Monday, August 3, 2009

R. D. Laing's Radical Psychology and My Arguments with Contemporary Psychiatric Diagnosis and Treatment

Radical Scottish psychiatrist, R. D. Laing, author of The Double Bind and Knots among other works, suggested that it is improper to lable a person psychotic, but more appropriate to realize the individual has learned to react to a psychotic situation in the only way they knew how, leading to exhibition of psychotic behavior patterns. (The same understanding can be reached with regard to the relationship of neurotic behaviors and other degrees on the scale of the psychosocial adjustment of individuals with relation to society, family, nation, religion or other group entity.)

Laing is regarded as an important figure in the anti-psychiatry movement, along with David Cooper, though he never denied the value of treating mental distress. He wanted to challenge the core values of a psychiatry which considers mental illness as primarily a biological phenomenon, of no social, intellectual or political significance.

Laing was a critic of psychiatric diagnosis, arguing that diagnosis of a mental disorder contradicted accepted medical procedure: diagnosis was made on the basis of behavior or conduct, and examination and ancillary tests that traditionally precede diagnosis of viable pathologies like broken bones or pneumonia occurred after (if at all) the diagnosis of mental disorder. Hence, according to Laing, psychiatry was founded on a false epistemology: illness diagnosed by conduct but treated biologically.

Laing argued that the strange behavior and seemingly confused speech of people undergoing a psychotic episode (or any other aberrant social interaction) were ultimately understandable as an attempt to communicate worries and concerns, often in situations where this was not possible or not permitted (or permitted to varyingly lesser degrees with the variation in degrees determining the variation of the effect from mild neurosis to debilitating psychosis). Laing stressed the role of society, and particularly the family, in the development of "madness" (his term). He argued that individuals can often be put in impossible situations, where they are unable to conform to the conflicting expectations of their peers, leading to a "lose-lose situation" and immense mental distress for the individuals concerned.

Laing's ideas are not currently espoused by the psychiatric establishment. Significant critiques of his ideas have been published by contemporary psychiatric authorities.

In 1999, Elizabeth Gould and Charles Gross of Princeton discovered neurogenesis in the primate brain. Elizabeth Gould's continued research into neurogenesis has revealed that stress inhibits neurogenesis, consequently also inhibiting brain function.

Current approaches in psychiatry express a fundamental difference with Laing's ideas. Laing saw psychopathology as being seated not in biological or psychic organs – whereby environment is relegated to playing at most only an accidental role as immediate trigger of disease (the "stress diathasis model" of the nature and causes of psychopathology) – but rather in the social cradle, the urban home, which cultivates it, the very crucible in which selves are forged.

Laing's re-evaluation of the locus of the disease process – and consequent shift in forms of treatment – was in stark contrast to psychiatric orthodoxy (in the broadest sense we have of ourselves as psychological subjects and pathological selves). Laing was revolutionary in valuing the content of psychotic behavior and speech as a valid expression of distress, albeit wrapped in an enigmatic language of personal symbolism which is meaningful only from within the understanding generated by the situation which gave rise to the behavior. According to Laing, if a therapist can better understand his or her patient, the therapist can begin to make sense of the symbolism of the patient's psychosis, and therefore start addressing the concerns which are the root cause of the distress. (Such a therapist is required to exert rigourous and insightful efforts to assist the patient which is not the most economically rewarding position for the therapist but it is the most physically, emotionally and mentally taxing).

Comtemporary psychiatry claims that all mental illnesses are related to physical organs' breakdown in function, removing the environment from the equation. The handy consequence for contemporary psychiatrists is that they refuse to treat the individual with ongoing verbal therapy methods, a difficult and lengthy process which exhibits small and incremental benefits that are often hardly perceptible, but do get at the underlying roots of the psychological issues giving rise to abnormal behavior strategies.

Instead, contemporary psychiatry treats patients with mind and emotion-numbing drugs.

Rather than actually lobotomize patients with a scalpel, today's psychotherapists use drugs. We actually witness the reality of the psychiatric treatment of Alex DeLarge's character in A Clockwork Orange through contemporary society's approach to dealing with so-called aberrant behavior. Rather that realize society is the cause of the behavior, and try to do something about curing society's ills, society places the "blame" on organs and then controls the afflicted individuals with drugs that sap the individual of their individuality, their drive, their angst and much of their free will.

