Originally a comment by karmacat on Psychiatry is an important skeptical and social justice issue.
My anger comes from working as a psychiatrist and watching my patients suffer and scared that maybe there is nothing I can do for some patients. SC does have valid criticisms because the brain is so complicated that we have a limited understanding of it.
Mental illnesses do exist but we still don’t really understand the pathophysiology of the brain. We can see how patients with schizophrenia have different brains from “normal.” but one patient with schizophrenia can be different from another patient with schizophrenia even though they have the same diagnosis.
The problem with the DSM is that it is just a description of symptoms but doesn’t describe the physiology of the brain. But, right now, it is the best way of standardizing the diagnoses of mental illnesses.
Another issue is that patients and doctors can expect too much from medications. Most antidepressants are prescribed by primary care physicians and they don’t have a lot of time to figure out what is really causing depression. The problem is most people don’t have access to therapists or even psychiatrists, so they only get treated for one aspect of the illness. they don’t get treatment for the psychological and social aspects of their illness.
Another question that is important is to ask how much depression, anxiety, hallucinations or mania interfere with a person’s life. If a patient is managing his or her moods, then the risks of medicines outweigh the benefits. If medicine is taking away all emotions then it is time to switch medicines and/or focus on therapy more.
I could go on and on, of course. the point is that there are people who are suffering a lot and we need to find ways that are effective and with minimization of risks and side effects. We have a long way to go. If you look at the history of psychiatry there are a lot of screw-ups but there are some breakthroughs, especially for schizophrenia and bipolar disorder. Through the years, there have been more legal safeguards for patients and in research. As SC has pointed out, there are still a lot of problems.
Psychiatry can be frustrating because there , the treatments are limited, the brain is complicated but the suffering continues. All I can do for my patients is to keep reading articles and keep trying. I hope I haven’t rambled too much.
Sigh.
Sigh, indeed. Someone dared to express a view different from yours!
SC, you’re really being a lousy advocate for your views here. You treat every expression of a different viewpoint — even one that largely agrees with you like this post — like it’s a personal insult or oppression. In the other thread, your only substantive response is to tell people to go read all these books. You come off as about as credible a critic of psychiatry as Tom Cruise.
The author is completely right. Many, if not most people with mental illnesses do not have access to therapists, counsellors, or psychiatrists. Mental illness has a pretty substantial overlap with poverty. In a lot of cases, medication is the only option. Some people can’t even get access to medication!
It’s a huge waste of time to complain about psychiatry and psychotropic medications when they are literally the only option for many people. You should be complaining about the underlying issues of poverty, about the lack of access to counselling programs for low-income families, about the lack of education funding to train more psychiatrists and registered clinical counsellors, about HMOs that will only let the GP see their patient for 5 minutes and refuse to pay for any treatment other than cheap general purpose SSRIs. THOSE things are the problem, not psychiatry.
screechymonkey, I’m asking this honestly: If you think I’m being a bad advocate, what do you suggest? Because I’ve spent several years writing posts and comments abut this, linking to studies, reviewing books, reporting on public statements from the leaders at NIMH and the APA and their professional critics, posting videos, explaining the human harms of the model, trying to alert people to human rights violations,… If I don’t provide a list of sources, I’m accused of making farfetched, unsupported claims; if I do, it’s “all you do is tell people to read books and articles,” which people then proceed not to read.
I don’t understand how listing and reviewing the material on which my arguments are based makes me appear noncredible. That seems wholly incongruous with the way the community approaches every other issue – if I were providing a list of books, articles, and posts for anti-vaxxers about the safety and efficacy of vaccines, no one would be suggesting that it makes me noncredible or a lousy advocate. The response to my arguments and reading recommendations strikes me as frankly hypocritical.
If I seem overly sensitive to these responses even when they’re not openly hostile, it’s because this has been happening for several years. The worst responses are the personal attacks – the claims that I’m callous and uncaring or anti-science – and the attempts to silence me altogether by blocking my comments or banning me. Responses like karmacat’s aren’t hostile in this way, but they paint what I know to be a false picture, making assertions that are false and leading people away from any real engagement with the evidence and towards an accommodation with biopsychiatry that’s based on myths.
