require reconsideration in light of evolving new information” (p. xxxiii).

In other words, it is fallible text that is constantly open to revision. People who treat it as the gospel truth are fools. That said, it is not entirely useless, and has been helpful in terms of helping clinicians and researchers be better able to communicate with one another, and thus should not be entirely discarded, but its limitations must always be kept in mind.

Seventh, you wrote that the DSM-IV is used to create “differing levels of humanity”. Well, the DSM-IV actually says: “A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are disorders that people have” (p. xxxi).

In other words, the authors attempted to make an explicit point that there are no schizophrenics, but only people with schizophrenia, i.e. not entirely identified with their illness. Unfortunately, it appears that has utterly failed to have happened.

Eighth, how do you like B.C.? I hear its beautiful there.

Lisa:

Orientation to time, place and person are not the only things that are necessary for informed consent.

What if someone knew who they were, where they were and what the date was, but believed that the intense abdominal pain was a test from God that they would have to endure, despite the fact that a CT scan showed that they had appendicitis and could die without surgery?

I don't know any surgeon that would wait for the appendicitis to become septic and the patient unconscious before doing the appendectemy.

Lisa:

Looking at my above example, I can see some obvious objections from you, so let me modify it to make it more plausible for my point. L

et us say that the person believed that the abdominal pain was due to an alien device implanted by extraterrestrials during a sexual device and that should not be touched, because otherwise, the aliens will return to abduct her.

There. That suits my purposes much better.

RE: hyperbole -- I've seen over two dozen DTC psychotrop commercials since this thread started.

Ask your doctor if propaganda is right for you!

The vast majority of psychiatric services are willing, eager patients. How that screamingly obvious fact should detract from arguments against coercion is beyond me. I understand strength in numbers, but if the numbers aren't there and you insist they are, it just leaves you with a reduction in the very credibility your argument seeks to engender. Well, who isn't neurotic?

If coercion is wrong it should be wrong whether it happens to the majority of psych patients or just you.

Courage is persuasive too.

dguller: "In other words, people are not supposed to infer a person’s level of function based solely upon their diagnosis."

But they do! The words "bipolar" and "schizophrenic" are two of the ugliest labels you can affix to a human being. If my bipolar disorder (which is a misnomer anyway as the manic half only appears in response to treatment for depression) comes up in conversation, people feel free to ask if I'm taking meds. When I say I'm not, their thoughts are apparent in their facial expression. "Bipolar" means unstable, potentially dangerous, ill-adjusted, defective. There's no getting around it. The risks from psychiatric labelling far outweigh the supposed benefits and the practice should stop.

Serious question: How much time has to go by without symptoms before I can shed the label? 10 years? 20??

I do agree with you that the vast majority of psych patients never get involved in the forced treatment scenario. Thousands in my community do, however. It's a very real issue.

I seem to have rubbed a nerve with "oddball circumstances." All I meant is that non-psychiatric forced medical treatment is almost unheard of. That's why the JW multiplets case with the blood transfusions made such big news.

And, just so you know, I can imagine circumstances where forced treatment might be justified. The trouble is that psychiatry has taken the notion of "imminent danger" and hugely expanded it to include an apparently healthy person wanting to be free of drugs. The "imminent danger" is that the patient won't be medicated.

To me, "imminent danger" means just that. A guy threatening suicide. Someone starving herself to death. Our Mental Health Act only specifies "capable of mental or physical deterioration" (or words to that effect). That's a meaningless specification that includes absolutely anybody you want. Which takes us back to the judgement of a psychiatrist. Too much power. Not enough science.

Guller,

I can't help you with this.

Sorry.

But I can help debunk your latest trap - substituting Psychiatry for Surgery. Again, the argument is hopelessly flawed:

(1) Any treatment that helps patients should be recommended.

If does not follow that any treatment that helps patients should be recommended. You would need to prove this. There are many instances when it is better to do nothing - unless you also consider that a treatment. You may postulate this, but it is absurd to do so.

(2) Medical treatment helps patients.

Not always. Sometimes medical treatment kills or mains the patient.

(3) Therefore, medical treatment should be recommended.

Flawed reasoning as per above.

(4) Surgical treatment helps patients.

Again, not necessarily.

(5) Therefore, surgical treatment should be recommended.

Same flawed reasoning.

Perhaps one could have said:

(1) Patients should be recommended any voluntary, reasonably affordable, safe, appropriate, effective, and socially accepted treatment that help.

(2) Medicine offers treatments that are voluntary, reasonably affordable, safe, appropriate, effective, and socially accepted that help.

(3) Patients should be recommended those medical treatments that are voluntary, reasonably affordable, safe, appropriate, effective, and socially accepted that help.

(4) Surgery is a medical treatment

(5) Some surgeries are not voluntary, affordable, safe, effective, and socially accepted medical treatments that help.

(6) Patients should be recommended those surgeries that are voluntary, affordable, safe, effective, and socially accepted that help.

Of course, this isn't perfect (what does help mean, what about non-medical treatments that help?, and so on??), but at least it's consistent in this limited sense - the conclusion is reasonably well supported logically. (4) has some major problems, but not fatally so I think.

Explain to me again how any of this matters to the mental illness labeled bitterness? Are we there yet?

Paul:

I am not substituting psychiatry for surgery. I only brought surgery up in the context of trying to show you that the way that you are using the fallacy of equivocation is incorrect. Nothing more sinister going on, I’m afraid. But you are right that the argument that I provided, although valid, is unsound. However, the point remains that what you are trying to do with “label” is what I did with “treatment”, and I hope that you can now see that is not how the fallacy of equivocation is supposed to be used.

Oh, and I only brought up the issue of labels, because I firmly believe that the issue is not the labels that psychiatry uses per se, but the fact that they are used in some cases to justify violating the individual rights of some patients in the form of involuntary confinement and treatment. If psychiatry no longer had the legal authority to perform those activities, then much of the criticism that it currently endures here would disappear. Naturally, there are other legitimate criticisms, as well, but this fundamental one would not remain.

Unfortunately, we got sucked into the intricacies of Buddhism and informal logic, which was nonetheless -- forgive the pun -- enlightening. :)

Now, feel free to let loose your incisive criticisms of “post-traumatic bitterness syndrome”.

P.S. Still waiting to hear what you do with your patients who present with psychiatric symptoms in which they could harm themselves or others after a thorough medical work-up comes up negative. Do you send them home? Or do you consult psychiatry? What do you do?

dguller, I've been present when many patients have been consented over the years and I've never seen patients who are oriented to person, place, & time forced to have surgery against their will. If the patients know who they are, where they are, and have a general idea of the date then it's pretty much assumed they can sign the consent form.

My apologies for using the abbreviated bitterness disorder/disease. Henceforth, I will refer to it by its proper, more fancy title "post-traumatic embitterment disorder"

Francesca:

First, I understand that people do infer from a diagnosis that a person has a variety of disabilities and difficulties, but that is not permitted by the DSM-IV. You cannot criticize the DSM-IV for those who fail to follow its rules. That would be like blaming the DSM-IV for someone running around and diagnosing people with major depression when they are very hungry. They aren’t following its criteria or guidelines in that case.

Second, I also understand that being labelled with a mental illness does bring with it a great deal of stigma, but I wonder whether that stigma would be removed if the label was gone? I mean, people are stigmatized for being psychotic and manic, for example, irrespective of what you decide to call their mental states. Again, the name that you decide to call that underlying condition has no stigma, except for the fact of what it refers to. And what should we do without identifying these conditions with labels or names? Just ignore that they exist? Should we also ban the use of “insane”, “lunatic”, “psychotic”, “manic”, and every other mental state that has a negative connotation? Do you really think that would eliminate stigma?

Third, you should NOT be diagnosed with bipolar disorder if your manic episodes were secondary to antidepressant use. That is explicitly stated in the DSM-IV. You can shed your label now, if you like, because you do not meet criteria for bipolar disorder. You should seriously talk to your psychiatrist about this, because it is important.

Fourth, no rubbed nerves about “oddball circumstances”. :) But I would have to say that non-psychiatric enforced treatment happens more often than you think. When I was doing by consultation-liason psychiatry rotation about a year ago, we were consulted on a daily basis to assist with a medical patient in the throes of a delirium with an unidentifiable etiology. The patient was ALWAYS being treated against their will by non-psychiatric physicians.

Fifth, with regards to someone being involuntarily treated for declaring that they wished to discontinue their medications, I would have to know their history. If they have a history of becoming psychotic after discontinuing their medications, even after a slow titration, and they have become a danger to themselves or others while in that state, and this has happened on several occasions, then I would have to strongly consider involuntary treatment. In Ontario, that would likely require defending that decision to a review board in which the patient has a lawyer present to defend them.

Sixth, I agree with that vague specification, other than the harm criteria, to justify involuntary admission for psychiatric assessment. We have something similar in Ontario. It certainly runs the risk of being abused, and should be closely monitored.

Guller,

I am pleased to hear you agree your argument is unsound. It is also invalid. Good. Now,
we can move on to other, less obtuse, things.

Sherry:

Sorry this is a little late. I missed your post earlier.

First, I am not king. I would have thought that was obvious to everyone, but I suppose I’ll explicitly say it now. I. AM. NOT. KING.

Second, if you are going to argue that force and coercion are utilized in every interaction between a psychiatrist and a patient, then you have to back that up with arguments and proof. And that’s not because I’m a control freak or have any authority here. It is a basic rule of discourse that if you provide a claim, then you should be able to back it up if questioned.

