“That’s Just a Brain Disease!” – The Poverty of Anti-Psychiatry Dualism
While having the same basic ideological base as vaccine rejectionism, anti-psychiatry has received considerably less attention in the skeptical community, some even going so far as to embrace it. It is hard to explain, but maybe it is the combination of the stigma associated with mental conditions, the complex and interdisciplinary nature of the area and political ideology, although like vaccine rejectionism, anti-psychiatry is not associated with any particular politics, but smeared out over many different groups.
A fairy standard tactic of anti-psychiatry is to outright deny the existence of mental conditions by claiming that there is no biological basis for their existence. They may preface their rejection of modern psychiatry by stating that, of course, they do not deny the suffering of the individuals, but that it is really no basis for psychiatry. While it is true that psychiatry is not as evidence-based as, say, physics or cardiology, it is still an area we should not neglect or dismiss out of hand. To be sure, there are improvements to be made, but don’t let us throw out the baby with the bathwater.
Anyways, the equally standard rebuttal by proponents of science-based medicine is to point to evidence of the biological basis of many of these conditions as well as discussing other conditions such as Huntington’s or Alzheimer’s that produce real psychological symptoms and detailing the biological background. Surely, we think, this would be enough to disprove their position.
Alas, this is where things start getting even more bizarre than normal: the response we get from proponents of anti-psychiatry is that all mental conditions, or diseases that have a clear neurological basis and feature significant mental symptoms, are not really mental disorders at all, but merely “brain diseases”. While this is strictly true, it shows how anti-psychiatry has become unfalsifiable. Because the moment anyone produced evidence of a biological basis or biological influence for a specific mental condition, then this does not disprove anti-psychiatry, since this mental condition is just relabeled as “brain disease” and the psychiatry rejectionists can go on to claim that there is no scientific evidence for the existence of mental disorders.
The real problem here is that these particular proponents of anti-psychiatry is implicitly presupposing some form of substance dualism. A mental condition, whether we know the precise etiology or not, is at some level related to the brain. In modern neuroscience, there is no real separating between the mind and the brain. While there is a genuine debate on how exactly how brain activity makes up the mind, there is no real opposition to the notion that the brain and mind are one and the same.
So in this context, these promoters of anti-psychiatry not only performs the fallacy of No true Scotsman, but actually assumes a backward and deprecated view on the science of the mind/brain.
You are putting in the same bag several movements that are loosely connected. Not all anti psychiatry people agree on the same claims. I for one think that there is enough data to say that the chemical imbalance theory that has been psychiatry main driver for the last 50 years is almost surely wrong. That doesn’t mean that I don’t believe mental disorders exist; they do exist but they are certainly not “diseases” in the sense HIV infection or cancer are.
Yet, lost in these debates is the corruption of the psychiatric establishment (pushed by its desire to become an actual science) and the drug companies, that bring in 80 billion dollars a year in psychiatric drugs revenue. They engage in dubious practices to keep the myth going. SSRIs have been shown to be no better than placebos treating depression (work by Irving Kirsch of Harvard University). These SSRIs, even the latest generation such as escitalopram, have severe side and withdrawal effects. If they were mere sugar pills I would not care much but these drugs not only are not very effective but they push people in the worst cases to commit suicide. This scandal needs to be exposed and we need to thank the anti psychiatry movement for working on the matter, even if we don’t agree with every claim of anti psychiatry.
Of course I understand that not all opponents of anti-psychiatry have exactly the same positions.
Your claim that the “chemical imbalance theory” is the “main driver” of psychiatry for the last fifty years is wrong. As I explained in the articles I linked to, the mainstream position is that mental conditions are caused by many different biological, psychological, social and environmental factors all interacting with eac other. So you are making a straw man of the explanations used by psychiatry.
Why should severe issues with the brain/mind not be classified as a disease like issues with other organ or body part? This is precisely what is wrong with anti-psychiatry dualism.
Psychiatrists are real scientists. A psychiatrist actually has an M. D. and many years of science education, just like any other doctor.
You are also making an appeal to motive when you cite the amount of money being generated. On a fundamental level, the motives a person have for making a specific claim has nothing to do witht he truth of that claim. For instance, many proponents of anti-psychiatry are also making a lot of money, yet you would not accept this as an argument for why they are wrong.
You are also mistaken in your belief that SSRIs have been shown to be nothing better than placebo. Kirsch found an effect size of 0.32 and none of his confidence intervals overlapped zero. The reason Kirsch came to the conclusion he did was because he used an arbitrary and deprecated standard of clinical significance of 0.5, which is no longer being used by the NICE.
So it is like saying that just because a glass is 1/3 full, it is not 1/2 full, so therefoer empty. I have written extensively about the problems with the Kirsch study on this blog. Try using the search feature.
Also, SRRIs do not cause suicide, because the increase in incidence of suicide can be seen in treatment with both SSRIs and non-drug psychotheraphy, and these are about the same. The best predictor of suicide is base line level of suicidal thoughts, which where not the same in the Olofson study that purported to show that SSRIs caused suicide. The reason for an increase in the incidence of suicide in the first few weeks of both SSRI and non-drug psychotherapy treatment is due to the fact that motivation increases faster than the level of suicidal thoughts decreases. Again, this has been written about extensively on this blog, so I suggest doing a search.
In fact, the anti-psychiatry movement is causing people to not take their medication, which we know leads to an increase in the level of suicides. So anti-psychiatry is actually directly harmful to people.
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The problem, like what you’ve stated, is that every instance when a biological basis for any mental disorder has been found, that mental disorder magically gets transported to any other medical field. So yeah, despite psychiatrists having MD’s in their names, it’s not really accurate to say that they are real doctors. I don’t deny mental illnesses/disorders exist, but their existence is akin to the existence of an objective morality (moral judgments of good & bad).
As for SSRIs “working”, all of them have effects on our bodies. OF COURSE it would work because it disrupts the normal function of any normal person’s brain & body, making the person gets distracted by whatever psychological problem is disturbing him/her.
No, every instance where a biological basis for any mental condition is found, that further cements psychiatry as evidence-based. What I am opposing is the common anti-psychiatry belief that once evidence of a biological basis is found, it somehow stops being a mental condition and becomes “just a brain disease”. This is wrong. It is still a mental condition as dualism is false, and the anti-psychiatry assertion is a desperate post hoc rationalization to defend the absolutist claim that there is no biological basis for mental conditions.
Psychiatrists are real doctors. They have gone through the exact same education, passed the exact same exams and fulfilled the exact same requirements for a medical degree.
Mental conditions exists just like any other medical condition. Depression is just as real as juvenile diabetes. You would never say to someone suffering from juvenile diabetes to “get it together, stop the underproduction insulin”. Similarly, depression has a biological influence that is just as real.
Your hypothesis that SSRIs work by distraction can easily be refuted as specific drug treatments (serotonin, dopamine, norepinephrine) differentially alleviate specific symptoms. norepinephrine relieve psychomotor retardation, dopamine alleviate anhedonia and serotonin alleviate grief (see Robert Sapolsky’s lecture on depression for more information). This would be completely unexplainable on the hypothesis that SSRIs works by distraction. Even in cognitive behavioral therapy, distraction is only a first method to handle negative automatic thoughts (NATs), yet CBT has around the same effect size as antidepressants.
Some of your statements actually prove the worthlessness of the field of psychiatry. For example, you admitted that just because a biological basis for any psychiatric disorder is found, it doesn’t stop to being labeled as a mental disorder. The question is: how the hell did it become a “mental disorder” in the first place if no biological basis has been found? What I’m saying is, the moment a biological basis has been accomplished, the “mental disorder” becomes an actual “brain disease”. So say, someone is severely unhappy, we call it “depression”, we call it merely a “mental disorder”. and THEN, say, a neurological cause was found, it then becomes primarily under Neurology, not Psychiatry. While Alzheimer’s disease has a known psychological symptoms, it doesn’t stop that Alzheimer’s disease rests on neurological signs (hard, concrete evidence found in the brains). In contrast, Psychiatry rests mainly on speculations! For example, you could be considered as having a mental disorder due to a certain label but let’s say, has the DSM revised, then you could not have a mental disorder anyway. I’m sure this has happened several times in the history of psychiatry, particularly in the case of homosexuality. Of course you’d say that psychiatrists do rigorous clinical research, experiments, etc. so their votes on what to consider a mental disorder is, counts, but a vote is STILL a vote, which means, entirely subjective, and so psychiatry remains more of a political field rather than a scientific field, despite the success of them trying to blur the lines between the two.
I don’t deny that psychiatrists can’t be called real doctors due to the experience and label that they have that the society sees. What matters, though, is what they do in their profession and in actuality and so far what they do is really unscientific. Hippocratic’s Oath is “First Do No Harm”, how the hell can they achieve this when they can prescribe psychiatric drugs without them performing any objective tests in the first place? The only assumption to be taken from this is NO BIOLOGICAL BASIS HAS BEEN FOUND FOR ANY PSYCHIATRIC DISORDER and like I said, once something has been found, that “disease” becomes an actual disease and gets treated under other medical fields. Psychiatry becomes a “soft alternative” or an “artistic field” in this respect.
Of course, severe unhappiness is real, but I would call it a psychological problem or a mental distress rather than a vague “mental illness”. I would help the person overcome whatever psychological problems he is facing in life. But severe unhappiness is not in the same league as diabetes, I’m sorry. With that, I disagree.
Also, you misunderstand my take when I say “distraction”. ALL psychiatric DRUGS have effects on our brains & bodies, whether it be making someone drowsy, hyper, alert, etc. That of course is an over-all effect to the human’s brain & body – of course all the “symptoms” like grief or whatever is reduced/alleviated BUT also, the person fails to realize that the drugs are affecting the person negatively, it reduces BOTH positive & negative experiences of the healthy body of the person. Of course the negative effects get excused as “side effects” when in fact, they are the only real effects along with the only real effects fogging your mind enough any “symptoms” of your psychiatric disorder fades. Case in point: you mentioned the studies in your blog post as showing that antidepressants do work with the analogy that “So it is like saying that just because a glass is 1/3 full, it is not 1/2 full, so therefore empty”. With all the effects the drugs give to a person’s brain & body, of course the people taking them would attribute to the fogginess of their minds as a “cure”, hence the SLIGHTLY positive result of the test, when compared to placebos. I must admit that I am not expert on statistics and all that, but I’m just giving my thoughts out here as a layman using his common sense, it’s okay for me for you to prove me wrong.
“Despite a hugely successful promotional campaign by drug companies and biological psychiatry, the effectiveness of most or all psychiatric drugs remains difficult to demonstrate. The drugs often prove no more effective than sugar pills, or placebos – and to accomplish even these limited positive results, the clinical trials and data that they generate typically have to be statistically manipulated” (p. 37) – Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs, Peter R. Breggin, MD & David Cohen, PhD. I am not flagging this out as the truth or even as an evidence against all your assertions but that is only one of the discovered studies about the inefficacy of drugs, along with the study you mentioned in your blog post. I assume many more have been found. Would you say they were all wrong and what Dr. Peter Breggin is saying that they have be statistically manipulated (hence also the slightly better results of drugs as shown in these trials) is wrong? I did see that article of “The Emperor’s New Drugs”, correct me if I’m wrong but I do remember them saying the FDA or whatever it is picking out only the statistics showing the drugs are slightly better than placebos to prove their case, but in the grand scheme of things, are just slightly better than placebos, like what you just said. Of course like what I also said, their effects disrupt normal brain function, any symptoms would naturally fade(or at least the person thinks so). How did I get that to the conclusion? If the problem is not in the brain, and you prescribe him a drug to “treat” the assumed problem in the brain, then there is no real “treatment” but only overall effect on the person’s brain & body, what do you make of that?
It does not stop being labeled a mental condition for a very good reason: it is still a mental condition. Just because we understand more and more about the specific neurological processes does not mean that the condition suddenly do not have behavioral and cognitive symptoms. You are still unable to realize that dualism is scientifically false. In other words, you have failed to grasp the central message of this blog post.
So tell me, why should I continue to interact with you?
For the same reason that juvenile diabetes became labeled as a condition even though we did not know about the specifics of autoimmune destruction of insulin-producing cells in the Islets of Langerhans.
For the same reason that migraine became labeled as a condition even though we did not know the specific neurological details behind it.
The prefix “mental” was because it affected the mental state and behavior of the patient. Conditions discovered in the past that was somehow related to the gums were called a gum condition. Was it related to the bowels, it became known as a bowel condition. This is all independent of us actually knowing what the specific molecular mechanisms were behind it.
Historically, conditions were labeled after the things it affected, even though we did not at the time understand the specific processes that contributed to the conditions (which required modern science). Things that affected mental state became known as a mental condition. Within modern science, mental conditions should really be known as mind/brain conditions. The reason why it is not is probably because dualism was widespread until maybe half a century ago and because it continues to be widespread among the public.
No. It is still a mental condition because it still affects the mental state and behavior of the patient. It does not become a brain condition, because we know from neuroscience that dualism is false, so by definition any mental condition is a brain condition, even if we do not know the specific neurological details.
You are confusing ontology with epistemology. Juvenile diabetes is still an autoimmune condition even if we had no idea what it was all about. Similarly, at a time when we did not understand the neurological basis of depression, it was still related to the brain.
That is simply because, in the history of science, we understood how to observe behavior and ask other people how they feel before we understood how to make tools like fMRIs or use model organisms to study neurology.
The dichotomy between psychiatry and neurology is a false one because the fields often overlap. See for instance Neuropsychiatry.
You are assuming dualism again. The moment a condition was psychological symptoms, the moment we know that it is related to neurology. The moment we know something is related to neurology, the moment we know that it has a psychological dimension. There really is no mental condition that does not have a neurological basis.
That is a sign of the scientific progress of psychiatry, since it revised it’s earlier position. This speaks in favor of psychiatry, not against it. Furthermore, this contradicts the popular anti-psychiatry argument that psychiatric diagnosis is merely expanding, labeling many normal behaviors as mental conditions. What will it be?
Most diagnostic criteria in all of medicine is determined by voting of expert professionals. How low does your CD4+ T cell count have to fall before we call it AIDS? What counts as a high platelet count? It is all based on the consensus of expert medical professionals. The take-home message is that voting is just a means of aggregating expert medical knowledge, which does not make it “entirely subjective”.
You still don’t get it, do you? Psychiatry is, from the perspective of medical education, just another branch of medicine and psychiatrists have the same medical training as any other specialty. They are just as much medical doctors as cardiologists or rheumatologists. IN psychiatry, treatment is based on clinical trials and the peer-review literature, just as any other field of medicine.
Modern medicine is not really about the Hippocratic Oath per se. Every medical treatment can do harm or have the potential to do harm: removing the appendix requires surgery and it is possible to have undiscovered allergies against stuff like antibiotics. Modern medicine is rather about the reduction of harm.
Psychiatrists do perform objective tests. The forms used have a high degree of reliability and validity. Furthermore, there are no 100% objective medical test in any area. They are affected by human biases, interpretations and the intrinsic specificity/sensitivity of the test.
Don’t you see the absurdity of your claim?
Every time evidence for a biological basis for a mental condition is found, proponents of anti-psychiatry claim that it is just a brain disease. A desperate move to be able to keep believing that there is no biological basis of mental conditions.
This is just like saying that no Scotsman eat meatballs, and every time examples of Scottish people eating meatballs, you claim that these people are not real Scottish people.
The fact remains that, since dualism is false, all mental conditions have a neurological basis and all neurological conditions potentially have mental and behavioral effects.
First of all, there are more components to depression that merely severe unhappiness, such as guilty, psychomotor retardation and anhedonia.
Ironically, by claiming that depression is merely severe unhappiness and not related to the brain or other symptoms, you are minimizing the suffering of depressed individuals and increasing the stigma because you imply that it is just “in their heads” and something they can “snap out of”.
In type-I diabetes, the pancreas is underproducing insulin. In depression, the brain is underproducing neurotransmitters. It is pretty analogous.
What evidence do you have for this? I also note that you are unable to explain why different antidepressant types affect the symptoms in a different manner. If it was just a provision of distraction, there would not be such a specific response depending on what type of antidepressant was used.
How do you know that fogging of the mind is the reason why psychiatric conditions go into remission? Ironically, you are asserting things that cannot be objectively tested.
No, that was an analogy to the invalid use of a particular standard for clinical significance.
The effect size of antidepressants that Kirsch found was 0.3. This qualifies as somewhere between a small and moderate effect. However, Kirsch did not want to write the statistically appropriate conclusion, so he used an arbitrary and deprecated standard for clinical significance: if a result did not have an effect size over 0.5, he thought that it was of no clinical value. However, this is wrong: as a 1/3 of a glass of water is not in practice empty.
There are many problems with that argument:
(1) side-effects are usually about the same in both the experimental group (given antidepressants) and in the control group (given placebo). This is because of the nocebo effect. An example study of this phenomena can be found here. To read more about the nocebo effect, read this article or watch this video.
This works similar to the placebo effect. If you are led to believe that a sugar pill will have beneficial effects, then those expectations will influence your view of their effect. Similarly, if you are told that a sugar pill will have specific side effects, your expectations will influence your view of their effect.
So about the same amount of “fog” would be experienced by both groups, making your argument unpersuasive.
(2) you have not provided any evidence that the primary effect of antidepressants are to “fog the mind” of patients. Indeed, how could you even test this? How do you operationalize “fog in the mind”? Remember, that you yourself claimed that any conclusion based on behaviors or reported mental/cognitive symptoms was not an “objective” test. You have painted yourself into a corner.
No, the anti-psychiatry argument is that pharmaceutical companies are selectively reporting positive results to the FDA, and that is why the antidepressants seem to be effective.
However, the FDA requires that all studies carried out are reported. This can be done by forcing pharmaceutical companies to report that they are going to carry out a study before it is actually done and only accept studies for consideration that was reported before being carried out.
Furthermore, the metaanalysis by Kirsch (2009) and Turner (2008) showed that even if you take into account publication bias (which can be quantified), antidepressants have an effect size of somewhere between small and moderate.
It is true that the effect size of medication is usually higher in trials carried out by pharmaceutical companies than independent researchers, but this is only partly due publication bias. Another important factor that needs to be taking into account is the fact that pharmaceutical companies (having much more money) can design much more rigorous studies and control for many more confounders.
I think the argument assumes substance dualism and no evidence has been presented that mental conditions (or any mental experiences) are independent of the brain. Therefore, the argument cannot be taken seriously from the standpoint of modern science.
“The only assumption to be taken from this is NO BIOLOGICAL BASIS HAS BEEN FOUND FOR ANY PSYCHIATRIC DISORDER and like I said, once something has been found, that “disease” becomes an actual disease and gets treated under other medical fields.”
Or I should say, the only assumption is that either A.) they are malpracticing their field B.) No biological basis has been found for any psychiatric disorder
The thing is, if biological basis has been found for any psychiatric disorder, like I said before, it becomes under any other medical field – not Psychiatry, putting into question the entire field of Psychiatry.
“How did I get that to the conclusion? If the problem is not in the brain, and you prescribe him a drug to “treat” the assumed problem in the brain, then there is no real “treatment” but only overall effect on the person’s brain & body, what do you make of that?”
Please ignore this. It’s just an after-thought that is unnecessary.
In medicine, a lot of fields overlap, such as forensic medicine, neuroimmunology, pharmacogenomics or, as I mentioned before neuropsychiatry.
Would you say that a neurological condition that was discovered to be related to immunology (like MS) is no longer a neurological condition? If no, why make that argument with regards to psychiatric conditions that are shown to be related to neurology?
That is because the different organ systems of the body is interactive and it is only because we want to simplify the situation that we treat the systems as separate. They are really not separate; they interact. That is the reason why many fields have become interdisciplinary, such as neuropsychiatry. Even biological psychiatry is an interdisciplinary field to begin with.
“It does not stop being labeled a mental condition for a very good reason: it is still a mental condition. Just because we understand more and more about the specific neurological processes does not mean that the condition suddenly do not have behavioral and cognitive symptoms. You are still unable to realize that dualism is scientifically false. In other words, you have failed to grasp the central message of this blog post.
So tell me, why should I continue to interact with you?”
“For the same reason that juvenile diabetes became labeled as a condition even though we did not know about the specifics of autoimmune destruction of insulin-producing cells in the Islets of Langerhans.
For the same reason that migraine became labeled as a condition even though we did not know the specific neurological details behind it.
The prefix “mental” was because it affected the mental state and behavior of the patient. Conditions discovered in the past that was somehow related to the gums were called a gum condition. Was it related to the bowels, it became known as a bowel condition. This is all independent of us actually knowing what the specific molecular mechanisms were behind it.
Historically, conditions were labeled after the things it affected, even though we did not at the time understand the specific processes that contributed to the conditions (which required modern science). Things that affected mental state became known as a mental condition. Within modern science, mental conditions should really be known as mind/brain conditions. The reason why it is not is probably because dualism was widespread until maybe half a century ago and because it continues to be widespread among the public.”
