Guest post: It’s worth running a simple filter


Originally a comment by Morgan on Psychiatry is an important skeptical and social justice issue.

Making demands about alternatives before you’ll bother to learn the truth about it seems callous, in addition to incurious.

Look, here’s the thing: you sound like a crank.

That doesn’t mean you’re wrong, but from what you’re saying, it’s more likely that you’re a crank than not. So before giving what you have to say much time or attention, it’s worth running a simple filter of asking what your views are, in case they’re “people need to regulate their orgone energy via crystals” or something else that would clearly indicate you’re not worth the effort. What you’re saying may seem obviously reasonable to you, but to me as an outside observer it’s not obviously different from any wooish alt-med claim about how, for example, AIDS isn’t caused by a virus but by poor nutrition / immorality / sinister Western drugs. It doesn’t help that the way you talk about “biopsychiatry” comes off to me as suspiciously dualist, like the idea that mental phenomena are based in the biological action of the brain and that treating or managing them may require medical interventions is just obviously false for some reason.

Your response does shift the odds away from crank, but it’s still vague enough not to be particularly compelling. Okay, so if I’m understanding you correctly, your contention is that much of psychiatry, in particular the diagnoses in the DSM and the pharmaceutical treatments for them, are so poorly evidenced as to be worthless – what’s labeled “schizophrenia” or “depression” is so poorly defined, ad-hoc, and lacking in scientific grounding that it doesn’t make sense to talk about “a mental illness” called schizophrenia. The obvious problem there, then, is that people do have issues that lead them to be diagnosed, and they do take medicines prescribed for their diagnosis, and at least some of those people do improve when they’re medicated (and notice a definite pattern of worsening if they stop). So maybe all such problems are the result of traumatic or stressful experiences or conditions, and there should be more focus on heading off mental health problems by reducing poverty and improving parenting and so on – sure, that’s not in principle a bad idea. But once someone ends up with an issue, are you saying the fix is to solve all the problems in their life that might have led to it? That’s not really useful to many, probably most, people actually trying to live their lives unable to remedy structural oppression. Are they to seek intervention, but definitely not drugs? So what about when they’ve tried everything they could, and it’s the drugs that seemed to actually made a difference? Is that always just the placebo effect? Or is the solution that

…some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.

? That’s kind of a convenient out – if the approach you advocate doesn’t work, just wait for the problem to go away by itself. The problems that are leaving you unable to function are just the pains of human living, tough shit, suck it up. You say you don’t want to stigmatize or minimize, but surely you can see where what you’re saying has that effect regardless of your desires?

In the other thread you ask:

If you think I’m being a bad advocate, what do you suggest?

My suggestion: have a clear summary that you can link or paste of what you are saying, and what you’re not. Be aware that “psychiatry is totally wrong and you don’t need your pills” is a claim made by a lot of people for bad reasons, and you’re going to have to work to distinguish yourself from those people – you may feel you’re doing so by recommending books or linking articles, but that doesn’t actually set you apart. Saying “we should be skeptical about this” is not as small and unobjectionable a statement as you seem to think when in effect it’s “we should disregard an entire branch of medicine as pseudoscience and any ways in which people find it’s helped them as accidental”. If you think the problem is pharmaceutical treatment of mental health problems but still think people will need professional, evidence-based, medical assistance to deal with them, then maybe focus your criticism a bit more, since as far as I can see that would still require psychiatry to gather and understand that evidence and provide that assistance.

Comments

  1. says

    I was just going to post my response there, but I’ll post it here:

    That doesn’t mean you’re wrong, but from what you’re saying, it’s more likely that you’re a crank than not. So before giving what you have to say much time or attention, it’s worth running a simple filter of asking what your views are, in case they’re “people need to regulate their orgone energy via crystals” or something else that would clearly indicate you’re not worth the effort.

    I understand that my views sound extreme if you’re hearing them for the first time. My problem with this is that I’ve been posting on these blogs for more than half a decade, and always as an advocate of science and reason. Ophelia knows me well enough, I think, to be confident that I’m not going to espouse some ridiculous woo, and I would expect that most other commenters here would at least give the arguments the benefit of the doubt and a fair hearing and investigation before going on the offensive against me. I’m hurt and angry that so many in a community I trusted instead respond by imputing terrible motives to me, calling me names, mocking me, and trying to silence me. Also, even without reading the books I recommend, you can look into the authors and arrive at some assessment of whether they’re likely to be making crank claims. I link, for example, to online and easily-read (really – go to the link and you can read them right now!) articles by Marcia Angell, former EIC of the New England Journal of Medicine. She’s not a crank, and nor are the others.

    What you’re saying may seem obviously reasonable to you, but to me as an outside observer it’s not obviously different from any wooish alt-med claim about how, for example, AIDS isn’t caused by a virus but by poor nutrition / immorality / sinister Western drugs.

    But see, this is the trap. If I make the arguments they can be dismissed on this superficial basis. If I say the arguments are supported in the books, which are based on years or decades of research, which the authors have often published in the peer-reviewed literature, I’m accused of refusing to address people’s arguments or concerns. It’s a lose-lose proposition.

    It doesn’t help that the way you talk about “biopsychiatry” comes off to me as suspiciously dualist, like the idea that mental phenomena are based in the biological action of the brain and that treating or managing them may require medical interventions is just obviously false for some reason.

    That’s not my argument, but I can see how you could make that assumption in the absence of more information.

    Your response does shift the odds away from crank, but it’s still vague enough not to be particularly compelling. Okay, so if I’m understanding you correctly, your contention is that much of psychiatry, in particular the diagnoses in the DSM and the pharmaceutical treatments for them, are so poorly evidenced as to be worthless – what’s labeled “schizophrenia” or “depression” is so poorly defined, ad-hoc, and lacking in scientific grounding that it doesn’t make sense to talk about “a mental illness” called schizophrenia.

    I’ve summarized my argument in response to questions here.

    The obvious problem there, then, is that people do have issues that lead them to be diagnosed,

    See the link to the other thread that I provided for PatrickG above.

    and they do take medicines prescribed for their diagnosis, and at least some of those people do improve when they’re medicated (and notice a definite pattern of worsening if they stop).

    The thing is the evidence overwhelmingly shows that psychiatric illnesses/disorders don’t exist, and that the drugs are not medications, not effective as treatments, and often very dangerous. This evidence is discussed in depth in the recommended readings, which address the questions and concerns expressed above. (Note that the pattern you describe for some people is also true of many CAM “treatments,” and exacerbated by the fact that these, while they aren’t medications, are real drugs with real effects on the brain and body and real discontinuation/withdrawal effects.) It’s just nearly impossible for me to continue debating with people who steadfastly refuse to engage with the evidence. My position is often misunderstood, and I spend most of my time battling misrepresentations.

    So maybe all such problems are the result of traumatic or stressful experiences or conditions, and there should be more focus on heading off mental health problems by reducing poverty and improving parenting and so on – sure, that’s not in principle a bad idea. But once someone ends up with an issue, are you saying the fix is to solve all the problems in their life that might have led to it?

    No, and I’m not sure how you got that from what I wrote. Understanding is not the same as fixing, although in practice understanding in a sympathetic environment can go a long way toward helping. Therapeutic interventions and social movements in this context are separate but overlapping. Of course I’m not suggesting that people can individually fix social problems. Nor am I saying that social change will immediately eliminate psychological distress. In fact, I explicitly argued with this view above. I offered several basic principles for a humanistic approach, which obviously is going to take a wide variety of forms in different circumstances.

    That’s not really useful to many, probably most, people actually trying to live their lives unable to remedy structural oppression. Are they to seek intervention, but definitely not drugs? So what about when they’ve tried everything they could, and it’s the drugs that seemed to actually made a difference? Is that always just the placebo effect? Or is the solution that

    …some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.

    ? That’s kind of a convenient out – if the approach you advocate doesn’t work, just wait for the problem to go away by itself. The problems that are leaving you unable to function are just the pains of human living, tough shit, suck it up. You say you don’t want to stigmatize or minimize, but surely you can see where what you’re saying has that effect regardless of your desires?

    I don’t understand where you’re getting this. I laid out some basic principles for humanistic therapeutic care – which, to be sure, has been marginalized and sneered at and defunded and so isn’t widely available – above. Nowhere did I say or imply that this was a description of problems for which humanistic approaches, when they’re actually tried, don’t work. It’s just a fact that some problems that have been medicalized are this – our moods aren’t always stable, we grieve, we have unhappy relationships and bad breakups, periods of uncertainty, stagnation, and hopelessness, and so on. Some problems are like this. We’re all, as Karen Horney eloquently puts it, to some degree “harassed human beings,” for whom things, including our internal states, don’t always go smoothly or happily. Some distress comes and goes without serious interventions of any sort. Recognizing this is in no way saying to people with persistent and serious problems to “suck it up” or “get over it.” Once again, I can see how an uncharitable and superficial reading would lead some people to think that’s what I’m saying, but I’m telling you it’s not, and explaining over and over that your misunderstandings will be cleared up if you do a little reading. I’m quite frustrated that arguing that familial, cultural, social, political, and economic experiences and our self-defense reactions in the face of them are the primary sources of psychological distress, such that addressing it requires both compassionate and educated approaches to individuals and attempts to address the structural problems, can be interpreted as saying that I think responding to psychological distress means expecting distressed people to fix these structural problems themselves.