You can’t just assert something and expect people to just agree with you, because you have some experience with it. So, feel free to share your personal experiences, because they are important, but be careful of what you infer from them. When I question you about certain points, I am not questioning or doubting the pain of your experience, but only what you infer from it. That’s all.

I’ll give you an example. I bought a Hyundai Sonata, which turned out to be a lemon. I was pretty pissed off about that, but I wouldn’t tell people not to buy a Hyundai, because I know that the statistics say that Hyundai makes reliable automobiles, and I just got unlucky with mine. Now, if I were to tell people to avoid Hyundais based on my experience, and someone were to challenge my advice, because I committed the fallacy of overgeneralization, then he or she would be totally right, as much as it would upset me. Does that change the fact that my Hyundai is a lemon? No. But it does prohibit me from logically inferring that all Hyundais are lemons.

So, if you’re going to claim that every encounter between a psychiatrist and a patient, including an ordinary initial assessment in the community after a family physician referral, then you really should provide support for that claim. But if you don’t want to, then that’s fine, too.

You are free to do whatever you want. :)

Paul:

Argh. I hate to be a nitpicker about this, but my argument above about treatment is, in point of fact, valid.

Validity just means that the argument is logically consistent, even if the premises are all false. Since my argument was a classic syllogism (i.e. If A, then B; A; Therefore, B), it is certainly logically consistent, and thus valid.

Soundness is when the argument is logically consistent AND the premises are true. My argument is definitely unsound, because the premises are all questionable, as you rightly pointed out.

Anyway, moving on, far, far away from obtuseness ... :)

Lisa:

No need to apologize for the lack of formality for this bitterness thing. My overlords haven't stamped it with their seal of approval yet as a legitimate disease. ;)

dguller: "And what should we do without identifying these conditions with labels or names?"

I believe it would be more helpful to identify areas that people require (and request!) assistance with, e.g. getting and holding down a job, managing a budget, eating properly, etc., rather than labelling the entire person.

dguller: "Third, you should NOT be diagnosed with bipolar disorder if your manic episodes were secondary to antidepressant use. That is explicitly stated in the DSM-IV. You can shed your label now, if you like, because you do not meet criteria for bipolar disorder. You should seriously talk to your psychiatrist about this, because it is important."

Well, this is very exciting news indeed. All of the psychiatrists I have encountered have assured me that the distinction is irrelevant. Doesn't matter how I became bipolar, the thinking goes, the important thing is that I am bipolar and need lifelong treatment. I'm going to have to consider the legal ramifications of this.

How is diagnosing people with "post-traumatic embitterment disorder" going to be helpful to patients? And isn't the whole point supposed to be about helping the patient? Do the inventors of this made up illness stop to think about the impact of these kinds of diagnoses on patients?

How do they come up with this abitrary time period for getting over trauma? You only get x amount of time to get over your tragic event or you have a disease. I heard a survivor of the Holocaust speak a couple of years ago. His voice still broke as he talked about unspeakable tragedy. He watched his sister die. He lost his mother and father. Is he allowed to be a little bitter? I guess he should just get over it, right? Not talk about it anymore? Move on?

Francesca:

First, you wrote that “it would be more helpful to identify areas that people require (and request!) assistance with, e.g. getting and holding down a job, managing a budget, eating properly, etc., rather than labelling the entire person”.

What if someone is having a hard time holding down a job, because they are obsessed about contamination and compulsively washing their hands 40 times a day? What if someone is having a hard time holding down a job, because they are hearing voices commanding them to preach to people about the apocalypse in the streets? What if someone is having a hard time holding down a job, because they are mentally retarded and have a very low IQ?

It is often important to identify WHY someone’s ability to function in different life domains is impaired before you can help them in those specific areas. Otherwise, you might exert a great deal of effort into a plan that will fall apart. And once you start asking why they cannot function, then you are forced to use words that will inevitably carry a negative connotation. Again, that is not because the words themselves are the problem, because they are just symbols, but because the words are referring to real-world behaviour that many people consider strange and Other, which is the real source of the stigma.

I’m afraid I still have to disagree with you that removing every single psychiatric or psychological word in the English language that has a negative connotation and stigma will not remove the underlying fear that people have of those who are perceived to be strange and Other. That is because there will still be the people who are psychotic, and manic, and so on, and they will still make most people afraid. Even changing the label to someone more neutral will not work for long, because that neutral word will then be infected by stigma, because the phenomena it labels are real and are considered bizarre by most of society.

The best way to eliminate stigma is not necessarily to censor language, but rather to provide people with opportunities to interact with those they are unfamiliar with in order to gain the familiarity needed to eliminate the fear.

Second, you should definitely see into the matter of getting the bipolar diagnosis revoked, because you do not meet criteria for it. Even ordinary depressed people become manic on antidepressants, because mania is a potential side effect. And it is possible to have psychiatric diagnoses removed, especially if DSM-IV criteria aren’t met. I recently had a patient who was diagnosed with de Clerambault’s syndrome (or delusional disorder, erotomanic subtype), and when I asked her about her symptoms, they actually didn’t meet criteria for it, and I told her this. She then had the diagnosis removed when a committee reviewed her case.

The problem is not that labels are applied which really means diagnoses are made. The problem is that the labeling, i.e the diagnosing system, is wrong on many levels. One, as dguller brings up is exemplified by Francesca's issue. Dguller is correct that "as reported" Francesca, your systems may not meet the dsm criteria for Bipolar disorder, as we know, this simply means that pshrinks disagree with you. And again, the word bipolar denotes very little. The problem with these labels is in the way they falsely denote conditions that don't exist and falsely indicate that if a person behaves a certain way in a certain context that person would always behave that way without treatment which has been demonstrated to have no efficacy at all out side of the most acute situations in the best case and a completely deleterious effect otherwise, e.g. a boy not "paying attention" in class may be attentive when playing and interacting with family, but once he gets the label adhd people really see him differently and treat him differently and cause and in some instances unconsciously force him to conform to these criteria. What effect does being on the other side of a pshrink's or on their "sofa" have on a person's perception? What effect does marital strife have on spousal reports of mental health? Psychiatry is a kind of labeling that is wrong because the labeling system is inaccurate.

Is the issue really labelling certain emotional and behavioral patterns in an individual as illnesses, which even Buddhists do? Or is the issue more the associated POWER that psychiatrists have to involuntarily treat those who they have labelled as having such illnesses?

What if involuntary treatment was no longer present? Would the objections to the labelling still exist? And if so, then where are the howls of outrage against the Buddhist tradition?

Posted by: dguller at May 30, 2009 04:46 AM

The BIG difference between Buddhism and Psychiatry is that Buddhism VALUES compassion ..
Psychiatry has no foundation of ethics or morality..
Comparing psychiatry with Buddhism or using them as analogies of each other is ridiculous , shame on you D Guller..

"force and coercion are utilized in every interaction "
And if you're going to quote me the least you can do is be accurate. That is NOT what I said.

Thanks, however, for proving once more your complete inability to hear anything you do not want to hear.

And, by the way, I'm in a conversation here NOT a debate. I do NOT have to prove my statements to your satisfaction. You are NOT the arbiter of conversation around here (so like you to split hairs over terminology instead of hearing the content) and I am NOT accountable to you in any way whatsoever.

You really need to get over yourself. But I doubt you ever will, you'd have too much to lose.

For the record, I never ask anyone "to just agree with" me. I do expect them to listen, to hear what others are saying, to focus on content instead of nitpicking peripheral issues, to refrain from trying to control the conversation and--most of all--to stop twisting other people's words and positions. And no, before you ask, I will NOT provide you with "proof" for any of this.

Sherry:

You previously wrote:

“It's been my experience, and that of many other people, that very little "voluntary" treatment is voluntary. How voluntary is it when you're told "You'll be sent to the state hospital if you don't co-operate"? There's also the rampant withholding of information, The lies, the collusion with trusted family members--in my case achieved by scaring the bejeebers out of them, the subtle and not so subtle threats, etc., etc.”

You also disagreed with my statement:

“although there is a group of practices within psychiatry in which involuntary treatment is enforced, this does not represent the vast majority of cases”.

In fact, you said that it was a “silly statement”.

The impression that I got from your remarks was that you doubted that there was any aspect of the psychiatric encounter between a physician and their patient that was genuinely voluntary, which implies that it is fundamentally defined by coercion and force. You explicitly said that it was “silly” to think that involuntary treatment “does not represent the vast majority of cases”. That is why I said that your position is that “force and coercion are utilized in every interaction”.

It seems that your real position is not that force and coercion are utilized in EVERY interaction, but only in the VAST MAJORITY of them. Only VERY LITTLE psychiatric encounters are genuinely voluntary. However, without any evidence or data to support your position, I will have to take it with a grain of salt.

Oh wait. That’s just a sign of my megalomania and arrogance, right? Okay. You’re right. From this moment on, whenever you make any assertions, I will take them to be the unassailable truth. I will not dare to offer any criticism of them whatsoever. Even when they violate the laws of logic, I will assume that logic is shattered into pieces and lies at your feet by the power of your emotional pain. Even when they violate the known facts, I will assume that reality itself has somehow bent to align itself with your declarations.

Oh, and you’re absolutely right. I’M the megalomanic and arrogant one. Shame on me for relying upon logic and facts instead of your almighty will.

dguller: "And once you start asking why they cannot function, then you are forced to use words that will inevitably carry a negative connotation."

I disagree. We can assist those who experience and struggle with barriers to employment without using all-encompassing and damning words.

The trouble with the current system is that the words "bipolar" or "schizophrenic" are used to mean chronically ill, lacking in insight, only suitable for disability services, etc. All these judgements are often completely untrue!

