From the Executive Director

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.

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.

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.

Mental Health Screening: Public Service or Dangerous Marketing?

Mental Health Screening: Public Service or Dangerous Marketing?

Chuck Ruby, Ph.D., Psychologist


In 2016, the Centers for Disease Control and Prevention (CDC) urged that children be screened for autism as early as three years old.1 In 2018, the American Academy of Pediatrics (AAP) recommended that all teenagers be screened for depression.2  The National Alliance on Mental Illness (NAMI) also supports widespread mental health screening:

Mental health screenings are a key part of youth mental health. Approximately 50% of chronic mental health conditions begin by age 14 and 75% begin by age 24. At the same time, the average delay between when symptoms first appear and intervention is 8-10 years. Mental health screenings allow for early identification and intervention and help bridge the gap.3

To the ill-informed, these pronouncements appear to be of great public service. Who could argue the virtues of identifying mental health problems in our children as early as possible so that we could offer them assistance in avoiding a life of suffering?

However, to those willing to question the conventional wisdom, and think critically about the matter, quite a different picture emerges. Screening tools are dangerous to our children, but they are helpful to the mental health industry by increasing the potential market of consumers.

Whereas it is true that mental health screening is a cost-effective substitute for full psychological testing, it nonetheless presents a significant danger. This is the danger of false positives. A false positive is when a screening tool wrongly identifies a child as having a problem (e.g, the DSM definitions of depression, autism, anxiety, etc.) when, in fact, the child doesn't have that problem.

Keep in mind that childhood problems do exist, even if they aren't illnesses. So, for instance, a child experiencing traumatic circumstances might withdraw from the world and that self-imposed isolation can have devastating effects. But this is not an illness called "depression." It is an understandable problem and an expectable reaction to trauma.

The false positive problem occurs even with the most accurate of screening instruments. An instrument's accuracy is stated as sensitivity and specificity. Sensitivity is the rate at which the tool correctly identifies a person with the problem. Specificity is when the tool correctly identifies a person who doesn't have the problem. Sensitivity and specificity rates of .80 are considered "levels that are reasonably good for a screening instrument."4

But regardless of this "reasonably good" accuracy, when we screen for any low base-rate event, such as the problems that are subsumed under the label "mental illness," we will necessarily have a large number of false positives. This results in many, many children being identified as the target of psychiatric intervention when there is no real problem.

To see just how dangerous this is, let's look at the statistical nuts and bolts in the table below. Take a hypothetical population of 1,000 kids and screen them for depression with an instrument that has a .80 accuracy rate. According to the CDC, 3.2% of children between 3 and 17 years old have been diagnosed with depression.5 This is a 3.2% base-rate. With this data, we would get the numbers below.

                       Actually Depressed?
Screening Results: Yes No Total
     Depressed 26 194* 220
     Not Depressed    6 774 780
     Total 32 968 1,000

* false positives

So out of 1,000 children and a 3.2% base rate of depression, there will be 32 children who actually are suffering from the problems labeled "depression" and 968 who aren't. A screening instrument with sensitivity and specificity of .80 will correctly identify 26 of the depressed kids. It will also correctly identify 774 of the non-depressed kids. However, it will wrongly identify 194 of the non-depressed kids as depressed. This is a 88% false positive rate (194 ÷ 220 = .88).

The significance of this cannot be overstated. When using a screening instrument like this, nearly 9 out of every 10 children who are identified as depressed wouldn't really be suffering from that problem. Nevertheless, they would still be subjected to the attention and potential treatment of the mental health system, with all of the accompanying stigma and other harmful effects, such as the prescription of unnecessary psychiatric chemicals.

And what do you think would happen when the children or their parents disagree with the professional's screening conclusion and become resistant to subjecting the child to treatment? Of course, it would very likely be seen as either a sign of anosognosia (lack of insight into one's illness) or as parental neglect in refusing to get treatment for their children.

This is frightening.

There are about 74 million children and adolescents living in the United States.When using screening instruments like this, imagine the untold number of kids who are not suffering from the problem but who would nonetheless be a target of the mental health industry. If all of them were screened with this tool, millions would be falsely targeted! And, if you are skeptical about whether our children would be subjected to these harmful screenings, just remember that the American Academy of Pediatrics recommended that all teenagers be screened for depression.

