Medicating Normal - an Interview

I was interviewed today on the Facebook page for a movie called "Medicating Normal" about the current problematic state of psychiatry - such things as malignant polypharmacy, the over-diagnosis of bipolar disorder and other b.s. diagnoses, doctors spending too little time with patients for a good evaluation, and such.

It can be seen at:

https://www.facebook.com/watch/live/?ref=watch_permalink&v=1479833659217305

Climate Change and Severe Mental Illness Deniers Use a Common Strategy

One topic I discuss on this blog is the tactics used by various advocacy groups to make misleading arguments in their efforts to advance their interests.

There is, of course, a large anti-psychiatry contingent that argues that severe and chronic mental illnesses like schizophrenia and (real) bipolar disorder are not real brain diseases.  They also argue that, since their brains are normal, the abilities of affected individuals to think rationally enough to properly take care of themselves are not highly impaired, so that involuntary commitment and treatment are never indicated under any circumstances. Of course, they seem to make a big exception for people who suffer from the brain disease of Alzheimer’s disease, but that’s another issue.

It recently occurred to me that the argument I have been hearing from those who deny that climate change exists, or that people are contributing to it, is very similar to one that is used by the mental illness deniers. They knowingly set a bar for “proving” the nature of these phenomena that is totally unachievable by science, and then use this ridiculously high bar to assert that, since the science is not "proven," then it is invalid.

In complex phenomena like weather or brain structure and function, the number of involved factors contributing to the final result is enormous, and their interactions unpredictable to a significant degree. Schizophrenia, for instance, is clearly not a disease of the gross pathology of the brain, which is what the deniers insist is necessary for “proof,” but is probably a disease of the interconnections between literally billions of nerve cell synapses that connect one neuron to others. We have no way currently to map out these connections in precise detail, and they change constantly over very short periods of time, so we cannot prove that they are pathological. There is, however, an astronomical amount of indirect evidence that they are.

Similarly, climate change deniers use the fact that the various computer models which predict how the process will unfold differ from one another in their predictions about the exact timing and locations of various expected weather events as evidence that the science is completely flawed. What they completely omit to mention, of course, is that no one is arguing that we have or probably ever will have the ability to predict weather patterns with that degree of precision. They also conveniently forget to mention that all the models point in the same direction, and that the patterns are already happening in ways that are consistent with the more general predictions.

Well, there are a lot of things that science cannot predict with absolute certainty, so we have to go with the preponderance of the evidence. In cases in which the consequences of inaction are enormous, we still have to act without this ridiculously high level of “proof.”

I would argue that allowing the mentally ill to languish in jails or in cardboard boxes on the streets of cities like San Francisco is such an instance. So is climate change that can lead to mass population dislocations with resultant wars, severe pollution, starvation, and the spread of tropical diseases that might kill us all.

I do not know if there is a name for this logical fallacy so glibly employed by science deniers. But there should be!

Horror Stories in the Public Domain: Often More to the Story

The Nocebo Effect

Since I started this blog, I have corresponded or interacted with several respectful, thoughtful, and caring (as well as some hateful, ignorant, and not so well-meaning) individuals who run websites that are critical of psychiatrists or psychiatric medication, or who run support groups for the parents of individuals with various psychiatric diagnoses. These folks collect and publish horror stories. Some of their readers report having had bad reactions to psychiatric drugs and/or awful interactions with mental health professionals, while others discuss interactions with relatives with specific psychiatric or psychological disorders.  

As to the psychiatry critics' drug websites: Of course, anyone who reads this blog knows that I believe that there are a lot of really bad psychiatrists out there who end up doing real harm to their patients. Mostly, they drug patients unnecessarily or over-medicate them, and do not recommend  - and therefore deprive patients of - psychotherapy or family therapy that might do their patients some real good. Others do not monitor patients for adverse reactions, with sometimes catastrophic results. These websites can often contain information that can be very helpful to such individuals.

It is also quite true that a small proportion of those taking any drug on the market, psychiatric or otherwise, can have bad reactions or bad withdrawal symptoms, and that certain drugs are of such high risk for potential toxicity that they should not be prescribed for anything but the most serious of reasons. Toxicity from drugs that for many people are truely helpful and indicated can be monitored for, of course, but often doctors do not do this, as mentioned above.

