Psychiatry Gone Awry
"Impulsivity In Kindergarten (Does Not) Predict Future Gambling" ››
If the front page of Psychiatric Times ran a story called DSM-V Controversies, and it contained this picture, what would you think the article would be about?
"DSM-V Controversies" ››
"Is Internet Addiction Really An Addiction?" ››
Certain psychiatrists carry considerable weight in determining the policy, the spirit, of psychiatry. Henry Nasrallah is one of those men, which is why, if you see him write an editorial called, "Should psychiatry list hubris in the DSM-V?" -- especially if it is tongue-in-cheek--- you should strike yourself in the head with a brick until you are unconscious. You are about to be manipulated with words, and then it will be too late.
"Should Hubris Be In The DSM-V?" ››
"1 In 5 Cars Has A Personality Disorder" ››
After some dozen years' immersion in intelligence, I still find myself reacting uncomfortably to its rather cavalier disregard for the footnote.
"The CIA Has The Same Problem Medicine Does" ››
This is an example of why the controversy over Pharma influence on doctors is, while accurate, likely irrelevant.
"Undue Influence On Psychiatrists, Or The Public?" ››
In case you doubted, here is today's front page of USAToday: Economy's stuck, but business is booming at therapists' offices.
If that was the end of the story-- if people had social troubles and turned to psychiatry for help because of those troubles, it would be a good thing. Get help where you can.
But the larger problem is that in going to psychiatry, their socioeconomic issues get demoted to "factors" and the feelings become pathologized. Psychiatry doesn't explain, it identifies. You're not depressed because you lost your house; you have depression, and one of the triggers is losing your house. See the difference?
You'll say this doesn't happen all the time, maybe not even the majority of the time. But even if it doesn't happen to a specific individual, it still happens to enough people that it bolsters psychiatry's role as the necessary player in managing suffering of any kind.
A 20% increase in therapy visits will be interpreted by psychiatry as a 20% increase in depression and anxiety. It will say depression has a prevalence of X, it will say it is underdiagnosed and undertreated, etc. And it will creep into the social consciousness that these are pre-existing diseases with triggers, not the consequences of external events.
Society needs that illusion, it needs that lie, because it has created unrealistic expectations in people and no way of fulfilling them. Here's what a society looks like under the similar economic conditions, but without psychiatry:
The absence of hope
Today's popular frustrations over flat-lining living standards have been building for years. The recent boom, felt only by the already well-off, has done little to change that discontent. Labor unrest has been growing for months; violent protests erupted... corporate taxes will be raised and gasoline subsidies cut... The move was designed to take the steam out of boiling anti-government sentiment.
The above article, also from USAToday, has a slightly different title: Egypt's economy soars; so does misery.
Score: 1 (1 votes cast)
And with good reason.
"Academics Hide Drug Company Payments" ››
The FDA Says No Black Box Needed On Drugs That Increase Suicidality, But Still Needed For Those That Don't
Yes, you read that right. Drink a big glass of OJ and put away your blotter paper, you won't need 'em in here.
Score: 0 (0 votes cast)
Agreed. And then let's rename the DSM The Book of Fantastikal Magickal Pixies and incorporate it into the Monster Manual. And let Mad Libs publish the assessment tools.
"Internet Addiction Belongs In The DSM-V" ››
"The Dead Sea Effect In Academia" ››
"First Anniversary Of The Death Of Antidepressants" ››
"The Pornography Of Medicine" ››
"Suicidal Patients' Access To Their Psychiatrist" ››
In which I take the semiotic logic of medication induced suicidality to its inevitable, silly end.
Using nothing more than a Volvo. And without lawyers.
"What Else Causes Suicide? You'll Never Guess" ››
ABC News, and others, report that the NEJM study found that antidepressants "may be duds."
Climb on the bandwagon, my bolsheviks, no brakes, no driver, let us see where it takes us.
