Tuesday, January 29, 2013

Is the media distorting findings about antidepressant effectiveness?

Adrian Preda in a rapid response to the debate about whether antidepressants are over-prescribed, which I have mentioned previously (eg. see post), makes reference to his blog entry that blames the media for distorting findings and misleading patients. He makes clear that he is worried that depressed patients may not take antidepressant medication.

I think it is clear that Irving Kirsch is making the case that antidepressants are amplified placebos (see previous post). Preda doesn't really deal with this issue. As I keep saying, there doesn't seem to be any argument that the drug placebo difference in clinical trials is small. The question is whether it can be explained by expectancy effects through unblinding in clinical trials.

29 comments:

Anonymous said...

How BORING is it to hear year after year psychiatry squabble over statistical artifacts?

It's simple. You're all quacks, you've convinced a large portion of the population you're not quacks. Your diseases aren't real diseases. You've convinced people they are real diseases. People trust people presented to them as "doctors" (you're not real doctors), and they'll swallow whatever toxic brain disabling crap you dispense to them.

Anyone who would even swallow a pill believing there is such a thing as an "antidepressant" has already swallowed so many lies from psychiatry before even getting to the point of popping their first pill, that it matters not what the latest "thought leaders" are squabbling about in their journals, these snake oil sorcerers are just giving the world a bum steer their whole careers.

Year after year, the same tinkering, the same squabbling. I actually hope it continues, because as the squabbling continues public faith in this profession of quackery will dissipate exponentially. Which is a good thing.

As for why Double would think rehashing a topic that has been done to death would be of interest to the Critical Psychiatry blog readers? I don't know.

Lynne Friedli said...

I appreciated your comment 'Your diseases aren't real diseases. You've convinced people they are real diseases.' (I tweeted it but couldn't acknowledge you properly because the comment is anonymous). I appreciated it because it's something I'm struggling with. Not so much in relation to ideas about mental disorder, but to the current debates about 'wellbeing' - or what used to be called 'mental health promotion'.

I'm increasingly concerned that 'wellbeing' is just reproducing disease models - rather than contributing to critical debate about health and what it means to be human.

Lynne Friedli

Adzcliff said...

Hi Lynne.

Are you able to elaborate on how on the ‘wellbeing’ discourse is reproducing disease models. I’m no expert, but haven’t detected this. For me, the recovery/well-being movement is increasingly enabling individuals to frame their distress in ways that are helpful and meaningful to them – though, granted, not necessarily excluding ‘disease models’ entirely if that sort of simplicity is for them – which invariably involves heavy emphasis on the psychosocial.

I should add that I’m sceptical of Anonymous’s tendency to lump critical and non-critical psychiatrists (and often all mental health professionals) together other as uncritical purveyors of harmful nonsense and quackery. Not to mention his/her tendency to reject out of hand some people’s experiences of benefit from a pharmaceutical element to their mental health support (regardless or not of whether these medications work as marketed). I think the work of the critical psychiatrists (amongst others) has been invaluable in exposing the poor science and practices of the psychiatric/pharmaceutical industries, and promoting the need for a greater humanity in psychiatric practice. Whether they’ve cracked it, or could’ve done anything differently, of course remains very much up for debate.

I should add that Dr Double has more than once referenced the work of Prof. Richard Bentall, whose whole thesis rests on the idea that ‘mental illnesses’ are arbitrarily defined extensions of normal human experience (as far as I can make out).

Not sure what you think…

Anonymous said...

" I think the work of the critical psychiatrists (amongst others) has been invaluable in exposing the poor science and practices of the psychiatric/pharmaceutical industries, and promoting the need for a greater humanity in psychiatric practice. Whether they’ve cracked it, or could’ve done anything differently, of course remains very much up for debate.

I should add that Dr Double has more than once referenced the work of Prof. Richard Bentall, whose whole thesis rests on the idea that ‘mental illnesses’ are arbitrarily defined extensions of normal human experience (as far as I can make out)."


Sure, the critical psychiatrists are okay... but they are apologists for coercion. Just this weekend Bentall had a piece calling for LESS coercion in British mental health services. He was at pains to point out that he's not calling for the abolition of coercion, and that it just needs to be "reduced".

Why he fights for the human rights of SOME, is beyond me. Slavery wasn't abolished by still keeping a little slavery around.

There is NO justification for the quack profession of psychiatry being forced by government into anybody's life, anybody's life, anybody's life, nobody, no one, none. It simply should not be an arm of state power, at all.

If someone wants to say no to a psychiatrist or choose prison if they've committed a crime, that should be allowed.

" Not to mention his/her tendency to reject out of hand some people’s experiences of benefit from a pharmaceutical element to their mental health support "
I don't reject people's claims that they faced life better while drugged, or face life easier while drugged. Good for them. I support their right to do heroin, crack, or Prozac, for it is their body and their life. I also support their right to say no to any type of drug, a right that tragically, a majority don't support extending to others given that so many people are supporters of forced psychiatry legislation.


If the critical psychiatrists of Britain wish to quell opposition from the anticoercion activists, they should lay on the table PRECISELY and to the letter, what THEY would coerce us into, what they would like the reserve powers to force on us for our own good, and to what extend they would and in what cases they will coerce.

