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Psychiatrists: The Men Behind Hitler
Psychiatrists: The Men Behind Hitler
by Thomas Roder
Edition: Hardcover

2 of 3 people found the following review helpful
5.0 out of 5 stars Wouldn't it be convenient if all the evil were really only one man's doing?, 7 Aug 2011
The Men Behind Hitler first appeared in German. Thankfully, it was translated into English by Rolf and Sybil Rentmeister, whose names deserve to be mentioned considering the excellent quality of the translation.

Like other historians writing on this subject around the middle of the previous decade, the authors explode the myth that the quest for racial purity started with Hitler. But they go one step farther, and also explode the myth that it ended with Hitler. "Eugenics" is still alive and well, particularly in North America and Europe. The name, of course, has been changed, but the idea behind it remains.

In the period leading up to Hitler's rise to power, Germany was the Mecca of psychiatry. Students from all over the world came to learn at the feet of the professors who would become king pins in third reich atrocities. Some of those king pins were later executed, several more committed suicide. Most not only escaped punishment, often protected from prosecution by U.S. psychiatrists, but continued their careers undisturbed. Furthermore, their students from across the world carried their teachings back to their own countries already before The Holocaust, and continue to do so to this very day. The mass murderers and their supporters are still considered authorities, and their works are widely quoted in current psychiatric professional literature. As though that weren't bad enough, after WWII psychiatrists in the U.S. lobbied to bring nazi psychiatrists to America so that their "knowledge" wouldn't be lost. These psychiatrists were responsible for, among other things, LSD experiments on unwitting prisoners.

In fact, the authors ascribe the origin of the drug culture which permeates developed societies to psychiatry. LSD, heroin, cocaine, and amphetamines were all first introduced by psychiatry, but leaked out into the general population, contributing to the violence of our societies.

Also interesting is the psychiatric connection to the war in the former Yugoslavia.

One surprising claim made by the authors is that by the fall of the third reich, over two million people had been compulsorily sterilized. Other historians place this figure at 400,000, most of those people later having been mass murdered. The authors provide no source for their figure, even though their book is otherwise well-researched. This probable exaggeration casts an undeserved shadow of incredibility over the rest of it.

Rather than dwelling on the details of the horrors, the authors repeatedly point to the source of psychiatric power: the state. Whether in the third reich, in the US, or in Bosnia, psychiatrists have always courted powerful politicians, permeated the military, and lobbied government.

Most unfortunate is that at least one of the book's authors is identified as head of the Citizens' Commission on Human Rights in Hamburg, and publication of the book was funded by the International Association of Scientologists. There is no reference at all to Scientology in the body of the book. The connection to Scientology no doubt keeps this excellent book off of academic library shelves and prevents its important message from receiving the attention it should.

Copyright MeTZelf

They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal
They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal
by Caplan
Edition: Paperback
Price: 12.13

2 of 2 people found the following review helpful
4.0 out of 5 stars Protester turned participant turned whistle-blower, 7 Aug 2011
When Caplan, professor of psychology, psychotherapist, and feminist, contacted the American Psychiatric Association (APA) to protest inclusion of premenstrual syndrome in the DSM, she was surprised to be invited to join two committees for reviewing such diagnostic categories. This provided her with an insider's look at how the DSM is compiled.

Although the APA repeatedly chants the mantra of the DSM's scientific basis, it fails to produce evidence. The DSM does not even achieve its claimed major accomplishment, namely reliability in diagnosis, which supposedly furthers the cause of scientific study. Its content is decided upon arbitrarily by a handful of powerful big shots on the basis of consensus and bias. The scant research made available to the various committees is methodologically faulty and funded by interested parties. The influence of pharmaceutical $$$ speaks louder than reason. A complicated bureaucratic network of manipulated due dates, false promises, double-standards, changing labels, and intimidation prevent objections raised by committee members from being taken into account. "Nixon-like claims about the righteousness and scrupulousness of the DSM committee's procedures [are] unjustified." Of the long list of weighty professionals whose names are listed as participating in the decisions, most probably had no influence, and agreed to have their names included anyway for the sake of professional prestige and income. Caplan, on the other hand, quit, and refused to have her name associated with the DSM.

Caplan argues persuasively that "mental illness" is a construct, an idea, not a scientifically provable fact. This construct harms people more than it helps them. It is often used to "blame the victim," that is, to ascribe problems in living to a fault within the person. For instance, a battered wife is told that she brings her husband's violence upon herself by unconsciously enjoying the battery. Caplan seems to think that depression, contrary to other DSM entries, is a real condition rather than a construct, but nowhere does she suggest it is an illness, caused by faulty brains or heredity, or treatable with drugs. On the contrary, she seems to consider it a form of unhappiness, and doesn't think drugs can cure it. Even when there is something inside the person which makes him different, this cannot be reliably identified by using DSM criteria, nor are they helpful in solving the person's problems, Caplan argues, disparaging the "mythical uniformity of human beings."

