Spitzer Recants: Why Can't APA Admit Mistakes and Correct Them | Psychology Today

Spitzer Recants: Why Can't APA Admit Mistakes and Correct Them | Psychology Today

Spitzer Recants: Why Can't APA Admit Mistakes and Correct Them

New APA leadership is last hope

Published on May 26, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

Spitzer Recants: Why Can't APA Admit Mistakes and Correct Them

Ben Carey's front page story in the New York Times movingly recounts Bob Spitzer's apology for an ill-advised study he conducted more than a decade ago.
http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-note...

The background is dramatic. Spitzer had been a hero to the gay and lesbian community because he was the person most responsible for removing homosexuality from DSM II. Lifting the cloud of mental disorder from sexual choice was a big step in the civil rights movement that only now is bringing full equality. I once attended an award dinner honoring Bob for his contributions to the gay/lesbian cause. I never saw a group more appreciative or a recipient so proud.

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How surprising then that Spitzer would later publish a methodologically flawed paper suggesting that psychotherapy might have some value in changing sexual orientation. Bob had serious misgivings almost immediately when fundamentalists exploited the paper to pursue their anachronistic agenda. He decided recently to make a very public apology. “I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some `highly motivated’ individuals.”

Let's compare Bob's forthrightness to the consistently evasive stonewalling that has characterized every step in the development of DSM 5. The American Psychiatric Association has a lot to apologize for- but instead maintains a doggedly defensive posture that prevents insight and self correction.

Bob was the first to point out the absurdity of the DSM 5 confidentiality agreements and to predict the poor results that would come from the resulting secretive and closed process. Each of his dire predictions has turned out to be right on target. DSM 5 badly missed every one of its deadlines- then with time running short, it quietly cancelled its quality control step because publishing profits trumped the public trust of producing a safe product. No apology for that.

When its field trial results were unacceptably low by historical standards, DSM 5 lowered its standards rather than working to improve its product to meet them. Again no apology.

DSM 5 persists in offering proposals that would inappropriately inflict the label ‘mental disorder’ on many millions of people now considered normal. These suggestions are unsupported by science and are strongly opposed by 51 mental health associations- but APA continues to refuse demands for independent external review.

The shabby DSM 5 enterprise has reduced the credibility of psychiatry and the stature of the APA. It may well have forfeited APA's right to continue as custodian of the DSM franchise. Yes, indeed, APA has a lot to apologize for and DSM 5 has a long way to go before it will be safe and scientifically sound.

But there are two small rays of hope. First, DSM 5 has belatedly dropped its worst proposal- psychosis risk- opening the door to the possibility that it is finally ready to make other much-needed concessions.

Secondly, the APA leadership changed hands at the recent annual meeting. Perhaps the new leaders will finally bring responsible governance to what has heretofore been the almost fatally flawed DSM 5 process.

The smart play for them now is also the only right thing to do. APA should, like Bob, come clean that many mistakes have been made and that it will take the time and make the effort to correct them. APA should cancel the arbitrary DSM 5 publication date and continue to work on DSM 5 until it can produce a quality document. It should drop the proposals that have drawn such widespread opposition or open them up to independent scientific review. Someone who can write clean and consistent criteria sets should be recruited and, after the badly needed editing is completed, previously poorly performing criteria sets need to be retested.

Unless it delays and reforms DSM 5, the new leadership will be left holding the bag- having to defend the truly indefensible when a fourth-rate DSM 5 is published next May. The new leaders are not responsible for this mess and don't deserve to be the butt of the harsh criticism that will follow. But if they don't fix DSM 5, they will own it and be tainted by it.

APA should clean the DSM 5 house now before it is too late. Were he alive today that's what Mel Sabshin, its long term and much revered leader, would certainly recommend.

And Bob Spitzer has shown the way. A clear parallel can be drawn between Bob's openly apologizing and withdrawing his paper and the need for APA to apologize and to withdraw its untenable proposals, end its closed process, and drop its slavish adherence to unrealistic timelines.

If a legendary figure like Bob can correct his mistakes, surely the APA can do the same- for the sake of protecting our patients and keeping the mental health field united.

There is always regret for having made errors along the way, but the far greater shame is in pressing forward when your own results reveal them. Inertia is one of the most powerful forces in nature -it takes real courage to oppose it. If APA changes gears, none of us is going to say, “I told you so!” We're going to applaud and feel proud that APA is finally on the right track. As with Bob Spitzer, sometimes the greatest honor is to admit mistakes and do the very best we can to correct them.