    In the other thread you ask:

    If you think I’m being a bad advocate, what do you suggest?

    My suggestion: have a clear summary that you can link or paste of what you are saying, and what you’re not.

    Thanks. I think that’s what I’ve now provided, rather late I admit, in the other thread and here.

    But there does come a point when trying to convince suspicious and often hostile and arrogantly self-righteous people (I don’t mean you) that I’m not a crank offers diminishing returns. Because my criticisms of biopsychiatry are very fundamental – it’s harmful quackery – and not “around the edges,” to people unfamiliar with the evidence they will continue to seem inherently cranky and callous regardless of how clearly or pleasantly I present them. At some point, I think, it’s incumbent on you who are presented with the arguments and recommendations to decide whether you want to engage honestly with the readings or just continue with your preexisting beliefs. If the latter, then appreciate that this approach isn’t scientifically sound.

  2. says

    And with that said, I think I’ll take my leave of this thread as well. As I said, there’s a certain level of concern and misunderstanding that I’m willing and even happy to address (like Morgan’s) because it’s important to get the word out, and I appreciate the suggestions for presenting the case in the future. But there’s little point in remaining in an environment where people who are actively hostile to engaging with the evidence merely name-call, attack, and misrepresent me.

    Morgan, I really hope you’ll get past your suspicions and read a couple of the works.

  3. PatrickG says

    SC,

    First, a serious question: a number of the sources you’ve cited — mind you, as a rebuttal to the current model — make a strong case for genetic disposition/heritability of what are currently classed as “mental disorders”. How do you account for these genetic studies/twin studies/etc? Without accounting for this (apparently) observed genetic component, it’s very difficult to accept your assertion that “familial, cultural, social, political, and economic experiences and our self-defense reactions in the face of them are the primary sources of psychological distress”. This is a subject I haven’t seen you fully address on your site, except to denigrate continuing to expect a biological source for what are currently classed as “mental disorders”. Granted, you are extremely prolific on this subject and I might have missed it.

    Second…. If you’re consistently getting the same reaction and feel you’re consistently being misrepresented, then perhaps the problem is not everyone else. With that in mind, I’d like to offer some impressions about why I, at least, react so strongly to your style and content. I offer them to you in the hope you’ll understand more why at least I expressed such anger — and please note that a lot of my anger came from after reading through your website and after a number of your linked sources. This isn’t just related to what is in these threads.

    [I’d intended to link to your website for some specific examples. Ran out of time. Also explains some duplication in the items below. Can respond further later.]

    In no particular order:
    Please don’t write your opponents off as too emotional

    You’ve several time expressed you basically feel that this so-called skeptical community was not being skeptical enough and just too darn emotional to READ SOMETHING. By your own account, you’ve been facing this reaction for years and you clearly haven’t modified your style. At least, that’s my impression from going through your archives over the past two days.

    People are time-limited — dismissing them out of hand this way is not going to convince them that what you’re linking is worth reading, or even that what you’re linking even supports what you’re saying. I hope I also don’t have to go into why anger and emotion aren’t necessarily bad things.

    Please don’t express surprise at the strong reaction you’re getting.
    First, by your own assertion you’ve gotten this reaction — from this community — for years, so it reads as disingenuous. It’s obviously not surprising.

    Second, you’re making extremely broad assertions with dramatic implications in an entire field of science, and one that has immediate implications for a lot of people who have struggled with very serious issues — including social stigma — for a very long time. Strong emotional responses are a given in this environment.

    Please don’t echo conspiracy theorists

    I’ve observed that you use quite strong invective when discussing the failings of the current system. Unfortunately, a lot of this almost exactly parallels things you can read from Alex Jones or your average anti-vaxxer. I suggest that you refrain from language such as the”pharmaceutical-governmental-academic complex” and accusations that scientists are adhering to this model (voluntarily or involuntarily) for the grant money, just to name a few things I’ve seen on your website.

    Given language like this, acting surprised when people liken you to conspiracy theorists and expressing hurt at the comparison casts you in the role of “suffering martyr”. Not a great perception.

    Please be as charitable to others as you request them to be to you

    Please recognize that you’re very, very quick to accuse people of being close-minded, of thinking unscientifically, of attacking you (personally) in order to avoid engaging. As you’ve already acknowledged, many people aren’t familiar with the body of your work, and you are making very large claims. Thus, it’s extremely off-putting to immediately see accusations like this when you get pushback, whether you consider such valid or not.

    Please be very careful when using the word “placebo”

    Please recognize that when you respond to people who hold to the current model of mental illness by using “anecdote” and “placebo” to describe their experiences with treatment, you’re not doing yourself any favors. Particularly when you’re talking to people who have described paralyzing anxiety, the inability to function for days on end, and the like. Whatever the underlying cause, it is demonstrable that psychiatric medications do help some people through a non-placebo mechanism. It’s frankly insulting to suggest otherwise, even by implication.

    Please start with compassion first

    Related to the above, it took multiple posts by you calling my personal experience nothing more than a placebo or other subjective effect before you expressed shock and horror that I was reading you as not at all sympathetic or compassionate. Sure, some of that’s me, but again, you say you’ve encountered this many times before.

    You may be able to ameliorate a lot of negative responses if you outline your motivation first, and acknowledge the limitations of your advocacy, instead of immediately launching into the attack on the current system/model and letting the rhetorical chips fall where they may.

    Please recognize the callousness of some statements

    Really, statements like this:

    some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.

    are all too easy to read this as “in the long run, you’re dead anyway”. Maybe it’s not what you mean, but it’s what comes across to me — and clearly I’m not the only one. This is a sentiment that comes up far, far too often in your writings to make me comfortable that you’re truly arguing from a humanistic perspective, instead of motivated more by dislike of the current model.

    Please avoid professional mind-reading

    Please recognize that you’re consistently linking to people who, by their own account, do not agree with you regarding the basic model, and then dismissing them as afraid to speak truth to power, or just simply too invested/locked in to the current model. I, at least, find that extremely disconcerting.

    Please stop using “some problems”

    In this very thread, you refer to “some problems” being miscategorized, which reads as a neat dodge to avoid the “other problems” that apparently are … what, appropriately categorized? Not in the category of bad science? You’re extremely vague on this.

    Please recognize that you have no replacement, and that’s a problem

    Humanistic therapeutic care would be a laudable goal. We don’t have it. Also, related to the above point, you acknowledge that this will not be universally effective, particularly when it comes to the “other problems” that may not be “just life”.

    Tied in with other points, it’s not unreasonable to conclude you think people should not be taking psychiatric medications. This is a position of advocating particular actions, which necessarily requires the question “what then?” It’s not unreasonable for people to ask that question.

    That’s a pretty comprehensive list of how your approach and style provoke confrontation and lead to lack of engagement. At least for me. Do with it what you will.

  4. says

    SC,

    First, a serious question: a number of the sources you’ve cited — mind you, as a rebuttal to the current model — make a strong case for genetic disposition/heritability of what are currently classed as “mental disorders”.

    What are you talking about? I can’t think of any who do, and several of them argue very strongly against this. In fact, I’ve discussed this at my blog:

    http://saltycurrent.blogspot.com/2013/05/decades-of-negative-results-failure-of.html

    http://saltycurrent.blogspot.com/2013/06/biopsychiatry-neo-eugenics-and-prison.html

  5. says

    Second…. If you’re consistently getting the same reaction and feel you’re consistently being misrepresented, then perhaps the problem is not everyone else.

    Well, if I didn’t think I was part of the problem in some way, I wouldn’t have asked (though I think your response is overkill and in large part continues the misrepresentation). But to clarify, as I said, I have gotten and seen this response in other situations in which people are hostile to the content of what I’m saying – as a feminist, as a gnu atheist, writing about CAM, and to some extent as an animal rights advocate. The same focus on tone, the same emphasis on the messenger rather than the message, the same uncharitable readings, the same demands that the issue be presented in the desired way as a precondition for engagement, the same misrepresentations, the same personalization, the same assumptions about callousness and motives, the same mocking and name-calling. In contrast, this hasn’t been the response from the community when I’m making arguments that people already agree with mostly or fully. This does suggest that the response is largely independent of my specific approach – that it’s more about the content of what I’m arguing than anything else.

