Friday, March 8, 2013
Report details flaws in Army's handling of PTSD
Report details flaws in Army's handling of PTSD: SEATTLE (AP) -- The Army has more than doubled its number of military and civilian behavioral health workers in the past five years, but a litany of shortcomings still plagues the force when it comes to diagnosing and treating soldiers for post-traumatic stress disorder, according to an Army report being released Friday....
Friday, March 1, 2013
Autism spectrum disorder, attention-deficit/hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia all share common genetic risk factors, according to the results of the largest genetic study of psychiatric disorders to date
Mike Nova's starred items
via Psychiatric News Alert by noreply@blogger.com (Psychiatric News Alert) on 3/1/13
Their study is the largest to date and the first to provide evidence that specific SNPs are significantly associated with a range of psychiatric disorders. In particular, they pointed to the effects of voltage-gated calcium channels on such disorders: "Our results implicate a specific biological pathway—voltage-gated calcium-channel signaling—as a contributor to the pathogenesis of several psychiatric disorders and support the potential of this pathway as a therapeutic target for psychiatric disease."
"These important findings indicate that fundamental alterations in brain development and biology can confer vulnerability to various types of mental disorders....," Jeffrey Lieberman, M.D., president-elect of APA told Psychiatric News." Overall, the study provides an important new clue about the etiology and pathogenesis of mental disorders."
APA President Dilip Jeste, M.D., also commented: "Research of this type would help in the development of future diagnostic systems in psychiatry that are based on validated biomarkers...this important study is one step in that direction."
(Image: Chepko Danich Vitalevich/Shutterstock.com)
For previous news alerts, click here.
via psychiatry research - Google News on 3/1/13
 TIME |
International research group finds genetic link among five major psychiatric ...
Public Radio International PRI International research group finds genetic link among five major psychiatric diseases. Home | Stories | Health and Medicine | International research group finds genetic link among five major psychiatric diseases. Font size: Decrease font Enlarge font ... 5 Disorders Share Genetic Risk Factors, Study FindsNew York Times Share via e-mailBoston Globe Five major psychiatric disorders, including autism and bipolar disorder ...GlobalPost TIME -The Conversation -TopNews New Zealand all 58 news articles » |
via international psychiatry journals - Google News on 2/27/13
Largest study reveals five major psychiatric disorders share common genetic ...
Medical Xpress These findings are particularly relevant in view of the imminent revision of classifications in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)." Writing in a linked Comment ... |
via international psychiatry journals - Google News on 2/28/13
Autism, Depression Genetically Linked
ABC News The results are "new evidence that may inform a move beyond descriptive syndromes in psychiatry and towards classification based on underlying causes," Smoller said in a statement. Read this story on www.medpagetoday.com. The findings are especially ... |
via international psychiatry journals - Google News on 3/1/13
 Times of India |
International research group finds genetic link among five major psychiatric ...
Public Radio International PRI International research group finds genetic link among five major psychiatric diseases. Home | Stories | Health and Medicine | International research group finds genetic link among five major psychiatric diseases. Font size: Decrease font Enlarge font ... 5 Psychiatric disorders share genetic linkTimes of India Study points to "shared biology" between 5 psychiatric disordersCBS News Share via e-mailBoston Globe The Takeaway -UPI.com (blog) all 58 news articles » |
via psychiatry - Google News on 3/1/13
Children with autism had higher levels of toxic metals
Healio Researchers reported that children with autism had higher levels of toxic metals in their blood and urine vs. healthy children. The levels of those toxic metals were associated with the severity of the disorder. “These significant associations may ... and more » |
via international psychiatry - Google News on 2/27/13
5 Psych Disorders Have Common Genetics
MedPage Today The results are "new evidence that may inform a move beyond descriptive syndromes in psychiatry and towards classification based on underlying causes," Smoller said in a statement. The findings are especially important because of revisions to the ... |
via international psychiatry - Google News on 2/27/13
Five Major Psychiatric Disorders Genetically Linked
Medscape "These findings are particularly relevant in view of the imminent revision of classifications in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases," said Dr. Smoller. The investigators add that ... |
via international psychiatry - Google News on 3/1/13
Times of India |
International research group finds genetic link among five major psychiatric ...
Public Radio International PRI International research group finds genetic link among five major psychiatric diseases. Home | Stories | Health and Medicine | International research group finds genetic link among five major psychiatric diseases. Font size: Decrease font Enlarge font ... 5 Psychiatric disorders share genetic linkTimes of India Study points to "shared biology" between 5 psychiatric disordersCBS News Autism, schizophrenia, and other psychiatric disorders share genetic ...Boston.com (blog) Wall Street Journal -UPI.com (blog) -The Takeaway all 57 news articles » |
Mike Nova's starred items
via DSM5 in Distress by Allen J. Frances, M.D. on 3/1/13
A new way that DSM-5 mislabels the medically ill. Stress, risks factors, noncompliance, and unhealthy lifestyles will now be called a mental disorder.read more
via psychiatric diagnosis - Google News on 3/1/13
Anti-Soviet 'Psychiatric' prisoners want diagnoses reversed
Deutsche Welle (press release) The film, “The Dissident," portrayed a 53-year-old Latvian lawyer who was locked up for many years in psychiatric hospitals. This kind of thing, it seems, was not an isolated incident. From the late 1960s to the mid 1980s, a group of Latvians were ... |
via international psychiatry journals - Google News on 2/28/13
Five Major Psychiatric Disorders Share Genetic Link
Medical News Today These findings are particularly relevant in view of the imminent revision of classifications in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)." In a linked editorial comment ... |
via international psychiatry - Google News on 3/1/13
 UConn Advance (blog) |
UConn Researchers Impacting Mental Health Treatment in Prison Population
UConn Advance (blog) Researchers at the University of Connecticut Health Center are making significant contributions to the treatment of mental illness in prisoners, with their efforts earning international recognition and continued federal grant funding. With current ... |
via international psychiatry - Google News on 2/28/13
Five Major Psychiatric Disorders Share Genetic Link
Medical News Today These findings are particularly relevant in view of the imminent revision of classifications in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)." In a linked editorial comment ... |
via psychiatric diagnosis - Google News on 3/1/13
Anti-Soviet 'Psychiatric' prisoners want diagnoses reversed
Deutsche Welle (press release) The film, “The Dissident," portrayed a 53-year-old Latvian lawyer who was locked up for many years in psychiatric hospitals. This kind of thing, it seems, was not an isolated incident. From the late 1960s to the mid-80s, a group of Latvians were ... and more » |
via NIMH | Recent Updates by Jules Asher on 3/1/13
Five major mental disorders share some of the same genetic risk factors, the largest genome-wide study of its kind has found.
