Administrator

Mind/Body Argument: Stop It, Just Stop It!

If you are not sick and tired of the question, “Is MADNESS a neurological disease of the brain or is it a mythological disease of the mind?” you should be! I defy you to have a thought without your body or to work your body without a brain. There is no mind/body split. And the countless scholarly papers regaling us with the proofs of how schizophrenia is a disease of the brain and not the mind or that schizophrenia is a disorder of the mind and not the body (remember, the brain is part of the body), well, to my mind they are all for naught.

Some historical perspective: There is a 1924 paper in the American Journal of Psychiatry, authored by the then prominent pathologist, Charles B. Dunlap, M.D., entitled, “Dementia Praecox. Some Preliminary Observations from Carefully Selected Cases, and a Consideration of Certain Sources of Error”. I reviewed this paper because one of my favorite mentors, Harry Stack Sullivan, who died in 1949 when I was 6 years old, referred to it when making the case that schizophrenia is NOT a brain disease.

Read the very first sentence of the paper: “Too many changes have been described in [autopsy] brains of dementia praecox even to be enumerated in this paper” (p. 403). He continues on page 404: “We have considered control brain [autopsy] material, collected from so-called normal persons [italics mine] without psychoses to be absolutely necessary…. No one knows the limitations of what is normal in the brain anyway…. Nissl [a prominent pathologist] who all his life was searching for a normal brain, died without finding one…”!!

Suffice it to say that Dr. Dunlap was not able to find any consistent gross or microscopic (cell counts & cellular pathology - pain staking work) abnormalities in these schizophrenic brains to warrant "an organic [my italics] basis for dementia praecox.” Thus, H.S. Sullivan was satisfied he was not dealing with neurological issues in his schizophrenic patients.

What interested me even more, though, was what was said in the discussion of the paper by other prominent physicians including Dr. William Alanson White, a pioneer of 20th century psychiatry and the director of St. Elizabeth’s Hospital (where I currently supervise residents). By the way, White was also a mentor to H.S. Sullivan.

Anyway, White points out that there was so much wrong with these patients whose brains Dunlap studied, that “… a pathological explanation of the mental disease [need not] be found in the [cerebral] cortex.” There were “defects of organs, thyroid, gonads, and adrenals and the circulatory system…that we would not expect the individual to be able to function efficiently, at least under stress.” Don’t you love that phrase “function efficiently”? In other words Dr White is beginning to suggest what I am more emphatically proclaiming, that schizophrenia, madness, is a “disease” of the PERSON, not the brain and not the mind.

Fast forward 78 years and E. Fuller Torrey in his “Studies of Individuals with Schizophrenia Never Treated with Antipsychotic Medication: A Review”, in Schizophrenia Research, Vol 58, pp. 101-115. Torrey wants to take on Breggin’s and Whitaker’s and others’ arguments that the brain pathology in people diagnosed with schizophrenia is all iatrogenic. He concludes: “…schizophrenia is a brain disease in the same sense that Parkinson’s disease and multiple sclerosis are….”

But wait, two other observations in his paper: “…psychiatrically normal individuals also [may] have structural changes in their brains” (p. 102) and on page 111, “It should be emphasized, however, that there is no single abnormality in brain structure or function that is pathognomonic for schizophrenia.” Torrey is an honorable man, I think. But he too is stuck in an either/or world of mind or body. None of the papers he reviews take up the challenge of examining the whole person, physiologically, psychologically, spiritually, and sociologically.

I say let’s be forgiving though, for indeed that is no simple task. We human creatures are so complex as are our ape relatives and other mammalian creatures. It is the role of the psychiatrist, ideally, to take on this task with each individual he treats. Few of us do that, I fear. The system is just not cut out that way yet. If we are to “save psychiatry” there has to be a change in medicine as a whole not just psychiatry. You might want to read Jim Gordon’s A Manifesto For A New Medicine. He takes on this dilemma. More to come.

ADHD Causes Car Accidents?

6/14/2017        In the News 1 Comment

by Chuck Ruby, Ph.D.


The results of a study, published in JAMA Pediatrics, claims that ADHD causes an increased risk of automobile crashes. I'll explain why this is a trivial conclusion. What's more, it is absurd that the authors suggest more research into “the specific mechanisms by which ADHD influences crash risk to develop effective countermeasures.” ADHD is not a disorder that causes anything. ADHD is a label that describes a constellation of behaviors. To say it is a disorder that causes an increased risk of crashes is like saying walking is a disorder that causes an increased risk of moving.

If we look at the definition of ADHD contained in the DSM, we find that it consists of an arbitrary checklist of items about not paying attention and not inhibiting impulses. It has nothing to do with brain dysfunction. There are no laboratory tests to detect it. It has nothing to do with pathology in the person. It describes people who do not pay attention, not people who can’t. It is written in the language of medicine and to the untrained eye, it seems to be talking about a brain disorder, when in fact there is nothing mentioned about the supposed disorder and no medical evidence ever presented that demonstrates its pathological basis, and thus why there is no lab test for it.

And yet the announcement of this study will worry parents of children who have been labeled with this mythical disorder. They will fear when their children start to drive and wonder if driving privileges should be contingent on their children being in psychiatric “treatment” consisting of daily stimulant drug doses. The already bloated departments of motor vehicles across the country might even see this and similar studies as reason to implement new rules and programs about monitoring or denying driver’s licenses to people “with ADHD”.

But if we brush away all the medical-sounding and misleading language, we are left with a trivial study. In short, its results are saying that people who don’t pay attention while driving are at increased risk of having accidents. Aren’t we already able to make that assumption? When we don’t pay attention, we don’t notice things. It doesn’t take a scientific study to tell us this. And it doesn't need the creation of a disorder.

