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Answering Our Critics, Part 1 of 2

Some people don’t like what we have to say on Science-Based Medicine. Some attack specific points while others attack our whole approach. Every mention of complementary and alternative medicine (CAM) elicits protests in the Comments section from “true believer” users and practitioners of CAM. Every mention of a treatment that has been disproven or has not been properly tested elicits testimonials from people who claim to have experienced miraculous benefits from that treatment. In previous articles I have compiled the criticisms of what I wrote about Protandim and Isagenix. It’s instructive to read through them. We welcome rational and substantive criticism, but most of these comments are neither.

Our critics keep bringing up the same old memes, and it occurred to me that rather than try to answer them each time, it might be useful to list those criticisms and answer them here. In future, when the same points are raised, we could save time and effort by linking to this page and citing the reference number. I know this list is not comprehensive, and I hope our readers will point out anything I’ve omitted. Here are some of the criticisms we keep hearing:

1. Big Pharma is paying you to promote their products and discredit CAM.

No it isn’t. We are not Pharma shills. We are not paid anything for writing this blog. We do not get money from pharmaceutical companies. We do not accept gifts from drug companies. We do not get kickbacks for prescribing certain drugs. We have no incentive to favor drugs over other treatments. Incidentally, critics who prefer natural remedies to pharmaceuticals should note that many CAM diet supplements are sold by subsidiaries of Big Pharma.

2. You’re biased.

Yes, we are, and that’s a good thing. We are biased in favor of science and reason. We are biased against claims that have been tested and disproven and that are incompatible with the rest of scientific knowledge. We are biased against health care providers telling patients things that are not true, presenting opinions as if they were facts. We are biased against using placebos because we consider it unethical. We are not biased against any CAM treatment just because it is CAM; we contend that there is only one medicine, that treatments have either been proven to work or they haven’t, and that all claims should be held to the same standard and tested by the same scientific method.

3. You’re afraid of the competition.

Not at all. The SBM bloggers aren’t affected by “competition,” since we are either salaried or retired and don’t make more money by seeing more patients. Most doctors are overworked and already have all the patients they can handle. CAM has only a very small share of the healthcare market. It’s not that we are afraid CAM will take patients away from us, it’s that we are concerned for our patients’ welfare and don’t like to see them lied to, given ineffective treatments, persuaded to reject effective treatments, and sometimes harmed.

4. Science isn’t everything: there are other ways of knowing.

When it comes to knowing whether a treatment is effective, there is only one reliable way of knowing: controlled testing using the scientific method. Intuition, tradition, revelation, “stoned thinking” à la Andrew Weil, dreams, extrapolation, speculation, and personal anecdotal experience can lead people to strong beliefs, but we can’t trust those beliefs to reflect reality. Only the scientific method can give us reliable knowledge. No matter how convincing they sound, claims must be tested before we can assume they are true.

5. It worked for me.

Maybe, maybe not. You can only know that you improved after the treatment; you can’t know for sure that you improved because of the treatment. That could be a post hoc ergo propter hoc logical fallacy. You may not be able to imagine any other possible explanation, but that doesn’t mean there isn’t one. Barry Beyerstein has explained some of the many ways people come to believe that a bogus therapy works. Also see the Quackwatch article on spontaneous remission and placebos.

6. Try it yourself.

Trying it for yourself is not a reliable way to find out if a treatment works. If the symptoms resolve, you have no way of knowing whether they resolved due to the treatment or whether they would have gone away anyway without treatment, or whether some other factor caused the improvement. That’s why science uses control groups. And what if your symptoms don’t resolve? That doesn’t rule out the possibility that the treatment works for 99% of patients and you just happened to be one of the other 1%. If you try a remedy and get better, it’s reasonable on a practical basis to try it the next time you have the symptoms, but it’s not acceptable to cite your experience as proof that “it works.”

7. Huge numbers of people use X, and they couldn’t all be wrong.

Yes, they could. Popularity is no indication of truth. Over the centuries, how many people have believed in astrology? For centuries, everyone believed bloodletting was effective in balancing the humors to treat disease. Only when it was properly tested did doctors discover they’d been killing patients instead of helping them.

8. It’s been used for centuries.

This is the argument from antiquity and is a logical fallacy. Dr. Novella explains why. It could be ancient wisdom, but it could just as well be ancient error carried over from a prescientific era.

9. It’s natural, therefore it’s safe.

Not necessarily. Many natural substances are poisons. Any natural remedy must be tested for efficacy and safety by the same standards we use to test “unnatural” remedies like pharmaceuticals. Dr. Novella has explained the naturalistic fallacy here. Herbs are drugs too, and anything that has an effect can have a side effect.

10. There is proof that X is correlated with Y (cites study).

Correlation does not prove causation. The rise in the number of diagnoses of autism correlates almost perfectly with the rise in the sales of organic food, but that doesn’t mean organic food causes autism. Correlation can be due to chance, error, poor data collection, and many other things. There may not really be a true correlation; and even if there is, that doesn’t tell us whether X caused Y or Y caused X or whether X and Y might both be caused by Z.

11. There are hundreds of studies that show X works.

In all-too-many cases, most of the studies supporters cite are in animals or test tubes, and others are opinion pieces, speculations, and irrelevant studies. There may be other, better quality human clinical studies that show it doesn’t work. Studies can be found to support almost any claim. Half of all published studies are wrong, for a variety of reasons that are constantly discussed on this blog. You can’t just look at positive studies: you have to look at the entire body of published evidence. That’s where systematic analyses come in. And they may not reflect reality: there may be negative studies that we don’t know about because they were never published: the file drawer effect and publication bias. And remember Carl Sagan: “Extraordinary claims require extraordinary evidence.” It would take a great deal of evidence indeed to overthrow all the established science that tells us homeopathy can’t possibly work as advertised.

12. You are just robotically supporting the official party line of mainstream medicine.

Most of the time we come to the same conclusions as the majority of mainstream doctors, because we are looking at the same evidence. When a body of experts evaluates all the published studies and makes evidence-based recommendations, we usually agree with them. Sometimes we disagree with their interpretation of the evidence (especially if they fail to consider prior probability or are including Tooth Fairy science) or with the way they have stated their conclusions. We understand that evidence-based guidelines are only guidelines, and judgment should be used in applying them to individual patients. We don’t agree just because we consider them authorities. There is a difference between the appeal to authority (he’s a professor at Harvard, so we should believe everything he says) and accepting the consensus of experts who know more about the field that we do (if 10 top mechanics all agree that your carburetor needs replacing, it is only reasonable to assume that it really needs replacing). All too often, CAM advocates are the ones who are parroting unreliable “authorities” who don’t know what they’re talking about.

13. Doctors only treat symptoms, not the underlying cause of disease.

This stupid CAM mantra is a vile, false accusation. Doctors treat the underlying cause whenever possible. If a patient has pneumonia, we don’t just treat the fever, pain, and cough; we figure out what microbe is responsible and provide the appropriate antibiotic. If a broken bone is painful, we don’t just treat the pain, we immobilize the fracture so it can heal. If a patient is in agony from pain in the right lower quadrant of the abdomen, we don’t just treat the pain, we try to figure out if the underlying cause is appendicitis, and if it is, we operate.

The people who accuse us of not treating “the underlying cause” are often the ones who think all disease is due to one bogus underlying cause (subluxations, disturbances of qi, poor diet, etc.). They also tend to use a single treatment (when all you have is a hammer, everything looks like a nail). I once googled for “the one true cause of all disease” and found 63 of them. Science-based medicine recognizes 9 whole categories of causes, with the mnemonic VINDICATE.

14. Science-based medicine can’t explain why some people get a disease and others don’t.

Neither can CAM. But doctors do have some pretty good ideas why it happens: exposure to infections, number of organisms that get into the body, genetic factors, toxins, immune deficiency, chance, and so on. CAM claims to fully understand why it happens, attributing it to some single cause that impairs optimum health (like a subluxation or a disturbance in qi, or improper diet). But they have not been able to show they understand the answer to that question any better than conventional medicine does, or that their understanding leads to better patient outcomes.

15. Conventional medicine kills patients.

I wrote about the “Death by Medicine” meme here. Critics gleefully cite statistics for drug reactions, medical errors, and iatrogenic deaths; but it is irrational to look at those numbers in isolation. Harms must be weighed against benefits. Medicine saves far more people than it kills. Many of those who develop treatment complications would have died even sooner without treatment. All effective treatments have side effects. We look at the risk/benefit ratios and reject treatments where the risk is greater than the potential benefit. The risk/benefit ratio of CAM should be compared to that of conventional medicine; if there is no proven benefit, no degree of risk can be justified.

16. Your minds are closed.

We are open to any new treatment, no matter how implausible, if only it can be shown to be safe and effective in well-designed controlled trials. Before we can ask how it works, we must ask if it works. If homeopathy had shown the same spectacular degree of success as penicillin, everyone would be using it. When Helicobacter was proposed as the cause of ulcers, it only took a few years for the evidence to accumulate and for antibiotics to become the treatment of choice. When a treatment like acupuncture has been studied for decades and even for centuries and its effectiveness is still uncertain, it is only reasonable to stop studying it and spend our research money elsewhere. We don’t need to keep an open mind about perpetual motion or a flat earth, and we don’t need to keep an open mind about homeopathy.

17. You are too prejudiced against CAM to look objectively at our evidence for it. No amount of evidence would change your minds.

We change our minds all the time based on changing evidence. We look at the best evidence for a CAM treatment before we reject it. We would accept CAM if it could present the same quality and quantity of evidence that it takes to reach a scientific consensus about any other medical treatment. What would it take for CAM advocates to change their minds? Most of them hold their beliefs so firmly that they reject any evidence to the contrary. One practitioner told me he would keep using his pet method even if it was definitely proven not to work, because “his patients liked it.”

18. Science keeps changing its mind.

Yes, and that’s a good thing. Scientific conclusions are always provisional. We follow the evidence wherever it leads, and we often have to change course as new evidence becomes available. CAM refuses to change its mind even in the face of clear evidence. Scientific medicine stops using treatments if they are proven not to work. CAM never rejects any treatment, and hardly ever tests one of its treatments against another to see which is superior.

19. Doctors are only out to make money.

I think most doctors go into medicine not because they want to get rich but because they want to help people. Medical education is long, grueling, and expensive. Most doctors incur substantial debts for their education and need years to repay them. The nice houses and cars don’t come until long after graduation. The median net worth for physician households is $700,000 and their median income is going down. The ones who really get rich are those who market bogus remedies or spread misinformation (like Dr. Oz, Andrew Weil, Burzynski, Daniel Amen, Kevin Trudeau, and all the companies that sell diet supplements and miracle weight loss aids). Boiron sold 566 million Euros worth of homeopathic remedies in 2012.

20. Alternative treatments are individualized and can’t be subjected to the same tests as pharmaceuticals.

Anything can and should be tested by scientific methods. For instance, homeopaths could prescribe individually in whatever way they chose, then the remedies they prescribe could be randomized with placebo controls and dispensed by someone else with double-blinding. Or the objective outcomes of treatment by conventional vs. CAM providers could be compared.

21. Doctors don’t do prevention.

They most certainly do! Who do you think invented vaccinations and preventive screening tests? Don’t you know about the US Preventive Services Task Force? MDs routinely talk to patients about weight control, diet, seatbelts and other safety topics, alcohol, drugs, domestic violence, exercise, etc. Studies on these topics are constantly appearing in the major medical journals. And there’s no evidence that the preventive efforts of CAM providers result in any better health outcomes than those of MDs.

22. Doctors don’t know anything about nutrition.

They understand the science of nutrition and advise their patients based on the available scientific evidence. Even if they haven’t taken a specific course titled “nutrition,” they learn how vitamins, minerals, and other nutrients are utilized biochemically throughout the body. CAM providers claim to know more about nutrition, but they often give pseudoscientific or unfounded diet advice.

23. CAM is better because it’s holistic.

CAM appropriated the holistic principle from mainstream medicine. Doctors are taught holistic principles in medical school. We are taught that the secret of the care of the patient is caring for the patient, not just treating the disease. Part of the standard medical history is a “social history.” Good clinicians consider the patient’s family, lifestyle, job, stresses, education, diet, socioeconomic status, beliefs, and everything about the individual that might have an impact on medical care.

24. We don’t need studies; we have plenty of testimonials.

10 anecdotes are no better than one; 100 are no better than 10. Anecdotal evidence is unreliable, no matter how many anecdotes you have accumulated. This lesson has had to be relearned over and over again throughout the history of medicine. Just think of how many testimonials there were for bloodletting in the Middle Ages. Anecdotes are useful, but only as a guide to what to investigate with scientific studies.

25. Why won’t you believe us?

We do. We believe you believe what you are telling us. We believe you had the experience you related. But that doesn’t mean your interpretation of your experience is true.

26. If you think X doesn’t work, why don’t you do a study to prove it?

It’s not that we think X doesn’t work, it’s that there is no evidence to make us think it does work. It is not up to us to prove a negative. It is up to the person making the claim to provide the supporting evidence. If I told you that putting a poker chip in your gas tank would give you better mileage, you should ask me to prove it. You shouldn’t feel obligated to either put a poker chip in your tank or do a study to prove it didn’t work.

27. Natural remedies don’t get tested because they can’t be patented and there’s no profit in it.

Nonsense. Many prescription drugs were developed from plants. The plant itself can’t be patented, but the drug company can isolate the active ingredient and patent that, or even improve on it with a synthetic version that is more effective and has fewer side effects. They can patent a unique method of converting a plant into a pill. There’s plenty of money to be made in herbal medicines, diet supplements, and even plain old vitamins: they generate billions of dollars’ worth of profits every year.

28. The medical establishment would drum out any doctor who tried to publish studies going against the party line, showing that X worked or that condition Y was real.

Quite the contrary. Peer review would critique the study. If it was a good study, others would investigate. A doctor who discovered a new disease or treatment would be honored. The treatment of ulcers with antibiotics is a case in point: Drs. Marshall and Warren won a Nobel Prize for their discovery. Montagnier was awarded a Nobel Prize for discovering the virus that causes AIDS only two years after the first reports of “gay-related immune deficiency syndrome.” Real diseases and new treatments are quickly recognized by the medical community.

29. You can’t know about it if you haven’t experienced it.

You don’t have to have been bitten by a snake to know how to treat snakebite. Male obstetricians are proof that you can deliver babies without having been pregnant yourself. We can know that antibiotics work for pneumonia without having had pneumonia ourselves. You don’t have to have used Perkins tractors to know that they don’t work. In fact, personal experience is a handicap: it tends to interfere with the ability to objectively assess the evidence.

And finally:

30. If CAM makes people feel better, why deny them that? Even if it’s just a placebo, isn’t that a good thing?

That merits its own post, which will appear as Part 2 next week.

Note: If readers can think of other recurring memes that I’ve omitted, I can add them to next week’s post if you let me know in time.

Posted in: Science and Medicine

Leave a Comment (494) ↓

494 thoughts on “Answering Our Critics, Part 1 of 2

  1. “My health insurer covers it” By chance I dumped my insurer
    today since it offers more rebates for magic than it does for
    dentistry,

  2. Bookmarked!! I’m sure I’ll be pulling this out again and
    again and again!

  3. The link in 5. is broken.

    1. cshearson says:

      An “f” is missing from the end of the URL in 5. It should be http://www.quackwatch.com/01QuackeryRelatedTopics/altbelief

  4. araikwao says:

    Love this post! Looking forward to the second instalment – maybe then I’ll know what to say to the friend who is happy to keep taking a certain popular leaf extract to supposedly prevent illness even it has been shown to be ineffective. Sigh.

  5. ccfoo242 says:

    You don’t even make money from ad revenue?

    1. mcrislip says:

      Not really. Ad money goes to pay for bandwidth/web hosting, evidently not a trivial cost. Nothing ends up in my wallet.

  6. Carl says:

    “Over the centuries, how many people have believed in astrology?”

    Yeah, that will convince our starry-eyed crystal skull critics.

  7. Xavier Morel says:

    > 11. There are hundreds of studies that show X works.

    Ben Goldacre’s Bad Science has a lengthy and extensive section on studies, on how easy it is to fuck up a study, on the average quality of medical studies (low) and CAM (mostly homeopathy) studies (absysmal) and on the importance meta-analysis.

  8. There is an often repeated argument that goes like this (it’s basically argument 5, but a bit extended):

    Statistics show that X (e.g. Oscillococcinum‎) doesn’t make any difference when treating Y (flu). But what do I care? It definitely helps ME. It may be not right for everyone, but it’s right for me and some other people like me, so it should be sold.

    But think about it. In the clinical trials they take 1000 people, treat them and see no difference with placebo. Now you claim that for you and, say, a 100 other people, drug X has a positive effect. How is this possible? Obviously, in order to help a 100 people, but keep the same results for a thousand, the drug has to HARM another 100 people in exactly the same amount as it helped the lucky hundred. Or perhaps to slightly harm 900 people. For each positive outcome (I took arsenic diluted a billion times and my asthma went away!) there must be another negative one (I drank a glass of concentrated nothing, and this kept my asthma going for another year). So where are these poor people harmed by overdose of nothing? If there are none, than there can’t be any who were actually helped, and not just fooled themselves.

    1. Young CC Prof says:

      If a group of people with a chronic condition like asthma take pure placebo, the average change in their condition should be zero. However, some will coincidentally improve shortly after the placebo, and some will get worse. If the group believes that the placebo is both safe and effective, the ones who get worse will attribute it to something else, like the weather, and the ones who get better will attribute it to the medicine.

  9. “claims must be tested before we can assume they are true”: I would expand this to something like “claims must be tested using procedures that eliminate human cognitive biases before we can assume they are true”

  10. Bobby Hannum says:

    At first I was like “Nice List!” and then I was like “Whoa, this is getting depressing…” and now I’m like “Nice List!”

    As an addendum of 2, many, many CAM providers have a huge stake in what they’re peddling. You mentioned it later with Dr. Weil and company, but a lot of the real money in CAM is branding your own supplements and herbs to sell to clients.

  11. Finally! I get so tired of seeing the same discussions played out in long time consuming comments. Now one can just say “27″ and link to the response. What a time saving device.

  12. Anders Gustafsson says:

    Could not have said it better myself!

  13. sham says:

    How about the common: “science doesn’t know everything, maybe we’ll be able to understand it later”.
    and great post, thanks!

  14. Louise Maine says:

    As a science teacher I have noticed that the part of the scientific method that others don’t seem to get is data is never used to support a particular point of view. They have made up their mind and use their use of the product to provide evidence. quite the opposite of how science works. I for one believe that diet can “cure” a lot. But I don’t mean it the way it sounds. Eating the way nature intended us to can keep a lot of problems at bay. I don’t buy into the hype of taking large amounts of extracts, etc.

  15. Adam Morrison says:

    This was a fantastic article! It’s nice to see all (or at
    least most) of the CAM canards rounded up and listed together.
    Makes a good reminder of some of the silly lines they try and pass
    off.

  16. Of course we all find this wonderful and useful, but I’d like to see what a group of alties have to say after reading through it. What could we expect as “counter-criticism”? The one I hear is a version of, “I just don’t care what science says, my naturopath (or whatever) makes me feel better and listens to me (read,meets my spiritual needs).”

    Perhaps in Part 2, you can cover how to respond to the question of SCAM-oriented MD’s? I’ve resorted to a sort of, “they’ve lost their way”, but that really isn’t adequate.

    1. Kate Rauner says:

      I have a friend who is an RN and extolls acupuncture and “Chinese medicine”. Presented with anything that refutes these, she says “well that’s not real acupuncture or CM”. She even dismisses the study showing that therapeutic touch practitioners can’t detect a human energy field by saying, ‘who cares if they detect it – therapeutic touch works.’ Sigh.

      1. Ross says:

        That’s the ‘No true scotsman’ logical fallacy. “Acupuncture works. Therefore, if something called acupuncture does not work, it is not ‘true’ acupuncture.” One of the criteria for something to be considered acupuncture is that it works, apparently.

  17. neilfeldman says:

    Well I can fully agree with all of your points except 22. I am afraid that few doctors truly understand the science of nutrition, and as such rarely advise their patients based on the latest available scientific evidence. Yes, I do agree that CAM providers claim to know more about nutrition, and they often give pseudoscientific or unfounded diet advice. But we should stop accepting “mainstream” medicines continued neglect or marginalization of healthy nutrition as being adequate or acceptable.

    1. @Neilfeldman

      Just who would you consider an expert on nutrition? I know of no doctor who “marginalizes” nutrition. It simply isn’t difficult to eat healthfully. Veggies, fruits and some kind of protein, vegetarian or as lean as possible for the meat-inclined–all in amounts that maintain a healthy weight. There’s no great mystery. People seem to prefer their diet advice to include a lot of hand-holding and exotic theories of the one true “nutrient” that will magically make them lean and free of all disease and therefore accuse MD’s of “knowing nothing about nutrition”.

    2. NSC says:

      One of the points made above was that providers should rely on the overall balance of evidence gathered over many years, not “the latest available scientific evidence”. New studies tend to be sensationalized in the media and later, more rigorous studies tend to show that the initial hype was unwarranted.

      I work in clinical research and read dozens, sometimes hundreds, of medical records a week. I can assure you that at least in my organization, a lot of doctors are having a lot of conversations about diet and exercise. The problem seems to be that people often don’t do what they’re told is best for them.

      I’m curious what you would consider an understanding of nutrition sufficient to advise the majority of patients. I can’t imagine doctors are leaving medical school without knowing this.

  18. vadaisy says:

    In preparation for Part Two: “You wouldn’t see so many glowing patient testimonials if the treatments didn’t work – that is indeed evidenced-based medicine. Countless numbers of patients reporting improvement after treatment should not be so easily dismissed. If the patient feels the treatment restores their health and they are willing to accept the risks, don’t deny or outlaw the treatment and commit them to a life of disability or hasten their death. That is inhumane and unethical. It’s their life, not yours.”

    1. Rob Hampshire says:

      Yes you would. We all see numerous glowing testimonials about
      treatments that don’t work. Those numerous glowing testimonials do not scientifically prove a treatment effective

  19. OlegSh says:

    I assume the correct link at the item 5 should be:
    http://www.quackwatch.org/04ConsumerEducation/placebo.html

    1. Harriet Hall says:

      @OlegSh,
      That’s not the one I meant, but it’s so good I added it.

  20. rork says:

    For 10, about correlation, I’m a nerd, so I might have mentioned the amalgamation paradox aka Simpson’s paradox (or the Yule-Simpson effect), where within subgroups correlation is zero or negative, but ignoring it you get positive correlation. I’ve seen it a few times, and it is always a eureka moment. Others try to abuse you by failing to look for it, or most commonly, knowing it’s there, but not mentioning it, cause it is “inconvenient”. Usually you suspect it is happening cause you think Z is really affecting both X and Y, and X and Y aren’t causing each other to change at all.

    For 15 (conventional medicine kills) I might have admitted that we have done suboptimal things, and maybe still are, but are getting better, doing what we can with limited data. I’m thinking of stuff like over-treatment for breast or prostate cancers, where in fact I still don’t think we can prove we are saving anyone with some forms of screening or procedures (we can prove we are saving some from that particular cancer though, but not that we aren’t killing folks in other ways to make up for that). Anyway, we try much harder than quacks. My friends are agonizing about screening methods for pheochromocytoma patients – it’s that much more difficult cause it’s not as common as dirt, and it’s just as hard or worse cause folks live with it fairly long.

    Thanks for the good read.

    1. “Simpson’s paradox”

      Heavy props for mentioning that! The complementing error might be “arbitrary post-hoc subgroup analysis”. Essentially that there exists a subgroup which shows a result contrary to the aggregate analysis within any sufficiently large sample with sufficiently large variability.

    2. OJ says:

      The yellow card scheme also deserves a mention in relation to 15

      http://yellowcard.mhra.gov.uk/the-yellow-card-scheme/

  21. You say: “Science-based medicine recognizes 8 whole
    categories of causes, with the mnemonic VINDICATE.” There’s
    actually 9, unless you were intentionally removing
    idiopathic?

    1. Harriet Hall says:

      Thanks for spotting that. I corrected it to 9. I had spotted that error myself and thought I had corrected it in the draft, but apparently something went wrong.

  22. WilliamLawrenceUtridge says:

    @neilfeldman

    Well I can fully agree with all of your points except 22. I am afraid that few doctors truly understand the science of nutrition, and as such rarely advise their patients based on the latest available scientific evidence. Yes, I do agree that CAM providers claim to know more about nutrition, and they often give pseudoscientific or unfounded diet advice. But we should stop accepting “mainstream” medicines continued neglect or marginalization of healthy nutrition as being adequate or acceptable.

    Your comment assumes there’s some sort of magical diet that will prevent all disease or somesuch. Doctors make the common-sense recommendation of “eat lots of fruits and vegetables, whole grains, not a lot of red meat, don’t gain too much weight, and avoid processed food”. Really, what more is there? Pursuit of the illusory claims of benefit for pomegranates, or perhaps the often-reiterated statement that blueberries contain a lot of antioxidants (ignoring the larger question – does that make a difference for personal health, and would you be better off just buying apples)? Bar perhaps vitamin D, the recommendations coming out of nutritional science has tended to consistently come down against artificial supplementation as unnecessary if not harmful, certainly there are few mainstream recommendations pointing to a need in the absence of frank deficiency.

    I don’t think they’ll ever improve on the advice of “eat a varied diet of mainly unprocessed foods that has a lot of fresh fruits and vegetables in it” and the pursuit of magical ingredients and ever-fleeting gains based on individual micronutrients just seems like a considerable waste of money. Get vaccinated, exercise and eat your veggies, what else is there to say to prevent 90% of the diseases that can be prevented in the first place?

  23. David Gorski says:

    Harriet: You forgot one, and it’s one going on in other comment threads right now. Here it is: “Why do you concentrate so obsessively on CAM instead of attacking big pharma’s abuse of science? How can you call the ‘science-based medicine’ if you don’t give equal criticism to big pharma and conventional medicine?” I sometime call this the “Why don’t you blog about what I consider to be important?” trope or the “hypocrite” gambit, in which critics will try to paint us as hypocrites because we don’t weight our criticisms more towards big pharma, conventional medicine, etc.

    1. Felix says:

      At the same time, it would be nice to have the same effort being put forward to debunk current myths in conventional medicine (feel free to point in the direction of such sites).

  24. Harriet Hall says:

    Yes, I just realized that myself. I’m sure I forgot more than one.

  25. neilfeldman says:

    WilliamLawrenceUtridge. That noise you hear is the sound of my head hitting my desk repeatedly.

    “I don’t think they’ll ever improve on the advice of “eat a varied diet of mainly unprocessed foods that has a lot of fresh fruits and vegetables in it”… Well, I certainly do believe they will and the sooner the better, ASIAK. But rather than hijack this thread I will just say that I assumed that this website was dedicated to “science-based medicine”. As such you might be amazed to discover just how much scientific research and debate is currently being devoted to this vast and vital subject.

    1. Harriet Hall says:

      Yes, there is a lot of scientific research and debate about nutrition. But it hasn’t yet resulted in a scientific consensus that would trump the current advice to eat a variety of food with a lot of fruits and vegetables. I agree that we will some day be able to improve on that, but I don’t see it happening any time soon. Those who claim to have better advice are going beyond the currently available evidence.

      1. neilfeldman says:

        Harriet. While I appreciate your reliance on scientific “consensus” being the ultimate arbiter, I think that is a big part of the problem. There is plenty of “available evidence” out there that bucks current consensus thinking. For example (and of course there are many, many others), take the “consensus” thinking right now for treating obesity. Just yesterday Swedish health authorities (“SBU”) published a report concluding that carbohydrate restriction appears to be the best short term dietary approach to lose weight for people with obesity. Furthermore, they concluded that the current scientific literature does not indicate that such an approach has any harmful effects on health. Their decision is based on an analysis of “currently available evidence” and hopefully will open the door to honest reevaluation of current recommendations worldwide.

        Regardless of how you view current the “consensus” approach to dealing with obesity or other medical conditions such as cardiovascular disease current mainstream nutritional advice it is not a “done deal” – nor should it be.

        If mainstream medicine clings to purely “consensus” thinking instead of truly considering currently available evidence (i.e. as made available from PubMed and other reliable peer-reviewed sources), more and more patients are going to be seeking answers far beyond their doctors trite nutritional advice.

        1. Harriet Hall says:

          “If mainstream medicine clings to purely “consensus” thinking instead of truly considering currently available evidence (i.e. as made available from PubMed and other reliable peer-reviewed sources)”

          I don’t understand what you mean. Mainstream medicine relies on the consensus of experts in the field who have truly considered all the currently available evidence. And that expert consensus changes as new evidence arises. Nothing is ever a “done deal.” I don’t think the consensus disagrees at all with the findings of the Swedish group. In fact, I think most doctors would agree that carb restriction is the most practical way to reduce calorie intake.

          Do you have a suggestion for some better guide to treatment than expert consensus?

          1. neilfeldman says:

            Harriet. I am not sure how you can think that “most doctors would agree that carb restriction is the most practical say to reduce calorie intake” when you have “consensus” advice from groups like the Academy of Nutrition and Dietetics (formerly the ADA) stating exactly the opposite:

            http://www.eatright.org/Public/content.aspx?id=10645

            No, I do not have a “better” guide than by considering ALL the various expert opinions. I am just pointing out the limitations of “consensus” group-think in stifling the minority view of some experts – which then often turns out to be “right” – decades later.

          2. WilliamLawrenceUtridge says:

            I don’t think minority experts are within their rights to expect changes by the minority if they lack convincing evidence. Further, the eatright page is, in purely thermodynamic terms, correct – eat too many calories, and irrespective the source you’ll gain weight. You seem to be more aiming at strategies to reduce the likelihood of eating too many calories. Put another way, I’m saying “eating 1,000 calories when your daily expenditure is 900 calories will cause you to put on weight” and you’re saying “it’s a lot harder to eat 1,000 calories worth of broccoli than it is to eat 1,000 calories worth of sugar”. Principles versus strategies, I would argue both are right, and both can be useful.

        2. David Gorski says:

          If mainstream medicine clings to purely “consensus” thinking instead of truly considering currently available evidence (i.e. as made available from PubMed and other reliable peer-reviewed sources), more and more patients are going to be seeking answers far beyond their doctors trite nutritional advice.

          Um, this doesn’t make sense. A major way that scientific consensuses come about, particularly in medicine when they are codified as care guidelines, is when the experts in the field examine all the available evidence, rank its validity and strength, and then try to put it together to come up with rational treatment guidelines that acknowledge the level of uncertainty in the field. And, as Harriet points out, consensuses change as the evidence changes. Just in my field of breast cancer surgery, one commonly used set of clinical guidelines, the NCCN guidelines, has averaged a couple of updates a year over the last few years, including a whopper of a change a couple of years ago in response to the ACSOG Z0011 sentinel lymph node trial.

          1. neilfeldman says:

            Others far smarter and more eloquent than I have repeatedly pointed out that the “consensus” only will change after one generation gives way to the next. Sadly, some of us don’t have that much time.

          2. WilliamLawrenceUtridge says:

            Really? Because my understanding of the medical community is a built-in expectation of change. For instance, when the evidence accumulated over a relatively short period, the treatment of ulcers changed pretty quickly – within a decade I believe. Even now, screening for breast and prostate cancers are extensively debated and have changed several times in the past decade. Recommendations for vitamin D have been updated by increasing the amount. Cancer treatments are now far less toxic because the evidence showed that highly toxic chemotherapy was no more effective than less toxic chemotherapy.

            From what I understand there’s a saying in medical school, “you will have to forget have of what you learn, the secret is knowing what half”, which rather sounds like an endorsement of changing your mind.

            It seems to me that the consensus changes rather rapidly in the face of good evidence, making your point a bit of a straw man.

          3. neilfeldman comments that “consensus” changes only as generations change. I believe he refers to Kuhn quoting Max Planck “”a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

            I’m not sure a consensus is the same as a paradigm. As you point out the consensus can change on a regular basis presumably within the current paradigm.

        3. arsawyer says:

          One of the problems with placing a heavy emphasis on implementing recent nutrition research into practice is that we inevitably run up against the lottery fallacy. There are dozens of camps of nutritionists that claim that some new balance of macronutrients is the key to reducing obesity, heart disease, cancer, etc. And with the thousands of studies published every year, there will ALWAYS be a lot of papers supporting any one camp. How do we know which group that’s bucking conventional wisdom is going to eventually be right? A lot of these groups have very similar standards of evidence so it’s incredibly difficult to tell. I’m sure in 50 years dietary recommendations will change and some group of gurus will insist they were right all along, but that ignores all the false advice that was properly ignored by mainstream doctors. We can’t implement all of these ideas at once, considering some of them are mutually exclusive.

          When people want super detailed advice on what to eat, they already have an option available to them – go see a professional dietitian. We don’t insist that doctors have years of training in this topic because they would have to cut out other vital parts of their education. Based on how many doctors struggle with things like interpreting simple statistics and explaining to patients why they should get a flu vaccine, I’m not a fan of cutting into their current curriculum.

          1. OJ says:

            All this talk about nutrition reminds me that the majority of people are completely clueless about the difference between a nutritionist and a dietitian, or even between one person who authoritatively offers nutritional advice and another.
            My housemate just informed me that he has bought an online nutritional course and qualification via the discount website groupon for a mere £45. This ‘qualification’ will allow him to practice as a nutritionist here in the UK. I despair.

        4. WilliamLawrenceUtridge says:

          The basic advice for weight loss is “lose more calories than you take in”. That’s the fundamental, the rest is ways to do so – exercise, eat less, and we’re done. Allow me to point out that “eat fewer carbohydrates” fits rather neatly into that basic advice.

          You seem to think that “innovative” thinking is better than “consensus” thinking, and that’s backwards. “Innovative” thinking becomes consensus thinking, as more evidence accumulates to support it. Otherwise you’re in the same boat as CAM pushers, recommending treatments based on rat and glass studies rather than human trials.

          Consensus changes in the face of the evidence; if the evidence isn’t convincing enough yet, you shouldn’t recommend behaviour change.

        5. WilliamLawrenceUtridge says:

          I also question whether “carbohydrate restriction to reduce weight” is a nutritional recommendation. That’s perhaps a “dietary” recommendation, in terms of “what to eat”, but in my (possibly idiosyncratic) interpretation of things, nutrition is about meeting your basic needs while diet is broader and does include things like caloric excess. Perhaps that’s the source of our disagreement – I am talking about what to eat to remain healthy, and you are more talking about what to eat (or to not eat) to avoid illness. I see nutrition and nutritional recommendations in terms of ensuring we reach our RDIs, not in terms of purely or largely obesogenics.

    2. WilliamLawrenceUtridge says:

      You might want to get a pillow for your desk.

      Can you point to any dramatic recommendations for diet? Aside from say, vitamin D, as far as I am familiar the basic recommendations have changed somewhat in proportions, but not really overall in intent. Reduce processed foods, eat a lot of whole, unprocessed fruits and vegetables, emphasize whole grains, keep meats to a minimum, calcium from milk, etc. etc. What do you expect to change? Dramatic, Atkins-style revisions to recommendations for meats and fats? Endorsement of higher RDIs or supplements? Sure, a lot of effort is being expended on examining the inputs and outputs of diet, but I can’t see them taking a dramatic step like recommending large amounts of a single dietary input to maximize a micronutrient or something similar. No dramatic signal has arisen from the noise, suggesting there isn’t much of one.

  26. Kat says:

    Misunderstanding behind the motivation for research or lack thereof.

    For instance, I often hear that government or university funded research is influenced by “big pHARMa” so only research that is likely to be in favour of big pHARMa gets funding. The research supporting CAM is lacking because they don’t have big industries like the pharmaceutical companies to back the research financially.

    MDs specialize in writing prescriptions, not lifestyle changes, diet, etc…

    CAM practitioners have a better understanding of the immune system than MDs

    1. arsawyer says:

      Please tell me what alternate universe you live in where the NCCAM hasn’t dumped millions of taxpayer dollars into nonsense research in academia, because I’d really like to live there.

    2. Andrey Pavlov says:

      MDs specialize in writing prescriptions, not lifestyle changes, diet, etc…

      I would have failed my classes and my board exams if I had not considered and discussed at length lifestyle and diet changes with my patients and answered that for questions. It is literally drilled into our heads ad nauseum that the first and foremost is always diet and lifestyle. And in fact, for many common things we have a formal set of criteria which starts with diet and lifestyle and we have to know when someone is at risk enough that those aren’t enough. In other words, when is their blood pressure or cholesterol or cardiovascular risk so high that we have to give medications in addition to lifestyle and diet changes.

      It is absolutely ridiculous to claim that we don’t focus on that because we have formal guidelines you can look up that explicitly reference them! And I myself experienced it – I was extremely overweight and had very high blood pressure. My internist tried to get me to lose weight and I didn’t. I also said I didn’t want pills. Finally I listened to reason and took the pills. I lost the weight, got fit, and then my internist took me off the pills! Imagine that! But, I still screwed myself over because I let my high blood pressure go for too long and now I have echocardiographically confirmed right atrial enlargement which has led to an ectopic atrial focus and so a few times a year I go into a supraventricular tachycardia that leaves me breathless and dizzy. Bad enough that the times it has happened driving I have to pull over. If I had taken the pills when I was advised and then stopped when I actually implemented my lifestyle changes and lost the weight, I would have avoided the permanent damage to my heart.

      There is a reason we do things the way we do. And yes, that absolutely includes diet and lifestyle and it has for a very long time! Decades in fact.

      1. rwk says:

        Andrey, I’m a little puzzled at your comment. Usually, i recognize that you know your stuff. RAH would be more likely caused by pulmonary hypertension not systemic. And weight gain alone wouldn’t be the primary cause. Did you not mention having a connective tissue disorder before Ehler-Danlos or Marfan’s?
        The SVT could be stress,alcohol, too much caffeine and drugs not things uncommon to a med student. So much for the SBM use of “correlation does not imply causation”. It’ll be interesting to see how much time you have for lifestyle mods when you seeing loads of pts. Cheers,Mate.

        1. Andrey Pavlov says:

          Thanks for the compliment.

          I actually am rather run ragged these days. Many things going on including applying for my residency and medical licenses. I was just tired and writing to quickly. I have left atrial hypertrophy.

          Also, I have been obese most of my life. And have been hypertensive as longlong as it has been measured. My hypertension went away after I dropped 75 pounds and became very fit. But not immediately. It took a few years actually. I’m now borderline off meds, but mostly fine.

          My cardiologist and electro physiologist are the ones who diagnosed my ectopic focus and the enlargement. They felt that it was my years of uncontrolled hypertension of 170′s/90′s that led to the enlargement and that to the focus.

          Yes, I do have a clinically diagnosed mild Ehlers as well, which may have contributed but is not ass likely to be the proximal cause.

          As for the stress, alcohol, etc, yes. Those certainly do aggravate it. But it happens in the absence of that and I have an EKG diagnosed ectopic focus with holterholter monitor diagnosed SVT from that focus.

          And yes, keeping fit is very hard in school. But I still do it. Not as much as before, but I still run and cycle pretty regularly. It is vital to incorporate it into my daily routine so I do. Which is why I tell my patients I appreciate how hard it is but encourage them that it can indeed be done. Before my 24th birthday I had never been able to run a full mile without stopping or do a single pull up in my life. I have since run a half marathon at a sub 8 minute mile pace, could do numerous one handed pull UPS, and cycled centuries. So it can be done.

  27. Woo Fighter says:

    Two that I encounter frequently:

    -Doctors (“allopaths” of course) prescribe a drug that causes side effects, then they have to prescribe a second drug to deal with the side effects of the first, then a third drug to deal with the side effects caused by the second, etc. There’s usually some claim that “the average person” is on six, or 10, or 12 prescriptions. The number varies but the implication is that all those drugs are needed to treat side effects of other drugs.

    -This one borders on conspiracy theory, but it’s quite prevalent: companies from Big Pharma or Big Agriculture cause diseases like cancer or AIDS (through toxins, GMOs, vaccines, etc.) so they can sell us the drugs to treat those same diseases. Monsanto, Donald Rumsfeld, the FDA and SV40 are often come up these discussions.

  28. o says:

    Another meme I hear quite a bit is: “maybe CAM interacts with an aspect of the human biology that we haven’t discovered yet and the effect gets washed out in clinical trials.”

  29. Derek says:

    It’s such a breath of fresh air to read such concise, well articulated, rational posts on the Internet. Keep up the great work.

  30. Woo Fighter says:

    Three names from history are often used by defenders and supporters of lone brave maverick doctors fighting the system. One day these mavericks will be proven correct and the skeptics will look like fools.

    The Schopenhauer quote about “All truth passes through three stages…”

    Similarly, Semmelweis and his theory of hand washing before surgery comes up a lot (“He was ridiculed, forced out of medicine and died in an insane asylum… but he was eventually proven to be right!”) .

    And finally, “They laughed at Galileo,” or “They laughed at Newton…” etc.

