Thursday, December 30, 2010

Talk Therapy with a Forked Tongue

Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried
by Ethan Watters and Richard Ofshe

The Goodread review:

In this clearheaded and courageous book, Ethan Watters and Richard Ofshe expose the pseudoscience behind the twentieth century's most enduring myth - Freud's theory of the psychodynamic mind. Despite the lack of credible evidence for a powerful unconscious that controls our behavior, a huge number of therapists continue to base their practice on the idea that only they can uncover their patients' unconscious motivations, luring thousands of Americans, from the mildly demoralized to the seriously ill, down dangerous and arbitrary paths of treatment. . . . This book is a call to action for reforming the poorly regulated mental health profession, so that no more patients are misled by a myth that has held sway over American minds for far too long
Finally someone is willing to come out and say it.  Much of what passes as psychotherapy is not based in empirical science and is quite often unhelpful or even worse.  This book is a wry yet disturbing romp through the cultural history of psychoanalysis from its birth out of the forehead of Freud, through it’s explosive captivation of the American pop psyche, and finally up to the present day accumulation of psychotherapy methods (the intellectual grandchildren of Freud’s) that are trademarked, patented and hocked to practitioners at carnival-like trade shows.  It is a must read for anyone who has questioned the Great Oz of the Ego/Id/Superego Trinity and wants to know who the man behind the curtain is.

While there has been a virtual Gatling Gun of  criticism of the biomedical model from psychosocial adherents, there has been very little in recent memory in the way of criticism of psychotherapy.  In that sense, Therapy’s Delusions is a breath of fresh air.  My only gripe with Watters and Ofshe is their implicit assumption that the biomedical model is more objective and has more to offer consumers of mental health.  While both theoretical arenas contain elements of empirical knowledge, they are also both driven by ideology and consumer-capitalism.  It is quite well known now that the pharmaceutical industry drives bio-psychiatry forward as a commercial enterprise.  The authors fail the test of objectivity by ignoring this plain fact.  However, they have done us a service by highlighting the equally disturbing but lesser known fact that psychosocial based therapy is also a capitalist endeavor made up of many entrepreneurs and businesses both large and small.  Every peddler of treatment models and every practitioner of psychotherapy has a profit motive hidden, undeclared, under the surface of their brand.

What’s wrong with that, you ask, it’s the American Way, is it not?  Yes, it is.  And it is not so wrong except that it is denied and hidden.  It is lurking in the id of the mental health industry, you might say.  Hidden from view, who can say when and how often the profit motive trumps the best interest of consumers of mental health care?  Don’t expect a straight answer from your therapist, especially if their house is underwater, as we say these days.

Wednesday, December 29, 2010

Parasitism as Psychotherapy

There is a lot of literature and professional discourse in the area of transference and counter-transference.  It is a staple of clinical supervision and represents some core concepts relevant to quite a few therapeutic models.  Anyone providing, or claiming to provide, psychotherapy must be aware of, and have at least a modicum of training on these core concepts.

So, why is it then, in the public mental health system, there is so much confusion and ignorance on such basic concepts?  Is it because graduate counseling and social work schools are vocational factory farms intended to get people in, take their money, then move ‘em out with their rubber stamp degrees?  Is it because the public mental health system attracts mediocre and failed therapists (I don’t think so because private therapists are hardly any better)?  Is it because of the confusing eclectic din of contradictory theories and “evidence based” practices that make it impossible for directors, clinical supervisors, and therapists alike to develop any kind of coherent vision of what they are doing?  Is it simply due to lack of oversight and supervision that individual professionals gradually drift into their own personal comfort zones, un-self-aware, and motivated by their own emotional needs?

Do I sound too harsh a critic?

I see it every single day in the field.  Every day.  The same dramas get played out endlessly with every possible variation, yet always the same.  The client with the borderline personality or complex PTSD or dysfunctional patterns of meeting their needs, whatever you want to label it, it plays out the same anyway.

