Ronald Pies In Psychiatryland

One of the biggest clown doctors going at the present moment has got to be Ronald Pies. It would be remiss of me to claim that in his latest post, Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, he has outdone himself. If there was anyone destined for a pie in the face that anyone has got to be Ronald Pies. I would be honored, in fact, to bestow upon Dr. Pies the moniker Ronald “Pie In The Face” Pies for all posterity. Ronald Pies is a marvel of nonsensical shrink think. In his latest escapade into the theory and practice of shrinkery, Pies, by some disingenuous twist of convoluted illogic, would blame “the chemical imbalance theory” on that bug-a-boo and will-o-the-wisp of modern psychiatry, antipsychiatry. Go figure.

Now, if you were to give credence to a recent online polemic posing as investigative journalism, you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called “Psychiatry” has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).

Those first two statements Pies alludes to here would be those that indicate either “mental illnesses” were caused by “chemical imbalances” in the brain, or merely that more “serious mental illnesses” were caused by “chemical imbalances” in the brain. What we don’t get out of this story is precisely who was responsible for promoting and spreading this “chemical imbalance theory” that these people in some antipsychiatry movement would be exposing. Where is psychiatry here? Defending itself from those who would be exposing a discredited theory. Certainly it is not defending itself from the ones who would be promulgating that theory. Curious indeed.

Among his more bizarre notions is the notion that this “chemical imbalance” theory has more to do with some catecholamine hypothesis from many years back than it does with the development, marketing and advertising of those trendy psychiatric drugs still surging strong on the market of today.

To the extent the “chemical imbalance” notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the “chemical imbalance theory” was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.

Does Dr. Pies mean that psychiatrists don’t use, or shouldn’t use, those drugs that would be advertised as purporting to correct some kind of postulated and theoretical “chemical imbalance”?  I think not. This leads to another question. To what extent has psychiatry, or the majority of its practitioners, colluded with pharmaceutical companies in producing an atmosphere that now has commercial interests in the media peddling pills, not just to medical professionals, but to the entire buying public perceived and re-envisioned as consumers who will purchase anything at the provocation of the most mesmerizing sound bite?

Psychiatry’s critics also conveniently omit reference to what was arguably the most prevalent paradigm in academic psychiatry, during the 1980s and beyond: the biopsychosocial model (BPSM) of Dr. George Engel. The BPSM has been subjected to much criticism, and some would argue that few psychiatrists nowadays use the BPSM in a systematic, evidence-based manner. And in recent years, several prominent psychiatrists have warned that “…pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.”

In the latex gloved mitts of Dr. Pies, our babble here has degenerated into very nuanced babble indeed. If you will notice, despite the nip at bio babble unrefined, bio still has top billing in the theoretical credits. I don’t think this is entirely because of the order of words in the alphabet, or accidental. The mad doctor has shown himself sufficiently proficient in blurring the lines between disciplines to earn himself a rank of major distinction in the therapeutic circus. If criticism equals antipsychiatry, well, there you go. The message is coming in loud and clear. Don’t criticize psychiatry or you must be promoting the discredited “chemical imbalance theory”, too. Clown psychiatry rules!

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Television Broadcaster ‘Off His Meds’?

NBC newscaster Brian Williams has been making irrational claims about Cleveland multiple kidnapper and rapist Ariel Castro. Brian Williams suggested Ariel Castro had a “mental illness”. Could it be that Brian Williams has a “mental illness”? This has got to be “delusional” thinking on his part. Do you think maybe it runs in his family?

The story, as run in the Orlando Sentinel, bears the heading, Brian Williams’ mental illness remark draws fire.

So when she [Candy Crawford, director of the Central Florida Mental Health Association] tuned in her favorite national news anchor Thursday — NBC’s Brian Williams — she was horrified. Opening his newscast with the sentencing hearing of Ariel Castro, who held three Cleveland women captive for a decade, Williams called the kidnapper and rapist “arguably the face of mental illness, a man described as a monster.”