  31. Actually, I’m a little torn on this one. I think the FIELD of scienc based medicine is good at nutrition, but one can certainly get an individual conventional doctor who doesn’t recognize the symptoms of lactose intolerences, celiac, etc (or doesn’t that count as nutrition? if not, just ignore my comment). I guess it’s an empirical question, “what percentage of MDs recognize common nutritional ailments”? That said, does CAM do better? I suppose that’s an empirical question too, but I really, really doubt it.

    1. To clarify my above comment. I’m torn on the question of doctors and nutrition. Better than CAM, yes, generally up to science based standards, I’m not sure.

      1. Harriet Hall says:

        Science based medicine is the ideal; there are still plenty of MDs who don’t measure up to its standards. That’s one of the main reasons for this blog.

  32. Self Skeptic says:

    “Doctors don’t really understand science and evidence very well, because their training emphasizes rote memorization and faith in authorities.”

  33. “We are biased in favor of science and reason” A bit of an oxymoron if you’d ask me. Next on Mike Adams’ creek of sh*t: SBM advocate biased!

  34. Rose says:

    Great article. – well done!

    I don’t know how many CAM websites/blogs/facebook/twitter say the same thing..

    “the human body has an amazing innate ability to heal itself”
    (with tons of supplements, gallons of green juice and good coffee being pumped the wrong way)

    1. Rose “the human body has an amazing innate ability to heal itself”
      (with tons of supplements, gallons of green juice and good coffee being pumped the wrong way)

      Oh, no! They don’t use GOOD coffee. Do they? Seems like Maxwell House or generic would “work” just as well.
      ;)

  35. Artur Król says:

    I’ve been doing a similar list for the Polish Scientific Scepticism Association, only using a “one page – one issue” format, for easier quoting in online discussion. Thanks for ideas for a lot of new “arguments” to put in.

  36. Sugarbubbie says:

    No. 13 doctors only treat symptons, not the underlying disease. This is pure bull…..how to explain then the successes in cancer cases. You sure aren’t going to find any CAM crap that can do that.

  37. Mark says:

    The problem I see with Dr’s addressing nutrition is that they seldom address it unless its already a problem for their patient. The average person isn’t educated enough on how to make wise decisions in regards to their diets. There is one model that some CAM practitioners use; pre emptive “education”, which I do think could be implemented more effectively in the medical setting.
    More often than not a here in Canada you may be in a the waiting room for an hour or more while waiting for your appointment and all you have to read are out dated Mclean’s or Cosmo magazines. I don’t understand why there isn’t something more health centred.

    1. duggansc says:

      In the last few years, I’ve noticed an increase in informational pamphlets in a large holder in both the waiting rooms and exam rooms. Unfortunately, a large number of them are put out by pharmaceutical companies who’ll end the pamphlet with a “And if you have blood pressure issues, try Lipitor ™!” which makes them seem more biased.

  38. Phil Koop says:

    Regarding 15. may I just note that sometimes it is withholding conventional medicine that has the potential to kill patients? A SCAMer doesn’t have to do anything else wrong; sometimes merely displacing or delaying conventional treatment with something benign can be fatal. Consider this message I received from my wife the other day:

    “I just completed an intake assessment with a patient. She was at home and developed facial droop, right-sided weakness (she dropped a glass of milk) and difficulty walking, all of which she ignored. The symptoms persisted and worsened so her husband took her to her naturopath who gave her garlic and grapefruit juice. Luckily, her daughter showed up and took her to ER – she is a very lucky lady as it seems she had a TIA not a full blown stroke.”

    Anyone worried about the iatrogenic problems of conventional medicine should reflect that there were no consequences for the naturopath in this story.

    1. Young CC Prof says:

      My favorite negative example is the acupuncture for asthma study. They did real inhaler vs placebo inhaler vs acupuncture, and what they found was that all three groups felt better after treatment. However, only the real inhaler group had improved lung function.

      The acupuncturists said, “See, acupuncture helps!” The realist response is, “Wow, it relieves symptoms without actually treating the lung problem. Acupuncture for asthma could be really dangerous!”

  39. Kevin Brown says:

    Great job.
    Keep up the good fight.
    This is much better the my usual argument, “Fuck CAM.”

  40. Jann Bellamy says:

    A wonderful post, Harriet.

    Would this be another one: “Only [fill in number] percent of conventional medicine is supported by evidence.” This and its variations are used by CAM supporters as an excuse for the lack of evidence in support of CAM. My understanding is that this is answered in part by the fact that medicine has, at the very least, biological plausibility behind it. I think Steve Novella actually looked at the numbers in a post but I can’t find the reference.

    Re: the ” competition” gambit. This is often used in legislative debates in the form of blowing off MD opposition to CAM licensing or expansion of scope of practice as a “turf war” no matter how ludicrous the proposed treatments and practices are. Fortunately for me, I don’t have to deal with the competition argument because I am not now, nor have I ever been, licensed to practice medicine:) Nor has big pharma ever offered me a penny — why would they?

  41. SpaceTrout says:

    This has to be one of the best SBM posts I’ve ever read. Thank you Harriet.

  42. Sastra says:

    23. CAM is better because it’s holistic.

    CAM appropriated the holistic principle from mainstream medicine.

    I think you’re misunderstanding what many CAM advocates mean by “holistic.” From what I can tell they usually mean that alt med addresses mind, body, and spirit. Mainstream medicine — modern medicine — only got started when people began to abandon that principle and dealt strictly with the natural world and what can be objectively known through common reason.

    But for many that’s a bug, not a feature. If conventional medicine doesn’t get into the supernatural then there’s a whole area of knowledge just left empty. And it leaves out faith, too — religious-style faith, that is, where reality behaves differently for the enlightened and the unenlightened cannot be made to understand this. From the standpoint of a skeptic, it can look like people are just making stuff up instead of doing what they’re really doing — tapping into deep spiritual wisdom.

    Ugh.

    Which gets into the criticism I regularly run into: “You’re in a different paradigm than we are.” If that’s one SBM doesn’t see much — then good.

    1. WilliamLawrenceUtridge says:

      And they never think about what happens if your doctor is of a different faith from you.

      “Yes, exercise for your heart, take these pills for your bloodpressure, talk to your wife for your mind, and pray five times to Allah for your soul.”

      I would change doctors.

    2. Harriet Hall says:

      I don’t think I’m misunderstanding. I think everyone means the same thing by “holistic” – the idea that you consider the whole patient, including everything about the patient that matters. Doctors who are religious may think the patient’s soul matters; others may think the patient has some kind of non-theistic spirituality that matters; CAM providers may think the patient’s aura or qi matters, or they may not be in a supernatural paradigm at all. I think some of them who think they are practicing holistically also imagine they are firmly in the material realm of science.

      1. Sastra says:

        The term “holistic” seems to be one of those deepities. It has two interpretations: one true but trivial (“all that matters”) and one extraordinary but false (“the transcendent spiritual realm.”) A deepity will often flip back and forth between meanings, as if they were just two sides of the same thing. It’s a mark of confused thinking.

        So while you’re technically right, not everyone really means the same thing by “holistic.” Sure, mainstream medicine has always considered the whole patient — but that’s not what’s at stake for them. Many alties (no, not all) have apparently turned it into a code word for woo — but will bring it back to the trivial-but-true realm of “including everything that matters” to show how reasonable they are (and how unreasonable mainstream medicine must be.)

        My altie friends think their supernatural claims (which they never call “supernatural” btw) are firmly fixed in the natural realm of science — proper science, that is, the kind that is taking all the breakthroughs on spirituality into account. When asked, one of them estimated that about 40% of physicists today currently endorse vitalism.

      2. I am wary of the holistic folks. When a doctor is trying to look at the big picture and incorporate evidence based medical interventions, realistic lifestyle and behavior modification and psycho/social support into cohesive treatment plan they seldom label it holistic (for instance my son’s cleft team has such an approach and I’ve never seen the word in their literature.).

        Often I see the word holistic used when a practitioner is, in essence, attempting to blame an emotional state for a physiological condition. For instance, I had a friend who saw a holistic medical practitioner* for medical advice who told her that her severe menstrual cramps were due to her unresolved feelings over her femininity. Her cramps would resolve when she worked through her conflicted emotions.

        Within the field of infertility treatment there is much acclaimed holistic centers that incorporates mind/body techniques (such as stress relief including yoga, massage and meditation) with medical fertility treatment that supposedly result in better fertility. While I’m all for lowering the stress in fertility treatment just for quality of life reasons, it’s curious how often one sees claims of increased fertility without actual significant studies showing increased live births. But, possibly I have missed the studies.

        Then there are, of course, the holistic mind/body cancer folks who put forth the idea that a positive outlook will increase survival rates.

        Of course this attitude is not isolated to CAM practitioners, you still get MDs who suggest that “lowering your stress” will help your stomach pain or fatigue or some other symptom without considering causes other than stress. Although I doubt they bill themselves as holistic.

        Regardless, holistic has become a red flag word suggesting not science based to me.

        *I don’t know what his medical qualifications were, I know he sold herbs and did acupuncture. My friend didn’t talk about him much after the initial conversation, where I suspect the horrified look on my face discouraged further discussion.

        1. Sastra says:

          Often I see the word holistic used when a practitioner is, in essence, attempting to blame an emotional state for a physiological condition.

          That’s a very good point.

          And since a lot of people are dualists — and believe that minds are basically magic — I think it fits in with the supernatural “spirituality.” Good emotional states are reflections of our spiritual selves and lead to holistic healing, as Nature/Spirit/God intended.

          1. Harriet Hall says:

            In essence, CAM has hijacked a perfectly good concept from conventional medicine, distorted it out of all recognition, and used it to support their own agenda.

  43. newcoaster says:

    What a great article

    I’d never really tried to add up all those tropes which we all deal with repeatedly in our various skeptical endeavors. It deserves it’s own bookmark for future reference. Next time I run across an example, I can just sent the link and advise on which specific number to read over, THEN get back to me.

    Thanks Harriet.

  44. Andy says:

    Maybe someone has already mentioned this – or maybe it doesn’t belong here, but here goes…

    “After several tests, an allopath said there was nothing wrong with me – but my alt-med practitioner did a special alt-med test that showed I had Problem X. They sold me Remedy Y and, after taking it for six months, the special alt-med test showed Problem X had become worse, which proved the remedy was working. So I took Remedy Y for six more months, along with Detox Z, which they also sold me. The next alt-med test was clear for Problem X. So alt-med clearly works better than allopathic med because now I have nothing wrong with me.”

  45. Regarding people who use 5. “It worked for me”. & 6. “Try it yourself.”:

    If they truly understood the problem we have with #5, they would also understand the problem we have with #6. It’s not so much that we don’t trust THEM and THEIR powers of observation; it’s that humans are inherently fallible and we don’t trust our own unblinded, uncontrolled observations either.

    #7 & 8 see #s 5 & 6 and expand to large groups over long periods of time. The meta of crap is not data.

  46. You’re right to put Chinese medicine in quotes. As Mark Crislip has expounded several times that acupuncture is largely new “ancient” medicine and when you write it in Chinese (針灸) it is indistinguishable from moxibustion (sometimes called “cupping”). So even if you were reading original texts on Chinese medicine it’s not always clear what exactly you’re supposed to do. A lot of what people call TCM comes from a particular text (素問) this is where we get told it’s best to take someone’s pulse in the early morning. However this is 2nd century. One of the earliest Chinese medicine texts 五十二病方 is all about drugs, lancing and magic words. No qi channels, no acupuncture. Symptoms map to ailments which map to remedies. Sound familiar?

  47. pmoran2013 says:

    “I think if the medical profession had a better rate of healing people or even promoting more prevention interventions based on proven motivational methods than so many people who are looking towards alternative modalities might be convinced of medicine.”

    This is a half-truth, although it is not demonstrable that CAM has unique capacity in either regard.

    What is the role of Harriet’s collection? For some users CAM is like a lifestyle choice and based upon a selection of these false premises and half-truths, but I suggest that such beliefs play a very secondary role in most other use of CAM. It is in consequence difficult to know how seriously to take them when they arise in discussions with some CAM users, yet they habitually sidetrack discussion onto largely irrelevant matters while often also deepening hostility.

    My hypothesis is that for most CAM users these are post hoc attempts to rationalise their CAM use or to justify it when under challenge. They are retaliatory, deriving from an inchoate emotional response to what medical scepticism is saying, or is thought to be saying, sometimes as the result of poor choices of wording, “tone”, or argument (an example is how CAM users are quite sure that we want to ban CAM entirely, because that is the clear, almost necessary, implication of so much of our rhetoric and even frankly stated as a desirable aim by some ) .

    In effect what most of these arguments are trying to convey is this — “butt out of my affairs!”. A more verbose version might run like this : “Give me a break! I am sick / in pain all the time / dying, I have tried your methods and they have not done what I desire, so why would you be pursuing me with your insistence that the mainstream is the only way and that I am a fool and desperately in need of re-education for having tried something else?”.

    The vast majority of CAM use occurs because, despite its many triumphs, the mainstream does not have entirely effective and safe treatments for many common and disabling conditions.

    That has no bearing on the effectiveness of CAM, but it should be an acknowledged common ground from which we can start when working with the public towards whatever shape of medicine yields best outcomes and least bad ones. While many of these accusations are false or overblown, we in the mainstream do indeed have much to be humble about and every CAM user knows that.

  48. Garett says:

    I’ve had my qualms with SBM posts before, but I must say this one is fantastic. I particularly liked:

    “Half of all published studies are wrong, for a variety of reasons that are constantly discussed on this blog. You can’t just look at positive studies: you have to look at the entire body of published evidence. That’s where systematic analyses come in. And they may not reflect reality: there may be negative studies that we don’t know about because they were never published: the file drawer effect and publication bias. And remember Carl Sagan: ‘Extraordinary claims require extraordinary evidence.’ It would take a great deal of evidence indeed to overthrow all the established science that tells us homeopathy can’t possibly work as advertised.”

    Couldn’t agree more. It takes someone completely immersed in a literature for years and years to be able to integrate findings and come to meaningful conclusions across the body of work.

  49. Garett says:

    Also (sorry one more), I have definitely perpetrated some of these myths in the past. These responses are very logical and well thought out. I feel that if someone had shown me this article sooner that propagation would not have happened. I think if people make comments on articles in line with one of the above, you should just reply with a link to this article. If they still persist after reading these, there is no chance of changing their mind – it’s very difficult to argue with the reasoning presented in this article.

  50. Andrey Pavlov says:

    @pmoran:

    Sorry for brevity and the hit and run. On my phone and will be in place with no electricity or cell service later today and for the weekend.

    “The vast majority of CAM use occurs because, despite its many triumphs, the mainstream does not have entirely effective and safe treatments for many common and disabling conditions.”

    You have no evidence to support this statement and plenty to prove it completely wrong. the vast majority CAM use is by middle aged, reasonably educated, upper middle class women. For extremely minor or non existent conditions. Or f for conditions which medicine does have a satisfactory solution.

    It is driven by marketing, ideology, and hype. Only a small percentage is driven by desperate need unanswered. And certainly not disabling conditions.

    Your premise it’s false. Otherwise show me the data on CAM usage that sports the statement you just made.

    1. pmoran2013 says:

      “Your premise it’s false. Otherwise show me the data on CAM usage that sports the statement you just made.”

      You mean that CAM usage is based mainly upon medical needs and not your model, wherein CAM peddlers and practitioners are seizing well-educated people off the street and forcing them to use their wares for no good reason?

      Actually most surveys do show that CAM use is correlated with ill-health even those which cover a mostly healthy populations, as does the widely discussed Eisenberg one.

      If you look at CAM use by specific patient groups, such as cancer, asthmatics, allergies, back pain, headache, arthritis etc you will find much higher rates of use of CAM. I don’t know of any collation of such, but you will find them easily on pubmed.

      Even those using CAM for seemingly trivial reasons can be regarded as having a medical need that for one reason or another the mainstream is not considered suitable. For example people may reasonably be wary of getting involved with the expense and risk of unnecessarily powerful drugs for minor complaints, and seek simpler options first.

      The mainstream used to support a lot of cheap, harmless remedies for just such situations but, somewhat sadly, the ethical and scientific standards we now aspire to have denied us these options. CAM has enthusiastically taken over.

  51. @pmoran and Andrey Pavlov

    I’ve gotten in the habit of ignoring your battles. But this week is my “Problems are Complicated” week, so your exchange caught my eye.

    I suspect the reasons people use CAM are varied – like cancer – there is probably not a simple one size fit all profile.

    For instance, I think this report shows that in the U.S. a significant (although not majority) of people who use CAM are uninsured and are attempting to treat specific conditions with herbs and supplements. This includes patients with mental health issues, for whom the access to mental health services has been a big concern in the states.

    http://www.hschange.com/CONTENT/722/

    Over the summer, on a slow (really hot) day I chatted with my fellow artist, many of whom are uninsured or underinsured. (Many carry some sort of insurance for major illness but pay a lot for it, then pay out of pocket up to $3000 – $6000 or more dollars.) Many of them use herbs, alternative diets, etc. to treat things like anxiety, depression, stomach problem (undiagnosed), aches and pains (undiagnosed). I think the only thing they go to the doctor for is something they suspect could be life threatening. Then there is just a lot of resentment for the huge amount of money they have to spend to find out they don’t have a life threatening illness, but maybe need more fiber or are heading for a joint replacement they can’t afford and that resentment is mostly directed at the doctor who was the bearer of bad/good news, who was sometimes good, but also sometimes less than informative or frugal with the expenses.

    There is not going to be one right way to talk to the paranoid conspiracy theorists, the self-indulgent healthy person who uses CAM to be MORE healthy, the uninsured person who’s just trying to get by without going bankrupt, the desperate ill person who just wants to be left alone to try different methods, not to mention the anti-vax folks, (adding even more subgroups.)

    Even if you could prove one group comprises the largest percentage, you may still be missing out on smaller subgroups that make up a large percentage (The curse of the Republican party in the U.S. now, apparently) AND the numbers are going to vary by country. Yes?

    And as much as I hate to admit it, many of the folks who use CAM, but are not dogmatic about it, (The people mostly likely to be convinced by new information or arguments) do not post comments on this site…even if they read the blog, many probably don’t read the comments. They are all on facebook, twitter, etc. Who knows, you might catch the attention of more non-dogmatic CAM users by posting creative or informative negative reviews on amazon.

    So, I don’t know, tap away at one group, nick away at another or just put all you efforts into convincing a third group of people…It’s unlikely that there will be any evidence that one approach is better than another without massive data collecting efforts (Maybe the U.S. government could help you with that one.)

    1. pmoran2013 says:

      MTR: “There is not going to be one right way to talk to the paranoid conspiracy theorists, the self-indulgent healthy person who uses CAM to be MORE healthy, the uninsured person who’s just trying to get by without going bankrupt, the desperate ill person who just wants to be left alone to try different methods, not to mention the anti-vax folks, (adding even more subgroups.)”

      The problem lies in finding a coherent voice on CAM, by which I mean one that is consistent with the science, while also dealing with certain practical realities, and the foibles of the human condition.

      SBM’s message is basically “CAM is wrong, wrong, wrong” . It is true that there is a wealth of things wrong within CAM but that does not automatically lead to rational or realistic objectives concerning it.

      I have been considering an approach that acknowledges that people can derive psychogenic and other minor benefits from the use of CAM, sometimes when these may not be easy to get within the mainstream. You have mentioned some of the reasons why that might be so, such as cost and a variable quality of medical services.

      So my approach it is directed at the main dangers of CAM. That is something that anyone can understand and easy to support scientifically.. It says that “CAM use seems able to help some feel better, but it should not be relied upon alone for the treatment of any serious illness”.

      Some CAM methods have other dangers and there are obvious frauds, but they can be dealt with directly. Advice on those will be more likely to be heeded if it is clear that all we are concerned about is individual patient welfare. We are not putting any particular world-view above that.

      1. I agree that in many cases advice is more likely to be heeded if the recipient knows that the advice is based on concern for their individual welfare, rather than a commitment to SBM as a superior methodology that may appear overly restrictive to many regular patients.

        But, it appears to me that a great number of folks who post as CAM proponents on this site are not everyday patients. Their goals for commenting is not to gain information, then make a decision. Their goal is to advocate for their preferred cure-all. The mere suggestion that their preferred method is not an effective treatment of disease marks you as an enemy and often attempts to show that you are concerned about their welfare are interpreted as insincere, at best.

        And it goes beyond that. These same proponent are not shy about pushing their recommendations onto friends, family members and folks online (folks, like me, patients) who are struggling with illness…often implying that the listener is either, gullible, close minded, lazy or faking illness if they are not willing to try their cure for neck pain, allergies, auto immune disease, etc.

        On the SLE/Undifferentiated Connective Tissue Disease board I frequent, it’s common for people to ask for information about some alternative diet or treatment and often it’s clear that they have no interest, that some “helpful” person has guilted them into checking it out or trying it.

        For folks like me (and these other folks) it’s nice to see some solid push back, that says “No, you don’t have to try this questionable treatment, it’s a waste of your time, money and energy and yes, you can even be irritated or even angry with the person who was pushing it and implying “if you really want to feel better you would try it.”

        I don’t see a good way to address the needs of that later person AND continually emphasis that some of these therapies may have some pyscogenic benefit…because differentiating psychogenic benefit is hard when your symptoms are something like pain from multiple tendon inflammation, brusitis or itching. Because how does one know if psychogenic benefit is going to be helpful?

        So I guess, personally, I like to see a variety of voices that may speak to different needs and I do think that concerned reasonable accommodation AND righteous indignation are both needed.

        Upon reflection, it seems unfortunate, but pretty much unavoidable that the two approaches would clash, though. All part of the human condition. I guess.

  52. Well, I didn’t mean to imply that non-dogmatic CAM users are ALL huddled on Facebook and Twitter, I just meant, they are probably not spending the majority of their online time on SBM.

  53. CannotSay2013 says:

    These 30 points also apply to the psychiatric pseudo science, especially point 7. When the most convincing studies pile up to say that antidepressants are basically active placebos or when Tom Insel is forced to agree, based on the evidence, that it could be the case that many people would benefit if they were not put on neuroleptics for life to treat invented diseases, the answer of the psychiatric establishment, ie the APA and the like, is similar: look at the “many people who are happy with their SSRIs, neuroleptics, etc” :D.

      1. CannotSay2013 says:

        Harriet,

        I was banned by Steven Novella from his blog for saying these things. Steven Novella is fully committed to bio psychiatry despite the fact that bio psychiatry shares many more traits with pseudo science than with genuine science. Apparently, me questioning his Yale appointment as a “genuine, tenure track one” was to much for him to bear :D.

        Glad to see that there is somebody in this movement whose brain is still functional, uncorrupted by psychiatric lies.

        1. WilliamLawrenceUtridge says:

          I would guess your banning would have more to do with you engaging in an ad hominen, that he’s not a “real” professor or somesuch.

          If you evidence is as convincing as you say, why is it not the policy statement of the AMA or APA on these dangerous drugs? And “sharing many traits” is not the same thing as “being a pseudoscience”.

          1. CannotSay2013 says:

            Two things,

            - On Steven Novella. His appointment at Yale is a clinician appointment. Most of hist work is done at Yale Medical Group, which is Yale’s medical division. The clinicians at Yale Medical Group have professor appointments at Yale. This is a scheme that is followed at many of our nation’s top schools that also happen to deliver healthcare. There is absolutely nothing wrong with that. However, if your are going to boast about a professorship at Yale, it only makes sense if it is a tenured or tenure track appointment, which are the type of appointments whose holders are expected to do cutting edge research. This is the equivalent of a car mechanic boasting knowledge about the latest trends in motor design. A travesty.

            - On the APA. You have to be seriously kidding me. Psychiatry is different from other medical specialties on many ways (as Harriet previously noted). One under appreciated way that sets psychiatry apart from other medical specialties is that it is onto itself a conflict of interest. If you are the director of a big research hospital, like say Yale Medical Group, and are doing your planning on the needs for doctors in the next 5 years, for normal diseases you have it easy, you just need to measure the prevalence of particular conditions, like cancer or infectious diseases, in the area that the hospital serves, then take into account population growth, retirements, etc and you get a pretty good idea of how many doctors you need to hire for a particular specialty. Psychiatry is different. The very existence of a psychiatric department depends on psychiatric labeling, which is not biologically based, and in the idea of “need to treat” those labels. This is why psychiatry needs to constantly exaggerate the prevalence of its diseases, invent new ones when the old ones are debunked, etc. Even with this, the APA was forced to admit recently that neuroleptics are over used and has proposed a new protocol to limit its use. Some will see this a step in the right direction, I see the APA recognizing a travesty for fear that it might become irrelevant if the current movement bashing organized psychiatry (which includes former chairmen of DSM task forces) continues. As to why the AMA allows the APA to be one of its umbrella organizations (ie, why the AMA recognizes psychiatry as a medical specialty), you’ll have to ask the AMA leadership. However, the AMA, despite its power, it is not representative of mainstream medicine because only 15% of all US doctors are members of the AMA. The AMA is just as corrupted by Big Pharma as the APA is. Only, for non psychiatric conditions, at least there is a biological marker that can falsify invented cures. It is one thing to use a neuroleptic to treat so called “depression” quite another to use an NSAID (like aspirin) as antibiotic. If you try to treat a syphilis patient with aspirin, he/she might die. In psychiatry you can treat anything with any psychoactive drugs in their arsenal because there is no objective way of defining their invented illnesses, let alone efficacy.

          2. CannotSay2013 says:

            Well,

            My answer, which was in no way offensive, was removed. I just explained the difference between the type of appointment that Steven Novella has at Yale and a tenure track or tenured appointment. It is useless to discuss anything here.

          3. weing says:

            @CannotSay2013,

            “There is absolutely nothing wrong with that.”
            No there is nothing wrong with that.

            “However, if your are going to boast about a professorship at Yale, it only makes sense if it is a tenured or tenure track appointment, which are the type of appointments whose holders are expected to do cutting edge research.”

            So you consider stating a fact, boasting. It must be easy to get a professorship. Why don’t you try getting one? What are the non-tenure track appointments expected to do? I have one of those appointments, not at Yale, I am expected to do teaching of residents and medical students, which I do.

            “The very existence of a psychiatric department depends on psychiatric labeling, which is not biologically based, and in the idea of “need to treat” those labels. This is why psychiatry needs to constantly exaggerate the prevalence of its diseases, invent new ones when the old ones are debunked, etc. Even with this, the APA was forced to admit recently that neuroleptics are over used and has proposed a new protocol to limit its use.”

            I suspect psychiatric labeling will be biologically based, given enough research. That still does not make psychiatric disease not-real. You may call it debunking, others may call it refining the diagnoses. As knowledge increases in a field, that is to be expected. I’m not a psychiatrist, but neuroleptic overuse has been recognized for much longer than ‘recently’ and any new protocols to limit their use are welcome as long as they are science-based.

            As to corruption, any organization is susceptible to it.

          4. weing says:

            “The clinicians at Yale Medical Group have professor appointments at Yale. This is a scheme that is followed at many of our nation’s top schools that also happen to deliver healthcare.”

            I love your use of the word ‘scheme’. I think it is a scheme to not pay the clinicians for what they do. They also aren’t eligible for the benefits that the tenure-tracked staff are. Like retirement plans, insurance, tuition waiver for their children if they attend the said university. Not a bad deal for the institutions.

            Hmmm. I wonder if outraged clinicians declined to accept students and residents when the schools institute SCAM departments that are tenure-tracked might be a way to exert some leverage on the administrators for such stupidity?

          5. Psych Survivor says:

            weing,

            “So you consider stating a fact, boasting. It must be easy to get a professorship”

            I discussed the issue below. My problem is not with Novella being a clinician is with him misrepresenting the nature of his appointment in order to deceive, namely, making arguments from authority.

            “I suspect psychiatric labeling will be biologically based, given enough research. That still does not make psychiatric disease not-real.”

            It is very ironic that this comes in a discussion about Science Based Medicine destined to debunk CAM. Psychiatry has been making such outrageous claims for as long as homeopathy has been making theirs that “just because they haven’t been able to explain how the infinitesimal dilutions work to heal it doesn’t mean that the healing effect isn’t there”. Same tricks.

            Psychiatry has had almost 200 years to make its case. All it has come up with are things such as drapetomania, female hysteria, homosexuality, lobotomy, insulin therapy, electroshock, forced drugging and a long list of invented diseases that can be imposed by the force of the state into innocent people. Psychiatry is the number one human rights violator in the Western World today, all that based on an idea that is as scientific as homeopathy. Anybody who cares about both science and human rights should be offended that somebody defends psychiatry in any way.

            “Hmmm. I wonder if outraged clinicians declined to accept students and residents when the schools institute SCAM departments that are tenure-tracked might be a way to exert some leverage on the administrators for such stupidity?”

            It is clear to me that if Yale, and other universities, are able to get away with these schemes is because there is a demand for them. Somebody like Steven Novella would not have been able to be appointed to a professorship at Yale otherwise since nothing in his resume indicates that he is a top notch researcher. However, it is one thing to state as a fact that one has a clinical appointment at Yale, quite another to pretend that it is tenure track as Novella does. That’s the deceiving part.

            1. Harriet Hall says:

              “misrepresenting the nature of his appointment in order to deceive,”
              “quite another to pretend that it is tenure track as Novella does”

              Where did he do that? Citations, please!

            2. Harriet Hall says:

              “Psychiatry is the number one human rights violator in the Western World today”
              Are you a Scientologist? That’s what they claim. Or have you just been reading Szasz?
              You call yourself Psych Survivor, so apparently you have a personal agenda.
              I recognize that there is a lot wrong with psychiatry, but there is also a lot of good. Psychiatrists prescribe medications that prevent suicides and allow previously incarcerated patients to live as useful members of society. They are striving to make their discipline more science-based. If you reject psychiatry, what other option do you propose? Not treating them? Using CAM? If psychiatrists can’t do much, who do you think can do more?

          6. WilliamLawrenceUtridge says:

            So…Dr. Novella is a bad person and deceptive for giving his clinical appointment…but not immediately saying he’s not really as smart or good as the “real” Yale people? Giving one’s work association is pretty standard and valid. Further, I have never seen Dr. Novella say “you should believe me because I work at Yale”. Dr. Novella’s status as a Yale employee is only a point of contention if he uses it to reinforce an argument from authority. And even so, he is still a practicing neurologist, which does give him expertise and experience. So what’s the issue?

            Further, Dr. Novella rarely restricts himself to his particular medical specialty. On occasion I can recall him commenting on areas that touch on neurology (MS and the CCSVI theory, and that awesome post where we’re one step closer to GIANT MECHA!!!) but usually I find his posts to be quite abstract and usually touching on things like logical fallacies, errors in reasoning, and high-level skeptical commentary, sometimes using a specific example such as Irlen syndrome as a real-life exemplar. So again, what’s the problem?

            Even with this, the APA was forced to admit recently that neuroleptics are over used and has proposed a new protocol to limit its use. Some will see this a step in the right direction, I see the APA recognizing a travesty for fear that it might become irrelevant if the current movement bashing organized psychiatry (which includes former chairmen of DSM task forces) continues.

            So…what you’re saying is:

            - the APA changed its mind in the face of new evidence. Hooray?
            - psychiatry, the study of the behavioural impacts of the most complicated thing we are aware of in the entire universe, is hard

            Yes, the diagnosis and treatment of mental illness is difficult, and errors have been made in the past. Yes, the DSM is an imperfect and controversial tool. Yes, because diagnosis is behaviour-based, small changes in criteria can significantly change incidence and prevalence. It can also leverage resources, draw attention, and encourage government action. And yes, it also has drawbacks.

            However, in denying the DSM and denying the current approach to mental illness, you also in some way deny the effort behind it – a systematic attempt to categorize diseases, dysfunctions and differences of cognition, emotions and behaviour. It’s difficult, it’s controversial, it has a large subjective component, but are we better off if it wasn’t done? Does it mean doctors and in particular psychiatrists uncritically embrace it and implement the recommendations naively? I doubt it. In fact, I wonder if psychiatrists are at the forefront of the criticisms you are making. I wonder indeed…

            And you’ll never get anywhere with the insistence the AMA or any profession or professional organization is wholly corrupted. “Big Pharma” is a point of concern and certainly raises serious problems with the research produced (I have urged my own national granting agency to require registration with Ben Goldacre’s Alltrials initiative). But it doesn’t invalidate the entire process, and all too often it’s used as an intellectually lazy way to discount any evidence that is inconveniently contrary to your pre-existing belief.

          7. CannotSay2013 says:

            Harriet,

            I sent you a private email with the exchange in question. Feel free to make your own conclusions. He made similar arguments that “validity in medicine is what Steven Novella thinks validity is” in the public discussion where I was banned. To Novella, that Tom Insel says that DSM diagnoses lack scientific validity is irrelevant. He is using his “Novella authority” to settle what “validity”. Coming from a tenured track professor at Yale you can give somebody some slack about it. Coming from a clinician, like Novella, not much especially when Tom Insel says otherwise.

            1. Harriet Hall says:

              @CannotSay2013, I got an email, but it didn’t feature any false claims. You have been posting under two different names from the same address. I wonder why. Trying to make it look like more people are on your side? You have accused Dr. Novella of lying, and also of arguing from “Novella authority.” I don’t think he is guilty of either. Unless you can post some clear-cut convincing evidence, I think you owe him an apology. And anyway, a tenured track professor can’t just argue from authority: he has to back up his statements with evidence just like anyone else.

              By the way, you didn’t answer my question about what would be more effective than psychiatry.

          8. WilliamLawrenceUtridge says:

            Psychiatry has had almost 200 years to make its case. All it has come up with are things such as drapetomania, female hysteria, homosexuality, lobotomy, insulin therapy, electroshock, forced drugging and a long list of invented diseases that can be imposed by the force of the state into innocent people.

            I’m not sure if you’ve seen the latest two versions of the DSM, but both are rather thicker than the 30 pages it would take to include these 7 diagnoses. And while the earlier versions of the DSM did include homosexuality, later versions removed it – and now the APA is among the leading champions of criticizing things like conversion therapy and homophobia. Electroshock is actually an effective treatment for certain patients, for instance providing short term improvements for patients with schizophrenia.

            You may be criticizing psychiatry for developing these treatments and ideas; an honest assessment may also recognize that psychiatry also investigated and rejected them too. Further, said honest assessment might also note that your list, at least the items that aren’t untraceably vague, are often in excess of three decades since their rejection; in some cases well over a century.

            If you insist that all medical knowledge and practices be perfect, risk free and valid before it is ever used, yes – one can find much to criticize. If you insist on judging all nations, people and practices solely on their errors (and never forgetting those errors), yes, on can insist that pretty much everything should be damned.

            If you’re looking to help someone whose mood is so low they decide to put a pistol in their mouth and pull the trigger, perhaps we might look towards some sort of profession and categorization that specializes in that sort of thing.

            Progress, not perfection.

          9. CannotSay2013 says:

            “- the APA changed its mind in the face of new evidence. Hooray?”

            That is not what happened by any stretch. Some of the studies mentioned by Tom Insel in his August post were known for many years, and had been brought to public attention by Robert Whitaker 3 years ago in his “Anatomy of an Epidemic” groundbreaking work. Harriet talked in 2011 about a review of Whitaker, and others, work by Marcia Angell. Kirsch made public his first analyses that SSRIs are active placebos more than 10 years ago.

            The APA has been forced to bow to the evidence by external forces, not from within, just as it was forced to remove homosexuality from the DSM through lobbing. That tells you how sloppy psychiatry is.

            “- psychiatry, the study of the behavioural impacts of the most complicated thing we are aware of in the entire universe, is hard”

            Leaving aside the fact that psychiatry’s behavioral diagnoses are invented (as Tom Insel mentioned in May), psychiatry cannot have it both ways. If behavioral issues are so complicated, then it is unlikely that simplistic models of “chemical imbalances” are going to be any good. Yet the “chemical imbalance” model is what lies behind the skyrocketing psychiatric drugging of the last 15 years.

            Psychiatry is a fraudulent endeavor and that is the main reason psychiatry is trying, just as it did after the Rosenhan experiment in the 1970s, to save face when its last scam, the “chemical imbalance” has been debunked.

            When I say that that psychiatry is more like homeopathy than like oncology I mean things like this.

            “However, in denying the DSM and denying the current approach to mental illness, you also in some way deny the effort behind it – a systematic attempt to categorize diseases, dysfunctions and differences of cognition, emotions and behaviour.”

            And yet that is precisely what Tom Insel, the director of the National Institute of Mental Health, just did in May this year a few weeks before DSM-5 was released. The secret was out, for everybody to see.

            ” It’s difficult, it’s controversial, it has a large subjective component, but are we better off if it wasn’t done? Does it mean doctors and in particular psychiatrists uncritically embrace it and implement the recommendations naively? I doubt it. In fact, I wonder if psychiatrists are at the forefront of the criticisms you are making. I wonder indeed…”

            The current criticisms of psychiatry are nothing more than recycles of criticisms made by Thomas Szasz 50 years ago in his groundbreaking paper “The Myth of Mental Illness”. What is happening is that these criticisms are now starting to divide those at the top. That is how other human rights abusing endeavors were destroyed in the past. Psychiatry is not an exception. Its role as the “Inquisition” (imposing “normality”) is being challenged from within because of decades of antipsychiatry activism.

            “And you’ll never get anywhere with the insistence the AMA or any profession or professional organization is wholly corrupted.”

            You are wrong about this. If just 1 year ago you’d had told me that the director of the NIMH would make his 50-year old Szaszian ideas, I would have told you: you have to be kidding me! Yet, that is precisely what happened 4 months ago.

            “But it doesn’t invalidate the entire process, and all too often it’s used as an intellectually lazy way to discount any evidence that is inconveniently contrary to your pre-existing belief.”

            The Big Pharma aspect is just one aspect. Also the idea that psychiatry has produced any “scientific evidence” at all is laughable. The largest metastudies performed to date on psychiatric drugging, like the infamous STARD study, have confirmed what we already knew, namely, that since psychiatry is non scientific, on average the value of psychiatric prediction is zero.

            When there is no objective reality to begin with, as it happens in the DSM process, he or she who screams louder, or with the largest pockets, ends up winning. And that is what the DSM is: a reflection of the power politics inside American psychiatry. Nothing more nothing less. None of its labels has any validity at all and that is what Tom Insel said.

          10. CannotSay2013 says:

            Harriet,

            “Are you a Scientologist? That’s what they claim. Or have you just been reading Szasz?”

            This must be one of the cheapest rebuttals ever. Now everybody who raises issues about abuses by psychiatry is a Scientologist or has a Scientology agenda? You’ve got to be kidding me! No, I am not. Also, for the record, I also consider that Scientology can be very destructive but with that said, this in no way invalidates CCHR’s or Szasz’s valid concerns about psychiatry. It’s like saying that just because Stalin opposed Hitler, all opposition to Nazism is invalid or suspect of being Communist.

            “I recognize that there is a lot wrong with psychiatry, but there is also a lot of good. ”

            Isn’t this what the practitioners of homeopathy also claim?

            “Psychiatrists prescribe medications that prevent suicides”

            Actually, this is not true, as in, there are studies that show that SSRIs increase suicidal behavior, and the FDA has been forced to warn about it. There is also the fact that the CDC made public data in May that showed that between 1999 and 2009, the rate of suicide increased 30% (that was the rate, the actual number followed an increased rate because of the population increase). That is correlated with data that shows massive increase in SSRI prescription over the same time. The scientific prediction of a massive prescription of substances known to increase suicidal thoughts, as SSRIs do, is an increase in suicides. That is consistent with the CDC data.

            “They are striving to make their discipline more science-based. If you reject psychiatry, what other option do you propose? Not treating them? Using CAM? If psychiatrists can’t do much, who do you think can do more?”"

            The Kirsch studies show that placebo intensive therapies (be them placebo drugs or CBT) are just as effective. These placebo intensive therapies do not cause the side effects (among them increase in suicidal thoughts) that SSRIs do.

            At this point it is just pathetic that a blog dedicated to advance Science Based Medicine is advancing a pseudoscience that is no different from homeopathy.

            1. Harriet Hall says:

              @CannotSay, That wasn’t a cheap rebuttal, it was a sincere question. I would like to understand how anyone would come to that conclusion unless he had been influenced by a source like that, and your language sounds just like what they say.

              Undiagnosed and untreated depression are the major cause of suicide, and drugs DO reduce the risk of suicide except perhaps in the younger age groups and the less severe depressions. The FDA warnings are for children and young adults only. The original reports of suicide risk have been tempered by further research. You say the rate of suicide increased with an increase in SSRI prescription. If so, that’s a correlation, not a proven cause, and it’s also true that after the first warnings of suicidal ideation (not completed suicides) in young people were issued, the SSRI prescription rate dropped by 18% and the suicide rate increased by 18%. Did you even read the 2 links I provided? Here’s another: http://www.sciencebasedmedicine.org/psychiatry-bashing Have you revisited the recent literature? Are you aware of the evidence that lithium prevents suicides? Are you aware that there are epidemiologic studies showing a correlation between lithium levels in public water supplies and a reduced risk of suicide in the population?

