Depends on your definition. Wovon man...

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.

The other 4 cars are now completely fine, thanks to early intervention.

After some dozen years' immersion in intelligence, I still find myself reacting uncomfortably to its rather cavalier disregard for the footnote.

This is an example of why the controversy over Pharma influence on doctors is, while accurate, likely irrelevant.

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.

And with good reason.

Yes, you read that right.  Drink a big glass of OJ and put away your blotter paper, you won't need 'em in here.

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.

And I am ashamed.

Belated, anyway.

In which appears the phrase, "the sticky pages of the New England Journal."

In the tradition of Robert Kagan and the folks at Policy Review, Robert Simon, MD defines foreign policy for the next century.

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.

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.

Do you dare defy the Will of God?

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.

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.

 

 

I'll take Paris any day. 

So Paris goes back to jail after the behind the scenes/cover of darkness/MK-ULTRA deal she made to get out of jail early was met by the public with consternation.

As near as I can tell,  a/her private psychiatrist (his blog here-- mine's better, dammit) visited her for two hours in jail, then made a plea to the sheriff that serving her sentence in jail was psychiatrically harmful to her.  So they let her out to serve it at home.

The argument here, of course, is that this is rich-white-girl gets special treatment; and the easiest  way to do it is to use psychiatry. And people say, "see?  This is they type of abuse we can expect if psychiatry is allowed to influence legal matters."

Fair enough.  I don't know Hilton's case, whether it was a appropriate or not, I don't know Dr. Sophy;  all I can say is, yes, the potential for abuse exists, but perhaps it is balanced out by the cases in which it is helpful to society.
 

But consider the reverse situation, and read it carefully because then I'm going to punch someone:

SELMER, Tennessee (AP) -- A woman who killed her preacher husband with a shotgun blast to the back as he lay in bed was sentenced Friday to three years in prison, but she may end up serving only 60 days in a mental hospital.

Mary Winkler must serve 210 days of her sentence before she can be released on probation, but she gets credit for the five months she has already spent in jail, Judge Weber McCraw said.

That leaves only two months, and McCraw said up to 60 days of the sentence could be served in a facility where she could receive mental health treatment. That means Winkler may not serve any significant time in prison.

 

Same gripe: look how people use psychiatry to manipulate the legal system-- "only two months for killing someone?!" and while I agree that's pretty pathetic, what's worrying me is this: who the hell spends five months in jail without getting a trial? 

This probably didn't occur to you, and that's why it still happens.  If I kill my preacher husband, I have the right to a speedy trial.  If I can't get a speedy trial, I get to pay a fee to be released, and then show up in court when the government gets their act together.  But what if I don't have bail money?  How can the courts justify indefinite incarceration in the absence of a trial?

Enter psychiatry.  You get a psychiatrist to evaluate the person and determine that he is not competent to stand trial.  They recommend 60 days involuntary commitment/treatment in a psych hospital in order to "restore them to competency."  If at the end of 60 days the evaluator comes back, and if he still thinks they're not competent-- they get (re)committed again.  Etc.

Trial competency has very specific requirements: understanding how you wish to plea, the possible sentences, working with your lawyer, etc.  Being depressed or psychotic, per se, isn't the determinant-- only if it seriously impacts your ability to, say, understand the charges against you.

But in the vast majority of cases I have been involved in, the report really only reflects the presence of a mental illness, not its impact to the case.  As if it is de facto proof of incompetency.  It's not.

But here's the move: the "psych hospital" they get involuntarily committed to is actually their cell. 

Technically, they are supposed to be committed to an inpatient hospital.  Many jails have them on the premises.  But if the commitment is for 60 days, and the psychiatrist treating them (i.e. not the evaluator) thinks they are cured, then they get sent back into population (their cell).  Maybe they continue on medication; maybe they see the psychiatrist weekly for "outpatient" visits.

Or maybe, maybe, the treating psychiatrist doesn't think they need any treatment.  So they spend their commitment in exactly the place they started. 

Worse, much worse, is how many people I see that I say are competent and still wind up recommitted for two months.  Six months.  A year.  Think I'm kidding?  It is impossible to even estimate how many charts I have read that indicate no psychiatric contact-- not medication, not therapy, not psychiatrist--  for the entire duration of their commitment.  And why should there be? The treating psychiatrist doesn't see anything to treat.

You're probably thinking about murderers and rapists; but the majority of these cases are theft, assaults, drug possessions. Can anyone explain to me what possible justification exists for locking up a guy charged with possession for eight months, no trial?  And I'll pretend the guy is whacked out of his nut psychotic.  Ok?  Any justification at all?

I'm not saying you can't sentence him to eight months-- cane him, for all I care;  I'm saying you can't jail him for eight months without a trial.  Is anyone listening to me? 

The system is designed with simply one outcome in mind: keep the poor with high recidivism rates and minimal social resources in jail-- a sort of half-way house for the disenfranchised-- until you can't possibly justify it any longer, and then give them a quick trial, accept the guilty plea ("what guilty plea?") and sentence them to time served and probation-- where you can add further controls.

It's debatable whether keeping potential terrorists in Cuba is a good idea.  But when the State starts using pyschiatry to manage their population...

I know you think I am exaggerrating.   I'll bet you're not poor.