In her only reference to involuntary commitment, the author lists it together with several other types of legal decisions based on the DSM which harm people's legitimate interests and pervert justice. She admits that therapists, including herself, have little to no understanding of their clients' problems or how to help them. "Humans' psychological functioning is so complex and unpredictable that current scientific techniques can reveal only a fraction of what therapists need to know" and the evidence provided by research "is often inaccurately reported because it is presented by drug companies or groups that have various stakes in the research." Caplan warns, "it is advisable to be cautious about therapists of all kinds."

She repeatedly refers to the side effects and dangers of drug therapy, including antidepressants. "It isn't safe to assume that drug companies' claims and popular media reports about medications are true." Antidepressants were still relatively new when she wrote "They Say You're Crazy." Even now, a decade later, the medical establishment is still only slowly and reluctantly recognizing these dangers "in a small minority of vulnerable patients." If Caplan clearly knew these dangers ten years ago, physicians could have known them as well. She does think people should have access to drugs if they want them provided they are fully informed about them.

The strange thing about Caplan is that she insists she is not out to trash all of psychiatry or therapy. How can one not propose trashing professions that stand on foundations the very validity of which one rejects? That's like saying you don't oppose driving cars, provided those cars' wheels are first removed. She argues that psychiatric labeling is fraudulent and treatments futile. How can she fail to reach the conclusion her own excellent arguments make inescapable?

Copyright MeTZelf
Comment Comment (1) | Permalink | Most recent comment: Oct 14, 2012 11:33 AM BST

Bruno Bettelheim: The Other Side of Madness
Bruno Bettelheim: The Other Side of Madness
by Nina Sutton
Edition: Hardcover
Price: 24.90

1 of 1 people found the following review helpful
4.0 out of 5 stars He managed to make it in life, but not enjoy it, 7 Aug 2011
Bruno Bettelheim's name is infamous among parents of autistic children. Presumably he coined the term "refrigerator mothers," blaming autism on the cold behavior of the autistic child's mother. (To this day, it is widely assumed that only children are autistic. I don't know what people think happens to autistics when they turn into adults.) It took a doctor named Rimland, who had an autistic son, to famously challenge this view. Not that mothers had not protested such injustice before, but doctors are simply taken more seriously by other doctors. Rimland himself turned into a quack peddling megavitamins for the supposed cure of autism. As for Bettelheim, according to Sutton, his biographer, when he realized he could not cure autism, he stopped accepting autistic "patients" for treatment at his "school."

In spite of his being famous for it, the term "refrigerator mother" appears nowhere in the biography. Rimland is mentioned briefly as an opponent of Bettelheim's methods. Ironically, although Bettelheim mis-identified the cause of autism, his proposed "cure" was no doubt indeed the best way to care for autistic children, as well as all other children. If Sutton's description is correct, then during the three decades that Bettelheim directed the "Orthogenic School" in Chicago, the care involved lots of individual attention, acceptance of children the way they were, and no psychoactive drugs. Ironically Bettelheim himself spent the last years of his life taking antidepressants.

Sutton seems to have researched Bettelheim's life thoroughly. Yet the inclusion of remarks about Bettelheim's thoughts, feelings, motives, and moods, as though she were psychoanalyzing him, constantly raises the question, "Is this true?"

She claims that although Bettelheim achieved great success and respect in the field of psychoanalysis, he himself was obsessed with guilt over being a fraud, because he didn't have an appropriate diploma. Sutton seems to think that Bettelheim had a natural talent for psychoanalysis, and therefore did not need the diploma, so he shouldn't have felt guilty about that. In fact, his successes were based on common sense, such as advising a mother not to nag her daughter to practice her music lessons, but to allow the child to stop the lessons if the child so wished. Sutton does not entertain the idea that perhaps the entire field of psychoanalysis is either common sense or psychobabble, and that any diploma anyone achieves in it is irrelevant. She does, however, acknowledge that inflating one's experience and successes is a normal part of professional behavior.

Reading this biography, I found myself liking Bettelheim more than I had intended. His individualism appealed to me, in spite of my general resentment of anyone who claims to have special understanding of the human mind. I was also surprised to learn how close I once came to meeting Bettelheim. When I lived on Kibbutz Ramat Yochanan in Israel, I had often heard about the famous doctor who had lived on the kibbutz (for only six weeks) and written a book about the way children were raised there, "Children of the Dream." The title was a source of pride to the kibbutzniks, independently of the contents, which were never mentioned. Thirty years later I learned that the famous "doctor" was the now infamous Bruno Bettelheim.

According to Sutton, Bettelheim had what today would be called "suicidal ideation" throughout most of his life, with the remarkable exception of his strong drive to survive during the year he was incarcerated in a nazi concentration camp. Towards the end of his life, when he was in poor physical health and missed his wife who had passed away, he contemplated coming to the Netherlands, laboring under the mistaken impression that he could obtain legal euthanasia here. Sutton fails to point out that that is not so. In the end, Bettelheim took matters into his own hands.

It's a thick book, 524 pages, not a waste of time.

