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Shouting "Screw You" At Prozac
Found via Kevin Drum at the Washington Monthly, an interesting new metastudy written up in the UK Guardian that casts doubt on the effectiveness of such SSRIs and SSNIs commonly prescribed for depression as Prozac and Effexor.
An excerpt from the Guardian account:
The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.
When all the data was pulled together, it appeared that patients had improved - but those on placebo improved just as much as those on the drugs.
The only exception is in the most severely depressed patients, according to the authors - Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.
"Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed," says Kirsch.
The paper, published today in the journal PLoS (Public Library of Science) Medicine, is likely to have a significant impact on the prescribing of the drugs.
.........
The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) was consistent. "Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance," they write.
From my own perspective on the rolling juggernaut of psychatric medicine, I somehow doubt the optimistic "likely to have a significant impact" bit. Especially given Kevin Drum's observation on how little play this has gotten in American media, which still seems to be the case.
Drum's comment thread is very interesting and worth at least skimming for those who care about this topic. Lots of people jousting with the results, some of them of the level of intellectual sophistication of those who note that, damn, that horoscope that day really described exactly what I was going through; others raise the notion that the study might be misleading for either conflating some drugs that work with others and dragging down the working drugs average, or for mixing subjects who really are depressed with a bevy of people to whom the drugs were misprescribed and thus don't work.
The full study, from the open-access Public Library of Science.
Ronald Bailey wrote back in July 2007 for reason on the fascinating world of public access open source scientific journals such as Public Library of Science.
This July 2007 reason feature by me touches on some of the things that psychiatric medical science can't quite tell us.
And see this July 2000 reason interview with psychiatric critic Thomas Szasz, conducted by Jacob Sullum.
SIV|2.29.08 @ 10:04PM|#
psychiatric medical science
Can you type that string of words with a straight face?
JMR|2.29.08 @ 10:06PM|#
or for mixing subjects who really are depressed with a bevy
of people to whom the drugs were misprescribed and thus don't
work.
Since there is no way to scientifically tell if someone is "really
depressed" (if that term has any real meaning at all), yeah, I
guess these drugs are misprescribed a lot.
|2.29.08 @ 10:27PM|#
As I said on another forum when this study came up:
With Zoloft I am a functional human being. Without it, I am
not.
As far as I'm concerned, that means 'case closed'. I wouldn't use
my anectdotal evidence to evaluate whether or not Zoloft will work
on anyone else... but frankly, I don't care if it works on anyone
else or not.
|2.29.08 @ 10:28PM|#
Theres no doubt in my mind that anti-depressants have a real
benefit for some people. Theres also no doubt in my mind that for
some people anti-depressants are a waste of money. The problem is
that no one has figured out a way to distinguish which case will be
true.
The real problem here is that there is no one disease called
depression. What health practitioners call depression is really
just a constellation of symptoms in the feel bad rainbow.
Some people may feel crappy because they are chemically imbalanced,
while others feel crappy because they have bad attitudes or make
terrible life choices. Some therapies help some people, while
others don't.
So if your sample size is broad enough to contain everybody that
feels bad about their lives for whatever reason, then yeah, its not
surprising to me that you don't see a statistically significant
effect to treatment. But this is not unique to
anti-depressants.
Bill Mill|2.29.08 @ 10:50PM|#
The reporting on this study has been terrifically bad; the new
study actually only confirms a guideline for treatment of mild
depression put in place in 2004. See:
http://www.badscience.net/?p=619
for more.
Someone Who Doesn\'t Want to L|2.29.08 @ 11:09PM|#
My experience was a little different than isildur's (apart from
not taking the one ring, I mean). I took Paxil and it seemed to
help at first. Later, I noticed that I was physically addicted to
it. (I missed a dose and got weird withdrawal symptoms - I felt
like my eyes were coming loose, my head rattled when I tried to get
out of bed, and so on.) Shortly afterward, I decided I had to give
it up. Before I used Paxil, I had tried Zoloft. When they put me on
a reasonable dose (after having a half-normal dose at first) it
immediately sent me into a pretty bad panic attack.
Suffice to say, I'm trying to deal with things without drugs
now.
|3.1.08 @ 12:48AM|#
Lots of people jousting with the results, some of them of
the level of intellectual sophistication of those who note that,
damn, that horoscope that day really described exactly what I was
going through;
Is being able to adopt a pose of intellectual sophistication the
main criterion for being a Reason writer? Like a lot of people, I
have pretty strong anecdotal evidence that antidepressants work.
No, anecdotal evidence doesn't prove anything. But when it comes
down to "Who are you going to believe, your own lying eyes, or a
smug Reason blogger who read a study somewhere," I'll reserve
judgment a little while longer.
The Wine Commonsewer|3.1.08 @ 1:18AM|#
....that casts doubt on the effectiveness of such SSRIs and
SSNIs commonly prescribed for depression as Prozac and
Effexor.
Red wine is clearly much more effective. Without those nasty side
effects. Unless, of course, you count calories..........
The Wine Commonsewer|3.1.08 @ 1:24AM|#
In completely unrelated news, Boyd Coddington (Boyds Wheels
& American Hot Rod) has died of complications of
Diabetes.
I once watched him take a chunk of aluminum and machine it into a
gorgeous custom valve cover. It was awesome.
I don't worship him, in part, because he didn't like me much (it
was a long time ago and that is not to say he would remember me
from Adam anyway). The feeling was a bit mutual, but he was an
incredible talent, with a penchant for perfection.
Jasonomics|3.1.08 @ 1:55AM|#
Warning: Anecdotal Evidence Forthcoming
I take Effexor to keep from going through everyday thinking that
something is terribly wrong with me and my life despite no evidence
to support such thinking.
Thus far it has worked for me.
I sincerely believe that far too many people are prescribed drugs
they don't need for problems that could be solved by eating a
little better and getting a little exercise. I have discovered I'm
not one of those many.
Thia|3.1.08 @ 6:01AM|#
from a libertarian point of view, the problem with stories like those in the Guardian is that the revelations will be used to increase state psychiatric power, rather than the other way round. there has been a trend towards a story of this kind for a while now, and it seems to be part of the plan to legitimise the massive increase in state spending on psychotherapy services. the leader of the Liberal Democrats has in effect admitted as much. also, such articles always hold on to the claim that forced drugging is a medical cure for real a disease, though only a proportion (but an important one) of those who now take these drugs have the disease. the issue is not whether the drugs work, and libertarians should understand this better than anyone.
