From the Executive Director

The Right to Mental Health?

The Right to Mental Health?

Chuck Ruby, Ph.D., Psychologist

Earlier this month, Dainius Pūras, M.D., was interviewed by Awais Aftab, M.D., of the Psychiatric Times. Dr. Pūras was asked about his experiences as a United Nations Special Rapporteur from 2014 to 2020. In that role, he was charged with assessing the human rights aspects of mental health1 systems across the globe and reporting his findings to the United Nations Human Rights Council.

A primary concern of Dr. Pūras' was his dissatisfaction with the traditional separation of physical health and mental health. He believes this separation causes stigma and discriminates against people who seek mental health services. He further thinks that combining them under the same rubric of health and medicine is the solution to achieving mental health parity, the end of stigma and discrimination, and the advancement of human rights for those seeking mental health services.

In addition to merging physical and mental health, he proposed that both systems deemphasize the biomedical approach, asserting that psychiatry and mental health professions are in a position to remind the rest of the medical world that medicine is fundamentally a social science. In other words, health and illness are largely affected by social determinants, such as poverty and other social inequities, and the field of medicine should be addressing these social determinants and not just the defective biology of patients.

I agree that the discrimination and stigmatization of those seeking mental health services are due to separating it from the rest of medicine, and I am glad to see Dr. Pūras objecting to the excessive biomedicalization of human living. However, I disagree that the solution to this problem is to merge mental and physical health.

Doing so would strengthen the medical industry's domination over individual lives, and solidify its role of morally judging the appropriateness of distress and behavior. Notwithstanding the importance of addressing social factors that impact health and illness, the study of medicine is primarily a chemical, mechanical, and biological endeavor. It is not suited for providing expertise in making judgements about how we should respond to the emotional challenges of living.

So, instead of combining physical and mental health, I suggest keeping them separate, but in a fundamentally different way. The solution to stigma and discrimination, and the subsequent threats to human rights for those seeking mental health assistance, is to realize that the essence of mental health care is not literally about health and illness. It definitely isn't about using chemical, mechanical, and biological knowledge and skills to correct dysfunctional physiology.

Instead, the term "mental health" is a figurative description of social challenges, personal meaning, emotional distress, and one's responses to these things. Therefore, it is in a domain completely separate from the study of medicine and the literal idea of health and illness, not a different type to merge with the physical type.

Of course, as with all human activity, there is underlying biology at work. This fact, however, is not the same as claiming the biology involved is defective or malfunctioning. It doesn't even mean the biology causes those human actions any more than it could be said the actions cause the biology to occur.2 For example, when we walk or talk, there is biology that allows for walking and talking. Does biology cause walking and talking? Or, does walking and talking cause the biology to occur.

The same goes for when we think, feel emotions, and take action of any kind. There is biology always at work. Yet this fact doesn't mean that biology causes those things, and it clearly doesn't mean those things are disorders or illnesses caused by defective biology. Even when those human actions are very problematic, it is not logical to conclude they equal illness and lack of them equals health. If I walk in front of a bus and get injured, the decision to walk and the act of walking are not illnesses. Instead, the subsequent injury is the illness.

Having said this, the field of medicine does have an important, but limited, role at the intersection of physical health and mental health matters. Specifically, medical intervention can serve three purposes: 1) it can alleviate the negative physiological correlates of personal actions and distress (e.g., gastric damage, injuries); 2) it can identify and treat physiological defects, the results of which mimic mental health problems (e.g., poor nutrition, urinary tract infections); and 3) it can offer chemicals to those who choose, with full informed consent, to subdue their experiences of distress (e.g., Valium, Zoloft) just like it does for people who want to numb arthritis or headache pain.

This limited role is inherent in the fact that mental health problems are based on a definition that is void of any physiological ailment that medical specialists can diagnose and treat. More importantly, in situations where there is a physiological affliction, psychiatry (or the other mental health professions) would not handle it; the appropriate medical specialty would step in. Psychiatrists and psychologists don't treat gastric damage, broken bones, vitamin deficiencies, or urinary tract infections.