Copyright MeTZelf

A Dose of Sanity: Mind, Medicine, and Misdiagnosis
A Dose of Sanity: Mind, Medicine, and Misdiagnosis
by Sydney Walker
Edition: Paperback
Price: 18.91

1 of 1 people found the following review helpful
3.0 out of 5 stars Somatic medicine as an alternative to psychiatry?, 7 Aug 2011
Walker's book rests on two main themes. One is that the DSM, in spite of its name, is not a diagnostic manual at all, but a catalogue of descriptive labels that serve as an excuse for abandoning further medical investigation. He calls the DSM "a cookbook listing of symptoms that has replaced the science of differential diagnosis."

The other theme divides into two parts. The minor one is that many people who are slapped with DSM labels and prescribed psychotropic drugs have nothing at all medically wrong with them.

The major theme, however, and the main theme of the book next to criticism of the DSM, is that almost all cases of serious aberrations of feelings or behavior stem from physical causes such as genetic disease, hormonal imbalances, toxins, infection, parasites, and tumors. The DSM encourages psychiatrists to be lazy and overlook these causes, he says. Psychotropic drugs only mask them, and do more harm than good. Psychotherapy, including psychoanalysis, are totally useless for these conditions. Psychiatry should return to its true mission as practiced (according to Walker) by Emil Kraepelin and Benjamin Rush, namely to identify and treat the physical causes of insanity.

I agree with Walker that cases of grossly aberrant behavior (as opposed to responses to stress) are probably due to unidentified physical causes. However, not identifying these causes is the failure of somatic medicine, not psychiatry. Psychiatry's mission has always been to sweep up after somatic medicine, and to sweep away society's rejects while it's at it.

Walker maintains that there is a legitimate use of psychotropic drugs, but only in those extremely rare cases that the physical cause cannot be identified, or no curative treatment exists. My opposition to this contention is that far from being extremely rare, those are exactly all cases with which psychiatry deals. One of Walker's examples of physical disease which psychiatrists frequently fail to identify and treat is Tourette Syndrome, which he calls genetic. In spite of his own insistence that the causes of conditions should be scientifically sought, he fails to provide any evidence that TS is genetic in origin. Even if he had such evidence, since when does identifying conditions as genetic make them curable? On the other hand, Walker overlooks compelling evidence that TS is caused by brain damage: it is common in people whose brains have been damaged by psychotropic drugs. He doesn't mention how he thinks TS should be treated. In fact, the only "treatment" that exists, whether effective or not, is Haldol, the very type of treatment he claims to oppose except in those extremely rare cases, whichever they are.

While correctly calling into question the efficacy and safety of psychiatric practice, Walker highly overrates somatic medicine. He attaches great diagnostic significance to gene mapping and brain scanning, whereas in reality such toys have as yet benefited no one but the doctors who employ them for research.

One of Walker's more bombastic claims for successful treatment of aberrant behavior is ... surgically cleaning cholesterol out of a patient's brain arteries! (Who would be so gullible as to believe that?)

Interesting to note are Walker's views on two of the greats among opponents to psychiatry, Peter Breggin and Thomas Szasz.

Walker duly credits Breggin with having called attention to the horrific harm done by psychiatric drugs. Unfortunately, according to Walker (and I agree with him on this) the flip side to Breggin is blaming serious dysfunctional behavior on "bad parenting." No, not such obvious bad parenting as battering children or trading them for cocaine, but vague failures that only Breggin himself can identify, like paying insufficient attention to children. Walker might have added that those parents who are likely to seek psychiatric services, not to mention pay big bucks for them (a subject on which Breggin never touches), are the very parents who are deeply devoted to their children. Walker also criticizes Breggin for blaming schools, though schools are very much known to contribute to the ill-being of children.

Contrary to his position on Breggin, Walker showers praise on Szasz, particularly for having been the first and the most relentless critic of DSM fake diagnoses. However, he feels Szasz goes too far in denying there is ever a physical origin for dysfunctional behavior, and by suggesting that such people are actually "incompetent, lazy, or bad." He presumes that Szasz would leave them to die in the streets and in jails, overlooking the fact that Szasz is the only writer in the field who has suggested a practical solution for dealing with such people, namely the non-medical asylum, or as Szasz nicknames it, the "adult orphanage."

Those of you who are interested in "alternative psychiatry" may be interested in Walker's views on such treatments. He does not reject the idea outright, though he considers most of them quackery and downright silly. Acupuncture he calls effective in treating pain - but not curing the cause of pain. Orthomolecular medicine can treat nutritional deficiency, but nothing else, he says.

Walker further criticizes judges' reliance on psychiatric expertise. He says nothing about it that Szasz hasn't said before him. He does not mention involuntary commitment anywhere in the book.

Finally, Walker calls on us, potential psychiatric patients, to take responsibility for our own health care. That's fine advice, but limited by the fact that responsibility can be carried out only in freedom. Massive state intervention in medicine means that much of his otherwise excellent advice is impossible to follow.

All in all, this book's power is the author's ability to state in layman's language why the DSM is a fraud.

Copyright MeTZelf

A History of Psychiatry: From the Era of the Asylum to the Age of Prozac
A History of Psychiatry: From the Era of the Asylum to the Age of Prozac
by Edward Shorter
Edition: Paperback
Price: 27.99

11 of 13 people found the following review helpful
1.0 out of 5 stars Confusing history with propaganda, 7 Aug 2011
Maybe I was wrong. When I reviewed Gemma Blok's history of anti-psychiatry in the Netherlands, I criticized her for interjecting her opinions, instead of sticking to reporting the facts. Perhaps that's not how historians see their role. Edward Shorter never even bothers to make a pretense of objectivity. I do admit that his unashamedly judgmental writing style makes for a stirring read. Let me be equally unashamedly judgmental about him.

