Comments: Senate Probe Snares Major Bipolar Researcher, "Infinite Mind" Radio Show
To some people, this is going to be, "A-ha, that d*mn Fred Goodwin!"
To me, this is a tragedy.
When I was first diagnosed with bipolar disorder, it was his writings that gave me hope I didn't have at that time (i.e., I was still somewhat suicidal) that the disease was something that could be controlled and managed.
Obviously I found out on my own, well before this report confirming his suspected corruption, that BP is in fact not at all easily controlled and managed. But it is still a disease one can live with, and I have a small amount of gratitude even now to Dr. Goodwin for reinforcing me at a vulnerable time.
Then again (and this will tell you my age) Pete Rose's hustle and O.J. Simpson's acrobatics lured me into baseball and football as a fan as well. The best and brightest among us are not immune to human weakness and frailty -- and sometimes, due to hubris, are especially susceptible.
Posted by Larry at November 21, 2008 11:22 AM
Philip correct me if my memory has failed here, but wasn't Goodwin overseeing the recent CBT vs. ZOLOFT FDA study???
Posted by Stephany at November 21, 2008 11:55 AM
Awright!
Posted by Sherry at November 21, 2008 12:30 PM
Seems kinda like, utterly awesome to me. I wish more of us felt there is hope without drugs, because, there is plenty of documented evidence that there is hope without drugs. Sh*t, there's even hope for Republicans (Grassley.)
Posted by Sophia at November 21, 2008 02:29 PM
I have to agree with Larry. This is disheartening news. For bipolar disorder information, I turned to his book with Jamison. I have read the diagnosis and epidemiology sections which were probably not effected by pharma money. I haven't read the treatment section. I wonder how much of that section is tainted by skewed pharma research. Is there any experts in bipolar disorder that are truly impartial?
Posted by Tony at November 21, 2008 02:31 PM
larry and tony, i understand your points. his book was very influential on me in the early 90s and i'll have more to say about that on monday.
tony, i'm beginning to think that there are few researchers in the bp/depression world who have clean hands. er, well erick turner at ohsu does, but he's an exception.
Posted by Philip Dawdy at November 21, 2008 03:04 PM
Had his book not made it to press along with all the other BS written about the treatment of BP, real research may have taken place that would have allowed you real peace.
Thats the problem that has occurred in Psychiatry, no real meaningful treatments have been examined or even looked for because they didn't need too. Pharma and their whores conned the world into believing their pills could cure them and make life grand.
Their is no doubt in my mind we would be much farther along in actually providing help to people with it weren't for the Goodwin's, so I say "a-ha, that damn Fred Goodwin!"
Posted by jane at November 21, 2008 03:19 PM
OMG -- he co-authored a book with that Lithium-addled Jamison? I'm sorry I know she's smart but she doesn't understand drug dependencies or withdrawal and totally mistook the course of her own drug-induced rebound experiences for "relapse" and has perpetuated this misunderstanding in her writings and gone on to become an "expert." It really frosts me at times.
Posted by Sara at November 21, 2008 03:23 PM
Last year even the vaguest criticism of Goodwin would get you labeled a Scientologist by the psychiatry is a real science folks, now The Infinite Mind is going off the air! Progress. Hopefully the biopsy stuff will be further debunked by next November.
Posted by Sally at November 21, 2008 03:46 PM
I'm glad Philip understood my point.
I'm sad but not in the least surprised so many others didn't.
Posted by Larry at November 21, 2008 05:09 PM
OK, so now Goodwin has been outed by Senator Grassley. Jesus! And the beat goes on. Who's next? Why on earth do these psychiatrists lie about their financial ties to drug companies? Are they sociopaths or what? I mean, it's not illegal to take money to pimp for drugs. Why don't these leaders of psychiatry simply admit they take money, and just say that it doesn't bias them and that they always keep the best interests of their patients in mind? But they lie! Nemeroff, Biederman et al. blithely ignore reporting requirements to NIH and go on their merry way. Goodwin lies to NPR. Why??? Don't they see that by covering up, they increase suspicion that they are, in fact, biased and on the take? This is disgusting for our profession!
Posted by Tom at November 21, 2008 05:50 PM
The phrase, "Physician, heal thyself" springs to mind, jostling for place with "First do no harm". It is appalling that these wankers are even employed. They truly have blood money on their hands.
I happen to rely on medications to keep me this side of the death line. My brilliant doctor sees a day for me in the future, where I will be meds free. I always viewed my BPII Disorder as a life-long maintenance, like HIV or diabetes.
I was astounded last year, when a British site talked about being CURED of my illness. It was something I had never even considered.
Possibly because of the culture of pills that exists here, pushed by all those f*cktards lining their wallets with the resulting profits.
Posted by Dano MacNamarrah at November 21, 2008 06:12 PM
sara, first of all i have to say i don't like your "lithium addled" insult. i don't think that's necessary. i suggest you read jamison's memoir which leaves no impression that her symptoms were brought on by drug withdrawal. just because you'd like something to be a certain way doesn't mean it is. also, she is considered an expert (no quotes) not because she takes lithium but because she knows her stuff. your attitude frosts me.
Posted by Ingrid at November 21, 2008 06:14 PM
I look forward to reading more of your thoughts on Dr. Goodwin .
I'm saddened because a story like this one, like any negative news article, will vilify Dr. Goodwin way more than what is reasonable.
He started at NIMH in 1965 and was one of the first researchers to identify the antidepressant effects of Lithium (this is from his website). Almost 30 of the 45 years of his career was at NIMH in research. I am sure he meant to "do no harm". I heard him speak to the DBSA group in Washington D.C. last year, where he showed some extensive data comparing Lithium and Lamictal, and made a case in favor of both of them based on specific diagnoses. If he was paid $329,000 by Glaxo over the period of one year to present his (legitimate) case for circumstances where he found Lamictal to be the best mood stabilizer, is it really that big a deal, for someone with Dr. Goodwin's reputation? I'm sure he could have made a lot more than whatever he did, if he wanted to. I think there's a fine line between 'promoting a drug' and being paid to speak about actual findings which show the effectiveness of a drug.
I think (hope) that most of us look to defend Dr. Goodwin as far as possible, while acknowledging possible lapses in judgment and unethical behavior. I hope a lot more details emerge which are not as damning as the first story.
Posted by Sekhar at November 21, 2008 07:32 PM
Ingrid:
Your attitude and close minded approach frost me!
You can kiss Lithium-addled Jamison's arse all you want. She has always been pro-pharma, and in reading her book "An Unquiet Mind" and her other questionable writings; I happen to believe she is in personal acceptance of her so called bipolar label, while maintaining a completely professional denial state and separate role as Dr. and bipolar genetic researcher @ John Hopkins University.
I just have to wonder when they and she will be outed by Congress. She is really big into the child bipolar fantasy and myth also! Look at that list of corrupt and criminal elements on that board which Jamison is a renowned member.
http://www.bpkids.org/site/PageServer?pagename=ppl_advisory.
"There is a tremendous amount of progress in understanding bipolar disorder. It's a bad illness to have, but a good time to have it."- Kay Redfield Jamison, PH.D.
Read this Ingrid and all; written in Dec 2007 on
http://bipolarsoupkitchen-stephany.blogspot.com/2007/12/1999-2007-ocd-adhd-childhood-bipolar.html
at Soulful Sepulcher Blog and wake up from your sleep walk through la la land.
Ingrid nice try, but I and others are not buying your bull even for lawn fertilizer!
Yours Truly,
Stan
Posted by Stan at November 21, 2008 09:24 PM
Ingrid, I have read her memoir twice and it's littered with signs that she was in drug-induced dependency and withdrawal and rebound. The whole course of her "illness" was influenced by her treatment along the way. But I appreciate this can be hard to accept until you've seen it and understood it in others from first hand experience.
Posted by Sara at November 21, 2008 09:42 PM
....In a program broadcast on Sept. 20, 2005, Dr. Goodwin warned that children with bipolar disorder who are left untreated could suffer brain damage,....
I've been reading this theory being used to other diseases.
I'm not a physician but it's quite odd to me.
Posted by Ana at November 22, 2008 04:02 AM
Jamison is a pretty horrible person, what with her acceptance of the bipolar label. Those of you happy with the label are generally affluent and I guess lacking in a certain integrity. It's the poor people with the label, whether powerless children, spouses, inmates in psych hospitals or aot'd non conformist who are literally murdered by this unscientific nonsense. Ingrid, maybe the problems you have sleeping are brought on not by bipolar disorder but by your guilty conscience. Surely you realize that all science is against your chemical imbalance theory of "mood disorder," and yet I would imagine that you blame all suffering of folks so labeling on some failure on those folks to comply with their drug regimes. Maybe when you your loved ones destroyed by lithium induced renal failure, you'll open your mind to reality a bit.
Posted by Sally at November 22, 2008 07:12 AM
Goodwin defenders, sheesh, it takes all kinds. I can't wait for Jamison's books to be opened. Jamison is a pretty horrible person, what with her acceptance of the bipolar label. Those of you happy with the label are generally affluent and I guess lacking in a certain integrity. It's the poor people with the label, whether powerless children, spouses, inmates in psych hospitals or aot'd non conformist who are literally murdered by this unscientific nonsense. Ingrid, maybe the problems you have sleeping are brought on not by bipolar disorder but by your guilty conscience. Surely you realize that all science is against your chemical imbalance theory of "mood disorder," and yet I would imagine that you blame all suffering of folks so labeling on some failure on those folks to comply with their drug regimes. Maybe when you your loved ones are destroyed by lithium induced renal failure, you'll open your mind to reality a bit.
Posted by Sally at November 22, 2008 07:13 AM
I read The New York Times enough to know that the Times does a better job covering mental health than any other big city paper. But that's not saying much, is it?
I read Philip Dawdy every day. I appreciate that Furious Seasons is pharma-free and supported by readers like you and me.
Dr. Goodwin is my doctor. I believe him to be the best doctor in the world for people with mood disorders. I am not alone in this belief system!
I agree with readers here that Dr. Goodwin should've let his radio listeners on The Infinite Mind know he's tight with big Pharma before each and every broadcast.
The Infinite Mind radio program hosted by Dr. Fred Goodwin and others has been on the air for over a decade and National Public Radio is just now noticing that Dr. Fred Goodwin is NOT a journalist?!!
Bill Lichtenstein, a respected journalist and producer of The Infinite Mind, just realized that Dr. Goodwin has connections to the drug industry?!!
In the acknowledgments section of the book Dr. Goodwin wrote with Dr. Kay Jamison, Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression published in 2007, Dr. Goodwin lists several big Pharma companies that support his work.
A quick Google search brings up Dr. Goodwin's entire professional life -- big Pharma relationships, ground breaking research and all.
I am cautious when I listen to National Public Radio or read The New York Times for mental health information. LOL
Cheers,
Moira
Posted by Moira at November 22, 2008 07:27 AM
Could anyone please post the timeline of Dr. Jameson's symptoms to account for whether her psychiatric symptoms were due to illness or medication withdrawal? Also, what about her years of suffering manic and depressive episodes prior to starting medication?
I recall that her symptoms did not appear within a few weeks after discontinuing her Lithium, but rather several months later, which is in keeping with a manic relapse. However, I read the memoir a while ago, and would appreciate someone posting some details on this with page references.
Thanks!
Posted by dguller at November 22, 2008 07:29 AM
Also, I think that two things are certainly true:
(1) Psychiatric symptoms secondary to illness are real.
(2) Psychiatric symptoms secondary to physical illness, medications and medication withdrawal are real.
I think that depending upon one's background, one will either emphasize (1) or (2). However, a reasonable position would be that BOTH are true, often in the same patient.
The best care for patients with psychiatric symptoms is to attempt to identify patients where medications are the solution and where they are the problem, because the management will be different for both.
It is highly unfair to demonize those who legimately suffer from mental illness and who have found benefit to taking medications, just as it is unfair to demonize those who have been mislabelled as having mental illnesses and who have struggled with medication dependence and withdrawal effects.
Mental illness is very complicated and the answers aren't always straightforward, but our knowledge base is expanding regularly, and reasonable criticism is always welcome for progress to be made.
Thank you.
Posted by dguller at November 22, 2008 07:40 AM
In response to Sekhar's comment I do have to say that the real disappointment here is that a lot of these doctors are well meaning and don't even realize quite how they are being sucked in when it happens. It's a great tragedy of medicine. Sekhar points to the science that Goodwin referred to in his presentations but after what I have seen of clinical research in psychiatry I wouldn't touch it with a ten foot pole and that isn't to say I think the researchers are engaged in some conspiracy to hide evidence. It's just that they don't get it, they lose sight of common sense, and they don't want to believe medication is harmful -- too much is at stake. And meaningful long term outcomes are rarely evaluated. Thus the research that is almost always devoid of any clinical narratives to give you any hint of what really happened is almost meaningless. There are scores of "good people" out there that have been brainwashed by forces much bigger than anything they can control. We are talking about some major social and cultural ills that have gotten us to this point. Our whole health care system is in danger of serious implosion if things don't change because we are no longer making people well -- we're making them ill.
Posted by Sara at November 22, 2008 08:24 AM
The only thing that qualifies someone in becoming a leading expert is how well they pimp for drug and device companies. I know that is hard to believe, but that is fact. The fast way for an "expert" to tarnish their name is to start discussing the harm medications do. They can kill as many people as they want. They just can't say anything wrong about a drug.
Posted by jane at November 22, 2008 08:46 AM
I'm no fan of "The Unquiet Mind", and was a critic of Kay Jamison as a "Bipolar Elite", until a friend pointed out to me a lot more about her background, and if she is "Bipolar Elite", it's deservedly so.
I just read the above-mentioned article in The Soulful Sepulcher, which refers to a Kay Jamison quote in CABF mailings ("...bad illness to have, but a good time to have it"). I remember reading that quote a long time ago, and she meant it about BP in general, not relating to childhood BP diagnosis. I too have serious reservations about the excessive use of BP diagnosis in adolescents.
I agree that something has to be done about the influence of pharmaceutical monsters. I believe that researchers and practitioners engaging in any unlawful dealings with pharmas have to be investigated. But sponsorship by pharmas helps Dr. Goodwin, Dr. Jamison etc. to dedicate a lot of time to mental health outreach, and brought more awareness to BP. Organizations like NAMI, DBSA, MHA, and yes, CABF, do some good work and are unfortunately dependent on pharma funding for the most part.
But I am wondering who WE are going after? Why are WE on a witch-hunt to completely condemn professionals who have been on our side for the most part? Sure, let's hold them to high standards, but let's look more at a system which has allowed pharmas to get away with absurdly high costs for meds, manipulation of FDA, and being a primary source of funding for researchers and even peddling influence with run-of-the-mill psychiatrists.
Those of us with mental illnesses might as well join an anti-psychiatry movement, if we want to crucify the likes of Dr. Goodwin and Dr. Jamison.
Posted by Sekhar at November 22, 2008 08:51 AM
Jane:
It is untrue that only those who are sponsored by drug companies are recognized experts. Dr. Peter Kramer does not take drug company money, but he is recognized as an expert in his field, and quite a popular one at that.
Thank you.
Posted by dguller at November 22, 2008 09:10 AM
I believe that corruption has to be redefined.
Posted by Ana at November 22, 2008 09:46 AM
I agree that psychiatric symptoms can be secondary to real mood issues that are not medication related. Whether I believe medication is really a good solution, especially long term, is another thing. And I do intend to report back on An Unquiet Mind and some of the issues I see in how it's written. I felt absolutely queasy reading it knowing what an influence this could have on someone who had some of the mood dysregulation that she so vividly and poetically describes. But as far as I'm concerned she idealized some things and brushed over others with only the slightest hint and I think there's more to her story than meets the eye that's for sure. But of course she isn't telling it with an eye to demonstrating things that would support my point of view but rather her own so it is a question of highlighting certain details that she includes almost inadvertently.
Posted by Sara at November 22, 2008 11:14 AM
Minimepes:
I would say your post is more than a little off topic, and smells of a bad pitch. But with that said; we will pass along the Hound Dog Site to Dr. Goodwin, even though I believe he has socked away enough pharma money to last a couple of life times {laughing}.
Stan
Posted by stan at November 22, 2008 11:28 AM
Dr. Fred Goodwin goes down hard. The Fred Goodwin. Author of the book that's cited on almost every article I've read on BPD.
$329k this year? Oh my.
It super banal to say so, and I'm sorry for that, but this is sorta shocking.
Did he really offer the defense that everyone else is doing it?
Posted by tom at November 22, 2008 11:36 AM
Sally:
I get that you have problems with Kay Redfield Jamison's professional work. I get that you do not accept that medication can treat mental illness. I get that you had a horrible tragedy in your family. My condolences.
Yet and still ...
My own grandmother, diagnosed with bipolar disorder, suffered terrible (though not, granted, fatal) side effects from lithium. Yet her grandson still takes lithium (and with some, less serious side effects), over his mother's objections, because after 11 years of sad trial and error, he has found it to be the best way to control his moods.
And because her grandson, unlike her daughter, has researched the h*ll out of all the health care decisions he makes because his very life is at stake.
I am not affluent; but I am also not powerless. I just draw a different conclusion from the data than you do. (Flawed though it is, I concede.)
So the statement that people who say they have bipolar disorder in fact have a "guilty conscience" and lack "integrity" is just galling. Talk about burning bridges. Be careful who you flame -- your searing attack gathers in not only people who disagree with you on these issues, but people who may agree with you at times as well.
Or both.
You probably won't believe this, but having just been cited by MindFreedom -- an organization whose goals, yes, I ordinarily oppose -- for my activism on the Bob Sandford case in Minnesota, I support to the death your right to refuse treatment you don't want.
But it won't stop me from worrying half to death, with far more compassion on my side than your letter seems to show from the other side, that it might be the wrong decision.
Because mine could be too, after all.
Posted by Larry at November 22, 2008 11:49 AM
Just found this on www.wamu.org (D.C. based NPR station):
"After ten years, the producers of The Infinite Mind have decided to bring the production of the program to a close. We will begin airing the BBC World Briefing at 6 a.m., Sundays, on an interim basis beginning Nov. 23, until a permanant replacement is selected for that timeslot."
MindFreedom is urging people to contact NPR, congratulate them for taking The Infinite Mind off their Sirius network and urge them to cover the broader story: medicine and media on the take from Pharma. I'll do that now...
Posted by Johanna at November 22, 2008 12:15 PM
Sekhar said, "If he was paid $329,000 by Glaxo over the period of one year to present his (legitimate) case for circumstances where he found Lamictal to be the best mood stabilizer, is it really that big a deal, for someone with Dr. Goodwin's reputation?"
If he failed to report these conflicts of interest, then yes, it's a very big deal. PI's are required to report financial conflicts of interest before their studies are approved to begin - it's a federal requirement not a recommendation.
Posted by anon at November 22, 2008 01:08 PM
Psychiatry is...
"The Infinite Lie" ..
Posted by truthman30 at November 22, 2008 02:53 PM
Larry,
Sorry if I was too harsh. Jamison is just the worst of the worst. I've seen the harm her bipolar pr has done but you obviously have different experiences. I have friends who take lithium and I have to stand by and watch it kill them as it is, in the end their choice, as it is yours.
Posted by Sally at November 22, 2008 03:16 PM
Sekhar:
So let me get this right! Your coming over from your regular posting pro-pharmaceutical paid for and supported site "BipolarConnect.com" with others doing John McManamy bidding in support of Dr. Goodwin; since I'm sure John wouldn't want to come here and face the litany of questions about how he gets his nice bling bling money checks, is completely bought into, controlled, and aligned with Big Pharmaceutical and his good Pal Dr. Goodwin {seeing as Goodwin did write that outstanding blurb on the cover of his Book}.
I have to wonder when Senator Grassley and Congress are going to start investigating this misrepresentation and pharmaceutical funded ran sites like “BipolarConnection.com” and their master “www.HealthCentral.com”; which in turn is pretty much completely controlled by AstraZeneca?
I’m just surprised that anyone in that tight little closed circle of happy pat you on the back pill poppers would want to come to an open forum and actually want to debate this corruption issue.
Especially since everything on that site is all about what a great guy Dr. Goodwin is, and how this Greed mongering, and unethical behavior in no way puts his research, opinions, and writings in question!
Is it time for a reality check people!!!
What a crock of S---- you have going on over there. Don’t you realize by directing research, wielding his influence, doing his tainted pro-pharma broadcast, and taking which accounts to bribes from Big Pharmaceutical; many less intrusive and more effective treatment modalities were never even considered or looked at because they were not going to make Big Pharmaceutical and Dr. Goodwin the Huge bucks.
Yeah, he’s a real gem alright! Tell that to the millions upon millions that have been damaged, maimed, or killed by these so called medication treatments!
Have you ever even considered that due to the pharmaceutical revolution in psychiatry; with all the greed, influence, and money it has generated; the true results have been not much better than before psychotropic medications, considering both the biological and mental damage they inflict upon consumers and the staggering levels of supposed mental illness we now have falsely diagnosed today?
How about the strong possibility that we have been going in the wrong direction for so long, everyone has lost sight of reality and what we are actually doing to real human beings and society with psychiatry as it is set in its medical model today! All the wasted resources, research, brain power, funds, and energy flowing down the drain for what?
The answer seems pretty simple and common sense considering what is coming to light among the most elite and so called respected of the industry and psychiatry; It’s called $$$$$$$$$$$$$$$$$$$, not health care!
In fact, it’s so far from ethical and humane! It could now be considered crimes against humanity itself.
Yours Truly,
Stan
Posted by Stan at November 22, 2008 11:38 PM
when i got my diagnosis recently i read jamison's unquet mind and hated it (my comments). later i tried to read mcman's book but could only make it about a hundred pages before throwing it at the wall.
both of these people have a profound need to gain public respect specifically as mentally ill people. motivating this need is the injury the idea of being mentally diseased did to their self image -- they needed to reverse the stigma.
this theory also explains why they go to such extraordinary lengths to propose that mania and thus BP has benefits. (i don't buy it.) this proposition is more rehabilitation of the sense of self. they argue that BP makes them special and better people, bringing the benefits of their elite minds, touched by fire, to us all. sounds like an argument based more on individual need than anything else.
Posted by tom at November 23, 2008 06:20 AM
Crimes against humanity? Stan dares question happy-pat-you-on-the-back-pill-poppers. I resemble that and how!
He asks:
"Have you ever even considered that due to the pharmaceutical revolution in psychiatry; with all the greed, influence, and money it has generated; the true results have been not much better than before psychotropic medications, considering both the biological and mental damage they inflict upon consumers and the staggering levels of supposed mental illness we now have falsely diagnosed today?"
What are the true results of the "glorious" revolution? At a recent national DBSA conference, I heard tell repeatedly that 90% of the seriously mentally ill are unemployed (statistic courtesy of SAMSA).
Factoids aside, here's a question. Are the people being roasted in this comment section afraid of debate? Are the people doing the roasting afraid of debate? I'd knock myself out to arrange for John McManamy to go up against Philip Dawdy in a public forum with audience Q & A on journalism and mental health.
