Sat Mar 23, 2024 11:33 pm by globalturbo
Psychiatry as Bullshit
By Niall McLaren
Is it possible for a modern medical specialty to be little more than what people in the street call bullshit? As scary as that sounds, I believe it is true of psychiatry. I’ve set out my case in some detail [1] and anybody who wants to disagree can read it. For readers who prefer to think outside the box, we can define both concepts, psychiatry and bullshit, and then see how psychiatry measures up.
We can define psychiatry as the medical approach to mental disorder. Psychiatry is what psychiatrists do, which these days means interview distressed people, make a diagnosis, and then prescribe pills. It can also mean compelling the person to enter a place called a hospital but, in reality, it is actually a place of involuntary incarceration where the inmate will have fewer rights and privileges than any prisoner in this country. Once detained, he can be forced to take any drugs the psychiatrist decides, however unpleasant; he can be locked in solitary confinement and can also be physically restrained more or less indefinitely. Finally, he can be compelled to submit to electroconvulsive therapy (ECT, “shock treatment”),
Now you might think that any non-forensic process that forces a perfectly innocent citizen to lose his freedom and all his rights, even to the point where he has no sexual function (mainly because of the drugs but also because somebody is always watching), would be based in some agreed, formalised, articulated, rational, publicly-available case which shows that the benefits outweigh the disadvantages. Sadly, and as a matter of firmly-established fact, you would be wrong [2]. Orthodox psychiatry has pulled a remarkable coup. Acting entirely without the benefit of a scientific model of mental disorder, it has managed to convince governments that their approach to mental disorder is at once correct, humane and the only possible choice. I believe this is bullshit, and will explain why. For the record, I firmly believe that severe mental disturbance is real. Thomas Szasz said that all people who claim to be mentally disturbed are pretending, but I have argued that he was totally (and brutally) wrong [3].
In 1986, the Princeton philosopher, Harry Frankfurt [4], published a paper entitled “On Bullshit.” It opens with some of the most memorable lines in modern philosophy:
“One of the most salient features of our culture is that there is so much bullshit. Everyone knows this….” He defined a lie as a very deliberate act of inserting a falsehood at some point in a discourse with the object of avoiding the consequences of having that point occupied by the truth. The successful liar is thus intimately concerned with the concept of truth. Bullshit, on the other hand, is the artistic production of statements that are neither true nor false, but are intended to create a particular impression in the listener. Given that definition, we can test psychiatry to see whether it passes the sniff test.
In the first place, orthodox psychiatry claims that in some vital causative sense, mental disorder is just a special case of physical malfunction of the brain. It is not psychological. Because of this, we are bombarded by material that says depression is “just” a matter of low brain serotonin, and Wonder Drug X will fix it. As a result, 10% of the Australian adult population now take antidepressants. We are routinely told these drugs are safe, effective, non-addictive, with minimal side-effects, and will be needed for life.
The whole thing is bullshit. In the first place, there is nothing in the entire psychiatric literature, nor psychological, nor philosophical, nor in the vast field of neurosciences, that would permit anybody to say that mental disorder is identical to or can be reduced to brain malfunction. Psychiatrists who state, as most do, that mental disorder is “just a chemical imbalance of the brain,” are stating something that is neither true, nor false, but is designed to create a particular impression in the listener. The impression is (a) that the psychiatrist knows what he is talking about, (b) has correctly assessed the patient’s life situation, and (c) his prescription will lead to an improvement in the patient’s life which would not otherwise happen.
None of these suppositions is true. Psychiatrists do not have a formal model of mental disorder. These days, psychiatric assessments, especially in public hospitals, are a joke, very often a matter of a nurse ticking a few boxes on a couple of questionnaires of very dubious validity and reliability. Psychiatric drugs are hardly effective. In depression, a placebo (sugar pill) will lead to improvement in 55-60% of cases, whereas antidepressants are effective in only 64% of cases (my experience says that figure is much lower). Psychotropic drugs have a huge range of highly unpleasant and/or dangerous side effects (e.g. loss of sexual function, massive weight gain, suicidal and/or homicidal impulses).
