Dissident Veteran For Peace

A large segment of the Left seems eager to advance the idea that Donald Trump is mentally unfit to be president of the US. I don't respect or admire Donald Trump, I never voted for him, and I never expected him (or Clinton) to be what I would consider a good or successful president.

However, I regard the public attacks on Trump's mental fitness as far more revealing of the depravity of some of his critics than of anything else. The public questioning of Trump's mental health by lay people and professionals who have never examined him in a clinical setting is little more than a scurrilous ad hominem attack in service of an unprincipled attempt to wield a tool of social control for for political purposes.

With respect to social control, people inclined to take seriously the ill-informed, politicized pronouncements of unethical mental health professionals that Trump is "mentally ill" may want to pause to reflect that it was not so long ago that these professions accepted surgical lobotomy and electroconvulsive "therapy" as common, if not routine, "treatments" for "mental illness". Despite a documented history of widespread and selective abuse they are far from rejected even today.

Psychiatry also gave us such enlightening concepts as "drapetomania"—the mysterious illness which caused slaves to try to escape their bondage. The wit who gave us that term was Samuel A. Cartwright, a physician who apprenticed with Benjamin Rush, the "father of American psychiatry". Then there's "The eugenic legacy in psychology and psychiatry". And don't forget that homosexuality was, according to the American Psychiatric Association (APA), also a mental illness until in 1973 (sort of) it wasn't. Finally, readers would do well to reflect on the weaponization of psychiatry in the Soviet Union and its correlates in the US.

Below are some thoughts of others who are concerned with the politicization of mental health by Trump opponents. The first excerpt is from Allen J. Frances who made his first appearance in this blog in 2013. I think Frances overstates the case against Trump and in so doing betrays his political bias nevertheless his main points are well-taken.

Fevered media speculation about Donald Trump's psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president ...

Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump's attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.

His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.

The second excerpt is from a defense in the Journal of the American Academy of Psychiatry and the Law by Redinger et al. last September of the APA's "Goldwater Rule".

... diagnosing public figures via observations culled from the media represents poor diagnostic methodology ... Public figures, especially politicians, intentionally cultivate a public persona that may not accurately reflect their psychological state. Given the risk and potential harm of error, it would be imprudent for any psychiatrist to render an opinion of a public figure's subjective thoughts or motivations, conscious or unconscious, in the absence of a personal and value-free diagnostic interview.

The APA's Goldwater Rule exemplifies a necessary and justifiable professional norm that is intended to temper the potentially imprudent and self-indulgent motivations of psychiatrists to use the cloak of their profession to further a particular political ideology and neutralizes a fallacious appeal to their own authority. Justifications based on freedom of speech, conscientious objection, or the public interest fail to offset the likely harms to the psychiatrist, profession, and public figure.

The final excerpt is by Sera Davidow from the web site of Robert Whitaker, author of the illuminating Mad in America. Davidow underscores the mental health professions as instruments of social control along with the inherent subjectivity of the whole concept of mental illness.

[Trump]'s not 'mentally ill,' because this whole manner of categorization of human beings is just that subjective.

In other words, Trump is not 'mentally ill' because he is not a member of any of society's groups for which tools of control (like our diagnostic system) are most specifically designed. His brand of dangerous is party to some other kind of measure. A different set of standards. And while this tells us something about Trump, it tells us much more about ourselves ...

We need to stop calling Trump 'mentally ill' because it suggests that emotional distress and trauma (and all the rest that often gets wrapped up in and confused with this idea of 'disorder') are somehow scarier and worse than what Trump is actually doing. It's a distraction of the worst kind from what we can actually see and know.

We need to stop calling him 'mentally ill' because it misdirects us away from holding ourselves accountable for his election and the societal ills that led us to this point. We're far better off learning from our mistakes, and figuring out a way to back off of this crumbling ledge.

And we need to stop calling Trump 'mentally ill' because such labels are routinely applied inequitably and in ways that have harmed so many, and this present maelstrom only further encourages that trend. Psychiatric labels tell us little to nothing about how to be with or support one another, and give almost no information about what's actually going on. This is true of both president and neighbor. Friend or lover. Child or parent. Human being.

It certainly tells us nothing about how to get us out of our current bind.

See also: "Friday Feedback: Questioning A Leader's Mental Health" on MedPage Today.

