| Monday
March 1, 2010 The other
side of the DSM
Dear Jerry,
I am highly against making just about everything
evidence of psychiatric disorders. It dilutes the value of a diagnosis for
those who really need it.
I was suicidal from somewhen in my 12th year. I was
bright but not able to find a safe outlet. I was the strange one who was
harassed and physically attacked, even when I spent my days in the library
and never did anything to offend those who hated me on a general basis of
being weird.
I eventually learned to fake interest in the stuff
these guys considered normal, found a place with a high school performance
art group that gave me a place, and generally attracted a group of other
strange ones that was strong enough to cause the creeps to leave us alone.
Some years into adulthood I needed medicines to save
my life. Apparently they are known triggers for latent Bipolar. I, of
course, refused to believe the diagnosis and rather quickly went on to
increasingly bizarre flights of mania. Then crashed. Then walked in the
mountain tops again. Then crashed. I did some pretty neat and intricate
stuff while manic, before the heights and crash.
Heh, being diagnosed while on a manic climb gave me
the time and willingness to read just about everything two libraries had on
the subject. (Along with a few side trips.) I went for a second opinion and
they started with no other records but came to the same conclusion. (A
change in medical coverage required me to go through the diagnosis process a
third time.)
Meds were important to stabilize me, but I had
reactions that made it clear I could be forever disabled on meds, or
unstable emotionally, or find another way. (Thou shalt NOT trust any doctor
who giveth thee a prescription after only 15 minutes in the office.)
Enter CBT. Cognitive Behavior Therapy did more for my
ability to live on minimal meds. (Gotta respect the biology of this thing
and acknowledge times I need more chemical assistance than I would like to
admit.) I have a small group of people who know me well enough to tell if I
am well but being just me, or that I am developing trouble. Any two agree
that I need to be back on meds I go...with a multi-year commitment to taking
them. I had to do that once. I also chose to go on meds prophylactically
when I knew I would be facing a year filled with some of my worst triggers.
So...I know this isn't all malarky. I am gainfully
employed, (even though I am terribly underemployed.) I have difficulties in
my interpersonal relationships but have developed, long, and trustworthy
friendships. My grown children speak to me and seem to like my company.
Without some psych intervention that wouldn't happen. My CBT was run with a
lay facilitator and small group with a year-long committment It proved far
more helpful than the psych. But I must respect the biology.
I still have a basic mistrust of the clinical
psychiatrists but also recognize the need for them. In another age I would
be the strange aunt that was kept in the attic, or locked in a back ward
somewhere. Instead I have a "real" life that has been worth the living. Many
of the great contributers in history have shared to some degree this
disorder, I am not one who rose to genius, but I did manage to carve out a
life.
At one point I "Walked with the gods, but paid for it
in hell." I had to choose to give up walking with the gods in order to keep
my family. Meds then were an act of love. I still miss the view from
Olympus, no matter how dimly remembered...but this has been better overall.
What I don't often let others know this about me any
longer. Years ago I was activist enough to hope that if I were open then
people would learn to accept...heh, I was young and dumb. I don't like
EVERYTHING being a disorder as it makes it harder for those of us who
sometimes need a little space to manage a mood disorder that is remarkably
painful mentally, emotionally, physically, and any other lly you can come up
with.
I was grateful to the ADA when I desperately needed a
couple weeks to withdraw from the world and practice keeping my feet on the
ground without wanting to die of it. I had a job when I came back. (I ended
up writing the book on how to do that job and saw it adopted nation-wide. I
was and am a producer who just ran into a couple weeks of trouble.) I didn't
take a proper vacation for years after that so no one would accuse me of
taking advantage. But if I had broken my thigh and needed to be in traction
the time would not have been held against me.
So, I remain conflicted. I don't want to see silliness
take over but it is also good to try and figure out what is really bipolar,
(or whatever.) I have mixed emotions about taking meds for just about
everything, but have learned to appreciate timely chemical intervention. I
have mixed emotions about going to extremes to prevent someone determined to
die from doing so. Then again, I am grateful to those who intervened for me.
I still occasionally go into suicidal ideation but know that I won't attempt
again...I will be damned if I am going to die because of a stupid
biochemical imbalance. Still, sometimes it is tough.
I am older and wiser now, (I think.) And have found my
best peace with being bipolar. Sometimes you have to turn and face the
dragon that is chasing you down. You will either win or die. Either way, you
will learn a strange love for your adversary. If I was told today that I
could be "cured" but that all the other things that come with it would also
be taken, I would choose to remain as I am. It is my difficult gift.
A long blab to simply say that some things are not
simple. The IDEA of a DSM is good, I worry about the practice. But that
worry seems to apply to a great many situations in the modern world.
