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Anti-psychiatry, Thomas Szasz, and teh crazies.

Wonder_HippieWonder_Hippie __BANNED USERS
edited March 2008 in Debate and/or Discourse
This thread is inspired by a friend of mine we'll refer to here as "Dee."

Currently, I'm in a graduate studies program for psychological counseling and diagnosis. As such, I am largely in defense of my field when these types of disagreements come up. I do agree with Szasz in a lot of ways; notably, his arguments about labeling and stigmatism as it is applied to the patients, or what he often calls the victims, of psychology and psychiatry. Dee takes my defense of what I think I rightly consider a valid science as a bias against, most specifically, the CCHR (Citizen's Commission on Human Rights, an organization founded by Szasz and the Church of Scientology in the late 60's) and dissenters. I argue that the CCHR is a paranoid, fearmongering organization that spends its time making shit up more than anything else, blaming all celebrity suicides on the evil psychiatric industry. I'm correct.

CCHR video about the DSM. Remember, despite their claims, they are more or less a part of the CoS.

Despite his paranoia and conspiracy theories, I think there is some logical root to Dee's problem. Dee is Canadian, and is apparently a part, or maybe even a leader of, a group dedicated to fighting what they perceive as legalized abuse and abduction on the part of the CAS. He claims to have convincing evidence of their abuses. Now, to be clear, I'm not nearly versed enough in Canadian law or anything like that to discuss this here, but it's far from beyond the realm of possibility that the CAS operates like the mismanaged, underfunded and understaffed DFACS in the US. If the problems in my version of the child protection agencies are any indicator, it is, in fact, very likely. But Dee takes it a step further and applies a conspiracy theory about profiting off of overmedication and such things. Again, I don't necessarily doubt, but I'm also unexposed to his evidence as of yet. He may very well be astute, and is fighting the good fight.

But Dee has taken it a step further from there and lays a whole slew of allegations and criticism against the entire mental health profession, believing that diagnosis is impossible and fabricated, and that it's all a massive conspiracy (buzz word of the day, it seems) to, once again, profit off of lies to patients and their misery, primarily through the use of psychopharmacotherapy, especially with regards to children and ADD/ADHD treatment. Some of these criticisms aren't entirely invalid, given that I've personally known lazy professionals that overmedicate and stuff in as many patients as they can in a day to make a buck without sufficiently treating them. However, I've also seen behavioral treatment - and the clinic I work for uses this program called Brain Games for ADD patients, often along with medication - that works wonders, as well as talk therapy and a variety of other methods.

I think part of the problem is that there's a faulty perception of overdiagnosis and overmedication that's rampant to the lay public because of ignorance. A hyper kid doesn't have ADHD. A hyper kid with a variety of symptoms has ADHD, but the general public doesn't actually know what those symptoms are, and if they do, they certainly don't know how to interpret or identify them appropriately. Dee, predictably, argues that ADD and ADHD, and others like autism and Asperger's, are completely fabricated. Szasz does as well.

Before I keep rambling, let me spell out exactly what I'm concerd with in regards to this thread in a quick TL;DR:

1. Can a psychiatric diagnosis be real at all? Is there any validity to the whole thing? Does it extend in purpose beyond Szasz's accusation that it's just a label? My answer is yes, of course.

2. Are the conspiracy theories valid? My answer is, in a nutshell, that there may be some measure of validity to the suspicion of such behaviors and policies, but that it's a problem with all medicine that's not exclusive to psychiatry, and that it's a problem that can be remedied by reform, transperency, and effective oversight.

3. What's your opinion on psychiatric pharmaceuticals? My opinion is that it's helpful and effective, but is most effective when paired well with other forms of behavioral or talk therapy, and also that is certainly not a panacea for all that ails your brain. My opinion is substantiated by numerous studies.

4. Are our children being overmedicated and drugged into near-comatose states by the evil psychiatric industry in an effort to make a quick buck? I think that conspiracy theories are more harmful than helpful, and that while there are problems, it's not nearly as far-reaching as Dee and others would have you believe.

Wonder_Hippie on
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  • MrMisterMrMister Valuing scholarship above all elseRegistered User regular
    edited March 2008
    1. Can a psychiatric diagnosis be real at all? Is there any validity to the whole thing? Does it extend in purpose beyond Szasz's accusation that it's just a label? My answer is yes, of course.

    ...

    3. What's your opinion on psychiatric pharmaceuticals? My opinion is that it's helpful and effective, but is most effective when paired well with other forms of behavioral or talk therapy, and also that is certainly not a panacea for all that ails your brain. My opinion is substantiated by numerous studies.

    Answering yes to 3 pretty much guarantees an answer of yes to 1. And, as you said, numerous studies have born out 3. As a result, I don't see how there can be any not-just-crazy-scientology controversy here.

  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    MrMister wrote: »
    1. Can a psychiatric diagnosis be real at all? Is there any validity to the whole thing? Does it extend in purpose beyond Szasz's accusation that it's just a label? My answer is yes, of course.

    ...

    3. What's your opinion on psychiatric pharmaceuticals? My opinion is that it's helpful and effective, but is most effective when paired well with other forms of behavioral or talk therapy, and also that is certainly not a panacea for all that ails your brain. My opinion is substantiated by numerous studies.

    Answering yes to 3 pretty much guarantees an answer of yes to 1. And, as you said, numerous studies have born out 3. As a result, I don't see how there can be any not-just-crazy-scientology controversy here.

    Well, Dee distances himself pretty fervently from the CoS ("their weirdos lol"), but still spouts these kinds of things. Doing a bit of digging and discussing, I've found a whole lot of people that I know, and that know what I do, that think that ADD/ADHD is a lie used by pharmaceutical companies to make tons and tons of money from the abuse of children. Due to the state of knowledge about mental health in America, there are a whole lot of people that are completely independent of Scientology that think it's not a real, valid science.

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  • RocketSauceRocketSauce Registered User regular
    edited March 2008
    Working in the mental health field myself, I am biased toward it. I deal with almost every diagnosis there is, and only once have I ever encountered someone who was "over-medicated". I completely understand the concerns parents have over some of the side-effects of certain medications, though. For a lay-person to say how much medication (or any at all) someone needs is irresponsible. That's up to their Psychiatrist or Doctor.

    I can say how many clients I've worked with who were able to get on the right medication at the right dose, and it made a huge improvement in the behaviors and personality.

  • durandal4532durandal4532 Registered User regular
    edited March 2008
    Your brain is a physical object, it can be injured and it can be treated.

    I don't try to pretend my migraines are somehow unreal just because I can't see blood. I treat them with a drug that does nothing but relieve a pain that only I feel. It's quite literally "all in my head". But that doesn't mean that there's not a medical problem that has a medical treatment.

    If anything, I think the idea that psychiatry is not really medicine makes it more likely that it will be abused. There needs to be a more coherent presentation of psychology and related fields as the study of a real object.