“You are assuming dualism again. The moment a condition was psychological symptoms, the moment we know that it is related to neurology. The moment we know something is related to neurology, the moment we know that it has a psychological dimension. There really is no mental condition that does not have a neurological basis.”
I did reread what the blog post is about. And yeah, I really have to disagree that the mind/brain dualism is invalid. I think it’s very valid. If it’s “mental”, as in, the “mind”, we can always refer it to the software of our brains. And so the proper treatment should not be in the perspective of the physical whereas if it’s in the “brain”, it’s actually the hardware. So yes, I think you’re still wrong.
“That is a sign of the scientific progress of psychiatry, since it revised it’s earlier position. This speaks in favor of psychiatry, not against it. Furthermore, this contradicts the popular anti-psychiatry argument that psychiatric diagnosis is merely expanding, labeling many normal behaviors as mental conditions. What will it be?”
I wish I can paste the exact quote from one author I found who said that within those span of time, there was this certain disorder, had it revised for another span of time so it disappeared, but then after that, it was again reinstated as a mental disorder. So you can have that mental disorder before, then gone, then voila! you have it again. I’m not sure, though, if that was the exact message but what I can remember was she saying that. So I wasn’t really referring to the revision as a “progress”, more like, the changes are political decision, rather than scientific progress. ‘It’s a matter of fashion,’ says Dr. John Spiegel of Brandeis University, who was president of the APA in 1973, when the debate over homosexuality flared. ‘And fashions keep changing'” (p. 30). That quote is found here: http://antipsychiatry.org/exist.htm . Of course, I assume you’ve already read and explored the website. Also, I remember seeing one of the videos at cchr.org saying one of the members of the APA declaring why something cannot be considered a mental disorder as proposed by his fellow members in a personal perspective and so the one tallying the vote was like, “OK, then. let’s remove it.” then removed it. I’m too tired and lazy to actually cite that video and I don’t think that matters – I’m just speaking in the perspective of the anti psychiatry’s view, not saying those are hardcore evidence against psychiatry. Just saying what other else I found out. Anyway, I was just letting you know that what I had in mind wasn’t actually “progress” as you’ve interpreted – merely the political decision of everything about the DSM. Further: A letter to the editors published in the July 30, 1998 issue of USA Today, page 11A, by the president of Concerned Women for America argues that “only about 30% of the APA [American Psychiatric Association] took part in the crucial vote that changed its view of homosexuality.” Her letter quotes a psychoanalyst, Dr. Charles Socarides, saying that in declaring that homosexuality would no longer be considered a mental illness, “The APA ignored the science, and for reasons that were nothing but political, ‘cured’ homosexuality by fiat.” The letter claims that a survey of psychiatrists four years later showed that “69% disagreed with the APA vote and still believed homosexuality to be a disorder.” So yeah, homosexuality is still a mental disorder but apparently the DSM considers it not. It’s all nebulous. The nebulousness of all this hints that psychiatric diagnosis is merely expanding, labeling many normal behaviors as mental conditions.
“Most diagnostic criteria in all of medicine is determined by voting of expert professionals. How low does your CD4+ T cell count have to fall before we call it AIDS? What counts as a high platelet count? It is all based on the consensus of expert medical professionals. The take-home message is that voting is just a means of aggregating expert medical knowledge, which does not make it “entirely subjective”.
Hmm, but deciding ‘how low does your CD4+ count to fall before we can call it AIDS’ is very different from deciding what kind of mental disorders should exist in the DSM. So yeah, I don’t think that analogy is valid. And even if say, we look past the voting, it doesn’t change the fact that “mind” is different from the “brain” going back to the main issue of this debate.
“Modern medicine is not really about the Hippocratic Oath per se. Every medical treatment can do harm or have the potential to do harm: removing the appendix requires surgery and it is possible to have undiscovered allergies against stuff like antibiotics. Modern medicine is rather about the reduction of harm.
Psychiatrists do perform objective tests. The forms used have a high degree of reliability and validity. Furthermore, there are no 100% objective medical test in any area. They are affected by human biases, interpretations and the intrinsic specificity/sensitivity of the test.”
‘Removing the appendix requires surgery and it is possible to have undiscovered allergies against stuff like antibiotics’ is very different from prescribing psychiatric drugs to someone you haven’t really performed objective tests to know that the problem is in his brain. And if Psychiatry is treating physical disorders (as in, brain disorders, for example), ‘forms used’ would never be considered as ‘objective’, what would be considered objective are PET, MRI, etc.
“Don’t you see the absurdity of your claim?
Every time evidence for a biological basis for a mental condition is found, proponents of anti-psychiatry claim that it is just a brain disease. A desperate move to be able to keep believing that there is no biological basis of mental conditions.
This is just like saying that no Scotsman eat meatballs, and every time examples of Scottish people eating meatballs, you claim that these people are not real Scottish people.
The fact remains that, since dualism is false, all mental conditions have a neurological basis and all neurological conditions potentially have mental and behavioral effects.”
Um. No. “Mental diseases” are not “brain diseases” because the mind is not the brain. This is why you think they seem like trying to make up excuses when they say “well, that’s not a ‘mental disease’ anymore, but now a proven ‘brain disease’ “. In short, they’re saying don’t treat anything in the physical perspective as a proven brain disease when it’s not a proven brain disease yet. A mental disease/problem/disorder may be a software error or psychological trauma, but cannot be considered a physical problem. The question gets murkier when we ask “since when can we consider someone having a mental disease?” In my opinion, someone can have a ‘mental illness’ but I do tend to see the patient as having psychological problems or traumas, not having physical defects in the brain. Of course, those who are going to go far as to say ‘mental illness’ doesn’t exist will say that someone can only be labeled ‘mentally ill’ if he displays socially deviant behavior or distress.
Also, some anti-psychiatrists don’t deny, they are actually on the idea that “mental illnesses” are different from “brain illnesses” and so when a “mental illness” is proven to be a “brain illness”, the idea of that illness being mental ceases. So they’re not denying that “mental illnesses” don’t have biological causes for them to exist, rather the “mental illnesses”(or distresses, whatever) cease being murky, nebulous, cloudy when transferred to other medical fields or shift from a psychological perpsective to a physical perspective rendering them “mental illnesses” as useless. However, some believe that mental illness getting transferred to neurology(that deals with brain disorders, not mental disorders) cease being called a “mental illness” as they believe that “mental illnesses” don’t exist as they define existence to something physical, like brain cancer. That is why they say that “mental illness” is a myth because they have the idea that for something to be called a real, physical illness, it has to have a biological cause first.
Then again, some believe that brain disorders and by extension, “mental disorders” or “mental illnesses” is already in the province of Neurology, not Psychiatry. anything Psychiatry treats – “mental disorders”/”mental illnesses” – to these people, are mere speculation and nonexistent.
“The fact remains that, since dualism is false, all mental conditions have a neurological basis and all neurological conditions potentially have mental and behavioral effects.”
Hence, why we have neurology (dealing with brain diseases & disorders – all originating in the brain), and we don’t need psychiatry (dealing with mental diseases & disorders – all originating in the mind)
“First of all, there are more components to depression that merely severe unhappiness, such as guilty, psychomotor retardation and anhedonia.
Ironically, by claiming that depression is merely severe unhappiness and not related to the brain or other symptoms, you are minimizing the suffering of depressed individuals and increasing the stigma because you imply that it is just “in their heads” and something they can “snap out of”.
In type-I diabetes, the pancreas is underproducing insulin. In depression, the brain is underproducing neurotransmitters. It is pretty analogous.”
Just because it is something in their heads does not mean they can snap out of it. In fact, it must even be the exact opposite! because it’s in their heads, it’s harder to actually overcome them! I believe mental illnesses might even be a little bit harder to overcome than physical illnesses. Do mental/emotional instability results to physical illnesses? Of course, but the mental/emotional instability cannot be considered as a “physical illness”.
There are many authors who have credentials that will laugh at you when you say that depression is a proven brain disease, underproducing neurotransmitters, I’m not saying I believe them, it’s just that when you state it like this, you’re making it out an obvious fact agreed upon many when there’s serious issues surrounding the mere cause/evidence of depression. For example: psychiatrist Peter Breggin says: “Depression is never defined by an objective physical finding, such as a blood test or brain scan. … Attempts have also been made to find physical markers for depression, the equivalent of lab tests that indicate liver disease or a recent heart attack. Despite decades of research, thousands of research studies, and hundreds of millions of dollars in expense, no marker for depression has been found” … “”In reality, science does not have the ability to measure the levels of any biochemical in the tiny spaces between nerve cells (the synapses) in the brain of a human being. All the talk about biochemical imbalances is sheer speculation aimed at promoting psychiatric drugs. … science has almost no understanding of how the widespread serotonin system functions in the brain. Basically, we don’t know what it does.” These are all in his book, The Anti-Depressant Fact Book. I’m curious how the debate between the two of you will happen if the two of you meet. There is another one: In the words of psychiatrist David Kaiser: “Patients hav[e] been diagnosed with “chemical imbalances” despite the fact that no test exists to support such a claim, and … there is no real conception of what a correct chemical balance would look like.”
“What evidence do you have for this? I also note that you are unable to explain why different antidepressant types affect the symptoms in a different manner. If it was just a provision of distraction, there would not be such a specific response depending on what type of antidepressant was used.”
“How do you know that fogging of the mind is the reason why psychiatric conditions go into remission? Ironically, you are asserting things that cannot be objectively tested.”
“The effect size of antidepressants that Kirsch found was 0.3. This qualifies as somewhere between a small and moderate effect. However, Kirsch did not want to write the statistically appropriate conclusion, so he used an arbitrary and deprecated standard for clinical significance: if a result did not have an effect size over 0.5, he thought that it was of no clinical value. However, this is wrong: as a 1/3 of a glass of water is not in practice empty.”
“There are many problems with that argument:
(1) side-effects are usually about the same in both the experimental group (given antidepressants) and in the control group (given placebo). This is because of the nocebo effect. An example study of this phenomena can be found here. To read more about the nocebo effect, read this article or watch this video.
This works similar to the placebo effect. If you are led to believe that a sugar pill will have beneficial effects, then those expectations will influence your view of their effect. Similarly, if you are told that a sugar pill will have specific side effects, your expectations will influence your view of their effect.
So about the same amount of “fog” would be experienced by both groups, making your argument unpersuasive.
(2) you have not provided any evidence that the primary effect of antidepressants are to “fog the mind” of patients. Indeed, how could you even test this? How do you operationalize “fog in the mind”? Remember, that you yourself claimed that any conclusion based on behaviors or reported mental/cognitive symptoms was not an “objective” test. You have painted yourself into a corner.”
“However, the FDA requires that all studies carried out are reported. This can be done by forcing pharmaceutical companies to report that they are going to carry out a study before it is actually done and only accept studies for consideration that was reported before being carried out.
Furthermore, the metaanalysis by Kirsch (2009) and Turner (2008) showed that even if you take into account publication bias (which can be quantified), antidepressants have an effect size of somewhere between small and moderate.
It is true that the effect size of medication is usually higher in trials carried out by pharmaceutical companies than independent researchers, but this is only partly due publication bias. Another important factor that needs to be taking into account is the fact that pharmaceutical companies (having much more money) can design much more rigorous studies and control for many more confounders.”
I’m merely stating the arguments of the anti-psychiatry field saying that antidepressants or drugs are no better than placebos and such. With them saying it like that, I just thought that it could mean that the slight improvement of people taking antidepressants could be attributed to the belief that they’re getting well because they think they are being cured because of the belief that they are receiving the real drug because of the “side effects” they are experiencing or that the effects of the drugs could be over-all affecting their brains & bodies that they can’t seem to realize that the drugs aren’t targeting specifically their depression (“fogging the brain”) (or any psychiatric disorder for that matter). That ‘specific drugs target specific symptoms’ doesn’t change this fact: drugs do affect people differently, so a certain drug could be affecting a person’s brain entirely differently compared to other drugs that a ‘specific symptom’ is gone when still in fact, the drug affects the entire brain. Further, if “mind” and “brain” are different, why would we assume that drugs can cure mental/psychological problems in the first place? That is why I could assume from that the people taking the drugs are falsely thinking that the effects are curing their psychological distress when in fact, that the drugs are impacting OVER-ALL their brain anyway, making any symptom gone.
Also, your argument about the nocebo is invalid. “Studies indicating psychiatric drugs are helpful are of dubious credibility because of professional bias. All or almost all psychiatric drugs are neurotoxic and for this reason cause symptoms and problems such as dry mouth, blurred vision, lightheadedness, dizziness, lethargy, difficulty thinking, menstrual irregularities, urinary retention, heart palpitations, and other consequences of neurological dysfunction. Psychiatrists deceptively call these “side-effects”, even though they are the only real effects of today’s psychiatric drugs. Placebos (or sugar pills) don’t cause these problems. Since these symptoms (or their absence) are obvious to psychiatrists evaluating psychiatric drugs in supposedly double-blind drug trials, the drug trials aren’t really double-blind, making it impossible to evaluate psychiatric drugs impartially. This allows professional bias to skew the results.” Found here: http://antipsychiatry.org/drugs.htm . Again, I’m not saying that as fact, just presenting what the anti-psychiatry side would say to you (am I siding with them? I think I am but still, I’m not saying that as fact as that would only prove I’m only citing/reading those things that would agree with me, I’m just pointing out the counter they have to say). But then again, you did admit that those drugs which are not real psychiatric drugs or only being used for nocebo still don’t have nasty side effects, making the judgment to this not impartial as I can imagine one patient saying, “I feel alleviated taking prozac more than taking this (nocebo/inert pill)drug” not knowing that the side effects of prozac made him decide that prozac was working for him.
“No, the anti-psychiatry argument is that pharmaceutical companies are selectively reporting positive results to the FDA, and that is why the antidepressants seem to be effective.”
Manipulated results. Same thing. Also: from: http://antipsychiatry.org/br-afb.htm
Throughout this book Dr. Breggin points an accusing finger at the USA’s Food and Drug Administration (FDA), which is given the responsibility of keeping harmful drugs off the market in the USA. After reviewing how the FDA had to accept misleading, manipulated data to approve SSRI antidepressants as safe and effective, and after reviewing the harm done by these drugs, he says “If the FDA had been more responsible, these continuing tragedies could have been avoided. … When I began my review of FDA documents as a medical expert in product liability suits against Eli Lilly and Co., I was shocked and disillusioned by what I found. Until that time, I had not fully confronted the willingness of the FDA to protect drug companies, even at the cost of human life.” (pp. 78-79). He says “The Food and Drug Administration (FDA) has forsaken its watchdog role. Instead, FDA officials climb like puppies into the laps of drug company executives who might some day hire them at enormous salaries” (p. 181). -The Anti-Depressant Factbook.
What do you make of that? Is this untrue?
Also, what do you make out of people saying psychiatric drugs have been harmful to them and made them feel suicidal or crazy or things like that or even contributed to them making homicides?
“No, that was an analogy to the invalid use of a particular standard for clinical significance.”
yeah, I know. I should have said your analogy to the invalid finding of that certain study. But I think I get what you’re explaining anyway.
“Would you say that a neurological condition that was discovered to be related to immunology (like MS) is no longer a neurological condition? If no, why make that argument with regards to psychiatric conditions that are shown to be related to neurology?”
That’s simple: neurology and immunology both deal with physical diseases.In contrast, psychiatry deals with mental diseases which is something different from the brain (neurology). We already have neurology(“brain diseases”), we don’t need psychiatry(“mental diseases”). Psychiatry remakes all mental diseases/psychological problems into something they’re not. Of course, some anti-psychiatrists would even claim to say that even the term “mental disease” is silly because they don’t believe that the mind is a physical component, it’s just an abstract description for what the brain does – kinda like a software to the hardware – so they’d say: “There can no more be a mental disease than there can be a purple idea or a wise space. The words “mental” and “illness” simply do not go together logically. Mental illness cannot be equated with brain disease, because brain diseases involve biological abnormalties, and mental illnesses do not (that anybody can prove). One might similarly point out: There can no more be a “mental” illness than there can be a “moral” illness. If the idea of a “moral illness” sounds strange, even impossible, why is “mental” illness any more logical or possible – because morality is merely one aspect of mentality! If a person were “morally ill,” would you call a doctor? Should you call a clergyman? Might it be possible to cure a “moral illness” with a drug? If it doesn’t make sense to “treat” a “moral” illness with a drug (or ECT or other biological treatment), why does it make sense to “treat” any other so-called “mental” illness this way?”
“That is because the different organ systems of the body is interactive and it is only because we want to simplify the situation that we treat the systems as separate. They are really not separate; they interact. That is the reason why many fields have become interdisciplinary, such as neuropsychiatry. Even biological psychiatry is an interdisciplinary field to begin with.”
hahaha, “biological psychiatry” is obviously an interdisciplinary field to begin with because psychiatry is never biological in the first place. Duh. Didn’t you even wonder about that?
And the truth is that when a “mental illness” is transferred to any other medical field, psychiatry doesn’t interact with that other field even if it seems so. It’s just that the other field really takes on that newfound physicall illness, rendering psychiatry, being only descriptive, useless. So “neuropsychiatry” is just neurology and “biological psychiatry” is really just biology. Haha.
“I think the argument assumes substance dualism and no evidence has been presented that mental conditions (or any mental experiences) are independent of the brain. Therefore, the argument cannot be taken seriously from the standpoint of modern science.”
The fact that brain diseases (neurology) are different from mental diseases (psychiatry) prove that neurology is the real medical field dealing with known brain disorders, not abstract mental disorders. Of course, this fact along with the fact once any mental disease is proven to be a neuorological disease, immunological disease, or something else, that disease gets transferred there. In short, as long as it’s only descriptive, it’s in psychiatry, but when it’s biological/physical, it becomes something else. So yes, “mental experiences” are independent of the brain, because once they are not independent of the brain, they become neurological. Tell me, why should softwares be treated like hardwares?
I think that you insisting that there has to be an evidence that mental conditions should be independent from brain is quite delusional. If they’re not, why should there be a fine line between the two? Furthermore, even if we start from your premise that mental conditions are not independent of the brain, it doesn’t really change the fact that psychiatry is merely descriptive and not biological (PET, MRI, etc.) in its approach, pointing to the fact that psychiatric disorders aren’t yet PROVEN to be biological disorders/diseases. 🙂 (UNTIL they get transferred to other medical fields).
Don’t you see the contradictory nature of your position? You claim that “mind” and “brain” are not independent of each other, but fail to realize that psychiatry and neurology are different medical fields! Neurology should be dealing with “mental disorders”, “mental illnesses” as much as it deals with “brain disorders” and “brain diseases” and such – psychiatry being a separate medical field would be redundant! Bizarre position.
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There are three general problems with your position with regards to mind/brain dualism:
I. I think you are confusing mind/brain substance dualism (i.e. the notion that the mind and the brain are of two fundamentally different “stuff”) with the position that the brain and the mind are two different levels of analysis (like how genes and development or individual and population are two different levels of analyses). Mind/brain dualism has been destroyed by modern neuroscience and can no longer be taken seriously. Brain damage effects cognition in predictable ways, cognition is evolutionarily correlated to neuroanatomical features; chemical compounds that effect aspects of the physical mind also affect the brain in extremely predictable ways etc. Any modern neuroscience textbook, such as Bears, Connor and Paradiso (2006) will lay out the evidence in more detail.
II. The hardware/software analogy for the brain and the mind is incompatible with the notion of mind/brain substance dualism. In a computer, both hardware and software are made up out of physical matter. They are just two different levels of analysis, but there is no additional “stuff” besides matter. Software is just as much matter as hardware.
III. Claims made by anti-psychiatry proponents, such as the notion that psychiatric medications have horribly negative effects on the mind and cognition, assumes that the mind is a function of the brain. If substance dualism was true, then no physical modification of the brain could ever cause any changes on the level of the mind.
There are such examples in many other areas of science where we would never say where due to political decisions, such as:
a) Around the turn of the 20th century, Einstein postulates the cosmological constant to be able to unite certain theoretical results of general relativity with his notion of a static universe. When the Big Bang theory emerged and replaced the steady state model, Einstein called the cosmological constant his biggest blunder. However, the cosmological constant has returned in fundamental physics as part of an explanation for the cosmic acceleration that was observed in 1998 in relation to the relationship between distance and redshift for a particular type 1a supernova. Does this mean that scientific progress in cosmology is merely political decisions? No.
b) Leeches were used to “treat” medical conditions in Medieval Europe via bloodletting. Bloodletting was advocated by many historical names in medicine, such as Hippocrates and Paracelsus. With the advent of better ideas in medicine, the idea of using leeches in medicine fell out of favor (for good reasons). Yet, modern medicine has discovered that leeches can be used to prevent tissue necrosis due to venous insufficiency after microsurgeries. This is because their saliva contains an anticoagulant. This has also been isolated and used in recombinant DNA technology to be able to give anticoagulants patients with blood clotting disorders that happen to be allergic to commonly used anticoagulants such as heparin. A third area of application of leeches is for treating hemochromatosis (accumulation of dangerous levels of iron in the blood). Does this mean that scientific progress (stopping with bloodletting or using leeches after microsurgery) was merely a political decision? No.
etc.