Psychiatric drugs produce some of the most persistent and damaging addictions of all. Finally, people who take psychiatric drugs for life can expect to die 19yrs younger than their un-drugged peers. Despite all the palaver about informed consent, psychiatrists never reveal these facts when prescribing their drugs. That’s not entirely unreasonable: if they did, nobody would take them.
Leaving drugs, we can look at electroconvulsive therapy (ECT, “shock treatment”). Many people believe this has not been used since the 1970s but it is still widely used. The Royal Australian and New Zealand College of Psychiatrists says that ECT is “…a useful and essential treatment option…” In 2013-14 in Queensland, 16,602 episodes of ECT were administered (oddly enough, the figures do not show numbers of patients). In 2014-15, this jumped to 19,365 [5]. Does the rate of depression jump 20% in one year? I doubt it. Since it’s more than were administered by the British National Health Service, I suggest something else is going on, and that something is money. A psychiatrist can easily do four per hour, at up to $150 a pop, for absolutely no intellectual effort whatsover.
But there is something more ominous in the use of ECT. Under various state mental health acts, ECT can be given against a person’s wishes if he “unreasonably refuses it.” Since I have practiced psychiatry for 40 years, in a wide variety of pretty tough settings, without using it, I would say that any refusal is reasonable. However, it is for the individual clinician to decide whether the detained person gets it, so you might expect that psychiatrists can define “unreasonable” refusal. They can’t.
If they decide the patient will get it, that’s it. A voluntary patient who refuses ECT will very quickly find himself detained. If he appeals to the mental health tribunal, the appeal will fail. The psychiatrist sitting on the tribunal will have long used ECT and will see it as “a useful and essential treatment” which cannot reasonably be refused. Moreover, all junior psychiatrists who apply to join a mental health service are required to be proficient in giving ECT, but they are not required to to be able to practice psychiatry without using ECT. This asymmetry is not seen as requiring explanation.
A psychiatrist who uses ECT is only saying that he can’t get the patient better any other way, i.e. he has reached the limit of his skill set. The claim that ECT is “essential” is factually wrong, and all talk of “reasonable” use of ECT is simply a cover for incompetence. The whole thing is pure bullshit.
Let’s look again at detention. Some years ago, I advised the Chief Psychiatrist of Queensland [Australia] that many people detained in security facilities, at a cost of about $1500 per day, weare not being actively treated and would not be detained in other states. I gave him several examples where perfectly harmless people had been detained for years, at costs ranging up to $4.5million each, yet showed no signs of aggression. Some were even allowed to come and go as they pleased. Nothing came of this; I presume the respective ministers were told (actually by the psychiatrists who authorised the detentions) that I didn’t know what I was talking about.
However, we now have the situation where detention is under intense scrutiny. The publicity surrounding Don Dale Youth Detention Centre in Darwin, and of Australia’s concentration camps on Nauru and Manus Island, has attracted psychiatric comment. Entirely trustworthy psychiatrists have argued that detention in itself is highly undesirable. They are free to argue as citizens that it is abhorrent and we should no more practice it than corporal punishment but, as psychiatrists, they go further. They argue that it is damaging to the person’s mental health, especially where the person has broken no laws.
If that is so, then they need to explain why the profession of psychiatry is far and away the major player in involuntary detention of people who have broken no laws. People are detained for decades and submitted to the repeated indignity of being held down and jabbed with very unpleasant and/or dangerous drugs, yet this is done in the name of “treatment.” Evil is as evil does: somehow, good intentions in mental hospitals seem to negate the adverse effects of detention in other settings. In philosophy, that is called Having your cake and eating it too.