  • StarcrossStarcross Registered User regular
    edited March 2008
    A lot of people are very uncomfortable with the idea of psychiatric medicine. I understand that psychiatry is less of an exact science than many branches of medicine but the signal:noise ratio of legitamite complaints about overdiagnosis of conditions or overprescription of meds to complaints by people who just don't like the idea of prescribing psychiatric medicine at all (especially to kids) means that i tend to assume any opinions like Dee's are largely without merit.

  • OboroOboro __BANNED USERS
    edited March 2008
    I put a great deal of faith in the axis I disorders and the medications designed to treat them; they've been effective for me re: the symptoms they targeted, and they've been effective for people around me. The number of people in my life whom I've met that have been similarly medicated -- forget overmedicated, I just mean medicated at all -- is much smaller than I expect, and the statistics offered vis-a-vis incidence rates.

    People get into a tizzy about how we're overmedicating and overdiagnosing, but the hard numbers show that in most populations (especially anything older than adolescents) reporting and especially self-reporting are far below expected incidences. I don't know enough about the ADD/ADHD situation to speak about it. I know that medications given for it are very, very widely available recreationally so maybe those in particular are getting overprescribed?, or maybe they're just being underused.

    I think there are some problems concerning axis II disorders, the diagnosis thereof, and the treatment options (and again, the outreach that precedes all of these), but I blame this more on the fact the industry is caught in the crisis you describe. Axis II diagnoses are like cheat sheets -- they're quick and fairly accurate assessments of a patient designed to help the patient more easily confront the issues preventing them from living a happy and productive life. But ... they've become commoditized.

    Professionals do not offer diagnoses unless the patient signs on for continuing treatment. Many outline this in the paperwork that gets shoved in the patient's face before they sign up for an intake or evaluation; unless you are prepared to offer this particular person your money, they are not willing to work with you in the least bit. This leads to issues with consumer confidence -- expensive co-pays and poor insurance coverage lead people to stick along with professionals they're uncomfortable with just because it's the only way that headway can be made.

    I've spent 8+ weeks in a single string of referrals. In the process, I exhausted the entirety of a very generous student health insurance package. Everyone that I spoke with was either very guarded and said they couldn't do anything for me unless I signed on for a few more sessions, or very open and said that they didn't even feel qualified. However, neither of these two responses I got contributed at all to finding a better referral -- if I asked flat-out what they thought in terms of diagnosis, to help me track someone down better, they would quote me their policy.

    The confidence crisis with the industry and the financial crisis that thrusts it firmly into the pocket of the pharmaceuticals makes it very hard for energy to be spent elsewhere -- on public image, on the improvement of axis II care and therapy (the administration/foundation of independent support groups, for example), and simply offering more affordable and accessible care.

    Many of the conspiracy theories take root in isolated instances that are actually true and really actually reprehensible -- however, they're a symptom of the struggle of the industry and not a symptom of some malevolence. Money-grubbing happens, but were it not for the money-grubbing and the catering to pharmaceuticals peddling very, very expensive medications (until recently, the atypical antipsychotics for example), the industry would not even exist in this day and age.

    I think that the federal government should intercede. The therapeutic industries need image therapy, and it needs to happen on a national level.

    words
  • WagsWags Registered User regular
    edited March 2008
    In answer to 1, it is very much real, and very much useful beyond it being a mere label. Clinician's don't diagnose just to label, they diagnose because the differing diagnoses have different prognoses. That is to say whether a person is suffering from A or B, will affect what kind of treatment course to follow and what their outcomes are likely to be. Not all clinical problems are equal and solved by the exact same thing.

    On a bit of a tangent, that video was horribly ignorant. The assertion that disorders are manufactured simply to have more ways to bill the unsuspecting public is disingenuous. A person is not likely at all to get a diagnosis unless it is causing marked dysfunction to their daily functioning or to the functioning of others. It is not a situation of people feeling a little quarky or a little blue, but otherwise getting on with life, and seeing a psychologist and that psyc deciding to turn you into a laundry list.

    Secondly, this assertion that "what would psychiatrists be with out their labels" as if this is a dirty, dirty thing is unfair. Labels can be bad, but one can easily say "what would doctors be with out their labels." Yet we don't hold MD's in contempt for categorization. It's not only the professionals who can use labels irresponsibly, but also the general public. What I'm getting at is, when a person is diagnosed with cancer, we don't say "that person is a cancer" or another example, if someone breaks a limb, we don't say "that person is broken armed." We say "they have cancer" or "they have a broken arm." We don't define the person as their problem. Yet with mental illness we seem to define people by the problems they face. We say things like "Oh, that person is a depressive" or that "that person is a schizo." We completely define them by the issue they are living with. It's an unfortunate double standard that those with a "physical" ailment do not have their person defined by their diagnosis, yet those with a "mental" ailment do. The general public often perpetuates it as well as this video you linked, for implying the only way a label can be used is to define what a person is rather than showing what a person is living with.

    My third issue with this video is it completely neglects the laws and governing bodies concerning the proper conduct of psychiatrists and psychologists. I'm not completely up on all of the laws and ethics committees and the like down in the states, but up here in canada there are some pretty clear and strict guidelines concerning decision making and ethics within the Canadian Psychological Association. The CPA damn well doesn't want to have professionals like this video suggests psych's are. The video goes on about how horrible the DSM is, but the DSM is a tool, whose contents aren't just arbitrarily put in (I'm not going to get into the research that goes into putting together DSM versions) and whose use isn't just free reign.

    The gods certainly weren't role models in our sense, unless you wanted to model a Mount Olympus trailer park.
  • LugatLugat Registered User
    edited March 2008
    1. Yes, I think it can help people to talk with someone who has some experience in talking with people who have the same problems.

    2. No, the problem of overmedication begins with over the counter drugs such as Aspirin and ends in hospitals creating MRSA. I do think that people rely too much on medication in general, which might be part of the problem.

    3. I don't think that they can help all by themselves. I think talk therapy or similar measures should always be part of a therapy against a mental problem.

    4. The pharma industry in general tries to make money as much as every other industry but I have yet to see a child drugged into oblivion. There are some cases but I think those are exeptions caused by careless doctors.

  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    Wags wrote: »
    Secondly, this assertion that "what would psychiatrists be with out their labels" as if this is a dirty, dirty thing is unfair. Labels can be bad, but one can easily say "what would doctors be with out their labels." Yet we don't hold MD's in contempt for categorization. It's not only the professionals who can use labels irresponsibly, but also the general public. What I'm getting at is, when a person is diagnosed with cancer, we don't say "that person is a cancer" or another example, if someone breaks a limb, we don't say "that person is broken armed." We say "they have cancer" or "they have a broken arm." We don't define the person as their problem. Yet with mental illness we seem to define people by the problems they face. We say things like "Oh, that person is a depressive" or that "that person is a schizo." We completely define them by the issue they are living with. It's an unfortunate double standard that those with a "physical" ailment do not have their person defined by their diagnosis, yet those with a "mental" ailment do. The general public often perpetuates it as well as this video you linked, for implying the only way a label can be used is to define what a person is rather than showing what a person is living with.

