When “Mental” Illness Isn’t

By Neuroskeptic | December 22, 2012 11:08 am
 

There’s a theory that ‘psychiatric diseases’ like depression and schizophrenia aren’t diseases because they’re not diagnosed on the basis of any kind of biological abnormality, but purely on symptoms – unlike ‘real’ diseases like cancer and AIDS.

Now, in my view there’s quite a bit of truth in that – but there’s also a serious flaw in the argument. Sometimes, disorders diagnosed on the basis of psychiatric symptoms do turn out to have had a clear biological cause. So the original diagnosis of a psychiatric disease was correct: there was indeed a disease.

This is happening more and more often now because of biomedical advances.

A group of German neurologists and psychiatrists recently wrote about a case of a man diagnosed with bipolar disorder:

In February 2009, a 28-year-old presented to our clinic with a first episode of depression. He reported depressed mood, anhedonia, decreased drive, reduced alertness and concentration. The symptoms responded well to quetiapine 100 mg.

Fourteen months later, a first manic episode with logorrhea [excessive speech], aggressive and disinhibited behavior occurred… it completely remitted after treatment with quetiapine 1000mg. A diagnosis of bipolar I disorder was made.

Two months later, the patient presented with another depressive episode… Despite treatment with quetiapine, aripiprazole, lithium, valproate and escitalopram, the patient did not improve…

So far, seems like a fairly typical case of bipolar. However, it turned out that…

Neurological examination was remarkable for extrapyramidal symptoms with left-sided rigor and bradykinesia [slowed movements]. On initial and concurrent magnetic resonance imaging (MRI), numerous subcortical lesions in the frontal lobes were detected… Screening for autoimmune antibodies detected NMDAR antibodies.

It turned out the guy had autoimmune encephalitis: his body was generating antibodies that blocked the brain’s key NMDA receptors; the drug ketamine does that too. Treatment with immunosuppressant drugs was started and he recovered fairly quickly. For a first-hand account of the disease, in which it was also diagnosed as a psychiatric disorder initially, see the recent book Brain On Fire.

Now, let’s imagine that this had happened in 1960. What would the guy’s story have been then?

He’d have been seen by a psychiatrist and diagnosed with bipolar, just as he was today. Depending on how severe the depression was, and whether or not he had any more episodes, he might well have ended up in a psychiatric hospital.

But he probably wouldn’t have been diagnosed with a neurological disorder. He’d have tested negative for all the neurological diseases known at the time. No-one tested for NMDA antibodies back then, because NMDA receptors weren’t even discovered until 1981.

It’s true that his neurological exam showed a movement disorder (left-sided rigor and bradykinesia)  but this might well have been written off as a side effect of the high dose antipsychotics he was taking, which cause similar movement disorders.

50 years ago this guy, and many others like him, could well have ended up committed to an asylum. 100 years ago, I think it would have been almost certain he’d have been deemed ‘insane’ and locked up at some point.

If so, some of the people in psychiatric hospitals 50 or 100 years ago will have had this disease – or others. And if we didn’t know about anti-NMDA encephalitis until recently, who’s to say what we’ll discover next?

ResearchBlogging.orgChoe CU, Karamatskos E, Schattling B, Leypoldt F, Liuzzi G, Gerloff C, Friese MA, and Mulert C (2012). A clinical and neurobiological case of IgM NMDA receptor antibody associated encephalitis mimicking bipolar disorder. Psychiatry research PMID: 23246244

  • http://petrossa.me/ petrossa.me

    As always it's somewhere in the middle.The big problem with psychiatry is that symptoms are observational since the begging of time, and what with confirmation bias it's hard to say which 'syndrome' is actually correct and which isn't causing the enormous amount of misdiagnoses. Obviously according to the profession this isn't so, but anyone who spend some time on a psych forum learns quickly that almost everyone had several diagnoses, sometimes overlapping, sometimes contradictory, inflicted on them.

    Lacking this feedback, due to ignorance or arrogance, many people still suffer needlessly from wrong treatments/therapies.

  • Anonymous

    again, it appears that reductionism has the last word on (almost) all the important questions of science, unlike T.Nagel

  • Anonymous

    Of course, as Szasz said, if all mental diseases were shown to have a biological cause then psychiatry would cease to exist. When behavioural symptoms are shown to have a physical cause then the treatment is moved to a scientific medical discipline.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “Of course, as Szasz said, if all mental diseases were shown to have a biological cause then psychiatry would cease to exist”

    Right. But the most biological of psychiatrists would agree with that. The only difference is that Szasz thought it wouldn't happen in the great majority of cases… but who's to say? My point is, neuroscience is still young, we're still discovering plenty of new neurological disorders. Why assume the process won't continue?

  • Stanley Holmes

    Thanks for this very informative post.

    I'd like to point the primary causes of a pathology and the nature of its treatment don't have to always be at the same level.

    First, there are some established cases of individuals with a developemental neurodisorder, for which genetic causation (down to a specific gene) is clearly established, and where behavioral interventions are very effective (and the only treatment currently available). Then, there are some cases where psychosocial causes are very well established, and where a drug treatment has helped changed the psychosocial dynamics and 'cured' the problem.

    And I wonder what is your position on things like 'psychoneuroimmunology' for instance, or more accurately with the notion that, for some subset of psychiatric problems, 'mental/social' processes and 'cellular' processes are likely interacting with each other in such a intertwined way, that distinguishing 'mental/psychological processes' from 'cellular-level processes' as a primary causal explanation, or as to the level of the primary required treatment would be very counter-productive.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Good point.

    Also I forgot to say in the post, this is one of the arguments I made in my UPenn talk Brain Rumors; I didn't use this example but I made the point that neuroscience doesn't know everything, far from it, so the idea that only what we can measure in the brain is 'real' is a misunderstanding (and also vice versa).

  • http://www.blogger.com/profile/03474899831557543486 George Dawson, MD, DFAPA

    Excellent points. There is a lot to be said for the future of neuroscientific reductionism but there is also the cultural perception of a disease versus a syndrome. Several studies show that people in general consider depression, schizophrenia, bipolar disorder and even alcoholism diseases based on the fact that they behave like diseases. I think that the idea of a brain disease is also much different than the idea of a blocked coronary artery and yet many people tend to use that standard.

  • http://www.blogger.com/profile/16203083806436919715 Bernard Carroll

    Your case summary opens the door to the entire world of organic psychiatric syndromes, which are important not as oddities but because they mimic those of presently unknown cause. Indeed, these secondary organic cases provide salient leads to the likely mechanisms/anatomy of the so-called functional psychiatric syndromes. Down through history, syphilis on the brain has been known to present with clinical pictures indistinguishable from classical mania or psychosis or depression or personality change: it was called the great mimic. Then we have the psychoses associated with temporal lobe epilepsy; we have vascular depression; we have mood change and psychosis in Huntington disease and Parkinson disease; and more – the list is surprisingly long. My generation of psychiatrists was steeped in these diagnostic considerations.

    We often hear people assert that psychiatric diseases are fictive because no diagnostic tests exist for them. That position has always seemed illogical to me. The existence of disease is not predicated on having a laboratory test for it. The laboratory test is developed in response to the fact of disease.

  • Anonymous

    Thanks for this. I have ME, also known as chronic fatigue syndrome. We get sent to psychiatrists who say we have a behavioural disorder or some such thing, they don't cure us and they sometimes make it worse. Recently Rituxan was shown to cure two-thirds of ME patients (Mella and Fluge, oncologists in Norway). As if it was an autoimmune illness.
    But for now at least, we are still sent to psychiatrists. Patients in their teens, twenties and thirties are dying.

