June 10, 2011

The Epidemic of Mental Illness: Because

detroit.jpg
spot the psychiatrist


Imagine it's 1981, and Leonid Breshnev is awoken by an aide.  "Comrade! I have wonderful news!  America--- it has surrendered!"  Breshnev slaps him in the teeth.  What do you mean, 'surrendered?'  "Surrendered!  Comrade Reagan is on the phone, he says the country is yours, all of it, and wants to know what he should do next to create a perfect communist world!"

This is a scenario that's been run in the minds of Americans and Russians, what if?  What if, indeed.  Play it out to its conclusion, and despair:

"The hell if I know what to do next... we exist only if we have an enemy... none of this stuff actually works..."

Marcia Angell, MD, a former editor of the NEJM has a new article, The Epidemic of Mental Illness: Why?  This is hardly a spoiler: the answer is Big Pharma.

She pretends to review three books critical of psychiatry (e.g. Carlat's Unhinged) but it's not obvious she really understands their nuanced criticisms, or cares to; she just needs them to pretend she has primary sources. 

[Big Pharma has] come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated. This is a subject to which I'll return.
When you see the phrase "a subject to which I'll return" it means that that's their whole thesis.  In her case, she uses this phrase twice:

Why the [chemical imbalance] theory persists despite the lack of evidence is a subject I'll come to.
She doesn't return to it, she never leaves it.  Big Pharma pays off docs, pays for/off research, pays for/to journals, and etc.  And it's certainly true that Big Pharma does all these things.

But who is she trying to convince?  Being anti-Pharma is hardly edgy business; it's now the established intellectual position of most academics, not to mention everyone.  Insurances are refusing to pay for the branded psych drugs, doctors are being forbidden from consulting; and, simultaneously, Big Pharma is abandoning psychiatry.  Pfizer has all but closed its CNS division, temporarily pretending to still care about something called Pristiq that no one takes.  By next year, all of your love-to-hate drugs-- Zyprexa, Geodon, Seroquel-- will be generic.  There are no new blockbusters coming, no innovative treatments, no Big Pharma research money.  By 2013, you'll have gotten what you were not careful to wish for.

So while the era of "unproven" pharmacotherapy is ending, Angell et al think it's because of their vigilance and diligence.  Hey, she says, as she bicycles home with a baguette and a bottle of red wine, look what a Pharma-free re-appraisal of the science has done!

It hasn't done anything.  If money is what pushed psychiatry down the road of unproven pharmacology, then what pushed psychiatry away from those drugs is also money.  That's all.  With Pharma gone, the only game in town for psychiatric research and academic tenure is the government, so you better have a generic medicine in your clinical trial or say something nice about CBT, capisch?  Or TMS, and don't make me come down there.  Psychiatrists aren't moving away from Eli Lilly because they got ethical; they moved away because they got a new treasure map.

You think the government money is free of agenda?  The new decade of psychiatry is all about prevention, but how can you prevent disorders that you said were genetic?  Or, how do you prevent a disorder in a kid whose parents are drunk, neglectful, or just plain mean?  Damned if I know.  But there's a lot of money in pretending to try.

II.

I know that Dr. Angell is not particularly knowledgeable about patent law, but about psychiatry she is devastatingly and utterly deluded.  I realize that's hardly a capital offense except that she is relied upon to drive policy, and if you're the go to person for The New York Review Of Books, you have to at least appear to care about what's going on in it.

Here's a typical paragraph from Dr. Angell revealing the mercilessness of her ignorance:

For example, the SSRIs may cause episodes of mania, because of the excess of serotonin. Antipsychotics cause side effects that resemble Parkinson's disease, because of the depletion of dopamine (which is also depleted in Parkinson's disease). As side effects emerge, they are often treated by other drugs, and many patients end up on a cocktail of psychoactive drugs prescribed for a cocktail of diagnoses. The episodes of mania caused by antidepressants may lead to a new diagnosis of "bipolar disorder" and treatment with a "mood stabilizer," such as Depokote (an anticonvulsant) plus one of the newer antipsychotic drugs. And so on.

There's no "and so on," the example is wrong all over the place.  First, while most psychiatrists believe antidepressants cause mania, it isn't actually true.   Second, even if they did cause mania-- not jumpiness or anxiety-- it would have nothing to do with the serotonin.   Third, the word "antidepressant" is hopelessly nonspecific; the only thing that Wellbutrin and Prozac have in common is nothing.  Fourth, "antipsychotics" don't deplete dopamine at all, they are dopamine receptor blockers, which may seem like a trivial difference except that it's not.  And so on, as Angell would say.  I could go on, but it's like criticizing the nutritional label of a Happy Meal.

Her writing is the worst kind of propaganda.  It takes conventional wisdoms of psychiatry that she read on an old Usenet group, inflates them to truisms, and then drowns you in them to provoke a panic attack.  Here is the next sentence:

Some patients take as many as six psychoactive drugs daily.
What does that have to do with anything?   How many people take 6 psychiatric medications? I don't know any.  Seriously.   She is also implying that the mere fact that someone is taking six medications is itself evidence of Satanism.  Could it be possible someone needs six meds?  Or twenty six?  Of course there are side effects, but there's a risk/reward calculation that had to be made.

One well- respected researcher, Nancy Andreasen, and her colleagues published evidence that the use of antipsychotic drugs is associated with shrinkage of the brain and that the effect is directly related to the dose and duration of treatment. As Andreasen explained to The New York Times, "The prefrontal cortex doesn't get the input it needs and is being shut down by drugs..."

This is how Dr. Angell decides the fate of the world.  She finds a study by a "well respected researcher"-- because, you know, as long as they're respected there's no possible bias there-- reads the title, drops it in the trash and turns to The New York Times for an explanation of its significance.  If you have any trouble getting the insanity of doing this, replace the words "New York Times" with "Fox News" and tell me if you get it now.  Angell doesn't.  She can't.  Her world is neither clinical research nor battlefield patient care, her world is The New York Review Of Books

"...That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."*

Admittedly, it's easy to misinterpret a scientific study.  But the NYT is written in crayon, it is impossible to misinterpret it.  Andreasen is clearly making the point that though the medications help the symptoms, they have long term consequences.  This is very different than the simple point that Angell is making: these meds are bad for you. 

You'll also observe that she shifts stealthily between "antidepressant" and "antipsychotic" and "psychoactive drugs."   Maybe Trina down at Victoria's Secret can be forgiven for seeing them all just as "football players" or "paychecks" but if you want to change the rules of the NFL you really understand the players.

III.

But the reason Angell is wrong is right up there in paragraph 1.

It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007--from one in 184 Americans to one in seventy-six. For children, the rise is even more startling--a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

Angell wants this all to be evidence that psychiatry is out of control.  Overdiagnosed and overmedicated.  She's absolutely right that it is, but she doesn't want to accept the real reason.  She wants the reason to be Big Pharma, because she thinks in terms of enemies.

First, the 15 minute med check had a much bigger impact on the pharmacologization of psychiatry than the meds themselves.  Psychiatry has always had medications, they just had an hour to decide which one to use.  You tell me I have 15 minutes minus 5 minutes for the chart and the bathroom to deal with a man who likes heroin and hates me, well, suddenly I have to believe that Zyprexa is awesome. Forget science, it's the 96th Thesis: Again: We assert that we are alone in our offices with no support, time, or margin for error; and we believe that antipsychotics can save both patient and physician, or else all of us are lost.

SSI hasn't tripled because more people are disabled; SSI tripled because more people have no other source of income.  That's not my fault, but it has most decidedly become my problem.  I don't mean they're faking, I mean it is in the government's interest to promote the "awareness" of "mental health" so that people have a place to go to get services while being removed from the rosters of ordinary people.  "Wow, the unemployment rate is falling!"  You don't say.

It's a carny act, and Angell is part of it.  Is Big Pharma responsible for the explosion in child psychiatry?  Really?  So it isn't anyone else's fault, I guess.   Those diagnoses are sufficiently vague that when the kid starts fighting in school or getting in trouble with the law, the solution is assumed to be psychiatric.  The government wants us to believe Ritalin can fix this, and Ritalin, BTW and FYI, is generic.   If you abolish psychiatry you won't reduce the SSI at all, the masses will move to whatever the government next creates as a conduit for social services; a conduit that is sufficiently separated from itself so as to offer plausible deniability.  "What the hell do we know about Detroit?" one G-man says to another.  "It's a medical problem."

If, however, you abolish SSI then you will reduce psychiatry to the size of neonatal endocrinology.  If you uncouple social services from "medical disability"-- not abolish them, just find some other, better, more logical way to distribute them-- you'll change America forever.  Stop promoting a culture of disability.

Psychiatry serves at the pleasure of the government.   If Dr. Angell and the good folks at the "Department of Social Medicine" [sic] want to help people, they should work on that.  But they won't.  Because, quite simply, there's no money in it.


--

The Terrible, Awful Truth About SSI

What to do with all those inmates

Special: what prompted me to start a blog?  The first post.










Comments

If we stop promoting a cult... (Below threshold)

June 10, 2011 12:47 PM | Posted by JM: | Reply

If we stop promoting a culture of disability, who will tell me my failures aren't my fault?

Vote up Vote down Report this comment Score: 14 (46 votes cast)
I thought this post was so ... (Below threshold)

June 10, 2011 1:16 PM | Posted by Redstocking Grandma: | Reply

I thought this post was so thought-provoking I sent it to Facebook and Twitter.

Vote up Vote down Report this comment Score: 0 (10 votes cast)
My favorite Angell quote fr... (Below threshold)

June 10, 2011 1:34 PM | Posted by Anonymous: | Reply

My favorite Angell quote from the article is:

" ... and about 10 percent of Americans over age six now take antidepressants. The increased use of drugs to treat psychosis is even more dramatic."

Vote up Vote down Report this comment Score: 4 (4 votes cast)
The New York Review of Book... (Below threshold)

June 10, 2011 1:39 PM | Posted by Bobby: | Reply

The New York Review of Books isn't exactly on top of things, is it? These three books came out ages ago.

