charlie’s world…

Posted on Thursday 30 September 2010

My comment here may be considered a piece of my own obsession with Dr. Nemeroff, but in my mind, it is the eye of the storm
An Epidemic of Domestic Violence
10 deaths in 24 hours


Sep 28, 2010

Riviera Beach early Monday morning, a man forces himself inside his estranged wife’s home, kills her, four of her children and then himself. In the afternoon, a second murder suicide in Lauderdale Lakes. A woman moved to a home there from Philadelphia to escape an abusive relationship. He found and killed her, then shot himself. Hours later in Tamarac, police discover the bodies of a couple, bringing the total up to 10 murder/suicide deaths in one day. The husband had sent relatives a letter, warning them of his plans to kill his wife and himself.

“It’s horrible for one life to be lost, but when you have 10 in one day and all with domestic violence,“ said Mary Riedel, president and CEO of Women in Distress of Broward, “it’s a wake up call for the community.”  As a result, more calls are coming into Women in Distress, which provides emergency shelters and services for families suffering from domestic violence. "It’s such an epidemic problem now," Riedel said. "If you think about it, one in three women at sometime in their life will be affected by domestic violence. That’s a huge number." She adds that incidents have been getting more violent.

Abusers often have undiagnosed or untreated mental illness, according to the Chairman of Psychiatry at UM Miller School of Medicine Dr. Charles Nemeroff. “So there’s obviously a tremendous amount of rage here," Nemeroff said. "I can’t emphasize enough the contribution of alcohol and drug abuse, because these are factors that disinhibit people.”
"Abusers often have undiagnosed or untreated mental illness." Who would ever argue with that? Or with "there’s obviously a tremendous amount of rage here" or "the contribution of alcohol and drug abusefactors that disinhibit people"? While those things are self evident, that’s not my complaint. It’s what Dr. Nemeroff means when he says, "undiagnosed or untreated mental illness" that gets to me.

I don’t exactly know how to say it. In Charlie’s world, a mental illness is like an entity, a thing. And there’s a treatment, discovered or not, probably some chemical, that will fix it. So a person has psychotic depression, and you treat it with a drug. If they don’t get better, you try another one, or add one. People who don’t respond are called "treatment resistant" and get put in a trial to try something else, like an atypical antipsychotic or a vagus nerve buzzer or maybe even a morning after pill. Here are the things in that logic stream that are unproven – all of them.

So when he says "Abusers often have undiagnosed or untreated mental illness," what he means is that  the kind of crazy, controlling men who get drunk and kill their wives and themselves in a fit of jealous rage have a mental illness entity and need treatment with some as yet undiscovered drug and also have substance abuse entity. What the hell is he talking about? Such men are a complex of biological, social, and psychological forces that each have their own wide spectrum of expressions – one of which is that they rarely come to see psychiatrists. My point is that what he said doesn’t mean anything.

All of his thinking is predicated on a simplistic notion that mental illnesses are a discrete set of entities, each having a specific treatment [biological entities, biological treatments]. I guess it’s more like an infectious disease theory or a genetic disease theory. I worked in two clinics yesterday and I saw only one patient that might fit such a model – a sixteen year old with Attention Deficit disorder with Hyperactivity [diagnosable from 100 yards]. Everyone else had the kind of confusing complex of problems that afflict real people – no entities noted. Some got medicines. Some got taken off medicines. Some were helped. Some weren’t. But there was none of the clarity advertised by Dr. Charlie’s World. There never is.

My point is that I don’t know exactly what I might have said to a reporter who called about a cluster of crazy murders by jealous or crazy husbands, but it wouldn’t have been what I read in the paper up there from Dr. Nemeroff. I think it might have been a plea for women who are dealing with such a situation to never look on the earlier signs that their ex-husband/boyfriend is threatening lightly – and to take definitive and dramatic action as soon as possible. I might have said that the cluster highlights the prevalence of the problem and how such cases often end up. Once they start, there is an immediate clear and present danger. I’d say that because it’s something we know to be true, and it might make a difference.

