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Summer 2014
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Theodore Dalrymple
Everyone on the Couch « Back to Story

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LMSWs, LCSWs are steeped in left-wing theory every moment of every class they take while getting their master's degree: it's never the patient, any problems ... depression, or violence, or anxiety, or alcohol addiction, or drug addiction ... whatever it might be ... is due to brain chemical imbalance and the patient is wholly a "victim of his brain chemicals" ... and ... there's a pill for that!

.............................

then Dr. Dalrymple himself must be 'left-wing' because he has no problem with lifetime medications for illnesses such as schizophrenia. he has no problems with neuroleptics.

there are people on this planet who have no time for the ridiculous left-right paradigm you reference.
(comment by "Jay" below): " Mr. Dalrymple appears to read the DSM-5 from the perspective that psychiatrists and psychologists are not well trained, nor are they interested in helping others. Ignoring the intensive education that members in the mental health field engage to gain the titles that they hold, his analysis appears to be based on an older understanding of mental health... "
- - - - - - - - - - -
Ha-ha-ha.

LMSWs, LCSWs are steeped in left-wing theory every moment of every class they take while getting their master's degree: it's never the patient, any problems ... depression, or violence, or anxiety, or alcohol addiction, or drug addiction ... whatever it might be ... is due to brain chemical imbalance and the patient is wholly a "victim of his brain chemicals" ... and ... there's a pill for that!

So the vaunted "new psychology" merely replaces that old 1930s-style lobotomy with a brand-new 21st-century pill, or (more common) pills: reuptake inhibitors, anxiolytics, etc. all taken together daily.

And, strangely enough, these drugs then usually end up being taken ... for life.

Because, after all, behavior and self-examination have nothing to do with anything ... it's all brain chemicals which ... we have a pill for!
'or protecting innocent citizens from the depredations of monstrous fiends, will hate it.'

A tad harsh. Psychiatrists aren't that bad and I'm sure that most of them are well intentioned.
Not all lawyers will celebrate the DSM V. Those seeking large fees from frivolous lawsuits, or from defending wicked criminals, will love it. But those other lawyers who devote themselves to the preservation of wealth by those who earned it, or protecting innocent citizens from the depredations of monstrous fiends, will hate it.
Such a perceptive analysis of what ails psychiatry as epitomized by DSM. As an academician and practitioner in a 'developing' country, I am dismayed by the relentless marketing of DSM, often by the pharma who have been distributing copies of DSM-V much like the free copies of Holy Bible. Talking of unhappiness, there is no linguistically equivalent terminology for depression in any Indian language...
Curiosity Killed the Cat December 26, 2013 at 9:14 AM
You mean abolish the medical model?

Hmm, good luck with that one. You'll be dealing with a lot of vested interests there.

Where to start...
We need to replace the APA medical model of psychiatry = diagnosing/treating pathology with the post-Jungian depth psychology model that teaches people how to manage those aspects of the psyche that can cause trouble, without labeling or turning people into 'victims'.
Jeffrey Asher December 09, 2013 at 7:17 AM
Dr. Dalrymple continues to endorse feminist politics.

No he doesn't. Inside he is still a little boy who loves his mother.
Brian Richard Allen December 18, 2013 at 11:15 PM
Michael Woodman asks "Would a Muslim living under Sharia be considered to have a personality disorder for harboring a persistent desire for individual freedom?"

Could be a reasonable impression to have formed and/or trend to have noted, dear Michael, given that for 1400-odd-years, to date, one-hundred per cent of those so persisting have been strapped with explosives and/or otherwise been put to death.

Brian Richard Allen
Brian Richard Allen December 18, 2013 at 11:08 PM
The "doctor" is in.

The "doctor" is but a statistician.

With "touchy-feely 101.

And, when he is contracted to an "insurance" scam and/or is an "expert witness?"

With, also, a graduate certificate from the Insurance-Clerical Mill of "medical-practitioner" impressive-paperwork-providers: -- Quod Erat Demonstrandum Division!
Lake Worth

"This seems odd: "...a description of behavior is not the same as a medical diagnosis...."

We're talking mental problems, not infectious diseases or birth defects. So what else could these categories have for definitions if not behavior?"

He said that a description of behaviour is not a diagnosis. He did not say that a diagnosis is not a description of behaviour. In other words he did not rule out that a diagnosis could come in the form of a description of behaviour, simply asserted that a description of behaviour need not be diagnostic.
Barrack Obama has at least 10 of those traits characteristic of personality disorders. Indeed I suspect any politician or anyone who has sought and found celebrity would show at least 6. So not only are they all suffering, they are all especially serious cases
Very interesting. I had no idea that psychiatric diagnosis had become so wide-ranging.

I was particularly struck by this: "An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, in fields such as thought, emotion, interpersonal relations and impulse control."

