Psychiatric Diseases…

Posted on Wednesday 29 May 2013

Suffering and Sadness Are Not Diseases
Harvard University Press Blog
by Richard Noll
28 May 2013

But the DSM effect on human lives is dramatic. Justification is provided for the widespread misapplication of drug therapies for millions of people who, as collateral damage, now suffer needlessly from side effects and withdrawal symptoms. Symptom relief, if it occurs, is often temporary and mild. Psychosocial factors, especially in children and adolescents, are often ignored. But this reflects the implicit cognitive categories of our historical epoch: in a radically biological psychiatry there can be no epistemic space for the unique individual circumstances or personal context in which symptoms arise. Neither DSM-5 nor ICD-10 reflects the wisdom of centuries of clinical observation, deep phenomenological understanding, or biomedical research in psychiatry. All mental disorders are not created equal.

Indeed, there is only a small subset of the hundreds of DSM mental disorders which serve as useful heuristics for clear biomedical conditions: schizophrenia, bipolar I disorder [in post-pubertal adolescents and adults, only rarely in children], obsessive-compulsive disorder, autism, dementia, panic disorder, and a presumed small fraction of those so loosely diagnosed with ADHD. Not included in DSM-5 are melancholia [a severe endogenous depression] and catatonia. For some, future treatments may target the endocrine system, the immune system, the microbiome, and other novel “whole body” physiologies. Let’s continue to deepen our understanding of genes, receptors, neurotransmitters, and brain circuits, but let us also widen our imagination to explore other medical hypotheses.

Whether the hundreds of remaining DSM mental disorders will continue to fall under the jurisdiction of psychiatrists as biomedical specialists within general medicine is doubtful. Other primary care medical specialties and non-medical professions already perform most of those services. Most of these conditions respond well to empathy and effortful changes in diet, exercise, cognition, and behavior. None of these actual remedies comes in pills…

A supervisor once said, "We have a hierarchy of identities – person, physician, psychiatrist, psychotherapist – and they come in order from first to last." His meaning is obvious, but it also happens to be a way that I think in general. I think of what I call the Psychiatric Diseases in a specific way. They are diseases in my mind – things to be diagnosed. There are many versions of the list of Psychiatric Diseases. Here’s Dr. Noll’s from above:
    … schizophrenia, bipolar I disorder [in post-pubertal adolescents and adults, only rarely in children], obsessive-compulsive disorder, autism, dementia, panic disorder, and a presumed small fraction of those so loosely diagnosed with ADHD. Not included in DSM-5 are melancholia [a severe endogenous depression] and catatonia…
Dr. Ed Shorter recently came up with a shorter list of sure things:

    … The point is that, floating around in nosological cyberspace, there are diagnoses that correspond to what people really have. Some, such as melancholia, possess genuine biological validation: the dexamethasone suppression test [DST], high serum cortisol, and a host of findings from sleep studies that show melancholia is a depressive illness sui generis, a disease of its own in other words. This has been known for centuries! And the DST has been available to psychiatry since Bernard Carroll introduced it for the study of depression in 1968.

    Catatonia is another basic disease entity that only now is being detached from “schizophrenia,” a non-disease, and made a disease of its own. DSM-5 goes part way in acknowledging catatonia as a separate illness. And there exist pharmacological verifications and validations of catatonia: the response to benzodiazepines and electroconvulsive therapy. So it’s a real disease too [no other serious disorder in psychiatry responds to benzodiazepines, though many garden-variety illnesses do]. 

    And what do we do about chronic psychosis, all forms of which up to now have been called “schizophrenia”? The term embraces many different patterns of illness. One in particular is onset of social isolation and withdrawal in adolescence, first psychotic break, then stabilization with some kind of mental “loss” – or “defect,” just to use the ugly technical term – at a relatively high level of functioning. You can work as a porter; you can get married and be a good husband and family father; but a neuroscientist … ahem … you’ll never be. Let’s call this hebephrenia, core schizophrenia. 