Psychiatrists claim individuals express aberrant behavior because they have a "chemical imbalance" thereby reframing maladjustment as physical impairment - turning matters of socialization, emotional sensitivity and cultural non-conformity into matters of disease rooted in the physical tissues of the brain. However, no scientist can actually tell you what a correct chemical balance is or should be. No tests have ever been done to provide any psychiatrist with scientific figures for optimum levels of chemical balances in the brain. Furthermore, no tests are done on the afflicted to even determine what their chemical balances (or imbalances, giving the physicians the benefit of the doubt) are or should be.

There is absolutely no scientific method in the current psychiatric modality for diagnosing and treating human behavior. In fact, the tome used for diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is based on statistical analysis and has very little to do with actually applying a mental examination to the patient based on lengthy observation of the patient or their socialization strategies. The DSM provides statistics that are used to determine diagnoses. For instance, if 80% of all patients exhibiting a particular "symptom" (socialization strategy) are diagnosed with a specific disorder, then all those who exhibit the same "symptom" and follow into the offices of psychiatrists and psychologists will be diagnosed with the same pathology, thus the system contains a built-in self-reinforcement mechanism which confirms and validates contemporary treatment programs. This isn't science and has nothing to do with the scientific method.

I argue, based on the findings of Elizabeth Gould in her later research, that in addition to the effects the environment (parents, the home, school, society, peers, etc.) impose upon the individual and which can potentially be seen as leading to some degree of social maladjustment through choices and strategies employed by the individual to deal with the relative "craziness" of the situation (where socialization strategies can be considered aberrant), the stress endemic to the living situation (the environment and pressures imposed by role models and authority figures within the environment) likely caused a deficiency in neurogenesis which then ended up leading to later increases in maladjustment because of brain impairment due to reduced neurogenesis which, consequently, negatively impacted the individual's ability to select appropriate socialization strategies. Gould has discovered that stress inhibits neurogenesis, not only at the time the stress is present, but in the future as well. The greater the stress is in the environment, the greater will be the impairment of neurogenesis both at the time the stress immediately affects the individual and in later life. Any deficiency in neurogenesis will negatively impact functioning of the brain, thereby initiating, continuing and perhaps intensifying the aberrant behavior or socialization strategy.

I suggest it is not be fair to attribute all abnormal behavior to the family home as Laing seemed to suggest. There are additional significant influences on individuals, for instance: television, video games, school, peer group pressures, music, popular culture, and other influences such as specific events which may occur, for example: involvement in a fist fight, witnessing a violent crime, being the victim of a crime or violence, or being subjected to some form of bigotry, as well as cultural events like 9/11.

As Jean-Paul Sartre noted, all experiences whether real, imagined or artificially created (including virtual) affect behavior, ethics, morals and value judgments made by individuals. Hence, the question - "Did an individual's parents' treatment of that individual cause him or her to become a murderer?" - would take years of verbal psychiatric treatment to unravel. Perhaps the cause was too much time spent playing with toy guns as a child, or too much time spent playing video games like World at War, Bully and/or Grand Theft Auto, or too much time watching violence on television and in the movies. Then again, the abnormal behavior may have been the product of a shock, some sudden occurrence which caused the individual to have to adjust behavior patterns - a rape, a beating, a gun in the face, or who knows what. Such an event might lead an individual down a path which could cause that individual to adjust their behavior to anywhere on the scale from introverted to catatonic to serial killer.

I have great difficulty accepting the currently advanced line of thinking that chemical imbalances are the cause of all abnormal behavior patterns and that all those abnormalities in socialization strategies can be "cured" with drugs. An article published in Los Angeles Times on August 3, 2009 titled "Treating depression can be hit or miss" informs us that psychotherapists have at their disposal some 20 different medications from which to choose when implementing a treatment program. The article goes on to quote Dr. Richard A. Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, as saying, "It's a hit-or-miss, trial-and-error kind of process." Just as with diagnosis, there is no scientific method attached to determining the drug treatment program. The best the physicians can do is try one, see if it works, if not, try another. The same is true for the dosages. This form of "medicine" is really just a variation on the idea that a devil has possessed the body and that an exorcism can cure the individual of the possession. If an eye of newt doesn't work in the treatment program, let's replace it with the wing of a bat taken during the full moon.

