Theodore A. Hoppe


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Does psychiatry have a financial interest in expanding the definition of mental illness?

Does both the pharmaceutical industry and the psychiatry profession have strong financial interests in convincing the public that drug treatment is safe and the most effective treatment for mental illness,

The National Institute of Mental Illness reports that currently only 36 percent of those who suffer from mental illness actually seek and receive treatment but they would still like to expand the definitions. What and why should be a concern to everyone.
There is no question that among the medical profession, psychiatry is the most scientifically primitive. The latest revision to the America Psychiastric Association's Diagnostic and Statistical Manuel of Mental Disorders (DSM-V) has drawn strong criticism. "Owing to criticism over the perceived proliferation of diagnoses in the current edition of the DSM, David Kupfer, M.D., who is the DSM-5 Task Force chair and is shepherding the DSM's revision, said in an interview: "One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis."

Dr. Daniel Carlet, an Associate Clinical Professor of Psychiatry at Tufts University admits, "We are no more than the most rudimentary understanding of the pathophysiology of mental illness and we have resorted to tenuous and ever-shifting theories of how ..treatments work."

Read "The Emperor's New Drugs" by Dr. Irving Kirsch or "The Anatomy of an Epidemic" by Robert Whitaker.

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    Gail .

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    Sep 15 2012: I have a brother and sister with schizophrenia. I also have a brother and a sister with bi-polar. My mother has been clinically depressed for most if not all of her life. I was also clinically depressed for about 20 years (though haven't had a day of depression in more than 15 years now). I am intimately familiar with psychiatric disorders - from within and without.

    On April 24, 1984 (at age 34) my worldview CRASHED. In the twinkling of an eye, I suddenly understood that truth, justice, equality, and freedom were not what I thought that they were. Immediately after that awareness, I understood that I might also have been lied to about God, Satan, and then about who and what I am and the rest of how life works. It was a devastating time.

    As I began the arduous job of creating a new worldview - fact-based this time so that it couldn't be threatened by untruths - my world began to change. I came to understand that thoughts and emotions were not what I thought they were, and as I learned about my internal processes, I began to walk in a world of peace, joy, and harmony.

    As a result of my expeerience, I believe that psychiatry today is facing the same type of connundrums as quantum physicists and economists face. Ideas that we fiercely cling to are irrational. Our definition of logic is not logical.

    When my schizophrenic brother tells me of the things his voice tells him (when unmedicated), my insides jump with joy in understanding. But he cowers in fear. I am left to wonder if schizophrenia was his coping method as he realized that the world he lived in was a rather insane one.

    It is my studied opinion that our economic system is the most disastrous thing to hit humankind. When profits are more important than humans, humans are mere pawns of a "system" that strips them of dignity. But the siren call of money is much more appealing than the still silent voice of sanity.

    This was the best I could do in 2k characters.
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      Sep 15 2012: Thank you very much for sharing your personal insights. It takes a lot of courage to be to this authentic.
      My own views on psychology and how we can maintain our mental wellness is to be more compassionate and empathic in our relationships. It is tied to our sense of trust and belongingness with others. You write, " I came to understand that thoughts and emotions were not what I thought they were," and this is the big secret. Your family members and indeed, everyone in your life, will greatly benefit from what you have learned, and your willingness to share your experience in ways they can understand.
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      Sep 15 2012: Good post TL

      The economic system has nothing to with mental health there is no correlation that would stand up to a modicum of scrutiny.

      I have seen a similar situation with some of my relatives a family with 3 sons. They have all grown up to be dysfunctional and all are on some sort psychological assistance and medication for many years and are all still dysfunctional.

      Using a modicum of logic regarding this situation what did the three sons have in common? They were all raised by an alcoholic father. That is a correlation, you see people don't get crazy by themselves they get helped by a genuinely crazy person. This is the core problem with most "crazy people".

      People often reject this idea because well then what would the psychologists and pharmaceutical companies do for a living. The other problem is they are looking in the wrong direction for answers they look inside, the answers lie outside, life lies outside.
      • Sep 15 2012: "The economic system has nothing to with mental health there is no correlation that would stand up to a modicum of scrutiny."

        Actually a more relaxed society would increase mental health. Most people have mental problems because of circumstances that have to do with the way society is run, not because they were molested or have some huge genetic defect.

        @Pat Gilbert below

        So you think a society with a workweek of 100 hours and no social security won't see a much higher level of mental illness than one with a workweek of 35 hours and ample social security?
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          Sep 15 2012: Your comment is duly noted and I could not disagree more, I would have to categorize this as regurgitating specious memes.
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        Sep 15 2012: John, I have been on the bottom and the top and still have friends on both extremes. It isn't what life hands you that makes this determination it is how you react to it. My family was dysfunctional and I was taken away and put in an orphanage. Give up ... hell no. Got an education (2 parents and 5 sisters with either little or no education). Became the first high school graduate in the family and the first colllege grad. Joined the military, retired; worked for General Dynamics, retired engineer; worked for the state, retired. It would have been real easy to give up. But there was no way.

        Now I give a opinion. The doctors and the government make it way to easy to give up. I have a friend with one arm. Handicaped .. hell no. Sometimes it is a little inconvient but he gets there. Coddle him hell no he one of the strongest people I know.

        "How society is run" is the problem ... bull. It is all about getting back into the game. We have become a generation of pill taking, excuse making, wooses. It is not someone elses fault ... it is your decision ... society was cruel to me .. so what go out and kick societys butt.

        Pills are not the answer. For me .... adjust, adapt, and overcome.

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          Sep 16 2012: Bob

          I would contend that a child has very few bench marks to navigate life's confusions. True north for a child is their parents. When the parent is bad that child is effected for a long time. That child likely will not even think about goals. Everyone is different but this is not a small thing.
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        Sep 16 2012: Pat, I was very strong in my comment. You are correct that there are true needs to be evaluated. I do still maintain that alternatives should be evaluated before we give the cure all ... medicate them.

        The parents are certainly the biggest impactors.

        Thanks for the gentle nudge back to your original thought.

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          Sep 16 2012: I agree whole heartedly with your response it is just that when kids are subjected to oppressive parents they are not all going to come out of it.

          But in no circumstances do I think psychiatric drugs are the solution. Many anecdotal stories will state how wonderful the psychiatric drugs are but I liken them to taking heroin in other words " I feel a lot better when I'm on heroin".

          My anecdotal story is when I was a kid the school counselor sent me to the school Psych who determined that I had "learning disabilities" and prescribed Ritalin. The result was at 12 I slept about 4 hr a night and ate maybe one meal a day. I have to admit that I was able to concentrate better but at what cost? either way as with Heroin Ritalin only masked the real problem.
  • Sep 17 2012: "profession"

    The words we use to describe physicians, therapists, and psychiatrists is a big part of the problem. One of the biggest lies being spread around today is that the USA has a "Heath Care System."