    So there we’ve got three diagnoses right off the bat that correspond to what people actually have. We don’t need a lot of cogitation about “negative valence systems” – à la RDoC – to make progress, though fundamental progress in neuroscience is devoutly to be desired…

And in a recent comment on Gary Greenberg’s blog about biomarkers, Dr. Bernard Carroll produced a list:
    …this process of convergent validity has already given us an A-list of psychiatric diagnoses that are candidate brain diseases. Here is the list: psychosis, mania, melancholia, vascular depression, crippling anxiety, panic disorder, dementia, autism, obsessive-compulsive disorder, delirium, catatonia, and more. If you want diagnostic certainty with clear cut necessary and sufficient conditions, then by all means tell the magistrate at your next commitment hearing that you were serious when you commandeered an airliner, prevented the scheduled passengers from boarding it, declared yourself the owner of the airline, announced that you were going to fly your entire extended family to London to meet with Margaret Thatcher, and that the psychiatrist who said you suffer from mania must be wrong because he hasn’t shown the court a laboratory diagnostic test for mania…
All three lists were created off-the-cuff for different reasons, but they came out pretty close to each other [from a psychologist, a historian, and a psychiatrist]. With only minor changes in emphasis, mine would be pretty close too. I guess with this DSM-5 launch, a lot of us are thinking about what the diagnostic system actually ought to look like. I think of the list in my mind as Kraepelinian, even though some things on it weren’t even recognized in Kraepelin’s day. They are the diagnoses that go with "psychiatrist" in my version of my supervisor’s hierarchy of identities – the Psychiatric Diseases.

This is nothing new, nor is it really Kraepelinian. Karl Jaspers had a version. Here‘s a century old version from Alienist John Turner. They don’t differ a lot. Tertiary Syphilis came and went. Some causes of Delerium change with the culture. But the gist of things stays close to the same. The list hardly encompasses the breadth of people who report feeling mentally ill or the even people brought for care identified by others as mentally ill. I haven’t thought about it before, but I guess for me, these Psychiatric Diseases are a small subset of the Mental Disorders. As a matter of fact, I don’t actually think the term Mental Disorder actually holds much meaning for me. But Psychiatric Diseases are important in my mind.

I expect most people think of the Psychiatric Diseases with some version of the medical model, biomarkers or not. I certainly do. These illnesses can be devastating to a life, and deserve all the attention we can muster and the front page at the NIMH. Biological interventions, psychosocial interventions, whatever it takes qualified by the "do no harm" prescription and solid evidence-bases including long term follow up studies. These are the afflicted among us and they deserve our focused and informed attention. They [still] don’t belong in prison where many of them currently live.

Some psychiatrists think of this group of patients with Psychiatric Diseases as psychiatry proper and see those of us who also see other kinds of help-seeking patients as … doing other things. I kind of think of things that way too, doing other things. I do other things. I expect that Gary Greenberg, Richard Noll, and I might have differing ideas about how to approach a given patient who presented for the treatment of mental symptoms but didn’t have a Psychiatric Disease, but that a fly on the wall wouldn’t see a massive difference in general approach over time. If we were forced to make a diagnosis, we might diverge, but if we talked about the patient’s problems and were allowed several paragraphs, we’d probably converge.

The current DSM model attempts to apply the medical model to all Mental Disorders. It doesn’t work. And it never did. We’d be better off with a Diagnostic and Statistical Manual of Psychiatric Diseases and some other way of codifying the majority of people who present for treatment. It was tolerable with the former DSMs because they stayed etiologically neutral, at least on paper, and were little more than code books [with too many words]. This DSM-5 was so obviously driven by the biomedical model [applied where it doesn’t fit] that it is no longer of value…
    Richard Noll
    May 29, 2013 | 10:46 PM

    Oh my!

    I am having an “Aw, shucks . . . .” experience at the moment, which followed a “WTF!” evoked potential when I clicked open your blog. Thanks for the kind words, Mickey.

    Good to see I am a scholar of”note” and not just notoriety. There are still people on this planet who find me a welcome as cholera. If they read the words in your flattering blog post they would start choking on their Kaiser rolls.

    For decades I have noticed a clear distinction between folks like myself who have had extensive inpatient or state hospital experience and the many, many more clinicians who have not. In recent decades this would include most physicians in training to be psychiatrists — their stints in such places are merely a matter of weeks or a couple of months at best. Folks like me easily see the distinction you make between psychiatric diseases and the hundreds of other DSM mental disorders. Most others simply cannot.

    Again, Mr. Koufax, thank you.

