How mental health law discriminates against people with mental illness

via Gresham College 

Professor George Szmukler, Institute of Psychiatry, King’s College London

How mental health law discriminates against people with mental illness 

 Summary

Mental health legislation, as currently conceived in most jurisdictions, discriminates against people with a mental illness.  It carries underlying assumptions that people with such illnesses are not fully autonomous and that they are dangerous to others.  Thus such legislation reinforces damaging stereotypes of people with a mental illness.  By building on the complementary strengths of capacity-based and civil commitment legislation, we propose a ‘fusion’ of legal principles into a model law which has decision-making capacity at its centre, but which clearly defines how the use of detention and force are to be governed.  This comprehensive law is designed to apply to all persons who lack capacity, from whatever cause and in whatever healthcare setting.  We have drafted a model law that demonstrates these principles can be given practical expression¹¹.  The model law, unlike the current MHA is, I would argue, compliant with the UN Convention on the Rights of Persons with Disabilities.

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A doctor of psychiatry and his medical instruments

When one realizes that Human Rights crimes are legally mandated but it's called providing "effective medical treatment" to people with a diagnosis of schizophrenia, who don't know what's good for them (because they supposedly have a lack of insight) it's truly stunning.  I realized this was happening when I was a kid---I have been aware way too long to be polite sometimes...The fact that a minority of people with a diagnosis of schizophrenia actually benefit from taking the neuroleptic drugs; but that everyone who takes them faces serious risks to their overall health is not relevant, and neither is determining if the person Court Ordered is among the minority of people the drugs help. The Nation's top psychiatrists, and grassroots mental health advocates for the "seriously mentally ill" lobby for public policies and Legislation so that more people can benefit from psychiatric treatment "for their own good." (and 'protect' society)

The fact that psychiatric treatment commonly results in iatrogenic illness and disability and leads to a decades earlier death is a well established; an obviously accepted, if not intended, outcome. It's plain that disability and early death is the most commonly achieved Real World Outcome for people treated by psychiatry; particularly for people who are diagnosed with schizophrenia. Obviously, words like "safe" "effective" and "treatment" had to be re-defined for psychiatry's clinical standards of care; the terms, "clinical care standards," "best practices" and "off label prescribing priveledges" have also been redefined by psychiatry. Psychiatrists who write, recommend, and use drug based treatment protocols and algorithms and who teach students and other medical professionals to use them, must believe that disability and early death are beneficial to patients; acceptable, desirable treatment outcomes and perhaps even deluded enough to believe that consensus is a substitute for ethical medical research. Doctors of psychiatry, leading psychiatric researchers and public mental health policy makers are providing a standard of care with consistent, reliable results; unfortunately, the most probable outcome is death. This bewing the case, one can understand how perjury and forgery have simply been re-defined, they are now part of psychiatry's standard of care which are supported by the specious claim that teratogenic drugs treat undefined "chemical imbalances" and unidentified "brain diseases" which psychiatrists believe may be causing "mental illnesses;" more accurately described as, psychiatric diagnoses. Unsubstantiated claims are the so-called "evidence" that standard clinical practices are based upon. The neuro-biological disease and/or chemical imbalance hypotheses are, at best, slurs which stigmatize; at worst, they are fraudulent claims made in order to deprive people of their human rights based on eugenic theory repackaged then marketed to the masses as valid, ethical "medical science."

People with a psychiatric diagnosis have their Human Rights violated as a matter of course; the rights most people take for granted. Mental health professionals have a moral and an ethical duty to preserve the fundamental human rights of people whom they give a psychiatric diagnosis. Instead, mental health professionals and 'patient advocates' support legally diminishing what are inalienable rights---but what the hell, safe and effective treatment is not actually safe or effective so what is a little deprivation of one's human rights in order to medically treat the diseases psychiatrists voted into existence! Even clinical care standards are determined by pseudo-democratic political process. The standards are not based on ethical, scientific research; or any ethical medical standards used by any other field of science based medicine. Psychiatry uses the Courts to strip patients of their human rights, psychiatry does not conform to legal standards i.e. Rules of Evidence, and Standard Court Procedures, that are required for for every other type of Court Proceeding, whether civil or criminal.

The nature of psychiatric diagnoses and the effects of the drugs is not relevant in commitment proceedings. No where in our society is psychiatry held to the ethical standards other medical specialties are; not even the ethical standards which are legally mandated by International Law for Clinical Research conducted by Medical Doctors on human subjects. Psychiatry is practiced in a dishonest, unethical manner. There is no evidence that the psychiatric profession values the ethical standards of science, medicine or the law. There is no evidence of psychiatry being compelled by an altruistic intent or that it values or is even aware of a primary ethical duty to psychiatric patients. Patients are disabled and killed at alarming rates by teratogenic drugs and shock treatments prescribed "for their own good."

