Sep 17 2013

More On Mental Illness Denial and How Not to Argue

I recently came across a critique of a prior post of mine on the DSM-V – Mental Illness vs Normal Behavior. The critique is by Philip Hickey, a retired PhD psychologist, on his blog Behaviorism and Mental Health – An alternative perspective on mental disorders.

Hickey disagrees with my defense of psychiatry, which he seems to equate with an extreme “medicalization” approach to life problems. In his response, however, he does not actually address my position, as I very carefully laid it out. Instead he attacks a series of straw men – characters in a narrative that he apparently already has well established in his mind. This narrative creates a very thick filter distorting his view of my position.

Hickey summarizes his position early on:

Now, for me, this is fairly obviously true and is borne out by the facts.  Psychiatrists who talk in terms of “diagnoses” and “chemical imbalances” etc., do in fact ignore causal factors such as abuse, poverty, and social deprivation.  They call their clients “patients” and they routinely tell these “patients” that they have “an illness just like diabetes” and that the pills will fix their brain chemistry.

He states as a fact that psychiatrists ignore “abuse, poverty, and social deprivation.” That is his premise, and he will not be dissuaded from his premise regardless of what I write. He dismisses my characterization of what is typical of psychiatry in favor of his own, but his distortions of my position (even right after quoting paragraphs from my post clearly stating what that position is) do not fill me with confidence in his perception.

I acknowledge it is difficult to provide solid evidence for what psychiatrists “typically” believe. In general when I talk about the standard within a profession, I am talking about the standard as established by official publications, academics, and published standards, not the average private practitioner “in the field.” Hickey, however, seems to prefer the “in the field” approach.

I have had much direct contact with psychiatrists, as a student and then as a colleague, and I am basing my impressions on that exposure. Also, however, reading articles written by psychiatrists is probably the best indication of what the profession generally believes. I never – ever – encounter Hickey’s extreme straw man, that all mental disorders are caused by underlying brain dysfunction and chemical imbalances, ignoring environmental factors. Hickey consistently confuses “sometimes” with “always” in this regard – even when I explicitly state the sometimes.

For example, he states of my position:

Dr. Novella delineates the two extreme responses to his essential question:

- those who consider human problems to be part of the normal spectrum

- those who medicalize all human problems

Dr. Novella then expresses the opinion that the best approach is something “in the middle:”  “…before you can recognize the abnormal you have to recognize the full spectrum of what is normal.”  He goes on: “…we need to recognize the full spectrum of human nature, accept less common and atypical forms of human mood, thought, and behavior, and also recognize the relative roles of biology, situation, and culture (and their interactions) in forming a person’s mental state.”  Now this is all fairly good stuff.  It certainly is a far cry from standard psychiatry, and you might actually be wondering if Dr. Novella is a closet “denier.”

I disagree with his assumption that the position I described in “a far cry” from standard psychiatry. My position is partly the result of my education at the hands of psychiatrists. Notice how he also confuses the nuanced and scientific position that I describe with the “denier” position. Hickey continues by quoting another paragraph from me:

“On the other hand, the brain is an organ, it is biology, and it can malfunction biologically just like any other organ. Further, even a biologically healthy brain can be pushed beyond tolerance limits resulting in an unhealthy mental state. We can reasonably define “unhealthy” in this context (probably a more appropriate word than “abnormal”) as follows – a mental state that is significantly outside the range of most people, may represent the relative lack of a cognitive ability that most people have, and results in definable harm. That last bit is critical – it has to be harmful.”

At this point my position should be very clear – I carefully define “mental disorders” and explain that they are caused by the full spectrum of influences from biology to social and environmental. Further, I explain that definitions are complicated and unavoidably subjective when dealing with something as horrifically complex as human behavior. This does not preclude a working definition of “disorder” that allows clinicians to identify, discuss, and treat problems of mood, thought, and behavior.

Hickey neither acknowledges nor addresses my actual position, even after directly quoting it. Instead he takes one piece of it, (quoting from myself again) “On the other hand, the brain is an organ, it is biology, and it can malfunction biologically just like any other organ,” and creates a straw man out of that. He writes:

Dr. Novella goes on to acknowledge that “there is an unavoidable amount of subjectivity in the above definition,” giving the impression that he is a reasonable person willing to concede that the “deniers” might have some validity in their corner.  But he evades the core issue – or at least what for me is the core issue – that although brain malfunction can and does cause problem behavior, problem behavior can and does occur in the absence of any brain malfunction.

The fallacy that Dr. Novella has fallen into is:  A has been noted to cause B.  Therefore every instance of B must have been caused by A.  A lightning strike can damage your TV.  But it would be unwarranted to assume that a lightning strike was the culprit every time your TV malfunctioned.

Hickey is comfortable concluding (assuming, really) that I am just giving the impression of being reasonable, rather than actually being reasonable. I am not evading the core issue – I spell it out explicitly. Hickey just ignores my explanation to erect a blatant straw man.

I never wrote or implied that all mental disorders are caused by brain malfunction. In fact he wrote that right after quoting me as saying:

“Further, even a biologically healthy brain can be pushed beyond tolerance limits resulting in an unhealthy mental state.”

I don’t see how this can be misinterpreted. I state directly that a biological healthy brain can be pushed into an unhealthy mental state by extreme circumstances. Yet, Hickey characterizes my position right after quoting me as being the opposite. He flays this straw man for a few more paragraphs, then tries to do it further by critiquing my characterization of ADHD as a deficit of attention:

(summarizing my position) Brains and parts of brains malfunction.  Parts of brains are dedicated to paying attention.  If a child isn’t paying attention, there must be something wrong with those parts of his brain.

But the reality is more complicated.  Children (and adults) are always paying attention to something.  The point about ADHD is not that the child is inattentive, but rather that he is not paying attention to the things that he needs to attend to.  Everyone knows that playing is easier than studying.  Doing what we like is easier than working.  A child will generally not pay attention to the latter items unless he has been actively trained to do so.  Absent this training, he does whatever he likes and consequently attracts a “diagnosis” of ADHD.

Yes – the reality, and my position, are more complicated that your straw man. Notice what he does here. I am clearly stating that mental disorders generally are caused by some combination of biological and environmental factors. He distorts this position into saying that my position is the extreme version of the “brain illness theory of the so-called mental illnesses.”

He then states that the reality is more complex, and then states an extreme non-biological theory of mental disorders. To be fair, he does also state:

“Nobody is denying that brain problems can cause behavioral problems.”

But I disagree. There are those who do deny that brain problems can cause behavioral problems. I have had many a debate with those who take that position. I will, however, take Hickey at his word that he is not such a person. He acknowledges that brain disorders that cause behavioral problems exist (I would add mood and thought disorders also) but does not seem to want to label such brain-caused behavioral problems as mental illness, and rejects the “disease model” of such brain problems.

In his one example, however (responding to my position on ADHD) he takes a position that is not supported by evidence and seems to be an extreme environmental position. He is saying explicitly that ADHD results not from a brain disorder (a decrease in activity in that part of the brain which allows us to pay attention, what is called “executive function”) but rather an absence of training – i.e. bad parenting.

This position flies in the face of decades of research which clearly show that ADHD is a genetic disorder characterized by hypofunctioning of the frontal lobes leading to a relative deficit of executive function. This part of the brain serves as a “resource allocator” – allocating brain resources to various tasks. Relative lack of this function results in a reduced ability to pay attention to the things we should be paying attention to.

(It’s difficult to provide a single reference to reflect all this research, but here is a JAMA summary.)

Now, before my position is distorted further, there are of course environmental influences on ADHD, and there is a role for psychological and behavioral interventions. But ADHD happens to be a dominantly biological disorder (that’s just the way the research turned out). Psychiatrists did not assume biology. In fact the “bad parenting” hypothesis was their assumption until the research proved otherwise. It would take a separate article delving into this one issue to do it justice – perhaps a follow up.

Hickey gives an indication of his opinion of such research, however, writing:

But let’s be clear.  Training causes changes in brains.  This is self-evident.  So there are differences between the brain of a disciplined, well-behaved child and an inattentive, self-indulged, misbehaved child.

This is a convenient way to dismiss all neuroscience providing evidence for specific mental disorders having an underlying biological basis. Hickey is falsely accusing those who acknowledge that biology sometimes plays a role in mental disorders of being hyperreductionist – pointing to brain changes and assuming they are the cause, rather than the result or just a marker, of the behavior in question. He writes:

If I were to kick you on the knee, and you asked why I had done this, would you accept it if I replied –”brain chemistry”?  That’s the essence of the brain malfunction theory of mental illness.

No, that is the essence of Hickey’s ridiculous straw man, not any serious position taken by any professional. Researchers do not assume that brain changes are the cause, rather than the result, of the correlating behavior. Neuroscientists speak of “neuroanatomical correlates” and recognize that correlation does not equal causation (although sometimes it can be due to causation).

Hickey further explains his position toward the end of his post:

The deniers’ point, however, (or at least this denier’s point) is that mental illness is an archaic, pre-scientific concept with no explanatory value, exactly analogous to phlogiston or witchcraft.

Wait – but I thought that brain disorders can cause behavior problems? Wouldn’t such a case that Hickey acknowledges exists be considered a “mental illness?” I’m trying to be fair, but such comments certainly sound like mental illness denial to me.

Conclusion

Hickey provides an excellent example of how not to argue or respond to a contrary position. He attacks a series of straw men, even immediately after quoting my position as being very different than the one he attacks.

He accuses me and psychiatrists generally of ignoring psychological factors, assuming all mental symptoms are caused by brain disease, assuming cause and effect from brain correlations, and taking a hyperreductionist approach to brain science. None of this is true – and he provides the quotes that betray his own distortions.

Rather, Hickey is taking an extreme anti-biology position. He pays lip service to the notion that brain disorders do exist and can cause “behavior problems,” which is vastly understating the reality, but then later contradicts that position by calling the very notion of mental illness pseudoscience.

If there is a reasonable position to be made against the concept of mental illness, I have yet to hear it. So far I have only encountered the level of argument similar to or worse than Hickey’s unfair and confused article. I am open to any reasonable argument to be made against my current position. That would require, however, engaging with my actual position, not a distorted cartoon of my position.

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187 responses so far

187 Responses to “More On Mental Illness Denial and How Not to Argue”

  1. Charcoton 17 Sep 2013 at 9:00 am

    I currently work in the mental health field (not a psychiatrist) and am daily “in the field” with both psychiatrists and patients with serious mental illness. I also read a lot of what comes out in research and academia. I can support Hickey on one aspect of his article, even though this is not exactly his point.

    There is a huge gap between the knowledge base in psychiatry and what goes on in the street in psychiatry. I have encountered all too many psychiatrists who are, frankly, clueless about anything other than how to prescribe medication. They have no idea how abuse, neglect, and various other environmental factors contribute to mental illness. And further, no idea how to handle it clinically. Or, if they have an idea, it does not find its way into their practice. So, in this respect Hickey is correct in that treatment in the real world can tend to be too medicalized.

    And I am neither anti-psychiatry nor anti-medicalization, I am disturbed at the way the research-based knowledge available in this field is not finding its way to the street level. If this were, say, cancer treatment, this gap would not be tolerated.

  2. oldmanjenkinson 17 Sep 2013 at 10:48 am

    # Charcot, that sounds very anecdotal and not based on any evidence. I (in my professional experience) do not see a “huge” gap between knowledge base and what occurs in practice. Then again this is based upon my professional experience and is wholly anecdotal and not “real” evidence.

    I have found the psychiatrists I work with to be very knowledgeable of the social factors that contribute (both positive and negative) to mental illness. That is not to say all practicing psychiatrists take these factors into account but I would not go so far as to generalize to all psychiatrists based upon my professional interactions (which is limited) to a small number of practitioners in this community. This is to use the same argument Dr Hickey uses.

    As well he (Dr Hickey) is not a psychiatrists so I might be so bold as to presume that Dr Hickey would find it vexing if a psychiatrist would take it upon themselves to vent what they felt the shortcomings of psychologist are.

    Also when some one makes the statement “And I am neither anti-psychiatry nor anti-medicalization,” the truth is usually the opposite. This is (to me) the same as “I don’t mean to be rude” when a person is about to be “rude.” Statement to the prior does not affirm the latter.

    Dr. Novella is very knowledgeable about the human brain. I would go so far as to say his training gives him a deeper knowledge base of the human brain and its functions. If you have read Dr. Novella’s postings I believe (in my opinion) you will see his (Dr Novella) position is that a combination of organic as well as environmental factors influence mental illness.

    This of course is my opinion, wholly anecdotal and not “evidence” of anything.

  3. Bruce Woodwardon 17 Sep 2013 at 12:06 pm

    Charcot and oldmanjenkins,

    I really think the degrees of how much mental health issues are over medicated has a lot to do with where you actually are. I know that the council area I work in, in Scotland, is very good and the doctors I know have a very good understanding of mental health issues that align very much with Steve’s position.

    On the other hand, I have a very good friend who practices in France (he is an iatrist and an ologist) and he says there is a culture of just prescribing amongst the psychiatrists there.

    That is not saying that all Scottish psychiatrists are brilliant and all French are rubbish… it just illustrates the fact that different territories will have different results when looking at the general health care and culture.

  4. Steven Novellaon 17 Sep 2013 at 12:07 pm

    Yes, it’s not much use playing “dueling anecdotes.” One thing is clear and documented – the standard of care and the academic culture within psychiatry displays a thorough and nuanced view toward the various causes of mental disorders, including the demarcation line between disorder and normal variant, and various approaches to classification. Anyone who addresses these issues needs to recognize and address the academic standard.

    If you also think that there is a disconnect between academia and private practice, that is a separate issue that needs to be addressed. I agree there is a gap – there always is (in medicine in general) – the only question is how wide is this gap. This conversation is best had in the context of actual evidence, rather than anecdote.

    It is disingenuous, however, to use one’s personal and anecdotal assessment of the culture of private practice as if that represents the profession of psychiatry. That is exactly what Hickey does.

  5. Kawarthajonon 17 Sep 2013 at 12:12 pm

    I have to admit that I used to question whether mental illnesses were real categories, believing instead that it was people’s experiences (i.e. abuse, neglect, exposure to violence, trauma, accidents, illnesses, poverty, etc) that were the cause of the so-called “diseases”. This was back when I was green, fresh out of university and, to be fair to myself, all of the clients I worked with had horrible childhoods, so it made sense to me.

    I now have a different and more refined perspective – mental health is about resilience. Some people are born with a personality and biology that is more resilient than others. When you look at multiple people experiencing the same events (i.e. children growing up in an abusive or neglectful family), I find that each child copes with the abuse or neglect differently. Those who are pre-disposed to have mental illnesses or addictions have a much harder time coping with difficult experiences. These difficulties translate into various problems later in life, like poor performance at school, trouble in relationships, addictions, criminal charges, etc. Even when children grow up in a relatively healthy family (lets face it, no family is perfect), some grow up to be able to cope with life, while others don’t. People with mental health issues are less resilient and need more support when dealing with life’s challenges (i.e. divorce, loss of job, retirement, death in the family, etc.), whereas others remain able to function and relatively positive no matter how many difficult things happen to them. I believe that resilience is a trait that people are born with, although there are many environmental things that can seriously affect a person’s resilience (i.e. brain injury). Mental illness is one of the things that can impact resilience, but not the only thing.

