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Nederlog

January 26, 2013


On psychiatry + Three psychiatrists

Sections
Introduction   
1.
On psychiatry
2. Dr Ghaemi vs Dr Frances
3. Dr Nardo
About ME/CFS



Introduction:

I am a little better than yesterday, and have another Nederlog on psychiatry and psychiatrists.

1. On psychiatry
Background: An article by Mala Szalavits in "Health and Family" (also elsewhere) from October 2012:
The psychiatrist is Dr David Healy, whom I wrote about in The Marketing of Medicines, who got invited - I am a bit amazed to report - to talk to the members of the American Psychiatric Association.

The article is interesting, also because it contains a number of links to other interesting relevant material.

I hope Dr Healy is right but I don't know, for various reasons, one of which is that I think psychiatry, for the most part, is dead, as a science, and has been replaced since the 1980ies by the science of public relations, that indeed has many ghostwriters who know how to write medicalese looking papers in "professional journals".

Here is my view of the field, copied from a note to my "
Arguments against psychiatry", with a few changes, and six notes to make my intended meanings clear:

Personally, I have never taken psychiatry serious as a real science, basically because I did read Freud, Jung, Laing and some others in my teens [1], and decided that whatever that was intented to be, and whatever that was good for - since many people do have psychological problems, and some get thoroughly mad, and all such persons deserve some form of help, however motivated, provided it is honest and not based on false pretensions - it certainly was not real science, in the sense that physics, chemistry, biology and most of medicine other than psychiatry are real sciences. [2]

Then again, until 2009 I never worried about psychiatry, because it seemed to me to be useful - more so than not - for at least two ends:

To help the insane, and to provide some sort of support for the neurotic [3], where I mean by "the insane" those who are thoroughly mad and not capable of helping themselves nor of functioning in society (without a lot of help), and by "the neurotic" those with psychological problems who can function socially, but who seek help from professionals, since they cannot find it elsewhere, and they feel miserable (depressed, fearful, nervous, unhappy etc.)

It also seemed to me, from what I knew about psychiatry and clinical psychology,  that much of that help was bound to be inept, since most of what I had read in those subjects seemed mostly false to me, but then in life one must make do with what there is rather than what there should be, while society is fundamentally an interpersonal contract for mutual help or protection.

It seems to me - after three years of reading since 2009 - that psychiatry since the DSM-III of 1980 is an intentional fraud, an intentional scam, that is meant to enrich psychiatrists and pharmaceutical companies by the selling of as many psychiatric drugs as is possible [4], and that for this purpose the whole diagnostic machinery of psychiatry, that never was really scientific, because there was not enough knowledge about how the brain manufactures human thought and feeling, has been transmogrified into an intentional pseudoscience that is designed on purpose to look and sound as if it is medical science, but is in fact intentional bullshit designed to give psychiatrists power without social control, without being found out, and with the possibility, that comes with their having a medical B.A., to sell as many medical drugs to laymen as they can. [5]

This is dangerous in itself, and the more since in the same period of the last 30 years the social control of the drug companies has grown much less, whereas great parts of what used to be more or less inept psychiatric attempts at science have been replaced by professional salesmanship and marketeering driven by the justified expectation of enormous profits:

Modern psychiatry, at least since the DSM-III, is not about helping people with psychological problems in an honest way, but is about selling them expensive drugs in a profitable way. [6]

2. Dr Ghaemi vs Dr Frances

I first learned about the existence of Dr Ghaemi when working through Question 1 of "The six most essential questions in psychiatric diagnosis" where I found he was one of the few psychiatrists who made some sense (to my way of thinking). Apart from what I read in the last link, I was not familiar with Dr Ghaemi or his writings, until today, but it turns out he also has a column on Psychology Today, which I know about because he has a difference of opinion with Dr Frances.

Dr Ghaemi's view - also a professor of psychiatry, considerably younger than either Dr Frances or myself - is this, and I copy from Psychology Today, but remove the links to its thoroughly inane explanations of terms, and to amazone.com, while the first line is a link to the original by Dr Ghaemi:

This is the ultimate flaw of the DSM system

Many people, including, it seems, the leadership of DSM-IV and DSM-5, have an unconscious postmodernist ideology. They distrust science; nosology leaders (like some of the leadership of DSM-IV) often have themselves been engaged in little, if any, scientific work. "Take the experts with a grain of salt" betrays a skepticism that, partly justified, can easily become an anti-scientific cynicism. Some readers may take this view to a nihilistic extreme, as did a national NPR science reporter with whom I once spoke. If they do, they share the same postmodernist ideology that has produced the DSM-5 which they criticize.  

Unless we get beyond this anti-science extremism, we cannot progress.

When the DSM leadership--whether in the 3rd, 4th, or 5th revision--gerrymanders psychiatric definitions for professional purposes, nature will not follow suit, and our biology, genetic, and pharmacology studies will be doomed to fail, as they have in the past three decades.  

This is a much sadder reality in psychiatry today than the APA Board of Trustees approval of DSM-5.