The British critical psychiatrists can't complain about people distrusting their positions on coercion when we see these horrible op eds like the Bentall one in the Guardian, which amounts to "oooh it's so ugly we are coercing so many people in the system in Britain, lets only coerce a few".

I want to know exactly where they stand on coercion, and exactly what I'm in for should they ever become my legal owners under the Mental Health Act. Given the Mental Health Act is all about creating psychiatric slaves, just what would our new overseers be like? in a critical psychiatry world?

I know Double has said he supports keeping the Mental Health Act, I don't think he's ever written a blog post detailing precisely what forced "services" he'd be looking to provide those who he'd force to accept this offer they couldn't refuse.









Adzcliff said...

Thanks for this anonymous.

“the critical psychiatrists are okay.”

This is the first time I’ve heard you differentiate between different types of psychiatrist/mental health professional. I think it might be worth being clearer about these distinctions, as the blanket view that all psychiatrists/mental health professionals are sorcerers and quacks promotes the unhelpful ad hominem that certain professions are incapable of new and interesting ideas. That’s not to reject ‘quackery’ as a useful dysphemism for unscientific and unethical beliefs/practices, but pioneers shouldn’t be shackled by their qualifications to be branded a permanent ‘quack’. (Was Laing a quack?)

“…but they are apologists for coercion. […] Why [Bentall] fights for the human rights of SOME, is beyond me. Slavery wasn't abolished by still keeping a little slavery around.”

I’m no expert here, but I don’t accept your analogy. I appreciate you’d argue the detained patient is ‘owned’ by state-appointed keepers in the same way slaves are owned by their purchaser. However, owning a human-being based on their race or gender sets up an easy moral binary between right and wrong. (If 'protection' comes into it at all, I assume it's more about property rights.) However restricting the liberty and life-choices of someone whose psychological and emotional processes could be placing themselves and/or others at risk of harm or indignity, is more complicated. This is why, I assume, you hear more talk about proportionality in mental health law, than absolutist right and wrong.

I think the trouble with the absolutist ‘anti-coercion’ view is that we can rally behind those survivors who resented and continue to resent state intrusion in their lives; but fail to deal with those service-users who resented, but grew glad of a legal system that enabled mental health professionals to intervene in their lives at a time when their distress was leading them down a path they ‘d likely grow to regret (assuming they lived through it). Of course we could just say they’ve swallowed lies and propaganda about the benefits of mental health law, but I’d still rather debate issues of proportionality than all sweeping moral binaries.

Not sure what you think (and thanks for the Bentall-Guardian heads-up, will Google it straight away.)

Adzcliff

Anonymous said...

"However, owning a human-being based on their race or gender sets up an easy moral binary between right and wrong. (If 'protection' comes into it at all, I assume it's more about property rights.) However restricting the liberty and life-choices"

Restriction. A word that conjures up images of a liberty that still exists but is at the time lessened. A word I hate.

To have your biology forcibly altered by a state that can't even prove disease exists in it, against your express wishes, is far more than a mere restriction of life choices. It is like saying the forcible insertion of a penis is a restriction on sexual choices.




"of someone whose psychological and emotional processes could be placing themselves and/or others at risk of harm or indignity, is more complicated."

You would prevent "indignity" with indignity? POSSIBLE violence with preemptive violence?


"This is why, I assume, you hear more talk about proportionality in mental health law, than absolutist right and wrong."

Whether one is forcibly drugged or placed in a cage, is not relative. It is an absolute fact. And it is always wrong to violate human rights.


"I think the trouble with the absolutist ‘anti-coercion’ view is that we can rally behind those survivors who resented and continue to resent state intrusion in their lives;"

Add to lives, bodies, biology.


"but fail to deal with those service-users who resented, but grew glad of a legal system that enabled mental health professionals to intervene in their lives at a time when their distress was leading them down a path they ‘d likely grow to regret (assuming they lived through it). Of course we could just say they’ve swallowed lies and propaganda about the benefits of mental health law, but I’d still rather debate issues of proportionality than all sweeping moral binaries."

Forced detention and behavior modification of millions of smokers, drinkers and overeaters would no doubt yield some thankful people, and some very upset people. There is a reason we don't try it. Because we are supposed to not be owned by the state.

If you don't accept that forced drugging is a great moral wrong, then I can't help you.

Laws forcing a controversial profession of quacks on people, inevitably destroy some and kill some. Pointing to the thankful coerced, in effect says that the collateral damage is acceptable, and this naivete that such brutality can perfected, is always something we hear.

How would you feel if society and the government forcibly took control of all your finances, and offered glib anecdotes of some of your fellow citizens who were "glad" that they could never misspend or get into to debt ever again.

Others will be happy to land in the safety net, while many will see it for the bear trap that it is.

There are myriad aspects of everybody's life, that could be forcibly removed from their control, that some would be thankful for.

Anonymous said...

Those whose experience of state coercion extend to something as mere as taxes and a speeding fine (the vast majority of voters), tend to not comprehend the absolute evil of tyranny.

And it is absolute.

Coercive psychiatry needs to go and has no place in a free society.

The thankful coerced need to go and ask for a guardianship that applies only to them if they wish to be treated like children. They have no moral right to benefit at the expense and deaths of others thrown into the forced psychiatry meat grinder.

Being a non criminal adult, in a free society, regardless of victimless crimes like nuisance and indignity, psychological distress should not yield a penalty of losing the right to own your body. It is a complete, absolute moral wrong that this is currently the case.

