PDA

View Full Version : Mental Disorders and Religious Sentiment...


stamenflicker
12th July 2006, 10:02 PM
I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

blutoski
12th July 2006, 10:24 PM
I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

I'm sure you're aware that there are certainly skeptics who are exasperated by this position. I've discussed it before in other threads, but skeptics shelve this under 'psychiatry denial'. My impression is that nothing that can be said will convince a PDer that the DSM-IV has medical value.

So, let me start this way: what would you be looking for to accept that a psychiatric condition is 'real'?

Avita
13th July 2006, 05:14 AM
Thanks, Stamenflicker, for starting this thread. As you and I were both responsible for "corrupting" the other thread, I would like my questions from there answered before I try to formulate an answer to your OP in this thread. To quote:


I would like to know what you mean by an "empirical disease." You say that there are no clear lines of demarkation for depression, and contrast it with diabetes. However, many, many diseases are not entirely clear-cut, either. For example, this description of the usual first symptoms of hypothyroidism is taken from the Merck Manual (http://www.merck.com/mrkshared/mmanual/section2/chapter8/8e.jsp) -

The symptoms and signs of primary hypothyroidism are generally in striking contrast to those of hyperthyroidism and may be quite subtle and insidious in onset. The facial expression is dull; the voice is hoarse and speech is slow; facial puffiness and periorbital swelling occur due to infiltration with the mucopolysaccharides hyaluronic acid and chondroitin sulfate; cold intolerance may be prominent; eyelids droop because of decreased adrenergic drive; hair is sparse, coarse, and dry; and the skin is coarse, dry, scaly, and thick. Weight gain is modest and is largely the result of decreased metabolism of food and fluid retention. Patients are forgetful and show other evidence of intellectual impairment, with a gradual change in personality. Some appear depressed. There may be frank psychosis (myxedema madness).
The manual goes on to list a few more things, but all of them are in the same vein - they might or might not occur, and practically all of them could occur in a perfectly healthy person, or at the least, in a person suffering from something other than hypothyroidism. There is no line of demarkation between a healthy person's dry skin and a hypothyroid person's dry skin. You may say that we have very specific tests for the levels of thyroid hormones in the body, and indeed, we do. But before the doctor orders those tests, it has to occur to him/her to do so. And that decision is made on the basis of the above symptoms. Similarly, there are some tests for things like depression (not very specific yet, and usually extremely expensive, which is why they are rarely used in diagnosis), but everyday diagnoses are made on the basis of what we know about the likely experiences of people with mental disturbances.

And:

You also equate mental illness with religious sentiment. Considering that you say that religious sentiment is primarily due to trusting God (whether or not there's any evidence for God), I am curious to know more about what you mean by this comparison. Do you mean, for instance, that mental illness is due to some sort of conviction?

Now, I am off to bed to try, yet again, to fall asleep. The insomnia appears to be caused by both physical and psychological factors. Some of the physical things I am experiencing are caused by my mental state. And vice versa. How, I ask, can this be, if mental diseases are subjective?

blutoski
13th July 2006, 10:30 AM
And vice versa. How, I ask, can this be, if mental diseases are subjective?

I'd also like to ask: what's wrong with subjective? Most organic 'diseases' are, too. You brought up hyperthyroidism, but I'd like to add:

back pain
headaches, including migraines
any type of pain-based illness, actually (there are 'fibro deniers')
cholesterol levels (what's 'too high'? - there are 'cholesterol deniers')
blood pressure (what's 'too high'? - there are 'blood pressure deniers')
sodium levels (see 'blood pressure deniers')
addictions (how 'serious' is an addiction to caffeine? Is there such a thing as addiction? there are 'addiction deniers')
obesity (notice a pattern: there is an 'obesity denial' movement, too)
dangerous tumours (when to remove? when to monitor?)
epidemics (what's an 'epidemic'? - see 'epidemic deniers')


Other arbitrary things in medical science:

confidence intervals of p<=.05 (ie: almost all medical research is based on an arbitrary confidence intervale - there are 'confidence interval deniers')
clinical trials have three phases (there are people who debate the need for three, there are people who think we should have more phases)






'arbitrary' is not a bad thing, even in science. Wherefore species? Completely arbitrary classifications, and most people are fine with that. Classifications usually are.

There is a logical fallacy called 'corruption of the continuum', which takes place when somebody expects a demarcation in a situation where one does not exist, or denies the endpoint categories because there is no clear differentiation among their intermediates. eg:

[-young----------------------------------------------------------------------old-]

My granmother was young when she was two, and old when she was ninety-six. When, exactly, (to the second, please) did she stop being young and start being old?

If we don't know, are the concepts of young and old 'meaningless'?

ETA: Corrupt Continuum (http://www.bcskeptics.info/resources/criticalthinking/hcf.continuum.html)

Dancing David
13th July 2006, 12:22 PM
I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

UH-huh,
and so are you saying that people who do hear voices aren't 'people living with schizophrenia', or are you saying that people who never sleep and think they are the president aren't 'people living with bipolar disorder', or are you saying that people who are hopeless, helpless, hate themselves are not 'people living with depression'?

There are people who suffer from things than can be benefitted from conventional medical treatment. are you saying that we should use terms like' person with symptoms which would indicate a psychosis'? Instead of the doctor using the label scfhizophrenia?

I can understand that the labels may seem rather large to those who don't worj in the mental health fireld and certainly there is room for refining the nomenclature but as someone who has to assess people everyday who try to kill themselves, I hope that you are not disputing the existance of mental disorders. Some people can be grossly misdiagnosed, some people use substances that alter thier behavior, some people are unedr stress, but it appears to me that the mental disorders do exist.

Unless you think it is okay for some person to kill themselves due to depression or murder thier family because of psychosis?

Dancing David
13th July 2006, 12:29 PM
Thanks, Stamenflicker, for starting this thread. As you and I were both responsible for "corrupting" the other thread, I would like my questions from there answered before I try to formulate an answer to your OP in this thread. To quote:



And:


Now, I am off to bed to try, yet again, to fall asleep. The insomnia appears to be caused by both physical and psychological factors. Some of the physical things I am experiencing are caused by my mental state. And vice versa. How, I ask, can this be, if mental diseases are subjective?


OOOPS


I misread the quoted quote and thought something I shouldn't,

the comment below is addressed solely to

Stamenfilicker!

Sorry this is silly , experience is experinece, there is a biological basis for the human body, unless you are an immaterialist.

Are you saying that diabetes doesn't exist or that it exists because you can do a glucose level?

Pharmaceutical companies may not be the best way to determine if psychiatric conditions exist. I suggest you make a trip to your local state operated facility and talk to someone who hears voices.

Obviously it is up to individuals who have an experince to determine if it distresses them enough that they would like help.

But you statement that 'mental diseases are subjective' is like saying doctors should not use anesthesia bacuase 'pain is subjective'.

A pwerson in a full blown panic attack has discernable sysmptoms, doctors will often treat infections on the basis of observed subjective report and in fact that is how most treatment occurs, there is not always a test for all conditions.

Are some condtions more accurately diagnosed sure, but you are saying that alcoholism doesn't exist because it is 'subjective', but it is an accurate term to say that a person who looses jobs, relationships, can't function in life and is dying from iver failure has 'alcohol dependance'.

Katana
13th July 2006, 12:52 PM
You can no more will depression away than you can will away diabetes.

If ignorance is bliss, stamenflicker must be euphoric.

stamenflicker
13th July 2006, 12:57 PM
How, I ask, can this be, if mental diseases are subjective?

As to hyper-thyroidism, I'm not an MD. However, if we have tests available (and apparently we do) which can measure literal levels of substances associated with the thyroid, and then conclusively determine that the substance X is causing a physical symptom, then it seems real enough to me.

The problem enters when we have two specimens with exactly the same measurement of substance X, yet one does not manifest any symptoms. To certain degree, pain itself is a subjective experience... and our best empiricism isn't going to answer why that it is after its finest hours.

So let's take Blutoski's excellent example of cholesterol. If Blutoski and I go get our cholesterol checked and have identical results, yet I am suffering from fatigue, high blood pressure, etc. and he is not, then with what degree of confidence can we assume my cholesterol is the problem? Supposing that we were identical twins, thereby ruling out genetic history problems, what would we do?

My body is manifesting symptoms that his is not. What we have is then is merely a symptom-- one that is understood only by encapsulating it in vectors that we deem to be relevant to the cause. So surrounding my fatigue and high blood pressure, we have determined scientifically that cholesterol is one of these vectors. Again, I'm no doctor, but I imagine that it has been scientifically proven that exercise is another one of these vectors. Both cholesterol and exercise are measurable. And while high blood pressure is a measurable symptom, fatigue is not. So we begin to get a picture of something that we can name, as we name the vectors that encapsulate the symptom(s).

Contrast that with depression:

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Note that an individual needs only three or more of the symptoms to be considered "depressed." Notice that 3,4,5 are the only vectors that are truly biologically accessible. The others are indicative of subjective states. And really we are left with only #3 when looking for something truly measurable since baseline measurements likely are not available prior to diagnosis in the others. So it is possible to receive the diagnosis of depression without any real evidence that there is such a thing at all.

If Blutoski choses to point to his back or his head and say it hurts-- he actually is pointing at a literal something, not a mood he may or may not be in.

Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

stamenflicker
13th July 2006, 01:04 PM
Are you saying that diabetes doesn't exist or that it exists because you can do a glucose level?

I'm not saying "they" don't exist at all. Certainly as a category of subjective experiences "they" are a real something. But a real what?

More specifically, I am saying that "depression" as a set of subjective descriptors are of no more or less importance than the set of subjective descriptors which comprise a kundalini awakening, divine bliss, or whatever else a person chose to build a category around.

stamenflicker
13th July 2006, 01:09 PM
so are you saying that people who do hear voices aren't 'people living with schizophrenia'

I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

slingblade
13th July 2006, 01:37 PM
I've long felt that many disorders are probably the same disorder, manifesting in an individual way within a particular individual.

This is not meant to be a sweeping statement. And I can't tell you specifically which ones I mean. But ADD and OCD are strongly related, I would think (this is not my area of expertise in the slightest, except as a patient ;)). What if they weren't just related, but were the same "problem," whatever we call that problem, which manifests differently, depending on the person.

People are different, she said simplistically, so why wouldn't manifestations of a brain disorder naturally differ among them?

I also think folks just get tired of the "31 Flavors" air of mental diagnosis, whether they should or shouldn't. I'm talking, for instance, about that recent article this summer about a "new kind" of anger disorder, a road-rage sort of thing. Can't recall the specifics just now...

I was, oddly enough, taking a basic sociology class at that time, and we discussed it: is this really a "new" disorder, or just a new label for something we already recognize? Did we really need this new label, if so?

How many perfectly "normal" but socially unacceptable behaviors are we medicalizing, maybe when they don't deserve to be such? Are we feeding a health-care/drug manufacturer's monster, or are we helping people?

How many "disorders" are simply products, results, of living in a hostile society? I don't always like to be around people much, but then, people often treat me like crap. Knowing I have to go around people sometimes makes me very anxious. Disorder or learned response? If learned response, can you really give someone a pill that will help?

Katana
13th July 2006, 01:42 PM
Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

Funny. I wasn't aware that being a "born again" Christian was a condition that responded to medications. If so, can we put one of them in the water supply?

Starrman
13th July 2006, 01:49 PM
I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

I would say that we can't measure the chemicals or mis-wiring that causes audio hallucinations in schizophrenia like we do cholesteral because those are occurring inside the brain. We can, however, take CAT scans - which do show physical abnormalities (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3154505&dopt=Abstract). We can conclude that these abnormalities were the cause by the fact that specific medicine makes it go away.

Katana
13th July 2006, 01:54 PM
Yes. I agree that we have begun to over-pathologize common symptoms and complaints. I am concerned that too many people now have names for their symptoms, an excuse to wear them on their sleeves, and spend the rest of their lives defined by their "condition." I also believe that some physicians are over-diagnosing and over-prescribing for mental illnesses.

However, don't discount the legitimacy of mental illness when properly diagnosed and treated. I don't like the loss of personal responsibility rampant in our society any more than the next person, but there are people out there genuinely impaired by issues like depression and bilpolar disorder. They're not happy about it, and they really only want to get better. Unfortunately, on top of their illness, they have to confront the societal bias against "believing in" mental illness that some have demonstrated in this thread.

blutoski
13th July 2006, 03:54 PM
The problem enters when we have two specimens with exactly the same measurement of substance X, yet one does not manifest any symptoms. To certain degree, pain itself is a subjective experience... and our best empiricism isn't going to answer why that it is after its finest hours.

You totally missed the point of my examples. I'll modify your example for illustration: we get our cholesterol tested. Your results are 5.9. My results are 6.0. I'm above the arbitrary threshold that says I should be on statins. You are below the arbitrary threshold that says you should be on statins. I have "a medical diagnosis"; you do not.

Medicine is like that.

Back to my prior examples:
Blood pressure (medicate above level x); pain (analgesics after point x, narcotics after point y, anaesthetize after point z, sedate after point z2)



Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

Sure it is: they describe depression. As opposed to, say, the amount of fish particles in the atmosphere, which is an objective measurement, but does not pertain to depression, and is not considered in the diagnosis.

Use common sense, man! Look at that list of diagnostic criteria. Are you saying that a patient with a fistful of those attributes is not likely to be more depressed than somebody with none of them? One of the appeals of skepticism is its grounding in science, which is basically organized common-sense. Fru-fru metaphysical arguments have little place in scientific discusisons.

I think you're conflating two issues:
1) standards/classification/identification/diagnostics and
2) thresholds for medicalization.

The value of diagnostics is that we have research that shows certain treatments work with certain problems; it behooves us to identify the correct underlying problem. Slingblade made this point, and it's the underlying principle of medicine: diagnostics are the key to proper treatment.



As for the relation to religous beliefs: the key difference is that religious people don't say things like: "Believing in Jesus has made my life a living hell. Ever since I started, my life has gone downhill. I wish I could stop, but I just can't. I wish there was something I could do to make this end."

Basically, if it's not having a negative impact on the patient's quality of life, it's not in the DSMIVR.

blutoski
13th July 2006, 04:20 PM
I've long felt that many disorders are probably the same disorder, manifesting in an individual way within a particular individual.

The trend has been toward more splitting, rather than more lumping, I'm afraid. However, there have been cases of reclassifications where distinct conditions got rejigged with one as a special case of the other.

This is what we should expect, though, as it follows the trend of medicine through the ages. We no longer talk about diseases with such vagueries as "he has the fever" - we now know which of the 3,000 *kinds* of illnesses are causing the fever, and that's what we name it.




This is not meant to be a sweeping statement. And I can't tell you specifically which ones I mean. But ADD and OCD are strongly related, I would think (this is not my area of expertise in the slightest, except as a patient ;)). What if they weren't just related, but were the same "problem," whatever we call that problem, which manifests differently, depending on the person.

I don't think there's a good case for that. OCD is obviously an anxiety disorder, whereas ADD is a concentration problem. Stimulants make OCD worse, but make ADD better. The underlying organic is almost certainly different.

Watch for the 'axes' and 'clusters'. This is how you find the diagnoses with shared underlying causes, although some axes and clusters are catchalls.




People are different, she said simplistically, so why wouldn't manifestations of a brain disorder naturally differ among them?

I also think folks just get tired of the "31 Flavors" air of mental diagnosis, whether they should or shouldn't. I'm talking, for instance, about that recent article this summer about a "new kind" of anger disorder, a road-rage sort of thing. Can't recall the specifics just now...

I was, oddly enough, taking a basic sociology class at that time, and we discussed it: is this really a "new" disorder, or just a new label for something we already recognize? Did we really need this new label, if so?

Well, the point of diagnostic categorization is to identify appropriate treatment. This disorder is different than others, and its treatment needs to be specialized. That was the thrust of the publication.

Previously, these people have been misdiagnosed as narcissistic personality disorder, but the usual treatment for this condition (cbt) is not effective. In order to return these rage-outburst patients to some sense of control, they need medication. It's a newly-discovered variation on Tourette's tic, and not at all a personality disorder.




How many perfectly "normal" but socially unacceptable behaviors are we medicalizing, maybe when they don't deserve to be such? Are we feeding a health-care/drug manufacturer's monster, or are we helping people?

It should be noted that again, diagnosis is not the same thing as medicalization. Psychology categorizes people all the time: introverts, communicative, fantasy-prone, innovative, &c. The DSMIVR is a tool that focuses on only a small segment of these categories - the ones that cause negative lifestyle impacts. Most diagnoses are treated with non-medical therapy in short timespans.



How many "disorders" are simply products, results, of living in a hostile society? I don't always like to be around people much, but then, people often treat me like crap. Knowing I have to go around people sometimes makes me very anxious. Disorder or learned response? If learned response, can you really give someone a pill that will help?

This is also a myth, though: that non-western, preindustrial, or primitive societies do not see mental problems. The reality is that they just don't have the infrastructure to recognize them as such, and deal with them as they see fit.

For example, my wife was literally half of "psychiatry" in Tobago for about 3 months earlier this year. She said the sad thing about it was that the people down there with mental problems are just as abundant as here, but the difference is that they do not get an iota of compassion. Narcissists are chopped up with machetes by angry neighbours, the depressed are allowed to kill themselves, and the schizophrenic get gunned down by police in a blind panic when they finally do their "I hear voices!" thing in the middle of downtown.



One of the other benefits of classification is predictability. We can predict a person's future behavior, given enough information to understand their diagnostic classification. In the example of the road-rage problem, this is debilitating, and these people now face the legal restriction against having a driver's licence. Just as if they were declared legally blind (an arbitrary legal threshold on a subjective medical diagnosis), the public can assess their risk of causing accidents, and protect ourselves accordingly.

Bipolars often lose their driver's licences, too (not to mention, being institutionalized).

stamenflicker
13th July 2006, 04:25 PM
Funny. I wasn't aware that being a "born again" Christian was a condition that responded to medications.

Have you ever seen one on crack?

stamenflicker
13th July 2006, 04:29 PM
I would say that we can't measure the chemicals or mis-wiring that causes audio hallucinations in schizophrenia like we do cholesteral because those are occurring inside the brain. We can, however, take CAT scans - which do show physical abnormalities (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3154505&dopt=Abstract). We can conclude that these abnormalities were the cause by the fact that specific medicine makes it go away.

I've stated before in other posts that schizophrenia might be one of only a handful of exceptions. The reason I might be willing to make one there? Is there is empirical evidence which can be pointed to with the human biology.

Look at some other dissociative disorders-- fugue states, multiple personality, whatever. Rarely if ever is there any tangible evidence of a true empirical disorder.

blutoski
13th July 2006, 04:33 PM
I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

Right, but again, common sense: children are big at pretend. They don't need a motive. It's natural. Psychiatrists are sensitive to this, and assessing whether a symptom is pathological is the point of the interview process.

For example, my wife had a patient who came into the hospital with concerns that he may be having a schizophrenic episode (his mother was schizophrenic). The patient wasn't hearing voices, but had delusions of persecution: he thought somebody was 'out to get him,' and was concerned he was losing it.

Story went like this: he went into work and there was no padlock on his locker. Had he taken it home with him yesterday? Had somebody cut it off? Then, for four days in a row, one of his car tires was flat when he came out of work. Different tire every day. No punctures. Just flat. Dead birds on his doorstep for a week. What are the odds that they're all just dying overhead and landing on his steps?

After a little bit of Q&A, my wife concluded that actually, somebody was out to get him, and his next stop should be the police. Three months later, he came back to thank her, and the complete story was that the patient was trying to unionize his workplace, so his employer had been hiring goons to intimidate him. A police stakeout had photographed them putting dead birds on his lawn, vandalizing his car, and charges had been laid.


Point is: psychiatry involves knowing what's normal. My wife can spot a schizophrenic at 100 paces.

stamenflicker
13th July 2006, 04:55 PM
You totally missed the point of my examples. I'll modify your example for illustration: we get our cholesterol tested. Your results are 5.9. My results are 6.0. I'm above the arbitrary threshold that says I should be on statins. You are below the arbitrary threshold that says you should be on statins. I have "a medical diagnosis"; you do not.

And while I recognize that we have to create somewhat arbitary lines of demarcation, it sounds more like you are agreeing with me than disagreeing. It still does not alter the fact that with medicines targeting specific empricial diseases we have things we can actually measure.

Sure it is: they describe depression. As opposed to, say, the amount of fish particles in the atmosphere, which is an objective measurement, but does not pertain to depression, and is not considered in the diagnosis.

And yet if we deemed fish particles in the atmosphere to be of any scientific value, we'd have vectors for determining them as well. That "depression" is considered scientific as opposed to say the affect of Beatles tunes in local elevators, is one of preference and practicality-- not scientific truth.

Look at that list of diagnostic criteria. Are you saying that a patient with a fistful of those attributes is not likely to be more depressed than somebody with none of them?

I'm saying that a person with a fist full of those attributes has a fist full of those attributes. I think that's all we can really say about it.

One of the appeals of skepticism is its grounding in science, which is basically organized common-sense. Fru-fru metaphysical arguments have little place in scientific discusisons.

And yet you are telling me that a person feelings of lonliness are of more scientific value than their feelings of oneness with nature. I'm just saying that I don't believe it, or have any method of determining which subjective state is worthy of statistical pursuit for the purpose of creating an false "condition" which attempts to pass itself off as an empirical reality.

The value of diagnostics is that we have research that shows certain treatments work with certain problems;

And things like pot work on almost all of us. That medication may or may not work on certain subjective states really does tell us anything about why we treat one set as scientific and the other as non-scientific.

As for the relation to religous beliefs: the key difference is that religious people don't say things like: "Believing in Jesus has made my life a living hell. Ever since I started, my life has gone downhill. I wish I could stop, but I just can't. I wish there was something I could do to make this end."

You are right they don't. But they may have some set of subject states they have in common with the experience of "born again;" states which when compiled an examined create a statistical "condition" to be named.

Basically, if it's not having a negative impact on the patient's quality of life, it's not in the DSMIVR.

Don't get me wrong, I'm not arguing that religious sentiment belongs in the DSMIV. I'm arguing that the DSMIV is treated as science by imposters, and accepted as science by the gullible. And worse still, used by lawyers to condone any number of activities-- be they religious or otherwise.

Dancing David
13th July 2006, 05:15 PM
I'm not saying "they" don't exist at all. Certainly as a category of subjective experiences "they" are a real something. But a real what?

More specifically, I am saying that "depression" as a set of subjective descriptors are of no more or less importance than the set of subjective descriptors which comprise a kundalini awakening, divine bliss, or whatever else a person chose to build a category around.


So it is just based upon your own a priori conjecture, whatever.

I will be sure to tell that to the next person who overdoses because they are depressed:

"Don't be depressed the Prophet Stamenflicker says you can't be depressed, it is only subjective.'

Are you saying pain is subjective, it is measured subjectively, would you take novacaine before having a tooth drilled? It is only subjective.

Avita
13th July 2006, 05:20 PM
Stamenflicker, there are several issues here. Are the descriptions in the DSM accurate reflections of inner states that people experience (i.e., can we differentiate using these criteria)? And if they are, can they be detected in physiological ways? You say that you don't believe in either, yet this whole conversation started because you claimed here (http://forums.randi.org/showpost.php?p=1759206&postcount=31) that:
I also believe that how we "feel" affects our health. Now I can't "sunshine sing" my way into a new arm, but certainly I can better fight off a cold by staying upbeat, positive, and active. That God does or does not play a role in that upbeat feeling, is hardly my concern.
And then I pointed out that "positive thinking" plays a more complicated role in human immunology than commonly supposed, and that your assertion was much of an overstatement.

Could you please explain how mood could affect us physiologically, yet mood disorders wouldn't? We don't test for depression by monitoring the immune system, just because too many things also affect the immune system, and because we have much easier ways to find out. And that's the list of criteria offered by the DSM. Yes, they can always be argued over and refined, but the truth is, they're useful.

Perhaps you have heard that women are more afflicted with depression. Latest research shows that men suffer from it more commonly than supposed. It's just that men tend to "cover up" the sadness more, especially with anger. But if you get that person into therapy, and start figuring out what's behind the anger, you'll find the same feelings of sadness, helplessness, hopelessness... The DSM doesn't need to change the criteria for depression to say "In men, excessive feelings of anger are common, etc." That's because it's not part of the underlying disorder, but merely one expression of it (and the DSM does make such a note in the section on "Specific Culture, Age, and Gender Features"), which not all men exhibit, and which women can also exhibit.

As for your objection that one can have people with, say, the same level of serotonin in their brains, one of whom is depressed and one of whom is not - well, of course. That's because neurotransmitters play multiple roles in the organism, and are affected by multiple factors. So one person may be more able to compensate for the lack than the other, same as how people with identical levels of sugar in their blood may have their health in different states (say, one already has nerve damage, and the other one doesn't), because diabetes does not affect the same organs at the same speed in all people, but we know which structures tend to break down first in diabetes, and can use that knowledge in diagnosing. Mental disorders have been shown to affect everything from brain structure to blood flow, just as physical diseases do, like my hypothyroidism example and Blutoski's much more extensive list. If medical disorders are often just as vague as psychological disorders in their symptoms, then how can you insist that one describes something real, and the other doesn't?

At one point you say:
And while high blood pressure is a measurable symptom, fatigue is not.
Stamenflicker, I have had the misfortune of suffering from several diseases, both physical and mental. Curiously enough, for most of my physical illnesses, the first and most noticeable symptom was fatigue. Of course, each time, I would at first dismiss it as due to stress, overwork, what have you, until such a point as I could not ignore it anymore. The doctor would then have to run a large battery of tests, because fatigue can indeed be a symptom of many, many diseases, including mental ones, and no disease at all. I was fortunate enough to have my problems identified relatively quickly, instead of being dismissed as a neurotic, but many people are not as fortunate, and suffer for years before being diagnosed properly by medical doctors. Does that make their experience any less real? By contrast, anxiety which is strong enough to make my whole body shake at the mere thought of doing the feared thing - that's rather noticeable and unmistakable.

I could go on, but the point is this - the measure of a disease, whether physical or mental, is often simply how much it disrupts the person's life. Some people don't wear glasses despite strong near-sightedness, simply because they can get along well enough without. Some people neglect their blood pressure or high blood sugar, despite all the tests showing them to be extremely high, simply because they can't feel the effects. Some people don't take their psych meds for the same reason. None of this means that they don't have a serious problem, one which will, in all probability, come back to bite them.

I can also point at my head when it hurts, but so what? I am not pointing at the actual pain I'm experiencing. I can similarly point to my chest when it tightens during a panic attack.

As for the example of Little Susie and her grandma - you're again ignoring the fact that there's a matter of degree involved. Little Susie is playing - she imagines hearing the voices, but she doesn't "actually" hear them, nor are they disrupting her life, or insisting that something terrible will happen if she does not give her dolls tea right now. If that happened, she'd have childhood schizophrenia, as one of my cousins does.

Finally, Katana and Blutoski also make the very good point that mental disorders respond to medication, while religious feelings don't. Of course, there are a few threads on this forum about the new mushroom that will induce such experiences for you (curiously enough, not in all people who try it, and not in the same way), but we yet know of nothing that would take them away (and we do know of other substances that induce mental disorders. Alcohol, for instance.) I'm restating what they said, because it bears repeating.

Dancing David
13th July 2006, 05:21 PM
I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

What a pile of barf , made up from your own head.
3.5 million people with schizophrenia in the USA, are you going to tell me dementia isn't real?

That is humor, except for the fact that little Suzy is imaging that the dolls are talking, a person who has schizophrenia hears actual auditory events generated in thier cortex due to a mental illness. I suppose you would think it funny if it happened to you.

You are a coward Stamenflicker, you joke about other people's suffering because you lack compassion, I suggest you come with me to the ED and talk to the people who think about killing someone bacause the voices tell them to, I know a family who had thier father murdered because they made the mistake of discharging thier very psychotic family member while they were delusional. Your joke won't bring back the dead will it?

Like I said you are a coward, mental illness is real and you are some sort of Ludite that wants to make mental illness a character defect. You are as bad a Christain Scientists and Joe's Wittnesses who let tghier family members die because they won't get medical treatment.

Prove yourself to not be a coward, read Surviving Scizophenia by E. Fuller Torrey, go to the NAMI web site or DBSA and read the stories. What a dung heap you are.

stamenflicker
13th July 2006, 05:23 PM
So it is just based upon your own a priori conjecture, whatever.

No, it's based on the reality that we classify what we want to classify. There's really nothing a priori about it.

I will be sure to tell that to the next person who overdoses because they are depressed:

"Don't be depressed the Prophet Stamenflicker says you can't be depressed, it is only subjective.'

You're clearly not getting the whole picture of what I've posted.

Are you saying pain is subjective, it is measured subjectively, would you take novacaine before having a tooth drilled? It is only subjective.

I would take whatever was available and do when I have dental procedures done. But then again, my teeth are real. My nerves are real. And there would be real signals sent to my brain via my empirical nervous system. None of that changes the fact that pain is relatively subjective and its threshholds sporadic and undefined.

Avita
13th July 2006, 05:32 PM
I want to add, since this thread grew while I was composing my post -
I'm saying that a person with a fist full of those attributes has a fist full of those attributes. I think that's all we can really say about it.
That's flat out wrong. You see a person about to jump off a bridge. You manage to talk him out of it, and spend some time exploring what he is feeling that is making him want to jump off the bridge. You do the same for a large number of other people who have chosen a variety of ways to kill themselves. You find out that in 90% of the cases, they are experiencing three or more of nine possible symptoms (actually, for the suicidal sample, you are likely to find more than three, but let's ignore that for the sake of the argument). Do you conclude that these are unrelated attributes just because not all suicidal people experience all of them, or do you conclude that they're symptoms of some underlying disorder that is expressed to different degrees in different people? Furthermore, you find out that such people tend to respond well to certain kinds of psychological interventions and medications, and poorly to others. What does that tell you?

(edited for clearer wording)

Dancing David
13th July 2006, 05:35 PM
I've long felt that many disorders are probably the same disorder, manifesting in an individual way within a particular individual.

This is not meant to be a sweeping statement. And I can't tell you specifically which ones I mean. But ADD and OCD are strongly related, I would think (this is not my area of expertise in the slightest, except as a patient ;)). What if they weren't just related, but were the same "problem," whatever we call that problem, which manifests differently, depending on the person.

People are different, she said simplistically, so why wouldn't manifestations of a brain disorder naturally differ among them?

I also think folks just get tired of the "31 Flavors" air of mental diagnosis, whether they should or shouldn't. I'm talking, for instance, about that recent article this summer about a "new kind" of anger disorder, a road-rage sort of thing. Can't recall the specifics just now...

I was, oddly enough, taking a basic sociology class at that time, and we discussed it: is this really a "new" disorder, or just a new label for something we already recognize? Did we really need this new label, if so?

How many perfectly "normal" but socially unacceptable behaviors are we medicalizing, maybe when they don't deserve to be such? Are we feeding a health-care/drug manufacturer's monster, or are we helping people?

How many "disorders" are simply products, results, of living in a hostile society? I don't always like to be around people much, but then, people often treat me like crap. Knowing I have to go around people sometimes makes me very anxious. Disorder or learned response? If learned response, can you really give someone a pill that will help?

You are right behaviors respond best to talk therapy, but mental illness is a biopsychosocial disorder, it has components of biology, psycholoy and social skills. It effects all three and can be changed in all three.

The road rage thing is crap. it won't make it into the DSM.

[/quote]
There are differences in each individual, but the braod categories are a guide to treatment, a person with OCD will generaly respond to an antidepressant while a person with ADD will respond to a stimulant.

As far as what behaviors are medicalizing, being a victim of domestic violence, they are often forced into treatment buy the perpetrator and medicated when they should be protected.

Now if you want to discuss the spectrum thing,
there is a four sided pyramid, one point is depression, one point is anxiety, one point is psychosis and the fourth is mania, using a three demesional plot within the pyramid you can describe fairly well what a mental disorder looks like at a given time.

I always felt that OCD was closer to psychosis than ADD, because obsession is often seen in people with schizophrenia.

stamenflicker
13th July 2006, 05:38 PM
Stamenflicker, there are several issues here. Are the descriptions in the DSM accurate reflections of inner states that people experience (i.e., can we differentiate using these criteria)?

If you're asking me, then I have no idea. Because they are subjective states we must rely on the person doing the describing.

And if they are, can they be detected in physiological ways?

I'm saying the ones that can are more likely to win my support in the science department than the ones that can't.

And then I pointed out that "positive thinking" plays a more complicated role in human immunology than commonly supposed, and that your assertion was much of an overstatement.

Exactly. And I'm stating that "negative thinking" plays a more complicated role than the DSMIV supposes. In fact, I'm saying that the whole subjective state or set of states are not as neatly quantifiable as people want to believe they are.

Could you please explain how mood could affect us physiologically, yet mood disorders wouldn't?

There is no difference between mood and mood disorder. They are both just moods. That we treat the bad ones as an objective entity while simultaneously treating the good ones as "pie in the sky" crazy talk is not logical.

Mental disorders have been shown to affect everything from brain structure to blood flow, just as physical diseases do, like my hypothyroidism example and Blutoski's much more extensive list. If medical disorders are often just as vague as psychological disorders in their symptoms, then how can you insist that one describes something real, and the other doesn't?

I believe that moods can affect many of these things, not only defined "mood disorders."

Stamenflicker, I have had the misfortune of suffering from several diseases, both physical and mental.

I am sincerely sorry. As for the items in the rest of this paragraph, I think we pretty much agree. It is only a very subtle difference we share.

As for the example of Little Susie and her grandma - you're again ignoring the fact that there's a matter of degree involved.

It is a matter of degree that we deem of value. In other words, we decide the degree subjectively. That's fine. I'm just saying its not science.

Finally, Katana and Blutoski also make the very good point that mental disorders respond to medication, while religious feelings don't.

I've responded by saying all moods respond to medication. Even the happy ones, or yes, the religious ones. With the exception of manic controlling drugs, we just don't spend much time and money altering the good moods.

Dancing David
13th July 2006, 05:41 PM
I've stated before in other posts that schizophrenia might be one of only a handful of exceptions. The reason I might be willing to make one there? Is there is empirical evidence which can be pointed to with the human biology.

Look at some other dissociative disorders-- fugue states, multiple personality, whatever. Rarely if ever is there any tangible evidence of a true empirical disorder.


Depression does effect levels of various receptors and related byproducts.

And there is a tangible experience, the events that are percieved by the individual, a perception of hopelessness is an actual perception, which is a physical event in the brain, validity is another issue that should be considered in assesment.

Or are you an immaterialist who believes thoughts and feelings occur outside the body?

Now when it comes to DID, the famous disassociative identity disoredr, I don'tr believe it. I have seen epople in the state, I would say they are having a 'panic attack'.

