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Biopsychiatry Illuminated

THE CANDLELIGHT PROJECT
by Bob Collier

1 December 2003
Issue 70

Pseudo-Science Among Us
by Dean Blehert

Part 2

DSM Science:

The psychiatrists do not seek causes for the disorders they define. That is, some assert one cause or another ("trauma", "the unconscious", "chemical imbalance in the brain", bad nerves, bad brains, bad parents, nasty church, guilt, poverty, etc.), but seldom attempt to perform scientific studies to prove such theories and more often ignore actual evidence of testable causes. For example, there is solid evidence that many so-called "mental" conditions are caused by long-understood medical illnesses and real physical pain, but most psychiatrists do not test for such conditions. They simply medicate to suppress the symptoms.

The head of the APA testified before Congress a few years ago that psychiatry doesn't understand the causes of mental illness and cannot cure it. What, then, is psychiatry trying to do? Well, let's not guess at motives yet. Let's look at the procedure itself: First, they define a disorder. "Clinical depression" means, essentially, that you're feeling very sad for weeks, have difficulty sleeping, etc. In other words, you act and feel like someone who has suffered a great loss or done things of which you're deeply ashamed or have recently been reminded of your childhood ideals and realized how far you are from having any hope of attaining them, or you're physically exhausted because you can't sleep well because of a mineral deficiency, or you've been in pain for years from an old injury, or you live with someone who makes your life hell (etc.). ADHD (Attention Deficit Hyperactive Disorder) means that you're active, your attention shifts rapidly enough to upset teachers who want you to concentrate on what they are saying, etc. In other words, you act like someone who is refusing to be bored stiff. Or you have a teacher who can't tolerate motion in her environment.

What is gained by creating these definitions and labels? We've always known that some kids seem over-active, that some people are more melancholy than others -- always or at times. What do the new definitions add? One incredibly perverse answer (from "mental health advocates") is that they "destigmatize" these conditions. The idea is that there's some stigma (shame, reproach, guilt) attached to these conditions, and that labeling them as mental illnesses removes the stigma. This is, of course, nonsense. There is stigma attached to being mentally ill because the words "mentally ill" or "insane" or "nuts" are often applied to people who behave weirdly and anti-socially, often in sensational ways. Similarly, there is stigma attached to crimes (like murder, rape, masturbating in public or mugging people at knife-point) because we don't want people to act that way and feel we can't understand people who do.

Perhaps some people are wrongly stigmatized -- called nuts because they are mildly eccentric or because a husband wants to get his inconvenient wife institutionalized so that he can misappropriate her wealth and live with his mistress. But in general, the mentally ill are stigmatized (made to feel bad about being mentally ill) just as children who misbehave are made to feel bad about misbehaving -- because we consider they haven't behaved very well, and we want them to behave better. The argument now is that they are simply ill, so shouldn't be blamed for their actions. (And this argument is made on behalf of murderers, too.) Perhaps blame is non-productive, but the argument that they are simply ill is based on the notion that any set of symptoms that psychiatrists elect to call an illness is an illness.

In any case, the effect of psychiatry's creating the new labels is not to destigmatize these conditions, but to stigmatize them. Children who used to be referred to as a little hard to handle or as "real boys" or as "spirited" or at worst as "brats" or "disciplinary problems" -- and at worst, these were adult admonishments that did nothing to lessen the admiration these "brats" often received from their friends, who considered them bold -- such children are now said to suffer from a mental illness with a big name (ADHD for short) and to require continual medication. THAT stigmatizes their condition. The real agenda here is not to destigmatize depression, anxiety, etc., but to destigmatize mental illness so as more readily to include all of us under its umbrella: don't feel that there's any stigma attached to being mentally ill, because we're all mentally ill, and we all need our psychiatric labeling, counseling and medication.

The result is, we are ALL stigmatized: we are all told that we are victims of conditions and can't help ourselves, that we all need "intervention". We are told that we are less than we thought we were in the days when we considered ourselves to be somewhat responsible for our own conditions and able to change them by our own decisions and self- discipline.

Those we don't understand and think to be less than human, we treat badly. As soon as a father is told his son has a disorder, his gut reaction is to withdraw responsibility, consider his son something that can't be understood, something with a scientific-sounding label, something for psychiatrists to handle, something to be drugged and controlled. Not that the father didn't love his son, but that his son vanishes behind the label with its cloud of pretended understanding. His son becomes a disorder. When we are all persuaded that we have and are our "disorders", we will, similarly, back away from ourselves, from our sense of being responsible for ourselves. The fact that we will consider that we are ALL mentally ill will not lessen the stigmatization, because we will still have become something that we cannot understand and that is less than what we are.