    The USA has a medical industry. Every medical practitioner is part of this industry, and every aspect of it should be viewed, first and foremost, from an economical perspective. When these kinds of questions are put into the context of a medical industry, the answer is obvious.
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    Sep 15 2012: Yes, there is a profit motive at work here, and it is utterly terrifying. I worry you to take your inquiry one step farther however. Who would benefit, if suddenly everyone who was unhappy, or disagreed with their society, were considered ill, and forced to take drugs? Why, the rulers of the society, of course. Welcome to 1984.
    • Sep 15 2012: "if suddenly everyone who was unhappy, or disagreed with their society, were considered ill, and forced to take drugs?"

      That is the real problem. The problem is that some people can use force against other people under the pretense of some kind of "authority". Can you use force against me, or I against you? We could, but the initiator of force would get jailed. What is the only entity that can use force and not be afraid of getting jailed? Yes! Government. In a country without state-run healthcare, including psychiatry, the opinion of the psychiatrist would matter only to the patient, the patient's family, and in rare cases, the patient's employer. The psychiatrist would not have any power to force-feed drugs even to the most paranoid schizophreniac, esp. without the family's consent. If the shrink were to attempt that, he/she would get charged for assault.

      Once government becomes in charge of our health, it would become necessary for the government to codify the various aspects of health. This is where the DSM-X could play a big role. If I were to be sentenced by the government only based on what kinds of harm I'm committing against people, and if I had not harmed anyone, and I felt no need to approach a psychiatrist, why should I care what bouquet of disorders DSM-X assigns to me?

      Big pharama and psychiatrists can become powerful entities only because we have granted our governments that power.
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      Sep 15 2012: So if we were to look at this in a non-linear manner, what's actually broken: What are we not adjusting to that we need to medicate? Big Pharma is merely the commercial side of the equation. The War on Drugs is really a war against people who feel the need to self medicate, and this does multiple the problem somewhat because the issue of addiction, from both drugs and alcohol, is probably hidden mental health issues as well.

      My suggestion to the question, "What is broken?" is that we are social animals and yet we have allow he bonds of social institutions to break down. We put our children into Day Care and our elderly into nursing homes, we feel no real sense of belonging, we fear what will become of us
      As Sherry Turkle notes in her TED Talk, we would rather text than talk. She says, "I believe it's because technology appeals to us most where we are most vulnerable. And we are vulnerable. We're lonely, but we're afraid of intimacy. And so from social networks to sociable robots, we're designing technologies that will give us the illusion of companionship without the demands of friendship. We turn to technology to help us feel connected in ways we can comfortably control. But we're not so comfortable. We are not so much in control.

      Is this the roots of some of our mental illness, I believe it is, and medicating will not make things better for us. Real human interactions will. but there is no societal pill for us to swallow that will make it all better. We'll need to learn to be more authentic, more caring, more nurturing and more compassionate toward one another. Big Brother is not the government, it is your neighbors.
      • Sep 15 2012: Yes I agree and the first step is to repair those social institutions which I would define as real-life communities i.e. villages, towns and cities.
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    Sep 15 2012: "Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible." Dr. Marcia Angell
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      Sep 15 2012: Um, it is called medicine... Doctors practice medicine. They identify a disease and have two basic modes of treatment. Medicine or surgery. Which one would you prefer?

      If you want to talk, see a psychologist.
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        Sep 17 2012: How does the disease model apply to psychiatry?
        To quote Dr Marcia Angell, " First, mental illness is diagnosed on the basis of symptoms (medically defined as subjective manifestations of disease, such as pain) and behaviors, not signs (defined as objective manifestations, such as swelling of a joint). Most diseases in other specialties produce physical signs and abnormal lab tests or radiologic findings, in addition to symptoms.

        Moreover, even if the underlying causes of other diseases are unknown, the mechanisms by which they produce illness usually are, and the treatments usually target those mechanisms. For example, we may not know what causes arthritis, but we do understand a great deal about the mechanism, and we know how anti-inflammatory agents work. Even when there are only symptoms, such as nausea or headache, other medical specialists, unlike psychiatrists, would be very reluctant to offer long-term symptomatic treatment without knowing what lies behind the symptoms."
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      Gail .

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      Sep 15 2012: Thank you, Mr. Hoppe.
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      Sep 15 2012: You talk about different things as would it be the same.

      There are mental healthy people, most of us, that can have a mental problem. Call it mental illness if you like and they can benefit sometimes by visiting a psychologist.

      There are mental disabled people, some of us, that can benefit from medicine prescribed by a psychiatrist and for them it's the only way to function like most of us.

      Most people with chronically mental problems that most of the time were visible from early childhood on have a disability.
      Brain cells, neurons or whatever doesn't communicate as it should or distribute incoming signals in different ways. They have a disability to move through the world the same way as the blind or the lame.
      Following their individual intelligence, gender and challenges thy each develop a pattern of strategy to communicate and associate with the people around them. These patterns are visible and labeled as a mental illness.
      So the same brain problem can result in different symptoms and are diagnosed with different names. In fact some drugs can have a big improvement for those people that have such disability but it is only due to experience and with try and error that a good treatment can be found because few people understand the real cause of their problems. However psychiatrists are best equipped to find positive results even without that there is much science to back it up.

      What I tell you I've learned over 40 years from the history of two of my children and their mother that have such disabilities and I'm very pleased that they live fairly well these days because of the recent possibilities of medication.
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        Sep 15 2012: "Disability," as it applies to mental health, is a term that can define both cognitive disability, and emotional and behavioral disability. So let's ask, "How did depression, which was once viewed as an episodic illness become a chronic and disabling condition?"
        The issue that I am raising here is that psychiatry has moved away from analysis and talk therapy, and one of the main motivations for this is that it is that it is just to easy to prescribe drugs. I think we have all seen the advertisement there suggest taking an additional medication,"ABILIFY," if our depression medication isn't doing enough for us. Does this make any sense? Should it even be allow to be advertised to us in all its cartoon wonderfulness? "I'll take the pills that surround me with sunshine and butterflies please"

        Additionally, there is a general divide between the psychiatrist and the neuroscientist and we would do well to ask who is building the between the two. Your comments raises an important issue, that we should make the distinction between neurological disorders and psychological disorders, and that the two sometime overlap. The mind and brain can both be described as being based in the physical world, but explaining the mind, or mental illness, purely in physical terms, may not always be appropriate or useful. Do if we cannot identify medical causations for psychological condition that others views as a disorder, are we not just substituting being medicated and all its side effects with actual wellness?
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          Sep 15 2012: To answer your question about depression I can tell that it can happen to a person with a proper functioning brain as a result from devastating circumstances that takes too much of the resilience of that person but it almost always happens with people that have a dysfunctional brain. This is because if you can't cope with the world that you perceive in a different manner as all other people do you have to try so hard that you live in a never ending stress condition.