Fugue states are more likely explained by the confusion and memory impairment of psychosis, depression and mania.

Dancing David
13th July 2006, 05:48 PM
No, it's based on the reality that we classify what we want to classify. There's really nothing a priori about it.



You're clearly not getting the whole picture of what I've posted.



I would take whatever was available and do when I have dental procedures done. But then again, my teeth are real. My nerves are real. And there would be real signals sent to my brain via my empirical nervous system. None of that changes the fact that pain is relatively subjective and its threshholds sporadic and undefined.


Oh so your subjective pain matters more than someone else's schizophrenia. You are still ------. mental illness is real, people who have schizophrenia hear voices that they experience as real real, people with amputated limbs feel real real 'phantom' pain.

Brain events are brain events , right?

But I know you think that brains are subjective and don't exist, therefore an event that occurs in a brain that you can't measure doesn't exist.

Go to the hospitals and heal the sick Stamenflicker. Tell them there illness isn't real because it is subjective.

What is the difference between their mental illness and the pain of tooth extraction, we can both agree that the word 'pain' describes the sensation of nerve stimulation through damage, why not say that schizophrenia is similar?

The word describes a subjective experience that hopefully can be treated.

stamenflicker
13th July 2006, 05:48 PM
What a pile of barf , made up from your own head.
3.5 million people with schizophrenia in the USA, are you going to tell me dementia isn't real?

Are we talking about schizophrenia or dementia? I've made my comments regarding schizophrenia above.

You are a coward Stamenflicker,

Is that a subjective state? If so, what medication should I be taking? :)

you joke about other people's suffering because you lack compassion,

Where have I made a joke? When I'm joking I tend to put in a :) (see above)

I suggest you come with me to the ED and talk to the people who think about killing someone bacause the voices tell them to, I know a family who had thier father murdered because they made the mistake of discharging thier very psychotic family member while they were delusional. Your joke won't bring back the dead will it?

Why do you assume I haven't spoken with people just like this?

Like I said you are a coward, mental illness is real and you are some sort of Ludite that wants to make mental illness a character defect. You are as bad a Christain Scientists and Joe's Wittnesses who let tghier family members die because they won't get medical treatment.

Man I really messed when I married that psychologist wife of mine. The cult will never take me back now! :)

Prove yourself to not be a coward, read Surviving Scizophenia by E. Fuller Torrey, go to the NAMI web site or DBSA and read the stories. What a dung heap you are.

I'll read yours after you've read mine-- Insanity: Its Scope and Consequences, Thomas Szasz.

In the meantime, can you stop insulting the skeptic on the skeptic forum?

stamenflicker
13th July 2006, 05:49 PM
Oh so your subjective pain matters more than someone else's schizophrenia. You are still stupid. mental illness is real, people who have schizophrenia hear voices that they think are real, people with amputated limbs feel real phantom pai.

But I know you think that brains are sucjective and don't exist, therefore an event that occurs in a brain that you can't measure doesn't exist.

Go to the hospitals and heal the sick Stamenflicker. Tell them there illness isn't real because it is subjective.

What is the difference between their mental illness and the pain of tooth extraction, we can both agree that the word 'pain' describes the sensation of nerve stimulation through damage, why not say that schizophrenia is similar?

The word describes a subjective experience that hopefully can be treated.

Are you drunk?

Dancing David
13th July 2006, 05:52 PM
If you're asking me, then I have no idea. Because they are subjective states we must rely on the person doing the describing.


Oh I see you assume that mental health workers are dumber than you and don't consider that, the technical phrase is validity. Duh, even a dummie like me thought of that one Stamen, us mental health people do learn how to judge when people are lying to them.

stamenflicker
13th July 2006, 05:58 PM
Depression does effect levels of various receptors and related byproducts.

No it doesn't. Moods affect it. By your logic, the absence of depression affect the chemical states in the brain. Should we assume that a person experiencing a kundalini awakening also is affecting them? Where is the baseline standard of measurement?

Or are you an immaterialist who believes thoughts and feelings occur outside the body?

How am I supposed to know?

Now when it comes to DID, the famous disassociative identity disoredr, I don'tr believe it. I have seen epople in the state, I would say they are having a 'panic attack'.

Fugue states are more likely explained by the confusion and memory impairment of psychosis, depression and mania.

And yet both of these "disorders" had specific spikes in the timeline, i.e. the culture in which they manifested. During the Japanese stockmarket crash, we didn't fugue states did we? Why?

blutoski
13th July 2006, 06:23 PM
And while I recognize that we have to create somewhat arbitary lines of demarcation, it sounds more like you are agreeing with me than disagreeing. It still does not alter the fact that with medicines targeting specific empricial diseases we have things we can actually measure.

This is the disjoint, then. Psychiatrists measure things all the time. For example, the severity of depression is related to the number of items on that list you provided. When we eliminate items from the list, the person is objectively less depressed. Within each item, the patient can be asked to scale the severity of each metric. We ask patients to keep a journal so they can chart progress. eg: 3 suicidal thoughts/day at outset, down to 1 suicidal thought/month after x months of therapy.

In terms of anxiety disorders, such as OCD, you'd want to measure the number of panic attacks per week.

In terms of antisocial personality disorder, there's usually a criminal record to track progress, or in the case of those who are institutionalized, there are inventory checklists that are standardized within most institutions to use as references.

Insight is a major factor in personality disorders, and there are marked progressions for degrees of insight. These are comparable from person to person, and from session to session with the same person.





And yet if we deemed fish particles in the atmosphere to be of any scientific value, we'd have vectors for determining them as well. That "depression" is considered scientific as opposed to say the affect of Beatles tunes in local elevators, is one of preference and practicality-- not scientific truth.

Nobody's claiming scientific 'truth' or scientific 'value'. Science does not have truths or values. I'm concerned that you're spinning your wheels with a strawman.

We're talking about Psychiatry, which is a specialty of medicine. There is no 'truth' that death or discomfort is bad, either, or that people with high blood pressure should be 'corrected', but people with brown eyes should not. It's a metaphysical discussion.

Yet, I don't hear you complaining that we should be agnostic to the claim that brown eyes should be 'fixed'. The underlying metaphysical reason we don't is for the same reason that we don't fix 'salesmanship', but we do fix 'depression': it's causing the patient discomfort, which we have [i]unscientifically[/u] decided is an issue.

I guess what confuses me is why you're singling out one aspect of medicine, when all others suffer from your same primary critique. In medicine, whether some condition is a medical condition or not is not a scientific question: it is a value question.





I'm saying that a person with a fist full of those attributes has a fist full of those attributes. I think that's all we can really say about it.

Then you're being wilfully blind, I think. I think we can all tell that a depressed person is not the same as a happy person. I think that from the human gift of empathy, we should be able to understand that it's not a good place to be.

These metrics in the DSMIVR are not especially different than metrics used in psychology, except they're the subset that are of interest to healers.

There is, for example, a religoiosity index. It's not part of the DSMIVR because it's not related to discomfort the same way other personality factors are.





And yet you are telling me that a person feelings of lonliness are of more scientific value than their feelings of oneness with nature. I'm just saying that I don't believe it, or have any method of determining which subjective state is worthy of statistical pursuit for the purpose of creating an false "condition" which attempts to pass itself off as an empirical reality.

Nope. Never said that.

As for which subjective state is more/less worthy... that's up to the patient. Psychiatric patients are almost entirely self-selected. They're the ones who say: "I want this to stop, but I don't know how to make it."




And things like pot work on almost all of us. That medication may or may not work on certain subjective states really does tell us anything about why we treat one set as scientific and the other as non-scientific.

Again: what's this 'scientific' crap?

The question is: does it address the underlying complaint. Pot does not reduce the symptoms of depression, so if the patient says, "give me something to prevent me from committing suicide," and I said, "gosh, we have no diagnostic criteria, so let's give you random meds," that would be unethical.

The DSMIVR is a continuation of the moral obligation to provide the best assistance to those in need.

The scientific method can support this medical goal by connecting the cluster of observable traits with the most promising treatment. This is done through an accumulation of outcome stats, and also through investigation of physiology to learn about underlying causes. Psychiatry has a special challenge, because the physiology of the brain is in a very early stage of understanding, and its mechanics are obviously more complex than any other organ.





You are right they don't. But they may have some set of subject states they have in common with the experience of "born again;" states which when compiled an examined create a statistical "condition" to be named.

It's only a condition if the patients beat down the door. Right now, I'd say epiphany is a phenomenon that is fairly well explored and documented, and positively correlated to fantasy-prone personality and religiosity. These are all legitemate fields of study, but are not medicine, and are not in the DSMIVR for the same reason that having freckles is not a 'condition': nobody's asking for relief.



Don't get me wrong, I'm not arguing that religious sentiment belongs in the DSMIV. I'm arguing that the DSMIV is treated as science by imposters, and accepted as science by the gullible. And worse still, used by lawyers to condone any number of activities-- be they religious or otherwise.

I'm dubious about that last statement. Be mindful that mental diagnosis almost always works against the defendant. Consider the example of a patient my wife had last month...

Defendant: "You see, your honour, I can't help but be a menace to society - I have antisocial personality disorder, and I'm not cured."
Judge: "Then probation is denied."
Defendant: "D'oh!"

Personally, I feel safer with dangerous people out of circulation.



I think there's a lot of urban legends circulating that give the impression that people 'get off' because they have mental conditions. Usually, it just makes their sentence longer, means they have fewer privileges, and reduces their prospects for early release.

blutoski
13th July 2006, 06:28 PM
I'll read yours after you've read mine-- Insanity: Its Scope and Consequences, Thomas Szasz.

Be mindful that Szasz is an ass. He's up to here (hand at eye level) in Scientology, and has more or less stopped producing cogent arguments.

He had some good points about institutionalization mabye forty years ago, but they've been addressed and then some, and at this point Szasz is living in the shadow of his previous achievements. It's like he's stopped reading the literature, and his arguments look very ignorant today.

Sort of like Pauling, I respect his earlier work, but since the '80s he's just been an embarassment to everybody these days, and it's more just sad, really.

Avita
13th July 2006, 06:34 PM
Cross-cultural differences in psychology, psychological self-expression, and psychological classifications, are endlessly interesting. But you seem to be claiming that because people in different cultures have a prevalence of one or another disorder, then that somehow proves that the disorder is not "real." It's real, though in a sense, "created" by the surrounding environment. First, people tend to have different vocabularies for expressing what they feel. (You are probably aware, for instance, that most people who have a panic attack for the first time think that they are having a heart attack - that's the closest fit they can find in their experience, as our society talks about heart attacks a lot). There's no difference between that and symptoms of physical diseases - you always evaluate them in terms of what you know. Second, the environment itself can create conditions for developing certain mental diseases, which continue existing long after the initial environment has changed (e.g., people obsessed about money long after the Great Depression has passed; immigrants from the former Soviet Union who continue to be paranoid). Third, certain behaviors are encouraged and discouraged by each society, and that will affect the presentation of the mental disorder (I already gave the example of depression manifesting as anger in men).


If you're asking me, then I have no idea. Because they are subjective states we must rely on the person doing the describing.
Of course, any mental professional who is any good will take that into account. I think that relatively few slavishly follow the DSM without engaging in at least some level of thinking. ;)



I'm saying the ones that can are more likely to win my support in the science department than the ones that can't.
I get that, but people have been trying to present evidence that mental states and physiology are tightly intertwined to you for a while now. They've also explained to you why certain diseases, both mental and physical, are not as clear-cut, and not as clearly diagnosable, as we would like. It's hard to tell, but at times your position seems to be that unless there's one single test to determine if a disease exists, it's not a disease - unless it's a "physical" disease, in which case never mind. If that's not your position, please make that clearer.



Exactly. And I'm stating that "negative thinking" plays a more complicated role than the DSMIV supposes. In fact, I'm saying that the whole subjective state or set of states are not as neatly quantifiable as people want to believe they are.
Nobody is arguing the "not as neatly quantifiable" part. What others and myself are arguing is that you're setting an impossible standard for mental illness. Also, the DSM says nothing about "negative thinking" - I'm not even sure you'd find the words in there. The DSM is also not about single moods, which are transient. The DSM attempts to describe certain conglomerations of experience that tend to be relatively long-lasting and interfere with people's lives. It attempts to figure out which experiences tend to go with which other experiences, and how we can make a person stop having those aversive experiences.



There is no difference between mood and mood disorder. They are both just moods. That we treat the bad ones as an objective entity while simultaneously treating the good ones as "pie in the sky" crazy talk is not logical.
No, we have some criteria - not entirely clear-cut, but there's that fallacy again - to distinguish moods from mood disorders. Also, mania is a "good" mood, yet listed in the DSM and treated. The same is true of certain kinds of religious feelings expressed by, for instance, people with schizophrenia. The DSM, contrary to popular opinion, is not out to demonize certain kinds of experience. Take any of the disorder criteria, and somewhere in there, you'll see a statement to the effect that whichever criteria the person fits, there must also be significant disruption to the person's life before it can be counted as a disorder.



I believe that moods can affect many of these things, not only defined "mood disorders."
Research shows that while moods are capable of briefly doing things like raising blood pressure, mood disorders cause more lasting changes, such as changes in brain structures.



It is a matter of degree that we deem of value. In other words, we decide the degree subjectively. That's fine. I'm just saying its not science.
My science textbooks disagree with you. Yes, there must be many more precautions taken when the phenomenon is not objectively quantifiable, but if we limited ourselves to just those phenomena, we strongly limit what we can learn about the world. Science, after all, is about testing and refinining hypotheses, not about handing down pronouncements from on high and stopping there.



I've responded by saying all moods respond to medication. Even the happy ones, or yes, the religious ones. With the exception of manic controlling drugs, we just don't spend much time and money altering the good moods.
All moods respond to something. The trick, when you have a person sitting in front of you whose moods have overwhelmed him or her, and are ruining that person's life, is to know what to apply to that person's particular state that will work better than placebo. Hence, classification, and hence, acceptance of a level of subjectivity.

blutoski
13th July 2006, 06:35 PM
And yet both of these "disorders" had specific spikes in the timeline, i.e. the culture in which they manifested. During the Japanese stockmarket crash, we didn't fugue states did we? Why?

Who knows? One interpretation for this is just small sample sizes (there are very few cases of fugue in any year, so a 1000% increase may be from 5 to 50). Another is the magnitude of the problem. It's estimated that the US crash wiped out 40 million US households, and ushered in a global economic failure, whereas the Tokyo crash may have wiped out a few thousand, and was isolated within Japan.

If the major cause of fugue is serious personal shock, this alone would explain a 1,000x+ difference in incidence between the two events.

Another reason is that we have increased ability to test for fugue and differentiate it with psychoses or drug-induced memory blackouts (wasn't the '30s a period of high alcohol abuse?)

blutoski
13th July 2006, 06:42 PM
Oh I see you assume that mental health workers are dumber than you and don't consider that, the technical phrase is validity. Duh, even a dummie like me thought of that one Stamen, us mental health people do learn how to judge when people are lying to them.

One of the things about psychiatrists is that the get good at the 'reality pill'. Patients lie about having a psychiatric illness because they believe they will have an excuse for some incident, usually criminal. Or they want to take a break from something. The term is 'malingering'. Psych 101 is to look for certain tells.

But this is not significantly different than other parts of medicine. I worked in Emerg on weekends for about two years straight at an inner-city hospital (St. Paul's, for those in Vancouver who would recognize it) and the #1 fake complaint was "I have a stomach ache." This does not invalidate the entire field of internal medicine, most of whose illnesses harbinger with this primary complaint. The second most common complaint was "I have a headache", followed by chest pains, blindness, and so on.

These guys are all looking for a free meal and a soft mattress, and have chosen conditions that require a few hours of 'observation' in the overnight wing of emerg. So, we give 'em an egg-salad sandwich, four hours of sleep, and they're on their way.

Such is medicine.

Kopji
13th July 2006, 07:56 PM
I hesitate to add to this, having lots of crazy people in my family certainly does not make me an expert.

If I were to identify something I thought was a common thread with insanity, it is in how choices are made: How do we choose this from that?

We label it insanity when our choices harm us, but otherwise we call it by all kinds of benevolent sounding things. This does not deny that there is an identifiable quality (the it)within us that could under the right circumstances, drive harmful choices.

The various conspiracy threads are a topic of continued interest to me because they support this idea of a flaw in our ability to choose rightly between things. While not religious, it seems similar.

I am sympathetic to stamenflicker's honesty in the opening post. Much religious sentiment and insanity seem the same to me. I cannot tell one from another - except for the kind of choices we make. I can understand why that looks subjective or cultural.

If your religiosity does not help direct or navigate you toward bad choices, it is hard to label it an illness. On the other hand, for some people the very same religiosity is a way to destruction. Perhaps this is an indication that there are real differences between us, and no religion (or atheism for that matter) can say it is best for all.

blutoski
13th July 2006, 08:18 PM
I hesitate to add to this, having lots of crazy people in my family certainly does not make me an expert.

If I were to identify something I thought was a common thread with insanity, it is in how choices are made: How do we choose this from that?

We label it insanity when our choices harm us, but otherwise we call it by all kinds of benevolent sounding things. This does not deny that there is an identifiable quality (the it)within us that could under the right circumstances, drive harmful choices.

The various conspiracy threads are a topic of continued interest to me because they support this idea of a flaw in our ability to choose rightly between things. While not religious, it seems similar.

I am sympathetic to stamenflicker's honesty in the opening post. Much religious sentiment and insanity seem the same to me. I cannot tell one from another - except for the kind of choices we make. I can understand why that looks subjective or cultural.

If your religiosity does not help direct or navigate you toward bad choices, it is hard to label it an illness. On the other hand, for some people the very same religiosity is a way to destruction. Perhaps this is an indication that there are real differences between us, and no religion (or atheism for that matter) can say it is best for all.


We have to be mindful that insanity is a legal term, and not a medical one. The closest medical category that looks like what people colloquially call insane is psychotic. This is very different than having odd ideas, and religion in no ways resembles psychoses.

eg: (taken from a transcript from last week)

Interviewer: "Why did you hit those people?"

Psychotic Patient: "The ultra ways is not in the CIA zoners. Unless who isn't the key. Aquaman! Winter! Unless unless unless unless unless unless unless unless unless unless unless unless unless unless unless unless unless. But only if we celery celebrate celebration. Fortune smiles smiling similar smiles. Not buttons but butt****. All almonds are arrgh! We're all going into caves!"



So, when people casually say, "Well, I think the psychiatrists are just calling ordinary behavior a pathology because they feel threatened by unfamiliar views." I think they're just plain ignorant.

If you took this guy to some Amazon tribe and dopped him there, they'd look at each other and say: "This guy's nucking futz," just like we would. Some things are culture-agnostic, and psycho is one of them.

SaintDymphna
13th July 2006, 11:40 PM
stamenflicker
I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me.

I think you may be surprised to know that your view is a common one among people like myself who have a major mental illness. Of course, I never measured the opinions in a scientific manner. I can say with absolute certainty,however, that many of the people with whom I've personally shared a hospital room, or sat beside in the mental health clinic, or suffered through therapy with, have often denied having a mental illness of any kind. But denying the truth is useless to us. I can wish I wasn't the way I am. I try not to be. But the end result is always,always, always that I cannot function unless I take medications for bi-polar illness. I could measure my illness in a financial way perhaps, IF I'd ever kept records of all the things I've lost in my life due to being bi-polar. I could probably measure my IQ as a young girl and what it is now after years of living as a bi-polar person. Are those things measurable proof to someone like you? They get my attention whenever I decide that I'm not really bi-polar or that I can pull myself up by my bootstraps and stop having unstable moods, wild plans and ideas, and everything else that goes with my illness.

I don't think you comprehend the amount of cruelty and prejudice you are encouraging with smug statements like the one you made here. I know you don't understand anything at all about mental illness if you really believe what you've posted.

You are fortunate that you are able to make a decision to not believe in mental illness. I can't. Millions of us aren't given that opportunity. So I think that to try to make a funny little debate about human suffering for your entertainment is just wrong.

Saint Dymphna

SaintDymphna
13th July 2006, 11:47 PM
I'm sorry. A double post.

Typical dumb bi-polar thing to do.

Peace,

Saint Dympha

Kopji
14th July 2006, 01:53 AM
I'm sorry. A double post.

Typical dumb bi-polar thing to do.

Peace,

Saint Dympha

Hi and welcome!


We have to be mindful that insanity is a legal term, and not a medical one.

Yeah, and I agreed with your earlier posts.
I'm comfortable with just 'crazy', the company is pretty good and it has a nice informal feeling to it. :)

Dancing David
14th July 2006, 10:09 AM
One of the things about psychiatrists is that the get good at the 'reality pill'. Patients lie about having a psychiatric illness because they believe they will have an excuse for some incident, usually criminal. Or they want to take a break from something. The term is 'malingering'. Psych 101 is to look for certain tells.

But this is not significantly different than other parts of medicine. I worked in Emerg on weekends for about two years straight at an inner-city hospital (St. Paul's, for those in Vancouver who would recognize it) and the #1 fake complaint was "I have a stomach ache." This does not invalidate the entire field of internal medicine, most of whose illnesses harbinger with this primary complaint. The second most common complaint was "I have a headache", followed by chest pains, blindness, and so on.

These guys are all looking for a free meal and a soft mattress, and have chosen conditions that require a few hours of 'observation' in the overnight wing of emerg. So, we give 'em an egg-salad sandwich, four hours of sleep, and they're on their way.

Such is medicine.

Ah the ' three hots and a cot' eh, there is also deliberate med seeking, back pain, and anxiety where the person knows the medication they prefer and demand it in triage.

I have to say I have a real respect for any one who works in the ED, I am just a monthly vistor who fills in magic papers and makes the pesky 'psych evals' disappear.

Dancing David
14th July 2006, 10:12 AM
snip...

I don't think you comprehend the amount of cruelty and prejudice you are encouraging with smug statements like the one you made here. I know you don't understand anything at all about mental illness if you really believe what you've posted.

You are fortunate that you are able to make a decision to not believe in mental illness. I can't. Millions of us aren't given that opportunity. So I think that to try to make a funny little debate about human suffering for your entertainment is just wrong.

Saint Dymphna


Hear hear, light shines upon the Cosmic Midden and says , here is filth and corruption.

I hope that you are well and that your life is fine, I work both sides I am a mental health worker and a patient.

Fie on stigma , fie.

Dancing David
14th July 2006, 10:13 AM
I'm sorry. A double post.

Typical dumb bi-polar thing to do.

Peace,

Saint Dympha

More likely human, the human condition is a spectrum disorder after all! ;)

slingblade
14th July 2006, 11:12 AM
Ah the ' three hots and a cot' eh,

Er, um, no...that's prison. :)

Katana
14th July 2006, 02:32 PM
Finally, Katana and Blutoski also make the very good point that mental disorders respond to medication, while religious feelings don't. Of course, there are a few threads on this forum about the new mushroom that will induce such experiences for you (curiously enough, not in all people who try it, and not in the same way), but we yet know of nothing that would take them away (and we do know of other substances that induce mental disorders. Alcohol, for instance.) I'm restating what they said, because it bears repeating.

Hey, thanks, Avita!

After reading the rest of the posts, many have made points that I would have, but we're clearly not making a dent in the mistaken beliefs of someone who seems quite attached to them.

Perhaps he will better understand that conditions based on subjective complaints are legit someday if he has to come into an ER or clinic with subjective back pain for which no explanation can be found, an unfortunate fact for many people with back pain. I hope that his doc takes it just as seriously as he does mental illness.

stamenflicker
14th July 2006, 02:55 PM
Cross-cultural differences in psychology, psychological self-expression, and psychological classifications, are endlessly interesting. But you seem to be claiming that because people in different cultures have a prevalence of one or another disorder, then that somehow proves that the disorder is not "real."

That's pretty close to my position. It's not that there is "not" anything happening. It's that the way we choose to classify what is happening is indicative of our cultural values. That we make the attempt of objectifying these moods and making them into real things doesn't say so much about what is happening in the patient, as it says about us.

We scoff at the use of leeches in the middle ages, or scoff at less developed cultures who resort to all sorts of insanity when dealing with medical conditions, why? Because we now have a scientific understanding what is going on. This is not the case with moods. We really don't know, but we've created some labels that make organizing what we do know easier.

It's real, though in a sense, "created" by the surrounding environment.

I agree with this statement. Mood disorders are real, but as I said above-- "a real what?" I think they are a real social construction.

Second, the environment itself can create conditions for developing certain mental diseases, which continue existing long after the initial environment has changed (e.g., people obsessed about money long after the Great Depression has passed; immigrants from the former Soviet Union who continue to be paranoid).

We are very close to agreeing here. If I interpret you correctly, then at least part of any "mood disorder" is social construction.

It's hard to tell, but at times your position seems to be that unless there's one single test to determine if a disease exists, it's not a disease - unless it's a "physical" disease, in which case never mind. If that's not your position, please make that clearer.

I'm only saying it loses credibility as a physical disease. My hope is that one day nueroscience will be able to answer these questions. However, I find that highly unlikely.

What is more likely to occur is another "wonder drug" marketed to the public, which "cures" all our bad moods. I for one, am uncertain that such a "wonder drug" will be a great idea to mass produce.

Look, we've already seen it with Ritalin. 1/3 of American boys are on it. That number is staggering. I believe in the future, if afforded such an opportunity, we will look back in disgust, not unlike looking back at the leeches used 1,000 years ago. We'll see over-medication as a form of human slavery.

What others and myself are arguing is that you're setting an impossible standard for mental illness.

I'm not setting any standard so much as stating that such a standard is already impossible.

The DSM, contrary to popular opinion, is not out to demonize certain kinds of experience.

Of course its not. It's only a reflection of what deem to be valuable, demonstrated by the strong language of the original versions against homosexuality.

My science textbooks disagree with you.

I'm not surprised.

Yes, there must be many more precautions taken when the phenomenon is not objectively quantifiable, but if we limited ourselves to just those phenomena, we strongly limit what we can learn about the world.

I'm not saying that we shouldn't. I'm saying that the areas that we "should" are not always chosen logically and that such choices once again, tell us more about ourselves than the object we wish to study.

stamenflicker
14th July 2006, 03:04 PM
I don't think you comprehend the amount of cruelty and prejudice you are encouraging with smug statements like the one you made here. I know you don't understand anything at all about mental illness if you really believe what you've posted.

You are fortunate that you are able to make a decision to not believe in mental illness. I can't. Millions of us aren't given that opportunity. So I think that to try to make a funny little debate about human suffering for your entertainment is just wrong.

Saint Dymphna

Jeez. According to the logic of modern pyschology, I'm suffering from "Christianity" but that doesn't stop people from asking questions on a skeptic board does it?

You and Dancing Dave and others make it sound like I have no experience in these matters. I'm married to a psychologist. I've worked as a chaplain in mental institutions-- in fact, I did my residency at one. And I have a member of my family who has been homeless for 8 years, who has been determined to have "bi-polar disorder."

You seem to believe that because I made a free choice to question something with no empirical evidence, that somehow I am a cruel person.

I also find it interesting that the people this issue seems to matter most to are the ones either a) suffering from, or b) working in the subject matter.

blutoski
14th July 2006, 06:17 PM
Ah the ' three hots and a cot' eh,

That's why we give egg salad sandiwches - they're the least popular. However, if you're so hungry that one of these is a good meal, and a flat cot in a busy, bright, emergency ward is a good sleep, then who am I to withold, and god bless.



...there is also deliberate med seeking, back pain, and anxiety where the person knows the medication they prefer and demand it in triage.

You can see word of mouth in action: one patient manages to sell his story to the new guy, tells his friends, and the next night, there's a rash of "... only thing that works to reduce my seizures is Tylenol 3s." Nice try.




I have to say I have a real respect for any one who works in the ED, I am just a monthly vistor who fills in magic papers and makes the pesky 'psych evals' disappear.

Fortunately, I don't have to anymore. And I don't want to give the misleading impression that I was medical staff - I worked in a support role. My first job there was housekeeping.

blutoski
14th July 2006, 06:55 PM
Jeez. According to the logic of modern pyschology, I'm suffering from "Christianity" but that doesn't stop people from asking questions on a skeptic board does it?

I think you know this is crap. There's no "logic of modern psychology" that says you're suffering from Christianity.



You and Dancing Dave and others make it sound like I have no experience in these matters. I'm married to a psychologist. I've worked as a chaplain in mental institutions-- in fact, I did my residency at one. And I have a member of my family who has been homeless for 8 years, who has been determined to have "bi-polar disorder."

You seem to believe that because I made a free choice to question something with no empirical evidence, that somehow I am a cruel person.

Because it sounds ignorant, and we're used to this approach with other issues. eg: people who have never cracked a science textbook are the rank and file of evolution-denial.

Question: do you tell your wife her career is meaningless, or is there common-ground somewhere?





I also find it interesting that the people this issue seems to matter most to are the ones either a) suffering from, or b) working in the subject matter.

ie: Stakeholders? Experts? Is this unexpected? Again, we see this with evolution-deniers: "The only people defending evolution are these scientitsts - what's with that, hmmm?"

Question: do you have perhaps a vested interest in dismissing psychiatric interpretations, as it obviously competes with ministry? Is it a coincidence that the publication you suggested is a religious screed (from the Church of Scientology, which also competes economically with psychiatrists?)

Do you want to perhaps steer the conversation away from ad hominem attacks and get on with a real debate?



I'm also a little confused sometimes with your approach:
Mood disorders are real, but as I said above-- "a real what?" I think they are a real social construction.
versus:
There is no difference between mood and mood disorder. They are both just moods. That we treat the bad ones as an objective entity while simultaneously treating the good ones as "pie in the sky" crazy talk is not logical.

It's hard to actually understand what you're saying, and mount a debate strategy.

However, to address the two statements above: they're actually different questions, both relevant to other scientific pursuits.

The first question is one of reification. Gould approaches this in great detail in Mismeasure of Man. He asks: is there such a thing as intelligence? We seem to know that there is, but is it a real thing? This is an ontological question that science handles downstream from metaphysics. Is there such a thing as species? There's no scientific definition of species, yet we're pretty sure that cats and dogs are different species.

The second question has already been addressed, and you seem to have conceded, then reversed your view. This is the fallacy of the corrupt continuum. Just because there isn't a clear distinction between moods and mood disorders (extreme moods) doesn't mean that there is no distinction. There is no clear distinction between child and adolescent, adolescent and adult, but we have no reservation about saying that children shouldn't drive on the freeway. It's a little blendy in the middle, but denying that they're different things is a logical fallacy.

What I'm saying is that this argument is itself unscientific, yet it's central to your claim that psychiatry is not scientific. Thus, my confusion.


This is also part of what other participants have identified as a strange focus: other sciences are even flakier: we don't know how statins work, but we prescribe them to address an arbitrary metric ("high" blood pressure - levels chosen for unscientific reasons, which vary from country to country). In any case, we prescribe them because we believe they will reduce suffering and/or extend life expectancy. Well, where's the scientific 'fact' that we need to do this? It's a social choice (and a choice that some communities do not make, incidentally.) It's still valid medicine.

There is a third problem with the assertion that because there is a cultural input to the definitions (and we're all aware that 50 years ago, 'homosexual' was a diagnoseable disorder) that they are useless. This is also a logical fallacy related to corrupt continuum, but is caused by the erroneous belief that cultures are entirely random. One thing we have learned is that cultural concepts of mental illness, moods, and so on, are very consistent - it is their attitude toward treatment of these sufferers which varies.

SaintDymphna
14th July 2006, 08:32 PM
Originally Posted by stamenflicker
I also find it interesting that the people this issue seems to matter most to are the ones either a) suffering from, or b) working in the subject matter

Interesting? Well I wonder why?

Jeez. According to the logic of modern pyschology, I'm suffering from "Christianity" but that doesn't stop people from asking questions on a skeptic board does it?

But I don't consider being a member of the Christian religion is the same thing as having delusions involving religion, nor have I met anyone who holds that belief. Are you saying that you do?

You and Dancing Dave and others make it sound like I have no experience in these matters. I'm married to a psychologist. I've worked as a chaplain in mental institutions-- in fact, I did my residency

You're a chaplain?:eye-poppi And you believe what you've posted here? You've worked in a mental institution(s) as a chaplain, representing God to people who are hugely troubled .....I"m speechless and unable to write anymore.



Saint Dymphna

Avita
14th July 2006, 09:23 PM
Just so we are very clear, both of your "vested interests" apply to me - I'm currently a student therapist, and I've experienced mental disorders. The one is closely connected to the other, as having gone through that myself, I really want to understand what happened, how to stop it from happening again, and to help others do the same. And you ask why people like me are interested in the topic? Whereas you yourself are a chaplain. I am guessing that you have your own interest - you want to help people get better by encouraging them to trust God, and you believe that God will respond by helping them through their mental illness. So in wanting to help people get better, we are working towards the same goal. But all my experience shows that your approach is not enough. Mine isn't always, either, but seeing as how it's a science, it's constantly working to improve methodology.

That's pretty close to my position. It's not that there is "not" anything happening. It's that the way we choose to classify what is happening is indicative of our cultural values. That we make the attempt of objectifying these moods and making them into real things doesn't say so much about what is happening in the patient, as it says about us.
And? Psychology is the study of humans by humans. If it manages to say something about us, that's great. Nobody is telepathic. Nobody can know what is going on inside the mind of another. We can only guess, based on our own experience, and adjust the guesses as evidence comes in. Psychology is a science, because it takes the guesses of many people and compares them, and distills and classifies the most important bits, and tries to eliminate wrong guesses by experimentation. In this, it's no different from any other science.

We scoff at the use of leeches in the middle ages, or scoff at less developed cultures who resort to all sorts of insanity when dealing with medical conditions, why? Because we now have a scientific understanding what is going on. This is not the case with moods. We really don't know, but we've created some labels that make organizing what we do know easier.
Even if that was all that psychology did (as you can guess, I rather disagree), that would already be a good thing. Chemistry started that way, by looking at properties of substances and creating labels for them. Medicine started that way. A host of other sciences started that way. This is the way science progresses.



I agree with this statement. Mood disorders are real, but as I said above-- "a real what?" I think they are a real social construction.
They're a real biopsychosocial construction. Just as physical diseases are. Maybe physical diseases have a bit more emphasis on the bio aspect, psych diseases on the psych aspect, and societal rules on the social aspect, but they are all tightly intertwined, and equally "real." Incidentally, what's your opinion of sociology - is that a "real" science or not?


We are very close to agreeing here. If I interpret you correctly, then at least part of any "mood disorder" is social construction.
See above. But I think you misinterpreted my point in this example, which is that certain societal conditions can predispose people towards certain mental (and medical) diseases. Hence, why you see preponderances of different mental diseases in different societies.


What is more likely to occur is another "wonder drug" marketed to the public, which "cures" all our bad moods. I for one, am uncertain that such a "wonder drug" will be a great idea to mass produce.