“Mental illness” and monster equals a man possessed. Does this describe you, Brian Williams? We just have no way of calculating how many people have been gunned down by the news, and it is news these days, hardly impartial, that is paid for by big multinational corporations with many hooks in what news is considered newsworthy. This is something for a person to think about the next time he or she takes an advertising break from the evening news broadcast to visit the frig.

As Ms Crawford puts it.

“When people hear these types of comments over and over, especially from someone so influential, it can sway their beliefs,” she says.

NBC did apologize, but executives and staff are probably still wincing over the public reaction.

For its part, NBC issued a quick reply. “Brian immediately realized his poor choice of words, and he updated the broadcast to omit that phrase for later feeds,” said spokeswoman Erika Masonhall. “We sincerely apologize for the unintended offense caused by these remarks.”

Maybe it’s time people pay more attention to how many news shows are sponsored by drug companies. The USA and New Zealand are the only countries on earth that allow direct to consumer advertising for pharmaceutical products. If it’s not “restless leg syndrome”, it’s “erectile dysfunction”, or any number of other ailments, many of them highly questionable in nature. Then there are the happiness pills that are known to be ineffective, and to give more side effects than they give happiness. As it is doctors who do the prescribing, the advertising should be going to doctors. Outlaw direct to consumer advertising, and you will also clean up many slips of the tongues made by newscasters who are presently, consciously or not, complicit in the legal drug trade.

Psychiatrists’ Say The Darnedest Things – 6/17/13

If I were going to include a periodic quote from the media on my blog, and I might eventually do so, the following might be a good place to start.

As part of a HuffPost Book Club discussion on the book that took place last year, Matthew Erlich, MD, a psychiatrist-researcher at the New York State Psychiatric Institute in the Division of Mental Health Services, told us that Caulfield would probably have been committed to a secure unit as a manic depressive at the time of the book.

This snippet was snipped from, Holden Caulfield Diagnosis: Psychiatrist Discusses Salinger’s Classic Character (VIDEO), Huff Post Books.

The main protagonist of the Catcher in the Rye, a great coming of age and prep-school novel, that many of us experienced first hand while growing up, has been reduced to a species of nervous disorder. Thank heaven Holden saw no reason to check himself into a psychiatric facility, huh? On the other hand, this scenario suggests alternate plot lines. What if J. D. Salinger had come up with a different twist? Holden could have been snatched up by the psychiatric authorities, and the mental patients’ liberation movement–it’s all anti-psychiatry to true believers–might have welcomed another fictional hero into their midst beyond the misbegotten, doomed, and mischievous Randle Patrick McMurphy from Ken Kesey’s One Flew Over The Cuckoo’s Nest.

Did I say, “might have“? Without rereading the novel, here’s what the wikipedia Catcher in the Rye page says.

Holden makes the decision that he will head out west and live as a deaf-mute. When he mentions these plans to his little sister Monday morning, she wants to go with him. Holden declines her offer, which upsets Phoebe, so Holden decides not to leave after all. He tries to cheer her up by taking her to the Central Park Zoo, and as he watches her ride the zoo’s carousel, he is filled with happiness and joy at the sight of Phoebe riding in the rain. At the conclusion of the novel, Holden decides not to mention much about the present day, finding it inconsequential. He alludes to “getting sick” and living in a mental hospital, and mentions that he’ll be attending another school in September; he relates that he has been asked whether he will apply himself properly to his studies this time around and wonders whether such a question has any meaning before the fact. Holden says that he doesn’t want to tell anything more, because surprisingly he has found himself missing two of his former classmates, Stradlater and Ackley, and even Maurice, the pimp who punched him. He warns the reader that telling others about their own experiences will lead them to miss the people who shared them.

Emboldened emphasis added.