In addition, there are basic statistical issues with this study that further trivialize it. When comparing the driving records of people “with ADHD” and people who have not been given that diagnosis, the study concluded, “…the crash hazard among newly licensed drivers with ADHD was 36% higher.” In the first place, this is inaccurate. The wording makes it sound that people “with ADHD” are more dangerous on the road than people without that diagnosis. But the statistics used in studies like this one are based on group averages, not individuals. In this study, the average number of accidents for the group of ADHD people was claimed to be 36% higher than the average number of accidents in the non-ADHD group. Graphically, this would look something like the following display of two normally distributed (bell curved) groups. The horizontal axis represents the number of accidents and the height of the curve is the number of people with that number of accidents. The dark group would be the people without a diagnosis of ADHD and the lighter color group would be those “with ADHD”.

 

One can easily see with this graphical representation that even though the average (indicated by the vertical line) number of accidents of the ADHD group is higher than the non-ADHD group, many people in the ADHD group have less accidents than many people in the non-ADHD group. The reverse is also true: many people in the non-ADHD group have more accidents than people in the ADHD group. The reason the researchers say there is a 36% increased crash hazard among ADHD drivers is only because the average number of crashes is higher than the average number of crashes for the non-ADHD group. Still there a many ADHD people with less accidents than people with no diagnosis.

This is because the 36% increased risk of accidents is minimal. As an example, ADHD males in this study had a 13% risk of having an accident within 6 months after getting their driver's license. On the other hand, non-ADHD males only had a 9% risk. Even though this is only a 4% absolute difference in risk, the relative difference is a 44% increased risk when compared to non-ADHD males. Using the relative difference in risk makes it sound more important than it really is.

As an aside, it is interesting to note that the researchers had the diligence to test whether stimulants prescribed to the ADHD people had any effect on accident risk. One might think that taking a daily dose of Ritalin, which is chemically similar to cocaine, could negatively affect driving skill. But, the researchers found that it didn’t. But this begs the question, then, of what value are the stimulants? If those ADHD people who were prescribed stimulants had the same accident risk as those who hadn’t been prescribed stimulants, but who were still diagnosed with ADHD, that suggests the conventional stimulant drug treatment is useless in increasing attention and, in this study, in reducing accident risk. This is not good news for the advocates of drug treatment.

In short, this study is trivial because it is saying that people who don't pay attention while driving are at a higher risk of having accidents. This is a "duh!" conclusion. Nonetheless, the authors mislead away from this simple fact of life and give the impression that a disorder called ADHD causes those accidents. Recommending further study to identify the "specific mechanisms by which ADHD influences crash risk" is absurd. It is absurd because there are no mechanisms of ADHD. It is tantamount to saying we want to find the specific mechanisms of inattention. What would those be? Inattention is inattention and it can be problematic. But even worse, the authors talk about developing "countermeasures" to this inattention. Those so-called countermeasures are very likely going to be just further authoritarian and inhumane attempts at control, not because they would be focused on reducing accidents, but because they would be focused on "treating" a mythical disorder.

Psychiatry, Medicine, and the Commonweal

Let me introduce myself and my blog.

I am a physician, first and foremost. Ironic though, when I first decided to become a doctor, at age 19, it was “psychiatrist” that I told myself was the goal, not simply physician. And throughout my training I oscillated between medicine and psychiatry. Intrigued by psychosomatic medicine yet hounded by my mentors, “Joe, you have to decide! Medicine or psychiatry.” Little did I realize at the time that this quandary, physical OR psychological, would become the hallmark of psychiatry’s split-personality: mental illness, a disease of the brain; no, mental illness a mental/social problem-of-living construct. And the debate has been belabored for millennia. Throughout this blog I will favor the concept that ALL ILLNESS IS PSYCHOSOMATIC/SOMATOPSYCHIC. There is no mind-body split.
In future blogs I will address what motivates one to become a physician but here just a few ethical reminders associated with the Hippocratic Oath:

(1) Primum Non Nocere (First Not To Harm)

(2) Keep confidential what the patient tells you, and

(3) Never promise more than you can deliver

I made #3 up but it is implied in the oath to honesty. Alright, it was not exactly how Hippocrates said it. In fact, the first do-no-harmer was a Frenchman, Auguste Francois Chomel (1788-1858) in his oral teaching to students. Then as now, I think, the debate centered on natural healing vs. radical intervention.

So, I want to SAVE psychiatry. Really? Psychiatry seems to be thriving without my help. Well over 10,000 psychiatrists attend their yearly conference, the American Psychiatric Association. No, I say “save” because I belong to ISEPP, I have contributed to Mad in America, I support Mind Freedom, and other similar organizations. In all of these and others there are folk who would like to disband psychiatry all together.

“No,” I say, if we rid ourselves of Psychiatry: WHO WILL MIND THE MAD HOUSE? WHO WILL MIND THE PHYSICIANS?

I liken this Anti-Psychiatry movement ushered in by the likes of Tom Szasz and Ronald D. Laing to the Anti-War movement of the 60’sand 70’s. But first I must clarify, Szasz would be livid to be placed in the same category as R D Laing. He saw Laing as an irresponsible “trickster” and miscreant. In fact he wrote a book about it:”Antipsychiatry: Quakery Squared” published in 2009. Szasz makes the case that Laing and others abandoned liberty, responsible science, and ethical social commentary. “Anti psychiatry” was merely a catch phrase for Laing and his followers, Szasz believed, in an attempt to appear like authentic critics of the status quo.

But back to the Vietnam war: We who were against the war were told to “Love It (i.e., the USA) or Leave It!” Most of us knew we were patriots but patriotic to the ideas of liberty, justice, and international peace. We knew the war was a horrible mistake, immoral, foolish, and ultimately self defeating. We opposed the war policy, not our country. We paid a heavy cost for that military adventure: 56,000 Americans dead, over a million Vietnamese dead. Laos suffered the worst per capita dead ever in the history of war! As you probably know given the front page publicity, the suicide rate of veterans is 2-4 times the civilian rate. More soldiers have been dying from suicide than in combat. And most of these suicides are Vietnam vets. Yes, 40 years after the fact of that foolish war, the moral, spiritual and psychological ill effects still haunt us. Some commentators believe, and I agree, that the moral injury of our current 14-year (and counting) middle east war(s) will be worse.