By the way, what's involved in getting a diagnosis "revoked"? Would they put a note on my medical records? Could I be compensated for my misdiagnosis and related mistreatment?

guller,
I have never once said all psychiatrists are lemons or bad people. I happen to know some that are very nice people, good docs and kind and compassionate people. The one guy I do refer people to. His colleague, who was even better, disappeared into the maw of an HMO. Your behaviour here, of course, makes it pretty clear you don't fit that description.

STOP twisting my words and making attributions to me that simply do not exist. At the very least it's incredibly rude and aggressive. It certainly stops anything that resembles meaningful communication. It's probably usually quite effective in controlling conversation for you, though.

Sally:

You raise fair points in criticism of psychiatric diagnoses, but I would have to disagree with you that all psychiatric diagnoses “falsely denote conditions that don't exist”.

I think that if you came across someone who had bizarre beliefs about being abducted by aliens and regularly heard alien voices commanding him to build an altar on the roof of his home and sell all his property to pay for it, and that this was unlike his premorbid personality, then you would quickly identify that there was something wrong.

Likewise, if you came across someone who was feeling euphoric, being hyperactive, having racing thoughts, spending all their money and engaging in promiscuous behaviour, without any hint of such behaviour being present before the onset of this episode, then you would likewise say that there was something wrong.

The DSM-IV essentially focuses upon the classical presentations of various mental illnesses that, I think, everyone would agree are unusual. Even Sherry speaks of some types of “blatant” enough schizophrenia that would require psychiatric care. But it also recognizes that there can be atypical presentations, which is why there is leeway in the diagnostic criteria. However, it explicitly warns in its introduction that once you start venturing into atypical territory, then you have to be aware of the reduced probability of accuracy.

It is not 100% accurate, and it is hard to know how much of it is descriptive and how much of it is prescriptive. That is why it is a fallible text that is constantly open to revision as our knowledge base expands. However, I think it is a mistake to infer 0% accurate from not-100% accurate. The reality is that there are many cases that are so classical in their presentation, that I doubt that anyone would doubt the diagnosis, and there are atypical cases, which do not seem to fit nicely, and thus require a measure of caution when making a diagnosis. Hopefully, as our knowledge base expands, this will change, but only time will tell.

Another point is that what you would DO about those two scenarios is a different issue from what you would LABEL those people as having. The current paradigm prioritizes medications, and to some extent, psychotherapy, but the treatment is not part of the diagnostic system at this point. In other words, just because the current climate demands medication management for schizophrenia does not mean that medication management is an essential feature of the diagnosis of schizophrenia. Perhaps in the future other treatments would be shown to be more beneficial. The diagnosis would remain, but the treatment would be different. So, I think that the labels and the treatment are different issues that should be kept separate.

You are also correct that psychosocial context is of paramount importance and that some symptoms are more likely to occur in some scenarios than others, and that must be an important component of any management plan. The DSM-IV states that the more situations in which a person is unable to function is a marker of the severity of the illness, meaning that there are many people who can function just fine in some areas, which indicates their strengths that should be built upon, even if they struggle in others.

I think that if psychiatrists saved medications for the most severe cases, and tried to focus upon psychosocial interventions of various types for most of their patients, then results would be much better. Unfortunately, in the United States, managed care and private insurance coverage makes this difficult, and it is cheaper for insurance companies to pay for medication sessions than extended psychotherapy, for example. Things are generally better in Canada, because of the public healthcare system, but there is still a culture of “pills first, pills only” that needs to change.

Guller reminds me of a bluebottle fly..

Always buzzing in and out, harassing and irritating people...

One day he'll be squashed into a wall..

Language tends to run 2 axes: context and content. The West tends to be content rich (many words to describe same thing) and context poor (meaning not strongly tied to situation). Asian societies tend the opposite (something to keep in mind when you're reading Buddhist texts edited by westerners).

We need words to describe many things, how things are related, ideas, feelings, but not always. Somethings cannot be adequately said, but must be thought, seen, heard, felt or experienced.

Words can convey far more than the plain dictionary meaning and can become ambiguous or contradictory (see previous diatribe on labels and names). Once the meaning of a word assumes a greater meaning within a culture it is very difficult to revert to the original (how many people say they're gay when they mean happy?).

Psychiatric labels are power, not words - this is their meaning, imo. Power is not inherently negative. However, I think that this power as been sufficiently abused that a major corrective action would seem appropriate. Labels are a huge part of the problem. I don't think just changing words will suffice.

You have to eliminate that which gives these power:
Force of law: no more forced treatment or special medical hold procedures
Insistence on objective diagnostics
Accountability for the bankrupt "chemical imbalance" theory
Demand regulators require pharma prove it knows what its drugs do, how they work, and how to get off them.
Disallow off-label drug prescription of psychotropics.

The DSM can be printed to say whatever it wants, but the proof is in what Psychiatry does. Labels are needed to bill insurance companies. Labels are needed to give authenticity to an unscientific discipline. Labels are needed for force of law. Labels are needed for treatments of incurable, lifelong diseases that can't be objectively tested for. Labels are needed for this, not simple names.

The fix won't come from within Psychiatry. When the bodies are stacked high enough, and the stench sufficiently overwhelming, then something will be done. We're not there yet, and so more bodies and sham diagnoses are to be served.

Sherry:

First, you are not my patient, and thus I am under no obligation to treat you as if you were. Do not assume that the way I interact with belligerent and offensive people online is how I treat my patients in my office. I do not assume that your nasty and derogatory remarks towards me represent how you interact with everyone else in your life. That would commit the fallacy of overgeneralization.

Second, do not forget that all I did here was question some of your assertions and criticize a few of your claims. You are the one who responded to my comments with personal insults and disparaging remarks about my character and integrity. So, don’t come to me all offended that I said something mean to you when you have been hurling offences upon me for some time. Something about glass houses and stones comes to mind. Hmmm ...

Third, I extensively quoted you from this thread, and gave my understanding of what you said. Instead of just saying that I am wrong -- and stupid, and arrogant, and grandiose -- why not clarify what your exact position is regarding the use of force and coercion in psychiatry? You neither believe that it never occurs nor that it always occurs. So, how often does it occur?

I’ll repeat my contention.

Yes, force and coercion are utilized extensively in the inpatient psychiatric units. That is a valid point that I’ll not dispute.

No, they are not utilized extensively in the more typical psychiatric encounter in an outpatient setting. They are used on some occasions, such as when someone is clearly psychotic and a danger to others, or extremely depressed and a danger to themselves, but those are uncommon situations. I even cited a study of Illinois psychiatrists in which the vast majority of them either never certified anyone in five years or did so once or twice a year.

In a sense, there is always the potential to utilize coercion in the form of involuntary confinement and treatment, but it does not follow that coercion is therefore a fundamental and integral part of psychiatry in general. I gave you the argument above about death and planes to show the flaw in that line of reasoning.

It would be more fair to say that most psychiatric care is voluntary and in an outpatient setting, but there are many occasions in which coercion and force are used in the form of involuntary confinement and treatment in an inpatient setting, mainly when safety becomes an imminent issue. Other areas of medicine also use coercion and force on occasion, but psychiatry uses them far more often. This has a great deal of potential for abuse, and abuse has occurred in the past for which those involved should be roundly criticized.

That is both fair and true.

Any thoughts?

Francesca:

First, how would you describe someone who obsesses over contamination to the point of compulsively washing their hands 50 times a day? How would you describe someone who hears voices telling him that he is the Messiah? How could you describe that behaviour without a smidgen of stigma or strangeness? Remember, you have to take this behaviour into account in order to have a successful social intervention.

Second, I understand how the diagnoses are used in psychiatry and the wider public to denote disability, poor insight, and so on. I can only say so many times that that directly contradicts the DSM-IV. In fact, lack of insight is not even part of the criteria for schizophrenia. One cannot blame it for people misusing it and not following its rules. Again, the best solution is public education and interaction with those who are mentally ill in order to decrease the strangeness and stigma.

I mean, look at how homosexual couples are now able to marry in many states. This did not happen, because the homosexual community suddenly derived a logical argument that eliminated the stigma against them. No. What happened was that more and more people either had homosexual friends or relatives, and through exposure to them and realizing that they are not what they feared, the stigma began to decrease to the point that legalized marriage is now on the horizon. I think that something similar should take place with psychiatric patients.

Third, with regards to getting your diagnosis revoked, there are two issues, as far as I understand. One, is to have a committee review your diagnosis and decide that it is valid or invalid. Two, is to have your medical records altered. The patient that I mentioned did the former, but chose not to pursue the latter. Instead, she has documentary proof that her diagnosis is invalid that she can present any time anyone questions her about this matter.

Paul:

I would love to respond to your above points about language. However, since you have been such a stickler about when I have misspoke, demanding retractions from me -- which I have provided -- I'll have to refrain from continuing our discussion unless:

(1) You retract your claim that my "treatment" argument was invalid. Come on. Man up. :)

(2) You inform me what you do, as a physician, with your patients who present with psychiatric symptoms after a thorough medical work-up is negative. Do you send them home? Do you refer them to psychiatry? Do you do something else?

I'm really baffled why your are so hesitant to answer these questions. People have asked me how I practice on multiple occasions, and I have answered them. Oh, and I'm not implying that you're a fake physician, as you accused me in the past. You've stated that you are a physician, and I believe you.

I'm just wondering what a physician who believes that psychiatry is pure quackery with Nazism cemented into its foundations does in his practice when faced with psychiatric patients with a negative medical work-up.

truthman30:

Is that a threat?