  • Anonymous

    Kisely et al recently made the point that cancer patients diagnosed with a psychiatric disorder had a much higher mortality rate than patients without a psychiatric diagnosis.

    The authors stated that the patients did not have the same access to specialized care – perhaps because if someone has been labeled with a psychiatric disorder (correctly or not) it is assumed they can't possibly have a severe medical disease instead or as well.

    Although the mind/body ideology has many good points, too often there is a backlash against “reductionist” thinking and it is the patient that suffers.

    The assumption that because medical and psychiatric knowledge hasn't advanced enough to accurately diagnose some patients means they do not have a disease is limiting and once again it is the patient that suffers.

  • Anonymous

    I believe that the vast majority of so-called mental illnesses are organic in cause, mostly related to vitamin deficiency, folate in particular.

    I wonder if this infection could be causing a localised vitamin deficiency.

  • Anonymous

    As Szasz has pointed out drapetomania, masturbatory insanity and homosexuality were once psychiatric diseases. Who is to say that ADHD is not just the reaction of that individual child to the prison that is called a school. Brain differences may be found but it is a society's morality that determines 'harm'. Neuroscience may in the future discover the 'abnormality' in the brain that makes someone gay. Does, as a previous poster suggested, alcoholism behave like a true disease? The danger here is that all 'unwanted' behaviour becomes subject to medical therapeutic treatments.

    • mjk

      masturbatory insanity is reality. insanity is reality. insanity is a sexual disease and has many causes and many manifestations.

      a medical approach to neglect and abuse issues is Hellish torture.

      sodomy = nerve stimulation alters the mind. the mind has dimensions, high and low, light and dark. people would like to believe that there are no natural consequences (homosexuality, masturbation, bestiality, incest, pedophilia, etc.) but there are. the sickest consequence of insanity (sexual disease) is cannibalism. jeffrey dahmer is proof.

  • Anonymous

    'So the original diagnosis of a psychiatric disease was correct: there was indeed a disease.'

    No. The original diagnosis of a mental disorder was totally wrong.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “No. The original diagnosis of a mental disorder was totally wrong.”

    The diagnosis of bipolar means, in effect, 'a disease, of unspecified nature, that causes depression and mania'.

    Which was right.

    Now if Szasz had come along and diagnosed a 'problem in living', on the other hand…

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “Brain differences may be found but it is a society's morality that determines 'harm'.”

    But that's true of much beyond psychiatry; for example, obesity is considered bad because it's associated with a higher risk of various diseases.

    However, another society, that considered obesity attractive, might consider those diseases to be a small price to pay for beauty – just as our society does consider being underweight, or undergoing unnecessary surgery, a small price to pay for being attractive… so who's right?

    There are people out there who deliberately get infected with HIV. Is HIV bad? Not for them.

  • Anonymous

    'The diagnosis of bipolar means, in effect, 'a disease, of unspecified nature, that causes depression and mania'

    Depression and mania may also be caused by abuse and trauna. Treating this as a disease and undermining that person's life experience may be devastating to some. Medical science such as neurology and psychosocial 'talk' therapy are more valid than psychiatric pseudoscience – the only medical discipline that does not actually examine the physical organ in question.

  • http://www.blogger.com/profile/01271590567394649679 Mental Illness Policy Org

    Saying mental illness doesn't exist because there is no test, is like saying colon cancer didn't exist before the invention of the colonsoscopy.
    DJ Jaffe
    http://mentalillnesspolicy.org

  • http://www.blogger.com/profile/06845842769360018122 L. Paul Strait

    @Anonymous — if that were actually accurate, we would expect something like Deplin to actually work well…

  • http://www.1boringoldman.com Mickey Nardo

    What a fine discussion. These psychiatric syndromes with medical etiology are indeed often missed. Just to add a few: Multiple Sclerosis, “Myxedema Madness”, Cushing's Disease, Brain Tumors, Avitaminosis syndromes. It is said that the commonest harbinger of Systemic Lupus Erythematosis is transient psychiatric symptoms. The “functional” mental illnesses are what's left over after those things have been ruled out…

  • Anonymous

    'Saying mental illness doesn't exist because there is no test, is like saying colon cancer didn't exist before the invention of the colonsoscopy.'

    As far as I know, the mind, unlike the colon, is not a physical object and cannot be examined using a microscope etc and cannot therefore be subject to a biological disease.

  • Anonymous

    The example here presented is just the exception to the rule: psychiatric 'diseases' have no known physical cause. Some drugs cause you to fall in love very easily, does that make 'falling in love' a disease? Or prove that ordinary falling in love has a physical cause?
    Some behavior can be elicited by pathological causes, but that just means the behavior is inappropriate in those circumstances.
    Reasoning that this example is proof of physical causes for (most) psychiatric problems is naive.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: “As far as I know, the mind, unlike the colon, is not a physical object”

    The Mind(TM) is a brand name for what's generically called the brain.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “The example here presented is just the exception to the rule…Reasoning that this example is proof of physical causes for (most) psychiatric problems is naive.”

    I didn't say most psychiatric problems have physical causes. My point is, it's an open question how many of them do, because neuroscience is young & we're still a long way from learning how the healthy brain works, let alone the diseased one.

    On the other hand cases such as this do prove one thing, which is that blanket statements that “mental illness isn't real” are wrong (even on their own terms by which 'real' means 'biological').

  • http://www.blogger.com/profile/15082555387748554859 maral sh.

    From a less scientific point of view I had written something similar to this post
    http://the-transhuman.blogspot.com/2011/12/sick-or-sage.html
    +
    Your blog is one of my favorites. Keep up the good work.

  • Anonymous

    @ Neuroskeptic:
    Of course mental problems are real!
    We know of many, many circumstances that are of influence, of which physical circumstances are the least common. So why put all the energy in experimenting en filosofising about just them?
    Social and psychological factors that can be influencend are plenty, while concrete physical factors we know of are very rare.
    Just because some medicines have a benificial influence sometimes, doesn't mean the problems are caused bij physical factors. The fact that alcohol reduces anxiety is by no means proof of a fysiological cause for anxiety.

  • http://www.blogger.com/profile/05670480634438801414 Budding Psychiatrist

    Nice piece, thanks! A small, but important proportion of psychotic presentations are likely to be autoimmune in nature and as this story develops we will get better at spotting them.

    I think however there is another important point in your post. As you note, on neurological examination, this 44 year old man had asymmetrical parkinsonism. While antipsychotics (APs) do cause these side effects, amisulpride and quetiapine are not the typical offenders and drug induced parkinsonism is usually bilateral.

    This story highlights the reason why all people with psychosis should be getting good physical exams, to spot these rarer but important causes.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    True. But 50 years ago he'd have been on chlorpromazine, which would have caused extrapyramidal symptoms. And while its true it would cause bilateral ones, those might have masked the unilateral ones. Or maybe not, but it's possible.

  • Anonymous

    @L. Paul Strait

    I think you were replying to me. L5-methyltetrahydrofolate, methylcobalamin, etc., do work. I have personal experience with them. Anyone who has discovered that they don't work clearly doesn't know what they are doing.

    People who have organic illness due to vitamin deficiency aren't just deficient in folate, B12, etc. They are typically suffering from serious malnutrition, gut problems, infections, etc. Simply giving the aforementioned substances simply isn't enough. The whole person needs to be treated.

  • Anonymous

    'The Mind(TM) is a brand name for what's generically called the brain.'

    WHO holds the patent? GSK? Why don't we just call 'mental illness' brain disease then? Much less confusing all round. Of course one may have to explain how talk therapy (or even prayer?) can cure a true medical disease. Tricky eh?

