Mental Disorders and Religious Sentiment...

[stamenflicker]

FireGarden,

Thanks for that link, it was awesome.

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

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

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

 

[Dancing David]

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

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

 

[Dancing David]

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

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

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

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

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

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

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

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

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

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

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



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

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

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

I shall dub thee , Ostrichflicker.

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

So how many nueroscience classes have you taken?

Zero?

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

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

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

Excuuuuse me, lets see the source for that statistic, I call you out. BOGUS, where did you get that one?

That number is staggering. I believe in the future, if afforded such an opportunity, we will look back in disgust, not unlike looking back at the leeches used 1,000 years ago. We'll see over-medication as a form of human slavery.

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

 

[Dancing David]

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

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

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

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

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

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

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

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

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

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

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

 

[Dancing David]

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





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






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

Gods bless the house keepers, ook.

 

[Dancing David]

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

I will take my issues else where.

 

[blutoski]

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

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

Yeah, you showed me.

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

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

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

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

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

I said:

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

You tell me?

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

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

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

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

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

Not surprising given the subject matter.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I wrote:

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

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

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

I wrote:

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

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

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

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

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

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

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

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

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

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

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

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

A fantasy.

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

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

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

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

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

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

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

 

[blutoski]

Apologies if this has been addressed before,

"On being sane in insane places"

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

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

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

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

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

 

[blutoski]

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

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

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

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

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

 

[Avita]

Rosenhan did important work in helping us look at inadequacies of mental hospitals, but his study is flawed in many ways. For a good look at this and two other similar studies, see the article "Diagnoses and the Behaviors They Denote: A Critical Evaluation of the Labeling Theory of Mental Illness." It's a long article, but well-worth reading to anyone interested in this issue. For those with minimal time, I will summarize its criticism of Rosenhan. One is that he cherry-picked his data to support the conclusions he wanted to reach. Another is that he exaggerated the significance of what he found. For instance, the famous "patient engages in writing behavior" note. The nurse simply put that down on the patient's chart, without any evidence that it was attached to a negative judgment of the patient. Since the most notable aspect of these pseudopatients' behavior was that they wrote a lot, what else should she have done, but note it for future reference? But most importantly, the author notes that the diagnosis of "schizophrenia in remission" was quite rarely employed at the time, though it describes someone who initially presents with schizophrenic symptoms, then doesn't show any. Given that:

Perhaps the greatest difficulty in accepting Rosenhan’s conclusions stems from the pseudopatients’ discharge diagnoses. Eleven pseudopatients were diagnosed with “schizophrenia, in remission” and one with “manic depression, in remission.” Spitzer (1976) gathered data that suggest these classifications were used extremely rarely in psychiatric hospitals. The impressive agreement that Rosenhan reports across diagnosticians working in widely varying settings and evaluating a number of different pseudopatients contradicts the assertion that diagnoses are unreliable. Moreover, near-perfect agreement on such an unusual diagnosis proves just how attentive professionals were to these individuals’ behaviors. Initial diagnoses of psychosis appear not to have significantly influenced perceptions, for in every case the staff correctly observed the absence of signs or symptoms of psychopathology at discharge. Thus, Rosenhan’s own observations suggest that important clinical decisions were based more on pseudopatients’ behaviors than their diagnoses. The shaky foundations of Rosenhan’s case should give one pause in drawing upon it as support for allegations that diagnostic judgments are made unreliably or that labels are, on balance, more harmful than helpful.

Thus, it wasn't just the other patients that noted the anomaly. The clinicians did as well. They did their jobs.


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

 

[stamenflicker]

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

Yeah, you showed me.

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

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

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

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

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

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

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

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

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

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

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

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

She is.

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

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

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

Thats really too bad.

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

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

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

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

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

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

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

My questions are philosophical.

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

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

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

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

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

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

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

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

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

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

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

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

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

My impression is that psychiatry is much more scientific than psychology

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

 

[blutoski]

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

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

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

Other reasons we attribute physical origins to mood disorders:

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

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

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

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

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

I don't get it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

blutoski:

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

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

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

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

blutoski:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Defendant: ?!



edit: typo.

 

[blutoski]

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

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

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

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

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

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

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

 

[stamenflicker]

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

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

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

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

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

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

 

[Elaedith]

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

 

[Dancing David]

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

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

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

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

 

[FireGarden]

Hi, Flick

As far as the criticism of the study goes, its absurd. Because anyone throwing up blood is going to most likely get a scope once the vomitting stops.

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

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

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

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

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

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

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

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

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

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

Avita's link also agrees with my text.

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

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

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

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


Avita

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

That's an acceptable point.

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

Another very good point.

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

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

 

[stamenflicker]

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

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

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

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

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

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

I don't get it.

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

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

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

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

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

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

So then disorders are determined by popular vote?

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

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

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

I didn't see the person's post.

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

So you are basically chosing one label over another?

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

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

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

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

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

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

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

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

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

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

These are my questions.

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

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

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

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

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

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

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

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

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

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

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

Defendant: ?!

Sorry you see it that way.

 

[hammegk]

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

[derail] What a silly statement. An immaterialist recognizes that perceived-as-physical structures are necessary for what we consider life, up to and including HPC, human/animal mental states, etc.[/derail]


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

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

 

[stamenflicker]

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

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

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

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

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

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

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

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

I'll look up the ADHD numbers.

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

Hope that helps.