What about marijuana ? My understanding was that it did not cause any direct physical dependance, although its use does stimulate reward circuits.
And you said :
“those drugs by their very nature take away liberty and freedom”
I don’t know if there is the hidden assumption here that we possess any form of free will. I’d like to know where you stand in the free will debate, because although I looked into compatibilist arguments, it seems to me that there is no strong case possible for free will in a naturalistic worldview.
Studies have shown that people who try hard drugs end up dependent (following cohorts over the years after their first experience) at roughly the 5-12% level.
If many individuals are then able to sample – even hard drugs – without developing dependency, then I think there is still some element of freedom and liberty that is a valid argument for the legalization of drugs.
A useful example is alcohol, where dependent alcoholics ruin lives and families – yet many people enjoy the freedom of being able to indulge in this drug in social venues where it performs the function of “social glue”.
Now this may be a cultural bridge too far from the world you inhabit Steven, but in the circles I’ve travelled many illegal drugs (most prominently marijuana – but including hallucinogens, ecstasy and even cocaine) perform these same functions. As with alcohol I have seen people develop problems. But also with alcohol, I’ve personally used all the substances I’ve listed in the same social way that others do with alcohol (they are ingrained in the night-life subculture I inhabit).
You may be overgeneralizing from a rather mechanical view of the way drug use works on the brain – leaving out the statistics showing that dependency is still something that happens to a minority and the socio-cultural milieus in which these drugs are taken.
Furthermore, when it comes to worry about the harm from drug use and our legal rubric – I think there is a strong case to be made that prohibition exacerbates and multiplies these harms. Too much to list here, but I find this site to be a very worthwhile compendium of research and studies across a variety of aspects of drugs and prohibition: http://www.countthecosts.org
“More to the point – neuroscientific research into addiction seems like a powerful argument again legalizing recreational drugs…
I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom.”
I think the first sentence is way too strong a statement, because there is far too much to unpack here. Your next paragraph is a bit better, but I don’t see how this neuroscience research is ” a powerful argument again (sic) legalizing recreational drugs.” It adds to our understanding of addiction, but it does not tell us what to do about our laws. There are too many specifics that matter much more than this general understanding. We would need to evaluate the effects of various controlled substance laws to know what is best. This is basic research, and you are extrapolating that research beyond what it tells us when you say it is a powerful argument against legalization.
Also, I am not sure what precisely you mean by “practical arguments.” What becomes law must also be practical, or you have lost me. I know you must mean you are excluding arguments based upon practicality, but then what arguments are you talking about? Just freedom arguments?
The practical arguments are critical to know what to do with our laws: What impact do our laws regarding controlled substances have on the use of those substances and the citizens more generally? In which ways do they help, and in which ways do they hurt. How are they different between substances? Are the laws on specific substance proportionate to their harm? Do the punishments help or hurt? etc
I agree that arguments solely based upon liberties and freedoms are not good ones, which you get to in this post, but those are only a small part of the arguments. Also, I think in order to have disussions about addiction and recreational drugs, we actually need to speak about specifics, since by lumping them into one category very few conclusions can be drawn. Not all recreational substance have them same addictive properties, and some substances cause addiction in a minority of the population (e.g. marijuana, alcohol) while others cause addiction in close to 100% (heroin, cigarettes).
To be clear, I am not necessarily a legalization advocate, I just disagree with your argument.
“At least, it seems to refute the argument that people should be free to choose for themselves if they want to use recreational drugs, because by the very nature of those drugs and brain function, they take away that freedom.”
Only for those who have already dogmatically concluded that,
- A experiment about behavior in rats extrapolates to humans completely
- Humans do not have “free will”
Even you admit that the second point is a contentious point. I side with “humans’ free will” over “rat experiments that provide insight about human behavior” any time, but again, my thinking is not corrupted with so called “skeptic dogma” .
cc – I specifically did not get into the question of whether or not specific recreational drugs should be legal. That’s what I meant when I wrote, “that is not a debate I am addressing here.”
Regarding the research, I said it “seems” like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.
I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.
There is a great deal of clinical addiction research on humans. Rat studies are helpful to sort out the neuroanatomical correlates because we can do things like slice up their brains. But there is plenty of human clinical research.
There is no such thing as “skeptic dogma” – only cranks who don’t understand scientific skepticism.
Actually the two threads in which psychiatry has been duly deconstructed (it was about time) show very convincingly that there is plenty of dogmatism in your movement. You have written in the past several posts that after May 2013′s crisis in psychiatry look ridiculous (they were ridiculous back then, only now authoritative figures in psychiatry have refuted many of your points). The post called “Responding to a Szaszian” is the poster example of the type of canards the so called “skeptic movement” dogmatically beliefs such as,
“ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”
Well, no, as Insel said ADHD (like other DSM labels) is just a label created by “consensus” of DSM committee members about a pattern of behavior that has a low reliability measure (0.6) and for which some time in the future some think there will be a “biological biomarker” but nobody has demonstrated in a way that passes any reasonable test that it is a “brain disorder” .
I am not the skeptical movement. There is actually quite a diversity of opinion among skeptics on this topic, and I am the only skeptic of note that I know of who writes regularly on this topic.
Second – a science-based and rational argument for a position does not equal “dogma.” It if very telling that you cannot tell the difference, or that you don’t care about the difference.
Regarding ADHD, your simplistic quoting out of context of one individual is also very revealing. Meanwhile, and actual scientific discussion on the nuances of validity and reliability are happening within psychiatry.
“This paper summarizes the results of a comprehensive review of the internal and external validity of ADHD as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”
About the notion of validity of mental disorders more broadly, they write:
“As described in more detail elsewhere in this special issue, the criteria, which must be met for a mental
disorder to be considered valid, have been the focus of considerable discussion. These authors have
considered an extensive range of important issues, including the role of theory in the development of diagnostic criteria, the utility of a dimensional versus categorical conceptualization of mental disorders, the extent to which the definition of a mental disorder is influenced by social values, and the potential usefulness of evolutionary theory to identify mental processes that have gone awry.”
“Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes.”
But they go on to conclude that the DSM IV subtypes are not sufficiently supported by evidence, and perhaps we should rethink (more dimensional, less categorical) how subtypes of ADHD are defined.
Contrast this to your simplistic cartoon. Where’s the dogma?
“I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”
seems to be an backhanded slap at the libertarian viewpoint. Whether you did that with intent I do not know. I once heard Penn Jillette (a big libertarian, for those who do not know) say that when considering potential solutions to a problem, one should consider whether increasing liberty and freedom is a better solution than decreasing it. In the case of addiction you seem to be limiting the discussion of freedom and liberty to the person consuming the drug. What about the liberty and freedom of a person who lives in a neighborhood that is unsafe due to crime, crime that is related to the sale and distribution of illegal drugs? If you are afraid to leave your house because you might be robbed or shot, I would say your freedom has been taken away to a degree.
I understand your premise, the irony that the freedom to take a drug results in a certain loss of freedom. And that irony should be considered as a part of any smart drug policy. But there is a much larger picture to consider.
Steve Novella said
I simply don’t buy
arguments for drug legalization premised on
liberty and freedom,
Someone else already mentioned that the loss of freedom from addiction is far from universal, so I will deal with the first half of the sentence.
I get the impression that you think drugs ought to all be illegal unless someone argues for “legalization”. But these drugs weren’t found in the woods wrapped up in prohibition laws. Prohibition was implimented without much more than political hatred, and I can dismiss the blanket “lock you up for your own good” brutality just as easily as you dismiss freedom.
The difference is that you are, by phrasing it as “legalization”, supporting a system which actively affirms the paternalistic basis for criminal prosecution as a default. I don’t ask for “legalization”, which implies that I am asking for a thing to be done, I ask that the government stop actively imprisoning people who haven’t harmed anyone.
I’m sure you want to respond with a claim to want to avoid making political assertions, but you have already made one.