Look, we've already seen it with Ritalin. 1/3 of American boys are on it. That number is staggering. I believe in the future, if afforded such an opportunity, we will look back in disgust, not unlike looking back at the leeches used 1,000 years ago. We'll see over-medication as a form of human slavery.
Sounds like a great idea for a science fiction book. In fact, I read a couple with similar premises. In real life, I see several trends leading us away from such a path, but as I can't know the future, let's just agree that time will tell.



I'm not setting any standard so much as stating that such a standard is already impossible.
This is where I have the hardest time understanding you. Why is it impossible? We have reviewed several lines of evidence that psychology is no better and no worse than many other sciences. Why do they get a pass, and psychology doesn't?



Of course its not. It's only a reflection of what deem to be valuable, demonstrated by the strong language of the original versions against homosexuality.
Remember that thing about science developing by sorting out the bad guesses from the good? That's one example. At one point, people knew very little about homosexuality, and assumed that people could be talked out of it. Now, we know differently. We also know several other ways in which homosexuality differs from, say, a paraphilia. That's because psychology is a science, and tests its assumptions. Of course, I'm not saying that the DSM has got everything perfectly right. But the people who compose it are working on it.



I'm not surprised.
So explain to me what makes you a better authority than the people who wrote the science textbooks.

stamenflicker
14th July 2006, 10:22 PM
I think you know this is crap. There's no "logic of modern psychology" that says you're suffering from Christianity.

It's not crap. There is no logic of modern psychology that says I'm suffering from Christianity because we don't have a reason to chart the vectors that encompass it.

Question: do you tell your wife her career is meaningless, or is there common-ground somewhere?

Of course not. My wife helps people. That doesn't change the fact that we have core philosophical differences. Nor does it change the fact that out of all the members of our shared family, I am the most sympathetic and compassionate to her "bi-polar" father.

ie: Stakeholders? Experts? Is this unexpected? Again, we see this with evolution-deniers: "The only people defending evolution are these scientitsts - what's with that, hmmm?"

You tell me?

Question: do you have perhaps a vested interest in dismissing psychiatric interpretations, as it obviously competes with ministry? Is it a coincidence that the publication you suggested is a religious screed (from the Church of Scientology, which also competes economically with psychiatrists?)

I have no knowledge of Szasz religious sentiments. If you dislike him, then read Mad Travelers or Multiple Personality Disorders and the Politics of Memory, both by Ian Hacking.

I'm also a little confused sometimes with your approach:

Not surprising given the subject matter.

The first question is one of reification. Gould approaches this in great detail in Mismeasure of Man. He asks: is there such a thing as intelligence? We seem to know that there is, but is it a real thing? This is an ontological question that science handles downstream from metaphysics. Is there such a thing as species? There's no scientific definition of species, yet we're pretty sure that cats and dogs are different species.

Of course I would make a somewhat similar argument for both "species" and "intelligence." I'm sure you are familiar with this:

http://en.wikipedia.org/wiki/Scientific_essentialism

One primary difference though is that we pull moods out of subjectivism and tigers from empiricism. Making it even more difficult to classify things appropriately.

Just because there isn't a clear distinction between moods and mood disorders (extreme moods) doesn't mean that there is no distinction.

What it means is that there is a distinction because we chose to make one.

There is no clear distinction between child and adolescent, adolescent and adult, but we have no reservation about saying that children shouldn't drive on the freeway. It's a little blendy in the middle, but denying that they're different things is a logical fallacy.

Again, it all comes back to what we do with the distinction we make, right? It says nothing about a geniune distinction.

What I'm saying is that this argument is itself unscientific, yet it's central to your claim that psychiatry is not scientific. Thus, my confusion.

I never claimed to have a scientific argument, only a philosophical problem when the dogma which says it is scientific to believe in one set of things that don't empirically exist verses any other set of things, which may or may not be of equal value but are never tested due to what we deem to be of value.

This is also part of what other participants have identified as a strange focus: other sciences are even flakier: we don't know how statins work, but we prescribe them to address an arbitrary metric ("high" blood pressure - levels chosen for unscientific reasons, which vary from country to country). In any case, we prescribe them because we believe they will reduce suffering and/or extend life expectancy. Well, where's the scientific 'fact' that we need to do this? It's a social choice (and a choice that some communities do not make, incidentally.) It's still valid medicine.

There is no scientific fact that we must reduce suffering. We have a moral obligation to do so. Unless (or perhaps until) it can be demonstrated that my moods carry an equal empirical weight as my blood (which incidently I can see, smell, and taste) then I doubt seriously you can convince me that we are talking about the same things with the same level of objectivity.

There is a third problem with the assertion that because there is a cultural input to the definitions (and we're all aware that 50 years ago, 'homosexual' was a diagnoseable disorder) that they are useless. This is also a logical fallacy related to corrupt continuum, but is caused by the erroneous belief that cultures are entirely random. One thing we have learned is that cultural concepts of mental illness, moods, and so on, are very consistent - it is their attitude toward treatment of these sufferers which varies.

Is that why many communities used to care for their own mentally ill before psychiatry came along, as opposed to keeping them drugged and locked away from the "normal" people?

stamenflicker
14th July 2006, 10:38 PM
But I don't consider being a member of the Christian religion is the same thing as having delusions involving religion, nor have I met anyone who holds that belief. Are you saying that you do?

Suppose one day Christianity is outlawed? And psychiatrists, with their new found scientific powers can point to the exact defect in the person with any sort of religious sentiment. It's illegal. We have identified the "disorder," now what?

Public nudity is now outlawed in parts of the United States. A person from another country may walk around without a top on, wearing only a thong. We might lock that person up if she went shopping topless. If she refused to wear a top because she believed it was her right not to, we might lock her up even longer. But is she crazy? Or does she just fall outside our lines of demarcation for sanity?

Given the right magical criteria, a future society could deem anything it wanted to be an illness. What about homosexuality? By the mighty DSM itself we could be locking up gays right now using "scientific" evidence had we not changed our values in this country. Why is this so hard to understand?

Again, we are using the same subjective criteria to determine the sanity of homosexuality or religious sentiment. We're relying on drawing up vectors of our choosing and placing them around "a problem" that may or may not exist. When the criteria-making becomes scientific, we can justify about anything in the name of taking away the poor person's suffering.

It's a classic "leaving the barn door open" mentality when we claim there is anything scientific about our decisions in these matters.

stamenflicker
14th July 2006, 10:43 PM
Remember that thing about science developing by sorting out the bad guesses from the good? That's one example.

While I'm certain that I agree with you that removing this from the DSM was a good thing, by what scientific criteria did psychology sort? Why was incest or necrophilia not also sorted? Under what scientific auspices do we make these decisions? Or can't we just agree that they are not scientific at all?

So explain to me what makes you a better authority than the people who wrote the science textbooks.

Never claimed to be. Why do your science books with all their authority never ask these kinds of questions?

Earthborn
15th July 2006, 03:06 AM
Given the right magical criteria, a future society could deem anything it wanted to be an illness.This is absolutely true. A future society will be different than the present one, and therefore also have a different understanding of what illness is. It will also have other illnesses that we don't have. There will be many things that we don't consider illnesses and that future people will consider illnesses, and there will also be things that we consider illnesses today and they won't consider them as such.

Whether there are objective criteria to measure those conditions, or whether they are subjective experiences, is however completely irrelevant to the decision what is and is not an illness.

Why is this so hard to understand?This is not at all hard to understand. It is just completely irrelevant.

Under what scientific auspices do we make these decisions? Or can't we just agree that they are not scientific at all?Those decisions are based on scientific data, but they are ultimately value judgements. Just as science can't answer what is good and what is evil, it cannot answer what is healthy and what is sick. Simply because that is not a scientific question.

Science can describe a condition, and can invent ways to manipulate it. But for many conditions there are always two ways of looking at it: the Medical Model, and the Social Model.

The Medical Model sees human suffering as a result of a condition in which a person's body is in. Therefore it is assumed that this person's body must be altered to relieve the suffering.

The Social Model sees human suffering as a result of society. A person may have a condition, but his suffering is caused by the fact that society does not accomodate a person with that condition.

A good example of the clash between those two views is Deafness. In the Medical Model, deafness is seen as a handicap and as something that needs to be corrected physically. Many Deaf people whoever object to this view and insist on the Social Model: they do not suffer from a handicap, but from social discrimination. They have their own language and culture, which they consider to be in no way inferior to hearing culture. They are obviously physically different from hearing people, but black people are also physically different from white people.

Even though deafness can in most cases be objectively measured, even if it is obvious that deaf people lack something that most people do have, science can't tell us whether it is an illness or a just a variation. It is a value judgement, and medicine is full of them.

You insist on a social model for mental illness. You point out that mental illness is defined and created by society. In many cases you are right, but you forget one thing: that social model is just one way of looking at it. Just because a condition exists because of societal influences and it is diagnosed on subjective experience does not defeat the medical model: the people suffering from it may still have objectively measureable differences from others and physical intervention on them can still relieve their suffering.

Future societies will certainly make different value judgements on whether mental or physical conditions need to be seen primarily through the medical or the social model. Perhaps a future ultra-Atheist society will indeed consider your Christianity a mental illness. Perhaps it will consider it a minor problem, such as hearing voices. Or maybe it will consider it a serious disorder requiring intervention. However it is considered by a future society, science will not have the last word on what it is. But it may discover what objectively measureable differences there are between the brain of a Christian and a non-Christian.

FireGarden
15th July 2006, 04:50 AM
Apologies if this has been addressed before,

"On being sane in insane places" (http://en.wikipedia.org/wiki/Rosenhan_experiment)

Rosenhan's study [1972] consisted of two parts. The first involved the use of healthy associates or 'pseudopatients', who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in 5 different states in various locations in the United States. The second involved asking staff at a psychiatric hospital to detect non-existent 'fake' patients. In the first case hospital staff failed to detect a single pseudopatient, in the second the staff falsely detected large numbers of genuine patients as impostors. The study is considered an important and influential criticism of psychiatric diagnosis.

The study concluded "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of depersonalization and labelling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

All eight were admitted, seven with a diagnosis of schizophrenia, the last with manic depression. None of the pseudopatients was detected during their admission by hospital staff, although other psychiatric patients seemed to be able to correctly identify them as impostors.

I always found that bit interesting! :)

During their stay, hospital notes indicated that staff interpreted much of the pseudopatient's behaviour in terms of mental illness. For example, the note-taking of one individual was listed as "writing behaviour" and considered pathological.

Criticism of the study:
[psychiatrist Robert Spitzer]

"If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a peptic ulcer, I doubt I could argue convincingly that medical science does not know how to diagnose that condition."

However, Spitzer believed that despite the perceived shortcomings of Rosenhan's study, there was still a laxness in the field. He played an important role updating psychiatric diagnosis, eventually resulting in the DSM-IV, in an attempt to make it more rigorous and reliable.

stamenflicker
15th July 2006, 06:57 AM
This is absolutely true. A future society will be different than the present one, and therefore also have a different understanding of what illness is. It will also have other illnesses that we don't have. There will be many things that we don't consider illnesses and that future people will consider illnesses, and there will also be things that we consider illnesses today and they won't consider them as such.

Whether there are objective criteria to measure those conditions, or whether they are subjective experiences, is however completely irrelevant to the decision what is and is not an illness.

This is not at all hard to understand. It is just completely irrelevant.

Those decisions are based on scientific data, but they are ultimately value judgements. Just as science can't answer what is good and what is evil, it cannot answer what is healthy and what is sick. Simply because that is not a scientific question.

Science can describe a condition, and can invent ways to manipulate it. But for many conditions there are always two ways of looking at it: the Medical Model, and the Social Model.

The Medical Model sees human suffering as a result of a condition in which a person's body is in. Therefore it is assumed that this person's body must be altered to relieve the suffering.

The Social Model sees human suffering as a result of society. A person may have a condition, but his suffering is caused by the fact that society does not accomodate a person with that condition.

A good example of the clash between those two views is Deafness. In the Medical Model, deafness is seen as a handicap and as something that needs to be corrected physically. Many Deaf people whoever object to this view and insist on the Social Model: they do not suffer from a handicap, but from social discrimination. They have their own language and culture, which they consider to be in no way inferior to hearing culture. They are obviously physically different from hearing people, but black people are also physically different from white people.

Even though deafness can in most cases be objectively measured, even if it is obvious that deaf people lack something that most people do have, science can't tell us whether it is an illness or a just a variation. It is a value judgement, and medicine is full of them.

You insist on a social model for mental illness. You point out that mental illness is defined and created by society. In many cases you are right, but you forget one thing: that social model is just one way of looking at it. Just because a condition exists because of societal influences and it is diagnosed on subjective experience does not defeat the medical model: the people suffering from it may still have objectively measureable differences from others and physical intervention on them can still relieve their suffering.

Future societies will certainly make different value judgements on whether mental or physical conditions need to be seen primarily through the medical or the social model. Perhaps a future ultra-Atheist society will indeed consider your Christianity a mental illness. Perhaps it will consider it a minor problem, such as hearing voices. Or maybe it will consider it a serious disorder requiring intervention. However it is considered by a future society, science will not have the last word on what it is. But it may discover what objectively measureable differences there are between the brain of a Christian and a non-Christian.

I think you've given us a great response here Earthbind, kudos. I enjoyed most every part of it.

I do however disagree that this issue is not relevant. Because, so long as psychology can pass itself off as science, it has greater legitimacies in courts of law, in restrictions of freedom, health care reform, in guiding politics and world decision making, etc.

Any of these can at any time be used to take my freedoms or fortunes away. And in many cases, it is already being used. As in the case of my grandmother's "dementia."

You insist on a social model for mental illness. You point out that mental illness is defined and created by society.

No, I don't really insist on it. I'm only saying that the evidence that it is medical is not enough to convince me at this time, again with a few exceptions.

stamenflicker
15th July 2006, 07:02 AM
FireGarden,

Thanks for that link, it was awesome.

All eight were admitted, seven with a diagnosis of schizophrenia, the last with manic depression. None of the pseudopatients was detected during their admission by hospital staff, although other psychiatric patients seemed to be able to correctly identify them as impostors.

The interesting part to me is that the patients themselves seemed to recognize them as imposters.

As far as the criticism of the study goes, its absurd. Because anyone throwing up blood is going to most likely get a scope once the vomitting stops. And once again, I have a stomach to look at, not someone's subjective experience.

Dancing David
15th July 2006, 09:29 AM
Er, um, no...that's prison. :)

It depends on how long you are in the ED, a person who is intoxicated on alcohol can take a while to reach the point of legal sobriety so we can do the assesment. they usualy no longer express suicidal ideation when they are sober, so maybe 'three box lunches and a cot' would be better, and all the ice chips you can eat! ;)

Dancing David
15th July 2006, 09:49 AM
That's pretty close to my position. It's not that there is "not" anything happening. It's that the way we choose to classify what is happening is indicative of our cultural values. That we make the attempt of objectifying these moods and making them into real things doesn't say so much about what is happening in the patient, as it says about us.

A subsistance farmer can suffer from depression as much as a corporate bussiness man, the important point about mental healtrh treatment is the functioning of the individual, if they are able to function at work, home and socialy they don't usualy seek treatment. If someone has no impairments in daily life they rarely walk through the dorr, becausde the are the 'wooried well'. But that is another thread.

The culture may siupport people differently but in many place Japan and Syria for example, if you are crazy they ship you off some place and they forget about you, which is the general response in any non-agrarian culture, in agrarian culture mentaly ill people marginaly participate in society and are often viewed as a family burden.

So what cultural values are the ones you talk about, the ones where they stone you for hearing voices?


We scoff at the use of leeches in the middle ages, or scoff at less developed cultures who resort to all sorts of insanity when dealing with medical conditions, why? Because we now have a scientific understanding what is going on. This is not the case with moods. We really don't know, but we've created some labels that make organizing what we do know easier.

there are valid tests to see if a person has byproducts from the metabolism of receptors that can indicate the precense or a receptor inbalance, they have been know since the eighties, so you can actualy teel if someone has a dopamine or a seratonon problem. Why these tests aren't used was a mystery at the time and remains a mystery.

There are also three hundred or so products involved as nuerotransmitters and then all the other hormones.

I also think that you overestimate the value of thyroid level; testing, it is not the definitive test that tells the doctor what treatment to use, they still have to look at the overall picture and decide if the person is hyper or hypothyroid to somextent, the test point a direction the doctor perscribes treatment.

Since there are som many hormones and nuerotransmitters, it is likely to be two hundred years before science understands the nature of depression to the poiny we understand heart diease.

But the things you say , and especialy when you mention Thomas Zsazs are going back to witch trials, talk to people who live with depression Stamenflicker, meet about fifty to a hundred of them and then tell me that they don't have a real problem.

So the science isn't real accurate, it is istill better than it was thirty years ago when people said that bad parenting caused schizophrenia.
[/quote]



I agree with this statement. Mood disorders are real, but as I said above-- "a real what?" I think they are a real social construction.


That is such crap! Do you really think a 'social construction' makes people want to kill themselves or have panic attacks and stay at home all day.

You are a coward for one reason, you sit there in Ivory Topwer estates talking about something that you know nada about. Go volunteer at your local mental health agency Stamen, then come back afetr a year and tell us what you think then, like I said neet a hundred people living with depression.

I shall dub thee , Ostrichflicker.
[quote]
I'm only saying it loses credibility as a physical disease. My hope is that one day nueroscience will be able to answer these questions. However, I find that highly unlikely.


So how many nueroscience classes have you taken?

Zero?


What is more likely to occur is another "wonder drug" marketed to the public, which "cures" all our bad moods. I for one, am uncertain that such a "wonder drug" will be a great idea to mass produce.


Appropriate treatment is another issue Ostrichman, don't confuse the difference.


Look, we've already seen it with Ritalin. 1/3 of American boys are on it.


Excuuuuse me, lets see the source for that statistic, I call you out. BOGUS, where did you get that one?
That number is staggering. I believe in the future, if afforded such an opportunity, we will look back in disgust, not unlike looking back at the leeches used 1,000 years ago. We'll see over-medication as a form of human slavery.

It is much more of a problem where there is family violence than anything, parent beats child child gets treatment.
[quote]

Dancing David
15th July 2006, 09:56 AM
Jeez. According to the logic of modern pyschology, I'm suffering from "Christianity" but that doesn't stop people from asking questions on a skeptic board does it?

You and Dancing Dave and others make it sound like I have no experience in these matters. I'm married to a psychologist. I've worked as a chaplain in mental institutions-- in fact, I did my residency at one. And I have a member of my family who has been homeless for 8 years, who has been determined to have "bi-polar disorder."

You seem to believe that because I made a free choice to question something with no empirical evidence, that somehow I am a cruel person.

I also find it interesting that the people this issue seems to matter most to are the ones either a) suffering from, or b) working in the subject matter.

So what makes you think that illness is a social construction?

I am not saying that the diagnosis is accurate just an indicator of treatment.

But you are ignoring the fact that medicine is limited by technology, it is like saying you shouldn't treat a someone with chestpain if you can't hook them to the heart monitor, that is bad medicine.

Now if you want to talk about innappropriate treatment and the over treatment of people I agrre wholeheartedly.

At my job everyday we see people who have beeb perscibed Xanax and Ativan by thier GP, when they should have never recieved the drug in the first place, a good psychiatrist will perscibe these medications on a limited basis while the person gets CBT.

That is an issue that i can agree on, but i have worked with too many people who have been unable to function because of depression, and they can't get on with thier lives without treatment.

But then as a crisis worker I see a select 'five percent' of the population.

Dancing David
15th July 2006, 09:57 AM
That's why we give egg salad sandiwches - they're the least popular. However, if you're so hungry that one of these is a good meal, and a flat cot in a busy, bright, emergency ward is a good sleep, then who am I to withold, and god bless.





You can see word of mouth in action: one patient manages to sell his story to the new guy, tells his friends, and the next night, there's a rash of "... only thing that works to reduce my seizures is Tylenol 3s." Nice try.






Fortunately, I don't have to anymore. And I don't want to give the misleading impression that I was medical staff - I worked in a support role. My first job there was housekeeping.


Gods bless the house keepers, ook.

Dancing David
15th July 2006, 10:10 AM
Sorry Stamen, I seem to be unable to understand the point you are trying to make and I have been very disruptive, so i will start another thread, your avatar did the same thing for my wife is does for me it made her laugh.

I will take my issues else where.

blutoski
15th July 2006, 10:13 AM
It's not crap. There is no logic of modern psychology that says I'm suffering from Christianity because we don't have a reason to chart the vectors that encompass it.

Now you're making less than no sense. You say there is, now you say, *hah!* there isn't!

Yeah, you showed me.

I have no idea how to approach many of your statements, because I have a lot of problems putting my finger on what you're actually saying. You appear to go in circles a lot, and I don't know which ones are part of your argument, and which are thrown out without forethought just to be contrarian.

You say, this, that, then the opposite, then something unrelated... I'm really struggling here.




Of course not. My wife helps people. That doesn't change the fact that we have core philosophical differences. Nor does it change the fact that out of all the members of our shared family, I am the most sympathetic and compassionate to her "bi-polar" father.

I don't get it then. How can she help people with what you assert are unsubstantiated lies?

Or are you saying she's not working within her field of study? ie: not a psychologist?




I said:ie: Stakeholders? Experts? Is this unexpected? Again, we see this with evolution-deniers: "The only people defending evolution are these scientitsts - what's with that, hmmm?"
You tell me?

My point was that when people run out of good arguments, they resort to ad hominem attacks. Sometimes they backfire, because they prove that they are missing the scientific value placed on expertise and experience.

Is this why you brought it up? You ran out of good arguments? Do you honestly think that expertise is a disqualifier?






I have no knowledge of Szasz religious sentiments. If you dislike him, then read Mad Travelers or Multiple Personality Disorders and the Politics of Memory, both by Ian Hacking.

I've read them, and my opinion is that just like "Mr. Post" is a good name for a mailman, Hacking is a good name for somebody who produces such shoddy books.

Another problem is that minor quibbles do not a medical specialty destroy. In particular, the latter book talks about what may be about 50 patients in marginal diagnoses, compared to the whole system, which has tens of millions of people under very solid diagnoses. It's like saying that because some people are occasionally misdiagnoses with slipped discs when they have a spinal tumour, that medicine obviously doesn't work.





Not surprising given the subject matter.

No, you're not getting away that easy. I was pointing out you've been contradicting yourself. I think you have a weak grasp on the topic, and are getting scrambled.

I'm investing time here, and when I show that you're contradicting yourself and you say "that proves my point!", I start to suspect that you're deliberately wasting my time. It starts to look like a troll.





Of course I would make a somewhat similar argument for both "species" and "intelligence." I'm sure you are familiar with this:

http://en.wikipedia.org/wiki/Scientific_essentialism

This has nothing to do with my example. I was talking about phylogeny. The Wikipedia entry is not addressing phylogeny debates. 'tigers' isn't even a species: it's a genera. Scientific essentialism is an extension of Aristotlean prototyping, and is a philosophical rather than scientific tool.

The reason I brought up Tigers, is that there's nothing substantially different than lions. The only difference is fur colour and some behavioral traits (ie: tigers are more independent, and swim). They can, however, breed successfully with lions, and often do, producing ligons. The reason they're considered diffrent genera is because when we're little, we're told the striped ones are tigers and the yellow ones are lions.

There is more substantial genetic variation between poodles and bouvier de flanders, but we not only assign them the same genera: we assign them the same species! This is because the scientific activity of species assignment is largely arbitrary. (there are whole schools of approach called 'lumpers' versus 'splitters')

But it doesn't prevent the concept of species from being scientific.





One primary difference though is that we pull moods out of subjectivism and tigers from empiricism. Making it even more difficult to classify things appropriately.

We do not pull tigers from 'empiricism'. That's the point. We have arbitrarily called them a 'different' animal than lions because of our cultural background. Same with wolves and dogs, or, by comparison, even varieties of dogs.

Same with planets and 'trans-neptunian objects'. Moons versus minor satellites. Rivers versus creeks. Cobbles versus stones. Scree versus talus. Lakes versus seas. Epochs versus eras.

In medicine, it's major versus minor surgery, diagnoses that involve MD judgement ('guarding', 'firm', 'feels inflamed', 'limited mobility'). It's *exactly* how science and medicine are done.

You've conceded that stuff like pain, &c are completely legitemate medical concepts, but completely impossible to detect empirically. Why are you making a special exception for psychiatry?

Arguably, pain is much less scientific than pain management, since there's no objective measure. Whereas, psychiatry has many objective measures, which I have listed in previous posts (eg: the reports of trained observers against a standardized checklist).






I wrote:
Just because there isn't a clear distinction between moods and mood disorders (extreme moods) doesn't mean that there is no distinction.
What it means is that there is a distinction because we chose to make one.

Yeessss. Like the science examples I mentioned above. Go on....



I wrote:
There is no clear distinction between child and adolescent, adolescent and adult, but we have no reservation about saying that children shouldn't drive on the freeway. It's a little blendy in the middle, but denying that they're different things is a logical fallacy.
Again, it all comes back to what we do with the distinction we make, right? It says nothing about a geniune distinction.

Yeessss. Like the science examples I mentioned above. Go on....






I never claimed to have a scientific argument, only a philosophical problem when the dogma which says it is scientific to believe in one set of things that don't empirically exist verses any other set of things, which may or may not be of equal value but are never tested due to what we deem to be of value.

I think you're making stuff up now. Psychiatry is psychiatry. It's medicine. Nobody claims it's science. It is, however, like medicine, supported by the same type of scientific findings, such as the utility of diagnosis for directing treatment.

Again, this is the reification argument. Science doesn't know if anything exists. Electrons are a model that fits the data. Evolution is a model that fits the data. These are still scientific, because they are the product of a scientific method.

Psychiatry is a product of the scientific method, so it is as real as electrons. Which is to say: who knows, but let's put the filosofizin aside and treat some patients.

I repeat the question: since psychiatry is as scientifically based as other medical fields, and probably more scientific than even some subfields within science, why are you singling it out for the universal problem of reification?





There is no scientific fact that we must reduce suffering. We have a moral obligation to do so. Unless (or perhaps until) it can be demonstrated that my moods carry an equal empirical weight as my blood (which incidently I can see, smell, and taste) then I doubt seriously you can convince me that we are talking about the same things with the same level of objectivity.

Well, see, this is just silly. The whole point of the scientific method is that the senses are the definition of subjectivity, whereas, scientific testing provides us with more objectivity.

You can't see, touch, or taste electrons. You can't see, touch, or taste Ancient Rome or planets around distant stars. We know these things exist through other means. That's what the scientific method is for: developing models for knowledge that do not rely on our faulty senses.





Is that why many communities used to care for their own mentally ill before psychiatry came along, as opposed to keeping them drugged and locked away from the "normal" people?

A fantasy.

The reality is that the mentally ill of the world have been historically marginalized and preyed upon by opportunists within their community. Especially the mentally delayed and psychotic. In prior cultures, these are the most likely to be abandoned or subjected to infanticide. In modern primitive cultures (which are sometimes used as a model for ancestral hunter-gatherers,) the trend is consistent with our historical observations. The mentally deficient do not last long outside the Western hegemony.

(It helps to have an ex-wife whose anthropology masters thesis was in the management of health problems in stone age societies)

Our ancestors mostly regarded the mentally ill just as much a 'burden' as they did the physically ill, and treated them accordingly. Depending on what era you're talking about (ie: primitive tribes such as first nations in BC (my ex-wife's specialty) would usually just reallocate resources away from these weaker community prospects, in favour of the more likely producers versus, say, civilizations such as Rome or Egypt, where infanticide was more cut-and-dried)

My ex's family totem was the Wild Woman of the Woods, whose legend is about a girl who was abandoned in the woods because she was a disobedient child, and grew up to be a spirit-woman.

As I pointed out, my current wife (a psychiatrist) spent quite some time in Tobago, where the people are living the same life they did 500 years ago, and the usual treatment of the mentally ill appears to be exploitation, shunning, and murder. My wife is from a nearby island of St. Vincent, where things are totally different *because* they have a functioning psychiatry service.

I am unusual in that I have both a PhD in science (Immunology/Research methodology) and a BA in psychology (family dynamics). My impression is that psychiatry is much more scientific than psychology in that it relies on the same standards of research as does the rest of medicine, whereas psychology is more about narratives, and borders on anthropology in some ways. Depends on the specialty.

As an immunologist, I am more satisfied with the levels of confidence generated by the DSMIVR than I am with many lab tests in my own field.

blutoski
15th July 2006, 10:28 AM
Apologies if this has been addressed before,

"On being sane in insane places" (http://en.wikipedia.org/wiki/Rosenhan_experiment)

It was an interesting study, but I can tell that the Wikipedia entry was submitted by somebody who was copy/pasting from an anti-psychiatry screed.

The patients weren't diagnosed with schizophrenia: they were diagnosed as normal, but they now had a chart that showed they had had a shizophrenic-like hallucinatory episode. Remember: the patients all lied to the doctors, insisting they were hearing voices. However, when observed, they were obviously not mentally ill, did not relapse, and were released within several days. One stayed a little longer than expected, but this is because he repeated his claim of hearing voices (this was contrary to instructions - he did not understand that the claim was only to be stated on admission)

A second important point about this report is that the opinions of other patients were not part of the study, were not recorded, and are essentially regarded as an urban legend that grew up around this study.

Regardless, what's valuable is that even if this were true, it lends support to the diagnoses: the patients were released very quickly, consistent with the claim that there is a universal standard for 'psychotic' that can be recognized at least by laypeople, and that it appears to be aligned with professional opinion.

The patient who was diagnosed with depression is an particluarly uninteresting case, because during the therapeutic sessions, he admitted to thoughts of suicide. This sounds like a legitemate diagnosis to most people, and is hardly a critique of diagnostic quality.

blutoski
15th July 2006, 10:38 AM
Any of these can at any time be used to take my freedoms or fortunes away. And in many cases, it is already being used. As in the case of my grandmother's "dementia."

Be mindful, though, that this doesn't cut a lot of ice with skeptics, because this is a logical fallacy known as 'appeal to consequences'. We should reject it because, if it's true, bad things may happen.

Regarding dementia and seniors (a growing problem). Five years ago, a Toronto woman was diagnosed with exactly this, and her driver's licence was cancelled. Her son felt he knew better and let her drive anyway. She hit a jogger who became trapped under the car and drove fifteen blocks with the woman pinned, and did not even notice when she got home.

The jogger's husband followed the trail of blood and body parts to the woman's home, and unfortunately, his wife was dead from blood loss when he found her. Mother of three.

Sometimes, we take people's rights away when their mind goes. If you've been in a mental institution as you claim, do you really want those guys outside around your kids?

Avita
15th July 2006, 10:49 AM
Rosenhan did important work in helping us look at inadequacies of mental hospitals, but his study is flawed in many ways. For a good look at this and two other similar studies, see the article "Diagnoses and the Behaviors They Denote: A Critical Evaluation of the Labeling Theory of Mental Illness." (http://www.srmhp.org/0301/labels.html) It's a long article, but well-worth reading to anyone interested in this issue. For those with minimal time, I will summarize its criticism of Rosenhan. One is that he cherry-picked his data to support the conclusions he wanted to reach. Another is that he exaggerated the significance of what he found. For instance, the famous "patient engages in writing behavior" note. The nurse simply put that down on the patient's chart, without any evidence that it was attached to a negative judgment of the patient. Since the most notable aspect of these pseudopatients' behavior was that they wrote a lot, what else should she have done, but note it for future reference? But most importantly, the author notes that the diagnosis of "schizophrenia in remission" was quite rarely employed at the time, though it describes someone who initially presents with schizophrenic symptoms, then doesn't show any. Given that:
Perhaps the greatest difficulty in accepting Rosenhan’s conclusions stems from the pseudopatients’ discharge diagnoses. Eleven pseudopatients were diagnosed with “schizophrenia, in remission” and one with “manic depression, in remission.” Spitzer (1976) gathered data that suggest these classifications were used extremely rarely in psychiatric hospitals. The impressive agreement that Rosenhan reports across diagnosticians working in widely varying settings and evaluating a number of different pseudopatients contradicts the assertion that diagnoses are unreliable. Moreover, near-perfect agreement on such an unusual diagnosis proves just how attentive professionals were to these individuals’ behaviors. Initial diagnoses of psychosis appear not to have significantly influenced perceptions, for in every case the staff correctly observed the absence of signs or symptoms of psychopathology at discharge. Thus, Rosenhan’s own observations suggest that important clinical decisions were based more on pseudopatients’ behaviors than their diagnoses. The shaky foundations of Rosenhan’s case should give one pause in drawing upon it as support for allegations that diagnostic judgments are made unreliably or that labels are, on balance, more harmful than helpful.
Thus, it wasn't just the other patients that noted the anomaly. The clinicians did as well. They did their jobs.


To Stamenflicker: I hesitate to argue with you any longer, because your argument currently seems to be down to "Well, I am not convinced by the amount of evidence we currently have." Which is fine, but may I know what amount of evidence is necessary to change your mind?

stamenflicker
15th July 2006, 11:46 AM
Now you're making less than no sense. You say there is, now you say, *hah!* there isn't!

Yeah, you showed me.

I have no idea how to approach many of your statements, because I have a lot of problems putting my finger on what you're actually saying. You appear to go in circles a lot, and I don't know which ones are part of your argument, and which are thrown out without forethought just to be contrarian.

Let me spell it out for you in terms that we can perhaps debate clearly.

1) I believe in moods in spite of the lack of empirical evidence. I have moods. I rely on my subjective experience of moods as evidence that they are in fact real.

2) I've not seen enough evidence, nor had enough experiences to believe that mood disorders exist, outside of course our definitions of them.

3) Given the above however, it can be shown that some mental conditions have empirical facts attached to them. We see these fairly clearly utilizing tests on actual biological and empirical entities.

4) These limited cases are more reflected in and defended by your statin level analogy. I am more likely to accept these as some kind of biological malfunction, however than a subjective disorder.

5) I also recognize that these malfunctions in biology (as distinguished from disorders lacking any empirical reliability) are also the product of our value system, or your social model. They rely on somewhat arbitrary lines of demarcation in complex relationships that we may need to alter over time.

6) Mood disorders without accompanying empirical evidence exist in the same manner as many other things, for example a kundalini awakening. My belief in them is contingent on my experience of them, or my acceptance of your experience of them. By belief in them is not rooted in any form of objective fact.

I don't get it then. How can she help people with what you assert are unsubstantiated lies?

Or a better question might be how can I help people with what I assert to be unsubstantiated "lies," when I am not a psychologist, utilizing means that are not bound by psychology?

For the record, "lies" is your word. No where have I used it, nor would I accuse a person with these moods as being a liar.

Or are you saying she's not working within her field of study? ie: not a psychologist?

She is.