Psychiatrists will often say that their treatment is sanctioned by something called the biopsychosocial model. A search of PubMed shows nearly 1600 publications on the topic since 2002, an impressive tally. However, there is a slight problem: it doesn’t exist. Nearly twenty years ago, I showed that it had never been written, that the whole thing is a charade, an illusion [6], but this doesn’t deter anybody. Psychiatrists routinely invoke the biopsychosocial model to justify their actions. Are they simply dishonest, carefully inserting a falsehood in a discourse to avoid the consequences of having that point occupied by the truth, or are they lazily allowing themselves to be taken in by their own inventions? Anybody who states the biopsychosocial model is a reality is not stating a truth, but I believe most of its supporters haven’t bothered to check the truth, they are just trying to create an impression. That is, they are bullshitting their audience.
My views are not popular with my psychiatric colleagues. I am seen as taking an extreme position but somebody has to occupy the extreme otherwise there would be no progress. Somebody has to criticise the institution of psychiatry because, rest assured, there is no institutional self-criticism. The profession has surrounded itself with walls of bullshit within which criticism is suppressed in the pursuit of an unproven concept of mental disorder. As Daniel Kahneman noted: “We know that people can maintain an unshakable faith in any proposition, however absurd, when they are sustained by a community of like-minded believers” [7]. To the great detriment of the community, that is exactly the position in which modern psychiatry finds itself.
References:
1. McLaren N (2016). Psychiatry as Bullshit. Ethical Human Psychology and Psychiatry 18: 48-57.
2. McLaren N 2013 Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.
3. Critique of Thomas Szasz. Chaps 12-13 in McLaren N 2012. The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press.
4. Frankfurt H (1986). On Bullshit. Raritan Quarterly Review 6, No. 2 (Fall 1986).
5. Qld Dept of Health RTI #3273, ECT Procedures in Qld Hospitals (September 12, 2016).
6. McLaren N. A critical review of the biopsychosocial model. Australian and New Zealand Journal of Psychiatry 1998: 32; 86-92.
7. Kahneman D (2011). Thinking fast and slow. New York: Allan Lane
From The Australian Independent Media Network @ http://theaimn.com/psychiatry-as-bullshit/
[size=32]'What About Tutoring Instead of Pills?'[/size]
Photos DPAHarvard psychologist Jerome Kagan is one of the world's leading experts in child development. In a SPIEGEL interview, he offers a scathing critique of the mental-health establishment and pharmaceutical companies, accusing them of incorrectly classifying millions as mentally ill out of self-interest and greed.
Jerome Kagan can look back on a brilliant career as a researcher in psychology. Still, when he contemplates his field today, he is overcome with melancholy and unease. He compares it with a wonderful antique wooden chest: Once, as a student, he had taken it upon himself to restore the chest with his colleagues.
He took one of its drawers home himself and spent his entire professional life whittling, shaping and sanding it. Finally, he wanted to return the drawer to the chest, only to realize that the piece of furniture had rotted in the meantime.
If anyone has the professional expertise and moral authority to compare psychology to a rotten piece of furniture, it is Kagan. A ranking of the 100 most eminent psychologists of the 20th century published by a group of US academics in 2002 put Kagan in 22nd place, even above Carl Jung (23rd), the founder of analytical psychology, and Ivan Pavlov (24th), who discovered the reflex bearing his name.
Kagan has been studying developmental psychology at Harvard University for his entire professional career. He has spent decades observing how babies and small children grow, measuring them, testing their reactions and, later, once they've learned to speak, questioning them over and over again. For him, the major questions are: How does personality emerge? What traits are we born with, and which ones develop over time? What determines whether someone will be happy or mentally ill over the course of his or her life?
In his research, Kagan has determined that how we are shaped in our early childhood is not as irreversible as has long been assumed. He says that even children who suffer from massive privations in the first months of life can develop normally as long as they are later raised in a more favorable environment. Likewise, he has studied how people become human in a certain programmatic way in the second year of life: Their vocabulary suddenly grows in leaps and bounds, and they develop a sense of empathy, a moral sensibility and an awareness of the self.
