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

  1. CannotSay2013 says:

    It seems that every defender if psychiatry is using some version of the so called “Texas sharpshooter fallacy” to defend psychiatry. I put the wikipedia link here so you guys enlighten yourselves: https://en.wikipedia.org/wiki/Texas_sharpshooter_fallacy ,

    “The Texas sharpshooter fallacy is an informal fallacy in which pieces of information that have no relationship to one another are called out for their similarities, and that similarity is used for claiming the existence of a pattern. This fallacy is the philosophical/rhetorical application of the multiple comparisons problem (in statistics) and apophenia (in cognitive psychology). It is related to the clustering illusion, which refers to the tendency in human cognition to interpret patterns where none actually exist.”

    That fallacy lies at the heart of those who see “risk of violence” in “those with serious delusional states”. Or those who think that neuroimaging studies that show some correlates among people who are selected for DSM label X are evidence that label X is a genuine disease, etc.

    Science needs PREDICTION not Texas sharpshooter fallacies, which BTW are also claimed by those who defend astrology, homeopathy, etc.

    1. WilliamLawrenceUtridge says:

      And you’ve set up a straw man, the idea that psychiatry is based purely on incarceration and coercive imprisonment. That is an epiphenomenon, psychiatry is a systematic attempt to understand the human mind, including deviations from the norm that cause suffering. Like so many branches of medicine, it started off focusing primarily on disability and dysfunction because those are the aspects that attracted the most attention and caused the most harm.

    2. pmoran says:

      CS2013, Here is a “PREDICTION”. A person who thinks that God is telling him to kill someone, or, who has already killed someone under similar circumstances, is more likely to commit homicide than a person not subject to those delusions.

      It is nothing to do with statistics or logical fallacies. This is a recurring event of sufficient frequency to suggest strongly that the act is the result of the mental state. It would take a prospective controlled study of considerable sophistication to refute this connection and the performance of such is an impossibility.

  2. pmoran says:

    CS2013: “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.”

    Yes, there can be loose language in sceptical discourse and you are using a similarly sloppy linguistic approach to justify an overly dismissive stance towards psychiatry .

    Homeopathy is first and foremost neither a “science” nor “not-science”. It is a set of highly specific claims about illness, what causes it and how to treat it.

    So, we NEVER have to refer to abstract notions as to “what is science?” to form an opinion as to whether any of the claims are valid or not. We have a mass of evidence to apply to that. Some might inconsequence refer to this field as “unscientific” but that is a very loose shorthand for a whole set of problems with the underlying hypotheses and the evidence base.

    Psychiatry raises somewhat similar questions and needs to be approached the same way. But it poses special problems because of its subject matter and the difficulties involved in performing blinded, prospective studies.

    So, in common with a few other areas of medicine, its knowledge is less secure, while not being capable of the same kind of refutation that can be applied to homeopathy. What this means is that each of numerous often tentative hypotheses have to be approached at an individual level. Whether it is “science” according to any definition of that is irrelevant.

  3. WilliamLawrenceUtridge says:

    CannotSay, I’ll pose the same question I posed before – can you point to any instance where you have convinced someone else of the validity of your argument? Has anyone come around to agree with the main thrust of your beliefs – that psychiatry is social control, not science; that it is pure pseudoscience with nothing scientific about it?

    You may claim this is an argument from popularity; I prefer to see it as a measure of the reasonableness and cogency of your arguments. If nobody is agreeing with you – perhaps the consistent feature is not your opponents.

    1. Harriet Hall says:

      This argument has gotten sidetracked. Let’s challenge CannotSay to explain whether he accepts the reality of mental illness and what he would recommend be done about it. For instance, a person suddenly develops grandiose ideas, spends all his money and goes into debt to support some impractical scheme, doesn’t sleep, is hyperactive, alternates euphoria with irritability, talks nonstop for hours on end, is distractible, shows poor judgment and reckless behavior like driving too fast or engaging in promiscuous unprotected sex, telephones strangers at all hours of the night, carries on inappropriate conversations, imagines he has some special relationship with God or with a public figure, and is unable to function in his job and social life. These symptoms go on for at least a week. Then he goes through a period where he is sad, hopeless, feels worthless, loses his appetite and loses weight, stays in bed all day, and may be suicidal. These behavior patterns repeat cyclically.
      Is this a mental illness? Is there any such thing as bipolar disorder? There’s no blood test or brain scan that can diagnose it.

      Now suppose his desperate family takes him to a psychiatrist who provides cognitive behavioral therapy and prescribes Lithium, a drug proven to relieve bipolar symptoms and suicide risk and to reduce the overall death rate by 60%. http://www.ncbi.nlm.nih.gov/pubmed/23814104 . Once he is stabilized on Lithium, his behavior essentially returns to normal, and he no longer has suicidal thoughts.

      Why do you think the patient improved? Did the psychiatrist help him or harm him? Was the drug useless? Would you have recommended something that you think is better?

      1. CannotSay2013 says:

        Also Harriet,

        “DATA SOURCES:

        Medline, Embase, CINAHL, PsycINFO, CENTRAL, web based clinical trial registries, major textbooks, authors of important papers and other experts in the discipline, and websites of pharmaceutical companies that manufacture lithium or the comparator drugs (up to January 2013).”

        We learned from the EH Turner / Kirsch reviews, that any metastudy that fails to work on raw data submitted to the FDA is likely to suffer from publication bias, I am still astonished that you keep submitting as “proof” of your point of view studies that are very likely to suffer from said bias.

        1. CannotSay2013 says:

          Harriet, I have a comment waiting moderation because, I suppose, of the numerous links I included to back my reasoning. Please delete this one once that one is published.

      2. CannotSay2013 says:

        Also Harriet,

        The reason I insist in comparing HIV coercion with psychiatric coercion is because we do have the data.

        Even the most anti freedom fanatics around concede that Approximately 1,000 homicides each year are perpetrated by a person with a mental illness., that’s out of around 16000.

        In the case of HIV, the prevalence in the US is ~ 0.4%. From the same link, the number of deaths a year due to AIDS is ~ 15,000 (a number that we can consider stable due to the failure of HAART after 15+ years of massive access to HAART). The prevalence of HIV in Cuba is 0.2%. So from a pure “evidence based” point of view, the potential for a coercive HIV policy is that of saving 7500 lives a year (once the number of people dead of the disease stabilizes over time), while the potential for “saving lives” of locking up all “labelled as mentally ill” is by TAC estimates -which tend to error always on the side of exaggerating psychiatry’s precision- at most 1000 a year. Yet, I have seen nobody here arguing for a policy of coercion for HIV. And the reason is obvious: as effective as such a policy would be, civil liberties trump the so called “evidence”. Yet, many people here fall in the contradiction of using “evidence” of a lesser quality (since there is no accurate “psychiatric test” to predict violence) to trump the civil liberties of those who lave been labelled with “something” as is even less real than the HIV virus.

        1. Harriet Hall says:

          You didn’t answer my questions about the patient with bipolar disorder. All you did was repeat your previous tirade. Please go back and answer my questions.

          1. CannotSay2013 says:

            I did. What I said is a) we have reasons to believe that the study is suspect and b) even if we were to give that study any credibility at all, that alone doesn’t justify imposing a “treatment” on somebody who has not committed a crime anymore than it is justified to force HAART on a newly diagnosed HIV patient who refuses it, even though we know from the Cuban experience that such a “coercive HIV policy” would save the life of the newly diagnosed patient as well as those who could get HIV from him/her.

            This is why your defense of psychiatry sounds dogmatic. Even if we were to give psychiatry the precision that you claim for it, your arguments would make a policy of coercive HIV medication even more “evident” given that we know how to diagnose HIV with a high degree of probability while, under the DSM-5 regime, the probability of a correct diagnosis of “Bipolar I” and “Bipolar II” is 52% and 40% respectively (per the Kappa values of the DSM-5 field tests). Not only we know how to diagnose HIV better than “bipolar” but we are also better at predicting the progression of HIV to AIDS (regular CD4 and viral counts measurements) while psychiatrists admit that they have very little ability to predict who is likely to become violent given that somebody is “bipolar” (and what is “bipolar” is not even clear in the first place).

            So I have answered. And my conclusion is the same: for some dogmatic reason you are defending coercive psychiatry, while you do not defend “coercive HIV medicine” even though the evidence for the second policy is at least an order of magnitude better than the best evidence available to force “treatment” on people labelled as “bipolar”.

        2. WilliamLawrenceUtridge says:

          We’re not talking about coercion for HIV, the two are completely separate and you are bringing up one to distract from the other. The coercive incarceration of HIV patients might lower death rates, perhaps we should do that. But that has nothing to do with whether the DSM diagnostic criteria are completely invalid (which is what you claim) or merely imperfect but subject to continuing research.

          1. CannotSay2013 says:

            “The coercive incarceration of HIV patients might lower death rates, perhaps we should do that”

            Good luck confronting the gay and NAACP lobbies :D.

            For the record I am not defending such policy, all I am saying is that if you are basing a coercive psychiatry policy in the extremely low ability of psychiatry to prevent violence, incarcerating HIV patients, makes more sense than incarcerating all so called “mentally ill”.

            ” But that has nothing to do with whether the DSM diagnostic criteria are completely invalid (which is what you claim) or merely imperfect but subject to continuing research.”

            Yes and no. Strictly speaking no, but the reality is that the reason psychiatry is given unwarranted powers to abuse people is because some claim that its labels are scientific, despite the scant evidence for such positioning (that somebody like you keeps repeating in the face of recent admissions of Tom Insel and David Kupfer to the contrary). You are a zealot in the strict sense of the word because you keep putting forward a view that not even the “gods” of psychiatry hold anymore.

            As I have said numerous times, my beef is with coercive psychiatry and I see attacking its unscientific nature as a very effective way of attacking the rationale behind coercive psychiatry. If we are to give psychiatry the legal power to impose itself despite its unscientific nature -and its inability to predict violence-, then the current policy about HIV/AIDS doesn’t make sense. Conversely, if we accept the current policy towards HIV/AIDS, coercive psychiatry should be banned for people who have committed no crimes.

          2. WilliamLawrenceUtridge says:

            Individuals infected with HIV could be incarcerated for attempted murder for infecting others deliberately or for manslaughter through carelessness.

            There are a multitude of reasons that someone with a mental illness could be coercively removed from society; some could be valid such as the protection of self or others, some invalid. Society attempts to maximize the former and reduce or eliminate the latter. Society is not always successful.

            But you don’t care about HIV or mental illness. You only care that you were personally hurt, and now lash out in frustration, pain and revenge. You could try moving on with your life, that’s another option. But right now you seem to be pretty strongly focused on a single episode. Not to play pop psychologist, but it kinda seems like you’re still trapped in the hospital, the one you keep inside your own head. If you were doing something worthwhile like launching a patients’ rights group, or an investigation into psychiatric abuses, I could get behind that. But you’re not, you’re perseverating on a blog that you’ve never visited before because someone else locked you out of another one. Each post makes it clearer that this is personal, it’s not about psychiatry, it’s about you. Couldn’t you find a more meaningful use of your time, one that’s genuinely cathartic and contributes some value to society rather than this narcissistic set of rants at strangers?

            Anyway, have all the attention you want, I’m done.

          3. CannotSay2013 says:

            WLU,

            There must be somewhere a book that tells how to “dogmatically defend psychiatry” because all of you have resorted to the same fallacies. HIV incarceration in the US is AFTER THE FACT, never a preemptive measure even though it is more precise to predict that a gay man living in a large metropolitan area will infect other gay men than predicting who is likely to become violent and when.

            “Not to play pop psychologist, but it kinda seems like you’re still trapped in the hospital, the one you keep inside your own head. If you were doing something worthwhile like launching a patients’ rights group, or an investigation into psychiatric abuses, I could get behind that.”