My point was that when people run out of good arguments, they resort to ad hominem attacks. Sometimes they backfire, because they prove that they are missing the scientific value placed on expertise and experience.

This "scientific value" is the very thing I reject. That expertise and authority can be given at all in matters of moods, when such matters lack any real ability to be submitted to empirical, and un-subjective testing, I cry foul.

I've read them, and my opinion is that just like "Mr. Post" is a good name for a mailman, Hacking is a good name for somebody who produces such shoddy books.

Thats really too bad.

Another problem is that minor quibbles do not a medical specialty destroy. In particular, the latter book talks about what may be about 50 patients in marginal diagnoses, compared to the whole system, which has tens of millions of people under very solid diagnoses. It's like saying that because some people are occasionally misdiagnoses with slipped discs when they have a spinal tumour, that medicine obviously doesn't work.

It does more than that. It brings to light the possibility of misuse. Because if my back hurts you can't make me get treatment. Under our laws today, you can force me into a mental hospital.

I think you have a weak grasp on the topic, and are getting scrambled.

Maybe so. But I've not evidence of that yet.

I'm investing time here, and when I show that you're contradicting yourself and you say "that proves my point!", I start to suspect that you're deliberately wasting my time. It starts to look like a troll.

Sorry you see it that way. Should I be instutionalized? Could we run a batterty of tests, or try a variety of medications to find out if I should be? If not, why?

Scientific essentialism is an extension of Aristotlean prototyping, and is a philosophical rather than scientific tool.

My questions are philosophical.

The reason I brought up Tigers, is that there's nothing substantially different than lions. The only difference is fur colour and some behavioral traits (ie: tigers are more independent, and swim). They can, however, breed successfully with lions, and often do, producing ligons. The reason they're considered diffrent genera is because when we're little, we're told the striped ones are tigers and the yellow ones are lions.

:)

But it doesn't prevent the concept of species from being scientific.

Not at all, but it does force to look closely at our categorizations.

In medicine, it's major versus minor surgery, diagnoses that involve MD judgement ('guarding', 'firm', 'feels inflamed', 'limited mobility'). It's *exactly* how science and medicine are done.

And yet you can't make me have it can you?

You've conceded that stuff like pain, &c are completely legitemate medical concepts, but completely impossible to detect empirically. Why are you making a special exception for psychiatry?

I've conceded that pain typically has an empirical root. With enough digging that root can be most always be observed empirically. In the case of something like fibromiagia, we're getting closer. Even so, pain is in some ways similar to my argument against moods... for example my entire body may hurt as I ease my way off of oxycontin. That the oxycontin would temporarily eliminate my pain doesn't really say anything about whether or not I should pop another pill.

Whereas, psychiatry has many objective measures, which I have listed in previous posts (eg: the reports of trained observers against a standardized checklist).

That's fine. Standard checklists are fine with pain too. For example, I ought to be able to walk to work, pick up my baby, or play softball without pain-- if I so choose. You however should not be able to develop a checklist in the attempt to convince me I need morphine.

I think you're making stuff up now. Psychiatry is psychiatry. It's medicine. Nobody claims it's science. It is, however, like medicine, supported by the same type of scientific findings, such as the utility of diagnosis for directing treatment.

But has a different authority than standard medicine does. That authority is granted by society whether or not a person believes it is real.

I repeat the question: since psychiatry is as scientifically based as other medical fields, and probably more scientific than even some subfields within science, why are you singling it out for the universal problem of reification?

Because it has the authority to go where it is not wanted. And to create "disorder" where there may not be any.

My impression is that psychiatry is much more scientific than psychology

Mine too. But that doesn't say anything about the things we choose not to medicate, experiment on, etc. etc. Again, its a philosophical question.

blutoski
15th July 2006, 12:52 PM
Let me spell it out for you in terms that we can perhaps debate clearly.

1) I believe in moods in spite of the lack of empirical evidence. I have moods. I rely on my subjective experience of moods as evidence that they are in fact real.

See, already we disagree. Question for patient: "do you have thoughts of suicide?" or "Has patient attempted suicide?" Yes/no answer is empirical, not subjective.

Other reasons we attribute physical origins to mood disorders:


specific responses to medications (that healthy people don't respond to)
consistency in family lines (especially clear in cases of identical twins separated at birth)


...and so on. These are all empirical support, and actually provide more support than many non-psychiatric organic conditions.




2) I've not seen enough evidence, nor had enough experiences to believe that mood disorders exist, outside of course our definitions of them.

Oh, c'mon! You don't believe people can be suicidal?

Or are you saying you're aware of suicidal tendencies, but consider them normal moods?

I don't get it.




3) Given the above however, it can be shown that some mental conditions have empirical facts attached to them. We see these fairly clearly utilizing tests on actual biological and empirical entities.

Again: questionairres are empirical. Police reports are empirical. These are all facts in the same way that my lab notes are facts. You can argue that when I read a thermometer, the readings are 'just one man's opinion', but that's la-la land, and the scientific standard is to accept them.




4) These limited cases are more reflected in and defended by your statin level analogy. I am more likely to accept these as some kind of biological malfunction, however than a subjective disorder.

I confess I don't understand this point at all.




5) I also recognize that these malfunctions in biology (as distinguished from disorders lacking any empirical reliability) are also the product of our value system, or your social model. They rely on somewhat arbitrary lines of demarcation in complex relationships that we may need to alter over time.

Right, given that we disagree on point#1, assuming that this point #5 is supported, why the focus on one aspect of medicine?






6) Mood disorders without accompanying empirical evidence exist in the same manner as many other things, for example a kundalini awakening. My belief in them is contingent on my experience of them, or my acceptance of your experience of them. By belief in them is not rooted in any form of objective fact.

Kundalini Awakening is different than mood disorders. For one thing, if you were to go to Tobago and ask somebody if they understand what that means, they would have no idea. But everybody knows what depression is.

Secondly, even the people who believe they are experiencing a Kundalini Awakening can't exactly tell you what that means. It's not the subjectivity that makes it flakey: it's the fact that it's gibberish.

I remember that thread, and I was able to identify pretty quickly that the poster was not straight in the head, and didn't post any replies.

Granted, this is because of my experience with patients who have bipolar, but I'm pretty sure that if we were to meet this poster in person, the Kundalani Awakening was the least of his problems.

I had this housemate years ago who was a bit of a CT. I told my friends I lived with a lunatic. When I was talking to other classmates about him, they pointed out that unusual political views were not by themselves a sign of mental problems. Then, they visit, and all the pieces of the picure fall into place: he had a 12-guage under his bed to fend off the "clay men", for example. His odd politics were just the tip of the iceberg.

My impression from the Kundalani dude is that this is just the tip of the iceberg. He admitted he was diagnosed with bipolar. I doubt it was just the Kundilani stuff that brought him to that point.






Or a better question might be how can I help people with what I assert to be unsubstantiated "lies," when I am not a psychologist, utilizing means that are not bound by psychology?

For the record, "lies" is your word. No where have I used it, nor would I accuse a person with these moods as being a liar.

No, actually, I was referring to psychology. Helping with people with psychology, which you have said is a lie, would be helping people with lies.





This "scientific value" is the very thing I reject. That expertise and authority can be given at all in matters of moods, when such matters lack any real ability to be submitted to empirical, and un-subjective testing, I cry foul.

Right, and again, I return to the discussion about point #1, where I actually think you are reinventing the word 'empirical' to mean what you want it to, and to point #5, which is: "why focus on psychiatry, when there are serious medical examples, too?"






It does more than that. It brings to light the possibility of misuse. Because if my back hurts you can't make me get treatment. Under our laws today, you can force me into a mental hospital.

But that's a legal question. There's pretty much nothing you can be put into a psych hospital for that you can't be put into prison for. In fact, the penal system is probably more likely to incarcerate you for your behavior than the psych diagnoses.





blutoski:I think you have a weak grasp on the topic, and are getting scrambled.Maybe so. But I've not evidence of that yet.

Right, but you have to see it from my point of view: you sound like a creationist. We can keep giving you examples, and you can keep sniffing them into non-existence, contradicting yourself, and not answering direct questions. Eventually, you just look like a troll.

Two posters, including myself, have asked you specifically: what would you accept?






blutoski:I'm investing time here, and when I show that you're contradicting yourself and you say "that proves my point!", I start to suspect that you're deliberately wasting my time. It starts to look like a troll.Sorry you see it that way. Should I be instutionalized? Could we run a batterty of tests, or try a variety of medications to find out if I should be? If not, why?

...he says, mocking the other poster with the logical fallacy argumentum ad absurdum. Why would I think this is a troll?







Not at all, but it does force to look closely at our categorizations.

OK: but my point was that it's not especially different than challenges all over science, so I put the burden on you to explain why you're saying it's different than science, which is your claim.

All sciences have a responsibility to examine the relationship between the proxy model and the presumed underlying reality: it's called validation. Validation in psychiatry and psychology are part of the management of diagnostic categories, just as validation is part of the process of phylogeny or immunology assays.





I've conceded that pain typically has an empirical root. With enough digging that root can be most always be observed empirically.

Nope. Pain is a medical mystery. More mysterious than mood disorders, I can tell you that. I think it's a good analogy.





In the case of something like fibromiagia, we're getting closer. Even so, pain is in some ways similar to my argument against moods... for example my entire body may hurt as I ease my way off of oxycontin. That the oxycontin would temporarily eliminate my pain doesn't really say anything about whether or not I should pop another pill.

Actually, fibro is almost certainly a somatiform. There is no evidence that the physical component is independent of psychiatric state. There is almost a 100% overlap between fibro and personality disorders, particularly anxiety disorders.





That's fine. Standard checklists are fine with pain too. For example, I ought to be able to walk to work, pick up my baby, or play softball without pain-- if I so choose. You however should not be able to develop a checklist in the attempt to convince me I need morphine.

Mm. I don't understand the point you're making. Be mindful that this is a legal question, not a psychiatric one.





But has a different authority than standard medicine does. That authority is granted by society whether or not a person believes it is real.

I'm not sure how to assess that claim. "different" ? I don't really see a difference. Anyway, it's a legal question, not a medical or scientific one. Again: appeal to consequences does not resolve epistemological questions.



Because it has the authority to go where it is not wanted. And to create "disorder" where there may not be any.

Meh. All medicine is like this. Is 'legal blindness' a disorder? Maybe, maybe not, but I don't want somebody below that threshold driving. How do we know if somebody's legally blind? They fail certain criteria. Do we test them with instruments? No, they tell us whether they can read a chart. Could they be lying? Sure, but who lies about something that makes them look dangerous?




Mine too. But that doesn't say anything about the things we choose not to medicate, experiment on, etc. etc. Again, its a philosophical question.

Very, but if your argument - which you've made - is that something is/is not based on scientific evidence, then it's a scientific question, right?

This is frustrating, because you keep shifting the argument, you see, and the resemblance to Creation Science / ID is disappointing:

Defendants: The evidence that underlies the classification system in the DSMIVR is about as scientific as that underlying any other medical specialty.

Response: OK, so let's have a different discussion. I think medicine and science is wrong about itself, and we need to redefine it, because I don't like what it implies.

Defendant: ?!



edit: typo.

blutoski
15th July 2006, 01:09 PM
And yet you can't make me have it can you?

Now I understand what you meant by this: that we can't force a citizen to undergo a procedure. That blindsided me because it's not related to the actual point, which was that many medical diagnoses depend on subjectivity.

OK: so, assuming that you changed the topic for innocent reasons (as opposed to avoiding acknowledging that a key assumption in your argument - that psychiatry is substantially different than other medical specialties in this regard - is dubious) I'll address your point.

Society has something called "compassion" which means that sometimes we do force people to undergo surgeries or to take medication. It is a legal question, not a medical one. Examples include:


those who are unconscious
those who are mentally deficient
those who are too young to understand
and those whose mental state demonstrates they cannot understand


In all cases, there must be a solid argument that the medical evidence favours benefit. In no case is this a psychiatric question, and what the legal system does or does not do in these circumstances is not a medical or scientific debate.

Consequently, this is still appeal to consequences, and basically a logical fallacy.

stamenflicker
15th July 2006, 05:39 PM
See, already we disagree. Question for patient: "do you have thoughts of suicide?" or "Has patient attempted suicide?" Yes/no answer is empirical, not subjective.

I'll respond to the rest of your post later tonight in that I currently have obligations around the house with kiddos and such.

I think it's fine that you deem the answer to be empirical. After all, we heard the answer didn't we? We saw the tremble in the face or the tear as they approached the question... We see the knife scars from the last attempt, right?

By your logic then, when we ask a subject, "Do you experience the divine at least three times a day," then its an empirical question. We hear them answer. We see them on bended knee during morning prayers.

Are we going to objectify their Deity in the same fashion we objectify their "disorder?"

If so, then fine. But let's be consistent, no matter which side of the fence we're on.

Elaedith
16th July 2006, 02:56 AM
How is a purely social constructionist account of mood disorders reconciled with evidence for heritability of these conditions? Especially for bipolar disorder, with substantially higher concordance rates for MZ compared to DZ twins, and heritability estimates ranging from 65 to 95%?

Dancing David
16th July 2006, 06:39 AM
Stamen, I have read Szasz many years ago during my first pass in college, in fact I had to read him for a class on abnormal psych taught by a man who believed that schizophrenia was caused by operant conditioning. I have found a copy of the essay and will read it and get back to you.

I understand what Szasz was about but want to make sure I understand the essay.

Did you find your citation for saying that 30% of american male youth have ADHD?

Q.: If a person reports a persistant sad mood, is that an empirical event or not? What if there are observable behaviors related to the report?

FireGarden
16th July 2006, 07:01 AM
Hi, Flick
As far as the criticism of the study goes, its absurd. Because anyone throwing up blood is going to most likely get a scope once the vomitting stops.

I agree with the last part.
Of course it's when their stomach is examined that causes other than an ulcer will be considered more likely. But what is the first diagnosis? Are you suggesting that doctors must get everything right first time?

I only quoted the ulcer-comparison because I felt it would look odd to leave it out. The part I wanted to highlight was:

However, Spitzer believed that despite the perceived shortcomings of Rosenhan's study, there was still a laxness in the field. He played an important role updating psychiatric diagnosis, eventually resulting in the DSM-IV, in an attempt to make it more rigorous and reliable.

since it was DSM-IV that was being debated earlier.


It was an interesting study, but I can tell that the Wikipedia entry was submitted by somebody who was copy/pasting from an anti-psychiatry screed.

I admit I'm not an expert. I was originally going to copy out the text from an A-level Psychology text. But the wiki article said what I wanted to copy. I only had to add a few comments.

Avita's link seems to agree on the improtant points, especially on the diagnosis. You say:

The patients weren't diagnosed with schizophrenia: they were diagnosed as normal, but they now had a chart that showed they had had a shizophrenic-like hallucinatory episode.

This is not what my A-level text says. (Written by Diane Dwyer and Jane Scampion, if that's useful)

5th paragraph, page 305
Not one of the pseudopatients was detected. All but one was diagnosied as schizophrenic and, when discharged, as schizophrenic in remission. Length of hospitalisation ranged from 7 to 52 days, 19 days on average.

Avita's link also agrees with my text.

A second important point about this report is that the opinions of other patients were not part of the study, were not recorded, and are essentially regarded as an urban legend that grew up around this study.

Oh, but that's the best part!
It's also in the A-level text. So it's a very widely believed urban legend.

Regardless, what's valuable is that even if this were true, it lends support to the diagnoses: the patients were released very quickly,

On average, 19 days. Longest 52 days.
Or is my text wrong on that too?


Avita
Another is that he exaggerated the significance of what he found. For instance, the famous "patient engages in writing behavior" note. The nurse simply put that down on the patient's chart, without any evidence that it was attached to a negative judgment of the patient. Since the most notable aspect of these pseudopatients' behavior was that they wrote a lot, what else should she have done, but note it for future reference?

That's an acceptable point.

The impressive agreement that Rosenhan reports across diagnosticians working in widely varying settings and evaluating a number of different pseudopatients contradicts the assertion that diagnoses are unreliable. Moreover, near-perfect agreement on such an unusual diagnosis [schizophrenia in remission] proves just how attentive professionals were to these individuals’ behaviors.

Another very good point.

Thanks, Avita
I'll keep your link for another day. I agree with the above points you've pulled out regarding the Rosenhan study.

I don't go as far as Flick, especially since I see signs of psychiatry correcting itself. Rosenhan's study is from the 70's. Surely someone has tried to repeat the experiment within the last few years. I've turned up nothing so far.

stamenflicker
16th July 2006, 07:29 AM
specific responses to medications (that healthy people don't respond to)
consistency in family lines (especially clear in cases of identical twins separated at birth)


I would accept the consistency in family lines as pointing to some kind of genetic evidence, but recognizing the social beliefs that also may be a part... ie. my dad was crazy, my grandpa was crazy, therefore I'm probably going to be crazy.

Medicine is an unconvincing argument to me, because I'd guess that with enough research and funding, we could make a pill for just about anything, not just mood "disorders."

Again, things like schizophrenia are a bit different in that we can measure specific brain activity and isolate things more clearly.

Oh, c'mon! You don't believe people can be suicidal?

Or are you saying you're aware of suicidal tendencies, but consider them normal moods?

I don't get it.

What I don't get is why people keep thinking that I don't believe things like suicide, or suffering are real. These are moods, and I've had them myself... even sucidial thoughts. I reject however that I was suffering from some kind of "real" or empirical disorder.

Again: questionairres are empirical. Police reports are empirical. These are all facts in the same way that my lab notes are facts. You can argue that when I read a thermometer, the readings are 'just one man's opinion', but that's la-la land, and the scientific standard is to accept them.

That's all fine and good, but we also have questionairres for things like my political beliefs. Are we going to create a category of inner states for say "Liberalism." Would such a category of states exist if we did?

I confess I don't understand this point at all.

I'm saying I would be more likely to accept a "disorder" that has an actual biological component attached to it-- like say, Parkinson's. Even the DSMIV agrees with me by saying that something is "depression" only when actual problems like thyroidism are ruled out.

Kundalini Awakening is different than mood disorders. For one thing, if you were to go to Tobago and ask somebody if they understand what that means, they would have no idea. But everybody knows what depression is.

So then disorders are determined by popular vote?

Secondly, even the people who believe they are experiencing a Kundalini Awakening can't exactly tell you what that means. It's not the subjectivity that makes it flakey: it's the fact that it's gibberish.

I'd say people can tell you exactly what it means. I could spell it out to you in a handful of unique "vectors," currently rejected as subjective mood making.

I remember that thread, and I was able to identify pretty quickly that the poster was not straight in the head, and didn't post any replies.

I didn't see the person's post.

My impression from the Kundalani dude is that this is just the tip of the iceberg. He admitted he was diagnosed with bipolar. I doubt it was just the Kundilani stuff that brought him to that point.

So you are basically chosing one label over another?

No, actually, I was referring to psychology. Helping with people with psychology, which you have said is a lie, would be helping people with lies.

But you missed my point. If psychology defines problem X, should I be able to help anyone with problem X if I don't use the methods outlined by psychology. What I do with a "patient" might be considered homeopathy. Do you believe in homeopathy or accept it for other physical diseases?

Right, and again, I return to the discussion about point #1, where I actually think you are reinventing the word 'empirical' to mean what you want it to, and to point #5, which is: "why focus on psychiatry, when there are serious medical examples, too?"

I don't think I'm doing that per say, but the question is much more potent in psychological affairs due to the authority the "helper" has at his disposal.

Right, but you have to see it from my point of view: you sound like a creationist. We can keep giving you examples, and you can keep sniffing them into non-existence, contradicting yourself, and not answering direct questions. Eventually, you just look like a troll.

Two posters, including myself, have asked you specifically: what would you accept?

It's not up to me is it? It's up to entities like the APA who have a vested self-interest in propogating disease, and inventing new diseases.

...he says, mocking the other poster with the logical fallacy argumentum ad absurdum. Why would I think this is a troll?

All sciences have a responsibility to examine the relationship between the proxy model and the presumed underlying reality: it's called validation. Validation in psychiatry and psychology are part of the management of diagnostic categories, just as validation is part of the process of phylogeny or immunology assays.

How do you validate that which you can't see, touch, taste, smell, or hear? Furthermore how do you validate my inner states? Which inner states are worthy of validation? Which ones aren't and why?

These are my questions.

Nope. Pain is a medical mystery. More mysterious than mood disorders, I can tell you that. I think it's a good analogy.

That's fine. But when I get a toothache I know who to go see don't I? And its not my protologist.

Actually, fibro is almost certainly a somatiform. There is no evidence that the physical component is independent of psychiatric state. There is almost a 100% overlap between fibro and personality disorders, particularly anxiety disorders.

I'm not going to debate fibro with you. I've not the time, and it really doesn't say anything about our debate.

Meh. All medicine is like this. Is 'legal blindness' a disorder? Maybe, maybe not, but I don't want somebody below that threshold driving. How do we know if somebody's legally blind? They fail certain criteria. Do we test them with instruments? No, they tell us whether they can read a chart. Could they be lying? Sure, but who lies about something that makes them look dangerous?

You are forgetting that by lying about my mood "disorders" I can have access to highly powerful drugs that make me feel really good, or that I can sell for a great profit after the State Health Care Agency pays for them. What would a lying blind person get?

Very, but if your argument - which you've made - is that something is/is not based on scientific evidence, then it's a scientific question, right?

I think its more of philosophical question regarding what "counts" as evidence and why we make those kinds of choices.

This is frustrating, because you keep shifting the argument, you see, and the resemblance to Creation Science / ID is disappointing:

Defendants: The evidence that underlies the classification system in the DSMIVR is about as scientific as that underlying any other medical specialty.

Response: OK, so let's have a different discussion. I think medicine and science is wrong about itself, and we need to redefine it, because I don't like what it implies.

Defendant: ?!

Sorry you see it that way.

hammegk
16th July 2006, 07:32 AM
Or are you an immaterialist who believes thoughts and feelings occur outside the body?
What a silly statement. An immaterialist recognizes that perceived-as-physical structures are necessary for what we consider life, up to and including HPC, human/animal mental states, etc.


An ancillary question to the thread, extending into 'physically diagnosed' conditions, is why are placebos ever effective?

The entire medical establishment remains more related to witch-doctors than science way too often for my liking. :boxedin:

stamenflicker
16th July 2006, 07:38 AM
Stamen, I have read Szasz many years ago during my first pass in college, in fact I had to read him for a class on abnormal psych taught by a man who believed that schizophrenia was caused by operant conditioning. I have found a copy of the essay and will read it and get back to you.

I understand what Szasz was about but want to make sure I understand the essay.

Did you find your citation for saying that 30% of american male youth have ADHD?

Q.: If a person reports a persistant sad mood, is that an empirical event or not? What if there are observable behaviors related to the report?

David, sorry I've not had time to respond to your other thread. I realize that what I'm saying may sound offensive and I apologize. I'm not trying to belittle people in pain. As I stated, a very close member of my family is homeless and "mentally ill."

If you were to meet him, you'd for sure recognize he needs some kind of intervention, maybe even hospitalization. He was on meds for almost 10 years. They kept him from running off, but he was pretty much a slobbering zombie the whole time. I don't blame him one bit for coming off the meds.

The question is, and has been, do I think he has a "real" condition. My answer has been consistent in that I don't think there is any way to know. Clearly his moods are not like mine. Whether or not he has a disorder, depends on who you talk to. He says no. Doctors say yes. Immediately family says, maybe, but he plays it up more than he has to.

I say and live out what I believe, that really it doesn't matter if he has a real disorder. He needs love and compassion-- and those things alone are methods of healing, even if he never becomes as "normal" as my wife and I. I put normal in quotations because obviously I don't think such a thing is real outside of our perceived values.

I'll look up the ADHD numbers.

As to your question about observable behaviors, I don't have a problem with accepting them. However, when we do this, we logically have to accept about anything. Such as "church attendance" as an event which justifies whatever we want to prove.

Hope that helps.

Ichneumonwasp
16th July 2006, 08:42 AM
I'm not sure that I understand the point of this thread. DSM IV criteria for these "disorders" include in their very definition that the person so diagnosed suffers an impairment that interferes with life function. The whole idea is that the "disorder" in question veers from statistically "natural" function and that the person (sometimes those around them rather than the patient him or herself, especially true for manic phases of bipolar since the absence of insight is so very obvious) wants intervention.

Of course it is a social construct. The very wording of DSM IV demonstrates the social construction of these categories. What is the point?

We do have to live with all sorts of people in this world. Watching the sheer terror of a schizophrenic deluded into thinking that everyone around him or her wants to kill invites our pity and desire to help if we can. None of these medicines are cures. They are treatments intended to improve people's lives. The same is true of the treatment of epilepsy. We don't cure (aside from the rare person -- about 1 in 10 -- who no longer needs medication after surgical intervention). We treat, in an attempt to help. If the treatment is worse than the condition then we tell people to stop taking medication. We don't treat diseases. We treat people.

blutoski
16th July 2006, 10:01 AM
I'll respond to the rest of your post later tonight in that I currently have obligations around the house with kiddos and such.

I think it's fine that you deem the answer to be empirical. After all, we heard the answer didn't we? We saw the tremble in the face or the tear as they approached the question... We see the knife scars from the last attempt, right?

By your logic then, when we ask a subject, "Do you experience the divine at least three times a day," then its an empirical question. We hear them answer. We see them on bended knee during morning prayers.

Yes. Not by my logic, though. It is the meaning of empirical. Like I said: you have been using the word incorrectly throughout the thread. I think you meant physical.




Are we going to objectify their Deity in the same fashion we objectify their "disorder?"

If so, then fine. But let's be consistent, no matter which side of the fence we're on.

That's not being consistent, though, right? The analogy is flawed. What we can measure is their religiosity, which we do in psychology routinely. There are three questionnaires that measure religiosity. We would be reifying (not 'objectifying' - that's a different thing altogether) the concept of religiosity, which most people think is pretty reasonable.

As mentioned at least once above, and you seem to ignore, we classify all sorts of personality traits, and the reification of these traits needs to satisfy validation steps before being accepted in the literature. They become disorders when the person comes into the doctor's office and says: "I want this to stop because it's wrecking my life, and I have failed to fix it myself."



To provide the psychiatric comparison, we can measure their level of depression, and the criteria appear valid (they sure look like things a depressed person would match for). It's a disorder when it's ruining the subject's life.



I think you're conflating different issues here. Your comments are all over the map. Here's my interpretation:

P1: You offer that psychology's criteria are merely describing things of current social interest, and do not represent an underlying physiology.

P2: You assert a priori that only things that have an underlying physiology can be classified as disorders.

Conclusion 1: from P1 and P2, you conclude that psychiatric criteria cannot be legitemate disorders.

P3: You offer that this is like religion: no connection to physical reality.

Conclusion 2: So, you infer that psychology is just like a religion, because they share these similar attributes.

P5: You observe that the law has powers to act upon people with certain psychiatric conditions.

Conclusion 3: So, you're concerned that from the combination of P1, C2, and P5 that there is a risk that religion could be reclassified as a type of psychiatric disorder, and that this would underwrite legal powers to be enacted against people with this new 'condition'.



I can mount a defense, but I'd like to be certain that you are laying out this argument pattern.

blutoski
16th July 2006, 10:07 AM
As to your question about observable behaviors, I don't have a problem with accepting them. However, when we do this, we logically have to accept about anything. Such as "church attendance" as an event which justifies whatever we want to prove.

This doesn't even make sense, and you obviously don't mean it. That makes it difficult to debate you.

eg: would you agree that if you provide church attendance statistics for Montana in the 1970s, that it would justify the claim that omega-6 fatty acids contribute to reduced LDL metrics in males over the age of 50?

stamenflicker
16th July 2006, 12:35 PM
Yes. Not by my logic, though. It is the meaning of empirical. Like I said: you have been using the word incorrectly throughout the thread. I think you meant physical.

So you are saying that asking a person if they have sucidial thoughts, writing the result on a piece of paper is empirical? Or is it not empirical?

So you are saying that asking a person if they experience the divine, writing the result on a piece of paper is empirical? Or is it not empirical?

Or do you mean physical?

That's not being consistent, though, right? The analogy is flawed. What we can measure is their religiosity, which we do in psychology routinely. There are three questionnaires that measure religiosity. We would be reifying (not 'objectifying' - that's a different thing altogether) the concept of religiosity, which most people think is pretty reasonable.

Notice the categorization here. "Depression" is given the category of "psychological feature" or "state." Why? Religiousity is given the category of abstraction. Why?


religiosity
A noun
1 religiosity, religiousism, pietism

exaggerated or affected piety and religious zeal
Category Tree:
abstraction
╚attribute
╚quality
╚morality
╚righteousness
╚piety; piousness
╚devoutness; religiousness
╚religiosity, religiousism, pietism


depression
A noun
sad feelings of gloom and inadequacy
Category Tree:
psychological feature
╚feeling
╚sadness; unhappiness
╚depression
╚dysphoria
╚oppression; oppressiveness
╚despondency; despondence; heartsickness; disconsolateness
╚helplessness
╚demoralization; demoralisation

6 depressive disorder, clinical depression, depression

a state of depression and anhedonia so severe as to require clinical intervention
Category Tree:
state
╚condition; status
╚disorder; upset
╚mental disorder; mental disturbance; disturbance; psychological disorder; folie
╚affective disorder; major affective disorder; emotional disorder; emotional disturbance
╚depressive disorder, clinical depression, depression
╚retarded depression
╚psychotic depression
╚neurotic depression
╚major depressive episode
╚exogenous depression; reactive depression
╚endogenous depression
╚dysthymia; dysthymic depression
╚anaclitic depression
╚agitated depression

7 depression

a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity
Category Tree:
state
╚condition; status
╚psychological state; mental state
╚depression
╚dejection
╚low spirits
╚slough of despond
╚melancholy
╚funk; blue funk
╚blues; blue devils; megrims; vapors; vapours
╚melancholia

--from WordReference.com


So is a person being "born again" or experience of "nirvana"

1) a state

or

2) an abstraction?

Secondly, is it a feeling or an attribute? And when or where do we make the distinctions?

So we take something like homosexuality, once in the DSMIV and we realize we are dealing with an attribute, right?

Not so. With homosexuality we are dealing with a "phenomenon."

http://www.wordreference.com/definition/homosexuality

What about lipids? They are an "entity."

http://www.wordreference.com/definition/lipid

Not that the latter two matter, I just find it interesting as to our categorizations.

So here we are with religiosity. It is an

abstraction
A noun
1 abstraction

a general concept formed by extracting common features from specific examples

And depression. It is a

state
A noun
1 state

the way something relates to its main attributes

What's the difference? Religiousity is an abstraction, I agree. It is an abstraction because of a collection of measurements. But depressive "disorders" are also a collection of measurements. Even so, we deem them to be "states." Why?

As mentioned at least once above, and you seem to ignore, we classify all sorts of personality traits, and the reification of these traits needs to satisfy validation steps before being accepted in the literature.

And still there are others we refuse to reify. Why?

They become disorders when the person comes into the doctor's office and says: "I want this to stop because it's wrecking my life, and I have failed to fix it myself."

Or when they get committed because a doctor says it is a disorder.

I think you're conflating different issues here. Your comments are all over the map. Here's my interpretation:

P1: You offer that psychology's criteria are merely describing things of current social interest, and do not represent an underlying physiology.

P2: You assert a priori that only things that have an underlying physiology can be classified as disorders.

Conclusion 1: from P1 and P2, you conclude that psychiatric criteria cannot be legitemate disorders.

P3: You offer that this is like religion: no connection to physical reality.

Conclusion 2: So, you infer that psychology is just like a religion, because they share these similar attributes.

P5: You observe that the law has powers to act upon people with certain psychiatric conditions.

Conclusion 3: So, you're concerned that from the combination of P1, C2, and P5 that there is a risk that religion could be reclassified as a type of psychiatric disorder, and that this would underwrite legal powers to be enacted against people with this new 'condition'.

I think this is more conflated than anything I've posted. I'm not sure what to make of it.

The question is still very simple. Why does a person's self report and others observations of them not allow them to exist in a "state" of being born-again? Why when given the same criteria is one subjective experience elevated to a different degree than another?

stamenflicker
16th July 2006, 12:40 PM
This doesn't even make sense, and you obviously don't mean it. That makes it difficult to debate you.

eg: would you agree that if you provide church attendance statistics for Montana in the 1970s, that it would justify the claim that omega-6 fatty acids contribute to reduced LDL metrics in males over the age of 50?

You know what I meant.

But in case you sincerely didn't here's a specific question:

Why does a person's church attendance not count as evidence for their experience of God?

Earthborn
16th July 2006, 01:10 PM
Because, so long as psychology can pass itself off as science, it has greater legitimacies in courts of law, in restrictions of freedom, health care reform, in guiding politics and world decision making, etc.Just think about economics and what influence that has on politics and world decision making. Psychology is much more scientific than that because it has far more reliable tools to measure human behaviour than economics does. In fact, psychology is actually taking over some parts of economics (or economics adopts methodologies of psychology, depending on how you look at it) because it makes it possible to experiment with behaviour. It has gone as far as economists doing animal experiments (http://www.freakonomics.com/times0605.php).

Any of these can at any time be used to take my freedoms or fortunes away.I don't know about the laws where you live, but where I am this isn't legally possible unless someone is either a danger to society or a danger to him/herself. And usually the choice is made to err on the side of freedom, causing many people who arguably are a danger to themselves or society to go without treatment.

I'm only saying that the evidence that it is medical is not enough to convince me at this timeThe evidence at this time is not enough to personally convince me of quantum mechanics, but fortunately its scientific status does not depend on the uninformed opinions of people who don't understand it.

Are we going to objectify their Deity in the same fashion we objectify their "disorder?"Depends. If we define "Deity" as a set of behaviours exhibited by a person, then yes. If we define "Deity" as something that may exist somewhere outside of that person (as a supernatural being or the creator of the universe) then no.

Medicine is an unconvincing argument to me, because I'd guess that with enough research and funding, we could make a pill for just about anything, not just mood "disorders."That's probably true and there is already a descriptive word for it: cosmetic psychopharmacology. Of course the existence of cosmetic surgery does not disprove the fact that there are physical disorders for which plastic surgery is necessary. Neither does it disprove the validity of cosmetic surgery.

I reject however that I was suffering from some kind of "real" or empirical disorder."Realness" is too vague a concept to be useful when discussing these things. "Disorder" is a value judgement: if doctors consider suicidal thoughts to be problem, then it is.

Are we going to create a category of inner states for say "Liberalism." Would such a category of states exist if we did?Yes, by definition. If you create a category of inner states and call it liberalism, then that category exists, just like when you create a house that house exists.

Some conceivable future societies (where Ann Coulter is president) may even consider "Liberalism" an illness and attempt to cure it. That fact does not disprove the validity of psychiatry or any other form of medicine.

