Psychiatry and psychology

2010

2010-02-10-NYT-DSM

Revising Book on Disorders of the Mind
By BENEDICT CAREY
New York Times, 2010-02-10

[1]
Far fewer children would get a diagnosis of bipolar disorder.
“Binge eating disorder” and “hypersexuality”
might become part of the everyday language.
And the way many mental disorders are diagnosed and treated
would be sharply revised.

[2]
These are a few of the changes proposed on Tuesday
by doctors charged with revising psychiatry’s encyclopedia of mental disorders,
the guidebook that largely determines where society draws the line
between normal and not normal, between eccentricity and illness,
between self-indulgence and self-destruction —
and, by extension, when and how patients should be treated.

[3]
The eagerly awaited revisions — to be published, if adopted,
in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013 —
would be the first in a decade.

[4]
For months they have been the subject of
intense speculation and lobbying by advocacy groups,
and some proposed changes have already been widely discussed —
including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.

[5]
But others,
including a proposed alternative for bipolar disorder in many children,
were unveiled on Tuesday.
Experts said the recommendations,
posted online at DSM5.org for public comment,
could bring rapid change in several areas.

[6]

“Anything you put in that book, any little change you make,
has huge implications not only for psychiatry
but for pharmaceutical marketing, research,
for the legal system,
for who’s considered to be normal or not,
for who’s considered disabled,”

said Dr. Michael First, a professor of psychiatry at Columbia University
who edited the fourth edition of the manual but is not involved in the fifth.

...

2010-02-28-Will-DSM

Handbook suggests that deviations from 'normality' are disorders
By George F. Will
Washington Post Op-Ed, 2010-02-28

[While the U.S. may no longer be able to compete with the rest of the world in producing manufactured goods,
it evidently leads the world in producing treatable “disorders.”
Way to go, shrinks.
Way to keep your business and income up.]

2010-08-15-NYT-Frances-Good-Grief

Good Grief
By ALLEN FRANCES
New York Times Op-Ed, 2010-08-15

...

The proposed change actually grows out of the best of intentions.
Researchers point out that, during bereavement,
some people develop an enduring case of major depression,
and clinicians hope that
by identifying such cases early
they could reduce the burdens of illness with treatment.

[The obvious question is:
What is the net cost differential?
How much money can be saved by treating these “disorders” early,
versus how much is spent on treating grief
that would just go away naturally, without cost or burden.]

This approach could help those grievers
who have severe and potentially dangerous symptoms —
for example,
delusional guilt over things done to or not done for the deceased,
suicidal desires to join the lost loved one,
morbid preoccupation with worthlessness,
restless agitation, drastic weight loss or a complete inability to function.
When things get this bad,
the need for a quick diagnosis and immediate treatment is obvious.
But people with such symptoms are rare,
and their condition can be diagnosed
using the criteria for major depression provided in the current manual,
the D.S.M. IV.

What is proposed for the D.S.M. 5 is
a radical expansion of the boundary for mental illness
that would cause psychiatry to intrude in the realm of normal grief.

...

[You know, we can go on endlessly driving up medical costs,
finding more and more aspects of life
that call for, in the eyes of some, medical treatment,
and keeping people alive, if not sentient, longer and longer,
the cost be damned.
Why stop with seventeen percent of GDP spent on health care?
Up, up, up with health care spending.

The needy and the greedy meet in the Democratic Party.]

2011

2011-11-03-NYT-psychology-researcher-Stapel-commits-fraud

Fraud Case Seen as a Red Flag for Psychology Research
By BENEDICT CAREY
New York Times, 2011-11-03

2013

2013-02-06-NYT-Opinionator-The-Stone-Gutting-the-limits-of-psychiatry

Depression and the Limits of Psychiatry
By GARY GUTTING
New York Times Opinionator, The Stone, 2013-02-06

I’ve recently been following the controversies about
revisions to the psychiatric definition of depression.
I’ve also been teaching a graduate seminar on Michel Foucault,
beginning with a reading of his “History of Madness.”
This massive volume tries to discover the origins of modern psychiatric practice
and raises questions about its meaning and validity.
The debate over depression is an excellent test case for Foucault’s critique.

At the center of that critique is Foucault’s claim that
modern psychiatry,
while purporting to be grounded in scientific truths,
is primarily a system of moral judgments.
“What we call psychiatric practice,” he says,
“is a certain moral tactic . . . covered over by the myths of positivism.”
Indeed, what psychiatry presents as the “liberation of the mad” (from mental illness)
is in fact a “gigantic moral imprisonment.”

