Gosh, they really had to do a study to discover this??? It is disturbing that this is apparently a revelation to the mainstream of psychiatric practitioners. And of course, most will probably ignore it. There’s no money in helping people have more satisfying lives, is there?
I think “productive” may be being used in the purely capitalistic sense here, as in “Doing something that has value for those running the show.” True productivity can embrace a lot of things that capitalist leaders don’t think of as productive.
Yeah, I love how they say “We do not suggest” instead of “It is malpractice to…” Most of those prescribing antipsychotics for “depression” are not doing so because of the amazing results, and they’re not going to care if an article “suggests” that they stop!
I think that sums it up. We don’t have to know where it comes from, but we do need to acknowledge that in a human being, SOMEONE is making and acting out and evaluating the survival decisions of the organism. Sure, there are primitive survival mechanisms like instincts and reflexes, but it seems obvious in humans that these impulses can be overridden at the discretion of the “agent” who seems to be running the show!
I tend to agree. Whatever “spirit” is (and I don’t think anyone really knows this for sure), it is clear from observation that there is an entity which is EVALUATING and DECIDING and EXECUTING the actions of the organism/being. Most of what is “wrong” with the “mentally ill” in my view originates in this mysterious entity, which is after all the agent deciding what is and isn’t important and what should and should not be done. Some might postulate that this “spirit” arises from the body in some way, though I’ve never heard a convincing explanation of how that would occur. But it certainly is clear that this entity is not something arising from the wrong brain chemicals being out of balance! And it’s not a computer – much more in common with a programmer than a computer!
I hear what you are saying. It would probably have been more productive to start with what the “computer mind” model entails and why it doesn’t work, so the purpose of the new explanation can be made clear. Otherwise, it’s hard to understand the purpose of the new model!
The second includes this paragraph, among others: “According to the
originally formulation, enactivism is committed to the idea that mentality is something that
emerges from the autopoetic, self-organizing and self-creating, activities of organisms. The
activities in question are themselves thought of as essentially embedded and embodied
interactions between organisms and their environments, interactions that occur and are
themselves shaped in new ways over time. ”
“Autopoetic?” Really? Hardly what I’d call 12-year-old language!
Besides, I’m quite capable of understanding very high level language. I don’t think it’s a lack of language skills that’s stopping me from understanding this – I think it’s simply a very complex theory that doesn’t meet my basic criteria for scientific models (making the world simpler to understand rather than more complicated). If someone can’t explain something to me, it’s generally not because I’m not smart enough to understand it – it’s usually because it doesn’t fully make sense!
Wow, dude, this guy sure does use complex language to make things obscure! A good scientific model simplifies our understanding of things or makes sense with the data we know. I still don’t know what he’s saying after reading the whole article, and I’m pretty darned smart. Why’s he have to make things so complex? Why not just show why the brain is NOT a computer (this has been done many times) and start from there?
They should “exercise caution?” How about “THEY SHOULD NOT DO IT!” Increased risk of death with no expected improvement in outcome? Sounds like malpractice to me!
POSTING AS MODERATOR: Sometimes you have to go back to the last comment that has a REPLY button on it. If you reply to that, your comment goes in after all the “replies” that appear on that thread, so it shows up in the right spot (most recent).
And it would have been easy for psychiatrists to debunk any drug company propaganda if they’d wanted to. It was “nudge-nudge, wink-wink, let’s all make some big money!”
I would agree that “education” to whatever degree does not qualify anyone to be actually helpful. The proof is in the pudding, and there is a lot of mediocre to dangerous “therapy” going around out there. Competent practitioners appear to be the exception rather than the rule, all the more so since the DSM mentality has taken over psychology training as well as that of psychiatry. My (competent) therapist in the 80’s never shared any “diagnosis” with me – she just asked questions and listened. Lo and behold, that’s what I really needed, whatever “diagnosis” she must have sent to the insurance company. But it seems such an approach is becoming rarer by the day.
I’m not sure psychiatry can be transformed into anything other than what it has become. I see too many conflicts of interest and too much money being made by the status quo. Having been a professional dissenter within the system, I can say that there seemed to be very little interest in changing despite demonstrating the effectiveness of a different approach. I could only conclude that healing is NOT a priority of the psychiatric system, and in fact, they tend to find it threatening to their prerogatives. The investment in biological theories of “mental illness” was so intense as to approach obsession in many, and attempts to soften it, I found, were more than unwelcome. How do you change a system whose basic intent is not to heal but to control?
Having been one of those dissenters, I can tell you that they get a lot of crap for offering compassion, understanding and equal footing. Those in charge seem to be categorically opposed to anything that empowers clients!
Most of what I know about being a good “helper” I learned from the people I was trying to help. Psychology has a few techniques that can be handy at times but no real curative plan. The best advice I got about this came from Milton Erickson, who said you have to re-invent “therapy” for every single person you’re trying to help. This means listening and getting to know the person from THEIR viewpoint rather than forcing them into some preconceived theoretical mold. I’ve always maintained that the client is the only one who knows the right answers for them, and our job is simply to help them find them and recognize their own solutions for what they are. It doesn’t take a degree or any specific training to do that. In fact, I don’t think you CAN train anyone to do that. It has to come from the heart!
These categories have no distinctive validity, IMHO. “Comorbidity” is a code word for “people don’t neatly fit into these arbitrary categories.” From a scientific viewpoint, these DSM “diagnoses” are very close to meaningless.
It’s not that physiology can’t cause any of these conditions. It’s that calling the phenomenon “ADHD” assumes a unitary cause and/or treatment. I wonder how many case of sleep disturbance are dismissed as “ADHD” every year? And apparently some kids are “cured” by simply waiting a year to begin formal schooling. Can’t think of two more divergent causes. So how can we even talk about “ADHD” as if it is a THING in itself, when it’s really just a heterogeneous collection of phenomena that share only attentional difficulties as a part of the phenomena. We are clearly far better off not to use that term and to treat sleep apnea or developmental delays or even not treat ANYTHING but simply wait for the kid to grow up a bit!
I would not agree that we have a “better understanding of illnesses” except to the extent that we are beginning to recognize that none of the DSM “disorders” meet the minimum criteria for being “illnesses” in the medical/scientific sense. It is also not correct to assume that studies from the past are lower quality – recent studies have shown that more than half of our scientific papers draw conclusions that eventually turn out to be incorrect. There are plenty of solid, quality studies done in the past, and it’s pretty biased to dismiss a study just because it’s not new or recent. Each study needs to be considered for its own value.
I won’t even get into the comment about “more efficient method… of treatment.”
This gives the impression that antipsychotics are mostly prescribed by hospitals. That is not my experience. Nursing homes, assisted living facilities, and adult foster homes very commonly prescribe these drugs for “behavior management.” I’m not surprised that they don’t really work and create bad outcomes. But do you think this will change the behavior of those handing out these prescriptions like candy? I don’t think it will. They are not operating on scientific data.