          As I said before psychiatrist can do some good, if any, with those that have a good functioning brain but they make the other group desperate with their talks and therapies.

          Luckily in our country medication may only be described by psychiatrists. Advertisements and sales via other channels are forbidden.

          This is a subject with many sides and I'm not familiar with the English terminology in the field. Yet I like to stress that depression is a natural but life threatening condition.

          That's why we don't need only psychiatrists and neuroscientists to understand it but all disciplines of biology.
  • Oct 1 2012: most definitely, and psychology too. as a teacher i've seen plenty of kids get put on medication instead of allowing them to be taught how to control themselves (heaven forbid we might consider that possibility). it's a boon for the doctors who get the credit for 'fixing' the child, and the pharmaceutical companies who also get credit for their 'effective' medication and of course lifetime sales.
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    Sep 28 2012: Yes there are definitely financial interests at work in the pathologising of mental conditions.

    The Ben Goldacre talk confirms a hunch I've had for a while now, about the deliberate witholding/distortion of research results and the publication bias that exists in rushing out the next profitable magic bullet from big pharma.

    It is open to question as to whether many of the conditions we have are 'mental illnesses' at all. Sitting alone in a darkened room with a box of antidepressants is certainly not a natural state to be in - yet for a whole host of insidious socio-economic reasons, it has become a kind of perverse norm where big profits can be made by the few from the misery of the many.

    Even though talking therapies are more effective in the long term than antidepressants (humans are social animals, after all), it still fails to be the prime front-line treatment for depression. I can only assume that is because talking therapies are not a tangible product from which profits can be made.
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      Sep 29 2012: I will only add that the, "withholding/distortion," is an issue in all of science and not just medicine when it comes to publishing research.
  • Sep 18 2012: I responded to another conversation, about the DSM V, and mentioned Albert Ellis, and Rational Emotive Behavior Therapy. I've never had any mental illness. I had a few rough times in life, once was suicidal during a divorce.
    I tried an SSRI once, didn't like it. I went to a shrink twice for brief periods. I have mostly self-created troubles, mostly from bad choices. I've never had any hardships. But I practice REBT. REBT is a little known psychology, and I try and encourage people to look into it. The jist of it is to try and define your own irrational thoughts, and replace them with rational ones. Now I'm not saying this would be easy for a severely mentally ill person having hallucinations. But many people I know have lighter mental illnesses, and are cognitive and alert. But they take bottles of pills, and run to shrinks constantly. In REBT, it's pretty anti-Freudian. Don't dwell on small problems. You fight with your mother, your boss, your mate, you CAN'T take it, you have to pay someone to tell them these fairly small troubles once a week. Albert Ellis, with his REBT, essentially tried to teach people, stop whining. Replace your irrational thoughts, I CAN'T handle this, with rational ones, you can handle it, and do every day. I can't take my boss. You went to work today, you're going to work tomorrow, you can and do handle your boss. Another good practice of REBT is to purposely try and push thoughts away that are about things you can't change right now. They cause undue anxiety. My lover has left me for someone else. You can't change that. You can't, not now, not tonight, and you are losing sleep. Try and push the thought aside, for now. It takes practice, but I do it. I sleep better. Force other thoughts, about anything, about a baseball game, or about tools, music, politics, anything but this thing you simply can not do anything about at this moment. REBT may sound simple, and it may even sound like escaping rather than facing yourself, but it works.
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      Oct 1 2012: I was not very familiar with Ellis's theory so I looked it up. Wikipedia has a lengthy explanation of the theory but I will just add this here for those interested:

      "REBT generally teaches and promotes:

      That the concepts and philosophies of life of unconditional self-acceptance, other-acceptance, and life-acceptance are effective philosophies of life in achieving mental wellness and mental health.
      That human beings are inherently fallible and imperfect and that they had better accept their and other human being's totality and humanity, while at the same time not like some of their behaviors and characteristics.
      That they are better off not measuring their entire self or their "being" and give up the narrow, grandiose and ultimately destructive notion to give themselves any global rating or report card. This is partly because all humans are continually evolving and are far too complex to accurately rate; all humans do both self- and social-defeating and self- and social-helping deeds, and have both beneficial and un-beneficial attributes and traits at certain times and in certain conditions. REBT holds that ideas and feelings about self-worth are largely definitional and are not empirically confirmable or falsifiable.
      That people had better accept life with its hassles and difficulties not always in accordance with their wants, while trying to change what they can change and live as elegantly as possible with what they cannot change."
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    Sep 18 2012: Yes, I believe that was the program.

    Personally I believe war is totally obsolete and no way for humans to interact particularly in the face of climate change and that we all ride spaceship earth together, sink or swim.

    However, beyond the carnage (which is always very difficult to overcome) the fact that today war is fought by soldiers (although many more civilians usually die) while back at the country club life is hardly affected at all. I believe it is this disconnect that in part drives the inability of returning vets to integrate after all they experienced. We've created the context of cultural PTSD, and few if any are addressing that. Whereas World War two was fought by the whole country, everyone participated. So that sense of meaning why they fought and died was universally understood and accepted. This hasn't been true since WW2 and since the military/Industrial complex has gained control.

    There certainly are many lessons here from the disenfranchised Vietnam veterans in our personal history, if we care to look.
  • Sep 17 2012: As long as the system operates under a financial premise, it opens the door to vested interests. Studies may become biased if financed by the drug producing industry and/or affiliates. There are surely alternative methods: natural products or change of environment. But given the fact that these methods to not provide profit, it surely leaves the power of expanding the definition of mental illness to the two parties you mentioned.
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    Sep 17 2012: Theodore,
    A bit embarrassed to say, I heard and saw it on the history channel recently. I see you have other information and I don't dispute it. However during the Civil war the level of human carnage was unprecedented in scale in this country. The primitive technology in medicine combined with advancing technologies of killing all contribute to the need of 'mental health'. Man's inhumanity to fellow man has driven many forms of science including psychiatry from many perspectives. Your question about having a financial interest is obvious. What's frustrating to me is how disconnected societal psychosis seems to be from individual treatments while serious pushing drugs without knowing the consequences. The whole Industry if fraught with contradictions, in my opinion.
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      Sep 18 2012: Craig, I appreciate you adding this, thank you. The History Channel presented a program called "Civil War-A Nation Divided." And I do not doubt that there was a push to open many more hospitals to care for those soldiers that survived that war.
      One of the things that prompted me to start this conversation was a discussion I had about returning veteran with PTSD, as well as other issues, and how to help them.
  • Sep 15 2012: Why is it that DSM-x receives so much flak in popular media, such as this, whereas ICD-10 (, which has many overlapping roles is ignored? Refer to section 5 ( for "Mental and behavioural disorders". Neither DSM nor ICD is the be-all and end-all of psychology and psychiatry.