Foucault may well be letting his rhetoric outstrip the truth,
but his essential point requires serious consideration.
Psychiatric practice does seem to be based on implicit moral assumptions
in addition to explicit empirical considerations,
and efforts to treat mental illness can be society’s way of controlling
what it views as immoral (or otherwise undesirable) behavior.
Not long ago,
homosexuals and women who rejected their stereotypical roles were judged “mentally ill,”
and there’s no guarantee that even today
psychiatry is free of similarly dubious judgments.
Much later, in a more subdued tone,
Foucault said that the point of his social critiques was
“not that everything is bad but that everything is dangerous.”
We can best take his critique of psychiatry in this moderated sense.

...

Foucault is, then, right:
psychiatric practice makes essential use of moral (and other evaluative) judgments.
Why is this dangerous?
Because, first of all,
psychiatrists as such have no special knowledge about how people should live.
They can, from their clinical experience,
give us crucial information about
the likely psychological consequences of living in various ways
(for sexual pleasure, for one’s children, for a political cause).
But they have no special insight into
what sorts of consequences make for a good human life.
It is, therefore, dangerous to make them privileged judges
of what syndromes should be labeled “mental illnesses.”

This is especially so because, like most professionals,
psychiatrists are more than ready to think that
just about everyone needs their services.
(As the psychologist Abraham Maslow said,
“If all you have is a hammer, everything looks like a nail”).
Another factor is the pressure the pharmaceutical industry puts on psychiatrists
to expand the use of psychotropic drugs.
The result has been the often criticized “medicalization”
of what had previously been accepted as normal behavior-
for example,
shyness, little boys unable to sit still in school, and milder forms of anxiety.

...

Philosophers of psychiatry have raised fundamental objections to
the DSM's assumption that
a diagnosis can be made solely from a clinical descriptions of symptoms,
with little or no attention to the underlying causes of the symptoms.

[I am not a psychiatrist.
But as a layperson, to me
that view seems to bespeak a combination of ignorance and arrogance.]

...

As Foucault might have said,
the psyche is too important to be left to the psychiatrists.

2013-05-07-NYT-psychiatrys-new-guide-falls-short-experts-say

Psychiatry’s Guide Is Out of Touch With Science, Experts Say
By PAM BELLUCK and BENEDICT CAREY
New York Times, 2013-05-07

Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”

The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

The revision, known as the D.S.M.-5, is the first major reissue since 1994. It has stirred unprecedented questioning from the public, patient groups and, most fundamentally, senior figures in psychiatry who have challenged not only decisions about specific diagnoses but the scientific basis of the entire enterprise. Basic research into the biology of mental disorders and treatment has stalled, they say, confounded by the labyrinth of the brain.

Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia in one person may predispose others to autism-like symptoms, or bipolar disorder. The mechanisms of the field’s most commonly used drugs — antidepressants like Prozac, and antipsychosis medications like Zyprexa — have revealed nothing about the causes of those disorders. And major drugmakers have scaled back psychiatric drug development, having virtually no new biological “targets” to shoot for.

Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.

Even the chairman of the task force making revisions to the D.S.M., Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh, said the new manual was faced with doing the best it could with the scientific evidence available.

“The problem that we’ve had in dealing with the data that we’ve had over the five to 10 years since we began the revision process of D.S.M.-5 is a failure of our neuroscience and biology to give us the level of diagnostic criteria, a level of sensitivity and specificity that we would be able to introduce into the diagnostic manual,” Dr. Kupfer said.

The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

Dr. Hyman, Dr. Insel and other experts said they hoped that the science of psychiatry would follow the direction of cancer research, which is moving from classifying tumors by where they occur in the body to characterizing them by their genetic and molecular signatures.

About two years ago, to spur a move in that direction, Dr. Insel started a federal project called Research Domain Criteria, or RDoC, which he highlighted in a blog post last week. Dr. Insel said in the blog that the National Institute of Mental Health would be “reorienting its research away from D.S.M. categories” because “patients with mental disorders deserve better.” His commentary has created ripples throughout the mental health community.

Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead. He said he had heard from scientists whose proposals to study processes common to depression, schizophrenia and psychosis were rejected by grant reviewers because they cut across D.S.M. disease categories.

“They didn’t get it,” Dr. Insel said of the reviewers. “What we’re trying to do with RDoC is say actually this is a fresh way to think about it.” He added that he hoped researchers would also participate in projects funded through the Obama administration’s new brain initiative.

