I found a great website which deals with matters that are being discussed in this thread:
Part I
Part II
Part III
Part IV
Part V
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Part 1
During the debate Dr. Baughman returned often to his central point – that you cannot have disease without pathology, and mental illness has no demonstrable pathology; therefore it is not a disease.
A very good point. I'd just like to add that in the future if mental illness is found to be caused by a disease, then and only then, can it be treated as one. There are tons and tons of people that have been diagnosed with schizophrenia (or another form of mental illness) given drugs to mask the symptoms only to be diagnosed a few years afterwards as having a known real disease. Furthermore, during those few years of ignorance the misdiagnosed individual suffered unnecessarily and even (in this particular case) permanent damage was sustained. Unfortunately, this sort of thing happens all the time.
Psychiatry, he argues, involves only fake diseases where no classic pathology can be seen.
Calling schizophrenia disease is like calling a brain tumor a mental illness.
Szasz, Baughman and others simply deny those factors that are unique to the brain, that relate to patterns of neuronal connections and neurotransmitter activity. They have no legitimate reason to do so. Rather, they rely upon semantic misdirection and evasion to avoid this core fallacy of their position. They cannot reasonably disagree with any of the premises I laid out, as all are demonstrably scientifically true. The logic also is valid, so the conclusion is sound – if part of the brain allows us to pay attention, in some people that part of the brain must function poorly causing a deficit of attention.
I think he's making some of the same errors which he's accusing other of making.
Baughman argues that this is not true. Why? Because there is no disease (read classical pathology) present, and everything else must be deemed normal. Why is it normal? Because there is no disease. What about abnormalities of neurotransmitter function or faulty patterns of neuronal connections? All normal. No pathology = no disease = normal.
If the
abnormalities aren't proven to be so, analyzing behavior shouldn't be very conclusive - at least not for all cases. Diagnosing someone with a mental illness based on their behavior... is just plain wrong. It's sorta like finding a lump and diagnosing it as cancer (more tests are needed!).
Part II
He argues, for example, that the entire range of human behavior should be considered normal. All traits vary, he argues, and it is not valid to simply label the extreme ends of this variation as abnormal.
That's right. If someone gets a severe case of gangrene, then it's normal for them to have their leg chopped-off.
First, it is not clear if the traits that are considered symptoms of any particular mental illness are simply the ends of the bell curve. It may be, in some cases, that there is not a simple bell curve of variation, but the illness represents a bi-modal distribution – a separate group off the bell curve.
Can someone please explain to me what this guy is trying to say?
By what logic should such maladaptive extremes be considered healthy?
By what logic should they not be considered a behavioral issues? Instead of damaging their brain and feeding them propaganda, maybe they should become more aware of what's going on. Perhaps then, they'd be able to take better control of their minds. And further, who's to say that such extremes are maladaptive... Perhaps, it's perfectly adaptive?
The response of the deniers is simply that without disease we cannot call something unhealthy – a return to their premise which is little more than an unsupported assertion.
Notice how this “believer” is trying to uplift his point of view? No one is saying that being depressing isn't unhealthy, rather it hasn't been proven to be a disease.
To avoid confusion of terminology the word “disorder” is often used to refer to the malfunction of some biological process when no underlying classical pathology is present. The term “disease” is reserved for a known pathophysiological process. Admittedly, the terms are sometimes carelessly interchanged, and this leads to confusion.
That's a good point. However, the disorder must be proven. To simply classify a person as mentally ill without any such disorder present is an abuse of power.
To be considered a biological disorder, vs a purely psychological disorder, there needs to be evidence that the symptoms emerge from internal rather than only external factors.
Another good point. These internal factors aren't known and this is what I've been talking about all along.
So how do we know such disorders are real? Well, sometimes, admittedly, it can be tricky.
HA-HA!!!
Many mental illness entities are disorders, like migraine, in that they can be reliably diagnosed, the diagnostic criteria have been validated, and they have a specific epidemiology and natural history. To dismiss the reality of all medical disorders where a specific pathology has not been identified is to reject much of modern medicine.
He's being sneaky again.
When applied to many psychiatric disorders the terms become a bit fuzzy.
HA-HA!!! (another one)
If we can identify that a specific neurotransmitter is deficient in certain parts of the brain, is this a disease or a disorder?
That won't be enough. What if someone just gets into a habit of being depressed, etc? We all have lot of sad times in our lives. If we were to constantly reflect upon these sad memories, would we not have an influence over these particular transmitters in our brain? If a behavior is the cause of our distress, then isn't it possible to fix this behavior and make mends by a greater understanding of the behavior (for instance: instead of thinking about bad thoughts, why not change them and view them as good thoughts?).