Many commercial websites for "patients" look like Mr. Roger's neighborhood to me. Anonymously standing up to the medical industrial complex with razor sharp wit in the comments section of someone else's independent blog? Rip off that old sweater! Fling those comfy slippers.
Calling Kay Jamison lithium addled?!! I don't know if Kay Jamison enjoys long walks in the rain or being bitch slapped in the blogsphere. But, if she do, comments like that let her know where it is.
Cheers,
Moira
Posted by Moira at November 23, 2008 06:26 AM
Let us slow down a bit here.
Yes, it was wrong of Dr. Goodwin not to disclose his ties to the drug industry when offering his opinions about medications and their use in mental illness.
But, a case against him must be stronger than an ad hominem logical fallacy. If you want to disprove his points about the efficacy of psychotropic medications in general, and in bipolar disorder in particular, then you must look at the DATA objectively.
Saying that he is an unethical person that should not be trusted, because on a few occasions he failed to disclose his conflicts of interest is not necessarily an argument against his research and medical advice. Just because someone benefits from a certain opinion does not automatically invalidate their opinion.
It is like a thief telling you not to steal, and you reply, "Like I would ever trust a thief to tell the truth!"
I mean, how often does this website and you individuals popularize and mass e-mail studies that show medications are effective? Do YOU have any conflict of interest in the matter, maybe not in terms of money, but in terms of your time invested in demonstrating that biological psychiatry is a sham?
Thanks!
Posted by dguller at November 23, 2008 06:29 AM
Anon,
I agree that it is a big deal if Dr. Goodwin failed to report something which reflects a conflict of interest. But as far as I know, they are not suggesting that he hid anything intentionally. For all the years that Bill Lichtenstein has been producing The Infinite Mind, and NPR has been carrying that show, did they not know that Dr. Goodwin receives substantial funding from pharmaceutical companies? I've known about The Infinite Mind, though I've heard only a couple of episodes in all these years. Those who are regular listeners can weigh in on whether the program was a mouthpiece for pharmas. I just think that the responsibility for this would lie with NPR, if they were really unaware of it all along.
Stan,
Do I know you? Do you know me? Your attempt to link me to pro-pharma agenda is the kind of baseless accusation that makes me wary of the rush to sling mud at Dr. Goodwin, and now Dr. Jamison - not looking at enough of the facts before making strong accusations.
I am here, and at a couple of other sites/blogs, to learn more about the issue, and to speak for myself, and what my opinion on the issue is. Why would you assume anything different?
I notice that you have linked to Mind Freedom on your blog. Talk to David Oaks (if you know who he is). I have helped him with the MF website as well. That doesn't mean I am a fan of MF and David doesn't approve of my site (Mood Garden) because Mood Garden is a community open to discussion of medications for treatment. It's possible to disagree and still work together!
I'm not here on behalf of someone else. I heard the news and came over to FS, since I expected that Philip will have more details (and I look forward to more of what Philip has to share).
As for me, what I know is that I landed in a hospital after my first manic attack and I have had (and sometimes survived) medical care over the years and I'm functional today.
I ask the same questions often: Is it possible we've been headed in the wrong direction with the medical model? I know that I've been (mis)treated by incompetent psychiatrists in my past, and wasted years taking the wrong medications. If there was a better modality of treatment, I wish I knew about it. But after the days/daze of the first manic episodes were over, I did feel fortunate that there was a name for the experience - or illness, as it's better known. I did feel comfort in knowing that there were many others who have shared similar experiences.
As it stands today, I have no way of knowing if things could have been better for me or not. My reality check is that I'm able to stay in touch with reality. And recovered enough to not be bitter about everything out there. It doesn't help our cause to cast everyone else in the system as evil. That validates the stigma experienced by those of us with mental illnesses, where the "normies" judge all of us by the few whose illnesses made them violent or dangerous.
I do believe a lot, if not a majority, of doctors and researchers and even some politicians do want to work for the betterment of people with good conscience. I know a lot of people with the diagnoses are functioning well today, because - and perhaps at times, in spite of - the treatment available to us today.
Sekhar
Posted by Sekhar at November 23, 2008 08:31 AM
Sekhar, if he did not follow the disclosure rules & profited from a gov't grant then that's a violation of the law - let's hope it's not true. It doesn't matter if he meant to or not, he's been in the field long enough to know the rules regarding reporting financial COI (and all of the other researchers of late who have been busted know about this little rule, also).
Posted by anon at November 23, 2008 11:34 AM
Dguller said, "Saying that he is an unethical person that should not be trusted, because on a few occasions he failed to disclose his conflicts of interest is not necessarily an argument against his research and medical advice."
Actually, IF he failed to disclose his financial COI it is a very good argument against his research & medical advice because it calls into question the integrity of his research. Failing to disclose financial COI is a major no-no in clinical research. Hopefully, it will come out that he has followed the rules. Ask the IRB & the FDA if they think failure to disclose financial COI is a big deal.
Posted by anon at November 23, 2008 11:48 AM
I am basing my impressions of Dr. Goodwin much more on the show reviewed by Philip that I also listened to called "Prozac Nation Revisited" than on his conflicts of interest although the two certainly paint a consistent picture. Philip's review was very aptly entitled "The Lies of the Infinite Mind." I have rarely heard such outrageous dismissals of the link between antidepressants and suicide or violence; furthermore there was no mention of withdrawal or issues surrounding long term chemical dependency even though callers into the show were describing this phenomenon without even realizing they were doing so -- their efforts to get off and the "return of their disease." It made me ill that none of the doctors would even consider that this might have been an issue of not tapering off slowly enough or having the adequate support the patients needed to get over being on antidepressants. It's not easy to get off these drugs but do you think anyone on the show would admit that? No they didn't. That's why I am angry at Dr. Goodwin. This stuff coming over the airwaves of a prestigious national radio show perpetrates a lot of misunderstanding. Let's admit there is a problem instead of sweeping it under the rug and labeling it a "life long disease." The reason these patients think drugs have "saved their life" is that they don't know that what they are experiencing when they give up the drugs (or just miss a dose) is withdrawal of the worst kind not the return of their depression.
Posted by Sara at November 23, 2008 12:31 PM
What a great day for John McManamy!
Three from his loyal fan club come here to post in a row!
So let's just ask this one simple Question first off! Since “John the ego maniac fraud” doesn't appear to want to come here himself! Does John McManamy get a pay check from www.HealthCentral.com; which is basically saying he is getting his pay check from Big Pharmaceutical? Once that question is answered; all the other questions will fall into line with his bought, well paid for stance, notorious associates, and following!
By the way, oh mighty JM fan club, Yes I am anti-psychiatry and anti-big pharmaceutical which I believe is not Philip's complete position. As if John McManamy could hold a candle to Philip in a mental health debate is laughable to say the least.
Philip is seeking the truth and questioning; while not being paid off to tow the line with the medical model and the huge Pharmaceutical industry for profit!
So spout off all you want, bow before the mighty corrupt Goodwin also if you wish! In fact believe in those magic pills and take them all you want! I do believe you have the choice, but don’t be shoving your poison down other’s throats without getting tagged for it here.
This doesn't change a failed model and the crimes being propagated inside Psychiatry and the Mega Pharmaceutical Industry as we speak. If the usual psychiatric suspects are guilty as they are now shown; then yes it would make perfect sense that any and all their criteria, research, book writing, and public speaking views would be very suspect, tainted, and be brought under magnified scrutiny . Thus the whole drug treatment paradigm created and promoted by people like Dr. Goodwin is in great peril and definitely questionable!
By the way Sekhar; I happen to know who David Oaks is! That doesn't change my stance one iota!
MindFreedom happens to be a great advocacy organization that is not begging at Big Pharmaceuticals Door for their Dollars! MindFreedom is unlike organizations like NAMI, DBSA, and others that are funded by Big Pharmaceutical.
For your information: In fact you cannot get treated or live as a mentally disabled person in NAMI supported group homes or facilities unless you sign a contract in advance to be completely medication compliant. Doesn’t that fall nicely in line with their Big Pharmaceutical funding? NAMI is extremely narrow focused, are totally close minded to any other treatment alternatives, and openly discriminatory against those they claim to advocate for is a truthful and honest way to put it here!
Why don't you investigate ”www.HealthCentral.com”; then come here and tell us all where their money comes from and who is pushing and driving the agenda at that site?
I would personally debate John in a public forum about the pharmaceutical funded mental health paradigm. The invitation is open.
Yours Truly,
Stan
Posted by Stan at November 23, 2008 12:31 PM
Sekhar: Is there anything at all Dr. Goodwin could have done that would make you question the integrity of his findings and research, if this is not enough? What more could you possibly need? Then you accuse others of being biased?
Posted by Sophia at November 23, 2008 12:40 PM
Moira said, "I'd knock myself out to arrange for John McManamy to go up against Philip Dawdy in a public forum with audience Q & A on journalism and mental health."
Oh, I would pay to see that:)
On a similar note, I said on Paxil Progress Board that I wanted to see Laurie Yorke, the administrator, debate someone like Charles Nemerhoff instead of seeing the Obama/McCain debates:)
Posted by AA at November 23, 2008 12:47 PM
DGuller, welcome back to the site. I really didn't want to respond because I know I won't get anything else done with our discussions but I have no choice.
You said:
"But, a case against him must be stronger than an ad hominem logical fallacy. If you want to disprove his points about the efficacy of psychotropic medications in general, and in bipolar disorder in particular, then you must look at the DATA objectively."
Robert Whittaker, a pulitzer prize winning health journalist has regarding neuroleptics and schizophrenia. This is a guy who started his research believing in the miracle of psych meds and found they don't work.
Irving Kirsch and Eric Turner came to the conclusion that antidepressants don't work. In response, physicians said in their own experience, they did work. If alternative folks had done that, you would be crucifying them as saying that anecdotal evidence is not valid.
Joseph Glenmullen, whose book you spoke favorably of, said that Glaxo Smith Kline deliberately hid data on suicidality.
"Saying that he is an unethical person that should not be trusted, because on a few occasions he failed to disclose his conflicts of interest is not necessarily an argument against his research and medical advice. Just because someone benefits from a certain opinion does not automatically invalidate their opinion."
DGullen, with all due respect, I couldn't disagree more. Have you read Danny Carlat's account of his days as a drug rep for Wyeth? He talks about how he bent the truth to fit the picture in Effexor's favor.
Obviously, in reading his blog, he seems like a very highly principled psychiatrist. But if someone like him can be influenced by money, anybody can be which will cause you to shade the truth.
"I mean, how often does this website and you individuals popularize and mass e-mail studies that show medications are effective? Do YOU have any conflict of interest in the matter, maybe not in terms of money, but in terms of your time invested in demonstrating that biological psychiatry is a sham?"
You're comparing apples to oranges. When you come on this site, you know exactly the crowd you're dealing with in same way that I know when I go on to a blog like Shrink Rap. By the way, if you're going to criticize our conflict of interest which I disagree with, you would have to do the same for them as they don't post studies showing that SSRIS cause long term cognitive damage even though they are from pub med sites.
Speaking of conflicts, Peter Kramer, whom you spoke highly of, deleted a dissenting post I made on his blog. So even though he takes no drug money which I salute him for, I find that conflict interesting. I guess he didn't like my posting those pub med citations.
Just like med journal articles are now mostly doing, radio shows have an obligation to disclose all conflicts so people have the tools to fairly evaluate the data.
Anyway, welcome back.
AA
Posted by aa at November 23, 2008 01:19 PM
just to clarify something here, robert whitaker has not won a pulitzer. he was a pulitzer finalist in the 90s and also won a polk award--the number 2 print award--back then as well.
Posted by Philip Dawdy at November 23, 2008 01:42 PM
Sorry about that as I am dealing with memory and insomnia issues as a withdrawal symptom and that is how I remembered it. But of course, you are right Philip and thank you for that correction.
Posted by AA at November 23, 2008 02:37 PM
Look, I have friends on both sides of this debate -- IRL and certainly on this thread.
I think Dr. Goodwin deserves any opprobrium being leveled against him if half the charges are true. (Philip, we await your further reporting with bated breath ...)
But I am also like Sekhar. I know what it is like to be hospitalized and literally out of my mind, and I know that being on medication for a proper diagnosis, despite a lot of other struggles, I have not had that experience in almost 9 years. And that priceless peace of mind is worth a lot of side effects (and medication blind alleys), IMO.
Those who are against medication would seemingly attack someone like me as a helpless victim of Big Pharma. But if they read a story like mine objectively, they would have to conclude that I've seen similar data and, from my experience, reached a different conclusion with at least a modicum of intelligence.
So instead, they attack those like me as hideous co-conspirators in Big Pharma's attempts to enslave all those with mental illness. No question, Big Pharma has a lot of sins to answer for. But I for one don't appreciate being labeled evil for attempting to save my own life.
Honestly, it's as if the proper response to Kohlberg's famous ethical "Heinz dilemma" (poor man unsuccessfully seeks expensive medication from greedy pharmacist for terminally ill wife) would be to shoot the pharmacist -- and then, instead of stealing the medicine, to shoot Heinz too for daring to even lobby such scum to change his mind.
It would feel good, no doubt. But such refusal to compromise wouldn't keep the sick wife alive. Which I thought was the object.
Posted by Larry at November 23, 2008 04:16 PM
Hey Philip! Totally OT and self serving comment here: My Uncle Jack won the Polk award for his photojournalism. It's so rare I find someone who knows what it is that I jump up and hoot about it whenever it comes up.
Sherry (basking in reflected family glory, wishing it would rub off...)
Posted by Sherry at November 23, 2008 04:57 PM
AA:
Thanks for the welcome back! I hope you've been well. :)
First, I haven't read Robert Whittaker's work, and so I cannot comment on it. However, I will say that antipsychotics, despite their drawbacks, have shown superiority to placebo in many trials. Unfortunately, they are the best treatment we have at this time. Also, no possible conflict of interest when he pronounces psychotropic medications harmful in terms of boosting sales of his book?
Second, Kirsch and his colleagues concluded that antidepressants were effective for very severe forms of depression. However, their methodology has been found suspect by multiple researchers. The alternative of psychotherapy has an even poorer evidence base than antidepressants. Also, Kirsch's preferred mode of treatment is hypnotherapy, which is even more suspect in terms of evidence.
Third, I agree that drug companies have engaged in reprehensible activities in the past in order to maximize their profits, but I still believe that ad hominem and guilt by association fallacies are inappropriate, and instead would prefer to look at the evidence objectively. I try to view all research with a healthy measure of skepticism, especially those sponsored by drug companies, usually awaiting independent replication of results, but I also will not reject information simply because I don't like its source.
Fourth, I agree that people should disclose their conflicts of interest in the name of fairness and justice to those who may be influenced by biased opinions. Therefore, Dr. Goodwin should be reprimanded. Whether he should be strung up and crucified in another matter altogether.
Thanks, and take care. :)
Posted by dguller at November 23, 2008 07:44 PM
It's an interesting topic: conflict of interests and money received and not disclosed. The more that happens here, with regard to these pharma funded research/ers investigations the more it seems lack of integrity and truth is exposed.
This is a freight train out of control and I applaud Philip for being on top of the stories as they unfold.
Side note:
Per the person wondering if Stan knows David Oaks...I've been in touch with David Oaks re: advocacy for Stan.
Losing his job as a psych tech, injured via a patient and having the termination blamed on bipolar disorder is discrimination at its worst.
After years of trialing most every psych med, Stan has lived and walked in most everyone's shoes that is posting here, as a patient, an advocate and an employee of the mental health system, his voice is one that should be listened to; as well as everyone else's.
I'm a caregiver of a 20 yr old daughter who is currently disabled after a decade of psych med treatment for a wrong dx; and I carry a BPII label and have suffered med trial and withdrawals.
I believe in truth and integrity. The pharmaceutical industry is an industry. It's for profit, and the data and trials are often skewed, cooked and withheld of information.
The Zyprexa scandal is one example of that.
Just a few of my .02
Posted by Stephany at November 23, 2008 08:37 PM
Sophia,
>>>You asked me: " Is there anything at all Dr. Goodwin could have done that would make you question the integrity of his findings and research, if this is not enough? What more could you possibly need?"
Yes, there are things Dr. Goodwin may/could have done that would make me pause and wonder about his integrity and motives.
But what I am reading is about one episode of Infinite Mind, which was the brainchild of Bill Lichtenstein, got funding from Eli Lilly and he recruited Dr. Goodwin to do the radio program. It was a well-received program, and I found the transcript of one of its interesting episodes ("Perfect Pitch : Why can some people name a note as soon as they hear it when others can't tell one from another?") . See http://www.wsf.org/music/articles/mind135.htm ; also an episode "Special on Trauma and Healing", soon after 9/11. One on "Satisfaction" this September, a discussion on stress caused by expectations, how to be grateful for what we have.
This is what I've heard about the show in general - good programming on topics of current interest. Generally boring, I'd say, unless you are a PBS type.
I don't think the program was intended to push meds. Even the program in question seems to be a response to a tragic event where Prozac was mentioned in the press, and the show attempts to balance the one extreme of "Antidepressant leads to violence" with one that points out that antidepressants do work well for most people who take them. Perhaps an attempt to counter the possibility that people may go off AD's based on what they hear in the news. I don't know. I know Philip analyzed it well from the perspective of an "expert patient", but I think the message to people in general would seem to be that AD's (or withdrawal from them) don't necessarily lead to violence.
This one episode is being picked apart, especially by a journalist on The Slate site who apparently had a previous run-in with Eli Lilly in an article she wrote for the British Medical Journal on this topic, which turned out to be inaccurate, causing BMJ to issue an apology to Eli Lilly. Seems to have an agenda.
Nevertheless, that particular episode of the program (which aired 7 months ago) is under the microscope. Philip caught it early, but by the time it made it to NY Times and Grassley, the impression people are getting is that The Infinite Mind was a show aimed at promoting use of meds.
If there's a COI involved in one episode, fine, let that be addressed. Seems rather benign to me, and certainly not as much of onus on Dr. Goodwin as LCMedia or NPR. That's my take. He taped a radio show each week, with programming by Lichtenstein, and BAM - 6 months later he's in trouble for one episode that can be interpreted as propoganda.
For me to question his entire body of findings and research, I've to see some major story of colluding with pharmas and engaging in deceptive practices. If he signed up for hosting The Infinite Mind from the outset as a scheme to get funding from pharmas and promote meds occasionally, that will definitely raise a red flag.
Stephany, I'm glad you are there to advocate for Stan. It certainly appears that he needs one.
Sekhar
Posted by Sekhar at November 23, 2008 10:16 PM
Sekhar:
I catch the faint smell of a condescending tone in your comment toward me. Please correct me if I wrong here? But thanks for your support if it was genuine.
Stan
Posted by Stan at November 24, 2008 09:31 AM
Sekhar: I'm sorry I don't tune in to the show, and those topics probably wouldn't interest me, but, my question is direct and based on the strange history of many mental health professionals who commit egregious acts and are constantly excused as having proper motives for committing these crimes.
Posted by Sophia at November 24, 2008 01:04 PM
Sekhar: Quotes and link From: http://www.healthcentral.com/bipolar/c/15/49780/comments
“Just a bad dream
Sekhar
Saturday, November 22, 2008 at 10:07 PM "
“Having met and interacted with Dr. Goodwin a bit, I feel sad about this. But those who don't know much about him are going to be quick to condemn Dr. Goodwin as some kind of a crook based on the NY Times article, without looking deeper into the facts. I just hope that he is fully vindicated real soon, after whatever investigation has to take place. Dr. Goodwin deserves nothing less.”
reply
re: Just a bad dream
John McManamy
Saturday, November 22, 2008 at 10:51 PM
“Hi, Sekhar. I agree that there are untold people out there, quick to condemn, without even checking the facts. But Dr Goodwin doesn't need an investigation to clear him. His dealings with GSK and others were public and above board. If anyone needs an investigation, it's the NY Times. I'd like to find out what their sorry excuse was for going to press with that piece of gratuitous character assassination.”
Commentary: Yeah you’re here to debate the issue alright! NOT! Tell us John McFraud “Expert Patient” and Sekhar, what are the facts? Why don’t you read up a few post about the king of child bipolar Dr.Biederman and more about your Pal Dr. Goodwin, and then sit here and defend Goodwin when he’s sailing along in high seas and taking on water in the same sinking ship as the notorious Biederman.
I can clearly catch the smell of a very condescending tone in your comments! Which in considering your befuddling defense of Goodwin and your Pal JM {it comes as no surprise since you are riding and petting their pony in this race}; though I still find it quite amazing on the rational and evidence front which you appear to ignore? You ask for data and research and yet it’s all skewed and tainted! So what’s your real argument?
I know your kind, after years watching your kind throughout the mental health system helping destroy or stand idle as others suffered at the hands of psychiatry and your medication paradigm (You are one of those want to be psychiatrist, and blind follower types).
Now the room is full of maimed, damaged, bloodied, and dead bodies; many of them children; the Goodwin’s of the world are standing there with bloody hands over the bodies, and you pull out the “if the glove doesn’t fit, you must acquit defense”. Those rose colored glasses your wearing must fit pretty damned well. Did AstraSeneca Pharmaceutical send them along with your last prescription refill?
But then maybe we can find you an advocate for your pure, utter, and unadulterated ignorance. I'm not bad at getting into the personal attack mode as you have started here, so just say go! You little kiss butt pharmaceutical whore! I am here to out you for what you really are, and then crush you like a little bug under my boot sole!
You have no grounds what so ever in your arguments, accept these are your Pals, and they couldn't be corrupt crooks that have cooked the Pharmaceutical books to load their bank accounts and propagate a myth; or your little confused support group world would turn upside down. Take a magic pill and toast to that you complete arse. So how does that taste in your drug induced mood garden? I sure this is the same kind of caring and nurturing support people will find when they go to your cozy little forum.
I see your buddy John McFraud is afraid to face the music; he’s probably hiding over in his Pharmaceutical paid for easy chair hoping against all hope this won’t come back to bite him to hard in the arse. What he doesn’t know or is blind too; is that there’s a mean and angry junk yard dog just waiting for him to stand up and make a move!
But then you’re just a cheap street walker, and the real Mr. John McPimp is standing on his renowned Book! What was it called anywise? “The pharmaceutical Guide to Bipolar 101 for dummies; the copy and paste version of the rehashed bull with all the usual suspects of obvious criminal connections”? Indorsed and verified by the infamous Dr Goodwin of lies, greed, and shame fame.
Have a nice day :)
Stan
Posted by stan at November 24, 2008 02:58 PM
Stan,
You are welcome.
Sophia,
You write: "...my question is direct and based on the strange history of many mental health professionals who commit egregious acts and are constantly excused as having proper motives for committing these crimes."
I don't know the history you're referring to, and in cases where there is absolute evidence of a malicious and immoral intent, I will sign up in a heartbeat to condemn them.
Of course, the rest of my answer is going to end up in a long post, so read on if you wish.