The generation of psychiatric leadership that gave us DSM-III, IV, and 5 has had its day. The future will belong to new generations of psychiatrists who, we can hope, will think for themselves, without personal commitments to these errors of the past.  

(PS: "First do no harm" is a pious slogan not to be found anywhere in the Hippocratic writings. It was invented in the 19th century by a British writer. The Hippocratic phrase is: "As to diseases, try to help, or at least not harm." By sacrificing science to "pragmatism," all versions of DSM prevent the profession from identifying diseases, making it harder to help, and ensuring that harm will ensue.)

I agree considerably more than not, since indeed I have argued this same point: The pernicious infuence of postmodernism on psychiatry in my long but still relatively often downloaded DSM-5: Question 1 of "The six most essential questions in psychiatric diagnosis" ... so I am intellectually pleased.

Dr Frances, as it happens, does not address these points at all - which does not amaze me. For more, see my
DSM-5: Question 1 of "The six most essential questions in psychiatric diagnosis", where you'll also find more of Dr Ghaemi with my discussion of those views.

As to "First do no harm": I was aware "primum non nocere" does not literally  occur in the Hippocratic corpus (also not in Greek), but it is quite close to what the man wrote (in English in fact:
"As to diseases make a habit of two things - to help, or at least, to do no harm"). It is often referred to as Hippocratic, I would say with at least as much license as "I disapprove of what you say, but I will defend to the death your right to say it" is attributed to Voltaire. ("The spirit, if not the letter.")

Also, the principle is not so much "pious" as moral - but I agree with Dr Ghaemi's point, since I hold that the end of human medicine should be the well-being of human beings (other than the medical doctor, to be sure).

3. Dr Nardo

In fact Dr Nardo's texts have been rather often referred to by me in Nederlog, since he is the same as
or at least: His blog goes by that name, and he recently has also used his name there.

He is a sensible and intelligent man, who wrote a lot of interesting texts - he started in December 2005 - about his own field, and in his latest blog
explains some about his own road towards psychiatry, whence he arrived after starting out specializing in internal medicine.

I have somewhere remarked I found that odd, but subsequently realized that if one is a student of medicine it may well seem one can be more helpful to people by helping them undo their confusions and delusions, than by practicing invasive medicine on them.

It seems this was a correct guess:
My interest developed in the course of internal medicine practice, realizing that many of the patients I saw may have come for help with physical symptoms, but the real problem was "supratentorial" [a doctor code word for "in the mind"]. Without actually noticing it happening, that’s where my interest was drawn. It wasn’t the major psychiatric illnesses – it was what the term "neurosis" means.
In fact, I have myself played with the notion that I might want to study medicine (not: psychiatry) when I was around 18, but then got a job for several months encoding medical abstracts for being fed to computers (at that time: in the form of punch cards), in the course of which I had access to more medical journals than almost anyone ever has or had, which cured me forever from wanting to study medicine [7]. (Otherwise, I might have tried, probably with no good outcome of any kind.)

He also has an interesting term and concept:
Therapeutic Zeal. It’s the danger behind the Hippocratic Oath’s injunction to "Do No Harm." (...) That’s what Therapeutic Zeal means, becoming too invested in treating and overlooking the dangers.
It seems a useful concept and term, though there are possible varieties, and there is room for Therapeutic Profitability, as is the case with many postmodern  psychiatric drugs, Therapeutic Trendiness, and Therapeutic Indifference: I recall the late Sixties - "Mother's Little Helper" time, when barbiturates were available through doctors as if it were candy:

"Kids are different today, I hear ev'ry mother say
Mother needs something today to calm her down
And though she's not really ill, there's a little yellow pill
She goes running for the shelter of a mother's little helper
And it helps her on her way, gets her through her busy day"


... while these days the kids are prescribed Ritalin, which is chemically like cocaine, and seems to be what moved Dr Frances against the DSM-5.

I also recall that in the late Sixties / early Seventies I had friends who studied physics and chemistry and who used to prepare their exams on dexedrine, that young women then could very easily get "for slimming purposes", though everybody knew - in the circles I moved, in Amsterdam - dexedrine was addictive (it's an amphetamine) and could lead to serious problems.

Nearly at the end Dr Nardo writes
Yet with my abiding interest in the history of medicine and psychiatry, and something almost like a hobby preoccupation with the shoals of Therapeutic Zeal, I was totally unprepared for what happened in psychiatry in these last thirty years – so unprepared that I didn’t even really see a lot of it happening.
I believe him, and apart from having read a lot from his recent wrtings, there are three other reasons why "what happened in psychiatry in these last thirty years" was hard to get:

First, it was all carefully kept secret, and what happened - secret pharmacological funding, ghostwriting, non-publication of experiments, miscodig of data - and what was made available to the public, including practicing psychiatrists, was presented in quite different terms than are factually adequate, and, it seems, generally with a lot of public relations techniques. Second, there was no fast internet, which makes it very much easier to access huge amounts of data and to find different points of view. Third, especially the lack of - widespread - fast internet for most of the past thirty years made if far more difficult for the few who did see what was happening, such as Dr Szasz and Dr Healy, to make themselves heard.