For one thing, Shorter loves psychiatry. That's clear. For another, there's no mistaking what his favored model of psychiatry is. He lavishes praise on early German psychiatry which was well-funded by the state, enabling plenty of experimentation, as "the triumphs of science" add to the national prestige. He even goes so far as describing the structure within which Kraepelin worked as "majesty." On France of the same period he pours scorn for being "a second-rate psychiatric power," whereas in pitiful England, where teaching hospitals were dependent on charity, there was little science at all, according to Shorter.

Shorter credits Kraepelin, a neurologist according to him, with being the inventor of psychotherapy, although it wasn't called that at the time of course. Wealthy people loathed asylums, so they avoided them by pretending their personal problems were neurological diseases. That's why they became known as neuroses. Neurologists soon recognized the role of placebo treatments (which worked) for these non-diseases, although neurology is actually, according to Shorter, the science of unusual and incurable diseases of the central nervous system. The nerve doctors, poor things, didn't have much choice but to go along with doing psychotherapy and running resorts, as that is where the money was at the time, and they couldn't cure any of their real patients anyway.

The irony is that Kraepelin, whatever his real job title was, worked in asylums where people were taken involuntarily. He is today considered the discoverer of "schizophrenia," a supposedly brain-based disease.

Freud, too, was a neurologist, Shorter points out (this time correctly), though he has no sympathy for psychoanalysis. He juicily describes a lecture given by a German émigré to the U.S., which was so well received that "it brought the house down." "Respected by all and understood by none," the émigré had spoken in broken English about "penis envoy." Psychiatrists in the U.S. welcomed psychoanalysis as a means to escape the asylums. Why they would want to leave all that majesty, Shorter doesn't say.

The early treatments for people brought into the asylums were geared at making them physically sick. Patients would be administered emetics (drugs to make them vomit) or injected with blood from people who were ill with malaria and tuberculosis. These treatments worked, according to Shorter, as did prolonged narcosis (keeping people asleep with drugs), a successful therapy that might still exist today had not some of the patients messed it up by dying. Alcohol was another treatment tried. Pharmaceutical treatments were promising, but unfortunately, Swiss psychiatrist Jakob Klaesi who was doing drug research at Hoffmann-La Roche, was subject to manic-depressive personality swings, says Shorter, and became a nazi sympathizer.

One would think that Shorter, writing in a period that the works of Healy (who is mentioned by him) and Breggin (who is not) are well-known in the psychiatric community, might have connected the term narcosis to the modern term narcotics, which is what all psychiatric drugs are. But no, to him they are medicines, and bear no relation to the early efforts to cure whatever ailed people by making them sick or drowsy. Nor does he express any skepticism of the bombastic claims for the success of any biological treatments, whether the ones mentioned above or ECT, opposition to which he labels "hostility." Only about the curative capacity of lobotomy is Shorter less confident.

For a book boldly named "A History of Psychiatry," reference to the psychiatric obscenities in Germany leading up to and during WWII is surprisingly brief. Not delving deeply into the facts, as though this were a minor sidestep in the history of psychiatry, Shorter condemns these events in no uncertain terms, manic-depressive personality swings or not. "Academic medicine in Germany on the whole stood waist-deep in the Nazi sewer" he asserts, suddenly forgetting about the glories of state funding and experimentation, which were the hallmarks of nazi medicine even more than of the earlier regime so praised by Shorter. Strangely, he ascribes the events under the nazis only to the theory of degeneration, not to the theory of heredity, even though degeneration rested on heredity.

Degeneration, Shorter laments, was seized upon by the eugenicists (so there was nothing wrong with the theory itself?). Later in the book Francis Galton is credited with proposing twin studies, about which Shorter is enthusiastic, without any mention of Galton being the founder of the eugenics movement, and twin children being the infamous Mengele's favorite victims. Mengele isn't mentioned in the book either. Instead, Shorter says defensively, "There was nothing intrinsically racist about the technique of twin studies in psychiatric genetics. ... Indeed, the next major contributions to the field came form Jewish scholars." Shorter misunderstands the meaning of the word racism in the nazi context, and implies that whatever any Jew does cannot be racist. He but regrets the influence of nazism on psychiatry because it imposed taboos on the discussion of biology and heredity in psychiatric disease for decades to come.

Advances in drug therapy were fortunately not held up too much by the nazi sewer, and by May 1952, Delay and Deniker's patients were all doing great on chlorpromazine, according to Shorter. It even cured "patient number one, Giovanni A., a 57-year-old laborer" of his propensity for "making improvised political speeches in cafés ... and ... preaching his love of liberty."

