May 21 2013

The Genetics of Mental Illness

You are currently browsing comments. If you would like to return to the full story, you can read the full entry here: “The Genetics of Mental Illness”.

Share

598 responses so far

598 Responses to “The Genetics of Mental Illness”

  1. ccbowerson 21 May 2013 at 10:55 am

    “In most areas of medicine, diagnoses are based on the cause of illness.”

    This is true when possible, but often it is not in all areas of medicine. The reason why this statement in that Wired article is misleading is because it impies that psychiatry has a fundamentally different approach than the rest of medicine, when really the difference is due to the nature of the brain and level of understanding. Its not like psychiatry is unconcerned with etiology and pathophysiology, it’s just that specific clinically useful information for psychiatric conditions is still limited.

    Understanding the causes of conditions are helpful to the extent that they help with treatments. A good example is hypertension, since it affects a large percentage of the adult population and the causes are not determined for 90%+ of people. That does not prevent the effective treatment of essential hypertension, however, as treatments are judged by their effectiveness of lower blood pressure and (more importantly) preventing cardiovascular complications from hypertension. In theory, having patient specific information about the specific causes of any disease is preferable, but not having such information due to limitations does not prevent us from identifying the best treatments from a population level. With hypertension you may never know that one treatment may be more effective for a given person, but you go with the best information you have.

  2. Ori Vandewalleon 21 May 2013 at 2:05 pm

    I know there are people opposed to psychiatry who claim that (some) psychiatric disorders don’t exist at all, but I also know that there are some who merely claim that psychiatric treatments don’t work. Usually they point to things like anti-depressants and psychotherapy.

    While scientists are busy investigating the neurological origin of mental disorders, how goes research into the neurological effect of treatments for mental disorders? It seems these are related but not one in the same. As our understanding of the brain increases, do you think it’s more likely that we will thoroughly replace the treatments now used or that we will simply refine them?

  3. cannotsay2013on 22 May 2013 at 12:14 am

    “I believe reports of the death of psychiatry are exaggerated”

    Let me respectfully disagree. Now we have the director of the NIMH on record bluntly admitting that,

    “the weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever”

    I month ago, anybody making such “outrageous” claim would have been dismissed as an antipsychiatry nutcase. Panicked, the chair of the DSM-5 task force, David Kupfer, wrote a few days later “We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

    Reading these two the only thing that seems clear is that the late Thomas Szasz would have a very good plagiarism case if he was alive. The NIMH and the APA issued a joint/travesty statement that does not deny any of that but tries to do damage control.

    Here is the other problem of the “damage control” that the defenders of psychiatry have to reconcile. While it is true that in other areas of medicine clinical symptoms are used for diagnosis, psychiatry does not look at symptoms but BEHAVIOR. So a more accurate way of saying what Insel said is,

    “the DSM diagnoses are based on a consensus about BEHAVIOR”.

    That my friends is exclusive to psychiatry. And it is no different from other times when a group of self selected “mind guardians” decided which behaviors were normal and which weren’t.

    Homosexuality is the best vehicle to illustrate the psychiatric fraud,

    - There is no question about the “reliability” of the description of somebody being “homosexual”. He/she is sexually attracted to individuals of the same sex while 95% of the population is sexually attracted to individuals of the opposite sex. It is probably accurate to say that no other so called “DSM diagnosis” provides a level of reliability as the identification of somebody as “homosexual”.

    - Because the issue of homosexuality is so contentious, there is probably more studies that give light to the conclusion that a mixture of genes (twin studies), environment and personal choice (people who have voluntarily reversed themselves) causes it. No other so called “DSM diagnosis” has been studied so deeply.

    Yet the decision of whether homosexuality is an “illness of the mind” is purely political. With a single vote, in the early 1970s the APA eliminated an epidemic that affected 5% of the population.

    That’s what the distinction “reliability” (which BTW is pretty awful in DSM-5) vs “validity” means. Each and every single one of the DSM diagnoses is political. Period.

    Other areas of medicine, even those that rely more on symptoms, do not make judgements about which behaviors are “normal”. And that’s why psychiatry’s days are numbered. Let me give you an example of how things might proceed.

    It all will come down to some legal case, carefully chosen, that was decided on the assumption that a DSM diagnosis is scientific and in which somebody was badly damaged because psychiatry was forced into him/her. Now that the top guys in the profession agree that it is not the case, the decision on that case could be challenged and get all the way up to the US Supreme Court. If the SCOTUS rules as it has ruled in the past against psychiatry, that could end up depriving psychiatry from all of its coercive powers. That would be enough to kill the so call “specialty” for good. For the first time in a long time, I am hopeful that I might see this happen in my life time. One month ago, I was resigning myself to being one of the numerous and anonymous victims of psychiatry.

  4. Sherringtonon 22 May 2013 at 12:54 am

    A related problem to the ones discussed by Steve is that drugs for schizophrenia and depression have for decades been based on rather simple ideas of the causes — too much dopamine activity for the former, and too little monoamine (serotonin, norepinephrine) activity in the latter. As a recent article in Science News noted, more money needs to be spent on basic research to get a better grasp of these conditions. It’s funny how a common theme in psychiatric drugs is that the first ones are discovered by accident — the first antidepressant was actually a tuberculosis drug that, it turned out, also improved people’s moods — and then later drugs are made that just do the same thing at the synapse. Although many antidepressants do raise the levels of certain neurotransmitters, they do this within hours although the effects on depression don’t occur for a couple of weeks, suggesting the mechanism is not so simple. When you add in the recent work suggesting that 75% of antidepressant action may be the placebo effect (except in severe cases), it is even more problematic. I am NOT anti-psychiatry or anti-drug company; I am “pro” more basic research to understand these conditions better.

  5. petrossaon 22 May 2013 at 5:47 am

    The biggest problem for neurologists/geneticists is that due to the way DSM (and other manuals) are setup there exists no unpolluted patient base from which to draw conclusive answers. Autism is a good example how this goes wrong, where people with only autistic symptoms get diagnosed with autism whilst they are not autistic.

    As in for example agenesis of the cc. Some of those get an autism diagnosis till a scan gets made and the agenesis is made clear. Simple indication of the fallacy of the autism criteria.

    So when a researcher tries to find a common cause he’s never going to find one, since the patients largely aren’t autistic but suffer from some other dysfunction making them display autistic symptoms strong enough to pass the tests.

    A new system of classing afflictions needs to be set up, separate and totally from scratch based on more objective criteria.

    Imho a large part of major mental afflictions is biological in origin, most due to white matter variations in the fetus. If one compares schizo and aspergers it’s hard to miss the enormous overlap. The chances that such an overlap happens merely by sheer hazard of environmental influences are infinitesimal.

    As such, working backwards, finding correlations between various toxic agents/maternal environmental factors/whatever are spurious.

    This way you can make a good selection by just throwing out all diagnosed autistics which do correlate to such factors since that is clearly impossible. A delicate, complex, subtle variation in the white and grey matter real autistics have can never get into existence without it being started at the earliest stages of gestation.

  6. Kawarthajonon 22 May 2013 at 9:47 am

    It seems like one of the main issues that many people are raising is the issue of inter rater reliability (IRR) for the DSM-5. I see a variety of perspectives, from this one (http://www.madinamerica.com/2013/03/the-dsm-5-field-trials-inter-rater-reliability-ratings-take-a-nose-dive/), which argues that there is almost no IRR, to these guys (http://psychiatryonline.org/data/Journals/AJP/4396/appi.ajp.2011.11010050.pdf), who argue that the IRR is pretty good and comparable to other medical diagnoses. Here’s a balanced article (http://ajp.psychiatryonline.org/article.aspx?articleid=1555604)

    The IRR of the DSM-5 has only been done in field tests so far, so it will be interesting to see how it will unfold over time. It seems like some disorders are more reliably diagnosed than others. Major Depressive Disorder seems to be one of the less reliably diagnosed disorders, which is a problem given its prevalence in the population.

    Obviously, as a field, it is really important for pschiatrists & psychologists to work on improving their IRR. I think that more standardization of interviewing and more collateral information would be helpful in that pursuit, as well as more follow up with psychiatrists/psychologists. I often see patients who have been seen once by a psychiatrist or psychologist, never to be seen again until they come to my office, having carried a questionable diagnosis with them for years. I’m sure that this happens in other areas of medicine too, but there’s no harm in wanting and trying to improve things. Here’s a brief but good article on how to improve IRR: http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/2106362?pageNumber=2

    It is an interesting debate and I appreciate Steve’s take on the issue.

  7. Ori Vandewalleon 22 May 2013 at 9:54 am

    cannotsay2013:

    Your main claim is that the diseases described by psychiatry are behavioral in nature, and that this differentiates it from other medical fields. Even if we were to grant that premise, it wouldn’t imply that this distinction is a bad one. Many people with psychiatric disorders engage in behaviors that directly harm themselves, that they won’t want to keep doing but find themselves unable to stop. Treating such symptoms would seem to be a goal of medicine.

    But all that aside, your premise doesn’t hold up. There are a multitude of examples of non-psychiatric disorders with behavioral symptoms and psychiatric disorders with non-behavioral symptoms. A couple examples:

    Rabies. Rabies has a distinct biological origin (virus) that doctors can pinpoint precisely, but one of the primary symptoms of rabies is a definitively behavioral one. People with rabies experience uncontrollable anger, excitement, and mania.

    Schizophrenia. Schizophrenia is a classic psychiatric disorder involving some very destructive behaviors. It can also involve hallucinations, which are most certainly not behaviors. Hallucinations represent some sort of failure in the perceptual system, and in this case that failure is a result of a psychiatric disorder.

    You also talk about the arbitrary nature of psychiatric diagnoses and the fact that homosexuality was voted out as a mental disorder. While situations like that (female hysteria is another example) represent problems in psychiatry, they don’t discredit the concept of psychiatry itself. Instead, they are characteristics of what psychiatry is: a medical field that treats disease which present primarily through behavior. This method has proven powerful, however. Two more examples:

    Dementia. A mental disorder with a history going back thousands of years. Psychiatrists figured out that in many cases, dementia can be classified as Alzheimer’s disease. While this disease presents primarily with behavioral symptoms, there are other symptoms as well, and Alzheimer’s also has distinct biological markers.

    General paresis of the insane. A disorder characterized by psychotic episodes, depression, and mania. But after sufficient study, it was determined that people with this disorder actually had late stage syphilis, a bacterial infection.

    In both cases, insights into these diseases were made because doctors paid attention to behavioral symptoms. These symptoms are the surface manifestations of underlying diseases. And this resonates with what Dr. Novella has said. The hard part of psychiatry is figuring out what the mechanism is that leads to a mental disorder.

    What this all represents is that there are a great variety of ways in which humans can breakdown. We are biological in nature, and biology isn’t perfect. If our brain malfunctions in some way, this can present in a purely physical way (loss of sight), a purely behavioral way (mood disorder), or some combination of the two. A purely behavioral malfunction is not any less real than any other malfunction, and not any less deserving of treatment.

  8. Kawarthajonon 22 May 2013 at 10:29 am

    cannotsay2013:

    When discussing the issue of “homosexuality” being taken out of the DSM a number of decades ago, I would have thought that this would be an argument in favour of the fact that the DSM editors/contributors are trying to get things right.

    I’ll also remind you that “medicine” used to be based on the unscientific and utterly wrong belief in “humours”. Do we then throw out the whole field of medicine because of a past belief in a nonsense theory? No, we don’t. We attempt to scientifically validate our hypotheses of what constitutes a mental illness and reject the notions/hypotheses that turn out to be invalid. This process took a long time to do in medicine (read up on the olde timey debate between physicians on the cause of cholera) and it will take a long time in psychiatry. The DSM-5 is a step, however imperfect, in the right direction in my opinion, although you are free to disagree with me.

  9. cannotsay2013on 22 May 2013 at 10:43 am

    Ori,

    Actually, the examples you provide are the prime reason why psychiatry is such a fraud. Both dementia and the symptoms related to late stage syphilis are understood as having biological causes and they do not belong to the realm of psychiatry anymore. Dementia is now considered a neurological disorder while syphilis is treated as an infectious disease. Same with rabies.
    Furthermore, while many decades ago, a syphilis/rabies/dementia diagnosis might have been reached based on behavior alone, that is not the case today. Even dementia, which is one in which biology might place a lesser role during the diagnosis process, is identified by precise by presence or absence of cognitive ability and only as a proxy to measure neurological damage (ie, the assumption is that the brain is diseased in one way or another).

    Schizophrenia, is, as are all other DSM disorders, “invented”. There is not a single biomarker to detect presence or absence of “schizophrenia”. In addition, unlike homosexuality, the field tests of DSM-5 show that a “schizophrenia” diagnosis is unreliable http://www.psychologytoday.com/blog/dsm5-in-distress/201205/newsflash-apa-meeting-dsm-5-has-flunked-its-reliability-tests (Cohen’s kappa of 0.46). In other words, there is a lot of subjectivity in assigning the label “schizophrenic”. As some have already pointed out, 2000 years of Western history are based on the predicament of somebody who would have no doubt be labelled as “schizophrenic” by psychiatrists today (that would be Jesus). The same is true in the Islamic, Hindu and Chinese traditions with different leaders.

    So what the DSM does, plain and simple, is to pathologize those behaviors that DSM committee members find objectionable. Absent science (now both the NIMH and the APA agree to the lack of scientific validity in DSM diagnosis), it’s those members’ bias that plays the main role in deciding what’s normal. Again, not very different from theologians agreeing to “who’s normal and who isn’t”. Having an MD degree is irrelevant. They could have a PhD degree in classics or in mathematical analysis (or no degree at all) and they would still be able to do the same job: pathologizing behavior they are biased against. Another example, along the lines of DSM-5, is the elimination of bereavement exclusion in depression. So before “DSM-5″, it was OK to feel “depressed” when you lost a loved one but now if you are sad when a loved one dies, you have a “mental illness”. That is what we are talking about here.

  10. Bruce Woodwardon 22 May 2013 at 10:43 am

    Cannotsay12:

    “Let me respectfully disagree. Now we have the director of the NIMH on record bluntly admitting that”

    The NIMH in the UK is the National Institute for Medical Herbalists, I actually did a double take there because I was wondering what the heck they had to do with mental health.

    Also… it would be really sad if psychiatry were to go and change the way it does things and grow from the mistakes it makes in the past, let me go take that Homeopathic remedy for Smallpox before an outbreak starts…

    People make mistakes, science makes mistakes and sometimes goes along with the population consensus, but as new things are learned it grows and as Steve said it will most likely be a very different discipline in 50 or 100 years due to us understanding the brain a little more and maybe even understanding consciousness a little better. If it refused to budge like some placebo based medical professions, then you may have a point, but your pointing out it’s willingness to change based on evidence is actually a positive for the field.

    I am at a bit of a loss as to what you are saying does not exist and is purely political… Autism? Bulimia? Anorexia? Would you deny doctors the chance to treat people who have these illnesses? Or would you just turn them away and tell them to “get over it”?

    It seems you had a problem with treatment yourself, but does this invalidate all of psychiatry?

  11. Bruce Woodwardon 22 May 2013 at 10:58 am

    “pathologize”

    You are intent on portraying being diagnosed with a mental illness as a wholly negative for the patient.

    Again, your bad experience does not invalidate the whole field and all the good it is doing to millions of people every day.

  12. Ori Vandewalleon 22 May 2013 at 11:36 am

    cannotsay2013:

    The Periodic Table of Elements was organized without any understanding of the physical principles underlying chemistry. It was simply observed that certain groups of elements behaved and reacted in similar ways. For a very long time, that’s all chemistry was: observing the behaviors of substances.

    And then quantum mechanics and the exclusion principle came along and gave a concrete mechanism by which chemical processes occur. Does that make chemistry fraudulent?

    But despite QM’s success in explaining the underlying principles of chemistry, the vast majority of chemistry far, far too complicated to be described in a quantum mechanical way. Chemists mostly trust (for very good reason) that deep down it’s still QM happening while using higher level abstractions to explain chemical processes.

    So we continue doing chemistry today, even though it is true beyond a shadow of a doubt that everything we say is chemical is really quantum mechanical, and that there are no true, pure chemical events. Surely chemistry is not a real science and chemicals are invented by chemists.

    Additionally, what of the hallucinations that present with schizophrenia? Are they invented, too? Have we all hallucinated schizophrenia’s hallucinations?

  13. Ori Vandewalleon 22 May 2013 at 11:52 am

    More to the point, you’ve already conceded that psychiatry has, in the past, identified real diseases. But you’re claiming that at present, no diseases described by psychiatry are real. This seems unlikely to be true. It’s much more reasonable to believe that some psychiatric illnesses have common neurological origins, some have infectious origins, and some may be a poor understanding of what should be classified as neurotypical behavior. I see no reason to believe that, at this stage, we’ve uncovered every single factor that can negatively affect the brain.

  14. steve12on 22 May 2013 at 12:45 pm

    “There is not a single biomarker to detect presence or absence of “schizophrenia””

    Come up with better nonsense. This rivals your facile computer analogue of how the brain works that explains nothing. You’re using the complexity of the disease as a smokescreen, because the same markers don’t always express themselves the same way across individuals, making diagnosis with these markers difficult. But to deny the group data (healthy controls vs. SZs) is absurd, and this is how you’re justifying your claim of 0 biomarkers.

    How do you explain genetic propensity to have SZ when controlling for rearing? Or why 40% 1st degree relatives of SZ show the same dysfunctional pattern of eye tracking that SZ show (along with many performance on many other low level visual perception tasks).There are many such findings – please give me the alternative explanation for all of these group differences – and this is a small sample pulled off of google scholar (though pay special attention to the first one, as it undercuts many of your claims re biomarkers and mental illness generally):

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962129-1/fulltext
    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0009166
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665704/
    http://archpsyc.jamanetwork.com/article.aspx?articleid=204685
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879227/

    If you wanna claim that SZ is real, but our culture’s reaction to is pathologizing, go for it. There’s some truth to this. But SZ having no bio basis is absurd. I know that it’s time consuming, but do some homework, then make your claims.

  15. steve12on 22 May 2013 at 1:34 pm

    Comment awaiting moderation? Was it something I said?

  16. ccbowerson 22 May 2013 at 2:35 pm

    “So when a researcher tries to find a common cause he’s never going to find one, since the patients largely aren’t autistic but suffer from some other dysfunction making them display autistic symptoms strong enough to pass the tests.”

    Your statements are framed in a way that assumes that there is one “true” autism with a single cause and that there are other conditions that are incorrectly getting lumped in due to the criteria used (but those conditions are otherwise not autism). The problem with this framing is that autism is defined by those criteria, so if there are many potential causes that may be identified in the future, but I’m not sure it is fair to say that any one of those distinct conditions was the “real” autism the all along. I would view that senario more like breaking up the diagnosis of autism into potentially more specific/accurate diagnoses that take the identified differences in etiology and manfestations into account. We don’t have that information yet, so that is why we don’t have those distinct diagnoses, but I’m not sure when we have that information that we will look back and say that only one of those conditions was the one true autism.

  17. petrossaon 22 May 2013 at 2:56 pm

    ccbower, imho there is only one autism but in varying degrees of success. The basic point is that it must be the neurological condition, but evidently due to the complexity of the basic layout of the white matter in the fetus neural pathways may take different directions causing anything from a retarded non-communicative person to a highly intelligent communicative one.

    If you follow any other road you end up in a mess exactly like the DSM, since you can’t separate out other conditions leading to autistic symptoms.

    The most famous cased in point the socalled Rainman who was diagnosed for along time to be autistic but in fact had agenesis of the CC. Which in itself is a dead giveway that white matter plays a major role in autism.

    Given that such a subtle yet unified result springs forth like for example the condition formerly known as Aspergers (CFKAA) makes it highly unlikely it is anything else but a very lowlevel biological phenomenon. You just can’t create such a condition in a year or two due to some toxic agent or other environmental factor

  18. cannotsay2013on 22 May 2013 at 3:30 pm

    To my critics,

    Sure I had a bad experience with psychiatry,

    http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770

    Many people (actually based on my own anecdotal experience MOST people) have had their lives ruined by psychiatry. But discounting my opinion based on that is like saying that victims of rape cannot talk about rape. I can assure you that no victim of rape would feel better if the abuse he/she suffered was described in such rosy terms as “intimate relationship between two people in which only one side agrees to the relationship” or “making love without the consent of the loved person”. Describing the abuse that I, and many others, have endured as “mandatory treatment” or “hospitalization for medical reasons” doesn’t make it any better. It just adds insults to injury.

    On the matter of the analogy to chemistry, again, a bad one. Chemistry has been accurate “measured”. You can make experiments such as if you mix this “amount” -that can be measured precisely- of this chemical with a different amount of that other chemical you get such amount of a third chemical. This statements can be made precise, so do predictions based on current knowledge. The same is true for physics.

    What are psychiatry’s points? First, all their invented illnesses are based on “behavior” -which is different from cognitive ability because said ability can be measured with things such as IQ tests and the like- such as,

    - if you eat “too little” you are mentally ill.
    - if you eat “too much” you are mentally ill (this is a DSM-5 innovation).
    - if you are sexually attracted to people of your same sex, you are mentally ill.
    - if you are sexually attracted to people of the opposite sex, but think too much about it, you are mentally ill.
    - if you hallucinate you are mentally ill (except if some religious sect recognizes your hallucinations as valid, then you are a mystic or something).

    And so on. I hope people reading this are smart enough to understand the very different nature of making diagnosis based on physical symptoms (such as I have a headache, etc), based on cognitive ability (memory loss, inability to make simple arithmetic when previously it was possible) and based on BEHAVIOR ALONE. I understand that the so called “skeptic” movement hates the idea of an immaterial “mind” but you don’t have to be a believer in God to come to the conclusion that psychiatry is a fraud. In fact, the late Thomas Szasz, who is the true giant here and who has been vindicated during the last month, was an atheist – he was awarded the Humanist of the year award in the 1970s- and was staunchly opposed to psychiatry. He saw it as nothing more than an instrument to do social control that economically benefits psychiatrists and Big Pharma (ie, social control and economics).

    We already have an instrument to do social control, is called the criminal justice system. Since it is understood as such, at least in the West is subject to the control of the people (via voting) and judges. This idea of giving absolute power to self proclaimed “mind guardians” that are accountable to none is preposterous on its face.

  19. ccbowerson 22 May 2013 at 6:03 pm

    “ccbower, imho there is only one autism but in varying degrees of success.”

    As long as that is your humble opinion, then I have little to say about that. Do you agree that the individuals with autism diagnosis is not homogenous? I’m not sure what it would mean to have just one autism, in the context of a nonhomogenous group. I am largely agnostic towards the topic, since the evidence will eventually help elucidate the issue.

    “If you follow any other road you end up in a mess exactly like the DSM, since you can’t separate out other conditions leading to autistic symptoms.”

    I’m not quite sure what you mean by following “any other road.” The road is constrained by the nature of what we are talking about. I’m not sure that we are in charge of that road as much as this statement implies. I do not think that our current diagnostic difficulties are chosen as much as we have limited understanding and are attempting to make do with what information we have. I expect that over time this will improve as we learn more

  20. SimonWon 22 May 2013 at 7:05 pm

    cannotsay2013 you seem to be implying behaviour isn’t measurable.

    Surely for illnesses that are called schizophrenic we can define fairly concrete things, like “makes a counter-factual statement” and simply count the frequency. Sure we all occasionally say something counter-factual, but the frequency is key.

    In practice most psychiatry isn’t making these measurement because the frequency with which most of my friends claim to be generals works for Napoleon is low enough, that any claim of that nature is inherently suspicious (unless they are acting), and my friend who occasionally does make such claims is clearly behaving abnormally during those episode – and the better you know him the easier it gets to spot.

    It is depressing that at this point we really aren’t closer to a better understanding of the diseases, but that doesn’t mean they aren’t real or problematic, nor that psychiatry can’t help, and that is orthogonal to the question of whether psychiatrists have too much power over their patients, or are properly regulated.

  21. cannotsay2013on 22 May 2013 at 9:12 pm

    SimonW,

    I am not implying that behavior is not measurable. I AM AFFIRMING it is not measurable in the way cholesterol levels are measurable or even cognitive abilities are measurable. Finding some behavior pathological (absent a biological cause such as behavior caused by brain damage) is a statement about the bias (political, moral, whatever) of whomever is making statements such as “homosexuality is a mental illness” or “binge eating is a mental illness”. Eating “too much” might be unhealthy for a variety of reasons, but it is not a “mental illness”.

    The appealing to “frequency” is again nonsensical, as nonsensical as being diagnosed with “binge eating”, a new innovation present in DSM-5, if you “eat too much twelve times in three months”. Why 12 and not 11? Or 13? And why 3 months and not 2 or 4? That is totally arbitrary.

    With respect to avoiding the question of coercive psychiatry. It is not orthogonal. Coercion is the only reason psychiatry has the consideration it has. Psychiatry would go to the ash heap of history if was deprived of ALL of its coercive powers. Not all except when I say so, but ALL. It derives its status, despite its unequivocal pseudo scientific methods, from being is a very convenient way by governments to exercise “social control” under the disguise of “science”.

    The irony, of course, is that it’s the only so called “medical specialty” (I put it into quotes because I don’t consider psychiatry to be a legitimate branch of medicine) that lacks scientific validity (agreed by both the NIHM and the APA) but it’s the only one that can be imposed into people. It cannot get more Draconian than this. You are HIV positive and refuse to take antiretrovirals (thus becoming a risk for the public)?, no problem, you are fine. You are labelled “mentally ill”, then so called “treatment” (ie, poisonous psychotropic drugs), can be imposed into you by psychiatrists who regularly lie to do so, by making outrageous and unsubstantiated claims of “dangerousness”.

    Ori,

    I am not conceding anything. What the case of syphilis shows is that as soon as the changes in behavior were found to have a biological cause, the condition ceased to be psychiatric. Psychiatry is in the business of making pathological behaviors DSM committee members don’t like, irrespective of biology. That’s what they have been doing for almost 200 years.

  22. cannotsay2013on 22 May 2013 at 9:32 pm

    SimonW,

    Something else,

    “I AM AFFIRMING it is not measurable in the way cholesterol levels are measurable or even cognitive abilities are measurable”

    I stand by that. But even if that measurement was “possible”, based on what authority does psychiatry decided that some behaviors are “normal” and other are “pathological”? Again, going back to the measurement of cholesterol levels or cognitive abilities. High cholesterol levels are linked with risk of heart disease. A neurodegenerative disease like Alzheimer’s shus down the individual and eventual kills it.

    What business is it psychiatry’s if I fear germs more than the average person? Based on what they threaten family (as they did to mine to justify the abuse) that I was destined to become homeless if left so called “untreated”. Many years later, I have the same, actually higher, standard of living that I had when my ordeal happened. The only way psychiatry altered my social situation is that it caused my divorce and estrangement from my parents. I am far from alone from having been abused this way.

    The people I have been in contact with through the survivor networks in the US speak of similar experiences of abuse. If you think that psychiatrists do not lie or exaggerate their claims to force themselves into people’s lives in the US you are living in an alternate reality. Here is an article on the matter from somebody who knows a thing or two about it because he has gained several important legal battles in the US against psychiatry http://psychrights.org/force_of_law.htm “psychiatrists, with the full understanding and tacit permission of the trial judges, regularly lie in court to obtain involuntary commitment and forced medication orders”.

    So again, how is this different from a group of self appointed theologians defining “normal behavior” based on their own criteria? Actually, it is no different, because psychiatry was historically born to replace those theologians.

  23. steve12on 22 May 2013 at 9:55 pm

    (This is a repost of a comment I have awaiting moderation. I think it had too many links, so I cut them down:)

    “There is not a single biomarker to detect presence or absence of “schizophrenia”

    Come up with better nonsense. This rivals your facile computer analogue of how the brain works that explains nothing. You’re using the complexity of the disease as a smokescreen, because the same markers don’t always express themselves the same way across individuals, making diagnosis with these markers difficult. But to deny the group data (healthy controls vs. SZs) is absurd, and this is how you’re justifying your claim of 0 biomarkers.

    How do you explain genetic propensity to have SZ when controlling for rearing? Or why 40% 1st degree relatives of SZ show the same dysfunctional pattern of eye tracking that SZ show (along with many performance on many other low level visual perception tasks).There are many such findings – please give me the alternative explanation for these group differences, or for this:

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962129-1/fulltext

    If you wanna claim that SZ is real, but our culture’s reaction to is pathologizing, go for it. There’s some truth to this. But SZ having no bio basis is absurd. I know that it’s time consuming, but do some homework, then make your claims.

  24. cannotsay2013on 22 May 2013 at 9:58 pm

    Sorry for posting yet another comment, but there is no “edit” button,

    “psychiatrists, with the full understanding and tacit permission of the trial judges, regularly lie in court to obtain involuntary commitment and forced medication orders”

    And the reason they are able to get away with so much dishonesty goes back to the lack of scientific validity of psychiatric diagnosis. If the prediction was “cholesterol levels are going to double” or “the IQ is going to decrease by 50%”, those things can be tested and measured (and thus falsified when the predictions do not happen). But a value judgement by a psychiatrist based on pseudo science cannot be challenged, so people are left at the will of the judges who incorrectly assume that the guy with the white coat must know something, after all he has an MD degree. Which is no different from judges trusting theologians who, after all, spread the word of God.

  25. starikon 22 May 2013 at 10:03 pm

    Cannotsay2013…

    You’re crazy and everybody but you knows it.

  26. cannotsay2013on 22 May 2013 at 10:06 pm

    steve12,

    There have been many such attempts in the past. Every single one has been found to be invalid because their results could not be replicated. This one will be no different. I note that the paper you mention was published in February. As of April 29th 2013, the NIMH director Tom Insel, is on record saying,

    “The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

    And a couple of days latter, David Kupfer, Chair of the DSM-5 Task Force, agreed that ”biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity” are still “disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

    If your study was the “breakthrough” you claim to be, surely it would have been mentioned at least by David Kupfer to defend DSM-5. It doesn’t cut it my friend.

    Those who argue along your lines need to understand that we are now in a new regime. The criticisms many had made to psychiatry prior to those two statements were equally valid -even if they were dismissed as “anti psychiatry nonsense”, only now they have become official talking points by the NIMH (and although the APA has not adopted those talking points, it has conceded that the criticism is valid). So!

  27. cannotsay2013on 22 May 2013 at 10:09 pm

    starik,

    Reminds me of the accusations of craziness to the Tea Party for saying that the IRS was targeting them….

    Actually, “crazy” remains today a subjective value judgement that has no scientific value. So from a pure scientific point of view, I am no more “crazy” than you or any other reader is “crazy”.

  28. Davdoodleson 22 May 2013 at 10:31 pm

    “- if you eat “too little” you are mentally ill.
    – if you eat “too much” you are mentally ill (this is a DSM-5 innovation).
    – if you are sexually attracted to people of your same sex, you are mentally ill.
    – if you are sexually attracted to people of the opposite sex, but think too much about it, you are mentally ill.
    – if you hallucinate you are mentally ill ”

    This is not correct. All of these behaviours/attractions/incorrect perceptions are (at their highest, and setting aside your doubly-absurd third example) possible signs or symptoms of mental illness.

    They also may very probably be signs of (non-exhaustively and in order):

    -a physical illness or aliment
    -an organic brain syndrome of some sort
    -one’s sexual identity
    -ones’s sexual identity plus horniness, and
    -intoxication, or an organic brain syndrome of some sort.

    It is absolutely standard procedure to rule out organic possibilities first.

    You might ask yourself why you won’t let your points rise, or fall on their own, actual, merits.
    .

  29. cannotsay2013on 22 May 2013 at 10:45 pm

    Davdoodles,

    I don’t understand your comment. What are you trying to say? My only point is that psychiatry is not a scientific endeavor and that “mental illness” remains a metaphor that lacks scientific validity. I think I have stated very convincingly why.

    In fact, the firestorm initiated by Tom Insel only caused controversy among those who had been traditionally defending psychiatry by repeating scientifically “mantras”, “analogies” and “name calling” (such as dismissing as “Scientology” every valid criticism of psychiatry). Tom Insel’s statements were nothing new. Thomas Szasz made exactly the same points, 53 years ago: http://www.columbia.edu/cu/psychology/terrace/w1001/readings/szasz.pdf . The novelty is having such a senior leader adopting that language and having the APA reacting in panic as David Kupfer did. The travesty/joint statement that the Insel/Lieberman issued to do damage control a couple of weeks later changes nothing of that. Add to this, that some quarters of psychiatry are unhappy with DSM-5 (Allen Frances) and I think that psychiatry has been delivered during the last month a blow that if not mortal, will be very hard for psychiatry to recover from.

  30. Davdoodleson 22 May 2013 at 11:20 pm

    You said that psychiatry claims that this-or-that “behavior” equals mental illness.

    Which is completely incorrect. In fact, you’ve rolled several ideas together, none of which are correct.

    First, you claim that psychiatry is only concerned with “behaviour”. It is not. It is, among other things, concerned with WHY, in the absence of organic causation, an unwanted, unusual or dangerous behavior is occurring, and WHAT can be done to assist a person wishing to change it (or, in relatively rare cases, where it is adjudged that a person needs compulsory intervention).

    Second, you claim that psychiatry says that behaviour is, itself, a mental illness. Again, it does not. As stated above, a behavior may be a sign or symptom of all manner of pysiological, organic or mental issues. But the behaviour itself is not a mental illness, or any illness.

    From the above (or for some other reason), you seem to posit that psychiatry is “fraud”. As the claims above are incorrect, they do not support a conclusion of “fraud”.

    So, I’m suggesting that you may have determined, for whatever reason, that psychiatry is “fraud” and then “adjusted” the available evidence to support your foregone conclusion.

    Your argumant certainly resembles the same dissonant contortions Don McLeroy seems to require to arrive most comforably at his conclusion.
    .

  31. cannotsay2013on 22 May 2013 at 11:54 pm

    Davdoodles,

    It seems you didn’t get the memo that dismissing criticism like mine as “anti psychiatry” does not work in the new, post April 29th 2013 NIMH statement world. Let’s begin by the most blunt falsehood,

    “It is, among other things, concerned with WHY, in the absence of organic causation, an unwanted, unusual or dangerous behavior is occurring, and WHAT can be done to assist a person wishing to change it (or, in relatively rare cases, where it is adjudged that a person needs compulsory intervention). ”

    This is like saying that politicians selfless souls that work for the common good. It’s a canard that only true believers believe. If a politician wanted to work for the common good, don’t you think that there are many ways one can affect meaningful change? Politicians are in politics attracted by political power. Psychiatrists are not concerned by the “why” of anything, but rather by using their pseudo scientific DSM to label people. That’s what psychiatrists do: they label people who deviate, behaviorally, from a norm that they themselves have defined. Your appeal to “rare cases” of coercive psychiatry is also a complete joke. While it is true that in the US rates of involuntary so called “treatment” (incarceration and human rights abuse seem more appropriate to me) have been steadily decreasing since the 1970s, that has happened IN SPITE of psychiatry, not because of it. The reason is a series of US Supreme Court decisions, starting with O’Connor v. Donaldson (1975), that made it increasingly more difficult for American shrinks to force their quackery into innocent victims. It’s not lack of “will” on the psychiatrists side, but lack of legal room to do so that is behind the trend. In Europe, where the European Court of Human Rights has repeatedly endorsed human rights abuses like that one repudiated in the US by O’Connor v. Donaldson, so called “involuntary treatment” rates remain stubbornly high, with a rate of 200 involuntary commitments per 100000 inhabitants in Finland (vs ~ 20 in the US in the 2000s). You do the math. I think that the divergence of involuntary psychiatric contact in the US vs Europe rooted in the different legal protections vis a vis abuse speaks volumes of psychiatry’s true colors.

    “you claim that psychiatry says that behaviour is, itself, a mental illness. Again, it does not. As stated above, a behavior may be a sign or symptom of all manner of pysiological, organic or mental issues. But the behaviour itself is not a mental illness, or any illness.”

    Again, psychiatry remains, to this day, doing their diagnosis SOLELY on behavior. If some condition that manifests as behavior, turns out to have a real biological cause, such as Alzheimer’s, it ceases to be psychiatry’s domain. I couldn’t care less about the propaganda that comes out of the APA, psychiatry remains a pseudoscientific endeavor that preys on behavior, nothing else.

    “From the above (or for some other reason), you seem to posit that psychiatry is “fraud”. As the claims above are incorrect, they do not support a conclusion of “fraud”.”

    Your “stuff above” is nothing more than “unscientific mantras” -typo in my previous comment- that those defending your position have been repeating for as long as we can remember. As I said, in the new, post April 29th 2013 NIMH statement world, those mantras do not work even with psychiatry’s true believers.

    So the whole thing was always a fraud, only now we have senior figures admitting to what the average psychiatrist has always known: psychiatry is a pseudoscience. This point was made explicit by one of the psychiatrists that joined the Occupy Psychiatry protest last Sunday (http://new.livestream.com/accounts/3973214/events/2094372 first video, minute 54:30). He spoke there right from the APA convention. I encourage you to watch to what he had to say (I actually encourage you to watch the whole thing to understand the damage that psychiatry causes). So please, stop repeating these discredited mantras (discredited by no other than the director of the NIMH).

    “Your argumant certainly resembles the same dissonant contortions Don McLeroy seems to require to arrive most comforably at his conclusion.”

    In fact, the real scandal is that psychiatry has gotten away for so long with its false analogies (like making the false equivalence headache with behavior or measure of cognitive abilities with behavior) and the lack of scientific validity of its pseudo science.

  32. rezistnzisfutlon 22 May 2013 at 11:58 pm

    Guys, you’re dealing with a troll in cannotsay the likes of AIDS denialists, or young earth creationists. I don’t know why you’re engaging with him seriously, unless it’s for your own edification.

  33. cannotsay2013on 23 May 2013 at 12:02 am

    Davdoodles,

    A survey of human rights abuses endorsed by the European Court of Human Rights (article from 2007, still relevant http://egov.ufsc.br/portal/sites/default/files/anexos/33124-41808-1-PB.pdf ). One example of the type of so called “interventions” that would be illegal in the US but that are perfectly normal in Europe,

    “The case Herczegfalvy v. Austria (10533/83) is characteris-
    tic of the Court’s difficulty in analysing the validity of medical
    treatment. The applicant, who had been on a hunger strike,
    was force-fed and given strong doses of neuroleptics. He
    was also placed in seclusion, restrained with handcuffs, and
    secured to a bed for several weeks on end. The Court criticized
    the lengthy duration of the seclusion and the immobilization,
    but accepted the argument of the Austrian government that
    this type of treatment was justified for therapeutic reasons,
    and thus could not be considered as inhuman and degrading.
    As for the appropriateness of the medical treatment pro-
    vided, various cases such Grare v. France (18835/91) or War-
    ren v. United Kingdom (36982/97) show that the ECHR
    always trusts the psychiatric medical evaluation, as far as it
    satisfies the criteria of usual practice [5].”

    Please spare us from your canards.

  34. cannotsay2013on 23 May 2013 at 12:06 am

    rezistnzisfutlon,

    “you’re dealing with a troll in cannotsay the likes of AIDS denialists, or young earth creationists. I don’t know why you’re engaging with him seriously, unless it’s for your own edification.”

    Actually I am neither an AIDS denialists nor a young Earth denialist. It seems to me, although Novella should know better (in fact, his blog indicates that he knows better) that you are unaware of the controversy created by Tom Insel with his April 29th entry.

    You are resorting to name calling (ie, ad hominem attack) totally ignoring that Tom Insel is on record making his Thomas Szasz’s criticism to psychiatry. We are in a new world. Repeating “skeptic dogmatism” will not cut it this time.

  35. cannotsay2013on 23 May 2013 at 12:28 am

    OK, readers of the Novella-verse. This is the blog I keep referring to,

    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

    “The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

    “The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.”

    Again, this is not Thomas Szasz, it’s Tom Insel, director of the US’ National Institute of Mental Health, the branch of the US government responsible for 1.5 billion dollars a year expenditures in psychiatric research.

    I am just curious why is that Novella does not make any reference to this in his post, when it is this entry that has taken the attack to psychiatry to a complete new level. It’s probably the single most important event for the survivor movement since around 10 years ago the APA was forced to admit that there are no bio-markers of so called “mental illness”, claim that the APA was forced to repeat a couple of weeks ago in response to Insel’s “outrageous” statement.

  36. Mlemaon 23 May 2013 at 1:54 am

    cannotsay2013

    thank you for your comments, which clearly illustrate the problem with psychiatry. Too many healthy individuals have been made unhealthy by treatment for “abnormal behavior”. I don’t think Dr. Novella or the posters here are aware of most of what’s in the DSM. Any individual can likely be diagnosed with a mental illness if they choose to visit a psychiatrist.

    Cognitive-behavioral therapy has proven to be effective for most psychiatric “diseases” – even schizophrenia. As Dr. Novella talks about psychiatrists perhaps one day finding “a subset of what are now called OCD patients as hyperactive disgust response disorder”, I ask myself “what bullshit this?” We’ll then try to find a drug to treat the disgust function of the brain – insanity! If we look more and more closely to find what is the brain difference in “mental illness”, we forget that we may be mixing cause and effect. If there is a medical problem, let the MDs handle it – if it is behavioral, let the psychologists handle it. And continue the medical research that will help us better know the difference.

    I think many of us think of the seriously troubled when we talk about “mental illness”, and I, personally, say that for those, instead of what’s now typically offered (which is a team of professionals who basically try to keep the patient on his meds and managing basic living conditions) we need something more involved. There’s no evidence that the drugs make a bigger difference than simply intensive involvement in the person’s life. In fact, the drugs damage the person’s brain and make managing life more difficult. But these people are a small minority of the population.

    Meanwhile we have tons of healthy kids being diagnosed with ADHD – a “mental disorder”. We’ve got kids with behavioral problems, none of whom are medically unhealthy, being given powerful drugs. And the ones who are unhealthy aren’t getting the kind of care they need: they’re just being drugged along with all the others! It’s shameful what we’re doing to our kids in this way, all for the sake of conformity to the desired norm, and, for convenience.

    I think as a skeptic, it’s easy for me to see the problem. But those in the medical field have a hard time with it because there’s a tendency to see everything as a medical problem. Remembering that it’s still a scientific problem might make it easier to discern the difference. There are reasons why we behave the way we do – sometimes they’re physiological, sometimes they’re psychological, or sociological. And sometimes we can’t explain someone’s behavior in any way at all. But that doesn’t mean that reasons don’t remain – it just means we have yet to find them.

  37. cannotsay2013on 23 May 2013 at 2:18 am

    Mlema,

    You are welcome!
    And I agree with everything you say.

    Psychiatry has an uncanny ability to cause damage across the board. It’s an equal opportunity harmer. It does not distinguish its victims based on religion or political ideology, which is why I am so surprised that the so called “skeptic movement” is general (although there exceptions like you) is so closed minded to the criticism to psychiatry.

    The criticisms against psychiatry are of the same rigor that skeptics usually employ against homeopathy or astrology. Yet, they give a pass to psychiatry for some obscure reason. My only hypothesis is that the average skeptic has a problem with the idea of a “mind” and thinks that by attacking psychiatry they are undermining their “general cause”. However, the opposite it’s true, it’s by giving a pass to psychiatry that they are damaging their cause because from the outside it looks dogmatic to cherry pick which unscientific endeavors are worthy of criticism. Imagine if homeopathic medicines manufactured 80 billion dollars a year (which is the amount of money Big Pharma makes every year out of psychotropic drugs; that’s ~ 15% of Big Pharma revenues worldwide). I am sure that the skeptic community would be “outraged” that so much money is made out of a scam. Yet, that is precisely what is happening with psychiatry.

    In the survivor movement, there are people from all walks of life, believers and non believers, conservatives and liberals, scientists and non scientists, etc. Our commonality is our shared experience of having been harmed by psychiatry, some to a greater degree than others. This is also something that differentiates psychiatry from other medical specialties. I don’t know of any mainstream support group of “survivors to chemotherapy” or “survivors to HAART”. There is medical malpractice in other areas of medicine, but what there is not is cancer survivors organizing against the people who saved their lives, or seropositive people organizing against the manufactures of HAART absent a finding of malpractice. It is one thing for people who have been victims of medical fraud (such as HIV positive blood in the 1980s) recognized as such by courts/public/etc to organize to defend their rights quite another that people who have had access to “psychiatry’s treatments of choice”, who should be “thankful” of the “treatment”, to organize to claim that their lives have been ruined/destroyed by psychiatry because psychiatry has given them the treatments that are considered “mainstream” in psychiatry.

  38. steve12on 23 May 2013 at 3:05 am

    “There have been many such attempts in the past. Every single one has been found to be invalid because their results could not be replicated. ”

    No,no, no

    On the group level, low level visual perception abnormalities like eye tracking and contrast detection have been replicated many times. Look at Steve Silverstein, Yue Chen, Dan Javett, etc. I’m sure that you won’t let your complete lack of familiarity with this work get in the way of summarily dismissing it. But there it is nonetheless.

    Moreover in your response, you are still confusing group level differences and individual diagnoses. Everything you’re saying is true re: diagnosing an individual. The expression of the disease at the individual level shows too much variability to be reliable. But the complex pattern of individual expression does not invalidate stable, replicable biological group differences, especially where genetics is concerned.

    And just a hint: you can’t dismiss scientific papers like this:
    “If your study was the “breakthrough” you claim to be, surely it would have been mentioned at least by David Kupfer to defend DSM-5. It doesn’t cut it my friend.”

    What you actually have to do is explain why stable genetic differences have been found to cluster around 5 major psychiatric disorders if these disorders are merely inventions of psychiatry. I guess those genetic differences actually don’t exist because David Kupfer didn’t mention them? I’ll be nice and say that this is an odd, odd argument.

    You have too much confidence in your conclusions for the amount of knowledge you possess. There are too many basic findings that you are completely unfamiliar with for you to be in any position to posit the arguments you’re positing. You need to do some WORK, which everyone in fringy groups seems deathly afraid of, and then present well reasoned arguments that you can actually defend.

  39. cannotsay2013on 23 May 2013 at 3:16 am

    steve12,

    “I guess those genetic differences actually don’t exist because David Kupfer didn’t mention them? I’ll be nice and say that this is an odd, odd argument.”

    Actually, straw man, I never made that argument. My argument is that the study you quote is one out of many. Over the years, many studies had made similar claims and none of stood the test of time. If David Kupfer, in full damage control mode, had had any reasonable degree of confidence that this study is a breakthrough, he would have gladly mentioned it instead of agreeing with Tom Insel’s proposition that there are no biological markers for so called “mental illness”. He went even further saying that those bio markers might be well far into the future. That’s it.

    “You have too much confidence in your conclusions for the amount of knowledge you possess. There are too many basic findings that you are completely unfamiliar with for you to be in any position to posit the arguments you’re positing. You need to do some WORK, which everyone in fringy groups seems deathly afraid of, and then present well reasoned arguments that you can actually defend.”

    Actually, this is nothing more than an ad hominem attack. You cannot refute the arguments (which again aren’t new, they just have been echoed by the two most powerful entities in American psychiatry), thus you have to resort to personal attacks about what I know and what I don’t know. One month ago, these arguments would have been dismissed as “anti psychiatry”, now that they have been accepted as valid criticism by these two guys, the problem is that “we making them” don’t know. Let me see. Insel is wrong. Kupfer is wrong. I, and the thousands of psychiatric survivors, are wrong. But you are right… Don’t go to a psychiatrist arguing that way (ie, that everybody is wrong except you), you might get an unwanted label as “paranoid schizophrenic”. If that were to happen, we would admit you in our movement with open arms :D .

  40. Mlemaon 23 May 2013 at 3:27 am

    I think there’s a pendulum swinging here. Once upon a time mental illness was “demon possession”. Not so long ago, we cut pieces of the brain out to change behavior. Then we blamed overbearing mothers and distant fathers for schizophrenia. The step to “medical problem” was a good one that relieved everyone, including the patient, of blame. Each was, in it’s way, an improvement over the one before (although, according to the bible, treatment for demon possession was fairly successful :)
    And certainly there are medical problems that cause mind problems. Now, hopefully, we can continue to discern what is truly physiologically based, and give dignity back to those who’ve been labelled “mentally ill” as we search for the experiential basis of psychological pain.

  41. cannotsay2013on 23 May 2013 at 3:39 am

    “Now, hopefully, we can continue to discern what is truly physiologically based, and give dignity back to those who’ve been labelled “mentally ill” as we search for the experiential basis of psychological pain.”

    That touched my heart, really, because honestly, that’s all I, and the other survivors, want: our dignity back.

    The argument that psychiatry comes up usually to counter this is that the lack of dignity comes form society’s inability to accept the reality of “mental illness”. But that is a false argument. It’s a “blame the victim” kind of argument instead of accepting the reality that psychiatrists have been oppressors. Even without getting into the bodily damage that results from lobotomy, ECT or forced drugging, the problem comes from that fact that being labelled as “less than human” has all kind of implications, including legal implications. A diagnosis of “mental illness” can be used against the victim in all kinds of situations. It effectively ruins a person’s life. You have to hate a person a lot to force this quackery into that person.