While a majority of the horror stories about drugs are therefore probably true, although unrepresentative for reasons about to be discussed, this does not necessarily mean that any story website readers submit about a bad reaction that they seem to have had to a drug is, in fact, due to the drug. That should go without saying.

First, there is what is called a nocebo reaction, which is sort of like a placebo reaction in reverse. People will develop symptoms that are not actually due to the drug itself because of their expectations about the drug - just like people can have a bad or good reaction to a sugar pill that is basically inactive, pharmacologically speaking. The popularity of the obviously bogus science of homeopathy, in which individuals are given what is basically water, attests to the power of placebos and nocebos.

It is ironic how some of the more strident anti-psychiatry folks go on and on about high placebo response rates in drug studies, yet systematically deny that anyone ever has a nocebo response. This lack of consistency is always an excellent clue that anything such a person says may be highly prejudiced, and that their reading of evidence is highly selective.

Of course, people who have good responses to drugs are not going to write into the sites designed for people who have a complaint. In a similar vein, parents who were severely abusive to their offspring are not going to write to parent support groups for the families of patients with alleged psychiatric “diseases.”  Therefore, both the leaders of parent support groups and drug site webmasters are hearing from a highly select sample of individuals who are probably not at all representative of the majority of people who are involved.  

Parents who contact the two support groups for the parents of patients with borderline personality disorder (BPD),  NEA-BPD and TARA, are an excellent example of an unrepresentative sample. Yet the leaders of these groups often deny or minimize the role child abuse and general family dysfunction play in the genesis of BPD because of their tendency to overgeneralize from their readers, despite the FACT that every study ever done shows that these factors are highly prevalent in families that produce children who grow up to have BPD.

As to the people who do seek help from support groups for relatives of people with various disorders: At least some if not most of these individuals have a strong need to blame their interpersonal problems solely on a mental illness that their relatives supposedly have. If that were the case, they would not have to feel guilty about their role in the family member’s problems. I discussed this phenomenon a long time ago in a post about a website supporting the parents of children who supposedly had bipolar disorder but were in actuality just plain ol' acting out. The post showed how Pharma, with the cooperation of corrupt psychiatrists, took advantage of these parents to sell inappropriate drugs for their kids.

Similarly, complainers about drugs may actually be miserable because of family problems, but would rather blame their misery on the drug rather than face the facts of their family dysfunction. This is the defense mechanism called displacement. 

Again, of course there are real psychiatric diseases like schizophrenia and real manic depressive illness, but as readers of my blog know, I believe that what are just behavior and interpersonal problems are frequently mislabeled as "diseases" by both mental health providers and the general public alike, such as ADHD, bipolar (my ass) disorder, and even borderline personality disorder. 

The webmasters for the sites under discussion here, and the leaders of these support groups, tend to just accept the pronouncements of their “customers” as true and complete and do not question them. Blindly taking the word of people who may have several skeletons in their family closets is probably not wise. These are people the webmasters usually do not know at all, although in some cases they may have corresponded more extensively, and there is rarely any way to verify what they say. Therefore, it seems to me that one can easily be misled about both the prevalence and/or the basic nature of these problems from reading these websites.

The same question of whether one is getting the whole story might also be said about letters to newspaper advice columnists. Admittedly, I have been guilty of using such letters to illustrate various points I make on this blog. Some letters to Dear Abby and her colleagues may be completely fraudulent, and they can easily be fooled into publishing a fake one.  

An even bigger problem is that, even when a letter writer is completely sincere, many times he or she is only telling part of a much bigger story. Patients, letter writers, and website visitors can be completely truthful in what they say, but leave out highly relevant facts that would change the opinion of anyone listening to them.

As a therapist, and as I have mentioned in previous posts, sometimes the truth about what is really transpiring with a patient, particularly during their interactions with family members, are not revealed until literally months or even years into ongoing psychotherapy. Family skeletons tend to remain family skeletons for a reason.