              Kirsch is biased and has his own agenda. Did you read my links?
              People who have experienced severe depression and psychosis are well aware of the advantages of drugs. True, psychotherapy can be effective, but sometimes an antidepressant drug has to be prescribed first, before the patient becomes capable of participating in therapy. And there is evidence that the combination of psychotherapy with medication is more effective than either alone.

              Modern psychiatry is a young science with growing pains, but it is not a pseudoscience like homeopathy. Comparing the two is ridiculous.

          11. CannotSay2013 says:

            WilliamLawrenceUtridge,

            “And while the earlier versions of the DSM did include homosexuality, later versions removed it – and now the APA is among the leading champions of criticizing things like conversion therapy and homophobia.”

            The fact that psychiatry went from considering homosexuality a mental illness to banning it to being a promoter of gay rights just shows that psychiatry is a pseudoscience, not the other way around.
            It shows that a particular pattern of behavior can go from being pathological to being normal to being promoted just because “self appointed mind guardians” say so. What sets homosexuality apart as well is that it fits the “reliability” requirement that most DSM diagnosis do not have. Unlike the definitions of ADHD, depression or even schizophrenia, there is no doubt about what “homosexuality” is. There are also a lot studies done on the possible biological origin of it, at least in part, with identical twin studies. So here we have a “pattern of behavior” whose definition is 100% reliable, that is known to have some biological origin of sorts that until very recently was considered a disease just because self appointed APA mind guardians said so. And now it is being promoted as normal because other self appointed self guardians say so. Now, if you have the stomach, please do a Youtube search of a 1967 special on homosexuality by Mike Wallace. You’ll see homosexuality being bashed by psychiatrists in the same way that psychiatrists bash the fad diagnoses of today, and also “threatening” about the dangers of leaving homosexuality untreated. It’s the same mantra, just a different pattern of behavior that is being targeted by their hate.

            “If you’re looking to help someone whose mood is so low they decide to put a pistol in their mouth and pull the trigger, perhaps we might look towards some sort of profession and categorization that specializes in that sort of thing.”

            The last thing that I would do if I know somebody who is feeling low is to send that person to a quack who is going to put the person on drugs, SSRIs, known to cause people to become suicidal or violent. That is in fact, the ultimate tragedy. In addition to the human rights abuses perpetrated by psychiatry through their forced treatments, you have that psychiatry’s drugs of choice are known to cause people to take their own lives or to take other peoples’ lives. All the American mass shooters who have come to prominence in the last decade were on some sort of psychiatric drugging (or had been recently) at the time they committed their crimes.

            You are promoting a pseudo science that is very dangerous in comparison with astrology or homeopathy.

          12. CannotSay2013 says:

            Harriet,

            The reason I have used two different names in this blog is because of a mistake. The email was the same though. And the reason why I use different names is, as I explained to you in private, to distract those who would use my condition of survivor of psychiatric abuse from using it against me.

            “You have accused Dr. Novella of lying, and also of arguing from “Novella authority.” I don’t think he is guilty of either.”

            I am not going to make the email that I sent you public because I respect Mr Novella more than he respects me. Needless to say that to defend what should be considered “validity” in psychiatry using Novella criteria instead of Tom Insel’s criteria is surely to speak from the point of view of “Novella authority”. With respect to misrepresenting his appointment he does. The notion that his current appointment can “lead to tenure” as he claims in that email is a fantasy that could warrant a schizophrenia diagnosis, for being so disconnected of the reality of his appointment, if Novella truly believes it.

            “Unless you can post some clear-cut convincing evidence, I think you owe him an apology. And anyway, a tenured track professor can’t just argue from authority: he has to back up his statements with evidence just like anyone else.”

            I don’t think I owe him an apology. On the contrary, I think he owes his readers an apology for misrepresenting his appointment at Yale and for contributing to scientific illiteracy for insisting that his notion of validity for a “psychiatric diagnosis” is the right one and that we should reject Insel’s which is also backed by Allen Frances, David Kupfer and Jerry Coyne all of whom are more credentialed, and have more credibility than him, in the matter of what constitutes validity in psychiatry.

            “By the way, you didn’t answer my question about what would be more effective than psychiatry.”

            I did, see above. Also I reject the premise of your question, namely, that a psychiatric intervention, which in these days is mostly drugging with poisonous drugs, is better than no intervention at all. SSRIs are known to increase suicidal thinking (in addition to having a lot of physiological side effects). Neuroleptics make people die 25 earlier than people that don’t take them. Stimulants (ie ADHD drugs) are known to turn people psychotic.

            This website, although not you personally, is aggressively promoting a murderous pseudoscience. That onto itself undermines your otherwise worthy efforts. When an objective person sees your website bashing homeopathy but praising psychiatry, obviously cannot conclude anything other than you have an agenda that has nothing to do with science or promoting scientific literacy.

            1. Harriet Hall says:

              Again, I’m truly puzzled, because I only got one email from you, and it did not say what you seem to think it said. I still have not seen a shred of evidence suggesting that Dr. Novella misrepresented himself or used the argument from authority.

              Your description of psych as “drugging with poisonous drugs” and “murderous” demonstrates your lack of objectivity and makes it hard to carry on a rational discussion with you.

              It is true that schizophrenics are more likely to die than others. But I don’t accept your “25 years earlier” as accurate. Where did you read that? And from what I have read, the excess deaths are largely from physical disease and have multiple causes like cigarette smoking, poor self-care, and delay in getting treatment. The role of neuroleptics in early deaths is uncertain.

              Ask anyone with a psychotic family member who is unable to care for himself or to survive without custodial care whether “no treatment at all” is an acceptable option.

          13. CannotSay2013Bis says:

            “Again, I’m truly puzzled, because I only got one email from you, and it did not say what you seem to think it said. I still have not seen a shred of evidence suggesting that Dr. Novella misrepresented himself or used the argument from authority.”

            We’ll have to agree to disagree. As I explain in a message that I now moderated, in all the academic circles that I know when one presents himself/herself as “professor” without a qualification about the title, the implicit assumption is that the person who makes the claim is a tenure track or tenured professors. I haven’t seen Steven ever making that clear which might or might not violate Yale’s policies about the usage of titles but it is certainly misleading, without qualification, in highly intellectual environments as the ones I know.

            “Your description of psych as “drugging with poisonous drugs” and “murderous” demonstrates your lack of objectivity and makes it hard to carry on a rational discussion with you.”

            We are back to “are you a Scientologist” type of rebuttal? SSRIs/neuroleptics are murderous in the sense that they increase violent behavior in people. This tendency is reflected both in controlled clinical trials, in macro data (increase of suicide rates correlated with increase usage of SSRIs) and the anecdotal level with each and every single one of the guys in Virginia Tech, Arizona, Aurora, Newtown, DC or even Columbine being on or having been on recently psychotropic drugs.

            “It is true that schizophrenics are more likely to die than others. But I don’t accept your “25 years earlier” as accurate. ”

            The 25 year is for medicated people, not only labeled people. The actual study is quoted in “Anatomy of an Epidemic” by Robert Whitaker. I take you are knowledgeable enough to do a Google search.

            “Where did you read that? And from what I have read, the excess deaths are largely from physical disease and have multiple causes like cigarette smoking, poor self-care, and delay in getting treatment. The role of neuroleptics in early deaths is uncertain.”

            There is a lot of spin in psychiatry. A recent study also concluded that neuropleptics shrink the brain. It was known for many years that people labelled as schizophrenic exhibited this, but it was attributed to the “illness”. It was in fact shown as “evidence” that schizophrenia was real. It took an Eli Lilly sponsored study to discover the truth: it’s the neuroleptics that shrink the brain not the invented label of schizophrenia.

            “Ask anyone with a psychotic family member who is unable to care for himself or to survive without custodial care whether “no treatment at all” is an acceptable option.”

            It seems that those of you in the psychiatry zealotry movement didn’t get the recent memo from the American Psychiatric Association (like in the last couple of weeks) acknowledging that neuroleptics are over prescribed and calling for a more restrictive usage. Even the APA is running away from the scare mongering that you are engaging in here.

  54. mousedthatroared says:

    CannotSay2013 says:
    “My answer, which was in no way offensive, was removed. I just explained the difference between the type of appointment that Steven Novella has at Yale and a tenure track or tenured appointment. It is useless to discuss anything here.”

    There’s no reason to believe your comment was removed. If you look in any thread you will see many commentors (including the blogger’s) complaining about comments disappearing, sometimes they show up later, sometimes they are gone for good. It’s clearly not intentional, the folks who maintain the site are struggling with some software issues. You are just sharing in the same pain as the rest of us.

    The surgeons, doctors and orthodontist who treat my son are all professors. I never assumed they were tenure type academic professors. They’re doctors at a teaching hospital and they teach. It’s pretty standard, it’s not a “scheme”.

    1. CannotSay2013 says:

      I emailed Harriet and she explained that as well. I apologize for believing otherwise. As you can imagine, having been banned by Steven Novella once for saying exactly the same things made the whole thing highly suspicious to me.

      As I said, I believe that there is nothing wrong with holding a clinical professorship. Being a PhD graduate from a prestigious university in a hard scientific field, I had my share of lecturers, adjunct professors and TAs teaching my classes, many of which were better than some tenured professors. The problem is when you try to deceive people about the true nature of the appointment you have, and that is what Steven Novella does. When I raised the issue of the nature of his appointment, he became nuts. I even have some private communications with him that I will not share here in which he tried to convince me that his appointment could eventually lead to tenure, to which I said LOL!!!!

      Discussing the nature of somebody’s academic appointment can only be interpreted as a personal attack if that somebody has been using the nature of that appointment in deceiving ways. That is my whole point and that was my point when I was banned from his website.

      1. WilliamLawrenceUtridge says:

        Can you point to any instance where Dr. Novella said “You have to believe me because I’m a tenured professor at Yale”? If not, he has never used his position to argue from authority.

        “I am a tenured professor of neurology at Yale and here is the evidence upon which I base my beliefs about this neurology topic” is a little different by the way – since that is an effort to show experience to interpret and apply the research in specific circumstances.

        So, where are the comments in which he tried to convince you of his beliefs solely on the basis of his position (without clearly labeling it his opinion and interpretation of ambiguous literature)?

        LOL.

    2. weing says:

      “There is also the fact that the CDC made public data in May that showed that between 1999 and 2009, the rate of suicide increased 30% (that was the rate, the actual number followed an increased rate because of the population increase). That is correlated with data that shows massive increase in SSRI prescription over the same time.”
      So now correlation equals causation? It’s interesting that the MMWR attributes it more to the downturn in the economy. Anyway, I checked out Insel’s blog and I can not find what you seem to have found there. Are we reading the same thing and coming out with totally different takes? Either my perceptions are wrong or yours are. He is leading an effort, with the nascent RDoC, a decade long endeavor, to replace the DSM. I agree with his take that the DSM not be a gold standard. It is a makeshift, until we get something better. That is, based on biology.

  55. mousethatroared says:

    “Discussing the nature of somebody’s academic appointment can only be interpreted as a personal attack if that somebody has been using the nature of that appointment in deceiving ways. That is my whole point and that was my point when I was banned from his website”

    I don’t agree – Accusing someone of lying, as it appears you are doing, is generally considered to be a personal attack as much to those innocent of lying as to those who are guilty.

    1. CannotSay2013 says:

      Again, all I have said is that he has misrepresented the nature of his appointment. A great example is here,

      http://www.doctoroz.com/videos/alternative-medicine-controversy-pt-1

      Mr Novella is introduced as Assistant Professor at Yale University. That introduction onto itself might or might not be misleading depending on Yale’s own policies. Some universities that I know of ask holders of non tenure track appointments to make it explicit when using the title such as Assistant Clinical Professor, or “Adjunct Assistant Professor”, etc.

      But that aside which only concerns Yale: during the program, Steven makes a series of statements like “I have reviewed the research” about this or that and treatment X doesn’t work. To be clear, I am not defending CAM of which I am a huge skeptic myself, but these type of statements about “reviewing research” only make sense if the person who makes them is perceived as a top researcher in that particular area, which is to be expected of tenure track or tenured professors, but which is not necessarily the case of a clinician. That clinician in all likelihood might not be up to date with the state of the art in research because a clinician’s job IS NOT to do cutting edge research.

      The whole debate that had me banned from his blog showed this tendency of Steven to seeing him as the ultimate arbiter of what is considered accepted and what isn’t in a particular area in which he is not a researcher. When I mentioned that Tom Insel had said that

      “The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

      That said statement had been agreed to by the CHAIRMAN of the DSM-5 task force and, later at an Al Jazeera interview, by the CHAIRMAN of the DSM-IV task force, Steven replied with a bunch of older citations claiming a different meaning for validity of a psychiatric diagnosis.

      So, we had the top dogs in psychiatry both at the NIH and the DSM committees agreeing to a particular notion of validity that psychiatric diagnosis doesn’t have. Still, Steven asks his readers to trust his own definition. At that point, Steven was spreading ideas that are contrary to what the correct meaning of scientific validity is in the context of psychiatry as agreed by psychiatry’s own top dogs.

      A different debate is whether psychiatry will ever achieve scientific validity under the so called biological model. I think it will not be the case while the top dogs think otherwise but at least we should all agree what “validity” is and whether the DSM has any (it has none).

      1. Harriet Hall says:

        You accuse Dr. Novella of misrepresenting himself, and the only evidence you can provide is Dr. Oz’s introduction? And now you admit that a non-tenure track academic can refer to himself as Assistant Professor but that you think Yale “might” ask that he make it explicit that he is an Assistant Clinic Professor because you know of some universities that make that request, although you have no evidence that Yale does? I am underwhelmed.

        “these type of statements about “reviewing research” only make sense if the person who makes them is perceived as a top researcher in that particular area, which is to be expected of tenure track or tenured professors, but which is not necessarily the case of a clinician.”

        That is absolutely not true. Where did you ever get such an idea? It amounts to a sort of “appeal to authority” (to the authority of tenured professors) on your part. ANYONE can make the statement that he has reviewed the research. That’s not an appeal to authority, that’s a statement that he has reviewed the research and bases his conclusions on evidence rather than opinion or authority. He could cite chapter and verse of the evidence, and he does so on the blog; but he doesn’t have any opportunity to present the details of the evidence on a TV show, so the best he can do is assure Oz that he has reviewed the research. All of us on this blog review the research just as he reports doing. You don’t have to be a top researcher or even a researcher at all to review the research, and any good clinician should be perfectly capable of doing so; in fact, some clinicians are much better at it than some tenured research professors I could name who lack Dr. Novella’s stellar critical thinking skills. In fact, I know people without any formal medical training who have learned to review research with a critical eye and excellent judgment.

        I am a retired family physician and I have never done research or held any academic appointment, but I think I can hold my own with anyone else when it comes to reviewing the research. In fact, when I have reviewed the research in a specialized area that I was not very confident about, I have frequently had my evaluation of the evidence confirmed by someone who was a true expert in the field as well as a researcher and tenured professor. It’s not who you are, but how well you can think and how well you can interpret the evidence and put it into perspective.

        I don’t have any interest in quibbling about DSM. It’s bad, but it’s arguably better than nothing, and we have to live with it. The diagnoses in it can be considered more or less “valid” depending on semantics. Dr. Novella refers to them as a “first approximation” which I think is a reasonable, nuanced approach.

        1. CannotSay2013 says:

          It might all come down to the implicit assumptions that one makes about somebody’s credentials when using titles like “professor”. The disconnect might come from this admission of yours,

          “I am a retired family physician and I have never done research or held any academic appointment, but I think I can hold my own with anyone else when it comes to reviewing the research.”

          I work in a highly intellectual environment. In my social circle there are professors (tenured ones), researchers, scientists, etc. I did cutting edge research for a long time (not much these days) and from that experience I WOULD NEVER claim to be expert in reviewing research in a field in which I have never done that type of cutting edge research. My own caution, which is obviously lacking in Novella’s case, comes from having done that type of high level research. In cutting edge research there are many suitabilities that escape the untrained eye.

          This arrogance that “pseudo skeptics” display is one of the reasons you guys put people off. Once I read Novella complaining that skeptic conferences don’t attract big names in science. I am not surprised at all. Big names in science do actual science. You guys do something else. To me you look more like dilettantes and “dilettante” is a word that scares the hell out of those who work on the real deal.

          Lastly, the notion that the DSM is better than nothing or that current mainstream psychiatry is better than no psychiatry at all is wrong on many levels. First, mainstream psychiatry is a source of human rights abuses. Many state laws make a generic reference to “the last edition of the DSM” when it comes to defining who is eligible for coerced psychiatry. By way of the DSM, the APA has an undue power into affecting people’s lives. The introduction of the DSM-5 expanded the pool of people who could find themselves as the target of psychiatric coercion without any change to the law. Everybody should be worried that a group of unelected mind guardians has so much undue influence in society.
          Second, the most scientifically sound studies have concluded that psychiatric drugs are nothing but active placebos. These drugs have all kinds of secondary effects that can affect organs of your body, in some cases in a fatal way. Since their efficacy is no better than placebo’s, in the overwhelming majority of cases patients are put into drugs that do nothing but cause bodily harm. And third, there is the documented, and established, relationship between psychiatric drugs and violence.

          To claim that our society is better off with a human rights abusing, body damaging, murderous discipline than without it is unbelievable.

          1. weing says:

            “To be clear, I am not defending CAM of which I am a huge skeptic myself, but these type of statements about “reviewing research” only make sense if the person who makes them is perceived as a top researcher in that particular area, which is to be expected of tenure track or tenured professors, but which is not necessarily the case of a clinician.”
            Horse manure. You are saying that because I am not a top researcher in a particular area I cannot review the research.

            And you must be the top researcher, as you came up with:
            “the most scientifically sound studies have concluded that psychiatric drugs are nothing but active placebos. These drugs have all kinds of secondary effects that can affect organs of your body, in some cases in a fatal way. Since their efficacy is no better than placebo’s, in the overwhelming majority of cases patients are put into drugs that do nothing but cause bodily harm.”

          2. mousedthatroared says:

            CNS2013 “Many state laws make a generic reference to “the last edition of the DSM” when it comes to defining who is eligible for coerced psychiatry”

            It doesn’t matter if they make a reference to it. The determinants for involuntary commitment are usual something like this: State of Michigan

            “An individual who has mental illness, and who as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure himself or herself or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation.

            An individual who has mental illness, and who as a result of that mental illness is unable to attend to those of his or her basic physical needs such as food, clothing, or shelter that must be attended to in order for the individual to avoid serious harm in the near future, and who has demonstrated that inability by failing to attend to those basic physical needs.”

            Also note: “Without a finding that the respondent is a person requiring treatment, there is no basis for a court in Michigan to order the involuntary civil commitment of an adult for mental health treatment. No matter how beneficial the attorney may believe that a course of treatment would be for his or her client or how hopeful a family member may be that their loved one will finally receive treatment, involuntary civil commitment cannot be ordered.”

            In other words, people are not just committed because they have a diagnoses. They are committed because they have engaged in acts or threatened acts that indicate they are a danger to themselves and/or others.

        2. CannotSay2013 says:

          I have to add,

          “Dr. Novella’s stellar critical thinking skills. In fact, I know people without any formal medical training who have learned to review research with a critical eye and excellent judgment. ”

          This can be easily refuted with: in the land of the blind the one-eyed man is king.

          I have been seen Novella’s entry in this SBM blog bashing Insel’s decision to get away with the DSM (interestingly he didn’t post anything in his own blog about the matter). His arguments were far from good. In his blind defense of psychiatry he always uses the fallacy of equating somatic symptoms with “patterns of behavior that DSM members do not like”. Nobody has challenged him on that here.

          The top dogs of psychiatry, such as Allen Frances, agree that such analogy is flawed. Yet he uses it here unchallenged. Then Novella complains that the big names in science run away from him. No wonder!

          1. weing says:

            “To claim that our society is better off with a human rights abusing, body damaging, murderous discipline than without it is unbelievable.”

            If that claim were true. You are arguing a straw man.

        3. CannotSay2013 says:

          And finally, those interested in the issues that are tormenting psychiatry these days, are encouraged to listen to this NPR webcast,

          http://www.npr.org/2013/05/31/187534467/bad-diagnosis-for-new-psychiatry-bible

          You’ll learn from the Insel approach (from himself), the position of mainstream APA psychiatry (from the current president of the APA), and the psychiatry bashing position from Gary Greenberg.

          1. weing says:

            “And finally, those interested in the issues that are tormenting psychiatry these days, are encouraged to listen to this NPR webcast”

            I read the transcript of the broadcast. They all sound reasonable. They all pretty much agree the DSM is a makeshift. It’s better than what we had in the past but far from what we hope to have in the future. What’s your point?

      2. weing says:

        “That clinician in all likelihood might not be up to date with the state of the art in research because a clinician’s job IS NOT to do cutting edge research.”

        I think I see your point. Only the researchers in the proverbial ivory tower are legitimate and capable of reviewing research. The rest of us are just peons. Funny, but I always thought it was necessary, but not sufficient, to review research in order to become a researcher. For that, you had to do actual research.

        1. mousedthatroared says:

          So, we can’t trust a clinician to review research, because they are not a researcher. And we can’t trust a researcher to make clinical judgements, because they don’t understand the clinical setting. The clinical/researcher are few and far between, often focused on very narrow areas, so they lack perspective and shouldn’t be trusted because they don’t see the big picture.

          Clearly it’s impossible to make an informed clinical judgements or recommend treatment based on this system. Therefore all clinical judgement are deceptive.

          CNS2013 – What do you think is the best way for a patient with bothersome symptoms or a serious illness to get help in such a deceptive environment.

          1. Harriet Hall says:

            There is another point to be considered in the clinician/researcher distinction. A tenured professor and researcher may be a world expert on a small area of research. He may know more about DNA analysis procedures than anyone else. But that doesn’t mean he knows anything about other areas like clinical research on treating heart disease. A urologist who sees a lot of prostate cancer is likely to have a different perspective on PSA screening than a family doctor who is biased by seeing how worried people get with a borderline elevated PSA level and how some get surgery they don’t really need.

            Arguably, the best person to evaluate the evidence objectively and dispassionately is someone who is uninvolved and hasn’t been biased by personal experience. Someone with a wide background knowledge of medicine, critical thinking, human psychology, and all the things that can go wrong with research. The writers on this blog fit that description. I don’t think the average researcher or clinician does. In fact, we think the average EBM proponent is misguided, and that’s why we established this blog. Look at all the examples of doctors who misinterpret or disregard the evidence, from Oz to Sears. Look at all the clueless shruggies. Look at the ivory tower deans who are letting quackery slip into their institutions.

  56. WilliamLawrenceUtridge says:

    So so far the arguments seem to be:

    - because the DSM is not perfect, it is worthless
    - because psychiatry is not perfect, it is worthless (and not just worthless, actively, constantly, consistently, purely harmful)
    - because the DSM was wrong in the past, it will always be worthless
    - because Dr. Novella (not Mr. Novella, by the way) doesn’t meet my arbitrary standards of disclosure and expertise, he is deceptive and not a real doctor
    - he’s not a real skeptic/researcher/expert, but I AM because I recognize MY limitations! Oh, and by the way – you should believe me without challenge because of this.

    You are showing an extensive amount of black-and-white thinking. You are projecting ill-faith whenever you can. You are hinting at, if not outright stating, that malfeasance is behind Dr. Novella’s every post, and further – that no argument he has ever made has been with merit. Oh, and then you called everyone here stupid. Your belief appears to be, and here I am interpreting, that if someone disagrees with you, it is in bad faith rather than disagreement. Ironically, you seem to be accusing Dr. Novella of being arrogant, relying purely on authority, oversimplifying things to a deceptive and self-serving degree, and demanding people believe him despite flaws in his arguments. Ironically, because these issues appear in your comments as well.

    Again, mental illness is probably always going to lag behind other sciences, in particular sciences that are purely based on body dysfunction. Your arguments give the illusion that treatment of mental illness is nothing but drugs, that psychiatry is primarily about involuntary confinement, that no drugs are effective (when it’s really more like “some drugs are less effective than previously thought” and others are really quite effective thank you very much), that the field is made up solely of predators who exist to commit human rights abuses, that it’s purely normative, and so on.

    Incidentally, when you said “In cutting edge research there are many suitabilities that escape the untrained eye”, did you mean “subtleties”?

    1. CannotSay2013 says:

      Guys,

      I have to admit that I am puzzled by some of the replies. I am making a generic reply here to the latest comments. If I miss something let me know.

      First, the notion that top notch researchers’ opinion of what “is” and what “isn’t” in their own area of research is just an opinion from the “ivory tower” and that others’ opinions can be just as valuable (this is what I read from the numerous complains). This coming from a group of people who claim to defend “science based medicine” from “pseudoscience” is certainly disturbing. Isn’t the main argument of proponents of all pseudo sciences something along those lines? The post of Mr Novella bashing Insel’s decision to drop the DSM for future research is a poster example of that attitude. The reason the DSM was dropped by Insel, namely, that its labels are constructs that do not reflect a biological reality, is agreed to by the top researchers/authorities in psychiatry. There is little disagreement about that. The disagreement is whether there is usefulness in continuing to use these constructs with actual human beings. Now, we have to agree to Novella’s notion that the labels have “validity” according to some obscure notion that Novella’s says is useful. This is when “arguing from authority” comes into play. If I have to trust Novella vs Insel/Kupfer/Frances/Lieberman/Coyne, obviously I am going to agree with the latter and not only because their opinion is coincident with mine, but also because they have more authority on the matter at hand than Steven Novella! Your attitude is analogous of God coming to Earth setting the record straight that some important biblical fact was a forgery (say that Jesus never lived or he was never crucified) and then having the most radical Christian zealots claiming that their own opinion to the contrary is as valuable or better than God’s! Obviously, many in your movement have made a living out of putting critics of psychiatry in the same bag as HIV denialists. Now when the gods of psychiatry come saying that those critics were right, you guys double down calling those gods wrong.

      Second, with respect to the DSM being into states’ laws. The necessary requirement to be abused by psychiatry is, generally speaking, that the person has A DSM LABEL. Then all the other considerations come into play (dangerousness, grave disability, etc). No DSM label, no abuse. The DSM-5 has expanded the number of people who qualify for the label. The abuse is perpetrated always on the subset of people who are eligible for a label. That subset is larger with DSM-5 than with DSM-IV. If you guys are not bothered by this is because you have too blind a faith in the members of the DSM committees. I do not have such blind faith in anybody.

      Third, on psychiatry in general and its murders. The notion that psychiatry has a murderous history is beyond dispute. Recent American history is even criminal, with all of main manufacturers of psychotropic drugs (Elli Lilly, GSK, AstraZence, Pfizer, etc) having settled civil or criminal charges at the cost of multimillion or (in some cases multibillion) dollars for promoting usage of psychiatric drugs off label. As Gary Greenberg pointed out the reason this happens at this high magnitude in psychiatry and not elsewhere is because of the very nature of DSM constructs. Psychiatry uses SSRIs or neuroleptics to treat any of their invented diseases in a way that other branches of medicine cannot to treat theirs. NSAIDs cannot be used to be treat infectious diseases or cancer because both an infection and cancer can be biologically defined and the effect on an NSAID to treat either can also be measured.

      Fourth, to denounce psychiatry as a pseudo science, because it is a pseudo science, in no way means that I deny human suffering. It is also 100% compatible with being an atheist, if that is your concern. The preeminent critic of psychiatry, Thomas Szasz, was an atheist who was awarded the “Humanist of the year” award by the US’ prominent atheist organization.

      Fifth, with respect to Mr Novella and his credentials. Obviously, in your pseudo skeptic movement it is not a big deal that he doesn’t set the record straight as to what a clinical appointment is vs what it is not. However, in my social circles, it does, a lot. Somebody who presents himself/herself as a “professor” without qualifications is understood to be tenured/tenure track. Those who use academic titles in the way Novella uses his are considered deceptive and misleading. But then again, you are a bunch of pseudo skeptic that have had little contact with top notch academics, so this shouldn’t be surprising either. I repeat, in the land of the blind the one-eyed man is king. You are blind with respect to top notch research, so a half-baked appointment at Yale impresses you in a way that it doesn’t impress me or any others who have worked with the real deal.

      1. mousethatroared says:

        “Fifth, with respect to Mr Novella and his credentials. Obviously, in your pseudo skeptic movement it is not a big deal that he doesn’t set the record straight as to what a clinical appointment is vs what it is not.”

        This is a bit like “Sen. Boregard needs to set the record straight on her history as a unrepentant thespian.”

  57. WilliamLawrenceUtridge says:

    First, the notion that top notch researchers’ opinion of what “is” and what “isn’t” in their own area of research is just an opinion from the “ivory tower” and that others’ opinions can be just as valuable (this is what I read from the numerous complains). This coming from a group of people who claim to defend “science based medicine” from “pseudoscience” is certainly disturbing. Isn’t the main argument of proponents of all pseudo sciences something along those lines?

    Nobody thinks this, which is why the contributors cite the experts in the form of review articles and meta analyses in the peer-reviewed literature. For certain disciplines, notably studies of SCAMs, the contributors add an extra layer often missing – critical examination of the prior probability of the specific SCAM. Criticisms of pseudoscience take a variety of forms, which can include argument from authority, but also cherry picking, prior probability, outright deception, favouring of testimonial over study, and a whole bunch more. And incidentally, you still haven’t demonstrated anywhere I’ve seen that Dr. Novella argues exclusively from authority.

    If I have to trust Novella vs Insel/Kupfer/Frances/Lieberman/Coyne, obviously I am going to agree with the latter and not only because their opinion is coincident with mine, but also because they have more authority on the matter at hand than Steven Novella!

    …never mind the fact that they are all still opinions, because DSM-5 hasn’t been out long enough for any research to be completed. Your choice of deity is propos for your argument, since the existence of God is nothing but an argument from authority, but useless otherwise since science is based on evidence.

    The necessary requirement to be abused by psychiatry is, generally speaking, that the person has A DSM LABEL. Then all the other considerations come into play (dangerousness, grave disability, etc). No DSM label, no abuse.

    By using the word “abuse” rather than “treatment”, you are rather giving away the problem – that you don’t believe there is any merit to the DSM, psychiatry, psychiatric treatment etc. People disagree.

    Fourth, to denounce psychiatry as a pseudo science, because it is a pseudo science, in no way means that I deny human suffering.

    Except your argument is circular, since it asserts and assumes it is pseudoscience rather than proving it.

    Obviously, in your pseudo skeptic movement it is not a big deal that he doesn’t set the record straight as to what a clinical appointment is vs what it is not.

    Who cares? I’ve never believed what Dr. Novella said because of his authority, either I found his arguments, or his citations convincing.

    Charming as your continuous reference to us as “pseudoskeptics” because we don’t agree with you, it’s also annoying. I can’t imagine why you are met with a hostile reception in other areas of the internet.

    1. CannotSay2013 says:

      This reply is too good…

      “never mind the fact that they are all still opinions, because DSM-5 hasn’t been out long enough for any research to be completed. Your choice of deity is propos for your argument, since the existence of God is nothing but an argument from authority, but useless otherwise since science is based on evidence.”

      The DSM-5 is a work of fiction, meaning, it is, as Insel said, the reflection about “a consensus” of DSM committee members.

      The choice of the deity as an explanatory vehicle is appropriate because in the Christian mythology, God wrote the bible. The DSM is written by selected APA members. The chief of the task force that wrote DSM-5, David Kupfer, agreed with Insel that there are no biomarkers associated with any of the DSM-5 labels. Yet we have the pseudo skeptic zealots like you, or Novella, saying otherwise.

      “Charming as your continuous reference to us as “pseudoskeptics” because we don’t agree with you, it’s also annoying. I can’t imagine why you are met with a hostile reception in other areas of the internet.”

      I am calling you guys pseudo skeptics because that is what you are. You have a dogmatic agenda, that for some reason includes defending psychiatry in a way that the gods of American psychiatry do not think needs to be defended, and that what makes you pseudo skeptics.

      You have no right that there are no Nobel Prize winners or members of the National Academy of Science who want to be part of your movement precisely for that reason. There is enough organized religion around, yours is just a different variant.

      1. WilliamLawrenceUtridge says:

        You might have a point about the DSM, if you were talking about DSM I or II. Since DSM-III the committee has adopted an explicitly empirical approach, which has driven the development of the manual ever since. You seem to be saying that if an illness is not biological, if it has no biological marker, it’s a worthless classification and/or is not real. That’s a rather questionable assumption, the lack of biological mechanism has not prevented research, diagnosis or treatment in the past; in fact, many syndromes were diagnosed on the basis of not having an objective marker of a class (AIDS is an example). However, these syndromes are still useful in research – and in some cases have resulted in biological causes being discovered (AIDS again).

        I am calling you guys pseudo skeptics because that is what you are. You have a dogmatic agenda, that for some reason includes defending psychiatry in a way that the gods of American psychiatry do not think needs to be defended, and that what makes you pseudo skeptics.

        Wrong. You think that because we fail to agree with your extreme contention, that all psychiatry is worthless, and exists solely as a punitive and normative entity, we are pseudoskeptics. I would suggest that this can be turned around. Your extreme position that there is no merit to psychiatry, none whatsoever, that the entire edifice needs to be burned to the ground and the earth salted, is the irrational position. I believe that psychiatry is imperfect, that it has been misused in the past and its history contains some egregious errors. I do not believe that invalidates all efforts to try to understand mental illness, I do not believe that invalidates the ongoing empirical efforts to improve the DSM, and I do not believe every single person who goes into or currently works in psychiatry either always was, or somehow became some sort of cruel monster. Rather the opposite, I think people go into this most difficult of medical specializations with good intentions.

        1. CannotSay2013 says:

          Several things,

          - The notion that the DSM-III and its successors are any less arbitrary than its predecessors is a fantasy that has been refuted by past members of DSM-IV committees (http://www.paulajcaplan.net/ ) and DSM-5 committees (http://www.psychologytoday.com/blog/dsm5-in-distress/201207/two-who-resigned-dsm-5-explain-why ). Allen Frances has also spoken intensively about how DSM-IV introduced several “fad diagnoses” like ADHD and “bipolar disorder” in children that are not born out by reality. Allen Frances is a peculiar individual in the sense that he lives in a constant cognitive dissonance. While he has no problem denouncing the excesses introduced by some DSM-IV diagnoses and most of the DSM-5 diagnoses, excesses that can be traced back to the DSM process itself, he is fine with the rest. Something that makes him an easy target from both believers in psychiatry (to the point that he was forced to abandon the APA) and critics of psychiatry like me.

          - AIDS. A lie repeated many times is still a lie. AIDS describes a set of SOMATIC SYMPTOMS (including reduction in CD4 count). DSM labels describe pattern of behaviors that APA mind guardians disavow. Very different matters. You can keep repeating the false analogy, only true “pseudo skeptic” believers believe it. People also forget that it wasn’t until science came up with HAART that the HIV/AIDS hypothesis was fully empirically verified. It was only when it was possible to put the HIV virus at bay, through the blocking of the HIV virus chemistry, which made possible for moribund AIDS patients to regain normal lives that all questions about the HIV/AIDS links were dissipated except among a fringe group. Duesberg had a lot of sympathy from many experts up to that point. After HAART proved that attacking the HIV virus made survival to AIDS possible, things were not as clear cut as there are now. In the case of psychiatry, it’s the guardians of MAINSTREAM psychiatry that are attacking the notion of DSM labels. Big difference as well.

          So, to equate HIV/AIDS denialism to the type of criticism of psychiatry that I have made here is dogmatic, dogmatic as in “it comes from pseudoskeptic dogmatism”, You guys have a religion on which many of you have built your careers and are doubling down on it.

          1. WilliamLawrenceUtridge says:

            I’m not a psychologist, psychiatrist or mental health professional. I’m not even a medical health professional. I’m merely a frequent reader and commenter with no particular position on the DSM. This website doesn’t spend much time on mental illness, and nobody here is particularly committed to the DSM or DSM process except you, apparently.

  58. mousethatroared says:

    “Second, with respect to the DSM being into states’ laws. The necessary requirement to be abused by psychiatry is, generally speaking, that the person has A DSM LABEL. Then all the other considerations come into play (dangerousness, grave disability, etc). No DSM label, no abuse. The DSM-5 has expanded the number of people who qualify for the label. The abuse is perpetrated always on the subset of people who are eligible for a label. That subset is larger with DSM-5 than with DSM-IV. If you guys are not bothered by this is because you have too blind a faith in the members of the DSM committees. I do not have such blind faith in anybody.”

    Actually, no I don’t think that’s true that a DSM Label is required. But feel free to link to a reliable source if you have one.

    1. CannotSay2013 says:

      Random example (first that shows up in the internet),

      http://codes.lp.findlaw.com/nycode/MHY/A/1/1.03

      ” 52. “Persons with serious mental illness” means individuals who meet criteria established by the commissioner of mental health, which shall include persons who are in psychiatric crisis, or persons who have a designated diagnosis of mental illness under the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders and whose severity and duration of mental illness results in substantial functional disability. Persons with serious mental illness shall include children and adolescents with serious emotional disturbances. – See more at: http://codes.lp.findlaw.com/nycode/MHY/A/1/1.03#sthash.h5MxhvkN.dpuf

      Note that a DSM label is a necessary condition. That law allows the APA to expand the subset of people who can be abused. Example, until DSM-5 binge eating was not recognized as an official DSM label. Now it is. If you happen to eat too much for your own good and some quack determines that that eating fits the other criteria, you could find yourself legally abused in the state of New York while prior to the publication of DSM-5, eating too much could not get you into legal trouble.

      1. weing says:

        “That law allows the APA to expand the subset of people who can be abused.”
        There are no laws needed to be able to abuse people. Do you mean treat?
        Do you have cases of people committed because of eating too much? You seem to be skirting the issue of what to do with people who are a danger to themselves or others. Why?

      2. mousedthatroared says:

        CNS13 quoted “which shall include persons who are in psychiatric crisis, OR persons who have a designated diagnosis of mental illness under the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders AND whose severity and duration of mental illness results in substantial functional disability. Persons with serious mental illness shall include children and adolescents with serious emotional disturbances.

        emphasis mine – It says psychiatric crisis OR designated diagnoses, then it goes on to say AND severity and duration results in substantial functional disability…but that’s only one section where they just defined mental illness. You’ve left out the rest of criteria for involuntary commitment.

        Very doubtful that your example obese person with an eating disorder would meet all those criteria. Unless there is evidence that they are going to cause substantial harm to themselves in the near future. Generally, you are allowed to kill yourself slowly (smoking, eating to much, drinking to much) it’s killing yourself quickly that attracts the attention of the law.

        You are acting like the states love to commit people to psychiatric care. They don’t. It costs lots of money.

  59. weing says:

    “Somebody who presents himself/herself as a “professor” without qualifications is understood to be tenured/tenure track”

    So you hang out with a crowd that considers itself superior to others. In other words, snobs. I’m not impressed. Frankly, I don’t see why you are making such a big deal about Dr. Novella’s professor status. It doesn’t impress me either. If a tenured professor of homeopathy in Harvard wrote about cutting edge research in homeopathy, I would not be impressed either. To me the proof is in the pudding.

    I am a clinician not a researcher. That does not mean I can’t review research. We depend on research. We need to be able to evaluate it also. Otherwise we might believe whatever your snobbish friends with big pharma ties have given us without question.

    1. CannotSay2013 says:

      You can review research but you don’t have any authority to invalidate the conclusions of those who do cutting edge research as Novella did with Insel.

      1. weing says:

        “You can review research but you don’t have any authority to invalidate the conclusions of those who do cutting edge research as Novella did with Insel.”

        We can certainly question their conclusions, assumptions, and premises, and determine whether their arguments are sound or not. Neither I, nor anyone else, needs authority to evaluate the soundness of an argument. I must be missing something, but I reviewed the post in question, albeit briefly, and I didn’t get the impression that he was invalidating Insel’s conclusions. If you could be more specific? I happen to think that Insel and Novella both have valid points. BTW, thanks for referring to his blog. I found it most interesting.

        1. CannotSay2013 says:

          “We can certainly question their conclusions, assumptions, and premises, and determine whether their arguments are sound or not”

          Not really, if that questioning is based on an incomplete understanding of the whole picture, something that is likely if you only see the “surface” or “the first order approximation” as somebody else put it.

          To put an extreme case, questioning the conclusions of the report by CERN scientists that says that the Higgs boson is real, based on numerous LHC experiments, is unlikely to have any value unless the person making that questioning is an expert in quantum mechanics, the Standard Model of physic particles and has had access to the data from the experiments. Just a “general knowledge” in the scientific method of physics will not cut it. In medicine, things are becoming increasingly complicated and specific to the point that the opinion of a dilettante like Novella on the conclusions by Insel that took the latter to reject the DSM is largely irrelevant for those whose job is to do research in behavioral issues. And yet, many here value more what Novella says than what Insel says.

          1. weing says:

            “Not really, if that questioning is based on an incomplete understanding of the whole picture, something that is likely if you only see the “surface” or “the first order approximation” as somebody else put it.”

