Wednesday, June 27, 2018

Words Do Matter in Psychiatry

I was pleased to see that in the June 2018 issue of one of the newspapers for psychiatrists, Clinical Psychiatry News, a psychiatrist by the name of Carl T. Bell wrote about something I have been harping about in this blog and elsewhere for years: the sloppy use of psychiatric terminology by both the public and by many psychiatrists themselves.

Glad to know I’m not the only one who has noticed this.

He brings up three examples: the use of the words (two of which also have a common meaning separate from the corresponding terms in psychiatry): traumatized, depressed, and bipolar.

Colleagues of his had used the word traumatized as something that happened to a person who was the subject of a statement by another person that has come to be known as a “microaggression.” A microaggression is defined as “a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority.” 

Worrying about that sort of thing has become endemic on college campuses recently. Especially if it unintentional, the result of the big ado is a communication to individuals that they are so fragile and vulnerable that they can’t handle anything. It also has led to a suppression of free speech.

As far as I know, there has never been an example of a microaggression, or even a direct verbal insult, in and by itself leading anyone to develop post traumatic stress disorder (PTSD). According to Dr. Bell, being stressed by something like that, or by your boss chewing you out, is a far cry from being traumatized. Being distressed by something like the death of a parent is a little worse. It can come up from time to time, like on the anniversary of the death. However, in both of these cases, unlike in PTSD, “the mind is able to make peace with the reality…and life goes on.

“Traumatic stress, on the other hand,” he adds, “is an event so painful and disruptive that it runs the risk of breaking the mind’s ability to make peace with the event…[and it] disrupts or destroys normal psychic life.”

I would add that if everyone around you treats you like you are so fragile that the slightest stress will do that, you start to believe it even though you probably aren’t that fragile at all. And if you feel like that, you are probably not going to take measures to actively oppose and undermine things like racism, sexism, and homophobia. If enough people think like that, it is paradoxically a great boon to racists, sexists, and homophobes everywhere.

I’ve already covered the misuse of the term depression in my post of November 24, 2015, Depression is a Symptom, not a Psychiatric Disorder. Major depression is a clinical condition has many physical symptoms and is something that can be quite disabling, while being unhappy, sad, grieving or even demoralized is not the same thing at all. The latter conditions do not respond to antidepressants in the least, but researchers doing current studies on antidepressant efficacy have become very sloppy and often do not exclude the latter people as they should.

Bell then addresses how the term “bipolar” is creeping into common usage to cover things such as being moody and having difficulty regulating one's moods and having a bad temper (especially in kids, I might add). For maybe thirty minutes or an hour. And many psychiatrists just take patients at their word when they misuse the term, and prescribe unnecessary and ineffective mood stabilizers.

In that vein, another article in the April issue of the same newspaper quoting a Gabrielle Carson M.S. talks about the issue of tantrums in children. It advocates investigating the child’s symptomatology to rule out bipolar and other mental disorders, as well as clearly behavioral problems like so-called disruptive mood dysregulation disorder, ADHD, and oppositional defiant disorder. 

The only mention of environmental factors that might lead to the tantrums is a quick and superficial reference to child abuse and school bullying. But the article says absolutely nothing about the far most common cause of frequent tantrums by children (as discussed by child psychologist and columnist John Rosemond as well as other people who actually look at what goes on in the child’s home): problematic parenting practices such as acting like a friend to your kids instead an authority figure, letting them make decisions that should be made by the adults, compulsive yelling or lecturing, and inconsistency in administering discipline.


  1. The difference between people who develop PTSD\ and those that don't when faced with the same trauma is NEUROINFLAMMATION. The ones who developed neuroinflammation got PTSD, The "resilient" didn't have neuroinflammation so no PTSD

    And the same is true for Borderlines. They have neuroinflammation plus a more complex PTSD because they had two hits of trauma (during childhood and adolescence).

    Or did you miss the link between Borderline disease and complex PTSD?

    In research when you approach something with your mind already made up, you may miss much, and you've already missed so much.

    1. Hi Anonymous,

      Thanks for your comment.

      While there is certainly some evidence that inflammatory processes may be involved in PTSD, I am afraid it's not nearly as definitive as you seem to be implying.

  2. "PTSD is associated with elevated inflammation."$=activity

    And borderlines have high indices of inflammation their entire lives.

    As a matter of fact, that's probably why Naltrexone helps some of the symptoms of BPD. Besides it being an opioid antagonist, it is also a TLR4 inhibitor.

    1. "Association" is not "cause," and it's usually hard to say which is the cause and which is the effect in these types of studies.

      Naltrexone blocks the endorphins that are released when patients with BPD cut themselves (the pain of which they find preferable to the emotional turmoil associated with being in a desperate no-win situation), so it sometimes help reduce self injurious behavior.

  3. Yes, Naltrexone blocks opioids, but it is also a TLR 4 inhibitor (TLR4 is activated by inflammation). In studies, Naltrexone has relieved neurocognitive side effects from interferon which is pro-inflammatory. In other words, Naltrexone is anti-inflammatory.

    So are some of the anti-depressants but some also dysregulate endocannabinoids and lower oxytocin.

  4. Cutting, spending, gambling, speeding, etc they all cause release of endogenous opioids. So does smoking and wearing bright colors.

    Have you noticed borderlines like bright colors?

  5. Dr Allen:
    It is a well known fact that borderlines don't feel pain when they cut. That's because cutting (as well as gambling, spending, speeding, etc) causes the release of endogenous opioids, which block pain. So if you produce opioids every time you cut, then perhaps cutting is an addiction to opioids, rather than a preference for PAIN THAT DOESN'T EXIST.
    Self injurious behavior is associated with having inflammation and besides being an opioid antagonist, Naltrexone is also a TLR4 inhibitor. In other words, Naltrexone is anti inflammatory.

    1. I have BPD, it hurts when I cut, burn, smash my face into the ground.

    2. Some people with the disorder do feel less physical pain than average, while others do not. The endorphans help with the psychologic pain - often of the feeling like someone just has to fix something right now - or disaster will strike - now but not knowing how.

    3. Dr Allen:
      I think that cutting is an attempt to stimulate a dysregulated endogenous opioid system.

      From a paper called, "Borderline Personality Disorder: A Dysregulation of the Endogenous Opioid System?

      " healthy persons only feel pain when they cut themselves, whereas BPD patients report euphoria and no pain. "

      "Whereas patients with BPD seem to have reduced pain during self-injury, they seem to have reduced pain tolerance when suffering from headache, toothache, or other forms of non-self-inflicted pain, as they require higher doses of pain medications than are normally used (Saper & Lake, 2002). This seems paradoxical, but the difference between these sources of pain and cutting or burning wounds is that headache and toothache are not associated with tissue damage as is the case with bleeding, which seems to be a prerequisite for endorphin release"