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Well, you could sit someone with cholera down, and talk them through their intestinal conflicts and 'problems in absorbing water'. And they'd eventually get better in most cases.

    Talk therapy cures cholera!

    Not to mention prayer, people thought prayer cured everything for about 5,000 years, for the same reason.

  • Anonymous

    http://www.madinamerica.com/2012/12/a-challenge-to-i-am-adam-lanzas-mother/

    Mrs Delano, received a calling and her mission in life is to suppress psychiatric illnesses and suffering and she will do so by suppressing psychiatry, psychiatrists,psychologists, psychiatric labels, and psychiatric drugs.

    This tautology is sold with zero empathy and a talent for manipulating others: textbook psychopath's conduct which works for an anti psychiatrist politician…

    According to this activist no mother must ask professional help for son threatening to kill his mother and siblings.

  • Anonymous

    So Neuroskeptic, you think that 'mental illness' is actually a brain disease and thus talk therapy is therefore useless. Does science agree?

  • Gad Mayer

    @budding psychiatrist:
    It has been my clinical impression that assymetrical drug induced EPS is the rule rather than the exception. This is also supported by systematic research:
    See pubmed ID: 2575771

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    You wrote:

    “There's a theory that 'psychiatric diseases' like depression and schizophrenia aren't diseases because they're not diagnosed on the basis of any kind of biological abnormality, but purely on symptoms”

    From my point of view they are labels. Those labels come from groups of responses (similar in their topography but not necessarily in their function).

    In a circular reasoning way those labels “magically” become “the cause” of the behaviors they were “discovered” and therefore acquiring the capacity of explaining those behaviors.

    Then, before we consider “the symptoms”, it is necessary to address the notion of mental illness itself. If we consider seriously the idea that mental illnesses are invented constructs without base, perhaps we would understand why after decades of study, no chemical imbalance has been found in the brain for any mental illness, no single breakthrough and no “cure” has been found for any of the mental pathologies proclaimed by psychiatry.
    No wonder why due to the lack of evidence, mental pathologies only exist thanks to the vote of a group of specialists (nothing to do with Science)in a “democratic” manner.

    Back to the point, I stated in my twitter account that the article contains a big non sequitur fallacy.
    For the author:
    “Sometimes, disorders diagnosed on the basis of psychiatric symptoms do turn out to have had a clear biological cause. So the original diagnosis of a psychiatric disease was correct: there was indeed a disease.”

    There are several problems with the above reasoning:

    -First: Just because “sometimes” something happen that does not mean that psychiatry is correct here. As a matter of fact it seems to me, and based on the article, it is more anecdotical or due to serendipity that we discover a real illness through psychiatric symptoms.

    -Second: If we discover a real disease then, by logic, the mental diagnostic was plainly wrong, not “correct”. As the author say “seems like a fairly typical case of bipolar. However, it turned out that…”

    -Third: Whatever treatment we try, no matter how unscientific is, if it leads to a real disease then we will be tempted to state that that treatment “works in some way”. This is a non sequitur argument and clearly wrong.

    Neurological diseases differ from mental diseases. That's why the article example would never be treated by psychiatry: There is no objective test (no fMRI, no blood test, etc) that can give us a real diagnostic for a mental illness.

    Finally, let us not forget that not all behaviors are symptoms of something. Behavior concerns the organism as a whole with his past and his environment. Behavior is about interactions, not about minds, ghosts in the machine, brains and similar locationist philosophies.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Jorge Campo: “Neurological diseases differ from mental diseases. That's why the article example would never be treated by psychiatry: There is no objective test (no fMRI, no blood test, etc) that can give us a real diagnostic for a mental illness.”

    But the example was treated by psychiatrists until it turned out to be autoimmune, and the psychiatrists were right to recognize it as a disease (it was one) and to treat it (their treatments were only symptomatic, not disease-modifying, but that's better than nothing.)

    Like I said earlier, the diagnosis of bipolar means 'a disease, of unspecified nature, that causes depression and mania', and the patient had exactly that.

    It's true that the psychiatrists didn't give a complete diagnosis, but they got halfway there.

    In the same way, if you were a paediatrician and you came across a child whose development was half what it should be for his chronological age, you would diagnose an intellectual disability and that would be meaningful (it's more true than saying he doesn't have an ID.)

    Now later a geneticist might find a deleted gene that explains the ID. But the original diagnosis of ID was correct.

  • Anonymous

    “the diagnosis of bipolar means 'a disease, of unspecified nature, that causes depression and mania',..”

    No, no, no, that is the fallacy!!!
    Bipolar disorder is nót the cause of depression and mania. It is just the descríption of it!!!

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Yes, yes, yes it is, actually, because making a diagnosis of bipolar is describing the symptoms and saying they are symptoms of a disease… of unspecified nature as I said.

    But if it were just a description, my argument would still be true however because in that case the anti-NMDA disease would be the cause of the symptoms described as “bipolar disorder”.

    Either way you look it, you lose.

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    Hi Neuroskeptic,

    what you are trying to argue in favor of psychiatry we see every day with interdisciplinary teams.
    Psychologist, speech language therapist, paediatricians, etc., refer their cases to other specialist when they cannot figure out was going on and when they suspect their cases have other reasons to happen.
    And still, that doesn't mean at all that what they do in their day to day practice is either correct or incorrect.

    Anonymous said too:
    “Bipolar disorder is not the cause of depression and mania. It is just the description of it!!!”

    and I have to agree and go further down on that:
    Bipolar, depresion or mania, they are still labels for certain behaviors we see.
    To say that those behaviors are caused by their label, is, at least, puzzling.
    Just because we cannot always figure out why the person behaves in a certain manner, that doesn't mean it has a disease, and even worse, that that disease explains those behaviors.

    In the example you use (a rare case, as I stated):

    The person received the wrong diagnose and the wrong treatment. Please notice that his depression is not at all explained in the example: we do not feel sad because we are depressed, and also we are not depressed because we feel sad.
    We feel depressed or we feel sad because a friend of us died, our girlfriend left us or because we didn't pass the SAT exam.

    Back to the case:
    The person was prescribed first with 100mg of quetiapine. It seems it worked but it didn´t since the amount was increased ten times! to 1000mg.
    That didn´t work either at the end so, the patient was treated with, what it seems, “all they have”:

    quetiapine, aripiprazole, lithium, valproate and escitalopram

    So finally, the person got a neurological examination where they discovered the NMDAR antibodies.

    To me, that's called “experimenting with all types of drugs in a patient since we have no clue”.

    Do we really need to stuff a patient with drugs to see if they produce any change on that person?
    How a failure like that can be considered positive for psychiatry.
    How it can be linked to the right diagnosis? under what conditions?
    Why the patient didn't get a scanner in the first place to discard illnesses of a different nature instead of being drugged at first?

    And still, my points from my first message remain unanswered.

  • shruti r

    On the subject of what mental illness isn't (or ought not to be)–a scapegoat for mass shootings–here's an NYT op-ed worth savaging: http://www.nytimes.com/2012/12/26/opinion/our-failed-approach-to-schizophrenia.html?hp

  • Anonymous

    http://www.madinamerica.com/2012/12/i-got-a-break-from-reality-for-christmas/

    ///(…) I realized for the first time how completely blind and unaware that even “leading” mental health professional were about the problems with labels and medications.

    I often think of what they are doing as genocide, but my friend Ken Braiterman says genocide needs to have “intent.”

    (…). During the day I was still working on my entrepreneurial approach to providing effective mental health care that completely bypasses labels and medications.