Take care, Jerry.
I understand the dilemma perfectly. My quarrel with
the DSM as it has been implemented is that it looks for an accuracy that we
can't have. Some people clearly need help. Some of those who need help can't
afford it.
The Constitution doesn't make this a federal
matter. It is a state matter, and some states handle that better than
others. Mental health will never be an exact science.
I am witness to the effectiveness of some of the
chemical treatments available today that were not even dreamed of when I was
taking Abnormal Psychology in graduate school. I know clinicians who think
very highly of the DSM as far better than nothing.
So: we're in agreement, it would be useful to have
a useful DSM. It would also be a very good thing now that we are in the 21st
Century for me to have my flying car. At least some think it would be. The
difference is that flying cars are (just barely) possible.
==
Subject: Diagnostic and Statistical Madness
IIRC, you entered grad school after you came home from
Korea. Since DSM-I was published in 1952, I suspect it was around. Actually,
I thought DSM-I and DSM-II were remarkably useful documents: they were
short, they followed the traditional medical method of identifying diseases,
and they did not try to go much beyond the data, given how little data there
was.
[rant]
I agree with much of the WSJ article. It seems that
the psychiatric poobahs are trying to expand the field to cover everything.
Heck, when they say 53% of Americans have a mental illness, they're either
smoking something or trying to make as much money as they can. You pick what
you think is going on.
The focus on bipolar disorder in the 1970's was to
distinguish it from schizophrenia. Both mania and Schizophrenia are serious
psychoses that create catastrophes for those who suffer from them.
The later focus on "bipolar disorder" - actually, I'll
call it Bipolar Syndrome, abbreviated BS - has been on what I believe is a
combination of fraud and self-aggrandizement. Basically, the symptoms of
ADHD (a real phenomenon) and neurotic depression have been twisted to invent
BS, so that lying awake at night worrying is now "racing thoughts" and
having surges of jollity or crises of emotion are called "mood swings." The
racing thoughts seen in mania is something I see but patients experience as
the world not keeping up with them. The mood swings seen in true bipolar
disorder is the phenomenon of someone switching rather quickly from a
profound (and often psychomotor retarded) depressive state to a rather
shocking manic episode. But the mavens of modern psychiatry call neurosis
and ADHD "bipolar." Why?
Well, true bipolar disorder is a biological disorder.
Insurance companies used to give shrinks a hard time about mere
psychological suffering. They couldn't argue with a biological illness. So,
with redefinition, BS is piggy-backing on real bipolar disorder.
Of course, this has come about because drug companies
saw that their patents on SSRI's were going to expire, and that these
medications are so good that the follow-on meds have little to offer. What
to do? Well, meds helpful in bipolar disorder had a longer patent life, so
the psychiatric profession was inundated with free continuing medical
education (and we all need CME to maintain our licenses) on how all these
symptoms were really bipolar disorder - all paid for by drug companies.
And this feeds into the egos of psychiatrists. They
are the new priests. Come once a month for absolution.
Pfah. You're better off going to your FP.
Then there are the patients. No one thinks they should
feel any discomfort. Unhappy? Grief stricken? They tell you they are
"depressed." They all want "benzos." Now, despite what the writer of the
article said, benzos are not "effective medications." They are drugs. They
are alcohol in a pill. Reduce anxiety and unhappiness? Sure. Alcohol does
too. And then there is the price: the little guy in your head that tells you
"Shut up! or "Don't do it!" is shut up, and you say or do things you should
not. Your driving is impaired. Your memory is impaired. You get addicted to
the stuff. And you can get seizures and DT's coming off it. Pretty ugly
DT's.
The most important new development in psychiatry is
the news that SSRI's are nerve fertilizer: they actually make nerve cells
grow in your brain where depression - true depression - has depleted them.
That's why they take a while to work, and that's why they usually don't
produce any drug-type effects when you take them.
I think that Prozac, Zoloft, Celexa, Buspar and their
generic equivalents should be over-the-counter meds. Then people could truly
"self-medicate."
As for DSM-V, I look at it as a nightmare. I hope the
feds enforce using the ICD system for all reimbursable diagnoses instead. It
already does this for Medicare.
[/rant]
Ed
I wonder whatever happened to the notion of
freedom?
===================
You Can't Judge a Book by Its
Author
http://online.wsj.com/article/
SB20001424052748704231304
575092032363611308.html
"Last week one of the large textbook publishers,
Macmillan, announced new software to let college instructors rewrite
textbooks by substituting new material for what the author wrote. This will
allow options such as deleting paragraphs or editing down to the level of
individual sentences. The software can bring to print and e-textbooks what's
called a "mashup" in other forms like music and videos, where people alter
the original with their own preferred version of the real thing."