  42. Mlemaon 23 May 2013 at 3:48 am

    Personality is a function of behavior.
    Beliefs > thoughts > moods and behaviors

    Beliefs aren’t physiological. They’re learned.
    Many psychological problems are belief problems. What’s learned can be unlearned. Drugs can make it harder to unlearn and relearn. And sometimes problems are purely a function of a social setting. Change the setting and the behavior resolves. Or, if a child has learned it in a family setting (we learn our beliefs from our parents first) then give help in examining the beliefs and thinking. What % of DSM “mental illness and disorders” are simply the symptoms of learned ways of thinking and behaving – all coming from beliefs that have failed to healthfully serve the person doing the thinking and behaving? And how many of those are simply a function of the person’s social environment?

  43. Bruce Woodwardon 23 May 2013 at 4:46 am

    Wow.

    All i see with cannotsay now is:

    “I was a victim of malpractice therefore all doctors and all of science is wrong”

    Dude, seriously, get off your horse and consider that there are people out there who have no idea why they wake up every morning with no will to live, or who feel if they don’t throw up after every meal they will become obese in two days. You really think that having a mental illness is a negative thing? Do you know how hard it is to have a problem and have everyone tell you that there is nothing wrong? Having something diagnosed and meeting people with similar problems is one of the best things to happen to people with these illnesses. I work in a Care environment and whether you “believe” in psychiatry or not, the mental illnesses are real and there are people out there who need help.

    You and Mlema can pat yourselves on the back with your semantics and point scoring all you like, the simple fact is these conditions are real, people suffer every day with them and they rejoice when someone finally tells them what is afflicting them has a name and there is a treatment out there and one day they will be able to manage their condition or those around them can understand why they act like they do and help them.

  44. Mlemaon 23 May 2013 at 5:49 am

    calling psychiatry a pseudoscience isn’t contrary to caring for people who are hurting by helping them to understand that it’s not their fault and that others suffer too. Nor does it in any way discourage really trying to learn, scientifically, why they’re suffering and what to do about it. It just says that not all causes of emotional and mental distress are physiological and need to be treated with drugs. Most of these conditions do not respond well to drugs in the long run. It’s easy to get confused because psychiatry does try to help psychologically as well. I understand why the phenomenon of throwing up purposefully after binge-eating would need a name if it happened repeatedly and among many people. But that doesn’t mean there’s something medically wrong with the people doing it.

    I do think this is an ideological problem. If we believe our thoughts are caused by our brain instead of learned from our social environment, then we’re going to believe that thoughts that cause us to have unhealthy emotions and behaviors are the result of a physical problem in our brain/body. But if thoughts are based in learned beliefs about self and the world, then treatment should involve unlearning and then relearning some healthier mind. Drugs don’t change thoughts.

  45. Bruce Woodwardon 23 May 2013 at 6:36 am

    Mlema, why do you assume psychiatrists just give out drugs all the time? Just because they can does not mean they do. That seems to be the basis of your argument.

    When you and cannotsay13 talk about psychiatry you seem to have this almost cartoonish image of men with straight jackets and injections against your will. Sometimes drugs work, sometimes they don’t, psychiatrists I have come across both directly and indirectly will prescribe drugs when needed but will also do the “ology” part of it that you seem to think is not a part of the psychiatry… The whole point of Steve’s post is that the field is changing, the science is developing. Do you think we would know what we know now without the psychiatrists?

    Your solution to helping those with mental health issues seems to be ridding the world of the field of study looking into the very issues you are trying to protect.

  46. BillyJoe7on 23 May 2013 at 7:32 am

    If there are no such thing as a psychiatric illnesses, I wonder what was going on with my receptionist…

    One monday morning about fifteen years ago, my recetionist suddenly started talking gibberish. At first I could understand the sentences but the sentences didn’t seem to fit together. I thought she’d had a bad weekend and I simply gave her an uncomprehending look. By the late afternoon even the words making up individual sentences didn’t seem to fit together and I knew I was looking at more than a bad weekend. She was diagnosed with acute psychosis, admitted to a psychiatric hospital, and put on medication. Within a month she was back to normal and back at work. Her medication was gradually ceased over the next few months. She had a similar recurrence a few years ago which lasted about a similar amount of time. Both episodes seemed to have been triggered by extreme stress in her personal life which she had managed to conceal completely until she suddenly decompensated.

    You have to understand how bizarre this was. Initially I took her home to her family who, all three of them, looked on with shock horror at the sudden change in her behaviour (yes!). She seemed totally confident that she was communicating meaningfully with them all, but none of them could understand a word she was saying. It was total gibberish. We contacted her GP who had her admitted urgently under the care of a psychiatrist.

    I guess I was wrong. I should have accepted this as a normal variant, not batted an eyelid, and let her turn up for work again on Tuesday.

    During my lifetime, I have had two further personal experiences of acute psychiatric illness amongst peope I know well who, similarly, have been appropriately diagnosed and treated and restored to their normal happy functioning selves. So what I am trying to say here is, that I won’t be wasting any more time on the two pseudosceptics here because….

    You are talking absolute bv||$#!+

  47. Bruce Woodwardon 23 May 2013 at 8:01 am

    I think you hit the nail on the head there BillyJoe.

    Aside from this issue, some names seem to come up again and again at the tail end of the comments on this blog arguing points that have been addressed repeatedly, often directly in posts just above them.

    I have monkeys in my pants and need not give credence to their rants!

  48. ccbowerson 23 May 2013 at 9:17 am

    “Guys, you’re dealing with a troll in cannotsay the likes of AIDS denialists, or young earth creationists. I don’t know why you’re engaging with him seriously, unless it’s for your own edification.”

    rezistnzisfutl – I have avoided engaging cannotsay2013, because we have traveled this road before, but I do think it’s important that at least his main points be exposed (if not by me). There will be new readers to this site who may not have witnessed the denialism and arguments the first time, so there is a cost to ignoring his comments completely, which may be greater than the costs in engaging him/her.

    “Initially I took her home to her family who, all three of them, looked on with shock horror at the sudden change in her behaviour (yes!). She seemed totally confident that she was communicating meaningfully with them all, but none of them could understand a word she was saying. It was total gibberish. We contacted her GP who had her admitted urgently under the care of a psychiatrist.”

    So I guess they all bought into the pseudoscientific labeling propaganda. If only they knew the truth – that she was just on one end of the spectrum of behaviors, which are all just fine. I guess there was never a problem after all.
    – One of the obvious flaws that is being made here is the continuum fallacy. Just because there is no neat and simple way of separating out a spectrum or range of thoughts and behaviors, does not mean that there are not meaningful differences at the extremes.

  49. steve12on 23 May 2013 at 9:19 am

    Cannotsay:

    refute the genetic evidence.
    refute the genetic evidence.
    refute the genetic evidence.

    and for good measure,

    refute the genetic evidence.

  50. cannotsay2013on 23 May 2013 at 10:17 am

    ccbowers,

    “There will be new readers to this site who may not have witnessed the denialism and arguments the first time, so there is a cost to ignoring his comments completely, which may be greater than the costs in engaging him/her.”

    The problem is that calling these arguments “denialism” does not work anymore after this http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml . You are correct that my arguments have not changed. What has changed is that now the director of the NIMH and the chair of the DSM-5 have accepted the criticism as valid. This “everybody is wrong but me” would warrant you a “paranoid schizophrenia” diagnosis if go tell your psychiatrist.

    Mlema, Bruce Woodward, BillyJoe7

    Agreed with Mlema, denouncing psychiatry as a scam is not the same as denying that people have problems of living. Even the example that BillyJoe7 put to illustrate his point of view (which BTW, it’s pure anecdotal evidence) shows that personal struggles can push people to a lot of distress. This idea that “drugs work for some people” has a name: placebo effect. In fact, the most rigorous studies performed on the most widely used class of drugs, antidepressants, show very convincingly that they are basically active placebos (E H Turner, Irving Kirsch independent studies both published in 2008 at different venues). What has also been shown beyond reasonable doubt is that these drugs increase the risk of people becoming violent, suicidal or both http://www.cnn.com/2005/HEALTH/01/03/prozac.documents/index.html “an internal document purportedly from Eli Lilly and Co. made public Monday appears to show that the drug maker had data more than 15 years ago showing that patients on its antidepressant Prozac were far more likely to attempt suicide and show hostility than were patients on other antidepressants and that the company attempted to minimize public awareness of the side effects.”

    We live in a world in which more Americans are on psychotropic drugs than ever. Yet, the rate of suicide per 100000 inhabitants increased 28% from 1999 to 2009 according to CDC data. This is consistent with drugging people with chemicals that make them violent.

    “I was a victim of malpractice therefore all doctors and all of science is wrong”

    Actually, that’s not what I said. You are making a strawman. What my own ordeal did was to raise awareness on the scam. Again, discounting valid criticism to psychiatry (now echoed by Insel) just because I happen to be a victim of psychiatry’s corruption is a “blame the victim” kind of fallacy.

    steve12,

    You should have your debate with Tom Insel, Kupfer or your psychiatrist. Tell the latter that “everybody seems to be wrong but me :D ”.

  51. steve12on 23 May 2013 at 10:25 am

    Great Moments in Non-Sequitur Reasoning

    me: refute the genetic evidence

    cannotsay:”You should have your debate with Tom Insel, Kupfer or your psychiatrist. Tell the latter that “everybody seems to be wrong but me”

    Oh, I get it now!

  52. daedalus2uon 23 May 2013 at 10:32 am

    Insel is not saying “there are no biological markers for mental disorders”, what he is saying is “we don’t know what are the biological markers for mental disorders”.

    He explicitly says: “…we cannot design a system based on biomarkers or cognitive performance because we lack the data.”

    There have to be biological principles behind all mental disorders because every behavior of the brain is a product of the biology of the brain (that includes typical and non-typical behaviors). All the biology of the brain is a product of the chemistry of the brain. All the chemistry of the brain is a product of the physics of the brain. All the physics of the brain is a product of the quantum mechanical wave functions of the brain. One of the difficulties in studying the brain is that it is self-modifying on sub-second time scales, and you can’t take biopsies in living people.

    Insel is simply pointing out what has been obvious to scientists for a long time. Many non-scientists still cling to superstitious ideas such as a non-material mind and so resist any explanation that puts their supernatural ideas at risk.

  53. cannotsay2013on 23 May 2013 at 10:34 am

    steve12,

    Actually, it’s a great moment in “dogmatic posturing” and the fact that in the so called “skeptic movement” there are dogmatic zealots for whom dogma takes precedence over science.

    steve12: “there are bio markers to detect absence or presence of so called “mental illness”"

    Insel, Kupfer: “actually there aren’t, in fact there might not be any for decades”

    steve12: but there are “because I say so” and there is this Lancet study.

    psychiatrist: steve12, you are “paranoid schizophrenic”.

  54. Bruce Woodwardon 23 May 2013 at 10:36 am

    “This idea that “drugs work for some people” has a name: placebo effect.”

    Nice taking my comment out of context there. Some Mental Health issues respond to medication and some don’t. If you have a beef with Prozac then fine, argue the efficacy of that, and I certainly hope you have something better than a CNN article to back your argument up there. But, there are other drugs out there that work for other mental health conditions (which is incidentally what I meant).

    You keep quoting that NIMH article… you do realise it just says that psychiatry is changing, which is actually a good thing and actually runs against your anti-psychiatry spiel. Did you read the article? Did you read what Steve said?

    I am done with you now.

  55. cannotsay2013on 23 May 2013 at 10:40 am

    daedalus2u,

    Actually, that’s a spin into what Insel said but again we can at least agree on the objective fact of what Insel is actually saying: “to this day, no bio markers have been identified to detect presence or absence of so called “mental illness”". The spin that this means that religious believers or those who believe in the mind are wrong is your own contribution (aka strawman) to what Insel said.

    What I still don’t understand is why Novella has completely ignored the topic in his entry when the whole controversy was caused precisely by what Insel said.

  56. steve12on 23 May 2013 at 10:41 am

    Thanks cannotsay.

    When you get a chance, though, could you give me your refutation of the genetic evidence for schizophrenia?

    thanks!

  57. cannotsay2013on 23 May 2013 at 10:43 am

    Bruce Woodward,

    The FDA has forced the warning of increase of suicide risk on ALL antidepressants, not only Prozac. The evidence linking violence to other classes of drugs, such as neuroleptics is also there.

    The spin that you and the others are now putting to the NIHM article does not change something that is a fact: Insel has agreed to the proposition “to this day, no bio markers have been identified to detect presence or absence of so called “mental illness””. He promises that he might be able to find them in the future, but that’s just a promise. The reality remains that to this day there are no biomarkers that can be reliably linked to so called “mental illness”.

  58. cannotsay2013on 23 May 2013 at 10:45 am

    steve12,

    The most obvious are the numerous “identical twins” studies that show very convincingly that so called “schizophrenia” is not caused by genetics alone. I get that you are smart enough (or maybe not?) to Google them.

  59. steve12on 23 May 2013 at 10:53 am

    “so called “schizophrenia” is not caused by genetics alone. ”

    I agree! I’m just glad you finally agree that there is a genetic component.

    But now my question is, why is there a genetic component to made up disease?

    We’re actually getting somewhere here….

  60. cannotsay2013on 23 May 2013 at 11:01 am

    steve12

    “I agree! I’m just glad you finally agree that there is a genetic component.”

    Just as there might be a genetic component to all kinds of behaviors (homosexuality, pedophilia, bestiality, propensity to violence, etc). That is not the same as to say that genetics can be used to diagnose something -ie schizophrenia- that is diagnosed based on “behavior alone”.

    What you are putting forward is the classic fallacy “confusing correlation with causation”. Even the most favorable studies to your cause show that the “predictive value” of genetics in twin studies is at most 50%. This is why Insel said what he said. You cannot label people with something as damaging as “schizophrenic” based on this fallacious reasoning (why you can do legal labeling based on the fraudulent DSM is a different matter).

    And this takes us back to homosexuality. The same arguments can be made about homosexuality (combination of genetics, environment, personal choice), but it was a political decision that decided that homosexuality is a “mental illness” (and the reliability to define “homosexuality” is higher than to define “schizophrenia”) just as it was a political decision to to decide otherwise. In fact, I made this very same point above in one of my first comments.

  61. Dick Stealon 23 May 2013 at 11:09 am

    @steve12

    “so called “schizophrenia” is not caused by genetics alone. ”

    I agree! I’m just glad you finally agree that there is a genetic component.

    But now my question is, why is there a genetic component to made up disease?

    We’re actually getting somewhere here….”

    Well there was definitely a genetic component to drapetomania. Google that ‘mental disease’! Yes we are finally getting somewhere here. Steve you could also read some of the research of Jay Joseph. Start with ‘The Gene Illusion’.

  62. steve12on 23 May 2013 at 11:10 am

    How can a made up disease have a genetic component?

  63. cannotsay2013on 23 May 2013 at 11:14 am

    steve12,

    To clarify,

    “-ie schizophrenia- that is diagnosed based on “behavior alone”.”

    Schizophrenia is defined and diagnosed based on behavior ALONE. And DSM-5 studies put the reliability of this labeling (Cohen’s Kappa) at 0.46 (in a 0 to 1 scale).

    Twin studies show that this labeling in identical twins has at most 50% predictive value (ie if you label one twin, the other might or might not get the label at most 50% of the time). What’s worse, if you use genes alone in people that have all genes equal, you can get at best a 50% prediction onto something that itself has at most 50% reliability.

    So the idea that you can use a particular “gene” (or a set of genes) to predict “schizophrenic” labeling in people who do not have identical DNA is preposterous. As I said, it has been refuted many times over in the literature because the studies presented with great fanfare suffered from strong selection bias that made impossible to replicate. This one will be no different.

  64. steve12on 23 May 2013 at 11:16 am

    Thanks for the info! One question you didn’t address though, is:

    how can a made up disease have a genetic component?

  65. cannotsay2013on 23 May 2013 at 11:16 am

    “How can a made up disease have a genetic component?”

    Ask homosexuals how is that their label as “mentally ill” isn’t there despite the fact that the genetic component in homosexuality has been very strongly established and quantitatively measured to be along the same lines as “schizophrenia”, around 50% in identical twins studies.

    The decision of whether homosexuality is or isn’t a “mental disease” is purely political, as are all the decisions made about which behaviors warrant to be in the DSM as “pathological”.

  66. steve12on 23 May 2013 at 11:32 am

    OK, I’ll stop here – it’s obvious you’re not going to answer any of the Qs, and equally obvious why.

    If anyone is reading this thinks they may need help, and your browsing the internet – go to a professional. When you run into people like cannotsay run the other way.

    Just look at these absurd arguments! What kind of good faith debater simply won’t acknowledge the evidence that doesn’t suit their claims? That should tell you all you need to know about this particular strain of denial. Just read the arguments above.

    Psychiatry and our knowledge of the brain are not perfect, and grave mistakes have certainly been made in the past. And there are still a lot of troubling issues specific to psychiatry that need to be worked out.

    But that doesn’t make denialism correct, as you can see from this exchange.

  67. daedalus2uon 23 May 2013 at 11:51 am

    cannotsay, all effective treatments for depression have increased suicidality while they start to be effective. All of them. That is one reason that many depressed people are in-patient hospitalized for a few weeks when they are first put on meds. That keeps them from killing themselves during that most dangerous period.

    That increased period of suicidality is transient. Once the treatment has been successful, the risk of suicidality goes down. If you look at short periods of time, all you see is the increased risk. If you look at longer periods, you see both the short-term increased risk at the beginning, and the reduced long-term risk.

    But people with an anti-mental health treatment agenda ignore the long-term reduced risk.

  68. The Other John Mcon 23 May 2013 at 12:00 pm

    What is “pathological” typically is best defined based on whether someone is suffering because of it (the person with the problem, or others close to them). Typically a psychiatrist or psychologist won’t label someone say “depressed” or “anxious” unless they are in the clinic reporting a problem with several behavioral clusters. The problem may be interferring with work life, social life, physical health, whatever.

    But the health care providers aren’t “making up” these problems, they are trying to treat these problems whose symptoms tend to show up in clusters, and which thus get labels identifying such clusters, and treatments that are sometimes effective with such clusters. No symptom is perfectly correlated with a particular label, and no treatment is perfectly effective with any given label of clusters, or with any given symptom. But to deny any of these clusterings, or to deny general effectiveness of some treatments on at least some symptoms, is demonstrably false in any way you choose to imagine.

    The brain is enough like a computer, and the mind enough like software, to make this analogy work: it’s next to impossible to look into a computer and see “where” or what the physical correlates are of a software problem. Likewise, looking into a human brain or for genetic components to understand dysfunctional or pathological or “problematic” software is only going to work on the most general level. But this does not mean software doesn’t exist in computers, or can’t go awry, or have clusters of issues that are in common across computer software problems. Analogously in human minds.

  69. Ori Vandewalleon 23 May 2013 at 12:21 pm

    cannotsay2013:

    You asked earlier why your opinion on this issue should be discounted just because you’re a victim of psychiatry. It shouldn’t, and I don’t think anyone is discounting it on that basis. It also sucks that your experiences with psychiatry were harmful to you (but I think it’s worth remembering that plenty of people have had very good experiences with psyhiatry).

    Consider this, however: What evidence would it take to convince you that psychiatry is not a fraudulent medical science?

  70. daedalus2uon 23 May 2013 at 12:23 pm

    Insel doesn’t explicitly say that all mental activity is biology based, but that is the premise behind every bit of research that the NIMH funds.

    That is the premise behind every bit of “scientific” research that has been done in the last 20 years. There is some woo being funded by the NCCAM which I ignore.

  71. cannotsay2013on 23 May 2013 at 3:24 pm

    steve12,

    I think I have perfectly addressed your question “how can a made up disease have a genetic component?”. As I said, the poster example is homosexuality (which I mentioned in my first comment),

    1- A “diagnosis” of homosexuality is both reliable (a person sexually attracted to people of the same sex is easily defined, with a high kappa value) and passes the “what’s not normal in the statistical sense” test.

    2- There is plenty of studies to confirm that a mixture of genes (twin studies), environment and choice (people who have so called “recovered” from it) is at the origin of it.

    Yet, the decision of calling homosexuality a “disease” was purely political, just as it was the decision of scrapping it from the DSM. Most DSM invented “diseases” are not as clearly defined as homosexuality and have not been as extensively research from the point of view.

    The fact that you don’t see this, and resort to logical fallacies, speaks more of your dogmatism as a so called “skeptic” than anything else. And again, this is not to deny that people have problems of living.

    daedalus2uon,

    You must have a problem with the whole idea of “double blind studies”. What these studies show is that EVERYTHING ELSE BEING EQUAL (including hospitalization, etc), antidepressants increase the risk of suicide, and across the board. In addition to the Eli Lilly data on Prozac, you might want to check the infamous study 329 that was included by the US Department of Justice in its evidence against GSK.

    “but people with an anti-mental health treatment agenda ignore the long-term reduced risk”

    There is not a single study that proves this only “anecdotal evidence” that comes from the mouth of psychiatrists, which again, is no different from the “anecdotal evidence” that comes from the mouth of homeopathic practitioners (many of them MD degree holders) to justify their pseudo science. I have a better name for what you are defending: “placebo effect” combined with pseudo science. You end your entry by “name calling – blame the victim” type of fallacy.

    The Other John Mc,

    Two things,

    1- What is pathological, at the time of this writing, is what the DSM considers to be pathological.

    2- I agree with your software analogy (that I brought myself a few months ago). This is the very reason why I think that the NIMH approach will fail. But at least, the NIMH approach gives us quantitative and falsifiable predictions to fight psychiatry. A DSM consensus on “what’s a disease and what isn’t” cannot be falsified any more than the consensus of the Inquisition of what’s “heretic” can be falsified.

    Ori Vandewalleon,

    “I think it’s worth remembering that plenty of people have had very good experiences with psyhiatry”

    Ok, and sorry to sound repetitive, WHERE ARE THE STUDIES THAT PROVE SUCH A THING. Because anecdotal evidence by some shrink that tells you that people were “thankful” to be “helped” is completely worthless. I told the shrink that committed me that I was “thankful” only to get out of there. But I am not thankful. This point was even present in the Rosenhan experiment, in which the false patients were only released after they agreed to their “diagnosis” and were “thankful”. Absent any study in this direction, which is hard to obtain because the relationship shrink/patient is captive, we need to look at medical outcomes. Antidepressants have the same efficacy as placebos, and they have been prescribed more than ever in the US in the 10 year period 1999-2009. During that time, the rate of suicide increased 28%. That finding is consistent with the finding in trials that antidepressants increase the risk of violence. In light of this data, it is very hard to argue that psychiatry does more damage than good.

    “Consider this, however: What evidence would it take to convince you that psychiatry is not a fraudulent medical science?”

    The same type of experiment (that I cannot possibly conceive) that will convince me that economics is not a dismal science. Psychiatry is at its core a fraudulent endeavor because it deals with the “mind”. As I said, whenever some behavior (like that associated with late stage syphilis) is understood to have well known biological causes, it ceases to be psychiatric. As I mention above, the great thing about the NIMH approach is that it levels the playing field along the lines of those like me who want to falsify psychiatry. The twin studies on schizophrenia and homosexuality show that the NIMH approach is doomed to fail because they show that identical DNA results in completely different behavior. It is going to be fun to watch this quackery go to the ash heap of history.

    daedalus2u,

    Regarding the NIMH thing, as I said, we already know, they are going to fail. What was relevant of Insel’s announcement is that it has leveled the playing field in a way that will allow us to falsify psychiatry.

  72. cannotsay2013on 23 May 2013 at 3:27 pm

    Typo,

    “In light of this data, it is very hard to argue that psychiatry does more damage than good.”

    I meant

    “In light of this data, it is very hard to argue that psychiatry does more GOOD than DAMAGE”

  73. cannotsay2013on 23 May 2013 at 3:40 pm

    Debate Allen Frances , Bob Whitaker on the matter

    http://www.youtube.com/watch?feature=player_embedded&v=alsZ7mq45sM

    In Al Jazeera. The real shame is that none of the large networks is willing to host a similar debate (actually it was more like a conversation).

  74. BillyJoe7on 23 May 2013 at 5:59 pm

    cannotsay,

    Against my better judgement, I feel compelled to respond…

    “Even the example that BillyJoe7…shows that personal struggles can push people to a lot of distress”

    This person was not “in a lot of distress”. In fact, she was not in distress at all. She felt perfectly normal in herself. She had escaped from being “in a lot of distress” by shutting it out. Unfortunately, as a result, she was unable to communicate, unable to work, and became a danger to her own safety. In short, she had developed a psychiatric illness.
    If you don’t think so, please tell me how you would have managed her – and, remember, that you cannotsay “I’m not a psychiatrist”.

    “(which BTW, it’s pure anecdotal evidence)”

    It is not anecdotal evidence, it is an example of a psychiatric illness.
    One the other two cases I mentioned was someone who was aslo under similar extreme stress in her personal life which went unrecognised by all those around her until she lapsed into a catatonic state, unable to speak, staring blankly into space, paying no attention to her young children. She was also admitted to a psychiatric hospital and treated with anti-psychotic medication. And she recovered though, in this case, she remains on medication, a least for the moment, to keep her from relapsing.
    How would you have managed her? Or perhaps you cannotsay.

    “This idea that “drugs work for some people” has a name: placebo effect. In fact, the most rigorous studies performed on the most widely used class of drugs, antidepressants, show very convincingly that they are basically active placebos”

    And anti-psychotics?
    Are they also “active placebos” as you call them?

  75. ccbowerson 23 May 2013 at 7:24 pm

    “You are correct that my arguments have not changed.”

    Yes, and they are just as unreasonable as before, and personally motivated. You are extrapolating your personal experiences outwards, and there is a danger in this because 1. you are biased and have a skewed view based upon how personal these experiences are to you and 2. your experiences may not be representative of others’ experiences. Your personal experiences are anectdotal, so reflect very little on this broad topic.

    “What has changed is that now the director of the NIMH and the chair of the DSM-5 have accepted the criticism as valid.

    Irrelevant, and untrue depending on what you mean by criticism. At best this is a nonsequitur, but you keep referencing these quotes as if they extremely compelling. It reminds me of the Young Earth Creationist that Steve interviewed that kept referencing other people’s quotes as if they were in support of his view, when they were not.

    No one is denying that there are challenges of diagnosis and areas in psychiatry which we need substantially more information, but that is not a valid criticism of the existence of that area of medicine. This is a limitation that all sciences and applications of science have at all times, to varying degrees. In the case of psychiatry, it has a tougher job by the nature of the subject, because human thoughts and behaviors are very complex. Also there is much more to learn about the brain. You want to take these limitations and use them to throw out all of psychiatry, which is absurd. You also like to reference decades old problems, while unfortunate, were more refective of the time in which they occured. The fact that the practice changed is reflective of progress, but you just want to stay hung up on past wrongs.

    “This ‘everybody is wrong but me’ would warrant you a “paranoid schizophrenia” diagnosis if go tell your psychiatrist.”

    Completely untrue, and is reflective of your level of intellectual honesty.

  76. cannotsay2013on 23 May 2013 at 9:26 pm

    BillyJoe7,

    “in short, she had developed a psychiatric illness”

    Only if you consider “psychiatric illness” as a metaphor to problems of living. No biological test whatsoever diagnosed her brain as diseased in the was a pancreas is diseased when it doesn’t produce enough insulin.

    With respect to alternatives to forced drugging (or drugging for life), there are, such as http://en.wikipedia.org/wiki/Soteria . But the guy who proposed the concept, and who painstakingly showed it to work, was pushed away from his position at the NIMH by Big Pharma pressure.

    “It is not anecdotal evidence, it is an example of a psychiatric illness.”

    In fact, no matter how you spin the matter, providing the example of 3 people you think were helped by the drugs, it’s anecdotal evidence. Second, as I mentioned above, the reliability of a “schizophrenia” label is 0.46 in DSM-5. So I am not questioning they were labelled, I am saying that they were labelled with something that is bogus and invented, and not reliable.

    And yes, even neuroleptics have a strong placebo response http://www.medscape.com/viewarticle/722736 .

    ccbowers,

    My experiences are anecdotal, but so are claims of “millions of people helped by psychiatry”. I always ask people, particularly shrinks, to provide a scientific evidence to support such outrageous claim. I am still waiting.

    What we know from the metastudies/aggregate data is this: antidepressants are not better than placebos, they increase risk of violence towards those taking the antidepressants and others and the rate of suicide has been positively correlated with an increase in use of psychotropic drugs in the US. So from a pure scientific analysis, the conclusion is inescapable: psychiatry does more damage than good.

    With respect to the Insel statement, it is not irrelevant. In fact, it is not very difficult to show that it is not irrelevant. Novella might have spared his apprentices from it, but the APA was forced to issue a statement in response, statement in which they conceded the point that psychiatry has no biomarkers to detect presence or absence of their bogus, invented disorders. So only the true believers (that would be you) would think that it is irrelevant. In your dogmatic worldview, you could have all the members of the APA signing a statement that psychiatry is bogus and you would still try to show otherwise. This is the problem with being a “skeptic zealot”, you are no different than the dogmatic religious people you so much despise. Only your dogmas are different. That promise of a “better understanding in the future” is what psychiatry has been promising for 200 years without delivering. They have been delivering scam after scam.

    “You also like to reference decades old problems, while unfortunate, were more refective of the time in which they occured. The fact that the practice changed is reflective of progress, but you just want to stay hung up on past wrongs. ”

    Actually, forced ECT and forced drugging still happen today in the Western World. In Europe, because their European Court of Human Rights is more friendly to psychiatric abuse than our SCOTUS, more frequently than in the US. You can pretend that these abuses do not happen, but for those who have been abused, many of us, the abuse is 100% real. What is more insulting is to have people like you who want to pretend that they don’t happen just you you feel better with your dogmatic worldview.

    ““This ‘everybody is wrong but me’ would warrant you a “paranoid schizophrenia” diagnosis if go tell your psychiatrist.”

    Completely untrue, and is reflective of your level of intellectual honesty.”

    Watch the conversation above between Frances and Whitaker. Even Frances concedes that DSM-IV caused several false epidemics despite the fact that, according to him, DSM-IV was conservative (some people question that). What people do not question is that DSM-5 is DSM-IV on steroids. You can try to repeat the Rosenhan experiment. Ie, go to an ER and start to speak nonsense. You’d be surprised how easy it is to get labelled. And that label stays for you for the rest of your life (a point that was also brought in by Frances in the video above).

  77. Ori Vandewalleon 24 May 2013 at 12:15 am

    So, cannotsay2013, you agree that people can have “problems of living” (suddenly speaking gibberish), that these people might improve with treatment (soteria), and that diseases with known biological origins can cause symptoms that exactly mirror said problems of living (neurosyphilis).

    What we can take from this is that a biological agent can cause nervous system dysfunction, and that this dysfunction can manifest as behavioral symptoms. So, then, if a patient presents with behavioral symptoms, it is reasonable to conclude that there is nervous system dysfunction. If all tests turn up negative for biological factors, however, then doctors must make a diagnosis of exclusion.

    This happens all the time in medicine. Doctors often can’t identify the cause of chronic headaches, but it’s nevertheless reasonable to conclude that something is responsible for a headache. That is, there must be some nervous system dysfunction responsible for chronic headaches, even though we can’t identify it.

    Similarly, it’s reasonable to conclude that there must be some nervous system dysfunction responsible for psychotic behavior, even if we can’t identify a biological cause. You also agree that people who have psychotic episodes should receive some kind of treatment. Psychiatry aims to treat people who manifest nervous system dysfunction without a known biological cause. That’s all.

    You can believe that psychiatry is not very good at this. You can believe it has used bad tactics, poor treatments, and coercive behavior, all of that. But you can’t argue that there is not a need to treat nervous system dysfunction that lacks a known biological marker. So you shouldn’t want to destroy psychiatry. You should want to make it better. You should want psychiatry to focus on finding the specific causes of nervous system dysfunction that lead to behavioral symptoms.

  78. cannotsay2013on 24 May 2013 at 12:51 am

    Ori Vandewalle,

    I have never said that people do not experience stress or problems of living. Please point me to the place where you think I claimed that those problems are non existent. What I claim, and I stand by it, is that labeling those problems as “disease”, absent a biological cause, is totally arbitrary and politically/morally biased. I don’t think that my position is very difficult to understand. I mentioned Soteria. But that was just an example. Religion also provides for many people solace when those problems arise.

    “But you can’t argue that there is not a need to treat nervous system dysfunction that lacks a known biological marker”

    Actually I do, because absent a biological marker, “nervous system dysfunction” is in the eye of the beholder, in this case, in the eye of DSM-5 committee members own biases. There isn’t any science to back DSM invented disorders. They are there because DSM committee members decide so. When Allen Frances was explicitly asked by the Al Jazeera host above about who decides “what’s normal”, Allen Frances dodged the question.

    The most profound irony of your explanation, and please correct me if I am wrong, is that you seem to say that when it comes to pathologizing behavior that has no known biological cause, a scam (ie psychiatry) is better than nothing. What’s wrong with “nothing” I ask? And this is ironic because I am sure that you, like the average so called “skeptic” has a huge problem with “God of the gaps” type of theories to explain nature. Now, when it comes to the human mind, you seem to be perfectly comfortable with a “psychiatry of the gaps” type of theory, meaning, we don’t have the slightest clue as to why some people behave some way but it must be “pathological” because psychiatry says so in total absence of scientific evidence :D . “Psychiatry of the gaps”… I am going to begin to use this nickname for people who argue along your lines.

  79. FrankClarkon 24 May 2013 at 2:52 am

    We can’t be realists about mental illness and monists. If we’re good monists then we must hold that all mental illness are actually just physical (or behavioral) illnesses, caused by physical or environmental problems, or both; we can’t reasonably say that these illnesses are ultimately caused by mental problems if we deny that the mental exists as a primary substance!

    The problem with the sort of argument put forward by “cannotsay2013″ is that there is no reason to treat mental illnesses (which, if we are monists, are really physical or behavioral illnesses), any different than physical illnesses. These sorts of arguments work just as well for bacterial infections as they do for schizophrenia; “we don’t consider the majority of our bacterial inhabitants ‘diseases’, so why should this one that’s eating away at our wound be any different?”.

    There’s a philosophical problem with defining disease, mental illnesses exasperate this problem experience, and the concept of disease has the potential to be used to oppress people, but that doesn’t mean that diseases don’t exist, just that we should be careful. It might be questionable whether homosexuality is a disease, but it’s clear that schizophrenia is.

  80. Mlemaon 24 May 2013 at 4:03 am

    I watched the video. I would suggest that others do the same. It’s a chance to hear a discussion of the problem by people who know what they’re talking about. Here’s the link again:

    http://www.youtube.com/watch?feature=player_embedded&v=alsZ7mq45sM

    And from The Economist
    http://www.economist.com/blogs/babbage/2013/05/dsm-5
    “Why is the controversy so important? Eleven percent of American school-age children have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Astonishingly, one in five boys aged 14-17 have been thus classified. Among those currently labelled as having ADHD, two-thirds are on prescription drugs.

    The DSM is likely to lead to even more ADHD diagnoses, particularly for teenagers and adults. The prior DSM, published in 1994, required symptoms to be present before the age of seven. The new version raises that to 12. Adults no longer have to present six symptoms to be diagnosed. The new threshold is five.

    This will have a big impact on drug sales. On May 21st Express Scripts, a pharmacy-benefit manager, published its annual report on American drug trends. The company expects broad drug spending for common ailments, such as asthma and hypertension, to fall by 4% over the next three years. However, sales of attention-disorder drugs will jump by 25% over the same period. The spike is due not to the arrival of expensive new treatment, but to a spike in prescriptions among adults. The use of attention drugs is highest in America’s south.

    This underscores something most psychiatrists know well. Neither a rise in drug sales nor geographic variation can be explained purely by prevalence of a mental disorder. Rather, these shifts reflect changes in diagnostic practice. Some of the newly diagnosed patients may have been unjustly neglected to date. Many will be the result of more relaxed diagnostic rules.

    This is problematic, not least because the over-treatment of some mental disorders coincides with the under-treatment of others. Public services for the mentally ill declined during the recession. Instead of receiving proper treatment, many end up in prison. More than half of America’s prison population has some kind of mental illness.”

  81. Bruce Woodwardon 24 May 2013 at 4:38 am

    Three things cannotsay:

    1) You say something does not exist, in order to prove you wrong all anyone has to do is present you with ONE example of this thing existing, therefore an anecdote (ie one example of such a thing existing) is in fact enough to refute you.

    2) Referrencing Big Pharma…? You want to be taken seriously on this site and you blame Big Pharma for suppressing someone?

    3) Calling people on this blog “Skeptic Zealots” which is, in my opinion, just another term for “Closed Minded” is really not going to win you any battles.

  82. Steven Novellaon 24 May 2013 at 7:17 am

    Cannotsay – I suggest you read my series of posts on mental illness denial starting here: http://theness.com/neurologicablog/index.php/mental-illness-denial-part-i/

    I address all of your claims and fallacies.

    I agree that it is reasonable to reserve the term “disease” for biological pathology. But that is a straw man, because most of your examples are not “diseases” but mental “disorders.” So, you are denying the existence of all medical disorders – a lack of a function or abnormality of a function that results in demonstrable harm.

    The reason we need this category in mental health is because brain dysfunction can exist without demonstrable pathology. To take one example – the wiring of networks and modules in the brain is not something that we can currently define as healthy or pathological, but it can result in disorders that are demonstrable harmful.

    The extreme examples establish this principle. People with severe OCD, for example, don’t just have a “problem with living” that needs some counseling. They have a brain disorder that can be totally debilitating. People who cannot get out of bed due to depression, are crippled with anxiety, cannot distinguish reality from fantasy, or are exhausted from spending their entire day flipping switches on and off or washing their hands, don’t just have “problems with living.” They have mental disorders. Their brains are not functioning within parameters that they themselves find acceptable. They want help.

    Yes – these categories are all fuzzy around the edges – no sharp demarcation line. Welcome to the real world. But you are committing the false continuum logical fallacy by essentially arguing that no sharp demarcation means that the extremes don’t exist at all. That is not a valid argument. The extremes are undeniable, even if the borders are fuzzy.

  83. The Other John Mcon 24 May 2013 at 7:37 am

    Cannotsay,

    You agreed with my analogy between brain/mind versus computer hardware/software, but don’t seem to agree with the conclusions that followed from this:

    Software problems (mental disorders) are real, even if one is unable to spot the problems in the hardware (brain/biology). And often the best way to treat software problems (mental disorders) is with a software troubleshooting guide (DSM, psychotherapy, CBT, etc.) as opposed to a blueprint of the hardware or with a computer hardware troubleshooting guide (neurology/biology). Sometimes hardware fixes are necessary though, obviously.

    Certainly psychiatry isn’t perfect, nor the DSM (lots of good controversy over it can be read at Psychology Today). But software troubleshooting, computer virus and worm detection/treatment, etc. is not perfect either, and doesn’t imply that software problems don’t exist, or that some software problems don’t appear in clusters enough to deserve a label, or that there aren’t a common set of fixes that often work for any given label of a cluster problems.

  84. ccbowerson 24 May 2013 at 7:45 am

    “But you are committing the false continuum logical fallacy by essentially arguing that no sharp demarcation means that the extremes don’t exist at all. That is not a valid argument. The extremes are undeniable, even if the borders are fuzzy.”

    I have pointed this out above, and this was ignored.

  85. ccbowerson 24 May 2013 at 7:56 am

    “they conceded the point that psychiatry has no biomarkers to detect presence or absence of their bogus, invented disorders. So only the true believers (that would be you) would think that it is irrelevant.”

    Here’s a fallacy that you don’t hear about much: the McNamara fallacy.

    The fact that good biomarkers do not exist is irrelevant to the existence of mental disorders (or whether they are ‘bogus’). Either they exist and we haven’t found them, or (imo more likely) that simple biomarkers don’t exist for many disorders. Either senario has no bearing on the idea that mental disorders exist. To bias your thinking to the easily measured distorts reality in a way that is detrimental to understanding reality.

    “In your dogmatic worldview, you could have all the members of the APA signing a statement that psychiatry is bogus and you would still try to show otherwise. This is the problem with being a “skeptic zealot”, you are no different than the dogmatic religious people you so much despise.”

    Yes yes yes. If we needed any more evidence that your denialism is fundamentally like other denialism, we have it. Replace psychiatry with evolution and I’ve heard that one before, nearly word for word, and it attempts to equivocate to very different things. I am not attached to any position, but what appears to be true.
    Also, you assume much with the word despise – I don’t despise any category of people – just the faulty thinking and actions that cause problems.

  86. Bill Openthalton 24 May 2013 at 7:59 am

    FrankClark

    It might be questionable whether homosexuality is a disease, but it’s clear that schizophrenia is.

    Whether a particular behaviour is deemed a disorder is also determined by the morality of a society. Agressivity is more acceptable in a militaristic society than a pacifist one. Homosexuality at the exclusion of procreation is less of an issue in a society that suffers from overpopulation than in one that is in constant need of new members.

    That being said, schizoprenia (and OCD, and psychotic behaviour, etc.) are indeed disorders in all societies.

  87. BillyJoe7on 24 May 2013 at 8:19 am

    BJ: “in short, she had developed a psychiatric illness”
    cannotay: “Only if you consider “psychiatric illness” as a metaphor to problems of living.”

    A person speaking gibberish has a “problem of living”?
    A catatonic person has a “problem of living”?
    Nice euphemism for “completely unable to function”.

    ” No biological test whatsoever diagnosed her brain as diseased”

    That’s because it wasn’t diseased, it was malfunctioning.

    BJ: “It is not anecdotal evidence, it is an example of a psychiatric illness.”
    Cannotsay: “In fact, no matter how you spin the matter, providing the example of 3 people you think were helped by the drugs, it’s anecdotal evidence”

    I was not providing you with anecdotal evidence, I was providing you with a counterexample.
    “All swans are white” is refuted by finding one black swan.
    “There are no psychiatric illnesses” is refuted by finding one instance of a psychiatric illness.
    What you are left with is denialism.

    And you have failed to say how this person should be managed.
    That’s a telling point.

  88. The Other John Mcon 24 May 2013 at 9:06 am

    Yes homosexuality used to be classified as a mental disorder, but that particular case was accepted as faulty and taken out due to good research, but this doesn’t invalidate all of modern psychiatry/psychology. Just like the theory that the sun goes around the earth has since been abandoned as a poor theory, but this doesn’t call into question all of modern physics and astronomy.

    I would argue the removal of homosexuality from disorder classification reflects a better understanding of what is pathological or a disorder, because the research suggested it wasn’t. It shows the science is progressing, not regressing or is completely “made-up”. Though we can and should continue to have debates about potentially questionable classifications, your example actually strengthens the case that modern mental disorder classification is generally useful and meaningful, because it was able to eliminate a set of behaviors (homosexuality) from being labeled pathological when the research showed that it wasn’t.

    And BillyJoe’s point is excellent: how do you suppose we treat people who show up, asking for help, with behavioral problems, perceptual/cognitive disturbances, mental suffering, etc. that can clearly be clustered by symptomology, thus often deserving a label of one particular sort or another? Especially when a whole variety of treatments have been shown to be helpful for many of these labels? Just tell them it’s made up?

  89. cannotsay2013on 24 May 2013 at 10:07 am

    Steven Novella

    “Cannotsay – I suggest you read my series of posts on mental illness denial starting here: http://theness.com/neurologicablog/index.php/mental-illness-denial-part-i/

    I address all of your claims and fallacies.”

    I’ve read it before. Sorry to disappoint you, but you do not address any fallacy, you just limit yourself to repeat “skeptic dogma” that is gladly accepted as “reasoning” by your followers but that has little credibility beyond that, or those who make a living out of the psychiatric scam. In fact, not even Allen Frances or Tom Insel buy some of the BS you defended before this month’s crisis. Some of the ones you repeat here are particularly outrageous, because they have destroyed my life (more below). My favorite that shows the level of dishonesty of your arguments: “you know is mental illness when you see it”. WOW! Try to use that to get some research published at any respected venue.

    “I agree that it is reasonable to reserve the term “disease” for biological pathology. But that is a straw man, because most of your examples are not “diseases” but mental “disorders.” So, you are denying the existence of all medical disorders – a lack of a function or abnormality of a function that results in demonstrable harm.”

    So we agree that only biological pathologies should deserve the consideration of “disease”. Good. The rest is pathologizing behavior. It might be news to you, but we, as a society, already have a system to pathologize behavior we don’t like (which is not linked to real disease). It’s called the criminal justice system that affords those accused of “misbehaving” of many safeguards that protects them against arbitrary abuse. What you, and the defenders of psychiatry defend (and this is not a straw man because I am almost literally quoting you, here and what you have said in previous entries), is a parallel system in which “self appointed mind guardians” decide who is normal in who isn’t ABSENT biological pathology. It cannot get more totalitarian than this.

    T”he reason we need this category in mental health is because brain dysfunction can exist without demonstrable pathology. To take one example – the wiring of networks and modules in the brain is not something that we can currently define as healthy or pathological, but it can result in disorders that are demonstrable harmful.”

    Again, and sorry to sound “repetitive”, “demonstrable harmful” by WHO? By DSM committee members? Don’t we have already the criminal justice system to make those judgements that protect people from arbitrary abuse by those who consider something harmful. DSM members considered “homosexuality” harmful until the 1970s. Being sad after the death of a loved one was not considered harmful pre DSM-5, now it is. Ditto of the other things that Frances mentions here http://www.psychologytoday.com/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes . What you see unable to understand is that absent a clear objective biomarker, labeling some behavior as “harmful” (which is codeword of “pathological”) is 100% arbitrary. That the people that make those value judgements have an MD degree is no more relevant than when the Inquisition tribunal members justified their own “value judgements” on their theology degrees. Totally irrelevant. There are value judgements about what’s pathological whose only cause is the committee members own bias. This is, again, why we have the current safeguards in the criminal justice system.

    Of all the exaggerations you use to justify your point of view, I will address this one,

    “People with severe OCD, for example, don’t just have a “problem with living” that needs some counseling. They have a brain disorder that can be totally debilitating. ..They want help.”

    In case you haven’t red it yet,

    http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770

    I do not have a brain disorder, it is the opinion of the DSM committee members that I have one, absent any biological test to justify the claim. Very different. My parents were told that I was destined to become “homeless” to justify the so called “intervention” on me. Years later this is the result of my contact with psychiatry: I am divorced, estranged from my parents, my kidneys and liver were almost destroyed by powerful psychotropic drugs and I have a standard of living that his higher than when this thing happened. No, I didn’t want “help”, “help” was forced into me by family members and willing psychiatrists who betrayed me during a vacation trip (because that type of “help” is illegal in the US). So you can keep your bs to yourself. Describing the abuse that I endure as “help” is no different than telling a rape survivor that she was being loved without her consent. Only adds insult to injury.

    “But you are committing the false continuum logical fallacy by essentially arguing that no sharp demarcation means that the extremes don’t exist at all. That is not a valid argument. The extremes are undeniable, even if the borders are fuzzy.”

    Actually this is a straw man, because I never denied the existence of extremes. My position was, and is, that absent a biological marker, it is not the job of self appointed “mind guardians” to decide which behaviors are pathological arguing from the point of view that they have an MD degree. That is psychiatry’s first lie: the notion that an MD degree qualifies one to make value judgements about which behaviors are normal and which aren’t ABSENT biological reasons to make that judgement call.

  90. Steven Novellaon 24 May 2013 at 10:18 am

    Cannotsay

    It is you who are arbitrarily deciding that biological markers is the only acceptable criterion for what is “real.” While there are certainly problems with the DSM, it is untrue and unfair to characterize all of psychiatry as made up value judgements by “mind guardians.”

    There is actually a great deal of research into various mental disorder. Many do have biologcail markers. The harm that is caused in many cases is not criminal (so that is irrelevant) but perceived by the person themselves. Many people with OCD perceive their OCD behavior as a problem. It takes over their lives, and prevents them from being functional. The harm is not arbitrary – you can measure outcomes that most reasonable people would agree constitutes harm – shorter life expectancy, lower happiness, higher divorce rate, poor physical health, etc.

    What you are engagnig in is blatant denialism. You have not actually addressed any of the criticism against you, only repeated your denialist talking pionts.

  91. cannotsay2013on 24 May 2013 at 10:21 am

    Mlema,

    Agreed, very interesting discussion. I also liked The Economist piece. The real pity is that no major US news organization (CNN, Fox or the big networks) has the courage to address the topic so openly.

    ccbowers,

    What you call “the McNamara fallacy” has been described for years as totalitarian thought. I prefer to call it “totalitarian thought”. I am not a big fan of semantics debates, but names matter

    The Other John Mc,

    You can search my previous postings. I have made repeatedly the claim that those “software problems” are better addressed by the exact opposite of psychiatry’s preferred interventions (lobotomy, ECT or drugging) which are hw interventions. CBT/psychotherapy is not psychiatry, is psychology. And another point that seems lost. Even with that, absent a crime, all contact with psychiatry or psychology should be entirely voluntary. As I have said many times, my only beef with psychiatry is its status as a coercive power. I couldn’t care less with people voluntarily engaging in so called “psychiatric treatment” no more than people engaging in astrology or homeopathy (actually the homeopathy-zation of psychiatry would be my preferred outcome).