Society seems to be just fine with destroying millions of lives to "save" millions of lives, and never tires of holding up the "saved" as poster children to keep the whole ghoulish enterprise of forced psychiatry going.

And tinkerers around the edges, naive fools who think somehow the experience of caging and drugging fully conscious noncriminal citizens can be made "better", have been around forever. There is a reason Thomas Szasz and others came to the conclusion that it cannot be reformed and must be abolished. It wasn't just some moral position, it was after living through the constant tinkerers around the edges who assume these policies can be perfected, and seeing that no, these polices cannot be perfected. Lives will always be destroyed by such heavy handedness. Innocent lives.

People seem to think it is cruel to let the cards fall where they may, but these people WILLFULLY IGNORE the inevitable harm in having a violent policy geared towards creating happy thankful mental patients.

When various and endless arrays of problem behaviors in the lives of people without psychiatry's labels, say indebtedness, misspending, overeating, overdrinking, oversmoking, risk taking of all kinds, skydiving, quitting college to aspire to be an actor, ANY AND ALL things that others might consider imprudent, get a free pass, but people with psychiatric labels are actively targeted with a short leash, the inevitable conclusion can only be that people with psychiatric labels are viewed as a subspecies of humanity unworthy of equal rights.

Anonymous said...

Oh and RD Laing was guilty of carrying out forced drugging. See Thomas Szasz's book Antipsychiatry: Quackery Squared.



Adzcliff said...

Thanks for that Anonymous, but you’ll perhaps appreciate too much to respond to in detail.

“To have your biology forcibly altered by a state that can't even prove disease exists in it, against your express wishes, is far more than a mere restriction of life choices.”

Now here we have some common ground. I too am uncomfortable with the reliance on drugs as a first-line ‘treatment’ for a broad range of emotional problems, as I don’t feel the evidence-base warrants this. I also question the scientific and therapeutic value of matching someone’s distress to a finite set of diagnostic categories, as I think this serves to reify and over-simplify issues that warrant complex biopsychosocial explanations. However this wasn’t always my view; rather it has been intellectually forced onto me by critical theorists with their inescapable data and ideas – many of whom hail from psychiatry.

“How would you feel if society and the government forcibly took control of all your finances, and offered glib anecdotes of some of your fellow citizens who were "glad" that they could never misspend or get into to debt ever again.”

Good analogy, but the state already does this. The state will intervene in my finances/property if it judges they are legally owed to someone else. The state also acts as appointee to many individuals who lack financial capacity – through a permanent or temporary ‘disability of mind’ – where it feels not to do so would cause them sufficient harm and/or hardship. So in answer to your question, I would hope the state would intervene in my finances if I were to lose capacity, and no trusted friend/relative was available to assume this responsibility. The ‘glib anecdote’ would be neither here nor there to me.

“Being a non criminal adult, in a free society, regardless of victimless crimes like nuisance and indignity, psychological distress should not yield a penalty of losing the right to own your body. It is a complete, absolute moral wrong that this is currently the case.”

I disagree that indignity is the mild problem you dress it up as here. Indignity ruins lives. I still wince at some things I did when drunk, young and peer-pressured, but the idea that I did some of them (or worse) in front of colleagues, friends, family and/or children, more than once, and likely again, may eventually become too much to live with. It is here where I’d welcome the intervention that in the moment I may try to reject – of course stopping short of unevidenced-based and potentially harmful ‘treatments’ for my uncharacter. But now I’m talking about proportionality again…

I admit, your questions and arguments unsettled me, as they force me to concede that I’m unable to dream up a humane system that doesn’t create losers. Like I say, I find this difficult; so as someone who clearly doesn’t, and thinks human rights are inviolable (I don’t), I’m bound to ask: what non-coercive, non-violent, collateral-free alternative do you suggest? I’m also curious why you’re referencing the psychiatrist Thomas Szasz – I thought they were 'all' quacks and sorcerers?

Anonymous said...

" admit, your questions and arguments unsettled me, as they force me to concede that I’m unable to dream up a humane system that doesn’t create losers. Like I say, I find this difficult; so as someone who clearly doesn’t, and thinks human rights are inviolable (I don’t), I’m bound to ask: what non-coercive, non-violent, collateral-free alternative do you suggest? I’m also curious why you’re referencing the psychiatrist Thomas Szasz – I thought they were 'all' quacks and sorcerers?"

You mentioned RD Laing, I thought of the immediately available cogent fact about RD Laing's conduct in relation to the topic at hand, coercion. Szasz wrote a book that mentioned RD Laing's conduct in relation to this. Szasz was not a drug/disease paradigm psychiatrist and he never coerced a soul.

"Good analogy, but the state already does this. The state will intervene in my finances/property if it judges they are legally owed to someone else. The state also acts as appointee to many individuals who lack financial capacity – through a permanent or temporary ‘disability of mind’ – where it feels not to do so would cause them sufficient harm and/or hardship. So in answer to your question, I would hope the state would intervene in my finances if I were to lose capacity, and no trusted friend/relative was available to assume this responsibility. The ‘glib anecdote’ would be neither here nor there to me."

Your naive trust that the state only coerces those legitimately adjudicated to have "financial incapacity" is touching.

Plus, the enforcement of property rights, in the case of you being ordered to pay a debt, is not what I was talking about.

