The science writers at The Economist discuss the American Psychiatric Association’s new Diagnostic and Statistical Manual (below the fold because it auto-plays when you load the page):
May 22, 2013
May 12, 2013
Thomas Szasz was no conservative
In Reason, Jacob Sullum looks at an essay on the late Thomas Szasz that puzzlingly attempts to portray him as a staunch conservative:
In an interesting but puzzling Aeon essay, Cornell historian Holly Case notes the resemblance between contemporary doubts about the scientific foundation of psychiatry and the critique first laid out by Thomas Szasz half a century ago. “It might be that the world has only recently come around to his way of thinking,” Case suggests. Yet she misconstrues an important aspect of Szasz’s thinking by portraying him as “a staunch Republican” and a “conservative,” apparently unaware of his self-proclaimed libertarianism. Szasz, who died last year at the age of 92, was a Reason contributing editor for decades. He described the main motivation for his intellectual career as “my passion against coercion,” which he opposed (outside of situations involving the defense of rights) no matter who was advocating it, left, right, or center. Hence he opposed forced psychiatric treatment, but he also opposed interference in consensual transactions between psychiatrists and voluntary patients. Here he parted company with some left-wing critics of psychiatry.
[. . .]
But Case focuses mainly on common ground between what she views as right-wing and left-wing critics of psychiatry. Beginning in the 1960s, she writes, “Right and left sought to eliminate insanity in order to lionise dissent, legitimise the marginal and condemn the new normal. Few other issues show a convergence of right and left so far-reaching, while still allowing both sides to adhere to their politics and maintain a sense of total opposition.” At the same time, she says “Szasz was conspicuously alone in mounting the barricades from the right,” so she really needs him to be a right-winger. Bending the facts to fit her thesis, she ascribes to Szasz a “distinctively conservative perspective.” That label does not jibe with his opposition to drug prohibition and his forthright defense of the right to suicide, two major themes of his career that Case tellingly ignores. Szasz’s position on physician-assisted suicide combined both of these themes and demonstrated that his perspective was in fact distinctively libertarian. He opposed Oregon’s Death With Dignity Act (later imitated by Washington) because it medicalized a moral decision and required people to meet government-dictated criteria before they could legally end their lives. If the drug laws did not make it difficult for people to obtain substances useful for suicide (such as barbiturates), he said, there would be no need for physician-assisted suicide.
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May 6, 2013
QotD: This seems like a bad idea
A Florida county sheriff is being given a million dollars to violate the rights of the people who were stupid enough to put him in office.
According to an article by Palm Beach Post staff writers Dara Kam and Stacey Singer, posted Monday, April 29, Palm Beach County Sheriff Ric Bradshaw has been awarded $1 million by Florida House and Senate budget leaders for a new “violence prevention unit aimed at preventing tragedies like those in Newtown, Connecticut and Aurora, Colorado.
It would be bad enough if this particular jackbooted thug planned only to use this ill-gotten tax money for the usual militarized toys — machineguns or armored personnel carriers — the cops are so crazy about today, but Bradshaw reportedly wants to create “prevention intervention units” consisting of “specially trained deputies, mental health professionals, and caseworkers”. which “will respond to citizen calls to a 24-hour hotline with a knock on the door and a referral to services”.
“We want people to call us if the guy down the street says he hates the government…” the Big-Brotherly Bradshaw bloviated. “What does it hurt to have somebody knock on a door and ask, ‘Hey, is everything OK?'” Since the cops these days do their knocking with a three-foot concrete-filled section of four-inch diameter steel pipe, with welded rebar handles, Bradshaw’s stupid question tends to answer itelf.
L. Neil Smith, “Cutting the Root of Tyranny”, Libertarian Enterprise, 2013-05-06
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April 26, 2013
Minnesota introduces new policy for dealing with veterans
You may not hear about this in the mainstream press, but The Duffel Blog digs for the real story:
Officials from the Minnesota Department of Motor Vehicles have confirmed approval of a new policy making it mandatory for all active-duty and military veterans to register their status with the agency. The move will require all veterans to have a special “Vet” designation on their drivers’ licenses and state identification cards.