It’s hard to keep writing and posting about this. I feel hurt and betrayed by a community I’d trusted (people who had no reason to believe me to be credulous or anti-science), and I’m angry at being told, as I have been for years as a feminist and a gnu atheist,* that the problem is that I’m not adopting the right tone or approach for people to listen, that I’m too shrill or “absolutist,” and so on. It’s the same tone and approach I use always, and funnily enough it seems only to be an issue in this community in two contexts: this one and discussions of animal rights. And I’m angry that once again it’s become about me when it shouldn’t be. I don’t think I’ll ever understand why this community is so hostile to engaging with evidence on this particular subject, but it’s been a painful experience. I’m upset about it. I’m just asking people to read a few fucking books and articles, for fuck’s sake.
* I think I remember when you adopted your pseudonym, and I think it’s relevant here.
@ SC #4 On the contrary, in the majority of posts I have read here, the defenders of the science of psychiatry have bent over backwards to acknowledge and explain the limitations of current instruments (Drugs and the DSM).
The problem you’re having is that you have focused on this issue through a lot of second-hand sources: popular books and press releases from the NIMH et al. Even though you may think you may have a mountain of evidence, these sources often don’t have the nuances and precision of the scientific literature. If you want to convince people with domain knowledge in the field that they are “doing it wrong”, you bear the burden of providing a better model and tools than the ones in use, and none of your posts seem to even bother attempting this.
The title Ophelia has given says it better than anything I could say.
I’m not saying not to read the articles and books. Criticizing research and ideas will hopefully move medicine forward. But I am confused about your position. Are you saying that there is no such thing as schizophrenia, bipolar disorder, post-traumatic stress disorder, etc? What are your suggestions for treating people who are so depressed that they can’t get out of bed? I haven’t had too much time but I did skim through one article about how antipsychotics just suppress the brain in patients with schizophrenia and the medicines don’t really do anything for the disease. But treatment is not so simple when it comes to schizophrenia. For some people and some medicines that is a problem. It stops the hallucinations but the patient is apathetic, anergic, and is flat. Supposedly the newer antipsychotics don’t do that but they have other bad side effects. The New England Journal of medicine had an article comparing one old antipsychotic with the newer ones. The real conclusion from the article is that 50% of patients stop medicines because of side effects. Maybe a better answer for those patients is to have supportive community and therapist.
karmacat articulates much of what bothered me about SaltyCurrent’s earlier post. I know there are real problems with psychopharmaceuticals. I also know there can be real problems without them. I’ve known people happy to have them and functional with them; not functional without. I’ve also read plenty about their use instead of real care, and that’s a very bad thing they enable. It’s a very difficult issue.
Somewhat related, it set me thinking about mental hospitals. The state ones in the Bad Old Days were (mostly? all?) horrific. So when that point got through to people, they were shut down. But nothing replaced them. Hallucinating schizophrenics and psychotics without anyone else to take care of them wound up homeless. That’s still the model for severely mentally ill without resources. Is homelessness a less awful alternative than the old state mental hospitals/prisons? I don’t know. I honestly don’t know which of those two awful choices I’d want if it was me.
But the real point is those are not our only choices. The real solution is to provide people the care they need. Whether it’s pills or counseling or halfway houses or all of that or none of it. That would cost money. Though if you figured in the social costs of homelessness and lost potential due to mistreatment, it’s probably actually cheaper.
SC,
I’m not calling you strident or shrill or any of the other anti-Gnu atheist code words for “shut up.” It’s quite the opposite: in these two blog posts and comment sections, you aren’t engaging with the arguments. People — including some with professional expertise in the area — are agreeing with some of your points, but you’re shrugging that off because nothing less than 100% capitulation to your views is acceptable. And you’re doing it without even giving a brief summary of where you claim they’re going wrong.
