Psychiatry and psychology


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

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.

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.

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.

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.

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.


“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.


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.]

Good Grief
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.]


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


Depression and the Limits of Psychiatry
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.

Psychiatry’s Guide Is Out of Touch With Science, Experts Say
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.”

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:
Adam Lanza’s Mental Problems ‘Completely Untreated’ Before Newtown Shootings, Report Says
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:
also at this one:

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.]

Labels: ,