    Berit Bryn-Jensen
    May 30, 2013 | 10:36 AM

    Whenever experts take off on the wings of abstractions, they are (at risk of) doing more harm to people suffering because of manmade and/or natural disasters. This, in my view, is the dominant theme in the history and practice of psychiatry. Ignorance may be less dangerous than the certitude of haughty, but unknowing experts. Open dialogue among equals – the persons who suffer first among them – as Jaakko Seikkula et al teach, is a lower, fertile, road to greater understanding and good outcomes than the high road of abstract theoretics, and as Richard Noll wrote:
    “Most of these conditions respond well to empathy and effortful changes in diet, exercise, cognition, behaviour … and these actual remedies do not come in a pill.”
    Well said!
    Actual remedies are relational, man-made, hand-and-heart-delivered, psycho-social approaches, as demonstrated time and again and related by survivors and (ex)patients and research into what works and what brings more suffering, iatrogenic illnesses and early death.
    Richard Noll’s humane blog, in warm duett with 1BOM, remind me of an unforgettable line from Shakespear’s Hamlet: “The heart-ache and the thousand natural shocks that flesh is heir to”…
    Gerry Roche, University of Limeric, has dissected coercive psychiatry as practiced and experienced in Europe, with an example from Norway, the infamous treatment of of Arnold Jukleröd.

    Discover and Recover
    May 30, 2013 | 1:02 PM

    Bernard Carroll,

    There are many reasons that ANY human being can become psychotic – including an adverse reaction to psychiatric drugs, by the way:

    Psychosis is an event, not a person.

    Re: Commitment hearings:

    I appreciated the exchange between Dr. Nardo and Richard Noll, but there seems to remain in the minds of many professionals this notion that 5% of the population suffer from psychiatric diseases, and that these diseases must continue to be treated by conventional methods.

    IMO, and in the opinion of a growing number of people, this is simply not accurate. Full recovery, which includes living in the community and working (paying taxes) is far more likely without conventional treatment. Some good sources for research on recovery (including “schizophrenia”… whatever that is):

    Boston University – Repository of Recovery Resources
    Foundation for Excellence in Mental Health Care
    International Society for Ethical Psychology and Psychiatry
    International Society for Psychological and Social Approaches to Psychosis
    Nathan Kline Institute – Center to Study Recovery in Social Contexts
    Mad in America – Science, Psychiatry and Community
    MindFreedom International
    Loren Mosher, MD – Soteria Project
    National Empowerment Center
    PsychRights – Law Project for Psychiatric Rights
    Temple University – Collaborative on Community Integration


    May 30, 2013 | 1:08 PM

    It’s time to open the paradigm.

    Open Paradigm Project –

    Duane Sherry, M.S.
    Retired Counselor

    May 30, 2013 | 3:16 PM

    I’m both very happy to see a mental health professional say out loud in a scholarly forum that life is hard sometimes, and in agreement with Discover.

    That said, I think it’s important to always keep in mind that the business of psychiatry is in no way limited to psychiatry. According to one forensic psychologist, the courts take the DSM much more literally and consider it to be far more authoritative than do psychiatrists.

    Karen Franklin, PhD— forensic psychologist— has two posts up about the DSM-5, forensic psychology experts, and courts. It’s a very interesting look at the impact the DSM-5 has on the exercise of criminal law.

    A piece of information from one of her posts has really dropped my jaw, though:

    PTSD got some significant tweaking in the DSM-5, mostly in directions that could increase its prevalence. The requirement of experiencing “fear, helplessness or horror” in reaction to the trauma was eliminated. There are now four “symptom clusters” rather than three. A new symptom of “reckless or self-destructive behavior” has been added, and the symptom of irritable behavior or angry outbursts has some added language, “typically expressed as verbal or physical aggression toward people or objects” and “with little or no provocation”

    How on God’s green earth does a person experience trauma without fear, helplessness, or horror? What does trauma mean without those feelings? If the person was unconscious, perhaps, but if they don’t experience fear, helplessness or horror in relation to an event, then how is it that they can be considered to be traumatized?

    Berit Bryn-Jensen
    May 30, 2013 | 3:26 PM

    The US documentary “Lost on Long Island” on NRK tonight, the national public radio- and TV, showing people in tears, in despair, unemployed for more than 99 weeks, their existence and health undermined by forces beyond their control. Millions of people – mostly sad, angry, afraid, depressed, sick – suicides up, death from infections up, not suffering because of genes or brains, but because of unjustice and marginalization. External forces impinging upon souls and bodies.
    Psychosis is a transient state of deepest angst and aloneness I’ve been told, afterwards, when terror has subsided and people feel safe enough, have slept and eaten and have access to words to communicate their feelings.
    When there is no safety and no words, internal turmoil is communicated in action or inaction – meaningfully, when we listen and see with eyes, ears, heart, open minds and create Open paradigm projects. Thanks, Duane!