That strikes me as having particularly chilling implications for social innovators, original thinkers, artists and philosophers. Would a Muslim living under Sharia be considered to have a personality disorder for harboring a persistent desire for individual freedom?
@Peter from Oz

'I think you will find that Dr Dalrymple is in fact a pssychiatrist himself.'

Indeed, and that's what makes this article so disturbing.

I love the subtitle:
'Today’s psychiatry undermines self-reliance and morality.'

Today's psychiatry? Not yesterday's, or last year's or tomorrow's. How terribly self exculpatory.

@Mary

'The men don't get diagnosed as crazy.'

Actually no one 'gets diagnosed as crazy'.
Jay

I think you will find that Dr Dalrymple is in fact a pssychiatrist himself.
Mr. Dalrymple appears to read the DSM-5 from the perspective that psychiatrists and psychologists are not well trained, nor are they interested in helping others. Ignoring the intensive education that members in the mental health field engage to gain the titles that they hold, his analysis appears to be based on an older understanding of mental health, and does not reflect lessons being taught to a newer generation of mental health professionals, including positive psychology and treatment for these mental illnesses. One may be led to believe that Mr. Dalrymple took one psychology class during his outdated education, which, when coupled with his fatalist perspective that "the sky is falling", leads to an improper and rather sad understanding of mental health care. I would encourage him to speak on topics which he may be more informed on, rather than misleading people, and possibly frightening them away from getting the help they may save their lives.
"He appears unaware that male partners (and children) may show higher indices of assault and from female partners and mothers. "

The men don't get diagnosed as crazy.
Nicolas December 11, 2013 at 9:18 AM
Psychiatry also undermines freedom and sound science. It has always relied on involuntary treatment (i.e., torture)

You mean something like this?

'Meanwhile, down in casualty a young lady in a red bandana was spraying everyone in sight with shaving foam. She had bought it, apparently,, as protection from the demons which she had recently taken to seeing and hearing everywhere, rather as nervous ladies in violent cities carry tear-gas around in their handbags.

'I had my revenge, however: I ordered her to be held down and injected in the buttock..'
As a therapist for over 40 years I have always considered the DSM to be a wonderful tool for those who really don't want to get their hands dirty in the wacky world of unknowing.
Psychiatry also undermines freedom and sound science. It has always relied on involuntary treatment (i.e., torture), and not a single psychiatric diagnosis has ever been confirmable by any biological or anatomical test.
Emma - that's beautiful
During a period when I felt unhappy, I told my grandmother I didn't know what was wrong with me, since I hadn't actually suffered an adverse event to account for my gloom. She diagnosed me as "Ungrateful".
A devastating critique by an insider of an 'industry," (yes, it is that), that to generate more customers, broadens its 'sale' structures to brainwash more people into thinking more placebos will recreate their identities and make them 'live happily ever after...' It is certainly a sign of a culture in irreversible decline.
@jane

So before the '60s psychiatry was completely credible?

You're having a giraffe!
Yes psychiatry has finally returned to its antecedents of quackery and not science. It is sad, but this happened long ago, like in the 60's when homosexual behaviour was classified as normal instead of previously as letcherous, environmentable and thus curable.
Brilliant and timely! Alas, hoping for common sense in psychology is a little like expecting pro bono to make inroads among lawyers. And TD's analysis suggests that psychiatry is not unlike government, an institution capable of making spare parts for itself. If all bad behavior is illness, what need do we have for laws, lawyers, or prisons. Why can't we just have a better pill?
Brilliant and timely! Alas, hoping for common sense in psychology is a little like expecting pro bono to make inroads among lawyers. And TD's analysis suggests that psychiatry is not unlike government, an institution capable of making spare parts for itself. If all bad behavior is illness, what need do we have for laws, lawyers, or prisons. Why can't we just have a better pill?
There's going to be a talk about some of this, and especially Szasz, at the upcoming American Psychiatric Association meeting in New York next May:

On Religious and Psychiatric Atheism: the success of Epicurus, the failure of Thomas Szasz

by Michael Fontaine

"In 271 BC the Greek philosopher Epicurus (340-271 BC) died. The scientific-materialist and theologically atheist philosophy that he had preached, Epicureanism, continued to flourish and grow in his school ("The Garden") in Athens. It soon spread throughout the Roman Empire, especially among the upper classes. When Christianity replaced Rome as Europe's dominant power, it faded away, but the Renaissance rediscovery of the Epicurean poetry of Lucretius (c. 99-c.55 BC) gave a massive impetus to the Enlightenment. The doctrine subsequently aided the replacement of religious (Christian) values with secular (atheist) ones in Western society.