To his credit, although I'm not sure his heart is in it, Shorter isn't totally oblivious to the aggressive expansion of psychiatric territory. He notes regarding "Tom-Sawyer-esque enthusiasm ... the natural spirits of ladhood, [that] in the 1960s and after a whole series of psychological diagnoses arrived to define such behavior as pathological" and "[Such programs as] Mental Illness Awareness Week encourage doctors to diagnose depression. ... the ultimate effect is psychiatric empire-building against other kinds of care." He also mentions some of the various influence groups which affected the content of the DSM (apparently only in the past).

As I started this review with a reference to Gemma Blok, let me not leave out Shorter's section on antipsychiatry movements. They flourished, he claims, throughout the nineteenth century, then apparently mysteriously disappeared for a while. In the 1960s they were reborn, with books published by Michel Foucault, Thomas Szasz, and Erving Goffman. But what really caused the movement to flair up was a novel by Ken Kesey, One Flew Over the Cuckoo's Nest. The movie made from it swept the academy awards of that year, winning all five main Oscars, Shorter relates. That none of these authors considered themselves antipsychiatrists is apparently beside the point. Like Blok, he pronounces this movement a failure.

Shorter ends the book with a justification for the existence of psychiatry. "Whereas the average consultation in internal medicine or obstetrics lasts only around 10 minutes, the average in psychiatry lasts over 40. Within this 40 minutes, psychiatrists do essentially two things that their competitors on either side - the psychologists on the one side, the neurologists on the other - do not do. Psychiatrists offer psychotherapy, which the neurologists generally speaking do not... And psychiatrists prescribe medication, which the nonmedical competition is not permitted to do. This combination of psychotherapy plus medication represents the most effective of all approaches in dealing with disorders of the brain and mind."

Conspicuous by their absence from this justification for the existence of a field of medicine so hated by many of its supposed benefactors, are words like cure, improvement, and customer satisfaction.

There's a snapshot of Shorter on the dust cover. He's quite good looking. If you happen to see him somewhere - turn around and run!

Copyright MeTZelf

The Dialectics of Schizophrenia
The Dialectics of Schizophrenia
by Philip Thomas
Edition: Paperback
Price: 17.95

2 of 2 people found the following review helpful
4.0 out of 5 stars The scourge of the lower classes, 7 Aug 2011
Published in 1997, this is apparently Thomas's first book, although he has publications in professional journals to his name. Perhaps because of his being a less prolific writer than some of his colleagues, his name is not yet known to us. He definitely deserves a place among the heroes of our movement.

A major theme in Thomas's book is the culture gap. In the introduction he describes an inner-city environment that many of us will recognize, though the accents may differ (Thomas works in Great Britain): poverty, homelessness, discrimination, disaffection. He poignantly portrays the contrast with the environment from which the doctor comes: wealth, comfort, privilege, and arrogance. Early in his career it became clear to Thomas that the job he was expected to do was not to treat people but to dispose of them.

Contrary to other writers in the field, Thomas does not advocate discarding the term "schizophrenia" altogether. He sees the "positive symptoms" as occurring in non-psychiatrized people as well and not necessarily a deviation from the normal. The term "schizophrenia" to him should be reserved for those people who present negative symptoms such as paucity of speech and shallow emotions (I assume he means before being drugged as he recognizes these characteristics as also being caused by the drugs) and for which according to him a plausible neurological explanation exists (what is it?). I could not discern what the difference is between Thomas' "narrow definition of schizophrenia" and autism, and wonder why we would need two separate terms. Indeed, at one time in history the two were the same. Yet throughout his book Thomas uses the term schizophrenia apparently in the meaning of "labeled schizophrenic."

Epidemiological studies of schizophrenia prove only one thing: that it is endemic to the disadvantaged classes, says Thomas. He correlates biopsychiatric theories - locating the cause of disease in the individual's brain chemistry or genes rather than in society - with political focus on individual responsibility as opposed to community responsibility. I do not agree with the political conclusions he draws but they will surely please the socialists among us.

Thomas relates an anecdote which illustrates what a special person he is in attempting to bridge the gap between himself and his patients. As part of an experiment conducted by him and his colleague David Healy (writer of "The Creation of Psychopharmacology"), he ingested 5 mg haloperidol. That's not the same as being injected with high doses for many years, but apparently it was enough for Thomas to get the point. By the end of that chapter he and Healy characterize the relationship between psychiatrist and patient as that which exists between abuser and victim.

Hearing voices fascinates Thomas. He has not experienced them himself, but goes to quite some length exploring their possible meaning in terms of "inner language." Here his thoughts remind me of Oliver Sacks's book Seeing Voices about language development in deaf people. As I have also not experienced hearing voices, I'm not in a position to evaluate Thomas's theories. However, I whole-heartedly agree with his endorsement of peer support rather than professional paternalism. In fact, Thomas feels that "patients" have more to teach psychiatrists than medicine. True, but then what is the point of the profession of psychiatry?

I'll end with a final anecdote. One of Thomas's patients, a woman who self-mutilated, invited him to act with her in a play. Thomas accepted (for which he terminated his professional relationship with her). You will surely agree with me that Thomas is a rare doctor who is capable of shrugging off arrogance and sees his patients as human beings like himself.

In spite of a few flaws, "The Dialectics of Schizophrenia" is a book that cries out to be recognized by our movement.