    Berit Bryn-Jensen
    May 30, 2013 | 4:37 PM

    INJUSTICE is the correct word. I’m a tad embarrassed for mistakes in spelling, but that’s nothing compared to huge injustices done to people who then come to doctors and psychologists for treatment, or sign up at any of the clinical trials gpses that are dotting the USA from coast to coast, according to the link provided the other day by
    a-non. I counted 28 pages of clinical trials for antidepressants, around 50 trial sites on each page. Parasitic

    Nick Stuart
    May 30, 2013 | 7:54 PM

    Sorry, but I still have difficulty with the concept of a psychiatric disease – although I do not rule out the possibility of a brain malfunction causing a change in behaviour – in which case it ceases to be psychiatric and becomes neurological. I personally love my manic episodes where I seem to have boundless energy and am at my most creative. I also know that I will sink into depressions where my music compositions are at their finest. When I read about commandeering an aircraft to fly my family to meet Thatcher – I think – how cool would that be!! Much better than politicians who kill thousands of Iraq citizens and who are deemed sane. My family worry about me! Obviously I am a Szaszian! Medicalization of deviant behaviour is rife. Probably it is a human instinct to impose conformity of thought and deed within the group for social cohesion. Not sure it is a true scientific disease though.

    Nick Stuart
    May 30, 2013 | 8:18 PM

    So each day I can create myself. One week I might want to be Jesus and save the world. On another I might be Buddha and meet other Buddhas on the road. A hindu would have no trouble with these beliefs. On other days I can pretend to be normal. I have become very good at that. Some days I have to embrace my death to rediscover the joys of life! Have I a disease? Or is, as Sartre said,hell is other people who cannot understand my beliefs. Do I have a disease? BTW I have been reasonably successful in this life – I own a couple of houses in the south of the UK, had a successful career that enabled me to retire at 50, now married to a pretty young girl and travel the world. But I always have known that I am different from everyone else. A stranger to humanity. Is this a disease? Any doctors out ther who have a view?

    May 30, 2013 | 9:20 PM

    Happy to help Berit Bryn-Jensen.
    The US accounts for 41 percent of all registered studies:
    ” currently lists 146,053 studies with locations in all 50 states and in 185 countries.”
    According to D.O.E. there are 47,230,388 research participants, I’ve not checked that statistic for a while.

    Nick Stuart
    May 30, 2013 | 9:47 PM

    And at the end of the day….I hope my fM. RI is different from every one else. I hope my brain scan has anomoolies (excuse speeeling). I want to be unique. Not like you..

    May 31, 2013 | 2:43 AM

    I totally agree with Duane Sherry.

    I have truly enjoyed Dr. Nardo’s comments and have a great respect for many of the abuses of psychiatry he exposes including their payola “studies” and many conflicts of interest.

    But, I must say that given the tons of evidence over many years that the DSM and its voted in stigmas are 100% fraud per Dr. Fred Baughman, Neurologist, since as he rightly claims in his book, ADHD FRAUD and many articles, there is NO DISEASE and NO EVIDENCE whatsoever of any lesions, chemical imbalances, faulty genes or wiring, inherited or other so called causes of these voted in disorders including bipolar. Dr. Baughman further claims that giving children and adults such voted in stigmas to push toxic drugs that DO CAUSE brain damage/disease constitute the worst medical crimes ever perpetrated against humanity. And given Dr. Insel’s recent admission that the DSM is INVALID with no evidence behind it, I find the above and latest “consensus voting in of the real psychiatric brain diseases” by mental “health” experts to be a total slap in the face and very arrogant to say the least. Where is the replicated, proven evidence that is required per Dr. Jay Joseph that he brilliantly explains in his books, THE MISSING GENE and THE GENE ILLUSION and many articles? Dr. Philip Thomas has said that most doing such research have admitted behind the scenes to dismal returns and prospects for such findings for the billions wasted on these ongoing horrible eugenics theories used to exploit and enslave the masses by the global psychopathic corporations and the power elite 1% (Dr. Robert Hare was able to diagnose THE CORPORATION as operating in a psychopathic manner. See book and DVD).

    Given Dr. Insel’s latest eugenics agenda and the tons of junk science psychiatry always manages to produce in droves with BIG PHARMA and now national brain projects, I have no doubt that the new junk science is well on its way by these boys who keep crying wolf when they are always proven to have no clothes like THE EMPEROR’S NEW DRUGS.