But this can be said more simply: "Hey, kid, you're not just an active kid. You suffer from a mental illness called Attention Deficit Hyperactive Disorder and need immediate treatment, which you are ordered to begin tomorrow morning by reporting to the school nurse for your drug.... Now, aren't you glad we've relieved you of the stigma of being an overly active kid by telling you that you can't help yourself because you're mentally ill and have a defective brain with a chemical imbalance?" Don't feel bad about being energetic enough to bother your teacher. You're just nuts.

If destigmatization isn't the reason for the new labels, what is? Do the new definitions point to a cause? Doubtful. For example, studies of kids diagnosed ADHD (and these studies were real science) found that in some cases the symptoms vanished when nutritional deficiencies were remedied (for example, too much sugar and fast food). In other cases symptoms vanished when situations at home or school (family breaking up, torment by bullies, etc.) were handled. The kid had had his attention dispersed by chaos in his life outside the class room.

In other words, "ADHD" is actually a variety of conditions with a variety of causes and handlings. In other words, there is no such thing as ADHD.

Did I just skip a logical step? The DSM lists a condition (a single condition) and calls it ADHD. In fact (and the scientific evidence for this is overwhelming), there are a variety of conditions that manifest the symptoms supposed to indicate ADHD. They have different causes and different remedies. Therefore, there is no one condition with the symptoms assigned to ADHD. There are MANY conditions that have those symptoms.

Another way of saying it is that ADHD is a confusing and counter-productive label, because it implies that anyone with the ADHD symptoms suffers from a particular condition called ADHD. This might be easier to see if, instead of using obscure technical jargon (ADHD), we use an example from outside psychology: There are a set of symptoms that indicate a diagnosis of tuberculosis. These are reliable and include various tests. These tests rely on the doctor's (or lab's) basic competence, not on any great subtlety or art or depth of judgment on their part. Anyone with minimal training can learn these tests and symptoms and accurately diagnose tuberculosis. Tuberculosis is a useful classification that has led to successful treatments. Doctors can show you the microbes associated with tuberculosis and can show you that medications that destroy those microbes improve the condition of the patient.

This is no absolute. For example, further study may lead to a greater understanding of what makes some patients fall prey to these microbes and not others. One can always achieve greater understanding of causes and better handlings. But tuberculosis makes sense as a medical category. It leads to a cause and a handling.

But what about tiredness? Tiredness is a condition. It can be described in detail -- yawning, heavy-headedness, dryness around the eyes, irritability, low energy, wanting to lie down, etc. But is tiredness a useful medical category like tuberculosis? Is tiredness a disease, a condition to be cured. Or is tiredness simply a symptom of a variety of conditions? You can be tired because you didn't have enough sleep, because you've had too much sugar or are lacking some vitamin or have a low-grade fever or were just told by your best friend that you're a jerk, or you keep trying to achieve something you've already achieved, or you have a dozen things started and can't seem to get any of them finished because other things keep coming up -- and so on. If you're tired because you have many things started and aren't getting any of them finished, you will feel less tired if you simply buckle down and take up one of the projects and finish it. If you're tired because you're short of sleep, you'll feel better if you get some sleep. And so on.

Thus, it would be worse than useless to announce as a new illness "Tiredness disorder", whose symptoms are the symptoms of tiredness. It wouldn't make it more useful to hedge by saying you mean only a LOT of tiredness over a long time. It would still imply that tiredness is a single condition with a single cause and cure. Even long-term tiredness can be a symptom of many different situations.

But of course there IS a single cure for all tiredness (many such cures). For example, anyone who is tired will perk up if they snort cocaine or other strong stimulants. A tired person will typically feel more energetic if you fire a gun at him and just miss him or confront him with a snarling tiger -- such things stir up the adrenalin. So, yes, you can "cure" tiredness -- that is, suppress with a single solution the symptom of some underlying condition, without knowing what that condition is.

What's wrong with such cures? You haven't found out why the person is tired and handled that situation. You haven't given him more sleep, missing vitamins, a more disciplined approach to unfinished tasks, an awareness that someone in his environment is putting him down, etc.