In September 2012 the Hungarian-American psychiatrist Thomas Szasz (1920-2012) died. His death was met with a brief obituary in the New York Times, but little more. The psychiatrically atheist philosophy that he had preached for over half a century has never flourished. Though he suggested and advocated many, he cannot be credited with implementing any psychiatric, social, political, or legal reforms, save perhaps deinstitutionalization. His philosophy, and especially his chief claim that mental illness is not a medical disease, has not spread throughout the world; rather, it is psychiatry that has flourished and grown worldwide, and has spread throughout all classes in the West.

Both Szasz and Epicurus preached freedom. Epicurus sought to free men from the fear of death. Szasz sought to free men from coercive psychiatry. Why was Epicureanism so successful, while Szaszianism is such a failure?

This paper offers a comparative study of Epicureanism and Szaszianism and points out many unnoticed similarities in the two philosophies. It concludes that Szaszianism was a two-pronged approach whose aims were quite different from each other. Epicurus sought to abolish men's private fear of (unhappy) life after death. Like him, Szasz attacked the private belief that mental illness has a psychochemical or physiological, rather than social, origin. Unlike Epicurus, who advocated complete withdrawal from political life (and made no effort to combat institutionalized religion), Szasz was highly political, and made every effort to combat institutional psychiatry. It is easy to see that public Szaszianism has been a failure – and deservedly so, many would say. But because we cannot, as a rule, tell how many atheists there are in the pews of a church-whether they are theological or psychiatric atheists, and whether the pews are in church or worldwide-it is far from clear now, in 2013, just how far private Szaszianism has spread, and whether it will simply fade away or someday enjoy a revival."

https://www.academia.edu/5101015/On_Religious_and_Psychiatric_Atheism_the_success_of_Epicurus_the_failure_of_Thomas_Szasz
This seems odd: "...a description of behavior is not the same as a medical diagnosis...."

We're talking mental problems, not infectious diseases or birth defects. So what else could these categories have for definitions if not behavior?

Axis II also presents paranoia and the anti-social/sociopathic disorder. That is defined with behavior patterns.

Intermittent Explosive Disorder is not to Dr. T's liking. But in the details this is more closely defined than paranoia. And people need to be warned that this is a dangerous mental condition. No one is saying that this is a disease. Nonetheless:

"To call the habit of losing one’s temper and destroying things or hurting people a medical condition (from which, according to the DSM-5, 2.5 percent or so of the adult population suffers in a given year) empties it both of meaning and moral content...."

Which of course it does not. Psychopathic PD has been around for a while, too. No one, really no one has been misled to believe that the crimes of psychopaths are emptied of meaning or moral content.

Dr. T. suffers a new memory problem here ???

Hopefully I.E.D. will serve as a wonderful transfer of militaria to this family problem. 'They go off like IEDs !" -- easy to remember.

for the rest of us.
Permit an addition to my earlier comment:
Dr. Dalrymple continues to endorse feminist politics. He refers to, "abused women that their male abusers ... women’s belief that their male attackers ..." He appears unaware that male partners (and children) may show higher indices of assault and from female partners and mothers.
Misandry is also a, moral failing,” which calls into question Dr. Dalrymple’s objectivity.

Among many other evidentiary sources, see:
http://www.bing.com/search?q=%22humphrey+Bogart%22+%2Bbattered+%22wife&go=&qs=n&form=QBLH&pq=%22humphrey+bogart%22+%2Bbattered+%22wife&sc=0-24&sp=-1&sk=&cvid=1c00f530211f4cdea19dee7acf988a36
http://www.bing.com/images/search?q=battered+men+&qpvt=battered+men+&FORM=IGRE
http://www.bing.com/search?q=battered+men+&go=Submit&qs=n&form=QBRE&pq=battered+men+&sc=8-13&sp=-1&sk=&cvid=337adb68e1614e828ed3d031375597f4
http://legalfighter.wordpress.com/2012/06/23/is-it-time-to-wake-up-women-are-more-violent-says-study/
Videos of Battered Men: http://www.bing.com/videos/search?q=battered+men+&qpvt=battered+men+&FORM=VDRE]
Indeed. Spot on.
Dr. Dalrymple continues to endorse feminist politics. He refers to, "abused women that their male abusers." He appears unaware that male partners (and children) may show higher indices of assault from female partners.

