ICSPP Newsletter

International Center for the Study of Psychiatry and Psychology

 

Special Pre-conference Spring 2004 Issue

 

            The Eighth Annual International Center for the Study of Psychiatry and Psychology Conference, entitled Critiquing Disease Models of Psychosocial Distress and Developing and Implementing Effective Psychosocial Theories and Interventions will take place on October 8^th, 9^th, and 10,^th 2004, in the Sheraton LaGuardia East, Flushing, Queens, New York. Outstanding, invited speakers include: George Albee, Ph.D., past president of the American Psychological Association; Mary Boyle, Ph.D author of Schizophrenia: A Scientific Delusion?; Peter Breggin, M.D., founder and director emeritus of ICSPP, author of Toxic Psychiatry; Celia Brown, president of Mindfreedom.org; David Healy, M.D, internationally recognized researcher and author of Let Them Eat Prozac.; Bertram Karon, Ph.D., Researcher, Psychoanalyst and author of  Psychotherapy with Schizophrenia: Treatment of Choice; Diane Lambert, Ph.D. Researcher, author and educator; Vera Sharav, founder and president of AHRP: and Robert Whitaker, author of Mad in America. Proposals for presentations are welcomed and information concerning proposals can be found on our website at www.icspp.org. and on page 20 of this issue.

 

DUES

            Many members of ICSPP are in arrear of their dues which for 2003 was $25.00. Dues for 2004 are $50.00 and are now payable. Our important organization cannot continue to function unless members keep it financially solvent. The costs of producing the newsletter keep escalating as do all others involved in maintaining the organization. Therefore, we may be forced to withhold the newsletter from those in arrears. Please do not allow this to happen and deprive yourself and us from maintaining the vital link of communication that the newsletter represents. Important: Any individuals who cannot afford the full dues can send whatever portion they feel their budgets will allow.

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 Another Surprise from American Psychiatry

George W. Albee, Ph.D.

University of Vermont and Longboat Key, FL

 

            American psychiatry often surprises the field of psychopathology with announcements of newly discovered mental disorders, with the discovery of new causes of old disorders, and with the discovery that former disorders no longer exist.  In the years since the mid 20^th century more than 100 new kinds of mental disorders have been added (and many have been deleted) in successive editions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association.  This DSM is the

official guide to mental disorders in America.  To receive treatment that is supported by health insurance, or by tax-supported agencies, and even by most voluntary agencies, the patient must have a label from DSMIV, the latest version.

            The alleged causes of many of these mental disorders have been changed over the years.  In earlier times the cause often was said to be excessive stress.  Shell shock, combat fatigue, poverty, a history of physical abuse and sexual molestation, parental alcoholism, and drug abuse,

and many other social stresses had been believed earlier to result in mental disorders.  But in recent years we have been told by the nation?s leading psychiatrists: ?All mental disorders are due to brain malfunctioning?; ?All mental illness is a brain disease?.

            When he was Director of the National Institute of Mental Health, Lewis Judd MD proclaimed the 1990?s to be the ?Decade of the Brain? during which research would locate all the causes of mental disorders in the brain (it didn?t). 

            The recently-resigned Director of the National Institute of Mental Health Steve Hyman MD, (now Provost at Harvard) says:  ?These are real illnesses of a real organ, the brain, just like coronary artery disease is a disease of a real organ, the heart. 

E. Fuller Torrey MD, a psychiatrist and chief guru of the National Alliance for the Mentally Ill, argues that people with severe mental disorders have ?neurobiological disorders of their brains that affect their thinking and moods and that can be measured by changes in both brain structure and function?. Torrey is also a leading advocate for involuntary drug treatment of the emotionally disturbed. 

            Recently an important new mental disorder, Anosognosia (translation: lack of awareness of illness), has been announced by the American Psychiatric Association (see Professional News, 2001, 36, 17, p 13.).  While this phenomenon was long known by the psychological term denial, it is now said to be a result of a brain defect, according to a recent article in Psychiatric News.  (September 7, 2001). 

            Anosognosia is commonly seen in persons (diagnosed by psychiatrists) with serious mental illnesses like schizophrenia.  Many diagnosed schizophrenics ?do not believe they are ill despite evidence to the contrary? (p.1). Some ?have a compulsion to prove to others that they are not ill?.  (p.1). These people are now said to be suffering from the brain defect that causes anosognosia.  This means, of course, that they have two mental illnesses requiring treatment (schizophrenia and anosognosia).  The treatment may have to be involuntary (forced) as they deny being ill at all.  (Unclear is whether also denying that one has a brain defect causing anosognosia is itself an illness caused by still another brain defect). 

There are several puzzling questions as yet unanswered.  Examples:

1) For many years homosexuality was included in the DSM as a mental illness.  A great many people, straights, gays, lesbians, bi-sexuals, argued that it was not a ?mental illness?.  Were all of them suffering from anosognosia?  Did they have a brain defect?  Since 1972, when homosexuality was removed from the DSM, it no longer is considered a mental illness.  Should there be a diagnostic category for all those psychiatrists who for many years were wrong when they insisted that homosexuality was a mental illness when it is not? A puzzle.