But why bother with all these things if a snort of cocaine handles the unpleasant tiredness? Because when he comes down from the cocaine (or other such "cure"), he will feel worse than ever and find it harder than ever to handle the real situation -- harder to sleep, for example, or to concentrate on tasks. So he must either continue to take cocaine (more and more of it) or to get into tiger cages. And both are dangerous.

Unlike tuberculosis, ADHD is not a condition with a single known cause or related group of causes. It's more like tiredness (or shall we say EDHD -- Energy Deficiency Hyperwakeful Disorder?), a group of symptoms associated with many different conditions. It too has many "cures", but no one cure. That is, there are many things that suppress the symptoms, but they don't handle the underlying situation. For example, ADHD can be handled in every case by giving the patient knockout drops or ether or any overwhelming narcotizing drug. It's not hard to make someone quiet. In this case, the usual drug prescribed is Ritalin, which is similar in action to cocaine. It is an upper or stimulant, a form of speed.

Psychiatrists often say they don't know why a drug used by adults as an energizer should have the opposite effect on children, but ANY drug in small quantities tends to stimulate, in larger quantities becomes narcotic (eventually puts you to sleep) and in still larger quantities kills you (and often over time will accumulate in the system and destroy organ function and kill, with the death attributed to something else). One or two coffees energize, several more make you tired. A dose of a stimulant (like Ritalin) small enough to energize an adult is large enough, in a child's system, to narcotize -- or make an active child sit still in school. Not so oddly -- in view of the fact that any narcotizing drug is also, potentially, a stimulant - one of it's listed "side effects" is that in some cases it has the opposite effect: it makes the active child far more active, anxious and generally crazy.

If the psychiatrists said that some kids are "antsy", we would say, "Well, duh!", and recognize that we were being given a symptom, not a condition. But they call it "Attention Deficit Hyperactive Disorder", to which we can only nod, in awe of the expertise such language implies. Aha! We now understand those troublesome kids! They have a CONDITION, a DISORDER, a DYSFUNCTION, a MENTAL ILLNESS. Oh, be careful, say the conscientious psychiatrists. We mustn't assume that ANY active child is ADHD. Some are only "borderline ADHD" -- they only have a little bit of the ADHD gene or germ or chemical imbalance. And to this we bow deeper before all this obvious scientific objectivity - scholarly qualifications! But in effect such warnings tell us that there is such a condition, and that it's all based on SCIENCE. Obviously scientists must have detected a real, treatable condition to be able to say someone is only borderline ADHD. (It wouldn't sound as impressive to say that some kids are very antsy and others only a little antsy.)

Now that we know the condition exists, we are more likely to welcome a claimed CURE. The psychiatrists announce that anxiety is a disease, and the pharmaceutical companies unveil TV and radio and magazine commercials for new anti- anxiety drugs. The psychiatrists announce that ADHD is a disease "like any other disease", and the pharmaceutical companies launch campaigns to educate doctors and teachers and to get their anti-ADHD drugs into school systems, insurance programs, federal programs, etc. And accuse those who oppose them of trying to stigmatize the suffering ADHD kids and thus prevent them from seeking the help they so desperately need.

If there were no DSM, no "scientific" condition called ADHD, and one day the drug companies started promoting drugs to make your children less antsy (drugs labeled dangerous by the Drug Enforcement Agency -- as Ritalin is labeled), most of us would be rather suspicious. Why should we give healthy active kids a dangerous drug? But once our children have been labeled as suffering from a tragic mental illness (ADHD), how can we deny them help? We could, of course, look for the causes of our child's antsiness, but why spend a lot of time on that when we know that the child suffers from a mental illness and that a simple cure (a medication) is available, paid for by insurance and federal money given the school for each "disabled" student.

The very fact that a drug is available that (it is claimed) cures ADHD and makes students brighter discourages looking for other causes and handlings. If your child has pneumonia, you put him in the hospital. You don't delay to look for nutritional or other causes. If your child has type one diabetes, you put him on insulin. It's a disease, it has a cure (or at least a means to stay alive), and that's all there is to that. Your child has ADHD, which is a disease just like any other disease (e.g., type one diabetes) -- or so all the media and school officials and counselors claim. It's a disease and has a cure (so say the drug ads, the doctors, the media). How can you waste time hunting for solutions when the cure is known and available?