Among many other evidentiary sources, see:
http://www.bing.com/search?q=%22humphrey+Bogart%22+%2Bbattered+%22wife&go=&qs=n&form=QBLH&pq=%22humphrey+bogart%22+%2Bbattered+%22wife&sc=0-24&sp=-1&sk=&cvid=1c00f530211f4cdea19dee7acf988a36
http://www.bing.com/images/search?q=battered+men+&qpvt=battered+men+&FORM=IGRE
http://www.bing.com/search?q=battered+men+&go=Submit&qs=n&form=QBRE&pq=battered+men+&sc=8-13&sp=-1&sk=&cvid=337adb68e1614e828ed3d031375597f4
http://legalfighter.wordpress.com/2012/06/23/is-it-time-to-wake-up-women-are-more-violent-says-study/
Videos of Battered Men: http://www.bing.com/videos/search?q=battered+men+&qpvt=battered+men+&FORM=VDRE]
I was also wondering whether DSM-IV has the 'common sense' that DSM-5 lacks.
I am a big fan of Thomas Szasz. I completely agree with the indictment of the psychiatric enterprise that he laid out in "The Myth of Mental Illness". I am happy to read this here, a venue too prone to scapegoat on the so called "mentally sick". Psychiatry is the largest perpetrator of human rights abuses in the US today. It has to be abolished, period.
I was under the impression that Dalrymple himself is a psychiatrist. Am I wrong?
This is why I buy your books, Dr.
Common sense is quaint and old-fashioned, and morals, how dare anyone bring up that old fogy notion. We live under a new tyranny of unspoken superstitions as alluded to by this wonderful sentence:

The manual’s lack of common sense would be amusing were it not destined to be taken with superstitious seriousness by psychiatrists around the world, as well as by insurers and lawyers.

As someone who used the manual in a courtroom, I have seen the depth of the superstition and the ease with which non-physicians subvert the manual for non-intended purposes.
I have a new word for you " psyquackery "
I'm pleased to see that persistent grudge-holding is a DSM-recognized disorder. I thought it was because I'm Irish.

A good antidote to ideologically-driven psychiatry can be found in the work of Paul R. McHugh, (see "Perspectives on Psychiatry") who is one of those attempting to put science back into the practice of psychiatric medicine.
"...given the great variation in emotion and behavior that humans display when they are functional and healthy, let alone when they are distressed or ill".

That hits the nail on the head. How can anyone tell whether a given "variation" is, or is not, pathological? Dr Dalrymple's example of manic behaviour is convincing; but how can one be certain (in principle) that even such extreme behaviour isn't just part of life's rich pageant? (Isn't it ironic that psychiatry is becoming so intolerant, just as political correctness is telling us all to accept diversity more willingly?)

As an introvert (apparently INTP according to the Myers-Briggs classification) I have been bemused to discover that most attributes of introversion have, at one time or another, been cited as symptoms of mental illness. Probably most of the technical (and perhaps even moral) advances that led to modern society were made by introverts; yet, when the socially approved norm is extraversion, introversion tends to be seen as unhealthy.
Anonymity Preferred December 08, 2013 at 11:29 PM
Another excellent column by Dalrymple. Psychiatric nosology has always been fraught with the potential for error, given the great variation in emotion and behavior that humans display when they are functional and healthy, let alone when they are distressed or ill. It is the shame of the psychiatric profession that this potential has become the commercial driver, based on pseudoscientific grounds, behind the expansion of the DSM to encyclopaedic length, but not depth.

I would be interested in reading more of Dalrymple's opinions on political correctness in psychiatry, as in the case of transsexuals denying that gender dysphoria should be classified as a disorder. The infamous incident from 1974, the year that homosexuality was taken out of the book of disorders, pretty much set the trend for any and all sexual deviances to be accepted as normal, whilst the crests and valleys of patients' feelings became, increasingly, a basis for phony diagnosis. But if we allow that disorders of the mind exist, certainly homosexuality argues for itself that it qualifies; it is difficult to imagine that a person attracted to the same sex does not have something going wrong in his brain. This does not mean that homosexuals are curable or that they cannot live happy, productive lives, but that their sexual proclivities deserve medical scrutiny. And just in case I should be called homophobic by a silly internet troll, let me admit that I am a gay man myself. (Yes, a gay man who believes that homosexuals are mentally defective. Spend enough time around them and you may reach the same conclusion.)

I'm anxiously waiting for how they codify the latest therapeutic craze of everyone either a bully, a victim or a bully enabler. That goes along with how to make sure racism, bigotry and sexism can be dealt with via solid diagnoses, treatments, behavioral modification and mandatory sensitivity training. But really, I will take my chances with DSM rather than holding out for a diagnosis that requires death as a final pop cultural solution from experts like Oprah Winfrey.
Medicalizing common neuroses into clinical disorders is psychiatry run amok. Any deviation from the "normal" becomes a disease, Soviet-style. However, it is also true that some mental problems can be alleviated via talk or drug therapy, such as anxiety and depression. The best book on the subject is "Listening To Prozac" by Peter Kramer. His thesis: if a drug can cure it, then it must be real.
Let's Talk Candidly December 08, 2013 at 6:54 PM
Frankly, given the overgeneralization of psychiatric diagnosis, I am surprised that ONLY one in seven of us are insane, according to the psychiatric profession. Surely they can find a insurable status that they can get paid for treating in my hesitancy to get out bed in the morning and go to work? Oops - I think I missed it on page 1586.
spot on.