Salty Current has an updated psychiatry-skepticism-social justice reading list on her eponymous blog. That’s a subject I know little about, so I appreciate having the list.
Back in 2012, I wrote about why psychiatry is an important skeptical and social justice issue and created a short list of reading suggestions for approaching psychiatry from these perspectives. The impending release later this week of Psychiatry Under the Influence has nudged me to update it.
Much has changed since 2012, and all of the developments point to the urgency of critically examining and speaking out about psychiatry and psychopharmaceuticals. Just prior to the publication of the DSM-5 in 2013, the NIMH announced that it would no longer use psychiatric diagnoses, acknowledging that they’re not scientifically valid,* which was then publicly admitted (again) by the leaders of the APA. Studies completed over the past three years have provided more evidence of the ineffectiveness andharms of psychiatric drugs, and others have demonstrated the profound psychological effectsof marginalization and socioeconomic trauma. Professional movements challenging biopsychiatry and its drugs have continued to grow.
Today, many continue desperately to try to sell the myths about brain diseases and disorders and chemical imbalances, at the same time as others have taken to claiming astonishingly that reputable psychiatrists never made such claims at all. Countless people, including children, have had their rights violated and been injured or killed by psychiatric drugs since 2012, while pharma has reaped the profits and its representatives in psychiatry continue to operate with impunity.** Tragically, the skeptical community continues to exclude and attempt to silence critical perspectiveswhile promoting psychiatric myths. I have no doubt that they believe their arguments and recommendations to be compassionate and helpful, but genuinely helpful approaches should be based in reality and not pseudoscience.
Head over there to get the list.
Wow! Thank you so much, Ophelia.
Sadly, my four years of unpleasant experience with raising the issue have led me to expectations so low that 1) not seeing my post deleted and future comments put in moderation and being accused of the worst callousness is a refreshing change, and 2) if just one or two people choose to read some of the books thoughtfully and critically then I’ll consider the post a success.
Thank you again for having an open mind.
Well your comment on the withdrawing room post was kind of heartbreaking. Of course I wouldn’t delete it!
And you’re welcome. 🙂
This post does make me angry. My anger comes from working as a psychiatrist and watching my patients suffer and scared that maybe there is nothing I can do for some patients. SC does have valid criticisms because the brain is so complicated that we have a limited understanding of it.
Mental illnesses do exist but we still don’t really understand the pathophysiology of the brain. We can see how patients with schizophrenia have different brains from “normal.” but one patient with schizophrenia can be different from another patient with schizophrenia even though they have the same diagnosis.
The problem with the DSM is that it is just a description of symptoms but doesn’t describe the physiology of the brain. But, right now, it is the best way of standardizing the diagnoses of mental illnesses.
Another issue is that patients and doctors can expect too much from medications. Most antidepressants are prescribed by primary care physicians and they don’t have a lot of time to figure out what is really causing depression. The problem is most people don’t have access to therapists or even psychiatrists, so they only get treated for one aspect of the illness. they don’t get treatment for the psychological and social aspects of their illness.
Another question that is important is to ask how much depression, anxiety, hallucinations or mania interfere with a person’s life. If a patient is managing his or her moods, then the risks of medicines outweigh the benefits. If medicine is taking away all emotions then it is time to switch medicines and/or focus on therapy more.
I could go on and on, of course. the point is that there are people who are suffering a lot and we need to find ways that are effective and with minimization of risks and side effects. We have a long way to go. If you look at the history of psychiatry there are a lot of screw-ups but there are some breakthroughs, especially for schizophrenia and bipolar disorder. through the years, there have been more legal safeguards for patients and in research. As SC has pointed out, there are still a lot of problems.
Psychiatry can be frustrating because there is no one answer for all patients, the treatments are limited, the brain is complicated but the suffering continues. All I can do for my patients is to keep reading articles and keep trying. I hope I haven’t rambled too much.
karmacat,
You’re making the same old assertions defenders of psychiatry commonly make. They’re addressed and refuted at great length in the materials I recommend. I’m probably not going to respond to any more comments, since it’s pointless to trade assertions. I would think that as someone who has responsibility for people’s care, you especially would be interested to know if your beliefs are wrong. Please understand – I’m not arguing that there are problems with the diagnoses and medications. I’m saying quite plainly that psychiatric conceptions of mental illness or disorders are scientifically invalid (as has been publicly admitted by the heads of NIMH and the APA) – they don’t exist – and that the “medications” are no such thing. Please, please instead of arguing with me in comments read a few of the books (maybe Mad in America, Cracked, and The Myth of the Chemical Cure) and honestly engage with the evidence they present.
There are people suffering and in need of help. But pseudoscience does not help and causes immense harm.
Ophelia
Why are you promoting this anti-science bullshit on stilts?
Psychiatrists (and psychiatric medications) save lives.
Psych-denialism kills.
And on it goes.
Okay. Tell that to my patient who had rather be on clozapine and gain 50 lbs and then stop it and be tortured by voices. Tell that to another patient who couldn’t work at the library because her voices are saying they will torture her. Tell that to my patients with PTSD who cannot sleep, some of who are scared to go anywhere. tell it to patients who have felt so hopeless that they kill themselves. Until there is something better, psychiatry is all we have
SC,
I understand what you are saying and a little bit of how you feel. I just ask that you imagine what it might be like for others.
karmacat,
Please stop this. This isn’t about me or my ability to imagine what it’s like for others (or that of the authors whose works I recommend, for that matter). But I can pretty much guarantee that if you read a few of the books you’ll have a better understanding of where I’m coming from and why I’ve been persisting in this for several years in the face of nearly universal hostility and refusal to read and engage with the materials.