First of all, CCHR is operated by the Church of Scientology. Therefore, I think that a moderate amount of skeptical source criticism is warranted. I also suspect that stronger evidence than such an anecdote is needed. Furthermore, I feel that you have not provided a reasonable rebuttal to my argument that specific symptoms of every medical diagnosis is to a certain extent decided by voting (i.e. scientific consensus). The current level of CD4+ T cells required for a diagnosis of AIDS is less than 200 cells per µL. Does that mean that if you have 201, you are perfectly healthy? Of course not. This level was set by scientific consensus by international experts, but that does not mean that evidence was not a relevant factor in the decisions made.
There is always going to be a scientific debate around various issues. Should this mental condition have this particular level of symptoms? Should the number of symptoms needed for a diagnosis be increased, decreased or stay the same? Etc. This, however, exists in all scientific fields as default, and a debate about details should not be confused with a debate on the major premises of the field.
In reality, it was not primarily a political decision. During the later stages of the civil rights movements, scientists became increasingly skeptical of the notion that homosexuality was a mental disorder as they failed to produce any consistent scientific justification for that claim. Most of the people who believed it to be a disorder were motivated by religious dogma or psychoanalytical ideas that also lacked evidence (remember that the cognitive revolution started as far back as the 1950s). As the evidence accumulated against the diagnosis, scientists started opposing it. It was also found that the supposed arguments underlying the diagnosis were based on erroneous social norms and unrepresentative samples. Considerations of the three Ds: dysfunction, distress and deviance, was no longer in their favor.
The physicist Max Planck use to say that science progresses funeral by funeral. I think this is applicable here. I am sure that older psychologists, particular those with a psychoanalytical inclination, tried to resist both the cognitive revolution and the removal of homosexuality as a diagnosis. However, the evidence defeated them and they have lost both battles.
It is true that diagnostic criteria have been expanded over the years. This is partly due to the fact that we now understand that mental conditions are no separate and discrete pathological states, but rather exaggerations of normal, adaptive behavior (i. e. anxiety is perfectly healthy when you face a lion, but not in individuals with severe anxiety to what others consider everyday events). Also, in the case of e. g. autism, other categories have been merged into autism spectrum disorder (they use to classify severe cases as just “mental retardation” and less severe cases as “eccentric” or “Asberger’s”). So the situation is more complex than you lead on.
You would probably be surprised to know that when the CDC changed their definition of AIDS to include a specific CD4+ T cell count and expanded the list of opportunistic infections characteristic of AIDS patients, critics made such claims as “the number of AIDS patients doubled over night” and similar. Ring a bell?
Actually, highly reliable and highly valid forms are considered objective tests. That is the very nature in what it means to be e. g. “highly reliable”. The main point is that medicine is not about avoiding harm at all costs, but making cost-benefit analysis and going with the most optimal treatment. Such a treatment is the one that produces the most benefits with the least amount of risk.
Actually, there are many, many, many pitfalls with scans such as PET or MRI. You need extremely tight controls and evaluation of the results, whether related to mental conditions, brain tumors or swelling, require an interpretation based on the biological and neurological context by the researcher. This introduces a certain degree of subjectivity. Furthermore, brain scans provide you with correlations, but as we all know, that does not itself imply causation. To make a causal inference more supported, you need independent lines of evidence. Such lines often include forms and inventories filled out by the patient and the therapist or psychiatrist.
That is like saying that because we know that MS is a neurological disease, we do not need immunology. Of course we do. The reason that medicine and science have different specialties is merely because it makes it easier for us. In reality, the human body is an integrated system and things that happen in one area (say, autoimmunity in immunology) often affect other areas (such as the origin and progression of multiple sclerosis in neurology). There are plenty of other examples: (1) HIV is a disease (i.e. relevant for immunology or pathology), but causes damages to certain organs such as kidneys (making nephrology relevant), (2) patients being noncompliant with diabetes (immunology or internal medicine) treatments can develop many complications, including kidney failure (nephrology) and blindness (ophthalmology). Clearly, these examples show that medicine is not a dichotomous as you make it out to be. Most conditions and most features of the human body fall within multiple disciplines. Ignoring them will have high costs. An oncologist who deals with hereditary cancers, but ignore, say, the genetics of tumor suppressor genes, will harm his or her patients.
Most researches do acknowledge that mental conditions are related to the brain. You can always find individual scientists who do not accept the scientific consensus position. There are scientists who are creationists (e. g. developmental biologist Jonathan Wells), HIV/AIDS denialists (e. g. molecular biologist Peter Duesberg), reject climate change (Fred Singer), reject the notion that smoking causes lung cancer (Fred Singer again), believe in astrology (Kary Mullis), reject safe vaccines (Diane Harper), believe that vitamin C cures cancers (Linus Pauling), believe that autism is caused by mothers (Niko Tinbergen), homeopathy (Luc Montagnier) etc. The list can be made huge, but the existence of a small number of detractors says nothing about the validity of the mainstream position.
As I have explained in numerous posts on this blog, “chemical imbalance” is a straw man or at any rate a gross, gross oversimplification. Mental conditions, according to mainstream science, are caused by an interaction of biological, psychological and environmental factors. In the biology category, contributions come from genetics, development, gene-environment interactions as well as neurochemistry. In neurochemistry, it is not as easy as “chemical imbalance” because the interaction of multiple neurotransmitter systems and brain areas have been implicated in scientific studies of various types. These all independently converge on the same general conclusion: neurochemistry is relevant and provide risk factors for mental conditions. Of course, it needs other risk factors from other areas, such as psychology and environment to trigger, but that does not mean that neurochemistry or other biological factors are irrelevant.
In the same way that the success of specific antiretroviral medication against HIV and HIV to AIDS progression show that HIV causes AIDS, so does the efficacy of e. g. antidepressants show that proposed explanations related to neurochemistry have scientific merits.
As always, there is no “objective physical test” for things like migraine, but that doesn’t mean that migraines do not exist, or that they do not have a biological basis (they do).
That argument does not work because (1) the improvement is between small and moderate, not “slight” and (2) the control group usually experiences the same amount of side effects.
Of course, if the mind is separate from the brain, chemical substances such as psychiatric medications that affect the brain could never have an effect of the mind. A curious contradiction at the very heart of your position.
If you believe that psychiatric medications can affect the mind, you must give up mind/brain dualism. If you want to keep believing in mind/brain dualism, you have to give up the notion that psychiatric medications can affect the mind, and therefore the belief that e. g. side effects on cognition even exists. You are trapped. Check mate.
At any rate, all forms of medications affect different people differently. If you have a certain gene mutation in the Vitamin K epoxide reductase complex subunit 1 (VKORC1 for short), you can bleed to death if you are given anticoagulants such as Warfarin. This does not mean that Warfarin is not effective in preventing thrombosis or that thrombosis does not exist.
Simple, the mind and the brain are not different, but part of an integrated physical system.
No, because side-effects experiences in both the experimental and control group are similar in type and prevalence. See the previous studies I referenced. The experience of side-effects will not have an asymmetric effect on the experimental group.
Then why does the meta-analysis done by Kirsch (2008), himself a strong critic of medical psychiatry, show that the efficacy of antidepressants, even if you take into account publication bias, has an effect size of 0.3 compared with placebo (which has the effect size baseline 0.0)?
Why does a second meta-analysis buy Turner (2008), that also took into account publication bias, independently converge with that of Kirsch?
Curiously, my position is almost the opposite: as a government regulatory agency, the FDA does everything it can to stall the development of new medications and food products.
But they are not qualitatively different! Conditions that traditionally fall under neurology, like Alzheimer’s or Huntington’s, have behavioral and cognitive symptoms. Conditions that traditionally fall under psychiatry, such as depression or anxiety, have increasingly well-defined and well-support relationships to biology, such as systems of neurotransmitters or the fight-or-flight response.
The division of disciplines is an artifact of history and tradition. The division does not reflect any underlying reality.
With that, your position crumbles.
Fine, the “mind” doesn’t exist. The mind is STILL the brain, but all else of my arguments regarding the uselessness of the field of Psychiatry remain true. For example: by saying the “mind” doesn’t exist because it’s STILL the brain, you just actually convinced yourself that there’s no room for Psychiatry(“mental disease”) because we already have something that deals with “brain disease” – Neurology (and by extension, “brain disorders”, “mental disorders”, “MENTAL DISEASES”)
They voted to determine when can someone be considered having AIDS, correct? It’s not the same thing as voting if AIDS SHOULD be a disease, which would be laughable. Psychiatrists determine whether certain behaviors should be diseases, or not. I rest my case.
EXACTLY! your example with AIDS is a debate about the details of that disease and the debates IN psychiatry are about the major premise of that field – whether a certain behavior should be considered a disease or not! Didn’t you see this?
I do not confuse the “debate about details” and the “debate on the major premises of the field”.
I still think some normal behaviors get wrapped up as mental disorders. For example, I think depression is normal. All of us, if severely unhappy, get depressed. I also think suicide is normal. Anyone has any circumstance in life they’d rather not face, and choose death instead as a utilitarian choice. I am aware that the judgment of mental disorders is a lot more complex than just a simple “hmmm, okay this behavior is normal but whatever, let’s make it a mental disorder!” but the fact that psychiatry is the only medical specialty voting disorders into existence by moral judgment alone makes you think they wouldn’t be able to involve some normal behaviors in there, as a mistake. I’m not complaining about that as I state this, it’s just a big possibility.
Okay. Yeah. Still, my criticism against psychiatry about its existence as a separate field than neurology (if you really insist that “mind” and “brain” are not different) is not yet rebutted.
I’m sorry but I really disagree with that. If you claim that a certain person has a brain disorder, objective physical tests are required. I also don’t appreciate the field of psychology so their use of psychological assessment tests is, for me, futile or useless.
Also, ‘that medicine is not about avoiding harm at all costs, but making cost-benefit analysis and going with the most optimal treatment’ is understood. To me, that’s still going in line with “first do no harm” as I understand that certain risk needs to be made such as (as what you’ve stated) that assuming the patient doesn’t allergy to antibiotics and such BECAUSE most patients don’t have allergies anyway, etc. but this isn’t going in line with psychiatry if they’re not proving that a certain patient has THIS THING in his head before performing physical treatments.
Even if you cite a disease that can be cured without any objective physical tests, my main issue with psychiatry/neurology divide remains intact.
SIGH. Even if there’s forms and inventories included, neurology and other fields of medicine have objective, physical tests to diagnose physical problems.
I’m sorry, but I think you’re getting me wrong. Of course I know all of the fields interact. My main gist is that neurology already deals with issues in the brain, what is psychiatry for – especially if you don’t believe there’s such thing as a “mind” ? Ring a bell?
Huh? Never did I propose that psychiatry claims that “chemical imbalance” is only the deal behind all mental illnesses.
I get that. But to clarify (and not to rebut anything really), you are saying that they’ve proved that antidepressants do work and only then, theories why they work were made afterwards, correct?
No, we assume that they do like how we assume extreme introversion, for example, could be a mental disorder when that kind of personality is just a normal human variation. Of course migraines is much more obvious to be assumed to be coming from the brain from a casual observer, silly. So I’m not excusing migraines (if indeed biological causation or existence has not been proven) from my criticism.
(1) the improvement between small and moderate IS “slight”, no? ‘Moderate’ would be acceptable.
(2) are you saying that the control group also receives pills with side effects to determine if the pills (psychiatric drugs) with their “side effects” given to the experimental group are effective?
Not really. SIGH. Fine, I’ll give up on the mind/brain dualism (whatever), but my criticism against psychiatry remains intact: IF ALL MENTAL DISORDERS ARE REALLY BRAIN DISORDERS, WHY SEPARATE IT FROM NEUROLOGY? YOU MUST BE SAYING NOW THAT PSYCHIATRY IS JUST PSEUDONEUROLOGY! Check mate. 😉
Really though, my argument that psychiatry is useless and questionable remains intact whether we remain the mind/brain dualism into the argument or not.
I fail to see how this example is even relevant to any of what I said. But anyway … if we just cut this into the first statement that you said: “At any rate, all forms of medications affect different people differently.” so are you saying that those psychiatric drugs have consistent, specific effects on different people taking them hinting to their efficacy? If that’s what you’re saying, I should still say that drugs do affect people differently and can be consistent in its effects in different people, making their ‘target on specific symptoms’ just fictional since the drugs could have targeted their entire brains anyway.
Huh? I thought that the nocebo effect is just the opposite of placebo effect – when you give an inert pill to someone and claims negative side effects to it when there’s none, the patient can believe he is being worsen by the drug. I thought nocebo effect uses inert pills!?, meaning having no chemical substance.
Let me digest this information in my head….
placebo effect – 0.0
It works! – 0.3
Is this how you interpret that information? Wow, in my opinion 0.3 is SLIGHT or even DOUBTFUL….and when we add to the interpretation that the drugs used in the control group have no side effects, OF COURSE the ones in the experimental group are going to claim “it’s working for them” because they’re experiencing effects in the drugs given to them even if the drugs aren’t really working for them or targeting their specific problem.
Of course they’re not qualitatively different now since we (or atleast I, for the sake of this debate am) are dropping the mind/brain dualism viewpoint. The question still remains: since mind/brain dualism is now invalid, what is the use for psychiatry then since it primarily deals with MENTAL DISORDERS? Your position crumbles.
AFTER-THOUGHT:
Ok, suppose we drop the label “mental illness” “mental disorder” since it’s synonymous with “brain illness” and “brain disorder” anyway….what then do we call people who seem crazy to us but don’t have any proven brain disease?
I learned something new here. mind/brain dualism is indeed invalid but that just reinforces that mental illness is indeed a myth since all psychiatric disorders are all speculative disorders about the brain since neurology already deals with those. 🙂
Thanks for proving me wrong and THEN, proving me right. Whatever.
“Even if you cite a disease that can be cured without any objective physical tests, my main issue with psychiatry/neurology divide remains intact.”
a disease that can already be proven objectively, physically but due to complacency (maybe because it’s a mild sickness, for instance) and/or because physical testing is trouble than its worth that physical testing becomes unnecessary is not counted.
….i mean if you’re going to ‘cite a disease that can be cured without any objective physical tests’
No, the mind exists. It is just a weakly emergent phenomena from brain activity, not some mysterious extra substance separated from the physical. Compare with the oversimplified case of water molecules and surface tension. No single water molecule has surface tension in isolation. Surface tension is a system property of lots of water molecules together. Nothing mystical thought, surface tension is a purely physical phenomena.
The reason it is called a “mental condition” is because it is a condition with a predictable impact on behavior, thoughts, feelings and other cognitions i.e. system properties of the material brain. Even those mental conditions were our understanding is quite good does not stop affecting cognitions or behavior — they are still mental conditions. Again, fields of medicine are not dichotomous or completely separate; that is just a simplification us humans have made. The different organ systems in the body is an integrated whole.
Sure it is. Before the 1980s, AIDS was not classified as a disease. As far as U. S. doctors were concerned, it was just a mysterious condition that made gay men have weird opportunistic infections.
The general problem is that you are confusing the label with that which the label labels. A chair is still a chair, even though we call it a rose, or don’t have a name for it, or are not aware of the existence of chairs. What is “voted” on is the labels, not reality.
You are right that everyone feels sad sometimes, feels the blues or feel depressed (in the every day sense of the word as in “depressed mood”), but that is not what is meant by depression in science. There it means something very different: a persisting condition with characteristic behavioral symptoms.
Compare with the word “theory”. In every-day life, it means a crazy idea. In science, it means a well-supported explanatory framework that is supported by a massive amount of independently converging evidence. Or compare with “energy”, “force”, “momentum” etc. they have a certain definition in our every-day language, but has a precise definition (that is often different) within science.
The notion that suicide is a rational, utilitarian choice is misconceived. That is because research shows that individuals with clinical depression tend to have biased attention, processing and memory. In other words, they are not necessarily seeing the world as it really is, but rather through negatively-tinted glasses.
But psychiatric diagnosis is not voted into existence by moral judgment. The labels are decided by scientific consensus of experts, that use scientific research and an appreciation of the level of functional impairment for the individual.
Neurology and Psychiatry consider different aspects of the same thing. So does microbiology (e. g. pathogens attacking humans) and immunology (humans defending themselves). That does not mean that either microbiology or immunology is a flawed field.
Claims about structural or functional brain abnormalities exists should be backed up by evidence, but remember that you yourself said that psychiatry is about behavioral symptoms. Most standard psychological assessment tests have been found to be statistically very reliable.
Sure it is. Psychiatrists can know that a patient is having a major anxiety problem without doing brain scans or testing for stress hormones, because of psychiatric assessments and patient information. The fact that we know that both adaptive and non-adaptive anxiety is related to the Hypothalamic–pituitary–adrenal axis and understand a lot about that is of secondary importance doesn’t change anything.
It is simply a way for me to expose the contradictory nature of your position. So what will it be: do migraines exist? If yes, then you agree that diagnoses without blood tests (or similar) are valid. If no, then your position becomes even more untenable.
As I have tried to explain to you, neurological or other medical tests are not as objective as you think: tight controls can be neglected, intrinsic error rate of medical tests, researchers’ subjective interpretation of data etc.
Psychiatry and psychology deals with the other aspect of the brain/mind complex: cognitions, thoughts, beliefs, feelings, as well as exaggerations of adaptive behavior (which we call mental conditions).
This should not make you feel any more uncomfortable than the fact that atomic physicists deal with subatomic particles, whereas chemists deal with chemical reactions. There is no “added stuff” that is qualitatively different that chemists care about that is not atomic physics. The only difference is the level of analysis. See previous description of water molecules and surface tension.
No, the efficacy of antidepressants, like the efficacy of antiretrovirals, provide an additional layer of evidence for the explanatory framework. We knew that HIV causes AIDS even before antiretrovirals of course, but they provide independent lines of evidence for the general conclusion that HIV does indeed cause AIDS. An analogous argument can be made with regards to antidepressants.
Mental conditions are not considered to be a qualitatively different pathological state, but rather exaggerations of normal, adaptive human behaviors.
Introversion is not itself a mental condition. Diagnostic criteria and psychiatric assessments are much, much more complex and well-controlled than that.
But there is no blood test or conclusive brain scan, and, since everyone gets headaches once in a while, migraines cannot, per your argument, exist. Does this mean that people who get migraine attacks and experience nausea, vomiting, photo- and phonophobia are just faking it? I do not think so, but your position finds itself built on quicksand.
An alternative is to accept that psychology and neuroscience is incredibly complex and that we are just scratching the surface, regardless of field.
I would not call an effect size somewhere between small and moderate “slight”.
Cohen, who defined the effect size used in medical literature (Cohen’s d) suggested that an effect size of 0.2 was small, 0.5 moderate and 0.8 large, He emphasizes that effect sizes need to be evaluated in their specific scientific context. In some areas, such as blood pH, even a extremely small difference of say, pH 0.1, is a huge deal in terms of physiology (acidosis). In other areas, such as pulse, a doubling is not really that dangerous for the average person.
In reality, we should leave the specifics of effect size interpretations to the actual scientists doing the research. That is why I said that an effect size of 0.3 was somewhere between small and moderate. Depression is very crippling, so an an effect size of 0.3 could well be considered practically significant and would spare a lot of people a lot of pain.
The control group receives placebo. It has no pharmacological side effects. But they do have expectancy side effects. In the same way you can feel better after taking a sugar pill if you are told it is a stimulant, you can feel worse if you are told about the side effects of the medications given to the experimental group. Remember that patients do not know which group they have been assigned to, and neither does the doctors, so they too get the information about the side effects of the psychiatric medication.
Nocebo effect (the evil twin of placebo) is quite fascinating, and a lot of studies have been done on it.
Amanzio et. al. (2009) looked at all of the placebo-controlled trials conducted on a specific migraine drug. They revealed that the placebo group who had gotten sugar pills also commonly experienced side-effects of whatever drug they thought they may have eaten e.g. memory difficulty and anorexia from placebo in a trial investigating anticonvulsants. Levine et. al. (2006) showed that if you give patients a placebo sugar pill and tell them it will make them more nauseous after the experimental protocol they not only get more nauseous, but also show a higher prevalence of gastric tachyarrhythmia. Ernst et. al. (2003) are critics of homeopathy and they showed that there was no statistically significant difference in side-effects between the placebo group and the group that where given homeopathy. Both groups experiences side-effects, even though it is clear that neither a sugar pill nor homeopathy has any pharmacological effect at all. Dr. Ben Goldacre has discussed these studies and others in a very interesting article called All bow before the mighty power of the nocebo effect.