In my next blog rendition I will be asking the question “Are you really anti psychiatry?”—IF THIS IS AN EMERGENCY GO TO YOUR LOCAL EMERGENCY WARD. Hmmm.

The Latest In A Long Line of Bogeymen?

5/22/2017        In the News 5 Comments

by Chuck Ruby, Ph.D.


A recent article in Health News From NPR asks the question: "Is 'Internet Addiction' Real?" Other than the possible minimizing effects of using quotes around the term, this article does nothing but reify a concept in a very misleading and potentially dangerous way. It adds to a long line of others that perpetuate the myth of mental illness, and in particular the recent technological phenomenon of social media over the Internet.

This article is an example of how mental health professionals are notorious for over-complicating human behavior. Instead of focusing on real life problems teens face in an increasingly compliance oriented and superficial world, they obsesses about what is the correct “disorder”. Then the “disorder” is the focus of investigation instead; meaning that something is wrong with the teen. To quote the DSM, it is “…a dysfunction in the individual.” It is the dysfunction “in” that causes the behavior. And this leads to meaningless questions as posed in the article, like “when does an obsession become an addiction?” Would it be better to think of these professionals having a “diagnosis addiction”?

In actuality, there is no dysfunction “in the individual”. There is a challenge over how, when, why, and to what extent technology is used and what things are considered popular and of value to teens. Internet and other IT technology is going to stay with us and probably get even more complex. My great grandmother told me how terrible the invention of the telephone was. Up until then people would write letters to each other. After the telephone, she feared they wouldn't write to each other anymore. Instead, they would become impersonal and spend too much time on the telephone. Her fears panned out. But was that an addiction at work?

Much of the description of Naomi’s behavior in this article is attributed to her “addiction” to the internet. But it actually just describes typical teen turmoil in their attempts to navigate that line between separation and belonging. But once a scapegoat like “addiction” is identified all sorts of problems can be attributed to it. The article actually points this out when it notes she also had to deal with how to become popular among her peers, how to cope with her parents’ discord, how to handle less then perfect academic performance, and how to cope with the death of her grandmother. These are all quite typical challenges of adolescence.

The overall flavor of this article reminds me of the alarmist quality of “Reefer Madness”, a 1930’s film that demonized marijuana, and implied that it led to all sorts of antisocial and dangerous behaviors. The psychologist at her $10,000 a week “treatment” facility said, “these teens are using smartphones and tablets…for the same reasons others turn to hard drugs - to numb what is really going on inside.” Really? Is that what doctors in the 1800’s would have said about my great grandmother’s prediction about telephone use?

The problems facing teens are significant and they can be very serious. But it is not because they “have” and “addiction” to anything. It is because they are faced with the most difficult set of social circumstances any teenagers throughout history have had to face before now. They struggle with the means of instantaneous gratification, the ever-increasing demand of consumerism, the age-old longing to belong, and how to meet parental expectations.

The term “addiction” is merely short hand for “a strong urge to do something because that something is enjoyable in the short term, but causes problems in the long term.” There is no need to reify it as if it is an entity that invades people and causes them to do things. In fact, it could easily be argued that talking about it and treating it as if it were some alien entity calling the shots is harmful and perpetuates the problem.

ADHD? A Food Deficit?

5/17/2017        In the News 1 Comment

by Elizabeth Szlek, LMHC, CGP


On April 9, 2017, an article appeared on the website, “The New American”. The writer, Joe Wolverton II, J.D., tells the story of a seven-year-old boy who was taken away from his family by Child Protective Services because his school decided he was “mentally unstable”. The parents of Cameron Maple, of Lebanon, Ohio, were instructed to take him to a hospital so that his disorder could be diagnosed. When the parents demurred, the state stepped in and placed the child in protective custody, citing “health neglect” against the parents, since they would not comply with the psychological evaluation recommended by the school administration.

This situation is wrong on many levels. There is no such thing as “ADHD” as a literal neurobiological disease that can be diagnosed and treated. With this in mind, it is regrettable this child was ripped from his parents’ home because a nonexistent “ADHD” was suspected. I think that something else could be going on. There could be a real bodily dysfunction that is being overlooked in many of these unfortunate children who are being labeled “mentally ill”. They could simply be malnourished.

There are many books out there written on the topic of “ADHD”, but as a Nutritional Therapy Practitioner and a Gut and Psychology Syndrome (GAPS) Practitioner, I have a different take on a possible answer to the question, “What is ADHD?” We know that a child’s brain requires nutrient-dense foods for proper development. This means things like eggs, cod liver oil or other fish oils, butter, liver, beef, lard, and a host of other fatty foods. The brain, of course, is largely made up of fats. When the proper fats are lacking or deficient, the brain does not function properly. We would say the child is malnourished.

How does a child with these nutritional deficiencies behave? They are not able to manage their behavior very well, and are apt to appear fidgety and unfocused. They lack the self-control they need to fit into social situations, like school, effectively. They have trouble controlling their moods, as well, and often seem inappropriate in their responses to the environment.

Children who are properly nourished, are much more able to control their behavior, to stay on task, and they suffer less from negative moods, like anxiety and anger. Their bodies can create the neurotransmitters their brain needs to calm themselves down and be happy, because they are eating the proper amino acids and other micronutrients their bodies need to do so.

A study done in Norway in 2013 showed that children who ate a diet largely consisting of processed sugary foods, and lots of starches like bread and buns, pizza and the like, were far more apt to exhibit either internalizing behaviors like worry, sadness and anxiety or externalizing behaviors like tantrums, hyperactivity and aggression.