My source of my sadness and disappointment are indeed those news stories that appear to add Dr. Goodwin to the Dr. Beiderman queue. I have met Dr. Goodwin a few times. I know he is well into his 70's. If he wanted to make money, even back when the program started, he didn't have to go from D.C. to NY each weekend for a radio program. He was heavily funded by possibly every major pharma out there for the research work he did. It may primarily have been for fame and padding up his resume. If he hasn't retired yet, it's safe to say he wants to maintain his standing name recognition in his profession. (Certainly not name recognition through Congressional investigation on COI or anything like that.)
So I do consider him different from the rest of the pack you're referring to, who get excused no matter what they do.
I will say one thing though. Maybe someone of Dr. Goodwin's caliber could have taken the stand that he'll not be party to the existing mess of research being primarily funded by pharmaceuticals. But I doubt that he will have the fame or name recognition if he had done that. Not everyone can be like Philip. If Philip, with all his talent, had a blog praising specific meds, and writing articles about break-throughs at various pharmas etc., he could probably be in a position to buy out a small island in the Carribean in a few years.
Sekhar
Posted by Sekhar at November 24, 2008 03:15 PM
dguller,
I just read Robert Whitaker's Mad in America and would recommend it to you since you haven't. He does a good job of documenting the damage psychiatrists did in America while they masquaraded as scientists. In my opinion psychiatrists have masquaraded as scientists for so long now people believe their lies. Even scientists. And that is part of the problem. To me it's very troubling that Whitaker presents evidence that neuroleptic use caused an increase in psychosis relapse. Or that drug data was manipulated by abrupt withdrawals causing psychosis. How can there be progress without honesty in research and practice? His book was written in 2002 and the past six years have brought only more lies and deception. I agree with Stan that these are crimes against humanity. Perhaps we need to put psychiatry on trial to get past people's misconceptions and even begin looking for alternative care. I still hope science will find some of the answers and so I applaud Senator Grassley's efforts. I am, however, no longer buying what psychiatry is selling.
Posted by Vicki at November 24, 2008 04:10 PM
Stan,
I read your last post after submitting my previous post.
I'm sorry I baited you, it was just too tempting to resist. I just didn't think you would bite so hard. I'm sorry that it affected you so badly, I didn't quite expect it.
Stephany wrote earlier:
>>>Losing his job as a psych tech, injured via a patient and having the termination blamed on bipolar disorder is discrimination at its worst.
After years of trialing most every psych med, Stan has lived and walked in most everyone's shoes that is posting here, as a patient, an advocate and an employee of the mental health system, his voice is one that should be listened to; as well as everyone else's.
My argument with you isn't personal, Stan, even if yours may be against me. I respect Stephany, and I empathize with your life struggles. Your voice is important. Please do try to tone it so that it's worth listening to. The more you take swipes at people who are your peers ("drug-induced mood garden"?!!), the less credibility you have as a mental health advocate.
People who join and support each other in communities like Mood Garden are sick and tired of medications. Their life is consumed in pain, and they have no clue about Goodwin, Beiderman etc. Please do try to exercise restraint and avoid swinging wildly. Sure, knock yourself out calling me names, or associating me with whoever irks you in the pharma-camp; if that makes you feel better, it's definitely worth it. But be a little thoughtful in casting a wide net over 6,000+ members of Mood Garden, most of whom don't know me, and are on the same life path as you.
Good luck to you.
Sekhar
Posted by Sekhar at November 24, 2008 06:55 PM
Bob Whitaker's book "Mad in America" is really worth a read, both because it gives the grotesque "history of psychiatry" but also because it has, as mentioned by Vicki, FOIA information on the atypical antipsychotic trial frauds that makes you cry. He is working on another psych- related book and I will rush to buy it. As for Jamison's book about herself, it didn't ring true to me. Poetic license, perhaps.
I stated on another site that the Goodwin-Jamison bipolar bible saved my daughter's life as it listed the symptoms of lithium toxicity. For that, and that only, I can give the authors creditm, though Jamison's "Touched by Fire" was interesting, given that (though many don't believe in a genetic element in mental illness) the book traced this very element in famous composers, artists, etc. , in previous years when there was no medication.
And as for the person who hates to stand by and watch her friends die of lithium, I wonder what else she might suggest for bipolar I. With one child dead from Zyprexa, we're sticking with the family drug, which had worked for him. It is not a little disturbing to come on here to post a comment and read something like "lithium kills my friends" with no thought by the poster how that might impact someone else. But I guess almost anything goes here.
Posted by Sorrowful at November 24, 2008 07:13 PM
Vicki:
Could you please cite the study that Whittaker used to demonstrate that antipsychotics actually increased the rate of relapse? Did it take into account comorbid substance abuse? Medication compliance?
Just to clarify, where there is clear evidence of the wilful use of deception and falsehood in order to defraud the public, this should be condemned wholeheartedly. However, there is a difference between that and making the strongest case possible for a position that one believes in.
I do not have the hard figures, but I believe that most researchers would probably land in the latter category of people who may disregard lines of evidence that oppose their theories, which places them in the negligent, rather than the mendacious, class of scientists.
It is also true that psychotropic medications have been overprescribed for conditions where there is little, if any, evidence for their efficacy. However, they have also been demonstrated to be effective in treating many psychiatric disoders and brought a great deal of relief to the lives of patients. No treatment is a panacea, and they all come with risks of side effects. The tragedy is not that there are side effects to these medications, but that they were not adequately disclosed to clinicians and thus, their patients.
Thanks!
Posted by dguller at November 24, 2008 08:05 PM
Sekhar:
I figure anything you’re a part of must be worth going after with booth barrels blazing! I mean you’re such a good Bait person, probably a master-bater with the very best! Probably why you need those rose colored glasses; didn't your mother warn you?
Stan
Posted by stan at November 24, 2008 09:25 PM
Yes Sorrowful, anything goes here, including engaging in intellectual dishonesty, and when that happens the speaker is simply being intellectually dishonest, that's all its about, and has nothing to do with you. Nothing. The best way to for me to keep my head on straight when things get personal here involves learning to recognize and quantify dishonest arguments, which means analyzing and putting the derailment into words whether I argue back or not, the point is to keep my own thinking straight, and second, never take an insult personally if I have said nothing to personally to offend. Taking it personally is also an intellectually dishonest tactic, and the manipulation involved is in making you feel bad, which is the goal, smothered in sheer assholery.
You don't have to succumb to that. And third, arguing with people who lack self-awareness (me, intellectually dishonest, manipulative? No way! is a waste of energy, but I do respect your asking for support or acknowledgment or whatever that was, and I hope there will always be some response, no matter how inadequate.
Posted by flawedplan at November 24, 2008 11:44 PM
Sorrowful,
It is hard to watch people die from Lithium toxicity, but of course not as hard as dying from it. I'm going through as similar thing with a friend who is taking zyprexa. She liked it a lot in the beginning but the effectiveness has worn off and she's left with the metabolic disorder alone and she's particularly at risk for developing diabetes. Of course she takes zyprexa for depression which she was labeled with 20 years ago which means that like so many people she's been on every trendy psych drug of the last 20 years. Her entire identity is wrapped around being a depressed person. Her problem is the doctor who tells her depression is a physical state that needs to be treated with drugs. Hard not to believe your doctor even when that hocum has been debunked. 20 years ago she got a divorce and ended up trying prozac and being labeled depressed. Since then she's been a lab for big pharma.
Meanwhile, I'm glad your daughter didn't overdose on lithium. As for whether I'd rather see someone die of bipolar I or lithium toxicity, there's no evidence that bipolar I exists and so it can't kill anyone. I particularly dislike "Touched with Fire" because it's romantic marketing for the label bipolar or manic depressive. It's being told that you can't control your moods, that your brain is different, that your genes are different, and believing it that kills.
Posted by Sally at November 25, 2008 05:02 AM
dguller,
Read the book yourself since you pretend to care. I'd rather not prolong this discussion. Thanks. Vicki
Posted by Vicki at November 25, 2008 06:19 AM
Sorrowful,
I have to respond directly to your last line which I neglected to do before:
"It is not a little disturbing to come on here to post a comment and read something like "lithium kills my friends" with no thought by the poster how that might impact someone else. But I guess almost anything goes here."
The evidence that lithium is toxic is not anecdotal, it is a medical fact which I don't think you are disputing. The evidence that there's a medical disease called bipolar I is anecdotal. There's just no science to back it up. Your belief in this condition as well as the romantic marketing of it by Jamison with evil crap like touched by fire is a belief with no facts behind it and your pushing of this belief as fact is irresponsible.
Wake up! Jamison's partner in crime, Goodwin, the father of the increase in nonsense like the entire bipolar paradigm is a fraud. Surely that must suggest that perhaps the "illness" is not as firmly founded in science as you believe. I know it's hard to here such a thing when being "bipolar" and a part of the "bipolar" community is such an important part of your identity.
There's no science to back up any of this with the exception of the hard cold facts that lithium and other psych drugs really can produce a pleasant state of calmness temporarily but have damaging, often, if not usually, fatal side effects. Your belief that bipolar I exists is just that a belief. My belief that it doesn't exist, while more fact based than your views, is still primarily anecdotal, so if you want to have a battle of the anecdotes, great, if you want to dare imply that suggesting that lithium kills is irresponsible which suggesting that bipolar I is a medical disease is not irresponsible, well, I don't care how vested you are in this belief, it's not a fact and you are harming people and should be called out.
Lithium is toxic, there's no controversy or speculation in this true statement.
Bipolar I is a medical disease, there's no evidence to indicate this belief of yours is true.
As for that tear soaked copy of touched with fire you keep on a shelf next to your copy of the Bell Jar, get over it, the treatment not any disease killed Plath.
Posted by Sally at November 25, 2008 06:24 AM
Word up! An unflinching scholar of the human condition has Sorrowful figured out to the core. She is very harmful and needs to be called out. Thank god someone finally had the cojones to say it.
Stay classy, Sally.
Posted by flawedplan at November 25, 2008 01:25 PM
Vicki:
I do care. If there is evidence that neuroleptics increase the rate of relapse in schizophrenia, then I would really love to read the article.
Can you please look in the reference section of the book, and cite it, please?
Thanks!
Posted by dguller at November 25, 2008 02:15 PM
**Her problem is the doctor who tells her depression is a physical state that needs to be treated with drugs. Hard not to believe your doctor even when that hocum has been debunked. ... As for whether I'd rather see someone die of bipolar I or lithium toxicity, there's no evidence that bipolar I exists and so it can't kill anyone.**
Sally:
I think Philip's case against Risperdal, Zyprexa, and so many other drugs is that they have terrible side effects and yet Big Pharma tried to hide them (going to outrageous lengths, no less).
But no one from John Cade on has tried to hide the fact that lithium has serious side effects, and people on lithium must be monitored to keep them from being dangerous and even fatal (as I guess tragically happened in your loved one's case). Therefore, no deception. I know the risks I'm taking on lithium.
But I have a more basic question. If depression is not a disease, WHY DOES THIS BLOG EXIST?!
PS -- Helluva nice touch making fun of The Bell Jar when Sylvia Plath was among the thousands, if not millions, in history who (yes) died of bipolar disorder.
Posted by Larry at November 25, 2008 03:15 PM
Sekhar:
What I wrote was "mental health professioanls who commit egregious acts and are constantly excused as having PROPER MOTIVES for committing these crimes." It doesn't matter if they thought they were doing the right thing. That means they are not in the right line of work, even if you have a lot of trouble proving everything that goes on in their hearts. You don't need absoulute evidence of malicious and immoral intent. The history that stands out in my mind as I write is regarding a Dr. Honig who established the Delaware Valley Mental Health Foundation, who, among his many atrocities, was excused for forcing a patient to eat the contents of an ashtray, and after vomiting, the patient was forced to eat the vomit. The DA found ..."the 'ashtray incident' to represent an inappropriate treatment judment made in good faith by the therapist." If one can excuse this, then they may as well excuse Dr. Goodwin because he was slumming it with PBS or NPR or whoever, and he could have chosen a much more profitable vehicle for spreading specious lies that were misleading the public about the dangers of drugging children. The lies may not have been as easy to believe, however. It must be well worth it to fly from D.C. to NY if you can get $329,000 for one episode.
Posted by Sophia at November 25, 2008 03:50 PM
With all due respect:I find it impossible to wrap my mind around an arguement re: :Li being a life saving drug while Zyprexa is a killer drug. All of these drugs trash human bodies, and it's a matter of time before our bodies tell us that in one way shape or form.
Whitaker is writing a book, and has interviewed me re: the last decade of hell and my daughter's journey with a wrong diagnosis and how she is somehow by the Grace of God still alive in the aftermath of the psych meds.
Whitaker may help shed some light on these nightmares, though I have not given permission for him to use my story.
Posted by Stephany at November 25, 2008 05:41 PM
Larry,
Depression is a serious condition but not a medical disease.
The analogy I like to use in thinking about human distress and emotional pain is this. Imagine 100 people in a freezing cold room at different ages from different regions dressed in various outfits some appropriate for the temperature, some not. Some of these people would get sick first and doctors, if they were biopsychiatrists would decide these people were genetically defective and treat them with drugs then but them back in the same freezing cold room in the same inadequate clothing. When the next group of people got sick, the biopsychs would decide that there most be more genetic defects than they realized and so on. They would never consider the room temperature. Depression is a serious condition but not a biological disorder that exists in a vacuum. If you treat symptoms ignoring environment people are harmed. This doesn't mean there's not a place for drugs, but it means drugs should be looked at very differently and us humans should look at changing the shape of our institutions to reduce the incidence of depression, etc.
Posted by Sally at November 25, 2008 06:21 PM
from mcman's website
In June 2007, the Seventh International Conference on Bipolar Disorder, acknowledged as the world's leading gathering of bipolar experts, honored me with the prestigious Mogens Schou Award for Public Service, citing this Website, Newsletter, Blog, and book, as part of "the strong tradition of honoring those heroes who are making major advances that bring hope to those suffering from bipolar disorder
Ha! The heroes are those who read this blog and comment, our blogmaster, not those reciding in ivy towers. Those who take meds and are successful or not successful and are in the trenches fighting either actively or with words. These are the real heroes in my book.
Posted by a fan of stan at November 25, 2008 06:25 PM
Sekhar,
Thank you for your comment that you have respect for me.
I appreciate that. I, as all of us here have and am walking in the same shoes of frustration and a life based on possible and real misdiagnoses.
One year ago, I was in the fight of my life for my daughter. The inpatient psych doc wanted to lock her up in the state institution and declared "no hope".
During this time, I commented at John McManamy's blog about how my daughter was mis-dx childhood bipolar, and medicated with horrible results.
John McManamy attacked me on his blog at the most vulnerable of times in my life.
My point here is to add perspective, and everyone is entitled to their own opinion of course.
But, it was as a result of what I did for my daughter--prevented her from being institutionalized--that fuels my fire for others (like Stan!) to advocate when I see a very big wrong that needs to be right.
Psychiatry in general has only one paradigm to go by and it is pharmaceutical intervention only, and when researchers such as Goodwin get caught in a snare of unethical behavior, it leaves us to wonder who is watching out for...example: my little daughter.
Respectfully,
Stephany
Posted by Stephany at November 25, 2008 07:15 PM
Sally:
You are absolutely correct that Lithium can be toxic, both acutely if used in high doses, and chronically over a few decades (especially in terms of kidney damage).
However, I would dispute with your contention that bipolar disorder is not real. There are certainly individuals who have suffered from manic episodes and major depressive episodes in a regular enough fashion with various characteristics from their histories that an entity known as bipolar disorder does exist.
That does not mean that everyone given that label is accurately diagnosed.
Perhaps your complaint is that it is overused? Or would you state that someone who spontaneously experiencing recurrent manic and depressive episodes is ... what ... faking or imagining it?
Take care.
Posted by dguller at November 25, 2008 07:47 PM
Sally:
I'm glad your life expectancy is 300 years and you can wait for global revolution to produce the freedom from stigma to care for depression purely holistically. Because mine, unfortunately, isn't.
And the idea that depression is the only disease that reflects societal problems is preposterous. Everyone acknowledges that super-size servings at restaurants and high-fructose corn syrup in most foods contributes immensely to diabetes.
That doesn't mean my girlfriend can afford not to take her glucophage for her type II diabetes -- and it certainly doesn't mean my sister can afford not to take insulin for her type I diabetes.
Posted by Larry at November 25, 2008 09:24 PM
**With all due respect: I find it impossible to wrap my mind around an argument re: Li being a life-saving drug while Zyprexa is a killer drug. All of these drugs trash human bodies, and it's a matter of time before our bodies tell us that in one way shape or form.**
Stephany:
I cannot even imagine what you and your daughter have gone through (and, I gather, are still going through) as a result of Zyprexa and atypical antipsychotics.
And to say I am not a fan of John McManamy right now, for these and other reasons, would be the understatement of the century.
Yet and still, some perspective that different people have different experiences:
My grandmother was diagnosed with bipolar disorder (type I, for those on the FS comment page who say it does not exist in either type) decades ago and prescribed lithium. She was hospitalized several times -- my mother insists to this day that all occurred because of side effects from her lithium. That may have happened, no doubt, though I suspect some of the hospitalizations may have instead been because she DIDN'T take her lithium.
Either way, when I was diagnosed with BP II (yes, it exists, doubters) in early 2000, I avoided lithium like the plague. And it cost me big time. Depakote and later (when my Pdoc said I was down to either/or with lithium) Zyprexa managed to put 50 pounds on me in just the 5 months I took them combined. At least Depakote controlled my moods for the munchies it gave me; Zyprexa was completely ineffective.
And so, in desperation, I tried lithium. And suffered the dry mouth, hand tremor, and GI symptoms that most people do. Several times in my first few months on Li I had to pull over from my car and puke on the side of the road. (I rarely drive now.)
But it controlled my moods. And that could not be denied -- even when my mother practically threatened to disown me for taking "the family poison."
That was almost 6 years ago.
And lithium, for me at least (I know it is not for others), was metabolism neutral. I've finally managed to lose most, if not all, of that awful Depakote/Zyprexa bloat.
Stephany, if your charge against me is commission of slow suicide via Li, then I plead guilty. Infinitely better, knowing the risks and maintaining quality of life in the meanwhile, to commit slow suicide than immediate suicide.
I wonder what your sentence would be for me.
Posted by Larry at November 25, 2008 09:42 PM
I said Li was helping me in "maintaining quality of life." That's true, but only of course because the extreme GI symptoms slowly went away as my system got used to Li. Sorry I didn't make that clear earlier.
Posted by Larry at November 25, 2008 11:41 PM
Larry,
I was thinking out loud referencing "sorrowful's" comment about Lithium and Zyprexa and her 2 adult children. My comment wasn't an attack on anyone, and hopefully not perceived that way....just a comment thinking out loud while typing, how my daughter trialed (well over a dozen) so many meds, and each one did serious physical damage to her body.
I wouldn't "sentence" you to anything. Taking meds is everyone's personal choice, I take them.(and have a BPII dx). Though I do, and have lived my daughter's nightmare with her, I have a harsh opinion about the drugs,(and pharma) but not condemnation for anyone taking them.
My daughter was on Depakote, Zyprexa and Lithium for 6 years and I know the Depakote/Zyprexa weight you speak of. She also had a permanent hand tremor that went away when off of Lithium, had diarhea most daily from it, and Depakote left her with Polycystic ovary syndrome (she has increased cancer risk now and low chance of having children if she could or wanted to).
I don't understand the "slow suicide" remark you made, I was discussing body damage, like kidney failure, tremors etc that I have seen happen to my daughter. A decade of psych med use and by age 20 her body shows much physical damage. (which causes me a lot of grief amd of course has limited her life in so many ways)
I don't even know if this comment makes sense, but hopefully it does.
Take care
Stephany
Posted by Stephany at November 26, 2008 02:36 AM
PS Larry--my "sentence" for you is to have a happy, good and long life.
Posted by Stephany at November 26, 2008 02:48 AM
Dguller,
You write: "Perhaps your complaint is that it is overused? Or would you state that someone who spontaneously experiencing recurrent manic and depressive episodes is ... what ... faking or imagining it?"
I'd say that the terms manic and depressive are subjective, I'd have to know the specific behaviors, the specific life events of the person, and I'd give more to the power of suggestion, valid expression of sane emotions and feelings, valid responses to internal and external stimuli than "faking it." Imagination isn't bad or the equivalent of "faking it."
Someone who believes they have a medical disease called bipolar disorder, or depression for that matter, isn't faking it or imagining it, they're just buying into a false story, dangerous trend...
Meanwhile, here's a quote from a real psychiatrist, The Last Psychiatrist:
" The term "bipolar"-- whether it exists (as a so far unknown physical pathology) or not-- isn't valid because it says nothing about the world; it only says what the person using it thinks about the world." http://thelastpsychiatrist.com/2007/11/the_extent_of_psychiatric_know.html
Larry, Depression is neither a disease nor the only problem reflective of societal problems, as I wrote:
"Depression is a serious condition but not a medical disease. The analogy I like to use in thinking about human distress and emotional pain is this." Human distress and emotional pain would cover the entire range of behaviors in the DSM and more.
As for the diabetes analogy, it's false, even if you buy the disease model which you seem to to say that because your girlfriend takes medicine everyday for her diabetes, someone with asthma has to be constantly hooked up to an inhaler every day whether they are having an attack or not is specious. Furthermore, to say that the treatment not the disease killed Plath is in no way "making fun" of The Bell Jar.
Posted by Sally at November 26, 2008 05:51 AM
Sekhar,
What you've written on the post "Thanks", November 26, 2008 is outrageous.
You've crossed all lines.
If he was paid $329,000 by Glaxo over the period of one year to present his (legitimate) case for circumstances where he found Lamictal to be the best mood stabilizer, is it really that big a deal, for someone with Dr. Goodwin's reputation?
But after reading this argumentation I can see what are your morals and values.
Now I can understand it all. We use to attribute to others behaviours that are ours, don't we?
Posted by Ana at November 26, 2008 11:52 AM
Sekhar:
You are now pulling out all the stops and have no conscience; in retort so will I!
What was your mood disorder by the way? Ego-maniac
You and John McPimp are in bed together! Must be quite cozy! How about that for s reality check!
So much for that lovely drug free and non-pharmaceutical promoting Mood Garden you personally run and collect donations for to line your pockets from. I guess it's my turn to play on your turf?
http://moodgarden.org/index.htm
"Mood Garden also provides free web hosting and web programming assistance to independent websites that support the community; currently, we host www.pokibid.org and partner with www.mcmanweb.com and other sites listed on the home page. (POKIBID , mcmanweb and the other sites are completely autonomous sites)."
"If you have any comments, please send feedback to admin@moodgarden.org . ( Site operated and edited by Sekhar Subramani, an individual living with a mood disorder. We can be reached at 1-888-226-6437 from within U.S.)"
This is right on your site for all to see: live and learn Sekhar; liar, liar, pants on fire, as they say on the play ground of life! Enjoy all those new hits!