Right from the beginning — and by that, I mean your beginning on this subject on this blog, because I don’t follow your blog and have no idea what you’ve been arguing for the last several years, and I doubt I’m the only one in that category — you engaged in well-poisoning and the Galileo Fallacy, claiming that you’ve been silenced and censored and expect to be so again, and implying that anyone who doesn’t agree with you is failing to keep an open mind.
I don’t doubt that the skeptical community is capable of laying a massive turd on a particular issue or issues, but that’s not a great beginning for you. Especially when you appear to be taking a position that an entire field of science and medicine is all bullshit. Again, that’s been known to happen, but you bear a pretty heavy burden and shouldn’t be surprised that it gets met with resistance, but you act like you’re shocked that one pseudonymous blogger hasn’t been enough to take down or reform an entire industry. Then you follow it up by refusing to engage with any criticism other than to tell people to go read an exhaustive homework assignment you’ve prepared.
This is a subject in which I might be interested, but it falls firmly into the category of “well, maybe I’ll read more when I find the time.” There are lots of people who want me (not me specifically, but the public in general) to just “read a few fucking books and articles.” I don’t have time to take up all those invitations/suggestions/commands, and I really haven’t gotten the impression that this would be a good use of my time. Yes, it’s great that you have a huge bibliography of sources, but if the only way for me to get into this subject is to spend hundreds of hours reading it, at the conclusion of which you’ll still accuse me of lacking an open mind if I don’t completely agree with you…. eh, I’ll pass, thanks. Which I’m sure is no great loss to you — unless I’m representative of other folks who are tuning you out.
And for what it’s worth, I do think some of the criticism has been illegitimate. Anecdotes about individuals who have supposedly been helped aren’t really that useful to the discussion other than to remind us that there are real consequences for people and so it’s important to get this stuff right as a society.
SC:
I can’t even say I disagree with you, because despite reading your posts, I can never actually pin down your actual position. Is it any of these, alone or in tandem?
A: “Psychopharmeceuticals (hereafter PP) are completely worthless, and any positive results are purely due to placebo effect and other factors.”
B: “PP have dangerous side-effects that are vastly underreported or completely covered up.”
C: “There is no basis for the current DSM method of diagnosis, and the entire field of psychiatry is bunk.”
D: “Biopsychiatry is a fraud–while the conditions it claims to treat are real, it has completely misidentified the cause behind these ailments.”
E: “PP do work in some cases, but we don’t know the actual causes for that, so it’s pretty much shooting in the dark.”
F: “PP may help some patients, but in the end, the side-effects are invariably worse than the ailment being treated.”
G: “PP work in some cases, and in desperate cases may be justified, but between their unreliability and their side-effects, it’s also clear that they are over-prescribed, used as a first resort rather than a final option.”
Yes. I’m not just saying it – it’s a fact. See especially here and here.
I’m going to answer this question more generally in the other thread.
There’s no disease of schizophrenia, and those aren’t medicines.
This is very confused. Explaining the fundamental problems with biopsychiatry and psychopharmaceuticals can’t be done in one or a handful of articles, though I’ve linked to several major studies at my blog. Nor can we rely on articles plucked out of the psychiatric literature to adjudicate the evidence, due to the issues with publication documented extensively by many of the authors I recommend, including Marcia Angell, Ben Goldacre, and Irving Kirsch. In order to perform the (peer-reviewed) meta-analysis of “antidepressants” that formed the basis for The Emperor’s New Drugs, Kirsch had to file a FOIA request with the FDA to get all of the studies that hadn’t been published. (And that’s not even to go into the corruption of research itself, also well documented.) The literature has to be understood as a whole and in context, and this takes longer works. In the case of psychiatric diagnoses being scientifically invalid, the most damning evidence is the admission (against interest) by the heads of the NIMH and the APA that this is a fact, and the admitted lack of any evidence, after several decades of desperate searching, for valid pathophysiologies in any of the DSMs. That they had valid diagnoses was a positive claim they’ve made which they can’t substantiate.
But if you’ll read a few of the books, we could discuss where precisely you believe they substantively lack nuance and precision.
SC,
Just to be clear: you’re arguing that mental illnesses aren’t real?