What psychiatrists do not explain is why the ethical standards of science, medicine or the law do not apply to the practice of psychiatry. What psychiatrists do not explain is why fraud, corruption, and lying in professional journals, textbooks, classrooms and to students and professionals is acceptable. What psychiatry needs to explain is why outright lying and using analogies to explain psychiatric symptoms and coercing "treatment compliance" is ethically acceptable. Dishonesty is not honorable, defense of dishonesty shows an utter lack of ethical integrity.

Why does a group of professionals that is so dishonest and unethical have Police Powers? Courts of Law have lowered all of the ethical legal standards for psychiatry so that the Courts and Police have in effect, become medical instruments used to strip patients of their inalienable rights to force compliance with psychiatric treatment. Rules of evidence do not apply to the "evidence" used against psychiatry's patients, and the lowered legal standard is claimed to be necessary for the patient/victim's "benefit."

It is patently obvious that the lower standards in scientific medical and legal arenas serve primarily to keep facts hidden. Lowered Court standards serve to protect psychiatry while failing to protect psychiatric patients or serve the Justice interests of society as a whole. The same patient can be seen by 3 psychiatrists and get 3 distinctly different diagnoses. Psychiatric diagnoses cannot truthfully be called "diseases." Teratogenic drugs and electrical shocks, both of which cause iatrogenic damage and dysfunction, cannot be truthfully called "safe and effective medical treatments."  Without lowered legal standards, a psychiatrist would not be able to offer "evidence" that a person has a "brain disease" requiring "safe and effective medical treatment." If the Rules of Evidence applied, a psychiatrist could offer little, if any, evidence that would support a petition forcing involuntary psychiatric "treatment."

Lowering scientific, medical and legal standards is necessary, but it is not done to provide "necessary medical treatment" that is "safe and effective." I suspect if any of psychiatry's claims were supported by scientific findings, or grounded in ethical medical principles, i.e. based on facts instead of  subjective opinions, innate biases, errors of attribution, and distorted research; psychiatry would not need to pervert and distort the truth. Police Officers have an ethical duty, an Honor Code, "To Protect and To Serve."  Courts of Law have an ethical duty to apply the law equally to all, as if the Courts were blind to special interests; not biased in favor of predetermined outcomes. In effect, to be blind to subjective biases; basing legal rulings on objective evidence offered in compliance with the rules of evidence, adhering to standard legal procedures. Why has human society allowed psychiatry to subjugate the role of Police Officers and Courts of Law to that of serving the interests of psychiatry? Police Officers and Courts of Law now are performing their jobs as if their ethical duty has become primarily to serve psychiatry as "medical instruments."  Police Officers and Courts of Law serve all of society by enforcing the Law, and preserving individual rights. Service in preservation of Blind Justice is honorable when done with integrity. It is a shameful disgrace; a blight on all humanity when it is not.

via Leonord Roy Frank


A SIGN FOR CAIN
An Exploration of Human Violence
FREDRIC WERTHAM, M.D.



The Geranium in the Window
THE "EUTHANASIA" MURDERS
If the physician presumes to take into consideration in his work whether a life has value or not. The consequences are boundless and the physician becomes the most dangerous man  in the state.

DR. CURISTOPH HUPELAND

(1762-1836)

IF we want to understand violence as a whole, we cannot leave any of its major manifestations in a fog of half-knowledge. But this is exactly what has happened with an unprecedented occurrence of mass violence, tile deliberate killing of large numbers of mental patients, for which psychiatrists were directly responsible. To both the general public and the psychiatric profession, the details and the background are still imperfectly known. This is not only a chapter in the history of violence; it is also a chapter in the history of psychiatry. Silence does not wipe it out, minimizing it does not expunge it. It must be faced. We must try to understand and resolve it. read here

Picture Credit: Just Ducks

Now that is crazy!

It is not surprising that the bio-disease psychiatric treatment paradigm has failed; it is  pseudo-science; based on biased assumptions, and errors of attribution.  The newest fad or incarnation is psychopharmacology.  It is hailed by those with a myopic devotion to a bio-medical model steeped in the aforementioned biases and errors.  Psychiatry, in this bio-disease paradigm, is not grounded in any moral, philosophical, or scientific principles.  Indeed, it is exists in stark contrast as a gross departure from these principles; it is wholly contradictory to Medicine in the Hippocratic tradition.  It does not seem to honor or value, much less adhere to, the Hippocratic Oath to "First, do no harm..."   