            Who says I am not already engaged in doing something like that? The fight against psychiatry is multifaceted. Fighting its scientific nature in places like this is something that I know how to do better than other survivors because of my scientific training, which is obviously better than yours given the numerous fallacious and intellectually dishonest statements that you have put forward.

            “Couldn’t you find a more meaningful use of your time, one that’s genuinely cathartic and contributes some value to society rather than this narcissistic set of rants at strangers? ”

            Your egotistical nature always forgets that this goes both ways, You could find something else to do other than uttering a series of dogmatic lies to defend a quackery at a forum that is “allegedly” about scientific medicine. With your comments you are discrediting the word “science” in SBM. If you truly cared about SBM, you’d rather stay away from defending psychiatry dogmatically in a way that gives ammunition to those who would use your tricks to defend homeopathy or astrology. You’ve put forward several lines of “reasoning” that surely will come back to bite you the next time you criticize homeopathy :D.

            And not, I am not done attacking psychiatry. The goal of my fellow survivors is to make coercive psychiatry history. We will not stop until that goal is accomplished in an American context.

      3. CannotSay2013 says:

        “Why do you think the patient improved? Did the psychiatrist help him or harm him? Was the drug useless? Would you have recommended something that you think is better?”

        These questions assume that every so called “patient” will benefit from a forced psychiatric intervention. Let me give you a different scenario. The intervention does nothing other than causing the so called “patient” a whole lot of side effects associated to Lithium,

        Hand tremor
        Increased thirst
        Increased urination
        Diarrhea
        Vomiting
        Weight gain
        Impaired memory
        Poor concentration
        Drowsiness
        Muscle weakness
        Hair loss
        Acne
        Decreased thyroid function (which can be treated with thyroid hormone)

        Also because the so called “patient” was “forced” into psychiatry and “labelled”, he/she will have social and legal consequences that he/she will endure for the rest of his life. From being a free citizen, he/she will be transformed by way of psychiatric labeling into a subhuman entity who will be unable to hold certain jobs or have a normal social life anymore. As the result of the betrayal, the “patient” disowns his/her family for the humiliation he/she suffered and becomes an anti psychiatry activist.

        That’s basically my story if you substitute “bipolar” with “OCD” and “lithium” with “SSRI/neuroleptics”. Only to force me into “psychiatry” the gravity of my so called “symptoms” was exaggerated by my ex-family as “families” usually do to force the quackery into innocent victims. These so called “symptoms” were no different from my current fears of HIV -on the side, that is why I know so much about HIV :D-.

        Several years after, not only the doomsday scenario never happened (I have a higher paying job than what I had back then and obviously I didn’t become homeless) but I find myself divorced, without ties with my ex-family and a social life that is severely limited because the stigma created by those who go around “threatening” the consequences of so called “mental illness”.

        My experience is far from unique as a visit to the website of the survivor site of your choice (Occupy Psychiatry, Open Paradigm Project, Mind Freedom International, etc) will show you.

        So to claim that a “psychiatric intervention” is better than nothing or to leave the person alone is preposterous. In my own case, even if I had ended up divorced anyway, my life choices are now legally limited because of psychiatry. You guys have a very peculiar way of defining “good outcome” :D.

        1. Harriet Hall says:

          If you think the bipolar patient I described should be left alone, that it was “preposterous” to successfully treat his incapacitating illness, reduce his risk of suicide, and restore his ability to function, you are heartless, despicable, and out of touch with reality. If you had ever truly engaged with a patient like that, you would not be able to maintain your total denial of mental illness and of any benefit to treatment. Szasz made some good points but went too far. Patients like the one I described are a reality, not a myth. Your beliefs are so absolute and dogmatic that you don’t respect anyone who disagrees even slightly with what you say, so it is impossible to carry on a discussion with you. And by the way, most psychiatric patients are not coerced to accept treatment: they are suffering and more than willing to do anything that might relieve their suffering.

          1. CannotSay2013 says:

            “If you think the bipolar patient I described should be left alone, that it was “preposterous” to successfully treat his incapacitating illness, reduce his risk of suicide, and restore his ability to function, you are heartless, despicable, and out of touch with reality”

            First, since you didn’t provide any info, I assume it was a “forced” intervention, like the one that was forced on me. As Szasz, I also believe that people should be able to voluntarily engage with the quackery of their choice. Now, I hope you realize that this same argument can be written for HIV,

            “If you think the HIV patient I described should be left alone, that it was “preposterous” to successfully treat his incapacitating illness -that would end up in an assured DEATH after the illness would have progressed to AIDS-, reduce his risk of suicide, and restore his ability to function, you are heartless, despicable, and out of touch with reality”

            Note that you don’t have the guts to make such a statement in the context of advocating for a coercive HIV policy even though the predictive value of HAART therapy to treat HIV is better (like an order of magnitude better) than the predictive value of the best available “psychiatric therapy” to treat so called “bipolar”.

            Finally,

            ” Your beliefs are so absolute and dogmatic that you don’t respect anyone who disagrees even slightly with what you say, so it is impossible to carry on a discussion with you.”

            This is an interesting statement from somebody who has ended the debate with an “appeal to emotion” fallacy. I am not despicable. I have a higher respect for individual freedom than you have. That is one of the main differences between you and me: you don’t respect individual freedom as much as I do. Note though, that the paternalism that you defend for psychiatry, not only would justify a coercive policy for HIV/AIDS (that you don’t have the gut to defend here), but also things such as kidnapping obese people to a “fat camp” so that they become thinner (and thus less prone to diseases associated with obesity), banning homosexual sex (since again, such sex results in a disproportionate amount of not only HIV infections but all kinds of STDs), etc. I hope that you get the idea.

            I have a better heart than you. My heart respects individual dignity. Yours obviously doesn’t.

            1. Harriet Hall says:

              For the record, I have the greatest respect for individual freedom. I fully support the medical ethical principle of patient autonomy. I accept that patients have the right to refuse lifesaving surgery as long as they are truly informed, no matter how sad it makes me to see them throw their life away. I never said anyone should be forced to take psych drugs or AIDS drugs, or even vaccines. I have never defended paternalism in any form, except in the case of children too young to consent.

              Did you respect my individual dignity when you assumed I believed things I don’t believe and have never given you reason to suspect I did?

          2. CannotSay2013 says:

            Harriet,

            Something doesn’t add up here,

            ” I accept that patients have the right to refuse lifesaving surgery as long as they are truly informed, no matter how sad it makes me to see them throw their life away.”

            You are on record defending coercive psychiatry in “some cases”. It bothers to repeat myself, but my only beef with psychiatry is its coercive status, as I have said repeatedly. The only reason I spend my time attacking psychiatry is because it can be legally imposed. And don’t misinterpret this. It is not that I say that psychiatry is unscientific because of coercion is more like: coercive psychiatry is wrong, the best way to attack it is, because psychiatry is unscientific, is to attack its unscientific nature since it is widely accepted that “coercion” is tolerated because some defend that psychiatry is “scientific”. The reason why this line of attack is so effective is because if we accept the notion that “scientific disciplines can be imposed”, then it makes more sense to impose chemotherapy, blood transfusions, HAART, ban gay sex and a whole lot of other interventions before one defends psychiatric coercion. Those who defend “psychiatric coercion” have little other than “dogma” to defend that position. I don’t buy the “lack of insight” argument to justify coercive psychiatry because that is a proxy for paternalism.

            “Did you respect my individual dignity when you assumed I believed things I don’t believe and have never given you reason to suspect I did?”

            Of course I do. I am NOT the one who called you “heartless, despicable, and out of touch with reality”.

            After these discussions, it seems to me that there is very little disagreement on the following facts:

            - Psychiatry’s labels have not been shown to correspond to biological realities in the way CDJ or Alzheimer’s have. These labels, to quote Allen Frances are nothing but “constructs, nothing more but also nothing less… useful for purposes of communication and helpful in prediction and decisionmaking ” (although Frances himself is on record criticizing the “reliability” of these labels in DSM-5; see, the man is also contradictory :D).

            - Psychiatry is not a precise discipline. It is at least an order of magnitude less precise than other areas of medicine like oncology or the science of infectious diseases. This is what has been agreed upon (I believe that it is several orders of magnitude less precise but I take “one order of magnitude less precise” as the basis of agreement).

            - Because of Big Pharma influence in clinical trials, all published studies for psychotropic drugs that do not publish the raw data that is required by the FDA for approval are suspect of at least exaggerating the claimed effect. Per EH Turner’s reviews we have evidence that Big Pharma regularly engaged in publication bias to exaggerate the effect of SSRIs and neuroleptic drugs.

            These facts are beyond dispute. Now, for some reason, that I call dogma, some here keep defending psychiatry as “scientific” as it belongs in the same company as oncology or the science of infectious diseases. Then you, and others, also defend coercive psychiatry. I respect that, although I call it dogmatic because it is dogmatic. Certainly it is not “rational” or “scientific” if we accept for “science” a strict definition that obviously psychiatry doesn’t have. And since it is dogmatic, it is prone to contradictions, like on one side defending coercive psychiatry and another denying coercive HAART. Call it the Gödel effect :D.

            1. Harriet Hall says:

              “You are on record defending coercive psychiatry in “some cases””
              I don’t know what you are referring to, but the only time I would defend coercion is when a patient is a threat to himself and others. That can admittedly be very hard to determine. And although a patient has a right to make his own decisions, he has to be informed to be truly autonomous, and a psychotic, delusional patient is not capable of processing the information needed to make a good decision. Yes, some patients are being inappropriately locked up against their will, but there are also cases where families have begged for institutional control of a psychotic patient who is threatening them with violence, and when they couldn’t get help, the patient went on to kill one or more family members. I don’t know how we can make better decisions in these cases, or how we can make use of science to do so. That’s a real dilemma, but it doesn’t negate the fact that some out-of-control people need to be controlled to protect the lives and rights of others. Individual freedom must be balanced against the safety of others.

          3. CannotSay2013 says:

            Harriet,

            My bad, I have been reviewing the past comments and it was WLU who made the comments I had associated with you in my mind. Sorry :(.

            Nonetheless, even in your limited defense of coercive psychiatry, which I will qualify later, you also make appeal to another of psychiatry’s canards, the notion of “delusional patient is not capable of processing the information needed to make a good decision” that also goes by the name of “lack of insight” which is a proxy to paternalism. The notion that there is “lack of insight” into DSM invented illnesses is another of those chimeras that originated in TAC circles. As I said, “lack of insight” was the excuse used to lock me up in a country with “need for treatment” standard, so I don’t take the matter lightly.

            With respect to danger to “self or others”, I can buy the “danger to others standard” but only if it is applied as it is applied in criminal proceedings, that requires “probable cause” for the initial arrest and conviction of a crime “beyond reasonable route” for a long term incarceration. Since “making criminal threats” is already codified in state and federal law, I don’t think that “mental health laws” are warranted and should be entirely abolished.

            With respect to “danger to self”, I believe that the danger to end one’s life is implicit in the right to life. Even in that, Szasz was consistent until the end.

            1. Harriet Hall says:

              No, you are confusing disordered thinking with lack of insight; they are not the same thing. A schizophrenic may truly believe he is Jesus, or he may have insight into the fact that the voices in his head are not real, but are a sign that he needs to seek help. A patient who attempted suicide over a romantic breakup may wake up the next morning and say “What was I thinking? No woman is worth killing myself over.” Those patients were “not in their right mind,” their brains were not functioning properly. They may or may not have insight into the fact that their thinking was impaired or that they had lost contact with reality. Insight facilitates cooperation with treatment. Patients with a lack of insight may deny that anything is wrong with them and refuse help.