If it fails to reform DSM 5 now, the APA leadership will have much more to apologize for in the future- to its members, to our colleagues, and of course most important to our patients.

New York Has Some Prisons to Sell You - NYTimes

Nathaniel Brooks for The New York Times

New York Has Some Prisons to Sell You

By THOMAS KAPLAN

Since tactics like freezing state workers’ wages didn’t help budget problems, Gov. Andrew M. Cuomo is trying a new tactic. Above, the former Oneida Correctional Facility.

Psychiatry’s internal war over “mental illness” unhinges everything « The Teeming Brain

Psychiatry’s internal war over “mental illness” unhinges everything « The Teeming Brain

Psychiatry’s internal war over “mental illness” unhinges everything

Posted: May 23, 2012 in Society & Culture
Tags: Consciousness, Psychology, Dystopia, medicine

5

Have you or anybody you care about ever suffered from depression? How about bipolar disorder? Autism? Schizophrenia? Attention-deficit disorder? Obviously, given the prevalence of these mental and neurological illnesses, the answer is almost certainly affirmative.
Or then again, maybe not. Here’s the dirty little trick that’s been pulled over on all of us: each of those illnesses is a wholesale semantic/cultural invention, concocted out of thin air, that deserves to be put in scare quotes. And this, of course, imparts a whole new tone to them. Think about it: there’s an entirely different feeling when you say somebody suffers from “depression” or “ADD.” For full effect, imagine translating the scare quotes into the now-trendy “air quotes.” In fact, why not try it out. Say the words out loud and make the quotation marks with your fingers: “depression,” “autism,” “bipolar disorder,” “attention-deficit disorder,” “schizophrenia.” Feel the irony now coating these familiar psychiatric terms. Note how they no longer seem so familiar or meaningful, how they no longer seem to signify something literally real.
If you’ve successfully achieved this disorienting act of linguistic dislocation and decontextualizing, then you’ve begun to deprogram yourself and wake up from the spell of cultural hypnosis that’s been cast over us all by the American Psychiatric Association and Big Pharma. And that’s not just me talking; it’s actual members of the APA, including, most significantly, the lead editor of the DSM-IV, the fourth edition of the APA’s Diagnostic and Statistical Manual (see the linked and excerpted articles below).
The DSM is, in the words of one of the items below, “as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians.” This is because it’s the official manual that lays out the APA’s official definitions of mental illnesses and the criteria for diagnosing them. I was first introduced to it personally when I worked as a producer of video courses for Missouri State University in the 1990s. The job entailed attending and videotaping every classroom meeting of various live, lecture-based college courses, and then spending months transforming them into video versions of themselves with the help of computer graphics, music beds, and creative editing. This meant I got to know these classes better than any of the enrolled students, and one of them was a social work class about substance abuse intervention that involved regular references to the DSM-IV. Spending six or eight months making that course burned into my mind the implicit understanding that this book is truly the Holy Scripture of mental illness, because the instructor referred to it at least one or two times in every lecture.
But the thing is — and I didn’t wake up to this until some years later — psychiatry as a formal profession really has no idea what constitutes mental illness, nor does it know what constitutes mental health, for the simple reason that it doesn’t know what the soul — the “psyche” in psychiatry and psychology — really is, does, means, or ought to be. And this is the dirty little not-so-secret that lies not just at the heart of psychiatry but at the heart of every one of the so-called human sciences. How is it that we ever came to think “science” in its modern-day iteration as “the study of empirically testable and verifiable phenomena” is applicable to the realms of human society and personal reality anyway? Where exactly does psychiatry, formally defined as a medical field and thus a “hard” science, diverge from the “soft” science of psychology or any other “social science”? If there’s a controversy going on in the area of consciousness studies right now (as indeed there is) about whether consciousness really boils down to the brain or is something else, something wider, then how did the biomedical model of psychiatry ever become the supreme reigning orthodoxy in modern technological society? The answer is simple: it became so by sheer assertion, by default assumption, and by the imposition of the anti-metaphysical claim of biomedical materialism (which is of course a metaphysical position in itself) onto the study of the human self. In other words, and to widen the frame a bit, it happened as part of the ongoing takeover (hijacking) of “mainstream thought” by fundamentalist materialism wedded to economic materialism that has characterized modern society ever since the epochal transformations of the scientific revolution and Age of Enlightenment.
In the 1960s and 70s, Alan Watts, one of my most beloved authors and primary philosophical influences, wrote and lectured regularly about the fact — the fact, mind you, not the ideologically motivated assertion — that the psychiatric and psychological professions as formally practiced literally have no idea what they’re doing. (And of course he wasn’t alone in this, as the example of R.D. Laing, to name just one notable spokesperson for the anti-psychiatry movement, shows.) Watts once wrote,