Something similar is the case in most antidepressant trials, such as the one by Walkup et. al. I referenced earlier and on other posts on this blog.
They fields are not really as separate as you think. They are overlapping and interdisciplinary. Psychiatry enters from the level of analysis of behavior and cognition, whereas neurology enters from on the level of analysis of the brain.
Since chemists study the same fundamental things that physicists do, why does chemistry exist? Because it is a different level of analysis. There is no particles in chemistry that does not exist in physics.
All medications affect people differently for the simple reason that people are not clones. Scientists can overcome this problem by making sure that their clinical trials have a high n (n=number of participants). That allows them to take into account the spread i.e. (the heterogeneity) of humans.
Compare with anticoagulants again: anticoagulants have specific biological effects (prevent blood clotting) and these are the same in every individual. However, the magnitude differs. For those with the particular mutation we discussed earlier, it involves a higher risk of bleeding. For most other, it does not.
Suffer pills contain sugar. That is a chemical substance. The deal here is that the only thing that differs between the experimental group and the control group is the pharmacologically active substance. The reason researchers use this set up is that makes it so that others cannot complain that there was something else in the pills, rather than the active ingredient, that produced the difference between the experimental group and the control group.
The reason people in the control group is experiencing the side-effects of the psychiatric medications is that they do not know if they are in the experimental group or the control group (they are “blinded”), and they know about the side effects of the treatment the experimental group is given. It is just the opposite as feeling better despite just getting a sugar pill if you are told that it works: you feel worse despite getting a sugar pill if you are told that it may have side effects.
I think that is mostly because of the units being used. The unit is called Cohen’s d and is defined as the difference between the averages of the experimental group and the control group divided by the pooled standard deviation.
Very generally, d = 0.2 is a small effect, d = 0.5 is a moderate effect and d = 0.8 is a large effect. If you consider an effect size of 0.3 as doubtful, you would have to chuck away a lot of medications (including psychotherapy).
As before, effect sizes are interpreted in their scientific contexts. These cut-offs are only a guiding principle.
For instance, the beta-blocker propranolol has an effect size of r = 0.04 (a very weak correlation, as r= 0 means no correlation). This result means that a ~4% decrease in heart attacks for people at risk. Seems small, but the U. S. is a large country and obesity and heart problems is quite prevalent. Calculations show that such a treatment, despite having a really small effect size, would save around 6000 people per year. I think that is pretty good.
Mind/bran dualism is invalid, but that does not mean that levels of analysis do not exist. They do. Historically, neurology started from the brain and worked it’s way upward, whereas psychiatry started from the top and is working its way down.
We humbly admit that the brain is an enormously complex organ, that science is a work in progress, admit that humans are fallible and do more psychological, psychiatric and neuroscientific research to find out if they do have a mental condition and need help or if we are mistaken.
Okay. I read all of your responses. Still, my main gist would be: if psychiatry really deals with the brain, shouldn’t it be more objective? For example: I visit a psychiatrist twice and for the first time I visit him, I was looking sullen and shy and he asked me questions….simple questions…that lead him to the conclusion that I have “major depression”. Then, off I go! No psychotherapy, nothing, but of course that’s besides the point as drugs could work. Now, my mother asked for me to consult a second opinion as she insists i must have a brain scan or something to really prove that i have a chemical imbalance, the psychiatrist I met said my “major depression” is due to “chemical imbalance”. So! shouldn’t the field of psychiatry be more objective? Are physical tests available but just way too expensive to perform so they just trust what the patient self-reportedly says? If physical signs for any psychiatric disorder exists, why is there no physical test to prove this when you visit a psychiatrist?
Even if you argue that in the field of neurology, it’s not “100% objective”, AT LEAST you can’t fake it as easy as merely being descriptive, because they can use physical tests or, a lot more objective tests. What do you make of that? Do psychiatrists ever use biological/physical tests at all?
Tell me then, what is the general difference between severe unhappiness, or extremely sad to being depressed? I actually think that extreme sadness=depression. So I wasn’t really thinking of the everyday word of “depression”, I was actually thinking of “depression” in its context as a psychiatric disorder but then, I was also thinking that everyone has the capacity to be depressed as I take it as extreme sadness. What’s your take on this?
Um, I don’t care if the psychological assessment tests have been found to be statistically very reliable. Any personality quiz test on the internet can be statistically very reliable. The point is, and based on my experience, the theories in psychology are very much subjective, based on common sense and contradict each other, you’d think it belongs to philosophy! It’s way too “soft”.
What is contradictory? To answer that question, I have to ask you then: are migraines proven brain disorders? yes or no? Ironically, if you can answer that then I can answer if migraines exist. TAKE NOTE: I am asking whether they’re proven brain disorders, NOT if they can be diagnosed without blood tests (or similar). The next question is, if your answer to the former question is a yes: so do doctors diagnose it without performing any physical tests because it’s unnecessary or they’re so sure of their diagnosis a physical test would be a nuisance?
I was referring to “extreme introversion”, something that might lead to asperger’s or something else. I also know that diagnostic criteria and psychiatric assessments are much, much more complex and well-controlled, at least as everybody seems to believe so. Obviously, I still can’t take psychiatry seriously, thinking about it.
I stand by my position. Nocebo sugar/inert pills are still not the same, as, say, giving pills with side effects to the control group to determine if the drugs given to the experimental group are effective. Of course I know that they don’t know whether they’re in the control or in the experimental group. Still, people in the experimental group can falsely think they are being cured because of the real side effects they’re experiencing as oppose to the sugar pills only given to the control group. Also, of course I know that sugar pills do have chemical substances of only sugar but no real pharmalogical treatment (or something like that). I should have been more keen in my usage of words.
I believe psychotherapy only works for those people with no close loved ones to help them get through their problems. In short, it’s not much different from their help. 0.2 is a small effect? 0.3 IS a small effect.
Um, I don’t really understand this part. Is it still based on Cohen’s d? I assume not as this is a different unit? I thought ‘r=0.04’ from ‘r=0 no correlation’ is pretty close to a ‘0.5=moderate’? ‘r=0.04’ is not a typographical error, is it? there’s two zeros in it? Haha. What would it be if you convert it to cohen’s d so that it would look understandable to me? Sorry, I was having problems back in my college classes, I was failing, and I almost failed my statistics so I could not comprehend this. I apologize for my ignorance. Haha!
I think I know you assumed the way that you did. You thought by me quoting doctors saying the chemical imbalance is wrong, is that what I was trying to say but I only did that because you were talking about depression underproducing neurotransmitters. I assumed you were also implying chemical imbalance in this? I only quoted those doctors who disagree with you. That’s it but I, in no way, said/implied that psychiatry is chalking it all up to “chemical imbalance”.
AFTER-THOUGHT:
I think I know what to call behaviors that are not normal although not yet proven mental disorders or brain disorders: psychological disorders. This also includes traumas and such.
Sure, all science should strive to be more objective than their currently are. That is the very reason that psychiatrists and other mental health professionals developed reliable assessments and started doing imaging techniques and genome-wide association studies in the first place. There is always room for improvement.
Take a look at e. g. Beck’s Depression Inventory or Major Depression Inventory. Do the questions match? At any rate, we should not judge an entire field based on a single practitioner, whether this particular practitioner is good or bad at his or her job. It is also important to remember that this would probably be an introductory assessment. If you start something like cognitive behavioral therapy, the assessment sessions (called “assessment and formulation”) will be more thorough.
In general, psychiatric medication and cognitive behavioral therapy together is the most effective treatment for major depression. Fight for your right to get good health care. Depending on what country you live, some sessions of CBT are covered by national health programs.
Yes, the symptoms of depression includes physical signs, but a diagnosis usually requires both physical signs and behavioral symptoms. For instance, the Mayo Clinic lists the following physical symptoms:
Of course, depression is a heterogeneous condition and will affect every person somewhat differently.
The diagnostic criteria of DSM-IV-TR and ICD-10 are more specific.
They do, but it depends on the condition. Anxiety is connected to the HPA-axis. ADHD is associated with deficiency in executive function (i.e. a specific function of the frontal lobes), biased processing in depression has been linked to e. g. DLPFC hypoactivity associated with decreased amygdala reactivity to negative stimuli etc.
If you are especially interested in depression and the brain, I highly recommend checking out the following overview published in Nature Reviews Neuroscience last year: Neural mechanisms of the cognitive model of depression. Some parts of it is somewhat speculative, but most of the framework is based on solid science (you can investigate this by checking out the papers the article references at the end).
Just over the past 5 years a huge amount of knowledge has been gained about the genetic influence, in terms of risk factors, on many mental conditions such as Alzheimer’s, ADHD, alcohol and nicotine dependence, anorexia, autism spectrum disorder, bipolar, major depression and schizophrenia. If you are interested in this, try reading Genetic architectures of psychiatric disorders: the emerging picture and its implications (a paper published in Nature Reviews Genetics in August 2012). I have not yet found a copy that can be accessed for those without a subscription, but you can read the abstract here and see the figures and tables summarizing the findings here. I am sure there are ways to obtain this article.
The physical tests in any field are not completely objective. Instead of thinking of the situation as “objective” and “subjective” think of it as a sliding scale, with each discipline in medicine including tests that are farther towards the extreme of objective, and some farther towards the extreme of subjective. Also do not forget intrinsic error rate of tests, researcher interpretation of results, the risk of inadequate controls etc.
Ultimately, the difference is the time. Depression requires that the state of severe unhappiness (and other symptoms) linger for a much longer than than the average. If you set the criteria too long, you will miss some people who have depression. If you set it too short, you will include people who do not have depression. It is a balance between reducing false positives and reducing false negatives. You want to include as many people who actually have depression as possible and at the same time exclude as many people that do not have depression as possible. Ultimately, this time period has to be decided by empirical observation and clinical experience by mental health professionals.
Here are the specific DSM-IV-TR criteria for major depression:
How long does acute inflammation (red and swelling) have to last before we say it is chronic? What level of CD4+ T cells is low enough to call it “AIDS”? What is a too high blood pressure? There are many clinical trade-offs in most areas of medicine and psychiatry is of no exception.
Shame. How do you think that psychological assessment tests should be evaluated then?
Yes, some historical notions in popular psychology are extremely subjective and arguably completely wrong. But that is very different from modern clinical psychology, which is based on well-controlled scientific studies.
Migraines have been demonstrated to have a neurological basis, just like most mental conditions that you and I have discussed. However, the diagnosis of migraines is usually based on behavioral symptoms. Here are the diagnostic criteria for (common) migraines:
Does the fact that these are behavioral symptoms make you doubt the neurological existence of severe headaches (migraines)? If no, then you should not display the same doubt for the other mental conditions that we have discussed.
You misunderstand. In most clinical trials of psychiatric medications, the control group is given pharmacologically inactive pills, yet experience the same type and level of side-effects as the experimental group. The nocebo effect is a common thread in the studies that I summarized, spanning from migraine to nausea.
No, because the control group are also experiencing these side-effects due to the nocebo effect. So that false belief would, in general, be equally prevalent in both groups.
I am confident that close social support by loved ones is necessary for all individuals with mental conditions. Although, according to your argument, individuals with both loved ones and psychotherapy should get a much higher effect than either alone.
No, according to Cohen’s criteria, 0.3 is between small and moderate. Also, as I pointed out, these criteria should only be used when the effect size cannot be interpreted by context. Even a small effect size signals clinical significance if the patient population receiving them are large (i.e. the absolute number of patients it will help is large).
I have already discussed a specific beta blocker, but the same argument is actually true for a lot of the most important life-saving medications we have, such as:
– cyclosporin (used to prevent rejection after transplantation of an organ)
– aspirin (anti-inflammation, anti-fever and painkiller)
– streptokinase (break down blood clots after heart attacks)
– cisplatin (anti-cancer drug)
– vinblastine (another anti-cancer drug)
– etc.
Studies show that these have, according to Cohen, a low effect size in clinical trials (often d < 0.1). That is, they only increase survival rates by a few %. Yet they are among the most important drugs we have. How does this make any sense whatsoever?
The answer is: because a lot of people use them. That means that even a small % of a huge population will in practice mean tens out thousands of patients saved, literally. This shows that Cohen's criteria are not absolute rules (Cohen believed that they were a last resort if you did not know the biological context to be able to evaluate the impact of these medications). Since I am not a medical researcher, I only refer to the Cohen criteria (and therefore call it between small and moderate), but the more precise interpretation should be done by medical professionals, and not me. Incidentally, such researchers, such as Turner et. al. (2008), concluded that e. g. antidepressants have a clinically significant effect size at 0.3 (actually, 0.32 to be more precise).
No problem at all.
So Cohen’s d is the difference between the averages, divided by the pooled standard deviation. Cohen’s cutoffs for effect size in terms of d: low is 0.2, for moderate it is 0.5 and for high it is 0.8. These should mostly be used if context-based interpretations cannot be made (i.e. if it is a study in a new field etc.).
r is the correlation coefficient between two variables (in this case, treatment and survival). It is calculated by dividing the covariance of two variables by the product of their standard deviations. The covariance of two variables is calculated by taking the sum of the product of the differences between each measurements for a given variable and the average of that variable and then dividing by sample size.
Cohen thought that a general rule (again, only when context is unavailable), that r = 0.1 is a small correlation, r = 0.3 is a moderate correlation and r = 0.5 is a large correlation.
There is a simple way to convert from Cohen’s d to r. d is 2r / sqrt(1- r^2).
Let me see if latex works in the comment section….
Cohen’s d:
Covariance:
Correlation r:
Conversion between d and r:
At any rate, don’t bother too much with the math; don’t forget the forest (clinical significance) by paying too much attention the the trees (arbitrary cutoffs).
The main idea I want you to take away from this: while there are cutoffs for different qualitative effect sizes for both d and r, the biological context matters more. Even very small effect sizes (e. g. for medication such as aspirin and cyclosporin) is sometimes enough for us to consider these to be clinically significant, depending on the absolute number of people they help. Without cyclosporin or any other type of immunosupressive drug, you will always reject the transplanted organ and die, often within days or less. With cyclosporin, tens of thousands of people have a fighting chance at having additional years to live.
Here is the most common anti-psychiatry view: scientists say that depression is caused by chemical imbalance (often they say this is only in one neurotransmitter, say serotonin) and this is the totality of the scientific viewpoint.
Here is the actual scientific view: depression is the result of many different interacting factors from biology, psychology and environment. Within these broad categories there are many subcategories. In biology, there is e. g. genetics, development and neurochemistry. Within e. g. neurochemistry, there are yet another set of subcategories that interact: neurological factors influencing depression includes emotional dysregulation between many brain areas and alterations in multiple neurotransmitter substances. Each specific factor interact with each other and with other psychological and environmental factors in very complex ways. That is, you need several factors from different categories to become clinically depressed.
To reduce the entire complex and multifactorial origin of depression to “chemical imbalance” [in a single neurotransmitter] is an unfair characterization. Even reducing just the complex neurological factors and processes to “chemical imbalance” is a gross oversimplification to the point of being misleading. This is why I call “chemical imbalance” an anti-psychiatry straw man.
This is not to say that neurotransmitter systems are irrelevant for depression (they are not). But neurotransmitter systems are not the entire story.
To some extent, the portrait may be acceptable in terms of very introductory explanations. I do not know what your position on evolution is, but that is an easy comparison to be made: to say that evolution is random is a gross oversimplification, but has a small kernel of truth in it: randomness affects evolution (e. g. genetic drift), but it is by far an incomplete description (natural selection, gene duplication, exon duplication etc. and about 40+ other processes are an integral part of evolution).
Despite the fact that extreme oversimplifications may be alright for giving a very brief and introductory explanation, it is inappropriate to consider them rich and detailed descriptions of the respective field (they are not).
I generally use “mental condition” as a synonym of terms such as “psychological disorder”, “mental disorder” and “mental illness”, mostly to sidestep the debate around whether “illness” or “disorder” is more appropriate. It is also a milder term.
Yeah, Latex typing is a real pain 🙂
I meant biological signs.
Um. What if personality test quizzes on the net made by some users passed the reliability? Are you getting my point here? I am not saying that reliability to psychological assessment tests cannot be used in the case for evaluation.
But then I remember validity…OK. you win.
what are the attacks fulfilling criteria B-D?
That’s just in theory. I mean, let’s be practical here. A genuine test to test whether drugs with side-effects have merits would be to test them with drugs with real side-effects as well. Particularly in this case of anti-depressants.
The problem is that people are better off talking to people with similar experiences of their problems rather than wasting their money on psychotherapy. They’d get better advices and “treatment”.
So far so good, I think I got your points. Here are my new points:
1.. so pro-psychiatrists say “mental illness does exist and HAVE evidences” and anti-psychiatrists say “mental illnesses DON’T exist and DON’T have evidences” … of course this will mean (SIGH) I need to review many scientific journals and studies elaborately and literally just to see which one is really telling the truth (you can’t really argue that just because the current mainstream position holds that mental illness exist means it’s the case), so tell me, how can the average layman know, by common sense alone, (as how I ended up through this path), which one is telling the truth? I guess what I’m asking is, is there any source/reference that I can just type/search ‘mental illness’ and which is credible enough that such result from source would be trusted immediately? can I trust Wikipedia on that matter?
2. Wikipedia says, “A mental disorder or mental illness is a psychological pattern or anomaly, potentially reflected in behavior, that is generally associated with distress or disability, and which is not considered part of normal development of a person’s culture. Mental disorders are generally defined by a combination of how a person feels, acts, thinks or perceives. This may be associated with particular regions or functions of the brain or rest of the nervous system, often in a social context. The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition, assessment and classification, although standard guideline criteria are widely used. In many cases, there appears to be a continuum between mental health and mental illness, making diagnosis complex. According to the World Health Organisation (WHO), over a third of people in most countries report problems at some time in their life which meet criteria for diagnosis of one or more of the common types of mental disorder.
I thought Wikipedia is very reliable as a summarized version to the average layman. I mean: “People of all ages, cultures and backgrounds can add or edit article prose, references, images and other media here. What is contributed is more important than the expertise or qualifications of the contributor. What will remain depends upon whether it fits within Wikipedia’s policies, including being verifiable against a published reliable source, thereby excluding editors’ opinions and beliefs and unreviewed research, and whether the content is free of copyright restrictions and contentious material about living people. Contributions cannot damage Wikipedia because the software allows easy reversal of mistakes and many experienced editors are watching to help ensure that edits are cumulative improvements. Begin by simply clicking the edit link at the top of any editable page!” (from the About page of Wikipedia) and also: “Between 2008 and 2010, articles in medical and scientific fields such as pathology, toxicology, oncology and pharmaceuticals comparing Wikipedia to professional and peer-reviewed sources found that Wikipedia’s depth and coverage were of a high standard.”
Having said that, Wikipedia did admit on its summary of its entry on “mental illness” that it IS indeed a SOCIAL JUDGMENT and that judgments of “mental health”, “mental illness” are all flexible and nebulous.
Also: http://www.youtube.com/watch?v=bguQkX1M1Pg = Psychiatrists did admit that there is no evidence/proof for the biological existence of “mental disorders”.
3. What changes do you have in mind to prevent the abuse of psychiatrists particularly in the realm of involuntary commitment given that you believe in the existence of “mental illness”?
4. What is your opinion on ECT?
5. As for the chemical imbalance theory, thinking about it, I have a hard time believing that psychiatry’s stance is that “mental illness/disorder” is a combination of temperament, environment and biology(chemical imbalances, etc.). If they believe that outside biology is triggering tendencies towards particular mental disorders, then they do believe, primarily, that mental disorders are actually first and foremost biological and this includes the chemical imbalance belief. Psychology and environment OR all the others remain just “triggers” or external forces that unleash the biology that drives someone to a certain mental disorder. With this, the anti-psychiatry is right that psychiatry’s main tenet of chemical imbalance or biology is the driving force behind any “mental illness”.
Mental illness doesn’t exist. If that’s the case, then the people who get labeled ‘mentally ill’ are either A.) way too different/eccentric B.) suffering from psychological problems/disorders. I rest my case.
All physical signs are by definition biological signs. There is nothing “non-biological” going on.
No, it is an observation. We have observed that the control group gets the same type and amount of side effects as the experimental group.
Ironically, that would break the blind, because the experimental group would get the side effects of the treatment, whereas the control group would get the nocebo side effects plus pharmacological side effects. So the control group would probably get more side effects than the experimental group, so that would bias the results.
What evidence do you have that talking with others with similar problems is more effective than psychotherapy?
Furthermore, there are forms of psychotherapy where you do talk with people with similar experiences.
Also, psychotherapy is often included in national health programs, so you get a certain number of sessions free. Finally, the efficacy of psychotherapy suggests that it is worth the money.
Great question.
Your reaction is understandable. On the Internet, anyone can say anything and there is no fact-checking required before you can post something online.