Copyright MeTZelf
Comment Comment (1) | Permalink | Most recent comment: Jul 19, 2013 8:55 PM BST

Seduced by Death: Doctors, Patients and the Dutch Cure
Seduced by Death: Doctors, Patients and the Dutch Cure
by Herbert Hendin
Edition: Hardcover

1 of 1 people found the following review helpful
4.0 out of 5 stars For relief from life: ask your doctor, 7 Aug 2011
Hendin, a psychiatrist, investigates the practice of euthanasia and physician assisted suicide (PAS) in the Netherlands. He does an excellent job of researching and understanding the Dutch medical system, in spite of the obvious obstacles of language and time limits.

Euthanasia is defined by Dutch law as the termination of the life of a patient at his own request by a physician. It is not legal, but under certain conditions the physician is granted immunity from prosecution, namely when the patient, who must be competent and have no mental illness, is suffering unbearably from a somatic, terminal disease. In addition, certain bureaucratic procedures must be satisfied, such as obtaining a second opinion by another physician, and the filing of a report to the proper authority after the fact. PAS is when under the same conditions, the doctor provides the patient with a deadly drug that the patient takes himself.

Hendin is vehemently opposed to this practice, although he is not motivated by a religious view of the sanctity of life. He does not oppose withholding from "brain dead" patients treatment the physician (but not the patient's family) considers futile, and even suggests that physicians are justified in denying it when the family demands it. He also does not oppose treatments for pain management, even when it is obvious that they will speed up death. He even seems accepting of withholding nourishment and hydration from dying patients. Rather, he feels that actively terminating patients' lives or assisting them in terminating their own lives leads to pressuring patients to ask for death. Once the practice is legally sanctioned, it becomes a solution to lack of palliative care, the family's discomfort at watching suffering or their burnout in caring for the sick person, the doctor's feelings of powerlessness to cure his patient, the financial burden of caring for the sick and elderly, etc. Or as Hendin puts it, euthanasia becomes a convenient cure for disease.

Citing the case of a doctor acquitted for PAS regarding a woman who was not physically ill but in mourning, Hendin proposes that the practice is already a long way down a slippery slope. In 1997 when his book was published he could not have known that subsequent court decisions would not uphold the acceptability of euthanasia or PAS for people not terminally ill. Though this perhaps counters the slippery slope theory, it does illustrate the fickleness of the Dutch courts.

Hendin, however, is completely correct in pointing out that the Dutch are mistaken in believing that their euthanasia laws provide them with the freedom to control their own deaths. In fact tolerance of euthanasia provides only more power and protection to physicians. Euthanasia is practiced widely one way or another quite without any of the supposed safeguards provided by the law being observed. Doctors openly admit that they don't want to bother with the bureaucracy and the examination of their decisions.

Hendin only incidentally hints at what in the Netherlands is perceived as a major problem, namely that people who want euthanasia are refused it by their doctor. He is critical of a directive ordering such doctors to refer the patient to a different physician who may be willing to perform the service. This, he feels, forces the doctor to act against his conscience. Hendin is a bit of a hypocrite here, as he doesn't mind the doctor acting against his conscience when the doctor's conscience is different from his own. He fails to mention that in this country we do not have the freedom to seek medical services from any doctor we choose, but can only obtain those medical services of which the registered family physician approves.

Other than that, Hendin correctly identifies the nature of the Dutch health system, which grants far-reaching powers to physicians. He keenly understands that the institutions created ostensibly to protect patients' interests, such as the medical ethics boards (which he calls medical tribunals) in fact protect the interests of physicians and their profession. Yet he does not seem interested in dismantling the massive power doctors have, only in prohibiting euthanasia, even though he acknowledges that as long as physicians have so much power, it is impossible to control their actions.

I completely endorse Hendin's negative appraisal of euthanasia and PAS. We part ways when it comes to considering the alternatives. Of course adequate palliative care and support for families coping with debilitating illness or disability would reduce the demand for euthanasia and PAS, but from where are care and support to come? The other alternatives Hendin repeatedly mentions are antidepressant drugs and electroshock, claiming that usually people who want euthanasia have treatable psychiatric illness, whether or not they also have somatic illness. I do not believe in the existence of "psychiatric illness" let alone that it can be cured by antidepressants. Electroshock is at least as cruel as euthanasia. The alternative that Hendin never mentions is lifting the prohibition on free trade in drugs, so that people can access them without a doctor's assistance. He is interested in the prohibition of euthanasia only, and not the empowerment of patients.

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Accepting Voices
Accepting Voices
by Marius Romme
Edition: Paperback

2 of 2 people found the following review helpful
4.0 out of 5 stars Hearing voices isn't sick, 7 Aug 2011
This review is from: Accepting Voices (Paperback)
Perhaps the year-and-a-half I waited for the public library to notify me that the book was available testifies to its popularity. One place the book is not popular is in academia. It is not available in the libraries of either of the two Amsterdam universities. Apparently young medical minds are to be shielded from such heresy.

The background to this book is described in Escher's thesis. This edition is an expanded version of one with the same name published in 1990, which was translated into six languages, including English. Besides the editors', there are contributions from voice hearers who have never been psychiatrized, voice hearers who have, psychologists, psychiatrists, mediums, and others.