            Then the gaps in my knowledge will need to be filled in order to understand. I would take the researchers at the LHC at their word. My knowledge of QM and the Standard Model, while above average, is inadequate to evaluate them. I know my limits. I do not have the time to achieve the depth and breadth of knowledge in another field. Much as I would like to. I disagree that an MD is considered a dilettante in medicine because he is not a researcher. I don’t know whether he does any research or not. I don’t care. I might be a dilettante in research but if I chose to, I could quickly learn.

  60. WilliamLawrenceUtridge says:

    CannotSay2013,

    I am sorry for whatever caused you to so vigorously and irrationally despise the DSM. While I could understand your sentiments if you objected to the empirical base of the manual, if you urged for improved evidence to back up the creation and separation of conditions, if you used the historical lessons of psychiatry to point to areas of concerns and ways to improve in the future. However, your unequivocal rejection to the idea, to even the possibility of the DSM and APA in some way may improve lives or reduce harm, the vehemence of your objections and your unwillingness to concede even one iota of benefit to the whole enterprise, suggests that whatever personal pain this topic has brought you is indeed personal. It’s not professional, it’s not empirical, it’s not intellectual, it’s deeply, profoundly personal to you in some way.

    I am sorry for whatever it was, but that does not mean my sympathy makes me any more likely to find your arguments convincing, any more than claims of “it worked for me” makes homeopathic preparations more likely to work.

    I hope the pain ebbs one day.

    1. CannotSay2013 says:

      Your pathetic “appeal to emotion” is just that, a pathetic appeal to emotion.

      It’s the National Institute of Mental Health that is abandoning the DSM. It’s the chair of the current edition, David Kupfer, the chair of the previous edition, Allen Frances, and to a lesser degree the chair of DSM III that all agree that DSM labels are not biologically based, just created out of “consensus”.

      Let me turn around your pathetic “appeal to emotion” towards you. I understand that you, and many here, have invested a lot of their careers and reputations defending psychiatry from its critics and that it must be disheartening to see the gods of American psychiatry -which in fact are the gods of psychiatry worldwide- debunking your line of attack to those critics. The scientific answer when something like this happens is to get over one’s pride (ie, your pride) and accept the reality that there is no scientific validity for ANY of the DSM labels, be it DSM-5 labels, be them labels from previous editions.

      By doubling down your blind defense of DSM psychiatry you are just giving ammunition to those who criticize your movement as a form or religion. What I do not understand is what is the vested interest of your movement in defending psychiatry.

      1. WilliamLawrenceUtridge says:

        I’m sorry you feel that way, and are unable to engage with the DSM except through hostility. It has apparently left you unable to see things in terms of battles and oppositions, sides without nuance.

        I’m not appealing to emotion, I’m not attempting to convince you of a position. I’m recognizing that your arguments are unlikely to be swayed by reason because they aren’t coming from reason, they’re coming from some personal pain.

        Claiming I am part of a movement, or that I am doubling-down, or that I have some pre-existing commitment to the DSM is a projection, probably one that you engage in frequently in the belief that if someone disagrees with you it must be due to ill-faith. I have no pride vested in the DSM or DSM process, I have no stake in it whatsoever.

        1. CannotSay2013 says:

          Of course you are appealing to emotion! And, I shall say, self-interest :D.

          Speaking of irrational discussion. The notion of “mental illness” that doesn’t have an underlying reality is just a metaphor. The position that any of the DSM labels is backed by biology is one based on “faith”, “irrational” if you will. The position that psychiatry has not produced biomarkers for any of its invented diseases, is the rational one: no evidence, no reality. The opinion of DSM committee members is not “evidence”, no matter how much you spin matters. This position is the one that the NIMH endorses, and one that has been agreed to, although a bit reluctantly, by the APA because the rational reality is what it is.

          Irrational is, from my point of view, what you defend, namely, that we have to have “faith” that maybe some day some DSM label will be shown to have a biological basis. You can have that faith, fine with me, but that is hardly rational. Or maybe it is “rational” but in an economic sense. Absent biological evidence for DSM labels, you are siding with the “faith” hypothesis because you have a vested interest in defending it because of your association with this pseudo skeptic movement.

          If you were a believer in homeopathy or astrology, it would be just funny. The problem is that you are defending the worst perpetrator of human right abuses there is in the Western world, and that is where you are pathetic, irrational, even cruel.

          1. weing says:

            “The position that psychiatry has not produced biomarkers for any of its invented diseases, is the rational one: no evidence, no reality. The opinion of DSM committee members is not “evidence”, no matter how much you spin matters.”

            What you are telling us, is that you are an essentialist. Very unscientific of you. I thought scientists rejected essentialism in favor of operationalism. We would never have been able to make progress in physics and other areas of science had we not embraced operationalism.

          2. WilliamLawrenceUtridge says:

            I’m sorry, I don’t believe there is any point in continuing to engage with you on this subject.

          3. CannotSay2013 says:

            weing,

            I am not sure what your point is. The DSM process is about stigmatization/pathologization of patterns of behavior that DSM committee members do not like. Homosexuality is rare (~ 4% of the people are gay), it is then not the norm in society. It is very clear what homosexuality is and there is even research that says that there might be some biological component in homosexuality (twin studies, studies about stuff that goes on in the womb,etc), even personal choice (since there are people who have switched from gay to heterosexual). Moreover, a disproportionate share of incidents in pedophilia are homosexual in nature. What does it say about whether homosexuality is an “illness” like Alzheimer’s is? Absolutely nothing. I don’t see what science and the scientific method have to do with the pathologization of homosexuality or any other of the ~ 400 labels that ended up in the DSM the same way homosexuality was there. Homosexuality was removed from DSM-III because of a referendum among APA members. Consensus and science are two different things.

            WilliamLawrenceUtridge,

            Same thing here. You are dogmatically defending the DSM in a way that those with the authority to defend it do not. You have to ask yourself why you are being this irrational.

          4. mousedthatroared says:

            CNS13 “What does it say about whether homosexuality is an “illness” like Alzheimer’s is? Absolutely nothing. I don’t see what science and the scientific method have to do with the pathologization of homosexuality or any other of the ~ 400 labels that ended up in the DSM the same way homosexuality was there”

            What are the positive objective finding that shows Alzheimer’s is a physiological disease of the brain? Why not just say Alzheimer’s is just a label for behavior that neurologist invented to stigmatize people they don’t like?

          5. CannotSay2013 says:

            mousedthatroared,

            Alzheimer’s can be seen in an autopsy because it is a brain degenerative disease. None of the DSM labels can. Even schizophrenia. MRI had shown that the brains of people treated for “schizophrenia” shrank over time. It was thought that the “shrinkage” was caused by the “disease”. it has now been shown by several studies (some of them mentioned in Nature) that the brain shrinkage was due to the neuroleptic drugs used to “treat” schizophrenia, not to “schizophrenia” which, to this day, remains a label for a pattern of behavior and nothing else.

            You are just showing the folly that comes from ignorance and blind faith in anything that comes from the mouth of a holder of an MD degree.

          6. mousedthatroared says:

            Shoot, I can swear that my whole comments was in the box, but got cut-off when posting.

            @CNS13 – how are delusions and hallucinations behaviors?

      2. mousedthatroared says:

        @CNS13 I said “What are the positive objective finding that shows Alzheimer’s is a physiological disease of the brain? Why not just say Alzheimer’s is just a label for behavior that neurologist invented to stigmatize people they don’t like?”

        My bad. Alzheimer’s is in the DSM. Clearly you must think it’s a social construct rather than a genuine physiological diagnoses.

        1. CannotSay2013 says:

          Alzheimer’s might be in the DSM for historical reasons but it is not considered a “mental illness” anymore by the APA.

          Alzhemer’s is considered a neurodegenerative disease that belongs to the realm of neuroscience, not psychiatry. You should research your stuff better before making a fool of yourself.

          1. mousedthatroared says:

            CNS13 ” You should research your stuff better before making a fool of yourself.”

            Making a fool of myself? I doesn’t matter so much to me. I’m not interested in what people think of my intelligence. But regardless of my foolishness, how am I to know which diagnoses that are in the DSM you dislike and which you like? I’m not psychic.

            Also – I believe the studies I’ve read said the medications contributed to gray matter shrinkage, not that they account for all brain changes. It’s curious to me that you believe the diagnoses of schizophrenia is based on behavior. You don’t believe that people with schizophrenia experience any upsetting or painful symptoms? Or are their symptoms just not of interest to you?

            1. Harriet Hall says:

              What was the clinical effect of the gray matter shrinkage?

          2. CannotSay2013 says:

            Again, check your sources,

            http://www.nature.com/news/2011/110207/full/news.2011.75.html

            “They found that treatment length and the type and dose of antipsychotic drugs taken were both relatively good predictors of total brain volume change”

            There have been several other studies that confirm this basic fact. Of course, there have also been an equal number of Big Pharma sponsored spin doctors trying to square circles to “deny” it, but the basic fact that neuroleptic drugs shirk the brain is beyond dispute now.

            Also mousedthatroared,

            “It’s curious to me that you believe the diagnoses of schizophrenia is based on behavior”

            Each and every single one of the DSM labels are diagnosed based on behavior alone. Period. That’s a fact that no psychiatrist disputes. There are no somatic symptoms associated to any of the DSM labels just there are no biological tests for any of said labels, which is the reason why Insel decided to abandon the DSM.

          3. weing says:

            “There have been several other studies that confirm this basic fact. Of course, there have also been an equal number of Big Pharma sponsored spin doctors trying to square circles to “deny” it, but the basic fact that neuroleptic drugs shirk the brain is beyond dispute now.”

            So the dilettante’s recommendation is not to use them.

          4. mousedthatroared says:

            CNS13 “Again, check your sources,

            http://www.nature.com/news/2011/110207/full/news.2011.75.html

            “They found that treatment length and the type and dose of antipsychotic drugs taken were both relatively good predictors of total brain volume change”

            Quoted from your link.
            “They found that treatment length and the type and dose of antipsychotic drugs taken were both relatively good predictors of total brain volume change. Use of antipsychotics explained 6.6% of the change in total brain volume and 1.7% of the change in total grey-matter volume.”

            Use of antipsychotics explained 6.6% of the change…There appears to be quite bait of change not explain by the medications use.

            Also – DSM IV
            “Two or more symptoms, each present for a significant portion of time during a 1 month period
            o Delusions
            o Hallucinations
            o Disorganized speech
            o Grossly disorganized or catatonic behavior o Negative symptoms

        2. mousedthatroared says:

          This threading is annoying, I’m posting this here in the hopes it will thread with the other comments (graphic designer obsessions taking over.)

          ————

          @CNS13 – how are delusions and hallucinations behaviors?

          1. CannotSay2013 says:

            mousedthatroared,

            From the nature link,

            “Animal studies support the link. David Lewis, a neuroscientist and psychiatrist at the University of Pittsburgh, Pennsylvania, found that healthy non-human primates, given doses of antipsychotics similar to those given to humans, showed brain volume reductions of around 10%, mostly attributable to loss of the glial cells that support and protect neurons”

            Meaning, the reduction is due to the neuroleptics although there is no shortage of Big Pharma paid spin doctors that distort the findings. Even those whose research results show unequivocally that the brain shrinkage is due to neuroleptics. Joanna Moncrieff discusses this “denialism” by Nancy Andreasen here: http://www.madinamerica.com/2013/06/antipsychotics-and-brain-shrinkage-an-update/

            With respect with what you call “symptoms”; these are behavioral patterns, no matter how much you insist in calling them “symptoms”. These behavioral patterns are self reported. The famous Rosenhan Experiment, https://en.wikipedia.org/wiki/Rosenhan_experiment , whose results were reported in Science showed that psychiatry is unable to tell “sane” from “insane”. Once a psychiatrist reaches the conclusion that you are insane, there is nothing that you can do to convince him/her otherwise. Everything you do afterwards will be considered as further evidence of your “insanity”. The response of organized psychiatry to this experiment was DSM-III. Still, the Rosenhan experiment has been repeated numerous times afterwards with similar results.

            For those of you that are so convinced of the infallibility of psychiatry I have a challenge that I also offered to the followers of Novella before he banned me: go to the ER of your choice and to what Rosenhan and his pseudo patients did. You’ll soon understand that psychiatry is indeed a pseudo science. I had no takers at the Novella blog, maybe here people are more courageous when it comes to defend psychiatry :D.

          2. CannotSay2013 says:

            BTW, here you can listen to Rosenhan himself https://www.youtube.com/watch?v=hqaptRYjhq4 . Please be courageous and take the challenge. Put your life where your mouth is :D.

          3. weing says:

            I remember that experiment from abnormal psych when I was in college. I always wondered whether “One Flew Over the Cuckoos Nest” was based on that.

            The power of confirmation bias is amazing, isn’t it?

          4. mousethatroared says:

            @CNS13
            Your video is terrifying. But I’m not sure how I’m going to get a time machine and go back to the 1970s, when hospitalizations for a person who hears a voice without any other symptom was (apparently) two months. I kept expecting young Jack Nicholson to appear.

            Come on, do you think I’m having this discussion without having had any contact with psychiatry? I already have put my “life where my mouth is” I have had full honest evaluations by psychiatrists and not only did I live to tell the tale. They helped me.

            I also grew up with two older siblings that would be later diagnosed with bipolar and paranoid schizophrenia. I won’t go into my experiences, because this conversation is not worth reliving that sh*t, but I can assure you (and you will not believe my assurances, because they don’t fit in with your storyline) that a serious untreated mental illness means a higher risk of serious injury or death to the sufferer, their loved ones and those around them. It mean serious dysfunction and emotional pain.

            Many of the drugs used in serious mental illness suck, just like the drugs for cancer, serious auto-immune disease, etc suck. They should not be used in cases where their risks and side effects outweigh their benefit.

            How to improve implementation of that requirement in a systematic way, that is a good and useful discussion. But it means that you have to honestly look at the risks of untreated mental illness as well as the side effects and benefits of medication. It means you have to look at the current mental health system (not the mental health system forty years ago) for strength and weaknesses. I have not seen any sort of reality based critique or recommendations for improvement from you. Not only do your arguments lack nuance, they appear to be based on outdated information and a fantasy vision of mental illness as a pattern of harmless eccentric behavior or intention political/social dissent.

            You have repeatedly been asked your recommendations for treatment of the symptoms of people with mental illness. But you have nothing to offer. All you offer is a denial of the true risks and misery of the condition.

            I am speaking to a wall and the void. It seems pointless to continue this discussion.

  61. Ravi says:

    Dr, Hall,

    I see that you did not refute these claims:

    - Medicine is not an exact science. There is still a lot we don’t know about biology, in fact there is a lot more to know that what is known. So the certainty that you and other doctors exude in your methods is misplaced.

    - Most clinical research is biased because it is necessarily done by those who have great stakes in a particular outcome. They fudge, hide or misrepresent results and therefore resultant medicines are suspect. There is a revolving door between FDA, AMA and pharma companies. So science only for the namesake?

    - Despite your protestations to the contrary most doctors do not or can not spend enough time with the patients to correctly diagnose and as a result dish out pro forma (pro pharma? couldn’t resist that one) prescription.

    - Clearly the reductionist approach to chronic diseases is not working and it has failed again and again to find cures. Sure, there are many stop-gaps that extend life, but at a great cost and discomfort to both individuals and the society, Allopathic medicine is not holistic enough (antibiotics anyone?)

    There are many more, but this should keep you and others here occupied for a while. Oh yes, there is one question that I have that you did answer, but hardly adequately.

    22. and your answer:

    “They understand the science of nutrition and advise their patients based on the available scientific evidence.”

    Where is the evidence madam? We have to just take your word for it? As far as I know most doctors just are required to study just 25 hours during their entire course. I will wait for your convincing answers, but I will not hold my breath.

    -RK

    1. arsawyer says:

      Ravi,

      Please read the other comments before you post. I already pointed out one of the sacrifices that has to be made if you want to teach doctors more nutrition, and there are dozens of other pitfalls that would be difficult to avoid. I’m sure there are some reasonable arguments that could be made in favor of more dietary education, but I have yet to encounter a food guru that understood how difficult a task this would be. It’s hard enough keeping quackery out of medical schools, and it will get even worse if you start letting second rate nutritionists through the door.

      The other criticisms you offered have also been addressed numerous times on this site. Just because Dr. Hall did not include them in her list does not mean they have not been thoroughly dissected. Check out some of the other contributors and see if you can find out why they don’t hold much water.

    2. WilliamLawrenceUtridge says:

      Regarding biology and certainty – the bloggers here are never certain, merely confident based on the quality of the studies (or critical if the quality is low). However, certain approaches we can know don’t work, even without RCTs. Homeopathy is one, therapeutic touch is another and acupuncture is pretty close to a third.

      Regards clinical research, not all is funded by Big Pharma, the NIH and similar funding bodies also dole out money for trials. Further, results and recommendations are rarely based on single “magic bullet” studies, but rather a convergence of evidence. That evidence can be problematic, and a better system would be greatly appreciated. My thought was that developers of drugs could take the money they would have spent on a clinical trial and give it to a third party (like the NIH) for independent testing before a drug is licensed. Efforts to register trials, such as Ben Goldacre’s Alltrials campaign is another effort, but more needs to be done certainly.

      The problem of doctors not spending time with their patients, if it exists (there’s more than just the US, and my doctor has never rushed me), is a structural one, not a research question. Hopefully Obamacare will help, but the citizens of the United States would be greatly assisted by a health care system rather than the health insurance system it is putting in place.

      Regarding the “reductionist” approach, the reason most chronic diseases exist is because people stopped dying of the acute ones. Further, they are largely behavioural conditions from people not following the recommendations of their doctors to quit smoking, eat better and exercise. In addition, the reality is that the human life is finite, the human body must fail, and eventually we all die. You seem to be critical of the fact that modern medicine cannot indefinitely extend the human lifespan while maintaining perfect health. That may simply be not possible. Finally, what’s wrong with antibiotics? If well-matched, they will eliminate a bacterial infection. If you have a bacterial infection, what needs to be “holistic”? And doctors will review for risk factors and behaviours if necessary (in general the risk factor is “were you breathing? Because that’s how you catch bacterial lung infections”).

      Regarding nutrition, doctors may not take a course labelled “nutrition”, or may take a single, short course, but so what? During their biochemistry classes, they learn what the individual macronutrients, vitamins and minerals do, far deeper than what I learned in my class. The basics of nutrition are pretty quick to learn, and the advice common-sense: eat more fruits and vegetables, lean meats and mil products, and whole grains. Are they supposed to waste time on Dr. Oz’s superfoods or something? A doctor, particularly a primary care physician, must learn a vast body of material. Anything truly nutritionally complicated should be referred anyway, so what else should they learn?

      Your implication seems to be “CAM knows more/is more holistic/learns more nutrition”. This may be true (for the latter two), but is really an assertion, not proof. “Holistic” is pretty meaningless anyway, and doctors will assess both mental and physical health – what else do you want? And learning more about nutrition is a questionable end, since food is not medicine, at best it is one contributing factor to long-term health, and one that continues to disappoint in its lack of magical ingredients. We have yet to see any consistent evidence that there is a single food that will prevent all disease and preserve health.

  62. CannotSay2013 says:

    Paula Caplan, a Fellow at the Women and Public Policy Program of the Kennedy School at Harvard during 2011-2012, and former member of a DSM-IV committee explains her experience here,

    http://www.madinamerica.com/2013/02/psychiatric-survivors-speak-up-harm-from-psychiatric-diagnosis-and-a-start-on-solutions/

    She has publicly accused the DSM process, and the APA, of inventing diseases. She has done so in writing. She has challenged the APA to take her to court if they think they could win a defamation case against her accusations. The APA has refused to do so. This video is from late 2012. The Insel crisis happened in May 2013 . Obviously, the APA has known through the years that under the rules of American courts, it would lose any defamation case against anybody who claims that DSM labels are invented constructs that have no basis in biology.

  63. Peter James Moran says:

    Ravi: “I see that you did not refute these claims:

    - Medicine is not an exact science. There is still a lot we don’t know about biology, in fact there is a lot more to know that what is known. So the certainty that you and other doctors exude in your methods is misplaced.”

    All scientific knowledge is tentative to some degree, but it would be ridiculous to seriously challenge much of it, and the remainder can be judged to have some validity (closeness to truth) when it has predictive value and delivering desired outcomes.

    Anything that you hold to be superior to that will have to judged by the same standard. Let’s have some specific claims concerning specific illnesses and we will see if they hold water.

    “- Most clinical research is biased because it is necessarily done by those who have great stakes in a particular outcome. They fudge, hide or misrepresent results and therefore resultant medicines are suspect. There is a revolving door between FDA, AMA and pharma companies. So science only for the namesake?”

    Most of us are deeply dismayed that this can sometimes happen. We feel betrayed, too. Yet what standard could we introduce that would be superior, or less prone to corrupting influences? We do plug up the holes as best we can, and being forewarned should make this kind of thing less common in the future.

    “- Despite your protestations to the contrary most doctors do not or can not spend enough time with the patients to correctly diagnose and as a result dish out pro forma (pro pharma? couldn’t resist that one) prescription. ”

    There is some truth to this, also. It is hard to stop doctors overprescribing or inappropriately prescribing powerful pharmaceuticals when that is the only option they may have for the clinical situation and the public has high expectations of having something prescribed. We hope that coming generations of doctors will be better equipped to handle the many pressures of medical practice.

    “- Clearly the reductionist approach to chronic diseases is not working and it has failed again and again to find cures. Sure, there are many stop-gaps that extend life, but at a great cost and discomfort to both individuals and the society, Allopathic medicine is not holistic enough (antibiotics anyone?)

    “Clearly not working?” How so? If it were not for the reductionist approach we would know no more about human illness than we did a few centuries ago and we would lack the highly effective treatments we do possess for many conditions. We would be still casting out evil spirits, bleeding and cupping, and applying the “four humors” theory of illness.

    Also, in what way is nutritional medicine not reductionist?

    WRT your last comment, give me an example of a condition for which nutrition is an established answer and that doctors will not know about by the end of his training.

  64. Peter James Moran says:

    MTR, thanks for the comments — all very sensible stuff.

    “But, it appears to me that a great number of folks who post as CAM proponents on this site are not everyday patients. Their goals for commenting is not to gain information, then make a decision. Their goal is to advocate for their preferred cure-all.”

    Yes, my last remarks referred specifically to “how we talk to patients — “.

    CAM practitioners, or lay advocates of CAM may warrant a different approach in some ways, although I think the default should be one of respect for the person where possible. I can’t prove it, but I think that will work better for most ends than all-out assault which will have minimal effect on the recipient and an unpredictable effects upon listeners.

    All these persons will at some point be in need of our help, and it is desirable that they not be pushed into too adversarial or suspicious a relationship with mainstream medicine by what can very easily to many minds look like an over-reaction to the realities of most CAM use. Also, despite apparent vehemence and perseverance, I think many advocates of CAM have much more tentative positions than they let on.

    1. mousethatroared says:

      @pmoran
      It’s going to be hard to have any sort of exchange with all the other long comments fly about and I’ve gotta get some work done today, but a couple of thoughts.

      I think I missed that you had specifically noted talking to patients. Although, there is such a diverse readers/commentors… I guess I can’t really address how one might handle this. It’s probably good to constantly keep in mind that the patients are listening, so saying something that you would never say in front of a patient is not a good idea. Of course I can think of at least one poster (gone now) who seemed to revel in saying things to patients online that they could never say in person without reprimand. What do you do short of banning folks? I don’t know.

      “CAM practitioners, or lay advocates of CAM may warrant a different approach in some ways, although I think the default should be one of respect for the person where possible. I can’t prove it, but I think that will work better for most ends than all-out assault which will have minimal effect on the recipient and an unpredictable effects upon listeners.”

      One issue here is that your version of showing respect may be different than other’s version and some commentors version of being respected is different than others. Some people feel that questioning anyone’s decision is a sign of disrespect. While other’s feel that NOT question someone’s decision is patronizing, therefore a sign of a lack of respect. One person’s diplomacy is another person’s passive aggressive.

      I think of respect in this way, is there a clear line of reasoning that suggests this criticism may be accurate or warranted or is the comment just an attempt to make someone else feel small for some personal reasons? It’s not the tone of the writing that differentiates these two approaches. It’s the content, the logic, the reasoning that differentiates them. Although tone (either overly abrasive or overly conciliatory) can be a distraction.

      “All these persons will at some point be in need of our help, and it is desirable that they not be pushed into too adversarial or suspicious a relationship with mainstream medicine by what can very easily to many minds look like an over-reaction to the realities of most CAM use.”

      I do wish that some commenters wouldn’t be too harsh on other’s who are merely CAM users. For one thing it’s important that patients be honest with their doctors. It’ weird to set up a scenario where you encourage a patient to seek out a doctor they think is science based, but then give the impression that the doctor will judge them negatively for using a vitamin D, calcium supplements.

      Also the comments “Oh they (people who take supplements, people who use acupuncture, people who try alternative diets) are just a bunch of worried well rich people or unintelligent slackers.” I sometimes see here doesn’t give me a lot of confidence that those posters are interested in helping folks with their symptoms.

      But that is not the tone of the bloggers that I have read, nor is it even the majority tone. It’s important to differentiate between individuals. What are you going to do about commenters? As I see it, there is a faction of readers who are more committed to anti-CAM efforts than pro-patient efforts. Personally, when I see that I mentally downgrade their usefulness score accordingly. Beyond that, what is to be done?

  65. Mal Adapted says:

    Dr. Hall,

    In your post, you forgot the one unanswerable challenge to SBM: I don’t care about your so-called “facts.” I know I’m right!

    1. Harriet Hall says:

      That’s not exactly a criticism of SBM; it’s more like an unwillingness to engage with SBM at all.

  66. David Aston says:

    What you have written should be a part in every curriculum for CAM education. Unfortunately there is too much lack of self-criticism and reflection within in the CAM community. One could argue that if a patient pays for CAM-treatment so what. But the dilemma is what to do if the government is thinking of subsidizing CAM. In Sweden some grazy members in the parliament are proposing this and at the same time our state controlled hospitals do not have enough of beds for patients.

  67. CannotSay2013 says:

    I posted this comment above answering weing and mousethatroared but it didn’t show up, so I am re-posting it here.

    weing,

    Confirmation bias in the sense that no evidence can possible convince believers in psychiatry that they are wrong :D.

    mousethatroared,

    You made several assertions that need to be addressed individually.

    - First, the Rosenhan experiment, or variants, has been tried elsewhere, during the DSM-III and DSM-IV regimes, with similar results. Once a psychiatrist is convinced that you are insane, everything you do is confirmation that you are insane. I suffered that in my own skin. I read the notes that psychiatrists wrote about me and they were pathetic.

    - You say that the situation is not anymore like in the 1970s. While that is a true statement when it comes to the US, and only because there is US Supreme Court precedent that limits psychiatrists’ ability to abuse people, that is certainly not true elsewhere. In several countries of the European Union, “need for treatment”, which is codeword for “whenever some psychiatrist wants” is still legal and that standard has been upheld by Europe’s top human rights court: the European Court of Human Rights: http://egov.ufsc.br/portal/sites/default/files/anexos/33124-41808-1-PB.pdf . Countries like Norway or Finland have involuntary commitment rates of ~ 200 per 100000 which are similar to the ones that existed in the US pre 1970s. So abuse is real, and I suffered it in my own skin in Europe http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770 .

    - The association of what you call “severe mental illness” and violence is a lie that, no matter how many times is repeated, is still a lie. The research is very conclusive: little relationship unless drugs and alcohol are involved http://psychcentral.com/blog/archives/2013/05/30/myth-busting-are-violence-mental-illness-significantly-related/ . There is a higher correlation between violent crime and “being a young male black in the inner city” than what you call “severe mental illness”. I see you nowhere advocating for the preemptive locking of said black males even though the statistical relationship is way higher.

    - You keep accusing me of denying that people suffer or that I offer no alternatives. Both accusations are false. My point is that a DSM label makes things worse, not better both socially as well as legally. Again there is a lot of research that concludes that your model (“chemical imbalance”, “genetic defectiveness”, etc) for DSM labels leads to increased stigma, not lower. A recent one http://www.madinamerica.com/2013/09/genetic-attribution-schizophrenia-leads-desire-social-distance/ . With respect to alternatives, there are: https://www.youtube.com/watch?v=syjEN3peCJw but it all begins by rejecting psychiatry’s invented diseases http://openparadigmproject.com/ .

    - The notion that opposing DSM psychiatry’s program of stigmatization and abuse is useless unless one offers an alternative is as pathetic as those who opposed the abolition of slavery under the excuse that the new freed slaves would not be able to live in freedom (and yes, that excuse was used by opponents of slavery).

    - Finally. I feel your pain of having lived the psychiatric lie. I have always said that one of roles that the psychiatric survivor movement has to assume is to educate the many people who find themselves in the same situation we found ourselves. Laura Delano, from Mad In America, has written extensively about her story of going from a “believer” in psychiatry to being one of its strongest adversaries http://www.madinamerica.com/2013/09/urge-take-life-decision-take-back-mental-health-system-instead/ .

    There is hope, and I bring a message of hope. What the APA and NAMI bring is a message of hopelessness, bullying for life by way of a DSM label and drugging for the rest of your life. All that based on a lie.

    There is absolutely no science behind psychiatry. None as in NONE.

  68. mousethatroared says:

    CNS13 “There is a higher correlation between violent crime and “being a young male black in the inner city” than what you call “severe mental illness”. I see you nowhere advocating for the preemptive locking of said black males even though the statistical relationship is way higher.”

    You ALSO don’t see me advocating for preemptive locking up of the severely mentally ill. That is why I was careful to point out that the laws requires clear threat of potential harm. So, say a young black male (or any other youth/adult) threatens my parents with a stair rail in a rage and says that he will destroy them because they are controlling his brain. I do advocate that, for the safety of the public and themselves, that person be committed and treated, either voluntarily or involuntarily for as little time as possible and with the safest and lowest side effect medication possible, until they are no longer a threat. These days in the U.S. the average for civil involuntary commitment is from 4 days to 2 weeks. The same goes for a person who intentionally engages in self-harm by drinking a can of drano, or goes on a week long oxycontin/alcohol binge that ends up with being revived with CPR. I am not making these scenarios up and I could go on, but there’s not much point.

    I have always stood up for the rights of any person with ANY diagnoses to live their life as they wish unless they “can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure himself or herself or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation” (that’s the law again)

    If that is not enough protection of your autonomy, I just don’t know what to tell you.

    Also, the family members that I’m talking about have substance abuse problems and have had (on and off) since they were teens. Clearly that has at least exacerbated the issue (although there is a sort of chicken and the egg problem) how do you propose to prohibit drug and alcohol use in a mentally ill person when that use is part of their “behavior”? Do you want to just throw someone who is delusional, hallucinating and, yes, violent (because they feel threatened by what their brain is telling them) in prison? How long do you think they’d last?

    It just wouldn’t happen if people were nicer to them. That seems to be your answer. But that is not adequate for dealing with the here and now were society does what it likes.

    pfft – I hate it when I know a conversation is pointless, but I don’t let it go.

    As to Europe, heck if I know. You started out specifically talking about the U.S.

    Also, maybe no one has told you, but it’s patronizing to tell someone they are being abused when it’s clear they don’t think so and it’s not cool to offer sympathy in a way that co-ops someone’s experience for your own ideological gain. I’ll assume it wasn’t intention, but don’t do that.

    *or any person who is not a child

  69. CannotSay2013 says:

    States and the federal government already have crimes like “making criminal threats” as a valid reason for sending somebody to jail so my point is that nobody should be locked in unless a crime, and making said threats would be a crime, is committed.

    While it is true that existing law in the US only allows for involuntary commitment in case of dangerousness, the standard is “clear and convincing evidence” which is below the standard “beyond reasonable doubt” used in criminal trials (per SCOTUS Addington v. Texas, 1979). No question that the situation in the US is much better than in Europe but this is still an abuse. A DSM label makes you more easily abused than if you had no label at all. Currently, we have two regimes to lock in somebody who is potentially dangerous, the one used on non labelled people (“beyond reasonable doubt”) and the one used for DSM labelled (“clear and convincing evidence”). This is plainly wrong because psychiatrists are notoriously unable to predict who is likely to become violent (and I can provide the actual research if you are interested). The DSM is a tool to make abuse easier.

    Finally, I am not patronizing, or at least it was not my intention. I do think though that you are the victim of a lie in the same way eugenics victimized many people, some even voluntarily, with its sterilization programs. In fact, when I think about psychiatry, its sister pseudoscience, eugenics, surely comes to mind.

    1. mousethatroared says:

      CNS13 – If a person threatens another person, is arrested and is determined a flight risk by a judge or can’t make bail, they can easily be locked up in the U.S. for the same length of time of the average involuntary committment, or longer, waiting for trial that may or may not show “beyond a reasonable doubt.” they committed a crime.

      As to your eugenics analogy, like many of your other analogies…they just don’t hold water. – It’s like saying – Rich people are greedy. Nazi’s were greedy, therefore rich people are fascists who hope to controll the populace through propaganda and fear. – It may sound awfully compelling (especially if you don’t like rich people) but I didn’t actually give any evidence to show the connection of rich people to Nazi’s.

      1. CannotSay2013 says:

        ” If a person threatens another person, is arrested and is determined a flight risk by a judge or can’t make bail, they can easily be locked up in the U.S. for the same length of time of the average involuntary committment, or longer, waiting for trial that may or may not show “beyond a reasonable doubt.” they committed a crime. ”

        You are mistaken in two very important ways. Before an arrest in a criminal case can be made, there is a legal standard called “probable cause” which has to be met. An arrest cannot be made unless there is “probable cause” that a crime has been committed. Also criminal procedure protects criminal defendants better than people arrested under so called “mental statutes”. The length of the detention, the right to an attorney and the right to habeas corpus are strictly followed. Second, there is the “long term commitment” if you will. For a crime, not only you need to be found guilty beyond reasonable doubt, but there are statutory rules as to how long you can be incarcerated even if you are found guilty. Under “mental health statutes” that’s not defined.

        The notion that we have two regimes for locking up people based on DSM labels is preposterous. Statistically speaking, having a past of drug abuse or criminality or being black in an inner city is a better predictor of “violence” than a DSM label. Yet, a criminal past does not weaken in any way the “beyond reasonable doubt” standard for conviction. We still required it for the particular crime under consideration, not a “weakened standard because we know that the past is a good predictor of potential for violence that makes you more likely to be guilty this time”.

        With respect to your reference to the Nazis, I could invoke Godwin’s law, declare victory and move on. But, I am not going to. Your analogy is false. The reason the analogy of psychiatry with eugenics holds is very strong: there is some truth in the idea that genes and biology determine part of who we are, so the idea of using the powers of the state to “purify” the race makes some scientific sense if one puts that small predicting ability of genes/biology and the interests of the state ahead of human rights. That idea was wholeheartedly embraced by the scientific elite of its time, especially in the US, before WWII.

        The underlying idea behind psychiatry is the same as behind eugenics: a group of self appointed mind guardians can decide, based on their own biases, which behaviors need to be encouraged and which can be pathologized, using the forced of government to impose that reality even it that means abusing human rights. Studies show that there is some “genetic predictive ability” in these behaviors. Calling these patters of behavior “a disease” and using the “forced of the state” to fight them is as eugenic as it can be.

  70. Francesca Allan says:

    In response to the “hey, it worked for me” line, you write “you can only know that you improved after the treatment; you can’t know for sure that you improved because of the treatment. That could be a post hoc ergo propter hoc logical fallacy”

    Funny how that’s unacceptable logic when it comes from someone questioning “science-based” medicine yet that’s exactly what mainstream medical practitioners do all the time. So your mania has disappeared and you’re on Risperdal? Ah, ha. That means you should stay on Risperdal for life.

    So which is it going to be? Is correlation a starting point for investigating causation? Or are we going to continue to have two sets of standards, one for the industry and one for the informed and skeptical consumer?

    Also, elsewhere you say that using placebos is unethical. Huh??? If they work as well as medication and aren’t harmful like most medication is, then how on earth is it unethical? If sugar pills are demonstrated to match SSRIs, then in fact it is unethical to prescribe SSRIs.

    1. WilliamLawrenceUtridge says:

      You’re missing the point – risperdal is tested in controlled trials, and that is what gives the evidence that it is effective at controlling seizures. If a diagnosis is incorrect, then the diagnosis is incorrect, though in that case it may be wrong to consider the response to the medication to be a confirmation of diagnosis.

      You are conflating the science of medicine with the art of medicine.

      The discussion regarding SSRIs might be more complicated than you are portraying it.

      1. Self Skeptic says:

        Saying that Risperdal was tested, isn’t convincing to a skeptic who is moderately well-informed about the pharmaceutical industry. How good are the trials of Risperdal for seizures? (Please don’t just say they were RCTs and hence impeccable.) Were the study designs plausible, to a critical eye? Were the effects claimed robust, or marginal? Were there conflicts of interest involved in the studies, or in marketing using them?Were the original trials done by groups, companies, etc. with a known history of publishing deceptive articles? Were any confirmatory trials affected by confirmation bias, or suspicious financial or intellectual COIs? All these factors have to be considered.

        Critical thinking demands that unless one has carefully vetted the actual details of the science and politics involved in developing and marketing the drug, one shouldn’t assume that actual science has shown the drug to be effective and safe.

        1. mousethatroared says:

          Self Skeptic “Critical thinking demands that unless one has carefully vetted the actual details of the science and politics involved in developing and marketing the drug, one shouldn’t assume that actual science has shown the drug to be effective and safe.”

          Critical thinking also demands balancing the risks that the information may be bias or not exactly as presented with the risks of the condition going untreated. Uncontrolled seizures and/or mania can be high risk conditions.

          Not everyone has the luxury of waiting until clinical research has been rid of pharmaceutical influence or bias.

          1. Self Skeptic says:

            Yes, I agree. My point is that critical thinking requires specific investigation. Just saying “It’s been tested in clinical trials,” is an avowal of faith, or trust; it’s the opposite of assessing the evidence.

            I’ve been tinkering with ways to check on subfields of medicine to see how likely it is that the majority concensus view has been skewed by skillful medical politics. It happens fairly often, and I’d feel like a sucker if my health were compromised because I hadn’t done my due dilligence on a diagnosis or treatment offered me.

            With the availability of the web, this is practical, in a way it wasn’t, when medical information was restricted to professionals. I think a significant proportion of laypeople could improve their odds, by checking around carefully for evidence of scams current in mainstread medicine. Granted, there will always be people who are necessarily at the mercy of the experts, however worthy or unworthy they may be. But those of us who can, should try to protect ourselves.

            By the way, I have no opinion about Risperdal, or other psych drugs. I’d have to specifically investigate it, to have an opinion. I was just using it as an example, to stand in for any drug one might want to investigate, as I presume WTU was doing, in the post to which I was responding.

          2. Self Skeptic says:

            Oops, typos. “Mainstream” not mainstread, “WLU” not WTU.

        2. WilliamLawrenceUtridge says:

          Francesca’s point wasn’t about the drug working or not. It’s about the post hoc ergo propter hoc fallacy as applied to clinical diagnostic. You could substitute any diagnosis and any drug alleged to treat that diagnosis. That’s my interpretation of her comment, perhaps she can show up and clarify.

      2. CannotSay2013 says:

        As I said below to Harriet the notion that risperdal has been shown to be “effective” is preposterous. Further, Tom Insel, the director of the National Institute of Mental Health -who has been dealing a few blows recently to those of your persuasion- has admitted that neuroleptics are overprescribed and that there is probably a lot of people who would do great without them http://www.nimh.nih.gov/about/director/2013/antipsychotics-taking-the-long-view.shtml . He is challenging the notion that people labelled as “schizophrenic” need these for life as the APA says.

        1. Harriet Hall says:

          You cite yet another link that you have read through biased eyes. It is clear that Insel strongly supports the used of psych meds and that he is only questioning details about how they are used.

          1. CannotSay2013 says:

            From the link, I could have said it myself,

            “It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous. For all, we need to realize that reducing the so-called “positive symptoms” (hallucinations and delusions) may be necessary, but is rarely sufficient for a return to normal functioning. Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.”

            Emphasis on WHAT WE CURRENTLY CALL SCHIZOPHRENIA, which is another way to say, that the DSM label schizophrenia doesn’t correspond to anything real.

            1. Harriet Hall says:

              It does correspond to something real, because there are people with those symptoms who are severely impaired and whose hallucinations and delusions resolve on psych drugs. As he says, treatment is necessary but not sufficient. The point is that it likely corresponds to more than one real thing, and we don’t yet know how to differentiate them. We currently call it schizophrenia so we can call it something while we are learning more.

              You are consistently reading your own opinions into the words of others that don’t mean what you would like to think they mean.

          2. CannotSay2013 says:

            “We currently call it schizophrenia so we can call it something while we are learning more.”

            It’s not a matter of semantics, it’s a matter of not having the slightest clue of what causes people to behave in certain ways.

            “You are consistently reading your own opinions into the words of others that don’t mean what you would like to think they mean.”

            You are consistently putting forward lies -about the scientific validity of DSM labels or the efficacy of psychiatric drugs- that are not backed by the hard data nor by the opinions of psychiatry’s top researchers.