I was obviously talking about subjectively imprudent financial conduct and the state protecting you from yourself. It is evident that my analogy was a sweeping one that was meant to apply to all the billions of people in this world who have to learn financial discipline, and not the few thousand people under guardianships.


"Now here we have some common ground. I too am uncomfortable with the reliance on drugs as a first-line ‘treatment’ for a broad range of emotional problems, as I don’t feel the evidence-base warrants this. I also question the scientific and therapeutic value of matching someone’s distress to a finite set of diagnostic categories, as I think this serves to reify and over-simplify issues that warrant complex biopsychosocial explanations. However this wasn’t always my view; rather it has been intellectually forced onto me by critical theorists with their inescapable data and ideas – many of whom hail from psychiatry."

In the biopsychosocial, you can keep the bio until you're prepared to table legitimate bio evidence for every single person you assume or accuse of having a biological problem.

The only evidence base one needs is to simply sit in the corner of a psychiatrist's office and by a fly on the wall and take note of one key fact. Psychiatrists don't examine biology in their practice, therefore they have no right to be telling anyone there is something biologically wrong with them.

A lot of less sophisticated people have saved themselves years of reading by simply noting this simple, stark, incontrovertible fact.

Anonymous said...


"I disagree that indignity is the mild problem you dress it up as here. Indignity ruins lives. I still wince at some things I did when drunk, young and peer-pressured, but the idea that I did some of them (or worse) in front of colleagues, friends, family and/or children, more than once, and likely again, may eventually become too much to live with. It is here where I’d welcome the intervention that in the moment I may try to reject – of course stopping short of unevidenced-based and potentially harmful ‘treatments’ for my uncharacter. But now I’m talking about proportionality again…"

I never said indignity wasn't a problem, I said it should not be criminalized. I also said that by forcing psychiatry in response to indignity, you are subjected the person to more indignity, in that coercive psychiatry is an indignity in and of itself.

I do believe all humans should have human rights.


"I’m bound to ask: what non-coercive, non-violent, collateral-free alternative do you suggest? I"

People own their own bodies, and should only have their liberty taken away if they commit a crime, that will be adjudicated in a court of law, with equal protection under the law, and for all other human actions apart from crimes, nonintervention should be the way. Persuasion should be allowed of course.

Collateral damage only results from interventions. When you don't intervene, you can't possibly destroy innocent people along the way.

Look at interventionist foreign policy. The invasion of Iraq. Messy. The fact we don't intervene in North Korea, because we know it would be very messy indeed.

When you intervene, you become responsible for the fallout.

As I said, all the extremely sad and tragic anecdotes in the world can't change the fact that when we have a vast legal machinery giving legal cover to those who would like to intervene and meddle, people will be destroyed as well as "saved".

As far as all shrinks being quacks, mostly they are. There are a few that are worthwhile, but they are invariably worthwhile for attempting to clean up the ruination the majority of shrinks are engaged in creating.

Adzcliff said...

Thanks for that Anonymous.

Yeah, I only extended your analogy to property rights as this is at least the state intervening in individuals’ affairs who can’t be trusted to meet their financial responsibilities at the expense of another. However…

“It is evident that my analogy was a sweeping one that was meant to apply to all the billions of people in this world who have to learn financial discipline, and not the few thousand people under guardianships.”

It may be so that your analogy was unintended to apply to the few thousand people under guardianships, but would you leave these people with mental health issues, dementia, learning disabilities, neurological injuries (etc.) to their own devices, or is the Mental Capacity Act right to interfere in their financial freedom, in an attempt to safeguard their health and well-being? I think it is, even though I can’t guarantee there won’t be losers, but that’s another discussion about process and proportionality.

“In the biopsychosocial, you can keep the bio until you're prepared to table legitimate bio evidence for every single person you assume or accuse of having a biological problem.”

Good point, but I only meant this in so far as we are, like it or not, biological beings. There is no suggestion in there that we understand the biological substrate of mental health problems, or even that there has to be one, but we might want to rule out known physical problems (e.g. infection, epilepsy, thyroid problems). We also know how pharmaceutical tinkering affects biochemistry for better or worse (if not necessarily ‘mental disorders’), and if an informed individual would welcome a degree of that tinkering, as preferable to managing their distress unmedicated, I would advocate that (and so would you from a previous post).

I might also add that “you can keep the [psychosocial] until you’re prepared to table legitimate [psychological and social] evidence for every single person you assume or accuse of having a [psychosocial] problem”. I think the trick is working with uncertainty, and individuals’ own framings of their distress, until such a time that the evidence pulls us unequivocally in certain directions.

“I do believe all humans should have human rights.”

With respect, that wasn’t what I asked. You’ve said that Human Rights are inviolable; I disagree. You’ve now said that certain human rights (e.g. liberty) should be taken away from criminals, suggesting you also accept that in certain circumstances, these rights can and should be violated. Straight away, we’ve moved from an absolutist position, to one of measure and proportionality (albeit we might be very differently positioned in amongst that).