Karmacat said:
I’d add “the political aspects” too. “Political” in the sense of how laws and institutions organize our societies and thus contribute to well-being and suffering.
The reason talking about the political aspects of mental health could be counter-intuitive is because politics don’t fit into the therapeutic metaphor: there’s something wrong with me, I go to the doctor and get a prescription. This goes for physical health too of course.
SC,
As a research psychologist from a medical family and also as someone who has had the occasion to experience psychiatric hospitals from both sides (both as practitioner and patient), I fully support your efforts to educate people.
Ophelia,
If psychiatry skepticism is a subject you know little about, why are you publishing a statement endorsing it? You are presenting this person’s views as if they are credible when you apparently have no grounds for believing that they are.
Is anything on that list an alternative? Like, if drugs don’t work, and therapy doesn’t work, what exactly am I supposed to do over here? Because, okay, supposing that the diagnoses are all bullshit and my doctor can’t accurately describe what’s going on with me, I’m still sick. This isn’t a “skeptical and social justice” issue for me, this is a “don’t die” issue.
I admit I’m not feeling too good about this post, but I’m not feeling too good about my therapist either, and after all I’m a skeptic and a Bayesian. So I’m willing to listen… but unless the message includes “and this is where you go to actually get better” it won’t make a difference. Without a plausible alternative, it doesn’t actually matter how much you decrease my confidence in psychiatry, I’ll just keep doing what I’m doing on the slim (if it turns out to be slim) chance that you’re wrong.
I have had a mixed experience with psychiatry. On the one hand, my son was nearly ruined by being on a medication he didn’t need, that I couldn’t get him off of because his father had primary custody, and that turned him from a lively little boy with a lot of energy and endearing mannerisms into a zombie. On the other hand, something worked for me. I don’t know if it was the psychotherapy or just me coming to grips with myself. I was arguing this weekend with a friend (also a trained scientist) who is willing to take her own anecdotal evidence as proof – although she probably wouldn’t do that in any of her own scientific work. Last week, I was in a discussion with people about Myers-Briggs and learning styles, and again, anecdotal evidence. This is such an emotionally laden topic that it can destroy friendships, but a diagnosis of a disease you don’t actually have can ruin lives. I read avidly on the topic, and I must say, I find myself highly skeptical of the claims of psychiatry, in spite of the fact that “I got better”. I don’t know exactly what it is I got better from (depression was the official diagnosis, and it sure as hell felt like that) and I don’t know exactly how it is I got better. So my anecdotal evidence is only that…anecdotal. And I’ve never heard anything from advocates of psychiatry that is anything but anecdotal. So I remain skeptical.
“Ophelia
Why are you promoting this anti-science bullshit on stilts?
Psychiatrists (and psychiatric medications) save lives.
Psych-denialism kills.”
I’d just like to point out how useless that dichotomy is. NOTHING in real life is that black and white.
We may not know all the intricacies of the “hows” and “whys” of the brain’s function (and dysfunction), but we’re learning more and more as time goes on. What we do know is that some medications, through whatever mechanisms, help with certain brain dysfunctions and imbalances.
I don’t need to know how and why and which neurons are borked — I just need whatever will correct the fucking problem without making me sick(er) or killing me. So far, the things that have worked have been psychiatry and meds.
@Emily — You really ought to be directing that at Salty Current. Xe’s the one taking the absolutist “psychiatry is bad” position.
Looking over SC’s post about “Why psychiatry is an important skeptical issue,” it strikes me that most of her complaints apply equally well to (physical) medicine. “Big pharma” (not SC’s word) has an incredible amount of influence in the field. Medicine certainly has its own dark history of racism and classism, etc. Yet somehow she’s not writing about the “body-disease model” being a “historically bound product of its time.”
SC seems to take issue with the idea of classifying mental disorders as, well..disorders. I’m not exactly sure why. The brain is a thing that normally operates in a particular set of ways. Sure, there’s a fair amount of normal variation around that, but that’s as true of livers as it is of brains. Sometimes brains do things that are far enough outside the normal range, and in so doing cause the brain’s owner (not endorsing dualism here, but what else do you call it?) an undo amount of suffering, and rob them of the ability to function freely in the world. When this happens, we call it a disorder, and that’s more or less the same criteria we use when we call diabetes a disorder.
All of that isn’t to say that the brain isn’t incredibly complicated, and it’s quite hard to noodle out exactly how the brain works in a scientific way–but that’s an argument for working harder at it, not giving up on the project. There’s too much psychological suffering in the world to give up on treating it in a systematic way. And if you’re trying to diagnose and treat mental suffering in a systematic way, you’re doing psychiatry.
The anti-psychiatry movement is as disreputable as the anti-vaxxers and it is a pity to see it given space here.
Exactly. And, of course, there is a movement out there that will tell you treatment for liver disease blocks the bodies natural regenerative powers, that it is a conspiracy of the medical establishment and big pharma, that disease is just a human constrict etc etc. That is not more woo than the stuff SC is peddling here. The harm her movement would do if it had the power is almost beyond imagining. The many lives I have seen transformed for the better by psychiatric medicine lost to misery.
Let me start with that I do think that SC has this one totally and utterly wrong. However. Like with all medications or medical procedures, the right indication decides over the success of anything we do. If you weigh 130kg and have chronic back pain from disk prolapses, an operation is not likely to fix your problem. Whereas if you are a bricklayer of normal stature who put a disk out bending down, you may be cured of pain and paralysis instantly with the same procedure.
If you are hearing voices telling you to murder your family or spend all your money to buy shoes or vintage cars, medication can very much fix that.