          4. CannotSay2013 says:

            “Those patients were “not in their right mind,” their brains were not functioning properly”

            After your clarification -and I take that you do not consider “lack of insight” grounds for any kind of forced intervention- it is still a lot of hot air. According to the link that I presented above, TAC estimates that 1000 killings a year are caused by so called “seriously mentally ill”. Given that TAC is basically an anti freedom propaganda machine, the right number of people who commit crimes because they are “not in their right mind” is probably half or a quarter of that. But let’s take 1000 at face value. In the same press release Murphy says that there are 11 million so called “seriously mentally ill” in the US. That gives a probability of 1/11000 that one of those goes on to commit a crime. Not very high (the prevalence of HIV in the general population is 40 times higher). Add to that that by psychiatry’s own admission, psychiatrists are not good at predicting who and when is likely to become violent. What this means is that it is not possible to determine who among those who hear voices asking them to do horrible things, will go and carry out a plan or who among those women who feel the need to take their own lives after being dumped, will go on and commit suicide. And the reason again is because people have free will. I remember when the Virginia Tech shooting happened. Psychiatrists ran to make their “scare mongering” to national TV -as they usually do in the aftermath of these tragedies- The best answer I heard to one of those fanatics who want to lock all so called “mentally ill” up was along the following lines. True, the shooter had disturbing thoughts that he had expressed in writing. However, so did Stephen King in his younger days. Stephen King chose to become a writer, the Virginia Tech guy chose infamy. It is impossible to predict who will do what because, again, we have free will.

            This, makes the whole notion that people should be “forcibly treated” a joke. The right approach is to leave those so called “seriously mentally ill” alone, just as we leave HIV positive patients alone even though we know that quarantining HIV patients would, in all likelihood, save 7500 lives a year, something like 7.5 times the number of lives that would be saved if all those 11 million so called “seriously mentally ill” were to be locked up -assuming that TAC numbers are correct which is a lot to assume.

            1. Harriet Hall says:

              Do you think there is EVER a situation where the rights of the individual are trumped by the rights of others? An individual has the right to explode a bomb, but don’t the victims have a right not to be killed? If we have reasonable certainty that someone is likely to use a bomb, should we leave him alone to exercise his freedom to bomb and only take legal action against him for murder after the fact? I agree that it is very difficult to predict a person’s behavior, that reasonable certainty is very hard to achieve, but does that mean we shouldn’t even try?

              And what if the seriously mentally ill don’t want to be left alone? Should the deficiencies of psychiatry and meds preclude him from using them?

          5. CannotSay2013 says:

            “Do you think there is EVER a situation where the rights of the individual are trumped by the rights of others?”

            I have been very clear in this thread that I AM NOT against behavioral control. What I have said repeated times is that behavioral control should be left in the hands of those whose job is to do behavioral control: the criminal justice system. Why? Because there are several layers of protections against abuse: first laws are made by legislators who are accountable to the people, they are also signed by executives that are also accountable to the people, they are subject to judicial review and applied by judges which, in most cases since these are state judges who make the majority of criminal determinations, are also accountable to the people. Also, people have the right to jury by a trial of their peers. The crime of “being dangerous” or “conspiring to commit a violent act” is already in the books of state and federal jurisdictions. This should be enough to take care of dangerous people.

            The thing that I object is the existence, as it is the case in the US right now, of a parallel system for those who have been given a DSM label. If you are given a DSM label, then the standard to lock you up is “clear and convincing evidence” which is below “beyond reasonable doubt” as required in criminal trials. You can also be locked up indefinitely, unlike the case of those convicted of a crime for which there are statutory protections against indefinite incarceration unless a crime is a very serious crime (like a mass killing).

            The notion that a group of self appointed mind guardians from the APA, by way of the DSM, have a right to expand the pool of people who can find themselves in the “sub par” category should be considered unacceptable to anybody who believes in human rights, even in science. We agree that psychiatrists cannot predict who and when is likely to become violent, yet we give them the right to decide who deserves to be treated as less than a citizen.

            With this said, I also grant that the situation in the US is at least an order of magnitude better than in Europe when it comes to preventing psychiatric abuse (and I have the rates of civil commitment on both sides of the Atlantic to prove it), but I am still unhappy with it. True justice will come only the day that psychiatric coercion is history. And I can also predict that once psychiatry is deprived of all its coercive powers, it will go the way of homeopathy. Psychiatry’s status as a legally sanctioned coercive force is one of the reasons mainstream doctors are fearful to speak against it. We do know from human experience that threat of coercion is a very strong incentive for people to accept all kinds of canards and lies.

            1. Harriet Hall says:

              Surely you don’t think the criminal justice system is based on science!

            2. Harriet Hall says:

              “I can also predict that once psychiatry is deprived of all its coercive powers, it will go the way of homeopathy”
              Psychiatry doesn’t have coercive powers per se; it is the state that does the coercion. I can predict that as psychiatry becomes more science-based, it won’t go away, even if all coercion is abolished.

          6. CannotSay2013 says:

            Harriet,

            “Surely you don’t think the criminal justice system is based on science!”

            Obviously not! That insinuation is a distortion of what I said. My point here is that I recognize the need for social control, but that social control has to be dealt with by those institutions whose role is to do social control. Because it is understood that what they do is social control, there are safeguards in place like “inalienable individual rights”, democratic control to excesses, etc. Even with that, the democratic system that is the model upon which other modern democracies are based, the US, was born accepting the notion that black people had no right to freedom in those states where slavery was legal. It took time to correct that disgrace, and 100 years more to end legal segregation (Brown vs Board of education). The liberation against psychiatric coercion has has its successes (Donaldson case in 1975) but we are still under a “Plessy like” regime, where a DSM label warrants a violation of the XIVth amendment. With time, we’ll correct that aberration too, just as Plessy was corrected.

            “Psychiatry doesn’t have coercive powers per se; it is the state that does the coercion.”

            Semantics red herring, you know exactly what I mean. Astrology, religion or more recently, eugenics, show that highly intelligent people are not immune to accepting lies as “scientific fact” if those lies are being enforced by the coercion of the state.

            ” I can predict that as psychiatry becomes more science-based, it won’t go away, even if all coercion is abolished.”

            I am so sure of what I say that I am willing to bet $1000 not only that psychiatry will not become more scientific (it has had 200 years to do so only to become increasingly unscientific and homeopathy like) that the day all psychiatric coercion ends, psychiatry will go the way of religion, astrology or eugenics: despised as a pseudoscientific endeavor that caused a lot of suffering. Just as we read critical essays about how was it possible that educated societies in the first half of the XX-th century were so blinded as to accept eugenics as “science”, 100 years from now there will be essays about how was it possible that a XX1st century, well educated society was able to put so many children on cocaine and amphetamine under the disguise of “treatment” or that poisonous SSRIs and neuroleptics were forced onto people just because they didn’t comply to DSM quackery. The joke will be on those of you who defend psychiatry just as the joke is now on those who defended eugenic sterilization policies under the disguise of “science”.

        2. WilliamLawrenceUtridge says:

          The fact that the drugs used to treat certain neurological illnesses have side effects does not mean those illnesses do not exist. It does mean that existing illnesses and treatments need to be investigated further to prevent the former and improve the latter. Similarly, your personal example is a reason to reduce stigma, improve understanding, diagnosis and treatment, not pretend mental illness does not exist.

          1. CannotSay2013 says:

            “The fact that the drugs used to treat certain neurological illnesses”

            No DSM label has been shown to be a neurological illness, per Tom Insel’s statement and David Kupfer’s acknowledgement. David Kupfer is the chairman of the DSM-5 task force. This statement of yours is scientifically false.

            “your personal example is a reason to reduce stigma, improve understanding, diagnosis and treatment, not pretend mental illness does not exist.”

            Quite the contrary. My personal story, the story of these people http://openparadigmproject.com/ and many thousands other speak of the real social and damaging consequences of putting forward “invented illnesses” to patterns of behavior that the APA doesn’t like. There is a lot research (that I am not going to repeat because I have already posted it here many times) that each canard put forward by psychiatry has resulted in increased stigma, not less. The reason stigma exists against those labelled with DSM labels is the same reason stigma existed back in the day against former slaves who had been labeled with drapetomania or women who had been labelled with “hysteria”.

            It’s an old “blame the victim” kind of trick. Instead of blaming the victimizer, you want to blame the victims of the scam for “not complying with the label”. It didn’t work against those slaves, it will not work against us. As I say above, 100 years from now, the joke will be on those of you that defended human rights abuses under the disguise of “science”.

  4. CannotSay2013 says:

    Harriet,

    I am glad you asked, My view is, generally speaking, the same as Thomas Szasz’s.

    Before anybody throws “anti Szasz” cliches, I would like he/she to read his ground breaking essay “The Myth of Mental Illness” entirely and tell me specifically what is that Szasz says there that he or she disagrees with. Allen Frances tried to have it both ways last year during a CATO institute’s debate and he failed miserably. Note that this discussion happened ~ 6 months before Tom Insel gave out the secret that the DSM labels had not been shown to correspond to “diseases” in the sense of “issue diseases”. Now, whether you agree or disagree with Allen Frances that “mental disorders are constructs, nothing more but also nothing less. Schizophrenia is certainly not a disease; but equally it is not a myth. As a construct, schizophrenia is useful for purposes of communication and helpful in prediction and decisionmaking — even if (as Schaler correctly points out) the term has only descriptive, and not explanatory, power”, to keep insisting that “mental illness” is like “diabetes” or “migraine” is to hold a position that is now outside mainstream psychiatry. And yet that is the position that has been repeated ad nauseum here. This point is important because “science” is not supposed to deal with “artificial constructs created for convenience of nomenclature” but with objective realities that exist independently of our ability to study them. This alone makes psychiatry a different animal altogether from other areas of medicine, to the point that Jeffrey Lieberman, the president of the APA that nobody can accuse of being “anti psychiatry”, acknowledged very explicitly in that NPR conversation that psychiatry is a step child of medicine.

    I think that I have argued very convincingly why psychiatry should not be considered “scientific” to the point it has been conceded here, even by you, that even if we give psychiatry the rank of “science”, it is very inaccurate, like one or several orders of magnitude less accurate than “real science”.

    It is so inaccurate in fact that when every possible bias is removed from their so called “studies”, it has has roughly the same precision as astrology or homeopathy, which begs the question about the “deferential” treatment given to psychiatry but denied to homeopathy and astrology. The excuse that “it helps some people” is also made by the defenders of homeopathy and astrology, which makes your defense of psychiatry look very dogmatic.

    And finally, regardless of where one lies on the debate of the status of psychiatry as a scientific disciple, I find it very hard to believe that people do give psychiatry coercive powers in “some cases” all while at the same time they deny the same powers to HIV science even though, HIV science is real science and the evidence is, based on the Cuban experience, that if the US were to adopt a coercive HIV approach, the number of annual deaths by preventable AIDS infection would be certainly lower than the 15000 that we have now. The number of infections would also be lower. As a side effect, the nation would save part of the 14 billion dollars a year it currently spends (by the federal government alone) in public HIV/AIDS programs, a big chunk of which goes to paying for expensive HAART therapies.

    Note that I am not defending a change in HIV policy, I am just highlighting the contradiction of on one side admitting that psychiatry has an accuracy that is several orders of magnitude lower than HIV science, while on the other giving psychiatry “coercive” powers that are denied to HIV science even though according to the best evidence available, more lives would be saved by quarantining HIV positive people than by locking up anybody that a psychiatrist thinks needs to be locked up.

  5. pmoran says:

    The HIV analogy is invalid on several grounds. It is time we saw you practicing what you preach, and showing an ability to examine the quality of your own reasoning and evidence. That is another essential facet of “good” science. Your tendency to fall back on perceived authorities is not .