I personally would be more than uncomfortable handing custody of all mental health ‘inpatients’ with a proven or suspected ‘actus rea’ over to the criminal justice system (and/or all equivalent community clients to fines, cautions, suspended sentences, community service etc.). The idea of distressed, traumatised and vulnerable individuals being detained in prison cells amongst other criminals makes me shudder. I’m not suggesting their problems should necessarily become the domain of illness experts working from hospitals, but I am insisting that many/most are entitled to specialist therapeutic support away from the criminal justice system. The societies that lock up the distressed and traumatised as criminals, I’d argue, are the less humane, more violent, and far from collateral-free.

I’m also not sure about your war analogies, as for every ‘mess’ that remains messy, there are ‘messes’ that eventually tidied. So how would you have addressed the Nazi genocide of the mentally ill? No intervention, no collateral?

Thanks for your time.

Anonymous said...

"but would you leave these people with mental health issues, dementia, learning disabilities, neurological injuries (etc.) to their own devices, or is the Mental Capacity Act right to interfere in their financial freedom, in an attempt to safeguard their health and well-being? "

http://dumpinggroundsforpeople.wordpress.com/read-the-investigation/interviews/interview-oliver-lewis-mdac/

Oliver Lewis has a few things to say on this issue that I agree with.

"Good point, but I only meant this in so far as we are, like it or not, biological beings. There is no suggestion in there that we understand the biological substrate of mental health problems, or even that there has to be one, but we might want to rule out known physical problems (e.g. infection, epilepsy, thyroid problems). We also know how pharmaceutical tinkering affects biochemistry for better or worse (if not necessarily ‘mental disorders’), and if an informed individual would welcome a degree of that tinkering, as preferable to managing their distress unmedicated, I would advocate that (and so would you from a previous post).
"

So what? there's a biological substrate that cannot be reliably implicated in the problem. Therefore I reject it's inclusion in the idiotic buzzword biopsychosocial. We all have feet too, maybe we should wheel in feet into the equation too, even though feet can't be implicated in the problem.

If someone has epilepsy they can see a neurologist. What does this have to do with psychiatry?

People should be able to take whatever drugs they like, and get them from anyone they like. If they want to employ an expert pharmacologist's services, good for them. No society is going to produce generalist "biopsychosocial" "experts", given that it would take like 12 years just to get the training to be a half decent pharmacologist, and then maybe another decade or so to handle the psychosocial.

"With respect, that wasn’t what I asked. You’ve said that Human Rights are inviolable; I disagree. You’ve now said that certain human rights (e.g. liberty) should be taken away from criminals, suggesting you also accept that in certain circumstances, these rights can and should be violated. Straight away, we’ve moved from an absolutist position, to one of measure and proportionality (albeit we might be very differently positioned in amongst that). "

Liberty, that vague word, is not a human right. Criminals in prisons still have human rights and various organizations globally work to improve conditions in prison. It is not a violation of human rights to expel a person who has committed a violent crime from society.

The difference between punishing criminals with prison time, and human rights abuses, is something you might want to look up.

The death penalty, forced drugging, forced marriage, war crimes, torture, are human rights abuses.

You simply saying in a blanket way that any removal of liberty is a human rights abuse, is glib and I don't know what you're trying at.

"“you can keep the [psychosocial] until you’re prepared to table legitimate [psychological and social] evidence for every single person you assume or accuse of having a [psychosocial] problem”."

A subjective claim about someone's social or psychological state is always understood to be a subjective interpretation. Bio is considered to be in a completely different discourse. For extraordinary claims, extraordinary evidence should be provided. To convince millions of people they have faulty genes based on a hunch, is very different than someone either claiming or accusing someone of having had a rough childhood.

"I personally would be more than uncomfortable handing custody of all mental health ‘inpatients’ with a proven or suspected ‘actus rea’ over to the criminal justice system"

What you're talking about is robbing people of their right to be seen and treated as responsible moral agents. Treating them like children.

Anonymous said...

Justice systems with two types of criminals, the ones who you subjectively label to be at a certain point on a spectrum of good/bad ...
childhoods, severe/not severe personal problems, stripping people of their natural right to be considered equal before the courts and to have equal due process, their citizenship rights essentially.
"The idea of distressed, traumatised and vulnerable individuals being detained in prison cells amongst other criminals makes me shudder."

Such people are detained in solitary confinement in psychiatric warehouses today as the alleged humane alternative after being denied the choice of normal prisons. A locked building is a locked building, a prison by any other name. People on psychiatry's "wards" are surrounded by violence, torture, and lose more rights than they would in prison anyway.

"I’m not suggesting their problems should necessarily become the domain of illness experts working from hospitals, but I am insisting that many/most are entitled to specialist therapeutic support away from the criminal justice system."

You're saying some criminals, arbitrarily chosen, deserve a completely different punishment, whatever. The use of the word therapeutic tells me you do in fact want medical prisons and normal prisons, and technocrats sorting which criminals go where. Would you give the criminal a choice on where they would like to go? Why not offer voluntary participation in your ill-defined utopian rehabilitation programs IN prisons, that they can participate in if they see merit in them. I believe all prisons should be made more humane. I don't believe in two types of criminals, because I know there is no profession qualified to determine which criminals should be discriminated against.

Anonymous said...

"The societies that lock up the distressed and traumatised as criminals, I’d argue, are the less humane, more violent, and far from collateral-free."

