Tag Archives: Mental health

How Do You Define Crazy?

What is “addiction”?  What causes it?  There’s a lot of attention given, lately, to various forms of “addiction,” but definitions of it and its clues about its causes are rare.  The American Psychiatric Association (APA), the primary lobbying organization for the professional mental disorder labelers, claims it is a “brain disease” that is “complex” and characterized by “compulsive substance use despite harmful consequences.”  The official platform, published on line, says there are a number of effective treatments, and that people can recover.

The APA also asserts there are “changes in brain wiring” as a result of addiction, and that “brain imaging studies show alterations in judgment, decision making, learning, memory, and behavioral control.”

The psychiatric establishment, including the National Institute for Drug Abuse, states brain changes in the brain stem, cerebral cortex and limbic system cause addiction.

So that’s our answer, in a nutshell.  Satisfied?

I’m not.  In fact, it’s embarrassing to admit I’m associated with such pretenders, because this propaganda campaign is nothing more than pandering to a group of people who probably know more about addiction than the “experts” do.  First, “addiction” per se is not listed among the growing list of “mental disorders” in the latest bible of psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, version V.  (DSM-V).  We have “substance use disorder,” and specific diagnoses related to the type of substance (mis)used, such as “opiate use disorder.”  We do have “internet addiction,” a new, DSM-V, excuse to seek funding for treatment.  But my rant here is not about addiction or the “opioid epidemic,” or even the marketing blitz that characterizes modern strategy for creating and perpetuating insanity.  It’s about terminology and the ocean of irrelevance that is pawned off as information to an under-informed, misinformed, and gullible public.

I first heard the term “brain disease” from members of the National Alliance for the Mentally Ill (NAMI), a lobbying group that prides itself on its family-associated organization, lobbying efforts for “mental health parity,” and its disassociation from mental health professionals.  NAMI has especially wanted to “de-stigmatize” mental illness by insisting it’s a “brain disease,” caused by a “chemical imbalance” in the brain, thus equivalent to physical diseases, even though there is little physical evidence for such conditions.

The psychiatric establishment, assisted by the pharmaceutical companies, the government, and to some extent, the insurance companies, has jumped on this opportunity to legitimize (and fund) research and treatment for a variety of mental disorders, and the list keeps growing.  Since the first DSM was published in 1952, the number of official mental disorders has steadily expanded, apparently to accommodate the tide of new medications flooding the market.  Homosexuality, formerly listed, has been expunged since 1987, but we have added problems you didn’t know were disorders, such as ‘social anxiety,” “adult attention-deficit hyperactivity disorder,” and “hypoactive sexual desire disorder.”  Insomnia is now an official psychiatric disorder, maybe thanks to the efforts of researchers and pharmaceutical companies that want to study and profit from it.

Lately, we are told the national suicide rate has gone up.  Army suicides are up, and there’s a question about whether some of the opioid-related deaths were intentional suicides.  We have the controversy over what used to be called “physician-assisted suicide,” which is no longer a politically or socially correct term, because it stigmatizes those who get a physician to help them die.  This is now called “medical aid in dying.”  Who remembers when Jack Kevorkian, a pathologist, went to prison in 1999 for helping patients die, convicted of second-degree murder?

Psychiatric terminology is tossed around with the same carelessness of standard epithets but carries the unsubstantiated veneer of insider knowledge.  Who hasn’t heard the president called a “narcissist?”  Look in the DSM-V to find out that “narcissistic personality disorder” could probably fit many people, depending on how one interprets the list of vague criteria, such as grandiosity or lack of empathy.  There are no “brain imaging studies” that prove it, and there’s no treatment.

To say the APA is misrepresenting itself, psychiatry, the mentally ill, and is flooding the public with irrelevance seems like a drastic claim, but here are the “facts.”  In its bid to align itself with “medical science,” such as it is, psychiatry likes to talk about “evidence-based” findings, but the evidence for most of its claims is based on subjective screening tools, such as Beck’s or Hamilton’s Depression scales, which depend on the patient or observer to assess symptoms or signs believed to contribute to clinical depression.

Also, the APA’s claim that “brain imaging studies” have identified specific areas of malfunction related to various mental disorders, is simply not true, but they keep trying, and the “psychiatric industry” is hot to obtain more funding for more research into the various potentialities of such tools as functional MRI and PET scans.

It is true that people under the influence of certain drugs and alcohol show more or less activity in certain brain areas, and autopsies of those with significant alcoholism, for instance, have brain changes consistent with long-term damage.

A great deal has been made over neurotransmitters, in order to justify the “chemical imbalance” hypothesis.  The class of antidepressants termed “serotonin-selective reuptake inhibitors” or “SSRIs”, led by the introduction of Prozac (fluoxetine) in 1989, quickly followed by copycats Zoloft (sertraline), Paxil (paroxetine), and others, spawned a new wave of psychiatric drugs that targeted specific brain chemicals (neurotransmitters).  Do they work?  There is increasing evidence that they don’t work for long, especially in children, and they may do more harm than good.  Approval by the FDA of direct-to-consumer (DTC) advertising in 1997 may have contributed to the upsurge in use of psychiatric as well as a host of other medications, and to the misperception that there’s a pill for every ill.