    I am not a psychiatrist, but having seen more than a handful of case studies of real patients, I can tell you that these codes are not that important (at least for the time being). These are just some boxes in some forms that the therapist/doctor fills in. What guides the treatment regiment is a very detailed case-history of the patient/client. These codes play practically no role at all at the individual level. I have seen that some psychiatrists are trigger-happy with drugs, but the patient and their family always have the option to go another psychiatrist who was not as trigger-happy. What is far more important is the education of patients, so that they learn the options, and make their own decisions. Good doctors (of all specialities) do it.

    Why do they fill in DSM/ICD codes in their boxes? People with heart disease (or whatever) get these ICD codes too. It's a way of collecting data for some statistics. "80% of the people of Timbuktu with B50.0 respond well to a cocktail of drugs XYZ and PQR". What is B50.0? A kind of malaria.

    I believe that people in the UK do not have the option of switching doctors. I can understand if this is a real problem for UK folks. But in the countries I have lived in, I have always screened my doctors. I educated myself, learnt my options, and if/when I found that the doctor was BS-ing, I went somewhere else. I am not a doctor, but I keep myself fully informed about the latest research going on about my specific illness.
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      Sep 16 2012: Good reply John. The only part that you missed is that the other reason the ICD codes are assigned is reimbursement. In the US insurance and medicare and medicaid reimburses a set amount based on the codes. So the more boxes checked, the bigger the paycheck.

      First there was the DSM, then came DRGs, finally ICD codes to facilitate computerized data for both the DSM and DRGs.

      So the ICD codes not only help track health data, insurance companies and all public reimbursement systems are based on them. That is probably the main reason it has taken so long to come up with DSM V. They really are working to get both treatment plans and reimbursement issues represented.
      • Sep 16 2012: Hi Linda,
        Thanks for the info about insurance. However, I do not see anything related to treatment and reimbursement in DSM5's proposed revisions. See for example.
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          Sep 16 2012: Medical billing is based on the ICD codes.

          And here is one of the APA publications. It looks like they want DSM 5 to be compatible with with ICD 11 when it comes out in 2014.

          Saxena S, Esparza P, Regier DA, Saraceno B, & Sartorius N (eds). Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders. Refining the Research Agenda for DSM-5 and ICD-11. Arlington, VA: American Psychiatric Association and World Health Organization, 2012.

          It will all coordinate with the new ICD codes based on WHO established definitions. Of course it includes reimbursement. They are just not going to advertise it.
  • Sep 15 2012: I think it's safe to say that all professions have a financial interest in expanding their customer base. The difference with psychiatry is that because mental health is subjective, it's hard to argue with a professional's opinion when they say you need their help. We can solve this problem easily however – all we need to do is separate those who define and diagnose mental illness from those who treat it.
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    Sep 15 2012: Psychiatry is a mental illness. Read R.D. Laing seminal book, the Politics of Experience to understand that the notion of 'Normal' as 'practiced' by humanity is certifiably INSANE!!!!!
  • Sep 15 2012: "One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis."

    Maybe it is needed to find out what a "sane" person shall be. Means, you might find a diagnosis for everything, but that does not mean there is a treatment needed. Like in medicine, not everything that does not fit the norm is abnormal or a threat to the patient.

    I guess that is the current problem, that nobody knows what exactly "sane" is (it is also a question if sanity truly exists, i mean, when we look around, who is really "sane"), but anyone knows something he or she would call insane almost instantly.

    On the other hand, even if anyone is insane, there are always some who are even more insane and need a treatment. Like in medicince, you can find a disease or something to correct in every person if you just look close enough, but some do really have a problem, or might be a problem for others if not "cured".

    As everything has a financial background today, it is nonsense to smell conspiracy here. Its just the wheel of time, psychology is very young, still for most things without effective treatments, anyhow some treatments do work.

    I guess the society has to define what role or weight they give "psychology". We decide if we think anyone is insane or how much that matters to us.
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      Sep 15 2012: To use the medical model, I think that you are asking, "What is wellness?" We are all in a degenerative physical state, but we all learn to cope with our developed conditions. Wellness is therefore relative.
      Health is very personal, and we usually get to make the choices regarding our quality of life, and this means that we get to make bad choices as well This is not true of mental health which is more socially driven, where one can be medicated against one's own will.

      I state that psychiatry is "scientifically primitive," but medicine has an obligation to "do no harm." Can psychiatry's answer to the question of whether its practices meet this obligation pass the straight face test?
      • Sep 15 2012: But that has changed a lot, there are not many mental diseases who can be medicated against ones will, at least in western world. And at least in my country it is like that, that without a given harm to oneself or others, you can't be medicated against your will, nor locked away.

        Like any medical attempt, physical or mental, it can cause harm or be a cure. I think that is partly in the hands of the people, if we want to be perfect, or if we can live with imperfection. Not every symptom must be seen by a doctor, also not every mental difficulty needs a therapy.
  • Oct 13 2012: Re: Mr. Hoppe and Mr. Frum
    NY Times article "Before a Wave of Meningitis, Shots Were Tied to Risks" dated 10/12/2012 by Andrew Pollack substantiates the point I try to make.
    More than greed of pharmaceutical companies or ethics of medical professionals, failure of rationality on the part of professionals create such `failures'. Field of psychiatry or is no different.
  • Oct 13 2012: @ Mr. Hoppe - In summary the point I make is that rationality can explain only so much just as Euclidean geometry does. We cannot come to any sustainable conclusion solely on the basis of linear reasoning. Indeed one cannot turn to supernatural or plain hunches to argue but at the same time one need to find the limits within which the rational explanations remain applicable. Throwing more evidence on the greed part of the industry or medical practitioners cannot serve any further purpose. I have already said that greed does play a part but - it does not tell the entire story as your question implies.