    What has surprised me has been that this response has come in part from people who I trusted knew me well enough to know that I wouldn’t promote woo and that I care about people’s suffering. To be honest, I’m feeling increasingly alienated from a community I’d trusted and in which I’d felt reasonably comfortable, and questioning whether I want to continue to participate in it. I’m also consistently surprised that it’s the response of so many people I know otherwise to be critical and curious, which reinforces the alienation.

    With that in mind, I’d like to offer some impressions about why I, at least, react so strongly to your style and content. I offer them to you in the hope you’ll understand more why at least I expressed such anger — and please note that a lot of my anger came from after reading through your website and after a number of your linked sources. This isn’t just related to what is in these threads.

    Are you saying the readings themselves made you angry, or that they didn’t but my presentation of them did? Which sources?

  6. says

    Please don’t write your opponents off as too emotional
    You’ve several time expressed you basically feel that this so-called skeptical community was not being skeptical enough and just too darn emotional to READ SOMETHING.

    I haven’t said anything about people not reading because they’re too emotional, much less written people off as too emotional. I don’t think the reason people are hostile to engaging with this evidence is that they’re too emotional.

    People are time-limited — dismissing them out of hand this way is not going to convince them that what you’re linking is worth reading, or even that what you’re linking even supports what you’re saying.

    Of course people are time-limited, and I’m not demanding that everyone drop everything and read these books. What I am saying is that not reading the materials and at the same time taking the time to call me a shrill anti-science crank and continuing to make baseless assertions about the science of biopsychiatry is unscientific and unkind. I didn’t dismiss honest questions and concerns out of hand – Morgan’s, karmacat’s, screechymonkey’s,… – even when they were presented in a hostile way. But it’s difficult to separate them out from the barrage of invective.

    Please don’t express surprise at the strong reaction you’re getting.
    First, by your own assertion you’ve gotten this reaction — from this community — for years, so it reads as disingenuous. It’s obviously not surprising.

    No, it’s still surprising, for the reasons I’ve stated. You can argue that it shouldn’t be, but each time it still is. I’m also continually surprised at the rightwing shit spewed by Dawkins. I honestly keep thinking he’ll get it, which isn’t really rational, and I’ve seen increasing evidence that these have been his views for decades, but every time I see the latest Twitter nonsense I’m surprised. As I said in my post, “hope springs eternal.” But you’re right – I should be more realistic in my expectations, which will also help me to remain more calm.

    Second, you’re making extremely broad assertions with dramatic implications in an entire field of science, and one that has immediate implications for a lot of people who have struggled with very serious issues — including social stigma — for a very long time. Strong emotional responses are a given in this environment.

    Yes, that’s true. I apologize to anyone who felt threatened by my argument for not making what I’m not arguing more clear. Part of the problem is that the marketing rhetoric of pharma and biopsychiatry has consistently told people that there are two choices – mental illness or character defect you should just get over – and that the former is destigmatizing. So the debunking of the former is read as saying the latter and as an attempt to restigmatize suffering and tell people to “buck up.” This is all false – these aren’t the only two choices, and the model and its labels are stigmatizing. But I should recognize that this is the context that arguments like mine enter, and make it clear from the beginning that this isn’t my argument.

  7. Morgan says

    I only have time for a quick reply at the moment, which may have to suffice if SC is bowing out of the discussion, but to clear one issue up:

    SC @1:

    No, and I’m not sure how you got that from what I wrote. Understanding is not the same as fixing, although in practice understanding in a sympathetic environment can go a long way toward helping. Therapeutic interventions and social movements in this context are separate but overlapping. Of course I’m not suggesting that people can individually fix social problems. Nor am I saying that social change will immediately eliminate psychological distress.

    So theraputic interventions are necessary. But that’s not psychiatry?

    You’ve brought up the idea of poor mental health (which phrasing I think you’ll accept, if mental illness is objectionable – yes?) being the result of trauma and stress, acute or chronic, and opposed this to the idea of people having mental illnesses describable by “biopsychiatry” and “chemical imbalances”. But that opposition doesn’t make sense – sure, mental illness isn’t infectious or, necessarily, congenital – but then again, nor are many other forms of illness. Setting aside examples such as schizophrenia and depression, PTSD is of course caused by specific experiences – but that doesn’t mean it’s not an illness or that it’s not appropriate to treat it with, in part, pharmaceuticals. You’re talking about the causes of problems, but once someone’s got a problem they have to deal with it somehow.

    Nowhere did I say or imply that this was a description of problems for which humanistic approaches, when they’re actually tried, don’t work.

    So the psychiatry you advocate isn’t adequate to deal with all problems. But the methods that currently appear to be helping people shouldn’t be used for those problems?

    And what PatrickG says @5:

    Please stop using “some problems”
    In this very thread, you refer to “some problems” being miscategorized, which reads as a neat dodge to avoid the “other problems” that apparently are … what, appropriately categorized? Not in the category of bad science? You’re extremely vague on this.

    I probably will check out some of the sources you recommend, out of curiosity to see if they make a better case than you have, but to be honest, you haven’t given me high expectations on that score.

  8. PatrickG says

    Are you saying the readings themselves made you angry, or that they didn’t but my presentation of them did? Which sources?

    I wish I’d gone back and edited that, as it was the start of a different thought and wouldn’t have survived proofreading. What made me angry was your describing my (and others’) successful experience with medication as ascribable to the placebo effect. I’m not going to apologize for my anger, because I do sincerely argue that your phrasing is in itself an extreme minimization of actual physiological/mental conditions and successful treatment thereof.

    I can now more appreciate your argument that the condition being treated is real, and that the medication is producing effects ameliorating the condition — but the current description/categorization/underlying physical model of that condition is not accurate. At least, that’s my characterization of (part of) your position at this point. If I had to go back and prioritize my points, I probably would have put “be careful with the word placebo” much further up the list.

    In other words, some of your statements could have been capped with “And that’s why you should try acupuncture instead” and be not at all out of place on some actual woo sites.

    What made me extremely wary were your statements like:

    On the other hand, both they and the psychiatric-government-academic complex that has built up around these drugs need to sustain the model itself – both for the sales of other drugs (including any in the immediate pipeline) and for their future funding, sales, and status. [Source]

    Call this the Monsanto or Novartis Red Flag, if you will, for reasons that should be obvious. This type of language, and the very strong accusation contained here, very much blurs discussion of the actual topic you’re attempting to promulgate. Particularly when attempting to discuss the science behind a proposition, bringing in venal or bad actions by corporations reads as an irrelevancy, and undercuts the main point. In my opinion, of course.

    There are other examples of this in your writing, which I suppose I could go back and find if necessary, though don’t know when I’ll get the time to peek at this again.

    Again, the language you’re using is very evocative of actual woo-meisters. I would urge you to find a different approach. Might give you better results?

    And yes, the response was overkill. However, the thoughts spanned multiple threads and I guess I felt like just putting it all in one place. I also felt very strongly a desire to communicate how one person, at least, was reading your comments in ways that you would consider misrepresentations. Hopefully I’ve done that at least!

  9. says

    Please don’t echo conspiracy theorists

    I’ve observed that you use quite strong invective when discussing the failings of the current system. Unfortunately, a lot of this almost exactly parallels things you can read from Alex Jones or your average anti-vaxxer. I suggest that you refrain from language such as the”pharmaceutical-governmental-academic complex” and accusations that scientists are adhering to this model (voluntarily or involuntarily) for the grant money, just to name a few things I’ve seen on your website.

    (Just an aside: I wish you would specify the posts you’re talking about; the descriptions I offered of specific people – Allen Frances, Joseph Biederman,…- are based on evidence of their willfully serving drug companies’ agendas, which has been revealed through court documents. It’s not a claim that every single psychiatrist is in on a conspiracy.) The problem, though, is that it has been a conspiracy of sorts, with pharma at its heart. And this is really well documented. Whitaker in particular, in Anatomy of an Epidemic, has a chapter about how this came to be. That researchers and academics in general have willingly done the bidding of corporations and the government is well established, as are the close ties between pharma and the APA and advocacy organizations.

    I won’t avoid the subject, any more than I do when talking about the US government’s actions in Latin America. And it’s backed up by evidence, if people would actually read some of the books. But I do understand that superficially it looks suspicious. So it’s a dilemma.

    Please be as charitable to others as you request them to be to you
    Please recognize that you’re very, very quick to accuse people of being close-minded, of thinking unscientifically, of attacking you (personally) in order to avoid engaging. As you’ve already acknowledged, many people aren’t familiar with the body of your work, and you are making very large claims. Thus, it’s extremely off-putting to immediately see accusations like this when you get pushback, whether you consider such valid or not.

    That’s a valid point.

  10. PatrickG says

    But I do understand that superficially it looks suspicious. So it’s a dilemma.

    If I had a good solution, I’d be the best science communicator in the world! More seriously, my initial thought would be to firewall the two topics from each other.