Beyond comprehension is the lack of meaningful response from the medical and legal professions.   Failing to repudiate the gross departure from Ethical, Medical, Scientific, and Legal Principles by remaining silent  is to be complicit in the targeting of specific groups of vulnerable people for legally authorized 'special treatment.'  How is this not seen for what it is?!  It is using fear-based misinformation, i.e. propaganda, recruiting family and community advocates to 'educate' and inform on those targeted; it is legally classifying particular groups of people as being in need of 'special treatment.'  This are the exact same social control strategies which were used leading up to the Holocaust for God's sake!  The 'needed treatment' never cures or heals, it always debilitates and inevitably leads to death.  We have as a society, been duped by 'medical professionals' who have convinced us that the best way to help is to harm vulnerable children, adults, the elderly and traumatized veterans and to deprive them of fundamental Human Rights, and even their right to object.   Now that truly is crazy!  Silence becomes complicity.  Medical and Legal professionals have went along with psychiatry's fraudulent, unethical, coercive and manipulative methods which disable and kill; but never cure or heal.  Psychiatry's 'psycho' pharmacologists insist that some people must be forced to have 'special treatment' for the rest of their lives---which really means, until it kills them... 

Medical professions have witnessed the negligent care psychiatry provides to psychiatric patients for the iatrogenic, or 'physician caused' diseases, and the cognitive and neurological impairments, along with the emotional injuries  inflicted upon psychiatric patients in this "Standard of Care."   The standard is based on the biased opinions of psychiatrists and are rooted not in medicine, but in a social control system embedded in standards of care and entrenched within our Human Social Service System.  The Human Services System is steeped in Eugenics theory.  The Human Service system was started by Eugenicists, who acting under the guise of benevolent assistance, ( for the good of society) targeted individuals  and families in need of social services.  Those targeted, were selected due to the perception that they were considered 'genetically inferior.'  The  historical roots of psychiatry are inextricably linked with this Eugenics history.  Psychiatry has always relied on coercion and other social control strategies, including using misinformation.  Psychiatrists today are vehemently defending the practices which effectively rob psychiatric patients of their dignity, their autonomy, their Human Rights and their very lives.  Psychiatry is in effect, defending a RIGHT to cause iatrogenic illnesses and disabilities, including causing drug-induced death to their patients.  Physician caused homicide is blindly accepted by society---it is even 'legal;' as it was in Germany leading up to the Holocaust.

The obvious primary function served (intentionally or not) that the claim people who have a psychiatric diagnosis 'lack insight,' is that when the claim is believed; it effectively deprives the person of ANY and ALL means of defending themselves against psychiatric assault.  Iatrogenic harm is common, and the harm is intentionally and purposely inflicted upon patients by psychiatrists.  It is a travesty that these so-called doctors claim it is 'necessary medical treatment' since their treatment doesn't actually 'treat' an identified disease;  but in fact causes a myriad of disabling and fatal diseases.  So drug-induced death is now an acceptable primary outcome achieved by Psychiatry with it's so-called "medical treatment."

Disability and Death are the new Recovery Standard

This is a gross abuse of power and medical privilege; based on an idea which is not even a validated hypothesis; yet is accepted as a basis to force treatment while depriving a person of their Individual Rights, their liberty, and their physical health.   First it was just done to the 'schizophrenics' now it is children and teenagers with behavior issues, trauma victims, vulnerable elderly, and now too also alcoholic/addicts who commit crimes or get federally funded treatment.  Psychiatry has slowly widened the net for potential patients to act in loco parentis  for.   Psychiatry without conforming to the ethical principles of scientific research or medical practice, has been granted the Legal Authority to determine who NEEDS this special medical treatment which can be, addictive, disabling, and fatal.  What exactly about all of this is so desirable yet none of the ethical standards or societal norms are needed?  How can it be overlooked that this 'medical specialty' continues to drug people into states of disability and sudden or early death. Psychiatry claims to be treating diseases and chemical imbalances, when in reality their treatments are causing diseases and chemical imbalances that can  disable and kill psychiatric patients.   Now these drugs are the most 'popular' prescription drugs, and are prescribed to all ages; prescribed off label for avirtually any and every psychiatric diagnosis, and even, absent any psychiatric diagnosis!  