Well, it’s more complicated than that. They’re drugs and they have various effects, some of which might be desirable in some contexts, but they don’t treat mental diseases or disorders or correct “chemical imbalances” or the like. Joanna Moncrieff’s book covers this in detail.
Yes.
There’s a basis in the sense that people really do have experiences and problems, sometimes very extreme. But the changing DSM categories and boundaries are essentially arbitrary. No biomarkers have been found for any of the diagnoses, as has been publicly acknowledged.
To the extent to which it’s based on the biopsychiatric model, yes. And I use “bunk” advisedly – the field has largely become a marketing arm for pharma. This isn’t to argue that everyone involved – in psychiatry or related professions – is intentionally lying (although some are – some people have publicly said that they lie to their patients, telling them they have a chemical imbalance when they know this isn’t true to get them to take drugs; this is ridiculously unethical). I think most doctors and people in mental health professions truly believe that these are real disorders and real medications.
Yes.
See above.
See above.
See above. But I’ll note that some of these drugs taken long-term are extremely dangerous. The so-called antipsychotics, for example.
Hrm. I want to answer this as clearly as possible. My issue is not with overprescription or first-line prescription, but with the fraudulent premise at the root of how they’re being “sold” to people (and their doctors). You’re much more likely to take a drug if you’re led to believe that you have a chronic chemical imbalance or a (degenerative) brain disease called schizophrenia. What I want is for the lies to be revealed – concerning both the invalidity of the diagnoses and the real effects of the drugs – so people, their doctors, and those making policy can make informed choices. Vyv*nse, for example, isn’t a “treatment” for “ADHD” or “Binge Eating Disorder,” which don’t exist, but a stimulant with the same stimulant effects across the board.
I’ll add a few more aspects of my larger argument:
The bogus labels and the biological model are stigmatizing and self-stigmatizing, and I’ve linked to the research that shows this overwhelmingly. They can affect people’s careers, opportunities, and many other aspects of their lives.
It’s a huge problem that people are being lied to and convinced to take these drugs, but in many cases the choice doesn’t even exist. People are detained and drugged forcibly or coercively, in violation of international human rights accords. Children, who are being subjected to “anti-psychotics” at a skyrocketing rate, of course have little choice concerning whether to consume the drugs. This is especially true for poor children in the Medicaid system, and is also true for people in institutions (prisons, juvenile detention facilities) and the elderly.
The belief in this model marginalizes other – familial, cultural, social, political, economic – sources of psychological distress (which I’ll talk about on the other thread). Even when projects aren’t being shut down and investigators marginalized – which happens – other approaches are starved for resources or attention.
I want to thank you for taking the time to write out the questions and ask me to clarify. I confess that in the past I’ve been suspicious when people said they didn’t know what I was arguing. I mistakenly thought it was more obvious than it could really be, given that the arguments were made over several blog posts in various places and numerous comments. I also forget how new and startling some of these claims are to people hearing them for the first time. I hope it’s more clear now.
Yes. But to be perfectly clear: The experiences and problems psychiatrists use their labels to describe are completely real. I’m neither denying that, nor arguing in any way that they’re trivial, that they’re character defects, or that people can or should just “get over” them. They have real and deep roots in people’s experience of the world and their defensive reactions to it. People struggling need help and compassion as individuals, and we as a society need to address the conditions that generate undue distress.
SC
And there it is — you think that mental illness isn’t real.
You’re a crank.
On behalf of myself and others who suffer from mental illnesses: fuck you and your anti-psychiatry agenda.
This comment from Jadehawk a couple below the comment that SC linked to above, seems paricularly lucid:
[emphasis mine] TBH, I don’t understand why this is controversial. I reread the NYRB columns from 2011 (I had read them back when they were first published), and they (and the books being reviewed) seem to me to be basically saying what I quoted from Jadehawk. Those reviews, and at least some of the books, are by psychiatrists themselves, so dismissing them as anti-science cranks is off the mark.
