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They Are Gone, But Still With Us

They Are Gone, But Still With Us

They Are Gone, But Still With Us


Chuck Ruby, Ph.D., Psychologist


ISEPP's courageous founders created a welcoming home for dissident voices within the mental health system, both for the professionals of that system and for those who have been harmed by the system. This legitimizes our voices and buffers against the many groundless and ad hominem criticisms about us and our efforts to reform psychology, psychiatry, and the allied mental health professions. Those founders established and continue to maintain our bona fides as a serious, scientifically-oriented, organization worthy of being heard.

ISEPP was built upon the backs of these giants. Sadly, though, we lost one of our giants when Bert Karon left us in his 90th year. I knew Bert only minimally, and so I do not have the intimate or in-depth memories of him as do those of you who paid tribute to him in these essays. Yet, in the short time I did know him, I found him to be a most welcoming, supportive, knowledgable, and encouraging voice. His support to me in my role as Executive Director was gold, and this was especially important given the difficulties and risks of our struggle against the inhumanity of the powerful mainstream mental health industry. Importantly, Bert's life with us shows how ISEPP is a living, organic organization that goes forth with those giants, even though they are gone. This is because their essence lives on in the rest of us. Many have gone before Bert and many are yet to leave, yet ISEPP will remain a strong force into the future because of these giants.

In reading the above tributes about Bert's warmth and support, I think I can understand his value to those of you who knew him so well, as I am reminded of another giant in my life, my mentor at the Florida State University during my doctoral training in clinical psychology and psychotherapy. This was the late mathematician and psychologist Sandy Kerr, Ph.D. Sandy introduced me to a humanistic and constructivist approach to understanding human pain and in helping people assimilate that pain into their lives in a more meaningful and personalized way, and far away from a medical model.

As with Bert, Sandy's approach was focused on helping his students develop a faith in themselves, their ideas, and their value in making an impact on people's lives. When I was lost or unsure of myself, struggling with a particularly difficult situation, and had questions about what to do, Sandy would rarely give me an answer. Instead, he nudged me in directions where I would learn more, and forced me to answer the question myself, or more typically, to realize I was asking the wrong question. Many times it was what he didn't say that helped the most. I once described my experience of his psychotherapy supervision as feeling like I was desperately trying to learn how to build a boat in order to cross a swift river, but finally realizing that all along I was a pretty good swimmer. I'm sure the same can be said about Bert's wise counsel.

Bert's message is that each of us is worthwhile and we have the capacity to make an indelible mark on this world. We differ on many things, including our interpretation of the research and the writings of those who came before us and, thus, our understanding of the human condition and the ways to help people in emotional distress. But we are the same in our ability to change people's lives for the better if we develop our own sense of value. There are many possible answers to life's questions, but none of them are possible if the one who tries to answer those questions doesn't feel worthy. This applies to the professionals trying to help and the people looking for help.

Bert's passion in helping us develop this sense of faith in ourselves is consistent with research on psychotherapy. Decades of studies repeatedly show that technique is secondary. The "common factors" are primary. It can be shown that even when a particular psychotherapy technique has a large effect on outcome, around 85% of that effectiveness is due to things other than the treatment -  the common factors. These factors include the person of the client and the person of the therapist, including whether or not both have faith in themselves and in the process.

So as we pay tribute to the life and works of our friend and colleague, Bert Karon, as well as to the rest of those giants who have come and gone, let's remember they will continue to live on in each of us and this strengthens ISEPP's ability to make a difference. Each of us has inherent worth, and if we are wise to cultivate that worth and share it with others, as Bert encouraged, we too can become the giants of a great movement such as ours.

From His Friends and Colleagues: In Memory of Bertram (Bert) P. Karon, Ph.D.

From His Friends and Colleagues: In Memory of Bertram (Bert) P. Karon, Ph.D.

 

The following are tributes by friends and colleagues of Bertram (Bert) P. Karon, Ph.D., in memory of his courageous and noble dedication to improving the lives of those labeled and stigmatized with mental illness diagnoses.


Ron Bassman

Cindy Baum-Baicker

Janet Boyer

Cynthia Call

Paula Caplan

David Cohen

Ty Colbert

Martin Cosgro

Mathy Milling Downing

Al Galves

Rebecca Hatton

Delores Jankovich

Daniel Mackler

Robert Morgan

Wayne Ramsay

Mark Richardson

Lloyd Ross

Richard Shulman

Hans Toch

Anmarie Widener

The “Sorry” State of American Health Practice

The “Sorry” State of American Health Practice

The “Sorry” State of American Health Practice


Joe Tarantolo, M.D., Psychiatrist


"Sorry, this medical practice does not take Medicare." "Sorry, I don't take Medicaid." "Sorry, I am not in your insurance network." "Sorry, your insurance does not cover this procedure." "Sorry, your insurance does not pay for this medication." How often do Americans hear these laments! The American medical "insurance" industry is fraught. I put “insurance” in quotation marks BECAUSE  AMERICAN INSURANCE IS NOT REALLY INSURANCE. Let me explain.

If you own an automobile, you are required to have automobile insurance. This insurance does not pay for gas, oil, new brakes, and other usual maintenance. You pay out of pocket for these. And you shop around ( if you are the thrifty type) to get the best price for these products and services. Insurance pays up if you have an accident or if your auto is stolen or vandalized. The same applies with homeowner insurance. It does not pay for maintenance. It pays up for fire or floods or if the wind blows your roof off or if you are robbed or vandalized. What we have come to call medical “insurance” is actually a way to pay for any medical attention. It is an elaborate bill paying scheme.

An example:  A couple years ago I had an inguinal hernia operation. A year later I needed a second repair on the opposite side. Same surgical problem, different side, and different surgeon. Both went pretty much as they should, the second with a bit more post surgical discomfort, nothing dangerous, in the hospital a few extra hours. I was interested in why I was a bit sicker post 2nd operation so I did some inquiries. It seems the 2nd anesthesiologist gave me more drugs.  Maybe that was why I needed a few more hours to recoup. Okay, each anesthesiologist has his own way to do the procedure. Interesting, but no significant complaints on my part. The shocker was in my research I discovered that the first operation cost about $8,000, and the 2nd operation cost about $16,000. When discussing what procedure to use for the 2nd hernia ( the surgeon was well versed in both), it didn’t occur to me to ask the price. I/we chose the 2nd procedure because it gave some quite small advantage to avoid relapse, i.e. failure of the repair. And the surgeon liked the 2nd procedure a bit more. The point I’m making here is: I NEVER ASKED HOW MUCH THE PROCEDURE(S) COST! (Note: There is a "Hernia Clinic" in California that offers hernia repairs for under $4,000)

I’m a capitalist. I’m also a progressive democrat. So I believe both in competition in the market place and I also understand that regulations are necessary given human insecurity and greed. I also understand the concept of universal responsibility for the poor, the hungry, the lame, the homeless, and children. So I see “universal health care” not as a political right (health care is not mentioned in the Bill of Rights) but a moral responsibility.  Oh, I have existential and  libertarian leanings as well, i.e. I believe in personal responsibility. How does a capitalist, a social democrat, a humanist, an existentialist come up with a plan for universal access to medical care. The answer: SUBSIDIZED PERSONAL HEALTH ACCOUNTS.