Thia|3.1.08 @ 6:03AM|#
Travis, can you offer any evidence that some people are chemically imbalanced?
|3.1.08 @ 8:56AM|#
Obviously everyone has an opinion. I have worked in a psychiatric hospital for ten years and have experienced a bout of depression in my time. There is no doubt that antidepressants work the majority of the time. That has been what I have observed. They worked for me many years ago and I went on to achieve my personal goals thereafter. I am now a professional.
Jared|3.1.08 @ 9:10AM|#
I just wrote a long-winded comment that I believe was lost.
(Unless this will appear right below it and I am double
posting).
But, while I used some examples about research and clinical
treatment, I will try to boil it down to it's simplest form,
Depression is likely to have numerous underlying problems.
Depression treatment often requires the patient trying a few
different drugs until they find one that works for them. Given that
it is a collection of problems with similar symptoms, and the drugs
are closer to treating the underlying problems than the symptoms,
the results of the study are unsurprising. Many depressed
individuals will not respond to one drug, or will respond only
weakly. The samples of the individual studies may have been skewed
so that when a difference was found between drug and placebo, it is
because the sample had people with a similar underlying problem -
and when no difference was found, the sample may have had more
diverse problems or fewer people with the problem the drug treats.
You would expect low significance and low effect sizes from these
experimental models, and likely none from a metaanalysis.
I will respond with more examples if my previous comment does not
appear or if anyone disagrees for a reason I can address.
Jared|3.1.08 @ 9:29AM|#
I am just going to include my favorite example that was lost in
my first comment. It is certainly not exactly analogous, but I
think helps illustrate some of the underlying problem.
Consider a group of patients being studied that all complain of a
fever. If you give them an antipyretic (fever lowering drug), it
will probably help most of them with that one symptom. Depression
is identified as a cluster of symptoms. However, a fever is more a
sideeffect of the real problem that can be treated somewhat
independently of the cause. The same does not hold true for
depression.
Consider the same group of patients. If given an antibiotic, some
of them with bacterial infections would show improvement of
symptoms. However, those with the fever caused by a viral infect, a
drug, cancer, or one of the other possible causes would not be
effected. This might look similar to the individual studies that
were analyzed in the meta study. There may be some improvement
statistically, or none statistically. The effect size would be low.
Now, if you treated them with other courses of treatment, you might
get similar results. If you then analyzed it altogether, you might
find this family of fever reduction treatments (all the treatments
that treat the specific ailment) are ineffective. You would be
missing the fact that they are effective if targeted correctly
though.
As I stated before, this is not a true analogy. The differences are
subtle, but I hope it helps illustrate why this study is not
surprising, and also does not necessarily mean that these drugs are
ineffective at treating cases of depression. It just means they are
not likely to be effective at treating all cases of depression.
The Wine Commonsewer|3.1.08 @ 10:51AM|#
I take Effexor to keep from going through everyday thinking
that something is terribly wrong with me and my life despite no
evidence to support such thinking.
I hear that, man. I know several people, some who surprised me at
the confession, who take these kinds of drugs and who are happy
with the results. One chick I know describes it exactly as you
do.
Me? I'm the glass empty guy just waiting in anticipation for the
inevitable descent of my day from that fabulous cup of morning
Columbian into crap. Then, in the evening, I pour a little red wine
and miraculously Life Makes A U-Turn.
Thia|3.1.08 @ 11:32AM|#
Jared, i disagree entirely with everything you wrote. Depression is not a real disease, but a metaphorical disease, like spring fever. hence, there can be no cure for it. whether ingesting a drug makes people report being less depressed has nothing to do with medicine.
|3.1.08 @ 11:34AM|#
With Zoloft cannabis I am a
functional human being. Without it, I am not.
As far as I'm concerned, that means 'case closed'. I wouldn't use
my anectdotal evidence to evaluate whether or not
Zoloft cannabis will work on anyone
else... but frankly, I don't care if it works on anyone else or
not."
There, fixed that for myself.
Neu Mejican|3.1.08 @ 12:04PM|#
Since there is no way to scientifically tell if someone is
"really depressed" (if that term has any real meaning at
all)
Well there is the common scientific practice of operationalizing a
definition--
Diagnosis of Major Depressive Disorder, Single Episode
Summarized from the Diagnostic and Statistical Manual of Mental
Disorders- Fourth Edition
A. The person experiences a single major depressive episode:
1. For a major depressive episode a person must have experienced at
least five of the nine symptoms below for the same two weeks or
more, for most of the time almost every day, and this is a change
from his/her prior level of functioning. One of the symptoms must
be either (a) depressed mood, or (b) loss of interest.
1. Depressed mood. For children and adolescents, this may be
irritable mood.
2. A significantly reduced level of interest or pleasure in most or
all activities.
3. A considerable loss or gain of weight (e.g., 5% or more change
of weight in a month when not dieting). This may also be an
increase or decrease in appetite. For children, they may not gain
an expected amount of weight.
4. Difficulty falling or staying asleep (insomnia), or sleeping
more than usual (hypersomnia).
5. Behavior that is agitated or slowed down. Others should be able
to observe this.
6. Feeling fatigued, or diminished energy.
7. Thoughts of worthlessness or extreme guilt (not about being
ill).
8. Ability to think, concentrate, or make decisions is
reduced.
9. Frequent thoughts of death or suicide (with or without a
specific plan), or attempt of suicide.
2. The persons' symptoms do not indicate a mixed episode.
3. The person's symptoms are a cause of great distress or
difficulty in functioning at home, work, or other important
areas.
4. The person's symptoms are not caused by substance use (e.g.,
alcohol, drugs, medication), or a medical disorder.
5. The person's symptoms are not due to normal grief or bereavement
over the death of a loved one, they continue for more than two
months, or they include great difficulty in functioning, frequent
thoughts of worthlessness, thoughts of suicide, symptoms that are
psychotic, or behavior that is slowed down (psychomotor
retardation).
B. Another disorder does not better explain the major depressive
episode.
C. The person has never had a manic, mixed, or a hypomanic Episode
(unless an episode was due to a medical disorder or use of a
substance).
Thia,
You seem to be suffering from disordered Szaszian thinking. You may
want to see someone about that.
Neu Mejican|3.1.08 @ 12:06PM|#
The problem is that no one has figured out a way to
distinguish which case will be true.
Well, to be fair, there is the best-practice recommendation of
trying the medication out, and seeing if it works by closely
monitoring the symptoms of those on the medication.
Thia|3.1.08 @ 12:29PM|#
Neu Mejican,
are you kidding? quoting the DSM is probably worse than making no
argument at all. and so how precisely is Szasz mistaken?