Romme takes the phenomenon most identified with schizophrenia and turns it from a symptom of disease into a normal, possibly even pleasant part of the person. Non-psychiatrized people often report benefit from the voices they hear. They are kept company and guided through life by them. The real problem with voices is not that they exist - or don't exist - but that in some people they can turn nasty, criticizing, nagging, and domineering. The solution is not to suppress them, which doesn't work anyway, but to learn to deal with them, to become assertive towards them.

Who can help a voice hearer learn to cope? Not the clinician, Romme feels, but rather fellow voice hearers. He reports sitting in on discussions between two voice hearers arranged by himself. He was surprised at how eager the discussants were. Apparently they felt that at long last they could talk openly and honestly about their voices with someone who understands. As a non-voice hearer, Romme was further surprised how little he himself understood of what was being said. This underscores the futility of trying to remediate hearing voices through therapy.

Happy voice hearers seem to be the minority. Most voice hearers have at best learned to cope. Voice hearing typically begins as a result of being subjected to situations in which one is extremely powerless (trauma). Sexual abuse in childhood is one of the situations frequently mentioned, but not a few people first begin to hear voices during psychiatric incarceration and even in psychotherapy. Not only is psychiatry not the cure but it is sometimes the cause.

The main coping tool that Romme suggests is peer support. Other authors take a supernatural view of voices, suggesting they are connected to mediums or reincarnation. Romme admits that this sounds rather flaky, but whatever works is welcome. The fact is that the people who accept supernatural explanations for their voices do well.

Perhaps in an effort to present a balance of opinions, Romme & Escher also give space in their book to psychiatrists and psychotherapists who advocate "treating" voice hearing. There are even several plugs for psychiatric drugs. This runs counter to the general theme of the book and confuses the message.

I greatly admire Romme's efforts to provide voice hearers with tools for staying out of psychiatry and taking control of their own lives. Not being a voice hearer myself, I am not in the ideal position to judge the book. If you hear voices, please try to access this book and send your thoughts about it to MeTZelf.

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DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Diagnostic & Statistical Manual of Mental Disorders)
DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Diagnostic & Statistical Manual of Mental Disorders)
by American Psychiatric Association
Edition: Paperback

1 of 10 people found the following review helpful
1.0 out of 5 stars Psychiatry's pride and shame, 7 Aug 2011
Don't laugh. This review is about the DSM. It's not a general description, as readers of MeTZelf will surely already know what the DSM is about. Nor is it a critique like those by authors such as Blom, Boyle, Caplan, Horwitz, Kutchins & Kirk, and Walker. Rather, it is an attempt to deflate some of the mystery surrounding the DSM.

For many years I refused to buy it, not wishing in any way to contribute to the APA. But, finally I relented when I wanted to check for myself whether what critics say about the DSM is true. So I went to my local bookstore in a suburb of Amsterdam, in Holland, you know, wooden shoes, tulips, windmills, etc. "Can you order the DSM for me?" I asked at the order desk. The salesman pointed to the shelf behind me and said, "We have it in stock." "In stock? Is there that much demand for it, that you keep it in stock?" "Yes," said the clerk, "mainly psychologists and psychotherapists are in here asking for it all the time."

Of course the book on the shelf was a Dutch translation. Mark Twain warned us tongue in cheek, "Be careful of reading health books; you may die of a misprint." Fearing I may likewise go crazy from a mistranslation, I asked the salesman to order the original version, emphasizing that I want it in American English, not British. The result was that I had to wait three months for it to arrive. I paid 68.61 euros for it, including tax. This was back in 2003. It may be more expensive by now due to inflation, or perhaps cheaper due to the weak position of the dollar to the euro.

My first impression of the book was its size. Wow, is it ever big. It's 9.9" (25.1cm) high, 6.9" (17.5cm) wide, and a full 1.8" (4.6cm) thick according to my double-edged ruler. It contains 943 pages, not counting the unnumbered blank pages in the back. I wouldn't claim that it's actually a small book, but there's not as much text in it as the first impression suggests. The letters are surprisingly large and the lines widely spaced. This is normal for books that are written to be read straight through, like novels, but for medical manuals this is quite unusual. I took several off the shelf and compared them, to make sure I wasn't imagining this, but the other manuals all have much smaller print. In fact, the first book I took off the shelf that has slightly larger letters than the DSM was Alice in Wonderland. However, the DSM's cover is prettier, a shiny gray that looks almost like silver. The cover design shows a lot of restraint: no picture or anything.

The title page mentions only the name of the book, not a writer or editor. On the back of it is the usual gobbledygook about the copyright, being printed on acid-free paper, Library of Congress cataloguing, etc. Then comes a surprise: a dedication page. Again, I checked all of the other medical manuals on my shelf, and not one of them has a dedication. The dedication is "To Melvin Sabshin, a man for all seasons." Melvin Sabshin was director of the APA for nearly a quarter of a century, and retired shortly before publication of this edition of the DSM.

