Making Our Children Conform Using Mental Trickery

Here is an absolutely excellent article by Elizabeth Weil in the New Republic in which she analyzes the increasing use of various therapeutic techniques to get kids to conform to expected classroom behavior. It is a more subtle but insidious form of pathologizing children who are being normal children.  Much of it is predicated on the now well known delayed gratification studies of young children.  You've heard it before--the test child is told not to eat the marshmallow in order to get two marshmallows in a few minutes.

Everyone who has a child with childhood impulses is immediately struck by inner fear.  Is my child the one who can't wait?  What does this mean for her/his future career?

Now this is the basis for all kinds of behavior modification schemes used in schools.  The problems Weil outlines include that (1) we are telling our children they are mentally sick or wrong, and (2) the empirical evidence does does not support the actual interventions being used.

It is yet another case of wanting to believe this is the right way to do things because it sounds good.

Self-Regulation:  American Schools Are Failing Nonconformist Kids

Please take a look, it is worth the read.

Seeking Safety from Trauma

Over the last decade we have seen a deluge of spilled ink and sermons delivered on the topic of Trauma (capital letter intended).   Therapists and other clinicians are wont to see Trauma as the cause of all mental/emotional distress and disorder.  Payers and regulators want to see Trauma informed care as the standard for all services.

Please don't misunderstand and think I am about to argue against trauma as a factor of etiology.  I am not.  Please do not think I am going argue against trauma sensitive care.  I am not.

I do, however, have to take issue with a number of things.  One of which, I will briefly introduce here, is an intuitive response to emotional trauma (or the vision of Trauma in the mind's eye of the therapist).  I have noticed a tendency among my colleagues to fix Trauma through the exclusive use of invoking Safety (capital letter intended).

What is Safety?  It is a mythical destination we point people to who we believe are wounded by emotional trauma.  In its simplest and cliched manifestation, it is the "safe place" we tell people to go to inside themselves when they are distressed by Traumas past or current.  In its most Utopian manifestation, it is the construction (socially and physically) of a space (or whole communities) designed to remove all sources of trauma and reminders of trauma.  A Safe place is a place where people speak to each other exclusively in soft and supportive tones.  A Safe place has no rules to remind us we are not in control.  In a Safe place no one tells me I am wrong.  A Safe place is a place without "no".

The idea of creating Safety seems to come to some practitioners by intuition and without need for training.  For other practitioners (e.g., Sandra Bloom) it is a treatment model that is bottled, trademarked and sold, but more than that it is a morally driven world view.  It is true by faith and has to be defended against the unbelieving (read: medical model).

Why do we need to create Safety?  Because Trauma doesn't just hurt in the moment, it continues to harm day after day, year after year.  Life's little annoyances and disappointments are more than they are.  They are reminders of the Trauma.  Triggers and re-triggers.  It harms even when the individual has no idea it continues to harm.  Why?  Because the clinician believes.  Sometimes the individual doesn't even know they were Traumatized.  In those cases, the true believing therapist has to help the individual remember . . . (we know where that leads).

That's the reasoning for it.  I can't fault the premise (that psychological trauma hurts), but I doubt the conclusions.

So then, does creating a Safe place help?  I feel the need to ask, if only because so many around me seem to take it on faith.

I haven't come across so much empirical evidence apart from the some apocryphal study about mice and cat hairs.  But maybe this Trauma-Safety dilemma has a corollary in Happiness?  Seeking Happiness for the Sad seems like a very similar impulse to me.  And in that realm I think we do have some evidence that tells us it is a fool's quest.  Turning Sadness into Happiness through the power of affirmations, replacing negative self talk with positive self talk, while intuitively sensible, turns out to be the psychological equivalent of trying to catch a rainbow.  Every time I tell myself I'm beautiful and smart and wonderful, the opposites of those things echo in the mind and I have to increase my affirmations louder and louder to myself, but in the end, affirmations in a vacuum do not lead to Happiness.

Could the quest for Safety be a similar fairy tale?  A nagging doubt tells me so.   The fact that no one questions it, makes me worry all the more.