On the one hand you have professionals who are frustrated at being manipulated and lied to by their client; cynical at dealing with clients who have no interest in working on their  issues or getting better but seem to only want to suck as much as they can out of the mental health system; and angry at colleagues who blame them while covering up, making excuses, and enabling the client’s manipulations and anti-social behaviors.

On the other hand you have professionals who, with great self-importance, take up the cause of these poor misunderstood individuals.  Somehow these professionals develop a shameless belief in their own “special” ability to connect and understand.  They quickly conclude and profess that all the client’s problems stem from the negative judgments of others, including judgmental mental health professionals.  They seem to believe that the “cure” is to empathize and sympathize with their client, while never questioning their client’s beliefs or behaviors.

I have news for you.  If you find yourself falling into one of these camps, you need to stop what you are doing and step back to find some objectivity.  Psych 101:  if you are emotionally enmeshed or reacting strongly to your client, you are not going to be able to provide any kind of real therapy.  And that is exactly how it plays out.  Clients who get this kind of dual reaction/enmeshment treatment don’t get better.  The reactors just play out the role of perpetrator, thus reinforcing the client’s belief in their own victimhood and allowing the client to dodge any responsibility for their own behavior.  The enablers do just that, they cover up for their client and enable them to continue with their dysfunction.

The enmeshed enablers are probably the worst of the two, simply because they will continue the “therapeutic” relationship for years and years and years regardless of the complete lack of progress.  What develops is a sort of emotionally symbiotic parasitism that’s paid for by Medicaid.

On the one side of the symbiotic relationship is a client whose dysfunction has led them to get all of their emotional needs met through therapy and the mental health system.  In other words, therapy is an end in itself.  The negative and positive relationships they develop with professionals feeds their emotional need for drama and attention and emotional enmeshment.  There is no desire for actual improvement.

On the reverse side of the symbiotic relationship is a professional who is hungry for attention and recognition and a feeling of efficacy.  As long as the therapist stays on the client’s good side by joining them in their denials, rationalizations, and reification of their victimhood, the client will return the favor by singing the therapist’s praises and generally playing to their ego.  The bigger the ego of the therapist, the more susceptible to this they seem to be.  These arrogant professionals believe they are somehow immune to counter-transference and ignore clinical best practices.  The result is they feed their client’s pathology without end and seem to be oblivious to the fact that their client never gets better.  It doesn’t seem to matter because both client and professional are getting their emotional needs met by the relationship and Medicaid pays for it all without question.

There does not seem to be any end in sight to this pattern.  It has been a major problem in the mental health system since it was first identified in the mid 20th Century.  But in spite of the mountain of literature and treatment guidelines, professionals continue to make the same mistakes time and time again.  How can a therapist help a client face their hard-to-face issues when the therapist isn’t willing or able to face their own issues and seriously look at how their counter-transference impacts their efficacy?

Tuesday, December 28, 2010

Therapist Types: The Confrontationalist

These are the overbearing I-have-all-the-answers counselors.  They listen only long enough to figure out what you need to be told.  The bulk of the counseling is directive and educational.  The direction might come from a defined theoretical perspective or it is often simply a hodge-podge of common sense and non-sense.

This is still the industry standard in drug and alcohol counseling where 12-step provides the material for indoctrination.  Input from clients is allowed so long as it follows the prescribed 12-step path.  Any wayward or contradictory beliefs expressed by the client about their own life and motivations are met with staunch correction from the counselor.  Independent thought is labeled intellectualization, rationalization, denial, “escape into health,” and such.

There are also Confrontationalists in mental health counseling.  The temperament and relationship is similar to the 12-step based counselor, but the content may be different.  Confrontationalists may impose a medical model or use reality therapy or any number of different approaches, but it is always delivered in a confrontational and directive manner.

Confrontationalists are the tough-love counselors who may tell you that you’re the boss but the unspoken message is: “My way or the highway.”  If you deviate, you feel like you are being corrected.  Any insight you express about your own inner life is squashed and replaced by common adage dressed up as psychological theory.