It annoys me that it keeps saying, “Not JUST genetics.” The fact that other family members have “diagnoses” does NOT imply a genetic cause! It could easily be that they were also traumatized by their own family/community growing up and simply did to others what was done to them.
Additionally, the definition of “trauma” in the study was EXTREMELY narrow! They did not include divorce, bullying, exposure to parental domestic abuse, or extreme poverty, just to name a few of many other traumatic events, and of course give zero credence to NEGLECT, which is probably far MORE common and possibly more damaging than overt abuse.
Despite this narrow definition, a quarter still had “trauma exposure” in their histories. Obviously, it is very common. The authors appear strongly biased toward believing a genetic basis is primary, but the study certainly does not show this to be the case.
Hey, fellow Obie!!! My wife and I both graduated in 1980!
I would hesitate to call yourself “treatment resistant.” What that REALLY means is: their treatment didn’t work for you! You didn’t RESIST, it just was a crap treatment plan! Not your fault they don’t know what they’re doing, but they try to blame the patient with terms like “treatment resistant.” Don’t give them the satisfaction of adopting that idea!
There is, unfortunately, no objective or accurate way to distinguish “mental patients” from “normal people.” That’s why it becomes OK to give “normal people” drugs for normal conditions, because there is no way to draw the line you seem to think exists. Your comment justifies abuse and prejudice against people who are given certain labels, often arbitrarily and ALWAYS subjectively. Certainly, we need to protect ourselves and our society from people who would do us harm, for whatever reason. But to suggest that “people with serious mental illness” is somehow a legitimate and definable category of people who DESERVE to be harmed by the drug-crazed system they encounter is rank prejudice. In my view, NO ONE deserves to force people to suffer adverse effects of “medications” (aka drugs) against their wills, and as soon as we make it OK for a certain subjective category of people to be abused in that way, the door is open for “normal” people to be swept up in the mess that is then created.
It is not the fault of people telling the truth if physicians behave irrationally. People should not have to silence themselves so that others don’t feel uncomfortable continuing to take or prescribe benzodiazepines. People should know the possible harms so they can make an informed decision. Are you suggesting censoring anyone who has a bad experience with benzos?
I don’t think it would be appropriate for you to push everyone to stop taking antidepressants or to ban their use. But why would it be wrong for you to let people know what a horrific experience you had on Cymbalta? In case they have similar symptoms and would then know the probable cause? What’s wrong with that?
The very screening process for who gets INTO medical school tends to weed out the creative and rebellious types and selects instead for those most successful in adhering to the authoritarian requirements of their school environments. Anti-authoritarians rarely become doctors, and those who survive are pre-selected to be less likely than most to question “the authorities” who are telling them what is what. And I highly admire those who manage to push through all of the authoritarian training and still maintain their integrity and independence of thought. I find such specimen rare, indeed.
Let’s not get into personal wrangling here. Sometimes off topic comments are allowed because they add to the discussion in some way. We’re trying to let everyone have a voice here. It’s not supposed to be personal.
No, it makes a certain SUBSET of depression a “neurometabolic condition.” Unless EVERY case of “depression” has low folate, etc. it is wrong to say that it is the cause of all cases that fit the “major depression” label.
In other words, low folate is a condition that might cause depression and is treatable by folic acid. We would be treating LOW FOLATE, not “Major Depression.”
Good point, actually. A real science would establish the homogeneity of a group before considering them legitimate to study as a group. Merely gathering people who feel a certain way does not meet the minimum criterion for being a meaningful grouping. It would be like studying people with sore knees. Some have bruising, some have arthritis, some have torn ligaments, some have just overexercised. They are not a group in the sense that all folks with, say, rheumatoid arthritis are a group. And interestingly, those with arthritis may have no knee pain at all but pains in other areas. The common CAUSE is what needs to be studied, and no one can find a common cause for all cases of “people who feel chronically depressed.”
Not arguing that point, merely that they’d have to be the same person (spiritual being) in a past life in order for a past-life decision to affect them in the present. You said they might have been a “different person” in the past and I was taking issue with that. Picky point, I admit.
A descriptor merely relates a particular set of observations. Like someone is anxious or sees things that others don’t see. A label has extra significance, like “anxiety disorder” or “schizophrenia.” The latter implies not only that the person feels anxious, but that they have a condition that causes them to experience anxiety and that they have something significant in common with others having the same label. Three people who feel anxious may well have three different reasons for feeling that way. Whereas three people “with an anxiety disorder” presumably have something WRONG with them, and presumably ALL have the SAME THING wrong with them to fit that label.
I suppose you could say that the descriptor is factual, whereas the label carries biases and assumptions with it that may or may not be true.
You mean they could have had totally different experiences, I think. The idea of past lives assumes the same essential person passes from one life to another, does it not? They might assume different identities, but the person him/herself would be the same person or else reincarnation would hold no real meaning.
I am afraid as soon as you allow these labels for “research purposes,” you have granted them a scientific legitimacy that they do not deserve. There is nothing wrong with relying on descriptors to guide research, such as “people who feel chronically depressed,” but as soon as you start calling this “major depression,” you enter into the assumption that folks who feel this way are all the same or similar in both the cause of and solution to their suffering. This, of course, plays into the drug companies’ hands and prevents any real research into the actual causal factors behind a given case of feeling chronically depressed. Such “science” leads to nothing but poor outcomes, as we can see from the current realities of the “mental health” system.
60% though? Seems like a lot of “normalizing” going on there. Hard to believe it’s all a matter of unconscious bias. I think it mostly has to do with intent. If you don’t want to deal with trauma, or don’t know how to, you try really hard not to see it.
I have always believed that the blunting effect contributes to the increase in both interpersonal violence and suicide attempts. Inhibitions serve an important purpose. If you are no longer worried what will happen if you shoot someone, it makes it more likely that those with such tendencies will do so. Same with suicide.
Parents can also traumatize their children unintentionally, either through unavoidable events like early hospitalization, or simply unconscious personality traits that lead to feelings of abandonment or insignificance on the part of the child. My mom was a perfectly nice person but did not attach well to her babies due to her personality. Nothing mean going on, she just wasn’t able to be there and it affected me very significantly. I could say “it’s not her fault” but it still messed me up pretty badly!
Additionally, antipsychotics lead to increased smoking, as they reduce dopamine and cigarettes increase dopamine slightly and so tends to reduce side effects.
Unfortunately, psychiatry plays right into this dynamic. I saw it many times working with foster youth. The kid is blamed for acting out when clearly s/he is reacting to horrible parenting or abandonment. They are told they have a “chemical imbalance” because they are upset or depressed or anxious about their clearly unstable and unsafe situations! And the psychiatrists generally play right along.