    Have you mental “health” experts considered the huge harm of such bogus stigmas like the latest fraud fad bipolar to push the latest toxic drugs on patent at the time it was invented and exploded into an epidemic as explained in David Healy’s MANIA and Paula Caplan’s many books and web sites with stories of many destroyed lives thanks to their bipolar stigma based on stress, abuse, trauma, combat, rape and other symptoms? Are you aware that many abused women and children are routinely stigmatized with bipolar, ADHD, paranoia, delusions and other life destroying stigmas to aid and abet the abusers per Dr. Carole Warshaw, Pyschiatrist and Domestic Violence expert? Dr. Warshaw like Dr. Heinz Leymann, mobbing/work abuse expert exposed psychiatry’s greatest failing with such victims of domestic, work, school and other abuse, bullying and mobbing: psychiatry only focuses on outer symptoms while refusing to acknowledge toxic, abusive, traumatizing environments. Dr. Robert Spitzer has admitted that if psychiatry did that, the whole house of cards of the DSM would fall apart. Perhaps one of the reasons the DSM has been falling apart is due to the awakening of so many people who went for help with such traumatic, stressful life crises only to be shocked and horrified/betrayed to get trapped into what Dr. Peter Breggin warned was the most dangerous thing one could do once psychiatry sold out to BIG PHARMA: Visit a biopsychiatrist of TOXIC PSYCHIATRY because YOUR DRUG MAY BE YOUR PROBLEM. If ONE person gets misdiagnosed or overdiagnosed, the whole bogus disease theory falls apart. But, the truth is anyone who has been given a bogus DSM stigma has been misdiagnosed/overdiagnosed. Even Allen Frances admitted that “defining mental disorders is bullshit” since there is no real way to define strict boundaries of normal and abnormal. As Joanna Moncrieff has exposed in great articles like “Psychiatric Imperialism,” biopsychiatry is about pernicious, abusive social control in the guise of medicine, so, insisting voted in degradation rituals like DSM stigmas to set in force psychiatry’s preplanned typical human rights abuses is simply trying to make a silk purse out of a sow’s ear.

    I know the above mental “health” experts have certain credentials, but many survivors have hard won painful experience, lost careers and reputations despite lots of credentials, tons of their own research and studies to back it up along with all the other many losses they have suffered from what should be called the mental death profession thanks to the likes of Joseph Biederman and all too many like him in BIG PHARMA pushing the new bipolar “sacred symbol of psychiatry.” This was very similar to the Texas Medical Algorithm scam with J&J’s poison Risperdal that unleashed this monstrosity in the first place.

    There is plenty of precedent to call drapetomania, hysteria and homosexuality diseases, but we have evolved. I would ask you to reconsider your claims about bipolar and other voted in social constructs being diseases since you really have no evidence to back it up. And the fact abused, traumatized people are routinely given this bogus, life destroying stigma is evidence of its fraudulent nature since bipolar, trauma and so called borderline symptoms are about the same. As Dr. Judith Herman exposed in her classic, TRAUMA AND RECOVERY, the former insult stigma for abused women was borderline now “updated” to bipolar for maximum profits from human suffering per Dr. Warshaw above.

    Citing the man flying to see Thatcher typical of psychiatry’s disease mongering and fascist forced treatment agenda, reminds me of Sally Satel in her speeches to push forced drugging and commitment on innocent people who have committed no crime when she refers to such “mentally ill” as publicly flinging feces! Now, I have been around a long time and no matter how weird someone looked or behaved, I have never ever seen anyone slinging feces in public. Others of her ilk like Fuller Torrey’s apostles have advised those seeking to forcibly drug and commit those they obviously hate to turn over the furniture and falsely accuse the victim of such violence. Who are the real violent ones, not to mention liars, terrorists, traitors betraying democracy and frauds who will do anything to push their sordid Stalinist agenda on their victims to rob them of all civil, human, democratic and other rights along with due process? Psychopathy, naricissism anyone? Dr. Robert Hare, world authority on psychopaths, is pretty convinced that psychopaths causing most social mayhem and ignored by biopsychiatry for the most part as they prey on and destroy countless people, may have a real brain disorder/faulty wiring, but he keeps such THEORIES theoretical until proven unlike the three mental “experts” here. Haven’t we had enough of such insulting, degrading, ostracizing stigma from THE BOOK OF INSULTS or adult name calling, a better name than THE BOOK OF WOE, that has led to so many destroyed, disabled lives as shown by Robert Whitaker in his books among a ton of others?