via Uploads by NIMHgov by NIMHgov on 3/1/13
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National Institutes of Health-funded researchers discovered that people with disorders traditionally thought to be distinct -- autism, ADHD, bipolar disorder, major depression and schizophrenia -- were more likely to have suspect genetic variation at the same four chromosomal sites. These included risk versions of two genes that regulate the flow of calcium into cells. Bruce Cuthbert, Ph.D., director of NIMH's Division of Adult Translational Research, explains the significance of the study findings for diagnosis and treatment of mental illnesses.
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From:NIMHgov
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via Healio.com PSYCHIATRY RSS Feed on 2/28/13
Autism spectrum disorder, attention-deficit/hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia all share common genetic risk factors, according to the results of the largest genetic study of psychiatric disorders to date.“This study indicates that some specific genetic variants confer risk to a range of psychiatric disorders that are treated as clinically distinct,” study researcher Jordan Smoller, MD, of Massachusetts General Hospital in Boston, told Psychiatric Annals. “The findings also highlight the role of calcium channel genes, which may provide a treatment target that is relevant to a range of psychiatric disorders.”
Five major psychiatric disorders may share common genetic risk factors - Healio
 Healio |
Five major psychiatric disorders may share common genetic risk factors
Healio Autism spectrum disorder, attention-deficit/hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia all share common genetic risk factors, according to the results of the largest genetic study of psychiatric disorders to date. and more » |
Friday, February 8, 2013
Eddie Ray Routh, Accused of Killing Chris Kyle, ‘American Sniper,’ Had Troubled Past - NYT
(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.
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.
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?
Thursday, January 24, 2013
News Review: What is Critical Psychiatry? | Critical Psychiatry and Psychology News
Mike Nova's starred items
via BEHAVIOR AND LAW - General, Forensic, Military and Prison Psychiatry News by Mike Nova on 1/24/13
What is Critical Psychiatry? | Mad In America: Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and ...
via Mad In America » Blogs by Philip Thomas, M.D. on 1/21/13
Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and chapters in books, hasn’t been written by academics, sociologists or cultural theorists. It has emerged from the pens and practice of a group of British psychiatrists.
This is not antipsychiatry. There are important differences between the antipsychiatry of the 1960s and present-day critical psychiatry; there are also important points of convergence, but the two nonetheless are quite different. Some of these similarities and differences will become clear as this series of blogs, written to complement the narrative blogs I’ll occasionally be posting, evolve over time.
In this series of postings, to appear under the ‘Critical Psychiatry’ tag, I want to present an overview of some of this work. This is because interest in critical psychiatry is growing, especially in the USA. There will be presentations by British critical psychiatrists at the APA annual meeting in San Francisco, and the Institute on Psychiatric Services in Philadelphia, both this year. This series of blogs about critical psychiatry is also by way of a sneak preview of a book I’m writing about British critical psychiatry, to be published by PCCS Books – http://www.pccs-books.co.uk – in the near future; watch this space!
So what exactly is critical psychiatry? The bulk of this work has been written by a small group of psychiatrists, all of whom are, or were, practicing psychiatrists in the NHS in England. All are associated with the Critical Psychiatry Network – http://www.criticalpsychiatry.co.uk – which first met in Bradford, England in 1999. The most active members of this group have between them written ten single or dual author books, ten edited books with forty-two chapters, and one hundred and thirty seven papers mostly in peer-reviewed journals. A survey of this work reveals that it covers five themes:
- The problems of diagnosis in psychiatry
- The problems of evidence based medicine in psychiatry, and related to this, the relationship between the pharmaceutical industry and psychiatry.
- The central role of contexts and meanings in the theory and practice of psychiatry, and the role of the contexts in which psychiatrists work.
- The problems of coercion in psychiatry.
- The historical and philosophical basis of psychiatric knowledge and the practice of psychiatry.
These three issues are of fundamental importance in understanding the limitations of scientific psychiatry. Most important of all, however, is a focus on the moral and ethical implications of the use of scientific knowledge (whether biological, psychological, sociological) in relation to madness and distress. Ultimately, critical philosophical thought has a great deal to offer when it comes to understanding how these different problems of psychiatric knowledge and practice are related. In this blog I will focus on the first of these themes. Subsequent blogs in the coming months will deal with the others.
The problems of diagnosis in psychiatry
The writings of critical psychiatrists see the problems of diagnosis in psychiatry in two areas: problems with the scientific basis of psychiatric diagnoses, and the moral problems that can arise from the use of psychiatric diagnosis.
The scientific basis of diagnosis in psychiatry
Joanna Moncrieff (1997) points out that despite extensive scientific research, there is no convincing evidence that specific biological causes account for either depression or schizophrenia. Research councils and other funding bodies have invested huge sums of money over the years in the quest for the biological basis of the condition called schizophrenia, but without success. Researchers in molecular genetics, neuroimaging and other neuroscientific fields persistently overstate the significance of their findings. Duncan Double (2000) also questions the evidence to support a biological basis for psychiatric diagnoses. He points out that a low level of agreement over the diagnosis of schizophrenia between psychiatrists in different countries has hampered psychiatric research.
Until the 1970s, American psychiatrists had a much broader conception of schizophrenia than their British colleagues, who used the diagnosis much less frequently. He also points out that the monoamine theory of depression and the dopamine theory of schizophrenia developed after the introduction of drugs that were claimed to ‘cure’ these conditions. Prior to this there was little interest in neurotransmitters like dopamine and the monoamines. This emerged when laboratory research drew attention to the effects of these drugs on neurotransmitters. Only then did these theories emerge. In contrast, the discovery of drugs to treat neurological conditions like Parkinson’s disease resulted from extensive laboratory research into the role of dopamine as a neurotransmitter.