Did you get that? Holden Caulfield was a mental patient. The mental hospital experience was his experience. Perhaps he’s still with our movement at this present moment. If it’s not too ‘schizoid’ a thing to say, I think I saw him in 2012 at the protest outside the APA convention in Philly I attended.

Future Psychiatry

Make way for the DSM-6 1/2 & 3/4. Some Oxford University mad shrink, a certain Kathleen Taylor, she calls herself a neurologist, thinks that religious fundamentalism and cult group membership could become a disease in the future.

Don’t look now, but religious fundamentalists and those whose ideological beliefs border on the extreme and may be potentially harmful to society could soon be called crazy—in a medical sense.

Remind me to stay way clear of the border of extreme.

Taylor also warned against taking “fundamentalism” to mean radical Islamism.

The story/review, Is religious fundamentalism a mental illness?, is to be found at GMA News Online, ‘the go-to site for Philipinos’.

I’m encouraged by all this potential broadening of commitment criteria in a way.  Just imagine, in the future maybe we could lock up members of the Church of Biological Psychiatry. As is, they do an inordinate amount of injury while everybody just looks the other way.

Kathleen Taylor has written a book, “The Brain Supremacy”, on the dangers of brain technology, but, oh, I don’t know…

“What we perceive from our perspective as our legitimate self-defensive reaction to the psychosis of the enemy, is from the perspective of the same enemy our equally malignant psychotic self-obsession,” it [Digital Journal] added.

Here it comes, here it comes…World War III!

This just goes to show now that, beyond intoxicating substances, behaviors have been found to be addictive, the bag is open, and anything can crawl in. Should psychiatry be your career choice, I hope we can find a cure before it’s too late, and the bombs start falling all around us.

Pre-psychosis In The News

Attenuated psychosis syndrome, alternately called psychosis risk syndrome, pre-psychosis and prodromal disorder is going into section 3 of the DSM-5. This is the section for disorder labels that need more review, and which will not be reimbursable. The bad news is that it is in the DSM at all, and being in the DSM, it’s going to be considered as a disorder. The good news is that it is not an “official” disorder label, insurance companies are under no obligation to pay for it, and so its not likely to explode into an epidemic next year.

Researchers, it seems, much less fastidious than DSM revisers, are intent in studying people afflicted with this fictitious and elusive label. The latest rage in pseudo-scientific discoveries concerns this nebulous early stage in the development of psychosis. An article in the Detroit Free Press, Schizophrenia may give early warning signs, is typical.

Researchers in Chapel Hill looked at brain scans of 42 children, some as young as 9, who had close relatives with schizophrenia. They saw that many of the children already had areas of the brain that were “hyper-activated” in response to emotional stimulation and tasks that required decision-making, said Aysenil Belger, associate professor of psychiatry at the UNC School of Medicine and lead author of the study.

Now whether psychiatrized families actually think differently from non-psychiatrized families is anyone’s guess, and it could always be the topic for additional research should anybody choose to go there.

People who have a parent or sibling with schizophrenia are about 10 times more likely to develop the disease than those who do not. Signs of the illness typically begin in the late teens to mid-20s. These include declines in memory, intelligence and other brain functions that indicate a weakening in the brain’s processing abilities. More advanced symptoms may include paranoid beliefs and hallucinations.

Perhaps this sounds like an astonishing figure until you realize that it actually means 1 in 10 people rather than 1 in 100 people.  This is to say that among the 1 in 100 people that get described as psychotic, 1 in 10 of their closest relatives could also be so described. Unlike in the rest of the world where the rate stays more or less at 1 %. 1 in 10 means that chances are, if you are in a family haunted by the phenomenon of psychosis in one of its members, 9 out of 10 of it’s members most probably wouldn’t be described as psychotic anyway.

“Of all the people who seem to have compromised circuitry in their brain, if we come back and image them in later years, some may be moving toward the cluster of symptoms for schizophrenia while others may have other types of deficits,” such as bipolar disorder or attention deficit disorder, Belger said.