    The role of a psychiatrist in our area is to focus on the medication aspect of treatment. They leave the counselling and psychotherapy to people like me, although they almost always (in my experience) take into consideration a person’s history (both family history and personal history) into account when dealing with their patients.

  6. pdeboeron 17 Sep 2013 at 1:06 pm

    “Training causes changes in brains. This is self-evident.”

    Is it really? Define changes for me. Could experiences cause changes in the brain? Would this then be a mental illness if it is a harmful change?

    Am I being over reductionist in saying that all of this is in your brain? The malfunctions Hickey admits are real mental illnesses are just those well documented by neuroscience. Could the some of the ones he dismisses as environmental yet be reduced to the neural level?

    Sorry if I’m off base, I’m not in the medical field in the slightest.

  7. Lukas Xavieron 17 Sep 2013 at 1:13 pm

    I’ve recently been in contact with the psychiatric profession and I can honestly say that I don’t recognize Hickey’s description at all. Through four doctors (one GP and three psychiatrists) I kept hearing the same thing:
    “Well, we can offer you some pills and they might help things along in the short term, but what you really need is therapy.”

    Granted, it’s just one experience, but you can chalk me up as a data point against the “psychiatrists think that pills fix everything” hypothesis.

  8. Charcoton 17 Sep 2013 at 1:13 pm

    Okkk, I guess if experience in a field is considered not something that can be used for discussion purposes, this is not the place I thought it was. My interest is in helping the mentally ill, educating about mental illness, and attempting to exact some change so that people with serious mental illness can be treated more effectively. I don’t have the time or the money to do a peer-reviewed study before I throw out my observation that what we know and what is applied in this field on the street is quite out of synch. I leave that to academians. I’m in the trenches, and deal with this gap and trying to bridge it in the interest of my patients on a daily basis.

    Apologies for stepping on any toes or goring any oxen.

  9. oldmanjenkinson 17 Sep 2013 at 1:16 pm

    # Bruce Woodward I agree. Even in my area there are practitioners who take a biopsychosocial approach to approach to their treatments. I also have patient’s who’s practitioners are more medication focused with regards to their approach. This is true of my other colleagues around the country as well. Geography in my experience has shown to have little to do with style and approach of psychiatrists.

    # Steven Novella I was just attempting to show # Charcot that anecdotes are irrelevant in proving one side or the other and I appear to have failed miserably :( . Anecdotal is akin to eye witness. There is too much subjective and not enough objective. And I agree there is a gap but I think (in my opinion/estimation) that it is not the chasm portrayed by Dr Hickey and # Charcot. I had the luck of working with a department in my schooling for which the professors where also in private practice so there was no disconnect. There were differences in “style” but they where scientists as well as practitioners.

    # Kawarthajon From working with my patient population, they (the patient’s) embrace their “physical” conditions and not their “mental” conditions as though there was a difference. The brain is an organ just like anything else and can be affected by ones environment as well as predispositions and organic syndromes. I know that there are stars such as Glenn Close with “BringChange2Mind” in order to de-stigmatize mental illness. And you are on target with resilience. I work with the strengths perspective and this has been shown to be effective in subjective observations (patients perspective of its effectiveness) as well as objective observations (research). And this is what I have seen as well with regards to psychiatrists role as the medication manager, and then a referral is sent to a licensed clinical social worker, licensed mental health counselor, or psychologist for the therapy. With those referrals to LCSW’s, MHC’s, or psychologists coordinating services with the psychiatrists for a patient centered focus.

  10. petrossaon 17 Sep 2013 at 1:21 pm

    Still, all things considered, it is impossible to prove definitively psychiatry ever healed anyone. Suppressing symptoms doesn’t count as healing imho. Using the same fuzzy tests based on observational cardhouses in the diagnostic manuals to check for a ‘disorder’ and its ‘healing’ is nothing more then circular logic.

  11. oldmanjenkinson 17 Sep 2013 at 1:45 pm

    # petrossa I think it would depend upon what is defined as “healed.” If by “healed” you mean to assist the person in effectively coping with whatever the condition/symptoms is/are so that the person is not unable to participate in life (personal, professional, etc) secondary to the symptoms (whatever those are defined by the person to be) severity then that is one thing. If by “healed” you mean the “condition” is “gone” then that is another. And I think the person who’s symptoms have been “suppressed” might consider the first “definition” of “healing” to in a sense to be a “cure.” And if you could elaborate on what you mean by “circular logic” related to “disorder” and “healing.”

  12. The Other John Mcon 17 Sep 2013 at 2:43 pm

    # pdeboeron: “Training causes changes in brains. This is self-evident.” You then asked “Is it really? Define changes for me. Could experiences cause changes in the brain?”

    Imagine someone who can’t speak Chinese. Then they learn how. Where did the learning occur? Some change obviously happened, this is self-evident (they couldn’t speak Chinese, then they could!). The learning didn’t really happen in the lungs, mouth, foot, or a nearby rock. What happened was information was stored/processed/modified in the brain (patterns in neuronal interconnections). This changed happened, and it happened in the brain. Self-evident, right?

  13. petrossaon 17 Sep 2013 at 2:55 pm

    #oldmanjenkins That is a very nice ‘if then would could should’ post. Obfuscation is an art. People are ‘healed’ by the strangest things, like Lourdes, Homeopathy, whatever.
    To my mind the largest part of the ‘psychiatry’ effect is due to the placebo effect of someone ‘in charge’ listening+various drugs.

    Redefining healing to fit your narrative is not changing very much to the fact you cannot prove empirically that people get healed by psy interventions since the disorders aren’t based on science nor are the treatments. Except symptom depressing drugs. Which are made by scientists.

  14. locutusbrgon 17 Sep 2013 at 3:28 pm

    “In his one example, however (responding to my position on ADHD) he takes a position that is not supported by evidence and seems to be an extreme environmental position. He is saying explicitly that ADHD results not from a brain disorder (a decrease in activity in that part of the brain which allows us to pay attention, what is called “executive function”) but rather an absence of training – i.e. bad parenting.”

    Steve I know your are all over the place dealing with guy’s straw men arguments. Given your expertise and how people will read this post. I though I should identify the complicating factors of ADHD. For example how the executive function deficit can be associated with other physical issues such a speech and hearing issues. Also the co-morbidity diseases are an array of behavioral issues conduct disorders and depression/anxiety. There is some research that shows ADHD may be the originators of these disorders or may be co-morbid conditions.
    Directed deniers will take you simplistic review as confirmation of the earlier straw man. “that although brain malfunction can and does cause problem behavior, problem behavior can and does occur in the absence of any brain malfunction.”

  15. Steven Novellaon 17 Sep 2013 at 3:54 pm

    locutus – I’m sure the deniers will distort everything I write. No way to prevent that. They will take things out of context, no matter how carefully I explain my full position.

    In any case – I don’t think what you are saying is incompatible with my overview. ADHD can be comorbid with other conditions, and is certainly modified by and interacts with environmental factors. This is almost universally true among mental disorders.

    But the deficit that defines ADHD is literally a decreased function in an identifiable part of the brain that is the neuroanatomical correlate with attention – frontal lobe executive function. That essentially defines the disorder. It was a really bad example for Hickey to use to make his case. He should have chosen depression or anxiety or something that is more complex, multi-factorial, and without such a clear neuroanatomical correlate. And really – going back in time several decades and blaming it on bad parenting is very irresponsible and potentially hurtful, in my opinion.

    Petrossa – requiring a clear definition of “healing” is perfectly reasonable. It sounds like you are rigging the game – defining “healing” arbitrarily in such a way that it excludes mental disorders a-priori. Further, you claim that homeopathy heals? You’re poisoning your own well.

    charcot – I did not mean to imply your observations are not welcome, rather just that they will not settle anything. Obviously there is a range of experience, and no one here can say what they mean – is it geography, quirky experience, biased perceptions?

  16. oldmanjenkinson 17 Sep 2013 at 4:04 pm

    # petrossa I apologize I was unaware I was confused.

    By including “homeopathy” as a device one is claiming to be “healed” with mental health services is quite the logical gymnastics. Are you equating the two you have listed (Lourdes, Homeopathy) with mental health services? And by “strange” are you implying unscientific, and implausible as with Lourdes and Homeopathy?

    My question still stands. By what definition are you operationalizing “healed?” By what evidence do you state “To my mind the largest part of the ‘psychiatry’ effect is due to the placebo effect of someone ‘in charge’ listening+various drugs.” Is this based upon opinion or evidence based research? Am I to understand your belief is that psychiatry is about listening and various drugs?

    I feel a strawman coming on with this statement “Redefining healing to fit your narrative is not changing very much to the fact you cannot prove empirically that people get healed by psy interventions since the disorders aren’t based on science nor are the treatments. Except symptom depressing drugs. Which are made by scientists.” I am not re-defining anything. I am simply asking by what definition you mean “healed?”

    By what evidence do you state “the disorders aren’t based on science nor are the treatments.?” While some modalities are not based upon scientific research nor valid you appear to imply that all modalities have no validity or reliability nor scientific research to back up claims of efficacy.

    I am quite certain you are not a fan of the mental health field but would wonder by what training/discipline you have come to this conclusion, and by what research do you reference these opinions?

  17. oldmanjenkinson 17 Sep 2013 at 4:13 pm

    # The Other John Mc And also very interesting in AD/Dementia research in which a person learns multiple languages in their life time, as their memory deficits go from short term to long term they “lose” the ability to speak anything but their “native” language. Some going so far at to speaking nonsensical neo-words which have only meaning to the speaker and not the recipient.

  18. wbiskiton 17 Sep 2013 at 6:13 pm

    I recently became quite fascinated in psychology and started reading a few books and I found surprising how fractured the area is especially over nature/environment and thats without adding psychiatry into the debate. One author from a psychoanalysis (bit unscientific in my very humble, layman’s opinion) background can completely contradict another from a different school of thought. I guess this is a similar argument though not a very good one from Hickey.

    On a different note can anyone recommend an intro book in regards to neuroscience and neurology? I couldn’t tell you the difference between an axon and a neuron.

  19. Bruce Woodwardon 18 Sep 2013 at 7:23 am

    /aside

    I always shudder when someone says they “started reading a few books” on something.

    Not implying you are doing this at all wbiskit, but what usually follows is an opinion made on very basic heuristics in that field that are not actually relevant at all at the deeper level. Being skeptical of your own understanding is always the hardest part especially when new information is involved. I find most people think a few books gives them the authority to debunk years of research and scientific consensus because of one “what if” thought that is not explained properly in one of the books.

    Neal Adams anyone?

    /end aside

  20. oldmanjenkinson 18 Sep 2013 at 11:00 am

    Very true # Bruce Woodward. I have a large library (thank you Kindle) of books I have read regarding critical thinking, logical fallacies, as well as how are brains are programmed to be deception engines. Some of the books give me a cursory understanding of other disciplines but my training is in the mental health field. Not to say that one cannot gain a great deal of knowledge of other disciplines by reading books, just that to go along with books must be a component of training in the field of the discipline to be able to appropriately apply that knowledge in practice.

    I think the better our understanding is of how biology plays a greater role in our cognition than we would like to believe, the better chance we have to recognize our tendency/propensity for faulty logic.

    To be able to recognize when we have become credulous and dogmatic in our thinking in my opinion is key. To recognize the difference between valid reliable evidence and our own personal beliefs/life experiences and how those beliefs/experiences can muddy the water of comprehension so to speak. To be able to ask ourselves when valid/reliable evidence is presented, why one person or another might not be able to let go of older outdated evidence. I have come to accept that through evolution by brain is biologically programmed to comprehend a certain way. Because of this I practice critical thinking skills by reading professional journal articles, attend seminars, continuing education etc.

  21. petrossaon 18 Sep 2013 at 12:14 pm

    #oldmanjenkins I have Asperger and my main obsession has always been the brain and everything around it. Although admittedly the jargon is tiresome to learn, it doesn’t take that long to learn the lingo. I started reading the subject about 40 yrs ago and never stopped. I can safely say i read more then the average professional and due to my intellect even managed to understand it.
    Thanks to my very good retentive memory, (earlier eidetic memory, which fortunately calmed down a bit, thank you alcohol) my capacity for out of the box thinking it was fun and rewarding.

    So this conclusion is based on 40 yrs of intense, almost obsessive, study. It is correct and inescapable. Psychiatry is based on a model of the human mind which is not valid. Thus the disorders found are not valid, thus the interventions aren’t.

    That’s my opinion, and that is what you’ll have to learn to live with.

  22. Hosson 18 Sep 2013 at 12:51 pm

    #petrossa

    What is not valid about the current neurological model of the brain/mind, or would you prefer to just assert it’s not valid? I’d ask for the studies you’re getting your information from, but I tend to think that 40 years of intense studying was nothing more than 40 years of conformation bias mostly reading books and articles from psychiatry deniers, while irrationally dismissing valid counter-arguments. If I’m wrong, please put forth the evidence for you position.

    “That’s my opinion, and that is what you’ll have to learn to live with.”

    I do not have to learn to live with it. I will always speak out when I hear unsound reasoning. And if that person does not stop making the same non-sequitors after I explain why they are invalid, I’m going to make fun of that person. Perhaps not the most effect method, but certainly an entertaining one(at least for me).

  23. The Other John Mcon 18 Sep 2013 at 1:24 pm

    #petrossa

    How do you know you have Asperger? I’m not trying to be facetious or impugn you. But how do you know *scientifically* that you do, in fact, have it? You claiming you have Asperger is at odds with your previous claim:

    “you cannot prove empirically that people get healed by psy interventions since the disorders aren’t based on science nor are the treatments”

  24. oldmanjenkinson 18 Sep 2013 at 1:39 pm

    Reading books makes one no more an authority than counting change makes anyone an accountant. It is through rigorous studies, training, fellowships etc that one gains the applied knowledge necessary to interpret the data. And once a person begins their career, the studies/training do not stop. I would no more accept a person who is “well read” on pipes as an authority on plumbing than I would some one who was “well read” on neurology to be a brain surgeon.

    While the comprehension level of the “well read’ individual might have a higher level of understanding, this does not qualify them for anything. There is a lot of information out there regarding the brain, mental illness and the like. It takes studies, training, and skill not just knowledge to be able to critically analyse what is valid/reliable and what is not in the way of information presented.

    Intellect also does not qualify a person to a particular discipline. I have met many a lettered individual in one particular study who hasn’t the slightest idea about another. And whilst you posit that “It is correct and inescapable” neither qualifies nor provides as evidence your position that “Psychiatry is based on a model of the human mind which is not valid. Thus the disorders found are not valid, thus the interventions aren’t.” This is an argument from fallacy. Denying the antecedent provides no validity to your position. That however does qualify your statement as circular logic.