    FrankClark,

    “Whether a particular behaviour is deemed a disorder is also determined by the morality of a society.”

    agreed

    “That being said, schizoprenia (and OCD, and psychotic behaviour, etc.) are indeed disorders in all societies.”

    Disagreed. As a sufferer of being labelled with OCD, I can tell you that that label is as bogus as the other ones. And as somebody who has known people labelled as schizophrenic for “disagreeing consistently with his entourage” (it was called “paranoid/delusional” behavior) I can tell you that even that one is bogus. In fact, it is so bogus that the Cohen kappa for the DSM-5 field tests of schizophrenia is 0.46 (1 is absolute reliability). So a lot of stuff gets labelled as “schizophrenic” that apparently isn’t.

    To the rest of Novella apprentices, if there was a prize that the master would award to his most fervent followers, probably you’d win for faithfully repeating his bs. The problem that he has is that the fallacious arguments he put forward in the past to discredit the critics of psychiatry have now been refuted by authorities such as Tom Insel. So he is too, in damage control mode.

  92. Bruce Woodwardon 24 May 2013 at 10:28 am

    Wow… just wow…

    Cannotsay, I think I finally understand you. As someone who has worked in a Care or Education environment and often with people with mental health issues I see you as a case in what could possibly be malpractice and if you were in the UK the social care system here would be something I would refer you to, I am not sure what is available where you live.

    And yes, you are a victim by the sounds of it, but of malpractice, not of some great constructed conspiracy. You need to see someone who can help you and you need to go out there and find that help instead of writing about it on an internet forum and creating demons to explain your situation. I would suggest you focus on your own issues and sort yourself out. You are not going to get better or lead a happy life by following the line of thought you are currently on.

  93. cannotsay2013on 24 May 2013 at 10:29 am

    Steven Novella,

    Now that it is obvious that you have lost the debate you do what so called “skeptics” do best, “name calling” as in,

    “What you are engagnig in is blatant denialism. You have not actually addressed any of the criticism against you, only repeated your denialist talking pionts.”

    I think that I can very convincingly say that what you are doing is to repeat “skeptic talking points”. This would be a never ending debate except for the fact that on April 29th 2013 the world changed. Now some of what you call “my talking points” have been accepted by both the NIMH and the APA as valid criticism to psychiatry. So it’s you in the “skeptic movement” that have a problem. You’ve been for years defending falsehoods such as,

    “There is actually a great deal of research into various mental disorder. Many do have biologcail markers. ”

    If there are, they have not gained any widespread acceptance by the field as agreed both by Insel and Kupfer like 2 weeks ago. We’ve seen this movie before. The promise that “bio markers are around the corner” and that they are about to be found has been repeated for many decades.

    “The harm that is caused in many cases is not criminal (so that is irrelevant) but perceived by the person themselves. Many people with OCD perceive their OCD behavior as a problem. It takes over their lives, and prevents them from being functional. The harm is not arbitrary – you can measure outcomes that most reasonable people would agree constitutes harm – shorter life expectancy, lower happiness, higher divorce rate, poor physical health, etc.”

    Then, if it is not criminal, I hope to have you ON RECORD calling for depriving psychiatry of ALL OF ITS COERCIVE POWERS. Not “most except in case a, b, c, d” but ALL OF ITS COERCIVE POWERS. Anything else means that you are either lying or you are suffering some kind of cognitive dissonance in which while accepting that behavior pathologized by the DSM, but not criminal, needs to be forcibly “treated”.

  94. cannotsay2013on 24 May 2013 at 10:36 am

    Bruce Woodward,

    First they came for the communists,
    and I didn’t speak out because I wasn’t a communist.

    Then they came for the socialists,
    and I didn’t speak out because I wasn’t a socialist.

    Then they came for the trade unionists,
    and I didn’t speak out because I wasn’t a trade unionist.

    Then they came for me,
    and there was no one left to speak for me.

    With DSM-5, it has been estimated that up to 50% of Americans will deserve a “psychiatric label”, which has all kinds of implications beyond civil commitment (which is hard in the US). In can be used against you in all kinds of legal proceedings (such as divorce, probate, etc). So here we ar.

  95. steve12on 24 May 2013 at 11:05 am

    “First they came…”

    Really? Are f*ing serious?

    I refuse t discuss the science with CS any further because he isn’t interested (his agenda is purely political) and he doesn’t really grasp how much he doesn’t understand. Fine. People who like to pontificate but don’t wanna go through the work of personal research or training annoy me personally, but whatever.

    But for the love of zeus, would you please knock off the Nazi comparisons? I’m not a f*ing Nazi, for chrissakes. No one is, except the Nazis. Not Obama, or Bush, or big pharma or psychiatry or anyone.

    I wanna ask these morons (and yes, I am trying to be insulting here because, well, you deserve it) who like to make Hitler comparisons: Do you know what the holocaust was? Do you understand what happened? The horror of it? I hope not. I honestly hope that you’re as ignorant of history as you are of neuroscience. Because this dishonors the memory of every victim of the Holocaust, and trivializes genocide generally.

    You – along with many others in modern life, unfortunately – should be ashamed at yourself.

  96. Steven Novellaon 24 May 2013 at 11:07 am

    Cannotsay – You can look at this as a debate and keep declaring victory if that makes you feel better.

    Or you can look at this as a discussion and try to understand those who disagree with you, and perhaps consider that the logic you are employing has some problems. If you think my logic is flawed you haven’t been able to make a convinging argument.

    There are plenty of biological markers for various mental illnesses. But they are population based. They tell us about what is happening genetically or in the brain in some people with the clinical syndrome, but they are not at a level useful for diagnosing an individual.

    You are also grossly misrepresenting Insel. He is not saying mental disorders do not exist He is saying we have to rethink how to categorize them as a guide to research. Again – classic denialist strategy. That is not a personal attack, it is a characterization of your logic, btw.

    Here are some biomarkers for some types of OCD
    http://www.ncbi.nlm.nih.gov/pubmed/23681167
    http://www.ncbi.nlm.nih.gov/pubmed/21781000
    http://www.ncbi.nlm.nih.gov/pubmed/23680103
    http://www.ncbi.nlm.nih.gov/pubmed/23668073
    http://www.ncbi.nlm.nih.gov/pubmed/19196924
    and
    http://www.ncbi.nlm.nih.gov/pubmed/18718575
    Here is the conclusion of the last one:

    “Our findings indicate volumetric differences between OCD patients and control subjects in the cortical and thalamic regions, suggesting that structural alteration of the thalamocortical pathways may contribute to the functional disruptions of frontosubcortical circuits observed in OCD.”

    While you deny OCD is real, neuroscience researchers continue to explore the underlying features of brain function that correlate with OCD and are finding interesting results.

    Read all of those links and then explain to me how there are no biological markers of OCD (and that is just a quick sampling, not an exhaustive review).

  97. Bill Openthalton 24 May 2013 at 11:26 am

    cannotsay2013

    You were quoting me, not FrankClark when you reacted to

    FrankClark,

    “Whether a particular behaviour is deemed a disorder is also determined by the morality of a society.”

    agreed

    “That being said, schizoprenia (and OCD, and psychotic behaviour, etc.) are indeed disorders in all societies.”

    I stand by what I said. In certain societies, behaviour we find acceptable can be experienced as a disorder, and vice versa. But disorders that take over the lives of the sufferers and their families cannot, and should not be cast as merely a societal problem. There is a difference between excentricity and behaviour that makes normal life difficult if not impossible. While the norms of a society (and its morality) are indeed arbitrary, humans are social animals and failure to integrate in society is a disorder.

  98. daedalus2uon 24 May 2013 at 1:13 pm

    If you look at whole population data, as antidepressant prescriptions go up, suicide rates go down.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071298/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395354/

    Studies can’t be done like that in clinical trials because it is unethical to not treat those who are depressed. Clinical trials also suffer from very small numbers and very short durations.

    As I said, it is well known that all effective treatments for depression increase the suicide rate in the short term. If treatment is effective, then the rate is decreased in the long term.

  99. sonicon 24 May 2013 at 3:04 pm

    cannotsay2013-
    I think you have made a number of points including-

    1) there are no biomarkers for the ‘diseases’ of psychiatry.
    1a) the ‘diseases’ and the labeling of people is therefore somewhat arbitrary.
    2) there is no scientific evidence for the efficacy of any psychiatric intervention
    3) there are numerous stories of horrible outcomes from the use of imprisonment and forced drugging.
    4) there are methods that don’t use coercion that have been found successful Soteria– thanks for that reference.
    5) psychiatry should not have any coercive powers over people (to detain or drug them…)

    The attempts to undermine these points seem to be failures.

    Or so it appears to me–

  100. cannotsay2013on 24 May 2013 at 3:04 pm

    daedalus2u,

    Not sure where you get your data from, but this is the reality in the US, fresh from the CDC,

    http://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html

    “Suicide rates among those 35 to 64 years old increased 28 percent (32 percent for women, 27 percent for men).
    The greatest increases in suicide rates were among people aged 50 to 54 years (48 percent) and 55 to 59 years (49 percent).”

    I let the numbers speak for themselves.

  101. cannotsay2013on 24 May 2013 at 3:06 pm

    Steven Novella,

    NOTE: I repeat my posting because the other one is being moderated probably because I was quoting the links you provided. Feel free not to approve it, this is the same without the links.

    “You can look at this as a debate and keep declaring victory if that makes you feel better.”

    It is not a question of me feeling better. In the US I am protected from the kind of abuse that I endured in Europe. It’s been a long time since I accepted that what happened to me was plain and simple, a human right abuses.

    To the poster that suggested that I file a medical malpractice lawsuit. I already looked into that. Only in the European country where this happened, as it is the case in all European countries signatories of the ECHR convention -that’s the UK, the EU and then some-, psychiatrists can pretty much abuse anybody they want for any reason they want. So I was told, by one of the top experts in the matter that I contacted, that it would be a waste of time and money. In the US, medical malpractice law is the second pillar that keeps psychiatrists under control (the first one is SCOTUS case law all the way back to the 1970s). So even though I lean conservative politically speaking, I steadfastly reject the notion that American medical malpractice law should be reformed to be kinder to doctors as long as psychiatrists are considered legitimate doctors. So if medicine – the AMA and similar lobbies- protect psychiatry, they’ll have to accept the consequences of doing so.

    “Or you can look at this as a discussion and try to understand those who disagree with you, and perhaps consider that the logic you are employing has some problems. If you think my logic is flawed you haven’t been able to make a convinging argument. ”

    This is very simple. It’s the same type of discussion that economists have when they speak about their dismal science. The joke goes that you ask 2 economists to make a prediction and you get three different answers. I understand your logic. I summarize it as “psychiatry of the gaps”. We have no biological explanation for behavior X. Behavior X is not criminal. It is still pathological because DSM committee members say so. Which is the same as some fundamental Christian defending Young Earth Creationism because of a literal interpretation of the Bible (which was written by God). You have replaced “God” with “DSM committee members”. But you can only point to your book to defend the truth of psychiatry since, we all seem to agree, that to this day there are no bio markers to detect presence or absence of so called “mental illness”.

    “You are also grossly misrepresenting Insel. He is not saying mental disorders do not exist He is saying we have to rethink how to categorize them as a guide to research. Again – classic denialist strategy. That is not a personal attack, it is a characterization of your logic, btw.”

    Actually it is a personal attack (it’s called straw man because I never said that Insel denies the reality of mental illness). Let me quote explicitly what Insel said,

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

    I think that there is little room for spinning this. DSM diagnosis lacks validity. Even the “reliability” claim can be disputed for DSM-5 (Allen Frances has done a great job on that regard, I refer you to his papers that I am sure you are familiar with).

    So that is what Tom Insel said, and that is that is what David Kupfer, chairman of the DSM-5 task force, agreed to like 3 weeks ago. Of course, then there is no shortage of promises of “better diagnosis systems” and that “a scam is better than nothing” (ie, psychiatry of the gaps). But there is a lot of agreement about the lack of scientific validity of DSM diagnosis. That is the falsehood that you have defending as a “zealot” for years. I am still laughing at the suggestion that “you know ADHD is real when you see it”.


    Some links…

    Here is the conclusion of the last one:

    “Our findings indicate volumetric differences between OCD patients and control subjects in the cortical and thalamic regions, suggesting that structural alteration of the thalamocortical pathways may contribute to the functional disruptions of frontosubcortical circuits observed in OCD.” ”

    I hope you understand that there is a great difference between “suggesting that structural alteration of the thalamocortical pathways may contribute to the functional disruptions of frontosubcortical circuits observed in OCD” and AFFIRMING “you have HIV infection because your HIV antibody test (ELISA+Western Bolt) came back positive”. If I have to explain this to you, I think that you are a lost cause.

    “While you deny OCD is real, neuroscience researchers continue to explore the underlying features of brain function that correlate with OCD and are finding interesting results.
    Read all of those links and then explain to me how there are no biological markers of OCD (and that is just a quick sampling, not an exhaustive review).”

    Actually, it’s not me that you have to convince, it’s Insel and Kupfer who agree to the proposition that to this day there are no bio-markers to detect presence or absence of so called “mental illness”. Correlation is not causation (you, of all people should know better). While you do so, be careful not to get a “paranoid schizophrenic” diagnosis in the process. This is not a joke. You wouldn’t be the first, nor the last, person that gets such diagnosis for claiming that everybody else is wrong.

    Twin studies show very convincingly that DNA alone is not the only cause of what DSM people call “mental illness”. Since we agree that behavior that has a valid biological cause (such as syphilis infection or neuro-degeneration caused by Alzheimer’s) is not the realm of psychiatry, we are left with behavior that DSM people don’t like. That is “psychiatry of the gaps”.

  102. cannotsay2013on 24 May 2013 at 3:19 pm

    sonic,

    > I think you have made a number of points including-
    >1) there are no biomarkers for the ‘diseases’ of psychiatry.

    Actually, this is now part of the official record of psychiatry, at least in the US. Both the NIMH and the APA agree to that.

    > 1a) the ‘diseases’ and the labeling of people is therefore somewhat arbitrary.

    Sure, and it follows from the statement that DSM lacks validity. Even Novella admits that the realm of psychiatry is outside biologically caused behavior such as Alzheimer’s. The so called “continuum fallacy” is a strawman because nobody is arguing that extreme behavior does not exist. My only contention is that the determination of what is “extreme” and what isn’t” is arbitrary. Even Allan Frances (who is in a crusade to save psychiatry from its most greedy members) seems to agree with that (watch the Al Jazeera video, the real scandal is to listen to that type of candid conversation you have to go to Al Jazeera).

    >2) there is no scientific evidence for the efficacy of any psychiatric intervention

    Indeed. I point to the studies that show that the most widely class of psychiatric drugs are not better than placebos and that they increase the risk of suicide and violence towards others. Those findings are consistent with the finding of 28% increase in suicide rate made public this month by the CDC (since we live in a society in which, according to Allen Frances, 20% are taking some kind of psychotropic drugs, the highest rate on record).

    >3) there are numerous stories of horrible outcomes from the use of imprisonment and forced >drugging.

    Actually this is where we have to go through anecdotal evidence because that is the reality that I know through the survivor networks. Psychiatrists give their own anecdotal evidence. When I ask to provide a scientific study -which takes into account that the psychiatric relationship is a captive one in which psychiatrists are regularly told what they want to hear- that shows that the vast majority of users of psychiatry are happy with it, I have none. So we have to go with the medical outcomes that the CDC made public this month.

    >4) there are methods that don’t use coercion that have been found successful Soteria– thanks >for that reference.

    Correct. I also add religion, even if it is unpopular around here.

    >5) psychiatry should not have any coercive powers over people (to detain or drug them…)

    Obviously.

    >The attempts to undermine these points seem to be failures.

    So it seems to me. But I understand that this audience is not friendly to my arguments because they somehow feel that accepting these points is the same as accepting the “existence of God”or something. Tell that Thomas Szasz or more recently Jerry Coyne, both of whom were excoriated for making exactly the same points. I take no credit for the originality of them. This is basically what Thomas Szasz said during 50 years before his death. He is the true hero.

  103. Ori Vandewalleon 24 May 2013 at 3:19 pm

    I’m curious, cannotsay2013, what kind of behaviors do humans engage in that are not biologically caused?

  104. cannotsay2013on 24 May 2013 at 3:24 pm

    Bill Openthalton

    “You were quoting me, not FrankClark when you reacted to”

    Sorry, too many people I need to address :D .

    “There is a difference between excentricity and behaviour that makes normal life difficult if not impossible. While the norms of a society (and its morality) are indeed arbitrary, humans are social animals and failure to integrate in society is a disorder.”

    And who is the judge that makes that distinction and based on what criteria? We agree that there is no biology (to this day) to make that distinction. So why give DSM members unchecked power to make those determinations given that, in addition, DSM-5 reliability tests suck? So if you want to blindly trust the APA to label behavior aberrant on their own terms absent biological evidence, so be it, I respect that. What I object is the imposition of that pseudo science on the rest of society.

  105. cannotsay2013on 24 May 2013 at 3:31 pm

    steve12,

    I thought that people here were smart enough to make the analogy themselves, but it seems I was overestimated people’s critical thinking abilities. So here it comes for you,

    First they came for the schizophrenic,
    and I didn’t speak out because I wasn’t schizophrenic.

    Then they came for the OCD,
    and I didn’t speak out because I wasn’t OCD.

    Then they came for the homosexuals,
    and I didn’t speak out because I wasn’t gay.

    Then they came for those who were grieving the loved of a lost one for more than two weeks,
    and I didn’t speak out because nobody closed to me has died yet.

    Then they came for those who eat too much,
    and I didn’t speak out because I eat healtht.

    Then they came for me,
    and there was no one left to speak for me.

    DSM-5 has been estimated to give 50% of Americans a psychiatric label. Again go back to that Al Jazeera video, as Allen Frances correctly points out, that labels follow you for the rest of your life.

    My opinion is that Allen Frances has an untenable proposition. He correctly seems to believe that there is no way psychiatry can get away with labeling 50 % of Americans as “mentally ill”, with all the legal implications it has. His hope is to go back to the times when psychiatry preyed on 5% of Americans (that helped him and his pals to keep their own niche market). But the opposite is happening, the greed of the APA is going to be their undoing. DSM-5 is to psychiatry what 9/11 was terrorism. An event so outrageous that has given visibility to the many abuses the DSM has caused over the years.

  106. Steven Novellaon 24 May 2013 at 3:32 pm

    Sonic – everyone of your points is wrong and have already been refuted.

    1) there are no biomarkers for the ‘diseases’ of psychiatry.
    - There are many of them. I gave a link to some for OCD. The fact that they do not have the individual sensitivity and specificity to be useful for diagnosis is not relevant. They are still biomarkers for metnal illness.

    1a) the ‘diseases’ and the labeling of people is therefore somewhat arbitrary.
    - Non sequitur. This assumes that only biomarkers render a diagnosis non-arbitrary. As with all of medicine, biomarkers are only one aspect of diagnosis. Clinical features, epidemiology, and response to treatment are all accepted and objective features used to define medical diagnoses.

    2) there is no scientific evidence for the efficacy of any psychiatric intervention
    - Hogwash. Here is just one example that disproves your absolute statement: http://www.ncbi.nlm.nih.gov/pubmed/18922243
    There are many proven effective treatments for many mental illnesses.

    3) there are numerous stories of horrible outcomes from the use of imprisonment and forced drugging.
    - There are also numerous stories of surgery gone wrong. What do anecdotes prove? Why don’t we instead evaluate the scientific evidence, and judge current best practice, not malpractice or practices that have already been abandoned.

    4) there are methods that don’t use coercion that have been found successful Soteria– thanks for that reference.
    - Most treatment for mental illness does not involve coercion. Patients have right, including informed consent. The burden of proof in on health care providers if they think that someone is an immediate danger to themselves or others or lack capacity.

    5) psychiatry should not have any coercive powers over people (to detain or drug them…)
    - This is a value judgement, not a statement of fact. It is currently standard of care and settled law that as a default no health care professional has coercive powers over anyone. Doctors have to document, immediate risk to self or others, and must always use the least restrictive option.

    It is absurd to say, however, that there is never a situation in which an individual lacks the capacity to make their own health care decisions. There are many situations, not only psychiatric, in which this is demonstrably the case.

    Of course if you simply ignore the points being made here you can continue in your belief that none have been refuted.

  107. cannotsay2013on 24 May 2013 at 3:32 pm

    Ori Vandewalle,

    Please read the software/hardware analogy. You are confusing “hardware providing physical support for software” with “software itself”.

  108. cannotsay2013on 24 May 2013 at 3:42 pm

    Steven Novella,

    I will just address point 5) because the rest is the type of disagreements that looks like the disagreements economists have and I don’t have a stomach for “splitting hairs”. Only say that individual studies that show efficacy of a drug for a narrow condition -which is subject to problems such as selective bias- is not the same as a meta-study that shows that antidepressants are no better than placebos.

    “It is currently standard of care and settled law that as a default no health care professional has coercive powers over anyone. Doctors have to document, immediate risk to self or others, and must always use the least restrictive option.”

    That is true in the United States. It is not true in the European Union. I am living proof of that and I can document the rates of civil commitment there. I also documented in this thread the ECHR case law that condones these practices. The problem is that DSM power goes beyond the US borders. What “treatment to OCD” cannot be imposed here, it can be imposed in all of Western Europe.

    “It is absurd to say, however, that there is never a situation in which an individual lacks the capacity to make their own health care decisions. There are many situations, not only psychiatric, in which this is demonstrably the case.”

    But in those cases, psychiatry should have no say. Judges should (and not in the mockery way cases are adjudicated today). The only evidence that should be accepted is measurement of cognitive ability (IQ tests and the like).

    “Of course if you simply ignore the points being made here you can continue in your belief that none have been refuted.”

    This goes both ways. Of course, if you accept the “skeptic dogmas” – the most important of which, the refutation of 1) which not accepted by the NIMH or the APA-, you can believe that these points have been refuted. But that is again a choice about one believes.

  109. BillyJoe7on 24 May 2013 at 5:59 pm

    So, cannotsay….

    How would you manage a person who suddenly starts talking gibberish but feels that everything is just fine and dandy and intends getting up tomorrow morning to go to work?

    How would you manage a single mother who suddenly lapses into a catatonic state, leaving her two pre-school aged children to fend for themselves?

    “…psychiatry should have no say. Judges should…”

    Call in the judiciary?
    Really?

    And, if she and her children survive the delay, and if the judge concludes that she has a psychiatric illness and needs admission to a psychiatric hospital for psychiatric treatment, would you be okay with that?
    And would you be happy towelcome your receptionist back to work next morning till a judge can be called in to adjudicate?

    Or perhaps you cannotsay…
    ….seeing you haven’t answered the question twice now?

  110. Bruce Woodwardon 24 May 2013 at 6:00 pm

    “I don’t have a stomach for “splitting hairs”.”

    Oh… I lolled at that.

    Do continue with your not splitting hairs.

  111. BillyJoe7on 24 May 2013 at 6:12 pm

    sonic,

    “cannotsay2013-
    I think you have made a number of points including-
    1) there are no biomarkers for the ‘diseases’ of psychiatry.
    1a) the ‘diseases’ and the labeling of people is therefore somewhat arbitrary.
    2) there is no scientific evidence for the efficacy of any psychiatric intervention
    3) there are numerous stories of horrible outcomes from the use of imprisonment and forced drugging.
    4) there are methods that don’t use coercion that have been found successful Soteria– thanks for that reference.
    5) psychiatry should not have any coercive powers over people (to detain or drug them…)
    The attempts to undermine these points seem to be failures.
    Or so it appears to me–”

    Wow!

    Usually you’re just full of doubt, unable to make any decision one way or other, or play devil’s advocate.
    You’ve exceeded yourself here.
    But, hey, I have never been fooled by your false reasonableness.

    Anyway, congratulations for making a decision…even though it’s an obviously wrong one.

    But maybe you could have a go at answering my questions to cannotsay, seeing as he seems to have no intention of doing so.

  112. Hosson 24 May 2013 at 8:55 pm

    Cannotsay,

    You sound like a theist arguing against secular morality having a foundation. Because there isn’t a biological marker, therefor secular morality is immoral. (Slow clap)

    You are cherry picking the data to “prove” your claim and irrationally dismissing counter evidence. You are highly bias, and I think it has skewed your perception of this issue. I could go on and on with the logical fallacies, but I don’t have the time.

    With all that said, nothing I wrote proves you wrong. But your reasoning is not sound, so your conclusions are unjustified, if not flat out wrong.

  113. cannotsay2013on 24 May 2013 at 9:28 pm

    Bruce Woodward,

    “Do continue with your not splitting hairs.”

    That is what Novella has done because really, it is very hard to argue with,

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

    Point that has been agreed by the chairman of the DSM-5 task force. If we are going to argue from “authority”, you’ll have to give me that both Insel and Kupfer are more authoritative voices in psychiatric matters than Novella.

    The problem that Novella has is that he keeps confusing correlation with causation, as in,

    “Our findings indicate volumetric differences between OCD patients and control subjects in the cortical and thalamic regions, suggesting that structural alteration of the thalamocortical pathways may contribute to the functional disruptions of frontosubcortical circuits observed in OCD.”

    If he/you were familiar with software/hardware you would understand that it is possible to see correlates in hardware -the activity that goes in the transistors- of genuine software problems such as “memory leaks”. But those correlates are not the cause of the problem.

    BillyJoe7,

    “Call in the judiciary?
    Really?”

    Of course.

    “And, if she and her children survive the delay, and if the judge concludes that she has a psychiatric illness and needs admission to a psychiatric hospital for psychiatric treatment, would you be okay with that?
    And would you be happy towelcome your receptionist back to work next morning till a judge can be called in to adjudicate?”

    But that would be the judge’s call. For non scientific matters, these type of judicial decisions are subject to “review by the voters” by way of the legislative process (and in the US by the voters themselves who have the power to through out of their positions abusive state judges who are the ones making most of these decisions). Labeling a problem “psychiatric” only makes the victim be more easily abused.

    “Or perhaps you cannotsay…
    ….seeing you haven’t answered the question twice now?”"

    Not sure what you mean here. Me, what?

    with respect to what you say to sonic,

    “But, hey, I have never been fooled by your false reasonableness.”

    It’s really pathetic that you have to resort to name calling to disqualify those who do not hold your dogmas (once you lost the debate on the arguments). This is the problem many people have with self described “skeptics”. They see you as no better than the religious dogmatic individuals you criticize. In the case of psychiatry, where the young Earth creationism has his/her bible written by his/her God, you have your DSM-5 written by your own Gods. Everybody who disagrees with the interpretation of their respective books is a zealot who isn’t illuminated yet.

    Bonus entry,

    Novella,

    “It is currently standard of care and settled law that as a default no health care professional has coercive powers over anyone.”

    Even though I agree with the general point that coercive psychiatry is not as pervasive as it once was in the US, I want to make sure people understand that it still happens, unfairly, in the US. I became involved in a campaign to stop forced ECT on this person that was successful,

    http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/glen-k-forced-ect/cuomo-forced-ect

    So please do not close your eyes to this type of abuses that happen today in America.

  114. cannotsay2013on 24 May 2013 at 9:45 pm

    And absent any smart refutation to my points, I leave the readers of this blog, now that I got your attention, with a challenge.

    If you are so sure that psychiatry is so good, you are all invited to repeat the Rosenhan experiment yourselves https://www.youtube.com/watch?v=FG4mOpQpmpw .

    I can assure you that your possibilities to get in are almost 100%. Just as I can assure you that once you get in, it will be very difficult to get out unless you “agree to the diagnosis” and “agree to take your meds”. Once in, everything you’d do, would be considered as evidence of “mental illness”.

    Jon Ronson, reports in his book
    http://www.amazon.com/Psychopath-Test-Journey-Through-Industry/dp/1594485755/ref=la_B001H6KH4U_1_1?ie=UTF8&qid=1369445359&sr=1-1 the case of a contemporary edition, if involuntary, of the Rosenhan experiment.

    If you read the book (or watch any of the talks he has given on the book), you’ll learn the case of a “fake patient” in the UK who faked psychosis in order to get a “gentler treatment” at a psychiatric hospital (the other possibility was to go to jail for a petty crime he had committed). What he didn’t anticipate is that once in, he couldn’t get out, even when the psychiatrists agreed that he had faked his psychosis. The fact that he had faked said psychosis was considered as “evidence” of a different “mental illness”. He eventually got out, because he went to the courts to challenge his detention, but he spent in the so called “psychiatric hospital” more time than the time he would have spent in jail if he had agreed to plead guilty to his original crime :D .

  115. BillyJoe7on 25 May 2013 at 1:44 am

    Cannotsay,

    Firstly, you don’t need to respond for sonic. We have a long history and I regard him as a friend. I think the feeling is mutual. We just disagree about pretty well everything. And he is a whole lot more capable of launching an argument than you have proven to be…though that’s not saying much |:

    BJ: “How would you manage a person who suddenly starts talking gibberish but feels that everything is just fine and dandy and intends getting up tomorrow morning to go to work?
    Call in the judiciary?”
    Cannotsay: “Of course”

    But, according to you, there is no such thing as a psychiatric illness, so apparently this person just has a variation of normal behaviour. So why is there any need to do anything. Just let her go into work in the morning as she plans on doing
    And good luck getting a judge to intervene before tomorrow morning.

    BJ: “How would you manage a single mother who suddenly lapses into a catatonic state, leaving her two pre-school aged children to fend for themselves?
    Call in the judiciary?”
    Cannotsay: “Of course”

    Congratulations, you have just killed two pre-schoolers with your effective inaction. That judge may be ready to help out in about one month. Too late for those young kids. But, again, why is the judge even needed seeing as this mother is just displaying a variation of normal behaviour.

    BJ: “Or perhaps you cannotsay…”
    Cannotsay: “Not sure what you mean here. Me, what?”

    I’m pretty sure sonic would have caught onto that joke in an instant. (:

  116. cannotsay2013on 25 May 2013 at 2:19 am

    BillyJoe7,

    “Firstly, you don’t need to respond for sonic. We have a long history and I regard him as a friend. I think the feeling is mutual. ”

    Without knowing the common history between you two, I think that calling names somebody against whom you don’t have any argument is the prime reason why so called “skeptics” are so much despised. It’s an insidious tendency that the “purest skeptics” share with the most dedicated “religious zealots”.

    “But, according to you, there is no such thing as a psychiatric illness, so apparently this person just has a variation of normal behaviour. So why is there any need to do anything. Just let her go into work in the morning as she plans on doing
    And good luck getting a judge to intervene before tomorrow morning.”

    I was under the assumption, when you asked the question, that a crime had been committed or the violation of some civil law. If that wasn’t the case then, of course the judge has no business intervening. Ie, if that talking you refer to was just “made uncomfortable” for those watching, her employer could fire her, end of the story.

    “BJ: “How would you manage a single mother who suddenly lapses into a catatonic state, leaving her two pre-school aged children to fend for themselves?
    Congratulations, you have just killed two pre-schoolers with your effective inaction. That judge may be ready to help out in about one month. Too late for those young kids. But, again, why is the judge even needed seeing as this mother is just displaying a variation of normal behaviour.”

    Actually, this is the paradigmatic example of “false threat” that was used to abuse me and that it is commonly used by psychiatry to demand ever increasing powers to force their quackery. In the words of the psychiatrist who committed me, I was destined to become “homeless” if left so called “untreated”. Not only that was completely impossible at the time (as my ex wife correctly joked about at the time, the same attire was described “neglected” by my European psychiatrists in their notes while it was described as “clean and normal” by my American ones in theirs) but, as I said, years later, my standard of living is much higher than when the whole ordeal happened. And for the record, my attire is exactly the same :D , which is the typical attire you find in people who make a living out of their scientific expertise in the US. What my contact with psychiatry brought me is a destruction of my family (they are now my “ex-family”) relationships. In your hypothetical case -which are always exaggerated examples invented by psychiatry to justify themselves- if there was actual neglect, the law has mechanisms to intervene to protect the children.

    Since I don’t share your dark sense of humor, I just give up understanding it.

    And please, do not skip the Rosenhan challenge. If you are so convinced that psychiatry is so great and so scientific, put your money (and your future) where your mouth is (ie, putting the future of those other women at play doesn’t count, we are talking about your own future). As I have said many times, I have no problem with pro psychiatry zealots bringing the psychiatric scam to themselves (I am a very strong defender of individual freedom). My beef is ith pro psychiatry zealots forcing the quackery on innocent victims.

    Tony, which is the name of the British pseudo patient that Jon Ronson wrote about, thought he could game the system and he learned painfully that it is not possible to show “sanity” to a psychiatrist who is convinced of your “insanity” even if said psychiatrist agrees that you faked the symptoms that brought to you your first label. The mantra in psychiatry is simple: “once labelled, always labelled”. After your first label, every thing else you do is evidence of so called “mental illness”.

    PS: I put here a beautiful and exquisite rebuttal to a recent article in Scientific American by Jeffrey Lieberman, the new APA president, that adopted a “either you are with me or against me” type of reasoning to defend his nonsense. It is priceless http://blogs.scientificamerican.com/molecules-to-medicine/2013/05/24/anti-psychiatry-prejudice-a-response-to-dr-lieberman/ .

  117. cannotsay2013on 25 May 2013 at 2:50 am

    Here is the “Tony” story as told by Jon Ronson himself http://www.ted.com/talks/jon_ronson_strange_answers_to_the_psychopath_test.html . Although he was introduced to Tony via CCHR, I hope people here are smart enough (although based on my interactions here I am now convinced that the “smarts” of so called “skeptics” are greatly exaggerated) to understand that the Tony is real. In other words, don’t “shoot the messenger” type of fallacy.

  118. BillyJoe7on 25 May 2013 at 9:41 am

    Cannotsay,

    “Without knowing the common history between you two, I think that calling names somebody against whom you don’t have any argument is the prime reason why so called “skeptics” are so much despised”

    Neither I not sonic made any argments. sonic made a number of unsuported statements. I’m not criticising that. He’s entitled to do that as long as he is actually able to support them when challenged. Steven Novella did challenge him on every point and we have yet to hear sonic’s counter-arguments. Im sure he will, he often disappears for days at a time. For my part, I simply made an observation about sonics usual modus operandi and congratulated him on actually taking a stand for once.
    Where was the name calling?

    “I was under the assumption, when you asked the question, that a crime had been committed or the violation of some civil law. If that wasn’t the case then, of course the judge has no business intervening”

    Well that’s just a bizarre interpretation of the situation I described.

    “Ie, if that talking you refer to was just “made uncomfortable” for those watching, her employer could fire her, end of the story.”

    Great solution. I’m sure she would have appreciated your consideration for her welfare.

    But she was my employee. And I didn’t fire her. And that was not the end of the story. I took her back to her family who arranged admission to a psychiatric hospital via her GP. She recovered within a month and was off mediation within three months. She decided her job here was out of her comfort zone and therefore did not return. However, she quickly found alternative employment. That was fifteen years ago. She has worked full time ever since apart from a brief recurrence of her illness a few years ago. Again, she fell into the trap of working outside her comfort zone. She again in full time employment, but is much kinder on herself these days.

    BJ: “BJ: “How would you manage a single mother who suddenly lapses into a catatonic state, leaving her two pre-school aged children to fend for themselves?”

    You have still not answered this question.
    What would you do with this catatonic young woman and her children?
    Remember, I am offering a counter-example to your bold statement that psychiatric illness does not exist. So, if she has no psychiatric illness (and she clearly has not committed a crime), how exactly would you manage this situation?

    “Since I don’t share your dark sense of humor, I just give up understanding it.”

    Oh well, never mind.

  119. dawso007on 25 May 2013 at 1:57 pm

    I found your site today thanks to a reference posted on my blog. It is quite exciting to find another physician who recognizes the false functional-organic dichotomy as it is portrayed in the media and the rhetoric of the psychiatry deniers.

    Keep up the great work!

  120. cannotsay2013on 25 May 2013 at 2:56 pm

    BJ7,

    ” Steven Novella did challenge him on every point and we have yet to hear sonic’s counter-arguments.”

    Actually, Steven Novella didn’t challenge him. He limited himself to repeat so called “skeptic dogma”, which again passes as “smart challenge” around here but it’s very laughable everywhere else. I am still having a hard time understanding how is that Novella keeps repeating his nonsense when it comes to point 1), ie, that there are “bio markers” for so called “mental illness” when the top dogs of the psychiatric profession said otherwise very recently. They basically were forced to admit the same thing that they admitted 10 years ago forced by David Oaks. Back then, just as now, they keep repeating the mantra that “we don’t have them now but we will have them in a decade”. Of all the nonsense he usually repeats (like confusing correlation with causation when it comes to his links to studies about OCD), this is probably the most corrosive. Steven Novella should know better than to deny reality. It is one thing to believe that those bio markers can be found in the future (that’s Tom Insel’s position), quite another to insist that we have them now as he has been repeating for years and to justify that position in anecdotal evidence that shows at best “correlation” in very narrow circumstances.

    “Well that’s just a bizarre interpretation of the situation I described.”

    I have already misunderstood several times your points like that dark humor you have. To the risk of sounding repetitive, let me say again what is my position. Society already has a way to punish behavior considered unacceptable, it’s the criminal justice system, or, in the case of children neglected by their families, the civil justice system. Before some behavior is considered deserving intervention, said behavior has to be subjected to review by the legislative bodies (which themselves are subject to review by voters every 2 years at the federal level in the US, 4 years at the state levels), and be approved by judges, who are also (in the individual states) subject to accountability by voters. Those are reasonable safeguards and even with that there is abuse (cases of miscarriage of justice happen all around the world).

    What you are defending is a system that bypasses that and that gives psychiatrists the absolute and unaccountable right to determine behavior that is unacceptable absent any scientific reason to do so (like biological diseases such as syphilis or genuine genetic diseases such as Down syndrome).

    So if your lady/single mother fits the description of those behaviors deemed unacceptable by society, the justice system should act. If they don’t, it is not psychiatry’s business to intervene. I hope this time you understand what I am saying.

    “Great solution. I’m sure she would have appreciated your consideration for her welfare.”

    Whatever. As I said, I have never opposed people voluntarily using psychiatry (or homeopathy or astrology). I don’t believe any of the three endeavors are scientific, but people’s freedom to voluntarily engage in them should be respected.

    “But she was my employee. And I didn’t fire her. And that was not the end of the story. I took her back to her family who arranged admission to a psychiatric hospital via her GP. She recovered within a month and was off mediation within three months. She decided her job here was out of her comfort zone and therefore did not return. However, she quickly found alternative employment.”

    She would have found alternative employment in any case. What you were complicit in is in assigning this poor woman a label that will follow her for the rest of her life (Allen Frances made a great point about this in his Al Jazaeera conversation with Bob Whitaker). That’s the thing you seem unable to understand. There are much better ways to deal with problems of living than stigmatizing (and in my case humiliating) a person for life.

    “You have still not answered this question.
    What would you do with this catatonic young woman and her children?
    Remember, I am offering a counter-example to your bold statement that psychiatric illness does not exist. So, if she has no psychiatric illness (and she clearly has not committed a crime), how exactly would you manage this situation?”

    I think I have. Again, read my statement above and please point out to the part you don’t understand.

    You keep avoiding the topic, but I insist, if you are so sure that psychiatry is so great, please take the Rosenhan experiment challenge. As the Tony story shows (and I can give you more examples in America if you think this things don’t happen in the US), psychiatry is still unable to differentiate sane from insane (the DSM-5 reliability tests show that DSM-5 will amplify the problem). So please, in an exercise of honesty and integrity, take the Rosenhan challenge (and BTW Steven Novella, if you are reading, the same applies to you).

  121. sonicon 25 May 2013 at 3:14 pm

    Dr. N.-
    I’m not sure we are disagreeing here–

    Individuals are diagnosed as having these ‘diseases’ or not.
    If the proceedure you are talking about can’t do that, then it is tangential to what I’m talking about– a person being diagnosed with the disease or not.

    Perhaps in the future there will be such tests– perhaps some of the literature you point to is part of that. Perhaps Catterall’s work will lead to further discovery…
    What you link to seems to be a possible avenue to developing an objective test for individual diagnosis- but individuals are not currently being given a diagnosis based on those types of test.

    It follows that if a test isn’t objective, then it is to some extent ‘arbitrary’. I believe that is by definition which is why it was point 1a.

    As to effacacy of treatment:
    I should recuse myself from that– I know people who the doctors call ‘successfully treated’. If that’s what counts as success– same situation as before but now hopelessly addicted to drugs… and let’s not even talk about ECT.
    I realize I’m not objective about this– I would probably be better to just leave that point out.
    Anyway, I would agree that many people say they are improved with treatment.

    Points 3,4, and 5 are each about opinions– as are the diagnosis and measures of efficacy.
    I’m not sure your point there.

    I still think cannotsay has made his points better than those attacking him. I’m not saying that he is right and others wrong– I’m just saying that according to my score keeping he is doing a better job.

    It does help cannotsay’s case that he is agreeing with Kupfer and Insel about current conditions, IMHO.

  122. BillyJoe7on 25 May 2013 at 6:34 pm

    Cannotsay,

    My argument here is not to say how great psychiatry is. My argument here is that psychiatric illness exists. You are in denial of that fact. I have offered two examples of psychiatric illness that refutes your argument that psychiatric illness does not exist.

    “So if your lady/single mother fits the description of those behaviors deemed unacceptable by society, the justice system should act. If they don’t, it is not psychiatry’s business to intervene. I hope this time you understand what I am saying”

    You still haven’t answered my questions about how you would handle the situation of these two women. You can’t just pass it off as something for the “justice system” to handle. How, in your opinion, should the “justice system” handle the catatonic young mother. How in your opinion should the “justice system” handle the lady whose speech has suddenly become unitelligible to everyone. How, in fact, could the “justice system” possibly help these women who are urgently in need of help, not in four weeks, but right now.

    And it is not a matter of these women’s behaviours being “unacceptable to society”. These women are seriously malfunctioning. They need you to help them. Their families need you to help them. They don’t need the intervention of the “justice system”. They need psychiatric intervention because…they have a psychiatric illness.

    How can you continue to deny what is staring you in the face.

    “What you were complicit in is in assigning this poor woman a label that will follow her for the rest of her life… There are much better ways to deal with problems of living than stigmatizing a person for life”

    Both these women developed a psychotic illness as a result of extreme personal stress. That is a fact. If you break your arm, you have a fractured humerus. There’s no denying it. If you go into a catatonic state, you have a psychotic illness. Ditto. Seems to me you are the one singling out psychiatric illness for stigmatisation. And then trying to get rid of the stigma by denying the existence of psychiatric illness altogether. You had a fractured humerus three years ago. She had a psychotic illness three years ago. Those are the facts. Now let’s proceed from there.

  123. cannotsay2013on 25 May 2013 at 7:26 pm

    BJ7,

    Your continues refusal to take the Rosenhan challenge speaks volumes. This is the THIRD time that you have ignored it. I will keep bringing it into the conversation until you address it (ie, either you decide to take the challenge or you tell me what reasons you have not to take it). So please, put your reputation where your mouth it and accept the challenge. I even give you the possibility of picking the Western country of your choice (EU, Canada, US, Australia or New Zealand) so sure I am that this type of abuses are pervasive in the Western world (knowledge that I got from my contacts in the survivor networks).

    The rest of your post is about strawmen, so we are going to have a very long “strawmen” discussion as long as you keep doing it.

    “My argument here is that psychiatric illness exists. You are in denial of that fact. I have offered two examples of psychiatric illness that refutes your argument that psychiatric illness does not exist.”

    Actually you have offered two examples of people who were labelled based on DSM criteria that both now Insel and Kupfer agree that,

    - Lack scientific validity
    - Are based on so called “consensus”

    That is not the same as providing examples of “real psychiatric illnesses”. You have provided examples of people labelled with such. And that is a complete strawman because I never denied the reality of people labelled with DSM consensus.

    “You still haven’t answered my questions about how you would handle the situation of these two women. You can’t just pass it off as something for the “justice system” to handle. How, in your opinion, should the “justice system” handle the catatonic young mother. How in your opinion should the “justice system” handle the lady whose speech has suddenly become unitelligible to everyone. How, in fact, could the “justice system” possibly help these women who are urgently in need of help, not in four weeks, but right now.”

    For the smart readers of this article I have. Again, you might want to believe that a so called “psychiatric intervention” is better but that’s a value judgement, not a rational or scientific statement.

    “And it is not a matter of these women’s behaviours being “unacceptable to society”. These women are seriously malfunctioning. They need you to help them. Their families need you to help them. ”

    And who is to decide that, you? This is the crux of the problem. What might be “malfunctioning” to you, might be OK for other people. This is why we have the justice system (criminal and civil) so that it is very difficult to violate other people’s civil rights.

    “Both these women developed a psychotic illness as a result of extreme personal stress. That is a fact. If you break your arm, you have a fractured humerus. There’s no denying it.”

    Back to false analogies. A broken arm can be diagnosed with accurate imaging tests. The equivalent for the broken humerus would be brain damage resulting from say a shot. A “broken mind” is a metaphor absent any biological explanation. But again, the legal implications of declaring that one has a “broken arm” are not the same as those declaring that somebody has a “broken mind”. I hope that even in your limited thinking abilities you can see this.

    “Seems to me you are the one singling out psychiatric illness for stigmatisation. And then trying to get rid of the stigma by denying the existence of psychiatric illness altogether. ”

    Actually this is a straw man (you seem an expert in the matter). The fight against stigma by the APA is the same as the fight against the stigma of what meant to be a slave in pre civil war America. It’s a “blame the victim” strategy. Those receiving a “psychiatric diagnosis” today have, legally speaking their civil rights compromised for the rest of their lives (again I encourage you to watch the Al Jazaeera discussion in which Allen Frances spoke clearly of this, it was taken down from youtube for copyright violations but that is available here http://www.aljazeera.com/programmes/insidestoryamericas/2013/05/201352352617473825.html). There is no workaround to that. No amount of “blame the victim” or “make the victim feel better with him/herself” is going to change that.

    My point is that absent biological/scientific indicators, “DSM consensus” is no different from “theologian consensus” when it comes to determining who has a “broken mind”. And that a diagnosis of “DSM mental illness” is the same as a finding of “heretic” by a religious tribunal. I think I have made my point clear several times, you keep making strawmen. It is going to be a very long exchange if you keep making these strawmen.

    “You had a fractured humerus three years ago. She had a psychotic illness three years ago. Those are the facts. Now let’s proceed from there.”

    Not sure about your point here (remember that I have a history of not understanding your dark humor :D ). I have never broken my humerus and my own contact with psychiatry happened many more years ago. I don’t see how being labelled OCD is equivalent to breaking one’s humerus. And while you are at it, please also tell me what are your plans with respect to the Rosenhan experiment :D .

  124. cannotsay2013on 25 May 2013 at 7:52 pm

    sonic,

    “It does help cannotsay’s case that he is agreeing with Kupfer and Insel about current conditions, IMHO.”

    The real problem Steven Novella has is that he has been presenting over the years as established fact that there are bio-markers for so called mental disorders. There isn’t a single one. You have explained very well why what he affirms is not supported by the evidence he provides to support what he says (I thought I had made those same points, but it seems that not everybody understood them).

    My own opinion on the matter is that those biomarkers will never be found. That’s where I disagree with both Kupfer and Insel. This promise has been made many times in the last decades and it remains a futile exercise. And these people should know that the are going to fail miserably. We all agree that psychiatry does not deal with the type of behavior caused by biological causes such as syphilis, Alzheimer’s or genetic diseases such as Down syndrome. We know that people with identical DNA (twin studies) do not develop so called “DSM mental illness” in a deterministic manner. So the quest for finding a “gene” or set of “genes” as explanation of “DSM mental illness” is doomed to fail. So if is not genetic, it is not caused by a virus/bacteria, then what is it? Environment as in “social environment”?

    It is going to be fun to watch because Insel has set psychiatry for a complete and spectacular failure. For every study that says that biomarker X shows “mental disorders”, there will be another one that shows the opposite.

  125. rezistnzisfutlon 25 May 2013 at 8:16 pm

    Cannotsay,

    I didn’t say you were an AIDS denialist or young earth creationist, I said you were like an AIDS denialist or young earth creationist, in your arguments, reasoning, weakness or lack of supporting evidence, long string of logical fallacies, and general mangling of science. But, I don’t think any of us expect any less considering that you have gotten pretty much everything wrong so far.

  126. rezistnzisfutlon 25 May 2013 at 8:33 pm

    To add, there was no ad hominem in my earlier post. Again, like with creationists, your apparent predisposition to logical fallacies seems to make you unaware of what they are in the first place. Simple name-calling is not an ad hominem. An ad hominem would be if I were to attempt to refute a specific argument of yours by pointing out something about you that is unrelated to the argument. A logical fallacies occurs when the syllogism’s conclusion does not logically follow the premise. My post had no syllogism, so there was no possibility of a logical fallacy.

  127. Dianeon 25 May 2013 at 8:51 pm

    @cannotsay

    For someone who had a bad experience with institutionalized coercion (in psychiatry), you have a remarkable faith in the justice system.