Stan
Posted by stan at November 26, 2008 01:15 PM
Sally:
I'm not too sure what you mean by "subjective".
If you mean that the symptoms of mania and depression are only present in the awareness of patients, and thus cannot be objectively quantified, then I would disagree, because there are physical signs present, as well:
-- For depression --> change in sleep patterns, change in dietary intake, psychomotor agitation or retardation, change in energy level.
-- For mania --> decreased sleep, pressured speech, talkative, engaging in reckless and impulsive activities with negative consequences (e.g. spending money, sexually promiscuous), increased energy.
These can be observed by others and are certainly not subjective.
If you mean that the cluster of symptoms is arbitrary and without any basis in objective reality, then I would also disagree with you to some extent, because the signs and symptoms that are present in depression and mania were collected through multifactorial statistical analysis. That analysis -- the "statistical" in the Diagnostic and Statistical Manual -- showed that those signs and symptoms happened to be clustered together to an extent that could not be explained by chance alone, and likely represented a diagnostic entity.
However, I do agree that the number of symptoms that could and the duration of symptoms is somewhat arbitrary, e.g. needing at least four symptoms for at least one week to qualify as a manic episode. Why not three for three days? Kind of arbitrary, right?
But, scientists have to draw the line somewhere in order to quantify their data. Why is a BP > 140/90 considered hypertension? Why not 139/87? It is also arbirary, but it is necessary in order to have some uniformity amongst clinicians.
Take care.
Posted by dguller at November 26, 2008 02:34 PM
Someone who believes they have a medical disease called bipolar disorder, or depression for that matter, isn't faking it or imagining it, they're just buying into a false story, dangerous trend...
Ha. False stories and danger. You've obviously never told someone in episode that he is manic, bipolar or delusional because the irony is that the person who strong-arms his way into the kitchen at Olive Garden in order to teach the cooks what a real chef does thinks you are deranged, not him. There is nothing wrong with me I'm just going to fix the recipe!
But you're so stuck in your blame the victim mentality you believe the Last Psychiatrist is referencing all your sworn enemies, in love with their label.
Try again, this time with your head out of your ass--
" The term "bipolar"-- whether it exists (as a so far unknown physical pathology) or not-- isn't valid because it says nothing about the world; it only says what the person using it thinks about the world."
Which in your hateful projections you take as a reference to
"Someone who believes they have a medical disease called bipolar disorder"
Putting words in his mouth because you assume he also hates people with mental disorders. He wasn't talking about them. It's not there.
Perhaps your hatred of people with mental disorders interferes with the reading comprehension.
Posted by flawedplan at November 26, 2008 03:03 PM
dguller: Quoting you and clarifying “subjective”
"I'm not too sure what you mean by "subjective".
If you mean that the symptoms of mania and depression are only present in the awareness of patients, and thus cannot be objectively quantified, then I would disagree, because there are physical signs present, as well:
-- For depression --> change in sleep patterns, change in dietary intake, psychomotor agitation or retardation, change in energy level.
-- For mania --> decreased sleep, pressured speech, talkative, engaging in reckless and impulsive activities with negative consequences (e.g. spending money, sexually promiscuous), increased energy.
These can be observed by others and are certainly not subjective."
My comment:
Observation is a subjective act in itself; example; two people walk into a room, it's the exact same environment, yet one may feel hot, and another cold, one may notice various objects scattered about the room, while another may not. So on and so forth as the story goes.
Depression:
1.change in sleep patterns - for one person three or four hours sleep may be normal, to another they may need eight or ten hours!
2. Change in dietary intake - one person may be a huge eater and another eats like a bird and still be considered normal. One may even change their eating habits and still be considered normal depending on the situation and other environmental factors.
3. Psychomotor agitation or retardation - one person may seem hyper active to another and still fall completely into a normal range of behavior, while another may appear smart or stupid and still be considered completely normal and function well within society and that’s person individual daily environment.
4. Change in energy level - as if everyone doesn't have times when they feel more energy than others, there are countless explanations for this without a classification of bipolar labeled on them.
Mania:
1. Decreased sleep - same as above, since personal sleep needs and patterns vary widely between people.
2. pressured speech - many factors can be involved here. This could be situational or the person is perceived to have pressured speech by another and still fall well into the completely normal category.
3. talkative - let's take a huge leap here and say some people are more talkative than others. I know some pretty quiet people than can get fairly talkative in the right situation or may be after one or two drinks.
4. engaging in reckless and impulsive activities with negative consequences - you must mean you would perceive them to be reckless with negative consequences; or everyone participating in the X-games or doing dare devil stuff like jumping out of airplanes, or climbing mountains would be Bipolar; or even those driving in rush hour traffic would or could get labeled!
5. Spending money, sexually promiscuous, increased energy - all could fall under perceived normal activity for each individual! I guess it's how you would perceive the activity from your life experience and observation personally.
Then you get into everyone’s individual value system, spiritual beliefs, and everything gets even more twisted, skewed, and mixed up; this amounts to quite a quandary for those supposed based on science people.
Do you notice a pattern here? The DSM and all the criteria are completely subjective upon who's doing the observation.
(now if you want to debate who is expert enough to non-subjectively interpret this continually changing data stream coming out of individual human behavior; we can do that in your next lesson K)
Because diagnosis is all based on subjective observation of human activities, and by other human beings. That is not sound science, or does it qualify as quantitative and irrefutable data.
So your understanding hopefully has improved, as is just maybe your questioning of what is and isn't real science. But then again that's pretty subjective thinking on my part. I gather that makes it so and solid rock hard evidence in your logic?
Yours Truly,
Stan
Posted by Stan at November 26, 2008 03:36 PM
dguller: Quoting you and clarifying “subjective”
"I'm not too sure what you mean by "subjective".
If you mean that the symptoms of mania and depression are only present in the awareness of patients, and thus cannot be objectively quantified, then I would disagree, because there are physical signs present, as well:
-- For depression --> change in sleep patterns, change in dietary intake, psychomotor agitation or retardation, change in energy level.
-- For mania --> decreased sleep, pressured speech, talkative, engaging in reckless and impulsive activities with negative consequences (e.g. spending money, sexually promiscuous), increased energy.
These can be observed by others and are certainly not subjective."
My comment:
Observation is a subjective act in itself; example; two people walk into a room, it's the exact same environment, yet one may feel hot, and another cold, one may notice various objects scattered about the room, while another may not. So on and so forth as the story goes.
Depression:
1.change in sleep patterns - for one person three or four hours sleep may be normal, to another they may need eight or ten hours!
2. Change in dietary intake - one person may be a huge eater and another eats like a bird and still be considered normal. One may even change their eating habits and still be considered normal depending on the situation and other environmental factors.
3. Psychomotor agitation or retardation - one person may seem hyper active to another and still fall completely into a normal range of behavior, while another may appear smart or stupid and still be considered completely normal and function well within society and that’s person individual daily environment.
4. Change in energy level - as if everyone doesn't have times when they feel more energy than others, there are countless explanations for this without a classification of bipolar labeled on them.
Mania:
1. Decreased sleep - same as above, since personal sleep needs and patterns vary widely between people.
2. pressured speech - many factors can be involved here. This could be situational or the person is perceived to have pressured speech by another and still fall well into the completely normal category.
3. talkative - let's take a huge leap here and say some people are more talkative than others. I know some pretty quiet people than can get fairly talkative in the right situation or may be after one or two drinks.
4. engaging in reckless and impulsive activities with negative consequences - you must mean you would perceive them to be reckless with negative consequences; or everyone participating in the X-games or doing dare devil stuff like jumping out of airplanes, or climbing mountains would be Bipolar; or even those driving in rush hour traffic would or could get labeled!
5. Spending money, sexually promiscuous, increased energy - all could fall under perceived normal activity for each individual! I guess it's how you would perceive the activity from your life experience and observation personally. Then you get into everyone’s individual value system and spiritual beliefs and everything gets even more twisted, skewed, and mixed up; this amounts to quite a quandary for those supposed based on science people.
Do you notice a pattern here? The DSM and all the criteria are completely subjective upon who's doing the observation.
(now if you want to debate who is expert enough to non-subjectively interpret this continually changing data stream coming out of human behavior; we can do that in your next lesson K)
Because this poor excuse for science is all based on subjective observation of human activities, and by other human beings. That is not sound science, or does it qualify as quantitative and irrefutable data.
So your understanding hopefully has improved, as is just maybe your questioning of what is and isn't real science. But then again that's pretty subjective thinking on my part. I gather that makes it so and solid rock hard evidence in your logic?
Yours Truly,
Stan
Posted by stan at November 26, 2008 03:55 PM
Dguller,
"change in sleep patterns, change in dietary intake, psychomotor agitation or retardation, change in energy level." These terms are subjective and value based.
"decreased sleep, pressured speech, talkative, engaging in reckless and impulsive activities with negative consequences (e.g. spending money, sexually promiscuous), increased energy." Again, subjective, value based, oppressive.
Fever of 101 is objective, weight of 170. Increased energy is subjective, reckless, sexually promiscuous - come on.
FP, clever semantic trap. I don't hate people with mental disorders. I do believe someone who believes they have a medical disease called bipolar disorder is mistaken. How many times have we been down this block. This doesn't mean I don't think insomnia and loss of appetite are serious problems, and perhaps even pressured speech. And sure medication can help and even therapy but your Olive Garden example, like your directing traffic example has varied interpretations.
Posted by Sally at November 26, 2008 03:58 PM
Stan:
Where to begin?
Of course some people sleep less or more than others. I mentioned a CHANGE in sleep from what is considered normal given a person's history.
If someone normally sleeps 7 hours a night, and then starts sleeping 10 hours, and this occurs in the context of a change in their appetite and weight, a loss of energy and motivation, and with near-constant sadness and loss of interest in once pleasurable activities over the course of several weeks, which makes them unable to function at work or home, then I would be suspicious of a major depressive episode.
Again, to reiterate, the criteria does not have some standard of "normal", and then anyone who deviates from it is branded with a mental illness even if they are functioning just fine in the world. No. If someone deviates from what is normal FOR THEM with various CHANGES in their mood, cognition, motivation, behavior and so on, to the point that they cannot function properly, THEN a mental illness can be considered.
And no, the criteria are not entirely dependent upon the clinician making the observation. For example, I rely upon collateral from family members and friends who know a patient for information. If people who know someone well express concern over a change in their behavior, then I will not dismiss their concerns saying, "Who are you to judge what is normal for this person? You are just bringing your subjective impressions to me!" That would be ridiculous.
I am not saying that psychiatry is akin to physics where objective test results prevail. However, I do believe that human cognitions, emotions and behavior can be quantified to some extent, and that conclusions can be drawn from those investigations that are useful to help people.
Perhaps you believe that human beings are utterly inscrutable entities that cannot be understand at all to any extent?
Is that your position?
Take care.
Posted by dguller at November 26, 2008 05:22 PM
Oh fuck your dehumanizing, morally repugnant objectifying interpretations.
My directing traffic "example" was an experience; concrete, felt, lived experience. Your breathtaking interpretation of that experience was that such a person is breaking the law and your solution was that such a person should be placed under arrest for being a public disturbance.
Lucky break how my psychiatrist had other ideas, including what it feels like to be running barefoot through the Congo on a sunny day in an urban city.
Where is the actor's subjectivity in your argument? You too Stan, step out of your unreadable batshittery for a minute and tell me where the agent's subjectivity is in your inane burble.
Now consider where mental health authorities get their leverage in their psycho-education campaign, how they convince a person they are cursed with a disorder characterized by mania.
Is there a maniac in the house?
As Lou Reed put it, How do you think that feels, and when do you think it stops?
Posted by flawedplan at November 26, 2008 05:49 PM
Stephany:
Thank you.
Sally, Sally, Sally ...
Are you saying that chronic disease in general does not exist, or only that mental illness does not exist? Because I'm confused, and I certainly wouldn't want to tell my girlfriend not to take her glucophage without at least being clear on the reason.
(Plus, the analogy you tried to construct applied to ECT, not to medication. I'm no fan of ECT.)
And I didn't even catch flawedplan catching you say that mental illness is "buying into a false story, a dangerous trend ..." FP is right -- I cannot imagine anything more patronizing possibly being said on these pages.
(And I'd MUCH rather you hate me than be so g*dd*mn condescending toward me, or anyone else who has -- or in your odd mind, "claims to have" -- a mental illness.)
Besides, if you're right, that means people who say they have mental illness are actually delusional, which means ... they have mental illness. So I'm not sure where your definition helps your theory of the non-existence of mental illness.
PS -- Which also means you're right, I shouldn't have said you were making fun of Plath's book. I should have said you were making fun of Plath herself. Along with me and everyone else on this comment board.
Posted by Larry at November 26, 2008 06:23 PM
Geez! dguller and Flawed-angry at the world-plan.
I will try to simplify this as much as possible so you can follow along Flawedplan! Let me say this about the insults and demeaning comments from you personally. I consider them indulgent flattery and esteemed compliments considering where they are coming from. So thank you very much.
Class 2 begins for your enjoyment!
Subjective has now been covered and you have made no argument against it unless you also agree with the last line of my prior post, which makes me absolutely correct in your logic anywise! So any combination of the about list as you use for DSM criteria are subjective and not real science! Collecting data from observation of behavior is not science, it just collecting subjective data! That isn’t real science, just speculation as an absolute. Psychiatry at its very core is not science, but subjective interpretations of what's normal and what's abnormal, thus we come to diagnostic criteria and who makes those judgments.
First off, many times the patient themselves are either aware or unaware they are deviating from what society calls acceptable norms. (Let us keep in mind that as human behavior changes, the norms are in constant state of change also! So what is normal today may very well be considered abnormal or obsolete tomorrow or ten years from now. There is no certainty in any of this).
Society makes the call on what’s normal or abnormal! Not psychiatry unless we allow it too! I personally consider them not qualified since they have shown us time and time again they are not to be trusted with prudent or responsible health care or treatment that is beneficial in both short and long term effectiveness to patients in need of mental health services. A diminished life is exactly that! You take away from a human being and leave nothing in its place to fill the void.
I don’t believe either of you are going to argue they are working from any other paradigm than the medical/medication or like model. This model is built on the theory that by changing brain chemistry, we can change behavioral symptoms and gain positive results. This model and other very similar to it have failed us for hundreds of years and are continuing to fail us today! Sometimes a medication works, sometimes it doesn’t work, sometimes it damages patients, sometimes it works for the short term and then causes other damaging or unpleasant side effects that are irreversible in the long term, sometimes it just stagnant and is no better than a placebo and nothing at all.
Basically, Psychiatry is throwing darts in the dark, sometimes they get lucky and hit the board, but more often than not they miss the mark by a mile. Then you add in Pharmaceutical industrial interest where huge profits are to be made, and humanistic greed that permeates our society and medicine (especially Psychiatry) at this time; and you create a perfect storm of failure and abuse.
Mental Health Issues and diagnostics are fairly whimsical at this time, though it may or may not have a biological base. We as human beings don’t know enough about the mind, brain, thought processes, and behaviors to really make sound calls in the name of science! The evidence is just not there! It’s all anecdotal and suspect to be honest. So we as a society need to wake up and call out psychiatry for what it really is, along with calling out the DSM for what it really is! They are both totally flawed and without any doubt incomplete. We need to only let a well regulated and truly independent body make Mental Health decisions within our society with ethically and moral integrity; but since we do have constitutional rights in this society in American. The patient should always in every case make the final call on treatment, and have proper recourse if that treatment is found to be flawed and damage them personally.
It is time to take the power away from the mental health profession and huge Pharmaceutical giants; and place where it belongs, with society as a whole, with communities taking their responsibility on like they have in other areas of accepted disabilities, with families in most cases (not all) as a fostering unit, and finally the personal rights of the person in question with the ultimate and final choice.
We need to throw all the labels out the window, a mental health issue should be just that! There is no need to stigmatize a person for their internal struggles and stimulus. It now time to take a big step back, question all the flawed science that has failed us, and reevaluate what really counts. I believe we are talking about real living human being here that deserve dignity and respect. That is not happening nearly enough or with quality today, nor will it happen if we stay on this same old and tired road of failure. End of class 2
Take a break and class three will begin shortly {laughing}
Yours Truly,
Stan
Posted by Stan at November 26, 2008 08:12 PM
Simple Larry, according to papa Szasz when convinced you are Jesus Christ you are actually a "liar", and when you amok through the city streets screaming in terror that you've been targeted by the CIA you are "self-dramatizing." These evaluations are necessary to make you a "humane" and "compassionate" "advocate" of the psychiatrically labeled.
What's truly hilarious about these fuckstains is their own lack of self-awareness and utter transparency in the eyes of the rest of the world. They think they're better than Fuller Torrey and the NAMI authoritarians, and never notice that their zealotry is what they privilege above all, and that their preoccupation with the zealot Fuller Torrey might reveal something interesting about themselves, but no. A zealot is a zealot.
With few exceptions the anti-psychiatry and psychiatric survivors are conducting a battle with each other, over our heads. The battle is about which is going to wield legitimate power over the psychiatric population. Sally and Torrey are mirror images; vultures fighting over a carcass. There's no talking back, no dialogue, you will not be heard, your words not assimilated, subjectivity denied. And when you do behave as a non-dead entity you will be punished, and they live with such unvarnished ass-holery via the magical powers of self-righteousness, which is a license to inflict.
Welp, I'm sure we know all this already, I'm just in an unusually chatty mood tonight.
Posted by flawedplan at November 26, 2008 08:45 PM
Stan:
First, I don't think you understand multifactorial statistical analysis.
You see, the developers of the DSM-III and -IV, analysed data from thousands upon thousands of patients and used statistics to determine if certain signs and symptoms tended to cluster together more than could be expected by chance alone. What they found was that people who complained of depression or anhedonia tended to also have changes in their sleep, appetite, concentration, energy, motivation, and so on. They did a similar procedure for other disorders.
You make it sound as if some people got together in a closed room and just randomly picked a set of criteria that made their right legs tingle. No. There is a logic to the criteria that is certainly not ironclad, but it is equally not haphazard.
Second, I didn't argue with your final statement, because I honestly didn't understand it. Sorry.
Third, observing behavior is subjective? So, if I measure someone sleeping 6 hours a night, then that is subjective? I don't think a reasonable person would think so. It is arbitrary in terms of what one considers "sleep", for example, non-REM versus REM sleep, but that is just a difference in opinion in terms of how one would describe an objective phenomenon, which is real and not simply subjective.
Fourth, there is nothing in the DSM-IV that says that someone has a psychiatric disorder, because they are not "normal". For example, for an belief to be considered a delusion, it has to conflict with one's culture! So, if someone has beliefs that we consider completely abnormal, but those beliefs are appropriate in their culture, then they cannot be called a delusion.
The DSM-IV actually puts priority on a person's ability to FUNCTION at school, at work, and in their relationships. If someone is abnormal, but is able to thrive in these areas, then the DSM-IV is silent and does not comment on them. However, if someone is unable to function and that inability is due to a problem with mood, anxiety, cognitive and/or psychotic symptoms, then a diagnosis may be appropriate. That's all. Nothing about everyone fitting nicely into a "normal" category, whatever that is.
Fifth, you are correct in stating that there is a suspicious collusion between the biomedical model of psychiatric illnesses and the pharmaceutical industry. I happen to believe that mental illness is a change in brain activity that has to do with neurotransmitters and neural pathways, and that medication can be helpful in some occasions. However, I also believe that psychotherapy is absolutely essential for most people, because the real change in people's lives comes from insight into how their problems came about and a richer integration of their self-understanding and life narrative, as well as better coping skills. Medications certainly cannot accomplish all that!
Oh, and by the way, when you try to be condescending and arrogant -- i.e. your whole idea of being a teacher dispensing lessons -- you only come across as foolish and comical.
Maybe we could discuss these matters without the negativity?
Take care.
Posted by dguller at November 26, 2008 09:20 PM
Gah, the Preview button is my friend.
"With few exceptions the anti-psychiatry and psychiatric survivors are conducting a battle with each other, over our heads"
should be "conducting a battle with organized psychiatry over our heads ... about which is going to wield legitimate power over the psychiatric population..."
Fixed!
(Hic!)
Posted by flawedplan at November 26, 2008 10:23 PM
dguller:
To start with the DSM is all about normality and abnormality; it is the base and true test all its data is weighed against. You are so off in some la la land that is incomprehensible.
What you don't seem to understand is that group of so called professionals had a high stakes investment in the game! So all that data you talk about is skewed and completely useless (it's all lies, a slight of hand trick, illusion, and deception; but then you’re so stuck on your theory that you're stuck in the concrete unable to move. So I say go with it as you choice) because they cherry picked the criteria off the data, and then made the outcome say what they wanted it to say! Funny how you can do that with statistical data when money is involved! Or are you actually so naive and totally blind that you don't know that the vast majority on the DSM panel had huge financial investments in Big Pharmaceutical and organized health care providers?
Who's in fantasyland here? I'm condescending because you are one of those one track ponies that never want to see the truth or even consider it as another option; I personally on the other hand have been down your road, I found it stinks, and is rotten to the core for myself and countless patients that were in my care.
Subjective or Objective?
So take your magic pills, believe in your lies, or whatever makes you feel wellness.
Your same old rehashed tired arguments tend to bore me anywise. I have heard them a thousand times before debated in much more persuasive ways.
I'm not here to play nice or be nice! I'm here because I happen to care about what happening to our kids and mentally ill populations; I’m demanding change, some ethical and responsible medicine preformed by pharma and doctors without dollar signs and greed attached to everything, and some much deserved self determination and dignity for those with Mental Health Issues.
That is not happening today in the real world! Sit there in your seat and tell me the system is running smoothly and all is well; if you can do that, then we know you’re so full of S---. You are just selling labels, pills, and lies; like Dr. Goodwin, John McPimp, Biederman, Nemeroff, and all the other arses.
I hope that fills you with great joy for this Thanksgiving.
End of school for you; you receive an “F” grade for pure ignorance. Class is now dismissed!
Yours Truly,
Stan
Posted by stan at November 26, 2008 10:44 PM
Stan:
I really don't think that we can have a productive discussion, which is unfortunate.
I am very sorry that you have had such a negative experience with psychiatry, but I really do not think that you know what you are talking about. You basically have one idea that you just rinse and repeat, again and again; namely, that psychiatry is utterly subjective, that its diagnostic criteria were manipulated by corrupt physicians in order to please their drug company overlords whose only purpose is to make money. That is too bad, because there is some truth to what you say, but you are so one-sided that what could be reasonable becomes a parody.
It is very easy to just sit back in fantasyland and say that the DSM defines what is normal and abnormal and that the various statistical analyses that went into its diagnostic criteria were all fraudulent, but here in reality, we require something called evidence.
I don't think you have ever read the DSM, other than in a cursory fashion. I use it on a daily basis, and I can tell you that it does not define what is normal and abnormal as its primary feature, but rather focuses on social, academic and occupational dysfunction. In other words, people are aren't functioning well in various important domains in their lives. That is why if you look at every single DSM illness, they always include something like, "The patient has difficulties in function due to these symptoms".