Dr. Michael First, a psychiatry professor at Columbia who edited the last edition of the manual, said, “RDoC is clearly the way of the future,” although it would take years to get results that could apply to patients. In the meantime, he said, “RDoC can’t do what the D.S.M. does. The D.S.M. is what clinicians use. Patients will always come into offices with symptoms.”

For at least a decade, Dr. First and others said, patients will continue to be diagnosed with D.S.M. categories as a guide, and insurance companies will reimburse with such diagnoses in mind.

Dr. Jeffrey Lieberman, the chairman of the psychiatry department at Columbia and president-elect of the American Psychiatric Association, which publishes the D.S.M., said that the new edition’s refinements were “based on research in the last 20 years that will improve the utility of this guide for practitioners, and improve, however incrementally, the care patients receive.”

He added: “The last thing we want to do is be defensive or apologetic about the state of our field. But at the same time, we’re not satisfied with it either. There’s nothing we’d like better than to have more scientific progress.”

2013-09-24-Watson-Lanza-state-of-connecticut-refuses-to-release-adam-lanzas-medical-records

State of Connecticut Refuses to Release Adam Lanza’s Medical Records
Paul Joseph Watson
Infowars.com, 2013-09-24

[(The following paragraph was written on 2013-11-20.)
I have been wondering when the authorities are going to release
a report on Adam Lanza's background,
his interactions with the Connecticut educational system
and whatever health authorities he may have interacted with.
They seem to be taking an awfully long time
to release basic information on these facts.
Today I googled him, and found this article,
which seems to explain part of the reason why such details have not yet been release.
I have to say, there seems something awfully fishy to me to say:
"We can't tell you how we were treating Adam Lanza,
because the knowledge of the truth might cause you to reach the wrong conclusions."
It was once said
"The truth shall make you free."
Evidently some have a different point of view.
Such hidings of the truth from the general public
are all too common, in my opinion, these days.
For example,
major news media, in particular the Washington Post,
refuses to print the race of criminal suspects,
arguing it would "promote stereotyping."

Oh wait, on 2013-11-25,
the Connecticut State's Attorney investigating the Newtown shooting
released his summary report on the shooting.
I have not read it, but newspaper articles summarizing it have stated that
the autopsy of Adam Lanza found no drugs in his body.
If that is correct, so much for the theory stated in the above Paul Joseph Watson article.
But still, at least the news articles in the New York Times and Washington Post
summarizing the Connecticut State Attorney's report
fail to answer the two basic, factual questions I posed above:
What was his educational history?
What was the history of his interaction with the mental health system?]








Ah, here at last on 2014-11-22 appears an extensive report on Adam Lanza's interactions
with the mental health system:

2014-11-22-NYT-before-newtown-shootings-adam-lanzas-mental-problems-completely-untreated-report-says

Adam Lanza’s Mental Problems ‘Completely Untreated’ Before Newtown Shootings, Report Says
By ALISON LEIGH COWAN
New York Times, 2014-11-22


[What I have been wondering about is:
What was Adam Lanza so upset about?
What were the causes of his alienation?
The news article, at least, says nothing about that.
The psychiatrists talk about "treatment" without addressing why the person was upset.
They say:
Don't worry about why this person is acting as he is.
Just chalk it up to "mental illness".
It seems to me that so-called "mental illnesses" often have causes,
and it is both possible and worthwhile to attempt to discern those.
Unfortunately, all too often polysyllabic words like "neurosis", "psychosis", and "schizophrenia"
are used as if they have precise meanings and are "illnesses" that strike people.
It is entirely possible that they are used to avoid recognizing, acknowledging, and addressing
the conditions that caused the behavior that is being labeled as an "illness".
Much like in "domestic violence", where an act of violence against a woman
automatically, to many, makes her a victim and activates the "Don't Blame the Victim" response.]

[The report itself is, as of 2014-11-24, at this URL:
http://www.nytimes.com/interactive/2014/11/22/nyregion/report-on-adam-lanza.html,
also at this one:
https://s3.amazonaws.com/s3.documentcloud.org/documents/1369013/report-on-sandy-hook-shooting.pdf.

On page 3, "Statement from the Authors", it contains the following sentence:

This report cannot and does not address the question of "why" [Adam Lanza] commited murder.

[So there you have it.
These weasels will not address the key question here.
Of course they could address the question.
They no doubt cannot give a definitive answer,
but I simply cannot believe that in Lanza's interactions with the world around him,
his surviving parent (his father), his classmates and teachers, his friends,
and the mental health professionals who interacted with him,
that he gave no clues on what he was upset about.]