The “opioid epidemic,” deserves particular note, because it has been deemed by the Powers-That-Be as a “public health crisis,” deserving of broad-scale funding, research, special treatment protocols, legislation, and lawsuits against the pharmaceutical companies deemed most responsible for creating the problem.

Here, the psychiatric establishment–along with the government and media–has gone out of its way to misrepresent and inflate the problem, as well as its preferred solution, which is to hook people forever on different opiates.  The Need-To-Be-Needed crowd indirectly admits it has no cure, yet, but more funding will provide for better access to “care,” and for more research, such that maybe someday we will know enough to cut people loose from their psychiatric problems.

 

 

 

 

 

The More Things Change . . .

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Above:  The professional literature in Psychiatry remains funded primarily by pharmaceutical companies.  I get up to eight Psychiatry periodicals every month, all containing about 50% advertising, most of it by Pharma.  This junk enjoys a privileged postage rate, because it is “educational.”

April 12, 2017–Reading old journal entries helps me focus blogs and show the trend of my thinking over time.  In April, 2007, ten years ago this month, I was considering allowing my medical and DEA licenses to expire, because I felt used by a medical system that causes more disease and suffering than it alleviates.  As a psychiatrist, I was under a virtual mandate to prescribe drugs that promised more help than they delivered.  Not only that, but the system itself was so dysfunctional that it put everyone at risk.

ON MEDICINE AND PSYCHIATRY
Wednesday, April 18, 2007 – If I can get out of the business of medicine, I can enjoy the fun of medicine, when it’s done right.

It starts with honesty.  We have created a sado-masochistic society that feeds failure and punishes success.  In today’s climate, the individual doesn’t matter.  “Equality” means bringing everyone down to the lowest common denominator, statistically speaking, to save the “economy” from the individuals who take more than they give.

Our society has rendered them so dysfunctional that they are incapable of doing anything useful and resentful of those who expect them to make an honest living.
What kind of psychiatrist would I be if I didn’t point out the insanity of that?  I believe the individual matters, if only to herself.  I matter enough to stand my ground in the face of society’s power struggles and to comment on the process.

The US psyche is caught up in the emotional two-year-old anal stage of psycho-sexual development, the “terrible twos,” the year of potty training, the age in which life-long issues related to power and power struggles emerge.  The “self” vs. “not-self.”
As we play with the shit we have created, we are evolving, hopefully, toward a greater understanding of what it means to be free.  Demonizing and drugging the individual mind and spirit is society’s game, not mine.  I have evolved beyond the anal stage.  I quit.  Get ahead by slowing down.  Take time to smell the roses before you pave them over.

This patient-churning prescription writing machine throws the government credentials—the medical licenses—into the compost bin.  Thus relieved of the paper shield, I step from in front of the DEA’s guns to show them aiming at my back, to control invisibly every aspect of the prescription game.

They need me more than I need them, but only because they believe in drug laws.  If there were no drug laws, we wouldn’t need the DEA, but doctors would still have jobs.

“Doctor,” a word my absentee bosses don’t know, is derived from the Latin “docere” meaning “to teach.”  A doctor is fundamentally a teacher about health.  That’s what I do – teach people about health, especially mental health.

You know what I tell my patients?

“It really is them,” I say.  “They are the crazy ones.  Don’t put your life on hold waiting for the government.  You’ll grow old and die waiting.  Live it up while you still can.  Dance in the living room.  Turn off the television, for your sanity’s sake.  Shut off the mind and noise pollution so you can hear yourself think, and you’ll get back in touch with your common sense.”

ADHD (ATTENTION DEFICIT HYPERACTIVITY DISORDER)

Tuesday, April 3, 2007 – I enjoyed working with kids and parents yesterday.  I gave practical advice and supported them in their efforts.  A little six-year-old hugged me on the way out.

These aren’t bad kids.  In fact, I think many who are branded with ADHD are brighter and more creative than the rest, with skills and interests that reach beyond the classroom.  A 12-year-old girl who is about to fail sixth grade for the second time daydreams and draws during class.  Likes violin and reading Japanese books in English.

I reassure them school really is boring, and teachers are busy pleasing absentee bosses.  Moms nod vigorously, and the kids stare at me as if they are shocked I would express such heresy.

CME ON ADULT ADHD

Tuesday, April 3, 2007 – I read a Continuing Medical Education article on ADHD (Attention Deficit Hyperactivity Disorder).  Bottom line is there’s nothing new, except the diagnosis of adult ADHD.