            As I exhorted the others, you cannot possible be taken seriously when you put AIDS denialists in the same company as those who criticize psychiatry along my lines. As long as you keep defending psychiatry with such poor arguments, you’ll have little success convincing people about the unscientific nature of CAM. You seem to have two standards about what is SBM: one for every officially recognized medical specialty except psychiatry, another for psychiatry. It just so happens that the standard you have for psychiatry also makes CAM look scientific. People are smart enough to reach that conclusion.

            1. Harriet Hall says:

              I have never said that DSM labels are valid; I said they are flawed. In many cases they are no more than placeholders. I think it is valid to use placeholders, in order to talk about why people behave in those certain ways.

              I don’t put AIDS and psychiatry in the same category, but I do put people who refuse to accept evidence into the same category.

              I do not admit that there is a different standard for psychiatry, or that the evidence for psychiatry is as poor as the evidence for CAM. There is only one science.

          3. CannotSay2013 says:

            “I do not admit that there is a different standard for psychiatry, or that the evidence for psychiatry is as poor as the evidence for CAM. There is only one science.”

            Of course there is only one science, but you don’t apply it as vigorously to psychiatry as you apply it to CAM. With the data at hand, there is as much evidence for any of the DSM labels as there is for the homeopathic effect. Neither can be measured biologically in the way HIV infection or cancer can, both have to appeal to “personal experience” to justify their treatments and neither does particularly better than placebo when trials are conducted objectively (ie, without the biases that corrupt psychiatric studies).

            There is absolutely no scientific proof that any of the DSM labels is a real disease. NONE. You keep pretending otherwise for some reason.

            The question that I have, that I haven’t seen addressed by anybody in your movement, is why you keep dogmatically defending psychiatry. Many in your so called “skeptic movement”, some like Jerry Coyne way more credentialed than you or Novella, have reached the correct conclusion that DSM psychiatry is scam. He is a Professor of Biology at the University of Chicago, with publications in Science and Nature. You guys don’t have that level or scientific recognition.

    2. Harriet Hall says:

      @Francesca,
      The post hoc ergo propter hoc fallacy applies to assuming a treatment works because of anecdotal evidence. When science has tested a treatment with controlled studies and has shown that it works, it is logical to assume that a patient’s response to the treatment is real. (Although we should keep in mind that there are exceptions.)

      Risperdal is seldom, if ever, recommended for lifelong treatment.

      Correlation is the starting point for investigating causation, but there are not two standards. There is only one science.

      Placebos DON’T “work as well as medication.” See http://www.sciencebasedmedicine.org/the-placebo-effect/ and http://www.sciencebasedmedicine.org/placebo-effects-revisited/ Dr. Novella concludes: “There is no measurable physiological benefit from placebo interventions for any objective outcome.”

      I have written 2 articles on SBM that address antidepressants: http://www.sciencebasedmedicine.org/antidepressants-and-effect-size/ and http://www.sciencebasedmedicine.org/angells-review-of-psychiatry/ The evidence is clear that antidepressants are effective, although the effect size is small for mild to moderate depression. They can be lifesaving in severe depression.

      1. CannotSay2013 says:

        Harriet,

        The problem is that you keep referring to outdated results. There is a lot of cumulative evidence that most clinical studies on psychotropic drugs rely on selective publication of positive results. EH Turner, author of the NEJM study on SSRIs, recently did another review on drugs used to treat so called “bipolar” and “schizophrenia” http://femhc.org/Portals/2/Publications/2013_May22_Combating%20Publication%20Bias_Turner.pdf . So the notion that “psychiatric drugs work because it has been established in unbiased clinical trials” is, as of this point, false. In fact, the evidence shows precisely the contrary. All NIMH sponsored macrostudies that attempted to “show” that some drugs were better than others when correlated with specific factors did in fact show that no drug is significantly better than any other and none of them is significantly better than placebo. One of the most famous of these studies is STAR*D.

        And the problem is clear: psychiatry is an unscientific endeavor that relies on the subjective opinion of psychiatrists. So it is no surprise that, as with other pseudo sciences that rely on the same like astrology or homeopathy, the average predictive value of psychiatry’s diagnoses and methods is zero when the sample is large enough.

        1. Harriet Hall says:

          You have misread the study you cite by Turner. He’s NOT saying that the efficacy of psych drugs is unproven; he is saying that publication bias distorts the evidence to make it appear that the effect size is greater than it really is. I know Dr. Turner personally, and I assure you he would strongly disagree with your contentions.

          1. CannotSay2013 says:

            I am sure he wouldn’t agree either with your statements that the efficacy of these drugs has been established with the same certainty as the efficacy of HAART drugs has for treating HIV infection/AIDS.

            And that is my whole point in this discussion. You in this SBM movement are putting critics of psychiatry like me in the same category as AIDS denialists, with the underlying assumption that the existence of DSM labels as genuine diseases has been established with the same degree of certainty as the like HIV/AIDS. And it has not.

            1. Harriet Hall says:

              I think he would agree that the efficacy of these drugs has been established with the same “kind” of certainty but with a lesser “degree” of certainty because of a smaller effect size and our inability to objectively define the diseases. No one is saying that psych drugs are as effective as HAART for AIDS. They aren’t. They are far from perfect solutions, but their usefulness is clearly established. Unless you can show that drugless treatment is more effective than the drugs, you should stop criticizing them so harshly.

              You are creating a false man argument when you imply that anyone thinks DSM labels are as evidence-based as AIDS. The DSM is criticized by everyone, including psychiatrists. Psychiatry is the least evidence-based of all the medical specialties. Its progress was held back by the philosophy of dualism, and it’s only now starting to benefit from progress in neuroscience and pharmacology. We need to improve psychiatry and the DSM diagnoses, not abolish them.

          2. CannotSay2013 says:

            “Unless you can show that drugless treatment is more effective than the drugs, you should stop criticizing them so harshly.”

            In addition to yours truly, http://openparadigmproject.com/ . Also you have EH Turner and Kirsch’s studies that show that on average, a placebo is just as effective as an SSRI.

            HIV infected people, except for a select group of long term nonprogressors, die if untreated with HAART. That is how HIV denialism is falsified. Nobody has died of stopping psychiatric drugs; on the contrary, a lot of people do despicable acts because of a well established link between psychotropic drugs and violence.

            To keep repeating the mantra that these psychotropic drugs are efficacious using the standard that is used in other areas of medicine is a lie.

            1. Harriet Hall says:

              I ask for evidence and you give me testimonials? Really?

              Once again, you have mischaracterized Turner’s research. He did NOT find that on average a placebo is as effective as an SSRI. He found that every SSRI studied was more effective than placebo, although publication bias had led to the impression that the effect size was larger than it really was.

              Nobody has died of stopping psych drugs? Wrong! Patients who have gone off their meds have killed themselves and murdered others. Mental illness itself causes violence, most commonly in young men who are also using alcohol. In fact, atypical antipsychotic drugs have been shown to reduce violence. See http://www.ncbi.nlm.nih.gov/pubmed/15176758

              I really don’t see any double standard for psych drugs. According to this report, effect sizes are no worse for psychological studies than for medical studies: http://www.tamiu.edu/~cferguson/effectsRoGP.pdf

          3. CannotSay2013 says:

            Mmmm, this is what the first author reports as conflict of interests in another study,

            http://archpsyc.jamanetwork.com/article.aspx?articleid=209569

            “Financial Disclosure: Dr Swanson has received research funding and consulting fees from Eli Lilly. Dr Swartz has received research funding from Eli Lilly; and consulting and educational fees from AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, Eli Lilly, and Pfizer Inc. Dr Rosenheck has received research funding from AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, and Eli Lilly; and consulting fees from Bristol-Myers Squibb, Eli Lilly, and Janssen Pharmaceutica Products, LP. Dr Stroup has received research funding from Eli Lilly; and consulting fees from Janssen Pharmaceutica Products, LP, GlaxoSmithKline, and Bristol-Myers Squibb. Dr McEvoy has received research funding from AstraZeneca Pharmaceuticals LP, Forest Research Institute, Eli Lilly, Janssen Pharmaceutica Products, LP, and Pfizer Inc; consulting or advisory board fees from Pfizer Inc and Bristol-Myers Squibb; and lecture fees from Janssen Pharmaceutica Products, LP, and Bristol-Myers Squibb. Dr Lieberman has received research funding from AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, and Pfizer Inc; and consulting and educational fees from AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, Eli Lilly, Forest Pharmaceuticals Inc, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Novartis, Pfizer Inc, and Solvay Pharmaceuticals, Inc.”

            These two studies (the one you offered) and the one I mention are from 2004 and 2006 respectively, right before the Chuck Grassley uncovered the dirty secrets of ghostwriting and Big Pharma money, so as you can understand, this study of yours looks suspicious and it is likely to suffer from the same selection biases that EH Turner denounces in his research.

            With respect to EH Turner, his finding of “average effect” for antidepressants was the same as Kirsch’s. At the time the study was published, the average effect size fell below the accepted criteria of clinical practice in the UK. Since Big Pharma knows how to bribe, it didn’t take long to alter the “clinical practice criteria” to fit the placebo like response of antidepressants.

            With respect to the link to “effect sizes” I really do not understand your point. We are comparing the results that we get with HAART to treat HIV, antibiotics to treat infections, vaccines to give immunity, etc with the efficacy of psychotropic drugs. In the first type, there is a biological cause identified (something that is missing in ALL studies about psychiatric drugs), then the effect of the treatment can also be biologically measured. In psychiatry there is no such a thing as measurement for “medical imbalances”.

            I don’t see how you have refuted anything. With your SBM operation you require that CAM shows biological measures that their treatments work. However, in your eyes, psychiatry gets a pass on that requirement. Suddenly for psychiatry, it is OK if treatment X works on a “subjective” way and “on average” performs essentially as an active placebo. Your double standard is evident. Your denial of a double standard speaks more of your own biases than of your “alleged” scientific approach.

            1. Harriet Hall says:

              Kirsch was using the 0.5 cut-off for effect size, so to him anything below that was negative. Values of 0.2, 0.5, and 0.8 were once proposed as small, medium, and large effect sizes, respectively. The psychologist who proposed these landmarks admitted that he had picked them arbitrarily and that they had “no more reliable a basis than my own intuition.” Later, without providing any justification, the UK’s National Institute for Health and Clinical Excellence (NICE) decided to turn the 0.5 landmark (why not the 0.2 or the 0.8 value?) into a one-size-fits-all cut-off for clinical significance. It is no longer using it as a cut-off. The published antidepressant studies had an average effect size of .41, overstating the average effect of .31 when the unpublished studies were added in. Even by the original proposed levels, .31 counts as more than a “small” effect

              To Kirsch, any glass less than half-full was empty. Turner saw the glass as 31/100 full. Others agree with him, for instance this organization chose a level of .25 as their criteria. http://www.tea.state.tx.us/Best_Practice_Standards/How_To_Interpret_Effect_Sizes.aspx They point out that effect size depends on sample size and different criteria can be appropriate for different fields, and that what really matters is whether the effect is meaningful in a practical sense. For antidepressants, it is. In the treatment of depression, responses are not all-or-none, and a partial response can be clinically meaningful.

              If you don’t understand my point, it’s your fault, not mine. I explained it clearly.

              And conflict of interest declarations are not sufficient to invalidate a study.

          4. CannotSay2013 says:

            “If you don’t understand my point, it’s your fault, not mine. I explained it clearly.”

            It goes both ways. If you don’t understand what science is vs what isn’t it is your problem not mine. You are certainly biased by your own training and a life of telling your patients that “psychiatry” is a valid medical specialty and no argument, however valid, will convince you of the opposite.

            A discussion about “effect sizes” is just a red herring that is not going to make psychiatry look more scientific. I repeat: no psychiatric diagnosis is based on objective tests (point recognized by the director of the NIMH). When data is aggregated either via the Turner or Kirsch studies or the STAR*D study, the average value of psychiatric prediction, using psychiatry’s own measure of efficacy which is answers to a questionnaire -very different from any objective test-, is zero, which means that psychiatry is all about subjectivity.

            You can repeat your mantras all the day long but psychiatry doesn’t pass the test to be considered a scientific discipline that you demand of CAM like homeopathy. Scientifically speaking, there is no difference between homeopathy and psychiatry.

            “And conflict of interest declarations are not sufficient to invalidate a study”

            When one brings a study from 2004, a time known to be a bonanza for bribing psychiatrists (per documents obtained through court depositions), of an author with a clear conflict of interests with one of the main manufacturers of neuroleptics about the virtues of neuroleptics, the study is suspect, especially in psychiatry. The Journal of the American Academy of Child and Adolescent Psychiatry has repeatedly refused to retract the so called Studty 329, published in 2001, despite the fact that GSK has publicly acknowledged that said study was ghostwritten and the data was “cooked” to confess efficacy even though the raw data didn’t warrant a conclusion of efficacy. The practices that were normal in psychiatry prior to the Chuck Grassley investigation of 2008 are considered “scientific misconduct” in scientific fields. So, obviously, I am not taking seriously your study. Through selection bias I can prove anything.

          5. sarkeizen says:

            “I repeat: no psychiatric diagnosis is based on objective tests”

            What makes you say this?

          6. Cannotsay2013 says:

            sarkeizen,

            There are no biological tests for any of the DSM disorders. This is a fact. DSM labels are assigned based on reported behavior. In addition, DSM-5 has a very creepy Cohen’s kappa record (Allen Frances, the chairman of the DSM-IV taskforce has written extensively about this), this means that not only there are no objective biological tests but that two psychiatrists using DSM-5 to label somebody are more likely than not to assign two different labels. Compare that with what happens with the diagnosis of HIV infection.

          7. sarkeizen says:

            “There are no biological tests for any of the DSM disorders.”

            Actually you’re making a category error. A lack of a biological test is not sufficient to demonstrate that something is subjective.

          8. WilliamLawrenceUtridge says:

            Objective tests exist to reduce false positives and false negatives (and even objective tests are not perfect; HIV tests, among the most reliable in the world, still make a small number of errors which is why confirmation testing is used), but nonobjective tests can still be meaningful. Diagnostic criteria are designed to increase concordance on patients where objective tests are lacking. The fact that an objective test does not (yet) exist does not mean that it will never exist, nor does it mean that a diagnosis is made up out of thin air. We can measure ephemeral things like beauty, red, pornography and smelly. Two, three, four and six doctors (or artists, or non-colour-blind people, or judges, or people with noses) agreeing on a diagnosis may not be perfect, but the fact that they can suggests there is some element of reality in their assessment.

            By your claim, people dying of bacterial infections didn’t die until the invention of the microscope, and viral infections until the invention of the Chamberland-Pasteur filter or electron microscope.

            But you’ve underscored yet again that talking to you is unlikely to convince you of anything. So this comment goes out to all the lurkers!

          9. CannotSay2013 says:

            sarkeizen,

            I have no time to waste on sophistry, It’s the psychiatrists themselves who claim that their invented diseases are “biological”, not me.

            WLU,

            I wrote below something about how Richard Feynman sees “science”. That applies to what you just said as well.

          10. sarkeizen says:

            “I have no time to waste on sophistry,”

            I’d suggest that actually looking the term up would not be a waste of time. That way, in the future you could use it correctly and would avoid the embarrassment of being corrected by people like me.

            “It’s the psychiatrists themselves who claim that their invented diseases are “biological”, not me.”

            You claimed that there were no biological tests for mental illness and appeared to consider that SUFFICIENT to claim that these tests are subjective. You are, in short entirely wrong.

            Similar to what WLU stated. By your criteria the question “Who won the election?” is subjective as there is a plurality of ways to interpret the data. Furthermore you appear to be arguing that this lack of ontological objectivity is sufficient to claim that the disorders have no basis in reality. However this is no more reasonable a conclusion to draw as is: “Nobody won the election.”

            As you can see (or perhaps can’t because nothing can convince you that you’re wrong) your reasoning is insufficient to make your point. I would suggest that having sufficient evidence to make your point would NOT be a waste of your time.

  71. mousethatroared says:

    FA – I think a good doctor should consider the possibility of placebo effect and coincidental improvement with any new medication, especially any condition that waxes and wanes on it’s own. But risk assessment for going off a drug that seems effective should be part of that consideration.

    WLU I would add, people love to knock SSRI because of the evidence of limited benefit in mild depression. But there is stronger evidence of their effectiveness in severe depression, anxiety disorders and some pain disorders.

    Just because they are not a panacea doesn’t mean they don’t work for somethings.

    That’s some fancy linking you got there.

    1. WilliamLawrenceUtridge says:

      I’m a fancy boy, what can I say?

      I swore there was a review of SSRIs on SBM in the past couple years, but can’t find it. If not, perhaps one is needed? I certainly wouldn’t mind being better informed on such an important and controversial topic.

      1. mousethatroared says:

        WLU – I would be nice to see a review, but it’s a pretty big topic. My fantasy is for evilrobotxoxo to write a series on psychiatric treatment, the good the bad and the ugly. But, sad to say, he or she only drops in occasional and seems too busy for such a thing.

        You can check out the Wiki page on SSRIs, for what it’s worth, you might find something worthwhile in the summaries/sources.

      2. mousethatroared says:

        WLU – I feel like a dweeb for asking, but do you mark up your links by hand, or is there some sort of easy automatic editing software you use? I just hate marking up by hand.

        1. WilliamLawrenceUtridge says:

          By hand, I’m a fast typist. If I’m doing a lot, I’ll copy the raw template out a couple time and then paste in the link and type in the titles. There may be a plugin or something to do it quickly, but I don’t use it. For being someone who comments frequently on a Web2.0 interface, I’m surprisingly luddish.

          1. mousethatroared says:

            WLU – oh well, Thanks!

  72. mousethatroared says:

    FA “In response to the “hey, it worked for me” line, you write “you can only know that you improved after the treatment; you can’t know for sure that you improved because of the treatment. That could be a post hoc ergo propter hoc logical fallacy”

    I just wanted to add that I agree with this to some extent, and I agree with WLU. The issue here (and it’s the same in other specialties as well as psychiatry) is how well the doctor is doing his job. If they are sloppy, you can certainly end up on a medication or with a surgery that only seemed to be effective (but wasn’t). All I can say is try to find a good doctor and then listen and question, but also be ready to listen to the things you don’t want to hear, if there is good reasoning behind them.
    (Then cross your fingers, cause there’s a certain amount of luck involved.)

    1. CannotSay2013 says:

      No, the issue is not that one. When you have to appeal to “keep looking for a good doctor” you fall into the same trap as those who defend astrology or homeopathy with “keep looking for a good professional”.

      It is not the “professionalism” of psychiatrists that is questioned here but the very “diseases” they come up with. You might find better HIV doctors than others, but there is no question about what HIV infection is and how to OBJECTIVELY measure it. Experiments such as Rosenhan’s and the like show that in psychiatry, the lack of objective tests for DSM invented labels results in 3 psychiatrists providing 4 different diagnoses (and no, this is not a typo, is meant to be a joke).

      You are confusing the question of whether psychiatry deals with objective diseases with the professionalism of psychiatrists.

      1. weing says:

        I think the DSM labels are just that and we should be ready to abandon them once we have something better. It looks like we don’t have it yet. I am not a psychiatrist, so I am not on the cutting-edge, as they say. Having said that, it in no way negates the existence of psychiatric illnesses. I think of them as porn. You may not be able to describe it, but you know it when you see it. A simple heuristic that I used in my psychology days was separating neuroses from psychoses. If I found I could empathize with a patient after talking to them, then they had a neurosis. If I couldn’t find a way to empathize with them, then the patient had a psychosis.

  73. mousethatroared says:

    CNS13 “No, the issue is not that one. When you have to appeal to “keep looking for a good doctor” you fall into the same trap as those who defend astrology or homeopathy with “keep looking for a good professional”.

    CNS your complete argument is based on the assertion that psychiatric conditions don’t exist because there is no physical evidence of these conditions. Yet when presented with physical evidence you refuse to believe it. So basically, your argument is “Because I said so.” AND you continue to offer no solutions for someone who is suffering from hallucinations, depression or anxiety…except, well one study showed that people treat them differently.

    If the evidence for many interventions for psychiatric diagnoses was as bad as the evidence for homeopathy or astrology approaches, I’d be inclined to agree with you. But it’s not.

    I can understand your concern with labels, but labels even if they may end up being inaccurate at some point, are essential for grouping characteristic and behaviors in order to research them.

    Consider Marsha M. Linehan and the label of borderline personality disorder. Probably one of the most maligned diagnoses for a patient to get. Yet she has taken that diagnoses and started to transform it through a focus on relief from the underlying emotional symptoms of people with that diagnoses. I think her research and invention of Dialectical Behavior Therapy has helped many people struggling with all sorts of emotional symptoms, not only folks with the BPD diagnoses, but also anxiety as well. I don’t know how anyone can think of this and continue to assume that this label only functions as a form of stigmatization or suppression.

  74. CannotSay2013 says:

    “yet when presented with physical evidence you refuse to believe it.”

    Apparently, the evidence was not strong enough to convince Tom Insel either, I am in good company!

    “If the evidence for many interventions for psychiatric diagnoses was as bad as the evidence for homeopathy or astrology approaches, I’d be inclined to agree with you. But it’s not”

    EXCUSE ME? Where is the evidence that a psychiatric intervention is better than no intervention at all? Right from the newsroom, we have the n-th case of a drugged so called “patient” doing something despicable (that would be the lady that was killed yesterday when she tried to get into the WH). I couldn’t care less about the scientific nature of psychiatry IF I hadn’t learned the hard way that a psychiatric intervention is worse than no intervention at all on many levels:

    - Physiologically speaking: these drugs have heavy secondary effects, some of them potentially fatal. In my case, I got kidney and liver failure that only reversed after I stopped the drugs. The overwhelming majority of people who take SSRIs or neuroleptics experience some kind of adverse effects (weight gain, cholesterol problems, etc) AND the fact that they create physical dependence. As I said above, when it comes to neuroleptics, people who take them in “maintenance mode” die 25 years earlier than average.

    - Socially speaking: stigma. A psychiatric label follows you for the rest of you life, and it results in you being considered “less than human” for many issues, from your second amendment rights, to your inability to hold jobs that require security clearance to scorn if you ever consider holding a job that would expose you to public scrutiny (such as running for office or holding a high level job at a corporation). The stigma exists, as I have shown above, PRECISELY because of the “biological defect” version that psychiatry projects.

    - Finally, in the case you are thrown into psychiatry against your will, as it happened to me, you endure the humiliation of a lifetime, something that follows you with a vengeance. It has been several years my own abuse happened and the resentment I have against those who did it to me has only grown over time. The fact that it cannot happen in the US only alleviates my anxiety, but in no way alleviates the pain, the sense of betrayal and the disdain that I feel for my “ex-family” for conspiring against me.

    I cannot see how giving that to somebody is better than no intervention at all. As I have also documented elsewhere, if the goal is to prevent violence, again, a psychiatric label alone is not a good predictor of violence.
    So if the goal is to give somebody a great deal of physiological and societal problems that could be avoided if no intervention had happened, then sure, you have a point. But if the goal is to promote societal well being, psychiatry is, I repeat, the worst violator of human rights currently under operation in the West.

    “Consider Marsha M. Linehan and the rest of the BS”

    Again, and this goes back to my analogy with eugenics, you are putting her experience ahead of the RIGHT OF THE INDIVIDUAL TO BE LEFT ALONE. This right is afforded to HIV patients even though the Cuban experience shows that a quarantine/forced HAART therapy would make HIV infection extremely rare in the US.

    The idea that human rights can be overruled just because mind guardians say that their approaches have worked for “some people” makes a mockery of the whole notion of individual rights. It is plainly wrong.

    From where I stand, psychiatry should have the same legal status as homeopathy. Those who want to engage with it, should be free to do so, however the state should not have any ability to impose it onto victims not should it promote it in any way just as it doesn’t promote homeopathy.

  75. mousethatroared says:

    CNS13 “Again, and this goes back to my analogy with eugenics, you are putting her experience ahead of the RIGHT OF THE INDIVIDUAL TO BE LEFT ALONE.”

    That is completely untrue, completely. I have repeatedly affirmed my support of patient rights to autonomy, which includes the right to be left alone. What you seem to ignore is that many people want help for their symptoms. They do not want to be left alone. In fact, some patients would rather die than be left alone with their symptoms and no help.

    Your denial of that and portrayal of people like me as ignorant victims, because we say that psychiatry has help us, just shows how very intractable your bias is. In fact you seem to be repeatedly saying that MY only right IS to be left alone. If you don’t want to take advantage of what psychiatry has to offer, don’t.

    1. Nashira says:

      MTR said: “In fact you seem to be repeatedly saying that MY only right IS to be left alone. If you don’t want to take advantage of what psychiatry has to offer, don’t.”

      I wish I had a like button to mash. If I had been left alone, my depression would have killed me. When my mom interfered with my psych care and talked me into stopping antidepressants, I started self-harming; I have some prominent scars on my legs. Having my doc interfere and help me to stay on meds is, quite seriously, one of the best things that ever happened to me. Call me strange, but I like still being alive.

      Psychiatry isn’t perfect, but it was so much better than being left alone.

      1. CannotSay2013 says:

        “I wish I had a like button to mash. If I had been left alone, my depression would have killed me.”

        This is a poster example of the type of “anecdotal evidence” that has no bearing in the question of whether psychiatry is a scientific discipline.

        I can give you also many testimonies of people who genuinely believe that their lives were saved by some homeopathic remedy and that they would be dead if they had followed conventional medicine’s treatments. In fact, I believe too that these people experienced a genuine “heal” in their usage of homeopathy.

        In either case, such anecdotal evidence is irrelevant to the matter at hand.

        1. nashira says:

          @CS2013: You do not bring the science you say you do, since you are concerned solely with “proving” a predetermined conclusion, with winning points like this is a game. People with much better qualifications have attempted to have a rational discussion with you, but you refused… then declared yourself the winner, again like this is some kind of game.

          I have met anti-psychiatry whackjobs like you before, and my purpose in commenting was not to say “I am completely certain that psychiatric meds fixed me.” It was not to provide an anecdote as proof of efficacy, since anecdata is not a thing.

          It was more to show that you and your brethren do not and will not speak for me.

          1. CannotSay2013 says:

            “People with much better qualifications have attempted to have a rational discussion with you, but you refused… then declared yourself the winner, again like this is some kind of game. ”

            Really? First, you don’t know my qualifications because I haven’t disclosed them. They are better than Novella’s and Harriet’s though. But second, since we are talking about qualifications, none of these two is better qualified than Jerry Coyne when it comes to the scientific method. Nothing that any of them, or you, has said here refutes this http://whyevolutionistrue.wordpress.com/2011/06/25/is-medical-psychatry-a-scam/ .

            “It was more to show that you and your brethren do not and will not speak for me.”

            Which is exactly the same argument that those who claim to have been helped by homeopathy make. And, as I have said many times, I respect your choice of accepting the quacks opinion of you which will be in the form of some DSM label(s). What I am saying is that since the DSM is unscientific, that we do not consider its labels as anything other than the ruminations of a bunch of MD degree holders that have no scientifically valid reality. And since it’s just “an opinion”, DSM labels should not be promoted as “facts” or imposed onto innocent victims. I am not asking too much, me thinks,

          2. WilliamLawrenceUtridge says:

            This comment needs a “like” button :)

          3. WilliamLawrenceUtridge says:

            Ugh, threading clarification. My above comment is aimed at Nashira‘s initial comment.

            See, if we had a “like” button, I wouldn’t have to say that.

          4. Nashira says:

            CS2013 said: “First, you don’t know my qualifications because I haven’t disclosed them.”

            I phrased that sentence badly. I meant better qualifications than I’ve got, with regards to medicine. Dr. Hall, Dr. Novella, and the rest of our esteemed hosts, are actual doctors, with decades of experience. I’m not a doctor, and I try to make it clear that I’m not.

            CS2013 then said: “They are better than Novella’s and Harriet’s though.”

            If your qualifications are really so superior, then you should have no problem laying them out in detail. In addition, you might wish to fix that misogyny if you are going to play social justice warrior on the Internet. It’s passe to use overly familiar forms of address in order to minimize women whom you dislike.

          5. CannotSay2013 says:

            Nashira,

            “Dr. Hall, Dr. Novella, and the rest of our esteemed hosts, are actual doctors, with decades of experience. I’m not a doctor, and I try to make it clear that I’m not.”

            Jerry Coyne has better scientific qualifications than both. He has published in Nature and Science which are the gold standard of scientific research (neither Novella or Harriet have any publications in these two journals). My arguments are basically his (with the added experience of having been a victim of psychiatric abuse). Now, it takes scientific training to understand these criticisms, and apparently a lot that is missing here.

            “It’s passe to use overly familiar forms of address in order to minimize women whom you dislike.”

            I don’t understand how my criticisms can be interpreted as misogynistic in any way. I have been an equal opportunity critic, without regard to sex, race, religion, national origin or any other social condition. I have been only after the arguments (unlike others who have been throwing ad hominem attacks against me).

            1. Harriet Hall says:

              You’ve done it again: referred to Dr. Novella by his last name and me by my first name.

          6. CannotSay2013 says:

            Harriet,

            “You’ve done it again: referred to Dr. Novella by his last name and me by my first name.”

            It comes down to this? WOW it is the first time that I am accused of being misogynistic for using a first name…

            Let me assure you that it has nothing to do with misogyny. Note that I haven’t used the title “Dr” to refer to Novella or to anybody else. Not only I do no like titles, but I do not believe in them either -as far as I am concerned, we are all “created equal”-. For instance, I do not refer to US presidents -in other debates- as President X or President Y. To me it is always Bush, Obama, etc. For Jerry Coyne I have used his full name, for Novella, only his last name and for Richard Feynman his full name. There is no misogyny or double sense implied. Your name is not common, there is only one “Harriet” around here while there might be many Stevens, Richards and Jerrys. I usually prefer first names but to make sure who’s who my nicknaming is justified, I believe. One of the great things of being an American is the egalitarianism that impregnates everything. Those who love titles will find, I am sure, Europe very interesting. Everything there is about status and pedigree. I worked very hard to get rid of my former European citizenship, so I didn’t mean any offense whatsoever :D.

            1. Harriet Hall says:

              You are forgiven for calling me by my first name. I couldn’t help but wonder if you had a reason for treating me differently. I don’t find first names as offensive as being called Ms., when they choose to address me with a title but then refuse to use the title I worked so hard to earn. I have a suggestion: if you are worried about confusion between common names, you can easily clarify who you are talking about by using both first and last names. It doesn’t take much longer to type Steven Novella than Novella.

          7. Chris says:

            Of course, CS2013, it you have trouble referring to Dr. Hall with the dreaded “Dr.”, you could also use her other earned title from the US Air Force: Col. Hall. ;-)

          8. CannotSay2013 says:

            Good one Chris…

            Harriet,

            Thanks for your forgiveness. I will call Novella “Steven Novella”, but you will still be “Harriet” :D.

          9. Nashira says:

            @CS2013: Thank you for clarifying, wrt names and titles. It looks odd when someone uses first names for one gender and more formal modes of address with the other, but I’m glad to hear that you prefer first names across the board. More often I run into that when dealing with individuals whose beliefs aren’t quite “get in the kitchen”, but who still view women as inherently lesser.

          10. CannotSay2013 says:

            Nashira,

            Nothing bothers me more than being confused for something that I am not :D. In fact, I have gotten into trouble for calling people by their first name in circles where titles are a big deal (like academia).

            Some people like it too much “Mr this”, “Ms that” or “Dr this”, “that, PhD”, “Professor this”, “Professor I don’t give a damn about your endowed chair name”. Honestly, I don’t care about titles. Some European countries, which I am not saying because I would be giving out too much about me :D, are particularly notorious for using titles all the time about everything. I guess it is a way of saying “I am better than you” but I find it disgusting.

          11. mousethatroared says:

            I second WLU’s like on Nashira’s comment. “It was not to provide an anecdote as proof of efficacy, since anecdata is not a thing.

            It was more to show that you and your brethren do not and will not speak for me.”

            As to addressing individuals. Usually using a screen name or an abbreviation of the screen name (such as SN for Stephen Novella and HH for Harriet Hall) is sufficient for a reference in an online discussion were the people are familiar with the other parties. This avoids giving impressions of intentionally slighting individuals.

      2. mousethatroared says:

        @Nashira – Thanks, Friends and family members (and strangers on the internet) who try to talk people out of needed medication without any consideration of the dangers bug me. This isn’t limited to psychiatric medications, I recall one woman online who was taking several medications to control Lupus with organ involvement (her kidneys were being damaged by the auto-immune reaction, the medication stopped that).

        She was upset because her friends were trying to talk her out of taking all those medications, because they thought they must be the thing making her so sick. They had no idea just how sick she could get without the medications.

        A similar thing happens with psychiatric treatments. People just have no idea how bad someone can feel without treatment. They think somehow people are just going to revert to “normal” when you they cease treatment.

        1. CannotSay2013 says:

          “People just have no idea how bad someone can feel without treatment. They think somehow people are just going to revert to “normal” when you they cease treatment.”

          Actually, I do. I was also told about the “dangerous consequences” of stopping mine or that “I wouldn’t be functional”. Guess what, several years later I am “more functional than ever” :D . My case is far from an isolated case. When it comes to so called “schizophrenia” the evidence is so strong that a lot of people doesn’t need to be medicated for life -even that said medication prevents recovery from psychotic episodes- that both the NIMH and the APA are now on record asking for a more limited use of neuroleptics. The mantra “take your meds or die” is not anymore the official line of the APA or the NIMH.

          And again, I repeat for the n-th time, personal testimony about how some drug helps somebody is not the same a a genuine scientific effect.

          1. weing says:

            “And again, I repeat for the n-th time, personal testimony about how some drug helps somebody is not the same a a genuine scientific effect.”

            Thank you for your personal testimony. It really doesn’t tell us whether you improved because of the drugs you took in the past or not. You may have improved spontaneously. It happens. All individual testimony is anecdotal.

          2. CannotSay2013 says:

            weing,

            Good try but it doesn’t work.

            You are right on one point though: my anecdotal evidence is just as good as Nashira’s. Only, those like you have nothing to show to defend psychiatry other than “anecdotal evidence” while I have many scientific arguments and studies to criticize psychiatry. I hope you see the difference although, I am not really surprised if you don’t. Given how poor the arguments presented here to defend psychiatry have been, I am increasingly convinced that this movement is very dogmatic. What I still don’t understand is what you see in psychiatry that is worth being defended so dogmatically. Certainly it is not science because, as I said numerous times, now every single top dog in psychiatry agrees that they haven’t come up with any scientific evidence that can show that the DSM labels correspond to genuine biological realities. In fact, the reason Insel rejected the DSM is precisely because thinking about behavioral issues in terms of DSM labels was preventing advances in neuroscience.

          3. mousethatroared says:

            @weing – I tend to think of anecdotes as illustrative, but not predictive. Like case studies, one can consider the existence of different risks or benefits, but can not predict how likely those risks or benefits are.

            So, If I read an account of a child being injured by falling off a trampoline…that is illustrative of a possible risk of trampolines, but it doesn’t tell us much about how high a risk trampolines are.

            What do you think?

          4. weing says:

            “Only, those like you have nothing to show to defend psychiatry other than “anecdotal evidence” while I have many scientific arguments and studies to criticize psychiatry.”

            I am not a psychiatrist and I am not trying to defend it. What you have are personal anecdotes. There are some crude scientific studies that are using the admittedly inadequate DSM for classification that show some improvement. I would like to have a science-based diagnostic system for psychiatry, as well as an equally science-based treatment approach. I want a lot of things. But as Rummy said, more or less, you have to take the army you have and not the one you wish you had.

            Coming from Eastern Europe, I am well aware of the ability of the state to utilize psychiatric labels for its own nefarious purposes. As Kissinger reputedly said, sometimes even paranoids have real enemies.

          5. CannotSay2013 says:

            “But as Rummy said, more or less, you have to take the army you have and not the one you wish you had.”

            This is why you do not help your cause. The notion that we have to take the DSM as “valid” because there is no better scientific alternative is problematic on many levels. From the pure scientific point of view, this is like saying that we have to take homeopathic remedies to treat pancreatic cancer because there isn’t anything better (and in fact, for pancreatic cancer, there isn’t anything much better than homeopathy from conventional medicine). More importantly, from the social/legal level, if psychiatry wasn’t legally recognized as a coercive force, I might even agree with you. My problem is that we have an unscientific discipline given a coercive status that more scientific ones (like AIDS science) do not have. That is plainly wrong. It is a first amendment violation in the sense that a belief system, psychiatry, is being promoted and imposed by force.

            “Coming from Eastern Europe, I am well aware of the ability of the state to utilize psychiatric labels for its own nefarious purposes. As Kissinger reputedly said, sometimes even paranoids have real enemies.”

            Apparently, while you were in Eastern Europe you probably didn’t get the Pyotr Grigorenko treatment, otherwise your perspective would probably be very different.

          6. WilliamLawrenceUtridge says:

            Actually, I do. I was also told about the “dangerous consequences” of stopping mine or that “I wouldn’t be functional”. Guess what, several years later I am “more functional than ever”

            Of course, given the lack of insight that most with mental illness have into their own conditions, an alternative explanation is that you aren’t necessarily aware of the impact mental illness is having on your life. To whit:

            And again, I repeat for the n-th time, personal testimony about how some drug helps somebody is not the same a a genuine scientific effect.

            Consider these quotes an ouroboros. To clarify, everyone should start at the top quote, then read the next quote, then read the first quote again. You may repeat several times, if you find the exercise to be of benefit.

          7. Cannotsay2013 says:

            WLU,
            I love this, now you are using TAC talking points about “lack of insight”, which of course, is another of those lies used by psychiatry, in this case fringe psychiatry, to justify their nonsense. Please enjoy having your nonsense debunked here by a psychiatrist,

            http://www.madinamerica.com/2012/08/anosognosia-how-conjecture-becomes-medical-fact/

            Anosognosia: how conjecture becomes medical “fact”

            Her conclusion,

            “As with the notion of “chemical imbalance”, the term anosognosia has crept into the psychiatric lexicon.  Its use confers a certain sophistication of understanding and knowledge that is not supported by the data.”

            Again, you are just a pseudoskeptic who pretends to know but who dissipates doubts about his ignorance when he tries to make an “alleged”sophisticated point which is nothing but a talking point by one of America’s top promoters of human rights abuses: TAC.

          8. WilliamLawrenceUtridge says:

            Actually, it was more of a comment that your observation of “anecdotes are not scientific” was immediately followed by your personal anecdote as proof of your assertions.

            That’s what I mean by lack of insight, regarding you specifically.

            Please, handwave away.

          9. CannotSay2013 says:

            WLU,

            “Lack of insight” is not a joking matter since in those countries. like in the country where I suffered my own abuse, where they have a “need for treatment” standard for forced commitment/drugging, “lack of insight” is a valid ground to lock somebody up.

            I ask you to watch this video, “The Homosexuals”, by Mike Wallace from 1967, particularly minute 1:20 and after. It is a recap version but you also see psychiatrists making a lot of outrageous claims about how dangerous homosexuality is,

            https://www.youtube.com/watch?v=-AXAOT_swIE

            Some homosexuals today would consider filing a civil rights lawsuit against the psychiatrist who bashes homosexuality. This is the same kind of outrage I feel when I am told that “I lack insight” into an invented disease that took me to the psychiatric ward.

          10. WilliamLawrenceUtridge says:

            Do you understand why I made the comments I did about a lack of insight? It’s because you criticize other people for using anecdotes to justify their beliefs about psychiatry – then justify your own beliefs through reference to your own personal experiences (i.e. an anecdote).

            I’m not sure how the history of homosexuality is anything but a distraction to that point.

        2. weing says:

          “And since it’s just “an opinion”, DSM labels should not be promoted as “facts” or imposed onto innocent victims.”

          They are labels not facts and amenable to change once we have more info. Innocent victims of what?

          “I am not asking too much, me thinks,”
          Yes you are, since you appear to be denying the existence of psychiatric disease.

          1. CannotSay2013 says:

            “They are labels not facts and amenable to change once we have more info. Innocent victims of what? ”

            Homosexuality is a FACT. There is even a lot research that indicates that homosexuality is partly biologically based (by way of genetics or other things that go on in the mother’s womb during pregnancy). To call “homosexuality” a disease is a value judgement. Each of the ~ 400 labels of the DSM ended up in the DSM in the same way homosexuality ended up there (and out).

            “Yes you are, since you appear to be denying the existence of psychiatric disease.”

            Sure I am denying the existence of DSM type of “diseases”, meaning, the process by which a set of self appointed mind guardians decide which patterns of behaviors are pathological just because they say so. This is the same model used in the past by religious tribunals to single out “heretics”. That is not to say that there aren’t any genuine brain diseases like Alzheimer’s , Creutzfeldt–Jakob Disease or brain cancer but none of the DSM labels fits the definition of brain disease that those these do.