  128. cannotsay2013on 25 May 2013 at 9:59 pm

    To all,

    Astonishing admission by Allen Frances (minute 41:20 and after; it’s from a hangout organized by Science magazine this week on the matter),

    http://www.youtube.com/watch?v=Gkibj2cDeUs

    To the question of what is “normal” he openly admits that the DSM definitions are not diseases but social constructs that exist in a cultural context that are relevant at the time they are written. If there was going to be an explicit admission that psychiatry is a parallel system of social control, this is it.

  129. cannotsay2013on 25 May 2013 at 10:08 pm

    rezistnzisfutl,

    Ironic you speak about logical fallacies when your replies have been anything but. I have been able to engage a few (including Novella himself), which is more than I usually get in forums filled with “psychiatry zealots”.

    As sonic correctly points out, the statements by Kupfer and Insel have left Steven Novella and his followers in a very untenable position. And the statement above by Allen Frances, in an even more untenable position. How can a DSM construct, which Frances agrees is a social construct, can ever be treated as diabetes is beyond me.

    WOW, still astonished that Frances has said that.

    Diane,

    I have none, but at least there is an explicit understanding that the justice system is imperfect because it is based on value judgements (even if they are subject to the controls I mention). Psychiatry is based on the false assumption that their social constructs are “truth” and that psychiatrists can accurately predict when somebody, like me, can become “homeless”.

    To address BJ7 above as well. At least in the US the most important battle as to when a “psychiatric intervention” is warranted was won in the 1970s at least in theory. It is now a matter of settled law that no intervention is warranted unless there is dangerousness towards self or others. That is not to say that abuses were stopped (case in point: Glen mentioned above being forcibly ECT-ed until last year) but they became less frequent in the US. I still see this situation as unwarranted -because a label of “mental illness” lowers the standard of evidence from “beyond reasonable doubt” to “clear and convincing evidence”- but it is definitely an improvement with respect to what existed in the US before the 1970s (and what currently exists in the European Union).

  130. cannotsay2013on 25 May 2013 at 10:28 pm

    Diane,

    “For someone who had a bad experience with institutionalized coercion (in psychiatry), you have a remarkable faith in the justice system.”

    And to be more clear. What happened to me happened in a legal context where that type of abuse is legal. Fortunately, this is not the case in the US. So what I am defending is depriving psychiatry of all of its coercive powers. The crime of “making criminal threats” or similar already exists in most US states (as well as at the federal level). So the law already has mechanisms to lock in those who a) have been convicted of a crime, b) that conviction has been established under the standard of evidence “beyond reasonable doubt”. Psychiatry has not been stripped of said powers in the US (yet) unfortunately but what we have is definitely better than what exists in the European Union. In all the European Union the standard “need of treatment” (which is codeword for “whenever a psychiatrist deems it necessary”) is legal. I already provided ECHR case law above to show my case.

    This difference in legal standard is what allows me to live a pretty much careless life -all while complying with American laws- while the decision of stopping the drugs would have meant in a European context a trip back to the psychiatric ward. Things have gotten so out or control in Europe that in the UK now one of the proponents of so called “outpatient commitment” -which is forced drugging under the threat of imprisonment- in the UK has reversed his position after a randomized study showed that such civil rights abuse accomplished nothing other than restricting freedom of innocent people

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960107-5/abstract

    “In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients’ personal liberty”

  131. BillyJoe7on 25 May 2013 at 11:22 pm

    Cannotsay,

    I asked you: how would YOU manage these two women?
    You said: let the JUSTICE SYSTEM manage these two women.
    You have clearly avoided answering my question.
    So I tried again by asking you: how do YOU think the justice system should handle these two women?
    You have not answered this question.

    In my opinion, you cannot answer that question and have been avoiding answering that question because that would mean acknowledging that these woman, at the very least, are malfunctioning.

    “What might be “malfunctioning” to you, might be OK for other people”

    But what do YOU think?
    Do YOU think it is okay for a woman to talk convincingly as if everyone understands her when, in fact, no one has a clue what she is talking about? Do YOU think that it is okay for her to continue to talk gibberish and that the fact that she is talking gibberish should concern no one and that we should all let her continue to talk gibberish and continue to turn up for work tomorrow morning where her sole role is to interact with clients?

    Do you think it’s okay for a woman to lapse into a catatonic state where she totally neglects her young children? You can’t remove the children from her because that would be acknowledging that she is malfunctioning. But suppose you can somehow justify removing the children from her care, do you think it’s okay for that woman to continue in her catatonic state. Remember that, in her catatonic state, she is unable to care for herself. Without help, she cold die of dehydration or starvation. But you can’t help her can you? Because that would be tantamount to acknowledging that she is malfunctioning. Maybe even that she is suffering from…shock, horror….a psychiatric illness.

    Finally…
    I will listen to your video but it has nothing to do with our argument which is: does psychiatric illness exist?

  132. BillyJoe7on 26 May 2013 at 12:13 am

    Cannotsay,

    I have watched the video you referenced.

    I found all three participants to be intelligent and very well informed.
    I found the questions to be intelligently asked and answered.
    And I found little that I would disagree with in the answers provided.

    I also found no suggestion by anyone that psychiatric illness does not exist.

  133. BillyJoe7on 26 May 2013 at 12:33 am

    Cannotsay,

    “The real problem Steven Novella has is that he has been presenting over the years as established fact that there are bio-markers for so called mental disorders.”

    Steven Novella said that there a markers for some mental disorders but that they are not sufficiently sensitive or specific to be used as diagnostic tests on individual patients.
    Do you disagree with this?
    (I’m only trying to clarify the disagreement)

    “My own opinion on the matter is that those biomarkers will never be found”

    That’s a tough call considering that our research into brain function is in its infancy.
    In other words, you can’t know what you don’t know.

    http://www.huffingtonpost.com/jon-raymond/knowing-what-you-dont-kno_b_132846.html

  134. Mlemaon 26 May 2013 at 1:00 am

    BillyJoe, I’m sure these women were taken to the hospital, right? And the catatonic woman’s children were cared for by her friends or relatives, right? (if she had no friends or relatives I think that would be a good clue as to why she had a “break”). You also seem to indicate that the gibberish was a result of extended stress. If that was the case, why would “mental illness” be suspected? It’s possible for people to have symptoms of extended stress without being mentally ill. Why not time off and bed rest if medical diagnostics reveal no disease? Why does she need to be “treated” with drugs that have some damaging side effects? why is the measure of her recovery how fast she’s back at full-time work? You said also that she did better in another line of work – doesn’t that say that the problem was her job? Why do people get to decide that if you’re catatonic you have a mental disease? Can’t we simply do the things we need to do to care for these people without labeling them mentally ill? Can’t we keep her in hospital and give her fluids and nutrition and rest, and look after her children until she comes out of it? Why do we have to confine her and give her drugs, and not let her out until she admits she is mentally ill and agrees to keep taking her drugs until her dr says ok? Because that is the kind of treatment that cannotsay is trying to tell you exists in Europe, and in many cases still here in the US/

    also, I think your questions are a little silly. You’re not giving us these women’s medical history, diagnostic results, socioeconomic situations, relationships, etc. You’re just telling as if they broke out in rashes and then saying: what would you do? It’s possible there were medical problems revealed. You wouldn’t know anything about that. And you don’t know what their thoughts and feelings about their own lives were when these crises happened. They don’t have anything to do with the discussion because they’re just little bits of stories about people you know. No one can say what they would do for these women. I’ve told you what i might do (rest and medical care) You can’t say that’s right or wrong so that just proves that it’s a silly exercise. The point is – you can’t say that declaring them mentally ill and giving them drugs was the right thing to do. And doing it does harm: the drugs are harmful and the label of mentally ill is harmful.

  135. rezistnzisfutlon 26 May 2013 at 1:35 am

    Cannotsay,

    You’re right, my replies have been anything but logical fallacies. You’re the one who erroneously stated that I committed one, which makes it clear that you don’t understand what a logical fallacy in the first place, much less logic. It may seem tangential to the present conversation except that it speaks toward your level of argumentation and weakness of your position. The fact is, all of the scientific and medical evidence speaks directly to what you are claiming here, and my only point has been that engaging with someone like you is like engaging with an AIDS denialist or young-earth creationist – it’s essentially fruitless (unless it’s for the edification of those arguing with you), it lends you and your kind unwarranted credence, and honestly it’s a waste of bandwidth. I’ve seen you hijack threads before, spamming them with endless posts from an implacable position, which is why I stand by my original assessment that you’re an attention-seeking troll and people should not feed trolls. But, it’s only a suggestion and it’s other peoples’ time to waste.

    Simply because you’ve gotten responses from Dr. Novella does not add gravitas to your arguments. That is the problem, as well, in that simply replying to you gives your facile arguments the illusion of weight. Again, it’s their time to waste. I suppose the good thing is that it familiarizes people with your arguments so they are better prepared if confronted with them in the future. IMO, you are such a harmless fringe that you should just be ignored, or treated, whichever works best (perhaps both?).

  136. Mlemaon 26 May 2013 at 2:24 am

    by the time the brain is born, it’s experienced deep wordless emotions in its mother’s womb. And before it’s learned language, it’s experienced many more emotions. This all helps to form the brain’s mind. Language-less interactions with parents, siblings or caretakers all teach the brain fundamental feelings: I am loveable, loved, I am safe, or I am alone, unable to get what I need, and in an unpredictable world which sometimes helps me and other times hurts me, regardless of my own actions.

    Then, with language, beliefs about the self are formed: I am valuable and capable, or I am lazy and worthless, people are predictable, or people are irrational. There is security for me, or, I am threatened. None of us can really comprehend the billions of worlds that are experienced in this one world we all share. These beliefs are deep, and our thoughts spring from the well of this depth. We think in words, pictures and symbols – all of which came INTO our brain from the outside, from the moment we could first hear and see. A brain without sensory input has no moods, thoughts – and therefore no depression, insanity, etc. Our experiences all go into affecting our thoughts.

    Thoughts reflect these sensory experiences and their nature is determined by them. Beliefs and thoughts then, in turn, determine mood and behavior. If your mood is troubling you, examine your thinking. If someone is engaging in what appears to be irrational behavior: find out what they are thinking. On some level, it’s very likely there is indeed a rationale, regardless of appearance.

    So, in my estimation, mood and behavior are the result of learned beliefs and thinking. If a person turns up “mentally ill” based on his behavior – it’s likely that his experience of life to that point has caused him to behave in a way that psychiatrists have decided is “abnormal”. Now I can’t say that it’s a bad thing to recognize behavior as abnormal, because, to me, that shows that a person has been incapacitated to the degree that he or she is being overwhelmed by his/her experiences. If a person is acting irrationally and against his own or others well-being, we must do something. This gives us a chance to help people who are in trouble because of the beliefs and thoughts that have formed in their mind. But the problem with the DSM: it takes an extremely broad range of behaviors, which may indeed be maladaptive (although often not at all in DSM 5) and it turns them into “mental disorders or diseases”, when they are really perfectly normal in the context of an individual’s life.

    When someone’s behavior is extreme and hard to get a handle on, it may be important to have a place for that individual to go – in order to be removed from their current situation and to have highly trained and compassionate people who can be thoroughly involved in their life in order to give them “reality feedback”. I think we had some of that about 30 years ago in the US, but it was unfortunately still a part of the lock-up paradigm, with psychiatrist’s having God-like power over patients. Now, with all the psychiatric drugs, which basically just mentally incapacitate people so their thoughts aren’t a problem anymore, we’ve simply turned them out into the streets and they’re ending up in jail. As in the economist article, estimates are that more than 50% of the prison population has “mental illness”. So, in effect, we are punishing abnormal behavior. In that respect, we can’t just do away with psychiatry. People shouldn’t be in jail because they’re “mentally ill”. However, it’s very obvious through all the links that cannotsay has provided that there’s a serious crisis of conscience, even among psychiatrists, over the current paradigm.

    We can’t just label people, give them drugs based on that label (drugs that control their behavior while damaging their brains and bodies) and let them wander the streets. For average people (all of us who could be diagnosed with so-called disorders based on the DSM 5) there needs to be assistance in coping/changing/overcoming our painful feelings and troubling thoughts, not simply prescriptions for drugs that make us “feel better”. A person whose reality is disorganized and painful needs a new reality – which is nothing more nor less than a new mind. You get a new mind the same way you got the old one – only it’s much more difficult because it requires highly trained and compassionate help, and involves an active role, not a passive one (for both the helper and the patient). And people who really cannot communicate or sort out their thoughts need to have an environment where they’re safe, and where they have help to live – and even have a chance to try to do the same sort of self-reinvention as any of us. They don’t need drugs that turn them into shaking zombies so they can sit quietly somewhere and not disturb us.

    I think a lot of people get scared when they witness someone acting irrationally. One way to cope with the fear is: label the person mentally ill. That immediately turns that person into the “other”, the “not me”, and helps reduce the fear, like: “That will not happen to me because I am not mentally ill!” Instead of: there but for the grace of God go you or I. It’s most likely that you or I, in that person’s life, would act exactly the same way. Most people have no idea the hell that exists here on earth for many many people in the form of truly traumatic mental and emotional experiences. Experiences that they spend their whole lives trying to recover from. Often the trauma is subtle and invisible. It’s wrong for drug companies and doctors to profit from this sort of suffering. I’m afraid that might be what’s going on in many cases now.

    But I also believe that there are many psychiatrists who chose their field because they really want to help suffering people. The problem is in the ideology of mental disease and the current popularity of the idea that it’s all physiological: we just have to develop the right drugs. I’ve tried to explain why i think that’s wrong. Cannotsay has provided lots of links that show that many other qualified people are saying the same thing. It’s ironic that many people in the US actually desire a label of a disorder because it gives them the comfort that they are understood and not alone, and it allows them to get treatment and assistance. The question is: are they really being helped? And of course, if a person is labeled with something really serious, there are many negative consequences – including a bigger sense of “there really is something wrong with me” – because we have a lot of trust in medical science. Only people who have a strong sense of self and worth will develop the righteous anger to mentally survive a label of psychosis.

  137. Mlemaon 26 May 2013 at 2:34 am

    so, sorry but I want to say too that those “highly trained and compassionate people” that I mentioned more than once above would ideally be: psychiatrists. It would be best to have people deeply involved in treatment who had medical training so as to recognize and differentiate medical problems from psychological problems. The problem we have now is: the psychological problem is believed to BE the medical problem, therefore, it is treated with drugs or ECT, and not with CBT or the like.

  138. cannotsay2013on 26 May 2013 at 5:14 am

    rezistnzisfutl,

    Name calling, what you keep doing, is not the same as arguing. You can repeat all the name calling all you want but you are only disqualifying yourself. It’s me who has no time to waste with a creature like you.

    BillyJoe7,

    At the risk of sounding repetitive, this is the FOURTH time that I ask you to take the Rosenhan challenge :D .

    Then you keep your strawmen.

    “In my opinion, you cannot answer that question and have been avoiding answering that question because that would mean acknowledging that these woman, at the very least, are malfunctioning.”

    I have already answered. It is not for me to legislate the specifics because, as Mlema has correctly pointed out, we know nothing about these women. Even if I knew, the legislative process is complicated and I am not a politician. What I insist, again at the risk of sounding repetitive, that “malfunctioning”, absent a biological reason (Alzheimer’s, Down syndrome, etc) is in THE EYE OF THE BEHOLDER. You might think they were malfunctioning but it is your opinion, nothing more, nothing less.

    In the opinion of the psychiatrists that committed me, my attire showed neglect and I was “destined to become homeless” (the same idiotic self serving justification that you keep repeating for these women). My attire back to the US was the same and it was described as “clean and normal” by my American psychiatrists. And years later, not only I am not homeless but my standard of living is higher. So again, you want to give the quackery practitioners the power to decide what to do with your life (even though you are unwilling to take the Rosenhan challenge), I am fine with it. I do not want these people to decide mine when a) there is no evidence of disease, b) I have not committed any crimes.

    With respect to the video, I encourage you to re-listen 41:20 and after. I did not say that Allen Frances acknowledged that “psychiatric illness does not exist”. What he said, very explicitly, is that those DSM definitions are not real diseases but social constructs that are defined on a particular society and in a particular context. So what he has admitted is to the same point that Thomas Szasz made 50 years ago: so called “mental illnesses” are not real diseases and one only can speak of “mental illness” as a metaphor.

    “Steven Novella said that there a markers for some mental disorders but that they are not sufficiently sensitive or specific to be used as diagnostic tests on individual patients.”

    Which is the same as saying that there are no bio markers that can be reliably used to detect presence or absence of so called “mental illness”. Again, the typical fallacy of confusing correlation with causation. As I have said many times, of all people, Novella should know better than putting forward such a blunt lie.

    With respect to brain research, I stand by my prediction that the Insel program is going to fail spectacularly (and we know that from the twin studies and the general agreement that psychiatry does not deal with genuine biologically caused behaviors such as Alzheimer’s or Down Syndrome), but I am very happy to embrace the approach because it gives us the playing field that will allow the debunking of psychiatry for good.

    Again, that is not to say that people’s suffering is not real. But the medicalization of that suffering is no better than the “eugenization” of the same.

    Mlema,

    I subscribe what you say. I think that the real tragedy is that it wasn’t until Insel made his statement that the legitimate issues that psychiatry poses are being considered here. From the purely scientific (ie, that mental “illnesses” are not scientifically valid) to the more human (that psychiatry has a dark history or being complicit in perpetrating human rights abuses that continues to this day).

  139. BillyJoe7on 26 May 2013 at 6:41 am

    cannotsay,

    I thought you wanted me to watch the video so that’s what I did.
    You’ll have to re-supply the link to the Rosenberg challenge if you are so keen for me to take that on as well. But I’m always reluctant to blindly follow links unless someone has given me good reason to do so because, in my experience, most links as usually wild goose chases. And, of course, you should be able to make your case without links. Your video was at least interesting, but it didn’t tell me anything new and it had absolutely no bearing on our argument. So I would class it as a wild goose chase, not very productive. I hope your Rosenberg challenge is better.

    mlema and cannotsay,

    Both of you seem to be going to extraordinary lengths to deny psychiatric illness. If your problem is stigmatisation, why dont you tackle that. Why deny the psychiatric illness. Catatonia is not normal behaviour by any stretch of the imagination, and having that woman’s full medical history won’t change that fact. If you want to argue whether or not drugs should be used to treat catatonia, why don’t you just argue that. Why the need to deny the psychiatric illness.

    cannotsay,

    You have a strange argument against Steven Novella. You seem now to be agreeing with what he said about biological markers but still insist on calling him a liar.
    As a matter of interest, he has posted about the DSM-5 on the science-based medicine blog as well:
    http://www.sciencebasedmedicine.org/index.php/dsm-5-and-the-fight-for-the-heart-of-psychiatry/

  140. rezistnzisfutlon 26 May 2013 at 6:50 am

    I never said that I was arguing – I never forwarded an argument in the first place. In fact, my statements were originally not directed at you. I only responded to your directed statements to me when you erroneously stated that I’d committed an ad hominem, at which time I pointed out how that was further evidence of your untenable position (as you said Dr. Novella’s is), seeing that not only is your position is weak on evidence, but is not based in logic, either, a la AIDS denialists or young-earth creationists. Furthermore, stating that you’re a troll has a high likelihood of accuracy considering the sheer preponderance of your posts, weakness of your arguments, evidence and science contrary to your position, extreme and inflammatory nature of your claims, hijacking of this and previous threads, evasion of questions, dodging of requests for (credible) evidence, and similarity with other known troll behavior, so it’s not really name-calling in an abusive, pejorative sense but more of a label, or descriptor.

    In reality, it’s people here who are wasting their time.

  141. rezistnzisfutlon 26 May 2013 at 7:10 am

    Mlema,

    That’s poetic, but ultimately meaningless here. Not trying to be rude, but if you’re going to come to a science blog full of skeptics, what’s meaningful here is evidence of the scientific type. If you’re going to lay out claims such as yours about the nature of human behavior as it interacts, and effects, the real world, then you should have evidence of the scientific variety not only that covers your assertions about how humans behave, but also how best to deal with destructive behavior.

    All I’ve seen from you is flowery language about how it’s the environment (nurture) that causes destructive behavior, that there are no biological causes of mental illness, that medication is a crutch used by psychiatrists who have some “god” complex, and that the DSM should be thrown out for what, some combination of Freudian/Jungian feel-good life coaching? There is a lot of strawmen in there about the profession of psychiatry and psychology that I would wager is based on ignorance. While no one here is claiming it’s a perfect discipline, the overriding problems aren’t with the profession but with lack of funding for enough qualified and competent psychiatrists to adequately visit and assess that many patients. Furthermore, it’s not like psychiatrists are in the habit of just throwing drugs at every problem they see in a shotgun fashion hoping it’ll cure whatever the problem is. They will refer patients to psychologists and counselors as warranted if longer-term therapy is called for.

    To deny that there are actual biological factors that effect behaviors that medication, behavior modification, skill learning, or a combination of these can improve quality of life for the patient, is to deny actual peer-reviewed, demonstrable scientific evidence. This near wild-eyed fervent psychiatric illness denialism really is akin to AIDS denialism or young-earth creationism.

  142. steve12on 26 May 2013 at 11:33 am

    “I thought that people here were smart enough to make the analogy themselves”

    “Frist they came…” can be used for analogies. In Rwanda or the Killing fields.

    Using it in lesser circumstances (like debates about the state of psychiatry) is an attempt to place oneself in a state of victimhood analogous to those victims while analogizing the “perpetrators” to the Nazis.

    It’s in appropriate in the extreme to casually use it in the fashion that you did. It absolutely amazes me that I actually have to explain to adults why it is inappropriate and selfish.

    Again, shame on you.

  143. Mlemaon 26 May 2013 at 2:43 pm

    rezistnzisfutl,
    there’s plenty of psychological evidence for my opinions. But what qualifications do any of us here have to make judgements on the current state of psychiatry? Cannotsay is sharing his experience and opinions just like all the rest of us. He has at least shown that some qualified psychiatrists share his thinking. If I’ve said something contrary to current scientific evidence, please point that out specifically.

  144. cannotsay2013on 26 May 2013 at 4:12 pm

    rezistnzisfutl,

    In some ways you are like those 9/11 truthers for whom no evidence will be never be enough to convince them that what they believe is a lie. You guys have been repeating for many years the same canards that right now the top dogs in the profession (Insel, Frances, Kupfer) agree: there are no biomarkers to detect presence or absence of so called “mental illness”. Replying to this with a strawman (ie that there are brain correlates with behavior) is again a strawman. And to compare my criticism to AIDS denialism is an exercise of utmost intellectual dishonesty. This is how AIDS denialims is falsified http://www.aidstruth.org/denialism/dead_denialists . Just as Steve Jobs learned the hard way the costs of denying oncology. What are the consequences of thinking along my lines? That my body has been spared from many years of the effects of poisonous drugs (SSRIs), saving me from a potential kidney/liver transplant (both of which had been slowly destroyed by the drugs). And of course, there is a social cost (my estrangement from my ex-family) but that only speaks of the evils of psychiatry, not its virtue.

    BillyJoe7,

    Here is the Rosenhan challenge https://www.youtube.com/watch?v=FG4mOpQpmpw . Basically, it’s the notion that psychiatry cannot distinguish sane from insane rooted in the fact that DSM diagnosis are value judgements without scientific validity. While this happened in the 1970s (and forced psychiatry to come with DSM-3), there are more contemporary examples like the person named Tony whose case is described in Jon Ronson’s book. In Tony’s case, he faked insanity to avoid a 5 year jail sentence for a petty crime he had committed. His thinking was that he would spend some time in a psychiatric ward and then get released. What he didn’t anticipate is that once in, there was nothing he could do to convince his psychiatrists that he was sane, even when his psychiatrists agreed that the had faked his insanity. The fact that he had faked his insanity was considered evidence of a different “mental illness”. The intent of those psychiatrists was to hold Tony indefinitely. Tony challenged his detention and he was eventually freed but he spent 12 years in involuntary confinement. I can attest that this is true still today. Everything that I did in the ward was also interpreted as a symptom of OCD, including behaving what as described as normally (it was interpreted as my “mental illness” in an effort to get out of there). I was only freed once I agreed that to the proposition that I had a problem -ie, I agreed to their dehumanization-, accepted to be put on meds and express “thankfulness” for having been abused.

    So the challenge is this: present yourself at an ER with some minor stuff (like hearing the word “thud”). I can almost 100% guarantee that you will be admitted to a psychiatric ward and that once in, nothing that you’d do will be considered sign of sanity save accepting that your are “mad” and accepting to “take your meds”. Although the frequency of the abuse is not as high as it used to be, abuses still happen. Paula Caplan has done a great job compiling over the years personal horror stories,

    http://psychdiagnosis.net/psychiatric_stories.html

    “Both of you seem to be going to extraordinary lengths to deny psychiatric illness. If your problem is stigmatisation, why dont you tackle that. Why deny the psychiatric illness. ”

    Again, strawman and already addressed. This is a “blame the victim” type of argument.

    Steven Novella has been telling lies for years. I am not putting the link (because I think that I would get moderated for surpassing the allowed number of links) but his posting called “Responding to a Szaszian” has been refuted by both Insel and Kupfer his month. He keeps putting forward “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior” while there is absolutely no evidence that that is the case. He keeps confusing correlation with causation and his own desires that some day a biological cause will be found for DSM nonsense. In some other instance, which I am unable to find now, he claimed that you can recognize ADHD when you see it.

    I understand Novella. It must be a bitter moment to see that the top dogs of psychiatry have, in a matter of days, deny the arguments he have been putting forward for years that he thought were a “stroke of genius”. Well, they were not. There were plain old sophistry.

  145. cannotsay2013on 26 May 2013 at 4:41 pm

    Mlema,

    “Cannotsay is sharing his experience and opinions just like all the rest of us. He has at least shown that some qualified psychiatrists share his thinking”

    The sad reality is that the arguments I have put forward here not only aren’t new but they aren’t original to me either. What Insel, Kupfer and Frances have been airing in public this month are things that were known for years by the bulk of psychiatrists, only “officially” they told a very different story because there are many interests at stake. Joel Hassman, a psychiatrist critical with the current state of affairs (but not ready to condemn psychiatry just yet) summarized very beautifully the reason this scam has the force it has,

    http://1boringoldman.com/index.php/2013/05/25/didnt-know-that/#comments

    ” I have noted legitimate criticism of psychiatry, and myself critical of the extreme elements that run APA and academia, I practice moderation in my profession and feel my blog represents this.

    I am not going to renounce my decade plus of education and training just because of a group of old, narrow minded, greedy, self serving bastards who get away with their disingenuous at best/egomaniacal needs of the few only agenda.”

    If somebody like him, who is able to see how rotten his profession has become, is unwilling to call it quits because of his own personal interests, it is a complete lost hope to have those like Lieberman or Ron Pies, true believers, to embrace reform, let alone to give up.

    The real struggle is among those who realize that psychiatry is a rotten profession but still stick to it for some reason without really embracing the reality that they have been lied to for most of their lives. I can put Frances and Insel in this category. Instead of being part of the solution they insist in being part of the problem. Frances’ case is astonishing. In his Science hangout he agreed that DSM definitions are social constructs. In his Al Jazeera interview then he said that he wants to go back to a time of 5% of Americans being deserving of labels/medication. Now, does anybody believe that his reasoning holds any ground. What makes it more acceptable, from a pure human rights perspective, to accept a quackery that impacts “only” 5% of Americans but not one that impacts 50% of Americans? The paradigmatic example of Frances’ untenable position is the bereavement exclusion of depression, that he calls one of the worst changes of DSM-5.

    Frances says that people sad for more than two weeks after the loss of a loved one will be now diagnosed with Major Depression Disorder. What he doesn’t say is that his task force (DSM-IV) lowered it from 1 year to two months, which is as arbitrary as lowering it from 2 months to 2 weeks. In some Islamic countries, for instance, women are expected to mourn their husbands for years after their deaths. Are they depressed, as in “Islamically depressed”. This is of course absolute nonsense. Which is why my proposition is that psychiatry should be deprived of all of its coercive powers (ALL) and be given the same treatment homeopathy has in the US. Homeopathic medicine is both regulated (its medications have to be approved by the FDA) and covered by certain private insurance companies. However, its findings are considered pseudoscientific and have no bearing in legal proceedings, etc.

  146. steve12on 27 May 2013 at 1:20 am

    Mleme:

    “But what qualifications do any of us here have to make judgements on the current state of psychiatry? Cannotsay is sharing his experience and opinions just like all the rest of us.”

    It’s not a matter of qualifications or experiences, but evidence. We can be about as sure as science allows that schizophrenia, e.g., is a brain condition driven by an interaction of genes and environment. It is as real as Parkinson’s or Huntington’s.

    Saying otherwise is simply denialism without stunning new evidence.

    As I said earlier, if someone wants to say that what we call schizophrenia is not pathological, because the classification of something as pathology is a value judgement, well, that’s anther argument. What we classify as schizophrenia might be a shaman in another culture, or someone might consider auditory hallucinations a gift, or whatever.

    You can make this argument and not be a denialist IF and only IF you acknowledge the extant evidence that whatever you might call these people, their brains are demonstrably different and they pass the propensity for these brain differences on to their progeny. Anything else is simply horsesh!t denialism in it’s most egregious form due to the overwhelming weight of the evidence.

  147. Mlemaon 27 May 2013 at 3:56 am

    Cannotsay, i get what you’re saying. I can only offer my opinion based on what I understand about why people think and behave as they do, and what I recognize as baloney – like “…a brand-new diagnosis called temper dysregulation disorder with dysphoria that members of the DSM work group hope will stem what they see as a false epidemic of juvenile bipolar disorder”

    Messing with kids this way ought to be illegal.

    I mean, really, the major determining factor of who will be diagnosed with ADHD in any given classroom is: age!

  148. Mlemaon 27 May 2013 at 4:20 am

    Steve 12,
    “We can be about as sure as science allows that schizophrenia, e.g., is a brain condition driven by an interaction of genes and environment.”

    Unfortunately, schizophrenia is still a diagnosis based on symptoms as varying as auditory hallucinations and delusional beliefs. All “brain conditions” are driven by interactions of genes and the environment. We still have no evidence that we can diagnose something we call “schizophrenia” by examining the brain/genes. There’s no doubt that these various behaviors, thoughts and beliefs change the brain however.

    “You can make this argument and not be a denialist IF and only IF you acknowledge the extant evidence that whatever you might call these people, their brains are demonstrably different and they pass the propensity for these brain differences on to their progeny.”

    haha! you are trying to box me in! Yes, their brains are demonstrably different, and they most likely pass on the propensity for these differences. But we don’t know if the differences are cause or caused. Maybe you can post some literature about that.
    Schizophrenics, even with their homogeneity, are about 1% of the population.
    You know what else gets passed on in families? Ways of thinking, beliefs, and ways of relating (sometimes to specific family members. Family sociology is really fascinating. Members often have roles: the scapegoat, the savior, etc. – very powerful brain shaping there)

    i remain in agreement with the growing number of psychiatrists who say the DSM is fundamentally flawed and puts us at risk for over-diagnosing and over-drugging more and more people who have nothing wrong with them physically.

  149. Mlemaon 27 May 2013 at 4:26 am

    Steve12, y’know – I do agree that it’s important to continue to research biological causes for behavioral problems. But I don’t think we should be looking for biological causes for symptoms that are not problematic for the person who’s experiencing them – but instead for parents, teachers, psychiatrists, etc.

  150. steve12on 27 May 2013 at 10:15 am

    “haha! you are trying to box me in!

    Little bit!

    ” Yes, their brains are demonstrably different, and they most likely pass on the propensity for these differences. But we don’t know if the differences are cause or caused. Maybe you can post some literature about that.”

    We absolutely know that it has a biological cause, as sure as we can be of anything in science, but that enviro triggers are also required. I.e., you can carry the genes and NOT get it – this doesn’t mean that these genes aren’t required.

    I think your confusion is re: what’s sufficient for individual diagnosis and what’s sufficient to show a biological cause – they are not one in the same because of the variation of expression. I went into detail with some links above as did Steve Novella on this point.

    I would say that this is the key misunderstanding of the entire thread.

  151. Bill Openthalton 27 May 2013 at 11:21 am

    Mlema

    I don’t think we should be looking for biological causes for symptoms that are not problematic for the person who’s experiencing them – but instead for parents, teachers, psychiatrists, etc.

    Information supplied by the environment, processed in such a way that it results in permament behaviour unsuitable to that environment qualifies as a biological cause. Given the nature of the brain (no clear distinction between hardware and software, and patterns that are all but impossible to change when laid down in early life), the result is very close to physical damage.

    What is difficult to accept is the fact that given different circumstances, the problem might never have arisen. It is true that sufficient knowledge of the specifics of an individual’s neural pathways could avoid problems caused by the inadequate behaviour (for that individual) of the people around them. Unfortunately, this knowledge is not available, and the familiars are themselves affected by their original “programming”, and limited in how they observe and react.

    Whatever the causes, it is simply so that humans have mental issues, some more, some less.

  152. cannotsay2013on 27 May 2013 at 1:23 pm

    steve12,

    Now that I got you saying something that actually makes sense,

    “As I said earlier, if someone wants to say that what we call schizophrenia is not pathological, because the classification of something as pathology is a value judgement, well, that’s anther argument.”

    THAT IS THE CRUX of the argument. And again, in schizophrenia, the Cohen’s kappa of that value judgement is 0.46 in DSM-5 field trials. So it is not even sure that there is reliability in identifying what is called “schizophrenia”.

    One of the most studied brains in the history of human kind is Einstein’s. The statement “Einstein’s brain was physiologically different than the brain of most people” is beyond dispute -as it is also true that not two brains are identical- just as many would also agree (although you might find this more contentious) that “those differences explain his genius”. That said, the decision of calling Einstein’s behavior, which is even rarer statistically speaking than whatever is called “schizophrenia”, “pathological” is purely a political decision as are all the decisions about what should be in DSM and what should not.

    Mlema,

    “i remain in agreement with the growing number of psychiatrists who say the DSM is fundamentally flawed and puts us at risk for over-diagnosing and over-drugging more and more people who have nothing wrong with them physically.”

    Agreed.

    steve12,

    “We absolutely know that it has a biological cause, as sure as we can be of anything in science, but that enviro triggers are also required. I.e., you can carry the genes and NOT get it – this doesn’t mean that these genes aren’t required.”

    Actually, if there is an agreement is that WE ABSOLUTELY DON’T KNOW whether biology is the only cause to any of the DSM invented disorders. Again, correlation is not the same as causation.

    Bill Openthalton,

    “Information supplied by the environment, processed in such a way that it results in permament behaviour unsuitable to that environment qualifies as a biological cause. ”

    Actually it doesn’t. A biological cause is the type of behavior caused by syphilis described by Ori, the type of behavior that results from neurodegeneration (Alzheimer’s) or the type of behavior caused by true genetic disorders such as Down syndrome. Everything else is an attempt of doing social control based on psedo science.

    Here is what I see happening in this thread. Now that the statement “there are no biomarkers for DSM labels” seem to be beyond dispute, you guys are trying to pull a “Clintonian” type of fallacy by moving the topic to “it all depends on what a biological cause is”. Sorry, but it doesn’t depend on that. Even Novella, in his long history of posting false arguments, was taking about biological causes along the lines that I mentioned above. The problem is that he was arguing with logical fallacies and wishful thinking. This month’s events put a dose of reality: to this day there are no biomarkers for so called “mental illness”.

    “Whatever the causes, it is simply so that humans have mental issues, some more, some less.”

    I have never said otherwise. What I have said repeatedly is that labeling certain behaviors as pathological absent a biological cause is a value judgement that has no more value than your or my value judgement. The fact that those making the value judgement have an MD degree is as relevant as if they had graduated from West Point, ie, totally irrelevant as to whether one can label behavior that has no known biological causes as pathological.

  153. cannotsay2013on 27 May 2013 at 1:49 pm

    To all, again, now that I have your attention. The problem of using the DSM to pathologize behavior is that you have it imprinted all around the place. This is a random example in NY State law,

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

    “52. “Persons with serious mental illness” means individuals who meet
    criteria established by the commissioner of mental health, which shall
    include persons who are in psychiatric crisis, or persons who have a
    designated diagnosis of mental illness under the most recent edition of
    the Diagnostic and Statistical Manual of Mental Disorders and whose
    severity and duration of mental illness results in substantial
    functional disability. Persons with serious mental illness shall include
    children and adolescents with serious emotional disturbances.”

    The law didn’t change last week, but a change in the DSM-5 expanded the number of people who could find themselves legally at the receiving end of coercive psychiatry.

  154. Bill Openthalton 27 May 2013 at 7:28 pm

    cannotsay2013

    The idea there should be a “true disorder” caused by an external agent (syphilis) or a major genetic defect (Down’s) for the problem to be biological is simplistic. Not so long ago, everything to do with the mind was deemed to be non-physical, and people with behavioural problems were thought to be possessed by devils. Now we know better, and the idea there are no biological reasons for a category of mental problems is untenable.

    That being said, it is for a group of people (or society if you wish) to accept a specific behaviour, or not. As an example, whether homosexuality is a disorder or not depends wholly on the attitude of “society”. Humans are social creatures, and those specimens who cannot adapt to the society they have been born into have a brain that is not “fit” for its purpose. This is not absolute, and a misfit in one society can be a perfect match for another. I do favour an inclusive, accepting and tolerant society, but that is my personal choice, not an absolute. There is no absolute morality.

    I agree there is a lot of abuse (by familiars and professionals) when dealing with ill-adapted people (I have first-hand experience, though not at the receiving end), but that doesn’t mean (what you call non-biological) mental illness does not exist. I also agree that the mental problems of some people have been exacerbated by their environment (their parents, siblings, teachers, colleagues and partners), but as social animals, not being able to deal with one’s social environment is a genuine problem, and rooted in the specifics of the brain.

  155. cannotsay2013on 27 May 2013 at 7:48 pm

    Bill Openthalt,

    It seems that there is a lot of agreement today :D . I will just highlight the disagreement -this is by no means an attempt to imply that there is mostly disagreement, I’d say that the opposite is true-,

    “Now we know better, and the idea there are no biological reasons for a category of mental problems is untenable. ”

    Again, this is confusing correlation with causation. “Mental illness” only makes sense as a metaphor, nothing else. It’s the whole sw/hw problem. My contention is you can only call disease hw problems, not software problems. As the Critical Psychiatry Network puts it, http://www.madinamerica.com/2013/05/dsm-5-statement-by-the-critical-psychiatry-network/ “the paper points out that since its origins in the early part of the nineteenth century, psychiatry has faced a fundamental question that remains unanswered: can a medicine of the mind work with the same epistemology as a medicine of the tissues. In recent decades, there has been a concerted effort to ignore this question and psychiatry has approached the ‘mind’ as if it was simply another organ of the body. ” I think absolutely NO.

    “but as social animals, not being able to deal with one’s social environment is a genuine problem, and rooted in the specifics of the brain”

    Whatever the cause of that social maladaptation, absent any genuine disease such as syphilis/Alzheimer’s/Down Syndrome, etc , I think that the right way to address it, especially in our open Western societies, is the democratic/legislative/judicial process where there are safeguards against abuse. What is considered “maladaptation” is very subjective and should not be subject to the type of arbitrary treatment that happens at the hands of DSM psychiatry. Said abuse is real and pervasive even though now, in the US, it is more under check than in decades prior. Just to give another data point. In 2008, Republican senator Chuck Grassley started a congressional investigation directed at uncovering conflicts of interests in academics receiving NIH (the parent institution of the NIMH) money. It was not directed at psychiatry per se. However, the overwhelming majority of conflicts untapped (that included corrupt practices such as ghost writing) affected psychiatrists http://www.nature.com/news/2009/090916/full/461330a.html . So to ignore that psychiatry, because of its own pseudo scientific bases, is not prone to corruption is also untenable.

    Other than that, as I said, I think that there is a lot of agreement here.

  156. Mlemaon 28 May 2013 at 1:07 am

    Steve12,
    “I think your confusion is re: what’s sufficient for individual diagnosis and what’s sufficient to show a biological cause – they are not one in the same because of the variation of expression.”

    with regard to schizophrenia:
    What’s sufficient for individual diagnosis is: a psychiatrist’s opinion, which is based on observed behavior, the anecdotes of family or others, and the authority of the DSM
    What’s sufficient to show a biological cause: evidence of a biological cause

    In focusing on schizophrenia, again, the symptoms are widely varied with the only thing tying them together in many cases being the label schizophrenia. The label is a sort of a catch all for: weird behavior. Diagnosis is 1.1% of the population (and as cannotsay has pointed out, the diagnosis has a low reliability). Even if some behavior labelled schizophrenia has a biological cause, it doesn’t mean all “weird behavior” has a biological cause, and SO WHAT IF IT DOES?

    The question is: do we treat weird behavior as illness? If so, then who decides what’s weird? And who decides what’s appropriate treatment? Is it ever appropriate to administer psychotropic drugs to someone who can’t wittingly consent? These are all questions that become more important as those who are non-schizophrenic and yet deemed “mentally ill” become a greater and greater percentage of the population, because of the growing inclusivity of the DSM.

    Really, you can say everything human has a biological cause. What I’m saying is: most of the behavior deemed pathological by the DSM is caused by beliefs and thoughts which have proven detrimental (maybe) to the person who has them. Oftentimes the behavior is simply unacceptable to others. It doesn’t mean it isn’t good that we recognize these behaviors as detrimental. It does mean it would be a good thing to help the person who has them. But does it mean the person should be medicated? or worse: locked up? My opinion is: in most cases no.

    And this is really the opinion of a growing number of professionals in the field.

    By focusing on the most extreme evidence of possibly harmful behavior we’re really not addressing the main problem of the DSM – which is that the book makes more and more behaviors into disorders which are considered appropriately treated by a growing number of different drugs.

    here’s some info from WebMD:
    “It usually is not the psychiatrists’ choice to only prescribe medicine,” Goin says. But if a psychiatrist participates in a health insurance plan, the plan’s fee structure may discourage time spent on psychotherapy.

    A study published in the journal Psychiatric Services in 2003 shows that psychiatrists earn less for doing therapy. On average, a psychiatrist who charges for 45-50 minutes of psychotherapy earns $74-$107 less than he or she would for three 15-minute sessions of medication management.”

    and a review of Robert Whitaker’s book “Anatomy of an Epidemic”:
    http://blogs.scientificamerican.com/cross-check/2012/03/05/are-psychiatric-medications-making-us-sicker/
    and his blog:
    http://www.psychologytoday.com/blog/mad-in-america

  157. Mlemaon 28 May 2013 at 1:21 am

    Bill Openthalt,
    I don’t disagree with what you’re saying, except I like to try to be optimistic about what can be done to help people who have maladaptive behaviors. I think the % of people who need hospitalization and/or medication is much much smaller than the DSM would lead us to believe. If you would please read my comment to Steve12 above it explains what I think a little more. Especially you might be interested in Robert Whitaker’s take on the subject.

    thanks for your comment

  158. steve12on 28 May 2013 at 1:53 am

    I don’t think you read any of what me or Steve Novella wrote above re: the difference between (1.) A sufficiently stable (in the sense of individual differences in expression) biomarker for diagnosis, and (2.) replicable group biological / behavioral differences sufficient to show there is a biological basis for the condition itself.

    You only need #2 (not #1) to show that there is biological (i.e., not made up by psychiatry) phenomena here.

    And this has nothing to with “who’s to say what pathological?” or any of that. I’ll leave that to others – I’m talking about interpreting the findings.

    If you take a group of people who have been diagnosed with schizophrenia (SZ), as messy and mistake-ridden as that process may be, and compare them with people not showing any of the symptoms leading to a SZ diagnosis, you’re going to find replicable differences in genetics and replicable differences in low-level functioning like startle response and visual contrast & motion sensitivity thresholds. Very basic stuff – and these are just a few examples. Interestingly, first degree relatives also show some of these differences, even when reared apart from an individual with SZ.

    How can anyone interpret that evidence as a “made up” condition? How can a made up condition manifest genetic differences? Or make first degree relaltives show low-level perceptual differences? A psychiatrist gives you this BS diagnosis, and suddenly the genes and perceptual systems of you and your family begin to change?

    It just doesn’t make sense.

    And I’m making 0 claims re: what should be done about it, and what is normal or pathological, etc. I’m a cog neuro basic-science guy, not a psychiatrist.

    I’m just saying that people who psychiatrists have been diagnosing as schizophrenic (and there’s certainly an error rate there) have different biology, and it results from how the genes that they carry express themselves in light of feedback from the environment. This is a messy, complex process. But none of that messiness is evidence that there isn’t a real phenomena present.

  159. steve12on 28 May 2013 at 2:01 am

    Also Mlema, you made a good observation that I didn’t address:

    “the symptoms are widely varied with the only thing tying them together in many cases being the label schizophrenia. ”

    There may be bio subtypes of schizophrenia that will be revealed to map onto to different symptoms, e.g.:

    http://archpsyc.jamanetwork.com/article.aspx?articleid=495549

    or many of these symptoms may be different expressions of the same underlying genetic differences, but express themselves idiosyncratically with the vagaries of personality and environmental feedback:

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962129-1/fulltext

    It’s simply not known, but I think it requires explanation.

    But it in no way underminds what I say above.

  160. Mlemaon 28 May 2013 at 2:02 am

    ok. certain behaviors that occur in less than 1% of the population are related to genes and environment and have been named by psychiatrists: schizophrenia. Does this satisfy you?

  161. Mlemaon 28 May 2013 at 2:06 am

    all behavior is genetic and environmental. We may one day find the reason why two unrelated people bite their nails.

  162. steve12on 28 May 2013 at 2:11 am

    “ok. certain behaviors that occur in less than 1% of the population are related to genes and environment and have been named by psychiatrists: schizophrenia. Does this satisfy you?”

    It’s not about satisfying me, but sure.

    The science is the science, and the evidence that the phenomena is not invented by psychiatry is overwhelming

  163. steve12on 28 May 2013 at 2:12 am

    “We may one day find the reason why two unrelated people bite their nails.”

    I don’t follow this.

  164. cannotsay2013on 28 May 2013 at 2:26 am

    “The science is the science, and the evidence that the phenomena is not invented by psychiatry is overwhelming”

    Could you just provide something to back that claim of “overwhelming evidence”. Because I remind you what Tom Insel said,

    “The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, CREATING a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are BASED ON A CONSENSUS about clusters of clinical symptoms, NOT ANY OBJECTIVE LABORATORY MEASURE. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

    I took the liberty of emphasize the points relevant to this discussion. How is that you – you = you + Novella + the rest of the pro psychiatry crowd- keep making these claims of “overwhelming evidence” now that the top dogs in the psychiatric profession say that DSM labels are “created” and “defined” based on consensus not on scientific evidence is beyond me.

  165. cannotsay2013on 28 May 2013 at 2:31 am

    steve12,

    I forgot to add,

    “If you take a group of people who have been diagnosed with schizophrenia (SZ), as messy and mistake-ridden as that process may be, and compare them with people not showing any of the symptoms leading to a SZ diagnosis, you’re going to find replicable differences in genetics and replicable differences in low-level functioning like startle response and visual contrast & motion sensitivity thresholds.”

    Except that twin studies realized in people labelled with “schizophrenia” refute this notion. Twin people: identical DNA, the labeling of one of the twins as “schizophrenic” is at best a 50% predictor of the same labeling of the other twin. So that claim you make doesn’t hold any ground. None of those studies that claim to have found “biomarkers for DSM behavior” has stood the test of time because they suffered from selection bias. NONE.

  166. Mlemaon 28 May 2013 at 3:09 am

    Steve12,
    “The science is the science, and the evidence that the phenomena is not invented by psychiatry is overwhelming”

    Of course the phenomenon of the behaviors labelled schizophrenia is not invented. The behaviors really exist and are problematic. Just like many other behaviors, all of which are caused by genes and environment. The problem is: who gets to decide what behavior is mental illness? We all have our opinions, but not everyone’s opinion leads to children being given Ritalin and Adderall.

    You are continuing to focus on schizophrenia. Of course there is a biological and environmental cause. So what? There’s also a biological and environmental reason a person bites his nails. The questions are about behavior: what’s pathological, who decides, and what to do about it. The reason that schizophrenia is well-studied is because it’s a set of behaviors that’s considered problematic. So, we’ve learned a lot about the genes and brains of people labelled schizophrenic. There will always be cause and correlation between genes; the physical, social and psychological environment; and behavior.

    I contend: the vast majority of disorders of the DSM are problems of belief and thought, which lead to moods and behavior. In Dr. Novella’s future we will be able to map every mood, behavior, thought, belief, etc. to genes and the brain. In that future perhaps we will be able to manipulate the genes and the brain so that no one is ever unhappy, obsessed, fat, weird, etc. And who am I to say that future is unlikely? But we will still have to decide which genes and brains get manipulated. I’m just saying that right now, we already have a way to address the brain: address beliefs, thoughts, and social and physical environments. This sort of treatment takes time, money, and highly educated and insightful people.

    I don’t think you’re saying that schizophrenia isn’t treatable by means other than drugs right? Because that’s not what the research shows. I feel like you just want me to say that schizophrenia, which is a set of behaviors, and which comprises a very small part of what the DSM now terms as mental disorder: has a genetic component. OK, I said it!