    Firstly, society does exert “coercion” of a degree appropriate to the HIV setting. HIV sufferers can by no means be regarded as completely “free”, and certainly not with respect to any right to infect others, partly because we can expect the majority of them to automatically behave in a rational, responsible and caring manner. Other strictures are in place, so that if they too carelessly infect someone else considerable punitive action including serious infringement upon their liberty, will follow.

    The opprobrium and likely shunning of their peers provides additional constraints of a kind that are usually lacking in an irrational schizophrenic.

    Secondly, preemptive action makes it much more likely that some schizophrenics will get appropriate treatment. Or, if you choose to be as ferociously and self-servingly skeptical and conspiratorial concerning that, they will at least be kept safe while natural remission may occur or the effects of any provocative drugs wear off.

    On one side of this argument has to be set that the seriously deluded are typically already involved in an unhappy, fearful, and dysfunctional lifestyle, while also being at risk of being locked up permanently should they at any time yield act upon their delusions.

    As Harriet asks, you do need to come up with a better explanation of why this is so totally unacceptable.

    1. CannotSay2013 says:

      “Other strictures are in place, so that if they too carelessly infect someone else considerable punitive action including serious infringement upon their liberty, will follow. ”

      I hope you understand that these laws that criminalize knowingly giving somebody HIV are applied AFTER THE FACT, not to people who “MIGHT TRANSMIT THE DISEASE”, which is how so called “mental health” laws are written. And it is not for lack of information. Under the standard that “there is a great likelihood that somebody will knowingly expose somebody else to HIV transmission through unprotected contact” you could lock up a great majority of gay men who live in America’s largest cities since there is a lot of research that backs the so called “unhealthy” live styles of these homosexuals (not homosexuals everywhere, but specifically those who live in large metropolitan areas) and that show that around 20% to 25% them are HIV positive. By your “preemptive locking” reasoning, which is what is applied in so called “mental health law” all these homosexuals should be locked up :D.

      “Secondly, preemptive action makes it much more likely that some schizophrenics will get appropriate treatment. Or, if you choose to be as ferociously and self-servingly skeptical and conspiratorial concerning that, they will at least be kept safe while natural remission may occur or the effects of any provocative drugs wear off. ”

      This is just a veiled defense of state imposed paternalism (that also assumes that the best so called “treatment” for so called “schizophrenia” is drugging, a line of thought that even mainstream psychiatry is in the process of abandoning per a recent APA statement that calls for a restricted use of neuroleptics).

      No other than the SCOTUS has refuted this line of thought in the O’Connor v Donaldson case,

      “May the State confine the mentally ill merely to ensure them a living standard superior to that they enjoy in the private community? That the State has a proper interest in providing care and assistance to the unfortunate goes without saying. But the mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution. Moreover, while the State may arguably confine a person to save him from harm, incarceration is rarely if ever a necessary condition for raising the living standards of those capable of surviving safely in freedom, on their own or with the help of family or friends. May the State fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different? One might as well ask if the State, to avoid public unease, could incarcerate all who are physically unattractive or socially eccentric. Mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty. In short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”

      Harriet is on record rejecting paternalism, so I doubt you are going to get any friends here. BTW, the same “paternalism” can also be applied to HIV positive people and, if I am not mistaken, it was one of the reasons the Cuban government quarantined them, so the could be “appropriately taken care of” :D.

      The HIV analogy is great because it shows the type of contradictions that people like you believe in to justify psychiatric coercion. Certainly, your position is not driven by science but by prejudice against those who behave in ways disapproved by DSM mind guardians.

  6. pmoran says:

    ” I hope you understand that these laws that criminalize knowingly giving somebody HIV are applied AFTER THE FACT, not to people who “MIGHT TRANSMIT THE DISEASE”, which is how so called “mental health” laws are written”

    The point of the various deterrents I mentioned is that you cannot rely upon any of them to limit risks from irrational behavior. Also, where the risks of HIV infection are at their greatest, those at risk know it in advance, and have some ability to avoid it. (Any who infect their wives probably should be locked up!)

    It is the combination of all these factors, including the self-interest of those of us not wanting to become random victims, and some justifiable paternalism towards those who are unable to make their own rational decisions, that makes preemption a reasonable option in mental disorders but not, so far, in HIV policy.

    And where do you draw your lines? Anywhere? Society is always ready to be coercive wherever there is foreseeable and preventable risk to its members. You could at one time not travel overseas without smallpox vaccination. If HIV was carrying off a seventh of the world’s population including its babies and children, as tuberculosis was said to be doing merely a century ago, then we very likely would have been more coercive, making testing compulsory, for example, and placing whatever restrictions were legally feasible on those found positive. .

    1. CannotSay2013 says:

      “Also, where the risks of HIV infection are at their greatest, those at risk know it in advance, and have some ability to avoid it. (Any who infect their wives probably should be locked up!) ”

      Good luck advancing the following proposals,

      - Locking up all newly infected gay males in large metropolitan areas, where the rate of infection is 20-25% of the gay male population.

      - Locking up black males in three adjacent Manhattan neighborhoods with relatively low poverty rates where very high prevalence (19.3%) was found among black males.

      - Locking up all HIV positive people in certain African nations (like South Africa or Botswana) that have infection rates well above that “1/7th”.

      You don’t have the guts. The real problem here is prejudice against those who behave in ways non approved by society. The DSM is just a reflection of what behaviors the APA quacks consider acceptable. Then they make the “leaf of faith” to say that those who deviate from their behavioral orthodoxy have “brain diseases” and that they are “dangerous” if left so called “untreated”. This is what they did to gays up until the early 70s before the APA decided via a referendum to remove homosexuality via a vote from the DSM. It doesn’t take a genius to conclude that psychiatry is all about behavioral control and economics. Not only there is no science to back up psychiatry’s invented diseases, but the notion that coercive psychiatric laws are based on “science” is also preposterous.

  7. Self Skeptic says:

    Here’s an interesting and relatively even-handed view of the issues involved in the “noble lie” aspect of psychiatry. This is a book review of Gary Greenberg’s book about DSM 5, “The Book of Woe.” Greenberg is a clinical psychologist, who has an inquiring and reasonably skeptical view toward his field. He dares to suggest that mental health professionals could adopt a policy of admitting the actual limits of knowledge regarding psychiatric diagnoses and medications. He regards the current strategy of spurious certainty, as deceptive, which I think is hard for any critical thinker to credibly deny. The only question remaining, is whether this is a “noble lie” that should be propagated and defended, “for the good of the public.”

    Needless to say, lies, even supposedly noble ones, are antithetical to science. However, in every medical field where I dig a little, I quickly find so many scientifically questionable assertions, that I’m willing to entertain the possibility that an insistence on scientific-style truth, which includes acknowledgment of uncertainty, may be intolerable in medicine, for perceived or actual pragmatic reasons.

    As Feynman recommended, as a scientist, I have to “bend over backward to show how I might be wrong,” and that precludes overselling my concern that disguising any lie, however noble, as “science,” will lead to the degradation of both the reputation and the standards of all science. My concern is that eventually no one will be able to tell the difference between real science and “noble lie” science, which the field of medicine (unconsciously?) condones. This concern that justified deception is likely to spread beyond its area of seeming necessity, is supported by current problems in non-clinical medicine. Apparently much of published preclinical research, where the humanistic arguments in favor of deception should be invalid, is suffering from such a lack of rigor in execution and peer-review, that it is irreproducible. See this summary, for example:
    http://www.nature.com/nature/focus/reproducibility/index.html
    I’m hoping this lack of rigor won’t leach into the bench science of molecular and cellular biology, but it’s hard to tell where a race to the bottom, lavishly supported by both public and corporate funding, will stop.

    Granted, the DSM is on the farthest fringe of medicine’s scientific respectability, and I suspect a large proportion of MD’s recognize that. Overall, I’m more interested in less obvious cases of dogma trumping reality. But the DSM is a good test case, for how far uncritical mainstream medical advocates are willing to go, in granting the label of “scientific” to mere consensual constructs. The noble-lie argument is especially prominent here.

    Whatever one’s bias on these issues, the book review (below) provides a good pro and con discussion of the noble-lie function, in psychiatry. It seems that all participants at SBM at least agree that psychiatry as a science is in its infancy. The question then lingers, whether its presence as part of mainstream medicine grants it, by association, the same presumption of membership in “the sciences” that the rest of mainstream medicine has achieved, in the public eye. The book that is being reviewed suggests that it would be better for psychiatry to publicly own its uncertainty. The book reviewer doubts that this strategy is practical.

    http://www.slate.com/articles/arts/books/2013/05/book_of_woe_the_dsm_and_the_unmaking_of_psychiatry_by_gary_greenberg_reviewed.2.html

    Is Psychiatry Dishonest?
    And if so, is it a noble lie?

    by Benjamin Nugent

    snip

    Of course, it was the DSM that launched the Asperger’s craze in the first place. The DSM-IV’s publication in 1994 was the moment the hitherto obscure disorder, which had never appeared in previous editions, entered the mainstream. Allen Frances feels responsible for the explosion of diagnoses; it was under his watch that the expansive DSM-IV criteria for Asperger’s made it in. (At the last minute, and, Frances tells Greenberg, too loosely defined). By “saving normal,” Frances means that he wants the next generation of psychiatrists to erect a bulwark against the wanton expansion of diagnostic boundaries.

    Whereas Greenberg sees more honor in frank ambiguity:

    “No one knows what would happen if psychiatrists simply let themselves out of their epistemic prison by no longer pretending to know what they can’t know. No one knows what would happen if they simply told you that they don’t know what illness (if any) is causing your anxiety or depression or agitation, and then, if they thought it was warranted, told you there are drugs that might help (although they don’t really know why or at what cost to the brain, or whether you will be able to stop taking them if you want to; nor can they guarantee that you—or your child—won’t become obese or diabetic or die early), and offer you a prescription.”

    That sounds pretty appealing when the examples you use are “anxiety or depression or agitation.” In fact, as Greenberg points out a page later, the above conversation is probably the one a lot of family doctors have with their patients when they prescribe antidepressants. But what if the example you use is the autism spectrum, and the patient is a kid? It seems problematic to tell a 10-year-old, or even a 20-year-old, that she might be on the autism spectrum. Can you imagine taking on adolescence while harboring the knowledge that you might be socially and/or cognitively impaired? Would you be able to say, “Aw hell, this quote-unquote disorder is just an intellectual construct anyway”? That strikes me as a situation in which transparent conjecture might cause substantial harm.

    And besides, a lot of medicine is mysterious, not just psychiatry. Doctors of all kinds are forced to make educated guesses as a matter of routine. They still try to follow an exacting set of common guidelines for treatment. Greenberg anticipates this argument, countering that “psychiatry, much more than other medical specialties, is still deeply in the debt of ancient medicine.” But he does not address the intrusion of politics and culture on all manner of healthcare. Surely the debate about whether childbirth should be medicalized is a cultural and political one. As is the fight over whether we should consider an ailing 95-year-old “sick,” when said 95-year-old demands constant medical attention and a poor 40-year-old can’t afford to see a doctor. If the difference between psychiatry and the rest of medicine is a matter of the degree of uncertainty, is psychiatry really trapped in its own “epistemic prison?”