Next comes the table of contents, written in letters that your optometrist might use to check your eyesight from across the room. After that is a list of names called "Task Force on DSM-IV". This goes on for only seven pages, as opposed to appendices J and K in the back of the book, listing the names of the contributors, advisers, etc. which go on for 27 pages. Yet more names appear in the acknowledgements. By now I'm beginning to suspect that people paid or were paid to have their name appear in the DSM.

Next come 13 pages of introduction, which is normal for the type of book that the DSM pretends to be. But after that comes another surprise: a disclaimer. In essence it says that there may be disorders that the book left out, and that "...mental disorders may not be wholly relevant to legal judgments..." Then come twelve pages of instructions on how to use the manual.

Skipping over 733 pages which form the body of the DSM, we arrive at Appendix A, decision trees, which look a lot like the ones on my tax forms. The Dutch Tax Service's motto is: "We can't make it more fun, but we can make it easier." (They don't.)

Appendix B is "Criteria Sets and Axes Provided for Further Study." That goes on for sixty pages. It seems to me that rather than study axes, they should use them to chop off big parts of the book.

Appendix C is a ten-page glossary. Appendix D is 15 pages of discussion on the changes made in this edition. Appendix E lists all the diagnoses in alphabetical order, and appendix F lists them in numerical order, leaving one wondering in just what order they are listed in the body of the work.

Appendices G and H provide the codes in the ICD, a rival publication by the WHO (World Health Organization). It's no secret that the DSM writers specifically aimed to have their list of diagnoses correspond with the ICD, in fact, they say so. They only don't add that the discrepancies in previous publications were embarrassing.

Appendix I is about "culture-bound syndromes." If you are a man (women don't get it) from Papua New Guinea, a perceived insult could provoke you to become sick with a disorder called amok. Indian men (only, I assume, though here it doesn't specifically say so) might go crazy from a discharge of semen. This mental disorder is called dhat. American Indians can get ghost sickness. Eskimos get pibloktoq, which includes tearing off clothes, eating feces, and fleeing from protective shelters. The Chinese get another apparently male only disorder, shenkui, caused by excessive semen loss from frequent intercourse or masturbation. Central and Latin Americans are subject to susto, which is when the soul leaves the body. Zar, which occurs in parts of Africa and Asia, is possession by spirits. Although recognized by the DSM as a mental disorder, the local population do not consider it pathological. But then they don't have the benefit of science like the APA does...

I've already mentioned appendices J and K. After that comes the index, and at the end, eleven blank pages.

Along with the DSM, I received an advertisement for 16 other APA publications. One of them is, believe it or not, a book called Infant and Toddler Mental Health, Models of Clinical Intervention With Infants and Their Families, edited by J. Martin Maldonado-Durán, M.D. The accompanying blurb reads: "Written by clinicians who work with infants and children and their families every day, this eminently practical guide illustrates what to do in numerous clinical situations, and addresses the most common and important problems in infant psychopathology."

Heaven help the babies of this world. Heaven guard us all from psychiatry.

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Damned Lies and Statistics: Untangling Numbers from the Media, Politicians and Activists
Damned Lies and Statistics: Untangling Numbers from the Media, Politicians and Activists
by Joel Best
Edition: Hardcover

1 of 1 people found the following review helpful
5.0 out of 5 stars Awe-struck by big numbers, 7 Aug 2011
The indelicate title of this book is taken from the well-known aphorism "There are lies, damned lies, and statistics" attributed to either Mark Twain or Benjamin Disraeli. It nearly caused me to not read it, unjustly, because the language between the covers is perfectly gentlemanly.

Most people, Best tells us, are innumerate. This means that they don't readily spot implausible numbers, and all big numbers are more or less the same to them, whether a million or a billion. Not only the people who hear statistics are often innumerate, but also the people who report them, and not infrequently even the people who generate them.

Statistics can be wildly off course for many reasons. They may originate in a guess. But even when they originate in research, there are many factors that can influence their accuracy. The researcher may have interviewed people using leading questions. The subject of the research may be poorly defined. The method of measuring it may be flawed. The sample on which the research is based may not be representative. Or perhaps a comparison was made between two entities that aren't comparable. Numbers may have been mangled by someone who quoted them, such as a reporter. Or the condition described mutates into something else during the retelling. The finesses of complex statistics may be overlooked. Basing new statistics on older ones may result in a chain of bad statistics. And, unavoidably, they are influenced by the interests of the party who compiles them.

The author does not mention the statistics used in modern medical mega-trials, but everything he says about statistics in general applies to those as well.

He warns us not to be nave or awestruck by statistics, but not to be cynical either. Statistics, he says, are a valid and useful tool. Not all statistics are bad statistics. So we shouldn't reject all statistics off the bat, just be critical. Of course we should always be critical about everything anyway, he concedes, not just about statistics. I'm afraid I'm not going to take Best's advice. He provides fine questions to ask when examining statistics, but who will answer them? So I am going to join his cynical group, and remain suspicious of all statistics.

Best's writing style is refreshingly uncomplicated. This little gem of a book is suitable for a broad audience, including the less sophisticated reader, readers for whom English is a second language, and people who, like me, are innumerate.

Best has since (2004) published a sequel to this book, called More Damned Lies and Statistics.

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