So, Dr. Pūras has good reason to be concerned about the separation of physical and mental health and the stigmatization and discrimination that come from it. However, it must be remembered that the mental health system created this problem in the first place in its definition of mental disorder. The DSM-5 defines it as a disturbance in thinking, feeling, or acting that is caused by impairment in mental functioning. Setting aside the circular nature of this definition, it makes mental disorder sound like a matter of dysfunction in a person, just like with physical illnesses.

But the main problem with this definition, and the reason it necessitate the separation of physical and mental health matters, is that such impairment in mental functioning cannot be identified without using moral judgments. It is not identified with an examination of chemical, mechanical, or biological dysfunction.

This is why DSM diagnoses and their criteria are developed out of the wrangling and consensus of committee members and not evidence of impairment. They are based on an aggregate moral judgment: what should we be distressed about, how much distress should we feel, how long should we feel distressed, and what should we do about the distress. In stark contrast to this, physical health matters are defined as actual bodily defects that threaten a person's physiological viability. No moral judgment is involved in identifying or theorizing about physical illness.

Therefore, it appears clear that the only way to eliminate the stigmatization and discrimination of those seeking mental health services is to eliminate this medical-moral model of mental health. Otherwise, those seeking services will continue to be seen as suffering from a mixture of medical and moral problems, which is why there is such popular fear and derision of those said to be mentally ill. It is also why they are stigmatized and discriminated against, and why their human rights are frequently violated.

By continuing to conflate physical health and mental distress, and anointing medical professionals as experts in the latter, the mental health system will always be prone to stigma and discrimination, opening the doors to involuntary and forced treatment. The resulting irony is that while we frequently see such coercion within the mental health system, we rarely see it with physical health. People who are diagnosed with physical health problems, such as diabetes, cancer, and heart disease are rarely treated involuntarily, against their will (unless, of course, they are judged mentally ill and, thus, not able to make "wise" choices).

In this way, the mental health professions have taken on a medical-moral role in identifying inappropriate (i.e., wrong, abnormal, bad, "sick") personal conduct and experiences, portraying them as the result of something impaired in the person, and seeking various ways to muzzle them. There is no way to medically correct the alleged impairment because there is no identifiable impairment to correct. All too often, the conventional methods of treatment are merely physical, chemical, and electrical restraint. Talk therapy, or psychotherapy, can also be a form of restraint in the form of scolding people for having these inappropriate experiences and persuading or coercing them to change their conduct. None of these are forms of medical treatment. They are forms of control.

Dr. Pūras' international efforts to ensure the right to mental health is a very worthy effort, but it means different things depending on the definition of “mental health” as explored above. If it is defined as in the DSM, then that right hardly applies to the person so affected. This is because, by definition, the affected person’s thoughts, emotions, and actions are the product of a dysfunction. Therefore, that person’s decisions and choices are not to be valued or honored because they are the tainted product of that dysfunction.

If, however, the right to mental health is defined as one’s right to decide how to resolve personal challenges, what to do about emotional distress, and what actions to take to resolve those challenges and distressing feelings, including which services of the conventional mental health system to take advantage of, then we’re really talking about respecting human rights.

In fact, Dr. Pūras was adamant that we should work toward eliminating all forms of coercive treatment and base our services on individuals' preferences and desires, even in cases where they are considered psychotic. But I don't see how this can possibly happen without abandoning the medical-moral model of human distress that defines mental health problems as something impaired in the person.

In his further emphasis on respecting individual choice, Dr. Pūras, pointed out the importance of democratic systems for the promotion of good mental health and adherence to human rights. But how can the right of mental health exist if the mental health system itself is not democratic, and instead mirrors the many totalitarian and authoritarian regimes that devalue the desires of its citizens? He lamented that mental health professionals and academics frequently block attempts to change the status quo, making the right to mental health impossible, since it prevents fully informed consent and it allows human rights to be routinely violated.