2)      Some current mental illnesses were not considered mental illnesses until recently.

Adolescent rebellion, arithmetic learning problems, childhood hyperactivity and attention deficit were not mental illnesses until they were put in DSM III & IV.  If children were exhibiting these behaviors at the time the behaviors were first called mental illnesses could they argue pre-existing non-illnesses? Does the brain defect occur only after the illness is named?

3)      For many years a very large number of people suffered with a neurosis. Freud was

especially interested in the neuroses and their cure through psychoanalysis.  Popular neuroses included neurasthenia, psychasthenia, hysteria, hypochondriasis, and multiple personality.  But in DSMIV these long-used diagnoses were stricken from the diagnostic system.  Unlike homosexuality, which still exists but is not a mental illness, the neuroses apparently no longer exist.  Were all those millions of neurotics suffering from non-existent disorders?  If they agreed that they were neurotic, but were not, were they suffering from a still-unnamed disorder that we might call pseudognosia? Is it caused by a brain defect?  Is Woody Allen really a non-neurotic?

4)      American and British psychiatrists vary consistently and significantly in the

frequency with which they label people ?schizophrenic?.  American psychiatrists use this diagnostic label far more often than their British colleagues.  To check the possibility that Americans might be more prone to this disorder a clever experiment sent a group of American psychiatrists to London to see incoming cases to a mental hospital for diagnosis, and brought a group of British psychiatrists to Brooklyn to see an incoming set of Americans requiring diagnosis.  Sure enough, the American psychiatrists, true to form, saw larger numbers of Brits in London as schizophrenic, and the British psychiatrists saw fewer Americans with the diagnosis.  Now the question is: If a British tourist acting strangely is taken to Belleview Hospital in New York and labeled schizophrenic can he/she argue that his/her psychiatrist back home disagrees, and claim not to be schizophrenic?  Does he/she have a brain disease, but only in America? Similarly, if an American labeled schizophrenic at home, on holiday in England, declares ?I am not schizophrenic? is this declaration valid, or a case of extra-territorial Anosognosia?

5)      It is not uncommon for distinguished psychiatrists to disagree on a diagnosis of

schizophrenia, and even for groups of psychiatrists testifying for the prosecution and for the plaintiff to come to opposing positions.  In the trial of the young man who shot President Reagan (to try to impress actress Jody Foster) he was seen as sane by psychiatrists for the government and as insane by psychiatrists representing the family.  The jury believed the latter group and ruled him ?Not Guilty by Reason of Insanity?.  In an ironic twist he is incarcerated in St. Elizabeth?s Hospital in Washington, D.C. in the care of government psychiatrists who found him sane! Who has the Anosognosia here?

6)      Recently it has been asserted that relatives of schizophrenics may show ?early

signs? of the condition.  They are alleged to be ?genetically vulnerable?.  Now, it is suggested, these people might benefit from prophylactic drug treatment, thereby preventing the debilitating consequences of later full-blown development of the condition.  The problem arises: If a relative does carry a diagnosis of incipient schizophrenia, and denies that they are at risk, can they be said to be suffering from anosognosia?  If they successfully resist the prophylactic treatment for many years, even a lifetime, and appear normal throughout does this require correction of an earlier diagnosis of anosognosia?  Can they sue? 

7)      Finally, there is a mammoth problem. Mary Boyle, a distinguished British

psychologist, has written a brilliant, carefully documented account of the history of ?schizophrenia?.  She details the confusion, the inconsistency, the lack of reliability, of the concept and concludes that in all probability there is no such disease.  (It should not be necessary to say that some people do have psychotic symptoms).  But the new label Anosognosia supposedly is common in schizophrenics (who cannot be schizophrenic if the condition does not exist).

If schizophrenic does not exist then those who deny that they are schizophrenic are correct and cannot have a brain defect that causes the denial!

            This bizarre situation suggests that brain defects should be identified only by direct observation (by neurologists preferably) rather than inferred from unreliable observations.

One of the greatest advancements in human knowledge and thought has come from the rise of science.  Science has many characteristics including the reluctance to accept any finding as absolute. Hypotheses are accepted or rejected with varying degrees of confidence, never with certainty. And scientists are always ready to examine new findings with appropriate skepticism. They repeat experiments or design new ones in a serious attempt to find errors.  Unfortunately, in psychiatry, much that passes as research is financed by the pharmaceutical corporate giants. They pay for the research. They pay the referees who judge the research. They underwrite the cost of the conferences where results are announced and the cost of publishing the psychiatric journals where they are published.  The usual freedoms of scientific inquire are missing. Anosognosia is just the latest example of a concept that has not received serious scientific study.  But it will be effective in selling more ?drugs for the mind?. 

 

Editor?s note: Dr. Albee?s paper raises certain other diagnostic questions. What can be said for those of us who follow the logic of Thomas Szasz and deny the existence of mental illness in general and therefore in others? Might Szasz, Albee, I, and others of our ilk be suffering from ?Anosognosia by proxy? or ?Hetero-anosognosia??