The US spends roughly $10,000 per person per year for medical care, twice the amount of other 1st world countries. Even so we get poorer outcomes as indicated by significantly decreased longevity and increased infant mortality. What Richard Nixon taught us (besides never to record personal criminal conversations) is that price fixing does not work. At least it does not work in the USA. His Executive order #11615 placing a nation-wide price freeze was a gross failure. “Ranchers stopped shipping their cattle to the market, farmers drowned their chickens, and consumers emptied the shelves of supermarkets.”  (Daniel Yergin and Joseph Stanislaw explain in The Commanding Heights: The Battle for the World Economy, 1973).  

______________________________

We need 329,000,000-payor medical coverage, not single-payor

______________________________

Medicare, Medicaid, and most insurance plans dictate both to the doctors and the patients not only what procedures and treatments are allowed but also how much they will pay. And oh yes, let's not forget the “co-pays”. There are even terrible plans that pay nothing until you spend $2,000-3,000. How many of you are told, “No, we will not pay for services with that doctor. He is not in your network!” And, you are not rewarded for being thrifty. Dr. X in your plan may charge $1,000 for a test whereas you might be charged $500 by Dr. Y. But Dr. Y is not in your plan. And there is no incentive to challenge or negotiate with your doctor. “Do I really need that expensive MRI?" "Can’t we wait a few weeks and see if  X clears?” And we never ask “How much does it cost?” No, we only want to know if our insurance plan pays for it.

Personal health accounts would require each of us to contribute to our own account. Those who can’t afford the contribution would be subsidized by public funds. Those whose Labor Union or corporation supplies coverage would place that money into each private health plan. So no one would lose the coverage that they like. But, it would give individuals more control of their coverage. And, this is important, each of us would have more responsibility. “How much is that going to cost, Doc? Hmmm, maybe I can get that cheaper!” Those who value their health and rarely use the medical system could be rewarded: A yearly refund out of their private health account!

One last important issue. There would have to be medical insurance for catastrophic events. Middle class incomes would be able to afford medical “maintenance” out of their health account. Very few would be able to afford hundreds of thousands dollars for a protracted hospitalization. That would require insurance.

In future blogs I will spell out how our horribly dysfunctional insurance system has a particularly injurious impact on the "mentally ill."

Don’t Be Fooled By Fake News

Don’t Be Fooled By Fake News

Don't Be Fooled By Fake News


Chuck Ruby, Ph.D., Psychologist


There is a pernicious problem in the media that has existed for some time, namely, "fake news." But unlike the political rantings intended to defame opposition information, this kind of fake news is truly fake and can be demonstrated.

The fake news I am referring to is the multitude of claims made by mental health researchers as reported in professional journal articles and popular news headlines, but that have no empirical basis. Instead, many times the results of research are presented in language that gives the impression of impactful scientific discovery supporting the reality of mental illness, as illness. It serves to mislead and misinform both lay and professional audiences. This is unethical and counter to the principles of "do no harm" and "informed consent."

A typical example was a very recent article published in The Journal of Clinical Endocrinology and Metabolism with the title, "Antidepressants reduced risk of mortality in patients with diabetes mellitus: a population-based cohort study in Taiwan". This title is clearly stating that antidepressant drugs were the causative factor in reducing deaths among diabetes patients. It is also implying the value, safety, and effectiveness of the drugs for the treatment of depression. However, if one looks at the study's methodology and results, it is clear this is fake news.

Because the study was retrospective and the people were not randomly assigned to groups, with one of the groups being prescribed antidepressants and the other not, causation cannot be determined. Correlation is the only conclusion possible. Thus the oft cited caution: "Correlation does not equal causation." Incidentally, this problem is sometimes used by our allies to support our opposition to the medical model of mental health. If we are to be true to our mission of using science and critical thinking to reveal our message, then we also have to be careful not to imply causation when it could be mere correlation.

But back the the above study. It found that people who are prescribed antidepressant drugs had a lower risk of death. The relative risk figures ranged from .20 to .73, meaning the risk of death for those taking the drugs was between 27% and 80% lower than those not taking the drugs. Using a 9% risk of death for diabetes patients over 10-years, this would mean those who take antidepressants would lower their risk to between 2% and 7%. Such a finding gives the impression that the drugs are beneficial, not only for depression but also for reducing mortality.

However, to be intellectually honest, the only thing that can be concluded with this data is that antidepressant drug use is correlated with lower mortality among diabetes patients, and then only in this study, not for the population at large. So it is intellectually dishonest to state that "Antidepressants reduced risk of mortality...." [Italics added] as in the article's title.

Let's look further into the data to see what the real news is. According to the researchers, the higher mortality non-drug group was composed of more people who were: male (lower life expectancy than women), elderly (more likely to die), and poor (less access to medical care). The non drug group also had a higher incidence of heart failure and more severe complications from diabetes (perhaps because of being male, older, and poorer?).

These factors are given only cursory attention in the article. The researchers point them out, yet they don't appear to place much significance in them. Still, they can clearly explain why on average those in the non-drug group died earlier than those in the drug group, independently of whether or not antidepressants were used. At the very least, these factors cast significant doubt on the researchers final conclusion as is stated in the article's title.

So, the correlation between antidepressant use and mortality may very well be bogus. The real correlation is very likely between mortality and these other factors. If so, the apparent correlation between antidepressant use and mortality is meaningless. The next time you see headlines claiming bold medical findings like this, especially those related to mental illness, take the time to consider how most of those studies are based on correlations, not sound evidence of causation.

A popular website humorously demonstrates this problem of misleading "spurious correlations" that don't account for many other factors involved. At this site you can see several examples of apparently strong correlations between two variables that have no true causative relationship. For instance, there is a .95 correlation (unheard of in medicine or the social sciences) between per capita cheese consumption and dying by becoming tangled in your bedsheets. If we took the approach of the above antidepressant and mortality study researchers, we would conclude that eating cheese causes us to die by getting entangled in our sheets! What a financial hit to the cheese industry but a boon to other competing snack companies.