Charlie Nemeroff is a representative of the takeover of Psychiatry by people who were determined to make Psychiatry "evidence based" – more like the rest of medicine with distinct disease categories, structured interviews, and treatment protocols. The focus was on treatments rather than a broad-based attempt to understand the breadth of the problems – more on neurochemistry than people. Psychotherapy was reduced to the application of protocolized programs like Cognitive Behavior Therapy or Dialectic Behavior Therapy. While there are aspects of those ideas that have some merit, the end result was that most people end up on medications for reported symptoms with little else to show for their time. It was an experiment with about the same success as world communism – lofty rhetoric, dismal outcome, lots of corruption. It’s time for the wall to fall…
    September 30, 2010 | 11:09 PM

    Great article, thank you.

    October 1, 2010 | 2:51 AM

    I agree, good article. What Nemeroff and psychiatry largely ignore in favor of the phrase “untreated mental illness” is that people have “problems in life.” Of course, no drug is going to fix their problems in life, but unfortunately, psychiatry has led us to believe otherwise. “Treatment resistant?” That means to me, that the person hasn’t yet gotten t the root of the problem. That would take a much more imaginative approach than offered by most present day psychiatry.

    October 1, 2010 | 11:20 AM

    btw what did you think of the Nemeroff meets Dalai Lama seminar? (if you attended that is…) the thought of Nemeroff being part of anything associated with the Dalai Lama was just incredulous to me

    October 1, 2010 | 12:22 PM

    “People who don’t respond are called “treatment resistant” and get put in a trial to try something else, like an atypical antipsychotic or a vagus nerve buzzer or maybe even a morning after pill. Here are the things in that logic stream that are unproven – all of them.”

    Let’s put Charlie aside for my purposes of our discussion and focus on the clinical treatment of the individual patient which you seem to subscribe to.

    Hmm! Let me see if I got this right. If holistic approaches fail and so too talk therapies as well as numerous medications subscribed to by psychiatry and throw in for good measure abstention from all treatments etc., just what is one to do?

    Do you sit you sit there and smile at your suicidal patient suffering for more than 3 decades from MDD with a number of suicide attempts notched into her history? Or better yet as my spouse’s psychiatrist has stated and I’ll paraphrase, “What other alternatives would you suggest?”

    I’m not here to defend Nemeroff, psychiatry or the pharmaceutical industry. I’m here to defend caring physicians who have attended to my spouse and through their knowledge and best efforts have over the past 10 years righted her course. That course being almost continuously depression free with a far better quality of life than the previous 3 decades.

    Oh by the way, that “vagus nerve buzzer” you referred happens to be an alternative we opted to try and while I’m only a lay-depression expert to my spouse approaching 5 decades and from my empirical observations and record keeping can attribute her success to that buzzer you refer to. Naturally my information can only be considered anecdotal along with that of other responders.

    Maybe in your clinical practice you just handled the everyday neurosis and/or situational causations while others tended to this most difficult population of patients to treat.

    I also never received a response from Drs. Lurie or Wolfe of Public Citizens inquiring if there were such a thing as Multi-Year Continuous Placebo Effect. It seems a number of patients I am acquainted with have similarly obtained reasonable degrees of wellness and long-term remission through the use of their buzzers as does my spouse.

    I’ll also pass along, although you admire Grassley, that his investigation or that of his underlings into VNS Therapy for Depression was half-ass in my opinion. I read careful through the full manuscript at the time of publication and I found it extremely interesting as to all the professionals having experience with the therapy that they conveniently or otherwise omitted investigating yet as I recall they included the comments of the above two named doctors having no experience in the specialty at all.

    You might also throw in to your catch all “logic stream,” rTMS currently receiving mixed reviews while DBS is still being studied.

    When nothing else works, “What other alternatives would you suggest?”


    October 1, 2010 | 4:05 PM

    I really don’t understand why the media continues to consult with and quote “experts” like Dr. Nemeroff.

    October 5, 2010 | 12:18 AM

    great post!

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