Was Bach mentally ill?

2013-08-15

A question most of us surely have is:
How broadly are the specialists in mental health
extending the definition of mental illness?
We see statistics claiming more and more of the population in general,
and young people in particular,
have some sort of problem that the specialists claim should be treated.
In most cases,
we either don’t understand
the detailed diagnosis the professional claims to have made,
or the specific behavior and actions the supposedly ill patient made
that caused the professional to make their judgment.

Well, a recent test case has come to my attention where
the label of “paranoid personality disorder” was assigned to
a person who has been thoroughly studied by many authors,
who indeed have written many books about the person,
and many of us are familiar with at least some of the work product of the person.
Based on our own knowledge,
we may well ask whether we would agree with that judgment.
Thus we may want to challenge either the criteria used
or whether the criteria fit the patient.

The person so labeled is one Johann Sebastian Bach,
born 1685 in Eisenach, Thuringia, died 1750 in Leipzig, Saxony.
His name is a fairly familiar one to most people interested in classical music.
Where was the assessment made, and by whom?
I became aware of it while watching the BBC documentary on the life of Bach
featuring the distinguished British conductor John Eliot Gardiner.

This links to the start of the video.
This links to the start of the dialogue below.
The viewscreen below will play the excerpt on this web page:


Here is a transcript of the relevant part of that documentary,
starting at 1:12:40 and ending about 1:14:22
(The two speakers are
John Eliot Gardiner, conductor and musicologist and
Tamar Pincus, Professor of Psychology)

---

Gardiner [speaking about a letter he displays]:
It’s the only truly personal letter we have of Bach’s,
in which he’s writing to his old pal Georg Erdmann
(he was the guy that Bach walked with from Ohrdruf to Lüneburg with
when they were both in their teens, early teens) and
Bach is just pouring out all his frustrations about
why the council had not responded to this entworf,
this statement of his intentions,
and Bach tells Erdmann
“My life is full of hindrance and vexation,
but I see no future for myself and my family here.”

Pincus:
One of the features that you might expect to see,
in this inflexible personae, if you like,
is that he would never be guilty.
No matter what happened,
it’s always somebody else’s fault.
Does that ring …

Gardiner:
Yes it does, um…, because
he’s never to blame, he always has a reason,
And his motto, I don’t know if it’s a motto, but something...
it’s like a mantra,
something that comes up again and again, is that
“My life is lived always with vexation and hindrance.”

Pincus:
I have brought you something here,
which is a textbook definition,
and this is paranoid personality disorder,
and these are the characteristics:

1. Pervasive suspicion of others, distrusting their motives.
2. Others seen as deliberately demeaning or threatening.
3. Constantly expect to be harmed or exploited.
4. Very sensitive to perceived slights.
5. Fear and avoidance of anything
   that could make them feel or seem weak.

Gardiner:
That’s a perfect description.

Pincus:
The one thing that we do know is that
there is an association with bullying and abuse in childhood.

[At this point the dialogue between Gardiner and Pincus ends,
and an unseen narrator voices:]

“Thanks to the boneheadedness of the city fathers,
and the obvious flaws in Bach’s own character,
his output of religious music now began to dwindle away …”

---

The letter from Bach to Erdmann, and the surrounding situation,
has been covered in the various biographies of Bach.

The biography J.S. Bach: A Life in Music by Peter Williams
has about a page devoted specifically to the letter,
and a lengthy eleven-page section titled “Character, quarrels”,
which contains the following observation:

If Bach’s un-docile responses to criticism
and to the machinations of those around him
now appear aggressive, truculent or at the very least self-protective,
a positive interpretation would be that
however naturally irascible or simply impatient he was,
any problem he perceived got in the way of his musical priorities.
Whatever hindered his creative duty would not be tolerated.
Any apparent territoriality
and any questionable behavior around job-applications or money-matters
were not at all outside conventional practice,
though no doubt they are revealing.
For a young musician simple ambition,
as when he left Muhlhausen after only a year
and before seeing through the organ-project,
was not unreasonable,
and to counter the usual adulation of J. S. Bach today
by accusing him of an
‘unmistakable harsh edge .. famously confrontational …
a pervasive sense of persecution and an attitude of spiteful defiance’
(Robert L. Marshall, ‘Toward a twenty-first-century Bach biography’,
The Musical Quarterly 84 (Fall 2000), page 502),
would be an exaggeration in the other direction.
Rather, he could simply have found that,
unlike the Weimar duke or the Cothen prince,
his church and school superiors in Leipzig
stood in the way of his work as creative musician.
....