Of course, "dangerous drug" is controversial, because many psychiatrists, psychologists, doctors and teachers (particularly those pushing the drug -- excuse me, prescribing or recommending the drug) claim it is harmless. Years ago psychiatrists (in published articles) claimed that LSD was a harmless and therapeutic drug. They said the same of angel dust. Earlier they prescribed heroin. They denied for years -- and only recently admitted -- that thorazine (the main anti-psychotic drug) was causing a chronic illness that gave mental patients grotesque muscular spasms. Many of them still deny the harmful effects of electro-convulsive "therapy" (shock therapy).

But dangerous or not, Ritalin is a multi-billion dollar product being given to millions of American school children (latest estimates range from 4 to 6 million) who are expected to take the drug for years. And it is being prescribed to handle a condition that doesn't exist, ADHD. Yes, some students are antsy. Yes, in many cases Ritalin makes them sit still (among other things). But no, there is no scientific basis for calling ADHD a mental illness.

This is a very simple distinction: The scientific basis for calling tuberculosis a disease does not exist for ADHD. There is no valid scientific evidence for ADHD. There is no objective test that says a child has ADHD. There is no evidence of any single cause for the symptoms called ADHD. There is no evidence that an antsy child has an illness of any sort, except if you simply assert that any antsy child is crazy and craziness is an illness (a rather circular argument). The valid science in the area of ADHD is that psychiatrists have described (but not very well) a set of symptoms that fit some children (and, unfortunately, can be made to fit nearly any alert child). And they've noted that certain drugs suppress those symptoms. In layman's language (as they say in court), psychiatrists have noticed that some children are antsy in school and that if you drug them with certain drugs, they are usually less antsy. That's all of the science here. The rest is scientism, big words, untested assertions, bullying and lobbying by authorities and big business, and great care to avoid looking at the negative effects of drugging these children.

The same is true for all or most of the many disorders listed in the DSM. They are lists of symptoms given heavy names and voted into the book, as if there were some scientific basis for considering them to be illnesses.

You might argue, it is unfair to compare a mental illness with a physical illness or to expect objective tests (e.g., the view of a germ through a microscope) for conditions that aren't physical. After all, if a condition is unwanted, isn't it fair to call it an illness?

The question is, what is the scientific basis for the illness. The value to psychiatry of the DSM is that psychiatrists are asserting (and state publicly -- most days on National Public Radio, for example) that the conditions listed in the DSM are diseases just like any medical diseases and should be treated the same way (mainly with medication) and, like any medical diseases, have physical causes (chemical imbalances in the brain). The whole history of psychiatry in the past two centuries has been in the direction of taking a non-science that was rife with superstition and arbitrary treatments, really a way to control difficult people in institutions, with little real treatment; and giving that non-science the aura and authority of science. This has been done by associating it with medicine (itself a mishmash of superstition and science, but having SOME claims to scientific credibility) and, more recently, biochemistry, genetics and other advancing fields.

So yes, if you wish, call "tiredness" or "antsiness" a mental illness. I don't agree, but that shouldn't stop you. And when I say, "but on what basis do you call them an illness? What is the cause? What is the cure?" -- you have all the right in the world to say, "these are MENTAL illnesses, and needn't be associated with some sort of cause like a germ or a toxin." But don't then fill the media with pronouncements that "tiredness and antsiness are just diseases like tuberculosis, diabetes or cancer and as easily treated and no more to be stigmatized." Don't, in other words, say that you don't NEED a scientific basis to claim the existence of a mental illness, then demand that mental illnesses be given the same sort of scientific validity as medical diseases that DO have a scientific basis. You can't have it both ways. Or perhaps you can. The psychiatrists and the drug companies are doing quite well at it.

Of course, psychiatrists will occasionally caution that drugs should be used only after "other means" have been tried, by which, if pressed, they explain they mean counseling by a psychiatrist or psychologist. But in practice, busy teachers and school administrators and doctors and insurance companies go for the quick fix and prescribe drugs. And it should be noted that psychiatrists and psychologists HAVE no effective, proven approach to counseling. In fact, it is the failure of the many and various forms of counseling (psycho-analysis, behavioral, etc.) that led us to the new chemical solutions. None of them have scientific validation. None of them ever produced better results than talking to a friend. Various studies of a wide variety of psychiatric and psychological and psycho- analytic patients and non-patients have shown that success rates of all of the therapies are about the same and are slightly LESS than the success rates among people with similar woes who choose not to enter counseling.