If you have social anxiety, medication may alleviate some of the symptoms, but psychotherapy/CBT etc may be just as effective. If you’re a druggie and inject Ice every weekend, your paranoia might not respond to antipsychotics.
Like with medical diagnoses, where the definitions of diseases tend to change, include new entities and get more precise over time, the same applies to psychiatric conditions.
I have seen too many mothers, fathers, brilliant kids, druggies, actors, hell, doctors, who were a total mess hiding in bed, committing crimes or neglecting themselves to the point of near death getting better and living a normal life on psychiatric medications, to doubt that they do something.
The fact that we don’t know exactly what and how is not a good enough reason to abandon them, it’s the nature of science to figure things out as we go along. But most often in medicine, it’s the indication that matters. Get that right, you will get your patient right.
Sanity from Rorschach. And, to pick up again on the earlier comment by Gormanator, everything Rorschach said could equally truly be said of cancer. Of course in one sense ‘cancer’ doesn’t exist, is a construct,but we have still be very effective in finding treatments for many ‘cancers’ despite the cranks like Salty Current who would have us believe that the disease is caused by the medicine that pretends to cure it.
Emily Vicendese @14:
“Vaccines save lives. Vaccine denialism kills.”
I’d expect that statement to be entirely uncontroversial hereabouts.
The way this is framed it is not entirely accurate. Since vaccination adverse events have killed people, and not vaccinating has failed to kill people in statistically relevant numbers. The notion is right, vaccination inoculates against certain illnesses, and if herd immunity is >90% in a population we are looking at eradicating preventable diseases, or at least impeding their spread.
The latest flu vaccine had a reported response rate of 5% in the UK, and around 25% elsewhere. And while that, if true, is pretty dismal really, a 25% chance to not get a potentially deadly disease is still better than nothing. If you were a gamer and you could get even a 5% shield improvement, you would take it wouldnt you?
That’s part of my point, though – the situation is more complicated than that, but it’s still a fair statement that I wouldn’t be surprised to see made and accepted without an issue on this blog (and with which, to be clear, I don’t disagree). Sometimes a black and white dichotomy is useful and reasonable to make.
“’Vaccines save lives. Vaccine denialism kills.’
I’d expect that statement to be entirely uncontroversial hereabouts.”
I’d say actually, no, that sort of language is too loose. It might actually be counter-productive because people KNOW that there are risks associated with vaccines, and that vaccine denialism by itself does not kill. I’d be happier with something like
“Vaccination is based on sound science and incontrovertible evidence. Vaccine denialism is dangerous pseudoscience with no evidence to support it.”
Of course, psychiatry and vaccination are not really analogous. Psychiatry is a long way away from the success of vaccination. It (and psychology) is still a fundamentally divided research paradigm. There are a still debates over what the proper objects of study are, methodology, etc. I don’t think psychiatry is pseudoscience, though, more like an “emerging science”.
Wow, that’s a lot to read but definitely worth it. I’ll have to take a week off…
Salty Current:
I am surprised you didn’t include philosopher Ian Hacking on your list. He thinks (to put it crudely) that psychiatry confuses human kinds for natural kinds:
http://www.lrb.co.uk/v35/n15/ian-hacking/lost-in-the-forest
http://www.ts-si.org/files/IanHackingLooping.pdf
You might also want to get the current edition of New Philosopher magazine (issue #7), which has as its theme the medical industry (including the psychiatric industry):
http://www.newphilosopher.com/magazines/issue-7-health/
I should add that I am not committed to a particular view at this stage.
As someone who has worked in clinical research and also experienced a psychiatric condition myself, I have to agree with karmacat here. All areas of medicine involve risk/benefit ratios and it’s acknowledged that the those in psychiatry are narrower and trickier to determine. However, the kind of shrill, one-sided denialism in the post doesn’t belong on a science blog.
‘…genuinely helpful approaches should be based in reality and not pseudoscience.’
That sounds all warm and fuzzy. But historically ’empiricism’ was a synonym for quackery. Blindly muddling with the reality of mental illness, in the absence of clear and repeatable data and techniques, is a recipe for generating pseudo-scientific claims and practices.
David Gorski and Harriet Hall at Science Based Medicine do a fairly good job of describing the benefits of psychiatry and the problems with it. One of the pointed out that we don’t know how and why migraines happen but we, of course, still treat them. The DSM is not just opinion but there is research on all the diagnoses to make sure there is consistency and validity. Again it is a very imperfect instrument but researchers are always trying to improve diagnosing mental illness. It is important to keep improving our understanding of the brain, which is still quite the black box
The mother of my wife’s best friend (*) was at one point engaged to a man with severe bipolar disorder.
At one point, he decided to go off of his medications. Perhaps for good reason, if they made him feel lifeless, joyless, or what have you. The problem was that he didn’t follow up with other therapy or substitute medication.
Subsequently, he went on a spree of spending lots of her money on all sorts of fantastic projects (collecting vintage cars, refurbishing a tractor for the purpose of using it in tractor derbies, and some others which I’ve forgotten).
Then he killed himself, in such a manner as to ensure she, specifically, discovered his body (in her laundry room, as I recall).
But I’m totes sure he killed himself (and said best friend and her mother had to deal with all the resulting emotional and financial fallout) solely because of Big Pharma malfeasance and socioeconomic marginalisation, amirite?
Ah, left in a reference to a footnote that I ended up not including. Please disregard the (*).
karmacat, that’s false.
Please, please, please read and engage with a few of the books and the information at my links before continuing to make these assertions. I don’t understand why that seems to be too much to ask of people here. This has been going on for more than four years now – instead of a real engagement with the evidence, it’s just fallacy after fallacy (red herrings, ignorant ad hominems, popularity, authority, anecdotal and clinical impressions,…), the same assertions that are flatly contradicted by the evidence, and the demand trap (provide all the answers for and solution to my or my friend’s or relative’s problem over the internet, but if you do make any suggestion I’ll slam you for not knowing enough about the situation).