The article goes on to add, “Still others may avoid serious disorders altogether”, but the damage has been done. If you were an agent of the inquisition, let’s say, looking for witches, you are not going to be questioning the existence of witches. If you want to find fault in anyone, or anything, no problem. Just conduct a fault finding mission. If you are out to praise those people, well, hunting for future “mental illnesses” is just not the way to do so.

I think these researchers have better things to be doing with their time. We really have a problem when the DSM starts predicting disorders in people.  Ignoring any fork in the pathway that may lead to dysfunction, from functionality, is a major shortcoming, I would imagine. Ditto, in the case of paths that lead to folly from reason and wisdom. You are postulating that mental and emotional disturbances are a matter of predestination, and I imagine such leaps of faith belong in the realm of superstition rather than in the realm of scientific inquiry and skepticism.

This doesn’t mean that pre-psychosis isn’t going to make it’s way as a reimbursable disorder in a future edition of the DSM. I imagine, if things continue going the way they are going, it will. There is a lot of nonsense in the DSM. I would say maybe 100 % of the DSM is sheer nonsense. All the same, quite literally, even a listing as a category for diagnosis won’t make future psychosis a real disorder in present time.

Governmental Persecution of Former Mental Patients

What’s wrong with entering the names of people who have been in the mental health system into the National Instant Criminal Background Check System (NICS) database, and barring them from gun purchases?

1. The law behind this action deprives US citizens who have committed no crime of their constitutional second amendment right to bear arms. In doing so, it is an UNCONSTITUTIONAL and, therefore, ILLEGAL law.

2. The act of depriving this group of their second amendment rights is an example of PREJUDICE directed people who have been on the receiving end of the mental health system. People who have received mental health treatment are being made the SCAPEGOATS for gun violence in this nation, and gun violence for which they are absolutely in no way, shape, or form responsible; they are being made to pay for gun violence of which they are completely INNOCENT.

3. Statistics show people who have received treatment for psychiatric labels to be more often the victims of violent crime than the perpetrators. They are, as a rule, peaceful, law abiding, and NONVIOLENT citizens. As they are more often the victims of violent crime than the perpetrators, and as it is merely a few frustrated and failed individuals for whom they are taking the rap. This rap is a matter of extreme prejudice, and it is entirely unjustified.

4. Placing the names of former mental patients on, of all things, a criminal background check list, is a blatant example of CRIMINALIZING people who have had mental health treatment. As I pointed out, most of them have broken no laws, and they are, therefore, not criminals. Not being criminals, there is no reason to place them on such a list.

5. When black people are harassed at traffic stops on account of their skin color by law enforcement, we call this harassment racial profiling. Use of the names and information entered into this database are going to be used, as that is its purpose, for doing psychiatric or MENTAL HEALTH PROFILING, that is, targeting former mental patients for harassment by law enforcement. This is not the way we should be treating our fellow citizens, neighbors, and human beings.

6. Through the names and information entered into this database police officers and federal agents are going to have access to people’s mental health treatment records. This access amounts to a BREACH OF CONFIDENTIALITY between patient and therapist at a massive level. The Health Insurance Portability and Accountability Act (HIPAA) was designed to guard people’s confidential relationships for health reasons, but the law pertains to the mental health system and civil actions, and it can be entirely superseded by the criminal justice system. The result of these breaches ultimately usually serves neither health nor justice.

We’ve got better things to do with our time and energy than to CONDEMN people UNTO PERPETUITY for the mental health treatment they have received. This NICS database only represents one more way of furthering the misfortunes of people who have experienced the mental health system  first hand as patients. It constitutes one more INJURY directed against this group of people, and as such, it cannot be said to be in the interests of mental health and recovery to maintain it.