So what psychiatrists are saying is, if you have ADHD, before getting yourself drugged, you should try some expensive counseling known to be ineffective in most cases. Not a very useful alternative.

I'm not saying that all counseling is ineffective. There are all sorts of useful approaches, but they are mostly unknown to psychiatrists and psychologists. For example, drug rehabilitation programs run by these trained experts produce, at best, about a 15% success rate -- people who, with effort and self-discipline, remain off drugs after graduating from the program. And these "successes" are often people whose treatment consists of their being addicted to a new drug (methadone) that is more addictive than heroin, its benefit being that its manifestations are less obvious. The big drawback is that methadone is such a downer, that many of the new methadone addicts look for other drugs as well. (The "little" drawback is that nothing has been done to reduce drug addiction.)

12-step programs developed outside psychiatry and psychology and run by addicts and alcoholics (e.g., Alcoholics Anonymous) do as well or better. Another sort of program altogether, Narconon, a worldwide drug rehabilitation program, including the world's largest rehabilitation center -- in Oklahoma -- uses NO psychiatrists or psychologists and none of their teachings, applying only technology developed by the leader of a religion. Its success rate ranges (from year to year) from 86 to 96%. In two independent studies, years ago, in Spain and Sweden, researchers studied hundreds of graduates and found that, two years after leaving the program (typically a 3-month program), 80% had not used drugs again -- and had NO DESIRE TO DO SO -- and 100% had not been back in jail (many previously had been in and out of jail). The Narconon program, thus validated, has, of course, been studied and emulated by psychiatric professionals -- NOT! They treat it as an embarrassment, try to get it discredited or ignore it.

I'm not trying to sell a drug rehabilitation program here, only to indicate that when psychiatrists say to try psychiatric counseling before resorting to an iffy drug, they are NOT saying, "Try other likely alternatives first." They don't KNOW the alternatives and don't want to know. Most of them, for example, know little about nutrition, a major factor in a child's ability to study. Most of them know nothing at all about study itself -- for example, that a student who, in reading or listening, goes past misunderstood words without stopping to clear up the meanings of those words will soon manifest most or all of the symptoms of ADHD listed in DSM IV, and that these symptoms will vanish when the misunderstood words are located and cleared up with a dictionary. (And this is something that has been subjected to exhaustive tests and found effective in tens of thousands of cases.)

So...there's no scientific basis for the DSM; its disorders, mostly, do not exist; and the medications offered to cure the conditions are fraudulent. Furthermore, it's arguable that many of these fearsome conditions are not bad conditions in the first place. ADHD is the perfect example. Einstein, Churchill and many other brilliant people were terrible students (probably bored to tears) and would, in our day, be classified as ADHD and drugged (with what loss to us?). We are told that kids with ADHD can't learn, and that we are drugging them to make them brighter and better students. But often it is the brightest, most eager students who are most troublesome, when bored by plodding classes. They want to get out and do something interesting. Left to themselves, perhaps they will. Drugged to sit still in class, probably they never will.

Furthermore, studies have shown that teachers use the ADHD classification to get troublesome students (e.g.,the ones who raise their hands, loudly begging, "Ask me! Please ask ME") quieted down -- actually nullified -- by drugs. And they do this without regard for the actual success of the student in his studies. Teachers asked to rate students on their abilities as students (in several studies), nearly always rated active, often troublesome students as stupider than the quiet ones, even where tests of the students showed the active students brighter. There are similar biases among parents: Some want their noisy active kids "fixed", and are likely to see anything that makes them sit still as good - and to ignore any negative side effects.

(This points to another difference between traditional medicine and psychiatry: Medical conditions are usually treated because the patient wants them treated. "Mental Disorders" are often conditions that someone else wants to change in the patient, even a form of punishment; and many treatments derive from the traditional psychiatric view of mental illness as a stubbornness to be driven out of the patient by electric shock, ice baths, beating and other forms of torture. It is perversely admirable that, in the past few decades, psychiatry has persuaded people to ASK to be nullified by their treatments -- with anti-depressants, etc. What an achievement!)

Copyright Dean Blehert

PART 3 OF 'PSEUDO-SCIENCE AMONG US' NEXT WEEK

Visit 'Words & Pictures', the website of Pam and Dean Blehert, artist and poet, at:
http://www.blehert.com/



 
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