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Taking Risks in the World of the ?Mental Health? system

 

Emmy Rainwalker

 

Recently, I was invited to give a 3 hour talk on the subject of ?childhood depression? to a group of about 30 school psychologists and guidance counselors.  My first impulse was to tell the organizer to get someone else for the job.  Two years ago, I addressed this same group and talked about psychiatric ?medication? (or what is more aptly called ?drugs?).  I openly declared my opinion that psychiatric drugs are not advisable when ?treating? children with troubling behaviors. The repercussions of that talk were quite interesting and led to the loss of a part time consulting job in a particular school.  After my first impulse to stay far away from this group, I thought to myself, ?well, they can get someone else who will probably give them a ?medical model? describing ?depression? as a biochemical imbalance or due to faulty genes and ?treatable? with drugs or they can get me and my perspective.  I accepted the engagement.

When I arrived, I mingled with the participants and a few of them remembered me and told me they had appreciated my talk last time.  One began again to debate the issue of drugs and paint me as a ?controversial social worker?, but I had decided this time that it would not be useful to try to convince anyone of my viewpoint in this type of forum.  I would not hide or back down from my beliefs, but because not enough personal connection could be established to challenge people?s views successfully, I would not engage in arguments.  So I deftly steered the conversation away.  Another person was visibly shaken to see I was the presenter and she had been the one who had told the school principal where I was a consultant that my views were dangerous.

The weekend before this talk, I went to a political rally and heard Michael Moore speak (the producer of the film ?Bowling for Columbine?.  He impressed me as being very honest and confidently ?himself?.  I imagined myself doing that.

I began, as always with a story about the importance of listening and how I was sure that they could use some listening, especially on the topic of their jobs.  I taught them to do ?support listening? (exchanging 5-minutes each of attention in pairs).  Then I asked them to go around and introduce themselves and say one quality that makes them well suited for their jobs. There was lots of laughter and people began to relax.

I made a ?presentation? of about 15 minutes about sadness, self-mutilation, suicide attempts and actual suicide in young people.  I asked who had experienced a young person killing herself.  Four people raised their hands and talked lightly about their feelings.

I then talked about ?turbo capitalism? and explained it as everyone in this culture having to work harder to keep themselves and their families alive?to keep making enough money to pay their bills by having to work longer hours with less support.  The floodgates opened.  They began to tell me how disappointing their jobs are, how they can?t really listen to students because there is no time, no space.  One psychologist told me he does not want students to talk to him because they might get hopeful and then be disappointed when he is not able to maintain the connection.

I asked how many people had a space in their school where they could close the door and allow someone to cry or openly complain or show anger.  Only about 5 people raised their hands.  Throughout, I kept reminding them that they are good, intelligent and caring people.  It seemed to me that the biggest hurt for many of them is that they cannot figure out how to show caring at their workplaces?even though that is why most of them chose these careers.

When the topic of medication came up, I told them about a recent article in Drug Trends magazine which reported that about 50% of people prescribed anti-depressant drugs stop taking them within a short time. (Thanks to whoever posted that.  This sharing of information that we do is enormously helpful.)  I said ?If you think you can refer someone for medication and then they will not be knocking on your door again, you may be surprised to find that their problems have not gone away and you will still have to deal with the situation.?  Heads nodded all around.

In the beginning I told them that the most important thing I could do to help them deal with sadness in others (I avoided the world ?depression? as much as possible) was to convince them to find a way to be listened to themselves so they could improve their ability to pay attention to others.  I explained how, as a ?mental health? worker, I exchange at least one hour of attention each way with another person, where I show my frustrations, anger, sadness and joys every week, and how much it helps me to keep going in these very confusing times.

At the close, I described how a ?peer counseling? project for students in schools could be established by teaching young people to give kind, relaxed attention to each other.  I pointed out how this might take a little of the pressure off them. People were very interested in a point of view that is hopeful and were lined up to find out where to get more information. 

I know some of the participants probably left with a critical attitude, as they had before, however this time I was quite aware of the risks and felt that they were worth it. In my own preparation, I kept saying (and laughing hard each time) ?some things are worth losing my job for?.  I was very pleased that I was able to be my ?confident self?, a warm, well-informed, caring, social worker.

Once again, I thank all of you on this ICSPP list for your support and your passion to disseminate the truth.  It makes a big difference for me in my work. 

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A Parents? Group with In-House Childcare: A Model for Helping Families with Separation Issues

By Emmy Rainwalker and Anne Piche

Separation anxiety is common in children and causes confusion and stress for parents. Holding a group for parents with a nearby group for their children has produced some positive results.

When we decided to do a daytime parenting group we realized that childcare for pre-school children is one of the most important services needed to get parents to come. Many at-home mothers wanted to attend the group, but did not have childcare.

The two authors, a parenting-group facilitator and a childcare worker especially good with babies and toddlers, decided to run a weekly parenting group with childcare offered in the same facility so the mothers could be close by.