    Keep in mind I’m still not convinced. There’s also the problem of the uninformed layperson here — I’m not in this field, and I don’t have the expertise to parse the subtleties. So on one side, I have the, what, established medical establishment arguing about what model we should use and perhaps being too conservative in updating their consensus, and on the other I have a small number of people sounding an urgent alarm about fraud. It’s very, very hard to avoid falling into automatic pattern detection here: this is precisely the same situation we face with climate change denialists, anti-vaxxers, anti-GMO people, pro-CAM/homeopathy crap, etc. If only we would listen to the people in the wilderness!

    I don’t, personally, believe you should be lumped in with those groups. But I think that pattern detection goes a long way to explaining why you’re encountering such out-of-hand dismissal. You are, after all, advocating that we overthrow the cumulative work of decades in a scientific field.

    Maybe you could establish a strong firewall between the two areas, i.e. over here is SC talking about whether the current model is falsifiable or holds up under rigorous study, and over here is SC making salient points about the individuals who are financially vested in poor scientific practices — regardless of the underlying model. It’s just a thought, and you will of course make as much or little of it as you choose.

    As an example, I absolutely share your concern about the increasing prevalence of anti-psychotics, especially since they’re now being marketed at people like me under very questionable circumstances (self-interest!). But my concern is rooted in the fact that the science — under the current model — does not show therapeutic value for major depressive disorder, just “promising initial results” and bullshit like that. But you don’t have to attack the current model to demonstrate the fiduciary conflict of interest that occurs between manufacturers, marketers, and prescribing doctors. I would argue that trying to do so undercuts both of your messages.

    Basically, if you’re right about the current model, you can argue that point without the elements that raise the red flags I’m pointing out.

  11. PatrickG says

    Oh, and something I thought I’d said already. I do apologize for automatically attributing bad motives to you in the original thread, and being so abrasive therefore. I could have expressed my skepticism and points in much more productive ways, and I apologize for not doing so.

    As non-exculpatory background: I will say that’s my failure at communicating. I tend to personalize when online too much. It’s landed me in trouble here at FTB several times already, and why I typically don’t comment much. :)

  12. karmacat says

    I have been thinking of what to write all day. I couldn’t think of what article to link to because there are so many. There are a large amount of articles on schizophrenia and relation with different brain functions and brain imaging. There are articles looking at twin and adoption studies to determine the genetics. Schizophrenia is not 100% genetic but they have looked epigenetic factors also. Psychotic symptoms have been studied for about 100 years and has been described centuries ago. The problem is that it is not just one disease. It is probably 10 to 50 different diseases. So there is evidence that schizophrenia has a biological basis and the brain is functioning differently. An antipsychotic, thorazine, was first used as an antihistamine but doctors found it helped people with psychotic symptoms.
    this is an article on the history of diagnosis of schizophrenia:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181977/

  13. karmacat says

    When it comes to medications, there seems to be an assumption that all researchers and doctors are strongly influenced by pharmaceutical companies. I definitely agree that these relationships need to be monitored and there needs to be more transparency with the drug companies. Again there are so many different articles on medications and some are independent of the drug companies. Researchers are still studying Lithium which has been around for decades and its ability to decrease suicide rates.

    Another example is that all the research of anorexia nervosa and medications have basically come to the conclusion that the only medicine that works is food. The doctors who treat eating disorders know this even though we wish there was a medication that works. Eating disorders have one of the highest mortality and morbidity of all mental illnesses.

    the difficult issue with the brain is that there are over 100 neurotransmitters and they all affect each other. there are at least 5 different serotonin receptors. There serotonin antidepressants therefore don’t just affect serotonin. Tricyclics have been around since the 1970’s but they have too many side effects for most people. The newer antidepressants are easier to use because of fewer or no side effects. The problem with studying depression is that there are probably a lot of different depressions and there is no particularly reliable way of determining how much is biological vs psychological. Family history can give you some clues.

    Reading personal accounts of mood disorders like William Styron’s and Kay Redfield Jamison’s will give you an idea of how much a person can suffer. People can have the best circumstances but still have depression. There is evidence that social circumstances don’t cause depression but can certainly exacerbate depression.

  14. screechymonkey says

    SC, I can’t say that I agree with you yet, in part because I’m still not even sure I understand what you’re claiming (or, if you prefer, which claims you’re disputing). But for what it’s worth, I completely believe that your heart is in the right place here and that you’re acting out of genuine concern for people’s well-being.

  15. karmacat says

    I do wish there was more public money for psychiatry research. That would hopefully reduce the influence drug companies on research. It is a problem but I’m glad there are doctors and researchers keep challenging the objectivity and validity of research. I hope in the end we will find what kind of medication and/or therapy works for whom. People’s brains are still so much a mystery

  16. says

    Call this the Monsanto or Novartis Red Flag, if you will, for reasons that should be obvious. This type of language, and the very strong accusation contained here, very much blurs discussion of the actual topic you’re attempting to promulgate. Particularly when attempting to discuss the science behind a proposition, bringing in venal or bad actions by corporations reads as an irrelevancy, and undercuts the main point. In my opinion, of course.

    Oh, dear. I think we’ve hit on a basic disagreement. One of the major points of my writing in various contexts is that “the science behind a proposition” isn’t some abstract thing – in a capitalist system, corporations have a huge influence on everything about science, in terms of both denying, obstructing, and marginalizing good science and producing pseudoscience or biased science disguised as the real thing. I’ve argued – actually here on this blog – that medicine and agriculture, which should fulfill basic human and other animal needs, should not be “governed” by corporations, which are not dedicated to knowledge but to markets, profits, and share-value. (I’ve also argued it at my blog.) I’ve probably discussed agriculture as much as health, in fact – sustainability, the IAASTD and the corporate response, Rick Relyea and Tyrone Hayes, ideologues like Paarlberg… (I swear if you show up on this thread, Ewan R, I will lose it. :)) It’s another issue in which corporate propaganda has convinced people that corporate “science” is science and that its rejection is a rejection of science itself, which is false. Extreme wariness of corporate scientific claims is warranted, and we can only reclaim science by removing corporations from it to the greatest extent possible. I won’t soften those arguments for the sake of making my arguments more palatable to some, because that would be a dishonest intellectual compromise.

    There’s a crucial distinction to be made, though. The corruption of medicine and agriculture by corporations is extreme, advanced, and harmful, but it’s corruption. There’s a core empirical knowledge base there, and my criticisms concern the corruption of that base and the move away from scientific-humanist approaches. In biopsychiatry, there’s nothing to corrupt – there’s no there there. It really is a giant marketing and PR effort, with no scientific core.

    OK, I have feline responsibilities. I’ll check back in tomorrow.

  17. says

    screechymonkey:

    SC, I can’t say that I agree with you yet, in part because I’m still not even sure I understand what you’re claiming (or, if you prefer, which claims you’re disputing). But for what it’s worth, I completely believe that your heart is in the right place here and that you’re acting out of genuine concern for people’s well-being.

    Thank you so much for saying that. It makes a huge difference.

  18. mithrandir says

    SC,

    I’ve done a moderate amount of thinking about this since my earlier post on the first thread challenging you to present an alternative, and although I haven’t got a coherent post to put together yet, I will say that I think we all could have a much more productive, and less confrontational, discussion about:

    1. What science does say about the human mind and brain;
    2. In light of (1), what specific practices enshrined in the current mental health care system need to be abolished entirely, which ones need to be reformed, and what new practices we need to put in place.

    I’d say my biggest concern with the present discussion could be summed up as an ethical dilemma: As a psychiatrist, is it ethical to discontinue a medicinal treatment when you know the medicine doesn’t have a scientific basis, but both you and the patient sincerely believe (anecdotally, if you will) that the treatment is making their life better, and you are not aware of a scientifically superior treatment regimen? (Obviously, ethics does demand one actively seek out better science, but this doesn’t preclude one’s ethical responsibilities to the patient in the here-and-now.)

  19. karmacat says

    This is another great article describing the problems of classifying illnesses in psychiatry

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843011/
    The title: Is psychiatry scientific: A letter to a 21st century psychiatrist.
    Psychiatry’s methodological issues are problematic because of “hybrid symptoms and disorders.” The author calls for a “new language” in psychiatry

  20. Lady Mondegreen says

    I can now more appreciate your argument that the condition being treated is real, and that the medication is producing effects ameliorating the condition — but the current description/categorization/underlying physical model of that condition is not accurate. At least, that’s my characterization of (part of) your position at this point.

    The position articulated here by PatrickG is one I can respect.

    I hope you take PatrickG’s suggestions to heart, SC.

  21. says

    SC

    I’m hurt and angry that so many in a community I trusted instead respond by imputing terrible motives to me, calling me names, mocking me, and trying to silence me.

    Oh, waaaaah. You’re totally the “real victim”, here, after saying that mental illnesses aren’t real diseases, that the entire field of psychiatry is a fraud, and that we’re all brainwashed True Believers. What’s next, claiming all psychiatric drugs are 100% addictive, and therefore anyone on them is an untrustworthy “addict”?