    And while this may be your “opinion” you did come to a SBM blog and post. Given the type of blog this is you should expect people not to take a persons words as evidence. Science is not a democracy nor is it based upon opinions. Reliable and valid evidence is required. And as you have provided no evidence to your opinion, it shall stay as that, an opinion which in science neither quantifies nor qualifies your post.

  25. The Other John Mcon 18 Sep 2013 at 1:41 pm

    #petrossa

    You also said “Using the same fuzzy tests based on observational cardhouses in the diagnostic manuals to check for a ‘disorder’ and its ‘healing’ is nothing more then circular logic.”

    Which would be true if there weren’t an objective reality we can point to, to ground all of this in. Observable, empirical data (self-reports, overt behavior, physiolgocal/biological markers) are used to build the foundation for it all, so it’s not necessarily a house of cards or a castle in the sky. The diagnostic manuals were not made out of thin air, they were constructed based upon observations of reality (which symptoms appear to cluster together into a ‘disorder’).

    Like Hoss said, point us to some empirical data that people cannot or do not get ‘healed’ by any sort of PSY interventions, ever, relative to placebo.

  26. oldmanjenkinson 18 Sep 2013 at 1:50 pm

    I was diagnosed with asthma 43 years ago. While this does give me a subjective perspective about “my” asthma, this does not qualify me as an authority on asthma. If anything this hinders my critical thinking as I will have a more difficult time being objective as it relates to asthma evidence. I will lack the capacity to fully separate my personal bias from the evidence presented.

    That being said, I recognize this bias and do what I can to circumvent my biologically predisposed brain.

    As # Hoss stated we do not have to live with it. We will acknowledge ones opinion but then require evidence for that opinion to determine what logical (or illogical) path was taken to come to that opinion.

  27. The Other John Mcon 18 Sep 2013 at 2:00 pm

    Here’s a really great review on the topic of validity and effectiveness in psychiatry (probably the most comprehensive and even-handed that I’ve seen) that may help you answer some of the questions/concerns you are working through, petrossa:

    http://journals.psychiatryonline.org/article.aspx?articleid=175948

    I’m hoping you can access it without some sort of subscription? If not you can arrange with me to send a PDF of it, let me know.

  28. The Other John Mcon 18 Sep 2013 at 2:38 pm

    A recent comprehensive, meta-meta-analysis of psychiatric medicine effectiveness, and relative to medicine effectiveness in general:

    http://bjp.rcpsych.org/content/200/2/97.long

    Again, let me know if paywall is thwarting your attempts at access.

  29. ccbowerson 18 Sep 2013 at 4:18 pm

    “I can safely say i read more then the average professional and due to my intellect even managed to understand it….
    So this conclusion is based on 40 yrs of intense, almost obsessive, study. It is correct and inescapable.”

    petrossa- Is that a joke? Ignoring who wrote it and the topic, read your quote above. How does that read to you? To me it reads like someone with no intellectual humility perhaps even intellectual hubris. Intellectual humility is a prerequisite for skepticism and critical thinking. Without it a person is vulnerable to motivated reasoning and cognitive biases. 40 years of intense study hasn’t helped you with that.

    ‘That’s my opinion, and that is what you’ll have to learn to live with.’

  30. Bruce Woodwardon 19 Sep 2013 at 4:47 am

    @petrossa,

    I am not sure you understand what an eidetic memory is and what it implies. Ccbowers has a point regarding humility, and I would add that intellect does not automatically imbue critical thinking skills; in fact just a couple of articles back in this very blog there was a post on how intelligent people will be more likely to read data in a way which bolsters their own idiologies.

    Never mind “Thinking outside the box” is one of the most banal and annoying management speak refrains along with “blue sky thinking” and “touch base”.

  31. BillyJoe7on 19 Sep 2013 at 9:06 am

    Just to put everyone in the picture….

    Petrossa believes that humans with autism of the high functioning variety are a superevolved form of human being and that these superevolved forms will be essential to the survival of the Earth.
    No emotion. Pure objectivity.
    He considers himself to be one of these superevolved forms.
    “I have Aspergers” is his badge of honour and his “superior intellect” his coat of armour.

    I think he’s rather cute, but that’s just me emotionalising.

  32. ccbowerson 19 Sep 2013 at 10:38 am

    “He considers himself to be one of these superevolved forms.”

    Why do these super evolved forms lack critical thinking skills and intellectual humility?

    Paraphrasing petrossa:

    ‘Hey guys, I’m really really smart so trust me. I’ve looked into it, and psychiatry is a scam. You’ll have to deal with that fact. You’re welcome.
    P.S. Did I mention how smart I am? It’s true’

    The Other John MC has a good point. On what basis does petrossa have Asperger disorder if he denies that such diagnoses are scientifically determined

  33. Hosson 19 Sep 2013 at 11:38 am

    Below are excerpts from Petrossa’s blog. I’m sorry the excerpts are so long, but I wanted as much context as possible. Hopefully this will give ya’ll insight into the Petrossa’s thinking.

    BillyJoe, I agree with your analysis after reading his blog.

    http://petrossa.me/2011/04/20/autism-revisited/
    “As having Asperger myself i can with certainty say that based on my own experiences and those of my peers that Autism is a different state of consciousness which presents the world some symptoms making communication difficult.

    This different state of consciousness is obviously hard to describe to someone who doesn’t have it. One can just make an effort similar like explaining a color to a born blind person.

    It is a world where thought patterns are more linear, more straightforward. Events have no emotional compound obfuscating, complicating the interpretation.

    An event gets analyzed on its face value, without interference. Whereas non Autists see the world through the limbic systems filter, coloring the event, Autists in general don’t.

    This frustrates the limbic system to no end. It wants to be heard. I know it’s there, screaming at me, but it’s in a soundproof room. Since this system still has functional control over your hormones it can make life pretty nasty for you. Anxiety/fear is one of the predominant expressions of this frustrated entity. This can in serious cases present itself as tantrums, rage. And that’s what the world at large sees, an anxious person with no or hardly any emotional interaction.

    To me my autism is a good thing. I see it works for me by freeing me from the shackles of the limbic system.

    The medical profession however sees this different, not fully comprehending it, and offers ‘treatments’ designed to make you behave as if you are controlled by the limbic system. More like them.

    But i don’t want to be like them. I want to be me, i don’t have a ‘disorder’. I am different. Not better, not worse. Different.”

    http://petrossa.me/2012/12/09/no-asperger-is-not-a-disorder/
    “IT IS NOT A DISORDER.

    It is a different state of mind, leading to communication disturbances with those who are not blessed with the freedom of mind it gives. We don’t like looking in your eyes because we see the lie. We see the neurotypical playing their games. We see the ape mind staring back at us, through the human eyes. It’s uncomfortable.

    Stop making this a disorder, stop treating it as if we are incompetent. It’s you who are incompetent to handle the apebrain inside pulling your strings. We don’t want to be like you, slaves to a anachronistic primal brain which outlived its usefulness.

    The anxiety we feel is caused by the high stimulation of the environment you created, full of bright lights, loud music and endlessly nattering people. Sure we like to talk, but not about what auntie Bridget did.

    For fuck sake. Stop already.”

    http://petrossa.me/2013/02/13/271/
    “Because Autism is a catchall for anybody with autistic symptoms, so is so diverse it’s totally impossible to say if ANY treatment effectively prevents/heals/lessens TRUE autism. True Autism being a genetic neurological disorder, and DSM defined Autism being whomever passes the DSM autism test. As with most definitions in the DSM, whichever version, the relation between the tests for the definition are wholly based on the assumption that the definition is correct in the first place. Which is a remarkable circular (lack of)logic since the DSM contains mostly observationally based selfconfirming definitions. There is no objective way to determine if they hold water.”

    http://petrossa.me/2013/05/21/dont-call-it-autism/
    “The reason why autism diagnosis rises is because it’s ill defined, the definition describes autistic symptoms not autism. Evidently the profession is rather confused as to what autism actually is. This pollutes the patient base, which in turn makes all research invalid since it’s unknown if participants in studies has autism or only autistic symptoms. This circular logic is the source of present day lack of common cause findings. The common cause is simple, altered white matter in the fetus leads to specific altered neural pathways resulting in a different structure of grey matter due to the neural feedback being directed differently. Which in turn reinforces white matter structures. After birth the job gets finished via environmental input. The origin of this is imho evolutionary try-outs of getting rid of the hindrance of limbic system supremacy in societal living. Where a million years ago the limbic system was perfectly capable to handle all events, nowadays it’s completely outclassed and outdated resulting in negative survival indices. Emotional/limbic reactions are a serious threat to human existence.”

  34. oldmanjenkinson 19 Sep 2013 at 1:29 pm

    “The reason why autism diagnosis rises is because it’s ill defined, the definition describes autistic symptoms not autism. Evidently the profession is rather confused as to what autism actually is. This pollutes the patient base, which in turn makes all research invalid since it’s unknown if participants in studies has autism or only autistic symptoms. This circular logic is the source of present day lack of common cause findings. The common cause is simple, altered white matter in the fetus leads to specific altered neural pathways resulting in a different structure of grey matter due to the neural feedback being directed differently. Which in turn reinforces white matter structures. After birth the job gets finished via environmental input. The origin of this is imho evolutionary try-outs of getting rid of the hindrance of limbic system supremacy in societal living. Where a million years ago the limbic system was perfectly capable to handle all events, nowadays it’s completely outclassed and outdated resulting in negative survival indices. Emotional/limbic reactions are a serious threat to human existence.”

    Anyone else think this was rather a tad tangential? And as he appears to have such a grasp of both the limbic system and autism, should he not publish his findings? It sounds like the ramblings of a manic, or someone who by their own admission has spent 40 years intensely studying the brain, and then mashed all the information together with no understanding, context, or discipline. And by the by, symptoms are what helps to defines a diagnosis. There is a better understanding of Autism compared to even 10 years ago the screening tools are much more sensitive and specific that Autism is recognized as a spectrum disorder. And “The common cause is simple, altered white matter in the fetus leads to specific altered neural pathways resulting in a different structure of grey matter due to the neural feedback being directed differently.” ??? I will contact my colleagues at All Children’s Hospital and let them know of the breakthrough in understanding. I guess I will have to “learn to live” with wondering “healed = ?” Well such is life.

  35. ccbowerson 19 Sep 2013 at 3:55 pm

    “Because Autism is a catchall for anybody with autistic symptoms, so is so diverse it’s totally impossible to say if ANY treatment effectively prevents/heals/lessens TRUE autism. True Autism being a genetic neurological disorder, and DSM defined Autism being whomever passes the DSM autism test.”

    What is this “true autism” he speaks of? If he has some information that no one knows about, he should share it- how does one determine this true autism? The reality is that there is no such test, and that is the reason why the diagnosis is as it is.

    “Stop making this a disorder, stop treating it as if we are incompetent. It’s you who are incompetent to handle the apebrain inside pulling your strings. We don’t want to be like you, slaves to a anachronistic primal brain which outlived its usefulness.”

    First, his description of autism and limbic system is far too simplistic to the point of being incorrect. To say that the limbic brain has outlived it’s usefulness shows a lack of understanding of the brain. He assumes that the fact that he can identify neurotypicals “playing their games” means that he is above it, but everyday I (and pretty much everyone) make similar observations. We may also think these “games” are absurd or are uncomfortable at times. The difference may be- how well can he identify these social cues, and how does he handle these situations?

    He wants to imply that Asperger syndrome is an improvement since it allows for clearer thinking, yet the rage, anxiety, and fear he feels are the same emotions that cause thinking problems for neurotypicals. These emotional states are probably more responsible for thinking problems than any others.

  36. Bruce Woodwardon 19 Sep 2013 at 4:38 pm

    Having worked with kids with autism, I have often felt a deep despair for them… to me it has always felt like they had no way of processing the feelings they were feeling. Like life for them was spent inside their own heads shouting at the world outside completely unable to express those thoughts and feelings.

    Reading Petrosa’s blog is like diving down that well again… such horrible loneliness that we “NTs” could never experience because we are able to connect with others.

    I really do feel for him because no matter what we say here or anything he ever reads or experiences anywhere will turn him from his obsession. He is right in that it is a different consciousness, but he assumes his consciousness is somehow better than ours… and that is the crux of why he will never be convinced otherwise, because he has his own unsinkable rubber ducky right there. He experiences things in ways we will never understand… he conveniently forgets that we experience things in ways he will never understand, and while we try to understand him, he is stuck in a rut and will never be able to move on and will just turn us into big bad demons if we even hint at him being in any way inferior.

  37. SteveAon 24 Sep 2013 at 7:25 am

    Thomas Insel’s Blog. September 16, 2013

    “Over the past 6 months we have turned a corner in our studies of the genetic basis of schizophrenia and autism. For years the field of psychiatric genetics has struggled: family and twin studies demonstrated that these disorders were heritable, but findings from small studies reporting specific risk genes could not be replicated. With larger samples and better tools, we have gone from famine to feast, with almost too many genetic findings to follow up. A new report has just described 13 new genetic findings associated with schizophrenia, resulting in over 100 common variants now identified as risk factors…”

    http://www.nimh.nih.gov/about/director/2013/in-vitro-veritas.shtml

  38. Mlemaon 24 Sep 2013 at 8:20 am

    I don’t like Hickey’s characterization of ADHD. It’s too simplistic. But Dr. Novella’s is just as bad.
    Dr. N says:
    “This position flies in the face of decades of research which clearly show that ADHD is a genetic disorder…”

    Dr. Novella, I think this is very misleading. The genetic studies have been inconsistent. Meta-analysis show some significance to “chromosome 16″. Genome-wide studies have not shown extensive overlap. And, since the disorder labels a wide variety of behaviors, how can we expect any consistency? If one child is labeled adhd because he interrupts his classroom continually, and another is labelled adhd because he’s clumsy and forgets things – and the biggest determinant of a child being diagnosed w/adhd is whether he is among the youngest in his classroom, well, why are we even looking for a genetic component?

    “…characterized by hypofunctioning of the frontal lobes…”

    doc, what does that MEAN? are they not secreting enough smarts?

    “…leading to a relative deficit of executive function. This part of the brain serves as a “resource allocator” – allocating brain resources to various tasks. Relative lack of this function results in a reduced ability to pay attention to the things we should be paying attention to…”

    The “executive function” is a psychological construct. You’re not going to find it or be able to measure its “deficit” in someones brain. You will only find the correlates of what you’ve determined to be dysfunctional behavior. And the judgement of “dysfunctional” is subjective, proven by your use of the word “should”.

    “….Now, before my position is distorted further, there are of course environmental influences on ADHD, and there is a role for psychological and behavioral interventions. But ADHD happens to be a dominantly biological disorder (that’s just the way the research turned out).”

    There’s no evidence that adhd is a biological disorder, except that adhd is a type of behavior, and behavior is mediated by the brain in response to internal and external stimuli. And since the brain is “biological”, if we then decide that some particular behavior is dysfunctional (my spouse always forgets my birthday), then we can say it is a biological disorder, and we may even be able to find how the brain causes it in some science of the future. So what? My spouse has limited hypofunction of the [word for part of the brain that calls up annually recurring socially significant events - frontal lobe executive function? - OMG my spouse is mentally ill!]