It appears clear to me that in order to arrive at a truly human rights based mental health system, we have to understand that the essence of mental health is not a matter of health and illness. Therefore, we need to find substitute terms for "mental illness" and "mental health" that accurately describe the very real problems that people endure and what can be done to help them. "Mental health" must not be seen as a different kind of hybrid health split off from physical health, and it must not be merged with physical health. It must be recognized as having to do with personal meaning, distress, and choice.

1I use the term "mental health" only as a metaphor. I do not intend to imply that it is a literal matter of health and illness.

2See Chapter 12, The Difference Between Brain and Mind in my book Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Welcome, MD: Clear Publishing for an elaboration of this conundrum.

Let’s Keep ISEPP Scientific and Focused

Let’s Keep ISEPP Scientific and Focused

Let's Keep ISEPP Scientific and Focused

Chuck Ruby, Ph.D., Psychologist

It is undeniable that officials within the CDC, FDA, and Big Pharma have engaged in corrupt practices and placed profit ahead of science. However, this doesn't mean everything they do is corrupt or unscientific. While skepticism is warranted - it is the hallmark of science - any claims of nefarious intent and action by them must be backed up by robust evidence. Leaping to conclusions based only on suspicion and cherrypicked evidence is conspiracy theory thinking.

Lately, the situation has become even more dangerous. Over the past few years, the political landscape has flipped. Left is right, yes is no, and true is false. The long-standing and generally condoned rhetorical tactics of politicians have been eroded away by insidious rumors, lies, and scapegoating that are so often used by totalitarian leaders to instigate widespread distrust of "elites" and long-respected institutions of information and knowledge. Public trust in critical thinking and science seems to be fading, while suspicion and accusations are overtaking reason as the criteria for truth. The resulting authoritarian effect of this phenomenon will remain with us like a stubborn stench that lingers long after the offending substance is gone.

These dangers are not new to ISEPP. For decades, we have been a passionate but marginal opponent in an uphill battle with an authoritarian emperor who lacks scientific substance for his medical model conspiracy theory of "mental illness" and instead peddles his own version of rumors, lies, and scapegoating. We have fought long and hard to expose this charade by doggedly presenting sound evidence that undermines the emperor. But, ironically, we are the ones who have often been viewed as conspiracy theorists, not the naked emperor and his conspiratorial followers. We are accused of being "mental illness deniers." How can we avoid this and not be lumped into the same category as the climate deniers, anti-vaxxers, and UFOlogists? How can we bolster our message and be taken seriously?

The answer lies in making sure our reason is not blinded by our passion. As a scientifically-minded research and public education organization, ISEPP must stand back from the current political maelstrom and not get drawn into its alluring but fatal depths. If we are to garner and maintain the respect of the public, and be seen as a serious challenge to the orthodoxy, it is essential that we do two things. First, we must prioritize the evidentiary foundations of our critique. Second, and perhaps more importantly, we must keep our focus on the ball and not get distracted by topics that are at best tangential to our mission. We cannot dilute our efforts and tarnish our reputation by joining the many ongoing bandwagons of alarming and hastily constructed theories that are divisive and that have little to do with the ethics of psychology and psychiatry.

Conspiracy theories abound during any crisis, and the current COVID-19 scare is no exception. News about  the development of vaccines and therapeutics for the virus, as well as efforts to determine its origin, have raised the specter of profit-driven corruption and conflicts of interest within government and the pharmaceutical industry. Unfortunately, this has drawn the attention of many in ISEPP who go beyond skepticism and entertain the idea that the crisis is being used by a cabal of powerful people as a "false flag" operation in order to increase and maintain control of the population. Multiple and rapid-fire bits of dubious "evidence" and innuendo have been offered in an attempt to shore up this theory. However, in addition to demanding that any such theory be firmly grounded in science, it is even more important to remember that the reality, origin, and contagion of COVID-19 is not ISEPP's target. We are not an organization that broadly investigates government and industry corruption in matters of healthcare. Instead, we are an organization that exclusively critiques the threadbare medical model of "mental illness" and the corruption that maintains it.