Jared|3.1.08 @ 1:00PM|#
There are so many ways to address the possible meanings of your
response, Thia.
However, I want to address a few quickly. If you are objecting to
the use of labels because there are different underlying causes, I
couldn't agree with you more. The labels only describe symptoms
which may have different underlying causes, which may even be (as
in this study, in my view) damaging to research into treatment. If
you think that human behavior is separate from underlying feelings,
I disagree completely, but I don't feel like getting into a
mind-body debate. If you think noone has the symptoms associated
with depression, then there is no point talking to you, because
that is silly (barring the aforementioned mind-body debate I do not
think is important here). However, I am going to guess that is not
the case.
If, however, you are arguing that people with depression fall on a
normal continuum of human emotion - I cannot disagree, there is not
enough evidence either way, and I certainly think many people
diagnosed with depression would fall into this category even if all
do not. In terms of whether or not to seek treatment (it should not
be forced unless someone has done something to justify depriving
their liberty of choice) I think the DSM has the useful criterion
of functional impairment. If people feel bad enough they want to
feel better, trying to find a useful drug or treatment is very
helpful. Of course, many people at the low end of this spectrum may
have real differences that are easily detectable in terms of brain
structure or function. Even if the differences are only in terms of
place on a scale - the same is true of other medical problems such
as heart disease.
Neu Mejican|3.1.08 @ 1:45PM|#
Thia,
Jared covers the basics.
Szasz: "To be a true disease, the entity must somehow be capable of
being approached, measured, or tested in scientific fashion."
In science it is quite routine to measure behaviors. Approaching
the entity of major depression is not a scientifically intractable
problem.
e.g.,
Biological Psychiatry
Volume 48, Issue 8, 15 October 2000, Pages 791-800
Dysfunction in neural circuits involved in the pathophysiology of
mood disorders
3D MRI studies of neuroanatomic changes in unipolar major
depression: the role of stress and medical comorbidity
Yvette I. Sheline
Abstract
Increasing evidence has accumulated for structural brain changes
associated with unipolar recurrent major depression. Studies of
neuroanatomic structure in early-onset recurrent depression have
only recently found evidence for depression-associated structural
change. Studies using high-resolution three-dimensional magnetic
resonance imaging (MRI) are now available to examine smaller brain
structures with precision. Brain changes associated with
early-onset major depression have been reported in the hippocampus,
amygdala, caudate nucleus, putamen, and frontal cortex, structures
that are extensively interconnected. They comprise a neuroanatomic
circuit that has been termed the
limbic-cortical-striatal-pallidal-thalamic tract. Of these
structures, volume loss in the hippocampus is the only consistently
observed change to persist past the resolution of the depression.
Possible mechanisms for tissue loss include neuronal loss through
exposure to repeated episodes of hypercortisolemia; glial cell
loss, resulting in increased vulnerability to glutamate
neurotoxicity; stress-induced reduction in neurotrophic factors;
and stress-induced reduction in neurogenesis. Many depressed
patients, particularly those with late-onset depression, have
comorbid physical illnesses producing a high rate of
hyperintensities in deep white matter and subcortical gray matter
and brain damage to key structures involved in the modulation of
emotion. Combining MRI studies with functional studies has the
potential to localize abnormalities in blood flow, metabolism, and
neurotransmitter receptors and provide a better integrated model of
depression.
|3.1.08 @ 2:01PM|#
Why exactly is hostility to psychiatry a libertarian issue? Is there a Libertarian-Scientology merger in the works?
Jared|3.1.08 @ 2:19PM|#
Hostility to it in and of itself isn't - but that doesn't mean
some libertarians might not also feel that way.
There are related issues though.
- Involuntary committal
- Involuntary medication
- Being declared unfit to make medical or economic decisions
Whether or not these should be allowed, are important issues of
psychiatry that relate to libertarian viewpoints.
I must admit I do not see how this article relates to them though,
even if the study was newsworthy (which I don't really think it
is). The coverage of it is pretty unscientific, though. So the
usefulness of showing that prozac or another antidepressant does
not work for most people with depression (the opposite of what I
think is a common lay view) is lost by the misinterpretation of the
data.
nebby|3.1.08 @ 2:37PM|#
Neu Mejican,
In the study you cited, can a person examining such neuroanatomic
structure diagnose specific "disorders" using those results in a
blind manner?
Until that happens, there is no disease to be diagnosed.
Thia|3.1.08 @ 4:00PM|#
Jared,
"If you are objecting to the use of labels because there are
different underlying causes, I couldn't agree with you more"
If by labeling, you mean detention and drugging, then that's a good
start. But causes of *what*?
"If you think that human behavior is separate from underlying
feelings, I disagree completely, but I don't feel like getting into
a mind-body debate."
It is separate in the sense that feelings are not political, but
behaviours (towards others) definitely are). There is no need to
debate mind-body.
"If you think noone has the symptoms associated with
depression."
If people say they feel x,y,z, then how could I possibly know
otherwise? But they are not symptoms, unless they are metaphorical
symptoms.
"it should not be forced unless someone has done something to
justify depriving their liberty of choice"
what does this mean?
i don't see that you addressed my initial response to you in any
way. Feelings, nor behaviour, can be a disease, except
metaphorically. And whether taking drugs makes one feel better is a
moral, and not a medical, matter.
Neu Mejican,
What are you trying to say? I assume you are not familiar with the
history of psychiatry, because if your were, you would do better to
not quote contemporary establishment "research" on the science of
locking people up and drugging them. If any present mental illness
were to be shown to be a real disease (much like epilepsy was),
then it would be treated only with consent from the person with the
disease. If this were so, psychiatry as we know it today would
disappear completely. I have no problem with your opinions on what
"major depression" is or is not, but stripped of power to coerce
persons said nor have the disease, your argument is merely
academic.
Neu Mejican|3.1.08 @ 4:10PM|#
Thia,
If people say they feel x,y,z, then how could I possibly know
otherwise? But they are not symptoms, unless they are metaphorical
symptoms.
By that definition most physical symptoms are metaphorical
symptoms.
I assume you are not familiar with the history of psychiatry,
because if your were,
Be honest...is this Tom Cruise?
Nebby,
Not yet, but they are making progress. See the recent Nature
article on identifying Alzheimer's using MRI.
Neu Mejican|3.1.08 @ 4:12PM|#
Nebby,
Until that happens, there is no disease to be
diagnosed.
You are making a fundamental error in thinking here. A diagnosis
and a disease are not the same thing. A disease can be present
without a way to diagnosis it, clearly.