If you disagree with this account, then please cite the page numbers in the DSM-IV that explicitly identify abnormality as the primary problem. Also, please cite your evidence that the researchers behind the DSM-IV manipulated the statistics. You are correct that 56% of the 170 panel members had financial ties to the drug industry, and that 100% of those involved in the mood disorders and psychotic disorders categories had ties. This is certainly concerning, but again, you must have evidence that these people manipulated the data. If all you can say is that everyone knows that they are corrupt and they must have committed fraud, then this conversation is over, and I hope you enjoy living in your paranoid fantasyland, and I wish you well.
As I have said previously, researchers with financial ties to the drug industry do not logically imply that their research is garbage. It only means that their research should be looked upon with greater scrutiny, because of the conflict of interest. If the research is found to be methodologically or statistically unsound, or that the data was manipulated in order to skew the results, then it should be rejected. However, if that does not happen, then the research can be accepted as valid even though its clinicians have an investment in one particular result.
Also, I never said that "the system is running smoothly and that all is well". I admitted that psychiatry's ties to the drug industry are a problem, that our diagnostic criteria are not ironclad, that our medications are not as effective as marketed and that their side effects are serious, and so on. I don't think you were ever debating me, but rather some straw man that you have invented who is so ridiculously corrupt and fraudulent that you have no need for evidence, because obviously he is wrong.
Again, if you can discuss things with me, the real flesh and blood person here, rather than the fantasy your imagination has concocted, then we can continue. If not, then, again, I wish you well and good luck.
Posted by dguller at November 27, 2008 04:10 AM
dguller,
What you portray here is a perfect example of "i'm right and your wrong" with re: to psychiatry, and it's victims.
Many people here, as you must know from reading here have been victimized and I don't say that lightly.
Drug trials for 18 or so years for several commenters including Philip speaks a lot for how this paradigm is old and washed up. Nothing has changed except the labels on the bottles and most of those are just new versions of pharma's way of making more profit from losing the patent.
Invega, Pristique, etc.
For as much as you may not want to hear the rants from people like Stan who have been inpatient in psych wards, worked in psych wards and trialed without success most ALL psych meds....
too bad.
You are right. There is no discussion with you.
I've been in this crap shit system for a decade and I wish I could say it has gotten better, but it has only worsened with the promoting of drugging children at earlier ages with highly potent chemicals such as Abilify and Risperdal.
The fact that their is a Senate investigation of all of these people says something and for further enlightenment read ALL of the Zyprexa documents hosted on this site, then look at the DSM, the pharma-funding and the corrupt KOL's that pocket cash and then sleep at night.
Posted by Stephany at November 27, 2008 01:23 PM
Stephany:
*Sigh*
Please re-read my previous post and see how many times I AGREED with much of what Stan and others here have said. I am not closeminded and dogmatic about these issues and try to avoid extreme positions.
That is all I am trying to accomplish here. To help you all see that those who practice psychiatry are not devils in human disguise who take gleeful pleasure in inflicting pain and suffering on their patients while pocketing a truckload of money.
It is very easy in the heat of emotion to set reason and logic aside, but that leads one to commit many fallacies and errors. For example, just because there are numerous dramatic examples of fraud in psychiatry -- which are to be condemned -- it does not follow that ALL psychiatry is equally fraudulent. That is just not a valid argument from a logical standpoint.
To make that claim would be equivalent to saying that since some Catholic priests are pedophiles that therefore the entire Church should be dismantled and all priests should be tried as child molesters. Clearly, that is irrational, and it is unjust to judge an entire group of people due to the negative behavior of a few.
Condemn those who have demonstrably committed fraud in their research and clinical practice. I wholeheartedly join you in your protect. However, do not cast your net so wide that you include innocents in your thirst for retribution.
Posted by dguller at November 27, 2008 04:24 PM
I don't need anyone to:
"To help you all see that those who practice psychiatry are not devils in human disguise who take gleeful pleasure in inflicting pain and suffering on their patients while pocketing a truckload of money."
I think for myself. and also have a psychiatrist who is a gem.
Posted by Stephany at November 27, 2008 05:58 PM
DGuller, I don't think you are evil just like I don't think my current psychiatrist is evil. But your profession has a problem in seeing everything through the lens of the label and drugs. Let me give you an example of my last session with my psychiatrist that I think is quite typical.
I go for my med check and this guy asks how my mood is instead of how I am coping with my mother's death. Then instead of asking how I am coping with my withdrawal symptoms, he asks questions trying to determine if I am relapsing. When I said I am doing good when I don't have withdrawal symptoms, his reaction was I shouldn't be having any since I am tapering slowly. I can't repeat what I wanted to say but needless to say, it wasn't positive.
Not once did this guy say, you know, considering everything you have been through, you are doing a great job in coping. Instead, I feel like he is waiting for me to relapse which isn't going to happen.
DGuller, my experience, Stephany's experience, Jane's experience, Sorroful's experience, Stan's experience are why we are mad as hell. Then you make remarks that while they don't show you are evil, you have the same mentality as my psychiatrist and probably the ones they saw judging from reading their histories. I see this same attitude by other internet psychiatrists even though they don't seem evil. You and your colleagues don't seem to believe that people can actually recover without meds.
You want us to stay on these meds and suffer from side effects that are worse than the cure. Why would I want to stay on meds that caused a hearing loss and worsened my LD issues? If I had completely lost my hearing on top of having LD, that would have been devastating. But yet, because my psychiatrist and your colleagues are stuck on depression relapses that most likely occur due to being withdrawn from meds too quickly, you are willing to sentence me to life on these meds and side effects be dammed. That is why we are mad as hell and feel frustrated with you.
I do applaud you for trying but you don't get it. No, you're not evil but when you don't get it, that can be just as damaging. As someone on an email list I belong to said, just because you didn't mean to hurt someone is not any less harmful than if you did.
AA
PS - I feel I can make the assumptions I made because prior to my current psychiatrist, I had 7 others that were even worse.
Posted by AA at November 27, 2008 07:35 PM
DGuller, I wish I had thought of this comment previously. You are right about not stereotyping all Catholic Priests as pedophiles or stereotyping anybody in general.
But true healing and trust didn't take place until assurances were made to victims that they were truly going to be heard and that is occurring in the Catholic religion.
Until psychiatry does the same thing and takes a position of humility, you are going to have same problems with people like us who have legitimate anger at what has happened to them.
Posted by AA at November 28, 2008 02:57 AM
AA:
Thank you for your feedback.
I do believe that some people can recover without meds, and the guidelines are explicit about this in some disorders. However, there are some people who cannot recover without medications, and that should be taken into consideration, as well.
I do not like these abstract, vague discussions about patients' recovery without any specific details. I see each of my patients in a case-by-case basis, and some I feel need medications and others don't.
Oh, and what I want my patients to do is irrelevant. I present them with their options, and they decide what would be best. I recently started a young lady on Lithium, because she had three manic episodes and a major depression. She was ambivalent about it, and so we went over the pros and cons of Lithium, no medication, and other meds. She discussed the matter with her family, and we agreed to a trial of Lithium, which she is responding well to.
That is early in treatment. I think that the cases you are discussing are those who fail to improve despite being on multiple medications in the past. In that case, I would have a discussion with my patient about the pros and cons of taking medications versus not taking them. I have had people choose to go off their medications, and there was no change in their mental status.
Now, regarding relapse versus withdrawal symptoms. I believe we already had this discussion on previous threads. I am sorry that your prior physicians were unable to make this distinction, and I'm sure many of my colleagues make the same mistake, but a change in mental status within a few weeks of decreasing dose, I would consider withdrawal, especially if their mental status now includes symptoms that weren't present during their episode of illness. However, after a month or more, if their mental status changes to resemble their episode of illness, thenI would strongly suspect a relapse. I would handle those two situations differently.
Posted by dguller at November 28, 2008 05:31 AM
Larry, Do you think it's cute do be deliberately obtuse? You ask: "Are you saying that chronic disease in general does not exist, or only that mental illness does not exist? Because I'm confused, and I certainly wouldn't want to tell my girlfriend not to take her glucophage without at least being clear on the reason."
You know even less about diabetes than you do about normal human responses ghettoized as mental illness.
Obviously there's a third choice. I'm saying that chronic disease exists and that mental distress is not a disease. Sure emotional distress can be chronic but it's not a disease.
Your girlfriend can check her blood insulin levels to see if she needs glucophage. Her doctor can also monitor this. There's no comparable objective measure for someone labeled as bipolar to check.
I have trouble getting this idea that it is only if mental distress is labeled a medical disease that such distress can be treated with compassion. Grief is not a medical disease, but that doesn't mean it's not real, fear is not a medical disease, physical or emotional pain, not medical diseases. PTSD is not a medical disease, it's a painful human response to trauma. Combat related ptsd should be treated with respect not doped up and locked up.
To say that mania has it's roots in human experience is different from saying mania doesn't exist, or that agitated people shouldn't be treated with compassion, though it is a vague and general term from the pejorative maniac, part of why the more pc term bipolar was introduced.
FP, you give me a clue here with your misinterpretation of Szasz: "Simple Larry, according to papa Szasz when convinced you are Jesus Christ you are actually a "liar", and when you amok through the city streets screaming in terror that you've been targeted by the CIA you are "self-dramatizing.""
That's simply wrong, FP, Szasz wouldn't think someone convinced s/he was Jesus Christ was a liar, he'd think they had a right to think they were Jesus Christ.
As for the traffic incident, I think my interpretation was that directing traffic isn't a sign of mental illness. I haven't reread that thread but I'd assume someone who did that would be arrested and would be better off arrested than hospitalized because the problem is the traffic not the person complaining about it. I think jail is less harmful than psych hospitals but that doesn't mean I think the person in the traffic incident should be arrested. People do that sort of thing here in Atlanta fairly often and save lives.
Liberals want to hospitalize people for breaking unfair laws and call it treatment for mental illness, conservatives make the unfair laws. What I think needs to happen is society needs to be reformed. When a teenager gets arrested with pot, liberals say he is a drug addict who should endure treatment for the rest of his life, conservatives say he should go to prison. What about those of us who think marijuana should be decriminalized and if the kid ever thinks he has a drug problem he should be free to go to an anonymous, free support group to try and change his behavior.
As for your Olive Garden example: the food at the Olive Garden really is an example of homogenized, flavorless, corporate crap being passed off as food. If the person who walks into the kitchen to complain knows anything about Italian food and/or is a victim of the mass closing of small family owned Italian restaurants due to the mega box Olive Gardens, his behavior is understandable. The food at Olive Garden is so bland, such a tragedy, that the dude should be commended.
So I'd say the guy who "You've obviously never told someone in episode that he is manic, bipolar or delusional because the irony is that the person who strong-arms his way into the kitchen at Olive Garden in order to teach the cooks what a real chef does thinks you are deranged, not him. There is nothing wrong with me I'm just going to fix the recipe!"
His mania is a sane reaction to the crappy food that Olive Garden serves and the horrible trail of society to a place where everybody takes their lithium and eats the flavorless red goo that passes for marinara sauce at Olive Garden. When I say the dude isn't mentally ill, that doesn't mean I think he should be put in jail, it means I think that the food would taste better if the cook listened to him. (olive garden doesn't hire trained chefs to work in it's local outlets)
Posted by Sally at November 28, 2008 06:57 AM
DGuller, You are sadly and very mistaken that withdrawal only lasts a month. We discussed this previously but it bears repeating. If medications take up to 12 weeks to work, there is no way that you can say that a relapse has occurred after a month.
You claimed my reasoning was invalid by using the example of a broken finger that takes awhile to heal. But you are comparing apples to oranges as we are not talking about biochemical reactions in the body.
If the brain needs 12 weeks to fully adjust to drugs in the body, there is no way it needs less time to withdraw from them.
If you look those the case histories on the Paxil Progress site, you will notice that alot of people posting also have physical symptoms that you can't attribute a mental illness such as dizziness and tinnitus.
http://www.paxilprogress.org/forums/showthread.php?t=20079
One of those people is the son (Ryan) of the administrator of the board, Laurie Yorke, an RN. I think he is almost recovered but it has been a long process.
Also, many people were put on psych meds for reasons other than mental illness. So what is you explanation for their persistent withdrawal symptoms that last longer than a month?
The vague cases you mention are only vague because of the mindset of psychiatry in consistently believing what you are told without question. You did say you questioned some of what your supervisors said and I applaud for that. But you're still falling way short.
Posted by AA at November 28, 2008 09:48 AM
AA:
That was an excellent counter-argument!
So, you are saying that Catholicism should not be rejected completely out of hand as a result of the reprehensible actions of a few pedophiles, because it the victims' concerns have received some measure of validation by the clergy.
You are right that the Catholic church has taken some modest steps to correct the abuse, such as having better screening for their seminaries. However, there is evidence that the Catholic church continues to invalidate the suffering of abused children. As recently as 2001, Cardinal Ratzinger -- the current Pope -- issued a secret edict to bishops around the world telling them to encourage the priests and children involved not to talk about their crimes on pain of excommunication.
That seems to invalidate your argument somewhat. I happen to feel that the fact that the Catholic church elected as their leader and figurehead a man who as recently as seven years ago encouraged the cover-up of the sexual abuse of children speaks against your conciliatory claim.
Again, if your position here is to reject psychiatry as a totality, because some high profile researchers and clinicians have engaged in reprehensible behavior, then you must also demand the dismantling of the Catholic church, because they have done the same thing, and possibly worse.
Posted by dguller at November 28, 2008 10:10 AM
Sally:
So, if a person -- with no culinary training -- while in a manic state barged into the kitchen of a restaurant you were attending, demanding to run the institution in a fit of grandiosity, because he knows better than everyone, then you would be okay with that? You "think that the food would taste better if the cook listened to him"? Really? You would be agitating on his behalf? "Oh come on, let him try to run the kitchen! Maybe he knows better than all the chefs there!"
Also, if someone suddenly believes that they are Jesus Christ, then we should do nothing about it, because it is their right to believe whatever they want? You wouldn't try to work him up for a medical illness? You wouldn't look at any medications or street drugs he may have ingested? You wouldn't try to intervene while he sells all his possessions and signs away his home and car, because Jesus had no material goods?
Posted by dguller at November 28, 2008 10:17 AM
Dguller,
You quoted me correctly, I wrote "think that the food would taste better if the cook listened to him." I didn't write that I would be agitating on his behalf or that I thought he should run the kitchen.
If someone believes he is Jesus, so what? If someone sells all off of his possessions, it doesn't necessarily mean he thinks he's Jesus. There are plenty of problems in the world that are not medical diseases or crimes. Why is that fact objectionable to you?
Posted by Sally at November 28, 2008 12:25 PM
AA:
I made no definitive remarks about withdrawal versus relapse.
I said that if I discontinue a medication and in less than a month they develop symptoms that are inconsistent with their mental illness, then I would "consider" a discontinuation syndrome. Nothing definitive, because I would need to know the entire clinical picture.
I also said that if I discontinue a medication and after a month a person develops symptoms consistent with their previous episode, then I would "suspect" a relapse. Again, nothing definite, because I would need the whole story.
If you are suggesting that I could discontinue a medication, see no adverse effects whatsoever, and then suddenly in two months a person presents with the same symptoms that I medicated them for to begin with, and I should conclude that they are in withdrawal, then I think that is a stretch. There would be SOME signs and symptoms within the first few weeks that would indicate a withdrawal reaction, I think.
Actually, there is new research that is questioning the delayed onset of antidepressant effect that is quite interesting. (See J Affect Disord. 2008 Nov 21.) In other words, when people report getting better after several weeks on the medication, that is when they are aware of the change, but that the change had been occurring early on. That is why two thirds of those who respond to medication within the first two weeks will go on to have a greater response later on. If that is true, then your point no longer holds true.
And regardless, you are assuming that if it takes 12 weeks to have an effect, then it should take (at least) 12 weeks to get a drug out of the system. That is like saying that if it takes two hours to ride a bicycle uphill, then it should take two hours to ride it downhill. We would need quality studies that demonstrate your point. I am unaware of any, but if you could provide them, then I would read them, eagerly. :)
About those individuals who continue to have symptoms for longer than a month after discontinuing medications, then I would say that they are likely vulnerable to such effects unless there are other factors, e.g. medical illness, other medications, OTC and herbal meds, etc.. However, you never stated that they suddenly developed those symptoms a few months later and they never went away. And that was my point.
Thank you for the dialogue.
Posted by dguller at November 28, 2008 12:31 PM
DGuller, as an aside, I saw your other post which I will respond to but since it is long, it might not be until tomorrow.
Fair points about the Catholic Church. I was talking about what I have observed in my neck of the woods.
You said:
"Again, if your position here is to reject psychiatry as a totality, because some high profile researchers and clinicians have engaged in reprehensible behavior, then you must also demand the dismantling of the Catholic church, because they have done the same thing, and possibly worse."
Sorry if I wasn't clear. It isn't just the reprehensible behavior that bothers me. It is the attitude that everything is seen through the lens of the "illness" and the drug come heck or high water. You seem like you're trying not to be like that and I applaud you for that. But many of your colleagues are stuck in that mode.
I don't know if I reject psychiatry as a totality or not but I do know that the day I am completely off of psychiatric meds and thus free from psychiatry will be one of the happiest days of my life.
Posted by AA at November 28, 2008 12:52 PM
Sally:
I see. Let me propose another scenario: What if a hyperactive and grandiose stranger off the street barged into your office and exclaimed that he could do a much better job than you could and that he should take over your position in the company immediately? Would look on with bemused interest and give him a shot at your job?
I agree that if someone believes that he is Jesus Christ, then that, in and of itself, is not necessarily a problem. However, if that person's loved ones have noticed a dramatic change in their personality, and that they are engaging in activity that could lead to harmful consequences to themselves, then you would idly sit by and do nothing? What if they had a brain tumour? What if they are delirious with a brain infection? What if they ingested a toxin in their food? Would you do nothing and allow this person to destroy their life and livelihood, because you happen to have a strong dislike for psychiatry?
And I am fully aware that there are problems in the world are are not medical issues. That fact is not objectionable to me. However, you have to acknowledge that there are some that do require medical treatment, and it is objectionable to me that you would deny someone treatment for the sake of a political statement rather than try to do what is best for them.
Before you reply, I will stipulate up front that you can likely come up with a counterexample that shows that psychiatric intervention in a case where someone is acting unusually, but isn't hurting anyone, is inappropriate. I would agree with you on that score. But I just want you to admit that there are also situations where intervention is necessary. Can you do so?
Posted by dguller at November 28, 2008 12:57 PM
dguller,
Thanks for your comments about the RC church. The same church that has rewarded Cardinal Bernie Law with a cushy sinecure in Rome for his part in covering up the sex abuse in the Boston Archdiocese. Yeah, that church.
I personally believe the church should, indeed, be dismantled brick by brick, its art donated to museums in the countries from whence it came, its Vatican gold melted down and distributed to the people it continues to injure and rob from all over the world. Even that wouldn't begin to atone for their sins, but at least it would stop them from dishonoring their god.
But on to other topics. I personally agree with Sally's assessment of the Olive Garden situation, although I'm a big fan of boundaries and don't favour sashaying into someone else's kitchen. I don't consider doing so a sign of mental illness, though. (Have you watched much Gordon Ramsay? He'd probably fit a DSM criterion or two after spending time in their kitchen.)
You said "Also, if someone suddenly believes that they are Jesus Christ, then we should do nothing about it, because it is their right to believe whatever they want? You wouldn't try to work him up for a medical illness? You wouldn't look at any medications or street drugs he may have ingested? You wouldn't try to intervene while he sells all his possessions and signs away his home and car, because Jesus had no material goods?"
My answer to you is yes. I do believe that if the person isn't harming anyone and isn't asking for your "help" you should jolly well leave them alone. I think if you think you're a dog, bark like a dog and insist upon wearing a dog collar but you're not biting anyone that it's no one's business to apply force to make you change your behaviour. I didn't always feel this way, actually. In fact, the "I think I'm a dog" example comes directly from my work, but being labelled "mentally ill" sure has changed my tune and helped me understand my literally barking mad client a lot better. He was neither biting nor seeking help and should have been left alone.
I also believe accountability is a big factor in working one's way out of mental illness. I think you shouldn't whine about if it you bark like a dog and no one wants to room with you or hire you. When it gets uncomfortable enough, you'll do what you need to do in order to be able to leave your Milk Bones at home before going to a job interview.
Your bland assumption that you have the right to "work him up for a medical illness" chills my soul. I am a survivor of sadistic incest. My doctor has learned he needs to stay on the other side of the room and be pretty careful about the questions he asks. He is not allowed to touch me. Ever. Once in a while I let him listen to my lungs with his stethoscope. Like once a year. I'm sure he thinks this is weird of me and I recognize it's off the charts. But anything more feels like rape to me and simply isn't worth it to me. It's my body and this is my choice. And I'm willing to take responsiblity for that choice.
I had a bum gall bladder for about ten years. I haven't taken an anti-depressant since the day I had it out. I simply forgot I was on them in post-surgery haze and by the time I remembered I was off them and feeling no different so why take them?
The gall bladder was making me really sick, kind of poisoning my body really. I didn't realize until I healed from surgery that I'd actually been in pain all that time, at least ten years. My abuse has rendered me unable to process an awareness of pain. It's there, but the instant I feel it I have a mental image of a radio knob. I just reach over and turn the pain off. But it's still there, draining me.
I feel much better since that surgery. I had a really nice surgeon, too. But I still have so many body issues that I never went back, took out my own stitches rather than set foot in his office again.
Do I wish I'd had that surgery ten years sooner? Yep. Do I blame the docs--the MANY docs in the MANY nuthouses I attended--in that time? Nope. They're not clairvoyant and I didn't know I was in pain. I take full responsibility for that. I don't know how it could have been prevented, however, given my inability to tolerate any form of touch.
I do blame them, however, for pooh-poohing my expressed concerns about hypothyroidism and the fact I was actually going through menopause. Because that was a case of not listening and of arrogance.
I'm telling you all this in hopes that you might be more aware of the impact of a blithe statement such as the need to "work someone up for a medical illness". If that person isn't asking you to do this you shouldn't be doing it. It may seem like nothing to you but have the power to set someone back decades. If someone's not hurting anyone and not asking for your help, don't assume you're being helpful by offering the standard treatment. Some of us have been marooned by life and don't relish the prospect of being lassoed off the island.
Posted by Sherry at November 28, 2008 01:57 PM
Sorry to interrupt your ongoing war with reality Sally but I'm quoting Thomas Szasz. Verbatim.
Your description of how a person in psychosis actually manifests insanity suffers from lack of experience. I will say this, these lives are not yours. Don't speak for them. You don't know shit. You don't have the right to intrude and commandeer external personhood. Other people are external. Write that down. You are living all over them. You think you're being nice?