The importance of ISEPP remaining focused and firmly rooted in science was highlighted recently. In the past few weeks, ISEPP social media posts have been identified by Facebook as "abusive." This is very likely due to our challenge to the medical model of human distress and how some people rely on that baseless model for comfort. We are appealing this ruling, but in the meantime, we have to remember that we are making a very unorthodox claim and we will have formidable and well-funded opposition that enjoys conventional trust. So, as we increase our public platform and reach, we are at risk of being belittled as just another among a plethora of dangerous conspiracy theorists, other well-known but denigrated public figures, and organizations whose reputations are damaged beyond repair because of their sensational but unfounded claims.

ISEPP's mission is to educate the public about the orthodoxy's lack of evidence that "mental illness" is a medical matter that is best treated within a medical model, and the many harms that come from that model. It is also to suggest more humane ways that we can help our fellow human travelers as they face the natural but painful parts of living this life. In this campaign, we demand the long asserted, but yet-to-be revealed, evidence that the orthodoxy continues to claim as the foundation upon which the conventional system has been built. In our efforts at chipping away at that system, we hope to remove the trust that has historically been placed with the orthodoxy. This will allow a more humane model to rise up and replace the old. Many have fought long and hard in our struggle, at times to their deaths. Let's honor them by keeping ISEPP on firm scientific footing with a crystal clear focus!

Coronavirus, Fear, Anxiety, and Faith

Coronavirus, Fear, Anxiety, and Faith

Coronavirus, Fear, Anxiety, and Faith

Chuck Ruby, Ph.D., Psychologist

It began on New Year's Eve 2019. Chinese officials announced that doctors in Hubei province were treating more than two dozen patients who were suffering from viral pneumonia. Within days, more and more cases emerged across Asia, and on January 11th, a  61-year-old man in China would be the first to die from COVID-19. In the intervening weeks, a rising and widespread sense of fear has accompanied the virus' spread to over 200 countries and the number of people infected has exceeded a million. Of those infected, more than 60,000 have died.

It is difficult to get a clear measure of COVID-19's true incidence, prevalence, and fatality rate because it is exponentially spreading well ahead of attempts to identify it, and there has been a shortage of tests kits needed in order to confirm infection. Further, COVID-19 has a longer incubation period, in contrast to influenza, and this increases the chances of person-to-person transmission by asymptomatic people. Therefore, health officials estimate the true prevalence of COVID-19 is greater than the above numbers indicate.

For this reason, many governments have ordered people to self-quarantine and "distance" from others in an attempt to slow the virus' spread. Health systems are at maximum capacity and are becoming overwhelmed. In many places they are witnessing a shortage of essential medical supplies and equipment not only for detecting the virus, but also to treat it. The world economies are suffering greatly.

Few people alive today have witnessed such an impactful crisis. The potential risks and inherent uncertainties of this disease fuels the emotional distress that gets labeled with the various "anxiety disorders." Thus, it is very likely that we'll see an increase in diagnoses such as "generalized anxiety disorder," "obsessive-compulsive disorder," and "post-traumatic stress disorder" among the people who seek out professional help during and after this crisis. Whereas the term "anxiety disorder" is only a figurative use of medical language and not descriptive of a real illness, it nonetheless refers to a very real problem.

The fear we are seeing with COVID-19 is the key feature of the anxiety problem. In contrast to an illness, "anxiety" is our natural and expectable response to fear. In other words, it is what we do in an attempt to deal with and reduce fear. Specifically, it is a ramping up of attention and vigilance focused on the threat in order to reduce the uncertainties about it. When we can gain more certainty about the feared thing through hypervigilance, such as what it is, where it is, and how dangerous it is, we can potentially take action that will reduce the fear and, thus, the turn toward anxiety.