Coming out next in NYRoB: a review of The Girl With The Dragon Tattoo

Vote up Vote down Report this comment Score: 9 (9 votes cast)
I took a half milligram o... (Below threshold)

June 10, 2011 1:55 PM | Posted by Harry Horton: | Reply

I took a half milligram of risperdaldaily in June 2001 and developed irreversible hyperglycemia, in other words I got chronically sick from the antipsychotic drug and remain so today. The Social Workers tried to lie to me saying the drug did not give me diabetes. My psychologist told me try suing the drug companies, which made me feel a little bit better, as my depression seemed to lift somewhat at the idea. Perhaps the other psychiatrist was well meaning, who knows but misguided when he prescribed the drug. In any case here in June 2011, South Carolina doctors (or the state of S.C. that is, not really clear who the plaintiffs actually were) were awarded somewhere around 276 million dollars from Johnson and Johnson on a risperdal suit for deceptive marketing practices and prescribing misinformation. With the federal govt prosecutors now in late May 2011 gearing up for a 1 billion dollar lawsuit against the New Jersey company, Johnson and Johnson over risperdal, it seems fraudulent activites were evident in their profits at any costs, when peddling the Big guns, antipsychotics, in their Darwinistic business approaches for revenue generation. Its sort of sad no one can work out a simple ethical protocol for treating mental patients and a workable economic model for these companies to accomplish research goals that do not involve preying on the most vulnerable of the public in order to generate the revenue necessary to develop the drugs. It would seem Wall street, other corporations and the U.S> govt along with other world govts could figure out some extraneous means for revenue accumulation, i.e. outside investments, as opposed to the market's supply and demand approach in current use. Any way I can go on and on on this topic... By the way, as of June 9, 2011 France suspended the diabetes drug actos on bladder cancer fears.

Vote up Vote down Report this comment Score: 10 (14 votes cast)
"SSI hasn't tripled because... (Below threshold)

June 10, 2011 4:15 PM | Posted by SteveBMD: | Reply

"SSI hasn't tripled because more people are disabled; SSI tripled because more people have no other source of income."

Truer words were never spoken. Thank you for getting it.

Vote up Vote down Report this comment Score: 23 (37 votes cast)
"First, while most psychiat... (Below threshold)

June 10, 2011 8:22 PM | Posted by Iatrogenia: | Reply

"First, while most psychiatrists believe antidepressants cause mania, it isn't actually true."

What does this mean? That most psychiatrists believe something that isn't true? And then they medicate the mania, escalating a case of adverse drug reaction to a spurious diagnosis of bipolar disorder and a future of multiple unsuccessful medications?

Because that actually is what's going on clinically, exactly as described by Robert Whitaker.

So even if something psychiatrists believe isn't actually true -- so much of what they believe is fallacious -- they follow it, and it has a destructive impact on patients, which is what Whitaker is saying.

Are you aware that many psychiatrists are still telling their patients they have a diabetes-like need for lifelong medication to balance neurohormones?

I'm surprised at you, Dr. Last.

Vote up Vote down Report this comment Score: 4 (22 votes cast)
About the generic ritalin; ... (Below threshold)

June 10, 2011 8:28 PM | Posted by Adam: | Reply

About the generic ritalin; I came across an old pharmacology textbook a few weeks ago. As in, from the 1960's. It was a quick reference guide to psychiatric meds, "for the busy physician". It was amazing to read, and to see how far things have come. But the funniest, by far, were the classification of antidepressants. They existed along a spectrum. There were MAOIs at one end, amitryptiline in the middle, and methylphenidate at the other end.

By the way; isn't quetiapine already generic? Seroquel XR is still brand-only, and not coincidentally the docs sure do love it up here.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
@Iatrogenia: I have a diab... (Below threshold)

June 10, 2011 8:53 PM | Posted by Dazed-and-Confused: | Reply

@Iatrogenia: I have a diabetes-like need for lifelong medication to balance my dysthymia.

Vote up Vote down Report this comment Score: 6 (12 votes cast)
I would imagine that the 44... (Below threshold)

June 10, 2011 9:54 PM | Posted by JanePhD: | Reply

I would imagine that the 44% of children in foster care maintained on antipsychotic drugs make up a good percentage of child SSI recipients. And then we can add in the medicated juveniles in detention facilities and residential treatment homes. These medicated youth will become unemployed and unemployable medicated adults on SSI. No doubt there are some layabouts on SSI and SSDI - well, damn them and their doctors.

Vote up Vote down Report this comment Score: 2 (6 votes cast)
"Or, how do you prevent a d... (Below threshold)

June 10, 2011 10:36 PM | Posted by Flailing Junk: | Reply

"Or, how do you prevent a disorder in a kid whose parents are drunk, neglectful, or just plain mean? Damned if I know. But there's a lot of money in pretending to try."

Oh that's easy, unthinkable, but easy. What do you do if parents are physically abusive?

Vote up Vote down Report this comment Score: 3 (7 votes cast)
Antidepressants do observab... (Below threshold)

June 11, 2011 12:03 AM | Posted by David M. Allen, M.D: | Reply

Antidepressants do observably trigger a manic episode in some patients. The question is, did these patients have bipolar disorder to begin with. True bipolar, (as opposed to "bipolar spectrum" - b.s. - otherwise known as cluster B personality disorders), is an episodic and remitting illnesses that sometimes become manifested somewhat late in life.

I believe anyone who switches from depression into mania has the disorder, but the DSM people don't want to say that since you can't prove it, so they call it "drug-induced mania."

I do hate to see Marcia Angell fall for the non-sequitur bullsh*t conclusions of Whitaker. TLP is exactly right about the real reasons for the increase in psychiatric disability cases.

The state hospitals were emptied because antipsychotic meds do in fact treat delusions and hallucinations, not because they just sedate patients. If the latter were true, barbiturates would work. They don't.

Angell could have at least reviewed my book, "How Dysfunctional Families Spur Mental Disorders." The explosion of so-called "biological psychiatry" resulted from a perfect storm of economic, social, and pseudo-scientific forces in society, of which drug company marketing is but one.

That does not mean that there are no mental illesses that are brain diseases at all, or that psych meds are worse than useless. We call that line of reasoning "black or white thinking." It's irrational. We do not have to make a forced choice between Ssazz and Biederman/Akiskal, the no-mental-illness and everything's-a-mental-illness gurus.

Vote up Vote down Report this comment Score: 12 (20 votes cast)
Your first post was about h... (Below threshold)

June 11, 2011 12:17 AM | Posted by Barry Kelly: | Reply

Your first post was about how abrogating patent rights would remove incentive for companies to create drugs.

The problem with your perspective is that patent rights aren't the only way to motivate companies to create drugs.

Vote up Vote down Report this comment Score: 3 (5 votes cast)
I agree with Dr. Allen. Whe... (Below threshold)

June 11, 2011 12:45 AM | Posted by Cambyses: | Reply

I agree with Dr. Allen. When we're talking about antidepressants, I don't know how much debate we'd have that MAOi or TCA's can trigger mania. As for SSRI's or SNRI's, I agree that this happens as well but it's impossible to ever fully disprove underlying bipolar illness as a confounder. But a secondary issue is that in contemporary psychiatric training, "mania" is any period of agitation. Is this mania, or restlessness, akathisia, irritability? This distinction has somehow been blurred for trainees these days. Take a look at Kaplan and Saddock's second edition and compare it's list of terms to discuss mental status with more contemporary texts. The actual vocabulary has shrunk. It's like Orwell's machine for discarding words in 1984. When we lose the ability to describe mental status, everything irritable becomes "mania", and this opens up the pharmacopeia. I mean, few psychiatric residents are taught about ego-defense anymore, and while the complaint that axis II diagnosis is predicated on evaluation of defenses is good, the larger question is whether or not axis I diagnosis is reliable when the psychiatrist has no familiarity with issues like defense and cannot include axis II in his/her differential at all. It a heuristic question.

More importantly, if we start with the thesis that Angell is not stupid, then how to we explain this lapse in her judgement? Why the scape-goat? In my familiarity with doctors, I have yet to see one led astray by pharma money. I have seen them tempted by something else--by the need to publish, to acquire admiration and acclaim, be it when rounding with medical students, when presenting at a conference or when publishing. Their self-esteem is predicated on this. I wouldn't expect NYT to understand this, because they've been publishing the same tired, hackneyed tale about money and corruption for so long. But is it possible that money is not what corrupts doctors, academics, the interpretive class generally? Again, I would include a certain cluster B personality disorder in the differential. And I would posit, at least hypothetically, that for Angell, it's much easier to externalize (i.e. evil big pharma) than to examine out own contribution to this issue (i.e. did I go to medical school for status in order to compensate for a deep and abiding dissatisfaction with myself).

Vote up Vote down Report this comment Score: 19 (23 votes cast)
Fuck you all and the time w... (Below threshold)

June 11, 2011 2:06 AM | Posted by Tired: | Reply

Fuck you all and the time wasted with blame. As a patient I am tired of being sick.

Vote up Vote down Report this comment Score: 19 (19 votes cast)
As another datapoint, I hav... (Below threshold)

June 11, 2011 6:53 AM | Posted, in reply to Dazed-and-Confused's comment, by Rational-by-nature: | Reply

As another datapoint, I have a nicotine-like need for lifelong paroxetine. I've changed dosages, including quitting entirely, often enough to know that I feel better, and enjoy my life much more, taking the (pretty low) dosage of 10 mg. per day. There are also minor physical side-effects (including, but not primarily, the sexual one) that dispel any myth about the irrelevance of hormone balances. My body and mind simply feel better by shifting the balance slightly.

Vote up Vote down Report this comment Score: 1 (3 votes cast)
I suffer a bi polar condi... (Below threshold)

June 11, 2011 11:28 AM | Posted by Harry Horton: | Reply

I suffer a bi polar condition,(along with schizophrenia)---the bi polar most likely from my mother's side of the family, my grandfather having the condition. I remember in my college years going out to restaurants at night riding the rush of these wild mania highs, thinking that I could learn all the knowledge in the world by daybreak.4;00 o'clock in the morning comes around and I'm totally blown out and exhausted as I descend into a depresseive state, falling to sleep at sunrise. What is interesting about the extremes of the disorder, once I reached 24yrs old, around the time adult judgement functions fully mature usually, the bi polar diminished off a good deal, though not totally gone. I read William James struggled with depression into his early thirties. And the psychologist Rollo May made an interesting observation about him, that along with James' depression William James possessed a substantial deal of immaturity. Not really sure what May meant by the statement. But it seems maturing processes and bi polar are entwined to somewhat of an extent.