The publication of my Psychotherapy East and West and Joyous Cosmology early in the sixties brought me into public and private discussion with many leading members of the psychiatric profession, and I was astonished at what seemed to be their actual terror of unusual states of consciousness. I had thought that psychiatrists should have been as familiar with these wildernesses and unexplored territories of the mind as Indian guides, but as I perused something like the two huge volumes of The American Handbook of Psychiatry, I found only maps of the soul as primitive as ancient maps of the world. There were vaguely outlined emptinesses called Schizophrenia, Hysteria, and Catatonia, accompanied with little more solid information than “Here be dragons and cameleopards.”

– Alan Watts, “The Soul-Searchers,” excerpted from his In My Own Way: An Autobiography, 1915-1965 (1972)

This isn’t just a problem from the past. The “emperor has no clothes” situation that Watts identified in the psychiatric profession half a century ago is still with us today, only more so, because today we are, if possible, even more overtaken and programmed and hypnotized by the false idea that psychiatry and psychology actually proceed on a basis of assured and verified knowledge. And this means we live even more fully under the sway of falsely conceived ideas about our very souls and subjectivities that are forced upon us from without like mental-spiritual straitjackets. Hence the almost universal, casual, workaday acceptance of the ideas of “depression” and all the rest. All of them, to repeat, are invented concepts, not discovered realities. Entrenched and sometimes debilitating sadness and lethargy, and the draining of happiness or even the ability to experience it — what used to be called “melancholia” — is a reality. But the label “major depression” and all that goes with it is a made-up concept that falsely implies psychiatrists really know what they’re dealing with. A high amount of jumpiness and nervous energy accompanied by a rapidly shifting focus of attention are experienced by a lot of people, but to call them “ADD” or “ADHD” is a sleight-of-hand maneuver that falsely reifies them and binds them together into a supposed illness. Hearing voices and experiencing a kind of volcanic uprush of sensory and mental-emotional activity from an apparently internal source in the psyche that feels separate and autonomous from one’s conscious self is as old as the human race itself, but to medicalize the experience by labeling it “schizophrenia” and then proceed on the idea that it requires drug-based treatment (which does, yes, prove helpful to some people) is to flat-out lie by saying the condition’s basic nature is scientifically understood even if its exact causes aren’t. (Who can confidently claim — as in truly, authoritatively, reasonably — that the psychiatric profession’s medicalized clampdown on this perennial human experience is any more valid than, say, Philip K. Dick’s assertion that “The schizophrenic is a leap ahead that failed”?)
For people who have never begun the journey down this path of mental deprogramming, it can be very difficult to get a handle on it and really feel the true depth of its earth-shattering implications, which center around the fact that the very view of human life — yours, mine, everybody’s, up-close and personal — and the nature of reality that we collectively share in our post-industrial techno-dystopia is shot through with arbitrary scientistic bullshit. The “official” (note the scare quotes) line about who and what we are, and who and what life is, is a scam, a snow job, a line we’ve been fed along with a spoonful of sugar about its supposedly solid status to help the medicine go down. There is no more intimate and comprehensive locus from which to arbitrate these kinds of all-encompassing, axiom-level notions than the psyche itself, the center-point of our individual perspectives. Blast the reigning assumptions and dogmas there, and the entire world radiating outward from them begins to crack apart.
As a starting point, I advise reading the following extended excerpts from various recent writings about the psychiatric profession’s internal war over the imminent new revision — the first in nearly 20 years — of the DSM. I’ve also included a couple of excellent pieces from The New York Review of Books about the deep history of how we arrived at the current biomedical model of mental illness, and why this development was very conscious, very illogical, and very driven, in part, by an unholy alliance between the psychiatric profession and what, with their help, became today’s Big Pharma.
James Howard Kunstler recently published a couple of blog posts (“Juked by Medicine” and “Matrix of Rackets“) about an unpleasant and thoroughly disillusioning experience he had with his doctor. In one of them he said, “I wonder if doctors are losing their legitimacy now in a way similar to the other authority figures in our culture: the political leaders, the bankers economists, the business executives.” The answer, of course, is yes, and this is something I assert based not only on hearsay but on recent and ongoing experiences that my family and friends have had with doctors and medical institutions. And the same point extends, clearly and incontrovertibly, to the psychiatric and psychological professions as well. All bets, as they say, are now off.