            Final point, with this creepy reference to “denialism”. From where I stand, those who defend DSM labels as if they were Creutzfeldt–Jakob Disease type of diseases are delusional and would probably qualify for a diagnosis of schizophrenia using DSM rules: you believe in the truth of entities for which there is no scientific evidence of their reality :D.

  76. mousethatroared says:

    CNS 13 “Apparently, the evidence was not strong enough to convince Tom Insel either, I am in good company!”

    Then why does Tom Insel propose the following?

    “A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,

    Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,

    Each level of analysis needs to be understood across a dimension of function,
    Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.”
    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

    1. weing says:

      “Sure I am denying the existence of DSM type of “diseases”, meaning, the process by which a set of self appointed mind guardians decide which patterns of behaviors are pathological just because they say so.”

      I have a problem with your definition of DSM type of disease. It is unique to you, and in order to communicate we need a common language with shared definitions. By your definition the disease is a process by which self-appointed mind guardians decide which patterns of behavior are pathological just because they say so. Sure, you can call it that but don’t expect others to know what you are talking about when use use the term that way. I can define coffee as “tea” and wonder why the waiter doesn’t give me coffee when I ask for tea. You really don’t understand the problem with your definition of disease?

      1. CannotSay2013 says:

        The DSM does more than “just establishing a common language” for patterns of behavior.

        It declares those behaviors DISEASES or “disorders” if you will, just because these mind guardians say so without any backing of biology. It is the pathologization aspect that I find problematic. Again, if there were no legal implications to this labeling the whole thing would be just a bad a joke,: the reflection of the internal political struggles in American psychiatry by way of the psychiatrists who seat in DSM committees. The problem is that these diseases that they declare have legal implications, and therefore, social implications as well. Astrologers also have their own common language and also create “solar signs”. But because these days astrologers have no legal bearing, that an astrologer declares you a “Leo” has no significant over said astrologer declaring you a “Cancer”. However, if a psychiatrist declares you “mentally ill”, I can assure you the consequences are severe.

        When people call the DSM “a bible” they refer to that: the DSM “creates” diseases just as God, through the Bible, created theology. In the case of the DSM, the role of “God” is played by the committee members who vote in (and out) diseases. The role of psychiatrists today is the same as the clerics’ during the time the behavioral orthodoxy was dictated by the theologians of the Church: they enforce the correct “behaviors” by way of pathologizing “wrong behaviors”.

        1. weing says:

          A knife can be used to cut your food, clothing, hides, it can even save your life. It can also be used to kill and maim. It is still a knife. Same with labels. You are concentrating on abuse of the labels and negating all the other functions they can perform. They are not necessarily all bad.

  77. mousethatroared says:

    Socially speaking: stigma. A psychiatric label follows you for the rest of you life, and it results in you being considered “less than human” for many issues, from your second amendment rights, to your inability to hold jobs that require security clearance to scorn if you ever consider holding a job that would expose you to public scrutiny (such as running for office or holding a high level job at a corporation). The stigma exists, as I have shown above, PRECISELY because of the “biological defect” version that psychiatry projects.

    We have privacy laws in the U.S. Any adult with any diagnoses had a right to keep their diagnoses private from anybody except an insurance organization that is paying for that treatment. Government Security Clearance does ask about past psychiatric treatment, but an answer of yes is not an automatic disqualification (but it’s not something they take lightly either). There may be some high stress professions (such as pilot, but then being color blind is also a disqualifying factor) that also ask about pass psychiatric treatment. Legally, because of disability laws, an employer can not ask about any disability unless it is directly related to job requirements. Of course some people don’t know their rights, so those right may get infridged upon because they are not aware they can say no to intrusive questions.

    The stigma against folks with mental illnesses has been around since long before there was a biological model. Some approaches thought of these conditions as demon possession or just a moral failing in a person that required more discipline.

    1. mousethatroared says:

      Shot, that first paragraph from my above comment was CNS13′s the later paragraphs are my response. sorry

      1. CannotSay2013 says:

        “The stigma against folks with mental illnesses has been around since long before there was a biological model.”

        And research that I pointed out above shows that the biological model makes it worse, not better, because people come to believe that DSM labelled people are “defective” in the way those who suffer from genuine brain diseases, like Alzheimer;s, are.

        1. mousethatoared says:

          CNS13 ” because people come to believe that DSM labelled people are “defective” in the way those who suffer from genuine brain diseases, like Alzheimer;s, are.”

          Well that’s a take away quote. Isn’t it?

      2. weing says:

        @MTR,

        I think that’s the function of anecdotes. That’s why they have such a powerful sway on us. There was survival value to them. Scientific studies sway scientists and, I like to think, MDs that are science-based. Anecdotes sway everyone on a personal level. If I have patients with a disease that is 90% fatal in 2 weeks and with treatment the mortality is 40% in 2 weeks, I can feel that I’m not doing the right thing by giving them the correct treatment as the population of patients I have is too small to make a judgement as to the success or failure of the treatment. I may see 100% success or failure of the treatment because of the law of small numbers. But my experience is all anecdotes and if my patients are the lucky ones, then I feel the treatment is excellent and vice-versa.

        1. mousethatroared says:

          Got it. Thanks weing.

  78. CannotSay2013 says:

    I have no respect for anybody, and that would include you, who accepts the notion that a DSM label warrants less legal rights.

    If you truly believed what you say, you would join hands with those of us who want to make coercive psychiatry history.

    You say that you respect individual freedom and choice but you are here on record defending “forced psychiatry” in “some occasions” that are not warranted in case of people who have not been given a DSM label.

    You keep saying “what you seem to ignore is that many people want help for their symptoms” but that again is not true. I have spoken here strictly from the point of view of science. As Jerry Coyne puts it, http://whyevolutionistrue.wordpress.com/2011/06/25/is-medical-psychatry-a-scam/ “personal testimony that a drug has “helped” a person is not the same thing as positive results in a double-blind study. Many people claim that they have been helped by homeopathic medicine or other “cures” that can’t be documented scientifically.”

    To defend psychiatry you keep appealing to “your experience”. To debunk psychiatry I keep giving data of meta-studies that favor the placebo hypothesis over the “psychiatric hypothesis”.

    I respect your right to accept the destiny of the psychiatric quackery. I do not respect your position that we should blindly accept as “scientific” the psychiatric quackery or that the state should have a right to impose this quackery onto people who have committed no crimes.

  79. CannotSay2013 says:

    Harriet,

    For lack of space, I put it here. You’ll find the following exchange between Lieberman (the current president of the APA), Insel (the director of the NIMH) and
    Greenberg (an outspoken critic of psychiatry who stops short of calling it a pseudoscience) enlightening. Note that when Greenberg says that psychiatry is a stepchild of medicine, he is just repeating something that Lieberman said earlier in the dialog.

    http://www.npr.org/2013/05/31/187534467/bad-diagnosis-for-new-psychiatry-bible

    GREENBERG: But let’s add to that, Jeff, that under the current regime, 50 percent of the American people will suffer mental illness in their lifetime and 30 percent, close to 30 percent in any given year. Also, it’s important to point out that those two moves which – the deletion of homosexuality and the addition of PTSD, both of which are great moves if you’re going to have something like a DSM. Both took place by expert consensus on – basically on the basis of a vote. In fact, in the case of homosexuality, a referendum. And this is the problem of the DSM. It is that – it is presented to us as a scientific text, and yet in what other medical field are scientists voting on what a disease is?

    LIEBERMAN: Oh, it’s not a vote in that sense, Gary. This is basically an analysis of the literature and consideration in the context of public health needs. But if you look at…

    GREENBERG: Excuse me.

    LIEBERMAN: But there are other disorders. Let’s take irritable bowel syndrome. Let’s take migraine headaches. There are conditions for which we do not have clear biological measures or known ideologies that are nevertheless distressing and harmful to people require treatment by physicians and the specialty that they occur in needs to make some determination as to how to characterize it and how to define it. And if in the absence of having these objective measurable tests that needs to be done by some clinical consensus based on the extant scientific literature, that’s the best way to they know to do it.

    GREENBERG: Yes. And that can’t be denied. I’d just say two things about that. One of them is that psychiatry, as I said earlier, is the only field as you says – I think you said it’s a stepchild – it’s the only field that can’t – hasn’t been able to keep up with this. With respect to all of its diagnoses, and I think that’s an important problem. It doesn’t mean that psychiatry is not a valuable profession. It means that it needs to be understood where it fits in in the panoply of scientific medicine.

    1. Harriet Hall says:

      I have been patient, but my patience is now exhausted. I will not be responding to CannotSay again.

      1. CannotSay2013 says:

        Basically, you have lost the debate, which is 100% fine with me. Your position is untenable or it is tenable only if you admit to the double standard. You accuse CAM defenders of the very same tactics that you yourself use to defend psychiatry. Something doesn’t add up here.

        1. WilliamLawrenceUtridge says:

          That only applies if you consider the discussion a “debate”, which it is on your side since a debate is a duel of rhetoric rather than evidence. It’s certainly not a rational discussion, since that would require you conceding any point besides yours has any merit.

          You’ve won the “debate” the same way the Republicans won the “debate” over Obamacare – by plugging their ears and stonewalling anything remotely close to a rational discussion.

          1. CannotSay2013 says:

            Introducing politics in a discussion about science is a red herring.

            What has been shown clearly in the debate here is that those of you who claim that psychiatry is “scientific” have very little to show to support that claim. And the “little” you show makes psychiatry look like the very CAM that you so much despise: “I know a guy who is happy with his SSRIs”, “that neuroleptic worked from my nephew”, “my son was civilly committed and his life was “saved”" and so on.

            What you haven’t shown is any single objective test that can attest to the scientific validity of DSM labels (because there aren’t any). You haven’t shown any unbiased, non corrupted study that shows psychiatric drugs to be “efficacious” even using psychiatry’s own measures of efficacy (which is a lot to give to psychiatry since there are no biomarkers for any of its invented diseases). And finally, you haven’t shown any argument to the notion that a psychiatric intervention is better than no intervention at all other than stories about nephews, sons and sisters that those of us who believe in science call aptly “anecdotal evidence”. What that “anecdotal evidence” cannot do is to refute both the legal and social consequences of a psychiatric label that will follow the victim until his/her death. The consequences of this labeling are evidenced by both the coercive psychiatric laws that exist in all 50 states (that are based on DSM labeling) and rigorous studies that show that stigma against people who behave in non socially accepted ways increases once those people are assigned a DSM label. Those are the facts, that is the evidence. Yours is dogmatism no different from the guys who defend homeopathy along the lines you use to defend psychiatry.

        2. weing says:

          @CNS2013,

          You keep repeating what Tom Insel says but I do not think what he says means what you think it means. I can see Tom Insel’s reasoning well enough to agree with it. I do not see yours, which appears to deny the existence of psychiatric illness. We all know that DSM is not ideal and that psychiatry has a long way to go to become a science. It appears you want to throw the baby out with the bath-water. Even a broken watch gives the correct time twice a day.

          1. CannotSay2013 says:

            What Tom Insel said is,

            “The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

            Which in plain English means,

            - DSM labels are CREATED by “consensus” of psychiatrists. While some people compare this with the debate about the status of Pluto as “planet”, the comparison is not pertinent because there is no question that Pluto exists as an independent solar system body.

            - The DSM labels have not been validated by independent biological tests to exist (which is where the analogy with the debate surrounding Pluto breaks; Pluto has been observed with telescopes and now there is a probe in its way to spend some time studying it).

            This is where I agree 100% with Insel. That is not to say that Insel denies “mental illness” or that he doesn’t express “faith” that biomarkers for so called “mental illness” will be found. But while the paragraph above is an accurate statement about the lack of scientific validity of DSM labels, his statements about “faith” are just that, “statements about faith” no different from the statements about “faith” that practitioners of homeopathy make about their discipline.

  80. mousethatoared says:

    I feel comfortable that any person who happens upon this discussion has a good amount of different points to inform their opinion on the topic of psychiatric diagnoses. It’s not an in depth view by any means, but it’s a start.

    I look forward to listening to the NPR interview. Science Friday is one of my favorite programs.

    I don’t have these sort of discussion to win or lose. I have them to learn, to share information and my perspective. The conclusions that people draw is up to them.

    So CNS13 -If you want to declare victory, that’s fine with me. Best of luck to you.

    1. CannotSay2013 says:

      I declare that I have won the debate because the motion, as far as I was concerned, was whether psychiatry is a scientific discipline and its corollary , whether psychiatry is closer to homeopathy than to scientific medicine. Based on the arguments provided the answer to both questions is Yes.

      I didn’t make it clear outright, but I thought it was understood in the premise what are the requirements of a discipline to be considered “scientific”. In case it wasn’t I want to make it clear that to call a discipline scientific it has to fulfill at least the following two requirements,

      1- It has to deal with entities (or “objects”) if you will that exist objectively. The very existence of these entities is NOT a matter of opinion no matter how imperfect our knowledge of them can be. Mechanics requires the existence of gravity, even though the Einstein model is better (see point 2-) than the the Newton model when it comes to making quantitative predictions, the existence of “gravity” is independent of the model used to understand it. The same is true with chemistry, biology or mathematics. The latter is a bit peculiar in the sense that the realities it deals with are conceptual, not material, but the existence of its objects (axioms, theorems, etc) is a precondition to do mathematics.

      2- The method to know the entities described in 1-, is the scientific method or, such as in the case of mathematics, the laws of mathematical deduction. The scientific method helps differentiate good models from bad models or better models from just “good ones”. The scientific method requires “falsifiability”, meaning, experiments that can turn out to be false if the theory under test is incorrect. A failed experiment serves to refine models or to discard bad ones. The ultimate objective of scientific discipline is to come up with some kind of theory that allows to make QUANTITATIVE falsifiable predictions., emphasis on QUANTITATIVE, even if it is binary (HIV infection leads to AIDS, while absence of HIV infection does not lead to AIDS, etc).

      When people make appeal to “scientific nature” of something, they have in mind hard sciences that make possible to send probes to Mars, planes fly or build the LHC to detect Higgs bosons. In the case of medicine, and the basic sciences it is related more closely (chemistry and biology), people have in mind vaccines, antibiotics and HAART therapies. In other words, when people use the word “science”, it doesn’t want to appeal to “economics” or so called “social science”. These are “physics envy” disciplines that only use the word “science” in the way psychiatry attempts to hijack the term “science”.

      Psychiatry has attempted to highjack the word “science” since its very beginning but it has failed miserably to meet the first point, let alone the second. DSM labels, it is now widely admitted by the psychiatric establishment itself, do not meet the requirement 1- in a biological sense. That is not to say that there aren’t genuine brain diseases, there are, Alzheimer’s or Creutzfeldt–Jakob Disease (all its variants) are examples of said diseases. None of the DSM labels has been shown to be of this nature in any way, neither through imaging techniques or autopsies. Psychiatry keeps asking for “more time” (as if 200 years weren’t enough) to prove that these labels are real each time there is a crisis that invalidates its latest scam, but at some point one has to say enough! In this regard, psychiatry is like homeopathy. Practitioners of homeopathy, many of whom have MD degrees, also appeal to the notion that “just because we have not explained how the homeopathic effect works, it doesn’t mean it isn’t real”. They also make claims about “effect sizes” and appeal to “anecdotal evidence” of nephews and sisters who were “cured” by homeopathy. Alas, those anecdotes are as irrelevant to determine the scientific nature of homeopathy as the numerous anecdotes brought here by the defenders of psychiatry are with respect to determining the scientific nature of psychiatry. If psychiatry claims that its invented diseases are biological, it has to come with a biological test that can be used to detect presence or absence of disease. Absent that, it is not science, it is something else. And,as Greenberg says above, that is not to say that there isn’t value in the psychiatric profession for some (just as some derive value from homeopathy), it just means that it is not a scientific discipline.

      And as a non scientific discipline, government should not promote it, nor should it “impose it by force” to innocent victims. It should be entirely voluntary.

    2. CannotSay2013 says:

      And a final note about homeopathy.

      What I find astonishing -even though there is an explanation for it- is that both homeopathy and psychiatry have been around for almost the same amount of time (~200 years). In its heyday, homeopathy was extremely popular, to the point that its remedies were officially sanctioned by the FDA in 1938 (and to this day homeopathic drugs continue to be FDA regulated). Yet, while the scientific establishment lost patience with homeopathy, it continues to have faith in psychiatry despite the fact that psychiatry has ruined more lives -by way of lobotomy, insulin therapy, ect, forced drugging, etc- than homeopathy ever will.

      As to the reason why psychiatry continues to be promoted to this day, I think that, as always, Thomas Szasz nailed it when he said that psychiatry is “politics and economics”. The economic part is the money made by both psychiatrists and Big Pharma companies. In the US alone, there are 50000 psychiatrists whose livelihoods would be threatened if psychiatry achieved homeopathy status. Big Pharma makes 70 billion dollars a year worldwide in psychotropic drugs (that’s 15% of their worldwide revenues). So the economic incentive, is real. The politics part is that governments have a “scientific” way of imposing behavioral control that substitutes the role played by religious tribunals to do the same prior to the birth of legal psychiatry.

      Now, to be clear I am NOT claiming a conspiracy. I am just say that there is a lot of self interest working in aggregation, both economic and political, that explains why psychiatry endures (while those interests are absent in the case of homeopathy). My claim is analogous to saying that a lot of people in developing countries (particularly China) work in deplorable conditions so that those of us in the Western world can buy cheap electronic gadgets. That is not the same as saying that there is a conspiracy among Western consumers to slave said workers. I hope that people here understand the difference between my explanation and a conspiratorial one -although honestly I am skeptic that you will given the low quality of the arguments put forward in defense of psychiatry.

    3. sarkeizen says:

      “None of the DSM labels has been shown to be of this nature in any way, neither through imaging techniques or autopsies.”

      As usual people like you who are kind of bad at math end up with pretty illogical results. So what’s our expectation here? “Psychological diseases should show up in imaging and autopsies”

      Well that’s an interesting, although a very exceptionally stupid position. Especially when you say: ‘You cannot see “software” anywhere but surely it is real’

      And yet by the same token you would be hard pressed with current imaging techniques to be able to determine if a program running on a computer was buggy. Similarly if you were to do an autopsy on a computer it would be difficult, to determine that there was a buggy program running on the computer EVEN if the entire contents of memory were preserved.

      1. CannotSay2013 says:

        Since it seems you understand the software analogy better than other people -even though you have some problem acknowledging the reality of mathematical objects- here is my claim in the context of this analogy:

        psychiatrists are hardware engineers doing software debugging with things like ECT (you can actually electroshock a memory chip), adapting the conductivity of semiconductors or resistors (that’s what SSRI and neuroleptics do). In Computer Engineering/Science, those hardware engineers would be fired. To do software debugging, you call software engineers no matter how many assurances you get from the guy who is a semiconductors expert that he can fix your memory leak by way of changing conductivities.

        I have never claimed that human suffering isn’t real nor that the brain is the physical support of the brain (in the way a memory chip is the support of software), what I am saying is that psychiatry is a fraudulent endeavor for claiming that software issues are just “conductivity in an NP junction gone wrong that can be fixed by changing the amount of doping material in the junction”.

        There is one place where the software analogy breaks, and that has to do with coercion. As far as we know, software doesn’t have free will, while humans do, a concept that is recognized as the basis of citizenship rights and responsibilities.

        So the notion of fixing “the software of the mind” assumes that there is an objective, applicable to all “right software” and denies the right to exists to other software. In the mind of a dogmatic Mac zealot, Linux and Windows are “software illnesses”.

        1. WilliamLawrenceUtridge says:

          The software analogy breaks down far before reaching coercion. Humans actively attempt to maintain behaviours, even those that are harmful in one way or another. Further, there is considerable reason to expect that some of the problems are found at the “hardware” (neurological and anatomical) levels. Humans are also self-reinforcing, they have independent agency, they exist within a massive collection of other humans (society) that attempt to live peacefully following rules (laws, customs and mores) but within which there can be local “cheaters” who can be tolerated in low numbers, with relatively mild “cheating” (violence, deception or delusion) but must be coercively dealt with to protect the larger body. Humans exist within conditions of uncertainty, unpredictability and imminent threat, with permanent consequences. If someone is killed, you can’t just reboot or reinstall – they’re gone forever. If someone is maimed, you can’t just give them a new arm. If someone gets AIDS, you can’t give them an HIV-free life. To offset that unpredictabilty and permanence of consequences, we have things like jails, mental hospitals and the criteria used to navigate them – laws and diagnoses. Imperfect criteria, but better than anarchy and might making right. There are controls in place, meta-level reviews of risks and impacts. Imperfect, but present.

          Part of the problem of your arguments is the simplicity of the analogies you use, but the larger issue is the fervour with which you believe in them. Dogmatically, one could say.

          I would be curious to know how many of the people you quote about the DSM wish to see it completely abandoned, and how many merely think the DSM-5 is flawed and would prefer a return to the DSM-IV-TR, and how many think that all attempts to categorize mental illness are outright worthless.

      2. sarkeizen says:

        “even though you have some problem acknowledging the reality of mathematical objects”

        It’s more that your notion of reality is poorly defined and inconsistent and that you have a terrible crippling ignorance which you patch up through ridiculous dogma. Some of which I’ve already given examples of.

        Are real numbers “real” even though some can not be represented in any physical system?

        “psychiatrists are hardware engineers doing software debugging with things like ECT (you can actually electroshock a memory chip), adapting the conductivity of semiconductors or resistors (that’s what SSRI and neuroleptics do). In Computer Engineering/Science, those hardware engineers would be fired.”

        Who says the psychiatrists have to be hardware engineers? Nobody. The point of the argument is that *you* say what the psychiatrists are identifying is not *real* by virtue of it not showing up in a set of tests. However the selfsame tests (or the analogous tests) would be unlikely to identify something you consider real. Thus your argument is not necessarily true. So, if you’re being rational (which you aren’t) your confidence in your belief should be reduced by exactly the same amount it had been bolstered by when you believed it correct.

        “I have never claimed that human suffering isn’t real”

        You did classify all psychological disorders as “not real”. Anorexia is a psychological disorder in the sense that it’s an Axis I DSM IV disorder. How is it “not real” but the person is “really suffering”?

        As I mentioned earlier your definition (or application) of “real” doesn’t appear to be very good.

        1. CannotSay2013 says:

          “Who says the psychiatrists have to be hardware engineers? Nobody.”

          The psychiatrists themselves who have become pill dispensers, ECT deliverers and things like that. There is also the fact that they attribute what they call mental “illness” to hardware issues. In the statement in which he rejected the validity of DSM labels, Tom Insel reinforced his view that so called “mental illness” is biological and that to search the “biological” causes, the DSM was impeding research.

          “Anorexia is a psychological disorder in the sense that it’s an Axis I DSM IV disorder. How is it “not real” but the person is “really suffering”?”

          It is not real in the sense that it is not “CJD or Alzheimer’s” real. I think I have made myself pretty clear.

          I made a typo earlier (emphasis on the correction),

          “I have never claimed that human suffering isn’t real nor that the brain is the physical support of the MIND (in the way a memory chip is the support of software)”

          mind = software, that is the analogy (with the free will caveat). Psychiatrists are just bad hardware engineers. They fix “memory leaks” adding RAM memory or disk fragmentation by adding hard disks. That is the type of person who does psychiatry these days.

          Anorexia is not an illness anymore than Linux is an illness in a MacOS dominated world.

          WLU,

          You lost any credibility that you might have when you compared so called “mental illness” to temperature, and “temperature” (hint for you, it is a number) to the DSM labels. Man, I can certainly suggest you take a serious, upper class or graduate level course in the scientific discipline of your choice (math, physics, chemistry) so you can understand the absurdity of your propositions. Probably you lack the intellect to succeed in any, which is why you come up with your nonsense.

          1. WilliamLawrenceUtridge says:

            You are certainly right that anorexia isn’t like linux or any other piece of software, because people aren’t computers. Again, your analogies are either non-commensurate, or are pushed too far and break down. It has been pointed out why, and there is a reason why analogies eventually must give way to actual descriptions of reality.

            I didn’t compare the DSM to temperature. I compared its diagnostic criteria as a whole to the very earliest cookbooks and attempts at forging, that relied on imprecise but generally, with experience, meaningful indicators of temperature. In this example, mental illness would be “heat” and “that’s cold/cool/warm/hot” would be akin to the behavioural criteria.

            I also pointed out that you should stop comparing it to precise disciplines like math, physics and chemistry because it is orders of magnitude more complicated, and has not reached the level of precision those are at. However, much like 22/7 once approximated pi, or alchemy approximated chemistry, the current DSM diagnoses approximate a meaningful categorization of qualitative differences between “normal” and “ill”, as well as different types of “ill”.

            Do you normally resort to insults and misrepresentations like this in all your conversations? Calling me stupid isn’t the same thing as indicating you have understood my own analogy, or the point behind it but it might indicate frustration on your part.

          2. CannotSay2013 says:

            “I also pointed out that you should stop comparing it to precise disciplines like math, physics and chemistry because it is orders of magnitude more complicated, and has not reached the level of precision those are at. ”

            Again, that is where the prestige of the word SCIENCE comes. Any discipline that doesn’t achieve that kind of precision is not, in my opinion, scientific. In fact, the lack of precision of the DSM was also invoked by Tom Insel in his statement about its lack of validity.

            Based on the Feynman testimony, I am far from alone in my appreciation. In fact, unlike you, I know many people in the hard sciences and they share also that view. It is only in this pseudo skeptic circles that the meaning of “science” is elastically applied to disciplines that pseudo skeptics consider “scientific” because they say so or because some “judge” says so. A judge is not qualified to define “science” anymore than a car mechanic is qualified to make determinations about matters of legal procedure he knows nothing about. I read once Steven Novella lamenting that big names in science do not want to have anything to do whatsoever with his “skeptic movement”. A few interactions with his followers is enough to understand why :D.

            “Calling me stupid isn’t the same thing as indicating you have understood my own analogy, or the point behind it but it might indicate frustration on your part.”

            If you don’t want to look stupid maybe you should not say stupid things. Speaking of Steven Novella, if you take a class like this one taught at his university http://catalog.yale.edu/search/?P=MATH%20247 , you will gain an appreciation of what real science “truly is” :D.

          3. CannotSay2013 says:

            WLU,

            And another thing that I find annoying is this reference about how the “complexity” of the brain makes comparison of psychiatry with actual science difficult. Apparently you must have missed the sequence of events that went on from 1964 to 2012 (time during which the Higgs boson was first postulated, then verified with highly sophisticated equipment that required thousands of people working together building instruments more complicated than you can possibly conceive). The experiments that led to the confirmation of the HIggs boson required a complexity that is several orders of magnitude greater than anything that psychiatry has ever accomplished. It is not like psychiatry didn’t have money at its disposal during this time. With a budget of around 9 billion dollars, the LHC’s total cost is less than what the bestselling drug in Big Pharma takes in in a year.

            If psychiatry hasn’t been able to make a similar progress is because it is a fraudulent endeavor. Just as astrology, they are stuck in nonsensical concepts.

          4. WilliamLawrenceUtridge says:

            Any discipline that doesn’t achieve that kind of precision is not, in my opinion, scientific. In fact, the lack of precision of the DSM was also invoked by Tom Insel in his statement about its lack of validity.

            I’ve highlighted the problematic part of your statement. The lack of precision is well-understood, which is why research on mental illness and diagnoses is ongoing. The alternative you seem to be arguing for would be ceasing to intervene until we have the perfect intervention, or giving up entirely. Neither option is particularly workable, either for psychiatry or for any other human endeavor.

            I know many people in the hard sciences and they share also that view.

            Yes, because they are in the hard sciences, so their view of science is shaped by the field they are in. They have less appreciation for the complexities of systems that can’t be well-characterized by equations. That’s rather the problem I’ve been pointing out in your reasoning.

            A judge is not qualified to define “science” anymore than a car mechanic is qualified to make determinations about matters of legal procedure he knows nothing about.

            Again, as I said before, the judge was making a judgement about the difference between a science and a pseudoscience, specifically creationism. The judge’s opinion was informed by Michael Ruse, a philosopher of science. And this is reverse argument from authority – “how could a judge know anything about it? Therefore I can discount his opinion.” Never mind that you haven’t really pointed out any flaws in it aside from it not coming from your preferred figure of authority. What part of naturalistic explanations, repeated testing, replication, publication, the tentative nature of results, and falsification do you find to be unscientific? You appear to have introduced your own criteria of “(arbitrary) precision”, and while I do think some form of less subjective decision-making is useful (that’s where statistics are handy) I don’t think it’s a necessity. Often meta-analyses are judged based on inter-rater reliability and simple nominal classifications, yet still produce useful products that represent reality.

            If you don’t want to look stupid maybe you should not say stupid things.

            Similar to your judgement about science, merely because you find them stupid doesn’t mean my comments lack value. I would venture that the issue here is your absolutist approach, and motivated reasoning to discount any disagreement or objections (in turn based on your personal, emotional reaction to psychiatry allegedly being improperly used coercively at one point in your life. While I can see why this would leave a bad taste in your mouth – it doesn’t automatically justify your opinions anymore than one car accident justifies removing all vehicles from the road. Again, it seems like you are unable to see how your own experience has biased you to the point of unreason and the persistent challenge is increasing your frustration to the point that you have reverted to simple insults rather than reason.

            Speaking of Steven Novella, if you take a class like this one taught at his university, you will gain an appreciation of what real science “truly is”

            I will note that the course you linked to is math. Math isn’t all of science, it’s a tool of science, and it’s not even necessary to conduct science – but it is extremely useful in many ways. Are there any definitions of science that you are aware of that require and embed “math” as part of their definition?

            Apparently you must have missed the sequence of events that went on from 1964 to 2012 (time during which the Higgs boson was first postulated, then verified with highly sophisticated equipment that required thousands of people working together building instruments more complicated than you can possibly conceive). The experiments that led to the confirmation of the HIggs boson required a complexity that is several orders of magnitude greater than anything that psychiatry has ever accomplished.

            Sure, that’s true – the experiments and equipment are incredibly complicated. But the underlying subject are really a small number of finite particles. Atoms are made of only three, protons, neutrons and electrons. These are in turn made up of 17 smaller particles. None of these particles are reactionary, you run the same million experiments and you get, within a statistical wobble, the same results. But you don’t have to deal with the Hawthorne effect, placebo effects, neurological damage, the multitude of processor units that underlie a functioning brain, between ten and twenty different sensory organs. The histories of these particles do not matter, they are interchangeable. So while the methods of particle physics require massive experimental apparatuses, their ultimate subjects are much, much easier to understand (the hard part about going deeper into the models is not the models themselves, but generating the energies sufficient to do so). Further, the histories of the people studying particle physics don’t have their own impacts and don’t add complications to the analysis. Subatomic particles don’t react differently depending on the geography, culture or time period that they exist in. You don’t have to worry about nutrition, or disease states modulating their interactions – leptons don’t get sick.

            So yes, psychiatry is more complicated than particle physics.

            It is not like psychiatry didn’t have money at its disposal during this time. With a budget of around 9 billion dollars, the LHC’s total cost is less than what the bestselling drug in Big Pharma takes in in a year.

            Psychiatry is not solely made up of drugs, and you can’t measure progress by the amount of money thrown at something.

            If psychiatry hasn’t been able to make a similar progress is because it is a fraudulent endeavor. Just as astrology, they are stuck in nonsensical concepts.

            Nope, psychiatry has abandoned concepts and evolved, slowly and painfully. Freud is now a historical curiosity, even Skinner is seen as useful but incomplete. Cognitive behaviour therapy, which recognizes the complexity and self-regulating nature of humans, is probably the dominant paradigm. And the progress hasn’t been wasted; behaviourism, while incomplete, is still a powerful and well-validated paradigm. If we’re playing analogies, it would be like the “solar system” model of the atom perhaps. The DSM might be seen as an early version of the periodic table, something before Mendeleev perhaps.

            Imperfect, but inching forward.

          5. CannotSay2013 says:

            WLU,

            You are doing yourself a great disservice. Every time that you try to “explain better” what you mean, you end up giving more reasons to those of us who discount your point view.

            You say that the opinion of those who do hard science is biased by the work that they do, and yet you want to hijack the very work that they do, and the prestige that comes from the precision of the work that they do, to claim that psychiatry is like that. It is a genuine expression of a phenomenon known as “physics envy”. You have a great discussion about the matter here http://www.nytimes.com/2012/04/01/opinion/sunday/the-social-sciences-physics-envy.html?_r=0 (it’s behind the NY Times pay wall, but if you use the browser in private mode you should be able to read it).

            Then you double down in discounting the complexity of the LHC, which just shows your intellectual inability to grasp the complexity required to make it work nicely: from computer chips that have billions of miniaturized devices (each of which designed with quantum physics equations that assume a great deal of randomness in the underlying phenomena), to the tunnels, to the instruments, to the different pieces of software -that control instruments as well that analyze data-, all of which needs to work with an extreme degree of precision in coordination (in other words, the fact that the pieces work together is itself astonishing).

            Finally, the progress that you claim for psychiatry is no different than when Western astrology introduced the use of ephemerides to make it look as if “astrology” was on par with “astronomy”. Since the underlying discipline was fraudulent that was just a cosmetic change. Same happened with psychiatry when it moved from being Freudian to being about “chemical imbalances” or “fMRI correlates”. Note that the parallel with the evolution of astrology is very strong since at the end of the day astrology moved from a vision of “planets influence your personality” to “the position of the planets correlates with your personality”, which is basically the latest scam of psychiatry: “fMRI correlates with behavior in an “astrological” sense”.

            Not sure with argument you will come up with, but as long as you keep talking, you will bury and discredit psychiatry even more in the eyes of those who take science seriously. Every argument that you have given in favor of psychiatry makes it look like astrology even more :D.

          6. WilliamLawrenceUtridge says:

            Every time you discount my ideas, you are pretty much repeating your “anything that isn’t physics, isn’t a science” line. Psychiatry and other social sciences aren’t “hijacking” the prestige of physics, they are adapting the methods of science to match their own disciplines. What’s your alternative, putting people in particle accelerators so we can find out the psychological effects of blasting them with electrons accelerated to the speed of light?

            I’m not discounting the complexity of the LHC. Again, you are by malice or bias, missing my point. The LHC is complex, but it is used to generate data on a very simple set of fundamental particles. Psychiatry and other studies of the mind uses different tools to generate less precise data on an extremely complex set of fundamental units of analysis (people). You yourself are grossly simplifying psychiatry to the point of caricature by pretending it’s nothing but Freud, drugs and coercion, not to mention ignoring (deliberately and with prejudice) its successes (identification of individual units of the physical brain; identifying correlates of diagnoses in the brain; identifying fundamental laws of behaviour, identifying damage that mimics illness, identifying tools to modify behavior, identifying chemicals that modify mood – your discounting aside, they do have limited utility in some subsets of patients even as they are grossly overused).

            In your mind, psychiatry may be similar to astrology, but you primarily maintain this by applying inappropriate comparisons to other sciences, ignoring substantive points made by others, using inapt analogies and having a history of psychology that ended circa 1960.

            It’s awfully easy to discount others arguments when you fail to acknowledge the premises from which they are made.

          7. CannotSay2013 says:

            WLU,

            I have said many times, please keep “defending” psychiatry :D. You claim a success “identifying correlates of diagnoses in the brain”… Sure, of the kind that show that a dead fish responds to human emotion!!!! In case you didn’t read the study about the dead fish, I did, the claim of the researchers was not that dead fishes respond to human emotion but rather than using the “generally accepted criteria for establishing correlation between fMRI and behavior” one could show that a dead fish responds to human emotion.

            So no, psychiatry has not had successes. It has been failure after failure. The only “success” is that its scams are increasingly less barbaric, but in terms of outcomes, psychiatry has been increasingly worse overtime.

          8. sarkeizen says:

            “The psychiatrists themselves who have become pill dispensers, ECT deliverers and things like that. There is also the fact that they attribute what they call mental “illness” to hardware issues.”

            Let me be clear…clearer because you seem to be intent on avoiding reading things that challenge your dogma:

            In your argument “psychological disorders are not real because they don’t show up in autopsies or in diagnostic imaging” nothing NECESSITATES that we look at psychologists as hardware engineers. Your argument was: software is real (and by extension software bugs must also be real) but psychological disorders are not *real* by virtue of being undetected by autopsy and diagnostic imaging.

            This is, as I’ve demonstrated several times logically inconsistent and you, by clinging to it are being irrational.

            Either that argument, when you thought it correct increased the likelihood (in your mind) that you are correct or it did not. If it did then you must now commensurately DECREASE your confidence in your thesis OR if it did not increase your confidence then the argument has no value as evidence.

            Let me know, what you decide here.

            “It is not real in the sense that it is not “CJD or Alzheimer’s” real.

            So then are psychological disorders are “fake” – that is *not real* or simply not “the same kind of real” and what is the significant difference between these two “realities*?

            “I think I have made myself pretty clear.”

            No, someone who rather suddenly changes their argument from “It’s not real it’s fake” to “well it’s real but a different kind of real”. Is not being clear – in fact it’s a form of a logical flaw called *equivocation*.

  81. pmoran says:

    CannotSay2013, I disagree totally with your definition of science, especially as it applies to medicine. Perhaps 50% or more of its activities have to do with the relief of subjective complaints.

    I don’t believe we even have an entirely satisfactory definition of what “science” is, yet you seem to be making far-reaching judgements about psychiatry on the basis of a rather idiosyncratic, purist, narrow, personal definition of this concept .

    I have come late to this and apologise in advance if I misunderstand you, but do you really regard human mental suffering and disability and the consequences of that for others as having insufficient basis in reality to form a field of scientific inquiry?

    Do you not also see that the first step in any such field is to try to break the material down into different diagnostic categories? This has proved as vital as any other component of medical “science” in developing an understanding of disease processes, causes, useful treatments, prognosis, prevention etc.

    moreover it is the subject matter that makes the attempts of psychiatry to do that difficult, not any ongoing general belief that psychiatry is exempt from the standards that apply in the rest of medicine or science.

    Nevertheless, I do strongly agree that some areas of medicine are less securely science-based than others and that psychiatry and perhaps its DSM (for all I know as a non-expert in this field) may be among the worst.

    Yet in all areas of medicine, especially intensive care, sports medicine and physiotherapy, and even parts of medicine and surgery we quite often have to make do with the best evidence we can marshal, from the anecdotal upwards in rare conditions where there is not much systematic data.

    This is not from any acceptance that these lesser standards allow equivalent degrees of “scientific” certainty or of an abstract state of “being scientific”. It mostly stems from resource constraints, the difficulty of ethically and safely investigating some questions, and the necessity of having to take immediate action on the best evidence available at that time.

    Thus, I contend that behind every “scientific ” judgement in medicine there is an unspoken “for present practical purposes”. There is also a tacit general understanding, which you fail to give us credit for, that this involves degrees of closeness to or distance from absolute “scientific” truth.

    So you would have to condemn a great deal of medicine, not only psychiatry, if your narrow, purist definition of “science” was to be regarded as the minimum qualification for being “science-based”. That term is quite consistent with the application of “the best evidence available”.

    You may have a valid case to make about certain details.

    1. CannotSay2013 says:

      Richard Feynman, who not only is the greatest American physicist that ever lived but he is also considered one of the top 10 physicists ever by a survey done by one of the British Royal Academies of science among its members, had this to say a few years before he passed away. I think he had people like you in mind,

      https://www.youtube.com/watch?v=IaO69CF5mbY

      Now, I am sure that you are also less forgiving with the applied physicists who design planes or cars. You don’t ask them to make the plane fly (or the car to work) with “the best evidence available”, you ask them to design the plane so that it flies always, even in very difficult meteorological conditions -ditto of the car. I am also sure that you require no less from the scientists who design computer chips (CPUs, memory, etc) and the computer scientists who design algorithms when it comes to handling your bank account.

      I get your point, but if I am to accept your notion of “science”, not only I would have to accept psychiatry, but also homeopathy, astrology or economics, each of which makes predictions “with the best available information” which turn out to be wrong most of the time.

      1. mousethatroared says:

        CNS13 “Now, I am sure that you are also less forgiving with the applied physicists who design planes or cars. You don’t ask them to make the plane fly (or the car to work) with “the best evidence available”, you ask them to design the plane so that it flies always, even in very difficult meteorological conditions -ditto of the car. I am also sure that you require no less from the scientists who design computer chips (CPUs, memory, etc) and the computer scientists who design algorithms when it comes to handling your bank account.”

        Oh dear, Clearly you are neither an automotive software engineers nor married to one and I guess you have never owned a car.

      2. WilliamLawrenceUtridge says:

        Your evidence that psychiatry is not a science is a 30-year-old clip of a physicist talking primarily about organic food. Here is a paper that social constructivism could mean the end of physics. Therefore your point is wrong.

        Your argument that psychiatry is harmful is a 30-year-old criticism of homosexuality. This past year the United States Supreme Court said gay couples could marry. A position held by the APA and the other APA have held since 2005. Both have also advocated for equal rights for homosexuals since the 70s.

        Your criticisms of anecdotes through reference to your own anecdote shows a fairly substantial double-standard that you are apparently unaware of.

