Friday, 2 May 2014

Mental help 8: IS IT A DISORDER TO BE DEVASTATED?

There is some recycled material from earlier blog posts.
I will be adding relevant links as I find them. 


Links to:

DR LANGFORD: By recognising that certain symptoms often occur together, like flashbacks, being on edge and feeling numb and by giving this syndrome a namein this instance PTSD, we can do research into causes, and treatments that might work.

There has been much research over the years. Do you have evidence that research has found treatments that work?

Why suicide rate among veterans may be more than 22 a day By Moni Basu, CNN

Would you tell a person who has multiple fractures in both legs after a car accident that they have an illness?  A disorder? Maybe a Compound Bipedal Ambulatory DisorderIn my frame, the concept of "post-traumatic stress disorder" is just as ridiculous. 

Post-traumatic stress is a natural reaction to traumatic stress. When experts label it an illness, a disorder, they are humiliating wounded people and filtering out helpful help. 

I couldn't believe my ears when a famous Norwegian psychiatrist said on TV many years ago that refugees from war zones needed to mingle with normal people and learn that life is peaceful and good. That attitude is a huge part of the problem: "Normal" people invade the personal stories of wounded people with a collective story of "you just need to be more like us", which creates "the problem is that you are not like us". 

SOMATIC
DRUG-INDUCED
ENVIRONMENTAL
Dementia
Dementia
depression


addiction


psychosis


Post-traumatic stress reactions

Sending anguished veterans off to talk to therapists conveys the message that the rest of us don’t want to listen—or that we don’t feel qualified to listen. As a result, the truth about war is kept under wraps. Most of us remain ignorant about what war is really like—and continue to allow our governments to go to war without much protest. Caplan proposes an alternative: that we welcome veterans back into our communities and listen to their stories, one-on-one. (She provides guidelines for conducting these conversations.) This would begin a long overdue national discussion about the realities of war, and it would start the healing process for our returning veterans.
And this applies just as much to post-traumatic stress from other horrors. You don’t need a psych degree to listen, you need to respect the vulnerability of the person who is talking. And you can do that by connecting to your own vulnerability. 

DR LANGFORD: Sometimes we even find a cure. We learn from these patterns we see in people – we don’t have to start from square one with everyone that comes through the door. So mental illness is a useful concept.
Please link to evidence that psychiatry has found cures for mental illnesses.

And please link to evidence that the patterns psychiatrists see in people are scientific and evidence-based. 


Where you write "patterns", I read "knee-jerk reactions". So I ask again: What do psychiatrists do about the homunculi who are jumping up and down in their heads? Everyone has one, so psychiatrists are not exempt.  

The patients Jake is telling us about are desperate for psychiatrists to start from square one, as Dr Nguyen describes it in "The Ethics of Trauma":  
 ...“remaining in empathic unsettlement”: to stay unsettled in order to look at, not past or beyond, the subject. To stay in the not knowing and trying to know with the subject ...
So ... for whom is the concept of psychiatric illness useful? 

It is useful for the patients it fits ... keeping in mind all the narratives of people who fit until the side-effects of drugs become a problem. I'll be following the Council for evidence-based psychiatry with great interest. 

The concept of mental illness provides heuristics - "patterns we see in people" - that lead to quick and confident System 1 conclusions, so it can be useful to helpers who do not have a mentalising approach.

And it is useful for parents and other people with power who reject responsibility for actions that harm the vulnerable. 

And psychiatric diagnoses are useful frames of reference for institutions, researchers, health services, social services. 

But what about all the people who do not fit into this concept of psychiatric  illness?


Scientific contrarians like Semmelweis  were my childhood heroes, and it does me good to know that such people still exist. 


DR LANGFORD: But is it a valid one – are mental illnesses real? Of course they are. Some mental illness or disorders are quite plainly real.
Dementia, addiction, severe autism and learning difficulties are all expressed through the mind, and therefore listed in those evil “psychiatric bibles” – but no one would argue that they didn’t exist.


Are you insisting that mental problems do not exist because "Some mental illnesses or disorders are quite plainly real". 

In that category of "expressed through the mind"you have placed dementia, addiction, autism and learning difficulties. I agree that all of them are expressed through the mind, but I cannot agree that all of them are "mental illnesses".

Dementia is a real illness, caused by changes in the brain that can be induced by psychiatric drugs.

And autism is a physical condition, illuminatingly described in The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism.

In my context, addiction is a natural defence against the pain and memories of societal harm, a mental problem and not a psychiatric illness.