On the other hand, children who ate lots of cheese, fish, vegetables and eggs showed fewer such symptoms. The point is, a child’s diet affects behavior and moods, either for good or ill, and diet is an important factor in this.

Another thought is that when a child develops his or her own diet, choosing starchy and sugary foods over anything else, it is likely that they are suffering from small intestinal bacterial overgrowth (SIBO). We know that if candida albicans, a fungus/yeast, takes over the small intestine, it is capable of sending messages to the brain instructing the person to eat more sugar and starch, its favored foods.

Thus, you have children who will preferentially eat these foods, to the exclusion of the healthier vegetables, meats, eggs, yogurt and other raw and fermented foods. This becomes a vicious cycle, eating the wrong foods, and being reinforced from the gut to continue to do so. Many parents despair of ever seeing their children take a bite of a vegetable. This is gut dysfunction, and when this situation continues for too long, intestinal permeability, or “leaky gut” appears. Toxins, produced by bacteria, or other toxic wastes, can leak into the bloodstream, and past the blood-brain barrier and into the brain, causing disordered thinking.

If some of you recall, ADD or ADHD used to be called “Minimal Brain Dysfunction”. It would be wonderful to get back to that concept, and apply the cure: Proper nutrition and healing the gut. Then, we could look forward to complete remission of that real dysfunction!

Elizabeth Szlek is the Director of The Door Counseling Center of Yorkville, NY. She is a Licensed Mental Health Counselor, a Nutritional Therapy Practitioner and a Certified GAPS Practitioner. She can be reached at (315) 768-8900 or at door@thedoorcounselingcenter.com.

I Am A Warfighter

4/19/2017        ISEPP In Action 3 Comments

Watch this wonderful video that says it all about the purpose of The Warfighter Advance non-drug, non-clinical, non-pathology program for responding to those veterans and military members who have been traumatized. Remember, The Advance is run by ISEPP's Mary Vieten, Ph.D., ABPP, along with other ISEPP members, and ISEPP is it's fiscal sponsor while they wait out the process of becoming their own non-profit organization.

Volunteers in Psychotherapy

4/13/2017        ISEPP In Action 0 Comments

ISEPP's Richard Shulman was recently interviewed by a local CBS affiliate Eyewitness News about his innovative Volunteers In Psychotherapy (VIP). Take a look!

Richard's program offers psychotherapy to clients who earn it by volunteering elsewhere, privately and independently, for the charity of their choice. This is a valuable service for people who either cannot afford therapy or wish to maintain complete privacy and avoid going through managed care organizations.

You can also visit VIP's Facebook page. Do them a favor by "Liking" or especially by positively "Reviewing" them. This will help them by bringing their charitable and decidedly non-medical psychotherapy service to the attention of lots of people who might use their service and give hope to people who want non-medical assistance with their difficulties.

Here Comes Julia!

4/5/2017        In the News 0 Comments

by Randy Cima, Ph.D.


A few weeks ago on 60 minutes, Leslie Stahl, my favorite reporter from the show, introduced us to Julia, the newest character on Sesame Street. Julia has autism.

Ms. Stahl interviewed producers and cast members from Sesame Street. She also spoke to parents with autistic children, and others who love them. It was an emotional segment, in a good way. Sesame Street intends to de-stigmatize children with autism, and everyone is proud.

I started watching 60 minutes and Sesame Street in the 1960's. Like most Americans, I learned to love, and trust, both shows. Coincidentally, during the same decade, I first became interested in autism.

Lloyd Nolan, a character actor from the 40’s, 50’,s and 60’s, was on the Johnny Carson show. He spoke of his “strange” 4 year-old son who had something called “autism.” I was captivated as he described in some detail the very odd behaviors of his son, Jay – and I’ve been captivated since.

Fifty years later, autism, Sesame Street, and 60 minutes converged in mid-March, 2017, with one reviewer of the show saying: “Sesame Street’s new Muppet Julia brought 60 Minutes viewers to tears.”

Brought me to tears too. For different reasons.

It’s Not So Easy Being Mean

Dear parents and other caretakers who love and protect and cherish these very unique children, I love them too.

For me, it’s a matter of temperament (See Keirsey’s brief portrait of this temperament in Notes). There is no biology to this, or genetics. These kids aren’t flawed or damaged. They aren’t disabled or disturbed or diseased either. That means they don’t need doctors, or their medicine. They do need our protection, because they are unique, and because they are so terribly misunderstood, and because someone is always trying to fix them. Some of their famous counterparts include Mozart, Spielberg, Cher, and Harpo Marx. There is much more about this, for a different place and time.

For now, parents and caretakers, and others who love these children as I do, please consider the following:

In 1983, the autism rate was 4.3 in 10,000

I know this is accurate. I was 38, in the profession for nearly 10 years, and I was in the final year of my Masters program (I received my Ph.D. about 4 years later). In the next 12 months I researched everything known at the time about autism, beginning with Leo Kanner. My research included Hans Asperger. I also did a year internship as a family therapist for 6 families with autistic kids (all boys). My Master’s thesis was titled: Autism and Other Self Defiling Phenomena. I was as informed about this very small population as anyone was at the time. Again, the incident rate was 4.3 in 10,000.

Keeping it simple, this means if there were 10,000 children randomly gathered in a large auditorium, we could expect to find 4 or 5 children who fit the description of autism in 1983.

In 2017, the autism rate is 1 in 68

Doing the math, that means the same auditorium with 10,000 randomly gathered children would now have about 150 children who fit the evolving, all inclusive description of autism. That’s an increase of 3500% - in 34 years.

How did that happen?

Is autism contagious? If so, how so? If not, how does it “spread?” Is there a virus or bacteria? Did something drastic happen to our water system in the last 4 decades? In the last 34 years, did the mercury just suddenly appear in the fish these children or their parents ate, that wasn’t there before? Did someone change the formulae for vaccines? Was there some other environmental catastrophe that triggered this incredible spike in the number of diseased children in that auditorium? By the way, these are some – not all – of the speculated “causes” of autism.