  167. steve12on 28 May 2013 at 3:21 am

    “Of course the phenomenon of the behaviors labelled schizophrenia is not invented. ”

    This was the issue that the denialism revolved around. The rest of the issues aren’t neuroscience but ethics, really. I’m not as familiar with those issues, but there seem to be reasonable opinions on both sides. I’m also not that familiar with treatment. I know some of the more basic findings pretty well, especially where perceptual differences are concerned.

    Denialism is a pet peeve of mine – don’t know if you can tell….

  168. Mlemaon 28 May 2013 at 4:04 am

    As I see it the problem is in the labeling of behaviors as disease. We can label behaviors as concomitant with disease – as in Alzheimer’s. But that’s not what we’re doing with schizophrenia. We’re treating the behavior as a disease.
    If you want to get an idea on how problematic it is to diagnose SZ, check out the wikipedia definition:
    http://en.wikipedia.org/wiki/Diagnosis_of_schizophrenia
    there’s a lot of argument about who is schizophrenic, and the definition continues to change. Did you know that many cases resolve over time without treatment? or that some psychiatrists believe the problems are purely cognitive? And that some psychiatrists believe that all the symptoms of SZ are common to almost everyone over time? What does this say about the cause of these problematic behaviors?

    I admire that you reserve your opinion on the ethics of the DSM with an admission of unfamiliarity. i never seem to be so restrained myself :)

  169. BillyJoe7on 28 May 2013 at 7:10 am

    Mlema,

    I would call Alzheimer’s a brain disease, and Schizophrenia a mental disorder.

    And, sure, there’s a spectrum from normal to Schizophrenia, so there’s always going to be disagreement, at the interface, as to whether or not an particular individual has Schizophrenia. But that is not to deny that there are those who, at one end of the spectrum, undoubtedly and unequivocally have Schizophrenia.

    These, perhaps extreme examples (and perhaps my personal examples were not sufficiently extreme), at the very least, give the lie to those who say mental illness does not exist.

  170. Viklundon 28 May 2013 at 7:26 am

    cannotsay2013:

    “Except that twin studies realized in people labelled with “schizophrenia” refute this notion. Twin people: identical DNA, the labeling of one of the twins as “schizophrenic” is at best a 50% predictor of the same labeling of the other twin.”

    A 50-fold risk increase for twins then? Or am I missing something. If we assume that the rate of schizophrenia in the population is ~1% (I think that’s the number you mentioned), then if there is no genetic component we would expect the risk of having schizophrenia if your twin has it to be ~1%. But here it is 50% (at most), that’s quite a difference. So according to these numbers there is at least some genetic component to schizophrenia.

  171. ccbowerson 28 May 2013 at 8:44 am

    “I would call Alzheimer’s a brain disease, and Schizophrenia a mental disorder.”

    Oh, so you ARE a dualist.

    Just kidding. Really. I don’t want to start that conversation up again. I didn’t mean it.
    ;o)

  172. steve12on 28 May 2013 at 10:02 am

    “A 50-fold risk increase for twins then? Or am I missing something.”

    No, you’ve got it.

    “If we assume that the rate of schizophrenia in the population is ~1% (I think that’s the number you mentioned), then if there is no genetic component we would expect the risk of having schizophrenia if your twin has it to be ~1%. But here it is 50% (at most), that’s quite a difference. So according to these numbers there is at least some genetic component to schizophrenia.”

    Exactly. And the relationship maintains after controlling for rearing.

    Yet another piece of evidence that can’t be explained by SZ being a made up phenomena. It’s a silly idea

  173. steve12on 28 May 2013 at 10:09 am

    “I admire that you reserve your opinion on the ethics of the DSM with an admission of unfamiliarity. i never seem to be so restrained myself ‘ ”

    I don’t see you pontificating – I see you asking legitimate Qs and wanting answers. NOthing wrong with that!

  174. cannotsay2013on 28 May 2013 at 11:44 am

    steve12, Viklund

    “A 50-fold risk increase for twins then? Or am I missing something.”

    The same is true for homosexuality (only it’s 10 fold because homosexuality affects 5%). Plus, a finding of “homosexuality” is more reliable than a finding of “schizophrenia” (check DSM-5 field testing). The decision of labeling one behavior “diseased” (schizophrenia) and another first “diseased”, then “normal and healthy” (homosexuality) is purely political.

    You keep making strammen such as,

    “Yet another piece of evidence that can’t be explained by SZ being a made up phenomena”

    What is MADE UP as in (quoting Tom Insel),

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, CREATING a set of labels and defining each”

    is the decision of labeling behavior as “disease” with the implication that a finding of “homosexuality” (or depression , schizophrenia, or whatever) is the same as a finding of diabetes.

    BillyJoe7,

    “perhaps extreme examples (and perhaps my personal examples were not sufficiently extreme), at the very least, give the lie to those who say mental illness does not exist.”

    Again, who is to decide what is “mental illness”? What DSM calls “mental illness” only exists as a metaphor and the distinction of what is “mental illness” and what isn’t is entirely arbitrary. We now have the chair of the DSM-IV task force, Allen Frances, admitting that DSM disorders are social constructs (hangout with the Science writer).

    BTW, have you made a decision about whether you are going to take the Rosenhan challenge? I would extrapolate from your answer that you are now afraid that if you take it you might be labelled. You don’t have to use your real name (although if you get in, you tell them you faked your name that could be interpreted as further evidence of “mental illness” and then there is no way you’d get out :D ).

    Mlema,

    “We all have our opinions, but not everyone’s opinion leads to children being given Ritalin and Adderall.”

    Or to detain somebody who has committed no crimes, forcing SSRIs on that somebody and only releasing that somebody from detention if that somebody agrees to the dehumanization that psychiatry decided for that somebody. That somebody would be me :D .

  175. Viklundon 28 May 2013 at 12:17 pm

    Something very similar to the Rosenhan challenge was performed as an art-project here in Sweden in 2009.

    The artist Anna Odell staged psychosis and suicidal tendencies, was noticed by a group of people that called the emergency services. She was picked up by police and taken to an emergency psychiatric ward (correct english?). One day later she confessed that she had been acting and was released.

    Here is an english-language report of the event:
    http://www.thelocal.se/17268/20090130/

  176. zplafon 28 May 2013 at 12:50 pm

    I suffer from behavioral problems and I’m glad that psychiatry exists. I’m glad that my parents had me hospitalised when I was psychotic. I’m glad that my shrink doesn’t think that I’m lazy or that if I really wanted I could have a normal life, like a lot of people in my family seem to think. I’m glad to know that there are people trying to understand why my life is now a nightmare.

    But I can’t stand how psychiatrists act like they know what they’re doing.

    We don’t even understand how the brain of a fly works, yet they have no problems flooding the human brain with some random quantity of a particular molecule which targets sometimes several kinds of receptors. If you know a bit about the brain, don’t tell me you don’t find it surprising that such a treatment could work.

    Yet some patients do get better. Ok it usually takes weeks – even if the patient experiences the side effects a few hours after beginning the treatment – but they do get better. Oh god we’re so lucky to have those drugs. I mean, imagine if we didn’t. Wait… there was a time when we didn’t. How exactly did human societies survive for thousands of years without the psychopharmaceutical industry? All those depressive people and psychotic people unable to recover because we couldn’t give them prozac or abilify… Wait… Could it be that most of them recovered without taking anything? Could it be that the brain has evolved somehow several means to avoid being stuck in depression or psychosis? No surely if mental issues are so prevalent today, it must be that there were so disabling in the past that evolution took care of it… Oops.

    What about the studies? After all they do show a dramatic beneficial effect. Wait. No they don’t. Most of the time it’s just slightly better than a placebo. But the main problem with those studies is simple, they’re total bullshit. To convince yourself, I challenge you to design a study about the effect of some drug on patients suffering from some DSM-approved pathology. First you need to match a drug with a pathology. Good luck. I challenge you to find one pathology listed in the DSM that we can explain from a molecular point of view. So what do you do? You pick one drug that affects the brain because it targets a bunch of receptors. At least it should have an effect. Nothing wrong with that but clearly not the best way to start. Now comes the funny part. You need to constitute 2 homogeneous groups of people suffering from your pathology. Good luck. Because remember, the only way we can label patients today is through the eye of a psychiatrist. So you contact your team of psychiatrists and ask them to provide you with some patients suffering from pathology X. Shouldn’t be that difficult, right? Wrong. Because any sensible psychiatrist will tell you that all patients are different, that there is a spectrum of mood and psychotic disorders. She would also tell you that the DSM diagnosis can evolve. She would also admit that she may not agree with a colleague. If you were rigorous, you would stop here. But you really want to help humanity. So you decide no longer to target a pathology but rather symptoms. You no longer target bipolar disorder with psychotic features, you target psychosis. You no longer target major depressive disorder, you target depression. You will call your drug antipsychotic or antidepressant. So you have your 2 groups of patients presenting some symptom. You need now to decide what quantity of the drug you should give to the lucky group. Good luck. Of course you could decide to recruit more patients to constitute other groups and give each group a different dosage. But who cares since what you’ll end up doing is convinced every psychiatrist that when the patient doesn’t improve, they should increase the dosage. Who said the brain was complex? Who said that targeting 50% of some category of receptors could have a totally different effect than targeting 75% of those same receptors? But let’s forget this. You need now to measure the outcome of the experiment, your carefully designed double blind study. Of course your drug has so many side effects that you’re pretty sure patients and psychiatrists will know whether they were in the placebo group or not. But who cares? After all, evaluating the mind is just the most subjective measurement we can imagine. But let’s forget this. So how long do you wait before asking your team of shrinks for news? Let’s say several weeks. If you’re lucky, you will measure a positive effect. If not, well, you don’t need to publish the study, right?

  177. The Other John Mcon 28 May 2013 at 2:25 pm

    The Rosenhan study has had some serious valid criticisms leveled against it. One good point is if someone showed up at an ER vomiting blood, but was only ‘faking it’ due to drinking several quarts of blood, it wouldn’t be unreasonable for the hospital staff to suspect the patient of faking but to begin treating the symptoms.

    Likewise, it’s not unreasonable for psychiatry to believe patients when they are reporting problems, cognitive/perceptual disturbances, hallucinations, urges, say they are suffering, etc. and to then try to alleviate such symptoms. And it’s not unreasonable for them to notice patterns and clusters of symptoms that go together, and to label such clusters, especially when such clusters sometimes respond to some treatments better than placebo.

    I think we all should be able to agree that the Rosenhan study was important for the field of mental health treatment to consider, as it led to an emphasis against institutionalization, humanistic treatment of patients, etc. And we should probably all agree that coercive treatment is in general not a good idea, and only used in extreme situations in which danger might be posed, and to use it sparingly if at all.

    But we should also agree that mental disorders are real, they do exist, they exist in clusters of symptoms, some treatments do work on some clusters for some people, and that we do need better, more focused, more effective treatments with less side effects. If you re-read Dr. Novella’s post, this is all he is advocating, a better understanding of the biology/brain system which will hopefully lead to better treatment in the hopefully-not-too-distant future.

  178. Mlemaon 28 May 2013 at 2:54 pm

    Viklund,
    I think that behaving in a way that’s going to get you diagnosed as psychotic points up the fact that psychiatric diagnoses are based entirely on behavior. But people who get diagnosed aren’t acting psychotic, they are genuinely behaving in a way that gets them labeled psychotic. The problem is: when we believe that such behavior requires imprisonment and drugging.

    I agree that the Rosenhan study was valuable in showing that simply hearing “thud thud thud” was enough to get you locked up and drugged.
    The art student acted like she was going to commit suicide, so, of course people tried to stop her. Then she just got violent against restraint.

    BUT, what i found very telling was the doctor’s comment, quoted at the end of the article:

    “But she’s welcome to come back so I can give her a shot of Haloperidol, and then we’ll see how much fun she has. That would make a great installation.”

    a sarcastic and somewhat sadistic remark which illustrates that doctors who use them know that anti-psychotic drugs f*** you up
    http://en.wikipedia.org/wiki/Haloperidol

    I would even go so far as to say that the powerful drugs administered to people who are “acting weird” could be seen as a type of punishment for unacceptable behavior (although i know that no doctor would ever administer drugs as punishment, but instead with the faith and hope that it will “correct” the behavior). But if a person can’t connect the punishment to the crime…and if behavior is the brain’s learned reaction to its psychological, social and physical environment…well, what good are these drugs beyond really just slamming the brain into submission to some idea of “acceptable behavior” (along with some horrible behavioral side effects that are troublesome only to the person experiencing them -so- therefore acceptable behavior to doc, family and society?)?

  179. cannotsay2013on 28 May 2013 at 3:02 pm

    Viklund,

    Thanks for bringing this to my attention. I wasn’t aware of it and it’s yet another instance to add to my arsenal when I engage in this type of debates. Not really surprised of what happened :D .

    zplaf,

    I am glad that to hear that you think you were helped. I 100% respect that. What I don’t respect is that then shrinks used anecdotal evidence like yours to impose their quackery on the rest of us. You seem to agree that theirs is a quackery. If you want to hear a different perspective you might want to join our community here http://www.madinamerica.com/ . Many of us were also convinced that we had been “helped” until we learned otherwise. These drugs they force onto us have very harmful effects. Not to mention that having a “label” is like having a “criminal” record for many legal purposes.

    The Other John Mc,

    Your critique to the Rosenhan experiment is invalid because even if somebody showed up at the ER with a fake vomiting, “real doctors” have procedures to detect that nothing is wrong (blood tests, imaging techniques, biopsies, etc). The Rosenhan experiment not only deals with the part about how easy is to get admitted but also with the fact that once labelled, there is nothing a patient can do to convince the psychiatrists that nothing is wrong. Every single behavior afterwards is interpreted as “sign of mental illness”. Those who took part of the original Rosenhan experiment attest to that, Tony attests to that, I (and that art student) attest to that. The only way to get away from there is to admit to the diagnosis (ie, to their dehumanizing view of you), take your drugs and convince them that you are “getting better”.

    ” And we should probably all agree that coercive treatment is in general not a good idea,”

    100 % agree.

    ” and only used in extreme situations in which danger might be posed, and to use it sparingly if at all.”

    I do not agree. No exceptions, sorry. Once you legislate/allow for exceptions, you open the door to abuse. For example, in the US, the Donaldson v. O’Connor ruling was very important in many ways and the rates of involuntary treatment show it. At the same time, there is plenty of evidence that the “dangerousness” exception is being abused continuously. I have heard many stories in Mad In America of people who were abused under that exception. The same justification was used to abuse Glen with forced ECT until last year http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/glen-k-forced-ect/cuomo-forced-ect .

    “But we should also agree that mental disorders are real, they do exist, they exist in clusters of symptoms, some treatments do work on some clusters for some people, and that we do need better, more focused, more effective treatments with less side effects.”

    Again, strawman. You can reliably define patterns of behavior. That is not the point. To this day no DSM diagnosis has the reliability that the labeling of “homosexuality” has. Yet considering that pattern of behavior pathological (or not pathological) is 100% a political decision. We already have the political process to deal with abnormal behavior.

    “If you re-read Dr. Novella’s post, this is all he is advocating, a better understanding of the biology/brain system which will hopefully lead to better treatment in the hopefully-not-too-distant future.”

    Actually Novella’s posting is wishful thinking. He is on record saying, in his posting called “Responding to a Szaszian”, things such as,

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    And I think that after this debate very few agree to that proposition. ADHD might be well defined as a behavioral pattern (even that is questionable because ot the lack of reliability of DSM-5), but there is not the slightest shred of evidence that ADHD is the result of a “brain disease” in the way that Alzheimer’s is the result of a brain disease.

    The problem that Steven Novella has is that he has been saying a lot nonsense over the years that was refuted in the span of 3 days by both Insel and Kupfer, which are the top dogs in American psychiatry, like one month ago.

  180. cannotsay2013on 28 May 2013 at 3:21 pm

    People,

    It seems that the denunciation of psychiatry is going mainstream,

    http://mobile.nytimes.com/2013/05/28/opinion/brooks-heroes-of-uncertainty.html

    “The problem is that the behavorial sciences like psychiatry are not really sciences; they are semi-sciences. The underlying reality they describe is just not as regularized as the underlying reality of, say, a solar system.”

    “If the authors of the psychiatry manual want to invent a new disease, they should put Physics Envy in their handbook. The desire to be more like the hard sciences has distorted economics, education, political science, psychiatry and other behavioral fields. It’s led practitioners to claim more knowledge than they can possibly have. It’s devalued a certain sort of hybrid mentality that is better suited to these realms, the mentality that has one foot in the world of science and one in the liberal arts, that involves bringing multiple vantage points to human behavior.”

    EXACTLY.

  181. zplafon 28 May 2013 at 5:13 pm

    cannotsay2013,

    When I said I was glad that my parents had me hospitalised, it’s because I was behaving too weirdly to be let free. Sure it’s humiliating but at least you can’t do whatever crosses your psychotic mind. But I don’t think I was helped at all by the drugs they gave me. They almost killed me actually. Luckily I was being asked questions by a shrink when I began having serious breathing difficulties, so they were able to inject me something to help me.

    A few decades ago, psychiatrists used lobotomy and electroshocks, today they have drugs called antipsychotics, antidepressants and mood stabilisers. They can’t help but tinker with the mind of their patients, even if they have no idea what they’re doing.

    If the skeptics community can’t grasp this simple fact, no wonder so many people fall for this scam.

  182. BillyJoe7on 28 May 2013 at 6:00 pm

    ccbowers,

    All I meant to say was that Alzheimer’s is a brain disease in the sense that there is a destruction of brain tissue (seen histologically as atrophy, amyloid deposits, neurofibrilliary plaques and tangles), whereas Schizophrenia is a mental disorder in the sense that there is a change in brain function without destruction of brain tissue. You can recover from an schizophrenic episode, but there is no such thing as recovering from a Alzheimer’s episode.

    cannotsay,

    You continue to avoid the question.

    You answer: “who is to decide what is mental illness?”
    I’m saying that, no matter how much you might disagree about marginal cases, at the extreme end of the spectrum, no one except a denialist disagrees that the person has a mental ilness called schizophrenia.
    In other words, to say that mental illness does not exist is denialism, proven by these extreme cases.

  183. ConspicuousCarlon 28 May 2013 at 6:31 pm

    zplaf said
    ” If the skeptics community can’t grasp this simple fact,”

    If you are trying to say that antidepressants are bad because they are used by psychiatrists and psychiatrists used to do lobotomies, then you will indeed have a hard time getting skeptics to “grasp” your point of view.

    If you are trying to say something else, you aren’t doing a very good job of it.

  184. cannotsay2013on 28 May 2013 at 8:45 pm

    zplaf,

    This is my own story,

    http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770

    I have nothing but contempt for the psychiatrists who did that to me and for the family members who were enablers of that abuse. My wish is that all of them suffer the utmost misery in life.

    BillyJoe7,

    “You continue to avoid the question.
    You answer: “who is to decide what is mental illness?””

    It seems you are the only one who doesn’t get it because the rest seem to have understood it a while ago.

    “I’m saying that, no matter how much you might disagree about marginal cases, at the extreme end of the spectrum, no one except a denialist disagrees that the person has a mental ilness called schizophrenia.”

    First, behavior labelled as “schizophrenia” has a reliability of 0.46 (in a 0-1 range) according to DSM-5. A bit better in previous editions but nothing extraordinaire. Homosexuality has a much better Cohen Kappa (if not 1, very close).

    The decision of making of “schizophrenia” a “mental illness” is as political as making “homosexuality” a “mental illness”. These labels are CREATED by DSM committee members as Tom Insel very eloquently put it. “Mental illness” only exists as a metaphor, end of the story.

    “In other words, to say that mental illness does not exist is denialism, proven by these extreme cases.”

    Well, according to all those who voted in 1973 to keep “homosexuality” as a mental illness in the DSM (which were quite a few), all those who think otherwise are, as you put it, “in denial that homosexuality is a mental illness”. So! If you don’t think that homosexuality is a mental illness, you are in denial as well, according to them.

    BTW, it seems that you are not up to the Rosenhan challenge. Can I claim victory that you lack the courage to put your future where your mouth is :D ?

  185. cannotsay2013on 28 May 2013 at 9:03 pm

    BillyJoe7,

    And, seems you seem to have problem understanding, let me tell you are confusing pattern in behavior -which can be defined with more or less reliability- with “illness” -which is what Alzheimer’s is. As the CPN said, you are using the epistemology of the tissue to talk about the mind, and that is completely nonsensical. To give the most obvious example.:

    Now DSM-5 considers a “mental illness” to be sad after the loss of a loved one for more than 2 weeks. DSM-IV thought that if you were sad more than 2 weeks but less than 2 months, you were not “mentally ill”. DSM-III thought that if you were sad more than 2 months but less than 1 year you were not “mentally ill”. Who is right? Was Robert Spitzer (DSM-III) in denial of Allen Frances’ depression (DSM-IV)? Is Allen Frances in denial of DSM-5 depression?

    The skeptic zealots usually answer this with a strawman known as the “continuum fallacy”, which is a strawman because nobody, at least I am not, is claiming that extreme behavior doesn’t exist. The point is that when it comes to define “pathological behavior” in this type of matter, you cannot get away with the fact that you are “inventing diseases” because any distinction is completely arbitrary as the history of the “bereavement exclusion” for depression shows. When you artificially make this distinctions, you are, de facto, inventing so called “mental diseases”.

    I wholeheartedly agree with David Brooks above. The “Physics Envy” diagnosis not only should be given to all psychiatrists, but also to all those skeptics who think that the “continuum fallacy” is a smart argument. Apparently these people failed their “mathematical analysis class” (http://en.wikipedia.org/wiki/Mathematical_analysis ) . Bonus points if somebody can tell me (although I doubt it) what is the relationship between mathematical analysis and the “continuum fallacy” canard :D . NOTE: this is no joke, it has been my own personal experience that the skeptics who believe this type of canards were pretty bad at advanced mathematics during their college years.

  186. steve12on 28 May 2013 at 9:06 pm

    I just want to reiterate, for those who may not be familiar with the topic or are joining late, that a biological basis for schizophrenia is settled science. Please don’t let Connotsay’s amazing air of confidence fool you: just check out the links that have been provided as evidence above along with his, well, “replies”.

    He is pretending that the scientific community is in consensus with him, when in fact the opposite is true.

    While he may bring up some important ethical issues that are worth considering re: psychiatry, his treatment of the neuroscience and genetic literatures are the best e.g. of the Dunning-Kruger effect you’ll find.

  187. cannotsay2013on 28 May 2013 at 9:20 pm

    steve12,

    “I just want to reiterate, for those who may not be familiar with the topic or are joining late, that a biological basis for schizophrenia is settled science.”

    Just as a biological component of “homosexuality” is also settled science. What is not settled science is that there are bio-markers that can be used to diagnose somebody as “schizophrenic”. Here, Tom Insel, the director of the NIMH said it,

    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. ”

    And here, David Kupfer, chairman of the DSM-5 task force, agreed a few days later,

    http://www.madinamerica.com/wp-content/uploads/2013/05/Statement-from-dsm-chair-david-kupfer-md.pdf

    “The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant.We’ve been telling patients for several decades that weare waiting for biomarkers.We’re still waiting.

    In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia. ”

    “Please don’t let Connotsay’s amazing air of confidence fool you: just check out the links that have been provided as evidence above along with his, well, “replies”.”

    Actually, your choice is not to believe me or steve12. Your choice is to believe Tom Insel and David Kupfer or to believe steve12.

    “He is pretending that the scientific community is in consensus with him, when in fact the opposite is true.”

    I just posted what is what the top dogs in psychiatry think about the matter. Can you bring any evidence to support your claim? Because a random, non replicated, study published by the Lancet -that has not stood the test of time- is not the same as what I brought here.

    “While he may bring up some important ethical issues that are worth considering re: psychiatry, his treatment of the neuroscience and genetic literatures are the best e.g. of the Dunning-Kruger effect you’ll find.”

    Now name calling :D . In fact, the irony of all this is that the events of this month have actually proved that Steven Novella and all his apprentices were the ones deluded under a Dunning-Kruger type of delusion. While they/you were preaching things such as (from Novella’s post “Responding to a Szaszian”),

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    The top dogs in psychiatry have recently agreed to,

    “”The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant.We’ve been telling patients for several decades that weare waiting for biomarkers. We’re still waiting.”

    I hope that readers are smart enough to know who’s likely to be right here.

    BTW, do you take the challenge of understanding why the so called “continuum fallacy” that Novella has used is a canard? Are you one of those who got an F in your analysis class?

  188. rezistnzisfutlon 28 May 2013 at 9:28 pm

    @Steve, agreed, that’s what I’ve been maintaining as well. There is a big difference between debating unsettled minutiae within science while discussing how better to improve patient care, and dealing with full-blown denialism based on ignorance, ideology, woo, or personal anecdotes. It’s little different from engaging with varying levels of creationists, or anti-vaxxers.

  189. cannotsay2013on 28 May 2013 at 9:34 pm

    rezistnzisfutl,

    “There is a big difference between debating unsettled minutiae within science while discussing how better to improve patient care, and dealing with full-blown denialism based on ignorance, ideology, woo, or personal anecdotes.”

    For dogmatic people like yourselves, sure. However, people who are smart know that these two statements are contradictory,

    “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant.We’ve been telling patients for several decades that weare waiting for biomarkers. We’re still waiting.”

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    The first one was made by David Kupfer, chairman of the DSM-5 task force, like 3 weeks ago; the second one by Steve Novella in one of his pontificating posts. Those whose critical thinking is not corrupted by “skeptic dogmatism” understand that the second statement is bs (probably wishful thinking) if the first one is true.

  190. cannotsay2013on 28 May 2013 at 11:21 pm

    OK, since I am sure nobody is going to address the “continuum fallacy” canard and its relationship with mathematical analysis here it comes.

    The argument that is called the “continuum fallacy” has been described, quoting Steven Novella in this same thread,

    “by essentially arguing that no sharp demarcation means that the extremes don’t exist at all. That is not a valid argument. The extremes are undeniable, even if the borders are fuzzy.”

    In fact, that is not what I argue. It is a strawman because I didn’t say that extremes do not exist. What I said is that any demarcation in a continuum is arbitrary. Why? Because as anybody who knows his mathematical analysis well will tell you, in a continuous interval, there are infinitely many points between ANY two points. Consider a close interval [0,1]. My argument is that any distinction between 0 and 1 based on picking some point in the middle is is completely arbitrary and creates an arbitrary distinction among the infinite points included in the interval that does not have a reason of being other than the decision of whomever decided to create that distinction.

    That is different from saying that you cannot divide the interval in two or that 0 and 1 are not points in the real line. Consider an arbitrary distinction made by saying that all points greater or equal than 0.5 are, for practical purposes, 1 and those that are strictly less than 0.5 are 0. You have created an artificial distinction because you can get as close to 0.5 from either side as you want (note that I am truncating these two because if left the infinite expansion both points would be 0.5, extra bonus points to those who understand this reasoning),

    - 0.4999999999999999999999999999999999999999999999999999999999999999999
    - 0.5000000000000000000000000000000000000000000000000000000000000000001

    So here are two points that have been arbitrarily separated by whomever decided that 0.5 is the dividing point. Does anybody believe that these two points are really THAT different as to define one pathological and the other normal? You can make that distinction based on “an arbitrary definition” but the argument that the are different doesn’t hold any ground other than “because somebody said they are different”. This is what the DSM does.

    Note that this problem does not happen in real medicine. Real medicine’s bases its diagnosis in addressing things such as,

    - Presence or absence of a virus/bacteria causing the disease (tests might not be perfect, but the objective of an HIV antibody test is to answer this question which is into itself a binary question).

    - Presence or absence of neuro-degeneration, in the case of diseases such as Alzheimer’s.

    - Presence of all or part of a third copy of chromosome 21, in the case of Down Syndrome.

    - Presence or absence of cancer cells in a biopsy.

    Some of the diagnostic tools might relay on measurements of quantities that are, at least in principle, continuous -in reality because of the resolution of the sensors they are discrete. But they questions they are trying to answer have clear demarcation: is there or isn’t there a viurs/bacteria, is there or isn’t there neuro degeneration or other type of degeneration, is there or isn’t there a genetic mutation, does the biopsy contain cancer cells -and if they are tumorous cells, are they malign?

    And so on. The mind does not fit this epistemology. Showing that there are hardware correlates to human behavior is 100 % irrelevant with respect to answering the question “what is normal, accepted behavior”? The latter is a political decision. And once you make the decision, you are, by the very nature of human behavior, creating an artificial distinction between normal and “abnormal”.

    Boy, if these skeptics had taken Analysis 101 during their college years. The quality of the conversation would be so much better!

  191. starikon 29 May 2013 at 12:31 am

    @cannotsay
    As one the sane people commenting here, it’s clear to me that you are completely insane. I hope you find help. I really do. I feel so bad for you :(

  192. BillyJoe7on 29 May 2013 at 12:45 am

    cannotsay,

    Firstly, let me remind you once again that I am here for the singular purpose of demonstrating the falsity of your statement that mental illness does not exist by providing the counter-example of schizophrenia. I am not here to talk about homosexuality no matter how close to your heart that problem may be, and I am not here to discuss the pros and cons of treatment of mental illness. Only that mental illness exists.

    But thanks for avoiding aswering the question now for about the sixth time…

    You said: “behavior labelled as “schizophrenia” has a reliability of 0.46″
    That does not mean that every patient labelled as schizophrenia has a reliability of 0.46 of that diagnosis being correct. In the extreme cases with extreme sumptoms, the reliability could be close to 1.0. Which makes your statement – that there are no mental illnesses – denialism..

    As for your analysis of the continuum fallacy…well, where do I start…
    I mean REALLY, you have to be joking!

    And, as for the Rosendam challenge or whatever it’s called, I’ll bet I could fake acute appendicitis and be rolled into theatre before I fessed up.
    People are easy to fool…
    …and you are a shining example of that.

  193. cannotsay2013on 29 May 2013 at 1:04 am

    BillyJoe7,

    “In the extreme cases with extreme sumptoms, the reliability could be close to 1.0. Which makes your statement – that there are no mental illnesses – denialism..”

    That’s an assumption. The official result from the trials is 0.46. Besides, what is “extreme”? You need to define “extreme”? And please, spare me from one of those Novella answers “you know it is extreme when you see it”. This takes me to the next point,

    “As for your analysis of the continuum fallacy…well, where do I start…
    I mean REALLY, you have to be joking!”

    Actually I am not. Define the “arbitrary” distinction in 0.7, you have the same problem, you are introducing an arbitrary distinction between,

    - 0.6999999999999999999999999999999999999999999999999999999999999999
    - 0.7000000000000000000000000000000000000000000000000000000000000001

    But I know, advanced math was probably not your forte in college, so I get that you don’t fully understand the argument and see that Novella’s bs is “brilliant”. In case you are asking yourself, mathematics, pushed by physics, has a way to deal with this problem http://en.wikipedia.org/wiki/Distribution_%28mathematics%29 . But again, we are talking real science here (physics, math), not psychiatric pseudo-science. It’s probably too much to ask from people like you to understand this.

    With respect to the Rosenhan challenge,

    “I’ll bet I could fake acute appendicitis and be rolled into theatre before I fessed up.
    People are easy to fool…”

    The difference is that one in, you could get out because it would be very simple for you to show that you don’t have appendicitis. The problem with the Rosenhan challenge is that people who have successfully faked “mental illness”, are then unable to show sanity to their captors. So please, if you are so sure, take the challenge. Don’t shy away from once in a lifetime opportunity to show those who think like me that we are wrong :D .

    “…and you are a shining example of that.”

    Actually, and to the risk of sounding repetitive, it’s you, the club of Novella followers/”mantra repeaters” that have been fooled by him for a long time. Let me repeat,

    Novella: “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    His followers: AMEN MASTER!

    Tom Insel: “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. ”

    Novella: Could this be true?

    David Kupfer: “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant.We’ve been telling patients for several decades that weare waiting for biomarkers. We’re still waiting.”

    Novella: Uhhhh, maybe I have been uttering nonsense for a few years…

    His followers: No master, what you say is the word of God to us. You are always right, so OBVIOUSLY, both Tom Insel and David Kupfer are wrong. After all, science is what Novella says science is.

    Cannotsay2013: Followers, be careful, you might get a “paranoid schizophrenia” diagnosis for saying that everybody is wrong but you :D .

  194. cannotsay2013on 29 May 2013 at 1:06 am

    starik,

    Whether you meant it seriously, or as a joke, I honestly couldn’t care less :D . If I don’t give a damn about what the DSM shrinks about me, how do you expect me to be “affected” by what some anonymous poster says here? Get a life :D !

  195. cannotsay2013on 29 May 2013 at 1:22 am

    When I see the type of arguments put forward here by steve12, BJ7, starik, Viklund or rezistnzisfutl a very famous movie scene comes to my mind,

    http://www.youtube.com/watch?v=Ym-k5viJ7tA

    It’s obvious who is Steven Novella in this metaphor. Can you recognize yourselves there ?

  196. steve12on 29 May 2013 at 2:05 am

    When you look at the actual “arguments”, it’s almost like the cognitive neuroscientist and world renowned neurologist are better able to interpret the neuroscience literature than the guy with the pet theory who’s never read any of that literature.

    Weird, huh? Funny how things work out sometimes. Not that we’re right because of credentials – we’re right because the evidence is clear. But ya know, sometimes a little self doubt can actually be useful, becasue being an obnoxious know-it-all makes learning something difficult.

    Like I said earlier, if anyone’s reading this thread – especially if you’re looking for help for yourself or a loved one, serious psychoses are not an invention of psychiatry. No one except this guy and some cultish cranks think this. You can find a lot of interesting links that reveal this a trivially and uncontroversially true above.

  197. cannotsay2013on 29 May 2013 at 2:22 am

    steve12,

    At the risk of sounding repetitive,

    Novella: “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    Tom Insel: “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. ”

    David Kupfer: “In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant.We’ve been telling patients for several decades that weare waiting for biomarkers. We’re still waiting.”

    If anybody in this forum can claim more authoritative knowledge on this matter than Insel or Kupfer, please raise your hand!

    On a more serious note,

    “Like I said earlier, if anyone’s reading this thread – especially if you’re looking for help for yourself or a loved one, serious psychoses are not an invention of psychiatry.”

    If anybody here has a loved one who, for some reason or another, is going through a extreme mental state, I implore you to spare him/her from a contact with psychiatry. Before you do, consider the following,

    - Your loved one is 100% guaranteed to be assigned one of those arbitrary DSM labels that will follow him/her for the rest of his/her life. This will have implications on many fronts, such as legal proceedings, job opportunities, etc. Please spare him/her from this. This is true, regardless of whether the contact is voluntary.

    - If the contact is involuntary, you are going to humiliate your loved one for the rest of his/her life. Even though in the short term he/she might be act as if he/she is thankful, over the long run he/she will hate you (best case), or will take his/her own life (as Rick Warren learned painfully).

    - Regardless of whether the contact is voluntary or involuntary, your loved one is going to be put on a drug regime that will, over time, do more damage than good. There is plenty of real evidence to back this up, including, but not limited to, the fact that people who have been on neuroleptic drugs experience brain shrinkage: http://archpsyc.jamanetwork.com/article.aspx?articleid=211084 .

    “No one except this guy and some cultish cranks think this. You can find a lot of interesting links that reveal this a trivially and uncontroversially true above.”

    Actually, there is plenty of prominent psychiatrist who, to a different degree, agree with my assessment of psychiatric labeling including,

    - Tom Insel, director of the National Institute of Mental Health
    - David Kupfer, chairman of the DSM-5 task force
    - Allen Frances, chairman of the DSM-IV task force
    - Even Robert Spitzer, chairman of the DSM-III task force, although to a lesser degree

    These shrinks of course, disagree with me that the sad state of affairs invalidate psychiatry as a legitimate branch of medicine. This is where “Anatomy of an Epidemic” comes into play http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452425 . A piece of investigative journalism that shows that in spite (or perhaps, because of) Americans being more drugged than ever with psychiatric medications, outcomes are worse than ever, with more Americans on psychiatric drugs being put on disability than ever before.

    You do the math. If you truly love your loved one, spare him/her from this.

  198. Bruce Woodwardon 29 May 2013 at 4:34 am

    Just dipped back in about 100 posts since I last checked…

    Seems we are stuck in a holding pattern:

    Cannotsay pukes his views all over the page

    Reasonable Skeptic presents evidence and a reasonable argument

    Cannotsay ignores everything said above while quoting it to give the illusion he is engaged in an argument as opposed to just banging on his own personal drum.

    Reasonable Skeptic attempts to point out the ignored issues

    Cannotsay pukes his views all over the page.

    Cannotsay, simply put, we have seen your arguments, we have understood you since your first few posts. You have been refuted many times and you have completely ignored all reason. Please stop clogging up my comment feed with your ranting.

  199. zplafon 29 May 2013 at 4:53 am

    ConspicuousCarl: “If you are trying to say that antidepressants are bad because they are used by psychiatrists and psychiatrists used to do lobotomies, then you will indeed have a hard time getting skeptics to “grasp” your point of view.
    If you are trying to say something else, you aren’t doing a very good job of it.”

    No I made my point in my first post. Please read it and tell me where do you think I’m wrong. I wasn’t trying to prove anything with the lobotomy analogy. I was just saying that psychiatry has never been a discipline where a lack of information, a lack of knowledge about the brain, would prevent psychiatrists from tinkering with the mind of their patients. Of course it’s totally different today because we understand the brain and because the drugs are supported by carefully designed studies…

  200. BillyJoe7on 29 May 2013 at 6:08 am

    cannotsay,

    Sorry, I should have been more explicit…
    Your maths has no bearing on the argument.

    An analogy:
    A child passes through adolescence to become an adult.
    We’ve got no idea when adolescence starts and ends.
    Yet at age one and at age thirty we clearly do not have an adolescent.

    ———————————————

    Regarding the Rosendam challenge:

    You have to compare apples with apples, not apples with oranges.
    For example, the diagnosis of acute appendicitis and catatonic schizophrenia are both based on symptoms and signs. If someone can accurately fake the symptoms and signs of acute appendicitis, he is likely to be diagnosed with acute appendicitis just like the person who accurately fakes the symptoms and signs of catatonic schizophrenia is likely to diagnosed with catatonic schizophrenia. If the person with fake appendicitis then leaps up from the operating table and starts doing push ups on the floor, the import would be exactly the same as if the person faking catatonic schizophrenic suddenly started talking and interacting normally with those around him.

    So, cannotsay, try faking catatonic schizophrenia. I’ll pretty much guarantee you will easily be able to convince your medical attendants that you don’t have catatonic schizophrenia.

  201. Bill Openthalton 29 May 2013 at 6:51 am

    cannotsay2013

    The same is true for homosexuality (only it’s 10 fold because homosexuality affects 5%). Plus, a finding of “homosexuality” is more reliable than a finding of “schizophrenia” (check DSM-5 field testing). The decision of labeling one behavior “diseased” (schizophrenia) and another first “diseased”, then “normal and healthy” (homosexuality) is purely political.

    Exactly. But, and it’s a big BUT, not being able to adapt to the society one is born into is a deficiency of the brain. Humans are social animals, and integrating in the group (so that one can thrive and procreate) is the essential function of the brain. To the extend that “schizophrenia” (as catalogued in the DSM) makes integration difficult or impossible (as determined by the other members of the group), it is a disease, because the human brain should be adaptable to the society it is born in (that’s the essence of human groups – the young ones discover and assimilate the culture of the group).

    And yes, that means homosexuals born into a homophobic society are indeed suffering from a disease, if their brains cannot adapt to that society. Whether a homophobic society is “moral” is a totally different discussion.

  202. steve12on 29 May 2013 at 10:29 am

    I wish I knew that quote trolling Tom Insel could trump so much literature, especially when those quotes aren’t really relevant to point being discussed. I’m starting to pick this technique up, though: instead of properly summarizing the relevant literature, string together non-sequitor quotes from Tom Insel.

    Let’s try….

    Reviewer: “Steve12, you neglected to discuss some very seminal work that directly refutes your hypothesis”

    Steve12′s response: Tom Insel once said “I like bacon, and I like cheeseburgers – but it’s the darndest thing – I do not like bacon cheeseburgers! What sense does that make, ya know? “.

    Reviewer: “ooohhhh, OK. Got it. Excuse me, I have to go nominate you for a Nobel Prize now.”

  203. sonicon 29 May 2013 at 10:50 am

    cannotsay2013-
    Ii seems there is a certain inability to understand the phrase-
    “DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

    I have known this is true about psychiatric diagnosis for years- I know a guy who worked on an earlier DSM. It’s basically a compilation of opinions.
    The news is that it is being admitted to at the highest levels.

    I believe that the research that will be seeing more funding will be like that done by Catterall- as it is most likely to find such biomarkers and objective tests.

    I don’t know how many if any such tests will actually be developed.

    But there is no doubt the ‘consensus’ about the current situation– there are no objective tests or biomarkers used to diagnose the diseases in the DSM.

    But it’s always been that way– isn’t it amazing the level of absolute ignorance there is about this?
    It seems there is also a great deal of ignorance about the amount and level of coercion that goes on in psychiatry as well.
    I thought everyone knew these things.

    Wrong again. :-)

  204. steve12on 29 May 2013 at 11:12 am

    “But it’s always been that way– isn’t it amazing the level of absolute ignorance there is about this?”

    No one’s debating definitive diagnostic markers – we all know we’re not there.

    Wait – let’s use the Tom Insel Quotation method and see i we can’t reason this out.

    Steve12: But I (as well as Steve Novella) have pointed out 12,000 x that biomarkers for definitive diagnosis of an INDIVIDUAL are not necessary to show that there is a discreet biological phenomena going on here. Replicable GROUP differences in genetics and cognitive / perceptual abilities are what’s needed, and links showing this have been provided in this thread time and time again only to be ignored.

    Don’t you at least have to address these studies?

    Rebuttal: Ya know, that Tom Insel is quite a character. Why, I remember it like yesterday when he said: “Did you ever see Rent, the musical? Not that crappy version they put on the road – I’m talking the original cast, on Broadway. Now THAT is a musical. I watched every show that first run dressed as the Hamburgler”. So you see, schizophrenia is a condition made up by psychiatry – Tom Insel just said so.

    Steve12: Foiled again!!!!!

  205. cannotsay2013on 29 May 2013 at 11:49 am

    Bruce Woodward,

    I agree there is a pattern and sonic has summarized it beautifully. From where I stand the pattern goes like this,

    cannotsay2013: hey guys, remember me the guy who a few months ago gave fair criticism for psychiatry :D ?

    Novella followers: Yeah, we gave you a run for your money, didn’t we?

    cannotsay2013: actually you didn’t but here are the news: Tom Insel, director of the NIMH, and David Kupfer, chairman of the DSM-5 task force, now agree to my most important point, ie, that there are no bio-markers of so called “mental illness” and that DMS labels are created.

    Novella followers: What? That cannot be true, it contradict the dogmas that we came to believe as sound scientific reasoning. Novella didn’t tell us….

    cannotsay2013: Well, that’s what happens when you have a situation in which repeating mantras passes as “scientific reasoning”. Group think ends up trumping critical thinking.

    Novella followers: You are wrong, Insel is wrong, Kupfer is wrong, Frances is wrong.

    cannotsay2013: Be careful, you might get a “paranoid schizophrenia” diagnosis :D .

    I think that my perspective is a more accurate description of what is happening here.

    BillyJoe7,

    You are about to find that you have provided a self refuting argument :D . First, it is a strawman to say that I said,

    “Yet at age one and at age thirty we clearly do not have an adolescent.”

    I never said otherwise but, here is what is self-defeating,

    We’ve got no idea when adolescence starts and ends.

    CORRECT, which is why any division is completely arbitrary, as in my math example (here in the US we don’t put the final “s” :D ). And that division has profound legal implications. In most jurisdictions in the US having sex with a minor, regardless of whether it is consensual, is considered a crime called “statutory rape”. Have sex with a girl who is 5 minutes short of her 18-th birthday, you are a criminal. Have sex with the same girl 5 minutes after her 18-th birthday, you are not. Criminals are created by whomever decided to put the artificial distinction minor vs adult in the 18-th year anniversary.

    Same argument can be made with people who are born 5 minutes before or after New Year’s Eve midnight. We would all agree that a 10 minute difference in getting out of the womb doesn’t change a person much, but that artificial difference about when the year begins has profound implications for that person: his childhood/classroom friends and experience could be dramatically different.

    This is not to say that those difference cannot be made, my point is that the distinction of minor/adulthood or “the year begins on January 1st and has legal implications” are completely arbitrary and not based on any science. As such, they are not left at the hands of self-appointed social engineers but to the legislative process. And they regularly change. For instance, in the US the voting age was lowered from 21 to 18 while still in many jurisdictions people younger than 21 cannot legally consume alcohol even though they are considered adults.

    Basically, you provided a self defeating argument :D .

    With respect to the Rosenhan challenge,

    “So, cannotsay, try faking catatonic schizophrenia. I’ll pretty much guarantee you will easily be able to convince your medical attendants that you don’t have catatonic schizophrenia.”

    I think you have it backwards. You are the one who have to try it. I don’t need convincing that once in, you cannot get out, no matter how normal you behave. That was the whole point of the Rosenhan experiment!!!! You are the one that lacks the courage to try on yourself your own nonsense :D .

    Bill Openthalt,

    “And yes, that means homosexuals born into a homophobic society are indeed suffering from a disease, if their brains cannot adapt to that society. Whether a homophobic society is “moral” is a totally different discussion.”

    You just provided the best explanation there is to the proposition that what the DSM calls “mental illnesses” are social constructs. Something I never disagreed (neither did Thomas Szasz). That is not what Novella claims though. What Novella claims is that,

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    If you want to call “diseased” the brains of those people who by their behavior alone are maladapted to the society in which they live in, that’s your right but that is not what the average psychiatrist thinks of “mental illness”. The speak of “chemical imbalance” nonsense and how “mental illness is like diabetes”. If you have ever been in contact with a psychiatry, that is the dehumanizing treatment they give you :D .

    steve12,

    Be careful with being so dismissive of the top psychiatrist at the NIH, you might end up in the asylum :D .

    sonic,

    Yes, I think that there is little room for spinning Insel’s proposition. What happens is that it is at complete odds with things that have been repeated as mantras many times here. The situation for sonic and the like must be as frustrating as for a Christian who suddenly learns that the bones of Jesus have been found, thus refuting the resurrection narrative. You’d find a lot of denial among them, and that’s what I am seeing here :D .

  206. cannotsay2013on 29 May 2013 at 11:55 am

    To the “skeptic true believers”, I hope you enjoy this joke,

    http://uncyclopedia.wikia.com/wiki/Asshole_Personality_Disorder

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM-5) inexplicably fails to detail Asshole Personality Disorder. However, APD is classed on “Axis II” as an underlying pervasive or personality condition. A diagnosis of APD requires five or more of the following to be present for a significant period of time:

    Self-importance
    Refusal to acknowledge or even comprehend social rules
    Delusions of adequacy
    Believes others would do just fine if only they were sensible like him
    Beliefs appear to change to match the situation, but that’s just other people being idiotic
    Pride in their superior people skills
    Recto-cranial inversion
    Projection of all symptoms on this list onto those around them.

  207. cannotsay2013on 29 May 2013 at 12:00 pm

    sonic,

    Obviously, there was a typo,

    “The situation for sonic and the like must be as frustrating as for a Christian”

    I meant,

    “The situation for STEVE12 and the like must be as frustrating as for a Christian”

    Sorry for so many comments, but they cannot be edited :( .

  208. steve12on 29 May 2013 at 12:36 pm

    Yup, Tom Insel sure thinks schizophrenia was made up by psychiatry. That’s what “neurodevelopmental” means, right?

    Rethinking schizophrenia
    Thomas R. Insel
    Nature 468, 187–193 (11 November 2010)
    How will we view schizophrenia in 2030? Schizophrenia today is a chronic, frequently disabling mental disorder that affects about one per cent of the world’s population. After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia. These current unsatisfactory outcomes may change as we approach schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage of the illness. This ‘rethinking’ of schizophrenia as a neurodevelopmental disorder, which is profoundly different from the way we have seen this illness for the past century, yields new hope for prevention and cure over the next two decades.

  209. The Other John Mcon 29 May 2013 at 12:54 pm

    @cannotsay:

    You claim “Real medicine’s bases its diagnosis in addressing things such as,

    - Presence or absence of a virus/bacteria causing the disease (tests might not be perfect, but the objective of an HIV antibody test is to answer this question which is into itself a binary question).

    - Presence or absence of neuro-degeneration, in the case of diseases such as Alzheimer’s.

    - Presence of all or part of a third copy of chromosome 21, in the case of Down Syndrome.

    - Presence or absence of cancer cells in a biopsy.”

    These tests aren’t perfect, as you admit, so there is a degree of arbitrariness that physicians/technicians have to make whether any given test is positive or negative. Which implies by your logic that the tests are thus completely arbitrary and not indicative of anything. We can even banish all world knowledge with your little logic games, yay! Or we can choose to live in the real world.

    I also notice there is no difference between the numbers 2 and 3 because there are infinitely many numbers in between them, and drawing a demarcation line between them is just an arbitrary choice. Wow twisted logic run amok is fun!