• Focusing so exclusively on Safety paradoxically highlights an individual's vulnerability.
• Focusing so exclusively on past Trauma reifies victimhood and takes the person out of the here and now.
• By focusing on victimhood we take away a person's agency.
• By focusing on the past we can't change, we forget the here and now where a person actually does have the power to change things.
• By externalizing cause and effect we have taken all control away from the person.

Considering these things, is it any wonder that we see so many people taking part in this therapeutic approach sink deeper and deeper into dysfunction?

The Folly of DID

Not that I've been there myself, but I understand if you travel through England you might come across some of these apparent medieval towers or castles in various states of ruin.

Except that they aren't medieval and they aren't ruins.  They were built to look like ruins.  Many of them were constructed in the 18th and 19th centuries by persons with excess wealth and imagination.  A little bit of deception for someone's amusement.  They refer to them with the term folly.

That brings us to Dissociative Identity Disorder, AKA multiple personalities . . .

I just came across this good review of the DID controversy by Dr. August Piper:

The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder. Part I. The Excesses of an Improbable Concept

Here is an excerpt:

With the recent appearance of several critical articles and books, the concepts of dissociative amnesia and dissociative identity disorder (DID) have suffered some significant wounds (1–5). Between 1993 and 1998, the principal dissociative disorders organization lost nearly one-half of its members (1). In 1998, Dissociation, the journal of the dissociative disorders field, ceased publication. A paper published in 2000 examined the weaknesses in the dissociative amnesia construct (6). Various dissociative disorder units in Canada and the US (for example, in Manitoba, Illinois, Pennsylvania, and Texas) have been closed down. US appellate courts have repeatedly refused to accept dissociative amnesia as a valid entity (6), and several ardent defenders of dissociative disorders faced criminal sanctions, malpractice lawsuits, and other serious legal difficulties.

Nevertheless, despite the significant harm these concepts have wrought in North America, some Canadian and US practitioners continue to support, and practise according to, dissociative disorder concepts (7–9). Further, these North American countries export the concepts. In India, for example, the cinema has influenced the production of dissociative signs (10), and 4 recent papers demonstrate a recurring interest in spreading awareness of DID to other countries (11–14).

and on it goes.

Like the follies built by the idle rich of the romantic period, DID is not simply wrong, it is a fantasy people want to believe and proliferate.

Dissociation, DID, Culture, and Empirical Evidence

Dissociation is some kind of human phenomenon that crosses time and place in the human experience.  Most forms of dissociation occur in the context of religious ecstasy.  There are many many examples.  Umbanda in Brazil.  Indigenous Taiwanese healers.  Balinese ritual trance (people have been know to go into spontaneous trance states even working in factories in Indonesia).  Pentecostal direct experiences with the Holy Spirit.  Speaking in tongues.

The list goes on.  But, we find that dissociation manifests differently in different cultural contexts.

Dissociation itself is not what is in question, but Dissociative Identity Disorder (DID), previously known as multiple personalities, is.

In North American culture, dissociation generally manifests, if not in a tent revival, than in the context of hypnosis or with the patients of certain therapists with proclivities for the promotion of DID.

Does DID occur universally or is it a product of the North American culture of psychopathology?  We already know that mental health disorders can be a product of cultural place and time.  Hysteria in Victorian Europe and America is one well known example.  Neurasthenia in China is another example that has been written on extensively.

Is DID another disorder that is not universal but tied to the Zeitgeist of a particular place an time?  Right now the field of mental health is in an intellectual tug of war on the topic.  We have the historical record that gives us some insight.  The concept of multiple personalities appeared early on in the development of the field of psychology, but it was an extremely rare diagnosis up to a certain point.  That point was the publication of "Sybil" in 1973 and the subsequent film adaptation.  This was the story of Shirley Mason, AKA Sybil Dorsett, who claimed to have multiple personalities, (and later said she made the whole thing up to please her therapist, and then changed her mind again).  After the popularization of multiple personalities by "Sybil" it became a mainstream diagnosis and has benefited from several waves of popularity since.

