The Myth of The Jail and Prison Treatment Facility

One Deinstitutionalization Is Not Two Deinstitutionalizations

Much bad ink has been spilled over calling the nation’s jails and prisons mental health facilities because of the number of people within their walls who have also been given psychiatric labels. The latest report along these lines claims there are something like 10xs more mental patients who reside in criminal justice facilities than in state hospitals. These numbers come from a study conducted by the Treatment Advocacy Center, the USA’s number one lobbyist for more forced psychiatric drugging, and the National Sheriffs Association. The culprit in this debacle is said to be deinstitutionalization.

Let me start off by saying people don’t go to jails and prisons because they are sick and because they wish to receive medical attention. People are sent to jails and prisons by the courts to receive punishments because they broke the law of the land. Second, state hospitals have traditionally been psychiatric jails and prisons. Merely trading this kind of prison for the other kind of prison doesn’t make a hospital in actual fact. I would say that, given the prison overcrowding problem that comes of three strikes laws, America has grown increasingly intolerant of difference, and law crazy itself. If your way of dealing with bizarre behavior is to outlaw it, your jails and prisons are going to fill with people behaving bizarrely. Bizarre behavior may be a crime, but it is only a disease by a wild stretch of the overactive imagination.

Statistics tell us their own story. For statistics, before we look at those coming from the recent study, let me refer to the Preface of the 2006 book crazy authored by journalist Pete Earley. Earley is another apostle of this blame deinstitutionalization religion. According to Earley, in 1955, there were 560,000 people in state mental hospitals. He speculates not about the numbers of people who might have been referred to as “mentally ill” in prison or jail at that time. Between 1955 and the year 2000, the population jumped from 166 million people to 276 million people. Given this population increase, and no change, the numbers of people in state mental hospitals would have been something like 930,000. Earley gives the present number of people, from maybe a 2002 or thereabouts survey, with “mental illnesses” in jails and prisons at 300,000. He gives the present number in state mental hospitals at 55,000.

Hmmm. Something peculiar is going on here. 500,000 people are unaccounted for. These are the people who, with the population increase figured in, would be in the state mental hospital system if we were still doing business the way we had in 1955. 500,000 people is more than half the number of people we are dealing with in the stats for a later year. You add 55,000 to 300,000 and you are still lacking 205,000 people from the 1955 figure. This is not the kind of figure that supports the contention that deinstitutionalization was a mistake, or that it was a disastrous failure. Instead it would seem to indicate that more and more people described as “mentally ill”, if not fully recovering, are being better integrated into the communities from which they came. This is a coup for least restrictive care, and least restrictive care is something that nobody receives as a prisoner on the locked ward of a state mental hospital.

According to the TAC and NSA research, there are 35,000 people in state hospitals, a 2012 stat, and 356,000 in jails and prison. Wow. We’ve got 20,000 fewer people, referencing the Earley stats, in state mental hospitals than we had 10 or so years earlier! If we’ve got more in jails and prison, too, part of that increase can be explained by population increase. What Earley gave us was something of an estimation based on statistics anyway, but we’re still minus a great number of people who would be “hospitalized” in the year 1955. All in all, I’d call deinstitutionalization a major success story. We’ve still got a lot of people in jails and prisons, given stiffer sentences and overcrowding, who don’t need to be there. One deinstitutionalization success story doesn’t justify an increased amount of institutionalization for another sort of institution.

Blaming violence on “mental illness” is the latest media and political trend. I’d like to remind people that the court of public opinion is not a court of law. We have a supply of the kind of acts, in the present climate, that the media circus demands. Should we look at the number of violent acts committed by people with no experience in the mental health treatment system, I’m sure that those crimes are not decreasing dramatically in number either. Violence is not a symptom of any “mental disorder” in the Diagnostic and Statistical Manual (DSM). When it comes down to it, death is much more likely to be a result of gun fire than it is to be a result of any psychiatric diagnostic label in a mental health professional’s repertoire. I suggest that we will have more success with the problem if we deal with the causes, and I don’t see “illness”, physical nor mental, as one of the primary causes. I would, on the other hand, do something about the climate of suspicion, hatred, and indifference that breeds crime, hardship, and troubles. Here, I think we can actually make a difference if we tried, and that is exactly what we should do.