The questions asked reflect the intentions of the questioner. If one really wanted to help, asking about what happened would be the natural first step. A semi-enlightened 8 year old child knows this. The adults should know better. They do know better, but their intention is not to help but to control.
You’d think it would be the first thing you ask them, right? And of course, most of the 20% that didn’t share probably had traumatic experiences as well, either not wanting to share it or not realizing it was traumatic based on it being what they were used to. I’ve found traumatic exposure to be almost universal in the foster youth that tend to occupy these homes. How can we ignore that fact?
I recall a study done in recent years where volunteers went in to interview kids in residential treatment centers. Over 80% of the kids identified traumatic experiences as a major factor in their lives (willing to reveal this information to total strangers), but something like only 20% had such events recorded in their notes or files!!! So either 60% of the kids knew they’d been traumatized and none of the staff ever bothered to asked them about it, or else 60% of the time, the staff didn’t regard these facts as relevant to the child’s treatment!
“Current theories” lack evidence to support them. It is clearly established that “high dopamine” in and of itself does not cause “schizophrenia.” Lots of people are very invested in maintaining the fiction that we “know” this is a purely biological “disease.” But those theories have no actual hard data supporting them. The burden of proof is on those claiming such theories, and so far, that burden remains very much unmet.
Please provide scientific studies to refute this if you have them. But I won’t hold my breath.
If you had read Whitaker, you’d know that is wrong. Patients diagnosed with “Schizophrenia” actually recovered more commonly BEFORE Thorazine. More people left the hospital because of public policy decisions to reduce hospital beds and do “community treatment.” Recovery rates are currently better in countries that use LESS modern antipsychotics. Please read Whitaker’s research on this, including the WHO studies in the late 90s, before assuming your conclusions are correct.
Posting as moderator: We’re getting a little intense here in criticizing each other. Let’s try to get back to critiquing ideas, not people. Let’s talk about how we use the term “Trauma” (or whatever) ourselves rather than criticizing how we perceive others to have used it. Remember who the real “enemy” is! It’s not each other!
Again, your optimism is touching. But naive in my view. I hope you are right, but I’m not holding my breath for the corrupt psychiatric industry to embrace something that won’t make them tons of money on drug sales and kickbacks. Perhaps I’m just cynical…
But they DON’T have the same type of damage. SOME have the same type of damage. Others do not. Until we can tell who has, say TH17 problems of a certain type, we are still shooting in the dark. Once we can make such distinction, we can determine who has TH17 damage and treat them for TH17 damage. But we are no longer treating “depression,” we’re treating TH17 damage. And those who DON’T have TH17 damage will need something else. Can you see this difference?
I think it can help because they are reviewing the traumatic events and bleeding off the intense emotion that is associated with it. That’s basic psychodynamic therapy. The only good thing I think EMDR adds is looking at earlier incidents if the incident in question doesn’t resolve or at least reduce in intensity after being reviewed. All that is logical. The eye movement part is not.
I have always thought the eye movement part to be of no importance. It’s basically a regressive therapy, which has always worked for some folks if done well, but doesn’t work for everyone.
That’s the other silly thing about “Evidence Based Therapy” – we are assuming that a percentage of people saying they benefit from a certain approach makes it most effective for everyone, when it may be only effective for that percentage and better approaches may be better for others. Why do we think one “treatment” is going to “work” for everyone with a certain emotional state? Why wouldn’t it depend on the person and their needs? It’s the “medical model” being forced in where it doesn’t belong.
Many, many commenters here have in fact gone through ECT. Believe me when I tell you, they know what they are talking about and they did not have an experience like you did.
I personally think it’s absurd that they found you “manic depressive and schizophrenic” when you were a scared 18-year-old girl whose husband had betrayed her and who was understandably lost and confused. Were you hallucinating at the time? Did you ever show any signs of psychosis again later on in life?
I think you were very fortunate to have gone through that with minimal damage and have gone on to live a good and happy life. I credit you with that rather than ECT. You sound like a tough person!
Absurd. Shows the true authoritarian nature of psychiatry, not really interested in or able to have a real conversation about what’s going on for the client/patient. Very dangerous attitude!
I am certain you are very “different” from the average person and that those differences are inherent and not the result of a “psychological” problem.
That being said, your claim that these are “neurotypes” that are distinguishable from “normal” neurotypes is not supported by actual data as far as my understanding of the research. So most of what you are saying is purely theoretical, regardless of one’s understanding of genetics, epigenetics, etc.
What IS a hoax is the idea that psychiatry as a profession has any kind of real understanding of “ADHD” or “ASD” as “mental health disorders,” a statement with which I assume you would agree. Pretending to understand the “biological basis” of these phenomena and trying to use drugs to “treat” them is the real hoax.
I also find it amusing when people mention people like DaVinci, Mozart, and Edison as examples of “famous people having ADHD” (or whatever.) Apparently these people were tremendously successful without any sort of “treatment” for their “disorders.” Which kind of begs the question, what exactly is being “treated” by psychiatrists claiming to help? And would these people have actually BEEN as successful had they been “treated” instead of being allowed to express their creativity through art, music, or inventions?
It is indeed a complex question, far more complex than I believe your analysis allows.
Sorry, I don’t see it. Psychiatry does not want to cure people, and polygenetics is not providing anything that will stop their slide toward greed and avarice and malpractice. They already ignore the science they do have. Why do you think that will change?
But I think that means that the entire psychiatric DISORDER itself (aka schizophrenia, major depression) has never been shown to have a biological cause. In other words, there is no biological reason that explains all or most cases of depression. That’s not the same as saying that a person can’t become depressed due to a physiological problem. That would not mean “Major Depression” is caused by physiology, but that a person having cancer, for instance, feels depressed as an effect of the disease. VERY different than saying “Major Depression is caused by biology!”
I tend to agree. I think we all know that there ARE physical reasons why people have mental/emotional problems, and those underlying physical issues should be explored and treated. But the idea that ALL (or even most of) such “disorders” are caused by mysterious, unknown physical issues is what psychiatry is based on, and that is absolute delusional nonsense!
It’s also a fantastically engaging story between the philosophy. Written by a guy whose personality was erased by ECT, and talks about how he recovers himself on a long motorcycle trip with his son. One of the best books I ever read!
Again, I think your optimism is touching but naive. The DMS 6 will be little to no more scientific than the DSM 5. Not because there isn’t science to be considered, but because there is WAY too much money being made with the status quo. A TRUE scientific approach would put 90+ % of psychiatrists out of business!
The thing is, paralysis of volition isn’t a side effect. It IS the intended effect of so-called “antipsychotic” drugs. If you can’t imagine anything, you can’t hallucinate. That’s exactly the whole point, not an accidental adverse impact!
You speak wisdom. Our lives are all polluted by users who wish to profit from our hard work and our sufferings. We no longer have real communities in most cases. We are constantly working against forces that are not concerned with our welfare. It is exhausting and it breaks us down. SO much more going on than biology!