    @ Mr. Frum - I do not know what informs your assertions about science knowing causality of various items mentioned in my earlier comments. Would you like to elaborate? Your mere "Not true" is not of much help. Thank you. Also, please reflect that whether such possible knowledge in science - given that your claim is true - informs the remedial actions either of pharmaceutical companies or medical practitioners. I am of the opinion that it does not - except, partially.
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    Oct 12 2012: A couple of points to make:
    1. Categorisation leads to error if the category is too large to discern the functional reality of category.
    2. Categorisation is, essentially, the only thing a human brain does.
    3. The Bayesian nature of human learning stipulates that all first attempts contain error. In a static world it's useless - but in the dynamic flow of observation and action it reduces errror very quickly.
    4. Anything that becomes codified in rules falls into stasis - the stasis induced by rules creates structures around which the dynamic world adapts - this is usually called "cheating".
    5. A diploma or degree is a rule. It does not bestow any particular guarantee of the holder's virtue. Thus, no static qualification determines the effective practice it portends to convey. In other words, qualifications are not the basis of teh quality of teh practitioner = most paractioners are inept. The catch-22 is that one can only know the success of a medical treatment through trial and error - with doctors or psychiatrists, you risk being killed or mentally damaged by them. Reputation becomes your only measure - and reputations can be falsified.
    6. The adoption of monetary units as the life-blood of community chanels all motivation into currency definitions.
    7. Currency units are relatively static. Thus they become the vehicle for cheating.
    8. The legal person (corporation) is a staticly defined entity desined to operate in the stataic continuum of currency. By definition, it thrives on cheating.
    9. The natural person (human being) is not adapted to monetary incentive - value vectors in the natural person exceed the static frame of money. Hence, a natural person (according to Blacks definitions of legal terms) can operate in the dynamic continuum - and may choose to deliver value beyond teh static frame.
    Conclusion - you get what you pay for.
    If you choose to observe the static frame, you will get your face ripped off - Don't deal with legal persons and you will do better.
  • Oct 11 2012: Indeed, pharmaceutical companies and the profession has financial interest in viewing mental disorders as they do or as they have done. The problem, IMO, is much deeper than that though. First, though we can witness and experience mental phenomena and mental disorders, we cannot understand or describe them with any degree of clarity or certainty. And, to boot, there are various alternative descriptions of the same phenomena. The behavior that was assumed to be caused by bad blood, or spell of the devil, got subsequently explained as `faulty conditioning' or `defect in psycho-sexual development'. The same odd behavior can also be classified on the basis of its severity in terms of neurosis and psychosis. Or, functionally, behavior can be dyslexia, discalculia, or autism. Each of these descriptions define but one aspect of mental disorders. The therapies are discovered to `cure' a particular explanation.
    Thus, financial gain may not be the only motive in defining and treating mental disorders but the multifarious definitions - each focusing on different aspect of the disorder - may be leading to varied remedial outcomes.
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      Oct 11 2012: Re: "The therapies are discovered to `cure' ."
      Not it all, therapists are designed to "treat" a particular disorder not 'cure' it, and thus the model of the treatment views the disorder as chronic and incurable, and they do this without identifying the root causes. To label something as disorder requires that we define the "order."
      It example of this would be where you develop an allergic reaction to something and a doctors puts you on a pill and requires you to care it all the time to control the symptoms of the reaction, since we can not control the environment. If you are reacting to golden rod pollen, why would you continue to medicate in the winter, when the pollen is gone. Well, if the doctor did not know it was pollen that creates the reaction you would be stuck on the medication needlessly. This is what is happening with disorders like depression where there is no neurological basis. .
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          Oct 12 2012: I agree.
          "Cure" is a silly word. It suggests a static reality in which absolutes can exist.
          In reality, time flows onwards and surpasses all notions of absolute.
          If a "treatment" results in the individual regaining the capacity to function sufficiently, then that is enough - but all individuals die eventually, so what is the objective?
          Is the goal to reduce "suffering"?
          I would offer that the true way to do that is to shift attention from retrospective "cures" of statically defined "conditions" and start concentrating on those factors that enhance adaptability - this is a process of enablement rather than constraint.
          For instance, to treat a sufferer of autism, it is disasterous to try to constrain the autistic's behaviour into "normal" definitions - it is far better to remove the constraints of "normalcy" and allow that sufferer to adapt to his/her own definitions of successful function. The path of the autistic is incomprehensible to those constrained in "normalcy" and the "normal" are incapable of delivering "treatment".
          I have proven this with my own autistic child - nearly every rule, law or institution has proven to be false and criminally inept. We live in a horror-zone of ignorance and arrogance - I am glad to have been shown the way out by my brilliant little boy.
          On the other hand - I applaud those researchers and scientists who are braking down the walls of ignorance - I defy anyone to categorize these brilliant individuals as "normal".
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          Oct 12 2012: Yes, the common cold. Eventually, the cold runs its course so treating the symptoms makes sense. You would not stay on cold medications forever. but this is what happens with depression.
          I address in a comment posted below on this thread on Sept 29, 2012 ,which reads in part:

          Marcia Angell responded to the critics of her review, "The Illussion of Psychiatry" by saying, (It is) "simply wrong in asserting that psychiatry, in using drugs to treat signs and symptoms of illness without understanding the cause of the illness or how the drugs work, is no different from other medical specialties."
        • Oct 12 2012: "...common cold. Science does not know why it is caused..."
          Not true.

          "No one knows what would have happened if financial institutions were allowed to fail but still the rescue work was initiated."
          Not true.
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        Oct 12 2012: I'd like to follow up on your assertion that there is no neurological basis for depression.
        As far as I can tell, there is a lot of evidence to show that there IS a neurological basis for depression .. mind you, there needs to be the distinction between transitory cortizol levels responding to imediate environmental threat and persistent cortizol levels resulting from systemic "latch-up" of the stress response system.
        Certainly, drugs that have blanket affect on neurotransmitters (SSRIs and their ilk) are a primative method for addressing chronic stress latch-up .. when prescribed as a cure, they will fail. When perscribed as a method as part of a strategy, they can be very useful - but only in allowing a window of opportunity for complimentary treatments such as talk therapy.
        The prescribing practitioner is absolutely key to the formulation of an effective treatment. The individual nature of mental dysfunction mandates the need for skilled individual treatment - this is a predicate for absolute focus on the part of the practitioner. Unfortunately, when you break-out the time cost of such focus, you will see that it is impossible to provide enough effective practitioners. It may be possible in a community that has a low level of pathology, but in a community that has as many as 1 in 4 suffering dysfunction, then the entire community is effectively "latched-up". The only feasible way out of such a situation is to educate the community such that the entire community spreads the time burden of healing its members. This cannot be done in a monetary based social order. Neural research is forging ahead quickly - hopefully, new methods will be discovered that may reduce the time burden - that is my hope.
        If you have evidence that clinical depression is not neurologically based - I'd like to see it? There is certainly plenty I have not yet read.
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          Oct 12 2012: A few quick points:

          1) Eric Nestler's research shows epigenetic changes in the brain, but these can reset themselves, similar to the brain states of addicts or alcoholics that stop using. Psychiatry does not currently look at neurological evidence.

