(title unknown):
Eddie Ray Routh, Accused of Killing Chris Kyle, ‘American Sniper,’ Had Troubled Past
www.nytimes.com
Eddie Ray Routh, accused of killing Chris Kyle, the author of “American Sniper,” had been released from a hospital over his parents’ objections just days before the shooting, his lawyers said.
Friday, February 8, 2013
Thursday, February 7, 2013
The recent revisions to the DSM's definition of depression are based on a questionable conception of what is "normal." Why is that dangerous?
Opinionator | The Stone: Depression and the Limits of Psychiatry
Depression and the Limits of Psychiatry
By GARY GUTTING
I've recently been following the controversies about revisions to the psychiatric definition of depression. I've also been teaching a graduate seminar on Michel Foucault, beginning with a reading of his "History of Madness." This massive volume tries to discover the origins of modern psychiatric practice and raises questions about its meaning and validity. The debate over depression is an excellent test case for Foucault's critique.
At the center of that critique is Foucault's claim that modern psychiatry, while purporting to be grounded in scientific truths, is primarily a system of moral judgments. "What we call psychiatric practice," he says, "is a certain moral tactic . . . covered over by the myths of positivism." Indeed, what psychiatry presents as the "liberation of the mad" (from mental illness) is in fact a "gigantic moral imprisonment."
Foucault may well be letting his rhetoric outstrip the truth, but his essential point requires serious consideration. Psychiatric practice does seem to be based on implicit moral assumptions in addition to explicit empirical considerations, and efforts to treat mental illness can be society's way of controlling what it views as immoral (or otherwise undesirable) behavior. Not long ago, homosexuals and women who rejected their stereotypical roles were judged "mentally ill," and there's no guarantee that even today psychiatry is free of similarly dubious judgments. Much later, in a more subdued tone, Foucault said that the point of his social critiques was "not that everything is bad but that everything is dangerous." We can best take his critique of psychiatry in this moderated sense.
Current psychiatric practice is guided by the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). Its new 5th edition makes controversial revisions in the definition of depression, eliminating a long-standing "bereavement exception" in the guidelines for diagnosing a "major depressive disorder." People grieving after the deaths of loved ones may exhibit the same sorts of symptoms (sadness, sleeplessness and loss of interest in daily activities among them) that characterize major depression. For many years, the DSM specified that, since grieving is a normal response to bereavement, such symptoms are not an adequate basis for diagnosing major depression. The new edition removes this exemption.
Disputes over the bereavement exemption center on the significance of "normal." Although the term sometimes signifies merely what is usual or average, in discussions of mental illness it most often has normative force. Proponents of the exemption need not claim that depressive symptoms are usual in the bereaved, merely that they are appropriate (fitting).
Opponents of the exemption have appealed to empirical studies that compare cases of normal bereavement to cases of major depression. They offer evidence that normal bereavement and major depression can present substantially the same symptoms, and conclude that there is no basis for treating them differently. But this logic is faulty. Even if the symptoms are exactly the same, proponents of the exemption can still argue that they are appropriate for someone mourning a loved one but not otherwise. The suffering may be the same, but suffering from the death of a loved one may still have a value that suffering from other causes does not. No amount of empirical information about the nature and degree of suffering can, by itself, tell us whether someone ought to endure it.
Foucault is, then, right: psychiatric practice makes essential use of moral (and other evaluative) judgments. Why is this dangerous? Because, first of all, psychiatrists as such have no special knowledge about how people should live. They can, from their clinical experience, give us crucial information about the likely psychological consequences of living in various ways (for sexual pleasure, for one's children, for a political cause). But they have no special insight into what sorts of consequences make for a good human life. It is, therefore, dangerous to make them privileged judges of what syndromes should be labeled "mental illnesses."
This is especially so because, like most professionals, psychiatrists are more than ready to think that just about everyone needs their services. (As the psychologist Abraham Maslow said, "If all you have is a hammer, everything looks like a nail"). Another factor is the pressure the pharmaceutical industry puts on psychiatrists to expand the use of psychotropic drugs. The result has been the often criticized "medicalization" of what had previously been accepted as normal behavior-for example, shyness, little boys unable to sit still in school, and milder forms of anxiety.