With the screening of real medical problems, such as cancer, there is a potential solution to this false positive problem. It is to conduct a more detailed examination of the patient with laboratory tests such as X-rays, CAT scans, and blood tests to determine if the disease is actually present.

But with the problems labeled "mental illness," there is no follow up to the screening instrument because there is no internal dysfunction that can be detected with a more detailed examination. Even more in-depth psychological testing wouldn't suffice since psychological tests are also screening instruments, they're just more complicated. But, they do not assess internal malfunctioning.

Mental illness diagnoses refer to problems only, not bodily disease processes that cause the problems. In fact, the formal diagnostic guidelines in the DSM are screening instruments themselves! They are merely checklists of "symptoms." In this sense, the DSM has the same false positive danger as does any other screening instrument. Using it to diagnose "mental illness" results in an overabundance of people wrongly branded with mental illness diagnoses. Yet, those people become a fertile market for the mental health industry.


1https://www.cdc.gov/media/releases/2016/p0331-children-autism.html.

2https://www.npr.org/sections/health-shots/2018/02/26/588334959/pediatrians-call-for-universal-depression-screening-for-teens.

3https://www.nami.org/Learn-More/Mental-Health-Public-Policy/Mental-Health-Screening.

4https://academic.oup.com/jpepsy/article/41/10/1081/2951811.

5https://www.cdc.gov/childrensmentalhealth/data.html.

6https://www.census.gov/quickfacts/fact/table/US/AGE295216#viewtop.

The Politics of ISEPP

The Politics of ISEPP

Chuck Ruby, Ph.D., Psychologist


Within the past few weeks, we've seen many comments on the ISEPP Listserv expressing support or displeasure with political figures in America. I'm sure you are all familiar with the current difficulties felt by many U.S. citizens and even by those beyond our borders who are significantly affected by what political leaders are doing in this country. I posted a comment about this on the Listserv encouraging people to refrain from such political postings, but given its importance, I also wanted to share my thoughts about the "politics of ISEPP" with everyone, not just members.

As a non-profit 501(c)(3) organization, we are prohibited by the Internal Revenue Service from endorsing or opposing any particular candidate. Also, we cannot have a substantial portion of our efforts, in time or money, spent on influencing legislation. We have filed the proper paperwork to authorize our support or opposition to specific policies and legislation, not candidates, but we have to be careful how much of our time is spent doing so in order to keep it under the "substantial portion" level.

Obviously, this prohibition does not apply to our individual members in their private lives. To the contrary, I encourage all of us to speak up about our political views, to use critical thinking in informing ourselves about significant issues, and to vote for representatives who we believe will best ensure policies consistent with our views. But, and this is very important, we cannot use ISEPP's platforms, including the Listserv, in that effort. Our other platforms that are also off limits are our website, Facebook, Twitter, Instagram, YouTube, and LinkedIn sites.

Our mission statement declares that ISEPP is "not affiliated with any political or religious group." While this is true, it doesn't mean ISEPP isn't political. In fact, I think the bulk of our efforts are political. What I mean by this is that our work is focused on critiquing the conventional mental health industry with the goal of eliminating the inhumanity in the system and of encouraging the development of more humane and respectful ways of assisting people who are suffering from emotional distress. Thus, our motto: "Restoring Humanity To Life."

This is a political mission in the sense that it has to do with power and who exercises that power, even when our efforts are not through formal legislative bodies. We believe in self-determination and human dignity. This means the individual should maintain that power. In opposition to this, the conventional mental health system believes they, with the backing of the State, should hold that power.

This is the power to decide whether people are acting, thinking, feeling, and believing things in socially appropriate ways. In essence, it is a moral judgment about the proper ways of being. It is a travesty that the mental health industry has been given the reigns of this power since they have no expertise in morality and shouldn't be given the authority to make moral decisions.

Laws about appropriate social behavior are necessary in a civil society, but that is the jurisdiction of representative legislatures, not medical or mental health professionals, especially since the people labeled with mental illness diagnoses are not literally ill. But, neither legislative bodies nor the mental health industry should try to prescribe or proscribe beliefs, thoughts, and emotions. That would be for each person to decide in the context of his or her own religious, spiritual, and intellectual views. ISEPP's political mission is to ensure individuals retain this power.

