Dr. Thomas Szasz

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05 Feb 2013, 3:47 am

Or it is possible that people have considered these other perspectives and disagree with them.

There's also the danger of universalizing one's experiences either way. One poster claimed that all anti-depressants are bad because he's had bad experiences with them. I think Raziel has actually been fairly reasonable in this regard - he's not declaring psychiatry as all bad, but he is pointing out that it has very real flaws, and using Szasz' words to reinforce that point.

However, people still do experience mental illness and find this unpleasant. I don't think my suicidal ideation reflects a version of me that I want to indulge, and so far, the only profession that has helped my depression is psychiatry. Even so, my interactions with my therapists are not 100% positive, and I do not agree with them on everything. It is not important to me to be "mentally ill" but it is important to me to have my very real difficulties understood and taken seriously.

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05 Feb 2013, 3:54 am

Verdandi wrote:

I agree

I can't stand seeing people talking in a very reasonable and intelligent manner shot down by the type who invariably use the 'strawman' word - they are on every forum and bring out a desire to fight in me! :evil:

They don't seem to want to consider things in an open-minded way or learn new things, they just shoot people and ideas down in order to try and make themselves look superior when they clearly aren't! I can't reconcile having to mix with people like this on forums - I am giving warning that things will deteriorate if these people don't stop being rudely dismissive of the ideas being discussed on here!

People using the tedious strawman stuff are invariably just looking for an argument in my opinion and should go off and start their own thread for one instead of spoiling what was a decent, pleasant discussion!

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05 Feb 2013, 4:08 am

Verdandi wrote:

I think Raziel has actually been fairly reasonable in this regard - he's not declaring psychiatry as all bad, but he is pointing out that it has very real flaws, and using Szasz' words to reinforce that point.

Thank you! :mrgreen:

Verdandi wrote:

It is not important to me to be "mentally ill" but it is important to me to have my very real difficulties understood and taken seriously.

Yes.

I was twice(!) by a shrink who toled me that I need therapy and medication and so on, because I have a long psychiatric history since childhood! I was dx and treated as a child because of dyslexia and just because of dyslexia! I went to a special institute for dyslexic ppl to learn how to read and write correctly. I was terrible mad when he used that argument, just because dyslexia is officially in the DSM.

I changed shrinks right away. The new shrink was very nice and just feels responsible for my mood. I mean with that, that he doesn't treat me like a nutcase because I had dyslexia as a child or because I have gender dysphoria. If I want to transition, that's my bussiness and not all shrinks would agree with that (he just once that the diagnoses is well evaluated). But it works well, he doesn't overmadicate me at all and is the first one who looks into my moodproblem more closely and also the first(!) shrink I ever had who askes me how I actually feel when he dx me.
So trust is important and I think forcing ppl or using power as a shrink is not a way at all to treat ppl and at least in my case it worked WAY better without.

I also want to point out that I was a very difficult patient in the past to work with, but treating me with respect and so on it works just fine and of course I behave normal and so on than!

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Last edited by Raziel on 05 Feb 2013, 4:23 am, edited 1 time in total.

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05 Feb 2013, 4:19 am

tall-p wrote:

Raziel wrote:

And seriously 300 disorders is way too many. So many are even don't get dx in most cases.

And that is what psychiatry is all about now. And many of the people here are way into getting a "real" diagnosis. It is a defining moment in their lives. So it is the same for all people who get a diagnosis... lots of time and money spent on it. And then when the diagnosis comes in it has consequences, drugs, and a schedule of appointments. Insurance, and perhaps assistance.

Well I think you can terrible missdx ppl, but also in a lot of cases it is more or less a matter of interpretation what you dx.

I once talked to a young woman who was dx with Borderline PD accentuation, because she fullfilled 3 diagnostic criterias. So she was in the psychiatry and asked the psychiatrists there why she got that diagnosis? They toled her, because she got it clarified in the first place (she wanted to know if she has BPD or not).

Also not every missbehaviour is a disorder and psychiatry misses that most of the time, because they are thinking way too much in disorders and not in "normal reaction of an unnormal environment" what can also cause missbehaviour and is NOT a disorder.

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05 Feb 2013, 4:39 am

Raziel wrote:

Well I think you can terrible missdx ppl, but also in a lot of cases it is more or less a matter of interpretation what you dx.

I agree with you. If a person went to half a dozen psychiatrists, and presented the same half dozen problems, I wouldn't be surprised to see half a dozen different dxs.