    Yeah, I've wrestled with this numerous times. Before my uncle died, my father referred to him as "a schizophrenic," but my aunt always insisted that my dad say he "had schizophrenia." It's a big distinction, but I'm not entirely sure if it's one of those things that's indicative of an actual attitude towards the subject or just something about the way people phrase it that ultimately doesn't indicate their intention and is instead just a nuance.

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  • The CatThe Cat Registered User, ClubPA regular
    edited March 2008
    I think people freak out about mental health these days because realising how many people actually have problems scares them. 'crazies' are 'supposed' to be very rare, sort of thing.

    tmsig.jpg
  • AegeriAegeri Registered User regular
    edited March 2008
    The Cat wrote: »
    I think people freak out about mental health these days because realising how many people actually have problems scares them. 'crazies' are 'supposed' to be very rare, sort of thing.

    It's even harder for many people who suffer from some sort of mental health affliction to approach someone they care about a lot to tell them. Often because they fear that person they go to would view that person once they knew as a 'crazy', 'abnormal' or worse even as potentially dangerous.

  • PalinDronePalinDrone Registered User
    edited March 2008
    Wags wrote: »
    Secondly, this assertion that "what would psychiatrists be with out their labels" as if this is a dirty, dirty thing is unfair. Labels can be bad, but one can easily say "what would doctors be with out their labels." Yet we don't hold MD's in contempt for categorization. It's not only the professionals who can use labels irresponsibly, but also the general public. What I'm getting at is, when a person is diagnosed with cancer, we don't say "that person is a cancer" or another example, if someone breaks a limb, we don't say "that person is broken armed." We say "they have cancer" or "they have a broken arm." We don't define the person as their problem. Yet with mental illness we seem to define people by the problems they face. We say things like "Oh, that person is a depressive" or that "that person is a schizo." We completely define them by the issue they are living with. It's an unfortunate double standard that those with a "physical" ailment do not have their person defined by their diagnosis, yet those with a "mental" ailment do. The general public often perpetuates it as well as this video you linked, for implying the only way a label can be used is to define what a person is rather than showing what a person is living with.

    Yeah, I've wrestled with this numerous times. Before my uncle died, my father referred to him as "a schizophrenic," but my aunt always insisted that my dad say he "had schizophrenia." It's a big distinction, but I'm not entirely sure if it's one of those things that's indicative of an actual attitude towards the subject or just something about the way people phrase it that ultimately doesn't indicate their intention and is instead just a nuance.

    I think people can be kind of put off by the thought of mental illness simply because it affects the mind--which yes, is a physical object--but as a result it can also affect the person. And when I say it affects the person, I mean it can affect things such as their personality or mannerisms, which, when these things undergo a sudden change in someone close to you, can be shocking and really difficult to wrap your head around. Sometimes when someone has a mental illness, you just don't know who they are anymore, and that can be hard to deal with.

    I'm just a beginner when it comes to studying matters of psychology, but I've had enough personal experiences with things like depression and bipolarism to know that mental illnesses can be really scary for not only the person who is experiencing it-- they can have a huge and lasting effect on the people around them who love and care for them.

    That being said, I think mental illnesses are very real but I don't agree with instantly medicating people until they are numb to all feelings. I think therapy is a good option, though obviously it might not be suited to all cases. Bottom line, drugs can help but they're not always necessary.

    Then again, I'm a no0b at this... nonetheless, I will be voraciously reading through this thread because I am in love with this subject.

  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    PalinDrone wrote:
    That being said, I think mental illnesses are very real but I don't agree with instantly medicating people until they are numb to all feelings.

    I'm glad somebody mentioned this perception. This misconception seems to be at the heart of the problem.

    The idea of the drooling, barely-there schizoid roaming around a mental hospital a la a certain Ken Kesey book is a powerful image, but, and this is the important part, you're most likely to see that sort of thing not from standard or even atypical psychopharmaceuticals, but rather from plain, old-fashioned tranquilizers, or more historically the mistreatment that was the frontal lobe labotomy. This kind of treatment is most certainly a thing of the past. They were used as a sort of last resort when no other traditional treatments had worked. The number of treatments available were admittedly limited because we're talking about the 50's through the 70's here, and that resulted in their higher frequency, but now most every psychiatrist or psychologist you'll talk to will lament those days as barbaric, as the early practitioners were often about as good as a witch doctor with an awl. Sometimes it worked, but generally with horrendous unintended results.

    Instead, what we're talking about with overmedication nowadays is not so much individuals being drugged into stupors, but rather the excessive application of drugs to groups of people. Psychiatrists are subject to fairly strict oversight. If an individual is being prescribed too much of a drug, a psychiatrist will quickly adjust the dosage, and continue to fine tune the prescription until something that works for the individual is reached. If they don't, they're a bad doctor. At that point, it's not a problem of the profession as a whole, it's just a problem with that doctor.

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  • AdrienAdrien Registered User
    edited March 2008
    PalinDrone wrote:
    That being said, I think mental illnesses are very real but I don't agree with instantly medicating people until they are numb to all feelings.

    I'm glad somebody mentioned this perception. This misconception seems to be at the heart of the problem.

    The idea of the drooling, barely-there schizoid roaming around a mental hospital a la a certain Ken Kesey book is a powerful image, but, and this is the important part, you're most likely to see that sort of thing not from standard or even atypical psychopharmaceuticals, but rather from plain, old-fashioned tranquilizers, or more historically the mistreatment that was the frontal lobe labotomy. This kind of treatment is most certainly a thing of the past. They were used as a sort of last resort when no other traditional treatments had worked. The number of treatments available were admittedly limited because we're talking about the 50's through the 70's here, and that resulted in their higher frequency, but now most every psychiatrist or psychologist you'll talk to will lament those days as barbaric, as the early practitioners were often about as good as a witch doctor with an awl. Sometimes it worked, but generally with horrendous unintended results.

    Heh, don't even get me started on that. For a few years, one of my mother's main responsibilities was administering a lifesaving treatment called ECT. Most people have heard of it. You wanna talk about misconceptions? Yow.

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  • OboroOboro __BANNED USERS
    edited March 2008
    I very narrowly dodged receiving ECT. D:

    Even in the most depressed [and generally elderly] patients, they were a hundred times as lifeless after they started ECT. They were holding it over my head as a third strike protocol since I was in and out of the hospital and on and off medication with no success, and then I squeaked out of getting sent back a third time by falsifying the evidence they were holding against me. ;/

    This is a really rich topic. Are we cool to go into the psychiatric industry in general or would that be too afar from your proposed topic, Hips? ;O

    words
  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    I don't think that's too far off base. If the general mood around here is that the anti-psychiatry movement is full of conspiracy theorists, then a more fruitful discussion is definitely welcome. I think Mr was pretty much right.