Sally Field acting

Shirley in youth

"Sybil" acting?

Dr. Richard J. McNally, et al., has now provided us with an empirical window on the topic.  He crafted a controlled study to test a fundamental basis of the DID construct, the amnesic barrier.  The amnesic barrier being the concept that as a DID identified individual transitions from personality to personality, the one personality has no direct memory of the other personality or personalities.

These researchers used a concealed information task that consisted of flashed words on a screen in which subjects were instructed to push "yes" or "no" based on whether or not the word was on a list.  What DID identified subjects did not know is that some of the words flashed on the screen were taken from surveys conducted with at least two of each of their personalities.  The words were specific to the personalities, such as the name of a friend or a favorite food, for instance.

The crux of the study was on a microsecond lag in pressing the button related to words autobiographical to the personality.  This occurred as expected.  Unfortunately for the construct of DID, the same delay occurred for words related to alternate personalities (not currently present/aware personalities), showing that knowledge crosses alternate personalities, undermining if not disproving the amnesic barrier.  It also implies, if not deception, at least an attempt on the part of the subjects to conform to the cultural model of DID.

McNally concludes that "Cultures provide envelopes for people to express suffering or psychological pain and DID is one such cultural trope. . . . I don't think much would be lost if the diagnosis were eliminated from the Diagnostic and Statistical Manual."

Source:  "A story that doesn't hold up" in the Harvard Gazette

Original paper is on PloS ONE here

DID in defense of crime: the case of William Bergen Greene and his therapist

William Bergen Greene was a troubled man who started with a troubled childhood.  He apparently suffered severe abuse as an early child until he was made a ward of the state at age eight.  He suffered further abuse in foster homes and institutions.  At age 17 he escaped from his institution and started his adult life of chronic criminality.  He was so frequently convicted of sexual offences that he spent the vast majority of his adult life in prison.  He remains incarcerated today in Washington State.

He became a prison sex offender patient after a 1988 conviction.  His prison sex offender therapist, known to the public only by the initials M.S. (because she later became another victim of Mr. Greene's many sex offenses), was the first to diagnose him with Dissociative Identity Disorder (DID) otherwise known as multiple personalities.

Her course of therapy started with hypnosis.  With this extremely questionable (if not negligent) technique she proceeded to draw out (or co-develop) some 24 personalities in her patient, not the least of whom were "Auto," a non-human robot personality, and "Smokey" the dragon.  Yes, a dragon personality.

Another therapist at the prison disagreed with M.S.'s diagnosis.  Instead he diagnosed Greene with Malingering.  Incidentally, malingering is listed and described in the psychiatric diagnostic manual and is designated with code V65.2.  V-codes generally indicate a diagnostically important factor or condition that is not itself a disorder.  Malingering, of course, is not a disorder that is treatable under Medicaid but is described as "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives."  Typically, external incentives have to do with financial gain, or avoidance of responsibilities or consequences.  In this case, Greene was already convicted and incarcerated.  The dissenting therapist warned that Greene's malingering was motivated by his life-long pursuit of sexual victims.  He warned that Greene was setting his therapist, M.S., up for a future assault.  The dissenting therapist's assessment proved to be prophetic, but sadly failed to influence M.S.  Not only did she continue her work treating Greene's purported DID, she seemed to become increasingly close to her patient.

Greene was released from prison in 1992.  Within days of his release, M.S. quit her job at the prison and took Greene on as a private patient.

Was it coincidence that she quit immediately after his release?  I can't say, but it is suggestive of a therapist who was severely enmeshed with her patient.

She met him for therapy on a routine of bi-weekly sessions, but if so, they must have been extremely long sessions, because by the end, when he finally assaulted her in 1994, she had racked up over 2000 hours of therapy with this single patient.  By comparison, standard out-patient therapy is generally in the range of 12 to 54 hours of therapy per year.  Yet more evidence of enmeshment if not outright obsession on the part of the therapist.