          2) In 1999, books such as John Horan's, " The Undiscovered Mind," has called into question the efficacy of drugs such as prozac (see ch 4. Prozac and Other Placebos). There really has not been any new class of drugs to treat depression, accept this past week when Yale released its study of Ketamine.

          3) I like your point about a community healing its members, and that is Vikram Patel's point: Vikram Patel: Mental health for all by involving all
      • Oct 12 2012: I am sorry. My comment was accidentally deleted. I don't know how to retrieve it.
        @ Mr. Hoppe - One does stay on medication forever for example, for diabetes, hypertension, higher cholesterol level though we do not know about the exact reasons for onset of any of these diseases. To repeat, we have some notion of `normality' and our individual and collective efforts are directed to nudge our condition or behavior as near to the band of normality - and the same applies to mental disorders too. Consider the following: One does not know if one's child is going to hurt herself while playing, so one supervises it, without precisely knowing the possible dangers the play may involve. One may not precisely know the damage that a war may cause but we go extra mile to avoid it. Similarly, part of the reason in continuing with medication for chronic conditions like depression could well be to restore normality so far as possible for as long as possible.
        • Oct 12 2012: "for diabetes, hypertension, higher cholesterol level though we do not know about the exact reasons for onset of any of these diseases"
          Not true.
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          Oct 12 2012: In this thread I have provided a number of good resources which you can review rather than have me address every point you might raise.
          See the link to New York Review of Books article by Dr Marcia Angell. In the article she review three book: Robert Whitaker's "Anatomy of an Epidemic" is excellent, you can find talks by him on YouTube, also Irving Kirsch's "The Emperor's New Drugs," there is also a "60 Minute" interview posted on line.
          Another book is "Big Pharma" by Ben Goldacre who has a TEDTalk.
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        Oct 13 2012: HI Theodore,

        Many thanks!

        Do you have a link for the Yale anouncement?

        My experience is that psychiatry is beginning to incorporate recent neural discoveries. Certainly, the blunt instrument of drugs were the pinnacle of psychiatry 10 years ago, but that seems set to change dramatically.

        My entry point into neural theory is from the AI perspective as pioneered by Minsky et al.
        To me, it is the topology created by synaptic potentiation that lies at the root of any affective treatment. For a long time, I was at a loss with how to reconcile the neural network paradigm with autonomous learning - Damasio gave me the breakthrough that I needed - and it is almost too obvious .. we are self-organising systems - and it was staring me in the face - it is in the words: "self".
        A neural system must have a self to be autonomous - and it can only exist in an open system of "selfs" - it can only be autonomous in the context of other automata.
        I regard conditions such as clinical depression as "local minima". Local minima might be described as self-perpetuating distortions in the perceptive system - if you were to graph the synaptic potentials, you would see something like a crater in the topology.
        Flooding a brain with some kind of offset chemical will only interupt the resulting endocrine response - it will not address the "crater" in teh synaptic landscape - at best it will bias the entire system. The classic example is how anti-psychotics, by reducing seratonin will eventually induce parkinson's disease (tardive dyskinesia).
        My hope is that finer detection systems will eventually reveal the exact synaptic topology - from there, some kind of elctrostatic induction might be applied to reduce/increase specific topologies to remove local-minimum craters without touching the rest of the brain.
        Before then, the only way to isolate an eroneous belief system is through re-training via the empathy system.
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    Sep 28 2012: ... so where is the mainstream discussion of this? I work among this fraternity daily and have also been personally ubject to their ministrations - one senior such practitioner described me as 'Tall and Dark' in her report - anyone who has met me with their eyes open would know that to be completely innacurate - and that's the least of the problem.
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    Sep 28 2012: The talk by Ben Goldacre explains a great deal about how research about drugs are distorted:

    "When a new drug gets tested, the results of the trials should be published for the rest of the medical world -- except much of the time, negative or inconclusive findings go unreported, leaving doctors and researchers in the dark"
  • Sep 19 2012: Also, I highly recommend reading the following article:
  • Sep 18 2012:

    Please look at the findings of this paper and tell me that putting kids on antipsychotics for having the sole diagnosis of ADHD is ethical or healthy.

    Above is a well developed list of possible side effects of atypical antipsychotics

    This is a link about the deception of the drug companies and how much money they have had to dole out for the expensive and potentially harmful antipsychotic Risperdal.

    When I look at these three articles I don't know how I couldn't come to the conclusion that psychiatry has a major interest in expanding the definition of mental illness. There are many good psychiatrists, psychotherapists, and psychologists in the field who wish to help and nurture clients back to health and happiness,and its sad to see psychiatry losing its credibility.

    so long as the incentive for monetary gain outweighs the incentive of compassion and the wish to help another person, this problem will persist. Big pharma must be held accountable and so should the doctors who either have not done their due diligence, or wish to remain happily ignorant of the influence that companies like Johnson and Johnson have over clinical trials and grant money. So my answer is yes psychiatry certainly has an interest in expanding the defenition of mental illness. Part of me thinks it is to expand the scope of helping suffering people, the other part tells me profit lies as the motive. ....
    • Sep 18 2012: "When I look at these three articles I don't know how I couldn't come to the conclusion that psychiatry has a major interest in expanding the definition of mental illness."

      The problem is that you're treating the entire field of psychiatry as one unified entity, with just one goal -- to make more money by hook or by crook. However, even the research papers and blogs that you link to are written by people who are part of this industry. What incentive do you suppose they have to publish such papers?

      Big pharma has certainly been involved in many kinds of fraud. Merck, for example, even published "scientific papers" in a fraudulent journal created just for this, by Elsevier -- a huge publisher of scientific journals.

      Seeing this, what is your stance on "western medicine"? Are you convinced that vaccinations are good for you? I don't mean specific vaccines like the one for flu, I mean in general, all vaccines. How would you convince the anti-vaxers? I have a disease that is likely to kill me soon, if I stopped using some specific drugs made by Big Pharma. Many people of a few Asian countries, in particular, China, India and the South East ones are skeptical of "western medicine". They prefer to use traditional herbs to "treat" their diseases. Are you convinced that their way is better?

      Given that fraud happens at every aspect of every industry, when taken as a whole, I think it is counterproductive to single out psychiatry here. When I look deeper and deeper at the problems in various kinds of industry, I see USPTO at the root of it all, followed by the FDA, the US$, and the US military -- all metastasized forms of the cancer of corporatism. Any country that does not fall in line is strong-armed or bribed into following.
      • Sep 18 2012: John, im not arguing from a black and white perspective. I am by no means an advocate of herbal remedy to treat serious diseases and disorders, some medications save lives period. It is the quick fix over dispensing of psychiatric medications that i have a problem with. Your right psychiatry is not one unified field I didnt mean to portray that message by any means. There is much dissent including some brilliant work from Dr. Allen Frances on this topic.