    Finally, I may be wrong, but is Gary Greenberg actually pushing ECT for the so called melancholia “disease” many seem to be pushing to help the recent comeback of this barbaric brain damaging electrical lobotomy that many recent studies expose as not only useless but causing permanent amnesia, cognitive decline as well as brain damage and death? I have not gotten the BOOK OF WOE yet, so perhaps I misunderstood, I hope? But, even the world’s greatest promoter of ECT, Dr. Harold Sackeim, admits at the end of his sordid career that his so called patients he discredited the whole time due to their “mental illness” were right all along. He admitted ECT does indeed cause permanent brain damage, loss of memory, reduced cognitive function and even death. It also came out that Sackeim had close financial ties to an ECT manufacturer that helped make him wealthy along with government grants to do the latter study he left to the end of his “career.” Psychiatric survivors were grateful for finally getting such validation better late than never. As Dr. Peter Breggin wisely said, to be part of the psychiatric reform movement, a cardinal rule must be no lobotomy whether chemical, surgical or electrical. Such a requirement would be a great part of psychiatry’s Hippocratic Oath many like the great Dr. Gaehmi, bipolar expert pusher with the goal of giving the bipolar stigma to everyone on the planet are trying to discredit and abolish for obvious reasons. DSM 5 expanding the bipolar stigma to merely increased activity and emotion will aid greatly in the BRAVE NEW WORLD of bipolar soma robots. Falling in love or being enthused about work and play is now outlawed! And given the many neurologists who have exposed the huge brain damage caused by the barbaric practice of ECT, I find it hard to believe that those above claimed to be such distinguished experts would push ECT. Perhaps the Bentall & Read studies may help in that they conclude that ECT has no efficacy whatever and the brain damage, amnesia and possible harm are so great that ECT cannot be recommended in any way. Even Max Fink admitted the brain damage early in his sordid ECT career when psychiatry didn’t try to hide the fact that brain damage and disabling the brain to reduce IQ and other functioning was the whole point of the so called treatment. And as many admit, there have been no real advances in psychiatry since the 1950’s.

    Similarly, I checked out HIPPROCRATES CRIED, since Dr. Nardo recommended it and was appalled that the supposed “neuroscientist” author is also pushing ECT as the only real treatment for depression that “works.” This is beginning to sound like BIG PHARMA ads for their toxic drugs. Who does psychiatry and Dr. Insel think they are kidding by adding neuro this and neuro that to everything involved in psychiatry now? There have been some great articles ridiculing all the neuro claims being made in recent times especially in THE STATESMAN. Many philosophers are exposing the scam. Many experts in psychiatry do not agree that neuroscience should play a big role in psychiatry supposedly helping people with typical life problems and human suffering. New books like DE-MEDICALIZING MISERY and old ones like PSEUDOSCIENCE IN BIOLOGICAL PSYCHIATY do a great job exposing the sham of using such supposed science when applied to social and other human stressors/problems in living. Dr. Szasz did a great job of debunking this scam as well.

    I am writing this not to be mean or abusive, but to express my sincere dismay, disappointment and sense of betrayal that such seemingly noteworthy people in the mental health profession would engage in such light hearted tossing around of such destructive, degrading, deadly stigmas with no regard for the many lives destroyed by them including children and toddlers no less. I would be very happy to learn I am wrong, but the recent comments and recommendations cited here and elsewhere lead me to believe otherwise.

    Thank you for listening.

    Nick Stuart
    May 31, 2013 | 3:51 AM

    Hey Florence! Brilliant stuff!

    Berit Bryn-Jensen
    May 31, 2013 | 4:27 AM

    Thank you, Florence, for the most genuine, heartfelt, truth-speaking to power that I’ve had the good luck to listen to since Martin Luther King! Thank you!

    May 31, 2013 | 6:47 AM

    Thanks for sharing your views Richard, I fully agree with you that the psychiatric disease are the problem in our mind if we can’t treat it properly then no physician in the world can’t help us. Thanks again for sharing this awesome fillings with us.

    May 31, 2013 | 6:59 AM

    What I find lacking in many discussions addressing or even obviously side-stepping (for lack of a better term) “the medicalness” of psychiatric diagnostics is, in a word: history. A description of the patient’s mental state, together with the a truly skeletal (meaning shorn of the meat) “history” entailing not a lot more than demographic facts and earlier run-ins with medical care and diagnostic entities, cannot help but miss the whole point of diagnosis (to discern not only the nature but the cause).