I'm saying I would be more likely to accept a "disorder" that has an actual biological component attached to itDepression has an actual biological component to it, although it is easier to measure after death by cutting up the brain than it is during life.

However, an actual biological component by itself is never a reason to consider something a disorder, because in a biological entity everything has an actual biological component to it. Einstein didn't have a disorder because he was smarter than some. For something to be a disorder there needs to be suffering.

So then disorders are determined by popular vote?No, by expert vote.

Furthermore how do you validate my inner states?They can't be validated but that's not a problem. The only "inner states" that are relevant are those reported by the patient, the rest of the disorder is diagnosed by the observation of behaviour.

You are forgetting that by lying about my mood "disorders" I can have access to highly powerful drugs that make me feel really goodAnd that usually don't work on most people except for causing often serious side effects. They either have no effect on people except those who have been disabled by the behaviour and feelings they consider themselves to be problematic. Or they appear to work only preventatively on people who have not been.

What would a lying blind person get?A dog? :)

I think its more of philosophical question regarding what "counts" as evidence and why we make those kinds of choices.Maybe you should take up a course in Philosophy of Science instead of making up reasons why mental disorders are not "real".

He needs love and compassion--Absolutely.

and those things alone are methods of healingMaybe, but often not enough. There are more than enough people who are surrounded by love and compassion, even recognise that they are, and still feel very ill.

--from WordReference.comYou are using dictionary definitions where you should use medical definitions. In dictionaries, not only the official meanings are included, but also the everyday uses of a word which are irrelevant here.

Why when given the same criteria is one subjective experience elevated to a different degree than another?It isn't.

Why does a person's church attendance not count as evidence for their experience of God?It does count as evidence for their experience of God. It just doesn't necessarily count as evidence for the existence of God.

Ichneumonwasp
16th July 2006, 02:29 PM
Or when they get committed because a doctor says it is a disorder.


Um, no, that is completely wrong. Commitment is a legal proceeding that depends on a judge rendering an opinion. A physician can admit someone under a 72 hour order if that person is deemed to be a danger to himself or others. If the doctor does not act and that person commits some crime, say murder, then the doctor can be held legally responsible.

This is a legal issue, not a medical one. Commitments are not based on having a "disorder". They are solely based on a judgment of whether or not person is deemed to be a potential danger.

Earthborn
16th July 2006, 03:06 PM
The patients weren't diagnosed with schizophrenia

(snip)

A second important point about this report is that the opinions of other patients were not part of the study, were not recorded, and are essentially regarded as an urban legend that grew up around this study.The Wikipedia article links to the original study report, and it directly contradicts you.

It was an interesting study, but I can tell that the Wikipedia entry was submitted by somebody who was copy/pasting from an anti-psychiatry screed.No, it looks about right to me. In fact, the Wikipedia article looks more like a copy/past from the original article, and I wouldn't classify it as anti-psychiatry.

blutoski
16th July 2006, 04:15 PM
You know what I meant.

But in case you sincerely didn't here's a specific question:

Why does a person's church attendance not count as evidence for their experience of God?

Because people go to church for many reasons! I did for many years, and I was an atheist at the time (if I didn't, I would be punished). My parents *didn't* go to church when they were younger, because they were excommunicated (they were part of a schism that disagreed with the pope's announcement on contraception). etc.

However, as I said, there *are* psychological surveys that measure religiosity. They ask different questions, like: "are you religious?" or "Do you believe in God?"

blutoski
16th July 2006, 04:22 PM
Um, no, that is completely wrong. Commitment is a legal proceeding that depends on a judge rendering an opinion. A physician can admit someone under a 72 hour order if that person is deemed to be a danger to himself or others. If the doctor does not act and that person commits some crime, say murder, then the doctor can be held legally responsible.

This is a legal issue, not a medical one. Commitments are not based on having a "disorder". They are solely based on a judgment of whether or not person is deemed to be a potential danger.

Absolutely. My wife's role for a few months was to ride in a dedicated police unit whose job was to evaluate the psychiatric situation for perps. Mostly, there's not enough time 'on the scene' to diagnose, but the police sure are willing to put the cuffs on. Or shoot. Psychiatry has nothing to do with it: dangerous is dangerous.

I'm sure it varies from region to region, but the committment procedings are started by the police, and the psychiatrist is merely an expert witness.

Two patients with the same diagnosis could be handled very differently: the dangerous one is committed; the harmless one is sent home. It's not the diagnosis that directs legal action, but the risk assessment.

Having said that, if a person's that dangerous, technically, they would have to have a disorder to be committed. If they didn't have a disorder, they'd be held in jail or prison instead.

blutoski
16th July 2006, 05:08 PM
So you are saying that asking a person if they have sucidial thoughts, writing the result on a piece of paper is empirical? Or is it not empirical?

Empirical.

So you are saying that asking a person if they experience the divine, writing the result on a piece of paper is empirical? Or is it not empirical?

Empirical.

Or do you mean physical?

No. I mean empirical.






Notice the categorization here. "Depression" is given the category of "psychological feature" or "state." Why? Religiousity is given the category of abstraction. Why?

You'd have to ask the authors, right? Looks like you're using a dictionary to quibble about technical stuff. I'd use the psychological literature to see how the surveys are applied.

Also: religiosity is slowly proving itself to be a personality attribute, as opposed to depression. It's rare for people to yo-yo with their religiosity indexes: they are very consistent from day to day, year to year. It's more akin to other personality traits, such as extroversion or imaginativeness.




So is a person being "born again" or experience of "nirvana"

1) a state

or

2) an abstraction?

Secondly, is it a feeling or an attribute? And when or where do we make the distinctions?

I'm not sure it's any of these things. Too granular a question. These are not psychologically meaningful terms. I'd say it's more of a manifestation of religiosity. All religions have these epiphany events, but the individuals score here or there on religiosity as individuals. I'm sure 'born again' means a different thing to every person to speaks to it.

You often have to ask a lot of questions to get an overall view. My sister would answer the question "are you religious" with a 'no'. But she's a Gaiaist, and a much bigger zealot than my parents, who are non-church-attending Catholics, and would answer 'yes' to the same question.





So we take something like homosexuality, once in the DSMIV and we realize we are dealing with an attribute, right?

Not so. With homosexuality we are dealing with a "phenomenon."

http://www.wordreference.com/definition/homosexuality

What about lipids? They are an "entity."

http://www.wordreference.com/definition/lipid

Not that the latter two matter, I just find it interesting as to our categorizations.

So here we are with religiosity. It is an

abstraction
A noun
1 abstraction

a general concept formed by extracting common features from specific examples

And depression. It is a

state
A noun
1 state

the way something relates to its main attributes

What's the difference? Religiousity is an abstraction, I agree. It is an abstraction because of a collection of measurements. But depressive "disorders" are also a collection of measurements. Even so, we deem them to be "states." Why?

Again, these are not psychological definitions, so I'm reluctant to speak for the authors of a usage-based dictionary. It reports how everybody uses the term, not necessarily how specialists use it. You'd have to ask psychiatrists how they regard individual indexes, and my impression is that they don't really distinguish. Any index could potentially lend itself to being a 'disorder' if the patient expresses suffering for no external reason, that they want to stop, but can't.




A thought, though: religiosity is a character of the individual, whereas depression is very transitional.

In comparison, euphoria is a state, often experienced by the religious. Nirvana is a bad example, because depending on who you ask, it's either a temporary state, a permanent characteristic of the individual, a real place, a mystical place, or an unachieveable internal state/characteristic/physical destination/mystical destination.





And still there are others we refuse to reify. Why?

You'd have to be specific. Some are not reified because they fail validation, for example. Kundilani Awakening would be difficult to validate, because you'd have to find independent sources with a convergent understanding of its meaning.




Or when they get committed because a doctor says it is a disorder.

Covered in another reply.




I think this is more conflated than anything I've posted. I'm not sure what to make of it.

Drat. So, why don't you throw us a bone, and outline your argument?



The question is still very simple. Why does a person's self report and others observations of them not allow them to exist in a "state" of being born-again? Why when given the same criteria is one subjective experience elevated to a different degree than another?

See, where here does it talk about being institutionalized? You keep bringing that up, but you haven't included it in your summary. Things like that.



However: to answer this specific challenge, I think part of the problem is validation regarding the expression 'born again'. If I went to China and asked a guy off a farm what 'Born Again' meant, could he explain it to me? If I asked him what depressed meant, could he explain it to me? (this experiment - mood and emotion validation - has been done, incidentally, with many cultures, some of them selected because they were isolated from other cultures, for example the Wayanas tribe in Brazil, and some tribes in New Guinea. Very good validation on moods and emotions, and perfect validation on interpreting facial expressions.)

If I asked random people in the US what 'born again' meant, would their answers be consistent enough to be convergent on a meaning? If not, then it's probably a cultural phenomenon, as opposed to moods, which appear to be an inherent part of the human experience.

This is not the same thing as reification, mind. Also: nobody says that there are underlying physical anomalies to all mood disorders. I personally suspect that some are acquired, and I think this represents the state of the profession. The scientific support comes from correlating the classifications with the


I'm also concerned that you're launching a semantic argument here, quibbling about words like 'state' or 'abstraction' and so on. I tend to withdraw from this when my opponents think their new weapon in a technical discussion is an on-line common-usage dictionary. I'm not sure you shed any light about what psychiatrists actually think or do by quoting it.

blutoski
16th July 2006, 05:39 PM
The Wikipedia article links to the original study report, and it directly contradicts you.

I appreciate that. However, there are analyses that go into more detail about the credibility of these reports, as they are not from the experimenters, but collected afterward from staff. Here's Rosenhan's description:

During the first three hospitalizations, when accurate counts were kept, 35 of a total of 118 patients on the admissions ward voiced their suspicions, some vigorously.

Yet, when asked to produce documentation of these findings, it turns out 'accurate counts' were word of mouth. These should be treated as apocryphal.



re: the diagnosis. True, they were diagnosed as schizophrenics in remission. They were released, because the MDs felt they were perfectly normal. Of note, some of the MDs' charts indicated suspicion that the patients were fabricating the stories (Rosenhann's claim that the psychiatrists 'did not suspect' are somewhat dishonest in this regard) but that they were keeping the patients under observation because this is very weird behavior in its own right, and they were waiting for another shoe to drop. Also: there is a policy element to admission that Rosenhan did not address (ie: the legal liability of MDs going with their 'gut' feeling about malingering, and not following procedure, was a factor in admission, but not in diagnosis)

As it happens, by today's DSMIVR, the patients' presentation would be described as normal, with a history of one auditory hallucination episode, brief.



No, it looks about right to me. In fact, the Wikipedia article looks more like a copy/past from the original article, and I wouldn't classify it as anti-psychiatry.

The original experiment was hostile to psychiatry!

There are entire books written analyzing this! There were attempts to replicate the experimental results, but they were disappointing. (granted, it's possible that word of Rosenhan's results may have provoked cynicism in admissions) &c.

Don't get me wrong: this was a blockbuster experiment, but its lack of replicability makes the results suspicious, and the complaint that Rosenhan exaggerated the meaningfulness of the results in media interactions is quite valid.


Unfortunately, none of these are available online. However, they're probably easy to locate at most university libraries:


"Reflections on Rosenhan's "On Being Sane in Insane Places" Theodore Millon (J Abnorm Psychol. 1975 Oct;84(5):456-61)

"On Being Sane in Insane Places": A Comment from England" Sidney Crown. (J Abnorm Psychol. 1975 Oct;84(5):453-5)

"On Being Sane in Insane Places": A Process (Attributional) Analysis and Critique" by Bernard Weiner (J Abnorm Psychol. 1975 Oct;84(5):433-41.)

"On Pseudoscience in Science, Logic in Remission and Psychiatric Diagnosis" by R. L. Spitzer (J Abnorm Psychol. 1975 Oct;84(5):442-52.)

On being detectably sane in insane places: base rates and psychodiagnosis. Davis DA. (J Abnorm Psychol. 1976 Aug;85(4):416-22.)

More on pseudoscience in science and the case for psychiatric diagnosis. A critique of D.L. Rosenhan's "On Being Sane in Insane Places" and "The Contestual Nature of Psychiatric Diagnosis". Spitzer RL. (Arch Gen Psychiatry. 1976 Apr;33(4):459-70.)

On being sane in insane places-reprise. Westermeyer J, Wintrob R. (Am J Psychiatry. 1979 Jun;136(6):755-61.)



(I analyzed Rosenhan's paper, support, and critiques for my abpsych course term paper, so I've waded through this material before. Unfortunately, that was in 1987, and I've long misplaced the essay, sorry)

stamenflicker
16th July 2006, 06:39 PM
Because people go to church for many reasons! I did for many years, and I was an atheist at the time (if I didn't, I would be punished). My parents *didn't* go to church when they were younger, because they were excommunicated (they were part of a schism that disagreed with the pope's announcement on contraception). etc.

There are also many reason that people frequently fantasize about suicide. And we can go to any of these places without the word "depression."

However, as I said, there *are* psychological surveys that measure religiosity. They ask different questions, like: "are you religious?" or "Do you believe in God?"

And what if they asked, "How many times to you experience God's unconditional love in your life each week?"

A question like this is much more applicable to moods.

stamenflicker
16th July 2006, 06:58 PM
Also: religiosity is slowly proving itself to be a personality attribute, as opposed to depression. It's rare for people to yo-yo with their religiosity indexes: they are very consistent from day to day, year to year. It's more akin to other personality traits, such as extroversion or imaginativeness.

I'd say most folks don't jump religions all that often you're right... but a personality trait? I don't know, but I'm open to think about it.

In the meantime, what I would be willing to bet does yo-yo, are people's experiences of the divine. And yeah, no matter what culture you go to, you could probably phrase the question in a way they understood-- just like "depression."

These are not psychologically meaningful terms.

What meaningful terms for religious experiences exist in psychology? Let me go ahead and answer that one-- few.

You'd have to ask psychiatrists how they regard individual indexes, and my impression is that they don't really distinguish. Any index could potentially lend itself to being a 'disorder' if the patient expresses suffering for no external reason, that they want to stop, but can't.

I lean toward agreement on this point.

A thought, though: religiosity is a character of the individual, whereas depression is very transitional.

Alright, but what about any subjective state of experiencing "God?" Those come and go like 'depression', even among the most devout of religious folk.

In comparison, euphoria is a state, often experienced by the religious. Nirvana is a bad example, because depending on who you ask, it's either a temporary state, a permanent characteristic of the individual, a real place, a mystical place, or an unachieveable internal state/characteristic/physical destination/mystical destination.

I agree we need better definitions, or perhaps to find a religious state we agree on the definition for, and talk from there.

You'd have to be specific. Some are not reified because they fail validation, for example. Kundilani Awakening would be difficult to validate, because you'd have to find independent sources with a convergent understanding of its meaning.

I understand what you are saying now, correct me if I'm off base. Because depression can be validated before the concept of depression is introduced, it lends itself to greater reliability?

However, a Kundalini Awakening would need to be validated then outside the yoga tradition...?

If this is the case, then we agree. My experience with Kundalini happened long before I had the words to articulate it, yet in my search for understanding-- which incidently included schizophrenic research-- led me to believe this was the only clear explanation.

Covered in another reply.

I agree you've answered and I've avoided to this point. But there's no sense in even talking about law, if we disagree about what constitutes an "expert" witness in its delivery.

Drat. So, why don't you throw us a bone, and outline your argument?

I laid it out simply above in a handful of points. You're issue was with point #1 remember?

I'm also concerned that you're launching a semantic argument here, quibbling about words like 'state' or 'abstraction' and so on. I tend to withdraw from this when my opponents think their new weapon in a technical discussion is an on-line common-usage dictionary. I'm not sure you shed any light about what psychiatrists actually think or do by quoting it.

Words are power. There's an old Arab proverb that says, "Always learn the language of your neighbor so you can be safe from his evils."

stamenflicker
16th July 2006, 07:27 PM
The evidence at this time is not enough to personally convince me of quantum mechanics, but fortunately its scientific status does not depend on the uninformed opinions of people who don't understand it.

Here's the real issue Earthborn. Very few people understand the details of quantum mechanics. I've known people with 4th Grade educations that understand psychology-- and actually some of them were better at it that most liscensed psychologists. My wife will tell you that I see problems much more quickly and with greater acuity than she does.

"Disorder" is a value judgement: if doctors consider suicidal thoughts to be problem, then it is.

I agree.

Yes, by definition. If you create a category of inner states and call it liberalism, then that category exists, just like when you create a house that house exists.

I agree. But it doesn't exist the same way my house exists right?

Some conceivable future societies (where Ann Coulter is president) may even consider "Liberalism" an illness and attempt to cure it. That fact does not disprove the validity of psychiatry or any other form of medicine.

Nope you can't ever disprove the provers when they define what can be proved.

Depression has an actual biological component to it, although it is easier to measure after death by cutting up the brain than it is during life.

We've had an abbreviated seratonin talk. Look, I think depression may one day be proved to have a definite biological component. Actually, I rather hope it does. Of course, at that moment our dialogue gets even more testy with each other. I think you understand this because of this sentence--

However, an actual biological component by itself is never a reason to consider something a disorder, because in a biological entity everything has an actual biological component to it.

No, by expert vote.

I've already said how I feel about "experts."

Maybe you should take up a course in Philosophy of Science instead of making up reasons why mental disorders are not "real".

I've never said they aren't real. Only that I don't believe they are real apart from social construction. Again, a real what?

stamenflicker
16th July 2006, 07:31 PM
Of interest...

http://www.spiritualcompetency.com/jhpseart.html


I'm afraid I am leaving for the week and will be away until Saturday afternoon. I will return to this thread then... don't forget unless you're just fed up with me. We'll find common ground, or not. Anyway it's fun.

blutoski
16th July 2006, 08:46 PM
There are also many reason that people frequently fantasize about suicide. And we can go to any of these places without the word "depression."

Yep. Which is why the psychiatrist asks lots of questions, and the diagnostic criteria is not based on one single question. Remember: you're not the first person to ask about validation. They had to punch these through peer-review and a hundred years of practitioners' opinions.




And what if they asked, "How many times to you experience God's unconditional love in your life each week?"

A question like this is much more applicable to moods.

Only if the person's religious. I'm not religious, so I'd say 'never', no matter how happy I was.

It would, however, distinguish a religious person from a non-religious person, which is why I think it would be a good question for religiousity indices. There are usually hundreds of questions on these, because you can't make any assumptions: my sister rates very high on relgiosity, but does not believe in an anthropomorphic God capable of love. Devil worshipers are usually very religious, and of course, they would answer the above question with an emphatic 'no'.

That's why I produced an example in an earlier post of a patient who thought he was delusional, but was not, which was revealed during the normal interview process.

Dancing David
17th July 2006, 04:33 AM
What a silly statement. An immaterialist recognizes that perceived-as-physical structures are necessary for what we consider life, up to and including HPC, human/animal mental states, etc.


An ancillary question to the thread, extending into 'physically diagnosed' conditions, is why are placebos ever effective?

The entire medical establishment remains more related to witch-doctors than science way too often for my liking. :boxedin:


What have you got against witches? ;)

I agree , but the question was asked in the heat of irrational thinking on my part, you are the only immaterialst who feel you need the physical structure on this board.(exageration)

Dancing David
17th July 2006, 04:49 AM
David, sorry I've not had time to respond to your other thread. I realize that what I'm saying may sound offensive and I apologize. I'm not trying to belittle people in pain. As I stated, a very close member of my family is homeless and "mentally ill."

If you were to meet him, you'd for sure recognize he needs some kind of intervention, maybe even hospitalization. He was on meds for almost 10 years. They kept him from running off, but he was pretty much a slobbering zombie the whole time. I don't blame him one bit for coming off the meds.

Neither would I. I am of of the post 'recovery' type of mental health professional. Intervention is not warranted to prevent homelessness, as that is a social economic issue, all I can and will force intervention on is :direct evidence of threat to harm other/self, and groos impairment leading to inability tpo protect ones self from harm.

Sloppering zombie, sound like the psychotropics were haldol and prolixon, effective but way over powered medications, especialy for the treatment of a mood disorder, Again as I have said before outside of the need to preserve life, a legal construction, I do not believe in forcing intervention, and especialy I do not believe in forcing medication.


The question is, and has been, do I think he has a "real" condition. My answer has been consistent in that I don't think there is any way to know. Clearly his moods are not like mine. Whether or not he has a disorder, depends on who you talk to. He says no. Doctors say yes. Immediately family says, maybe, but he plays it up more than he has to.

I would have to meet him and talk to him, homelessness has a way of being the preffered mode of life for some people, they like the freedom and disregard the danger. Being undomiciled itself is not a product of MI, usualy more economics.

The question for an individual with bipolar disorder is : do they sleep, are they irritable almost all of the time, do they show any persistant elavated or depressed moods, do they show and display a frequent to consistant pattern of anger and over angry responses to situational stress.

The main quation is one for the individual: are you bothered by your level of functioning?


I say and live out what I believe, that really it doesn't matter if he has a real disorder. He needs love and compassion-- and those things alone are methods of healing, even if he never becomes as "normal" as my wife and I. I put normal in quotations because obviously I don't think such a thing is real outside of our perceived values.


I agree unless it is the town next to Bloomington IL. Normal as a human condition is usualy fairly miserable any how.


I'll look up the ADHD numbers.

As to your question about observable behaviors, I don't have a problem with accepting them. However, when we do this, we logically have to accept about anything. Such as "church attendance" as an event which justifies whatever we want to prove.


I understand the analogy, but church attendance would be an observable behavior that indicates someone being a participant in a social group, it does not indicate the motivation of the individual who attends, you have to ask them and then judge the validity of the response.

mental health is about where alchemy was when Levosier came along, part science, mostly conjecture and hopeful thinking. A good set of ethics is very helpful, I am of the 'benign neglect' school of intervention.

But observable behaviors are used in many settings to determine possible internal states of individuals as a way of gauging the verbal reports validity, like the 'observed pain scale' used in the emergency department. Sometime you have better data than others.


Hope that helps.

Dancing David
17th July 2006, 05:05 AM
From Thomas Szasz The Myth of Mental Illness found here
http://psychclassics.yorku.ca/Szasz/myth.htm


This position implies that people cannot have troubles -- expressed in what are now called "mental illnesses" -- because of differences in personal needs, opinions, social aspirations, values, and so on. All problems in living are attributed to physicochemical processes which in due time will be discovered by medical research.


Ah I remeber now, but we do have to put this comment in perspective, at the time 1960, modern psychiatry was dominated by psychogenic models and psychotherapy of the Freudian sort. people were being 'regressed' for no good reason and told they had to understand their childhoods to get well. Most succesful adults were thinking that they needed weekley therapy sessions for years and years and years.

Not the current best practise.

This position implies that people cannot have troubles

No it doesn't, that is an overgeneralization, no decent clinician would feel that human problems are generated by mental illness. Especialy the following part

because of differences in personal needs, opinions, social aspirations, values, and so on,
these are now considered to be a framework and supporting cast of characters. I am not sure that this position was supported by anyone at the time.

All problems in living are attributed to physicochemical processes which in due time will be discovered by medical research.


This was a bold assertion even for 1960, but i am sure that there were people out ther claiming that all social ills were caused by an unbalanced psyche. There are still those who do so, they are mainly newspaper journalists and pop psych and woo psych individuals.


Poblems in living are problems in living, to assume that a mental health perspective will assume that homelessness is not a social economic condition is a bold mistake, domestic violence and sexual trauma can cause people to have depression, it is not the root cause.

More later, time to go to the loony prison and force treatmen on people, to thier detriment and the oppression of society, Mwaa haaha, I love the untold power and riches it brings! ;)

kurious_kathy
18th July 2006, 12:30 PM
Yep. Which is why the psychiatrist asks lots of questions, and the diagnostic criteria is not based on one single question. Remember: you're not the first person to ask about validation. They had to punch these through peer-review and a hundred years of practitioners' opinions.






Only if the person's religious. I'm not religious, so I'd say 'never', no matter how happy I was.

It would, however, distinguish a religious person from a non-religious person, which is why I think it would be a good question for religiousity indices. There are usually hundreds of questions on these, because you can't make any assumptions: my sister rates very high on relgiosity, but does not believe in an anthropomorphic God capable of love. Devil worshipers are usually very religious, and of course, they would answer the above question with an emphatic 'no'.

That's why I produced an example in an earlier post of a patient who thought he was delusional, but was not, which was revealed during the normal interview process.
Do you really think someone has to be religious to come to the conclusion that sin is real and the devil is a liar? I don't. I think each one of us has a certain amount of realitybuilt in to the concept of sin. It is something we are born into and until we acknowlege it and try to find a way to deal with it, it can and does plaugue our society.

I have been through recovery programs that were court ordered after my DUI 2 years ago and they left me knowing there is still more that needs to be acknowledged to help the captives be set free from the self destruction sin causes in our lives. This recovery program better covers what I went through to get out from under the control of substance abuse and sin that was ruining my life, here's a link if anyone cares to ponder these truths...
http://www.onesteptofreedom.org/
I know it worked for me and many others out there that use to be in bondage.

Tricky
18th July 2006, 12:49 PM
Do you really think someone has to be religious to come to the conclusion that sin is real and the devil is a liar?
Actually, yes. "The devil" is a purely religious concept.

I don't. I think each one of us has a certain amount of reality built in to the concept of sin. It is something we are born into and until we acknowlege it and try to find a way to deal with it, it can and does plaugue our society.
Each of us has a moral code, by which they judge right and wrong, but "sin" is most often considered to be an offense against religious law, although is sometimes considered an offense against moral law. But we are not just born with it. Much of it is taught, which is why morality varies so much from place to place.

I have been through recovery programs that were court ordered after my DUI 2 years ago and they left me knowing there is still more that needs to be acknowledged to help the captives be set free from the self destruction sin causes in our lives. This recovery program better covers what I went through to get out from under the control of substance abuse and sin that was ruining my life, here's a link if anyone cares to ponder these truths...
http://www.onesteptofreedom.org/
I know it worked for me and many others out there that use to be in bondage.
I am glad you are getting help for your problem. My dad was big in AA and so I know a lot about 12-step programs, including the acknowledgement of a "higher power". I also know that many do not consider this higher power to be "God". And it works about as well as anything, although Rational Recovery (http://www.rational.org/faq.html) also has good success without any religious overtones. But believing in God helps you stay off booze, I'm very happy for you. All too frequently, though, people who have such experiences tend to think that because they were successfull, that proves God exists. (Believe me, I heard plenty of them among my Dad's AA friends.) This is not the case.

hammegk
18th July 2006, 12:55 PM
Interesting thread. Which disorder will be first formalized in DSM-XX; belief in god, or belief that god does not exist?

kurious_kathy
18th July 2006, 01:17 PM
Actually, yes. "The devil" is a purely religious concept.


Each of us has a moral code, by which they judge right and wrong, but "sin" is most often considered to be an offense against religious law, although is sometimes considered an offense against moral law. But we are not just born with it. Much of it is taught, which is why morality varies so much from place to place.
No the reality is this world is being run by satan and his demons until Jesus comes back and reigns again on earth. He has promised to make the lion lay down with the lamb someday. It will take an act of God to take away the sins of this world once and for all. It will happen and the whole idea of being in a perfect world like heaven someday gets me excited. This world is not my home. I wish you could want that for yourself.

And what is mans morility compared to God's Holiness? We need Him to make us holy and make us new. It may sound religious, but it's not this is the reality. All were created to have a relationship with the creator, but because of free will it got really messed up. I'm not into religion, I'm into having a relationship with God through receiving Christ. It is true!

Truth is the only thing that sets ones mind at ease. Deny Him all you want, but I never will. I love Jesus because He is Holy!

Tricky
18th July 2006, 01:35 PM
No the reality is this world is being run by satan and his demons until Jesus comes back and reigns again on earth. He has promised to make the lion lay down with the lamb someday. It will take an act of God to take away the sins of this world once and for all. It will happen and the whole idea of being in a perfect world like heaven someday gets me excited. This world is not my home. I wish you could want that for yourself.

And what is mans morility compared to God's Holiness? We need Him to make us holy and make us new. It may sound religious, but it's not this is the reality. All were created to have a relationship with the creator, but because of free will it got really messed up. I'm not into religion, I'm into having a relationship with God through receiving Christ. It is true!

Truth is the only thing that sets ones mind at ease. Deny Him all you want, but I never will. I love Jesus because He is Holy!
Where were you when I was selling insurance?

kurious_kathy
18th July 2006, 08:42 PM
Where were you when I was selling insurance?
Hiding under a rock so no one else could do me harm. This world is full of choices, so whos side are you on?

ceo_esq
18th July 2006, 09:40 PM
Interesting thread. Which disorder will be first formalized in DSM-XX; belief in god, or belief that god does not exist?

I daresay that neither side would ever want to classify as a mental disorder the belief that God does not exist.

Tricky
18th July 2006, 09:42 PM
Hiding under a rock so no one else could do me harm. This world is full of choices, so whos side are you on?
Odd you should feel that way. Insurance isn't harmful. It is a hedge against unlikely events for which you pay a premium so as not to suffer just in case bad events happen.
Christianity is like insurance, at least the way you describe it, except it is much more dishonest than real insurance. If you are worried that death may bring bad things, you take out an insurance policy with Jesus so that just in case there is a life after death, your soul will be covered. Of course, there is no way to get your money back in case the insurance salesmen were wrong. And there is not a single verifiable example of anyone collecting on a claim.

So if you buy their policy, they get a pliant servent to help them push their policies to others (and occasionally they'll suggest you give them money). You get nothing but a promise. No, it's not even God's promise. It is the promise of the "heaven realtors". You don't get to see what they promise. You can't complain if it isn't there once you die. It is the perfect scam. And they sell it. They sell a LOT of it. And people buy it. People like you, Kathy.

hammegk
19th July 2006, 06:15 AM
I daresay that neither side would ever want to classify as a mental disorder the belief that God does not exist.
Yeah, death to the unbelievers remains an option in any case.

nescafe
19th July 2006, 06:36 AM
Christianity is like insurance, at least the way you describe it, except it is much more dishonest than real insurance. If you are worried that death may bring bad things, you take out an insurance policy with Jesus so that just in case there is a life after death, your soul will be covered. Of course, there is no way to get your money back in case the insurance salesmen were wrong. And there is not a single verifiable example of anyone collecting on a claim.

Yeah. Christianity is not nearly as good an insurance policy as the Church of the SubGenius when it comes to salvation. At least the CotS offers triple your money back if you are not saved after paying the membership fee.

Meffy
19th July 2006, 08:19 AM
This world is full of choices, so whos side are you on?
I'd guess that most of us are on your side, though you don't seem able to see it. You're under the sway of a group that has an interest in maintaining your dependency on them. People who would like to see you kick that dependency are not your enemies. Think about it.

kurious_kathy
20th July 2006, 05:29 PM
Odd you should feel that way. Insurance isn't harmful. It is a hedge against unlikely events for which you pay a premium so as not to suffer just in case bad events happen.
Christianity is like insurance, at least the way you describe it, except it is much more dishonest than real insurance. If you are worried that death may bring bad things, you take out an insurance policy with Jesus so that just in case there is a life after death, your soul will be covered. Of course, there is no way to get your money back in case the insurance salesmen were wrong. And there is not a single verifiable example of anyone collecting on a claim.

So if you buy their policy, they get a pliant servent to help them push their policies to others (and occasionally they'll suggest you give them money). You get nothing but a promise. No, it's not even God's promise. It is the promise of the "heaven realtors". You don't get to see what they promise. You can't complain if it isn't there once you die. It is the perfect scam. And they sell it. They sell a LOT of it. And people buy it. People like you, Kathy.
Do you really believe Chrisitianity is a scam? I think that's pretty sad if you do. Salvation is free my friend. Faith to choose to believe is too!
I know there have been many false teachers and false religions in this world, but the Word of God stands all by itself. You don't even have to go to church to read it, it's free. And if I could encourage anyone to stop, look and listen all on their own to ask God to reveal the truth to them, then this is what I pray for. The true miracle in this world is faith and God can give it to you free of charge, all we must do is want it and ask. Seek and you will find, knock and it will be opened to you!

Man made religion is not something I'm interested in, but faith is. We can have it just by choosing to believe. The bigger problem is people don't care to try anymore, why?

I have been pretty excited lately about this new satellite station called NRB. Has anyone here seen it? They seem to have what I would say is definitely more of the good solid Bible teaching going on 24/7. No hype just good stuff. So far everyone I've seen on this telecast has been more real.

Dancing David
22nd July 2006, 07:01 AM
More from Szasz
In the area about assuming MI as brain illness

In the first place, what central nervous system symptoms would correspond to a skin eruption or a fracture? It would not be some emotion or complex bit of behavior. Rather, it would be blindness or a paralysis of some part of the body. The crux of the matter is that a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, and not a problem in living


I do grant that Szasz wrote this a long time ago, but the basic idea is that there are regulatory problems under the symptoms of mental illness, thery may be caused by regulatory disorders from a nuerological defect, such as autism. Or in the case of depression a lack of appropriate regulation in the complex anatomy of the brain, like a timing chain slipping in a car.

But here Szasz empasises the 'problem in living', at the time he wrote this, cognitive behavioral theory was just about to happen, Ellis had not yet formed rational Emotive therapy, or the other behavioral based interventions. The predominant theories at the time were psychogenic in nature, and they are no longer exactlt mainstream, although psychotherapy and existential therapy do exist.

But you can have the person change the behaviors and address thier problems in living and the persistant sad mood still exists .

What then the sad mood still is reported , as is the lack of energy and motivation, the problems sleeping etc?

Some people do not need medications , they will respond solely to the behavioral interventions, but what about the people who don't , how does that remain solely a problem in living?

…..
The second error in regarding complex psycho-social behavior, consisting of communications about ourselves and the world about us, as mere symptoms [p. 114] of neurological functioning is epistemological. In other words, it is an error pertaining not to any mistakes in observation or reasoning, as such, but rather to the way in which we organize and express our knowledge. In the present case, the error lies in making a symmetrical dualism between mental and physical (or bodily) symptoms, a dualism which is merely a habit of speech and to which no known observations can be found to correspond. Let us see if this is so. In medical practice, when we speak of physical disturbances, we mean either signs (for example, a fever) or symptoms (for example, pain). We speak of mental symptoms, on the other hand, when we refer to a patient's communications about himself, others, and the world about him. He might state that he is Napoleon or that he is being persecuted by the Communists. These would be considered mental symptoms only if the observer believed that the patient was not Napoleon or that he was not being persecuted[sic] by the Communists. . This makes it apparent that the statement that "X is a mental symptom" involves rendering a judgment. The judgment entails, moreover, a covert comparison or matching of the patient's ideas, concepts, or beliefs with those of the observer and the society in which they live. The notion of mental symptom is therefore inextricably tied to the social (including ethical) context in which it is made in much the same way as the notion of bodily symptom is tied to an anatomical and genetic context (Szasz, 1957a, 1957b).
]

I understand where szasz appears to be coming from, thier are problems in communication that create difficulties in the human condition.