As for depression, it can be diagnosed using other tools...the MRI
is not needed.
dhex|3.1.08 @ 4:13PM|#
*makes popcorn*
wheeee!
engrams go bye-bology
when it's time for scientology!
Jared|3.1.08 @ 4:19PM|#
I think it was quite clear that I meant causes of symptoms
associated with depression, such as high levels of negative affect.
Also, if you read what I wrote, you would know that I think forcing
drugs on people is bad. However, one gets the idea that you do not
really care to read responses for content, but to just react.
Barring actual thought out critiques or opinions, I am not going to
continue posting responses.
However, the idea that feelings cannot be a symptom is ridiculous.
I understand you wish to discredit psychiatry and psychiatric
illness, so I will not bother discussing them further, as there
seems little chance you would read and think about it, instead of
just read and respond. However, *feelings* that you might consider
psychiatric can be caused by many things and are known symptoms of
diseases or health concerns that would be even more interesting for
you to deny. There are many examples, this is just the two that
come to mind first: vitamin deficiency (such as B) - depression,
paranoia - and cardiac problems (feeling of impending doom can be
the only felt symptom)
Thia|3.1.08 @ 4:21PM|#
Neu Mejican,
i am talking about metaphorical *diseases*.
why would you smear anyone who disbelieves the state-sponsored
history of psychiatry (as a progressive humanitarian science) as a
Scientologist? having said that, at least that religion has the
decency to oppose psychiatric coercion.
"the MRI is not needed"
ouch!!!
Neu Mejican|3.1.08 @ 4:27PM|#
Thia (Tom, whatever),
Metaphorical diseases...
Metaphorical symptoms...
You are presenting metaphorical arguments...lacking substance,
without merit, worthy of mocking...
I agree that Szasz has legit points regarding coercion, the
confluence of state power and medicine...
This does not make his misguided position on the existence of
mental illness worth taking seriously.
Thia|3.1.08 @ 4:29PM|#
Jared,
but that is a different argument. if you can offer nothing against
the proposition that mental illness is never a justification for
coercion, then discussing whether depression is x,y,or z in your
opinion is, to my mind, completely pointless. you continue to use
the word "symptom," but if we are not talking about medicine, then
why bother with the medical metaphor? i suggest that if you are
against psychiatric coercion, you ought to drop the use of
psychiatric terminology. not doing so implies a) that you do not
reject psychiatric coercion, and b) think that psychiatric
terminology is helpful is having honest conversations about human
life.
Thia|3.1.08 @ 4:30PM|#
"This does not make his misguided position on the existence of
mental illness worth taking seriously."
why not? or am i not allowed to ask?
thoreau|3.1.08 @ 4:51PM|#
If mental illness isn't real, then how do some of the posters
here explain what they see when they look in the mirror?
Do the voices just assure you that it's an illusion put there by
THE MAN?
research assistant|3.1.08 @ 6:12PM|#
I was working in a psych hospital while fluoxetine was being tested back in '88. I don't know about depressed patients, but for Obsessive Compulsive Disorder patients it was like a miracle cure. People who hadn't worked for years because of handwashing or counting obsessions just gave them up and became functioning adults again. It was really amazing in a field where cures are usually incremental.
|3.1.08 @ 7:30PM|#
@ Isildur
I am also on Zoloft. I can function fine without it, but I have
noticed a marked improvement in my relationships and stress levels
since i've gone on it. It could possibly be placebo effect.
The problem i have with this study is that depression coexists with
a number of other disorders, such as OCD, ad(h)d, etc...so even if
the drug doesn't "work" on depression, it can alleviate it by
fixing other issues, like mild ocd for example.
|3.1.08 @ 7:36PM|#
actually, scratch that. Before i was on zoloft i had substance abuse issues which went away almost immediately upon starting Zoloft.
SIV|3.1.08 @ 7:43PM|#
Well, to be fair, there is the best-practice recommendation
of trying the medication out, and seeing if it works by closely
monitoring the symptoms of those on the medication.
Like this.......
When all the data was pulled together, it appeared that
patients had improved - but those on placebo improved just as much
as those on the drugs.
They should have more control groups.I'll suggest wearing a lucky
rabbit's foot,burying some personal items in a Prince Albert can,
putting a piece of camphor in your shoe and sacrificing a
chicken.Then seeing if it works by closely monitoring the symptoms
of those on the hoodoo
Neu Mejican|3.1.08 @ 8:02PM|#
Thia,
You are, of course, allowed to ask.
The main reason Szasz's arguments are not worth taking seriously is
that they are based on idiosyncratic definitions of almost all the
key terms...disease, symptom, science, entity, mind, mental
illness. For instance, the whole "metaphoric disease" tact misuses
both the term "metaphoric" and the term "disease."
Psychiatric illnesses, just like other illnesses, are based on
assessment of the functioning of body systems serving body
functions. Like most assessment of body functioning, indirect
measures are used when less direct means are unavailable. This is
true in diagnosis of disease inside or outside of the realm of
mental illness. Impairment or disease of mental systems serving
mental functions are as real as disease or impairment of other body
systems.
You do not need to deny the existence of impaired functioning in
mental systems to raise the issues of coercion and consent for
treatment.
SIV|3.1.08 @ 8:23PM|#
"Mental illness" has no known pathologies.
Sci-Tech Encyclopedia: Pathology
The study of the etiologies, mechanisms, and manifestations of disease. Techniques and knowledge gained from other disciplines, including anatomy, physiology, microbiology, biochemistry, and histology, are utilized. The information obtained from the study of pathology is necessary prior to developing methods with which to control and prevent disease.
Notice how they left out "behaviors"
Bring on your "scientology" ad hominems, it is all you've
got..........
|3.1.08 @ 8:32PM|#
I've taken Prozac since 1994 and it has helped me. Two things
I've noticed:
1) It lowers my sex drive to near zero
2) If I miss a day or so I start to have weird dreams, about havng
violent arguments with my deceased mother (no joke here)...
Take it for what it's worth...
SIV|3.1.08 @ 8:38PM|#
standard libertarian disclaimer:
I think people ought to be able to shoot speedballs or sit in
Orgone accumulators if they feel it "helps them".
Neu Mejican|3.1.08 @ 8:47PM|#
SIV,
That wins the non-sequitor of the day award.
The most widely used classification system of disease
world-wide
http://www.who.int/classifications/apps/icd/icd10online/
Please note the section at this link
http://www.who.int/classifications/apps/icd/icd10online/navi.htm#f00
SIV|3.1.08 @ 9:00PM|#
non sequitur?
that is one of the facts central to Szasz' assertions on "mental
illness". If and when a pathology is discovered it becomes a "real"
physical illness and leaves the sphere of psychiatry for neurology
or whatever other branch of "real medicine" that is
appropriate.