Possibly relevant personal anecdote: I’ve been diagnosed with major depressive disorder and generalized anxiety disorder for a decade. I’ve seen three therapists, a psychiatry PA, three psychiatrists, been hospitalized, and taken more combos of antidepressants and anxiolytics than I can remember and, quite frankly, most of that was fruitless. I still take Paxil and Klonopin but I have questioned for quite some time how much good, if any, the first does (the second does help me sleep better).
TBH, cannabis and alcohol have done far more to help me cope than any of my prescriptions and therapies have. I have a loose hypothesis that much psychological distress/mental illness could be resolved, or at least significantly relieved, by structuring society so that it serves human needs rather than profit for capitalists.
Salty, do you think any disease is real or just the experiences and problems that doctors use their labels to describe?
In very many cases the exact opposite of this is true. Recognising that your mental illness is an illness like any other, treatable with medicine (sometimes, to some degree, like any other illness), no more your fault than if you had asthma or eczma, nothing shameful, nothing to be hidden can be enormously liberating. It is your idea that their condition is in some way imaginary, that they should be able to free themselves from it if they just made the right sort of effort (with support) that immiserates, that makes people ashamed of who they are instead of being able to deal with what they’ve got.
We’ve been here before.. There used to be a prevalent view that cancer was a manifestation of the character faults of the sufferer and it was shameful even to mention. Remember whispers about the ‘c’ word? Shaking off that absurdity enormously helped millions of cancer sufferers even if it did not cure them.
SC, #11
Haha.
SC #15,
Is this your actual alternative model of mental illness? If so, it sounds disturbingly (and ironically) close to some of Freud’s more discredited theories, not to mention Dianetics. My personal mental illness is not a defensive reaction to my experience of the world; it is a deep part of my mental function, and how my mind works, which nevertheless causes me a lot of difficulty and discomfit, and is therefore treated (more or less successfully) as a disease.
WTF?
***
It’s not a joke. Did you read my links at #10? Did you read the quote from NIMH head Thomas Insel in my post and here? (“His psychiatric colleagues, [Insel] said dismissively, ‘actually believe [that the diseases they diagnose using the DSM] are real. But there’s no reality. These are just constructs. There is no reality to schizophrenia or depression…we might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things[’].”*)
There’s no disease of schizophrenia.
(Let’s leave aside for the moment that “there is a disease of schizophrenia” is the positive claim here, and not “there is no disease of schizophrenia.”) Try to imagine that you had no preexisting belief one way or the other. I have to think you’d find strong evidence against its existence in the facts that:
– no biomarkers or pathophysiology has ever been found for “schizophrenia” or any of the alleged disorders/diseases listed in the DSM
– The present and former heads of NIMH and the APA (which produced the DSMs and has, alongside pharma, perpetuated the myth) have publicly admitted that no biomarkers have been found and that the “constructs” have no scientific validity
– the construct of schizophrenia and the others have also consistently demonstrated low reliability over several decades
– although the latest DSM was hoped to be based on solid biology, since none has been discovered, no biological markers or pathophysiology appear there, just like in previous editions; the diagnoses are purely descriptive, based on self- or other’s reports of experiences and behaviors
– there is extensive historical evidence (provided best by Joanna Moncrieff) showing how “antipsychotics” were originally promoted as means to control people in institutions who were in extreme states, and they were understood as drugs, in terms of sedation and suppression; it was only after drug companies and psychiatrists realized that they could backwrite a story about a disease from the chemical workings of the drugs – they act on dopamine receptors, so schizophrenia must be a problem with dopamine receptors! – that they started claiming the drugs as “medications” to treat a “disease” (once again, no evidence exists for a dopaminergic or any other neurological dysfunction in people labeled as “schizophrenic” under any definition vs. controls)
– the largest studies have shown the effectiveness of “antipsychotics” long-term to be absolutely dismal
– the brain shrinkage and other physical problems and degeneration that were claimed to be symptoms of the “disease” are increasingly recognized to result from the drugs themselves, and the ways the drugs cause these serious problems are well understood
People’s experiences are entirely real, but there’s no disease of schizophrenia, and the drugs are a public health catastrophe.