    I feel it’s important that we try to understand how to address what we consider problematic behavior in children. We either need to deal with it by re-contextualizing it, or we need to modify it with interventions that don’t risk our children’s physical health in order to improve their so-called mental health. ADHD is the new homosexuality of mental illness. It’s worse though because we’re drugging kids and hindering healthy development.

    Easing ADHD without meds
    http://www.apa.org/monitor/2013/02/easing-adhd.aspx

  39. Mlemaon 24 Sep 2013 at 9:25 am

    found this paper which perhaps offers a possible reason why it might be unwise to mess with young children’s brains just for the sake of “correcting” frontal lobe “hypofunction”

    http://www.sas.upenn.edu/psych/stslab/assets/pdf/STS_CDPS09.pdf

  40. Hosson 24 Sep 2013 at 9:34 am

    #DickSteal and Mlema

    Thanks for the example of how not to argue.

    Selecting evidence that backs your position while irrationally dismissing counter evidence(I do this all the time too, but when it’s pointed out to me…I freaking stop doing it.)

    Modern psychiatry helps many people live better lives. Anecdotal evidence does not trump all the efficacy studies for all the different treatments found within psychiatry.

  41. Hosson 24 Sep 2013 at 1:17 pm

    #DickSteal

    “Irrationally? I was expressing the views of the NIMH and the APA. Anyone who disagrees is anti-psychiatry. So research has shown 100 genes involved? This statement must ring alarm bells in any skeptic or scientist.”

    Most of your statements make alarm bells go off in my head(probably the same for most skeptics).

    You are a denier, and as such, you speak Non-sequitor, which is a language I have no tolerance for.

  42. Hosson 24 Sep 2013 at 2:17 pm

    #Dicksteal

    “Homeopathy and astrology also help many pople feel better. It doesn’t make them scientific medical disciplines.”

    No shit.

    That was not the point I was making.

    You do know the difference between a treatment that has proven efficacy and a treatment with an effect same as placebo, right?

    I think it would be unethical for a doctor to defer treatment of symptoms and/or disorders of mental health issues, which are decreasing the patients quality of life, until medical science provides better information, especially when efficacious treatments are available.

    I maybe slightly presenting some of my statements incorrectly. I’m still new to understanding psychiatry and psychiatry denial, and I’d like to thank you for introducing me to psychiatry denial, specifically right before the last time you were banned from this blog.

  43. sonicon 24 Sep 2013 at 3:15 pm

    There is a claim that ADHD is a genetic disease.

    Has anyone ever been diagnosed with ADHD based on a genetic test?
    Has anyone who has been diagnosed with ADHD ever been found to be not ill based on a genetic test?
    If I were to be diagnosed with ADHD, could I have a genetic test to confirm or deny the diagnosis?

    If ADHD is a genetic disease, I would expect that such tests would exist– perhaps not immediately but eventually. It seems there can be doubt about any such claim of genetics until such tests exists and are shown to be accurate.

    Am I asking too much?

  44. BillyJoe7on 25 Sep 2013 at 12:35 am

    “Am I asking too much?’

    Of course.
    Sometimes there is just a genetic predispostion to a disease so not everyone develops it.
    Sometimes a genetic test takes a long time to develop and its therefore not yet available.
    Sometimes too many genes are involved for there to be a useful genetic test.
    Sometimes there are lots of good reasons to beleive a disease is genetic despite the lack of a genetic test.

  45. BillyJoe7on 25 Sep 2013 at 7:58 am

    Well, yes, okay, I mispelt “believe”, but apart from that…
    Also, “instrumental in getting you banned”? I don’t think so. All I remember is that I reluctantly agreed after the fact.
    Anyway, here you are.

  46. BillyJoe7on 25 Sep 2013 at 8:12 am

    …oh, and it was cwfong, not cc, who felt he could comment on the contents of Krauss’ book without actually reading it.

  47. sonicon 25 Sep 2013 at 11:40 am

    Mlema-
    An inability to control one’s attention could lead to any number of behavioral manifestations.

    BillyJoe7-
    I said–
    If ADHD is a genetic disease, I would expect that such tests would exist– perhaps not immediately but eventually. It seems there can be doubt about any such claim of genetics until such tests exists and are shown to be accurate.
    I understand that if one is looking for reasons to believe ADHD is genetic, there are reasons to believe and of course there can be good reason to believe a disease is genetic despite the lack of genetic test.

    My point is that until such a test exists, one can have doubt that such a test will exist. And if a test will never exist- then one could imagine the reason for that is because the disease isn’t really genetic to begin with.
    Is my reasoning on this faulty?

  48. BillyJoe7on 25 Sep 2013 at 5:13 pm

    sonic,

    One of my points was that there may never be a genetic test for a disease because multiple complicated interacting genes are responsible for that disease. So you cannot exclude a genetic basis for a disease on the basis that there is no genetic test for that disease. Otherwise we would have to continue to doubt that many things, other than diseases, are genetic. Does eye colour have a genetic basis?

  49. BillyJoe7on 25 Sep 2013 at 5:31 pm

    Three of my posts have not appeared here and I’ve just realised that it’s because I included a certain individuals name in these posts.

  50. Mlemaon 25 Sep 2013 at 6:30 pm

    Sonic,

    “An inability to control one’s attention could lead to any number of behavioral manifestations.”

    what is the significance of this statement?
    we are always controlling our attention, just not always the way others might want us to
    did you read the article on development of the functionality of the frontal lobe?

    BJ, so i guess it’s always safe to say “genes didit”?

    If ADHD is subjectively diagnosed, it’s irrelevant whether or not we ever find a genetic link to the behavior. To me it seems unlikely that we will ever find a genetic component for ADHD because it seems that the behavior it describes is linked to developmental rates, and also to societal judgments on what that rate should be, and what behavior in general should be like.

  51. sonicon 26 Sep 2013 at 12:40 pm

    BillyJoe7-
    I am not excluding anything.
    I am maintaining doubt.
    You seem to be demanding ‘no doubt’ when I think there is plenty.

    Mlema-
    I think it is a true statement.
    I don’t know the significance.
    I did read the article about the prefrontal lobes– very interesting. I think kids shouldn’t be taking any drugs for behavioral problems but I realize I’m not objective about that.

    As I understand it from my friend who works with ‘problem’ kids at the local school– if I were in school now, I would be taking fist-fulls of highly addictive poisons everyday. Apparently I am all sorts of things that kids get drugs for these days.

    Perhaps if I had been on the proper drugs I’d be more normal now.
    My friend tells me she’s is glad I’m not, so there you have it. :-)

  52. starikon 26 Sep 2013 at 1:01 pm

    cannotstayaway2013?

  53. Hosson 26 Sep 2013 at 2:41 pm

    Sonic

    I think we can both agree that the evidence for a genetic component of ADHD isn’t strong enough to justify ADHD as a genetic disorder. The diagnosis of ADHD probably has a social component to it. I also think genetics probably plays a important role in ADHD. I freely admit this position is based more on my interpretation of the plausibility of a genetic mechanism rather than the evidence of a genetic mechanism. I also freely admit this line of reasoning leads me to a position that is not necessarily true, so I could very easily be wrong.

    You appear to believe that ADHD is a social construct based on abnormal behavior, which I find to be a very weak argument against the plausibility of ADHD being a genetic disorder.

    To clarify, can you state what you believe causes ADHD or the symptoms (if you prefer to not recognize ADHD as a disorder)? If you do think ADHD is a social construct(or something similar), can you explain your reasoning why that is more plausible than ADHD being a genetic disorder?

  54. BillyJoe7on 26 Sep 2013 at 4:30 pm

    sonic,

    “You seem to be demanding ‘no doubt’ when I think there is plenty”

    You’ll have to quote me because I said no such thing.
    I didn’t even address ADHD specifically
    My point is simply that you cannot exclude a genetic basis for a disease just because there is no gentic test and I explained why.

    “I am maintaining doubt”

    Why is that not a surprise.
    I’m pretty sure you still maintain doubt about heliocentrism.

    “I think kids shouldn’t be taking any drugs for behavioural problems”

    The problem is that, in the USA, these drugs are massively overprescribed
    In Australia, it is difficult to commence a child on behaviour modification drugs. GPs cannot do it. They must refer to a paediatrician who specialises in behavioural disorders and the Paediatrician must apply for a permit to prescribe such drugs and apply for an authority each time they prescribe it.
    However, there is no doubt that some kids need such drugs.
    I can only assume that your experience with kids with severe behavioural disorders is extremely limited.

  55. Mlemaon 27 Sep 2013 at 3:09 am

    Sonic,

    “I think kids shouldn’t be taking any drugs for behavioral problems but I realize I’m not objective about that.”

    Personally, i believe it’s possible to be too objective when it comes to human problems. I’m not an emotionless robot. These drugs are detrimental to children – they have unpleasant side effects that children are expected to get used to, and they retard their growth and development. They typically don’t work beyond about 3 years, and we don’t know if the kids ever make up for the damage that is done. That sucks. Especially when (to me) it seems likely that this is simply a rate-of-development problem, compounded by the nature of interaction the child has experienced prior to the date of diagnosis.

    “Perhaps if I had been on the proper drugs I’d be more normal now.”

    I know you’re making a joke, but unfortunately it’s not funny to me. Apparently I’ve begun to take this site too seriously. sorry.

  56. sonicon 27 Sep 2013 at 1:24 pm

    Hoss-
    I think ADHD has a social construct aspect to it- yes, no doubt.
    I’m not completely convinced by the evidence that there is a genetic component– although I do think there is good reason to suspect such and I would think some would take it as a working hypothesis.

    I’m objecting to the certainty with which the conclusion is being presented.
    I’m suggesting what I would want to see before having that level of certainty on this.
    Dean Hamer. Need I say more?

    If there were one child in the world– that child would not be considered ‘hyperactive’ would he?
    That tells you there is a social aspect to the diagnosis.
    The ‘problem child’ will always be a social construct- the question is then; is there more to it that that?

    I think what causes ADHD is the same thing that causes any mental disorder.
    It has to do with losing site between the difference between one’s imagined world and the actual world to an extent that it bothers others or causes one to become dangerous to himself and others.

    I’m not comfortable explaining the hypothesis further right now.

    BillyJoe7-
    I’m sorry if I misunderstood you. It seems my language is sometimes too wishy-washy for you and sometimes your language expresses too much certainty for me. Occasionally it does seem that way at least– wouldn’t you say? I mean there is a possibility that’s the problem— right? :-)

    My statement about the kids and drugs was overly strong. You are right– the drugs are massively over prescibed here and that effected my language.
    I’m not sure that some don’t benefit from the drugs. I’m not sure drugs are ever the best option either.

    You can assume more than that. I’ve seen you do it. :-)

    Mlema-
    I’m sorry if my flippancy offends.

    I’ve had relatives who were ‘successfully treated’ by psychiatrists.
    I’m thinking the people who perpetrated this ‘successful treatment’ should be in prison.
    I understand there is a problem with inmates getting gang raped in prison…

    Perhaps it would be better if I stick with the flip. I think it is part way to my forgiving.
    I’m trying.

  57. SteveAon 27 Sep 2013 at 2:39 pm

    Sonic: “If there were one child in the world– that child would not be considered ‘hyperactive’ would he?”

    And if there was one person in the world, and they had leprosy – would they be considered diseased?

    To slip back into reality for a moment, like it or not, there is a range of behaviour that is considered normal. You can argue where to draw the line, but you can’t deny that some people exhibit extremes that cause themselves and/or others to suffer as a consequence.

    Sonic: “I understand there is a problem with inmates getting gang raped in prison…”

    Careful, your mask is slipping…

  58. sonicon 27 Sep 2013 at 4:55 pm

    SteveA-
    There is an objective test for leprosy because it is caused by specific bacterium. So, yes, if there were only one person– he might have the disease. And there is a specific test to find out.

    That is not the case with ADHD or ‘problem child’ as there are no objective biological tests currently available.

    People demonstrate behaviors that are problematic for others.
    For example– there are people in government who continue to demand higher taxes.
    And I have to suffer the consequences of this egregious behavior every single day.

    What’s your point?

    I don’t think I’ve ever tried to hide that my opinion of psychiatry is colored by the ‘results’ I’ve seen on some of my family members and others close to me. And I would be the first to acknowledge that this colored view is not completely accurate for the entire profession or indicative of all results obtained.

    I was trying to explain my lack of militancy on the issue to Mlema.

  59. BillyJoe7on 27 Sep 2013 at 5:35 pm

    sonic: “I’m not sure that drugs are ever the best option either”

    I repeat: I can only assume that your experience with kids with severe behavioural disorders is extremely limited.

    And drugs, at least here in Australia, are never the only treatment given, which is part of the reason these drugs can only be prescribed by paediatricians with an interest in managing behavioural disorders.

  60. BillyJoe7on 27 Sep 2013 at 5:50 pm

    sonic,

    “I’ve had relatives who were ‘successfully treated’ by psychiatrists.
    I’m thinking the people who perpetrated this ‘successful treatment’ should be in prison.
    I understand there is a problem with inmates getting gang raped in prison…”

    It seems you’re advocating for something.
    Oh well, you are not a scientist, so I guess that’s okay then. ;)

  61. Mlemaon 27 Sep 2013 at 7:05 pm

    Sonic, I appreciate you expanding your views on this, and I do, as a matter of fact, agree.

    I’m posting the abstract from the paper here, just to share with those who don’t read such links.

    “The prefrontal cortex is crucial for the ability to regulate thought and control behavior. The development of the human cortex is characterized by an extended period of maturation during which young children exhibit marked deficits in cognitive control. We contend that prolonged prefrontal immaturity is, on balance, advantageous and that the positive consequences of this developmental trajectory outweigh the negative. Particularly, we argue that cognitive control impedes convention learning and that delayed prefrontal maturation is a necessary adaptation for human learning of social and linguistic conventions.”

    It’s something to think about. If you put 30 children, up to a year different in age (a year is a long time in the development of a young brain) in a classroom where they’re all expected to behave similarly, you’re apt to have brains with an even broader range of development struggling to conform. Add to this the disparate nature of the communicative and social experiences these children have outside the classroom, and the artificiality of ADHD becomes evident (IMHO) the kids that aren’t behaving are still learning how to conform. If we use drugs to cause them to conform, their brains are robbed of the opportunity to develop those abilities. Your brain has to learn how to behave and learn how to learn. again, IMHO, the types of interventions talked about in the first article i linked to make more sense to me than drugs. However, they require one on one interaction, planning and implementation time – which is costly and not widely available.

  62. BillyJoe7on 28 Sep 2013 at 12:33 am

    It’s a matter of severity.

    Take someone in a severe anxiety state…
    You’re not going to get any benefit from counselling, CBT, or relaxation therapy until the anxiety is at least partly controlled with medication. If you disagree, you haven’t had to deal with someone in a severe anxiety state.
    Same with a kid with severe ADHD.
    You just can’t get any purchase until you first get some control.