Of course, for a good number of mental conditions there is almost universal agreement that they are humanly devastating and should receive psychiatric treatment. For these, psychiatrists are good guides to the best methods of diagnosis and treatment. But when there is significant ethical disagreement about treating a given condition, psychiatrists, who are trained as physicians, may often have a purely medical viewpoint that is not especially suited to judging moral issues.
For cases like the bereavement exclusion, the DSM should give equal weight to the judgments of those who understand the medical view but who also have a broader perspective. For example, humanistic psychology (in the tradition of Maslow, Carl Rogers, and Rollo May) would view bereavement not so much a set of symptoms as a way of living in the world, with its meaning varying for different personalities and social contexts. Specialists in medical ethics would complement the heavily empirical focus of psychiatry with the explicitly normative concerns of rigorously developed ethical systems such as utilitarianism, Kantianism and virtue ethics.
Another important part of the mix should come from a new but rapidly developing field, philosophy of psychiatry, which analyzes the concepts and methodologies of psychiatric practice. Philosophers of psychiatry have raised fundamental objections to the DSM's assumption that a diagnosis can be made solely from clinical descriptions of symptoms, with little or no attention to the underlying causes of the symptoms. Given these objections, dropping the bereavement exception-a rare appeal to the cause of symptoms-is especially problematic.
Finally, we should include those who have experienced severe bereavement, as well as relatives and friends who have lived with their pain. In particular, those who suffer (or have suffered) from bereavement offer an essential first-person perspective. As Foucault might have said, the psyche is too important to be left to the psychiatrists.
Gary Gutting is a professor of philosophy at the University of Notre Dame, and an editor of Notre Dame Philosophical Reviews. He is the author, most recently, of "Thinking the Impossible: French Philosophy since 1960," and writes regularly for The Stone. He was recently interviewed in 3am magazine.
At the center of that critique is Foucault's claim that modern psychiatry, while purporting to be grounded in scientific truths, is primarily a system of moral judgments. "What we call psychiatric practice," he says, "is a certain moral tactic . . . covered over by the myths of positivism." Indeed, what psychiatry presents as the "liberation of the mad" (from mental illness) is in fact a "gigantic moral imprisonment."
Foucault may well be letting his rhetoric outstrip the truth, but his essential point requires serious consideration. Psychiatric practice does seem to be based on implicit moral assumptions in addition to explicit empirical considerations, and efforts to treat mental illness can be society's way of controlling what it views as immoral (or otherwise undesirable) behavior. Not long ago, homosexuals and women who rejected their stereotypical roles were judged "mentally ill," and there's no guarantee that even today psychiatry is free of similarly dubious judgments. Much later, in a more subdued tone, Foucault said that the point of his social critiques was "not that everything is bad but that everything is dangerous." We can best take his critique of psychiatry in this moderated sense.
Current psychiatric practice is guided by the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). Its new 5th edition makes controversial revisions in the definition of depression, eliminating a long-standing "bereavement exception" in the guidelines for diagnosing a "major depressive disorder." People grieving after the deaths of loved ones may exhibit the same sorts of symptoms (sadness, sleeplessness and loss of interest in daily activities among them) that characterize major depression. For many years, the DSM specified that, since grieving is a normal response to bereavement, such symptoms are not an adequate basis for diagnosing major depression. The new edition removes this exemption.
Disputes over the bereavement exemption center on the significance of "normal." Although the term sometimes signifies merely what is usual or average, in discussions of mental illness it most often has normative force. Proponents of the exemption need not claim that depressive symptoms are usual in the bereaved, merely that they are appropriate (fitting).
Opponents of the exemption have appealed to empirical studies that compare cases of normal bereavement to cases of major depression. They offer evidence that normal bereavement and major depression can present substantially the same symptoms, and conclude that there is no basis for treating them differently. But this logic is faulty. Even if the symptoms are exactly the same, proponents of the exemption can still argue that they are appropriate for someone mourning a loved one but not otherwise. The suffering may be the same, but suffering from the death of a loved one may still have a value that suffering from other causes does not. No amount of empirical information about the nature and degree of suffering can, by itself, tell us whether someone ought to endure it.
Foucault is, then, right: psychiatric practice makes essential use of moral (and other evaluative) judgments. Why is this dangerous? Because, first of all, psychiatrists as such have no special knowledge about how people should live. They can, from their clinical experience, give us crucial information about the likely psychological consequences of living in various ways (for sexual pleasure, for one's children, for a political cause). But they have no special insight into what sorts of consequences make for a good human life. It is, therefore, dangerous to make them privileged judges of what syndromes should be labeled "mental illnesses."