Six particular moments of contention during his Leipzig years,
known from documents and quite possibly indicative of others not documented, deserve attention.
Some were more serious than others:
...
August 1730:
Reproached by the main town council
(under the two consuls and burgomaster)
for dismissing a chorister, being absent without leave, failing to teach
(i.e. in some or all of the seven hours musical instruction scheduled per week)
or supervise his substitute
(all this without offering an explanation),
failing to take a singing class,
showing little pleasure in work,
and generally being incorrigible.
[Emphasis in the original.]
Some payment to be withheld.
A few weeks later, but before writing to Erdmann
[see the section on that subject],
he was denied additional payment for temporary extra duties
but applied again the following year of so,
despite having had no known extra duties...

Williams goes on to discuss the mitigating circumstances in each of the six cases.

---

Another biography which discusses the Erdmann letter at length is
Johann Sebastian Bach: The Learned Musician
by Christoph Wolff,
which discusses this letter and the surrounding situation
in the ten-page section titled “At a crossroads”
in the chapter dealing with Bach in the 1730s.

Here are extended extracts from that section:

---

[After discussing several perhaps positive developments
in Bach’s situation in early 1730,
Wolff writes the following:]
It aeems all the more puzzling then, that
despite these mostly favorable developments,
Bach seemed to find himself at a crossroads,
as he makes clear in a letter of October 28, 1730,
to his classmate from Latin school days, Georg Erdmann:

This post was described to me in such favorable terms that finally
(particularly since my sons seemed inclined
toward [university] studies)
I cast my lot, in the name of the Lord,
and made my journey to Leipzig, took my examination,
and then made the change of position
[from his previous position as Kapellmeister [Director of Music] at Köthen].
Here, by God’s will, I am still in service.
But since
(1) I find that the post is by no means so lucrative
as it was described to me;
(2) I have failed to obtain many of the fees pertaining to the office;
(3) the place is very expensive; and
(4) the authorities are odd and little interested in music,
so that I must live amid
almost constant vexation, envy, and persecution;
accordingly I shall be forced, with God’s help,
to seek my fortune elsewhere.
Should Your Honor know or find a suitable post in your city
for an old and faithful servant
[Bach was 45 at the time of writing],
I beg you most humbly to put in a most gracious word of recommendation for me—
I shall not fail to do my best to give satisfaction
and justify your most gracious intercession in my behalf.
My present post amounts to about 700 talers,
and when there are rather more funerals than usual,
the fees rise in proportion
but when a healthy wind blows, they fall accordingly,
as for example last year,
when I lost fees that would ordinarily come in from funerals
to an amount of more than 100 talers.
In Thuringia I could get along better on 400 talers
than here with twice that many,
because of the excessively high cost of living.

[from the New Bach Reader, no. 152]

This is a set of extraordinarily honest statements
made in a private letter by a frustrated man
who had never failed to do his best
but had waited in vain for official recognition of his accomplishments
over seven years as composer and performer of
an unparalleled repertoire of music for Leipzig’s main churches.
Bach now painfully realized that his regular income as cantor
depended in part on soft money
and that, for example, the “more than 100 talers” from funeral fees
could not be counted on.
In addition, he now understood much better
the cost of living in a large commercial city
ten times the size of a small princely residential town.
He also saw the discrepancy between a fixed salary of 400 talers
and the misleading—even outright false—
promises of “favorable terms” (1,000-1,200 talers)
described to him in 1723 when he applied for the cantorate.
...

Why did Bach reveal his dissatisfaction to Erdmann?
The two had last exchanged letters in 1726,
but it is clear from the opening of Bach’s 1730 letter
that he wanted to respond to a request from his old friend
to provide “some news of what had happened to [him].”
So writing the letter gave Bach, above all, an opportunity to let off steam.
...

The immediate context for the fourth point raised in the Erdmann letter—
“the authorities are odd and little interested in music”—
may be garnered from the memorandum Bach had sent two months earlier,
on August 23, 1730,
to the Leipzig city council
and to which he had not yet received a reply
(which never materialized; perhaps the Erdmann letter was even prompted by
a verbal notification that there would be no reply).
In this memorandum, which he titled
“Short but Most Necessary Draft for a Well-Appointed Church Music,”,
Bach outlined his concept for significant improvements
and demanded better pay for his instrumentalists,
who, for worry about bread, “cannot think of improving.”
...