* * *

Trouble at the Heart of Psychiatry’s Revised Rule Book
Edward Shorter (historian of psychiatry, University of Toronto), Streams of Consciousness, Scientific American, May 9, 2012

One might liken the latest draft of psychiatry’s new diagnostic manual, the DSM-5, to a bowl of spaghetti. Hanging over the side are the marginal diagnoses of psychiatry, such as attention deficit hyperactivity disorder and autism, important for certain subpopulations but not central to the discipline. At the center of the spaghetti bowl are the diagnoses at the heart of psychiatry: major depression, schizophrenia, bipolar disorder… The main difficulty is that the principal diagnoses of psychiatry are artifacts…[Major depression was created by] lumping…two forms of depressive illness together. In fact, they are so disparate that the depression term itself should be abandoned. It is now shopworn with use and has approximately the same scientific value as other discarded psychiatric diagnoses such as hysteria and madness…There is no natural disease entity called schizophrenia: it has no typical, or pathognomonic, symptom, no predictable response to treatment, no reliable prognosis. Chronic psychosis is really a common final pathway for several disparate forms of psychotic illness that should not be lumped together…[L]umping] all [forms of chronic psychosis] together commits the same error as lumping together melancholia and nonmelancholia…The third fatal flaw at the center of the bowl of spaghetti is bipolar disorder, a diagnosis that assumes that the depression of unipolar disorder (otherwise known as major depression) is different from bipolar depression. But they’re really the same…And the entire concept of bipolar disorder has been a gift to the pharmaceutical industry, which has been able to re-position anticonvulsant drugs to counter the terrible bipolar menace.

* * *

Inside the Battle to Define Mental Illness
Gary Greenberg, Wired, December 27, 2010

“We made mistakes that had terrible consequences [in the DSM-IV]” [says Allen Frances, the edition's lead editor]. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics — and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs…The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it….At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians…What the battle over DSM-5 should make clear to all of us — professional and layman alike — is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench.

* * *

The Epidemic of Mental Illness: Why?
Marcia Angell, The New York Review of Books, June 23, 2011
The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain…What is going on here? Is the prevalence of mental illness really that high and still climbing?…On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one?…In the space of three short years…drugs had become available to treat what at that time were regarded as the three major categories of mental illness — psychosis, anxiety, and depression — and the face of psychiatry was totally transformed…[I]nstead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug. That was a great leap in logic…“By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin…[B]ecause the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants…[E]ven as drug treatment for mental illness has skyrocketed, so has the prevalence of the conditions treated…”Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?”…[T]he natural history of mental illness has changed. Whereas conditions such as schizophrenia and depression were once mainly self-limited or episodic, with each episode usually lasting no more than six months and interspersed with long periods of normalcy, the conditions are now chronic and lifelong. Whitaker believes that this might be because drugs, even those that relieve symptoms in the short term, cause long-term mental harms that continue after the underlying illness would have naturally resolved.

* * *

The Illusions of Psychiatry
Marcia Angell, The New York Review of Books, July 14, 2011
[T]he medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible…Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies…”A powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority”…[The psychiatric profession is currently beset by a] “frenzy” of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest.

* * *

‘Label jars, not people’: Lobbying against the shrinks
James Davies, New Scientist, May 17, 2012
“Label jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters — including former patients, academics and doctors — gathered to lobby the American Psychiatric Association’s (APA) annual meeting. The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification. At the heart of the issue is the Diagnostic and Statistical Manual of Mental Disorders (DSM) — psychiatry’s diagnostic “bible.” Allen Frances, who headed the last major rewrite of the manual — DSM-IV — fears that the revised version will undermine the profession’s credibility. “What concerns me most,” he says, “is that its publication will dramatically expand the realm of psychiatry and narrow the realm of normality.”

A Way Out of the Same-Sex Marriage Mess - NYTimes.com

A Way Out of the Same-Sex Marriage Mess - NYTimes.com

Mr. Obama was right both to embrace equality as a principle and to respect the process by which the understanding of marriage gradually evolves to include same-sex couples, within the premises of federalism. What is needed now is a similarly coherent and sound ruling by the Supreme Court.       

Welcome End of a Pseudotheory - NYTimes.com

Welcome End of a Pseudotheory - NYTimes.com

May 23, 2012

Welcome End of a Pseudotheory

Many opponents of giving equal rights and protections to gay Americans — at the workplace, in the military, in marrying and forming families — make the claim that homosexuality is a chosen way of life. They have long seized on the work of a towering figure in psychiatry to justify their position.