    I had the beginning of a spiritual emergency where I realized I was still connected with my friend, Al Henning, who had been killed by psychiatry and I was trying to send him home.

    At the end of the month, I started feeling good about a possible $25,000 grant that I could get if I got enough comments and online votes.
    (…)
    I decided that helping people with spiritual emergencies was one more powerful tool in solving the mental health puzzle.(…)///

    No comment needed!

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    shruti r: Thanks, but I'm staying away from that whole debate until it cools down (if ever).

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “Bipolar, depresion or mania, they are still labels for certain behaviors we see. To say that those behaviors are caused by their label, is, at least, puzzling.”

    But that's not what psychiatry says. As I've said twice in this thread already, a diagnosis of bipolar means that a disease of unspecified nature is causing the symptoms.

    Now, that theory of the causation of the behaviour may be wrong in any particular case. Like you say someone could feel sad because of a life event and then a diagnosis of depression would be wrong.

    But the disease theory could be right. In this case, it was (as I said – the diagnosis of bipolar was correct but incomplete insofar as the guy had a disease, causing depression and mania.)

    The point is, you can't just say that all psychiatric diagnoses are wrong and there's no such thing as a disease causing psychiatric symptoms because there are in fact loads of them (anti-NMDA being just one).

    At best, you could say that if you don't have one of the neurological disorders we currently know about and can test for, then you don't have a disease.

    But that assumes that we know everything about neurology which we don't.

  • Anonymous

    shruti r

    Please read what you offer us to read: the shrink wrote just the opposite of your summary:

    http://www.nytimes.com/2012/12/26/opinion/our-failed-approach-to-schizophrenia.html?hp&_r=0&pagewanted=print

    By PAUL STEINBERG
    Washington

    ///(…)TOO many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.

    Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls.(…)///

  • http://www.blogger.com/profile/16203083806436919715 Bernard Carroll

    NS said just now “… that assumes that we know everything about neurology which we don't.” I would say it a little differently… we don’t know everything about clinical neuroscience. We do, though, know enough about clinical neuroscience that we can recognize show stopper psychiatric diseases as mediated through altered brain function. I refer to mania, melancholic depression, catatonia, personality change in dementia, things like that. A good illustration in the clinical neuroscience/experimental medicine of major psychiatric disorders is the effect of lorazepam in reversing the signs of catatonia. The symptoms may have persisted for days or weeks, they are thought to be driven by abnormal circuit activity, and the drug activates inhibitory GABAergic receptors. The clinical effect is rapid and dramatic. Something similar occurs with aspects of mania in response to the cholinesterase inhibitor physostigmine, as David Janowsky and John Davis described 40 years ago.

  • Anonymous

    George Orwell explained in 1984 how the language we use controls how we can 'think'. George Lakoff explains that how we frame a metaphorical idea rules how our minds work. Psychiatry is state contolled doublethink. It has nothing to do with medicine. Think.

  • Anonymous

    George Orwell will not have approved of a bunch of sectarian antipsychiatrists unable to think straight but awfully good at selling simplistic dreams to mental illnesses sufferers!

    Those who claim that psychosis is simply and only the results of abuses and difficult life situations have just not got anything really scientific to back it up.

    The big Pharma scandal helps them thrive and get an audience and
    those demagogues oppose medicine and psychiatry as if medicine had not suffered from dishonest Pharma marketing…

    Those sectarian demagogues gain money since they sell their supposed expertise and take power over gullible sufferers.

  • Anonymous

    A man making a living out of antipsychiatry can xrite:

    http://www.madinamerica.com/2012/12/a-recent-study-of-atypical-neuroleptics-the-results-of-our-study-are-sobering/
    ///
    The are two differences between psychiatry and other forms of medicine:

    1) Psychiatric drugs are designed to cross the blood brain barrier (no-man’s land), and not only intentionally alter brain chemistry, but alter the mind as well (using subjective guess work, *at best*).

    2) These drugs (along with ECT and incarceration) are used by force. Not the case with other health conditions.

    This makes psychiatry unique – bringing politics and law (or lack thereof) into the equation.

    IMO, psychiatry is not *medical* science, but *political” (junk) science.///

    To answer only on the point of spinning data by Big Pharma which happens in all fields of medicine:

    http://www.washingtonpost.com/business/economy/anemia-drug-made-billions-but-at-what-cost/2012/07
    /19/gJQAX5yqwW_story_2.html

    http://www.npr.org/2009/12/21/121609815/how-a-bone-disease-grew-to-fit-the-prescription

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: “I'm living proof that mental illness is not a brain disease: I'm mentally ill, and I have no brain.”

  • Anonymous

    I agree with Jorge. Your 'unwanted' misbehaviour, (from the DSM), 'running or climbing trees inappropriately', ' forgetting your homework', 'not sitting still and listening to teacher', 'not being able to pay attention to stuff you are not interested in', is given a label – ADHD. Your label is then reconfigured into a 'disease', ADHD, which then becomes linguistically and magically transformed into the cause of your (mis)behaviour. This is tautological illogical pseudoscientific nonsense. As is psychiatry – the new astrology.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    You don't seem to be able to read, so there's no point my saying anything in response, I've already answered that about three times.

  • Anonymous

    George Orwell's 1984 and the description of Smith's torture is a pure example of psychiatric practise. The ability to frame ideas is determined by language so to define the metaphor defines the 'reality' one can experience. Anosognosia rules ok.

  • Anonymous

    'I've already answered that about three times.'

    Define the 'that' you have explained. Ta.

  • blackbook doc

    Jorge Campo:

    ///”Bipolar disorder is not the cause of depression and mania. It is just the description of it!!!”

    Not every one depression sufferer also suffers from maniac episodes -and not even on SSRIs treatment everyone suffers maniac episodes.

    This means that we have got a small bit of knowledge which can be used to help study different categories of depressions and their response to treatment as long as you do not take any PMTS for a maniac episode.

    Of course we work with syndromes and the DSMs are just the product of APA greed for money and power;

    I happen to agree with you about the dangerous overdiagnosing of ADHD and I worry about the drug treatment of it.

    This ADHD scandal is one good reason to try harder and diagnose with care but isn't a serious motive -for responsable people- to throw the baby with the dirty APA treated bath water.

    The story of medicine is full of syndrome who became different illnesses after clinical and fundamental science work. For some syndrome hard work and bright ideas found a cause and etiological treatment of sort like AIDS which is known to be the result of a viral infection since a couragous researcher ordered his technicians to look for a virus.

    Still, some people do claim that the AIDS virus doesn't cause AIDS like Mrs Delano claim that the mother's behavior is responsable of children rage and life threat…

    Where do you wan tto belong Jorge?

  • blackbook doc

    ano 27 December 2012 10:22

    As is psychiatry – the new astrology.

    Actually the antipsychiatry manipulative nonsenses one can read on Mr Robert Whitaker's Mad on America website under the signature of his co-runner of the website Laura Delano would shame any decent astrologer. Problem is that those antipsychiatrists are socially irresponsible since their aim is to prevent psychotic persons and family to seek psychaitric help.

    Thanks ano for the links to “A challenge to I am Adam lanza 's mother”

    http://www.madinamerica.com/2012/12/a-challenge-to-i-am-adam-lanzas-mother/

    and to “i got a break of reality for Christmas”.