Other meaningless but very strong correlations shown on this site are:

  • the number of people who drown by falling into a pool and the number of Nicolas Cage films. Don't watch Nicolas Cage films if you want to avoid falling into pools and dying.
  • U.S. spending on science, space, and technology, and the number of suicides from hanging, strangulation, and suffocation. Increased government spending on science, space, and technology causes people to commit suicide by hanging, strangulation, and suffocation.
  • the per capita consumption of margarine and the divorce rate in Maine. If you want to stay married in Maine, don't eat margarine.

Incidentally, a very troublesome finding of the antidepressant/mortality study, and that wasn't reflected in the title, is that one of the seven psychiatric drugs tested was correlated with a 48% increased risk of death. The drug is called a "reversible inhibitor of monoamine oxidase A" (RIMA), which increases the effects of serotonin, norepinephrine, and dopamine in the brain. This drug is euphemistically said to offer "a multi-neurotransmitter strategy for the treatment of depression." By the way, this "multi-neurotransmitter strategy" has no scientific foundation. It is more like the idea of throwing as many things as possible against the wall and seeing if any stick.

Only one short sentence in the antidepressant/mortality article mentions this potential danger of RIMA, but says nothing else about it. It is also given trivial mention in the concluding remarks: "Most ATDs but not RIMA were associated with significantly reduced mortality among population with comorbid DM and depression." [Italics added] Notice that statement didn't say that RIMA increased the risk of death. Why wasn't the article entitled, "Newly developed multi-neurotransmitter drug for depression shown to increase risk of death."?

Be careful what you read. Don't trust the headlines as they are usually written in a way to grab attention, not honestly summarize the matter. Moreover, don't unquestionably trust the mental health industry as its leaders have a political and financial agenda that many times outweighs any interest in accurately portraying research results. Be informed, think critically, and take the time to learn the truth.

Turning Negative Emotions into Positives

Turning Negative Emotions into Positives

Al Galves, Ph.D.

What are the negative emotions?

Anger
Jealousy
Fear
Guilt
Sadness
Anxiety
Others?

 Why do we think they are negative?

 They aren’t comfortable.

 It’s interesting to wonder about why these important feelings are uncomfortable.  Perhaps it is because we need to be motivated to do something about the concerns that are causing them.

 They are associated with behavior that is dangerous.

 It’s important to make a distinction between the emotion and behaviors that are associated with the emotion.  All emotions are valid, OK and potentially useful.  But the behavior that results from emotions can be either helpful or dangerous and hurtful.

 They can make us sick.

 When these emotions are stuffed and repressed, they go inside, put a strain on the body, impair the immune system and cause sickness.

 What evidence is there that these emotions are useful?

 Evolution or Creation

 Whether you believe in evolution or creation, there is evidence that the “negative” emotions are beneficial and useful.  If you believe in evolution, you understand that the human organism has been evolving over the past 30 million years. Any faculty or state of being that wasn’t useful and didn’t have survival value would have been wiped out long ago by the process of natural selection.  If you believe in creationism, why would God have given us a faculty or state of being that wasn’t somehow useful?

 Research

Antonio Damasio

 In his book Descarte’s Error, Antonio Damasio describes his study of people who, due to lesions on their amygdalas, were unable to experience emotions.  He found that such persons were unable to make good use of their reasoning abilities. Unable to feel bad, they couldn’t learn from mistakes.  For example, they would see a stock they owned going down in value but wouldn’t feel bad about it so wouldn’t sell it.

James Pennebaker

 People who write about the most traumatic experiences of their lives have better immune system functioning and are healthier than people who write about impersonal topics.

 Method Actors

The immune systems of actors function better while they are experiencing emotions and it doesn’t make any difference if the emotions are “positive” or “negative”.

 Medical students

Medical students included in the “Bland-No emotions” group were 16 times more likely to contract cancer than those in the “Acting out” group.

 Joseph Ledoux

 Signals that are received through the eyes, ears, nose and skin pass through the amygdala (the part of the brain which processes emotions) before they go to the neo-cortex (the part of the brain which processes thinking, problem solving and analyzing), evidence that the human organism is “designed” to enable the emotional processing and reasoning faculties to work together.

 How are these “negative” emotions useful?

Five basic ways in which they are useful:

 They tell us what’s important, what we care about, what we like, what we don’t like, what we are afraid of, what we want to get rid of.

They help us get clear about our values.

They help us make decisions.

They give us energy and motivation.

They help us understand other people and, therefore, to behave in better ways.

Following are some examples:

Anger: Anger tells us what we don’t like, what we want to get rid of, what is threatening us, what we want to overcome.

Jealousy: Jealousy tells us what we want and don’t have or what we have and don’t want to lose.

Fear: Fear tells us what we want to avoid, what we want to be careful about, what can hurt us, what we must protect ourselves against.

Sadness: Sadness tells us what is precious to us and what we want to nurture and protect in our lives.

Anxiety: Anxiety gives us the energy, the mental acuity and the stamina to do things that we want to do but which are going to be difficult and scary.

Guilt: Guilt tells us what we think is wrong, keeps us from doing things we think are wrong and enables us to make amends to persons we have wronged.  It enables us to act in accordance with our moral code.

What do we have to do in order to use them?

 1. Experience them.

We experience them in our bodies.  We first get in touch with them through bodily sensations.  What we have to do is let them in, sit with them, wait with them, let them work in us. Many of us have been told that these emotions are bad, that they can’t be trusted, that they only lead to no good. So, as soon as we begin to feel them, we find a way to avoid them.  We get busy, we act out, we take drugs and alcohol, we escape.  If we only would let them work in us for five minutes or so, we could take the first step to turning them into positives.

2. Find out what they are telling you.  What is behind them?  What are they about? What is the message?

This is easier said than done. It may take some time to get the message from the emotion.  One thing that will help is to find a quiet place in which to sit.  Sit in a comfortable position.  Tell yourself that you are open to receiving whatever the message is.  Take some time to relax, let the tension out of your body and allow yourself to receive whatever messages come up from inside of yourself.

Here are some other rules of thumb that may be useful in taking this step.

• Anything which gets in the way of you loving the way you want to love and working - expressing yourself and using your abilities - the way you want to work is going to cause one of these “negative” emotions.

• Welcome whatever thoughts come up.  Even if they don’t make sense or seem to be coming out of left field, they may be the start of a useful insight.  If they seem weird, ask them what they are doing there and what they have to tell you. Be open to answers.

• It is not necessary to push yourself hard at this point.  It works better to relax and allow things to come to you – all by themselves – without you making it happen.