    Imagine a person limping into an ER, and imagine if you will the ER-physician assembling details regarding the individual’s social situation, age, income, present medications, earlier contacts with medical care, earlier diagnoses, then after noticing a nasty-looking wound on his lower leg perhaps even going so far as to inquire when the wound might first have been noticed by the patient, but (after having looked straight into the wound) skipping blithely past “What sort of dog, and when, and can the dog be apprehended” or perhaps not even knowing (!) that “a dog-bite” is among the possible causes of a limp due to a festering wound on a lower leg…

    “Triaging” the community of complaints that the single patient brings to you the psychiatrist is something one does, not always in a rational manner: do you treat what hurts the most, or what is most apparent (the “loudest” complain), and how do they differ, and why is it important…

    And so, instead of understanding, we have follow-the-leader, after geneticists, now the “epigeneticists” (“…are still exploring which phenomena belong to epigenetics…” – why, it must be: all of them!), the pharmacologists, the surgeons (dusting off their ice-picks), the opinion builders, the powers-that-be in our militaristic medical world, chasing transcription factors, neurotransmitter mechanics, metabolic loads, meandering in science-babble, mesmerized by the sheer variety of accidental explanations, eyes firmly planted on the shadow preceding you…

    I am appalled at the present widespread nearly complete loss of perspective on the entire human drama that should be our single most important tool in understanding and helping people who suffer from the agonies that bring them to us. It may be as some persuasively indicate that the infiltration of the world of medicine by big business especially big pharma, and by big business models, is the most pernicious factor behind this enormous shift away from medicine and toward business-model-dominated diagnostic-code-driven population-wide product placement. And remember: “just following orders” is not supposed to save you from the noose.

    How will we ever get back…

    May 31, 2013 | 12:37 PM

    Thank you, Florence. There was a time that I was almost convinced that an uncle who was diagnosed with paranoid schizophrenia, who had an horrific childhood and had PTSD from two tours in Viet Nam as Marine helicopter gunner; and his emotional messes of sisters might have a disease that they inherited from their parents. Much later I learned about sociopathy (from experience and reading), and realized that my grandfather was a psychopath (he started raping his children when they were infants) and my grandmother was a sociopath —- a thief who stole from her own children and a scammer who was very skilled at falling down steps. My uncle’s episodes were always the worst when he was staying with his mother. It wasn’t a Freudian mother thing; it was a monster for a mother thing.

    Thanks, drb. When I was in the hospital with my first (and hopefully last) psychotic episode, I found the interview very frustrating. My psychotic episode was a waking night terror that was all about trauma I suffered while working in nuclear forces. I was dealing with profound emotional and existential pain about self-inflicted human extinction, and she was asking me about my childhood and other dry questions from a clipboard. If she had asked me, “What’s going on with you?” I could have articulated it well. Most mental health professionals I’ve seen considered my childhood to be key long after I stopped being bothered by it (mental health professionals did help me get over it). After I got out of the hospital I got the records and saw that she had made a note that I did have a service-connected disability (it was on my veteran’s I.D.) but she didn’t believe it was from what I said it was.

    I had experienced psychosis for the first time (a month prior to my 51st birthday), was hyper-vigilant and overwhelmed with traumatic grief and shame about something so huge and unpublished that nobody has written about the emotional impact of it. Not one single mental health profession working in lock-down asked me about that in the two weeks that I was there. I have no doubt that the only reason they kept me for two weeks was because the V.A. would pick up the tab and because I was so “lacking in insight” that I kept insisting that my trauma, stress, and the worst prolonged sleep deprivation (by far) I had ever had was responsible for my psychotic episode. The psychiatrist kept insisting that he could keep me for 180 days. I said, “Threat to self and others— you have no right to keep me here until I agree with you.” They really thought that knowing my rights was a joke.

    May 31, 2013 | 1:39 PM

    Dr. Noll,

    Only the end of this comment is addressed to you, but am addressing it to ou as you may or may not read through all the comments.

    “is Gary Greenberg actually pushing ECT for the so called melancholia “disease” many seem to be pushing to help the recent comeback of this barbaric brain damaging electrical lobotomy that many recent studies expose as not only useless”….