In order to be true to our mission, ISEPP cannot ally with any political party or candidate. We ally with political policies. Given that our focus is on creating a humane system of assistance to people in distress, and respect for human autonomy, our principles span across candidate and party lines. We support the notions of compassion for fellow human beings, self-determination, dignity and worth of human life, concern for the effects of distressing social contexts, the value of faith and trust in the "process," appropriate governmental assistance to people in distress, the ideas of personal responsibility for one's actions, and the avoidance of harm and dependency. When, as ISEPP members, we limit our support to a particular party or representative, we can weaken our ability to fulfill the mission, because no one party or candidate encompasses all these tenets and many are in opposition to them.

It is easy to get wrapped up in political intrigue. Many of the painful things we see happening among our elected representatives of all persuasions seem beyond the pale. I think our human tendency to resort to anger and attack in order to soothe intolerable feelings like this is behind the political polarization that occurs. Perhaps it is an evolutionary holdover from when anger served a survival purpose - anger is more useful than despair (I think Arnold Schwarzenegger said that in Terminator 3). For what ever reason, resorting to anger in today's world, along with the accompanying bashing, blaming, name-calling, personal attacks, demonization, and righteous indignation, does not serve us well when distressing things happen. They only make things worse.

Instead, it would behoove us to recognize the incredible variation of our desires, interests, and goals. Each of us is stuck "inside" ourselves forever and we must make choices, not only in what we do, but also in how and what to think. Our reality is limited to ourselves. This includes what kind of representatives are best for us. But, we cannot get "outside" ourselves to see a universal or absolute truth about the matter, and then go back inside in order to see if we are "right." Therefore, we must accept that fact that we will forever disagree, sometimes vehemently. But, still, it is possible to cooperate respectfully instead of competing, especially when it comes to prosecuting ISEPP's mission.

ISEPP is not a forum for political ideas outside our mission. Venturing outside that political mission will only serve to create friction among us. We have plenty of real enemies to battle, we don't need to create more within our ranks. Let's move forward together, not apart.

Mental Illness Again Implicated in Violence

Mental Illness Again Implicated in Violence

 

David Katz, the Jacksonville shooter, is the latest in a long line of scapegoats for an apparent epidemic of violence. Just this past Sunday he opened fire at a e-sports tournament, wounding 10 and killing three, including himself. Katz' motives are still under investigation, but people are already implicating the bogeyman of mental illness. See CNN's reporting today - Jacksonville shooter had a history of mental illness and police visits to family home.

According to the report, Katz was prescribed "a number of psychiatric medications," including antidepressants and antipsychotics. He also was said to have seen "a succession of psychiatrists." These statements imply that Katz' a mysterious alien entity residing with him, called "mental illness," was the culprit. There is even current quibbling over what the "correct" diagnosis was.

A more reasonable explanation would be that Katz had been struggling with several real personal dilemmas, he wasn't infected with a nonsensical illness of the mind. Just one example is that he had to witness his parents' vicious divorce and custody battle over him. Instead of following the suggestion of his father for peer-based support group assistance during middle school, there was the default turn toward psychiatric treatment, as if there was something in him to truly treat via medical means.

If the treatment went as it typically does, this would have meant increasing focus on him as the problem, rather than his circumstances. Being subjected to a "succession of psychiatrists" means that one superficial attempt after another didn't work, so he was shuffled to the next psychiatrist in line. He likely felt the increasing sense of being misunderstood and persecute by those medical attempts to sedate him.

This is just the last in a long and continuing line of horrific episodes. It will continue. It will continue because the authorities are not looking at the causes of these events. They are trying to find a scapegoat. Three hundred years ago that scapegoat would have been witchcraft or demons. Now, it is the internal infection of "mental illness."

To make matters worse, the alleged treatment for that infection is typically to coerce the person into compliance. In other words, it is to get them to stop complaining about the problems (euphemistically called "symptoms reduction"). And the icing on the cake is that psychiatric drugging into a state of agitation clearly increases the chances of impulsive outbursts of violence. See ISEPP's White Paper on the link between psychiatric drugs and violence.

Genetic Language Smokescreen

Genetic Language Smokescreen

Genetic Language Smokescreen


Chuck Ruby, Ph.D.


The online magazine Science published a study titled "Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap," which purports to show genetic underpinnings of several mental disorders. It claims a breakthrough in understanding the genetic causes of these "disorders." 