The Confrontationalist Symptom List
  • Loud or authoritative tone of voice
  • Interrupts
  • Talks-down-to
  • Educates
  • Directs
  • Poor listening skills
  • Imposes a model of therapy regardless of whether it fits the clients needs
  • If the client is argumentative he or she is re-educated or may be booted from therapy.

Therapist Types: The One Diagnosis Wonder

Certain therapists become enamored with a particular diagnosis.  This one diagnosis becomes their professional obsession.  They become widely knowledgeable on the topic and proficient at diagnosing even latent and subtle manifestations of the chosen disorder.  Soon they are uncovering the disorder everywhere they look and in just about every client they see.  Besides providing the therapist with that Maslowian peak feeling that he or she has become a true expert in something, it also becomes quite lucrative and therefore a little difficult for the therapist to be truly objective.

Through the 1990’s and 2000’s the mental health industry relentless expanded its markets into new niches and populations that had never been tapped before, benefiting drug companies and therapists alike.  One of the ways this happened was through the promotion of “shadow” or “spectrum” syndromes.  These are mild versions of genuine psychiatric disorders.  Shadow syndromes have been identified for Attention Deficit Disorder (ADD), Autism, and Bipolar Disorder, among others.  The idea that some people manifest “sub-clinical” symptoms of these disorders is not new.  What is new is that some professionals now diagnose and treat people who present with these mild forms. 

This is one way in which the One Diagnosis Wonders get away with over-diagnosing their favorite disorder.  Another approach is the development of non-standard and unapproved diagnostic criteria that are broader than that given in the Diagnostic and Statistical Manual (DSM) of the APA.  One example of this is the currently popular “Complex PTSD” that allows counselors to semi-legitimately diagnose people with PTSD (Posttraumatic Stress Disorder) who do not meet the criteria for the official diagnosis as defined in the DSM.

Lastly, there are One Diagnosis Wonders who simply do not use careful or considered judgment in assessing and diagnosing.  These are therapists who diagnose from the hip and never give it a second thought.  Some may even disavow using the DSM criteria because they believe their expertise is so great, they can simply intuit that someone is afflicted with [insert favorite diagnosis].  This approach to diagnosing is particularly favored among the proponents of recovered memories and dissociative disorders (such as Multiple Personalities).

The problem with over-diagnosing is the simple fact that people are being labeled and treated, sometimes with medications, for a spurious or at least questionable diagnoses.  This can cause problems with side effects from psychiatric drugs (up to and including death), undue dependence on a therapist or the mental health system, and unnecessary labeling that can have an adverse effect on self-esteem, identity and personal development.

The One Diagnosis Wonder Symptom List
  • Many or most clients are diagnosed with the very same thing
  • The therapist seems to ignore, discount or minimize problems that don’t fit their favored diagnosis
  • The therapist pressures clients to accept they have symptoms or past experiences (such as childhood sexual abuse) even when the client denies these things.
  • Often these therapists will be good at talking and explaining their expert knowledge but don’t come off as very good listeners.

Therapist Types: The Rescuer

This type is also very common and has several sub-types.  The rescuer may be male or female but is more often female (as mental health workers are predominately female anyway).  The Rescuer often projects a maternal or maternalistic feel.  Typically if her client is compliant than she is maternal, but if her client is non-compliant she becomes maternalistic, meaning she knows what best for the client.

Like the Narcissist, the Rescuer also likes dependent relationships.  But, she is less intolerant of antagonistic clients.  She may see the difficult client as a challenge to prove herself as a carer.  It goes with the whole maternal thing, after all.

The main identifying characteristic of the Rescuer is she does-for the client instead of teaching the client or challenging the client.  She takes on the problems of the client and does her upmost to fix them, or failing that, to protect her client from anything that might cause distress or pain.  She may go to extraordinary lengths to do so, such as giving the client access to her on a 24/7 basis.  In the business we call this poor boundaries and it results in . . . you guessed it . . . dependence on the therapist.