Well, it depends on whether or not you count brain structure and neurotransmitter function as a criteria for “disease.”
Hmmm... maybe while we're at it we should be critics of our appearances, etc. Hey. All those above 6ft aren't normal! Hey, everyone that's bald or thinning on top has a disorder! Anyone with 6 fingers? We'd all be fucked!
But this is all a semantic argument – it does not get to the real point, that the “soft” problems that can occur in the brain, problems with the pattern and strength of signaling, can result in real mental dysfunction.
All that must first be fucking proven before the fucking diagnosis. Fuck!
Baughman retreats to the semantic argument as a way of glossing over the real question.
Notice how he (the writer) does the same thing!
But Baughman is operating within a very simple paradigm (no disease = normal) and must constrain all arguments to this narrow (and arbitrary) box that he has constructed. He cannot allow for any broadening of the definition of what counts as biological dysfunction, because then mental illnesses might sneak in.
And now he's lost all his long term memory...
During the debate I gave him the example of migraine headaches, as it is the closest non-controversial analogy for mental disorders.
Can someone please explain to me what he is trying to say there? Anyway, it's different. To me, it's the difference between knowingly imagining something and that of having a full blown hallucination (ex. Meeting a friend for lunch only to be getting funny looks from the people around, because there really isn't anyone with you. That's different! It's like: a small cut vs a deep one – one requires medical attention or stitches while the or does not). Btw, that's a good analogy, because for me it was like going to the doctor with a minor cut, having him make it deeper, and then getting stitches!
He was taken aback by this and did not have a good response.
Again with the personal jabs. Fuck! Work on proving your point already!
Dr. Baughman wants a clean separation between classical disease and mental illness – but no such separation exists.
Do you agree or disagree with this point? And why? The separation does exist. This is the problem with two extremes coming together, they're both wrong to some degree!
Further, the same mental symptoms can result from more subtle dysfunction – such as poor development, a paucity of connections, or abnormal neurotransmitter activity. If we consider two hypothetical patients: patient A has a congenitally underdeveloped frontal lobe which can be demonstrated to have low physiological function, and patient B had a motor vehicle accident that caused trauma to his frontal lobes. Both patients may now exhibit the exact same clinical symptoms – namely poor executive function (the ability to inhibit one’s desires and act strategically for long-term goals). It seems clear that both patients have a mental illness but with differing underlying causes. The symptoms are the same because the same part of the brain is affected. Dr. Baughman would say that patient A is normal, and patient B has a neurological disorder, and that mental illness does not exist.
The problems occur with the treatment of these patients.
Part III
Today I will discuss in more detail the evidence for a biological correlate to mental illness.
Great, can't wait!
Dr. Baughman insisted numerous times during the debate that there is no evidence for a biological cause of any mental illness.
But then that is no longer a mental illness, now is it?
There is good evidence that schizophrenia is strongly influenced by genes. Identical twins have about a 50% concordance, while fraternal twins have about a 4% concordance. This points strongly to genetic factors modified by environment, or requiring an environmental trigger.
That's interesting. Why don't identical twins both have schizophrenia if there's such good evidence that genes are a cause of schizophrenia? Stress is another cause. Wouldn't a diagnoses cause stress?
There is a similar story with attention deficit hyperactivity disorder (ADHD). It is defined as a constellation of signs and symptoms, most notably a decreased capacity for sustained attention to a task, easy distractibility, and sometimes hyperactivity. Moreover, these symptoms must be greater than what is average/appropriate for age, and must exist in more than one setting – so if they exist only in school that is not sufficient.
I'm sure that we've all heard about the misdiagnoses of ADHD.
There is copious evidence for both schizophrenia and ADHD that brain function is abnormal.
Yes, but not for all cases. I asked my psychiatrist to make me an appointment to get my brain analyzed and he said something like: “it can't be used as evidence.” Recent studies show that it can. Furthermore, if we take someone who's having a traumatic experience out of their immediate environment, and put them into a psychiatrists office, what happens? I don't see how giving such a person a mental illness. Second, giving them pills is in some ways like giving a person who's about to be attacked by lions, a tranquilizer.
(In other words, the clinical syndrome is determined by the brain function that is compromised, not the underlying cause – so multiple underlying causes are possible and even probable).
Meaning: they have no idea how such phenomena is caused.
Further, there are different identifiable subtypes of these disorders, and there are efforts to create more precise clinical descriptions that will allow researchers to reliably separate out the subtypes, and therefore more efficiently identify the underlying cause (because a subtype may have a single cause that will be easier to identify if it is isolated).