M.S. received a phone call from a distressed Greene on April 29, 1994.  She knew he was under stress from several things and she was worried he might be suicidal, so she went to meet him at his apartment.  He was talking very slowly with a childlike voice.  He kept referring to himself as "we."  I will add here, the "royal we" is a common trait or affectation among DID patients and it seems unlikely it was the first time he used it in M.S.'s presence but later, in court, she would use it as one of the evidences of his personality fragmentation at the time of the crime.

At some point, as M.S. tried to console the oddly behaving Greene, alone with him in his apartment, she figured out that he was on cocaine.  In a moment of good judgment, she chose to leave.  Unfortunately for her, he barred her way out.  They struggled and M.S. fell.  He ripped off her shirt and bra and touched her, ignoring her protestations and clear statements for him to stop.  He took her to the bathroom and held her there for two hours.  He continued to molest her there, taking breaks only to shoot up a drug, presumably cocaine.  Throughout this incident, Greene's behaviors were later described by M.S. as childlike with frequent but brief bouts of crying. Near the end he removed his own pants and touched himself but failed to achieve a result and soon after said she could go, but when she tried, he changed him mind, tackling her and left her bound and gagged as he removed himself from the scene in M.S.'s car.

Once Greene had fled, M.S. was able to remove her bonds and escaped to a hospital across the street where she called the police.  Greene was soon apprehended and charged with kidnapping and indecent liberties.

Greene plead not guilty by reason of insanity, but in his first trial, Judge Thorpe ruled that DID could not be used in an insanity defense due to lack scientific consensus on the existence of the disorder.  The defense attorney, David Koch, was not permitted to even mention DID.  Greene himself assisted his defense attorney, telling his attorney that one of his alter personalities was trained in law.  Without DID as a defense, the case rested solely on whether or not Greene had committed the deeds.  He was quickly found guilty on both counts.

In 1998, Greene and Koch appealed to the Washington Court of Appeals.  Appeals continued back and forth up to the U.S. Ninth Circuit Court and, in the end, he was granted a retrial.

A pre-trial hearing was held to determine if DID could be used as an insanity defense.  The defense team brought in expert Dr. Robert B. Olsen who testified that DID was generally accepted in the field but conceded after interviewing Greene, he could not say who Greene really was much less determine his sanity due to the number of alter personalities.  The prosecution brought in their own expert, Gregg J. Gabliardi who failed to challenge DID, stating that he agreed it was generally accepted.  His only contribution to the prosecution was to testify that it would be impossible to determine the sanity of each separate personality or determine which personality was responsible for which of the actions Greene had taken.

This was clearly a low point in the field of psychiatry when two psychiatrists under oath fail to mention any controversy related to this diagnosis.  One wonders if Olsen or Gabliardi had in fact believed they could determine guilt and responsibility of one specific personality out of 15, what the criminal justice system would be expected to do with that information?  How do you incarcerate one personality out of many?

With the given experts, it is not surprising in the retrial the defense was allowed to use DID as an insanity defense to claim that Greene was not legally responsible for his actions.  He had two new public defenders in the second trial, Teresa Conlan and Marybeth Dingledy.  The second trial took place over five days in September 2003 in Snohomish County courthouse.

In one of the strangest twists in the history of DID being used to avoid truth and consequences, Greene's victim, his former therapist, the now 53-year-old M.S. demanded to testify in his defense.  In the retrial she was permitted to do so.  She claimed that only she could explain the impact of his terrible disorder, DID, on Greene and its role in causing his behavior on the night of his attack on her.  M.S. testified before the court that it was not Greene himself who had attacked her but actually three of his alter personalities:  Sam; Tyrone, a three or four year old; and Auto, a robot.  She explained to the jury it was not Greene, but Auto the robot who grabbed her and held her down.  It was not Greene who molested her for two hours, but Tyrone the child.  The personality Sam appeared for only a moment and tried to save her, but was quickly taken over by the other two personalities.  M.S. testified her belief that the chronic sex offender Greene was not responsible for the attack because he was not present during the attack and had no awareness of it until he was informed of it later when he was in police custody.