Protecting the client from distress or pain includes protecting the client from the natural consequences of his or her own choices and behaviors.  Rescuers will not confront their clients about their problematic behaviors or distorted thinking and they will resist any attempt by others to do so.  This comes from the belief that to do so will cause too much emotional distress to the client.  There may be a secondary rationalization that the client is being victimized by the judgments of others, and therefore is not responsible for his or her behavior.

The Rescuer feels good about doing-for.  It gives her the feeling she is helping and that’s why she became a therapist.  Her motivation is pure, and Rescuers are typically good people at heart, but, unfortunately, they are blind to the harm they do.  Because their motivation is “good,” they run on the belief that their intuitive values trump counseling ethics and best practice.  As a result they may resist or ignore supervision.  If she is allowed to practice like this unabated, she will often create a large clientele of child-like dependents who go to her for their every need.  That is when the Rescuer feels at home—at least, that is, until she gets burnt out and has to quit and abandon all her infantilized clients.

The Rescuer Symptom List:
  • Manner: friendly, good eye contact, touchy, huggy, minimal personal space.
  • Clothing:  lose-fitting casual clothing, often with beaded accessories and, of course, sandles.
  • Speech: every phrase is framed in the positive with no negative, critical or politically incorrect words spoken.
  • Resists challenging the client on beliefs or behaviors, sometimes to the point of reinforcing and even advocating for the client’s rationalizations and denial systems.
  • Continually in motion in the service of clients.  Looks like frantic activity, multitasking, advocating, interrupting therapy sessions to give crisis counseling to another client with a hangnail (for instance).
  • Does not set limits on availability to clients.  May give out home number or cell number.
  • Does not set limits on what she will do for clients.  May provide many non-therapy services such as giving rides, taking shopping, helping with chores, paying bills, etc.
  • Actively and assertively advocates in the community to prevent the effects and consequences of the client’s behaviors from having a negative impact without making any attempt to prompt a change in the problematic behavior.

The Wounded Healer
This is a sub-type of the Rescuer.  It is a commonly held maxim that psychologically wounded people are drawn to work in the mental health field.  This may be so, but not everyone displays their wounds on their sleeves—the Wounded Healer does.  She is more often female than male, but not exclusively so.

In the simplest form, she uses her personal history for therapeutic illustration.  In her worst form, she uses her personal material to create empathy from the client toward the therapist.  The Wounded Healer is a deeply empathetic carer toward clients who have a similar profile or history to herself, but she often has trouble understanding or empathizing with clients who do not.

Problems develop because (1) she cannot distinguish between her own issues and those of her clients, and (2) her divulging of her personal material puts an emotional burden on her clients.  She is motivated to connect with others who have suffered similarly to herself and, in some cases, may seek an empathic reaction.

The Wounded Healer Subtype Symptom List
  • Talks openly of her past psychological trauma in a manner that seeks an empathetic reaction or acknowledgement of a special condition/status.
  • Drawn to work with a special type of client that matches her own profile or history.
  • Has difficulty understanding or working with clients who do not share her issues.
  • Becomes emotionally enmeshed with clients and may misunderstand clients due to projecting her own issues on them.
  • Clients become emotionally burdened or alienated by the therapist’s needs.

The Alan Alda
This is another sub-type of the Rescuer.  This is specific to men who came of age in the 1960’s and 1970’s.  Many men of this generation accepted the belief that men of previous generations were the source of all social ills through patriarchy, racism and violence.  To counter-act this, they were drawn to caring “feminized” professions where they could actively heal the wounds caused by patriarchy.

In character, they are beneficent and generally non-violent in word and deed.  The concept of non-violence may be so prominent that he is unable to make any comment that could be viewed as even remotely critical.  Because of this, this type is not able to effectively deal with entrenched denial or poor insight in a client.  They may even encourage denial in order to avoid the perception of conflict.  The exception to the rule of conflict avoidance is if he has a client who reports being a victim of injustice, especially sexist or racist injustice, then this type will become a fearless advocate and activist regardless of actual facts.