 

The Three Babbles of Mind Brain Research

Back in 1973, the late Dr. Thomas S. Szasz published a slim volume of aphorisms and sayings under the title The Second Sin. The title of this book referred a parable found in the Old Testament. This parable dealt with the sin of clear and decisive language, back at a time when only one language ruled the world, for which God punished man through the tower of Babel with a confusion of languages. This confusion of languages, according to Dr. Szasz, has become a means the authorities use to deceive and manipulate a gullible public. Among the authorities, of which Dr. Szasz was acutely concerned, were the mental health authorities.

I’d say that the use of babble has evolved much since the publication of The Second Sin. A metaphoric second tower of Babel, you could say, is expanding skyward. Recently I’ve come to identify three primary forms of babble used by the psychiatric profession’s hacks to achieve it’s ends, and to facilitate social control. These three languages, three jargons, three pig-Latins, if you will, are psycho-babble,  bio-babble, and the newest arrival on the block, neuro-babble. Given these three specialist technological languages, I think it can be safe to say that nonsense has a great future in the realm of psychiatry.

Perhaps you’ve heard about psychobabble, a popular book was published under that title a few decades back. Wikipedia defines psychobabble “as “(a portmanteau of” “psychology” or “psychoanalysis” and “babblle”) is a form of speech or writing that uses psychological jargon, buzzwords, and esoteric language to create an impression of truth or plausibility. The term implies that the speaker or writer lacks the experience and understanding necessary for the proper use of psychological terms. Additionally, it may imply that the content of speech deviates markedly from common sense and good judgement.”

Psycho-babble has it’s antithetical complement in bio-babble, or nonsense, in lieu of credible convincing evidence,  asserting the primary role of biology in the development of psychiatric disorders. The bio-psychiatrists seem to think that if we continually make the same assertions, over and over again, regarding the primacy of biology over other factors involved in the development of psychiatric disorders, that this effort will give those assertions the ring of authenticity. Science and logic, on the other hand, insist that we must dig a little deeper, and be a little more fastidious in our investigations.. Bio-psychiatry has been supremely effective in having this bias taint much of it’s research attempts with shoddy methodology.

More recently, we have seen the arrival of neuro-babble. Neuro-babble is a sort of hybridized bio-babble with a blur of epiphenomenon thrown into the mix. As the dawn of the second decade of the brain fades into artificial sunlight, neuro is here to stay. Neuro is the new fad, trendy prefix, and buzzword.  Everything is neuro these days. I tried to count the number of neuro-words I’d encountered not long ago, but as would be expected, I lost count eventually. Neuro-babble would resolve the Cartesian mind body duality by declaring mind body. Neuro-scientists, mostly neuro-psychiatrists, are intent on making the “substance” of mind, the substance of body, or brain. Getting that thought under a microscope lens though has proven more elusive than I care to elaborate on.

Psychiatry Drumming Up More Business From School Children

An abstract in HealthDay News announces, Most Teens With Psychiatric Disorders Don’t Receive Care. By care the article means psychiatric treatment. Consider, did we replace the words psychiatric disorders with the words personal problems, and if we replace the word care with the word solutions, we would be saying something entirely different. The question is whether, given a kid with overwhelming troubles, would the mental health system help the kid resolve those difficulties any better than the kid going at it alone. I think there is a great deal of question as to the effectiveness and benefits in the mental health system for doing so. In so many instances, people who enter that system only get worse. This is particularly true when there was little to nothing intrinsically wrong with the kid in the first place.

Let’s look at these disorders and their rates. We’ve got two types of disorders we are dealing with here. We’ve got specifically childhood and adolescent disorders, and we’ve got disorders that have a potential to persist into adulthood. I submit that both types of disorder are, in the main, entirely bogus. Let’s look at the stats given.

45 % of adolescents labeled with a psychiatric disorder received some sort of treatment during the course of a single year. If “having a psychiatric disorder” is synonymous with “receiving treatment”, maybe it is not such a bad thing that 55 % of the adolescents given diagnoses no longer receive treatment. The person, for example, who is unable to back out of “receiving services” is a lifelong or “chronic” mental patient.