I’m not a geneticist but my read of this research suggests it is another language smokescreen that obscures a simpler, more humane, and non-disease description of human problems. It is a way to continue on the charade of the myth of mental illness through a verbal sleight of hand trick. The genetic and medical terms used sound impressive (e.g., transcriptomic, phenotypes, pleiotropic) but they are euphemisms that refer to far more common, non-disease matters. Yet because they are used, they give the flavor of real disease.

Just a quick look at the study's abstract demonstrates this deceptive ploy:

"The predisposition to neuropsychiatric disease involves a complex, polygenic, and pleiotropic genetic architecture. However, little is known about how genetic variants impart brain dysfunction or pathology. We used transcriptomic profiling as a quantitative readout of molecular brain-based phenotypes across five major psychiatric disorders—autism, schizophrenia, bipolar disorder, depression, and alcoholism—compared with matched controls. We identified patterns of shared and distinct gene-expression perturbations across these conditions. The degree of sharing of transcriptional dysregulation is related to polygenic (single-nucleotide polymorphism–based) overlap across disorders, suggesting a substantial causal genetic component. This comprehensive systems-level view of the neurobiological architecture of major neuropsychiatric illness demonstrates pathways of molecular convergence and specificity.”

  • neuropsychiatric disease, polygenic, pleiotropic,architecture, dysfunction, pathology, transcriptomic, phenotypes, perturbations, dysregulation, polymorphism, and molecular convergence and specificity??

Now doesn't that sound impressive? I'm certain that most people will glaze over about half way through it and stop reading, and instead just accept the claims like this headline:

"Major mental illnesses unexpectedly share brain gene activity, raising hope for better diagnostics and therapies."

I’ve taken the time to wade through the abstract's wording and replace all that nifty medicaleze and substituting more common and humane terms:

"Behaviors have a genetic substrata. However, we don’t know how that substrata causes those behaviors. We examined cellular RNA activity to see how they varied across different types of behaviors. This showed differences and similarities among those behaviors, suggesting they have a genetic substrata.”

All this research says is there are genes being expressed as people experience the problems we call “mental illness” and that genetic expression is shared to some degrees across different types of problems, but also retains a degree of differences across those problems.

Didn’t we already know this?

Further, don't we already know that any human activity or experience is going to be represented by underlying gene expressions? What does that have to do with verifying something as an illness? Ans. Nothing. Looking from the outside, this smokescreen gives the impression of precision science identifying and confirming that mental illnesses are about genetic anomalies. But on the inside, once the smokescreen is blown away, it is merely pointing out that gene activity is going on during any human behavior.

 

Ignoring the Real World of Depression

Ignoring the Real World of Depression

Ignoring the Real World of Depression


Chuck Ruby, Ph.D.


The Observer published a January 7th article by Johann Hari entitled, "Is Everything You Think You Know About Depression Wrong?" In it he questions the prevailing views about depression being caused by a chemical imbalance, among other things, such as the grief exception in the DSM5. One day later, Dean Burnett, identified as a "doctor of neuroscience," critiqued Hari in one called, "Is Everything Johann Hari Knows About Depression Is Wrong?" Dr. Burnett's piece addresses Hari's claims by, first, denigrating him, and then by basically claiming the bulk of what Hari said was either not true or that it is common knowledge and, thus, inconsequential. But there are some huge problems with Dr. Burnett's critique.

Whereas considering one's reputation is important in assessing an author's credibility, still the validity of the material is an independent matter. Disreputable people can claim valid facts. Ad hominem attacks are never helpful. Ending the opening section after having denigrated Hari with a comment to imply something like, "Let's see what he has to say anyway" ("...assume Hari has written this article with 100% good intentions and practices.") Dr. Burnett doesn't negate the preemptive negative effect of questioning his credibility.

Dr. Burnett avoids, as do most advocates of the medical model of human suffering, the big question: Is depression (and all other so-called "mental illnesses) a brain illness as supported by scientific evidence? Demonstrating biological underpinnings of depression obfuscates the issue. All things human are accompanied by biological underpinnings without being considered illness. Take for example hair color, height, temperament, athleticism, and cognitive ability. All these things are possible because of their biological underpinnings. But none are considered illnesses. It is only when we can scientifically demonstrate some lesion, malfunction, or defect in that biology that leads us to a conclusion of illness. For instance, we can demonstrate dangerous blood glucose levels with diabetes; detect damage to bones in a broken leg; and observe the ravenous onslaught of cancer. There is no such thing happening to the biology that underlies depression (or any other mental illness). Given this lack of evidence, medical treatment is not appropriate, and potentially dangerous.