Societies don't lock up people "as" criminals. If you've committed a crime you ARE a criminal. A proper jury trial with all the processes and a judge shall determine your guilt. But wait, you're skipping too far ahead, society already locks up people haven't even committed a crime, it's called forced psychiatry. By definition a mental hospital as an institution is more violent than a prison (excluding death row). And I'm talking here about the violence carried out by the state as a matter of official policy, not prison conditions or inter-inmate violence. In a prison, you're simply put in a cage, in psychiatry, you're put in a cage AND you get your mind raped with drugs. At least in prison someone can sit peaceably in a cell and read a book or write some letters with a clear head. In a forensic institution, you're a human guinea pig for life, interrogated daily with forced interactions with quacks, etc.

"I’m also not sure about your war analogies, as for every ‘mess’ that remains messy, there are ‘messes’ that eventually tidied."

Whether a mess is "tidied" or not is neither here nor there. Vietnam is stable enough today, but millions of civilians died. And on and on I could go with whatever other nasty invasions the interventionists have carried out. It's interesting that you had to go back over 60 years to arrive at this...


"So how would you have addressed the Nazi genocide of the mentally ill? No intervention, no collateral?"

Nobody addressed this. It was happening throughout the 30s, and wasn't the reason for going into a defensive war on the part of the allies. This defensive war, against an imperialist aggressor, was not an intervention, it was a response to violence initiated by Germany and Japan against the allies.

Just as North Korea has death camps today and we do nothing. Just as millions of lives are damaged by psychiatry today and we do nothing but take away more rights.

If I should commit a violent crime, I'd much prefer to go to a normal prison.

Adzcliff said...

Thanks for all this Anonymous – I’ll try and respond to some of it.

1. Firstly, can we agree to drop the war analogies, as I’m not sure they’re helpful.

2. You make a valid point that the ‘bio’ in biopsychosocial commonly refers to genetic and biochemical factors. However, you also now know how I was using it. If you want to explore the role of diet and exercise in addressing your problems, that’s fine by be. If you want to increase your pain-killers to address the physical issues that are impacting so dramatically on your mood, I’d hope you got support with that. You may also enjoy a joint at bedtime to help you sleep; or a wacking dose of haloperidol to suppress your anger – if this is your informed choice, then probably fine by me. These are all designed, entirely or in part, to work at the biological level, and in conjunction with psychosocial factors. At no point have I suggested that psychiatry is crucial to any of this.

3. I don’t know Oliver Lewis, but if talking about the UK, he is wrong:

“And once one is stripped [in court] of his/her legal capacity and is placed under guardianship, s/he is deprived of numerous rights, for example the right to vote, to work, to manage his/her finances, to decide where to live, to marry. The properties of such person are managed by his guardian.”

Not true, unless capacity and best-interests was assessed in every one of these areas. I know of no case where so many decisions were assessed and transferred to others in a single sitting, if at all. Capacity, in Anglo-Welsh law, is decision-specific, not global.

“We believe that this binary approach is unsuited to the realities of life: everyone has functional capacity to do something, and that people are capable of different things.”

So does the Mental Capacity Act. That’s why capacity is assumed until assessed otherwise, and is decision specific. If this doesn’t happen in practice, then this is in violation of the law.

4. It may be that “such people are detained in solitary confinement in psychiatric warehouses today as the alleged humane alternative [to prisons]” but it won’t do to quote the status quo back at me time and time again every time I disagree with you. I’ve shared my issues with the status quo, so making a straw-man of my position-in-principle that something other than prisons should be made available to offenders experiencing acute psychological disturbance looks designed to mislead.

5. As I say, I find all this very difficult, and aren’t feeling helped by your moral absolutes. I think liberty is a human right – albeit a violable one under certain circumstances. I’m also not robbing any one group of their right to be seen as moral agents; in fact I think everyone is a slave to their context and might be considered more/less guilty and/or welfare-entitled than the next person for all sorts of reasons (one of which being their psychological state at the time of the offence). In fact it is your absolutist talk of criminal status and moral agency that flies in the face of contemporary philosophy and neuroscience.

6. So would you imprison the person labelled with autism and a severe learning disability for regularly hitting their parents – given that autism, IQ and learning disability are arbitrarily defined constructs with no firm biological basis?

Thanks for your patience.

Anonymous said...

" In fact it is your absolutist talk of criminal status and moral agency that flies in the face of contemporary philosophy and neuroscience."

You use the word offender, I use the word criminals, so what?

Neuroscience? what does neuroscience have to do with crime?

6. So would you imprison the person labelled with autism and a severe learning disability for regularly hitting their parents – given that autism, IQ and learning disability are arbitrarily defined constructs with no firm biological basis?"

Children's behavior at home doesn't get controlled by the criminal justice system. If they are an adult, they'd be hitting people other than their parents.

What's a learning disability?

" something other than prisons should be made available to offenders experiencing acute psychological disturbance looks designed to mislead."

All depends on whether "made available" means forced upon people. Like I said, if you're willing to give people the option of participating in whatever alternative you have in mind, or to choose prison, that's reasonable.

" However, you also now know how I was using it. If you want to explore the role of diet and exercise in addressing your problems, that’s fine by be. If you want to increase your pain-killers to address the physical issues that are impacting so dramatically on your mood, I’d hope you got support with that. You may also enjoy a joint at bedtime to help you sleep; or a wacking dose of haloperidol to suppress your anger – if this is your informed choice, then probably fine by me. These are all designed, entirely or in part, to work at the biological level, and in conjunction with psychosocial factors."