A great example of someone leaving out a lot of relevant details, if true, was seen in a couple of letters to the advice column Annie’s Mailbox. A daughter-in-law was accused by a letter writer of what sounded like some pretty rude and unpleasant behavior, and the Annies were sympathetic in their answer to the writer. Then the daughter-in-law herself wrote in with her side of the story. Although I cannot be certain that the letter writers were not making this stuff up, I reproduce the letters because I have seen real examples of patients “spinning” facts to make themselves look better than they are, or in many cases, to make themselves look worse than they are.

These letters do illustrate some of the ways that facts can indeed be “spun” in such a way that a reader or listener is completely misled.

Letter #1: Aug 5, 2013. Dear Annie: My husband and I drove a long distance from our home to help our son and his wife with their move from another state. They have two infant daughters, and we wanted to help in whatever way we could. The first morning, Dad went with our son to the bank, leaving me at the house with the movers. My daughter-in-law stayed in her bedroom with the babies. The movers' questions were directed to me, and my daughter-in-law didn't come out of the bedroom until my son came home. It was hard to believe she wouldn't want to be involved in the decision-making process about where her furniture should go. 

On the fourth day, our son went back to work, and we were left to fend for ourselves in the morning while his wife slept in. There wasn't even a TV to keep us occupied while we waited for her to get up. At 11 a.m., we decided it was time to leave, and we cut our stay short. We called our son on the way back home and explained the situation. In seven months of our son saying everything was "fine," they never initiated any contact. There were no acknowledgements of Christmas and birthday gifts, much less a thank you. There were no phone calls. Now his wife is demanding an apology from us, saying we were rude to leave so abruptly. We believe this was inappropriate behavior on her part. What is your opinion? -- Disappointed Parents

Dear Parents: We think you will have ongoing problems with your daughter-in-law. She was rude and ungracious. But she is your son's wife, and he is disinclined to stand up to her. You will have to work through her if you wish to maintain a relationship with your son and grandchildren. Apologize, even if it sticks in your throat. If she avoids you by staying in the bedroom, don't make it a problem. Learn to keep your negative opinions to yourself. Remain upbeat and positive. Always be nice to her. Remember, you can catch more flies with honey than vinegar.

Letter #2: 10/18/13.  Dear Annie: I am the daughter-in-law mentioned in the letter from "Disappointed Parents," who said I retreated to the bedroom while my mother-in-law handled the movers. From their letter, I can understand why you think I might be a problem. Yes, they did travel a long distance to help us with our move, and it was greatly appreciated. I kept thanking them and continuously asked whether they were OK and whether they needed anything. I was told over and over that they were just fine. The day the movers arrived, my husband and I agreed that he would deal with them and I would keep our small children out of the way in our bedroom. He didn't tell me that he and his father left to go to the bank, leaving his stepmother to handle the movers. 

My husband and I both slept until noon that day, but they only castigated me for being "lazy." They didn't mention that I was up until 4 a.m. unpacking. They were bothered that I didn't have breakfast ready for them, even though the kitchen wasn't unpacked. They expected to be entertained. When they decided to leave in a huff, I was bathing our kids. They didn't even lock the front door behind them. After they left, I received nasty emails saying how rude I was and that I need to apologize. Each one included a laundry list of the ways I am a terrible daughter-in-law and don't know my place. I didn't send birthday and Christmas greetings because my husband said he wasn't interested in doing so. His father has a history of anger issues and has alienated every other family member. My last email stated that I was cutting off contact. I am too busy raising my children to raise my in-laws. They smile to your face while making lists of slights behind your back. I don't want my kids around such behavior. Thank you for reading my side of the events. — Shell-Shocked Daughter-in-Law

Dear Shell-Shocked: Thanks for providing it. Many readers came to your defense, saying that a new mother who had just moved had her hands full and deserved more consideration. We agree.