I’ve asked medical professionals who should know how this “epidemic” occurred, many, many, many times. They usually duck the question, or provide some form of psychobabble. I’m skilled at recognizing psychobabble.

So, can anyone from medicine explain this “epidemic,” please? Short answer? No. No one can. Long answer? No.

No one can.

So what really happened?

Psychiatry Happened

I’ve been awestruck, and demoralized, as the rate of autism has skyrocketed, without much fanfare. It’s been dramatic.

Take a look:

AUTISM RATE SINCE 1975

1975 – 1 in 5000
1985 – 1 in 2500
1995 – 1 in 500
2001 – 1 in 250
2004 – 1 in 166
2007 – 1 in 150
2009 – 1 in 110
2016 – 1 in 68

(SOURCE: Autism Speaks)

Why the "epidemic?” Because there has been an epidemic of diagnosers, armed with an ever-widening, all-inclusive diagnosis - nothing else.

The Psychiatric Process: Change the Definition

Autism was added to the 1980 edition of DSM III (Diagnostic Statistical Manual). This made it official. Autism became medical. It was called Infantile Autism disorder back then. There were six characteristics listed and each of the six had to be present to be diagnosed. Doctors mostly ignored what was then a very, very rare phenomenon. (See what Leo Kanner had to say about the rarity of autism in Notes)

By 1985, the rate was 1 in 2500.

In 1994, the DSM definition of Autism changed again, significantly. This is when I first became concerned. I knew what was coming. After a forty-year career – the last 25 as director of several mental health facilities for children - I’ve seen psychiatry do this as a matter of course.

Now there were 16 different symptoms, and only six of the 16 were needed to receive the diagnosis. As a result, the universe of diagnosable children grew exponentially. The game was officially rigged. The "epidemic" started.

By 1995, the rate was 1 in 500.

Enter ASD: The Final Solution

In 2013, DSM V was released. The diagnostic criteria for autism included these instructions to all professionals: "Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder (PDD) should be given the diagnosis of autism spectrum disorder."

There you have it. They "lumped" together all the symptoms of Asperger’s and PDD with "autism," and the population's diagnostic horizon multiplied - again. Now, any child who is a little too quiet, a little too distracted, a little too defiant, a little too introverted, can be on the “spectrum.” Also, because he can speak, doesn’t mean he isn’t on the “spectrum.”

By 2016, the rate is 1 in 68.

The Rest Is Easy for Psychiatry

Psychiatric scientists will argue for years, in the right journals, with academic vigor, about scientific studies that expose the real cause of autism. Is it genetic? There’s some “convincing” evidence. Is it the vaccine? Studies show a “link.”

What about a chemical “imbalance” in the brain? “There’s a correlation,” says the psychiatric scientist. By the way, psychiatry will neither offer, nor promise any cures. There’s a good reason for this. Psychiatry has a perfect record in this regard – 0 cures.

Will psychiatry ever find a “cause?” No, they won’t, for two reasons: (1) they never have, for any of the more than 400 disorders in DSM V and, (2) autism isn’t a disease, so a medical cause can never be found.

In the meantime, psychiatry will eagerly “treat the symptoms” with a variety of chemicals. Here’s what they’ve tried so far with these children:

• Adderall
• Ambien
• Anafranil (cloripramine)
• Clomipramine
• Clonazepam
• Desipramine
• Desyrel
• Dexedrine
• Dilantin (phenytoin)
• Dipiperon
• Fenfluramine
• Haldol (haloperidol)
• Imipramine
• Lithium
• Luvox (fluxovamine)
• Melatonin
• Naltrexone
• Periactin
• Piracetam
• Prednisone
• Risperdol (risperidone)
• Ritalin
• SSRI’s
• Tegretol
• Zoloft (sertraline)

Finally, psychiatry will caution all of us routinely, in eye-popping, fear invoking headlines, that the “epidemic” is worsening, again.

This is what the psychiatric medical model has to offer humanity, and it's 2017.

One More Thing to Consider

In 1957, Hollywood released "The Three Faces of Eve.” Based on a true story, the movie is about a young woman with three personalities. Joanne Woodward won an Academy Award for her portrayal of Eve. For a few years afterwards, there was a short-lived “outbreak” of multiple personality disorder reported by psychiatrists in America. A small industry was born, and then faded away. The “outbreak” ended.

If this movie was made in 2007 instead of 1957, there would be multiple personality websites, multiple personality theories, multiple personality medications, a slew of multiple personality books, multiple personality experts, and endless studies among medical professionals searching for the cause that would include genes, brain damage - maybe even vaccines - and a huge epidemic would still be growing. And, as usual, psychiatry would be ready to supply the chemicals, to treat the symptoms, while they look for the ever-elusive cause of multiple personalities.

This is, as far as I'm concerned, the genesis of modern day psychiatric "epidemics."

Like I Said – It’s not so easy being mean

The people at 60 minutes, and the actors and crew at Sesame Street, and the parents and professionals who know these children have unquestioned love and honest and pure intentions. They are assertively protective of these children, and they make sure they are informed.

From my perspective, it is a gut wrenching experience watching this tragedy unfold. I’ve known for forty years – as do many, many others – these kids need good teachers, not doctors. There isn’t a deficiency or – forgive us all – a “handicap.” (See what Hans Asperger had to say about “cure” in Notes.)

I’ll Be Watching Too

How will they portray Julia on Sesame Street?

Will she be unresponsive? Will she avoid eye contact? Will she be off to herself, isolated? Will she be portrayed as socially inept? Will she have difficulty making friends? Will she be fixated on an unusual object? Will she engage in various rituals? Will she become expressionless? Will she use peculiar phrases? Will she lack an interest in making friends? These are just some of the “symptoms” of children on the “spectrum.”