You're talking about people choosing for themselves solutions to problems, the biopsychosocial model is a model of the problem itself, not the panoply of potential solutions.

And as for capacity, it is completely ludicrous for a quack to say someone can't manage their money but they can still vote.

War analogies are great. They capture the horror of interventionism.

And interventionism is what shrinks are all about, especially when combined with the force of law.

"(one of which being their psychological state at the time of the offence)"

What qualifies a shrink who was not present at the time of the offence and didn't even know the offender, to speak to the state of mind of the offender?

You still haven't told me your alternative to nasty prisons? Locked rooms with bean bags and nature music recordings? Forced interrogations with lovely RD Laing clones?

If someone's actions have proven they are dangerous people, society is going to want them locked up. It is only decent to offer the person the right to be treated like an ordinary criminal if they wish to be treated as one.

Forced interaction with utopian tinkerers in psychiatry, is a nightmare world. Just as it is a nightmare to live in a communist society with utopian economic tinkerers.



Adzcliff said...

Thanks for this Anonymous, I was looking forward to your response.

"Neuroscience? what does neuroscience have to do with crime?"

Neuroscience has plenty to do with moral agency, which has plenty to do with justice, which has plenty to do with crime. You find me ‘free will’, and I’ll give you your moral agency. Until then, I’ll continue to believe that individuals’ contexts affect their accountability for their actions. What I can’t provide is a clear dividing line between the accountable and unaccountable – it’s kind of fuzzy – but my starting point is the polar opposite of yours. And like I say, I find this difficult.

“Children's behavior at home doesn't get controlled by the criminal justice system. If they are an adult, they'd be hitting people other than their parents. [And] What's a learning disability?”

I’m not sure what you mean by this? It’s strange you think adults don’t hit their parents? Assume my fictional character is 20 years old, has limited to no verbal communication skills, is unable to prepare their own meals, dress themselves, attend to their personal care or toilet unsupported, and would spend every waking hour tearing newspaper on the kitchen floor. For the sake of argument, let’s say she does still live with her 50 year old parents (this isn’t uncommon), but struggles every time a parent needs to leave the house, and will spend the entire time communicating her distress by attempting to assault the remaining parent, in between thrashing her own head against walls and doors. (None of this is implausible.) Parents are battered, bruised and exhausted and have called the police again in an act of desperation. Would you be happy for this serial offender to serve time in a prison?

“All depends on whether "made available" means forced upon people. Like I said, if you're willing to give people the option of participating in whatever alternative you have in mind, or to choose prison, that's reasonable.”

I take your point, but no, I’m not suggesting people should be able to ‘choose prison’, as I can only see this creates problems with those offenders who don’t? As to what this other system is, I’m stuck, but don’t necessarily think it needs to be hospital or include forced drugging, but is equipped to walk the delicate line of managing/supporting certain offenders who don’t want support (or prison).

"And as for capacity, it is completely ludicrous for a quack to say someone can't manage their money but they can still vote."

I disagree, and so, it seems, does your Oliver Lewis. Individuals have different capabilities at different times. There’s also nothing in the Mental Capacity Act that says judging someone’s capacity for a certain lifestyle decision is exclusively a psychiatrist’s role. From memory, this responsibility falls to the best-placed person for the job, whoever that may be. It’s entirely plausible to me that someone with mid-stage dementia might lose the concept of money and budgets – and be vulnerable as a result – but love that Cameron off the telly because he says nice things about gay people.

Will look forward to your response, especially if and how the state should intervene in the lives of the family above.

Anonymous said...

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mctps said...

"When various and endless arrays of problem behaviors in the lives of people without psychiatry's labels, say indebtedness, misspending, overeating, overdrinking, oversmoking, risk taking of all kinds, skydiving, quitting college to aspire to be an actor, ANY AND ALL things that others might consider imprudent, get a free pass, but people with psychiatric labels are actively targeted with a short leash, the inevitable conclusion can only be that people with psychiatric labels are viewed as a subspecies of humanity unworthy of equal rights."

This is a point that bears repeating. I've thought of all the arguments someone could counter that with and there are none. Prison is for those who have committed crimes, been judged guilty, and are deserving of imprisonment based on that. Freedom is for the rest, thanks.

The current system adds insult to injury by pretending that their drug treatments are effective and — further — because they are often expensive. And further still, because they are often harmful.

When humans in the West stop warring, polluting, killing themselves with bad diets, using cellular phones, making profit for profit's sake, supporting the porn industry, drunk driving, and importing new species of brain parasite from the third world, and become some sort of angelic creatures of moral perfection and wisdom, I'll concede their ability if not their right to manage my health.

I'm somewhat averse to even discussing the issue of human rights in this context, because that would imply I think the authorities are competent to begin with. I'd like to remind everyone that it is now public information that the drug companies have made their fortunes through deception and manipulation. The FDA is part of that, as it approves drugs when two trials are "positive" EVEN THOUGH there is no limit on how many trials can be submitted on the same drug!! And this is known! And psychiatrists do nothing about it! There should be profession wide boycott of ALL antidepressants and antipsychotics until the system has been changed, period. But no. That to me signifies the psychiatric community is corrupt as a whole and worse than worthless as an authority. Blaming the media is exactly what you'd expect from these people, as if they themselves weren't the ones with all the power. They're the ones prescribing that crap, after all. No one would even be able to buy it if they weren't prescribing it.