Let me quote from the article to support this contention.

"Depression is a common condition, affecting nearly 15 million Americans a year and one in six over their lifetime. Antidepressants are believed to work by blocking the reuptake of neurotransmitters such as serotonin, norepinephrine and dopamine, increasing the amount available in the synapses.

"A review article in the November 2008 issue of the Annals of Internal Medicine looked at more than 200 studies of 12 second-generation antidepressants -- primarily selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft and serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Effexor and Cymbalta -- and concluded that no substantial differences existed in how well they worked. 'There's no clear evidence that one antidepressant is more effective than another,' said Dr. Ian A. Cook, director of depression research at UCLA's Semel Institute for Neuroscience and Human Behavior. Even if modest differences do exist among antidepressants, he said, patients vary widely in what will work for them. 'There is not a good way to know what medication is going to be the best for your patient,' said Dr. Raymond J. DePaulo Jr., a professor of psychiatry at the Johns Hopkins University School of Medicine. 'At this point, many of the treatment recommendations are oversimplifications,' Dr. Maurizio Fava, a professor of psychiatry at Harvard Medical School, said.

"About 60% of patients get at least some benefit from the first drug they try, with half of those recovering fully. Although patients become less likely to respond with each new cycle, a significant number still do. 37% of patients went into remission after the first round of treatment, 31% after the second, 14% after the third, and 13% after the fourth. A third of patients in the study continued to struggle with depression after four cycles of treatment."

Let's hang on a moment here and contemplate what pharmacologists are trying to accomplish with the brain in the treatment of depression as discussed above. Pain medication works on the basis, not of actually numbing the nerves in the part of the body where the pain persists, but in suppressing the neurotransmitters in the brain which would receive the information that pain exists in part of the body. The process is basically like unplugging part of your brain. If you don't know that you are experiencing pain, you will cease to believe pain is inflicting some part of the body. One of the unfortunate consequences of this method of treatment is that an individual may perform some action or activity thinking that the pain is gone when it is still there, and not know that the pain is increasing due to the physical exertion. That can exacerbate the injury and lead to complications or new maladies.

With regard to the kinds of drugs described above as being used in the treatment of depression, the medications used adjust the brain's secretion of otherwise essential chemicals for normal brain functioning. However, neuroscientists are only beginning to scratch the surface of how the brain functions and the interrelationships of neurotransmitters, synapses, the effects of chemical reactions in the brain and their relationship to both physical functioning, emotional states and psychosocial adjustment strategies. The scientific inquiry into these areas is less than 10 years old. Neuroscientists will tell you they really don't know very much for sure, but psychotherapists speak with certainty on their efficacy. It's hardly scientific method for the clinicians to claim certainty in the same areas where researchers feel they are still groping in the darkness. That's the equivalent of the mechanic claiming he knows more about a machine than the engineer who designed it.

When considering what some studies have determined for the physicians' real effectiveness with these drugs, one discovers the difference with the effectiveness related to the placebo-effect is marginal. An analysis performed in 1998 found that 75% of the effectiveness of anti-depressant medication is due to the placebo-effect rather than the treatment itself. An analysis performed in 2008 found that 79% of depressed patients receiving placebo remained well compared to 93% of those receiving antidepressants for the effect of placebos (for 12 weeks after an initial 6–8 weeks of successful therapy). Another analysis in 2002 found a 30% reduction in suicide and attempted suicide in the placebo groups compared to a 40% reduction in the treated groups. You can see, the difference in effectiveness is actually marginal (especially when one considers the size of the study groups: the difference of 10% to 14% can be as small as 1 or 2 in study groups of 10 or 20 to maybe 5 or 10 people in study groups of 50 or 100 for 10% variation or 7, 14, 21 or 28 people for in study groups of 50, 100, 150 or 200 for 14% variation).

A 2002 article in The Washington Post titled "Against Depression, a Sugar Pill Is Hard to Beat" summarized research as follows, "in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as - or better than - antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval. The makers of Prozac had to run five trials to obtain two that were positive, and the makers of Paxil and Zoloft had to run even more.” So, the ability to repeat the benefit, which is a scientific necessity for a claim to be considered scientifically valid, occurred in only 40% of the trials for Prozac and was even less predictable with Paxil and Zoloft. These would not be scientifically acceptable rates in any other field of scientific study. it seems far more likely that the equivalent of lobbyists for pharmaceutical companies must be greasing the FDA wheel so their products can get on the market and generate profits for the companies.