This is especially so because, like most professionals, psychiatrists are more than ready to think that just about everyone needs their services. (As the psychologist Abraham Maslow said, "If all you have is a hammer, everything looks like a nail"). Another factor is the pressure the pharmaceutical industry puts on psychiatrists to expand the use of psychotropic drugs. The result has been the often criticized "medicalization" of what had previously been accepted as normal behavior-for example, shyness, little boys unable to sit still in school, and milder forms of anxiety.
Of course, for a good number of mental conditions there is almost universal agreement that they are humanly devastating and should receive psychiatric treatment. For these, psychiatrists are good guides to the best methods of diagnosis and treatment. But when there is significant ethical disagreement about treating a given condition, psychiatrists, who are trained as physicians, may often have a purely medical viewpoint that is not especially suited to judging moral issues.
For cases like the bereavement exclusion, the DSM should give equal weight to the judgments of those who understand the medical view but who also have a broader perspective. For example, humanistic psychology (in the tradition of Maslow, Carl Rogers, and Rollo May) would view bereavement not so much a set of symptoms as a way of living in the world, with its meaning varying for different personalities and social contexts. Specialists in medical ethics would complement the heavily empirical focus of psychiatry with the explicitly normative concerns of rigorously developed ethical systems such as utilitarianism, Kantianism and virtue ethics.
Another important part of the mix should come from a new but rapidly developing field, philosophy of psychiatry, which analyzes the concepts and methodologies of psychiatric practice. Philosophers of psychiatry have raised fundamental objections to the DSM's assumption that a diagnosis can be made solely from clinical descriptions of symptoms, with little or no attention to the underlying causes of the symptoms. Given these objections, dropping the bereavement exception-a rare appeal to the cause of symptoms-is especially problematic.
Finally, we should include those who have experienced severe bereavement, as well as relatives and friends who have lived with their pain. In particular, those who suffer (or have suffered) from bereavement offer an essential first-person perspective. As Foucault might have said, the psyche is too important to be left to the psychiatrists.
Gary Gutting is a professor of philosophy at the University of Notre Dame, and an editor of Notre Dame Philosophical Reviews. He is the author, most recently, of "Thinking the Impossible: French Philosophy since 1960," and writes regularly for The Stone. He was recently interviewed in 3am magazine.
Wednesday, February 6, 2013
Personal Health: Effective Addiction Treatment
Personal Health: Effective Addiction Treatment: Many addiction treatment programs are rooted in outdated methods rather than new evidence-based approaches, dooming many addicts to failure.
Treatment, Not Jail, for the Mentally Ill
Treatment, Not Jail, for the Mentally Ill: In an ideal system, the mentally ill who commit minor offenses and pose no real danger to the public would never see the inside of a jail.
Boycott the DSM-5!
via Mad In America » Blogs by Jack Carney, DSW on 2/5/13
Boycott the DSM-5!
Believe it or not, there’s some confusion about what “boycott” means. Bluntly, it means “Don’t purchase or use the object being boycotted.” Remember the United Farm Workers and table grapes and iceberg lettuce? I remember walking a picket line daily for weeks in front of my neighborhood supermarket carrying a sign urging customers entering the store not to buy grapes and lettuce. It must have worked – this was back in the 1970’s – because the grape and lettuce growers in California’s Salinas Valley were obliged to sign contracts with the UFW and its members.
The Committee to Boycott the DSM-5 is comprised of regular, not-so-famous mental health professionals, users of psychiatric services and their family members and those who’ve managed to survive many years as patients in the mental health system. In short, folks like many others, who’ve grown to mistrust and/or been adversely affected by the psychiatric establishment and its series of “bibles” or DSMs, and who anticipate even worse experiences with the new DSM-5. Our objectives are to trigger the memories and sensibilities of those – professionals, patients, family members and survivors – who’ve had similar unhappy experiences; convince the professionals neither to buy nor use the new DSM; encourage current patients to urge their psychotherapists and psychiatrists to neither buy nor use the DSM-5; and ask the survivors to do what they do best, viz., reach out to those they know still caught up in the system and support their efforts to press those who treat them to neither buy nor use the DSM-5.
I think you get the message.