The Alan Alda Symptom List (symptoms in addition to the Rescuer symptoms)
  • Ponytail
  • Good listener
  • Mostly non-assertive.  In instances where he is assertive, he will be passive-aggressive and condescending.
  • Will inexplicably develop a spine and argue for the rights of his client if triggered by he perceives social injustice against his client.  This will be done with no attempt to actually verify the facts.

Therapist Types: The Miracle Worker

These are the woo-woo practitioners, the snake-oil salesmen, of the 21st century.  This tradition goes back to the Paleolithic when certain unscrupulous shamans played tricks on their patients to make them think they were healed.  Sometimes the belief alone caused the patient to get better.  Other times, the patient died anyway, probably cursing the quack shaman.  These days, we call this the placebo effect.

Don’t be fooled by the Evidence Based Practice jingle.  That’s just another way of not saying anything at all.  It means about as much as “New and Improved” on a box of detergent.  There are plenty of Evidence Based Practices that are nothing more than placebos.  After all, there is plenty of scientific evidence that placebos can have a positive healing effect.  Thus, anything with a placebo effect can and does get labeled an Evidence Based Practice.

The Miracle Worker type peddles questionable and nonsensical therapies.  Does that mean Miracle Workers are shameless swindlers and mountebanks?  Maybe, but usually not.  Most Miracle Workers sincerely believe in the efficacy of their own therapy but lack the ability or intellectual will to critically analyze their own practices.  He or she (and there doesn’t seem to be a gender preference) present no objective scrutiny regarding their therapy.  Any attempt to apply critical analysis will be met with hocus pocus, meaningless jargon, and if that doesn’t work, the final fall-back of “There are more things in heaven and earth . . . than are dreamt of in your philosophy.”

Cultic non-therapies include, but are not limited to, Eye Movement Desensitization Reprocessing (EMDR),  Primal Therapy, Past Life Therapy, Thought Field Therapy (TFT), Emotional Freedom Technique (EFT) (and variants), brainwave synchronizers (various brands), Orthomolecular Therapy, etc.  These are just a few. There are many more and many therapies to be skeptical about.

The Miracle Worker Symptom List
  • Sounds too good to be true.
  • One easy solution for many or all problems.
  • Feels like you’re being sold something.
  • Counselor uses an excess of scientific-sounding words but without fully explaining their meaning.
  • Explanations of the therapeutic method are confusing and contradictory, or may be overly simplistic.
  • When asked to clarify, the counselor responds with more jargon and gobbledygook.
  • Criticism of the method is responded to with irritability or hostility.
  • The counselor only uses one method of therapy—few or no therapeutic choices are offered.
  • Counselor only collaborates with colleagues who use the same method.

Therapist Types: The Narcissist

This type is not uncommon and may come in male or female, hippy or square varieties.

The classic Narcissist type was a male Freudian analyst.  They would sit behind their “patients” while making them divulge shaming thoughts and feelings they may have experienced as children.  They would then “educate” their patients about what was really going on in their head.  The analyst had the knowledge and insight.  The patient was ignorant and unconscious of their own mental emotional processes.  The “insights” generally boiled down to repressed sexual feelings for Mom or Dad.  And if you didn’t buy it, obviously you’re an unsophisticated dufus.

Nowadays, Nacissitic therapists come in all shapes and sizes and theoretical orientations.  They may be traumatologists or chi-id synergistic specialists or psychodynamically informed eclectic practitioners or anything in between.  The common thread is, the therapist is the source of knowledge and insight.  There is often a distinctly paternalistic quality to the person or the relationship.  The therapist has special inside knowledge about what makes the client tick (regardless of theoretical frame—special inside knowledge may derive from beliefs about childhood trauma or beliefs about chemical imbalance, or any of the other myriad theories and wacky beliefs floating around out there).  Alternatively, the therapist may offer a special relationship and understanding of the client that no one else could offer.  The client could never solve his or her own problems without the therapist.  And, finally, the therapist seems to derive emotional sustenance from dependent relationships and will nurture dependence, sometimes indefinitely, but will not tolerate a critical client or colleague.  Some therapists of this type will actually meet the DSM-IV criteria for Narcissistic Personality Disorder.