  210. sonicon 29 May 2013 at 3:26 pm

    steve12-
    If you would look up the work of Catterall, you would realize that I am aware of the biology of mental illness and the possible genetic components. I’ve known about his work for many years.
    http://www.iups2013.org/scientific-programme/prize-and-keynote-lectures/william-catterall

    That’s where I differ from cannotsay– I think continued work in those areas might be productive in the future. I’m not sure.

    But in the meantime lobotomies and shocks and mind-killing drugs (thorazine for example) are given to individuals– not based on any objective test- but based on opinions about behaviors that are based on opinions about what behaviors should be.

    That is that fact that many don’t seem to grasp.

    The ‘treatments’ are given to individuals. Not groups.
    And once your brain has been chopped out, it really doesn’t help that there might be some ‘evidence’ that people ‘like you need it’.

    Are you understanding that?

  211. cannotsay2013on 29 May 2013 at 3:28 pm

    steve12,

    You are beyond hope. What Insel says there is perfectly consistent with what he said recently. In fact, as sonic has correctly pointed out,

    “I have known this is true about psychiatric diagnosis for years- I know a guy who worked on an earlier DSM. It’s basically a compilation of opinions.
    The news is that it is being admitted to at the highest levels.”

    Paula Caplan has repeatedly talked about this, as a former DSM committee member (DSM-IV in her case),

    https://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-voices-of-people-harmed-by-diagnosis-and-refuses-and-refuses-and-refuses/

    She is on record saying that DSM committee members regularly lie to get their diagnosis in the book and has challenged the APA to sue her for defamation if they disagree with her assessment. In fact, many of us are waiting for the APA to take such step, because that would kill psychiatry for good.

    The Other John Mc,

    I hope you understand the difference between these two statements,

    1- We are attempting to detect presence or absence of HIV infection and for that we use sensors that measure continuous quantities and that are inaccurate. There might be inaccuracy, that impacts borderline cases mostly when the patient is going through seroconversion. The HIV virus has been isolated it has been shown to cause, you know CAUSE, AIDS. We are trying to detect whether the virus is in somebody’s body.

    2- We CREATE artificial illnesses by creating artificial distinctions in a continuum, such as, deciding that having sex with a person younger than 18 year old is a “mental illness” or, “a crime”.

    If I have to explain this difference to you, then you are hopeless. Bill Openthalt above has understood perfectly my reasoning. Yet, he insist that “social control”, such as making “mental illness” out of homosexuality in a society that does not tolerate homosexuals, is perfectly acceptable. I beg to differ a lot. Social control, especially in democratic societies, must be left to the legislative/judicial bodies that are setup precisely because it is understood that criminalizing/penalizing behavior that a majority doesn’t like is subject to a lot of abuse and can only be done in very narrow circumstances.

    “I also notice there is no difference between the numbers 2 and 3 because there are infinitely many numbers in between them, and drawing a demarcation line between them is just an arbitrary choice. Wow twisted logic run amok is fun!”

    In fact, that has never been my claim. My claim is not that 2 or 3 do not exist (again you keep throwing this straw man). My point is that saying that all numbers that are greater or equal than 2.5 are equivalent to 3 and those who are lower are equal to 2, introduces an arbitrary distinction between the following two numbers,

    - 2.4999999999999999999999999999999999999999999999999999999999999999
    - 2.5000000000000000000000000000000000000000000000000000000000000001

    Both of which also exist. But deciding that 2.5 is the dividing line, for EQUIVALENCY purposes, creates an artificial distinction that the continuum does not imply. These two numbers are separated by a narrow distance of 0.5000000000000000000000000000000000000000000000000000000000000002 . To say that they are different is a completely arbitrary decision. As I said, the theory of distributions solves this problem in the case of continuous processes that are concentrated in time, but again, we are talking real science here, something that is probably above your (and most of the readers’ here) pay grade :D .

  212. cannotsay2013on 29 May 2013 at 3:30 pm

    sonic,

    “That’s where I differ from cannotsay– I think continued work in those areas might be productive in the future. I’m not sure.”

    Yes, and I accept that. I disagree with Insel on that as well. But I completely agree with the rest of what you had to say (and what Insel had to say :D ).

  213. cannotsay2013on 29 May 2013 at 3:39 pm

    Another typo :D ,

    “These two numbers are separated by a narrow distance of 0.5000000000000000000000000000000000000000000000000000000000000002″

    should say,

    These two numbers are separated by a narrow distance of 0.0000000000000000000000000000000000000000000000000000000000000002″

    And you can find numbers that make this difference as small as you want -as in infinitely small-, once you create the artificial division line in 0.5. That’s what people who didn’t do mathematical analysis during their college years have a difficulty understanding.

  214. steve12on 29 May 2013 at 3:51 pm

    Steve12 – How do shenanigans in the making of the DSM invalidate the evidence that schizophrenia has a biological basis?

    Rebuttal: Tom Insel once said to me “Don’t ask me anymore – I just said that I also believe schizophrenia has a biological basis in Nature, and you already pasted it in above”

    I mean…

    Paula Caplan recently intoned “Ya know, some people like to go to a ball game or maybe a movie. Me? I like to relax on my couch with a hot cup of Celestial Seasonings. Camomile is my favorite. The box is yellow.”

    Steve12 – One upped once again!

  215. Mlemaon 29 May 2013 at 5:28 pm

    Steve12, I liked your quote from Insel above:
    http://theness.com/neurologicablog/index.php/the-genetics-of-mental-illness/#comment-55255

    here’s some more for anybody to read regarding Insel, the DSM, and “mental disorders”
    http://www.newyorker.com/online/blogs/elements/2013/05/the-scientific-backlash-against-the-dsm.html

  216. Mlemaon 29 May 2013 at 5:29 pm

    and from a link within the New Yorker article:
    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

  217. BillyJoe7on 29 May 2013 at 5:50 pm

    What Cannotsay did say: “My claim is not that 2 and 3 do not exist”

    What Cannotsay did also say: “My claim is not that children and adults do not exist”

    What Cannotsay cannot say: “My claim is not that schizophrenia and normality do not exist”
    (I hope you finally understand my joke now: Cannotsay => cannot say)

    He is quite happy to say that just because there is an arbitrary dividing line between children and adults, that doesn’t mean that children and adults don’t exist, but he cannot understand the simply analogy that just because there is no clear demarcation between schizophrenia and normality that doesn’t mean that schizophrenia and normality don’t exist. He is quite happy to maintain a distinction between 2 and 3, and between children and adults, but he won’t allow exactly the same reasoning to make a distinction between schizophrenia and normality.

  218. BillyJoe7on 29 May 2013 at 5:55 pm

    Cannotsay,

    You didn’t need to make the correction.
    Everyone here is as aware of your physical typos as your mental typos.

  219. Bill Openthalton 29 May 2013 at 6:55 pm

    cannotsay2013

    You just provided the best explanation there is to the proposition that what the DSM calls “mental illnesses” are social constructs. Something I never disagreed (neither did Thomas Szasz). That is not what Novella claims though. What Novella claims is that,
    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    It is quite possible that some of the behavioural patterns described in the DSM would be quite acceptable in other societies. Apparently, they are not acceptable in ours (even though our society accepts homosexuality), and this is where your bone is. You are not talking science, but morality.

    Given that the mind is what the brain does, it is almost certain there are observable patterns in the brain corresponding to behavioural issues, and there is a possibility these patterns are, or can be affected by interventions such as medication or surgery. Furthermore, it is likely that some of these issues, or their more extreme manifestations, are unacceptable in the vast majority if not all societies, or else directly harmful to the individual or society (such as psychopathic or psychotic behaviour). Hence can be qualified as “true” disorders or diseases, and your original claim is false.

    As far as ADHD is concerned, it could well be that a percentage of children is not fit to productively attend school after a certain age, and maybe we should work towards a society where they (like in earlier times) can leave school and enter the workplace at 14. Given this alternative, I can understand why many of today’s parents would prefer to believe it is a treatable disorder.

  220. Mlemaon 29 May 2013 at 7:08 pm

    Interesting article in “Psychology Today”:

    http://www.psychologytoday.com/articles/200910/what-is-normal

    “How will it feel to live in a culture in which few people are free of psychological defect? Well, we’ve been there before, and we can gain some clues from the past. The high-water mark for diagnosis occurred in the heyday of psychoanalysis. The Midtown Manhattan Study, the premier mental health survey of the 1950s, found that over 80 percent of respondents—more than triple our own abnormality rate—were not normal. “Only 18.5 percent of those investigated were ‘free enough of emotional symptoms to be considered well,’” the New York Times reported. It even cited a psychiatrist who reasoned that, since health includes awareness of conflict, subjects who express no neurotic anxiety must also be abnormal.”

  221. Mlemaon 29 May 2013 at 7:12 pm

    Isn’t it the case that anyone who displays complete certainty in his own opinion has a form of personality disorder?

    I’d better see someone…

    But wait, if I’m having doubts, then I’m OK!

    :)

  222. cannotsay2013on 29 May 2013 at 8:05 pm

    BJ7,

    You can repeat as many times your straw man, it will not become true

    “he cannot understand the simply analogy that just because there is no clear demarcation between schizophrenia and normality that doesn’t mean that schizophrenia and normality don’t exist”

    Only schizophrenia is a completely made up behavior that has 0.46 reliability in DSM-5. Adulthood vs children can be defined in biological terms (the most obvious distinction is procreation capability; in fact, in ancient times that was the actual distinction). So your analogy falls apart completely. Note that this is a common theme in this thread coming from those of your side. You keep making false analogies in the sense that you forget that equating the epistemology of the tissue with the epistemology of the mind is onto itself a huge leap of faith.

    Even if “schizophrenic behavior” could be reliably defined at the extremes, something that remains also in question -ie, a “you know when you see it” type of argument does not work-, it remains the fact that making an arbitrary determination of what is and what is not schizophrenic creates, by its own, “schizophrenic behavior” in innocent victims. As a society, it is completely unacceptable that the guys in in white coats pathologize behavior they don’t like.

    So, going back, you want to pathologize behavior? Use the criminal/civil law system. Don’t use the name of science in vain because what you are suggesting is not science. It’s pseudo science at best, “eugenics” type of pseudo science.

    BTW, I do not forget: THE ROSENHAN CHALLENGE!!!!!

    Bill Openthalt,

    “Apparently, they are not acceptable in ours (even though our society accepts homosexuality), and this is where your bone is. You are not talking science, but morality. ”

    Of course, that’s where it is. And what I say is that psychiatry is de facto a parallel system of social control that bypasses the legal system of social control, as in,

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

    ” 52. “Persons with serious mental illness” means individuals who meet
    criteria established by the commissioner of mental health, which shall
    include persons who are in psychiatric crisis, or persons who have a
    designated diagnosis of mental illness under the most recent edition of
    the Diagnostic and Statistical Manual of Mental Disorders and whose
    severity and duration of mental illness results in substantial
    functional disability. Persons with serious mental illness shall include
    children and adolescents with serious emotional disturbances.”

    DSM-5 created a whole new category of people who can be now at the receiving end of coercive psychiatry in NY state (and in fact in most states because most of them have the DSM codified into their laws).

    “Given that the mind is what the brain does, it is almost certain there are observable patterns in the brain corresponding to behavioural issues, and there is a possibility these patterns are, or can be affected by interventions such as medication or surgery.”

    This goes back to the sw/hw problem that I am not going to repeat. A memory leak can be correlated with hw activity. However, a memory leak IS NOT caused by hardware nor can it be fixed by a HW intervention even if, but matter of pure chance, you might get if fixed by ECT-ing the RAM of the computer. I don’t know why is that you guys have such difficulty understanding this. You don’t even have to be a believer to accept it. The “programming” of the brain can be the result of evolution, the environment or whatever, but to say that the mind and the tissue are the same is a fallacy. Here we have an example where ideology (so called “skepticism”) is trumping science.

    “Hence can be qualified as “true” disorders or diseases, and your original claim is false.”

    Again, only if “mental illness” is a metaphor, not a genuine disease. In hw/software the metaphor is used all the time. People speak of “broken software” even though “broken” in a strict sense can only apply to broken hw, just as people speak of “hw bugs” even though, in its strict sense, bugs are software phenomena. This is not where the problem is. The problem is when you pretend that the two things are the same and try to apply what works in one domain to another blindly, which is how we got lobotomy, insulin therapy, ECT and chemical lobotomies. “Broken software” is not fixed the same way as a “broken CPU”.

    “Given this alternative, I can understand why many of today’s parents would prefer to believe it is a treatable disorder.”

    Only, as with many things psychiatric, the notion that so called ADHD left “untreated” (ie, children deprived of cocaine and amphetamines) will result in academic failure with certainty is one of the many fantasies that Big Pharma has been able to sell as “truth” when it’s nothing more than a marketing device.

    Mlema,

    You are wasting your time with steve12. It’s clear by now that he has a “denialism” agenda. “denialism” as in “Tom Insel never said what he said on April 29th, it’s just a collective delusion” :D .

  223. cannotsay2013on 29 May 2013 at 8:49 pm

    And to continue with this,

    “Again, only if “mental illness” is a metaphor, not a genuine disease. In hw/software the metaphor is used all the time. People speak of “broken software” even though “broken” in a strict sense can only apply to broken hw, just as people speak of “hw bugs” even though, in its strict sense, bugs are software phenomena. This is not where the problem is. The problem is when you pretend that the two things are the same and try to apply what works in one domain to another blindly, which is how we got lobotomy, insulin therapy, ECT and chemical lobotomies. “Broken software” is not fixed the same way as a “broken CPU”.”

    This is the crux of the problem. Pathologizing the mind, absent biological causes such as Down Syndrome’s, based on consensus is de facto social control. A “broken mind” (assuming that a “broken mind” can be defined) has legal implications that a “broken bone” doesn’t have, just as a “broken software” is more consequential than a broken hardware. You break your CPU? Change it. Your encryption software is “broken”?, bad luck you open the door to losing all your private information, including your money.

    ECT-ing the machine that runs the encryption software or replacing the CPU will do nothing to fix it, nor is it conceivable to switch individual transistors to fix the “broken system”. You need to reprogram the system. While it is possible that an external observer “sees” different patterns in the fixed system, and comes with all kinds of correlates in the on/off positions of the transistors, that is not how software malfunction is detected nor does such rudimentary analysis provide any clue as to how to fix it.

  224. steve12on 29 May 2013 at 11:40 pm

    Really? No love for Tom Insel watching “Rent” dressed as the Hamburglar? At least I got a kick out of it…..

    Here’s the deal CS:

    Everyone here realizes that psychiatry has problems, and diagnosis is a big part of that. Everyone agrees that the interpretation of people’s behavior as being “crazy” is to a large extent culturally dependent, and that we should be weary about revoking individual liberty considering all of these issues.

    This is the heft of what you’re saying, and just about everyone (including me) agrees with you.

    Where you’re losing literally everyone is your stubborn insistance that major psychoses like schizophrenia are completely invented by psychiatry, and have no biological basis. I don’t know why you’re so afraid to look at the sum total of evidence and let go of this notion, or why you think any of your other points would be invalidated by acknowledging that this is not true.

    I can tell you this – if you want to convince scientifically-minded people of the much more important points above re: real problems in psychiatry, you should really do some reading with an real open mind and stop the Szaszian denialism.

  225. steve12on 29 May 2013 at 11:41 pm

    And never do anything – EVER – that puts you in league with Holocaust victims.

    EVER

  226. cannotsay2013on 29 May 2013 at 11:58 pm

    “This is the heft of what you’re saying, and just about everyone (including me) agrees with you.”

    Good! If my memory serves me well, it was not the case a few months ago when I made exactly the same arguments. All it takes is to have the NIMH director to publicly criticize dogmas :D .

    “Where you’re losing literally everyone is your stubborn insistance that major psychoses like schizophrenia are completely invented by psychiatry, and have no biological basis.”

    Again, complete STRAW MAN. The label “schizophrenia” is invented. From Insel,

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, CREATING a set of labels and defining each”.

    If you don’t see that CREATING is synonymous with INVENTING, that’s your problem. That inventing would include, schizophrenia, which in fact has a 0.46 kappa reliability in DSM-5.

    That is not to say that people cannot hallucinate, become delusional or psychotic or that biology might not have some role to play in that (even if its only role is to be the physical support of the mind). But again, calling that behavior an “illness” is a metaphor. The epistemology of the tissue is not valid to deal with problems of the mind. The problems of the mind are not “medical”, but of “social control” in nature.

    As such, the decision of what is pathological and what isn’t should not be in the hands of the guys who have a history of creating labels such as Drapetomania, Female Hysteria or Homosexuality or treatments such as ECT, insulin therapy, lobotomy or chemical lobotomy. This is the part that I still do not understand. How is that you guys want to give the guys with the white coats the authority to do social control.

    “you should really do some reading with an real open mind and stop the Szaszian denialism.”

    The problem is that parts of what Novella/you called “Szaszian denialism” is now part of the official NIMH record :D .

    Finally,

    “And never do anything – EVER – that puts you in league with Holocaust victims.”

    I know that you are going to invoke the Godwin’s law mantra (which is a mantra, nothing scientific), but here is the deal. It’s easy to say that our -our = survivor of abuse, situation is not comparable but, I remind you that,

    - I was forcibly detained
    - I was forcibly restrained for almost one day
    - I was forcibly incarcerated for months
    - I was forcibly drugged
    - I was forced to agree to their nonsense if I wanted my freedom back
    - I committed no crimes to deserve this abuse

    And I was on those who got the gentler treatment. The CDC says that there are now 30000 suicides a year. Given the empirically established fact that SSRIs increase the risk of suicide -while being active placebos- and that Americans take more psychiatric drugs than ever before, a fraction of those 30000 (although I don’t know how many) have been caused by psychiatry. That’s somebody who lost a husband or a wife, a parent or a child to psychiatric nonsense.

    It might not be millions of people assassinated by gas chambers, but it’s thousands of people killed in the name of a quackery. It’s equally evil.

  227. steve12on 30 May 2013 at 12:23 am

    Luckily, everyone sees that you’re completely full of shit re: SZ having no biological cause, and you will never be able to convince anyone in science of it because it’s BS. So really, it doesn’t matter.

    Re: this nonsense:

    “It might not be millions of people assassinated by gas chambers, but it’s thousands of people killed in the name of a quackery. It’s equally evil.”

    Psychiatry is equally evil as the Holocaust…ummm…I’m speechless.

    Hey – you’re a complete f*ing asshole to say something like this, but at least you put it out there for the world to see.

    WOW….

  228. cannotsay2013on 30 May 2013 at 12:40 am

    steve12,

    “Hey – you’re a complete f*ing asshole to say something like this, but at least you put it out there for the world to see.

    WOW….”

    Please, take the Rosenhan challenge and then we have more honest conversation. Or take some SSRIs, neuroleptics for a prolonged period of time (I am sure that you’ll find crooks willing to prescribe them to you). Then we can talk with the same knowledge base.

    Until then, from where I stand, it’s you who is full of sh%$%@#$%. I am still unable to understand why you stick so strongly to your dogmas.

  229. cannotsay2013on 30 May 2013 at 12:45 am

    “Psychiatry is equally evil as the Holocaust…ummm…I’m speechless.”

    In fact, historically speaking, psychiatry took part in the Holocaust,

    http://en.wikipedia.org/wiki/Political_abuse_of_psychiatry#Nazi_Germany

    “In Nazi Germany in 1940s, the abuse of psychiatry was the abuse of the ‘duty to care’ in enormous scale: 300,000 individuals were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe.[14] For the first time in history, during the Nazi era, psychiatrists sought to systematically destroy their patients and were instrumental in establishing a system of identifying, notifying, transporting, and killing hundreds of thousands of “racially and cognitively compromised” persons and mentally ill in settings that ranged from centralized mental hospitals to jails and death camps. Psychiatrists played a central and prominent role in sterilization and euthanasia constituting two categories of the crimes against humanity.[15] The taking of thousands of brains from euthanasia victims demonstrated the way medical research was connected to the psychiatric killings.[16] There were six psychiatric extermination centers: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein.[17][18] They played a crucial role in developments leading to the holocaust.[17]“

  230. cannotsay2013on 30 May 2013 at 12:48 am

    steve12,

    In a more recent American context,

    http://en.wikipedia.org/wiki/The_Protest_Psychosis:_How_Schizophrenia_Became_a_Black_Disease

    “The Protest Psychosis: How Schizophrenia Became a Black Disease is a 2010 book written by psychiatrist Jonathan Metzl (who also has a Ph.D. in American studies), and published by Beacon Press,[1] covering the history of the 1960s Ionia State Hospital—located in Ionia, Michigan and now converted to a prison. The facility is claimed to have been one of America’s largest and most notorious state psychiatric hospitals in the era before deinstitutionalization.

    The book focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of their civil rights ideas. The book suggests that in part the sudden influx of such diagnoses could be traced to a change in wording in the DSM-II, which compared to the previous edition added “hostility” and “aggression” as signs of the disorder. Metzl writes that this change resulted in structural racism.”

    So to claim that psychiatry has not been used as a tool of political control, even in the United States, is to talk from ignorance.

  231. steve12on 30 May 2013 at 1:27 am

    I suppose I have to accept your despicable comments trivializing the Holocaust as the ramblings of kid lost in the throes of zealotry for a cause.

    But I increasingly find that people see this as no big deal. I guess we have forgotten.

  232. cannotsay2013on 30 May 2013 at 2:08 am

    steve12,

    “I suppose I have to accept your despicable comments trivializing the Holocaust as the ramblings of kid lost in the throes of zealotry for a cause.”

    Please tell me what is not historically accurate in the statement

    “psychiatrists played a central and prominent role in sterilization and euthanasia constituting two categories of the crimes against humanity.[15] The taking of thousands of brains from euthanasia victims demonstrated the way medical research was connected to the psychiatric killings.[16] There were six psychiatric extermination centers: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein.”

    Now, if I didn’t bring this issue earlier is because I thought people were aware of it. Apparently one of my faults is to overestimate the knowledge and intelligence of the average reader of this forum. My fault. So, I’ll mention another case of political usage of psychiatry that was common in the Soviet Union until barely 20-25 years ago -which was common knowledge in all of Western Europe when I was growing up-,

    https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union

    “In the twentieth century, systematic political abuse of psychiatry took place in the Soviet Union.[1] Psychiatry was used as a tool during the reign of Leonid Brezhnev to eliminate political opponents (“dissidents”) who openly expressed views that contradicted official dogma.”

    And the reason why psychiatry is used for these purposes should be now clear to all who have followed the debate until now.

    There seems to be agreement in the following facts,

    - Psychiatry’s labels are arbitrary and culture dependent, with one of the posters accepting the notion that in a homophobic society, “homosexuality” is a legitimate mental illness. In other words, psychiatry is mostly about social control.

    - Psychiatry’s labels are not validated by biological causes but created by consensus.

    Anybody who doesn’t see in these features the germ that makes psychiatry uniquely positioned to be an abusive force is very much still believing in Santa Claus or fairy tales.

  233. steve12on 30 May 2013 at 2:46 am

    No one here thinks SZ has no biological cause except you.

  234. cannotsay2013on 30 May 2013 at 3:11 am

    “No one here thinks SZ has no biological cause except you.”

    What is this, an “appeal to popularity” type of fallacy?

    Let me reply with an “appeal to authority” as in “the top psychiatrist of the federal government”,

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, CREATING a set of labels and defining each”.

    If you are so sure of your bs, please take the Rosenhan challenge. If you live in the US, I can do the homework for you by pointing out the hospital you should report to if you tell me the state you live in (I don’t need to know the actual place). Please, put your future where your mouth is.

    I have asked steve12 and BJ7 to take the Rosenhan challenge so they put their lives where their mouth is. Both have dodged the question. If you will, I can hypothesize why you guys keep ignoring the challenge :D .

  235. Bruce Woodwardon 30 May 2013 at 4:09 am

    Godwin’s Law has once again been proven!

    This is absolute gold.

  236. BillyJoe7on 30 May 2013 at 6:10 am

    Cannotsay,

    If you believe that schizophrenia does not exist (because there are no biological markers for example), then your mathematical argument (you know, the one where you made that obvious-to-everyone typo) is just totally irrelevant. Just like I said a few posts ago. On the other hand, if you think your mathematical argument is relevant, then you have to accept that schizophrenia exists, just like childhood and the number 2 exists. Because that’s what the argument concludes. Unless you assume your conclusion that schizophrenia doesn’t exist which then makes the mathematical argument irrelevant. You can’t have it both ways.

    As for the Rosedamn Challenge….
    You challenging me to take that challenge is no different from me challenging you to try faking catatonic schizophrenia to beat the challenge. If you won’t take up my challenge (and I don’t really expect you to), then how can you expect me to take up your challenge? My point in offering you that challenge was to demonstrate how unreasonable it is for you to expect me to take up your challenge. Seems you missed the point.

  237. The Other John Mcon 30 May 2013 at 8:01 am

    Cannotsay, your beloved quote that you have puked up about 100 times: “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, CREATING a set of labels and defining each.”

    Notice that the quote says creating a set of labels [for clusters of symptoms], not creating the underlying symptoms represented by the labels. Yes, humans create labels, because labels are words which are social constructs and in some philosophical sense arbitrary. But you have hijacked the words “arbitrary” and “creating” to mean completely invented, just made up out of thin air, and with no underlying real-world referents, which is not the case. Instead of using the words arbitrary, invented, or created, try being explicit in what you mean exactly by this, instead of using them loosely to imply something which was not stated by the heads of psychiatry (e.g., mental disorders don’t exist).

    Basically every field of endeavor uses their own labels to identify/define/label/classify complex and sometimes slippery concepts/ideas. Speaking-loosely (which you are obviously good at), these labels are “invented” but it doesn’t mean they don’t refer to something real. The labels in psychiatry/psychology clearly refer to real clusters of symptoms in real people suffering from real problems, which can be biologically detected in grouped data. Why are you still denying the obvious?

  238. The Other John Mcon 30 May 2013 at 8:43 am

    Also, your observation that schizophrenia has a kappa reliability score of 0.46 in DSM-5 invalidates your entire premise, because it shows there is at least some inter-rater reliability in classifying SZ. If the score were zero, then yes there would be some serious explaining to do by psychiatry.

    The fact that the kappa score is non-zero strongly suggests there is something real being detected by the DSM classification, even if reliability is imperfect. Maybe you can use some more of your astounding mathematical reasoning to explain why the score is non-zero if mental disorders do not exist and all of psychiatry is arbitrary and invented.

  239. The Other John Mcon 30 May 2013 at 9:15 am

    For some kappa comparisons to your beloved medical diagnosticity:

    “Examples in the medical literature of test-retest reliability are rare. The diagnosis of
    anemia based on conjunctival inspection was associated with kappa values between
    0.36 and 0.60, and the diagnosis of skin and soft-tissue infections was associated
    with kappa values between 0.39 and 0.43. The test-retest reliability of various findings
    of bimanual pelvic examinations was associated with kappa values from 0.07 to
    0.26. From these results, to see a Kappa for a DSM-5 diagnosis above 0.8 would be almost miraculous; to see Kappa between 0.6 and 0.8 would be cause for celebration. A realistic goal
    is Kappa between 0.4 and 0.6″

    from: http://psychiatryonline.org/data/Journals/AJP/4396/appi.ajp.2011.11010050.pdf

    Shall we abandon all of medicine now as made up and fraudulent, on par with the Holocaust?

  240. Steven Novellaon 30 May 2013 at 9:37 am

    John MC is correct about labeling.

    Think about taxonomy. Linnaeus created an elaborate taxonomical system that was purely descriptive. It lacked grounding in any underlying theory of species origin. Still – he was describing actual reality, not just making stuff up. Also, the boundaries among species and groups are often very fuzzy. Is a platypus a mammal?

    Now that evolution provides an underlying causal framework, the classic Linnaean taxonomical system is being redrawn as a cladistic system. This is definitely changing many of the lines – but not completely. There are still mammals and reptiles, although birds are now understood as a subclade of dinosaurs. Birds still exist, however – they are not made up.

    In the same way, the descriptive system of the DSM will gradually give way to a new system based upon a deeper understanding of neuroscience. Schizophrenia is just as real a category as birds, even if our understanding and therefore classification evolves.

    Another analogy – you can classify species based upon morphology, genetics, molecular analysis, or fossil evidence, and you will get slightly different results.

    In medicine (not just psychiatry) you can classify diseases/disorders by cluster of clinical symptoms, anatomy, physiological markers, biochemical markers, or genetics and you will get different classification systems, often without any objective answer. So experts have to agree by consensus which criteria to use and how.

  241. sonicon 30 May 2013 at 10:10 am

    If you are dealing with a factor that can’t be quantized– what is the unit of measure for Schizophrenia?, for example– then the ‘line’ between one state and another cannot be based on objective criteria.

    This is basically by definition– correct?

    It is possible to create tests with objective answers and scoring– but those tests will be based on subjective criteria– there is no unit of measure being applied.

    At what point does one’s ‘vivid imagination’ become ‘reason to treat’?

    Because the behaviors are problematic?

    And what unit of measure is being used to determine that?

  242. ccbowerson 30 May 2013 at 10:17 am

    “Also, the boundaries among species and groups are often very fuzzy. Is a platypus a mammal?”

    The platypus is clearly a mammal. The recent post on birds and feathered dinosaurs is a more apt example. Applying the continuum fallacy as ‘cannotsay does,’ one would then conclude that there are no distinct animal classifications and that this is all an elaborate fraud.

    By this logic it is arbitrary to say that something is primate versus a theropod versus a maple tree. While specific dividing lines are somewhat arbitrary, they are not baseless, and it is clear that we are tapping into something real when no one gets a maple tree and theropod confused. A feathered dinosaur and early bird might be a bit trickier. Just as people do not confuse eating disorders with schizophrenia, yet bipolar disorder may be difficult to distinguish from depression at a given time. When things aren’t simple and black and white, deniers can more easily dismissive. Yet they are still wrong

  243. Bruce Woodwardon 30 May 2013 at 10:40 am

    Sonic,

    At what point do you take a pain killer when you have a headache? What unit of measure do you use to determine when medicating a headache is correct? At what point does a bit of a headache become a problem to function normally?

    At one end of the scale a small headache is not relevant to medicate, on the other end it leaves you crying on the ground wanting to throw up from the pain… does that mean medicating for headaches is wrong?

    This has been addressed a few times above.

  244. Steven Novellaon 30 May 2013 at 11:37 am

    Bruce – you beat me to it. Pain is the obvious analogy – no objective measure, only subjective, and no dividing line between when pain needs to be treated as a symptom and when not.

    Typical denialist strategies, again.

    There is a subjective element to human experience. This does not rule out all of human experience from scientific investigation, classification, or intervention. It simply means we have to proceed very cautiously, use the best pseudoquantifiable mechanisms we can (like pain scales), and be especially on the alter for bias.

    But none of this means that pain is not real, that human experience does not exist, or that attempts at addressing human problems are all fraud.

  245. Mlemaon 30 May 2013 at 2:17 pm

    “But none of this means that pain is not real, that human experience does not exist, or that attempts at addressing human problems are all fraud.”

    Human experience isn’t mental illness. Addressing human problems is not forcing drugs.

    I decide when to take medicine for a headache. I wouldn’t expect someone else to force me to take medicine, or lock me up until I said my headache was gone. If i were hurting someone else because I was in pain, then i would expect someone to prevent me from doing that. Or, if I asked for help, or was immobilized by the pain, then too i would expect someone to try to help me.

    Applying this to my behavior/thoughts/feelings: don’t help me unless i ask for it, hurt someone, or become disabled by my behavior. And then, let the treatment fit the problem. If there’s no disease or injury, then address my cognitive or behavioral problem with cognitive or behavioral therapy, or maybe even family therapy if I’m a kid whose behavior you just can’t manage.

    And don’t try to force the disease/drug paradigm on me.

    If my behavior is determined to be schizophrenia, which might now be classified as a neurodevelopmental disorder, treat me with cognitive, behavioral, and physical therapy.

    I think the problem with the ideology that every mental illness has a CAUSE internal to the brain/body rather than in the physical, psychological (interpersonal relationship), or societal environment is that we are not acknowledging how behavior develops – including simple motor skills. And when we get to the level of societal environment, it’s pretty easy to admit that the cause is arbitrary and based on social norms or moral beliefs. You can’t separate behavior from the brain, so there’s ALWAYS a biological component. But if you expand biology to include the psychological environment, there’s no conflict between the skeptic who says: it’s mental/brain, and the psychiatrist who says: it’s mental/environmental.

    “Neurodevelopmental disorder” places the cause of SZ within biology, but doesn’t exclude physical and emotional environment.

    Neurodevelopmental disorders can arise from “deprivation”
    http://en.wikipedia.org/wiki/Neurodevelopmental_disorder

    perhaps SZ is an opportunity to explore whether other types of emotional environment besides “deprivation” can contribute to SZ. You can imagine how difficult this would be, since SZ doesn’t typically show up until psychosis symptoms manifest. Insel talks about this in one of articles linked to somewhere above (sorry – but you can find it)

    We need to get away from this idea that when someone has “problem” behavior it’s because there’s something physically wrong with his brain that needs to be corrected with drugs, shock, etc. Sometimes the problem is the brain, sometimes it’s the psychological/emotional or even physical environment (put a person in seclusion and he will develop “mental illness” and his brain will change), sometimes it’s just a construct of society that labels the behavior “ill”. Or it can be any combination of these! It’s very difficult, but, again, the ideology of disease/drug is what appears to be restricting advancement in psychiatry. You can see why we got here, how do we go forward? That’s the question. Insel is hoping to point the way.

    If you’re interested, previous links on this page point to some of what Insel is saying. And the book “Anatomy of an Epidemic” by Robert Whitaker, is an exploration of the phenomenon of more and more “mental illness” and psychiatric drugs in our society.
    http://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic
    Interestingly, in response to the idea that various mental illnesses are cause by imbalanced brain chemistry:
    “According to Whitaker’s analysis of the primary literature, lower levels of serotonin and higher levels of dopamine ‘have proved to be true in patients WITH prior exposure to antidepressants or antipsychotics (ie as homeostatic mechanisms) but NOT in patients without prior exposure.’”

  246. Mlemaon 30 May 2013 at 2:24 pm

    here’s my analogy for this problem:

    I’ve got a pound of hamburger here. I leave it sitting on the kitchen counter and it starts to spoil. I take it to the lab and analyze everything about it that i can and develop chemistry that will stop the spoiling. The chemistry’s not perfect, it has a bad effect on the flavor, but it works. Now why didn’t I just put it in the fridge?

  247. cannotsay2013on 30 May 2013 at 3:19 pm

    Bruce Woodwardon,

    Only Godwin’s Law is not a scientific law, just a mantra used by those who are as dogmatic as you are to dismiss fair criticism. In this particular case, denying that psychiatry played a prominent role in the Nazi regime program of extermination of undesirables is in fact DENYING history. So here is how absurd this debate has become: you rather be perceived as a denier of history than acknowledge fair criticism to psychiatry :D .

    BillyJoe7,

    I don’t have high hopes for you. Again you are pulling a strawman here (for the n-th time). Extreme behavior exists (hallucinations, psychotic symptoms, etc), just as there are people who are sexually attracted to people of their same sex. Schizophrenia, as a “mental illness”, however is a made up condition based on consensus about social control, not bio markers. Just as pre 1970s, homosexuality was a made up “illness”. And to compound matters, it is not even clear that what DSM-5 labels as “schizophrenia” is reliable. Before repeating your strawman for the n-th + 1 time, please make sure you understand this.

    On the Rosenhan challenge, I think that the conclusion is obvious: you lack the courage to take on it. Cowardice is a perfectly acceptable excuse for not taking it. However, you need to admit that there is some cognitive dissonance / hypocrisy going on here :D .

    The Other John,

    “Notice that the quote says creating a set of labels [for clusters of symptoms], not creating the underlying symptoms represented by the labels.”

    Except when a field like immunology creates the label “HIV infection/AIDS” it matches a biological condition. The same thing for oncology and cancer and Alzheimer’s and neurons. The labels that DSM people invent ARE UNMATCHED by known biological conditions, they only stigmatize and pathologize behavior that DSM committee members do not like.

    On the kappa thing, your criticism is unwarranted because another of the Insel points is that while the rest of medicine has moved on from that, psychiatry remains stubbornly stuck there with its pathologies for BEHAVIOR. And my hypothesis is that they are using the epistemology of the tissue to address social problems. As I have repeated many times, it’s like using hw tools (CPU replacement) to fix software problems (memory leaks).

    Stephen Novella,

    “In the same way, the descriptive system of the DSM will gradually give way to a new system based upon a deeper understanding of neuroscience. Schizophrenia is just as real a category as birds, even if our understanding and therefore classification evolves.”

    That is Insel’s bet. My bet is that the NIMH has set psychiatry up for the kind of spectacular failure that economics is (the David Brooks reference of psychiatry being a “semi science” – I’d prefer “pseudo science”- is spot on).

    Schizophrenia to this day remain as consensus definition on unaccepted behavior, nothing else.

    “So experts have to agree by consensus which criteria to use and how.”

    Now you are pulling another strawman. The Tom Insel attack to psychiatry was to its VALIDITY not its reliability (for that you are welcome to read Allen Frances in the context of DSM-5). Nobody is arguing that fields of medicine invent labels to describe phenomena. The point is that those phenomena they describe (such as HIV infection) have a biological cause. Absent that cause, it remains a value judgement or wishful thinking.

    sonic,

    PRECISELY!!! That is another of psychiatry’s limitations. Not only it is not reliable, it lacks quantitative measures.

    Stephen Novella bis,

    “Typical denialist strategies, again.”

    We are past the point in which my criticism, or those along my lines, can be dismissed as “denialist thing”. From where I stand it’s those like you who have been, and still are, in denial of psychiatry’s shaky foundations.

    “There is a subjective element to human experience. This does not rule out all of human experience from scientific investigation, classification, or intervention. It simply means we have to proceed very cautiously, use the best pseudoquantifiable mechanisms we can (like pain scales), and be especially on the alter for bias. ”

    That is A DOGMA. And even if doesn’t rule out study, IT DOES RULE OUT PATHOLOGIZING what you consider subjectively to be bad just because you have an MD degree. Again, no different than some guy armed with a Theology degree saying that in his subjective point of view you are a “heretic”.

    Mlema,

    AMEN!

  248. sonicon 30 May 2013 at 3:43 pm

    Pointing out that not having a ‘unit of measure’ leads to subjective analysis is now a ‘denialist strategy’.
    Seriously?

    Is there a unit of measure for ‘denialism’?

    Bruce-
    I don’t ever take pain killers for headaches.
    What’s your point– that it is subjective when to do so?
    And how is that in anyway different from what I was saying?
    Note- I did not deny that people have imaginations that can be ‘vivid’ did I?
    Your response (which is apparently the same as Dr. N.’s) is a non-sequitur.

    Mlema-
    You are acting as the voice of reason here.

    (BTW- if there really are ‘objective tests’ for SZ, then I would guess anyone who has been diagnosed one way or the other without that test could sue the pants off the doctor. And probably should. Such obvious malpractice.)
    Just saying.. ;-)

    And I don’t even ask for a percentage of the huge settlements that should be coming. Is that proof I have a ‘mental disease’? Probably is, huh? :-)

    BillyJoe7-
    I noticed you warned cannotsay of me- and he basically called you an arse for doing so.
    I was going to agree with him– but wait, there isn’t a unit of measure for being an arse, is there?

    Carry on :-)

  249. Steven Novellaon 30 May 2013 at 3:56 pm

    Sonic wrote: “Pointing out that not having a ‘unit of measure’ leads to subjective analysis is now a ‘denialist strategy’.
    Seriously? ”

    No – it is a denialist strategy to use the lack of a unit of measure to say that something does not exist. Somethings don’t break down into units. Pain is the example we gave – and like all of the false analogies and unfair claims being made by the mental-illness deniers here, all of the criticisms of psychiatry also apply to some other area of medicine or even science. They are being applied inconsistently and unfairly as a biased campaign against an undesired scientific conclusion. That is denialism.

    Mlema – you seem to be making a non-sequitur about forcing treatment. That has nothing to do with any of the discussion about how mental illness is defined and studied. There are specific criteria that are used to determine when someone is not competent to make their own healthcare decisions – and guess what – they apply to all of medicine, not just psychiatry. Harping about forcing treatment is a scare tactic, not a reasoned argument. If you agree that people can be incompetent to take care of themselves, then you really have no argument.

    Also, your conclusion that mental illness can be treated with cognitive bahavioral therapy but not medication is a complete non-sequitur. How about – we use what is safe and effective, based upon the evidence. It’s OK to also favor the least invasive/inconvenient/expensive treatments as well. Put you have not put forward any argument to ban the use of medications for brain problems that manifest as mood,thought, and behavior. Unless you are denying that these things are manifestations of brain function.

  250. steve12on 30 May 2013 at 4:10 pm

    I’m not sure how this veered into Fallacy of the Beard-ville. But we got there! Ridiculous….

    I wanna know this: how do these psychiatrists, by make-believe diagnosis, change the genes and perceptual systems of the patients AND their first degree relatives?

    If someone can account for that, I’m in.

  251. ccbowerson 30 May 2013 at 4:36 pm

    “all of the criticisms of psychiatry also apply to some other area of medicine or even science.”

    Exactly, the main problems with the arguments being made (primarily by cannotsay) is that there seems to be a lack of understanding of science and philosophy of science. Nearly all of the criticisms of psychaitry are true in all of medicine, and many are shared by science more generally.

    Many of these criticism are limitations due to the nature of what is being studied. Physics is more straightforward, because it doesn’t deal with the complexities of biological systems (there are exceptions), not because it is a better science. Economics (which was trashed by cannotsay) has a harder time because it is a science of human behaviors within human constructs, which is messy. All sciences that deal with human behaviors have added difficulties because biological systems are much more complex. All of this is unfairly used to criticize the sciences themselves (or their applications).

  252. BillyJoe7on 30 May 2013 at 6:02 pm

    And so the pattern repeats itself…

    Cannotsay makes a statement of belief.
    Other posters make valid criticisms of his statement of belief.
    Cannotsay ignores these valid criticisms.
    Cannotsay repeats his statement of belief.

    —————————————————

    Cannotsay,

    I’ll will try one final time.

    You have two arguments here.
    You believe that schizophrenia does not exist….

    1) because there are no biological markers
    2) because of the continuum fallacy.

    As I have clearly shown, your second argument (the continuum fallacy), used in isolation from your first argument, is actually an argument against your belief the schizophrenia does not exist. The logical conclusion of your second argument is that 2 is distinct from 3, that childhood is distinct from adulthood, and that schizophrenia is distinct from normality. You then use your first argument to exclude schizophrenia/normality from the logical conclusion of your second argument.

    In other words, you are using your first argument to argue against your second argument.

  253. BillyJoe7on 30 May 2013 at 6:05 pm

    Sonic,

    I have no idea what you are talking about.
    Perhaps you should use the quote function every now and then.

  254. sonicon 30 May 2013 at 8:25 pm

    Dr. N.-
    I have disagreed with cannotsay about whether or not objective tests for ‘mental disorders’ will exist in the future.
    He seems certain there won’t be, I am not.

    Note: He has accepted my disagreement on that.

    But the facts are what they are– no unit measure and—

    “We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.” Kupfer.

    One might think that the reason we are still waiting is because such biomarkers don’t exist- after all several decades of research have failed to produce the evidence.

    Oh, there are reasons to believe such markers really do exist. But how many decades have to pass before it is legitimate to question?

    It seems that there is a lot more certainty about how things will come out than there is evidence.
    And that’s true of cannotsay as well as others.

    ccbowers-
    Physics has some fairly large problems– how to reconcile QM with GR, for example.
    Nobody tries to hide it, nobody calls someone a ‘denier’ for recognizing it.

    Yet with a subject that doesn’t even have a unit of measure yet– criticism is uncalled for.

    Hello?

  255. cannotsay2013on 30 May 2013 at 8:49 pm

    Steven Novella,

    “Put you have not put forward any argument to ban the use of medications for brain problems that manifest as mood,thought, and behavior. Unless you are denying that these things are manifestations of brain function.”

    This is what happens when one argues from dogma. Taking the sw/hw model. One doesn’t have to deny the existence of a particular programmer -ie Bill Gates- to make the very convincing case that you cannot fix memory leaks, which are software problems, with ECT/medications (ie hw) type of interventions.

    What this conclusion of yours shows, very candidly, is that you see psychiatry as a one way proxy for your “skeptic agenda”. Not even Richard Dawkins goes that far with evolution and whether evolution refutes the existence of God.

    The criticism raised here against psychiatry is agnostic with respect to other items in your agenda. That you are going great lengths to rationalize fair criticism of psychiatry, including the fact that none of its social constructs has, to this day, any reliable biological cause that can be defined in the same way diabetes is defined in terms of sugar levels/pancreas function just shows how detrimental dogmatism is to critical thinking.

    ccbowers,

    “the main problems with the arguments being made (primarily by cannotsay) is that there seems to be a lack of understanding of science and philosophy of science. Nearly all of the criticisms of psychaitry are true in all of medicine, and many are shared by science more generally.”

    Actually NOT. Here is your problem. The type of science I practice makes planes fly. Newtonian mechanics is falsified in the US alone 30000 times a day (number of domestic flights). It makes computers work (quantum mechanics might have a statistical component, but its predictions are so accurate that allows putting billions of devices that can be individually programmed in a chip). HIV medicine is falsified this way http://www.aidstruth.org/denialism/dead_denialists . Psychiatry? Psychiatry gives us the Rosenshan experiment. Anybody who sees these endeavors as suffering from the same type of problems/limitations/accuracy is nuts, as in “cannotsay2013 thinks that people who think along these lines are mentally ill” :D .

    “Physics is more straightforward, because it doesn’t deal with the complexities of biological systems (there are exceptions), not because it is a better science. ”

    You mean as in quantum mechanics and putting 5 bullion transistor in a single chip http://en.wikipedia.org/wiki/Transistor_count that can be then individually programmed? Really, more complex than that? Or that the computers behind Google? That you say these things only shows how incapable you are of appreciating the complexity behind even a regular laptop.

    “Economics (which was trashed by cannotsay) has a harder time because it is a science of human behaviors within human constructs, which is messy. All sciences that deal with human behaviors have added difficulties because biological systems are much more complex. All of this is unfairly used to criticize the sciences themselves (or their applications).”

    Economics, rightly so, is called “dismal science”. As David Brooks correctly point out, the only disorder that seems to be missing in DSM -5 is “Physics Envy”, which is what the practitioners of this fields suffer from.

    The big lie of these “physics envy” sufferers want to put forward is that by calling their endeavors “science”, they evoke in the public’s imagination the type of feats that only mathematics and physics have been able to accomplish. They want to make the public believe that “given time”, theirs will be one day as accurate as physics, while the main problem is that by their very nature these fields are not scientific, at least not “scientific” in the sense that gives science its well deserved reputation.

    BillyJoe7,

    Actually BJ, you have proved yourself again the expert in strawmen. I give up. People are smart to understand what I have repeated many times over.

    I accept Bill Openthalt’s notion that so called “mental illness” is a mechanism of social control that makes is acceptable to create the “mental illness” called “homosexuality” by a homophobic society. Not something that I would do, but at least he is consistent.

    Those in the Novella-verse who stick with your mantras just show how dogmatic you are. The top dogs of psychiatry are denying your very dogmas, but you stick to them because they mean so much to you.

  256. cannotsay2013on 30 May 2013 at 8:51 pm

    sonic,

    “I have disagreed with cannotsay about whether or not objective tests for ‘mental disorders’ will exist in the future.
    He seems certain there won’t be, I am not.

    Note: He has accepted my disagreement on that.”

    Correct :D .

  257. ccbowerson 30 May 2013 at 10:19 pm

    “Physics has some fairly large problems– how to reconcile QM with GR, for example.
    Nobody tries to hide it, nobody calls someone a ‘denier’ for recognizing it.
    Yet with a subject that doesn’t even have a unit of measure yet– criticism is uncalled for.
    Hello?”

    How to reconcile QM with GR is a scientific question, but there are very few people denying that gravity exists because of this unresolved question. In fact very few people are denying most implications of QM and GR separately, they just know something important is missing. They are not denying the science and its process and that is very different than what we are talking about here. The fact that other sciences have their stumbling blocks yet don’t get this kind of absurd criticism is part of my point.

    I’m not sure what you mean by unit of measure. There are units of measure of signs and symptoms, and there are degrees of severity of illlnesses on occasion. What are you looking for… paranoia in milligrams? Or anxiety in mLs? Perhaps what you are demanding is unreasonable, and unrealistic. Although there are units of measurement for many things in medicine, the actual practice of medicine rarely relies on such a simple and straightforward measurement. Biological systems are messy, variable, and some people have difficulty accepting this concept. Again, this is not unique to psychiatry

  258. ccbowerson 30 May 2013 at 10:30 pm

    ‘They want to make the public believe that “given time”, theirs will be one day as accurate as physics, while the main problem is that by their very nature these fields are not scientific, at least not “scientific” in the sense that gives science its well deserved reputation.’