Cluestick: Jejune trivializing of the incomprehensible and traumatizing horrors experienced by someone who has very good reason to be terrified by the workings of his mind: not so nice. Any more than your rationalizing the ruinous behavioral consequences that are borne in shame and humiliation, accompanied by the unrelenting fear that it will happen again, of what one is capable of doing. How nice for you that it's all cheap talk, but to present yourself as the solace is obscene. Do you understand the need for solace in psychotics?
You're on a mental health blog and won't even acknowledge what actually happens when someone is delusional. Few people are capable of acknowledging it, so what. The last thing antipsychiatry wreckers want is for people who live through it to be able to describe psychosis with authority. Throw them right under the bus, everytime.
Solace is to be found in a good psychiatrist. There is a template for that too.
You however are infantilizing people much stronger than you, who are capable of carrying what you won't let yourself look at. There's no call to be hard or soft about that or anybody's lot in life; it's not like there's a choice in the matter. But you are in the way, your overbearing ego won't allow these phantom person's reality to exist and be shaped by them. But we are not phantoms. You're a thief. You steal autonomy.
You might consider that the breadth of lunatic stories are worth investigating. Or not. You can disdain the quest to be known, but you don't get to deny what is public knowledge. It's fine to welcome and quote Pat Deegan's story, but cherry-picking, not so much, and yes, it's transparent as hell.
Once again I'll recommend you look into The Devil and Daniel Johnston, because he is such a banquet and probably all over youtube, but the shelves are groaning with books, comix, CDs, movies and plays authored by the labeled. I should think these works would be of great interest to anyone anxious to be seen as concerned about the plight of one so situated. Instead we have presumptuous activists editorializing on "what it means to be you," while pointedly ignoring their body of work. And that makes you the quintessential wingnut, choosing to ignore inconvenient truths.
Posted by flawedplan at November 28, 2008 02:29 PM
Sherry:
Thank you for your well thought out remarks, and I am sorry to hear about your traumatic experience. I hope that you are on the path of recovery.
I would only say that if there is a sudden personality change in which someone is acting psychotic, then that would merit a medical work-up to rule out brain tumour, brain or systemic infection, toxic ingestion or metabolic changes. Perhaps that is my bias by working in a hospital where I see people admitted for psychotic behavior, and they have an underlying medical condition that can be treated. I would not feel comfortable leaving that person in the streets acting abnormally when they could be easily managed. Now, if the medical work-up is negative, and it looks like a mental illness, then things change.
You said that "if someone's not hurting anyone and not asking for your help", then we should withhold medical assessment and treatment. Does that include them acting in ways that are harmful to themselves? Like, if they have a medical illness, like a heart condition, and in a psychotic break refuse to take their cardiac medications, which could lead to a cardiac failure. What about if they have stopped eating food, because they think it's been poisoned by the CIA? What about if they have stopped paying their bills and going to work, and are at risk of becoming homeless and destitute? What kind and how much harm would you feel merits medical attention?
Posted by dguller at November 28, 2008 03:27 PM
AA:
I look forward to your long post tomorrow. :)
And I want to say that I also look forward with hope for the day that you are well without medications or psychiatrists in your life. When I terminate my sessions with my patients, I often say that I hope I never have to see them in my building again! :)
Posted by dguller at November 28, 2008 03:50 PM
FP,
You write:
"I'm quoting Thomas Szasz. Verbatim. "
Can you give me a cite?
dguller,
Due to my own experiences with involuntary treatment, I can never stipulate that there is a situation where psychiatric intervention is necessary. There are situations where I think compassion and vigilance are necessary. For example, if you're speaking with someone who thinks they are Jesus, it would depend on the situation as to whether it's better to explain to that person that you don't think s/he's Jesus or whether it might be a good idea not to challenge this person's belief.
What exactly would psychiatric treatment entail as you use the phrase in your post?
A supportive environment like Soteria House is something you would likely call psychiatric care, and I think, feel appropriate in certain situations. I would agree that this sort of treatment might well be helpful but I wouldn't call it psychiatric care.
I can stipulate that there are situations where compassion and/or honesty, and even a safe secure environment would probably be advisable, I would imagine that some things I don't consider psychiatric intervention you would consider psychiatric intervention.
Posted by Sally at November 28, 2008 04:15 PM
Sally:
Diabetes is not as "objective" as you make it out to be, particularly for women. Menstrual cycles can wreak havoc with glucose levels, making levels in blood tests that would ordinarily seem "normal" abnormal and vice versa.
Both my sister and my girlfriend report the treatment is as much art as science. Yet you concede it is a "disease," not a condition. Interesting.
So until there's a blood test for mental illness, it doesn't exist. It's really "creative maladjustment." I know that game.
I'm quite amused with this ideological idea that people with mental illness are worse off if it's called a disease rather than it not being called a disease.
(This is a different debate, BTW, than whether or not it actually IS a brain disease, a fact on which you and I emphatically disagree. If it's not a brain disease, then nothing is happening in the brain when someone has depression. That would mean it's likely a "broken heart," a condition that, as a medical as opposed to romantic matter, most people learn doesn't exist after playing "Operation" as a kid.)
It seems to me that for the terrible things that have happened to FS members (for which I have full sympathy, having had a few much less terrible things happen to me as a result of my DISEASE), it was a lot worse back in the days when people could be thrown into hideous hospitals willy-nilly simply for being "neurotic" or "hysteric." (Talk about non-diagnoses.) Today, in involuntary commitment cases, even Fuller Torrey has to have more scruples. (Which isn't saying that much, I realize.)
And if you SERIOUSLY think we are better off in jail than in a hospital, read Pete Earley's book "Crazy." Oh, that's right, you won't because you don't share Earley's ideological biases toward medication (which I basically share) and involuntary commitment (which I emphatically don't).
I mean, here in New York, that's the difference between Bellevue and Rikers Island. And Bellevue is bad, but compared to Rikers ...
Posted by Larry at November 28, 2008 04:45 PM
Sally:
Really? If someone said that they were Jesus Christ and since they are the Son of God, they no longer need to feed themselves, because God would take care of them, then you would just smile and say, "Yes, although I disagree with you, I think you are perfectly alright to go and find your fortune!" What if someone was so paranoid that they refused to feed themselves, because the CIA has poisoned all their food? Would you also reject involuntary admission to hospital to get treatment, i.e. medications? What if those people starved to death? Is that a better outcome than the possible side effects of medications?
I have heard about Soteria House before. Have they conducted any studies that showed that their treatment is effective? What would they do if they admitted a psychotic patient into their residence, and in a fit of paranoia or grandiosity, wanted to leave the House in order to prove that they could walk on water, because they are divine? Would they gently try to explain things to them? Have you ever talked to someone in the midst of a psychotic episode? They aren't the most rational of people.
You also mentioned compassion and vigilance. Please explain what you would do while you vigilantly and compassionately watch someone self destruct during a manic or psychotic episode.
Again, antipsychotic medications are horrific in their capacity to cause side effects, but they are the only treatment that has been demonstrated to be effective in reducing psychotic symptoms. If someone has received medication and attained a level of normal level of insight and judgment, and upon reflection would prefer to be psychotic rather than face the side effects, then they are allowed to make that decision, as long as while psychotic they aren't a danger to themselves or others. In that situation, safety takes priority.
What alternative would you suggest in that situation?
Posted by dguller at November 28, 2008 04:55 PM
Larry,
You write: "This is a different debate, BTW, than whether or not it actually IS a brain disease, a fact on which you and I emphatically disagree. If it's not a brain disease, then nothing is happening in the brain when someone has depression."
Nope dude, it's not a different debate. You are so locked in the disease model you can't even write outside of it. When someone is unhappy, even depressed, something is happening in their brains but to blame the brain for mental distress is like blaming the bat for a home run. When your heart beats, something is happening in your brain, when your girlfriend's blood sugar changes something is happening in her brain, this doesn't mean heart disease and diabetes are brain diseases.
If you don't think Bellevue is worse than Rikers, you are naive.
Posted by Sally at November 28, 2008 06:13 PM
Sally:
Mental illness is certainly a brain disease, but that does not mean that the neurobiological changes occur in a vacuum and independent of environmental factors. It also does not mean that the only way to correct the neurobiological problems is with medications. Psychotherapy has been shown to cause changes in the brain, too. :)
Those who deny that mental illness is a brain disease have the burden of proof of showing how one can have changes in mental states without a corresponding change in brain states, because you cannot have the one without the other.
The current status of neuroscience is much advanced from even a decade ago, and we know a great deal. However, we are still in the early stages of this exciting field of science, and there is a lot to learn!
Posted by dguller at November 28, 2008 07:09 PM
Sally:
I'll bow to dguller with the medical expertise (even if we don't always agree) on the subject of mental illness as a brain disease. Though to my mind, you citing the interconnection of the brain, and control through the brain, of many vital organs is more evidence, not less, that depression is a brain disease. If stroke is a brain disease, how is depression NOT a brain disease?
Your analogy of the bat seems to posit mental illness almost as an external -- as if the cloud hovering over someone shown as depressed in a cartoon LITERALLY CONTAINS THE ILLNESS.
If it was external, how could the obnoxious advertising slogan of Lilly for Cymbalta -- "depression hurts" -- also be an inconvenient truth? It would be impossible.
BTW, while I am not in the least meaning to say Bellevue is wonderful (it's not, it's horrible), you are desperately naive about Rikers, a place for which the term "hellhole" was invented.
Posted by Larry at November 28, 2008 09:19 PM
If a man lies to us about his car so he can get more money from us, that is understandable economic behavior. But if he lies to us about himself so he can attract more attention to himself, that is mysterious madness. We respond to the former by bargaining about the price, and to the latter by fighting "mental illness."
That's right; headcases are just trying to rip you off.
The economic analogy is not coincidental. The dependence on economic allegory throughout his discourse reveals the underpinnings of Szaszian poetics, don't you wonder about that when you read his work? There's more to his bloodless misanthropy than the red meat Szasz throws at antipsychiatry parrots who devour his text like pigs at a trough and with the same critical eye for discernment.
He's a freeper, pure and simple. The antispsychiatry you kiss his ass for would not exist without his overarching allegiance to the tenets of free market libertarianism, from which all manner of ludicrous true-believer philosophy and anti-social public policy results, as it must, given its adherence to the myth of self-centered individualism.
Scratch Thomas Szasz and you find a libertarian, scratch a libertarian and you find Thomas Szasz. You think he cares about freeing the oppressed, when what he cares about is the freedom of the marketplace. Your heroes matter, but discussion of his libertarianism is taboo in antipsychiatry and small wonder, it being the daily howl of the Internet and the gift that keeps giving. But hey, I am simply identifying the FOUNTAINHEAD of a worldview, and endlessly fascinating source of nonsensical false dichotomies that abound therein, characterized by boorish dehumanization and argument by declaration as found on page 78:
Much of what now passes as mental illness is actually force and fraud -- the so-called patient trying to coerce others by pretending to be sick. ...Some would cite the nastiness of the madman to justify the behavior of the psychiatrist. Others would cite the nastiness of the psychiatrist to justify the behavior of the madman. The upshot is that either madness or mad-doctoring is glamorized and romanticized, when, in fact, both are too often displays of deplorable behavior.
ibid:
Mental illness is self-enhancing deception, self-promotive strategy.
pp 103:
"mental diseases" are members of a particular class of annoying self-affirmations."
Anyone who denies his contempt for the psychiatric would do well to consider your reaction were it to come from someone other than your psychiatric overlord. Page 102:
We don't say: "I live badly, I am immoral"; instead we say: "I am confused. My mind doesn't work properly. I am sick." And we don't say: "You live badly. You are immoral"; instead we say "You are confused. Your mind doesn't work properly. You are sick."
Why can't you can't be both confused and immoral? Because nuance violates the tenets of Aristotelian free market objectivist libertarian epistemology and makes his wingnut head explode. It's either/or, not plus-and-too, and the childlike mumbo-jumbo of Check your premises, A is A, Let the market dictate will keep us on the straight and narrow, since we all know the road to perdition begins with the regulations of the busybody nanny state.
Fritz Perls said it best a long time ago, there are three kinds of people in the civilized world: Those who fit, those who are misfits and the class of people who's job it is to look after the misfits. You resent the fact that your lot in life is to be looked after? This is what 90% of the commenters here are railing against. Their own clownish and steadfast refusal to Deal With It.
Posted by flawedplan at November 29, 2008 12:37 AM
What if someone was so paranoid that they refused to feed themselves, because the CIA has poisoned all their food?
Gee! Americans lunatics still have delusions about CIA?
:o)
It's amazing!
Brazilians nuts are claiming that Bush has poisoned their food.
CIA delusions are so 70ies!
I hope that American Psychiatrists Hospitals starts providing newspapers of this century to their inmates. It's not fair to let them uninformed.
I urge Philip to report this human rights violation.
I hope Philip is in a good mood.
BTW: I'm missing you Philip! Hope you're fine!
Posted by Ana at November 29, 2008 03:39 AM
Dguller,
This is the crux of our disagreement. You write: "Those who deny that mental illness is a brain disease have the burden of proof of showing how one can have changes in mental states without a corresponding change in brain states, because you cannot have the one without the other."
You are wrong, you who believe that mental problems are not just diseases but brain diseases have the burden of proof of showing how one can have changes in brain states unrelated to external stimuli and environment. You haven't proven your positive. It's sort of like the idea that if I don't believe in God, I have to prove s/he doesn't exist which is horsesh*t because it's the believer who has a burden of proving existence in the first place. You believe that mental problems are medical diseases and you believe these medical diseases exist in the brain but you can't prove it and you have no right to falsely imply that you can.
As you know one of the main problems with the idea that mental problems are diseases is the idea of chronic care, forced chronic care. I believe Larry and his ilk, and maybe you, are all about the idea that once you get a psych label, whether it's depression or bipolar disorder or schizophrenia...you must always take drugs prophalactically because the chemical make up of the brain as well as its structure is static and yours is out of whack. These drugs then cause a life time of drug related behaviors that really do destroy lives.
And there is just no proof that neurobiologically the brain is static, that there is a neurobiological profile of a biopolar brain or schizophrenic brain or adhd brain. Larry, lets see your ideas on the chemical imbalance in the brain. I bet you think there's science behind these ideas when there's not.
I have no burden of proof, you have the burden of proof of showing that changes in the brain cause changes in mental states independent of external stimuli. There is no medical proof that "mental illness" is a brain disease, if there were you wouldn't have to rely on phrases like "early stages."
Feelings and thoughts are not diseases and thus are not illnesses Larry, so they're not physically contained anywhere.
If you treat feelings as illnesses, the treatment fails as we all know. Psychiatry doesn't work, psychology doesn't work, psychotropic drugs work the same on people with psych labels as they do on people without them, unlike insulin.
As for the "depression hurts" campaign, if you are depressed, which is a mental state not a physical disease, you focus more on your aches and pains.
As Dguller and Larry both admit, science wants biopsych to be true, but science keeps proving the opposite. Feelings really are associated with events, and do not occur independently of events.
Posted by Sally at November 29, 2008 05:34 AM
Dguller:
"Mental illness is certainly a brain disease" Prove it! I mean prove objectively! Show a true biological connection, or any solid scientific test to show with repeatable results that proves there is a disease present?
Don't pull out your subjective DSM diagnostic bullshit, Show us the evidence of true disease; there's probably a Nobel waiting if you can actually do that in this broad spectrum of what is so called mental illness.
Stan
PS: Having worked in both; prisons are pretty harsh and inhuman environments especial for those with mental health issues; but as far as rights and humane care go, and treatment for those who have committed no crime in government run mental institutions is by far a bigger concern and a black mark of our society. Though neither are anywhere close to a walk in the park or a place I would wish on anyone I gave a flying leap about.
NOTE: I HAVE EDITED THIS COMMENT TO REMOVE PERSONAL INFORMATION ABOUT ANOTHER COMMENTER THAT WAS POSTED HERE.
PHILIP DAWDY
Posted by Stan at November 29, 2008 06:49 AM
I frequently hear the comparison of mental illness to diabetes. My own shrink made that comment many times. If only mental health professionals would practice what they preach & treat people with mental illness just like health care professionals treat adult patients with diabetes. There wouldn't be so many angry people floating around.
If I had had a disease just like diabetes I seriously doubt I would have witnessed a nurse yanking the phone cord out of the wall while an adult patient was talking - they wouldn't dare. If it were a disease just like diabetes would a nurse have said, "turn the tv off it's not tv time" like I'm a four year old or threatened me that if I didn't do thus & such I wouldn't be able to go home? Doubtful. If it were a disease just like diabetes would adult patients be taken down & dragged off to have their treatment? Nope. Can you imagine adult diabetic patients being sent to group to color a picture like they're little children? If only it were a disease just like diabetes & people were treated respectfully.
Posted by Lisa at November 29, 2008 09:04 AM
Sally:
I don't think you actually read my post properly. Let me quote the relevant portion again:
"Mental illness is certainly a brain disease, but that does not mean that the neurobiological changes occur in a vacuum and independent of environmental factors. It also does not mean that the only way to correct the neurobiological problems is with medications. Psychotherapy has been shown to cause changes in the brain, too. :)"
I actually EXPLCITLY stated that the brain changes occur within the context of a specific environment that interacts with underlying vulnerabilities to result in the neurobiological changes that result in mental illness.
You are right that your inability to prove the negative does not prove the positive. Absolutely so. However, that equally applies to you, as well. You have ducked my question about whether you believe in mental states that occur independent of underlying brain states. Do you believe in this?
You seem to imply that you do not. You say that "Feelings and thoughts are not diseases and thus are not illnesses [...] so they're not physically contained anywhere." I think that there is a great deal of neuroscientific evidence both from lesion studies and imaging studies that if certain areas of the brain cease to function, then there are corresponding changes to thoughts and feelings. You can look at the famous case of Phineas Gage as a good example of this.
If you honestly believe that thoughts and feelings can occur independently of underlying neurobiological pathways, then how can you explain the mental status changes in people who have suffered brain damage? Also, does that mean that there is some kind of an immaterial soul that interacts with the body, and that thoughts and feelings are contained within that entity, much like Descartes believed? That position is fraught with problems that are insoluble. I am actually more a Spinoza man, because his position has less inconsistencies, but it is unpalatable to many people.
Also, I do not believe that once someone is diagnosed with a mental illness that they must be on medications for the rest of their lives. I challenge you to find a single instance where I made this universal statement. I routinely do not put patients on medications after diagnosing them with a mental illness, and I have frequently taken people off medications once their purpose has been served. Again, I would appreciate it if you would have a dialogue with me and not with a strawman.
Posted by dguller at November 29, 2008 11:36 AM
Lisa:
You make many excellent points, and I suppose that there is a huge danger of infantalizing psychiatric patients, which must be avoided whenever possible.
Posted by dguller at November 29, 2008 11:39 AM
Stan:
What would you accept as proof? It is likely that current scientific research would not meet your demands, but they may actually be so strict that many other acceptable diagnoses would also be rejected. For example, do you accept the diagnosis of delirium? What about dementia? There aren't any lab tests for these conditions, and yet they are acceptable medical diagnoses.
And the weather is beautiful. Just a bit of snow, but the temperature is wonderful. You may like to visit Ottawa some time, but I would recommend the spring and summer, especially to come see the annual Tulip Festival. :)
Oh, and I post here whenever I have a break from my clinical duties. I don't think my supervisor will mind. :)
Posted by dguller at November 29, 2008 11:46 AM
Ana:
You still avoided answering the question. Rather than mocking people with paranoid delusions about the CIA poisoning their food, why not tell us what you would do about somone with such beliefs who refused to eat? Would you let them starve? I only ask, because I have treated several unfortunate individuals with this particular delusion, and so it is not an abstract issue at all. So, I would love to hear your answer.
Posted by dguller at November 29, 2008 11:49 AM
dguller, you seem to be saying that "changes in brain states" are a disease. This is news to me. Does that mean learning is a brain disease, happiness is a brain disease? What in heavens' name do you mean? The brain is changing all the time, -- an incredible organ with an intricate feedback mechanism that we can only begin to understand. I don't think anyone is saying that mental "illness" does not mean changes aren't going on in the brain -- we're just saying it's not a "disease" caused, for instance, by a "chemical imbalance" -- if there's an "imbalance" please tell me how you determine the "balance?" If it's a "disease" what is the means by which we determine a disease state and what would healing look like and how is that dramatically different from what's going on in the brain all the time? Life is all about changes in brain states occurring all the time. Just how naive about neurochemistry do you think we are?
Also you missed my point about people in withdrawal (after a washout period) being divided between two arms in a clinical trial. Even if they are equivalently divided between the two arms those in the placebo arm are going to stay in withdrawal and have adverse events related to that withdrawal. Those going into the antidepressant arm will be given a drug that relieves their withdrawal symptoms. This has nothing to do with what the trial is purportedly measuring and increases adverse events in the placebo arm and lowers them in the drug arm over what they would be if everyone was truly coming in with just an untreated "mood disorder." This is just one example of the kind of confounding event that occurs in a clinical trial, especially in psychiatry where the drugs themselves cause the same kind of symptoms as the "underlying disorder." Think about it -- how crazy is it to give a drug to a disturbed individual that increases agitation, sleep disturbances, and the risk of suicidality (however slightly and we know this risk is underestimated in clinical trials compared to its occurrence in clinical practice)? If someone came from another planet and you told them this is what you were doing I think they'd look at you cross-eyed (if they even had eyes). The confounding effects of drug interactions and withdrawals, especially in psychiatry, play an enormous role in how trials turn out and are rarely acknowledged.
And also you don't get it about the rebound effects of antipsychotic medication. If someone has been treated over time with antipsychotics their psychosis can become dramatically worse if they stop, unless the medication is painfully slowly and carefully withdrawn -- much worse than it ever would have been if they had never been crippled with those debilitating drugs for any length of time. What happens when the antipsychotics are withdrawn abruptly has next to nothing to do with what the course of their underlying psychosis might have been without drugs. It's all about withdrawal, the seriousness of which you have repeatedly underestimated in your comments here. And, of course, if they are put back on, their withdrawal psychosis ameliorates, but that is not "proof" that they were really and truly that sick, just that they had a very bad withdrawal. Anyway you make me tired. You spout the lingo and jargon that's been coming out of psychiatry for at least a generation and cling to nearly worthless studies as if they are gospel and seem to be closed off to a new, original and more empathic view of the individuals suffering from mood problems and treatments they could undergo.
Posted by Sara at November 29, 2008 11:54 AM
Sally:
Let me get this straight:
To you it is the believers in the scientific method who are having to, like St. Anselm and St. Thomas of Aquinas of yore, prove how many angels dance on the head of a pin to describe a MEDICAL CONDITION. But you just have to disagree, even though your envisioning of depression is not only non-scientific, but disembodied and almost ghost-like. The switched roles are mind-boggling.
BTW, why wouldn't psychology (therapy) work for anyone, since -- if depression is just our reaction to external events and has no other existence -- it would seem to work for EVERYONE?!