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  • AdrienAdrien Registered User
    edited March 2008
    Oboro wrote: »
    I very narrowly dodged receiving ECT. D:

    Even in the most depressed [and generally elderly] patients, they were a hundred times as lifeless after they started ECT. They were holding it over my head as a third strike protocol since I was in and out of the hospital and on and off medication with no success, and then I squeaked out of getting sent back a third time by falsifying the evidence they were holding against me. ;/

    This is a really rich topic. Are we cool to go into the psychiatric industry in general or would that be too afar from your proposed topic, Hips? ;O

    I don't mean to be flippant, but the most depressed patients are dead. If you have severe major depression that doesn't respond to medication, your prognosis is pretty pessimistic. ECT can be a breakthrough treatment in that case, but it's psychiatry; at its core, it's guesswork. I can't speak authoritatively, of course, but if you were in a situation where involuntary ECT was a real possibility, none of us can imagine what your life was like.

    My understanding is that in the case of catatonia, it can actually be something of a magic bullet. But this is all second hand, of course.

    tmkm.jpg
  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    ECT is extremely hit-and-miss, you're right. For whatever reason, it is potentially very effective with the most severe cases of depression, but everybody responds to the treatment differently.

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  • NerissaNerissa Registered User regular
    edited March 2008
    ECT is extremely hit-and-miss, you're right. For whatever reason, it is potentially very effective with the most severe cases of depression, but everybody responds to the treatment differently.

    I think this part (not just for this particular treatment but really for most treatments) is more true for mental illness than it is for (most) physical illnesses, and that is probably a big part of the basis behind the perception that mental illness is somehow less "real" than physical illness.

    If you can say that X treatment always has Y effect ( i.e. a good dose of antibiotics will usually clear up a case of strep ), it's easy for people to see that yes, it's effective, and yes, the problem was obviously caused by some external factor.

    Treating mental illness is perceived as a great deal of trial and error, which is in turn perceived as meaning the practitioner doesn't really *know* what's causing the problem, so how can they treat it? That, in turn, leads the cynical to believe that practitioners aren't even trying to help but rather trying to exploit their patients.

    Personally, I like D&D because I find OCD much more interesting than ADD.
  • GungHoGungHo Registered User regular
    edited March 2008
    I can say how many clients I've worked with who were able to get on the right medication at the right dose, and it made a huge improvement in the behaviors and personality.
    That's the rub. Sometimes it takes more than one shot to get someone on the right medication at the right dose... brain pharmacology isn't an exact science, and some people react to things differently than others. However, there's also a significant amount of onus on the patient to speak up if it's not working or making them feel/act weird and not just go cold turkey without telling anyone. You wouldn't keep taking something for your eyes or your penis that makes them swell/bleed/turn black without calling your doctor immediately, would you? Mental health is a partnership... even more so than physical health.
    Aegeri wrote: »
    The Cat wrote: »
    I think people freak out about mental health these days because realising how many people actually have problems scares them. 'crazies' are 'supposed' to be very rare, sort of thing.
    It's even harder for many people who suffer from some sort of mental health affliction to approach someone they care about a lot to tell them. Often because they fear that person they go to would view that person once they knew as a 'crazy', 'abnormal' or worse even as potentially dangerous.
    There is a very bad stigma to it, even now when people are more cognizant. While my boss knows my military history, some of my family history, marital history, etc... I'll be damned if I tell people from work that I'm bipolar and on medication to control it, because I don't want them thinking I'm going to go postal or have a "flashback", especially when I have a high-stress job. It's not a career enhancer... especially when they were talking about putting in metal detectors and other shit the last time there was an office shooting on the news.

    "Adios, mofo" -- TX Gov Rick Perry (R)
  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    Nerissa wrote: »
    ECT is extremely hit-and-miss, you're right. For whatever reason, it is potentially very effective with the most severe cases of depression, but everybody responds to the treatment differently.

    I think this part (not just for this particular treatment but really for most treatments) is more true for mental illness than it is for (most) physical illnesses, and that is probably a big part of the basis behind the perception that mental illness is somehow less "real" than physical illness.

    If you can say that X treatment always has Y effect ( i.e. a good dose of antibiotics will usually clear up a case of strep ), it's easy for people to see that yes, it's effective, and yes, the problem was obviously caused by some external factor.

    Treating mental illness is perceived as a great deal of trial and error, which is in turn perceived as meaning the practitioner doesn't really *know* what's causing the problem, so how can they treat it? That, in turn, leads the cynical to believe that practitioners aren't even trying to help but rather trying to exploit their patients.

    Also, some mental health issues can have innumerable causes, so picking out which one it is for a particular patient is difficult.

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  • wawkinwawkin Registered User
    edited March 2008
    1. Mental Diagnosis can be real, but that doesn't mean it isn't just a label. Labels are perfectly real. I find it difficult to attach validity to a science that lacks consistency in it's results. Isn't a correct diagnosis neccesarily general? Aren't details surrounding a diagnosis often couched in words of uncertainty (i.e. - 'possible', 'perhaps', 'likely cause', etc)?

    2. I agree with your assesment of the problem; however, I do not agree with your analysis concerning a remedy. Other than administering all prescription drugs under qualified supervision, how can you stop the misuse?

    3. The point of those is to limit the variation of emotional response, yes? They seem like instant-zombie drugs. In my opinion, they tend to dull the points that characterize the persons individual nature, as well as dull the supposed cause of depression or hyper-activity. I'm really not a fan of them.

    4. Are our children being overmedicated and drugged into near-comatose states by the evil psychiatric industry in an effort to make a quick buck? Yes
    It has always been business first, patient second.

    Talkin to the robbery expert.

    "This is where I say something profound and you bow, so lets just skip to your part."
  • ViolentChemistryViolentChemistry __BANNED USERS
    edited March 2008
    Let's pretend ADD isn't real. That's absurd, but let's pretend. Clearly there are still people who have a great deal of difficulty focusing in a majority of contexts. Clearly there are several prescription drugs that help to counter this difficulty and that when combined with help structuring positive study-habits and the like can help many of these people to function more effectively and more productively in society. Take note that capitalism is not a professional sport, and then give me a substantiated reason why these people should be barred from access to treatment that helps them contribute more to society than they can presently. And good luck substantiating that reason without employing any scientific research, in the cases of people who actually think psychology and psychiatry are a conspiracy.

    DAMM
    Drunks Against Mad Mothers
  • NerissaNerissa Registered User regular
    edited March 2008
    Nerissa wrote: »
    ECT is extremely hit-and-miss, you're right. For whatever reason, it is potentially very effective with the most severe cases of depression, but everybody responds to the treatment differently.

    I think this part (not just for this particular treatment but really for most treatments) is more true for mental illness than it is for (most) physical illnesses, and that is probably a big part of the basis behind the perception that mental illness is somehow less "real" than physical illness.