Labels: medicine, politics, psychology, Trump

Creative Maladjustment Week is July 7 - July 14. Here is a bit about the event from cmweek.org:

Philosophy and Principles

"There are some things in our world to which I'm proud to be maladjusted." ~ Martin Luther King, Jr.

Who are the Creatively Maladjusted?

• Critical thinkers: The creatively maladjusted focus on a problematic area of society (something to which people of good will simply can't be adjusted) with critical thought, examining the history of a bad idea, its branchings and consequences — the better to weed it out, roots and all.
• Architects of alternatives: Not merely content with tearing down an existing structure, the creatively maladjusted offer alternatives and are willing to demonstrate those alternatives with good cheer and positivity in public places. They believe that loving and loud public action is the foundation of a true non-violent revolution.
• Believers in humanity: Most importantly of all, the creatively maladjusted resist the pressure to dehumanize any and all of their fellow men. They believe in the inherent uniqueness and worth of every individual and demonstrate this belief in every action they take.

Creative maladjustment is a natural human response to oppression, an organic and highly adaptable way to oppose injustice.

What are they creatively maladjusted to?

The Creatively Maladjusted are active on a variety of important societal issues, including:

 • Racial equality • Religious tolerance • Economic fairness • Peace • Ecological sustainability and energy security • Individual liberty • Fighting psychiatric profiling and human rights abuses in the mental health system • Transparent and corruption-free government • Community and family values

The creatively maladjusted are incredibly diverse in the societal problems they aim to solve, but they are united in their opposition to the basis of all oppression: "man's inhumanity to man."

See also:

• "Martin Luther King on the International Association for the Advancement of Creative Maladjustment"
• Ambrose Bierce's definition of "mad"

Labels: critical thinking, culture, psychology

About 25 years ago I was a computer technical assistant at a large public university. I remember then being struck and puzzled by the cult-like loyalty of my boss and two of my co-workers to Apple and its products. The Macintosh GUI was superior to what Microsoft had on offer at the time but the devotion to Apple exceeded what such a difference could rationally command.

Having recently watched Alex Gibney's excellent documentary Steve Jobs: The Man in the Machine I now have much greater insight as to why so many Apple consumers have invested themselves into the products of a huge multinational profit-making entity. Steve Jobs and his PR team deliberately and deftly branded Apple as a countercultural corporation (an oxymoron, to be sure) and the siren call of this manipulative marketing (a redundacy, to be sure) seduced tens of millions and helped changed society for the worse.

Labels: culture, film & television, psychology, technology, video

Happy Misappropriation of a Christian Martyr's Death for the Crass Commercial Exploitation of a Basic Human Need Day!



See also:

• "Martyrdom of St. Valentine" on Christianity.com 
• "The Feast of St. Valentine, martyr" on HigherThings.org

Labels: capitalism, Christianity, psychology, religion

Not everybody is able to see me ... I'm real and most earthlings can bear very little reality.


The temptation ... is to stay an immature pleasure-seeker. When we seek our own pleasure as the ultimate good we place ourselves as the center of the universe ... nothing created is the center.


When everything is nothing there will be no more war, no illness, no death. There will be no more poverty, no more pain, no more slums, no more starvation ...

Labels: art and literature, Madeleine L'Engle, philosophy, psychology, quotations, religion

Labels: art and literature, film & television, psychology, video

Happy Misappropriation of a Christian Martyr's Death for the Crass Commercial Exploitation of a Basic Human Need Day!



See also:

• "Martyrdom of St. Valentine" on Christianity.com 
• "The Feast of St. Valentine, martyr" on HigherThings.org

Labels: capitalism, Christianity, psychology, religion

To be stupid, selfish, and have good health are three requirements for happiness, though if stupidity is lacking, all is lost.

Source: Gustave Flaubert. "Letter to Louise Colet." The Letters of Gustave Flaubert, 1830-1857, Vol. 1 (Harvard UP, 1980) p. 62.

Labels: psychology, quotations

"Here's the problem," Frances* said. "There is no definition of a mental disorder."

I mentioned that that hadn't stopped him from putting one into the DSM-IV^†, or the people who were then making the DSM-5 from fiddling with it.