    Fuck your whining about “being silenced”. You’re not being silenced, you fucking douche. You’ve just had three fucking blog posts dedicated to your little crusade.

    Three. Posts.

    Three posts wherein you continue to make unsupported claims, smear the mentally-ill, ignore actual lived experiences, and refuse to cite even a single source that isn’t a link to your shitty little conspiracy blog.

    The thing is the evidence overwhelmingly shows that psychiatric illnesses/disorders don’t exist, and that the drugs are not medications, not effective as treatments, and often very dangerous.

    [CITATIONS NEEDED] on that claim.

    Real citations, not your so-called blog.

  22. says

    Please be very careful when using the word “placebo”

    Please recognize that when you respond to people who hold to the current model of mental illness by using “anecdote” and “placebo” to describe their experiences with treatment, you’re not doing yourself any favors. Particularly when you’re talking to people who have described paralyzing anxiety, the inability to function for days on end, and the like. Whatever the underlying cause, it is demonstrable that psychiatric medications do help some people through a non-placebo mechanism. It’s frankly insulting to suggest otherwise, even by implication.

    Please start with compassion first

    Related to the above, it took multiple posts by you calling my personal experience nothing more than a placebo or other subjective effect before you expressed shock and horror that I was reading you as not at all sympathetic or compassionate. Sure, some of that’s me, but again, you say you’ve encountered this many times before.

    You may be able to ameliorate a lot of negative responses if you outline your motivation first, and acknowledge the limitations of your advocacy, instead of immediately launching into the attack on the current system/model and letting the rhetorical chips fall where they may.

    Please recognize the callousness of some statements

    Really, statements like this:

    some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.

    are all too easy to read this as “in the long run, you’re dead anyway”. Maybe it’s not what you mean, but it’s what comes across to me — and clearly I’m not the only one. This is a sentiment that comes up far, far too often in your writings to make me comfortable that you’re truly arguing from a humanistic perspective, instead of motivated more by dislike of the current model.

    I’ll address these all together, as I think they stem from the same problem, which is one largely created by pharma-psych marketing. Of course there have always been people who dismiss much emotional suffering and psychological problems as weakness or a character flaw, and expect suffering people to snap out of it or get over it. The biopsychiatric model, despite its claims, hasn’t so much displaced this idea as reinforced it by situating it in a new framework. This is very similar, again, to what religious ideology has done – either the universe is suffused by God’s love and guided by divine ethical mandates or we’re “just” raw matter. Either we have a soul or we’re “just” nasty brutes. And so when you reject the idea of gods, you’re taking away all meaning and beauty and you had damned well be prepared to offer a replacement to the only real consolation – religion. But it’s a lie built on centuries of religious disdain for the natural world and our relationships within it. There is no “just.”

    Something similar is going on here. The suggestion is that people either have a mental disorder/chemical imbalance or they’re “just” depressed, “just” anxious, and so on. Some suffering and problems are “real” because they’re an illness, and others are somehow less or not real and not to be taken very seriously. A placebo, a compassionate therapist, or other non-drug interventions might have a positive effect for people who are “just” depressed, but a “real” depressive disorder requires drugs. A “real” disorder isn’t temporary, so if some suffering subsides over the course of time it must not have been a “real” problem. I should be more aware of this because I hear it all the time, in a number of contexts – comments like “I thought I was just X, but then realized I had X disorder” or “Talk therapy worked better for her because she was just depressed – she didn’t have depression.”

    This is also a lie, since there are no disorders or chemical imbalances. For me, recognizing this doesn’t mean treating all psychological problems as less real or less serious. On the contrary, it means treating all psychological problems as real and trying to understand their real sources and learn from them rather than falsely attributing them to a brain disorder.

    I think this disorder-vs.-“just”-problems distinction has had noxious consequences. It leads people to denigrate and dismiss, or ignore, many of their own or others’ problems as not real or worthy of attention. This becomes particularly apparent in debates over what to include in the DSM (which is always decided through debate because, once again, there are no biomarkers for any of these so-called disorders). I was seething when I read DSM-IV task-force chair Allen Frances arguing that “Binge Eating Disorder” shouldn’t be included because it’s really just gluttony. But this is what the model has wrought: a world in which a problem is a disorder or basically nothing. (The strangest were the debates about grief, to which this distinction obviously couldn’t easily be applied, but the discussion showed just how impoverished our language for talking about suffering has become.)

    This has terrible consequences in the sense that “respect” for suffering and access to services (often woefully inadequate in the first place) are often contingent on having received a “real” diagnostic label. Everyone else is out in the cold. And it puts pharma in charge: “real” problems are those for which they have a drug to sell. They wouldn’t give a rat’s ass about binge eating if they couldn’t call it a disorder and use it to sell drugs. Rage from years of experience of violent racial oppression isn’t on the radar, or only is to the extent that it can be called a disorder which is used to drug and control people.

    The notion that “real” troubles will likely require drugs also causes problems when people are trying to deal with their problems. The drugs’ placebo effect (discussed by Kirsch in The Emperor’s New Drugs and James Davies in Cracked) is enhanced by the fact that people have hope for their success. Hope is a powerful thing, and PR has led people to believe that “real” problems are unlikely to be helped by any interventions that don’t include drugs, so these other interventions are less likely to be effective.

    Given that this sort of propaganda has been ongoing for several decades now and forms the context in which my arguments are read, I should absolutely be more appreciative of how my arguments are heard. So I’ll say it as plainly as possible: The disorders and imbalances and such claimed by biopsychiatry and pharma don’t exist. I don’t divide suffering into “real” – a chronic disorder that can only really/fully be treated with drugs – and everything else. I believe that all emotional suffering and psychological problems are real and people suffering should be treated with respect (and no, I don’t believe respect includes shying away from exposing psychiatric quackery). I don’t believe that problems that aren’t included in the DSM or given a diagnostic label, that are limited in time or improve with changed circumstances, or that respond to nondrug interventions are any less real or worthy of compassion and support. I believe we as a society have an obligation to understand the sources of psychological troubles and to help suffering people with respect, humility, and compassion. Again, I apologize to those who read me as saying something else.

    Please stop using “some problems”

    In this very thread, you refer to “some problems” being miscategorized, which reads as a neat dodge to avoid the “other problems” that apparently are … what, appropriately categorized? Not in the category of bad science? You’re extremely vague on this.

    No, no, no. I’m saying that all of the problems that have been medicalized by pharma and psychiatry as disorders/chemical imbalances/caused by a brain dysfunction/… are not really that. There are no such brain diseases or disorders. Of these, some problems – like grief; pain caused by a breakup, divorce, rejection, failure; periods of sadness, uncertainty, stagnation, hopelessness – are common to pretty much everyone, and will often subside with the passage of time or changed circumstances. This isn’t to say that any of these are nothing, or that all hopelessness, for example, is temporary, or that they can all be dealt with by the suffering person on their own (far from it – this individual pain and how its addressed are also very social). But this statement

    The human condition is such that we love others, and feel pain when we lose them through death or otherwise. We have desires and dreams that sometimes go unfulfilled, which hurts. We sometimes go through periods of feeling confused, hopeless, dejected, sad, anxious, weary,…as well as periods of relative focus, happiness, hopefulness,…because our moods aren’t always stable and we’re emotional beings. Our relationships, including with those we love, are sometimes difficult and stressful. We sometimes feel overwhelmed by the violence and suffering in the world.

    shouldn’t be remotely controversial. It’s because the model has so warped people’s thinking that they read this as saying those experiences somehow aren’t “real.”

    (This is actually quite helpful, Patrick. I think I’ll write a post about it, addressing these concerns in one place.)

  23. says

    Please avoid professional mind-reading

    Please recognize that you’re consistently linking to people who, by their own account, do not agree with you regarding the basic model, and then dismissing them as afraid to speak truth to power, or just simply too invested/locked in to the current model. I, at least, find that extremely disconcerting.

    I’m not sure I know who/what you’re talking about.

  24. says

    [CITATIONS NEEDED] on that claim.

    Real citations, not your so-called blog.

    ? The purpose of my post was providing a list of citations. About nine of the books provide extensive evidence in support of this claim.

  25. Morgan says

    SC @24:

    It’s because the model has so warped people’s thinking that they read this as saying those experiences somehow aren’t “real.”

    No. I can’t speak for PatrickG, but speaking for myself and the reason I agreed with his point you were quoting here: it’s not that I think you don’t believe people are sometimes sad. It’s that we say “well what about people with e.g. debilitating depression that leaves them barely able to function for months, who’ve tried therapy and so on and found it doesn’t help”, and you respond with a passage like that, and it reads very much like saying “well they’re just sad, it’s normal to be sad sometimes“, which makes a very callous and ignorant impression. If you’re claiming that “humanistic therapy” is adequate to address all problems people experience, what about those who try it with no success? If you’re not, then what are those whom it doesn’t help meant to do? When you talk about “other problems”, it reads as evasive, like you’re conceding that your model isn’t actually adequate to address people’s needs but minimizing the importance of the needs it doesn’t address.