        I just happen to believe that in a science and in a field that is not hardened such as psychiatry we shouldn't be so quick to prescribe drugs to developing brains for disorders that could be helped tenfold through extra guidance and talk therapies.

        "Given that fraud happens at every aspect of every industry, when taken as a whole, I think it is counterproductive to single out psychiatry here"
        I cannot agree with this statement. If the police break the law and the law is broken in every institution, would it be counterproductive to highlight police corruption?

        Psychiatry holds a position of immense importance and power, this issue needs to be highlighted and discussed by mature adults, who understand that because big pharma is corrupt and there are some bad doctors out there, it doesn't mean that all medication is bad.

        I completely agree that it starts right at the top with the FDA who seem to be in cahoots with the drug companies, corporatism is the really the major problem here and something needs to be done about it, at least there are some in the field who will speak on this topic.
        • Sep 18 2012: Hi Brian,
          I think we largely agree about the general evils of the system as it is now. Just a few small differences.

          I believe that the evils of government and corporate entities cannot be compared with each other. Government entities, especially the police, are authorized to use force. If any government entity has a conflict with us, they can easily set the police on us. Corporates have to approach the court unless WE have made threats of physical damage.

          Coming to psychiatry, well... this is where I blame patients as much as doctors. In most kinds of medicine, we usually have some kind of immediate danger if we don't use the medicine. Even a minor infection, untreated, can sometimes lead to gangrenes. Patients do not usually have the time to research and be competently informed before making a decision. Psychiatry is usually not like that. As long as I have control of my senses, or as long as I have family I can trust, we are just as responsible for due diligence. If my child were prescribed ADHD meds, I'd make sure I've learnt enough to fire BS-ing doctors. If the doctor has led me to believe that my kid almost certainly has ADHD, I'd start the meds, but start researching it soon after that. Psych drugs are lenient that way... so few of them have immediate long-term effects that if I stop my kid's medication after a couple of weeks of due diligence, well... no harm done.

          I liked the bulk of what Allen Frances wrote. However, I mostly disagree with his 5-point solution. The only solution I agree with, was "reducing the period of product patent protection." This is why I mentioned USPTO first. Companies are so aggressive about patents because the government grants them a monopoly for 17 years. So, no one can legally compete with them for the same product for about 12+ years. In the current system, this can make or break a company's fortune. If we were to reduce the validity of the patent from 17 to 3-4 years after the clinical phase, they'd not fight so hard for
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        Sep 29 2012: Let's understand the differences between western medicine and psychiatry, they're like apples and oranges.
        Marcia Angell responded to the critics of her review, "The Illussion of Psychiatry" by saying, (It is) "simply wrong in asserting that psychiatry, in using drugs to treat signs and symptoms of illness without understanding the cause of the illness or how the drugs work, is no different from other medical specialties. First, mental illness is diagnosed on the basis of symptoms (medically defined as subjective manifestations of disease, such as pain) and behaviors, not signs (defined as objective manifestations, such as swelling of a joint). Most diseases in other specialties produce physical signs and abnormal lab tests or radiologic findings, in addition to symptoms.

        Moreover, even if the underlying causes of other diseases are unknown, the mechanisms by which they produce illness usually are, and the treatments usually target those mechanisms. For example, we may not know what causes arthritis, but we do understand a great deal about the mechanism, and we know how anti-inflammatory agents work. Even when there are only symptoms, such as nausea or headache, other medical specialists, unlike psychiatrists, would be very reluctant to offer long-term symptomatic treatment without knowing what lies behind the symptoms."
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      Sep 18 2012: Brian, I think anti-psychotic medications are indicated in the treatment of ADHD as long as they are administered to the parents. - just kidding. This off-label use has been going on for some time. But kids with real ADHD have limited medications that work and it is an important social issue. Did you ever think that those meds would never be needed if we did not expect children to sit in a classroom for 6 or more hours a day? Maybe its the schools that should be medicated.

      Did you also know that schools get financially reimbursed for each child they have with ADHD? So the schools have a financial incentive to get kids on medication. This is getting worse with larger classroom sizes.
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        Sep 29 2012: What is "real ADHS?" Schools may have a financial incentive to see that a child is diagnosed, but where is the financial incentive for them to be on medication?

        Marcia Angell wrote in an article "The Illusion of Psychiatry"

        "These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects. The apparent prevalence of "juvenile bipolar disorder" jumped forty-fold between 1993 and 2004, and that of "autism" increased from one in five hundred children to one in ninety over the same decade. Ten percent of ten-year-old boys now take daily stimulants for ADHD—"attention deficit/hyperactivity disorder"—and 500,000 children take antipsychotic drugs."

        However you raise another interesting point with your quip that it is the schools that should be medicated: should we be more concerned about the mental well-being on our teachers? Should there be a requirement to disclose mental health issues that might affect their contact with children or their teaching abilities?
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    Sep 17 2012: Consider the roots of Psychiatry. The first 'hospital' grew out of the civil (so -called) war where over 600,000 soldiers (not counting civilians) died, most from the effects of their 'hospitals'. Think about the udder horror of treating amputees without any anesthesia. Out of those ashes, our present day psychiatry grew......And so the dysfunction grows...
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      Sep 17 2012: You will have to provide a reference for this. There is evidence that the Quakers were providing care to the "curably" insane as early is 1752. The establishment of state mental hospitals in the U.S. is partly due to reformer Dorothea Dix. Under the Kirkbride Pan there were 12 hospital built before the start of the Civil War.
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    Sep 16 2012: So what is happening in the states will eventually spread across the planet?
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    Sep 15 2012: If I understand the purpose of the DSM-5 it is the deinitive book of what treatments and illnesses exist and codes for how they will be billed and what medications have been found successful in the treatment.

    As Dr Carlet stated " .. ever shifting theories ...." Now the question would be are any of the disproved "theories" deleted from the book and the medications removed as non effective.

    Books of this nature tend to go from small to very large.

    Of course the profession and the pill makers will benefit. It is the billing guide and what the insurance companies will accept and pay for. It defines what the lawyers will use as defenses for the criminals who either have it or not.

    If it was not financially advantagous it would not sell and therefore not be published.

    In my humble opinion.

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      Sep 15 2012: There are several different points here to address:
      a) the DSM is currently being revised, DSM-5, see the following for some explanation of the controversies surrounding the revisions:
      "Bereavement, which has always been excluded from the mood disorders, will become a mental disorder. Mild forgetfulness will become a mental disorder ("mild neurocognitive disorder"). Your child's temper tantrums will become a mental disorder ("disruptive mood dysregulation disorder"). "

      2)Prozac should have taught us something. Placebo works. But in America, unlike Europe, it cannot be prescribe.