"And it's bullshit," he said. "I mean you can't define it." [p. 23]

"the personality disorders are not at all clearly distinct from normal functioning or from each other," [p. 263; quoting Allen Frances; emphasis added]

What Insel^‡ heard "over and over again" on his tour [of "hospitals and universities around the country"] was that psychiatrists were tired of being trapped by the DSM. "we are so embedded in this structure," he told me. He and his colleagues had spent so much time diagnosing mental disorders that "we actually believe they are real. But there's no reality. These are just constructs. There's no reality to schizophrenia or depression." [p. 340]

"Whatever we've been doing for five decades," [Insel] told me, "it ain't working. And when I look at the numbers–the number of suicides, the number of disabilities, mortality data–it's abysmal, and it's not getting any better. All the ways in which we've approached these illnesses, and with a lot of people working very hard, the outcomes we've got to point to are pretty bleak–especially, he added, compared with the "extraordinary" progress in other fields, such as the 70 percent drop in mortality from cardiovascular disease since he went to medical school or the steep reductions in deaths from auto accidents and homicides. There are some people for whom some of what we do is enormously helpful," he said. But even so, "we don't know which treatments are working for which people." And this litany of failure, he said, "gets us back to your interest in nosology. Maybe we just need to rethink this whole approach." [pp. 351-352]

Source: Gary Greenberg. The Book of Woe: The DSM and the Unmaking of Psychiatry (Penguin, 2013).

Notes:
    *Allen J. Frances, MD is the former head of the Duke University School of Medicine's psychiatry department and was once referred to by The New York Times as "perhaps the most powerful psychiatrist in America." Frances served on the American Psychiatric Association's (APA) personality disorders work group for the 1980 DSM-III. He was chair of the APA task force responsible for the 1994 DSM-IV.
     ^†DSM is an abbreviation for the APA's Diagnostic and Statistical Manual of Mental Disorders.
     ^‡Thomas R. Insel, MD, is the Director of the National Institute of Mental Health.


See also:

• Gary Greenberg. "Inside the Battle to Define Mental Illness." Wired. 27 Dec. 2010.
• Gary Greenberg. "Not Diseases, but Categories of Suffering." The New York Times. 29 Jan. 2012.
• Gary Greenberg. "The Rats of N.I.M.H." The New Yorker. 16 May 2013.

Labels: medicine, psychology, quotations

On page 217 in his chapter on "Saddleback Church and the Montgomery Bus Boycott," Charles Duhigg explains in The Power of Habit:

A movement starts because of social habits of friendship and the strong ties between close acquaintances.

It grows because of the habits of a community, and the weak ties that hold neighborhoods and clans together.

And it endures because a movement's leaders give participants new habits that create a fresh sense of identity and ownership.

He refers to this as "a three-part process that historians and sociologists say shows up again and again".

Labels: history, psychology, quotations

A curious thing happened as I was listening to the radio Friday night. Two different shows, separated by only an hour, featured segments touching on the same general subject--what cognitive science tells us about honesty and depression.

First at 7 PM was Radiolab, replaying an episode called "Lying to Ourselves". It first aired in 2008 and featured psychologist Joanna Starek and the team of psychiatrists Harold Sackeim and Ruben Gur.  Below is a partial transcript from the last two minutes or so of the episode. 

Co-host Robert Krulwich: ... denying certain facts about the real world ... according to any number of new studies produces people who ... are better at business and better at working with teams. And now here's the real kicker: They turn out to be happier people ...

Sackeim: ... people who were happiest were the ones lying to themselves more ...

Krulwich: Time and time again, researchers have found that depressed people lie less.

Sackeim: They see all the pain in the world, how horrible people are with each other. And they tell you everything about themselves, what their weaknesses are, what terrible things they've done to other people. And the problem is, they're right. And so, maybe it's, the way we help people is to help them to be wrong.

Krulwich: It might just be that hiding ideas we know to be true, hiding those ideas from ourselves, is what we need to get by.

Sackeim: We're so vulnerable to being hurt that we're given the capacity to distort, as a gift.

Then, at 9 PM, a 2012 episode of To The Best of Our Knowledge came on. Entitled "You & Your Brain," the segment featured an interview by Senior Producer Anne Strainchamps with neuroscientist Julian Paul Keenan. Below is a partial transcript from the last three minutes or so of the interview.

Strainchamps: I just keep thinking that what you're saying is that much of our experience of life and of the world and even of ourselves is a lie.

Keenan: Yeah. And you can either be depressed about it or just go for the ride. A lot of this remains still to be confirmed and, uh, replicated, but a lot of the indications are that we are living in a deceptive world, at best, perhaps a false world in its most extreme.