Someone Who Doesn\'t Want to L|3.1.08 @ 9:52PM|#
I dunno about what's a disease and what's not, I just know that
the SSRI pills did me some serious damage (on the order of five
years of my life down the toilet) and being off them is not really
helping either.
Disclaimer: And also, I'm drunk.
The Wine Commonsewer|3.1.08 @ 10:07PM|#
With Zoloft cannabis I am a
functional human being. Without it, I am not.
You're my brother-in-law, aren't you?
The Wine Commonsewer|3.1.08 @ 10:08PM|#
WTF?
Dam HTML Gremlin Squirrels! Gimme some of that Zoloft before I take
the 12 Gage to the computer.
SIV|3.1.08 @ 10:23PM|#
SWDWtLHJ,
(on the order of five years of my life down the
toilet)
Why did you keep taking them for 5 years then?
Feelings of depression would seem to be wholly subjective. Maybe
happy people actually feel worse than you but they just don't know
it!
I kind of feel a constant low grade mania and can't really focus on
any one thing for any length of time.I could probably parlay that
into a dexedrine 'script but I don't think the legal speed is worth
the stigma.
Someone Who Doesn\'t Want to L|3.1.08 @ 10:44PM|#
SIV,
Actually it was going off them once I discovered I was addicted
that took me roughly 5 years to get through. I still may have some
lingering physical side-effects, but I can sort of deal with most
of them.
I don't know from "feeling worse". I only know that it's often a
struggle to try to convince myself not to commit suicide. So if
happy people feel worse, I pity them.
Someone Who Doesn\'t Want to L|3.1.08 @ 10:48PM|#
Dondero: More reasons why I don't use my real name or credit
card number or allergy to Kryptonite or whatever else your
identity-thieving ass wants me to post.
Everyone else: Apologies for the honesty.
My only excuse: drugs - this time alcohol, not Paxil.
Neu Mejican|3.1.08 @ 10:54PM|#
If and when a pathology is discovered it becomes a "real"
physical illness and leaves the sphere of psychiatry for neurology
or whatever other branch of "real medicine" that is
appropriate.
So you are saying that if recent evidence that schizophrenia is
associated with caudate nucleus abnormalities pans out it will
become a neurological disorder and not a mental illness.
That seems inappropriate for many reasons.
A nice article on the ins and outs of this kind of
thinking...
http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/30/4/1043
The difficulty in defining disease is not restricted to impairments
of mental function...
SIV|3.1.08 @ 11:08PM|#
So you are saying that if recent evidence that schizophrenia is
associated with caudate nucleus abnormalities pans out it will
become a neurological disorder and not a mental illness.
Where did you get the idea that I said that?
I just worked 20 days straight 10 hours per so I'm too tired to
copy and paste your link tonight but "recent evidence schizophrenia
is associated with....." sounds like the usual neuroscience imaging
phrenology that never pans out.
The Wine Commonsewer|3.2.08 @ 1:09AM|#
Green, the dreams don't frighten me anymore. Not sure why,
they're just as intense but, somehow, it's like, oh, one of those
again.
Wrestled a rattle snake wrapped around my neck and strangled him
with my bare hands last night.
The Wine Commonsewer|3.2.08 @ 1:30AM|#
Job Guy, I think you gotta do whatever gets you through the
day.
You know, I don't know how to get around to saying it, but anyone
who has actually pulled somebody from the abyss knows that it's
real. The abyss, I mean. Sometimes it's just a lapse, sometimes
it's a lifestyle, and sometimes the neurons just ain't firing on
all eight cylinders. Nonetheless, if you've ever dragged anyone in
or out of the green ward at county lock down, the one with the
frosted glass and the wire mesh inlay, it sort of puts things in a
bit of a different perspective.
I seen some really odd things in my day and let me assure you,
normal is vastly underrated. I'll take it.
Thia|3.2.08 @ 6:37AM|#
Neu Mejican,
"The main reason Szasz's arguments are not worth taking seriously
is that they are based on idiosyncratic definitions of almost all
the key terms"
Don't you see? The definition of disease has been stretched (by the
state) so that it can encompass anything at all. As Szasz quite
correctly points out, without agreement on what constitutes
disease, any talk of mental illness is difficult, to say the
least.
"Psychiatric illnesses, just like other illnesses, are based on
assessment of the functioning of body systems serving body
functions."
But psychiatric illnesses are not "just like" real illnesses, in so
many ways. If you want to use the metaphor, then go ahead, but
without the power to coerce, mental illness is useless as a
strategy to render people not responsible for their behavior.
"You do not need to deny the existence of impaired functioning in
mental systems to raise the issues of coercion and consent for
treatment."
I am aware of this, but simply think you are grossly mistaken. Who
defines what constitutes mental impairment? If you agree that all
coercive psychiatry is illegitimate, then why are you trying to
legitimize all of the instrumentation the state psychiatric
industry use?
Neu Mejican|3.2.08 @ 11:18AM|#
Thia,
The definition of disease has been stretched (by the
state)
No. It was never as strict as you would like to believe.
without agreement on what constitutes disease, any talk of
mental illness is difficult, to say the least.
Again, it is incorrect to assume that illness is a concept with
clear boundaries. It is a very difficult concept to pin down
generally...
but without the power to coerce, mental illness is useless as a
strategy to render people not responsible for their behavior.
You assume that is the purpose of nosology in psychiatry, but it
isn't. The primary purpose is to find ways to help people. There
may be abuse in particular cases, and the state may use the system
for its purposes, but the system was not set up to control people,
but to help them. This is where you go off the rails.
Who defines what constitutes mental impairment? If you agree that
all coercive psychiatry is illegitimate, then why are you trying to
legitimize all of the instrumentation the state psychiatric
industry use?
The tight relationship you imagine between state interests and
medical interests is a phantom. Most state involvement in the
industry has been to restrain doctors in an effort to reduce harm
to their patients, as the state recognizes the power they can have
in over a patient (licensing is more about assurance of treatment
quality than anything else...[no need to bring up the standard
libertarian boiler plate about how it distorts the market]).
JMR|3.2.08 @ 11:50AM|#
Close italics...close italics... Damn
Yeah, it started looking like you were having a dialogue with
yourself. A sure sign that some psychiatric "help" is needed
Thomas Szasz|3.2.08 @ 11:55AM|#
Yeah, it started looking like you were having a dialogue
with yourself. A sure sign that some psychiatric "help" is
needed
No it isn't!