But Stamen, he here is making specific reference to delusions, he is ignoring the fact that there is a biological basis for the way the brain works, unless you support immaterialsm.

He is specificaly saying that delusions are a product of social communication issues, and while that is true, delusions create a specific threat when they involve the paranois are bizzare elements.

people do try and do kill people because of delusional beliefs, I would say that is an extreme communication problem.

And you say Stamen, that you count schizophrenia as possibly a real menatl ilness, you are aware I assume that there are people who when depressed or manic hear voices and experience delusions? People with OCD can have the same intensity of belief as a person with delusions, they just recognise the irrational nature of the belief.

I don't see how needing to count steps to avoid a panic attack is a 'problem in living', it is a problem that effects behavior, but changing the person's life is not going to make the compulsions go away.


I agree with Szasz, there are many people who do not need mental health treatment, there are people who do attempt to medicate conditions other than mental illness, but that in and of itself does noty preclude mental illness, there are those who change thier lives and still suffer.

stamenflicker
22nd July 2006, 08:30 PM
Only if the person's religious. I'm not religious, so I'd say 'never', no matter how happy I was.

So then the category remains undefined for you. So if I don't believe in "depression" then am I never "depressed" no matter how sad I feel?

stamenflicker
22nd July 2006, 08:35 PM
I understand where szasz appears to be coming from, thier are problems in communication that create difficulties in the human condition.

But Stamen, he here is making specific reference to delusions, he is ignoring the fact that there is a biological basis for the way the brain works, unless you support immaterialsm.

I'm not a materialist, nor an immaterialist. I'm just stating that the jury is still out on these matters, and that I need more evidence before jumping on the materialist bus in matters of mood.

And you say Stamen, that you count schizophrenia as possibly a real menatl ilness, you are aware I assume that there are people who when depressed or manic hear voices and experience delusions? People with OCD can have the same intensity of belief as a person with delusions, they just recognise the irrational nature of the belief.

I recognize that this is standard procedure.

I agree with Szasz, there are many people who do not need mental health treatment, there are people who do attempt to medicate conditions other than mental illness, but that in and of itself does noty preclude mental illness, there are those who change thier lives and still suffer.

Again, mental illness is real. But I ask "a real what?" And I've not been convinced that much of it exists outside social construction.

blutoski
23rd July 2006, 01:05 AM
Again, mental illness is real. But I ask "a real what?" And I've not been convinced that much of it exists outside social construction.

I think I'll have to ask you to elaborate on what that means, exactly, as it sounds like basic postmodernism.

Recall: science is an example of a social construction.

blutoski
23rd July 2006, 01:12 AM
So then the category remains undefined for you. So if I don't believe in "depression" then am I never "depressed" no matter how sad I feel?

It's not undefined, it's a real negative.

Atheists live and grow up in a religious world. We know what religious people mean when they say 'God'. We know 'love' from secular experience. I have not felt God's love in the same way that I have not felt Winnie The Pooh's love. It's not required that I believe Pooh is real to know it hasn't happened, as such.



In the case of a sad person, it is possible that they have never even heard of the word depressed. We can ask other questions: do you feel like killing yourself? Why? Do you feel like getting up in the morning? Do you have hobbies or activities you enjoy? Have you given all your posessions away lately? &c.

These are universal signs of depression, and a person exhibiting them is usually depressed, no matter what they call it.

Dancing David
23rd July 2006, 06:08 AM
The issue with comparing religous beleief to menatl illness, hmm?

A person can state that they have a mental illness, or a person can state that the have personal knowledge of god, correct. And that neither is dierectly observable? Right.

Well that is a fine point, I will grant you that.

But the question for mental health professionals is not the lable that is used to address the issues in a persons life, it is getting them to the point where they are functioning in thier lives.

So while the underlyiong condition can not be verified or fully understoodm what is addressed is the decrease in role functiong, which can be gauged through observation and self report. If a perwson is having great difficulties maintaining thier lives and they improve that functiong then the benefit is there.

Some people benefit from medication some do not. Those that benefit from medication are more likely to be the ones with mental illness.

The issue of wether mental illness is endogenous or exogenous is moot, if the person suffers a decrease in role function that is detrimental to thier lives.

The fact that aperson goes to church is an observable behavior, as is thier self report of thier experience, the issue is one of world view in both cases.

I do not attribute the religous experience to anything other than brain states, no devine interventions needed. But then i am a materialst.

What eveidence is there which supports immaterialism and the non-physical nature of human reality Stamen.

You also whipped out Szasz and then totalay didn't respond to my attempted critique.

All evidence, unless you believe in the magic behind the curtain theory points to materialism being correct, there is no evidence os immaterial components to reality at this time.

stamenflicker
23rd July 2006, 09:34 PM
It's not undefined, it's a real negative.

Well, for starters, "Depression" is not undefined for me. I know what one means when they use the term, and I have a negative-to-netural feeling about it. However, I fail to see where I am required to believe it exists, as you seem to think I must.

Atheists live and grow up in a religious world.

I've grown up in a world of psych definitions too.

We know what religious people mean when they say 'God'. We know 'love' from secular experience.

I know what psychologists mean when they say "depressed." I know sadness from secular experience.

I have not felt God's love in the same way that I have not felt Winnie The Pooh's love. It's not required that I believe Pooh is real to know it hasn't happened, as such.

I have not felt depressed in the same way that I have not felt Brother Maynard's carrot angst. Sorry for the Tool reference.

In the case of a sad person, it is possible that they have never even heard of the word depressed. We can ask other questions: do you feel like killing yourself? Why? Do you feel like getting up in the morning? Do you have hobbies or activities you enjoy? Have you given all your posessions away lately? &c.

We can ask these questions. That's great.

These are universal signs of depression, and a person exhibiting them is usually depressed, no matter what they call it.

These are universal signs of what we identify as depression, because quite frankly, we choose to do so. That you choose to identify whatever mood you have as being religious or a-religious is again a choice.

stamenflicker
23rd July 2006, 09:37 PM
What eveidence is there which supports immaterialism and the non-physical nature of human reality Stamen.

You also whipped out Szasz and then totalay didn't respond to my attempted critique.

All evidence, unless you believe in the magic behind the curtain theory points to materialism being correct, there is no evidence os immaterial components to reality at this time.

If we want to debate materialism vs. immaterialism, I suggest another thread. I'm only pointing out that the "evidence" isn't conclusive in the matter of moods.

As for Szasz, I wouldn't deem myself a follower so much as I think he asks the right questions.

stamenflicker
23rd July 2006, 09:39 PM
I think I'll have to ask you to elaborate on what that means, exactly, as it sounds like basic postmodernism.

Recall: science is an example of a social construction.

It's about the choice you assume I should make in one category of things as opposed to another. Yet, you offer no real logical reason why I should.

Dancing David
24th July 2006, 06:32 AM
It comes down then to the philospohy of science and the defintion of theory.

a. I state there is no observable immaterial component to emotions.
b. you state that there might be.


Okay.

But in the case of the two theories describing human behaviors.

we have

a. a person reports a persistant sad mood.
b. a person reports an experience of god.

Theory A1
There is a physical brain state which creates a persistant sad mood, wether the state is created by an internal imbalance or external stress is irrelevant, there is a persistant state that does not elevate.

Theory A2
There is a sad mood , it is called depression for the sake of human communication.

Between theory A1 and A2, what predicatble outcomes are there which might verify either?

There is no discernable difference, unless we take A2 to mean, there are no physical states involved in a persistant sad mood.


Then we come to the experience of god.

Theory B1
There is some sort of immatterial 'divine' being capable of creating changes in the material world, although his being is immatterial.

Theory B2
There are human experiences which are a consequence of having an organic brain. this experiences are human induced states and they are related to brain states solely.

What about these two theories?

As of yet there is no evidence for a divine being, although any violation of the natural progession of physics would be a clear demonstration of god.

stamenflicker
25th July 2006, 05:27 AM
But in the case of the two theories describing human behaviors.

we have

a. a person reports a persistant sad mood.
b. a person reports an experience of god.

Theory A1
There is a physical brain state which creates a persistant sad mood, wether the state is created by an internal imbalance or external stress is irrelevant, there is a persistant state that does not elevate.

Theory A2
There is a sad mood , it is called depression for the sake of human communication.

Between theory A1 and A2, what predicatble outcomes are there which might verify either?

There is no discernable difference, unless we take A2 to mean, there are no physical states involved in a persistant sad mood.


Then we come to the experience of god.

Theory B1
There is some sort of immatterial 'divine' being capable of creating changes in the material world, although his being is immatterial.

Theory B2
There are human experiences which are a consequence of having an organic brain. this experiences are human induced states and they are related to brain states solely.

What about these two theories?

As of yet there is no evidence for a divine being, although any violation of the natural progession of physics would be a clear demonstration of god.

You miss my point. I'm not making any claims that God exists in this thread.

I'm making the case that when it comes to moods, we change our logic mid-stream sometimes. Something like "depression" is much more likely understood via inductive reasoning than deductive.

Once again, I don't need to outline the defintion of "depression" to understand what sadness means anymore than I need to outline the existence of a specific deity to understand a divine experience.

My point is that the world seems comfortable using inductive reasoning to create some "states," while rejecting others via deduction.

Blutoski has tried to point out that all cultures know what depression is, even if they don't have a name for it. I'm just noting that they also likely all know what the experience of god is as well, even if they don't have a name for it. And I would make a pretty safe bet that more people in the world have had the experience of god, than the experience of depression-- giving us a much safer "sample size" from which to draw our inductions.

As to your theories, I obviously lean toward A2. I didn't really follow the B1 or B2 theories.

Avita
25th July 2006, 05:51 AM
People have consistently pointed out to you your own changes in logic mid-stream, and you have yet to explain why you do so. But putting that aside for now...

On the one hand, you insist that depression is "nothing more" than a social construct. On the other hand, you seem to be viewing depression as something that happens in isolation from the rest of the person's life. In other words, you consistently ignore the fact that we know that certain mental states affect people's lives in predictable ways.

If a person says "I believe in God," or even, "I have experienced God's love," do you have any idea what that implies about that person's life? No, you don't, because religion is entirely a social construct, and therefore, you can't tell which behaviors (and other beliefs) will follow from a belief in God, unless you know which God that person believes in. The consequences of a Christian Fundamentalist's belief in God versus the consequences of a Maasai tribesman's belief in God(s) will be very different, even if they are both experiencing the same state of religious feeling.

The same cannot be said of mental disorders. Yes, people are different, and their social circumstances are different, and therefore, everyone will experience, a particular mental disorder a little differently. However, we can predict with a high degree of certainty that someone in the state called depression will behave in ways designed to minimize expended energy, and will have some associated beliefs (hopelessness, for instance). And this will happen no matter the person's social circumstances. That's the difference.

Miss Whiplash
25th July 2006, 06:19 AM
Stamenflicker sounds like Tom Cruise spouting Sciencetology. I've suffered from chronic depression for more than 20 years. There is definately an organic reason. Psychotherapy does little but medication does. There is also evidence it is hereditary.

Stamenflicker should have the joy I experienced not long ago. A happy, seemingly well adjusted family member shot themselves out of the blue due to a break with reality. I'm sure he could explain it all away.

stamenflicker
25th July 2006, 11:43 AM
If a person says "I believe in God," or even, "I have experienced God's love," do you have any idea what that implies about that person's life? No, you don't, because religion is entirely a social construct, and therefore, you can't tell which behaviors (and other beliefs) will follow from a belief in God, unless you know which God that person believes in. The consequences of a Christian Fundamentalist's belief in God versus the consequences of a Maasai tribesman's belief in God(s) will be very different, even if they are both experiencing the same state of religious feeling.

But there is research out there, and probably more would exist should we set our prejudices aside. I would only point you to "The Psychology of Religion: An Empirical Approach" by Hood, et. al. as a place to begin.

The same cannot be said of mental disorders. Yes, people are different, and their social circumstances are different, and therefore, everyone will experience, a particular mental disorder a little differently. However, we can predict with a high degree of certainty that someone in the state called depression will behave in ways designed to minimize expended energy, and will have some associated beliefs (hopelessness, for instance). And this will happen no matter the person's social circumstances. That's the difference.

The only reason that we can do anything you've posted here is because we first decided that these signs and associated beliefs indicate a state we call "depression." We fail to decide inductively anything about religious states prior to making a deductive analysis of the deity in question.

Dave1001
25th July 2006, 11:53 AM
I think it's kind of categorical to say that there are no psychiatric disorders. But, I'm also skeptical about how and why quite a few are diagnosed. For example, huge numbers of people in recent years have been diagnosed with bipolar disorder (manic depression) as a lifelong, chronic illness, and have been prescribed various drugs for it. Given that the diagnosis process is a checklist rather than a blood sample or an MRI, and it then effectively sentences someone to a lifetime of taking the drugs, I am a bit skeptical and suspect that the disorder is being overdiagnosed.

Diagnoses of temporary, situational depression, I'm a much less skeptical about. Medication can help smooth things over while while the person works to improve the areas of their life that are depressing them.

Dancing David
26th July 2006, 06:21 AM
You miss my point. I'm not making any claims that God exists in this thread.

I'm making the case that when it comes to moods, we change our logic mid-stream sometimes. Something like "depression" is much more likely understood via inductive reasoning than deductive.

Once again, I don't need to outline the defintion of "depression" to understand what sadness means anymore than I need to outline the existence of a specific deity to understand a divine experience.

My point is that the world seems comfortable using inductive reasoning to create some "states," while rejecting others via deduction.

Blutoski has tried to point out that all cultures know what depression is, even if they don't have a name for it. I'm just noting that they also likely all know what the experience of god is as well, even if they don't have a name for it. And I would make a pretty safe bet that more people in the world have had the experience of god, than the experience of depression-- giving us a much safer "sample size" from which to draw our inductions.

As to your theories, I obviously lean toward A2. I didn't really follow the B1 or B2 theories.

So it gets back to nothing to do with sasz or wether mental illness exists or not but the validity of the report of the person being assessed as having the potential state we refer to as mental illness, in the case of a theist vs. the case of the person with a persistant sad mood the point is one of interpretation.

In the case of the person with the persistant sad mood, there is not the interpretation that an irrational being has possessed them and is creating the persistant sad mood, in the case of the theist the interpretration is that there is an irrational being intervening and doing supernatural things for the theist.

So in terms of the subjective experience, one is saying that they have a persistant sad mood and the other is saying that a divine being has interefered in thier life, the one at least contains q plausible explanation, a persistant biological state which creates a sad mood, while the other involves the biolation of the laws pf physics as we know them.

So make you point because to me , it seems that you are just saying that the report of a persistant sad mood is as ridiculous as the report of god?

This thing we term depression , and they are just terms of convinience in the DSM-IV-R, as aknoledged by the creators of said document, is very similar to pain, gastric distress and dizzyness, those are treated by doctors evrey day, pain is primarily assessed by the report of the person, with a judgement of the validity of the report and observable things that are assumed to be related to the pain, same for gastric upset and GERD or nausea and dizzyness.

It comes down to assessing the validity of the persons' report.

In the case of theism, i assume that the validity of the report is accurate, the person very likely does believe that thier religous practise is beneficial, but the interpretation of the events is where I differ.

Dancing David
26th July 2006, 06:34 AM
The only reason that we can do anything you've posted here is because we first decided that these signs and associated beliefs indicate a state we call "depression." We fail to decide inductively anything about religious states prior to making a deductive analysis of the deity in question.

If you ignore the history of psychology from shamanism through it's current mix of art vs, science , yes. But in the begining the theory was demonic possesion or imbalance of spiritual powers.

Then the theory was that these people had psychogenic routes to develop mental illness, the current theories are mixed, there are a minority of practioners who still follow the psychogenic schools.

But most practioners will tell you the same thing, that mental illness has three components, a biological component , a psychological component and a social component. The vast majority of people who seek mental health treatmen recieve it for a very short time, a year or less and thier problems resolve without resort to long term medication, in fact most people seek just talk therapy(which is another issue, as I believe it should never last more than twelve sessions.)

But there are plenty of deductive indicators used in a good assesment, one should ask the person alot more than "Do you have a persistant sad mood?'

The issue in treatment is very rarely , does this person have a biological condition that causes them to have a sad mood? The good practioners will view the individual in all three realms and recomend changes in social and psychological behaviors , medication is considered to reduce the symptoms of the medicaly assumed state, wether they are palative or not is immaterial. The goal is to reduce the symptoms to improve the person's functioning. Most practioners assume that the bulk of people in treatment have exogenous states, that will occur as a result of stress. The ones who seek long term treatment are the ones who appear to have the underlying biological condition, although given the number of people with post traumatic stress disorder, there are a lot of people who have symptoms due to trauma.

And then you were talking about the Zombie Nation of Overtreated Individuals as a side bar, with no evidence that it occurs.

Dancing David
26th July 2006, 06:54 AM
I think it's kind of categorical to say that there are no psychiatric disorders. But, I'm also skeptical about how and why quite a few are diagnosed. For example, huge numbers of people in recent years have been diagnosed with bipolar disorder (manic depression) as a lifelong, chronic illness, and have been prescribed various drugs for it. Given that the diagnosis process is a checklist rather than a blood sample or an MRI, and it then effectively sentences someone to a lifetime of taking the drugs, I am a bit skeptical and suspect that the disorder is being overdiagnosed.

Diagnoses of temporary, situational depression, I'm a much less skeptical about. Medication can help smooth things over while while the person works to improve the areas of their life that are depressing them.


The diagnosis of bipolar depressive disorder is very difficult and the problem as I see it is the number of general physicians who make the diagnosis. The checklist should always be viewed as what it is, a diagnostic and statistical tool that a physician uses to determine an appropriate label that then leads to succesful treatment.

There are a number of issues in the over diagnosis of bipolar disorder:

a. Hospitals do not recieve reimbursment for treating those with substance induced disorders, so while the correct diagnosis would be 'some condition induced by a substance', you would loose meoney for treating individuals who are at substantial risk of harming themselves or others.

(And as a side bar, it is very hard to get into the hospital in the first place.)

b. The prevalence of individuals who use alcohol, methamphetamine and cocaine. All substances can aggravtae people's lives and give them secondary features of a mental illness. A lack of co-occurrent substance abuse treatment is very detrimental, and the place where GP's often fail.

c. Lack of in depth assessment, most psyciatrists take a short time to do an assesment, 45 mins. to an hour. Something that GP's rarely have time for. There are a lot of people who have post traumatic stress, but you won't find that in a fiveteen minute interview. It usualy takes a lot of time, at least an hour , to get people to trust you enough to discuss trauma. So many people wh9o are diagnosed with bipolar disorder are actualy living with PTSD.

d. The eleventh hour syndrome, people, especialy those looking for help with thier children, almost never get help when the horse is just sticking thier head out the barn door, they usualy get help only after the horse has run away and the barn has burned down. this makea accurate assessment very difficult.

e. Denial: it is such a strong mechanism that iot intereferes in all human interactions, A just interview involves asking the person many clarifing issues, take the last flavor of the month, attention deficit hyperactive disorder', you have to ask the person alot of specific behavioral questions to get a good assessment.A child in school may be harrassed, have a parent beating the crap out of them or a learning disability and they are reffered for 'find out if they have ADHD', it helps to know how the child behaves in all enviroments before making the diagnosis.

f. The 'identified client' syndrome, very often the person seeking treatment is not the one with the actual problem.


Now, there are many bad psychiatrists who just perscribe the crap out of thier favorite meds, and if thier favorite med is a bipolar medication, then off they go.

Krandal2
26th July 2006, 04:28 PM
Stamenflicker,

I'd be quite willing to classify being born again as a kind of psychological state, with a typical set of behaviors and beleifs etc. that is comparable in some ways to being in a state of depression. But as far as I can tell no one here is suggesting that depression is a real experience, adn that being born again isn't. I fail to see what your point is?

Perhaps you believe, that if a person admits that religious experiences are real, they must at the same time admit that the beleifs *behind* the experience must be real too? But this is hardly the case. Going back to depression, many severely depressed people carry negative beleifs about themselves and the world, that are obviously false, but this doesn't make their depression any less real.

Why hold religious "states" to a different standard? (and btw, I happen to beleive many religous experiences, and the beleifs behind them often do have thier origin in an objective reality.)

stamenflicker
27th July 2006, 05:56 AM
So make you point because to me , it seems that you are just saying that the report of a persistant sad mood is as ridiculous as the report of god?

No. The report of a persistant sad mood as being any sort of "thing" lacks evidence, just as there is the report that a person experiences god lack evidence.

That one might be able to find more evidence, or agree on the "thing" we have dubbed depression, is a reflection of human volition, not scientific reason, logic, or empirical fact.

stamenflicker
27th July 2006, 06:20 AM
I fail to see what your point is?

Most of this started when I said that I don't really believe in mental illness. On a skeptics board, no less. Perhaps I would have been better to say I'm a mental illness agnostic??

First came a slew of insults hurled at me as being some kind of uncompassionate person.

All that coupled with assertions that it was real-- most of the strongest defenses came from either:

a) a person who has experienced it
b) a person who works in mental health

When pointing this out, I'm accused of sounding like an ID'r. Yet, were this a religious discussion, as a Christian, I expect that my self-reports of anything spiritual in nature would be immediately recognized as biased by my experience. Naturally then, we have to assume that the poster's are trying to tell me that the discussions of religious moods and the discussion of "other moods" are somehow fundamentally different.

I reject this conclusion, and it demonstrates the kind of faulty thinking will one day become in future governments, a source of power over people and their moods. All in the name of benevolence.

If you think I'm wrong then ask yourself why do we even need a Child Medication Safety Act?????

And listen to the APA froth at the mouth over it:

http://www.apa.org/ppo/issues/cmsa1170.html


So I'm told basically that these mental "states" which exist because of surveys, studies, reports from highly intelligent observers are to be given power over me by my benevolent benefactors??? Sounds like the Catholic Church of the middle ages to me.

Krandal2
27th July 2006, 09:28 AM
Most of this started when I said that I don't really believe in mental illness. On a skeptics board, no less. Perhaps I would have been better to say I'm a mental illness agnostic??

First came a slew of insults hurled at me as being some kind of uncompassionate person.

All that coupled with assertions that it was real-- most of the strongest defenses came from either:

a) a person who has experienced it
b) a person who works in mental health

When pointing this out, I'm accused of sounding like an ID'r. Yet, were this a religious discussion, as a Christian, I expect that my self-reports of anything spiritual in nature would be immediately recognized as biased by my experience. Naturally then, we have to assume that the poster's are trying to tell me that the discussions of religious moods and the discussion of "other moods" are somehow fundamentally different.



Yes. But the fundamental difference between being born again and being depressed is not that one is a "real" state and the other is not, but that the first has a (usually) positive psychological effect, while the latter is destructive, making it a mental *illness*. and thats the issue here. You're claiming that mental illness *doesn't exist* and mood disorders *don't exist*, and the people here are (rightly so) trying to explain to you why they think you're wrong.

You're also questioning many of the assumptions and much of the authority of the psychiatric community, which I applaud, but I consider the idea that mental disorders don't exist as ludicrious as the idea that religious transformation doesn't exist or occur. Both clearly do.



I reject this conclusion, and it demonstrates the kind of faulty thinking will one day become in future governments, a source of power over people and their moods. All in the name of benevolence.



ok, but whether or not mental illness's exist and whether or not those trusted to treat mental illness's are given far too much authority are two *very* seperate questions.


If you think I'm wrong then ask yourself why do we even need a Child Medication Safety Act?????

And listen to the APA froth at the mouth over it:

http://www.apa.org/ppo/issues/cmsa1170.html


So I'm told basically that these mental "states" which exist because of surveys, studies, reports from highly intelligent observers are to be given power over me by my benevolent benefactors??? Sounds like the Catholic Church of the middle ages to me.

I agree that coercing parents into medicating their children is reprehensible, and that parents and teachers all too often resort to medicating problems that could be treated in other ways, but again to jump from this to the conclusion that mental illness is merely a social construct with no basis in reality, is way too much for me.

Dancing David
28th July 2006, 10:49 AM
No. The report of a persistant sad mood as being any sort of "thing" lacks evidence, just as there is the report that a person experiences god lack evidence.

That one might be able to find more evidence, or agree on the "thing" we have dubbed depression, is a reflection of human volition, not scientific reason, logic, or empirical fact.

If you deny the biological basis for human eistance, I don't put mood in the same category as 'free will', which is an illusion. Mood does create physiological changes, and depression does cause changes in PET scans.

I understand that there is solely a subjective report of the moods but I would say that there are observable physical corellates, I am not sure the experience of god shows on PET scans.

aggle-rithm
28th July 2006, 11:00 AM
Depression does effect levels of various receptors and related byproducts.

And there is a tangible experience, the events that are percieved by the individual, a perception of hopelessness is an actual perception, which is a physical event in the brain, validity is another issue that should be considered in assesment.

.

Also, a depressed person has fewer dendrite connections in their neurons. It's not known whether this is a symptom or the cause, but there's a definite physiological correlation.

Of course, taking a brain biopsy is not a viable option when diagnosing depression.

Dave1001
28th July 2006, 11:34 AM
Of course, taking a brain biopsy is not a viable option when diagnosing depression.
:D

stamenflicker
28th July 2006, 10:40 PM
You're claiming that mental illness *doesn't exist* and mood disorders *don't exist*, and the people here are (rightly so) trying to explain to you why they think you're wrong.

Not really. I'm saying I don't believe in mental illness. In other words, the actuality of mental illness existence is hardly my concern. That one would expect me to put faith in some subjective experiences while simutaneously rejecting others is illogical. I have no problem with illogical beliefs. I have some myself, but no one should be telling me which ones to have when the evidence for them is on its best day, shoddy.

stamenflicker
28th July 2006, 10:44 PM
If you deny the biological basis for human eistance, I don't put mood in the same category as 'free will', which is an illusion. Mood does create physiological changes, and depression does cause changes in PET scans.

I understand that there is solely a subjective report of the moods but I would say that there are observable physical corellates, I am not sure the experience of god shows on PET scans.

The problem with PETS is that you never know if you are seeing the presence of something, or the absence of something else. You never know if something just got switched on, or something else just got switched off.

That is the problem with moods.

stamenflicker
28th July 2006, 10:47 PM
Also, a depressed person has fewer dendrite connections in their neurons. It's not known whether this is a symptom or the cause, but there's a definite physiological correlation.

Of course, taking a brain biopsy is not a viable option when diagnosing depression.

I've read some of these reports. Unfortunately, they are not consistent. Some people with the same degeneration of dendrites have never been diagnosed as depressed, or shown signs of being depressed.

I hope they find a "definite physiological correlation." I sincerely do. But for now, it just doesn't exist.

Dancing David
29th July 2006, 07:14 AM
The problem with PETS is that you never know if you are seeing the presence of something, or the absence of something else. You never know if something just got switched on, or something else just got switched off.

That is the problem with moods.


That seems to be a moot point, there are theories that depression is caused by an overactivity of certain regulatory systems in the brain, while schizophrenia is theorised to be from a lack of activity in another area of the brain..

I will ask straight up then, why should it matter, depression has observable physical coorelates, which is a reason that you said you feel it is a social construction, but then when I have pointed out that there are observable physical things you just say " poo poo they don't matter'. So if you have a counter theory to the biopsychosocial model of mental illness, lets hear it.

Dancing David
29th July 2006, 07:16 AM
Not really. I'm saying I don't believe in mental illness. In other words, the actuality of mental illness existence is hardly my concern. That one would expect me to put faith in some subjective experiences while simutaneously rejecting others is illogical. I have no problem with illogical beliefs. I have some myself, but no one should be telling me which ones to have when the evidence for them is on its best day, shoddy.

When I said that it is the interpretation of the subjective experience that is the thoerhetical contention, your response was vauge at best. I am stating that both the experience of god, trees, dogs and moods are biological based in the human nervous system, do you agree with that?

Dancing David
29th July 2006, 07:19 AM
I've read some of these reports. Unfortunately, they are not consistent. Some people with the same degeneration of dendrites have never been diagnosed as depressed, or shown signs of being depressed.

I hope they find a "definite physiological correlation." I sincerely do. But for now, it just doesn't exist.


Good point, so why do people commit suicide?

BTW all words and concepts are human social construction, it is wether a word or theory has valid predictive qualities that make it useful, what is the difference between the word 'GERD' and the word 'depression'?

Katana
29th July 2006, 07:37 AM
I'd be quite willing to classify being born again as a kind of psychological state, with a typical set of behaviors and beleifs etc. that is comparable in some ways to being in a state of depression.
Yep. Both evidence of mental illness.

I agree that coercing parents into medicating their children is reprehensible, and that parents and teachers all too often resort to medicating problems that could be treated in other ways, but again to jump from this to the conclusion that mental illness is merely a social construct with no basis in reality, is way too much for me.

Most of my friends in child psych would disagree with this oft-painted picture of what's going on. Their impression is that it is frequently the parents pushing to have their kids put on meds. Unfortunately, it's usually the parents themselves whose actions (or inaction) have created the problems in their children that they then want/expect/demand psychiatrists and teachers to fix.

It is unfortunate that overdiagnosis of psychiatric illnesses and over-reliance on meds has contributed to the impression that all mental illness is bogus. It only hurts those who are genuinely ill. I agree with you in that one cannot conclude from the irresponsible and unethical behavior of some psychiatrists, teachers, and parents that it is just a social construct.

blutoski
29th July 2006, 12:58 PM
It's about the choice you assume I should make in one category of things as opposed to another. Yet, you offer no real logical reason why I should.

I was trying to get an anchor on your worldview framework. You're rejecting the reification of things like depression, but appear quite satisfied with other reifications, many of which are dubious. ie: PET scanners are used to show some of the structural distinctions that are correlated with schizophrenia. PET scanners rely on the concept of antimatter. This is, in my opinion, way, way, more speculative than the idea that depression is an actual 'thing'.

Why is antimatter - which nobody has ever seen, heard, smelled, tasted, or even theorized existed until two generations ago - so much more 'real' than depression, which has been recorded as a state of mind for all known history?

The reason I'm confused about your argument is that it's a confusing case of special pleading. I ask you specifically to identify what it is that is unique about mood disorders that leads you to concern.

Dave1001
29th July 2006, 01:09 PM
I ask you specifically to identify what it is that is unique about mood disorders that leads you to concern.

To play devil's advocate :D

1. There are parties with a huge financial interest in mood disorders as a construct, such as major pharmaceutical companies.
2. I've never experienced what's described as a mood disorder personally. But, I've pretended to be sick in the past for special treatment, such as getting to stay home from school. I'm concerned that people may be pretending to have mood disorders for attention and special treatment.
3. What is called mood disorder may just be mood diversity. Deviation is not necessarily disorder.
4. One could just as well define society as having the disorder and the individual as being fine. Claiming that a mood pattern which clashes with the modern, capitalist industrial society is a disorder is just a quick way to fix elements of our society that aren't producing enough wealth for capitalist elites.

:D :D :D

blutoski
29th July 2006, 01:32 PM
Most of this started when I said that I don't really believe in mental illness. On a skeptics board, no less. Perhaps I would have been better to say I'm a mental illness agnostic??

Not really: agnostics believe there is no way to know about something. They may or may not have a personal opinion on top of this. You seem pretty sure they're not real based on what you think is good evidence against their existence, which puts you squarely in the group called 'psychiatry deniers'.




First came a slew of insults hurled at me as being some kind of uncompassionate person.

Assumption based on experience. The majority of psychiatry deniers are targetting their issues at disorders such as the personality disorders and the anxiety disorders. An example is a coworker who thinks the clinically depressed should just suck it up: that they're just trying to solicit special favours, &c.




All that coupled with assertions that it was real-- most of the strongest defenses came from either:

a) a person who has experienced it
b) a person who works in mental health

When pointing this out, I'm accused of sounding like an ID'r.

'cause it's true. They pull this 'bias' accusation all the time. Avoids the chore of talking about the evidence.





Yet, were this a religious discussion, as a Christian, I expect that my self-reports of anything spiritual in nature would be immediately recognized as biased by my experience. Naturally then, we have to assume that the poster's are trying to tell me that the discussions of religious moods and the discussion of "other moods" are somehow fundamentally different.

Not following. I don't think we've been saying this. Again: I repeat: I think you're conflating four different issues:

1) whether mental states are reified (real)
2) whether some mental states are disorders
3) whether mental disorders have a physical cause
4) whether mental disorders can be abused by authorities

To give you an analogy, let's consider the antivax debate, which is a parallel healthfraud issue.

They argue:
1) chickenpox is a real thing
2) but it is not an illness
3) and it has a physical cause
4) and the classification of it as an illness has led to abuse by authorities

I disagree, of course, but the point is that there are four issues here which are almost orthogonal.

So, for the sake of argument, I'd like you to understand my side of the discussion. I invite you to play devil's advocate (or blutoski's advocate, if you prefer)... is chickenpox an illness?




I reject this conclusion, and it demonstrates the kind of faulty thinking will one day become in future governments, a source of power over people and their moods. All in the name of benevolence.

If you think I'm wrong then ask yourself why do we even need a Child Medication Safety Act?????

And listen to the APA froth at the mouth over it:

http://www.apa.org/ppo/issues/cmsa1170.html


So I'm told basically that these mental "states" which exist because of surveys, studies, reports from highly intelligent observers are to be given power over me by my benevolent benefactors??? Sounds like the Catholic Church of the middle ages to me.

Politics, and does not actually address whether these conditions exist or not. See above point four.

There was a time in this country when people with certain genetic conditions were sterilized. The fact that the government was abusing its power did not mean these people did not have these genetic conditions. It is a debate about politics, not science. The laws have long since been repealed, but these people are still genetically identifiable.

I'll use that example, too:

They argued:
1) Down Syndrome is a real thing
2) and it is a disability
3) and it has a physical cause
4) and these people should be sterilized

We now argue:
1) Down Syndrome is a real thing
2) and it is a disability
3) and it has a physical cause
4) and these people should not be sterilized


However, there are support groups that argue:
1) Down Syndrome is a real thing
2) but it is not a disability
3) and it has a physical cause
4) and these people should not receive special treatment

blutoski
29th July 2006, 01:40 PM
To play devil's advocate :D

1. There are parties with a huge financial interest in mood disorders as a construct, such as major pharmaceutical companies.
2. I've never experienced what's described as a mood disorder personally. But, I've pretended to be sick in the past for special treatment, such as getting to stay home from school. I'm concerned that people may be pretending to have mood disorders for attention and special treatment.
3. What is called mood disorder may just be mood diversity. Deviation is not necessarily disorder.
4. One could just as well define society as having the disorder and the individual as being fine. Claiming that a mood pattern which clashes with the modern, capitalist industrial society is a disorder is just a quick way to fix elements of our society that aren't producing enough wealth for capitalist elites.