        Again, presumably due to whatever personal experience you had that so irrevocably prejudiced you against the mental health profession, you appear unwilling to admit even on principle that the approach might possibly do some good. In response, you are engaging in some egregious motivated reasoning that makes further conversation pointless, so once again I’ll try to stop. Enjoy talking to Pete Moran.

        1. CannotSay2013 says:

          As always, you keep missing the point.

          This “physicist” is not “any physicist”. Your answer implies you don’t know who is is, and that tells more about your own scientific ignorance than anything else.

          With respect to homosexuality, you are still missing the point. Here is an example of a pattern of behavior, that can be reliably defined, for which there is at least some biological explanation, that has been both a “dangerous mental illness” and a “perfectly normal behavior” only because of a vote of psychiatrists. Homosexuality is the poster example of why psychiatry is fake science. In real science, we deal with objective realities. The status of something as a “disease” doesn’t depend on a vote, only in psychiatry it is the case that all its diseases are created or removed via a vote.

          Finally,

          “Your criticisms of anecdotes through reference to your own anecdote shows a fairly substantial double-standard that you are apparently unaware of.”

          You are confusing the reason why I became aware of the evilness of psychiatry with the reasons I have give to claim that psychiatry is non scientific. This is simply an ad hominem attack of no value.

          Just as surely the people who were victims of eugenic policies were more aware of the social effects of that pseudoscience, those of us who have suffered the consequences of the psychiatric pseudoscience are more aware of its damning effects. But the arguments against it still stand by themselves.

          1. WilliamLawrenceUtridge says:

            I know who Richard Feynman is, and even the greatest physicist in the world and in history can be wrong. Einstein was. In particular, there is good reason to think that a physicist discussing something grossly outside his area of expertise, stands a very good chance of being wrong.

            Since there’s no objective test for homosexuality, do you think it exists?

          2. sarkeizen says:

            “In real science, we deal with objective realities.”

            Really? Is math “real science”? I mean there’s probably not a stick of modern real science you could do without math but is math an “objective reality”?

            “The status of something as a “disease” doesn’t depend on a vote, only in psychiatry it is the case that all its diseases are created or removed via a vote.”

            So cute when people make errors like this. You are conflating diagnostic criteria with illness. Or do you consider Bulimics people without a problem?

            “evilness of psychiatry”

            ROFL. Tell Tom I say: “Hi”

          3. CannotSay2013 says:

            “Really? Is math “real science”? I mean there’s probably not a stick of modern real science you could do without math but is math an “objective reality”? ”

            Of course. Mathematical objects do have a reality by themselves, even though it is not physical. Mathematics is to science what software is to computer science. You cannot see “software” anywhere but surely it is real (and for those confused with the matter, “software” is not the source code of “software”).

            “ROFL. Tell Tom I say: “Hi””

            You mean Szazs? I wish I had had the luck to meet him personally. He is the greatest intellectual ever in the antipsychiatry movement (even though he despised the word “anti psychiatry” because he was mostly bothered by its coercive powers).

            In case you didn’t get the memo, Thomas Szasz has had his standing very much rehabilitated in the aftermath of what the other Tom said back in May (that would be Insel).

            From your interventions here, you are just a sophistry oriented pseudo skeptic who loves to argue about dogmatic technicalities and minutiae. Really, not the type of debate that I find interesting.

          4. sarkeizen says:

            “Of course. Mathematical objects do have a reality by themselves, even though it is not physical.”

            So something can be real and not physical? So Borel’s number is real?

            “You mean Szazs?”

            I mean Cruise.

            “From your interventions here, you are just a sophistry oriented”

            You actually haven’t looked that word up yet have you…

            “pseudo skeptic who loves to argue about dogmatic technicalities and minutiae. ”

            You really need a dictionary. The only person being dogmatic out of the two of us is, of course you. None of your arguments appear to be more than ankle-deep regurgitation of some poorly understood concept.

            To wit: Feynman veneration bordering on worship. Instead of actually talking about what Feynman *said* and arguing your point there you just point to a largely irrelevant YouTube video and then denigrate people for not taking away the same thing you did. Your frequent use of terms like “Sophistry” which appear to be a way of sweeping unexamined arguments under the rug so you don’t have to pay attention.

            “Really, not the type of debate that I find interesting.”

            I get how you might be afraid of losing some of your dogma but at some point everyone must grow up. Let me know when you start…okay? :D

          5. WilliamLawrenceUtridge says:

            In case you didn’t get the memo, Thomas Szasz has had his standing very much rehabilitated in the aftermath of what the other Tom said back in May (that would be Insel).

            My word, it’s almost as if psychiatry were self-critical and evolves in response to reasonable suggestions, observations and evidence!

            From your interventions here, you are just a sophistry oriented pseudo skeptic who loves to argue about dogmatic technicalities and minutiae. Really, not the type of debate that I find interesting.

            Oh, my poor, dripping keyboard. I don’t know if I’ll ever get the irony out once it dries.

            Though you have a point, your preferred style of debate appears to be crystalized opinions and knowledge, asserted without nuance or balance.

    2. CannotSay2013 says:

      And one more thing. This is not to say that there is no worth in the disciplines that I consider “non scientific”. I do not endorse scientism ( https://en.wikipedia.org/wiki/Scientism ) by any means nor I think that the scientific method is the best method for all areas of human knowledge.

      For instance, I do not know that there is a particular “scientific” way of enjoying music. The sublime experience that I have every time that I listen to 1812 by Tchaikovsky is my own experience that is not “scientific”. All science can say is to monitor my cells about how they react when I have the experience or even, if you consider a group of people, which percentage of people consider 1812 enjoyable (even that is problematic because “enjoy” might mean different things to different people), or yet things about the mathematical structure of the waveforms that make up 1812. However, the act of enjoying 1812 is subjective, and none of those things are relevant to the question of whether “enjoying 1812 is a disease”.

      Science, as Feynman said, has had a tremendous success producing results that have benefited humanity. It would be tempting to say that we should scrap all non scientific endeavors, and perhaps that is the true motivation behind this pseudo skeptic movement cherry picking the areas that they consider scientific among the non scientific ones. You proclaim that “science is all that matters” by cherry picking, among the non scientific areas, which areas you consider “scientific”.

      However, I am more of the opinion that science should be used, in its strict form -what you call “pure”- to those areas of human knowledge that are prone to be known scientifically. I am perfectly comfortable with the non scientific areas of my life. In fact, my life would be pretty miserable if I were to exclude all my non scientific interests. No more “enjoying 1812″ for instance!

  82. pmoran says:

    “I get your point, but if I am to accept your notion of “science”, not only I would have to accept psychiatry, but also homeopathy, astrology or economics, each of which makes predictions “with the best available information” which turn out to be wrong most of the time.”

    Not in the least. Does that dubious definition of science have your mind caught in a rut?

    Economics suffers from similar barriers to the performance of desperately needed controlled experimentation to those affecting some areas of medicine, so that it is bound to be riddled with poorly supported precepts. But it will also contain sound “scientists” trying to make the best sense they can out of whatever data they can collect and expressing their findings with due caution.

    In contrast, the hypotheses upon which homeopathy and astrology are based are rendered invalid by a rider that might be attached to different attempts to define science — or “sound science”, — i.e. that its activities be consistent with the best evidence and the whole evidence available ” at the time”.

    So it is that homeopathy was based upon as reasonable “scientific” hypotheses as many others circulating within medicine two hundred odd years ago. Hahnemann, its founder, certainly regarded himself as being at the cutting edge of medical science. IIRC, he was critical of “allopaths” for being “unscientific” . But neither homeopathy, nor astrology, can be considered valid on the evidence we have today and even he would almost certainly think very differently if born today.

    1. CannotSay2013 says:

      I think that the root of the difference here lies in our standard for “science”. In my view, “economics” doesn’t qualify as “science”. It has been ridiculed as “dismal science” for several centuries now and the joke goes that economists are failed mathematicians :D.

      With that said, I do think that there is value in economics, but I don’t consider it a “science” in the same way I consider physics or chemistry to be sciences.

      Even with your extended view of “science”, the critique that you make of astrology or homeopathy still applies to psychiatry. Psychiatry postulates its invented diseases to be “biological diseases” even though there is no biological proof for that, just as astrologers say that there is correlation between planets positions and people’s personalities or homeopaths say that there is a genuine effect in their drugs and they point to “anecdotal cases” as “evidence”.

      With your extended standard for “science”, surely both astrology and homeopathy qualify for it.

    2. mousethatroared says:

      @pmoran – I like your series of comments here. Very helpful to me.

  83. Self Skeptic says:

    Now both copies have disappeared. Here it is, again. My apologies to the moderator, if I’m making extra work for you.

    @CS2013,
    I’ve been reading through these comments, and I followed the link you provided to your NYT comment. I am sorry for your troubles.

    I’d like to say something about this part of your comment:

    “As the vast majority of people, I had a neutral position on the whole field of psychiatry. I assumed that it was just like any other branch of medicine, tested and confirmed by the scientific method to be 100% accurate both in diagnosis and prediction.”

    There is no branch of medicine that meets those expectations. Some of this is because biology is more complex than engineering; an organism isn’t a machine that humans designed and built from the ground up. Some few medical conditions are understood well enough that diagnosis and prognosis are pretty good, but mostly it’s a matter of gathering clues and making guesses, based on what limited evidence is available. I agree that many people don’t realize this until they come up against it personally. There is often a sense of betrayal, and it’s upsetting to lose the sense of safety that faith in medicine provided. But, it is what it is. Once the bubble has been punctured, I think we should cultivate a more realistic view of mainstream medicine’s limitations.

    Here are some studies that can help us dispell our illusions:

    http://www.ncbi.nlm.nih.gov/pubmed/18089495
    Am J Clin Pathol. 2008 Jan;129(1):102-9.
    Discrepancies between clinical and autopsy diagnoses: a comparison of university, community, and private autopsy practices.
    Tavora F, Crowder CD, Sun CC, Burke AP.
    Source
    Department of Pathology, University of Maryland, Baltimore, MD 21201, USA.
    “The overall rate of major discrepancy that involved the cause of death was 17.2%…Additional major findings were present in 28.5% of autopsies.”
    PMID: 18089495 [PubMed - indexed for MEDLINE] Free full text

    Psychiatry was excluded from the following study:

    “The five most commonly misdiagnosed diseases were (in order) infection, neoplasm, myocardial infarction, pulmonary emboli, and cardiovascular disease.”
    http://archive.ispub.com/journal/the-internet-journal-of-family-practice/volume-7-number-2/the-five-most-common-misdiagnoses-a-meta-analysis-of-autopsy-and-malpractice-data.html#sthash.j6dow8fG.dpuf
    C. McDonald, M.B. Hernandez, Y. Gofman, S. Suchecki, W. Schreier: The five most common misdiagnoses: a meta-analysis of autopsy and malpractice data. The Internet Journal of Family Practice. 2009 Volume 7 Number 2. DOI: 10.5580/9ce

    A widely-reported study in BMJ Quality and Safety concluded that diagnostic errors are the most common type of medical error:

    http://www.ncbi.nlm.nih.gov/pubmed/23610443
    BMJ Qual Saf. 2013 Aug;22(8):672-80. doi: 10.1136/bmjqs-2012-001550. Epub 2013 Apr 22.
    25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank.
    Saber Tehrani AS, Lee H, Mathews SC, Shore A, Makary MA, Pronovost PJ, Newman-Toker DE.
    Source
    Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
    “CONCLUSIONS:
    Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.
    PMID: 23610443 [PubMed - in process]

    One of the authors of this paper, Marty Makary, is a surgeon at Hopkins, and he published a book titled Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. It’s very readable. Amazon has 154 reviews of it.
    http://unaccountablebook.com/

    Another recent report, in the Journal of Patient Safety, suggested upping the estimate for the number of premature deaths per year attributable to preventable medical errors in the US:

    http://www.ncbi.nlm.nih.gov/pubmed/23860193
    J Patient Saf. 2013 Sep;9(3):122-8. doi: 10.1097/PTS.0b013e3182948a69.
    A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care.
    James JT.
    Source
    From the Patient Safety America, Houston, Texas.
    Abstract
    OBJECTIVES:
    Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011.
    METHODS:
    A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm.
    RESULTS:
    Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.
    CONCLUSIONS:
    The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.
    PMID: 23860193 [PubMed - in process]

    I agree, of course, that psychiatry adds another order of magnitude of fuzziness. I think most of the misdiagnosis analyses don’t even include the psychiatric field, because there’s no good way to assess it. But it’s worth becoming more realistic about the rest of medicine, while you’re adjusting your expectations.

    I’m not suggestingthat we shouldn’t use mainstream medicine. Obviously, it has more to offer than CAM, which I just ignore. But I think we need to dispell our idealized notions about mainstream medicine, and learn how it really functions, warts and all. Then we’ll have a better chance at avoiding harm, and getting what we need from it.

    1. CannotSay2013 says:

      “I agree, of course, that psychiatry adds another order of magnitude of fuzziness. ”

      Correct, which is what my “100%” reference was mean to be. It is an order of magnitude fuzzier than any other area of medicine. In fact, so “fuzzy” that is is as accurate as homeopathy.

      The other thing that psychiatry adds is coercion, which is the real travesty here. HIV science is more accurate than psychiatry will ever be. In the US, each year 15000 people die of what could have been a preventable AIDS infection (more than all victims of violent crime combined). The Cuban experience shows that a policy of “forced HAART treatment” and quarantine of HIV positive people would reduce that toll dramatically : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688320/ .

      The great tragedy is that we have the fuzziest of all medical specialties given a legal right to impose its vision of humanity (in the same way religion was imposed in the past) in a way that other more scientific areas of medicine cannot be imposed.

  84. pmoran says:

    “With that said, I do think that there is value in economics, but I don’t consider it a “science” in the same way I consider physics or chemistry to be.”

    I can agree with the “in the same way”, but don’t understand the basis of the distinction you are making with psychiatry. There is also “value” in knowing that whenever someone claims to be (literally) hearing the voice of God they are a potential danger to themselves and others. That is an example of the predictive value of “science” that you referred to earlier.

    We can also regard ALL scientific knowledge as tentative to varying degrees. The fact that it may be proved wrong or incomplete with advancing knowledge or technology does not reduce its right to be regarded as part of legitimate scientific inquiry, as applied to Newtonian physics, or some of the past speculations about medicine. Likewise, when the intangibility of the subject matter makes psychiatry lag behind the rest of medical science.

    1. CannotSay2013 says:

      “There is also “value” in knowing that whenever someone claims to be (literally) hearing the voice of God they are a potential danger to themselves and others. That is an example of the predictive value of “science” that you referred to earlier.”

      Actually, despite exaggerations to the contrary, psychiatry is notoriously bad at predicting who’s likely to become violent and when as Allen Frances has said repeatedly -will cite the studies later. When it comes to violence, being a young black man drug user in an inner city is a much better predictor of violence than any DSM label (that includes schizophrenia with auditory hallucinations). We do not use that against anybody. Psychiatry’s only purpose is to abuse human rights under the name of “fake science”.

      1. Nashira says:

        CS2013, the concern is not solely that a severely ill person may be violent towards others. We also try to help protect them from being harmed due to their illness, whether at their own hands or someone else’s.

        1. Harriet Hall says:

          Not just violence, also the suffering their illness causes them, as well as consequences such as not being able to hold down a job or sustain relationships with other people.

          1. Nashira says:

            @Dr.Hall: Thank you, I was in a rush when I commented, and forgot to include all the major points. (I thought I hadnt even hit post!)

          2. CannotSay2013 says:

            Whatever… Here is the research that attest that psychiatrists cannot predict violence with any degree of accuracy,

            http://psychcentral.com/blog/archives/2013/05/30/myth-busting-are-violence-mental-illness-significantly-related/

            As to the “alleviating suffering” part, give me a break! That is a similar argument as the one used by proponents of astrology or homeopathy, many of who also find solace in these two.

            The answer is the same as with those two: make psychiatry an entirely voluntary endeavor. Do not give it a scientific value that it doesn’t have. Treat it as what it is: a belief system along the lines of religion.

          3. WilliamLawrenceUtridge says:

            “Psychiatry is not scientific, unless it supports my preconceived notions about it, at which point it is scientific and cannot be questioned, unless it’s a blog, in which case it is more scientific than actual science, as long as it supports my preconceived notion.”

    2. mousethatroared says:

      Just heard and interesting interview about the book Hallucinations by Oliver Sacks on the Diane Rheme Show (NPR). Sounded cool.

      1. Harriet Hall says:

        I’ve read it. It is fascinating. Thumbs up from me.

  85. mousethatroared says:

    CNS13 “Psychiatry postulates its invented diseases to be “biological diseases” even though there is no biological proof for that.”

    I actually don’t think it’s true that no physical destinguishing characteristics have been found for psychiatric conditions, just google OCD and neuroimaging, but even if you won’t acknowledge that evidence…

    Absence of evidence is not evidence of absence.

    1. CannotSay2013 says:

      You again are confusing effects with causes. It’s like saying that memory leaks are caused by an increase of memory usage, when the fact is that the memory increase is the effect.

      Second, to designate the pattern of behavior that the APA calls OCD (which BTW is an umbrella of patterns not a single one) a “disease” is a 100% value judgement just as when the APA called homosexuality a disease. It’s an opinion that has been elevated to the level of fact by a group of self appointed mind guardians that has had disastrous effects in my life. And no, I do not “lack insight into OCD” not any more than a homosexual who refused to be called a “mentally ill” lacked insight into his/her attraction to people of the same sex. All I am saying is that DSM labels are fraudulent, invented diseases. Period.

      You are incurring in every single fallacy of the book used by the quacks that defend homeopathy in order to defend psychiatry. Very pathetic.

      1. mousethatroared says:

        CNS13 “Second, to designate the pattern of behavior that the APA calls OCD (which BTW is an umbrella of patterns not a single one) a “disease” is a 100% value judgement just as when the APA called homosexuality a disease. It’s an opinion that has been elevated to the level of fact by a group of self appointed mind guardians that has had disastrous effects in my life. And no, I do not “lack insight into OCD” not any more than a homosexual who refused to be called a “mentally ill” lacked insight into his/her attraction to people of the same sex. All I am saying is that DSM labels are fraudulent, invented diseases. Period.”

        It’s called a disorder, not a disease. They are seperate entities. As to cause and effect. So you think that someone makes an effort to check that they have locked to door thirty times…maybe just for fun, then does it repeatedly many days in a row, for fun, thus changing their brain? Seems far fetched. What’s your evidence for that?

        The difference between Homosexuality and OCD is that when you accept that someone is homosexual they live a perfectly happy life (well, unless something else is going on in their life). When you accept someone who has OCD…it doesn’t really help, because they experience their symptoms as intrusive and distressing. If they don’t experience their symptoms as intrusive and distressing, they don’t have OCD.

        Do you think you could come up with another insult besides pathetic? It’s getting a bit redundant. Thesauruses are good.

        1. mousethatroared says:

          I said “The difference between Homosexuality and OCD is that when you accept that someone is homosexual they live a perfectly happy life (well, unless something else is going on in their life). ”

          Well to be clear, that’s not the ONLY difference. I should have said ONE difference.

          1. CannotSay2013 says:

            Even assuming it is “just one difference”, how do you know?

            I can tell you that what the psychiatric nutcases at the APA call OCD has served me very well in life. In fact, the only trouble that has brought me is when a so called “loved one” (which after what happened I refer to as “hated one”) didn’t like it enough to have me civilly committed.

            Note that this is very similar to what happened prior to the removal of homosexuality from the DSM with “loved ones” being bothered by their homosexuals family members, many of whom where committed (some even lobotomized).

            Eleanor Longden said here https://www.youtube.com/watch?v=syjEN3peCJw that when she started hearing voices, she made two mistakes: one telling a friend, second telling a psychiatrist.

            That is the point that you still don’t get it. Each and every single one of the DSM labels are “pathological” only in the mind of the nutcases who are part of the different DSM committees. As far as I am concerned, they are the ones that should be civilly committed for their hatred of patterns of behaviors that they don’t like :D.

          2. CannotSay2013 says:

            With respect to being lobotomized for being a “homosexual”, I am not making it up. It happened here, in the US,

            http://www.davidmixner.com/2010/07/lgbt-history-the-decade-of-lobotomies-castration-and-institutions.html

          3. mousethatroared says:

            CSN13 – “I can tell you that what the psychiatric nutcases at the APA call OCD has served me very well in life. In fact, the only trouble that has brought me is when a so called “loved one” (which after what happened I refer to as “hated one”) didn’t like it enough to have me civilly committed.”

            Was this here in the U.S., Recently? I know a number of people through online groups who have been diagnosed OCD usually more severe forms. I have never heard of one of them being committed or even using inpatient psychiatric services…unless we are talking about OCD with an eating disorder as well. I have heard about involuntary treatment for eating disorders.

            Since anecdotes are not useful. Do you have any current statistics for the percentage of people in the U.S. with OCD alone that have been committed involuntarily? Even an individual state percentage would be useful.

          4. CannotSay2013 says:

            mousethatroared ,

            As I have said numerous times, this happened in Europe, in a country where the standard for commitment is “need for treatment” which is a fuzzy word that means “whenever some psychiatric nutcase thinks to be appropriate”. In the US, the standard has been “dangerousness” since the 1970s due to several SCOTUS cases. As to how recent, this happened a few years ago, certainly after the 1970s :D. To the best of my knowledge, the laws of that country with respect to civil commitment are essentially the same as when I was committed.

            Before the SCOTUS decisions of the 1970s, the civil commitment rates in the US were ~ 200 per 100000 along the lines of what is common in Europe wost offenders. Now in the US is more like 10 per 100000.

            So I owe my current freedom to me being a US citizen living in American. I am going to fight with every bit of my soul so that such reality doesn’t change (in other words, I will support any political party that opposes lowering the standard for civil commitment under any circumstance of this ever becomes a campaign issue).

  86. Self Skeptic says:

    To the moderator: Would you please remove the two redundant posts 90 and 91?
    I’ll be slower to repost, in the future, when it seems as if a post failed to be transmitted. Maybe it’s because this is a high-volume site – congrats! ;)

    1. WilliamLawrenceUtridge says:

      Lately it seems that even when the webpage gives a “we effed up” message, it still manages to save my comments. I’ve been trusting it to catch them and so far I haven’t lost one on a couple weeks.

  87. pmoran says:

    Psychiatrists may be poor at predicting violent behaviour in general, but delusional ideation remains a risk factor for episodes of extreme, unprovoked, irrational violence against both relatives and multiple random strangers. The fact that terrorists have an even more murderous bent does not change that.

    1. CannotSay2013 says:

      ” delusional ideation remains a risk factor for episodes of extreme, unprovoked, irrational violence against both relatives and multiple random strangers”

      Again, with the studies at hand (see above), that is a false statement. The only factor known to increase violence is drugs or alcohol abuse.

      In fact, many religions idealize those with what you call ” delusional ideation”, be them Christian or Eastern (like Buddhism).

      As with many things in psychiatry, that is a myth used by psychiatrists to justify that hospitals have them in their payroll or that insurance companies pay for their quackery.

  88. Andrey Pavlov says:

    Some people like it too much “Mr this”, “Ms that” or “Dr this”, “that, PhD”, “Professor this”, “Professor I don’t give a damn about your endowed chair name”. Honestly, I don’t care about titles. Some European countries, which I am not saying because I would be giving out too much about me , are particularly notorious for using titles all the time about everything. I guess it is a way of saying “I am better than you” but I find it disgusting.

    Funny that, coming from someone who so frequently uses argument from authority to outright state that the opinions of those here are not as valid as others because they aren’t credentialed enough for your liking.

    Must be nice using arguments and ideas willy nilly as the suit you and ignoring them when they don’t.

    1. CannotSay2013 says:

      You are confusing “titles” with “authoritative knowledge about something”. These are two different things.

      An academic title, or any title, but itself doesn’t mean much. I have appealed to credentials in a wider sense, not just academic titles.

      When you have people saying “psychiatry is a science because I have an MD degree” you can tell them, well, this other guy, who BTW not only has a PhD degree but such an recognition in scientific research that he has published in science’s gold standards (journals Science and Nature) thinks otherwise.

      At the end of the day, the people who have argued for psychiatry here, have done if from the point of view of “belief” and “faith that DSM labels will be found to be real”, not from logic. All you can tell them is that people who are recognized by the wider scientific community as better scientists than them do not think much of their arguments in favor of psychiatry.

      1. WilliamLawrenceUtridge says:

        You are confusing “authoritative knowledge about something” and “ideas with which I agree”. There are authoritative sources and people who disagree with the people that you are agreeing. What you are doing is referred to as “cherry picking”.

        Nobody here “argues for psychiatry”, it’s more the recognition that mental illness is difficult to treat, and that the DSM is an imperfect step at systematizing that needs to be improved – but is not worthless.

        1. mousethatroared says:

          WLU “You are confusing “authoritative knowledge about something” and “ideas with which I agree”. There are authoritative sources and people who disagree with the people that you are agreeing. What you are doing is referred to as “cherry picking”.”

          Actually, CSN13 had repeated pointed to people like Insel and James Coyne as people that are experts, but then stated they make claims that they don’t appear to be making. ex: CSN 13 claims that Insel is against the DSM because there is no biological evidence of psychiatric illness, while actually, Insel appears to disagree with the DSM because it does not adequately incorporate the biological evidence of psychiatric conditions.

          So it’s not exactly cherry picking, it’s kinda like fishing, then calling fish cherries.

          1. WilliamLawrenceUtridge says:

            One of my earlier comments mentioned “motivated reasoning”, which I stand by and neatly incorporates all the issues of problematic evidence raised in response to shims* comments.

            *My attempt at a Spivak pronoun.

  89. pmoran says:

    No, CS2013, that study referred to any kind of violence, whereas my “statement” specified the acts of violence characteristic of those with serious delusional states.

    Of course you may well hold that laying into a random cinema audience with an axe because “God told me to” should be regarded as merely one variant of “normal” human behavior. I admit in advance that I have no urge to respond to that.

    For the record, I think, as I am sure do most here, that coercive aspects of psychiatry should be a very last resort. I don’t think it happens very often in my country, to the despair of some relatives of the suicides, or those killed in bizarre acts of murder.

    I suspect from my observations over many decades that that the need for that in some psychiatric disorders has been has been drastically reduced by drugs. If true that might be another little way in which psychiatry is earning its spurs as a branch of medical science even if it has some glaring weaknesses in other areas.

    1. CannotSay2013 says:

      You keep repeating a lie, still a lie. The largest study of its kind on so called “schizophrenia” which, by definition is a label applied to those that some psychiatrist nutcase considered “deluded” had this to say,

      http://www.ox.ac.uk/media/news_releases_for_journalists/090520.html

      “There is an association between schizophrenia and violent crime, but it is minimal unless there are also drug or alcohol problems, a large-scale study led by Oxford University has shown. ”

      Then you say,

      “For the record, I think, as I am sure do most here, that coercive aspects of psychiatry should be a very last resort.”

      And for the record, I have little respect for anybody who defends coercive psychiatry in “some cases”. It’s like defending slavery in “some cases”.

      “I suspect from my observations over many decades that that the need for that in some psychiatric disorders has been has been drastically reduced by drugs. If true that might be another little way in which psychiatry is earning its spurs as a branch of medical science even if it has some glaring weaknesses in other areas.”

      Actually, we are now in a position of making precise the statement “psychiatry is a murderous endeavor”. According to the CDC, http://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html

      “Suicide deaths have surpassed deaths from motor vehicle crashes in recent years in the United States. In 2010 there were 33,687 deaths from motor vehicle crashes and 38,364 suicides. Suicide rates among middle-aged Americans have risen substantially since 1999, according to a report in today’s CDC journal, Morbidity and Mortality Weekly Report. ”

      This is during a decade during which the usage of psychotropic drugs skyrocketed.

      This data is consistent with this other finding,

      https://www.madinamerica.com/2013/09/nz-psychiatrist-psychiatrys-medical-model-suicide-prevention-30-year-failed-experiment/

      “Given the Director of Mental Health reports the rate of suicide by those who have used mental health services within the previous year is 18 times higher than that of those who have not used services in the year prior to their death, CASPER would argue that rather than failing to influence suicide rates, the evidence is that mental health treatment has in likelihood increased them. In fact, 137.6 suicides per 100,000 for those who have used mental health services in the last 12 months compared to 7.6 per 100,000 for those who have not had recent mental health involvement.”

      In fact, it would seem to indicate that psychiatry, in addition to being a pseudoscience, it kills a lot of people. And I am not getting even into the mass shooters who were on psychotropic drugs!

      1. Discussant says:

        Here’s another recent study on suicide:

        http://archpsyc.jamanetwork.com/article.aspx?articleid=1555602
        “Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.”

  90. pmoran says:

    CS2013: I quote from the account of that study: “The violent crimes included in this study were homicide, assault, robbery, arson, any sexual offence, and illegal threats or intimidation.”

    So, even though the bizarre and relatively rare acts of violence that are most characteristic of delusional states would have been diluted by all these more “normal” acts of violence there was still a 1.2 X greater incidence of violence among schizophrenics!

    And so suicide-prone patients are more likely to consult psychiatric services? Who would have guessed? (I am not here claiming that psychiatrists have a good record in preventing them but I will defend almost anyone who tries to do so in a reasonably rational and respectful manner.)

    I suggest that the reasoning you are bringing to these questions definitely does not qualify as being called “science” by YOUR definition. It is providing too many weakly supported conclusions.

    By my understanding of science (I hesitate to attempt a complete definition of it) they might scrape in as a relatively unsophisticated version of it. That is not meant to be a put-down, actually. It is meant to emphasises that “science” can come in different degrees of rigour and of quality in other respects. The very process of trying to reason through into knowledge from basic observations has a “scientific” quality, whether it always immediately gives the right answer or not.

    1. CannotSay2013 says:

      “So, even though the bizarre and relatively rare acts of violence that are most characteristic of delusional states would have been diluted by all these more “normal” acts of violence there was still a 1.2 X greater incidence of violence among schizophrenics!”

      Gimme a break! 1.2 is hardly the exaggerated claim you suggested. Being black jn the US puts someone at a risk of being a murderer which is 4 times higher than the general population. Go lock up Obama just in case (especially now that he has the nuclear codes).

      Then you are making a mockery of the suicide data now that your statement about the “benefits” of psychiatry has been debunked.

      See, the problem of people like you is that you go around making blanket statements about “your observations” (ie anecdotal evidence) of the benefits of psychiatry that the data doesn’t support. Please check your sources before making such ridiculous claims.

      1. mousethatroared says:

        CNS13 ” Gimme a break! 1.2 is hardly the exaggerated claim you suggested. Being black jn the US puts someone at a risk of being a murderer which is 4 times higher than the general population. Go lock up Obama just in case (especially now that he has the nuclear codes).”

        I believe what you meant to say is “convicted of murder”. Regardless, there are various effort in urban communities targeted at the youth who are most at risk of being a victim or perpetuator of violence. This includes programs in conflict resolution and efforts to help young people recognize the dangers of gangs and leave them in as safe a way possible. Understand, these interventions are not risk free. A person exiting a gang is at risk of retaliation. This is an example (I think, pmoran, please forgive if I misinterpreted) of the usefulness of risk assessment outside of careless imprisonment based on statistics.

        1. CannotSay2013 says:

          Yes, convicted or murder, but it is an irrelevant distinction in the sense that what matters is that,

          - At least in theory blacks are not treated by the justice system differently just because they are blacks. An arrest still requires “probable cause” and a criminal conviction still requires proof “beyond reasonable doubt”. Nor are blacks afforded less due process just because being black means that a person is 4 times more likely to be convicted of a crime.

          - Come to the world of so called “mental health”. First, in some countries (like the one where my abuse happened), a DSM label alone is enough ground to lock you up. In the US, we are much better but still a DSM label lowers the standard for locking you up from “beyond reasonable doubt” to “clear and convincing evidence”. In addition, unlike what happens in criminal proceedings, you can be locked up indefinitely (there are no statutory protections against abuse).

          All this based on lies along the line “my “statement” specified the acts of violence characteristic of those with serious delusional states” which are not based on reality.

          Put in another way, if blacks, who are 4 times more likely to be convicted of a crime, are afforded all protections against an unfair conviction, I don’t get how you can justify that a 1.2 times more likelihood of conviction justifies scrapping due process protections. It is as unscientific as it comes.

          1. mousethatroared says:

            CNS13 “- At least in theory blacks are not treated by the justice system differently just because they are blacks. An arrest still requires “probable cause” and a criminal conviction still requires proof “beyond reasonable doubt”. Nor are blacks afforded less due process just because being black means that a person is 4 times more likely to be convicted of a crime.”

            The risk statistics are relevant to coming up with programs that prevent violence, they should not be relevant to either incarceration or involuntary commitment, where the burden of proof is not statistical, it is based on the evidence from that individual case. Both arrest and pretrial and involuntary commitment are decided by a judge. I believe using a criminal model on a person who is delusional and doesn’t understand the court proceedings has been declared unconstitutional. But I am not a lawyer. Maybe you should contact a lawyer. Maybe you’ll have to take that concern up with the Supreme Court. Good Luck.

            It really doesn’t have much to do with your DSM campaign, though, as I showed before, a DSM diagnoses is not needed for involuntary commitment.

  91. mousedthatroared says:

    CNS13 “So I owe my current freedom to me being a US citizen living in American. I am going to fight with every bit of my soul so that such reality doesn’t change (in other words, I will support any political party that opposes lowering the standard for civil commitment under any circumstance of this ever becomes a campaign issue).”

    And so you should, as well as being completely aware of your rights and having a good plan of action for defending your rights if an issue arises here in the U.S.

    But, my point was that you used your experience to criticize the diagnoses of OCD, when it appears clear to me that the abuses that you encountered were due deficiencies in the law and ethics. You haven’t shown any evidence that the diagnoses of OCD has higher risk than benefit to the patient in an environment where patients rights are protected.

    Also, your use of a computer programing analogy to explain human biology/cognition isn’t going to fly. Researchers see a specific patterns on neuroimaging in OCD patients, My understanding is that in a noticable percentage (higher than placebo) patient’s undergoing treatment of OCD, through SSRI and/or specific CBT exercises show neuroimaging patterns closer to typical controls.

    Explain to me, what do you think is causing these neuroimaging results?

    Also, with use of SSRI for OCD was more effective than placebo at reducing symptoms “Seventeen studies were included in the review, involving 3097 participants. Based on all 17 studies, SSRIs as a group were more effective than placebo in reducing the symptoms of OCD between 6 and 13 weeks post-treatment, measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS) (WMD -3.21, 95% CI -3.84 to -2.57). The WMD for individual SSRI drugs were similar and not statistically different. Based on 13 studies (2697 participants), SSRIs were more effective than placebo in achieving clinical response at post-treatment (RR 1.84, 95% CI 1.56 to 2.17). The pooled RR was shown to be similar between individual SSRI drugs.”

    And the use of CBT appears to be effective for children and adolescents with OCD
    “The results show that, compared to a wait-list or pill placebo, BT/CBT is an effective treatment for reducing OCD symptoms and lowering the risk of having OCD after treatment. Based on three studies that directly compared BT/CBT with medication, there was no current evidence to suggest that either BT/CBT or medication was superior to the other. When combined with medication, BT/CBT produces better outcomes than medication alone. Although based on a small number of studies, these findings provide support for the value of BT/CBT in the treatment of children and adolescents with OCD.”

    These are both Cochrane Reviews you can look them up if you like.

    Explain to be why these results show better result than placebo if psychiatric treatment of OCD is the same as homeopathy (which is just water, so also placebo).

    1. CannotSay2013 says:

      “And so you should, as well as being completely aware of your rights and having a good plan of action for defending your rights if an issue arises here in the U.S.”

      :D Indeed. First, my commitment would not have happened under the “dangerousness” standard that exists in the US, and particularly in my state. Also, in addition to having a contingency plan against a commitment order -which again is unlikely to happen because I have no plan to become dangerous to anyone- there is a great protection in the US against psychiatric overreach which is unavailable in most European countries: medical malpractice law. Any psychiatrist would would attempt to “test waters” with me would find himself/herself at the receiving end of such a lawsuit after getting out of a hypothetical commitment. In other words, the possibility of me being committed again is as remote as it can be :D.

      The rest of points are problematic on many levels:

      - On the neuroimaging thing, somebody else already mentioned the Ig Nobel prize that was awarded to a team that “showed” using said techniques that a dead fish responds to human emotion. Go figure!

      - With respect to measuring the efficacy of drugs/CBT, you forget that the YBOCS, just as its counterpart for depression -the HRSD- is NOT an objective laboratory measure, rather a set of subjective questions about a variety of self reported behavioral patterns. So measuring “efficacy” using such a measure is problematic onto itself because there is a lot of subjectivity involved in this type of questionnaires (unlike an IQ test where the idea is to measure and individual’s speed in completing a set of well defined tests that require cognitive ability).

      - The fact that even accepting YBOCS as a valid measure of efficacy, CBT alone (which is basically a placebo intense “treatment”) is better than drugs alone should tell you that the only thing that these drugs might do is to improve the placebo response of CBT rather than a genuine “drug effect”.

      - Third, I am not aware of any EH Turner / Kirsch type of study on the efficacy of OCD drugs. Meaning, that the averages of the studies you mention are likely to suffer from publication bias. For any such average to be of any value, it should include the results of both positive and negative studies and be done on the raw data directly submitted to the FDA (not on published data). EH Turner has done a review of efficacy of drugs to treat so called “bipolar” and “schizophrenia” this year and he has found that there is also a significant publication bias in the studies used to advertise the efficacy of these drugs. I wouldn’t be surprised if the same was true for so called “OCD”.

      So no, OCD is not a “disease” anymore than homosexuality is a “disease”. In fact, there are some that even advertise lobotomy (or psychosurgery as they call it these days) to “treat” OCD. I am not making this up either http://www.livescience.com/37120-psychosurgery-ocd.html . The only difference between homosexuality in the 1950s and OCD now is that these days in most states one has the legal right to refuse lobotomies no matter what :D.

  92. mousethatroared says:

    Firstly
    CNS13 ” On the neuroimaging thing, somebody else already mentioned the Ig Nobel prize that was awarded to a team that “showed” using said techniques that a dead fish responds to human emotion. Go figure!”

    First you say it was a confusion of cause and effect, now that the neuroimaging testing is not valid. I don’t accept “somebody else mentioned” as a citation. Tell me why science is using neuroimaging to study OCD and neuroimaging studies are being published in reputable journals if it’s a discounted technology. If you can’t show me that, then you don’t have convincing evidence that the results of neuroimaging studies are unrelated to the OCD symptoms.

    Secondly CNS13 “- With respect to measuring the efficacy of drugs/CBT, you forget that the YBOCS, just as its counterpart for depression -the HRSD- is NOT an objective laboratory measure, rather a set of subjective questions about a variety of self reported behavioral patterns.”

    Lets talk about the YBOCS – which an interview that assesses the patients subjective symptoms in order to judge severity. This is similar to the clinical exam that I had the other day assessing pain in my neck, arm, hand, which was entirely based on my subjective reporting. The Scale starts out by these definitions

    “Obsessions are unwelcome or distressing ideas, thoughts, images or impulses that repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, are often senseless, and may not fit your actual personality at all (for example, the recurrent thought or impulse to harm to your children, even though you never would).”

    “Compulsions are behaviors or acts that you feel driven to perform, even though you may recognize them as senseless or excessive. At times, you may try to resist doing them, but this may prove difficult. You may experience anxiety that does not diminish until the behavior is completed.”

    It list a variety of intrusive fears, images , concerns as asks for participant to check if they have had in the past or currently. It lists a variety of compulsions that participants have felt driven to engage in to check if for current or past engagement. It asks questions about the time consumed by symptoms, level of distress associated with symptoms and level of interference from social and work roles by symptoms.

    Why is it not logical to think, if you are a patient who wants help with intrusive thoughts, images, and compulsions that you feeling driven to perform because your subjective symptoms are consuming more time than you would like and causing you distress, that you can use this scale and the research associated with this scale to decide which treatments may work better than placebo?

    Thirdly CNS13 “The fact that even accepting YBOCS as a valid measure of efficacy, CBT alone (which is basically a placebo intense “treatment”) is better than drugs alone should tell you that the only thing that these drugs might do is to improve the placebo response of CBT rather than a genuine “drug effect”.

    No, in these studies CBT performs better than placebo. CBT is not placebo any more than physical therapy is placebo. It sounds like you misunderstand placebo.

    Fourthly, CNS13 “Third, I am not aware of any EH Turner / Kirsch type of study on the efficacy of OCD drugs. Meaning, that the averages of the studies you mention are likely to suffer from publication bias. ”

    Sorry, just because publication bias exists, doesn’t mean you get to assume that it completely invalidates the Cochrane review. When you can show evidence that THESE results were effected by publication bias and how much they were effected, then you have an argument. But until then, it is reasonable for a patient to conclude that if they want help for their intrusive thoughts and distressing time consuming compulsions, that the results of these 17 RCT studies with 3097 participant may be predictive of their chances of SSRI treatment being successful for them over placebo. Which is an average chance of some reduction of symptoms.