"But we have to wonder about the unintended
consequences of a textbook absent an author. For example, since 1948
generations of students learned from Paul Samuelson's "Economics," which has
sold four million copies. It had quirks and went through many editions. But
it also was elegantly written and became canonical. What happens when
students learn from what appears to be the same text but isn't?"
Charles Brumbelow
I saw that at breakfast and intended to recommend
it. One needs to think on the subject. I don't use the modern "electronic
style" of commentary in which someone text is chopped into small pieces
with comments interjected, because I believe it is rude, but it is
commonly used; with a book you would have no real choice.
Medieval writers used to write a "gloss" of a
book: that is they would insert comments between the lines of a text.
I certainly have no objections to instructors
inserting comments at chapter ends of textbooks, or even at the ends of
major sections; but I could certainly hate it if they inserted remarks
disguised as part of the original text. This whole matter needs more
thought.
=====================
New cuss word......
Years ago when I sometimes used unsavory language, I
often used the expression "Bull S***." As I grew up a bit and discovered it
was not necessary to use such crude language, that expression became "BS."
What did I really mean when I used those expressions?
I meant that something was ridiculous, or idiotic or a half truth or just
stupid. It covered any number of negative formats. The dictionary defines it
as: nonsense; especially: foolish insolent talk...
I have decided that I no longer will use either of
those expressions in the future. When I have a need to express such
feelings, I will use the word "Pelosi." Let me use it in a sentence. "That's
just a bunch of Pelosi.." I encourage you to do the same. It is such a nasty
sounding word, it really packs a punch, we are no longer being vulgar, and
it clearly expresses our feelings. If enough of us use it, perhaps the word
could be entered into the dictionary. When on a ranch watch your step and
don't step in Pelosi. It will get on the bottom of your boot and won't go
away until next election.
What a fitting and descriptive legacy for the Speaker
of the House!
Pass it on to at least 10,000,000 people. Do not break
this chain or you will get more Pelosi than you can shake a bull at.
P.S. Betcha when this new word reaches D.C., the
PELOSI WILL HIT THE FAN!
===========
Pack the Court (because it went so well the last
time?)
Dr. Pournelle --
Proof positive some people have a hard time learning
from history.
Obama should expand court
http://www.philly.com/inquirer/opinion/
20100228_Obama_should_expand_court.html
Pieter
===========
AlGore is back
Hello Jerry,
Well, allegedly.
http://www.nytimes.com/
2010/02/28/opinion/28gore.html
A few comments:
1. If ANYONE thinks that Al Gore was the author of
this, himself, personally............
2. WHOEVER wrote it is either completely detached from
reality or has completely put his faith in the 'big lie' theory as espoused
by Goebbels et al.
3. The fact that it can, knowing what we KNOW now, be
printed in what is touted as the leading newspaper in the US as a serious
piece on the state of climate science confirms what has become obvious in
recent years: leading newspapers, outside of disasters, weddings, and
funerals, have become wholly devoted to 'progressive' propaganda.
4. If additional confirmation is needed, Al Gore
'produces' and has published pieces such as this while continuing to live in
the style to which he has been accustomed since birth--squared and is NOT
laughed out of town.
By the way, on the precision of global temperature
measurements, here is a quote from a January 12, 1999 Associated Press
article by Randolph E. Schmid, titled "Researchers: 1998 was the hottest
year on record.": "The NASA findings indicate a mean worldwide temperature
of about 58.496 degrees F., topping the previous record, set in 1995 of
58.154." I particularly like the touch of using 'about', followed by a world
temperature quoted to 1/1000 degree F. One wonders how they would have done
if they had gone for precision. I also find it amusing that NASA was cited
as the source of the temperature figures. I wonder if they weigh the shuttle
to +/- one grain when doing their launch calculations?
Bob Ludwick
About 58.496 degrees F. Wow, that's accuracy! So
the question becomes "how much hotter" were the hottest twenty years on
record? And it would be worth looking at the algorithms used to compute
these three decimal places averages...
==
Don't bother to research climate on Wikipedia
Jerry
In your Current View for Thursday you wrote:
"Accepting that chart -- I grabbed it off Wikipedia as convenient, but I'm
never comportable with using that as a data source on anything important
about a controversial subject -- "
http://www.jerrypournelle.com/view/
2010/Q1/view611.html#Thursday
I never use Wikipedia as a source for climate-related
matters. Wikipedia's articles on climate and AGW have been taken over by the
pro-AGW crowd and nothing (or very little) we climate skeptics come up with
lasts there for very long.