I shouldn’t have to plead with people in this community for literally years to read a few books with an open mind, but I will continue to because this is too important. There are lives at stake – people, especially kids and other vulnerable people, are being harmed terribly. If there’s any community that has the potential to critically evaluate the evidence and call out the pseudoscience, it’s this one, but people just haven’t been willing to do it. If someone were to read, say, the three books I mentioned above, and came away still believing that these were scientifically valid and reliable diagnoses and effective treatments, I would be astounded, but I would vastly prefer that to this endless litany of claims, fallacies, and refusal to engage in any meaningful way.
This model is increasingly being exposed for the harmful pseudoscience it is, while this community – which prides itself on skepticism, critical thinking, and humanist values – is among its last defenders. I don’t understand it; I really don’t.
Thank you to the people who haven’t tried to shut down critical inquiry and have kept an open mind.
“You’ll understand my argument if you just read these books!” is a pretty big warning sign for crankery, to me. I don’t expect you to provide all the evidence that’s convinced you of your position, but after looking through the linked post and some of its links on your blog, I can’t tell what your position actually is – that the DSM is not scientifically valid, that mental illnesses in some sense aren’t real, that psychiatric medication is bad and doesn’t work, I get that, but then what in your view is the cause of the suffering currently explained by mental illness, and how are people meant to deal with it? Is there a post I missed that outlines what you think people should be doing, if not diagnosing and treating mental illness as they currently are?
As is, you’re positioning yourself in the same general space as conspiracy theorists, dualists, and woo merchants, and doing little to distinguish yourself. When there’s a whole lot out there telling people they shouldn’t seek treatment or consider medication, for clearly terrible reasons, it’s hardly surprising that people aren’t much interested in your reasons for saying something so similar.
SC, I’ll be happy to tackle your reading list on one condition: it must provide a substantiated answer to “X is the most scientifically sound and evidence-based approach to treating mental illness presently known.” If all it has to say is that X is not present-day psychiatry, without saying what X is, I’m not interested.
Karmakat points out that we don’t know why or how migraines happen but we still believe they are real disorders and treat them. She could have added that one of he treatments is paracetamol and we don’t know day of how that is effective in treating pain either. But we keep on using it.
I plan to respond to these comments, but it will probably be tomorrow morning. Cats are my priority.
(I’ve clarified my argument in the karmacat-response thread, for anyone interested.)
It’s very possible that there are more familial and social and socio-political aspects to mental illness than are commonly recognized by psychiatry. Those are difficult variables to test.
Psychiatry and psychology are, if not in their infancy, still in a troublesome early adolescence.
That doesn’t mean we throw out approaches to psychological dysfunction that work. And that includes psychiatric drugs that, properly administered, save lives and improve the quality of life for sufferers.
SC thinks she’s battling on the side of sufferers. To that end, she basically tells people who suffered for decades until psychiatric meds made a demonstrable difference in their lives that they’re imagining things. Way to ally.
“SC thinks she’s battling on the side of sufferers. To that end, she basically tells people who suffered for decades until psychiatric meds made a demonstrable difference in their lives that they’re imagining things. Way to ally.”
Yep. I was feeling like I was the only one picking up the subtext of SC’s statement, and it’s nice to hear someone else point out and articulate what I’m seeing.
You know, you could take me off the meds.
It’d be a Very Bad Idea, but you could do it.
But then you’d have to deal with a complete nervous wreck who can’t keep anything down, can’t sleep, can’t stop crying, and just. wants. to. die. (And is even more depressed because xe can’t. fucking. end. it. and even if xe could, doesn’t have the energy, motivation, or attention span to go through with it.)
Tell me, how is talking to someone or deep breathing going to fix what’s wrong in my head? How is it going to make me eat? Or sleep? Or let me focus on something? Or shut up the latest niggling worry that’s waiting to explode into a full-blown panic?
I really wish I could make SC live for a month or two in my head.
I don’t particularly feel like engaging with SC after the last time I did so, but this perfect comment prompts me to chime in. As does WMDKitty expressing they felt like the only one picking up this subtext.
In no other arena would denigrating personal, lived experience be considered appropriate. But somehow, because SCIENCE!, SC gets to dismiss personal, lived experience as anecdote.
ANECDOTE: I had to leave PhD studies due to crippling major depression. After that, I lost two years of my life to deep, harmful, persistent depression (which totes doesn’t exist, right?) until I found a medication regimen that materially helped me. Prior to beginning a regimen of citalopram, I was unable to work, my relationships suffered, and I was unable to find joy in life.
So yeah, SC, when people dismiss you and consider you verging on conspiracy theories, it’s not because we’re not open to new ideas. It’s because you’re an asshole who regularly and consistently dismisses our personal, lived experiences.
A huge shout out to Ophelia Benson for legitimizing some truly harmful shit here. Well fucking done.
Apologies to everyone for what will be a somewhat long comment. In the interest of full disclosure, I commonly suffer from a variety of mental states which make my life very unpleasant, and prevent me from engaging in activities that many take for granted, and which I would like to be able to do. For several years I was prescribed a medication which seemed to help me, but had rather serious side-effects, and which was later determined to be no more effective than a placebo in ameliorating my condition. Even after I read those studies, however, I continued to take the drug and continued to experience relief for a couple of years. Now, I drink a lot, as it is incredibly effective in ameliorating my worst symptoms, though the side-effects are very serious.