Vote up Vote down Report this comment Score: 2 (4 votes cast)
True Story. Several weeks a... (Below threshold)

June 12, 2011 9:00 AM | Posted by Jack Coupal: | Reply

True Story. Several weeks ago, the Wall Street Journal had a first page story about a SSDI/SSI judge in West Virginia who approved almost all new claims for SSDI/SSI payments that hit his court. The national average is 60% claims approved.

The Social Security Administration then suddenly decided to "investigate" his high approval rate. The SSA placed that judge on administrative leave. He still got paid but not allowed to hear cases. Sounds like a promotion.

The topper: A lawyer in eastern Kentucky (near WV line) with the last name of Conn [I kid you not] had been advertising all over the region about his ability to get SSI/SSDI claims approved in SSA court.

With Alone and the WSJ on duty, that fraud against taxpayers may end.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Alone's response:No, it ... (Below threshold)

June 12, 2011 9:29 AM | Posted, in reply to Jack Coupal's comment, by Alone: | Reply

Alone's response:No, it won't ever end, because it's not a fraud, it's the whole point of SSI, to have it get approved. I don't know the WSJ you are referring to, but I would bet all my rum that the 60% approval referred to first time cases, which typically have high rejection rates. It goes: 35% win on first attempt; 15% more win on reconsideration; and 65% win on appeal. If that fails, you can reapply all over again. These numbers will only get bigger.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
<a href="http://thirdtierre... (Below threshold)

June 12, 2011 9:46 AM | Posted by lowkey: | Reply

http://thirdtierreality.blogspot.com/

This guy also covers mental illness, when it comes to professors and an entire profession.

Vote up Vote down Report this comment Score: -2 (4 votes cast)
You are nuts, Dr. Last Psyc... (Below threshold)

June 12, 2011 8:47 PM | Posted by Tom: | Reply

You are nuts, Dr. Last Psychiatrist. You demean Nancy Andreasen, M.D. perhaps the most eminent biological psychiatric researcher in the the States? You gloss over Big Pharma's sins ("Well, yes they do that") meaning that bought off all the key opinion leaders in "academic psychiatry", a term that is now an oxymoron? To what end? To blame the government???? No you miss the real culprit: It is not Big Pharma, or the "Government" it is "GREED." Period. And why do you think Big Pharma has pulled out of psychiatric "research" which, in of itself, is a joke: It is because they (Big Pharma) have been exposed as greedy profiteers who have been outed by the likes of Dr. Angell, Senator Grassely and others. Who the hell cares that their drugs are going off-patent? They didn't work anyway! Or if they "worked" they subjected ignorant patients to horrific side effects that their doctors never told them about because they were being "Greeded" by pay-offs!That's what Big Pharma realized and they are headed for the hills. Good riddance!!!

Vote up Vote down Report this comment Score: -5 (21 votes cast)
I hope I've clarified th... (Below threshold)

June 13, 2011 3:15 AM | Posted by Reader: | Reply

I hope I've clarified things. The important thing for you to remember, Montag, is we're the Happiness Boys, the Dixie Duo, you and I and the others. We stand against the small tide of those who want to make everyone unhappy with conflicting theory and thought. We have our fingers in the dike. Hold steady. Don't let the torrent of melancholy and drear philosophy drown our world. We depend on you. I don't think you realize how important you are, to our happy world as it stands now.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Tom, you and all the other ... (Below threshold)

June 13, 2011 9:46 AM | Posted by Bobby: | Reply

Tom, you and all the other Pharma haters will be the first in line for the Alzheimer's or cancer or whatever medications when the time comes for you. In the meantime, knock off the cheap jabs ("ignorant patients", really?) at the people who have found these drugs to be helpful to them. And give thanks that you and yours are healthy today -- because it won't always be that way.

Tend your own garden.

Vote up Vote down Report this comment Score: 5 (15 votes cast)
SteveBMD and TLP: one thin... (Below threshold)

June 13, 2011 11:09 AM | Posted by JanePhD: | Reply

SteveBMD and TLP: one thing we can all agree on - a lot of those SSI recipients are being treated with Depakote for their acute mania and prophylaxis of their migraine headaches! http://i.bnet.com/blogs/depakote-sales-to-medicaid-alone.jpg?tag=content;drawer-container No doubt these sales also reflect the off-label use of Depakote as a "mood stabilizer" (I believe it was Abbott that coined that term). Well, here's how that "mood stabilizer" performs http://www.ncbi.nlm.nih.gov/pubmed/21593515
Sorry it's an abstract, but that opening sentence "Valproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse." speaks volumes about modern psychiatry and the drug industry.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
Oops, forgot to include epi... (Below threshold)

June 13, 2011 11:16 AM | Posted by JanePhD: | Reply

Oops, forgot to include epilepsy (my bad!) as an indication for Depakote. So, alot of SSI recipients are being treated for epilepsy, acute mania, and migraines.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
I hope they're being treate... (Below threshold)

June 13, 2011 11:36 AM | Posted by Doe: | Reply

I hope they're being treated, Jane Phd.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
"Sorry it's an abstract, bu... (Below threshold)

June 13, 2011 12:16 PM | Posted by Bobby: | Reply

"Sorry it's an abstract, but that opening sentence "Valproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse." speaks volumes about modern psychiatry and the drug industry."

I would say that it speaks more about your abilities to cast aspersions and cherry-pick scientific papers.

Vote up Vote down Report this comment Score: -1 (3 votes cast)
Bobby: I have a PhD in pha... (Below threshold)

June 13, 2011 1:25 PM | Posted by JanePhD: | Reply

Bobby: I have a PhD in pharmacology; I'm married to a physician;
I have a sibling who is a psychiatrist; and both my husband and each have a sibling who has been poorly served by the mental health system. So yeah, I think I'm in a position to cast an"aspersion" or two. Cherry-picking scientific papers? Hey, I was just following up on the August 14, 2008 post by TLP.

Vote up Vote down Report this comment Score: 2 (6 votes cast)
After working in com... (Below threshold)

June 13, 2011 2:52 PM | Posted by SteveBMD: | Reply


After working in community mental health for 3+ years in a large urban setting, I've realized that most patients come in with genuine suffering but usually due to "lifestyle stressors" (eg, abusive boyfriend, gun violence on the streets, drug abuse, unemployment, poverty, homelessness, etc)

Trust me, those things would make me depressed and anxious, too. And yes, I do believe in the effects of chronic stress on disease pathogenesis. However, oftentimes there's no overt pathology on the part of the patient (certainly nothing that a medication would fix... well, scratch that, Valium helps). Rather, it's the environment that's pathological.

Giving the patient a mental health diagnosis (a) legitimizes their suffering; (b) abdicates them of any responsibility; (c) makes them eligible for an SSI check; (d) keeps our office running (and our bloated staff employed); and (e) eliminates any need for our State or County to develop the services our patients truly need.

Vote up Vote down Report this comment Score: 13 (19 votes cast)
SteveBMD: If I understand ... (Below threshold)

June 13, 2011 4:37 PM | Posted by JanePhD: | Reply

SteveBMD: If I understand you and TLP correctly, the driving force for the soaring SSI enrollment is welfare reform and not deficiences or excesses in psychiatric diagnoses and the accompanying drug "therapy". If you go to Whitaker's website - http://www.madinamerica.com/madinamerica.com/Home.htm - he does have a section (upper right) titled "Answering the Critics". I would suggest that you read it; Whitaker does not deny that there is a certain amount of "gaming of the system" going on, but he clearly demonstrates that the soaring use (and cost) of psychiatric medications(see, for example, the Medicaid costs for Depakote that I cite in an earlier comment) correlates with the increasing (epidemic)occurence of "psychiatric disability". As for your large urban population, I recall reading that the incidence of personality disorders approaches 30% in the "inner city". Individuals so afflicted do suffer terribly, but I would agree with you that the last thing these people need is a prescription that absolves them of responsibiilty.

Vote up Vote down Report this comment Score: 4 (4 votes cast)
As much as I respect Whitak... (Below threshold)

June 13, 2011 5:21 PM | Posted by SteveBMD: | Reply

As much as I respect Whitaker, and as much as I agree we pay far too little attention to the side effects of the drugs we use, I think the "drugs-->disability" argument has been argued a bit too strongly. I know NO psychiatrist who will keep a patient on medication(s) that are clearly causing harm to the point of disabling them further, relative to baseline.

The "soaring use and cost" of medications does correlate with the occurrence of disability. True. True. But unrelated. Often prescribing drugs keeps people from being disabled, and the high cost is just profiteering, not evidence of greater disability.

In the end, labeling someone disabled is a way for us "progressives" to cope with those personality-disordered (or unlucky, or irresponsible, or ...) inner-city denizens and feel like we've done our duty to society.

(BTW, thanks, 'absolve' was indeed the word I was looking for.)

Vote up Vote down Report this comment Score: -2 (6 votes cast)
SteveBMD: You agree that t... (Below threshold)

June 13, 2011 6:25 PM | Posted by Anonymous: | Reply

SteveBMD: You agree that the soaring use of medications does correlate with the increasing occurence of psychiatric disabilty. This correlation is true, btw, for both the poor and the not-so-poor (SSDI recipients whose drug/psychiatric hospitalization costs are covered by Medicare). If, in fact, the medications prevented people from becoming mentally disabled, the disability rolls would not be increasing. Unless, of course, we are in the midst of a mental illness epidemic, which means that we should have been looking for the infectious agent (a virus?) decades ago.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
"If, in fact, the medica... (Below threshold)

June 13, 2011 6:34 PM | Posted by SteveBMD: | Reply

"If, in fact, the medications prevented people from becoming mentally disabled, the disability rolls would not be increasing."

You're assuming we prescribe medications in order to treat disease. In my clinic, if I don't prescribe meds, the patient can't be seen because the clinic doesn't get paid. Moreover, the patient's case for disability looks worse to the judge.

Vote up Vote down Report this comment Score: 3 (5 votes cast)
SteveBMD-- Are you saying, ... (Below threshold)

June 13, 2011 7:05 PM | Posted by Anonymous: | Reply

SteveBMD-- Are you saying, "This is the way it should be" or "this is the way it is and that might be a problem"?