Will adults – professional and otherwise – be defending her behavior by explaining to everyone that Julia has a brain disorder and needs our understanding about her “challenges?”

Not without hearing from me, for what it’s worth.

Finally

To Ms. Stahl, to Oscar, to Big Bird, and all the others at Sesame Street, and to the parents and caretakers of these very special kids – we are on the same side. I love these kids too. I want to protect them too.

Lastly, dear Julia, your debut is loved and protected, and that’s a good thing. I can already tell, you’re going to be great. Everyone is watching.

Just be yourself.

~~~~~~~~~~~~~~~~~~~~~~~~~~
Notes

Kanner believed, and argued over his lifetime, that autism was rare. He must have noticed an initial “outbreak.” The John Hopkins psychiatrist “undiagnosed” – and sent home – 9 out of 10 children sent to his practice by other clinicians.

Asperger believed the "cure" for the most disabling aspects of autism is to be found in understanding teachers, accommodating employers, supportive communities, and parents who have faith in their children's potential.

Many people have read or are familiar with Kanner’s first 11 cases of autism. Less well known is the 30 year follow up for those 11 cases. Note the outcomes for the children left in hospitals. You can read it here.
~~~~~~~~~~~~~~~~~~~~~~~~~~

“Autism” from another point of view

Composers are just as plentiful as the other Artisans, say nine or ten per cent of the population, but in general they are very difficult to observe and thus greatly misunderstood. Very likely the difficulty comes from their tendency not to express themselves verbally, but through their works of art. Composers are usually not interested in developing ability in public speaking, or even in the art of conversation; they prefer to feel the pulse of life by touch, in the muscles, in the eyes, in the ears, on the tongue. Make no mistake, Composers are just as interested as other types in sharing their view of the world, and if they find a medium of non-verbal communication-some art form-then they will express their character quite eloquently. If not, they simply remain unknown, their quietness leaving their character all but invisible.” Keirsey - (Please Understand Me II)

A Replacement for the DSM?

4/2/2017        In the News 0 Comments

by Chuck Ruby, Ph.D.


A recent article in the Journal of Abnormal Psychology, also publicized in Science Daily, reports on the results of research that is attempting to develop a better way to classify mental disorders by using a dimensional rather than categorical approach. The system is called the Hierarchical Taxonomy of Psychopathology (HiTOP). While it might correct some of the shortcomings of the present Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic system, it nonetheless falls short. Its weakness is three-fold: 1) as with the DSM, it still regards human struggles as pathology; 2) despite its use of dimensions, it still retains the main categorical challenge of determining normal from abnormal human experiences; and 3) the factor analysis statistical approach does not always account for all variation among individuals' experience of distress.

First and foremost, the HiTOP continues to use a medical model and invokes the term “psychopathology”. It must be remembered that this is figurative language at best and misinformation at worst. There is no evidence that anything psychological or mental can literally be pathological. If any “mental disorder” is shown to be caused by true brain pathology, then it would fall within the medical specialty of neurology. The HiTOP continues to perpetuate the scientifically empty hypothesis that existential human problems are illnesses. While it does use a dimensional approach in an attempt to recognize human diversity, it still couches those problems in language that implies illness (e.g., pathology, patient, symptoms, syndromes, clinical, illness, comorbidity, diagnostic, psychopathology, etiology, pathophysiology, etc.)

More over, the HiTOP might actually be increasing the extent to which natural human struggles are considered pathological, even more than the DSM. For example, it is said that “[d]imensions are psychopathologic continua that reflect individual differences in a maladaptive characteristic across the entire population (e.g., social anxiety is a dimension that ranges from comfortable social interactions to distress in nearly all social situations)." But how can “comfortable social interactions” be considered psychopathological (or even problematic) and entire dimensions of human experience be "psychopathologic continua"? This seems to be saying that all human activity can be considered pathological.

So in continuing to use the medical model, but absent any evidence of biomarkers that identify the putative pathology, the HiTOP remains a pseudo-medical endeavor and suffers the same weakness of the DSM. It claims pathology but it must rely on moral judgements, not science, to identify pathology. Given the lack of evidence of literal pathology, who determines whether something is maladaptive?

The researchers consider the HiTOP to be a project alongside the National Institute of Mental Health (NIMH) program called the Research Domain Criteria (RDoC) as promising dimensional alternatives to the DSM system. But the RDoC and HiTOP suffer from the same weakness: they fail to start with evidence of real pathology. Rather, they assume it. In the case of the RDoC, neurological concomitants of human distress are described as pathology. With the HiTOP, natural variation of human distress is considered pathological.

The HiTOP’s second weakness has to do with how the researchers use the dimensional model. They pass up an opportunity to use the factor analytic statistical approach to create a system of hierarchical continua with which to describe the intensity and types of distress outside a medical and pathology model. Such an approach is seen in the NEO Personality Inventory (NEO-PI-R), which is an instrument providing a measurement of five personality factors, each with six facets. It is one of the few psychological instruments that does not conjure up pathology.

To the contrary, the HiTOP retains a focus on distinguishing between abnormal and normal human experiences. Thus, despite using a dimensional approach, it still saddles itself with a categorical decision.  This is the exact opposite of what the HiTOP was intended to do. It is said, “[t]his quantitative approach responds to all aforementioned short- comings of traditional nosologies. First, it resolves the issue of arbitrary thresholds and associated loss of information.”  Really? If the task is to differentiate between normal and abnormal, there will always be the need to set an arbitrary threshold between psycho-normality and psycho-pathology.

This problem is manifest in the following statement: “A common concern with dimensional classifications is whether they are applicable to clinical settings, as clinical care often requires categorical decisions. Indeed, actionable ranges of scores will need to be specified on designated dimensions for such a classification to work effectively in clinical practice. Rather than being posited a priori, these ranges are straightforward to derive empirically, as is commonly done in medicine (e.g., ranges of blood pressure, fasting glucose, viral load, etc.).”