  26. says

    My blood has been boiling through all this talk against psychiatric drugs and diagnoses. I was agitated and hypersensitive and “different” from the moment of my birth. I was diagnosed with bipolar disorder in my 40’s. Thank god. I finally found a reason for being “such a bad person,” and that reason was hard-wired into me at birth.

    The erasure of mental illness is beyond disgusting. It places SC in the same position as Scientologists, as far as I’m concerned. I have no interested in reading books that tell me my illness-from birth-has nothing to do with altered brain chemistry. And drugs have helped. They have not “fixed” me, but at least they’ve kept me from commiting suicide and have enabled me to live a somewhat normal life.

    Thank you, WMDKitty, and Patrick G, for perfectly expressing my own objections and feelings. (And nothing said afterward has changed my mind.)

  27. says

    It’s that we say “well what about people with e.g. debilitating depression that leaves them barely able to function for months, who’ve tried therapy and so on and found it doesn’t help”, and you respond with a passage like that, and it reads very much like saying “well they’re just sad, it’s normal to be sad sometimes“, which makes a very callous and ignorant impression.

    Except that that’s not an accurate representation. Read the quote in context:

    Many of the sources of psychological suffering have long been known: authoritarian or abusive and other problematic parenting (which we can recognize and address without excessive parental blaming); traumatic violence; racism; sexism; homophobia and transphobia; cultures or hierarchies that don’t allow for the fulfillment of our real needs; political oppression and terror; poverty; social isolation and marginalization; homelessness; unemployment; injuries and sickness; austerity projects;… I’ve written about this in general and my updated list in particular includes works in this vein, but humanistically oriented people working in these fields have always appreciated it. It’s really interesting how feminist and other social-justice advocates consistently point to the effects of living in a discriminatory culture (the cumulative harm of microaggressions, stereotype threat and various challenges to confidence, etc.) but there seems to be a line drawn around the most serious forms of distress that blocks their consideration as social issues. Also, some of the same people who talk in heartbreaking terms about their childhoods or their violent victimization seem to be the most resistant to the idea that their problems aren’t rooted in a chemical imbalance or disorder.)

    There’s this rich vein of humanistic psychiatry-psychology (and relevant sociology, philosophy, anthropology) – including feminist, anti-racist, liberation writing – that’s been tossed aside in recent decades. At the same time, interventions not based on the biopsychiatric model have been marginalized. It’s quite similar, I think, to what religion has done.

    Of course, it’s not as simple as a one-to-one cause and effect relationship. First, all of these factors are operating at once, and some factors (especially humanistic parenting and community relationships) can go a long way to offset the negative consequences of others. So we can’t assume that the same events or situations will have invariant psychological effects. Furthermore, due to individual differences and various chance factors, people will have different defensive and self-preserving responses to their experiences, some of which will become deeply embedded. (This is why Karen Horney argues that, while we should of course work to make society most conducive to flourishing, we shouldn’t expect large-scale social change to reverse problems that have become psychologically entrenched. I plan to discuss this in my review of The Therapy Industry.) And some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.

    So naturally there’s no single approach for every problem or extreme experience, and the response to psychological and emotional problems has to be a social one that seeks to address structural problems. In terms of individual therapies, generally they should be based on the understanding of the most likely sources of pain and suffering (discussed above) and the most frequent self-protecting responses to them, recognizing how those responses can become entrenched and have long-term consequences. This can take a wide variety of forms. Above all, the response should be humanistic, compassionate, respectful, humble, and dedicated to helping people understand the roots of their struggles, and needless to say it shouldn’t be based on lies and pseudoscience.

    I think you really have to be going for an uncharitable interpretation to read that as “reads very much like saying well they’re just sad, it’s normal to be sad sometimes’.” And I’m not the one using the word or the concept “just,” as if to minimize or trivialize people’s experiences. Look, I don’t know that I can make what I’m saying much more clear than I did just above. I’ve acknowledged above that I should have been more attuned to how my arguments could come across to some people in this cultural context, and apologized for the misunderstanding. If you wish to continue to believe that I’m inherently dismissing people’s experiences and pain by arguing that psychiatry is pseudoscience and the drugs aren’t medications, and looking for reasons to reject the argument on that basis, that’s your right. But it’s not true.

  28. says

    Please recognize that you have no replacement, and that’s a problem

    Humanistic therapeutic care would be a laudable goal. We don’t have it. Also, related to the above point, you acknowledge that this will not be universally effective, particularly when it comes to the “other problems” that may not be “just life”.

    I hope my last long post above clarifies this a bit.

    Tied in with other points, it’s not unreasonable to conclude you think people should not be taking psychiatric medications. This is a position of advocating particular actions, which necessarily requires the question “what then?” It’s not unreasonable for people to ask that question.

    I think it in the same sense that I think people should not be religious. I don’t go to religious chatrooms and provide citations of atheist books, and I’m not demanding or advocating that any specific religious person take any specific action. Some people believe their life would be joyless and bereft of meaning without Jesus; others would lose friends, family, or employment if they left their religion; and some would be subjected to ostracism, violence, or abandonment. For many, their religion provides them with an identity and sense of stability. I also know that in their current state the atheist and humanist communities are in pretty bad shape, and I’d have some difficulty recommending joining them. I also can’t provide a perfect substitute for the sense of community that religion provides for some people.

    But still I do write critically about the falsity of religion at my and other atheist-secular blogs, I openly state that religious beliefs are fraudulent, and I discuss the many harms of religion and faith. I advocate for working toward a secular and humanistic society. I encourage religious people to question their beliefs. I criticize the people who profit off of the faithful. I challenge religious apologists and religious bigots who write publicly. I call attention to religious violence and oppression. I protest discriminatory and harmful religious practices and policies. I seek to challenge the remnants of religious thinking that I find in humanism.

    Just as I wouldn’t go into a church or to a religious site and start making my arguments, I wouldn’t go into a chatroom of users of psychiatric drugs and start debunking psychiatry. (This is a little bit complicated because some people who write about their personal experiences with psychiatry do so from their platform as advocates of science, reason, and humanism.) I don’t tell people to stop taking the drugs (once again: no one should ever stop taking any drugs unless under a doctor’s supervision). I don’t tell them to try this or that specific alternative. I don’t try to provide them with an alternative replica of drug treatment promised to work for everyone.

    But I do write publicly about psychiatry being pseudoscience. I provide evidence that the drugs aren’t medications and are often extremely dangerous. I describe the medical, social, and political harms of the model. I protest forced and coercive interventions and the drugging of children. I criticize psychiatric apologists who publicly mislead people. I show evidence of the corrupt nature of the whole enterprise. I challenge public policies based on the model and the waste of public resources it’s led to. I provide information about humanistic alternatives, past and present. I advocate for the spread of humanistic approaches to the understanding of psychological problems and effective humanistic interventions, both therapeutic and social/political/economic. (This is even more of a catch-22 than in the case of religion, since billions and billions have gone into pharma coffers and decades of fruitless research in this paradigm while alternatives have been marginalized, defunded, or shut down. Fully developing these alternatives necessarily requires a fundamental move away from biopsychiatry, which is hindered by the dearth of alternatives,…)

    I don’t think any of this is unsympathetic, though it can be done more or less sympathetically. Being sympathetic shouldn’t require lying. It doesn’t mean accepting people’s beliefs about the specific nature and cause of their problems. I can understand that someone believes a CAM treatment helped them overcome crippling pain or that Jesus saved their life and makes them a better person or that psychiatric drugs fix their chemical imbalance and respect those experiences without accepting that any of these specific beliefs are true. And I can continue to debunk these claims in general while also being concerned about the people who fear they would otherwise be lost. What makes things different and especially difficult with psychiatry is that, while the freethought community isn’t a psychiatric chatroom, there are many people in it, the vast majority, who genuinely believe in the model and that the drugs are effective medications which have helped them personally. Even if they’re not posting, they’re likely reading. So I’m not sure how to deal with this, except to take comments like Patrick’s to heart.

