From the wikileaks dump on Stratfor, The Stratfor Glossary of Useful, Baffling and Strange Intelligence Terms (pdf). This is almost as fun as The Devil's Dictionary by Ambrose Bierce.
One of my favorite Stratfor definitions:
empathy-- Thinking about the world the way the other guy thinks about the world. Essential to both operators and analysts. Both have to put themselves into the other guy’s shoes to figure out what he will do next. Definitely not about warm fuzzies.
Monday, February 27, 2012
Tuesday, February 7, 2012
I just love Frank. He writes so well and does it so prolifically. I have neither the patience nor the inclination.
I particularly liked this post about general health and diet and exercise.
I didn't get started on the diet and exercise thing until ten years ago. It's made a world of difference in how I think of myself and how I feel. Weight training is just as hypnotic and entrancing as the drugs I used to do. It's also made me look a lot better and it's kept off the 110 pounds that I lost. I would recommend it to anyone.
I left a comment on Frank's post that was wildly off-topic, so I'll repost it here. After all if a person's going to make OT comments of novella length, maybe he needs to get his own blog. lol:
I’m very confused as to what constitutes the difference between schizophrenia and a psychotic episode. I’ve personally had four psychotic episodes.
With the first one, I was examined by the college psychiatrist, who then drove me in his car to be examined by a psychiatrist at a local hospital. I didn’t stay at the hospital. The college shrink took me back to campus. He said I needed to flush the speed down the toilet, stop the drinking, beg forgiveness of the people I’d pissed off and take some Xanax, which as far as I could tell didn’t do shit.
With the second one, my parents took me to the hospital, but the hospital sent me home after three days with a script for Haldol, which I liked much better than the Xanax. I took it as long as it worked and got me high. After it stopped doing anything at all, I quit.
The third time I ended up in the hospital again. They sent me home after three days because I seemed to enjoy the Thorazine which they gave me along with the prolixin decanoate injections. I got buzzed on that stuff for several months and then it stopped doing anything, so I quit.
If you’ve not noticed a common thread to these three episodes, I was never committed for any of them.
The fourth time was entirely different. They committed me to two separate 90-day outpatient commitments and forced me to take Risperdal and Depakote, which as far as I could tell did absolutely nothing in the mental functioning department. I’ve refused to have a thing to do with mental health after that. And that was 17 years ago.
Like I say, I was always really confused as to what constituted the difference between psychosis and schizophrenia and what it means to “recover”. I guess it’s whatever the shrink says it is.
I particularly liked this post about general health and diet and exercise.
I didn't get started on the diet and exercise thing until ten years ago. It's made a world of difference in how I think of myself and how I feel. Weight training is just as hypnotic and entrancing as the drugs I used to do. It's also made me look a lot better and it's kept off the 110 pounds that I lost. I would recommend it to anyone.
I left a comment on Frank's post that was wildly off-topic, so I'll repost it here. After all if a person's going to make OT comments of novella length, maybe he needs to get his own blog. lol:
I’m very confused as to what constitutes the difference between schizophrenia and a psychotic episode. I’ve personally had four psychotic episodes.
With the first one, I was examined by the college psychiatrist, who then drove me in his car to be examined by a psychiatrist at a local hospital. I didn’t stay at the hospital. The college shrink took me back to campus. He said I needed to flush the speed down the toilet, stop the drinking, beg forgiveness of the people I’d pissed off and take some Xanax, which as far as I could tell didn’t do shit.
With the second one, my parents took me to the hospital, but the hospital sent me home after three days with a script for Haldol, which I liked much better than the Xanax. I took it as long as it worked and got me high. After it stopped doing anything at all, I quit.
The third time I ended up in the hospital again. They sent me home after three days because I seemed to enjoy the Thorazine which they gave me along with the prolixin decanoate injections. I got buzzed on that stuff for several months and then it stopped doing anything, so I quit.
If you’ve not noticed a common thread to these three episodes, I was never committed for any of them.
The fourth time was entirely different. They committed me to two separate 90-day outpatient commitments and forced me to take Risperdal and Depakote, which as far as I could tell did absolutely nothing in the mental functioning department. I’ve refused to have a thing to do with mental health after that. And that was 17 years ago.
Like I say, I was always really confused as to what constituted the difference between psychosis and schizophrenia and what it means to “recover”. I guess it’s whatever the shrink says it is.
Friday, January 20, 2012
Wednesday, January 4, 2012
Copyright Troll Alert
This is absolutely over the top.
The American Psychiatric Association are acting like copyright trolls over the DSM and the people who would want to examine the DSM 5 approval process.