    I red a comment to this:”Corinna, that’s well said. It seems to me, you have a great intellectual grasp of what you went through. In particular, you are aware that a lot of your angst was triggered by (well-founded) fear of having the mental health system intervene, as it did in the past.(…)The hair off my dog in the back seat kept blowing into my face like bullets from a death squad, and the morning sunlight on the horizon was burning holes in my windshield.” Wow. (So beautifully descriptive.)Also, I love that you conclude, “there is so much of this process that was not just scary, but glorious and giganticly interdimensional and impactful…””

    I am waiting for Mrs Delano to write a post congratulating the dead sister of the recent arsonist and killer of two firemen for not seeking help for him after their mother he doted on so much had died. Mrs Delano and follower will tell the world that no doubt that man liked to kill because psychiatry does exist…

    The shame is also that that this dangerous website is run under the moral protection of a famous USA journalist , Robert Whitaker…

  • Anonymous

    Blackbook doc – I hope you are not a real doctor. God help us all. You may state that ADHD and such fictions are over diagnosed. Of course this statement is impossible to say with a scientific medicine. Is measles over diagnosed? Can cancer be overdiagnosed? No. But you can see and define behaviour as being one thing (what one's self controls )and not the other (disease). A school shooter attempts to change his world with the most powerful weapon devised – violence. USA foreign policy is no different. http://www.guardian.co.uk/commentisfree/2012/dec/17/us-killings-tragedies-pakistan-bug-splats

  • blackbook doc

    I received an e-mail from Mr Robert Whitaker in response to my protesting the Laura Delano post bullying Mrs Liza Long “A challenge to I am Adam lanza's mother by his dear Mrs Delano, I want to share:

    ///Dear Dr. xxxxx,

    I certainly believe autism exists. I believe Laura Delano believes autism exists. She is writing in response to a blog that was posted in the U.S., in which a mother said her son, with some apparent unknown mental illness, could be a mass murderer because of his mental illness.

    She is challengel the medical model of mental illness here, which says that these disorders are due to chemical imbalances, which are then fixed by the brain. She is not saying that autism doesn't exist. You are misreading her post.

    Sincerely,

    Bob Whitaker///

  • blackbook doc

    ///Can cancer be overdiagnosed? No.///

    Yes breast cancer and prostate cancer can be overdiagnosed in the sense that people can receive harm from overscreening and overdiagnostic which result in receiving more harm than good from treatment of cancers which will not have kill them and might even have disappered.

    Lots of papers have been published on those controversies about the benefit of systematic screening.

    And osteoporosis of course is overdiagnosed to make Bad Pharma money. See like anonymous's link on that discussion :http://www.npr.org/2009/12/21/121609815/how-a-bone-disease-grew-to-fit-the-prescription

    Trouble is for you that you want to believe that psychiatry is evil when medicine is good.

    You can also believe that the earth is flat and that Jesus drove on its flat surface on a dinausor as much as you wish.It just doesn't make it true!

    That Mad in America website is worth exploring indeed to understand antipsychiatry bigotry!

    http://www.madinamerica.com/2012/11/five-types-of-mental-health-advocates/

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “Can cancer be overdiagnosed?”

    Er, yes, and some forms of it are. It's a matter of public record, Google it. Or read blackbook's comments.

  • Anonymous

    Oh dear Blackbook doc. You suffer from delusions so severe that can only be cured by cutting out little bits of your (mindTM) brain.

  • blackbook doc

    http://www.madinamerica.com/2012/12/a-challenge-to-i-am-adam-lanzas-mother/

    Ano :
    “Oh dear Blackbook doc. You suffer from delusions”

    I would not even call that a projection since I can easily find a kindred spirit of yours on the crazy comments of “A challenge to I am Adam lanza 's mother” from Mrs Dealano on Mad in America website:

    “Copy_cat on December 19, 2012 at 12:39 pm said:
    The origninal “I am adam lanza” was reputation management spam to cover all the keywords like school shooting psychiatric drug links from google index.

    If no one pointed that out already , great reply Laura !”

  • blackbook doc

    To understand the conspirationist delusional comment, it is worth knowing that for Mrs Laura Delano and followers 's tautology in Mad in America mental illnesses are caused by psychiatry. For Mrs laura Delano Mrs Liza long's son behavioral problems is due to his mother having asked psychiatry help after being threatened to death with a knife…

    NB: Not to understand that any woman her own son threaten to kill holding a knife needs empathy and not bashing is heartless and i agree with ano that she is vey manipulative and wrote like only a textbook psychopath could:

    “Would you have any desire to treat your mother with respect, with love, with dignity, if you knew that she’d written an exploitative piece to the entire world stating that she saw you no differently than she did a mass murderer?”

    When the mother reacted in panic and her life is hell.

    One subset of those antipsychiatrists is altostrata who refuses to acknowledge that JFK was not actually a Berliner and that “Ich bin a Berliner” is a figure of speech…
    http://www.madinamerica.com/2012/12/a-challenge-to-i-am-adam-lanzas-mother/
    “Altostrata on December 18, 2012 at 7:22 pm said:
    Great post, Laura.

    I also found Liza Long speaking for someone who can no longer tell her side of the story extraordinarily presumptive. Everyone is using this case to amplify his or her own cause.

    In other news, it’s rumored Adam Lanza had a paradoxical reaction to the antipsychotic Fanapt: http://www.businessinsider.com/adam-lanza-taking-antipsychotic-fanapt-2012-12

    Altostrata has a political agenda of her own which is to use psychiatric drugs side effects and withdrawing symptoms as an antipsychiatry tool by refusing to acknowledge that actually some people get less likely to kill a person their delusion make them hate and fear when taking neuroleptics and that some are greatly helped by antidepressants…

    Then the conspirationist from Mad in America website accuses Mrs Long to try to prevent the public to know that Adam Lanza killed because he was receiving psychiatric treatment…

  • Anonymous

    Neurosceptic you are wrong. Cancer is not overdiagnosed. It is the conditions that may result in a harmful cancer that are over diagnosed. From wiki 'Thus, another definition of overdiagnosis is simply the detection of pseudodisease.' Which is exactly what psychiatry deals with. But I am not a medical doctor so I leave you with the last word.

  • blackbook doc

    http://www.guardian.co.uk/world/2012/dec/19/france-europe-news

    “Psychiatrist whose patient hacked man to death convicted of manslaughter

    French judges say Danielle Canarelli was 'blind' to risk posed to public by man who committed axe murder in the Alps(…)”

    After his 2004 murder of his step grand-mather under psychotic delusions the French justice system send the schizophrenic client to be treated and not to be presented to criminal court.

    Since then he married and has one child when under Dr canarelli's care -she refused to believe the diagnostic of schizophrenia made by several colleagues – the man was always in trouble with his violent behavior because he was delusional fearing homosexual attacks etc…

    Even if the man were to suffer from an undiagnosed infectious disease or whatever better to make love than committing murders. Isn't it?

    Nb: I am not writing that every person with schizophrenia symptoms improves dramatically under neuroleptic treatment regimen and that those treatment are without side-effect.

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    Neuroskeptic wrote:

    “a diagnosis of bipolar means that a disease of unspecified nature is causing the symptoms.”

    Perhaps that's the meaning for psychiatry and for you, but I’m sorry to say I would adscribe that meaning better to wishful thinking rather than reality.

    A diagnosis of bipolar really means that the subject states (or the observation made by others) that he feels sad or empty, that he has diminished interest or pleasure in activities, etc., etc.

    Those definitions come from psychiatry themselves. They are not mine.

    If you meet their subjective criteria, then you are considered to be bipolar.
    As I said before, the behaviors were there first and then, later on, we invented a name for certain clusters of them.
    It is irrational (and tautological as somebody say ) to think that the label causes the behaviors (your “disease causing the symptoms”) specially when those labels where invented based on those behaviors.

    The problem is to consider that certain behaviors necessarily occult a disease behind.