From Bach’s perspective, it was indeed an odd government
that expected him to bring luster to the city by mounting regular performances
of the finest conceivable church music
with essentially the same setting and budget
that [his predecessor] Kuhnau had had at his disposal.
How could they expect him to attract and inspire the university students
with stipends that “should have been increased rather than diminished”?
The authorities were indeed showing little interest in music
if they would not even agree with his concept, let alone meet his demands.
From their own penny-pinching perspective, however,
it was hard to understand why the cantor needed more money.
To their ears, the performances went well,
and they were surely impressed with
a work of such unprecedented proportions and size of performing forces
as the St. Matthew Passion.
They thought the cantor was doing very well,
raising funds for his projects by selling text booklets and by other means,
and even enlarging his pool of musicians
by drawing the Collegium Musicum from the New Church
into the musical establishment at St. Thomas’s and St. Nicholas’s.
If he was able to attract the best musicians in town, why spend more money?
But the authorities did not understand how much Bach struggled;
they did not see that he was weary of
asking his musicians to play for very little or nothing,
and that these musicians were forced by circumstances
to accept money-making engagements for weddings and other private events
rather than take the time to practice and rehearse Bach’s challenging works.
Most of the city fathers thus failed to understand Bach’s primary concern, namely

“that the state of music is quite different from what it was,
since our artistry has increased very much,
and [as] the taste has changed astonishingly,
and accordingly the former style of music
no longer seems to please our ears,
considerable help is therefore all the more needed
to choose and appoint such musicians
as will satisfy the present musical taste,
master the new kinds of music,
and thus be in a position to do justice to the composer and his work.”

The intent of Bach’s memorandum could not have been more to the point, but

the council apparently lacked the political will to respond positively;
and
the long-standing skepticism
about the ambitious capellmeister-cantor
among councilors who wanted to see
more of a modest schoolmaster-cantor
did not help.

[In other words,
while Bach may be writing the greatest music the world has ever known,
he was also a money sink,
and all that great music may be of interest to future generations,
but it wasn't helping the current residents of Leipzig that much.]
...

---

Back to comments by the author of this blog.
I have included these somewhat lengthy excerpts in this post
to show that Bach was having
very real and quite understandable conflicts with his authorities
at the time he wrote his letter to Erdmann.
Yes, Bach had tunnel vision, was focused on the success of his music program,
and also on his compensation and thus the place in the larger society
his superiors granted him.
On the other hand,
his superiors had many other needs and demands to juggle
besides those Bach was asserting.
Conflicts such as this are routine in all societies, in all eras.
Bach, in complaining about “vexations and hindrances” from the authorities,
was not exhibiting paranoia, but rather an accurate description
of the conflicts he was having.
It would seem fair to describe him as grandiose and temperamental,
but not paranoid.

Thus it seems unreasonable to me that
the expert on Bach (Gardiner) should so emphatically assert that
the “textbook definition” of “paranoid personality disorder”
was “a perfect description” for Bach,
and that the psychology professor
(who one would think had familiarized herself with Bach
at least to the level of reading
the well-known and highly-regarded biography by Wolff
quoted from above before appearing on the program)
would allow Gardiner to apply her “textbook definition” to Herr Bach.
But maybe such harsh judgments on the giants of the past
improve the ratings and the “buzz” for the program.

---

The following is here temporarily, until I make a better place for it:

The following is from pages 170–172 in the chapter ‘The Incorrigible Cantor’ in John Eliot Gardiner’s 2013 book Bach: Music in the Castle of Heaven.