My point is: there are no “true patients” in the scientific sense. Your reasons are utterly speculative in every case. No one can “diagnose” something that is so completely subjective. There is zero validity to “Bipolar 1” as a diagnosis. I am sure there is lots to be learned from polygenetics, but finding the “cause” of such speculative “disorders” as “bipolar disorder” will never be a reality.
What comment are you referring to? If you can get me a time and date and maybe the first sentence, I can look for it. It’s possible it just slipped through the cracks. That happens occasionally even in the best programs.
You are incredibly overly optimistic based on the evidence to date. Normal science postulates a cause and tests for it. Psychiatry postulates a conclusion and looks for data to “prove” it after the fact. If there are some genetically-identifiable cases, they ought to be identified as SEPARATE CONDITIONS that may be amenable to treatment. But the vast majority of DSM cases have NOTHING in common with the genetics you mention. NOTHING.
I would also ask you to consider the following: even if genetic markers DO occur in common between people with these subjective “disorders” tossed on them, why does that mean these people are “abnormal?” Maybe it’s just NORMAL to have people with a wide range of activity levels or sociability or any of a number of these “criteria” which remain completely subjective and unmeasurable scientifically? For instance, why is there no “Hypoactivity disorder”? Is this because there are not kids who have very low activity levels? Or perhaps it’s only because kids with HIGH activity levels ANNOY ADULTS, even if their behavior is entirely normal? Maybe there are advantages to a certain genetic arrangement which are ignored by your normal/abnormal framing?
GWAS is a dead end. At best, it will identify a tiny, tiny percentage of vulnerable people, and we already know that many such people never develop any kind of “DSM” problems. And the vast majority so labeled have zero connection to the GWAS genes in question.
The problem is having the cart before the horse. We can’t decide to define diagnoses by totally subjective criteria and then expect scientific verification of them. We have to do it the other way around, and again, it will only be a tiny percentage that are predicted by GWAS data. Trauma and loss is a much better predictor BY FAR of the presence of “mental illnesses.”
You are making my point for me. There is no way that any “genetic risk factors” can possibly explain more than the tiniest percentage of “bipolar diagnoses.” There is no effort to establish any other cause, including the obvious one of lack of sleep. They just see if you “fit the criteria” and label you with these subjective “diagnoses” that have no particular connection to reality. There is no “DSM logic”. It’s complete speculation.
I have found four out of five different for MDD and ADHD.
For schizophrenia, we need two out of the following 5 symptoms for a mere one month.
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (i.e., diminished emotional expression or avolition)
We need one of the first three. So we can have hallucinations, disorganized speech, and grossly disorganized behavior. Or we can have delusions, catatonic behavior, and negative symptoms. Nothing in common between the two.
For Bipolar I disorder, we need four of the below criteria:
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli), as reported or observed
Increase in goal-directed activity (either socially, at work or school, or sexually)
or
psychomotor agitation (i.e., purposeless, non-goal-directed activity)
Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions,
or foolish business investments)
There are obviously many combinations of the above that would enable two people with no symptoms in common to fit the criteria.
We will have to agree to disagree on this one. The massive numbers of genes needed to predict a tiny percentage of the possible “schizophrenia” cases does not make for accurate “diagnosis”. The number of “schizophrenics” who do NOT have these high-risk combinations is in itself sufficient to invalidate this approach. Not that a small percentage of folks (like yourself) may be able to find some correlations – it is certainly more than possible that a certain subset of “schizophrenia” gene combinations conveys a certain vulnerability to psychosis. However, correlations with trauma, urbanization, and other social causes are much, much higher than anything these giant genetic experiments have ever demonstrated. At best, a certain level of vulnerability can perhaps be imputed from this data, but to suggest it is CAUSATIVE of “schizophrenia” is just not the case.
That’s not really an answer, though, not scientifically. It’s a hypothesis, untested and unproven. In fact, the very idea that cases of “schizophrenia spectrum disorders” or “major depression” or any DSM diagnostic category have common etiologies is pure speculation. It is just as legitimate to hypothesize that environmental triggers play a role in all forms of “mental illness”. In other words, the same etiology might result in PTSD, ADHD, depression, anxiety or psychosis depending on the person and the context. At this point, there is no scientific basis to assume the DSM categories are legitimate in any scientific sense, so talking about etiologies of these so-called “disorders” makes no scientific sense at all.
It is worth noting that a two people could have literally no symptoms in common and yet qualify for the same “diagnosis.” Plain common sense says that can’t be right.
That was my point. If doing whatever they do gives them better outcomes than the ADs, it stands to reason that on the average, the AD’s are not helping. Which really calls into question the euphemistic use of the term “treatment resistant.” The actual term should be “treatment failure” or “ineffective treatments.” The client isn’t resisting. Their drugs just aren’t doing what they claimed to do!
Nicely articulated! I will add that in Antidepressant trials, those with preexisting suicidal ideation are almost always excluded. So finding an increase in suicidality can’t be explained by the client already being suicidal and his/her “disease” worsening. In any case, it is clear that on the average, there is certainly no argument that ADs REDUCE suicidality. At best, they have no effect, but it is likely that the overall effect is to increase the average risk, whatever individuals themselves may experience.
Sorry, not a relevant question. The AD’s did not work, whatever other means they may be using to cope. That’s the point. If you are more likely to recover without antidepressants than with them, then it’s not that they are “resisting treatment.” It means the “treatment” does not work!
Gosh, they really had to do a study to discover this??? It is disturbing that this is apparently a revelation to the mainstream of psychiatric practitioners. And of course, most will probably ignore it. There’s no money in helping people have more satisfying lives, is there?
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I think “productive” may be being used in the purely capitalistic sense here, as in “Doing something that has value for those running the show.” True productivity can embrace a lot of things that capitalist leaders don’t think of as productive.
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Yeah, I love how they say “We do not suggest” instead of “It is malpractice to…” Most of those prescribing antipsychotics for “depression” are not doing so because of the amazing results, and they’re not going to care if an article “suggests” that they stop!
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Very true!
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I think that sums it up. We don’t have to know where it comes from, but we do need to acknowledge that in a human being, SOMEONE is making and acting out and evaluating the survival decisions of the organism. Sure, there are primitive survival mechanisms like instincts and reflexes, but it seems obvious in humans that these impulses can be overridden at the discretion of the “agent” who seems to be running the show!
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Goffman is a great example of writing a strong model that is easily grasped and applied.
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Well, the title of the article is “The Brain Isn’t a Computer.” I kinda thought we’d start off with demonstrating that premise.