Because prescribing meds to someone that doesn't need them so that they can qualify for the services they do need, sounds like a problem. Right?

Vote up Vote down Report this comment Score: 5 (5 votes cast)
"Because prescribing med... (Below threshold)

June 13, 2011 7:08 PM | Posted by SteveBMD: | Reply

"Because prescribing meds to someone that doesn't need them so that they can qualify for the services they do need, sounds like a problem. Right?"

It's a problem, but it's a problem that makes a lot of people feel good about themselves.

Vote up Vote down Report this comment Score: -1 (3 votes cast)
Hey Booby: My ga... (Below threshold)

June 13, 2011 10:20 PM | Posted by Tom: | Reply

Hey Booby:
My garden is well tended to, Thank You very much. I will be first in line for cancer drugs. But as for psychiatric meds? Oh PUH-LEEZ! I will gladly take a placebo instead. I will get just as "well."

Vote up Vote down Report this comment Score: -2 (10 votes cast)
Easy.Just say some... (Below threshold)

June 14, 2011 1:38 AM | Posted by Anonymous: | Reply

Easy.

Just say something else and soon everyone will totally forget you said the opposite 10 years ago.

For evidence, see the "fat causes heart disease' ranting in the 1980s, leading to people consuming lavages worth of corn syrup, flour, and hydrogenated oil.

Enter the 90s. "You need to eat fat it's totally necessary for normal physiology. Saturated fat causes heart disease only. Sugar might not be a good idea either. Or "bad" carbs. All cholesterol isn't bad, just the LDL."

Note no one sent you a card saying "WOOPS, we goofed! here's a voucher for a free tub of fresh pressed olive oil because we told you to eat that processed shit which fucks up your cell membranes". No guru or government agency or anyone at all admitted they were wrong, they just subtlely retooled their original message little by little so that no one noticed it was changing.


Then enter the 2000s. "Fat is actually good for you and some evidence suggests a diet high in fat, particularly mono/omega 3 fatty acids is curative and preventative of many conditions including, ironically, heart disease. It's actually blood glucose that fucks your body up royally, and all that sugary starchy shit we told you to eat 20 years ago made your diseases way worse. "


Again no one admitted they were WRONG. They just slowly directed you away from the fat free saltines, and toward the fish oil/vegetables/protein.

YOu never knew they were saying the exact opposite, unless you were paying attention, and no one was paying attention unless you cared.


The exact same thing will happen in psychiatry.

When convincing parents to give their toddlers brand name antipsychotics for their "pediatric bipolar" no longer becomes financially marketable, they will just start saying "well it's not genetics, it's actually genetics and environment, and the chemical imbalance may also be treated with CBT". And "some cases of bipolar seem to respond very well to TMS".

Vote up Vote down Report this comment Score: 8 (10 votes cast)
"I know NO psychiatrist who... (Below threshold)

June 14, 2011 1:47 AM | Posted by Anonymous: | Reply

"I know NO psychiatrist who will keep a patient on medication(s) that are clearly causing harm to the point of disabling them further, relative to baseline."

The problem in psychiatry is that "functionality" becomes redefined to mean something bizarre.

A person will have no memory from ATC benzos and antiepileptics, completely disabled and unable to work because of this, lethargy and depression and apathy from dopamine/serotonin blockade and b vitamin depletion of depakote leading to severe metabolic / endocrine disorders... but they will be said to be "functional" if some arbitrary mentalo/emotional parameter is numbed into submission. They will be said to be a success if they are less impulsive or violent. Nevermind the fact their feet are rotting from diabetes and they are totally unable to work because of dumbness and apathy and no memory from psych meds.

Often times the "symptom" is behavioral or cognitive, clearly a bad habit/compulsion more than a real disease. This level of aforementioned disability is completely unjustified.

It would be justified if we are numbing severe psychosis or severe mania... but often time the issue is "anxiety" or some other heavily personality related issue. "I'm a girl who is lonely because I am stuck in the house with a toddler and I have no friends and no career. I must be crazy let me go the the psych and throw down ativan like it's my job". In this case, it's debilitating. The girl needs to be told that she needs to confront her anxieties and differentiate herself and form a separate identity and career or at least a hobby. Sucking back benzos and hiding away in her "madness" which you are labeling her with is NOT HELPING, evne if your progress notes say "reduction in anxiety from last visit, continue sertraline and PRN ativan, follow up in 2 wks"

Vote up Vote down Report this comment Score: 7 (9 votes cast)
Just in case it wasnt' clea... (Below threshold)

June 14, 2011 1:54 AM | Posted, in reply to SteveBMD's comment, by Anonymous: | Reply

Just in case it wasnt' clear my Above comment was a response to yours.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
The original article appear... (Below threshold)

June 14, 2011 8:28 AM | Posted, in reply to Alone's comment, by Jack Coupal: | Reply

The original article appeared in the May 19th issue of the Wall Street Journal. It was written by Damian Paletta and headlined, "Disability-Claim Judge Has Trouble Saying 'No'".

That same day, SSA reps descended on Huntington, WV and placed that judge on administrative leave. Nationally, what we're seeing with many SSI/SSDI recipients IS a fraud.

Under "occupation", too many able-bodied and able-minded people successfully write the term, "Disabled". Gaming the system is too easily a fraud against taxpayers in many parts of the nation.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Hey Tom, don't want to admi... (Below threshold)

June 14, 2011 9:08 AM | Posted, in reply to Tom's comment, by Bobby: | Reply

Hey Tom, don't want to admit you'd be first in line for the Alzheimers' drugs too then? Hm, maybe because they could be some of the drugs you're railing against now?

And what about your old folks? You'd rather have them with dementia than consider meds?

Vote up Vote down Report this comment Score: 4 (6 votes cast)
Ah, the good old days -- wh... (Below threshold)

June 14, 2011 10:31 AM | Posted by Bobby: | Reply

Ah, the good old days -- when the mentally ill just dropped out of school and the workforce and spent the rest of their lives in their parents' basements. Like the guy from Pink Floyd who died a year or two ago. Life was sure less complicated for us back then, in those "out of sight, out of mind" days.

No SSI claims then -- the mentally ill knew their place. And it wasn't with the rest of us, obviously. And they had their parents to take care of them. What a great set up! Now parents don't want to do that job -- they say they have jobs of their own, and can't look after their adult kids.

So, here we are with the rise of SSI. And all those wheel-chair ramps, and close-captioning services, and braille ATMs. It's almost as if society changed the way it looked at the the mentally/physically challenged some decades ago. Like there was an act, or something, for people with disabilities.

Now, if only someone would figure out that people with unpredictable illnesses are not good candidates for jobs that require a predictable M-F, 9-5 routine. That if we want such people out in the workforce, and off SSI, then we need to create more flexible workplaces -- with jobs that don't disappear when an "episode" flares up.

Vote up Vote down Report this comment Score: 10 (18 votes cast)
Bobby,Good points,... (Below threshold)

June 14, 2011 10:49 AM | Posted by SteveBMD: | Reply

Bobby,

Good points, but my comments (and, if I'm not mistaken, TLP's original post) pertain to those "disabled" for whom wheelchair ramps, closed-captions, and Braille ATMs-- and virtually any of the accommodations intended by the original ADA-- are irrelevant, and for whom SSI is another form of welfare.

As Jack Coupal wrote, "disabled" now can be used to describe just about anyone. All it takes is a diagnosis. And a good lawyer who runs ads on afternoon TV. It also helps if you live in Huntington, WV.

Vote up Vote down Report this comment Score: 1 (5 votes cast)
Good points from you and TL... (Below threshold)

June 14, 2011 12:21 PM | Posted, in reply to SteveBMD's comment, by Bobby: | Reply

Good points from you and TLP, too. As always. My point is that it is possible to be able-bodied and "disabled" at the same time. A person may not be able to hold down a job -- at least without breaks in employment -- if they have a condition that's unpredictable, e.g. rapid-cycling bipolar, certain sleep disorders.

How many employers would consider hiring someone who has a history of being fired for not showing up for work, for a regular full-time job with benefits? So that leaves those people to low-paid, temporary, day-laborer type of work, assuming they can find that -- and what happens when they can't show up there because of an "episode"? Fired again.

That's where SSI comes in. And if we want to cut those numbers down, we need to find a different employment model for the able-bodied who are "disabled" on an episodic, but unpredictable, basis. IMHO.

Vote up Vote down Report this comment Score: 15 (15 votes cast)
Dr. Nancy C. Andreasen conc... (Below threshold)

June 14, 2011 1:00 PM | Posted by markps2: | Reply

Dr. Nancy C. Andreasen concluded her interview with "we need more drugs" and you also want more NEW drugs.
Medications or drugs? We already have plenty of drugs, drugs that work to affect the mind.
The legal drug dealers wants more (magical) drugs to treat his NON physically ill patients. Brilliant.

1% loss of brain tissue per year from antipsychotics.
You are helping people?
"Wizard's Ninth Rule"
A contradiction can not exist in reality. Not in part, nor in whole.

Vote up Vote down Report this comment Score: 2 (8 votes cast)
Hey Bobby: I'll ... (Below threshold)

June 14, 2011 9:51 PM | Posted by Tom: | Reply

Hey Bobby:
I'll take Alzheimer's drugs just so long as they out perform placebos AND they don't make me put on 200 pounds!

Vote up Vote down Report this comment Score: 0 (6 votes cast)
Your choice, Tom. Let's ho... (Below threshold)

June 15, 2011 9:13 AM | Posted, in reply to Tom's comment, by Bobby: | Reply

Your choice, Tom. Let's hope it's not one you have to make. For some of us, the weight gain thing might not be as important as it is to you.

Vote up Vote down Report this comment Score: 1 (7 votes cast)
Awesome, Alone!Sta... (Below threshold)

June 15, 2011 9:43 AM | Posted by medsvstherapy: | Reply

Awesome, Alone!

Stay on track with this. I have a different spin on the SSI: SSI rosters have burgeoned not only because the enrollees have no other source of income, but "because they can."

"Because they can" should always be suspected when examining huamn behavior. The clinical supervisor I had who was very behaviorally-oriented taught me this axoim of human behavior with the joke: "Q: Why does a dog lick his b@lls? A: Because he can."