Each of us came to this with the experience that working with only parents or children at different times was limited, and parents were continually frustrated with the seeming lack of progress around separation issues. We hoped we could help families move through this difficult stage more efficiently by holding the groups simultaneously with a common theory guiding each.

The assistance of a graduate intern in the childcare room contributed greatly by giving the primary childcare provider the freedom to be able to focus her attention on one child when necessary to assist that child through a difficult transition. Also, sharing the ideas and demonstrating the practice was valuable to the intern.

For the ten weeks of the group, the mothers and children arrived and went into the children?s room first. They were greeted warmly by the team members who took a few minutes to listen to them. The mothers were encouraged to take some time saying goodbye to the children, assuring them they would be back, as always. The caretakers also reassured the children that they were safe and that the moms would be back in awhile.

When the mothers left, some of the children cried. The caretakers were able to give the children attention and encouraged them to show how badly they feel when their moms go away.

Usually, when children show their fear and anxiety, people try to distract them or tell them their feelings are not appropriate. In this group, the children could work through their struggles with help. The other children sometimes asked questions and the staff was able to directly and simply talk about how it feels when someone you love leaves you.  Normalizing this separation phenomenon and seeing an adult stay relaxed and attentive when a child is having difficulty created safety for all the children. Allowing a child the space to work through to a positive outcome, teaches a child that with support, they can toil through even very difficult feelings. When their minds are free of worry, they can return to relating to the people and world around them.

Here is Anne?s description from the children?s? space: As the childcare provider for the team, I experienced success that gave me great satisfaction, especially with one of the young people.I had seen this mother and son previously and they had been struggling with separation issues. For the first session, D. screamed and clung to his mother when she prepared to leave him with me and go to the mothers group. D. expressed his anger, sadness and fear for the entire hour by screaming, crying, shaking and generally not relating to anyone else in the room. I continually paid close attention to him. He did not want me to touch him so I stayed with him at a respectful distance, continuing to talk to him. When his mother returned, he again clung to her and cried and buried himself in her arms. The second week, D. started to cry and scream on his way to the building and continued through their separation and for the entire hour.  I was, however able to make eye contact with him for brief periods this time. Upon her return, he clung to his mother and continued to cry. On week three, D. came in expressing his distress again and cried and screamed for a few minutes. When he quieted a bit, I attempted to engage him and interest him in some of the activities that were happening in the room. He refused and ?sulked? awhile. I kept connecting with him, inviting him, and remaining hopeful and then, quite spontaneously he joined me at the chalkboard and happily drew pictures, directed my drawings, chatted with me and smiled for the remainder of the hour. When his mother returned, D. engaged her in his activity, continuing to draw and chat for several minutes until the group dispersed.

At the same time, the parents were in the next room for a support and skill-building group.  Here is Emmy?s report. The parents could hear the children crying. I was able to work with the mothers about how they felt when their children have strong emotions. I explained that adults have physical and emotional reactions to children crying and that is normal. I emphasized that the children were safe, and each parent was free to check on her child at any time. I encouraged them instead to tell the group how it feels when their children are crying. 

This led to wonderful disclosures and emotional releases about the challenges, the loneliness and the stresses of parenting. This was accompanied by loads of tears and laughter. In addition, the parents were able to know that other adults could be relaxed and attentive while the children were expressing difficult emotions and I reminded them repeatedly that this is exactly what was happening in the children?s? room. They found that hard to believe, and were quite surprised when they later saw the childcare workers looking relaxed and pleased. The mothers were able to wrestle with their own feelings while their children struggled nearby. We exposed the common parental difficulty of allowing children their full expression, including the ?negative? emotions.  We had good discussions about the challenge of setting clear limits for children without blaming or hurting them and how to stop the pull to stifle or punish a child who is struggling.

One parent, T. worked through a great deal. Her son D. was very upset about leaving her and she had not known what to do. The parents encouraged her to keep coming to the group, even though her son cried long and hard for the first two sessions. She cried in the parents? group about how desperate she was, feeling crowded by her son?s attachment to her and guilty about wanting space. After the third meeting, when she saw her son playing happily, she was encouraged.

At the end of each session, the parents went back into the childcare room and talked with their child and the workers about how it went. We spent the last minutes together enjoying the reunions. During their separation, some had released emotions, some witnessed others releasing emotions, some discovered abilities that surprised them. They were happy to come back together having learned something important by being apart.

Parents want to spend quality time with their children but are hampered by discomfort or confusion about how to resolve conflicts, such as separation. Parenting in isolation does not help.

Our working theory was that the struggle these families faced around separation issues would be alleviated by giving parents time to develop trusting support, to learn and practice new skills and to release some of their own anxieties, while allowing the same for the children. We were able to use the parent/child issues that were presented by the families themselves and we were pleased with what we were able to accomplish.

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THE BANALITY OF POSITIVE THINKING

Simon Sobo, M.D.