    If you can say that X treatment always has Y effect ( i.e. a good dose of antibiotics will usually clear up a case of strep ), it's easy for people to see that yes, it's effective, and yes, the problem was obviously caused by some external factor.

    Treating mental illness is perceived as a great deal of trial and error, which is in turn perceived as meaning the practitioner doesn't really *know* what's causing the problem, so how can they treat it? That, in turn, leads the cynical to believe that practitioners aren't even trying to help but rather trying to exploit their patients.

    Also, some mental health issues can have innumerable causes, so picking out which one it is for a particular patient is difficult.

    I'd kinda come to that conclusion myself, without any formal training in the field. Any time you can't do something simple as a blood test and say, "Look, here I find X bacteria which causes Y condition" and have to rely on a collection of symptoms, you're probably grouping together several different actual disorders under one label. But since most mental health issues only manifest as collections of symptoms, you're kinda stuck with trying to come up with some way to narrow down which one you're working with this time.

    Personally, I like D&D because I find OCD much more interesting than ADD.
  • peterdevorepeterdevore Registered User regular
    edited March 2008
    1. Can a psychiatric diagnosis be real at all? Is there any validity to the whole thing? Does it extend in purpose beyond Szasz's accusation that it's just a label? My answer is yes, of course.

    There are some clear somatic effects that are co-prevalent in some mental disorders. These and changes shown by MRI scans show that there are some disorders that can be clearly labeled as such. That does not take away that psychiatric diagnosis is largely done by talking and ticking off a DSM list however.
    2. Are the conspiracy theories valid? My answer is, in a nutshell, that there may be some measure of validity to the suspicion of such behaviors and policies, but that it's a problem with all medicine that's not exclusive to psychiatry, and that it's a problem that can be remedied by reform, transperency, and effective oversight.

    Due to capitalism, you can expect some bias from pharmaceutical companies in their findings. To think psychiatrists are 'in on it' and willfully exploit their patients is rather ridiculous. Some may be misguided by claims made by companies, but they are not malevolent.

    Agreed on point #3.
    4. Are our children being overmedicated and drugged into near-comatose states by the evil psychiatric industry in an effort to make a quick buck? I think that conspiracy theories are more harmful than helpful, and that while there are problems, it's not nearly as far-reaching as Dee and others would have you believe.

    How are you going to convince people with such a level-headed argument? Exaggerating the problems in psychiatry makes good propaganda. Some statistics seem frightening, like the amount of people on antidepressants, and the amount of children on ADHD meds. I think we can fault the eagerness of people to take meds instead of proper therapy and problem solving much more for that than the industry.

    Faulting culture and the general populace for their own problems is rather unpopular compared to faulting an industry or the government. We can't expect other people to take care of our modern problems, most people do not realize the scope of personal responsibility that comes with modern living.

    If there is one sector we can blame for the injudicious thinking of the general populace however, it's education. We can't expect that a system designed to whip 19th century germans into obedience still holds up today.

  • GungHoGungHo Registered User regular
    edited March 2008
    2. Are the conspiracy theories valid? My answer is, in a nutshell, that there may be some measure of validity to the suspicion of such behaviors and policies, but that it's a problem with all medicine that's not exclusive to psychiatry, and that it's a problem that can be remedied by reform, transperency, and effective oversight.
    Due to capitalism, you can expect some bias from pharmaceutical companies in their findings. To think psychiatrists are 'in on it' and willfully exploit their patients is rather ridiculous. Some may be misguided by claims made by companies, but they are not malevolent.
    They are not "in on it", but they are as biased as any other doc who can write a prescription is towards certain medications when pharmacutical companies come by on office visits with whatever goodies they bring along with them. It's a form of corruption, but it exists in all sorts of sectors so it's hardly a major concern. Until they find out that Lunesta makes you a Manchurian Candidate.

    "Adios, mofo" -- TX Gov Rick Perry (R)
  • AJAlkaline40AJAlkaline40 __BANNED USERS
    edited March 2008
    These sort of things are partially why I'm going into neuroscience. The thing is, all these functions of your brain exist physically, and if we can progress science to a point where we can accurately say "this is the chemical makeup of your brain, or this is the pattern of activity of your brain, and therefore you may have this and this and this disease" then we would no longer have to base our treatment plans only off of psychiatrists. More or less, in most other medical fields it's a three step process; 1. the patient's symptoms are analyzed, 2. the cause of the symptoms is nailed down, and 3. the patient is treated. In modern psychiatry, step 2 can't exist because we don't have a very firm understanding of what physically causes or how we can physically observe these diseases, they're described entirely by symptoms.

    Additionally I've been diagnosed with ADD and I do take medication for it. To be honest, I can't be particularly sure that I really do have ADD, but I can be positively sure that the medication has benefited me. Then again, I'm not exactly sure that I use my medication in a standard manner. I don't take large doses of medicine every day, instead I sort of spot treat with small doses when I need concentration. In this way I generally avoid deleterious affects to my personality (I get pissed off easier) while taking advantage of the benefits of the medicine. The medicine has had definite results, though; I've doubled my grade point average in a year and a half, and I'm still happy and the people around me have not indicated that I've had a significant change in personality.

    I suppose I could pose my own question, what if the psychiatric system were to work like this?: A patient goes to their psychiatrist with a list of aspects of their personality that they wish to change, then the psychiatrist takes those into account and supplies the person with the medicine that alters those aspects. A disease never has to really enter into it, it's just a list of things that the person wants to change about themselves. In effect, like a cosmetic psychiatry. Would people feel that is amoral? Why?

    idiot.jpg
  • WagsWags Registered User regular
    edited March 2008
    A patient goes to their psychiatrist with a list of aspects of their personality that they wish to change, then the psychiatrist takes those into account and supplies the person with the medicine that alters those aspects. A disease never has to really enter into it, it's just a list of things that the person wants to change about themselves. In effect, like a cosmetic psychiatry. Would people feel that is amoral? Why?

    Interestingly enough, you replace "medicine" with therapy/behavorial strategies/talking you basically have counselling psychology/pastoral counselling/any profession with advice giving. Funny they both do the same thing, just using different methods. In my perception, so take that for what it is, there is often this backlash with in the population against pyschopharmaceuticals because it "fucks with the personality," yet changing one's personality through other means doesn't elicit this back lash even though the evil diagnostic criteria of medicine is that it changes the personality. Funny dichotomy to me.

    For me personally, I don't find it all that amoral. I do believe people deserve to be successful so long as they aren't harming others. What one person needs to be successful is not the same as someone else and vice versa. I guess in the end to me, it's your path to walk and not necessarily for me to judge as I haven't had to walk it and frankly in the end, we all just want to be happy/successful/whatever. Though as previously said, it's important to know the benefits and the cons of each such path whether it be medication or counselling.