Psychotropic Drugs are the antithesis of  

'Medicine' in the Hippocratic tradition.

Psychiatry in the bio-medical paradigm of 'care'  lacks the support of ethical scientific research, but it is the lack of respect for psychiatric patients which inflicts untold emotional harm upon patients and family members alike; and rightly causes deep mistrust.   The underlying message patients and family members harmed by this disrespect is that psychiatric patients do not deserve to be respected, to be listened to, to be defended or protected; they do not even deserve to be told the truth.  Seems to me this is backwards--- how does believing a person has an illness and doesn't know they're sick, who needs others to act on their behalf, justify lowering standards of care and adopting treatment compliance as a primary measure of successful treatment?  This lowering of standards effectively sends the message: Psychiatric patients are not worthy of respect. 

Now that is crazy!

This failure to respect the dignity and humanity of psychiatric patients is allowed, accepted and even encouraged by some as a valid ethical medical practice!  Coercion, and manipulative abuse of  authority are dishonest, unethical behaviors; in any other context, the behaviors  are easily recognised as bullying behaviors.  People are told what perhaps is a gross exaggeration, and may not even be true at all. People are told that the psychiatric diagnosis that they are labeled with means they have a disease which requires medical treatment for the rest of their life, because the disease cannot be cured.  This is fraud.  It is without empirical data to validate the claim; without evidence that supports the Standard Practice of using neuroleptic drugs automatically as a first-line treatment. Standards are to be derived from the scientific evidence; not developed and implemented as part of the Standards of Clinical Care, by consensus, without supporting evidence.  Particularly when there is ample evidence the drugs are inefficacious for many, and have significant risks, including fatality.

One wonders how has the medical profession become willfully blind to iatrogenic disease, disability and death?  These are common real world outcomes of standard psychiatric treatment.  Patients are rarely warned of the risks for the harm ultimately caused to them by unethical practitioners.  It is also standard practice to avoid telling patients, family members and the general public the truth about the teratogenic nature of psychiatric drugs.  It is even more common to deny the adverse effects patients experience, or worse, attribute iatrogenic injury to the 'disease' supposedly being treated...How many in the medical profession are aware that psychiatric patients are routinely misled, manipulated and coerced?  As a matter of course parents are misinformed and pressured, coerced and worse, have their children taken from them for not consenting to giving them neurotoxic drugs---This is a gross abuse of medical and legal 'authority.'  In fact this practice does not adhere to any ethical or legal standards, it is tearing families apart.  Psychiatry, in effect, captures patients and robs them of the rights everyone else has. How is this not recognized as an utter lack of respect which strips people of  their human dignity?   How is it ethical or moral to drug people who are effectively politically and legally dis-empowered upon diagnosis? In effect, de-voiced.  

Psychiatric diagnosis is the "stigma"

I do not understand how inhumane unethical treatment of this type is accepted as a valid medical treatment.  How can it be medically or morally justifiable?   It is morally reprehensible that it as a direct result of standard 'medical treatment' a significant percentage of patients are disabled.  How can it be justified with a claim that it is, 'for their own good?'  One does not need to be a doctor to know that when far fewer patients are 'effectively treated,' than are disabled and die from the treatment; it is only an 'effective treatment,' if disability and death are the desired treatment outcomes.  Calling this medical treatment and making it 'Legal' doesn't make it efficacious; it certainly does not validate the claim that it is, 'medically necessary,'  and it certainly is not ethical... Why are psychiatric diagnoses used so casually in Courts of Law?  Rules of Evidence are ignored in Commitment proceedings.  Unlike any other medical illness, a psychiatric diagnosis can be adjudicated, instead of being verified or supported by the results from medical diagnostic procedures.  This legal determination becomes a part of a person's pemanent legal record.   Psychiatric diagnosis can be more accurately described and understood as a restriction of political and legal power.

A psychiatric diagnosis is a legal determination of one's diminished political power and legal status. Involuntary Treatment statutes lower evidentiary standards used in civil commitment proceedings; the lowered legal standards effectively deprive a person of their Human Rights.

If that isn't stigmatizing, I don't know what is!