The biological basis of schizophrenia remains elusive and unsubstantiated (Thomas, 2011). One reason for this as Duncan Double (2002) points out that is the poor level of agreement between psychiatrists over the diagnosis. This was one of the factors responsible for the move towards a more scientific psychiatry heralded by DSM-III. The first edition of the DSM published in 1952 gave definitions and criteria for 106 categories of psychiatric disorders, but the publication of the fourth edition in 1994 saw this number swell to 354. The third edition ‘…encouraged the reification of psychological conditions. Social phobia, post-traumatic stress disorder, for example, were first included in international classifications in DSM-III.’ (Double, 2002:902). The third edition, he suggests, coincided with the growing influence of scientific psychiatry, and a return to the values expounded by the German psychiatrist Emil Kraepelin a hundred years earlier.
Sami Timimi (2004) argues that the diagnosis of attention deficit hyperactivity disorder (ADHD) is a cultural construct. He points out that there are no specific biological or psychological markers for the condition, and as a result of disagreements and uncertainties over the definition there are wide variations in the prevalence of the condition. One thing that is clear from epidemiological studies is the condition has become much more common over time. In order to understand this we have to adopt a cultural perspective, and in particular recent changes in Western culture.
The expansion of diagnosis has also been a feature of child psychiatry. Until relatively recently the emphasis here was on child development, the family, and psychodynamic and social understandings of childhood. Sami Timimi (2004a) points out that before the introduction of DSM-III, depression was an uncommon diagnosis in childhood. It was also considered to be different from depression in adults, and not to respond to antidepressant drugs. This changed when an influential group of academic child psychiatrists claimed that childhood depression was more common than most people thought, and that it responded to physical treatments. Sami Timimi argues that current psychiatric diagnostic criteria in depression are so broad as to be useless. Most children can be identified as suffering from some form of psychiatric disorder. In addition there are low levels of agreement between the diagnosis of depression and the psychosocial problems that are usually associated with it. This raises serious doubts about the value of constructs like childhood depression.
The moral problems of diagnosis
In Britain this is seen most tragically in the problematic encounter between psychiatry and people from Black and Minority Ethnic (BME) communities. Suman Fernando (1991) argues that belief in the neutrality of psychiatric knowledge and practice has helped to conceal the racist assumptions in which the two are based. This problem operates nationally and globally. In Britain there a huge body of evidence has accumulated over the last fifty years that the incidence of schizophrenia is much higher in people from African-Caribbean communities, especially young men. This fact, allied with what is a widely held but racist perception that young Black men are dangerous, is linked to the higher rates of compulsion and coercion they experience in mental health services. Young black men are also more likely to receive physical treatments and higher doses of drugs in hospital than other groups.
But the problem doesn’t end there. Psychiatric theories resort to racist explanations for the raised incidence of schizophrenia in black people, based either in supposed biological or genetic differences between black people and the white majority, or in the family structures and life styles (especially cannabis use) that are said to characterise the African-Caribbean cultures. Psychiatry consistently locates the origins of the problem of schizophrenia in the biology or culture of these young men, and not in the experiences of racism and discrimination that feature prominently in their lives. This is a serious moral failure.
Racism is a difficult issue for health professionals to have to face up to. Kwame McKenzie (2003) argues that the experiences of racism have adverse effects upon the health of those affected. This can be seen in the raised incidence of high blood pressure, respiratory illnesses, anxiety, depression and psychosis in black people. Writing in the context of the Macpherson Report into the failure of the Metropolitan Police to bring about a prosecution in the racist murder of black teenager Stephen Lawrence, he (McKenzie, 1999) points out that like the police, doctors take offence to accusations of racism. This is where the idea of institutional racism is helpful, because it considers how the values and structures of mental health services inadvertently discriminate against minority groups.
More generally, as Duncan Double (2002) argues, the use of diagnosis based in biological explanations of experience eliminates the possible significance of the meaning of distress, and obscures its social and psychological origins. This encourages people to see themselves as powerless to do anything about their problems. This has important implications for recovery.
The use of diagnosis has become an important tool in the pharmaceutical industry’s attempts to extend its global commercial interests, and Suman Fernando (1991) points out that this has harmful consequences on local understandings of distress and madness and the systems of support that are based in this, especially in non-Western countries. Western scientific understandings of distress originate in historical and philosophical assumptions about the self that are a feature of Western civilization. International agencies like the World Health Organisation (WHO) place additional pressures on non-Western countries to adopt Western ‘solutions’ to the problem of madness, indirectly endorsing the pharmaceutical industry’s agenda and further weakening local support systems. Support for this view comes from a paper that Pat Bracken & I wrote (Bracken & Thomas, 2001), which argues that scientific accounts of distress exemplified by the DSM are rooted in the view that human suffering would ultimately yield to scientific progress.
The notion of progress through rational scientific thought originated in the European Enlightenment. One of the important outcomes of this period of thought and history was the replacement of religious belief and superstition by science and rationality in our attempts to understand our lives and our relationship to the world. The scientific approach, which reached its apogee in the Decade of the Brain, replaced a wide variety of non-scientific ways of understanding madness and distress, first in Europe, but increasingly through the second half of the twentieth century, across the globe.
If it is the case that psychiatric diagnoses have no firm scientific basis, and that they are little more than consensus statements produced by committees of experts, then it should come as no surprise to discover that political factors play an important part in their creation and abolition. Forty years ago the British and American psychiatric establishments rightly attacked the former Soviet Union for its use of the diagnosis sluggish schizophrenia as a means of silencing dissidents. At the same time gay activists in the USA campaigned politically to have homosexuality removed as a diagnosis from the DSM, and in 1973 it was replaced by the category sexual orientation disturbance. Derek Summerfield draws attention to the political nature of psychiatric diagnosis, and the moral problems that arise from this. He argues that the origin of the diagnosis of post-traumatic stress disorder (PTSD) was a political, not scientific, achievement.