"A Study Finds Antidepressants Don't Work, And Suddenly It's October 25" ››
Bipolar Rates Are Increasing As Long As You're Willing To Call Everything Bipolar And Defy God's Will
Score: 1 (1 votes cast)
A diagnosis of borderline personality disorder could, theoretically, mean that the psychiatrist made a serious attempt at evaluating defense mechanisms and ego integrity; or at least a matching of symptoms to DSM criteria. It's theoretically possible, yes. Other things that are theoretically possible include alien abduction, peace in our time, dual eigenstates, user friendly Movable Type upgrades, political discussions that don't rely on information from John Stewart, Daleks, recession with low unemployment, Independents, Madonna/whores, a benignly rising Russia.
"The Diagnosis of Borderline Personality Disorder: What Does It Really Mean?" ››
In case there was any doubt that psychiatry is on the march (from Psychiatric Times June 2007):
The mass murders at Virginia Tech [sic: there was only one mass murder] could lead to harsher laws restricting [mentally ill people's] rights... Perlin, professor of law at NYU, predicted that several states will try to change the basis for involuntary commitment from danger of harm to self and/or others to the need for psychiatric treatment. [emphasis mine, but really, does it need emphasis?]
Mr. Perlin said he expects the U.S. Supreme Court will be asked to rule on such a statute's constitutionality within 10 years. "I am already counting the votes."
Me, too: Scalia, Thomas, Roberts, Alito, Ginsburg-- strange bedfellows, indeed, but Scalia and Ginsburg spend every New Year's Eve together-- against; Souter, Kennedy for; the rest is anyone's guess (Stevens may not even be there.)
The second article, from the same issue, accidentally describes the crux of the psychiatry/violence dichotomy. In "Mental Health Staff Can't Sue If Injured By Patient," the writer explains how it is rare, and generally discouraged, for staff to sue or press charges against a patient who is violent and injures them.
Patients who attack mental health professionals in hospital settings are rarely prosecuted and usually cannot be sued for civil damages [said] Ralph Slovenko, Ph.D. at the annual meeting of the American College of Forensic Psychiatry.
...Authorities usually take the position that it would be inconsistent to prosecute a person who has already been hospitalized for reason of mental illness...
... a New Jersey Court ruled [that] to convict a mentally ill person for displaying symptoms of mental illness... could not be justified constitutionally or morally.
Anyone disagree? Choose carefully. Here's the problem: the exemption from prosecution isn't for the insane behaving insanely, or the schizophrenic exhibiting psychosis; the exemption is for any patient. "Patient" in this context, is defined as anyone who is in the psychiatric hospital. In other words, it's not a label based on pathology; it's a label based on geography.
This may surprise many people, but psychiatrists hospitalize non-mentally ill people all the time. Any resident will lament how often they are confronted with the malingering drug user who fakes suicidality to gain admission. Well, if you admit him-- strike that, if he has ever been admitted-- then he is a de facto patient. If he kills you, he is automatically in a different legal status than if he murdered you in a supermarket. For example: no death penalty.
It goes without saying, of course, that even the presence of mental illness shouldn't free one from prosecution. That's why we have the legal construct of insanity.
Here's the clincher:
The situation is analogous to the "Fireman's Rule" in tort law, he said. A firefighter... cannot sue the owner of a burning building for injuries sustained in firefighting.
... I assume because a firefighter must have a reasonable expectation of fire-related danger. Fine. But if the firefighter, while fighting the fire, gets shot in the face by one of the meth-lab workers inside that the owner of the building is employing to make methamphetamine, is there no basis for a suit? Does reasonable expectation of a certain level of danger extend to, well, to volitional acts of violence that have nothing to do with the physical structure that the violence happens in?
The reason I mention these two articles together is because they are the same. "Mental illness" is a term so vague and empty that it is dangerously useless. Reducing one's responsibility, or restricting their freedom, based on such an arbitrary term is, well, insane. Doing both at the same time is a tacit acceptance of classism; that some have the responsibility to rule, and some have the responsibility to be ruled.
Oh, I know: everyone hates George Bush because he has no respect for civil liberties. Ok.
Score: 3 (3 votes cast)
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