Guller,

You said:

"In a sense, there is always the potential to utilize coercion in the form of involuntary confinement and treatment, but it does not follow that coercion is therefore a fundamental and integral part of psychiatry in general. I gave you the argument above about death and planes to show the flaw in that line of reasoning."

Try taking away this power and see what happens institutionally. It's fundamental and integral to the power base. It's not a question of how often it's used, but that Psychiatry MUST have the ability as part of its core. Take away the power and psychiatrists will have to choose between neurology and therapy.

re: validity means an argument is valid just if the set consisting of its premises and the negation of its conclusion is inconsistent. This also requires premises to not be unambiguous - this where I take issue.

A threat?..

No..

Just an analogy ..

Guller,

Sorry. Can't help you with that.

I don't care if you respond or not. I'm more interested in the other commenters opinions. I can't get the party line any time I want...

Note that last sentence should say:
This also requires premises to not be ambiguous - this where I take issue.

Paul:

First, you are still wrong about my argument. A valid argument is one in which if the premises are all true, then the conclusion must be true.

Here is the argument again:

(1) Any treatment that helps patients should be recommended.
(2) Medical treatment helps patients.
(3) Therefore, medical treatment should be recommended.
(4) Surgical treatment helps patients.
(5) Therefore, surgical treatment should be recommended.

All that matters is that IF the premises (1), (2), and (4) are true, THEN the conclusions (3) and (5) follow. The fact that the premises are all false has nothing to do with the validity of the argument in this case.

Here's another valid argument:

(1) All glasses are purple.
(2) Plato is a glass.
(3) Plato is purple.

(1) is false, (2) is incoherent, and yet the argument is valid, because IF (1) and (2) are true, then (3) follows. It is irrelevant whether they are actually true, or even coherent, for it to be valid.

Second, psychiatry would do just fine without involuntary treatment. There would just be fewer people in hospital, and more people off medications. There would still be plenty of people receiving psychotropic medications and psychotherapy voluntarily.

P.S. Still waiting to hear what you do with your patients who present with psychiatric symptoms in which they could harm themselves or others after a thorough medical work-up comes up negative. Do you send them home? Or do you consult psychiatry? What do you do?

truthman30:

What is me getting "squashed into a wall" an analogy for?

Paul:

I'm sure you're interested in the other commenters opinions. Here, I'll give you what you'll hear in response to your posts:

"You're right, Paul!"

"That's so true, Paul!"

"Of course, you are correct, Paul!"

I find it fascinating that you are more interested in hearing from people who will agree with everything you write rather than with someone who will engage in a spirited debate with you. Hmm.

The analogy is really quite simple Dr Guller..

I said you reminded me of a bluebottle fly , and I made the analogy because you display the same characteristics as a fly on this blog, you appear suddenly into a thread and you proceed to irritate and annoy the majority of the posters on here. Am I wrong for making such an analogy? ...

I am sure many would agree that my analogy was actually quite apt.. (definitely more valid than your "buddhism and psychiatry " comparison , you would have to agree..)

The "squashed into a wall" part is simply an elaboration on the analogy and like most "subjective" and abstract concepts , an analogy can often be interpretive and ambiguous ..

My analogy was no more a threat than saying every "cloud has a silver lining" ...

You could be "squashed into a wall" in a metaphorical (and argumentative) sense by someone like maybe... Dr David Healy or Dr Peter Breggin..

I am sure they could squash any of your pro-psychiatric-pseudo babble- drug rhetoric with a mere quip of their tongue...

(that's if they could ever be bothered of course, I am sure they have better things to be doing with their time) ..

Philip Dawdy responds: can someone remind me what this thread was about?

Guller,

Go figure out why validity means an argument is valid just if the set consisting of its premises and the negation of its conclusion is inconsistent. Figure out why premises should not be ambiguous. Consult someone in the mathematics department. Don't bother me any further with stupid logic problems that have nothing to do with anything. It's boring me and everyone else to tears.

Secondly, I don't come here and wave my credentials about. I don't think my professional background should mean anything in a place like this. I don't come here to render professional judgments. Philip has made a wonderful place here and (most) people that comment are just absolutely brilliant. I stand in awe of their insight and experiential knowledge. I've really learned a lot by listening to them. However, I'm not interested in any more "learned" effluent. It's boring, trite, and predictable.

Good, now you have your answer.

Paul:

You wrote:

“Language tends to run 2 axes: context and content. The West tends to be content rich (many words to describe same thing) and context poor (meaning not strongly tied to situation). Asian societies tend the opposite (something to keep in mind when you're reading Buddhist texts edited by westerners).”

That is fascinating. Do you have any references to recommend so that I could explore this issue further? I do have a few questions, though.

First, what does having many words to describe the same thing have to do with content? I mean, the content is the same if all those words refer to the same thing. I could have sixteen different words that all refer to an apple, and they all have the same content, i.e. an apple. How does having more words multiply the content? Perhaps if they have different connotations? Does that mean that there is less connotation in Asian languages?

Second, I’d need some examples to show that in Western languages, the meaning of words is not “strongly tied” to the context in which they occur. I’m not too sure about this, because my understanding is that all semiotic meaning is strongly context-dependent, whether we are consciously aware of it or not. That is probably one of the key useful insights of Derrida, for example.

Third, you say that Asian languages have words with fewer synonyms (i.e. content poor), and the meaning of those words is highly dependent upon the context. I’ll admit that I’ve tried to find some information about this online, but have come up empty handed, thus far.

Fourth, would you include the form of language as another axis? I mean, the way that language is spoken and written, for example, does have an impact upon its meaning and significance in many cases. For example, there is an argument that the linear and sequential form of Phoenician script in the ancient world contributed to the primacy of logical analysis and reason in ancient Greece after they adopted that script.

Very cool!

P.S. Still waiting to hear what you do with your patients who present with psychiatric symptoms in which they could harm themselves or others after a thorough medical work-up comes up negative. Do you send them home? Or do you consult psychiatry? What do you do?

Guller,

I take from your response you've had little or limited business experience in Asia. Take some courses on transcultural management. It might help you dealing with colleagues from other backgrounds.

I'm not interested in a discussion with you here on linguistic semantics. I can do that in another more appropriate forum.

Do you fish perchance?

Guller,

Did you ever consider I was interested in what people had to say about the topics at hand and not what I had to say (if anything) about those topics?

Amazing... Absolutely amazing, but at least it explains a few things...

Paul:

First, what was ambiguous about my treatment argument? How did the senses of some terms change?

Here it is AGAIN:

(1) Any treatment that helps patients should be recommended.
(2) Medical treatment helps patients.
(3) Therefore, medical treatment should be recommended.
(4) Surgical treatment helps patients.
(5) Therefore, surgical treatment should be recommended.

Do I really need to define "help" and "treatment"? Fine. "Help" means "makes someone feel better". "Treatment" means "an intervention with the intention of curing an illness". There is NO ambiguity, except in your imagination. Just because you can conceive of some possible sense of these words in which there is an inconsistency does not mean that your imagination is determinative in this case.

The meaning of "help" and "treatment" stays the same throughout the argument. You are making a completely irrelevant point to this issue. The argument is perfectly valid. Just man up and admit that you are wrong about this ... one ... thing. Is that really so hard?

Second, you have already waived your credentials about. You have told us that you are a physicist by training, are a physician, and participate in clinical trials for pharmaceutical companies, if I recall correctly. So, you've already broken your rule in the past, and yet now you are suddenly evasive.

Let me tell you the reason why I asked you those questions.

I want to know if you have the strength of your convictions. If you honestly believe that psychiatry is a form of quackery that invariably harms its patients and perpetuates the stain of Nazism in the course of its practices, then I would like to know whether you participate in this horrid sham or refuse to.

Seriously, why not just send a suicidal patient home? Record in your notes, "Patient is depressed and suicidal. No genuine medical issues. Psychiatry is bullshit and would only destroy his brain through toxic medications and rob him of his human rights. Sent patient home." Then if your patient commits suicide and his family sues you, then you can have your day in court to publicize the fraud that is psychiatry.

Or, you could stand by and wait until "the bodies are stacked high enough, and the stench sufficiently overwhelming", as you put it. How many lives could you save if you just refused to consult psychiatry when a patient presents with psychosis or mania, for example? How anyone can sit by and do NOTHING while declaring that we are in the midst of a virtual holocaust is beyond me.

And just so we are clear, none of this has anything to do with the validity of your criticisms of psychiatry. They have great merit, and they stand or fall on their own merits and have nothing to do with anything that I have just said.

Just some thoughts that have been on my mind for a while.

truthman30:

Dr. Healy? What exactly would he disagree with?

He supports the idea that psychiatric illnesses do exist (but criticizes drug companies' creating new alleged illnesses for the sake of prescribing medications to them). I agree.

He supports the use of psychotropic medications for psychiatric illnesses (but criticizes their indiscriminant use in an authoritarian fashion and demands that patients be participants in their care, which includes disclosure of risks and the fact that we are ignorant of many aspects of how they work). I agree.

He supports the use of ECT (but only for catatonia, melancholic depression and mania). I agree.

He supports the use of psychotherapy (but not exclusively, because there are some situations in which medications are necessary). I agree.

Dr. Healy has a very nuanced position that I have learned a great deal about. I'm afraid that he is not the anti-psychiatry caricature that you imagine.

So, what exactly would he "squash" me with?

Dguller,

You write:

"Sally:

You raise fair points in criticism of psychiatric diagnoses, but I would have to disagree with you that all psychiatric diagnoses “falsely denote conditions that don't exist”."