But that psychiatrist, Dr. Robert Spitzer, has now renounced a study he did a decade ago that suggested that “reparative therapy” can help homosexuals who are highly motivated to change their sexual orientation. Dr. Spitzer’s admission that his study was deeply flawed should discredit, once and for all, those claims of social and religious conservatives that homosexuality is not a fundamental part of human identity.

Dr. Spitzer’s turnabout was described by Benedict Carey in The Times on Saturday. Dr. Spitzer’s enormous influence came from the fact that he directed a rigorous rewriting of the psychiatry profession’s diagnostic manual of mental disorders. Even before that, he successfully pressed to drop homosexuality from the manual.

Two decades later, still eager to challenge accepted wisdom, he conducted an in-depth telephone survey of 200 gay men and women who had received therapy or pastoral counseling to change their sexual behavior. Most told him that they had changed from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation.

Now Dr. Spitzer, who just turned 80, has acknowledged that his survey was deeply flawed. In a letter to the editor of the Archives of Sexual Behavior, which had published his study, he said he had no way of knowing whether the patients who said they had changed were deceiving themselves, lying or reporting accurately. He apologized for making “unproven claims” about reparative therapy and for any harm he may have caused to anyone who “wasted time and energy” undergoing the therapy.

Critics have noted that the people interviewed were nominated by centers that were performing the therapy and that there was no control group and no clear definition of what counted as therapy. There is also some evidence that reparative therapy can lead to depression or suicidal thoughts and behavior. It is absurd, potentially harmful, pseudopsychiatry. It should have been rejected long ago.

Mike Nova: Beliefs, their phenomenology, psychopathology, sociopathology and clinical quantitative assessment - working draft

Last Update: 11:41 AM 5/22/2012

 

Mike Nova: Beliefs, their phenomenology, psychopathology, sociopathology and clinical quantitative assessment - working draft

 

Outline

Introduction

Beliefs, their place and assessment in Mental State

Wundt

Affective Component

Jaspers & others

The historical clinical concepts of "paranoia" and "paraphrenia"; Krepelin, Freud, J. Wagner-Jauregg, Schneider and others: 19 - 20 centuries "paradigm"  

Kuhn

Beliefs as paradigms and paradigms as beliefs

 

Phenomenology

Nature and cognitive purpose of beliefs

The Range of Beliefs

Common, religious, scientific, medical, judicial and other beliefs

The Hierarchy of Beliefs and Belief Systems

The elements of normal belief formations

The dynamics of normal belief formations

The "Tree" metaphor and model of normal belief formations

Psychopathology

The hypothesis of "abnormal" ("aberrant, deficient", etc.) "cognitive (including its ideational and affective components) pruning": concepts selection, elimination and confirmation as a psychopathological model of "Delusional Beliefs" formation.

The role of affective factor in "normal" and "abnormal" belief formations

 

Social Pathology

Shared Beliefs and shared Delusions

Societies: "Sane" and "Insane"

Eric Fromm

 

Clinical Quantitative Assessment of Delusional Beliefs

Categorical "cut off" vs. Dimensional approach; Delusional Beliefs as Psychopharmacological Targets

 

Intensity, strength of delusional conviction; the degree of their "incorrigibility" 

Functional Impairment

Features: Oddity; cultural factors

 Nosology of Delusional Beliefs

Disorder specific Delusional Beliefs

__________________________________________

Sources, References and Links

cognitive pruning: GS


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OpEdNews - Article: Psychiatrists Seek New Patients At Annual Meeting; Watch For These New Diseases

Monday, May 21, 2012
Psychiatrists Seek New Patients At Annual Meeting; Watch For These New Diseases
(6 comments) Some question the objectivity of a disorder manual written by those who stand to benefit from an enlarged patient pool and new diseases. Furthering the appearance of self-dealing is the revelation that 57 percent of the DSM-5's authors have Pharma links.