The Narcissist Symptoms List:
  • Excessive number of capital letters listed after name
  • Posture:  sits back in chair with legs crossed, looks down nose.
  • Speech:  arrogant and polysyllabic with gratuitous use of opaque technical jargin.
  • Actively or inactively endorses criticism of other therapists, may even take part.
  • Deeply committed to his or her own opinions even in the face of contrary evidence.  This may be most apparent in the process of diagnosing and post diagnosis education.
  • Fails to stop or dismiss flattery.
  • Appears to thrive on the positive transference, adoration and emotional dependence of clients.
  • Promotes the idea the he has a special relationship/rapport with client or that no one truly understands the client at the same level that he does (yes, that’s an old pimp trick).
  • Low esteem or tolerance for colleagues.  May refuse to consult or collaborate.
  • Becomes irritable or even hostile in the face of criticism.  May even terminate services to clients who fail to reinforce the therapist’s ego.
  • Clients and colleagues are obsequious and sing the therapists’ praises.

Thursday, December 23, 2010

Recovery or Denial?

“The Recovery Model.”  It sure sounds good, don’t it?  Recovery is one of the now buzzwords.  So, what does it really mean?  Did someone find a cure for schizophrenia?  Because, if they did, it’s a well kept secret.

The recovery model promotes the idea that people can recover from mental illness.  This is an important concept for a lot of reasons, not the least of which is that it promises to counter the phenomenon of people getting labeled and institutionalized and then forgotten.  It challenges the neglectful attitude that people can’t get better.  It highlights the fact that some problem behaviors are actually a result of institutionalization and over-medication.  It provides hope.  These are good things.

It is also used by state human services departments as a rationale for cutting or even eliminating funding for secure residential care for people with severe psychiatric disabilities.  The result?  People with severe disabilities are forcibly moved to community placements, and if-and-when they don’t make it, they end up on the streets.

That sure-as-shit don’t sound like recovery to me.

The fact is, there are some people who will get better with treatment (or sometimes even without) and there are some with more severe conditions who will not recover and need continuing treatment and care.

Yet again, we have a treatment model that is not based on science, but on political and economic expediency and because there is so much political correctness and complacency in the system, very few seem willing to speak up about it.

Dr. Munetz put it with nicer words than I can muster in his letter to Psychiatric Services (APA journal):  Denial of Mental Illness

Maybe, just maybe, this is the beginning of an honest discussion of the issues.  That would be real hope.