And please don't counter with the worn-out "but things like chronic fatigue syndrome and restless leg syndrome don't have evidence of pathology either." First, you're right. But I question whether these "syndromes" are actually physiological illness, since they can be explained by other means. But second, this lack-of-evidence problem doesn't apply to a whole grouping of disease entities in real medicine. The so-called mental illnesses are all this way. Imagine if all pulmonary diseases were created without any evidence!

The chemical imbalance theory of mental illness does not need to be "challenged." One cannot challenge a theory that has no supporting evidence, other than to point out it has no supporting evidence. Science doesn't work by proving negatives; i.e., that there is no chemical imbalance. Those who assert the hypothesis are obligated to provide the evidence, and they haven't. There has never been any evidence presented that demonstrates a chemical imbalance (or any other bodily malfunction) causes depression or that depression is an illness. Keep in mind the term "imbalance": an imbalance vs. a balance must be demonstrated. Not just neurochemical changes that occur when a person is depressed. Neurochemical changes occur for every human experience and activity. And this empty theory has been going on since the 1950's when the drug industry and psychiatry stumbled upon chemical "cures." The convenience of this coincidence cannot be ignored.

Despite pointing out that Wikipedia outlines "several factors widely considered to be important" in depression, physicians, psychiatrists, and drug companies (at least as of last night when I watched the Abilify commercial) still encourage people to think it is a chemical imbalance. People don't go to Wikipedia for depression; they go to their doctor. Those of us in the business know first hand that those doctors tell people they have a chemical imbalance, sometimes for life, and sidestep "bio-psycho-social" factors as mostly irrelevant (actually, and not surprisingly, they do give some attention to the "bio-" part).

They also do not explain how drugs work, what they do, what they don't do, and the harmful effects of taking them, especially in combination with other drugs and over a long period of time. In my 20 years of doing this work I have never heard of even one example of such an explanation.

All this despite what NHS, NIMH, NAMI, CDC, or any other organizations may display on their websites and despite what faculty and students talk about in universities. The truth is that where the rubber meets the road it is explained as a chemical imbalance and pills are pushed, and the psycho-social part is just portrayed as an afterthought. The widespread belief in this chemical imbalance by the lay public attests to what they are being told.

While it is clear Hari's exaggerated use of depression being diagnosed one minute after the loss of a baby was intended for effect, any currently practicing psychotherapist, psychologist, psychiatrist, or physician knows full well that it doesn't take weeks of complaints before a person is diagnosed with depression. That can happen within minutes of walking into a doc's office for the first time and complaining about the so-called symptoms of depression. We who actually do this work on a daily basis hear about examples from the victims themselves. And the typical response by the doc is a prescription for antidepressants, or worse yet, benzodiazepines. "Oh, and yes, it would be a good idea to talk to someone."

It is not about what Dr. Burnett knows that is important. It is about what happens to that "average person” he talks about when they seek out help in real life. And what happens to them is a shame. That is why what he knows and what they know is wildly different, as he points out.

And, finally, people do not get depression in their brain. Depression is a meaningful dilemma that resides in experience. It is not a medical matter, nor a matter to be drugged, anymore than a rough day should be drugged with a stiff drink. But then, we don't consider stiff drinks as medicine and we don't think of bartenders as doctors.

Bipolar Disorder – Missing the Point!

Bipolar Disorder – Missing the Point!

Bipolar Disorder - Missing the Point!


by Al Galves, Ph.D.


A recent study on bipolar disorder published at the International Journal of Epidemiology has problems. The biggest problem is it is not asking the most important question: How is bipolar disorder related to the desire and ability of people to live the lives they want to live? Bipolar disorder is a state of being characterized by certain subjective feelings and certain behaviors. If we assume that human beings are organisms which want to live their lives in enjoyable, satisfying ways, what does this state of being have to do with their ability or inability to do that?

The study is being done with apparent ignorance of the fact that human beings are meaning-making, desiring organisms who want to live their lives in certain ways and who, if they are unable to do so, are going to experience the states of being associated with all of the mental illness diagnoses. The study is missing its proper context. It is hanging in a kind of limbo. In the absence of a proper context, it is unlikely to be very useful to human beings.