It's criminal.

vintage ad found at practiceofmadness.com

first posted 5-5-2012 rewritten 7-2-2012

I'm no ding a ling...if it walks like and talks like a duck, it must be

"PERCHANCE he for whom this bell tolls may be so ill as that he knows not it tolls for him.  And perchance I may think myself so much better than I am, as that they who are about me, and see my state, may have caused it to toll for me, and I know not that. "

John Donne

A short time ago Robert Whitaker wrote a post, that I was personally grateful he wrote.  "The Taint of Eugenics in NIMH Research Today"   I was grateful because based on my own research on history and psychiatry, and my lived experience, I had come to realize that the NIMH has focused it's efforts on finding 'proof' of genetic defect and/or biological disease in people who have symptoms of 'mental illness.'  While it very well may make good sense to look for a disease or defect; to do so at the expense of neglecting other valid areas of research, into etiology, diagnosis and treatment is not scientific, ethical or wise!  That is exactly what the NIMH has done, and Tommy Insel is continuing with his 'Stay the Course' translational neuroscience marketing agenda  in the desperate quest for the disease, or the gene that causes madness; searching for proof people with a 'mental illness' are genetically defective is the #1 priority.  

Why?  Because bio-psychiatry desperately wants to validate it's Standards of Practice used in clinical practice; particularly the standards which recommend using neuroleptic drugs as a first-line treatment for schizophrenia as an 'Evidence Based practice;' which is ludicrous---ALL the treatment algorithms, and practice parameters for using psychiatric drugs particularly the neuroleptic drugs, are not based on the evidence base, but were "standardized" by consensus---which offers protection to psychiatrists from liability claims, but offers none for patients, which is the purpose of having standards of care--to protect the patients.  In psychiatry what a Standard Practice is is an affirmative defense based on what psychiatrists do in clinical practice to "treat mental illness." Absent a show of the evidence that the standards are derived from, a reasonable person would wonder, how in the world does a treatment become a standard treatment without definitive evidence it is effective and safe? CAN a treatment be an ethical standard medical treatment absent definitive supporting evidence of it's safety and effectiveness? Evidence is a requirement for validity to be determined--do psychiatrists not understand that? I don't believe so. The psycho-pharmacological treatment first, bio-disease paradigm lacks the sort of evidence required to validate diagnoses, it lacks evidence that any particular prescription drug is an "Evidence-Based" treatment for any diagnosis; so simply mixes and matches diagnoses and drugs.

THAT is the real (potentially fatal) elephant in the room.

The evidence on neuroleptic drugs has always been substandard, which is not a big deal--unless you wish to exaggerate the drugs effectiveness while minimizing the very real life changing risks of disability and early fatality.  Psychiatry has some Standard Practices that are not therapeutic that is reality violate people's Human Rights; coercion, misleading patients and family members about what is and is not known about psychiatric diagnoses and 'treatments,' abuse of authority, are some of them. The Civil Commitment Laws in this Country mean psychiatrists in effect have, police powers when as a profession, psychiatry has been misleading patients and families, the general public, Legislatures and Courts of Law how have they earned so much "trust" without the ability to tell the truth?

Indeed, E. Fuller Torrey, the "Brain Collector," forced psychiatric treatment demagogue, and NAMI's hero psychiatrist, has been quoted in the press recommending lying to the police, and courts--why would perjury be necessary to "practice medicine?" How is open deceit, and "metaphorical" explanations of a supposed "disease" ethically ACCEPTABLE in the practice medicine? If it is the practice of Medicine, medicine has been redefined with disability and death being the "successful treatment" outcome.  It's so "effective" and desirable in fact, we legally compel people to be "treated" with drugs which more often than not, are disabling and fatal to the patient, taken as prescribed. Calling it 'necessary medical treatment' is true if early death and disability are the desired end points; because in Real World Practice, any therapeutic value to the patient, is irrelevant.

The most sickening ugly part of my experiences with psychiatry is seeing what the drugs do to a human being; not being allowed to have any say, let alone stop it.  My son was tortured; I'm a MadMother, because I witnessed the crime.  Neuroleptics are no 'first-line treatment,' a treatment of desperation, or of last resort maybe--but certainly not something to be considered safe and effective or prescribed coercing treatment compliance using fraudulent claims. The neuroleptics in truth do not "treat" so much as they alter physiological processes which may not be dysfunctional; much less, need to be altered.  Specifically, the neuroleptics alter cognition, metabolism, and cadio-vascular processes; indeed they effect the parasympathetic nervous system, which regulates all major processes in human beings. This broad spectrum effect is why neuroleptic drugs have a myriad of serious, adverse effects and fatal risks. Characterizing neuroleptic drugs as effective medical treatment in a Court of Law, or anywhere else, is a gross misrepresentation of the facts.