    There is a reasonable case for a psychiatric bible designed to nip protestant speculation in the bud and written in a papal cast of mind. Greenberg argues persuasively that the current DSM encourages psychiatrists to reach beyond their competence. But perhaps we can save the DSM by making its definitions of mental illness stingy enough to encourage reticence. That DSM would not be hard science but a set of highly constrictive rules about what you are allowed to prescribe a patient and under what circumstances you’re allowed to evoke a diagnosis. It seems to me—and I am a novelist, not a mental health professional, and so have no dog in this fight, no drug company consulting gig, no claim on insurance payments to protect— that the DSM’s great purpose should be to curb the exuberance with which enterprising doctors and laymen invent, buy, and sell diagnoses for fun and profit. To be sure, this is a Kissingerian stance: Let’s prop up the dictator with the medals on his chest so long as he keeps the guerillas at bay. But if the DSM ceases to be the sourcebook doctors and patients use to determine the parameters of diagnoses, other sourcebooks will proliferate. Like those websites spreading the good news that Nabokov and Dickinson had Asperger’s.

    I can’t personally condone propping up dictators, when they are pretending to be scientists. This extends to any rigid enforcement of (inevitably oversimplified) guidelines. And I think much of medicine, not just psychiatry, is “trapped in its own epistemic prison,” and that this perception will always be deeply threatening to doctors who perceive their profession as science-based.

    But I think Nugent’s justification for a psychiatric bible, based on the concern that “other sourcebooks will proliferate,” expresses the core belief at SBM, regarding all consensus views in medicine, however demonstrably weak their basis in published evidence, and however great the circumstantial evidence that they aren’t working well for the patients. Think how inadequate the 7-minute HMO appointment would be, for any non-obvious set of signs and symptoms, if existing algorithms and “care pathways” were replaced by thoughtful investigation? Primary care, especially, in which the illness has not already been provisionally assigned to a likely specialty, would become impossibly complex, or alternatively, impossibly expensive.

    1. CannotSay2013 says:

      ” I suspect a large proportion of MD’s recognize that”

      I think it is patently obvious that at least the majority of MD – psychiatrists recognize that. Note that when Tom Insel initiated the firestorm earlier this year, the official response of the APA was not to deny Insel’s claims, but rather to affirm them (there are no biomarkers for DSM labels) , then put forward what you have nicely called “the noble lie”.

      The notion that “science” should accept “noble lies” is a mockery of science, regardless of any other considerations. This alone should make this movement reject psychiatry altogether for not being “scientific enough” just as this movement does with astrology or homeopathy.

      In the case of psychiatry, things get worse. You can add that its “noble lies” have also caused a lot suffering to people who have been abused by psychiatry like me, even death (psychiatry’s hands are tainted by every single person who has taken his/her own life under the influence of SSRIs or who has committed a Virginia Tech type of shooting under the influence of SSRIs/neuroleptics). In the case of the Virginia Tech guy it has been disputed whether he had been on neuroleptics during the killings, but there is no doubt that the Columbine guys were under the influence of psychotropic drugs when they committed their crime.

      Sorry, but the only decent thing that this SBM movement can do with respect to psychiatry is to fight is even more fiercely than it fights homeopathy because at least homeopathic drugs do not kill anybody.

  8. Tamar says:

    You are a disastourous joke. You started this blog, for ego purposes I’m sure, but you are a brainless dope with zero ground in actual science, sucking off the big boys. You are pathetic! What’s it like to live without a soul, or brain?

    1. Harriet Hall says:

      Thanks for the compliment. I consider it a compliment when my critics can’t find anything specifically wrong that they could rebut, and they are reduced to the only weapon left to them: juvenile personal insults.

    2. Chris says:

      Tamar, why do you think insults are a valid form of evidence, or discussion?

  9. pmoran says:

    “He regards the current strategy of spurious certainty, as deceptive, which I think is hard for any critical thinker to credibly deny. The only question remaining, is whether this is a “noble lie” that should be propagated and defended, “for the good of the public.””

    This sounds like another CS2013. That some aspects of psychiatry are arguable (with which we agree) does not mean that they can automatically be assumed to be wrong, nor that every other aspect of that field is also wrong.

    It is far more likely that the differences of opinion arise from tricky questions, such as” what human behaviour should be regarded as normal, or otherwise” and “when do individual rights outweigh the rights of others”.

    Until something is proved one way or the other, which is impossible with some such paramedical matters, there can be no “spurious” and there is no need for a “noble lie”.

    1. CannotSay2013 says:

      What you don’t get is that all DSM labels are in fact “lies” (I refuse to use the word “noble” because there is nothing noble in stigmatizing a person for life, which is what DSM labels do). They are lies in the sense that none of them has been shown to be a tissue pathology other than in the mind of DSM committee members who surely have disturbed minds. These disturbed minds have changed their opinion over the course of the life of the DSM as to what is “pathological” and what isn’t, based solely on their own biases. I see the DSM more a reflection of the committee member’s unstable minds than anything else. I claim that labeling behavior that you disapprove of as “disease” is itself a “mental illness”. All the DSM committee members suffer from said mental illness :D.

      1. pmoran says:

        CS2013:”What you don’t get is that all DSM labels are in fact “lies” (I refuse to use the word “noble” because there is nothing noble in stigmatizing a person for life, which is what DSM labels do). ”

        That’s a bit rich. At the margins some aspects of the DSM may be debatable and I certainly don’t approve of over-medicalizing truly harmless behaviour. But “lies”?

        To my understanding the DSM is a standard and necessary element within medicine’s working papers as it tries to come to grips with the best ways of dealing with problems that patients and their relatives bring to it.
        The DSM thus describes the problems that psychiatry encounters, not something that it is trying to trick anyone into (as some drug company advertising and CAM’s pretensions concerning some Holy Grail of “wellness” might).

        If it is not a problem for the patient, caring relatives or a risk to the general public, then it is not (or, I agree should not be) a problem for psychiatry.

        The stigma comment is also grossly unfair. Psychiatry has itself worked hard to dispel the stigma that the man in the street attaches to the “mentally ill”. It was never the origin of that, by the way — it has always been the regular guy who smirks behind his hand at those who are odd. And why would regarding mental disorders as an illness like any other not reduce the stigma attached to them?

        Think a little also about the “medical tool” aspect to the DSM. I have pointed out before that it is essential to have some such basic diagnostic framework within which to try and work out, and especially to test out, the best pharmaceutical or psychological ways of dealing with differing medical problems.

        That is, unless you wish to claim that there is no significant difference between, say, paranoid schizophrenia, and OCD, or manic or depressive states, or mild anxiety states, and that none of them should ever require intervention under any circumstance. That is coming across.

        1. WilliamLawrenceUtridge says:

          Pete, the frustration you may end up feeling, if you continue interacting with CannotSay, is a mirror of the frustration that the rest of us feel when you defend CAM.

          Just noting.

          1. pmoran says:

            “Pete, the frustration you may end up feeling, if you continue interacting with CannotSay, is a mirror of the frustration that the rest of us feel when you defend CAM.

            Just noting.”

            Firstly I object to my finely tuned remarks :-) being classed as “defending CAM”. My thrust is that therapeutic interactions seem to be more complex than a simple “working better than placebo” model of medicine can describe. That viewpoint is well-supported by other kinds of scientific study and, I suspect, critical to a complete understanding of medicine at its interface with users.

            I am also not naïve enough to expect that deeply held beliefs can be dispelled by a few days exchange over the Internet especially once it degenerates into the usual exchanges of ad hominem attacks.

            I am learning from CS2013 that some elements of psychiatry may indeed be going a little overboard with a “chemical imbalance” theory of mental disorders. Nevertheless, he, and those he quotes, may not yet be aware of the limitations and potential problems of being overly committed to psychosocial factors, such as intractability (often), poor patient insight, and the cost if prolonged psychological interventions are required.

            If you are reading this Cannot Say, it is my response to your anecdotes, which derive from psychologists and academics who may not be entirely wrong, but who have their own furrows to plough.

            Everyone wants medicine to be simple. It rarely is.

          2. mousethatroared says:

            When you say “the rest of us” I hope you are not including me. While I might sometimes disagree with pmoran (as I sometimes disagree with many others) I wouldn’t consider many of those disagreements equivalent to my disagreement with CSN13.

          3. CannotSay2013 says:

            pmoran,

            You’ve made a few priceless comments that are quite astonishing,

            ” Nevertheless, he, and those he quotes, may not yet be aware of the limitations and potential problems of being overly committed to psychosocial factors, such as intractability (often), poor patient insight, and the cost if prolonged psychological interventions are required.”

            For those who understand the software/hardware analogy (I am not sure if it is your case), you are basically saying that we shouldn’t attempt to solve a genuine memory leak via fixing the software because many are “intractable”, it’s difficult to isolate them or that it is cheaper in most cases to keep adding memory to the system. WOW, if there was to be a nonsensical defense of psychiatry, this is as close as they come :D.

            “If you are reading this Cannot Say, it is my response to your anecdotes, which derive from psychologists and academics who may not be entirely wrong, but who have their own furrows to plough.”

            A recognition by the NIMH director and an acknowledgement by the chairman of the DSM-5 task force (the current standard bearer of American psychiatry) that none of the DSM labels have been shown to be biological is hardly “anecdotal”. Nor is the research that has pushed both the NIMH and APA, in recent press releases, to ask for a limited usage of neuroleptics. It is just that you guys are, for some reason, committed to the idea of psychiatry as a “science”.

            Since I haven’t followed you, I didn’t even know that you were a defender of CAM. If you are a defender of CAM, then you get a pass as a defender of psychiatry, since psychiatry is actually another form of CAM – where people used to go to spiritual counselors to deal with life issues 50 or 100 years ago, now they go to psychiatrists. What I don’t get is those who strongly defend psychiatry while at the same time demonize CAM!

        2. CannotSay2013 says:

          “The DSM thus describes the problems that psychiatry encounters, not something that it is trying to trick anyone into (as some drug company advertising and CAM’s pretensions concerning some Holy Grail of “wellness” might). ”

          Maybe when the first DSM was conceived that was the goal, but right now it is absolutely not the case. The reason it is called “bible” is because diseases are literally “made up” via a vote. The most clear example is homosexuality, but there are also recent ones, of both diseases that made it to the DSM (binge eating) and those who failed to make it (internet addiction) because of votes. Once in the DSM psychiatrists tell those who have been unlucky enough to land in their hands that they have a disease like “diabetes”. Do not believe me? Read point 5 here. It is an “anecdote” -a real one- but it is how it works. As a condition of getting out of my commitment I had to agree to the idea of having a “broken brain” that needed “medicine” for many years to be corrected. Saying something like that to anybody should be considered a form of psychological abuse. Yet, that type of psychological abuse happens every day and it is perpetrated by thousands of psychiatrists in the US because of the DSM.

          “Psychiatry has itself worked hard to dispel the stigma that the man in the street attaches to the “mentally ill”.”

          Quite the contrary. Psychiatry wastes no time every time that there is one of those mass shootings to reason by anecdote about the dangerous consequences of leaving so called “mental illness” untreated, leaving the impression that every person who doesn’t get treated for their invented labels is a “time bomb”. Therefore, psychiatrists themselves are the prime reason stigma exists. As I said, there is a lot of research about the matter, so this point is fairly well established.

          “That is, unless you wish to claim that there is no significant difference between, say, paranoid schizophrenia, and OCD, or manic or depressive states, or mild anxiety states, and that none of them should ever require intervention under any circumstance”

          I think that “deviating from a behavior that the morals of the day consider normal” is not a disease -in the sense CJD is a disease-, regardless of the existence of patterns of behavior and labels. Said behavior might be “criminal” or “disgusting” but it is not a “disease” in the literal sense. And yes, I believe that unless a crime has been committed, no forced intervention is warranted EVER. Never as in NEVER. Just as we don’t force HAART on non criminal HIV positive patients. This is 100% compatible with agreeing with people voluntarily engaging in the quackery of their choice, be it psychiatry or astrology.