However, when it is not possible to eliminate uncertainty about the feared thing, as is mostly the case with the invisible coronavirus, we still might attempt to do so through increasing hypervigilance - anxiety. Think of this like having several radars focused in all directions at once, with sensitivity to the maximum level. Yet, despite this ever-increasing heightened state of alert, we still aren't able to see the threat more clearly and so we can't reduce the uncertainty or fear any further. Furthermore, despite this unproductive level of hypervigilance, there is a reluctance to turn off the radars except for one or two, "just in case," so we don't miss something.

In all of this, it is important to remember that fear, per se, is not the principal problem. Fear is inherent in life and it is meaningful - it points to the solution. It helps us identify potential threats and motivates us to take protective action. Instead of the fear, the principal problem is when the increasing hypervigilance in response to fear reaches a point where the costs far outweigh the benefits. That point was described more than a century ago with the so-called Yerkes-Dodson law, which proposed that hypervigilance (stress) enhances performance until it reaches a point of diminishing returns. Any increase in hypervigilance past that point is counterproductive and detrimental to our sense of well-being. It actually results in an increase in fear. So, there is typically a spiral of increasing hypervigilance, which leads to more fear, which leads to increasing hypervigilance, which leads to more fear, and so on. The end result can be panic attacks and confused/disorganized thoughts.

So, our challenge during this medical crisis is to be vigilant in planning and preparing by finding out what we can about COVID-19, what we can do to stem its transmission, what we can do to protect ourselves, and then taking action to the extent that we can. In doing this, it is important to avoid rumors and conspiracy theories about the virus, and to get information from reputable and credible sources. Above all, it is important to use critical thinking when evaluating information.

But we have to be honest with ourselves that, just as with many trials in life, we will never achieve 100% certainty about it or how we will be ultimately affected. This will leave us with a continuing sense of fear about which we can do nothing, but accept it. That level of uncertainty also means that faith in the process is crucial - being willing to go forward despite the uncertainty and fear, and carry on with our lives as much as we can, nonetheless.

The 2019 Annual Conference in Baltimore

The 2019 Annual Conference in Baltimore

The 2019 Annual Conference in Baltimore

Chuck Ruby, Ph.D., Psychologist

Our annual conference in Baltimore this past October was a success! We had a stellar lineup of speakers who addressed the conference theme: "Do No Harm? How the Ethics of Psychology and Psychiatry Have Become Unethical." Our intention was to make a strong statement about the harm that comes from the existing orthodox mental health system and the consideration of alternative humane forms of helping people in emotional distress.

The conference kicked off with our traditional Friday evening reception. This has been a time for us to enjoy the annual opportunity to gather in person with our like-minded colleagues and show support to each other. During the reception, our newest ISEPP Board member, Dr. Gail Tasch, described her journey from being a traditionally minded psychiatrist to a critical thinking reformer who strives to battle the harm from the conventional system. Her talk was inspiring and it provided much needed encouragement to those of us who persist in our attempts to re-humanize our professions of helping.

The first day of plenary presentations led with Dr. Paula Caplan and her remarks about how the unscientific psychiatric diagnostic system is the fundamental source of harm within the mental health industry. Dr. Caplan shared her many years of work as a reform minded psychologist and her attempt to correct this problem, both from within the system (serving on a DSM task force) and from without. Her tireless efforts have been a shining example for the professionals among us to emulate.

Dr. Caplan was followed by Stephen Sheller, Esq. Mr. Sheller was plaintiff's co-counsel in Murray vs. Jansen Pharmaceuticals, in which Jansen (a subsidiary of Johnson & Johnson) was accused of wrongfully marketing the antipsychotic Risperdal to teenage boys, despite knowing it caused gynecomastia, or the development of female breast tissue. Mr. Sheller recounted his many years of work on this case and that just days prior to his appearance at our conference, the court ordered the defendant to pay $8 billion in punitive damages. As of October, there were 7,000 other similar cases still pending.