We are once again 'investigating' instead of STOPPING how this Nation is drugging poor children who are on Medicaid in vast numbers with drugs that have a significant risks for disability, sudden and/or early death. The leaders in the American Academy of Child and Adolescent Psychiatry estimate in their Practice Parameters for Schizophrenia 50 % of the children given neuroleptic drugs will develop Tardive Dyskinesia, a neurological disorder which can be permanent and disabling; even if the neuroleptic is discontinued.  "As described above, the main symptoms of TD are continuous and random muscular movements in the tongue, mouth and face, but sometimes the limbs and trunks are affected as well. Rarely, the respiration muscles may be affected resulting in grunts and even breathing difficulties. Sometimes, the legs can be so severely affected that walking becomes difficult."

Opinions, even a whole bunch of educated opinions--are not scientific evidence.  It is 'Standard Practice' to drug people with a diagnosis of schizophrenia 'for their own good; it is not based not on empirical data, but on subjective opinions.'  This is a Standard Practice has killed more people with a diagnosis of schizophrenia than are allowed to survive, to perhaps, one day recover.  Court Orders that do not need to comply with the Rules of Evidence or Standard Legal procedures without meeting the burden of proof required in any other type of Legal proceeding. Conveniently, the FDA does not require 'adverse events' caused by FDA approved drugs be reported.  Fatalities caused by the drugs are drug induced deaths; in all reality, iatrogenic, or 'physician caused' homicide.  It is a common Real World Outcome in Standard Practice; such deaths are said to be "natural" although it is drug-induced.

It may be legal, but it is not ethical, or moral.  

It is not 'medicine.'  

It is eugenics.  

From the Director's Blog:

After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia. These current unsatisfactory outcomes may change as we approach schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage of the illness. This ‘rethinking’ of schizophrenia as a neurodevelopmental disorder, which is profoundly different from the way we have seen this illness for the past century, yields new hope for prevention and cure over the next two decades. here. 

This does this help explain the focus on early intervention. Basically, 'pre-treatment' for those targeted as being 'vulnerable' to perhaps, maybe, at some point in the future, as maybe, having a chance of experiencing psychosis. 

These services target poor children, the traumatically wounded, and the elderly; and since Alcohol and Substance Abuse was melded with Mental Health into SAMHSA, alcoholics and addicts are another demographic now targeted as well. 

nothing to see here...move along.

update from over the weekend, apparently they're a slow reader...

 bell photo credit

forget where I got the elephant it's in another post though

unaddressed "concerns" or cause for criminal investigation and prosecution?

Washington State Capitol

I write about my son's case in specific with the intent of bringing attention to the the larger issue of psychiatric mistreatment and psychiatric oppression; because they are Human Rights crimes that destroy lives all over the globe. My son is one of far too many victims who have been abused and used in drug trials.  My son was, in effect, tortured for the majority of his childhood by psychiatrists who used drugs "off-label." Ultimately, my son was used as a guinea pig without consent in Federally-funded drug trials at the state-run psychiatric facility for children by the Medical Director of the facility, Jon McClellan, one of the investigators in the TEOSS drug trials.

via Psychiatric Times:

Some Concerns Regarding Diagnosis

By Joseph Friedman, PhD, and Robert E. Kay, MD | October 21, 2011

Dr Friedman is a clinical psychologist with 50-plus years of experience. He has worked in military and private psychiatric hospitals, and outpatient clinics. Formerly, he was Adjunct Assistant Professor at Temple University, lecturer at St. Joseph’s University and Special Lecturer, and Senior Clinician at University of Pennsylvania Medical School. Dr Kay is a retired psychiatrist who worked with both adults and children in various outpatient and inpatient settings, mostly as part of the community health system in Philadelphia.

The mental health professions are currently awaiting the American Psychiatric Association’s newest version of the Diagnostic and Statistical Manual. The need for a fifth revision underscores the lack of satisfaction within the professions with our diagnostic schema. In this article we address several issues that have troubled us in the past versions and seem likely to do so in the forthcoming edition.

In modern medicine, there has been what is labeled as the laboratory revolution.1 This stresses that verifiable biologic and chemical finds in the laboratory contribute greatly to diagnosis and treatment.

However, it is abundantly clear that no such markers exist in the sphere of emotional disorders.2,3

My hopeful prayer is to:

The article in the Psychiatric Times, "Some Concerns Regarding Diagnosis" very succinctly states concerns about validity and reliability of psychiatric diagnosis which should alarm anyone who has a conscience. I am biased; biased by my horrifying experiences parenting a child with emotional and behavioral issues and seeking help for the complex PTSD he had after being traumatized by violent crime when he was three. At age seven, he was diagnosed with Left Temporal Lobe Epilepsy. Left Temporal Lobe Epilepsy is one of the neurological conditions which can be mistaken for schizophrenia; it is thought to be the result of brain injury.