*I’ll note once again that Insel remains a True Believer, despite the lack of anything to show from decades of attempts, in the idea that biological causes for these problems will one day be found, even if it takes decades.
@ SC, #15
Ah, here it is. Finally we have your theory on what psychiatric illnesses are and it’s bunk. If you think it’s difficult finding biomarkers for that correlate with psychiatric symptoms, good luck finding “experiences” which are reliable predictors, especially with illnesses that emerge in childhood.
Quick follow-up:
Your cherry-picking of the evidence became obvious after I followed up on just one item from you list of evidence. The claim that a Dutch study by Wunderink et al. “invalidates” all antipsychotic therapy. With just a cursory search, you can find that the study actually shows that certain drugs that are effective for acute symptoms do not need to be maintained after initial treatment and the scientists who did it cite their understanding of the dopaminergic receptors in the brain (i.e. biology) as part of the rationale for this refinement of the standard of care.
source: http://www.medscape.com/viewarticle/807894#vp_1
That’s right, those voices you are hearing that are destroying your life? Your defensive response to the world. Stop being so defensive. Pull yourself together. Bye!
nrdo, stop being a spoilsport by actually looking at the science! Biology indeed!
Is this a joke? Has thinking about these problems really become so warped that the idea that childhood physical, sexual, and emotional abuse, or poverty and economic insecurity, or discrimination and oppression, for example, are strongly linked to psychological suffering is seen as “bunk”? If so, I fear that reclaiming and developing a humanistic approach amid the fall of biopsychiatry will be a hard struggle. This is very sad.
Salty you are talking nonsense. Some mental disease seems to be rooted in trauma and some isn’t. Trauma can damage organisms but isn’t the only thing that can damage organisms so that should not be a surprise.
As hard a struggle as a humanistic approach to the treatment of asthma or athletes foot. God protect you from your own quackery.
That was not my claim. My claim was about the long-term use of the drugs, drawing on both the Harrow and the Wunderink studies and in light of Moncrieff’s drug-centered model, and the fact that the authors of these studies continue to believe in the biopsychiatric model is irrelevant (if anything it’s relevant in the other direction). But I remain amazed that people think they can google up some MedScape article – your link is borked, by the way – that will refute my arguments while refusing to read the books that cover years of research by experts (I have to wonder if you even read the articles at my link @ #20 under “largest studies” if you’re so confused about what I’m even saying).
I’m not going to respond to any more random, decontextualized links to MedScape or the like. In fact, I think I’m done here. It’s become a mix of namecalling and abuse, ridiculous disingenuous questions, and alleged “refutations” from Google U. I think I explained/clarified my arguments well enough above and in the other thread, and think it’s unproductive to subject myself to this any longer. As I said in the other thread, my expectations are very low at this point. If just a couple of people take the time to read a couple of the books, I’ll consider that progress.
You have a weak grasp of logic.
Says the person who wrote: ‘the fact that the authors of these studies [which I quoted to disprove the relevance of the biopsychiatric model] continue to believe in the biopsychiatric model is irrelevant’.
@ SC
I posted the follow-up to illustrate your cherry-picking of that particular study, not to support a broad case for or against anti-psychotics. Several of the quotes on your website (by you and one Robert Whitaker) go way beyond what the authors reported, and I called you out on it.
In the course of Medical Research, it is to be expected that studies will emerge indicating that treatments don’t work as well as originally thought or, more often, that they work but in a more limited scope. This is how science works properly. It is a classic denialist tactic to focus on these corrections and then insinuate that the whole endeavor is false.
“I think I explained/clarified my arguments well enough above and in the other thread, and think it’s unproductive to subject myself to this any longer.”
You haven’t. I started your post as a fence-sitter who suffers from long-term depression. I now am fairly certain you are a dangerous crank I would be better off ignoring.
It’s interesting that almost every single point SC is trying to make about mental illness applies equally well to cancer. Cancer has no consistent biomarkers, no consistent pathology or progression, the treatments have horrific side effects that are sometimes not adequately disclosed, the pharmaceutical industry makes tons of money off of it, and so on. So does cancer not exist either?
Please just stick the flounce, SC.