3. Take some action based on what you have learned or decide not to take action.

This may be the hard part.  Since these emotions are usually about something which is bothering you or is in your way, something you want to get rid of or you want to confront, it may take some courage to take action.  And since action will often involve confronting other people you will have to learn how to confront without making them defensive.

Here are some rules of thumb for taking action.

• If you are confronting another person, use the rules of assertiveness.

Describe what is going on for you, what you are noticing, how you are feeling using “I” instead of “You”.

Tell the person that you are having a problem with what is going on, that you don’t know what the solution is and that you’d like her or him to join with you in finding a solution.

Take responsibility for your feelings, your thoughts and your desires.

Say what you want – calmly and directly.

Don’t take responsibility for the other person’s feelings.

• If you are afraid, ask yourself what you are afraid of.  When you get the answer, see if it is a fear that you can walk with, that you can manage without letting it stop you.

• Ask yourself what is the worst thing that can happen and see if you could live with that or somehow mitigate it.

• Be aware of the ways in which you habitually stop yourself from taking action.  We often stop ourselves by saying things like:

"I don’t want to be petty."

"I’m afraid if I say something or do something, things will get worse."

"It’s not that important."

"I’ll just let things ride and see what happens."

"Who am I to think I should get what I want?"

"If I do what I want to do, they’re going to think I’m mean and nasty and not a nice person."

Check these thoughts out to see if they really make sense and if you want to let them stop you or not.

What if I don’t want to take action?

After experiencing the emotion and getting its message, you may decide not to take any action.  If so, you need to find some way of discharging the energy that is in the emotion.  Examples of how some people use this energy effectively is exercise, sports, creative activity, talking to friends, writing, playing music, and helping other people.  Any activity which uses energy and is not harmful to self or others will work.

So what is the bottom line?

These so-called “negative” emotions are valid, beneficial and potentially useful.  They tell you what is important to you and what you need to do in order to live more the way you want to live.  If you want to use them, take the following steps:

1. Experience them.  Let them in and let them work on you.

2. Learn from them.  What are they telling you?

3. Take action based on them.  If you decide not to take action, find a way of using the energy in them that is helpful to you and/or others.

The Dewey-Bull Theory of Emotions

The Dewey-Bull Theory of Emotions

Thomas Scheff, Professor Emeritus, University of California, Santa Barbara, Department of Sociology

Many years ago (1894), the noted philosopher John Dewey published a theory of emotions that today might seem peculiar, at least at first glance. He proposed that each emotion is a bodily process like breathingonly painful if obstructed. Dewey’s articles were ignored because, oddly, he provided no examples: he didn’t describe the patterns of obstruction that cause grief, anger, fear or shame to be painful.

Much later Bull (1951) partially responded to Dewey’s theory. She provided one example: grief is painful only if there is too little crying. No attention has been given to these writings; little evidence has been offered to support them. This note describes a small bit of evidence that might be relevant: my own personal experience of catharsis of obstructed emotions (Scheff 1979, 2007).

Some 50 years ago (I am nearing 90), I had a personal experience of removing obstructions of grief, anger, shame and fear. It occurred when I enrolled in a small informal class called Re-evaluation Counseling (1965). Although not mentioned in the class or it’s supportive writings, it seems to be based on the Dewey-Bull theory. After the first class, I cried every day for almost a year. Since at the age of 40 I hadn’t cried since childhood, I was quite surprised and gratified. The crying seemed to remove or at least decrease a substantial amount of pain and doubt.

Similarly, instead of bearing anger for much of a day and night, I saw that my little screams produced a flash of heat in my whole body that ended the anger. After a few minutes. I was no longer angry. A great relief, since in those days I was often angry.

A prolonged burst of happy laughter seemed to remove shame or embarrassment completely.

Unlike the other three emotions, fear was infrequent. But a few moments of intense sweating and shaking removed fear the few times that it occurred.

There is a complication which I can only mention in passing in this brief note: not all crying, shouting, shaking and laughter removes obstructions of emotions. For example, one can cry for many, many hours without removing the obstructions. I would guess that most of the crying, laughter and shouting that we see is like this. To remove obstructions, these actions must be under control, even though the person who is crying, laughing and/or shouting may not know that they have control. But in my experience, there have been moments when I needed to attend to business other than my emotions. To my surprise, I could stop and start the cathartic process at will. I have called this feature “aesthetic distance” because it resembles that emotional reactions of audiences in the theatre (Scheff 1979).

Most people in modern societies seem to have little interest in emotions. They take their beliefs about them for granted. In actuality all emotion terms, especially in English, are undefined and highly ambiguous. For example, most of the emotion research in psychology is not about emotions themselves, but about facial expression of emotions. Facial expressions are visible, without dealing with the problem of emotions, which are partly internal. In this way, they think they are studying emotions, but they only deal with a very small aspect.

Since the public and most of the researchers seem to be certain that the four emotions dealt with in this note are inherently painful, it will be difficult to convince them that they are not. According to this theory, we need not only to think differently about emotions, but research them directly, and also stop hiding them from self and from others so one can experience each emotion directly.


Bull, Nina. 1951. The Attitude Theory of Emotion. New York: Nervous and Mental Disease Monographs.

Dewey, John. 1894. The Theory of Emotion. Psychological Review. 1; 6 (553-568) and 2; 1 (13-32).

Jackins, Harvey. 1965. The Human Side of Human Beings. Seattle: Rational Island.

Scheff, Thomas. 1979. Catharsis in Healing, Ritual and Drama, Berkeley: U. of Calif. Press.

Scheff, Thomas. 2007. Easy Rider, pp 194-195. Lincoln, Nebraska: iUniverse Press.

 

Why the Myth of Mental Illness Lives On (Part 1)

Why the Myth of Mental Illness Lives On (Part 1)

Wayne Ramsay, J.D.

“The opinion that mental illness does not exist has been advanced by, among others, psychiatrist Thomas Szasz, sociologists Thomas Scheff and Erving Goffman, and psychologist Theodore Sarbin”.1  In his testimony before the Mental Health Committee of the New York State Assembly (state legislature) on May 18, 2001, neurologist John Friedberg, M.D., said this:

I do not believe in mental illness.  ...  Psychiatric drugs and electroshock inflict real injury in the name of treating fictive maladies.  ...  My opinions are based on my years of experience with patients and review of records from all over the country as an expert witness in electroshock malpractice cases.2

In 2011, Steve Balt, M.D., a psychiatrist at the UCLA-Kern Medical Center in Bakersfield, California, acknowledged “some argue convincingly that mental illness is itself a false concept," citing an article by psychiatry professor Thomas Szasz.3  Dr. Szasz published his book The Myth of Mental Illness in 1961, which now in 2019 is 58 years ago.  If mental illness is a myth, why do people still believe in mental illness?