    Do not let me wrong, we have the right to, and we must, study how stimuli interacts with the organism . That's the case of behavioral pharmacology or physiology for example. However, I believe we do not have the right to create fictitious illnesses based solely in how we behave and even worse, create treatments for those fictions (mainly drugs) and think they will work.

    Please notice that up to date nobody has objectively demostrated any of the diseases created by psychiatry. Neither have we found a “cure” for any mental disease. And let's not forget what happened with “ilnesses” as “idiocy”, “hysteria” or “homosexuality” for different reasons.
    Definitely, mental illnesses are not, and never have been, scientific in any sense.

    You also wrote:
    “But the disease theory could be right. In this case, it was (as I said – the diagnosis of bipolar was correct but incomplete insofar as the guy had a disease, causing depression and mania.)”
    I am afraid you are jumping to conclusion too fast. What we know is: The subject behaved in a certain manner. The subject received drugs which didn't change his behavior. Somehow, he got an objective test and got a different diagnostic. And wee do not know how one wrong diagnostic led to the right one.

    Notice also that what we called mental diagnosis is just: “the subject behaved in certain ways”. To say that the diagnosis is correct is to add really nothing to it:
    If you are not interested in anything, or pleasured anything I can say that you are bipolar (let's say “depressed”), but this is just a label. Now that I have that label I am not supposed to go the other way around and say that you are not interested in anything because you are depressed.

    So, what is the diagnose adding to why the person feels sad?
    Let's consider another case: a person that has lost his legs in an accident. Does not he would feel sad and, let's say “depressed”? Probably.
    Is “depression” explaining its sadness? Is his sadness explained by his depression?
    How on earth the diagnosis of depression in this person explains the fact he has lost his legs and that is the real reason why he feel depressed ?

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    (Second part of my message- it was too long for Blogger)

    Let me get back to the quote where you stated the diagnosis was correct. Checking the symptoms for NMDR antibodies we get:
    (..)All patients presented with psychiatric symptoms or memory problems; 76 of them suffered from seizures, 88 developed unresponsiveness (decreased consciousness), 86 – dyskinesias, 69 – autonomic instability, and 66 – hypoventilation

    Forgive if I am wrong me since I am entering in a foreign field: How those symptoms are related to the ones described to bipolar disease?

    As a matter of fact, it seems that some of the symptoms for immune encephalitis were left at first under the rug since they didn’t adjust well with the bipolar description:

    “It's true that his neurological exam showed a movement disorder (left-sided rigor and bradykinesia) but this might well have been written off as a side effect of the high dose antipsychotics he was taking, which cause similar movement disorders.”

    Finally you wrote:

    “At best, you could say that if you don't have one of the neurological disorders we currently know about and can test for, then you don't have a disease.”

    Again that seems a long shot too. You are implying that every single behavioral issue can be explained sooner or later looking in the brain for the right clues.

    The problem is that the brain is a necessary but not a sufficient condition for behavior. It took us a long time to remove the earth as the center of the universe, but we persist today in a similar mistake when considering that behavior is created by something called the mind which is located in an organ called the brain. That sort of “brain-centrism” is the dominant paradigm in Science. Too bad.

    There are more conceptually grounded and demonstrated alternatives to that…and obviously I am always talking about from the science perspective. ;)

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    Hi blackbook, the below sentence wasn't mine, but I agreed with it:

    ///”Bipolar disorder is not the cause of depression and mania. It is just the description of it!!!”

    Back to your message:
    the world of pathologies and mental pathologies are quite different and if we are not able to see how radically they differ from each other we are certainly in trouble.

    The conceptual background of mental illnesses, their treatments and results, unequivocally ask for a revision of the model but at its roots.
    To believe that better diagnose is the solution is, quite frankly, delusional. Instead of persisting in the same mistake over and over (the DSM-V continues on that sense) it is time to change, not to perfectionate the mistake.

    Where do I belong?
    Clearly in the side of science.

    Precisely because the scientific community didn't take seriously the flaws of psychiatry, others, like Scientology, New Age, etc. did and were quite sucessful in transmiting the wrong message: “Since psychiatry is not right, we have the answer”.

    It is time the scientific community begins to look closely at psychiatry. Some already have done so and some, are at least, considering to do so.

    As B. F. Skinner used to say:
    “Regard no practice as immutable. Change and be ready to change again. Accept no eternal verity. Experiment.”

  • Anonymous

    I totally agree with Jorge Campo.
    NS talks about psychiatric illness as a hypothetical underlying cause for de symptoms we can observe.
    But so far not a single underlying cause has been discovered!!!!
    This should make one think if we you are on the right track. But what happens is that a very rare case (such as presented in this blog) is used to illustrate that perhaps in the future more and more of such causes could be revealed. That's called wishful thinking.
    So far not one single biomarker has been detected for a psychiatric disorder.
    Yes, the brain is a necessary thing for behavior, but almost never a cause for behavior labeled as a disorder.
    Bottomline again: you are not depressed (manic, hyperactive etc.) because you have depression/mania/adhd (brain dysfunction still unknown but no doubt to be revealed in the future), again: no, no, no!!! You are depressed and we náme it depression. Just language. But then 'reification' starts and you believe there must be such a thing as a depression, and the cause must be in the brain because all awareness happens in the brain. Etc. etc.
    Thanks for your clear comments Jorge Campo!

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    “But what happens is that a very rare case (such as presented in this blog) is used to illustrate that perhaps in the future more and more of such causes could be revealed. That's called wishful thinking.”

    You're just not paying attention. I didn't say that. All I was saying is that this case proves that anyone who says that psychiatric disorders never have a biological cause – i.e. you – are verifiably wrong.

    Actually, I can see why you're not paying attention, because if you did you'd be admitting your mistake.

  • Black book doc

    Jorge,

    I am glad you are on the side of science and I think the best you could do for medical science would be to give a little of your own money to a good lab or a good clinical research unit.

    Sincerely.

    What I like with psychiatrists is that they are clever since to enter med school you have to be; and hard working since you cannot survive med school when lazy.

    Also, general med school makes psychiatrists very aware of the difficulties and shortcommings of medical science and medical practices.Trouble is in French speaking countries often psychoanalysis washes the brain of too many psychiatrists too often.

    (One of the brightest of the fRMI gang I ever met told me that her lab will be soon suppressed in French speaking Switzterland because the academic psychoanalyst psychiatrists didn't feel they need to spend the money on her work.)

    Skinner like other great theorical psychologists worked with rats or people devoid of mental illnesses. Great to sell those people soap, business training or third wawe psychology costly therapies or whatever.

    In the meantime psychoanalysts run the show in psychiatry with disastrous results opening a boulevard for Bad Pharma to promote the silly monoaminergic theory of mental illnesses and to make GPs believe that every sadness was a depresion disease to be treated for life etc…

    To give you just two examples of your shortcomings on one of your point:

    “To believe that better diagnose is the solution is, quite frankly, delusional”:

    1)Can't you read that dear Bernard caroll remind the lay people that a benzodiazepine can cure catatonia -a psychiatric condition that can kill the person.In clear it means that to make the diagnosis of catatonia can be life saving on the condition that the psychiatrist is a good doctor and not a psychoanalyst who think that the woman doesn't move because she wants a penis and her mother is a typical schizophrenic mother.

    2) Pr Hans Asperger's clinical work taught the world that you can be autistic with good verbal skills at a young age and a good IQ (to resume it crudly). His diagnostic work makes persons with Asperger's syndrome free from being diagnosed as antisocial personality disorder or rude or even schizophrenia-you name it.Plus they can get the special needs help at school and at the work place -when they choose to do a coming out, so to speak.