I’m making an assumption here. I need to explicate it. I am assuming that human beings want to live enjoyable, satisfying lives. I’m also assuming that, in order to live satisfying and enjoyable lives, the great majority of human beings will have to be able to love the way in which they want to love and work (express themselves) in the way in which they want to express themselves. In the words of the positive psychologists, they will have to use the best part of themselves in the interest of something larger than themselves, have positive relationships with others and experience competence, achievement and mastery.

What evidence is there for these assumptions? What do human beings want in their lives? What are the roots of happiness? What are the ingredients of human well-being? What are the components of health? What are some of the factors with which health is associated?

I don’t have the answers to these questions. But I think these are the questions that need to be asked.

How does this relate to this study? This study is gathering information about people who have been diagnosed with bipolar disorder. It is comparing that information with similar information on persons who are not diagnosed with bipolar disorder or who have not been diagnosed with any psychiatric disorder. It is gathering information on the neurocognitive functioning of these people, their temperaments and personalities, their motivated behaviors, their life stories, their patterns of sleep and circadian rhythms and the outcomes and courses of their lives. It is also gathering information on biological factors – genetic components, the nature of the disease and nutrition.

But this data is being gathered in the absence of a useful context or an attempt to make meaningful sense of it. The authors say the etiology of bipolar disorder is unknown. But they don’t offer any hypotheses about what that etiology might be. And they don’t seem interested in exploring that question. It used to be that one of the psychologist’s jobs was to come up with a formulation of the case. What is going on with this person? This person is engaging in some bizarre, troubling and somewhat impairing behavior. What is the meaning of it? In what way may it be somehow functional? What can this tell us about what this person wants, how are they going about getting it and how they are reacting to the results they are achieving. These researchers aren’t asking these questions.

They also don’t seem open to the possibility that mania or depression might be somewhat functional for a person, might help a person have a useful experience or a desired experience, albeit bizarre and even impairing in some way. They are assuming that these states of beings are diseases and nothing more.

So the researchers find that there is a history of childhood trauma among the people diagnosed with bipolar disorder. They have suffered significantly more childhood trauma than the control group. But they don’t seem interested in wondering about how a history of childhood trauma would be related to the experiences and behaviors associated with bipolar disorder. Why might it be that people who have experienced childhood trauma would be subject to alternating mania and depression? How might we understand this in the context of people wanting to live satisfying and enjoyable lives? They also find that this history of childhood trauma is associated with a detrimental effect on inhibitory control and attention accuracy. This seems to fit with mania, to be somewhat of an explanation of the connection between what happened to this person as a child and being subject to manic episodes. But they don’t connect these dots.

I, for example, hypothesize that the manic episode is an attempt by an individual who has had a lot of pressure to be great and hugely successful but who is unable to do so, to experience the illusion of being great and successful. In other words it is an attempt to fake success and greatness or to have a faux experience of success and greatness.

The connections between childhood trauma and mania makes sense in this context. People who experience trauma in early life will likely have trouble managing their emotions and will have various kinds of trouble in interpersonal relationships. They will also suffer from cognitive deficits. The development of the brain in the first year of life is contingent on good attunement between mother and infant. We can assume that a child who is traumatized probably did not benefit from such attunement. So this child will suffer some cognitive and emotional deficits. Those deficits will make it difficult for him to be as successful in life as he might want to be. If a tremendous about of pressure is put on him to be successful, great, exalted, he might want to experience that kind of success and greatness. But the only way he will be able to do that is to go through a manic episode in which he can have the illusion of such greatness and success.

The researchers are not open to this connection between the states of being of mania and depression and the desire of people to live the kinds of lives they want to live and the inability to do that. Therefore, their efforts are unlikely to help human beings live the kinds of lives they want to live. Their considerations are too decontextualized from life, too divorced from what matters to human beings to be of much use.

Spooky Language!

Spooky Language!

Spooky Language!


Chuck Ruby, Ph.D.


In 2001 the late irreverent comedian George Carlin used the phrase "spooky language" to describe the wording of the 10 commandments. I do not cite Carlin in order to debase religious beliefs as he did. I think spirituality and religion can be of immense comfort and contribute to a sense of meaningful well-being for some people. I mention Carlin's comedic use of the phrase only in order to apply it to a recent study by Schmitz and colleagues entitled, "Hippocampal GABA enables inhibitory control over unwanted thoughts". This study claims that brain activity is the key to understanding a person's intrusive thoughts. But the authors of this study use spooky language in order to obfuscate and mislead about what would otherwise be a more simple, yet still difficult, non-disease matter.

