Tag Archives: suicide

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.

 

 

 

 

 

Involuntary Manslaughter?

Twenty-year-old Michelle Carter was convicted last week of “involuntary manslaughter” for encouraging the suicide of her friend Conrad Roy III, in July, 2014. While I’m not surprised by the outcome, I’ve always wondered if anyone should be held responsible for another person’s actions, up to and including suicide and murder.

The law says they should.  Psychiatrists, in particular, can be held liable if their patients–present or past–kill themselves or anyone else.  A mere hint of “suicidal ideation” in an emergency room is enough to get someone committed to psychiatric hospitalization, at least for an observation period of up to 72 hours.

That homeless people, alcoholics, drug addicts, and those escaping the law or outside enemies use this ploy to obtain “three hots and a cot” on cold or stormy winter nights is common knowledge in the medical world.  There are also the drug seekers, who hope to receive controlled substances to alleviate their pain.  While others want to blame the patients, I look to the crazy-making system itself. Those who learn to “work the system” are only doing what they believe is necessary for survival.

The professional’s challenge and dilemma is always to determine intent to act. Psychiatric evaluation is meant to assess the seriousness and immediacy of the threat.  It includes questions about access to weapons, past attempts, serious stressors (like medical diagnoses, relationship breakups, financial crises, for instance), level of intoxication (if any), mental stability (such as psychosis) and other possible contributing factors to the person’s distress.

In most cases, a 24-hour hospitalization is enough to alleviate the symptoms and allow a person to be discharged safely.  By morning, most people have changed their minds, at least until the next time.  Those who are truly suicidal can remain in the hospital for weeks, months, or even years, although this is becoming rarer. Psychiatric hospitals are so crowded that there’s constant pressure to discharge as soon as possible, or at least as soon as insurance coverage ends.

Bottom line is potential suicidality is taken very seriously in the medical and psychiatric world, and each case is different.  Although it is an ethical no-no for psychiatrists to diagnose or analyze people they have not personally examined, I deduce from news reports that there were a number of factors playing into the Carter case, including the un-examined belief that anyone can prevent anyone from doing what they intend to do.

News sources say Mr. Roy had attempted suicide four times in the past.  Ms. Carter met him in 2012, had emotional and mental problems of her own, and needed to be needed.  She fancied herself a helper, and up until the last two weeks of his life, she tried to convince him not to kill himself.  Then she suddenly changed tack and began encouraging him to act on his threats.  She even ordered him back into the carbon-monoxide filled vehicle when he became scared and got out.  Most of this was done long-distance, say the reports.

Witnesses for the prosecution claimed her motive was attention, as she was communicating various moves in this two-year dance to a variety of other people. It’s not clear whether anyone intervened or tried to break up this dangerously destructive dynamic.  Was this so-called need for attention a desperate cry for help by Ms. Carter herself?  Apparently Ms. Carter at one point encouraged Mr. Roy to seek professional help, but did she consult anyone herself about this problem? Chronically suicidal people can be exhausting, even for professionals, when they begin to manipulate for sympathy, attention, or to control the relationship.  At what point does the helper give up and say (or think), “Quit talking about it and just do it.”?

I don’t mean to excuse Ms. Carter for her actions.  She apparently gave a lot of bad advice over a long period of time, and she was way out of her depth.  Who can ascribe motive? For all anyone knows, Mr. Roy may have killed himself sooner if not for Ms. Carter’s friendship.  I happen to believe suicide is a personal choice.  I don’t recommend it, but I also believe we all choose our time to die, on some level.  We only differ in how we do it.