    Absurd strawman. Economics is a very different science than physics, and anyone with physics envy is misguided. Physics largely looks at the simplest particles in the universe and economics looks at the behavior of complex organisms within their own complex sets of rules. That does not make economics a failure by any stretch of the imagination. What is the more successful alternative to economics that you would promote? Oh yeah, again you don’t have one, you just want to play denier.
    You are just again spouting vile with little knowledge, but I guess that doesn’t stop countless others from having opinions.

    “Actually NOT. Here is your problem. The type of science I practice makes planes fly. Newtonian mechanics is falsified in the US alone 30000 times a day (number of domestic flights).”

    Except that we know that Newtonian mechanics is not correct in an absolute sense. Its just accurate enough under these circumstances. You keep making these vague references to your “type of science” you “practice.” What is that exactly?, because it clearly isn’t medicine, yet that doesn’t stop you from making ignorant comments about it.

  259. cannotsay2013on 30 May 2013 at 10:33 pm

    sonic, ccbowers,

    Sonic made a very good point. Moreover, the only attempt to unify QM and GR, string theory, has received severe criticism http://www.amazon.com/Not-Even-Wrong-Failure-Physical/dp/0465092764 . Nobody has accused Peter Woit of being a denialist for it. And the reason behind the criticism of string theory is that physics has a very strict standard for accepting validity in its theories: these theories need to be able to make empirically verifiable predictions that are unique to the new proposed theory. In other words, explaining the past is not enough nor it is predicting the future with the same accuracy as existing theories. That is how Special Relativity and General Relativity came to be accepted as better models for the macro world than Newtonian mechanics (even though Newtonian mechanics is still the most widely used approximation in practice). Which takes me to the following point,

    “How to reconcile QM with GR is a scientific question, but there are very few people denying that gravity exists because of this unresolved question. In fact very few people are denying most implications of QM and GR separately, they just know something important is missing. They are not denying the science and its process and that is very different than what we are talking about here. The fact that other sciences have their stumbling blocks yet don’t get this kind of absurd criticism is part of my point.”

    I hope you understand the travesty you are putting forth here. Both QM and GR have been validated in their own scopes, QM in the micro level (those 5 billion transistor chips are probably the greatest validation there is when it comes to impacting our daily lives), GR at the macro level http://en.wikipedia.org/wiki/Tests_of_general_relativity .

    Psychiatric diagnoses DO NOT HAVE THAT validity. In fact, as it is widely accepted now, psychiatric diagnoses do not have ANY validity. So comparing the QM/GR unification problem with the lack of scientific validity of DSM labels is an insult to the intelligence of anybody who has one. It is becoming increasingly obvious that very few have something akin to it here.

  260. rezistnzisfutlon 30 May 2013 at 10:39 pm

    Sorry, but Newtonian physics is not really false, just incomplete and ultimately not the best primary explanation for gravitational and space/time physics on a grand, unifying scale. There is a reason why physicists and engineers continue to use Newtonian calculations every day – because they work. Newtonian physics may be unable to adequately explain gravitation and has problems when it comes to, say, quantum mechanics, but that does not mean it’s not applicable in certain circumstances, such as with ballistics, motion, force, and momentum when gravity can be assumed to remain (relatively) constant. If it was outright false, it would not continue to be taught in college physics classes or be used by professional engineers on a daily basis.

    Again, denialism based on a faulty understanding of science. This may seem like splitting hairs, but is speaks to the larger issue here, which is a gross misunderstanding of science itself, much less what the science says. Classic denialism.

  261. cannotsay2013on 30 May 2013 at 10:54 pm

    ccbowers,

    “Economics is a very different science than physics, and anyone with physics envy is misguided.”

    Good luck bolstering psychiatry’s case by making a case that economics isn’t dismal science!

    “Physics largely looks at the simplest particles in the universe and economics looks at the behavior of complex organisms within their own complex sets of rules. That does not make economics a failure by any stretch of the imagination. ”

    Here is the thing. When people mock, rightly so, economics as a “dismal science” is because the joke goes that you ask four economists to make a prediction like next year’s GDP growth and you get five different opinions. That’s why it is a joke (as a science). Economics has value as tracker of data and giving “value judgements”. The most mathematical of its branches, microeconomics, is so disconnected from reality that it would be a true science if only reality happened to match its models (the problem is that in science, it goes the other way around, it’s not about reality matching one’s models but about one’s models matching reality :D ).

    “What is the more successful alternative to economics that you would promote? Oh yeah, again you don’t have one, you just want to play denier.
    You are just again spouting vile with little knowledge, but I guess that doesn’t stop countless others from having opinions.”

    Again, what is a strawman is to say that a scam is better than nothing, which is basically what the DSM defenders say. Let me see, would you be happy if next time you take a plane the pilot told you that there is 50% change that the plane will not take off? Or that even if the plane is flying, there is a non negligible probability that using the same engines, and same technologies, our understanding of gravity is so imprecise that it might happen that the plane will stop flying for no reason at all? What about your bank account. The computers that manage them are built on our understanding of quantum mechanics. Would you be happy if your bank told you that there is a 50 % probability that money will disappear from your bank account? Where HIV patients happy when AZT killed more people than it cured? I hope you get the idea.

    The problem that people like you have – people like you = “people who are unable to grasp the complexity of true science”- is that you have become so accustomed at accepting as valid reasoning that would get you expelled from the ranks in true science that you are even unable to differentiate scientific reasoning from pseudoscientific reasoning.

    “Except that we know that Newtonian mechanics is not correct in an absolute sense. Its just accurate enough under these circumstances.”

    Which is way, way, more than what we know about DSM nonsense. And because we know its limits, nobody proposes using it for building microchips. Yet, those of your kind keep defending poisonous drugs to treat invented disorders for which there isn’t any known biological cause. From where I stand, you are no different from an alchemist.

    “You keep making these vague references to your “type of science” you “practice.” What is that exactly?, because it clearly isn’t medicine, yet that doesn’t stop you from making ignorant comments about it.”

    That is part of the thing that I keep anonymous, just as I keep anonymous the European country where my ordeal happened.

    I have a PhD in hard science from an American university which is ranked higher than Georgetown by US News not only in medicine but also in the areas that matter here (physics, math, even economics). In my PhD program, those in economics and other “pseudo sciences” were the laughing stock. I practice my PhD skills everyday. In my field, we don’t have the luxury of working on “hypothetical realities” and “things that could be true”. People could die, literally.

    Doctors in the medical school were more respected, especially because they were a great source of funding so we could solve the problems they were unable to solve by themselves, but… Nobody thought very much of psychiatrists as actual doctors, really.

  262. cannotsay2013on 30 May 2013 at 11:00 pm

    rezistnzisfutl,

    You just provided me with a great line that I plan to use in the future,

    “Again, denialism based on a faulty understanding of science”

    In fact, it’s the so called “SKEPTIC MOVEMENT” that is based on a faulty understanding of science :D . Self declared skeptics have this false notion that science can explain it all : as in giving science more power than what it actually has, or as in calling “science” endeavors such as psychiatry that are “pseudo scientific” :D .

    Those of us who make a living out of real science, ie our livelihoods depends on accurate scientific predictions, know better :D .

    It is my experience that many “skeptics”‘ problem is that they spent too much time reading Isaac Asimov’s books but very little reading Newton’s Principia Mathematica.

  263. rezistnzisfutlon 30 May 2013 at 11:46 pm

    I wasn’t going to engage you, but this needs to be corrected.

    Self declared skeptics have this false notion that science can explain it all…

    I’d like to know where you’re getting this from. Ask ANY skeptic and they’ll tell you that science decidedly CANNOT explain it all. Furthermore, a skeptic is going to know that there is no way any person, way of thinking, philosophy, or method that is infallible.

    What we do know, however, is that science and the scientific method are by far the best ways of determining what is true – we know this because science works. No other method, philosophy, or way of thinking can provide the practical results science does. This is a far cry from assuming that science can “explain it all”. That is a massive strawman on your part.

    Science at its core is skepticism, which is the withholding of conclusions until adequate standards of evidence are met and critically evaluated. In other words, conclusions follow the evidence, not the other way around, and the evidence must meet certain standards.

    I find it ironic that on the one hand you criticize skeptics for relying on science so much, but on the other admit that your livelihood depends on “real science”.

    I also am dubious of your claim that you’re a professional scientist given your apparent lack of understanding of the very fundamentals of science as well as denialism of entire lines of settled science. I defer back to my original notion that you’re a troll who is basking in the attention of actual scientists and academics.

  264. cannotsay2013on 31 May 2013 at 12:34 am

    rezistnzisfutl,

    “I’d like to know where you’re getting this from. Ask ANY skeptic and they’ll tell you that science decidedly CANNOT explain it all.”

    This whole thread has been a great example, with Steven Novella and his followers defending something that I call “psychiatry of the gaps”. DSM disorders are not biological diseases as Alzheimer’s or Down Syndrome. There are no biomarkers to explain them because psychiatry says so. But! There is “science” behind them, and by “science” they mean, of course, “psychiatry pseudo science”. You could as well define your version of psychiatry as any behavior that is not known to be otherwise biologically caused but that is find objectionable by the guardians of “psychiatry of the gaps” :D .

    “Furthermore, a skeptic is going to know that there is no way any person, way of thinking, philosophy, or method that is infallible.”

    That’s why you use insults such as “denialist” to somebody who doesn’t agree with your dogma even when the dogma has been refuted by the very same top experts that you are allegedly defending. The steve12 personal conflict with Insel was very enjoyable.

    “What we do know, however, is that science and the scientific method are by far the best ways of determining what is true – we know this because science works.”

    The assumption of the scientific method is that there is an absolute, and rational underlying reality that science will uncover via the scientific method. Science is not a democratic endeavor but a very totalitarian one: it is governed by the rules of logic and the laws of nature.

    So for those areas of knowledge sure, science is the best. The problem is that the human experience is vastly more complex than that. There are areas of knowledge where there is no such rational underlying reality nor it is governed by any rational laws. The most obvious example, of course, is art appreciation. I am not talking about the notion that “good” music has patterns or that there isn’t regularity, but the notion that what is “good” has very subjective meaning for individual people. A tune that might be just OK for you, might touch somebody else in very deep ways. Try to talk to a Guns and Roses fan of the “rationality/scientific reasoning” that Hip Hop music is better. Good luck! There are many areas of knowledge where this underlying rational objective reality is non existent. That was David Brook’s whole point. His worry is that the science zealots have corrupted economics and the like. My problem is the opposite, ie, that to make economics acceptable as a “science”, many are corrupting “science” from the pure endeavor it is.

    “No other method, philosophy, or way of thinking can provide the practical results science does. This is a far cry from assuming that science can “explain it all”. That is a massive strawman on your part.”

    Actually, it is not a straw man http://commonsenseatheism.com/?p=16151 .

    “Science at its core is skepticism, which is the withholding of conclusions until adequate standards of evidence are met and critically evaluated. In other words, conclusions follow the evidence, not the other way around, and the evidence must meet certain standards.”

    This method does not work for instance when it comes to picking a wife (my case) or husband.

    That aside, I find it very ironic coming from somebody who defends DSM labels as “scientific” despite the fact that the top psychiatrists of the land agree that the standard you are asking for DSM labels is lacking :D .

    “I find it ironic that on the one hand you criticize skeptics for relying on science so much, but on the other admit that your livelihood depends on “real science”.
    I also am dubious of your claim that you’re a professional scientist given your apparent lack of understanding of the very fundamentals of science as well as denialism of entire lines of settled science. I defer back to my original notion that you’re a troll who is basking in the attention of actual scientists and academics.”

    As you can imagine, I couldn’t care less about what an anonymous skeptic troll thinks about my credentials. They are as real as the fact that I make a living out them.

    My advise to you guys is to do more actual science and less “science fiction”. Science popularization is great. I loved Carl Sagan documentaries and he inspired a great deal of my desire to become a scientist.

    That said, as soon as I started to do serious science it became very obvious that I had to stop thinking in simplistic, “Sanganian” if you will, terms and accept the complexity of what it comes with working with real science. The actual work is infinitely more interesting than the simplistic vision that comes from pseudo skepticism. Nothing matches the joy that one gets from deriving a complicated formula that predicts something which is later empirically verified. This is the “joy of science” that I talk about and the joy I have experienced myself many times.

    Although nothing that I have done in my life (yet :D ), matches http://en.wikipedia.org/wiki/Quantum_electrodynamics , I fully agree with Feynman’s contention that the accuracy of this theory’s predictions is the paradigmatic example of what real science looks like. Anything else might be worthwhile pursuing, but it’s hardly something I would consider “great science”.

  265. steve12on 31 May 2013 at 1:19 am

    “as soon as I started to do serious science”

    You’re not a scientist. Stop lying.

  266. cannotsay2013on 31 May 2013 at 1:24 am

    steve12,

    The position I find myself in here is that of explaining pseudo skeptics who are scientifically illiterate how true science, as in http://en.wikipedia.org/wiki/Precision_tests_of_QED , works.

    The problem is that you are so used to having your canards accepted as “science” that you don’t recognize true science even when you have it in front of your eyes.

    Your personal vendetta with Tom Insel has provided the paradigmatic example of what I am talking about.

  267. steve12on 31 May 2013 at 1:27 am

    What’s your Ph.D. (or equivalent) in?

  268. cannotsay2013on 31 May 2013 at 1:30 am

    steve12,

    Good try. As I said, I keeping it for myself for anonymity reasons. It’s a PhD, in a hard scientific field at one of America’s top universities (ranked higher than Georgetown).

    If I don’t have one, I must have been very smart (like in a “conspiracy type of smart” :D ) to fool my current employer that carried out a full background check on my credentials before hiring me. Boy!

  269. steve12on 31 May 2013 at 1:36 am

    Telling me what field you’rein compromises your anonymity?
    HAHAHAHAHA!

    You are such a bullshitter, and you picked the wrong people to bullshit with. It’s obvious from what you’re saying that you are no scientist.

    So if you have a Ph.D. in physics, I’ll be able to ID you? Ph.D. aren’t that rare – but you wouldn’t know because you do not have one. You’re unfamiliar with the basics of science

    Trivializing the holocaust then posing as a scientist to those who actually worked their ass off to actually get one.

    You’re a real prince CS.

  270. steve12on 31 May 2013 at 1:40 am

    And WTF does this mean?

    “Your personal vendetta with Tom Insel has provided the paradigmatic example of what I am talking about.”

    Because of the hamburglar joke (which was hillarious, btw).

    Dude – I’m not making fun of Tom Insel. I agree with Insel on most things I’ve read.

    I was making fun of YOU. thought that was obvious….

  271. cannotsay2013on 31 May 2013 at 1:42 am

    steve12,

    See, the funniest part of the discussion is that the only reason you want to know more details about me is PRECISELY to identify me to then do some kind of ad hominem.

    I return the question to you, my friend. Do you have a science background? Because honestly, in my grad school your bs would have gotten you an F in all classes, let alone your prelims! So no PhD for you. If you have a science education it probably comes from a third rate place that doesn’t even make it to the Shanghai ranking.

    Regarding the Holocaust, again, my fault to have assumed that people were aware of the role psychiatry played on it. I have assumed too much knowledge and too much intelligence from a bunch of people that probably are McDonalds workers that only take solace in their Mensa membership… As if raw IQ is all there is to science :D .

  272. steve12on 31 May 2013 at 1:52 am

    I have a Ph.D. in cognitive neuroscience. I specialize in vision & memory. And I also plan on keeping my anonymity.

    But listen – I know you’re not a scientist. It’s as obviously false to me as if you said you were a Martian.

    You are a bullshitter, and you know that if you name a field, your ass is getting called out and you won’t know what to say.

  273. steve12on 31 May 2013 at 1:54 am

    I don’t care what you’re gonna say, really. We BOTH know the truth, don’t we?

  274. cannotsay2013on 31 May 2013 at 2:04 am

    steve12,

    OK, that explains things :D . I have done a Google search of cognitive neuroscience phd; this is the first one that shows up (it’s irrelevant if you went to Duke, it’s just an example; although based on your responses seems unlikely),

    http://www.dibs.duke.edu/education/graduate/cogneuro-ap/requirements

    Compare that with the curriculum of the PhD program in physics at the same university,

    http://www.phy.duke.edu/graduate/curriculum2010/index.php

    Anybody who thinks that these two programs are equally rigorous when it comes to the scientific and intellectual challenges involved in meeting the requirements, literally, forgot to take their meds :D .

  275. steve12on 31 May 2013 at 2:05 am

    so you’re a physicist?

  276. cannotsay2013on 31 May 2013 at 2:08 am

    steve12,

    I will not confirm not deny :D . Regardless of what I confirm or deny, my science is of the same type of caliber as that that is taught in that PhD program at Duke. So obviously, we are not talking apples to apples here (ie, cognitive neuroscience vs physics). That was the whole point of the proposed “physics envy” disorder by David Brooks :D .

  277. cannotsay2013on 31 May 2013 at 2:12 am

    steve12,

    I am reading the syllabus of the first class that shows up there,

    http://www.phy.duke.edu/graduate/curriculum2010/courses/MM.php

    I spent many lonely nights doing these and more,

    Probability: distributions, generating functions, central limit theorem, stochastic processes.
    Complex Variables: analytic functions, complex integrals, residues, contour integration asymptotic expansions.
    Group Theory: definitions, examples, applications, representations, characters, product reps, Clebsch-Gordan coefficients, irreducible representations, irreducible Tensors, Wigner-Eckart.
    Fourier transforms, delta functions, convolution, correlation, power spectrum density.
    ODEs: exact solutions, series solutions, Legendre polynomials and functions, Frobenius method, Bessel functions, eigenfunctions, orthogonal functions, Sturm-Liouville theory, Green’s functions, qualitative methods, numerical methods.
    PDEs: separation of variables, cylindrical coordinates (Bessel), spherical coordinates (Legendre and Spherical Harmonics), Green’s functions, boundary problems.

    Do you even know what these concepts are? You might even know what the central limit theorem is, but I doubt.

  278. steve12on 31 May 2013 at 2:23 am

    So you can’t say what field it is, but it’s AS superior to cog neuro as physics is? And I suppose if I said I had a Nobel, you would say that you had 2, right?

    Do you know how ridiculous you sound? Seriously? I think you actually tried to pull this shit here before.

    I know you can’t backtrack now, but I would refrain in the future from saying stuff like this if you have an audience of scientists, and this blog seems to attract a few. But we’ll say that you’re a physics-like scientist. Any more specific than that would get you outted!

    ok, you can have the last word (because it’s clear that you must for whatever reason).

  279. cannotsay2013on 31 May 2013 at 2:34 am

    steve12,

    There are many fields that do physics-type of work. You’ll have to agree that you never did any work along the lines of what was described above in your life. Do you know what the central limit theorem is. I would suppose you should because many bio medical studies take it as a dogma (even when it is not warranted).

    “But we’ll say that you’re a physics-like scientist. Any more specific than that would get you outted!”

    Correct. And I can engage in any technical discussion on the matter. So, now that we are at it, what is the key distinction between the concept of differentiable functions in the real variable functions vs the “equivalent” concept of holomorphic functions for functions of complex variables. And I put “equivalent” between quotes because that key distinction is what makes the two concepts different.

    “ok, you can have the last word (because it’s clear that you must for whatever reason).”

    Actually, you can have the last word if you answer my question. Note that to convince me that you know, you have to reply now. Checking with some friend who knows what I am talking about is cheating :D .

  280. cannotsay2013on 31 May 2013 at 2:49 am

    steve12,

    I see you don’t have the slightest clue. Here comes the answer. For functions of complex variables, being differentiable in all directions, which is what being holomorphic means, implies that the function is differentiable ad infinitum, which in turns means that the function is analytic,

    http://math.stackexchange.com/questions/404906/holomorphic-vs-differentiable-in-the-real-sense

    For functions of real variables though, this is not necessarily the case. Ie, a bi-variate function of real values can be differentiable in all directions once without implying that the function is infinitely differentiable.

    The beauty of functions being analytic is that they can be expanded in its Taylor series (and convergence is assured http://en.wikipedia.org/wiki/Analyticity_of_holomorphic_functions ). This property allows to approximate any analytic function to the required degree of accuracy.

    This is one of the reasons why many problems in physics are formulated in terms of their equivalent in the complex plane.

    But what do you know… You are just a PhD in cognitive neuroscience :D .

  281. rezistnzisfutlon 31 May 2013 at 5:08 am

    Yea, Steve, he’s completely full of it, we all know it, and he’s just getting off on the attention and watching us get wound up. Come to think of it, that’s the definition of troll. It’s a waste of neurological energy to engage him any further.

  282. Bruce Woodwardon 31 May 2013 at 5:42 am

    The smilies creep me out to be honest. I stopped reading way back and have just skimmed to see if anyone else has had anything useful to say.

    I have to say, for my first encounter with a mental illness denier I am pretty disappointed in that he really has no idea what he is talking about… for someone who professes to be knowledgable he has a very limited view.

  283. Bill Openthalton 31 May 2013 at 6:18 am

    cannotsay2013

    “Broken software” is not fixed the same way as a “broken CPU”.

    We have already been down this path, but what the heck, let’s try again.

    Even though the brain is an information processing device, like a digitial computer, it has no software/hardware distinction comparable to that of a modern stored program computer. A computer can indeed have perfectly working hardware and faulty software. The software is merely a set of patterns, recorded as electric charges in silicon or magnetic media, or holes in paper, or printed marks, or electrons in a copper wire, or photons in a fibre, etc. These patterns can be read, modified, and written back to the hardware, resulting in an immediate change of behaviour of the computer.

    In a brain, the information is encoded in neurons and connections between neurons. These connections have to be physically grown (matter has to be mobiised and transformed), rather than merely encoded in neutral, infintely modifiable information storage devices. I mentioned paper — if you record a program on paper tape by punching holes in it, the recording is essentially permanent and unalterable. Of course, you could glue the chad back into the holes, and re-punch the tape, but that would be a laborious and unreliable process that would become more difficult and less reliable with every modification. Mutatis mutandis, this is the issue faced by the brain — once patterns are laid down, they are very difficult, and sometimes impossible, to change. The software and hardware are intricately interwoven, and you have to effect a physical change to modify the information.

    The idea that the brain “hardware” is always functioning perfectly, and that only the brain “software” needs a new version is wrong. Attractive (“My brain is OK”), but wrong.

  284. ccbowerson 31 May 2013 at 9:27 am

    “Again, what is a strawman is to say that a scam is better than nothing, which is basically what the DSM defenders say. Let me see, would you be happy if next time you take a plane the pilot told you that there is 50% change that the plane will not take off?”

    It is hard to have a conversation with such a black-and-white thinker. You want to break up all sciences into hard sciences and pseudosciences, and you are primarily making these divisions by the nature of the subjects rather than the fact that all of them are using scientific processes. The fact that economists have more difficulty with predictions than physics is pretty obvious, and it is not because economists are not smart enough. Particles are more predictable than large groups of humans in their ‘behavior.’ If it were so simple than a physicist would enter economics and win a Nobel Prize. But of course it is not about that.

    Asking an economist to predict what will happen next year is like asking a meteorologist what the weather will be like in a few months. Unless you think that is also pseudoscience.

  285. Steven Novellaon 31 May 2013 at 9:33 am

    You have terminal cancer. The doctor tells you that the best treatment available offers a 50% chance of a cure, and in any case will prolong survival somewhat. Do you take it, or do you consider that a scam because they can only offer a 50% chance of a cure?

    Medicine is a population-based probabilistic science, because everyone is a little different. Biological diversity and extreme complexity mean that all we can do is make probabilistic statements, about anything in medicine.

    Planes are child’s play by comparison.

  286. ccbowerson 31 May 2013 at 9:35 am

    I am done engaging this cannotsay, because ignorance and arrogance are not a good combination. There is zero chance of reaching him, and he has been more than sufficiently challenged by others here.

    He makes unsubstantiated assertions, and he has an extremely flawed understanding of science. THis is distinct from his denialism, which is another related topic, but is clearly as result of very strong motivational reasoning. I think it is clear to nearly everyone that he cannot thinking clearly about this topic. I’m not sure why he picked “cannotsay” when he clearly can and does say. “cannotthinkclearly2013″

  287. daedalus2uon 31 May 2013 at 9:44 am

    He is probably a pretty high level Scientologist. High enough that he has a lot of their awards, but not high enough to know that it is a scam.

  288. ccbowerson 31 May 2013 at 9:56 am

    “Sorry, but Newtonian physics is not really false, just incomplete and ultimately not the best primary explanation for gravitational and space/time physics on a grand, unifying scale. There is a reason why physicists and engineers continue to use Newtonian calculations every day – because they work.”

    No one said they didn’t ‘work’ for accurate approximations, but they are ultimately approximations or simplifications. They work because the error that is introduced can be safely ignored in many applications. I’m assuming you are objecting to what I wrote, but maybe not. I don’t think I wrote anything factually incorrect.

    Also, with regards to gravity and space-time, I think you must be referring to general relativity, which is the most current and complete understanding of those. The concepts of space-time did not exist within Newtonian mechanics. In fact Newton viewed that space and time were absolute and separate, which turns out to be one of the problems corrected by Einstein. This is not a criticism of Newton, this is good example fo the progression of science

  289. ccbowerson 31 May 2013 at 10:04 am

    “Medicine is a population-based probabilistic science, because everyone is a little different.”

    I would rather say that medicine is the application of science rather a science itself, but I like how you were able to be succinct with the point I’ve been trying to make. Cannotsay apparently thinks that airplanes are impressive

  290. rezistnzisfutlon 31 May 2013 at 10:17 am

    ccbowers,

    It wasn’t as criticism of what you were saying but more directed at CS, as he was taking what you were wrote and running with it, erroneously of course.

  291. ccbowerson 31 May 2013 at 10:40 am

    “It wasn’t as criticism of what you were saying but more directed at CS, as he was taking what you were wrote and running with it, erroneously of course.”

    I see. I stopped reading many of the posts above, because it’s hard to read. I have trouble reading so many misconceptions without feeling compelled to correct them, and I have other reponsibilities in my life than engaging in a lost cause. Its like a written wack-a-mole, and becomes more frustrating than intellectually stimulating. Fortunately for me, I don’t follow many other blogs, and none as closely as this one.

  292. steve12on 31 May 2013 at 10:54 am

    So let me get this straight:
    You refuse to address any of the links that I posted here that were actually germane to the thread. You refuse to divulge – even broadly – what kind of scientist you are while insisting that you are one.

    But you expect me to take a math quiz for questions you found on internet?

    I mean, sticking to that facile, non-explanative computer-brain analogy you came up w/ is enough to tell me you’re not a scientist.

    I called you a BS artist – but that’s too high of praise. Even your BS is kind of BS.

  293. ccbowerson 31 May 2013 at 11:13 am

    “my science is of the same type of caliber as that that is taught in that PhD program at Duke.”

    Can this be more awkwardly written? Can this guy be more transparently evasive. Hey, I get the concern about privacy, but man the exchanges on the education thing are pathetic. I don’t think this is a concern about privacy, but he realizes that he is out of his league with his appeals to physics.

    “So obviously, we are not talking apples to apples here (ie, cognitive neuroscience vs physics). ”

    Yeah, one is somewhat relevant to the topic (psychiatry) and the other is not. That is the first good point he made, even though he didn’t intend to make it

  294. cannotsay2013on 31 May 2013 at 11:31 am

    rezistnzisfutl,

    I hope you realize that you just refuted steve12′s point that “a skeptic is going to know that there is no way any person, way of thinking, philosophy, or method that is infallible” :D .

    ccbowers,

    Same goes to you ” I’m not sure why he picked “cannotsay” when he clearly can and does say. “cannotthinkclearly2013″”

    Bill Openthalton,

    “In a brain, the information is encoded in neurons and connections between neurons. These connections have to be physically grown (matter has to be mobiised and transformed), rather than merely encoded in neutral, infintely modifiable information storage devices. I mentioned paper — if you record a program on paper tape by punching holes in it, the recording is essentially permanent and unalterable.”

    Apparently you never heard of http://en.wikipedia.org/wiki/EEPROM or http://en.wikipedia.org/wiki/Flash_memory .

    The idea the the mechanism by which information is encoded and its durability makes this different from hw/sw is preposterous. Software can be stored in any of the two above ways. You have also, specially in dedicated devices -think your DVD- that software can be reprogrammed permanently (as opposed to general purpose computers where the program dies after switch off).

    “Mutatis mutandis, this is the issue faced by the brain — once patterns are laid down, they are very difficult, and sometimes impossible, to change. The software and hardware are intricately interwoven, and you have to effect a physical change to modify the information.
    The idea that the brain “hardware” is always functioning perfectly, and that only the brain “software” needs a new version is wrong. Attractive (“My brain is OK”), but wrong.”

    Which is of course disproved by the many cases of recovery from delusions and psychosis without hardware intervention, the most famous case being John Nash whom you can see being completely lucid,

    http://www.nobelprize.org/mediaplayer/index.php?id=429

    One of the many things that the movie A Beautiful Mind got wrong (not the book though) is that he recovered because of the drugs. In fact, the OPPOSITE is true. He stopped all the drugs in the early 1970s and he slowly recovered (he makes the point in that interview, starting in minute 25). As it was shown by the Soteria experiment that it, Soteria, was superior to drugging. So the idea that the mind cannot be reprogrammed without hardware interventions is preposterous. The mind is more complicated than our average software. It doesn’t mean the same principles are at work.

    ccbowers,

    “the fact that all of them are using scientific processes.”

    The problem is that not all areas of knowledge are prone to be known by the scientific method because, as I said, for the scientific method to be useful, there has to be an underlying, rational and totalitarian reality to be uncovered. That is why it works in physics. And that’s why it doesn’t work when determining the proposition “is Guns and Roses better than Hip Hop” in the “subjective sense” not even “predicting next year’s GDP” because the latter involves many agents who have “free will”, something that the Earth doesn’t have. The Earth, and other planets, are subject to the law of gravity.

    Steven Novella,

    It’s the shortest of your comments, but it’s probably the most insightful. Which proves that old adage that when one has nothing smart to say, it’s better not to say it,

    “You have terminal cancer. The doctor tells you that the best treatment available offers a 50% chance of a cure, and in any case will prolong survival somewhat. Do you take it, or do you consider that a scam because they can only offer a 50% chance of a cure?”

    Oncology diagnosis has both reliability (imaging, biopsies, etc) and validity (abnormal cell replication). The top dogs of psychiatry agree that DSM psychiatry lacks validity, and many even agree that it lacks reliability (Allen Frances). So that’s where your analogy falls apart. But second, even if this was true (which isn’t) you are confusing outcomes of existing treatments with understanding the underlying cause. What’s worse, psychiatry doesn’t even have “working treatments” for its invented diseases. If you DON’T treat cancer, the person will die. If you TREAT DSM disorders, the person will be insulin ECT-ed, ECT-ed, lobotomy-ed, chemically lobotomy-ed, etc, causing even more damage to the person.

    Anybody who sees any merit, or believes your analogies, obviously has some kind of agenda that conflicts with his/her critical thinking.

    “Medicine is a population-based probabilistic science, because everyone is a little different. Biological diversity and extreme complexity mean that all we can do is make probabilistic statements, about anything in medicine. ”

    That is a great admission. So we can settle the question that medicine in general is not real science? Which is very ironic, because then, medicine does not accepts anything other than 100% guarantee from those who design MRI instruments, for instance. There are probabilistic methods in MRI imaging, that have other advantages in terms of speed, but they are not accepted because they are not deterministic.

    And then there is psychiatry, which make the rest of medicine look like 100% deterministic, Newtonian mechanics like.

    “Planes are child’s play by comparison.”

    Tell that to the guys who built this and found the Higgs boson with it,

    http://lhc.web.cern.ch/lhc/

    Or to the guys who built the 5 billion device chips.

    What seems obvious to me now is that your inability to grasp the complexity of all these other areas is at the core of your deep misunderstanding of science.

    steve12,

    The issue of holomorphic functions vs bi variate real valued differentiable functions is one of those things that you NEED to know. It’s not even a “hard core” issue, but it is something that is deeper than what you get in calculus 101. Of course, for those who know, the issue is easily found in the internet, but note that you need to know what the issue is, in order to be able to search for it.

    Obviously, you said you have a PhD in cognitive neuroscience, so this is completely alien to you “D.

  295. cannotsay2013on 31 May 2013 at 11:32 am

    NOTE: I surpassed the number of links again. I put the same comment without some links.

    rezistnzisfutl,

    I hope you realize that you just refuted steve12′s point that “a skeptic is going to know that there is no way any person, way of thinking, philosophy, or method that is infallible” :D .

    ccbowers,

    Same goes to you ” I’m not sure why he picked “cannotsay” when he clearly can and does say. “cannotthinkclearly2013″”

    Bill Openthalton,

    “In a brain, the information is encoded in neurons and connections between neurons. These connections have to be physically grown (matter has to be mobiised and transformed), rather than merely encoded in neutral, infintely modifiable information storage devices. I mentioned paper — if you record a program on paper tape by punching holes in it, the recording is essentially permanent and unalterable.”

    Apparently you never heard EEPROM or Flash Memory .

    The idea the the mechanism by which information is encoded and its durability makes this different from hw/sw is preposterous. Software can be stored in any of the two above ways. You have also, specially in dedicated devices -think your DVD- that software can be reprogrammed permanently (as opposed to general purpose computers where the program dies after switch off).

    “Mutatis mutandis, this is the issue faced by the brain — once patterns are laid down, they are very difficult, and sometimes impossible, to change. The software and hardware are intricately interwoven, and you have to effect a physical change to modify the information.
    The idea that the brain “hardware” is always functioning perfectly, and that only the brain “software” needs a new version is wrong. Attractive (“My brain is OK”), but wrong.”

    Which is of course disproved by the many cases of recovery from delusions and psychosis without hardware intervention, the most famous case being John Nash whom you can see being completely lucid,

    http://www.nobelprize.org/mediaplayer/index.php?id=429

    One of the many things that the movie A Beautiful Mind got wrong (not the book though) is that he recovered because of the drugs. In fact, the OPPOSITE is true. He stopped all the drugs in the early 1970s and he slowly recovered (he makes the point in that interview, starting in minute 25). As it was shown by the Soteria experiment that it, Soteria, was superior to drugging. So the idea that the mind cannot be reprogrammed without hardware interventions is preposterous. The mind is more complicated than our average software. It doesn’t mean the same principles are at work.

    ccbowers,

    “the fact that all of them are using scientific processes.”

    The problem is that not all areas of knowledge are prone to be known by the scientific method because, as I said, for the scientific method to be useful, there has to be an underlying, rational and totalitarian reality to be uncovered. That is why it works in physics. And that’s why it doesn’t work when determining the proposition “is Guns and Roses better than Hip Hop” in the “subjective sense” not even “predicting next year’s GDP” because the latter involves many agents who have “free will”, something that the Earth doesn’t have. The Earth, and other planets, are subject to the law of gravity.

    Steven Novella,

    It’s the shortest of your comments, but it’s probably the most insightful. Which proves that old adage that when one has nothing smart to say, it’s better not to say it,

    “You have terminal cancer. The doctor tells you that the best treatment available offers a 50% chance of a cure, and in any case will prolong survival somewhat. Do you take it, or do you consider that a scam because they can only offer a 50% chance of a cure?”

    Oncology diagnosis has both reliability (imaging, biopsies, etc) and validity (abnormal cell replication). The top dogs of psychiatry agree that DSM psychiatry lacks validity, and many even agree that it lacks reliability (Allen Frances). So that’s where your analogy falls apart. But second, even if this was true (which isn’t) you are confusing outcomes of existing treatments with understanding the underlying cause. What’s worse, psychiatry doesn’t even have “working treatments” for its invented diseases. If you DON’T treat cancer, the person will die. If you TREAT DSM disorders, the person will be insulin ECT-ed, ECT-ed, lobotomy-ed, chemically lobotomy-ed, etc, causing even more damage to the person.

    Anybody who sees any merit, or believes your analogies, obviously has some kind of agenda that conflicts with his/her critical thinking.

    “Medicine is a population-based probabilistic science, because everyone is a little different. Biological diversity and extreme complexity mean that all we can do is make probabilistic statements, about anything in medicine. ”

    That is a great admission. So we can settle the question that medicine in general is not real science? Which is very ironic, because then, medicine does not accepts anything other than 100% guarantee from those who design MRI instruments, for instance. There are probabilistic methods in MRI imaging, that have other advantages in terms of speed, but they are not accepted because they are not deterministic.

    And then there is psychiatry, which make the rest of medicine look like 100% deterministic, Newtonian mechanics like.

    “Planes are child’s play by comparison.”

    Tell that to the guys who built this and found the Higgs boson with it,

    http://lhc.web.cern.ch/lhc/

    Or to the guys who built the 5 billion device chips.

    What seems obvious to me now is that your inability to grasp the complexity of all these other areas is at the core of your deep misunderstanding of science.

    steve12,

    The issue of holomorphic functions vs bi variate real valued differentiable functions is one of those things that you NEED to know. It’s not even a “hard core” issue, but it is something that is deeper than what you get in calculus 101. Of course, for those who know, the issue is easily found in the internet, but note that you need to know what the issue is, in order to be able to search for it.

    Obviously, you said you have a PhD in cognitive neuroscience, so this is completely alien to you “D.

  296. Bill Openthalton 31 May 2013 at 11:46 am

    cannotsay2013

    Which is of course disproved by the many cases of recovery from delusions and psychosis without hardware intervention, the most famous case being John Nash whom you can see being completely lucid,…

    Do you really think that recovering from delusions and psychosis is akin to uploading a corrected version of a program? I have seen people suffering from Alzheimers have lucid episodes, only to deterioate even further. Drunk people recover not because the program is rebooted, but because the alcohol is metabolised. We do know that the brain can “repair” itself by retargetting resources, but that is demonstrably a physical process, not merely changing the contents of memory cells. Learning brains undergo physical change. Laying dowm memories implies physical change. Brains are not at all like computers, apart from the fact that both are information processing devices. Think Turing machines.

  297. Ori Vandewalleon 31 May 2013 at 11:58 am

    This has been a truly fascinating discussion. For example, I’ve learned that cancer did not exist 2,000 years ago.

  298. sonicon 31 May 2013 at 1:32 pm

    cannotsay2013-
    It seems you are the only commenter that has considered the possibility you might be wrong about this.

    In your favor are the statements of Insel and Kupfer– that there are currently no known biomarkers for any of the diseases in the DSM.
    Further they openly question the validity of these ‘mental illnesses’.

    You have addressed steve12 on his ‘lancet’ paper and he seems to have missed the point.

    It seems it boils down to this-

    You are saying the current situation will continue– they will not find ‘biomarkers’ for the specific diseases in the DSM. (I think Insel would largely agree there– he is saying he wants to fund on a basis other than DSM categories– right?)

    The others are saying you are wrong– there will be biomarkers found for the specific diseases listed in the DSM (SZ, for example).

    This is what I get when I remove the name calling and red-herrings and off-topic from the 297 responses thus far.
    And there has been far too much of that from all concerned IMHO– and I’m not claiming to be clean or anything.

    Anyway– I believe the old adage ‘time will tell’ is appropriate here.

  299. The Other John Mcon 31 May 2013 at 1:43 pm

    Can’t Say but Won’t Stop Saying, you said:

    “Psychiatry doesn’t even have ‘working treatments’ for its invented diseases. If you DON’T treat cancer, the person will die. If you TREAT DSM disorders, the person will be insulin ECT-ed, ECT-ed, lobotomy-ed, chemically lobotomy-ed, etc, causing even more damage to the person.”

    And you pretend like you know something about psychology, psychiatry, and medicine.
    That’s hilarious. Why is it so uncomfortable for you to admit that you don’t know what you are talking about? There’s no shame in it. I’m no expert in quantum physics, mathematical logic, computational theory, and word vomiting like you are, but I’m happy to admit it and defer to actual experts. Give it a try sometime, you might learn something.

  300. steve12on 31 May 2013 at 1:45 pm

    “It seems it boils down to this-”

    No, not at al.

    You CANNOT have this discussion if you do not make the distinction between

    1. Biomarkers suffucient for individual diagnosis
    2. Biomarkers that are reliable between groups.

    No one should even comment on any of the biological-basis argument if they don’t understand this distinction.

    There’s a reason why it’s been explained several times by several people, including Steve Novella, but Sir Jing Dr. Cannotsay, M.D., Ph.D., Esq. refuses to address it. Because it completely falsifies his argument that major psychoses are inventions of psychiatry.

  301. Mlemaon 31 May 2013 at 3:22 pm

    Steve12, maybe you can help me understand “biomarkers that are reliable between groups”. A very specific example might help me (and I apologize because I think maybe you gave me that example earlier). What are the groups and how are they determined?

  302. cannotsay2013on 31 May 2013 at 3:24 pm

    Bill Openthalt,

    John Nash experienced “full remission” not sporadic “lucid episodes”. He was declared fully recovered like 1-2 years before he got his Nobel Prize in 1994. That interview was from 2004, here is a more recent one from 2011,

    http://www.youtube.com/watch?v=PxqDi2lugo0

    John Nash is, of course, the most prominent case, but you’ll find thousands of stories of people who recovered from extreme mental states without drugs (in fact, ONLY AFTER they quit their drugs) in the survivor networks, you have samples of recovery stories here http://openparadigmproject.com/ .

    Ori Vandewalle,

    That was a complete nonsensical comment, of the kind that gives your movement the bad reputation it has :D .

    sonic,

    I agree with your assessment, we could have been spared from the name calling such as “denialist”.

    The Other John Mc,

    Here is psychiatry’s record. Its most widely used, and studied, class of drugs, SSRI antidepressants have been shown to have an efficacy (using psychiatry’s own metric of efficacy, the Hamilton Rating Scale for Depression) no better than placebos (EH Tuner in the New England Journal of Medicine, Irving Kirsch in PLOS medicine, both 2008). There drugs have been shown to increase the risk of suicide (so much so that the FDA now forces all manufacturers of antidepressants, not only SSRIs, to include a black box warning on the matter). The data from the CDC that shows that the rate of suicide increased 28% from 1999 to 2009, a time during which more Americans were taking SSRI medication, is consistent with hat FDA warning.

    So we have, medications that are no better than placebos, that increase suicide risk, and its widespread usage correlated with increase of suicide. Boy! I think that it’s those like you who are clueless about psychiatry’s evil, that do not know what you are talking about. You defend it as a dogma, just as a Young Earth creationist defends his :D .

    steve12,

    Nobody has addressed anything except for sonic, and that includes Novella. I have a further thought to his blunt admission today,

    “Medicine is a population-based probabilistic science, because everyone is a little different. Biological diversity and extreme complexity mean that all we can do is make probabilistic statements, about anything in medicine. ”

    See, I am about to use your “continuum fallacy canard” against you :D . Even if we accept this as a matter of fact, it doesn’t mean that EXTREMES cannot be defined :D ,

    - On one extreme you have oncology, HIV medicine, cardiology, actually all branches of medicine except for psychiatry.

    - On the other extreme you have one branch of medicine- psychiatry-, homeopathy, astrology, etc.

    Most reasonable people would agree to call the first extreme “scientific” (even though it is still not really science in the “physics” sense), while they call the second pseudo science :D .

  303. steve12on 31 May 2013 at 3:32 pm

    I don’t have time right now – but I mined at least 3 times above (sad indictment on my life), and Steve Novella explained it as well

    ME:
    on 22 May 2013 at 12:45 pm
    on 23 May 2013 at 3:05 am
    on 28 May 2013 at 1:53 am

    Steve Novella
    on 24 May 2013 at 11:07 am

  304. cannotsay2013on 31 May 2013 at 3:36 pm

    steve12,

    That is your value judgement. Mine, that is shared by posters like sonic, is different.

    And again, I encourage all who are reading these pages to listen to the testimonies here http://openparadigmproject.com/, especially how life improved the moment they rejected their DSM labels and DSM imposed drugging. Your position is condemning many people to a life of misery.

  305. steve12on 31 May 2013 at 3:39 pm

    I mean, if you compare 1st degree relatives of patients diagnosed by DSM criteria for psychoses with those having no family history you see reliable genetic and perceptual differences.

    How can a made up disease do that (as I’ve asked 12 times)?

    That falsifies the proposition that these are made up.

  306. steve12on 31 May 2013 at 3:40 pm

    Why don’t you cut the nonsense and answer my Q above?

  307. steve12on 31 May 2013 at 3:41 pm

    Why the differences in 1st degree relatives of patients diagnosed by DSM criteria for psychoses ?

  308. sonicon 31 May 2013 at 3:54 pm

    steve12-
    Perhaps there is more agreement about this than is currently being acknowledged–

    I understand the distinction you make and understand the implications regarding biomarkers and ‘mental illness’.

    However–
    When it comes to finding these markers–

    http://www.nimh.nih.gov/about/director/index.shtml
    “…it is critical to realize that we cannot succeed if we use DSM categories as the ‘gold standard.’”

    http://www.ncbi.nlm.nih.gov/pubmed/22869033
    “Rather than seek biomedical tests that can ‘diagnose’ DSM-defined disorders, the field should focus on identifying biologically homogenous subtypes that cut across phenotypic diagnosis–thereby sidestepping the issue of a gold standard.”

    If Insel (the first paper) and the other researchers are correct, then it seems likely we will not find any biomarkers for many of the ‘diseases’ listed in the DSM. Right?

    And I think that is what cannotsay is suggesting — there won’t be biological tests for any (as opposed to many) of the diseases listed in the DSM.

    But, Suppose Insel and the other researchers are correct– the DSM categories will not be useful in finding biomarkers for ‘mental illness’.

    What does that say about the DSM?
    And what does that say about psychiatry in general?

    Those are not meant to be rhetorical questions.

  309. steve12on 31 May 2013 at 4:00 pm

    It says that the DSM is wrong, but everyone already knew that. PArts of the DSM are absurd, actually.

    But psychoses exist and have biological bases. Maybe we’ll find they’re all the same disease with idiosynchratic expression or we maybe there are distict subtypes with distinct pathophysiologies

    I covered this at
    on 28 May 2013 at 2:01 am

  310. cannotsay2013on 31 May 2013 at 4:18 pm

    sonic,

    Great analysis, as always.

    steve12,

    “It says that the DSM is wrong, but everyone already knew that”

    Well, it is news for me that you admit that, reall!

    You are on record saying that schizophrenia is a valid, biologically caused illness like diabetes. Apparently, you don’t have the slightest clue of what you are talking about (it seems a pattern of your interventions here). This is what DSM-IV calls schizophrenia,

    DSM-IV-TR: Diagnostic criteria for schizophrenia https://sites.google.com/site/punishingthepatient/medical-model/dsmIV

    A. Characteristic symptoms: Two (or more) for the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

    delusions
    hallucinations
    disorganised speech (for example frequent derailment or incoherence)
    grossly disorganised or catatonic behaviour
    negative symptoms, that is,, affective flattening, alogia, or avolition

    Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or more voices conversing with each other.

    B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

    C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (that is, active-phase symptoms) and may include prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (for example, odd beliefs, unusual perceptual experiences).

    D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

    E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (for example, a drug of abuse, a medication) or a general medical condition.

    F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are present for at least a month (or less if successfully treated).[46]

    That is a completely made up condition as when “homosexuality” was a made up “mental illness”. That is not to say that people cannot experience hallucinations or psychotic behavior.

  311. Mlemaon 31 May 2013 at 5:16 pm

    I’m not encouraged by the fact that various mental disorders which seem to share biomarkers don’t share symptoms. How is the information gained from this research valuable (outside increased scientific information)?

  312. Bill Openthalton 31 May 2013 at 6:13 pm

    cannotsay2013

    John Nash experienced “full remission” not sporadic “lucid episodes”. He was declared fully recovered like 1-2 years before he got his Nobel Prize in 1994. That interview was from 2004, here is a more recent one from 2011,
    John Nash is, of course, the most prominent case, but you’ll find thousands of stories of people who recovered from extreme mental states without drugs (in fact, ONLY AFTER they quit their drugs).

    You’re missing the point. When people recover from a brain malfunctions by themselves, they are healing. Your broken bones, damaged liver, cut up tissue etc. heal by themselves — that’s what living organisms do. It means there is physical, observable change to these tissues. Giving people drugs is not the same as repairing hardware (changing a CPU, or re-soldering a cold connection), but more like spraying coolant on an overheating CPU and seeing functionality restored.

    Computer hardware has no self-healing powers, and spraying coolant is not a long term solution to an overheating CPU, so we either scrap the machine or replace the CPU. Humans, on the other hand, heal. I am not surprised when certain types of brain problems disappear after a while. I also know this doesn’t always happen.

  313. Bill Openthalton 31 May 2013 at 6:25 pm

    cannotsay2013

    when “homosexuality” was a made up “mental illness”.

    Actually, when society did not accept homosexuality, it was a mental illness. There are no unalterable specifications for the human brain you can use to determine whether a person is “normal”, and failure to adapt to the society in which one is born is a mental deficiency. Not being aggressive in a warrior society is a mental disorder. Being aggressive in a peace-loving society is a mental disorder. It’s all relative, and normal just means “conforming to the norms of the moment and location”.

    This means that you honestly believe you are totally OK and “normal”, and did nothing wrong, while at the same time the society in which you live decides to put you in their loony bin. That sucks, but that’s life.