Your vision would describe PTSD, perhaps, but not all depression is like or even related to PTSD. And even you admit that some people do react positively to medication. Why? A placebo effect? IN ALL CASES?!
Your irrational anger to me seems to come down to your outright accusation (as opposed to my misinterpretation of Stephany) that I am committing slow suicide because of potential side effects from psychiatric medications.
To which I heartily plead guilty. Better to commit slow suicide than immediate suicide, which I almost succumbed to twice in my life.
Posted by Larry at November 29, 2008 11:59 AM
Lisa:
I would not disagree that, say, the endocrinologist of my sister (also named Lisa) was a superior doctor to many of the psychiatrists I have had -- and that this may unfortunately be true in general of psychiatry. (Sorry, dguller.)
But IMO, that's a different question than the one being debated.
Posted by Lisa at November 29, 2008 12:01 PM
Larry, Feelings are not a disease. I am glad that you have not succumbed to suicide and glad that you find the regime you follow helpful. This won't keep me from disagreeing with you but I certainly don't wish you ill.
Dguller,
You write: "You are right that your inability to prove the negative does not prove the positive. Absolutely so. However, that equally applies to you, as well. You have ducked my question about whether you believe in mental states that occur independent of underlying brain states."
My belief is that mental states occur probably along with brain states as well as many other physiological states. I believe that for a person to think s/he must have brain activity. This doesn't go anywhere towards proving or disproving either one of our beliefs. I also believe that you must have a functioning heart and respiratory system to have thoughts but I don't think this proves that depression (or any other mental condition) is either a heart disease or a respiratory disease.
Posted by Sally at November 29, 2008 01:19 PM
Sara:
First, I am happy that we agree that whatever is going on in people diagnosed with mental illness, it must be due to their underlying neurobiology. I never endorsed the "chemical imbalance" theory, but rather believe that it more has to do with multiple neurotransmitters' activity within various neural circuits in ways that result in dysfunction in several areas in a person's life. Nothing about "balance", just getting back to an ability to function properly in one's life, especially when there has been a radical deterioration from a previous well-functioning state.
Second, your points about the washout period are well-taken, but I think mistaken. If what you said was true, then studies that included a washout period should have a larger difference in efficacy between the active medication versus the placebo arm, compared to studies that did not include a washout period. However, there were two meta-analyses that did not find a difference between studies that used a wash-out period and those that did not. See Neuropsychopharmacology 1994; 11(1):33-43 and Percept Mot Skills
1995; 81:688-90. So, your hypothesis makes perfect sense, but does not appear to be born out by the facts.
Third, regarding relapse versus withdrawal symptoms. Can you please tell me which comments of mine you are responding to? Perhaps then I can answer your points better.
Thanks!
Posted by dguller at November 29, 2008 01:29 PM
Sara:
Oh, and one more thing. I would love for you to cite ANY passages of mine where I did not demonstrate empathy for psychiatric patients, or where I minimized the importance of ruling out withdrawal symptoms when changing a patient's medications. Please. It might help you reconsider your ill opinion of me, because I do not believe that I have done either of the two charges that you accused me of.
In the past, I did not adequately take account of withdrawal symptoms, but after reading some literature and discussing things with people here, I have changed my practice accordingly. That is one of the reasons I post here. You all have perspectives that I would likely never encounter in my practice, and I appreciate all your feedback, positive and negative.
Posted by dguller at November 29, 2008 01:33 PM
dguler,
I'm sorry but now I'm concerned with people whose religion don't include Jesus.
Can anybody explain to me who do they think they are?
Hi Philip!
Hope you're in a good mood! I'm missing you!
Posted by Ana at November 29, 2008 02:17 PM
The Truman Show delusion, or Truman Syndrome, has drawn attention in recent months, in the United States and Britain, as psychiatrists in both countries describe a small but growing number of psychotic patients who describe their lives as mirroring that of the main character in the 1998 film "The Truman Show."
The delusions are fueling a chicken-and-egg debate in psychiatry: Are these merely modern examples of classic paranoia fed by the cultural landscape, or is there something about media like reality television and the Internet that can push people over the sanity line?
"Most likely these people would be delusional anyway," said Dr. Joel Gold, a psychiatrist at Bellevue Hospital Center in New York, who said he saw five patients at the hospital from 2002 to 2004 with Truman Show delusion. Gold and his brother, Dr. Ian Gold, the Canada research chair in philosophy and psychiatry at McGill University in Montreal, came up with the term "Truman Show delusion."
"But the more radical view is that this pushes some people over the threshold; the environment tips them over the edge," said Joel Gold, who is a clinical assistant professor of psychiatry at New York University. "And if culture can make people crazy, then we need to look at it."
One way of looking at the delusions and hallucinations of the mentally ill is that they represent extreme cases of what the general population, or the merely neurotic, are worried about. Schizophrenics and other paranoid patients can take common fears - like identity theft because of information transmitted on the Internet, or the loss of privacy because of the prevalence of security cameras to fight crime - and magnify them, psychiatrists say.
"There is the old saying that just because you're paranoid doesn't mean there's not somebody after you," said Dr. Jeffrey Lieberman, chairman of the Department of Psychiatry at Columbia University.
The prevailing view in psychiatry is that a delusion is just a delusion, psychosis is psychosis, and the scenery is incidental. Fear, a sense of persecution and grandiosity are static features of delusional thinking, many psychiatrists say.
During World War II, for example, psychotics might have believed a neighbor was a Nazi. During the Cold War, they might have thought the KGB or CIA was following them. In a post-Sept. 11 world, the persecutor might be Al Qaeda or the Department of Homeland Security.
"Cultural influences don't tell us anything fundamental about delusion," said Vaughan Bell, a psychologist at the Institute of Psychiatry at King's College in London, who has studied Internet delusion.
British psychiatrists, writing in this month's edition of the British Journal of Psychiatry about the phenomenon, called it the Truman syndrome and said they had seen a growing number of patients claiming to be the stars of a filmed reality show.
The Diagnostic and Statistical Manual of Mental Disorders defines a delusion, considered still to be little understood in psychiatry, as, essentially, a false belief that is not grounded in reality and that is held with absolute conviction despite proof to the contrary. The manual lists a caveat that a belief is not delusional if it is something widely accepted by other members of a person's culture or subculture - for example, religious faith. But some psychiatrists say the exception is too vague.
http://www.iht.com/articles/2008/08/30/arts/truman.php
Never underestimate other people's knowledge, culture and feelings even when they are delusional.
Posted by Ana at November 29, 2008 03:09 PM
Ana:
Still dodging the question, eh? Why not just answer it instead of avoiding the issue? What would you do in the situations that I described?
Posted by dguller at November 29, 2008 04:11 PM
Sally:
You wrote: "I also believe that you must have a functioning heart and respiratory system to have thoughts but I don't think this proves that depression (or any other mental condition) is either a heart disease or a respiratory disease."
Okay, fair point. But I think you are confusing necessary and sufficient conditions. Having a functional cardiovascular and respiratory system is necessary, but not sufficient, to having a normal mental status. In other words, without them, the brain could not function, but with them, there is no guarantee that a person's mental status will be normal.
However, having a functional brain is both necessary AND sufficient to having a normal mental status. In other words, without a functional brain, one would not have a normal mental status, AND with a functional brain, one has a normal mental status.
So, there is an important distinction to be made between the need for a functional cardiovascular system and a functional brain to have a normal mental status. It follows that a problem with someone's mental status MUST be due to their brain state, but it MIGHT also be due to their cardiovascular system malfunctioning, which has impacted their brain.
You can look at it like this, in a simplified conditional statement:
(1) Functional physical body --> (2) Functional brain --> (3) Normal mental state.
If there is no (1), then there is no (2) and thus, no (3). If there is no (2), then there is no (3), even if (1) is present. Therefore, the most immediate cause of an absence of (3) must be a problem with (2) -- but there could also be a problem with (1) that led to a problem with (2).
That is why I believe that mental illness is a problem with the brain, which could be due to genetics, early childhood development, medical illness, substance abuse, psychosocial stressors, maladaptive coping styles, and so on, which all affect the brain in various ways, resulting in psychiatric illness. Attempting to treat these conditions by altering the brain makes sense to me, and that can be done with medications and psychotherapy, both of which have been shown to alter the brain.
I do not think that any of this is especially controversial. I think that what you disagree with is the label of "disease" or "illness". Why do you object with my using that language? Perhaps if you clarified this, then our dialogue could be developed further?
Also, nobody said that feelings in and of themselves are a disease. Feelings are normal neurobiological responses to internal and external stimuli that prepare us to act in certain ways, depending on the stimulus. For example, sadness is a feeling of slowing down, isolating oneself and taking a break from one's life in response to the loss of something or someone precious and valued. Without it, we could never integrate important losses in our lives into our life narrative in a way that allows us to build on them and continue to move in a valued direction.
However, if our feelings are so overwhelming in intensity and duration that they stand in the way of our ability to function in various life domains, then I would say that they can be conceptualized as an illness that requires treatment.
Thanks!
Posted by dguller at November 29, 2008 04:34 PM
Sally:
Also, the DSM-IV allows for psychiatric illnesses to be secondary to a generalized medical condition, intoxication or withdrawal from substances/medications. So, it allows for situations where a dysfunctional brain state can be due to a dysfunctional body state (for a variety of causes). For example, if someone is depressed due to low blood sugar levels secondary to incorrect insulin use in someone with diabetes, then that is not called a major depressive episode -- even if it has all the DSM-IV signs and symptoms of the major depressive episode -- but rather is a major depression secondary to a general medical condition (i.e. insulin in diabetes) and would not be treated with antidepressants, but rather correcting the underlying medical problem. It would certainly not be called a mental illness. :)
Posted by dguller at November 29, 2008 06:12 PM
Egads am I in moderation? I dug through a pile of books to find Szasz perfidy, read through them til I wanted to gouge out my eyes, then painstakingly typed out his passages verbatim. Philip?
Posted by flawedplan at November 29, 2008 06:45 PM
Thanks Philip. The proof is up there now Sally, Szasz in his own words.
Posted by flawedplan at November 29, 2008 07:01 PM
Sally:
I can't escape the feeling that you wish me ill with extreme prejudice ...
So what is my paranoia? If it's not pathological, then it's just a "feeling." But where did it come from? You say you wish me no harm, yet I have come to think you do. This is not rational (we're just having an argument, you haven't threatened me), yet there must be an explanation.
Have you traumatized me? Is what we know as "depression" in the modern age really just an expanded definition of PTSD?
Actually, I suspect your actual definition of what I and others call "depression" would be much more along the lines of what Blessed Mother Teresa and countless Catholic mystics before her have experience -- "the dark night of the soul."
Would that prayer had done anything for me; but as a Jesuit-educated ex-altar boy, I can't say that it has. Lithium has proved far more effective than liturgy.
Posted by Larry at November 29, 2008 07:49 PM
dguller,
I'm not avoiding. This question you made is not a real issue.
You should spend a couple of days day on a mental institution to see what are the real problems instead of raising hypothesis.
I don't feed trolls that come here claiming they are on a break of their clinical practice.
It's always the same: "-You're all wrong and don't understand nothing about blah blah blah... ".
What is amazing is how easy it's to mix a couple of theories and give lectures on mental illness putting words on other people's arguments.
This is sad, scary and, Jesus, how far we are from helping those who need!
Posted by Ana at November 30, 2008 12:23 AM
Stan and others:
I recently read an interesting review article on the hypothetical neurobiological underpinnings of major depression. It is available free online, and I would appreciate you reading it and giving me your opinions. It is available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17944926
Take care!
Posted by dguller at November 30, 2008 06:10 AM
Larry,
You write: "Sally:
I can't escape the feeling that you wish me ill with extreme prejudice ..."
If you take the fact that I disagree with you personally, I'm sorry. Obviously I'm not neither a medical doctor nor a neuroscientist and hence, my opinions, etc., should not have the power to harm you.
Lithium will sedate most people. Here's a link to some ads for it:
http://www.bonkersinstitute.org/medshow/7up.html
If it works for you, great. It is a toxic drug but it sounds like you are fully aware of that fact and are being medically monitored.
Also, I do think that in an ideal world everyone would seek therapy. Psychotherapy, in an ideal world, free and anonymous, really can help us all.
Posted by Sally at November 30, 2008 07:07 AM
FP,
You write: "Thanks Philip. The proof is up there now Sally, Szasz in his own words." I don't see it, which probably means it's there and I'm just looking in the wrong place. While I don't always agree with you, I value your words more than those of Szasz anyway.
Dguller,
You write: "However, if our feelings are so overwhelming in intensity and duration that they stand in the way of our ability to function in various life domains, then I would say that they can be conceptualized as an illness that requires treatment."
I am glad you use the term "conceptualized as an illness." I think that is what's going on when you write about mental distress as a physical disease. You don't mean that it's literally a physical medical disease. You probably think it's helpful to tell someone that you label as bipolar that they have a chemical imbalance in their brains though you know this is, to put it charitably, a fiction. And I concede that there may be acute situations where you may be, if not right, at least justified in so doing.
Still, I'm sure you get the danger of medicating people with dangerous, mood altering, central nervous system modifying, etc. drugs because they have "feelings are so overwhelming in intensity and duration that they stand in the way of our ability to function in various life domains."
There are so many problems with that vague phrase, but lets start here - what exactly do you mean by "ability to function in various life domains?" I was recently pet sitting for someone whose house is so disorganized that my old self that shared your views would think he suffered from clinical depression, but then I realized his maid was off for three weeks every Thanksgiving.
As for ECT, if you really thought mental disorders were medical diseases, you wouldn't ever recommend ECT which is the ultimate "just snap out of it" treatment for depression, any more than you'd recommend ect for someone with paraplegia or lung cances because you'd believe that depression, like paraplegia and lung cancer, is not all in the head. (I'd love to discuss hysterical conversion and various electrical based treatments for spinal injury if you want).
In the end your biomedical mumbo jumbo is just a particularly sophisticated way of demeaning "patients" in emotional pain by telling us/them it's all in our heads, we're just crazy and have no reason to be upset. Freud was the visionary (imperfect though he was), you're moving back towards phrenology with a touch of eugenics a la Goodwin, etc.
And no Larry,
I'm not a religious fanatic. I am certain lithium will chill you out better than prayer, I'm just not such a puritan that I think you need a medical excuse to take a drug to change the way you're feeling if that's what you want and/or feel you need.
Posted by Sally at November 30, 2008 07:58 AM
dguller, the meta-analyses you refer to are from 1994 and 1995, that's a very long time ago in the era of psychopharmacology. I don't buy it. Maybe wash-outs didn't make as much of a difference because people weren't so heavily medicated then with multiple medications. I still say a wash-out, where people are hastily withdrawn from prior treatment, completely compromises the results of a clinical trial and if there is no washout and other medications are just left as is well that also compromises things considerably too. Unless all other medications and prior treatment are taken into consideration the science is junk. I was witness to a clinical trial for chronic fatigue in which patients were being put on a potent anti-retroviral drug, yet they were allowed to remain on Ambien, Ativan and Cymbalta and just about anything else that they had already been prescribed for their CFS. I can't tell you how outraged I was by this. It should be well known that hypnotics, benzos, and antidepressants can create debilitating fatigue when dose tolerance is achieved. In my view chronic fatigue is often the end result of long term use of psych drugs. Did the doctor running the trial give even the slightest nod to this at all? Absolutely not. And so he put scores of people at risk on a dangerous drug without ever addressing some underlying addictions/dependencies to psych drugs. I felt like writing him a poison pen letter. And the trial was a flop too - I wonder why!! If you don't think I saw that coming - all I can say is good money is actually being spent on this rubbish. Professionals don't seem to have a clue how debilitating and dangerous psych drugs can be to well being so they carry on prescribing them one after another and sometimes they work for awhile because they medicate some side effects of prior or concomitant treatment but the long term prognosis for this kind of treatment is crippling disability. Do you think removing a drug is ever taken seriously as an option? It doesn't seem to be so at academic institutions anyway. Only adding something new and ever more potent.
Posted by Sara at November 30, 2008 09:17 AM
Dguller:
Buzz!! Still waiting on that proof you’re supposed to provide us Mr. Resident Doc in training! I see a lot of conjecture, speculation, subjective spin, but no real evidence for your tainted and unsubstantiated belief that Mental Health Issues in humans is a true definable disease.
I don't see where you have any specific cause and effect to show anyone, no biological evidence that can be considered reliable or unquestioned science, you can't point to a pacific gene, or the exact brain chemistry imbalance you talk so much about, or any physical abnormality, no virus, germ, or outside/internal pathogen that you can point out to us, and you definitely can't use your approach in each case and come out with similar or related results.
You’re just taking what you refer to as science and making a “Philosophical Defense of Scientific Knowledge". When you can produce the actually evidence and knowledge to back up your claims, let us all know. You spin untruth, and call it science; but that does not make it so!
Until you can produce puritanical and objective proof of disease your just making your spin on the same old pharmaceutical and medical model that does not have a solid base in science, but is based on changing human behavior and cannot be quantified or have any absolute predicted outcome; since it's solely how an individual reacts to a certain attack or change of brain chemistry by pharmaceutical or outside means. Pretty sloppy argument Psychiatry has been using for decades about mental health issues.
When you can really even prove exactly how these so called treatments for the fantastical drummed up and created diseases work, then you might have something! Yet you can only sit here and make conjecture about how they work, but then again you can't prove it!
You are defending principles you don't have the science to back up! That's called a scam, and medical malfeasance. You should feel so proud, for every hit and miss success you have; there is coming to light at least another that gets horrific and damaging results from your so called treatments.
Again you’re preaching to the choir here, to use your religious spin to support scientific principles and argument. The Same argument and analogy you use in referring to destroying a church based on the behavior of a minority of its leadership can be used to directly refute your shaky theory about Mental Health Issues and your failed treatment modality. Just flip the words, replace clergy with psychiatrist around, and say they all are pedophiles; but a few are innocent and you come up with a completely different take and outcome.
That would be very similar to the psychiatry’s and pharmacology’s shotgun medication approach to behavioral issues you refer to so much in your belief system. You’re in other simple words, attacking the whole body with a treatment you don’t really know how it actually works, or what the outcome will be in truth! That’s called guess work, not evidenced science!
Again that’s all fine and dandy for you “a"; your making your buck, who cares about those Mentally Issued lesser people anywise( the label you place on people, the denial of self determination, your forced or misrepresented medical treatments, and the incarceration in itself are objective proof of that fact) .
You still cannot prove squat, or have provided any rock solid evidence beside subjective and unreliable data to throw at the patient and "consumer" as those with Mental Health Issues should be referred; since it really is about selling a product now isn’t it. There is no proof in anything you have presented here! You’re just like the Big Pharmaceutical Industry whores in your reasoning. You take old ideas, like they take old drugs; then you repackage them and say they get different results.
Geez, amazing you have spent all this time making post after post; and it's all come down to you can’t show any substantial proof that a disease exist besides subjective observation (unless you have some special powers as a mind reader?) of behavioral subjective symptoms. Since you don't really know what causes the behavioral symptoms with any certainty. Then you pull out subjective science of questionable clinical trials, flawed research, and twist and skew statistical data in really proving without doubt to everyone you cannot do that very thing we are asking you to show us (“PROOF” “Show us the Diseases you claim exist”).
Then you go on way past reason and science in your own defense, because you don’t have the goods and material to back it up.
You and the Industry treat subjective symptoms with treatments that you can't even in any depth or detail explain how they work with brain chemistry; besides broad and sweeping innuendo by saying that they change it and we have results! I could take a baseball bat to someone head and change their behavioral symptoms, doesn’t mean I’m treating them!
You can't tell us why Cognitive, Behavioral Modification, CBT, and others forms of talk therapy have proven to be just as effective, if not more effective with many Mental Health Issues than pharmaceutical means.
I don't think that your arguments are good enough to be considered actual science, and thus in you not being able to prove objectively with real evidence. Then the real evidence is that psychiatry has just propagated a scam, myth, and thrown a cloud over all medicine by actually considering themselves Doctors. We know better, you don’t because your pony is in the race.
Psychiatrists generally in fact are just pharmaceutical salesman with some medical training! Again that's not good enough when you are playing with children’s or people’s lives using them as Ginny pigs and destroying whatever hope they had or will have of living a normal productive life in the allusive pursuit of happiness.
Yes, I say you’re a fraud, and you cannot produce the goods to prove me otherwise! You probably should have made yourself a philosophy major and taught instead of becoming a witch doctor.
But then again, you will just keep beating your same old tried drum here in post after post because I believe you like hearing yourself talk (ego-centric) and have no real argument in fact. This behavior just reaffirms your faulty doctrines. You’re practicing the non-science of beliefs! Psychiatry and the Pharmaceutical Industry is no more than of a huge 330 billion dollar a year cult and hoax. You only have look at the results, and to follow the money trail; then you see the fallacy in it all.
Think about what we could do with 330 billion dollars a year? Cure Cancer, AIDS, and Diabetes; build much better educational systems, Feed and house the hungry and homeless, even take people with Mental Health Issues and integrate them fully into society with real dignity and respect.
Now do you have anything really new to add, or is it more of the same old, same old reworded and spewed out like toxin bullshit as psychiatry does best?
Stan
Posted by stan at November 30, 2008 09:31 AM
Flawedplan:
Thank you for the quotations above about Sczasz. I had no idea that his anti-psychiatry was grounded in his Randian libertarianism and free market capitalism. It is absolutely disgusting if your quotations are accurate, and he claims that those with mental illness are simply degenerates who are engaging in deception in order to maximize their returns. Truly, there are some people whose ego defenses are pathological and they engage in manipulating others for selfish gain, but they are a minority who consist mainly of the cluster B personality disorders.
I think that you are right that those who use his work to support their crusade against psychiatry should open their eyes to the other features of his worldview. Dr. Goodwin failed to disclose his financial ties on a single show and he is being crucified on this website. Dr. Szasz's core worldview involves a derogatory view of psychiatric patients. Where are the howls of protest against his entire body of work?
Posted by dguller at November 30, 2008 11:29 AM
The other Lisa, I do understand what is being debated. My point is that even though I have heard mental health professionals compare mental illness to diabetes, my experience has been that few in an inpatient setting really believe it - their actions did not reflect it.
As for whether or not depression is a disease, I don't know. All I know is it was bad. I do think, though, that the focus on depression as a disease has not been helpful to me - others may feel differently. Hearing the dx of severe recurrent major depression made me feel like this was something I would have to deal with the rest of my life - it sucked any hope of recovery away from me which only reinforced my despair.
Posted by Lisa at November 30, 2008 11:32 AM
Flawedplan:
Quote from your site;
“I want to be remembered as someone who made trouble where trouble was needed.”
Another nice quote from your site:
"thanks, it’s true, and they give the rest of us AXIS II folks a bad name.
dguller is a godsend. but when he quits posting furious seasons will revert the antipsychiatry semantic swamp it’s become since six awful people took over a blog."
http://writhesafely.wordpress.com/awkward-compulsory-page-about-me/#comment-28636
Are you saying I, and who else is awful and took over Philip's Blog?