Neu Mejican|3.2.08 @ 12:15PM|#
JMR,
The inner dialogue is not indicative of mental illness...but
thinking I will convince anyone of anything on this thread might
be.
Thia|3.2.08 @ 12:40PM|#
Neu Mejican,
"No. It was never as strict as you would like to believe"
Sure it was. Virchow's definition of disease is still what
pathologists look for. When you find mental illness in the cadaver,
then you might have a case. Most sensible people today know that
people can be sick literally, but the economy, or a joke, can be
sick only metaphorically.
"it is incorrect to assume that illness is a concept with clear
boundaries. It is a very difficult concept to pin down
generally..."
But i already told you that the stricter definition constitutes
what the word meant, and hence what it means. If you want to
broaden the definition to include any unwanted behaviors, then the
definition will obviously be difficult to pin down. But this is a
problem for you, not me!
"You assume that is the purpose of nosology in psychiatry, but it
isn't. The primary purpose is to find ways to help people."
Are you serious? Earlier you said that "I agree that Szasz has
legit points regarding coercion, the confluence of state power and
medicine...", but now you are pulling a 180 and saying that locking
people up and drugging them is how to help a person. Which is
it?
"Most state involvement in the industry has been to restrain
doctors in an effort to reduce harm to their patients"
I can only think that you are joking. Who gave psychiatrists the
power they today enjoy? Who gets to define mental illness? The
State, of course. Moreover, your definition of "help" is a strange
one indeed, because if I decide that my friendly psychiatrist is
not helping me, there is nothing I can do, because *you* know that
he is helping me. And once coercion is decided upon, how better to
justify it than showing that the "patient" has a disease, which is
no different to heart disease or cancer. Etc, etc.
Your point about the literal/metaphoric nature of illness is an
interesting topic, and you correctly point out that one does not
need disbelieve in mental illness to reject psychiatric coercion.
But, in my opinion, you are dead wrong on both counts, and your
blind re-assertions of the standard psychiatric industry propaganda
makes me think I was right to question your motives re: definition
of disease. If you want to convince anyone of anything, try using
better arguments.
Neu Mejican|3.2.08 @ 1:34PM|#
Thia,
Are you serious? Earlier you said that "I agree that Szasz has
legit points regarding coercion, the confluence of state power and
medicine...", but now you are pulling a 180 and saying that locking
people up and drugging them is how to help a person. Which is
it?
You are assuming that the point of diagnosing mental illness is to
lock someone up and drug them. That is untrue on its face. A
majority of treatment for mental illness is provided to people who
are seeking help, not being institutionalized. The system is set
up, actually, in such a way that many people seeking help can't get
it. The hurdle for coercive treatment is pretty steep in this
country. It may not be steep enough. It may even be abused in
particular cases. Recognizing that is not the same as asserting
that all diagnosis of mental illness serves the purpose of
confinement and coercive treatment.
Moreover, your definition of "help" is a strange one indeed,
because if I decide that my friendly psychiatrist is not helping
me, there is nothing I can do, because *you* know that he is
helping me.
Strange assertions continue. If you are unhappy with the treatment
you are getting from your psychiatrist...stop consenting to
treatment, seek treatment with someone else. You are acting like
most psychiatric services are involuntary. They are not. (I feel
safe with an estimate with 10- 20% on the high end for those with
serious mental illness that would result in the option even being
considered...and they are a minority of patients seeking
psychiatric treatment).
Virchow's definition of disease is still what pathologists look
for.
Pathologists are not the only ones interested in disease. Here is a
standard medical definition of disease (emphasis added).
disease /dis·ease/ (di-zez´) any deviation from or interruption of
the normal structure or function of any body part,
organ, or system that is manifested by a characteristic set
of symptoms and signs and whose etiology, pathology, and prognosis
may be known or unknown.
Neu Mejican|3.2.08 @ 1:43PM|#
I will point out that I did not search for that definition...it was the first one to pop up in a google search for "disease definition"
Thia|3.2.08 @ 2:05PM|#
Neu Mejican,
"You are assuming that the point of diagnosing mental illness is to
lock someone up and drug them. That is untrue on its face"
No, that is not my assumption. I said that mental illness is the
*justification* for detention and drugging. Without it, the
political aspect of the whole thing is made explicit. Mental
illness is strategy, not disease.
"The hurdle for coercive treatment is pretty steep in this country.
It may not be steep enough."
no comment required.
"If you are unhappy with the treatment you are getting from your
psychiatrist...stop consenting to treatment, seek treatment with
someone else. You are acting like most psychiatric services are
involuntary. They are not."
All psychiatric treatment is coercive, actually or potentially. If
you disagree, you might try walking out of a psychiatric
institution when you feel that it is not the place for you. If the
powers that be do happen to agree that you can leave, then you have
been lucky, but it must be said that they will do more than "keep
you on file," so to speak. Anyway, the point you keep avoiding is
that they have no justification in having the power to decide
whether you go free or stay in a prison and ingest poison. I am not
disagreeing that a small percentage are officially "voluntary," but
personally I think it mendacious to assert that voluntary
psychiatric services are anything of the sort. While entirely
unnecessary for my argument, I have personal experience of working
in these places, and know it to be true. I am sure most
psychiatrists would readily admit that if a "patient" refused to
stay, they could and would detain them if they felt it necessary.
And it is much less paperwork if the person remains "voluntary"
(ask any junior doctor).
"Pathologists are not the only ones interested in disease"
I never implied that to be the case. It is however true that
psychiatrists today have no interest in the subject.
"It is true that, in the strictest terms, we cannot speak of the
mind as becoming diseased." - Emil Kraepelin
Pendulum|3.2.08 @ 2:30PM|#
Thia,
I'll grant that depression is not a disease, under a traditional
definition thereof. So what?
Why is it wrong for psychiatrists to prescribe medicines which both
they and the patient believe increase functioning?
All psychiatric treatment is coercive, actually or
potentially.
Well, yeah, and going to the mall is a life-threatening activity,
actually or potentially. But the theoretical possibility that a
psychiatrist will lock up you when you complain that you've been
feeling down lately is not a good reason to criticize the
effectiveness of SSRIs.
Neu Mejican|3.2.08 @ 2:32PM|#
Thia,
I have personal experience of working in these
places
Are you working under the assumption that most psychiatric
treatment is inpatient?
I said that mental illness is the *justification* for detention
and drugging. Without it, the political aspect of the whole thing
is made explicit. Mental illness is strategy, not
disease.