Ms. Chapman's blog here.
The American Psychiatric Association are acting like copyright trolls over the DSM and the people who would want to examine the DSM 5 approval process.
Ms. Chapman's blog here.
Friday, December 30, 2011
Police called after father stopped daughter taking medication
This story was interesting.
A father sticks up for his daughter's best interests. He does everything he should-- takes a fatherly concern for his daughter and tries to talk to thestate-sanctioned drug peddlers mental health services team about what had happened before. They pay him no attention to his concerns and continue doing what they're doing because only they know what's best. He gets reported to the police and the arrogant lack of concern by the state-sanctioned drug peddlers mental health services team is deemed "appropriate."
The family doesn't appear to be happy with the investigation's findings. I hope they don't give up. They need to vocally and publicly pursue this matter. The general public, who have had little contact with psychiatry, need to understand what it's all about.
A father sticks up for his daughter's best interests. He does everything he should-- takes a fatherly concern for his daughter and tries to talk to the
The family doesn't appear to be happy with the investigation's findings. I hope they don't give up. They need to vocally and publicly pursue this matter. The general public, who have had little contact with psychiatry, need to understand what it's all about.
Sunday, November 13, 2011
Profits all around
It's very sad that our veterans receive such a lousy shake in their needs and healthcare when they get home, as this article points out.
I think the key concept, however, is here:
One reason that these antipsychotics are among the most profitable products for the pharmaceutical industry is that many of the purchases are paid for by the US government.
Another reason that makes them the cash cows of the pharmaceutical industry is that patients are required to take them by force of court order, with Medicaid being the most likely payor.
I always found it odd that CEOs would embrace these government subsidies over private enterprise and the free markets. I guess it all depends on what makes you the easiest and quickest buck.
I think the key concept, however, is here:
Ironically, yet not surprisingly, pay-to-play in Washington becomes more egregious every day. Heather Bresch, daughter of U.S. Sen. Joe Manchin, (D-WV) was recently named CEO of WV drug-maker Mylan Inc., that recently contracted with the DoD for over 20 million doses of Seroquel.
One reason that these antipsychotics are among the most profitable products for the pharmaceutical industry is that many of the purchases are paid for by the US government.
Another reason that makes them the cash cows of the pharmaceutical industry is that patients are required to take them by force of court order, with Medicaid being the most likely payor.
I always found it odd that CEOs would embrace these government subsidies over private enterprise and the free markets. I guess it all depends on what makes you the easiest and quickest buck.
Saturday, November 5, 2011
A Concise History of the DSM
From a blog comment made by an anonymous commentator. (Note: NPD stands for Narcissistic Personality Disorder):
As a psychiatrist with personal experience with NPDs, I fully concur with Anna's views that this change in the DSM is essentially a non-event for all the reasons she enumerated. Perhaps some additional information about the DSM may be helpful in fully appreciating some of the reasons for its meretriciousness. (To save some of you from consulting a dictionary, "meretricious" is defined as apparently attractive but having in reality no value or integrity. I also use this word not unintentionally for its archaic meaning - of, relating to, or characteristic of a prostitute.)
Some of the individuals who first developed the DSM are well known among psychiatric circles to have severe NPD themselves. The interests of one DSM "innovator" in particular were in statistics and in ways to categorize knowledge generally. At the time in the 1960s, a dedicated system of classification of mental disorders was lacking. Previously these disorders were given codes in a manual called the International Classification of Diseases (ICD) along with all other medical disorders. Seeing an "opportunity," one DSM originator chose to go to medical school and specialize in psychiatry exclusively in order to have the credentials to create a classification system. Medicine and psychiatry were merely means to another end. The womb of the DSM resided in an obsessive individual who possessed a prominent dearth of humanity and who by the same token could have easily chosen to classify machine tools, toads or sea shells. In addition, for the initial DSM there was very little consensus. It is the product of just a few individuals. This was the inauspicious inception of the run-away train we now call the DSM.
Another critical point to remember is that the primary impetus for a classification of mental disorders was for research purposes - not for clinical utility. That is why it is a diagnostic and STATISTICAL manual. The use of medications in psychiatry began in earnest in the 1950s creating a need to do clinical trials. A system was needed to enable researchers to group individuals together diagnostically. One cannot for example do a trial of a drug for schizophrenia without defining the population for which the medication is purported to be effective. Thus the birth of the DSM and its subsequent revisions has been influenced in no small way by changes in the field of psychiatry and in pharmaceutical technology.