I was asked to see "Bob," a 16-year-old prep school student, who a month and a half earlier had been placed on a selective serotonin reuptake inhibitor by his family physician. The medication had been somewhat effective. He had been dysphoric periodically, and he still could get down, sometimes feeling very isolated. But overall, he was now OK when "doing things" with his friends. When Bob was alone for a few hours, he tended to have morbid thoughts about death. He felt the authorities at school had totally overreacted when the nurse misinterpreted some remarks he had made about death two months before he saw me. They immediately sent him home, insisting that he be put on medication, and did not let him return until his therapist, whom he had been seeing for a year, agreed Bob had never been suicidal.

Meeting Bob for the first time, I was struck by a false jocularity, an awkward quality he shared with his father, whom I briefly met in the waiting room. Both spoke slightly too loud and did not really give me a chance to be infected with their cheerfulness. Their eye contact and body language did not agree with this cheerful demeanor. They were on automatic pilot. Both looked a little frightened, which is not unusual when meeting a stranger, especially a psychiatrist. It was the cheerfulness that seemed off. Bob's therapist suggested that he seemed to almost enjoy the darker side of things, especially conversations about death. The therapist wanted him to think more positively and gave him homework assignments to accomplish this. His negativity had tended to isolate him at his prep school, where conversation tended to the lighter side.

When Bob settled down and told me his story, the happy face dissipated, and we began to connect. Bob had been raised by his grandparents. He had never met his biological father and did not know who he was, and his mother was a drug abuser who had given him to his grandparents for adoption at infancy. He had met his biological mother a few times but preferred "not to think about her." However, he did think about his (grand)parents a lot. His (grand)mother had died two years before in her mid-70s after several strokes. He thought this was a good thing because she had suffered greatly in her later years. His (grand)father was 79 years old and also was not healthy. In my waiting room, he labored to catch a breath. My assumption was that he had emphysema. He sat in the chair with a broad-based posture, like he might fall off. There were not a lot of good years left. Bob told me that many of his parents' friends had died in recent years, as well as two of his aunts. He might soon be an orphan, and this got him down. It should be noted that his visit to the school nurse occurred shortly before Thanksgiving. He had been thinking about the holidays without his (grand)mother.

The issue for us is whether positive thinking is relevant in this kind of situation. Would it help him, or would it create more problems than it would solve? True, finding a positive outlook is helpful in any set of circumstances. If he could relax and let life's bountiful pleasures and rewards reach him; if he could turn off bad death thoughts and replace them with optimistic ways of thinking about life's mysteries -- who knows? Hope is always crucial. If only he were religious, that could put a positive spin on everything. Meaning and purpose would be restored. However, he wasn't religious and neither was his counselor. So he was left with homework assignments, which he diligently attended to. His counselor felt that his need to think about death was not only causing his depression but that his morbid thoughts were "obsessive" in nature. Given that Bob was trying not to be so negative, the negative thoughts were "intrusive."

It reminded me of another patient I saw whose husband left her after a 35-year marriage. She still could not get him off her mind eight months after his intentions about their future were made clear and four months after she began doing cognitive-behavioral homework assignments to clear her thinking of ?obsessive? morbidity. In her case, the futility of this became clear at one of our medication visits. She told me how she had overreacted to playing terribly at her tennis game. She was not simply down about her poor play; she was down on herself for being down. As with Bob's case, her therapist seemed to imply that she liked being negative. I told this patient to be kinder to herself. If she needed to be down, it was perfectly fine. Anyone in her circumstances would not be enjoying a wonderful state of mind. It would take a little while -- maybe more than a little while -- until she would get back to her old self. Trying to be positive was unnecessary, certainly not as a standard to hold for herself. In the meantime, I told her we could probably medicate her into a state of relative comfort.

Obviously, Bob's need to talk about death was based on a real ongoing stressor in the here and now. It was going to have social consequences. Bob was going to be heavy-hearted, and those looking for a good time would most likely be able to identify his state with a glance. It would not matter if he talked about death or did not talk about death. True, if he could become a very funny guy, his popularity might improve. And for teen-agers, being acceptable to peers, getting asked to parties and having someone to sit with in the cafeteria are all important parts of gaining self-esteem. But even if his (grand)mother had not died and she was a healthy 75-year-old, it is unlikely that Bob's joke-telling abilities would have been greatly improved. He is not that kind of guy. Nor is his (grand)father. Their cheerfulness in social situations comes across as being "off." As for coming across with a relaxed persona, that is always helpful in dealing with people, and fluoxetine (Prozac) might do wonders for him in this regard, but, important as it is to teen-agers, I would like to drop this whole subject of how to seem positive to others and get to the real point of this article.