Let's go on now to question the morality involved with the field of mind control through drug therapy.

Even if the drugs used by psychotherapists in the treatment of depression, for instance, are effective (and the jury is still out on that based on the evidence above and the link of drug therapy effectiveness to the placebo-effect), is it ethical for doctors (and often governments through doctors operating under authority granted by courts, probation departments, and competancy adjudicators among other similar entities) to require any individual to submit to drug therapies? We don't know that the drugs are returning an individual to some "normal" (whatever that is) state of chemical balance. For all we know the drugs are merely sufficiently sedating a segment of the non-conformist population into a state of compliant acquiescence. In such a scenario, society isn't returning an individual to mental health, society could be sufficiently medicating the non-conformist revolutionaries who have, throughout history, brought necessary change to previous cultures and helped advance civilization and the causes of freedom and human rights.

Wouldn't Van Gogh have been determined to be manic-depressive? If he had been given medication, the world might have been denied his great artistic achievements. Mozart probably would have been diagnosed as ADHD, so maybe he'd have been medicated to a degree that none of his brilliant musical compositions would have been composed (or just not been any good). Charles Darwin likely would have been determined to have been hyperactive, obsessive-compulsive and maybe even delusional. If so, would the world ever have come to understand natural selection? Certainly, Great Britain would have decided that men like Sam Adams, Thomas Jefferson, Nathan Hale, and those like them were a criminal element who needed to be subjected to anger-management training, and in the course of such a program, likely would have been given medications for some combination of obsessive-compulsive disorder, hyperactivity, paranoia or whatever other diagnosis might have been convenient in their day. The medications they'd have been given would likely have sapped them of the will to pursue, as well as strenously and convincingly argue for, the cause of freedom. How many poets' genius would have been lost to medication? Every religion is founded on the basis of "prophets" who claimed to have seen a vision or heard the voice of God. Each of them would have been declared delusional, locked up, and given mind-numbing drugs.

I'm not trying to suggest that no one be treated for real psychological disorders or psychosocial maladjustment. I strongly advocate psychological counseling and verbal psychotherapy. Furthermore, I agree with R. D. Laing in the assertion that verbal psychotherapy is both the proper method for arriving at a diagnosis and the proper treatment strategy for assisting patients to deal with their psychological issues. I also believe that, since individuals are individual, each must be assessed as an individual and not on the basis of some self-reinforcing, statistical probability list.

I simply resist arriving upon convenient diagnoses based on some arbitrarily applied statistical list of behaviors which are, in actuality, prevalent in just about every segment of society and which diagnoses strip individuals of their individuality, especially when no scientific method is applied in the determination of the diagnoses, nor to the finding that such a disease even exists, nor to the assumption that the pathology is rooted in tissue. I strongly resist the failure to arrive at diagnoses through a lengthy observation of the patient and an in-depth inquiry into the nature and roots of the patient's complaints (like any good medical doctor would do with any real biological disease) as opposed to running through a quick checklist of symptoms and derriving a diagnosis based on the statistical probability of a specific psychological disorder because previous, and potentially erronious, determinations have been made under similar circumstances in the past (again omitting to see the individual as an individual with unique circumstances and unique psychosocial adaptation strategies). I also strongly resist the application of medication as therapy when there is no scientific basis for what drug is prescribed or knowing, ultimately, which drug is the most likely to be effective in the treatment program. Additionally, I strongly resist the idea that the drugs are really "curing" anyone of anything when: 1) the efficacy rate is only marginally better than the placebo-effect and 2) there is no proof that the psychosocial integration issues are even rooted in tissue.

I think it is far too convenient a truth for governments, pharmaceutical companies, probation departments and psychotherapists (who want to assert for the first time in the history of their profession that they can actually cure anything and thus increase their incomes) to suggest that maladjustments of individuals for integrating with society are rooted in tissue and curable by medication rather than rooted in how society functions and trying to find ways to improve society.

1 comment:

shantishanti.net said...

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