But Kagan's most significant contribution to developmental research has come through his examination of innate temperaments. As early as four months old, he has found, some 20 percent of all babies already have skittish reactions to new situations, objects and individuals. He calls these babies "high reactives" and says they tend to develop into anxious children and adults. Forty percent of babies, or what he calls the "low reactives," behave in the opposite manner: They are relaxed, easy to care for and curious. In later life, they are also not so easily ruffled.
Kagan could have reacted to his finding in a "low-reactive" way by kicking back and letting subsequent generations of researchers marvel at his findings. Instead, he has attacked his own profession in his recently published book "Psychology's Ghost: The Crisis in the Profession and the Way Back." In it, he warns that this crisis has had disastrous consequences for millions of people who have been incorrectly diagnosed as suffering from mental illness.
SPIEGEL: Professor Kagan, you've been studying the development of children for more than 50 years. During this period, has their mental health gotten better or worse?
Kagan: Let's say it has changed. Particularly in poorer families, among immigrants and minorities, mental health issues have increased. Objectively speaking, adolescents in these groups have more opportunities today than they did 50 years ago, but they are still anxious and frustrated because inequality in society has increased. The number of diagnosed cases of attention-deficit disorders and depression has increased among the poor…
SPIEGEL: … you could also say skyrocketed. In the 1960s, mental disorders were virtually unknown among children. Today, official sources claim that one child in eight in the United States is mentally ill.
Kagan: That's true, but it is primarily due to fuzzy diagnostic practices. Let's go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). That's why the numbers have soared.
SPIEGEL: Experts speak of 5.4 million American children who display the symptoms typical of ADHD. Are you saying that this mental disorder is just an invention?
Kagan: That's correct; it is an invention. Every child who's not doing well in school is sent to see a pediatrician, and the pediatrician says: "It's ADHD; here's Ritalin." In fact, 90 percent of these 5.4 million kids don't have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they'll make the corresponding diagnosis.
SPIEGEL: So the alleged health crisis among children is actually nothing but a bugaboo?
Kagan: We could get philosophical and ask ourselves: "What does mental illness mean?" If you do interviews with children and adolescents aged 12 to 19, then 40 percent can be categorized as anxious or depressed. But if you take a closer look and ask how many of them are seriously impaired by this, the number shrinks to 8 percent. Describing every child who is depressed or anxious as being mentally ill is ridiculous. Adolescents are anxious, that's normal. They don't know what college to go to. Their boyfriend or girlfriend just stood them up. Being sad or anxious is just as much a part of life as anger or sexual frustration.
SPIEGEL: What does it mean if millions of American children are wrongly being declared mentally ill?
Kagan: Well, most of all, it means more money for the pharmaceutical industry and more money for psychiatrists and people doing research.
SPIEGEL: And what does it mean for the children concerned?
Kagan: For them, it is a sign that something is wrong with them -- and that can be debilitating. I'm not the only psychologist to say this. But we're up against an enormously powerful alliance: pharmaceutical companies that are making billions, and a profession that is self-interested.
SPIEGEL: You once wrote that you yourself often suffered from inner restlessness as a child. If you were born again in the present era, would you belong to the 13 percent of all children who are said to be mentally ill?
Kagan: Probably. When I was five, I started stuttering. But my mother said: "There's nothing wrong with you. Your mind is working faster than your tongue." And I thought: "Gee, that's great, I'm only stuttering because I'm so smart."
SPIEGEL: In addition to ADHD, a second epidemic is rampant among children: depression. In 1987, one in 400 American adolescents was treated with anti-depressants; by 2002, it was already one on 40. Starting at what age is it possible to speak of depression in children?
Kagan: That's not an easy question to answer. In adults, depression either implies a serious loss, a sense of guilt or a feeling that you are unable to achieve a goal that you really wanted to reach. Infants are obviously not yet capable of these emotions. But, after the age of three or four, a child can develop something like a feeling of guilt, and if it loses its mother at that age, it will be sad for a while. So, from then on, mild depression can occur. But the feeling of not being able to achieve a vital goal in life and seeing no alternative only starts becoming important from puberty on. And that is also the age at which the incidence of depression increases dramatically.