Most likely to receive mental health services

ADHD                                                          73.8 %

Conduct Disorder                                     73.4 %

Oppositional Defiant Disorder              71   %

Least likely to receive mental health services

Specific Phobias                                        40.7  %

Anxiety Disorders                                     41.4  %

Services received

School setting                                            23.6 %

Specialty mental health setting             22.8 %

General medical setting                         10.1 %

Where are the statistics saying that 55 % of the kids given psychiatric labels are going to hell in a handbag because they aren’t receiving mental health treatment? Where are the statistics saying that 45 % of the kids are headed for the pearly gates because they are receiving services? Mental health workers and drug companies do better when they have more students doing business with them, but this doesn’t mean that the students are doing any better in treatment than they would do outside of treatment.

Attention deficit hyperactivity disorder only officially reached the age of consent with the recently published DSM-5. Previously ADHD was  primarily a juvenile chaos. Mine may be a minority opinion but I don’t think of this milestone as particularly conducive to good mental health. Quite the reverse. Now that adult ADHD is an official disorder label we are likely to see much more of it than we have seen in the past.

Conduct used to be a grade on a report card. Conduct was then previously not a disorder. Certainly making it a disorder might make things easier for teachers. I definitely don’t think making conduct a disorder makes things any easier for school children. Should conduct disorder progress into out and out criminality, the child would probably have to put some distance between him or herself and the school system. Or get expelled. I imagine conduct disorder helps flustered parents get disobedient children back into school following suspension or expulsion.

Oppositional defiant disorder is sheer nonsense. It means a child is being rebellious. Children do become rebellious. In fact, they go through phases that include rebelliousness. The terrible twos and the teenage years are two such phases, but they are by no means the only periods in childhood and adolescence potentially beset with disobedience and rebellion. If the child doesn’t grow out of it, the good news is that there is no adult ODD. Not yet anyway.

Anxiety is human, not medical. Nonetheless, psychiatrists and drug company exes make money treating it as medical. Ditto, phobias. This is a particularly sticky subject because children are particularly prone to anxiety and phobias. Adults, given much more life experience than children dealing with such, tend to be less seriously affected. Anxiety and fear are symptoms of inexperience. Inexperience is a disease that can be cured fairly easily. I suggest that parents and teachers experiment with ways to cure their school children’s inexperience as that is part of the job description.

The good news is that 55 % of the teens in this study once receiving mental health treatment are no longer receiving services. The bad news is that psychiatric researchers want even more teens to receive services. Swallow hard and go figure.

Maryland Hopes To Get The Potentially Potentially Violent Into Treatment

The U.S. government has been very successful in its effort to lay the blame for mass violence on pathology rather than individuals. The disturbed individual is no longer an individual. He or she now has a psychiatric label, whether bestowed by a doctor or a newspaper reporter, and thus belongs to a grouping of disturbed people. People with psychiatric labels aren’t their own moral agents goes the ruse.  They are adult children instead requiring full or part time professional supervision.

If violence is a matter of pathology rather than choice, fine and dandy, and this pathology is a matter of biology, alright. The thing to do is to catch violent offenders before they violently offend. When his “disease” made him (we’re talking mostly young males here) do it, after all, we’re looking at “diseases” and not individuals. Individuality is not an option. People either conform to custom and law (regardless of whether that custom and law means wearing a suit and tie or a tee-shirt, jeans and ponytail) or they are “diseased”.

The idea of pre-psychosis, although deferred from categorization as a bona fide “mental disorder” in the DSM-5, is back. The Baltimore Sun reports, New Maryland mental health initiative focuses on identifying and treating psychosis. This headline doesn’t tell you everything. Maryland is beefing up it’s mental health police state system in an effort to catch more pre-psychotic pre-killers.

Founded using a $1.2 million state appropriation approved this year, the Center for Excellence on Early Intervention for Serious Mental Illness has a goal of identifying psychosis in a fresh way: by taking notice in the earliest stages and providing support before symptoms spiral out of control.

I guess they think that by busting pre-psychotics they will be preventing psychotic mass murder in the long term. The problem I see with this plan is that you don’t have a psychotic “until symptoms spiral out of control”, and my understanding is that the majority of pre-psychotics don’t go psychotic, and so, by targeting them for treatment, one could be acting in a causative rather than a preventative fashion.

[University of Maryland child and adolescent psychiatrist, Gloria] Reeves and her colleagues say they’re working to ensure patients can live normal lives by short-circuiting the possibility of a deeper psychosis that could intensify if left untreated.