Personally, I have never heard of a psychiatric patient getting well. If you can pay the bills, or have good insurance, your "therapy" may go on your whole life. And, what ever problems you present with they will give a dx soon, and quite often meds to "help."

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05 Feb 2013, 5:22 am

tall-p wrote:

Raziel wrote:

Well I think you can terrible missdx ppl, but also in a lot of cases it is more or less a matter of interpretation what you dx.

I agree with you. If a person went to half a dozen psychiatrists, and presented the same half dozen problems, I wouldn't be surprised to see half a dozen different dxs.

No at least a dozen diagnoses, because most shrinks dx more than one disorder!

Just kidding. :lol:

tall-p wrote:

Personally, I have never heard of a psychiatric patient getting well. If you can pay the bills, or have good insurance, your "therapy" may go on your whole life. And, what ever problems you present with they will give a dx soon, and quite often meds to "help."

I personally think that a lot of suffering comes from the fact because the person is different in a society who has difficulties with different ppl and also the person itself has problems to accept that.
Also we are being toled that we can change, we just have to go to therapy and so on. Well I think that's possible to some degree and for the mainpart we are just the way we are.

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05 Feb 2013, 6:20 am

Dillogic wrote:

Raziel wrote:

Dillogic wrote:

Dr. Strawman

What do you mean?

He is using a variety of strawman arguments to denounce a whole scientific field.

This is exactly what I was trying to say, I was just using too many words. He appears to be condemning psychiatry as a whole profession, even though there is an element of truth in some of his points, he's stretching common sense to make his condemnation. Maybe he means it humorously and we are missing the joke! :lol:

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05 Feb 2013, 6:35 am

whirlingmind wrote:

nessa238 wrote:

Dreycrux wrote:

nessa238 wrote:

Dreycrux wrote:

nessa238 wrote:

He's saying that rather than keep creating new diagnoses for every permutation of human behaviour, it's far better to find out what it is specifically that is troubling that individual person and resolve that, instead of labelling them with a psychiatric diagnosis

A lot of these diagnoses are just pathologising the human condition

So you saying my OCD is just due to some underlying "trouble" and I can simply resolve that?

OCD is a form of anxiety displacement

ie something specific is causing your anxiety but rather than face it you displace this anxiety/fear into the OCD activity,
which gives you a feeling of control

Usually the more checking/hand washing etc that goes on, the more anxious the person is about something

Hmm i'm not sure where you were going with that but ocd It is said to have a physical component. And then there is the dopamine hypothesis for schizophrenia...Again I am not sure if your against mental disorders having a physical component or not. You seem to be... which I find bewildering.

Quote:

OCD has been linked to abnormalities with the neurotransmitter serotonin, although it could be either a cause or an effect of these abnormalities. Serotonin is thought to have a role in regulating anxiety. To send chemical messages from one neuron to another, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that the serotonin receptors of OCD sufferers may be relatively understimulated. This suggestion is consistent with the observation that many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications that allow for more serotonin to be readily available to other nerve cells.[32]

A possible genetic mutation may contribute to OCD. A mutation has been found in the human serotonin transporter gene, hSERT, in unrelated families with OCD.[33] Moreover, data from identical twins supports the existence of a "heritable factor for neurotic anxiety".[34] Further, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than do matched controls. In cases where OCD develops during childhood, there is a much stronger familial link in the disorder than cases in which OCD develops later in adulthood. In general, genetic factors account for 45-65% of OCD symptoms in children diagnosed with the disorder.[35] Environmental factors also play a role in how these anxiety symptoms are expressed; various studies on this topic are in progress and the presence of a genetic link is not yet definitely established.

People with OCD evince increased grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, while decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[36][37] These findings contrast with those in people with other anxiety disorders, who evince decreased (rather than increased) grey matter volumes in bilateral lenticular / caudate nuclei, while also decreased grey matter volumes in bilateral dorsal medial frontal/anterior cingulate gyri.[37] Orbitofrontal cortex overactivity is attenuated in patients who have successfully responded to SSRI medication, a result believed to be caused by increased stimulation of serotonin receptors 5-HT2A and 5-HT2C.[38] The striatum, linked to planning and the initiation of appropriate actions, has also been implicated; mice genetically engineered with a striatal abnormality exhibit OCD-like behavior, grooming themselves three times as frequently as ordinary mice.[39] Recent evidence supports the possibility of a heritable predisposition for neurological development favoring OCD.[40]

Rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections (PANDAS)[41][42] or caused by immunologic reactions to other pathogens (PANS).[43]

- Wikipedia

Let me explain OCD like this...This is how I explain it to everyone. OCD is like a fire that you keep batting the flames down, but the fire (anxiety) never fully goes out and it can rage up at anytime (triggers) where you have to beat back the flames. The underlying problem of anxiety and rumination is still there, you can get over some things with exposure and response therapy but then underlying ocd just spread to other topics over your life time. It's a never ending fight against the spreading flames. SSRI's are almost like a fireplace to contain the fire so it doesn't spread...it's still there and you would have to feed it with triggers to get it going as it will just be hot coals ready to ignite at any time. It is a physical disorder in function.

People probably have a genetic disposition to OCD but I think it's mainly environmental things that trigger it, such as interpersonal relationships and how much stress a person suffers from other things on a daily basis, like work etc

I know people say the OCD in AS is different to ordinary OCD, but my daughter (awaiting assessment for AS) has shown OCD behaviours since the age of 4. She has them really bad now at age 11.

...my too subtle point being, that it is due to differences in the brain (http://www.nhs.uk/news/2007/November/Pa ... iffer.aspx), not pure anxiety or reaction to environment. My daughter has had no reason to be anxious, she displayed these behaviours without any trigger, she tells me now that she remembers being really little and specific OCD behaviours she remembers performing (she doesn't know that it's a psychiatric condition). She doesn't want to perform the behaviours and it worries her, she literally can't help it. As OCD is caused by brain differences, it is likely genetic like a lot of autism. When science recognises a physical cause for a condition, that is not pathologising human behaviour, that is recognising an illness to treat. However frequent anxiety may be, it's not a normal behaviour, and in some identified cases there is likely a reason in the brain that someone worries to that almost irrational degree.

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05 Feb 2013, 6:56 am

whirlingmind wrote:

I don't like too long quotes, so I'm shortening this.

My personal experience it, that it doesn't make sence searching for reasons in the environment because of every little difference the person is displaying. This is also a form or psychiatric force on the other hand.
When I was a little child and didn't talked, there was no specific reason in the environment for it and I strongly believe that this was my brain.

But it also doesn't help just anounce that all psychiatric disorders would be chemical and just neuropsychiatry would be right, That's another extreme.
When I lived in an unhealthy environment and started to "freak out", this was a "normal reaction to an unhealthy environment" I believe and nothing you can fix with drugs. Drugs can't do everything.
And when I have headache because I didn't drank enouth, I drink a glas of water and don't take a pill. I try to fix the problem. If this doesn't work and the reason is something else, I can still take a pill, no question.

Very often it is from the outside not possible to tell what is troubeling the person.
Disorders, psychiatric once, those are just names to describe behaviours, but it doesn't say anything about the reason why the behaviour occoured in the first place. At least most disorders don't.
So there is no way to say: "All cases of ADHD, all ppl with OCD and so on..." when the disorders just describe a certain behaviour and nothing more and of course this way disorders are just becoming a form of metaphore, but it doesn't mean that there can't be a neuropsychiatric component to it in a lot of cases or that this behaviour isn't real.

But you could have also called my behaviour different and when I go to a different shrink he or she will have a different opinion about it. There is no objective way to say who is right or wrong, it's a matter of interpretation, that's all.

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05 Feb 2013, 7:04 am

An experiment was once carried out and it was found that when a group of some 20 people were sent to a variety of psychiatrists, almost every one was diagnosed with something. All felt they were able to function well with life and had no history of wanting psychiatric help or having had any.

So either almost every person on the planet needs psychiatric help or psychiatrists just think they do. You decide.

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05 Feb 2013, 7:11 am

Pianist wrote:

This has actually also a lot to do with the health system.
I don't know about other countries, but in my country if I go to a shrink, they just get payed from the insurence when there is a disorder they can treat. So either they haveto dx something or there is already a "dx disorder".
So if I go to a therapiest or shrink regulary and I don't want to pay for it by myself the therapist HAS TO dx something, at least depression, no matter if I have something or not or just want to talk.
So it's the entire system in fact.

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05 Feb 2013, 7:33 am

@Pianist: Is that a conspiracy though - or is it that psychiatrists are humans too and maybe prone to insecurities like the rest of us? Maybe they felt the pressure of their job, took it so seriously that they thought people would only be coming to them if they had a genuine problem (they were tricked really) and so they were desperately fishing around to find the relevant label. I know this doesn't make it right, that they found diagnoses for people not needing them, but they are prone to the same failures and assumptions that everyone else is. Perhaps this shows that QA (such as some sort of spot checks) needs to be put in place.