“Regarding the research, I said it ‘seems’ like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.
I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.”
I agree with all of your follow up, but your post implies something different. I assume that this post is a continuation of previous conversations that you have had with others with a libertarian/legalization perspective, but without this context it is misleading. I agree that the freedom of choice argument alone is not a good one, but there is much more to this conversation.
“Contrast this to your simplistic cartoon. Where’s the dogma?”
Apparently he thinks that if he repeats the word dogma in different forms, it becomes more true. He has used it dozens of times, and keeps using it despite the fact that I have demonstrated that he doesn’t know what the word means or is at least misusing the term.
Dogma is really argument from authority, and the skeptical movement is not heirarchically structured- there is no built in authority. It’s one of his weasel words of choice.
You are correct about the low probability of encountering a foodstuff that will contain an addictive compound that will hijack your brain. There are currently 322 addictive drugs and precursors on the DEA list of controlled substances compared with a total of 34 million compounds in Chem Abstracts. George Koob has defined addiction as a disorder that moves from an impulse control disorder involving positive reinforcement to compulsive disorder involving negative reinforcement. In clinical work with addicts this is commonly observed as “chasing the high”. With chronic use it is rare to talk with anyone who is getting high anymore and the bulk of their behavior is focused on avoiding withdrawal symptoms. I also agree with your observations that legalization of drugs doesn’t make any sense from the standpoint of neurobiology. Historically we have already done these experiments and they have failed. That does not mean that addicts need to be criminalized and treatment is an option. Musto does a good job of documenting what he describes as oscillations between periods of tolerance of drug use to periods of disapproval and demarcating three temperance movements so far in the US.
Reality is not as harsh as being stuck on the compulsive negative reinforcing side of an addiction. The reward system operates well in response to the less intense biological reinforcers like social affiliation, more intimate relationships, and hedonic activities that activate the reward system in more predictable ways. Those same activities can be a pathway to sobriety for anyone who is experiencing an addiction.
First, I must note that this is your first non condescending answer to me that goes to address the meat of the matter.
Let’s see where now it seems there is agreement: the issue of whether DSM “labels” are genuine brain disorders is controversial. If this is the case, then what you said that “ADHD is demonstrably a brain disorder” cannot be true at the same time.
So admitting that there is controversy on this matter is a perfectly valid position. Calling “denialist” somebody who has your opposite point of view on the controversy, controversy that exists because the issue has not been given a scientifically valid answer, not only is not scientific but is counterproductive.
In other areas of science, there are controversies and arguments being made about which position is true. For instance, on the https://en.wikipedia.org/wiki/P_versus_NP_problem , most top notch computer scientists and mathematicians are in agreement that it is very likely that P is not NP. There is anecdotal evidence that it is the case. However, nobody, to my knowledge, has called “denialist” to those who take the opposite position because the history of science is full of instances of controversies where the “mainstream thinking” was proven wrong.
But here is the thing, when it comes to psychiatry- June 2013 which is after both those studies you have mentioned-, the mainstream thinking is that “there are no biomakers for DSM mental disorders” and as a result the validity of “DSM labels” has not been established with the same criteria that HIV has been shown to be the VALID cause of AIDS. This takes me to the next point, from one of the studies you refer,
“Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”
This was something that another commenter already addressed (I think it was BO but I could be wrong). With that notion of validity, homosexuality is a genuine and valid “mental illness” in homophobic societies. So a country like Iran is its perfect right to “quarantine” homosexuals that pose a danger to the “public health”. Since I can only assume that you find this proposition preposterous, then you’ll have to agree that this notion of validity is BS and it’s the type of fallacious thinking that psychiatry needs to engage in to justify itself.
Instead, the scientifically honest position to take is to say that to this day none of the DSM labels has been shown to have a valid biological cause in the sense HIV has been shown to be the cause of AIDS. It might be a “simple statement” but it also happens to be scientifically true.
That statement, as sonic also pointed out, is perfectly consistent with admitting that a) I could be wrong and that this time’s promise that “biomarkers are around the corner” will not be empty, and b) I could still be true that Insel’s program will fail miserably.
Whether a) or b) is true is a matter of controversy. What is not controversial in June 2013 is the statement: “DSM disorders lack scientific validity with the criteria of validity that HIV causes AIDS”. So to put somebody like me in the company of AIDS denialists is offensive.
Now, to support b) what I have said (since it is impossible to prove the negative) is that most of the evidence provided by those who “believe” in a) is “correlates of brain physiology with behavior” of the kind that support that dead fishes respond to human emotion or that Internet Explorer usage is the cause of crime in the US. Really, none of your arguments is stronger than the arguments that could be made to support either statement.
If you “believe” that biomarkers will eventually found, as Tom Insel does, fine, but state it as such, don’t give the false idea to your readers that those biomarkers have been found because that is categorically false as of June 2013.
Now, the reason this matters is because you have a following and you could be a great influence to fix the current system that results, more often than not, in blunt human right abuses, like those 10000 British citizens who had their civil liberties restricted gratuitously, or that guy who was until last year forcibly ECT-ed in New York, or that woman who is now facing criminal charges because the state wanted to force anti psychotics on her daughter against the woman’s judgement. This type of human rights abuses are specific to psychiatry, which is ironically the only branch of “medicine” that has not had any of its invented labels scientifically validated. These are the lives of individual people, like mine, that have been ruined by a quackery.
“I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”
I would tend to agree that this liberty argument is naive considering the data (though marijuana is an exception to this), but I think the practical argument that you’re not addressing trumps this argument re: legalization.
The current model doesn’t stop drug use in any way. Anyone can get any drug whenever they want – and driving up the cost doesn’t lead to ess use as much as it leads to crime. So now, we have all of the drug use + the cost of a drug war, which is substantial.
I think we need a treatment regime – in some cases forced treatment, especially when a crime is committed. If someone were to apply the libertarian argument at this point I woud indeed reject it for the reasons that you site.
“Once addicted, however, withdrawal from the substance creates a powerful dysphoria, and users seek out drug use in order to reduce this extremely negative experience. This leads to not just addiction but dependence.”
Steve, this is not the same thing as there being no choice whether to seek out the drug. As you said the human brain is much more sophisticated than other animals. While I do not dispute the idea that humans work on a reward/aversion model, we should not think about this in overly simple terms. A lot of cognition occurs between the feeling dysphoria and seeking out drugs as a means of stopping the dysphoria. In other words, the reward/aversion system is not the only system in operation here. If it is possible for a one of those cognitive processes to override drug seeking behavior, then the person does have a choice in the relevant sense for this question. I think it is clearly the case that this is possible for some people at the very least. If it weren’t, its hard to see how people who overcame their addiction did so.
Chris – the vast majority of people cannot simply override their addiction by making a choice. It’s not a matter of will power. Those that can beat their addiction mostly have help, whether counseling or otherwise. I agree with the consensus of opinion among addiction experts that framing addiction as a matter of choice or will power does not fit the evidence and is counterproductive.
“The deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.”
Once we’re able to do this without harm, plus immortality, it would be hard to convince anyone to opt out. Maybe this is why haven’t seen any evidence of advanced alien civilizations.
cannotsay – I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior.
There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment.
You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.
You ignore the point that mental illnesses lack classical pathology (like infection) but are based in brain function determined by the pattern of neuronal connections and regulations of these circuits.
Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)
The neuroanatomical correlates of ADHD are even more well established -http://www.ncbi.nlm.nih.gov/pubmed/20546170. In short, ADHD is primarily a disorder of executive function, with reduced activity in those parts of the frontal lobes that are responsible for executive function.
Finally, you keep doing the denialist shuffle – attempting to refute one valid point with another unrelated point. Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context. Some diagnoses are more culturally subjective than others, and you keep choosing a historical diagnosis (homosexuality) that is among the most sensitive to cultural context – and one that has already been dealt with within psychiatry (making its relevance even more dubious).
It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.