          1. Harriet Hall says:

            Diseases and malfunctions occur in every part of the body. Wouldn’t you expect them in the brain, also? Behaviors are not a disease, but why couldn’t they be manifestations of disease in the brain? Just as a diabetic coma is a manifestation of disease in the pancreas. We are much better at diagnosing diseases of the pancreas than of the brain, but the only way we can get better at it is to try to use the scientific method to study the problem. If you could abolish DSM and coercion, how would you go about studying diseases of the brain?
            And do you think migraine sufferers should not be labelled as having a disease just because we don’t have a blood test or imaging method to diagnose it? The whole history of medicine has been to recognize a pattern of symptoms and then try to figure out the cause and treatment.

          2. CannotSay2013 says:

            Harriet,

            This Mad In America article The Myth of Mental Illness Revisited, NIMH Style addresses your questions including the conjecture of DSM labels as unproven putative brain diseases. Bottom line, yes, the brain can be sick -CJD or Alzheimer’s sick- and it could be well be that DSM labels are putative diseases of the brain. However, there is no evidence of that to be the case. And as you guys say in the skeptic movement, “extraordinary claims require extraordinary evidence”. As I said, every single “defense” of psychiatry along your lines does nothing but to weaken your movement because it makes psychiatry look like astrology or homeopathy which on the other hand you criticize as unscientific.

            1. Harriet Hall says:

              It is not an “extraordinary claim” to say that since thinking processes are a product of the brain, things can go wrong with them, just as insulin is a product of the pancreas and something can go wrong with its production. It would be more extraordinary to claim that such malfunctions don’t exist simply because we don’t yet have a diagnostic test.

              You keep reverting to criticizing DSM labels, and you don’t seem to realize that we AGREE with you that they are not valid diagnoses, but are merely placeholders until we can do better, and that that kind of placeholder concept is a NECESSARY step to studying any disease. For centuries, “fever” was a placeholder concept, and it was treated by what you might characterize as assault and battery: bloodletting. We didn’t even have thermometers to measure body temperature until 1867, and we gradually learned that “fever” was not one disease, but a sign of many different diseases, and that bloodletting was harmful. Today we can diagnose and treat malaria, bacterial pneumonia, and many other causes of fever. But the scientific process had to start with studying patients labeled as having “fever.” Diabetes was initially labeled as “honey urine” and “too great emptying of the kidneys.” If we had not identified people with those labels to study, we never could have made progress in learning about diabetes.

              And we certainly do have good observational evidence that patterns of behavior like bipolar disorder exist.

          3. CannotSay2013 says:

            It is a “extraordinary claim” on many levels:

            - With its limitations, the software/hardware analogy – that is obvious you don’t understand (although there was another commenter who did) – shows very convincingly that “software” (ie thoughts) and the physical support for them called “hardware” (ie, the brain) are two different things. In human beings things are even more complicated because of “free will”, which is a concept that is recognized societies around the world, democratic and non democratic alike. What a “human being does” cannot be a disease other than as a “metaphor”. As Jonathan Raskin says in the piece that I mentioned earlier, even if some of the DSM labels are placeholders for putative diseases (it has happened in the past), the overwhelming majority are not:

            “Medicine, for all its virtues, will never be able to “treat” (in a literal, medical sense of the term) people who are struggling over whether to quit their jobs, end a relationship, or give up grieving a loved one because to treat such things would mean there would have to be a biological malfunction, rather than a set of life circumstances, triggering these difficulties. Being upset about something does not always—or even usually—mean that one is sick. The negative feelings that life problems evoke are not always diseases. They are usually part and parcel of being human.”

            - I have already debunked the “temperature” analogy so I am not getting there. You also keep making the fallacious analogy “behavioral issues” with SOMATIC SYMPTOMS that I am tired of debunking as well. This is why I say that your defense of psychiatry is dogmatic. You accept as matter of “fact” or “dogma” that a behavioral issue is a SOMATIC SYMPTOM as fever. You don’t question that dogma even though it is obviously fallacious. Except for a few putative diseases that were first seen as “behavioral issues” (like CJD or Alzheimer’s) the vast majority of DSM labels are not putative diseases, and that would include schizophrenia or OCD,, none of which can be seen, in a biological sense, in an autopsy as Alzheimer’s or CJD can.

            1. Harriet Hall says:

              Thoughts are not a “thing,” but a manifestation of the neurophysiologic processes of the brain.

              Free will is an illusion, a useful fiction created by the brain to allow us to function more efficiently. See Wegner’s book “The Illusion of Conscious Will”

              I don’t know how you could know that “most” DSM labels are not placeholders for diseases.

              There is a difference between the problems of everyday life and mental illness. I agree that psychiatry does not have a good track record of distinguishing between them, and I agree that ordinary life problems have been pathologized. But I think there is a difference between “normal” grief, even severe grief, and a prolonged major depression with inability to function; I don’t know how we could draw a dividing line on the continuum, but I think it is worthwhile to try, because the ends of the spectrum require different responses.

              Behavior and thoughts are manifestations of neurophysiologic processes in the brain. They could be classified as “somatic” since the opposite of somatic is “psychic” and that term is meaningless to science. The brain is part of the “soma.” The concept of an immaterial mind is a holdover from mind-body dualism. The “mind” is only a metaphor for what the brain does. There is no reason to think the neurophysiologic processes in the brain wouldn’t be subject to malfunctions we could call diseases, just as happens in every other part of the body.

              Being seen on an autopsy is not a necessary condition for the diagnosis of a disease. Nothing can be seen on the autopsy of a person with migraine, irritable bowel syndrome, etc. They are not anatomical diagnoses, but manifestations of abnormal functioning of anatomically normal organs. They can’t be diagnosed with any test; we rely on the patient’s own report of his subjective symptoms. Do you accept that migraine is a real disease? The pancreas of a person with diabetes may appear normal on autopsy, and we didn’t have any tests that could diagnose diabetes in a living patient until we learned how to measure glucose. Did the disease diabetes only become real when we learned how to test for it?

          4. CannotSay2013 says:

            Harriet,

            “Free will is an illusion, a useful fiction created by the brain to allow us to function more efficiently.”

            That is quite an statement given that “free will” is assumed by the legal system. Without free will there is no crime.

            However, I think that is a statement that helps us get closer to your obstination in the defense of psychiatry. It seems to me, and correct me if I am wrong, that your problem is that the admission of a “mind” independent of the body would be threatening to a dogma that “there is no free will” so you rather go with the psychiatric canard, even though you know all two well that it is fallacious, than admitting “free will”.

            This contradiction of yours results from your inability to understand the “software/hardware” analogy. In a computer “software” doesn’t have free will. Maybe some day some computer will be able to pass a Turing test that makes it completely indistinguishable from a human, but we are not there by any stretch of the imagination. The brain is not just “an organ” just as in a computer the pair CPU+RAM running “software” is not “just a piece of hardware” than can be treated like any other piece of hardware. A faulty software, like a “memory leak” has effect on the hardware, notably memory that is increasingly occupied for no reason at all, but while all you see is memory being occupied, the problem is not the memory occupation, but the software running it.

            For those of you with an atheistic streak, there is no need to recognize a “deity” to see things this way. The programming of the brain can come from the environment, evolution, etc. In fact, Szasz was atheist -so much so that he was awarded the Humanist of the Year Award by America’s most prominent atheist organization.

            When dogma gets in the way of clear thinking, it is possible to say things like,

            “Did the disease diabetes only become real when we learned how to test for it”

            No, but “homosexuality” became a disease when it was voted in the DSM and stopped being a disease when it was voted out (as somebody pointed out, with a single vote, the APA eliminated an epidemic disease that affected 5% of the world population, I wish it was possible to do the same with diabetes, cancer or AIDS!!). Regardless of voting, diabetes can kill a person when the level of sugar in blood becomes too high. Homosexuality cannot kill anybody, it can only annoy “behavioral controllers”, that’s about it.

            Many DSM labels are defined with regards to the interaction with other humans. Before I was banned by Steven Novella, one of his followers conceded that he accepted the notion of homosexuality as a “disease” in the context of a homophobic society. And sure, if your notion of “disease” includes that, then the DSM has a point however, I don’t think that that’s what we are talking about here!

            This takes me to the following,

            “I think there is a difference between “normal” grief, even severe grief, and a prolonged major depression with inability to function; I don’t know how we could draw a dividing line on the continuum, but I think it is worthwhile to try, because the ends of the spectrum require different responses. ”

            Allen Frances has been ballistic that DSM-5 lowers the so called “bereavement” exclusion for depression from 2 months to 2 weeks. He has been all around the place claiming that this is an artificial introduction of “illness” in what is otherwise the “normal” process of grieving. He has been more quiet that the version of the DSM that he chaired, DSM-IV, did the same when it lowered that exception from 1 year to 2 months. That might be acceptable in a US context, but in certain societies, Muslim societies to be more precise, grieving the death of a very closed loved one (a spouse, a child) is expected to last at least that much. So obviously it cannot be the case that “depression” as defined by DSM-III, DSM-IV or DSM-5 is a disease.

            Diabetes is not dependent on the social context, regardless of our ability to measure sugar levels in blood! Diabetes in an Muslim country is the same as diabetes in the US or a communist country like Cuba.

            1. Harriet Hall says:

              “It seems to me, and correct me if I am wrong, that your problem is that the admission of a “mind” independent of the body would be threatening to a dogma that “there is no free will””

              You are wrong. There is no “mind” independent of the body: that is the most reasonable provisional conclusion based on the available evidence. The fact that free will is an illusion is not a dogma, but a conclusion based on evidence. It does not mean the individual is not responsible for his actions. This is complicated and hard to explain. I wish you could read Wegner’s “Illusion of Conscious Will.”

              “The programming of the brain can come from the environment, evolution, etc.”
              Of course it can. In fact, the brain’s thought processes themselves can contribute to programming itself. In fact, your mention of different grieving processes in different cultures means that the brain is programmed differently by those cultures, (and also for different individuals in the same culture) so that setting an arbitrary length of time for normal grieving doesn’t make sense. As I said, there is a continuum from grieving to depressive illness, and it is very difficult to pinpoint a demarcation between them; but it is clear to me that there is a difference and that it is worthwhile trying to identify the worst cases.

              “Diabetes in an Muslim country is the same as diabetes in the US”
              And severe depression and psychosis are basically the same everywhere, although their expression is influenced by cultural factors programming the brain. A Muslim would not be likely to have the delusion that he is Jesus Christ. An Amazon tribesman would not be likely to report that he was abducted by aliens and subjected to sexual probings on a space ship. And the physiology of pain is the same everywhere, but the experience of pain is different in cultures that value stoicism and those that encourage emotional outbursts and complaints.

              “Diabetes is not dependent on the social context” But the expression of mental illness is, precisely because of the kind of cultural programming you mentioned. There’s an interesting discussion of how culture can affect the expression of mental illness at http://www.scientificamerican.com/article.cfm?id=foreign-afflictions. That doesn’t mean mental illness doesn’t exist; it does mean it is more complicated and multifactorial than diseases like diabetes, so it is overly simplistic to try to compare them and to require equally stringent diagnostic criteria.

              ““homosexuality” became a disease when it was voted in the DSM and stopped being a disease when it was voted out”
              No, it never was a disease. It was falsely identified as a disease. It’s a good example of the very lack of validity of DSM that you are complaining of.

  10. WilliamLawrenceUtridge says:

    It is not that I say that psychiatry is unscientific because of coercion is more like: coercive psychiatry is wrong, the best way to attack it is, because psychiatry is unscientific, is to attack its unscientific nature since it is widely accepted that “coercion” is tolerated because some defend that psychiatry is “scientific”.