One reason is the effects of repetition over time.  The more often one hears a myth stated, the harder it is to bring oneself to use one's own powers of perception and reason to examine and question it.  Almost everything we read in newspapers and magazines, and almost everything we see on television or hear on radio, and much of what we read on the Internet, discusses “mental illness” as if it were as real and valid a concept as heart disease or cancer.  We tend to believe what those around us believe, and eventually “most of our stored misinformation is virtually [metaphorically] cast in concrete.”4

Another reason the myth of mental illness and other widespread myths persist is the risk to anyone who questions what almost everyone believes.  Dare one be the first to declare the emperor has no clothes?  People who clearly understand the mythical nature of a widespread belief risk the disapproval of others, or worse, if they speak the truth about these myths. Historians have said those questioning the concept of witchcraft in the 1690s when the Salem, Massachusetts witch trials took place risked being accused of being witches themselves.  According to Peter Charles Hoffer, research professor of history at the University of Georgia, in his book The Salem Witchcraft Trials—A Legal History:

In the 1600s, popular or “vernacular” belief in witches was repeated in the writings of the most learned men.  ...  In the late sixteenth century, many educated men assumed that there was a spirit (invisible) world, and that the Devil and His witches could move freely through it.  ...  Everyone believed in witches ... no lawyers stepped forward during the [witch] trials to help the accused”, but if they had, the people making such accusations “would probably have accused the lawyers of witchcraft before long.”5

Just as lawyers speaking on behalf of defendants in the Salem, Massachusetts witchcraft trials of the 1690s would have been in danger of being accused of witchcraft themselves, as a lawyer representing or speaking in defense of people accused of mental illness today, a reaction I sometimes get is people accusing me of being crazy.  As psychiatry professor Thomas Szasz says in his book Suicide Prohibition—The Shame of Medicine, “The individual who assumes the task of setting such dislocations aright runs the risk of being destroyed in the process.”6

A related reason for the persistence of the concept of mental illness is support by supposed experts—psychiatrists and psycholo­gists—who make money and acquire professional prestige with the use of the concept.  Their status as experts would be lost and their incomes would drop dramatically if the falseness of the concept of mental illness were widely and generally acknowledged. As Judi Chamberlin wrote in her book about psychiatry, “Leaving the determination of whether mental illness exists strictly to the psychiatrists is like leaving the determination of the validity of astrology in the hands of professional astrologers.”7  Support for a myth from those perceived as experts, even if they actually are not experts, makes a myth harder to question.

The inexplicit nature of the concept of mental illness also contributes to the perpetuation of this myth.  Consider another myth: Can it really be proveevil spirits do not exist, and that they do not possess people?  Even as perceived by those who believe in it, the concept of mental illness is as amorphous and difficult to pin down in specific terms as the idea of evil spirit posses­sion.   Some, like Millen Brand in an article in 1970 in The Jour­nal of Contemporary Psychotherapy titled “Is Mental Illness a Myth?” argue against the notion that “because ‘mental illness’ isn't a medical or physical illness, it doesn't exist at all.”Psychologist Vernon W. Grant, Ph.D., in his book This Is Mental Illness, says this:

There is, again, a certain tendency in popular thinking to suppose that mental illness includes something more than the symptoms.  Thus a person is said to be doing or saying certain things because is mentally ill.  The illness, supposedly, causes him to act and speak as he does.  ...  It would be misleading, however, to say that the abnormal ways of feeling and perceiving are caused by “mental illness.”  These ways of feeling and perceiving are the illness.  Too often the term suggests a mysterious some­thing behind the unusual behavior.9

Other mental health professionals argue there is a mysterious some­thing behind, or causing, the person's behavior, or so-called symptoms, and that this mysterious something is a still undis­covered “chemical imbalance” in the brain or some other brain abnor­mality. They argue mental illness is, by definition, a disease of the brain, even if current science can find nothing wrong with the brains of supposedly mentally ill people.  Mental health professionals can't agree among themselves about whether mental illness is physical or non-physical. Being a vague concept makes the concept of mental illness more difficult to disprove and reject than it would be if it were clearly defined.

Also helping to perpetuate the myth of mental illness is the desire of some people to avoid personal responsibility for their actions and their lives.  These are the people who telephone or write to me hoping I will, as a lawyer, help them prove that because of their supposed mental illness they are not responsible for something they did.  These also are the people who go to a mental health professional and in effect say “Doctor, make me happy”: It is much easier to swallow supposedly antidepressant pills than get a better education or a better job, or a better marriage or intimate relationship, or be cured of a serious health problem like cancer.  People who neglect or mistreat their children sometimes rely on the concept of mental illness to relieve them of responsibility for how their children turn out as adolescents or adults.  What have they done wrong?  In many cases, the answer is plenty.  But they prefer to believe a disease (mental illness) that “could happen to anyone” intervened and that “It's no one's fault.”

Another reason is our dis­comfort with ignorance.  When we don't understand the real reasons for something, we often create myths to give us an illusion of understanding.  Believing a myth is more comfortable than acknowl­edging ignorance.  For example, ancient man did not understand the why behind rain and therefore created the myth of the Rain God.  As man gained a knowledge of meteorology and hence a true knowledge of the why behind rain, the Rain God was no longer needed, and the Rain God idea was discarded.  Earlier in human history, being baffled by the thinking and behavior of some people, people theorized the existence of evil spirits or demons and created the myth of demon possession, the belief that people behaved strangely or wrongly because they were possessed by evil spirits. In the words of A. John Rush, M.D., “Deranged behaviors were typically con­sider­ed curses from the gods by the Ancients... During the Dark Ages, Western civilization returned to beliefs in possession and super­natural forces as explanations for psychiatric disorders.”10 Today we attribute thinking or behavior we dislike and don't understand to mental illness.  However, mental illness is just as much a myth as curses by gods or possession by evil spirits.  Often we just don't know why people think or act as they do.  Rather than acknowledge our ignorance, which makes us uncom­fort­able, we create myths such as evil spirits or mental illnesses to provide an explanation.

Why aren't all crimes considered mental illnesses or the result of mental illness?  Some people do say “all criminals are sick.”  However, for those of us who don't agree with this viewpoint, the difference between crime and mental illness typically is this: When we feel we understand the motives behind the disapproved behavior, we make the behavior a statutory offense.  When we do not understand the motives behind disapproved behavior, we cover up our ignorance of these motives by creating a myth—the myth of mental illness—and say mental illness caused the behavior — and punish the supposedly mentally ill person with involuntary “hospitalization” or an involuntary outpatient commitment order, and forced psychiatric “therapy” such as “involuntary medication”, or involuntary guardianship of his person and property.  The myth of mental illness deludes us into believing we understand the reasons for disliked behavior that we in fact do not understand.