See this blog posting, which links to some detailed
articles about this:
A Voice Crying in the Wilderness: Don't trust
Wikipedia when it comes to climate issues
http://vozclam.blogspot.com/2010/02/
don-trust-wikipedia-when-it-comes-to.html
See also
http://www.google.com/search?q=wikipedia+climategate
In freedom, Angus W. S-F
I do not rely on Wikipedia for anything that I
can't quote as "famously". Those with strong incentives spend more time
"correcting" Wikipedia entries; in general Wikipedia reflects the
strongest held opinions.
At some point I suppose we ought to have a full
discussion of the usefulness of Wikipedia as opposed to Britannica and
other encyclopedias -- and the viability of the Britannica model in
an age when information wants to be free.
==
This is an article in the British newspaper the
Telegraph (not in any US newspaper, btw), by Christopher Booker one of my
favorite writers. See link. We all should realize the consequences of
highly flawed science becoming international energy policy. The damage has
already been enormous. Send to all decision makers state and federal.
Mike
http://www.telegraph.co.uk/comment
/7332803/A-perfect-storm-is-
brewing-for-the-IPCC.html
As the consensus unravels, the mainstream press
must at some point wake up.
==
Speaking of Climate Change
Ooops, U.S. government scientists conclude that trends
since 1985 fail to show warming? Well, I guess a lot of government entities,
Congress, and several private corporations and individuals have a lot of
explaining to do and a lot of money to be paying back. Add that to the list
of Congressional investigations we need to demand from our new crop of
Congress critters once we throw 95% of them out in November and we need to
push them to do their jobs before they find themselves corrupted after the
first year and thrown out upon completion of their terms.
I mean it, we need to stay on these people. Elections,
phone calls, emails, neighborhood groups. We need to put aside the pointless
political prostitutions and deal with some core issues and get our country
back.
http://www.nytimes.com/1989/
01/26/us/us-data-since-1895-
fail-to-show-warming-trend.html?pagewanted=1
-- BDAB,
Josh
"Men stumble over the truth from time to time, but
most pick themselves up and hurry off as if nothing happened." —Winston
Churchill
Dream on. Not that I disagree.
==
Dear Jerry,
Ran across this today. It is just a small commentary
on what is becoming very obvious about the AGW "consensus".
http://www.reuters.com/article/
idUSTRE61O3O820100225?loomia_ow
=t0:s0:a49:g43:r4:c0.062660:b31108080:z0
Scientists examine causes for lull in warming
R,
Rose
============
Harry
Erwin's Letter from England
Senior judges say they can't
trust MI5. Government responds with personal attacks. <http://tinyurl.com/ycr7hev>
<http://tinyurl.com/yahrngf>
Tory situation tightens. <http://tinyurl.com/yezmbzp>
<http://tinyurl.com/yh92gam>
<http://tinyurl.com/ydhghmn>
California bonds now regarded as
riskier than those of the PIIGS (Portugal, Ireland, Italy, Greece, Spain) <http://tinyurl.com/ybvzcco>
New Scientist coverage of
climate change: "Honesty is the best policy for climate scientists" <http://tinyurl.com/ylfrl8g>
<http://tinyurl.com/yc3zgtu>
Crack down on health tourists <http://tinyurl.com/ydwf4zq>
--
Harry Erwin
harry.erwin@btinternet.com
==
"Woman who found coin worth £2,000 in garden becomes
first to be prosecuted for not reporting treasure"
http://www.dailymail.co.uk/news/
worldnews/article-1253991/Woman
-coin-worth-2-000-garden-prosecuted-
reporting-treasure.html
"There will always be a large island off the coast of
France."
Cordially, John
===========
"Why does the country need an
independent Air Force?"
<http://www.washingtonpost.com/
wp-dyn/content/article/2010/02/27/
AR2010022703754_pf.html>
----- Roland Dobbins
A good article. The subject is worth
discussion.================
SUBJECT: New York Times article: Depression's Upside
Hi Jerry.
Related to some of the topics you've touched upon
recently, here's a long-but-interesting article on one hypothesis regarding
the evolutionary origins (and usefulness) of depression in certain cases:
http://www.nytimes.com/2010/02/28
/magazine/28depression-t.html
Cheers,
Mike Casey
===========
'However, Apple has not stopped using the factories.'
<http://www.telegraph.co.uk/technology/apple/7330986/Apple-admits-using-child-labour.html>
--- Roland Dobbins
============
Palace of Sextus Tarquinius found?
<http://news.discovery.com/archaeology/prince-palace-rome.html>
-- Roland Dobbins
Do they have a search warrant? Perhaps this was
the crime scene of the rape of Lucretia. Ah, but Italian Law is a bit
different from US...
=====================d
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