  314. cannotsay2013on 31 May 2013 at 6:35 pm

    Bill Openthalt,

    “You’re missing the point. When people recover from a brain malfunctions by themselves, they are healing. Your broken bones, damaged liver, cut up tissue etc. heal by themselves — that’s what living organisms do. It means there is physical, observable change to these tissues. Giving people drugs is not the same as repairing hardware (changing a CPU, or re-soldering a cold connection), but more like spraying coolant on an overheating CPU and seeing functionality restored. ”

    Actually YOU are missing the point here. Continuing with the analogy, it is perfectly possible to see correlates in HW when a software problem (such as a memory leak) is fixed. If you live under the dogma that Bill Gates does not exist, you might get the wrong impression that hardware is self-correcting. But the reality is that Bill Gates fixed that genuine software problem.

    Or, better yet (if you don’t want to believe in Bill Gates but in “evolution”), “evolution” programmed the computer to be self-correcting but the problem was not biological to begin with even though hw reflects changes when software fixes itself.

    This is where I affirm, with the slightest doubt now, that “skeptic dogma” is just as bad as “religious dogma”. In order to deny the mind, you need to believe in increasingly “difficult to believe” canards.

    I don’t need much faith to believe in “self correcting software whose changes are reflected in hardware”, they already exist and do pretty complicated stuff (even if those like you or Novella do not appreciate this complexity).

    Google is estimated to have millions of computers distributed across the planet that operate 24 h x 7, that pretty much by themselves with zero or minimal human intervention (human intervention is usually limited to hardware problems!). Each of those computers has CPUs that have billions of transistors and memory that has billions more. Then there are network interfaces, routers, etc, etc. All that works together beautifully and there isn’t a single person that knows every single detail. Google search handles 3 billion searches a day, that’s 35000 queries per second distributed across the world, seamlessly.

    Software makes it possible. Go tell those who designed that software that software does not exist and that every problem is a hw problem in nature!

  315. cannotsay2013on 31 May 2013 at 6:42 pm

    Bill Openthalton,

    “This means that you honestly believe you are totally OK and “normal”, and did nothing wrong, while at the same time the society in which you live decides to put you in their loony bin. That sucks, but that’s life.”

    I think you nailed it here, but you have a couple of details wrong :D . The APA doesn’t like my behavior, but the society in which I live, the United States of America, is perfectly OK with it as long as I follow the law and don’t become violent.

    The European society in which I grew up and where my parents live both DOES not like my behavior and IT WAS NOT ok with it.

    But you are basically repeating your previous point: so called “mental illness”, in DSM terms, is social control, it is not real illness. And I agree with that. But because it is social control, it needs to be left to the democratic institutions.

    This is where Europe’s totalitarian past shows its true colors. Social control that has been found unacceptable by our SCOTUS, because it violates the 4-th amendment, is considered acceptable by Europe’s European Court of Human Rights. It cannot be more explicit than this :D .

  316. sonicon 31 May 2013 at 7:34 pm

    steve12-
    “It says that the DSM is wrong, but everyone already knew that”
    Thank-you.

    And I will give you that it is possible that a reliable biomarker will be found for psychosis.
    Your welcome.

    I knew we could find common ground here. :-)

    Mlema-
    “I’m not encouraged by the fact that various mental disorders which seem to share biomarkers don’t share symptoms.”
    I think you have hit the nail on the head.
    Perhaps if the researchers take Insel’s advice and forget about the DSM designations, some of this problem will go away.

    Well.. it might, anyway. I think that’s the hope… right?

    cannotsay-
    Thank-you.

  317. BillyJoe7on 01 Jun 2013 at 1:14 am

    Cannotsay,

    “John Nash experienced “full remission””

    A “full remission” from what?

  318. cannotsay2013on 01 Jun 2013 at 2:05 am

    BJ7,

    From something that in the late 50s (time of the first DSM which was even more nonsensical than the current one) was labelled as schizophrenia. Please take a look at what DSM-IV considered “schizophrenia”. Very different from the DSM-I label.

    By his own admission, he suffered from delusions. As I said, he was not the only one who recovered from a extreme mental state by rejecting psychiatric drugging. Please tell these people http://openparadigmproject.com/ , many of whom I have communicated electronically, that they would be better off drugged until the end of their lives.

    The very notion of recovery is anathema in today’s psychiatry. It is obvious by now that your cowardice prevents you from taking the Rosenhan challenge. If you had, you’d learn that upon your so called “diagnosis” you would have been told that your brain is screwed by a chemical imbalance and that your only hope is to accept that you are going to be “ill for life”. Taking the drugs was going to be your only chance of being a “functional member of society”. This is no joke. This is what I was told and this is what every individual who has been unlike enough to get in touch with a psychiatrist is told. They threaten you with the worst possible scenarios to “make you understand” that taking the drugs is in your best interests. If you don’t, in Europe, they will force you to take them whether you like it or not.

    As the many stories above tell, the rejection of psychiatry is in fact the only thing that gave them (actually us!) our life back. I am divorced, but I am freer than what I was during the last year of my marriage, during which my “alleged” mental illness was used against me by my ex-wife, my parents and siblings. The label had hijacked my social life. Not to mention that there was always the veiled threat that I would be committed again if I ever decided to take off the drugs (while on vacation there). So, I went off drugs, and I never returned to Europe. I sent all of them to hell and I never looked back.

    As I said, I have now a better standard of living and a better job than when the whole thing happened. To hell with psychiatry and creepy family members :D .

  319. steve12on 01 Jun 2013 at 10:36 am

    “And I will give you that it is possible that a reliable biomarker will be found for psychosis.
    Your welcome.”

    If you mean diagnostic biomarkers, I agree.

    If you mean biomarkers that show the major psychoses are biologically based phenomena, no need to wait. We’ve had them for a while.

  320. cannotsay2013on 01 Jun 2013 at 1:05 pm

    steve12,

    “If you mean biomarkers that show the major psychoses are biologically based phenomena, no need to wait. We’ve had them for a while.”

    Only if you accept a fallacy called “confusing correlation with causation” :D . Going to the sw/hw analogy, if you deny the existence of software, you can be misled to believe that a memory leak is a hardware based phenomenon: the computer becomes increasingly slow and the bits of the memory that were set to off begin to have some random patterns that imply usage without the computer doing much.

    Now if you tell somebody who knows a thing or two about software that a memory leak is a hardware based phenomenon he will laugh at your face. Which is what I have been doing with you for a while now :D .

  321. titmouseon 01 Jun 2013 at 1:50 pm

    Cannotsay posted a link to something he’d written on another blog. This bit struck me:

    Even though the APA also says that Cognitive Behavioral Therapy, CBT, alone is more efficient than meds for the treatment of OCD, I was made very clear that unless I agreed to be put on a medication regime, I would not be released from my involuntary commitment.

    Cannotsay, the APA can’t be all bad if they’re recommending CBT for some problems, eh? Seems they don’t push pills *all* the time.

    There are organized antipsychiatry groups who love bomb and encourage disgruntled psychiatric patients to get political. It’s sad to watch, because the resulting activism comes off as extremist rather than realistic and progressive. Extremism just distracts from real situations that need our attention right now.

    Fight all you want for the end of psychiatry it ain’t gonna happen. The people with psychotic episodes, with progressive dementias, and overwhelming urges to harm themselves or others are now waiting for days and even weeks in our emergency rooms, thanks to recent closures of psychiatric units. Somebody thought the closures would save money. But they forgot that our patients don’t go away just because the beds aren’t available.

    Talk all you want about Soteria and other idealistic settings for emotional healing. But figure out where our adults with intellectual disabilities, autism, and recurrent aggression are going to live right now, this week and next. If you say “jail,” I will say, “f*ck you,” because they will get beat up in jail.

    Roll up your sleeves and help us, activist. We need your help. But please leave your demonization of psychiatry behind you.

  322. Mlemaon 01 Jun 2013 at 2:40 pm

    Steve12, can you please tell me which biomarkers you’re referring to when you say “show the major psychoses are biologically based”? (maybe from just one of the articles you think best shows this?)

    Since many different types of behavior are labelled SZ, and since many schizophrenic’s problems resolve over time without treatment, and since some psychiatrists believe that all the symptoms of SZ are common to almost everyone over time – what is the significance of a biomarker tied to the major psychoses? And what if it’s also linked to many other behaviors that are different from those of SZ?

    If, as Insel suggests, SZ may be a neurodevelopmental problem, how would this tie to the biomarkers?

    This is complicated stuff for me, and I’m hoping you can give me some help in deciphering its meaning.

  323. cannotsay2013on 01 Jun 2013 at 2:57 pm

    titmouse,

    The APA recommends non drug therapy for many things, the problem is that such recommendation is in theory, in practice psychiatry has become a dispenser of poisonous drugs. The NY Times had an excellent article on the matter a couple of years ago,

    “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”

    http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?pagewanted=all&_r=0

    Besides, in my case, my therapist was a psychologist, not a psychiatrist. In fact, he, the therapist, was the only “sane/normal” person that I met during the whole ordeal. After I stopped the drugs I hesitated for a while whether to dump him, because he was a nice guy, but I came to the conclusion that my only chance at rebuilding my life was to cut all my contact with the system. It turns out that my hunch was right. I have never looked back.

    “Fight all you want for the end of psychiatry it ain’t gonna happen.”

    Just 1 month ago, it was inconceivable that the director of the NIMH was going to issue such an explicit, and overreaching, condemnation of the current practice of psychiatry.

    We have two former chairs of DSM task forces -Robert Spitzer from DSM-III and Allen Frances from DSM-IV- demonizing the DSM-5 although to different degrees and for different reasons (with Frances being by far the most assertive).

    So the events of the last month have made my resolution to fight this scourge stronger not weaker. To the point that I am seriously thinking to out myself and become an official activist as a part time, non remunerated job, not just some anonymous guy who debunks psychiatric pseudoscience. The decision is not final, and the time horizon is not immediate but I am seriously considering it. I think that because of my scientific background and credentials, I can attack psychiatry more effectively than other activists, especially now that Insel has set it up for becoming an official pseudo science like economics.

    “The people with psychotic episodes, with progressive dementias, and overwhelming urges to harm themselves or others are now waiting for days and even weeks in our emergency rooms, thanks to recent closures of psychiatric units. Somebody thought the closures would save money. But they forgot that our patients don’t go away just because the beds aren’t available.”

    As somebody who was forced into psychiatry under phony excuses such as this one, I find it completely laughable. The only thing that psychiatrists are fighting for now is their livelihood (ie, salaries, research money, etc).

    “Talk all you want about Soteria and other idealistic settings for emotional healing. But figure out where our adults with intellectual disabilities, autism, and recurrent aggression are going to live right now, this week and next. If you say “jail,” I will say, “f*ck you,” because they will get beat up in jail.”

    You have completely misrepresented my positions. My position is that all contact with psychiatry should be ENTIRELY voluntary. Not except case a, b, c, d, but ALL contact. If society wants to build houses for those who are unable to provide for themselves for whatever reason, fine, but it should not be a mandatory experience imposed by force. You laugh at Soteria but Loren Mosher showed very convincingly that its emphasis on recovery vs “there is something wrong with you” and on community support vs “forced drugging” resulted in significantly better outcomes long term. And again, tell that to these people http://openparadigmproject.com/ (one day you might even see my own story there).

    “Roll up your sleeves and help us, activist. We need your help. But please leave your demonization of psychiatry behind you.”

    Actually, think about psychiatry like sex. My fight is against rape, not sex. I don’t have to see psychiatry banned as a medical specialty to declare victory. It would be enough to have some kind of SCOTUS decision for instance that takes the standard from locking people against their will because of dangerousness from the current “clear and convincing evidence” to “beyond reasonable doubt”. I say that after the events of this month, this is more likely now than just 1 month ago.

  324. cannotsay2013on 01 Jun 2013 at 3:15 pm

    “Actually, think about psychiatry like sex. My fight is against rape, not sex”

    Just as if astrology or homeopathy had found a way to imposed themselves into society, I would fight them. I have no problem with people engaging voluntarily in pseudo science or for insurance companies paying for it (in the US, some pay for homeopathy, even acupuncture). I get mad that the premiums are higher to pay for those services, but that’s a different matter :D .

    My fight is with the state imposing this quackery onto innocent victims. Those in the survivor movement are fighting on the right moral side of history, as well as on the right side of science (lack thereof in this case).

  325. Mlemaon 01 Jun 2013 at 3:39 pm

    holy crap, this makes my blood run cold: ofstereotactic surgery for OCD? (it has actually been performed?)

    http://www.ncbi.nlm.nih.gov/pubmed/23668073

    This is the type of “medicine” that ought to be criminalized, along with giving psychiatric drugs to healthy children.

  326. cannotsay2013on 01 Jun 2013 at 3:43 pm

    Mlema,

    That’s one of psychiatry’s best kept secrets. When people think of lobotomy they think of the past. However, it still exists today under the name http://en.wikipedia.org/wiki/Psychosurgery . Thankfully, in the US, forced so called “psycho-surgery” is banned in most states, ie, it cannot be used as a forced treatment even when psychiatry is forced onto you.

    But yeah, I know. Imagine me being forcibly “psycho-surgered”. Boy :D !

  327. cannotsay2013on 01 Jun 2013 at 3:44 pm

    This is Harvard’s center for psycho-surgery,

    http://neurosurgery.mgh.harvard.edu/functional/psysurg.htm

    So yeah, it is still pretty much alive :D .

  328. Mlemaon 01 Jun 2013 at 3:52 pm

    I can’t understand why any doctor would recommend this procedure for OCD (or any behavioral problem). All the articles that Dr. Novella linked to regarding OCD fail to show any brain/physiology problem for OCD. There are volumetric differences in adults – which are likely caused by long-term performance/thought patterns (or by the drugs they’re given). In OCD children who’ve never been given drugs, there’s more gray matter in specific areas (seems likely caused by the behavior already in place in a child diagnosed with OCD, right?) Will we experiment on OCD children by removing gray matter? Holy shit. How is this different from drilling holes in peoples heads to “let the demons out”?

  329. cannotsay2013on 01 Jun 2013 at 3:59 pm

    Mlema,

    You are making me laugh, really :D ,

    “All the articles that Dr. Novella linked to regarding OCD fail to show any brain/physiology problem for OCD”

    Let’s be clear, since when lack of scientific evidence has been an obstacle for psychiatry to impose their quackery? What was the scientific evidence backing widespread usage of cocaine (as Sigmund Freud recommended), or insulin therapy, or ECT, or lobotomy, or neuroleptic drugs or SSRIs. In each and every case, psychiatry invented a reason, and provided an equally invented solution. When their scam showed not only not to work but to do more damage than good, they moved to their next scam.

    This is what Insel is doing now in order to save psychiatry from itself. Only, there is a big difference. Now, we have been promised objective, quantifiable measurements as predictors of so called “mental illness”. And that gives us a chance to completely falsify psychiatry while there is no way a DSM 5 consensus can be falsified :D .

  330. cannotsay2013on 01 Jun 2013 at 4:20 pm

    Another interesting piece that I think aligns with what Bill Openthalt thinks mental illness is,

    http://www.guardian.co.uk/science/political-science/2013/may/28/politics-psychiatry

    “In a relatively short historical time sex between people of the same gender has gone from sinful act, to a pathological sexuality, to one form of human sexuality. To recognise the role of psychiatry in the production and transformation of sexuality is to recognise the moral and political significance of the discipline and the knowledge it has to offer. We might then reflect on the moral and political significance of transforming the cultural problems of “overeating” and “grief” when we label them “binge-eating disorder” and “major depressive disorder” respectively.”

    I of course disagree that psychiatry has anything to offer other than making it look like “scientific” to do social control, but I agree with the author’s other points, including this one,

    “Where the natural sciences have objects – atoms, electromagnetic waves, molecules, cells and organisms – the science of human beings has subject-objects. Human beings conduct those sciences that take “human being” as the object of their attention. They are ways of understanding ourselves and, since we are reflexive beings, they cannot but impact upon us as the subjects of their investigation. This does not prevent the human sciences from being rigorous but it does alter the basis on which they are conducted; it alters the ethical and political orientation we ought to adopt towards the knowledge they produce. ”

    But at least that recognition would stop for once and for all using the name of science in vain. The reason psychiatrists want the label “science” for themselves is because it evokes in the public’s imagination flying planes, the space shuttle or the LHC, not because it involves economics, even though psychiatry is more like economics than like physics.

  331. steve12on 01 Jun 2013 at 4:21 pm

    Mlema

    “Steve12, can you please tell me which biomarkers you’re referring to when you say “show the major psychoses are biologically based”? (maybe from just one of the articles you think best shows this?)”

    Seriously, I provided the links about the genetics and low level perceptual attributes (like contrast sensitivity) in first degree relaltives above at least 5x.. Look at Silverstein’s work, Yue Chen’s work, the new Lancet study, etc. – All provided multiple times y me.

    If these diseases are made up, why are there replicable genetic & perceptual differences not only in those diagnosed, but in first degree relatives?

    This FALSIFIES the notion that there is no underlying biological basic for diseases like schizophrenia.

    But if y’all simply ignore all of that evidence, maybe it will just – POOF! – go away….seems to work for Dr. Cannotsay, JD, Ph.D., MD, MS, BS

  332. steve12on 01 Jun 2013 at 4:24 pm

    http://scholar.google.com/scholar?hl=en&as_sdt=0,22&q=schizophrenia+first+degree+relative

  333. cannotsay2013on 01 Jun 2013 at 4:28 pm

    steve12,

    You can repeat your canard,

    “This FALSIFIES the notion that there is no underlying biological basic for diseases like schizophrenia.”

    As many times as you want. It will not become true.

    The only thing you have provided is correlation. I can make a very convincing case that all memory leaks can be seen as randomly occupying unused positions of memory for no apparent reason. In fact, your computer does that when ti tells you that memory is becoming increasingly occupied. But that is not the same as saying that memory leaks have a hw basis (they don’t, it’s just you see the effect in HW).

    I know that in your PhD in cognitive neuroscience probably you didn’t study things with this level of subtlety, probably because those who are capable of understanding these issues would never think of doing a PhD in cognitive neuroscience when they can do it in Math of Physics, but that’s a fact.

  334. steve12on 01 Jun 2013 at 4:40 pm

    “The only thing you have provided is correlation. ”

    So the made up diagnosis changes the relative’s genes and visual systems?

    That’s the alternative interpretation interpretation, right? If the diagnosis is completely made up, how do those relatives’ genes and physiology get changed?

  335. steve12on 01 Jun 2013 at 4:41 pm

    YOu have never accounted for the genetic and perceptual differences in patients and 1st degree relatives.

    You dodge or simply point to correlation with 0 explanation.

  336. cannotsay2013on 01 Jun 2013 at 4:50 pm

    steve12,

    You have a real problem here. The reason I keep repeating the memory leak example is because in that example the cause and effects of the problem can be clearly identified just as it is possible to show correlates between sw problems and hw, observable behavior.

    In the case of schizophrenia, you have the first problem that it is not clear what that is because it is a made up condition (check the DSM-IV criteria and compare that with DSM-I criteria).

    So let’s consider something that we can all agree: delusions or hallucinations, particularly the latter. We can all agree that if somebody tells you that he/she hears voices that nobody else does, that person is experiencing a genuine problem in his/her mind.

    If this was a hw problem, you would expect that only a hw intervention would fix it. Not “some times” or “some times for some people” but always. Going back to the memory leak analogy, adding memory fixes a memory leak temporarily just as rebooting the machine is likely to bring temporary relief because most memory leak problems require particular circumstances to occur (which is why many go undetected for years but show up when you least expect them). However, the true fix for a memory leak is fixing the software.

    There are people who have completely recovered from their delusions and hallucinations, without any hw intervention whatsoever. That should give you a hint that although some people claim that this drug or that ECT helped them (and the placebo effect seems like a more likely explanation), so called “mental illnesses” are not hw (ie biological) in nature although it is possible to establish biological correlates with them.

  337. steve12on 01 Jun 2013 at 4:53 pm

    Dodge.

    Why the differences in first degree relatives?

  338. Mlemaon 01 Jun 2013 at 6:08 pm

    Steve12, I’m just trying to understand how you’ve drawn your conclusions. I don’t have your education, so it’s a bit difficult for me. Of the articles you’ve linked to above, only the Lancet article seems to indicate anything beyond correlation.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962129-1/fulltext

    however, in that case, the genetic differences are linked to various behaviors which are quite unlike each other, are based in subjective diagnoses, and, are exhibited in almost everyone at some point in life (according to some psychiatrists) So, maybe it’s a start, but: maybe it’s not. Everything I’ve read about the disease since this conversation started (as the disease is defined by certain behavior, including the eye tracking problems) leads me to agree with Insel that it may be a bunch of different neurodevelopmental problems. Are you familiar with the environmental factors that have been linked to SZ?

    With all the variety within SZ, and with all the various and dissimilar symptoms of all the other mental disorders included in the lancet article research, I think it’s too early to claim a genetic cause. However, I will always agree that behavior has a biological basis. Behavior is the nervous system’s learned response to its environment. A brain that never has an environment has no sight, sound, language, etc. Behavior doesn’t exist without a nervous system, and plenty of things can go wrong with that from the “inside”. But with the depth and breadth of human behavior, I would guess there are probably way more things that can go wrong from the “outside”. Also, there’s the fact that behavior in turn will change the plastic brain. Cause gets more and more difficult to establish. That doesn’t mean we should stop looking. But if we’re finding external causes of behavior that allow us in turn to modify that behavior with participation from the individual suffering – isn’t that where therapy ought to be focused? I understand you’re unwilling to offer an opinion on that, and I actually think that’s admirable. But if we are working to establish a definitive genetic cause, it seems to me we’re dismissing the success of non-invasive therapies that don’t require coercion. I’m talking very broadly here because that’s all the Lancet article did too.

  339. Mlemaon 01 Jun 2013 at 6:11 pm

    sorry Steve, can you link me to one of the first-degree research? I know it’s something like 40%, but I would like to see the contingencies. (thanks)

  340. Mlemaon 01 Jun 2013 at 6:13 pm

    whoops! nevermind, I just saw your google page link. I will look through them later. thanks

  341. Mlemaon 01 Jun 2013 at 7:49 pm

    I’m ready to admit that there’s a genetic component to the symptoms we describe as schizophrenia. Since these symptoms are various, I’m not ready to admit that it’s the major component. The debate is ongoing as to what causes a person to begin to exhibit symptoms. Since this disorder is most likely less than 1% of the population (I’ve reduced my estimate of the frequency), and since 20% of Americans take or have taken psychiatric drugs, I think we’re treating plenty of people for “mental illness” that simply have behavioral/thought problems. In my opinion, even schizophrenics shouldn’t be treated with the drugs they’re currently being treated with – because – if SZ is genetic/environmental (neurodevelopmental) those drugs are not helping and are instead damaging their brains.

  342. Mlemaon 01 Jun 2013 at 7:54 pm

    remember: many schizophrenics recover without treatment, and many schizophrenic symptoms are experienced in many people at some point in their lives. How does this reflect on the genetic component and/or the definition of the disease?

  343. BillyJoe7on 01 Jun 2013 at 9:23 pm

    Cannotsay,

    A couple of things…

    There a many people with psychiatric diagnosis who don’t end up on life long treatment. On of my examples fit that description. She had two psychotic episodes in twelve years and recovered completely within weeks of commnecing hospitalisation and medication and came off medication within months.

    You make a distinction between hardware and software, and you seem to deny the existence of psychiatric ilness on the basis that there is no problem in the hardware of the brain. In other words, that differences in software produce differences in behaviour, even extreme behaviour, but not psychiatric illness. But, it there is no clear distinction between brain hardware and brain software, how can you exclude psychiatric illness on that basis.

    ——————————-

    Also, at this point, I might as well relate my third example:

    This young man was the son of a female friend. I had met him on several occasions but can’t claim to have known him well, so my information is largely second hand. He had what can only be described as a severe life limiting case of OCD. His whole life revolved around his obsessions. If he sat down at a table or desk he compulsively had to rearrange the objects in precise positions, though it was not clear to himself or anyone else why those positions mattered. Sometimes the objects had to be evenly spaced. Cups handles might need to all point in the same direction. He might need twelve inches of clear space in front of him. He might need to remove microscopic bits of dust.

    On Friday nights he would meet up with his few remaining friends in a pub. He lived on the outskirts of the city and it was a clear road from where he lived to the pub. Every friday, he would set off from home at the precisely the same time, drive at precisely the same speed, and arrive at precisely the same time at the pub. One day the speed limit through a small township along his route was changed. The next friday on his way to the pub, he was pulled aside by a policeman and given a fine plus demerit points. Because of his OCD, he was completely unable to adjust his routine. He drove home from the pub with exactly the same routime as he had done numerous times before. The policemen, laying in wait, pulled him up again, berated him, gave him another fine and further demerit points. The same thing happened the following Friday.

    On the third occasion, when he realised that he would lose his licence and therefore his job, he begged the policeman leave him be. When he did not comply, he grabbed his revolver, forced him face down onto the ground, and held the revolver against the back of his head. The policeman begged for his life, pleading on behalf of his wife and a young child. Unknown to him, this actually sealed the policeman’s fate, because it had always pained the young man that he would never be able to attract a wife and have child of his own because of his severe OCD. he shot the policeman in the back of the head killing him instantly. He then shot himself.

    The only reason we know all these details is that, before he shot himself, he retreated into the bush leaned against a tree and rang his mother who was doing nightshirt as a nurse in a nursing home. He told her what had happened. She frantically pleaded with him when he told her what he now must do. But he was now calm and determined. There was only one solution to both his problems and he was ready to take it. He apologised to his mother for all the trouble he had caused. He hung up and shot himself in the head.

    This young man was diagnosed with severe refractory OCD by his psychiatrist. All sorts of treatments had been tried over many years but nothing seemed to help. Psychiatry was unable to help him, but does that mean that he did not have a psychiatric illness? Just because there is no hardware problem, does that mean he was just exhibiting an extreme example of normal behaviour. In the end, he rejected all treatment because nothing helped. But neither did his condition resolve spontaneously. For him, death was the only solution.

    (As a matter of interest, following this incident, and because of it. police were issued with revolvers that could not be easily removed from their holsters)

  344. sonicon 01 Jun 2013 at 9:55 pm

    steve12-
    “If you mean that major psychoses are biologically based phenomena…”
    You mean my car can’t be have psychosis?
    Oh, darn. :-)

    But seriously–

    From the Lancet article–
    Our findings show that specific SNPs are associated with a range of psychiatric disorders of childhood onset or adult onset. In particular, variation in calcium-channel activity genes seems to have pleiotropic effects on psychopathology. These results provide evidence relevant to the goal of moving beyond descriptive syndromes in psychiatry, and towards a nosology informed by disease cause.

    If this is accurate, then what we are calling ‘mental illness’ will be replaced by notions of ‘variants of calcium- channel regulatory systems’ which in turn will be understood as ‘G protein beta-gamma subunit variations’ which will in turn be explained by ‘SNP variants at site xyz’ on the genome (or some such terminology).

    I’m not sure the terms ‘psychoses’ or ‘SZ’ will survive the transition.
    And I think this is what Insel is hinting at– right?

  345. cannotsay2013on 01 Jun 2013 at 10:19 pm

    Steve12,

    “Why the differences in first degree relatives?”

    In your opinion, why is that if those genetic biomarkers are so “conclusive”, identical DNA does not result in a 100% prediction as to who gets the labels? Because in genuine hw problems, like Down Syndrome, DNA is the 100% predictor of disorders.

    Mlema,

    It is a futile exercise to argue with steve12 about the different between “there a genetic component” and “genetic biomarker is the cause”.

    But again, even if there is a genetic component, that doesn’t settle anything. The genetic component of homosexuality, using the twin studies, has been to be shown of the same magnitude as in so called schizophrenia (50%). What makes schizophrenia a “mental illness” and homosexuality “normal” (normal now, before it was indeed a “mental illness”)? The bias of DSM committee members. In that I agree with Bill, “mental illness” is social control.

    BJ7,

    “But, it there is no clear distinction between brain hardware and brain software, how can you exclude psychiatric illness on that basis.”

    This is where dogma interferes with critical thinking. The main problem of so called “skeptics” is that the mind does not exist. And I really I do not understand why they have that point of view because it is perfectly possible to be an atheist and be the harshest critic of psychiatry (Thomas Szasz). Mind is what makes us human. You could perfectly believe that it came from “evolution” and that the Big Bang was a random event that had no “prime cause” (ie, no creator), but the mind is still the mind.

    Software is the same thing. When software runs on a computer, you “don’t see it”. All you see are billions of switches going on/off at incredible fast speeds. The brain might be incredibly complicated, but we are past the time when a human brain can compete with a supercomputer to do computations. Way past that time. To claim that those super computers are not complex is to speak from ignorance. http://en.wikipedia.org/wiki/Cray_XK7 has thousands of CPU (ie, small brains, each of which has billions of small devices called “transistors”) working together seamlessly. It has achieved a peak computation power of 27.1 petaFLOPS ( a FLOP is a unit of floating point computation used in benchmarks; a “peta” is a 1 followed by fifteen zeros). Without software that wouldn’t be possible. And when software fails, nobody thinks about about changing CPUs as the solution.

    On your 3rd example, and as somebody whose fear of HIV/AIDS was labelled as OCD, I have to say this. There is absolutely no way to predict what a person will do when faced with the circumstances of that example. Some other people, with the same label, and same past behavior would have done something different, like not going to the town for a third time because their own fear of losing his driving license would have prevented them from putting it at risk. I fear HIV, but, unlike the doomsday predictions that those crook European psychiatrists made, my own self interest of living a comfortable life is stronger than it, so there is no way I would ever become homeless as long as I can make a living out of my brain. Now, that book of insults, the DSM, was used to say that my mind is diseased as in “chemically imbalanced”.

    In other words, the adage “past performance is no predictor of future performance” with which stock brokers warn future clients is also valid in human behavior. However, in real science, well understood past modeling can indeed predict future events.

    I reject the notion that psychiatry can predict behavior in humans. We are not deterministic machines. Even our own deterministic computers are not so dumb as to be deterministic in the sense implied by psychiatry with their simplistic doomsday scenarios.

    I also reject the notion that we are to use statistical correlation to lock in people who have committed no crimes. Using this statistical correlation, gun violence could be dramatically reduced, by several orders of magnitude, if all (not a few, but ALL) American black males between the ages of 12 and 60 were to be locked up. You wouldn’t achieve the same reduction even if you were to lock in all people that DSM witches label as “mentally ill”. We know that “mental illness” alone is not a good predictor of violence. We do know that “race” is an excellent predictor of violence and crime in the US https://en.wikipedia.org/wiki/Incarceration_in_the_United_States#Race .

  346. cannotsay2013on 01 Jun 2013 at 10:28 pm

    And let’s look the master describe psychiatry’s ills better than anyone. Note that this video would have been dismissed as “nonsense” just a month ago. Now it looks tremendously visionary in retrospect (note, I am not a Scientologist nor do I endorse Scientology),

    https://www.youtube.com/watch?v=r1uDkvqY5Tg

  347. ccbowerson 01 Jun 2013 at 10:44 pm

    “But, it there is no clear distinction between brain hardware and brain software, how can you exclude psychiatric illness on that basis.”

    That’s right BJ7. The hardware/ software analogy is not a good one for the brain (its not even that clear-cut in computing, but at least the analogy is somewhat apt there). The brain does not have distinct hardware and software, so using this analogy to draw conclusions about the brain (as cannotsay has several times), will lead to incorrect conclusions. In many cases what corresponds to software in the brain also has hardware functions, and visa versa.

  348. ccbowerson 01 Jun 2013 at 10:50 pm

    “This is where dogma interferes with critical thinking. The main problem of so called “skeptics” is that the mind does not exist. And I really I do not understand why they have that point of view because it is perfectly possible to be an atheist and be the harshest critic of psychiatry (Thomas Szasz).”

    What is this dogma you refer to? Meaningless accusations. Dogmas are incompatible with skepticism.

    The mind is simply a word we use to describe what the brain does. Are you advocating for a mind separate from the brain? If not, you are not saying much here, and the mind you refer to is simply the result of the brain functioning and is determined by the brain’s function. If you are advocating for a mind independent of the brain, then that is really something else, and may explain where you are coming from

  349. cannotsay2013on 01 Jun 2013 at 10:56 pm

    ccbowers,

    “That’s right BJ7. The hardware/ software analogy is not a good one for the brain (its not even that clear-cut in computing, but at least the analogy is somewhat apt there). The brain does not have distinct hardware and software, so using this analogy to draw conclusions about the brain (as cannotsay has several times), will lead to incorrect conclusions. In many cases what corresponds to software in the brain also has hardware functions, and visa versa.”

    Actually, that is an assessment based on dogma, nothing else. If I give you a computer you cannot tell where software is. In fact, if you new nothing about where that computer came from or that there are software engineers who make a living out of programming the computer, you could say that there is no software to speak of, only hardware switching. That we don’t know how the brain is programmed does not mean that it is not programmed. The software/hardware analogy makes perfect sense because it provides the perfect distinction between,

    - Biological illnesses (hw ones, that require hardware intervention).
    - Software problems, that could be called “mental illness” only as a metaphor but that are different in nature and that can be solved, there are plenty examples of this, with not hardware intervention whatsoever.

    Remember ccbowers, and the rest, that repeating a mantra is not the same thing a putting forward a smart argument. You just repeated a dogma, that might be even popular in so called “skeptic” circles, but it’s just that, a dogma that does not stand any scrutiny.

  350. cannotsay2013on 01 Jun 2013 at 11:05 pm

    “If you are advocating for a mind independent of the brain, then that is really something else, and may explain where you are coming from”

    Of course, and that could come from “millions of years of evolution”. That is the problem with dogmatic skepticism, that you believe in canards for the sole reason of denying the mind. And that’s the part that I do not understand, because it is perfectly possible to accept the possibility of an independent mind and be an atheist. Nobody in this forum has yet been awarded with http://www.americanhumanist.org/AHA/Humanists_of_the_Year by one of America’s most prominent atheist organizations. Thomas Szasz has (1973).

    But, as I said, it goes both ways. Your dogma that the mind does not exist (as in “software does not exist”) explains your recalcitrant reluctance to accept that the nosology of the mind and the nosology of the tissue can be different. But this dogma has profound implications, both for computers and people. If we were to fix computers as if “software didn’t exist”, we wouldn’t be able to do much beyond replacing CPUs and memory. Similarly, the insistence that so called “mental illness” is a hw problem condemns people to poisonous interventions while other interventions might be more appropriate http://openparadigmproject.com/ .

    The dogma repeated here to claim that the mind is indistinguishable from the brain can be also made about computers running software. You burn a computer, no more software. But that doesn’t mean that the software, ie the intelligence behind everything the computer does, is real and has an independent existence.

  351. cannotsay2013on 01 Jun 2013 at 11:23 pm

    TYPO,

    “But that doesn’t mean that the software, ie the intelligence behind everything the computer does, ISN’T real and has an independent existence.”

    Sorry to sound repetitive, but maybe this point is too subtle for the average neuro scientist to understand. After all, as I said, those who are capable of understanding this type of subtleties would rather do a PhD in real science, not neuroscience.

  352. Mlemaon 02 Jun 2013 at 12:18 am

    BJ, there’s no relationship between OCD and murder. There is however a relationship between delusional belief and murder. My godparents were killed by their schizophrenic son who believed that stabbing them was the only way to get the aliens out of them. He was around 39 years old and had been living with them all his life and on meds for many many years. Relatives had found his behavior disconcerting from the time he was a young man. You can see why I rather support a supervised environment for someone like him.

    Based on statistics, it’s not extremely unusual for a schizophrenic to kill his parents or siblings, or even his children. But it’s not so typical for a schizophrenic to murder anybody else, and it’s more likely than either case that a schizophrenic will kill himself. That is: you don’t really have to fear a schizophrenic neighbor, but you may begin to fear your schizophrenic child. We have not done a good thing by closing institutions that provided housing and supervisory care for SZ. But I don’t really see that drugs have helped the situation. Some forms of intensive psychotherapy seem to help, but what seems to help most is having them moved to a new location apart from caretakers. And I’m starting to think that some types of physical therapy might help.

    But to me, above all, there are many people out there who have serious problems, and since the 70′s (at least in the US) there’s less help available and they’re ending up in jail for all kinds of reasons. And at the same time, we’ve got more and more people who are depressed, anxious, shy, or simply don’t behave the way their parents would like, utilizing psychiatric resources. I don’t wish to minimize these problems, but if we only have a certain number of psychiatrists I think it’s more important to address people with serious delusional and dangerous behaviors. With behavior, to me, the most important thing is: address it appropriately. I don’t think it’s appropriate to treat someone like cannotsay with lock-up and drugs. If he had debilitating ocd, ideally there would be intensive CBT for him, it would be voluntary, and there would be no stigma or legal remifications. And I don’t think it’s appropriate to leave delusional schizophrenics in their homes with parents, siblings or their own children. Throw out the DSM, give partial confinement to those who express violent delusions, and give intensive CBT to people with ocd, depression, etc (as you can see I’ve got it all figured out) It’s a long road from where we are now to helpful treatment for people who are suffering mentally and emotionally.

  353. Mlemaon 02 Jun 2013 at 12:25 am

    and the idea that all mental disorders are brain disorders is unhelpful.

  354. cannotsay2013on 02 Jun 2013 at 12:34 am

    Mlema,

    I am sorry to hear that story. It is very dramatic. I just want to challenge your assertion that

    “There is however a relationship between delusional belief and murder.”

    The largest study conducted on the matter by Oxford researchers found otherwise,

    http://www.ox.ac.uk/media/news_releases_for_journalists/090520.html

    “There is an association between schizophrenia and violent crime, but it is minimal unless there are also drug or alcohol problems, a large-scale study led by Oxford University has shown. ”

    The details are there. That is not to deny the reality of the cases like the one you mention, but the general relationship between so called “schizophrenia” and violence is not there unless there is drugs involved. It seems that your godparents’ son fits the description, ie, that it’s probably the drugs that are more to blame for the fatal result than so called “schizophrenia”.

    On the other hand, I thank you wholeheartedly for this,

    “I don’t think it’s appropriate to treat someone like cannotsay with lock-up and drugs. If he had debilitating ocd, ideally there would be intensive CBT for him, it would be voluntary, and there would be no stigma or legal remifications.”

    Thank you, thank you!!!

  355. BillyJoe7on 02 Jun 2013 at 1:24 am

    Cannotsay,

    Seems to me…
    1) you don’t want labels to be applied to certain behaviours.
    Because…
    2) you believe these behaviours are untreatable.
    Does that mean you won’t describe someone as being “in a catatonic state”, or just that you don’t want labelled as “catatonic” or “catatonic schizophrenic”?

    Seems to me the word would be useful.
    You could describe someone as not talking, not responding, not moving, showing no emotion, and staring blankly into space. Or you simply state they are catatonic.

    ———————-

    We probably shouldn’t disrail the thread but seeing as you bought it up…

    If the mind is not the result of deterministic cause and effect relationships within the brain (plus or minus quantum probability thrown in from time to time) how does it work in your opinion? In other words, by what possible non-mechanism (because mechanism implies deterministic cause and effect) could it possibly work. And what is the evidence for this?

    Come to think of it, even the word work implies mechanism which implies deterministic cause and effect. So we are having trouble even speaking about an alternative. Which is why, to me, the idea of a non-deterministic mind (whether separate from or part of the brain) seems incoherent.
    There doesn’t seem to be any way for it to…um…work.

  356. cannotsay2013on 02 Jun 2013 at 2:05 am

    BillyJoe7,

    “Seems to me…
    1) you don’t want labels to be applied to certain behaviours.”

    Correct. And my sensitivity to the matter comes from the fact of having been labelled with one, and that label having been used as a excuse to abuse me for “medical reasons”.

    If you read my long, long story, up until I was forced to a contact with psychiatry, I thought that psychiatry was a legitimate branch of medicine. My eventual liberation from that thinking came only after everything that I was told during my ordeal contradicted what I consider to be sound scientific reasoning. It was very hard for me to accept that a whole branch of medicine was in fact pseudo science.

    But what has happened this month is basically the top dogs in psychiatry have acknowledged its limitations. While they don’t go as far as calling it pseudo science, Insel and Lieberman just yesterday agreed in NPR that psychiatry is a step child of medicine, in the sense that it is the only branch of medicine in which NONE of its diagnoses has a known biological cause http://www.npr.org/programs/talk-of-the-nation/ . Since I don’t have any vested interest in calling “psychiatry” medicine, I just call it for what it is: a pseudo science.

    “Because…
    2) you believe these behaviours are untreatable.”

    Not really, it’s because absent behaviors that have a clear biological cause which all people here agree are out of the realm of psychiatry (ie not Alzheimer’s, Down Syndrome and the like), “treating behaviors” is really “doing social control”.

    So while I accept the notion that a society has a right to decide which behaviors it finds unacceptable (such as murder, stealing, etc), it also has, at least in Western democracies, a very high burden to show before it determines which behaviors it doesn’t like. We cannot let the guys in the white coats invent “pathological behavior” that are not biologically based in the sense Down Syndrome is.

    On the mind/body problem, which I agree is a total different matter, I think that thinking with the sw/hw analogy helps because the principles at play are very similar.

    Software, once encoded in on/off positions in a computer makes that computer work in a deterministic matter. Only now there are several layers of abstraction that make computers work in very complex and sophisticated ways, something that the average neuroscientist is unable to grasp. For instance, a normal laptop today has several so called “cores”, which are little brains each of which has billions of little devices. These cores, share the same memory and have to be able to run programs in parallel without corrupting the memory. Getting so called http://en.wikipedia.org/wiki/Concurrency_%28computer_science%29 right is one of the toughest jobs a programmer can face. But all those layers of software is what makes your PC or Mac work so beautifully with nice user interfaces, etc.

    Software, in this model, is the “intelligence” that is behind that. It exists in the mind of the software programmers that designed it, even though, once the design is finished (the programmer express his/her ideas in something called a “programming language”), it is encoded as a set of on/off positions.

    Those on/off positions is all you see if you were to be able to see how each of the computer’s billion devices work when the computer operates. In other words, that “intelligence” cannot be seen in a working computer, in the working computer all you see is the result of that intelligence working.

    In the case of the human brain, how this “intelligence” gets to our neurons is a matter of debate and still not understood even by those who are God believers.

    But you don’t have to be one. Even if you believe that evolution is all there is (ie, that evolution is not a God-guided process but something that started out of nothing in the Big Bang), the evolutionary process + genetics + the boundary conditions that determine which outcomes are acceptable -by acceptable I mean survival of the fittest- provide a good model about how “intelligence” was imprinted in our brains. You cannot see this “intelligence”, only its encoding in the brain and how the brain operates when this intelligence is at work. This intelligence can be, as a lot of software is, self correcting. That means that some behavior can correct itself once our own intelligence determines that something is not right.

    I hope this clarifies what I think.

  357. cannotsay2013on 02 Jun 2013 at 2:14 am

    BJ,

    And I forgot to add to the discussion. That “intelligence” can perfectly use random components when it executes. So called “randomized algorithms” https://en.wikipedia.org/wiki/Randomized_algorithm have been used for a long time very successfully, especially in systems that have to make decisions based on data analysis of past events.

    So, it is perfectly possible to have an intelligence that, as part of its logic, uses randomness, thus even though the the intelligence is clearly defined, it can be that two different iterations of the same algorithm, even with the same starting conditions, end up with different paths and outcomes, which is why I claim that human behavior is not deterministic even if it is possible to have an “intelligence”. What these randomized algorithms provide is expected performance in the average case.

    This is the type of subtle argument that the average neuroscientist doesn’t grasp very well. They still live in a XIX-th century, give me a formula with three variables type of world :D .

  358. cannotsay2013on 02 Jun 2013 at 2:41 am

    More Thomas Szasz’s wisdom: https://www.youtube.com/watch?v=tY78qJNLoQ0

    Boy, the man was a true genius!

  359. Mlemaon 02 Jun 2013 at 4:00 am

    cannotsay: from the article:

    “People with schizophrenia were twice as likely to have committed a violent offence than controls in the general population”

    when they adjusted for socioeconomic effects by measuring against non-schizophrenic siblings, the rate drops to 1.6. Now I have to wonder if they adjusted for sex as well, because females tend to be less violent than males. If most male schizophrenics are diagnosed as young adults, and the siblings were at least %50 female, and most of these schizophrenics also happened to come from poor families, then there is little difference between murder by schizophrenics and murder in the general population. Because poor people commit more violent crimes.

    I think maybe the impetus for your response to my comment was this sentence in my own:
    “Based on statistics, it’s not extremely unusual for a schizophrenic to kill his parents or siblings, or even his children.”
    That was obviously wrong on my part. It IS unusual for a schizophrenic to kill his parents. HOWEVER, when a son kills his parents, it’s very likely that if he’s ever been diagnosed for mental disorders, he’s been diagnosed with “positive” symptoms of schizophrenia (delusions, possibly paranoid, and hearing voices)
    http://www.treatmentadvocacycenter.org/resources/consequences-of-lack-of-treatment/violence/1384
    “of parents killed by children – 25.1 percent of defendants had a history of untreated mental illness”

    I guess it seems weird to me that that would mean 75% were either being treated for mental illness or WERE NOT MENTALLY ILL??? because to me, if you kill your parents, you’re mentally ill!!! Either way, it’s a problem.

    I agree that most schizophrenics aren’t violent, and as I said it’s more likely they will kill themselves than anyone else (10x the rate of the general population). But that is a serious problem too. And SZs are more likely to be the victims of violent crime than the perpetrators. (all of this is talked about in the above link too) So, I don’t believe that the vast majority of people diagnosed with schizophrenia are really problematically ill or will ever hurt anybody – and are probably therefore mistakenly identified as mentally ill.

    But, I think there is a population of people who have been diagnosed with schizophrenia who are dangerous to their families.

    I have the strange distinction of knowing another man who also killed his parents for some irrational reason. I am less familiar with the particulars because he killed them many years after I knew him. He had given me occasional rides to college and was really intelligent and totally normal-acting, unlike my godparent’s son. At the time he killed his parents, he was independent and was engaged to be married. It seems that when there was some kind of argument with his parents he thought an appropriate reaction was to get post and club them. He ended up in the same prison/psych hospital as my godparent’s son. My Mom worked there and told me he didn’t seem to understand what he’d done. I have no way to know if it would have been possible to predict that this guy would kill his parents, but I think that in the case of my godparents it might have been predictable based on the nature of his delusions.

    So, I recognize that this is a rare phenomenon, but it’s not hard to find the news stories about it. Again, I recognize that we don’t know what makes someone experience voice commands and act on them. All I can tell you is: there are some people who experience dangerous delusions or breaks with reality who end up killing their parents or other family members. This may be genetic, it may be socioeconomic, or it may be caused by some unknowable relationship between the parents and the son. Regardless, if a person is having dangerous delusions, or is out of touch with reality and is likely to find himself in a confrontation, I think they need to be removed from their familial situation, and I think they need intensive therapy.

    This site isn’t scientific, but gives plenty of anecdotes of this problem:
    http://www.schizophrenia.com/New/Dec2002/violenceDec02.htm

    So, cannotsay, I agree with you regarding the definition of mental illness. But I have to stress that there are people among us who have serious trouble with their thinking, and who are suffering and causing suffering because they’re not receiving help. I’m not saying that help should be “covert pharmaceutical therapy” (that’s the favored term for forced drugging :) nor lock-up. But I am saying there’s no substitution for some kind of physical dwelling apart from whatever situation is contributing to their problem. Because even if they’re not violent, and they’re not really mentally ill, a lot of these people are ending up in prison because there’s no place else for them to go and people can’t deal with their behavior. This is really shameful.

  360. BillyJoe7on 02 Jun 2013 at 4:50 am

    Cannotsay,

    You say “not really” but, in fact, you do believe these behaviours are untreatable, don’t you? Otherwise you’re back to having to accept mental illness as being real. The only other thing you said in response to this was to say that society has a right to decide what to do with people with unacceptable behaviour (I presume you mean harmful to others), which is not really “treatment” is it?

    Regarding the mind problem…

    It is unclear whether quantum probability has any effect on the brain. Otherwise there seems to be no “random element” as far as we can tell. Neurones fire or they don’t and this is decided by the sum total of action potentials reaching it via thousands of connections from other neurones in the brain. If the sum total exceeds a certain threshold, it fires. The threshold in turn depends on the state of the neurone which is the result of previous inputs and discharges. But all this is the result if deterministic cause and effect. Do you disagree?

    And while the “intelligence” behind a computer is the computer programmer, the “intelligence” behind the brain is surely evolution. At least that is our best guess based on the available evidence. Random mutation and natural selection created the complexity in our brains. Do you disagree?

  361. BillyJoe7on 02 Jun 2013 at 5:13 am

    Mlema,

    You have probably read my story in this blog about my own encounter with a person who had killed his parents. You’ve probably heard about people who seem to look right though you with a cold hard stare that send shivers up your spine. Unless you’ve had this experience yourself, you can never quite appreciate how this actually feels. It was only a chance encounter with someone I didn’t know and haven’t had the misfortune to come across again. I believe my life was saved by the intervention of some passers by. The interaction between the two of us was triggered by a friendly gesture on my part towards him as we were passing in the street to which he somehow took offence. Police