This study is peppered with the same spooky language as others reported throughout academic journals and the media that make the ontological mistake of conflating human experiences with the neurochemical happenings going on during those experiences, and of using this language in a way that implies those brain happenings are pathological, while no evidence is ever presented to support that assertion.

The mental health industry is replete with this mistake because it is an inevitable result of the medical model - assuming troublesome experiences are symptoms of brain dysfunction without evidence of such. If this assumption were true, it would make sense to pay attention to brain chemistry and functioning when those experiences occur.

For instance, when a person has a brain tumor in just the right place, she might experience the world differently and act differently than without the tumor. In this situation, neurologists are helpful medical specialists who can address this problem and possibly alter brain chemistry or surgically remove the tumor in order to fix the problem.

This is similar to how a mechanic would identify a faulty car part and repair or replace it. But absent an identifiable broken brain part, this model is inappropriate when dealing with individual experiences of intrusive thoughts. People are not cars and, as far as we know, cars do not have meaningful experiences they can complain about.

Consider just a few examples of spooky language in the Schmitz study and a more simple, straightforward (non-spooky) translation in parentheses:

"Intrusive memories, hallucinations, ruminations, and persistent worries lie at the core of conditions such as post-traumatic stress disorder, schizophrenia, major depression, and anxiety." (When people complain of persistent and intrusive thoughts we say they have a disease.)

"These debilitating symptoms are widely believed to reflect, in part, the diminished engagement of the lateral prefrontal cortex to stop unwanted mental processes, a process known as inhibitory control." (When people are experiencing intrusive thoughts, we notice a part of the brain becomes less active.)

"In individuals with schizophrenia, the severity of positive symptoms, such as hallucination, increases with hippocampal hyperactivity, as indexed from abnormally elevated resting blood oxygen-level-dependent (BOLD) activity, or increased regional cerebral blood flow, blood volume, or blood glucose metabolic rate." (When the severity of intrusive thoughts increases, we notice another part of the brain becomes more active.)

"Consistent with this view, animal models of schizophrenia show that disrupting GABAergic inhibition in the hippocampus by transgenic or pharmacological manipulations reliably reproduces hippocampal hyperactivity and volume loss, along with behavioral phenomena paralleling symptoms present in this disorder." (When we disrupt the natural workings of the brain it causes problems for the owner of the brain.)

"Together, these findings suggest that a deficit of GABAergic inhibition local to the hippocampus contributes to problems controlling a spectrum of intrusive memories and thoughts, although the pathogenesis of this deficit and its specific manifestations across disorders may vary." (When people experience intrusive thoughts, an area of the brain becomes more active, but we really aren't clear on this.)

"We hypothesized that GABAergic inhibition in the hippocampus forms a critical link in a fronto-hippocampal inhibitory control pathway that suppresses unwanted thoughts." (We think two areas of the brain change in activity level when people experience intrusive thoughts.)

I could go on and on. The point is that spooky language is often used in studies like this in order to mislead the reader into thinking something that isn't true; that being, scientific medical precision about a brain disease. Despite all the medical-sounding words and phrases, there is not one bit of real evidence ever presented that intrusive thoughts have anything to do with real brain health or illness. And, by the way, if such evidence were presented, this wouldn't be a matter for psychiatry. It would be a neurological problem to be addressed by neurologists and other real medical specialists.

All this study shows is that when people are having experiences (intrusive thoughts), their brains are working. The fundamental mistake is in conflating individual experiences with the workings of the brain during those experiences, and claiming that brain activity is therefore pathological.

Perhaps an analogy would help. What if we noticed that when people are lifting weights their level of muscular contraction and innervation simultaneously react in a particular way. Would we then conclude that lifting weights is a disease? Of course not. And we wouldn't say things like, "In individuals with weight lifting disorder, the severity of positive symptoms, such as muscular contraction, increases with motor and sensory cortex hyperactivity, as indexed from abnormally elevated resting blood oxygen-level-dependent (BOLD) activity, or increased regional cerebral blood flow, blood volume, or blood glucose metabolic rate." That would be preposterous.

Muscle contraction and changes in the sensory/motor cortex is not evidence of disease and it is not the same as the human experience of lifting weights. Likewise, hippocampal and prefrontal cortex activity is not evidence of disease and it is not the same as the meaningful human experience of intrusive thoughts.

That is another matter completely.