So how can you tell if what someone writes online is reliable? The best way is to review many articles published in the scientific literature. But this would probably take a lot of effort. That is why high quality journals put out so called “review articles”. Those are summaries of a large and complex body of research literature, giving you an overview of the area in question, as well as lots of references if you want to check the claims being made or read more about it.
Here are some review articles:
Psychiatric Genetics: Progress Amid Controversy
Neural mechanisms of the cognitive model of depression
Mechanism of Disease: Major Depressive Disorder.
It is worth pointing out that there are different quality journals out there.
Some, like Nature or Science, can generally be trusted. That is because they publish research only after it has been examined in details by professionals in the field. If the research or review article survives this critical analysis by multiple reviewers, it will get published. Science and Nature only publish a small percentage of articles sent in, so they have a high quality control.
Other journals, like Medical Hypotheses or The Journal of Scientific Exploration, are low-quality journals. They either have no peer-review quality control or just publish any old crap that is sent their way.
The quality of a scientific journal is measured by e. g. impact factor. It is a measure of the impact of the journal has on the research field, related to how much it is quoted. As a rule of thumb, the higher the impact factor, the higher quality the journal has and the more influential it is. Science and Nature has an impact factor of around 36. The other two journals I mentioned have 0.5. You can find the impact factor of a journal by typing “[journal name] impact factor” into Google.
So for laymen, try to start with a review article in journal with a high impact factor. Articles can be obtained through google (authors sometimes post full pdfs), in open access journals that publish their articles in full text for free, or you can buy them, or print them at your local library.
Michael Shermer has put forward the following ten questions worth holding in mind when thinking about a claim:
1. How reliable is the source of the claim?
2. Does the source make similar claims?
3. Have the claims been verified by somebody else?
4. Does this fit with the way the world works?
5. Has anyone tried to disprove the claim?
6. Where does the preponderance of evidence point?
7. Is the claimant playing by the rules of science?
8. Is the claimant providing positive evidence?
9. Does the new theory account for as many phenomena as the old theory?
10. Are personal beliefs driving the claim?
With regards to Wikipedia, it has been shown that Wikipedia is almost as reliable as Encyclopedia Britannica, but there have been cases where Wikipedia could not be trusted i. e. certain biographical information, celebrities, certain international conflicts etc. So it is always a good idea to use multiple, independent sources. I don’t just mean different websites that link to each other, but sources that are actually independent.
That is not really what the quoted text from Wikipedia says. The article says that social context influences what we se as distressing or disability and that this has changed over time (I would arguably say improve over time). That does not mean that a mental condition is merely a social judgment and that the judgments are nebulous.
Let’s apply the source criticisms we talked about earlier. This video is produced by an organization belonging to Scientology. Is Scientology a reliable scientific source?
Does the video appear to take what people say out of context? Does the video provide us with any information with regards to who is being interviewed? How do we know they are psychiatrists?
I am no mental health professionals, but off the top of my head: (1) additional evaluations by independent mental health professionals before using involuntary commitment? That would limit the ability for individual psychiatrists to abuse the system, (2) more frequent reassessments of patients? That would limit any errors being made, (3) more money to make a better general mental health care? That might reduce the need for involuntary commitment in the first place?
ECT should only be used as a final recourse for treating very severe depressions when no other treatment is working, despite many and long efforts. There are also many anti-psychiatry myths about ECT, but we could save those for another time.
Remember what we said? It is a complex interaction between biology, psychology and environment, and the neurochemistry influences is poorly described by the phrase “chemical imbalance”. That is because it is a complex interaction between many different neurotransmitter systems and brain areas, all modulated by other biological, psychological and environmental factors.
All other medical conditions, like high blood pressure or even HIV, is due to a combination between biology and environment. So why should mental conditions not be seen in as similar light? The interaction position is widely accepted in all other areas of medicine without any problem, so why should psychiatry be any different?
At any rate, this interaction between biology, psychology and environment can be found in almost any psychology / psychiatry textbook.
Here is a better way to think about it:
Biology (including genetics, development, neurotransmitter systems etc.) are risk factors. That is, if you have certain variations in these biological systems, you have a higher probability of developing a certain mental condition. A higher biological susceptibility does not mean that you will develop the condition, just that it is more likely.
But you will not get the mental condition if you do not have the required psychological or environmental influences. The biological risk factors by themselves will almost give you a mental condition (there could be certain rare exceptions such as single-gene disorders). It is also not the case that psychology and environment are merely “triggers”; they are important and influential factors in their own right.
Think of the situation as baking a cake that require many different ingredients (analogous to many different factors influencing mental conditions). You would never say that flour is “the real cause” of a cake or that eggs are merely “triggers”. Flour and eggs (and other ingredients) are important in their own rights and the resulting cake is deeply connected to each ingredient.
So this does not mean that biology is more important than psychological or environmental factors. It just means that every category is very important. Discussing and pointing to a certain influential factor (say, neurotransmitter systems, history of loss and rejection, propensity towards negative thoughts etc.) is not an attempt at marginalizing the other factors. They are just as important.
The only physical signs I can count here is “Unexplained physical problems, such as back pain or headaches.” But since we are debating whether mental illness really exists (including the illness called “depression”), the point that this is a symptom of the illness rests on that debate, whether that mental illness even exists.
But as you said, “unexplained physical problems, such as back pain or headaches” meaning as long as it has a symptom of “unexplained” in there, it is in the domain of psychiatry or a symptom of any so-called mental illness. (My guess is that the “symptoms” were found before the mental illness was even proven, but whatever.)
In contrast, the symptoms for migraine are:
“Headache attacks”, vomiting are all not “unexplained”, are they? And you still haven’t answered my question: What is the criteria B-D? Would they involve biological testing or further physical/biological signs Psychiatry doesn’t have?
This is funny. We’re not talking about applying the nocebo effect to the control group. We’re talking about “OK. let’s see, let’s try these drugs FOR YOU, just tell us if it WORKS” kind of thing without applying the nocebo effect to the CONTROL GROUP. Of course, we give them drugs with side effects. The experimental group gets the “real” drugs with side effects. This would be fair, in my opinion. All talk that “nocebo effect is powerful” as statistically documented or whatever fails when you even try to apply practicality or common sense here. (I mean, I haven’t really bothered reading up all those nocebo effect studies if they were the ones you typed and shared before because I’ve been too lazy to even bother that to confirm whether they’re valid BUT the simple judgment of what’s ‘fair’ here is something that can be confirmed without a shadow of a doubt.)
Evidence? Geez. Is it really about that evidence all the time? What if someone was murdered, and all the evidences point to a certain person, we can’t believe that he really murdered the victim? We need to have 100% evidence? We really need to witness that person who has committed the crime? The same thing applies here. Let’s just use logic here. Who would you trust more? A similar comrade who is facing the problems you are facing and is looking/has looked into all possible solutions for those problems or someone who apparently has an “education” in the corners of the classroom and some clinical setting who hasn’t been put through the same problems who apparently can help you more than the similar comrade!? You would trust someone who has a phD in their names who claims he is well-versed in psychotherapy and has studied your problem from afar. Hmm.
I wasn’t even saying that “I have the evidence”. I was merely thinking about it simply. The way you worship these doctors – extending to psychotherapy – is something I find really odd.
As for the efficacy of psychotherapy: “Yes, there are studies purporting to prove conversation with professional people (“psychotherapy”) is more helpful than conversation with people who have no training in so- called psychotherapy, as you claim in your letter. However, in Lawrence Stevens’ The Case Against Psychotherapy (found on this web site) you will find references to other studies showing conversation with psychiatrists or psychologists is no better than conversation with untrained persons – and justification for the view that consultation with or advice from untrained persons is usually better than professional “psychotherapy.” The webmaster of the antipsychiatry said that, in a debate with a psychiatrist. The debates can be found here: http://antipsychiatry.org/e-mail.htm#debate . So there is something the ANTI side that can rebut with that simple assertion as well.
Wikipedia’s entry about schizophrenia admits that it’s not a real disease:
No single isolated organic cause=no proof that it is actual disease.
Okay. Let’s suppose that the people being interviewed there aren’t real psychiatrists and so forth (which I doubt but for the sake of logical consistency). Haha, somehow, I also think you yourself saying they aren’t real psychiatrists is something you don’t believe, either. But I’m just merely speaking out of my mind. So nevermind. Let’s proceed…
but would you say that ECT is a genuine, effective treatment?
Uh…No.
This is all just illusion or meant to confuse you. The fact that there’s biology involved makes it clear: Biology is the first and foremost factor, everything else is a trigger.
Or are you saying that causes of mental illness/disorder are not yet determined, very confusing – but that would make the point for the anti-psychiatrists’ argument? 😀
No, all of them are physical symptoms. Remember, substance dualism is false.
Which is true for all autoimmune disease, for instance. We knew about their symptoms far far earlier than we knew about the specific immunological processes that lead to their origin and maintenance. To be honest, there are many autoimmune diseases where we still do not know exactly how they are caused or maintained. Does this mean that rheumatoid arthritis, multiple sclerosis etc. “does not exist” or “is not proven”? Of course not.
They are usually patient-reported. But that does not mean that migraine headaches do not exist.
So my argument about the nocebo effect fails because….you have not bothered reading the articles I cited? Forgive me, but I cannot possibly take that argument seriously.
The bottom line here is that scientific evidence beats “common sense”, “what’s fair” etc. If we did not do science, but stayed at “common sense”, we would still be in the pre-scientific dark ages.
Bingo! That is the only way we can attain a high degree of certainty and objectivity.
No, that is the beauty of science. We can almost conclusively show that a certain person, (even if we believe that he or she would never do it) has committed a murder if the forensic evidence (fingerprints, DNA, etc.) points to it.
The way to think about it resembles Hume’s dictum: what would be more miraculous? That all the forensic evidence crime scene investigators gathered and analyzed is wrong, or that the person we trust is a psychopath? Clearly, the latter option is more likely, even if we dislike the thought of it.
The problem is that that comrade could be as deep into the condition as I hypothetically would be. There is nothing that suggests that such a person could help in any clinically significant way.
Professional psychotherapists are actually different from what you describe. They usually have more than half a decade of university-level education together with a broad and deep clinical experience. Usually, to complete the degree, 50+ hours of psychotherapy is required as the client to understand the perspective and dynamics. They are much more than bookworms.
I do not worship psychotherapists (who are psychologists, not medical doctors). I accept the independent convergence of evidence which shows that psychotherapy is clinically effective.
1. Psychotherapy (in particular cognitive behavioral therapy) has been successfully tested against sham psychotherapy where patients in the control group had an actor, not a psychotherapist.
2. Most of the psychotherapies described at the anti-psychiatry website is not cognitive behavioral therapies, but things like psychoanalysis, which we know is ineffective and pseudoscientific. This is easy to realize since most of the references are 30-40 years old, and therefore outdated. Finally, it is not enough to look at single studies, which for various reasons can be flawed. You need to look at large aggregations of studies known as quantitative meta-analysis. These combine research from often hundreds of independent studies. These show that modern psychotherapy is better than placebo and has about the same efficacy as antidepressants (d around 0.3).
In general, the articles at antipsychiatry.org is often 2-3 decades old. From a scientific standpoint, such discussions are almost completely irrelevant.
No, that is not what the entry is claiming. It says that schizophrenia has no single isolated organic cause. This is unsurprising because we know that factors influencing schizophrenia are multiple biological, psychological and environmental factors. There is no reason to think that there will just be a single factor causing the mental condition.
As I explained before, these factors are risk factors; they increase the probability of developing the mental condition.
I have not read the studies in detail, but ECT seems to be more effective than placebo, or any other available treatment for severe treatment-resistant depression. But as I said before, these are only used as a last recourse when nothing else is working.
You can read some abstracts on the efficacy of ECTs here and here. Mayo Clinic also has an informative page here.
I think you are misunderstanding the phrase “trigger”. It is a short-hand and an oversimplification for a much more complex scenario and it does not mean that those factors are unimportant.
No, we know a lot about the risk factors for mental conditions. We also know that it is much more complex than a single influencing factor. In general, this is true for almost any medical condition, such as autoimmune diseases.
This puts into doubt your words that once a biological basis has been found for any illness, it doesn’t stop being under the field of Psychiatry and that, Psychiatry is progressing. But are these untrue? Are you saying that in the year 2000 and on, that finally biological bases for all or most mental illnesses have been found already? Heh. 😀
Source: http://www.antipsychiatry.org/abolish.htm
btw, I am going to try to read those articles about depression and such you shared as I have time.
No, it does not. The book that is being quoted is “The Death of Psychiatry” by E. Fuller Torrey. It is not a credible source and it was written for almost 40 years ago, making it completely irrelevant to modern psychiatry.
I read (one almost completely) all the links. Now:
the first link: http://psych.colorado.edu/~carey/pdfFiles/PsycGenetics_Burmeister.pdf
“Abstract| Several psychiatric disorders—such as bipolar disorder,schizophrenia and autism—are highly heritable, yet identifying their genetic basis has been challenging, with most discoveries failing to be replicated. However, inroads have been made by the incorporation of intermediate traits (endophenotypes) and of environmental factors into genetic analyses, and through the identification of rare inherited variants and novel structural mutations.Current efforts aim to increase sample sizes by gathering larger samples for case–control studies or through meta-analyses of such studies. More attention on unique families,rare variants, and on incorporating environment and the emerging knowledge of biological function and pathways into genetic analysis is warranted.”
I don’t know but it sounds like they’re really unsure in their abstract. Should I really even bother reading everything? Hahah.
the second link: http://people.uncw.edu/tothj/PSY595/Disner-Neural%20Mechs%20of%20Beck%27s%20Model%20of%20Depression-NRN-2011.pdf
In general…? Seems like they’re not really sure of what they’re talking about. This is interesting.
Hahaha. I thought anti-depressants work or something? “Adequate”?Hmmm…
I’m not sure if I read it right or got the quote right because I only have a substitute for PDF reader as I can’t install PDF. I will try to install it again.
Biased processing of emotional stimuli:
It then went on how the amygdala was related and such.
I am tired.
On the section of rumination:
I can go on and on. So maybe, I’ll continue reading that “study”. Heheh …
The last link had me almost completely falling apart due to shock. In their abstract, it directly admits that depression is nebulous and cannot be established a disease, I think we can go home now. LOL.
Link: http://laasistencial.com/downloads/Depresion/Depresion-medicos-1.pdf
“Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the
major current approaches to understanding the biologic mechanisms of major depression.”
This critical reading I’ve done or have been doing brings me to mind what I found here or what the webmaster of this website said. Of course, again, coming from that antipsychiatry.org website: http://antipsychiatry.org/br-pibp.htm (as he was doing a book review):
“Among the gems in this book are the following observations by two psychiatrists. Dr. Ross says during his training to become a psychiatrist, when the “cognitive errors pervading clinical psychiatry [were] unwittingly demonstrated to me by my residency supervisors” he learned that not only medical students but even “psychiatrists rarely do the critical reading” that would make the nonsense they learn in their psychiatric training apparent for what it is (pp. 85, 87 – emphasis added). In a chapter by Susan S. Kemker, M.D., staff psychiatrist at North Central Bronx Hospital in New York City, she says “most of us [psychiatrists] have been taught to believe [that] biology is the science of psychiatry. That fact that I believed this dogma made Pam’s (1990) critique of biological psychiatry especially unsettling. When I read his work, I felt that my entire education as a psychiatrist was subject to question” (p. 241). Speaking of herself and other psychiatrists, she says “our understanding of our own field remains naive” (p. 242 – italics in original). Statements like these from board-certified psychiatrists make me wonder if just by reading a book like Pseudoscience in Biological Psychiatry – or even just this book review – you know more about the “cognitive errors” that pervade modern biological psychiatry than many or even most psychiatrists.”
Of course, that book is outdated and blah blah … But I was just saying and makes me wonder whether what he was saying remains true today.
btw, how do you get these from Science or Nature journals? Do I need to have account? Do I need to pay in order to have an account, do I have to buy these? How can I subscribe to regular updates and things like that? Thanks.
Yes, all of them are physical symptoms except maybe there is in no way you can objectively determine whether the patient is lying or not. But you were trying to prove with the case of migraine that is is also just self-reported. Am I correct? You also said that migraine is indeed a proven neurological disorder, correct? Just trying to clarify your points.
From Wikipedia:
multiple sclerosis: “Multiple sclerosis (MS), also known as “disseminated sclerosis” or “encephalomyelitis disseminata”, is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms.[1] Disease onset usually occurs in young adults, and it is more common in women.[1] It has a prevalence that ranges between 2 and 150 per 100,000.[2] MS was first described in 1868 by Jean-Martin Charcot.[3]
MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are contained within an insulating substance called myelin. In MS, the body’s own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals.[4] The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) particularly in the white matter of the brain and spinal cord, which is mainly composed of myelin.[3] Although much is known about the mechanisms involved in the disease process, the cause remains unknown. Theories include genetics or infections. Different environmental risk factors have also been found.[4][5]
Almost any neurological symptom can appear with the disease, and often progresses to physical and cognitive disability.[4] MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).[6] Between attacks, symptoms may go away completely, but permanent neurological problems often occur, especially as the disease advances.[6]
There is no known cure for multiple sclerosis. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability.[4] MS medications can have adverse effects or be poorly tolerated, and many people pursue alternative treatments, despite the lack of supporting scientific study. The prognosis is difficult to predict; it depends on the subtype of the disease, the individual’s disease characteristics, the initial symptoms and the degree of disability the person experiences as time advances.[7] Life expectancy of people with MS is 5 to 10 years lower than that of the unaffected population.”
rheumatoid arthritis: “Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (hyperplasia) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, membrane around the heart (pericardium), the membranes of the lung (pleura), and white of the eye (sclera), and also nodular lesions, most common in subcutaneous tissue. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in both its chronicity and progression, and RA is considered a systemic autoimmune disease.
About 1% of the world’s population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but people of any age can be affected. In addition, individuals with the HLA-DR1 or HLA-DR4 serotypes have an increased risk for developing the disorder. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. It is a clinical diagnosis made on the basis of symptoms, physical exam, radiographs (X-rays) and labs, although the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) publish classification criteria for the purpose of research. Diagnosis and long-term management are typically performed by a rheumatologist, an expert in joint, muscle and bone diseases.[1]
Various treatments are available. Non-pharmacological treatment includes physical therapy, orthoses, occupational therapy and nutritional therapy but these do not stop the progression of joint destruction. Analgesia (painkillers) and anti-inflammatory drugs, including steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.[1] Clinical trials have shown that consumption of fish oil reduces the number of swollen joints for people with rheumatoid arthritis,[2] provides a beneficial anti-inflammatory effect, and provides a protective effect for occlusive cardiovascular disease, for which people with RA are at risk.[3]
The name is based on the term “rheumatic fever”, an illness which includes joint pain and is derived from the Greek word ῥεύμα-rheuma (nom.), ῥεύματος-rheumatos (gen.) (“flow, current”). The suffix -oid (“resembling”) gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of rheumatoid arthritis was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris.[4]”
I think it’s fair to say that there is a proven biological manifestation/cause (even if people argue or speculate about what could be the “first cause”) to these diseases and Wikipedia doesn’t admit or even simply state in their summary that ” Current research is focused on the role of neurobiology, although no single isolated organic cause has been found. The many possible combinations of symptoms have triggered debate about whether the diagnosis represents a single disorder or a number of discrete syndromes” . Quite frankly, I am turned off by that kind of reporting.
Are you sure?
So in order to pass as “migraine”, there are at least five attacks fulfulling criteria B-D but then you said “they are usually patient-reported”.Hmm.Weird.Okay.Uh.Perhaps.Aheh.
So if you’ve read articles that cite why “the earth is flat” for example or that “law of gravity is false”, you would believe them because they are science-sponsored articles or something like that? Interesting perspective.
What else would you beat the bush around for? You give the control group drugs with side effects then you give the experimental group the psychiatric drugs with “side effects”. That’s just fair. Apparently, those scientific articles you mentioned state that “nocebo effect” is enough(Correct me if I’m wrong). Oh well, let’s throw logic and minds out the window and just look for evidence! Oops….I cannot eat my cereals the next morning because I have no proof it will be safe. But anyway, based on evidence, all the cereals I ate every morning were safe so the next cereal would be as safe….but, oops….we cannot be so sure about that! I’ll make my dog eat a bit of the cereals first before I can take it. That way, if he dies, I won’t eat it. That’s the proof!
Is this how your world works? Haha! o.O
I think common sense/logic beats science and science SHOULD align itself with that. I mean, I think science is part of logic but doesn’t trump it and becomes entirely a different world. This is confusing. I think your perspective would be confusing. Somehow, every scientific article published should be trusted because that’s evidence. Maybe there would be an evidence that men actually have vags, not penises and balls and it’s just an illusion. Interesting. Hehehe.