OpEdNews - Article: Psychiatrists Seek New Patients At Annual Meeting; Watch For These New Diseases

May 21, 2012 at 13:28:42

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Psychiatrists Seek New Patients At Annual Meeting; Watch For These New Diseases

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The first week in May brought a new leader in France and new prospects for same sex couples seeking marriage. But at the American Psychiatric Association's annual meeting in Philadelphia, attended by 11,000 psychiatrists, it was the same old same old. Instead of listening to the public outcry about overmedicated children, soldiers, elderly and everyday people watching too many drug ads, the psychiatry group re-affirmed its resolve to pathologize healthy people and even rolled out new groups to target.
This is the year the APA puts the finishing touches on DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, a compendium that determines what treatments insurers will cover, what disorders merit funding as "public health" threats and of course, Pharma marketing and profits. Some question the objectivity of a disorder manual written by those who stand to benefit from an enlarged patient pool and new diseases. Furthering the appearance of self-dealing is the revelation that 57 percent of the DSM-5's authors have Pharma links.
No kidding. Present at this year's meeting were former APA president Alan F. Schatzberg, MD and Charles Nemeroff, MD, both investigatedby Congressfor murky Pharma income. Schatzberg and Nemeroff are co-editors of the APA-published Textbook of Psychopharmacology whose 2009 edition cites the work of Richard Borison, MD former psychiatry chief at the Augusta Veterans Affairs medical center who was sentenced to 15 years in prison for a $10 million clinical trial fraud. Also present was S. Charles Schulz, MD, who was investigated for financial links to AstraZeneca believed to alter his scientific conclusions.
Even though Assistant Secretary of Defense Jonathan Woodson sent a memo to all branches of the military in February about overprescription of antipsychotic medications like Seroquel and Risperdal for PTSD, military figures closely linked to that overprescription were listed in attendance at the APA meeting.
Elspeth Ritchie, MD, who told the Denver Post that AstraZeneca's Seroquel was "very useful for the treatment of anxiety and combat-related nightmares," though it was (and is) not approved for such treatment while she was medical director of the army's Strategic Communications Office in 2008, participated in many symposiums. Ritchie, who is now chief clinical officer for the District of Columbia's department of mental health, appeared in an AstraZeneca and Eli Lilly funded webcast for the Massachusetts General Hospital Psychiatry Academy in 2008 in which she lauds the use of "sophisticated" psychiatric medicines "on the battlefield." (see endnote)
Seroquel earned AstraZeneca nearly $6 billion in revenue last year, reports the Philadelphia Inquirer. "IMS Health, a healthcare information and services company, said that in the 12 months ending in February of this year, 14.1 million Seroquel prescriptions were written, more than any other antipsychotic," it reports.

Also participating in the military and PTSD content at the APA meeting was Matthew Friedman, MD, Executive Director of the VA's National Center for PTSD who reported, "I received an honorarium from AstraZeneca in the past year," in a 2009 government slide show called "Pharmacological Treatments of PTSD and Comorbid Disorder." Friedman also served as a Pfizer Visiting Professor at the Medical University of South Carolina College of Medicine last year yet is listed in the APA meeting guide as having no "significant relationships to disclose." APA officials have not responded to several requests for comment.
Of course disorders that Big Pharma has helped monetize like bipolar (which was termed "under diagnosed" and emerging in the elderly at the meeting) and "mood disorders" (once called "life") were well represented. But an alarming amount of attention also went to the apparent new Pharma profit center of alcoholism and drug addiction.
Addiction specialists have known for more than 70 years that the only "treatment" for drug addiction and alcoholism (after patients are detoxed) are anonymous, self-help programs that are also free. In fact medicine is as powerless to understand or treat drug addiction and alcoholism as alcoholics and drug addicts are over their addiction.
Still the National Institutes of Health, in conjunction with Big Pharma, continues to spend millions, some say billions, developing "animal models" of addiction and vaccines to "cure" them. Nora D. Volkow, MD director of the National Institute on Drug Abuse, says she seeks a vaccine to treat those at risk of alcoholism and drug addiction on the basis of "biological and environmental factors," before they get sick. (See: treating those "at risk" for psychosis or depression or bipolar disorder on the basis of their family histories with no symptoms or evidence.)

(Photo from "Maternal and Fetal C-Cocaine Uptake and Kinetics Measured In Vivo by Combined PET and MRI in Pregnant Nonhuman Primates," Journal of Nuclear Medicine, February 1, 2005 vol. 46 no. 2 312-320)
It is pretty fair to say Volkow is not an alcoholic or drug addict. Any of them could tell her they don't seek "help" until they're out of options--and even then not from a doctor but from each other. If Pharma, the National Institute on Drug Abuse and the American Psychiatric Association think they can treat a disease caused by drugs with a drug, that's pretty insane. In fact, one of the treatments suggested for alcoholism at the meeting was quetiapine, also known as Seroquel.