The Minn. DMV, which hopes to have the policy implemented by 2015, cites an inherent mental health threat by veterans as their main reason for devising the plan.
“We’ve seen what these savages are capable of all over CNN and MSNBC,” says DMV director, Greg Olson. “Out of all the millions of men and women who have deployed to combat zones this past decade, there are literally a dozen, perhaps even two, who have come home and committed atrocious acts. That’s way too big a chance. We can’t risk having these people hidden in our community and will be making sure they’re easily identifiable to law enforcement personnel and citizens in general.”
The new strategy will most likely result in changed police escalation-of-force procedure when dealing with veterans during routine traffic stops.
According to Olson, law enforcement officers will be given more opportunity to defend themselves against a perceived threat.
“Phase One will consist of the officer identifying an individual’s vet status on his or her driver’s license,” he says. “Once the officer realizes what he or she is dealing with, Phase Two will kick in and they will immediately unsheathe their pistol and drawdown on the potential psychopath. Then, at Phase Three, the officer will be given free reign to search the individual’s vehicle for weapons and dead bodies. If, and only if, the officer doesn’t find anything, then he will subsequently release the veteran and thank them for their service.”
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April 24, 2013
QotD: Welcoming the DSM-V appropriately
The much-awaited arrival of DSM-5 (the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) should ensure that every human being is classed as insane. At this point we might be able to start again and consider what psychiatry is for. Genomics is keen to help in the effort by finding the loci that are associated with all sorts of mental disorders. Enter a huge population based study funded by the National Institute of Mental Health: “Our findings show that specific SNPs are associated with a range of psychiatric disorders of childhood onset or adult onset. In particular, variation in calcium-channel activity genes seems to have pleiotropic effects on psychopathology. These results provide evidence relevant to the goal of moving beyond descriptive syndromes in psychiatry, and towards a nosology informed by disease cause.” Hmm. I think that when authors have to use words like “pleiotropic” and “nosology” there is a high chance that they do not know what they are talking about. So before welcoming the marriage of genomics and psychiatry, let us remember that there is a strong history of madness on both sides.
Richard Lehman, “Richard Lehman’s journal review—22 April 2013”, BMJ Group blogs, 2013-04-22
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March 29, 2013
Demonizing smokers hasn’t forced them to quit … let’s start sending them to psychiatric care instead
When the all the persuasion, “nudging”, shaming, harassment, and legal shenanigans haven’t worked, try taking a leaf out of the old Soviet Union playbook for dealing with dissidents:
Smoking may be a sign of psychiatric illness, experts say. Doctors should routinely consider referring people who smoke to mental health services, in case they need treatment, they add.
The controversial recommendation from the British Lung Foundation, a charity, comes in response to a major report, Smoking and Mental Health, published this week by the Royal College of Physicians and the Royal College of Psychiatrists with the Faculty of Public Health. It says that almost one in three cigarettes smoked in Britain today is smoked by someone with a mental disorder. When people with drug and alcohol problems are included the proportion is even higher.
The reason is that smoking rates have more than halved over the past 50 years, but the decline has not happened equally in all parts of society.
“Smoking is increasingly becoming the domain of the most disadvantaged: the poor, homeless, imprisoned and those with mental disorder. This is a damning indictment of UK public health policy and clinical service provision,” the report says.
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December 16, 2012
The domestic terror: “I live with a son who is mentally ill. I love my son. But he terrifies me.”
Anarchist Soccer Mom has a story to tell. It’s neither pleasant nor uplifting, but it needs to be told:
I live with a son who is mentally ill. I love my son. But he terrifies me.
A few weeks ago, Michael pulled a knife and threatened to kill me and then himself after I asked him to return his overdue library books. His 7 and 9 year old siblings knew the safety plan — they ran to the car and locked the doors before I even asked them to. I managed to get the knife from Michael, then methodically collected all the sharp objects in the house into a single Tupperware container that now travels with me. Through it all, he continued to scream insults at me and threaten to kill or hurt me.