Nope. People use their brains and as a result, learned how to use science. Not the other way around. So “common sense” or “fairness”(whatever that is) beats science in this respect, not saying science is unnecessary or useless. I don’t know. Science means “100% evidence”, am I correct?
Well, if we can stop to that point of “evidence”, common sense/logic would trump because you would say, “I have enough evidence that shows he did it so I trust that” you would not really go far as to say, “well, apparently, all the evidence we’ve gathered so far points to him doing it but we really needed to witness that person commit the crime for it all to be conclusive, we need 100 per cent evidence. After all, SOMEONE could have made him DO IT”. The latter would speak more of science and is not half-assed. So which is it?
That is, if you insist that “mental illness” does exist and so the comrade is “mentally ill” and could not be trusted and etc. Man, psychiatry is indeed confusing and complicated – I bet out of all those medical fields. SIGH.
Does this situation ring a bell to what the antipsychiatrists are saying? OH, SURE IT DOES A GREAT DEAL!
You know what? an interesting thought came to me: I was so close to looking for a psychotherapist to help me deal with my problems. And then I found a support group and/or a bunch of people in a forum discussing meeting and trying to help each other, sharing what they think they know to overcome those problems, some are struggling, probably some have gone through it all, etc. I thought meeting the latter makes much more sense.
I then remember something that antipsychiatry website stated again: http://antipsychiatry.org/psychoth.htm
“ In his defense of psychotherapy in a book published in 1986, psychiatrist E. Fuller Torrey makes this argument: “Saying that psychotherapy does not work is like saying that prostitution does not work; those enjoying the benefits of these personal transactions will continue doing so, regardless of what the experts and researchers have to say” (Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future, Jason Aronson, Inc., p. 198). If you really are desperate for someone to talk to, then “psychotherapy” may in fact be enjoyable. However, if you have a good network of friends or family who will talk to you confidentially and with your best interests at heart, there is no need for “psychotherapy”. Just as a happily married man or a man with a good sexually intimate relationship with a steady girlfriend is unlikely to have reason to hire a prostitute, people with good friendships with other people are unlikely to need “psychotherapy”.
What if you need information about how to solve a problem your family and friends can’t help you with? In that case usually the best person for you to talk to is someone who has lived through or is living through the same problem you face. Sometimes a good way to find such people is attending meetings of a group organized to deal with the kind of problem you have”
Of course, it is outdated and all that. But then having that realization I stated above whether meeting a psychotherapist or just a group of people with those problems and having to decide to do the latter makes me wonder if what that article is saying appears to be true as it was decades back then. I did wonder whether the psychotherapists’ (psychoanalysts or cognitive behavioral therapists/psychoanalysts being beaten by cognitive behavioral therapists) “progress” changed in any meaningful way for decades. How many decades did people believe that bloodletting is a good solution, by the way? But then of course I remember you saying it seems to be somewhat still true today in a modified form as seen (or evidenced) by science.
Can you cite me a specific (summarized?) study where psychotherapists are better compared to placebos that is relevant today? But then … even if they did work, we need to agree whether:
1.) mental illness exists or not (so that we can determine if the comrade can be trusted or not)
2.) if mental illness doesn’t exist, but psychological disorders/problems DO exist(of course whether “mental illness” exists or not), if asking a psychotherapist should be better than someone who has dealt with those problems and knows the proper solutions.
Well, to highlight your analogy:
Actually, there is no “cake” and “ingredients”.
All the illusion and deception that they also take into account environment is just as it is – illusion and deception. Why would we spend our time trying to counsel how you think or how to change your social-environmental problems when we can just cure your biology since there’s biology as well affecting you? Wouldn’t it be a lot easier to just cure how you react than trying to change what can’t be changed (e.g. your enivonment)? You see, how you’ve been duped? It’s all about the biology and the neurotransmitters and the “chemical imbalances” or whatever.
putting biology into account makes everything meaningless to the pragmatic mind.
I like how you take the word “triggers” and rename them to “risk factors” when essentially they mean to say “triggers”. I’m sure almost any medical condition, such as autoimmune diseases are complex but having said that, it still does have a biological manifestation/cause (Are you really expecting me to ask: that “cause” is NOT enough. What is the cause of that cause?! I mean, maybe they’re wondering about that but honestly the first thing they witnessed would be acceptable, psychiatry doesn’t hold that if we just stick to the basic stuff that I found in Wikipedia and what I got from your articles.)
Nowhere did I deny that it’s not outdated or anything…the September 1999 finding of Attitudes Toward Psychiatry as a Prospective Career Among Students Entering Medical School was in, you guessed it, 1999. It is now 2012. Are you saying Psychiatry’s stance progressed/improved from that time? Take note that after a year, it’s already 2000. So it kept on progressing up through now. That’s what you seem to be saying. As for the quotes taken from “The Death of Psychiatry” for almost 40 years ago(or whatever), are you saying that now epilepsy can be studied/experimented as “neuropsychiatric” ? He was saying that it WAS WHOLLY transferred to the field of Neurology. Some diseases in that quote were also cited as being transferred. Are you now saying that more than those almost 40 years ago, epilepsy and all the other disorders/diseases which were WHOLLY transferred are NOW being treated with neurology and psychiatry conjoined? Of course I am just laying out all these questions in a general-impression sense and should not be taken seriously. It’s worth a thought, I think. Of course it is outdated. Hahah.
Doctors often trust many aspects of what patients tell them. Not doing that would probably qualify as a medical error. If you told your doctor of a serious symptom you have and the doctor ignores you, then that could be very bad.
I consider migraine to be of similar scientific status as mental conditions. There is scientific evidence for factors influencing it and their existence, yet there is no blood test for either. In your terminology, I consider all mental conditions to be evidence-based neurological conditions.
In other words, the status of things like MS and RA is similar to that of many mental conditions. We know a lot about risk factors and we are fairly good at characterizing the conditions, but we lack knowledge about many aspects of the disease pathogenesis mechanism.
So you are faced with the dilemma that if you reject the existence of mental conditions, you must also reject the existence of autoimmune conditions. If you accept the existence of autoimmune conditions, you must accept the existence of mental conditions.
No, such articles would never make it past peer-review.
Obviously, you cannot emphasize finding evidence for every single part of your every day life, but I think it makes sense to ask for evidence when it comes to medical treatments.
No, no. I am not saying that every scientific article published should be trusted. Quite the opposite. A single study should not be trusted in isolation. Rather, if many independent studies looking at e. g. different populations converge on the same general conclusion, then that conclusion should be trusted.
What I am also saying is that the scientific literature should be believed over personal anecdotes.
The more people learned how to use science, the more they learned that their private intuitions are often flawed and can be exploited by predictable processes.
Here is how it works:
1. Science can never prove something like stuff can be proven in mathematics. There is always the possibility of being wrong.
2. Independent converging evidence is a strong argument for why a general conclusion should be (tentatively) accepted. This does not prove it mathematically, but makes the conclusion so strong that it would be unreasonable to doubt it.
In otherwise, science is rarely black and white, but not all shades of gray are the same.
No, I am not saying that the comrade could not be trusted. He or she probably could be. The problem is that the comrade probably does not have expertise in psychotherapy. Would you want a truck driver to perform surgery? The truck driver is probably a great truck driver, but surgery are for surgeons to perform.
I do not think it should be an either-or situation. Psychotherapy (particularly CBT) is an effective treatment, but social support, whatever the form, is vital. Friends and social support does have a role to play, but they generally are not experts in cognitive psychology. In the same way, social support probably makes it easier to recover from any medical condition, but clearly, medical expertise is also useful.
Also, some forms of psychotherapy include group sessions.
Absolutely! CBT is effective in:
– anxiety conditions: http://www.ncbi.nlm.nih.gov/pubmed/22275847
– clinical depression: http://www.ncbi.nlm.nih.gov/pubmed/20599132
– eating disorders: http://www.ncbi.nlm.nih.gov/pubmed/20599136
– personality disorders: http://www.ncbi.nlm.nih.gov/pubmed/20599139
– psychosis: http://www.ncbi.nlm.nih.gov/pubmed/19401859
– schizophrenia: http://www.ncbi.nlm.nih.gov/pubmed/20599131
– substance abuse: http://www.ncbi.nlm.nih.gov/pubmed/20599130
– obsessive compulsive conditions: http://www.ncbi.nlm.nih.gov/pubmed/22275846
– etc.
You can access the full-text articles of most of them by clinking the image that says “Free full text article in Pub Med Central” to the top right. Happy reading!
Because we know that treatments focusing on biology as well as environment is better than treatments solely focus on just biology or just environment.
Also, cognitive behavioral therapy often provides something that antidepressants do not, namely relapse prevention.
No, it is not all about biology and the neurochemistry involves interactions between many different neurotransmitter systems and brain areas, which cannot be reduced to “chemical imbalance”.
It is very easy to confuse uncertainty with scientific humility. Scientists get strong social punishments for exaggerating their findings and so there is many incentives for making their conclusions tentative.
That is why they use terms like “may” and “suggest”. If they were more categorical, then they are overstating what level of certainty science can bring to the table in any issue.
There is always disagreement about details, but as you can read further down, there is a large, general agreement on the general features.
Adequate treatment here refers to getting access to modern antidepressants and/or cognitive behavioral treatment. They are complaining about the messed up U. S. health care system, basically.
You can find many of them on the authors websites, so just search for “article title filetype:pdf” on Google. My university subscribes to the journals, so I can access them in that way. Otherwise you need your own subscription or you can probably get them from a larger public library.
However, Nature and Science regularly provide free science news, giving popular descriptions of the research published in their journals, such as Nature News & Comments and Science News.
Hi, my responses were queued up “awaiting moderation”. I wish I can edit some of them or delete them but I can’t. Oh well. Here’s hoping you’d still understand why I quoted some of those statements from the journals.
Sorry about that. I have auto-moderation on comments containing two or more links to reduce those spammers who post large lists of 100s of links. It has also been a quite busy week.
Please disregard my first post. Delete them, if you can. I’ve edited it.
Here is what’s clearer (please put all of your responses to my first post here with all of your additional insight):
I read (one almost completely) all the links. Now:
the first link:
“Abstract| Several psychiatric disorders—such as bipolar disorder,schizophrenia and autism—are highly heritable, yet identifying their genetic basis has been challenging, with most discoveries failing to be replicated. However, inroads have been made by the incorporation of intermediate traits (endophenotypes) and of environmental factors into genetic analyses, and through the identification of rare inherited variants and novel structural mutations.Current efforts aim to increase sample sizes by gathering larger samples for case–control studies or through meta-analyses of such studies. More attention on unique families,rare variants, and on incorporating environment and the emerging knowledge of biological function and pathways into genetic analysis is warranted.”
I don’t know but it sounds like they’re really unsure in their abstract. Should I really even bother reading everything? Hahah.
the second link:
“Abstract | In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model — biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas — have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck’s cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck’s cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.”
In general…? Seems like they’re not really sure of what they’re talking about. This is interesting.
“Approximately 51% of individuals who experienced MDD in the past year received healthcare treatment for MDD, although treatment was considered adequate in only 21% of the cases”
Hahaha. I thought anti-depressants work or something? “Adequate”?Hmmm…
“Below, we discuss the neural mechanisms that may underlie biased attention in individuals with depression”
“It is possible that in depression, attentional focus on a negatively valenced stimulus effectively blocks out the processing of other, potentially more positive …”
I’m not sure if I read it right or got the quote right because I only have a substitute for PDF reader as I can’t install PDF. I will try to install it again.
“Several theorists have suggested that inhibitory deficits are manifested clinically as a ruminative response style. Depressive rumination — the tendency to think repetitively about the causes and consequences of negative affect — has been associated with the onset, deteriorating course, chronicity and duration of depression.”
Biased processing of emotional stimuli:
“Below, we discuss the neural mechanisms that might underlie this bias (FIG. 3)”
It then went on how the amygdala was related and such.
I am tired.
On the section of rumination:
“In addition, rumination seems to be facilitated by a broader version of the neural network that is associated with self-referential processing (FIG. 4)”
“Therefore, increased MPFC activation in response to negative rumination (that is, prior to reappraisal) may underlie the tendency of individuals with depression to interpret stimuli as self-referential”
I can go on and on. So maybe, I’ll continue reading that “study”. Heheh …
The last link had me almost completely falling apart due to shock. In their abstract, it directly admits that depression is nebulous and cannot be established a disease, I think we can go home now. LOL.
Source: http://laasistencial.com/downloads/Depresion/Depresion-medicos-1.pdf
“Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the
major current approaches to understanding the biologic mechanisms of major depression.”
This critical reading I’ve done or have been doing brings me to mind what I found here or what the webmaster of this website said. Of course, again, coming from that antipsychiatry.org website: http://antipsychiatry.org/br-pibp.htm (as he was doing a book review):
“Among the gems in this book are the following observations by two psychiatrists. Dr. Ross says during his training to become a psychiatrist, when the “cognitive errors pervading clinical psychiatry [were] unwittingly demonstrated to me by my residency supervisors” he learned that not only medical students but even “psychiatrists rarely do the critical reading” that would make the nonsense they learn in their psychiatric training apparent for what it is (pp. 85, 87 – emphasis added). In a chapter by Susan S. Kemker, M.D., staff psychiatrist at North Central Bronx Hospital in New York City, she says “most of us [psychiatrists] have been taught to believe [that] biology is the science of psychiatry. That fact that I believed this dogma made Pam’s (1990) critique of biological psychiatry especially unsettling. When I read his work, I felt that my entire education as a psychiatrist was subject to question” (p. 241). Speaking of herself and other psychiatrists, she says “our understanding of our own field remains naive” (p. 242 – italics in original). Statements like these from board-certified psychiatrists make me wonder if just by reading a book like Pseudoscience in Biological Psychiatry – or even just this book review – you know more about the “cognitive errors” that pervade modern biological psychiatry than many or even most psychiatrists.”
Of course, that book is outdated and blah blah … But I was just saying and makes me wonder whether what he was saying remains true today.
btw, how do you get these from Science or Nature journals? Do I need to have account? Do I need to pay in order to have an account, do I have to buy these? How can I subscribe to regular updates and things like that? Thanks.
OOPS. This is like the second time I’m going to re-post this, I’m afraid I haven’t still done what I wanted to do with that post. I’m hoping this is the last post of that post I’m going to do…Please delete the first one and the second one (currently awaiting moderation), and replace them with this one. Also, copy-paste your responses here and modify them if you have additional input:
I read (one almost completely) all the links. Now:
the first link:
“Abstract| Several psychiatric disorders—such as bipolar disorder,schizophrenia and autism—are highly heritable, yet identifying their genetic basis has been challenging, with most discoveries failing to be replicated. However, inroads have been made by the incorporation of intermediate traits (endophenotypes) and of environmental factors into genetic analyses, and through the identification of rare inherited variants and novel structural mutations.Current efforts aim to increase sample sizes by gathering larger samples for case–control studies or through meta-analyses of such studies. More attention on unique families,rare variants, and on incorporating environment and the emerging knowledge of biological function and pathways into genetic analysis is warranted.”
I don’t know but it sounds like they’re really unsure in their abstract. Should I really even bother reading everything? Hahah.
the second link:
“Abstract | In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model — biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas — have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck’s cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck’s cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.”
In general…? Seems like they’re not really sure of what they’re talking about. This is interesting.
“Approximately 51% of individuals who experienced MDD in the past year received healthcare treatment for MDD, although treatment was considered adequate in only 21% of the cases”
Hahaha. I thought anti-depressants work or something? “Adequate”?Hmmm…
“Below, we discuss the neural mechanisms that may underlie biased attention in individuals with depression”
“It is possible that in depression, attentional focus on a negatively valenced stimulus effectively blocks out the processing of other, potentially more positive …”
I’m not sure if I read it right or got the quote right because I only have a substitute for PDF reader as I can’t install PDF. I will try to install it again.
“Several theorists have suggested that inhibitory deficits are manifested clinically as a ruminative response style. Depressive rumination — the tendency to think repetitively about the causes and consequences of negative affect — has been associated with the onset, deteriorating course, chronicity and duration of depression.”
Biased processing of emotional stimuli:
“Below, we discuss the neural mechanisms that might underlie this bias (FIG. 3)”
It then went on how the amygdala was related and such.
I am tired.
On the section of rumination:
“In addition, rumination seems to be facilitated by a broader version of the neural network that is associated with self-referential processing (FIG. 4)”
“Therefore, increased MPFC activation in response to negative rumination (that is, prior to reappraisal) may underlie the tendency of individuals with depression to interpret stimuli as self-referential”
I can go on and on. So maybe, I’ll continue reading that “study”. Heheh …
The last link had me almost completely falling apart due to shock. In their abstract, it directly admits that depression is nebulous and cannot be established a disease, I think we can go home now. LOL.
“Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the
major current approaches to understanding the biologic mechanisms of major depression.”
This critical reading I’ve done or have been doing brings me to mind what I found here or what the webmaster of this website said. Of course, again, coming from that antipsychiatry.org website: http://antipsychiatry.org/br-pibp.htm (as he was doing a book review):
“Among the gems in this book are the following observations by two psychiatrists. Dr. Ross says during his training to become a psychiatrist, when the “cognitive errors pervading clinical psychiatry [were] unwittingly demonstrated to me by my residency supervisors” he learned that not only medical students but even “psychiatrists rarely do the critical reading” that would make the nonsense they learn in their psychiatric training apparent for what it is (pp. 85, 87 – emphasis added). In a chapter by Susan S. Kemker, M.D., staff psychiatrist at North Central Bronx Hospital in New York City, she says “most of us [psychiatrists] have been taught to believe [that] biology is the science of psychiatry. That fact that I believed this dogma made Pam’s (1990) critique of biological psychiatry especially unsettling. When I read his work, I felt that my entire education as a psychiatrist was subject to question” (p. 241). Speaking of herself and other psychiatrists, she says “our understanding of our own field remains naive” (p. 242 – italics in original). Statements like these from board-certified psychiatrists make me wonder if just by reading a book like Pseudoscience in Biological Psychiatry – or even just this book review – you know more about the “cognitive errors” that pervade modern biological psychiatry than many or even most psychiatrists.”
Of course, that book is outdated and blah blah … But I was just saying and makes me wonder whether what he was saying remains true today.
btw, how do you get these from Science or Nature journals? Do I need to have account? Do I need to pay in order to have an account, do I have to buy these? How can I subscribe to regular updates and things like that? Thanks.
As soon as you confirm/reply to that edited post of mine, I will then reply to your replies along with your replies to my second post which is continuing our debate. Thanks.
Sorry, but I am not going to delete or edit any of your posts. I want this discussion to be as complete and transparent to readers as possible.
My general reply stands: when scientists use terms like “may” etc. that is because they are being modest; being overly confident in the scientific literature is strongly looked down on. I also feel you are trying to put undo emphasis on the areas where uncertainty and unknowns still exist, while almost completely disregarding areas were broad confidence exists; there will always be disagreements about details, but the evidence for the general picture (i. e. mental conditions exists, biological influences are important but not the sole cause, mental conditions are multifactorial etc.) is pretty much beyond reasonable doubt at this point.
Uhhhh genius, those posts are exactly the same as that edited post. The edited post is just clearer, like there is a bold edit on certain texts. Actually, I am also thinking for the benefit of those reading. It would be utterly confusing if they are going to endure reading repetitive posts (as I have posted the exact same thing over and over again with varying edit) when I just wanted some aspects (like the bold edit) to be paramount for it to be clearer to the reader.
Take your time deleting unnecessary posts please. It’s a headache to the readers. Cheers. :/
Not sure if you’re just making up a weird excuse.
so you’re saying that the doctors just trust what the patients should report and the patients should just trust what the doctors would say? Not to say that’s wrong but is this what you’re basically saying?
There is no scientific evidence that mental illness exists. Period. Therefore, it cannot be labeled under the same league as migraine, sir. 😉
First of all, if we can trust Wikipedia enough (and I think we agreed both that we can?), we can go home now, again, Wikipedia admits “mental illness” is just a social judgment and doesn’t exist: “A mental disorder or mental illness is a psychological pattern or anomaly, potentially reflected in behavior, that is generally associated with distress or disability, and which is not considered part of normal development of a person’s culture. Mental disorders are generally defined by a combination of how a person feels, acts, thinks or perceives. This may be associated with particular regions or functions of the brain or rest of the nervous system, often in a social context. The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition, assessment and classification, although standard guideline criteria are widely used. In many cases, there appears to be a continuum between mental health and mental illness, making diagnosis complex. According to the World Health Organisation (WHO), over a third of people in most countries report problems at some time in their life which meet criteria for diagnosis of one or more of the common types of mental disorder.”