Ultimately, the 'mental health care' he received from six years of age to his present age of twenty-three, has never addressed his initial trauma. The fact is, not only was his initial trauma ignored, the so-called 'professionals' refuse to acknowledge it, much less the traumatic effects of the 'treatment,' i.e. psychiatric drugs, which have NEVER helped. Professionals who are his current "treatment providers" refuse to even acknowledge the harm caused by the callous disregard shown to my son; apparently, believing he has some disease or defect makes this abusive attitude justifiable. I still cannot fathom the twisted logic of blaming a victim for the harm caused from being victimized. It has long been my perception that many 'professionals' blamed and shamed my son for the behaviors and emotional difficulties he had no control over, and did not understand. His symptoms were treated as if the BELIEF that the symptoms were the result of a disease or defect, was a medical reality---so apparently his severe PTSD had nothing to do with getting beat up and locked in a closet...or the subsequent traumas inflicted by 'professionals.'

Based on this belief, the State of Washington's employees and contracted 'service providers' repeatedly traumatized, stigmatized and discriminated against my son for the effects of being severely traumatized by violent abuse in Foster Care; and repeatedly retraumatized him with callous disregard in the manner the State provided, 'mental health and social services.' The initial traumatic abuse in foster care was an obvious case in which the Child Welfare system was negligent. In an attempt to cover up this crime; State employees committed further crimes.

The State of Washington has continuously committed Medicaid fraud for over 17 years in my son's case; including using my son as research fodder in the State-run psychiatric facility for children without Informed Consent. My son is handicapped as a result. The State of Washington allowed a State employee to give my son massive amounts of dangerous drugs not FDA approved or even tested on children. Worse there is no concern that the doctor who did this is still in a position to harm other children. There is no interest in holding him accountable for the crimes he committed as an agent of the State of Washington, when he drugged my son into a state of profound disability, Under Color of Law. The State of Washington is not interested in complying with Federal Medicaid Law; or in preventing fraudulent claims from being submitted; and continues to commit Medicaid fraud to this day in my son's case.

In providing my son's 'mental health care' State, Federal and International Laws were violated: The State of Washington repeatedly violated my rights as a parent, and my son's Human Rights by allowing fraud, perjury, assault, cruel and unusual punishment, undue restraint, and loss of Liberty without Substantive or Procedural Due Process of Law. At one point, as a teenager, my son was held in a locked facility for close to two years with the facility telling one County's Superior Court he no longer needed to be there; while obtaining a Court Order in another county for Involuntary Commitment. It is my belief the Involuntary Commitment court order was obtained to prevent me from rescuing him, as I had suggested I would.

Not once has a crime that I have reported to appropriate State authorities been investigated by Law Enforcement. What seems to matter to child and adult protective services is protecting the State of Washington; and maintaining control over individuals once a psychiatric diagnosis is attached. The actual effects of treatment, even if lacking any benefit to the patient, is never as important as maintaining 'treatment compliance' through any means necessary. The patient's outcome is never as important as the maintenance of State-Sanctioned, psychiatric authority and control; it is the primary goal and the purpose of Washington State's public Mental Health system.

And that is why in Washington State my son can be ordered by a Court of Law to take drugs that have caused him illness and serious disability----NOT because they are effective or safe, not because they are of therapeutic value, and/or that the drugs 'help' him. He can be, and has been Court Ordered to take teratogenic drugs, "to maintain the ethical integrity of the medical profession." Psychiatric diagnosis and authority is not to be questioned. Last summer, the psychiatrist who sought the order and cited the aforementioned reason the order was necessary, showed no professional or ethical integrity in the 'care' he provided my son. He even put false information in my son's medical record--another crime. This psychiatrist and another 'designated mental health professional' committed felony perjury and forgery, to obtain the Court Order.

The Yakima County Deputy Prosecutor knew he was submitting perjured testimony to the Yakima County Superior Court. The defense counsel knew, yet failed to mount any defense whatsoever for my son. NO investigation occurred in response to filing complaints with State of Washington's "authorities." The Community Mental Health Center that employs the two criminals who started the proceedings, shredded all of the Original Court Documents and the CEO told me, "We do it all the time." The County Prosecutor told me I would hear from him when I spoke to him. I have yet to hear from him despite leaving numerous messages with his receptionist in person. I have been told the Deputy Prosecutor is 'no longer working in this office.' I have also heard that the psychiatrist no longer works for the local clinic.