Then again, whether
"what happened in psychiatry in these last thirty years" can be rapidly undone remains to be seen, especially as the pharmaceutical companies have vast amounts of money, very effective public relations, no conscience, and a very strong profit motive.
---------------------------------------------------
Jan 27, 2013: Corrected some typos and added some links I had forgotten.
Notes
[1] The relevance of "in my teens" - in fact: 17-19 - is threefold: First, I still could very well remember my childhood: It just wasn't as psychiatrists said it was (and at 17 I was no more tricked by the contention that "you must have repressed it" than I am now: without specific evidence that's just a dishonest claim); second, if ever I was to be convinced by psychiatric theories it was then; third, the fact that I wasn't is probably mostly due to a combination of being very intelligent and being so in a specific way.

To elucidate the third point some: I have known some very intelligent men, including psychologists, who were far more impressed by psychiatry and - especially - Freud than I ever was. The reason Freud and other psychiatrists didn't much appeal to me is that I have a mathematical type of mind: Theories make real sense to me only if they are logical deductions from credible assumptions.

Psychiatry seemed arbitrary and literary ("literary" as in "fictional literature") - to me, both of which are not science, even if psychologically speaking that is how real science gets started: In the imagination.

[2] I read far and widely in and around various sciences, and met very few who did. Psychiatrists and psychologists who believe their fields are real sciences should read some good introductions to physics, biochemistry or mathematics to get some firm grasp of what real science is really like.

[3] I did choose the terms "insane" and "neurotic" on purpose, in part because the former is a legal term, and because both terms are currently not part of the DSM.

[4] Having worked my way through part of the psychiatric writings that belong to purported foundations for the DSM-5 (
Submission to the DSM-5 Task Force of the APA) and through a recent disquisition on the fundamental questions of psychiatry (DSM-5: Question 1 of "The six most essential questions in psychiatric diagnosis") I am not capable of seeing how anyone with a good intelligence (IQ > 130) and a good grounding in science and logic can see this otherwise, and be honest and impartial.

[5] It is not as if there is not an eminently clear very strong, human all too human, very well known motive for psychiatry having been made intentionally into a pseudocience: Billions of dollars of yearly profits on psychiatrically prescribed drugs!

All that psychiatrists have as arguments against this are fallacies: That one should trust them, "because" they are "medical doctors", and that one should trust their diagnostic system, because it is written in medicalese almost no laymen can see through.

It's the same line or argument as the thoroughly corrupt and atheistic Renaissance popes and cardinals used - see Barbara Tuchman's "The March of Folly".

[6] To make that very clear, I copy and somewhat rewrite something I wrote in September last year, speaking about psychotherapy - understood as the provision of help to people with psychological problems, which I am in favor of - in general:

The point I want to make in the present section is that especially psychiatrists and psychologists, who are, in terms of years and level of education the highest trained among the psychotherapists, and who tend to pretend that they have a level of expertise, knowledge and insight that ordinary people - "layman" - lack, are almost all of them
bulllshitting if not deluded (or indeed both).

Here are some of my reasons - and as it happens my academic degrees are in philosophy and psychology, so indeed I am not speaking in ignorance:

NONE of the psychotherapeutical professionals, and NONE of the psychiatrists is able to give anything like rational, empirically supported, scientific answers to the following questions (and there are quite a few more that are relevant that they rarely can answer, about epistemology, statistics, probability, logic and science, for example, but these are too technical to consider here and now):

(1) What is a human personality, a human self, a human character?
(2) What is consciousness, and why do we have it?
(3) How does the brain generate commonsense experiences?
(4) Do we all experience similar things in similar circumstances?
(5) What is meaning and why and how can we communicate with language?


ALL of the psychotherapeutical professionals, and ALL of the psychiatrists presuppose SOME sort of answers to ALL of these questions, indeed like anyone else who can function in a human society without creating major problems for others - but ALL of the professionals mentioned bullshit you or delude themselves if they pretend to be able to answer these questions, other than by what is mostly faith or illusion, if indeed not intentional bullshit meant to make you pay.

[7] Why, you may ask: Many reasons, that can be conveniently summarized by saying I learned a lot more about what medicine involves, in practice and in theory, and I realized it just wasn't for me. Actually, this is good advice for people who are interested in studying a certain science: First read some of the introductory texts that are used in universities, and check out the professional journals of the science, to see whether it is like you believe.


About ME/CFS (that I prefer to call M.E.: The "/CFS" is added to facilitate search machines) which is a disease I have since 1.1.1979:
1. Anthony Komaroff

Ten discoveries about the biology of CFS(pdf)

2. Malcolm Hooper THE MENTAL HEALTH MOVEMENT:  
PERSECUTION OF PATIENTS?
3. Hillary Johnson

The Why  (currently not available)

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2003)
5. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2011)
6. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

7. William Clifford The Ethics of Belief
8. Malcolm Hooper Magical Medicine (pdf)
9.
Maarten Maartensz
Resources about ME/CFS
(more resources, by many)


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