Wednesday, December 22, 2010

An Outline of Farce in the Public Mental Health System

As I see it . . .
This is just a partial list to get started with.  Not in any particular order.
  • Blind Advocates—There is a tendency among mental health workers to advocate blindly regardless of actual clinical need. This is far more true in the mental health system than is found in the developmental disability services arena or the addiction treatment arena.
    • Blind advocates will misrepresent the truth about their clients to potential landlords, employers and even other mental health professionals in order to get their client whatever he or she wants without consideration for the fact that by not addressing the underlying problems they are simply setting their client up for another failure.
    • Some professionals will implicitly or explicitly promote fraud as they look the other way when their clients lie about income and symptoms in order to maintain entitlements.
  • We’re All Disabled—creation and promotion of disability. Some mental health professionals seem to be of the opinion that any client who comes to them or their program should get cash disability payments. Some go so far as to misrepresent the severity of the clients' condition in order to help them get disability. Very little thought seems to be given to the fact that someone who is not truly disabled will ultimately be detrimentally affected by being told they are now disabled (and shouldn’t work) and by being escorted into the Social Security trap.
  • You Need My Help—nurturing or creating dependence on the therapist and the system. It is truly overwhelming how much of public mental health resources (Medicaid and Medicare) are channeled into treatment models that have no positive clinical outcomes except the promotion of more mental health services.
  • Cherry Picking—therapists and programs who are only willing to work with favored (i.e., easy-to-work-with) clients and unwillingness to work with clients with actual severe disabilities with difficult behaviors associated with their disability. Where does this leave people with severe disabilities? Overcrowded state institutions or the street. Where is the compassion?
  • Pseudoscience—use of pseudoscientic data to bolster vacuous treatment models. Just take a few examples, out of many:
    • Eye Movement Desensitization and Reprocessing—belief that having a client track a moving finger or object with their gaze while concentrating on a stress inducing thought will reduce symptoms of mental illness.
    • Neurolinguistic Programming—assumes that by tracking another's eye movements and language, an NLP trainer can shape the person's thoughts, feelings, and opinions (There is no hard evidence to back this up).
    • Emotional Freedom Technique—tapping acupuncture points with your fingertips. The principle behind EFT is that negative emotions can cause disturbances in the body's “energy field.” Your tax dollars hard at work, tap, tap, tap . . .
  • Diagnostic Fads—faddish use of popular diagnostic categories and treatment models. The result is overwhelming increases in certain diagnoses due to popularity rather than objective facts. There are a number of reasons behind diagnostic fashion crazes but the primary driving force seems to be a widespread culture of pathologization of day-to-day problems. People are increasingly demanding that personal and interpersonal problems be described through a disease model and treated with medications or other quick fixes. Added to this is the commercial pressure from the army of therapists out there looking for business and, of course, the massive influence of the pharmaceutical industry. Some examples of diagnostic fads:
    • ADHD—this seemed to peak in the Nineties and was driven by schools, parents and society at large moving away from traditional methods of child discipline and seeking new forms of behavioral control for the modern child (RitalinÒ). In its heyday, in the late Nineties, some elementary schools had upwards of 25% of young boys diagnosed and on these medications. Its popularity has diminished, only a little, because of the rampant problem of boys and girls on amphetamine-based medications growing up (all too quickly) into methamphetamine addicts.
    • Bipolar Disorder—this is a very real and serious disease. However, sadly, it is very poorly defined. Many professionals are confused by the diagnosis and do not really understand it. It has become a very convenient label to throw at anyone with mood and behavioral difficulties (gee, isn’t that the entire human race?). This diagnosis became very widespread in the Nineties and was, and still is, very popular among adults who just want something to deal with emotions that get in the way of professional and relationship successes. It got another boost in the 20-Ought decade when anti-depressant drugs were found to increase the likelihood of teen suicide. The solution? Yeah, we'll just slap a Bipolar label on ‘em and feed ‘em Lithium Carbonate for breakfast. Problem solved.
    • Dissociative Identity Disorder (AKA Multiple Personalities)—Where do you even begin with this one? So for one thing, it’s very very questionable whether this is even a real disease. But, the point I wanted to make here is that this diagnosis has mushroomed quite recently. You might remember the big implanted/recovered memory scandal of a few years ago? Yeah, well all those mentally unbalanced therapists who were driving that bus are still out there and still practicing. Now they don’t do the recovered memory thing anymore because they don’t want to get sued, but they are pushing this diagnosis hard. It is a sick, sick thing when a therapist plants and nurtures a mental illness in a client for their own emotional and financial gain.