I think basically, the middle ground needs to be found. It seems this thread is largely about extremes of belief in either direction. There is some common sense in what he says, but he's stretched it too far. Psychiatry was presumably originally invented by a person/people wanting to solve the problems people suffered, admittedly these days it's a money machine, but they aren't all unscrupulous.

It's less about the labels themselves, but more about what society and the law uses those labels for. For someone to be sectioned they probably like a label to describe why the person is mentally incapacitated, and if labels are negatively stigmatising and perjorative then they matter, and of course if they are genuinely misused in some cases then steps need to be taken about this, not just demonising the whole profession.

Drug companies...that's a whole other (if related) story.

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05 Feb 2013, 7:55 am

whirlingmind wrote:

It's less about the labels themselves, but more about what society and the law uses those labels for. For someone to be sectioned they probably like a label to describe why the person is mentally incapacitated, and if labels are negatively stigmatising and perjorative then they matter, and of course if they are genuinely misused in some cases then steps need to be taken about this, not just demonising the whole profession.

There is some truth to it, what do we do with that labels?
But on the other hand, it is really a mental illness when a mother is sad when her child died for example or normal grief because of that situation? I tend to the second answer.
We are all just human beings, most of us with very complex feelings. We have the right to feel angry, sad, grief, happyness and so on without being labelt menatlly ill. Those are upto some degree normal reactions. Even in my case having problems that are over the norm shrinks dx some stuff way to fast, just leading to a redx in the end or to a wrong interpretation of my situation I had at that time. Even with moodproblems not every sadness is depression and so on and I had such an unhealthy way at looking at my feelings, I even had to learn that again.

whirlingmind wrote:

Drug companies...that's a whole other (if related) story.

Yes, so long you are not in a mental hospital you can decide for your own in most cases what drugs you want to take or how many. A good shrink should discuss that with you accourding on your suffering and if you really need them or not and even as a person with Bipolar disorder I have to learn to stand some feelings. "Normal" people also get sad or something or stressed out, without being able to take a drug right away. A healthy way of dealing with the personal situation, with enough rest and so on is much more important I think.
It doesn't mean that some drugs con't help me, but overmedication doesn't make sence at all either.

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05 Feb 2013, 8:08 am

Raziel wrote:

whirlingmind wrote:

Yes, to address where psychiatrists are wrongly diagnosing there needs to be, like I say, some sort of watchdog or QA involved. This will ensure the reputation of the good ones is not trashed along with the crap ones.

Raziel wrote:

whirlingmind wrote:

Drug companies...that's a whole other (if related) story.

Yes, so long you are not in a mental hospital you can decide for your own in most cases what drugs you want to take or how many. A good shrink should discuss that with you accourding on your suffering and if you really need them or not and even as a person with Bipolar disorder I have to learn to stand some feelings. "Normal" people also get sad or something or stressed out, without being able to take a drug right away. A healthy way of dealing with the personal situation, with enough rest and so on is much more important I think.
It doesn't mean that some drugs con't help me, but overmedication doesn't make sence at all either.

It's all about balance isn't it. And if overdiagnosing is sorted out, then presumably overdrugging will be taken care of by default.

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05 Feb 2013, 8:27 am

Pianist wrote:

This was, what I'm thinking about reading that, I couldn't think on the name.
It is quite interesting actually:
Rosenhan experiment

"Rosenhan's study was done in two parts. The first part involved the use of healthy associates or "pseudopatients" (three women and five men) who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different States in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release. The second part of his study involved an offended hospital challenging Rosenhan to send pseudopatients to its facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 193 new patients the staff identified 41 as potential pseudopatients, with 19 of these receiving suspicion from at least 1 psychiatrist and 1 other staff member. In fact Rosenhan had sent no one to the hospital."

And this is the most interesting part in my opinion:
"Despite constantly and openly taking extensive notes on the behavior of the staff and other patients, none of the pseudopatients were identified as impostors by the hospital staff, although many of the other psychiatric patients seemed to be able to correctly identify them as impostors."

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05 Feb 2013, 9:53 am

Perhaps as a profession, psychiatry has not had enough accountability, and this is all it needs. People can get too sure of themselves given enough rope, so perhaps a profession as a whole can too. Goes back to what I said about industry watchdogs, keeping things in check.

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