    Therapeutic nihilism is just an absurd proposition

  63. sonicon 28 Sep 2013 at 12:32 pm

    Mlema-
    Thanks.
    It seems that because there are ‘extreme cases’, some people can justify drugging millions of kids into stupor with addictive mind altering drugs.

    An article you might find useful–

    http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?pagewanted=all&_r=0

    “TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve.”

    BillyJoe7-
    You seem to be talking about emergency use of drugs to deal with an agitated individual who is unresponsive to efforts to calm.
    I worked in a hospital– often in the emergency room. I can think of examples where a shot of valium really did make things better for everyone– including the patient.

    I’m talking about giving a child- perhaps as young as 3 or 4- an addictive mind-altering drug to be used daily because he doesn’t want to sit still and be quite.

    I’m not sure our positions are necessarily at odds.

    And you are right- as I stated earlier, I am not objective about this.

  64. BillyJoe7on 28 Sep 2013 at 4:08 pm

    sonic,

    “I’m talking about giving a child- perhaps as young as 3 or 4- an addictive mind-altering drug to be used daily because he doesn’t want to sit still and be quite”

    Actually, this is what you said:

    “I’m not sure that drugs are ever the best option”

    As usual you equivocate, but that’s a bit broarder than giving a child as young as 3 or 4 mind altering drugs because he doesn’t want to sit still and be quiet.

    What about a child who CANNOT sit still, who in fact runs riot, disrupting, antagonising, even physically assaulting other students, parents, and teachers, and who is not learning anything because he flits relentlessly from topic to topic, whose father has long since left the scene, and whose mother is at the point of despair?

  65. Mlemaon 28 Sep 2013 at 8:54 pm

    sonic. thank you for that link. The writer is far more knowledgeable on this that anyone here and eloquently describes the problematic nature of the current state of diagnosis and treatment of ADHD.

    DR. NOVELLA, if you happen to see this comment, PLEASE READ AND CONSIDER:

    “Ritalin Gone Wrong”
    http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?pagewanted=all&_r=0

  66. BillyJoe7on 29 Sep 2013 at 3:23 am

    Mlema,

    It’s par for the course for sonic, but why are you so impressed by a cherry-picked article by one particular psycologist giving his personal opinion regarding ADHD and Ritalin?

    I have no stake in this and I’m not about to get involved in this particular discussion.
    I’d simply like to refer you to an opposing opinion by another psycologist…

    http://www.childmind.org/en/posts/articles/2012-1-30-adhd-righting-record-stimulant-medications

    We can all cherry pick but what exactly does it prove to cite the opinion of one psychologist or another?

  67. sonicon 30 Sep 2013 at 12:43 pm

    BillyJoe7-
    You seem to be talking about a specific circumstance.
    I gave you a situation where I thought it was OK to give a person a drug to calm them down.

    Good luck.

  68. Mlemaon 30 Sep 2013 at 5:43 pm

    BillyJoe,
    I wasn’t trying to prove anything.

  69. steve12on 30 Sep 2013 at 5:46 pm

    From the article:

    “Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.”

    This just isn’t so. It’s fine for him to say that he doesn’t find the evidence for a genetic cause compelling and here’s why, or for him to say that the evidence is there but the behavior isn’t really pathological.

    But it’s irresponsible and unprofessional to simply ignore all of the evidence and lead the lay readership to believe this evidence doesn’t exist. THAT is denial.

  70. Mlemaon 30 Sep 2013 at 11:32 pm

    steve12, what is the evidence?

  71. steve12on 01 Oct 2013 at 12:29 am

    There’s this, which garnered a lot of attention recently:
    http://www.nature.com/ng/journal/v45/n9/full/ng.2711.html

    But there are many studies:
    http://scholar.google.com/scholar?hl=en&q=adhd+genetics&btnG=&as_sdt=1%2C22&as_sdtp=

    And I’m fine with him arguing about the methods, intepretations etc. But I’m not cool with him denying them. More to the point, why IS he denying the existence of this evidence instead of confronting it?

  72. Mlemaon 01 Oct 2013 at 12:50 am

    ok Steve. Thanks. i know we’ve been through this before. First: you, me, and the author all agree that behavior is biological.

    the author:
    “Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.”

    Here’s what I understand the author to be saying:
    There’s no evidence to support the theory that difficulty in concentrating is the same kind of “inborn chemistry” problem as type I diabetes (a problem that requires pharmaceutical intervention).

    In other words, there’s no evidence that ADHD requires chemical intervention.

  73. steve12on 01 Oct 2013 at 1:09 am

    “In other words, there’s no evidence that ADHD requires chemical intervention.”

    Re-reading it, it is kind of ambiguous. If the theory is that there are genetic factors, he denying. But if he’s saying that ADHD isn’t helped by pharmacological intervention, that’s different.

    I’m weary of long-term use of many of these drugs, as is the author. Really, the only way to know what the long term effects of these drugs are is to wait! If your question is about long-term effects, there’s no substitute for long terms…

  74. Philip Hickeyon 01 Oct 2013 at 11:14 am

    Dr. Novella,

    I have written a response to this post.

     

    Phil Hickey
    http://www.behaviorismandmentalhealth.com/

  75. steve12on 01 Oct 2013 at 4:36 pm

    Philip :

    I read your critique. I think that it can be boiled down into 4 themes:

    1. Semantics disagreements that are irrelavent to the uderlying issues

    2. You don’t like psychiatry but offer no plausable alternative for serious psychoses (or people who behave in a manner that would be consistent with what psychiatry calls psychosis, see #1).

    I think the approach you describe is probably wonderful for people who are have problems and aren’t psychotic. But the notion that this will work for a person with symptoms consistent with, say, paranoid schizophrenia – I would need to see strong evidence for that. Not anecdotes, carefully controlled studies.

    3. Denial of evidence about the brain and genetics. YOu bring this up and the

    4. Did I mention that we’re against psychiatry?

    From everything I read on your site, it’s a very vague, postmodern-ish look at an issue that needs sorting out by science. And again, I’m talking about serous psychoses here.

  76. steve12on 01 Oct 2013 at 4:53 pm

    Oh, and BTW: this cite in no way call into question the genetic link for ADHD. The arguments are inane, not to mention outdated:
    http://www.academyanalyticarts.org/galvesealker.htm

    And I have to say, I don’t get it. Why are you guys SO invested in the notion that the brain cannot “break” where the mind is concerned? Every other organ and bio process can go awry, and the brain CAN break where the mind is not concerned (e.g., MS, though this is not entirely true), but the brain cannot break where the mind is concerned.

    It seems like a bizarre and arbitrary line. The only sense that I can make of this is that you don’t want to leave dualism behind, but you don’t want to posit a “soul” either. You want a special middle ground, but in reality that ground dos not exist.

  77. BillyJoe7on 01 Oct 2013 at 5:24 pm

    sonic,

    “I gave you a situation where I thought it was OK to give a person a drug to calm them down.”

    My point was that this was in direct contradiction to your broard sweeping statement…

    “I’m not sure that drugs are ever the best option”

  78. BillyJoe7on 01 Oct 2013 at 5:28 pm

    Mlema,

    “I wasn’t trying to prove anything”

    Then why all the capitalisations…

    “DR. NOVELLA…PLEASE READ AND CONSIDER”

  79. Mlemaon 02 Oct 2013 at 2:01 am

    Sorry BillyJoe – I honestly didn’t know what you meant. I capitalized because I was hoping to catch Dr. Novella’s eye. I guess i understand why you thought I was trying to prove something, as in, “you must read this link because it will prove you wrong”. But i think if you just read what i wrote you’ll realize there was no “proving” involved or intended. I’ll try to be more careful. I just thought sometimes people who don’t mark up for emphasis use caps. For instance, if i were going to dismiss someone who was ‘gettin’ in my face’, I might say “eh, screw you” But if i wanted to express my disgust and annoyance, I might type “SCREW YOU!” I’m being emphatic there, not trying to prove anything.

    hope you understand

  80. BillyJoe7on 02 Oct 2013 at 8:29 am

    Okay, fair enough, but then perhaps you should also bring to Steven Novella’s attention the rebuttal of that psychologist’s opinion by the psychiatrist in my link.
    BTW, did you read it and what did you think of the rebuttal?

  81. The Other John Mcon 02 Oct 2013 at 10:14 am

    Philip Hickey,

    I also took a look at your post:

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

    My personal impression is that you have lost yourself in a jungle of semantic hooplah, and would politely recommend that you try to ground what you say with reference to the real-world (data, measurements, established facts, etc.) as this will help side-step a lot of the problems you seem to have with spinning your wheels over semantics. If we can agree that we are grunting and pointing at the same thing in the world, then who cares what exactly we are grunting.

    For instance, you admit that “brain problems can cause behavioral problems” but then claim “there are no mental illnesses; that the concept of mental illness is spurious”.

    To me, this sounds like a contradiction, in that you are basically saying “what you call mental illness definitely exists, but I refuse to call it that, and now I am going to claim the concept is spurious while providing no actual scientific reasons for doing so, just fun twists of logic and word-games”

  82. The Other John Mcon 02 Oct 2013 at 10:25 am

    In regards to Steve12′s comments:

    “And I have to say, I don’t get it. Why are you guys SO invested in the notion that the brain cannot “break” where the mind is concerned?”

    Exactly. Here’s an example we should agree on: color blindness. This exists, right? It has clear genetic components, and is a neural/brain “dysfunction” that results in abnormal perception that result in clear and systematic differences in perception and thus behavior (like on a color-sorting task). If the brain is made up of thousands of different, interconnected, interacting modules (color vision is one of them), and we agree one can go “awry”, why couldn’t any of the other modules possibly have similar types of problems resulting in perceptual/cognitive/behavioral differences that manifest as real problems for an individual?

  83. Mlemaon 02 Oct 2013 at 6:31 pm

    The other John Mc
    why is it so important that depression, anxiety, ADHD, etc. be caused by brain problems?

    if a behavioral problem is caused by a brain problem, it’s not a mental illness, it’s a brain illness
    if we can’t find a brain problem, it’s just a problem with my thoughts that’s affecting my mood and behavior. This may just be a difference between believing that thoughts just come magically from the brain vs. they are a response to sensory input that begins at birth. If you’re not a dualist, how else might you explain how the brain thinks? We think in pictures and language (the language we learn) do you think those pictures and words magically proceed forth from the brain? or is the brain simply mediating the organisms response to its environment? It’s the fact that there’s a continuum that allows us to argue whether it’s the brain or the sensory environment that is the cause of the problem or the problem itself

  84. Mlemaon 02 Oct 2013 at 6:34 pm

    BillyJoe, knowing that you don’t really want to get into this discussion, i will just say that the article you chose to link to is not a good defense of Dr. Novella’s position. This is for a number of reasons, but i will just echo the very words you’ve used yourself on this site: do your own homework.

  85. BillyJoe7on 03 Oct 2013 at 1:00 am

    No, I just thought that, for you to try to bring to SN’s attention a particular article, you must have thought it was a pretty damn good read. I mean how often do you try to bring an article to his attention? And, therefore, I thought it might be good for you to read the rebuttal of that article and to refer it on to SN as well if for no other reason than balance. But apparently not.
    Oh well…

  86. Mlemaon 03 Oct 2013 at 1:55 am

    BillyJoe, you and I are just on completely different wavelengths. But I know that you always try to find something to call me out on, even when we agree. I’m not really sure why, but I’ve accepted it. Because that’s what you do when you’re friends.

  87. The Other John Mcon 03 Oct 2013 at 7:47 am

    Mlema,

    you said: “if a behavioral problem is caused by a brain problem, it’s not a mental illness, it’s a brain illness…and if we can’t find a brain problem, it’s just a problem with my thoughts that’s affecting my mood and behavior.”

    To be perfectly honest, this makes no sense to me whatsoever, and like the post I was critiqueing, it sounds just like jibberish and non-sensical semantic hair-splitting with nothing to show for it. What distinction are you making between a “brain problem” and “mental illness” and “brain illness” and “just thoughts affecting mood and behavior”? Is this distinction really important?

    you also said: “why is it so important that depression, anxiety, ADHD, etc. be caused by brain problems?”

    It’s only important if “brain problems” are indeed primary causes for depression, anxiety, ADHD, etc. Then it’s really damn important. And that’s what the current best evidence indicates, and so that’s what we should pursue with vigor with the goal of understanding, detecting, and treating mental illness….right?

  88. BillyJoe7on 03 Oct 2013 at 8:50 am

    Mlema,

    Yes, as a friend, I thought it would be worth pointing out to you that drawing Steven Novella’s attention to a sonic cherry-picked article is perhaps not the cleverest move you’ve ever made. I mean have you not learnt anything about sonic’s cherry picks links?

    There, now I’ve managed to insult two dear friends.

  89. Francesca Allanon 03 Oct 2013 at 7:33 pm

    Dr. Novella, you write: “But the deficit that defines ADHD is literally a decreased function in an identifiable part of the brain that is the neuroanatomical correlate with attention – frontal lobe executive function. That essentially defines the disorder.”

    No, it certainly does not define the disorder. What defines the disorder is someone in authority (most often a teacher) being frustrated and unhappy with a child’s behaviour. That’s a problem, it’s true, but it doesn’t equate to a brain disease. Once a kid is labelled ADHD, then that sets him up for a significant risk of later being labelled with serious mental illness like bipolar disorder. Aren’t you concerned about the explosion in ADHD diagnoses? About the expanded criteria in the DSM V to capture even more unfortunates? Raising a nation of kids on speed is not a good idea.

    Neurological “explanations” are posited for all mental illnesses. In all cases, however, including ADHD, mental disorders cannot be diagnosed on a biological basis. There’s no brain scan, no blood test, no nothing, that will reliably predict presence or absence. In real medicine, this is occasionally also true e.g. with migraine headaches. What distinguishes psychiatry however is that this is true for ALL of their disorders and that this lack of science doesn’t deter those in authority from force drugging (or worse) those deemed inferior.

    The sad result of this absence of science is that once you’re accused of having a mental illness, there is no way to prove that you don’t. In the case of mental illness, anyone misdiagnosed who says “Hey, wait a minute, I don’t this is accurate and here’s why ….” will just be written as suffering from anosognosia, yet another “neurological” condition for which there is no biological test (so no means to deny).

    Psychiatry is a crap science with almost no redeeming qualities. You state upthread that environmental factors are assessed. In the nightmarish ten years I spent in psychiatry’s clutches, my childhood and adolescent traumas were never once addressed. It was just “You’re screwed up? Your neurotransmitters are out of balance. Here are some drugs? Bad reaction to the drugs? Here are some more.” It’s a disgrace.

  90. Francesca Allanon 04 Oct 2013 at 1:19 am

    Hoss, you responded to another poster above with “What is not valid about the current neurological model of the brain/mind, or would you prefer to just assert it’s not valid? I’d ask for the studies you’re getting your information from, but I tend to think that 40 years of intense studying was nothing more than 40 years of conformation [sic] bias mostly reading books and articles from psychiatry deniers, while irrationally dismissing valid counter-arguments. If I’m wrong, please put forth the evidence for you position.”