When a patient is already a patient, hey, what have you got? Shallow psychosis or pre-psychosis? In which case prevention is a matter of preventing deep, “deeper” ,or what is known in the trades as ‘full blown’, psychosis? My point is that maybe sometimes it is better to completely prevent the problem by eliminating the doctor patient relationship in its entirety first. Labeling a person “disordered” is the way you make a mental patient. Once a mental patient has been made, and is being subsidized by the state, unmaking a mental patient, unburdening the state of the financial expense, becomes a major problem in itself.

A growing body of research over the past two decades, however, has shown patients are much more responsive to treatment if they’re diagnosed early, and there are early warning signs that suggest when a person is at risk for developing psychosis.

Patients again. If we have more psychosis, but more treatment compliant psychotics, are we 1. upping the number of over all patients labeled psychotic, or 2. lessening the number of disturbed mass gunman in the nation? My feeling is that we are certainly doing # 1 while it is entirely questionable as to whether we’re getting anywhere with # 2.  Next question, do we really want a larger population of psychotics in the nation?

Before you think that the impetus for this measure is entirely medical, let it be known that the funding for this initiative was voted in by the Maryland General Assembly at the prompting of  Governor Martin O’Malley. Mental health treatment then is the state of Maryland‘s answer to massive acts of violence. Of course, this is providing that they’ve got the right suspects, uh, I mean patients, and that pre-psychosis leads to psychosis which, in turn, leads to massive acts of violence. I don’t even think that is a great theory on paper, but Maryland is not the only state that sees the answer to extreme violence in the nation as a matter of increasing the amount of oppression directed against people with psychiatric labels.

Overcoming Namby Pamby Disorder And, With It, The Psychiatric Nanny State

Iranian born Dr. Nassir Ghaemi in a MedScape piece, Fallacies of Psychiatry, actually only succeeds in revealing his own bias.

His first conjectured fallacy, the psychological fallacy, he would answer with a fallacy of his own. Namely, the flat earth fallacy. If enough people think a person “needs” psychiatric “help”, in other words, it must be so, and this makes the difference between a biological basis and a psychological, social, or psycho-social origin for “mental disorder”. If the person makes his way into the doctors office, at his friends and associates bequest, his or her “illness” must be biological.

These psychological judgments are essentially made on the basis of common sense. But if common sense were enough to explain things, then our patients would have convinced themselves, or been convinced by their friends and family. If a patient crosses the threshold of a clinician’s door, then common sense has failed — no need to keep using it. What is needed is scientific sense, which is quite different than common sense.

Suddenly because a doctor has entered the picture, we’ve got science. Really? Conventional wisdom may not apply here, but reason doesn’t cease to apply. I wouldn’t be beyond suggesting that our mad doctor’s uncommon sense was a little tainted with an unreason of his own.  If a pseudo-scientific credentialed elite says it is true, it must be true. Right? I’d say, reasonably, that it isn’t true until it is proven true. Here we have one theory in competition with others. The winner is only a poser. The scientific method is about disproving, not proving.

Dr. Nassir would then debunk such a biological reductivist view for certain “mental illnesses” that, in his view, have a psycho-social basis. This creates an even more serious dilemma for our doctor because now we have two entirely distinct species of “mental illnesses”, those with a primarily biological basis, and those with a primarily psycho-social and environmental basis. I would suggest that if “mental illness” is not actually “brain disease”, but erroneous ways of thinking, you don’t need two species of “illness” at all to explain it. Simply put, removing consciousness from the equation does not, at the same time, remove consciousness from the organism.

The doctor’s view is a pretty conventional one, but it asks many serious questions about the profession of psychiatry today. He establishes the psychiatric divide. His examples of biologically based disorders is pretty orthodox, as are his examples of more psycho-socially based disorders. On one side we’ve got schizophrenia, bipolar disorder and major depression, the holy trinity of the “mental illness” belief system, and on the other side, we’ve got PTSD, adult ADHD, and borderline personality disorder. I’ve seen this divide presented before. Recently I encountered a person attributing minor disorders to stress factors and major disorders to heredity and biology. In psychoanalytic theory, what has become the divide between major and minor “mental illness”, constituted the division between psychosis and neurosis. If these “disorders” existed on a continuum–big if, but they could–you’ve still got the psyche in psychosomatic. I don’t think it has, by any stretch of the imagination, been proven that they don’t exist on a continuum.

Big problem, little problem. Major “disease”, minor. The big secret is that diagnosis doesn’t represent the eternal biological curse that some professionals would have it represent for people given serious diagnostic tags. Some people manage to get out of the system, and to cope, and even to flourish, despite the cynicism of professionals. The devastating statistics actually represent a systemic challenge. When you’ve got a system based on unequal power relationships, that’s what happens. The success and independence of professionals is based on the failure and dependence of patients. Step back a little bit, and consider, the success of the professional actually depends on failing his patients. You’ve got more job security when your job is keeping a junkie supplied with dope (and this dope could be methadone, heroin, haldol or clozapine) than you would have if your job was getting him or her off drugs entirely.

Initially asylums were set up to segregate and imprison lunatics, i.e. people believed afflicted with any earlier version of the holy trinity in the psychiatric belief system. The advent of psychoanalysis expanded that field a great deal to include people suffering from more minor afflictions and offenses. General anxiety disorder, for instance, is in many ways the mental health equivalent of a skinned knee. Recently, psychiatry has been accused, due to the absolutely absurd number of “diseases” proliferating in the DSM, of pathologizing “normal”. Since the genesis of psychoanalysis, utilizing professional services has been put forward as a way of life. I’d suggest that there are other roads to take besides that of treatment, and maybe we’d better look to them. Take the case of what used to be called hysteria, or the case of what used to be called hypochondria, when a crutch is imaginary, perhaps a person would do better to get along without it.

Light Reflected Off The Expanding Bubble of Mindless Brain Research

A seminar in New York, at Fordham University School of Law of all places, is “symptomatic”, to use the  wrong word, of what’s wrong in brain research today. Somehow  it is believed that by studying the brains of people thought to be abnormal we are going to figure out how the brain works. If we do so, this line of reasoning presumes, we can end massive acts of violence taking place in the world today. You think?

The story in the New York Times is entitled The Day When Neurons Go on Trial.

Neurons are the new superstars in today’s brain research world. We’ve got neurologists, neuro-scientists, neuro-researchers, neuro-psychiatrists, neuro-philosophers, etc, etc. Who knows? Maybe neuro-attorneys are the next wave. The latest trend is neuro, but neuro with a twist, as nothing in the brain, and especially nothing in brain research, seems to proceed in a straight line.

Over and over, they put questions to a guest speaker, Joshua R. Sanes, director of the Center for Brain Science at Harvard, about the implications for society if and when brain science can identify with confidence a propensity for violence, or for lying.

Dr. Sanes answer was he wished he knew.

It is now believed that diseased circuits caused diseased brains, which we experience as psychiatric disorders, Dr. Sanes said. A student, Brittany Taylor, asked what such broken structures would mean if they cause somebody to commit a crime. “Are we going to look at that as a mitigating circumstance, or are we going to have to change our culpability standards completely?” she asked. What if other parts of the brain were involved, or if environmental factors were influencing the neurons? Could someone say with confidence that the neurons made him do it?

Stupid is as stupid does. If diseased brains are brains with diseased circuits, isn’t it a bit disingenuous to say that diseased circuits cause diseased brains? The cause, it would appear, is still X, and X is basically unknown.

Dr. Sanes reply seemed to be expect a lot of useless information. Following this plea of overwhelming informational overload, Dr. Sanes goes onto make a few predictions, the kind of predictions that could earn him a spot on my projected future column, Psychiatrists Say The Darndest Things.

“Fifteen years from now, somebody is going to say it’s the 489th neuron from the back of your ear that made you do it,” along with a mutant gene, Dr. Sanes said. “That’s going to be hard to dismiss.”

I suspect Dr. Sanes could not imagine himself, as a neuro-science-freak, being the person to have such a couple of willfully rebellious neurons. My own prediction is much more modest. I predict that this Decade of the Brain is likely to be as much of a vacuous bubble, a dud, as the last Decade of the Brain. We still have to make that little leap to consider what many neuro-science-types refuse to consider, namely, that maybe obnoxious and aberrant behavior isn’t entirely determined by biology.

8 Tips And A Bonus

If I were a betting man I wouldn’t bet on so called “mental illness”. It sounds like a losing proposition from start to finish. Okay, you may be asking, what brought this on? Well, there’s this article in the Boston Globe, of all places, entitled,  8 tips for living with mental illness in college.

Uh, living with a “mental illness”? Why would I want to do a crazy thing like that? Aren’t there enough bitches in the world as is?

Number uno is ‘do your research’, but I think that’s funny. You don’t know how phony baloney so much of this research is, nor how pathetic the statistics look. Anyway, usually this means look there, but don’t look there. Our watchdogs we persecute. Biological medical model is the bias, and that means our researchers are mainly interested in drug development. We’re not dealing with people so much, we’re dealing with biological defectives, mutants. There’s a difference. People, having taken hundreds of thousands of years to evolve into what they are, don’t need chemical readjustments so much.

‘Understand policy’ is number two. This is the biggest reason you can imagine not to wrangle a pet “mental illness”. Why? Look at the examples. ‘Privacy and confidentiality’. Alright. A pet “mental illness” gives roommates the right to spy on you, monitor your behavior, and report you to the authorities if your pet acts up. Next…’leave of absences’. Should you need a break, it’s gonna help to plead a pet “mental illness”? I don’t think so. ‘Processes for responding to psychiatric crises’.  Automatically I’m seeing revolving red and blue lights on top of a patrol car. He’s got his handcuffs out if you “need” ’em.

Next comes ‘a support network’. This is a plus minus sort of thing. Sure, people support each other. People also call the cops. Be positive and imagine them calling the cops on somebody elses pet “mental illness”.

Four, you ‘set goals for yourself’, perhaps ‘hire a life coach’. Ouch! Like college isn’t about setting goals. Two sets of goals aren’t going to decrease the challenge, and hiring a life coach, on top of today’s tuition! How long do we have to pay this off? There comes a point two or three tips ago, when I consider silence and secrecy a better avenue than true confessions, especially when those confessions are going to be bullied and cajoled out of one.

Five is about ‘creating structure’, but that’s only common sense, especially if you want to get through college.

Six is a humdinger. Rat on yourself. You got a pet “mental illness”, don’t you? Let your pet “mental illness” out of the bag. You also might consider carrying a gun just in case  you need to kill yourself after your pet “mental illness” spilled its guts, and ruined your life. The biggest baddest and most dangerous cop of all can be the cop within.

Seven is dope. Some people take seven different kinds of ’em. This is legal dope so folks assume it is okay.  If it kills you 25 years early, well, that’s acceptable trade-off for keeping your pet “mental illness” under wraps. Pet “mental illnesses” are temperamental, and it takes dope to manage them. Pet “mental illnesses” feed on heavy duty  horse tranquilizers. Sometimes it’s impossible to tell them apart, that is, drug effects from ‘disease symptoms’. Without the pills you take your poor “mental illness” might actually starve to death, and we couldn’t have that, now could we?

Finally ‘take care of your health’ because “mental patients” are dying off early at an incredibly high rate. The authorities are blaming the pet, but we know, we know, the pills have a lot to do with it. You just try taking care of yourself when you’re zonked out of your frigging mind sometime, and see how well you do? Doctors are dense though, and they don’t tend to grasp these things.

I came up with a ninth tip that I think has all the others beat. Unleash your pet “mental illness”, and send it back to the wild. Free it, and if you can’t free it, give it away. There are plenty of people out there wanting a pet “mental illness”. If there weren’t, they wouldn’t proliferate so. You don’t need a “mental illness”, believe me. It will only drag you down. The difference between having and not having is perched on the tip of your tongue right now. Be careful, and “stable” your pet, by sending it away. “Mental illnesses” are like wars. Ugh. Who needs ’em!

More Or Less Biology In Psychiatry–That Is The Question

Much newsprint has been wasted recently on the split between the APA (American Psychiatric Association) and the NIMH over the revision of the DSM (Diagnostic and Statistical Manual of Mental Disorders)  that is going to be called the DSM-5. In my view, letting the 100,000 manuals bloom is not going to be any better of a solution than letting the 100,000 diagnoses bloom in the long run. If we are going to treat every patient as an individual, for the sake of the individuality of his or her condition (and genetic makeup), that’s going to make for a whole lot of variation in disorder (and/or order) expression.

The New York Times covers the story, regarding the NIMH APA divide, in a story with the heading, Psychiatry’s Guide Is Out Of Touch With Science, Experts Say. Of course, it always depends on which experts you ask. The experts the mass media is still slow to consult, and the New York Times is no exception in this regard, are those experts with lived experience on the receiving end of mental health treatment.

While typically critics of the DSM have tackled the subject from one side of the political psychiatric spectrum, here comes mob boss Thomas Insel, godfather of the NIMH, attacking from the other. In the first instance, you have people who object to the biology in biological psychiatric theory, (Theory, now there’s as important a word as any.) in the second, you have a group that doesn’t think the APA is biologically grounded enough.

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

The DSM focuses on symptoms precisely because we don’t know the causes. Dr. Thomas R. Insel, apparently, thinks otherwise.

Precision seems to be a big part of the problem. In psychiatric diagnosis, theoretical speculations aside, there are no precision tools.

The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

Or, a possibility not considered here, we’ve got five misdiagnoses floating around for which there was no underlying condition in the first place.

Solution. The NIMH is developing it’s own manual, Research Domain Criteria, or RDoC.

About two years ago, to spur a move in that direction, Dr. Insel started a federal project called Research Domain Criteria, or RDoC, which he highlighted in a blog post last week. Dr. Insel said in the blog that the National Institute of Mental Health would be “reorienting its research away from D.S.M. categories” because “patients with mental disorders deserve better.” His commentary has created ripples throughout the mental health community.

Consider, ripples sent throughout the mental health community, ripple throughout the “mental illness” community (i.e. the mental health ghetto). Now whether “patients with mental disorders” are going to get “better” treatment thereby is a big leap. Too big a leap in fact to make. So sorry, my poor victims of standard psychiatric malpractice!

Whatever you call it, my guess is that this switch still represents a way of billing insurance companies, the most important role for patient consumers a psychiatrist assumes. Of course, given that this paradigm change is all about biological explanations, I expect the treatment the insurance companies will be paying for is a chemical fix. Given this situation, the extent to which pharmaceuticals damage patients is still the great unasked question biological psychiatrists do their best to avoid asking.

The Evolution Revolution

Forced treatment is the big secret in the mental health “care” world today. Once upon a time, not that long ago, there was only one form of mental health treatment available, and that was it.

The American Psychiatric Association in fact grew out of the Association of Medical Superintendents of American Institutes for the Insane. Where once you had the heads of what were then called Lunatic Asylums, now you have an association of professional pill pushers.

The big lie is that the pills they are pushing, and whose usage they are promulgating, are good for people, and not people in general, but specific people. People diagnosed with a “mental disorder”. This diagnosis is thought to make the people who have been given one somehow different from the general run of humanity and, therefore, in need of the fix that comes with a drug.

The truth is that mental health treatment is about social control. We have this law that permits confinement of anybody acting oddly on the grounds that they may cause harm to themselves or others. It would be a serious mistake, albeit a common one, to assume that people are held in psychiatric institutions because they are dangerous.

People in mental hospitals are not there because they were given a trial by jury. Usually they are there because they were given a hearing by judge, attorney, and psychiatrist in which judicial opinion subordinates itself to the whims of professional bias and procedural habit. Mental health commitment hearings, in other words, in the present day and age, are little more than kangaroo courts.

Drugs can’t fix people. Drugs can damage people. Drugs can’t straighten out faulty logic. Education can teach logical deduction. Drugs can’t supply insight. Drugs generally mask a problem rather than correct it. Masking a problem is not dealing with it, and coming  up with a solution to it.

Waiving independence in order to be treated by the mental health authorities, usually as a charity case, is not the best course of action to take as a rule. Doing so often involves forfeiting rights we think of as basic to our species. This revelation may take time to register and resonate, but it should come in time.

Yes, Virginia, there is life beyond the confines of the Mental Health clinic. One is not bound to the human services system the way a rat can be restricted to its track through a maze.  The thing is that that system shares many similarities with a rat maze. If it didn’t, researchers wouldn’t be studying rats with the idea of better understanding human behavior. I would strongly suggest that if success in the world is at all important to you, you should abandon the maze.

The irony found in the heading of this post comes with the realization that more complex organisms evolved from less complex organisms. The butterfly in a display frame is not a butterfly in flight. Our capacity expands to the extent that we learn to escape those boxes that other people would try to contain us within. Quite apart from biological limitations, and barring extreme circumstances, we have minds that allow us this advance and that departure.

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.