Often the possibility that details are being left out of a description of an interpersonal problem can be suspected from a very careful reading or listening to what is said. For example, I see a lot of letters to advice columnists by elderly parents complaining that their adult children are ignoring them or are angry at them, seemingly for no apparent reason. In point of fact, there is always a reason. For example:

Dear Annie: I could have written the letter from "Hurt in Florida," whose children and grandchildren don't include her in their get-togethers. My daughter told me they are "just too busy" for me. But they somehow have time for her dad and stepmother, as well as her in-laws and several friends. I haven't seen them in more than a year. We don't talk because I don't call. I don't understand any of it. I just wanted to let "Florida" know that she's not alone. I'm hurting with her. — Midwest Grandma

The key question raised by what is said in this letter is why said daughter seems to love to get together with every family member except the letter writer. Could it be that the writer has distanced her child in some way? You can almost bet on it.

The Tragedy of Thomas Szasz

Thomas Szasz

The following is a mini-obituary for Thomas Szasz, M.D. from the National Review on October 15, 2012. He died at the age of 92 on September 8, 2012.  He was the author of a book called The Myth of Mental Illness in 1961, in which he argued that there is no such thing as schizophrenia or any other severe mental illness, and that all people mislabeled in this manner should be free to wander the streets, no matter how mentally impaired they may seem to be.

He later undermined any credibility he might have had, which was precious little to begin with, by throwing in his lot with Scientology by serving as spokesman for their Citizen’s Commission on Human Rights.

The obit expresses my sentiments exactly.

"Like most people whose writings do great harm, Thomas Szasz started with a plausible-sounding principle, but instead of using it to clarify his thoughts, he made it the center of his worldview, bending everything else to fit while he ratcheted up the overstatement. Szasz’s governing notion was that psychiatry is not just an inexact branch of medicine, not just a discipline subject to misuse, but nothing less than a gigantic fraud, useful only for keeping inconvenient people under control.

“Mental illness did not exist. It was merely a myth, on par with witchcraft, exploited by those in power to control the masses. By denying the existence of what everyone could see with his own eyes, Szasz threw out the baby with the bathwater, and included the tub and plumbing fixtures for good measure. The 1960s spirit of “only the mad are sane” romanticism, and the 1970s post-civil-rights hangover, gave his pernicious doctrine a long shelf life.

“With his sharp mind, Szasz could have helped curb psychiatry’s abuses and excesses; instead, his charismatic nihilism led to the usual overreaction (most notably the draconian policy of deinstitutionalization, unfortunately still very much with us) and ensuing counterreaction (nowadays he is widely and correctly considered a crank). Dead at 92. R.I.P."

Peter Breggin Goes Off the Deep End

Peter Breggin

Peter Breggan is a psychiatrist who is often highly critical of the use of any and all psychiatric medication, which makes him the favorite psychiatrist of the rabid anti-psychiatry movement along with Tom Ssazz. 

For some of these zealots, it is very understandable why they hate psychiatrists so much.  As anyone who reads my blog knows, incompetent psychiatrists or those docs who have been brainwashed by big Pharma often do a lot of damage to patients through misdiagnosing them, using inappropriate medications, and/or not monitoring their patients for side effects.

I cannot blame such victims for having a highly emotionally charged negative attitude towards my entire profession. 

Still, that does not make everything they think correct.  In fact, it often kind of impairs their ability to be objective about psychoactive substances.

Personally, I always felt that Breggin has used half truths to justify some of his opinions.  But now I think he has gone completely off the deep end. 

After reading what follows, I have this to say to anyone who still thinks he has a shred of credibility: You should look into joining the Flat Earth Society. You’d fit right in.

A news article by Phil Willon of the Los Angeles Times appeared on June 12, 2012, with a follow up story the very next day and again on June 21.  I quote parts of the three stories:

“A San Bernardino County prosecutor Tuesday urged a jury not to be swayed by testimony that the antidepressant Zoloft put a former Westminster police detective in a fog that made him not responsible for kidnapping and raping a waitress in 2010. Deputy Dist. Atty. Debbie Ploghaus called the so-called Zoloft defense, backed by a psychiatrist's testimony, "a bunch of baloney" and a desperate attempt by Anthony Nicholas Orban to sidestep overwhelming evidence against him.

Orban was identified by the victim, was implicated by his best friend, was captured on security video footage at the scene of the attack and left his police service weapon, with his name on it, in the victim's car. Ploghaus told the jury that while bar-hopping in Ontario before the kidnapping, Orban groped a woman's chest, grabbed a man's crotch and repeatedly texted a former girlfriend hoping for an afternoon tryst. "He was a highly trained officer who wanted to have sex. He had sex on the mind. Don't forget that," Ploghaus told jurors in her closing argument.