I think that you are wrong. I think the cause of Multiple Sclerosis is clear: “an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms.” etc… although it goes on to say that the ’cause is unknown’, this is inaccurate as they can’t explain why the disease came to be – doesn’t mean they can’t spot the cause of which I quoted. The same thing can also be said with RA: “The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (hyperplasia) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium.” etc…
The “cause” in “mental illnesses” like schizophrenia and obsessive-compulsive disorder are behaviors only. Of course you would rebut and say “they’re still physical” because “behavior IS physical” (software is still made up of the hardware despite: http://www.computerhope.com/issues/ch000039.htm but anyway, for the sake of logical consistency). The problem is if it’s a behavior we have no way to know if it’s a disease or a normal behavior or malingering because the observation is outside.
Schizophrenia: “Current research is focused on the role of neurobiology, although no single isolated organic cause has been found. The many possible combinations of symptoms have triggered debate about whether the diagnosis represents a single disorder or a number of discrete syndromes.” I must say, the bold line makes everything more hazy it’s almost funny.
Obsessive-Compulsive Disorder: “Multiple psychological and biological factors may be involved in causing obsessive–compulsive syndromes.” Take note of the word “syndrome”… why not use “symptoms”? hazy… That, or I am just ignorant in the proper usage of terms and such. Anyway that’s just a minor thing and it’s not a big deal.
SIGH.
and, as for about science and common sense:
science is part of common sense. we are not talking about “private intuitions“. geez. we are talking about common sense. let’s see if the psychiatric drugs work by giving out the (non-psychiatric)drugs w/ side effects to the control group with the experimental group being given the real psychiatric drugs(which have side effects as well). Now, what are you beating the bush around for? You have got to be kidding me. All this circular talk is funny.
As for weird facts making it past peer-review, OF COURSE you would think they would not make it past peer-reviews! But what do you know!? After all, a lot of the common sense facts that we know can be proven wrong in one snap by the “evidence” as published whatever you want me to read. Are you getting my point here? I am not disregarding those studies, I am just saying that in this case that in order to test the efficacy of psychiatric drugs (like the one we’re debating with these antidepressants), it has to be FAIR. sure, you have studies indicating that “nocebo effect” works but IN ORDER TO BE SURE, why not make it fair? why beat around the bush and claim that the nocebo effect is enough!? Are you getting me here? I think that science should align itself with common sense, not the other way around and our common sense tells us to make these trials FAIR ENOUGH. 😉 so STOP BEATING AROUND THE BUSH.
Wow. Too much headache! just kidding. NOPE. Let’s see if this will work. Let’s say you’re trapped in a mine shaft or tunnel or whatever that is…now you’ve been with 2 people: one known for having the idea FOR THE PLACE, e.g. it’s based on his theory, he was maybe the architect or something. The other one IS a WORKER who has gone through the place all around and stuff for like days and know every possible path and ways. Who would you trust more? Really basic stuff.
Yay! Just kidding. No. Uh.. let’s see, now thinking about it, of course CBT would be effective THAN a placebo because CBT is based on metuculous common sense coping strategies. That means, whatever is the placebo, it’s a phony practice of helping the client. So OBVIOUSLY, CBT works! The funny thing is, it actually even works without the help of psychotherapists because it is only common sense. Now, if you don’t have any friends or family members to help you with your psychological disorder and also by them helping you apply the CBT (Woah! BIG WORD! just kiddin..) to yourself, of course you WOULD want to go to a psychotherapist who would perform the CBT to YOU. Ring a bell? I’m tired.
Guess what antipsychiatry site said about psychotherapy rings true even today:
Implicit in the idea of “psychotherapy” is the belief that “psychotherapists” have special skills and special knowledge that are not possessed by other people. In making this argument against “psychotherapy”, I am arguing only that conversation with psychotherapists is no better than conversation with other people. In his defense of psychotherapy in a book published in 1986, psychiatrist E. Fuller Torrey makes this argument: “Saying that psychotherapy does not work is like saying that prostitution does not work; those enjoying the benefits of these personal transactions will continue doing so, regardless of what the experts and researchers have to say” (Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future, Jason Aronson, Inc., p. 198). If you really are desperate for someone to talk to, then “psychotherapy” may in fact be enjoyable. However, if you have a good network of friends or family who will talk to you confidentially and with your best interests at heart, there is no need for “psychotherapy”. Just as a happily married man or a man with a good sexually intimate relationship with a steady girlfriend is unlikely to have reason to hire a prostitute, people with good friendships with other people are unlikely to need “psychotherapy”.
I guess this applies to CBTs too! Oh well. Some things never change! 😀
Nope. Wrong again. Again, if biology is taken into account, everything else become meaningless because you would think you’d just target the brain of the person to “change the chemistry” or whatever that is, in order to deal with his/her life. It doesn’t matter that CBT offers relapse prevention for you can just prescribe as many drugs you want (or as many right amount of drugs that you need) in order to prevent your “mental illness”. See? Of course, “drugs with CBT” is a good combination in the long run so that there are these two forces who can help you… but the thing is … the practicality and logic here is, you can just focus on the brain and change that, so problem solved. And this is why a lot of psychiatrists focus on prescribing as much drugs as possible, especially on first meetings and such, without focusing on the patient’s other factor- psychologically handling his/her current situation, because they see this logic clearly. Got it?
but you know what I mean. I meant the biological factor of the person.
What are you talking about? but I never saw any evidence for the existence of mental illnesses, particularly major depressive disorder (the one most obvious), in any of the links you shared.
I’m sorry but I find it hard to believe your claim that they are “just being modest”. What the hell? We are talking about scientific discovery and they are littered with “may” “seems” “no established mechanism” basically … UNCERTAIN. I am sure a lot of studies in science which are certain don’t have strange wordings … I didn’t even have to go through the details, all of them in their abstract show that no proof/evidence exists for their case and they are just mere speculations in progress.
“Everybody gets so much information all day long that they lose their common sense.” -Gertrude Stein
I think that this is the case with most people, particularly in the “mental health” field.
I am saying that doctors have and should have some degree of trust in what their patients report about e. g. their medical history. If a patient tells the doctor that the he or she have had certain symptoms, like neck pain, then the doctor should take that seriously. The patient could have bacterial meningitis and that could be life-threatening. Not taking this into account could qualify as a dangerous medical error.
I think you are being somewhat dishonest. I have provided scientific evidence for the existence of mental illness, which I feel that you have not taken seriously.
I have shown in previous comments that you are misunderstanding the Wikipedia article. It says that social judgments play a role, not that mental illness is merely a social judgment.
The article says that the cause is unknown. The fact that we know certain details about the process does not mean we know the cause in detail. If you reject mental illness because the causes are not determined in detail, you must reject the existence of autoimmune diseases, which is an absurd position.
No, the cause of mental conditions are a complex interaction of biology, psychology and environment. We have been over this many times now.
The chronic inflammatory disease called inflammatory bowel disease (IBD) is probably also collection of many similar conditions. Does that mean it does not exist? Obviously not. An elucidation of the subtypes of a mental condition is actually further evidence of its existence.
Science is the rejection of common sense and the acceptance of scientific testing. I have already shown why your experimental design is flawed (it would give the control group more side effects than the experimental group and the control group would not be comparable).
I am not claiming it, I am referencing scientific studies showing that this is the case. There are comparable levels of side effects in the experimental and control group during most antidepressant trials.
False analogy, since the worker is an expert in his field, whereas another depressed comrade is not an expert on the treatment of mental conditions.
No, CBT is based on empirically validated methods, not on “common sense”. In fact, CBT contains quite a few counterintuitive features that are supported by the evidence, such as the factors causing the mental condition are often different from the processes that maintain the condition. A lot of psychotherapists of previous therapies considered this weird. But it works scientifically, so science wins over common sense.
It is not a belief, but a scientific fact. Psychotherapies have many years of scientific education and practical training. Ergo, they actually do have special skills and knowledge not generally possessed by the average person.
No, because biological factors are risk factors only. They do not determine everything. I think you have a quite naive view of biology.
No. The use of the term “may” indicates modesty, not uncertainty. That is because these words are used in almost every single scientific article there is. It is a way to prevent making too strong claims that could potentially be overturned by later research.
I dare you to find a single scientific paper written during the past 10 years that do not have words like “may”, “might”, “could” or similar.
I know this seems strange to you, particularly if you have read a lot of the anti-psychiatry literature. Pseudoscience such as anti-psychiatry rarely attach qualifiers to their statements, but rather pretend they have absolute truth in their grasp. This is unfortunate, because that makes them insulated from disproof and opens up to dogmatism in a way that rarely happens in science.
but I am being honest. I feel like you haven’t provided enough evidence. All the articles’ abstracts say that they’re still on progress and everything is inconclusive.
I am sorry but I think Wikipedia’s summarized entry on “mental illness” is as clear as the sky.
I think that with the other diseases you mentioned, even if the causes are unknown, the manifestations are concrete and not abstract. In contrast, “mental illnesses” like OCD, schizophrenia and the likes only have behaviors which could be just behaviors, malingering or something else which might not be genuine diseases. I think the difference is clear.
I think that you’re hopeless. Maybe you need to elaborate more on what you meant why my experimental design would be flawed: you give false drugs with side effects to the control group and then you give the true drugs with side effects to the experimental group. Let’s see then…. Apparently this is “wrong”.
Of course you’re claiming it.
Of course the comrade who has gone through the same life problems is an expert on those problems.
A psychiatrist/psychotherapist, on the other hand, studying the entire problem from a distance, with some clinical setting, is NOT. 😉
so architect/conceptualizer=pretending to be IN the place, but NOT really=psychiatrist/psychotherapist
worker=the one REALLY dealing in and out of the place=comrade
Apparently to you, you have it reverse:
architect/conceptualizer=pretending to be IN the place, but NOT really=comrade
worker=the one REALLY dealng in and out of the place=psychiatrist/psychotherapist
Take note for comrade that I mean to say that the one who has gone through the same problems and solved them are probably better than the ones who are still trying to solve them.
Let’s say I have an extreme fear regarding germs, I wash my hands 70 times a day. I’m having a hard time handling this fear so I wear gloves but one time I feel like I want to live my life more to the fullest so I want to combat my fear regarding germs and get used to them. Step by step, I try to overcome this fear with the help of my family, friends and those people who have gone through it. The step by step process of overcoming your fear is just another word for CBT, correct? If I’m correct, CBT is exactly THAT. so yes, it’s just common sense. OF COURSE IT WOULD WORK THAN A PLACEBO! LOL!
In the antipsychiatry forum, one sent in a question what the webmaster of the website would do given an example of someone suffering from extreme OCD, and in his reply he said: “explain to the man who washes his hands 200 times a day what’s known about the ability of intact skin and the human immune system to protect us from germs. I’d educate him about the real risk of encountering pathogens that can overcome a human body’s defenses. In small steps I’d encourage him to do things he irrationally fears (which is sometimes called “behavior therapy.”) Sometimes irrational beliefs and irrational phobias fade away when subjected to a carefully administered dose of reality, and sometimes they don’t.” he then admits of course he was just replying to the best of what his common sense could offer as some of these problems, he said, can be a lot tougher to overcome. You can take a look at the forum here: http://antipsychiatry.org/e-mail.htm#criticisms
“These by the way, are composites of actual psychiatric patients. Should these people be “convinced” they’re not really sick? Jailed? Shot? Exiled to some remote island? What do you think are solutions to the problems of suffering, drug use, emotional pain. Please post this on your website along with your reply. The feeling I got from your site was that like most people with extreme opinions, you see all the problems but no solutions. Am I wrong? I would very much like to see your reply.”
“I’m sure many other readers of this web site have had thoughts similar to yours. While I have my own common sense ideas about how I would try to help people like those you describe, I do not think being able to devise solutions for the problems of troubled people is a prerequisite to criticizing the harm now inflicted on them in the name of help. Part of a physician’s oath is to first do no harm. A general answer to your question about how to help troubled or irrational people is don’t add brain damage or a lifetime of psychiatric stigma to their problems. My general answer to family members of troubled, irrational, or obnoxious people such as those you describe is: You have a right to disassociate yourself from any adult in your family whose behavior you dislike or consider unacceptable, but morally you do not have a right to use or authorize the use of force against them even if the law gives you a means of doing this.” He then proceeds giving out his common sense solutions in helping troubled people such as the one I mentioned above having extreme OCD (as one of the examples given by the person who was asking).
So “cognitive behavioral therapy” is just “common sense therapy with a lot of convoluted steps” LOL! 😀
It is a belief.
LOL. I think that you do not fully understand the point of view of your masters. Since there are medicines for “mental illnesses”, why waste time trying to change that person’s situation if we can just CHANGE HOW HE/SHE VIEWS THE SITUATION BY CORRECTING HIS “MENTAL ILLNESS”? Ironically, you do not even understand the point of view of your masters or where they’re coming from. It seems as if you’re going against their main tenet/logic but trying to defend them anyway! Hahaha…Amusing.
First of all, I’m not even just talking about their usage of the word “may” but the abstracts on those articles are basically inconclusive. I did not say that most scientific articles don’t have words like “may”, “might”, or “could” but the way the “facts”(on those areas that should be reasonably sure) were presented in these articles you presented were so unsure it’s almost laughable.
It is a way to prevent making too strong claims that could potentially be overturned by later research.
yes, they are afraid to make too strong claims because basically everything that they are saying IS unsure. 😉
Of course in scientific journals/articles where there are specific things they are SURE, they wouldn’t use those words in explaining those things to prevent making too strong claims that could potentially be overturned by later research because they are SURE about THOSE. However, it’s basically understandable for them to be using unsure words in describing things which are inconclusive or they aren’t really sure about, or quite frankly, speculative only. 😉
Show me any of the abstracts that say “everything is inconclusive”.
Actually, there are many aspects of the manifestations of autoimmune diseases that we do not understand.
– What antigen is being destroyed in the synovium by autoreactive immune cells in rheumatoid arthritis?
– What determines when the diseases such as SLE or IBD flares up after being dormant for a while?
– What role does B cells play in type 1 diabetes?
– etc…
The claim that mental conditions do not only have behaviors. We have identified many genetic, environmental and psychological risk factors for most mental conditions. In other words, you are confusing diagnosis with knowledge of the causes.
Alright, I will clarify.
Purpose of a clinical trial: the groups should differ only in the active pharmaceutical substance.
Using non-pharmacological placeo: the experimental groups get the pharmacological side effects, the control group gets expectancy side effects. These are often about equal in severity and frequency.
Using pharmacological placebo: the experimental groups get the pharmacological side effects, the control group gets expectancy side effects + pharmacological side effects from the placebo.
So in your design, the groups do not differ only in the active pharmaceutical substance, clouding any interpretation made from the results.
No, because his sample size is n = 1. There is no reason to suppose that all or most individuals with depression share his experiences. Coping strategies that work for him might not work for you and vice versa.
Mental health professionals, on the other hand, have access to scientific knowledge from literally hundreds of thousands of patients. The psychiatrist/psychologist/psychotherapist is not studying the problem “from a distance”, but has rolled up his or her sleeves and is sitting right in the midst of the situation, working his or her ass off.
In addition to my previous criticisms, there is no reason to suppose that the comrade really has solved the problems. It could just be a temporary relief in an otherwise chronic situation. At worst, the methods that comrade has used only offer temporary relief, but lead to worse outcome over time e. g. self-harm.
No, CBT is not just “common sense”, but an empirically supported approach.
Ironically, the webmaster is actually suggesting a form of psychotherapy, namely behavioral therapy, which is an intellectual ancestor of CBT. The problem with pure behavioral therapy is that it may cause too much anxiety for the person trying to overcome his or her fear. That is why you need the cognitive element as well: a way to handle, control and modify your cognitions. Also, psychotherapists will have had much experience with setting up these kinds of treatments than a single earlier patient.
1.Since the causes of mental conditions are multifactorial, the treatments also need to tackle these different processes.
2. Furthermore, the processes that causes the condition are often different from the processes maintaining the condition, so that is another reason why you need psychotherapy.
3. We know from scientific studies that medication and therapy is better than medication alone, so that in itself is an argument for why it is not a waste of time.
Actually, most top-tier science journals do not allow speculations. That is because they are interested in publishing the top articles in the field, which includes research backed by evidence.
I think you have lost this argument many times over by now.
Geez. And I thought you were paying attention. First of all, and I will repeat this again, on wikipedia’s summarized entry, you have already lost. I’m not going to paste the entire thing again, geez.
Second, if you really insist your(their) abstracts:
First link:
Abstract| Several psychiatric disorders—such as bipolar disorder,schizophrenia and autism—are highly heritable, yet identifying their genetic basis has been challenging, with most discoveries failing to be replicated. However, inroads have been made by the incorporation of intermediate traits (endophenotypes) and of environmental factors into genetic analyses, and through the identification of rare inherited variants and novel structural mutations.Current efforts aim to increase sample sizes by gathering larger samples for case–control studies or through meta-analyses of such studies. More attention on unique families,rare variants, and on incorporating environment and the emerging knowledge of biological function and pathways into genetic analysis is warranted.
1 point.
Second link:
“Abstract | In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model — biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas — have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck’s cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck’s cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.”
It’s funny you want to sugarcoat that article. Anyway,
Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.
so the negative mental biases in depression are facilitated by increased influence from subcortical emotion processing regions(CAPTION OBVIOUS, of course, they are going to be influenced from emotion processing regions) combined with attenuated top-down cognitive(mental) control. So? Stating the obvious but still no proof of the existence of mental illness.
Furthermore, I have already addressed all the speculation bullshit that was stated in that article above, perhaps numerous times because of my numerous editing. Critical thinking requires courage rather than intelligence. If you have the courage to see clearly, you’ll notice that you’re wrong. There is a lot of beating around the bush and “circular talk” in this argument it’s almost funny.
2 points.
Third link:
“Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the
major current approaches to understanding the biologic mechanisms of major depression.”
So yes, everything is inconclusive regarding the existence of mental illness. We(You) are beating a dead horse.
Alright, I will clarify what I meant, too. But we are not going to use the nocebo effect.
We just give the control group the nonpsych drugs with side effects and then give the experimental group with psych drugs which have side effects. But we’re not going to make them believe that there are side effects, or in other words, we’re not going to use expectancy side effects. You are twisting my experimental design. There is no “expectancy side effects” along with the pharmacological placebo, you idiot. So many posts have passed and you did not even get it. Well, naturally, if the pharmacological placebo has real side effects, there’s no use for “expectancy side effects” or the “nocebo effect”. Are you getting me here? So making them ‘believe that there are side effects’ would be redundant. We give the control group the real psych drugs (with side effects), tell them “those drugs have side effects”(or not tell them) and then give the experimental group a pharmacological placebo and say the same thing(or not tell them, either). Then we get to tally the results. That’s just fair. Why would we ‘make them believe there are side effects’ in the experimental group when there’s already naturally side effects in the pharmacological placebo?. Too much beating around the bush.
I am sorry but you are wrong again. The mental health professional IS not the ONE depressed or has experienced being depressed. That’s like pretending you know what your friend feels. LOL! Gross abuse of common sense and logic here, I can’t help myself but laugh. I think that, I kinda feel sorry for your reasoning.
There is no reason to suppose that all or most individuals with depression share his experiences. Coping strategies that work for him might not work for you and vice versa.
That is why, sir, you need to find people who are experiencing your SAME problems to be exact and to make sure. Or better yet, those who have gone through those problems. GEEZ.
Ironically, what the webmaster was saying is that it’s basically just common sense. “behavioral therapy” – that’s why he used quotation marks. He was saying that kind of common sense help would be called “behavior therapy” by psychotherapists (who are pretending that their knowledge is based on some expertise, LOL!).
That is why you need the cognitive element as well: a way to handle, control and modify your cognitions.
Meh….that’s just one of those tough, hard ways to overcome your fears. OF COURSE you’d need to modify your cognitions FIRST, and I mean, that’s one of those ways. Sure, you can pick which way could help you most. This is common sense.
how is CBT not “common sense”? It sounds sure it just is!
But we are still arguing whether “mental illness” exists, to give those scientific studies any merit. Clearly, you have put yourself into a high horse and claiming hypotheses like this one in the context of this debate as fact. You are not being honest. Instead, you are like a parrot saying non-stop what you have learned which may or may not be wrong but stubbornly believing that they are right, anyway. Reread all your posts and you will notice in some (or most?) that you tend to go circles and say things like, “Well, that’s not how you should think. This is how you should think…” etc. etc.
And apparently, you still didn’t get it because you’re circling back. Again. And again. Even if the claim of the causes of “mental illnesses” are multifactorial, psychiatrists(your masters) see the practicality and logic of just correcting the mental illness so that it will all be over, by prescribing drugs or getting to the physical root of the matter. Of course, you’d OVERLOOK (Phew! It went past his head) this again and goes parroting: “Well, the causes of mental conditions are actually multi-factorial so you can’t really say it’s just biological. . .” failing to grasp what I was saying anyway in the first place as a MAJOR REBUTTAL to that. (Or what the psychiatrists(and psychiatry) stand on, anyway).