Again, insulting and “strawmanning” will not take you very far. You’ve made only one valid admission and now you are back to your insults.
“I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior. ”
WOW, now it’s not that I have not addressed arguments (to the opinion of several commenters I have perfectly addressed the arguments put forward by people like you), it’s that I “exhibit a denialist behavior” or something. Glad you didn’t have a say in any DSM discussions .
“There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment. ”
I remind you that the two studies you have provided are very clear that their “notion” of validity is,
“in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span”
That is not what Insel or anybody who takes medicine seriously thinks that “validity is”. Your counter argument is just a Clintonian answer, known in your circles as a “semantics fallacy”.
So, don’t pile sh%@#$%#$ on you because you were doing just fine with the previous post admitting that there is a controversy.
“You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.”
“Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)”
As for the study which you fail to put the tile on, I’ll put it:
“Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder.”
Again, none of the so called “evidence” provided is stronger than the evidence that can be provided to show that dead fishes respond to human emotion: it has a name: confusing correlation with causation in a situation where there are with many hypothesis at play, scenarios in which anything can be shown to be correlated with almost anything.
I do not dispute that somebody with your point of view takes this so called “evidence” as something that puts your position on the “brink of being finally established” but for those of us for whom science matters and who cannot afford to make unscientific statements in our lines of work, we’ll take it as some studies that you use to confirm your own bias and beliefs but that actually accomplish nothing with respect to the matter at hand.
Regarding you straman tendency, here is a perfect example,
“Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context.”
YOU ARE THE ONE who have as notion of validity adaptation with society. No real biological disorder has that notion of validity. In order to accept ADHD as valid, you need to accept that canard, to which I add, if you accept that, homosexuality is also a valid disorder in homophobic societies. After all, in Iran, being homosexual results in “impairment in social, academic, and occupational functioning”. So indeed, it seems to me that this is a cheap attempt on your side at double backing by introducing a strawman (your specialty, like that nonsense that I was denying the existence of extremes in a continuum). You cannot have it both ways. If “impairment in social, academic, and occupational functioning” is VALID as a criteria to establish scientific validity, then homosexuality is also a valid “mental illness” in most non Western societies. Similarly, graduating from Yale might not be a desired outcome in societies where he/she (normally he) who owns most land is the most powerful, so something as what is labelled as “ADHD” might prevent that somebody from going to Yale, but it will give that somebody the skills required to become very successful in that other society. So no pal, you cannot have it both ways no matter how many strawmen you introduce in your reasoning.
“It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.”
Just as for all the reasons I have described I claim that you lack critical thinking skills and that you argue from the point of view of “skeptic dogmatism” -you are even on record now admitting that this is a matter of controversy in scientific circles, but you still insist on showing as “proof” something that shows “correlation” at best. Again, “not dismissive or unfair-it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.” .
Little boy Brewers,
” What about the liberty and freedom of a
person who lives in a neighborhood that is
unsafe due to crime, crime that is related
to the sale and distribution of illegal drugs?”
“Related to” is a pretty loose legal standard. It sounds like you want the person you sympathize with to be treated as an individual with rights, but anyone who uses drugs is part of some inhuman conglomerate.
And I feel for my fellow non-drug users. I hate stoned dipshits who can’t hold jobs and alcoholics who lie to get money for vodka. But not everyone who has snorted coke, smoked weed, or drinks alcohol is like that. A lot of the pot prohibitionists drink alcohol, which kills 10k people on the road every year, and yet they don’t expect to be locked up simply for consuming beer at home.
Here is something I have wondered about.With the exponential progress of human endeavor(tech,science,medicine)are we getting over on evolution.Are we antagonizing our biology that evolution has selected for.
Cannotsay- I guess this post is an example of skeptical dogma in action, right? Of course, Steve is well known person in skepticism, but that does not stop others from from being critical of his posts, even when there is mostly agreement. Skepticism requires a rigorous process for evaluating claims so often that results in similar conclusions, but note that this is not a top-down process.
PTSD is another diagnosis that had been ignored during this discussion. The increase in recognition of this disorder has increased access to treatment. In the past, problems after tramatic experiences like war or assault were more likely to be framed as character or morality issues, which caused many people to go untreated/ unhelped. . You fail to acknowledge these obvious benefits that have come from attempts to categorize mental illness by focusing on the difficulties. This is another denialist strategy, to add to the ones others have mentioned.
With respect to Steven Novella, he is making no favors to the “skeptic movement”, when he claims that “impairment in social, academic, and occupational functioning” is a valid criteria to establish scientific validity of a “mental illness” (something that BTW will gain him a lot of enemies even among those who believe that psychiatry has scientific validity) and then reject that standard applied to homosexuality or other invented DSM disorders. He cannot have it both ways. What he is doing is digging deeper into the hole just when he was about to start climbing out of the hole he has dug over the years. I expect that at least some of the readers are smart to see that he has written two entries in this blog entry that are utterly contradictory, first admitting to a controversy, then going back to his nonsense to claim that there is no controversy.
I am not very familiar with PTSD, but here is the historical fact that cannot be denied. Even in the context of American history alone, many more million people went to war and died in war than those who have gone to war or died in the wars of Afghanistan and Iraq. Many veterans came back, had some issues adjusting back to civil society but they eventually did, to the point that many WWII, Korea and Vietnam veterans are among our most successful members of society. I don’t think that the veterans of those wars had an experience any less traumatizing than the average experience of today’s veteran. What the historical context of those wars didn’t have was an unholy alliance between Big Pharma and academic psychiatry to label a normal reaction to trauma as a “mental illness” to be treated with drugs. If my memory serves me well, PTSD was “invented” as a disease by DSM-III.
The whole recreational drug issue is one that is difficult for me to work out. By many of the criteria people often list, it seems to me that alcohol should absolutely be illegal. The problem is that we tried that out, and it failed utterly. Maybe for other drugs, there could be legal levels like blood alcohol content. The problem is that it may be difficult to test, like the commonly heard poppy seed and positive opium test story. Of course, I’m not saying that specific case is a problem.
I haven’t read most of the comments, so this point has probably already been made, but I don’t see the neurological research as an argument against legalizing drug use as much as an arugment in favor of decriminalizing drug use. Currently our justice system treats drug addiction as a crime, rather than a medical issue in need of treatment, although that has started to change somewhat in recent years.
It’s a tricky question because, on the one hand, we don’t want to encourage drug use, but on the other hand, we don’t want to lock people up simply for being addicted, which I don’t see as a crime. As others have said, making drugs illegal seems to have done very little to prevent their widespread use, and the war on drugs has been a total failure. Our society needs to find a better way of dealing with drugs and people who use them rather than simply arresting and incarcerating drug addicts over and over for something they can’t help.
I didn’t mean to suggest that addiction can be simply over come with will power and I agree that addicts generally cannot overcome addictions without help. However, counseling is not a direct pharmacological intervention on the reward/aversion system. As I understand it, the consensus is that cognitive behavioral therapy is the best form of counseling. This consists in helping patients think about their situation in a new way and in suggesting ways to build new behavioral patterns. The patient presumably has to CHOOSE to accept this advice and implement it. So there is an element of choice in overcoming addiction. My complaint is that you are oversimplifying the problem by ignoring the cognitive element.
A balancing of harms due to legality and drug use and illegality and drug harms might be defensible if illegality of drugs was dealt with in ways to try and minimize harm to drug users, but it isn’t. Drug laws are made, designed and enforced to maximize harms on drug users at the whim of “authorities” so as to harm drug users.
Those who design, enforce, prosecute, sentence and incarcerate drug offenders claim they are simply trying to deter drug use. There is zero evidence that deterrence can work against drug addicts.
It is well known that drug addicts will share needles with people they know are HIV positive. Law makers who claim to be trying to “protect” drug addicts from themselves by making clean needles more difficult to obtain are lying. Their actual goal is to harm drug addicts to the point of death.