Strainchamps: ... I'm trying to figure out what the consequences are of everything you've laid out. We have no free will, we're basically lying ourselves through life. What do you do with those insights? Should you just sit back and enjoy the dream or should we all be meditating very hard and trying to lose our sense of self?

Keenan: I, you know, I'm going to go with the former. I think a lot of self-deception goes a long way, that giving yourself positive affirmations in the mirror, whether you believe them or not, would probably be the route I would suggest taking. You know, surrounding yourself with people who, even though you know they're lying to you, as long as they're saying good things, that's probably a healthy way to go. The alternative scares me. We used to think people with clinical depression didn't see the world realistically, you know, they saw it in an overly negative light. Well, it turns out, they're seeing it quite realistically and it's you and I who were seeing it in an overly rosy light, we're the ones not in reality. So, the suggestion is that reality is a somewhat scary place to be.

Strainchamps: So the purpose of therapy is to learn to be better at lying.

Keenan: Absolutely. It clearly puts into question this idea of deception is morality, "Thou shalt not lie." Well, then thou shalt be depressed.

So, here's what I found striking, even disturbing, about both of these programs. No one--not the researchers, not the interviewers/hosts--ever raised the idea that the solution to the depression that realism and honesty bring to some people is not to train or encourage people to "distort" or "just go for the ride"--to engage in deception--but to work to figure out how make the world a less painful, a less  depressing place. Yes, of course, there will always be the pain of loss and death but to suggest that deception is the only desirable or viable solution for coping with "all the pain in the world" seems to me to evince a defeatism of the worst, saddest, and, ultimately, the most ethically bankrupt sort.

12 Feb 2013 Addendum: It is has been suggested to me by a friend and reader of this post that religion is a form of deception or dishonesty that people employ in order to avoid reality. I have two responses to this: First, yes, religion can be and has been used for deceptive and dishonest purposes but that is not inherent in religion; science, too, can be so used.

Second, the idea that religion is an invalid or false way of knowing about the world and that only a scientific approach can tell us anything meaningful or true about reality is itself a deception and logically invalid. The supposed conflict between science and religion is a subject I have blogged about on several occasions and my comments on it here will be brief. This viewpoint that rejects religion is known as scientism and even the National Academy of Science and the American Association for the Advancement of Science have published statements rejecting it.

I'll close with the thoughts on the subject of two noted physicists. According to Freeman Dyson:

"Science and religion are two windows that people look through, trying to understand the big universe outside, trying to understand why we are here. The two windows give different views, but they look out at the same universe. Both views are one-sided, neither is complete. Both leave out essential features of the real world. And both are worthy of respect.

"Trouble arises when either science or religion claims universal jurisdiction, when either religious dogma or scientific dogma claims to be infallible. Religious creationists and scientific materialists are equally dogmatic and insensitive. By their arrogance they bring both science and religion into disrepute."

Ian Barbour writes:

"I suggest that the concept of God is not a hypothesis formulated to explain the relation between particular events in the world in competition with scientific hypotheses. Belief in God is primarily a commitment to a way of life in response to distinctive kinds of religious experience in communities formed by historic traditions; it is not a substitute for scientific research. Religious belief offers a wider framework of meaning in which particular events can be contextualized."

Labels: critical thinking, psychology, religion and science

Anger is more useful than despair.

Source: Character of The Terminator in Terminator 3: Rise of the Machines (2003).

Labels: psychology, quotations

In Manufacturing Depression: The Secret History of a Modern Disease (Simon & Schuster, 2010) author Gary Greenberg cites studies from 1975 and 1980 and a 1995 Consumer Reports reader survey in support of the 1936 finding that "all forms of [psycho]therapy, competently practiced, were equally effective" (pp. 299-300). Greenberg summarizes:

The conclusion is inescapable: to the extent that therapy succeeds, it's not due to the particular help that's offered, but rather to the fact that something is offered in the first place, and by a person whom the patient expects, and believes, will help. Therapy, no less than drugs, works by the placebo effect.