The pharmaceutical industry is not the only one that has influenced the evolution of the DSM. Since the 1980s, the health insurance industry has exerted an increasingly formidable influence on the way mental health disorders are viewed. Because it determines the reimbursement of treatment services, it creates demands on the field for the EXPLICIT purpose of decreasing expenditures. This industry has clearly had an impact on how individuals are diagnosed. In stage one, personality disorders were excluded from any reimbursement. The DSM then responded by creating all sorts of other reimbursable categories into which a psychiatrist could "fit" that patient. More recently the insurance companies for reimbursement considerations have created strata of severity of mental illnesses in which, for example, major depression, schizophrenia and full-blown bipolar disorder are reimbursed more fully than other less debilitating "disorders" such as adjustment disorders, anxiety disorders, etc.
Perhaps one day a historian will go back and rigorously track the developments in the DSM against the developments in the pharmaceutical and insurance industries. I am convinced that we will see clear concordance.
And as other industries as well as cultural views continue to pressure and influence how we view behavior, thought and "feelings," the DSM will follow in kind. One example is "Social Anxiety Disorder" as if there is one person who doesn't get anxious speaking in front of a group of people. The list of inane diagnostic classifications is endless.
In order to keep ahead of the game, the DSM revisionists employ two other strategies. The first has always been unspoken and is rarely contested: that all behavior, thought and "feeling" is under the purview of "mental health" and its soldiers, psychotherapists (psychiatrist, psychologists, etc.). Should tomorrow many people start snapping their fingers frequently, the DSMers would have a classification for that in the next revision. The underlying problem here is that there is no definition of "mental illness" or "mental disorder."
A fine example is just this topic: NPD. For years, I frequently have read laying down on my sofa and crossing my legs. Now I have a knee problem, one that the orthopedic surgeon can directly relate to my bad reading habits. With proper changes in behavior and stretching, the knee problem is much improved. So is the case with malignant narcissists. As this blog pointed out several times, "garbage in, garbage out." If one goes through life executing malice and then must distort the truth in order to not be caught, one's thinking will become disordered. That is NOT a mental disorder. It is the ramification of a habit over which one can exert control. The DSM makes no distinction between the ramifications of controllable and self-modifiable bad habits versus the ramifications of a process over which volitional control is impossible (e.g., schizophrenia).
The second DSM strategy is to create categorical buckets so over-inclusive that it is irrefutable. Hence nearly every "diagnosis" contains a "disclaimer" with language such as, "The present symptoms cannot be otherwise better accounted for by [another] diagnosis." Or, another sub-category is created to allow for any exception to the rule. This sub-category is termed "NOS" which stands for "Not Otherwise Specified." Thus if someone complains of depression of a type that does not fit exactly with the sub-types enumerated in the DSM, that depression is deemed, "Not otherwise specified."
Therefore the DSM "takes all comers." It is set up in a way that one cannot even attempt to challenge or refute it because it contains inherent escape clauses which are designed only to make it immune from any criticism. Thus it exists to perpetuate its own existence. It is a simulacrum; i.e., an image without the substance or qualities of the original. Simulacra may contain elements of truth (e.g., the DSM's description of schizophrenia), but due to the lack of definition, coherence, mission and integrity in its core being, its utility is best characterized by where my copy ended up.
One winter, I ran out of firewood...
One postscript. It may appear that the DSM committee is composed of "academics" and not clinicians. The distinction today is not very sharp as nearly all "academics" do clinical work. (I know not a few of them and can vouch for that statement). In my opinion, psychiatrists have thrown their hands up in trying to understand the "personality disordered" for which, not for nothing, they have little chance of obtaining research funding. And although they will never publicly admit it, they don't want to even see those "bad and difficult patients" anyway.
As a psychiatrist with personal experience with NPDs, I fully concur with Anna's views that this change in the DSM is essentially a non-event for all the reasons she enumerated. Perhaps some additional information about the DSM may be helpful in fully appreciating some of the reasons for its meretriciousness. (To save some of you from consulting a dictionary, "meretricious" is defined as apparently attractive but having in reality no value or integrity. I also use this word not unintentionally for its archaic meaning - of, relating to, or characteristic of a prostitute.)
Some of the individuals who first developed the DSM are well known among psychiatric circles to have severe NPD themselves. The interests of one DSM "innovator" in particular were in statistics and in ways to categorize knowledge generally. At the time in the 1960s, a dedicated system of classification of mental disorders was lacking. Previously these disorders were given codes in a manual called the International Classification of Diseases (ICD) along with all other medical disorders. Seeing an "opportunity," one DSM originator chose to go to medical school and specialize in psychiatry exclusively in order to have the credentials to create a classification system. Medicine and psychiatry were merely means to another end. The womb of the DSM resided in an obsessive individual who possessed a prominent dearth of humanity and who by the same token could have easily chosen to classify machine tools, toads or sea shells. In addition, for the initial DSM there was very little consensus. It is the product of just a few individuals. This was the inauspicious inception of the run-away train we now call the DSM.