I'd bet that if everyone went to a variety of different psychiatrists, they'd all be diagnosed with something, especially when they took the time to explore their quirks.
In schizophrenia there is evidence that certain brain regions are smaller, on average, than in normal controls – for example the hippocampus and thalamus. There is also evidence from fMRI (images brain activity) studies that certain brain regions are hyperactive while others are hypoactive. Further many studies have shown that dopamine (a neurotransmitter) function is altered in the frontal lobes of schizophrenics.
You see, it's evidence like this that doesn't tell me anything because there are many causes for such finds. I'd rather look at the facts (once they're known), rather then to drive myself crazy with speculation.
To summarize, the exact types of abnormalities that we would expect to see are found in subjects with schizophrenia – namely a diminished volume of certain brain structures and abnormalities in the amount of activity in both connections and neurotransmitters. Moreover, these abnormalities are not found throughout the entire brain, or in random parts of the brain, but in those parts of the brain involved with the functions that are observed to be abnormal in schizophrenics, such as reality testing.
The problem is (again) that these finding aren't reliable with all cases of diagnosis. That's my main issue with the mental health community. I've seem numbers like 60% show this and that, but what about the 40% that don't? I'm fighting for that 40%!
Here is an excellent and up to date review of the current evidence for a biological cause of ADHD for those who are interested in further reading and references.
This can also be true for people that were never diagnosed. These same people may have come out alright, while the diagnosed may have died from complications.
Even with our current uncertainty and unknowns, the evidence I outlined above, which is just a taste of this vast body of research, taken as a whole is very compelling.
This allure can be very deceptive and dangerous.
In order for a biological test to be useful for diagnostic purposes it must be cost effective and practical to administer, and it must have sufficient sensitivity and specificity – far above what is necessary to establish a connection scientifically. For example, in the studies I cited and most studies in schizophrenia and ADHD biological correlations are shown with around a 40-60% correlation. This is sufficient to establish a connection to a high degree of statistical significance. But it is almost worthless for clinical diagnosis, because applied to an individual it is almost a coin flip.
Do you see the problem?
Further, such tests would not add significantly to the clinical diagnostic criteria. There is a good rule of thumb in medicine, before ordering a test you should decide how the outcome of that test will affect your clinical management. If I have a confident clinical diagnosis, a biological test that is only 50% sensitive, whether the result is positive or negative, is unlikely to affect my management.
Ahh... the way of the ignorant!
In addition, the studies that are showing biological correlations, like fMRI, are mainly research tools and are not yet in widespread clinical use. So availability is limited, and resources are currently dedicated to research, not clinical studies. Clinical tests have to go through additional studies of validity and reliability in order to know how useful they will be clinically. This is additional information to the basic science studies that are designed to just establish a biological correlation.
Amazing how he's disproving his own points! (if you use something as evidence to prove a point and then when that evidence is inspected you find ways to mark it as unreliable... weird huh?).
Part IV
there is no clean distinction between mental and other medical symptoms as even classical pathology can cause psychiatric symptoms
And that is unfortunate!
the clinical basis of their diagnosis is legitimate medicine, and objections to the very existence of mental illness are not valid.
It's not legitimate when someone gets their life ruined because of a misdiagnosis.
Mental illnesses do have a special problem in that human thought and behavior is particularly complex with multiple influences, not only from brain physiology and anatomy but from transient effects on the brain (like sleep deprivation), culture, family situation, personality, daily events and stressors. Also, one mental disorder may influence other mental processes and symptoms, and therefore there is often great overlap in symptoms. For example, a primary anxiety disorder may make a child inattentive and figity – symptoms that can be mistaken as symptoms of ADHD. This complexity does not make clinical diagnoses of mental disorders impossible, just difficult, and we are still left with using scientific evidence to make an individual decision about the reliability of a particular diagnosis.
I like that.
we will see an increasing use of biological tests to aid in the diagnosis of ADHD and other mental disorders.
Question: if they do find biological tests that guarantee a diagnosis of schizophrenia, then what will happen to the schizophrenics that are negated as having schizophrenia? Oh, and I'd bet that this will happen! What then? They'll probably be sent to a shrink!
The reality, transparent for anyone to see in the published literature, is a far cry from the caricature painted by Dr. Baughman – that the diagnosis of ADHD is a simple fraud perpetrated by the pharmaceutical industry conspiring with deceptive psychiatrists. Rather, this is a serious and fruitful domain of research in the academic setting. Also, the research is moving forward and creating tangible results – unlike the research done in truly pseudoscientific arenas, such as ESP, that seems to only go around in circles without ever making identifiable progress.