So I should assume you are pro-pharmaceutical now, pro Goodwin, Biederman, Nemertoad, Pro-FDA, Pro- forced ECT and Medication, in favor of corruption and bad medicine? Maybe you can join John McPimp, Herb, with new buddy TF over on that pharmasuedical ads plastered site and live in denial while having a nice little hug fest.
So you’re playing in psychiatry's and TF's court and your true colors have finally shown. I think everyone that post here should know where you really stand. So they are fully aware of your declarations you have made on your site, which now flows over to this comment section. When are we going to see your first Pharmaceutical ads up?
I could give a Flying Duck if you like me or not! Why don't you ask Philip to ban the notorious terrible six! Why don’t you go ahead and name the terrible six in the open here? I invite you to do that! Believe it or not, I happen to have my own views and opinions with the evidence and experience to back them up!
What do you have besides your anger, an Axis 2 diagnosis label - which I take, is Borderline Personality Disorder, and whatever else suits your fancy at the moment? You want to whine about how bad, unfair, and evil the six that post here are! Go for it!
Now everyone will know when they read your post, where you really stand on these issues!
I’m sure you’ll have a wonderful day; since in your world, you’re and the Psychiatrist opinion only counts!
To quote one of TF’s favorites “the road to Hell is paved with good intentions”.
Yours truly,
Stan
Posted by stan at November 30, 2008 01:38 PM
"antipsychiatry semantic swamp"
WOW.
Posted by Stephany at November 30, 2008 02:24 PM
Ana:
Still avoiding the question. I have actually faced that decision in my practice. This is not an abstract academic issue. I am asking you a concrete and practical question. What would you do if someone was so paranoid that they refused to eat food, because it had been poisoned? Would you let them starve?
Posted by dguller at November 30, 2008 03:17 PM
Well Guller, welcome to my world.
My daughter is psychosis NOS/label. She was so severely dehydrated she needed to go to the ER 3-4 times the Spring of 07.
She was admitted as a medical patient to Swedish Medical Center in Seattle, (who have been reported for internal investigation per their own nurses)and she was dumped to the parking lot once they "discovered" she was "a psych patient, we cannot treat her on a medical floor".
Dumped. As in 2 armed (guns)security guards strong armed her, shoved her in a wheel chair and into my car at 11pm at night. Only after medical staff attempted to strap her to a bed, and I got MOUTHY and told them she has rights, etc etc.
She was so paranoid she only drank from sealed bottles and that became so bad she would open a bottle of choc milk and shove it away, as it was contaminated in her mind.
How to deal with these patients Guller?
Live with them. Get out of that hospital and go into the community.
Go find a Soteria house and take a lot of time (like I have, a decade!)
Then get back to asking Ana what she would do.
Posted by Stephany at November 30, 2008 05:39 PM
Sara:
First, it is not enough to refute a paper to say that it is old. Those are two separate meta-analyses that showed that there was no difference in the end result in antidepressant trials whether there was a washout period or not. And most of the antidepressants in those trials were older medications, such as TCA’s, which have a far worse side effect profile than SSRI’s. If there was going to be a difference, then it should have been MORE pronounced in the older studies than in the later ones. Again, pull the papers and give me your critique of them. If you cannot, then it is fine to continue to hold your position, but know that there are studies that show it to be factually incorrect. You are naturally entitled to your opinion.
Second, you are absolutely correct that a decent trial must take into account confounding factors, such as comorbid illnesses and other medications that people are taking. I will not argue with you there. It sounds like the trial that you participated must have been a horrific experience for you. It seems like a very poorly designed trial that naturally failed to show anything. Thankfully, not all trials are that badly designed and executed, but unfortunately many still are.
Posted by dguller at November 30, 2008 06:09 PM
Stephany:
You found my grand rounds presentation from two years ago! I hope you will be able to download it, because I think you’ll find it interesting. It was actually a rebuttal to the postmodernist position that there is no such thing as objectivity and rationality, and that all is simply power and propaganda. It’s kind of philosophical in nature, but that’s part of my background. :)
Posted by dguller at November 30, 2008 06:13 PM
Sally:
First, I used the word “conceptualized” in the same sense that there is a “theory” of evolution. It does not mean “made up” or “fantasy”.
Second, I do happen to believe that mental illness is a physical dysfunction of the brain, because that is where mental states are generated and experienced. Naturally, where mental states are dysfunctional, there must be underlying brain states to explain it. Just because the current status of neuroscience is still in its infancy, there has been much learned about various brain regions and neural circuits to shed some light on what a neurobiological explanation of mental illness could look like. Oh, and actually Freud believed in mental illness being a brain disease involving neural circuits, but he was unable to demonstrate this fact during his time, and so he focused on psychoanalysis instead. Just an interesting historical side note. :)
Third, the type of inability to function that I referred to a person who has experienced distress and recurrent problems in the workplace, at school, in social relationships, and so on. Again, this is a necessary condition of mental illness, but is not sufficient, because many people experience an inability to function in their daily lives and it is not due to a mental illness. If you want something more specific, then please tell me what you have in mind. There are various assessment scales where we can quantify the degree of dysfunction, but I do not think that this is what you mean, either.
Posted by dguller at November 30, 2008 06:20 PM
Stephany and Ana:
I read a few of your comments, and I think that Ana does not understand a few things. The published a case report with Dr. Bach in radiology when I was a medical student. After getting into a psychiatry residency, I have given a few presentations at the Royal Ottawa Hospital, as you referenced. I have no idea about the other things on Stephany's website that are going on at the Royal Ottawa. I have nothing to do with it. But have no doubt, Ana, that I am a psychiatry resident, almost at the end of my training! :) There is no conspiracy or hidden agenda here, I'm afraid.
Posted by dguller at November 30, 2008 06:25 PM
Stan:
Would you classify delirium and dementia as diseases? Just wondering.
Thanks!
Posted by dguller at November 30, 2008 06:28 PM
Stephany:
I am terribly sorry for what your daughter went through. In my neck of the woods, we would never do that. If someone has a medical complaint, then we ensure that they receive a medical workup and treatment on a medical floor with psychiatric support. I think that it is absolutely revolting to hear about your daughter being refused treatment, because she was diagnosed with a mental illness. Again, I am so sorry.
Posted by dguller at November 30, 2008 08:03 PM
Dguller,
You write: "I do happen to believe that mental illness is a physical dysfunction of the brain, because that is where mental states are generated and experienced."
It seems to me you're staking a lot on a belief, but I'm sure it's not one you've entered into lightly and doubt it's one you'll hold on to if it's proved false. I can see where physical dysfunction of the brain might sometimes cause mental illness, but I would then ask what causes physical dysfunction of the brain and also posit the idea, popular with neuroplasticity and scientifically valid, that experience whether trauma, tragedy, physical illness, drugs including alcohol, what have you can change the structure of the brain. A stressed brain can come to look like a "normal" brain when stress is removed. But there doesn't seem to be a direct correlation between brain structure and behavior.
That fact that there are underlying brain states to explain normal brain functioning would see to me to weaken your argument, but I can see how you might argue that they strengthen it.
You view is problematic to me because it assumes that you have a normal to compare dysfunctional too. What happens when someone survives a disaster like 9/11? What is the abnormal response?
If the goal of biopsychiatry is to be able to identify brain function and predict feelings and behavior based on some sort of genetic and/or chemical profile, and then treat asymtomatic people, this goal is to me flawed. Take Charles Manson, did he murder because of his childhood, because of genes or because of some combination of the three? I'm assuming that you, like me, can easily provide examples of people with similar backgrounds who didn't become serial killers, that possibility is out. Does that mean we're left with genes and chemicals? Of course not. All you have to do to prove that theory wrong is find one person with the same genetic profile who didn't act the same way to prove that theory wrong, the same with brain chemicals. And, of course since there's no normal genetic profile or brain chemistry to measure against, we can't test your theory and I think the world would be a worse place if we could. This doesn't mean I think drugs should be withheld from unhappy people or from people who experience terrifying auditory hallucinations, etc., but I do think it's important to note that the vast majority of drugs don't work, prophylactic psychiatric care is a colossal failure, and the overall mental health of society has deteriorating from trying things your way, which as I'm sure you'll agree is the strongest argument against your belief. If your beliefs about brain chemistry were true, it would seem that we'd see a lot more mental "health."
You write: "There are various assessment scales where we can quantify the degree of dysfunction, but I do not think that this is what you mean, either."
This is what I meant. I'm sure I could argue with you about what these tests are measuring but I haven't denied that dysfunction exists.
Posted by Sally at November 30, 2008 08:57 PM
thanks, it was a nightmare.
Posted by Stephany at November 30, 2008 09:07 PM
Lithium: the new LSD
Prozac: the new pot
The mind boggles, Sally ...
You honestly think there is no difference between pharmaceuticals and illegal drugs? You sound like the folks in 12-step groups who say people in recovery from alcoholism/addiction/etc. can't take any medicine -- because, after all, drugs are drugs.
Sounds pretty d*mn Puritan to me.
Posted by Larry at November 30, 2008 09:44 PM
Sally:
First, you are correct that if the brain states consistent with a major depression are being perpetuated by a stressful situation, then if you remove the stressful situation, then the brain states should return to a pre-stress state, assuming a variety of other factors, such as underlying genetic vulnerabilities, coping responses to stress, and so on. However, it has been demonstrated that some stress can actually damage the brain, e.g. the hippocampus, and that can contribute to scenarios where even if the stressor is removed, the brain state can remain, because of a vicious spiral that was triggered by the stressor to begin with. You can think of PTSD here.
Second, you write: “But there doesn't seem to be a direct correlation between brain structure and behaviour.” You are correct if you are referring to reflexes, which are actually mediated by the spinal cord, but you are incorrect if you are referring to higher order behaviour that requires conscious decision making, and even habitual behaviours that occur automatically, because they are all mediated by the brain. I would refer you to my previous post about the necessary and sufficient conditions of mental states, which include having a functional brain. Just because we do not know every single component of what creates a mental state in the brain does not mean that this is not the case.
Third, the goal is biopsychiatry has never been to treat “asymptomatic people”. If they are asymptomatic, then what is the point of treating them? People are innocent until proven guilty, right? However, some people may have various vulnerabilities to future distress, whether genetic though family history of mental illness, childhood trauma or neglect, or other risk factors, and those people certainly do not have to be medicated, but they do need intervention to, even if only in the form of monitoring over time. Some women carry a gene that predisposes them to breast cancer (BRCA-1 and -2), and they are monitored closely for cancer. No-one says to give them chemotherapy and radiation therapy for a condition that hasn’t even happened yet.
Fourth, you are right that the mental health of society has deteriorated. Whether that can be rested solely at the feet of psychiatry is another matter. I’m sure you’ll agree that there are many factors that impact the mental health of people. There is evidence that one of the core factors of depression, for example, is due to cultural factors in Western society that happen to be absent in Asia, thus contributing to lower levels of depression there. But I will agree that psychiatry certainly has not had the positive impact that it would like.
Posted by dguller at December 1, 2008 04:42 AM
Larry,
Twelve step groups, in my experience, do not discourage people from taking prescription drugs, and I've got referral lists and pamphlets to back me up;).
As I know many people in the social services system and have worked in it myself in the past, I can assure you that the ever rising dual diagnosis, alcoholic and bipolar and/or drug addict and bipolar is on the rise and there are huge numbers of people in 12 step programs who agree with you about the chemical imbalance theory and take prescription drugs.
The idea is that drug addicts and alcoholics prior to diagnosis were self medicating, as I assume you know. I don't think any drug should be criminalized and I bet you're also aware that prescription drugs from Prozac to the major tranquilizers we choose to call anti psychotics were developed largely to mimic the positive effects of drugs like opium, marijuana, lithium, and alcohol without having the negative side effects, or god forbid producing euphoria. The thing is it ain't worked. Prozac will freak you out worse than pot any day.
I'm not telling you to stop taking your drugs, but I wish you'd stop responding with anger to my posts. I suspect you're angry about your situation and transferring that anger to me but I think that's a normal human response not a mental illness.
Posted by Sally at December 1, 2008 05:11 AM
Larry,
Missed the top of your last post, lithium has been in use as a psychiatric drug way longer than LSD and as a recreational drug longer than as a psychiatric drug, but then surely you're familiar with the history of lithium and LSD psychiatry stuff.
In someways though prozac really is a new lethal form of marijuana. Even the most conservative studies show that prozac causes what is clinically reported as psychosis more often than marijuana and marijuana has never made anyone violent or suicidal and has been shown to be successful in treating depression and what is labeled as bipolar mania. Legalize it dude;).
Of course marijuana doesn't work for me, it makes me extremely anxious so I'd be in a terrible fix if it were prescribed as wantonly as prozac, and my responses labeled as proof of a biological brain defect, still I think people should have a right to try it and use it if it works for them.
You still seem to think that because I don't think mental pain is a medical disease, I don't think it's real, and worse that feelings aren't real but are just neurobiological symptoms.
Posted by Sally at December 1, 2008 05:43 AM
Okay FP,
I finally found your Szasz quotes. Thanks for getting them. To do so would have been an arduous task for me. It seems there is no verbatim quote from Szasz that someone who believes he's Jesus is lying:
From Szasz "The Second Sin, page 103:
"If a man lies to us about his car so he can get more money from us, that is understandable economic behavior. But if he lies to us about himself so he can attract more attention to himself, that is mysterious madness. We respond to the former by bargaining about the price, and to the latter by fighting "mental illness."
Your interpretation: "That's right; headcases are just trying to rip you off."
That's a misinterpretation. Jesus wasn't mentioned.
Assuming your references are correct, and I assume they are Szasz wrote: "Much of what now passes as mental illness is actually force and fraud -- the so-called patient trying to coerce others by pretending to be sick. ...Some would cite the nastiness of the madman to justify the behavior of the psychiatrist. Others would cite the nastiness of the psychiatrist to justify the behavior of the madman. The upshot is that either madness or mad-doctoring is glamorized and romanticized, when, in fact, both are too often displays of deplorable behavior."
Again, I have to say I agree with this. It's a pretty good explanation of learned dependency and the back and forth we see between you and Dguller in here.
Among the problems with psychiatry, is that a psychiatry cannot predict behavior and hence once one is labeled as a psychiatric patient all of their behavior becomes aberrant.
Szasz: "We don't say: "I live badly, I am immoral"; instead we say: "I am confused. My mind doesn't work properly. I am sick." And we don't say: "You live badly. You are immoral"; instead we say "You are confused. Your mind doesn't work properly. You are sick."
Why can't you can't be both confused and immoral?" Szasz is likely saying that sometimes behavior is interpreted as immoral and sometimes as "crazy," and that both terms are ambiguous. Does confusion preclude immorality? That's the insanity defense in a nutshell. You were doing the wrong thing when you really thought it was the right thing. Your question why can't you be both confused and immoral, hits on the root of my problems with biopsychiatry which says if you're confused you can't be immoral. I disagree.
I would imagine I would not agree with every thought or idea Szasz or anyone else has every had, but you get that, you're just angry because you identify as a person who is mentally ill and I don't.
I guess your primary identity as a person who is mentally ill is spelled out here: "Fritz Perls said it best a long time ago, there are three kinds of people in the civilized world: Those who fit, those who are misfits and the class of people who's job it is to look after the misfits. You resent the fact that your lot in life is to be looked after? This is what 90% of the commenters here are railing against. Their own clownish and steadfast refusal to Deal With It."
Three kinds of people in the world, really now. It's that kind of bs segregation that causes so many problems. I disagree, and when you suggest that it's my lot in life to be looked after, damn right I'm going to start railing, but then I'm lucky enough not to be living on SSDI, to be able to look after myself but people who live on ssdi aren't solely looked after, they do some looking after to. Psychiatrists are generally more psychologically dependent on their patients than their patients are on them. Patients are of course completely dependent on psychiatrists who control their liberty and financial and physical lives.
But here's some interesting Perls:" In Gestalt therapy we are Existentialists, in contrast to being moralists or symbolists. When you look into your relationships with people, into the relationship of yourself with yourself (or your "I" with your "self"), you find that you are always, always full of shoulds. "You should do this," "Don't do this," "This shouldn't be," "This isn't fair." In other words, you are always trying to change the world, to do something and, believing that good intentions are mere words of "you should," that these letters S-H-O-U-L-D would have an actual power of transforming reality.
In contrast to this we try to see what exists. And what does exist are contact functions that strive for creation, for creating situations in which you can complete your own vocation, in which you can be and experience. These situations are not achieved with "shoulds," but they are achieved with anxiety. And this is, I would say, perhaps my greatest difference with the psychoanalytical schools. To them anxiety and guilt are the "bugs" of the neuroses and they say you have to avoid creating anxiety in the patient.
This is exactly the issue about which we have to talk right now, the avoidance of anxiety. To be anxious is the basis of going forward, of becoming outgoing, of doing something. Now, what happens if you are anxious to do something and you do not dare to take the peep into the unknown? You stifle your anxiousness, and out of this former state of anxiousness you are no longer anxious to do something but you develop, instead, a state of anxiety. And, in this state of anxiety, there is the choice of creation." from Finding Self Through Gestalt Therapy
Fritz Perls delivered "Finding Self Through Gestalt Therapy" as part of the Cooper Union Forum Lecture Series: "The Self" in New York City on March 6, 1957.
Not sure I agree with every bit of it, but it's thought provoking and no matter what thoughts are not mental illnesses.
Posted by Sally at December 1, 2008 06:36 AM
Dear Philip:
I have stopped posting on this thread as of this final posting per your request. Though, I still hold fast to my view on psychiatry as a whole.
This thread has got off topic; and on to philosophical debates about the church and other areas that are not directly related to the Goodwin corruption scandal. Though I personally would enjoy continuing to show that psychiatry is flawed in its approach to mental health issues and care. There is plenty of time and threads ahead that will just further this debate about the state of our mental health system as it operates today.
Yours Truly,
Stan
Posted by stan at December 1, 2008 08:33 AM
Dguller,
You write: "However, it has been demonstrated that some stress can actually damage the brain, e.g. the hippocampus, and that can contribute to scenarios where even if the stressor is removed, the brain state can remain, because of a vicious spiral that was triggered by the stressor to begin with. You can think of PTSD here."
I'll assume this is a proven fact because I think it is too;). But I'll dispute the idea that ptsd causes chronic and permanent damage because I think the hippocampus is one of very few brain regions where new neurons continue to be created throughout life. Hence PTSD is a perfect example of a condition where the brain is changed as a response to stimuli and can change back, or the traumatized person can learn from his trauma and integrate it into her or his personality and world view. PTSD can be disabling but it is a sane response to an insane world, a part of living and all humans experience it to some degree.
You write: "Third, the goal is biopsychiatry has never been to treat “asymptomatic people”. If they are asymptomatic, then what is the point of treating them? People are innocent until proven guilty, right? However, some people may have various vulnerabilities to future distress, whether genetic though family history of mental illness, childhood trauma or neglect, or other risk factors, and those people certainly do not have to be medicated, but they do need intervention to, even if only in the form of monitoring over time."
I disagree and think that intervention often aggravates and causes more problems than it solves. As you may suspect I don't like the idea that someone once determining to be "psychotic," must always be medicated for schizophrenia, psychosis, a subjective term which does have meaning for me, can be a reasonable response to an insane situation, as can mania or depression hence I don't think chronic treatment is a good idea and I do think that all of the mumbo jumbo about people who are labeled bipolar taking medication to prevent future episodes lacks any basis in science.
As for the breast cancer gene, I once had a conversation in a bar (I admit the reliability is low) with a man who worked for an insurance company and had some reason to know about the breast cancer gene screening test. He said it seemed valueless to him because the gene was less likely to prevent breast cancer than lifestyle or heredity. In other words, there were more people who had first degree relatives who got breast cancer when neither they nor the relative had breast cancer than there were people who had the gene and got cancer.
If you are a psychiatrist who is opposed to the idea of chronic meds for psych labels, that is a good thing.
I don't think psychiatry sets out to harm but I think the idea that some people have feelings and thoughts that are not valid because of chemistry and/or genes is just that an idea and one that causes harm.
Posted by Sally at December 1, 2008 10:30 AM
Fritz Perls also famously said the purpose of psychotherapy is to teach people how to wipe their own ass.
But it's amazing Sally how you can read the words "if a man lies to us" in the above passage and then deny that Szasz is smearing patients as liars. Your linguistic contortions are quite the thing.
And AA is notorious for its anti-medication bias, I know many people who've been the brunt of it for decades. If that's changing now that doesn't mean anti-meds is not an entrenched view in the membership.
http://www.aca-usa.org/recoveryforum.htm
American Council on Alcohlolism:
For many years, even the use of Physician prescribed anti-depressants was actively discouraged by most well meaning AA groups. The bias against the use of any medication that alters mood or the need to consume alcohol is clearly part of the AA mantra. This is largely due to the fact that many medications (especially psychotropic medications) are not understood by the general public, and in turn, by members of the AA community. As a result, this continuing bias against the use of appropriate medications has resulted in disastrous consequences for countless individuals.
Posted by flawedplan at December 1, 2008 12:33 PM
Sally:
Excellent points, as usual!
I would disagree that the brain changes secondary to trauma that result in PTSD -- especially in the hippocampus -- just spontaneously recover on their own without any external assistance. People with PTSD suffer tremendously, because they are unable to regulate their difficult emotions and memories. You are right that the damage is not permanent in the sense or irreparable, but the repair does not occur without proper intervention, which includes both psychotherapy and medications.
Posted by dguller at December 1, 2008 12:44 PM
Dguller,
I don't think people recover spontaneously from PTSD, otherwise it wouldn't be PTSD even if I said so and I'm too tired to re-read my posts because this thread is too long, again partly due to my posts. I do think PTSD can heal over time and that proper intervention does not necessarily include psychotherapy or medications. I'm a counseling and support group type, but psychotherapy can be helpful as can medications though I've seen horrible results in the ptsd group I'm most familiar with, veterans, who seem to sometimes have bad reactions the the drugs forced upon them, and then the bad reactions are blamed on the ptsd not the drug...Philip's written some about this.
And now I think I'll take the lead from Stan and try and stop posting on this thread.
Posted by Sally at December 1, 2008 05:52 PM
**You still seem to think that because I don't think mental pain is a medical disease, I don't think it's real, and worse that feelings aren't real but are just neurobiological symptoms.**
Yeah, you've got it right. You give yourself too much credit to say I'm transferring my anger from having bipolar to you (though I think it's the proper human reaction to be angry at having bipolar -- look at the title of this blog), but I'll be d*mned if I have anyone tell me what I'm going through is some kind of illusion as you have through this entire discussion.
(You've never disclosed whether you are a fellow traveler, interestingly -- and I WOULD be angry at you if you're not, for assuming my experiences in such an arrogant way.)
BTW, you must not have attended many 12-step groups lately. Many are still in denial of "dual diagnosis."
Posted by Larry at December 1, 2008 10:56 PM