The Westminster detective is accused of abducting the waitress, then 25, as she walked to her car after a Saturday shift at the Ontario Mills mall. His police service weapon drawn, Orban forced the victim to drive to a self-storage lot in Fontana, according to authorities. The victim told the jury that Orban sexually brutalized her in the parked car, hidden behind tinted windows, as people walked a few feet away.

At one point, Orban snapped pictures with his cellphone, telling her to "smile for the camera." He chambered a round in his semiautomatic pistol, shoving the barrel deep into her mouth as tears rolled down her cheeks, she said. "He said if I cried, he would kill me," the victim told jurors. "Then he pulled the gun out and said, 'I think we'll continue this in the desert.'"

Orban had shared eight margaritas and two pitchers of beer with a friend, and was seeking sexual encounters before he kidnapped the victim at gunpoint and made her drive to a Fontana storage facility, where he raped her, Ploghaus told jurors.

Orban's attorney, James Blatt of Los Angeles, said the assault ran counter to a life spent protecting community and country as a police detective and a Marine veteran of the Iraq war. The only plausible explanation for the defendant's behavior, Blatt argued, was the potent effects of Zoloft, which sent Orban spiraling into an "unconscious" delirium.

"At the time he was not aware, not aware of the torturous things he had done,'' Blatt told the jury…The victim sat in the front row of the Rancho Cucamonga courtroom, clutching a friend's hand, as the prosecutor recounted her testimony that Orban rubbed his weapon against her face during the attack.

Now here’s the relevant part:

The defense relied on Dr. Peter Breggin, a New York psychiatrist and critic of psychotropic drugs who has testified in other cases across North America. Breggin said he believed Orban suffered a psychotic break from reality shortly before the kidnapping and was in an unconscious state of delirium, void of control or memory, during the attack. "I don't even think he knows he's tormenting her," Breggin testified. "He would not under any circumstances behave like this if he was not driven over the edge by the drugs." Orban had temporarily quit taking Zoloft, prescribed by his psychiatrist, then resumed it at full dosage five days before the attack, which Breggin said sent him into a state of manic psychosis.

Breggin testified that Orban had stopped taking the prescribed antidepressant, then resumed it at full dose, provoking a psychotic break during which he was "delirious" and not fully aware of his actions.

The prosecutor criticized Breggin as "intentionally misleading" and told jurors that the scientific community rejects his medical theories. Ploghaus' medical expert, Dr. Douglas Jacobs, an associate clinical professor at Harvard, testified that Zoloft has been prescribed to millions of people and proved to be safe. There has been no evidence that Zoloft causes delirium or unconsciousness, he said.

While antidepressants can definitely cause someone who actually has bipolar disorder to become manic (more on that near the end of the post), and even though Breggin used the word "manic" in his testimony, symptoms of mania were not what Breggin and the defendant testified to.  


They said he was in an unconscious state of delirium.  That is not and has never been alleged to be a symptom of mania at all.  And the degree of the planning and execution of the series of events involved in the rapes is entirely inconsistent with delirium, which is defined as a disturbance of consciousness - reduced clarity of awareness of the environment with reduced ability to focus, sustain or shift attention - and is usually caused by metabolic abnormalities due to a medical condition or to an overdose of certain drugs, Zoloft not being one of those drugs.  


The actions of the defendant seemed  pretty focused to me! In fact, it sounded as if he were mentally quite sharp even though he had mixed the Zoloft with a lot of alcohol. (Being drunk is not at all the same as being delirious).


And then there was this from the defendant:

Within days, he said, he was overwhelmed, hearing voices at night, contemplating suicide and fantasizing about killing his wife and dog.

Sounds more like depression to me, not mania.  Perhaps a “mixed state,” but those are fairly rare.

And the kicker: the prosecutor questioned the defendant about parallels between his testimony and similar accounts in a magazine and book by a well-known critic of psychotropic drugs.  Orban acknowledged reading both works, but denied they had influenced his testimony.  Oh, and the critic who authored the book?  Breggin!