    If you’d honestly like to review the evidence for our position, you could start with the World Health Organization studies, the Open Dialogue studies, the work of Robert Whitaker and the myriad testimonies of complete recovery without drugs. I realize I’m not a study but I have completely recovered from clinical depression, bipolar disorder, schizoaffective disorder, schizophrenia and borderline personality disorder (and those are just the labels that I remember) without conventional treatment. In fact, I didn’t recover UNTIL I abandoned psychiatric treatment.

    Nobody’s disputing the neurological model of the brain. And nobody’s disputing that the mind is anchored to the brain as everything about our thoughts, feelings, personalities, experiences also is. What we’re disputing is that emotional distress must reside in the brain, rather than the mind. I’ve read a good analogy: just because you find something upsetting or offensive on the internet, you mustn’t conclude that your computer system doesn’t work. I am not “irrationally dismissing valid counter-arguments.” My skepticism is very rational and the counter-arguments are not valid. If these disorders were brain diseases, then we could scan brains and diagnose them. We can’t do that and we’re never going to be able to do that. The millions of dollars we sink into futile brain research could be spent on things that we already know work: housing, good nutrition, reasonable social support, alcohol and drug counselling, accessible education, etc.

    Psychiatric labels are fluid and arbitrary and are completely devastating to a person’s life. Being diagnosed with a serious mental illness is a life sentence, potentially subjecting you to the loss of your fundamental civil rights. We treat the mentally ill worse than we do convicted murderers. Psychiatry is a disgrace and should be abolished.

  91. Mlemaon 04 Oct 2013 at 3:20 am

    The other John Mc:
    “What distinction are you making between a “brain problem” and “mental illness” and “brain illness” and “just thoughts affecting mood and behavior”? Is this distinction really important?”

    It’s the crux of the whole dilemma. Although the mind doesn’t exist without the brain, the two are not the same thing. The mind is: thoughts, sensory experience, feelings, memory, language, etc. Dr. Novella calls it a function of the brain. Does the brain create these? Yes, it’s not wrong to say that. But they are not created from the brain tissue without input from the five senses. The brain mediates the organisms response to it’s environment? In this model, everything the organism does is behavior. And that includes thinking. If thinking goes wrong (or if behavior goes wrong for that matter), we have to first agree that it’s wrongness is valid. Is it only wrong because 2 out of 3 say it’s wrong? No, not necessarily. So, let’s say we all agree it’s wrong, including the person doing the thinking. An example of this is: we all agree that it’s wrong for a young person to want to kill himself. There are some who would disagree based on individual integrity of choice. But i think that is such a small minority I’m willing to be a little less than 100% accurate. Well, it makes sense to look for a brain problem because thoughts are formed by the brain. But, if we can’t find anything physiologically or structurally wrong with the brain, but we do find that intervening in the thinking directly (cognitive therapy), or in the environment of the thinker (remove him from a home where Dad keeps telling him he’s worthless), or in some other aspect of the thinker’s world as he’s experiencing it (perhaps finding a way to interrupt the train of bad logic and reinforce more self-loving thoughts), we’re able to affect and change his thinking. The thoughts that caused depression are molded to more realistic ones (you’re not worthless, you have value even if your father doesn’t respect that fact) and the mood eventually improves. If we were to instead diagnose this young man with depression. (you HAVE depression) then, on top of his suffering, we are piling more. Now he’s not just depressed, he has a mental illness. We treat illness with medication, and the guy is given SSRIs. These drugs have mental, emotional and behavioral side effects that can actually exacerbate the situation. He may go ahead and commit suicide, or become violent towards others. Additionally, they’ve not been proven to be more effective than a placebo in all but the most entrenched cases. This is why it’s important to distinguish between “brain illness” and “just thoughts affecting mood and behavior”. We wouldn’t be able to help this young man through non-medical means if there were something physically wrong with him. This gets incredibly complicated because strictly speaking, all these things are physical. What I’d like to emphasis is cause.

    you also said:

    “It’s…important if “brain problems” are indeed primary causes for depression, anxiety, ADHD, etc. … And that’s what the current best evidence indicates, and so that’s what we should pursue with vigor with the goal of understanding, detecting, and treating mental illness….right?”

    The best evidence doesn’t indicate that brain problems are the primary cause of depression, anxiety, ADHD, and probably 99% of the current list of mental illnesses. And you’ve stumbled into the big re-evaluation that’s currently happening within this branch of medicine. We can’t extricate medicine from the treatment of problems like depression, anxiety, etc. – because they can be caused or effected by physiological problems separate from thinking. It gets a bit sticky. What we have to do is re-conceptualize what we now call mental illness in order to treat physiological problems which affect thought with medicine or surgery, and problems of thought with types of therapy that don’t rob people of their mental integrity, or make things worse with psychoactive drugs. That doesn’t really solve the problem.

    My viewpoint is not anti-skeptic. You can find skeptic sites that discuss this issue.

    Please note – I am not saying that the problems that all the various diagnoses the DSM describe don’t exist! I’m just saying they’re not medical problems.

    now here I’ve deleted another paragraph that I think might have been pointless depending on what your response is.
    thanks

  92. The Other John Mcon 04 Oct 2013 at 8:05 am

    Mlema, you said:

    “But, if we can’t find anything physiologically or structurally wrong with the brain, but we do find that intervening in the thinking directly (cognitive therapy), or in the environment of the thinker (remove him from a home where Dad keeps telling him he’s worthless), or in some other aspect of the thinker’s world as he’s experiencing it (perhaps finding a way to interrupt the train of bad logic and reinforce more self-loving thoughts), we’re able to affect and change his thinking.”

    Like steve12 said, this is a great approach that we should certainly try, but it’s goofy to think it will work in all cases, especially the most severe ones. And it seems goofy to think that we shouldn’t be looking for genetic/biological components underlying mental illness, and attempting to treat as such.

    Again, your argument seems to be: I don’t like that we use drugs in psychiatry, and I don’t like the label “mental illness” and that it gets treated in some ways like a medical condition. I would agree that there shouldn’t be a negative connotation to “mental illness” but that seems more like a wider sociological/cultural issue than a scientific/treatment issue.

    I’m not saying you are anti-skeptic, I’m saying that your words look amazingly similar to the arguments put forth by mental illness denialists, whether they are intended to or not.

    And I’m not married to the idea of drug treatment, we should go with what works, whatever that might be. To claim little or no efficacy of current treatments is just wrong. Is there lots of room for improvement, and can we do better? Hell yes, let’s figure them out. The way forward I see is (eventually) a restructuring of DSM based on better bio/genetic/brain scan studies, an understanding of how brain circuitry contributes to mental illness, and whatever treatments we can come up with that are demonstrably effective and minimization of sometimes undeniably bad side effects. But let’s not go throwing the whole system out just yet, as mental illness denialist seem to want to do.

  93. The Other John Mcon 04 Oct 2013 at 8:14 am

    Francesca Allan,

    you claim: “If these disorders were brain diseases, then we could scan brains and diagnose them. We can’t do that and we’re never going to be able to do that.”

    Um, not quite. We will be able to do that, we can’t yet because the brain scanning technology is just too coarse. When we can see at the level of neuronal circuitry, we should be able to diagnose with high confidence. If the technology improves, but we still can’t diagnose as good as we want, fine, at least we know that, we’ll have to look elsewhere. There’s a good chance we will be able to, and that’s what the field is working towards.

    you also say: “The millions of dollars we sink into futile brain research could be spent on things that we already know work: housing, good nutrition, reasonable social support, alcohol and drug counselling, accessible education, etc.”

    First of all, it’s not futile brain research. It may have been futile for YOU, but c’mon now, get serious. Of course we should be supporting good housing, nutrition, social support, etc. Absolutely. And to the many people who inevitably don’t respond to these “treatments”, then what? Do you have an alternative? Because the “futile” brain research is working on alternatives, and providing alternatives.

  94. steve12on 04 Oct 2013 at 11:46 am

    There’s a lot of problems with the assumptions in this discussion.

    1. There is no mind separate from the brain (or body). There is no contradiction to be solved. The mind is simply a human semantic conception of our conscious selves – beyond that it does not exist. The brain/ body and processes thereof are what exist.

    The “mind” is simply our shorthand for a subset of what our bodies’ do. To say otherwise is like saying that physical legs cannot explain “running”. It makes no sense unless you change mind to soul and revie dualism.

    2. Absence of evidence is not evidence of absence. Just because the pathophysiology of MI has not been identified clearly does not mean it’s not physical! In fact, genetic differences (the evidence which everyone continues to ignore) tells us we will certainly find this pathophysiology in the future.

    This should not be taken to mean I agree with any particular treatment or approach – each needs to be adjudicated individually and due attention paid to the alternatives.

  95. Francesca Allanon 04 Oct 2013 at 12:13 pm

    The “genetic evidence” for mental illness is based on extremely flawed studies. The twin studies are confounded by very relevant factors that are never considered by the researchers. See Jay Joseph for a good analysis of their non-validity.

    And mind vs. brain is a good position, even if the mind ultimately is rooted in neurotransmitters. Seeing an offensive website on the internet doesn’t mean the problem lies with your wireless connection. Similarly, having perceptual difficulties (which ultimately is what all mental illness is) should lead caregivers to deal with the perceptions (the troubling internet sites) not the hardware.

    And, as for brain scans being too coarse at the moment, that’s right. And they will always be too coarse. If we found a reliable anomaly (and we certainly haven’t yet, as proven by the fact that we can’t diagnose on that basis) that seems to go with schizophrenia, then we have to use caution: Is schizophrenia related to other conditions (e.g. alcoholism) that can cause brain weirdness? Are we going to consider the well-documented effects of antipsychotic medication upon the brain? Are we looking at the cause or the effect of mental illness?

    We’ve been hearing about the biological tests being “just around the corner” for decades. Not going to happen. Believe me, if mental illness turned out to be a brain problem fixable by drugs, my life would be a lot easier so it’s not like I have a vested interest in declining bioreductionism. As it stands, the error rate on psychiatric diagnosis approaches 50%. Give a bipolar SSRIs and she’s in big trouble. Ditto giving antipsychotics to anyone who disagrees with you.

    Outcomes are worse with conventional treatment. That alone should give forced drugging enthusiasts pause to reflect. I was devastated by psychiatry and there are thousands like me. This is bogus pseudoscience and the public deserves to know the truth. Stigma has actually increased since this “medical illness just like diabetes” crap has taken hold. We’re seen as a discrete group of others, not entitled to our civil rights.

  96. steve12on 04 Oct 2013 at 12:39 pm

    “The “genetic evidence” for mental illness is based on extremely flawed studies. The twin studies are confounded by very relevant factors that are never considered by the researchers. See Jay Joseph for a good analysis of their non-validity.”

    This?
    http://jayjoseph.net/the_gene_illusion

    I’ve read excerpts previously. It evinces a stunning lack of understanding of genetics specifically and science generally. It’s almost like it wa written by a non-qualified person to gind an axe. Oh wait…

    But I don’t need to refute it because there are plenty of genetic studies that don’t use twins:
    http://www.nature.com/ng/journal/v45/n9/full/ng.2711.html
    http://scholar.google.com/scholar?hl=en&q=adhd+genetics&btnG=&as_sdt=1%2C22&as_sdtp=

    I won’t get into the correlation/cause argument because its absurd. You wanna write it all out feel free.

    “Similarly, having perceptual difficulties (which ultimately is what all mental illness is) should lead caregivers to deal with the perceptions (the troubling internet sites) not the hardware.”

    Mental illness is not just perceptual difficulties. I don’t know where you got that but it’s false. And even if it were, the perceptions and the hardware are one in the same for the purposes of this discussion. ONce that input goes into the brain, where else would “perceptual difficulties” come from?

    “And, as for brain scans being too coarse at the moment, that’s right. And they will always be too coarse.”

    You have no way of knowing whether this is true or not.

    “If we found a reliable anomaly (and we certainly haven’t yet, as proven by the fact that we can’t diagnose on that basis)”

    Can’t diagnose individually, true, because the phenotypical expression is to varied, and probably for other reasons that we don’t yet understand. We can tell groups apart though. We can even tell first degree realtives of the afflicted from the non-afflicted. We are getting there. And as I asked many times before – how can we tell first degree relatives apart if there is no biological basis o mental illness?

    “We’ve been hearing about the biological tests being “just around the corner” for decades. Not going to happen. ”

    Again, how is that you can predict the future?

    As far as the rest is concerned, I’m not going too argue about treatments. I’m not a clinician. Evidence for the indaquecy of a clinical approach has no bearing on the basic science findings, which for some reason you guys feel the need to “refute”.

    Your beef should stay with psychiatry, becasue when you start denying neuroscience and genetics you venture into untenable territory for which the evidence is stacked against you

  97. sonicon 04 Oct 2013 at 12:42 pm

    The Other John Mac-
    You say-
    “you claim: “If these disorders were brain diseases, then we could scan brains and diagnose them. We can’t do that and we’re never going to be able to do that.”
    Um, not quite. We will be able to do that, we can’t yet because the brain scanning technology is just too coarse. When we can see at the level of neuronal circuitry, we should be able to diagnose with high confidence.”

    steve12-
    You say-
    “Just because the pathophysiology of MI has not been identified clearly does not mean it’s not physical! In fact, genetic differences (the evidence which everyone continues to ignore) tells us we will certainly find this pathophysiology in the future.”

    Both of you assume things not in evidence.
    Anyone disagreeing with you here would agree– if the tests you say will exist did exist, the argument would be over.
    But the test don’t exist.
    Claiming they ‘will’ and making your judgements based on that is just making stuff up to make your point. Perhaps if you were to limit the discussion to things that actually exist…

    The fallacy is referred to as ‘begging the question’ in general.

    Your entire argument rests on this fallacy.

  98. steve12on 04 Oct 2013 at 12:42 pm

    And a PS – there are plenty of practices in psychiatry that raise my hackles! With so much to go after, you guys completely invalidate your own movement by needlessly veering into science denial.

    I do not get it.

  99. steve12on 04 Oct 2013 at 12:43 pm

    “Claiming they ‘will’ and making your judgements based on that is just making stuff up to make your point. Perhaps if you were to limit the discussion to things that actually exist…”

    Where did I claim that a test will exist?

    I did no such thing.

  100. steve12on 04 Oct 2013 at 12:47 pm

    Wait – I know what you’re going to say. An you’re wrong Sonic.

    If you have stable genotypic and phenotypic differences by group, you are not “begging the question” (not even sure that I understand this) to say that there is a pathophysiology to be found.

  101. Francesca Allanon 04 Oct 2013 at 1:43 pm

    Steve12, no, I was referring to this: http://jayjoseph.net/yahoo_site_admin/assets/docs/AJP_MISTRA_PDF.157214425.pdf

    You think caution re: correlation/cause is unwarranted? Really? Isn’t that one of the fundamental tenets of science?

    And don’t you think that one schizophrenic in family makes it more likely to produce another? Do you think that even if there’s not a second schizophrenic, a psychiatrist wouldn’t be more likely to attribute disturbing behaviour to it anyway?