Disagreement noted. To use a legal term, psychiatric diagnoses are void for vagueness.

you write:

I think that if you came across someone who had bizarre beliefs about being abducted by aliens and regularly heard alien voices commanding him to build an altar on the roof of his home and sell all his property to pay for it, and that this was unlike his premorbid personality, then you would quickly identify that there was something wrong."

I'd say the guy has the right to his beliefs in that hypo and to do as he will with his property. Though I'm wondering why you add in premorbid personality. Bizarre beliefs are not crimes.

You write:

"Likewise, if you came across someone who was feeling euphoric, being hyperactive, having racing thoughts, spending all their money and engaging in promiscuous behaviour, without any hint of such behaviour being present before the onset of this episode, then you would likewise say that there was something wrong.""

No, I'd say they'd have that right. I think it's odd that it's the change from one state to another that you mention here rather than the behavior itself. I'm wondering why and how you'd know? Again though your symptoms are void for vagueness.

Further along you write:

"It is not 100% accurate, and it is hard to know how much of it is descriptive and how much of it is prescriptive. That is why it is a fallible text that is constantly open to revision as our knowledge base expands. However, I think it is a mistake to infer 0% accurate from not-100% accurate."

The DSM has the force of law. It's essentially a legal coding book. If it wasn't, I'd have no problem with it as there's some interesting stuff in there kind of like a Gnostic Bible, I'm not saying the whole thing is worthless just that as we see here all of the time most people who wave their labels around proudly haven't any real idea what the dsm says about them.

Then you ask, about your two above hypos:

"Another point is that what you would DO about those two scenarios is a different issue from what you would LABEL those people as having."

I wouldn't label them as having anything but a right to live as they want. Take all of the bloggers here who mention a label and imagine their lives without the label. Telling someone they have abnormal brain chemistry and the voyage from chemical response to feeling they take is a disease, causes bad behavior, it doesn't treat or relieve bizarre thoughts or behavior troubling to self or others.

Sally:

First, I included premorbid personality to indicate a dramatic change in behaviour in the cases I that described. I would know about their premorbid personality through collateral information from their friends and family members. This is important to know, because it is the difference between their normal personality and this new changed state. This does not imply that their problem is necessarily psychiatric, because there are many medical conditions that can present in such a way, and I think it would be unnecessarily harmful to them to simply ignore the marked change in their behaviour on the basis of your difficulties with psychiatry.

I’ll give you an example. A patient presented with a manic episode that greatly concerned his family members who brought him to hospital. He was diagnosed with bipolar disorder and placed on Lithium, stabilized and discharged. I followed him as an outpatient at which point he was Lithium toxic, and I discontinued his Lithium. His medical work-up was incomplete, and his presentation was atypical, and so I did some investigations, and eventually discovered that he had neurosyphilis. He was then admitted under internal medicine, treated with IV penicillin, and his condition improved dramatically. My supervising staff wanted to continue him on a mood stabilizer “just in case”, and I argued against it, saying his manic episode was purely medical and the medical illness has been treated.

So, in that case, if that gentleman’s family members had done what you recommended, and just accepted his bizarre behaviour, then his neurosyphilis would have remained untreated until it potentially resulted in permanent brain damage. That is why it is important to consider premorbid personality and level of function, because it is the marked and dramatic change that we usually look for as indicating something is wrong.

Second, your criticism of the use of DSM-IV for legal purposes is valid. It is used as a kind of Holy Scripture that contains all truth about human psychopathology when this goes directly against its explicit instructions. The problem is when its tentative and provisional nature is forgotten, and its criteria are reified into permanent structures.

So, what exactly would he "squash" me with?

He would squash you with his HUMILITY ...

Guller,

OMFG

You're a nut job - holy smokes!!!!

Wow! It's nice to see you reveal yourself so... so... obviously...

Film at 11

Do you fish Guller?

Paul:

You wrote:

“I’m not interested in a discussion with you here on linguistic semantics. I can do that in another more appropriate forum.”

Then why the hell did you bring up that content-context axis crap about Western and Asian languages? To demonstrate just how intelligent you are? I already know that you are incredibly well-read and smart. No need to bring extraneous information that is irrelevant to the subject matter at hand.

Or maybe you brought it up for some other reason? Hmm. You DID include the following statement: “something to keep in mind when you're reading Buddhist texts edited by westerners”. Ohhhh. Now, I see. You brought it up to subtly undermine my previous claims about Buddhism, because I relied upon Western translators and interpreters. Unlike yourself who obviously reads Buddhist texts in their Sanskrit and Tibetan originals, right?

Or maybe you don’t have to? After all, you probably took some transcultural management courses, which have magically unlocked the key to adjusting the content-context axis whatever that now provides you with an unvarnished view of Buddhist truth.

Rrrrright.

Oh, and I don’t fish.

Oh, it must hurt Guller,

Knowing there is another way, but be unable to see it. Perhaps if you were subjected to these "treatments"? Perhaps, you might gain some real insight? I think you would. But, it seems beyond your perception, so you you just blah blah blah...

I think you're a smart guy. Plenty of smart guys see the trees but not the forest, and vs. of course...

I can tell you, with no equivocation, that fewer lives are lost without Psychiatry than with. It helps not to be an atheist, but that's an occupational hazard. And, who - but you - suggests anyone stands idly by? Just you. There are many ways to treat suffering - not just you way, no?

Basic flaws in logic, basic lack of understanding of humanity, it all leads to a predictable conclusion.

Do you fish?

Guller,

I'm a bit surprised you haven't sorted out which element is ambiguous... No it's not "help" - that's a separate issue. I misdirected you...

I think a sidebar forum discussion area "Furious Seasons Forum" would be a good idea, because every thread seems to end up like this one, and the topic always is the same until the last person goes down in flames and the thread gets closed. Look back at how many threads have been recently "sadly this thread is now closed" ended, and with this same stuff that is in this thread.

After a while, as wordy as I've been over the last 3 years on this blog, even I am skipping reading these threads, they begin to appear to be ego-battles and arrogant ones at that, and it's a turn off.

Thanks for the space to give my opinion.

Guller,

I'm surprised to hear you don't fish given your baiting skills. You're quite the master.

I'm just a cunning linguist.

Stephany,

Mea Culpa.

Fish. Barrel. I can't help myself, but I will try to do better. I should probably focus on my day job... Thanks for reality check!

Guller,

I might also be Asian and a buddhist...

Truly amazing.

Truthman30:

How would his humility squash my “pro-psychiatric-pseudo babble- drug rhetoric with a mere quip of [his] tongue”?

Give me a scenario in which his humility could crush my position through use of a clever and funny remark, mainly used in the context of taunting others.

Thanks.

Paul:

First, there is nothing ambiguous in my argument. Nothing. If there is, then point it out. I can see that you enjoy playing games with misdirection and so forth, but I think that that is pretty dickish in the context of a legitimate discussion. It’s also pretty dickish to be unable to man up and admit that you are wrong about even a single point. I’ve been able to admit my errors on numerous occasions, and yet still survive with my integrity and intelligence intact. And no, you’re not an egotistical narcissist for acting that way that you do. Just a bit of a prick (which we all can be from time to time).

Second, good to know that you do refer your patients to psychiatry, despite believing that they will almost invariably be harmed by such a referral. I’ll keep that in mind the next time you talk about how psychiatry’s sole purpose is power and control, that its diagnostic categories are bullshit without objective markers, and that its treatments are almost uniformly toxic and harmful. That you knowingly and willingly send your patients into the lion’s den is quite remarkable in that context. Another example of your inability to man up, I suppose.
And you are right that you do not “stand idly by”. You appear to be an active agent in this process, which I believe is much worse. I’m a “nutjob”? Well, you’re apparently a collaborator.

Third, I don’t fish. I eat fish, though. I can also spell “fish”. I sometimes play fish. I know people who fish. You’re right! Playing games with people IS fun!

Paul:

And one more thing.

I do see that there are other ways to treat psychiatric patients. I’ve been fortunate enough to have supervisors that practice psychiatry in all different kinds of ways, some more traditional and others more eccentric, some in hospital and others in the community, but I’ve been able to learn from them all.

I personally never enjoyed my inpatient rotation, because of the presence of coercion and force, because of the pressure to discharge people before they had sufficiently recovered, and so on. I have never been a patient on such a unit, but I’ve seen enough of it to know that it must be traumatic to endure.

That is why my intention is to practice outpatient psychiatry where I can take my time my patients, get to know them properly, and care for them in a multifaceted manner more consistent with their problems. Given the public funding in Canada, I will not have the same pressure as my American colleagues to see as many patients a day, which usually means just a medication visit.

And yes, in some severe cases, I will be prescribing psychotropic medications in a participatory manner with my patients, actively involving them in the decision-making process, informing them of the risks and of the fact that we really don’t know how these drugs work, but that they do work in some people.

That’s what I’ve been doing for the past year anyway, and have been successful thus far.

Stephany, you might be on to something though it might be even more of a b*tch for Philip to moderate, still not a bad idea though I do think and could be wrong that these threads generate hits for the site as people follow.

Dguller,

You write:

"First, I included premorbid personality to indicate a dramatic change in behaviour in the cases I that described. I would know about their premorbid personality through collateral information from their friends and family members. This is important to know, because it is the difference between their normal personality and this new changed state. This does not imply that their problem is necessarily psychiatric, because there are many medical conditions that can present in such a way, and I think it would be unnecessarily harmful to them to simply ignore the marked change in their behaviour on the basis of your difficulties with psychiatry."