I believe that SC is saying that the system of categorization of various mental states is arbitrary, and moreover is without foundation in biological reality as is acknowledged by many parties in the field. This is bad, because the model leads to systems of treatment that overprescribe meds (which have significant side-effects), and fail to address other factors that may cause undesirable mental states but which are untreatable without more fundamental and expensive changes to our society. On the other side are people who have experienced relief themselves, or seen others experience relief, after using the treatments offered by psychiatry. They are annoyed and/or angered that their personal experience is being denied, and question what the value is of toppling psychiatry when there is no alternative.
The problem, it seems to me, is that the anecdotal experiences described by those suffering and those who have treated them cannot constitute a significant objection to the assertion that psychiatry’s model is inaccurate and unscientific for the very same reasons as the experiences of those who get relief from crystals, homeopathy, and other alternative treatments do not demonstrate the truth of the various models of reality that underlie those various alternative treatments. As annoying as it might seem, a particular person’s lived experience is, at best, a single data point, and cannot by itself validate a particular treatment or a model of reality. This doesn’t mean that a person is not suffering, it just means that the model used to understand that suffering and the strategies to treat it should be reformed to allow for better understanding of reality and more effective treatments.
However, for people who are suffering, the question of how accurate or scientific a model might be is usually secondary to finding relief. I am a great believer in the value of placebos, the beneficial effect of being treated (whether or not the treatment is actually effective), and the power of hope that things can get better. It is a fact that I experienced considerable relief when, after several years of not seeking treatment, I finally did get my prescription. It is also a fact that my treatment was shown to be no more effective than placebo in treating my condition. It is possible that I was already on an upswing, and that it was this initial improvement that allowed me to get treatment in the first place, but that I would have improved even in the absence of treatment. It is also possible that my upswing resulted from a self-reinforcing cycle of behaviors and beliefs which created in me the expectation that I would actually get better. It is even possible that I was one of a small number of people for whom the treatment was pharmacologically effective (in contrast to just a placebo).
After this experience, I decided I would no longer criticize treatment systems that had allowed people I knew to experience relief who had not had relief from scientific medicine. Moreover, I would not criticize those systems to people who were interested in them but had yet to try them, if there was no alternative offered by scientific medicine. People need to believe that there is a treatment that can help them, even if the only treatment is in actuality only a placebo. Taking away a treatment that people believe is effective when there is no better alternative is not only cruel, it may be foolish, because placebos are really quite effective in many cases.
The problem here is the question of what to do if the treatment itself is potentially harmful, which I believe is the real point where SC and other critics of psychiatry on the one hand, and psychiatrists and sufferers on the other, have an issue. SC appears to believe that the treatments being used are a net detriment, whereas people who have experienced relief after being treated using this paradigm see it as a net benefit, or at least a benefit to them personally. Here is one place where the argument can become very emotional, because it involves comparing the suffering and damage of those who did not experience relief (and may not have even subjectively experienced any dysfunction prior to treatment) to those who did experience relief.
This will sound condescending, and maybe it is, but I would ask the reader to recall that I have been through this myself, and struggled with the conflict between truth and the need for relief. I think the best thing that people who have found a treatment that works for them can do is to ignore the scientific analysis of the actual effectiveness of that treatment while also keeping an eye out for new treatments that may be more effective. These people should also probably avoid delving into the foundation of the model on which their effective treatment is based. If you value the relief that you get from the treatment enough, the power of motivated thinking will make it almost impossible to keep an open mind about the treatment and the model supporting it.
I also think SC and other critics of psychiatry, and indeed any system of treatment that has no good alternatives, should be very careful to consider what kind of real damage their criticism can do, and how insulting their criticisms can be to people who are suffering. I’ve read SC on and off for years, and believe that SC’s criticisms are motivated by a desire to improve treatment outcomes. However, in this case, I think SC didn’t make clear that although mental illnesses may not be ‘real’ in the sense that the system of categorization of various mental states and conditions does not correspond to any actual physical condition (which is not to say that these mental states do not have a physical reality, but just that the way they are categorized is nonsense), the symptoms and suffering are very real, as is the relief that some people get from these treatments. I think that SC agrees with this, and it was just that having argued these points for so many years, SC didn’t bother to clarify what SC believes to be obvious at this point.
It is a complicated business, and I sympathize with both sides in the debate. I hope everyone here will be well.
AHHH! Just wanted to clarify that the bolded phrase above should be more like, ‘without foundation in the biological reality described in the model used in psychiatry’. It is not intended to mean that mental states or conditions are ‘all in the mind’ and don’t correspond to actual physical states in the brain. I apologize for my sloppiness, and hope it doesn’t contribute too much to a misunderstanding of SC. Damnit.
Here’s my response to what I quoted at #37:
First, I’ll say that I find these arguments bizarre. If a crime has been committed and we don’t know who committed it, do we refuse to hear evidence that exculpates someone on trial? Do we just say “Well, someone’s been arrested, and that’s what we’ve got”? If we don’t know what causes a problem or behavior, do we accept an explanation of demonic possession, along with corresponding torturous exorcisms? Of course not. The argument that an explanation or intervention exists and so shouldn’t be debunked unless a ready-made alternative can be immediately supplied is one I see as extremely weird and don’t support.
Moreover, I’m arguing that this is a public falsehood that works to the profit of pharma and psychiatry. It involves violations of human rights and harm on a huge scale, with children increasingly the victims. Making demands about alternatives before you’ll bother to learn the truth about it seems callous, in addition to incurious.
But yes, the materials I recommend do discuss alternatives, both in terms of our understanding of psychological and emotional experiences and distress and in terms of interventions. Some I think are valuable; others less so. And there are plenty of other sources about various specific problems.