    Then you say: “Mental illness is not just perceptual difficulties. I don’t know where you got that but it’s false. And even if it were, the perceptions and the hardware are one in the same for the purposes of this discussion. ONce that input goes into the brain, where else would “perceptual difficulties” come from?’”

    Name me one mental illness that doesn’t boil down to a problem with perception. And, no, the perceptions and hardware are not the same, just as what’s on the internet isn’t the same as the hardware holding it. And perceptual difficulties come from the mind, not the brain — that’s why you can often cure mental disorders without tinkering with the brain.

    You’re right that I should haven’t said brain scans will always be too coarse. Just like you shouldn’t say that they will eventually be accurate enough. Ditto that there will/won’t be a biological test.

    No, we can’t tell groups apart. Schizophrenia is an entirely subjective judgment on the part of a psychiatrist. When we do all these studies, we don’t even know what we’re counting. And those supposed abnormalities occur in lots of people w/out schizophrenia and there are lots of schizophrenics without those abnormalities. it’s potentially interesting research, sure, but I’m not holding out much hope for useful results.

    Actually, I love neuroscience and genetics. The problem is that psychiatry wants to be considered a neuroscience and it’s clearly not. If bipolar disorder turned out to be a neurological disease, then we’d be consulting neurologists, not psychiatrists. And genetic research for such disorders strikes fear into our hearts in a way. They’re trying to predict who’s at risk for developing a mental disorder. That sounds to me like the (forced) Treatment Advocacy Center wants to get those poor, urban kids onto antipsychotics pre-emptively.

  102. Francesca Allanon 04 Oct 2013 at 1:46 pm

    And you’re not going to argue about treatment because you’re not a clinician? We’ll I’m going to argue about it and I’m not a clinician either. Just someone who’s been incarcerated, force drugged and electroshocked on the basis of bogus science.

  103. sonicon 04 Oct 2013 at 1:47 pm

    steve12-
    Oh, you are correct. ‘theother’ claimed the existence of tests that don’t exist.
    You claimed the discovery of pathophysiology that hasn’t been found.

    I stand corrected.

    Begging the question (Latin: petitio principii, “assuming the initial point”) is a type of informal fallacy in which an implicit premise would directly entail the conclusion; in other words, basing a conclusion on an assumption that is as much in need of proof or demonstration as the conclusion itself.

    The argument hinges on if what you assert exists actually does exist.
    You assert the existence of something that is not actually evident– there are no tests and there is no pathophysiology that has been found.
    That is part of the factual background to the discussion.
    You assume the existence of facts that are not actually in existence to make your case.

    That’s why I said- ‘begging the question’.

  104. Francesca Allanon 04 Oct 2013 at 1:47 pm

    Nobody’s denying science! Knock it off, that’s offensive. We’re denying that psychiatry is a science. Please don’t put words in my mouth.

  105. Francesca Allanon 04 Oct 2013 at 1:50 pm

    And, Steve12, you’re quite right: IF there were stable differences in geno/phenotypes between groups and IF schizophrenia was a valid category and IF confounding factors like antipsychotic treatment were accounted for, then we’d have some science. Until then … maybe you should give some air time to those who’ve had the hypodermic needle in the ass.

  106. Francesca Allanon 04 Oct 2013 at 1:53 pm

    When you said that such a test didn’t exist “yet,” it was entirely reasonable to assume that you were implying that one would at some point in the future. Funny how I’m a nutter for saying something won’t happen; but you’re designated sane for saying it will. We just won’t know, will we?

  107. steve12on 04 Oct 2013 at 2:03 pm

    I know what begging the question is, it just doesn’t apply. The evidence is the phenotype and genotype – not knowing HOW one gives rise to the other is no the same as not knowing that it does.

    I suppose that it’s possibe that people with MI and their first degree relaltives have the same genetic differences compared to non-MI groups by coincidence, and this coincedence has been replicated.

    Or (for Francessa and Jay Joseph), a diagnosis by psychiatry has caused genetic differences to appear in these groups.

    I am indeed assuming that neither of these is the case.

    And there are tests, they just work at the group level becasue we don’t understand the variation in expression. That does not make this relicable work less real.

  108. steve12on 04 Oct 2013 at 2:04 pm

    “Funny how I’m a nutter for saying something won’t happen; but you’re designated sane for saying it will. We just won’t know, will we?”

    See my last reply…..

  109. steve12on 04 Oct 2013 at 2:07 pm

    “And, Steve12, you’re quite right: IF there were stable differences in geno/phenotypes between groups”

    There are, and I provided the links

    ” and IF schizophrenia was a valid category”

    No perfect, but valid enough to produce reliable genetic and behavioral differences by group in the links you won’t read

    ” and IF confounding factors like antipsychotic treatment were accounted for, ”

    antipsych meds are changin people’s genetics? Anyway, there are fist degree relative differences that simple explodes this notion.

    then we’d have some science. Until then … maybe you should give some air time to those who’ve had the hypodermic needle in the ass.

  110. steve12on 04 Oct 2013 at 2:09 pm

    “Nobody’s denying science! Knock it off, that’s offensive. ”

    Tough. Stop denying the genetics and neuroscience and I’ll stop calling you a denier.

    “We’re denying that psychiatry is a science. Please don’t put words in my mouth.”

    Nope. You’re denying genetics and neuroscience as well.

  111. steve12on 04 Oct 2013 at 2:11 pm

    “And you’re not going to argue about treatment because you’re not a clinician? ”

    That’s right. I do this weird thing were I don’t argue authoritatively about things that I don’t understand.

    You should give it a shot, becasue you’re knowledge of the state of science where MI is concerned is woefully inadequate.

    It’s OK though. A lot of work and critical thinking can overcome this.

  112. sonicon 04 Oct 2013 at 4:24 pm

    steve12-
    There are no biological test or markers currently in use to determine these diseases. That’s because there are none known.
    Those are the facts.

    Now you say there is good reason to think that a test will be found and this will be coming soon- and I agree– there are reasons to think the tests will be coming. The genetics and so forth are pretty convincing.
    But reasons to think something is a certain way and reality don’t always match.
    Nobody thought quantum mechanics would be the way it is, for example.

    I’ll know there is a test when I see it and it has been demonstrated accurate.
    Apparently you know it somehow else. OK. But I don’t know it somehow else.

    Is that an anti-science stance on my part?

  113. Mlemaon 04 Oct 2013 at 4:47 pm

    Steve12, you may think that you have nothing to say regarding clinical issues. But insisting that MI is genetic and neurological means: medical intervention with drugs and surgery. shock, etc. The cause determines the treatment.
    Also, you’re using the term “mental illness” when i believe you are in fact really just referring to a tiny percentage of the millions diagnosed with “mental illness” – a percentage of the 1% diagnosed with SZ. While at the same time, the head of the NIMH has admitted that the DSM is a complicated symptom-labelling system with no medical evidence, and that SZ may be a developmental problem.

    Frankly, I’m indifferent if you want to insist that we have evidence that “mental illness” is a brain problem. As long as you’re never allowed to have any input on who’s diagnosed and how they’re treated.

    If you’re researching a connection between genotype and phenotype, and the current biggest determining factor (more than genetics in fact) is whether or not a person lives in an urban setting, mightn’t you look into expression being affected by mental/social environment (or even physical environment)?

    the nazis said the Jews were mentally defective. And they said they proved the genetic basis: they were Jews.

  114. The Other John Mcon 04 Oct 2013 at 6:39 pm

    and there it is! Godwin’s Law strikes again….

  115. Mlemaon 04 Oct 2013 at 7:37 pm

    All the Chinese had genetically enlarged feet, but only some of the women were treated with binding.

    what’s the name of that law?

    you and steve12 have no more evidence for drugging, shocking, frying brain tissue, and incarcerating the people you’ve labeled mentally ill than the nazis had for gassing Jews.

  116. Francesca Allanon 04 Oct 2013 at 10:57 pm

    Steve12, your dismissal does nothing to change the facts:

    - There is no reliable clinical standard for schizophrenia. You have it if your psychiatrist says you do.
    - Twin studies are hopelessly flawed.
    - Genetics research in this area is absurdly biased in favour of legitimatizing psychoneuroscience.
    - Whatever jackass purports to find the gene for schizophrenia will likely win a Nobel Prize.
    - All of this does nothing to help people with emotional difficulties.
    - You don’t have to be a researcher to question methodology, any more than you have to be a politician to spot corruption.
    - Psychotic disorders can often be cured without altering the brain. This alone calls into question the bioreductionist model.
    - Current conventional psychiatric treatment often involves human rights violations.
    - Current conventional psychiatric treatment often devastates people (including me) and doesn’t address the underlying factors that cause emotional disorders.

    Even if you found a genotype linked with schizophrenia, who gives a shit? What does that do to help people? Wouldn’t resources be better spent actually helping people? Or would you rather identify the gene so that we can have the “likely to become mentally ill” registry? And, if you think I’m kidding, check out the current proposals re: the mentally ill.

    Calling me “anti-science” just confirms to me that you can only resort to unwarranted attacks. What’s “anti-science” about demanding some answers? Psychiatry is a pile of shit perpetrated on people we don’t like or find offensive.

  117. Francesca Allanon 05 Oct 2013 at 1:14 am

    Steve12, you’re wasting a lot of time misrepresenting my position. I didn’t say (or even suggest) that antipsychotics changed genetics. I’m simply letting you know that they cause documented brain anomalies (damage). So when you’re comparing schizophrenics vs. normals, it’s prudent to consider this confounding factor.

    And I am not denying neuroscience, genetics, or science in general and it’s puerile of you to keep saying that I am. What I am denying is that psychiatry is a valid medical science. The fact that outcomes are worse with treatment confirms this. The fact that I was misdiagnosed for ten years with various mental illnesses confirms this. The fact that we have this unexplained explosion in mental illness concurrent with the ever-expanding DSM confirms this. The fact that the DSM checklists are voted on by a group of doctors (most of whom are subsidized handsomely by Big Pharma) confirms this. The fact that we have no definitive test for any of these “disorders” (and thus no way to defend ourselves against these accusations) confirms this.

    You’re certainly right that I’m not an expert in either genetics or neuroscience. I am, however, an expert in how psychiatry maims people. That power is based on the idea that it all boils down to neurotransmitters and/or structural problems. Until diagnosis is reasonably accurate and until neurotransmitter levels/brain abnormalities are reliable enough to make coherent interpretation possible, it is absolutely evil of our society to promote the status quo.

    Writing off skeptics of psychiatry is ill-advised. You have said nothing, absolutely nothing, of substance to support your position. No reliable tests? Oh, well, it’s too complicated. No current accurate diagnosis? Oh, well, there will be one day. Don’t agree with this horseshit? Oh, well, you’re woefully misinformed. I believe it is you, Steve12, who is woefully misinformed and I have utterly lost patience with your so-called arguments.

  118. Francesca Allanon 05 Oct 2013 at 1:29 am

    Steve12, you said “That’s right. I do this weird thing were I don’t argue authoritatively about things that I don’t understand.”

    Well, I sure as hell do understand it because I’ve been on the receiving end of the hypodermic needle and the electroshock machine. I understand that mental patients routinely lose their civil rights, solely on the basis of a psychiatrist’s say-so. I understand that it’s impossible to prove a negative, i.e. I can’t prove to you that I’m not mentally ill, which is a convenience to the mental death system.

    But, more importantly, I understand that we don’t have a clue what mental illness is nor what causes it. We can’t reliably diagnose it and we can’t effectively treat it. What we do know is that oftentimes people are troubled. We do know that there’s lots about modern society that breeds these troubles. We do know that if we load some of these troubled people up with atypical antipsychotics, they bother us less. Ditto ADHD kids on speed.

    The current state of psychiatric research is appalling. It is going nowhere. My introductory psych textbook states unequivocally that schizophrenia is a brain disease (yet refers to all the others as psychological disorders). There’s nothing special about schizophrenia except the shaming and abuse that we permit against those unfortunate enough to be so diagnosed.

    You might want to consider these points before mouthing off some more about these magical tests and research findings that are never, ever going to surface. You might want to investigate the spectacular success stories of many so-called “mentally ill individuals” who recovered without “medical” intervention. You might even want to consider that your attitude (all too common) is exactly what drives our persecution.

  119. sonicon 05 Oct 2013 at 12:43 pm

    steve12-
    I’m wondering about a hypothetical–

    Let’s suppose a genetic test for ADHD becomes available.
    Now we give this test to a group of kids.
    Turns out the kids who test positive aren’t all on drugs.
    Turns out a bunch of the kids on drugs don’t have the genes.

    What to do?

    Do you give the drugs to the kids with the genes who haven’t been taking them?
    Do you take all the kids who don’t have the gene off the drugs?
    Or does this depend on the behaviors of the kids?

  120. steve12on 07 Oct 2013 at 12:31 am

    Mlema, you have crossed over. You are now a denialist.

    You say:

    “But insisting that MI is genetic and neurological means…”

    IT HAS NOTHING TO DO WITH MY INSISTENCE!!!!!!!!!!!!!!!!!

    I have given you COPIOUS evidence that psychosis is genetic.
    I have given you COPIOUS evidence that psychosis has group level biomarkers
    I have given you COPIOUS evidence that 1st degree relatives of those w/ psychosis (but not those w/o) show many of the same biomarkers and genetics

    And you continually ignore (NOT challenge) that evidence, and ask for it again and again and again. And then you say there’s no such evidence your aware of. Can I maybe provide you with some links? Maybe for 43rd time?

    At some point it becomes clear: you don’t wanna know. You don’t wanna open your eyes and see the reality.

    What is this if not denial? So believe what you feel like you want to believe in…

  121. steve12on 07 Oct 2013 at 12:33 am

    # sonicon 05 Oct 2013 at 12:43 pm

    I’m not sure any of these kids should be on these drugs. And I have no idea what this has to do with my saying that phenotype+genotype = pathophys.

  122. steve12on 07 Oct 2013 at 12:33 am

    “you and steve12 have no more evidence for drugging, shocking, frying brain tissue, and incarcerating the people you’ve labeled mentally ill than the nazis had for gassing Jews.”

    Wow. Just, wow.

  123. steve12on 07 Oct 2013 at 12:42 am

    Sonic:

    “There are no biological test or markers currently in use to determine these diseases. That’s because there are none known.

    Those are the facts.”

    Noooo they are not the facts! There are many, many biomarkers that differentiate groups – even with first degree relatives of those afflicted. YOu should be aware of this because I’ve pointed it out 15 million times, with links!!!!!!

    “Now you say there is good reason to think that a test will be found and this will be coming soon- and I agree– there are reasons to think the tests will be coming. The genetics and so forth are pretty convincing.
    But reasons to think something is a certain way and reality don’t always match.
    Nobody thought quantum mechanics would be the way it is, for example.”

    The group tests are sufficient for showing this. So guess what? They are here now.

    “I’ll know there is a test when I see it and it has been demonstrated accurate.”
    Apparently you know it somehow else. OK. But I don’t know it somehow else.
    Is that an anti-science stance on my part?”

    No, you’re just not familiar with the literature. But I ahve pointed that literature out many times to you and Mlema and Cannotsay in that long epic post previously.