Another reason for continued belief in mental illness is drug company advertising designed to convince everyone mental illness is biologically caused.  Marcia Angell, M.D., former editor-in-chief of the New England Journal of Medicine, in her book The Truth About Drug Companies—How They Deceive Us and What To Do About It approvingly quotes bioethicist Carl Elliott saying “The way to sell drugs is to sell psychiatric illness.”11  Psychiatrist Colin A. Ross, M.D., makes a similar comment in his auto­biographical book The Great Psychiatry Scam—One Shrink's Personal Journey: “Whatever makes mental illness be biological sells drugs.”12  In Saving Normal—An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, psychiatrist Allen Frances says —

Psychotropic drugs are now among the very top best sellers for the drug companies.  Their stock prices would be cut by more than half were it not for the antipsychotics, anti­depressants, stimulants, antianxiety agents, sleeping pills, and pain meds.  ...  At the very top of the Pharma hit parade are the antipsychotics at a resounding $18 billion a year.13

Do you think drug company executives and advertising departments will tell the depressing truth about their products if widespread awareness of the truth would cause their company stock to be worth less than half what it is now?  It is more likely they are determined to maintain the myth that mental illness is biological and to hide the harm done by psychiatric drugs so they can continue to earn huge profits from selling them.  Adver­tising mental illness as biological when it is not to sell more psychiatric “medications” is unethical, but as Dr. Angell warns us in The Truth About Drug Companies, “Drug companies are in business to sell drugs.  Period.”14  And drug companies have huge advertising budgets.


REFERENCES

1 Judi Chamberlin, Own Our Own: Patient-Controlled Alternatives to the Mental Health System(National Empowerment Center 1977), p. 8

2 John Friedberg, M.D., https://ectjustice.org/neurologist-john-m-friedberg-on-ect, https://web.archive.org, archive date: February 19, 2017, accessed August 5, 2019

3 Steve Balt, M.D., “Is the Criticism of DSM-5 Misguided?”, psychiatrictimes.com, December 22, 2011

4 I borrow this phrase from Donald G. Smith, How to Cure Yourself of Positive Thinking, E. A. Seemann Publishing, Inc., Miami, 1976, p. 73.

5 Peter Charles Hoffer, The Salem Witchcraft Trials—A Legal History(University Press of Kansas 1997), pp. 4, 78, 87, 89, 90

6 Thomas Szasz, M.D., Suicide Prohibition—The Shame of Medicine(Syracuse University Press 2011), p. 105

7 Judi Chamberlin, Own Our Own(note 1, above), p. 9

8 Millen Brand, “Is Mental Illness a Myth?”, The Jour­nal of Contemporary Psychotherapy, Summer 1970, Vol. 3, p. 13

9 Vernon W. Grant, Ph.D., This Is Mental Illness(Beacon Press 1963), p. 4, italics in original

10 A. John Rush, M.D., “Diag­nosis of Affective Disorders” in Depression Basic Mechanisms, Diagnosis, and Treatment(Guilford Press 1986), p. 2 

11 Marcia Angell, M.D., The Truth About Drug Companies—How They Deceive Us and What To Do About It(Random House 2005), p. 88

12 Colin A. Ross, M.D., The Great Psychiatry Scam—One Shrink's Personal Journey(Manitou Communications, Inc. 2008), p. xv

13 Allen Frances, M.D., Saving Normal—An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life(HarperCollins 2013), p. 104

14 Marcia Angell, M.D., The Truth About Drug Companies—How They Deceive Us and What To Do About It(Random House 2005), p. 250

Don’t Be Fooled by Fake News

Don’t Be Fooled by Fake News

Don't Be Fooled By Fake News


Chuck Ruby, Ph.D., Psychologist


There is a pernicious problem in the media that has existed for some time, namely, "fake news." But unlike the political rantings intended to mislead the public and denigrate the sources of opposition information, this kind of fake news is truly fake and that claim can be demonstrated.

The fake news I am referring to is the multitude of claims made by mental health researchers that show up in professional journal articles and popular news headlines, but that have no empirical basis. Instead, many times the results of research are presented in language that gives the impression of impactful scientific discovery supporting the reality of mental illness, as illness. It serves to mislead and misinform both lay and professional audiences. This is unethical and counter to the principles of "do no harm" and "informed consent."

A typical example was a very recent article published in The Journal of Clinical Endocrinology and Metabolism with the title, "Antidepressants reduced risk of mortality in patients with diabetes mellitus: a population-based cohort study in Taiwan". This title is clearly stating that antidepressant drugs were the causative factor in reducing deaths among diabetes patients. It is also implying the value, safety, and effectiveness of the drugs for the treatment of depression. However, if one looks at the study's methodology and results, it is clear this is fake news.

Because the study was retrospective and the people were not randomly assigned to groups, with one of the groups being prescribed antidepressants and the other not, causation cannot be determined. Correlation is the only conclusion possible. Thus the oft cited caution: "Correlation does not equal causation."

The study found that people who are prescribed antidepressant drugs had a lower risk of death. The relative risk figures ranged from .20 to .73, meaning the risk of death for those taking the drugs was between 27% and 80% lower than those not taking the drugs. Using a 9% risk of death for diabetes patients over 10-years, this would mean those who take antidepressants would lower their risk to between 2% and 7%. Such a finding gives the impression that the drugs are beneficial, not only for depression but also for reducing mortality.

However, to be intellectually honest, the only thing that can be concluded with this data is that antidepressant drug use is correlated with lower mortality among diabetes patients. It cannot be concluded that "Antidepressants reduced risk of mortality...." [Italics added] as is stated in the article's title.

Let's look further into the data to see the real news. According to the researchers, the higher mortality non-drug group was composed of more people who were: male (lower life expectancy than women), elderly (more likely to die), and poor (less access to medical care). The non drug group also had a higher incidence of heart failure and more severe complications from diabetes (perhaps because of being male, older, and poorer?).

These factors are given only cursory attention in the article. The researchers point them out, yet they don't appear to place much significance in them. Still, they can clearly explain why on average those in the non-drug group died earlier than those in the drug group, independently of whether or not antidepressants were used. At the very least, these factors cast significant doubt on the researchers final conclusion as stated in the article's title.