    The APA didn't describe (discover in a way) Asperger's syndrome and want to suppress it (DSM5). it shows that comittees cannot elect diseases and make classifications. No more , no less.

    PS: Jorge , since you are a Skinner's fan -and I like his work too- you must know that to be aggressive and assertive is OK as long as you can endure the consequences of your behavior: if you want to ignore what psychiatrists like dear Bernard put on the debate and call him delusional you have to assume being demonstrated stupid.

    I don't care to be called delusional what I have difficulty with is arrogant stupidity.

  • Anonymous

    NS, I didn't pay attention because I have add, so please don't blame, it's because of my disease :)

    Of course, sometimes there is a specific physical cause in psychiatry. But this is so very rare, that you cannot build your theory of everyday psychopathology on that. Even less can you decide which therapy to choose on this. A very good rule of thumb for every day psychiatric work is: there is nothing wrong with your patient's brain. It's the least likely place to search for things out of order.
    But: never say never, I agree with you on that. Sometimes pigs can fly.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Ah, now you're revealing what I pointed out in the OP – that you think you understand the brain far better than anyone currently does, so well in fact, that you can definitively diagnose someone as not suffering from any brain disease – even the ones that we can't even conceive of yet.

    In other words… that you are the ultimate biological psychiatrist!

    That's always been the inconvenient truth of antipsychiatry.

  • Black book doc

    Hi again Jorge,

    Reading your own website, you are selling ABA therapies.

    Pr Mottron from Montreal is reputed to say that the persons with autisms and their families fall under the rule of the stalinists of ABA -and you are one of those for sure reading your own website- when they are lucky enough to escape the tzars of psychoanalysis.

    ABA is not a miracle, it doesn't work at all for some autistic children and the ABA practitionners are wrong in asking for very costly and intensive ABA therapies for every autistic children.

    The only proven advantage of intensive ABA -without any stats needed – is that it makes a lot of work and then money for disonest psychologists who fail to tell the parents that TEACH and other techniques work better for some autistic children and that aspies do not like too much ABA when they accept it at all.

    -see Pr Gillberg MD and team latest work showing that half intensive autism therapy works as nicely as very intensive autism therapy and some children do not gain anything from it-

    You wrote to me :

    ///Hi blackbook, the below sentence wasn't mine, but I agreed with it:

    “Bipolar disorder is not the cause of depression and mania. It is just the description of it!!!”///

    To believe that a psychiatric label is the main cause of psychiatric symptoms you need to have your intelligence and critical senses washed away by antipsychiatrists of the worst sort like the scientologists or many of Mr Robert Whitaker 's bloggers on his website “Mad in America” Corinna West and Laura Delano between others-see the links to their outragous posts in this discussion.

    Bad Pharma marketing and mental illnesses stigmatization in the general population and unfortunatly in many of the mental health professionals- with misconducts of the worst sort in some psychiatric hospitals- make it easy to find believers and followers for the antipsychiatrists.

    Idem for the psychoanalysts accusing the mothers's behavior to a child to be rersponsable for autism which makes parents becoming antipsyhiatrists and blind buyers of the most costly private ABA therapies.

    For the Mrs Laura Delano and the worst of psychoanalysts -the lacanians to be precise- to declare a mother responsable for her children's behavior is a sure win since the silly Freudian influence in society is still strong when the man was a crook like Bruno Bettelheim was another to remain in your field of expertise,ie the autisms, dear Jorge.

    (I know those were MD although Freud never was and never wanted to be a psychiatrist unlike Dr Szasz who became rich as a psychiatrist telling mental disease sufferers that they were OK with all the authority of a psychiatrist! DR Breggin is another sacred cow of the antipsychiatrists and both the later must have let some clients go to hell or a psychiatric hospital because reassurances are not a reasonable treatment of every psychosis.

    Of course, the clinical description of any illness is never the cause of it and even lab tests are not always giving away a causality in medicine.

    To give you an example: Even if I were to take a red or redish liquid out of your spinal canal through a lumbar puncture it will not means I would then knew the only one possible causation for your sudden very severe headache etc..!

    ( I will have the choice between trauma, vascular malformations, or bleeding diatheses that can be intramedullary, subarachnoid, subdural, or epidural.)

    Plus the history of medicine is full of nice clinical description of the cluster of symptoms of disease long before the causation of it was found like from the ancient Greeks the diabetis type 1 acurate description with the sudden production of lots of sugary urines by young people who died quickly after loosing a lot of weight…

  • Anonymous

    NS says: “Ah, now you're revealing what I pointed out in the OP – that you think you understand the brain far better than anyone currently does, so well in fact, that you can definitively diagnose someone as not suffering from any brain disease – even the ones that we can't even conceive of yet.”

    I just mean to say: there is no (need to talk of) brain disease until proven otherwise.
    There is absolutely no reason to search for brain pathology in everyday psychiatric problems like depression and anxiety. Or even psychosis and mania. Just to be sure you can do a one time neurological examination, even MRI, but almost never you will find anything wrong.
    And why keer searching for possible physical factors when psychosocial factors are so abundant?
    NS, what I mean to say: it is hardly necessary for a psychiatrist to understand the brain. He just has to be aware that sometimes (almost never) there can be a distinct brain pathology involved in the problems.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    That's a weak response. First you assume – as I pointed out – that our current ability to detect neurological diseases by biological tests is perfect, and then you question why anyone would want to.

    So not only are you claiming to be the ultimate neuroscientist, you're also claiming to be the ultimate psychologist.

    While people throughout history have felt that some minority of behaviours are simply inexplicable in normal terms, and reached for supernatural or other explanations, you deny this… except in cases where you with your knowledge of neuroscience can detect a biological cause.

    And yet, you'll claim that you're just being skeptical of psychiatry.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    To make that clearer: you say “There is absolutely no reason to search for brain pathology in everyday psychiatric problems like depression and anxiety. Or even psychosis and mania.” Now I agree with that in most cases of depression & anxiety, but most psychiatrists do too, so you're not being very anti-psychiatric there. At best you're being anti- the American Psychiatric Association.

    But with psychosis and mania there obviously is a reason to suspect that they're caused by a disease because (inter alia) we know they can be caused by diseases (e.g. the one in my post, and many others, thyroid stuff, Cushing's, syphilis, and of course by drugs.

    If you see someone on amphetamine or crack, and then you see someone manic, you'll be struck by the similarity.

    By itself that doesn't prove anything of course. But it does deflate your 'no reason to suspect' thing.

  • Black book doc

    “And why keer searching for possible physical factors when psychosocial factors are so abundant?”

    Why bother to do clinical examination and lab tests to diagnose coronary thrombosis or whatever physical pathologies when -as you stated- “psychosocial factors are so abundant” often in that kind of “somatic pathology”?

    To improve present and future treatments and to rule out false diagnosis come to mind.

    Sometimes I think we have to come back to the time where you couldn't qualify in France as a psychiatrist without qualifying as a neurologist as well before choosing to practice neurology or psychiatry.

  • Athena

    Is Ivana Fulli trying to disguise herself as “blackbook doc?”

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Hmm. Good question.

  • Black book doc

    My identity a good question?

    Are you serious anonymous neuroskeptic?

    And can't you keep your attention on the important subject of your post?

  • http://www.blogger.com/profile/09469017420000014493 Jorge Campo

    Some misterious person wrote:
    “can't you keep your attention on the important subject of your post?”

    you mean “the stalinist behaviorists”? or perhaps how I get rich through ABA? to put just two examples.