And now to the issue of antidepressant-induced mania. Apparently no one else testified that the detective had any history of having the disorder.  If he were bipolar and Zoloft was going to make him switch into mania, it would have most likely already happened when he was first taking the drug – not when he resumed it after a short break.  Resuming a “full dose” may lead to other side effects, but not that one.  As far as I know, the ability of antidepressants to kick someone into a manic state is not dose-related.

Besides, very few patients in a manic state become violent rapists. 

And patients in a manic state still can still tell right from wrong unless they are out-of-their-mind psychotic.  There was apparently no evidence he was delusional.  (If there is, then I might have to take back some of what I am saying about this case, and, if it turns out that the detective had a grandiose delusion that raping the woman would somehow save the world from an alien invasion, owe Dr. Breggin an apology).


As to the rape being "counter to a life spent protecting community and country?"  As we all know, soldiers in Iraq and police are never guilty of violent behavior.  Before he died, you could have asked Rodney King.  And I suppose we know for a fact that this was not just the first time he got caught.

What this is, barring further revelations about the defendant’s history of mental illness, is a variation of “The devil made me do it.”  Or perhaps a version of assassin Dan White’s defense in the case of his murder of two San Francisco politicians, “He did it because he was depressed, as evidenced by the fact that he was pigging out on a lot of Twinkies.”

Dan White assassinated  San Francisco Mayor George Moscone and  Supervisor (and gay hero) Harvey Milk on November 27, 1978, and was sentenced to only seven years

Apparently, the jurors also thought it was a stupid defense:

A jury of eight women and four men deliberated less than a day before dismissing that defense and finding Orban guilty of kidnapping, two counts of rape, two counts of forced oral copulation, two counts of sexual penetration with a foreign object and one count of making a criminal threat.

Orban is now facing a sanity hearing to determine whether he knew the difference between right and wrong at the time of the attack. He almost certainly faces a life prison sentence if the jury determines he was sane. If declared insane, he would be sent to a state mental institution for treatment, and later could be released. The same jurors have been impaneled for the sanity proceeding.

"What it comes down to is whether, at the time of this incident, he understood the difference between right and wrong," Orban's attorney, James Blatt of Los Angeles, said outside the courtroom. "I believe [the jury] will keep an open mind in reference to the sanity phase."


Addendum (6/27/12): The jury rejected the insanity defense, although some prosecutors apparently did blame the alcohol (rather than the Zolfot) for his "mental fog."  That's nonsense, too, considering the intricacies of his actions during the attack.  Looks like he had a lot of tolerance to the booze.

Nothing Other than Stupid (NOS): Is Being a Rapist a Mental Disorder?

This post relates to two seemingly unrelated topics that were subjects of previous posts.  First, in my post of July 24, 2010, Counting Symptoms that Don't Count, I mentioned the improper use of the "NOS" category of psychiatric disorders in the DSM, psychiatry's diagnostic manual.  NOS stand for not otherwise specified.   This designation is used for patients who just barely miss DSM criteria for a particular disorder, like someone having manic symptoms for six rather than the required seven days, but who are suffering distress and/or dysfunction from their symptoms similar to that from the real thing.  It is not supposed to be used for people who just sorta kinda somewhat resemble people with the disorder on some dimension or other.

Second, in my post of November 3, 2010, Psychiatry Bashing, I kvetched about how pressure from the public is one of the major factors that has led to the misuse of psychiatric drugs and diagnoses by psychiatrists.

Now, one of the things the public is often somewhat hysterical about, and justifiably so, is the release of violent sexual offenders such as serial rapists after they have served their prison sentences.  However, as pointed out by Allen Frances in an article in the September 2010 issue of Psychiatric Times, the length of prison sentences for these felons is partially a product of the public's own misguided pressure on politicians. 

In their zeal to deal with judges who were perceived as "soft on crime," large segments of the public demanded fixed sentences for various crimes, rather than allowing the judge any discretion in the matter.  This actually led in some cases to sentences for those who were termed Sexually Violent Predators (SVPs) that were much shorter than they would have been had judges been allowed to use discretionary sentencing. (This problem has lately been correcting itself, but those sentenced under the old guidelines still have to be released).