Why does some guy beat his wife? Because he can. Why does some woman throw hysterics to atteract the attention of her physician? Why does this mom's teen play vid games all day and slip out the window at nite, instead of doing homework and following any rules of the home?

Because he can.

You have a choice: find easy-to-find work for $8/hr, work 40/wk, and enjoy the little time and money you have left over, OR follow the instructions from your neighbor who is on the disability, go to a headshrinker, report a bunch of symptoms, get Dx, get Rx, get hooked up with a lawyer who will carry out the disability paeprwork for you, sign the form, make your q 3 mo RTC, file your claim, and hang tight.

Now, you are hooked up. Zero hours per week versus 40.

Now, what to do with your time?

You are retired. What does the bumper sticker say? "Retired. No job no kids no money no problems."

Help the next neighbor get hooked up. And enjoy the fruits of mother earth, courtesy of the other guy down the street who knows hydroponics.

It is impossible that the vast majority of ppl on these disability roles are "disabled" from work.

It is true that "we" need some victim class so we can sustain our political power. As long as it is not money out of our pocket individually, we are fine with sending that person "disabled" by major depression their $600/month.

All the while, psychotherapy is actually an intervention that would work for a lot of the morbidity that is actually out there. Without (figuratively, or functionally) shrinking your frontal lobe.

I love that "prefrontal lobe" stuff. It sounds so scientific. For those not yet in the know, the impressive-sounding "prefrontal lobe" is actually just a part of the frontal lobe, not some other, more focused, more distinct part. But it sounds relly technical, like if I claimed your computer had a problem with its "volatile ess-dee-ram," instead of its "memory."

Vote up Vote down Report this comment Score: -2 (16 votes cast)
I went on SSI in 198... (Below threshold)

June 15, 2011 2:15 PM | Posted by Anonymous: | Reply


I went on SSI in 1986 because I had a hard time making enough money to pay my rent (and I have very low standards) because I was very unhappy, very tense and (on looking back) had a very slight acquaintance with "reality," and because most people who knew me for 5 minutes thought there was something very wrong with me.

I stay on SSI because I have very low standards and because it's still true that most people who know me for 5 minutes think there's something very wrong with me. It's true that I'm a little less unhappy and tense because I've been taking "antidepressants" (Celexa and Wellbutrin); this doesn't really solve anything but I manage to stay out of bed about half the time and I haven't bothered to kill myself yet. I've also noticed in the past 15 years that if I take an SSRI I'm able to keep myself from freaking out with "OCD" that I might have left the stove on or something, though I still have to "check things" before leaving.

There are times when I get very cranky for weeks or months and start to believe things like the CIA is following me and that random-looking people on the street are in on it (and sometimes they wear red jackets to spook me). When that happens somebody will eventually catch on if I don't -- like they'll see me "acting crazy" in public and dial 911 -- and I'll wind up taking an antipsychotic to calm myself and help me sleep just long enough for it to fade away. The side effect profile of this class of drugs scares me about as much getting paralyzed by a trigger-happy cop so I try to avoid both as much as possible.

As for responsibility, fuck you.

First off, I figure I had a genetic susceptibility for something that can be called "mental illness" -- my dad was diagnosed several times as "paranoid schizophrenic," was hospitalized in locked wards against his will several times for varying periods, and was on Thorazine for 25 years till he died at 64 (I think, basically, of Thorazine poisoning). That by itself was not enough -- my sister has always been "within normal range" as have her two daughters.

What clinched it was being stomped on hard in elementary school by Society. First I had an "unusual" home life, then the other kids picked on me day in and day out over my crazy father and my mother's cerebral palsy -- "Your mother's a retarded monkey!" Which led to what were described as "fights": you see, somehow the teachers and principal would believe stories that for no reason at all I'd see 4 or 5 bigger kids minding their own business in a hallway or stairway and force them to torment me and beat me up.

So the school system decided I was "a problem child" and got the State Dept. of Health and Mental Hygiene and the juvenile court system on me, which resulted on my being cast at age 9 into the locked institutions they establish for poor children that are hard to deal with, where I was gang-raped by the other inmates and beaten by the "care workers" for telling my parents "those lies." (These days, I gather, I'd've been drugged at home into sluggish compliance instead; I don't know whether to prefer one or the other, given the side-effects of such as Seroquel.)

And once you're in that system you get a File, and....

Basically, everybody Power Figure who represented "normality" told me I was an evil white-trash monster who of course normal people wanted to stomp on sight and that the best thing for all concerned is that I be locked up, doped up and forgotten. So I have trouble with Society, and over the course of decades it's worked out that Society and I like each other better if they pay me just enough to survive on so I can sit alone in my tiny apartment and be "symptomatic" on the Internet.

I.E. I was born with a brain that doesn't like stress very much, then was subjected to so much stress for such a long time that my brain broke. Before I was 10. And my stress level didn't diminish so my brain stayed broke.

Like I said, as for "responsibility" -- fuck you. You people -- by which I mean normal mundane taxpayers and voters -- have not fixed your System. You have not trained your children not to stomp on those who are "different" and too weak or outnumbered to fight back, you have not trained the "Authority" figures in charge of your schools to do more than label "weird" kids and do (even more) things to them, and you have not trained your policy-makers to fashion a better "way of life" for children an adults. You have not done these obvious things because you are stupid (Sarah Palin for President?!?), weak and morally deficient, and because you LOVE to be stupid, weak and morally deficient.

Who cares whose fault it is? Even if you people admitted it's your fault you'd be too stupid, weak and morally deficient to fix it. And if it's my fault, well, I'm 48 and I've been on SSI for 25 years.

Hey! I know! Let's blame GOD!

Vote up Vote down Report this comment Score: 17 (25 votes cast)
Dear Bobby,... (Below threshold)

June 15, 2011 2:34 PM | Posted by Anonymous: | Reply


Dear Bobby,

They're too stupid, weak and morally deficient to listen to you and properly address the problem. You're wasting your time.

What I see happening is this: they've closed down most of the "warehouses for the mentally ill" and they've built lots of prisons for "drug offenders" and "non-white gangs" and "sexual deviants" and so on. (Prisons bring in jobs!)

So whether they planned it this way or not, what they're doing now instead of busting people and locking them up "for their own good" in "hospitals" is locking us up in prison, for drugs or acting in what some nervous old lady would call "a threatening manner," to "protect Society." Which is a Good Thing for those poor rural counties where they put the prisons. How else are my hillbilly cousins going to support their Vicodin and Double Down habits?

"Medications?" Those cost Society too much in Medicaid and so on to treat their side effects like diabetes. Somehow it's becoming cheaper and more acceptable to the Mundanes to throw "unusual" people in prison where we can die of untreated AIDS and hepatitis, not to mention type 2 diabetes. For one thing prison guards are cheaper than medical personnel: it takes years to become, say, a Registered Nurse Practitioner, but only a few weeks to become a Correctional Officer, and guards' salaries are correspondingly lower.

Arguing with idiots, while a nice hobby, won't fix anything. Nothing will work, except hunkering down for a few generations till they hit on another social paradigm.
Which probably won't work either.

Vote up Vote down Report this comment Score: 10 (10 votes cast)
And yes, I do think ... (Below threshold)

June 15, 2011 3:09 PM | Posted by Anonymous: | Reply


And yes, I do think Society will go back to locking us up, in prison now, instead of letting us continue to "abuse" those precious "entitlements" like SSI and Medicaid. If we're too poor to afford good lawyers and or "private treatment." Because above all Society must be served and protected.

The last day of 4th grade was the day of Hurricane Agnes in 1972. Mrs. Monocrusos, the principal, after watching me wait in the front lobby for the storm to pass for two hours, overcame her obvious aversion to me and risked her life driving me home. Which she took as an opportunity to explain that I didn't belong in public school because I was broken and dangerous, and that for my own good and everybody else's I really ought to be put away someplace with people who can manage me. Which, thank heaven, she understood was what they were going to do over the summer, so that she would not have to spend another grade protecting the other kids and the teachers from my "mental illness."
She further opined that, because I would clearly never be "cured," that they ought to keep me locked up in a proper environment for the rest of my life, which they should have done with my father. And, she said, I should consider myself lucky that she was compassionate enough to tell me the truth, instead of mealy-mouthing liberal platitudes like the social workers do. I can't recall many of her exact words but she made herself so clear it's hard to forget the gist of it: Society needs to be protected from "disturbed" 9 year olds.

So.

This thing with SSI and pharmacological treatment has been a sideline which is now ending. The obvious solution is to provide "crazy people" with a secure environment where Society can be protected from us. "It's really better for all concerned, when you think about it."

Me, by the time they get around to making this "just the way things have always been done" I'll be old enough to kill kill myself without feeling like I'll miss out on anything but becoming poorer, sicker and older. You young people should think about finding places to hide where you can establish your own little societies.

Vote up Vote down Report this comment Score: 8 (10 votes cast)
To quote <a href="ht... (Below threshold)

June 15, 2011 3:20 PM | Posted by Anonymous: | Reply


To quote Alone:

"Paradigm shifts do not occur in physics because the principles do not change. Newtonian mechanics will always be useful for prediction because it is correct for the cases in which it is applicable (i.e. for measurable bodies.) It is furthermore not susceptible to political influence. Psychiatry is the opposite. The decision to accept or reject the paradigms in psychiatry are very clearly political, not evidentiary."

This is valid not only for medications but but for "dealing with 'disturbed' people" in general.

Get ready for locks clanking shut.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
I fully believe rates of di... (Below threshold)

June 15, 2011 4:42 PM | Posted by SteveBMD: | Reply

I fully believe rates of disability (and of all psychiatric diagnoses in general) would decrease if we could improve the quality of education in this country.

Could be the most effective public mental health measure ever implemented.

Vote up Vote down Report this comment Score: 5 (7 votes cast)
And not only psyc... (Below threshold)

June 15, 2011 7:19 PM | Posted, in reply to SteveBMD's comment, by Anonymous: | Reply


And not only psychiatric disability: well-educated people are less likely to get Type II diabetes, e.g.

But it's more cost-efficient to build lock-ups (construction jobs) and lock people up (guard jobs). We as a Society don't want to spend money on education: for one thing it takes too long to see results. But a "public safety" project, well, that's something the voters can get behind.