And while some learning difficulties can have physical causes, learning difficulties can also be caused by invisible wounds: Children Who Are Spanked Have Lower IQs, New Research Finds

SOMATIC
DRUG-INDUCED
ENVIRONMENTAL


depression


addiction


Psychosis
autism

Post-traumatic stress reactions
Dementia
Dementia

Learning difficulties

Learning difficulties
DR LANGFORD: But as soon as something is found to have a solid cause in the brain, it tends to get called “neurology”, so the heat can be kept focussed on psychiatry, on disorders for which a biological focus is less clear cut.
Why don't psychiatrists use their medical training to look at how societal harm can cause both physical illness and mental problems? 

What would your next argument look like from this viewpoint?

And who are "some"?

DR LANGFORD:Some say, well, you've had years to find a simple cause or test for these disorders, things like depression, and you haven’t done it. So depression can’t be a real illness! But medicine doesn’t work like that. We don’t suddenly decide that the symptoms don’t add up to an illness just because we haven’t found a cause or a test yet – because the symptoms are there.
Maybe psychiatry hasn't found a cause or test for depression because it has its head stuck in the brain? What might it find if it took depression out of the intuitive box of psychiatric illness and instead looked for individual loss and trauma and large and small border violations? 

We don’t even have a good idea what causes migraines yet, we certainly don’t have a test, but no one will be telling people with headaches that sorry, no clear cause yet and no test, so no illness. So we won’t stop calling things like OCD and bipolar disorder illnesses. Our patients deserve better than that.
In my frame, your patients deserve to be asked, by a mentalising helper who is in square one,  "in the not knowing and trying to know with the subject": 


"What do you think your problem is?"

“What has happened in your life?”

“What are your days like?”

“What do you need?”

And I cannot agree that obsessive-compulsive reactions and bipolar belong in the same category.

In my frame of invisible wounds, obsessive-compulsive reactions belong with addictions in the category of "natural defense reactions to the pain of societal harm".

Bipolar? Some people are helped by treatment of bipolar as a medical illness. 

Bipolar can be a side-effect of antidepressants. 

And I know people who lost their symptoms when they began to sceptically investigate their lives: The manic phase had been an intense attempt to shut out intrusive memories and emotions, and the depressive phase was exhaustion.

SOMATIC CAUSES
DRUG-INDUCED
ENVIRONMENTAL CAUSES


depression


addiction


psychosis


Post-traumatic stress reactions


Obsessive-compulsive reactions
Dementia
Dementia

Bipolar
Bipolar
Bipolar
autism


Learning difficulties

Learning difficulties
      '

Who are " a lot of people"?

DR LANGFORD: A lot of people think that no two psychiatrists will agree on a diagnosis, that there is no reliability, but the reality in very different. Here are some correlation co-efficients – the closer to 1.0 the number is, the more psychiatrists agree on the diagnosis. Anywhere near 0.7 is pretty damn good. Mostly ok.

This brings on a smile. The specific examples you have chosen can probably be diagnosed with pretty good correlation co-efficients by an informed layperson. 

I have many links about confusing multiple diagnoses, but I'll let them lie.

Commenting in your table: 

Autistic Spectrum Disorder

I agree that autism stems from the brain. And here is information about harmful psychiatric medication of children with autism:

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PTSD

Not a disorder or illness. Post-traumatic stress is “a normal reaction to abnormal events”, according to this website :     

There I found an article on Emotional and Psychological Trauma

And I quote:

Childhood trauma increases the risk of future trauma
Experiencing trauma in childhood can have a severe and long-lasting effect. Children who have been traumatized see the world as a frightening and dangerous place. When childhood trauma is not resolved, this fundamental sense of fear and helplessness carries over into adulthood, setting the stage for further trauma.
Childhood trauma results from anything that disrupts a child’s sense of safety and security, including:
  • An unstable or unsafe environment
  • Separation from a parent
  • Serious illness
  • Intrusive medical procedures
 Symptoms of emotional and psychological trauma: Following a traumatic event, or repeated trauma, people react in different ways, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond to trauma, so don’t judge your own reactions or those of other people. Your responses are NORMAL reactions to ABNORMAL events.
In an editorial to “Today’s children are tomorrow’s parents”Dag Nordanger writes:
This special issue of “Today’s children are tomorrow’s parents” is dedicated to the topic of “Childen and trauma”. Most likely, if such an issue was produced 15 years ago, its focus would have been quite different. Probably, articles would have focused more on dramatic events visible to the public, such as accidents, disasters and sudden loss. Moreover, it would have been inappropriate at the time not to focus particularly on the Post traumatic stress disorder diagnosis – its origins, symptoms, and its treatment. Since then we have learned that although these are severe sources of stress for a child, the most devastating traumatic events happen in rooms hidden to the public. We have learned that those experiences which threaten the health and development of a child the most are the complex traumas – the persistent traumas which undermine the child’s secure base and the relationship to primary caregivers. Examples of such traumas are child maltreatment or abuse, or getting the platform of one’s life torn apart because of war and flight. We have also learned that when the traumas are complex, the health consequences are complex as well, and cannot be limited to a certain existing diagnostic category such as PTSD.
What is psychiatry doing to incorporate research on complex traumas into its cognitive frame?