What to do?  Well, according to Dr. Frances, twenty states and the federal government have passed laws allowing continued incarceration of SVP's, often for life, in psychiatric settings.  This is, in effect, preventive detention, which is generally considered a violation of due process and unconstitutional in legal circles.  Nonetheless, the Supreme Court has ruled that SVP statutes are constitutional on three different occasions.  In order for SVP's to be subject to preventive detention, however, the court ruled that their dangerousness must be the result of a "mental disorder."  Trouble is, they refused to exactly define what qualifies as a "mental disorder."

This has led to extreme pressure on forensic psychiatrists to invent specious diagnoses in order to protect the public from serial rapists and other SVP's.  One way to do that is through the use of the "NOS" category.  The DSM lists several sexual perversions (paraphilias), such as exhibitionism or fetishism, as mental disorders.  The  definition of a paraphila is recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or  children or other nonconsenting persons.

By the general definition of a paraphilia, it would seem that a serial rapist would qualify, since rape involves non-consenting persons as well as the suffering and humiliation of the victim.  However, rape is not listed in the DSM as a mental disorder.  Most people correctly think of it merely as a crime.  So under pressure forensic psychiatrists came up with paraphilia NOS, nonconsent. This seems to me to be just a made up diagnosis used to deny criminals due process.  It sure is not in the DSM.  (Then again, why is having a foot fetish a mental disorder?  That is in there).

Psychiatry bashers would undoubtedly have the opinion that forensic psychiatrists are, once again, acting like Nazis.  This opinion does not take into account at least two essential considerations: forensic psychiatrists are under tremendous pressure from all sides to protect the public from SVP's (and who would want to be responsible for unleashing one?), and for a variety of reasons the public is loathe to make rape (or even pedophilia, for that matter), a crime punishable by life imprisonment.

If you were forced into a choice between setting a SVP loose on women everywhere, or making up a diagnosis, what would you do?  Readers?

Psychiatry Bashing

Anyone who follows this blog or who has read my new book is well aware that I am highly critical of many of my colleagues in the mental health professions. Drugs are prescribed inappropriately and dangerously, diagnoses are made cavalierly and without considering all the evidence, relationship problems and family dysfunction are ignored, and some therapists think that an unresoved Oedipus Complex is the final common pathway for all mental and behavioral problems, or that food pellets and electric shocks are more important than relationships in shaping human behavior.

Furthermore, I have written about how many so-called psychiatric "experts" are in bed with the pharmaceutical companies and how managed care insurance has done its best to devalue all psychiatric treatments.

My own brother-in-law stated, after he read my book, that on the basis of what I had written he would be reluctant to consult any mental health provider.

Nonetheless, I know that there are a lot of ethical and competent psychopharmacologists and psychotherapists doing fine work out there.  They have just become a bit harder to find.  In my book I tell the reader what to look for when they first visit a new clinician.

Folks, there is more than enough blame to go around for the current troublesome trends in the mental health field.  Another party also worthy of blame is the American public.  In fact, none of the horrible practices in mental health could have taken root without the American public's enthusiastic support and participation.

Consider the following: a lot of people these days seem to be looking for a quick cure for everything. For all the anti-drug hysteria in this country, people want to be medicated for everything. Do the hard work of therapy on your relationships? It's too much work!

Distracted at home or at work?  Taken an Adderal.  Doctors will hand them out like water.

As one psychiatry blogger, FunPsych, pointed out, "...many Americans, if given a choice between exercising for an hour a week versus taking a weight-loss pill, would choose the pill...Furthermore, Americans are already overworked and feel pressured to work even more. At least half the patients that I've seen that I want to do therapy with just don't have time for it."  Or so they say. 

Kids out of control? Do most parents want to look at their own parenting practices to see if they are contributing to their children's behavior problems? Some may write to get free advice from the Supernanny and get on TV, but I've already placed several posts about the answer to this question.  Rampant child abuse and neglect?  Nothing but implanted memories and false accusations, according to many.