This shouldn't be a surprise. To the extent that it is understood, the placebo effect seems to be the result of a patient's entering into a caring relationship with a healer, which is a much more explicit feature of psychotherapy than of general medicine. Nor should this be bad news. It just means that when therapists listen with empathy, when we offer support and understanding, when we help people to pick up their pieces and fashion a story out of them, to make as much sense of their lives as they can and to withstand the uncertainty of whatever is left over, when we provide a space in which they are free to be just as confused and demoralized and ambivalent as they really are—that when we do all that, and when we do it well, it really does help. It would no doubt be better to have a world in which we therapists weren't necessary, where narrative coherence wasn't so hard to come by and people weren't driven into private rooms to plumb the depths of their fears and their hopelessness, but that's not this world, so having those rooms, and the professionals who occupy them, is the next best thing. [pp. 300-301]

Regarding cognitive behavioral therapy in particular, Greenberg writes:

Other studies ... strengthen the finding that to the extent that cognitive therapy works for depression, it is not because its specific ingredients act on specific pathologies. Instead, according to the meta-analysts, cognitive therapy's success depends largely on the therapeutic alliance, therapist empathy, the allegiance of the therapist to his technique, and the expectations of the patient ... How therapy is conducted is more important ," as one researcher put it, "than what therapy is conducted." [p. 309]

Elsewhere Greenberg quotes a telling admission from the American Psychiatric Association's document, A Research Agenda for the DSM-V:

The major problem for mental disorders as currently defined is that their causes and pathophysiological mechanisms remain largely unknown. It is expected that, at some point in the future (perhaps decades from now), the pathophysiological states predisposing or contributing to major mental disorders will be identified ... once it is possible to define a mental disorder based on the identification of its underlying pathology, then it would surely make sense to follow the course of other medical conditions and have the presence of disorder be based solely on pathology and not on the effect this pathology exerts on the individual's functioning.

One take-home lesson from this is that by 2002 the psychiatric profession knew that the chemical imbalance theory of depression is speculative, not established fact.

Regarding the efficacy of psychopharmaceuticals, here's a quote from "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy" by Turner et al., a study Greenberg cites in his discussion of antidepressants:

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

In the paper's discussion section the authors write:

We found a bias toward the publication of positive results. Not only were positive results more likely to be published, but studies that were not positive, in our opinion, were often published in a way that conveyed a positive outcome. We analyzed these data in terms of the proportion of positive studies and in terms of the effect size associated with drug treatment. Using both approaches, we found that the efficacy of this drug class is less than would be gleaned from an examination of the published literature alone. According to the published literature, the results of nearly all of the trials of antidepressants were positive. In contrast, FDA analysis of the trial data showed that roughly half of the trials had positive results.

To distill this: Drug companies suppress the results of clinical trials which show the drug they're trying to get approved for consumers is ineffective. So, if they don't dump the drug, they keep trying until they get a positive result they want to publish.

Greenberg also cites a 2002 article by Kirsch et al, "The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration". The authors studied clinical trials data for six popular antidepressants: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), nefazodone (Serzone), and citalopram (Celexa). Here are the final two paragraphs of their article:

To summarize, the data submitted to the FDA reveal a small but significant difference between antidepressant drug and inert placebo. This difference may be a true pharmacological effect, or it may be an artifact associated with the breaking of blind by clinical trial patients and the psychiatrists who are rating the severity of their conditions. Further research is needed to determine which of these is the case.

In any case, the difference is relatively small (about 2 points on the HAM-D), and its clinical significance is dubious. Research is therefore needed to assess the additivity of antidepressant drug and placebo effects. If there is a powerful antidepressant effect, then it is being masked by a nonadditive placebo effect, in which case current clinical trial methodology may be inappropriate for evaluating these medications, and alternate methodology need to be developed. Conversely, if the drug effect is as small as it appears when drug/placebo differences are estimated, then there may be little justification for the clinical use of these medications. The problem, then, would be to find an alternative, as the clinical response to both drug and placebo is substantial. Placebo treatment has the advantage of eliciting fewer side effects. However, the deception that is inherent in clinical administration of placebos inhibits their use. Thus, the development of nondeceptive methods of eliciting the placebo effect would be of great importance.

In layperson's terms: We can't really tell from the clinical data if the billions of dollars worth of antidepressants prescribed to Americans every year are really helping them or not. The lead author, Irving Kirsch, published a book on the subject in 2010, along with a summary of sorts in The Huffington Post.

Kirsch was the lead author in a 2008 article, "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration," also cited by Greenberg. The authors found:

Using complete datasets (including unpublished data) and a substantially larger dataset of this type than has been previously reported, we find that the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance. We also find that efficacy reaches clinical significance only in trials involving the most extremely depressed patients, and that this pattern is due to a decrease in the response to placebo rather than an increase in the response to medication.

Labels: medicine, psychology