The afternoon of our first day of plenaries started with Dr. Patrick Hahn, a free-lance writer and independent scholar who has debunked the genetic myth of mental illness. Dr. Hahn provided a comprehensive accounting of how genetics have been used by authoritarian systems to falsely identify and control troublesome people under the guise of medicine. The research he presented makes it clear that the difficulties for which people are diagnosed with mental illness are a reaction to environmental conditions, not genetic anomalies.

Dr. Irving Kirsch once again honored us with his presentation about the placebo effect and antidepressants. He detailed the research showing that placebo and antidepressant outcomes are virtually identical, casting serious doubt on the usefulness and safety of conventional drug treatment for depression. He also pointed out recent research that shows an increased risk of suicide for those taking antidepressants, and this risk extends to adults who take the drugs, not just youth as is admitted by the drug companies. 

Our first day culminated with an amazing and moving presentation by Tonier Cain-Muldrow, who grew up on the streets and survived to tell her story. Despite her experiences of neglect, crime, drug abuse, and trauma, she came to develop a sense of hope and understanding that the source of her problems wasn't something wrong with her, but something wrong with the system in which she lived. She survives as a model for thousands of people who have suffered similar conditions.

We had a wonderful meal and more time to socialize at our Saturday night Awards Dinner. We were fortunate to have guest speaker Art Levine, investigative journalist and author, share with us his ideas about reform of the mental health system. Mr. Levine's talk was followed by the presentation of our three awards. Dr. Peter Groot of the Netherlands was awarded the ISEPP Special Achievement Award for his work in developing commercially available tapering strips to help people wean off of psychiatric drugs. Dr. Paula Caplan was awarded the ISEPP Lifetime Achievement Award for her decades of steadfast work as a reformer psychologist. Lastly, our guest speaker Mr. Levine was awarded ISEPP's Mary Karon Memorial Award for Humanitarian Concerns for exposing a wide range of corporate and governmental corruption within the mental health industry.

The second day of our conference kicked off with a lively presentation by Dr. Ben Rall, a wellness physician dedicated to holistic healthcare. Dr. Rall blew away much of the convention's ideas about the causes of illness by exposing very entrenched flaws in the system and by proposing far more effective ways of healing. He pointed out that traditional forms of healthcare many times serve to perpetuate illnesses.

I followed Dr. Rall with a talk about the link between psychiatric drugs and violence as contained in ISEPP's White Paper. The evidence for the link is hiding in plain site, even evidence presented by the drug companies in their randomized controlled trials of the drugs effects. Whereas the science is not precise enough to predict who among those who take psychiatric drugs will become violence, it is clear that the use of the drugs increase one's risk.

After lunch, Dr. James Gordon presented his ideas on mind-body healing. Focusing on trauma as the basis for the development of problems that get diagnosed as mental illness, he demonstrated, partly with audience participation exercises, how those problems can be alleviated without traditional medical interventions. 

Two special treats closed out our last day of the conference. The first was a panel presentation of military members who suffered at the hands of the conventional system. They each told their poignant stories of how they were harmed by but overcame that system through more humane and personalized care that has been provided by Dr. Mary Vieten's Warfighter Advance Program. These warfighters discovered their inherent worth and ability to heal.

The second special presentation was a full screening of Medicating Normal - The Film. Co-producer Lynn Cunningham explained the genesis and production of the film which showed the stories of several people harmed by yet recovered from the mental health industry, in particular the toxic effects of psychiatric drugs. The film shows what happens when for-profit medicine is applied to suffering human beings. 

The conference weekend was well-received by many. It succeeded in exposing the harm done by the orthodox mental health system. Some comments were:

    " was so encouraging and energizing to be among such positive, "kindred     spirits" who are fighting the good fight...."

    "Thank you for a great conference! was wonderful!"

    "Mary's warfighter panel stole the show!"

    "It was just awesome. I think I have told hundreds of my colleagues about the caliber of the group."

Now, let's get ready for Los Angeles in 2020!

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.

1, paragraph 5.
World Health Organization. (1994). The ICD-10 Classification of Mental and Behavioural Disorders.p. 11. Retrieved from:
 4, 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:
 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.







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.