Another critical point to remember is that the primary impetus for a classification of mental disorders was for research purposes - not for clinical utility. That is why it is a diagnostic and STATISTICAL manual. The use of medications in psychiatry began in earnest in the 1950s creating a need to do clinical trials. A system was needed to enable researchers to group individuals together diagnostically. One cannot for example do a trial of a drug for schizophrenia without defining the population for which the medication is purported to be effective. Thus the birth of the DSM and its subsequent revisions has been influenced in no small way by changes in the field of psychiatry and in pharmaceutical technology.
The pharmaceutical industry is not the only one that has influenced the evolution of the DSM. Since the 1980s, the health insurance industry has exerted an increasingly formidable influence on the way mental health disorders are viewed. Because it determines the reimbursement of treatment services, it creates demands on the field for the EXPLICIT purpose of decreasing expenditures. This industry has clearly had an impact on how individuals are diagnosed. In stage one, personality disorders were excluded from any reimbursement. The DSM then responded by creating all sorts of other reimbursable categories into which a psychiatrist could "fit" that patient. More recently the insurance companies for reimbursement considerations have created strata of severity of mental illnesses in which, for example, major depression, schizophrenia and full-blown bipolar disorder are reimbursed more fully than other less debilitating "disorders" such as adjustment disorders, anxiety disorders, etc.
Perhaps one day a historian will go back and rigorously track the developments in the DSM against the developments in the pharmaceutical and insurance industries. I am convinced that we will see clear concordance.
And as other industries as well as cultural views continue to pressure and influence how we view behavior, thought and "feelings," the DSM will follow in kind. One example is "Social Anxiety Disorder" as if there is one person who doesn't get anxious speaking in front of a group of people. The list of inane diagnostic classifications is endless.
In order to keep ahead of the game, the DSM revisionists employ two other strategies. The first has always been unspoken and is rarely contested: that all behavior, thought and "feeling" is under the purview of "mental health" and its soldiers, psychotherapists (psychiatrist, psychologists, etc.). Should tomorrow many people start snapping their fingers frequently, the DSMers would have a classification for that in the next revision. The underlying problem here is that there is no definition of "mental illness" or "mental disorder."
A fine example is just this topic: NPD. For years, I frequently have read laying down on my sofa and crossing my legs. Now I have a knee problem, one that the orthopedic surgeon can directly relate to my bad reading habits. With proper changes in behavior and stretching, the knee problem is much improved. So is the case with malignant narcissists. As this blog pointed out several times, "garbage in, garbage out." If one goes through life executing malice and then must distort the truth in order to not be caught, one's thinking will become disordered. That is NOT a mental disorder. It is the ramification of a habit over which one can exert control. The DSM makes no distinction between the ramifications of controllable and self-modifiable bad habits versus the ramifications of a process over which volitional control is impossible (e.g., schizophrenia).
The second DSM strategy is to create categorical buckets so over-inclusive that it is irrefutable. Hence nearly every "diagnosis" contains a "disclaimer" with language such as, "The present symptoms cannot be otherwise better accounted for by [another] diagnosis." Or, another sub-category is created to allow for any exception to the rule. This sub-category is termed "NOS" which stands for "Not Otherwise Specified." Thus if someone complains of depression of a type that does not fit exactly with the sub-types enumerated in the DSM, that depression is deemed, "Not otherwise specified."
Therefore the DSM "takes all comers." It is set up in a way that one cannot even attempt to challenge or refute it because it contains inherent escape clauses which are designed only to make it immune from any criticism. Thus it exists to perpetuate its own existence. It is a simulacrum; i.e., an image without the substance or qualities of the original. Simulacra may contain elements of truth (e.g., the DSM's description of schizophrenia), but due to the lack of definition, coherence, mission and integrity in its core being, its utility is best characterized by where my copy ended up.
One winter, I ran out of firewood...
One postscript. It may appear that the DSM committee is composed of "academics" and not clinicians. The distinction today is not very sharp as nearly all "academics" do clinical work. (I know not a few of them and can vouch for that statement). In my opinion, psychiatrists have thrown their hands up in trying to understand the "personality disordered" for which, not for nothing, they have little chance of obtaining research funding. And although they will never publicly admit it, they don't want to even see those "bad and difficult patients" anyway.
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