    Lastly, CNS13 “In fact, there are some that even advertise lobotomy (or psychosurgery as they call it these days) to “treat” OCD. I am not making this up either http://www.livescience.com/37120-psychosurgery-ocd.html . ”

    No, all brain surgery is not a lobotomy and you didn’t link to an advertisment, it was a report on a study. Can you show me that the study didn’t meet the standards of ethics when it comes to FDA approval, informed consent, etc? Can you show me an actual current advertisement for a brain surgery that is a lobotomy for OCD?, Can you even show me an advertisement for this surgery that claims it treats OCD? No?, well then you are making it up.

    1. CannotSay2013 says:

      ” Tell me why science is using neuroimaging to study OCD and neuroimaging studies are being published in reputable journals if it’s a discounted technology. If you can’t show me that, then you don’t have convincing evidence that the results of neuroimaging studies are unrelated to the OCD symptoms.”

      What I am saying is that a neuroimaging study that shows that people who exhibit so called “OCD” behavior have some correlates in fMRI is not useful to determining that “OCD” is a disease. Again, you are confusing effect with cause, and the dead fish is a perfect example of how this type of studies are useless. Anything behavioral can be correlated to anything you want.

      “Lets talk about the YBOCS – which an interview that assesses the patients subjective symptoms in order to judge severity. This is similar to the clinical exam that I had the other day assessing pain in my neck, arm, hand, which was entirely based on my subjective reporting.”

      Actually it is not. Your exam asks you about a SOMATIC SYMPTOM. The YBOCS asks you about BEHAVIORAL ISSUES. Calling a “behavioral issue”, “symptom” doesn’t make that issue a “symptom” in the somatic sense. This is one of the numerous fallacious tricks that psychiatry uses to present itself as “scientific”. It’s a lie that will continue to be a lie, no matter how many times it is repeated :D.

      On a more personal note, I have been given the YBOCS and it is as useless as it comes. A complete idiotic questionnaire that measures nothing whatsoever.

      “No, in these studies CBT performs better than placebo. CBT is not placebo any more than physical therapy is placebo. It sounds like you misunderstand placebo.”

      CBT is pure placebo in the sense “it is all in your mind”. I followed the CBT charade for a while. The fact that CBT is more efficacious than any drug even if you accept that the YBOCS measures “something”, means that “it’s all in your mind” as are all of the DSM invented diseases. The mind cannot be “sick” in the sense the brain can be (with CJD for instance), only as a metaphor.

      “Sorry, just because publication bias exists, doesn’t mean you get to assume that it completely invalidates the Cochrane review.”

      It makes the review suspect because prior to the EH Turner/Kirsch studies there had been many such reviews on SSRIs for so called “depression” concluding “fabulous effects”. We now know the truth, which is, that those SSRIs are more likely active placebos.

      With respect to psychosurgery/lobotomy. Thanks God we live in America where this cannot be imposed onto anybody anymore, even onto those who have been dehumanized through civil commitment. However, that is not the case in other parts of the world.

      My bottom line is that the way you have spoken of so called “OCD” is no different than the way a psychiatrist would have spoken of homosexuality in the 1950s, including the availability of “psychosurgery” to treat it (only back then, psychosurgery could indeed be forced onto you).

      Homosexuality was dropped from the DSM in the early 1970s. One label gone, 400+ to go!

      1. mousethatroared says:

        CSN13 “CBT is pure placebo in the sense “it is all in your mind”. That is like saying jogging will correct shoulder impingement, because it’s all physical exercise after all.

        “What I am saying is that a neuroimaging study that shows that people who exhibit so called “OCD” behavior have some correlates in fMRI is not useful to determining that “OCD” is a disease. Again, you are confusing effect with cause, and the dead fish is a perfect example of how this type of studies are useless. Anything behavioral can be correlated to anything you want.”

        Well since no one is claiming that OCD is a disease (for the third time) then that shouldn’t be a problem. MRI doesn’t show that bursitis is a disease either. I have no idea how dead fish behave. You didn’t explain why the journals that you seem to think are good journals, like Nature are still publishing studies based on neuroimaging if they are completely discredited by a dead fish study.

        “It makes the review suspect because prior to the EH Turner/Kirsch studies there had been many such reviews on SSRIs for so called “depression” concluding “fabulous effects”. We now know the truth, which is, that those SSRIs are more likely active placebos.”

        Firstly, to make something suspect, is very different than a reanalysis of the evidence which gives a different result. Which is what you have been assuming. And your misinterpretation of the depression study was already addressed by Harriet Hall. She has already shown that the effects are still greater than placebo. You are overstating the conclusion…once again. If you are going to claim that the suspicion of publication bias negates ALL Reviews to being equal to placebo without actual evidence, then you have just negated treatment for most of the other fields of medicine as well. This has nothing to do with the subjectivity of psychiatry or the DSM.

        CNS13 “Actually it is not. Your exam asks you about a SOMATIC SYMPTOM. The YBOCS asks you about BEHAVIORAL ISSUES. Calling a “behavioral issue”, “symptom” doesn’t make that issue a “symptom” in the somatic sense. ”

        No – “Fear of blurting out obscenities or insults” is directly from the YBOCS
        http://www.stlocd.org/handouts/YBOC-Symptom-Checklist.pdf
        As are many other fears, concerns and intrusive thoughts. They are not behaviors. “Fear” is an emotion that the subject is reporting, just like a patient reports pain to a doctor doing a physical exam. Fear and pain are not behaviors. The behaviors are in the complusions part of the checklist. I’m not sure what test you took, but there clearly is a large symptoms section on this scale.

        The bottom line is that you still haven’t shown any evidence that negates the usefulness of these studies for people who suffer from intrusive thoughts and compulsions that they feel driven to engage in.

        1. CannotSay2013 says:

          “That is like saying jogging will correct shoulder impingement, because it’s all physical exercise after all.”

          No, my friend. NON DRUG OR OTHERWISE biological interventions (like surgery, exercise, etc) are by definition “in your mind”. CBT is a placebo intensive method (or “mind intensive” if you prefer).

          “Well since no one is claiming that OCD is a disease (for the third time) then that shouldn’t be a problem”

          I am sorry but I don’t have a stomach for one of those semantic debates that you guys in this pseudo skeptic movement love so much. “Disease”, “disorder”, “mental illness”, you call it the way you want to call it, is pathologization of a pattern of behavior disavowed by DSM committee members nutcases.

          “You didn’t explain why the journals that you seem to think are good journals, like Nature are still publishing studies based on neuroimaging if they are completely discredited by a dead fish study.”

          I can assure you that many such journals published “wonder stuff” about SSRIs before EH Turner/Kirsch published their reviews.

          “Firstly, to make something suspect, is very different than a reanalysis of the evidence which gives a different result. Which is what you have been assuming”

          After what was uncovered by the Chuck Grassley investigation, each and every single study that is made by so called “researchers” with Big Pharma ties is suspect. See the pattern: SSRIs for depression: the published literature speaks of “wonder effects”, the average on the raw data, not so much. Same for neurleptics when it comes to bipolar and schizophrenia. And you want me to believe the results of a study whose data comes from “published studies”. Give me a break!!!

          “Fear of blurting out obscenities or insults” is not a somatic symptom like a headache no matter how many spin doctors you cite to back your claim :D.

          “The bottom line is that you still haven’t shown any evidence that negates the usefulness of these studies for people who suffer from intrusive thoughts and compulsions that they feel driven to engage in.”

          I have. Only those who insist in calling “symptoms” things that are not symptoms, who negate that CBT is basically a placebo method, who insist in seeing value in fMRI studies of the type that show that dead fishes respond to human emotion -hit for you: nobody HAS EVER been labeled as “OCD” based on an fMRI alone- and who insist in negating that most (if not all) Big Pharma sponsored trials in psychiatry are corrupted by Big Pharma interests are those who are unconvinced. The rest, and that would include somebody like Jerry Coyne whom we know has better scientific credentials than you, are convinced that psychiatry is a scam.

          And then, I am the one called “denialist”. If this isn’t ironic, I don’t know what it is :D.

          1. mousethatroared says:

            CNS13 CBT is a placebo intensive method (or “mind intensive” if you prefer).”

            No, What we are talking about is Neuroplasticity. How you think and behave changes your brain. Analogous to how you exercise changes your muscle. It’s not all in your mind, it’s a mind/brain interaction. It’s neurobiology.

            “Neuroplasticity, also known as brain plasticity, is an umbrella term that encompasses both synaptic plasticity and non-synaptic plasticity—it refers to changes in neural pathways and synapses which are due to changes in behavior, environment and neural processes, as well as changes resulting from bodily injury.[1] Neuroplasticity has replaced the formerly-held position that the brain is a physiologically static organ, and explores how – and in which ways – the brain changes throughout life.[2]”

            http://en.wikipedia.org/wiki/Neuroplasticity

          2. CannotSay2013 says:

            I have to admit that the last thing that I expected to hear in a pseudo skeptic forum is appeals to the ability of the “mind” to change “the brain”. I don’t think you will find many friends here to that idea :D.

          3. mousethatroared says:

            CNS13 – To sum up -Firstly, I have never thought of myself as a skeptic, so I doubt The term pseudo skeptic applies. But, who care?

            Secondly, I don’t believe that neuroplasticity is controversial. Ask yourself how do people learn a new language? How do people recover skills after a brain injury.

            CBT is not magic. It’s just learning specific mental/behavioral skills. It suggests it may be less stressful and more effective to think “I can’t find my keys. Where did I last have them?” than “Oh my gosh, I can’t find my key, I’m going to be late.”

            You seem to think both strategies would be equally effective and stressful as well as equal to someone giving you a pill and saying “this pill will help you find your keys.”

            That’s fine. It’s a testable idea. Which takes us to the Cochane Review of children and adolescents with OCD and CBT vs placebo (or waiting period).
            —————-
            Also – definitions from free dictionary/medical dictionary

            “symptom /symp·tom/ (simp´tom) any subjective evidence of disease or of a patient’s condition, i.e., such evidence as perceived by the patient; a change in a patient’s condition indicative of some bodily or mental state.”

            “sign (sīn) an indication of the existence of something; any objective evidence of a disease, i.e., such evidence as is perceptible to the examining physician, as opposed to the subjective sensations (symptoms) of the patient.”

            “behavior /be·hav·ior/ (be-hāv´yer) deportment or conduct; any or all of a person’s total activity, especially that which is externally observable.behav´ioral”

            When you need to make up your own definitions, like calling fear a behavior, that’s an indication that you are twisting the information to fit a preconceived notion. and by the way, that’s not a “skeptical” thing, it’s a logical thing.

            As to judges…If judges are involuntarily committing a sustantial number of people who’s actions are not obviously indicative of danger to themselves or others, such as threatening suicide or violence or using an object to threatens themselves or others, if judges are committing people based solely on exhibiting a delusional state, you may gain some success in your legal battle. Having lived with family members that were threatening and unwittingly self-destructive and having heard from lawyers on the burden of proof for involuntary commitment in my state, I would suggest you don’t have an adequate argument of arbitrary commitment.

            As to Jerry Coyne – Well lots of people are better scientists than me. If I went by that rule of thumb I’d have to believe all the global warming scientists and all the anti-global warming scientists too. Not particularily helpful.

            In conclusion, the comments have gone to two pages now. Which is even more difficult to manage than one page of strange threading.

            So, “So long and thanks for all the fish.”

          4. CannotSay2013 says:

            mousethatroared,

            There is a non written rule that he/she who needs to resort to some “authoritative dictionary” to back his/her claims about what “this is” and what “this is not” is the first who is admitting to have committed a “semantics fallacy”. That would be you, both on what “placebo” is and what a “symptom” is. If I remember it well, you also resorted to Godwin’s Law so this is hardly surprising :D.

            Judges; I have admitted that in the US there is a lot diversity. I am not denying your experience in your state but I have also been in contact with people who live in states where commitment hearings are pretty much a “rubber stamp” of the psychiatrist’s decision. As you can imagine, the state that I choose for myself is one of those that has the highest legal protections there can be in the US against involuntary so called “treatment” and commitment.

            Finally, my summary of this discussion is the following: there is a general agreement that psychiatry is not scientific in the sense particle physics is.

            Then, for some reason, you guys have “extended” the definition of “science” in a way that includes psychiatry but does not include homeopathy or astrology. No argument has been provided to justify this other than “because I say so”, which is the dogmatic part of this discussion :D.

          5. WilliamLawrenceUtridge says:

            First mention of Nazism was made on September 28th, by you.

      2. Harriet Hall says:

        “the dead fish is a perfect example of how this type of studies are useless. ”
        No it isn’t. The dead fish is an example of how statistical errors can be made in interpreting fMRI studies.
        I reviewed the book “Brainwashed” about how people tend to read more into brain imaging studies than is warranted. http://www.sciencebasedmedicine.org/brainwashed-neuroscience-and-its-perversions/
        Brain imaging studies are invaluable research tools. They have the potential to contribute a great deal towards making psychiatry more of a science-based discipline. There are problems with the way they are being misinterpreted, not with the scans themselves.

        1. CannotSay2013 says:

          Harriet,

          The dead fish study is a warning for those who see too much in “correlates of behavior and fMRI imaging”. It’s a different version of the so called “Texas sharpshooter fallacy”.

          Nobody HAS EVER been labeled as “OCD” – or any other DSM label- based on an fMRI alone. That is why those neuroimaging studies, in the context of DSM labels, are useless. If you get ANY group of people, you can find neuroimaging correlates among them, regardless of the reason that group of people was selected.

          1. Harriet Hall says:

            I agree that the dead fish study is a warning for those who read too much into imaging. But it is NOT a reason to call those studies “useless.” They are not useful in making psychiatric diagnoses of individuals, but they are useful in research that may some day contribute to a more scientific basis for psychiatry. Isn’t that what you would like to see? Or do you just want psychiatry to remain in its current flawed state so you can continue to rant about it?

          2. CannotSay2013 says:

            I have a different take altogether, and perhaps I should clarify what I mean by “useless”.

            My basic conviction is that psychiatry, as it is understood today -mind guardians pathologizing behavior that they dislike and claiming that those behaviors they disown are brain diseases like CJD-, will never become a scientific discipline for the very reason that they are ignoring free will altogether. Whether “free will” is real or an illusion is irrelevant. The reality is that “free will” is recognized even by the legal system as the basis of citizenship.

            What these fMRI studies will do to psychiatry is to send it to the ash heap of history for once and for all. In a way, psychiatry is like economics only worse because right now it deals only with “subjective matters”. Economics at least deals with trying to predic quantitative measures t, like GDP numbers, unemployment rates, etc. They are wrong most of the time but they have these metrics. The NIMH model of Research Domain Criteria will give psychiatry a similar thing, quantitative measures. Only, just as it happened to economics, the end result will be that psychiatry will be humiliated in front of the world for being more often wrong than right (as it happens with economics). And boy it is going to be fun to watch!

          3. WilliamLawrenceUtridge says:

            CannotSay does seem to be making the nihilistic argument that because psychiatry is not “scientific” today, that it can never be scientific. It’s the God of the Gaps argument found in creationism, writ intrapsychicly to discourage further research (or in this case to justify a conclusion that is not open to revision).

  93. pmoran says:

    CS 2013: “Gimme a break! 1.2 is hardly the exaggerated claim you suggested. Being black jn the US puts someone at a risk of being a murderer which is 4 times higher than the general population. Go lock up Obama just in case (especially now that he has the nuclear codes).”

    The miracle is that any signal showed up at all in all that noise.

    I have made no “exaggerated claims” nor yet suggested that anyone be locked up.
    I have merely defended the right of psychiatry to be called a “science”. I also stated outright that the events I referred to are “relatively rare”.

    That along with the difficulties in selecting out those at risk of acts of extreme violence is why coercion should be used very sparingly, even when that entails leaving society exposed to some foreseeable risk. I don’t pretend to any legal or medical expertise relevant to how this is handled.

    1. CannotSay2013 says:

      I have to admit that I am puzzled by your reply. You said, I am quoting you,

      “my “statement” specified the acts of violence characteristic of those with serious delusional states. ”

      Now, if you want to have a “Clintonian” type of discussion about what “serious delusional states” is, well fine, but what the DSM quacks consider the worst of them, ie, schizophrenia, the predictive value of a “schizophrenia” label is worse than a description of somebody as “black” or even “black, young, male, drug user, inner city dweller”.

      I don’t see why you still defend coercion against whose labelled “schizophrenic”, despite the lack of predictive value of the label, while I am sure you don’t have the guts to defend coercion, even in “some cases”, against “black, young, males drug users who have committed no crimes other that what that drug consumption might entail” even though that description is likely to give you more potential criminals than a label of “schizophrenia”. I mean, if you are going to lock up somebody for what he or she might do, a label of “schizophrenia” (or any other DSM label) should be totally irrelevant. The rules of evidence of criminal law proceedings is all that should matter.

      1. mousethatroared says:

        Still the same strawman. No one is defending mass involuntary commitment based on statistics or a diagnoses of schizophrenia. If a black man threaten you with a bat and talks about you relationship with another man, that is an individual circumstance. If a person with schizophrenia threatens you with a bat and talks about how you are controlling his mind. That is an individual circumstance. The legal decisions are based on the evidence. If you don’t like how the burden of proof falls in those cases, take it up with the law, it’s not medicine.

        Personally, I will say that any legal system that releases someone who has threatened physical violence to an individual, without some assurances to the accused individual will not walk right back to the victims house and hit them with the bat until they are dead, is insufficiently protective of it’s citizens.

        1. CannotSay2013 says:

          And you keep pulling the same “straw man” to defend psychiatry,

          “Personally, I will say that any legal system that releases someone who has threatened physical violence to an individual, without some assurances to the accused individual will not walk right back to the victims house and hit them with the bat until they are dead, is insufficiently protective of it’s citizens.”

          Psychiatrist have ZERO ability to predict who will “walk right back to the victims house and hit them with the bat until they are dead”.

          That is the point that you are completely missing in this debate, because PSYCHIATRY IS NOT SCIENCE. Science requires PRECISELY that you can make those type of predictions.

          Without that predictive ability, the legal system is just trusting a quackery that is no better than astrology when it comes to predicting violence,!

          1. mousethatroared says:

            “Psychiatrist have ZERO ability to predict who will “walk right back to the victims house and hit them with the bat until they are dead”.”

            Well, luckily it’s not psychiatry that is trying to predict these things, in either case of threatened violence (due to delusions or jealousy). It is the judge who looks at the evidence in the individual case. If you think the judges are balancing the evidence incorrectly, then you should take it up with the legal system.

          2. CannotSay2013 says:

            Unfortunately, judges usually behave as the FISA Court behaves with NSA requests:: mere rubber stampers of psychiatrists.

            While it is true that there is a lot diversity around the US -ie, the situation is not nearly as bad as in Europe-, a good lawyer can get you out of trouble and of course there is the medical malpractice aspect as a second line of defense , the fact remains that psychiatry has an undue influence in legal matters, not only in commitment hearings but also in estate matters, custody battles, etc. The reason is that the legal system still hasn’t figured out that psychiatry is a quackery, which is why my dedication is to fight the quackery. The rest will follow.

            So to end the undue influence of psychiatry into the legal system, the only option is to delegitimize it in the court of public opinion. That is how the current protections against psychiatric abuse came about. The hardest battles were won in the 1970s. Now those of us in the anti psychiatry movement are after the full and complete delegitimization of psychiatry in legal proceedings. The Insel crisis was a gift from God.

      2. pmoran says:

        CS2013: “I don’t see why you still defend coercion against whose labelled “schizophrenic”, despite the lack of predictive value of the label, while I am sure you don’t have the guts to defend coercion, even in “some cases”, against “black, young, males drug users who have committed no crimes other that what that drug consumption might entail” even though that description is likely to give you more potential criminals than a label of “schizophrenia”.”

        Yet again leaving aside the fact that I have yet to say anything at all about what USE any such conclusion might be put to, it is about as certain as we ever get in medicine that schizophrenia is an independent risk factor for one form of violence i.e. unprovoked, completely irrational, and directed against strangers (sometimes relatives).

        Since it seems I have to elucidate further, what this means is that even among black, young, male, urban drug users, being schizophrenic would increase the risk of this specific kind of behaviour. There is no way you can escape this conclusion.

        The overall impact of this on society may be small, as you say, and it is likely to apply only to a small subgroup of schizophrenics (another reason why any influence from this will be small in the usual epidemiological study design) but it is still a bit of a bother for the persons involved (they end up having to be “coerced” anyway), their victims and their relatives.

        I hazard that it is the expectations of the latter that they be offered some protection that is the main inducement of elements of coercion from the legal system, rather than any enthusiasm of psychiatrists for having to assume that responsibility. Go talk to those invariably asking “why couldn’t we get something done?” after one of these episodes and having had ample warning that something was brewing.

        No one is pretending that this is not a difficult and contentious matter.

    2. CannotSay2013 says:

      “I have merely defended the right of psychiatry to be called a “science”.”

      Sure, but under a “wide definition” that would also make of homeopathy a “science”. And I have absolutely no problem with that. Call me a “purist” but to me, science is something else. Clearly, psychiatry does not pass the litmus test that I require for a discipline to be called “scientific”. Also, I am far from being alone in that appreciation. In fact, even Jeffrey Lieberman, the president of the American Psychiatric Association, called psychiatry a “step child of medicine” at that NPR interview.

      1. WilliamLawrenceUtridge says:

        Psychiatry changes in the face of new evidence (witness the updates of the DSM, and criticisms of the DSM – from psychiatrists). Homeopathy does not, it is the essence of ontological inertia. There’s a multitude of other reasons why psychiatry is not comparable to homeopathy, but you won’t listen to any of them so there’s no point in discussing further.

        1. CannotSay2013 says:

          “Psychiatry changes in the face of new evidence”

          You have to be kidding me… The only thing that changes in psychiatry, and thankfully for the better, is its barbaric methods. Psychiatry has kept telling the lie of “mental disease” as “brain disease” for as long as homeopathy (like 200 years). In fact, the only conclusion is that psychiatry finally caught up with homeopathy: drugs with “invented effects” for “invented diseases”.

          With respect to the “nihilistic” thing that you say in your other comment, I hope you understand that it goes both ways: just because psychiatry keeps promising that some day, some how it will become scientific, it doesn’t mean it is going to happen.

          But I am satisfied with your implicit statement, namely, that today psychiatry does not qualify as a scientific branch of medicine even if you believe that some day things will be different. That has been my whole point all along!

          1. WilliamLawrenceUtridge says:

            Psychiatry is not perfect, but it is scientific. It’s not scientific in the same way physicis is, because it is not talking about particles. Pretending psychiatry is, can be, or should be like physics is woefully naive or (in your case) an absurd straw man that you set up just to knock down in a dishonest attempt to butress your own flawed argument.

            You aren’t interested in an honest discussion, you are using these comments as an excuse to rant about how you have been “done wrong”. I’m sorry that psychiatry isn’t perfect. I’m sorry that your former partner may have abused the psychiatric system to punish you. But that doesn’t mean the entire enterprise is currently or permanently doomed to failure, and you should stop dishonestly pretending that it is or that your alternative, burning it to the ground and dancing on the ashes, is a viable one. Psychiatry makes mistakes, and needs to improve, but abandoning the idea that mental illnesses are real is not the solution any more than the first car accident was a reason to revert back to horses and buggies or the first adverse event due to vaccination is a reason to start dying of pertussis and influenza.

          2. CannotSay2013 says:

            “. It’s not scientific in the same way physicis is, because it is not talking about particles”

            Precisely, but when psychiatry uses the word “scientific” it is to hijack the precision of particle physics has because it is this type of science the one that has success. Although Feynman did not comment on psychiatry particularly is this type of distortion that he denounced.

            So we are left that all our disagreements are
            “Clintonian”. It depends what “science” is.

            So let’s agree that psychiatry is not scientific in a Feynman sense.

            The next question is about why you consider psychiatry deserving of being called “scientific” while you don’t give the same latitude to homeopathy or astrology. What none of you has shown very convincingly is why you keep defending psychiatry and repudiating homeopathy. And that would include your analogies to vaccination or car accidents, both of which deal with entities (viruses/bacteria in one case, cars in the other) whose reality has been independently verified, which is not the case with any of the so called “mental illnesses”. That is the “dogmatic” part of your argument.

          3. WilliamLawrenceUtridge says:

            You are mistaking science as a method with precision of measurement. Psychiatry can still come to agreement on diagnostic criteria (the DSM and ICD-10 are both examples, which are imperfect but still useful) and diagnoses (applying the criteria). It’s not a perfect process and there is not 100% concordance, but neither is a criteria to define a science. The fact that you can’t distinguish it from astrology and homeopathy is evidence of your bias, not proof of your assertion.

            1. Harriet Hall says:

              This is not directed at CannotSay. I’ve given up on him. But I wanted to clarify for the rest of our readers why psychiatry is a science and why astrology and homeopathy are not.

              Astrology isn’t a science because it didn’t develop from careful observation, record-keeping, and testing. The scientific approach would have been to accumulate large databases of birth dates, times, personality characteristics and fates, notice apparent correlations with heavenly signs, and then do controlled studies to test whether those correlations were real, check to see whether similar correlations might exist with something other than the 12 constellations, and then search diligently for evidence that might confirm causation. Astrology never did anything like that, and its philosophy was based on wildly implausible ideas. And it has never rejected anything and has not made progress.

              Homeopathy is not a science, but a cargo-cult endeavor. They pretended to do science but didn’t understand how. They imagined that their silly “provings” constituted evidence. They didn’t compare their treatment results to control groups. They didn’t try to disprove anything, and they never rejected anything. Evidence did not build on other evidence to make progress. Its philosophy was entirely divorced from reality.

              Psychiatry started out as a non-science (think of possession by devils, and Freud). It is still groping its way out of its infancy. It is trying to categorize symptoms into syndromes to facilitate study and treatment. It tests its drugs and psychotherapies for efficacy, and compares them to each other. It eventually rejects treatments and practices that are found not to work (like lobotomy). It’s philosophy is realistic: it accepts that human behaviors arise from physiologic events in a material brain as well as from social and environmental factors. It doesn’t yet have a lab test for bipolar disorder, but it can identify people who swing back and forth between incapacitating depression and manic behavior, and it can treat them effectively with lithium, which has been proven to reduce the risk of suicide. Psychiatry is using scientific methods and is the only hope for progress in the field. Yes, it’s far from perfect, but it’s better than denying the reality of mental illness and not trying to help suffering people.

          4. CannotSay2013 says:

            Harriet,

            It seems that you call psychiatry a “science” because of its “reliability” and a “wishy washy” appeal to suicide/violence prevention. Well, no other than Allen Frances, the chairman of the DSM-IV task force, has refuted both:

            - On reliability: http://www.huffingtonpost.com/allen-frances/dsm-5-reliability-tests_b_1490857.html . Note that this is 2012 psychiatry, not Rosenhan times psychiatry. I declare the reliability argument “nullified” since DSM-5 is now the standard bearer of American psychiatry.

            - With respect to violence prevention, Allen Frances had this to say as well: http://www.huffingtonpost.com/allen-frances/gun-control-cant-work-if-_b_2359049.html “It is impossible to predict in advance who is likely to become violent and when”.

            - With respect to suicide I remind readers that it is the FDA who warns people of the risk of suicide of SSRIs, not me.

            So unless you have something more, I think that your arguments about why psychiatry should be a science don’t convince the guy who defined what psychiatry is until the DSM-5 was approved this year. Allen Frances has other reasons to believe that psychiatry is a “science” (basically “faith” arguments that somehow someday psychiatry will be found to be scientific) but he surely wouldn’t use your arguments for that. In fact, he has convincingly accused psychiatry of being the opposite of what you claim it to be.

      2. pmoran says:

        CS 2013″ Sure, but under a “wide definition” that would also make of homeopathy a “science”. ”

        My position is that there is no entirely satisfactory definition of “science”. This is where your argument about psychiatry falls over, and why such statements as the above make little real sense.. .

        To the extent that the early homeopaths wanted to solve real problems, put forward testable hypotheses that were as tenable as any others at the time they were made (e.g. “Like cures like” goes back to the ancient Greeks), and then tested them out (albeit in highly unreliable ways) homeopathy could be regarded as at one time having many of the qualities that we generally think of as being “scientific”.

        Hahnemann even understood some weaknesses to his system. He understood that venereal diseases and cancer did not fit that well with his basic theories of the causation of disease.

        So, — so what? Psychiatry has similar “scientific” qualities, even the highly “scientific” quality of dispensing with unsupported hypotheses, as WLU describes.

        1. pmoran says:

          Sorry, Harriet. My post and yours overlapped, or I probably would not have presented a somewhat different appraisal of what it means to be “doing ‘science’”.

          Mine should not be thought to be a response to yours. It is looking at science and its history in a slightly different way.

          I have for some time been inclined to the view that sacrificing virgins to the volcano God is a highly primitive version of “science in action”. There is, at minimum, the formulation and testing out of a hypothesis.

          I can agree that it is unlikely to have ever ended well, either for anyone’s welfare, or for the subsequent evolution of human knowledge.

          1. CannotSay2013 says:

            I think that this discussion has been very constructive. Finally you guys come clean about what you mean by “science” in science based medicine. “Science” is whatever you guys say that science is. It is not a pre-established definition that then is tested against every discipline that aspires to be scientific but rather some “elastic” definition that you adapt to include those disciplines you consider scientific and you deny to those that you don’t like.

            I am afraid that not only that definition is unlikely to convince any scientist who respects science (think Nobel Prize winners or members of the National Academy of Science), but also the whole method of “elastic definition” is unscientific itself :D.

          2. WilliamLawrenceUtridge says:

            Science is a systematic search for knowledge characterized by naturalistic explanations, repeated testing, replication, publication, the tentative nature of results, and falsification. It has all of these things:

            Naturalism – yup, mental illness ascribed to the interaction of neurons
            Testing, replication and publication – yup, lots of clinical trials
            Tentative results and falsification – yup, practices are adopted and abandoned in the face of evidence; increasingly so since the DSM adopted an explicitly empirical approach.

            CannotSay, has anyone, anywhere in this post, ever agreed with your overall point? Have you ever convinced anyone? How about on any other discussion board or comments thread?

            If the answer to all three questions are “no”, then consider the possibility that your arguments genuinely do reflect solely your own personal opinions rather than compelling universal truths.

          3. CannotSay2013 says:

            “If the answer to all three questions are “no”, then consider the possibility that your arguments genuinely do reflect solely your own personal opinions rather than compelling universal truths.”

            Since Jerry Coyne basically agrees with my views and he has better scientific credentials than anybody that has intervened here, and that would include you, I offer you a different possibility. Most of the self declared “defenders of science based medicine” that have commented here are so dogmatic that no amount of good rational argument will convince them that they are wrong. In that respect they are no different from those who claim that homeopathy or astrology are scientific. Think about this pal!

            PS: I hope you understand that you just have committed an “appeal to popularity” fallacy :D.

          4. WilliamLawrenceUtridge says:

            I’m not sure why you keep pointing to Jerry Coyne, as he is an evolutionary biologst. Then again, I never understood why you kept treating a 30 year old interview with a physicist as a trump card either. I will say that yet again, I find this unconvincing. Certainly Coyne is well-qualified in evolutionary biology, it just happens to be an utterly irrelevant field. How have his musings on mental illness been received in the peer reviewed press? I’m not sure why you would think I would find yet another expert in an irrelevant field, posting on their blog, convincing when the first one wasn’t.

            My criteria for science is in large part drawn from McLean v. Arkansas, which discussed the characteristics of a science in order to distinguish it from pseudoscience.

            It’s not quite the argument from popularity, I’m not saying I’m right because other people are right. I’m saying nobody agrees with you. When everyone else says “red”, and you say “blue”, perhaps you’re colourblind. I don’t think the problem is “we are dogmatic because we don’t agree with your rational arguments”. I think the problem is your arguments are not rational. Certainly they are not convincing, and I find your explanation for this – that we are all dogmatic promoters of psychiatry – specious, special pleading and ad hominem. But reasonable people can disagree. I mean, I disagree with your overall conclusion, even if I agree with individual premises. You, on the other hand, seem to disagree with pretty much everything. And all the smileys in the world doesn’t make your argument any more convincing, rational or effective.

            And incidentally – saying psychiatry isn’t a science because Feynman and Coyne agree with you, is pretty much the definition of the fallacy of argument from authority; specifically because they aren’t experts in mental illness. Do you understand that?

          5. CannotSay2013 says:

            You keep burying yourself in bad arguments. Now “science” is what the justice system says that “science” is? Are you really serious? You lost any credibility you had earlier.

            I leave you with the “Heat Equation” https://en.wikipedia.org/wiki/Heat_equation . Whenever psychiatry comes with something remotely similar, give me a call. I think I am done for now arguing nonsense :D.

          6. WilliamLawrenceUtridge says:

            The judge in that case based his opinion on and definition of science primarily on the testimony of Michael Ruse, a philosopher of science.

            What specifically is wrong with the definition, as a broad way of defining the approach?

            As my comment below states, psychiatry does have something broadly similar to the thermometer. But the human brain is a fair bit more complicated than a uniform block of matter. Your ongoing claims that psychiatry should be as simple as thermodynamics is a false analogy. A better comparison would be thermodynamics when the caloric, elemental and current theories were still contemporary – a field in flux being tested and proven. Merely because psychiatry can’t be currently reduced to your unrealistic standards of simplicity doesn’t mean it can’t be improved or will one day be better understood. It is still at a descriptive state, working its way towards a explanatory one (and there’s no reason to assume a single explanation will explain all mental illnesses or diagnostic categories).

            Again, merely because your unrealistic demands aren’t being met doesn’t mean they will never be met; that is curiosity and discovery-destroying fallacy used by intelligent design proponents, “If I don’t understand it now, that must mean God did it and therefore there’s no point in researching it further”. It’s the argument from incredulity.

        2. weing says:

          “I am afraid that not only that definition is unlikely to convince any scientist who respects science (think Nobel Prize winners or members of the National Academy of Science), but also the whole method of “elastic definition” is unscientific itself ”

          Another essentialist argument. Science is using the scientific method to study the world around you and to solve problems you encounter by using that method. Testing the theories that have formed from the said method and then applying the knowledge gained to further study.

          It’s interesting that you have not provided a definition of science. You have only said that psychiatry is not a science. To me, psychiatry can be compared to the study of heat. Everyone, well maybe not people like you who had been burned, agreed that heat exists. Most thought it was contained in various amounts in different objects. It wasn’t until more was learned about the physical world, that the phenomenon of heat could be explained. Same with psychiatry. With progress in neurosciences we may be able to explain the various diseases and have more precise treatments.

          1. CannotSay2013 says:

            Actually, I have provided a definition . Psychiatry doesn’t pass my litmus test. While Feynman only made a vague reference to “social science”, I doubt he would have had in mind psychiatry as an example of a scientific discipline.

          2. WilliamLawrenceUtridge says:

            It’s funny, because in the comment that you link to, you proclaim yourself to have won the debate. As I note above, you do not appear to have convinced anyone except yourself, and mostly discount others’ points through ad hominem proclaimations of others being “pseudoskeptics” and claiming we are all employed as psychiatrists (thus having an inherent bias towards the discipline and an incentive to promote it). You also note that psychiatry doesn’t pass your litmus test. You also use a physicist, discussing the topic more than three decades ago, as your proof that psychiatry isn’t a science (despite Feynman being not a psychiatrist, not a social scientist, not specifying psychiatry, and spending most of the clip you link to discussing organic food, not psychiatry). In fact, many of your criticisms are based on practices now-abandoned by psychiatry, often several decades old.

            Your entire approach to argumentation appears to consist of “nuh-uh” and irrelevant tangents. It’s easy to “win” arguments when you refuse to concede the points made by other, and attribute their failure to agree with you to be due to bias rather than flaws in your reasoning and examples.

            It’s a shame, because any valid criticisms you might have of psychiatry, and they are there (the discipline does need to improve its evidence base, diagnostic criteria, treatment of patients and its ability to be used to support an illigitemate satus quo – though the latter point completely ignores the efforts made to destigmatize mental illness by psychiatrists) are completely lost in the volume and unrelenting dogmatism of your rhetoric.

            You can keep thinking that you are right, but that doesn’t mean you are right – any more than a schizophrenic’s belief about the voices in their head being broadcast by the CIA is right. Put another way, the vehemence of your criticisms implies that concerns about your mental health were valid, not that you were a victim of an unjust society. And that’s a shame, becuase it makes your good points very easy to discount.

            I just wonder if you might try reflecting on your success rate. If nobody has ever been convinced, in any discussion you have ever had, perhaps the problem isn’t with everybody else.

          3. CannotSay2013 says:

            WLU,

            “any more than a schizophrenic’s belief about the voices in their head being broadcast by the CIA is right”

            Mmmm. I think that there is a big difference, namely, that now even the top dogs of psychiatry agree that the DSM labels do not correspond to diseases in the “biological sense”. I think that those of you who express “belief” in the reality of DSM labels, in spite of the top of dogs of psychiatry saying otherwise, are the ones who are truly deluded, in a schizophrenic sense. You believe that DSM labels are actual diseases in spite of the lack of evidence to prove it :D.

            “To me, psychiatry can be compared to the study of heat.”

            Which just shows you lack of intellectual rigor, in case it wasn’t clear enough from your previous interventions :D.

            In case you forgot about it, there is a very accurate measurement called “temperature” that objectively measures “heat”. Further, there are equations to model heat that accurately predict its propagation. Nothing remotely close to that exists for any of the DSM labels. So keep piling up your excuses to defend psychiatry. Those excuses only make my criticism that you are dogmatic even stronger!

          4. WilliamLawrenceUtridge says:

            even the top dogs of psychiatry agree that the DSM labels do not correspond to diseases in the “biological sense”

            Universally? All “top dogs” of psychiatry believe the DSM labels are useless? Or merely the select number that you choose to quote? There are no people saying “the DSM labels aren’t perfect, but they are useful”? Not even the members of the individual committees who approved the updated criteria? All members of the individual criteria approved the final document even though they didn’t believe in it? That’s a pretty bold assertion, particularly given the latest version has been demonstrating pretty brisk sales. I guess they’re all buying it to burn or criticize it?

            Also, while mental illnesses do have a biological sense, they are expressed via the neurons that make up the human brain and thus the subjective experience of mind, they are not the same thing as a viral infection. Much like your flawed “psychiatry as heat” analogy below, you are attempting to apply simplistic reasoning from a completely different set of problems on to the most complicated thing we are aware of in the universe – the human mind. The fact that we haven’t located a 1:1 ratio of disease-to-neurons, when there are billions (trillions?) of neurons, each connected via millions of synapses, isn’t a reason to proclaim the enterprise dead. Mental illness is a disease in the sense that it is a deviation from normalcy, one that is difficult to measure. That doesn’t mean there are no underlying unifying processes that can be extrapolated across patients with the same diagnosis.

            Which just shows you lack of intellectual rigor, in case it wasn’t clear enough from your previous interventions

            Part of the reason you don’t get many takers for your arguments could be that you are incredibly condescending and insulting. Of course, the very high-handed, absolutist and arrogant nature of your statements overall is another.

            In case you forgot about it, there is a very accurate measurement called “temperature” that objectively measures “heat”. Further, there are equations to model heat that accurately predict its propagation. Nothing remotely close to that exists for any of the DSM labels.

            Temperature is conceptually and empirically extraordinarily simple – it is the average measure of heat, anchored to a physical absolute, that is an expression of the average movement of individual atoms and molecules. It has well-understood and relatively simple effects, it runs from hot to cold, it expands most substances, it is the basis of states of matter changes. This is why analogies can be useful – but can also fail. The failure to find an analogous measure of “temperature” is not a failure of psychiatry. It’s a failure of analogy. The equivalent measure does exist for mental illness – the DSM diagnostic criteria are to mental illness as temperature is to heat. They are imperfect “measures” for nebulous categories, but just like my thermometer can be useful even though it doesn’t measure from zero kelvin to infinity to six decimal places, the DSM criteria can be useful despite their imperfections. Much like cookbooks and blacksmithing, before the invention of the thermometers, relied on imprecise measures like “warm” or “hot” or the colour of the iron but now rely on precise instructions in Celcius, Fahrenheit or Kelvin, so is the DSM still relying imprecise but better-than-nothing criteria.

            Pretending that psychiatry should be as simple as thermodynamics doesn’t mean that it actually is. It just means your assessments are unrealistic.

          5. weing says:

            “In case you forgot about it, there is a very accurate measurement called “temperature” that objectively measures “heat”. Further, there are equations to model heat that accurately predict its propagation. Nothing remotely close to that exists for any of the DSM labels.”

            It’s obvious you missed the analogy to thermodynamics. It must be like the joke about the roof. These equations of heat transfer, etc., were they available in the 17th and 18th centuries? So the pioneers in the nascent field of thermodynamics would be considered pseudo-scientists by you. We have it easy now as these equations are known and all you have to do is look them up. My how smart you are. Regarding your snobbishness about physics being the real science as opposed to medicine, I still think you have a way to go. Once you can make 2 identical snowflakes, I will accept that physics has achieved the crown.

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