Following the Vietnam War the U.S. anti-war movement persuaded military psychiatry to provide help and support for veterans. As a result the diagnosis of PTSD replaced earlier conceptions of battle fatigue and war neurosis, and drew attention to the traumatogenic nature of war. In doing so the diagnosis also transformed Vietnam veterans from perpetrators of war atrocities to victims of trauma; the category ‘…legitimized the “victimhood”, gave moral exculpation…’ (Summerfield, 2001:95). The diagnosis of PTSD has less to do with science and natural categories than it has to do with internal political struggles to salve a nation’s conscience after a terrible conflict.
Western concepts of trauma and the psychiatric diagnosis of PTSD attempt to redefine the moral consequences of conflict. In another paper Derek Summerfield points out that surveys of the residents of war zones tend to interpret feelings of revenge as an indicator of poor mental health (Summerfield, 2002) For example in Croatia, a foreign-led project told Croatian children affected by the war that not hating Serbs would help them to recover from trauma. In South Africa, studies of the victims of apartheid found that PTSD was significantly more common in those who were unforgiving (as measured by their score on a ‘forgiveness’ scale).
These, and similar, studies give weight to the view that forgiveness is necessary for recovery. Thus the emotional responses of those affected by war, ‘traumatisation’ or ‘brutalisation’, are held to be harmful and in need of modification. This belief, he argues, provides the basis for large scale counselling interventions by Western aid agencies. He challenges this view, by asking is anger and the need for revenge necessarily a bad thing. They draw attention to the moral aspects of injustice that lead to suffering in the first place, and the importance of social cohesiveness and solidarity as a social and cultural response to the injustices of war.
References
Bracken, P. & Thomas. P. (2001) Postpsychiatry: a new direction for mental health. British Medical Journal, 322, 724 – 727.Double, D. (2000) Critical Psychiatry. CPD Bulletin Psychiatry, 2, 33 – 36.
Double, D. (2002) The Limits of Psychiatry. British Medical Journal, 324, 900-904.
Fernando, S. (1991) Mental Health, Race and Culture. Macmillan / Mind Publications, London. (1st edition).
McKenzie, K. (1999) Something borrowed from the blues? British Medical Journal, 318, 616 – 617.
McKenzie, K. (2003) Racism and Health. British Medical Journal, 326, 66.
Moncrieff, J. (1997) The medicalisation of modern living. Soundings, 6, 63 – 72.
Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. British Medical Journal 322, 95 – 98.
Summerfield, D. (2002) Effects of war: Moral knowledge, revenge, reconciliation, and medicalised concepts of recovery. British Medical Journal, 325, 1105-1107.
Thomas, P. (2011) Biological explanations for and responses to madness. Chapter Fourteen in (eds. D. Pilgrim, A. Rogers and B. Pescosolido) The SAGE Handbook of Mental Helath and Illness. London, Sage. (pp 291 – 312).
Timimi, S. (2004) In Debate: ADHD is best understood as a cultural construct – For. British Journal of Psychiatry (In Debate) 184, 8-9.
Timimi, S. (2004a) Rethinking childhood depression. British Medical Journal, 329, 1394-1397.
Reprinted from CPD Bulletin Psychiatry
(2000) 2 33-36
Critical Psychiatry
- Critical
psychiatry. by Duncan Double
- Modern-day psychiatry relies too much on the "medical model" and emphasises
diagnostic decisions. If psychiatrists adopted a more social or therapeutic
community approach treatments would be more effective.
- The categorisation of psychiatric illness is not as clear as most
psychiatrists believe. Assessment of aetiology too often fails to take personal
and social factors into account.
- There is too much emphasis on the scientific possibilities of randomised
controlled trials. The evidence of these trials is biased.
Introduction
Psychiatry is open to criticism because of its power of
compulsory detention and treatment. This issue could be avoided by psychiatrists
restricting themselves to voluntary treatment, and psychotherapists indeed
routinely do practise on this basis. However, the social responsibility of
caring for the mentally ill is an essential function of psychiatry and should
not be neglected. The question is how well psychiatry fulfills its role.
Critical psychiatry suggests that psychiatric practice is often
inadequate for a number of reasons. This article will review this critique of
psychiatry by examining its main constituents. Over recent years mainstream
psychiatry has marginalised its critics by dismissing them as
"antipsychiatrists". However, those identified as part of the antipsychiatry
movement, such as David Cooper, Thomas Szasz and RD Laing do not represent a
single view (Tantam 1991). Cooper was politically Marxist and the only one that
accepted the designation "antipsychiatrist"; Szasz (1972) regards mental illness
as a myth; Laing recognised the turmoil of mental suffering, whilst
acknowledging that the term mental illness is used metaphorically. Arguably, the
"antipsychiatrists" are only linked by their willingness to criticise
psychiatric practice.
Biological bias in psychiatry
Detaining the mentally ill creates the potential for abuse.
From the 1950s, attempts were made to make psychiatric hospitals more
therapeutic by unlocking the doors (WHO 1953). The maltreatment of patients in
hospital was exposed in several scandals that gave an impetus to the
dehospitalisation of patients (Martin 1984). Conversely, inquiries over recent
years, particularly following homicides by psychiatric patients, have expressed
concern about neglect of patients in the community (Peay 1996). Psychiatric
services have to find a precarious balance beside abuse and neglect.
Accordingly it can be difficult to sustain interpersonal
relationships. One temptation is to retreat into objectification of those
identified as mentally ill, insisting on the somatic nature of their illness. An
advantage of this strategy is that it protects those trying to provide care from
the pain experienced by those needing support. Notwithstanding some intuitive
understanding of mental illness as a disorder of the mind, it is simpler to
concentrate on its bodily substrate. Such a biological bias is not new in
psychiatry, although psychopharmacological developments following the discovery
of antipsychotics and antidepressants have reinforced this emphasis. As
expressed by John Haslam (1798) over two centuries ago: "[T]he various and
discordant opinions, which have prevailed in this department of knowledge, have
led me to disentangle myself as quickly as possible from the perplexity of
metaphysical mazes."
Both the dopamine theory of schizophrenia (dopamine
overactivity in schizophrenic brains) and the amine hypothesis of depression
(amines depleted in depressed brains) arose following the introduction of
psychotropic drugs, at a time when only few neurotransmitters had been
discovered. Despite the subsequent discovery of a vastly more complex
neurotransmitter network, psychiatrists still use such simplistic notions in
their everyday management of patients when they explain that mental illness is
due to "chemical imbalance".