Many of the sources of psychological suffering have long been known: authoritarian or abusive and other problematic parenting (which we can recognize and address without excessive parental blaming); traumatic violence; racism; sexism; homophobia and transphobia; cultures or hierarchies that don’t allow for the fulfillment of our real needs; political oppression and terror; poverty; social isolation and marginalization; homelessness; unemployment; injuries and sickness; austerity projects;… I’ve written about this in general and my updated list in particular includes works in this vein, but humanistically oriented people working in these fields have always appreciated it. It’s really interesting how feminist and other social-justice advocates consistently point to the effects of living in a discriminatory culture (the cumulative harm of microaggressions, stereotype threat and various challenges to confidence, etc.) but there seems to be a line drawn around the most serious forms of distress that blocks their consideration as social issues. Also, some of the same people who talk in heartbreaking terms about their childhoods or their violent victimization seem to be the most resistant to the idea that their problems aren’t rooted in a chemical imbalance or disorder.)
There’s this rich vein of humanistic psychiatry-psychology (and relevant sociology, philosophy, anthropology) – including feminist, anti-racist, liberation writing – that’s been tossed aside in recent decades. At the same time, interventions not based on the biopsychiatric model have been marginalized. It’s quite similar, I think, to what religion has done.
Of course, it’s not as simple as a one-to-one cause and effect relationship. First, all of these factors are operating at once, and some factors (especially humanistic parenting and community relationships) can go a long way to offset the negative consequences of others. So we can’t assume that the same events or situations will have invariant psychological effects. Furthermore, due to individual differences and various chance factors, people will have different defensive and self-preserving responses to their experiences, some of which will become deeply embedded. (This is why Karen Horney argues that, while we should of course work to make society most conducive to flourishing, we shouldn’t expect large-scale social change to reverse problems that have become psychologically entrenched. I plan to discuss this in my review of The Therapy Industry.) And some problems that have been falsely labeled as disorders in order to sell drugs are really the pains of human living, part of the human condition in an imperfect world, and will pass.
So naturally there’s no single approach for every problem or extreme experience, and the response to psychological and emotional problems has to be a social one that seeks to address structural problems. In terms of individual therapies, generally they should be based on the understanding of the most likely sources of pain and suffering (discussed above) and the most frequent self-protecting responses to them, recognizing how those responses can become entrenched and have long-term consequences. This can take a wide variety of forms. Above all, the response should be humanistic, compassionate, respectful, humble, and dedicated to helping people understand the roots of their struggles, and needless to say it shouldn’t be based on lies and pseudoscience.
This “ally” or “not ally” nonsense needs to stop. You know nothing about me or my personal experience.
***
PatrickG, I have not done that, and I’m surprised and horrified that that’s how you’re reading what I’m saying. Please see my comment here.
But the fact is that the placebo and other related effects are real, as everyone here recognizes when the subject is CAM “treatments.” This is why anecdotal and clinical experience can be so misleading. It’s the reason for double-blind RCTs, especially in areas in which what’s being measured is entirely a subjective state, and if you reject it here you have to reject it everywhere. It doesn’t mean people’s experiences aren’t real, and if you make that claim then you’re essentially arguing that the basic principle behind double-blind RCTs is callous and dismissive.
I really think that if you read just one of the books (Cracked? Mad in America?) you would understand that I’m not saying what you think I am. In the meantime, I would appreciate if you would stop making bullshit assumptions about me or my motives and calling me names.
Look, here’s the thing: you sound like a crank.
That doesn’t mean you’re wrong, but from what you’re saying, it’s more likely that you’re a crank than not. So before giving what you have to say much time or attention, it’s worth running a simple filter of asking what your views are, in case they’re “people need to regulate their orgone energy via crystals” or something else that would clearly indicate you’re not worth the effort. What you’re saying may seem obviously reasonable to you, but to me as an outside observer it’s not obviously different from any wooish alt-med claim about how, for example, AIDS isn’t caused by a virus but by poor nutrition / immorality / sinister Western drugs. It doesn’t help that the way you talk about “biopsychiatry” comes off to me as suspiciously dualist, like the idea that mental phenomena are based in the biological action of the brain and that treating or managing them may require medical interventions is just obviously false for some reason.
Your response does shift the odds away from crank, but it’s still vague enough not to be particularly compelling. Okay, so if I’m understanding you correctly, your contention is that much of psychiatry, in particular the diagnoses in the DSM and the pharmaceutical treatments for them, are so poorly evidenced as to be worthless – what’s labeled “schizophrenia” or “depression” is so poorly defined, ad-hoc, and lacking in scientific grounding that it doesn’t make sense to talk about “a mental illness” called schizophrenia. The obvious problem there, then, is that people do have issues that lead them to be diagnosed, and they do take medicines prescribed for their diagnosis, and at least some of those people do improve when they’re medicated (and notice a definite pattern of worsening if they stop). So maybe all such problems are the result of traumatic or stressful experiences or conditions, and there should be more focus on heading off mental health problems by reducing poverty and improving parenting and so on – sure, that’s not in principle a bad idea. But once someone ends up with an issue, are you saying the fix is to solve all the problems in their life that might have led to it? That’s not really useful to many, probably most, people actually trying to live their lives unable to remedy structural oppression. Are they to seek intervention, but definitely not drugs? So what about when they’ve tried everything they could, and it’s the drugs that seemed to actually made a difference? Is that always just the placebo effect? Or is the solution that
? That’s kind of a convenient out – if the approach you advocate doesn’t work, just wait for the problem to go away by itself. The problems that are leaving you unable to function are just the pains of human living, tough shit, suck it up. You say you don’t want to stigmatize or minimize, but surely you can see where what you’re saying has that effect regardless of your desires?