    Ironically [?] enough, I wrote a couple of years ago on the practical ethics of debunking, and discussed some of these very issues:

    http://saltycurrent.blogspot.com/2013/03/thoughts-on-practical-ethics-of.html

    http://saltycurrent.blogspot.com/2013/03/thoughts-on-practical-ethics-of_27.html

    In retrospect, it probably would have been useful to have finished part 3…

  29. karmacat says

    Mithrandir has a good point of starting with what science says about the brain in general. Ultimately, the brain is another organ, albeit an amazing, complicated organ. SC, you keep mentioning what you have read, but have you read about twin and adoption studies in relation to schizophrenia and bipolar illness? Schizophrenia and Manic-depressive Disorder: The Biological Roots of Mental Illness as revealed by the landmark Study of Identical Twins By Edwin Fuller Torrey, Ann E. Bowler
    There is also research in how “physical” and “mental” illnesses are related . There was an expectation that physical illnesses led to depression but it turns out it is more the opposite, that depression can lead to physical diseases. Some of the same neurotransmitters in the brain are also in the rest of the body.
    It is hard to link to any particular study or book because the study of the brain is huge and still there is so much we don’t know. There is a lot of research looking at genetics and mental illness.
    HOw do you explain people hearing voices when there is no one around or the bizarre delusions some people have. And it can start when someone is 18 or in their 20’s. Working with patients with anorexia, it is impossible to convince some of them that they are too thin. They just can’t “see it.” Starvation definitely affects the brain and what we perceive but some of these patients had this delusion even before they started starving themselves.
    For some people, it is a frightening idea that our brains can dysfunction. Hearts can get arrhythmias because of impairments in the electrical system that tells a heart when to contract. The brain is an even more complex electrical system that gives us emotions, perceptions of ourselves and the world.
    Again, I encourage anyone to look at research about the brain and how scientists look for differences between people’s brains

  30. PatrickG says

    SC, you keep mentioning what you have read, but have you read about twin and adoption studies in relation to schizophrenia and bipolar illness?

    I’d really like your answer to this SC. I’ve asked it a few times now.

  31. says

    SC, you keep mentioning what you have read, but have you read about twin and adoption studies in relation to schizophrenia and bipolar illness?

    Yes. Please see my first link at #6 above. (If you go to the link I provide there for the book chapter you’ll see that Joseph has a new book on the subject this year.)

    Schizophrenia and Manic-depressive Disorder: The Biological Roots of Mental Illness as revealed by the landmark Study of Identical Twins

    Published in 1994.

    By Edwin Fuller Torrey

    Ew. Ew.

    It is hard to link to any particular study or book because the study of the brain is huge and still there is so much we don’t know. There is a lot of research looking at genetics and mental illness.
    HOw do you explain…

    Let me ask you: Do you plan to read some of the books I recommended? If not, why do you assume they don’t address and/or refute your questions and arguments? If so, why do you keep throwing the questions and arguments out there before engaging with the evidence they provide?

  32. says

    OK, I’m going to have to go, I think. I’m grateful to people who offered comments about approaches and asked for specific clarifications. At this point, I don’t think anything more I can say will make much of a difference in terms of people choosing to read the recommended materials or not, and I have other things to attend to. Whatever anyone decides, I wish you well.

  33. medivh says

    I understand that my views sound extreme if you’re hearing them for the first time.

    Oh, salty… I’ve seen your views written in cramped (and oddly overlapping) hand on a placard held aloft on a street corner more than a decade ago. I couldn’t make sense of the disordered “argument” on that placard that I saw every day for four years, and I’m really having trouble thinking much better of your argument for the number of counterexamples shown to you and left unanswered.

    Put another way: the Church of Scientology got there way before you did, as have numerous people of no fixed address and large numbers of mental health issues. Your views are extreme, yes, but that doesn’t warrant a second look. Your views, demonstrably harmful, are far too similar to kooks and cranks, and your refusal to answer counterexamples only cements that.

    Or yet another way: your self-admittedly extreme views carry no such extreme evidence. Stop “Dr. Oz”ing around and telling people their medications (and experiences!) are worthless.

  34. PatrickG says

    (If you go to the link I provide there for the book chapter you’ll see that Joseph has a new book on the subject this year.)

    This is not at all convincing, nor is it feasible for most of us. Particularly given that your rebuttal of the provided study consists of attacks on the author for completely different reasons (which, by the way, do appear valid — but have nothing to do with the science of heritability of mental disorders). Is this actually a case of ad hominem in the wild? You’re discrediting the claims of a particular book by citing the bad public behavior of an author? Is that really where you want to go? Why not just provide a link and a quick synopsis?

    Though I will say, finding Jay Joseph’s book itself (or at least one of his books) makes me kind of skeptical right from the beginning — literally in the Introduction. At the beginning of the “Outline of the Chapters” (source):

    Chapter 2 looks into the history of twin research, for a simple reason: The full story of this history has never been told. Unfortunately, twin researchers cannot be relied upon to provide details on the more unsavory aspects of this history. In fact, the origin of twin research as a tool of eugenics, “racial hygiene,” and Nazism is rarely mentioned by twin researchers

    Uh, wut? He says he’ll discuss some methodological problems too, but wow. He leads with “twin studies are unreliable because NAZIS! ” And people using twin studies won’t mention this! What else won’t they tell you? DOOOOOM.

    Note to self: when attempting to revolutionize science, try to avoid Godwinning self in introduction.

    If I get the time, I’ll try to read the substantive criticisms he presents, but since this will also require reading the work he criticizes, as well as a number of other papers/books to actually be sure I can critically evaluate what I’m reading, it won’t be any time soon.

  35. sawells says

    I think the trouble with SC’s argument is that a number of valid points about pharmaceutical company behaviour, over-medicalisation, corruption, and bad science (e.g. nonpublication of negative studies) are mixed in with the ridiculously sweeping claim that there are no mental illnesses and no working pharmaceuticals for them.

    Every other human organ has pathologies which interfere with its function either grossly or subtly; it’s not plausible that the brain is uniquely free from these. And we know that there are a lot of chemicals with profound effects on the mind, because people have been entertaining themselves with them since before recorded history.

  36. sawells says

    I also note that, in the article by Torrey which was linked from one of SC’s “Ew” links, Torrey says this: “Whitaker is correct in criticizing the pharmaceutical industry, the overuse of psychiatric medications by physicians and the psychiatric profession for being financially in the pocket of the pharmaceutical industry.” So those criticisms seem to be pretty mainstream and don’t require the Galileo gambit.

  37. says

    OK, now I’m actually angry, and done.

    This is not at all convincing, nor is it feasible for most of us.

    What the fuck are you talking about? I linked to my post, which contained a link to a page with a recent book chapter available for free online (here it is again). I even provide the full citation so you’ll know which one I’m talking about:

    Joseph, J., and Ratner, C. 2013. “The Fruitless Search for Genes in Psychiatry and Psychology: Time to Reexamine a Paradigm.” In S. Krimsky and J. Gruber (Eds.), Genetic Explanations: Sense and Nonsense (pp. 94-106). Cambridge, MA: Harvard University Press.

    How the hell is this not feasible? What you quoted was a parenthetical fucking remark.

    Evidently, no one is interested in engaging with the materials, but I’m supposed to respond to every bullshit assertion and piece of garbage anyone googles up, even if it’s covered in detail in the books I recommend, or it “stands.” karmacat just made a statement and then wrote the title and authors of a book. No link, no date, no summary of the argument, no evidence of replication. Nothing. But my providing a link to a free recent book chapter summarizing several decades of studies in the area, where you can read not only the chapter but the author’s list of publications on the subject and see that he’s probably the most recently published, that’s unconvincing and unfeasible. Ridiculous.

    Particularly given that your rebuttal of the provided study consists of attacks on the author for completely different reasons (which, by the way, do appear valid — but have nothing to do with the science of heritability of mental disorders).

    First, that wasn’t a rebuttal, but an expression of disgust. My rebuttal was that it was a book based on a single study published more than twenty fucking years ago, and my link to a book chapter analyzing all of the studies over this time. But the “Ew” links are in fact also relevant. E. Fuller Torrey, affiliated with the Heritage Foundation, is probably the most notorious propagandist for forced detention and drugging in the US. He has a political agenda, his public lies about the “mentally ill” being violent and dangerous have resulted in terrible human rights violations (but of course I’m the one who hates people diagnosed with mental illnesses), and he’s been shown to misrepresent the facts repeatedly.

    Is this actually a case of ad hominem in the wild?

    Are you fucking kidding me? There have been three threads of ad hominem attacks in response to my arguments, and you’re suggesting that my expression of disgust at seeing a citation of a known disseminator of falsehoods and advocate of human rights abuses is your example of an ad hominem?

    You’re discrediting the claims of a particular book by citing the bad public behavior of an author? Is that really where you want to go? Why not just provide a link and a quick synopsis?

    Yes, this must be a cruel joke.

    Though I will say, finding Jay Joseph’s book itself (or at least one of his books)

    Oh Jesus fuck.

    makes me kind of skeptical right from the beginning — literally in the Introduction. At the beginning of the “Outline of the Chapters” (source):

    Chapter 2 looks into the history of twin research, for a simple reason: The full story of this history has never been told. Unfortunately, twin researchers cannot be relied upon to provide details on the more unsavory aspects of this history. In fact, the origin of twin research as a tool of eugenics, “racial hygiene,” and Nazism is rarely mentioned by twin researchers

    Uh, wut? He says he’ll discuss some methodological problems too, but wow. He leads with “twin studies are unreliable because NAZIS! ” And people using twin studies won’t mention this! What else won’t they tell you? DOOOOOM.