Vote up Vote down Report this comment Score: 2 (4 votes cast)
Bobby:The "weight ga... (Below threshold)

June 15, 2011 10:15 PM | Posted, in reply to Bobby's comment, by Tom: | Reply

Bobby:
The "weight gain" thing is not nearly as important as the "better than placebo" thing. LOL. I noticed you left this out of you asinine response.

Vote up Vote down Report this comment Score: -3 (5 votes cast)
Really liked this one.<br /... (Below threshold)

June 16, 2011 12:53 AM | Posted by Clinician: | Reply

Really liked this one.
I have worked with chronically mentally ill for 8 yrs. I see people who really are ill and medication helps them, despite the side effects. I see SSI scammers, about 1/3 are. At least half of the clients are axis II on mood stabilizers, and it rarely helps. Most of our psychiatrists refuse to give any "feel good" meds. No ativan, Ritalin, etc. About 1/3 of the clients use alcohol or pot.
Most all that are stable and not personality disordered have genetic issues and supportive families, and they are easy and I enjoy them.
The nightmare clients came from nightmare parents, but a few are just personality disordered.
The axis two are so exhausting -and the screwing I get from DMH productivity measures and the axis two- feels beyond dysfunctional. I regret ever going into this field.

I really wish we taught basic psych in schools. Insight, diagnosis, coping skills, relationship skills, responsibility, consequences, empathy, appropriate reactions and self care, etc. etc. I really have thought this would change the world. I have thought that not doing so is a strange kind of subconscious need for drama and abuse of children on many people’s parts. Information is power and giving this self/relational power to children/teens would be respectful.

Vote up Vote down Report this comment Score: 8 (12 votes cast)
"[A] strange kind... (Below threshold)

June 16, 2011 1:21 AM | Posted, in reply to Clinician's comment, by Anonymous: | Reply


"[A] strange kind of subconscious need for drama and abuse of children on many people’s parts."

What else are children for? People have kids to prove they're real men and women; people teach kids to feel somebody knows less than they do... It's all about power and control. You raise children, you produce them, you mold them, "love" them into shape, a pinch here, there a little stretch.

At least here in the U.S.A., the only society I'm familiar with, it's been a long time since people had children for any natural reason. There's too much involved, too much invested, too much at stake. "Children are our future!"

They're just not people. Not like we are. We adults who make the rules and adjust the kids to fit them, or not. They're not real, not real people. They can't be or we wouldn't treat them like we do. Right?


Vote up Vote down Report this comment Score: 0 (8 votes cast)
Dear Alone,You see... (Below threshold)

June 16, 2011 8:37 AM | Posted by Dawer: | Reply

Dear Alone,

You seem very troubled. It's as if you're using cynicism and sarcasm to express a deep anger you cannot normally express--they give you a cause to pretend you care about. And then you can get angry about the cause you pretend to actually believe in. Life seems like it has a point for a little bit.

But the anger is actually not to anyone but yourself, and you know that..you fear that.

i think you should ask for help from the john of god http://www.spiritualdoctors.info/ . he can cure all sorts of psychosis and shit. LOL

Vote up Vote down Report this comment Score: -2 (4 votes cast)
Clinician, you make very go... (Below threshold)

June 16, 2011 1:15 PM | Posted, in reply to Clinician's comment, by Jack Coupal: | Reply

Clinician, you make very good points. Children provided such skills would lead happier, more productive lives, and would not become a sinkhole for their neighbors' money.

However, the K-12 public school system is operated by and for the adults in the system (teachers, staff, administrators, parents). The kids are an afterthought. If a kid manages to emerge from the system whole, we call that a miracle. A few miracles do occur in each school system, but they're way outnumbered by the failures.

Those failures become life-long visitors to the helping professions.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
Anonymous and Jack... (Below threshold)

June 16, 2011 10:24 PM | Posted by Anonymous: | Reply

Anonymous and Jack

Thank you for the support. I have been upset and angry sense I learned about basic psychology thirty years ago because it would have been the most incredible information for me as a young person and teen. It would have changed the course of my life and given me real freedom- not rebellion. It would have helped me understand real self-respect and strength.
And understanding personality disorder criteria would have helped me understand the abusive people in my life and learn what maturity and emotional regulation are: happiness and love.
My life would not have been a 20 year struggle to figure this out- even getting my masters in counseling barely helped me. It was a co-worker who went to a very good college that had about six classes on personality disorders alone- who helped me see the clear picture of what I had been dealing with.

As to the point of this article on pharma- children and teens given this information for an hour each school day would make them informed participants- really informed- leading to choice and less control by pharma. But we as a nation do not seem to want to really inform young people on the most important part of their future happiness and the worlds- mental health and loving relationships.

With the drop out rates- I always think “What is their motivation, they can’t have perspective and they have personality disordered and /or unconscious parents” If there is no attachment, there is no investment.

Vote up Vote down Report this comment Score: 1 (3 votes cast)
Ranting anon:Rathe... (Below threshold)

June 18, 2011 1:20 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Ranting anon:

Rather than tell yourself fairy tales that society prevents you from working, why don't you try to go to community college, learn a trade, and get a FRIGGING JOB so that your 25 year stretch of SSI can be broken? It's not hard. If you have no education and are very poor, most likely that evil horrible government will pay for most of your tuition. I know the government paid for almost all of my6 nursing education, because I am poor, and never took liberal arts classes for an undergrad degree (I went to school to contribute to society, not to delay adulthood).

It may take way longer to become a RNP, but there are very very few nurse practitioners running any medical facility. Typically a mental health clinic for example will have a psychiatrist or two, a few NPs, a few RNs, and a TON OF UNSKILLED LABOR who do all the grunt work. Orderlies/nurse assistants who get paid barely above minimum wage make up the overwhelming majority of any inpatient medical staff team. Prison guards make way more than a NA/orderly.

Jails never replaced psych houses; the streets replaced psych houses. Boarding homes/shelters too. No one goes to jail for being crazy - you got to jail for doing significantly illegal antisocial things. Unlike jean valjean, no one gets locked up for stealing a loaf of bread - as you pointed out, prisons cost money. You get locked up for stealing a car, or breaking into a house, or selling /buying drugs, or raping people. No one gets locked up for hearing voices, although a lot of prisoners pretend to be crazy because that's what sociopaths do - if they think your crazy you can score seroquel (what do they call it baby q? that is sellable) plus it gets you leniency/special treatment that you would not otherwise get if you were a straight up sociopath. Crazy people rarely have the logic requried to commit and carry out a crime, most "crazy people" in jail are faking it for the drugs and time outs/attention. Remember, I"m a nurse. I know a lot of nurses who worked in jails. They are all fakers, almost all of them anyway.

Vote up Vote down Report this comment Score: 1 (5 votes cast)
So you've experienced bias ... (Below threshold)

June 18, 2011 1:30 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

So you've experienced bias for your mental illness? Big deal. You are a minority. People are ignorant. Thats what happens to minorities.

Every day of my life I experience bigotry for my sexual orientation. I don't even flaunt it - I am gender conforming, I never disclose it. I "conform", I just don't lie and pretend to be straight and choose to be private about my life. In other words, I don't pretend to want to be a normal christian woman who wants a husband and children, and I never brag about all the d*** i s*** like those other moral religious hypocrites. All of my cowo9rkers gossip about me and treat me like a sex offender. If they are alone with me, they run away as if I might try to seduce them (even the fattest ugliest memaws will do this). The males treat me like I am a freak, oddity, try their best to avoid me.


I experience this every day, and I still get up and go to work. It's depressing sure, but what the fuck, I am not going to sit in my house on welfare complaining about how life isn't fair and people hate me because of how I was born.

Mental illness is something people don't understand and will stigmatize you for. The answer is not to be like "yes, your right, I am going to sit in a dank apartment and do nothing all day". You have nothing but time on your hands - why don't you use it to dig yourself out of this hole you're in? If you tell yourself you can never do better, you sure as hell won't.

Hey, I've been crazy too. I didn't leave my house for years and had massive knots in my hair and slept all day, I've known severe depression. You have to fight for life, some people have it harder than others.

Vote up Vote down Report this comment Score: 1 (9 votes cast)
I think we could improve ra... (Below threshold)

June 18, 2011 1:34 AM | Posted, in reply to SteveBMD's comment, by Anonymous: | Reply

I think we could improve rates of psych illnesses if we stopped compensating psychiatrists for diagnosing normal people with them.

The reason so many people are diagnosed with "depression/bipolar spectrum/anxiety" and other BS is because a psychiatrist gets his payment from the insurance company whether or not the patient REALLY NEEDS the services. And people are always willing to hear their problems are not their fault. The psychiatrist and malingerer are in a parasitic symbotic relationship and the insurance companies fuel it.

Vote up Vote down Report this comment Score: 0 (2 votes cast)
Mentally impaired people ha... (Below threshold)

June 18, 2011 11:42 AM | Posted by KILL DR. PILL: | Reply

Mentally impaired people have no rights. There is your answer. They can and will be rounded up and put to some "mental institution".

Vote up Vote down Report this comment Score: 0 (2 votes cast)
"Hey, she says, as she bicy... (Below threshold)

June 22, 2011 7:13 AM | Posted by AMH: | Reply

"Hey, she says, as she bicycles home with a baguette and a bottle of red wine, look what a Pharma-free re-appraisal of the science has done!"

The snarker in me loves that. It shouldn't--snark is not a decent trait--but, yeah. Love it.

Now I have to stop reading (and commenting) on your blog.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
I just want to point out it... (Below threshold)

June 23, 2011 11:38 PM | Posted, in reply to Bobby's comment, by Anonymous: | Reply

I just want to point out it is ILLEGAL to fire someone who requires time off for mental health reasons.

Just like you can't fire someone who needs to take off of work for treatments for a cancer flare up, you can't fire a bipolar person who gets unstable and requires some sick leave to get well enough to come back to work.

The problem is many mentally ill people behave like children and take no responsibility for their illness. They get sick and just stop going to work. They make no attempt to cope and go in, and they don't do the responsible thing of going to get treatment and taking sick leave, either.