    The gods certainly weren't role models in our sense, unless you wanted to model a Mount Olympus trailer park.
  • OboroOboro __BANNED USERS
    edited March 2008
    There's a huge amount of conflating axis I and axis II in this thread, as well as just general ignorance of what the difference is between axis I and axis II, and the usual ignorance altogether of what axis II is.

    Yes, you're all right, this is incredibly open-shut if you want to focus on axis I disorders where the neuroscience is not just usually the cause but also the only possible solution. The waters get muddied, though, when you move to axis II -- affective and pervasive 'disorders' where medication is often there to ease symptoms, and not the condition itself. Axis II, where therapy is the end-all be-all and only possible solution ... but where medication may or may not be prescribed along the way.

    words
  • peterdevorepeterdevore Registered User regular
    edited March 2008
    I suppose I could pose my own question, what if the psychiatric system were to work like this?: A patient goes to their psychiatrist with a list of aspects of their personality that they wish to change, then the psychiatrist takes those into account and supplies the person with the medicine that alters those aspects. A disease never has to really enter into it, it's just a list of things that the person wants to change about themselves. In effect, like a cosmetic psychiatry. Would people feel that is amoral? Why?

    I think you can see a 'dependency' on a product by a company to keep you happy as something not necessarily immoral, but certainly undesirable. Once we begin to discover permanent treatments we can see that change however. It's interesting to note that right now, none of the major psychopharmaceuticals permanently cure you of the disorder, you have to keep taking them.

    As we move towards transhumanism, being able to mold our mind and bodies to our desire, we will necessarily have to become more accepting of other people's choices. When the 'gay-cure' comes around, we will have a moral shitstorm on our hands unless we come to accept that other people have the right to be different, even by choice.

    Right now the law offers you more protection if you are hated for something you can't help to be. I am still looking for good arguments why we have this dichotomy of rights between choice and nature.

    To get back to the pharmaceuticals. Right now there is a bit of a bias towards people on meds. They are often portrayed as weak willed or unwilling to go through proper therapy. Disregarding the 'dependency' issue, I can't really see how we can truly fault them for the choice they made, but I just caught myself doing it in my last post as well.

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited March 2008
    This thread is inspired by a friend of mine we'll refer to here as "Dee."

    Currently, I'm in a graduate studies program for psychological counseling and diagnosis. As such, I am largely in defense of my field when these types of disagreements come up. I do agree with Szasz in a lot of ways; notably, his arguments about labeling and stigmatism as it is applied to the patients, or what he often calls the victims, of psychology and psychiatry.

    I have a lot of respect for Szasz. I don't see him so much as a member of the anti-psychiatry movement as a satellite orbiting its penumbra. Unfortunately his (loose) alliance with the Church of Scientology damns him by association, but he differs from the CoS on one significant philosophical point: Scientologists oppose voluntary psychopharmacology. Szasz does not. If you feel you need Prozac and you go to a doctor and ask for it, Szasz would have no problem with that - he may or may not, depending on the circumstances of your life, argue that your strategy was ill-advised, but he would not want to take away your ability to take such drugs. (In fact, he's a pharma-Libertarian and believes that people should be able to do whatever they want to themselves chemically.) The Scientologists do want to take that ability away, and argue that all psychopharmacology is wrong and destructive.

    The problem here is that when you're dealing with the science of the mind, you tread on some very difficult issues that, prior to William James, were almost entirely the domain of philosophers and theologians. He's dealing with, essentially, the intersection of science and religion with nuance and sophistication that very, very few other thinkers have shown. (Szasz, Charles Tart, and Michel Foucault are the only modern thinkers that I can recall off the top of my head who deal with these questions in the same way.) And they are very, very important questions to be grappling with as they can (and IMO should) inform your moral and intellectual calculus on issues from euthanasia to the drug war to addiction treatment to intelligent design.

    Szasz sides with the CCHR because he opposes involuntary hospitalization and psychomedication. He opposes treating crazy people like criminals simply for being crazy. (And he would oppose my use of the word "crazy" in that sentence.) Unfortunately, the CCHR opposes voluntary psychomedication as well. Szasz sees the issue of voluntary medication as being so unimportant that, in TV interviews, he diverts any questions on the subject back to his pet issue of involuntary hospitalization. IMO, I feel that any good Szasz is doing to improve the treatment of the sickest patients is by far overshadowed by the harm that the CCHR is doing by dissuading the mildly and moderately ill from seeking effective treatment.
    1. Can a psychiatric diagnosis be real at all? Is there any validity to the whole thing? Does it extend in purpose beyond Szasz's accusation that it's just a label? My answer is yes, of course.

    The short answer to all your questions is "yes," of course. But it would be folly to let the discussion end there.

    ADD is a good example. Right now, in first world countries, any feasible path to personal success is going to involve sitting still in a room with books, paper, and pencils doing something that is probably going to be really repetitive and boring. Classroom learning, studying, test taking, homework, paperwork, office work, Internet research... these are the realities of living in a service and information based economy.

    So, yes, ADD is a "real" condition in that it reflects biological underpinnings that can be seen using objective measurements. (Differences in dopamine metabolites in cerebrospinal fluid, different patterns of brain activity on fMRIs, etc.) But what makes it a disease rather than a simple academic curiosity of interest only to neurobiologists is how it makes it difficult for the "sufferer" to engage with classroom and office work. So is the problem with the individual or is the problem with the way society is arranged?

    Could we be setting up our classrooms and our workplaces in such a way that people with ADD could flourish without medication? Do we refuse to do so out of a lack of funds in the education system (or out of a need to maximize corporate profits)? Are we de facto forcing people to medicate themselves through cultural pressure?
    2. Are the conspiracy theories valid? My answer is, in a nutshell, that there may be some measure of validity to the suspicion of such behaviors and policies, but that it's a problem with all medicine that's not exclusive to psychiatry, and that it's a problem that can be remedied by reform, transperency, and effective oversight.

    Conspiracy? No. But there is a problem that's compounded by expediency and by performance pressure. Your average GP needs to have 3000-4000 appointments per year in the US to keep a practice in business. That comes out to more or less one appointment every 20-40 minutes. And GPs know that patient inadherence - the tendency of patients to ignore a doctor's advice - is endemic. So if you tell a patient to get exercise, eat right, and seek therapy; that's a patient who is most likely to ignore you and never come back. So you give them a prescription knowing that, at the very least, you can require them to come back for a follow-up appointment every few months for refills.
    3. What's your opinion on psychiatric pharmaceuticals? My opinion is that it's helpful and effective, but is most effective when paired well with other forms of behavioral or talk therapy, and also that is certainly not a panacea for all that ails your brain. My opinion is substantiated by numerous studies.

    I agree with you, in general.

    However, I do think that they should be used strategically. Not just "in combination with other therapies," but when and how they're used in the context of other therapies is important. Which is one of the reasons I suppose attempts by psychologists to gain prescribing privileges.
    4. Are our children being overmedicated and drugged into near-comatose states by the evil psychiatric industry in an effort to make a quick buck? I think that conspiracy theories are more harmful than helpful, and that while there are problems, it's not nearly as far-reaching as Dee and others would have you believe.