In the other thread you ask:
My suggestion: have a clear summary that you can link or paste of what you are saying, and what you’re not. Be aware that “psychiatry is totally wrong and you don’t need your pills” is a claim made by a lot of people for bad reasons, and you’re going to have to work to distinguish yourself from those people – you may feel you’re doing so by recommending books or linking articles, but that’s doesn’t actually set you apart. Saying “we should be skeptical about this” is not as small and unobjectionable a statement as you seem to think when in effect it’s “we should disregard an entire branch of medicine as pseudoscience and any ways in which people find it’s helped them as accidental”. If you think the problem is pharmaceutical treatment of mental health problems but still think people will need professional, evidence-based, medical assistance to deal with them, then maybe focus your criticism a bit more, since as far as I can see that would still require psychiatry to gather and understand that evidence and provide that assistance.
You don’t understand. I do not actually care about arguing with you. I am sick, actually sick, right now, and want the most effective possible treatment. According to the evidence which I had seen so far, I am using the most effective possible treatment. Then I met you, doing everything but waving your arms in the air and shouting “evidence, evidence, look at my evidence!”
Okay, fine. I like evidence. But evidence in favor of what? If you were right, what should I do? It’s not reasonable to expect you to have a specific treatment plan in mind, since you don’t know me and haven’t claimed to be a practitioner of whatever you think would help me. But your airy unconcern for the whole question is troubling, and telling. When your response to “How do I get better?” is “That’s a bizarre argument, and I don’t support it,” that says that your goals don’t actually include our health. When you open the conversation with a list of sources that according to you contains a mix of effective and ineffective treatment suggestions
and you haven’t tagged or mentioned or sorted by which you think is which? (And for that matter, you’re describing their quality with “Some I think are valuable” and not, say, “some have been confirmed by clinical trial”?) What are we supposed to do, read everything, pick one of the conflicting suggestions therein, and hope we guessed right? That’s not helpful even if everything you believe is true.
When you say “this is an important social justice issue”, you are saying “people are in trouble, and I am advocating for them.” But you’re not. People are in trouble, and you find our needs “bizarre” and do not support them, your actions are orthogonal to our well-being. In social justice terms, this is somewhere in the “bad ally” to “exploitation” range. Quit pretending you’re on our side, SC. You’re just trying to be right on the internet.
Can we get a flat out straight answer from you on this SC?
Robert,
I understand that you’re hurting. You’re not sick, but you’re clearly struggling. There’s no “airy unconcern” here. (And I’ll ask you, too, to stop making assumptions about my status as an “outsider” or possible “ally” – you don’t know anything about me.) I’m glad that you’ve found something that works for you (although I’m concerned because I know what the drugs do, especially over the long term). The purpose of my writing about the pseudoscience of biopsychiatry is critical and concerned – to expose a public falsehood and practice that’s having devastating effects on people’s lives. Not yours, but millions of others’. The people reading here are not the only ones affected by this, and many have no choice in the matter.
My posts aren’t addressed to you – or anyone else – personally. I don’t know you or what’s available to you. I’m not seeking to take the drugs away from you* or telling you to stop taking them (even if that was your decision, you should only do it under a doctor’s supervision). I’m not telling you to try something else instead, or seeking to provide you with a different therapy, and I would expect you to critically evaluate other models and approaches just like this one. I want to provide evidence to help you and others make more informed choices, but I have no interest in making those choices for you.
There’s just a basic problem here. There are many people who believe that CAM treatments and other forms of quackery (often far less dangerous than psychopharmaceuticals) are helping them or have saved their lives. And every day on skeptical and humanistic blogs we expose these treatments as pseudoscience. We explain that people’s anecdotal experience (and the clinical experience of doctors like Jay Gordon) is not a basis for claiming their scientific effectiveness. This isn’t to deny or dismiss their experiences, but to protect them from pseudoscience and help them make informed decisions; to warn others; and to protect those, like children, who might be subjected to these interventions without choice. We excoriate the quacks who profit off of lies. We do the same thing with religion, which many people credit with saving their lives in various ways and giving them meaning and purpose, and our answers to what should replace it are far more vague than anything I’ve presented here. And none of it is done out of callousness, although we’re not always as sensitive as we could be.
The problem is that many of the strongest voices about CAM and religion turn around and refuse to engage with the evidence that biopsychiatry is dangerous quackery. People who would be very quick to publicly stand against dangerous CAM and religious interventions then write about how they’ve come to accept that they’ll have to take psychiatric drugs for years because of their “chemical imbalance.” And even if you make a general argument, people read it as a personal comment. Things just can’t work this way. We can either feel comfortable exposing quackery, or we can remain silent about some forms out of fear of personalization and attacks, which isn’t right.
If you don’t want to read the information because you don’t think it suits your needs, don’t read it. But don’t accuse me of being uncaring because I’ve argued against harmful quackery on a blog and blog network that champion science, reason, and humanist values. I’m exposing quackery because I care about its many harms; this is legitimate whether or not I have all of the answers for everyone individually.
* I do, I should note, support a ban on all forcible or coercive drugging and the use of drugs in children.
I should’ve just linked to this post.
What needs to stop is your condescension. I’ve tried discussing this with you before, SC, and you were hurtful and condescending–in part because you failed to do what you’ve implied I should have done–realized that you knew nothing about me.
In fact I am quite sympathetic to the argument that the biological model currently popular in psychiatry is a poor one, and that familial and social problems create what we call mental illness.
I also know–first hand–that drugs can ameliorate some extreme, prolonged suffering that has nothing to do with the normal vicissitudes of life.