In an odd about face, the expert witness, Dr. Olsen, who had originally testified for the defense, switched sides and testified for the prosecution in the actual trial itself.  He now said he believed Greene was malingering.  In the trial, the prosecution also brought in a new expert witness, psychologist Richard Packard who testified that Greene did not have DID at all.  Packard diagnosed the chronic sex offender with antisocial (AKA psychopathic) personality disorder and a sexual paraphilia disorder.  Packard further stated his doubt about the veracity of DID as a legitimate disorder.  Packard firmly believed that Greene had simply been faking DID from the beginning.  Greene's cellmate, a certain Eric Fleischmann, testified that he too attempted to fake DID with Greene's coaching but had failed.

Defense witness, Dr. Marlene Streinberg, then vice president of the International Society for the Study of Dissociation, testified that DID was real and that Greene fit the profile.  In spite of Dr. Streinberg's rather weak assertions and in spite of the frantic testimony of an enmeshed and obsessed therapist, Greene lost his second trial and was again found guilty on both counts.  The jury deliberated for five hours and were done in time to go home for dinner.  Greene was sentenced to life as a three-strike felon

Now in prison, Greene has since been charged with the 1979 rape and murder of a 25 year old woman by the name of Sylvia Durante in Seattle.  Greene's DNA from his sperm was found on Ms. Durante's body.  He was convicted of her murder in 2005.

Not everybody is a believer in DID.  No matter how self important and self righteous the tone of its promoters like Streinberg, jurors, and most people with any level of critical thought or common sense, remain unconvinced.  Juror, Jim Camp, from Greene's retrial, stated the jury "just didn't believe it."

Sources:

Sullivan, Jennifer; Insanity defense fails for attacker; The Seattle Times; Nov. 21 2003; as viewed on web 8/2012. 

Fersch, Ellsworth; Thinking About the Insanity Defense: Answers to Frequently Asked Questions; iUniverse, Lincoln, NE: 2005

They Want Us to Believe

There is a ubiquitous use of tense in mental health treatment, and curiously, it highlights an interesting contrast with the evangelists of multiple personalities.

In working with people on the more severe end of the spectrum of mental health disease (or "disease" in quotations if you prefer) we usually find that we cannot directly challenge beliefs we believe are delusive without threatening to lose the relationship, the precious rapport, that is often our only hope of helping, and yet we don't want to reinforce the delusion just in order to maintain rapport as that would also be counterproductive, so we try to ease our way through the dilemma with a little play of tense.  The client speaks in the indicative, "I have an implant in my neck that Richard Nixon speaks to me though." It is a solid fact.  Meanwhile, we clinicians reflect in the subjunctive, "You believe . . .", "You said . . .", or you might even risk a "I believe you believe . . ."  We leave it in an open and conjectural mood to show understanding, and thereby avoiding conflict, but without reinforcing.

Changes in tense are also important in the strictly professional side of mental health when we take our professionally sanctioned beliefs and apply them in the real world.  The ultimate document of professional belief, the Diagnostic and Statistical Manual, The DSM, is written entirely in the indicative tense.  Every mental health diagnosis is a fact and every criterion of every diagnosis is a fact.  These facts are immutable immobile objects with crisp edges.  The DSM is seemingly free from conjecture or uncertainty, much less fantasy and make believe.  Here we find ourselves in another dilemma because most clinicians (and researchers too I would guess) do not believe the diagnostic categories handed down from on high are factual at all.  Most of us handle these interesting but crude objects with healthy skepticism.  They are all works in progress that may or may not hold up long enough for the next edition.  The clients we work with are individual people who do not always so easily fit these models.  We are well aware they are just that, models.  Is Schizophrenia really a single disease entity or several that happen to look similar?  No one really knows for the time being.  So, we think and talk about these things in the subjunctive manner even though Medicaid forces us to write out our final diagnoses in the indicative.

It has recently struck me, however, when it comes to therapists who are wont to diagnose and promote Dissociative Identity Disorder (or Multiple Personality Disorder), the above outlined patterns do not hold.