    No.
    There are some children who are being given psychopharmaceuticals who do not need them.

    There are also children who need psychopharmaceuticals but are not getting them.

    Every reasoned analysis of the subject has come to the conclusion that the second group vastly outnumber the first.

    On an individual level, the consequences the second situation are significantly more deleterious than the consequences of the first.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited March 2008
    Wags wrote: »
    In answer to 1, it is very much real, and very much useful beyond it being a mere label. Clinician's don't diagnose just to label, they diagnose because the differing diagnoses have different prognoses.

    ...

    My third issue with this video is it completely neglects the laws and governing bodies concerning the proper conduct of psychiatrists and psychologists.

    Clinicians diagnose partly for the reasons you mention, but also because insurance companies and review boards require them to.

    Theoretically, I could go to a doctor, say, "I'm feeling kinda down, can I go on Effexor for a few months?" and he could give me a prescription for Effexor. If I pay cash for his services and cash for the drugs, he could probably get away with never diagnosing me at all.

    But if I want my insurance to pay for it, he's going to have to mark down on a form somewhere a numerical code that means that I had depression (or dysthymia or some other mood disorder).

    If the drug I want is a controlled substance - say, Oxycontin or Adderall - then there has be a diagnosis, by law.

    Even if all his patients were paying cash, and even if none of his prescriptions were controlled substances, if he hands out too many prescriptions without diagnoses, he could potentially be audited by his licensing board and potentially lose his license to practice.

    So, yes, there are legal and ethical imperatives requiring doctors to "label" their patients.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited March 2008
    Oboro wrote: »
    There's a huge amount of conflating axis I and axis II in this thread, as well as just general ignorance of what the difference is between axis I and axis II, and the usual ignorance altogether of what axis II is.

    Unfortunately, Axis I and Axis II disorders are commonly conflated in practice, especially in the US.

    There is a lot of evidence that a significant proportion of patients diagnosed with Bipolar Disorder actually have Borderline Personality Disorder. The main reason for this is insurance - most insurance companies cover medication for Axis I disorders but not for Axis II disorders. A secondary reason for this is social stigma - if you have a "biological" mental illness like bipolar, you can tell people it's a chemical imbalance in the brain and it's not your fault and you can relate your reliance on mood stabilizers to a diabetic's reliance on insulin. But if you have Borderline Personality Disorder, the implication is much more difficult to wrap your mind around. "Personality" is right there in the name of the disorder - it threatens to define you as a person and giving somebody that diagnosis carries the very real risk that they'll just reject it outright and find a new doctor.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited March 2008
    Okay, I'll stop bogarting the thread after this post.
    Instead, what we're talking about with overmedication nowadays is not so much individuals being drugged into stupors, but rather the excessive application of drugs to groups of people. Psychiatrists are subject to fairly strict oversight. If an individual is being prescribed too much of a drug, a psychiatrist will quickly adjust the dosage, and continue to fine tune the prescription until something that works for the individual is reached. If they don't, they're a bad doctor. At that point, it's not a problem of the profession as a whole, it's just a problem with that doctor.

    Real-world issues of overmedication are far, far more likely to occur when doctors don't talk to one another. Psychiatrist prescribes one drug for depression, neurologist prescribes another drug for seizures, patient breaks their leg and gets painkillers, and end up having a dangerous interaction. And that is a systemic problem, not a simple problem of individual incompetence. Even in situations where, theoretically, every doctor had complete access to the patient's records (say, Veteran's Administration or HMOs), doctors often don't check medication lists and instead expect the patient to just... remember. And I'd relate that to performance pressure as I mentioned above - it's easy to overlook when you need to see over 20 patients a day.

    But having electronic records systems would reduce the amount that that happens by at least giving providers the tools they need to cross-reference scrips, in the event that they have the time or thoughtfulness to do so.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • Mom2KatMom2Kat Registered User regular
    edited March 2008
    Feral wrote: »
    Okay, I'll stop bogarting the thread after this post.
    Instead, what we're talking about with overmedication nowadays is not so much individuals being drugged into stupors, but rather the excessive application of drugs to groups of people. Psychiatrists are subject to fairly strict oversight. If an individual is being prescribed too much of a drug, a psychiatrist will quickly adjust the dosage, and continue to fine tune the prescription until something that works for the individual is reached. If they don't, they're a bad doctor. At that point, it's not a problem of the profession as a whole, it's just a problem with that doctor.

    Real-world issues of overmedication are far, far more likely to occur when doctors don't talk to one another. Psychiatrist prescribes one drug for depression, neurologist prescribes another drug for seizures, patient breaks their leg and gets painkillers, and end up having a dangerous interaction. And that is a systemic problem, not a simple problem of individual incompetence. Even in situations where, theoretically, every doctor had complete access to the patient's records (say, Veteran's Administration or HMOs), doctors often don't check medication lists and instead expect the patient to just... remember. And I'd relate that to performance pressure as I mentioned above - it's easy to overlook when you need to see over 20 patients a day.

    But having electronic records systems would reduce the amount that that happens by at least giving providers the tools they need to cross-reference scrips, in the event that they have the time or thoughtfulness to do so.

    this is one of the reasons that you should always use the same pharmacy, and be sure to tell any doctor about all drugs you are taking if you are getting a prescription. You should have a history done if you are in an Emerg situation, and if you can't talk try to keep a card with all your meds on you in your wallet just in case. Your family might not remember the names of what you take or even that you take it.

    This is another reason for universal health care. If you can have one primary care physician rather than hopping all over the place to different walk in clinics you will have a chart that will follow you and a Doctor who knows you. By using the same pharmacy for a scripts you have another defense against interractions. They have all your records on file and it is the pharmacists job to check on interactions as well.

    Now to be more on topic.

    I have major depression. I take Effexor Xr 150mg and have done therapy. I will likely be on this medication for the rest of my life. You know what? I hate that but to me the fact that I no longer feel worthless and can enjoy things again is worth taking a pill every morning. Note that I say I have dression. I am not depressed, I would not say I am a cold, I would say I have a cold. You do not have to identify yourself as a disease.

    Depression is real, scary and real. What we really need to be doing is educating every one on mental health issues, so that people are not so margionalized by a diagnoses that could very well save thier life.

  • themightypuckthemightypuck MontanaRegistered User regular
    edited March 2008
    I agree with 4 on economic bases. It isn't a conspiracy, it's more like a natural consequence that for any system there will be people who game said system. It isn't planned. It is more an emergent property and is one of the prices you pay for having worthwhile pharmaceutical treatments to begin with. I suspect the benefits of having the medications available for people who truly need them outweighs the costs associated with overmedication. There is probably some ethical anchor to this property as well.

    “Reject your sense of injury and the injury itself disappears.”
    ― Marcus Aurelius
  • Wonder_HippieWonder_Hippie __BANNED USERS
    edited March 2008
    Feral wrote: »
    The short answer to all your questions is "yes," of course. But it would be folly to let the discussion end there.

    ADD is a good example. Right now, in first world countries, any feasible path to personal success is going to involve sitting still in a room with books, paper, and pencils doing something that is probably going to be really repetitive and boring. Classroom learning, studying, test taking, homework, paperwork, office work, Internet research... these are the realities of living in a service and information based economy.

    So, yes, ADD is a "real" condition in that it reflects biological underpinnings that can be seen using objective measurements. (Differences in dopamine metabolites in cerebrospinal fluid, different patterns of brain activity on fMRIs, etc.) But what makes it a disease rather than a simple academic curiosity of interest only to neurobiologists is how it makes it difficult for the "sufferer" to engage with classroom and office work. So is the problem with the individual or is the problem with the way society is arranged?

    Could we be setting up our classrooms and our workplaces in such a way that people with ADD could flourish without medication? Do we refuse to do so out of a lack of funds in the education system (or out of a need to maximize corporate profits)? Are we de facto forcing people to medicate themselves through cultural pressure?

    There's more I want to talk about, but I've got company over and don't really have time to. I just wanted to note how much these few paragraphs positively reek of Szasz, and that I agree with him about most of that. Our society has create a standard for normalcy that is moderately strict and rigid, and instead of shunning the people that don't toe the line like we might have done before, we're now "treating" them or hospitalizing them. It's certainly not universally true - there are lots of very real mental disorders and problems that aren't tied to societal constructs - but it's truer than I think a lot of people would like to admit.

    Spoiler:
  • PositivistPositivist Registered User
    edited March 2008
    I've been reading PA for a long time, and this is the first I've been strongly motivated to actually post.

    In reading and discussing Szasz, I think it's far more interesting to take his thoughts as philosophy rather than as a scientific argument. Remember that Szasz was a psychiatrist, and during his time in that field he encountered many psychiatric practices which we would now agree are rather abhorrent; ECT, lobotomy, etc, and I see his thoughts as a perhaps extreme, but not altogether unjustified reaction to that.

    I think the topics on which he is most interesting are involuntary commitment and the essence of mental illness. Psychology is the study of behavior; abnormal psychology is abnormal behavior. Most of us likely exhibit abnormal behavior at some point or another in our lives, and this is likely a function of how our physical brain is working at the time – but where do we draw the line between 'odd' and 'mentally disordered'? This is a philosophical, legal, or moral question – not a scientific one. Currently, mental illnesses are created very much based on social norms. Someone is mentally ill if their behavior is incompatible with current social/legal/cultural norms (and other criteria - but this is part of it). We let psychiatrists make judgments about what is and is not appropriate behavior. Shouldn't the legislature be doing that?

    Normally, we deal with behavior we consider 'wrong' with the law. We assume people have free will, and choose to do things which harm others that we call illegal, and punish them for it. However, now we are dealing with behavior by calling it an illness. Then, instead of the 'punishment' of incarceration, we often imprison people in a mental hospital indefinitely. This is a difference in approach which needs to be discussed, analyzed, and evaluated as to whether or not it is appropriate. To the extent that someone may be committed for (perhaps) the rest of their life without having committed a crime, without seeing a jury, and without the standards and protections the law provides, simply based on the opinion of medical professionals is something I see as highly problematic. The fact that we consider many of these commitments appropriate does not invalidate an attack on the approach itself.

    Szasz has no problem with voluntary psychiatry; if someone sees how they are behaving and chooses to change it with the assistance of a psychiatrist, there is no problem with this. It is forced behavioral modification that he would have a problem with, hence his strong stance against involuntary psychiatry. He was, after all, a practicing psychiatrist.

    In medicine, we do not have this problem. If a person wants medical treatment, they can have it; if not, they need not accept it. If I have a broken leg and I for some reason would prefer it to stay that way, there are no doctors locking me up against my will and forcing treatment on me. The problem is that mental illnesses affect the very decision-making agent, and necessarily bring up the question of free will. Does everyone with what we currently call a mental illness want to see a psychiatrist? No. Does that mean their mind is affected by their illness, and that they would want to see a psychiatrist and change that behavior if they were not ill? In some cases perhaps, in many others I'm not so sure, and I don't think you can be either. But even to allow for this in some cases is to assume that the psychiatrist indeed knows what their patient “really” wants more so than the patient.

    The point is that labeling someone mentally ill can be rather nebulous, and if we associate that label with the power to infringe upon a person's rights, well, you can clearly see how this could be problematic and arbitrary. More sensationalist people will see the end of a free state.

    Concerning 'danger to oneself and/or others' does this label not apply to every human being? Everyone could harm another or them self, the claim here is rather that we believe they are very likely to, so much so that we take away their liberty. Locking someone up because our best guess is that they are going to do something wrong is also highly problematic, and also does away with the presumption we have in the criminal law that people act of their own free will, and can choose whether or not to offend.

    Szasz is one of the few people who philosophically consider the intersection between psychology/psychiatry and law, and this in itself is a fascinating topic.

  • EchoEcho staring is caring Super Moderator, Moderator mod
    edited March 2008
    The Cat wrote: »
    I think people freak out about mental health these days because realising how many people actually have problems scares them. 'crazies' are 'supposed' to be very rare, sort of thing.

    Oh yes. I've done a bunch of personality tests in connection with my autism diagnose.

    I'm just barely below the definition of having borderline personality disorder and schizoid personality disorder.

    Anyone that knows me would never guess I'd be that close.

    As I said in another thread: I consider a personality to be our own individual blend of psychoses and mild personality disorders. :P

  • themightypuckthemightypuck MontanaRegistered User regular
    edited March 2008
    Oboro wrote: »
    There's a huge amount of conflating axis I and axis II in this thread, as well as just general ignorance of what the difference is between axis I and axis II, and the usual ignorance altogether of what axis II is.

    Yes, you're all right, this is incredibly open-shut if you want to focus on axis I disorders where the neuroscience is not just usually the cause but also the only possible solution. The waters get muddied, though, when you move to axis II -- affective and pervasive 'disorders' where medication is often there to ease symptoms, and not the condition itself. Axis II, where therapy is the end-all be-all and only possible solution ... but where medication may or may not be prescribed along the way.

    I think it's more an issue of: pharmaceuticals can improve people's lives. There are a lot of theories about why drugs work or don't work but the basic standard to get them on the market is black box. Do they have a measurable effect? Axis II disorders (layman's view) tend to be harder to diagnose, and possibly more difficult to treat than Axis I disorders. Hell, I think if drug treatment was effective on an Axis II disorder they would probably move it to Axis I.

    “Reject your sense of injury and the injury itself disappears.”
    ― Marcus Aurelius
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