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