    If this were a textbook of cognitive psychology, this would be the example under the definition of “motivated reasoning”. What you’re saying is you don’t care about fair criticisms, you don’t care about facts, you don’t care about whether psychiatry can do good or be scientific. What you care about is that it did something nasty to you, and now you hate it. You’re attacking the science of psychiatry not because it is unscientific, merely because that is the point you perceive it to be weakest.

    So, your ultimate reasoning is irrational, even if your individual arguments contain reason.

    So there’s pretty much no reason to bother trying to have a rational conversation with you then. You can’t reason someone out of a position they haven’t reasoned themselves into, and rather clearly you haven’t reasoned yourself into this one.

    1. CannotSay2013 says:

      ” What you’re saying is you don’t care about fair criticisms, you don’t care about facts, you don’t care about whether psychiatry can do good or be scientific”

      You’ve already shown your limited intellectual abilities earlier with comparisons between heat and “mental illness” or your dismissal of the complexity of the LHC, so this straw man is hardly surprising.

      What I am saying is that GIVEN THAT psychiatry is unscientific, coercive psychiatry can be fought by fighting psychiatry itself. And sure, I wouldn’t give a damn about psychiatry if it didn’t the ability to ruin lives by way of coercion. I don’t give a damn about whether some astrologer might think whether the label “leo” fits me better than the label “cancer”. Psychiatric labeling does ruin lives BECAUSE of psychiatric coercion, which is why I spend my time fighting psychiatry not astrology. Astrology has ZERO ability to destroy lives. Psychiatry does nothing but destroying lives.

    2. mousethat roared says:

      WLU “You can’t reason someone out of a position they haven’t reasoned themselves into,”

      I’ve never thought of it that way before…but yeah, that’s about it, itsn’t it? and it’s applicable in a broad range of discussions ( particularily many with my mother-in-lay).

      :)

      1. WilliamLawrenceUtridge says:

        I’m surprised you haven’t seen that expression before, I cribbed it off of SBM somewhere.

        And yeah, that’s about it.

        1. mousethatroared says:

          Well, maybe I’ve seen it before, but wasn’t in the midst of trying to figure out where some of my MIL’s ideas comes from, so it didn’t jump out so clearly before. :)

          serendipity.

          1. WilliamLawrenceUtridge says:

            Have you read Mistakes were Made? It seems like it is a book that you would find interesting. I’d love to see a comprehensive book covering all the cognitive and logical fallacies the human mind is prone to.

          2. CannotSay2013 says:

            How pathetic to watch two dogmatic defenders of psychiatry agreeing that that those who don’t share the dogma are, by definition, wrong.

            Just as pathetic as watching two astrologers thinking that those who don’t “believe in the science” of astrology are wrong :-).

          3. mousethatroared says:

            Well, to be honest, I’m not sure it’s a good idea to read a whole book just to figure out why my MIL seems so set on coming up with her own* theories on what I must be doing wrong that caused any of my recent health issues. Maybe later when I have simmered done.

            Although I do remember listening to an interview with the author. It sounded good. Right now I’m reading the hallucination book that I mentioned earlier.

            *Which completely ignores any recommendations from doctors.

          4. WilliamLawrenceUtridge says:

            It’s a pretty short, easy read, but very worthwhile. Perhaps for your MIL… :)

    3. CannotSay2013 says:

      “So there’s pretty much no reason to bother trying to have a rational conversation with you then. ”

      I see a comment pending from mousethat roared on this line. I hope both of you also understand that this goes both ways.

      Based on your arguments, you hold the belief that “psychiatry is scientific” based on “dogma” not reason. The excuses you have given to defend it is not psychiatry’s precision nor that it deals with “real” biological conditions rather arguments along the lines “it works for some people”, give it enough time (as if 200 years was not enough time!) and it will surely will become scientific. Arguments that are suspiciously similar to those used by defenders of homeopathy or astrology. In this day and age, to keep putting the line that psychiatry is “scientific” is to argue from a dogmatic point of view, not from reason.

  11. pmoran says:

    CS2013:”For those who understand the software/hardware analogy (I am not sure if it is your case), you are basically saying that we shouldn’t attempt to solve a genuine memory leak via fixing the software because many are “intractable”,”

    Some will be, in the real world. Not everyone has the intelligence, will, insight or funds to engage productively in psychotherapy and a lot of people are locked into social situations from which they cannot escape. Psychiatrists have to treat these patients too when they present for help.

    And this before many other constraints that health care systems impose upon what its practitioners can deliver. Look at ALL relevant matters and you may realise that you are judging psychiatry from a rather extreme, very speculative, and impossibly idealistic stance .

    I am also not “saying” that the software should be ignored. I doubt whether any psychiatrist worth his salt will not be trying to provide whatever psychosocial support and fixes he can alongside any medications.

    In your #5 anecdote the patients were actually recruited from a support group. Did it escape your attention that these patients, though supposedly told they had a chemical imbalance, and becoming deeply disturbed when instructed otherwise within an ill-judged academic study, were nevertheless still having their “software” addressed in this way? I don’t think that story supports your case.

    1. CannotSay2013 says:

      “were nevertheless still having their “software” addressed in this way? I don’t think that story supports your case.”

      Yeah, but it was mostly through the placebo effect, nothing else. How do I know this? Because it has been fairly well established, using psychiatry’s own measures of OCD, that CBT alone (which is basically placebo) is more effective than drugs to treat so called “OCD”.

      I do not question that psychotropic drugs alter the mind. What I question is that they treat actual diseases, in the sense CJD.

      Messing up with your serotonin and dopamine levels alters your brain in a way that changing the conductivity of a PN junction can alter a CPU. I concede that such alteration has the potential of changing software.

      But that is not to say that they correct anything. In fact, there are studies that show that when it comes to depression, SSRIs are “active placebos”. People get to feel both the side effects of SSRIs as well as their “mind altering” effects and convince themselves that they are being “treated” and thus placebo enters the equation. The most common example is the guy (or girl) who takes the SSRI and claims, two days later when side effects begin to show up, that he/she feels better than ever. Yet, the changes in the brain due to SSRI action do no begin to appear until several weeks later :D.

      Anyhow, since you are a believer in CAM, I accept that you see psychiatry as another form of CAM: it works for some people and that alone should be enough to let it being used. To which I say, no problem, my problem is when psychiatry is used for coercive purposes, not only for civil commitment / forced drugging but in other areas like custody battles, estates, etc. Imagine that astrologers would be able to influence the justice system so that on the advice of astrologers judges would preemptively lock up a guy whose natal chart predicts that tomorrow he is likely to do something dangerous or to take away the custody of his children because his natal chart predicts that he will be a bad parent or to undo his will because his natal chart says that the will was done under “astrologically negative influence”. Well, that is the undue power that psychiatry has in society these days, and that is why it has to be confronted fiercely.

  12. CannotSay2013 says:

    Fresh from Scientific American,

    http://www.scientificamerican.com/article.cfm?id=mind-reviews-the-book-woe

    “Relying heavily on interviews with distinguished insiders in the psychiatric establishment, Greenberg paints a picture so compelling and bleak that it could easily send the vulnerable reader into therapy. The basic message is this: everyone in the mental health profession knows full well that the DSM is a work of fiction—that the hundreds of “disorders” described therein are just labels for fuzzy, overlapping clusters of symptoms and that we have never found a definitive biological marker for even one of those disorders. Mental health professionals pretend that the disorders are real, but they’re not, period.”

    That has been my basic message.

    1. weing says:

      I don’t think you said this part. If you did, then the message didn’t get through.

      “that the hundreds of “disorders” described therein are just labels for fuzzy, overlapping clusters of symptoms”

      1. CannotSay2013 says:

        “clusters of symptoms”

        http://www.behaviorismandmentalhealth.com/2013/10/01/the-concept-of-mental-illness-spurious-or-valid/

        It might called a “symptom” but as Phil Hickey says above that is onto itself a dogma. To me “patterns of behavior” is more appropriate.

        1. weing says:

          I’ll take patterns of behavior if you will. I also don’t think that grief and anxiety are necessarily illnesses. Are psychopaths real or not?

          1. weing says:

            BTW, there can be also symptoms of health.

  13. Andrey Pavlov says:

    So CannotSay2013 is not only ideologically bound to his anti-psych conclusions, but he has been himself subject to the negative aspects of psychiatry (whether perceived or an actual harm against him) to fuel it, and he is a mind/brain dualist.

    Sorry, CS2013 – you’ve simply lost on too many counts. The popular notion of free will does not make it so.

    But I have no desire to engage you since based on those 3 facts it is clear that there is as infinitesimal a chance of convincing you your conclusion are false as can be scientifically possible. The fact that you are at least somewhat intelligent really seals the deal since you have more capacity for motivated reasoning.

    However, I’d suggest everyone engaging him take a step back and re-evaluate whether you wish to or not. I cut my teeth, so to speak, doing exactly that right here on this very blog. If that is your goal and you know it, more power to you. Otherwise, you are wasting your e-breath.

    1. CannotSay2013 says:

      “So CannotSay2013 is not only ideologically bound to his anti-psych conclusions, but he has been himself subject to the negative aspects of psychiatry (whether perceived or an actual harm against him) to fuel it, and he is a mind/brain dualist. ”

      As all other pro psychiatry zealots that preceded you, you are also arguing from dogma. Now accepting that the mind is an independent abstraction of the brain is “heretical” here, which is of course a travesty because it’s like denying the existence of the Linux operating system on a computer that runs Linux and to be dogmatically defending that “Linux doesn’t exist”, and that “Linux is the result of transistor switching”. I can connect you with Linus Torvalds or Richard Stallman. It would be an interesting conclusion that you try to convince them that the GNU/Linux operating system is an “illusion” of every computer that runs it :D.

      It just shows how small minded and dogmatic people in this movement are. But again, it also explains why you guys dogmatically defend psychiatry using the very arguments that you decry on those who defend other forms of CAM.

      As WLU said, you cannot be reasoned out of things you have not been reasoned in. Defending psychiatry as science is a dogma of your movement and I take it as such :D.

  14. pmoran says:

    CS2013: :Anyhow, since you are a believer in CAM, –”

    WLU, see what you have done?

  15. pmoran says:

    “– – for fuzzy, overlapping clusters of symptoms and that we have never found a definitive biological marker for even one of those disorders. Mental health professionals pretend that the disorders are real, but they’re not, period.”

    This is also terribly ill-considered, and I don’t care what supposed authority has said it. If we are talking about “symptoms” then we are by definition talking about something that is causing distress to someone and they are seeking relief.

    That alone makes the phenomenon real enough to be a legitimate field of medical inquiry, and the process of trying to bring order into this complex and difficult field will inevitably follow.

    So it is not the DSM that makes the “disorders” real. Nor does the lack of a biological marker matter. The DSM’s validity depends wholly upon the extent to which it is descriptive of distinguishable states, both from each other and from what will always be a highly arbitrary concept of “normality”.

    And, sheez, Greenberg himself describes how “everyone in the mental health profession” is aware of limitations to the DSM, but he still goes on to castigate them for something that no one is quite saying. The disorders are not made real because of the DSM, they are made real because people want them gone.

    1. CannotSay2013 says:

      I hope that you understand that you are defending psychiatry as a tool of “behavioral control” or if you will of imposition of an arbitrary “behavioral orthodoxy” by pathologizing everything else. And indeed, that is what the DSM is, an instrument of behavior control (which also benefits economically a lot of people).

  16. pmoran says:

    It is obvious I would disagree with that as a general rule, although I agree that there is a risk of abuse, that it has happened in the past, and that it could happen again.

    Fortunately we have seen that a lot of people are alive to the risks, both within medicine and outside of it. Even most commenters here have gone some of the way with you.

    The prognosis looks reasonable.