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<!--[if !supportFootnotes]-->[i]<!--[endif]--> "The Returning Veteran: PTSD and Traumatic Brain Injury," Massachusetts General Hospital Psychiatry Academy, May 28, 2008

Martha Rosenberg is a health reporter and commentator whose work has appeared in Consumers Digest, the Boston Globe, San Francisco Chronicle, Chicago Tribune, New Orleans Times-Picayune, Los Angeles Times, Providence Journal and Newsday. She serves (more...)

The views expressed in this article are the sole responsibility of the author
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Blogs de ParaSaber.com » Darlene's blog » Download ebook: Marijuana and Madness: Psychiatry and Neurobiology

Blogs de ParaSaber.com » Darlene's blog » Download ebook: Marijuana and Madness: Psychiatry and Neurobiology

Darlene's blog

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20 May 2012

Escrito por: buvygaty el 20 May 2012 - URL Permanente

Download ebook: Marijuana and Madness: Psychiatry and Neurobiology

Marijuana and Madness: Psychiatry and Neurobiology by David Castle, Robin Murray

Download Marijuana and Madness: Psychiatry and Neurobiology

Marijuana and Madness: Psychiatry and Neurobiology David Castle, Robin Murray
Language: English
Page: 236
Format: pdf
ISBN: 0521819407, 9780511195761
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"We congratulate them (the authors) on their accomplishment and recommend this book enthusiastically for all clinicians and researchers interested in substance related issues." Journal of American Medical Association (JAMA), Shahla Modir, MD, UCLA Neuropsychiatric Institute, and John Tsuang, MD, Harbor-UCLA Medical Center

DSM critique in the New England Journal of Medicine is not what it seems « ALTmentalities

DSM critique in the New England Journal of Medicine is not what it seems « ALTmentalities

DSM critique in the New England Journal of Medicine is not what it seems 05/21/2012Posted by ALT in DSM-5, Mental Health Research.
Tags: biopsychiatry, brain disease, diagnosis, DSM-5, New England Journal of Medicine, psychiatry, schizophrenia
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I heard the rumors of a fight, and I came a-running.

Fisticuffs, you say? I’m in!

This morning, I read [here] that the following inflammatory remarks were published in this week’s New England Journal of Medicine:

… [Only when psychiatrists address] psychiatric disorders in the same way that internists address physical disorders, explaining the clinical manifestations … by the causal processes and generative mechanisms known to provoke them … will psychiatry come of age as a medical discipline and a field guide [the DSM – Diagnostic and Statistical Manual] cease to be its master work.
- Paul McHugh, MD and Phillp Slavney, MD in the NEJM [emphasis added]

Damn, that’s cold. And did I mention it was published in the New England Journal of Medicine (!), which is “one of the world’s most prestigious medical journals… cited in scientific literature more frequently than any other biomedical journal”? All kinds of doctors, clinicians, and practitioners read this thing!
A big deal.
Sounds like the authors are saying mental illness is fundamentally NOT like diabetes, that psychiatry as a discipline will continue to suffer from its immaturity and crippling inferiority complex (“we wanna be scientists, too!”) as long as diagnosis doesn’t rest on a firmly established foundation of physical pathology, and that the DSM is a poor substitute for that kind of a foundation.
Them’s fighting words. Words that might make the NEJM readership think twice before handing out diagnoses and their accompanying pharmacological interventions like the proverbial candy.

Don’t believe every rumor you hear

Having matured a bit from my high school days of running directly to join the ring of kids chanting “fight, fight, fight!”, I decided to get a little context. Who are these guys -– researchers? psychiatrists? some other kind of doctors? — and what does the rest of their NEJM editorial say?
“These guys” are two psychiatrists, professors at the Johns Hopkins School of Medicine. Paul McHugh, the lead author, is a rather famous one. He’s attended Harvard, designed a famous cognitive test often used as a dementia/Alzheimer’s diagnostic tool (a mere 11 questions!), served on the Presidential Council of Bioethics under GW and on a lay panel put together by the Catholic Church to look into the abuse of young boys by priests – none of these things being very high recommendations in my book. The two, together, have written a popular paperback for the general public entitled The Perspectives of Psychiatry which takes the biopsychiatric/disease-based approach to mental health.
And their editorial? It starts off very nicely with a critique of the DSM-delineated “field guide” method of diagnosis – the main problem being that clinicians no longer think too long or hard about causation. This promotes a “rote-driven” method of treating folks, and as the authors so rightly state “identifying a disorder by its symptoms does not translate into understanding it.” Or treating it effectively, if long-term studies of schizophrenia outcomes are any indication.
But things go sour real fast as we get to the “what’s to be done about it” part. We simply must establish causation for psychiatric disorders, and – guess what?—the authors have already done that!