Yes, if you stop going to work and don't do it the proper way by taking medical leave, you will be fired. You're not a special bipolar artist, you are a regular fucker like everyone else. If I get the flu and cant get out of bed for a week, I need to call my boss and tell them I'm sick. If I can't come in after 5 days, I need to go on disability temporarily.

I can't just lie in bed and not pick up the phone because my arm is too heavy to move it because I have a bad case of the flu. I will be written up and/or terminated if I do that.

The problem , and you are demonstrating this well, is mentally ill people are conditioned to view themselves as children who should not can not and will not be responsible for their sickness. You CAN NOT just not go to work. You have a chronic disease but you have the same responsibilities as everyone else. My coworker with lupus takes days off and calls in for them. She doesn't just NOT SHOW UP. If she did, she would be fired, and it's not because of her lupus and requiring time off, its because she was an irresponsible idiot.


Now it's tough with bipolar because in the manic phase you may be too crazy to do what's right. However, you seem to be alluding to time off due to depression (not being able to come in, vs acting like a psycho when you are already there). Only very severe depression is that debilitating and there is usually a period of mild or moderate depression before that point where you can take responsibility and handle your sickness properly with your employeer.


I mean, a mentally ill person has two options. 1) COPE with your episodes while also working (only feasible to a point) or 2) CALL your employer, call out sick properly, go on disability for depression temporarily.


I mean, I really don't want to hear it. I have depression and I've done both things... I've been totally irresponsible with it and I've been responsible. Millions of people have chronic illnesses, you are not special for having bipolar, it is illegal to fire someone for taking leave for mental illness a medically real problem.

Vote up Vote down Report this comment Score: 2 (8 votes cast)
Ooo! Ooo! Okay, I'll take T... (Below threshold)

June 24, 2011 9:54 AM | Posted, in reply to Anonymous's comment, by AMH: | Reply

Ooo! Ooo! Okay, I'll take Troll's bait!

So Troll, if mental illness isn't an excuse for "behaving like children" what's your excuse? I mean, you're ranting and raving, attacking someone so bravely from behind your computer screen, hurling names like psycho at them. I would think that you wouldn't want to say that mental illness doesn't have a behavioral component, since your behavior is so freaking atrocious.

Are you sure what you have is depression and not, say, a personality disorder?

Otherwise, I must applaud you for your faulty logic. Yes, bipolar disorder is JUST LIKE lupus. You know, because lupus causes psychosis and all. Do you understand that one of the hallmarks of psychosis is lack of insight? Like what you have, but much, much worse.

Oh, and by the way, that you have depression (I guess) does not make you an authority, but I love the way people with depression think it does. What it makes you an authority on is YOUR EXPERIENCE OF DEPRESSION.

So STFU.

Vote up Vote down Report this comment Score: -2 (8 votes cast)
Oops, you didn't use the wo... (Below threshold)

June 24, 2011 10:02 AM | Posted by AMH: | Reply

Oops, you didn't use the word "psycho," just "crazy," as well as "irresponsible idiot." And by the way, severe depression can have a component of psychosis.

Wow, I really see red when someone acts like you, all stigmatizing, mentally-ill-hating, and judgmental. Ptttthhhh.

Vote up Vote down Report this comment Score: -1 (3 votes cast)
Under what law is it illega... (Below threshold)

June 24, 2011 8:38 PM | Posted, in reply to Anonymous's comment, by Bobby: | Reply

Under what law is it illegal to fire someone who can't show up for work for an extended period in the scenario I mentioned -- regardless of whether the cause is mental illness or cancer? Now, it could be a state law where you live, but I'm not aware of any Federal law that kicks in immediately. I thought you had to work at a company for over a year, to get any protection under Federal law and even then, only if the company is a certain size. But if I'm wrong, that'd be great.

You made the following comment in reply to my post: "The problem , and you are demonstrating this well, is mentally ill people are conditioned to view themselves as children who should not can not and will not be responsible for their sickness."

Weird, since I don't have a mental illness, nor did I claim to have one.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
YOu're being a dumbass.... (Below threshold)

June 25, 2011 1:23 AM | Posted, in reply to AMH's comment, by Anonymous: | Reply

YOu're being a dumbass.

I specifically cited a manic episode as an exception to the "just take responsibility" expectation. Sometimes in mania you are too CRAZY to have insight to do what's right, and in genuine manic episode you can be expected to do the irresponsible thing.

However Bobby's writing suggested he was speaking more of a depression problem rather than a manic one (not being able to show up for work). Yes, in depression, you DO have insight unless you are severely far gone. YOu KNOW you have to pick up the phone and call out. Lying in bed, not taking any responsibility at all for your former life, and playing elliot smith on loop and crying and allowing depressive thoughts to circle through your head and going into the void without a fight is not a valid response to a beginning depressive episode. I have depression, I know the warped reality you are sucked into, but I also know there are severities and I know you rarely wake up one day completely far gone. You get there, assuming you slide there, assuming you take no action.

PS I have bipolar II not depression.

I don't think I'm an authority on all depression... I just know that I am sick of mentally ill people justifying their nonfunctionality. I've been SO FUCKING BAD , my life has been ruins, and now I'm doing way better, and the reason I am doing better is because I fight and try and stopped telling myself I was powerless.

Vote up Vote down Report this comment Score: 0 (2 votes cast)
I said they were acting lik... (Below threshold)

June 25, 2011 1:27 AM | Posted, in reply to AMH's comment, by Anonymous: | Reply

I said they were acting like one, assuming it applied to them, and that would be accurate.

If someone with alcoholism drinks a litre of booze, they can be said to be "acting like a drunk" and that would be correct. However "acting like" means you can change it, and should change it. You will always have alcoholism, but ultimately you choose to act like a boozed up drunk or not , i.e. to stay sick or not, to take action and be responsible and handle your addiction or not.

Vote up Vote down Report this comment Score: -1 (1 votes cast)
This "I cant work because I... (Below threshold)

June 25, 2011 1:30 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

This "I cant work because I'm crazy because my dad wasnt nice to me because because because" is the wail of the powerless.

It is a lie people tell themselves, and often mental health professionals are complicit in fostering a sense of eternal defectiveness and powerlessness in their patients.

I attribute my well being and relative stability to a lot of things, and avoiding therapists and psychiatrists is an important part of that. They are the WORST with helping grown adults feel like dependent incompetent powerless broken beings who can never function or equal "normal" people in society.

Vote up Vote down Report this comment Score: 2 (4 votes cast)
HERE I'LL HELP U<a... (Below threshold)

June 25, 2011 1:32 AM | Posted, in reply to Bobby's comment, by Anonymous: | Reply

HERE I'LL HELP U

http://www.eeoc.gov/eeoc/newsroom/release/3-18-03b.cfm

"In its lawsuit, case number CIV-02-92-C in U.S. District Court for the Western District of Oklahoma in Oklahoma City, the EEOC charged Voss with violating the Americans with Disabilities Act of 1990 (ADA) by terminating a long-time employee of its Oklahoma City facility who needed in-patient care due to bipolar disorder, a psychiatric disability. Rather than allow the employee the additional time off recommended by his physicians, Voss fired him by taping a termination letter to the front door of his home, the EEOC said in the suit."


You can't do that shit. Mental illness is a real illness. If an employeer does this they will expect legal reprocussions. You can NOT fire someone for needing time off for any kind of disability or sickness and that includes a mental illness episode.

But like I said, many MI people just lie in bed and don't take responsibility and simply don't show up. In that case, it is totally valid to fire the person and its not because they are an awesome bipolar artist who is too badass for this world, but instead its because they were an idiot who just stopped coming into work one day.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
"You can NOT fire someone f... (Below threshold)

June 25, 2011 9:56 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"You can NOT fire someone for needing time off for any kind of disability or sickness and that includes a mental illness episode."

You CAN fire someone under those circumstances. To get any kind of employment rights, a person has to work for a certain length of time, for a certain sized-firm. If you don't qualify, then it doesn't matter if you call in when you're sick, you can be fired.

Now, I thank you for the link -- I will look into the ADA as it should apply to a family member. But, again, the eeoc case might not apply in the scenario I set out as it concerned a "long-term employee" and I was talking about someone who had to take part-time/temporary/day labor type of employment -- because they couldn't get hired for full-time jobs with benefits due to a spotty work history. My point was that sometimes a person can be on SSI even when they want to work and have taken responsibility and called in sick, etc.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Oops, I forgot to put my na... (Below threshold)

June 25, 2011 9:59 AM | Posted by Bobby: | Reply

Oops, I forgot to put my name on my last comment at 9:56AM to Anonymous

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Well, no, if you are not a ... (Below threshold)

June 26, 2011 1:58 AM | Posted by Anonymous: | Reply

Well, no, if you are not a full time employee you don't have the same rights to disability.

And if you are still in a probationary period at your place of employment you also do not qualify for protection.

However, if you are SO UNSTABLE that you can't work long enough to get passed a probationary period at your job without having a major inpatient requiring psych episode... I think then you need to first focus on getting your head right enough before taking on a major responsibility like full time employment. Very few bipolar people are that unstable, and the few who are that unstable are not prepared for a full time job at that point in time.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Those are the guys I was ta... (Below threshold)

June 26, 2011 10:51 AM | Posted, in reply to Anonymous's comment, by Bobby: | Reply

Those are the guys I was talking about. No job, unstable health situation, no insurance, no unemployment eligibility because they hadn't worked -- so they're on SSI. I would imagine that's a hard cycle to get out of.

Which I why I was saying perhaps we should try to find a new employment model for people in this position -- help them make the first step. Right now, they'd most likely be at the very end of any hiring manager's list of job candidates.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
But, very few SMI people me... (Below threshold)

June 27, 2011 1:10 AM | Posted by Anonymous: | Reply

But, very few SMI people meet that criteria. Most do not have episodes that frequently. Most COULD GET A JOB and work if only they had the motivation and internal sense of control that is required to be an independent adult. Psychiatrists beat that out of them, though, convincing them a manic depressive could never work or be a normal functional adult.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
How do we know how many SMI... (Below threshold)

June 27, 2011 9:56 AM | Posted, in reply to Anonymous's comment, by Bobby: | Reply

How do we know how many SMI people meet that criteria? Has anyone taken the trouble to find out? Maybe we could start really looking at the people on SSI, to see how many of them would meet that criteria.