My hypothesis of the euphoria of drug use is that it hacks into what I call ENDS, the euphoric near death state, where physiology induces euphoria so that organisms can run themselves to death while trying to escape from a predator. If my hypothesis is correct (and there is no data I am aware of that conflicts with it), then deterrence cannot work against anything that induces an ENDS-type state because no civil society can invoke or threaten the kinds of harms that are acceptable to those in an ENDS-like state. What possible deterrent is there for a crack-whore who is willing to share needles with HIV positive individuals?
The whole point of an ENDS-type state is to allow organisms to run themselves to death because organisms that can do that will escape from more predators than organisms that cannot divert metabolic resources to that extent. Running oneself to death doesn’t help a particular organism, but the ability to do so can be lifesaving, which is why it persists.
ConspicuousCarl: I think you misunderstand my comment. Steve Novella suggests that using the ‘right to personal freedom and liberty’ as a basis for legalizing drugs is not a choice based in science, since the resulting addiction takes away the freedom and liberty the addict desires. I merely pointed out that taking away the freedom and liberty of the addict by criminalizing a drug can impact the freedom and liberty of others due to the unintended side effects of drug laws.
I am very interested in this topic. Can you suggest a review article or some other source of information that supports your claim that the consensus among addiction experts is that addiction ought not be framed in terms of choice? Again I agree it is not a matter of willpower, but that is not the same thing as saying that choice plays no roll at all.
Now, I will put a comment with respect to the matter of drug addiction that “takes away the freedom and liberty the addict desires”
As a strong proponent of free will, I think that this argument is preposterous. In August last year there was a conversation about “Mental Health and the Law” at the CATO institute where these matters were discussed not in the context of drug addiction but “forced treatment, involuntary commitment” in general. The best rebuttal that I read from those arguing with my position (others were good as well, but this was in addition humorous) I think that addresses this point as well,
“Appealing to libertarians, Jaffe wants to flip that view of reality, saying coercive psychiatric treatment actually restores people’s freedom. One way we know this, he says, is that most people who are civilly committed for treatment of schizophrenia “retrospectively express gratitude.” Frances likewise writes that “the majority [of involuntarily treated mental patients] are unhappy at the moment when involuntary treatment is imposed on them, but they understand why it was necessary once they have recovered from their acute symptoms.” This retroactive validation of coercion seems suspect to me, not least because formerly confined patients may surmise (perhaps correctly) that agreeing they were correctly diagnosed and properly treated helps them remain free by showing they have recovered their senses.
Then, too, retrospective gratitude could be used to justify all manner of paternalistic interventions, whether or not they involve a psychiatric diagnosis. If the government began kidnapping obese people and forcing them into a strict diet-and-exercise program, how many newly thin former captives would eventually be thankful for the help? Let’s not find out.”
Cannotsay – I’ll take the time to thoroughly deconstruct your arguments, but won’t do this dance forever.
You wrote: “Again, insulting and “strawmanning” will not take you very far.”
Pointing out illogic is not an insult, but it is a very common dismissive strategy to call valid argument insults. By contrast your comments are frequently directly insulting (writing, “for those of us for whom science matters” for example).
I also disagree that my characterization of your logic is in any way a straw man. You keep throwing out the names of logical fallacies, but not correctly.
Regarding validity, this is yet another example of how you don’t actually address the points that are being made, you simply introduce a new variable. In this last case you may be demonstrating that you don’t know what validity means. You refer to playing “semantic” games but that is exactly what you are doing.
Validity simply means that a measure has real-world implications – it predicts or correlates to some objective measure of outcome. The diagnosis of ADHD has validity because it correlates to real world outcomes – whether or not you think those outcomes constitute a disorder. You see how you are mixing variables at will? This gives you the ability to dodge any point – you simply bring up a different point as if it is address the one that is being made, when it isn’t.
The diagnosis of ADHD has validity. Whether or not we consider ADHD to be a disorder is a separate question. I argue that having impairment in a function that most people have, which results in demonstrable harm (harm being defined as a negative outcome that most people would consider undesirable), is a reasonable definition of disorder. People with ADHD have higher divorce rates, higher imprisonment, shorter life-expectancy, lower income, etc.
Obviously you dismiss the entire concept of mental disorder, but it all circles back to your refusal to accept the premise, so it’s just circular reasoning on your part.
Meanwhile – the diagnosis of ADHD has both validity and reliability, relates to real world outcomes, and “disorder” is being reasonably and operationally defined.
Your homosexuality example is yet another example of shifting variables and criteria at will in order to dodge valid criticisms of your position. You have incorrectly framed my position as being inconsistent, because I accept the validity of ADHD but not homosexuality as a disorder. You never asked why, and don’t seem to understand the consensus opinion for this.
In order to be considered a mental disorder the dysfunction has to be on the part of the person, not simply a cultural bias or bigotry in society. Like everything in psychiatry, this is not black or white, and we have to confront the fuzzy nature of social constructs when talking about human thought, mood, and behavior. But again, the fuzzy lines do not mean the extremes cannot be meaningfully defined.
Further – we need to distinguish human variation from dysfunction. Homosexuality was thought of as a sexual dysfunction, but improved knowledge has put this behavior into a more thorough context in that we now recognize a far greater spectrum of diversity in sexual behavior and much of it can reasonably be considered part of the normal human diversity. Also decades of research has shown that there is no harm from being homosexual – it does not correlate with any negative or harmful outcomes. This evidence, btw, was a strong argument in favor of removing it as a DSM diagnosis. Homosexuals are no more likely to have any form of mental illness, disorder, or dysfunction than heterosexuals.
In other words – there are valid reasons to reject homosexuality as a mental disorder even if we accept ADHD and other diagnoses without any internal inconsistency.
Other points – dismissing all genetic linkage analysis as merely correlational is not a valid criticism, and betrays a misunderstanding of this research. This is also pure denialism – denying entire categories of evidence because you don’t like their implications. Genetic linkage analysis is a proven valid method for determining which genetic variants are causally related to certain clinical syndromes. We need other data (biochemical, physiological) to determine how a genetic variation causes a specific outcome, but not to know that it has a causal role. You cannot reasonably dismiss all this evidence as “dead fish” science, as you try to do.
Regarding validity you also write:”YOU ARE THE ONE who have as notion of validity adaptation with society. No real biological disorder has that notion of validity. ”
Your first sentence is misleading – it’s not just adaptation with society, but lack of an ability or function that most people have. Societal factors certainly affect how much of a problem a disorder is in practical terms, but not if it’s a disorder.
For example, if someone has complete dyslexia, and inability to read, this is a disorder, since most humans are able to read. Dyslexia is not a problem in a society that does not have a written language, however. It is more of a problem the more reading is critical to functioning in society.
You also return to your arbitrary “biological” criterion for what is valid. As I and others have already pointed out, and you have failed to address, brain function depends on the pattern of robustness of circuits in the brain and biochemical factors that affect the functioning of those circuits, and how they interact with other circuits in the brain. We don’t expect to always find classic pathology for mental disorder. Rather we expect to find a pattern of brain activation that is different from healthy controls. This, of course, is very complex to tease apart, but that is exactly what researcher are doing – they are finding neuroanatomical correlates to clinical mental disorders. I already gave you a link to one for ADHD, which you ignored.
Do you deny that brain function is demonstrably different in many mental disorders? This is a factual claim that can be resolved with evidence. I can send you links all day to studies showing that brain function does correlate with mental disorders – or you could do an honest search for this evidence yourself.
You write: “Just as for all the reasons I have described I claim that you lack critical thinking skills and that you argue from the point of view of “skeptic dogmatism” -you are even on record now admitting that this is a matter of controversy in scientific circles, but you still insist on showing as “proof” something that shows “correlation” at best.”
If you really want to take the position that I lack critical thinking skills, go ahead. I only have over a thousand articles online as evidence for what my critical thinking skills are, and your claim puts your own logic and critical thinking into sharp focus.
I never stated that “this” is a matter of controversy in scientific circles. I am assuming that by “this” you meant the validity of mental illness. I said that there is a diversity of opinion among skeptics, to counter your false accusation of “skeptical dogma.” The skeptical community is not the same as the scientific community. Not all skeptics are scientists. Further – when deciding if a position is truly controversial, only relevant scientific experts really matter.
As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. Many of the details, of course, are, but not the existence of brain-function determined mental illness. Again – typical denialist strategy to confuse controversy over details as if they call into question the larger question of validity, and further to confuse popular controversy with scientific controversy.
I never claimed “proof” of anything – I have offered evidence to support the conclusion that some mental disorders are clinically valid and correlate to genetic markers as well as altered brain function, using ADHD as one example. This is just a quick sample to counter your position that such evidence is lacking.
If you actually come back with any valid response I will be happy to address it.
This offers perhaps the most comprehensive vision I have come across w/ respect to what a legalized world could look like.
from page 75:
“However, while the physiological elements of drug action as it relates to dependence can be assessed and potentially ranked, dependency issues are dramatically complicated by the individual user, and the range of psycho-social factors that interface with physiological processes.
This interaction produces dependency-related behaviours, which may require the attention of policy makers and service providers. The psycho-social influences upon, or components of dependency relating to, a given drug are far harder to quantify and rank, and far more contentious in the literature. For example, psychological dependence—‘addiction’—is now also associated with sex, shopping, gambling, the internet and so on.34
These psycho-social components are, however, arguably no less important in terms of determining behaviours. Some drugs that have relatively moderate or low physiological dependency effects are none the less frequently associated with powerful psychological dependency, cocaine being an obvious example. Whether physiological and psychological dependence should be pooled together in rankings remains a moot point—as does the question of whether ‘addiction’ remains a useful term, as opposed to dysfunctional, problematic or dependent use.”
There is a useful discussion of the issues around how addiction is conceptualised in
B.Alexander, ‘The Globalisation of Addiction: A Study in Poverty of the Spirit’,
Oxford University Press, 2008.
I think this is an important point, so I will break a little.
I’ve interviewed a lot of schizophrenics (maybe there’s a study re: this – I don’t know) and almost all of them mention at some point how thankful they are that they were civilly committed, because they were terrified and in an awful state w/o help.
When someone is psychotic, they’re not going to get help! The idea that the person running up and down the street ranting and raving is enjoying some sort of “freedom” is preposterous on its face.
I think this is much the same for recovered addicts. If we decriminalize most drugs, as I think we should, some form of forced treatment is a must.
Naive and high minded ideas about “freedom” simply ignore the horrific nature of what we’re talking about.
“As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. ”
I think that this cannot be stated enough as these posts go on. While trolls can be irritating, I think the far worse outcome would be a well-meaning lay person coming to your blog only to be mislead due to the sheer volume of nonsense posted.
“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.”
“Validity simply means that a measure has real-world implications – it predicts or correlates to some objective measure of outcome. The diagnosis of ADHD has validity because it correlates to real world outcomes – whether or not you think those outcomes constitute a disorder. You see how you are mixing variables at will? This gives you the ability to dodge any point – you simply bring up a different point as if it is address the one that is being made, when it isn’t. ”
NOTE: It is obvious that Insel meant “validity” in a “biological sense” as in “HIV is the cause of AIDS”.
Now, if you are saying is that I, Tom Insel, David Kupfer and in fact, the majority of psychiatrists who claim that “psychiatry has validity” have a different notion of “validity” than yours, sure, I agree with that proposition. I have a disagreement with Insel that his program will ever be able to find “valid” (in the sense he discussed in his blog) biomarkers for so called “mental illness”, but I side with his notion of validity because at least that can be falsified.
Now, you say that I unfairly accuse you of strawmanning, but, you keep at it,
“Your first sentence is misleading – it’s not just adaptation with society, but lack of an ability or function that most people have. Societal factors certainly affect how much of a problem a disorder is in practical terms, but not if it’s a disorder.
For example, if someone has complete dyslexia, and inability to read, this is a disorder, since most humans are able to read. Dyslexia is not a problem in a society that does not have a written language, however. It is more of a problem the more reading is critical to functioning in society. ”
You are just trying to define “social maladaptation” in a different way, but you are still defending “social maladaptation” as valid notion for “disease”. Even accepting your concept of “validity” this way for dyslexia, you seem to suggest that for the longest time humans have been on Earth, dyslexia was not a valid “illness” while as soon as some humans started to be able to read, an epidemic of “dyslexia” affected human kind. Note that before “ability” to read came to existence the notion of “dyslexia” didn’t make sense. And, if you are of the opinion that humans were never destined to be able to read in the first place (that it all happened “by accident”) you cannot claim that the very notion of “dyslexia” existed in prehistoric times. Compare this to “cancer”, whose notion of biological validity means that it has existed regardless of any social interactions for as long as there have been human beings on Earth and regardless of human’s ability to establish or measure the biological cause of cancer.
“brain function depends on the pattern of robustness of circuits in the brain and biochemical factors that affect the functioning of those circuits, and how they interact with other circuits in the brain”
This point have been addressed many times over with the sw/hw problem. Now, your dogma makes it for you impossible to accept “the mind” even as a useful “abstraction” for the programming of the brain that results from millions of years of evolution and interaction with the environment. So once you accept that the sw/hw model a is a valid abstraction that explains problems of living , the notion of “mental disorders” has a completely different meaning -as a metaphor for behavioral problems-, and one that explains better how is that these people http://openparadigmproject.com/ or John Nash can fully recover from whatever extreme mental states they were going through without any hw (ie drugging, ECT, insulin therapy, etc) intervention whatsoever.
If you lack the background to understand what the sw/hw difference means -because like BO have not kept up with the latest developments in technology like content addressable memory-, I give you that, but nobody has refuted the above in any meaningful way. They have just limited themselves to repeat dogmas.
“I only have over a thousand articles online as evidence for what my critical thinking skills are, and your claim puts your own logic and critical thinking into sharp focus. ”
WOW, now “I am holier than you” type of argument. Great. Look, if I had not been abused by psychiatry, I would challenge you to public, Intelligence Squared US type of debate with a jury and I am very confident that I would win it because your arguments are nonsensical. But because I was harmed by psychiatry, and I don’t want psychiatry to harm me for a second time, I am perfectly comfortable with people making their own judgements on whether my arguments have value. I think that I have convinced a few of your readers that they have. The sad thing though, is that I came armed with the same arguments a few months ago, before Tom Insel started the current crisis in psychiatry, and nobody took them seriously. Now, all it took was the director of the NIMH to validate my most important argument, to be taken seriously, including by you. So sir, I think that this whole episode speaks very well of the dogmas in this community.
“As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. Many of the details, of course, are, but not the existence of brain-function determined mental illness. ”
Again, straw man, because I never claimed that there is controversy on this matter among neuroscientists or psychiatrists. What I said is that the mainstream thinking in psychiatry now is that NONE OF THE DSM DISORDERS HAS BEEN SHOWN TO HAVE BIOLOGICAL VALIDITY. That is a simple statement that has now been agreed by the top dogs of psychiatry. And that, again, is perfectly compatible with these same people “believing” that biological validity will eventually be found. But while one is a statement of fact about the current lack of biological markers for so called “mental illness”, the other is a statement of belief, like “most computer scientists believe P is different from NP”.
“I never claimed “proof” of anything – I have offered evidence to support the conclusion that some mental disorders are clinically valid and correlate to genetic markers as well as altered brain function, using ADHD as one example. This is just a quick sample to counter your position that such evidence is lacking. ”
Well, we are faced with another “semantics” issue, because to me claiming that,
“ADHD is demonstrably a brain disorder”
Means that an actual proof that passes the scientific criteria of falsifiability has been found, such as when one says “HIV is demonstrably the cause of AIDS”,
- Diagnosis of HIV infection is made through presence or absence or HIV antibody test (ELISA/Western Bolt) or the HIV virus itself (so called NAT testing).
- The overwhelming majority of people HIV positive, eventually develop AIDS, except for a minority called “Long-term nonprogressors”. But even then, we know that “Long-term nonprogressors” have within their bodies the ability to keep HIV replication under control, so it’s not like HIV infection goes out of control and these people do not develop AIDS, it’s that their bodies keep HIV under control naturally and AIDS does develop, providing extra validation to HIV as the cause of AIDS.
And yet, there are very few cases where AIDS type of symptoms that have been found in people who test negative for HIV infection (fact that is used by AIDS denialists to put forward their nonsense).
If you believe that “ADHD is demonstrably a brain disorder” has been established in the same qualitative way HIV infection has been established as the cause of AIDS, then we’ll just have to agree again to disagree about what “demonstrably” means in addition to disagreeing to what “validity” means.
Now, one thing you’ll have to agree. When psychiatry makes outrageous claims about “validity” of this or that disorder, the reaction they are seeking into the public and policy makers is not the notions of “validity” and “proof” you have defended here but the notions of “validity” and “proof” that I have defended, ie, that which transformed AIDS from a sure death sentence to a chronic condition for most people (unfortunately, some people on HIV drugs still die of AIDS, although at much lower rates than previously),
“I’ve interviewed a lot of schizophrenics (maybe there’s a study re: this – I don’t know) and almost all of them mention at some point how thankful they are that they were civilly committed, because they were terrified and in an awful state w/o help. ”
As I said, and I can attest to that, the main driver behind people claiming to have been helped by “psychiatry” when interviewed by so called “professionals” of mental health, is to get out of their unfair incarceration.
I always ask those who make yours or Allen Frances’ type of outrageous claims about the “help” people feel in retrospect to produce a single study that shows it -a study that eliminates the captive nature of the “shrink” in a hospital setting or the threat of going back for non compliance- and I haven’t seen a single one. This fits into psychiatry’s tendency to make outrageous and unscientific statements about their “ability to predict violent behavior” or “depression is caused by a serotonin deficit”. Psychiatry is so used to make unscientific statements that go unchallenged by their own peer review and by those who would otherwise object (but are fearful to do so because of psychiatry’s legal sanctioned status as a coercive force) that they have come to believe their own lies.
This is why what happened in May 2013 was as an incredible crisis: we had psychiatry’s top dogs in public admitting that they regularly speak nonsense but that “a scam known as DSM is better than nothing”.
“The Court in its decision wrote that the standards it outlined will allow involuntary medication for the sole purpose of rendering the defendant competent to stand trial only in rare instances. The standard implies that a court must find that important governmental interests are at stake and that its interest in bringing the accused to trial for serious crimes is important enough to override constitutional issues, and that the forced medication will not significantly interfere with the defense or have untoward side effects. Therefore, in each case the facts and circumstances must be considered individually, balancing the government’s responsibility to ensure timely prosecution with an equal interest in making sure a defendant obtains a fair trial. The court must weight these factors and decide if forced medication will significantly further or hinder these conflicting interests of the state.”
” others disagreed, arguing that the strict limits imposed by the Supreme Court on involuntary medication meant that the involuntary medication of a non dangerous defendant would be rare, especially since government’s “important” interest in bringing the defendant to trial must be unattainable by alternative, less invasive means.
At the very least however, the criteria set forth by the court will ensure that the lower courts considering the issue of forced medication must determine why it is medically appropriate to force drug an individual who is not dangerous and furthermore is competent to make up his own mind about treatment”
Which is why I feel so confident about our SCOTUS ability to inflict damage to psychiatry. I hope that the current crisis brings another case that results in psychiatry losing even more power to force itself onto its victims .
Not that I believe you were ever committed, but I have come to believe you have real issues. I mean, haven’t you just replaced your OCD fear of AIDs with OCD fear of psychiatry?
You’ve said psychiatry has performed every bad deed save for steeling the Lindbergh baby.
The only caveat that you would offer in saying that psychiatry’s victims were worse than those of the holocaust was that psychiatry caused the holocaust. You make casual joke about how wonderful it woulld be to round up all the psychiatrists and shoot them.
And this is not even mentioning that you seem reasonably intelligent, but can’t add 2+2 when the evidence relates to psychiatry.
Why don’t you stop posting here and get some help, regardless of what that means to you. Cause dude, you are obssessed with psychiatry. And it ain’t healthy.
“Not that I believe you were ever committed, but I have come to believe you have real issues. I mean, haven’t you just replaced your OCD fear of AIDs with OCD fear of psychiatry?”
Again, what an anonymous poster thinks about whether I am telling the truth is irrelevant to me. What counts is that you have made a fool of yourself with your nonsensical arguments that only showed to the world that you are clueless about Bayesian statistics.
“Why don’t you stop posting here and get some help, regardless of what that means to you. Cause dude, you are obssessed with psychiatry. And it ain’t healthy.”
This is like asking a rape survivor to forget to forget about rapists. Some do, some don’t. Some others channel their experience in a way to help prevent future abuse. That’s what I am up to. The people in this community, like Novella, or you if it is true that you work with victims of psychiatry, are intellectually complicity with psychiatry’s atrocities (those 10000 British citizens who had their civil liberties abused, your program to forcibly drug criminal defendants that are “addicts”, etc). Intervening here is my way to fight this scam that has impacted negatively so many people.
While you, and Steven Novella, side with the tormentors, I side with the victims of the abuse. I also happen to have the science backing me (actually, in psychiatry’s case the lack of science) but the reason I am here and other blogs debunking your nonsense is the moral sense that with knowledge comes the responsibility to fight this scourge up until it loses all of its coercive powers. Tom Insel made that goal achievable in my life time.
Several years ago I attended a lecture from a psychiatrist a Johns Hopkins and the topic was on addiction, addiction treatment paradigms and mental health. The lecturer was a well-respected researcher/clinician in the field and always gave insightful talks. The crescendo of the talk was in a story that he told about a series of experiments with rats and (I think) heroin. The paradigm that they used to study the rats and addiction was that they were rigged to a device that would give them a dose of heroin if they pushed a lever, but each time they got a dose, it increased the number of pushes necessary for the next dose. So first dose on 1 push, second dose after 2 pushes, 3rd dose after 3 pushes; etc. They could get them up to 10,000 pushes to get the dose (and then it’ll start pushing to get to 10,001 …. which must have taken a long time!). But the rats are stuck in cages, and it’s pretty boring, and life isn’t satisfying to them, so why not take a drug. They wanted to see what would happen if they took the rats out at night to the middle of a football field in the suburbs, opened the cage doors. They expected to come back the next morning and find the rats pushing on the levers. But it didn’t happen. The rats opted for freedom. He then made the analogy to humans and our sociological, psychological, mental “cages” that would drive or maintain addiction. If you take the person out of the cage, they will choose freedom. I suppose for a rat to be suddenly freed at night in a wide open field vs. having been stuck in a cage its whole life would be like for a human taken from the worst of the worst parts of Baltimore, addicted to some substance (e.g. cocaine or heroin) and then bringing them to a tropical paradise where every pursuit and action they choose to take is the most rewarding and valuable things ever, vs. being stuck in their crappy neighborhood in Baltimore getting high — they’ll choose the tropical paradise. The task for clinicians, policy makers, voters, neighbors, family, and friends — is to recognize peoples’ cages and make life rewarding. Yes …. it’s all wired in the brain. I’m by no means supporting a viewpoint that this metaphor is separate from brain circuitry & chemistry driving behavior; just that context in which a particular brain is acting is what sets up its circuitry & chemistry. The rewards and reward systems that are available are what a brain will respond to. In other words, we need our environment, actions, and opportunities to be more motivating, stimulating, and rewarding than the reward from getting high; and there’s individual variation. Regarding marijuana — I do think that even though it’s not physically addicting, the fact that it activates reward centers so strongly makes it psychologically addicting. I have had several friends waste several years of their lives spending >$300 per month on pot. They weren’t physically dependent on the pot, but getting high was the only satisfying thing they had going for them. Most people grow out of this though.
“I’m by no means supporting a viewpoint that this metaphor is separate from brain circuitry & chemistry driving behavior; just that context in which a particular brain is acting is what sets up its circuitry & chemistry. ”
You “de facto” are. I don’t understand why there is this reluctance in this movement to accept “the mind” as a useful abstraction/metaphor or whatever.
When a computer executes software (and as I said, FPGAs can reconfigure their own damaged circuits as part of execution, fact used by NASA to design computers that are able to fix their own circuits when damaged by radiation), there is a lot of electrical signalling going on. If you had access to the micro and nano level you’d only see electrical signals going around, but software is a very different abstraction. Nobody thinks that software can be “fixed” by adjusting the conductivity levels in transistors, even though these transistors carry the electrical signals that make software execution possible.
steve12 – I had actually reached your conclusion a while back about CS2013. He is clearly unhinged. He’s got all the markings of someone who is manipulative and vindictive in their personal lives. I’m sure that his ramblings here are markers of a larger problem and he acts just this way in other aspects of his life. He’s got the attributes of someone with (perhaps) paranoia and delusions of grandeur. He thinks there’s a large conspiracy of psychiatry keeping everyone down and that inflicted great harm on his life. His delusions of grandeur are that only HE can see the truth and that he is a savior and will “bring psychiatry down.” I can make predictions on how he treats his friends / girlfriends / family, too. This isn’t because of my background in neuroscience … I learned more about human behavior from several years as a waiter and bartending in college.
CS2013 – No. I, de facto, am not. Our reward systems are in flux and constantly getting stimulus and reinforced or inhibited by input from around us and by our own actions. At a casino – put in money, pull a lever – lights! noise! moving colors! – activates the reward circuitry. Doing drugs – going to a place, rolling a joint, sniffing, getting high – activates the same circuitry. Exercising – tying up shoes, running 5 miles, endorphins, running high, bragging rights – activates reward circuitry. How strongly, how often, and how susceptible we are to these behaviors and rewards varies, but is encoded in the physical substrates of our brains.
“He’s got all the markings of someone who is manipulative and vindictive in their personal lives. I’m sure that his ramblings here are markers of a larger problem and he acts just this way in other aspects of his life. He’s got the attributes of someone with (perhaps) paranoia and delusions of grandeur.”
WOW! Now I have been diagnosed on the spot by somebody who is not even a shrink (this is what happens when you spend too much time with them).
” He thinks there’s a large conspiracy of psychiatry keeping everyone down and that inflicted great harm on his life. His delusions of grandeur are that only HE can see the truth and that he is a savior and will “bring psychiatry down.” ”
Actually, and it is funny that every shrink I have encountered in my life always tries to project “conspiracy theories” into their victims, I have been on record several times that I do not believe in conspiracy theories (you can double check my previous entries).
So no conspiracy pal. It’s a demonstrable fact (as in established by the court of law) that Big Pharma companies have spent tens of millions of dollars bribing psychiatrists that are considered the top of their profession (Joseph Biederman, Martin Keller, Charles Nemeroff) to promote their drugs off label. Maybe one day you’ll reach KOL status and you too will be bribed with millions.
Neither I claim I am the only one that sees these things. It is interesting that Bob Whitaker was also put in the company of AIDS denialists when he published his ground breaking work Anatomy of an Epidemic http://www.amazon.com/books/dp/1455884197 . Now he has been invited to speak at this year’s NAMI convention. See how things go!
“I can make predictions on how he treats his friends / girlfriends / family, too. This isn’t because of my background in neuroscience … I learned more about human behavior from several years as a waiter and bartending in college.”
That explains probably your own “delusions of grandeur”. From waiter to the “pride” of being an assistant professor who still has to be slave of associate and full professors (ie suck their penises) if he wants to obtain tenure. Advise to you: there is life beyond the Ivory Tower.
It’s a different name for what in computer science is called “software”. Software is not the lines of code nor is the encoding in zeros and ones, it’s the intelligence that drives the computer that the programmer expresses in “lines of code” and that the compiler translates into “zeros and ones” so that the computer can execute it.
I understand that to get tenure you have to agree with your masters at your university that “the mind” doesn’t exist because that is academia’s fad du jour in neuroscience, but you have “de facto” admitted that “the mind” is a useful abstraction to think about these matters .
There isn’t a single argument of Steve’s that you logically refuted. If “skeptical dogma” is rationality and critical thinking, you need to get some of it. You keep making the same logical fallacies and demonstrably false claims. Stop repeating yourself, especially since you’re not changing your arguments after they have been thoroughly refuted, it’s annoying.
I believe there is enough evidence to conclude that you are a walking, talking, non sequitur, although there is room for debate if you can actually walk or talk.
Steven Novella has gone to the game of semantics, which is an implicit admission that there was not much logic in his arguments.
The way I see it comes down to this: I and Steven Novella (and his followers) have different notions of what “validity” means in the context of medicine and what “demonstrably” means in the context of science.
Only I can claim that my concepts are behind AIDS having been transformed in most cases in a “chronic” disease, and human’s ability to build the LHC, while your and Novella’s concepts have resulted in 10000 British citizens -and counting- having had their civil liberties violated gratuitously.
I think that CS2013 is possibly addicted to posting on this forum. To him, the reward is to see his writing and for us to respond to it. We’re feeding his paranoia by confirming his suspicions of a grand conspiracy and also his delusions of grandeur in being the lone voice and savior from psychiatry. He must be on to something if we are responding and arguing. If only he could write 3 – 4 more paragraphs, maybe then we’d see the light and come around. I didn’t post my anecdote to get into a comment war with CS2013, I wanted to share a memorable story on this topic to a group I thought might find it interesting.
Look, Steven Novella himself started the “semantics” discussion. When you have to go to a discussion about what in mathematical terms is called axioms http://en.wikipedia.org/wiki/Axiom , is that the disagreement is not in the “rules of logic” or in the “deductive logic” used to make the arguments but in the axioms themselves.
- Posters Mlema and sonic agree with the proposition that Insel’s statement (and the subsequent crisis) validates my main point: to this day there are no biomarkers for so called “mental illness”.
- Steve12 attempted to pull off a nonsensical argument based on statistical inference that only showed that he doesn’t understand Bayesian statistics well. But even he agreed that much of the DSM is nonsense.
- Some poster (I think it was BO) agreed that DSM disorders are real diseases if one considers the “social context”, ie, that it is legitimate (although he never endorsed it) to call “homosexuality” a “mental illness” in the context of a homophobic society.
All that was argued to oblivion. If there is anything that is not clear to you from that discussion, please let me know and I will address it in a that even a PhD in chemistry who works with shrinks can understand it. Don’t worry, I will not tell anybody at UCSD that you are on record saying things that might challenge the dogma of non existence of the mind .
“Two generations of molecular genetic researchers have attempted, yet failed, to discover the genes that they believe underlie the major psychiatric disorders. The most recent failure is a molecular genetic study that was unable to find genes for symptoms of depression. Like most genetic researchers in psychiatry, the authors failed to consider the possibility that no such genes exist, and instead concluded that much larger samples of at least 50,000 subjects are needed to detect genes”
This is why I am so confident that Tom Insel will fail miserably!
@ # etatro
“I have had several friends waste several years of their lives spending >$300 per month on pot.”
Still not all that far off from some healthy alcohol budgets in the 25-40 age range! The thing that galls me though is how high prices are due to prohibition – I could keep an ounce a month habit up for 30-60$, even with really high taxes.