The causes of psychiatric disorders derive from four interrelated but separable families: brain diseases, personality dimensions, motivated behaviors, and life encounters.
-McHugh et al.

Good, good.
They have also helpfully sorted out some common psychiatric disorders into the four families, or “causal perspectives”:

It’s written in a table so it MUST be true!

Right there, in the NEJM (remember – prestigious medical journal read by everybody), we’ve got schizophrenia neatly categorized as “brain disease.”
Oh, dear.

I diagnose thee… Flipfloppers!

Contrast the NEJM editorial with the polite phrasing the authors used in the aforementioned co-authored The Perspectives of Psychiatry, chapter 6:

The continuing failure to identify a particular cerebral pathology or pathophysiology in these disorders [manic depression and schizophrenia] undermines attempts to proclaim them as diseases with complete confidence. They remain mysteries in the sense that a confirmation of their essential nature is lacking…
- authors Paul McHugh, MD and Phillp Slavney, MD in The Perspectives of Psychiatry [emphasis added]

And yet they feel comfortable, only a few years after these words were published, with proclaiming schizophrenia as a “brain disease,” without providing any citations for new, groundbreaking research whatsoever. Clearly this “DSM critique” is not what it seems.

Middle way protestors all the way

As it turns out, these guys are total middle way DSM protestors – the only thing they’d like to fight is the bad public image of the DSM, not the institution of psychiatric diagnoses masquerading as science, and all of the poor treatment that goes along with such posturing (symptom suppression via pharmaceuticals, coercive treatment, et al.).
According to McHugh and Slavney, “no replacement of the criterion-driven diagnoses of the DSM would be acceptable; clinicians are too accustomed to them.” Rather, the only solution is for everyone [clinicians, researchers, families, patients] to embrace their causation groupings – and for that to be coded and billable, too, one can only presume.
In no other field would you continue to reach for an admittedly blunt, ineffective tool simply because it’s “what people are used to.” Surely there are some other possiblities?
I believe that there is another way – instead of fitting people and their “symptoms” into predetermined boxes, we could communicate with each unique individual, offering our support and encouragement (help) when it’s wanted, and offering our respectful non-interventionism and acknowledgement of the humanity of the suffering individual when our “help” is neither helpful nor desired.
I believe there is life after the DSM – and I’d like, as a society and a community, to live it!

Psychiatrists identify 'asylum seeker syndrome' - Yahoo!7

Psychiatrists identify 'asylum seeker syndrome' - Yahoo!7

A group of Australian psychiatrists has identified a new mental illness syndrome unique to asylum seekers.
The group is presenting its evidence on Prolonged Asylum Seekers Syndrome at an international psychiatry conference in Hobart.
It was identified after studying the mental health of asylum seekers and refugees living in Melbourne.
Major depression was diagnosed in more than 60 per cent of asylum seekers and about 30 per cent of refugees.
Associate Professor Suresh Sundram, from the University of Melbourne, says asylum seekers who had their applications rejected repeatedly showed clinical symptoms not seen before.
"It's people who are being subjected to protracted periods of refugee determination, so ones who are not getting quick responses," he said.
"But maybe even more importantly, it's people who are being repeatedly rejected and have continued to press claims for protection.
"They seem to be especially vulnerable.
"We have talked about this syndrome before but it is becoming increasingly clear that it appears to be distinct from anything else that we have been seeing."
Psychiatrists say the latest evidence shows asylum seekers should be allowed to live in the community to improve their wellbeing.
"The refugee determination process in Australia seems to contribute to the prevalence of post traumatic stress disorders (PTSD) in asylum seekers insofar as asylum seekers who have had four or more rejections for protection visas, the level of PTSD correlates with the number of rejections that they have had," Associate Professor Sundram said.
"Those asylum seekers who seem to have a protracted process of refugee determination, they seem to demonstrate clinical features that we haven't seen before and certainly seem to characterise a unique, or distinct, syndrome from other people who have been through similar types of traumas.
"We've coined the term to best describe this subgroup of asylum seekers who've had this protracted and difficult refugee determination process."
He says Australia does not have adequate services to deal with the problem because it is not well understood or recognised within the public mental health system.
An Iranian man who waited for four years to have his refugee status approved has backed the findings.
Mohsen Sultani was approved in 2004 and says he still suffers mental anguish, as do many people who were in his situation.
"They don't know anything about (their) future and on top of that the Government accused them of (being) a queue jumper, children overboard, all this stuff...it is absolutely a nightmare," he said.