That conflict ended with three burly police officers and a paramedic wrestling my son onto a gurney for an expensive ambulance ride to the local emergency room. The mental hospital didn’t have any beds that day, and Michael calmed down nicely in the ER, so they sent us home with a prescription for Zyprexa and a follow-up visit with a local pediatric psychiatrist.
We still don’t know what’s wrong with Michael. Autism spectrum, ADHD, Oppositional Defiant or Intermittent Explosive Disorder have all been tossed around at various meetings with probation officers and social workers and counselors and teachers and school administrators. He’s been on a slew of antipsychotic and mood altering pharmaceuticals, a Russian novel of behavioral plans. Nothing seems to work.
[. . .]
When I asked my son’s social worker about my options, he said that the only thing I could do was to get Michael charged with a crime. “If he’s back in the system, they’ll create a paper trail,” he said. “That’s the only way you’re ever going to get anything done. No one will pay attention to you unless you’ve got charges.”
[. . .]
No one wants to send a 13-year old genius who loves Harry Potter and his snuggle animal collection to jail. But our society, with its stigma on mental illness and its broken healthcare system, does not provide us with other options. Then another tortured soul shoots up a fast food restaurant. A mall. A kindergarten classroom. And we wring our hands and say, “Something must be done.”
I agree that something must be done. It’s time for a meaningful, nation-wide conversation about mental health. That’s the only way our nation can ever truly heal.
God help me. God help Michael. God help us all.
H/T to Drew M. for the link.
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February 18, 2012
March 1, 2010
Miami considers new ways to marginalize the homeless
Miami has a problem with the homeless, so it has come up with a new and innovative way to address it: making it even more difficult for people to (legally) help feed them.
Miami residents may have to think twice before giving up their leftovers to the homeless.
The Miami City Commission is set to consider a proposal next month that would prohibit unauthorized people and groups from feeding the homeless downtown, an ordinance proponents say will cut down on litter and ensure the safety of the food the homeless do eat.
The Miami Downtown Development Authority recently approved the measure, sending it up to the commission.
Though the change could draw objections, David Karsh, spokesman for Development Authority Chairman Marc Sarnoff, said the rule isn’t a blanket ban. He said that anybody would be able to feed the homeless, but they would have to go through formal training first — amateurs couldn’t just give up part of their lunch to help someone they meet on the street.
I’m sure there are problems . . . few people are homeless voluntarily unless they have other issues (commonly mental health problems). But this proposal appears to be moving in the wrong direction, by discouraging individual efforts to help. Give a homeless man a sandwich and face a $300 fine? Two predictable results 1) fewer ad hoc efforts to help the homeless, and 2) fewer meals for the homeless.
November 24, 2009
Friendly reminder to UK readers: you do not have a right to remain silent
A fascinating story about a case in Britain where the government’s shiny new powers under Regulation of Investigatory Powers Act (RIPA) have been used to jail a schizophrenic man for refusing to divulge the passwords to access his files:
The first person jailed under draconian UK police powers that Ministers said were vital to battle terrorism and serious crime has been identified by The Register as a schizophrenic science hobbyist with no previous criminal record.
His crime was a persistent refusal to give counter-terrorism police the keys to decrypt his computer files.
The 33-year-old man, originally from London, is currently held at a secure mental health unit after being sectioned while serving his sentence at Winchester Prison.
In June the man, JFL, who spoke on condition we do not publish his full name, was sentenced to nine months imprisonment under Part III of the Regulation of Investigatory Powers Act (RIPA). The powers came into force at the beginning of October 2007.
[. . .]
Throughout several hours of questioning, JFL maintained silence. With a deep-seated wariness of authorities, he did not trust his interviewers. He also claims a belief in the right to silence — a belief which would later allow him to be prosecuted under RIPA Part III.
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