So, the correlation between antidepressant use and mortality may very well be bogus. The real correlation is very likely between mortality and these other factors. The apparent correlation between antidepressant use and mortality is meaningless. The next time you see headlines claiming bold medical findings, especially those related to mental illness, take the time to consider how most of those studies are based on correlations, not sound evidence of causation.

A popular website humorously demonstrates this problem of "spurious correlations." At this site you can see several examples of apparently strong correlations between two variables that have no true causative relationship. For instance, there is a .95 correlation (unheard of in medicine or the social sciences) between per capita cheese consumption and dying by becoming tangled in your bedsheets. If we took the approach of the above antidepressant and mortality study researchers, we would conclude that eating cheese causes us to die by getting entangled in our sheets! What a financial hit to the cheese industry but a boon to other completing snack companies.

Other meaningless but very strong correlations shown on this site are:

  • the number of people who drown by falling into a pool and the number of Nicolas Cage films. Watching Nicolas Cage films causes people to fall into pools and die.
  • U.S. spending on science, space, and technology, and the number of suicides from hanging, strangulation, and suffocation. Increased spending on science, space, and technology causes people to commit suicide by hanging, strangulation, and suffocation.
  • the per capita consumption of margarine and the divorce rate in Maine. If you want to stay married in Maine, don't eat margarine.

Incidentally, a troublesome finding of the antidepressant/mortality study, and that wasn't reflected in the title, is that one of the seven psychiatric drugs tested was correlated with a 48% increased risk of death. The drug is called a reversible inhibitor of monoamine oxidase A (RIMA), which increases the effects of serotonin, norepinephrine, and dopamine in the brain. This drug is said to offer "a multi-neurotransmitter strategy for the treatment of depression." 

Only one short sentence in the antidepressant/mortality article mentions this potential danger of RIMA, but says nothing else about it. It is also given trivial mention in the concluding remarks: "Most ATDs but not RIMA were associated with significantly reduced mortality among population with comorbid DM and depression." [Italics added] Notice that statement didn't say that RIMA increased the risk of death. Why wasn't the article entitled, "Newly developed drug for depression shown to increase risk of death."?

Be careful what you read. Don't trust the headlines as they are usually written in a way to grab attention, not fully summarize the matter. Moreover, don't unquestionably trust the mental health industry as its leaders have a political and financial agenda that many times outweighs any interest in accurately portraying research results. Be informed and take the time to learn the truth.

Reaching Out

Reaching Out

Reaching Out


Joe Tarantolo, M.D., Psychiatrist


Reaching out to the other fringe groups in conflict with conventional medicine. (Yes, ISEPP is at the margins, not with the conventional.)

Wise Traditions is the quarterly journal of the Weston A. Price Foundation, an organization that is dedicated to restoring “nutrient dense” food to our  20th-21st century high fructose corn syrup processed food addicted diets. High fat, unpasteurized milk, grass fed beef, wild salmon, fermented vegetables, anti fluoridation, anti vaccination---you get the picture.

Sally Fallon, an old friend whose cook book is my frequent guide in the kitchen , called me recently to ask me to present a talk this fall at their conference in Dallas. Their yearly conference attracts over a thousand folk (has ISEPP ever had a thousand attendees?). I hadn’t spoken to Sally in several years but she remembered a comment I had made about the dangers of antidepressants, viz., they induce “not caring.” She asked me to present  a talk. I accepted. The title of my talk: NOT BY BREAD ALONE DOTH MAN LIVE, EVEN IF IT’S SOURDOUGH: A CRITIQUE OF ANTIDEPRESSANTS AND THE MEDICAL MODEL IN PSYCHIATRY.”

My observations of those I see and read and with whom I interact in the alternative world, the herbalists, the naturopaths, the nutritionists is that they tend to make a mistake similar to the conventional model. But because they are not burdened by the prescription pad and the legal torments of forced treatments, they do less harm. But, they too make the mind/body split and tend to characterize “mental illness” as a “brain disease.” In fact “brain health” is a big seller in the alternative world. I am not dumping criticisms on brain herbs. I love them: Bacopa, Gingko, Rosemary, Kava, not to mention the plethora of herbs called adaptogens such as Reishi mushrooms  and Ashwaganda (one of my favorites, a potent Indian herb very useful in the prevention and treatment of cancer). But what I will tell the Wise Traditions crowd is that no amount of the best high Vitamin A and E cod liver oil will cure a bad marriage. High dose vitamin therapy will not cure schizophrenia. Actually, the high dose vitamin crowd doesn’t do too badly with schizophrenia. If you read the Canadian guru, Dr. Carl Pfeiffer, who claims an 80% cure rate of schizophrenia, what you see is he takes the schizophrenic off of neuroleptics and gets rid of those who don’t cooperate, i.e., they are not included in his statistics. Yes, taking people off of neuroleptics will improve their chances of getting better. I suspect it has little to do with the vitamins.

A healthy body does not determine psychological health. The person dying with a terminal illness can be psychologically and spiritually healthy: facing mortality with courage, leaving behind old complaints and petty slights. I was thinking about “The Longest Day”; yesterday was the 75th anniversary of D-Day. I’m told that General Eisehower could not sleep the whole week before the Normandy invasion. I am sure he did not go to a psychiatrist and complain about insomnia. Ike was psychologically healthy, preoccupied about the thousands of boys he was sending on an uncertain task to certain death. He was healthy. Hitler took a sedative, he was sick!

Mental health is not about being happy. Evil sadists are often happy and they are mentally sick. Mother Teresa who cared for the dying struggled with despair. She was mentally/spiritually healthy. Mental health includes the ability to hold conflict, i.e., to suffer. The psychotic, the manic, the obsessed, the somatically preoccupied, the sadist, the pathologic narcissist, all take flight from suffering. Drugging and ECT aid in this escape caper. They do not promote mental and spiritual health. That’s the second time I used the term “spiritual.” What’s up with spiritual? The terminology about health is fungible. The pre-enlightenment idea of health was being at peace with God/Yahweh/Allah. We post-enlightenment religious types are not satisfied with that too easy of a position. The capacity to doubt and question and struggle with meaninglessness must be part of the picture. There is no easy path.

Morality-Driven Illnesses

Morality-Driven Illnesses

Morality-Driven Illnesses


Chuck Ruby, Ph.D., Psychologist


Here we go again!

In response to political pressure, The World Health Organization's legislative body just ratified a June 2018 proposal to redesignate "gender incongruence" (called "gender dysphoria" in the DSM) so that it is no longer a mental illness.1 This change will be reflected in the 11th edition of the International Classification of Diseases (ICD). While I applaud any effort to depathologize natural human variation in interests and preferences, is this really how it works? Mental illnesses are voted in an out of existence because of political pressure and changes in ideas about morality? Well, yes, that is precisely how it works. 