The evidence for the organic basis of functional psychiatric
conditions such as schizophrenia is not as considerable as certain claims
suggest. Functional imaging of receptors has produced equivocal results.
Structural and functional cerebral abnormalities in schizophrenia are at best
subtle rather than gross (Chua & McKenna 1995). In contrast, the
identification and cloning of genes and the elucidation of chromosomal
abnormalities has led to major progress in the molecular biology of genetic
neuropsychiatric disorders, such as Huntington's disease, in which the
abnormality of triplet repeat on chromosome four has now been demonstrated.
Taken to its extreme, the danger is that people with mental
health problems will be reduced to purely physical terms wherein their brain
chemistry needs correction. Moreover, the biological hypothesis is used to give
justification to medical control in the treatment of mental illness. In
relations of power, it suits psychiatrists to keep other mental health
professionals thinking that they may be missing vital knowledge about bodily
processes. The authority of the challenge to the biological hypothesis is
thereby undermined.
Diagnosis
Single-word diagnoses fail to give an adequate understanding of
a person's mental health problems. The modern explicit and intentional concern
with diagnosis and classification disguises uncertainty about psychiatric
disease entities.
In particular, over recent years, psychiatric diagnosis has
become increasingly codified following the original paper by Feighner et al
(1972), and the introduction of the Research Diagnostic Criteria (Spitzer et al
1975), through editions of DSM-III, DSM-IIIR and DSM-IV (APA 1994) and ICD-10
(WHO 1992). Robert Spitzer, who chaired the DSM-III Task Force, was particularly
concerned about a study by Rosenhan (1973), which raised the fear that
unreliable diagnoses may invalidate the whole process of psychiatric practice
(Spitzer & Fleiss 1974). Rosenhan demonstrated that normal people could gain
admission to hospital and acquire a diagnosis of schizophrenia by merely
feigning a mundane, simple hallucination, saying they were hearing a voice say
"thud", "empty" or "hollow". He concluded that professionals were unable to
distinguish the sane from the insane. Operationalisation of psychiatric criteria
arose as a response to the perceived need for objectification in diagnosis.
The US-UK Diagnostic Comparison Study demonstrated that
American psychiatrists were using the term schizophrenia more inclusively than
their British counterparts (Kendell et al 1971). This finding also contributed
to a tightening of diagnostic criteria, particularly a restriction of the use of
the term schizophrenia. Concern about stigmatisation has made psychiatrists much
less ready over recent years to use a diagnosis of schizophrenia which tends to
imply poor prognosis.
The movement to create explicit diagnostic criteria has been
called neo-Kraepelinian, as it promotes many of the ideas associated with the
views of Emil Kraepelin, often seen as the founder of modern psychiatry (Klerman
1978). Adolf Meyer was regarded as extremely influential in American psychiatry
in the first half of this century, and his influence came to Britain via Aubrey
Lewis and David Henderson (Gelder 1991). Meyer (1951/2) is remembered for his
opposition to the preoccupation of the Kraepelinians with diagnosis. Although he
accepted that there may be a place for classification, he argued that if
diagnosis was meaningful, it was secondary to the assessment of the patient as a
person (Double 1990). He may be held responsible for helping to create a trend
which depreciated the role of diagnosis, which the neo-Kraepelinian movement
deliberately countered. Psychoanalysis was strong in academic psychiatry in the
post-war period in America and also appears to have played a role in
de-emphasising the importance of diagnosis and classification..
It is illegitimate to postulate an underlying disease entity
just because mental disorders may seem unintelligible. Assessment should
concentrate on the "facts of the case", as Meyer was fond of saying, and
diagnosis usually does justice to only part of "the facts". Even if "the facts"
do not constitute a diagnosis, clinical management has to act on them. Meyer
favoured a psychogenic explanation of mental illness and regarded it as not
completely foreign to normal experience. In particular, he explained
schizophrenia (dementia praecox) as a maladaptation that could be understood in
terms of the patient's life experiences. Psychiatric assessment too often fails
to appreciate personal and social precursors of schizophrenia by avoiding or not
taking account of such considerations.
Social therapy
Several experimental attempts have been made to provide a more
therapeutic milieu than the traditional hospital environment. For example, Harry
Stack Sullivan established a small ward for schizophrenic men that was staffed
with hand-picked attendants, set apart from the rest of the Sheppard Pratt
Hospital in the 1920s (Barton Evans III 1996). He gave his staff autonomy to
operate on their own with patients. As Sullivan (1962) stated:
[W]e found intimacy between the patient and the employee
blossomed unexpectedly, that things I cannot distinguish from genuine human
friendship sprang up between patient and employee, that any signs of the alleged
apathy of the schizophrenic faded, to put it mildly, and that the institutional
recovery rate became high.
Sullivan's experimental ward could be seen as a precursor of
the therapeutic community movement, whose influence came to be integrated with
mainstream psychiatry (Jones 1952, van Putten 1973). This emphasis on the social
aspects of treatment, though, is much less obvious in the current climate of
risk assessment and psychotropic drug management (Clark 1974).
The "antipsychiatrists" also experimented with institutional
alternatives. For example, David Cooper set up Villa 21 in Shenley Hospital,
although Cooper's positioning as an antipsychiatrist makes it difficult to
appreciate the similarity with ventures like that of Sullivan. Cooper's (1967)
"experiment in antipsychiatry" failed to change the ward staff's role-bound
behaviour. Laing's Kingsley Hall was outside the hospital system and was perhaps
more like a commune. Criticism of its laissez-faire ethos should take account of
Laing's own concession - that he had failed to find "a tactical, workable,
pragmatic . . . . sort of thing that could work for other people" (Mullan
1995).
Scepticism about therapeutic efficacy
Historically doctors have prescribed medications which are now
regarded as useless and often dangerous. Non-specific placebo effects can be
powerful (Shapiro & Shapiro 1997). Uncontrolled evaluation of the efficacy
of treatment was eventually replaced by clinical trials and the acceptance and
use of the double-blind method. However, randomised controlled trials are
commonly flawed in practice and the most rigorous trials are associated with
less treatment benefit than poor quality trials (Moher et al 1998). The recent
emphasis on evidence-based medicine with initiatives such as the Cochrane
Collaboration has also focused on methodological issues.