0.67
ADHD

Annus Horribilis for ADHD

Is ADHD a helpful diagnosis? 


http://time.com/25370/doctor-adhd-does-not-exist/


http://www.cbsatlanta.com/story/25021892/emory-expert-on-adhd-refutes-chicago-doctors-statement-disorder-does-not-exist


0.61
Bipolar Disorder

People have been helped within your frame, I give you that. Bipolar seems to be the poster child of psychiatry.

And Peter Gøtzsche from the Nordic Cochrane Centre writes: 
In 1987, just before the newer antidepressants (SSRIs or happy pills) came on the market, very few children in the United States were mentally disabled. Twenty years later it was over 500,000, which represents a 35-fold increase. The number of disabled mentally ill has exploded in all Western countries. One of the worst consequences is that the treatment with ADHD medications and happy pills has created an entirely new disease in about 10% of those treated – namely bipolar disorder – which we previously called manic depressive illness.
Leading psychiatrist have claimed that it is “very rare” that patients on antidepressants become bipolar. That’s not true. The number of children with bipolar increased 35-fold in the United States, which is a serious development, as we use antipsychotic drugs for this disorder. Antipsychotic drugs are very dangerous and one of the main reasons why patients with schizophrenia live 20 years shorter than others. I have estimated in my book, ‘Deadly Medicine and Organized Crime’, that just one of the many preparations, Zyprexa (olanzapine), has killed 200,000 patients worldwide. - See more at: http://davidhealy.org/psychiatry-gone-astray/#sthash.75THkAGQ.dpuf

0.56
Borderline Personality Disorder

I decided a long time ago to flaunt my borderline diagnosis as a banner of autonomy. That liberated me from the shame and humiliation that is a harmful side-effect of borderlining. 

Rebecca J Lester describes this in  Lessons from the borderline: Anthropology, psychiatry, and the risks of being human:
Clinicians generally detest working with borderline patients.These clients can present as unpredictable, needy, hostile, overly dramatic, and emotionally draining. As McGlashan (1993: 241) observes: ‘Officially, ‘borderline’ is a diagnostic label. Unofficially, in clinical parlance, it is synonymous with ‘anathema.’’ Gabbard  (1997: 26) elaborates: ‘A significant number of professionals within the industry regard borderline patients with contempt.’ And as one psychiatrist told anthropologist Tanya Lurhmann (2000: 113), you look for the ‘meat grinder’ sensation: if you are talking to a patient and it feels like your internal organs are being turned into hamburger meat, she’s probably borderline.

Link to: People with a borderline personality disorder diagnosis describe discriminatory experiences
The experiences described by some participants regarding making complaints provide food for thought; the idea that making complaints is typical behaviour for someone with a BPD diagnosis seems to be a powerfully silencing one, positioning the client as someone whose complaints are trivial and/or pathological. The idea of BPD diagnosed clients as prone to making complaints probably also has ties to this client group being seen as difficult and angry, and being responsible for ‘splitting’ staff (Gallop 1985). 
In my frame, the symptoms that get labelled Borderline Personality Disorder are symptoms of societal harm, loss, trauma and border violations. The meat grinder sensation is discomfort at getting a glimpse into an invisible war zone that the professional does not want to know about, and the diagnosis of “Borderline Personality Disorder” is generated by a professional Somebody Else's Problem field and upheld by little homunculi that are jumping up and down in professionals' heads.

In a strange double bind, psychiatry is clear about there being no need to be ashamed of having been sexually used, hit or gaslighted - and then treats the symptoms of having been used, hit or gaslighted as shameful and contemptible personality defects. 