But they did allow speculations and admit on those articles that you showed me that they’re just still mere speculations. Nothing wrong with that, if you’re just being honest, and just presenting the current speculations and progress (of course, not yet proven) with things that they are studying including the ones that you showed me.
There are many points I admit I lost, I think. As far as I can remember but I’m not sure. . .
However. . .
The main thing about this argument is proving whether mental illness exists and unfortunately, your position always crumbles in that main aspect. It’s true that it took me a lot of time to get to that simple point of just proving whether the concept exists (by just trying to find the most credible source, for example) and along the way there were many points I started off on but in the end, I actually felt like I was right all along. 😉
And your weak defense about that flawed experimental design is SORE.
It’s OK to admit you’re wrong but I guess that would require TOO MUCH EFFORT as you’ve spent your time DESIGNING this blog and all that. So, continue whatever you’re doing I guess and pretending that you’re correct! 😉 This is off-topic but I just…you know…I kinda sense this is a bit going nowhere…
I have already demonstrated that you have misunderstood what the text says. You single out individual statements that you interpret to support your position, but ignore the vast descriptions that contradict your conclusion. This is known as confirmation bias.
At any rate, this discussion is starting to go in circles and it is becoming rapidly uninteresting as you are repeating the same canards over and over again without engaging with counterarguments. My patience is growing short.
Actually, what you just quoted is evidence. Read the article in full.
Again, top-tier journals like Nature does not publish idle speculation. All the articles I posted discuss actual research. But you would have known this if you actually had taken the time to read the articles in full.
Stop looking at words or sentences in isolation! Read what you have quoted. The article discusses the established approaches to understanding the biological mechanisms of depression, which you just denied the existence of.
At the very least, read the full articles instead of just quoting abstracts out of context.
No, the fact that somethings are inconclusive does not mean that “everything” is inconclusive. Stop insulting your own intelligence. You are better than this.
You are not going to inform patients about the side effects of a treatment they have a high chance of getting? That violates the basic principle of informed consent that is crucial for all medical research. Your study design will never ever be approved by a ethical review committee, and few people will volunteer a treatment they do not know enough about.
I also do not appreciate being called an idiot, especially when I have spent over 1 month talking about these things with you.
Because the principle of informed consent tells us that researchers need to make sure that the patients understand the possible side effects of what they are getting. They need to know this before they enter into the trial and therefore before they are randomly assigned to a group so that is why it will not work to tell them before. Also, since the two groups will get different types of side effects, this will damage the interpretations of the results, which require a trial where the only difference between the two groups is the pharmacological side effects of the active treatment.
The mental health professional can marshal experience from thousands of studies, case studies and has a lot of experience with successfully treating patients. Your depressed friend does not. All he knows is what he believes works for him. But there is no reason to suppose that those coping strategies are actually beneficial.
There is no reason to suppose that the coping strategies that works for an individual with the same subtype of depression will work for you anyways. The life histories will be different and the efficacy might be due to chance. That is why you need more than a sample size of n = 1.
But that is not what is done in pure behavioral therapy. So you are calling pure behavioral therapy and CBT common sense, despite the fact that they have opposing ideas and focus for e. g. fear. That is a contradiction.
Then show me where the methodology of those studies are flawed. Go on, impress me.
Again, top-tier journals do not publish speculation. You really need to understand this basic point before we can move on.
Anyways, you are not really responding to any of my arguments and call me idiot, so I am not really that interest in continue to interact with you.
I mean, of course, in terms of common sense, we need to modify our cognition first so that it would affect our behavior.
Which of course is not what is being done in pure behavioral therapy, which you also call “common sense”.
So is it common sense to modify cognitions (part of CBT) or to not put any emphasis on them (behavioral therapy)?
First of all, I would like to apologize for calling you an “idiot”. Just my frustration. And you do realize I respect everything that you had to say but I believe there are some things that you deny so I became a bit flippant. Anyway, don’t take that seriously. I was just being casual. I’m the kind of person who is just brutally honest so there you go. (That means I can admit that I’m an idiot if I really think I am and I might be, if you can convince me, just kidding. 😉 )
OK. Let’s make this short.
you say I take things out of context, but I don’t. I do not use confirmation bias. So maybe you can say I was confused when I was reading but I am not using confirmation bias. That’s a little bit of an insult. Let’s try it again. First of all, we’re arguing whether “mental illness” exists. For an average layman seeking the truth in an easy way, can he/she trust Wikipedia as it is the most common source of knowledge/information in this age? Wikipedia says,
People of all ages, cultures and backgrounds can add or edit article prose, references, images and other media here. What is contributed is more important than the expertise or qualifications of the contributor. What will remain depends upon whether it fits within Wikipedia’s policies, including being verifiable against a published reliable source, thereby excluding editors’ opinions and beliefs and unreviewed research, and whether the content is free of copyright restrictions and contentious material about living people. Contributions cannot damage Wikipedia because the software allows easy reversal of mistakes and many experienced editors are watching to help ensure that edits are cumulative improvements. Begin by simply clicking the edit link at the top of any editable page!
but then, that’s in “About Wikipedia” page so they could be lying to save themselves – let’s turn for other more credible sources – you mentioned before that Wikipedia is as almost reliable as Brittanica or an encyclopedia, am I correct? OK I guess, almost reliable as Brittanica cannot be counted then. So let’s drop Wikipedia. Are you following me here…
So you provided proofs of the existence of mental illness by those articles. I thought abstracts are summarized conclusions of the entire study, so I think it’s safe to say, to rely on the abstract for the average layman trying to save their time, correct?
the first article says in their abstract……but wait, the sources of this Nature review are (as I found on the left part of the PDF page):
*Molecular and Behavioral Neuroscience Institute
*Department of Psychiatry and Depression Center
*Department of Human Genetics
*Department of Biostatistics
We can’t trust the article then because Psychiatry is there. If you know what I mean, since we are trying to know whether psychiatry holds any merit for the existence of “mental illness”, it would make no sense to review an article coming from that as a *proof*. It has to be neutral, correct? Likewise, I also cannot cite a source opposing psychiatry and claim that it’s the *proof*. But then it’s published 2008 which makes it, I guess, relevant but that makes me wonder if the study itself is relevant but I guess we can assume that since it’s published 2008 that the study must be somewhere between 2004-2008.
Moving on to the second article…
The second article’s sources are:
*The University of Texas at Austin, Department of Psychology
*University of Pennsylvania, Department of Psychiatry
so it also has a source emanating from Psychiatry, not neutral. But it’s publisehd 2011 so it’s very relevant. So dropping that and moving on to the third article:
The source is from the New England Journal of Medicine. I think we can accept that. It’s also published 2008.
The abstract from the third article reads:
Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emotions dissipates, and it is disproportionate to their cause. Classic severe states
of depression often have no external precipitating cause. It is difficult, however, to draw clear distinctions between depressions with and those without psychosocial precipitating events. The diagnosis of major depressive disorder requires a distinct change of mood, characterized by sadness or irritability and accompanied by at least several psychophysiological changes, such as disturbances in sleep, appetite, or sexual desire; constipation; loss of the ability to experience pleasure in work or with friends; crying; suicidal thoughts; and slowing of speech and action. These changes must last a minimum of 2 weeks and interfere considerably with work and family relations. On the basis of this broad definition, the lifetime incidence of depression in the United States is more than 12% in men and 20% in women.
Some have advocated a much narrower definition of severe depression, which they call melancholia or vital depression.A small percentage of patients with major depression have had or will have manic
episodes consisting of hyperactivity, euphoria, and an increase in pleasure seeking. Although some pathogenetic mechanisms in these cases and in cases of major depressive disorder overlap, a history of mania defines a distinct illness termed bipolar disorder.Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. This review presents the major current approaches to understanding the biologic mechanisms of major depression.
so there is no established mechanism, the abstract admits, but then this “review presents the major current approaches to understanding the biologic mehcanisms of major depression” so that means it presents the current approaches to understanding depression in the biological context but the conclusion is that there’s no established mechanism yet. Am I reading it right? Tell me if I’m wrong.
There, I tried to clean my mind when replying this.
So what I glean from this is that there is no proof for depression as a mental illness yet. And in the end of the day, we should still be asking whether *mental illness* really exists.
I am not saying that the Wikipedia page on mental conditions is unreliable. I am saying that you selectively quote the sections that you feel confirm your position and ignore the ones that do not. I also point out that you are actively misunderstanding the sections you do quote. The existence of some uncertainty in the origin and nature of mental conditions does not mean they do not exist. This is because there is uncertainty in the origin and nature of pretty much all known diseases.
Your argument that we cannot trust peer-reviewed articles in top-tier journals because the authors work at department that has the word “psychiatry” in it is absurd in the highest possible degree. You are also forgetting that these journals do not publish any old speculative stuff, but only the studies and reviews of the highest quality.
Listen, you need to actually read the entire article in order to evaluate it. You cannot dismiss an entire body of research because one of the writers happen to work in a psychiatry department at a university or quote a sentence from the abstract.
You actually need to read the articles if you have any hope whatsoever about having an honest and intellectually productive discussion with me on this topic.
I have presented the evidence that mental conditions exists. Your stubborn refusal has no impact on this.
I know you didn’t say that about Wikipedia. In case you didn’t notice, I was clarifying both our points in that post, to ‘renew’ everything. I mean, sort of a recheck on where we’re at. So you didn’t say that about Wikipedia but I was trying to see where common sense/logic would bring me in our discussion so far. So you assumed a lot of things in there that aren’t true. I am not actively misunderstanding the sections that I quote. Maybe I was stupid enough that I didn’t get it but actively misunderstand ? Um…no way. You can say I was ‘confused’, but no way I would “actively misunderstand”. You are accusing me of things.
Why is that absurd? I thought I made it clear that the sources should be neutral. No proofs taken from antipsychiatrists and no proofs taken from psychiatrists. Just neutral. What is so illogical about that? smh
I am not accusing them of being outdated. I just thought I’d show you how my thinking works. I was basically thinking out loud. I am not saying that they could not be trusted because they could be outdated or “old speculative stuff” (in that recent ‘clean-up’ post anyway). I just thought that just because it was published a certain date does not mean the studies were conducted in the same year, nothing wrong with that. I mean. . . I do believe that they do their best to publish studies and reviews of the highest quality. Again, you just accused me of something based on your impression about me. I was just saying that A leads to B to C. . . that it was published a certain year and I thought that could mean the studies were not in the same year or many years before or something then I thought that could be a little bit impossible, so you were interpreting things and reading way too much on things that I said. Read it again:
So reading this with an objective and pragmatic mind, tell me, what is wrong with that? I was just basically thinking out loud for god’s sake! Haha. smh
So I’m saying it’s STILL relevant and that the study must have been conducted somewhere 2004-2008 AND nothing’s wrong with that. It’s STILL relevant. So?
Like I said, you throw any logical valid points that I made which is extremely unfair.
I did READ and WANT TO PAY ATTENTION on the abstract of the article, the summarized findings of that study. As an average layman, that’s all I need. I am not a scientist who needs to study that. What is wrong with reading the abstracts to get the summarized findings in order to save time? What is your problem really? o.O
I am astounded by the kind of attitude that you’re showing me right now.
Some points:
1. About that flawed experimental design, my point simply is, WE DO NOT USE EXPECTANCY SIDE EFFECTS.
We just do it this way:
control group = nonpsychiatric drugs with side effects
experimental group = psychiatric drugs with side effects
**But in the end, we still need to prove whether *mental illness* exists. If it does indeed exists, then we can continue talking about whether antidepressants or psychiatric drugs or psychotherapy works. Because it CAN work even if “mental illness” doesn’t exist, are you getting me here? So let’s drop this first.
2. About the effectiveness of psychotherapy: again, I think we need to agree whether *mental illness* exists first before talking about this. If it does exist, then I agree that doctors(like psychiatrists) can study it and then treat it and people suffering from them, like people who suffer from depression, cannot be counted on to help others suffering the same illness because they are suffering the same thing OR in the case of people who have gone through them, are not expert enough or knowledgeable enough to handle the illness because they haven’t professionally studied or undertook the matter. However, if it doesn’t exist, then psychiatrists are fools and the only people who can help other depressed people are those people who have gone through that phase. They’d be the closest ones who can help you, if your friends and family members can’t.
3. CBT vs. BT . To my understanding, CBT is changing cognitions first but BT is getting used to the fear so the fear would go away, correct?
The reason why I said both is “common sense” is this:
Imagine if you have a phobia regarding rats. You want it to go away. Common sense is to get used to rats or expose yourself to them. (that’s BT) but then … suppose you’re having a hard time doing that because the fear is crippling, you look for other ways to alleviate your fear and that is trying to change your cognitions first (CBT) … and that is why both of them are really just common sense in my understanding. Are you getting me now? but of course, we need to agree whether “mental illness” exists first. If it does exist, then these therapies do HELP to cure those “mental illnesses”. If it doesn’t, then they’re not REALLY curing anything. (I mean, they are practically helping the person through his mental problems but logically speaking they’re not “curing his/her mental illness” like “curing STD”)
However, if you think about it, suppose “mental illness” does exist, and these things are really just common sense, if they’re just really common sense (as how I interpret them to be), then there’s no reason to hire psychotherapists to help you with this but if they’re not along common sense, then we need to hire psychotherapists to achieve these things. But this is something I’m not interested to talk about since if “mental illness” does exist, then you probably need to acquire some professionals(who are studying your mental illness) to help you with your disease.
4. I think more than any other issue about the existence of “mental illness”, suicide is what I’m worried about. If “mental illness” exists, then suicide is the result of a mental disease and so we need to prevent someone from committing suicide and cure that person instead. If “mental illness” doesn’t exist, then suicide is just a rational act to get out of a very tangled situation like escaping your unbearable depressed feelings. If it wasn’t for this issue, I think I wouldn’t have leaned a bit towards antipsychiatry’s side. I firmly believe in “the right to die”. What is your general impression of this article? Take time reading it to your delight. http://antipsychiatry.org/suicide.htm Thanks.
I do apologize for being flippant sometimes.
I already shown why this is bad research design, because (1) there are more things than just the pharmacologically active treatment that differs between the groups thus making the interpretation more difficult and (2) the control group will have more side effects than the experimental group biasing the results.
Simplified, CBT focuses on cognitions, BT does not.
You seem to accept the value of psychotherapy now.
I support the ability of individuals (such as Tony Nicklinson) living with strongly debilitating and untreatable diseases to end their life in dignified way. However, that decision must be a result of a rational and evidence-based view of reality.
Individuals with e. g. depression tend to have, as we saw in the articles I referenced, negatively tinted glasses. This means, more concretely, that individuals with depression have a sustained, negatively biased attention, processing and memory. This could mean that the reasonings used by a person with depression might be colored by this negatively and therefore not be as objective as we would like. So the decision to commit suicide might not be completely rational in certain cases. That means that the person, if he or she was fully informed of all the facts and were reasoning without fallacies, might not have wanted to kill him- or herself.
I would like to avoid situations were a person who would not have committed suicide if he or she was aware of all the facts and were reasoning without fallacies or biases, committed suicide because society could not provide the support and help he or she needed.
There were a few flaws in the articles you linked, such as confusing psychiatric and legal definitions of mental conditions and not clearly distinguishing between cases such as Nicklinson from cases where a person with e. g. depression wants to end his or her life.
“So the decision to commit suicide might not be completely rational in certain cases. That means that the person, if he or she was fully informed of all the facts and were reasoning without fallacies, might not have wanted to kill him- or herself.”
Are you saying that the person should have a psychiatric evaluation first before being allowed to commit suicide? (To see if his decision to commit suicide is motivated by a rational decision) *rolls eyes* .
“I am going to kill myself because I can’t bear to live my life as an obese and I can’t have the effort to lose weight and all that” “NO! You can’t! That’s irrational! You’re just being negative! Think positive! Work hard for a better tomorrow!” It’s his life, why does it have to be “valid” in someone else’s point of view? Are you kidding me?
What if the person decides to kill himself because he doesn’t want to deal with curing his “bipolar disorder” anymore in one of his sane moments? Is that a “rational decision”? Are you seeing where the lines are blurred here?
I never saw any flaws in that article. He did start to sound as if he’s confusing psychiatric and legal definitions of mental illness but proved that wrong as he 1.) proves that “mental illness” doesn’t exist. 2.) even if it does, there is no convincing evidence that people who do commit suicide are due to “mental illness”.
So yeah, you are wrong in so many ways and your denial doesn’t change that fact.
Yes, if we put in place a system with doctor-assisted suicide, we should definitely have a psychiatric evaluation as a requirement. Because we want to know if that person’s decision is based on sound reasoning (e.g. incurable and painful terminal disease) or based on fallacious reasoning (e. g. due to mental illness). In the latter case, it may be possible to treat that person so that the underlying condition gets better. Most people who commit suicide strongly influenced by mental illness do not necessarily want to, but they see it as the only way out. One of the jobs of the health care system should be to show that there are alternatives in this later case. This seems perfectly reasonable to me and you have not put forward any substantive arguments against it.
Reality is never black and white, but don’t let’s replace a naive two-colored view with an even more naive one colored view. All grays are not on the same shade. Individuals with e. g. a bipolar condition can make rational decisions about their life, and there may be practical difficulties in evaluation to what degree the wish to commit suicide is based on a rational judgment. This, however, is not a very strong argument, because as a society we can chose to put the bar higher and play it safe: if you have a mental condition that we know affects rational decision-making in such a case, then we would disqualify that individual from receiving doctor-assisted suicide. Because, as a society, we would rather help people get better than to help them die. Only when the former is not possible, such as in the case of terminal and painful illness, should we explore the latter option.
Mental illness does exist and scientists have identified genetic risk factors for many of them. This has been demonstrated beyond any reasonable doubt.
You claim that there is no convincing evidence that mental illness influences the decision to commit suicide. This is also completely false because we know that e. g. clinical depression causes a negative bias in attention, perception and memory. Depending on the population studied, [url=http://en.wikipedia.org/wiki/Suicide#Mental_disorders]as many as 90% of people who commit suicide may have suffered from clinical depression[/url]. This disproves your claim.
There’s also another point that I forgot to address before when I was reviewing where we’re at:
1. The role of the biological factor of “mental illness” : My point here is that, even if psychiatry’s stand is that there are multiple factors to take into account, the single factor to be taken account logically would be the biological because it will be a lot easier.
there’s the environment, then there’s biology. . . so to make it easier, let’s just change how the person thinks. Problem solved! That seems to be the logical route if there IS a biological factor (his brains) to take into account.
**But then of course, we still need to make up whether *mental illness exists* before talking about this.
Again, I am just reviewing this point, clarifying this point.
No, you cannot reduce the complex interaction of biological, psychological and environmental factors to “just biology”. It make it a lot easier for you, but it is scientifically wrong and would hurt individuals with mental conditions. Effective treatments are going to be based on an accurate understanding on the complexities of the condition. No understanding, very hard to develop effective treatments.
Studies that I have referenced in this discussion, as well as other articles on anti-psychiatry, shows that psychiatric medications and cognitive behavioral therapy are better together than any of the two are on their own.
EDIT: “That seems to be the logical route if there IS a biological factor (his brains, for example) to take into account.”
EDIT: “That seems to be the logical route if there IS a biological factor to take into account.”
I would also like to point out that I’m more of a student here rather than a debater. I am trying to learn. But I admit sometimes or maybe most of the times I get so confused. I am willing to admit my mistakes and errors and so should you. But anyway…let’s get back on track.
The first step to changing your mind is admitting the possibility of error.
I admit the possibility of an error. I have admitted numerous times in this discussion when I’m on the ‘error side’. The question is, are you willing to admit that you’re wrong when you’re indeed wrong? The answer seems likely no as you are showing a very rude, condescending attitude right now. But I guess that’s okay. Any objective mind who will read our discussion up until this end will see who is really trying to evade valid points. And that is a shame, really as I had so much respect for you. 🙂
I think you should try to re-assess yourself. Did you even read entirely my latest posts such as the one most recent continuing our discussion regarding whether “mental illness” exists and that where I stated that I was merely reviewing both our points to know where we’re at?
The fact that two people express their views with equal emphasis does not mean that the truth lies between. I would be happy to admit any errors I have made, but I do not see any in this discussion. That is probably because I have sticked to the bare basics of the subject.
At any rate, I think we have outlined our two positions with enough detail and clarity and since it is starting to go in circles, I do not know if it is a productive use of our time to continue.
Thanks for your contribution, though.
58 COMMENTS! 😀
“The fact that two people express their views with equal emphasis does not mean that the truth lies between.”
Now that’s just stupid. He was just merely reviewing the points you and he had so far. He was in no way implying that the truth lies in between. And are you actually saying that you are correct and he is downright wrong? I guess you two people expressing their views with equal emphasis SHOW that you are the right one and he’s the wrong one. Bullshit.
Yes, it is my position that anti-psychiatry is a position that is almost certainly globally wrong. I have presented arguments in various articles on this blog for that conclusion.
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