    If you want (at least) me to take you seriously, please:

    1. Refrain your ad-hominem attacks
    2. Stop jumping from subject to subject like a butterfly from flower to flower
    3. Do not patronize thinking the rest are ignorant
    4. Stop twisting other people words and think twice before you get that easy to certain conclusions.
    5. Leave your anonymity aside
    6. (The most difficult one) Try to explain what it is that produce all of the above and that desperate defense of psychiatry.

    Best regards.

  • Black book doc

    Dearest Jorge,

    To compete with you on logic is out of the question after reading your production but i will agree that you are rather looking for your age…

    “What it is that produce all of the above and that desperate defense of psychiatry?”

    The fact that people like you and your fellow antipsychiatrists are much worst that psychiatrists for public health and clients in the spirit of what sir W C said of democracy:”It has been said that democracy is the worst form of government except all the others that have been tried.”

  • Athea

    I'm pretty sure that “blackbook doc” is indeed Ivana Fulli. Her peculiarly incoherent rants and ad hominem attacks are easily recognizable. (She recently got kicked off of Mad In America for posting a barrage of personal attacks.) I wonder what her DSM Dx is, not that I think they have any validity beyond describing “unusual” behavior. Anyone care to flex some diagnostic muscle and venture a guess? What fun!

  • Athena

    Oopsy. I neglected to proof read my own name. Athena

  • 4 black book doc

    ” I wonder what her DSM Dx is, not that I think they have any validity beyond describing “unusual” behavior. Anyone care to flex some diagnostic muscle and venture a guess? What fun!”

    A manipulative antipsychiatrist in full rage proposing to use the DSM as an intimidation tool!

    How fun and informative.

    Not as informative as the content of Mrs Laura Delano psychopathic post against Mrs Liza Long 's “I am Adam Lanza 's mother” though:

    http://www.madinamerica.com/2012/12/a-challenge-to-i-am-adam-lanzas-mother/

  • Athena

    Yep. It's Ivana all right.

  • Suzanne

    How can you say that a paychiatrist's “treatment” of a misdiagnosed “disease” is “better than nothing?” the drug treatment (with neuroleptics especially) can be dangerous and neurotoxic.

  • Suzanne

    Stupid iPhone. The above was supposed to be a response to something Neuroskeptic posted on Dec. 25. Never mind.

  • Black book doc

    Suzanne,

    About the subject of that post , had the client committed suicide when severely depressed or being killed in a traffic accident when intoxicated (in a real maniac state people take many risks and make mistakes of every sort you can imagine ) an etiological cure would not have been possible.

    A dead person cannot receive a proper treatment – besides the fact that immunosuppressants are not sugar pills…

    One of the biggest lies of the fundamentalist antipsychiatrists is that nobody ever can benefit from a psychiatric label or a psychiatrist’s prescription when it can saves lives and also make people live a better life.

    Other big lies psychosis, depression and mania are good for your spiritual awaking and makes you a superior human being or that otehr people's behavior are the only responsable for your condition (the trauma theory) with society at large and family having only the right to suffer in silence your most violent or disturbing behaviors.

    The reality is that some people would not accept to be deprived of antidepressants and for other people neuroleptics make them able to have a family and a proper job.

    It is a fact and I even met a a recovery meeting in London a man who told us that he chose a depot form in order to prevent his youngest children to know about his neuroleptic treatment and risk an accidental ingestion of neuroleptics.

    In medicine, psychiatry included, symptomatic treatments can be extraordinarily useful in relieving symptoms- be it drugs or psychological and educational interventions like ABA and other autisms. It is a fact that down syndrome is due to three 21 chromosomes instead of two but caring and education not genetic treatment is the good practice for the time beings.

    (Please, Suzanne, read Stanley Holmes above in the discussion.)

    Every potent recreational or medical drug, psychological intervention, diet, or surgical procedure has side effects which means that you have to be very careful in taking and prescribing them.

    Many people die in rich countries as a result of medical treatments or surgical procedures and it is always a risk/benefit decision to take- or give your child- a potent drug.

    For a concrete example, when an orthopedic surgeon cannot fix a brocken bone(s) with a simple cast working “on the open” or even introducing pins through the skin means taking the risks of an anesthesia accident, of a nasty chronic bone infection.

    Do we want many people unable to walk properly or use an arm properly when a surgical procedure might have prevent it for a terror of the evil orthopedic surgeons induced by bloggers on a “Brocken bone in America” website ?

    We need more science not less of it and some of the big lies of antipsychiatrists are of a fundamentalist obscurantist intrinsic frightening quality with psychiatry becoming the “Big Satan” and Mrs Laura Delano pretending that she received the calling to make earth a better place by suppressing psychiatry as a mean of suppressing mental illnesses…

    Idem for labels: some people and families want a label for the benefits it offers.

    NB: Mr Robert Whitaker refused to an Asperger's syndrome person activist the right to respond on Mad In America to Mrs Laura Delano post abusing Mrs Liza Long infamous and cruel post ” A challenge to I am Adam Lanza's mother”

    PS: I am for peers support and the least possible psychiatric drugs prescription what I am against is fundamentalist antipsychiatrists forbidding anyone to benefit from psychiatric drugs and any single mother dealing with a violent behavior of an adolescent to cry for help.

  • Suzanne

    My question was directed to Neuroskeptic. My intent is not to be combative, but to challenge an assumption Neuroskeptic mentions that misdiagnosing a physiological problem as a mental problem and then treating that physiological problem with psychotropic drugs is “better than nothing.” I wonder if he thinks it may be possible that such mistreatment could instead be “worse than nothing.” For example if a child with Chiari malformation is misdiagnosed with and treated for a psychiatric disorder, might that mistreatment be “worse than nothing?” Who knows what kind of damage such treatment might do to a developing brain? Or what about misdiagnosing a thyroid condition as depression? Might treatment with an SSRI be worse than no treatment, considering that they carry a black box warning in the U.S. for increased risk of suicidal thinking and behavior? I don’t understand why NS would say that mistreatment is “better than nothing.” However, I don’t really expect a response, as this thread has gotten rather stale.

    But while I’m bothering to blather on, I may as well mention that DSM-IV chair Allen Frances’ recent piece on Mislabeling Medical Illness as Mental Disorder might be of interest. http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder

    PS: Neuroskeptic’s tag line made me laugh out loud. Does he see himself as the Austin Powers of neuroscience?

  • http://www.blogger.com/profile/04103502029181168438 E

    'The Mind(TM) is a brand name for what's generically called the brain.'

    This is a re-run of the dualism /materialism theory of mind debate. Dualists form an orderly cue here behind the psychiatrists while materialists form another orderly cue here behind the neurosurgeons. The question is do Psychiatrists believe that their drugs are ever disease modifying? Or are they simply offering palliative treatments for neurological/ immunological conditions that have yet to be discovered or properly diagnosed?

  • Black Book doc

    Suzanne,

    It is a pity that Dr Frances Allen didn't retired some decades earlier becoming available to critic harshly the man who would have had to direct the previous DSM task force in his place then!

  • http://www.blogger.com/profile/10982658260354790408 retrun

    And with DSM, would this gentleman have the wiggle room to ever be diagnosed accurately?

  • me

    the initial diagnosis of bipolar I turned out to be wrong, when in the end the right diagnosis in DSM IV TR would have been mood disorder due to a general medical condition. there’s nothing wrong about that, given the timely, financial, and logistic limitations of diagnostic testing for (all) possible underlying diseases. the IgM NMDA antibody is a great catch, but fairly uncommon. my point is that as neuropsychiatric research advances, psychiatry will do so as well.

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Neuroskeptic

No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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