A psychiatrist who wants to do the right thing can go bankrupt.  If a resident fresh out of training is looking for a job, he or she will find this situation as described by another psychiatry blogger, Pacificpsych: 

"Show me one [psychiatry] job in the entire US ... that entails psychiatrists doing therapy. The entire system consists of psychiatrists being forced to medicate, as well as them being controlled by insurance, UR people, nurse admin, non nurse admin...Show me the clinics or hospitals where you can get a job doing anything else but medicating patients." 

Rehabilitation for schizophrenic patients instead of just meds?  The public will not pay for it, and therefore it has become nearly non-existant in the public sector, and almost as rare privately.

Mental health is the first thing that is cut when state finances get tight?   Why?  I'll tell you why.  Because the mentally ill do not vote, and most of the public does not give a sh*t.  Because many politicians seem to think the mentally ill are all slackers, agreeing with the rabid antipsychiatry zealots (more on them shortly) that all mental illness is a myth. (How ironic that Ronald Reagan suffered from a mental illness - Alzheimer's disease - for the last part of his life).

And then we have the antipsychiatry lot who seem to be incapable of making any distinctions at all. All psychiatric drugs damage people and do nothing else, according to these people.

Apparently they believe there is some vast worldwide conspiracy to ignore the supposed horrific dangers of, say, antidepressants (which have been in use since the 1950's), and that the FDA as well as legitimate FDA watchdog groups like Public Citizen (not to be confused with Scientology's Citizens Commission on Human Rights) have somehow completely missed the millions and millions of patients around the world who have been destroyed by these widely-used and popular drugs.

But we know the FDA is completely in the hip pocket of the pharmaceutical companies.  (Of course, the FDA put a "black box" label on antidepressants on the basis of rather minimal evidence warning of potential suicidal ideation caused in teens and children.  How did that ever happen?)

I received a few comments on one of my blog posts by one reader that I decided not to post. I'd like to share some of them here: 

"Psychiatry is an evil profession, and you know it...Psychiatry has changed very little since 1938, when it was the training ground for the SS - exterminating up to 100,000 German citizens who were deemed "mentally ill" with 'special treatment'...Is psychiatry an evil profession? Absolutely...

I looked [at your blog]. What I found was the writing of a guy who wants to be different from his peers, but isn't. You have very little respect for people who suffer. One minute, describing how their condition is related to past trauma, the next minute ridiculing their behavior. You wrote the book on personality disorders, it appears. Yet your own personality is about as twisted as any person I've ever read...You seem to be a very miserable person, an abusive person...Your arrogance leaves me nauseated...You are an abuser, and YOU KNOW IT !!!!!!!!!!!!!!!!!!!!!!!!!!!!!"

Let's see. If I use a little snarky humor or exaggeration in a blog in order to make a point and to entertain readers (guilty as charged!), then of course I surely must consistently and abusively ridicule my own patients. I suppose I should never see any black humor in my patients' horrible predicaments; if I had any empathy at all I would be depressed along with them. (That's what patients really need: a doctor who is as depressed as they are).

This guy says I am a knowing participant in an evil profession. Psychiatrists like me who have committed people who are a danger to themselves or others are no better than the Nazi psychiatrists who helped exterminate the mentally ill during WWII.  Yes, I know all about Ernst Rudin and the eugenics movement - you will find an interesting discussion of it in Chapter One of my new book.   I guess that makes me a Nazi. There will undoubtedly be a picture of me with a Hitler mustache on some placard someday.

He accuses me of all these horrible things and yet he tells me I am abusive? That's rich! Pot, meet kettle.

Are patients who are terrified by persecutory delusions and hallucinations and who are found running nude on the freeway by the police better off in jail, where many of them in fact are now, or on Skid Row, than in a hospital? 

Pacificpsych also said, "...even psychiatrists who are completely opposed to the current system have no power to change it. They are trapped, unless they are in private practice and doing well there. YOU, yes YOU need to help us. Go to the administrator of the clinic, call the health insurance/medicare/medicaid administrator, call your senator and congressman. Demand that you get proper treatment. That means spending as much time with your psychiatrist as you and your psychiatrist feel is necessary..."