If the criminal mistreatment and repeated victimization of my traumatized son is not evidence that the diagnosis and treatment of psychiatric conditions have nothing to do with the patient's needs or the outcome for the patient; I don't know what does. Seems to me the fact that all of the crimes committed in my son's case were committed Under Color of Law, and have yet to be investigated by Law Enforcement or  prosecuted; should cause a hell of a lot more than 'concern.' But like I said, I am biased.

The rest of the Psychiatic Times article in it's entirety:

"Lacking such markers, past diagnostic manuals have consisted of lists of symptoms grouped into syndromes with the groupings done by committees that were far from unanimous. In past editions, diagnoses have been shifted from one axis to another and definitions have changed. Therefore, there is good reason to question the validity and reliability of the resultant coding.

Specific diagnostic codes imply that these are discrete and separate entities. In practice, the boundaries are fuzzy and allow for much overlap and results in the listing of comorbid conditions. In physical medicine, comorbidity refers to conditions (diseases) existing at the same time but that are independent of the primary diagnosis.

Consider a patient presenting with strong compulsive behaviors who periodically experiences marked anxiety and bouts of depression. Most clinicians, even of differing theoretical orientation, would consider these to be intimately related. In the mental health field, comorbidity does not mean discrete separate issues but is a way of including mention of related aspects of the patient’s distress. Some view comorbidity as an artifact of the diagnostic system.4

A third troubling issue is what we describe as fluidity. People change over time in their modes of adaptation. A diagnosis is akin to a photograph. It may be accurate but it is also static. The very next frame would show a somewhat different picture. It is not uncommon to consult with a patient who has seen other therapists. The patient may currently show all the requirements for a diagnosis of depression. A report from the first practitioner offered the diagnosis of generalized anxiety disorder.

It is not usually a matter of one professional or another being right or wrong. Possibly both correctly categorized the patient as he/she was at that time. Presenting symptoms often change over time as part of the patient’s continuing efforts at adaptation and defense.

Concerns about the variability (weak reliability) and essential validity have inclined some to favor abandoning the concept of diagnosis. But, to be replaced with what? It is on this issue that the current authors differ. One of us (J.F.) believes that even with these constraints, diagnoses have utility. They enable practitioners to communicate some shared ideas about patients. They are used in research and in relation to insurers and governmental agencies. The task is to refine our schemes.

While a complete explication of the etiology of emotional disorders seems quite distant, it remains a worthy goal. As the professions make progress toward understanding the genetic predispositions and the impact of psychological trauma at various developmental stages, it might be possible to conceive of a more tailored therapy for these disorders. One such effort is the Psychodynamic Diagnostic Manual.5 Similar efforts from other viewpoints6 might provide commonalities upon which to build a richer diagnostic approach.

The other of us (R.E.K.) feels that while diagnoses have utility, there will probably never be clear “markers” as found in general medicine and that the idea of “chemical imbalances” or “neurotransmitter problems” is highly speculative.7,8 The mental health field establishes so-called diseases out of patient behavior and reports; both are prone to conscious and unconscious distortions. Thus, it would be better to give on establishing etiology and deal with what the patient presents.

We reunite on the important notion that the combination of psychotherapy, carefully used medication, and environmental manipulation stands a very good chance of helping people (not disease entities) lead more satisfying and effective lives.

References

1. Cunningham A, Williams P (Eds). The Laboratory Revolution in Medicine. Cambridge: Cambridge University Press; 1992.

2. Kendall R, Jablensky A. distinguishing between the validity and utility of psychiatric diagnosis. Am J Psychiatry 2003;160:4-12.

3. Sobo S. A Reevaluation of the Relationship Between Psychiatric Diagnoses and Chemical Imbalance. 1999 Grand Rounds of University of Alabama Medical School.

4. Maj M. Psychiatric comorbidity: an artifact of current diagnostic systems. Br J Psychiatry. 2005;186:182-184.

5. Greenspan SI (Chair). Psychodynamic Diagnostic Manual. Silver Springs, Md; Alliance of Psychoanalytic Organizations: 2006.

6. Oken D. Multiaxial diagnosis in the psychosomatic model of disease. Psychosom Med. 2000;62:171-175.

7. Kirsch I. The Emperor’s New Drugs: Exploding the Anti-Depressant Myth. Philadelphia: Basic Books; 2010.

8. Angell M. The Truth About the Drug Companies: How They Deceive Us and What To Do About It. New York: Random House; 2004.