The double-blind method is not infallible because frequently
the double blind can be broken (Fisher & Greenberg 1997). Patients and
doctors may be cued in to whether patients are taking active or placebo
medication by a variety of means. For example, they may notice that placebo
tablets they have been taking taste differently from medication to which they
have previously become accustomed. Active medication may produce side effects
which distinguishes it from inert medication. There is evidence even of
deliberate deceit in clinical trials so that randomised allocation is not
concealed (Schultz 1996).
Studies where an attempt to measure unblinding has been made
confirm that it does occur and significant correlations with efficacy ratings
have been found (Shapiro & Shapiro 1997). These problems of unblinding may
be minimised by trialists because there seems to be nothing that can be done to
prevent it completely. Nonetheless, there should then be no pretence that
unbiased evaluation of treatment is being carried out. Although the apparent
specific effect of treatment may not be as great as the placebo effect itself,
it may merely be the wishfulfilling amplification of nonspecific effects. Using
active drugs without apparent specific treatment effects as controls generally
reduces the effect size of the active treatment, maybe because patients are less
likely to be unblinded in the trial because of the detection of active effects
in the control drug (Thomson 1982).
The placebo effect may be relevant to problems in
discontinuation. People may form attachments to their medication more because of
what it means to them than what it does. Any change threatens an equilibrium
related to a complex set of meanings that their medication has acquired. These
issues of reliance on medication should not be minimised, yet commonly
compliance with treatment is reinforced by emphasising that antidepressants, for
example, are not addictive (Double 1997). Psychotropic medication is often
prescribed in life crises reinforcing defensive mechanisms against overwhelming
anxiety, and the power of the placebo effect should be recognised. Counteracting
such placebo effects may not be easy when discontinuing medication.
Conclusion and future developments
Psychiatric practice can be criticised for its failure to
regard the patient as a person. Mainstream psychiatry acts on the somatic
hypothesis of mental illness to the detriment of understanding people's
problems. Laing's (1982) primary motivation was his appreciation that
schizophrenia, in particular, was more understandable than mainstream psychiatry
recognized. This stance is consistent with Adolf Meyer's (1951/2) philosophy.
The neo-Kraepelinian has eclipsed the Meyerian approach over recent years and
encouraged excessive enthusiasm about diagnosis and treatment which requires
critical analysis (Double 1991).
Antipsychiatry has been marginalised because it accuses
psychiatry of social control (Farrell 1979). Renewed criticism of modern
psychiatry is required and the Critical Psychiatry Network gives expression to a
"post-psychiatry" (Critical Psychiatry Network website). Psychiatry need not
feel negative about this process. Patients and society will continue to demand
its services and appreciate realistic expectations.
References
American Psychiatric Association (1994)
Diagnostic and
Statistical Manual of Mental Disorders (4th edition). Wahington: APA.
Barton Evans III, F. (1996)
Harry Stack Sullivan.
Interpersonal theory and psychotherapy. London: Routledge.
Chua, S.E. & McKenna, P.J. (1995)
Schizophrenia - a
brain disease? A critical review of structural and functional cerebral
abnormality in the disorder. British Journal of Psychiatry, 166,
563-582.
Clark, D.H. (1974)
Social therapy in psychiatry.
Harmondsworth: Penguin.
Cooper, D. (1967)
Psychiatry and anti-psychiatry.
London: Tavistock Publications.
Critical Psychiatry Network (no date)
Double, D.B. (1997)
Prescribing antidepressants in general
practice. People may become psychologically dependent on antidepressants.
[Letter] BMJ, 314, 829.
Double, D.B. (1991)
What would Adolf Meyer have thought of
the neo-Kraepelinian approach? Psychiatric Bulletin, 14,
472-4.
Farrell, B.A. (1979)
Mental illness: a conceptual
analysis. Psychological Medicine, 9, 21-35.
Feighner, J.P., Robins, E., Guze, S.B., et al (1972)
Diagnostic criteria for use in psychiatric research. Archives of General
Psychiatry, 26, 57-63.
Fisher, S. & Greenberg, R.P., (eds) (1997)
From
placebo to panacea. Putting psychiatric drugs to the test. Chichester: John
Wiley.
Gelder, M. (1991)
Adolf Meyer and his influence on British
psychiatry. In Berrios, G.E. & Freeman, H., (eds) 150 years of British
psychiatry. London: Gaskell.
Haslam, J. (1798)
Observations on Insanity. London:
Rivington.
Jones, M. (1952)
Social psychiatry: A study of
therapeutic communities. London: Tavistock.
Kendell, R.E., Cooper, J.E., Gourlay, A.J., et al (1971)
Diagnostic criteria of American and British psychiatrists. Archives of
General Psychiatry, 25, 123-130.
Klerman, G.L. (1978)
The evolution of a scientific
nosology. In Shershow, J.C. (ed) Schizophrenia: Science and Practice.
Cambridge, Mass: Harvard University Press.
Laing, R.D. (1985)
Wisdom, madness and folly. The making
of a psychiatrist. London: Macmillan.
Martin, J.P. (1984)
Hospitals in trouble. Oxford:
Blackwell.
Meyer, A. (1951/2)
Collected Papers (Four Volumes).
Baltimore: John Hopkins.
Moher, D., Pham, B., Jones, A., et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet, 352, 609-613.
Moher, D., Pham, B., Jones, A., et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet, 352, 609-613.
Mullan, B. (1995)
Mad to be normal. Converations with RD
Laing. London: Free Association.
Peay, J. (ed) (1996)
Inquiries after homicide.
London: Duckworth.
Rosenhan, D.L. (1973)
On being sane in insane places.
Science, 179, 250-258.
Schultz, K. (1996)
Randomised trials, human nature, and
reporting guidelines. Lancet, 348, 596-98
Shapiro, A.K. & Shapiro, E. (1997)
The powerful
placebo. From ancient priest to modern physician. London: John
Hopkins.