Do you think anyone would consider causes pills won’t treat, like multi-sensory fatigue from the environment?  Machine noise from traffic and power tools, airplanes, blowers, coffee grinders, speakers in coffee shops, grocery stores, hardware stores, banks, blaring “I Died and Went to Hell” music and advertising at top volume?  The screeching, attention-starved voices from the halls of hell?  Who can attend to anything with all that noise?

No.

Think they might consider that the same drugs are used by drug addicts and schools to treat the same symptoms, but it’s okay if you have the correct diagnosis?

No.

Think the lack of physical education in the schools, or the fact that kids with too much energy are punished by depriving them of play time might contribute to their hyperactivity?

No.

It’s all in the brain chemistry, you know.  Hit ‘em up with a little Adderall or Ritalin and we’ll let ‘em come back to school.  Never mind that they have been suspended the last X days and are even further behind.  They shouldn’t have acted out.

The other two psychiatrists here, Child & Adolescent psychiatrists, indulge me in my one-to-two minutes of tirade.  Each says separately, unfortunately, the kids who come here need to be on meds.  Doctors have adapted to being prescription writing machines, drones in the endless grind of patient-churning status quo.  They see the hypocrisy, but they learn quickly to keep quiet, to show in behavior the repressed anger generated by power abuses.

Learned helplessness vies with identification with the aggressor, but do you think psychiatrists make the connection between abstract understanding and the evidence in front of them?

No.

Why learn psychiatry if nobody cares?  You could get a computer to write prescriptions faster and more legibly.

The inertia is as cloying as clear gelatin.  Perhaps this is the egg; the yolk, the planet, the albumin the atmosphere, with humans poised at the interface, possibly growing and possibly getting big enough to crack the shell.

 

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If We’re So Smart, Why Aren’t We Sane?

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September 10, 2016

by Kookie the Shrink
an alter ego of katharineotto.wordpress.com
President, Chair, and CEO, Psychiatrists for Sanity
(and so far the only member)

The August, 2016 issue of Psychiatric Times has two good articles related to recent topics in my senior citizens’ discussion group.  One is on gun violence, and the other on physician-assisted suicide.

Gun Violence and Mental Illness

There’s a good interview with forensic psychiatrist Liza H. Gold, MD regarding her book, Gun Violence and Mental Illness.  She claims that most serious mental illness is only weakly associated with violence, and gun violence in particular.  There are 33,000 firearm deaths each year, and two-thirds of them are suicides.  Less than one percent occur in mass shootings.   Firearm violence by individuals with serious mental illness against strangers is one of the rarest forms in the US.  If seriously mentally ill people do become violent, it is usually against family members or in committing suicide.  Those with serious mental illness only commit 3-5% of all types of violence.

When Dr. Gold talks about legislation, she says only felons with a history of gun violence should be denied weapons.  Now, all felons are prevented from buying guns.  Psychiatrists and therapists should ask not only if the patient owns a gun but whether there is a gun in the household.  Better access to mental health care would perhaps prevent suicides (10th leading cause of death in the US and second among adolescents and young adults).  There are 40,000 suicides/year in the US with more than one-half using a gun.  As many as 90% of people who commit suicide have a history or current diagnosis of a psychiatric problem

We are the only nation in the world with this kind of gun violence problem.  Access to mental health treatment would not reduce homicide rates (11,000/year), which are usually interpersonal (domestic, gang wars, etc.)

The most dangerous time for a woman is in trying to leave an abusive relationship.  Temporary restraining orders do not prevent the perpetrator from having a firearm, but permanent ones do.  Gold says the temporary restraining order should also prohibit firearm possession for the perpetrator.

She says we should educate family members to remove firearms from the homes of those in crisis, such as depression, psychosis, substance abuse, dementia, recent trauma–such as loss of job or relationship–or has a recent diagnosis of serious medical illness.

Physician-Assisted Suicide

A commentary, “Physician-Assisted Suicide and the Rise of the Consumer Movement,” by Ronald W. Pies, MD, addresses the current status of so-called “physician-assisted suicide” movement and the ethical implications for psychiatrists.  While others refer to “death with dignity,” he likes to think in terms of “life with dignity,” and implies this is the main goal of psychiatry.

Dr. Pies says PAS is now legal in Oregon, Washington, Vermont and California.  They are considering a law in Canada that would allow for assisted suicide in mentally ill adult minors. He states the broad terms under which euthanasia is used in the Netherlands.

Dr. Pies correlated this with the growing “consumer rights” movement, which has replaced “physician” with “provider,” and “patient” with “consumer.” He hints that insurance companies–guided by numbers and statistics more than good care–are behind this language pollution.  He implies this subtle shift in terminology has dehumanized both parties and has undermined the therapeutic relationship between patient and physician.

My take is medical journals subsist on advertising, primarily from pharmaceutical companies.  Content usually reveals the medical bias toward expensive, patented medications and overtreatment for relatively minor problems.  The August issue of Psychiatric Times shows a heartening trend toward more clinically relevant information.  I commend this issue’s attempt to educate psychiatrists and the public about common sense solutions to common problems.