Replacing [the cruel Johann Heinrich] Arnold as cantor [of the Michaeliskirch, where Bach sang as a chorister, and his form master in the tertia phase of his schooling] was the 23-year-old Elias Herda.
[Footnote:
Herda (1674–1728), a farrier’s son from near Gotha where he went to school, went on to spend two years in northern Germany as one of those Thuringian boys much sought after ‘for their musical skills’ and recruited for the Mettenchor of the Michaeliskirch in Lüneburg.
He subsequently trained for the priesthood at the University of Jena and was about to be ordained in Gotha when the call came for him in Jan. 1698 to audition for the cantor’s job in Ohrdruf in succession to the disgraced Arnold.]
Getting wind of Bach’s plans to move to Lüneburg in 1700 and having spent his own teens at the Michaelisschule,
Herda could (and perhaps should) have warned him that membership of the Mettenchor there included more than just daily choir practice and the liturgical singing of an exciting new repertoire in a protected environment: that as likely as not it entailed street-singing or busking that often led to fisticuffs.
[Footnote:
The larger twenty-strong chorus symphoniacus was one of only two Lüneburg choirs (the other being attached to the Johannesschule) which took part in frequent street-singing in front of well-to-do burghers’ houses, hopeful of charity—or, if we are to believe one commentator,
‘thriving on chance charity passed from the windows to put an end to what was frequently an irritating noise’.
Busking in Lüneburg was initially popular—obviously with the choristers as a desirable perk—in fact it was one of the best sources of supplementary income, though Bach himself started in May 1700 in ninth place with a mere twelve groschen.
Initially the citizens welcomed it, too.
But what began as harmless rivalry between the two Currende choirs soon acquired a nasty competitive edge as they fought over turf, each seeking out the wealthier streets and the most lucrative front doors, reserving the best times of day and squabbling over the distribution of rewards….]
During the last third of the seventeenth century, street brawls between the two choir schools in Lüneburg had developed unchecked while the burghers stood by, impotently wringing their hands.
It seems the choir prefects planned the pitched battles, dictating the no-go areas and the territorial division of the town between these embryonic Jets and Sharks or Mods and Rockers.
The town council passed innumerable protocols and by-laws in its attempt to bring some sort of order into what eventually erupted into gang warfare, an eight-year Sängerkrieg (1655–63).
At one point [the endnote references a letter dated 1660] they even contemplated bringing in the army to sort things out.
No doubt Herda stressed the standard virtues of boy choristers—modestia, pietas et diligentia—and advised Bach to keep out of trouble and set a good example.

But, as already suggested, there are no grounds for supposing that Bach was such a model boy at any stage during his school years—nor for assuming the same of his mentor Elias Herda.
In the Lüneburg town archives there is a document labeled ‘The Investigation and Punishment of the Schoolboy Herda’ based on the sworn testimony of a respectable citizen.
Sometime around 1692 [when Herda was 18] Herda had been spotted with an accomplice [!!] in a local hostelry looking for trouble [!!] — ‘undoubtedly [!!] with the intention of starting a brawl, as they were thoroughly drunk and had [placed] their daggers on the table, and were arguing about nothing other than slashing and stabbing with [their] dirks and hunting knives’.
[Gardiner assumes that blustery talk would lead to action.]
The plaintiff, who had known Herda for the past three years and previously thought well of him, was incensed by his anti-social behavior.
That evening, making his way home, he was accosted by Herda, who called him a ‘rogue, thief, and swine’ —a felony which in parts of Germany incurred the legal requirement to make a public apology and a six-week gaol sentence.
The citizen now wanted satisfaction and proper assurances from the school authorities that Herda would be suitable punished for ‘such grievous and bare-faced insults’.
The incident reveals a different side to the character of someone who has previously been portrayed as Bach’s erstwhile savior and unofficial godfather, whose motto seems to have been:
‘Do as I say, not as I do.’
[Gardiner might have noted that a cantor of age 23 might have matured from when was a student of age 18.]
With the example of a former gang-leader-turned-respectable before his eyes,
Bach may have followed a similar path.
[I do not know what other facts Gardiner may have in mind, but based on those he has just set forth in the above passage, that seems a grossly unfair description of Herda.
In the first place, recall how Gardiner introduced the phrase “gang warfare”:
“gang warfare, an eight-year Sängerkrieg (1655–63).”
Herda was not born until 1674, eleven years after the “gang warfare” described by Gardiner ended.
Was there additional “gang warfare” during Herda’s time at Lüneburg?
None that Gardiner has bothered to document in his book.
Gardiner does document rowdy behavior by Herda with one of his peers, and insulting a “respectable citizen”.
But that hardly qualifies as gang activity, at least in my view, let alone making Herda a “gang leader”.]
There is certainly sufficient circumstantial evidence here to dent the traditional image of Bach as an exemplary youth, on his way to becoming ‘the learned musician’, surviving unscathed the sinister goings-on in the schools he attended.
It is just as credible that the bewigged cantor-to-be was the third in a line of delinquent school prefects—a reformed teenage thug.

[This is manifest guilt by association.
Whatever mistakes Herda may have made in his earlier years cast light on Herda’s character, not Bach’s.
Why on earth should Bach be tarnished by the earlier mistakes of one of his teachers?
And as to what Herda really did, as Gardiner has described it, it never reached the level of actual physical violence, but just talk.]