    “Wut” is right. He’s saying he has one chapter on the history of twin studies, which will discuss particularly those aspects the researchers are less comfortable with. The fact is that twin studies and research on the alleged genetics of “mental illness” and behavioral problems has a long, sordid history (and Fuller Torrey isn’t exactly an example of a move away from this in the present), and people should be very careful about tossing out claims about hereditary mental problems. If you look at his publications, you’ll see that he’s published on the subject, and so probably knows a fuckton more about it than you. He does not claim in that paragraph that that history makes twin studies unreliable. In the book chapter I recommended, he discusses the failures of and scientific issues with these studies in depth.

    Note to self: when attempting to revolutionize science, try to avoid Godwinning self in introduction.

    He’s not attempting to “revolutionize science.” Honestly, this rubbish is shocking coming from you.

    If I get the time, I’ll try to read the substantive criticisms he presents, but since this will also require reading the work he criticizes, as well as a number of other papers/books to actually be sure I can critically evaluate what I’m reading, it won’t be any time soon.

    You clearly don’t want to read any of the works I’ve recommended, and are going to great and rather embarrassing lengths to avoid doing so. So be it. But this is bullshit.

    I’m out.

  38. PatrickG says

    Deep breath here: Torrey is not the only one asserting heritability. Attacking Torrey may be perfectly legitimate — as I acknowledged and even agreed with — but it does not refute heritability.

    The problem is I can easily find many, many articles (though of course, I’m not an expert in the field and I’ve only skimmed abstracts) which either take heritability for granted or assert to show heritability. I even linked one at random! Refuting that body of peer-reviewed work with a redirect to a chapter of a book is simply not sufficient.

    You (and Joseph, it seems in my limited reading so far) are making an extraordinary claim in light of that, and you know what they say about those.

    As to my snarky comment about Joseph, yeah, it was snarky. I’m like that sometimes. You may have noted that I explicitly said I would try to find time to read his substantive comments, but that I was personally weirded out by the primacy of Nazi experiments in his book.

    He’s not attempting to “revolutionize science.”

    No, but you are, and you’re citing this author as a major element of your advocacy. Your goal here, after all, is to dismantle a major conceptual model that provides a system of clinical diagnosis and treatment for millions upon millions of people and is currently accepted (if subject to debate) as a linchpin of scientific thinking in peer-reviewed work. If that’s not revolutionary, then what the fuck is?

    You clearly don’t want to read any of the works I’ve recommended

    No. The reading I done has failed to be convincing so far, and I have deadlines.

    I’ve read at least 8 of your blog posts (since this discussion started, I’d read some previously — you can probably see me visiting repeatedly because I want to make sure I’m clear on what you’re linking), checked out abstracts on several articles, and clearly I started to check out a book you recommended. Or I wouldn’t have, you know, quoted it.

    And this was in my goddamn free time, of which I have had little, over the past couple of days. By the way, this does explain some of my rambling writing — I am totally not proofreading beyond making sure html is properly closed.

    Let me repeat myself:

    If I get the time, I’ll try to read the substantive criticismshe presents, but since this will also require reading the work he criticizes, as well as a number of other papers/books to actually be sure I can critically evaluate what I’m reading, it won’t be any time soon.

    But frankly, I don’t think my being skeptical of an author who chooses to lead with Nazis(!) is unreasonable. If twin studies are bad, then show them bad on scientific grounds. That kind of silliness is best reserved for a footnote or an end-of-chapter digression. Again, I’m not saying I won’t read it — I’m saying that I only had time for a snarky comment so far.

    Until I get that time, I have several deadlines to meet, a sick partner to make dinner for, and major depression to manage. I’m sure you understand.

  39. says

    For the record, before I go, here are the recommendations I provided at my post:

    Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (2002)

    James Davies, Cracked: The Unhappy Truth about Psychiatry (2013)

    Irving Kirsch, The Emperor’s New Drugs: Exploding the Antidepressant Myth (2009)

    Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010)

    Marcia Angell, “The Epidemic of Mental Illness: Why?”, “The Illusions of Psychiatry,” and “‘The Illusions of Psychiatry’: An Exchange” (2011)

    Joanna Moncrieff , The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment (2008)

    Stuart A. Kirk, Tomi Gomory, and David Cohen, Mad Science: Psychiatric Coercion, Diagnosis, and Drugs

    Ethan Watters, Crazy Like Us: The Globalization of the American Psyche (2010)

    Christopher Lane, Shyness: How Normal Behavior Became a Sickness (2007)

    Ben Goldacre, Bad Science: Quacks, Hacks, and Big Pharma Flacks (2008)

    Ben Goldacre, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (2012)

    Paul Moloney, The Therapy Industry: The Irresistible Rise of the Talking Cure, and Why It Doesn’t Work (2013)

    Erich Fromm, various

    Karen Horney, Neurosis and Human Growth and New Ways in Psychoanalysis

    Marcia Westkott, The Feminist Legacy of Karen Horney (1986)

    Alice Miller, Thou Shalt Not Be Aware: Society’s Betrayal of the Child

    Ignacio Martín-Baró, Writings for a Liberation Psychiatry

    Frantz Fanon, The Wretched of the Earth (1961)

    I said there that “Once again I’ll note that recommending these books doesn’t mean that I endorse each and every argument they contain, which would be impossible in any case as they often disagree amongst themselves.”

    I’ve had it with this. I can’t take the self-righteous intellectual dishonesty, hypocrisy, fallacies, misrepresentations, and other bullshit any longer. I’m in it for the long haul, but I understand that this community isn’t open to radically challenging arguments on certain subjects. Thank you, Ophelia, for originally linking to my post, but I’ve had enough. So long. If anyone wants to discuss any of these works, you can find me at my blog.

  40. PatrickG says

    I can’t take the self-righteous intellectual dishonesty, hypocrisy, fallacies, misrepresentations, and other bullshit any longer. I’m in it for the long haul, but I understand that this community isn’t open to radically challenging arguments on certain subjects.

    I’d take this more seriously if you had actually taken the time to answer my very basic questions about heredity. Saying “Here! A book!” does not cut it. ESPECIALLY WHEN COUPLED WITH:

    I said there that “Once again I’ll note that recommending these books doesn’t mean that I endorse each and every argument they contain, which would be impossible in any case as they often disagree amongst themselves.”

    In utmost sincerity, how on earth do you expect us to know what you do and do not endorse? Particularly when they disagree? When you can’t be arsed to provide a brief summary of the books you’re demanding we read before we respond? I’ve been over many of your blog posts now, and I still am unclear on what you advocate for in a number of areas.

    And c’mon, you refuse to answer direct questions. I’ve asked you, at this point, at least four times to directly address the apparent role of heredity in particular mental disorders, because I really find that in direct conflict to your claims. All I get is book citations! You claim expertise, after all, but when it comes to evidence, you demand that we have to educate ourselves to your standards before you’ll engage!

    That’s extremely frustrating from this side of the aisle, to put it charitably.

    I’ll reiterate my opinion that you really, really need to find a different strategy. This one clearly ain’t working. But for what it’s worth, I do plan on following up on your links and citations (again, when I have time, and I’ve bookmarked this conversation for future reference. So there’s that, I guess.

    Whatever. Bye.

  41. Lady Mondegreen says

    The drugs’ placebo effect (discussed by Kirsch in The Emperor’s New Drugs and James Davies in Cracked) is enhanced by the fact that people have hope for their success. Hope is a powerful thing, and PR has led people to believe that “real” problems are unlikely to be helped by any interventions that don’t include drugs….Given that this sort of propaganda has been ongoing for several decades now and forms the context in which my arguments are read

    It may be pointless to mention this now that SC has gone and the thread is presumably dying, but it’s been rankling at the back of my mind for a while now, and this brought it forward, so here goes.

    I was suffering from MDD–for a long time without a diagnosis–since before SSRIs were invented. I was suffering before the mental-illness-as-faulty-brain-chemistry model. I was reading Alice Miller before her third book came out.

    I went to talk therapy (which by the way has its own skeptics, but I didn’t know that at the time), fully expecting it to help me. It didn’t.

    I took Elavil (a tricyclic antidepressant that long antedated the SSRIs.) All it did was make me anorexic.

    After my experience with the Elavil, I resisted trying antidepressants again for years. When I finally tried Zoloft, I had only moderate hope for relief. Actually I didn’t expect much. Nothing else had helped; why would this stuff? The psychiatrist who prescribed it was no cheerleader for pharmaceuticals.

    I was quite surprised when the stuff worked.

    And, unlike my (years of) talk therapy, SSRIs have continued to work long past the point that placebo effect could be expected to wane.

    Personal anecdote. I know. But one not at all reflected in SC’s apparent idea about how naive sufferers are fooled by simplistic medical models and slick marketing.

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