The advocates of this change claim it "...was taken out from the mental health disorders because we had a better understanding that this wasn't actually a mental health condition and leaving it there was causing stigma."2 But we don’t identify real illnesses this way. Instead, we study the problem to determine what is causing the symptoms. It is only after we have a good theoretical hypothesis for, or actually find, the bodily defect responsible for the symptoms that we dub it an illness. We don’t merely claim that we have a “better understanding” of it without providing any scientific evidence or critical reasoning. It seems that "a better understanding" in this case means that they just thought it was a good idea to do it that way.

So how do we define mental illness? The ICD defines it as "a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions."3 (I wonder why just in "most cases"). The DSM's definition is far more convoluted than the ICD's, but it still seems to include just about anything that causes distress and interference in social functioning. Since it is clear that bucking the conventional ideas and behaviors about gender is going to attract righteous indignation and cause distress for the person, why wouldn't gender incongruence be considered a mental illness regardless of political pressure?

Further, keep in mind that gender incongruence was not completely removed from the ICD with the World Health Organization’s vote. Instead, it was only removed from the section dealing with mental illness but it was added to the section entitled "conditions related to sexual health." This was done in order to "...reduce the stigma while also ensuring access to necessary health interventions...."It is there along with the paraphilias, sexually transmitted diseases, and premature ejaculation. But how does removing gender incongruence from the mental illness section and placing it into the real illness section reduce the stigma? And why would we need a separate category identifying "necessary health interventions" that only transgender people suffer unless it is because of their transgender status? Doesn't this just worsen and perpetuate the stigma?

There have been other examples of this kind of shell game of eliminating mental illness by moral decree. For instance, during antebellum America, "dysaesthesia aethiopica" and "drapetomania" were discarded as mental illnesses.These had been used to diagnose slaves' laziness and their urges to escape their masters, respectively. They were considered serious mental illnesses at the time and slave owners must have been quite worried that they would contagiously spread throughout plantation life. But we now rail against the blatant racist morality upon which they were founded. 

This is also what happened in 1930s Germany when Dr. Hans Asperger came to the Nazi party's aid to designate the inappropriateness of socially reticent children as "autistic psychopathology."6 With this mental illness Dr. Asperger explained why those children didn't want to join the Hitler Youth and gave a reason for the Third Reich to euthanize some of them. We have heard echoes of this mental illness throughout the subsequent decades in the familiar name "Asperger's disorder," until it was removed from the DSM in 2013 and incorporated into the more serious designator "autism spectrum disorder" (by a vote).

Lest you think these examples were due to uninformed or prescientific minds of the times, there are more recent examples. For instance, the American Psychiatric Association (APA) asked its members in attendance at its 1973 annual convention to vote on whether homosexuality was a mental illness. The resulting tally was 3,810 in favor of its illness status and 5,854 votes against. Consequently, the "homosexuality" designator was removed from the DSM as a mental illness.7  However, even though "homosexuality" was no longer considered a mental illness, those same people who had earlier been diagnosed with homosexuality could still be diagnosed with "sexual orientation disturbance," "ego-dystonic homosexuality," or other diagnostic categories that reflect the difficulties inherent in living a gay lifestyle, especially openly. It is absurd to vote on whether homosexuality is a mental illness, it is even more absurd that 40% of those voting believed it was an illness. And this is science?

In the 1980s, "masochistic personality disorder" was considered for inclusion in the DSM. This disorder was thought to be the cause of (mostly women) allowing themselves to be abused by others (mostly men). Because of its glaring bias against women, the DSM committee proposed adding another disorder called "sadistic personality disorder" to balance out the situation with a mental illness that was equally biased against men. Fortunately, both were eventually dropped from consideration. The DSM task force that debated this issue included the wife of the task force chair. At one point she noted that one of the proposed symptoms for the disorder applied to her. In response, the chairman removed the symptom from the list.8 Even though masochistic personality disorder was dropped, there was a diagnosis remaining in the DSM section on conditions needing "further study." It was "self-defeating personality disorder," which mirrored the diagnostic criteria of masochistic personality disorder. Can it be more obvious?

All mental illness diagnoses suffer from this very same problem, including gender dysphoria. They aren't diagnoses of true illnesses. Instead, they are designators for experiences and behaviors that are considered by DSM or ICD committee voting members to be abnormal because they are in conflict with appropriate ways of living. This is reflected in the branch of psychology that deals with mental illness - abnormal psychology. But there is more to it than just being abnormal (it would require a whole chapter to explain the phantom concept of abnormality). There is also an element of contempt and disgust that is reflected in popular comments about those labeled with mental illnesses, such as, "He's not right in the head," and "Something is wrong with her." We don't see similar comments about right and wrong regarding true illnesses such as cancer and diabetes, unless the illness has to do with a moral failing such as with sexually transmitted diseases.

But just how do we distinguish between this kind of normal (right) and abnormal (wrong) mental functioning and behavior? If we dig down beneath the layers of medical disguise, we inevitably find the answer. The kind of abnormality associated with mental illness and the commonly held contempt about it is based on morality, not science. This includes the most recent example of how moral standards were the basis for identifying gender incongruence as a mental illness until this month, when a different set of moral standards were used to justify eliminating it as a mental illness. This move was not science and it does nothing to address the larger problem of allowing the medical and mental health industry to dictate appropriate morals.


1https://www.hrw.org/news/2019/05/27/new-health-guidelines-propel-transgender-rights
https://www.cnn.com/2019/05/28/health/who-transgender-reclassified-not-mental-disorder/index.html, paragraph 5.
World Health Organization. (1994). The ICD-10 Classification of Mental and Behavioural Disorders.p. 11. Retrieved from: https://www.who.int/classifications/icd/en/bluebook.pdf.
 4 https://www.cnn.com/2019/05/28/health/who-transgender-reclassified-not-mental-disorder/index.html, paragraph 5.
 5 Cartwright, S. (1851). Diseases and Peculiarities of the Negro Race. DeBow's Review,11.
 6 Sheffer, E. (2018). Asperger’s Children: The Origins of Autism in Nazi Vienna. New York: W. W. Norton & Company.
 7 Burton, N. (2015, September). When homosexuality stopped being a mental disorder: Not until 1987 did homosexuality completely fall out of the DSM. Psychology Today. Retrieved from: https://www.psychologytoday.com/us/blog/hide-and-seek/201509/when-homosexuality-stopped-being-mental-disorder.
 8 Kutchins, H. & Kirk, S. (1997). Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: Free Press.