The Boycott statement below contains a series of brief rationales for our opposition to the DSM-5: that it’s unscientific, unsound and ultimately unsafe; that it continues the DSM tradition of pathologizing ordinary behaviors – the new DSM will contain over 300 diagnostic categories, up from DSM-IV TR’s 250; that it narrows “treatment of choice” to the prescription of psychoactive medications despite their known toxicity and suspect effectiveness; that the APA has undermined its own credibility by disregarding the many criticisms of the DSM’s nosology.
If you’re so inclined, additional and more detailed critiques can be obtained on this very website in the several articles about DSM-5 written by me and others over the last 12 and more months. My last post was on December 10, 2012 and entitled “Boycott The DSM-5: Anachronistic Before Its Time.”
If we succeed in getting a sizable number of the millions of prospective DSM buyers to sign on to our Boycott statement, a copy of which you’ll find at the end of this post, we’ll put a sizable dent in the sales needed by the American Psychiatric Association to recoup its investment in the development of the new DSM.
Allen Frances, the most well-known critic of the DSM-5, has estimated that the new DSM cost the APA $25 million to bring to press, which explains the hefty price for each volume — $199 per – the APA is charging. Which translates to a break-even figure of 12.5 million buyers world-wide. The APA is already soliciting pre-orders of on its website, nearly four months before the new DSM’s scheduled mid-May publication.
One final point. We realize that all professionals employed in the public mental health system, indeed any professional or agency seeking third party reimbursement for services rendered, must use diagnostic codes. Accordingly, we are recommending that, if you must use diagnostic codes, use those contained in the ICD-9. Please be advised that you do not need to rely on the DSM’s codes – they are entirely superfluous to billing procedures, which, by U.S. law and international treaty, must employ ICD codes. Our recommendation should not be construed as an endorsement of the ICD – we consider all diagnoses reductive and demeaning to the persons so diagnosed. Rather, our recommendation to use the ICD codes is meant as a bureaucratic expedient for those obliged to use them. In short, anything but the DSM-5.
The Boycott statement itself can be found and signed by those who agree with its contents and intent at Boycott the DSM-5 (http://www.ipetitions.com/petition/boycott5/) on petitions.com. I realize that our Boycott statement is far from perfect – frankly, it’s impossible to address or anticipate all the concerns of prospective supporters in a brief document. But, as I like to say, any rock that’s handy, I’ll toss it at the behemoth.
And that’s also why we have a companion information website — Boycott DSM-5— (http://boycott5committee.com) where additional information will be posted by the Committee and where those who wish to can post comments. Should any reader wish to join the Committee and do some work on its behalf or should you belong to an organization that might be interested in co-sponsoring the Boycott, please contact me via MIA e-mail, via our support website or directly to me at jacarneysr@aol.com.
I trust that most readers will find themselves able to support the Boycott and sign the Boycott statement. Feel free to cut and paste it, send it on to friends and colleagues, post it on your Facebook pages or websites. Thanks.
Remember, “Don’t mourn, organize! We are all prisoners of hope.”
For the Committee, Jack Carney
References:
Carney, J., “Boycott The DSM-5: Anachronistic Before Its Time,” December 10, 2012, www.madinamerica.com/jcarney/author/
Frances, A., Price Gouging: Why Will DSM-5 Cost $199 a Copy? http://www.psychologytoday.com/blog/dsm5-in-distress/
* * * * * *
Boycott the DSM-5!
We, the undersigned, will not purchase nor will we use the new DSM-5 when it is published by the American Psychiatric Association. Further, those of us associated with professionals who use the DSM – as persons receiving services from them or as family members, friends or advocates – will urge service providers not to use the DSM-5:
• DSM-5 is unsafe and scientifically unsound.
Its categories or diagnoses, including newly introduced diagnoses, are not supported by scientific evidence. These diagnoses will pathologize rather than bring relief to persons in distress.
• DSM-5 will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication.
All references to psychosocial, environmental and spiritual factors have been removed from DSM-5. This sends a clear message to clinicians that treatment for persons judged to have psychiatric disorders can be reduced to the prescription of psychoactive medications, despite growing concerns of their dangers and skepticism about their effectiveness.
• The APA has been unresponsive to widespread opposition.
The APA has been unresponsive to criticism received from professional, advocacy and lay public stakeholders during the three public reviews of its proposals. The concerns expressed by over 14,000 signatories to the “Open Letter to the DSM-5” and the request for independent, scientific review of proposed changes to the DSM have been ignored.