Sadly, one thing this can imply is that their families are lying or it can imply that their family has a sexual double standard or monetary for that matter. And it's odd that you think the behavior only troubling if it's new behavior, thus persecuting people for changing as generally psychiatric treatment marks the end of a person's life as a functioning member of society and begins their lives as a patient. And of course it implies that the problem with the behavior isn't some much with the behavior but with the newness of it, the change in affect and/or routine.

Should we all go to the doctor when our behavior changes? Go on a diet, is this mania? Stop going to the gym, depression? Begin watching Fox News, paranoid schizophrenia - okay that's really true but the others, do you see my point?

Civilization involves a constant struggle of private quality of life v. public safety and I'd say letting one guy die of neurosyphlis every now and then to prevent a psychiatric police state is a fair trade. If the guy comes in voluntarily and when asked how he's been acting says, "I don't know, ask my wife," that's a bit different but the family thing is a bit sketchy.

Still I'd wonder what the specific "manic" behavior was. It's not that it's wrong to ask someone if they've had a sudden change in affect and/or behavior, it's just that you can't take the families hearsay as proof for a conviction, i.e. diagnosis. And if not a medical problem, you have a duty to let a person go on their way or at least not falsely represent knowledge of psychiatric diseases and treatments that you don't possess. Furthermore why not just give folks narcotics and or amphetamines, drugs that really do create euphoria, oh I know, drug addiction, but still they work.

Paul:

Oh, and one more thing. If you want a great example of a fallacy of equivocation, then just look at your response to one of my posts.

I wrote:

“Or, you could stand by and wait until "the bodies are stacked high enough, and the stench sufficiently overwhelming", as you put it. How many lives could you save if you just refused to consult psychiatry when a patient presents with psychosis or mania, for example? How anyone can sit by and do NOTHING while declaring that we are in the midst of a virtual holocaust is beyond me.”

You wrote:

“I can tell you, with no equivocation, that fewer lives are lost without Psychiatry than with. It helps not to be an atheist, but that's an occupational hazard. And, who - but you - suggests anyone stands idly by? Just you. There are many ways to treat suffering - not just you way, no?”

When I wrote that you “sit by and do NOTHING”, I was obviously referring to your refusal to take steps to prevent patients from being referred to psychiatric care despite your firm beliefs that they would likely be harmed by such care. (You wouldn’t even have to do anything dramatic, like form a human chain at the entrance of the inpatient unit. Nope. Just stop referring your patients.) And yet you responded that “stands idly by” referred to not providing any treatment to those who suffer.

I'm sure you see the difference between not stopping one’s activity of directing patients into harm (i.e. doing nothing to prevent harm) and the refusal to provide treatment to alleviate suffering (i.e. doing nothing to help). After all, not all cases of preventing harm are considered treatment, and not all forms of treatment actually prevent harm. Hell, "harm" and "treatment" are themselves ambiguous terms!

All that in a paragraph assuring that there is “no equivocation”!

Priceless!

dguller: "First, how would you describe someone who obsesses over contamination to the point of compulsively washing their hands 50 times a day?"

I would call that compulsive. And I would keep in mind that many compulsions are harmless, like my excessive Scrabble games. It's only a problem if it's interfering with the patient's life. And even when it is interfering it's still only a compulsion not a brain defect.

Stephany, I totally agree that we need a Furious Seasons forum.

dguller: "How would you describe someone who hears voices telling him that he is the Messiah?"

I would call that delusional. And I would keep in mind that the Queen believes she was selected by God as monarch. George W. Buch believed he was bringing freedom and democracy to the world. Paris Hilton thinks she's interesting. Many, many people believe that there's an invisible guy up there in the sky who watches and judges everything that you do.

dguller: "How could you describe that behaviour without a smidgen of stigma or strangeness?"

I never said that was possible. What I did say, however, was it's a mistake to write off the whole person with damning pseudo-medical words like "schizophrenic."

dguller: "Remember, you have to take this behaviour into account in order to have a successful social intervention."

Of course. But you should intervene respectfully or not at all.

dguller: "One cannot blame [the DSM] for people misusing it and not following its rules."

We sure as hell can. The potential for abuse is quite obvious and should have been apparent at the outset of the project.

dguller: "Again, the best solution is public education ...."

Public to be educated by whom? The brains that broughts us 'depression equals low serotonin, treatment is to increase serotonin, class dismissed'? Or perhaps E. Fuller Torrey's brand of public education where you manipulate and distort data to the point where crazy equals dangerous?

dguller: "... and interaction with those who are mentally ill in order to decrease the strangeness and stigma."

That's going to be tough when we lock our undesirables away before we send them to assisted housing and limit their activities to busy work projects at mental health centres.

I think a far more effective answer would be to dismantle the labels and avoid the misery that they cause. I'm more interested in helping the hand-washer reduce the severity and helping the "Messiah" find his way back to reality. Declaring one schizophrenic and the other exhibiting obsessive-compulsive disorder reduces that likelihood.

You would not believe the sad sacks I run into that identify themselves primarily by their psych label. They've been taught that they are virtually worthless people and they've come to believe it. They've given up their dreams. It's terribly sad.

Sally:

Excellent points.

First, you are absolutely right that collateral information from family members is not uniformly reliable, and there is always the possibility of intentional or unintentional deception. That is an important point that always has to be kept in mind. However, you have to remember that the final diagnosis will be based upon the patient’s account, the family and friends’ account, the clinician’s observations of the patient, as well as any additional information present in their medical records and possible police reports.

So, it isn’t that someone is acting perfectly normal in the interview room while their family is swearing that there is something wrong, and that the family’s word is uniformly taken over the person’s. It’s usually that the family gets concerned, calls the authorities who bring the person in for an assessment, and then we try to put the total picture together, which will inevitably be fallible, because some people have to be followed over time to see what is going on. Regardless, your point still stands. Caution with collateral information must be the default when taking a history.

Second, the newness of the behavior is one thing to take into consideration, but it is not the only thing. There is nothing wrong with someone suddenly deciding upon a change in their life, especially if they are able to take the appropriate and meaningful steps to achieve their goals. However, it is different when someone suddenly begins to feel elated and euphoric almost constantly for several days, believes that failure is utterly impossible because they have acquired supernatural powers and abilities, starts spending money recklessly and having multiple casual sexual encounters, is bursting with energy, and cannot keep their thoughts in order, because they are racing through their minds. This is especially the case when all that behavior is completely out of character.

I respect your opinion and if you were ever faced with a loved one in such a scenario, I’m sure you would act in whatever way you thought would be appropriate, but I doubt if most people would do what you endorse. And when the mania finally subsides (because most do last a few months without treatment)? And the person is effectively bankrupt, having spent most of their money, or has contracted a sexually transmitted disease during their reckless sexual encounters? What then? Still just collateral damage?

Well, fair enough, but again, I doubt that most people would agree with you. I think that most people would agree that such people should be assessed for an underlying physical illness or substance-induced problem, and if that comes up negative, then a trial of medications that have been shown helpful to reduce manic symptoms.

This does not necessarily mean that they have to be medicated for the rest of their lives, and there can be a trial period off medications, if that is what the patient wants. However, if even after a careful titration, there are still multiple manic episodes that wreak havoc on their life, then perhaps more long-term medication might be needed. But if that person, when back to their baseline, demands to be taken off their medications despite the potential consequences, then I would respect that wish, unless there is an element of danger towards other people while mania occurs. If there is no harm, then they are free to make their choice, whatever the result for them.

But I do recognize that this issue has no real clear-cut answers, and we as a society ultimately have to decide where to draw the line. It is important to hear all viewpoints, especially the views of those who have actually lived their lives in the shadow of a psychiatric diagnosis and have felt the impact of involuntary treatment. The most vulnerable must be heard in this debate, and I want to thank you for sharing your opinions with me.

Guller,

Dickish? Does your mom know you use that language? Tut Tut. Btw, do girls have to man up, too?

I never said I refer or don't refer anyone to a psychiatrist or anyone else. Where did I say this? You made this up. Again, this is a pattern with you.

Apparently, I need to to a better job with paragraphs to make it easier for you to follow my thoughts. I was WRONG to think you would not be able to separate different thoughts within a single body of text and not misconstrue them.

Is there any more to say? Do you feel better now?

Paul:

First, girls don’t have to man up. Men do. And you are a man. So, man up. And don’t talk about my mother.

Second, I find it adorable that you are being evasive because you have lofty principles about not disclosing anything about your professional life due to its lack of relevance to a thread discussion.

Except for disclosing that you are a trained physicist.

And a physician.

And work on clinical trials for a drug company.

And have done business in Asia.

And have captured Osama Bin Laden. (No, I made that one up.)

And you were even quite detailed about what you did as a physician when you treated a patient with paranoid delusions about the CIA poisoning his food, which was preventing him from eating. Remember the pituitary adenoma that you discovered and treated? I know I do!

Hmm. Seems like you disclose a hell of a lot about your professional life on this website. And now suddenly, for this particular issue, you discover a highbrow principle never to discuss your professional practice with me.

As I said, very cute.

Anyway, have fun with the evasion, because you sure are good at it. Hell, you might even be right after all about my committing the fallacy of equivocation earlier. You seem to know a lot about equivocation, after all!

I guess there’s nothing more to say, except that you are a total and utter hypocrite if you refer your patients to psychiatry, given your previous statements about its power hungry, toxic and fraudulent nature. Oh, and remember, I’m not actually calling you a total and utter hypocrite. No, no. Only if, if.

Adios, amigo.

Anyone uncomfortable with this thread doesn't understand what's happening here. Or wait, perhaps they do. Furious Seasons is all about investigative journalism, no?