Spitzer, R.L. & Fleiss, J.L. (1974)
A reanalysis of the
reliability of psychiatric diagnosis. British Journal of Psychiatry,
125, 341-347.
Spizer, R.L., Endicott, J. & Robins, E. (1975)
Research diagnostic criteria (RDC) for a selected group of functional
disorders. New York: New York State Psychiatric Institute.
Sullivan, H.S. (1962)
Schizophrenia as a human
process. New York: WW Norton & Co.
Szasz, T.S. (1972)
The myth of mental illness.
London: Paladin.
Tantam, D. (1991)
The anti-psychiatry movement. In Berrios,
G.E. & Freeman, H. (eds) 150 Years of British Psychiatry, 1841-1991.
London: Gaskell.
Thomson, R. (1982)
Side effects and placebo amplification.
British Journal of Psychiatry, 140, 64-68.
Van Putten, T. (1973)
Milieu therapy: contraindications?
Archives of General Psychiatry, 29, 640-643.
World Health Organisation (1992)
The ICD-10
classification of mental and behavioural disorders. Geneva: WHO.
World Health Organisation (1953)
Third report of the
expert committee on mental health. Geneva: WHO.
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News-Medical.net Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does ... |
via Psychology / Psychiatry News From Medical News Today on 1/24/13
A new study of 152 Vietnam veterans with combat-related brain injuries offers the first detailed map of the brain regions that contribute to emotional intelligence - the ability to process emotional information and navigate the social world. The study found significant overlap between general intelligence and emotional intelligence, both in terms of behavior and in the brain...
via Psychology / Psychiatry News From Medical News Today on 1/24/13
Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD)...
via Psychology / Psychiatry News From Medical News Today on 1/24/13
Sports-related concussions and mild traumatic brain injuries have grabbed headlines in recent months, as the long-term damage they can cause becomes increasingly evident among both current and former athletes. The Centers for Disease Control and Prevention estimates that millions of these injuries occur each year...
via international psychiatry - Google News on 1/23/13
Psychiatric patients wait in ERs as inpatient beds are scaled back
Long Beach Press-Telegram Psychiatric patients make up 7 to 10 percent of emergency room visits, said a 2012 study in the Emergency Medicine International journal. For many patients suffering from psychiatric crises, this translates to longer waits in emergency departments ... |
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via Critical psychiatry by Duncan Double on 12/1/12
Wonder why it's taken so long to do that! Perhaps the article is trying to dissociate itself from psychiatry's history (see my chapter in Mental health ethics). If it's following the previous article, this means believing that psychiatry needs to "realign itself as a key biomedical specialty at the heart of mental health". That's always been the hope of psychiatry that it will find the biological basis of mental illness. And, what's that got to do with being a "branch of medicine that seeks to support some of the most marginalised members of society", which is what the article says psychiatry is?
The latter characterisation of psychiatry may even raise questions. The article favourably references The Lancet's Global Mental Health Series, which I have commented on in a previous post. However, social factors, such as poverty and injustice, are not necessarily at the centre of the understanding of mental health problems in modern psychiatric practice.
The article also mentions the Schizophrenia Commission's recent report, but doesn't mention the Inquiry into the schizophrenia label (ISL) (see previous post). Suman Fernando, one of the ISL co-ordinating group, has commented on the report. Psychiatry should be about treating people with mental health problems as persons, but this isn't always the case. A helpful feature of the Schizophrenia Commission's report is its recognition that too many people with a diagnosis of schizophrenia are in secure psychiatric provision.
via Critical psychiatry by Duncan Double on 12/5/12
Special article, with my name (see my book chapter on need for paradigm shift in psychiatry) as one of the 29 authors (first author Pat Bracken - see previous post), has been published in the British Journal of Psychiatry. An accompanying editorial by Arthur Kleinman, who I have mentioned in previous posts (eg. see entry), argues that academic psychiatry has been too biomedical. Perhaps it's easier for Kleinman to say this in a British journal, rather than in the USA where NIMH has dominated research (eg. see previous blog entry).
Congratulations to the BJPsych editor for encouraging this debate. I have said previously that I have been surprised by some of his comments from the editor's desk (eg. see post). He has made his position clearer in his current commentary. He seems worried that psychiatry may be no more than quackery. I'm not saying this to encourage a civil war in psychiatry, but his position could encourage neuromania (eg. see previous post). We need to move on from this.
via Critical psychiatry by Duncan Double on 1/19/13
via critical psychiatry - Google Blog Search by Duncan Double on 12/4/12
Special article, with my name (see my book chapter on need for paradigm shift in psychiatry) as one of the 29 authors (first author Pat Bracken - see previous post), has been published in the British Journal of Psychiatry.
via critical psychiatry - Google Blog Search by dave traxson on 1/14/13
The Critical Psychiatry Network is a group of British psychiatrists who first met in Bradford, England in January 1999 in response to proposals by the British government to amend the 1983 Mental Health Act (MHA). There was ...
via critical psychiatry - Google Blog Search by Philip Thomas, M.D. on 12/15/12
Over the coming months I will use these stories to examine the different ways of working that follow on from being a 'critical' psychiatrist. The great advantage with thinking about psychiatric practice in terms of narrative, as ...
via critical psychology - Google News on 1/24/13
Expanding mental health services is a far better alternative than armed guards
Kansas City Star A yearlong study commissioned by the American Psychological Association found no evidence that zero tolerance contributes to school safety or improved behavior, and concluded that it worsens racial disparities in school discipline, causes hardship for ... and more » |
via critical psychology - Google Blog Search by desmondpainter on 9/17/12
I am attending the Third Critical Psychology Symposium in Diyarbakir, Turkey — another great opportunity for psychologists from the peripheries of North-Atlantic psychology to forge links, create alternative networks, and learn ...
via critical psychology - Google Blog Search by admin (Mark Burton) on 9/21/12
Statement agreed following discussion at the Third Critical Psychology Symposium (Diyarbakir, Turkey). It has been forwarded to those in Mexico campaigning for a proper investigation into the disappearance of Ana Belén, ...
"Critical Psychiatry and Psychology News" bundle created by Mike Nova
A bundle is a collection of blogs and websites hand-selected by your friend on a particular topic or interest. You can keep up to date with them all in one place by subscribing in Google Reader.