But how do we determine that point (or range) between normal and abnormal human experiences? In real medicine, that decision is based on the extent to which the pathological factor threatens the physical viability of the patient. We do not have that with “mental health” because none of the ranges or levels of "mental illness" affect the physical viability of people any more than other behaviors not typically considered pathological affect physical viability, such as high risk recreational pursuits and sports.

The problem with using dimensional tools to assess “illness” is that the assessors must arbitrarily determine the separation between abnormal (ill) and normal (healthy) without any scientific foundation to do so. It gets back to what I said earlier, the assessor will be making a moral judgement about how much distress is normal.

Lastly, like all research, the variation of human experiences of distress cannot be explained completely by factor analyses. In some research a sizable portion of the natural variation of human distress is unexplained. This can be a problem for the HiTOP, but it is difficult to determine as the authors do not report the specific statistics that would allow one to make that determination. For instance, the eigenvalues, loadings, and communalities of the factor analyses in studies used to construct the HiTOP are not given. There can be a substantial amount of the factor analytic data that isn’t accounted for by the dimensional model.

Also, factor analyses are dependent on the scales/instruments that are used in collecting the original data. Therefore, information that is not collected via these instruments is not considered. The factor analysis identifies the relationship between the variables assessed by the instrument. It doesn’t identify variables that are not assessed by the instrument. If there is an important variable that is overlooked by the original instruments, it won’t be included in the factor analysis. So, if the instrument only looks at variables consistent with a medical model, as is done here, then only medical model factors will result.

The HiTOP is the latest in a line of "newer and better" diagnostic systems. Even though it might offer a more realistic view of human variation, it nonetheless still suffers the same weaknesses as other attempts to classify the scientifically threadbare pathology model of human distress.

An Interview with Steve Spiegel

3/14/2017        ISEPP In Action 0 Comments

ISEPP member, Steve Spiegel (uat@naturalpsychology.org), is an independent natural scientist and theoretical neuroscientist. His experiences with mental distress initiated an investigation into natural human suffering and the pseudoscience of the medical model of mental distress. Steve is currently producing video lectures and launching a free therapy program that unifies alternatives to drug therapy into a single, comprehensive program. Steve was interviewed by ISEPP's Michele Paiva about his experiences. The content of that interview follows.


I grew up near Portland, Oregon, and now live nearby, in the Pacific Northwest. I embraced natural science at an early age from my enjoyment of natural environments and my father’s advocacy. I was fortunate to live with atypically positive experiences of emotional well-being through my youth until I experienced trauma during early adulthood.

I did not serve in the war in Vietnam but was nevertheless traumatized by my unique experiences related to the war. The trauma derailed my life. Instead of continuing on a path that garnered positive social and economic support, I felt alienated from my community and began experiencing social ostracizing and economic hardship. Extremely distressful experiences were enlightening; I could not have imagined extreme emotional suffering (pain) during my happy years. Thus I came to understand mental distress as a social welfare problem of natural emotional suffering from unusually distressful experiences rather than a disease.

I investigated my perception of mental distress and human psychology as a social welfare problem with psychology theory to better understand it and explain it. It took me a couple decades to understand basic psychology theory and feel that I could not explain my theory of mental distress without neuroscience support. Thereafter, I investigated neuroscience for a decade until I gained an undergraduate level understanding that I felt informed my psychology theories.

My perception of basic empirical neuroscience was radically different than mainstream neuroscience; I felt that mainstream neuroscience was missing important implications from basic neuroscience while focusing on more obscure investigations. Thus, I began more recently to investigate neuroscience theory.

Please note that I consider myself a “theoretical neuroscientist” but not a “neuroscientist;” I am comfortable with the first label but not the second. I challenge the mainstream perception of accepted, elemental empirical neuroscience (cellular and tissue neuroscience) so I consider myself a “theoretical neuroscientist.” However, I have only an understanding of basic elemental neuroscience (little understanding of molecular neuroscience) so I do not consider myself educated enough to defend the label “neuroscientist.”

The greatest shock in my research was realizing that psychiatry’s neuroscience dazzles with complexity while contradicting the most fundamental principles of every science that informs it. Psychiatry’s neuroscience contradicts the most basic tenets of: 1) general science, 2) biology, 3) physiology, 4) natural science, and 5) the philosophy of science.

First, psychiatry’s neuroscience contradicts the most basic principle of general science - parsimony. Science theory is based on parsimony - Occam’s razor: fewer assumptions make better science. Neuroscience theory has lost sight of this tenet of science. Neuroscience theory was brilliant in pursuing empirical neuroscience to make the astonishing breakthrough of discovering the basic functions of a neuron cell - cellular neurophysiology.

Neuroscientists deserve substantial admiration for this complex achievement. However, subsequent neuroscience theory has embraced the complexity of neuroscience from a religious rather than scientific perspective. Psychiatry’s current neuroscience theory is not concerned with the number of assumptions that it makes; it crosses the line that separates philosophy and science.

Second, psychiatry’s neuroscience contradicts the most basic principle of biology; biological reductionism states that an organism is understandable through its biology. Consistently, neurology is the biological (medical) science that investigates the brain and nervous system. In contrast, psychiatry investigates a philosophy - a philosophy of mind; it contradicts biology theory to investigate a non-physical entity.

Third, psychiatry’s neuroscience contradicts the most basic principle of physiology; physiology investigates organisms at various organizational levels and explains organs at the tissue level - with tissue physiology.

Physiologists explain the function of organs of the body with tissue physiology and only tissue physiology; in contrast, neurophysiologists try to explain the brain with cellular and molecular physiology. For instance, physiologists explain organs like the heart with tissue physiology after describing its function more generally as a pump nourishing the body.