You are conflating two distinct concepts.
Yes, mental illness may be used as a justification for detention
and drugging...it may be used as a strategy, and it is a strategy
that may be abused...this does not mean that mental illness is
unreal or metaphorical.
Guns don't kill people, people do...
Mental Illness doesn't coerce people, people do...
Or something like that.
Neu Mejican|3.2.08 @ 2:35PM|#
In other words, to note that a diagnosis of mental illness can be used as a weapon against a political enemy is not an argument against the reality of the underlying disease that diagnosis attempts to describe.
Neu Mejican|3.2.08 @ 2:38PM|#
A gun is an inanimate object.
A gun can be used to kill people.
A gun, however, is not death.
A gun does not stop existing because it can be used to deny people
their basic rights.
Neu Mejican|3.2.08 @ 2:41PM|#
Mental illness is a real thing.
Mental illness can be used (illegitimately) as an excuse to take
away people's rights.
Even worse (?), a diagnosis of mental illness can be used against
someone who does not, in fact, have a mental illness as a strategy
to take away their legitimate rights.
Mental illness does not stop existing because of this
potential.
Neu Mejican|3.2.08 @ 2:47PM|#
It is however true that psychiatrists today have no interest
in the subject.
If that is true, it seems odd that the put so much effort into the
effort to improve diagnosis so that it is more fruitful in
elucidating underlying etiology and effective treatments.
http://www.dsm5.org/planning.cfm
and
http://appi.org/book.cfm?id=2292
Thia|3.2.08 @ 2:51PM|#
Pendulum,
"Why is it wrong for psychiatrists to prescribe medicines which
both they and the patient believe increase functioning?"
It is wrong because state licenses for prescribing drugs is
coercive. People should be free to ingest any substance they wish,
and should not have to get the approval of an agent of the state to
do so.
"Well, yeah, and going to the mall is a life-threatening activity,
actually or potentially. But the theoretical possibility that a
psychiatrist will lock up you when you complain that you've been
feeling down lately is not a good reason to criticize the
effectiveness of SSRIs."
I wasn't using the existence of state psychiatric powers to
criticize the effectiveness of SSRIs. Perhaps my words were not
clear - where did you think that I made such a claim?
Neu Mejican,
"Are you working under the assumption that most psychiatric
treatment is inpatient?"
That is the paradigm, but it is becoming less so. This is important
in that the coercion becomes less direct, and I could ask you if
you are working under the assumption that psychiatrists lack the
power to detain and drug outpatients?
"You are conflating two distinct concepts.
Yes, mental illness may be used as a justification for detention
and drugging...it may be used as a strategy, and it is a strategy
that may be abused...this does not mean that mental illness is
unreal or metaphorical."
Mentall illness is used to justify psychiatric coercion. If I were
to write a list of behaviors I felt were "mental illnesses," then
nothing would happen. When the state does it, on the other hand, it
has the power to use the alleged existence of mental illness to
deprive people of responsibility and liberty. Bad behavior is
something you do, not something you have. Where is the disease to
be found in someone washing his hands fifty times a day?
psychiatry|3.2.08 @ 2:54PM|#
pathology...etiology....who needs 'em!
Disease can be thought of as the presence of pathology, which
can occur with or without subjective feelings of being unwell or
social recognition of that state. Illness as the subjective state
of "unwellness" can occur independently of, or in conjunction with,
disease or sickness (with sickness the social classification of
someone deemed diseased, which can also occur independently of the
presence or absence of disease or illness (c.f. subjective medical
conditions). Thus, someone with undetected high blood pressure who
feels to be of good health would be diseased, but not ill or sick.
Someone with a diagnosis of late-stage cancer would be diseased,
probably feeling quite ill, and recognized by others as sick. A
person incarcerated in a totalitarian psychiatric hospital for
political purposes could arguably be then said to not be diseased,
nor ill, but only classified as sick by the rulers of a society
with which the person did not agree. Having had a bad day after a
night of excess drinking, one might feel ill, but one would not be
diseased, nor is it likely that a boss could be convinced of the
sickness.
Neu Mejican|3.2.08 @ 2:57PM|#
Where is the disease to be found in someone washing his
hands fifty times a day?
Depends.
Is the hand-washing a) compulsive and something the patient wishes
they didn't do...or b) do they work in a restaurant?
In case "a" above, the disease is in the patients brain. Their body
system for control of behavioral impulse control is
malfunctioning.
Etiology is unclear, but quite likely involves the fronto-striatal
system involved in impulse control. Active research is making
progress. The condition appears to be responsive to medication,
which improves outcomes for many who seek treatment.
Thia|3.2.08 @ 3:00PM|#
here is a joke, of sorts.
Person A: Mental illness is a real thing
Person B: Where is it?
Person A: In your mind.
Person B: No, it really isn't. And it isn't in the cadaver either.
But from what you've been saying, it is quite definitely in your
mind, for you believe in it so resolutely.
I don't remember the last time I heard someone say "medical illness
is a real thing." If mental illness is so real, then why do the
public need to be told again and again (via state funding) that
this is so?
Neu Mejican|3.2.08 @ 3:01PM|#
And, again, to be clear.
Since this is an internet thread, I have diagnosed the above
illness without including all the important contextual information
that would be needed to do it properly. Assume, in my assertion,
that the proper procedures were employed.
Is is possible that even then, my diagnosis would be
incorrect...yes, it is. But that is a whole nuther issue.
Thia|3.2.08 @ 3:03PM|#
my attempt at a joke surely takes second place to your answering of the hand-washing question! i hadn't even thought of people working in a restaurant!!
Neu Mejican|3.2.08 @ 3:04PM|#
The real joke is that Thia thinks a cadaver has a mind.
Mind = the functioning of the brain.
Cadaver's do not have functioning brains, so the do not have
minds.
Neu Mejican|3.2.08 @ 3:08PM|#
An tangent.
Why is there no love for the (state enforced?) rule that the first
letter in a sentence be capitalized?
The rule helps segregate individual thoughts into units for ease of
comprehension.
Thia|3.2.08 @ 3:10PM|#
What if I don't work in a restaurant, but choose to wash my
hands 50 times in one day anyway? Or, would my brain disease
disappear as soon as I stopped washing my hands so regularly?
Anyway, I thought we were talking about *mental* illness? Why then
would my *brain* be the location of the disease? If so, it would be
a real disease, and we both be happy.
*I was so amused at your answer that I didn't think to
capitalize.