Borderline personality disorder: Abandon the label, find the Person 
by Steven Coles

Linking to "Is Anakin Skywalker suffering from borderline personality disorder?" This might seem like a reasonable question to a psychiatrist:  
Anakin Skywalker, one of the main characters in the "Star Wars" films, meets the criteria for borderline personality disorder (BPD). This finding is interesting for it may partly explain the commercial success of these movies among adolescents and be useful in educating the general public and medical students about BPD symptoms.
We are three generations of Star Wars fans in my family, and my children and grandchildren have often started discussions about this universe. Looking at how the character's lives shape their actions and their options has led to useful explorations of free will, ethics, responsibility and values in the world we live in, far, far away from the fixed and pathologizing mental illness frame of psychiatry.  

A huge problem with the limited psychiatric illness model is that it gives up on people with "personality disorders". I'll be following this program with interest: 

 “Some psychopaths can be treated”
David Bernstein, Sacha Ruland



0.54
Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren't there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. For women, they start in the mid-20s to early 30s. 
Other symptoms include:
unusual thoughts or perceptions
disorders of movement
difficulty speaking and expressing emotion
problems with attention, memory and organization
no one is sure what causes schizophrenia, but your genetic makeup and brain chemistry probably play a role. Medicines can relieve many of the symptoms, but it can take several tries before you find the right drug. You can reduce relapses by staying on your medicine for as long as your doctor recommends. With treatment, many people improve enough to lead satisfying lives.
Do you agree with this description from the ICD-10? 

What is your opinion on this description from BrainBlogger:
Is Schizophrenia Really a Brain Disease?
In spite of over a hundred years of research and many billions of dollars spent, we still have no clear evidence that schizophrenia and other related psychotic disorders are the result of a diseased brain. Considering the famous PET scan and MRI scan images of “schizophrenic” brains and the regular press releases of the latest discoveries of one particular abnormal brain feature or another, this statement is likely to come as a surprise to some, and disregarded as absurdity by others. And yet, anyone who takes a close look at the actual research will simply not be able to honestly say otherwise. And not only does the brain disease hypothesis remain unsubstantiated, it has been directly countered by very well established findings within the recovery research, it has demonstrated itself to be particularly harmful to those so diagnosed (often leading to a self-fulfilling prophecy), and is highly profitable to the pharmaceutical and psychiatric industries (which likely plays a major role in why it has remained so deeply entrenched in society for so many years, in spite of our inability to validate it).
And what is your opinion on the varieties of non-medical treatment of schizophrenia, as described in the following links?
The society recommends a lot of books. I like this one: 

Models of Madness 2nd Edition 

John Read (Editor), Jacqui Dillon (Editor)

There is much sceptical interrogation of "schizophrenia" here. 

A review by Lois Achimovich: 
Review of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia

http://www.amazon.com/Models-Madness-Psychological-Schizophrenia-International/dp/1583919066
"This is mandatory reading for all psychiatrists. Read et al. have issued a serious challenge to psychiatry. Are we totally on the wrong track with both understanding and treating schizophrenia? Are we doing more to create mental disorder than to prevent it? Since we have shuffled off responsibility for almost everything except mental illness, this challenge to the medical model suggests that we may have sawn off the last branch on which we had any purchase." - Carolyn Quadrio, Australian and New Zealand Journal of Psychiatry
This book deals with many different non-medical approaches to psychosis and “schizophrenia”: Alternatives Beyond Psychiatry  by Peter Stastny (Editor) , Peter Lehmann (Editor)
0.46

And now my table looks like this:
SOMATIC CAUSES
DRUG-INDUCED
ENVIRONMENTAL CAUSES


depression


addiction


psychosis


Post-traumatic stress reactions


Obsessive-compulsive reactions


Schizophrenia


borderline
Dementia
Dementia

Bipolar
Bipolar
Bipolar                                                     
autism








ADHD

ADHD
Learning difficulties

Learning difficulties


Surely physical health problems all score 1 though? I’m afraid not. Here are the scores for a few physical conditions.
Why do you use the word "problems" about physical illness when you are arguing that mental problems do not exist?


Atherosclerotic stroke
0.60
Lung cancer under a microscope
0.57
Osteoarthritis on X ray
0.51-0.68
Reflux using endoscopy
0.56
Heart attack using blood test and ECG
0.52
Smaller stroke
0.20

I am going to compare psychiatry with translation again: It would be stupid to say that "Journalists also make mistakes!” when explaining why translation is useful. Yet psychiatrists seem to think that “other specialties aren't perfect either” is a valid argument.


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