Physiologists explain how muscle tissue makes the heart and its chambers and pushes the blood throughout the body by flexing heart muscles, how connective tissue creates valves to produce directional flow, how nervous tissue creates a periodic spark to flex heart muscles, and how epithelial tissue creates pipes to carry the blood throughout the body and allow nourishment to pass through the pipe walls. Physiologists can only explain our organs with tissue physiology and only tissue neurophysiology can explain the brain.

Investigating molecular neuroscience to understand human psychology is analogous to investigating the molecular structure of pistons and spark plugs to understand the function of an automobile engine. Physiologists explain organs with tissue physiology; molecular physiology is far too complex to explain an organ and attests to an unscientific embrace of complexity.

Fourth, psychiatry’s neuroscience contradicts the most basic principle of natural science; natural scientists consider human nature to be based on simple principles hidden beneath an appearance of complexity.

Our most eminent natural scientists (Einstein, Greene, Weinberg, Lewin) contend that human nature is a function of simple principles that are obscured by a manifestation of complexity. In contrast, psychiatry refuses to consider simple principles. Psychiatry models the brain after computers that operate on the simple principle of binary science and yet refuses to consider a simple principle of binary neuroscience. Psychiatry’s embrace of complexity is unscientific.

Lastly, psychiatry’s neuroscience contradicts the most basic principle of the philosophy of science: falsifiability (Popper). The philosophy of science contends that true science theories can be differentiated from pseudoscience by falsifying them - identifying the assumptions that can disprove the theory.

The philosophy of science expects scientists to explain how to disprove their science theories - to falsify them. Falsifiability is a process of identifying assumptions as potential sources of disproof; this separates real science from ad hoc and post hoc theories. Psychiatry is so comfortable with limitless assumptions (obscure theses) that the philosophy of science has never been considered or mentioned in psychiatry theory; this is an unscientific acceptance of complexity.

I got involved in producing my videos because the predominance of criticism of mainstream mental health care is written by academics and professionals for academics and professionals; there is a lack of overviews for the general public.

At the ISEPP conference in Philadelphia five years ago, I was impressed with Lloyd Ross’ attempt to communicate with the general public at libraries and with pamphlets for doctor’s offices. More recently, I felt frustrated with my efforts to communicate an overview of my criticisms of mainstream mental health care aimed at academics (and professionals); I do not speak their language.

About a year ago, I thought that I was better able to communicate with the general public and decided to try. Communicating with the public is now done by YouTube so I thought that I would develop a half hour video lecture aimed at the general public.

The DSM and the Medical Model is a new video lecture that provides the general public with an overview of criticisms of mainstream mental health care. It is a sharp rebuke of psychiatry and its disease narrative of mental distress. I seek feedback about the video from the MIA and ISEPP communities before a final editing and widespread distribution; I also seek feedback about how to distribute it. This video lecture is intended to give voice to the disenfranchised faced with the injustices of their interaction with the mental health care system; it pulls no punches. It lays bare the counterproductive nature of the medical model and the pseudoscience and elitism that support it.

The DSM and the Medical Model: 1) introduces the medical model of mental distress, 2) introduces an alternative, social welfare model, 3) describes criticism of the medical model, 4) describes obstacles for changing paradigms, 5) describes the harm of the medical model, and 6) advocates true justice and support for the disenfranchised. The social welfare model of mental distress is an important alternative narrative that fills the void created by the bankruptcy of the disease narrative.

The first section of the video introduces the medical model of mental distress (the disease model) and the DSM that describes it. The medical model narrative is a classical paradigm as introduced by Thomas Kuhn in his landmark book, The Structure of Scientific Revolutions. A classical paradigm is a complete world view; it is difficult to challenge because terms have interrelated connotations and contexts that support the existing narrative. The video also describes the difficulty of imagining emotional suffering greater than experienced.

Section Two introduces an alternative, better narrative of mental distress- a social welfare model of natural emotional suffering and natural, “anti-social” reactions to the suffering. Emotional suffering is described as varying in direct proportion to the degree of the distressfulness of personal experience. The aversion of extreme emotional suffering is described as emotionally painful- sensed similar to physical pain.

Section Three is an overview of criticism of the medical model of mental distress. It begins with a brief history of the DSM- psychiatry’s attempt to explain its medical model. The video criticizes the DSM for its: 1) lack of validity, 2) lack of reliability, 3) discounting personal histories, 4) discounting the intensity of distress, 5) ambiguous category boundaries, 6) common symptoms for categories, 7) stigmatizing clients, 8) promoting self-fulfilling prophecies, and 9) ignoring its cultural biases. Besides summarizing popular criticisms of the DSM, this section also addresses the scientific absurdity of the new DSM-5 changing its definition of a “mental disorder” without commenting.

Section Four discusses vested interests- obstacles to changing narratives. Besides psychiatry and Big Pharma, several other groups are also identified as strongly vested in the medical model. The annual profit from sales of psychotropic drugs as medicines will be edited to reflect the correct figure of 18 billion dollars.

Section Five discusses the harm of treating a social welfare problem as a medical problem as documented in Robert Whitaker’s classic book, Anatomy of an Epidemic. First, the medical model harms mental health by gaslighting emotional sufferers- by advocating that natural emotional suffering is instead a disease. Secondly, the medical model harms mental health by stigmatizing emotional sufferers as having a malfunctioning brain. Thirdly, the medical model harms mental health by promoting drug abuse by falsely describing psychiatric drugs as medicines- treating a biological problem. Lastly, the medical model harms mental health by promoting “coercive therapies.” Denying basic human rights to people suffering emotionally from unusually distressful experiences is absurdly cruel; it worsens outcomes that include suicide.

The conclusion is an appeal to challenge the medical model narrative and “coercive treatments.” It tries to voice the tragedy of considering natural emotional suffering (and natural, “anti-social” reactions to the suffering) to be a disease. I welcome comments and feedback on the video. Please email me at UAT@NaturalPsychology.org.