SC @ 49
It’s hard to “engage with evidence” that isn’t there.
So you want to let legitimately dangerous violence-prone assholes like my ex just run around unmedicated being a danger to others?
Fuck you.
And if it weren’t for meds, I wouldn’t have had a childhood.
SC again at #50:
How about showing us some actual evidence, instead of pointing us to your tin-foil-hatter “blog”?
… so, the treatment I’m getting now is dangerous quackery and harmful pseudoscience, but you’re not telling me to try something else?
To the extent that it’s based on biopsychiatry, it is, yes.
I’m providing information and encouraging people to engage with it, in the hope that everyone can make informed choices and recognize social harms. I’m not telling you to do anything. Whatever choices you make, I wish you the best.
I’m a bit perplexed by the idea that we don’t know anything about links between psychiatric conditions and mental illness. There are probably many, many millions of people by now whose debilitating depression, confusion, irritability, dementia, irascibility, suicidal thoughts and other indications of mental dysfunction have been resolved, once and for all, by the simple process of taking the correct dose of thyroxine prescribed for them. (Not forgetting those who have suffered unnecessarily for the lack of it.)
Hypothyroidism is well known as a biological cause of depression and other psychological/ psychiatric symptoms. Just because we don’t understand how and why a lack of thyroxine in the metabolism often, but not always, shows up as a “classic” set of depression and-or confusion/ dementia and-or irritability/ anti-social symptoms doesn’t mean that doctors shouldn’t do a thyroid test for someone presenting with those symptoms.
It also doesn’t mean that there is no biological cause acting to cause those symptoms if that particular test comes back as “normal”. There are some adrenal or other hormonal dysfunctions, less common than hypothyroidism, that can have similar depressive, confusion, anxiety or behavioural symptoms as part of their presentation. There are some vitamin deficiencies that can have weird, delusional effects or “straightforward” fatigue-depression symptoms – vitamin D is a common culprit for the latter problem.
And it’s also obvious that some apparently psychiatric presentations of “mental Illness” turn out to be totally and entirely due to tumours, cancerous or otherwise, interfering with normal brain function.
I’d be a lot more receptive to SC’s remarks about the lack of understanding about the links, or lack of them, between biology and mental/social functioning if there were some acknowledgement that many such presentations do have an undeniably – totally – biological basis.
Having trouble with wordpress, so I got me a new account. I’m kellyw. if anyone cares.
You’re not providing anything of value, SC (Salty Current). You think that those of us who have mental illness don’t really have mental illness. I’m not sure what your agenda is, especially since all it seems you want is people to think. That doesn’t help me, not now and not when I was in crisis. People suffering don’t have time to mentally wank when their world is going to shit. You don’t sound like someone who has experience with the mental health system. Like, maybe you’ve never seen anyone have an episode of paranoid delusions. I have. Someone who couldn’t control their thoughts and absolutely could not work because of it. Career destroyed because of the very real illness he suffered from. All the morale support in the world wouldn’t have helped him, and that’s what you pose as a solution. Unbelievable. You don’t sound like someone who’s been through the abyss, either. I have. Had to take a leave of absence from work in order to get on the right meds and the right dosage. Had lots of therapy. I’d be dead now without it.
Mental illness is an important social justice issue. We, the mentally ill, are marginalized by the not mentally ill. Our ability to get disability when we need it is largely dependent upon having a label to our conditions. If everyone at work thought I really wasn’t ill, if my doctor didn’t really think I was ill, if my therapist thought I wasn’t sick, if the government thought that mental illness was complete bullshit, I’d never been able to use the Family and Medical Leave Act to take time off of work so that I could get well. I am fairly certain I would be dead without it.
What is your personal beef? You must have some kind of stake in this, otherwise you wouldn’t have spent 4 years (?) on a crusade. What’s your story?
Wow, evasive much? You making decisions for me was never on the table. Since we’ve been having a conversation about whether it’s worth listening to you at all, I don’t believe you could have honestly thought that was a concern. The only reason for you to answer me in that way is that you don’t want me to know what you want. This is not a thing that remotely trustworthy people do.
You’re right about one thing, people with mental illnesses often have been through some bad experiences. That experience means we can see your sketchy ass coming. See ya, SC. You should probably try your pitch somewhere you can delete responses you don’t like. I hear tumblr is nice this time of year.
Oh dear. The first sentence of my previous comment was a combination of two drafts – completely borked.
… links between psychiatric conditions and mental illness … should really be
… links between psychiatric conditions and biological/anatomical disorders.
[kellyw – I changed your name on that comment, which might make it possible for you to use it in future – or might screw things up further, I don’t know; but you could try it.]
Good lord, I tried to read through the OP, but if SC would link to the source material rather than their own damn blog, there might be a chance of making sense of their claims. Burying the original material in secondary sources is a classic denialist move, as who takes the time to dig through the layers to find the truth? It’s how Natural News operates, FFS. One is forced to either take the arguments at face value or ignore.
Thanks, Ophelia, we’ll see what happens when I post. If I’m gonna be iratebowel, that’s fine by me (it’s quite fitting!)—I’ll identify myself as kellyw. in my posts for a while. I don’t want FTB to think I’m a sockpuppet or up to fuckery. I hope that’s ok.
SC (Salty Current) seems to fall under the category of “The Selective ‘Skeptic'” (coined by Emil Karlsson at Debunking Denialism
http://debunkingdenialism.com/2013/08/07/some-common-anti-psychiatry-archetypes/
An interesting read on psych denialism http://debunkingdenialism.com/2014/11/23/scientific-american-publishes-anti-psychiatry-nonsense/
Sure, kelly, that’s fine.