      3) regarding criminally and mental illness, I can recommend the book by David Eagleman, "Incognito." There is also an recent this article by Eagleman from, "The Atlantic."
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        Sep 15 2012: A quick story: The school call Mr Jones and said that his son had ADD. When the son got home Mr Jones took the boy to the woodshed whipped his butt and no more ADD.

        I am becoming really afraid of the world on pills. Perhaps the old fashion cures are not so bad. If the kids throws a tantrum and it achieves the goal (he gets his way) he will repeat it forever. I threw a tantrum once and got a sore butt and the problem still was there. I learned to resolve the problem without getting a sore butt. Forgetful ... make notes.

        A guy was being treated for monsters under his bed at $300 per hour for over a year. He told his bartender who went over to his house and cut the legs off the bed ... no more monsters under the bed.

        The point here is ... are these really problems or are we making them problems by giving them a medical name and a accompaning pill.

        My opinion ... I see less of these problems in families that go to church often and spend time with their children like camping, hunting, sports and generally take an interest in them. These are parents that do what is necessary in the best interest of the child. Kids have enough friends they need parents.

        Thanks for letting me vent. Bob.
        • Sep 15 2012: And what happens to those where butt whiping shows no effect? I do not say that every child that is difficult has a disorder, but anyhow some will have.

          I do not think that everything has a simple solution.
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        Sep 15 2012: Lars the point was not to go out and give every kids a butt whippin. The point was that we have less family interaction, less social values, and more medication. A great amount of elementery school children are on medication. Is it really necessary? Could another method of "cure" be explored prior to "labeling" and "medicating"?

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    Sep 15 2012: Dawkins & many of his followers consider folks with a religious conviction to be mentally ill . That should keep the shrinks busy for a while.

    • Sep 15 2012: What they honestly are. You need an infants frame of mind or a heavy mental developmental delay to believe in "gods/ghosts". Or do religious people agree with the idea there are zombies, vampires, unicorns? Well, if religion was no mental disorder, they would need to to do this-and each of these religious beliefs has their own bible too, Stokers Dracula to mention just one, or think about those of the Prophet Stephen King, he created numerous gods/ghosts and spiritual phenomenons.

      The only reason why people praying to zombies get locked away, while others who believe in rebirth and virgin birth are not is simply a space issue-such a big mental asylum goes literally beyond all human imagination.
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        Sep 15 2012: Proves my point. Half the world have mental illness ?
        • Sep 15 2012: Why not, could be? Think about physical diseases, almost every second person develops cancer or heart diseases during lifetime, most of them pre-cancer state.

          And the difference between a religious person and the behaviour of psychotic people is not that big. Like there is no big difference between a normal cell and a cancerous cell.

          What is so unbelievable, that back in history without scientific knowledge about brain chemistry and behavior, mental diseases etc....what is so unbelievable that some psychotic persons back in that time were taken serious?

          And you have to consider that brains develop with time. While you can fool a child that there might be a ghost under his bed, a mature person might not be fooled by this. Anyhow, if specific development was not archieved, even mature persons can believe there is a ghost under their bed.

          Also the architecture of religion is always very simple structured, to fit infantile minds. A fantasy movie with the same plot would be considered total trash, because of all these contradictions and false facts. But, in a mental ill environment, with lots of behavioural disorders, such plot could be taken serious.

          When you tell young children a horror story, they will take this serious and act like that. When you tell a person with development issues something, they will take it serious too.

          And in an insane group, its likely to happen that sooner or later anyone will act wired, just in reference to the environment, who forces them to act insane. You can see that in strong religious cultures, if you look objective.

          If someone told you, your leg was broken, would you act aggressive and ask "how can you dare to say that"? If someone tells you, you might have a mental problem, this is taken as an insult, an attack. But, this can just be an attack if people believe they are totally sane, from first breath until last breath. Such a condition is not known.
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      Sep 15 2012: While psychiatry and psychology has been referred to as a new religion I'd prefer to not turn this into a discussion into a religious debate.
      The relevant point here is that social context can very often deem what is socially acceptable behavior and what is a behavioral "disorder." For example, being homosexual was in the DSM and thought to be treatable. It has since been removed.
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        Sep 15 2012: Exactly. What we are talking about is to some extent mob rule. Many mental illnesses are obviously just that. However we must be careful that folks are not so labelled just because they do not fit the prevailing norm, or fall foul of a dictators preference like the Jews in ww2. The real illness here was with the nazis, not the Jews.
        As Lars (above) together with his guru Dawkins, this disease is very close to the surface, & will take little encouragement to take hold again in our 'free' society.
      • Sep 15 2012: "The relevant point here is that social context can very often deem what is socially acceptable behavior and what is a a behavioral "disorder."

        This is why I don't trust psychiatry. Psychiatrist don't set social norms; they follow them. If they really knew what was best for us, they would have been the first ones to approve of homosexuality (for example). Instead they were one of the last. Their definition of "disease" depends entirely on the culture of the time.
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    Sep 15 2012: Absolutely, but not as much of a financial interest as big pharma.
    The reality is that there are many people out there suffering whose suffering is relived by medical treatment. It's when big psychoactive drugs are used to treat normal human experience that I have a problem.
    Everyone gets sad or depressed on occasion. Everyone has quirks to their personality. Not everyone needs medication for those experiences. But by far, that is where the money is made. They only make money when working insured individuals contribute.

    Most adults who truly suffer from mental illness are not working and insured.

    NOTE: The DSM-V is developed by the American PSYCHOLOGICAL Association. Not psychiatrists.
    • Sep 15 2012: Pretty sure it's the "American Psychiatric Association", but that's still a problem: other countries use the DSM-V too and British psychiatrists have criticised it as being biased by American cultural norms and being geared towards medicalization of minor or doubtful "problems".
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        Sep 15 2012: Ah yes, you are correct. My bad. I haven't worked with DSM since it was version III when they assigned DRGs to them.

        That is another point. How the DSM V drives reimbursement.
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      Sep 15 2012: While there is two APAs; the American Psychological Association and the American Psychiatric Association, it is the American Psychiatric Association that publishes the DSM.

      "The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides a common language and standard criteria for the classification of mental disorders"
  • Sep 15 2012: "Does psychiatry have a financial interest in expanding the definition of mental illness?"

    Yes, at least the pharmaceutical sector does. Individual psychiatrists don't operate like that but they do have an incentive to expand those definitions because that makes them feel like they're helping more people and are more important.

    Society plays happily along with this when we expect psychiatrists to diagnose and fix people like a technician does with a machine. And that's just real psychiatrists with actual scientific training, the therapists still using Freud's pseudoscience are even worse.
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    Sep 15 2012: Theodore

    Exactly right. There earlier renditions brought us eugenics.