Yeah, but that's all crap, though. With very few exceptions, people with personality disorders are mostly at large to act as they see fit. There's no grand conspiracy to manage them. The point where they come across a professional's desk is either when they collide with the law, or come in voluntarily and ask for help.

Regarding faking illnesses: it's come up on this thread before. I can fake a headache, back pain, blindness... does that undermine the validity of these ideas? No.

Regarding point 3: you're right. Deviation is not disorder. Nobody claims so. Disorder is when the patient has negative consequences.

Again, this is why skeptics get froozled by this debate. Within minutes, psychology deniers run out of good arguments, and it's all conspiracy theories from then on.

Dave1001
29th July 2006, 02:18 PM
Yeah, but that's all crap, though. With very few exceptions, people with personality disorders are mostly at large to act as they see fit. There's no grand conspiracy to manage them. The point where they come across a professional's desk is either when they collide with the law, or come in voluntarily and ask for help.

Regarding faking illnesses: it's come up on this thread before. I can fake a headache, back pain, blindness... does that undermine the validity of these ideas? No.

Regarding point 3: you're right. Deviation is not disorder. Nobody claims so. Disorder is when the patient has negative consequences.

Again, this is why skeptics get froozled by this debate. Within minutes, psychology deniers run out of good arguments, and it's all conspiracy theories from then on.

Devil's advocacy continued:

Just because someone suggests that powerful interests are vested in a social phenomenon, and may be help shaping society in such a way as to promote that outcome, doesn't necessarilly mean that one is suggesting a "grand conspiracy". For example pharmaceutical company executives may be able to determine independently from each other that the more a concept called medical illness is promoted in society, the more social resources are likely to end up redistributed to their management, and thus most of them are likely to feel vested in promoting the belief in and diagnoses of mental disorders, even if they didn't sit down in a smoke filled back room to plan it all out.

In truth (devil's advocacy cap off), I think many forms of non-strictly utilitarian forms of privilege, and resource and hierarchy advantage are maintained in these sorts of informal ways. Which is why I think it's an unenlightening criticism of folks alleging unfairness to point out the unlikeliness of a grand conspiracy, when such a grand conspiracy may be unecessary to maintain the sort of unfair inequalities that they're alleging.

blutoski
29th July 2006, 02:43 PM
Devil's advocacy continued:

Just because someone suggests that powerful interests are vested in a social phenomenon, and may be help shaping society in such a way as to promote that outcome, doesn't necessarilly mean that one is suggesting a "grand conspiracy". For example pharmaceutical company executives may be able to determine independently from each other that the more a concept called medical illness is promoted in society, the more social resources are likely to end up redistributed to their management, and thus most of them are likely to feel vested in promoting the belief in and diagnoses of mental disorders, even if they didn't sit down in a smoke filled back room to plan it all out.

In truth (devil's advocacy cap off), I think many forms of non-strictly utilitarian forms of privilege, and resource and hierarchy advantage are maintained in these sorts of informal ways. Which is why I think it's an unenlightening criticism of folks alleging unfairness to point out the unlikeliness of a grand conspiracy, when such a grand conspiracy may be unecessary to maintain the sort of unfair inequalities that they're alleging.

Fair enough. One thing I like to always point out when critiquing conspiracy theories is that the JFK assassination was a conspiracy: Oswald's wife was in on it, too. Some grand conspiracies are real. Watergate comes to mind.

However, the problem is that I'm unable to pin down the distinction between the actual critique of the existence of these disorders from the credible problem of their exaggeration in, say, politics or commerce. These will happen whether or not there is scientific merit for the claim. This is the basic issue about healthfraud: it's the misrepresentation of hypotheses as scientific findings.

But a review of corporate balance sheets does not tell us anything about scientific findings, so I prefer to put that real issue on the back burner and address it in a political forum. Granted: scientific findings inform political debates, but it is a one-directional information flow.

I can't give much credibilty to arguments that look like:

[x is a scientific fact] because [y politics is such]

stamenflicker
29th July 2006, 08:52 PM
'cause it's true. They pull this 'bias' accusation all the time. Avoids the chore of talking about the evidence.

And makes it a handy-shandy scapegoat for those pointing out the lack of evidence when you can fall back on those with vested interests.

Not following. I don't think we've been saying this. Again: I repeat: I think you're conflating four different issues:

1) whether mental states are reified (real)
2) whether some mental states are disorders
3) whether mental disorders have a physical cause
4) whether mental disorders can be abused by authorities

You are following just fine. 1, 2, and 3 are all related, though you don't seem to want to believe they are. 4 is why it is important, at least to me.

So, for the sake of argument, I'd like you to understand my side of the discussion. I invite you to play devil's advocate (or blutoski's advocate, if you prefer)... is chickenpox an illness?

illness (noun)

1. The condition of being sick

I haven't had the pox since I was a kid, but I've seen kids since that time who did. They have fevers (measurable), they have visible rashes, etc. etc. So if "illness" means the "condition of being sick," then sure they have a short-term illness.

If you or anyone else wants to define "illness" some other way, then be my guest, we can go from there.

Politics, and does not actually address whether these conditions exist or not. See above point four.

I've continually said that they don't, and we agree. I've also continually said, that politics is a fundamental reason to ask the right questions of our "experts."

blutoski
29th July 2006, 09:49 PM
You are following just fine. 1, 2, and 3 are all related, though you don't seem to want to believe they are.

I disagree. I'll reprint them:

1) whether mental states are reified (real)
2) whether some mental states are disorders
3) whether mental disorders have a physical cause

Whether or not they're "related" is vague. I'm saying they're not dependent. There is a complete mix-and-match in medicine. These factors can be true or false, independent of each other. Some physical conditions are disorders; others are not. Some disorders are real; others are not. Some disorders have known physical causes; some do not.




illness (noun)

1. The condition of being sick

I haven't had the pox since I was a kid, but I've seen kids since that time who did. They have fevers (measurable), they have visible rashes, etc. etc. So if "illness" means the "condition of being sick," then sure they have a short-term illness.

If you or anyone else wants to define "illness" some other way, then be my guest, we can go from there.

No, that's fine, defined as it is. You've defined what illness is. You have not answered my question. I am asking you the same question you asked me about mood disorders, but this time about chicken pox.

Why is chicken pox an 'illness'? Why is fever, rashes, and other symptoms an 'illness'? Isn't this just a social construct for a combination of measureable symptoms? Who are these illness police that decide which set of temperatures qualify as 'fever' and are 'evidence' of 'illness'?





I've continually said that they don't, and we agree. I've also continually said, that politics is a fundamental reason to ask the right questions of our "experts."

Are you an "expert" in illness? You seem pretty comfortable classifying arbitrary temperatures and skin lesions. Is acne an illness? Birthmarks? Scars? Freckles? Why chicken pox?

My wife has a karyotype reversal on one of her chromosomes. It's a measureable, confirmable, biological fact. It is completely abnormal, caused by a mutation. Probably a meiosis error in a parent's germ cell. Is it an 'illness'?

stamenflicker
30th July 2006, 10:12 AM
I disagree. I'll reprint them:

1) whether mental states are reified (real)
2) whether some mental states are disorders
3) whether mental disorders have a physical cause

Whether or not they're "related" is vague. I'm saying they're not dependent. There is a complete mix-and-match in medicine. These factors can be true or false, independent of each other. Some physical conditions are disorders; others are not. Some disorders are real; others are not. Some disorders have known physical causes; some do not.

But they are all manifested physically in a physical body. Whether its blood, urine, or biopsy we have something to look at. With mental illness we have? Self-report? Behavior? I don't understand why you can't admit that these are fundamentally different.

Why is chicken pox an 'illness'?

Because we note a condition of being sick.

Why is fever, rashes, and other symptoms an 'illness'?

Because these are evidences of a condition of being sick.

Isn't this just a social construct for a combination of measureable symptoms?

Yes to an extent. But its a construct with a definite, indisputable referent.

Who are these illness police that decide which set of temperatures qualify as 'fever' and are 'evidence' of 'illness'?

Alright, I'll bite. I'm assuming you mean the "police" associated with real conditions of being sick? They're called doctors. And yeah, sometimes it's hard to determine just what's going on. You seem to be suggesting that with my train of thought, when my tooth hurts I'd be just as helped by visiting my proctologist. I think the argument is silly.

So if you'd like to consider the "police" associated with real displays of being in a foul mood or a sad mood, then we can call them psychologists. We can also call them bartenders. Or priests. Or a good friend.

Again back to point number one above, the latter group attempts to reify the mood state to gain legitimacy in the professional world. It uses error prone surveys, self-report, and the ability to "fake it" to draw its conclusions. While the former group has normal temperature (98.6) from which to draw its conclusions.

Are you an "expert" in illness?

Nope. Would it matter if I was?

You seem pretty comfortable classifying arbitrary temperatures and skin lesions. Is acne an illness? Birthmarks? Scars? Freckles? Why chicken pox?

They could be if we made them so. For example, if I found obesity to be threatening to my social experiences, and enough people agreed with me, we could institutionalize empirically verifiable fat people. What's your point?

My wife has a karyotype reversal on one of her chromosomes. It's a measureable, confirmable, biological fact. It is completely abnormal, caused by a mutation. Probably a meiosis error in a parent's germ cell. Is it an 'illness'?

Again, it could be if we decided to make it such. But then again, we can't force treatment in conscious subjects can we?

hammegk
30th July 2006, 03:11 PM
Why chicken pox?

Er, hmm, bacterial or viral, communicable, objectively measureable physical symptoms ... yeah, just like psychoses. :rolleyes: ROFL.

Dave1001
30th July 2006, 03:33 PM
Why chicken pox?

Er, hmm, bacterial or viral, communicable, objectively measureable physical symptoms ... yeah, just like psychoses. :rolleyes: ROFL.

Interesting you bring that up. I believe I remember some publicized epidemiological studies a few years back suggesting that some mental illnesses may have viruses as causal factors. Anyone know the latest status on those theories?

blutoski
30th July 2006, 04:17 PM
Again, it could be if we decided to make it such. But then again, we can't force treatment in conscious subjects can we?

This is where I'm going. So: anything's an illness, if we decide it is?

ie: why is chickenpox not a 'condition' or a 'physical state'? Why is it a medical thingie?

blutoski
30th July 2006, 04:18 PM
Because we note a condition of being sick.

What is 'sick'? Who decides what is a 'sickness'. You're just going in circles. It's an illness because the person is sick, and the person is sick because they have an illness.

Why is it an 'illness'?

We get viruses all the time. Warts, for example. Why are only some infections an 'illness'?

blutoski
30th July 2006, 04:20 PM
Interesting you bring that up. I believe I remember some publicized epidemiological studies a few years back suggesting that some mental illnesses may have viruses as causal factors. Anyone know the latest status on those theories?

I'm not saying they're 'just like' psychoses. My question is: why do we consider them an illness, as opposed to, say, having brown eyes, which is a demonstrably physical condition?

Why isn't chickenpox a 'state of body' or 'physical condition'? Why is it an 'illness'?

hammegk
30th July 2006, 05:30 PM
Interesting you bring that up. I believe I remember some publicized epidemiological studies a few years back suggesting that some mental illnesses may have viruses as causal factors. Anyone know the latest status on those theories?
Are all viruses communicable? ;)

I'd say there is no doubt that some "mental illness" has a physical cause, yet if a specific virus, or chemical, or whatever, is not identified and has actually been proved as causal, the symptoms are mental and subjective more than physical and objective.


And I see bluto still doesn't get it... :)

stamenflicker
30th July 2006, 06:06 PM
What is 'sick'? Who decides what is a 'sickness'. You're just going in circles. It's an illness because the person is sick, and the person is sick because they have an illness.

Why is it an 'illness'?

We get viruses all the time. Warts, for example. Why are only some infections an 'illness'?

My question is: why do we consider them an illness, as opposed to, say, having brown eyes, which is a demonstrably physical condition?

Why isn't chickenpox a 'state of body' or 'physical condition'? Why is it an 'illness'?

Now you're asking the right questions. They're important questions. They're questions we should have been asking back when we were sterilizing people. They're the same questions we should be asking now that we're mentally sterilizing people's moods.

blutoski
30th July 2006, 08:23 PM
Now you're asking the right questions. They're important questions. They're questions we should have been asking back when we were sterilizing people. They're the same questions we should be asking now that we're mentally sterilizing people's moods.

No, that's the question I've been asking all along. This is the third time. You still haven't answered it.

blutoski
30th July 2006, 08:24 PM
Are all viruses communicable? ;)

I'd say there is no doubt that some "mental illness" has a physical cause, yet if a specific virus, or chemical, or whatever, is not identified and has actually been proved as causal, the symptoms are mental and subjective more than physical and objective.


And I see bluto still doesn't get it... :)

Oh, please...

stamenflicker
30th July 2006, 09:04 PM
No, that's the question I've been asking all along. This is the third time. You still haven't answered it.

Seems to me like you just started asking questions, that prior to now you've been chocked full of answers and examples as to why your mythology is better than anyone else's.

Maybe there just isn't a good answer. If there is one, perhaps we'll see it 100 years down the road, when doping up the population is rightly viewed as a form of slavery. But hey, at least we did it in ignorance, and with our warmest sympathies for the mentally ill. Hindsight is 20/20.

Or maybe, we'll just all be too doped up to care.

blutoski
30th July 2006, 11:11 PM
Seems to me like you just started asking questions, that prior to now you've been chocked full of answers and examples as to why your mythology is better than anyone else's.

Maybe there just isn't a good answer.

Well, you were pretty sure a few posts ago. I'm asking these questions because throughout this thread I observe you've frequently contradicted yourself and been inconsistent. My impression was that you haven't explored these thoughts.

Earlier, you said that chickenpox was an illness. OK: I ask you again: why is chickenpox an illness, but having brown eyes is not? Or are you unsure about the criteria?

hammegk
31st July 2006, 07:03 AM
Sorry, I should have said bluto doesn't want to get it.

Or he actually does need to have the difference between brown eyes and disease explained to him.

Which is the truth, I wonder?

Meffy
31st July 2006, 08:15 AM
Or he actually does need to have the difference between brown eyes and disease explained to him.
Misrepresentation. I hope a knowing one but only you can tell us that.

It seems to me that Blutoski is asking for is an explanation of stamenflicker's take on this. Not a primer on communicable diseases and genetics. But as I said I think you knew that already. At least I certainly hope you were able to work that out on your own, and were just being preciously disingenuous as usual.

hammegk
31st July 2006, 08:57 AM
Someone is certainly being 'preciously disingenuous'. When does "skeptical inquiry" cross the line into idiocy?

And when will Meffy actually add something in a thread other than a (useless) aroma?

stamenflicker
31st July 2006, 10:43 AM
OK: I ask you again: why is chickenpox an illness, but having brown eyes is not? Or are you unsure about the criteria?

And I will answer you, yet again. Chickenpox is an illness because illness is defined as "the condition of being sick." People with brown eyes are not in the condition of being sick. People with freckles are not in the condition of being sick. However people with brown eyes and freckles may be in the condition of being sick if they have chicken pox. I'm not sure why this is not coming across.

Your real question is who decides. I answered that too. We do. Usually with input from medical professionals. These professionals are often referred to as doctors. Doctors could rally around the notion that people with freckles really are sick. We could go along with them. We could force them to enter freckle removal surgery, or commit them to a freckle hospital. We could let them get away with murder because of their freckles. We can do anything we want with backing from the right professionals.

Will you continue down this path?

Or will you admit that a person's self-reported feelings are much different than an objectively gathered body temperature? Will you admit that a survey and an X-ray are really two different things altogether? Will you admit that the observation of one's behavior is much different than observing blockage in their large intestine? Will you admit that no doctor in this country as the right to force me to take Tylenol for my headaches? Or that my family has no right to manage my estate because of my broken rib?

You can say I'm confusing the issue all you want, but these realities bear out with common logic. You can say I've not thought this through as much as U want, but the reality is that I don't have to believe in anything lacking evidence. I don't care how many definitions we create in an attempt to absolve Yates of responsibility or to justify altering the moods of our hyper-active children who are just bored to death in classroom to begin with.

Dancing David
31st July 2006, 12:54 PM
Since you have ignored my posts, I will ask you instead, what prove do you have of society forcing treatment on adults? Children can be forced by thier parents, but where are adults being forced into treatment. You can be detained in a psych hospital while you present a risk to self or other, but in Illinois you can't force treatment.

Have you found that statistic that 30 % of male chilluns are being medicated?

blutoski
31st July 2006, 05:52 PM
And I will answer you, yet again. Chickenpox is an illness because illness is defined as "the condition of being sick." People with brown eyes are not in the condition of being sick. People with freckles are not in the condition of being sick. However people with brown eyes and freckles may be in the condition of being sick if they have chicken pox. I'm not sure why this is not coming across.

I'm saying this is a circular argument: who says that chickenpox is 'a condition of being sick'. Why is chickenpox not, say, 'a state of being,' just like brown-eyedness?

blutoski
31st July 2006, 05:58 PM
Since you have ignored my posts, I will ask you instead, what prove do you have of society forcing treatment on adults? Children can be forced by thier parents, but where are adults being forced into treatment. You can be detained in a psych hospital while you present a risk to self or other, but in Illinois you can't force treatment.

Have you found that statistic that 30 % of male chilluns are being medicated?

I think that given enough jurisdictions, there's a good chance that at least one state, province, county, or whatever, may have this kind of latitude. Stamenflicker did provide a link to the APA's position statement on educational requirements for children with certain conditions to be medicated in order to be permitted to attend normal classes. This isn't the same as 'forcing' the kids to take medication (20 years ago, they would have been expelled without a medication 'option'), but it's getting there.

Also: people *are* medicated without consent from time to time. Sedatives comes to mind. If the guy's punching the emerg doc, he's going under. There's no screwing around. But these judgement calls would be made whether or not the situation had a psychiatric dimension.

Like I said: we could just go back to the old days, and stack them up like cordwood in prison, or leave them sitting in their own feces in alleys. At least they'd have their "dignity".

Dancing David
31st July 2006, 06:11 PM
I think that given enough jurisdictions, there's a good chance that at least one state, province, county, or whatever, may have this kind of latitude. Stamenflicker did provide a link to the APA's position statement on educational requirements for children with certain conditions to be medicated in order to be permitted to attend normal classes. This isn't the same as 'forcing' the kids to take medication (20 years ago, they would have been expelled without a medication 'option'), but it's getting there.

Also: people *are* medicated without consent from time to time. Sedatives comes to mind. If the guy's punching the emerg doc, he's going under. There's no screwing around. But these judgement calls would be made whether or not the situation had a psychiatric dimension.

Like I said: we could just go back to the old days, and stack them up like cordwood in prison, or leave them sitting in their own feces in alleys. At least they'd have their "dignity".

There are a people recieving medication against there will, although they are usualy going to get physical restraint first, but that is the call of the ED doctor, not a member of the mental health establishment.

The number of children who recieve medication is more proportional to the stigma, embarrasment and problems that the parents have.

People are very free to not take thier medication, it happens quite frequently, and then , just like alcoholics they create a burden on the EDs and jails. But the largest inpatient treatment unit in the United States (LA county jail), is full of people who weren't forced to take thier medications and are only taking them while they are incarcerated.

And I personaly wouldn't have it any other way, there is not benefit to depriving people of thier liberty, I often frustrate family members that they do not have ground for forcing treatment upon thier mentaly ill family member.

The number of people who are in long term care has gradualy decreased since 1980, in Illinois, a very populous state ther are now four state hospitals for the whol;e state, which i think is a good thing, the average lenth of stay in a non-state operated facility inpatient psych unit is about 5 days. The treatemnt model is the medical model, patch em up, prop em up and shove out the door.

I defy any one who states that there is this large horde of overtreated people out there, especialy being treated against thier will. And if they are taking medicine that they shouldn't it is more likely from a GP than a psychiatrist.

This woo notion that there is some state sponsered plan to medicate the nation into submission, is only held by the John Birchers, alternative medication whackos, and people who can't substantiate thier claims, usualy because they are talking about the system the way it used to be, prior to de-institutionalization.

blutoski
31st July 2006, 06:29 PM
There are a people recieving medication against there will, although they are usualy going to get physical restraint first, but that is the call of the ED doctor, not a member of the mental health establishment.

Sure. I'm just saying that unless Stamenflicker contains the accusation a bit to, say, North America, it's hard to refute. I'm sure psychiatric patients in China are medicated against their will.

And anyway, I agree with his point that vigilance is merited so the state is not given excessive power. We're just quibbling over what 'excessive' would look like, as far as I can tell.




The number of children who recieve medication is more proportional to the stigma, embarrasment and problems that the parents have.

Absolutely. It's the parents driving this. Can you say: "doctor shopping"?

Psychiatrist: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 2: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 3: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 4: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 5: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 6: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 7: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist 8: "Your kid's a jerk."
Parent: "We're getting another doctor."
Psychiatrist: "Your kid needs bucketloads of medication."
Parent: "Finally. All the other doctors we saw were quacks."

I recall reading that there was a review that suggested there is this tiny fraction of psychiatrists with a huge number of monthly prescriptions.




This woo notion that there is some state sponsered plan to medicate the nation into submission, is only held by the John Birchers, alternative medication whackos, and people who can't substantiate thier claims, usualy because they are talking about the system the way it used to be, prior to de-institutionalization.

Watched One Flew Over a few times too many, and forgot it was fiction.

stamenflicker
1st August 2006, 05:57 AM
Have you found that statistic that 30 % of male chilluns are being medicated?

No, you are right, it's only about 5%. So I withdraw my statement...

But I did find this interesting...

"In 1997 alone, nearly five million people in the United States were prescribed Ritalin -- most of them young children diagnosed with attention deficit disorder. Use of Ritalin, which is a stimulant related to amphetamine, has increased by 700 percent since 1990. And this phenomenon appears to be uniquely American: 90 percent of the world's Ritalin is used in the United States."

Running on Ritalin
by Lawrence H. Diller, M.D.

And this one... http://health.msn.com/centers/adhd/articlepage.aspx?cp-documentid=100109567

"Adult use of antidepressants nearly tripled during the periods of 1988-1994 and 1999-2000. For example, as of December 2004, 10% of adult women were taking antidepressants."

http://www.dpna.org/drugarticles/7society_perscription_drugs.htm


The stat I am likely remembering is that 1/3 of the US population is taking some form of psychotropic drug, or will be prescribed on in their lifetime. I will keep looking.

stamenflicker
1st August 2006, 05:59 AM
I'm saying this is a circular argument: who says that chickenpox is 'a condition of being sick'. Why is chickenpox not, say, 'a state of being,' just like brown-eyedness?

I don't want to say this isn't a good question, because it is a good question. I guess you are saying its not a good question? I think it is one that we should be asking with regards to some physical conditions and most psychological ones.

It's the kind of question that got homosexuality removed from the DSM.

Meffy
1st August 2006, 06:07 AM
Someone is certainly being 'preciously disingenuous'. When does "skeptical inquiry" cross the line into idiocy?
The most reliable indicator I know of is the appearance of an avatar depicting a sad old possum. (Not the person with the nick "old possum," who's perfectly fine by me.)

And when will Meffy actually add something in a thread other than a (useless) aroma?
Whenever the occasion calls for it, which is not infrequent. [edit: such as when calling out fallacies and dishonest tactics, such as yours above...] I can only presume that's in discussions that don't interest you, which is likewise fine by me. Here, have a kettle.

hammegk
1st August 2006, 07:39 AM
... Here, have a kettle.
Nice try. Feel free to compare the nonsense and useless interjections the greatest number of your posts to date consist of with posts of mine.

I agree you won't underatnd the actual substance contained in most of my posts, but that doesn't mean the substance is lacking. Your bon mots are just that. :)


I will take this opportunity to ask, again, on topic, which 'malady' will first be described in some future DSM; theism, or atheism?

A great many posters here have faith 'theism' is the mental disease; unfortunately for them, they represent a tiny and basically useless minority of humanity. A particularly poor track record exists for societies that tried atheism as the cohesive societal force.

Katana
1st August 2006, 07:43 AM
Your real question is who decides. I answered that too. We do. Usually with input from medical professionals. These professionals are often referred to as doctors. Doctors could rally around the notion that people with freckles really are sick. We could go along with them. We could force them to enter freckle removal surgery, or commit them to a freckle hospital. We could let them get away with murder because of their freckles. We can do anything we want with backing from the right professionals.


Not really. Society and the rest of the medical community would expect credible evidence that freckles caused ill health.

Or will you admit that a person's self-reported feelings are much different than an objectively gathered body temperature? Will you admit that a survey and an X-ray are really two different things altogether? Will you admit that the observation of one's behavior is much different than observing blockage in their large intestine? Will you admit that no doctor in this country as the right to force me to take Tylenol for my headaches? Or that my family has no right to manage my estate because of my broken rib?


Maybe I'm missing something, but how did you get from the beginning to the end of this paragraph?

Anyway, it sounds to me like you assume that objectively-gathered information is always reliable and correlates with illness. The fact is that even objective information can be misleading. A person with complete obliteration of the joint space of the knee on x-ray may have very little discomfort while another person is in excrutiating pain even with less radiographic evidence of joint damage. Even certain lab tests are only as good as the context of the patient, meaning is the patient symptomatic which is inherently subjective. Reference (or "normal) ranges are determined by having the blood test performed on a large, "normal" population, and then the average is determined. The reference range is created around the average (plus and minus 2 standard deviations from the average).

What that means is certain population of people will still be normal outside of that range while another population will be abnormal within it. So it sometimes comes down to is the subjective experience of the person in determining what you do with a test result.


You can say I'm confusing the issue all you want, but these realities bear out with common logic. You can say I've not thought this through as much as U want, but the reality is that I don't have to believe in anything lacking evidence.

No. You're not believing in something that you simply do not want to. Your argument that the evidence is lacking is simply wrong, but you wish to discount all of it. Much of your argument seems to be based on the fact that illnesses diagnosed by subjective measures are bogus. Would you then discount the existence of migraine (or any) headaches, chronic back pain, or heartburn? These are subjective diagnoses that seldom have objective correlates. Are they invalid then?

Dancing David
1st August 2006, 12:52 PM
No, you are right, it's only about 5%. So I withdraw my statement...

But I did find this interesting...

"In 1997 alone, nearly five million people in the United States were prescribed Ritalin -- most of them young children diagnosed with attention deficit disorder. Use of Ritalin, which is a stimulant related to amphetamine, has increased by 700 percent since 1990. And this phenomenon appears to be uniquely American: 90 percent of the world's Ritalin is used in the United States."

Running on Ritalin
by Lawrence H. Diller, M.D.

And this one... http://health.msn.com/centers/adhd/articlepage.aspx?cp-documentid=100109567

"Adult use of antidepressants nearly tripled during the periods of 1988-1994 and 1999-2000. For example, as of December 2004, 10% of adult women were taking antidepressants."

http://www.dpna.org/drugarticles/7society_perscription_drugs.htm


The stat I am likely remembering is that 1/3 of the US population is taking some form of psychotropic drug, or will be prescribed on in their lifetime. I will keep looking.


I think the statistic can be found readily, ten percent of the population is considered to be depressed, and thirty percent of the population will experience depression in thier lifetimes.

I fgorget if that comes from NIMH, APA, or NAMI. But if they choose to get treatment and does it cause functional impairment are different questions. While the DSM defines the criteria for depression as two weeks, I think that most mental health professionals will look at adjustment disorder or stress disorder for the short term depression.

Dave1001
1st August 2006, 06:10 PM
I think the statistic can be found readily, ten percent of the population is considered to be depressed, and thirty percent of the population will experience depression in thier lifetimes.

I fgorget if that comes from NIMH, APA, or NAMI. But if they choose to get treatment and does it cause functional impairment are different questions. While the DSM defines the criteria for depression as two weeks, I think that most mental health professionals will look at adjustment disorder or stress disorder for the short term depression.


Well, that raises my eyebrow. Ten percent of the population is considered to be depressed?! And 5 million kids on Ritalin. This stuff does deserve more study. What is causing 10% of the population to be in a current state of depression according to the mental health community? What are their proposed solutions? And why so many kids on Ritalin? What are the proposed solutions and directions on that?

Dancing David
2nd August 2006, 10:44 AM
Well, that raises my eyebrow. Ten percent of the population is considered to be depressed?! And 5 million kids on Ritalin. This stuff does deserve more study. What is causing 10% of the population to be in a current state of depression according to the mental health community? What are their proposed solutions? And why so many kids on Ritalin? What are the proposed solutions and directions on that?

The five million kids on Ritalin is not my quote, depression is defined as a persistant sad mood that lasts for more than two weeks, although most mental health professionals will use adjustment disorder for most people with that short a depression, the DSM-IV guidelins for depression can be found on the web although it takes some effort.

The ten percent number comes survey, ten percent of the people respond to surveys as though they meet the criteria for depression, in a longitudinal survey that is usualy post event and not truely longitudinal 30% of people will say that they met the criteria for depression at some point in thier lives.


What is causing 10% of the population to be in a current state of depression according to the mental health community?

Most depression is stress related and usualy accompanied by severe sleep disturbance, if the depression is situational and not interfereing with the person's life than supportive counseling would help, if the depression is longer term, than therapy or medication is usualy beneficial.

Someimes people have to make major life style changes as well.



What are their proposed solutions?

I go to work everday, we do psyco education as part of our jobs, I try to help the people who want help. Most people have a situational depression, and so the best treatment is to change the situation, intervention is only warranted where there is a decrease in functioning.


And why so many kids on Ritalin? What are the proposed solutions and directions on that?


That is a subject of considerable debate, I would never recommended medication unless a child is having a decrease in functiong in all enviroments. Parents often abuse thier children or lead chaotic lives, whcih can cause kids major problems, often kids are recommended for an evaluation for ADHD, when really they have just crappy lives. Then the best intervention is individual and when possible, family therapy.

stamenflicker
3rd August 2006, 10:02 PM
No. You're not believing in something that you simply do not want to. Your argument that the evidence is lacking is simply wrong, but you wish to discount all of it.

Not all of it. Just most of it.

Much of your argument seems to be based on the fact that illnesses diagnosed by subjective measures are bogus.

Bogus on their worst days... weak on their best days.

Would you then discount the existence of migraine (or any) headaches, chronic back pain, or heartburn? These are subjective diagnoses that seldom have objective correlates. Are they invalid then?

The presence of psycho-somatic factors makes them more suspect than say a fractured bone, so their evidence is also weaker. As to whether or not I "believe" in them, I'm certainly hampered in doing so.

Dancing David
4th August 2006, 05:31 AM
Not all of it. Just most of it.



Bogus on their worst days... weak on their best days.



The presence of psycho-somatic factors makes them more suspect than say a fractured bone, so their evidence is also weaker. As to whether or not I "believe" in them, I'm certainly hampered in doing so.


So you don't think people should be treated for migranes? that is really too bad, so I suppose doctors dhould just avoid all treatment based upon subjective report and observation, that would exclude a lot of treatment.

You can have ineffective and innapropriate treatment even in the precense of objective dadta Stamen, medicine will not be the state where physicis is for quite a while yet.

What is your competing theory Stamen, what creates the phenomena that are labels as mental illness? What te=reatmenst do you suggest? Most people recive 'life style counseling' or whatever you want to call it, the changes a person makes in thier day to day life are always part of conventional mental health treatment, that sualy has the greates benefit in the vast majority of cases, such things as the medical nomeclature of 'sleep hygiene' are based upon the subjective report of the patient and thier reported behaviors, the counselor or doctor then makes suggestions for changes in behavior that are often very effective in changing the persons's reported slweep patterns. that is rather typical of mental health treatment.

Are there dcotors who perscribe medication at the drop of the proverbial hat? Sure but it is part of all medicine, not just mental health. That is the nature of medicine as it is practiced. You are aware that many medical ethicists are opposed to always having to make tests and see specialists, there are many who consider it to be bad medicine.

If every person who reports they have recieved a blow to the head is sent for a CT scan or NMRI, that is bad medicine. How is a doctor to use that specific test?

By the report of the patients subjective experience and observation of the patients behaviors. that is the way medicine is Stamen, not just the limited area of mental health but all medicine.

andyandy
4th August 2006, 06:04 AM
Much of your argument seems to be based on the fact that illnesses diagnosed by subjective measures are bogus.


Bogus on their worst days... weak on their best days.


Would you then discount the existence of migraine (or any) headaches, chronic back pain, or heartburn? These are subjective diagnoses that seldom have objective correlates. Are they invalid then?


The presence of psycho-somatic factors makes them more suspect than say a fractured bone, so their evidence is also weaker. As to whether or not I "believe" in them, I'm certainly hampered in doing so.

plenty of people suffer from chronic pain. Pain is subjective. Do you therefore not "believe" that this pain exists?

stamenflicker
4th August 2006, 07:03 AM
Pain is subjective. Do you therefore not "believe" that this pain exists?

Maybe it does, who is to know? What I do know is that you can't force me to take medicine if I'm in pain, nor can you commit me to an institution. You can't force my kids to take Oxycontin at school for their pain. You can't use my pain to excuse my behavior in a court of law.

Mental pain is different. It carries a different authority. It wields a different power. By labeling our moods "disorders," we can afford ourselves and others an opportunity to move away from personal responsibility, not toward it.

andyandy
4th August 2006, 11:17 AM
Maybe it does, who is to know?

i think that highlights your ignorance quite succinctly.




Mental pain is different. It carries a different authority. It wields a different power. By labeling our moods "disorders," we can afford ourselves and others an opportunity to move away from personal responsibility, not toward it.

the problem that mental conditions cause for society is that people such as yourself are unable (or unwilling) to empathize - and without empathy there is no understanding. Instead there's a rather cold "well I'm all right, I reckon everyone else is all right too...." mentality. This is quite a depressing view.

kmortis
4th August 2006, 11:24 AM
Stamenflicker,
Are you willing to concede that, as Dr. Ramachandran put it, neurology is in the same state as electromagnetism was prior to Maxwell? IOW, that it's still in the empirical data gathering stage, not at a solid predictive stage. Only recently have we been able to open up the head and take a peek without damamging the whole system. It will take a while to collect the data necessary to see a causal correlation.

Dancing David
4th August 2006, 11:34 AM
Maybe it does, who is to know? What I do know is that you can't force me to take medicine if I'm in pain, nor can you commit me to an institution. You can't force my kids to take Oxycontin at school for their pain. You can't use my pain to excuse my behavior in a court of law.

Mental pain is different. It carries a different authority. It wields a different power. By labeling our moods "disorders," we can afford ourselves and others an opportunity to move away from personal responsibility, not toward it.