Neu Mejican|3.2.08 @ 3:10PM|#
Thia,
That last comment is general.
Your last post just reminded me of the tendency on
H&R...related to the LatinoInvasion lack of spaces thing.
Thia|3.2.08 @ 3:12PM|#
It sounds like you work in the mental health profession. Is it rude to ask if this is the case?
Neu Mejican|3.2.08 @ 3:13PM|#
I thought we were talking about *mental* illness? Why then
would my *brain* be the location of the disease?
Are you under the impression that your mind is some magical spirit
that inhabits your earthly body?
The mind is nothing more, nor less, than the activity of the
brain.
As for your question...washing your hands is not the issue.
Compulsive behaviors are not determined to be compulsive solely on
frequency of occurrence. There needs to be the whole "I can't stop
myself" thing going on.
But you know that and are just being disingenuous now, right?
Neu Mejican|3.2.08 @ 3:16PM|#
Thia,
It is not rude to ask.
And no, strictly, strictly speaking, I do not work in the mental
health profession...although I work alongside many who do.
I do research in diagnosis and treatment of developmental
disabilities.
An area which shares many of the challenges of psychiatry.
psychiatry|3.2.08 @ 3:16PM|#
I don't remember the last time I heard someone say "medical
illness is a real thing." If mental illness is so real, then why do
the public need to be told again and again (via state funding) that
this is so?
The public suffers from the disease of psychiatry denialism. The
etiology of which is trusting their intuition and experience more
than the command of authority.
Thia|3.2.08 @ 3:20PM|#
"The mind is nothing more, nor less, than the activity of the
brain."
Well, that is quite a philosophical position to take, especially
with regard to human freedom and responsibility. No time for that
here though.
So you actually believe in addiction too? Sometimes I feel like I
can't stop myself from going to work, and wished to God that I
could just go back to sleep. As Thomas Szasz likes to say, mutatis
mutandis...
Neu Mejican|3.2.08 @ 3:22PM|#
The public doesn't believe in mental illness...what, are you all
crazy? ;^)
The main source of the confusion about "depression" versus "Major
Depression" is that the public believes the first to be an example
of the second. Mental Health is not a state sponsored myth being
foisted on the public against their better judgment (unless you
think Dr. Phil is a covert state agent, I guess).
Thia|3.2.08 @ 3:25PM|#
You know, I got the feeling we could have an interesting chat, and then you go and spoil it all by saying something like "Mental Health is not a state sponsored myth being foisted on the public against their better judgment"
Neu Mejican|3.2.08 @ 3:26PM|#
"The mind is nothing more, nor less, than the activity of
the brain."
Well, that is quite a philosophical position to take, especially
with regard to human freedom and responsibility. No time for that
here though.
Not really.
It is pretty much axiomatic.
Cartesian dualism hasn't been taken seriously in the mainstream of
science for quite a time now.
Of course, Szaszian thinking may require dualism to make sense.
Neu Mejican|3.2.08 @ 3:31PM|#
I am curious, btw, why you think that an embodied mind is
somehow a threat to human freedom and responsibility.
The premise that you are free do act and are responsible for your
actions does not require dualistic views on mind/brain.
And the existence of mental disorder does not, automatically,
exempt one from responsibility for one's actions.
It's not like the embodied mind support assertions like "I didn't
do it my brain did..."
Quite the opposite, in fact.
SIV|3.2.08 @ 5:35PM|#
JT,
if by "crank" you mean "zealously eccentric", that would describe
most libertarians.
It doesn't mean Szasz is wrong.
The Wine Commonsewer|3.2.08 @ 6:34PM|#
crank
Look, if you intend by that utilization of an obscure colloquialism
to imply that my sanity is not up to scratch....
Neu Mejican|3.3.08 @ 11:12AM|#
Jamie,
Because they do...
e.g., Strattera
http://www.addcoach4u.com/adhdmedicationco.html
Jared|3.4.08 @ 12:03PM|#
Thia,
I stayed away as long as I could. Neu has made alot of the same
points I would, in regards to coercion. The parts you are missing,
or just plain disbelieving where evidence lies - again, the mind
body problem I referenced originally may explain this - are as
follows.
1. Psychiatry is coercive "care."
This certainly is possible the way things are set up, and may often
be the case. Whether or not this is justified is a much broader
subject. However, a large amount of psychiatric care is outpatient
work with little likelihood (although some possibility of)
coercion.
"If it is possible that p, then p" is a false statement, and that
seems to be your guiding belief in relation to coercion in
psychiatry. Even if in your (as I see it) extremely twisted
worldview, the majority of psychiatry was for evil, coercive
controlling purposes, that does not mean there is not a valid
treatment for the disorders psychiatry claims to treat.
Whether or not it is a social issue that needs more attention to
limit possible coercion is different from whether or not all care
is coercive. I think there are many everyday examples of uncoercive
care, but that there are also abuses in the system. I think the
good generally outweighs the bad, but that does not mean
improvement is not necessary.
2. Psychiatric disorders are only behavior and feelings, there is
no underlying physical cause.
Currently, there are many disorders where behavior is the main form
of diagnosis. It is the most obvious one, a complaint of depression
is the best way to know if someone is depressed. That is, again,
not the same thing as saying that there is not an underlying
physical problem. Assuming there isn't requires a dualistic view of
the mind-brain relation. (Unless, as I stated before, you just mean
it isn't enough to make it a disease, which I addressed
earlier).
You may deride MRI evidence at times, and cadaver brain analysis,
but that is just a way to avoid physical evidence of problems. But
you cannot deny them and then say that there is no evidence of
disease similar to that found in other illnesses. You may say, hey,
that cadaver doesn't have a mental illness, just some abnormality.
The same can be true of a heart problem. You can see the cause of
the problem (clot, or whatnot) that impairs functioning, but not
the impaired functioning itself, as it is no longer functioning.
The same is true in the brain, with certain mental illness. In
people with certain disorders, their are differences in the amount
of matter, and in the structure of neurons (such as a decrease in
amount of dendritic projections in one brain area) that change the
functioning. How and why is not understood (by me at least, but I
am not an expert), but it will be. Just because it is more complex
and harder to understand does not deny it's reality. These signs
are much like plaques in the brain or other problems that would be
found in brain of someone being treated by a neurologist (the field
you mentioned as where the "real" psychiatric diseases would
migrate to).
In both cases, the logic you use to disassemble the system seems
either faulty on it's face, or to use different assumptions at one
point than at another, or just nonexistent. I have the distinct
feeling that if anyone agreed with you at the beginning of your
comments, you have since convinced them otherwise.
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