What if Bob were negative and enjoyed being negative and wanted to pull others into his negativity because he wanted company in that part of his experience? What if "misery loves company"? I would argue that Bob has a right to his morbidity. He needs to work through his experiences, and having someone, maybe more than one person, go there with him and understand, rather than react to his negativity like he is being a creep, is crucial to the formation of a solid identity and his later capacity for intimacy. True, many, perhaps most, of his friends cannot and, probably, do not want to go there. They do not really want to understand, which is certainly understandable. It would be futile for Bob to force the issue on others, and it might just be that there will be limitations on how close he can get to certain people. Maybe many people. It is very possible, however, that he might find a companion who can dig the "blues," and this could form a solid starting point for a relationship. I think of the character Mel Gibson played in the movie "The Man Without a Face," his calm guiding strength shaped out of suffering, able to help the teen-ager transform life's hardship into tolerable proportions with his dignity and vision.

That used to approximate the ideal in therapy. That was a "positive" outcome. Oh, none of us were ever as cool as Mel Gibson. But sometimes we were. All this focus on chemical imbalances and negative thinking! The old kind of therapy does not loan itself very well to short-term efficacy studies. The new scientific therapy loans itself all too well to short-term results. We live in a world of short-term corporate profits; a "Have a nice day" sensibility about our well-being.

DSM-IV provided a scientific discipline with its clearly defined syndromes, based on clearly defined symptoms. From there, the next logical step was empirically based treatments, based on the defined disorder. But the downside of DSM-IV is that it has tempted clinicians to force a diagnosis so that they can use a proven treatment (Sobo, 1999). Apparently, some clinicians feel that if a DSM-IV category cannot be assigned, there is no illness and therefore no justifiable treatment. Certainly, this is the position of HMOs, and at this point, treating DSM-IV symptoms has become the only thing that some psychiatrists will do. Everything else is not illness but problems in living. Bob qualifies for a diagnosis of depression not otherwise specified. Cognitive-behavioral therapy has been shown to work for depression. The issues I am raising in his treatment have nothing to do with DSM-IV, yet they are most certainly vitally connected to his treatment.

The point of DSM-IV was not to ignore clinical phenomena that are not categorized by DSM-IV. It was not to toss out decades of observations, thoughts, discussions and theories about the developmental and emotional needs of patients should their unhappiness not fit easily into modern categories. We are far too young in our science, far too ignorant of etiology to limit our field in this way. Ultimately, even our science will suffer if heuristic pathways are dismissed as not a part of our field. But, more to the point, our patients now, as much as ever, still turn to us for understanding, not cookie-cutter, one size fits all treatments. Is it sound clinical judgment to bypass hard efficacy data for a softer but, I believe, more relevant perspective? Or is this a bit of nostalgia that interferes with the work at hand? To me the answer is clear.

Dr. Sobo is in private practice in northwest Connecticut. His book The Fear of Death (1999) is available from Xlibris Corp.

Reference

Sobo S (1999), Mood stabilizers and mood swings: in search of a definition. Psychiatric Times 16(10):36-42.

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Not at all in the genes

Craig Newnes interviews Jay Joseph

Some things bear repeating: science is a mixture of good and ill, much in psychology is a story told entirely in metaphor, and, just because various things run in families, genetics may have nothing to do with it. This last point has been addressed by Kamin, Laing, Marshall and others, all swimming against the tide of bio-determinism so little questioned in our times. In The Gene Illusion Dr Jay Joseph, a clinical psychologist from California argues that all the research to date into the genetics of schizophrenia, intelligence and criminal behaviour is so flawed that the results are meaningless. Joseph suggests that in their determination to find genetic causes for behaviour researchers have ignored basic research rules governing controlled studies and other factors. With a blend of irrefutable logic and systematic science The Gene Illusion debunks all the myths of the bio-genetic industry. The book explores the eugenic foundations of genetic research in psychology and psychiatry and systematically critiques every major attempt to prove that we are little more than our genes. For some researchers, psychologists and psychiatrists, it could change their view of genetic research forever.

In the end, Joseph shows that far from demonstrating that schizophrenia, intelligence and criminal conduct are genetically determined, research to date actually supports nurture (or, more accurately, lack of it) over nature. Craig Newnes thought it might be a good time to find out what all the fuss is about.

 

Who the devil are you?

I?m a clinical psychologist practicing in the San Francisco Bay Area of California. I made a career change in my 30s, and received a doctoral degree in clinical psychology in 2000 from the California School of Professional Psychology, Alameda, California. My dissertation consisted of a critical analysis of the evidence supporting a genetic basis for schizophrenia, which consists mainly of twin and adoption studies. Since then, I have published several articles on the genetics of schizophrenia and other psychiatric diagnoses. The Gene Illusion combines much of the work and thinking I had done in the previous six years, plus research into new areas (for me), such as IQ and molecular genetics. Currently, I take the minority position challenging the current widespread belief, recounted in untold textbooks and journal articles, that psychiatric disorders and normal psychological trait variations have important hereditary influences.

 
How did the passionate interest in genetics develop?