Let me reiterate for the sake of those of you who may not have been paying attention. The law behind the NICS database is unconstitutional. It is illegal. Former mental patients are being made the scapegoats for violence in this country. Entering information on former mental patients onto a criminal background check database is a form of criminalization. This list is going to be used for mental health profiling, that is, police harassment. It is also going to be used to disarm innocent people who are more likely to be the victims than the perpetrators of violent crime. It is a massive government intrusion and an invasion of privacy. It serves neither the interests of social justice nor of mental health.

Okay then. Why the bad law? Law makers, confronted with a monumental tragedy in the form of a number of copy cat crimes, have to give the impression that they are doing something to relieve the situation. Unfortunately, it is more important for them to do something about the issue than it is for them to do something about the issue that is effective or that makes sense. They have their electorate to think about. If they do nothing, they are going to be savaged in the media and by the public. If they have no guilty parties in custody, then someone is going to have to take the heat. In this case, that someone is the set of people who have done time in mental institutions.

Just Wait Until “Adult ADHD” Rates Catch Up

Attention deficit hyperactivity disorder (ADHD) rates are going up. Hardly a shocking finding. If you invent a disease, disease rates are likely to go up rather than down without an effective way to expose you, and with you, it. As reported in Psychiatric Annals, Rate of ADHD diagnosis increased in past decade, researchers looking at trends among 842,830 schoolchildren aged 5 to 11 found the following.

According to the researchers, rates of ADHD diagnosis were 2.5% in 2001 vs. 3.1% in 2010, a relative increase of 24%. During the same period, the rate of ADHD diagnosis increased among whites (4.7% to 5.6%; RR=1.3; 95% CI, 1.2-1.4), blacks (2.6% to 4.1%; RR=1.7; 95% CI, 1.5-1.9) and Hispanics (1.7% to 2.5%; RR=1.6; 95% CI, 1.5-1.7). Rates of diagnosis among Asian/Pacific Islander and other racial groups remained unchanged.

We’re more hyperactive then in 2010 than we were in 2001, that is to say, that boys will be boys, and not only will boys be boys, but girls will be girls. Confused? You’re not alone. Or to be more on target, children will be children.

The rate increase among blacks was largely due to a growing number of girls with an ADHD diagnosis (RR=1.9; 95% CI, 1.5-2.3). Boys were more likely than girls to be diagnosed with ADHD, but study results indicated that the sex gap may be closing among blacks. The researchers also observed a much higher rate of ADHD diagnosis among children living in high-income ($70,000 per year or more) households (P<.001).

Just imagine, sex equality in pathology. Things must be improving for folks of color out there, wouldn’t you say? Or, maybe not. The good news is the arrival of the spoiled brat syndrome so you folks out there in the ghetto don’t have to feel like you’re alone in your misery. Or, maybe not. Mommy and daddy uptown can buy success for junior, can’t they? …Oh, well…Them’s the breaks.

“Although the reasons for increasing ADHD rates are not well understood, contributing factors may include heightened ADHD awareness among parents and physicians, increased use of screening and other preventive services, and variability in surveillance methods among institutions,” the researchers wrote.

Okay dokey. If awareness induces contagion, no wonder they say ‘ignorance is bliss’. Screening for figurative disease is going to increase the incidence of figurative disease. Undoubtedly. Calling screening and miseducation preventive is the real kicker though. Rates go up, and you’re preventing. Oh, yeah? Uh huh. Alluding to surveillance is more to the point. This isn’t about letting children be children, this is about training the next generation of corporate bureaucrats, and maybe, just maybe, we’ve got better things to be doing in the first place.

One factor  not listed, although the authors did mention not having any published ties to pharmaceutical companies, is the influence of drug markets on this increase. I can’t imagine it doesn’t have anything to do with stimulant, and the miscalled ‘performance enhancing’, drug sales, does it? Check out stock exchange figures sometime. I reckon, if anything, ADHD treatment drug makers aren’t suffering. The wall street party goes on and on, even if from here on out at a tightly guarded secret location.