SPIEGEL: The fact is that younger children are also increasingly being treated with antidepressants.
Kagan: Yes, simply because the pills are available.
SPIEGEL: So would you completely abolish the diagnosis of depression among children?
Kagan: No, I wouldn't go as far as that. But if a mother sees a doctor with her young daughter and says the girl used to be much more cheerful, the doctor should first of all find out what the problem is. He should see the girl on her own, perhaps carry out a few tests before prescribing drugs (and) certainly order an EEG. From studies, we know that people with greater activity in the right frontal lobe respond poorly to antidepressants.
SPIEGEL: Should one just wait to see whether depression will go away by itself?
Kagan: That depends on the circumstances. Take my own case: About 35 years ago, I was working on a book summarizing a major research project. I wanted to say something truly important, but I wasn't being very successful. So I went into a textbook-type depression. I was unable to sleep, and I met all the other clinical criteria, too. But I knew what the cause was, so I didn't see a psychiatrist. And what do you know? Six months later, the depression had gone.
SPIEGEL: In a case like that, does it even make sense to speak of mental illness?
Kagan: Psychiatrists would say I was mentally ill. But what had happened? I had set myself a standard that was too high and failed to meet that standard. So I did what most people would do in this situation: I went into a depression for a while. Most depressions like that blow over. But there are also people with a genetic vulnerability to depression in whom the symptoms do not pass by themselves. These people are chronically depressed; they are mentally ill. So it is important to look not just at the symptoms, but also at the causes. Psychiatry is the only medical profession in which the illnesses are only based on symptoms …
SPIEGEL: … and it seems to discover more and more new disorders in the process. Bipolar disorders, for example, virtually never used to occur among children. Today, almost a million Americans under the age of 19 are said to suffer from it.
Kagan: We seem to have passed the cusp of that wave. A group of doctors at Massachusetts General Hospital just started calling kids who had temper tantrums bipolar. They shouldn't have done that. But the drug companies loved it because drugs against bipolar disorders are expensive. That's how the trend was started. It's a little like in the 15th century, when people started thinking someone could be possessed by the devil or hexed by a witch.
SPIEGEL: Are you comparing modern psychiatry to fighting witches' hexes in the Middle Ages?
Kagan: Doctors are making mistakes all the time -- despite their best intentions. They are not evil; they are fallible. Take Egas Moniz, who cut the frontal lobes of schizophrenics because he thought that would cure them …
SPIEGEL: ... and received a Nobel Prize for it in 1949.
Kagan: Yes, indeed. Within a few years, thousands of schizophrenics had their frontal lobes cut -- until it turned out that it was a terrible mistake. If you think of all the people who had their frontal lobes cut, being called bipolar is comparatively harmless.
SPIEGEL: It's not entirely harmless either, though. After all, children with this diagnosis are being subjected to a systematic change in their brain chemistry through psychoactive substances.
Kagan: I share your unhappiness. But that is the history of humanity: Those in authority believe they're doing the right thing, and they harm those who have no power.
SPIEGEL: That sounds very cynical. Are there any alternatives to giving psychoactive drugs to children with behavioral abnormalities?
Kagan: Certainly. Tutoring, for example. Who's being diagnosed with ADHD? Children who aren't doing well in school. It never happens to children who are doing well in school. So what about tutoring instead of pills?
SPIEGEL: Listening to you, one might get the impression that mental illnesses are simply an invention of the pharmaceutical industry.
Kagan: No, that would be a crazy assertion. Of course there are people who suffer from schizophrenia, who hear their great-grandfather's voice, for example, or who believe the Russians are shooting laser beams into their eyes. These are mentally ill people who need help. A person who buys two cars in a single day and the next day is unable to get out of bed has a bipolar disorder. And someone who cannot eat a bite in a restaurant because strangers could be watching them has a social phobia. There are people who, either for prenatal or inherited reasons, have serious vulnerabilities in their central nervous system that predispose them to schizophrenia, bipolar disease, social anxiety or obsessive-compulsive disorders. We should distinguish these people from all the others who are anxious or depressed because of poverty, rejection, loss or failure. The symptoms may look similar, but the causes are completely different.