    • Posttraumatic Stress Disorder—yes, this is real, but it is way overdiagnosed. Humans are, in fact, quite resilient. I am here to tell you that not everybody who has experienced trauma needs to take drugs or spend money on a therapist. PTSD is on the crest of a wave right now. There are some therapists out there who have reduced their professional vocabularies down to a single word: Trauma. Yes, understanding trauma is very important for promoting mental health, but in the hands of confused but well meaning professionals, it leads to drowning in past traumas with absolutely no clue about how to help a person recover and build resilience.
    • Autism Spectrum—another very real and very serious disease that has become exceedingly popular and chic among parents and even among adults who have only very minimal signs of the disorder.  Here is another case of individuals with severe disabilities losing resources to people who don't really have a disability
  • The Paradigm Pendulum—quick radical changes in paradigms based, not on science, but on politics, popular culture, political correctness, and economic incentives/pressures. This problem has plagued psychology/psychiatry from the very beginning. The human brain is maybe the most internally complex organ known to biology and empirical science (not psychology) is only now beginning to scratch the surface of this amazing complexity. So what has driven psychology/psychiatry over the past century? I don’t know what you call it, but isn't empirical science. So, lacking a true empirical basis, what drives these paradigm shifts? Ideology and wishful thinking, I say. That’s why the history of paradigms in psychology looks a lot more like the history of politics than it does medicine. There are thousands of theoretical models out there, most of whom bit the dust long ago, but there is a bigger pattern in which the culture seems to go back and forth between the two great paradigms of the biomedical model and the psychosocial model. In recent history, the biomedical paradigm gained overwhelming ascendancy in the Eighties and into the Nineties on the Prozac locomotive and the “chemical imbalance” explanation-for-everything. Now that’s out, the new slogan is “trauma,” and the psychosocial paradigm is king. But, the cracks in the façade are already developing and there is a building swell of genetics research that’s threatening the party-line. Look at your watch, give it 10-15 years and the medical model will be back on top again. You can put money on it.
  • I’m Not Mentally Ill But You Have to Support Me and Serve Me—psychiatric consumers and survivors who represent their own personal interests but packaged as social activism. How many times can someone unironically claim there is no such thing as mental illness, yet on the other side of their mouth, demand more and more services from the mental health system? It is a fact that very few people who publicly represent themselves as consumer/survivor activists have ongoing severe mental illness. As a consequence, the interests and needs of people with severe disabilities continue to go unheeded. Decades after “deinstitutionalization” we still have people with severe mental illness housed in deplorable conditions in institutions, prisons, emergency shelters, and the streets. Are these people represented by the self-styled activists? Not that I see. But, the full-time activists are marshalling all their energies to address their personal pet peeves while many of them fraudulently continue to draw down social security payments. Listen, Buddy, if your doing networking and activism 60 hours per week, you are perfectly capable of getting a job just like anyone else and you have no right to take public disability payments intended for people who can’t work.
  • Drug Money—psychiatric medications are big business, in fact, prescription drugs have the biggest profit margin of any major industry, even bigger than the petroleum industry. Where do they spend their money? Just like any for-profit industry, a sizeable portion of expendable resources goes into promoting their products. This certainly includes advertising. It also includes funding biased research that promotes their products; flooding journals and literature with redundant studies that promote their products; deceptive “public education” campaigns; creating and financing activist and consumer groups that promote their products; etc. You get the idea. It has a huge huge impact on beliefs and practices in the mental health field. When encountering McScienceÒ, buyer beware.
  • Let’s Play Pretend—politically correct professionals who willfully misdiagnose or simply avoid properly identifying personality disorders or any problem that fails the political correctness test. Borderline Personality Disorder, as one example, is often diagnosed, incorrectly, as depression, bipolar, PTSD, and dissociative disorders. This is pervasive and causes no end to problems in mental health programs where the actual issues are misunderstood or ignored. Conflicts occur between professionals resulting from attempts to address and discuss the problems while not being free to identify the problems properly. Resources are taken away from disabled individuals in order to support massive amounts of services to individuals who are not significantly disabled and may not even have a severe mental illness.

Drug Culture

from False Advertising: A Gallary of Parody

A funny but poignant comment on the modern family and our increasing dependence on Prozac, anti-depressants, and psychoactive medications in general just in order to cope with the irritations of daily life.