    1. CannotSay2013 says:

      I am wrapping up the discussion here because I have finally understood why you guys defend psychiatry so irrationally. It is not because of respect for science, because several people have conceded that psychiatry is at least an order of magnitude less accurate than what many here would consider acceptable for non psychiatric scientific disciplines but because you see psychiatry fulfilling the role that churches had in the past: imposing the “notion of behavioral normality” that you guys consider appropriate via “votes” without the need to invoke deities. “Behavioral normality” is what self appointed “experts” decide normality “is” without regard to what the rest of society thinks via the democratic process. I hope that I don’t have to convince anybody who believes in individual freedom about the danger of letting any group of self appointed, non accountable mind guardians to decide what “normal” is.

      This takes me to Harriet’s comment above which also reflects this line of thought,

      “You are wrong. There is no “mind” independent of the body: that is the most reasonable provisional conclusion based on the available evidence. The fact that free will is an illusion is not a dogma, but a conclusion based on evidence. It does not mean the individual is not responsible for his actions. This is complicated and hard to explain. I wish you could read Wegner’s “Illusion of Conscious Will.””

      Again, those who reason along your lines fail utterly to understand the software analogy. A process running inside an instance of Linux has no possible way to determining whether the software that made that process behave the way it does is real. It’s like a character inside a movie, only “software processes” have much more autonomy than characters inside movies. You fail to understand that, and that’s the root of the disagreement here. To me you sound like that software process denying the existence of the software that make that process do what it does (which is different from the source code that describes the software).

      “As I said, there is a continuum from grieving to depressive illness, and it is very difficult to pinpoint a demarcation between them; but it is clear to me that there is a difference and that it is worthwhile trying to identify the worst cases.”

      I put emphasis in “IT IS CLEAR TO ME”. Again, we go back to this notion that even though you guys recognize the diversity of human behavior, somebody has to say what is “NORMAL”. Everybody who is not “normal” is by your take, “ill”.

      “And severe depression and psychosis are basically the same everywhere, although their expression is influenced by cultural factors programming the brain.”

      I couldn’t disagree more. In many Eastern cultures, what the Western culture calls “psychosis” is a religious experience. Not to mention that there is a whole branch of Christianity, the Roman Catholic Church, that names people whom you would certainly warrant labels of “depression” and “psychosis” as the standard bearers of its doctrine by way of “sainthood”. In fact, the founder of Christianity himself would have been labelled as “schizophrenic” by one of you.

      “A Muslim would not be likely to have the delusion that he is Jesus Christ. An Amazon tribesman would not be likely to report that he was abducted by aliens and subjected to sexual probings on a space ship. ”

      That misses the point completely. Why is it a “disease” when a Muslim has visions of something, but when a Christian sees Jesus, and that vision is approved as “authentic” by the Vatican, it is not a disease?

      “But the expression of mental illness is, precisely because of the kind of cultural programming you mentioned. ”

      I go back to what I said at the beginning, only if you see “mental illness” as an expression of deviation from a “behavioral orthodoxy” imposed by self appointed mind guardians. But this is the whole notion of “mental illness as a myth” that Thomas Szasz already described 50 years ago. This is why I asked people to read the paper. When Thomas Szasz said that “mental illness” was a myth he didn’t say that there aren’t life issues, just that using the epistemology of the tissue to talk about these issues was misleading and trickery. Which seems to be something that everybody agrees now.

      “No, it never was a disease. It was falsely identified as a disease. It’s a good example of the very lack of validity of DSM that you are complaining of.”

      I beg to differ. Homosexuality meets very strictly the criteria that most DSM labels aspire to but unable to achieve,

      - It is a pattern of behavior that can be reliably defined. The Cohen Kappa value of “homosexuality” beats every single DSM label. There is no question about what homosexuality is: sexual attraction to people of the same sex.

      - It is relatively rare in society, with the best estimates speaking of 5% of the general population being homosexual. Certainly, homosexuality is not “normal” in the probabilistic point of view (ie, the overwhelming majority of the population is not gay).

      - There is a lot of research that homosexuality is a good predictor of a whole lot of other so called “psychiatric issues”: addiction, suicide, “depression”, etc.

      - There is even a lot of research to conclude that homosexuality is partly caused by biology (genetics and other biological effects) and also that it is related to personal choice (since there are numerous causes of people who have done a successful transition from homosexual to heterosexual and the other way around).

      So it has all the components of a “mental illness”: a relatively rare pattern of behavior, that is partially caused by biology, which causes other “behavioral issues” in those who exhibit it. And yet, via voting, homosexuality went from being a “mental illness” to being a “mental illness” only if it was unwanted (prior to DSM-5) to being 100 % a “normal behavior”. In each case, the change was pushed by voting not by any evidence whatsoever.

      Again, I take that you see psychiatry as a way to impose “normality” and in that regard, it is no different from religion. Where religion invokes “divine inspiration” you invoke “consensus among self appointed mind guardians” to define what “normality” is.

  17. Nick Stuart says:

    There would be many more people here in agreement with CS2013 if it was not for the fact we are routinely banned by Novella.

  18. Nick Stuart says:

    Not to mention all of our comments are ‘moderated’ then deleted with no reason given.

    1. WilliamLawrenceUtridge says:

      Very few contributors I am aware of have been banned here. Not to mention, your comments are not being censored.

  19. Self Skeptic says:

    My local library just got Allen Frances’s book “Saving Normal” for me.
    I have Greenberg’s “Book of Woe” on order too.
    Should be interesting reading.

    1. WilliamLawrenceUtridge says:

      I’m reading Book of Woe now. So far I’m unimpressed. It seems to be mostly Greenberg screaming “Big Pharma is EEEVUL!!!” at the top of his lungs, and offering no real solutions. There’s some criticisms of the DSM itself, mostly from interviews with Allen Frances and Michael First, as lacking validity (true) and empirical rigor (also true) and you see traces of Greenberg’s apparent opinion that there might not be any mental illnesses, it’s just people with poor adjustment. If you ask me (and nobody did), Greenberg’s background as a psychotherapist really comes out – everybody can just be treated with talk therapy (oh, and he’s not an evil drone of Big Pharma because he charges his patients less and made a point of saying he’s probably lost out on millions of dollars in treatment fees as a result).

      Some of the things he says are valid, but it’s heavily one-sided, a polemic more than a study. That’s my impression 1/3 of the way in.

      1. Self Skeptic says:

        @WLU,

        I just re-read your comment on Greenberg’s “Book of Woe”. My favorite take-home from that book was the term “placeholder fictions”. This is a kinder and gentler term than “noble lie”, though without the later’s historical resonance. I think there are a lot of placeholder fictions in medicine, and that they may be an indispensable part of medicine, pragmatically speaking. That obviously puts a big wrench in the works of EBM. In fact, maybe this helped motivate the substitution of “plausibility” for “evidence”, that distinguishes SBM from EBM.

        I saw your recent message at the Lyme disease thread, regarding your policy of not reading anything that disagrees with dominant medical experts, for fear of confusion.

        t’s clear that you’d be far more likely to appreciate Allen Frances, MD’s “Saving Normal”. Frances was the leader of the committee that published the DSM-4.

        Unless, that is, you’ve lost interest in defending psychiatry. I’ve decided psychiatry is almost all empirical, and each patient needs to advocate for him/herself if able, and if not, to find a capable advocate among family members, for monitoring, advice, and protection. This is a disappointing conclusion, to those who don’t really appreciate patient and family participation/interference in medical decisions. But while the medical profession is in this phase of cutting face time with patients to the absolute minimum, being gullible about pharma marketing, and relying on supposedly scientific guidelines, many of which are placeholder fictions – I don’t see a reasonable alternative.

        1. WilliamLawrenceUtridge says:

          “Placeholder fictions” is what humans use until the actual etiology is understood. Currently, we are at least aware that these fictions are tentative until we can do something better. I hated The Book of Woe, that chatty, gossipy, trivializing, quote-mining sack of crap. Greenberg came across as a smug little shit, with his “aw shucks, I’m jus’ tryin’ to make people better” attitude and pretending the DSM committee wasn’t desperate for answers just like everyone else. I’ll add Frances book to my reading list, if I ever get to it, though Frances himself didn’t look great in Greenberg’s book either. It’s the fallacy of the perfect solution – either DSM is perfect, or it is worthless. Nope, it is neither. What distinguishes placeholder fictions from the real thing is evidence, replicable, prediction- and testing-enabling evidence. Right now it’s scanty for the DSM and chronic “Lyme” disease, chronic fatigue syndrome by another name.

          I saw your recent message at the Lyme disease thread, regarding your policy of not reading anything that disagrees with dominant medical experts, for fear of confusion.

          I read books that disagree with dominant medical experts. I just finished Is Breast Best, which is highly iconoclastic. I like iconoclasm. But that doesn’t mean I am going to be expert enough to parse a detailed medical literature that has already been parsed (twice) regarding a condition made up of vague and subjective complaints whose various advocates like to issue death threats. My time is limited, and as soon as you start legislating, threatening and suing to force your preferred, unsupported treatment options into the medical system, I lose interest because you come across as a bit of an asshole with no self-awareness. And my opinion is at least party mitigated by the awareness that this is an extraordinarily complicated question that, if correct, hints at aspects to human biology poorly understood by even the most advanced scientific research, the ability for a bacteria or bacterial illness to have years-long sequelae despite absence of any objective evidence of infection. There’s a difference between “I prefer to spend my time on other things and thus defer to the medical experts for this issue particularly in the absence of any good evidence to the contrary” versus “the medical experts are always right and there is never a reason for them to change their mind”, the false dilemma you appear to be trying to throw in my face.

          Psychiatry is hard, dealing with the most complicated structure we are aware of in the universe, using that exact same structure. Plus, the American social safety net and medical system are kinda shit, particularly for those who don’t have private insurance. You want to improve things? Advocate for higher taxes and a real federally-funded health care system, not the half-assed shit you’re stuck with because of (and here I’ll fully admit it’s my left-leaning political inclinations, not evidence) the nutjob racists in the Republican party who would rather fuck over the entire world’s economy than pay higher taxes.

          It’s a real shame the direction the US has headed in the past couple decades. From such wonderful promise to the current mire. The citizens deserve better, the principles of the Founding Fathers deserve better (except slavery, that principle was stupid). The world deserves better, because when it’s good, the US is a tremendous force for good.

  20. Errol Krieg says:

    A healthy diet can actually increase your chances of getting pregnant fast. A balanced diet ensures proper supply of the required vitamins and micronutrients to your body. Deficiency of certain micronutrients may make your body sluggish and you may take more time to conceive. Foods containing folic acid should be included in your diet, as it increases your chances for getting pregnant fast. Regular exercise also helps in getting pregnant quickly, as it improves overall health and makes you active. It also detoxifies your body, which again aids conception. Avoid smoking and alcohol a few months earlier if you want to be at your best during this period.

    1. Harriet Hall says:

      Changing to a healthy diet might increase your chances of getting pregnant fast if you are suffering from some nutrient deficiency from a poor diet. Most of what you say is generally good advice consistent with what doctors recommend, but I question the idea that exercise “detoxifies” your body. What toxins does it remove? Why would a person need detoxification beyond what the liver, kidneys, etc. do to remove toxins?

      1. James says:

        The only possible way I can see that exercise helps “detoxify” the body.
        Is that it helps the lymphatic system circulate.
        Of course I could be wrong on that.

    2. WilliamLawrenceUtridge says:

      This comment is so out of left field that it makes me wonder if it’s spam. Nobody else on this thread mentions pregnancy, and the author’s weblink is to a page on erectile dysfunction.

      The fact that it’s just a combination of standard recommendations and unscientific blather is a rabbit pellet on the turd cake.

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