Firstly, there is no distance between the belief of the clinician and the belief of the client.  They become fused in a shared belief.  A shared fantasy.  A shared dramatic enactment.  Between clinician and client, the belief system is spoken of in the indicative.  Changes of mood are distinct personages inhabiting a single body.  The clinician pronounces it.  The client reflects it and gradually comes to act it and be it.  The reality that DID becomes depends on the indicative mood.  The clinician and client must truly believe and always speak of it in the most confident and unwavering language.  Any doubt may cause the mirage to waver and blow away in the wind.  The clinician is on stage also, enacting the role of professional therapist, but it is an "as if" that only looks like therapy.  In fact, it is therapy in reverse, rather than curing or ameliorating, with this therapy the symptoms of the client strangely increase in strength and definition over time and eventually become cemented facts.

Secondly, there is no healthy skepticism on the part of the clinician in the professional realm.  Always these therapists use the same indicative tense used in the DSM whenever discussing their one cherished true diagnosis of DID.  They are believers who want us to believe in it too.  To convince themselves and us, they don't use the language of belief, they use the language of hard facts.  There are no maybes or uncertainties.  The facts of DID are proven and true.  Professionals who doubt run the risk of being called closed-minded or ignorant of the facts, or finally when we fail to align we are told we are invalidating toward their clients--spoken as if it is the worst possible insult.  It always strikes me that the selfsame therapists who want so hard to believe in the fact of DID are often the most doubtful of just about any other diagnosis in the DSM.  I have been told by a straight faced bearded therapist that many cases of Schizophrenia are actually DID.  There are many many people out there with mood fluctuations who have DID and don't even know it.  Or so I'm told.  I suppose the right therapist can skillfully draw out the symptoms and turn annoying mood fluctuations into a disabling condition and Medicaid will reward the therapist for many years to come.

It may be no coincidence the only other people I have experienced such a hard sell from, miraculously turning uncertainties into facts, are car salesmen and preachers.  I can't say that I've ever knowingly been part of a cult, but I imagine cult leaders also are inclined toward an indicative mood.

Crime, stupidity and responsibility among mental health professionals

I in no way want to promote the Church of Scientology nor am I in the fan club of Dr. Thomas Szasz.

I don’t have much to say about Scientology other than the fact that it gets pretty annoying to be accused of being a Scientologist simply because I question the validity of a diagnostic category like Attention Deficit Disorder and maybe I’ve suggested that giving amphetamines to young children might not be the best solution to this non-disease.

On the other hand, I could say a lot about Szasz who is something like the father of the anti-psychiatry movement.  I certainly think that he has done a lot of good by questioning the assumptions and practices in the mental health field going all the way back to the 1950’s.  Unfortunately, his discourse and that of his anti-psychiatry disciples is just as ideological and lacking in factuality as the worst drivel coming out of NAMI and from pharmaceutical marketers and the APA for that matter.  But, we’ll save that discussion for a later post.

Today, I just wanted to share about their Psychiatric Crimes Database, a rogues' gallery of badly behaved mental health professionals.  It makes for a, maybe not exactly fun, but perhaps amusing at times and otherwise disturbing read.  It is part of a website presented to the world by the Citizens’ Commission on Human Rights (CCHR).  CCHR is a joint effort by Szasz and the Scientologists dating back to 1969.  Its mission is to ”investigate and expose psychiatric violations of human rights and to clean up the field of mental healing.”

They claim to have aided in increasing prosecutions of mental health professionals of all kinds and to have promoted improved ethical and legal standards in the industry.  As to the later of these claims, I cannot vouch for the activities of CCHR itself, but I can say from my experience in mental health that the consistent pressure from the psychiatric survivor and anti-psychiatry movements, which have at least symbolic if not real leadership and impetus from Szasz, have had an actual and positive impact in the industry by increasing awareness and respect for things like informed consent and patient/client choice.  Yet, that being said, I do have to question what they seem to want to imply about themselves and the industry with their database.