We might find out what contributed to the downward spiral, and how to stem it. Studies I've read -- where they've been looking at general social functioning -- show a high rate of unemployment associated with BP in adulthood, even after the manic/depressive/mixed state has passed. Some of that will be due to residual symptoms (which could include a lack of motivation and internal sense of control) and some of that will be due to reluctance to hire such a person in the first place.

In an earlier post, I mentioned people with sleep disorders -- an area of medicine with almost no answers if the problem is something other than apnea. For people with Ideopathic Hypersomnia, the problem is walking up and staying awake -- some of them could sleep through a marching band and have tried everything to be able to keep a schedule, losing jobs and relationships and dropping out of school along the way.

And, yes, I agree with you that a person with manic-depression can live a full, happy, and employed life -- in fact, most do -- but some continue to have difficulties, even with medical care.

And I would bet that most of people I was talking about have never seen a psychiatrist in their lives.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Where did you get the idea ... (Below threshold)

June 28, 2011 1:15 PM | Posted, in reply to Bobby's comment, by Anonymous: | Reply

Where did you get the idea that NYRoB only reviews recent books?

And why is the publishing date of the reviewed books relevant to the content of the review?

Vote up Vote down Report this comment Score: 1 (1 votes cast)
I think you're being hypocr... (Below threshold)

June 28, 2011 1:25 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I think you're being hypocritical here. If you started to suffer from severe depression and were unable to work, you'd claim disability faster than I can say, "bullshit."

One more thing: visit a hospital psychiatric ward and talk to some patients. Pay particular attention to how well they are grounded in reality. Then tell me with a straight face that their rantings are just the "wail of the powerless" and really, it's all a lie.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Apologies for posting the l... (Below threshold)

June 28, 2011 1:29 PM | Posted by Vladimir G. Ivanovic: | Reply

Apologies for posting the last two comments as 'anonymous'. I stand behind what I say.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
The kernel of what Dr. Ange... (Below threshold)

June 28, 2011 1:49 PM | Posted by Vladimir G. Ivanovic: | Reply

The kernel of what Dr. Angell is saying is that when failed trials are taken into account, medication is no better than a placebo, particularly if the placebo mimics the side effects of the medication. Nowhere in your review is this finding addressed. (Who are you, by the way? I couldn't find your name anywhere on this web site.)

Your review is full of slurs, ad hominem attacks, criticisms of minor points and non seqiturs. But, what should I expect when your ox is gored?

Vote up Vote down Report this comment Score: 3 (3 votes cast)
Who are you talking to, me?... (Below threshold)

June 28, 2011 2:33 PM | Posted, in reply to Vladimir G. Ivanovic's comment, by Bobby: | Reply

Who are you talking to, me?

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Whoever is the author of th... (Below threshold)

June 28, 2011 5:37 PM | Posted, in reply to Bobby's comment, by Vladimir G. Ivanovic: | Reply

Whoever is the author of the review. If you are, then, yes, I'm talking to you. Otherwise, I'm not.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
I have to agree with Vladim... (Below threshold)

June 28, 2011 8:43 PM | Posted by MyWits'End: | Reply

I have to agree with Vladimir G. Ivanovic. It seems you are tilting at windmills, my friend. It's not evident that you have read the books under review, nor are very familiar with the history of psychiatry, else you would not say something as blatantly mistaken as: "Psychiatry has always had medications, they just had an hour to decide which one to use." As usual, your thesis is hard to disentangle from all of the drunken ranting and raving. Maybe you do have a valid point, it's difficult to tell.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
The norm is to review books... (Below threshold)

June 29, 2011 9:21 AM | Posted, in reply to Anonymous's comment, by Bobby: | Reply

The norm is to review books when they are hot off the presses, and on tables at the front of bookstores, in Costco, etc. -- not when they've been out for months. The latter's more like a book report (for school) than a book review, to me.

When the review is done at such a late stage, it seems a bit stale as they've been talked to death in other publications by that time.

Vote up Vote down Report this comment Score: -1 (1 votes cast)
"Which I why I was saying p... (Below threshold)

July 3, 2011 4:48 PM | Posted by Anonymous: | Reply

"Which I why I was saying perhaps we should try to find a new employment model for people in this position..."

In order to solve the current economic crisis amongst SSI disability recipients we need to put all of these unemployed and/or underemployed people back to work rebuilding small/medium-sized towns, farms, villages, and hamlets. There are hundreds if not thousands of small to medium-sized towns across the USA with declining populations that could be revitalized with an influx of people in to them (from America's overgrown cities) which would revive local/regional markets. People keep cramming in to cities/suburbs (major metro areas) where the employment market is vastly over-saturated and this only serves to exacerbate employment problems.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
"Which I why I was saying p... (Below threshold)

July 3, 2011 4:49 PM | Posted by Eman: | Reply

"Which I why I was saying perhaps we should try to find a new employment model for people in this position..."

In order to solve the current economic crisis amongst SSI disability recipients we need to put all of these unemployed and/or underemployed people back to work rebuilding small/medium-sized towns, farms, villages, and hamlets. There are hundreds if not thousands of small to medium-sized towns across the USA with declining populations that could be revitalized with an influx of people in to them (from America's overgrown cities) which would revive local/regional markets. People keep cramming in to cities/suburbs (major metro areas) where the employment market is vastly over-saturated and this only serves to exacerbate employment problems.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Sure, because all mentally ... (Below threshold)

July 3, 2011 8:24 PM | Posted, in reply to Eman's comment, by Anon: | Reply

Sure, because all mentally ill people are alike in their abilities, just as all women are alike in their abilities, all children, all men, all gay people, all French people, and on and on. If you had any conception of the issues mentally ill people grapple with, one of them quite often is physical--chronic physical illness often precedes mental illness or comes alongside of it, in terms of the effects of some medication. Anti-psychotics can cause body temperature regulation problems--e.g., causes some people not to sweat. That is incredibly dangerous in hot weather. What a boffo idea. Not.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
More please, this informati... (Below threshold)

July 26, 2011 6:39 AM | Posted by Oakley Limited Editions Sunglasses: | Reply

More please, this information helped me consider a few more things, keep up the good work.
Oakley">http://www.theoakleysunglasses.com">Oakley Limited Editions Sunglasses

Vote up Vote down Report this comment Score: -2 (2 votes cast)
do you know what antipsycho... (Below threshold)

July 28, 2011 10:26 PM | Posted, in reply to Bobby's comment, by cherry: | Reply

do you know what antipsychotics do to people with dementia? they usually die, they die quicker, their cognitive functions decline rapidly they become zombies much more prematurely then they are supposed to. these drugs dramatically reduce their quality of life because it is a knee-jerk reaction when it is proven biopsychosocial cares works better.
they arent medicated for THEIR best interests, they are medicated so US .. the carers, the family members can MANAGE them.

Vote up Vote down Report this comment Score: 2 (2 votes cast)
A knowledge, a growth, a go... (Below threshold)

July 29, 2011 10:56 PM | Posted by cheap chi flat iron: | Reply

A knowledge, a growth, a good article can make a person to enhance the taste, thank you for sharing, I will carefully read the product to make themselves rich!
cheap chi flat iron

Vote up Vote down Report this comment Score: -1 (1 votes cast)
I've just read this editori... (Below threshold)

August 10, 2011 5:14 PM | Posted by tshann: | Reply

I've just read this editorial. I have to say, you have a lot to say - about Angell. You sound like you clearly don't like her, not just that you don't agree. But the difference between your prose and hers, and more importantly Whitaker, Carlat, & Kirsh is they actually have data to back up their pov. You, unfortunately, are primarily just spewing unfounded opinions. I would be VERY interested in your pov if you could actually back it up. Otherwise, your prose, so far, is merely a "I don't like Angell" and here's my vent.
So, back up your claims with something of substance - then it could be respected. If you feel that Angell has made some significant errors or poor assumptions, use logic and data to help us all learn. Dramatic terms and flashy metaphors about bicycling with wine and a loaf of bread is good for the movies - but it makes you look flashy without substance. I'm sure there is some substance to what you say - I'd like to hear it. Without all the drama.

Peace

Vote up Vote down Report this comment Score: 5 (7 votes cast)
First of all I like this po... (Below threshold)

June 3, 2012 8:58 AM | Posted by BSL: | Reply

First of all I like this post.
I´ve tried practically all sort of medicine. I believe the only “winner” is the companies that produce the meds. Too many people are diagnosed, especially with depression. I think that depression is a normal reaction to the things we experiences in life. Perhaps talking about it is the best medicine after all.

Greetings from Denmark. :)

Vote up Vote down Report this comment Score: 2 (2 votes cast)
Great article, thanks. ... (Below threshold)

September 6, 2012 1:42 AM | Posted by Phineas: | Reply

Great article, thanks.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
It's not JUST the doctors, ... (Below threshold)

March 16, 2013 12:50 PM | Posted, in reply to Harry Horton's comment, by Dovahkiin: | Reply

It's not JUST the doctors, the entire culture has thought that the answer to any condition is drugs, drugs, drugs. It's a bias that doctors can't help but repeat. It's not just psychiatry, any MD could point to dozens of their own patients that almost if not outright demand a pill to take their troubles away. It's how we got bacteria immune to drugs -- people demand anti-biotics for flus (which are caused by a virus) and end up causing lots of problems down the line when bacteria in their system evolve immunity to whatever we gave them for the flu.

The only way to really fix all of this is to change the medical default protocols, make drugs -- any drugs -- the last resort, rather than the standard we use today of "let's find a pill to fix that". Personally I'm appalled to think that TLP is dismissive about the large numbers of pills people are taking. If they really really need that, ok, but to suggest that anyone who balks at the notion of a person needing 6 different drugs is deranged to the point of suspecting Satan is silly. There is a problem when those who are supposed to be evaluating the need for drugs are that blase about needing so many. There may very well be five that are not working. But of course if you're thinking that, you must be reaching for the holy water and the crucifix. American culture for the win.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Excellent, the more I read ... (Below threshold)

July 1, 2013 12:37 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Excellent, the more I read your comments, the more I enjoy your intelligence.

Vote up Vote down Report this comment Score: 0 (0 votes cast)

Post a Comment


Live Comment Preview

April 18, 2014 09:06 AM | Posted by Anonymous: