Wednesday, August 15, 2012

The historical evidence compels us to conclude that, after more than 200 years of psychiatric criticism, we have made no progress in unshackling the psychiatric slave from his psychiatric master: Thomas Szasz on "Varieties of Psychiatric Criticism" - 15 August 2012 -

via psychiatry research - Google Blog Search by Stephen T Casper on 8/15/12
Psychiatric research today promises to produce a true science of the brain … Mental disorders are brain disorders. … What is emerging today is a picture of mental illness as the result of a pathophysiological chain from genes ...
  
  • Thomas Szasz

  • Varieties of psychiatric criticism

    History of Psychiatry September 2012 23: 349-355, doi:10.1177/0957154X12450236

    Varieties of psychiatric criticism

    I present a brief overview of the history of psychiatric criticism, followed by a critique of modern objections to diverse psychiatric practices, focusing on the critics’ neglect of the core problematic issue – the psychiatrist’s role in depriving innocent persons of liberty.


    The Neuro Times: A blog about neurology and neuroscience 



    15 August 2012

    Thomas Szasz on "Varieties of Psychiatric Criticism"

    In an article published in "History of Psychiatry", Thomas Szasz offers the following provocative comment:
    The historical evidence compels us to conclude that, after more than 200 years of psychiatric criticism, we have made no progress in unshackling the psychiatric slave from his psychiatric master. So-called psychiatric critics are largely responsible for this situation: instead of focusing on the timeless task of enlarging the sphere of human liberty by seeking the abolition of psychiatric slavery, they choose to pursue fleeting popularity by the self-righteous denunciation of one or another psychiatric treatment of a non-disease, and/or converting inpatient insane asylum slavery into outpatient medical disability-dependency.

    Let us not fool ourselves. Mental patients and mental health practitioners are more securely attached to the coercive apparatus of the therapeutic state than they have ever been. And let us not lose sight of the falsehoods psychiatric leaders tell politicians, the press and their fellow psychiatrists. Thomas Insel, MD, Director of the National Institute of Mental Health, explains:

    "It’s time to fundamentally rethink mental illness. … Psychiatric research today promises to produce a true science of the brain … Mental disorders are brain disorders. … What is emerging today is a picture of mental illness as the result of a pathophysiological chain from genes to cells to distributive systems within the brain, based on a patient’s unique genetic variation. … With a true science of mental illness – from genes, to cells, to brain circuits, to behavior – psychiatrists will be able to better predict who is likely to develop a mental disorder and to intervene earlier. Once that happens, we will be in a different world. (Moran, 2011)"
    As Szasz captures so eloquently, we need to strip such beliefs of their rhetorical power. There are very real reasons to worry about the status of neuroscience and neurology, especially as those fields become ever-more linked to a State and its putative therapeutic edifice. How should we understand these concerns?

    We ought to move beyond simple paranoia about the action of an unintentionally malevolent State to endeavor to see the potential threats engendered by melding neuroscience to constitutional law, ethics, and policy.

    Consider those who see the need for neuroscience and politics to be reconciled. There are many people (we've critique some of them here) who see in neuroscience and neurology the promise of further liberation. The common law system from these perspectives is often cast in the role of an especially antediluvian beast that has not yet recognized the hard truths of human neurobiology and its hard wiring. Policy and law informed by neuroscience, so these arguments go, can empower citizens, call into question the status of a crime, and revise legal and ethical understanding of intentionality.

    Circumstances, however, are not so simple. True, many scholars (among them many historians of medicine) believe that critical questions or observations about the legal and therapeutic status of psychiatry have become passe, perhaps even irrelevant. These arguments are either construed as self-evident, impractical, or utopian. Such views are, of course, not really reflecting circumstances. Indeed, what seems to have most changed is the willingness of elites (self-fashioned, of course, because who can tell if they really represent an elite) to trust that they ought to have the authority to decide whether critical questions or provocative observations about the status of psychiatry or clinical psychology have legitimacy at all. The tin ear that has plagued one side of the DSM-5 controversies is just one example.

    But where has this 'elite' confidence come from? Here speculation provides tentative suggestions: it seems likely that the fusion of neuro pharmacology with neuro imagining has aided and abetted their confidence. The phrases "we have data" and "we now know that" have become rhetorical strategies for communicating the new authority and license of practitioners of these fields. They no longer appear insecure, as they might have done in the 1960s and 1970s.

    It is perhaps too late to say this, but neurobiologists and neurologists might wish to think carefully about the ways in which psychiatric authority and psychiatry therapeutic traditions may influence their attitudes about science and clinical practices.




    Link: Behavioral Forensics: Bringing Freud to Fraud

    Verbrechen & Kriminalität: Behavioral Forensics: Bringing Freud to Fraud: Behavioral Forensics: Bringing Freud to Fraud S. Ramamoorti (Autor) Neu kaufen: EUR 56,99 (In der Beliebte Neuveroffentlichungen in der K...

    Behavioral Forensics: Bringing Freud to Fraud

    S. Ramamoorti (Autor)

    
    Kurzbeschreibung
    24. April 2013
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    More Treatment, More Mistakes - NYT

    Op-Ed Contributor

    More Treatment, More Mistakes

    DOCTORS make mistakes. They may be mistakes of technique, judgment, ignorance or even, sometimes, recklessness. Regardless of the cause, each time a mistake happens, a patient may suffer. We fail to uphold our profession’s basic oath: “First, do no harm.”

          
    Sophie Casson

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    According to a 1999 report by the Institute of Medicine, as many as 98,000 Americans were dying every year because of medical mistakes. Today, exact figures are hard to come by because states don’t abide by the same reporting guidelines, and few cases gain as much attention as that of Rory Staunton, the 12-year-old boy who died of septic shock this spring after being sent home from a New York hospital. But a reasonable estimate is that medical mistakes now kill around 200,000 Americans every year. That would make them one of the leading causes of death in the United States. Why have these mistakes been so hard to prevent?
    Here’s one theory. It is a given that American doctors perform a staggering number of tests and procedures, far more than in other industrialized nations, and far more than we used to. Since 1996, the percentage of doctor visits leading to at least five drugs’ being prescribed has nearly tripled, and the number of M.R.I. scans quadrupled.
    Certainly many procedures, tests and prescriptions are based on legitimate need. But many are not. In a recent anonymous survey, orthopedic surgeons said 24 percent of the tests they ordered were medically unnecessary. This kind of treatment is a form of defensive medicine, meant less to protect the patient than to protect the doctor or hospital against potential lawsuits.
    Herein lies a stunning irony. Defensive medicine is rooted in the goal of avoiding mistakes. But each additional procedure or test, no matter how cautiously performed, injects a fresh possibility of error. CT and M.R.I. scans can lead to false positives and unnecessary operations, which carry the risk of complications like infections and bleeding. The more medications patients are prescribed, the more likely they are to accidentally overdose or suffer an allergic reaction. Even routine operations like gallbladder removals require anesthesia, which can increase the risk of heart attack and stroke.
    So what do we do to be safer? Many smart people have tackled this question. Peter Pronovost at Johns Hopkins developed a checklist shown to bring hospital-acquired infections down to close to zero. There are rules against disturbing nurses while they dispense medications and software that warns doctors when patients’ prescriptions will interact badly. There are policies designed to empower nurses to confront doctors if they see something wrong, even if a senior doctor is at fault.
    What may be even more important is remembering the limits of our power. More — more procedures, more testing, more treatment — is not always better. In 1979, Stephen Bergman, under the pen name Dr. Samuel Shem, published rules for hospitals in his caustically humorous novel, “The House of God.” Rule No. 13 reads: “The delivery of medical care is to do as much nothing as possible.” First, do no harm.
    One place where I have seen these issues addressed is in Morbidity and Mortality, or M and M — a weekly gathering of doctors, off limits to the public, which serves in most hospitals as a forum for the discussion of mistakes, complications, deaths and unusual cases. It is a sort of quality-assurance conference where doctors hold one another accountable and learn from one another’s mistakes. They are some of the most candid and indelible meetings I have ever attended.
    I will never forget when one of our most talented surgeons operated on the wrong side of someone’s brain. The patient was bleeding internally; everyone was rushing, and someone had hung up the CT scans backward. Thankfully, the patient survived. The distraught doctor spent hours throwing up following the operation.
    After he told the story in our M and M meeting, the hospital implemented a “time out” protocol in the operating room for everyone to stop and agree on what operation would be performed, on what side of the body, and whether the correct patient was indeed lying on the operating table, to make sure that kind of mistake would never happen again.
    At my first M and M as a medical student, I heard the story of a patient who had received antibiotics for an upper respiratory tract infection. Two weeks later she developed joint pain and blisters on her chest and arms, a condition known as Stevens-Johnson syndrome, which can be caused by an allergic reaction to antibiotics. She ended up with sepsis, a bodywide infection, and spent two weeks in intensive care. She, too, survived, but most stunning was the doctor’s admission that her original ailment had been a mild viral illness — she hadn’t even needed the antibiotics that led to such a terrible reaction. Years later, that case still makes me think harder about every test I order and every medication I prescribe.
    Hospitals are supposed to take care of the sickest members of our society and uphold the highest standards of patient care. But hospitals are also charged with teaching doctors, and every doctor has a first mistake. The only thing we can do is learn each time one happens, and reduce future errors in the process. Having a consistent gathering to talk about the mistakes goes a long way toward that goal, and just about any institution, public or private, could benefit from a tradition like M and M. It is not enough to stop the practice of defensive medicine, but when doctors are asked by their colleagues to justify the tests they ordered and the procedures they performed, perhaps they will be reminded that more is not always better.
    Sanjay Gupta, the associate chief of neurosurgery at Grady Memorial Hospital and the chief medical correspondent for CNN, is the author of the novel “Monday Mornings.”

    Oslo Breivik Attack Could Have Been Prevented - Commission - Wall Street Journal

    "Anders Behring Breivik" bundle created by Mike Nova - 8/15/12



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    Oslo Breivik Attack Could Have Been Prevented - Commission
    Wall Street Journal
    OSLO--Norwegian authorities failed to protect the victims of Anders Behring Breivik's shooting rampage and could have prevented his bomb attack on government quarters, a government-commissioned report said Monday. The report, initiated to examine the ...


    By Kjetil Malkenes Hovland
    OSLO--Norwegian authorities failed to protect the victims of Anders Behring Breivik's shooting rampage and could have prevented his bomb attack on government quarters, a government-commissioned report said Monday.
    The report, initiated to examine the authorities' response to Mr. Breivik's twin terror attacks on July 22 last year, said police were too slow to respond to the shooting spree on Utoya island, adding that Mr. Breivik could have been arrested sooner had the police response been more effective.
    "The attack on the government complex could have been prevented through effective implementation of already adopted security measures," Ms. Alexandra Bech Gjorv, the July 22 commission leader, told a press conference.
    The commission also concluded that the Norwegian Security Service, or PST, could have picked up on the trail of Mr. Breivik prior to the attack, although it stopped short of venturing as to whether the PST could have averted the attacks.
    The commission set out to examine Norway's ability to uncover, prevent and respond to terrorist attacks as well as propose measures to improve the country's preparedness to handle large scale attacks. The report was widely anticipated to raise questions about the ability of authorities and society as a whole to protect themselves against and minimize the consequences of future attacks.
    On July 22 last year, Anders Behring Breivik, now 33, set off a car-bomb next to the government block in Oslo, killing eight people, before heading to a youth camp at the nearby island of Utoya, where he went on a shooting spree for more than an hour, killing 69 people, before being arrested.
    Ms. Gjorv described the attacks as "the most incomprehensible brutality."
    
    Write to Kjetil Malkenes Hovland at kjetilmalkenes.hovland@dowjones.com 


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    Norway PM under pressure to quit after Breivik report - Chicago Tribune


    WPTV

    Norway PM under pressure to quit after Breivik report
    Chicago Tribune
    OSLO (Reuters) - Norway's prime minister came under pressure to resign on Tuesday after an official report said police could have prevented a murder spree by far right militant Anders Behring Breivik last year that killed 77 people. The attack, which ...
    In Norway, calls for the prime minister to step downChristian Science Monitor
    Anders Behring Breivik: Norway massacre could have been avoided, report findsWPTV
    Anders Behring Breivik could have been halted – reportThe Guardian
    The Independent -TVNZ
    all 827 news articles »


    Breivik could have been arrested sooner: report
    ABC Online
    An independent inquiry in Norway has found police could have prevented Anders Behring Breivik from carrying out deadly twin terrorist attacks last year. The independent panel investigated how Anders Behring Brevik was able to set off a bomb in Oslo and ...

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    Oslo Breivik Attack Could Have Been Prevented - Commission
    Wall Street Journal
    OSLO--Norwegian authorities failed to protect the victims of Anders Behring Breivik's shooting rampage and could have prevented his bomb attack on government quarters, a government-commissioned report said Monday. The report, initiated to examine the ...

    Independent Breivik panel reaches finding - video

    Independent Breivik panel reaches finding



    Published on Aug 13, 2012 by
    http://www.youtube.com/EnglishNewsToday
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    It is now more than a year since Anders Behring Breivik gunned down 69 men and women on Utoeya Island and killed eight others in a bombing in Oslo.

    According to the results of an independent inquiry presented to Norway Prime Minister Jens Stoltenberg, police could have prevented the attack in the capital and caught Breivik faster.

    Al Jazeera's Charlie Angela reports.

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