I came into the field of psychology believing that 1) many psychiatric diagnoses can be seen more as labeling and pathologizing deviant behaviour than as real diseases, and 2) to the extent that people suffer psychological distress and damage, the likely causes are abusive and neglectful family environments, social and political factors, and the pressures of living in advanced industrial societies. I discovered that most psychiatric conditions were viewed by psychiatry as "biological" and "genetic." This motivated me to go to the primary sources of genetic theories? family, twin, and adoption studies? as well as to the works of critics. I found that twin and adoption studies contained massive methodological problems, and more importantly, that their authors' conclusions in favour of genetics rested on very questionable theoretical assumptions. In the case of twin studies, it is assumed that there are no differences in the social and physical environments experienced by identical versus fraternal twins, which seemed to me obviously untrue. Naturally, the deeper I dug the more motivated I was to dig even further. I also found out that the early genetic studies were performed by people strongly devoted to the genetic position, who performed their studies in order to bolster the case for human selective breeding programmes - eugenics.

The Gene Illusion is extraordinarily detailed in its critique of schizophrenia twin studies. The psy-complex has a habit of acting as if serious criticism of this kind simply doesn't matter. How have the psychological and psychiatric community responded?

 

They have responded, as is their habit, mostly by ignoring my work (although several mainstream journals have published my articles and have been quite fair with me). An exception has been my work on the genetics of ADHD, where my publications on this topic have been followed by responses from American psychiatric geneticists Steven Faraone and Joseph Biederman. They argued that my work contained errors of scientific logic and ignored the results of ADHD segregation analyses and molecular genetics research. They claimed that genetic theory makes predictions that turn out to be true. While acknowledging that some of my criticisms have merit, they concluded that genetic explanations are more "parsimonious," and should be accepted because they "have not been disproved." But the burden of proof falls on them, not the critics.

 

I have always taken the position that I don't need a systematic critique of the research data on schizophrenia because the idea of mental illness is fundamentally flawed. People like Thomas Szasz and Mary Boyle have pretty much trashed the whole concept as far as I?m concerned. Am I just being lazy?

 

I agree that the schizophrenia concept is fundamentally flawed. But this is still the minority view, so it?s necessary to demonstrate that, even if schizophrenia were a valid entity, there?s little if any scientifically acceptable evidence that it is caused by genetic factors. After nearly two decades of looking, no schizophrenia genes have been found. The reason is that they don?t exist.

 

In my experience psychiatrists are very pragmatic and a lot of the work is done by junior doctors who don't have much time to read, especially big books. Is it psychiatrists or psychologists you are trying to influence?

 

I am trying to influence psychologists, psychiatrists, and others in related fields. I suspect that I will receive more of a hearing from younger professionals and academics. They may be more open to new ideas. I tried to write the book in a way that could be understood by the general public as well; this was often difficult.

 What would you hope psychologists would do differently having understood the weakness of the pro-gene lobby's arguments and research?

 

I would hope that they would go back and read the original studies with a more critical eye. If this isn?t possible, they should view the arguments of critics as being on at least equal footing with mainstream arguments in support of genetics. Clinicians should become more skeptical of both genetic and biological theories, which are the foundation of biological psychiatry's now mainstream position that mental disorders are "brain diseases." It might also lead them to become more skeptical of the emphasis on pharmacological interventions. I believe that many clinicians are already unconvinced by biological theories, based in part on clinical experience showing that most people carrying more disabling diagnoses experienced chaotic and abusive family and social environments. We learn about this because we talk to people in distress and empathically listen to their stories, whereas in genetic research people are seen mainly as diagnosed subjects. In my book I quoted the American psychologist and psychiatric genetic researcher David Rosenthal, who in 1968 observed that supporters of environmental causes of schizophrenia tend to be interested in people, whereas genetic researchers focus on numbers. These words are truer today than in Rosenthal?s time. At bottom, I hope that the rejection of genetic theories will help us understand more clearly that the people we work with are not damaged biologically or hereditarily, but emotionally.

 

Having discovered people are "damaged emotionally" what would psychologists do?

It is essential that we help people change their environments. Even more important, however, is that therapists must themselves do something to change the social and political environments that inflict the psychological damage we see in the people we work with. It is not enough to undo this damage on the individual level; change must be made at the political level as well. Otherwise, psychotherapists may be unwittingly helping people adapt to oppressive conditions, when the goal should be to eliminate oppression.

 

As well as schizophrenia, The Gene Illusion covers intelligence and criminality. You?re very critical of research in both fields. If most of what has been done in the world of intelligence research is based on flawed methodology, do you think IQ testing should be abandoned?

 

In Chapter 9 of The Gene Illusion I wrote that IQ tests should indeed be abandoned. I realize that many psychologists who might agree with this position also feel that the tests have some positive features apart from the alleged measurement of "intelligence." However, any possible useful aspects of IQ tests could be incorporated into new tests, or could be obtained from existing tests. The main thing would be to abandon any test claiming to be able to measure and quantify "intelligence." I am partial to Ken Richardson's position, in his 2000 book The Making of Intelligence, that IQ tests were promoted by the economic elite to reproduce the existing ranks in society, but were claimed to be measuring something else ("intelligence"). IQ tests are, by their very nature, biased against minority groups and the working class.

 
The research on the genetics of criminality is equally weak. What's going on here? Why are people funding research that is doomed to fail rather than looking into more obvious causes of criminality - poverty, greed, the need to destroy?