Adzcliff said...

Anonymous

It's a shame you haven't got back to me with a response to the crisis scenario I set you. I'm not sure why you haven't, but of course wonder if it's because you can't provide a humane response that doesn't treat this distressed lady as a common criminal. My guess is that you intuitively realise that this lady shouldn't be considered criminally accountable for her actions, but requires an alternative state response to safeguard all parties' safety and well-being. Not sure…

Suicide Ted McGloomy said...

I'm with Anonymous on the issue of coercion. The coercive psychiatrist should be legally compelled to come down into the market place of ideas and services, and his/her actions should be dealt with within the purview of the same legal code that governs us all.

Some might dismiss this as Ivory Tower philosophizing, or that I have not taken into consideration all the practical implications of such a position, or that I have no experience of the so-called "clinical reality" (which properly decoded should read "the perceived reality of people who, through the habit of rationalizing what they are mandated to do, the mind's capacity for rationalization being far greater than its capacity for reasoning, have convinced themselves there is an imperative to force "treat" certain people, that the exigencies of the situation compel it).

Coercive powers should be restricted to police officers, who at least won't violate the sanctity of the body with potentially torturous and poisonous chemicals (and believe me, there is a fair weight of experience behind this assertion. I wouldn't wish akathisia, NMS, or cervical dystonia, on my worst enemy).

The moral moral dilemma the coercive psychiatrist faces is this; how can you possibly justify forced "treatment" (I have bracketed this word between speech marks because I only consider something to be treatment when it isn't done against a person's will) cognisant of all the anecdotal evidence of the torturous effects of these drugs, and the scientific evidence conclusively showing the immense damage and the pathogenic potentiality of many of these drugs?

For example, on MIA, Sandy Steingard, who has become like some sort of object of cultic veneration on that site, understands all this, yet still takes the position that it is all right in so-called "extreme cases" (once again, this is bracketed. I have done this because I reject the perspective of the average coercive psychiatrist as hallucinatory).

Or put another way, the class of psychiatrist of which Mrs Steingard is an exemplar, the human mind being better at rationalizing than reasoning, rationalizes the fact that their allegiance to their career is greater than that of her allegiance to oppressed humanity, by claiming it is sometimes necessary, after all few in her position are willing to do the decent thing, which is to quit a job that implies the destruction of individual initiative and intellectual autonomy, and compromises one morally.

Maybe if their beliefs had an experiential basis, I would take them a little bit more seriously, yet all these people have never even taken the drugs (apart from Bentall who has a modicum of experience, so he should know better)! Couple this with the fact that such people are aware of their harmfulness, and I am left wondering how they can possibly make these assertions in good conscience.

Suicide Ted McGloomy said...

That should be "their" twice, not "her". Darn.

Suicide Ted McGloomy said...

If you don't appreciate the analogy, may I recommend for your reading Szasz's "Psychiatric Slavery and "Liberation by Oppression". He has cogently elucidated and enumerated the points of congruency between the two institutions of involuntary psychiatry and involuntary servitude, similarities that can't be so easily effaced as you try to do in your comment.

Suicide Ted McGloomy said...

Owning a slave was based on race, but this also implied similar justifications as are invoked in support of psychiatric slavery.

Suicide Ted McGloomy said...

Throughout history many victims of oppression and abuse have internalized the interpretations of their oppressors. For this and many other reasons, I find the invocation of the voices of retrospectively grateful patients unsatisfactory.

Suicide Ted McGloomy said...

The thought of locking up distressed, traumatised people with criminals makes Adzcliff shudder. It makes me shudder also, though not as much as locking them up in a nominal hospital, where there are no proper avenues open to them of redress for their grievances (as I found out when I was detained); where you are left at the mercy of people who for the past two hundred years have been killing, torturing, abusing, damaging, poisoning, diseasing and traumatising patients in the name of treating the patient!

Suicide Ted McGloomy said...

Neuroscience has nothing to do with moral agency. You are thinking of neuroscientism.

L K Tucker said...

The reports of ineffective psychotropic drugs for depression are accurate. Tests for these drugs are allowed to be repeated until the drug beats placebo no matter how many tests the drug failed.

This method does not prove efficacy. Tests provide a statistical correlation not proof.

There is no "testable objective evidence" available that these drugs do anything except cause side effects. No such evidence can exist. They cannot be tested for that.

No test program is aware of or eliminates chronic exposure from a little known problem of human physiology discovered by engineers when it caused mental breaks for office workers in 1964.

Subliminal Distraction, explained in first semester psychology lectures on peripheral vision reflexes, is so simple that the "special circumstances" to cause it can be created almost anywhere.

All that is needed is long hours of full mental investment, concentration, while there is repeating detectable movement nearby in peripheral vision to cause a massive number of subliminal failed attempts to execute the vision startle reflex.

Because our brain deals with the vision startle reflex subliminally this exposure cannot be consciously experienced. It is undetectable.

Anyone with a computer at home, or who works in an office without Cubicle Level Protection should be aware of it. Students, especially college students, are at high risk. They can spend long hours experiencing this exposure when they use a computer or study.

The cubicle was designed to block peripheral vision for a concentrating worker to stop it in offices by 1968.

VisionAndPsychosis.Net is a simple presentation of the problem after a ten year investigation.