I heart Dguller.

Francesca:

I’m afraid I won’t be able to give a detailed response.

I agree with much of what you say, but we’ll have to disagree about the use of labels. I still feel that the label’s stigma is secondary to the stigma of the behavior that it labels. You could call it “sunshine and lollipops”, and then that term would become tainted by stigma if it was used to refer to bizarre and strange behavior that make people uncomfortable and frightened.

But regardless of the labels issue, people should be treated with dignity and respect, especially those who are most vulnerable, and efforts should be made to protect them from being abused and neglected. And no-one should be identified with their label, and if the system current reinforces that incorrect perception, then the system has to change.

I’ve got exams to prepare for, and so I’ll have to take my leave for a while.

Thanks for the stimulating conversation, and be sure to look into correcting your apparent misdiagnosis.

Take care.

Truthman30:

How would his humility squash my “pro-psychiatric-pseudo babble- drug rhetoric with a mere quip of [his] tongue”?

Give me a scenario in which his humility could crush my position through use of a clever and funny remark, mainly used in the context of taunting others.

Thanks.

Guller..

Oh man..

You do get tiresome after a while, it's no wonder most people give up on engaging with you.. it must be my Irish Blood that keeps me coming back for more..

If you don't see how your attitude is the absolute antithesis of humility then I think that furthers my argument even more..
Take a read through your perpetually arrogant posts here on this blog, you just might encounter a revelation ...

truthman30:

Honestly, I can't even be bothered with your nonsense. And it's not because I'm arrogant. It's that time is too short to waste it. My mother taught me that. As well as to watch out for dickish behaviour.

In short: What. Ever.

flawedplan:

Love you right back, sister!

It would be nice if it was on topic Robin, after it hits archives these discussions are lost and therefore in my opinion not able to be appreciated for what they might and could offer, and the arrogance factor remains to be a thorn in my side, but so what!

Here's my suggestion #2 about the Forum idea as if it matters but this thread is so off topic what the hell:

Philip needs to write an article about mental illness and religion and philosophy and let's not forget about what a soul is, and all of those other topics that come around eventually in these long threads.

If a person wants to re-read any of these threads, just TRY and remember where they are! they usually get closed due to increased and heated debates, and there were (for example) many eloquent comments re: psychiatry and the soul of human beings, that is now tucked away under some obscure post.

So, that's my point. (about needing a separate forum)

Well, if you can't be bothered, then don't respond..

And anyhow, your doing more damage to the profession of psychiatry with your attitude and remarks than I ever could..
You inflame and get on most peoples goat on this website, and you fail to see them all telling you that you are an arrogant, conceited , ego-maniac.. surely you can see that if most people are irritated and annoyed by your very presence , there must be something you are doing with your own behavior to evoke that reaction? ..
I never ceases to astound me how psychiatrists almost always fail to notice or acknowledge flaws in their own personalities , yet are always the first ones to point out the "defects" in everyone else's...
And as far as I am concerned, most psychiatric diagnosis are completely invalid..
I think you (and people like you) are dangerous and I think the absolute crap you sprout comes from a sinister and insidious ideology ..
I choose to engage with you because I think people need to see what kind of people the profession of psychiatry attracts to it..
I have no problem with you as an individual..
You have made your choices , misguided though they may be..
I think you really think you are doing the right thing..
But, I also feel you should open your eyes to the reality of the people's opinions on this blog..
Most of them have had absolutely awful experiences with psychiatry and psychiatric meds..
You seem to forget that...

Just in case you check back in on this thread, dguller, I wanted to clarify that the focus should be on addressing (and, I concede, labelling) specific behaviours (compulsive handwashing) rather than perpetrating the all-encompassing personal judgements that psychiatric diagnoses represent.

dguller wrote, "I still feel that the label’s stigma is secondary to the stigma of the behavior that it labels."

The problem with this is that people don't have the characteristics of this label 100% of the time. Think of the label "borderline." When a patient has the borderline diagnosis/label medical staff make immediate judgments about that person before they've even met them. This includes those working in psychiatry. I know because I've heard it. They may not roll their eyes and say negative things in front of patients, but you can be sure that if a new patient arrives with the label "borderline" and this patient gets angry over something it will never be viewed as justifiable anger, it will be viewed as that overreactive troublemaker acting up again. I'm not sure how that label will be helpful to the patient, but I do see how it would be harmful.

To me it's important to hammer this stuff out and at times fun. And of course not really off topic.

Dguller,

You write:

"I respect your opinion and if you were ever faced with a loved one in such a scenario, I’m sure you would act in whatever way you thought would be appropriate, but I doubt if most people would do what you endorse. And when the mania finally subsides (because most do last a few months without treatment)? And the person is effectively bankrupt, having spent most of their money, or has contracted a sexually transmitted disease during their reckless sexual encounters? What then? Still just collateral damage?"

I'm wondering where you get this stuff from. Are you watching made for tv movies about the "mentally ill?" The vast majority of people who spend irresponsibly are not labeled as being in a "manic" state? The vast majority of people who get sexually transmitted diseases again not labeled as "manic." The collateral damage would be the person labeled as "mentally ill" because they're relatives chose to intervene on behavior others do all of the time, or are you alleging that sexually transmitted diseases and bankruptcy are psychiatric disorders themselves?

The fact that I fall in a group where you can patronize me with stuff like

"It is important to hear all viewpoints, especially the views of those who have actually lived their lives in the shadow of a psychiatric diagnosis and have felt the impact of involuntary treatment. The most vulnerable must be heard in this debate, and I want to thank you for sharing your opinions with me."

is creepy. Do you see how your assumption that people with psychiatric diagnoses are vulnerable and live in the shadows is demeaning and harmful? I suppose it's a double edged sword. You probably think that giving psych labels is a way of being compassionate but it's not.

Guller,

I'm not going to discuss my professional life with you. You are free to say anything you want about yours - that's your business. It's not being "cute", lofty", or "highbrow". Curious you see it this way. It's a decision I made for my own reasons long before you flew into town. It's not all about you, you know? You don't have standing to demand anything from anyone here. Don't ask again.

If only I had a nickel for every time I've had to correct your misrepresentations of my statements. It's a troubling pattern that forces me to keep you at arm's length. I'd like to think it's not deliberate, but you seem to do this with other commenters too often for my radar.

You claim I've disclosed a "hell of a lot". Actually, you know next to nothing about me so you have no basis to assert whether I've disclosed little or much. You're just making this up.

I never claimed to have worked in Asia. I suggested that I didn't think to you had based on your response to the east/west language content/context bit. Suggesting you haven't doesn't imply I have.

Physics is a huge field - I've said nothing about my area of expertise, nothing of published works or inventions, zero, nada, zilch.

I've shared personal experiences I've directly observed both as a medical professional and as a patient - that's the point. I try to be careful not to distinguish between the two, but it happens.

I've said nothing of the other fields I've qualified in.

You don't know if I even like curry, hehe.

I can't be bothered going through the rest of the laundry list - too boring, although I am fond of our hypothetical CIA guy.

This qualifies as a "hell of a lot"? What qualifies as a "hell of a lot" are the seemingly endless pointless posts dealing with your proclivities. Isn't this a sign to start your own blog? Regardless, I am going to work very hard not to further enable you.

Lastly, I spent a few hours today drinking with some math buddies. I'll shorten what we concluded to a few sentences to be merciful:

1. Most thought your first premise was vague, but only half thought sufficiently so. It would have been easy to fix by changing a single word and adding another. Everyone thought, however, I should have said your argument was not valid, rather than invalid, due to the ambiguity in the first premise. Premises and conclusions must not be ambiguous, but this does not make the argument invalid, strictly speaking. It makes the argument flawed and neither valid or invalid. So it does turn out I was WRONG! See, I can say it!

2. Everyone thought the argument not especially germane for this topic. A better example to show validity could have been:

2+2=5. So it is raining.
or
2+2=5. So it is not raining.

Both are valid arguments, but also meaningless to the discussion here. At least these examples are concise, clear, and unambiguous valid arguments.

Stephany,

It's a good idea. I try to cut and paste the gems, but I lose track from which article it came from. I guess some forum system with threading and search functions would be useful, but I wonder about the cost and upkeep to Philip.

There are some free open source solution like slashcode.com (see slashdot.org for a well established implementation), but this is pretty big step up in complexity and utility if you're not in the trade.

I like the idea in principle, but it may end up as a detraction from what Philip is trying to accomplish.

Sorry guys.

I would love to continue to this dialogue, because some good points have been raised. Unfortunately, I've got some exams coming up, and have to devote my time to studying.

Maybe some other time, then!

Wow. I've been away for a few days and just got caught up on my reading of this thread.

I'm sure it's no secret that I despise guller. But even I am astonished at the pathology he's demonstrated here (and no, I'm NOT going to play your tiresome "provide me with proof" game). I found myself actually feeling sad as I watched him disintegrate over the course of the thread, especially as this is not the first time this has happened (nor will it be the last, I suspect).

My dad came from a wild Irish family who had a great deal of difficulty with intimacy. They were quite brilliant, creative, amusing people. But the only way they could engage their fellow humans was in endless arguement and debate. That's what I'm seeing here, no ability to have what most people would call a normal discussion, just a never-ending need to triumph, score points and overcome the... well, the word enemy comes to mind. Sad.

Of course, guller puts the cherry on his sundae by adding a huge, flaming blob of arrogance to top it all off. My Dad's family at least didn't have that quality.

This is the second psychiatrist in my time here to show up and, over time, provide a free demonstration of sheer pathology under a nice, socially acceptable shiny surface.