One wonders if the business case for prohibition couldn’t be made solely on the delta between what legal and illegal prices are – all that money people could be rediverting back to legitimate business subject to taxation. I know in some of my crazier days I mighta been able to buy more clothes and electronics if I wasn’t paying such high prices for illegal drugs.
Issues such as repurposing of law enforcement assets, rising addiction and resocializing gang members into more productive work could likely be largely paid for on the back of that effect and the peace dividend.
(and I would even say that rising addiction from the end of prohibition is very much a debated downstream effect – I threw that in there for the legalization skeptics who worry about that [without much backup])
As my wife (a Doctor of Psychology) often reminds me, one shouldn’t form dialogistical opinions of someone just by what they post. That said, can we stop feeding the paranoid delusions of cannotsay2013 by giving leave to post here? I’m sure he can find other spots on the internet where his muddle of poor logic, quote mining and pretensions to education will find an audience that cares.
“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.”
Cannotsay- Tom Insel has explained that the quotes you are using were directed towards researchers, and the problems with the use of the DSM in research. The concept of validity comes into play when a given diagnosis in the DSM may, in theory, refer to more than one distinct disorder physiologically, but manifest clinically in very similar ways.
That does not mean that there is anything wrong with attempts to create this “dictionary,” in fact it is necessary and has been very helfpul. His point was that there is much progress that needs to be made (and commented that recent progress has been less than people had hoped) with regards to understanding mental disorders themselves, and he implies that this lack of progress has been in part due to prioritizing research that focus on treatment. You use his words as if they support your denial when they don’t.
…but that doesn’t stop you from denying its existence. As if we needed another example of your white knuckle grip on your denialist ideology.
“Many veterans came back, had some issues adjusting back to civil society but they eventually did, to the point that many WWII, Korea and Vietnam veterans are among our most successful members of society…. If my memory serves me well, PTSD was “invented” as a disease by DSM-III.”
This is absurd. So because some veterans had successful professional lives after war, that is evidence for the nonexistence of PTSD? No one is claiming that PTSD eliminates the possibility of professional success, but a disproportionate number have great difficulty with personal and professional relationships, suffer from anxiety/mood disorders, and all you have to say is ‘look at him, he looks like he’s holding it together. Why can’t you?’
Don’t forget PTSD is not just a wartime phenomenon, but can occur with other types of physical abuse. These difficulties can be improved with various treatments. Your denial of its existence also denies treatments because it denies the need for treatments.
I still find it unbelievable that you start by saying you don’t know much about PTSD and then end the paragraph by denying its existence. Denialism that anyone can see
I wish cannotsay hadn’t hijacked this thread. I find the possibilities for involving addiction fascinating.
Is it possible to constantly stimulate the pleasure sensors in the brain while maintaining “functionality”? Is it possible to disassociate free will from our pleasure sensors? Both possibilities seem likely due to Murphy’s Law of the brain, although this is a gross characterization.
If either possibility has a high potential of occurring due to selection or some other potential process, then perhaps the future of addiction won’t looks as grim as it does today. I don’t think this kind of adaptation will happen on a mass scale any time soon though, if ever.
Sure, a PhD in psychology is as relevant in a discussion about the scientific foundations of psychiatry as a PhD in English literature, ie, useless.
“The concept of validity comes into play when a given diagnosis in the DSM may, in theory, refer to more than one distinct disorder physiologically, but manifest clinically in very similar ways. ”
I am happy that at least we can agree that what you, Novella and the like call “validity” is different from the concept “validity” that is used in the rest of medicine. However, what you call “validity” of so called “mental illness” is what I have called several times more appropriately “social control”, which again, it is preposterous to be left in the hands of unaccountable, self appointed “mind guardians” that impose their own concept of “normal behavior” on the rest of society.
“…but that doesn’t stop you from denying its existence. As if we needed another example of your white knuckle grip on your denialist ideology.”
Not being familiar with PTSD, just as not being familiar with “binge eating”, doesn’t prevent me from making the argument that it was introduced in DSM-III or to make the case that today’s veterans are not any more stressed than the veterans of previous wars. According to you, Allen Frances is also a “denialist” of “binge eating”.
“but a disproportionate number have great difficulty with personal and professional relationships, suffer from anxiety/mood disorders, and all you have to say is ‘look at him, he looks like he’s holding it together. Why can’t you?’ ”
The veterans of WWII fought an enemy like no other. Those who flew bombers for instance had a very important likelihood of not coming back alive http://en.wikipedia.org/wiki/Strategic_bombing_during_World_War_II . 400000 American soldiers died in WWII. So to claim that today’s veterans have a harder time than previous veterans is simply to be an ignorant of the history of the wars the US has been involved in (not uncommon in today’s academia since ROTC has been all but banned from many universities).
What today’s veterans have going against them is the unholy alliance Big Pharma with Charles Nemeroff and the like http://www.youtube.com/watch?v=93sdAPOmHcE . That soldiers die of the cocktails veterans are administered? Big Pharma has no problem at all, and the army sincerely doesn’t care.
While that type of trickery is not exclusive to psychiatry, the nature of psychiatry as an unscientific endeavor that has no objective measures of efficacy makes that corruption more pervasive in psychiatry than in other areas of medicine. Just, as I pointed out in the other thread, psychiatrists regularly top the list of the most bribed doctors by Big Pharma,
“Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems.”
WOW, are these people also conspiratorial? Are they also deluded?
We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased.”
While I do not agree with the proposition that more regulation is the answer (in fact, it’s precisely regulation what has made of Big Pharma an oligopoly with such influence) the language they use to denounce the corruption that pervades the healthcare industry, which is disproportionally present in psychiatry, would no doubt deserve insults from etatro. Alas etatro, these people have no psychiatric masters to please to achieve tenure, which is probably they can be so blunt about what is going on.
CS2013. While it’s been a pleasure serving as your punching bag, I would just like to point out a few things. You responded to my prediction that you are manipulative and vindictive by attempting to target insecurities of mine to lure me into a rabbit hole with you. You attacked my masculinity, my status, and my career trajectory — probably assuming that those are things that I value or am insecure about. You’ve probably successfully gotten a rise out of 30-something males before and lured them into arguments with you then bombasted them with gish-gallops of links, non-sequitors, unverified assertions. When I didn’t respond, you moved to using creepy overly-familiar language and patronizing. How many times over the past several weeks have you checked this forum for responses to your posts? How much time passes between thinking about it? Do you get anxious if you don’t know whether someone has responded to you? Do you stay up later than you normally would, skip a meal, ignore other responsibilities?
See, this is the difference between not having “masters to please” (as you do), and being a free thinker (me). I don’t have to backtrack from my statements.
You can try to project your frustrations on me, it doesn’t cut it. Unlike your pathetic “publish or perish” life, I have more than enough time to spend here and elsewhere. Are you perhaps envious that you don’t have such latitude? Do you feel betrayed that being an assistant professor is not the bargain it looked to you as a grad student?
Remember that while all you get after you sucked all those penises at UCSD is the illusion of a “job for life” while life outside academia has a lot more to offer, both economically and intellectually. As somebody said, what is pathetic in academia is that the viciousness of its politics are amplified because there is usually so little at stake.
The funny thing is that you are not even a shrink. Apparently you spend too much time with them so they have corrupted your think.
Oh, and BTW, it’s you who started your interactions with me insulting. If you cannot stand the heat, get out of the kitchen!
I understand that in order to investigate even enormously complex problems as occur in neuroscience, one must deconstruct those problems to their roots, their bare-bones, to be able to design and execute experiments that reveal useful knowledge. That is inescapable.
What I suppose I take some issue with is that those deconstructed problems, which give rise to a line of research, are sometimes applied from an equally narrow vantage point.
I absolutely respect what you have assembled here, Dr. Novella. And I am continually quite satisfied with your analyses, conclusions and further comments on the issues you raise. At the risk of applying the evidence presented a bit too broadly, I would simply encourage that basic neuroscience research