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6 feeds included in this bundle
- Critical psychiatry
- critical psychiatry - Google Blog Search
- critical psychology - Google Blog Search
- Mad In America » Blogs
- critical psychiatry - Google News
- critical psychology - Google News
via critical psychology - Google Blog Search by Lisa Firestone, Ph.D. on 1/23/13
Overcoming that internal critic we all possess By Lisa Firestone, Ph.D....
via critical psychology - Google Blog Search by critpsych IKP on 1/15/13
The conference attempts to substantiate a critical situated approach to the experiences and actions of practicing human life in today's social and technological world, and to debate how the study of subjects in the context of ...
via critical psychology - Google Blog Search by Antonio C. S. Rosa on 10/12/12
`Critical psychology` has emerged in academic arenas very fast in recent years, and it stretches to the limit the self-critical reflexive activity that should characterise any good mainstream psychological research. It should be ...
via critical psychology - Google Blog Search by By Andy Greder, Sarah Horner and Will Ashenmacher Pioneer Press on 1/14/13
Peter Linnerooth was an affable, punctual and conscientious graduate student at Minnesota State Mankato. He later earned a doctorate degree, became an Army psychologist and was deployed to Iraq during the height of the ...
via critical psychology - Google Blog Search by Centre for Medical Humanities on 1/22/13
The 8th Biennial Conference of the International Society of Critical Health Psychology (ISCHP) will be held at the University of Bradford in Bradford, Yorkshire, England, 22nd-24th July 2013. This conference is being ...
via critical psychology - Google Blog Search by marianohadi on 1/8/13
How to Think Like a Psychologist: Critical Thinking in Psychology (2nd Edition) book download Donald McBurney Download How to Think Like a Psychologist: Critical Thinking in Psychology (2nd Edition) Teaching Critical ...
via critical psychology - Google Blog Search by admin (Mark Burton) on 9/21/12
Statement agreed following discussion at the Third Critical Psychology Symposium (Diyarbakir, Turkey). It has been forwarded to those in Mexico campaigning for a proper investigation into the disappearance of Ana Belén, ...
via critical psychology - Google Blog Search by desmondpainter on 9/17/12
I am attending the Third Critical Psychology Symposium in Diyarbakir, Turkey — another great opportunity for psychologists from the peripheries of North-Atlantic psychology to forge links, create alternative networks, and learn ...
via critical psychology - Google Blog Search by unknown on 3/4/11
Critical psychology has emerged as a vibrant site of research and reflection on the assumptions and practices of its host discipline. As serious scholarship flourishes in the area as never before, this new collection from the ...
via critical psychology - Google Blog Search by CritPsych IKP on 1/23/13
CfP Critical Health Psychology (http://criticalpsychology.wordpress.com #cfp #criticalpsychology #health) Call for Papers: 8th Biennial Conference of the International Society of Critical Health Psychology; Bradford, UK; 22-24 ...
via critical psychology - Google News on 1/13/13
 Examiner.com |
Former Army psychologist critical of military dies by suicide
Pioneer Press After his career as an Army psychologist, Linnerooth was critical of the Army and its response to the mental health needs of soldiers. In a 2010 interview, he lambasted military leadership for not being more connected with on-the-ground troops and for ... Army psychologist critical of military rights abuses commits suicideExaminer.com all 7 news articles » |
via critical psychology - Google News on 1/24/13
Should babies be allowed to 'cry it out'?
CNN International A few weeks ago, the journal Developmental Psychology published a study supporting the notion that a majority of infants over the age of 6 months may best be left to self-soothe and fall back to sleep on their own. Noting that sleep deprivation can ... and more » |
via critical psychology - Google News on 1/23/13
NZ Experts Join International Counterparts on Glenn Inquiry
Scoop.co.nz (press release) Associate Professor in Critical Psychology and Head of School at the School of Psychology at Massey University. Involved in a research programme on domestic violence services and interventions. Recently collaborated with other researchers and ... and more » |
via critical psychology - Google News on 1/24/13
 Global Times |
Time starting to heal old wounds of Mubarak regime
Global Times Predictions can seldom be accurate, but it is certain that the evolution of domestic politics and the social psychology will be critical to the final judgment. Despite strong opposition from his arch-opponents, the general political atmosphere will be ... and more » |
via critical psychology - Google News on 1/24/13
 Straight.com |
Wagner's Dream is a fitfully engaging film
Straight.com Still, such messy psychology may be lost in the abstract vision of Robert Lepage as captured in this fitfully engaging film. For more than three years, ... Certainly, it glosses over the critical reaction this cycle generated from the start. The New ... |
via critical psychology - Google News on 1/23/13
The Formula for Obesity
Huffington Post UK (blog) Children's minds are very impressionable and this would allow me to gain lifetime customers because the children's minds would be made up about their favourite products before they became adults that could think intelligently and use their critical ... |
via critical psychology - Google News on 1/23/13
Holding information hostage
RU Daily Targum Overall, he touched on several critical issues that demand immediate attention — like how we need to deal with other nations more peacefully, which I can only assume means more drone strikes. I cannot help but think, however, that if we had better ... |
via critical psychology - Google News on 1/24/13
 Flickering Myth (blog) |
The Gospel of American Mary – A Horror in the Shell of a Psychological Thriller
Flickering Myth (blog) Whilst American Mary's singular identity as a horror does not span every critical and non-critical reaction to the film, it nevertheless felt fitting to write a piece on the perception of American Mary as a horror, and tackle its relationship with ... |
via critical psychology - Google News on 1/23/13
 National Post |
Don't believe medicine's wizards of Oz
National Post It does not hurt that TV doctors tend to have movie-star good looks, which studies of human psychology have long shown can inspire our confidence. Just think about the chiseled features and dreamy blue eyes of Dr. Travis Stork, star of The ... Jenny ... |
via critical psychology - Google News on 1/24/13
Expanding mental health services is a far better alternative than armed guards
Kansas City Star A yearlong study commissioned by the American Psychological Association found no evidence that zero tolerance contributes to school safety or improved behavior, and concluded that it worsens racial disparities in school discipline, causes hardship for ... and more » |
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