    I would be curious about this myself. If that is the case then it would seem like Drs. Greenberg, Carroll, Healy, Goldacre, Shorter, and 1bom, whatever their other differences, all view Melancholia as an important construct and view ECT as a potentially useful option, albeit one with very serious risks, for some of those who suffer from it.

    I would be curious to hear Dr. Noll’s thoughts on Melancholia. Even if it is simply in the form of a link to extant work.

    May 31, 2013 | 1:52 PM


    Thank you for sharing your story and for your military service.

    Knowing your rights was not a joke.
    I’m sure you realize that… It would be nice if more mental health professionals realized the same.

    From Jim Gottstein, Attorney with PsychRights:

    The United States Supreme Court has unequivocally declared
    involuntary commitment a “massive curtailment of liberty” requiring due
    process protection
    .94 While the government does not have to prove its case
    beyond a reasonable doubt, it does have to prove it with more than a
    preponderance of the evidence.95 Further, involuntary commitments are
    constitutional only when: “(1) ‘the confinement takes place pursuant to
    proper procedures and evidentiary standards;’ (2) there is a finding of
    ‘dangerousness either to one’s self or to others;’ and (3) proof of
    dangerousness is ‘coupled . . . with the proof of some additional factor,
    such as a “mental illness” or “mental abnormality.’’”96
    The Court has suggested that the inability to take care of oneself cannot
    be considered a sufficient finding of dangerousness, unless survival is at
    stake: “a State cannot constitutionally confine without more a
    nondangerous individual who is capable of surviving safely in freedom by
    himself or with the help of willing and responsible family members or
    friends.”97 In addition, “although never specifically endorsed by the
    [United States] Supreme Court in a case involving persons with mental
    disabilities,” it also seems people may not constitutionally be involuntarily
    committed if there is a less restrictive alternative.98
    93. See, e.g., Seikkula, supra note 52 (suggesting that an open-dialogue approach
    is effective in treating schizophrenia).
    95. Addington v. Texas, 441 U.S. 418, 432–33 (1979).
    96. Kansas v. Crane, 534 U.S. 407, 409–10 (2002) (quoting Kansas v. Hendricks,
    521 U.S. 346, 357–58 (2002)).
    97. O’Connor v. Donaldson, 422 U.S. 563, 575–76 (1975).
    98. PERLIN & CUCOLO, supra note 27, at § 2C–5.3.

    In short, it is not okay to lock someone up or drug them down because a doctor is convinced they are acting strange. Not enough!


    May 31, 2013 | 1:57 PM

    Dangerousness must be proven in a court, with adequate representation by counsel . Even if the person insists they are Margaret Thatcher or the Queen of England!


    May 31, 2013 | 7:38 PM

    I so agree. The people working in psyche wards could prevent a lot of problems with patients by not being imperious, controlling, and dismissive rick-n-racks. I had not been in isolation more than ten minutes before I was reminded of a study done on a psyche ward that concluded that most of the times that patients “acted out” that the someone on the staff of their family members had insulted them or discounted what they said unfairly.

    May 31, 2013 | 7:41 PM

    That was addressed to you, Discover.

    June 1, 2013 | 4:55 PM


    Psychiatric wards induce the classic fight-or-flight response.
    Common sense trumps the long-held psychiatric tradition of “hospitalizations”.

    They are about as therapeutic as”helping” a lost dog by tossing it into a kennel.

    How brililant.


    June 1, 2013 | 4:57 PM

    And the classic argument for these wards is:

    “It’s better than prison.”

    Who came up with the either-or scenario?
    Why not neither?
    Why not something new?!


    Richard Noll
    June 2, 2013 | 3:23 PM


    I am so sorry that I missed your earlier comment! I dip in and out of these blogs quickly and don’t always read the comments (and sometimes hurry though the blogs as well — except Dr. Nardo’s).

    As for melancholia, you already know the names of the experts: Michael Alan Taylor, Bernard Carroll, Edward Shorter. works by any of these authors would have all the clinical and scientific information you might find useful. Taylor and Fink’s 2006 book on melancholia is excellent.

    As for ECT — it works. It really does. And the transformation — especially after years of multiple meds which did not — can sometimes be stunning. Taylor has a vivid description of modern ECT treatment in Hippocrates Cried: The Decline of American Psychiatry, and also says a great deal about what sorts of persons might benefit from it.

    I hope this helps.

    June 2, 2013 | 7:22 PM

    Richard Noll,

    ECT is not safe.
    I hope this helps. –


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