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I tend to agree. Whatever “spirit” is (and I don’t think anyone really knows this for sure), it is clear from observation that there is an entity which is EVALUATING and DECIDING and EXECUTING the actions of the organism/being. Most of what is “wrong” with the “mentally ill” in my view originates in this mysterious entity, which is after all the agent deciding what is and isn’t important and what should and should not be done. Some might postulate that this “spirit” arises from the body in some way, though I’ve never heard a convincing explanation of how that would occur. But it certainly is clear that this entity is not something arising from the wrong brain chemicals being out of balance! And it’s not a computer – much more in common with a programmer than a computer!
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I hear what you are saying. It would probably have been more productive to start with what the “computer mind” model entails and why it doesn’t work, so the purpose of the new explanation can be made clear. Otherwise, it’s hard to understand the purpose of the new model!
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The first link appears to be broken.
The second includes this paragraph, among others: “According to the
originally formulation, enactivism is committed to the idea that mentality is something that
emerges from the autopoetic, self-organizing and self-creating, activities of organisms. The
activities in question are themselves thought of as essentially embedded and embodied
interactions between organisms and their environments, interactions that occur and are
themselves shaped in new ways over time. ”
“Autopoetic?” Really? Hardly what I’d call 12-year-old language!
Besides, I’m quite capable of understanding very high level language. I don’t think it’s a lack of language skills that’s stopping me from understanding this – I think it’s simply a very complex theory that doesn’t meet my basic criteria for scientific models (making the world simpler to understand rather than more complicated). If someone can’t explain something to me, it’s generally not because I’m not smart enough to understand it – it’s usually because it doesn’t fully make sense!
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Wow, dude, this guy sure does use complex language to make things obscure! A good scientific model simplifies our understanding of things or makes sense with the data we know. I still don’t know what he’s saying after reading the whole article, and I’m pretty darned smart. Why’s he have to make things so complex? Why not just show why the brain is NOT a computer (this has been done many times) and start from there?
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They should “exercise caution?” How about “THEY SHOULD NOT DO IT!” Increased risk of death with no expected improvement in outcome? Sounds like malpractice to me!
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I bet people whose partners have sleep problems get worse sleep. Because their partners tend to wake them up more often when they wake up themselves!
How can this kind of crap be taken seriously?
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POSTING AS MODERATOR: Sometimes you have to go back to the last comment that has a REPLY button on it. If you reply to that, your comment goes in after all the “replies” that appear on that thread, so it shows up in the right spot (most recent).
Hope that helps!
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And it would have been easy for psychiatrists to debunk any drug company propaganda if they’d wanted to. It was “nudge-nudge, wink-wink, let’s all make some big money!”
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I would agree that “education” to whatever degree does not qualify anyone to be actually helpful. The proof is in the pudding, and there is a lot of mediocre to dangerous “therapy” going around out there. Competent practitioners appear to be the exception rather than the rule, all the more so since the DSM mentality has taken over psychology training as well as that of psychiatry. My (competent) therapist in the 80’s never shared any “diagnosis” with me – she just asked questions and listened. Lo and behold, that’s what I really needed, whatever “diagnosis” she must have sent to the insurance company. But it seems such an approach is becoming rarer by the day.
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As we used to say in the ’60s, “Talk is cheap!”
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I hope we get to read it soon. That sounds like the kind of care we need to see encouraged!
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I’m not sure psychiatry can be transformed into anything other than what it has become. I see too many conflicts of interest and too much money being made by the status quo. Having been a professional dissenter within the system, I can say that there seemed to be very little interest in changing despite demonstrating the effectiveness of a different approach. I could only conclude that healing is NOT a priority of the psychiatric system, and in fact, they tend to find it threatening to their prerogatives. The investment in biological theories of “mental illness” was so intense as to approach obsession in many, and attempts to soften it, I found, were more than unwelcome. How do you change a system whose basic intent is not to heal but to control?
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Having been one of those dissenters, I can tell you that they get a lot of crap for offering compassion, understanding and equal footing. Those in charge seem to be categorically opposed to anything that empowers clients!
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I have to say, I’ve always wondered why something proven to be destructive needs an “alternative” before we stop doing it?
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Most of what I know about being a good “helper” I learned from the people I was trying to help. Psychology has a few techniques that can be handy at times but no real curative plan. The best advice I got about this came from Milton Erickson, who said you have to re-invent “therapy” for every single person you’re trying to help. This means listening and getting to know the person from THEIR viewpoint rather than forcing them into some preconceived theoretical mold. I’ve always maintained that the client is the only one who knows the right answers for them, and our job is simply to help them find them and recognize their own solutions for what they are. It doesn’t take a degree or any specific training to do that. In fact, I don’t think you CAN train anyone to do that. It has to come from the heart!
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I would not assume what Bill has or has not experienced. He might surprise you.
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Are you F-ing serious???? This IS a new low!!! And who thought they could get any lower!
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Very well said!
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Precisely.
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These categories have no distinctive validity, IMHO. “Comorbidity” is a code word for “people don’t neatly fit into these arbitrary categories.” From a scientific viewpoint, these DSM “diagnoses” are very close to meaningless.
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It’s not that physiology can’t cause any of these conditions. It’s that calling the phenomenon “ADHD” assumes a unitary cause and/or treatment. I wonder how many case of sleep disturbance are dismissed as “ADHD” every year? And apparently some kids are “cured” by simply waiting a year to begin formal schooling. Can’t think of two more divergent causes. So how can we even talk about “ADHD” as if it is a THING in itself, when it’s really just a heterogeneous collection of phenomena that share only attentional difficulties as a part of the phenomena. We are clearly far better off not to use that term and to treat sleep apnea or developmental delays or even not treat ANYTHING but simply wait for the kid to grow up a bit!
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I would not agree that we have a “better understanding of illnesses” except to the extent that we are beginning to recognize that none of the DSM “disorders” meet the minimum criteria for being “illnesses” in the medical/scientific sense. It is also not correct to assume that studies from the past are lower quality – recent studies have shown that more than half of our scientific papers draw conclusions that eventually turn out to be incorrect. There are plenty of solid, quality studies done in the past, and it’s pretty biased to dismiss a study just because it’s not new or recent. Each study needs to be considered for its own value.
I won’t even get into the comment about “more efficient method… of treatment.”
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POSTING AS MODERATOR: I am approving the above on the assumption that the comments re: Birdsong are intended as sarcasm.
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That’s what gets us through it!
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Whoops! I guess this is a good plan if you want another generation of customers, eh?
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This gives the impression that antipsychotics are mostly prescribed by hospitals. That is not my experience. Nursing homes, assisted living facilities, and adult foster homes very commonly prescribe these drugs for “behavior management.” I’m not surprised that they don’t really work and create bad outcomes. But do you think this will change the behavior of those handing out these prescriptions like candy? I don’t think it will. They are not operating on scientific data.
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It annoys me that it keeps saying, “Not JUST genetics.” The fact that other family members have “diagnoses” does NOT imply a genetic cause! It could easily be that they were also traumatized by their own family/community growing up and simply did to others what was done to them.