The only reason that people are commited is because they are at risk of harming themselves and others, and the standard in Illinois is very high for involuntary commitment. But I can see that it is a serious abrogation of civil liberties. I do not fill in a petition for involuntary hospitalization lightly or frivolously.

As for moving away from personal responsibilty, I disagree, I am all for the legal charging of crimes wether the person has a mental illness, or not.

And again, if you eat a really high fat diet, what resp[onsibilty is there in being perscribed Lipitor, that cuts across all areas of medication. In Illinois you don't have to wear a motorcycle helmet, but I have to pay all the tzes to support the people who get gorked or other brain trauma for it.

there is areal lack of responsibility in all areas, not just mental health. Saying that your mental illness made you act out is like saying that diabetes made you act out, I don't encourage it and I certainly confront people about it.

stamenflicker
4th August 2006, 03:14 PM
the problem that mental conditions cause for society is that people such as yourself are unable (or unwilling) to empathize - and without empathy there is no understanding. Instead there's a rather cold "well I'm all right, I reckon everyone else is all right too...." mentality. This is quite a depressing view.

Not at all, the problem is quite "succiently" that you and others are quite quick to label anyone who doesn't buy into your mythology as lacking empathy. I've already addressed this above. I'm deeply empathetic to people's moods.

stamenflicker
4th August 2006, 03:17 PM
Are you willing to concede that, as Dr. Ramachandran put it, neurology is in the same state as electromagnetism was prior to Maxwell?

Yes.


IOW, that it's still in the empirical data gathering stage, not at a solid predictive stage. Only recently have we been able to open up the head and take a peek without damamging the whole system. It will take a while to collect the data necessary to see a causal correlation.

I completely think that this is the case.

However, I also think that we'll forever be without set answers because even if we had identical twins with the exact same physiological condition I suspect that we could very well see difference in mood management.

I also think that as we proceed, we should pay very careful attention to our "kind making" or we could trap ourselves in a new dark age.

stamenflicker
4th August 2006, 03:19 PM
The only reason that people are commited is because they are at risk of harming themselves and others, and the standard in Illinois is very high for involuntary commitment. But I can see that it is a serious abrogation of civil liberties. I do not fill in a petition for involuntary hospitalization lightly or frivolously.

As for moving away from personal responsibilty, I disagree, I am all for the legal charging of crimes wether the person has a mental illness, or not.

And again, if you eat a really high fat diet, what resp[onsibilty is there in being perscribed Lipitor, that cuts across all areas of medication. In Illinois you don't have to wear a motorcycle helmet, but I have to pay all the tzes to support the people who get gorked or other brain trauma for it.

there is areal lack of responsibility in all areas, not just mental health. Saying that your mental illness made you act out is like saying that diabetes made you act out, I don't encourage it and I certainly confront people about it.

We're not so different then -- maybe in simple categories of naming.

kmortis
4th August 2006, 09:37 PM
Yes.
Okie dokie.




I completely think that this is the case.

However, I also think that we'll forever be without set answers because even if we had identical twins with the exact same physiological condition I suspect that we could very well see difference in mood management.

I also think that as we proceed, we should pay very careful attention to our "kind making" or we could trap ourselves in a new dark age.
What does the bolded phrase mean? Maybe it's that i'm running on WAY too little sleep to get it, but I'm completely lost to your point.

To the twins point; I disagree. It would be possible to figure out from a statistical standpoint a causal correlation. Using Dr. Ramachandran as an example, he was able to make great strides in treating phantom pain by correlating the responses of various of his, and other doctors' paitents. Was it enough to completely rid the amputee community of that affliction? No, not yet, but he was able to understand the phenomon a bit more. One day, perhaps.

stamenflicker
5th August 2006, 06:48 AM
What does the bolded phrase mean? Maybe it's that i'm running on WAY too little sleep to get it, but I'm completely lost to your point.

I mean treating something as a natural kind, when in reality it may not be. Even if we completely map the human brain (and again I have doubts), we can't really be certain which items getting mapped are natural kinds and which are merely cultural artifacts. It's the "what" that we chose to map that seems important, at least to me.

To the twins point; I disagree. It would be possible to figure out from a statistical standpoint a causal correlation.

I think it might be possible, especially in some areas like extreme mood swings such as "bi-polar." But I think we will have to have a much tighter definition for "depression" to be able to generate an acceptable relation. Even then, we'll be left with other things that just won't correlate (my hunch)... things like preference, purpose, etc.

One day, perhaps.

I've said all along that I hope that day comes-- and that I hope we are wise enough to know how to handle this kind of knowledge.

blutoski
5th August 2006, 07:55 PM
Now you're asking the right questions. They're important questions. They're questions we should have been asking back when we were sterilizing people. They're the same questions we should be asking now that we're mentally sterilizing people's moods.

Two things:
1) I can't help but notice that you did not, in fact, answer my question. As a result, I'm losing interest in participating in the thread, because I get the impression you're just screwing with me.

2) We've always asked these questions. I asked them of myself and others when I was 12. Psychiatry asks itself these questions every day for the past century, and publishes stacks of papers on it. Scientists ask themselves these questions every day, and so on. The fact that you're evading the question suggests that it's unfamiliar to you, which puts you almost three decades behind me in this particular philosophical zone.

The point I'm trying to get at is that the aspect of chickenpox that makes it an illness - as opposed to a 'state of being' or whatever - is that the patient wants to get better. That's it.

Understanding the underlying physiology creates insight into how to direct efforts for treatment, but is not necessary for classification.



My concern is also that you are not in touch with these general problems' universality to all aspects of existence, and are very focused on only one application. You feel that for psychiatry, this metaphysical challenge is sufficient to reject the field. In other fields with the same challenge, you're not at all concerned.

My interpretation is that there's something special about psychiatry that you don't like that is not related to scientific issues, but more about religious or political ones, and the metaphysics of reification is an excuse and rationalization to reject the field without admitting the real underlying reasons. My assumption is that this is because you know that skeptics would reject their importance on the grounds that they are religious or political opinions.


For example above, you bring up eugenics. Probably for emotional reasons, since it is not related to the topic at hand. This is a particular interest of mine, as I am trying to finish a manuscript on Canadian eugenic programs, particularly as they applied to the religious conflict in Canada in the early 20th century (Protestants were 100% behind it, whereas Catholics were 100% against it - it was a contraception showdown, basically). The science was, and remains, sound. The politics was faulty: it was theocratic and partisan.

stamenflicker
5th August 2006, 09:55 PM
Psychiatry asks itself these questions every day for the past century, and publishes stacks of papers on it.

Modern psychiatry asks these questions when in it is in its best interest to do so. Period. Modern psychiatry does not call to us in our ignorance. It reflects the trends of the culture in which it is embedded, making it fashionable to issue changes to its theories as people demand, not as anything particularly relevant crops us scientifically. Case in point: homosexuality.


which puts you almost three decades behind me in this particular philosophical zone.

To bad the view from back here stinks so bad.

is that the patient wants to get better. That's it.

So will we see liposuction in the next DSM-IV?

My concern is also that you are not in touch with these general problems' universality to all aspects of existence, and are very focused on only one application. You feel that for psychiatry, this metaphysical challenge is sufficient to reject the field. In other fields with the same challenge, you're not at all concerned.

I've never stated that I am unconcerned in other fields. That's rubbish. I've stated all along that the stakes are higher in mental health, and therefore require greater scruntiny because unlike the other fields, mental health carries a un-scrutinized authority over people.

But somehow everytime I bring that up, I'm accused of going off topic.

My interpretation is that there's something special about psychiatry that you don't like that is not related to scientific issues, but more about religious or political ones, and the metaphysics of reification is an excuse and rationalization to reject the field without admitting the real underlying reasons. My assumption is that this is because you know that skeptics would reject their importance on the grounds that they are religious or political opinions.

Am I paying for this counseling session? Save your two-bit babble for the asylum then.

kmortis
6th August 2006, 05:02 AM
I've never stated that I am unconcerned in other fields. That's rubbish. I've stated all along that the stakes are higher in mental health, and therefore require greater scruntiny because unlike the other fields, mental health carries a un-scrutinized authority over people.
No it doesn't. There's pleny of scrutiny involved in the MH field. We went from asylums being standard, where the paitents were essentially tortured on a daily basis as part of their treatment; to more modern hospitals and half-way houses (where the paitents are simply maltreated, but it has nothing to do with their treatment...hey, it's an improvment in a way).

There are non-governmetal bodies (like NAMI) who help to oversee a person's diagnosis. People who have gone before and know what should be happening. Is it perfect? No, but what in life is?

Mentally Ill people used to be thought to be possessed by demons and other evil spirits. Now, other than certain backwater African countries, that's not true. Psychaitry is in its early childhood.

Dancing David
6th August 2006, 06:49 AM
Modern psychiatry asks these questions when in it is in its best interest to do so. Period. Modern psychiatry does not call to us in our ignorance. It reflects the trends of the culture in which it is embedded, making it fashionable to issue changes to its theories as people demand, not as anything particularly relevant crops us scientifically. Case in point: homosexuality.
More bold assertions unsupported by evidence, what evidence do you have that there are currently the same processes in place to supress the right of humans in the name of culture, and I will limit this to discussions of the uS. In the 17TH,18TH and 19TH centuries it was common to ostracize and warehouse indivuduals for wide variety of reasons in very inhumane conditions, then some french guy began to advocate for more ethical treatment of individuals, and belive me I am very aware of such inhumane things as all the bizzarre treatmnent being used prior to the 1960s and through the seventies, most notably lobotomy and involuntary sterilization, and all the abuses heaped upon the mentaly ill and developmentaly disabeled. the common example of ECT is still there as well, but now it is very arely used, the voltages are extremely smaller than they were in the past, people are given medications to counter the bad effects and it is only used with the volunary assent of a person to treat treatment refactory depression. the use and practice is now more refined than it was forty years ago. But you are acting as though the past evils of the scoiety in using menatl health to deprive people of thier human rights is well known in the mental health field.

So I ask youi plainly , what evidence do you have that it is not a commonly discussed topic, that mental health professionals are not aware of, and that bodies such as the Office of the Inspector general for the Office of mwenatl health as well as legislavtive investigation are not currentl watching the system. At the office where I work, the OIG investigates DD reports approximatley once a month and menatl health reports twice a yera.

So where in the uS is there this current wide spread abuse of human righst? (I won't discuss the systems of other countries in this context because I know they are atrocious, and I do not work in other states , so there could be widespread abuses certainly outside Illinois, but in my experience, you get you ass chwed for a wide variety of non-abuses and fired for actual abuse.)





To bad the view from back here stinks so bad.

I think most professionals are aware of that, the unmarked graves that are numbered only, the stories of the past, the current stigma and ostracization, the people who run and shame the minute they hear the word psychosis.

And yes the past is real , but where should the system be currently changing, I see a real lack of available support and resources leading to homelessness as a much greater threat in the current system, than any wide spread human rights violations, i see people who are in jail because they can't get treatment for substance abuse, that seems to be a real shame to me, but then i am a hard hearted liberal, I do believe in incarceration in spite of mental illness.




So will we see liposuction in the next DSM-IV?

that is hyperbole and you are probably aware of it, the tentative diagnosis rarely make it into the DSM, and in fact the categories have been sort of stable. they have not continued the Passive/Agressive Personality D/O and have not added a whole lot in the last three versions III, IV and IV-R.

I personaly would like to see the personality disorders reduced to behavioral descriptor indicitave of future behaviors rather than have them on Axis II, the only ones that are usueful are Boderline and Anti-Social, and the there is wide spread misapplication of them, the DSM states very clearly that they should not be diagnosed in the precence of Axis I sysmptoms, yet someone with severe depression and anxiety will get tagged with Axis II, very unproductive, they should be downgarded to behavioral only.




I've never stated that I am unconcerned in other fields. That's rubbish. I've stated all along that the stakes are higher in mental health, and therefore require greater scruntiny because unlike the other fields, mental health carries a un-scrutinized authority over people.



man are you in disgareement wit me, relgous sentiment has much higher respect, there is denial all over, which is good because people don't get help until they want it, but we are constantly being QAd QId, have supervisory review and quality review, then there are all sorts of family, friends and other 'helping' individuals who are constantly questioning everything I do. Hospitals always tride doctors about thier admission rates as do insurance carriers.

we haven't even discussed the other side of mental health, clamoring family members who demand treatment but are frustrated when they are told 'no this is behavioralor situational or your manipulation or substance induced."



But somehow everytime I bring that up, I'm accused of going off topic.


What evidence is there that this is a special problem for mental health, I am curious what you would point to, I find that in general people are dismissive and unsupportive of menatl health until it happens to them or someone they care abouty. So what are you reffering too?




Am I paying for this counseling session? Save your two-bit babble for the asylum then.

I hope not, couseling and seventy five cents will buy you coffee.

;)

blutoski
6th August 2006, 12:51 PM
Modern psychiatry asks these questions when in it is in its best interest to do so. Period. Modern psychiatry does not call to us in our ignorance. It reflects the trends of the culture in which it is embedded, making it fashionable to issue changes to its theories as people demand, not as anything particularly relevant crops us scientifically. Case in point: homosexuality.

We'll have to disagree, right. Psychiatry is constantly updating its reference, and the issues are a living debate. This is why the DSM is constantly being revised. Case in point: homosexuality.




So will we see liposuction in the next DSM-IV?

That doesn't even make sense. It's not a diagnosis, it's an activity. However, morbid obesity is a diagnosis of a medical condition, yes. And cosmetic surgery operates under medicine, yes.






I've never stated that I am unconcerned in other fields. That's rubbish. I've stated all along that the stakes are higher in mental health, and therefore require greater scruntiny because unlike the other fields, mental health carries a un-scrutinized authority over people.

But somehow everytime I bring that up, I'm accused of going off topic.

That's not true. You're not always being accused of going off-topic when you bring this up. It's off-topic when you claim that's a scientific failure rather than a political one. You are not resolving between the two problems, and saying that the political risk is a consequence of a field of study, which nobody else believes, and you refuse to explain why, stating it's self-evident. Whether psychiatry is legitemate or not, the field could still be abused!




Am I paying for this counseling session?

No, it's aaall part of the service... (with apologies to Blackadder)

stamenflicker
6th August 2006, 06:30 PM
We'll have to disagree, right. Psychiatry is constantly updating its reference, and the issues are a living debate. This is why the DSM is constantly being revised. Case in point: homosexuality.

No, Blutoski. You can't just let something like that slip without addressing my point. The DSM found homosexuality to be a disease when our culture thought it was a disease. The DSM changed it's stance on homosexuality as our culture changed its stance on homosexuality. Again, I'll tell you that science had nothing to do with it. Just like science has little to do with current DSM categorizations. They are trendy... like Fugue states, like MPD, like ADD. Trends.

It's off-topic when you claim that's a scientific failure rather than a political one.

I've never claimed this. I have claimed that that the political consequences are much more important in this area than the others. Case in point: you can't make get treatment for anything other than my "mental condition."



....

That doesn't even make sense. It's not a diagnosis, it's an activity. However, morbid obesity is a diagnosis of a medical condition, yes. And cosmetic surgery operates under medicine, yes.

But your point was the reason something is an illness is because "the patient wants to get better."

So how are we to treat the good looking 37-year old woman, weighing in at a nice 130lbs... a bit of a pooch in the tummy after three kids? She still looks good, nothing out of the ordinary for her age and the number of births...

But she wants that little pooch gone... she wants to "get better????"

Is she ill?

stamenflicker
6th August 2006, 06:49 PM
So where in the uS is there this current wide spread abuse of human righst?

The place I see it the most is in children. Doping them up. When I coordinated safety for my local school district, part of my responsibility was organizing community drug/violence prevention.. this meant that I was able to target early intervention programs in elementary schools, as well as colaborate with juvenile courts for restorative justice programs.

I've seen these kids first hand-- and the most disgusting thing????

Medication with no form of counseling whatsoever. Dope em up and send them out the door. In many cases it was the family doctor writing the prescription... but I've known psychiatrists who doped up kids after one meeting and the only follow-ups they scheduled were to see how the meds were working.

You can't tell me that this is a problem isolated in my home town... I've read similar stories from all over the place...

"You son has ADD."

"Take this... we'll adjust as needed..."

Yeah right. Many of the kids I worked with just sold their meds to users to crush and snort. Others just cried like babies in my office about how much they hated their meds. And yeah, a few it actually helped.

Then there was my time in the area mental health hospital... as I stated I was on the women's floor. Time and time again, I watched men drop of their women in a state of hysteria (probably because of something sh!tty he did) I watched them get their meds, calm down... then the husbands were there first thing Monday morning to pick them up... betcha he had a great weekend!

I'll never forget the 19-year old hooker... the cops would pick her up and dump her at the institution. They keep her as long as the law said they had to (usually 48 hours)... they'd drug her up, pat her on the back and send her home with a brand spanking new prescription. Her pimp was waiting at the gate to pick her up every time... 10 days later, we'd see her come through the system again-- RINSE AND REPEAT.

And this was 1993, my friend. Not 100 years ago. Slap a diagnosis on them, give them their meds, and send them on their merry little way.

So go ahead and say, "That's a shame." They should have gotten counseling... go ahead and appeal to words, because we need them to make a difference. But don't try to tell me that you can talk away my miagraine, cause it just aint the same damn thing.

blutoski
7th August 2006, 02:02 AM
No, Blutoski. You can't just let something like that slip without addressing my point. The DSM found homosexuality to be a disease when our culture thought it was a disease. The DSM changed it's stance on homosexuality as our culture changed its stance on homosexuality. Again, I'll tell you that science had nothing to do with it. Just like science has little to do with current DSM categorizations. They are trendy... like Fugue states, like MPD, like ADD. Trends.

I'm going to dispute your claim that the DSM classified homosexuality as a 'disease'. You'll have to provide cites for this one.

I think my argument was that it was scientific, although not a science. The reason homosexuality was dropped was that there didn't seem to be serious consequences, most homosexuals stopped wanting to change, and therapy was ineffective, which meant the classification had little utility. This is pretty scientific in nature.

A few years ago, neandertals were considered a different genus, then they were considered a different species, and now, they're the same species as we are. Things change in scientific fields as knowledge builds. That's an indicator that they're scientific, actually. If the DSM was static, I'd be more inclined to agree with your claim.

Also: you're not grasping that I don't see this as a big leap from other medical classifications. You still haven't explained to me why you think chickenpox is 'an illness'. Is it not because our society just sort of thinks it is? What about the serious consequences of this? In my province, a kid who wants to go to school with chickenpox would be tackled by the police before they got to the door. There are thousands of antivax people out there giving their kids chickenpox on purpose (chickenpox "parties"), and disagree with you. Like pretty much all science, it's a human classification to call it an 'illness'. What's special about psychiatry?

Personally, the scientific fields that I think stand out are geology, astronomy, and evolutionary biology. These are historical sciences, and experimental reproduction for theory-testing is weak at best. Psychiatry is pretty solid in comparison.




I've never claimed this. I have claimed that that the political consequences are much more important in this area than the others. Case in point: you can't make get treatment for anything other than my "mental condition."

But you haven't demonstrated why, exactly, you think the consequences are 'more important'. You brought up Germany: blue eyes were eugenic ('healthy'), whereas brown eyes were dysgenic ('unhealthy'). Does this bring the concept of eye colour into question? Again: isolate the political issues from the scientific ones.





But your point was the reason something is an illness is because "the patient wants to get better."

So how are we to treat the good looking 37-year old woman, weighing in at a nice 130lbs... a bit of a pooch in the tummy after three kids? She still looks good, nothing out of the ordinary for her age and the number of births...

But she wants that little pooch gone... she wants to "get better????"

Is she ill?

This looks like cosmetics, right? You'd have to ask her what she thinks the consequences are. It doesn't sound like if you asked her, she'd say "I want to get better." I predict she'd say "I want to <i>look</i> better."

Here's a related question: what if it wasn't a paunch, but was elephantisis instead?



One of the things that gets glossed over about skeptics is that we have a method whose purpose is to make practical decisions. My overview of science is that much of it is a human endeavour, pursuing human priorities, through methods that we adopted somewhat arbitrarily. We are entitled to make judgement calls. We can disagree on them, which is human, but they don't stop being scientific. An example is the neandertal classification I mention above. Another is the assignment of p<=.05 for statistical significance.

This is what science is like, unfortunately. Human judgements. Applied common-sense. &c.

Katana
7th August 2006, 04:47 AM
Modern psychiatry asks these questions when in it is in its best interest to do so. Period. Modern psychiatry does not call to us in our ignorance. It reflects the trends of the culture in which it is embedded, making it fashionable to issue changes to its theories as people demand, not as anything particularly relevant crops us scientifically. Case in point: homosexuality.
Why do you assume that society drives changes in the psychiatric field rather than the other way around?

My interpretation is that there's something special about psychiatry that you don't like that is not related to scientific issues, but more about religious or political ones, and the metaphysics of reification is an excuse and rationalization to reject the field without admitting the real underlying reasons. My assumption is that this is because you know that skeptics would reject their importance on the grounds that they are religious or political opinions.


Am I paying for this counseling session? Save your two-bit babble for the asylum then.

Nicely said, blutoski.

Sounds like you struck a nerve.

Dancing David
7th August 2006, 05:46 AM
You obviously did not read a lot of my posts as this thread progressed, I will address your issues that you mention but again, you sure didn't read alot that I wrote, i already mentioned the domestic violence issue and the issues with kids, perhaps a better question to be asking is this.

Why is menatl health the only provier of services?

Why aren't there more supports for children?

Why doesn't society support the victims of domestic violence?

Why don't we have more drug rehab?

The place I see it the most is in children. Doping them up. When I coordinated safety for my local school district, part of my responsibility was organizing community drug/violence prevention.. this meant that I was able to target early intervention programs in elementary schools, as well as colaborate with juvenile courts for restorative justice programs.

I've seen these kids first hand-- and the most disgusting thing????

Medication with no form of counseling whatsoever. Dope em up and send them out the door. In many cases it was the family doctor writing the prescription... but I've known psychiatrists who doped up kids after one meeting and the only follow-ups they scheduled were to see how the meds were working.

And whose fault is that Stamen, why isn;t the judge asking for counseling?

Is a family doctor a mental health practioner?

Is a psychiatrist suppossed to force counseling on people? i have worked in mental health for 16 years. In the town where I live the mental health center is so busy that there wait time for a psychiatrist is eight months. is that the fault of the mental health worker or the government that doesn't give a crap?

I agree there are kids who should not be medicated, and there are kids who should have counseling. But is that the fault of the mental heath practioner or the political system that underfunds the system? Or is that the fault of the crappy parent?


You can't tell me that this is a problem isolated in my home town... I've read similar stories from all over the place...

"You son has ADD."

"Take this... we'll adjust as needed..."

So that is a bad practioner, I can't help that, there are also family doctors who perscribe xanax to addicts, is that the fault of the mental health system or the doctor?

There are bad doctots, that is not some sort of philosophical issue for the defintion of mental health.


Yeah right. Many of the kids I worked with just sold their meds to users to crush and snort. Others just cried like babies in my office about how much they hated their meds. And yeah, a few it actually helped.

Then I sympathise, but what did you do about it? Did you talk to thier doctor's and families to find out why that medication was perscribed, did you advocate for a change? Why couldn't they get counseling?

I am not blaming you believe me, these are mental health issues but where were the supportive case managers and counselors? Why isn't mental health funded like other service provisions, why aren't there more funds to help people? It is not because there isn't mental illness, it is because we live in a society that favors the rich and ignores the poor.


Then there was my time in the area mental health hospital... as I stated I was on the women's floor. Time and time again, I watched men drop of their women in a state of hysteria (probably because of something sh!tty he did) I watched them get their meds, calm down... then the husbands were there first thing Monday morning to pick them up... betcha he had a great weekend!

And that is the fault of the mental health systems, that they get stuck with everybody else's problems. or is that a scoietal problem, that allows domestic violence? Asd I said in many posts earlier i feel that the medication of domstic violence is a real issue that needs to be addressed but it is not solely a mental health issue, the fault lies with a society that does not offer any supports for women fleeing domestic violence, I know there are shelters, I worked in on for three years, and they are woefully underfunded.


I'll never forget the 19-year old hooker... the cops would pick her up and dump her at the institution. They keep her as long as the law said they had to (usually 48 hours)... they'd drug her up, pat her on the back and send her home with a brand spanking new prescription. Her pimp was waiting at the gate to pick her up every time... 10 days later, we'd see her come through the system again-- RINSE AND REPEAT.

And whose fault is that? I don't know why they treated her Stamen, you haven't said that , but the issue most likely is that there is no support for substance abuse treatment, there are no services available to help abused children after they turn the age of twelve, child protective services are alomost non-existant and there are almost no programs to help prostitues break the cycle of drug addiction and domestic violence.

And this was 1993, my friend. Not 100 years ago. Slap a diagnosis on them, give them their meds, and send them on their merry little way.

And what the heck else can they do Stamen, you are blaming the person who gets to pull the bodies out of the river for the bodies in the river. the problem is not the medical model of mental illness, the problem is that if you don't give the 'dump jobs' treatment then there is no other place for them to go. There is no funding for rehab for the individuals who need it, there is no funding for supportive housing, there is very little funding for the mental health system to begin with.

A psych hospital can do little more, in the town where we work I can only admit people to the hospital when they are at rsik of suicide, homocide or just so out of it they will walk in front of a bus. So the vast majority of people I see, and especialy the drug addicts get zero intervention. Why ? Not because of the medical model of mental illness, but because our society favors the rich and takes a squat on everybody else.


So go ahead and say, "That's a shame." They should have gotten counseling... go ahead and appeal to words, because we need them to make a difference. But don't try to tell me that you can talk away my miagraine, cause it just aint the same damn thing.

I won't call you names for saying that I am indifferent, these are issues that are old hat Stamen, it shows that whatever you do you aren't a mental health worker and you haven't been to your local mental; health center.

The people who stick out mental health are the ones who can adjust to the depressing facts and not burn out.

It is not the fault of the diagnostic criteria that these things happen, it is the fault of a society that doesn't want to help people and then just stands there and expects the mental health system to cope with the lack of services.

Did you know that? Is this the fault of the psychiatrist and the DSM-IV or is this the fault of a society that expects the menatl health system to just cope with every issue that is doesn't address.

This is why i called you names earlier, you haven't been to your local service providers, you haven't been to your local mental health center to see how it deals with it's huge case load, you haven't been to your local elder abuse and victimization intervention provider, you haven't been to your local substance abuse provider, you haven't been to your local domestic violence shelter, you haven't been to your local children's inervention provider.

Why do i say this?

Because verything you have mentioned Stamen is old hat, I had to cope with it from the minute I became a case manager working with adults living with persistand and severe mental illness. They don't get squat for a check, housing costs alot, and no one wants the medical card because it pays a quarter on the dollar.

I had to deal with it at the domestic violence shelter, there is no emergency housing to meet the needs of womren and children, public housing is not a safe place, there families won't help. Society barely cares and generaly looks the other way.

And now I am a crisis woker , so I get to see all the people who get drowned in the river, all the people who can't get disability because the current adminstration makes them wait sixteen months between appeals, the others that society has drowned in the river of capitalism, stigma and indifference. I also do the intakes. so I see the children brought in because thier parents have a problem.

But why is that the fault of mental health, depression exists and is a normal reaction to stress. is that the fault of the system that creates the stress and doesn't do anything about it. Or is that the fault of the system that gets left pulling the bodies out of the river?

stamenflicker
7th August 2006, 08:20 AM
I'm going to dispute your claim that the DSM classified homosexuality as a 'disease'. You'll have to provide cites for this one.

Should I have said "illness?"

http://www.mhsource.com/expert/exp1052101c.html


The reason homosexuality was dropped was that there didn't seem to be serious consequences, most homosexuals stopped wanting to change, and therapy was ineffective, which meant the classification had little utility. This is pretty scientific in nature.

I think by the time we got to the DSM-IV you view might have a case, but certainly not prior to it.

Also: you're not grasping that I don't see this as a big leap from other medical classifications. You still haven't explained to me why you think chickenpox is 'an illness'.

And you're not addressing that there is a radical difference between chicken-pox and somebody's moods.

Is it not because our society just sort of thinks it is?

I said above that it is because we deem it to be so. Didn't I say that? Do have to dig it out?

What about the serious consequences of this?

We've seen the consequences, as you have pointed out. We saw them in mandatory sterilizations, etc. etc.

There are thousands of antivax people out there giving their kids chickenpox on purpose (chickenpox "parties"), and disagree with you.

Do you really think that just because these people are giving their kids pox on purpose that they would not define chicken pox as "a condition of being sick?" Answer the question.

Like pretty much all science, it's a human classification to call it an 'illness'. What's special about psychiatry?

It has an incredible power to "create" disorder(s). So much has been created that 1/4 of the American population is "suffering." Was 1/4 of the populations "suffering" 50 years ago? 200 years ago? The number of ADHD kids has increased 700% over the past 15 years... really? You think?

http://www.nimh.nih.gov/publicat/numbers.cfm

Psychiatry has the power to create illness under the umbrella of "science," innoculate the public with their shamanism, and POW! suddenly we're all hurting. It's a self-fulfilling prophecy if I've seen one...

The website also claims that depression is the number source of disability claims in America and Canda. How new is that? Maybe half the reason these people are depressed is because they're sitting home drawing disability checks.... and how helpful of a treatment is it for depression to send someone home from work to sit around the house and get more depressed?

Do you really believe that general medicine is creating more illness in otherwise healthy bodies?

If psychiatry is so effective, why is our society getting worse and not better? Simply put, its trendy to be sick these days. Just like running off on a Fugue was trendy 75 years ago. Just like having MPD was trendy when Hollywood was making movies about it. Just like having ADHD is trendy today.

This is a funny little sidenote on illness creation:
http://www.freepress.org/departments/display/20/2003/336

At least I'm assuming its a joke...

Personally, the scientific fields that I think stand out are geology, astronomy, and evolutionary biology. These are historical sciences, and experimental reproduction for theory-testing is weak at best. Psychiatry is pretty solid in comparison.

Except that none of these fields have the same benefit of getting insanely rich from their discoveries. Hey, it pays my bills because I married one, I know.

But you haven't demonstrated why, exactly, you think the consequences are 'more important'. You brought up Germany: blue eyes were eugenic ('healthy'), whereas brown eyes were dysgenic ('unhealthy'). Does this bring the concept of eye colour into question? Again: isolate the political issues from the scientific ones.

Are people getting "sicker" because of medical advances? Why are people getting "sicker" because of mental health "advances?"

stamenflicker
7th August 2006, 08:26 AM
Why is menatl health the only provier of services?

Why aren't there more supports for children?

Why doesn't society support the victims of domestic violence?

Why don't we have more drug rehab?


And why is the APA taking legal action on keeping children drugged? Where is their legal action on any of these items?

The APA has a vested interest in keeping itself at the center of power... at the center of disease construction... at the center of disease alleviation. And yet we have more disease now than we've ever had before.

Nice work!

stamenflicker
7th August 2006, 08:42 AM
I won't call you names for saying that I am indifferent, these are issues that are old hat Stamen, it shows that whatever you do you aren't a mental health worker and you haven't been to your local mental; health center.

The people who stick out mental health are the ones who can adjust to the depressing facts and not burn out.

It is not the fault of the diagnostic criteria that these things happen, it is the fault of a society that doesn't want to help people and then just stands there and expects the mental health system to cope with the lack of services.

You see working in mental health was like pushing your finger in the dike; every time you blocked one leak another one would gush out someplace else.

I wouldn't categorize my decision to leave as burn-out. Instead of keeping my fingers in the dike, I decided to hike up river to see where all this damn water was coming from.

Everything you've posted just further proves my point. Social intervention, programs, etc. all involve the landscape of the person who is suffering... this makes pyschology an art, not a science.

Much of the time, it's about perspective and purpose, not physiology. Most mental illness is an intangible "disease" with only intangible answers. That's my take anyway.

I'm glad the medical model is out there, for the times there is truly an underlying physical cause. But there are too many people pushing it too often... and this is a Western worldview, not a mere question of pushing poor people aside.

Dancing David
7th August 2006, 11:00 AM
You see working in mental health was like pushing your finger in the dike; every time you blocked one leak another one would gush out someplace else.

I wouldn't categorize my decision to leave as burn-out. Instead of keeping my fingers in the dike, I decided to hike up river to see where all this damn water was coming from.

I did not say yopu burnt out, I said that many people do, because there is a blanket system that is meant to deal with a single issue, mental health, and it gets everything else because it is there, with very little support.

But you can't blame the medical model of mental illness for a societal issue, you don't diagnos someone with depression if they are homeless, unless they pass the criteria for adjustment disorder. It is not the fault of the medical model that homeless people are likely to be depressed.


Everything you've posted just further proves my point. Social intervention, programs, etc. all involve the landscape of the person who is suffering... this makes pyschology an art, not a science.


Thats a real shame, you are saying that it is the fault of mental health that people have life issues, no they can meet the criteria while they have life issues, a good practioner will address the life issues along with the 'depression', just as a good doctor will advise that the patient get on a healthy diet and exercise more frequently. A good mental health practioner will do the same, you don't call heart disaease treatment an art and a science unless you are a doctor, it is true for the field. Same:Same.


Much of the time, it's about perspective and purpose, not physiology.

And most of those people should have CBT as opposed to medication, but 'duh' it is a free society than can choose either or neither.
Most mental illness is an intangible "disease" with only intangible answers. That's my take anyway.


And worth what my opinion is, what is your competing theory and evidence, people need treatment to improve, it is not the mental health model that is fault there, it is a systems issue with a lot of personal discretion.

You are blaming the mental health system for not treating the whole person, they can and do, what evidence do you have that it is willfull on the part of the pra ctioners to just medicate. It is not the best practice nor is it the main stream, it is usually the individual that declines therapy.

I'm glad the medical model is out there, for the times there is truly an underlying physical cause. But there are too many people pushing it too often... and this is a Western worldview, not a mere question of pushing poor people aside.

And that and a flying saucer make for a vauge conspiracy theory, your argument that there is a problem with the mental health model is based upon solely that. If I say that the system is not designed to provide support for all the people asking for help, you seem to blame it on the DSM, and the vast psychiatric conspiracy theory.

It is amtter that crosses into society and personl freedom as well, you seem to want top blame the mental health system for not giving the prostitue more support, what were they supposed to do?

What are your answers?

Where are your solutions?

Mental health is not saying that medicine is the only method to health, you treat the symptoms with medicine when warranted and you treat the rest of the person when you can, what is your beef with that?

That is why I say you need to go to the local menetal health center, see the people who get just therapy, see the people who need help in daily living, see that they try to help peopel qadress the life issues that they can, the main problem being that if soomeone does just have a situational problem, they aren'y likely to get treatment, because there ain't enough to do around.

You should also check out the devolpmental disability system, basicly they are just being shoved off onto thier parents because the government doesn't want to pay for the care they need.