SPIEGEL: But how are you going to distinguish between them in a concrete case?
Kagan: Psychiatrists should begin to make diagnoses the way other doctors do: They should ask what the causes are.
SPIEGEL: The problems you describe are not new. Why do you believe psychiatry is in a crisis at this specific time?
Kagan: It's a matter of the degree. Epidemiological studies are saying that one person in four is mentally ill. The Centers for Disease Control and Prevention in Atlanta recently announced that one in 88 American children has autism. That's absurd. It means that psychiatrists are calling any child who is socially awkward autistic. If you claim that anyone who can't walk a mile in 10 minutes has a serious locomotor disability, then you will trigger an epidemic of serious locomotor disabilities among older people. It may sound funny, but that's exactly what's going on in psychiatry today.
SPIEGEL: Do you sometimes feel ashamed of belonging to a profession that you think wrongly declares large parts of society to be mentally ill?
Kagan: I feel sad, not ashamed … but maybe a little ashamed, too.
SPIEGEL: Over 60 years ago, when you decided to become a psychologist, you wanted "to improve social conditions so that fewer people might experience the shame of school failure … and the psychic pain of depression," as you once put it. How far did you get?
Kagan: Not very far, unfortunately, because I had the wrong idea. I thought family circumstances were crucial to being successful in life. I thought that, if we could help parents do a better job, we could solve all these problems. That's why I chose to be a child psychologist. I didn't recognize the bigger forces: culture, social standing, but also neurobiology. I really thought that everything was decided in the family, and that biology was irrelevant.
SPIEGEL: Over time, you've come to realize that the bond between a mother and her child is not so important after all.
Kagan: That's right, though one must remember that the mother's role was not emphasized until quite recently. Sixteenth-century commentators even wrote that mothers were not suited to looking after children: too emotional, overprotective. But when the bourgeoisie increased in the 19th century, women didn't have to go out and work anymore. They had a lot of time on their hands. So society gave them an assignment and said: "You are now the sculptress of this child." At the same time, middle-class children didn't have to contribute to their family the way peasants' children did. They were not needed and therefore ran the risk of feeling worthless. But when a child doesn't feel needed, it needs another sign. So love suddenly became important. And who gives love? Women. Eventually, John Bowlby came along and romanticized maternal attachment.
SPIEGEL: Bowlby, the British psychiatrist, was one of the fathers of attachment theory. Do you consider his hypotheses to be wrong?
Kagan: People wanted simple answers, and they longed for a gentler conception of humanity, especially after the horrors of World War II. This fit the idea that only children who are able to trust their mothers from birth are able to lead a happy life.
SPIEGEL: Anxieties over whether raising children in day care centers could harm them persist to this day.
Kagan: Unfortunately, even though we already disproved this in the 1970s. Nixon was president at the time, and Congress was toying with the idea of national day care centers. Along with two colleagues, I got a big grant to study the effect of day care on a group of infants. The children in the control group were looked after at home by their mothers. At the end of 30 months, we found that there was no difference between the two groups. Nonetheless, to this day, 40 years later, people are still claiming that day care centers are bad for children. In 2012.
SPIEGEL: Professor Kagan, we thank you for this conversation.
Interview conducted by Johann Grolle and Samiha Shafy
From Spiegel Online @ http://www.spiegel.de/international/world/child-psychologist-jerome-kagan-on-overprescibing-drugs-to-children-a-847500.html and http://www.spiegel.de/international/world/child-psychologist-jerome-kagan-on-overprescibing-drugs-to-children-a-847500-2.html
Thanks to: http://nexusilluminati.blogspot.com