• The APA has undermined it own credibility, choosing to protect its intellectual property and publishing profits, not the public trust.
Accordingly, we agree to boycott the DSM-5 and to urge service providers and others not to use it. If we find ourselves obliged to employ diagnostic codes, we agree to disregard the new DSM and utilize the codes listed in the ICD-9 and the next edition of ICD, when the latter is implemented in October, 2014.
SPONSORED BY THE COMMITTEE TO BOYCOTT THE DSM-5
http://www.ipetitions.com/petition/boycott5
DSM5 in Distress
Monday, February 4, 2013
eddie ray routh - GS
eddie ray routh - GS
Eddie Ray Routh - News Review
Last Update: 2.10.13
"A puzzle inside of an enigma wrapped in a mystery"
Eddie Ray Routh, Accused of Killing Chris Kyle, ‘American Sniper,’ Had Troubled Past
www.nytimes.com
Eddie Ray Routh, accused of killing Chris Kyle, the author of “American Sniper,” had been released from a hospital over his parents’ objections just days before the shooting, his lawyers said.
Eddie Ray Routh - News Review
Last Update: 2.10.13
"A puzzle inside of an enigma wrapped in a mystery"
Eddie Ray Routh, Accused of Killing Chris Kyle, ‘American Sniper,’ Had Troubled Past
www.nytimes.com
Eddie Ray Routh, accused of killing Chris Kyle, the author of “American Sniper,” had been released from a hospital over his parents’ objections just days before the shooting, his lawyers said.
Chris Kyle’s Alleged Killer – Who Is Eddie Ray Routh?
Landov
He’s been charged with murdering Chris Kyle, the deadliest sniper in U.S military history but who is Eddie Ray Routh and what made him allegedly turn his gun on one of the countries’ most decorated Iraq war heroes?
Routh is accused of killing both Kyle, a retired Navy Seal and author of the best-selling American Sniper, and his neighbor, Chad Littlefield, at the posh Rouge Creek Lodge gun range near Glen Rose, Texas.
Now RadarOnline.com is looking at new details about the man behind bars.
PHOTOS: James Holmes’ Yearbook Photos
Routh is accused of killing both Kyle, a retired Navy Seal and author of the best-selling American Sniper, and his neighbor, Chad Littlefield, at the posh Rouge Creek Lodge gun range near Glen Rose, Texas.
Now RadarOnline.com is looking at new details about the man behind bars.
PHOTOS: James Holmes’ Yearbook Photos
Saturday, February 2, 2013
NYT: Veterans Make Up Shrinking Percentage of Suicides
Veterans Make Up Shrinking Percentage of Suicides »
The convergence reflects the fact that suicide numbers are rising slightly among both veterans and everyone else, but has increased more in the general population.
If psychiatry is not successful, APA will not be successful
(title unknown):
PsychiatryOnline | Psychiatric News | News Article
psychnews.psychiatryonline.org
James H. Scully Jr., M.D., will retire as APA medical director and chief executive officer at the end of this year after a decade of remarkable change and progress.
PsychiatryOnline | Psychiatric News | News Article
psychnews.psychiatryonline.org
James H. Scully Jr., M.D., will retire as APA medical director and chief executive officer at the end of this year after a decade of remarkable change and progress.
Scully will leave behind an APA stronger than he found it when he became medical director 11 years ago, and one that is poised to face the future. “We are the voice of psychiatry,” he said. “No other group does what we do. If APA is not successful, psychiatry will not be successful.”
Comment:
I would phrase it a little differently, Dr. Scully:
If psychiatry is not successful, APA will not be successful.
Sometimes it is important to position chickens and eggs properly. And, maybe it is exactly this "mispositioning": prioritising psychiatry as a profession and as a professional organisation over psychiatry as a unique medical and social science and discipline, that is a part of the problem.
Michael Novakhov.
(title unknown)
(title unknown):
The Complicated World of Higher Education for Troops and Veterans
www.nytimes.com
With more than $10 billion being spent this year educating troops and veterans, the order has been given: help them graduate. But how?
The Complicated World of Higher Education for Troops and Veterans
www.nytimes.com
With more than $10 billion being spent this year educating troops and veterans, the order has been given: help them graduate. But how?
Subscribe to:
Posts (Atom)