...
Part V
Rational pharmacotherapy is a critical and effective part of modern medicine. The bottom line is that drugs save lives, extend our lives, and improve our quality of life. Like any technology, they are a tool. Because they are a potent tool, however, they also have the ability to harm.
True. As long as it appears to do more good than harm... To those that are harmed: sorry.
Drugs for mental illnesses are no different. Sometimes, for example with schizophrenia, the benefits might include the ability to live an independent and somewhat normal life. The side effects of drugs used to treat psychotic disorders, unfortunately, are significant, and may include sedation and movement disorders. Pharmaceutical technology is improving, like all technologies, and newer drugs are generally better, but at present the drugs we have available are useful but could be a lot better.
It would be nice if they can cure. All that money, all that research, all that time, etc etc etc ...And no cure. Question: treating is much more profitable, so why would some money obsessed power cure something that can be treated well enough? (I've heard Noble Prize, but that doesn't pay very well)
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Shahrazad wrote:Nothing about you is normal, DI.
:)
Elizabeth Isabelle wrote:when I was looking for references for Animus, most of what I found focused on the decreased amount of white matter found in the brains of schizophrenics.
Yeah, I've heard about that as well. They don't know why it happens and it doesn't happen in all schizophrenics. Btw, white matter development (I've heard) peaks in middle age. Gray matter peaks in the twenties.
Ultimately, a diagnosis is just a word, a term, a label. Some people find comfort in that there is a name for what is going on, and that others experience something similar. Some people do not.
Sure, but I think that the significance of such a term is of greater importance. For example: if a doctor told you that you had cancer (god forbid), wouldn't that word take up a whole new meaning? I believe that it would do so.
What I'm seeing is that with naturally occurring schizophrenia, medication is important to making sure it doesn't get worse as fast.
That's another thing, I don't believe that my so-called schizophrenia has occurred
naturally. That's not what I mean. There's a lot more to it, but I don't want to get into it right now.
It's hard to judge when it is your own mind
It can be the other way around! The mentally ill may have more insight into their condition, then most trained professionals. It's not like a scale thing, you know. It's more complex then that!
so all I can do there is wish you luck.
I believe that I can reason my way out of it.
Diebert van Rhijn wrote:This is more like a Cartesian understanding of the process and seems rather outdated to me. What we perceive is not some neutral signal that fuels some construction in the mind. The whole line, from nerve-end to brain handling seems more like a product of processes laying inside as well as outside the body including but not limited to forms of back propagation. These are all highly shaped by things as convention, expectation, habit, symbols, semiotics and so on. And all these are quite variable and dynamic, not just a function of fixed biological responses. Although socially they can remain fairly static - hence the normal is born, which is mostly just a form of being functional under the circumstances.
For some examples of 'active perception' in action I have to dig into my memories, but one example is how memories of shapes and forms could be represented as a sequence of eye movements. So the patterns those eye movements follow would be determined by circumstance and expectation. Same could be with focus, but also the way the following cognition and memorization works, or in other words: what we think we're looking at. Many 'hallucinations' are therefore often misrepresentations of perceptions, the mind just decides to present them to us in a wrong context and the mis-identification requires then a lot of imagination to make sense, a mechanism to create a more or less consistent worldview.
If consistency would fail, the brain would not be able to function at all and experience severe confusion which would threaten the whole organism, so the behavior of a schizophrenic is best explained in cognitive terms: as a highly unusual and most likely dysfunctional reference frame a few sensory experiences are occurring in. This as opposed to the idea of a golden standard of reality because that would become just a more or less common reference frame. And the more consistent this framework is, the more persistent and shared it will become. But this is not related to the direction the signals in our nervous system are traveling. This is always a two-way direction when seen as a whole and at all levels.
Whoa. At the moment I can't really tell if that makes any sense, so I really don't know the difference between: 1) you don't know what you're talking about, or b) you're on to something. Mind explaining? I'll get back to you.
The process I referred to is subconscious at best. The memory involved would be more like sensory memory, a very short-term type of memory. Schizophrenia influences these memory systems, affecting perhaps the identification on a somatic level here. The sensory memory is able to instruct the senses how to perceive based on what is expected on a level of pure pre-conceptions, which are signaled to them by other areas in the brain in advance.
Seriously, what are you talking about? Break-it-down (please), so that I can determine whether I should ignore you or not.
Animus wrote:my interest is in the the difference between the vagueness of imagining an "apple" and actually seeing an "apple".
What if a person's imagination and memory is as vivid as the real thing?