Wow!!!!!!!!!!!!!!!!
Still?

Truthman30,
I didn't know you are Irish.

"How would you describe someone who hears voices telling him that he is the Messiah?""

guller,
Again?
You love to raise this question over and over again.
I believe that for your hearing voices is the...
Why bother?

There are other posts.
All I know is that whenever I see on the list of "Recent Comments" so many comments by Dguller I don't feel like commenting.
I usually look and just read Philip's posts.
Dear Lord man!
Don't you have a job?
Go read Ludwig Wittgenstein.
I will never understand why a psychiatrist likes to participate blah blah blah....

But keep coming dguller.
It's good to raise the number of comments but unfortunately these threads are not of any help for those who come here for the first time.

For those who are here at the first time:

READ THE POSTS!
Philip's work will offer you very good information.

Lisa:

I agree with your point about Holocaust survivors. There shouldn't be a time limit on "getting over" events that caused harm in one's life. Sadness, rage, anger, and bitterness are normal, human responses to injustice and loss. Loss, of any kind, hurts and can hurt for a long time.

If people are feeling bitter about losing jobs, money,and homes, the feelings are valid, especially in a culture that puts emphasis on possession, money, and "keeping up with the Jonses" as markers of personal worth. Lose the things, then you lose the worth and bitterness ensues from the anger. It's the American Dream gone sour mixed with fear.

And as a Buddhist, I'll add this: Buddhism labels mental states, but out of a sense of compassion and belief that mental states are temporary, and part of the journey toward enlightenment. The process of enlightenment entails shedding erroneous beliefs and this can take many lifetimes. The bottom line though is having compassion toward oneself and others as we all must work through these mental states. According to Buddhism, we are capable of breaking out of these mental states and evolving, a hopeful belief.

Based on my own experience with therapists and pyshiatrists, they label but lack compassion, and believe these mental states are permanent with little hope for improvement. The label becomes not a marker for a temporary state but a definition for life, thus limiting a person to that particular state.

Paul:

Sorry, but I just can’t resist, because it’s all just too ridiculous.

You previously wrote: “I don't think my professional background should mean anything in a place like this. I don't come here to render professional judgments.”

Except that you DO “render professional judgments” from time to time from the standpoint of a trained physicist, a practicing physician, and a participant in clinical trials by drug companies, WHEN IT SUITS YOUR PURPOSE. You have already done this from time to time, and thus have no problem, in principle, of disclosing information about your “professional background”. You wouldn’t have disclosed any details whatsoever if you firmly believed that your “professional background” should not “mean anything in a place like this”. But you do, which falsifies your cited justification for not responding to my points.

If you want to nitpick my depiction of the DEGREE to which you disclose information, then that is fine. I may have used a bit of hyperbole, which would actually make me a bit of a hypocrite myself since that is one of the criticisms I often level against people here. So, that’s a fair point, but completely irrelevant to my point.

To remind you, my point is that if you are a practicing physician and refer your patients to psychiatry, then you are a total and utter hypocrite, given your beliefs about its Nazi-like foundational structure, its thirst for power and coercion, its fraudulent diagnostic system, and its toxic treatments.

You have defended yourself through evasion and subterfuge, which is certainly your right, but I find it incredibly strange that you are doing so, because this matter should be very easy to clarify. There are only one of three possible reasons that I can see that you are doing this: One, you know that you are a hypocrite, and are being evasive to avoid this truth being brought to light. Two, you are a liar about being a physician, and are being evasive to avoid this truth being brought to light. Or, three, you are being evasive just for kicks, and thus are engaging in supremely dickish behaviour.

And if you reply by being more evasive, then please see the previous paragraph. And again, none of this has any bearing upon the validity of your criticisms of psychiatry. That is a separate issue altogether.

Anyway, I am happy to see that regarding our previous logical dispute, we were potentially BOTH wrong. You know what, I can live with that, and I do appreciate you finally manning up to your mistake (sort of). I’ll do the same. :)

Okay, now I REALLY have to get back to work. :)

Sherry:

You can point to two aspects of my conduct here that are "pathological".

One, I question some of your assertions -- not all -- and ask you for evidence for them. Clearly, a sign of a demented mind. Accepting your pronouncements as gospel truth with an unquestioning frame of mind? Ahh, therein lies true mental health.

Two, in response to hostile and derogatory remarks, I can eventually become snarky and belligerant myself. Also, an apparent sign of pathology. Sure, it would be healthier if I just let people displace their negative experiences with previous mental health practitioners onto me without comment. Thank you, sir, may I have another!

Once again, I do not doubt the sincerity and authenticity of your negative experiences with psychiatry, nor anyone else's here. Your experiences must be articulated and voiced publicly, because they are important and must be incorporated into any future reform of my field.

However, there is a difference between having an experience and inferring other ideas from that experience. (See my Hyundai analogy above.) To do the former just requires having undergone the experience in question, which you definitely have. To do the latter requires that one is consistent with both known facts and logic. I doubt that anyone would say that I am pathological for saying this.

What I find here is that when I raise questions about what people infer from their negative expereinces of psychiatry, and I do not immediately accept their explanations and justifications, then I am automatically described as an arrogant, intolerant and pathological human being. I assume that this is because people think that if I question their inferences from their experiences, then I must question their experiences. This is neither true nor logical.

I know that this will not change your revulsion towards me. We are too far gone down that path for anything to change. And that's fine. We can both live long and fruitful lives without each other's affection. Just remember that not everyone who questions your claims and requests evidence is a totalitarian dictator who has a pathological sense of arrogance and grandiosity. I know I'm not, at least! :)

Take care.

"Nazi-like foundational structure, its thirst for power and coercion, its fraudulent diagnostic system, and its toxic treatments." Guller

GREAT definition of psychiatry!

"Nazi-like foundational structure, its thirst for power and coercion, its fraudulent diagnostic system, and its toxic treatments." - guller

"One of its interesting findings: Psychiatrists are more likely to be Jewish than non-psychiatric physicians. I suppose that is evidence of the historic tensions between Jews and non-psychiatric medicine. Also, I wonder what it is about Jews and the attraction to become Nazi-like human rights violaters? Hmmm. Now that's a deep thought." - guller

"Yes, you got me. I do strangle puppies and poison schoolchildren. My secret's out." - guller

"Sure, maybe if he was on medications, then that could have been a factor. But if we're going to be listing other contributing factors, then why not include his belief in an immortal soul? I mean, he was part of a virulently anti-abortion Christian group, and likely thought that his precious immortal soul was doomed to perdition if he did not stop Dr. Tiller from performing abortions. It was the soul!" - guller

I'm sure everyone who wants professional mental health care will be lining up to see the likes of you when hell freezes over rock solid in the near future.

http://bipolarsoupkitchen-stephany.blogspot.com/2009/06/i-am-captain-of-my-soul.html

final words for this thread:

Invictus

Out of the night that covers me,

Black as the Pit from pole to pole,

I thank whatever gods may be

For my unconquerable soul.

In the fell clutch of circumstance

I have not winced nor cried aloud.

Under the bludgeonings of chance

My head is bloody, but unbowed.

Beyond this place of wrath and tears

Looms but the Horror of the shade,

And yet the menace of the years

Finds, and shall find, me unafraid.

It matters not how strait the gate,

How charged with punishments the scroll.

I am the master of my fate:

I am the captain of my soul.

~William Ernest Henley

Truthman30,
I didn't know you are Irish.

Only an Irish man could have this much fire in his belly , don't ya reckon? ;)

Dguller,

You take criticisms of psychiatry personally. Just because your career path is immoral, harmful and archaic (not necessarily in that order;), doesn't mean you're a bad person, just a very young and naive one. It is scary to think how much power you have over the lives of others when practice is based on incorrect information and belief. When you explained to me that the ultimate purpose of psychiatry is the prevention of bankruptcy and venereal disease, well Thomas Szasz himself couldn't have made the anti psych point better than you yourself.

The entire fight we're having here is one that Szasz and Torrey have gone round on for decades:

http://www.idiom.com/~drjohn/review.html

I'm not sure why I'm bothering, guller, but once again you've totally misinterpreted what I said. Please stop.

Sally:

No, I take personal insults personally. I know. It's shocking, no?

Feel free to criticize psychiatry all you want. I'll happily join you when the criticisms are appropriate and valid.

And regarding your previous comments. No, not every case of STD contraction is a manic state, but if manic, then there is a higher risk of contracting one, especially if one of the symptoms of being carelessly and recklessly promiscuous.

Oh, and I have participated in the care of patients who have contracted STD's while manic, and after their manic episode has resolved, have expressed total regret about their previous behavior. Even a few that contracted HIV. I have also cared for patients who have almost gone bankrupt in the midst of manic spending. So, no this is not something I saw on a television show. I have seen its impact in real patients.

Reality Check:

You are right. All those quotes of mine were said in total earnestness. And Jonathan Swift was serious about solving the Irish potato famine by eating babies. What a monster!

Guller,

I'm so sorry I can't help you. I'm sure some one can, but I cannot. Good luck with your search for help. It's out there somewhere.

Try to focus on the positives, get enough sleep, and think of the other person's well-being as you do them harm. Leave each place a little better before you move along. Try to think of what a person is trying to say rather than what you need it to mean.

Again, I am sorry I can not be of any help to you, but I think you will eventually move forward.

Sherry:

Look. All that matters is that we both agree that it is very important for you to keep telling your story, because it contains truths that members of my field often forget. No matter how much we mutually seem to frustrate one another, I still have to thank you for sharing your story.

with regret, i am closing this thread. it's gotten a bit out of hand.