 

Because this type of research is promoted by the wealthy elite, who seek to distract attention from the social conditions causing crime that they created. The goal of biological and genetic research on crime is to place blame on people's biology, not their social conditions. Genetic research on criminality has a long and ugly history. Criminal offenders were labelled by eugenicists, racial hygienists and Nazis as the biological remnants of our "savage" past in need of sterilization, castration, or worse. The racist implications of these theories are obvious. 

 
Do we have a responsibility to let the public know the implications of your work?

Yes, because the public's views are shaped by the views of mainstream psychiatry and psychology. These views are typically delivered to the public by journalists, in articles and in popular books. I?m really pleased that in the UK at least my work is being quoted in the press. Psychologists need to be much more open to critical reflection and be more outspoken about what creates madness, limits creativity, and pushes people into criminality. Genetics is a one way street leading to a blind alley in all these areas.

The Gene Illusion: Genetic research in psychiatry and psychology under the microscope. (ISBN 1 898059 47 7) is published by PCCS Books

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OVER THREE DECADES OF ICSPP ACCOMPLISHMENTS:

Stopping the worldwide resurgence of lobotomy and psychosurgery on adults and children, and all psychosurgery in federal and state institutions.

?        The creation of a federal Psychosurgery Commission by Congress (1970's)

?        Alerting professionals to the dangers of tardive dyskinesia in children (1983). Tardive dyskinesia is a potentially devastating neurological disorder caused by neuroleptic or antipsychotic drugs.

?        Alerting professionals to the dangers of dementia produced by long-term neuroleptic drug use (1983).

?        Motivating the FDA to force the drug companies to put a new class warning of tardive dyskinesia on their labels for neuroleptic drugs (1985).

?        The withdrawal of a large multi-agency federal program to perform dangerous invasive experiments in inner-city kids in search of supposed genetic and biochemical causes of violence (the violence initiative) (early 1990's).

?        The initial cancellation and later modification of a potentially racist federally sponsored conference on the genetics of violence (early 1990's).

?        Alerting the profession to danger of down-regulation and dangerous withdrawal reactions from the new SSRI antidepressants such as Prozac, Zoloft, and Paxil (1992-4).

?        Monitoring, and at times modifying or stopping unethical, hazardous experimental research on children (1973-present).

?        Encouraging that NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder to raise serious concerns about "ADHD" and stimulants for children.

While each of these critiques and reform projects was initially considered highly controversial, and while each was frequently opposed by organized psychiatry, most are now widely accepted as rational, ethical, and scientific. For example,

Psychosurgery is no longer widely practiced and not at all in state or federal institutions or on children in the United States; the multi-agency federal program aimed at using invasive biological procedures on inner-city children has been disbanded; the conference on the genetics of violence was delayed and then vastly modified; all experts now recognize the dangers of tardive dyskinesia in children; many researchers have confirmed that the neuroleptic drugs produce dementia, and experienced doctors now recognize the potential for dangerous withdrawal effects from the SSRIs.

      Become a member by mailing a $25 check or money order (U.S. funds) ($35 U.S. dollars if mailing address is international). Check or money order should be made out to ICSPP. An additional tax-deductible donation can be added, and would be deeply appreciated.

 

 

 

 

 

 

 

Your Donations to ICSPP help!                

            Your membership in ICSPP covers the expense of producing four newsletters per annum and other mailings, and helps us to continue to respond to the hundreds of information queries we receive from the public, the media, and concerned professionals.

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Editors - Ethical Human Sciences & Services: An International Journal of Critical Inquiry

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Laurence Simon, Ph.D.

 

 

 

 

 

 

 

 

 

 

 

For International/National membership, newsletter, advocacy, and technical information contact the international office. For regional activities contact the regional

directors and watch this newsletter for announcements.

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ICSPP Australia

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Australia

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Medical Director, La Piece

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USA-ICSPP Southeast

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USA-ICSPP Four Corners

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USA-ICSPP Mid-Atlantic

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Longwood College, Psychology Dept.

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USA-ICSPP New England

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USA-ICSPP Northern California

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CALL FOR PAPERS AND CONFERENCE REGISTRATION FORM

 

Eighth Annual Conference of the

International Center for the Study of Psychiatry and Psychology (ICSPP)

October 8^th, 9^th, and 10^th, Sheraton LaGuardia East, New York City

 

Critiquing Disease Models of Psychosocial Distress and Developing and Implementing Effective Psychosocial Theories and Interventions

 

Outstanding Invited Speakers Include: George Albee, Ph.D. Researcher and past president of the American Psychological Association; Mary Boyle, Researcher and author of ?Schizophrenia: A Scientific Delusion?? Peter Breggin, M.D., founder and President Emeritus ICSPP, author of numerous scientific works including Toxic Psychiatry; Celia Brown, President of Mind Freedom; David Healy, M.D., Researcher and author Let Them Eat Prozac;  Bertram Karon, Ph.D., outstanding Psychoanalyst, researcher, and prolific au