Additionally, the definition of “trauma” in the study was EXTREMELY narrow! They did not include divorce, bullying, exposure to parental domestic abuse, or extreme poverty, just to name a few of many other traumatic events, and of course give zero credence to NEGLECT, which is probably far MORE common and possibly more damaging than overt abuse.
Despite this narrow definition, a quarter still had “trauma exposure” in their histories. Obviously, it is very common. The authors appear strongly biased toward believing a genetic basis is primary, but the study certainly does not show this to be the case.
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Hey, fellow Obie!!! My wife and I both graduated in 1980!
I would hesitate to call yourself “treatment resistant.” What that REALLY means is: their treatment didn’t work for you! You didn’t RESIST, it just was a crap treatment plan! Not your fault they don’t know what they’re doing, but they try to blame the patient with terms like “treatment resistant.” Don’t give them the satisfaction of adopting that idea!
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ANY mental condition, actually, at least if we are looking at the DSM. Not one of them is verifiable by physical testing.
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I would certainly think so.
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There is, unfortunately, no objective or accurate way to distinguish “mental patients” from “normal people.” That’s why it becomes OK to give “normal people” drugs for normal conditions, because there is no way to draw the line you seem to think exists. Your comment justifies abuse and prejudice against people who are given certain labels, often arbitrarily and ALWAYS subjectively. Certainly, we need to protect ourselves and our society from people who would do us harm, for whatever reason. But to suggest that “people with serious mental illness” is somehow a legitimate and definable category of people who DESERVE to be harmed by the drug-crazed system they encounter is rank prejudice. In my view, NO ONE deserves to force people to suffer adverse effects of “medications” (aka drugs) against their wills, and as soon as we make it OK for a certain subjective category of people to be abused in that way, the door is open for “normal” people to be swept up in the mess that is then created.
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It is not the fault of people telling the truth if physicians behave irrationally. People should not have to silence themselves so that others don’t feel uncomfortable continuing to take or prescribe benzodiazepines. People should know the possible harms so they can make an informed decision. Are you suggesting censoring anyone who has a bad experience with benzos?
I don’t think it would be appropriate for you to push everyone to stop taking antidepressants or to ban their use. But why would it be wrong for you to let people know what a horrific experience you had on Cymbalta? In case they have similar symptoms and would then know the probable cause? What’s wrong with that?
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That is both sad and enraging!
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The very screening process for who gets INTO medical school tends to weed out the creative and rebellious types and selects instead for those most successful in adhering to the authoritarian requirements of their school environments. Anti-authoritarians rarely become doctors, and those who survive are pre-selected to be less likely than most to question “the authorities” who are telling them what is what. And I highly admire those who manage to push through all of the authoritarian training and still maintain their integrity and independence of thought. I find such specimen rare, indeed.
IMHO.
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COMMENTING AS MODERATOR:
Let’s not get into personal wrangling here. Sometimes off topic comments are allowed because they add to the discussion in some way. We’re trying to let everyone have a voice here. It’s not supposed to be personal.
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Exactly. Same person, differing identities. We’re on the same page.
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No, it makes a certain SUBSET of depression a “neurometabolic condition.” Unless EVERY case of “depression” has low folate, etc. it is wrong to say that it is the cause of all cases that fit the “major depression” label.
In other words, low folate is a condition that might cause depression and is treatable by folic acid. We would be treating LOW FOLATE, not “Major Depression.”
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Good point, actually. A real science would establish the homogeneity of a group before considering them legitimate to study as a group. Merely gathering people who feel a certain way does not meet the minimum criterion for being a meaningful grouping. It would be like studying people with sore knees. Some have bruising, some have arthritis, some have torn ligaments, some have just overexercised. They are not a group in the sense that all folks with, say, rheumatoid arthritis are a group. And interestingly, those with arthritis may have no knee pain at all but pains in other areas. The common CAUSE is what needs to be studied, and no one can find a common cause for all cases of “people who feel chronically depressed.”
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Not arguing that point, merely that they’d have to be the same person (spiritual being) in a past life in order for a past-life decision to affect them in the present. You said they might have been a “different person” in the past and I was taking issue with that. Picky point, I admit.
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A descriptor merely relates a particular set of observations. Like someone is anxious or sees things that others don’t see. A label has extra significance, like “anxiety disorder” or “schizophrenia.” The latter implies not only that the person feels anxious, but that they have a condition that causes them to experience anxiety and that they have something significant in common with others having the same label. Three people who feel anxious may well have three different reasons for feeling that way. Whereas three people “with an anxiety disorder” presumably have something WRONG with them, and presumably ALL have the SAME THING wrong with them to fit that label.
I suppose you could say that the descriptor is factual, whereas the label carries biases and assumptions with it that may or may not be true.
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You mean they could have had totally different experiences, I think. The idea of past lives assumes the same essential person passes from one life to another, does it not? They might assume different identities, but the person him/herself would be the same person or else reincarnation would hold no real meaning.
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I am afraid as soon as you allow these labels for “research purposes,” you have granted them a scientific legitimacy that they do not deserve. There is nothing wrong with relying on descriptors to guide research, such as “people who feel chronically depressed,” but as soon as you start calling this “major depression,” you enter into the assumption that folks who feel this way are all the same or similar in both the cause of and solution to their suffering. This, of course, plays into the drug companies’ hands and prevents any real research into the actual causal factors behind a given case of feeling chronically depressed. Such “science” leads to nothing but poor outcomes, as we can see from the current realities of the “mental health” system.
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And we have to remember that in EVERY case, the prenatal environment was more or less identical for both twins.
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They may be rare but they DO exist out there!
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And good for the psychologist for encouraging her to listen to herself!
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Quite so!
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Labeling allows people to pretend they “know” things without any actual meaningful knowledge.
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60% though? Seems like a lot of “normalizing” going on there. Hard to believe it’s all a matter of unconscious bias. I think it mostly has to do with intent. If you don’t want to deal with trauma, or don’t know how to, you try really hard not to see it.
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I have always believed that the blunting effect contributes to the increase in both interpersonal violence and suicide attempts. Inhibitions serve an important purpose. If you are no longer worried what will happen if you shoot someone, it makes it more likely that those with such tendencies will do so. Same with suicide.
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Parents can also traumatize their children unintentionally, either through unavoidable events like early hospitalization, or simply unconscious personality traits that lead to feelings of abandonment or insignificance on the part of the child. My mom was a perfectly nice person but did not attach well to her babies due to her personality. Nothing mean going on, she just wasn’t able to be there and it affected me very significantly. I could say “it’s not her fault” but it still messed me up pretty badly!
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Additionally, antipsychotics lead to increased smoking, as they reduce dopamine and cigarettes increase dopamine slightly and so tends to reduce side effects.