Carrie Denbow, social worker, had her license suspended, according to the CCHR site, due to accusations she had sexual relations with a minor client in a motel room with two other students while drinking and smoking marijuana.  The client was an adolescent to whom she was providing counseling.  It is further alleged that Ms. Denbow took the client to her office three or four times a week where she performed oral sex followed by intercourse.  It is also alleged she broke confidence by seeking relationship advice from her minor client's peers.  Ms. Denbow was let go from her job in 2009.

The Psychiatirc Crimes Database is, very simply, a list of prosecutions and licensing censures against mental health professionals.  It appears to be updated quite frequently; there are eleven items in the database for January of 2011.  If CCHR had a role in any of these investigations, it is not evident and seems unlikely.  It appears to simply be a list of items gathered from the news and public records.  Items span a gambit of crimes and ethical violations.  Just in the last couple of months we see everything from a psychologist having his license placed on probation due to DUI to a psychiatrist charged with attempted murder for stabbing a patient twice in the chest with a sword.

My non-scientific cursory look at the database leads me to the conclusion that the most common category is the big no-no of sexual relationships between providers and clients, in some cases with minor clients.  This appears to be followed by billing and documentational faults leading to charges of fraud.  A third category is providing excessive prescriptions of controlled substances, sometimes for a payoff, sometimes without medical examination (as in being handed out in a public park in one case).  Otherwise, items are a miscellany of misdemeanors, violations and serious crimes.

The website explains its purpose:

The following database is being presented as a public interest service to law enforcement agencies, health care fraud investigators, immigration offices, international police agencies, medical and psychological licensing boards, and the general public.

And claims to impact larger issues:

Many psychiatrists have an intimate knowledge of criminality-one which has nothing to do with the professions involvement in the expert witness field.

• Between $20 billion and $40 billion is defrauded by the American psychiatric industry in any given year.

• At least 10% of psychiatrists admit to sexually abusing their patients: In America, that's at least 4,500 rapes and, internationally, more than 15,000 rapes.

• Psychiatrists, psychologists and psychotherapists have the dubious distinction of having laws specifically designed to curtail their tendency to commit sex crimes against those in their charge.

• A 1992 study of Medicaid and Medicare insurance fraud in the U.S. showed psychiatry to have the worst track record of all medical disciplines.

They don’t indicate how they came up with the specific numbers (e.g., 10% of psychiatrists admit to sexually abusing patients), but it is also true that both Szasz and the Scientologists share an overall denouncement of the very concept of mental illness and this database has to be seen as part of their larger pogrom against all things psychiatric.

Psychiatrist Douglas Rank who, according to CCHR, was charged with stabbing a woman in the chest twice with a sword in front of his office.  The wounds were life-threatening, but she survived after hospitalization.   She was apparently both his patient and in a "personal relationship" with him.  Rank was sentenced to 15 years after plea bargaining down from attempted murder to first-degree assault.  He had previously been investigated for over medicating and having sex with a patient.

Speaking to that implied intent, I have to feel that simply listing every kind of crime and stupid behavior of individual mental health providers cannot be taken as a condemnation of the industry as a whole.  There is plenty of room to criticize the mental health field and all of its tenuous assumptions and cherished beliefs, but, in my opinion, the fact that a particular California psychologist had his license placed on a probationary status, for instance, according to the CCHR site, because he was found awakening from unconsciousness in a department store after hours with a pocket full of methamphetamine, has no real bearing on the field of mental health other than the fact that it is peopled by human beings who are capable of addictions, errors, criminality and stupidity as humans are in any profession.  

Furthermore, the fact that professionals are censured, placed on probation, suspended and prosecuted, if anything, indicates that the industry does in fact have good safeguards and oversight by which to protect consumers and the public.

Yet, the database does have an impact on the reader, and if you haven’t yet, I suggest every one take a look at it who has an interest in mental health whether as a provider, consumer, family member or interested bystander.  If nothing else, it serves as a reminder that it is always a good idea to be cautious and do a little research before accepting a particular professional as the mechanic of your mind, so to speak.

Psychiatric Crimes Database

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 20^th 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?

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 (Ritalin^Ò). 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 McScience^Ò, 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.