  124. steve12on 07 Oct 2013 at 12:52 am

    Francesca: explain the following:

    Why do first degree relatives of people diagnosed with schizophrenia differ from first degree relatives of people NOT diagnosed with schizophrenia genetically *AND* on biomarkers like startle response, contrast sensitivity, electrophysiological responses, etc?

    If schizophrenia is not a brain disease, why is this true?

  125. steve12on 07 Oct 2013 at 1:12 am

    And just one more point on Mlema comparing me to Hitler over and over….

    Ya know Mlema, we make basic science findings. Folks like you and Francesca and Cannotsay have political axes to grind, and many times don’t like those findings. So instead of take on the evidence, you use demagoguery to try and invalidate us, like reaching for Nazi comparisons.

    I have an idea: why not take on the evidence instead? Comparing my work to that of the Nazis is as irrelevant as it is sleazy and shameful.

  126. Mlemaon 07 Oct 2013 at 6:22 am

    Steve12, you’re being overly dramatic. I absolutely did not compare you “to hitler over and over…”
    Neither did I compare your work to the nazis. Can’t you read?

    So, here it is again:
    You may think that you have nothing to say regarding clinical issues. But insisting that MI is genetic and neurological means: medical intervention with drugs and surgery. shock, etc. The cause determines the treatment.
    Also, you’re using the term “mental illness” when i believe you are in fact really just referring to a tiny percentage of the millions diagnosed with “mental illness” – a percentage of the 1% diagnosed with SZ. While at the same time, the head of the NIMH has admitted that the DSM is a complicated symptom-labelling system with no medical evidence, and that SZ may be a developmental problem.

    You’re the one who’s being sleazy and shameful for accusing those who’ve suffered because of this pseudoscience of having “political axes to grind”. Nice. Obviously you have no idea what psychiatric treatment is like. I guess people who’ve gained 100 lbs and become diabetic, or little kids who’ve developed tardive dyskenesia, or people who’ve hurt or killed themselves, or hurt or killed someone else…all have political axes to grind? And those are just the most glaring.
    Side Effects. Anti-Depressants
    http://www.youtube.com/watch?v=lONSsOJBG_I

    The model: ‘mental illness is brain problem’ CAUSES the development of these drugs, along with burning little pieces of the brain or electroshock – BECAUSE the cause determines the treatment. As long as we refuse to see: behavior, including thoughts, which affect mood and further behavior, IS THE ORGANISM’S RESPONSE TO THE ENVIRONMENT we will continue to develop and use drugs which do not address the CAUSE of the problem. You really ought to familiarize yourself with the side effects of some of this treatment. It’s fine to look for the organism’s correlations of whatever behavior you’re referring to as sick – but if you think you are looking for a cause that will allow you to “cure” the mental illness, you have no history to support that. What is it that you’re envisioning? Do you think we’re going to find genes for depression that we can do therapy on to cure depression? That shows a fundamental lack of understanding for the psychological/environmental causes of depression. Research on depression running in families has the same flaws that much of psychiatric research has – it assumes the cause. If mental illness is genetic why is one’s socioeconomic status such a large factor? You’re not suggesting wealthy people are genetically mentally healthier? Hmmm….

    Diagnosis is everything in psychiatry.
    Some schizophrenia may be a biological disorder. It may have something to do with the environment of the womb. Or an aging father’s sperm. And you will like this:
    http://www.newscientist.com/article/dn23995-genetic-discovery-links-autism-and-schizophrenia.html#.UlKCLCTXGX1

    But, at the same time, whether or not a person lives in an urban setting is a greater determinant of sz than having a relative who’s sz. How can this be? Because we still diagnose schizophrenia based on behavior. So, it is not homogeneous, and anyone whose behavior is weird or troublesome can be diagnosed with schizophrenia.

  127. Mlemaon 07 Oct 2013 at 6:24 am

    Now, is this argument all because you’re using the term mental illness to refer to schizophrenia? When in fact 20% of the US population has been diagnosed with mental illness?
    http://www.samhsa.gov/newsroom/advisories/1201185326.aspx

    Maybe if you’d educate yourself a little more about what these problems are, that you’re calling mental illness, while meaning to refer to some subset of those diagnose with schizophrenia, I wouldn’t have to say: you and JohnMc have no more evidence for drugging, shocking, incarcerating, etc. the people you label mentally ill than the nazis had for gassing the Jews.

  128. BillyJoe7on 07 Oct 2013 at 7:06 am

    Steve,

    “we make basic science findings…
    you…have political axes to grind”

    I think this is a the real problem.

    If you start with a particular political stance and you look to science for supporting evidence, you are always going to end up in denial. You’re always going to be cherry picking every skimpy bit of evidence that supports your pre-determined point of view and you’re always going to be denying the vast majority of the evidence that doesn’t.

    The science must inform the politics.

  129. steve12on 07 Oct 2013 at 9:35 am

    “I absolutely did not compare you “to hitler over and over…”

    OK. Someone else logged in and said these things?

    “I wouldn’t have to say: you and JohnMc have no more evidence for drugging, shocking, incarcerating, etc. the people you label mentally ill than the nazis had for gassing the Jews.”

    “the nazis said the Jews were mentally defective. And they said they proved the genetic basis: they were Jews.”

  130. steve12on 07 Oct 2013 at 9:52 am

    “I think this is a the real problem.”

    Right BillyJoe. And it’s why I just need to refuse the trip down the rabbit hole, repeating the same things over and over only to be ignored and asked to repeat yet again.

    It’s futile because the objection is not scientific but political, so it’s sort of dopey for me to continue arguing scientifically.

    So on a political note, we should all remember: next time you see someone ranting and raving that the CIA is after them, they look filthy and they’re living on the street, they’ve been beaten, robbed or worse and seem absolutely terrified, you should smile!

    THAT lucky dog has escaped the literally Nazi-like clutches of psychiatry! Those drugs that he COULD be on, that would at least help stabilize him or her? They’re unneccessary because, really, who’s to say what mental illness is? He’s chosen this life, and we should be happy for his decision. And anyway, those drugs have Nasty Side Effects!

    While this existence seem cruel and unusual, keep in mind: while YOU may like a hot mean and warm bed at night, some people prefer eating the marrow from a chicken bone they find in the gutter. Who are we to tell him he’s wrong? To deprive him his right to live this way would be similar to what the Nazis did.

  131. Francesca Allanon 07 Oct 2013 at 10:33 am

    Steve12, you wrote:
    “Francesca: explain the following:

    Why do first degree relatives of people diagnosed with schizophrenia differ from first degree relatives of people NOT diagnosed with schizophrenia genetically *AND* on biomarkers like startle response, contrast sensitivity, electrophysiological responses, etc?

    If schizophrenia is not a brain disease, why is this true?” and I’d be happy to.

    First of all, startle response isn’t a biomarker and neither are any of the diagnostic criteria for SZ. You can’t diagnose on the basis of genetics, beyond saying “Hey, her mum has SZ too!” Most biological children live in the same family home or are closely connected to each other. It’s not a surprise that the same psychological factors sometimes impact more than one family member. Both my sister and I suffer(ed) from eating disorders but it’s a mistake to conclude, therefore, that it must be genetic. Twin and adoption studies are hopelessly flawed.

    And, to answer your question accurately, let’s look at it again: Why do first degree relatives of SZs differ from first degree relatives of normal? I would suggest that much of this supposed difference is due to confirmation bias on the part of the researchers. The guy who purports to prove the genetics of mental illness will win a Nobel Prize.

    Now, Steve12, I have a question for you: If SZ is a brain disease, how can you recover from it without messing with the brain? Name me another neurological disorder that you can do this with.

  132. Francesca Allanon 07 Oct 2013 at 10:35 am

    Steve12, you say: “Noooo they are not the facts! There are many, many biomarkers that differentiate groups – even with first degree relatives of those afflicted”

    Then why on earth can’t you take a patient and search for the biomarkers to conclude that he does/doesn’t suffer from schizophrenia?

  133. Francesca Allanon 07 Oct 2013 at 10:43 am

    Steve12, I have no political axe to grind. I am simply pro-recovery. I want to do everything that I can to help people recover from emotional distress. I’m not a “science denier”; I simply am stating that psychiatry is not science.

    You know, I had ten years of my life robbed from me due to misdiagnosis, mistreatment, etc. If mental illness was a brain disease, life would have been much easier for me. I could have corrected the so-called “imbalance” or ameliorated the so-called “anomalies” and got on with my life. I’m not an idiot: I chose to do the things that I knew would cure me. And, surprise! I recovered.

    And I agree that calling you a Nazi is absurd and I hate it when people get angry enough to do stuff like that because it undermines the credibility of our movement. You’re not a Nazi; you’re just a very arrogant, dismissive man who belittles those who disagree with you.

    Could we move on from the neuroscience debate and talk about the implications of supposed “broken brains” and social policy? Please? You said upthread that you wouldn’t because you’re not a clinician. You are, however, a citizen. What are your thoughts on forced treatment? The whole rationale for forced treatment rests on the assumption that we’re dealing with a legitimate disease here. I really, really want to know what you think.

  134. Francesca Allanon 07 Oct 2013 at 10:52 am

    Steve12, one last comment before I go:

    All of this “scientific” research is suspect because it rests on the assumption that schizophrenia is a discrete entity. So when we’re comparing first degree relatives or those on gluten-free diets or any, any differential you want to use, we don’t even know what we’re counting. The error rate on psychiatric diagnosis approaches 50%. Is this really accurate enough to proceed on? Can’t you see that when one family member is diagnosed that it makes it more likely that any “abnormal” behaviour will also be attributed to SZ because we’ve decided a priori that the “disease” is genetic?

    And please don’t be like E. Fuller Torrey and suggest that the typical schizophrenic is naked running down the street with a meat cleaver. Yes, I know, we have terribly troubled street people. We also have a dearth of appropriate housing and social programs. And, as somebody who has been both, I can tell you that life on the street is vastly better than life in and out of a psych hospital.

    As an aside, it’s a funny thing about delusions. Thinking there’s a guy up there in the sky watching everything you do: okay. Thinking you’re a turtle persecuted by the CIA: not okay.

  135. steve12on 07 Oct 2013 at 11:34 am

    Francesca:

    YOu are simply unaware of the state of neuroscience research as it pertains to schizophrenia.

    There are problems with diagnosing schizophrenics. This is probably one of the reasons why we compare GROUPS – those diagnosed with schizphrenics vs. those not diagnosed. Will a few that don’t belong sneak into the groups? Sure – but that only hurts are efforts to find differences.

    If these differences are stable and replicable, are genotypical and phenotypical, **AND** exist in first degree relatives, it becomes highly unlikely that they are not caused by a brain condition. If there’s no specific differences in the brains of those diagnosed as schizophrenic, how come I can predict who was diagnosed as schizophrenic and who was not by examining their parent’s low level perceptual performance and genetics? Did the diagnosis change their parent’s genetics and contrast sensitivity?

    “And, to answer your question accurately, let’s look at it again: Why do first degree relatives of SZs differ from first degree relatives of normal? I would suggest that much of this supposed difference is due to confirmation bias on the part of the researchers.”

    This is a good example of denialism. YOu simply cannot dismiss HUNDREDS of papers representing converging evidence from multiple fields by saying it all must be confirmation bias! Catch-all phrases are insufficient for these purposes. This is not politics. You need to be a lot more specific, and you need to go result by result, paper by paper.

  136. sonicon 07 Oct 2013 at 1:31 pm

    steve12-
    Sorry- I agree that perhaps none of these kids should be on drugs and I agree this had nothing to do with what you were saying about the disease being genetic.

    If the tests are available, then why are they not in use?
    Seems we have a potential for a great deal of money to be made here.

    If you are willing to testify that genetic tests exist that prove or disprove a person having mental illness– then we can sue any one who has labeled a person ‘mentally ill’ or ‘not mentally ill’ for failing to do the test (as they are never done– right?)

    All we have to do is find a few people who say they have been harmed by the mislabeling– and that isn’t too difficult- then we get a judge to buy your story the tests exist– we can make bank here.
    A case like this would bring in millions per judgement– we can get 1000′s of these cases.
    (I know the lawyer to handle this all ready.)

    We can make bazillions on this.

    What say you?

  137. steve12on 07 Oct 2013 at 2:23 pm

    Because, as I’ve already said:

    “Can’t diagnose individually, true, because the phenotypical expression is to varied, and probably for other reasons that we don’t yet understand. We can tell groups apart though.”

    How many times can I repeat the same things?

    Ya know what – you guys win. There’s no such thing as mental illness. It’s just a construct made up by psychiatry.

    Those thousands of papers I cited? Nonsense. You were all quite right to disregard them or dismiss them w/o consideration.

    You know better than everyone else. so believe what you wanna believe.

  138. sonicon 07 Oct 2013 at 3:28 pm

    Steve12-
    When did I say that mental illness wasn’t real?
    I’m saying there aren’t objective biological tests to determine if a person has any of the diseases or not.
    A person.
    We agree on that– right?

    I am interested in if there is a test to determine if a person has a particular disease. That’s how I would judge if there is a test for the disease or not, since it is an individual that either has or doesn’t have the disease.

    Perhaps your position is more nuanced than mine.

  139. Hosson 07 Oct 2013 at 4:11 pm

    Sonic
    “When did I say that mental illness wasn’t real?”

    “I think what causes ADHD is the same thing that causes any mental disorder.
    It has to do with losing site between the difference between one’s imagined world and the actual world to an extent that it bothers others or causes one to become dangerous to himself and others.
    I’m not comfortable explaining the hypothesis further right now.”

    Now is the time to actually explain the hypothesis you speak of. I’m mostly interested in the contrast between your hypothesis and modern psychiatry.

    I’m asking you to do this because you’ve been using denialist arguments(or maybe like a denialist), yet claim not to be a denier, which is fine but confusing.

    Steve12
    I commend you. You lasted longer than I did. I quit after the first Gish Gallop, but I found Sonic’s last comment too annoying(sorry sonic, but to anyone who is not a psychiatry denier, you’re being annoying as hell) to not jump back in.

  140. BillyJoe7on 07 Oct 2013 at 4:35 pm

    Hoss to sonic:

    “you’ve been using denialist arguments…yet claim not to be a denier, which is fine but confusing”

    You should hear him on climate change!
    …and evolution.
    …and GM foods.

    I’m afraid sonic is a contrarian.
    Give him the consensus view of the experts in any field of enquiry and he’s against it.
    And there are plenty of non-experts and experts-with-fringe-views that he can link to and quote.

    Come on, sonic, admit it, you’re just a contrarian.

    “explain the hypothesis”

    I wouldn’t hold your breath
    I’m still waiting for his hypothesis regarding directed mutation.
    And that argument has been going on for three years!

  141. Hosson 07 Oct 2013 at 5:04 pm

    BillyJoe
    I’m trying my best to hold back from ripping these deniers new cornholes using satire. Out of respect for this blog, I’m highly censoring my humor, which I’d describe as a mixture of George Carlin and Bob Saget.

    Right now, I keep getting these images in my head of a bunch of kids with mental illness surrounding the deniers from this blog and beating the