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Unfortunately, psychiatry plays right into this dynamic. I saw it many times working with foster youth. The kid is blamed for acting out when clearly s/he is reacting to horrible parenting or abandonment. They are told they have a “chemical imbalance” because they are upset or depressed or anxious about their clearly unstable and unsafe situations! And the psychiatrists generally play right along.
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The questions asked reflect the intentions of the questioner. If one really wanted to help, asking about what happened would be the natural first step. A semi-enlightened 8 year old child knows this. The adults should know better. They do know better, but their intention is not to help but to control.
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You’d think it would be the first thing you ask them, right? And of course, most of the 20% that didn’t share probably had traumatic experiences as well, either not wanting to share it or not realizing it was traumatic based on it being what they were used to. I’ve found traumatic exposure to be almost universal in the foster youth that tend to occupy these homes. How can we ignore that fact?
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I recall a study done in recent years where volunteers went in to interview kids in residential treatment centers. Over 80% of the kids identified traumatic experiences as a major factor in their lives (willing to reveal this information to total strangers), but something like only 20% had such events recorded in their notes or files!!! So either 60% of the kids knew they’d been traumatized and none of the staff ever bothered to asked them about it, or else 60% of the time, the staff didn’t regard these facts as relevant to the child’s treatment!
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You need to read Whitaker’s works. It’s clear you have not done so or you would not make that claim.
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“Current theories” lack evidence to support them. It is clearly established that “high dopamine” in and of itself does not cause “schizophrenia.” Lots of people are very invested in maintaining the fiction that we “know” this is a purely biological “disease.” But those theories have no actual hard data supporting them. The burden of proof is on those claiming such theories, and so far, that burden remains very much unmet.
Please provide scientific studies to refute this if you have them. But I won’t hold my breath.
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If you had read Whitaker, you’d know that is wrong. Patients diagnosed with “Schizophrenia” actually recovered more commonly BEFORE Thorazine. More people left the hospital because of public policy decisions to reduce hospital beds and do “community treatment.” Recovery rates are currently better in countries that use LESS modern antipsychotics. Please read Whitaker’s research on this, including the WHO studies in the late 90s, before assuming your conclusions are correct.
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Posting as moderator: We’re getting a little intense here in criticizing each other. Let’s try to get back to critiquing ideas, not people. Let’s talk about how we use the term “Trauma” (or whatever) ourselves rather than criticizing how we perceive others to have used it. Remember who the real “enemy” is! It’s not each other!
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“Combating stigma regarding mental illness” is code for “Making it safe for us to drug as many people as possible without anyone complaining.” IMHO.
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Again, your optimism is touching. But naive in my view. I hope you are right, but I’m not holding my breath for the corrupt psychiatric industry to embrace something that won’t make them tons of money on drug sales and kickbacks. Perhaps I’m just cynical…
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But they DON’T have the same type of damage. SOME have the same type of damage. Others do not. Until we can tell who has, say TH17 problems of a certain type, we are still shooting in the dark. Once we can make such distinction, we can determine who has TH17 damage and treat them for TH17 damage. But we are no longer treating “depression,” we’re treating TH17 damage. And those who DON’T have TH17 damage will need something else. Can you see this difference?
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I think it can help because they are reviewing the traumatic events and bleeding off the intense emotion that is associated with it. That’s basic psychodynamic therapy. The only good thing I think EMDR adds is looking at earlier incidents if the incident in question doesn’t resolve or at least reduce in intensity after being reviewed. All that is logical. The eye movement part is not.
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I have always thought the eye movement part to be of no importance. It’s basically a regressive therapy, which has always worked for some folks if done well, but doesn’t work for everyone.
That’s the other silly thing about “Evidence Based Therapy” – we are assuming that a percentage of people saying they benefit from a certain approach makes it most effective for everyone, when it may be only effective for that percentage and better approaches may be better for others. Why do we think one “treatment” is going to “work” for everyone with a certain emotional state? Why wouldn’t it depend on the person and their needs? It’s the “medical model” being forced in where it doesn’t belong.
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Many, many commenters here have in fact gone through ECT. Believe me when I tell you, they know what they are talking about and they did not have an experience like you did.
I personally think it’s absurd that they found you “manic depressive and schizophrenic” when you were a scared 18-year-old girl whose husband had betrayed her and who was understandably lost and confused. Were you hallucinating at the time? Did you ever show any signs of psychosis again later on in life?
I think you were very fortunate to have gone through that with minimal damage and have gone on to live a good and happy life. I credit you with that rather than ECT. You sound like a tough person!
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Absurd. Shows the true authoritarian nature of psychiatry, not really interested in or able to have a real conversation about what’s going on for the client/patient. Very dangerous attitude!
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I am certain you are very “different” from the average person and that those differences are inherent and not the result of a “psychological” problem.
That being said, your claim that these are “neurotypes” that are distinguishable from “normal” neurotypes is not supported by actual data as far as my understanding of the research. So most of what you are saying is purely theoretical, regardless of one’s understanding of genetics, epigenetics, etc.
What IS a hoax is the idea that psychiatry as a profession has any kind of real understanding of “ADHD” or “ASD” as “mental health disorders,” a statement with which I assume you would agree. Pretending to understand the “biological basis” of these phenomena and trying to use drugs to “treat” them is the real hoax.
I also find it amusing when people mention people like DaVinci, Mozart, and Edison as examples of “famous people having ADHD” (or whatever.) Apparently these people were tremendously successful without any sort of “treatment” for their “disorders.” Which kind of begs the question, what exactly is being “treated” by psychiatrists claiming to help? And would these people have actually BEEN as successful had they been “treated” instead of being allowed to express their creativity through art, music, or inventions?
It is indeed a complex question, far more complex than I believe your analysis allows.
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Sorry, I don’t see it. Psychiatry does not want to cure people, and polygenetics is not providing anything that will stop their slide toward greed and avarice and malpractice. They already ignore the science they do have. Why do you think that will change?
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But I think that means that the entire psychiatric DISORDER itself (aka schizophrenia, major depression) has never been shown to have a biological cause. In other words, there is no biological reason that explains all or most cases of depression. That’s not the same as saying that a person can’t become depressed due to a physiological problem. That would not mean “Major Depression” is caused by physiology, but that a person having cancer, for instance, feels depressed as an effect of the disease. VERY different than saying “Major Depression is caused by biology!”
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I tend to agree. I think we all know that there ARE physical reasons why people have mental/emotional problems, and those underlying physical issues should be explored and treated. But the idea that ALL (or even most of) such “disorders” are caused by mysterious, unknown physical issues is what psychiatry is based on, and that is absolute delusional nonsense!
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It’s also a fantastically engaging story between the philosophy. Written by a guy whose personality was erased by ECT, and talks about how he recovers himself on a long motorcycle trip with his son. One of the best books I ever read!