United States of Psychotherapy

Our motto:

One Nation Under Psychotherapy

2010

2010-04-11-Parker

The U.S. can't ignore Karzai's tantrum
By Kathleen Parker
Washington Post Op-Ed, 2010-04-11

...

Our mission remains to prevent Afghanistan
from once again becoming a haven for terrorists,
an achievable goal if our military is successful
in emasculating, if not defeating, the Taliban.
Karzai can be helpful in that pursuit, but, like all of us,
he could use a good shrink.

[If Ms. Parker had left out the “like all of us”,
that last remark would seem to be either humor or an insult.
With “like all of us”, is this intended to be facetious
or hinting at a serious view? :-)
Certainly the business of psychotherapy seems to be a growth one
in the U.S.]

2016

2016-01-27-NYT-post-partum-depression-test-epds-screening-guidelines

Panel Calls for Depression Screenings During and After Pregnancy
By PAM BELLUCK
New York Times, 2016-01-27

...

“There’s better evidence for identifying and treating women with depression” during and after pregnancy, said Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill and an author of the recommendation, which was issued by the United States Preventive Services Task Force. As a result, he said, “we specifically called out the need for screening during this period.”

The recommendation was part of updated depression screening guidelines issued by the panel, an independent group of experts appointed by the Department of Health and Human Services. In 2009, the group said adults should be screened if clinicians had the staff to provide support and treatment; the new guidelines recommend adult screening even without such staff members, saying mental health support is now more widely available. The 2009 guidelines did not mention depression during or after pregnancy.

...

The panel gave its recommendation, which was published in the journal JAMA, a “B” rating, which means depression screening must be covered under the Affordable Care Act.

[Note well that this article, and evidently the panel,
makes NO estimate as to the cost of doing this.
This "cost is no object" approach to health care really sucks.
It's a hidden tax on wage earners.]

...

2016-01-26-WP-with-mental-illness-set-to-be-a-top-cause-of-death-by-2020-panel-recommends-that-all-adults-in-u-s-be-screened

This new approach to mental health care could save lives
By Ariana Eunjung Cha
Washington Post, 2016-01-26

All American adults should be screened for depression as part of their normal health-care routine, an influential panel recommended on Tuesday. The U.S. Preventive Services Task Force also singled out maternal mental illness for the first time by suggesting that women be screened during pregnancy and after childbirth.

The new guidelines, updated for the first time since 2009 and published in the journal JAMA, are a recognition of the devastating toll mental illness is taking around the world. Researchers have noted a surge in diagnoses in recent years related to the stress of modern life and fears of terrorism, violence and poverty. The World Health Organization has predicted depression could jump from the fourth leading cause of death and disability to second place by 2020.

The task force, an independent body appointed by the Department of Health and Human Services, noted that major depressive disorder is associated with suicide and impaired ability to manage other health issues. An estimated $22.8 billion was spent on depression treatment in 2009, it said, and lost productivity cost an additional estimated $23 billion in 2011.

"Depression has a major effect on quality of life for the patient and affects family members, especially children," the group noted in its report.

Screening for depression typically involves starting with a series of questions about individuals' feelings about their lives. Examples include asking them the extent to which these types of statements are true: "I can laugh and see the funny side of things," "I feel as if I am slowed down," or "I look forward with enjoyment to things."

If these initial screening tests show elevated risk for depression, providers are asked to conduct additional assessments to look for other issues such as anxiety panic attacks, substance abuse or other medical conditions.

"In the United States, like many other economically developed nations, primary-care practices represent the best place for implementation of these methods, because it is the only venue where both screening and, if clinically indicated, treatment can be provided," Michael E. Thase, a professor of psychiatry at the University of Pennsylvania, wrote in an editorial accompanying the publication of the guidelines.

The report recommends screening each adult at least once, but it notes that the "optimal frequency of such screening has not been established."

Thase suggested "for patients in generally good health who only see their primary care physicians sporadically, it may make sense to screen at each visit" and possibly to "incorporate periodic web-based 'health checks.'"

The guidelines also go into significant detail about the risks for women during and after pregnancy -- underscoring new research about just how big an effect postpartum depression can have on the well-being of a mother and her child. Risk factors listed for maternal depression include poor self-esteem, child-care stress, prenatal anxiety, life stress, decreased social support, single relationship status, history of depression, difficult infant temperament, lower socioeconomic status and unintended pregnancy.

The task force gave the recommendations a grade of B based on how much clinical evidence there is to support their findings, a rating that should provide coverage for the screenings under the Affordable Care Act.