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Again, I think your optimism is touching but naive. The DMS 6 will be little to no more scientific than the DSM 5. Not because there isn’t science to be considered, but because there is WAY too much money being made with the status quo. A TRUE scientific approach would put 90+ % of psychiatrists out of business!
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Zen and the Art of Motorcycle Maintenance is a great volume on this very topic! Spoiler: it’s all Aristotle’s fault!
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The thing is, paralysis of volition isn’t a side effect. It IS the intended effect of so-called “antipsychotic” drugs. If you can’t imagine anything, you can’t hallucinate. That’s exactly the whole point, not an accidental adverse impact!
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You speak wisdom. Our lives are all polluted by users who wish to profit from our hard work and our sufferings. We no longer have real communities in most cases. We are constantly working against forces that are not concerned with our welfare. It is exhausting and it breaks us down. SO much more going on than biology!
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So tell us about the method!
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It’s all basically “Behavior that makes adults uncomfortable.” That should be the only “diagnosis” in my mind!
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Wow, seriously? Talk about a euphemism!
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The ad hominem attack is the last resort of those who have no actual data to support their argument.
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My point is: there are no “true patients” in the scientific sense. Your reasons are utterly speculative in every case. No one can “diagnose” something that is so completely subjective. There is zero validity to “Bipolar 1” as a diagnosis. I am sure there is lots to be learned from polygenetics, but finding the “cause” of such speculative “disorders” as “bipolar disorder” will never be a reality.
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COMMENTING AS MODERATOR:
What comment are you referring to? If you can get me a time and date and maybe the first sentence, I can look for it. It’s possible it just slipped through the cracks. That happens occasionally even in the best programs.
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The product information says not to prescribe for more than two consecutive weeks. Clearly ignored by many doctors!
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You are incredibly overly optimistic based on the evidence to date. Normal science postulates a cause and tests for it. Psychiatry postulates a conclusion and looks for data to “prove” it after the fact. If there are some genetically-identifiable cases, they ought to be identified as SEPARATE CONDITIONS that may be amenable to treatment. But the vast majority of DSM cases have NOTHING in common with the genetics you mention. NOTHING.
I would also ask you to consider the following: even if genetic markers DO occur in common between people with these subjective “disorders” tossed on them, why does that mean these people are “abnormal?” Maybe it’s just NORMAL to have people with a wide range of activity levels or sociability or any of a number of these “criteria” which remain completely subjective and unmeasurable scientifically? For instance, why is there no “Hypoactivity disorder”? Is this because there are not kids who have very low activity levels? Or perhaps it’s only because kids with HIGH activity levels ANNOY ADULTS, even if their behavior is entirely normal? Maybe there are advantages to a certain genetic arrangement which are ignored by your normal/abnormal framing?
GWAS is a dead end. At best, it will identify a tiny, tiny percentage of vulnerable people, and we already know that many such people never develop any kind of “DSM” problems. And the vast majority so labeled have zero connection to the GWAS genes in question.
The problem is having the cart before the horse. We can’t decide to define diagnoses by totally subjective criteria and then expect scientific verification of them. We have to do it the other way around, and again, it will only be a tiny percentage that are predicted by GWAS data. Trauma and loss is a much better predictor BY FAR of the presence of “mental illnesses.”
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You are making my point for me. There is no way that any “genetic risk factors” can possibly explain more than the tiniest percentage of “bipolar diagnoses.” There is no effort to establish any other cause, including the obvious one of lack of sleep. They just see if you “fit the criteria” and label you with these subjective “diagnoses” that have no particular connection to reality. There is no “DSM logic”. It’s complete speculation.
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I would also ask how the word “overdiagnosing” can be applied when there is no objective means to make the “diagnosis” in the first place?
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I have found four out of five different for MDD and ADHD.
For schizophrenia, we need two out of the following 5 symptoms for a mere one month.
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (i.e., diminished emotional expression or avolition)
We need one of the first three. So we can have hallucinations, disorganized speech, and grossly disorganized behavior. Or we can have delusions, catatonic behavior, and negative symptoms. Nothing in common between the two.
For Bipolar I disorder, we need four of the below criteria:
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli), as reported or observed
Increase in goal-directed activity (either socially, at work or school, or sexually)
or
psychomotor agitation (i.e., purposeless, non-goal-directed activity)
Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions,
or foolish business investments)
There are obviously many combinations of the above that would enable two people with no symptoms in common to fit the criteria.
I could go on.
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We will have to agree to disagree on this one. The massive numbers of genes needed to predict a tiny percentage of the possible “schizophrenia” cases does not make for accurate “diagnosis”. The number of “schizophrenics” who do NOT have these high-risk combinations is in itself sufficient to invalidate this approach. Not that a small percentage of folks (like yourself) may be able to find some correlations – it is certainly more than possible that a certain subset of “schizophrenia” gene combinations conveys a certain vulnerability to psychosis. However, correlations with trauma, urbanization, and other social causes are much, much higher than anything these giant genetic experiments have ever demonstrated. At best, a certain level of vulnerability can perhaps be imputed from this data, but to suggest it is CAUSATIVE of “schizophrenia” is just not the case.
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That’s not really an answer, though, not scientifically. It’s a hypothesis, untested and unproven. In fact, the very idea that cases of “schizophrenia spectrum disorders” or “major depression” or any DSM diagnostic category have common etiologies is pure speculation. It is just as legitimate to hypothesize that environmental triggers play a role in all forms of “mental illness”. In other words, the same etiology might result in PTSD, ADHD, depression, anxiety or psychosis depending on the person and the context. At this point, there is no scientific basis to assume the DSM categories are legitimate in any scientific sense, so talking about etiologies of these so-called “disorders” makes no scientific sense at all.
It is worth noting that a two people could have literally no symptoms in common and yet qualify for the same “diagnosis.” Plain common sense says that can’t be right.
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But it’s wrong to assume that ALL psychiatric problems are physiological!
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That was my point. If doing whatever they do gives them better outcomes than the ADs, it stands to reason that on the average, the AD’s are not helping. Which really calls into question the euphemistic use of the term “treatment resistant.” The actual term should be “treatment failure” or “ineffective treatments.” The client isn’t resisting. Their drugs just aren’t doing what they claimed to do!
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Nicely articulated! I will add that in Antidepressant trials, those with preexisting suicidal ideation are almost always excluded. So finding an increase in suicidality can’t be explained by the client already being suicidal and his/her “disease” worsening. In any case, it is clear that on the average, there is certainly no argument that ADs REDUCE suicidality. At best, they have no effect, but it is likely that the overall effect is to increase the average risk, whatever individuals themselves may experience.
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Sorry, not a relevant question. The AD’s did not work, whatever other means they may be using to cope. That’s the point. If you are more likely to recover without antidepressants than with them, then it’s not that they are “resisting treatment.” It means the “treatment” does not work!
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Gosh, they really needed a study to figure this out???
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